实施结直肠手术的时代方案后，成本效益分析和短期结果：倾向得分匹配分析
Cost-benefit analysis and short-term outcomes after implementing an ERAS protocol for colorectal surgery: a propensity score-matched analysis
影响因子:2.90000
分区:医学3区 / 胃肠肝病学3区 外科3区
发表日期:2024 Sep 23
作者:
I Ruiz Torres, A B Serrano, L D Juez, A Ballestero Pérez, J Ocaña Jiménez, J Die Trill, J M Fernandez Cebrian, J C García Pérez
摘要
手术后（ERA）的恢复增强在腹部手术的术后治疗中变得越来越流行。已发表的数据表明，关于时代方案的患者的轻微和重大并发症较少，并突出了医疗发病率的降低（例如尿和呼吸道感染）。有关手术并发症的数据有限。该研究的目的是评估时代方案对术后并发症和住院时间长度的影响。此外，我们旨在确定该方案对成本效益的影响。从2016年1月到2022年12月，进行了532个结肠癌（CRC）。在三级医院对18岁及以上的患者队列进行了一项前瞻性观察性研究，该研究针对非紧迫性大肠癌进行了操作。两组分析了对术后并发症，住院住院和经济影响的影响：根据ERAS和非ERAS方案进行管理的患者。在两组之间进行了倾向得分匹配分析。在匹配1：1之后，每个队列包括71名患者，临床病理学特征在肿瘤类型，手术技术和手术方法方面都具有很好的平衡。时代患者的感染并发症和术后较短的住院时间更少（p <0.001）。特别是，它们的吻合性裂开（p = 0.012）和手术伤口感染（p = 0.029）降低了8.5％。在分析了医学并发症后，在尿路感染，肺炎，胃肠道出血或败血症中未发现统计学上的显着差异。时代协议比对照组更有效，更具成本效益，总体节省37,673.44欧元。在高等教育医院中，增强的恢复恢复方案的实施具有成本效益，并且与术后术后并发症的减少有关，尤其是感染性的并发症。
Abstract
Enhanced Recovery After Surgery (ERAS) has become increasingly popular in the post-operative management of abdominal surgery. Published data suggest that patients on ERAS protocols have fewer minor and major complications, and highlight a reduction in medical morbidity (such as urinary and respiratory infections). Limited data is available on surgical complications. The aim of the study was to evaluate the impact of the ERAS protocol on post-operative complications and length of hospital stay. Furthermore, we aimed to determine the impact of this protocol on cost-effectiveness.From January 2016 to December 2022, 532 colectomies for colorectal cancer (CRC) were performed. A prospective observational study was conducted in a tertiary hospital on the cohort of patients, aged 18 years and older, operated on for non-urgent colorectal cancer. The impact on post-operative complications, hospital stay and economic impact was analysed in two groups: patients managed under ERAS and non-ERAS protocol. A propensity score-matching analysis was performed between the two groups.After propensity score matching 1:1, each cohort included 71 patients, and clinicopathological characteristics were well balanced in terms of tumour type, surgical technique and surgical approach. ERAS patients experienced fewer infectious complications and a shorter postoperative stay (p < 0.001). In particular, they had an 8.5% reduction in anastomotic dehiscence (p = 0.012) and surgical wound infections (p = 0.029). After analysis of medical complications, no statistically significant differences were identified in urinary tract infections, pneumonia, gastrointestinal bleeding or sepsis. ERAS protocol was more efficient and cost-effective than the control group, with an overall savings of 37,673.44€.The implementation of an enhanced recovery protocol for elective colorectal surgery in a tertiary hospital was cost-effective and associated with a reduction in post-operative complications, especially infectious complications.