Golder Henry John, Papalois Vassilios
School of Medicine, Imperial College London, London SW7 2AZ, UK.
Department of Surgery, Imperial College London, London W12 0HS, UK.
J Clin Med. 2021 Apr 12;10(8):1634. doi: 10.3390/jcm10081634.
Enhanced recovery after surgery (ERAS) aims to improve patient outcomes by controlling specific aspects of perioperative care. The concept was introduced in 1997 by Henrik Kehlet, who suggested that while minor changes in perioperative practise have no significant impact alone, incorporating multiple changes could drastically improve outcomes. Since 1997, significant advancements have been made through the foundation of the ERAS Society, responsible for creating consensus guidelines on the implementation of enhanced recovery pathways. ERAS reduces length of stay by an average of 2.35 days and healthcare costs by $639.06 per patient, as identified in a 2020 meta-analysis of ERAS across multiple surgical subspecialties. Carbohydrate loading, bowel preparation and patient education in the pre-operative phase, goal-directed fluid therapy in the intra-operative phase, and early mobilisation and enteral nutrition in the post-operative phase are some of the interventions that are commonly implemented in ERAS protocols. While many specialties have been quick to incorporate ERAS, uptake has been slow in the transplantation field, leading to a scarcity of literature. Recent studies reported a 47% reduction in length of hospital stay (LOS) in liver transplantation patients treated with ERAS, while progress in kidney transplantation focuses on pain management and its incorporation into enhanced recovery protocols.
术后加速康复（ERAS）旨在通过控制围手术期护理的特定方面来改善患者预后。这一概念由亨里克·克勒特于1997年提出，他认为虽然围手术期实践中的微小变化单独来看没有显著影响，但纳入多种变化可能会大幅改善预后。自1997年以来，通过成立ERAS学会取得了重大进展，该学会负责制定关于实施加速康复路径的共识指南。2020年一项对多个外科亚专业的ERAS进行的荟萃分析表明，ERAS可使住院时间平均缩短2.35天，每位患者的医疗费用降低639.06美元。术前阶段的碳水化合物负荷、肠道准备和患者教育，术中阶段的目标导向液体治疗，以及术后阶段的早期活动和肠内营养是ERAS方案中通常实施的一些干预措施。虽然许多专业很快就采用了ERAS，但在移植领域的采用速度较慢，导致相关文献匮乏。最近的研究报告称，接受ERAS治疗的肝移植患者住院时间（LOS）缩短了47%，而肾移植的进展则集中在疼痛管理及其纳入加速康复方案方面。
