From the Division of Thoracic Surgery, Université de Montréal, Montreal, Que. (Tahiri, Goudie, Jouquan, Thiffault, Martin, Ferraro, Liberman); and the CHUM Endoscopic Tracheobronchial and Oesophageal Centre (CETOC), Montreal, Que. (Tahiri, Goudie, Jouquan, Thiffault, Martin, Ferraro, Liberman).
Can J Surg. 2020 May 8;63(3):E233-E240. doi: 10.1503/cjs.001919.
Enhanced recovery pathways or fast-tracking following surgery can decrease the rate of postoperative complications and hospital length of stay. The objectives of this study were to implement an enhanced recovery after surgery (ERAS) pathway for patients undergoing a video-assisted thoracoscopic surgery (VATS) lobectomy, to assess the safety and efficiency of this protocol by measuring associated postoperative outcomes, and to compare the outcomes for patients in the ERAS group with the outcomes for patients in a propensity-matched control group.
The study was a prospective clinical trial. Patients who were scheduled to undergo VATS lobectomy at the Centre hospitalier de l'Université de Montréal in Montréal, Quebec, Canada, were enrolled between November 2015 and October 2016. The ERAS pathway was used for all enrolled patients. The primary outcome was the number and severity of complications measured by the Comprehensive Complication Index. Secondary outcomes included length of stay, readmission and recovery. Recovery of patients was measured using EQ-5D-5L preoperatively and at 1 week, 1 month and 4 months after surgery. Prospectively enrolled patients were propensity matched to historical controls.
Ninety-eight patients (36 men and 62 women) in the ERAS group and 98 patients in the control group (29 men and 69 women) were included in the analysis. The mean age was 65.2 ± 9.3 years, the mean body mass index (BMI) was 26.9 ± 5.9 kg/m2 and the median Charlson Comorbidity Index score was 2 (interquartile range [IQR] 2-3) in the ERAS group. In the control group, the mean age was 66.2 ± 9.4 years, the mean BMI was 27.4 ± 5.6 kg/m2 and the median Charlson Comorbidity Index score was 3 (IQR 2-3). A total of 23 patients (23.4%) in the ERAS group and 28 (28.6%) in the control group experienced 1 or more postoperative complications. The mean Comprehensive Complication Index score was 7.4 ± 16.8 in the ERAS group compared with 8.0 ± 14.3 in the control group (p = 0.79). The median postoperative length of stay was 3 days in the ERAS group and 5 days in the control group (p < 0.001). Five patients in the ERAS group and 4 patients in the control group were readmitted. The protocol adherence rate was 64.3%.
It is feasible to implement an enhanced recovery protocol after VATS lobectomy. Although the pathway is still early in its development in Canada, implementation of an ERAS pathway after VATS lobectomy was associated with decreased length of stay, with no observable increase in complication or readmission rates.
手术后的强化康复路径或快速通道可以降低术后并发症的发生率和住院时间。本研究的目的是为接受电视辅助胸腔镜手术（VATS）肺叶切除术的患者实施术后强化康复（ERAS）路径，通过测量相关术后结果评估该方案的安全性和效率，并比较 ERAS 组患者的结果与倾向匹配对照组患者的结果。
该研究为前瞻性临床试验。2015 年 11 月至 2016 年 10 月，在加拿大魁北克省蒙特利尔的蒙特利尔大学医院中心招募了计划接受 VATS 肺叶切除术的患者。所有入组患者均采用 ERAS 路径。主要结局指标为综合并发症指数测量的并发症数量和严重程度。次要结局指标包括住院时间、再入院和恢复情况。使用 EQ-5D-5L 在术前和术后 1 周、1 个月和 4 个月评估患者的恢复情况。前瞻性入组的患者与历史对照组进行倾向匹配。
ERAS 组 98 例患者（36 例男性和 62 例女性）和对照组 98 例患者（29 例男性和 69 例女性）纳入分析。ERAS 组的平均年龄为 65.2 ± 9.3 岁，平均体重指数（BMI）为 26.9 ± 5.9 kg/m2，中位 Charlson 合并症指数评分为 2（四分位距[IQR]2-3）。对照组的平均年龄为 66.2 ± 9.4 岁，平均 BMI 为 27.4 ± 5.6 kg/m2，中位 Charlson 合并症指数评分为 3（IQR 2-3）。ERAS 组 23 例（23.4%）和对照组 28 例（28.6%）患者发生 1 次或多次术后并发症。ERAS 组的综合并发症指数评分平均为 7.4 ± 16.8，对照组为 8.0 ± 14.3（p = 0.79）。ERAS 组的术后中位住院时间为 3 天，对照组为 5 天（p < 0.001）。ERAS 组有 5 例患者和对照组有 4 例患者再次入院。方案依从率为 64.3%。
在 VATS 肺叶切除术后实施强化康复方案是可行的。尽管该方案在加拿大仍处于早期发展阶段，但 VATS 肺叶切除术后实施 ERAS 路径与住院时间缩短相关，并发症或再入院率无明显增加。
