Adherence to the Enhanced Recovery After Surgery Protocol and Outcomes After Colorectal Cancer Surgery
Adherence to the Enhanced Recovery After Surgery Protocol and Outcomes After Colorectal Cancer Surgery
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DOI：
10.1001/archsurg.2010.309
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发表时间：
2011-05-01
影响因子：
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通讯作者：
Nygren, Jonas
中科院分区：
文献类型：
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作者：
Gustafsson, Ulf O.;Hausel, Jonatan;Nygren, Jonas
目的：为了研究不同的遵守水平的影响，以增强术后恢复（ERAS）协议和各种ERAS元素对结果的影响以下major surgery.Design：单中心前瞻性队列研究ERAS协议加固前后。使用多变量logistic回归进行期间和期间之间的比较。所有临床数据地点：瑞典斯德哥尔摩Ersta医院。患者：953例连续的结直肠癌患者：2002年至2004年治疗464例，2005年至2007年治疗489例。主要结果测量：对ERAS方案依从性的改善与术后症状、并发症结直肠癌手术后的住院时间进行了分析。在术前和围手术期对ERAS方案的依从性从2002 - 2004年的43.3%总体增加到2005 - 2007年的70.6%之后，术后并发症（比值比，0.73; 95%可信区间，0.55-0.98）和症状（比值比，0.53; 95%可信区间，0.40-0.70）均显著下降。限制静脉输液和术前使用碳水化合物饮料是主要的独立预测因素。在不同时期，与ERAS依从性低的患者相比，术后不良结局（30天发病率、症状和再入院）的比例随着ERAS方案依从性的增加而显著降低（> 70%、> 80%和>90%）。
Objectives: To study the impact of different adherence levels to the enhanced recovery after surgery (ERAS) protocol and the effect of various ERAS elements on outcomes following major surgery.Design: Single-center prospective cohort study before and after reinforcement of an ERAS protocol. Comparisons were made both between and across periods using multivariate logistic regression. All clinical data (114 variables) were prospectively recorded.Setting: Ersta Hospital, Stockholm, Sweden.Patients: Nine hundred fifty-three consecutive patients with colorectal cancer: 464 patients treated in 2002 to 2004 and 489 in 2005 to 2007.Main Outcome Measures: The association between improved adherence to the ERAS protocol and the incidence of postoperative symptoms, complications, and length of stay following major colorectal cancer surgery was analyzed.Results: Following an overall increase in preoperative and perioperative adherence to the ERAS protocol from 43.3% in 2002 to 2004 to 70.6% in 2005 to 2007, both postoperative complications (odds ratio, 0.73; 95% confidence interval, 0.55-0.98) and symptoms (odds ratio, 0.53; 95% confidence interval, 0.40-0.70) declined significantly. Restriction of intravenous fluid and use of a preoperative carbohydrate drink were major independent predictors. Across periods, the proportion of adverse postoperative outcomes (30-day morbidity, symptoms, and readmissions) was significantly reduced with increasing adherence to the ERAS protocol (>70%, >80%, and >90%) compared with low ERAS adherence (