377659 Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas, Austin, TX, USA.
1685 Department of Surgery, Uniformed Services University, Bethesda, MD, USA.
Am Surg. 2021 Mar;87(3):473-479. doi: 10.1177/0003134820951440. Epub 2020 Oct 13.
Enhanced recovery after surgery (ERAS) protocols have been shown to decrease length of stay (LOS) and improve patient outcomes in a wide variety of surgical fields; however, barriers exist preventing the implementation of all elements. We hypothesize that a subset of ERAS elements are most influential on LOS and readmission following colorectal surgery.
A retrospective review of 840 patients was performed and their compliance with 24 ERAS components evaluated. Two independent machine-learning statistical algorithms were employed to determine which subset of ERAS elements was most impactful on LOS <3 days and hospital readmission.
Increasing compliance with ERAS elements had an inverse linear relationship with LOS. Open (vs minimally invasive) surgery was associated with increased LOS. Early mobilization and multimodal pain management are the elements most protective against increased LOS. Readmissions increase with the number of morphine milligram equivalents (MME)/day. The subset of patients who underwent minimally invasive procedures, had multimodal pain control, and less than 16 MME per day were least likely (23%) to have >3-day LOS. Those patients who underwent an open procedure with less than 15 ERAS elements completed were most likely (84%) to have >3-day LOS.
While increasing compliance with ERAS protocols and minimally invasive procedures decrease LOS and readmission overall, a subset of components-multimodal pain control, limited opioid use, and early mobilization-was most associated with decreased LOS and readmission. This study provides guidance on which ERAS elements should be emphasized.
加速康复外科（ERAS）方案已被证明可减少多种外科领域的住院时间（LOS）并改善患者预后；然而，存在一些障碍阻止了所有要素的实施。我们假设 ERAS 要素中的一部分对结直肠手术后的 LOS 和再入院率影响最大。
对 840 例患者进行回顾性分析，评估其对 24 项 ERAS 要素的依从性。采用两种独立的机器学习统计算法来确定哪些 ERAS 要素对 LOS<3 天和医院再入院率的影响最大。
ERAS 要素的依从性增加与 LOS 呈反比线性关系。开放（与微创）手术与 LOS 增加相关。早期活动和多模式疼痛管理是最能预防 LOS 增加的要素。随着吗啡毫克当量（MME）/天的增加，再入院率也随之增加。接受微创手术、多模式疼痛控制且每天 MME 少于 16 毫克的患者再入院率最低（23%）， LOS 超过 3 天的可能性最小。接受开放手术且完成的 ERAS 要素少于 15 个的患者再入院率最高（84%）， LOS 超过 3 天的可能性最大。
虽然增加 ERAS 方案和微创手术的依从性可降低 LOS 和再入院率，但多模式疼痛控制、限制阿片类药物使用和早期活动等要素与降低 LOS 和再入院率的相关性最大。本研究为强调哪些 ERAS 要素提供了指导。
