Swerdloff Daniel, Podolski Demitri, Smith Rachel E, Lee Donald, Swerdloff Michael, Feustel Paul J, Williams Kanwaldeep K, Galay Igor, Afroze Farzana, Kaufman Ronald P, Kogan Barry A
Division of Urology, Department of Surgery, Albany Medical Center, Albany, New York.
Department of Anesthesiology, Albany Medical Center, Albany, New York.
Urol Pract. 2020 Jan;7(1):41-46. doi: 10.1097/UPJ.0000000000000070. Epub 2019 May 21.
Enhanced recovery after surgery pathways are multidisciplinary, multimodal approaches to perioperative care that aim to improve patient outcomes. In this study we evaluate the outcomes of the implementation of enhanced recovery after surgery pathways in patients undergoing nephrectomy.
A retrospective analysis was performed comparing patients who underwent renal surgery before vs after implementation of enhanced recovery after surgery pathways. Data analyzed included length of stay, opioid use, cost and complications before and after the enhanced recovery after surgery protocol was implemented.
There were 76 patients in the pre-enhanced recovery after surgery group and 42 in the enhanced recovery after surgery group. Median length of stay in the pre-enhanced vs enhanced recovery after surgery group was 3 days vs 2 days (p <0.005). For open procedures median length of stay was 5 days vs 2 days (p <0.001). For robotic procedures median length of stay decreased from 3 days to 2 days (p <0.001). Median length of stay was lower in the enhanced recovery after surgery group independent of age, sex, body mass index, American Society of Anesthesiologists® score and anesthesia time. Median total morphine equivalents decreased from 4 mg to 0 mg (p <0.005) while median total oxycodone went from 52.5 mg to 8.75 mg (p <0.005). Direct cost per patient decreased from $13,036 pre-enhanced recovery after surgery to $9,779 (p <0.001) in the enhanced recovery after surgery group, representing a 25% decrease. The 30-day readmission rates did not change after implementation of enhanced recovery after surgery protocol, and a National Surgical Quality Improvement Program sampling showed similar rates in complications, although this was not amenable to statistical analysis.
Enhanced recovery after surgery improves the care of patients undergoing renal surgery. It significantly decreased length of stay, opioid use and hospital cost without having a significant effect on complications.
术后加速康复路径是围手术期护理的多学科、多模式方法，旨在改善患者预后。在本研究中，我们评估了在接受肾切除术的患者中实施术后加速康复路径的效果。
进行回顾性分析，比较在实施术后加速康复路径之前和之后接受肾脏手术的患者。分析的数据包括术后加速康复方案实施前后的住院时间、阿片类药物使用情况、费用和并发症。
术后加速康复前组有76例患者，术后加速康复组有42例患者。术后加速康复前组与术后加速康复组的中位住院时间分别为3天和2天（p<0.005）。对于开放手术，中位住院时间分别为5天和2天（p<0.001）。对于机器人手术，中位住院时间从3天降至2天（p<0.001）。术后加速康复组的中位住院时间较低，与年龄、性别、体重指数、美国麻醉医师协会评分和麻醉时间无关。吗啡当量中位数从4mg降至0mg（p<0.005），而羟考酮总量中位数从52.5mg降至8.75mg（p<0.005）。每位患者的直接费用从术后加速康复前的13,036美元降至术后加速康复组的9,779美元（p<0.001），降幅为25%。实施术后加速康复方案后，30天再入院率没有变化，国家外科质量改进计划抽样显示并发症发生率相似，尽管这无法进行统计分析。
术后加速康复改善了接受肾脏手术患者的护理。它显著缩短了住院时间、减少了阿片类药物使用和医院费用，且对并发症没有显著影响。
