Department of Digestive and General Surgery, Hospital Saint-Antoine, Sorbonne University, Paris. Hôpital Saint-Antoine, Paris, France.
Sorbonne Université, Paris, France.
Langenbecks Arch Surg. 2020 May;405(3):337-344. doi: 10.1007/s00423-020-01879-y. Epub 2020 Apr 15.
The reduction of length of hospitalization without compromising the patient's safety constitutes the challenge of the enhanced recovery after surgery (ERAS) programs. Our aim was to evaluate the feasibility and safety of a 3-day hospitalization after colectomy and 5-day hospitalization after proctectomy in the setting of an ERAS program.
An ERAS program was prospectively proposed to all patients who required a colorectal resection (January 2014-December 2018) with a 3- or 5-day discharge objective. The success of the program was defined by a 3-/5-day hospitalization without complications and without readmissions.
Among 283 patients included, 232 patients had a colectomy (82%) and 51 (18%) patients a proctectomy. Eighty-six patients experienced complications (30%) including fifteen severe complications (5%). Mean hospital stay was 5.1 ± 3.7 (2-33) days. A total of 136 patients (48%) were discharged at 3-/5-day, within 9 were readmitted (3%). Discharge was delayed after 3-/5-day for complications (n = 65, 23%), CRP > 120 (n = 45, 16%) or refusal without medical reason (n = 37, 13%). The success rate of the program was 45% (n = 127). This success rate was similar between colectomy and proctectomy (p = 0.277) and between right and left colectomy (p = 0.450). In multivariate analysis, predictive factors associated with the program success were intraoperative use of lidocaine (OR 2.1 [1.1-4.1], p = 0.022), time to remove perfusion ≤ 2 days (OR 10.3 [5.4-19.6], p = 0.001), time to recover bowel movement ≤ 2 days (OR 4.0 [1.7-9.6], p = 0.002) and time to walk out of the room ≤ 2 days (OR 2.6 [1.1-6.0], p = 0.022).
Integrating a realistic hospitalization duration objective into an ERAS program guarantees its safety, feasibility and effectiveness in reducing hospitalization duration.
在不影响患者安全的前提下缩短住院时间是加速康复外科（ERAS）方案面临的挑战。我们旨在评估 ERAS 方案下结直肠切除术后 3 天和直肠切除术后 5 天住院的可行性和安全性。
我们前瞻性地向所有需要结直肠切除术（2014 年 1 月至 2018 年 12 月）的患者提出 ERAS 方案，并设定 3 天或 5 天的出院目标。该方案的成功定义为无并发症和再入院的 3/5 天住院。
283 例患者中，232 例患者行结肠切除术（82%），51 例患者行直肠切除术（18%）。86 例患者发生并发症（30%），其中 15 例为严重并发症（5%）。平均住院时间为 5.1±3.7（2-33）天。共有 136 例（48%）患者在 3/5 天出院，其中 9 例（3%）患者再入院。由于并发症（n=65，23%）、C 反应蛋白（CRP）>120（n=45，16%）或无医学原因拒绝（n=37，13%），3/5 天后延迟出院。该方案的成功率为 45%（n=127）。结直肠切除术和直肠切除术之间（p=0.277）以及右半结肠切除术和左半结肠切除术之间（p=0.450）的成功率无差异。多因素分析显示，与方案成功相关的预测因素包括术中使用利多卡因（OR 2.1[1.1-4.1]，p=0.022）、灌注时间≤2 天（OR 10.3[5.4-19.6]，p=0.001）、肠蠕动恢复时间≤2 天（OR 4.0[1.7-9.6]，p=0.002）和离床活动时间≤2 天（OR 2.6[1.1-6.0]，p=0.022）。
将实际住院时间目标纳入 ERAS 方案可保证其安全性、可行性，并有效缩短住院时间。
