Garin Christophe
Chirurgie orthopédique pédiatrique, hôpital femme-mère-enfant, hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron, France.
Orthop Traumatol Surg Res. 2020 Feb;106(1S):S101-S107. doi: 10.1016/j.otsr.2019.05.012. Epub 2019 Sep 12.
"Enhanced recovery after surgery" is now the official term: ERAS. Patients come to a specialized center for surgery, and early recovery is ensured by minimizing the impact of surgical stress, controlling pain and stimulating autonomy. Patient information and education concerning the process and care organization enable short hospital stay with early discharge. The expected benefits are fewer postoperative complications and shorter hospital stay. There is nothing to prevent this kind of program being implanted for children, so long as age and the parent-child relationship are taken into account. Lessons should be drawn from existing pediatric therapeutic education programs, to adapt information and training to the child's cognitive, motor and psycho-affective development. Setting up an ERAS program is the result firstly of medical and surgical reflection. All healthcare actors need to be actively involved, to set up a management program for the parent-child duo. Implementation, monitoring and assessment are the responsibilities of the physicians who initiate the program. Fewer postoperative complications, with earlier discharge and rehabilitation, should reduce costs and improve patient management in hospital. Such is, indeed, usually the case, but unfortunately drastic health expenditure curbs greatly attenuate the expected benefit in terms of care organization and cost savings.
“术后加速康复”现在有了官方术语:ERAS。患者前往专门的手术中心,通过将手术应激的影响降至最低、控制疼痛并促进自主能力来确保早期康复。关于手术过程和护理安排的患者信息及教育能实现短住院时间和早期出院。预期益处是术后并发症减少和住院时间缩短。只要考虑到年龄和亲子关系,就没有什么能阻止为儿童实施这类方案。应该借鉴现有的儿科治疗性教育方案,使信息和培训适应儿童的认知、运动及心理情感发展。设立一个ERAS方案首先是医学和外科思考的结果。所有医疗保健人员都需要积极参与,为亲子二人组设立一个管理方案。实施、监测和评估由启动该方案的医生负责。术后并发症减少,出院和康复更早,应能降低成本并改善医院的患者管理。实际情况确实通常如此,但遗憾的是,大幅削减医疗支出极大地削弱了在护理安排和成本节约方面的预期益处。