Weng Xi-Sheng, Liu Juan, Wu Duo
Department of Orthopedics, Peking Union Medical College Hospital, Beijing, China.
Medical Affairs Department, Pfizer Inc, Shanghai, China.
Orthop Surg. 2020 Jun;12(3):900-906. doi: 10.1111/os.12705. Epub 2020 Jun 3.
To examine the current perspectives of enhanced recovery after surgery (ERAS) and the clinical practice applications of important ERAS principles among Chinese orthopaedic surgeons.
This was a cross-sectional study using an online survey that was completed between November and December 2018. A 16-item online questionnaire regarding the experiences of ERAS, perceptions of methods, and durations and concerns of venous thromboembolism (VTE) prophylaxis was sent to 2000 orthopaedic surgeons nationwide, and 1720 (86%) surgeons responded. Statistical analyses were conducted to assess all respondents' results and to compare differences among subgroups that were stratified according to city and hospital level, as well as their professional title.
According to the results of the survey, ERAS awareness was high (65.1%) and most surgeons recognized the importance of thromboprophylaxis. However, the timing of ERAS was not consistent, with 22.8%, 31.9%, and 37.7% of surgeons choosing to initiate pharmaceutical prophylaxis within <6 h, 6-12 h, and 12-24 h after surgery, respectively. Low-molecular-weight heparin was mainly selected during hospitalization, and new oral anticoagulants (NOACs) were the first choice after discharge. Regarding postoperative antithrombotic therapy, particularly when combined with analgesics, the potential bleeding risk was mostly considered (80.0%)Tranexamic acid was believed to have no effect on the timing of NOAC therapy initiation (56.2%). Most of the above outcomes were influenced by the hospital level and professional title of the surgeon. Surgeons who had higher awareness on ERAS and better adhered to the guidelines were from higher-level hospitals as well as had more advanced professional titles. City level partly might influence their practice but not impact surgeons' awareness.
The awareness and perception of the concept of ERAS and prophylactic antithrombotic regimens remain different among Chinese orthopaedic surgeons in different level cities and with various professional titles. Continuing medical educations (CME) on VTE prophylaxis is needed for improving the quality of health care in China.
探讨中国骨科医生对术后加速康复（ERAS）的当前认知以及ERAS重要原则的临床实践应用情况。
这是一项横断面研究，采用2018年11月至12月期间完成的在线调查。一份关于ERAS经验、方法认知、静脉血栓栓塞症（VTE）预防持续时间及相关问题的16项在线问卷被发送给全国2000名骨科医生，1720名（86%）医生做出了回应。进行统计分析以评估所有受访者的结果，并比较根据城市、医院级别以及职称分层的亚组之间的差异。
根据调查结果，ERAS认知度较高（65.1%），大多数医生认识到血栓预防的重要性。然而，ERAS的实施时机并不一致，分别有22.8%、31.9%和37.7%的医生选择在术后<6小时、6 - 12小时和12 - 24小时内开始药物预防。低分子肝素主要在住院期间选用，新型口服抗凝药（NOACs）是出院后的首选。关于术后抗栓治疗，特别是与镇痛药联合使用时，大多会考虑潜在的出血风险（80.0%）。氨甲环酸被认为对NOAC治疗开始的时机没有影响（56.2%）。上述大多数结果受医生的医院级别和职称影响。对ERAS认知度较高且更遵循指南的医生来自级别更高的医院且职称更高级。城市级别可能部分影响他们的实践，但不影响医生的认知。
不同城市级别和不同职称的中国骨科医生对ERAS概念及预防性抗栓方案的认知和理解仍存在差异。在中国，需要开展关于VTE预防的继续医学教育（CME）以提高医疗质量。
