Department of Gastrointestinal Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
Department of Digital Center, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
BMC Anesthesiol. 2024 Mar 22;24(1):110. doi: 10.1186/s12871-024-02433-9.
The current study used a composite outcome to investigate whether applying the ERAS protocol would enhance the recovery of patients undergoing laparoscopic total gastrectomy (LTG).
Laparoscopic total gastrectomy and perioperative interventions were the exposure. An ERAS clinical pathway consisting of 14 items was implemented and assessed. Patients were divided into either ERAS-compliant or non-ERAS-compliant group according the adherence above 9/14 or not.
The primary study outcome was a composite outcome called 'optimal postoperative recovery' with the definition as below: discharge within 6 days with no sever complications and no unplanned re-operation or readmission within 30 days postoperatively. Univariate logistic regression analysis and multivariate logistic regression analysis were used to model optimal postoperative recovery and compliance, adjusting for patient-related and disease-related characteristics.
A total of 252 patients were included in this retrospective study, 129 in the ERAS compliant group and 123 in the non-ERAS-compliant group. Of these, 79.07% of the patients in ERAS compliant group achieved optimal postoperative recovery, whereas 61.79% of patients in non-ERAS-compliant group did (P = 0.0026). The incidence of sever complications was lower in the ERAS-compliant group (1.55% vs. 6.5%, P = 0.0441). No patients in ERAS compliant group had unplanned re-operation, whereas 5.69% (7/123) of patients in non-ERAS-compliant group had (p = 0.006). The median length of the postoperative hospital stay was shorter in the in the ERAS compliant group (5.51 vs. 5.68 days, P = 0.01). Both logistic (OR 2.01, 95% CI 1.21-3.34) and stepwise regression (OR 2.07, 95% CI 1.25-3.41) analysis showed that high overall compliance with the ERAS protocol facilitated optimal recovery in such patients. In bivariate analysis of compliance for patients who had an optimal postoperative recovery, carbohydrate drinks (p = 0.0196), early oral feeding (P = 0.0043), early mobilization (P = 0.0340), and restrictive intravenous fluid administration (P < 0.0001) were significantly associated with optimal postoperative recovery.
Patients with higher ERAS compliance (almost 70% of the accomplishment) suffered less severe postoperative complications and were more likely to achieve optimal postoperative recovery.
本研究采用复合结局指标来探讨实施 ERAS 方案是否能促进腹腔镜全胃切除术（LTG）患者的康复。
腹腔镜全胃切除术和围手术期干预是暴露因素。实施并评估了包含 14 项内容的 ERAS 临床路径。根据是否符合 9/14 项或以上标准，将患者分为符合 ERAS 方案组或不符合 ERAS 方案组。
主要研究结果是一个称为“术后最佳恢复”的复合结局，其定义如下：术后 6 天内出院，无严重并发症，术后 30 天内无计划再次手术或再次入院。采用单因素 logistic 回归分析和多因素 logistic 回归分析，对符合条件的患者和不符合条件的患者的术后最佳恢复和符合情况进行建模，调整了患者相关和疾病相关的特征。
本回顾性研究共纳入 252 例患者，符合 ERAS 方案组 129 例，不符合 ERAS 方案组 123 例。符合 ERAS 方案组中，79.07%的患者达到了术后最佳恢复，而不符合 ERAS 方案组中，这一比例为 61.79%（P=0.0026）。符合 ERAS 方案组严重并发症的发生率较低（1.55%比 6.5%，P=0.0441）。符合 ERAS 方案组无一例患者计划再次手术，而不符合 ERAS 方案组有 5.69%（7/123）的患者计划再次手术（p=0.006）。符合 ERAS 方案组患者术后住院时间中位数更短（5.51 天比 5.68 天，P=0.01）。逻辑（OR 2.01，95%CI 1.21-3.34）和逐步回归（OR 2.07，95%CI 1.25-3.41）分析均表明，患者总体上高度符合 ERAS 方案有助于实现最佳恢复。在对术后恢复最佳的患者的依从性进行二元分析中，碳水化合物饮料（p=0.0196）、早期口服喂养（P=0.0043）、早期活动（P=0.0340）和限制静脉输液（P<0.0001）与术后最佳恢复显著相关。
符合 ERAS 方案的患者（完成度近 70%）术后并发症较轻，更有可能达到术后最佳恢复。
