标准化加速康复外科（ERAS）方案对微创心脏瓣膜手术患者的影响。
The impact of a standardized Enhanced Recovery After Surgery (ERAS) protocol in patients undergoing minimally invasive heart valve surgery.
机构信息
Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Hamburg, Germany.
Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
出版信息
PLoS One. 2023 Mar 24;18(3):e0283652. doi: 10.1371/journal.pone.0283652. eCollection 2023.
BACKGROUND
An enhanced recovery after surgery (ERAS) protocol is a multimodal and multi-professional strategy aiming to accelerate postoperative convalescence. Pre-, intra- and postoperative measures might furthermore reduce postoperative complications and hospital length of stay (LOS) in a cost-effective way. We hypothesized that our unique ERAS protocol leads to shorter stays on the intensive care unit (ICU) and a quicker discharge without compromising patient safety.
METHODS
This retrospective single center cohort study compares data of n = 101 patients undergoing minimally invasive heart valve surgery receiving a comprehensive ERAS protocol and n = 111 patients receiving routine care. Hierarchically ordered primary endpoints are postoperative hospital length of stay (LOS), postoperative complications and ICU LOS.
RESULTS
Patients risk profiles and disease characteristics were comparably similar. Age was relevantly different between the groups (56 (17) vs. 57.5 (13) years, p = 0.015) and therefore adjusted. Postoperative LOS was significantly lower in ERAS group (6 (2) days vs. 7 (1) days, p<0.01). No significant differences, neither in intra- or postoperative complications, nor in the number of readmissions (15.8% vs. 9.9%, p = 0.196) were shown. In hospital LOS (7 (3) days vs. 8 (4) days, p<0.01) and ICU LOS (18.5 (6) hours vs. 26.5 (29) hours, p<0.01) a considerable difference was shown.
CONCLUSION
The ERAS protocol for minimally invasive heart valve surgery is safe and feasible in an elective setting and leads to a quicker hospital discharge without compromising patient safety. However, further investigation in a randomized setting is needed.
背景
术后加速康复（ERAS）方案是一种多模式、多专业的策略，旨在加速术后康复。术前、术中和术后措施还可以以具有成本效益的方式减少术后并发症和住院时间（LOS）。我们假设我们独特的 ERAS 方案可以缩短重症监护病房（ICU）的停留时间，并在不影响患者安全的情况下更快地出院。
方法
这项回顾性单中心队列研究比较了接受微创心脏瓣膜手术的 101 例患者（接受全面 ERAS 方案）和 111 例接受常规护理的患者的数据。按层次顺序排列的主要终点是术后住院时间（LOS）、术后并发症和 ICU LOS。
结果
患者的风险状况和疾病特征相似。两组之间的年龄差异具有统计学意义（56（17）岁 vs. 57.5（13）岁，p=0.015），因此进行了调整。ERAS 组的术后 LOS 明显较低（6（2）天 vs. 7（1）天，p<0.01）。在术中或术后并发症以及再入院人数方面（15.8% vs. 9.9%，p=0.196）没有显示出显著差异。在住院 LOS（7（3）天 vs. 8（4）天，p<0.01）和 ICU LOS（18.5（6）小时 vs. 26.5（29）小时，p<0.01）方面，差异显著。
结论
微创心脏瓣膜手术的 ERAS 方案在择期手术中是安全可行的，可加快患者出院，同时不影响患者安全。然而，需要在随机对照研究中进一步研究。
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