围手术期强化恢复概念可显著改善克罗恩病患者的术后效果。

Matthias Kelm, Lena Wagner, Anna Widder, Regina Pistorius, Johanna C Wagner, Nicolas Schlegel, Christian Markus, Patrick Meybohm, Christoph-Thomas Germer, Wolfgang Schwenk, Sven Flemming
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引用次数: 0

摘要

背景和目的:尽管克罗恩病(Crohn`s Disease,CD)患者的医疗和手术技术近来取得了进步,但由于疾病长期无法治愈,术后发病率仍然很高。正如在肿瘤患者身上所展示的那样,围手术期增强恢复概念为改善术后效果提供了巨大的潜力。然而,关于围手术期增强恢复概念在 CD 患者这一特定群体中的效果,目前还缺乏有力的证据:在一项前瞻性单中心研究中,纳入了 2020 年至 2023 年期间因 CD 而接受回盲部切除术的所有患者。研究实施了特定的围手术期强化恢复概念(ERC),并将患者分为两组(实施前和实施后)。主要结果是以综合并发症指数(CCI)衡量的术后并发症,次要终点是严重并发症、住院时间和再次入院率:对83名患者进行了分析,其中33名患者参加了增强康复计划(postERC)。虽然两组患者的特征相当,但ERC显著降低了总体和严重术后并发症的发生率(CCI:21.4 对 8.4,P=0.0036;Clavien Dindo >2:38% 对 3.1%,P=0.0002)。此外,ERC 术后患者出院时间更早(6.5 天对 5 天,P=0.001),再次入院率显著降低(20% 对 3.1%,P=0.03)。在多变量分析中,恢复理念被认为是减少术后严重并发症的独立因素(P=0.019):结论:特定的围手术期强化恢复理念可显著改善克罗恩病患者的术后效果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Perioperative Enhanced Recovery Concepts Significantly Improve Postoperative Outcome in Patients with Crohn`s Disease.

Background and aims: Despite recent advancements in medical and surgical techniques in patients suffering from Crohn`s disease [CD], postoperative morbidity remains relevant due to a long-standing, non-curable disease burden. As demonstrated for oncological patients, perioperative enhanced recovery concepts provide great potential to improve postoperative outcome. However, robust evidence about the effect of perioperative enhanced recovery concepts in the specific cohort of CD patients is lacking.

Methods: In a prospective, single-centre study, all patients receiving ileocaecal resection due to CD between 2020 and 2023 were included. A specific, perioperative, enhanced recovery concept [ERC] was implemented and patients were divided into two groups [before and after implementation]. The primary outcome focused on postoperative complications as measured by the Comprehensive Complication Index [CCI], secondary endpoints were severe complications, length of hospital stay, and rates of re-admission.

Results: Of 83 patients analysed, 33 patients participated in the enhanced recovery programme [post-ERC]. Whereas patient characteristics were comparable between both groups, ERC resulted in significantly decreased rates of overall and severe postoperative complications [CCI: 21.4 versus 8.4, p = 0.0036; Clavien Dindo > 2: 38% versus 3.1%, p = 0.0002]. Additionally, post-ERC-patients were ready earlier for discharge [5 days versus 6.5 days, p = 0.001] and rates of re-admission were significantly lower [3.1% versus 20%, p = 0.03]. In a multivariate analysis, the recovery concept was identified as independent factor to reduce severe postoperative complications [p = 0.019].

Conclusion: A specific, perioperative, enhanced recovery concept significantly improves the postoperative outcome of patients suffering from Crohn`s disease.

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