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Abstract：
UNASSIGNED: Enhanced Recovery After Surgery (ERAS) protocol for esophagectomy may reduce the high incidence of postoperative morbidity and mortality. The aim of this study was to assess the impact of properly conducted ERAS protocol with specific emphasis on fluid balance and opioid-sparing anesthesia (OSA) on postoperative major morbidity and mortality after esophagectomy.
UNASSIGNED: Patients undergoing elective esophagectomy for esophageal cancer at the Hospital for Digestive Surgery, University Clinical Center of Serbia, from December 2017 to March 2021, were included in this retrospective observational study. Patients were divided into two groups: the ERAS group (OSA, intraoperative goal-directed therapy, and postoperative “near-zero” fluid balance) and the control group (opioid-based anesthesia, maintenance mean blood pressure ≥ 65 mmHg, and liberal postoperative fluid management). The primary outcome was major morbidity within 30 days from surgery and 30-day and 90-day mortality. Multivariable analysis was used to examine the effect of the ERAS protocol.
UNASSIGNED: A total of 121 patients were divided into the ERAS group (69 patients) and the control group (52 patients). Patients in the ERAS group was received less fentanyl, median 300 (interquartile range (IQR), 200–1,550) mcg than in control group, median 1,100 (IQR, 650–1750) mcg, p < 0.001. Median intraoperative total infusion was lower in the ERAS group, 2000 (IQR, 1000–3,750) mL compared to control group, 3,500 (IQR, 2000–5,500) mL, p < 0.001. However, intraoperative norepinephrine infusion was more administered in the ERAS group (52.2% vs. 7.7%, p < 0.001). On postoperative day 1, median cumulative fluid balance was 2,215 (IQR, −150-5880) mL in the ERAS group vs. 4692.5 (IQR, 1770–10,060) mL in the control group, p = 0.002. After the implementation of the ERAS protocol, major morbidity was less frequent in the ERAS group than in the control group (18.8% vs. 75%, p < 0.001). There was no statistical significant difference in 30-day and 90-day mortality (p = 0.07 and p = 0.119, respectively). The probability of postoperative major morbidity and interstitial pulmonary edema were higher in control group (OR 5.637; CI95%:1.178–10.98; p = 0.030 and OR 5.955; CI95% 1.702–9.084; p < 0.001, respectively).
UNASSIGNED: A major morbidity and interstitial pulmonary edema after esophagectomy were decreased after the implementation of the ERAS protocol, without impact on overall mortality.
UNASSIGNED: Patients undergoing elective esophagectomy for esophageal cancer at the Hospital for Digestive Surgery, University Clinical Center of Serbia, from December 2017 to March 2021, were included in this retrospective observational study. Patients were divided into two groups: the ERAS group (OSA, intraoperative goal-directed therapy, and postoperative “near-zero” fluid balance) and the control group (opioid-based anesthesia, maintenance mean blood pressure ≥ 65 mmHg, and liberal postoperative fluid management). The primary outcome was major morbidity within 30 days from surgery and 30-day and 90-day mortality. Multivariable analysis was used to examine the effect of the ERAS protocol.
UNASSIGNED: A total of 121 patients were divided into the ERAS group (69 patients) and the control group (52 patients). Patients in the ERAS group was received less fentanyl, median 300 (interquartile range (IQR), 200–1,550) mcg than in control group, median 1,100 (IQR, 650–1750) mcg, p < 0.001. Median intraoperative total infusion was lower in the ERAS group, 2000 (IQR, 1000–3,750) mL compared to control group, 3,500 (IQR, 2000–5,500) mL, p < 0.001. However, intraoperative norepinephrine infusion was more administered in the ERAS group (52.2% vs. 7.7%, p < 0.001). On postoperative day 1, median cumulative fluid balance was 2,215 (IQR, −150-5880) mL in the ERAS group vs. 4692.5 (IQR, 1770–10,060) mL in the control group, p = 0.002. After the implementation of the ERAS protocol, major morbidity was less frequent in the ERAS group than in the control group (18.8% vs. 75%, p < 0.001). There was no statistical significant difference in 30-day and 90-day mortality (p = 0.07 and p = 0.119, respectively). The probability of postoperative major morbidity and interstitial pulmonary edema were higher in control group (OR 5.637; CI95%:1.178–10.98; p = 0.030 and OR 5.955; CI95% 1.702–9.084; p < 0.001, respectively).
UNASSIGNED: A major morbidity and interstitial pulmonary edema after esophagectomy were decreased after the implementation of the ERAS protocol, without impact on overall mortality.
摘要：
■食管切除术的术后增强恢复（ERAS）方案可以降低术后发病率和死亡率的高发生率。这项研究的目的是评估适当进行的ERAS方案，特别强调液体平衡和阿片类药物保留麻醉（OSA）对食管切除术后主要发病率和死亡率的影响。
■在消化外科医院接受食道癌选择性食管癌切除术的患者，塞尔维亚大学临床中心，2017年12月至2021年3月,纳入本回顾性观察性研究.患者分为两组：ERAS组（OSA，术中目标导向治疗,和术后“接近零”的液体平衡）和对照组（基于阿片类药物的麻醉，维持平均血压≥65mmHg，和宽松的术后液体管理）。主要结果是手术后30天内的主要发病率以及30天和90天的死亡率。多变量分析用于检查ERAS方案的效果。
■共121例患者分为ERAS组（69例）和对照组（52例）。ERAS组患者接受较少的芬太尼，中位数300(四分位数间距(IQR)，200-1,550)mcg比对照组，中位数1100（IQR，650-1750)mcg，p<0.001。ERAS组的术中总输注中位数较低，2000(IQR，与对照组相比，1000-3,750）mL，3,500（IQR，2000-5,500)mL,p<0.001。然而,ERAS组术中输注去甲肾上腺素更多(52.2%vs.7.7%,p<0.001)。术后第1天，累积液体平衡中位数为2,215(IQR，−150-5880）mL在ERAS组中与4692.5(IQR,对照组为1770-10,060)mL,p=0.002。ERAS协议实施后,ERAS组的主要发病率低于对照组(18.8%vs.75%,p<0.001)。30天和90天死亡率没有统计学上的显着差异（分别为p=0.07和p=0.119）。对照组术后主要发病率和间质性肺水肿的概率较高（OR5.637；CI95％：1.178-10.98；p=0.030和OR5.955；CI95％1.702-9.084；p<0.001）。
■实施ERAS方案后，食管切除术后的主要发病率和间质性肺水肿降低，对总死亡率没有影响。
■在消化外科医院接受食道癌选择性食管癌切除术的患者，塞尔维亚大学临床中心，2017年12月至2021年3月,纳入本回顾性观察性研究.患者分为两组：ERAS组（OSA，术中目标导向治疗,和术后“接近零”的液体平衡）和对照组（基于阿片类药物的麻醉，维持平均血压≥65mmHg，和宽松的术后液体管理）。主要结果是手术后30天内的主要发病率以及30天和90天的死亡率。多变量分析用于检查ERAS方案的效果。
■共121例患者分为ERAS组（69例）和对照组（52例）。ERAS组患者接受较少的芬太尼，中位数300(四分位数间距(IQR)，200-1,550)mcg比对照组，中位数1100（IQR，650-1750)mcg，p<0.001。ERAS组的术中总输注中位数较低，2000(IQR，与对照组相比，1000-3,750）mL，3,500（IQR，2000-5,500)mL,p<0.001。然而,ERAS组术中输注去甲肾上腺素更多(52.2%vs.7.7%,p<0.001)。术后第1天，累积液体平衡中位数为2,215(IQR，−150-5880）mL在ERAS组中与4692.5(IQR,对照组为1770-10,060)mL,p=0.002。ERAS协议实施后,ERAS组的主要发病率低于对照组(18.8%vs.75%,p<0.001)。30天和90天死亡率没有统计学上的显着差异（分别为p=0.07和p=0.119）。对照组术后主要发病率和间质性肺水肿的概率较高（OR5.637；CI95％：1.178-10.98；p=0.030和OR5.955；CI95％1.702-9.084；p<0.001）。
■实施ERAS方案后，食管切除术后的主要发病率和间质性肺水肿降低，对总死亡率没有影响。
