Departments of Obstetrics and Gynecology (Drs. Ren, Sun, H. Liu, Mrs. X. Liu, and Mrs. Y. Liu); Anesthesiology (Dr. Pei), Peking Union Medical College Hospital, Beijing, China; Outcomes Research Consortium (Dr. Pei), Cleveland, Ohio.
Departments of Obstetrics and Gynecology (Drs. Ren, Sun, H. Liu, Mrs. X. Liu, and Mrs. Y. Liu); Anesthesiology (Dr. Pei), Peking Union Medical College Hospital, Beijing, China; Outcomes Research Consortium (Dr. Pei), Cleveland, Ohio.
J Minim Invasive Gynecol. 2021 Sep;28(9):1610-1617.e6. doi: 10.1016/j.jmig.2021.01.024. Epub 2021 Mar 4.
To assess whether a full enhanced recovery after surgery (ERAS) program can further improve perioperative outcomes among patients undergoing gynecologic laparoscopic procedures relative to those receiving limited ERAS management.
Randomized controlled trial.
Tertiary hospital, China: December 2018 to October 2019.
Total of 144 women scheduled for simple elective gynecologic laparoscopic surgery.
The participants were randomized into 2 groups: full ERAS intervention or limited ERAS management (without preoperative carbohydrate loading or total intravenous anesthesia or opiate-sparing multimodal analgesia).
The primary outcome was postoperative length of stay (LOS), and the secondary outcomes included postoperative pain, time to postoperative milestones, morbidity, and in-hospital cost. Postoperative LOS for the full ERAS program showed a 1-day reduction in comparison with the limited ERAS group (median of 1.0 day vs 2.0 days, respectively; p = .001). Multivariate regression analysis identified preoperative carbohydrate loading and opioid-sparing analgesia as the independent factors for discharging on postoperative day 1. Patients in the full ERAS program reported less pain within 72 hours after surgery and had a lower narcotic consumption rate compared with those in the limited ERAS management. They also enjoyed better and faster recovery as demonstrated by the Quality of Recovery-15 scale on postoperative day 3: 137.0 (interquartile range, 126.3-141.0) for full ERAS program vs 130.0 (23.5-139.0) for limited ERAS management, respectively (p = .030). There were no significant differences between the groups regarding postoperative 30-day morbidity, readmission rate, or in-hospital cost.
The addition of full ERAS management can further reduce postoperative LOS and improve patients' quality of life after laparoscopic surgery for gynecologic diseases.
评估在接受妇科腹腔镜手术的患者中，与接受有限的加速康复外科（ERAS）管理的患者相比，完整的 ERAS 方案是否可以进一步改善围手术期结局。
随机对照试验。
中国三级医院：2018 年 12 月至 2019 年 10 月。
共 144 名计划接受单纯择期妇科腹腔镜手术的女性。
参与者被随机分为 2 组：完整的 ERAS 干预或有限的 ERAS 管理（不进行术前碳水化合物负荷或全静脉麻醉或阿片类药物节约多模式镇痛）。
主要结局是术后住院时间（LOS），次要结局包括术后疼痛、术后里程碑时间、发病率和住院费用。与有限的 ERAS 组相比，完整的 ERAS 方案的术后 LOS 减少了 1 天（中位数分别为 1.0 天和 2.0 天；p = 0.001）。多变量回归分析确定术前碳水化合物负荷和阿片类药物节约镇痛是术后第 1 天出院的独立因素。与接受有限 ERAS 管理的患者相比，接受完整 ERAS 方案的患者在术后 72 小时内疼痛较轻，且阿片类药物使用率较低。他们在术后第 3 天的恢复质量-15 量表上也表现出更好、更快的恢复：完整的 ERAS 方案为 137.0（四分位距，126.3-141.0），而有限的 ERAS 管理为 130.0（23.5-139.0），分别（p = 0.030）。两组在术后 30 天发病率、再入院率或住院费用方面无显著差异。
完整的 ERAS 管理的加入可以进一步减少腹腔镜妇科疾病手术后的术后 LOS 并提高患者的生活质量。
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