择期结直肠手术患者在实施加速康复外科（ERAS®）前后的术后早期恢复情况比较——一项单中心三臂队列研究

Comparison of early postoperative recovery in patients undergoing elective colorectal surgery before and after ERAS® implementation-a single center three-armed cohort study.

作者信息

Knab Katharina, Aurnhammer Leon, Büttner Sylvia, Seyfried Steffen, Herrle Florian, Reissfelder Christoph, Vassilev Georgi, Hardt Julia

机构信息

Department of Surgery, Medical Faculty Mannheim, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167, Mannheim, Germany.

Department of Biometry and Statistics, Medical Faculty Mannheim, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167, Mannheim, Germany.

出版信息

Int J Colorectal Dis. 2024 Dec 2;39(1):194. doi: 10.1007/s00384-024-04770-0.

DOI:10.1007/s00384-024-04770-0

PMID:39623070

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11611963/

Abstract

PURPOSE

This study examines the impact of enhanced recovery after surgery (ERAS®) on patient recovery after elective colorectal surgery. The innovative PostopQRS™ tool was used for the analysis of patient recovery.

METHODS

This single-center study compares three cohorts: two retrospective cohorts before (A) and after (B) ERAS® implementation and a prospective cohort post-ERAS® implementation (C) using PostopQRS™. The present study was prospectively registered in the German Register of Clinical Trials (DRKS00026903).

RESULTS

A total of 153 patients were included from June 2020 to February 2022. Significant differences were observed in bowel function, oral food intake, opioid use, and PONV (postoperative nausea and vomiting) occurrence. By the day of discharge, 98% in cohorts B and C had bowel movements or stoma output, compared to 66% in cohort A (p < 0.001). Solid food intake on POD1 was higher in cohorts B and C (p = 0.025), while opioid use was lower (p = 0.003 and p < 0.001). Cohort C showed 90% recovery on discharge.

CONCLUSION

This study demonstrates improved early mobility, reduced need for opioids, a higher rate of patients with solid food intake on POD1, and earlier bowel movement as well as excellent recovery following the colorectal ERAS® implementation.

摘要

目的

本研究探讨术后加速康复（ERAS®）对择期结直肠手术后患者恢复的影响。采用创新的PostopQRS™工具分析患者的恢复情况。

方法

这项单中心研究比较了三个队列：两个分别为ERAS®实施前（A）和实施后（B）的回顾性队列，以及一个使用PostopQRS™的ERAS®实施后的前瞻性队列（C）。本研究已在德国临床试验注册中心（DRKS00026903）进行前瞻性注册。

结果

2020年6月至2022年2月共纳入153例患者。在肠道功能、口服食物摄入量、阿片类药物使用以及术后恶心呕吐（PONV）发生率方面观察到显著差异。到出院时，队列B和C中98%的患者有排便或造口排出物，而队列A中这一比例为66%（p<0.001）。队列B和C在术后第1天的固体食物摄入量更高（p=0.025），而阿片类药物的使用量更低（p=0.003和p<0.001）。队列C在出院时显示90%的患者恢复良好。