Fast tracking after Ivor Lewis esophagogastrectomy
Fast tracking after Ivor Lewis esophagogastrectomy
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DOI：
10.1378/chest.126.4.1187
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发表时间：
2004-10-01
期刊：
影响因子：
9.6
通讯作者：
Bartolucci, AA
中科院分区：
文献类型：
--
作者：
Cerfolio, RJ;Bryant, AS;Bartolucci, AA
目的：我们使用一种算法来简化我们的护理，用于依瓦尔-刘易斯食道胃切除术患者的术后护理，以试图将住院天数减少到7天，并保持安全性和患者满意度。采用避免ICU、早期下床、术后第1天开始空肠管喂养、术后第3天拔除鼻胃管及硬膜外、术后第4、5天吞食胃涂鸦、术后第7天出院等方法指导术后护理。共有90例患者(70名男性)。52名患者(58%)接受了术前放疗和化疗。食道切除术是为了治疗癌症或高度不典型增生。最后55名患者中有42名(77%)直接躺在地板上。主要并发症16例(17.7%)，其中肺炎5例，吸入性肺炎4例。无吻合口瘘发生，手术死亡4例(4.4%)。在接受新辅助治疗的患者中，快速治疗失败和发生主要并发症的发生率更高(分别为p=0.025和p=0.048)。中位住院天数为7天(6~74天)。并发症或死亡率不能确定地归因于快速追踪。97%的患者对他们的住院时间非常满意，4名患者在出院后1个月内再次入院。结论：食道切除术后使用算法快速跟踪患者是安全的，具有最低的发病率和死亡率，患者满意率高。中位住院时间为7天是可能的，而且大多数患者都可以避免进入ICU。
Objectives: We streamlined our care using an algorithm for the postoperative care of patients who undergo Ivor Lewis esophagogastrectomy to try to reduce hospital stay to 7 days and maintain safety and patient satisfaction.Methods: A consecutive series of 90 patients who underwent elective esophageal resection by one general thoracic surgeon were studied. An algorithm to guide postoperative care was used, featuring avoidance of the ICU, early ambulation, jejunal tube feeds starting on postoperative day (POD) 1, removal of nasogastric tube and epidural on POD 3, a gastrograffin swallow on PODs 4 or 5, and discharge on POD 7.Results. There were 90 patients (70 men). Fifty-two patients (58%) underwent preoperative radiation and chemotherapy. Esophagectomies were done for cancer or high-grade dysplasia. Forty-two of the last 55 patients (77%) went directly to the floor. Sixteen patients (17.7%) had major complications, which included pneumonia in 5 patients and aspiration pneumonia in 4 patients. There were no anastomotic leaks, and there were four operative deaths (4.4%). There was a greater incidence of failure to fast track, and to have a major complication in patients who underwent neoadjuvant treatment (p = 0.025 and p = 0.048, respectively). Median hospital stay was 7 days (range, 6 to 74 days). Complications or mortality could not be definitively attributed to fast tracking. Ninety-seven percent reported excellent satisfaction with their hospital stay, and four patients were readmitted within 1 month of discharge.Conclusions: Fast tracking patients using an algorithm after esophageal resection is safe and delivers minimal morbidity and mortality, and a high patient satisfaction rate. A median hospital stay of 7 days is possible, and the ICU can be avoided in most patients.