Department of Gastroenterological Surgery, Ikeda City Hospital, Ikeda, Japan.
Division of Health Sciences, Graduate School of Medicine, Osaka University, Suita, Japan.
Surg Today. 2023 Feb;53(2):242-251. doi: 10.1007/s00595-022-02568-7. Epub 2022 Aug 7.
To evaluate the efficacy and safety of the enhanced recovery after surgery (ERAS) protocol and quantify the impact of each ERAS item on postoperative outcomes.
We used a generalized linear model to compare 289 colorectal cancer patients treated with the ERAS protocol between June, 2015 and April, 2021, with 99 colorectal cancer patients treated with the conventional colorectal surgery pathway between April, 2014 and June, 2015.
The median length of hospital stay (LOHS) was significantly shorter in the ERAS group, at 9 days (range 3-104 days) vs. 14 days (range 4-44 days) (p < 0.001), but the complication rates (Clavien-Dindo grade 2 or more) were similar (16.6% vs. 22.2%; p = 0.227). However, in the ERAS group, the higher the compliance with ERAS items, the lower the complication rate and LOHS (both p < 0.001). Multiple regression analysis demonstrated that "Discontinuation of continuous intravenous infusion on POD1" and "Avoidance of fluid overload" were significantly associated with the LOHS (p < 0.001 and p = 0.008).
The ERAS protocol is safe and effective for elective colorectal cancer surgery, and compliance with the ERAS protocol contributes to shorter LOHS and fewer complications. Items related to perioperative fluid management had a crucial impact on these outcomes.
评估术后加速康复（ERAS）方案的疗效和安全性，并量化每个 ERAS 项目对术后结果的影响。
我们使用广义线性模型比较了 2015 年 6 月至 2021 年 4 月期间接受 ERAS 方案治疗的 289 例结直肠癌患者与 2014 年 4 月至 2015 年 6 月期间接受常规结直肠手术治疗的 99 例结直肠癌患者的治疗效果。
ERAS 组的中位住院时间（LOHS）明显更短，为 9 天（范围 3-104 天） vs. 14 天（范围 4-44 天）（p<0.001），但并发症发生率（Clavien-Dindo 分级 2 级或更高）相似（16.6% vs. 22.2%；p=0.227）。然而，在 ERAS 组中，ERAS 项目的依从性越高，并发症发生率和 LOHS 越低（均 p<0.001）。多元回归分析表明，“术后第 1 天停止持续静脉输注”和“避免液体超负荷”与 LOHS 显著相关（p<0.001 和 p=0.008）。
ERAS 方案对择期结直肠癌手术是安全有效的，ERAS 方案的依从性有助于缩短 LOHS 和减少并发症。与围手术期液体管理相关的项目对这些结果有重要影响。
