Division of Gynecologic Oncology, Obstetrics and Gynecology, University of Alabama at Birmingham HCOP, Birmingham, Alabama, USA
Division of Gynecologic Oncology, Obstetrics and Gynecology, University of Alabama at Birmingham HCOP, Birmingham, Alabama, USA.
Int J Gynecol Cancer. 2021 May;31(5):721-726. doi: 10.1136/ijgc-2020-002270. Epub 2021 Jan 25.
Enhanced recovery protocols are now established as the standard of care leading to improved perioperative outcomes and associated cost-benefits. The objective of this study was to evaluate the impact of an enhanced recovery program on complication rates in high-risk gynecologic oncology patients undergoing surgery.
This retrospective cohort study included gynecologic oncology patients with pathology-proven malignancy undergoing non-emergent laparotomy from October 2016 to December 2018 managed on an enhanced recovery protocol, and a control group from October 2015 through September 2016 prior to enhanced recovery protocol implementation. The primary outcome was complication rates in a high-risk population pre- and post-enhanced recovery protocol. High-risk patients were defined as those with obesity (body mass index >30 kg/m) and/or age ≥65 years. Analysis was performed using Statistical Package for Social Sciences (SPSS) v.24.
A total of 363 patients met the inclusion criteria: 104 in the control group and 259 in the enhanced recovery protocol group. Patient demographics, including age, body mass index, diagnosis, and performance status, were similar. Overall complication rates were less in the enhanced recovery protocol group (29% vs 53.8%; p<0.0001). The enhanced recovery protocol group had a shorter length-of-stay compared with control (3.3 vs 4.2 days; p<0.0001). The 30-day readmission rates were similar between the groups (9.6% vs 13.5%; p=0.19). In the enhanced recovery protocol group compared with control, complication rates were less in obese patients (29.4% vs 57.8%; p<0.0001), morbidly obese patients (20.9% vs 76.2%; p<0.0001), and age ≥65 (36.1% vs 57.1%; p<0.0001). The most common complications in the enhanced recovery protocol group were ileus (9.7%), pulmonary complications (2.7%), and blood transfusions (10.8%).
Implementation of an enhanced recovery protocol decreases complication rates and length-of-stay in morbidly obese and geriatric patients with gynecologic malignancy without an increase in readmission rates.
强化恢复方案现已成为改善围手术期结局和相关成本效益的标准护理。本研究的目的是评估强化恢复方案对接受手术的高风险妇科肿瘤患者并发症发生率的影响。
本回顾性队列研究纳入了 2016 年 10 月至 2018 年 12 月期间接受非紧急剖腹手术且病理学证实为恶性肿瘤的妇科肿瘤患者，并在强化恢复方案下进行管理，对照组为 2015 年 10 月至 2016 年 9 月强化恢复方案实施前的患者。主要结局为高风险人群在强化恢复方案前后的并发症发生率。高危患者定义为肥胖（体重指数>30kg/m）和/或年龄≥65 岁。使用社会科学统计软件包（SPSS）v.24 进行分析。
共有 363 名患者符合纳入标准：对照组 104 例，强化恢复方案组 259 例。患者的人口统计学特征，包括年龄、体重指数、诊断和表现状态，相似。强化恢复方案组的总体并发症发生率较低（29%比 53.8%；p<0.0001）。与对照组相比，强化恢复方案组的住院时间更短（3.3 天比 4.2 天；p<0.0001）。两组的 30 天再入院率相似（9.6%比 13.5%；p=0.19）。与对照组相比，强化恢复方案组肥胖患者（29.4%比 57.8%；p<0.0001）、病态肥胖患者（20.9%比 76.2%；p<0.0001）和年龄≥65 岁患者（36.1%比 57.1%；p<0.0001）的并发症发生率较低。强化恢复方案组最常见的并发症为肠梗阻（9.7%）、肺部并发症（2.7%）和输血（10.8%）。
在患有妇科恶性肿瘤的病态肥胖和老年患者中实施强化恢复方案可降低并发症发生率和住院时间，而不会增加再入院率。
