Ding Yi, Zhou Leiming, Shan Lei, Zhang Weiquan, Li Peichao, Cong Bo, Tian Zhongxian, Zhao Yunpeng, Zhao Xiaogang
Department of Thoracic Surgery, The Second Hospital of Shandong University, Jinan, China.
Department of Thoracic Surgery, People's Hospital of Laoling, Laoling of Dezhou, China.
Front Oncol. 2024 Nov 8;14:1474438. doi: 10.3389/fonc.2024.1474438. eCollection 2024.
This study was conducted to evaluate the postoperative short-term outcomes of patients undergoing video-assisted thoracoscopic surgery (VATS) for lung resection with the enhanced recovery after surgery (ERAS) protocol.
A single-institution, prospective randomized controlled study was conducted. The primary outcome measures were postoperative pulmonary complications (PPCs) and postoperative short-term effects.
Among the 611 patients, 305 were assigned to the ERAS group, and 306 were assigned to the routine group. The ERAS group achieved earlier oral feeding, earlier mobilization, a shorter duration of drainage (2.0 vs. 5.0 days, P<0.001), and a shorter hospital stay (3.0 vs. 7.0 days, P<0.001). The biological impacts were confirmed to be significantly better for the ERAS group. Furthermore, the ERAS group also had a lower incidence of PPCs (11.5% vs. 22.9%, P<0.001) than did the routine group. Multivariate logistic regression analysis revealed the following predictors of drainage tube removal on the 1st day after surgery without pneumonia during hospitalization: comorbidity (P=0.029), surgical procedure (P=0.001), and operation time (P=0.039).
Implementation of the ERAS protocol led to a decreased incidence of PPCs, suggesting that the ERAS protocol has a better biological impact on patients undergoing VATS for lung resection. Multigradient individual ERAS protocols are recommended at different institutions according to the individual conditions of patients.
https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0009ZT9&selectaction=Edit&uid=U0002ZGN&ts=3&cx=ks7hrg, identifier NCT04451473.
本研究旨在评估采用术后加速康复（ERAS）方案行电视辅助胸腔镜手术（VATS）肺切除术患者的术后短期结局。
开展了一项单机构前瞻性随机对照研究。主要结局指标为术后肺部并发症（PPCs）及术后短期效应。
611例患者中，305例被分配至ERAS组，306例被分配至常规组。ERAS组实现了更早经口进食、更早活动、更短引流时间（2.0天对5.0天，P<0.001）以及更短住院时间（3.0天对7.0天，P<0.001）。证实ERAS组的生物学影响显著更好。此外，ERAS组的PPCs发生率也低于常规组（11.5%对22.9%，P<0.001）。多因素逻辑回归分析显示，以下因素是术后第1天拔除引流管且住院期间无肺炎的预测因素：合并症（P=0.029）、手术方式（P=0.001）及手术时间（P=0.039）。
实施ERAS方案导致PPCs发生率降低，表明ERAS方案对接受VATS肺切除术的患者具有更好的生物学影响。建议不同机构根据患者个体情况制定多梯度个体化ERAS方案。
