An Enhanced Recovery After Surgery (ERAS) Protocol for Ambulatory Anorectal Surgery Reduced Postoperative Pain and Unplanned Returns to Care After Discharge
An Enhanced Recovery After Surgery (ERAS) Protocol for Ambulatory Anorectal Surgery Reduced Postoperative Pain and Unplanned Returns to Care After Discharge
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DOI：
10.1007/s00268-017-4414-8
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发表时间：
2018-07-01
影响因子：
2.6
通讯作者：
Aboulian, Armen
中科院分区：
文献类型：
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作者：
Parrish, Aaron B.;O'Neill, Sean M.;Aboulian, Armen
已被证明，非卧床肛门直肠手术是安全有效的。结合多种干预措施的特定围手术期途径已被证明可以优化与住院结直肠手术相关的恢复和结局。然而，目前还没有大型研究描述和评价门诊肛门直肠手术的标准化方案。本研究的目的是评价改良的术后增强恢复（ERAS）方案在门诊肛门直肠手术中的效果，这是一项回顾性研究，前瞻性收集了来自南加州Kaiser Permanente医疗中心的14个数据。8项方案包括：术前教育、术前处方分配、术前碳水化合物治疗、多模式镇痛、优先使用监测麻醉护理（MAC）、常规使用局部麻醉/区域阻滞、术中限制静脉输液和出院后电话联系。评估术后疼痛评分和可预防的急诊室或紧急护理，当方案的所有八个要素都提供时，术后疼痛评分降低（p = 0.005）。在多变量分析中，当完成术前碳水化合物治疗（p = 0.002）、MAC（p = 0.003）和使用多模式镇痛（p = 0.02）时，术后疼痛减少。当使用MAC时，可预防的急诊室或紧急护理返回减少（p = 0.03）;术前碳水化合物治疗后，便秘返回更多（p = 0.04），但疼痛返回较少（p = 0.002）。局部麻醉与便秘患者较少的复诊相关（p = 0.01）。在门诊肛肠手术中实施标准化ERAS方案可减少术后疼痛和计划外的急诊复诊。
Ambulatory surgery for anorectal procedures has been proven to be safe and effective. Specific perioperative pathways combining multiple interventions have been shown to optimize recovery and outcomes associated with inpatient colorectal surgery. However, there are no major studies describing and evaluating a standardized protocol for ambulatory anorectal surgery. The purpose of this study was to evaluate the outcomes of a modified enhanced recovery after surgery (ERAS) protocol for ambulatory anorectal surgery.This was a retrospective review of prospectively collected data from 14 Southern California Kaiser Permanente medical centers. An eight-item protocol including: preoperative education, preoperative distribution of prescriptions, preoperative carbohydrate treatment, multimodal analgesia, preferential use of monitored anesthesia care (MAC), routine use of local anesthesia/regional blocks, intraoperative restriction of intravenous fluids, and post-discharge phone call. Postoperative pain scores and preventable returns to the emergency department or urgent care were assessed.Postoperative pain scores were reduced when all eight elements of the protocol were delivered (p = 0.005). On multivariate analysis, there was reduced postoperative pain when preoperative carbohydrate treatment was completed (p = 0.002), with MAC (p = 0.003), and when multimodal analgesia was used (p = 0.02). There were decreased preventable returns to the emergency department or urgent care when MAC was used (p = 0.03); there were more returns for constipation (p = 0.04) but fewer returns for pain (p = 0.002) after preoperative carbohydrate treatment. Local anesthesia was associated with fewer returns for constipation (p = 0.01).Implementation of a standardized ERAS protocol for ambulatory anorectal surgery decreased postoperative pain and unplanned return visits to emergency care.