Carolinas Center for Surgical Outcomes Science, Department of Surgery, 1540 Garden Terrace, Suite 306, Atrium Health, Charlotte, NC, 28203, USA.
Scientific and Medical Affairs, Abbott Laboratories, 2900 Easton Square Place, Columbus, OH, 43219, USA.
Clin Nutr ESPEN. 2023 Jun;55:109-115. doi: 10.1016/j.clnesp.2023.03.001. Epub 2023 Mar 11.
Enhanced recovery after surgery (ERAS®) pathways aim to improve patient outcomes by applying multimodal practices before, during, and after operative procedures. Compared with standard care before ERAS, we investigated whether compliance to ERAS guidelines for nutritional care, preoperative oral carbohydrate loading and postoperative oral nutrition, was associated with a decrease in hospital length of stay (LOS) after pancreaticoduodenectomy, distal pancreatectomy, hepatectomy, radical cystectomy, and head and neck tumor resection with reconstruction.
Compliance to ERAS nutrition recommendations was evaluated. Post-ERAS cohort was retrospectively analyzed. Pre-ERAS cohort consisted of case matched patients one year before ERAS: age more than or less than 65 years, body mass index (BMI) more than greater than or less than 30 kg/m, diabetes mellitus, sex, and procedure. Each cohort consisted of 297 patients. Binary linear regressions evaluated the incremental effect of postoperative nutrition timing and preoperative carbohydrate loading on LOS. Multivariate regressions adjusted for postoperative complications.
Compliance with preoperative carbohydrate loading for the post-ERAS cohort was 81.7%. Mean hospital LOS was significantly shorter for the post-ERAS cohort compared with pre-ERAS cohort (8.3 vs 10.0 days, p < 0.001). By procedure, LOS was significantly shorter for patients undergoing pancreaticoduodenectomy (p = 0.003), distal pancreatectomy (p = 0.014), and head and neck procedures (p = 0.024). Early postoperative oral nutrition was associated with a 3.75-day shorter LOS (p < 0.001); no nutrition was associated with a 3.29-day longer LOS (p < 0.001).
Compliance with ERAS protocols for specific nutritional care practices was associated with a statistically significant decrease in LOS without subsequent increases in 30-day readmission rates and positive financial impact. These findings suggest that ERAS guidelines for perioperative nutrition are a strategic pathway to improved patient recovery and value-based care in surgery.
加速康复外科（ERAS®）路径旨在通过在手术前后应用多模式实践来改善患者的预后。与 ERAS 之前的标准护理相比，我们研究了在接受胰腺十二指肠切除术、胰体尾切除术、肝切除术、根治性膀胱切除术和头颈部肿瘤切除与重建后，遵守 ERAS 营养指南（包括术前口服碳水化合物负荷和术后口服营养）是否与住院时间（ LOS ）的缩短相关。
评估对 ERAS 营养建议的遵守情况。回顾性分析接受 ERAS 治疗的患者。ERAS 后队列包括一年前 ERAS 时进行病例匹配的患者：年龄大于或小于 65 岁，体重指数（BMI）大于或小于 30kg/m2，糖尿病，性别和手术。每个队列包括 297 例患者。二元线性回归评估术后营养时机和术前碳水化合物负荷对 LOS 的增量影响。多变量回归调整了术后并发症。
ERAS 后队列的术前碳水化合物负荷遵守率为 81.7％。与 ERAS 前队列相比，ERAS 后队列的住院时间明显缩短（8.3 天 vs 10.0 天，p <0.001）。按手术分类，胰十二指肠切除术（p = 0.003）、胰体尾切除术（p = 0.014）和头颈部手术（p = 0.024）患者的 LOS 明显缩短。早期术后口服营养与 LOS 缩短 3.75 天相关（p <0.001）；无营养与 LOS 延长 3.29 天相关（p <0.001）。
遵守 ERAS 特定营养护理实践的方案与 LOS 呈统计学显著降低相关，而 30 天再入院率没有增加，并且具有积极的财务影响。这些发现表明，ERAS 围手术期营养指南是改善患者康复和手术价值为基础的护理的战略途径。
