背景:手术后增强恢复(ERAS)已被证明对接受骨科手术的患者有益。然而,ERAS在转移性硬膜外脊髓压迫症(MESCC)中的应用尚不明确.
目的:本研究旨在建立一种植根于ERAS概念的医疗途径,最终目标是研究其在改善MESCC患者术后结局方面的疗效。
方法:一项观察性队列研究。
方法:收集了2016年1月至2023年1月在两家大型三级医院接受手术的304例MESCC患者。
方法:手术相关变量,患者生活质量,和疼痛的结果。研究中与手术相关的变量包括手术时间,手术部位,术中失血,和并发症。
方法:从2020年1月起,在这两个机构中对MESCC患者实施ERAS治疗。因此,ERAS队列包括2020年1月至2023年1月接受手术的138例MESCC患者,而传统队列包括2016年1月至2019年12月接受手术的166例MESCC患者.临床基线特征,手术相关特征,收集手术结果。使用癌症治疗功能评估-一般量表(FACT-G)评估患者的生活质量,使用视觉模拟评分(VAS)评估疼痛结果。
结果:基线特征的比较显示两个队列相似(均P>0.050),表明临床特征的可比分布。就手术结果而言,ERAS队列中的患者表现出较低的术中失血量(P<0.001),术后住院时间短(P<0.001),围手术期并发症发生率较低(P=0.020),以及明显缩短了步行时间(P<0.001),恢复规律饮食(P<0.001),拔除导尿管(P<0.001),开始放射治疗(P<0.001),与传统队列中的患者相比,开始系统内部治疗(P<0.001)。关于疼痛结果和生活质量,接受ERAS计划的患者表现出明显较低的VAS评分(P<0.010)和较高的物理评分(P<0.001),社会(P<0.001),情绪(P<0.001),和功能(P<0.001)与传统队列患者相比。
结论:ERAS计划,以其加快术后恢复的能力而闻名,作为改善MESCC患者康复过程的一种有希望的方法。它不仅在增强疼痛管理结果方面表现出潜力,但它也有望提高这些人的整体生活质量。未来的调查应该更深入地研究ERAS计划的复杂组成部分,旨在揭示其对患者预后的显着影响的确切机制。
BACKGROUND: Enhanced recovery after surgery (ERAS) has proven beneficial for patients undergoing orthopedic surgery. However, the application of ERAS in the context of metastatic epidural spinal cord compression (MESCC) remains undefined.
OBJECTIVE: This study aims to establish a medical pathway rooted in the ERAS concept, with the ultimate goal of scrutinizing its efficacy in enhancing postoperative outcomes among patients suffering from MESCC.
METHODS: An observational cohort study.
METHODS: A total of 304 patients with MESCC who underwent surgery were collected between January 2016 and January 2023 at two large tertiary hospitals.
METHODS: Surgery-related variables, patient quality of life, and pain outcomes. Surgery-related variables in the study included surgery time, surgery site, intraoperative blood loss, and complication.
METHODS: From January 2020 onwards, ERAS therapies were implemented for MESCC patients in both institutions. Thus, the ERAS cohort included 138 patients with MESCC who underwent surgery from January 2020 to January 2023, whereas the traditional cohort consisted of 166 patients with MESCC who underwent surgery from January 2016 to December 2019. Clinical baseline characteristics, surgery-related features, and surgical outcomes were collected. Patient quality of life was evaluated using the Functional Assessment of Cancer Therapy-General Scale (FACT-G), and pain outcomes were assessed using the Visual Analogue Scale (VAS).
RESULTS: Comparison of baseline characteristics revealed that the two cohorts were similar (all p>.050), indicating comparable distribution of clinical characteristics. In terms of surgical outcomes, patients in the ERAS cohort exhibited lower intraoperative blood loss (p<.001), shorter postoperative hospital stays (p<.001), lower perioperative complication rates (p=.020), as well as significantly shorter time to ambulation (P<0.001), resumption of regular diet (p<.001), removal of urinary catheter (p<.001), initiation of radiation therapy (p<.001), and initiation of systemic internal therapy (p<.001) compared with patients in the traditional cohort. Regarding pain outcomes and quality of life, patients undergoing the ERAS program demonstrated significantly lower VAS scores (p<.010) and higher scores for physical (p<.001), social (p<.001), emotional (p<.001), and functional (p<.001) well-being compared with patients in the traditional cohort.
CONCLUSIONS: The ERAS program, renowned for its ability to expedite postoperative recuperation, emerges as a promising approach to ameliorate the recovery process in MESCC patients. Not only does it exhibit potential in enhancing pain management outcomes, but it also holds the promise of elevating the overall quality of life for these individuals. Future investigations should delve deeper into the intricate components of the ERAS program, aiming to unravel the precise mechanisms that underlie its remarkable impact on patient outcomes.