在非选择性结直肠手术后改善康复:是时候让紧急整形外科医生效仿了吗?
Ryan Downey1, Kunal Verma1, Audrene Edwards1
1Baylor Scott & White Memorial Hospital Temple, TX, USA.
American journal of surgery
|July 26, 2024
概括
增强恢复 (ERAS) 途径可以在非选择性结直肠手术中实施,挑战以前的外科手术教条. 关键的ERAS指标与该患者群体的手术部位感染 (SSI) 减少有关.
科学领域:
- 结肠直肠手术 结肠直肠手术
- 外科手术的结果
- 增强的恢复途径
背景情况:
- 传统的外科实践往往将增强恢复 (ERAS) 途径排除在非选择性手术之外.
- 这项研究调查了ERAS在非选择性结直肠外科手术中的可行性和影响,挑战了已有的外科教条.
- 通常情况下,ERAS协议只适用于选择性的外科病例.
研究的目的:
- 评估ERAS途径在非选择性结直肠外科手术中的实施和有效性.
- 根据ERAS原则管理的选择性和非选择性结直肠手术之间的结果进行比较.
- 确定特定的ERAS指标,在非选择性情况下与改善结果相关.
主要方法:
- 在ERAS实施后,针对非选择性病例进行了结直肠手术的单一中心审查.
- 对选择性和非选择性患者队列的ERAS协议的遵守率进行了评估.
- 结果,包括停留时间 (LOS) 和手术部位感染 (SSI) 率,在各组之间进行了比较.
主要成果:
- 在选择性结直肠手术中,遵守ERAS途径的比例为84%,在非选择性结直肠手术中为46%.
- 与非选择性手术患者相比,非选择性手术患者的平均LOS时间更长 (8天 vs. 3天) 和SSI率更高 (15% vs. 1%).
- 多变量分析表明,五个特定的ERAS指标与降低的SSI费率有显著联系.
结论:
- 在非选择性环境中经常被忽视的ERAS途径,在结直肠外科手术中证明了可行性和潜在的益处.
- 急性护理外科医生应适应和实施适当的ERAS原则,以适应非选择性手术患者.
- 对ERAS指标的有针对性的应用可以改善非选择性结直肠手术的结果,并减少非选择性结直肠手术的并发症.
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