Tweed Thaís T T, Woortman Carmen, Tummers Stan, Bakens Maikel J A M, van Bastelaar James, Stoot Jan H M B
Department of Surgery, Gastrointestinal Surgery, Zuyderland Medical Centre, Dr. H. van der Hoffplein 1, 6162BG, Sittard-Geleen, The Netherlands.
Int J Colorectal Dis. 2021 Jul;36(7):1535-1542. doi: 10.1007/s00384-021-03948-0. Epub 2021 May 11.
Despite the enhanced recovery after surgery (ERAS) protocol, length of stay (LOS) after colorectal surgery varies considerably. The majority of longer admissions is often not medically necessary. We aimed to investigate possible reduction of LOS by perioperative education with an expected discharge date (EDD).
This single-centre retrospective study included 578 patients who underwent surgery for colorectal cancer in 2016 with standard care (ERAS) and in 2018 with the addition of EDD education program (ERAS+). A comparison was made of a 1-year period prior to and following the implementation of EDD. The EDD was discussed at the outpatient clinic, preoperatively and during admission (with both the patient and family members daily). Standard EDD varied between 3 and 5 days depending on the resection type. Primary outcome was LOS; secondary outcomes were readmission, serious complications and 90-day mortality.
Patients in ERAS+ (n = 242) had a shorter median LOS (4.0 vs. 5.0, p < 0.001) compared to patients in the regular ERAS group (n = 336). Fewer patients of ERAS+ experienced postoperative complications (71 (29.3%) vs. 198 (58.9%), p < 0.001). No difference was found in the number of readmissions (23 (9.5%) vs. 34 (10.1%), p = 0.807), reinterventions (25 (10.3%) vs. 30 (8.9%), p = 0.571) or mortality (5 (2.1%) vs. 9 (2.7%), p = 0.261) between the two groups.
It is possible to reduce LOS within the ERAS program, by better perioperative education and expectation management of patients with use of an EDD. This program ensures better understanding, faster discharge and lower costs for the hospital without added risk of readmissions or complications.
尽管有术后加速康复（ERAS）方案，但结直肠手术后的住院时间（LOS）仍有很大差异。大多数较长时间的住院往往并无医学上的必要。我们旨在通过围手术期教育和预期出院日期（EDD）来研究是否有可能缩短住院时间。
这项单中心回顾性研究纳入了2016年接受标准护理（ERAS）的578例结直肠癌手术患者以及2018年增加了EDD教育计划（ERAS+）的患者。对实施EDD前后各1年的时间段进行了比较。在门诊、术前以及住院期间（每天与患者及其家属）讨论EDD。根据切除类型，标准EDD在3至5天之间。主要结局是住院时间；次要结局是再入院、严重并发症和90天死亡率。
与常规ERAS组（n = 336）的患者相比，ERAS+组（n = 242）的患者中位住院时间更短（4.0天对5.0天，p < 0.001）。ERAS+组术后发生并发症的患者较少（71例（29.3%）对198例（58.9%），p < 0.001）。两组之间的再入院次数（23例（9.5%）对34例（10.1%），p = 0.807）、再次干预次数（25例（10.3%）对30例（8.9%），p = 0.571）或死亡率（5例（2.1%）对9例（2.7%），p = 0.261）均无差异。
通过对患者进行更好的围手术期教育和使用EDD进行预期管理，有可能在ERAS方案内缩短住院时间。该方案可确保患者更好地理解、更快出院并降低医院成本，但不会增加再入院或并发症的风险。
