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首页> 外文期刊>Surgical Endoscopy >Does adherence to perioperative enhanced recovery pathway elements influence patient-reported recovery following colorectal resection?
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Does adherence to perioperative enhanced recovery pathway elements influence patient-reported recovery following colorectal resection?

机译：依从围手术期增强的回收途径元素会影响结肠直肠切除后患者报告的恢复吗？

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Introduction Patient-reported outcome measures (PROMs) are pivotal to promote patient-centered perioperative care. Adherence to enhanced recovery programs (ERPs) is associated with improved clinical outcomes (i.e., morbidity, length of stay), but the impact of adherence on PROMs is uncertain. The objective of this study was to evaluate the extent to which adherence to an ERP for colorectal surgery is associated with postoperative recovery as assessed using PROMs. Methods and procedures 100 patients were included [median age 63 (IQR 50-71) years, 81 laparoscopic, 37 rectal surgery]. Overall adherence to the ERP and adherence to specific ERP elements were analyzed. Adjusted linear regression was used to evaluate the association of adherence with PROMs assessing early recovery [Abdominal surgery impact scale (ASIS) and Multidimensional fatigue inventory (MFI) on POD2] and late recovery (Duke Activity Status Index, RAND-36 Physical and Mental Summary Scores, Life-Space Mobility Assessment at 4 weeks after surgery). Missing data were addressed using multiple imputations. Results Median adherence to the ERP was 80% (16/20 elements, IQR 70-90%). Overall adherence was associated with ASIS scores on POD2 (4% increase per additional element, 95% CI 1-8%; p = 0.018). When specific ERP elements were analyzed, ASIS scores were associated with adherence to PONV prophylaxis (34% increase, 95% CI 5-63%; p = 0.023) and early solid food diet (20% increase, 95% CI 5-35%; p = 0.009). MFI General fatigue and MFI Mental fatigue scores on POD2 were associated with adherence to PONV prophylaxis (36% decrease, 95% CI - 64 to - 8%, p = 0.014 and 22% decrease, 95% CI - 44 to - 8%, p = 0.042). Overall adherence and adherence to specific elements were not associated with PROMs at 4 weeks after surgery. Conclusion Our findings suggest that, from the perspective of patients, adherence to an ERP for colorectal surgery impacts early, but not late postoperative recovery. This result may reflect the lack of PROMs able to validly measure postoperative recovery beyond hospital discharge.
机译：引言患者报告的结果措施（PROMS）是促进患者中心的围手术期护理的关键。遵守增强的恢复计划（ERP）与改善的临床结果相关（即发病率，逗留时间），但遵守对舞会的影响是不确定的。本研究的目的是评估依赖于结直肠手术的ERP的程度与使用PROMS评估的术后恢复有关。方法和程序100名患者包括[中位年龄63（IQR 50-71）岁，81腹镜镜，37例直肠手术]。分析了对ERP的整体遵守和对特定ERP元素的遵守。调整后的线性回归用于评估依从性与评估早期恢复的竞争协会[腹部手术冲击尺度（ASIS）和多维疲劳库存（MFI）和POD2的多维疲劳库存（DUKE活动状态指数，RAND-36身体和精神概要）分数，手术后4周的生命空间移动性评估。使用多个避免解决缺少数据。结果中位于ERP的中位依从为80％（16/20元素，IQR 70-90％）。整体依从性与POD2上的ASIS分数有关（每个额外元素增加4％，95％CI 1-8％; P = 0.018）。当分析特定的ERP元素时，随着刺激的分数与PONV预防粘附有关（34％增加，95％CI 5-63％; P = 0.023）和早期固体食品饮食（20％增加，95％CI 5-35％ ; p = 0.009）。 POD2上的MFI一般疲劳和MFI精神疲劳评分与栓塞预防粘附有关（36％降低，95％CI-64至-8％，P = 0.014和22％降低，95％CI - 44至-8％， p = 0.042）。在手术后4周内，整体依从性和对特定元素的依从性与PROM无关。结论我们的研究结果表明，从患者的角度来看，依从ERP用于早期的结肠直肠手术影响，但术后恢复晚期。这一结果可能反映了能够有效地衡量医院放电超出术后恢复的竞争。

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