Grieco Michele, Lorenzon Laura, Pernazza Graziano, Carlini Massimo, Brescia Antonio, Santoro Roberto, Crucitti Antonio, Palmieri Raffaele Macarone, Santoro Emanuele, Stipa Francesco, Sacchi Marco, Persiani Roberto
General Surgery Unit Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Catholic University, Largo Agostino Gemelli 8, 00168, Rome, Italy.
San Giovanni Addolorata Hospital, Rome, Italy.
Int J Colorectal Dis. 2020 Mar;35(3):445-453. doi: 10.1007/s00384-019-03496-8. Epub 2020 Jan 2.
ERAS implementation improved outcomes in patients undergoing colorectal surgery. The process of incorporating this pathway in clinical practice may be challenging. This observational study investigated the impact of systematic ERAS implementation on surgical outcomes in patients undergoing colorectal resections in a regional network of 10 institutions.
Implementation of ERAS pathway was designed using regular audits and a common protocol. All patients undergoing elective colorectal surgery between 2016 and 2017 were considered eligible. A collective database including 18 ERAS items, clinical and surgical data, and outcomes was designed. Univariate and multivariate analyses were performed for the following outcomes: morbidity, anastomotic leak, reinterventions, hospital stay, and readmissions.
A total of 827 patients were included, and a mean of 11.3 ERAS items applied/patient was reported. Logistic regression indicated that an increased number of ERAS items applied reduced overall and severe morbidity (OR 0.86 and 0.87, respectively 95%CI 0.8197-0.9202 and 95%CI 0.7821-0.9603), hospitalization (OR 0.53 95%CI 0.4917-0.5845) and reinterventions (OR 0.84 95%CI 0.7536-0.9518) in the entire series. The same results were obtained for a prolonged hospitalization differentiating right-sided (OR 0.48 95%CI 0.4036-0.5801), left-sided (OR 0.48 95%CI 0.3984-0.5815), and rectal resections (OR 0.46 95%CI 0.3753-0.5851). An inverse correlation was found between the application of ERAS items and morbidity in right-sided and rectal procedures (OR 0.89 and 0.84, respectively 95%CI 0.7976-0.9773 and 95%CI 0.7418-0.9634).
Systematic implementation of the ERAS pathway using multi-institutional audits can increase protocol adherence and improve surgical outcomes in patients undergoing colorectal surgery.
实施加速康复外科（ERAS）可改善接受结直肠手术患者的预后。将该路径纳入临床实践的过程可能具有挑战性。这项观察性研究调查了在一个由10家机构组成的区域网络中，系统性实施ERAS对接受结直肠切除术患者手术结局的影响。
采用定期审核和通用方案设计ERAS路径的实施。2016年至2017年间所有接受择期结直肠手术的患者均被视为符合条件。设计了一个包含18项ERAS项目、临床和手术数据以及结局的综合数据库。对以下结局进行单因素和多因素分析：发病率、吻合口漏、再次干预、住院时间和再入院情况。
共纳入827例患者，报告每位患者平均应用11.3项ERAS项目。逻辑回归表明，应用的ERAS项目数量增加可降低整个系列患者的总体和严重发病率（OR分别为0.86和0.87，95%CI分别为0.8197 - 0.9202和0.7821 - 0.9603）、住院时间（OR为0.53，95%CI为0.4917 - 0.5845）和再次干预（OR为0.84，95%CI为0.7536 - 0.9518）。对于延长住院时间，在区分右侧（OR为0.48，95%CI为0.4036 - 0.5801）、左侧（OR为0.48，95%CI为0.3984 - 0.5815）和直肠切除术（OR为0.46，95%CI为0.3753 - 0.5851）时也得到了相同的结果。在右侧手术和直肠手术中，发现ERAS项目的应用与发病率之间呈负相关（OR分别为0.89和0.84，95%CI分别为0.7976 - 0.9773和0.7418 - 0.9634）。
通过多机构审核系统性实施ERAS路径可提高方案依从性，并改善接受结直肠手术患者的手术结局。
