Lohsiriwat Varut, Jitmungngan Romyen
Division of Colon and Rectal Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
World J Gastrointest Surg. 2019 Feb 27;11(2):41-52. doi: 10.4240/wjgs.v11.i2.41.
Enhanced recovery after surgery (ERAS), a multidisciplinary program designed to minimize stress response to surgery and promote the recovery of organ function, has become a standard of perioperative care for elective colorectal surgery. In an elective setting, ERAS program has consistently been shown to decrease postoperative complication, reduce length of hospital stay, shorten convalescence, and lower healthcare cost. Recently, there is emerging evidence that ERAS program can be safely and effectively applied to patients with emergency colorectal conditions such as acute colonic obstruction and intraabdominal infection. This review comprehensively covers the concept and application of ERAS program for emergency colorectal surgery. The outcomes of ERAS program for this emergency surgery are summarized as follows: (1) The ERAS program was associated with a lower rate of overall complication and shorter length of hospital stay - without increased risks of readmission, reoperation and death after emergency colorectal surgery; and (2) Compliance with an ERAS program in emergency setting appeared to be lower than that in an elective basis. Moreover, scientific evidence of each ERAS item used in emergency colorectal operation is shown. Perspectives of ERAS pathway in emergency colorectal surgery are addressed. Finally, evidence-based ERAS protocol for emergency colorectal surgery is presented.
加速康复外科(ERAS)是一项旨在将手术应激反应降至最低并促进器官功能恢复的多学科计划,已成为择期结直肠手术围手术期护理的标准。在择期手术中,ERAS计划一直被证明可以减少术后并发症、缩短住院时间、缩短康复期并降低医疗成本。最近,有新证据表明,ERAS计划可以安全有效地应用于患有急性结肠梗阻和腹腔内感染等紧急结直肠疾病的患者。本综述全面涵盖了ERAS计划在急诊结直肠手术中的概念和应用。ERAS计划在这种急诊手术中的结果总结如下:(1)ERAS计划与总体并发症发生率较低和住院时间较短相关——急诊结直肠手术后再入院、再次手术和死亡风险没有增加;(2)急诊情况下对ERAS计划的依从性似乎低于择期手术。此外,还展示了急诊结直肠手术中使用的每个ERAS项目的科学证据。探讨了急诊结直肠手术中ERAS路径的前景。最后,提出了基于证据的急诊结直肠手术ERAS方案。