Dept. of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada.
Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
Eur J Cardiothorac Surg. 2022 May 27;61(6):1223-1229. doi: 10.1093/ejcts/ezab492.
Data regarding enhanced recovery after thoracic surgery (ERATS) are sparse and inconsistent. This study aims to evaluate the effects of implementing an enhanced ERATS programme on postoperative outcomes, patient experience and quality of life (QOL).
We conducted a prospective, longitudinal study evaluating 9 months before (pre-ERATS) and 9 months after (post-ERATS) a 3-month implementation of an ERATS programme in a single academic tertiary care centre. All patients undergoing major thoracic surgeries were included. The primary outcomes included length of stay (LOS), adverse events (AEs), 6-min walk test scores at 4 weeks, 30-day emergency room visits (without admission) and 30-day readmissions. The process-of-care outcomes included time to 'out-of-bed', independent ambulation, successful fluid intake, last chest tube removal and removal of urinary catheter. Perioperative anaesthesia-related outcomes were examined as well as patient experience and QOL scores.
The pre-ERATS group (n = 352 patients) and post-ERATS group (n = 352) demonstrated no differences in demographics. Post-ERATS patients had improved LOS (4.7 vs 6.2 days, P < 0.02), 6-min walk test scores (402 vs 371 m, P < 0.05) and 30-day emergency room visits (13.7% vs 21.6%, P = 0.03) with no differences in AEs and 30-day readmissions. Patients experienced shorter mean time to 'out-of-bed', independent ambulation, successful fluid intake, last chest tube removal and urinary catheter removal. There were no differences in postoperative analgesia administration, patient satisfaction and QOL scores.
ERATS implementation was associated with improved LOS, expedited feeding, ambulation and chest tube removal, without increasing AEs or readmissions, while maintaining a high level of patient satisfaction and QOL.
有关胸外科术后加速康复（ERATS）的数据较为匮乏且不一致。本研究旨在评估实施增强型 ERATS 方案对术后结果、患者体验和生活质量（QOL）的影响。
我们进行了一项前瞻性、纵向研究，评估了单家学术性三级护理中心实施 ERATS 方案的 3 个月前（ERATS 前）和 3 个月后（ERATS 后）9 个月的数据。所有接受大型胸部手术的患者均纳入研究。主要结局包括住院时间（LOS）、不良事件（AE）、4 周时 6 分钟步行测试评分、30 天内急诊就诊（无需住院）和 30 天内再入院。过程护理结局包括下床时间、独立行走、成功摄入液体、最后一根胸腔引流管拔除和导尿管拔除的时间。还检查了围手术期麻醉相关结局以及患者体验和 QOL 评分。
ERATS 前组（n=352 例患者）和 ERATS 后组（n=352 例患者）的人口统计学特征无差异。ERATS 后组患者的 LOS（4.7 天比 6.2 天，P<0.02）、6 分钟步行测试评分（402 米比 371 米，P<0.05）和 30 天内急诊就诊率（13.7%比 21.6%，P=0.03）均有所改善，AE 和 30 天内再入院率无差异。患者经历了下床、独立行走、成功摄入液体、最后一根胸腔引流管拔除和导尿管拔除的时间更短。术后镇痛管理、患者满意度和 QOL 评分无差异。
实施 ERATS 与 LOS 缩短、喂养、活动和胸腔引流管拔除加速相关，同时不增加 AE 或再入院率，同时保持高水平的患者满意度和 QOL。
