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在手术后增强恢复 (ERAS) 研究中的挑战

Dileep N Lobo¹, Girish P Joshi², Henrik Kehlet³

¹Nottingham Digestive Diseases Centre, Division of Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK; National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, UK; MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK; Division of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.

British journal of anaesthesia

|July 27, 2024

概括

手术后增强恢复 (ERAS) 途径减少了住院时间,但个性化的方法至关重要. 确定ERAS的基本要素需要将大型试验与详细的观察性研究进行平衡,以有效实施.

科学领域:

外科手术的途径
患者恢复协议的患者恢复协议.
医疗保健管理的管理

背景情况:

手术后增强恢复 (ERAS) 途径通常被接受,以减少住院时间.
实施ERAS的一个重大挑战是缺乏特定于程序和患者的方法.
过度复杂化可能导致选择性遵守,称为"部分ERAS",可能会损害结果.

研究的目的:

解决ERAS途径中需要程序和患者特定方法的需求.
确定ERAS的基本要素,以实现广泛实施.
探索不同研究设计之间的最佳平衡,以推进ERAS研究.

主要方法:

审查关于ERAS途径实施和挑战的现有文献.
分析合规性和途径复杂性对结果的影响.
关于随机临床试验 (RCT) 与观察性研究在ERAS研究中的作用的讨论.

主要成果:

符合ERAS途径与改善患者结果相关.
由于过度复杂化或桃挑选元素的"部分ERAS"方法是一个公认的问题.
很少有高质量的RCT评估单个ERAS元素.

结论:

个性化,程序和患者特定的方法对于有效实施ERAS至关重要.
需要进一步的研究来确定ERAS的基本组成部分,平衡RCT和观察性研究.
优化ERAS需要一个细微的理解超出一般的路径坚持,以避免"部分ERAS".

关键词:

在手术后改善恢复.快速进行手术的手术.未来的发展未来的发展术后并发症术后并发症研究的研究研究的研究.

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