Improved Outcomes With an Enhanced Recovery Approach to Cesarean Delivery.
Improved Outcomes With an Enhanced Recovery Approach to Cesarean Delivery.
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DOI：
10.1097/aog.0000000000004023
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发表时间：
2020-10
影响因子：
7.2
通讯作者：
Yodice P
中科院分区：
文献类型：
--
作者：
Mullman L;Hilden P;Goral J;Gwacham N;Tauro C;Spinola K;Rosales K;Collier S;Holmes L;Maccione J;Pitera R;Miller R;Yodice P
实施剖宫产术后加速康复计划与缩短住院时间、护理成本和阿片类镇痛药物的使用有关。旨在检验一项针对剖宫产实施加速康复外科 (ERAS) 计划的质量改进研究的结果。采用术前术后设计来评估自 2018 年 12 月开始实施基于证据的 ERAS 途径对患者进行术前、术中和术后管理之前和之后所有接受剖宫产的患者阿片类药物使用、住院时间和费用的变化。从 2018 年 1 月 1 日到 2019 年 8 月 31 日，总共纳入了 3,679 例剖腹产（计划的和紧急的），其中2018年12月17日实施前发生2,171起，实施后发生1,508起。 84% 的患者在剖宫产后住院期间接受阿片类药物治疗，而在实施后这一比例为 24%（比值比 [OR] 16.8，95% CI 14.3–19.9）。在需要任何阿片类药物的患者中，总吗啡毫克当量也显着下降（中位数 56.5 vs 15.0，平均相对变化 0.32，95% CI 0.28-0.35）。与实施前相比，实施后的患者剖宫产后住院时间较短（3.2 天 vs 2.7 天，平均相对变化 0.82，95% CI 0.80-0.83，中位 3 天），中位直接费用降低 349 美元（平均相对变化 0.93，95% CI 0.91-0.95），并且30 天再入院率（1.4% vs 1.7%，OR 0.83，95% CI 0.49–1.41）。针对剖腹产人群的 ERAS 方法与改善结果相关，包括减少阿片类药物的使用、住院时间和费用。
Implementing an enhanced recovery after surgery program for cesarean delivery is associated with reduced length of stay, cost of care, and opioid analgesia use. To examine the results of a quality-improvement study that implemented an enhanced recovery after surgery (ERAS) program for cesarean delivery. A pre–post design was used to assess changes in opioid use, length of stay, and costs among all patients undergoing cesarean delivery before and after implementation of an evidence-based ERAS pathway for the preoperative, intraoperative, and postoperative management of patients beginning December 2018. A total of 3,679 cesarean deliveries (scheduled and emergent) were included from January 1, 2018, through August 31, 2019, of which 2,171 occurred before implementation on December 17, 2018, and 1,508 occurred postimplementation. Eighty-four percent of patients received opioids as inpatients after cesarean delivery during the preimplementation period, as compared with 24% in the postimplementation period (odds ratio [OR] 16.8, 95% CI 14.3–19.9). Among patients who required any opioids, the total morphine milligram equivalents also significantly decreased (median 56.5 vs 15.0, mean relative change 0.32, 95% CI 0.28–0.35). Compared with the preimplementation period, those in the postimplementation period had a shorter postcesarean length of stay (3.2 vs 2.7 days, mean relative change 0.82, 95% CI 0.80–0.83, median 3 days in both periods), lower median direct costs by $349 (mean relative change 0.93, 95% CI 0.91–0.95), and no change in the 30-day readmission rate (1.4% vs 1.7%, OR 0.83, 95% CI 0.49–1.41). An ERAS approach for the cesarean delivery population is associated with improved outcomes including decreases in opioid use, length of stay, and costs.