Department of Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands.
School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands.
Sci Rep. 2024 Aug 19;14(1):19132. doi: 10.1038/s41598-024-67813-0.
Previous studies showed that accelerated enhanced recovery programs (ERPs) with discharge 1-3 days after colorectal surgery are feasible for specific patients without compromising patients' safety. This study aimed to examine the incidence, severity, and treatment of complications after treatment according to an accelerated ERP (CHASE). This accelerated ERP consisted of adjustments in pre-, peri- and postoperative care. Patients treated according to the CHASE protocol were compared to a retrospective cohort of patients who received standard ERAS care. The primary outcome was the rate of severe complications. The overall complication rates were similar in both cohorts (CHASE 30.7% vs ERAS 31.4%, p = 0.958) as well as severe complications (CHASE 20.9% vs ERAS 21.4%, p = 0.950). Among the 113 patients with a complicated course, the readmission rate was significantly higher in the CHASE cohort (41.9% vs 21.4%, p = 0.020). LOS after readmission was longer in the CHASE cohort (p = 0.018), but the total LOS was shorter (4 versus 6 days, p = 0.001). This study demonstrates that accelerated recovery can be safe for ASA I-II patients and has the potential to become a standard of care. Moreover, the CHASE protocol proved to be beneficial in terms of total LOS for patients with complications.
先前的研究表明,对于特定的患者,加速康复计划(ERPs)可以在结直肠手术后 1-3 天出院,而不会危及患者的安全。本研究旨在根据加速 ERP(CHASE)检查治疗后并发症的发生率、严重程度和治疗方法。该加速 ERP 包括术前、术中和术后护理的调整。根据 CHASE 方案治疗的患者与接受标准 ERAS 护理的回顾性队列患者进行比较。主要结局是严重并发症的发生率。两个队列的总体并发症发生率相似(CHASE 为 30.7%,ERAS 为 31.4%,p=0.958),严重并发症的发生率也相似(CHASE 为 20.9%,ERAS 为 21.4%,p=0.950)。在 113 名病情复杂的患者中,CHASE 组的再入院率显著更高(41.9%比 21.4%,p=0.020)。CHASE 组的再入院后 LOS 较长(p=0.018),但总 LOS 较短(4 天比 6 天,p=0.001)。本研究表明,加速康复对于 ASA I-II 患者是安全的,并有潜力成为一种标准的护理方法。此外,CHASE 方案在并发症患者的总 LOS 方面证明是有益的。