减肥手术中实施强化恢复计划的效果。

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research Pub Date : 2024-11-01 DOI:10.1016/j.jss.2024.09.082

Lisa P. Doshi MHS, DrPH , Richard Nudotor MD, MPH , Gina Lynn Adrales MD, MPH , David Chin MD, MBA , Matt Austin PhD, MS , Conan Dickson PhD, MPH , Lilly D. Engineer MD, DrPH, MHA

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引用次数: 0

摘要

导言：虽然在减肥手术中采用 ERAS 方案的人数有所增加，但各中心之间存在差异，反映出不同的实施阶段。本研究的目的是了解减肥手术中术后恢复强化方案（ERAS）的有效性，并提高对其有效性的认识，因为该人群在围手术期存在特殊的困难和风险。我们旨在研究在减肥手术中实施ERAS计划与具体结果之间的关联：将一家学术机构的初诊减肥患者（≥18 岁）分为 ERAS 前和 ERAS 后两组。采用泊松回归和量子回归分别检验ERAS方案与住院时间和费用之间的关系。逻辑回归用于评估ERAS对30天再入院的影响：结果：ERAS实施前共进行了680例手术，而ERAS实施后进行了1124例手术。与ERAS实施前的患者相比，ERAS实施后的患者住院时间中位数缩短了1天（P = 0.001），手术费用中位数降低了2000美元。与ERAS实施前的患者相比，ERAS实施后的患者有一次或多次计划外再入院的比例更高（P 结论：ERAS实施前的患者住院时间更短，手术费用中位数更低，而ERAS实施后的患者住院时间更长：这项研究强调了加强康复计划在减肥手术中的价值，对患者和医疗系统都有好处。

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Effectiveness of Implementation of an Enhanced Recovery Program in Bariatric Surgery

Introduction

While the adoption of ERAS protocols in bariatric surgery has increased, variability exists across centers, reflecting a spectrum of implementation stages. The objective of this study is to understand and increase awareness of the effectiveness of enhanced recovery after surgery (ERAS) protocols in bariatric surgery, given the specific perioperative difficulties and risks for this population. We aimed to study the association between implementation of the ERAS program in bariatric surgery and specific outcomes.

Methods

Primary bariatric patients (≥18 y old) at a single academic institution were divided into pre-ERAS and post-ERAS groups. Poisson and quantile regressions were used to examine the association between the ERAS protocol and length of stay and cost, respectively. Logistic regression was used to assess the impact of ERAS on 30-d readmissions.

Results

A total of 680 procedures were performed in the pre-ERAS cohort, compared to 1124 procedures post-ERAS. The median length of hospital stay was shorter, and median cost of surgery was lower for post-ERAS patients compared to pre-ERAS patients by 1 d (P = 0.001) and $2000, respectively. A higher proportion of patients in the pre-ERAS period had one or more unplanned readmissions compared to the post-ERAS period (P < 0.001). The ERAS protocol was associated with decreased length of stay (incidence rate ratio = 0.72, P < 0.001), decreased median cost (−$2230, P < 0.001), and lower risk of 30-d unplanned readmissions (odds ratio = 0.48, P < 0.001).

Conclusions

This study highlights the value of an enhanced recovery program in bariatric surgery, benefiting both patients and health systems.

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来源期刊

Journal of Surgical Research 医学-外科

CiteScore

3.90

自引率

4.50%

发文量

627

审稿时长

138 days

期刊介绍： The Journal of Surgical Research: Clinical and Laboratory Investigation publishes original articles concerned with clinical and laboratory investigations relevant to surgical practice and teaching. The journal emphasizes reports of clinical investigations or fundamental research bearing directly on surgical management that will be of general interest to a broad range of surgeons and surgical researchers. The articles presented need not have been the products of surgeons or of surgical laboratories. The Journal of Surgical Research also features review articles and special articles relating to educational, research, or social issues of interest to the academic surgical community.