Unit of General Surgery, Department of Surgery, S. Anna University Hospital of Ferrara, Ferrara, Italy.
Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, Ferrara, Italy.
J Laparoendosc Adv Surg Tech A. 2021 Apr;31(4):363-370. doi: 10.1089/lap.2020.0716. Epub 2020 Nov 9.
Most of the evidence for enhanced recovery programs (ERPs) in colorectal surgery relies on nonrandomized studies with control groups either historical or operated on at different facilities. The aim of this study was to investigate ERP in coeval groups admitted in different wards at the same hospital. A prospective cohort of consecutive patients ( = 100) undergoing elective laparoscopic colorectal resection completing a standardized ERP (ERP group) was compared with patients ( = 100) operated with traditional perioperative care in the same period at the same institution (non-ERP group). The two groups were located in separate wards and shared the same anesthesiologists. The exclusion criteria were: >80 years old, American Society of Anesthesia (ASA) IV, metastatic disease, and inflammatory bowel disease. The primary outcome was hospital length of stay (LoS), used as a proxy of functional recovery. Secondary outcomes included: postoperative complications, readmission rate, mortality, and protocol adherence. The ERP group protocol adherence was 81%. The LoS was significantly reduced in the ERP group (4 versus 7 days). The number of 30-day postoperative complications was lower in the ERP group ( < .001). No increase was found in 30-day readmission or mortality. Conventional perioperative protocol was the only predictor of any postoperative complication and, together with male sex and age 65-74 years old, was the only factor associated with prolonged LoS. Implementing a colorectal ERP is feasible, safe, and efficient for functional recovery, but high protocol adherence is needed. Following traditional perioperative care is associated with more postoperative complications and prolonged LoS.
大多数结直肠手术中加速康复方案（ERPs）的证据都依赖于非随机研究，对照组为历史对照组或在不同医疗机构接受手术。本研究旨在调查同一医院不同病房同时入院的患者中 ERP 的应用情况。前瞻性连续患者（ = 100）接受择期腹腔镜结直肠切除术并完成标准化 ERP（ERP 组），与同期在同一机构接受传统围手术期护理的患者（ = 100）进行比较（非 ERP 组）。两组分别位于不同病房，共用相同的麻醉师。排除标准为：>80 岁，美国麻醉医师协会（ASA）IV 级，转移性疾病和炎症性肠病。主要结局是住院时间（LoS），用作功能恢复的替代指标。次要结局包括：术后并发症、再入院率、死亡率和方案依从性。ERP 组方案依从率为 81%。ERP 组的 LoS 明显缩短（4 天与 7 天）。ERP 组术后 30 天并发症的数量较低（ < .001）。未发现 30 天再入院或死亡率增加。传统围手术期方案是任何术后并发症的唯一预测因素，与男性和 65-74 岁年龄一起是与 LoS 延长相关的唯一因素。实施结直肠 ERP 是可行、安全和有效的，有利于功能恢复，但需要高度的方案依从性。遵循传统围手术期护理与更多的术后并发症和延长的 LoS 相关。
