实施结构化多中心术后强化恢复(ERAS)方案对结直肠手术后住院时间的影响。

IF 3.5 3区 医学 Q1 SURGERY BJS Open Pub Date : 2024-09-03 DOI:10.1093/bjsopen/zrae094
Zubair Bayat, Anand Govindarajan, J Charles Victor, Erin D Kennedy
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引用次数: 0

摘要

背景:手术后住院时间的延长与医疗保健使用的增加和患者的不良预后有关。虽然在试验环境中,增强术后恢复(ERAS)方案已被证明可以缩短结直肠手术后的住院时间,但其在实际环境中的效果还不确定。本研究旨在利用真实世界的数据评估ERAS方案的实施对结直肠手术后住院时间的影响:方法:2012 年,作为 iERAS 研究的一部分,安大略省 15 家医院引入了 ERAS 协议。利用卫生行政数据建立了 2008 年至 2019 年期间在这些医院接受结直肠手术治疗的患者队列。计算了ERAS实施前后的平均住院时间。针对预定义的亚组,即所有结直肠手术、无并发症结直肠手术、右侧结直肠手术和左侧结直肠手术,进行了间断时间序列分析。然后使用调整后的住院时间进行敏感性分析,考虑住院时间的预测因素,包括:患者年龄、性别、边缘化程度、并发症和诊断;外科医生的病例量、从业年限和结直肠手术专长;医院规模;以及其他背景因素,包括手术类型和时间、手术方式和院内并发症:研究期间,共有 32 612 名患者接受了结直肠手术。ERAS的实施使住院时间缩短了1.05天(13.7%)。更复杂手术的住院时间缩短幅度更大,左侧结直肠手术患者亚组的住院时间缩短了 1.17 天(15.6%)。在所有分析中,观察到的住院时间缩短在研究间隔期内都是持久的。在对住院时间的预测因素进行调整后,ERAS的实施对住院时间的影响更大(缩短了1.46天):结论:采用正式的ERAS方案可显著缩短结直肠手术后的住院时间,与住院时间缩短的时间趋势无关。这些效果是持久的,表明实施ERAS方案是减少结直肠手术后住院时间的有效医院干预措施。
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Impact of structured multicentre enhanced recovery after surgery (ERAS) protocol implementation on length of stay after colorectal surgery.

Background: Increased length of stay after surgery is associated with increased healthcare utilization and adverse patient outcomes. While enhanced recovery after surgery (ERAS) protocols have been shown to reduce length of stay after colorectal surgery in trial settings, their effectiveness in real-world settings is more uncertain. The aim of this study was to assess the impact of ERAS protocol implementation on length of stay after colorectal surgery, using real-world data.

Methods: In 2012, ERAS protocols were introduced at 15 Ontario hospitals as part of the iERAS study. A cohort of patients undergoing colorectal surgery treated at these hospitals between 2008 and 2019 was created using health administrative data. Mean length of stay was computed for the intervals before and after ERAS implementation. Interrupted time series analyses were performed for predefined subgroups, namely all colorectal surgery, colorectal surgery without complications, right-sided colorectal surgery, and left-sided colorectal surgery. Sensitivity analyses were then conducted using adjusted length of stay, accounting for length of stay predictors, including: patient age, sex, marginalization, co-morbidities, and diagnosis; surgeon volume of cases, years in practice, and colorectal surgery expertise; hospital volume; and other contextual factors, including procedure type and timing, surgical approach, and in-hospital complications.

Results: A total of 32 612 patients underwent colorectal surgery during the study interval. ERAS implementation led to a decrease in length of stay of 1.05 days (13.7%). Larger decreases in length of stay were seen with more complex surgeries, with a level change of 1.17 days (15.6%) noted for the subgroup of patients undergoing left-sided colorectal surgery. The observed decreases in length of stay were durable for the length of the study interval in all analyses. When adjusting for predictors of length of stay, the effect of ERAS implementation on length of stay was larger (reduction of 1.46 days).

Conclusion: Introducing formal ERAS protocols reduces length of stay after colorectal surgery significantly, independent of temporal trends toward decreasing length of stay. These effects are durable, demonstrating that ERAS protocol implementation is an effective hospital-level intervention to reduce length of stay after colorectal surgery.

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BJS Open
BJS Open SURGERY-
CiteScore
6.00
自引率
3.20%
发文量
144
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