Department of Anesthesiology and Perioperative Medicine, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA; Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA.
Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA.
Best Pract Res Clin Anaesthesiol. 2023 Sep;37(3):285-303. doi: 10.1016/j.bpa.2023.04.007. Epub 2023 Apr 23.
In the United States, ambulatory surgeries account for up to 87% of all surgical procedures. (1) It was estimated that 19.2 million ambulatory surgeries were performed in 2018 (https://www.hcup-us.ahrq.gov/reports/statbriefs/sb287-Ambulatory-Surgery-Overview-2019.pdf). Cataract procedures and musculoskeletal surgeries are the most common surgical interventions performed in ambulatory centers. However, more complex surgical interventions, such as sleeve gastrectomies, oncological, and spine surgeries, and even arthroplasties are routinely performed as day cases or in a model of an ambulatory extended recovery. (2-5) The ambulatory surgery centers industry has grown since 2017 by 1.1% per year and reached a market size of $31.2 billion. According to the Ambulatory Surgery Center Association, there is a potential to save $57.6 billion in Medicare costs over the next decade (https://www.ibisworld.com/industry-statistics/market-size/ambulatory-surgery-centers-united-states/). These data suggest an expected rise in the volume of ambulatory (same day) or extended ambulatory (23 h) surgeries in coming years. Similar increases are also observed in other countries. For example, 75% of elective surgeries are performed as same-day surgery in the United Kingdom. (6) To reduce costs and improve the quality of care after those more complex procedures, ambulatory surgery centers have started implementing patient-centered, high-quality, value-based practices. To achieve those goals, Enhanced Recovery After Surgery (ERAS) protocols have been implemented to reduce the length of stay, decrease costs, increase patients' satisfaction, and transform clinical practices. The ERAS fundamentals for ambulatory surgery are based on five pillars, including (1) preoperative patient counseling, education, and optimization; (2) multimodal and opioid-sparing analgesia; (3) nausea and vomiting, wound infection, and venous thromboembolism prophylaxis; (4) maintenance of euvolemia; and (5) encouragement of early mobility. Those pillars rely on interdisciplinary teamwork led by anesthesiologists, surgery-specific workgroups, and safety culture. (2) Research shows that a team of ambulatory anesthesiologists is crucial in improving postoperative nausea and vomiting (PONV) and pain control. (7) This review will summarize the current evidence on the elements and clinical importance of implementing ERAS protocol for ambulatory surgery.
在美国，门诊手术占所有手术的比例高达 87%。（1）据估计，2018 年进行了 1920 万次门诊手术（https://www.hcup-us.ahrq.gov/reports/statbriefs/sb287-Ambulatory-Surgery-Overview-2019.pdf）。白内障手术和肌肉骨骼手术是在门诊中心进行的最常见的手术干预措施。然而，更复杂的手术干预措施，如袖状胃切除术、肿瘤学和脊柱手术，甚至关节置换术，通常作为日间手术或在门诊延长恢复模式下进行。（2-5）自 2017 年以来，门诊手术中心行业以每年 1.1%的速度增长，市场规模达到 312 亿美元。根据门诊手术中心协会的数据，在未来十年内，医疗保险费用有望节省 576 亿美元（https://www.ibisworld.com/industry-statistics/market-size/ambulatory-surgery-centers-united-states/）。这些数据表明，未来几年门诊（当日）或延长门诊（23 小时）手术的数量预计将会增加。其他国家也观察到类似的增长。例如，在英国，75%的择期手术都是作为日间手术进行的。（6）为了降低成本并提高这些更复杂手术的护理质量，门诊手术中心已开始实施以患者为中心、高质量、基于价值的实践。为了实现这些目标，已实施增强术后恢复（ERAS）方案以缩短住院时间、降低成本、提高患者满意度并改变临床实践。门诊手术的 ERAS 基本原则基于五个支柱，包括（1）术前患者咨询、教育和优化；（2）多模式和阿片类药物节约型镇痛；（3）恶心和呕吐、伤口感染和静脉血栓栓塞预防；（4）维持血容量正常；（5）鼓励早期活动。这些支柱依赖于由麻醉师领导的跨学科团队、特定于手术的工作组和安全文化。（2）研究表明，门诊麻醉师团队对于改善术后恶心和呕吐（PONV）和疼痛控制至关重要。（7）本综述将总结实施门诊手术 ERAS 方案的要素和临床重要性的现有证据。
