Learning curve of enhanced recovery after surgery program in open colorectal surgery

作     者：Varut Lohsiriwat 

作者机构：Division of Colon and Rectal Surgery Department of Surgery Faculty of Medicine Siriraj Hospital Mahidol University 

出 版 物：《World Journal of Gastrointestinal Surgery》 (世界胃肠外科杂志（英文版）（电子版）)

年 卷 期：2019年第11卷第3期

页      面：169-178页

核心收录：

学科分类：10[医学] 

主　　题：Enhanced recovery after surgery ERAS Colon Rectum Surgery Learning curve Outcome Compliance 

摘      要：BACKGROUND Enhanced recovery after surgery(ERAS) reduces hospitalization and complication following colorectal surgery. Whether the experience of multidisciplinary ERAS team affects patients outcomes is *** To evaluate and establish a learning curve of ERAS program for open colorectal *** This was a review of prospectively collected database of 380 unselectedpatients undergoing elective open colectomy and/or proctectomy under ERAS protocol from 2011(commencing ERAS application) to 2017 in a university hospital. Patients were divided into 5 chronological groups(76 cases per quintile). Surgical outcomes and ERAS compliance among quintiles were compared. Learning curves were calculated based on criteria of optimal recovery:defined as absence of major postoperative complications, discharge by postoperative day 5, and no 30-d *** Hospitalization more than 5 d occurred in 22.6%(n = 86), major complication was present in 2.9%(n = 11) and 30-d readmission rate was 2.4%(n = 9) accounting for unsuccessful recovery of 25%(n = 95). Conversely, the overall rate of optimal recovery was 75%. The optimal recovery significantly increased from 57.9% in 1 st quintile to 72.4%-85.5% in the following quintiles(P 0.001). Average compliance with ERAS protocol gradually increased over the time-from 68.6% in 1 st quintile to 75.5% in 5 th quintile(P 0.001). The application of preoperative counseling,nutrition support, goal-directed fluid therapy, O-ring wound protector and scheduled mobilization significantly increased over the study *** A number of 76 colorectal operations are required for a multidisciplinary team to achieve a significantly higher rate of optimal recovery and high compliance with ERAS program for open colorectal surgery.