Department of Surgery, Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, CO.
Department of Surgery, University of Colorado School of Medicine, Aurora, CO.
Ann Surg. 2024 Jun 1;279(6):1062-1069. doi: 10.1097/SLA.0000000000006243. Epub 2024 Feb 22.
We sought to evaluate how implementing a thoracic enhanced recovery after surgery (ERAS) protocol impacted surgical outcomes after elective anatomic lung resection.
The effect of implementing the ERAS Society/European Society of Thoracic Surgery thoracic ERAS protocol on postoperative outcomes throughout an entire health care system has not yet been reported.
This was a prospective cohort study within one health care system (January 2019-March, 2023). A thoracic ERAS protocol was implemented on May 1, 2021 for elective anatomic lung resections, and postoperative outcomes were tracked using the electronic health record and Vizient data. The primary outcome was overall morbidity; secondary outcomes included individual complications, length of stay, opioid use, chest tube duration, and total cost. Patients were grouped into pre-ERAS and post-ERAS cohorts. Bivariable comparisons were performed using independent t -test, χ 2 , or Fisher exact tests, and multivariable logistic regression was performed to control for confounders.
There were 1007 patients in the cohort; 450 (44.7%) were in the post-ERAS group. Mean age was 66.2 years; most patients were female (65.1%), white (83.8%), had a body mass index between 18.5 and 29.9 (69.7%), and were ASA class 3 (80.6%). Patients in the postimplementation group had lower risk-adjusted rates of any morbidity, respiratory complication, pneumonia, surgical site infection, arrhythmias, infections, opioid usage, ICU use, and shorter postoperative length of stay (all P <0.05).
Postoperative outcomes were improved after the implementation of an evidence-based thoracic ERAS protocol throughout the health care system. This study validates the ERAS Society/European Society of Thoracic Surgery guidelines and demonstrates that simultaneous multihospital implementation can be feasible and effective.
评估实施胸外科加速康复外科（ERAS）方案对择期解剖性肺切除术术后结局的影响。
在整个医疗保健系统中实施 ERAS 协会/欧洲胸外科协会胸科 ERAS 方案对术后结局的影响尚未报道。
这是一项在一个医疗保健系统内进行的前瞻性队列研究（2019 年 1 月至 2023 年 3 月）。2021 年 5 月 1 日，对择期解剖性肺切除术实施了胸科 ERAS 方案，并通过电子健康记录和 Vizient 数据跟踪术后结局。主要结局是总体发病率；次要结局包括各并发症、住院时间、阿片类药物使用、胸腔引流管持续时间和总费用。患者分为 ERAS 前组和 ERAS 后组。采用独立 t 检验、χ 2 检验或 Fisher 确切检验进行两变量比较，采用多变量逻辑回归控制混杂因素。
该队列中有 1007 例患者；450 例（44.7%）在 ERAS 后组。平均年龄为 66.2 岁；大多数患者为女性（65.1%）、白人（83.8%）、体重指数在 18.5 至 29.9 之间（69.7%）、ASA 分级 3 级（80.6%）。实施后组患者的任何发病率、呼吸系统并发症、肺炎、手术部位感染、心律失常、感染、阿片类药物使用、ICU 使用和术后住院时间较短的风险调整率均较低（均 P <0.05）。
在整个医疗保健系统中实施基于证据的胸科 ERAS 方案后，术后结局得到改善。本研究验证了 ERAS 协会/欧洲胸外科协会指南的有效性，并表明同时在多家医院实施是可行且有效的。
