Zhang Wenxian, Wang Fang, Qi Shujung, Liu Zhijun, Zhao Subin, Zhang Ning, Ping Fumin
Department of General Surgery, Affiliated Hospital of Hebei Engineering University, Handan, Hebei Province, China.
Wideochir Inne Tech Maloinwazyjne. 2023 Dec;18(4):565-577. doi: 10.5114/wiitm.2023.131426. Epub 2023 Sep 20.
The Enhanced Recovery After Surgery (ERAS) protocol reduces surgery-related stress and hospital stays for complicated surgical patients. It speeds recovery, reduces readmissions, and lowers morbidity and mortality. However, the efficacy of ERAS in colorectal surgery is still debatable.
To evaluate the effectiveness and safety of the ERAS program for patients undergoing colorectal surgery.
PRISMA-compliant searches were performed on Medline, Embase, PubMed, the Web of Sciences, and the Cochrane Database up to March 2023. The included articles compared ERAS protocol results for colorectal surgery patients to those of conventional care. RevMan was used for the meta-analysis, and the Cochrane RoB Tool was used to assess the study quality.
The meta-analysis included 12 randomized controlled trials with a total of 1920 participants. There were 880 individuals in ERAS care and 1002 in conventional care. Weighted mean difference: -1.07 days, 95% confidence interval (CI): -1.53 to -0.60, p = 0.00001), overall length of stay: -4.12 days, 95% CI: -5.86 to -2.38, p = 0.00001), and post-operative hospital stay: -1.91 days, 95% CI: -4.73 to -0.91, p = 0.00001). Readmissions were higher in the ERAS group than in the normal care group (odds ratio (OR) = 1.20, 95% CI: 0.82 to 1.75, p = 0.35). Post-operative complications were lower in the ERAS care group (OR = 0.42; 95% CI: 0.27 to 0.65, p < 0.0001) and SSIs (OR = 0.75; 95% CI 0.52 to 1.08, p = 0.00001) than in the routine care group.
Care provided in line with the ERAS protocol has been shown to be successful and beneficial for patients following colorectal surgery, because it minimizes post-operative problems and length of hospital stay, and improves outcomes.
术后加速康复（ERAS）方案可减轻复杂手术患者的手术相关应激并缩短住院时间。它能加速康复，减少再入院率，并降低发病率和死亡率。然而，ERAS在结直肠手术中的疗效仍存在争议。
评估ERAS方案对接受结直肠手术患者的有效性和安全性。
截至2023年3月，在Medline、Embase、PubMed、科学网和Cochrane数据库上进行了符合PRISMA标准的检索。纳入的文章将结直肠手术患者的ERAS方案结果与传统护理结果进行了比较。使用RevMan进行荟萃分析，并使用Cochrane偏倚风险工具评估研究质量。
荟萃分析纳入了12项随机对照试验，共1920名参与者。接受ERAS护理的有880人，接受传统护理的有1002人。加权平均差：-1.07天，95%置信区间（CI）：-1.53至-0.60，p = 0.00001），总住院时间：-4.12天，95%CI：-5.86至-2.38，p = 0.00001），术后住院时间：-1.91天，95%CI：-4.73至-0.91，p = 0.00001）。ERAS组的再入院率高于正常护理组（比值比（OR）= 1.20，95%CI：0.82至1.75，p = 0.35）。ERAS护理组的术后并发症（OR = 0.42；95%CI：0.27至0.65，p < 0.0001）和手术部位感染（OR = 0.75；95%CI 0.52至1.08，p = 0.00001）低于常规护理组。
已证明按照ERAS方案提供的护理对结直肠手术后的患者是成功且有益的，因为它能将术后问题和住院时间降至最低，并改善治疗效果。
