实施增强恢复方案（ERAS）在结直肠手术中的成本效益分析及短期结局：一种倾向评分匹配分析

Cost-benefit analysis and short-term outcomes after implementing an ERAS protocol for colorectal surgery: a propensity score-matched analysis

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Techniques in Coloproctology

影响因子:2.9

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

DOI: 10.1007/s10151-024-02997-1

keywords: Colorectal surgery; Cost-effectiveness; ERAS; Protocol compliance

摘要

增强康复外科（ERAS）在腹部手术的术后管理中日益普及。已有研究显示，采用ERAS方案的患者更少发生轻度和重度并发症，并显著降低医疗不良事件（如泌尿系统和呼吸系统感染）。关于手术相关并发症的资料较少。本文旨在评估ERAS方案对术后并发症和住院时间的影响，以及其在成本效益方面的作用。2016年1月至2022年12月期间，在三级医院对532例结直肠癌（CRC）患者进行了观察研究，纳入年龄在18岁及以上的非急诊手术患者。通过倾向评分匹配，将接受ERAS和非ERAS管理的患者进行比较，分析其对术后并发症、住院时间和经济影响的作用。匹配后，每组各71名患者，临床病理特征在肿瘤类型、手术技术和手术方式上均衡。结果显示，ERAS组感染性并发症明显减少，术后住院时间缩短（p < 0.001），其中吻合口瘫裂率降低8.5%（p = 0.012），手术伤口感染率降低（p = 0.029）。在其他医疗并发症方面，尿路感染、肺炎、胃肠出血和败血症无显著差异。ERAS方案比对照组更高效、更具成本效益，整体节省37,673.44欧元。结论显示，在三级医院推广ERAS方案进行择期结直肠手术具有良好的成本效益，能显著减少术后并发症，尤其是感染性并发症。

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.