General and Emergency Surgery Dept, University of Milano-Bicocca, School of Medicine and Surgery, Monza, Italy.
Genereal Surgery, University of Verona, Italy.
Eur J Surg Oncol. 2024 May;50(5):106650. doi: 10.1016/j.ejso.2022.06.033. Epub 2022 Jul 1.
Early non compliance to postoperative ERAS pathway has been reported in 20-30% of patients who underwent elective colon surgery. The aim of the present study is to investigate the possible relationship between early non compliance and postoperative complications.
We reviewed a prospective database including 1391 consecutively collected patients undergoing elective colon surgery in 22 Italian hospitals between January 2017 and June 2020. Early compliance to ERAS protocol was assessed on postoperative day (POD) 2. Failure of oral feeding, urinary catheter removal, intravenous fluids stop, and adequate mobilization were indicators of non compliance. Postoperative follow-up was carried out for 30 days after hospital discharge. The association among early postoperative ERAS compliance and the occurrence of complications was assessed with uni- and multivariate analysis.
A total of 1089 (78.3%) patients had malignancy and minimally invasive surgery was successfully performed in 1174 (84.3%) patients. Postoperative morbidity occurred in 403 (29.0%) patients. At multivariate analysis, male gender, open surgery, and each of the four non compliance indicators on POD 2 were significantly associated to postoperative complications. Morbidity progressively increased from 16.8% in patients with full compliance to ERAS protocol to 47.2% in patients with two non compliance indicators and 69.2% in patients with all four indicators (p < 0.001).
Early non compliance to ERAS protocol was significantly associated with postoperative morbidity.
据报道，接受择期结肠手术的患者中有 20-30%在术后早期不遵守加速康复外科（ERAS）路径。本研究旨在探讨早期不遵守与术后并发症之间的可能关系。
我们回顾了一项前瞻性数据库，其中包括 2017 年 1 月至 2020 年 6 月期间在 22 家意大利医院接受择期结肠手术的 1391 例连续收集的患者。术后第 2 天（POD2）评估 ERAS 方案的早期依从性。口服喂养失败、导尿管拔除、静脉输液停止和适当的活动是不遵守的指标。出院后进行 30 天的术后随访。使用单因素和多因素分析评估早期术后 ERAS 依从性与并发症发生之间的关联。
共有 1089 例（78.3%）患者患有恶性肿瘤，1174 例（84.3%）患者成功实施了微创手术。403 例（29.0%）患者发生术后并发症。多因素分析显示，男性、开放手术以及 POD2 时的四项不遵守指标中的每一项均与术后并发症显著相关。从完全遵守 ERAS 方案的患者（16.8%）到有两个不遵守指标的患者（47.2%）再到有四个不遵守指标的患者（69.2%），发病率逐渐增加（p<0.001）。
早期不遵守 ERAS 方案与术后发病率显著相关。
