手术康复促进可减少安大略省一家小型农村医院结直肠手术后的住院时间。

Enhanced recovery after surgery reduces length of stay after colorectal surgery in a small rural hospital in Ontario.

机构信息

Chief of Surgery, Department of Surgery, Muskoka Algonquin Healthcare, Associate Professor Northern Ontario School of Medicine University, Sudbury, ON, Canada.

Chief of Surgery, Muskoka Algonquin Healthcare, Huntsville, ON, Canada.

出版信息

Can J Rural Med. 2023 Oct-Dec;28(4):179-189. doi: 10.4103/cjrm.cjrm_71_22.

DOI:10.4103/cjrm.cjrm_71_22

PMID:37861602

Abstract

INTRODUCTION

Enhanced recovery after surgery (ERAS) programmes include pre-operative, intraoperative and post-operative clinical pathways to improve quality of patient care while reducing length of stay (LOS) and readmission. This study assessed the feasibility and outcomes of an ERAS protocol for colorectal surgery implemented over 2 years in a small, resource-challenged rural hospital.

METHODS

A prospective cohort study used retrospectively matched controls to assess the effect of ERAS on LOS in patients undergoing colorectal surgery in a small rural hospital in northern Ontario, Canada. ERAS patients were matched to two patients in the control group based on diagnosis, age and gender. Patients had open or laparoscopic colorectal surgeries, with those in the intervention group treated per ERAS protocol and given instructions on pre- and post-operative self-care.

RESULTS

Most of the 47 ERAS patients recruited to the study reported adherence to ERAS protocols before surgery. Adherence to protocol was strongest for chewing gum in the days after surgery. Most patients were sitting in a chair for their afternoon meal by the 1 day and most were walking down the hallway by the 2 day. The control group had significantly higher (P < 0.001) malignant neoplasm of the colon (C18, 69% vs. 35%) and significantly lower malignant neoplasm of the rectum (C20, 0% vs. 5%). The control group had an average ln-transformed LOS that was significantly longer (exponentiated as 1.7 days) than ERAS patients (t-test, P < 0.001).

CONCLUSION

This study found that ERAS could be implemented in a small rural hospital and provided evidence for a reduced LOS of approximately 2 days.

摘要

简介

手术后恢复加速（ERAS）方案包括术前、术中及术后临床路径，以改善患者护理质量，同时缩短住院时间（LOS）和再入院率。本研究评估了在加拿大安大略省北部一家资源有限的小型农村医院实施为期两年的结直肠手术 ERAS 方案的可行性和结果。

方法

前瞻性队列研究使用回顾性匹配对照来评估 ERAS 对加拿大安大略省北部一家小型农村医院结直肠手术患者 LOS 的影响。ERAS 患者根据诊断、年龄和性别与对照组中的两名患者相匹配。患者接受开腹或腹腔镜结直肠手术，干预组按照 ERAS 方案进行治疗，并接受术前和术后自我护理指导。

结果

研究纳入的 47 名 ERAS 患者中，大多数患者报告在术前遵循 ERAS 方案。术后咀嚼口香糖的依从性最强。大多数患者在第 1 天就能坐在椅子上吃午餐，大多数患者在第 2 天就能在走廊里走动。对照组恶性肿瘤的结直肠（C18）比例显著更高（P < 0.001，69%比 35%），而直肠恶性肿瘤（C20）比例显著更低（P < 0.001，0%比 5%）。对照组的平均自然对数 LOS 显著长于 ERAS 患者（检验，P < 0.001），其外推值为 1.7 天。