漏斗胸手术五点强化康复方案的制定。
Development of a five point enhanced recovery protocol for pectus excavatum surgery.
作者信息
Downing Lynsey, Ramjist Joshua K, Tyrrell Aidan, Tsang Maisie, Isaac Lisa, Fecteau Annie
机构信息
Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, ON, Canada.
Department of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada; Department of Surgery, Temerty Faculty of Medicine, University of Toronto, ON, Canada.
出版信息
J Pediatr Surg. 2023 May;58(5):822-827. doi: 10.1016/j.jpedsurg.2023.01.028. Epub 2023 Jan 18.
PURPOSE
We implemented and evaluated an Enhanced Recovery after Surgery (ERAS) protocol for Nuss procedures consisting of patient education, bowel management, pre/post-operative transitional pain service involvement, serratus anterior plane blocks and intercostal nerve cryoablation.
METHODS
A 5-point ERAS protocol was implemented using multiple plan-do-study-act (PDSA) cycles. Data was collected prospectively for patients in the full ERAS protocol and retrospectively for previous patients. The primary outcome was length of stay (LOS). Secondary outcomes were opioid consumption, pain scores, protocol compliance and patient satisfaction. The impact of PDSA cycles and the ERAS protocol was quantified using statistical process control charts and Mann Whitney U test.
RESULTS
A total of 53 patients were identified, 13 within the ERAS protocol and 40 prior to introduction. There was no difference in age, sex, or Haller index between the two cohorts. The median LOS was decreased by 3 days in the ERAS cohort (P = 0.00001). There was decreased opioid consumption on post-operative day 1 (1.47 vs 1.96 MME/kg, p = 0.009) and overall (3.12 vs 6.35 MME/kg, p = 0.0042) in the ERAS cohort. Median pain scores did not differ between cohorts. ERAS bundle element compliance was: education 92%, bowel management 100%, transitional pain involvement 100%, serratus block 100% and cryoablation 100%. The 1-month survey revealed that 92% of patients were satisfied with their experience.
CONCLUSION
Our results demonstrate significant reduction in LOS and a trend to decreasing opioid consumption in hospital following ERAS protocol implementation and support the further application of ERAS protocols in pediatrics.
LEVEL OF EVIDENCE
III - Retrospective comparative study.
目的
我们实施并评估了一种用于努氏手术的加速康复外科（ERAS）方案，该方案包括患者教育、肠道管理、术前/术后过渡性疼痛服务参与、前锯肌平面阻滞和肋间神经冷冻消融。
方法
使用多个计划-实施-研究-改进（PDSA）循环实施了一个5点ERAS方案。前瞻性收集接受完整ERAS方案患者的数据，回顾性收集之前患者的数据。主要结局是住院时间（LOS）。次要结局是阿片类药物消耗量、疼痛评分、方案依从性和患者满意度。使用统计过程控制图和曼-惠特尼U检验对PDSA循环和ERAS方案的影响进行量化。
结果
共确定了53例患者，其中13例在ERAS方案组，40例在引入该方案之前。两组在年龄、性别或哈勒指数方面无差异。ERAS组的中位住院时间减少了3天（P = 0.00001）。ERAS组术后第1天的阿片类药物消耗量减少（1.47 vs 1.96 MME/kg，p = 0.009），总体减少（3.12 vs 6.35 MME/kg，p = 0.0042）。两组的中位疼痛评分无差异。ERAS方案要素的依从性为：教育92%，肠道管理100%，过渡性疼痛参与100%，前锯肌阻滞100%，冷冻消融100%。1个月的调查显示，92%的患者对其经历感到满意。
结论
我们的结果表明，实施ERAS方案后住院时间显著缩短，且住院期间阿片类药物消耗量有减少趋势，支持ERAS方案在儿科的进一步应用。
证据级别
III - 回顾性比较研究。
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