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首页> 外文期刊>Surgical Endoscopy >Adoption of enhanced recovery after surgery (ERAS) strategies for colorectal surgery at academic teaching hospitals and impact on total length of hospital stay
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Adoption of enhanced recovery after surgery (ERAS) strategies for colorectal surgery at academic teaching hospitals and impact on total length of hospital stay

机译：学术教学医院采用大肠手术的术后恢复（ERAS）策略及其对住院时间的影响

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Objective: The objective of enhanced recovery after surgery (ERAS) programs is to incorporate strategies into the perioperative care plan to decrease complications, hasten recovery, and shorten hospital stay. This study was designed to determine which ERAS strategies contribute to overall shortened length of hospital stay in patients undergoing elective colorectal surgery in hospitals. Methods: A retrospective cohort study of 336 consecutive patients at seven hospitals was performed. Demographic and data on 18 ERAS components identified from a systematic review of the literature were collected. A multiregression analysis was performed to assess for factors independently associated with a total length of hospital stay of 5 days or less. Results: Fifty-five percent were male (mean age, 62 years), 57.5% had an ASA III or IV, 76.9% had cancer, and 28.6% had low rectal procedures; 46.3% were completed laparoscopically. The median length of stay was 6.5 days with a mean of 8.6 days. On bivariate analysis, strategies associated with a stay ≤5 days were preoperative counseling, avoidance of oral bowel preparation, use of a laparoscopic approach, use of a transverse incision, introduction of clear fluids on day of surgery, and early discontinuation of the Foley catheter (all P < 0.05). On multivariate analysis, factors that remained significantly associated with a stay ≤5 days included use of a laparoscopic approach (odds ratio (OR), 1.24; 95% confidence interval (CI), 1.12-1.38), preoperative counseling (OR, 1.26; 95% CI, 1.15-1.38), intraoperative fluid restriction (OR, 1.26; 95% CI, 1.15-1.37), clear fluids on day of surgery (OR, 1.09; 95% CI, 1.00-1.2), and Foley urinal catheter discontinued within 24 h of colon surgery and 72 h of rectal surgery (OR, 1.13; 95% CI, 1.01-1.27). Conclusions: In hospitals with variable uptake of ERAS strategies, preoperative counseling, intraoperative fluid restriction, use of a laparoscopic approach, immediate initiation of clear fluids after surgery, and early discontinuation of the Foley catheter are all independently associated with shortened length of stay.
机译：目的：提高术后恢复（ERAS）程序的目的是将策略纳入围手术期护理计划中，以减少并发症，加快恢复速度并缩短住院时间。这项研究旨在确定哪些ERAS策略有助于在医院进行选择性结直肠手术的患者总体住院时间的缩短。方法：对7家医院的336名连续患者进行回顾性队列研究。收集了从系统地回顾文献中发现的18个ERAS组成部分的人口统计学和数据。进行了多元回归分析，以评估与5天或更短总住院天数独立相关的因素。结果：55％的男性（平均年龄，62岁），57.5％的ASA III或IV，76.9％的癌症和28.6％的低位直肠手术;腹腔镜检查完成率为46.3％。中位住院时间为6.5天，平均为8.6天。在双变量分析中，与停留≤5天有关的策略是术前咨询，避免口服肠道准备，使用腹腔镜方法，使用横向切口，在手术当天引入透明液体以及及早停用Foley导管（所有P <0.05）。在多变量分析中，与停留≤5天仍显着相关的因素包括使用腹腔镜方法（优势比（OR）为1.24; 95％置信区间（CI）为1.12-1.38），术前咨询（OR为1.26; 95％CI，1.15-1.38），术中液体限制（OR，1.26; 95％CI，1.15-1.37），手术当天清除液体（OR，1.09; 95％CI，1.00-1.2）和Foley小便导管在结肠手术后24小时和直肠手术后72小时内停用（OR，1.13; 95％CI，1.01-1.27）。结论：在采用不同ERAS策略的医院中，术前咨询，术中液体限制，腹腔镜方法的使用，手术后立即开始清除液体以及Foley导管的早期中断均与住院时间缩短有关。

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