Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore.
Department of Colorectal Surgery, Singapore General Hospital, Singapore City, Singapore.
Int J Colorectal Dis. 2023 May 1;38(1):110. doi: 10.1007/s00384-023-04408-7.
Enhanced recovery after surgery (ERAS) programs are well-established, resulting in improved outcomes and shorter length of hospital stay (LOS). Same-day discharge (SDD), or "hyper-ERAS", is a natural progression of ERAS. This systematic review aims to compare the safety and efficacy of SDD against conventional ERAS in colorectal surgery.
The protocol was prospectively registered in PROSPERO (394793). A systematic search was performed in major databases to identify relevant articles, and a narrative systematic review was performed. Primary outcomes were readmission rates and length of hospital stay (LOS). Secondary outcomes were operative time and blood loss, postoperative pain, morbidity, nausea or vomiting, and patient satisfaction. Risks of bias was assessed using the ROBINS-I tool.
Thirteen studies were included, with five single-arm and eight comparative studies, of which one was a randomised controlled trial. This comprised a total of 38,854 patients (SDD: 1622; ERAS: 37,232). Of the 1622 patients on the SDD pathway, 1590 patients (98%) were successfully discharged within 24 h of surgery. While most studies had an overall low risk of bias, there was considerable variability in inclusion criteria, types of surgery or anaesthesia, and discharge criteria. SDD resulted in a significantly reduced postoperative LOS, without increasing risk of 30-day readmission. Intraoperative blood loss and postoperative morbidity rates were comparable between both groups. Operative duration was shorter in the SDD group. Patient-reported satisfaction was high in the SDD cohort.
SDD protocols appear to be safe and feasible in selected patients undergoing major colorectal operations. Randomised controlled trials are necessary to further substantiate these findings.
手术后加速康复（ERAS）方案已经成熟，可改善手术结果并缩短住院时间（LOS）。当日出院（SDD）或“超级 ERAS”是 ERAS 的自然发展。本系统评价旨在比较 SDD 与结直肠手术中常规 ERAS 的安全性和疗效。
该方案已在 PROSPERO（394793）中前瞻性注册。在主要数据库中进行了系统检索，以确定相关文章，并进行了叙述性系统评价。主要结局是再入院率和住院时间（LOS）。次要结局是手术时间和失血量、术后疼痛、发病率、恶心或呕吐以及患者满意度。使用 ROBINS-I 工具评估偏倚风险。
纳入了 13 项研究，其中 5 项为单臂研究，8 项为对照研究，其中 1 项为随机对照试验。这总共包括 38854 名患者（SDD：1622；ERAS：37232）。在 SDD 路径上的 1622 名患者中，有 1590 名患者（98%）在手术后 24 小时内成功出院。虽然大多数研究的总体偏倚风险较低，但纳入标准、手术或麻醉类型以及出院标准存在很大差异。SDD 可显著缩短术后 LOS，而不会增加 30 天再入院的风险。两组间术中失血量和术后发病率相当。SDD 组的手术时间更短。SDD 组患者报告的满意度较高。
在选择接受大型结直肠手术的患者中，SDD 方案似乎是安全可行的。需要随机对照试验来进一步证实这些发现。
