Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands.
Department of Anesthesiology, Radboud University Medical Center, Nijmegen, The Netherlands.
World J Urol. 2024 Mar 22;42(1):187. doi: 10.1007/s00345-024-04911-8.
No data exist on perioperative strategies for enhancing recovery after posterior retroperitoneoscopic adrenalectomy (PRA). Our objective was to determine whether a multimodality adrenal fast-track and enhanced recovery (AFTER) protocol for PRA can reduce recovery time, improve patient satisfaction and maintain safety.
Thirty primary aldosteronism patients were included. Fifteen patients were treated with 'standard-of-care' PRA and compared with 15 in the AFTER protocol. The AFTER protocol contains: a preoperative information video, postoperative oral analgesics, early postoperative mobilisation and enteral feeding, and blood pressure monitoring at home. The primary outcome was recovery time. Secondary outcomes were length of hospital stay, postoperative pain and analgesics requirements, patient satisfaction, perioperative complications and quality of life (QoL).
Recovery time was much shorter in both groups than anticipated and was not significantly different (median 28 days). Postoperative length of hospital stay was significantly reduced in AFTER patients (mean 32 vs 42 h, CI 95%, p = 0.004). No significant differences were seen in pain, but less analgesics were used in the AFTER group. Satisfaction improved amongst AFTER patients for time of admission and postoperative visit to the outpatient clinic. There were no significant differences in complication rates or QoL.
Despite no difference in recovery time between the two groups, probably due to small sample size, the AFTER protocol led to shorter hospital stays and less analgesic use after surgery, whilst maintaining and even enhancing patient satisfaction for several aspects of perioperative care. Complication rates and QoL are comparable to standard-of-care.
目前尚无关于增强后腹腔镜肾上腺切除术（PRA）术后恢复的围手术期策略的数据。我们的目的是确定多模式肾上腺快速通道和加速康复（AFTER）方案是否可以缩短恢复时间，提高患者满意度并保持安全性。
纳入了 30 例原发性醛固酮增多症患者。15 例患者接受了“标准护理”PRA 治疗，并与 AFTER 方案中的 15 例进行了比较。AFTER 方案包括：术前信息视频、术后口服镇痛药、早期术后活动和肠内喂养，以及在家中监测血压。主要结局是恢复时间。次要结局是住院时间、术后疼痛和镇痛需求、患者满意度、围手术期并发症和生活质量（QoL）。
两组的恢复时间均明显短于预期，但无显著差异（中位数 28 天）。AFTER 组患者的术后住院时间明显缩短（平均 32 比 42 小时，CI 95%，p=0.004）。两组的疼痛无显著差异，但 AFTER 组的镇痛药使用量较少。AFTER 组患者对入院时间和术后门诊就诊的满意度有所提高。并发症发生率和 QoL 无显著差异。
尽管两组的恢复时间无差异，可能是由于样本量小，但 AFTER 方案导致术后住院时间缩短，镇痛药使用减少，同时维持甚至提高了患者对围手术期护理多个方面的满意度。并发症发生率和 QoL 与标准护理相当。
