加速康复外科（ERAS）在城市妇科手术患者群体中的实施。
ERAS implementation in an urban patient population undergoing gynecologic surgery.
作者信息
Brown Morgan L, Simpson Vidda, Clark Annabelle B, Matossian Margarite D, Holman Stacey L, Jernigan Amelia Marie, Scheib Stacey A, Shank Jessica, Key Alison, Chapple Andrew G, Kelly Elizabeth, Nair Navya
机构信息
Department of Obstetrics and Gynecology, LSU School of Medicine, 1542 Tulane Avenue, Room 519, New Orleans, LA 70112, USA; Department of Surgery, LSU School o Medicine, 1542 Tulane Avenue, New Orleans, LA 70112, USA.
Department of Obstetrics and Gynecology, Tulane University, 1430 Tulane Ave #4500, New Orleans, LA 70112, USA; Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta University 14 Medical Center, Augusta, GA 30912, USA.
出版信息
Best Pract Res Clin Obstet Gynaecol. 2022 Dec;85(Pt B):1-11. doi: 10.1016/j.bpobgyn.2022.07.009. Epub 2022 Aug 7.
BACKGROUND
Enhanced recovery after surgery (ERAS) protocols improve outcomes. We investigated ERAS implementation in a population with comorbid conditions, inadequate insurance, and barriers to healthcare undergoing gynecologic surgery.
OBJECTIVE
To investigate ERAS implementation in publicly insured/uninsured patients undergoing gynecologic surgery on hospital length of stay (LOS), 30-day hospital readmission rates, opioid administration, and pain scores.
STUDY DESIGN
Data were obtained pre- and post-ERAS implementation. Patients undergoing gynecologic surgery with private insurance, public insurance, and uninsured were included (N = 589). LOS, readmission <30 days, opioid administration, and pain scores were assessed.
RESULTS
Implementation of ERAS led to shorter LOS 1.75 vs. 1.49 days (p = 0.008). Average pain scores decreased from 3.07 pre-ERAS vs. 2.47 post-ERAS (p = <0.001). Opioid use decreased for ERAS patients (67.22 vs. 33.18, p = <0.001). Hospital readmission rates were unchanged from 8.2% pre-ERAS vs. 10.3% post-ERAS (p = 0.392).
CONCLUSIONS
ERAS decreased pain scores and opioid use without increasing LOS or readmissions.
背景
术后加速康复（ERAS）方案可改善治疗效果。我们调查了ERAS方案在患有合并症、保险不足且就医存在障碍的妇科手术人群中的实施情况。
目的
调查ERAS方案在接受妇科手术的公共保险/无保险患者中对住院时间（LOS）、30天再入院率、阿片类药物使用和疼痛评分的影响。
研究设计
在ERAS方案实施前后获取数据。纳入接受妇科手术的有私人保险、公共保险和无保险的患者（N = 589）。评估住院时间、30天内再入院情况、阿片类药物使用和疼痛评分。
结果
ERAS方案的实施使住院时间缩短，从1.75天降至1.49天（p = 0.008）。平均疼痛评分从ERAS实施前的3.07降至实施后的2.47（p = <0.001）。ERAS患者的阿片类药物使用减少（67.22对33.18，p = <0.001）。医院再入院率从ERAS实施前的8.2%降至实施后的10.3%，无显著变化（p = 0.392）。
结论
ERAS降低了疼痛评分和阿片类药物使用，且未增加住院时间或再入院率。
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