胰十二指肠切除术后住院时间的早期预测。
Early Prediction of Length of Stay After Pancreaticoduodenectomy.
机构信息
Department of General Surgery, University of Rochester Medical Center, Rochester, New York, USA.
Department of General Surgery, University of Rochester Medical Center, Rochester, New York, USA.
出版信息
J Surg Res. 2021 Apr;260:499-505. doi: 10.1016/j.jss.2020.11.060. Epub 2020 Dec 23.
BACKGROUND
Enhanced recovery after surgery (ERAS) is an evidence-based clinical pathway designed to standardize and optimize care. We studied the impact of ERAS and sought to identify the most important recommendations to predict shorter length of stay (LOS) after pancreaticoduodenectomy (PD).
METHODS
We retrospectively reviewed all patients undergoing PD at our institution between January 2014 and June 2018. We compared clinicopathologic outcomes for patients before and after ERAS implementation. We defined "A-recommendations" as those that were graded "strong" and had "moderate" or "high" levels of evidence. We then compared outcomes of the ERAS group with adherence to "A-recommendations" and performed a subset analysis of "A-recommendations" over the first 72 h after surgery, which we termed "early factors".
RESULTS
A total of 191 patients underwent PD during the study period. We excluded 87 patients who had minimally invasive PD (22), vascular reconstruction (53), or both (12). Of the 104 patients studied, 56 (54%) were pre-ERAS and 48 (46%) were ERAS. There were no differences in comorbidities or demographics between these groups, and morbidity, mortality, and readmission rates were also similar (P > 0.6). Median LOS was 3.5 d shorter in the ERAS group (7 versus 10.5 d, P < 0.001). Adherence to "A-recommendations" within ERAS was associated with a decreased LOS (r = -0.52 P = 0.0001). Patients with >5 "early factors" had a median LOS of 6 d, whereas patients with <5 "early factors" had a median LOS of 9 d (P = 0.008).
CONCLUSIONS
ERAS is an effective protocol that standardizes care and reduces LOS after PD. Implementation of ERAS resulted in a 3.5-day reduction in our LOS with no change in morbidity, mortality, or readmissions. Adherence to ERAS protocol "A-recommendations" and ≥5 "early factors" may be predictive of shortened LOS.
背景
手术后加速康复（ERAS）是一种基于证据的临床路径，旨在标准化和优化护理。我们研究了 ERAS 的影响，并试图确定最重要的建议，以预测胰十二指肠切除术（PD）后较短的住院时间（LOS）。
方法
我们回顾性分析了 2014 年 1 月至 2018 年 6 月在我院接受 PD 的所有患者。我们比较了 ERAS 实施前后患者的临床病理结局。我们将“ A 建议”定义为那些被评为“强”且具有“中等”或“高”证据水平的建议。然后，我们将 ERAS 组的结果与对“ A 建议”的依从性进行了比较，并对手术后前 72 小时内的“ A 建议”进行了亚组分析，我们称之为“早期因素”。
结果
研究期间共 191 例患者接受 PD。我们排除了 87 例接受微创 PD（22 例）、血管重建（53 例）或两者均接受的患者（12 例）。在研究的 104 例患者中，56 例（54％）为 ERAS 前，48 例（46％）为 ERAS。这些组之间在合并症或人口统计学方面没有差异，发病率，死亡率和再入院率也相似（P> 0.6）。ERAS 组的 LOS 平均缩短了 3.5 天（7 天与 10.5 天，P<0.001）。ERAS 内对“ A 建议”的依从性与 LOS 降低相关（r =-0.52，P=0.0001）。具有> 5 个“早期因素”的患者的 LOS 中位数为 6 天，而具有<5 个“早期因素”的患者的 LOS 中位数为 9 天（P=0.008）。
结论
ERAS 是一种有效的方案，可标准化护理并降低 PD 后的 LOS。实施 ERAS 可使我们的 LOS 缩短 3.5 天，而发病率，死亡率或再入院率没有变化。对 ERAS 方案“ A 建议”的依从性和≥5 个“早期因素”可能可预测 LOS 缩短。
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