背景:为了改善患者预后,UT西南医学中心的脊柱综合中心实施了一项增强术后恢复(ERAS)方案,该方案包括术前和术后指南.许多研究表明,实施ERAS协议有利于根据最佳做法标准化围手术期护理;然而,关于并发症发生率的文献,LOS,再入院显示出不同的结果。
目的:本研究的目的是探讨ERAS方案实施对围手术期并发症发生率的影响。以及医院和ICU的住院时间和再入院率。
方法:对2016年9月至2021年9月在单一机构接受脊柱手术的所有患者进行了回顾性队列研究。符合纳入标准的患者分为非ERAS和ERAS组,并使用比较统计数据来评估ERAS方案的有效性。
方法:对2016年9月至2021年9月在UTSouthwestern接受脊柱手术的所有患者进行评估,以纳入研究。进一步细化患者样品以仅包括能够接受完整ERAS方案(非紧急入院)的复杂患者病例。
方法:是否存在包括手术部位感染在内的术后并发症,AKI,DVT,MI,脓毒症,肺炎,PE,中风,震惊,和其他并发症进行组间比较,以及医院和ICU的住院时间,以及7、30和90天的再入院。自我报告或功能测量未用于结果评估。
方法:使用EMR查询工具并由作者进行抽查,建立了患者和手术特征数据库。对照组和治疗组进行性别匹配,年龄,BMI,ASA得分,和手术类型。比较ERAS和非ERAS组的并发症发生率总数,并使用比较统计数据来确定显著性。
结果:发现ERAS与非ERAS组之间的UTI发生率存在显着差异(6.8%与3.1%,分别为;P=0.031),便秘(20.6%vs.11.4%,分别为;P=0.001),和任何并发症(31.4%vs.19.4%,分别;P<0.001)。其他并发症的发生率无显著差异,住院时间或ICU住院时间,或在7、30和90天重新入院。
结论:实施ERAS方案并未降低并发症发生率或住院时间,ERAS患者的UTI发生率明显较高,便秘,和任何并发症。由于COVID-19对护理提供的影响,可能存在混杂因素,以及ERAS目标和结果测量之间的错位。
BACKGROUND: With the goal of improving patient outcomes, the Integrated Spine Center at UT Southwestern Medical Center implemented an enhanced recovery after surgery (ERAS) protocol which includes pre- and post-surgery guidelines. Numerous studies have shown benefit of implementation of ERAS protocols to standardize perioperative care in line with best practices; however, the literature on complication rates, LOS, and readmissions shows mixed results.
OBJECTIVE: The goal of this
study was to investigate the impact of the ERAS protocol implementation on complication rates in the perioperative period, as well as hospital and ICU length of stay and hospital re-admission rates.
METHODS: A retrospective cohort
study was performed on all patients who underwent spine surgery between September 2016 and September 2021 at a single institution. Patients who met inclusion criteria were divided into non-ERAS and ERAS groups, and comparative statistics were used to evaluate ERAS protocol effectiveness.
METHODS: All patients who underwent spine surgery at UT Southwestern between September 2016 and September 2021 were evaluated for inclusion in the
study. The patient sample was further refined to include only complex patient cases which were able to receive the full ERAS protocol (non-emergent admissions).
METHODS: Presence of absence of post-operative complications including surgical site infection, AKI, DVT, MI, sepsis, pneumonia, PE, stroke, shock, and other complications were compared between groups, as were hospital and ICU length of stay, and 7, 30, and 90 day readmissions. Self-reported or functional measures were not used in outcome evaluation.
METHODS: A database of patient and surgery characteristics was built using an EMR query tool with spot checks performed by the authors. Control and treatment groups were matched for gender, age, BMI, ASA score, and surgery type. Total number of complication rates was compared between ERAS and non-ERAS groups, and comparative statistics were used to determine significance.
RESULTS: Significant differences between ERAS versus non-ERAS groups were found in rates of UTI (6.8% vs. 3.1%, respectively; p=.031), constipation (20.6% vs. 11.4%, respectively; p=.001), and any complications (31.4% vs. 19.4%, respectively; p<.001). There was no significant difference in the rates of other complications, in length of hospital or ICU stay, or readmissions at 7, 30, and 90 days.
CONCLUSIONS: Implementation of the ERAS protocol did not decrease complication rates or length of stay, and ERAS patients had significantly higher rates of UTI, constipation, and any complications. There may have been confounding factors due to the impact of COVID-19 on delivery of care, as well as misalignment between ERAS goals and outcome measures.