General Surgery Unit, Ospedale C.G. Mazzoni Ascoli Piceno, AV 5, Azienda Sanitaria Unica Regionale (ASUR), Marche, Italy.
Direttore UOC Chirurgia Generale, Ospedale "C. e G. Mazzoni"-AV5-ASUR Marche, Via degli Iris snc, 63100, Ascoli Piceno, Italy.
Updates Surg. 2021 Feb;73(1):123-137. doi: 10.1007/s13304-020-00885-5. Epub 2020 Oct 22.
Although there is clear evidence that an Enhanced Recovery After Surgery (ERAS) program in colorectal surgery leads to significantly reduced morbidity rates and length of hospital stay (LOS), it is still unclear what modalities and levels of implementation of the program are necessary to achieve these results. The purpose of this study is to analyze the methods and results of the first year of structured implementation of a colorectal ERAS program in two surgical units of the Azienda Sanitaria Unica Regionale (ASUR) Marche in Italy. A two-center observational study on a prospectively maintained database was performed on 196 consecutive colorectal resections (excluding emergencies and American Society of Anesthesiologists class > III cases) over a 1-year period. More than 50 variables including adherence to the individual items of the ERAS program were considered. Primary outcomes were overall morbidity, major morbidity, mortality and anastomotic leakage rates; secondary outcomes were LOS, re-admission and re-operation. The results were evaluated by univariate and multivariate analyses through logistic regression. After a median follow-up of 39.5 days, we recorded complications in 72 patients (overall morbidity 36.7%), major complications in 14 patients (major morbidity 7.1%), 6 deaths (mortality 3.1%), anastomotic dehiscence in 9 cases (4.9%), mean overall LOS of 6.6 days, 10 readmissions (5.1%) and 13 reoperations (6.7%). The mean adherence rate to the items of the ERAS program was 85.4%, showing a significant dose-effect curve for overall and major morbidity rates, anastomotic leakage rates and LOS. The implementation methods of a colorectal ERAS program in this study led to a high adherence (> 80%) to the program items. High adherence had significant effects also on major morbidity and anastomotic leakage rates.
虽然有明确的证据表明，结直肠手术中的增强术后恢复（ERAS）方案可显著降低发病率和住院时间（LOS），但仍不清楚实施该方案所需的模式和实施程度。本研究的目的是分析意大利马尔凯大区单一区域卫生机构（ASUR）的两个外科单位实施结直肠 ERAS 方案的第一年的方法和结果。在一年的时间里，对前瞻性维护的数据库进行了一项针对 196 例连续结直肠切除术（不包括急诊和美国麻醉医师协会分类> III 类病例）的两中心观察性研究。考虑了 50 多个变量，包括对 ERAS 方案的各个项目的依从性。主要结局是总发病率、主要发病率、死亡率和吻合口漏率；次要结局是 LOS、再入院和再次手术。通过逻辑回归进行单变量和多变量分析来评估结果。中位随访 39.5 天后，我们记录了 72 例患者（总发病率 36.7%）的并发症、14 例患者（主要发病率 7.1%）的主要并发症、6 例死亡（死亡率 3.1%）、9 例吻合口裂开（4.9%）、总 LOS 平均为 6.6 天、10 次再入院（5.1%）和 13 次再次手术（6.7%）。ERAS 方案项目的平均依从率为 85.4%，显示出总发病率和主要发病率、吻合口漏率和 LOS 的显著剂量-效应曲线。本研究中结直肠 ERAS 方案的实施方法导致了对方案项目的高度依从性（>80%）。高度依从性对主要发病率和吻合口漏率也有显著影响。
