Chiewhatpong Phasawee, Charoenkwan Kittipat, Smithiseth Kannika, Lapisatepun Warangkana, Lapisatepun Panuwat, Phimphilai Mattabhorn, Muangmool Tanarat, Cheewakriangkrai Chalong, Suprasert Prapaporn, Srisomboon Jatupol
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Int J Gynaecol Obstet. 2022 Nov;159(2):568-576. doi: 10.1002/ijgo.14211. Epub 2022 Apr 21.
To examine the effectiveness of applying the recommended enhanced recovery after surgery (ERAS) protocol compared with our usual care in women with gynecologic malignancy undergoing elective laparotomy.
From June 2020 to May 2021, 93 women with gynecologic cancers (cervix, endometrium, and ovary) undergoing elective laparotomy at our institution were randomly assigned into an intervention group (ERAS protocol, 46 women) or control group (usual care, 47 women). For the intervention group, each woman was brought through the pre-specified ERAS protocol starting from preoperative counseling to postoperative management. For the control group, participants underwent routine standard care. The primary outcomes were length of hospital stay and postoperative pain.
The intervention group demonstrated shorter hospital stay by 20 h (47.48 h vs 67.17 h, P = 0.02) with lower postoperative pain score at postoperative day 0 (1.58 vs 4.00, P < 0.01) and day 1 (1.00 vs 2.67, P < 0.01) while having decreased opioid consumption (P < 0.01). The intervention group also had faster recovery of gastrointestinal function. Overall, good compliance to most of the ERAS pathway domains was obtained.
The ERAS protocol demonstrates benefits on shortening hospital stay, reducing pain, and bowel function recovery without increasing complications in our population.
The present study was registered at clinicaltrials.gov (NCT04201626) on December 3, 2019. Initial participant enrollment began on June 1, 2020. Access through URL of the registration site: https://clinicaltrials.gov/ct2/show/NCT04201626?cond=ERAS&cntry=TH&draw=2&rank=3.
探讨在接受择期剖腹手术的妇科恶性肿瘤女性患者中，应用推荐的术后加速康复（ERAS）方案相较于常规护理的有效性。
2020年6月至2021年5月，在我院接受择期剖腹手术的93例妇科癌症（子宫颈、子宫内膜和卵巢）患者被随机分为干预组（ERAS方案，46例）和对照组（常规护理，47例）。干预组的每位女性从术前咨询到术后管理均按照预先制定的ERAS方案进行。对照组的参与者接受常规标准护理。主要结局指标为住院时间和术后疼痛。
干预组的住院时间缩短了20小时（47.48小时对67.17小时，P = 0.02），术后第0天（1.58对4.00，P < 0.01）和第1天（1.00对2.67，P < 0.01）的术后疼痛评分更低，同时阿片类药物消耗量减少（P < 0.01）。干预组的胃肠功能恢复也更快。总体而言，对大多数ERAS路径领域的依从性良好。
在我们的研究人群中，ERAS方案在缩短住院时间、减轻疼痛和促进肠功能恢复方面具有益处，且未增加并发症。
本研究于2019年12月3日在clinicaltrials.gov（NCT04201626）注册。初始参与者招募于2020年6月1日开始。通过注册网站的网址访问：https://clinicaltrials.gov/ct2/show/NCT04201626?cond=ERAS&cntry=TH&draw=2&rank=3 。
