目的:研究提高对当代围手术期护理措施的依从性的影响,正如增强术后恢复(ERAS)指南所概述的那样,在接受根治性膀胱切除术(RC)的患者中。
方法:从国家外科质量改善计划数据库中,我们捕获了2019年至2021年接受RC的患者。我们确定了五种围手术期护理措施:区域麻醉阻滞,血栓栓塞预防,≤24h围手术期抗生素给药,没有肠道准备,和早期口服饮食。我们通过使用的措施数量(一到五个)对患者进行分层。统计终点包括30天并发症,住院时间(LOS),再入院,和最优RC结果。最佳RC结果定义为没有任何术后并发症,重新操作,LOS延长(第75百分位数,8天),没有再入院。使用Bonferroni校正进行多变量回归,以评估当代围手术期护理措施的使用与结果之间的关联。
结果:在3702名接受RC的患者中,73(2%),417(11%),1010(27%),1454(39%),748人(20%)收到一份,两个,三,四,和五项干预措施,分别。在多变量分析中,增加围手术期护理措施与任何并发症的几率较低相关(比值比[OR]0.66,99%置信区间[CI]0.6-0.73),和较短的LOS(β-0.82,99%CI-0.99至-0.65)。此外,对现代护理措施依从性增加的患者获得最佳结局的几率增加(OR1.38,99%CI1.26~1.51).
结论:在我们评估的指标中,在接受RC的患者中,更高的依从性改善了术后结局.我们的工作支持ERAS方案在降低与RC相关的发病率方面的功效。
OBJECTIVE: To examine the impact of increased compliance to contemporary perioperative care measures, as outlined by enhanced recover after surgery (ERAS) guidelines, among patients undergoing radical cystectomy (RC).
METHODS: From the National Surgical Quality Improvement Program database we captured patients undergoing RC between 2019 and 2021. We identified five perioperative care measures: regional anaesthesia block, thromboembolism prophylaxis, ≤24 h perioperative antibiotic administration, absence of bowel preparation, and early oral diet. We stratified patients by the number of measures utilised (one to five). Statistical endpoints included 30-day complications, hospital length of stay (LOS), readmissions, and optimal RC outcome. Optimal RC outcome was defined as absence of any postoperative complication, re-operation, prolonged LOS (75th percentile, 8 days) with no readmission. Multivariable regressions with Bonferroni correction were performed to assess the association between use of contemporary perioperative care measures and outcomes.
RESULTS: Of the 3702 patients who underwent RC, 73 (2%), 417 (11%), 1010 (27%), 1454 (39%), and 748 (20%) received one, two, three, four, and five interventions, respectively. On multivariable analysis, increased perioperative care measures were associated with lower odds of any complication (odds ratio [OR] 0.66, 99% confidence interval [CI] 0.6-0.73), and shorter LOS (β -0.82, 99% CI -0.99 to -0.65). Furthermore, patients with increased compliance to contemporary care measures had increased odds of an optimal outcome (OR 1.38, 99% CI 1.26-1.51).
CONCLUSIONS: Among the measures we assessed, greater adherence yielded improved postoperative outcomes among patients undergoing RC. Our work supports the efficacy of ERAS protocols in reducing the morbidity associated with RC.