Sant'Eugenio Hospital, Piazzale dell'Umanesimo, 10, 00144, Rome, Italy.
San Giovanni Addolorata Hospital, Rome, Italy.
World J Surg. 2022 Oct;46(10):2288-2296. doi: 10.1007/s00268-022-06694-8. Epub 2022 Aug 16.
The aim of this study was to investigate how the COVID-19 pandemic influenced ERAS program application in colorectal surgery across hospitals in the Lazio region (central district in Italy) participating in the "Lazio Network" project.
A multi-institutional database was constructed. All patients included in this study underwent elective colorectal surgery for both malignant and benign disease between January 2019 and December 2020. Emergency procedures were excluded. The population was divided into 2 groups: a pre-COVID-19 group (PG) of patients operated on between February and December 2019 and a COVID-19 group (CG) of patients operated on between February and December 2020, during the first 2 waves of the pandemic in Italy.
The groups included 622 patients in the PG and 615 in the CG treated in 8 hospitals of the network. The mean number of items applied was higher in the PG (65.6% vs. 56.6%, p < 0.001) in terms of preoperative items (64.2% vs. 50.7%, p < 0.001), intraoperative items (65.0% vs. 53.3%, p < 0.001), and postoperative items (68.8% vs. 63.2%, p < 0.001). Postoperative recovery was faster in the PG, with a shorter time to first flatus, first stool, autonomous mobilization and discharge (6.82 days vs. 7.43 days, p = 0.021). Postoperative complications, mortality and reoperations were similar among the groups.
The COVID-19 pandemic had a negative impact on the application of ERAS in the centers of the "Lazio Network" study group, with a reduction in adherence to the ERAS protocol in terms of preoperative, intraoperative and postoperative items. In addition, in the CG, the patients had worse postoperative outcomes with respect to recovery and discharge.
本研究旨在调查 COVID-19 大流行如何影响参与“拉齐奥网络”项目的拉齐奥地区（意大利中部地区）医院的结直肠手术 ERAS 项目的应用。
构建了一个多机构数据库。本研究纳入的所有患者均因良恶性疾病于 2019 年 1 月至 2020 年 12 月期间接受择期结直肠手术。排除急诊手术。人群分为 2 组：2019 年 2 月至 12 月期间手术的 COVID-19 前（PG）组和 2020 年 2 月至 12 月期间手术的 COVID-19（CG）组，意大利大流行的前 2 波。
PG 组纳入 8 家网络医院的 622 例患者，CG 组纳入 615 例患者。PG 组应用项目的平均数量较高（65.6%对 56.6%，p<0.001），包括术前项目（64.2%对 50.7%，p<0.001）、术中项目（65.0%对 53.3%，p<0.001）和术后项目（68.8%对 63.2%，p<0.001）。PG 组术后恢复更快，首次排气、首次排便、自主活动和出院时间更短（6.82 天对 7.43 天，p=0.021）。术后并发症、死亡率和再次手术率在两组之间相似。
COVID-19 大流行对研究组“拉齐奥网络”中心 ERAS 的应用产生了负面影响，术前、术中和术后项目的 ERAS 方案依从性降低。此外，CG 组患者的术后恢复和出院情况较差。
