在医院网络中实施子宫切除手术后增强恢复,并进行审计和反:一个阶梯集群随机试验
Elisa Piovano1, Andrea Puppo2, Marco Camanni3
1Obstetrics and Gynaecology Unit 2U, Sant'Anna Hospital, AOU Città della Salute e della Scienza di Torino, Turin, Italy.
BJOG : an international journal of obstetrics and gynaecology
|February 26, 2024
概括
实施手术后增强恢复 (ERAS) 协议与审计和反 (A&F) 改善了宫切除患者的合规性. 然而,这并没有显著减少住院或并发症,这表明需要更高的遵守临床益处.
科学领域:
- 手术创新和患者的结果.
- 医疗保健质量改善倡议.
- 在区域网络中实施临床协议.
背景情况:
- 手术后增强恢复 (ERAS) 协议旨在优化患者的康复.
- 审计和反 (A&F) 是一种促进遵守临床指南的策略.
- 选择性子宫切除术是一种常见的妇科手术,其中协议的实施可能是有益的.
研究的目的:
- 评估ERAS协议在选择性切除子宫的患者中的有效性.
- 评估密集审计和反 (A&F) 方法对ERAS协议实施的影响.
- 测量住院时间 (LOS) 和并发症率的变化.
主要方法:
- 一个多中心,阶梯集群随机试验,涉及意大利23个妇科单位.
- 包括接受选择性子宫切除术的患者.
- 在A&F的支持下,ERAS协议在各单位顺序实施,并与标准护理周期进行比较.
主要成果:
- 遵守ERAS协议的比例显著增加,从A&F方法的60%增加到76%.
- 没有观察到医院住院时间 (LOS) 的显著减少 (3.5 vs 3.2 天).
- 在对照期和ERAS期之间,并发症的发生没有差异.
结论:
- 在区域一级,A&F方法有效提高了ERAS协议的合规性.
- 提高合规性并没有导致LOS或并发症的显著减少.
- 为了实现有意义的临床结果改善,可能需要更严格地遵守ERAS协议.
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