Agusti Nuria, Zorrilla Vaca Andrés, Segarra-Vidal Blanca, Iniesta Maria D, Mena Gabriel, Pareja Rene, Dos Reis Ricardo, Ramirez Pedro T
Department of Gynecologic Oncology, Hospital Clinic de Barcelona, Barcelona, Spain.
Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Int J Gynecol Cancer. 2022 Apr 4;32(4):480-485. doi: 10.1136/ijgc-2021-003244.
Open surgery has become the standard approach for radical hysterectomy in early stage cervical cancer (International Federation of Gynecology and Obstetrics (FIGO) 2018 IA1 with lymphovascular space invasion-IIA1). Our primary objective was to compare the length of stay in patients undergoing open radical hysterectomy before and after implementation of an enhanced recovery after surgery (ERAS) program.
This was a single center, retrospective, before-and-after intervention study including patients who underwent open radical hysterectomy for cervical cancer from January 2009 to December 2020. Two groups were identified based on the time of ERAS implementation: pre-ERAS group included patients who were operated on between January 2009 and October 2014; post-ERAS group included patients who underwent surgery between November 2014 and December 2020.
A total of 81 patients were included, of whom 29 patients were in the pre-ERAS group and 52 patients in the post-ERAS group. Both groups had similar clinical characteristics with no differences in terms of median age (42 years (interquartile range (IQR) 35-53) in pre-ERAS group vs 41 years (IQR 35-49) in post-ERAS group; p=0.47) and body mass index (26.1 kg/m (IQR 24.6-29.7) in pre-ERAS group vs 27.1 kg/m (IQR 23.5-33.5) in post-ERAS group; p=0.44). Patients in the post-ERAS group were discharged from the hospital earlier compared with those in the pre-ERAS group (median 3 days (IQR 2-3) vs 4 (IQR 3-4), p<0.01). The proportion of patients discharged within 48 hours was significantly higher in the post-ERAS group (47.3% vs 17.3%, p=0.013). There were no differences regarding either overall complications (44.8% pre-ERAS vs 38.5% post-ERAS; p=0.57) or readmission rates within 30 days (20.7% pre-ERAS group vs 17.3% ERAS group; p=0.40). Adherence to the ERAS pathway since its implementation in 2014 has remained stable with a median of 70% (IQR 65%-75%).
Patients undergoing open radical hysterectomy on an ERAS pathway have a shorter length of hospital stay without increasing overall complications or readmissions rates.
开放手术已成为早期宫颈癌根治性子宫切除术的标准术式（国际妇产科联盟（FIGO）2018年IA1期伴脉管间隙浸润-IIA1期）。我们的主要目的是比较实施加速康复外科（ERAS）计划前后接受开放性根治性子宫切除术患者的住院时间。
这是一项单中心、回顾性、干预前后对照研究，纳入2009年1月至2020年12月期间接受开放性宫颈癌根治性子宫切除术的患者。根据ERAS实施时间分为两组：ERAS前组包括2009年1月至2014年10月接受手术的患者；ERAS后组包括2014年11月至2020年12月接受手术的患者。
共纳入81例患者，其中ERAS前组29例，ERAS后组52例。两组临床特征相似，中位年龄无差异（ERAS前组为42岁（四分位间距（IQR）35 - 53）vs ERAS后组为41岁（IQR 35 - 49）；p = 0.47），体重指数也无差异（ERAS前组为26.1 kg/m²（IQR 24.6 - 29.7）vs ERAS后组为27.1 kg/m²（IQR 23.5 - 33.5）；p = 0.44）。与ERAS前组患者相比，ERAS后组患者出院更早（中位时间3天（IQR 2 - 3）vs 4天（IQR 3 - 4），p < 0.01）。ERAS后组48小时内出院患者比例显著更高（47.3% vs 17.3%，p = 0.013）。总体并发症（ERAS前组为44.8% vs ERAS后组为38.5%；p = 0.57）及30天内再入院率（ERAS前组为20.7% vs ERAS组为17.3%；p = 0.40）均无差异。自2014年实施以来，ERAS路径的依从性保持稳定，中位数为70%（IQR 65% - 75%）。
接受ERAS路径开放性根治性子宫切除术的患者住院时间更短，且未增加总体并发症或再入院率。
