Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
Department of Anesthesia, University of Texas Southwestern Medical Center, Dallas, Texas.
J Reconstr Microsurg. 2022 Jul;38(6):506-510. doi: 10.1055/s-0041-1740125. Epub 2021 Nov 24.
The Enhanced Recovery After Surgery (ERAS) protocol is a multivariate intervention requiring the help of several departments, including anesthesia, nursing, and surgery. This study seeks to observe ERAS compliance rates and obstacles for its implementation at a single academic institution.
This is a retrospective study looking at patients who underwent deep inferior epigastric perforator (DIEP) flap breast reconstruction from January 2016 to September 2019. The ERAS protocol was implemented on select patients early 2017, with patients from 2016 acting as a control. Thirteen points from the protocol were identified and gathered from the patient's electronic medical record (EMR) to evaluate compliance.
Two hundred and six patients were eligible for the study, with 67 on the control group. An average of 6.97 components were met in the pre-ERAS group. This number rose to 8.33 by the end of 2017. Compliance peaked with 10.53 components met at the beginning of 2019. The interventions most responsible for this increase were administration of preoperative medications, goal-oriented intraoperative fluid management, and administration of scheduled gabapentin postoperatively. The least met criterion was intraoperative ketamine goal of >0.2 mg/kg/h, with a maximum compliance rate of 8.69% of the time.
The introduction of new protocols can take over a year for full implementation. This is especially true for protocols as complex as an ERAS pathway. Even after years of consistent use, compliance gaps remain. Staff-, patient-, or resource-related issues are responsible for these discrepancies. It is important to identify these issues to address them and optimize patient outcomes.
加速康复外科（ERAS）方案是一种多变量干预措施，需要麻醉、护理和外科等多个部门的协助。本研究旨在观察单一学术机构的 ERAS 依从率及其实施障碍。
这是一项回顾性研究，观察了 2016 年 1 月至 2019 年 9 月期间接受深部腹壁下动脉穿支皮瓣（DIEP）乳房重建的患者。ERAS 方案于 2017 年初在部分患者中实施，2016 年的患者作为对照组。从患者的电子病历（EMR）中确定并收集方案中的 13 个要点，以评估依从性。
共有 206 名患者符合研究条件，其中对照组有 67 名。在 ERAS 前组中，平均有 6.97 个项目符合要求。到 2017 年底，这一数字上升到 8.33。2019 年初，符合要求的项目达到 10.53 个，达到峰值。导致这一增长的干预措施主要是术前药物的应用、目标导向的术中液体管理和术后定时给予加巴喷丁。术中达到 >0.2mg/kg/h 的目标剂量的氯胺酮应用这一标准的符合率最低，最高符合率为 8.69%。
新方案的引入可能需要一年多的时间才能全面实施。对于像 ERAS 这样复杂的方案尤其如此。即使经过多年的持续使用，仍然存在依从性差距。与员工、患者或资源相关的问题是导致这些差异的原因。确定这些问题并加以解决对于优化患者的治疗结果非常重要。
