Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland (Dr. Stone).
Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, New Orleans, Louisiana (Dr. Scheib).
J Minim Invasive Gynecol. 2021 Mar;28(3):481-489. doi: 10.1016/j.jmig.2020.12.024. Epub 2020 Dec 24.
This review formulates the rationale for using enhanced recovery protocols (ERPs) to standardize and optimize perioperative care during this high-risk time to minimize poor outcomes owing to provider, patient, and system vulnerabilities.
n/a METHODS OF STUDY SELECTION: A literature review using key Medical Subject Headings terms was performed-according to methods described by the Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines-on studies that described enhanced recovery and coronavirus disease (COVID-19).
TABULATION, INTEGRATION, AND RESULTS: Modifications to our existing ERPs related to the COVID-19 pandemic should include new accommodations for patient education, preoperative COVID-19 testing, prehabilitation, and intraoperative infection as well as thromboembolism risk reduction.
ERPs are evidence-based, best practice guidelines applied across the perioperative continuum to mitigate surgical stress, decrease complications, and accelerate recovery. These benefits are part of the high-value-care equation needed to solve the clinical, operational, and financial challenges of the current COVID-19 pandemic. The factors driving outcomes on ERPs, such as the provision of minimally invasive surgery, warrant careful consideration. Tracking patient outcomes and improving care in response to outcomes data are key to the success of clinical care protocols such as ERPs. Numerous emerging clinical registries and reporting systems have been activated to provide outcomes data on the impact of COVID-19. This will inform and change surgical practice as well as provide opportunity to learn if the advantages that surgeons, patients, and the healthcare system might gain from using ERPs during a pandemic are meaningful.
本综述制定了使用强化康复方案（ERPs）的基本原理，以标准化和优化围手术期护理，从而最大限度地减少由于提供者、患者和系统脆弱性而导致的不良结果。
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根据 Cochrane 协作组织和系统评价和荟萃分析报告的首选项目指南中描述的方法，使用关键医学主题词进行文献回顾，对描述强化康复和冠状病毒病（COVID-19）的研究进行了回顾。
列表、整合和结果：与 COVID-19 大流行相关的现有 ERP 修订应包括针对患者教育、术前 COVID-19 检测、术前康复以及术中感染和血栓栓塞风险降低的新适应措施。
ERPs 是循证的最佳实践指南，适用于围手术期连续体，以减轻手术应激、减少并发症并加速康复。这些益处是解决当前 COVID-19 大流行临床、运营和财务挑战所需的高价值护理方程式的一部分。推动 ERP 结果的因素，例如微创外科的提供，值得仔细考虑。跟踪患者结果并根据结果数据改进护理是 ERPs 等临床护理方案成功的关键。许多新出现的临床登记处和报告系统已经启动，以提供 COVID-19 影响的结果数据。这将告知并改变外科实践，并提供机会学习，如果在大流行期间使用 ERPs 对外科医生、患者和医疗保健系统可能获得的优势具有重要意义。
