Value-Based Healthcare Group, Waardegedreven Zorg B42 Enschede, Medisch Spectrum Twente, Postbus 50000, 7500 KA, Enschede, The Netherlands.
Department of Urology, Medisch Spectrum Twente, Enschede, The Netherlands.
World J Urol. 2024 Aug 20;42(1):490. doi: 10.1007/s00345-024-05176-x.
To study the effect of ERAS on a textbook outcome (TO) after elective renal surgery.
Retrospective study of all patients who underwent a robot-assisted laparoscopic partial or radical nephrectomy or robot-assisted laparoscopic radical nephroureterectomy in Medisch Spectrum Twente (MST), Enschede, the Netherlands. In total, 277 patients were included. 66 patients from 2018 to 2021 (pre-ERAS group) and 211 patients from 2021 to 2023 (ERAS group). TO is a maximum of two nights in the hospital after surgery, no severe complications during or after surgery ≥ grade IIIb, no blood transfusions, no intensive care, no readmissions, and no mortality within 30 days after surgery. Comparisons were made between the pre-ERAS and ERAS groups using unpaired t-test, Mann-Whitney U test, the chi-squared test or Fisher's exact test. Multivariate logistic regression was used to adjust for possible confounding.
TO was significantly (p = 0.005) better in the ERAS group (TO = 76.8%) compared to the pre-ERAS group (TO = 59.1%). Compared to a pre-ERAS patient, the adjusted odds ratio for achieving a TO as an ERAS patient is 2.1 (95% CI 1.15-3.78).
The implementation of ERAS showed a positive effect on the TO of elective renal surgery patients.
研究 ERAS 对择期肾手术教科书结局（TO）的影响。
对荷兰特温特医疗中心（MST）所有接受机器人辅助腹腔镜部分或根治性肾切除术或机器人辅助腹腔镜根治性肾输尿管切除术的患者进行回顾性研究。共纳入 277 例患者。2018 年至 2021 年（ERAS 前组）的 66 例患者和 2021 年至 2023 年（ERAS 组）的 211 例患者。TO 是术后住院时间最长为两晚，手术期间或之后无严重并发症≥IIIb 级，无输血，无需重症监护，无再入院，术后 30 天内无死亡。使用配对 t 检验、Mann-Whitney U 检验、卡方检验或 Fisher 精确检验对 ERAS 前组和 ERAS 组进行比较。使用多元逻辑回归调整可能的混杂因素。
ERAS 组（TO=76.8%）的 TO 明显（p=0.005）优于 ERAS 前组（TO=59.1%）。与 ERAS 前组患者相比，ERAS 组患者达到 TO 的调整后优势比为 2.1（95%CI 1.15-3.78）。
ERAS 的实施对择期肾手术患者的 TO 产生了积极影响。
