Hayek Judy, Zorrilla-Vaca Andres, Meyer Larissa A, Mena Gabriel, Lasala Javier, Iniesta Maria D, Suki Tina, Huepenbecker Sarah, Cain Katherine, Garcia-Lopez Juan, Ramirez Pedro T
Gynecologic Oncology, SUNY Downstate Medical Center, Brooklyn, New York, USA
Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Int J Gynecol Cancer. 2022 Nov 7;32(11):1443-1449. doi: 10.1136/ijgc-2022-003840.
To evaluate compliance with an Enhanced Recovery After Surgery (ERAS) protocol for open gynecologic surgery at a tertiary center and the relationship between levels of compliance and peri-operative outcomes.
This retrospective cohort study was conducted between November 2014 and December 2020. Two groups were defined based on compliance level (<80% vs ≥80%). The primary outcome was to analyze overall compliance since implementation of the ERAS protocol. The secondary endpoint was to assess the relationship between compliance and 30-day re-admission, length of stay, re-operation, opioid-free rates, and post-operative complications. We also assessed compliance with each ERAS element over three time periods (P1: 2014-2016, P2: 2017-2018, P3: 2019-2020), categorizing patients according to the date of surgery. Values were compared between P1 and P3.
A total of 1879 patients were included. Overall compliance over the period of 6 years was 74% (95% CI 71.9% to 78.2%). Mean overall compliance increased from 69.7% to 75.8% between P1 and P3. Compliance with ERAS ≥80% was associated with lower Clavien-Dindo complication rates (grades III (OR 0.55; 95% CI 0.33 to 0.93) and V (OR 0.08, 95% CI 0.01 to 0.60)), 30-day re-admission rates (OR 0.61; 95% CI 0.43 to 0.88), and length of stay (OR 0.59; 95% CI 0.47 to 0.75). No difference in opioid consumption was seen. Pre-operatively, there was increased adherence to counseling by 50% (p=0.01), optimization by 21% (p=0.02), and carbohydrate loading by 74% (p=0.02). Intra-operatively, compliance with use of short-acting anesthetics increased by 37% (p=0.01) and avoidance of abdominal drainage increased by 7% (p=0.04). Use of goal-directed fluid therapy decreased by 16% (p=0.04). Post-operatively, there was increased compliance with avoiding salt and water overload (8%, p=0.02) and multimodal analgesia (5%, p=0.02).
Over the time period of the study, overall compliance increased from 69.7% to 75.8%. Compliance (≥80%) with ERAS is associated with lower complication rates, fewer 30-day re-admissions, and shorter length of stay without impacting re-operation rates and post-operative opioid use.
评估在一家三级医疗中心，开放性妇科手术患者对加速康复外科（ERAS）方案的依从性，以及依从性水平与围手术期结局之间的关系。
本回顾性队列研究于2014年11月至2020年12月进行。根据依从性水平（<80% 对≥80%）定义两组。主要结局是分析自ERAS方案实施以来的总体依从性。次要终点是评估依从性与30天再入院率、住院时间、再次手术、无阿片类药物使用率和术后并发症之间的关系。我们还评估了三个时间段（P1：2014 - 2016年，P2：2017 - 2018年，P3：2019 - 2020年）内对每个ERAS要素的依从性，根据手术日期对患者进行分类。比较P1和P3之间的值。
共纳入1879例患者。6年期间的总体依从性为74%（95%置信区间71.9%至78.2%）。P1和P3之间的平均总体依从性从69.7%增加到75.8%。依从性≥80%与较低的Clavien - Dindo并发症发生率（III级（比值比0.55；95%置信区间0.33至0.93）和V级（比值比0.08，95%置信区间0.01至0.60））、30天再入院率（比值比0.61；95%置信区间0.43至0.88）和住院时间（比值比0.59；95%置信区间0.47至0.75）相关。阿片类药物使用量无差异。术前，咨询的依从性提高了50%（p = 0.01），优化的依从性提高了21%（p = 0.02），碳水化合物负荷的依从性提高了74%（p = 0.02）。术中，短效麻醉剂使用的依从性提高了37%（p = 0.01），避免腹腔引流的依从性提高了7%（p = 0.04）。目标导向液体治疗的使用减少了16%（p = 0.04）。术后，避免盐和水超负荷的依从性提高了8%（p = 0.02），多模式镇痛的依从性提高了5%（p = 0.02）。
在研究期间，总体依从性从69.7%提高到75.8%。对ERAS的依从性（≥80%）与较低的并发症发生率、较少的30天再入院率和较短的住院时间相关，且不影响再次手术率和术后阿片类药物的使用。
