Pesce Antonio, Portinari Mattia, Fabbri Nicolò, Sciascia Valeria, Uccellatori Lisa, Vozza Michela, Righini Erminio, Feo Carlo V
Unit of General Surgery, Department of Surgery, Azienda Unità Sanitaria Locale of Ferrara, University of Ferrara, Ferrara, Italy.
Unit of Surgery 2, Department of Surgery, S. Anna University Hospital of Ferrara, Ferrara, Italy.
Heliyon. 2024 Jul 3;10(13):e33989. doi: 10.1016/j.heliyon.2024.e33989. eCollection 2024 Jul 15.
The main purpose was to determine the impact on postoperative outcomes of a standardized enhanced recovery program (ERP) for elective colorectal surgery in a rural hospital.
A prospective series of patients (N = 80) undergoing elective colorectal resection completing a standardized ERP protocol in 2018-2020 (ERP group) was compared to patients (N = 80) operated at the same rural hospital in 2013-2015 (pre-ERP group), before the implementation of the program. The exclusion criteria for both groups were: ASA score IV, TNM stage IV, inflammatory bowel disease, emergency surgery, and rectal cancer. The primary outcome was hospital length of stay (LoS) which was used as an estimate of functional recovery. Secondary outcomes included 30-day readmission and mortality rates as well as associated factors with both postoperative complications and prolonged hospital LoS.
Baseline characteristics were comparable in both groups. The median adherence to ERP protocol elements was 68 % versus 12 % in the retrospective control group. The median hospital LoS in the ERP-group was significantly lower than in the pre-ERP group (5 . 10 days) with no increase in 30-day readmission and mortality rates. The Body Mass Index ≥30 and the traditional peri-operative protocol were the associated factors to postoperative complications, while following a traditional peri-operative protocol was the only factor associated with a prolonged hospital LoS (p < 0.0001).
Although limited hospital resources are perceived as a barrier to ERP implementation, the current experience demonstrates how adopting an ERP program in a rural area is feasible and effective, despite it requires greater effort.
主要目的是确定农村医院中标准化的择期结直肠手术强化康复计划（ERP）对术后结局的影响。
将2018 - 2020年接受择期结直肠切除术并完成标准化ERP方案的一系列前瞻性患者（N = 80）（ERP组）与2013 - 2015年在同一农村医院手术的患者（N = 80）（ERP前组）进行比较，后者是在该计划实施之前。两组的排除标准为：美国麻醉医师协会（ASA）评分IV级、TNM分期IV期、炎症性肠病、急诊手术和直肠癌。主要结局是住院时间（LoS），其被用作功能恢复的估计指标。次要结局包括30天再入院率和死亡率以及术后并发症和住院时间延长的相关因素。
两组的基线特征具有可比性。ERP方案要素的中位依从率在回顾性对照组中为68%，而在对照组中为12%。ERP组的中位住院时间显著低于ERP前组（5.10天），30天再入院率和死亡率没有增加。体重指数≥30和传统围手术期方案是术后并发症的相关因素，而遵循传统围手术期方案是与住院时间延长相关的唯一因素（p < 0.0001）。
尽管有限的医院资源被视为实施ERP的障碍，但目前的经验表明，尽管需要付出更大努力，但在农村地区采用ERP计划是可行且有效的。
