Park Sang Hyeok, Kang So Hyun, Lee Sang Jun, Won Yongjoon, Park Young Suk, Ahn Sang-Hoon, Suh Yun-Suhk, Park Do Joong, Kim Hyung-Ho
Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
J Minim Invasive Surg. 2021 Dec 15;24(4):184-190. doi: 10.7602/jmis.2021.24.4.184.
The Enhanced Recovery After Surgery (ERAS) protocol enhances recovery rate after laparoscopic distal gastrectomy (LDG). An ERAS protocol has been applied to most patients who underwent LDG at our center. In this study, we determined the actual compliance rate of the ERAS protocol and analyzed the risk factors for noncompliance.
Medical records of 1,013 patients who underwent LDG from March 2016 to December 2017 were reviewed retrospectively. The compliance group (A) included 327 patients who were discharged within four days postoperatively. The noncompliance group (B) comprised 686 patients who were not discharged within four days postoperatively.
The compliance rate of the ERAS protocol was 32.3%. Potential compliance rate was 53.2%. Most common reasons for noncompliance were fever (n = 115) and ileus (n = 111). The 30-day emergency room visit rate was significantly lower in group A than that in group B ( = 0.006). Median age, American Society of Anesthesiologists (ASA) physical status classification, operation time, and pathologic stage were significantly higher in group B than those in group A ( < 0.001, < 0.001, = 0.005, and < 0.001, respectively). Risk factors for noncompliance were ASA classification of ≥III (odds ratio [OR], 2.251; = 0.007), age of ≥70 years (OR, 1.572; = 0.004), operation time of ≥180 minutes (OR, 1.475; = 0.003), and pathologic stage of ≥III (OR, 2.224; < 0.001).
The current ERAS protocols should be applied to patients without risk factors.
术后加速康复（ERAS）方案可提高腹腔镜远端胃癌切除术（LDG）后的恢复率。我们中心大多数接受LDG的患者都采用了ERAS方案。在本研究中，我们确定了ERAS方案的实际依从率，并分析了不依从的危险因素。
回顾性分析2016年3月至2017年12月期间接受LDG的1013例患者的病历。依从组（A组）包括327例术后4天内出院的患者。不依从组（B组）包括686例术后4天内未出院的患者。
ERAS方案的依从率为32.3%。潜在依从率为53.2%。不依从的最常见原因是发热（n = 115）和肠梗阻（n = 111）。A组的30天急诊就诊率显著低于B组（ = 0.006）。B组的中位年龄、美国麻醉医师协会（ASA）身体状况分级、手术时间和病理分期均显著高于A组（分别为 < 0.001、< 0.001、 = 0.005和 < 0.001）。不依从的危险因素包括ASA分级≥III（比值比[OR]，2.251； = 0.007）、年龄≥70岁（OR，1.572； = 0.004）、手术时间≥180分钟（OR，1.475； = 0.003）和病理分期≥III（OR，2.224； < 0.001）。
当前的ERAS方案应应用于无危险因素的患者。
