Enhanced recovery after fetal spina bifida surgery: global practice.

IF 6.1 1区医学 Q1 ACOUSTICS

Ultrasound in Obstetrics & Gynecology Pub Date : 2024-11-01 Epub Date: 2024-10-10 DOI:10.1002/uog.27701

K Nulens, Y Kunpalin, K Nijs, J C A Carvalho, L Pollard, N Abbasi, G Ryan, T Van Mieghem

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引用次数: 0

Abstract

Objectives: Enhanced recovery after surgery (ERAS) protocols are multimodal evidence-based care plans that have been adopted for multiple surgical procedures to promote faster and better patient recovery and shorter hospitalization. This study aimed to explore whether worldwide fetal therapy centers offering prenatal myelomeningocele repair implement the ERAS principles and to provide recommendations for improved perioperative management of patients.

Methods: In this survey study, a total of 53 fetal therapy centers offering prenatal surgery for open spina bifida were identified and invited to complete a digital questionnaire covering their pre-, intra- and postoperative management. An overall score was calculated per center based on compliance with 20 key ERAS principles, extrapolated from ERAS guidelines for Cesarean section, gynecological oncology and colorectal surgery. Each item was awarded a score of 1 or 0, depending, respectively, on whether the center did or did not comply with that principle, with a maximum score of 20.

Results: The questionnaire was completed by 46 centers in 17 countries (response rate, 87%). In total, 22 (48%) centers performed exclusively open fetal surgery (laparotomy and hysterotomy), whereas 14 (30%) offered both open and fetoscopic procedures and 10 (22%) used only fetoscopy. The perioperative management of patients undergoing fetoscopic and open surgery was very similar. The median ERAS score was 12 (range, 8-17), with a mean ± SD of 12.5 ± 2.4. Center compliance was the highest for the use of regional anesthesia (98%), avoidance of bowel preparation (96%) and thromboprophylaxis (96%), while the lowest compliance was observed for preoperative carbohydrate loading (15%), a 2-h fasting period for clear fluids (20%), postoperative nausea and vomiting prevention (33%) and early feeding (35%). ERAS scores were similar in centers with a short (2-5 days), medium (6-10 days) and long (≥ 11 days) hospital stay (mean ± SD, 12.9 ± 2.4, 12.1 ± 2.0 and 10.3 ± 3.2, respectively, P = 0.15). Furthermore, there was no significant association between ERAS score and surgical technique or case volume.

Conclusions: The perioperative management of fetal spina bifida surgery is highly variable across fetal therapy centers worldwide. Standardized protocols integrating ERAS principles may improve patient recovery, reduce maternal morbidity and shorten the hospital stay after fetal spina bifida surgery. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

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加强胎儿脊柱裂手术后的恢复：我们的全球实践是什么？

目的：与产后手术相比，产前脊柱裂闭合术可改善胎儿的预后，但与孕产妇的严重发病率相关。对接受胎儿脊柱裂手术的产妇进行围手术期护理优化可改善产妇和妊娠结局。术后恢复强化方案（ERAS）是以证据为基础的多模式护理计划，已被多种外科手术采用，以促进患者更快、更好地恢复并缩短住院时间。本研究旨在探讨胎儿中心是否在此环境中实施了ERAS原则。此外，我们还为脊柱裂胎儿手术患者的围手术期管理提供了建议：方法：我们确定了 53 家提供开放性脊柱裂产前手术的胎儿治疗中心，并邀请他们填写一份数字问卷，内容包括术前、术中和术后管理。根据中心对ERAS 20项主要原则的遵守情况计算出每个中心的总分，这些原则是从ERAS剖宫产、妇科肿瘤和结直肠手术指南中推导出来的。当中心符合或不符合每项原则时，每项得分1或0，最高分为20分：17 个国家的 46 个中心完成了问卷调查（回复率为 87%）。22个中心（48%）只进行开腹胎儿手术（开腹和宫腔手术），14个中心（30%）同时进行开腹和胎儿镜手术，10个中心（22%）只进行胎儿镜手术。胎儿镜手术和开腹手术患者的围手术期管理非常相似。ERAS评分的中位数为12分（平均12.5分，标差2.4分，范围8-17分）。各中心对使用区域麻醉（98%）、避免肠道准备（96%）和血栓预防（96%）的依从性最高，而对术前碳水化合物负荷（15%）、术后恶心呕吐预防（33%）、避免隔夜禁食（33%）和禁食2小时饮用清水（20%）的依从性最低。短期（2-5 天）、中期（6-10 天）和长期（≥11 天）住院中心的 ERAS 评分相似（分别为 12.8 ± 2.4、12.1 ± 2.0 和 10.3 ± 3.2，P=0.15）。此外，ERAS评分与手术技术或中心规模无明显关联：结论：世界各地的胎儿治疗中心对胎儿脊柱裂手术的围手术期管理差异很大。结论：世界各地的胎儿治疗中心对胎儿脊柱裂手术的围手术期管理差异很大，根据ERAS原则制定标准化方案可改善患者的恢复、降低产妇的发病率并缩短胎儿脊柱裂手术后的住院时间。本文受版权保护。保留所有权利。

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来源期刊

Ultrasound in Obstetrics & Gynecology 医学-妇产科学

CiteScore

12.30

自引率

14.10%

发文量

891

审稿时长

1 months

期刊介绍： Ultrasound in Obstetrics & Gynecology (UOG) is the official journal of the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and is considered the foremost international peer-reviewed journal in the field. It publishes cutting-edge research that is highly relevant to clinical practice, which includes guidelines, expert commentaries, consensus statements, original articles, and systematic reviews. UOG is widely recognized and included in prominent abstract and indexing databases such as Index Medicus and Current Contents.