结直肠外科手术增强恢复计划的哪些单个组成部分与改善的外科手术结果有关?
Bayley A Jones1, Bethany Brock2, Joshua Richman2
1Department of Surgery, University of Alabama at Birmingham, AL. Electronic address: https://twitter.com/bayley_jones.
Surgery
|July 13, 2024
概括
增强的恢复计划显著改善了外科手术的结果. 早期动员和避免鼻胃管等关键组成部分减少了结直肠手术患者的住院时间和并发症.
科学领域:
- 结肠直肠手术 结肠直肠手术
- 外科手术的结果
- 增强的恢复程序 恢复程序
背景情况:
- 增强恢复计划 (ERP) 旨在优化手术患者的治疗结果.
- 个人ERP组件对逗留时间,再录取和并发症等结果的具体影响需要进一步澄清.
研究的目的:
- 调查全面增强恢复计划的单个组件的坚持与选择性结直肠手术中的外科结果之间的关联.
- 确定影响居留时间,再接收率和并发症率的关键ERP组件.
主要方法:
- 对1175名选择性结直肠手术患者 (2019-2022) 的回顾性研究.
- 从机构ERP仪表板和ACS-NSQIP数据库收集的数据.
- 分析包括传统的统计方法和机器学习分类树.
主要成果:
- 多个ERP组件与停留时间 (LOS) 的缩短有关,包括手术前教育,区域止痛疗法,多式止痛疗法,没有鼻胃管,早期动员,早期饮食,早期静脉输液停止,VTE预防和早期福利切除.
- 坚持不长时间禁食的做法使再接收率降低了4.1%.
- 没有鼻胃管,早期动员,早期饮食,多式止痛疗法和早期静脉输液中止显著降低了并发症率 (7.028.2%). 机器学习发现没有鼻胃管和早期IV液体停止作为较短的LOS的预测因素,也没有鼻胃管和早期动员作为减少并发症的预测因素.
结论:
- 几个ERP组件与改善的外科结果有关,没有鼻胃管,早期动员,早期定期饮食,术后多式止痛,以及早期停止维护IV液,影响多个结果.
- 专注于这些高影响力的组件可以提高ERP的可行性,特别是在资源有限的环境中.
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