成功实施手术后的恢复恢复的影响
Impact of Successful Implementation of an Enhanced Recovery After Surgery Protocol for Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy
影响因子:3.50000
分区:医学2区 / 外科2区 肿瘤学3区
发表日期:2023 Dec
作者:
Beatrice J Sun, Tiffany M Yue, Nova Xu, Cedar Fowler, Byrne Lee
摘要
细胞减少手术和高温腹膜内化疗（CRS/HIPEC）是治疗腹膜转移的复杂操作。手术后的恢复（ERA）方案的增强旨在标准化术前，术中和术后途径，以改善患者护理。这项研究描述了在三级学术中心实施CRS/HIPEC的时代协议后的可行性和结果。从2020年1月至2023年3月，对CRS/HIPEC的单一机构经验进行了审查。患者是根据在ARAS启动之前还是在ARAS启动之前或之后对CRS/HIPEC进行了分类。评估了结果和协议依从性。在实施之前，总共包括115个CRS/HIPEC操作，而ERAS实施后41个。在频道后组中，中位年龄年龄较小，而性别，合并症，腹膜癌指数，执行手术和手术时间相似。最常见的原发性癌症部位是妇科（40％），阑尾（24％）和结直肠癌（22％）。遵守所有术后时代成分的依从性为76％。通过术后日（POD）1（90％vs. 54％; P <0.001）的越来越多的ERAS患者，POD 2（88％vs. 32％; P <0.001）耐受液体饮食，并被POD 3（86％vs. 43％vs. 43％; P <0.001）取出。在埃拉斯后队列中停留长度的趋势趋势（7天vs. 8天； p = 0.092），在重大并发症，重症监护病房的入院或30天的再入院中没有差异。尽管CRS/HIPEC操作的异质性是为我们的患者进行的异质性，但在我们的患者中实施了eras方案，并且在后表现出了其他效果和其他效果。这支持了CRS/HIPEC患者的时代计划成功的潜力。
Abstract
Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) are complex operations for the treatment of peritoneal metastases. Enhanced recovery after surgery (ERAS) protocols are intended to standardize preoperative, intraoperative, and postoperative pathways, with the goal of improving patient care. This study describes feasibility and outcomes after implementing an ERAS protocol for CRS/HIPEC at a tertiary academic center.A single-institution experience of CRS/HIPEC was reviewed from January 2020 to March 2023. Patients were categorized according to whether they underwent CRS/HIPEC before or after ERAS initiation. Outcomes and protocol adherence were evaluated.A total of 115 CRS/HIPEC operations were included-74 before and 41 after ERAS implementation. Median age was younger in the post-ERAS group, whereas sex, comorbidities, peritoneal carcinomatosis index, operation performed, and operative time were similar between groups. The most common primary cancer sites were gynecologic (40%), appendiceal (24%), and colorectal (22%). Adherence to all postoperative ERAS components was 76%. More post-ERAS patients ambulated by postoperative day (POD) 1 (90% vs. 54%; p < 0.001), tolerated liquid diet by POD 2 (88% vs. 32%; p < 0.001), and had foley removed by POD 3 (86% vs. 43%; p < 0.001). There was a trend toward decreased length of stay in the post-ERAS cohort (7 vs. 8 days; p = 0.092), with no difference in major complications, intensive care unit admission, or 30-day readmission.Despite the heterogeneity of CRS/HIPEC operations, implementing an ERAS protocol for our patients was feasible and resulted in postoperative outcomes and adherence comparable with that of other major abdominal surgeries. This supports the potential for success in ERAS programs for CRS/HIPEC patients.