Department of Anesthesia and Perioperative Medicine, Infanta Leonor University Hospital, Madrid, Spain; Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain; Universidad Complutense de Madrid, Madrid, Spain.
Department of Anesthesia and Perioperative Medicine, Infanta Leonor University Hospital, Madrid, Spain; Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain; Grupo Español de Rehabilitación Multimodal (GERM), Zaragoza, Spain.
J Clin Anesth. 2022 Sep;80:110752. doi: 10.1016/j.jclinane.2022.110752. Epub 2022 Apr 8.
Assess the relationship between the Enhanced Recovery After Surgery (ERAS®) pathway and routine care and 30-day postoperative outcomes.
Prospective cohort study.
European centers (185 hospitals) across 21 countries.
A total of 2841 adult patients undergoing elective colorectal surgery. Each hospital had a 1-month recruitment period between October 2019 and September 2020.
Routine perioperative care.
Twenty-four components of the ERAS pathway were assessed in all patients regardless of whether they were treated in a formal ERAS pathway. A multivariable and multilevel logistic regression model was used to adjust for baseline risk factors, ERAS elements and country-based differences.
A total of 1835 patients (65%) received perioperative care at a self-declared ERAS center, 474 (16.7%) developed moderate-to-severe postoperative complications, and 63 patients died (2.2%). There was no difference in the primary outcome between patients who were or were not treated in self-declared ERAS centers (17.1% vs. 16%; OR 1.00; 95%CI, 0.79-1.27; P = 0.986). Hospital stay was shorter among patients treated in self-declared ERAS centers (6 [5-9] vs. 8 [6-10] days; OR 0.82; 95%CI, 0.78-0.87; P < 0.001). Median adherence to 24 ERAS elements was 57% [48%-65%]. Adherence to ERAS-pathway quartiles (≥65% vs. <48%) suggested that patients with the highest adherence rates experienced a lower risk of moderate-to-severe complications (15.9% vs. 17.8%; OR 0.71; 95%CI, 0.53-0.96; P = 0.027), lower risk of death (0.3% vs. 2.9%; OR 0.10; 95%CI, 0.02-0.42; P = 0.002) and shorter hospital stay (6 [4-8] vs. 7 [5-10] days; OR 0.74; 95%CI, 0.69-0.79; P < 0.001).
Treatment in a self-declared ERAS center does not improve outcome after colorectal surgery. Increased adherence to the ERAS pathway is associated with a significant reduction in overall postoperative complications, lower risk of moderate-to-severe complications, shorter length of hospital stay and lower 30-day mortality.
评估加速康复外科（ERAS®）路径与常规护理以及 30 天术后结局之间的关系。
前瞻性队列研究。
欧洲 21 个国家的 185 家医院。
共纳入 2841 名择期行结直肠手术的成年患者。每家医院在 2019 年 10 月至 2020 年 9 月期间进行为期 1 个月的招募。
常规围手术期护理。
无论患者是否在正式的 ERAS 路径中接受治疗，均评估了 24 项 ERAS 路径组成部分。使用多变量和多水平逻辑回归模型，根据基线风险因素、ERAS 要素和基于国家的差异进行调整。
共有 1835 名患者（65%）在自报的 ERAS 中心接受围手术期治疗，474 名（16.7%）发生中重度术后并发症，63 名患者死亡（2.2%）。在接受或未接受自报 ERAS 中心治疗的患者中，主要结局无差异（17.1%比 16%；OR 1.00；95%CI，0.79-1.27；P=0.986）。在自报 ERAS 中心接受治疗的患者的住院时间更短（6 [5-9] 天比 8 [6-10] 天；OR 0.82；95%CI，0.78-0.87；P<0.001）。24 项 ERAS 要素的中位依从率为 57%[48%-65%]。ERAS 路径四分位数（≥65%与<48%）的依从率表明，依从率最高的患者发生中重度并发症的风险较低（15.9%比 17.8%；OR 0.71；95%CI，0.53-0.96；P=0.027），死亡风险较低（0.3%比 2.9%；OR 0.10；95%CI，0.02-0.42；P=0.002），住院时间更短（6 [4-8] 天比 7 [5-10] 天；OR 0.74；95%CI，0.69-0.79；P<0.001）。
在结直肠手术后，在自报的 ERAS 中心治疗并不能改善结局。增加对 ERAS 路径的依从性与整体术后并发症显著减少、中重度并发症风险降低、住院时间缩短以及 30 天死亡率降低相关。
