Seyfried Steffen, Herrle Florian, Schröter Michele, Hardt Julia, Betzler Alexander, Rahbari Nuh N, Reißfelder Christoph
Chirurgische Klinik, Universitätsmedizin Mannheim, Medizinische Fakultät, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
Chirurg. 2021 May;92(5):428-433. doi: 10.1007/s00104-020-01341-1. Epub 2021 Jan 20.
To further improve treatment quality and patient orientation, a multiprofessional enhanced recovery after surgery (ERAS®) transformation program was initiated in our clinic in January 2020. The ERAS® treatment pathway for colorectal surgery was established in October 2020.
The aim of the study was to show that the perioperative treatment quality can be increased by implementing a certified ERAS® program in the setting of a fast-track pathway that has been established since 2008.
The first ERAS® patients from October/November 2020 (ERAS®) were compared with those of a representative consecutive control cohort (pre-ERAS®) who had undergone interventions from August to December 2019. Patient care and data collection of the ERAS® patients were ensured by an ERAS® nurse in daily visits. For the comparison cohorts, the electronic patient files were analyzed and historical colon pathway data from our clinic from 2008 were used.
A total of 10 ERAS® and 50 pre-ERAS® patients were included. After the ERAS® transformation, an increase in overall compliance with ERAS® guideline recommendations from 45% (pre-ERAS®) to 75% (ERAS®) was achieved. The number of days to tolerance of solid food decreased from 2 days (pre-ERAS®) to 1 day (ERAS®). The general postoperative complication rate was comparable (22% pre-ERAS® vs. 20% ERAS®). Most noticeable was the reduction of the median hospital stay of 9 days in the historical cohort to 3 days after ERAS® implementation. We attribute the necessary high ERAS® pathway compliance of 75% to a successful combination of process standards and multiprofessional ERAS® teams.
为进一步提高治疗质量并以患者为导向，2020年1月我们诊所启动了一项多专业术后加速康复（ERAS®）转型项目。2020年10月建立了结直肠手术的ERAS®治疗路径。
本研究的目的是表明，在自2008年以来已建立的快速康复路径背景下，实施经过认证的ERAS®项目可提高围手术期治疗质量。
将2020年10月/11月的首批ERAS®患者（ERAS®组）与2019年8月至12月接受干预的代表性连续对照队列（ERAS®前组）进行比较。ERAS®护士通过每日查房确保对ERAS®患者的护理和数据收集。对于对照队列，分析电子病历并使用我们诊所2008年以来的历史结肠手术路径数据。
共纳入10例ERAS®患者和50例ERAS®前患者。ERAS®转型后，ERAS®指南建议的总体依从性从45%（ERAS®前）提高到75%（ERAS®）。固体食物耐受天数从2天（ERAS®前）降至1天（ERAS®）。总体术后并发症发生率相当（ERAS®前为22%，ERAS®为20%）。最显著的是，历史队列的中位住院天数从9天减少到ERAS®实施后的3天。我们将75%的必要高ERAS®路径依从性归因于流程标准和多专业ERAS®团队成功结合。
