ABSTRACT
Antecedentes: los programas fast-track en cirugía hepática muestran ventajas con respecto al manejo perioperatorio tradicional al favorecer principalmente una disminución de la estancia hospitalaria y, por ende, de los costos hospitalarios. Material y métodos: en un estudio observacional y descriptivo se analizan resecciones hepáticas abiertas dentro de un programa de recuperación rápida, haciendo especial hincapié en la adherencia a este, la recuperación total de los enfermos, la morbilidad y la estancia hospitalaria. Resultados: se realizaron 32 hepatectomías en 30 pacientes, 27 de los cuales fueron oncológicos. La adherencia al programa utilizado fue del 78,1% y la recuperación total al momento del alta del 75%. La morbilidad fue del 12,5% y las complicaciones fueron de baja complejidad, aunque 2 pacientes necesitaron reingresar. La estancia hospitalaria tuvo una media de 3,4 días y, sumando los reingresos, de 3,6 días. Conclusión: la aplicación de un ERP en cirugía hepática no solo es factible sino trae aparejada como principal beneficio una disminución en la estancia hospitalaria y, por ende, de los costos. Pero no estamos convencidos de que un ERP mejore la morbilidad de los pacientes.
Background: Background: Fast-track programs in liver surgery offer advantages over traditional perioperative management, particularly in terms of reducing length of hospital stay and hospital costs. Material and methods: We conducted an observational and descriptive analysis of patients undergoing open liver resections as part of an enhanced recovery program. Adherence to the program, full recovery of the patients, complications and length of hospital stay were assessed. Results: A total of 32 liver resections were performed in 30 patients, 27 with cancer. The adherence to the program was 78.1% and full recovery on discharge was 75%. The incidence of complications was 12.5%; most of them were not severe but two patients required rehospitalization. Mean length of hospital stay was 3.4 days and 3.6 days when readmissions were considered. Conclusion: The implementation of an ERP after liver resections is feasible and offers advantages in terms of reducing length of hospital stay and hospital costs. We do not think that ERP improves morbidity in these patients.
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Objective To evaluate the stimulative role of the enhanced recovery program after surgery (ERAS) protocol in patients undergoing radical resection for gastric cancer.Methods A total of 102 consecutive patients undergoing elective gastric resection were included in either the ERAS (n =35,received ERAS perioperative treatment from June 2013 to June 2014) or the control group (n =67,received conventional perioperative treatment from June 2011 to June 2013).Outcomes related to nutrition index,stress index,and recovery index were measured.Results The nutritional index of patients (total lymphocyte count,serum albumin and prealbumin) in the ERAS group was improved on postoperative day (POD) 1 compared with that in the control group [(1.25±0.65) × 109/L vs (1.09±0.71) × 109/L,(36.4±5.2) g/L vs (31.3±4.1) g/L,(0.19±0.08) g/L vs (0.17±0.05) g/L,P ＜ 0.05,respectively].The level of negative nitrogen balance on POD 1 in the ERAS group was slightly lower than that in the control group (P ＞ 0.05),and the level of negative nitrogen balance on POD 7 in the ERAS group was higher than that in the control group (-0.93±2.17 vs -3.87±4.45,P ＜ 0.05).The postoperative cortisol level in the control group was elevated on both POD 1 (P ＜ 0.05) and POD 7 (P ＜ 0.05) compared to the preoperative level [(5.06±1.87) mg/L vs (3.60±1.5) mg/L],(5.15±1.33) mg/L vs (3.60±1.51) mg/L,P ＜ 0.05,respectively].However,the cortisol level was not increased until POD 7 in the ERAS group [(5.08±1.18) mg/L vs (3.20±1.43) mg/L,P ＜ 0.05].The level of IL-6 was elevated in postoperative period compared to preoperative period both in two groups (P ＜ 0.05).And the level of IFN-γin the ERAS group on POD 1 was reduced compared to the preoperative level (P ＜ 0.05).Whether in preoperative or postoperative,the level of IL-1β and TNF-α showed no statistical significance change.In addition,the postoperative recovery conditions (day of oral all-liquid recovery,first day of defecation,hospital stay,maximum pain on visual analogue scale) in the ERAS group were better than those in the control group (P ＜ 0.05).The incidence rates of complications between the two groups were 13.4 ％ (9/67) and 17.1％ (6/35) respectively (P ＞ 0.05).Conclusion ERAS protocol can alleviate surgical stress response and accelerate postoperative recovery without compromising patients' safety.
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PURPOSE: A multidisciplinary program for early recovery after colorectal surgery has been developed continuously since 2000. The purpose of this study was to evaluate the effects of the standardized postoperative enhanced recovery program (SPERP) after a colorectal resection. METHODS: The patients undergoing laparoscopic colorectal resection for colorectal cancer were cared for by using the SPERP after surgery. The comparison group consisted of patients who had undergone similar surgery before establishment of the SPERP. The two groups were compared with respect to the patients' characteristics, operation methods, operation time, blood loss, amounts of intravenous fluid and intravenous antibiotics, complications, postoperative hospital stay, readmission rate, and reoperation rate. RESULTS: The number of patients being treated with the standardized postoperative recovery program, the standardized group (SG), was 63, and that of the traditional group (TG) was 61. Even though the day of oral feeding (1.02 vs. 2.67 days) was faster in the SG, the day of flatus and defecation was not different between two groups. The postoperative hospital stay in the SG (6.76 days) was significantly shorter than that in the TG (10.43 days). The total amount of intravenous fluid after surgery in the SG was 8,574.75 mL, compared with 19,568.22 mL in the TG. The duration of intravenous antibiotics was 2.69 days in the SG and 7.38 days in the TG (P=0.0001). The rates of complication (27.0% in SG vs. 39.3% in TG), reoperation (3.17% vs. 9.84%), and readmission (7.94% vs. 6.56%) did not increase after implementation of this program. CONCLUSION: The standardized postoperative recovery program reduced the amounts of postoperative intravenous fluid and antibiotics and the postoperative hospital stay without increasing either complications or the readmission rate. A prospective multi-center study of this program is needed.