Yvonne Nguyen, Leopoldo Fernandez, Brooke Trainer, Marilyn McNulty, Michael R Kazior
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引用次数: 0
Abstract
Background and objectives: Enhanced recovery after surgery (ERAS) pathways are associated with better postoperative recovery; however, evidence is lacking in liver cancer surgery. This study aimed to evaluate the impact of an ERAS pathway in US veterans undergoing liver cancer surgery.
Methods: We initiated an ERAS pathway for liver cancer surgery with preoperative, intraoperative, and postoperative interventions, which included a novel regional anesthesia technique, erector spinae plane block, for multimodal analgesia management. A retrospective quality improvement study was conducted with patients undergoing elective open hepatectomy or microwave ablation of liver tumors before and after ERAS pathway implementation.
Results: With 24 patients in the post-ERAS group and 23 patients in the pre-ERAS group, we found a significant decreased length of stay in the ERAS group (4.1 days ± 3.9) compared with traditional care (8.6 days ± 7.1, P = .01) and decreased perioperative opioid consumption including intraoperative opioids (post-ERAS 49.8 mg ± 28.5 vs pre-ERAS 98 mg ± 42.3, P = 4.1E-5), postoperative opioids (post-ERAS 65.3 mg ± 59.9 vs pre-ERAS 175.7 mg ± 210.6, P = .018), and patient-controlled analgesia requirements (post-ERAS 0% vs pre-ERAS 50%, P < .001).
Conclusion: The implementation of ERAS for liver cancer surgery in our veteran population translates into decreased length of stay and perioperative opioid consumption. Although this study is limited as a quality improvement project implemented at one institution with a small sample size, our results are clinically and statistically significant and sufficient to warrant further investigation into the efficacy of ERAS as the surgical needs of the US veteran population increase.
背景和目的:增强术后恢复(ERAS)途径与更好的术后恢复有关;然而,癌症手术缺乏证据。本研究旨在评估ERAS途径对接受癌症手术的美国退伍军人的影响。方法:我们启动了癌症手术的ERAS途径,包括术前、术中和术后干预,其中包括一种新的区域麻醉技术,直立脊柱平面阻滞,用于多模式镇痛管理。对在ERAS途径实施前后接受选择性肝开放切除术或肝肿瘤微波消融术的患者进行了一项回顾性质量改进研究。结果:ERAS后组有24名患者,ERAS前组有23名患者,与传统护理(8.6天±7.1,P=0.01)相比,ERAS组的住院时间(4.1天±3.9)显著缩短,围手术期阿片类药物消耗量(包括术中阿片类)减少(ERAS后49.8 mg±28.5 vs ERAS前98 mg±42.3,P=4.1E-5),术后阿片类药物(ERAS术后65.3 mg±59.9 vs ERAS术前175.7 mg±210.6,P=.018)和患者自控镇痛需求(ERAS后0%vs ERAS前50%,P<.001)。尽管这项研究仅限于在一个样本量较小的机构实施的质量改进项目,但我们的结果在临床和统计上都具有显著意义,足以保证随着美国退伍军人手术需求的增加,对ERAS的疗效进行进一步调查。
期刊介绍:
Quality Management in Health Care (QMHC) is a peer-reviewed journal that provides a forum for our readers to explore the theoretical, technical, and strategic elements of health care quality management. The journal''s primary focus is on organizational structure and processes as these affect the quality of care and patient outcomes. In particular, it:
-Builds knowledge about the application of statistical tools, control charts, benchmarking, and other devices used in the ongoing monitoring and evaluation of care and of patient outcomes;
-Encourages research in and evaluation of the results of various organizational strategies designed to bring about quantifiable improvements in patient outcomes;
-Fosters the application of quality management science to patient care processes and clinical decision-making;
-Fosters cooperation and communication among health care providers, payers and regulators in their efforts to improve the quality of patient outcomes;
-Explores links among the various clinical, technical, administrative, and managerial disciplines involved in patient care, as well as the role and responsibilities of organizational governance in ongoing quality management.