Pecorelli Nicolò, Mazza Michele, Guarneri Giovanni, Delpini Roberto, Partelli Stefano, Balzano Gianpaolo, Turi Stefano, Meani Renato, Beretta Luigi, Falconi Massimo
Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
Vita-Salute San Raffaele University, Milan, Italy.
HPB (Oxford). 2021 Dec;23(12):1815-1823. doi: 10.1016/j.hpb.2021.04.016. Epub 2021 Apr 27.
In bowel surgery, adherence to enhanced recovery program (ERP) has been associated with improved recovery. The objective of this study was to evaluate the impact of adherence to ERP elements on outcomes, and identify factors associated with successful recovery following distal pancreatectomy (DP).
Data for 376 patients who underwent DP managed within an ERP including 16 perioperative elements were reviewed. Primary endpoint was successful recovery, a composite outcome defined as length of hospital stay≤7 days, no severe complications nor readmissions.
Patients had a mean (SD) overall adherence of 76 (14)%. Overall, 166 (44%) patients had a successful recovery. There was a positive association between overall adherence and successful recovery (OR 1.19, 95%CI 1.08-1.31 for every additional element, p = 0.001), while an inverse relationship was found with comprehensive complication index (8% reduction, 95%CI -15 to -2%, p = 0.011). Adherence to postoperative phase interventions had the greatest impact on recovery (OR 1.29, 95%CI 1.13-1.47 for every additional postoperative element; p < 0.001). At multivariable regression, early termination of IV fluids was the only ERP element associated with successful recovery (OR 2.80, 95%CI 1.73-4.54; p < 0.001).
Increased adherence to ERP elements was associated with successful early recovery and reduction of postoperative complication severity.
在肠道手术中，遵循强化康复计划（ERP）与恢复情况改善相关。本研究的目的是评估遵循ERP要素对结局的影响，并确定与胰体尾切除术（DP）后成功恢复相关的因素。
回顾了376例行DP且在包含16项围手术期要素的ERP管理下的患者数据。主要终点是成功恢复，这是一个综合结局，定义为住院时间≤7天、无严重并发症且无再入院。
患者的总体依从性平均（标准差）为76（14）%。总体而言，166例（44%）患者成功恢复。总体依从性与成功恢复之间存在正相关（每增加一项要素，比值比为1.19，95%置信区间为1.08 - 1.31，p = 0.001），而与综合并发症指数呈负相关（降低8%，95%置信区间为 - 15%至 - 2%，p = 0.011）。遵循术后阶段干预对恢复的影响最大（每增加一项术后要素，比值比为1.29，95%置信区间为1.13 - 1.47；p < 0.001）。在多变量回归分析中，早期停止静脉输液是与成功恢复相关的唯一ERP要素（比值比为2.80，95%置信区间为1.73 - 4.54；p < 0.001）。
对ERP要素的依从性增加与早期成功恢复及术后并发症严重程度降低相关。
