在紧急腹部手术中，增强术后恢复方案安全加速恢复：一项多变量风险分析的随机对照试验。

IF 1.6 4区医学 Q3 SURGERY

ANZ Journal of Surgery Pub Date : 2025-07-11 DOI:10.1111/ans.70251

Jianing Lu, Yan Zhuang, Zhenglu Wang, Hong Zheng, Xi Ma, Dejun Kong, Jinliang Duan, Shaofeng Chen, Tao Chen

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引用次数: 0

摘要

背景：急诊腹部手术涉及复杂、多样的情况，患者的差异很大，对恢复提出了挑战。虽然手术后增强恢复（ERAS）项目有利于选择性手术，并在紧急情况下显示出希望，但目前的研究是针对疾病的，限制了广泛的评估。本研究评估了ERAS在多种紧急腹部疾病中的安全性/有效性，并确定了恢复的风险因素。方法：本单盲试验将305例急诊腹部手术患者随机分为ERAS组（n = 151）和常规组（n = 154）。ERAS患者接受围手术期强化恢复计划，而对照组接受常规管理。主要观察指标为术后恢复时间。次要结局包括首次术后胀气/半流质饮食耐受时间、并发症发生率、最大疼痛评分（1-5天）、30天再入院率和满意度。通过t检验、Mann-Whitney U检验、Fisher精确检验和多元回归分析数据(p结果：ERAS缩短了中位恢复时间（141 h [IQR: 114-179] vs. 163 h [IQR: 131-204], p 0.999）。休克指数和APACHE II是常见的危险因素；eras特异性风险包括SOFA （OR = 1.31, 1.03-1.71, p = 0.034）、术前血红蛋白（OR = 0.95, 0.89-1.00, p = 0.046）、术前准备时间（OR = 0.33, 0.14-0.68, p = 0.005）、输血（OR = 0.01, 0.00-0.23, p = 0.003）。结论：ERAS可提高急诊腹部手术的术后恢复和满意度，且不增加并发症和再入院率。确定的风险因素支持个性化协议，推进ERAS的实施。

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Enhanced Recovery After Surgery Programs Safely Accelerate Recovery in Emergency Abdominal Surgery: A Randomized Controlled Trial With Multivariable Risk Profiling.

Background: Emergency abdominal surgery involves complex, diverse conditions with high patient variability, posing recovery challenges. While Enhanced Recovery After Surgery (ERAS) programs benefit elective surgery and show promise in emergencies, current research is disease-specific, limiting broad assessment. This study evaluates ERAS safety/effectiveness across multiple emergency abdominal conditions and identifies recovery risk factors.

Methods: This single-blind trial randomized 305 emergency abdominal surgery patients to ERAS (n = 151) or conventional care (n = 154). ERAS patients underwent perioperative enhanced recovery programs, while controls received conventional management. The primary outcome was time to postoperative recovery criteria. Secondary outcomes included first postoperative flatus/semi-liquid diet tolerance time, complication rates, maximum pain scores (days 1-5), 30-day readmissions, and satisfaction. Data were analyzed via t-tests, Mann-Whitney U, Fisher's exact tests, and multivariate regression (p < 0.05 significance).

Results: ERAS reduced median recovery time (141 h [IQR: 114-179] vs. 163 h [IQR: 131-204], p < 0.001), accelerated gastrointestinal recovery (first flatus: 1.10 vs. 1.30 days; semi-liquid tolerance: 3.60 vs. 4.10 days, both p < 0.05), and improved satisfaction (95 vs. 91, p < 0.001). No differences in complications (11.9% vs. 15.6%, p = 0.353) or 30-day readmissions (2.0% vs. 2.6%, p > 0.999). Shock index and APACHE II were common risk factors; ERAS-specific risks included SOFA (OR = 1.31, 1.03-1.71, p = 0.034), preoperative hemoglobin (OR = 0.95, 0.89-1.00, p = 0.046), preparation time (OR = 0.33, 0.14-0.68, p = 0.005), and blood transfusion (OR = 0.01, 0.00-0.23, p = 0.003).

Conclusion: ERAS enhances postoperative recovery and satisfaction in emergency abdominal surgery without increasing complications/readmissions. Identified risk factors support personalized protocols, advancing ERAS implementation.

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来源期刊

ANZ Journal of Surgery 医学-外科

CiteScore

2.50

自引率

11.80%

发文量

720

审稿时长

2 months

期刊介绍： ANZ Journal of Surgery is published by Wiley on behalf of the Royal Australasian College of Surgeons to provide a medium for the publication of peer-reviewed original contributions related to clinical practice and/or research in all fields of surgery and related disciplines. It also provides a programme of continuing education for surgeons. All articles are peer-reviewed by at least two researchers expert in the field of the submitted paper.