Ren Qiu Ping, Luo Yan-Li, Xiao Feng Ming, Wen Tian-Fu, Wu Meng-Hang, Xie Ze-Rong
Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.
Medicine (Baltimore). 2020 May;99(20):e20062. doi: 10.1097/MD.0000000000020062.
The aim of this study was to investigate the effect of enhanced recovery after surgery (ERAS) on perioperative outcomes, with an emphasis on patient-reported outcomes (PROs) and functional recovery.We compared the clinical outcomes in a cohort of 275 patients undergoing liver resection before and after the implementation of ERAS. The PROs were preoperatively and postoperatively compared until 14 days after surgery using the MD Anderson Symptom Inventory.The patients in the ERAS group experienced fewer symptoms and a shorter functional recovery time than the patients in the non-ERAS group. The group × time interactions were different between the groups for pain (F = 4.70, P = .001) and walking (F = 2.75, P = .03). On the 3rd, 4, and 5th days after surgery, the ERAS group experienced less pain and more walking than the non-ERAS group. The ERAS group experienced less fatigue (0.407 [95% confidence interval, CI: -0.795, -0.020], P = .035), less sleep interference (0.615 [95% CI: -1.215, -0.014], P = .045), a lower rate of reduced appetite (0.281 [95% CI: -0.442, -0.120], P = .001), and less abdominal distension (0.262 [95% CI: -0.504, -0.020], P = .034) than the non-ERAS group. Those in the ERAS group had a significantly shorter median time from surgery to mild fatigue (5.41 vs 6.87 days, P = .003), mild pain (4.45 vs 6.09 days, P = .001), mild interference when walking (3.85 vs 5.54 days, P < .001), and mild interference when sleeping (5.49 vs 7.43 days, P < .001). ERAS patients were more likely than non-ERAS patients to achieve a functional recovery (5.70 vs 6.79 days, P < .001) status in a shorter time period. The ERAS pathway, operation time, and the minimally invasive approach were independent predictors of functional recovery time.In hepatocellular carcinoma liver resection patients, the primary mechanism of ERAS is to reduce the postoperative interference burden and promote rapid functional recovery.
本研究的目的是调查术后加速康复（ERAS）对围手术期结局的影响，重点关注患者报告的结局（PROs）和功能恢复情况。我们比较了275例行肝切除术患者在实施ERAS前后的临床结局。使用MD安德森症状量表在术前和术后直至术后14天对PROs进行比较。与非ERAS组患者相比，ERAS组患者的症状更少，功能恢复时间更短。两组在疼痛（F = 4.70，P = 0.001）和行走（F = 2.75，P = 0.03）方面的组×时间交互作用存在差异。在术后第3、4和5天，ERAS组比非ERAS组疼痛更轻，行走更多。ERAS组比非ERAS组疲劳感更轻（0.407[95%置信区间，CI：-0.795，-0.020]，P = 0.035），睡眠干扰更少（0.615[95%CI：-1.215，-0.014]，P = 0.045），食欲减退率更低（0.281[95%CI：-0.442，-0.120]，P = 0.001），腹胀更轻（0.262[95%CI：-0.504，-0.020]，P = 0.034）。ERAS组患者从手术到出现轻度疲劳（5.41天对6.87天，P = 0.003）、轻度疼痛（4.45天对6.09天，P = 0.001）、行走时轻度干扰（3.85天对5.54天，P < 0.001）和睡眠时轻度干扰（5.49天对7.43天，P < 0.001）的中位时间明显更短。与非ERAS患者相比，ERAS患者更有可能在更短时间内实现功能恢复（5.70天对6.79天，P < 0.001）状态。ERAS路径、手术时间和微创方法是功能恢复时间的独立预测因素。在肝细胞癌肝切除患者中，ERAS的主要机制是减轻术后干扰负担并促进快速功能恢复。
