Dong Xuezhi, Burton Brittany N, Little Christopher, Woodhouse Logan, Grogan Tristan, Blumberg Jeremy M, Gritsch Hans A, Rahman Siamak
Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 3325, Los Angeles, CA 90095, USA; Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 3325, Los Angeles, CA 90095, USA.
J Clin Anesth. 2022 Aug;79:110751. doi: 10.1016/j.jclinane.2022.110751. Epub 2022 Mar 22.
The primary aim of this study is to understand how intraoperative medication administration patterns change in response to ERAS® protocol implementation for patients who underwent laparoscopic donor nephrectomy.
Single-center, retrospective analysis of laparoscopic donor nephrectomy patients.
Large tertiary academic medical center.
We divided all cases of laparoscopic donor nephrectomies (n = 929) over seven years into three approximately equal time periods: Pre-ERAS 1 (n = 317), Pre-ERAS 2 (n = 297) and Post-ERAS (n = 315).
We examined patient demographics, intraoperative opioid and non-opioid pain adjuvant administration, Post Anesthesia Recovery Unit (PACU) pain scores and opioid use as well as PACU and hospital lengths of stay (LOS).
Segmented regression analysis of interrupted time series was utilized to evaluate the association of ERAS protocol implementation with the amount of intraoperative opioid and non-opioid pain adjuvant use. In adherence to our institutional ERAS protocol, there was a significant reduction in intraoperative fentanyl use after ERAS protocol of -70.2μg (95% CI -106.0, -34.2, p < 0.001) and a significant increase in intraoperative hydromorphone use of 0.47 mg (95% CI 0.284, 0.655, p < 0.001). However, in contrary to our ERAS protocol, we found no significant change in odds of receiving IV acetaminophen OR 1.31 (95% CI 0.450, 3.76, p = 0.613) or IV ketorolac OR 1.65 (95% CI 0.804, 3.41, p = 0.172) after ERAS protocol implementation. We found a significant reduction in PACU opioid use of -9.68 Morphine Milligram Equivalents (MME) (95% CI -17.1, -2.31, p = 0.010) but no significant change in PACU initial pain score, PACU LOS and hospital LOS.
We examined intraoperative practice pattern changes by anesthesiologists in response to ERAS protocol implementation for laparoscopic donor nephrectomies. Our results suggest that there was a variable uptake of recommendations from ERAS protocol. While ERAS protocols are often studied as a bundle of best practice recommendations, understanding the variability of provider adherence represents an important future research direction for the ERAS initiative.
本研究的主要目的是了解接受腹腔镜供肾切除术的患者在实施加速康复外科（ERAS®）方案后术中用药模式如何变化。
对腹腔镜供肾切除术患者进行单中心回顾性分析。
大型三级学术医疗中心。
我们将七年内所有腹腔镜供肾切除术病例（n = 929）分为三个大致相等的时间段：ERAS前1期（n = 317）、ERAS前2期（n = 297）和ERAS后（n = 315）。
我们检查了患者的人口统计学数据、术中阿片类药物和非阿片类疼痛辅助药物的使用情况、麻醉后恢复室（PACU）疼痛评分和阿片类药物使用情况以及PACU和住院时间（LOS）。
采用中断时间序列的分段回归分析来评估ERAS方案实施与术中阿片类药物和非阿片类疼痛辅助药物使用量之间的关联。按照我们机构的ERAS方案，ERAS方案实施后术中芬太尼使用量显著减少了-70.2μg（95%可信区间-106.0，-34.2，p < 0.001），术中氢吗啡酮使用量显著增加了0.47mg（95%可信区间0.284，0.655，p < 0.001）。然而，与我们的ERAS方案相反，我们发现ERAS方案实施后接受静脉注射对乙酰氨基酚的几率（比值比1.31，95%可信区间0.450，3.76，p = 0.613）或静脉注射酮咯酸的几率（比值比1.65，95%可信区间0.804，3.41，p = 0.172）没有显著变化。我们发现PACU阿片类药物使用量显著减少了-9.68吗啡毫克当量（MME）（95%可信区间-17.1，-2.31，p = 0.010），但PACU初始疼痛评分、PACU住院时间和住院时间没有显著变化。
我们研究了麻醉医生在腹腔镜供肾切除术实施ERAS方案后术中实践模式的变化。我们的结果表明，ERAS方案的建议接受程度存在差异。虽然ERAS方案通常作为一系列最佳实践建议进行研究，但了解医疗服务提供者依从性的差异是ERAS倡议未来一个重要的研究方向。
