Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC.
Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC; Department of Anaesthesia, McGill University Health Centre, Montreal, QC.
Surgery. 2022 Mar;171(3):607-614. doi: 10.1016/j.surg.2021.08.062. Epub 2021 Nov 26.
Early identification of colorectal surgery patients predicted to have uneventful gastrointestinal recovery may allow for early discharge. Our objective was to identify trajectories of gastrointestinal recovery within a colorectal surgery enhanced recovery pathway.
Data from 2 prospective studies enrolling adult patients undergoing elective laparoscopic colorectal resection at a specialist colorectal referral center were analyzed (2013-2019). All patients were managed according to a mature enhanced recovery pathway with a 3-day target length of stay. Postoperative gastrointestinal symptoms were collected daily and expressed using the validated I-FEED score. Latent-class growth curve (trajectory) analysis was used to identify different I-FEED trajectories over the first 3 postoperative days.
A total of 192 patients were analyzed. Trajectory analysis identified 3 distinct trajectories: trajectory 1 had no gastrointestinal symptoms (41%); trajectory 2 had mild early symptoms with improvement over time (48%); and trajectory 3 had gastrointestinal symptoms that significantly worsened between postoperative days 1 and 2 (11%). I-FEED score ≤1 on postoperative day 1 predicted trajectory 1. Trajectory 1 had the best clinical outcomes, whereas trajectory 3 had the worst.
I-FEED trajectory over postoperative days 1-3 was associated with clinical outcomes and may be used to predict gastrointestinal recovery. Findings from this study may inform clinical decision making regarding early hospital discharge within colorectal enhanced recovery pathways.
早期识别预计胃肠道恢复顺利的结直肠手术患者可能有助于提前出院。我们的目的是确定结直肠手术加速康复路径中胃肠道恢复的轨迹。
对在一家专业结直肠转诊中心接受择期腹腔镜结直肠切除术的 2 项前瞻性研究的数据进行了分析（2013-2019 年）。所有患者均根据成熟的加速康复路径进行管理，目标住院时间为 3 天。术后胃肠道症状每日采集，并使用经过验证的 I-FEED 评分进行表达。采用潜在类别增长曲线（轨迹）分析来确定术后第 1 至 3 天内不同的 I-FEED 轨迹。
共分析了 192 例患者。轨迹分析确定了 3 种不同的轨迹：轨迹 1 无胃肠道症状（41%）；轨迹 2 早期有轻度症状，随着时间的推移逐渐改善（48%）；轨迹 3 胃肠道症状在术后第 1 天至第 2 天之间显著恶化（11%）。术后第 1 天 I-FEED 评分≤1 预测轨迹 1。轨迹 1 的临床结局最佳，而轨迹 3 的临床结局最差。
术后第 1-3 天的 I-FEED 轨迹与临床结局相关，可用于预测胃肠道恢复。本研究的结果可能为结直肠加速康复路径中提前出院的临床决策提供依据。
