Implementation of Modified Early Recovery after Surgery in Minimally Invasive Colorectal Surgery at a Single Community Hospital

在單一社區醫院微創大腸直腸癌手術經驗中實施經修改的手術後早期恢復

王偉林(Wei-Lin Wang) ； 黃彥鈞(Yan-Jiun Huang) ； 盧延榕(Yen-Jung Lu) ； 林恩光(En-Kwang Lin) ； 陳嘉哲(Chia-Che Chen) ； 湯堯舜(Yiu-Shun Tong) ； 郭立人(Li-Jen Kuo) ； 陳建信(Chien-Hsin Chen) ； 魏柏立(Po-Li Wei)

《中華民國大腸直腸外科醫學會雜誌》 31卷1期 (2020/03) Pp. 32-40

https://doi.org/10.6312/SCRSTW.202003_31(1).10822

摘要

Aims. The benefits of early recovery after surgery (ERAS) in perioperative management and postoperative recovery of colorectal surgery are well known. We assessed the outcomes and quality improvement of patients with colorectal cancer achieved through the implementation of modified ERAS (mERAS) at a community hospital. Methods. A retrospective review of patients with colorectal cancer who underwent minimally invasive surgery was conducted. The primary end points assessed included emergency department (ED) visit within 3 days after discharge (3-day ED visit) and readmission within 14 days after discharge (14-day readmission). The secondary end points included time to first flatus, time to first soft diet intake, surgical morbidity, and postoperative hospital stay. Results. Atotal of 424 patients with colorectal cancer (51% male and 49% female patients; mean age, 63 years) who underwent minimally invasive surgery from January 2014 to December 2018 in our hospital were enrolled. The pre-ERAS and post-ERAS groups consisted of 243 and 181 patients, respectively. Overall, no statistical difference was observed in 14-day readmission between the two groups. The most common reasons for post-ERAS 14-day readmission were ileus (2/4, 50%), intra-abdominal abscess (1/4, 25%), and colitis (1/4, 25%). The post-ERAS group (2%, 4/181) had a higher 3-day ED visit rate than the pre-ERAS group (0%, 0/243; p ＜ 0.033). The most common reasons for visiting the ED were wound infection (2/4, 50%), ileus (1 of 4, 25%), and wound pain (1/4, 25%). Patients in the post-ERAS group had earlier time to first flatus (2.3 ± 1.0 days), earlier time to soft diet intake (1.9 ± 1.5 days), and shorter postoperative hospital stay (7.8 ± 3.6 days) than those in the pre-ERAS group (2.6 ± 1.0, 3.8 ± 1.7, and 9.3 ± 4.2 days, respectively; p ＜ 0.001). Conclusions. Implementation of the ERAS pathway in a community hospital has a positive effect on the length of postoperative stay and is not associated with increased 14-day readmission. The majority of patients returning to the ED do not require hospital readmission. The main reason for ED return is wound complications.

關鍵字

Early recovery after surgery (ERAS) ； Colorectal cancer

並列摘要

目的：手術後早期恢復（ERAS）的好處在結腸直腸手術的手術期管理和術後恢復方面是眾所周知的。我們試圖藉由社區醫院實施經修的ERAS（mERAS）來研究病患照護的結果和品質挖制。方法：對接受常規性微創手術的結腸直腸癌病患進行回顧性研究。主要探討焦點的評估包括出院後三天重返急診就診以及出院後14天再入院比率。次要探討焦點的評估包括術後第一次排氣時間、第一次軟食進食時間、手術後住院天數與術後併發症率。結果：收集2014年1月至2018年12月共424名結腸直腸病患（51%為男性，49%為女性；平均年齡為63歲）接受常規性結腸直腸癌手術。ERAS前組有243名病患，ERAS後組有181例。在14天再入院方面是兩組統計學上沒有顯著的差異。在ERAS後組最常見的14天再入院原因為腸阻塞（2/4, 50%），以及腹內膿瘍（1/4, 25%）和結腸炎（1/4, 25%）。與ERAS前組相比，ERAS後組（2%, 4/181）之出院後3天內重返急診的比率較高（p＜0.033），重返急診最常見的因素是傷口感染（2/4, 50%），其次是腸阻塞（1/4, 25%）以及傷口疼痛（1/4, 25%）。與ERAS前組（2.6±1.0 days）相比，ERAS後組（2.3±1.0 days）有更早術後排氣p＜0.001。與ERAS前組（3.8±1.7 days）相比，在ERAS後組（1.9±1.5 days）也觀察到較早軟質食物之進食（p＜0.001）。ERAS後組之術後住院天數比ERAS前組短The（7.8±3.6 vs. 9.3 ±4.2 days）（p＜0.001）。結論：在社區醫院實施ERAS對術後住院天數有明顯縮短之影響，且與14天再入院無明顯關聯。重返急診的主要原因是傷口併發症，然而，大多數重返急診不需再入院接受治療。

並列關鍵字

術後早期恢復 ； ERAS ； 結腸直腸癌

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