ABSTRACT
INTRODUCCIÓN: Los protocolos de recuperación intensificada (PRI) en cirugía de colon y recto disminuyen la estancia hospitalaria y las complicaciones, pero son pocos los estudios acerca de si son coste-efectivos. MÉTODOS: Comparamos un grupo de 121 pacientes (grupo RICA) operados de forma consecutiva de cirugía electiva de colon y recto según un PRI, con una cohorte histórica de 135 pacientes (grupo preRICA) operados antes de la implantación del PRI de forma tradicional. Se realizó un análisis univariante para comparar los datos de estancia, complicaciones, reingresos y coste efectividad, y un análisis multivariante para comprobar si la realización de cirugía laparoscópica, el PRI, las complicaciones, el sexo y la edad influían de forma independiente en la estancia hospitalaria, los reingresos y los costes. RESULTADOS: Los dos grupos fueron homogéneos, realizándose más cirugía laparoscópica en el grupo RICA (27 (20%) vs 45 (37,2%), p = 0,006). En el grupo RICA se objetivó una disminución de la estancia hospitalaria de 1,2 días (11 ± 3,8 vs 9,8 ± 3,7, p = 0,018), sin aumentar la tasa de complicaciones (49 (36,3%) vs 38 (31,4%), p = 0,49), de reingresos a los 30 días tras el alta hospitalaria (15 (11,1%) vs 12 (9,9%), p = 0,756), la mortalidad (1 (0,7%) vs 2 (1,7%), p = 0,498) ni el gasto sanitario (1618,8 ± 830,5 ± 1578,6 ± 491,1, p = 0,634). La laparoscopia redujo de forma independiente la estancia hospitalaria y la tasa de reingresos, mientras que la presencia de complicaciones severas lo aumentó. CONCLUSIONES: La aplicación de un PRI en cirugía electiva de colon y recto es coste-efectiva, pues mejora los resultados obtenidos sin incrementar el gasto sanitario
INTRODUCTION: ERAS (Enhanced Recovery After Surgery) protocols in colorectal surgery reduce hospital stay and com-plications, but there are few studies on whether they are cost-effective. METHODS: We compared a group of 121 patients (ERAS group) consecutively operated on elective colorectal surgery according to an ERAS protocol, with a historical cohort of 135 patients (preERAS group) operated prior to the implantation of the protocol in a traditional manner. A univariate analysis was performed to compare the data of stay, complications, readmissions and cost effectiveness, and a multivariate analysis to check whether laparoscopic surgery, the ERAS protocol, complications, sex and age had an independent influence hospital stay, readmissions rate and costs. RESULTS: The two groups were homogeneous, with more laparoscopic surgery performed in the ERAS group (27 (20%) vs 45 (37.2%), p = 0.006). In the ERAS group, a decrease in hospital stay was observed in 1,2 days (11 ± 3.8 vs 9.8 ± 3.7, p = 0.018), without increasing the complication rate (49 (36.3%) vs 38 (31.4%), p = 0.49), readmissions at 30 days after hospital discharge (15 (11.1%) vs 12 (9.9%), p = 0.756), mortality (1 (0.7%) vs 2 (1.7%), p = 0.498) and healthcare costs (1618.8 ± 830.5 vs 1578.6 ± 491.1, p = 0.634). Laparoscopic surgery independently reduced the hospital stay and the rate of readmissions, while the presence of severe complications increased them. CONCLUSIONS: The application of an ERAS protocol in elective colorectal surgery surgery is cost-effective, since it improves the results obtained without increasing healthcare costs
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Elective Surgical Procedures/rehabilitation , Colon/surgery , Rectum/surgery , Postoperative Care/methods , Non-Randomized Controlled Trials as Topic , Cross-Sectional Studies , Postoperative Care/economics , Length of Stay , Statistics, Nonparametric , Elective Surgical Procedures/economics , Operative Time , Treatment Outcome , Patient Satisfaction , Cost-Benefit Analysis , Multivariate AnalysisABSTRACT
ABSTRACT Objective: To evaluate the results of an Enhanced Recovery After Surgery (ERAS) protocol in elective colorectal surgery compared to the historical cohort of this hospital with standard care, in terms of hospital Length Of Stay (LOS), 30 days readmissions rate and 3-5 Clavien-Dindo Complications (CDC). Methodology: Data were collected from consecutive patients during 2 time periods, before (135 patients from hospital database) and after implementation of an ERAS protocol (121 with prospective follow up). Multivariate lineal or logistic regressions were used to assess the impact of ERAS program, adjusting by gender, age, laparoscopy and 3-5 CDC. Results: The two groups were homogeneous in terms of demographic and surgery details, with the exception of the operative approach, with increased use of laparoscopy in the ERAS group. The ERAS protocol decreased LOS (9.8 ± 3.7 vs. 11 ± 3.8, p = 0.018) without increasing 30 days readmission rate or the number of severe CDC. In a multivariate analysis, age and 3-5 CDC were independently associated with a longer LOS while male gender, ERAS protocol and laparoscopic surgery with a decreased LOS. 3-5 CDC increased readmissions (OR = 3.5, 95% CI 1.2-10.2) while laparoscopic surgery decreased them (OR = 0.2, 95% CI 0.1-0.8). ERAS improved compliance with secondary variables in a statistically significant way: more laparoscopic surgery; more regional analgesia in the intraoperative period; earlier adherence to ambulation; faster onset of oral liquid diet and analgesia by mouth; and lower requirements of opioids. Conclusions: ERAS protocol and laparoscopic surgery decreased LOS without increasing 30 days readmission rate. Severe CDC increased LOS and readmissions.
RESUMO Objetivo: Avaliar os resultados de um protocolo de recuperação aprimorada após a cirurgia (enhanced recovery after surgery [ERAS]) em cirurgia colorretal eletiva em comparação com a coorte histórica deste hospital, que recebeu o tratamento padrão, em termos de hospitalização, taxa de readmissão de 30 dias e graus 3 a 5 na escala de complicações cirúrgicas de Clavien-Dindo (CCD). Metodologia: Os dados foram coletados de pacientes consecutivos em dois períodos de tempo: antes (135 pacientes do banco de dados do hospital) e depois da implementação de um protocolo ERAS (121 pacientes com acompanhamento prospectivo). Regressões lineares ou logísticas multivariadas foram usadas para avaliar o impacto do protocolo ERAS, ajustando por sexo, idade, uso de laparoscopia e graus 3 a 5 na escala CCD. Resultados: Os dois grupos foram homogêneos em termos de características demográficas e cirúrgicas, com exceção da abordagem operatória, com o aumento do uso de laparoscopia no grupo ERAS. O protocolo ERAS diminuiu o tempo de internação (9,8 ± 3,7 vs. 11 ± 3,8; p = 0,018) sem aumentar a taxa de readmissão de 30 dias ou a severidade na escala CCD. Na análise multivariada, a idade e os graus 3 a 5 na escala CCD foram independentemente associados a uma hospitalização mais longa, enquanto o sexo masculino, o protocolo ERAS e a cirurgia laparoscópica foram independentemente associados a uma hospitalização mais curta. Graus 3 a 5 na escala CCD foram associados a um aumento nas readmissões (OR = 3,5; IC 95%: 1,2-10,2), enquanto a cirurgia laparoscópica foi associada a uma diminuição nesse número (OR = 0,2; IC 95%: 0,1-0,8). O ERAS melhorou a adesão às variáveis secundárias de uma forma estatisticamente significativa: aumento no número de cirurgias laparoscópicas; maior uso de analgesia regional no período intraoperatório; adesão precoce à deambulação; início mais rápido da dieta líquida oral e analgesia por via oral; finalmente, menor uso de opioides. Conclusões: O protocolo ERAS e a cirurgia laparoscópica diminuíram o tempo de internação sem aumentar a taxa de readmissão de 30 dias. Um grau severo na escala CCD aumentou a hospitalização e readmissões.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Elective Surgical Procedures/rehabilitation , Colorectal Surgery/rehabilitation , Patient Readmission , Postoperative Period , Linear Models , Logistic Models , Multivariate Analysis , Prospective Studies , Laparoscopy , Perioperative Care , Length of StayABSTRACT
Abstract Introduction: Enhanced Recovery After Surgery (ERAS) programs have been shown to reduce hospital stay, without increasing the rate of complications or readmissions 30 days after discharge; however, there is limited information about patient satisfaction. Objective: To determine the satisfaction of our patients following the implementation of an ERAS protocol in elective colorectal surgery. Materials and methods: A period of 4 days after discharge, a telephone survey was conducted based on the enhanced recovery in abdominal surgery clinical survey of the first 55 patients aged 70 years or older, who underwent elective colorectal surgery according to an ERAS protocol at the Hospital Universitario de Guadalajara, Spain. This is a cross-sectional analytical study. Results: Most of our patients are very satisfied with the care and the way they were treated by the health staff during their hospitalization, and they would be willing to undergo surgery again following this protocol. Most of them consider that the information received in the pre-anesthesia and surgery consultation is very good, and they value this consultation as one of the most positive aspects of the protocol. More than half of the patients did not experience any nausea or vomiting and rated their pain as <3 (minimum 0 and maximum 10). Most considered the introduction of oral feeding and ambulation as on time or somewhat early. Conclusion: Elderly patients undergoing elective colorectal surgery according to an ERAS protocol are highly pleased with the care received. Standardized surveys are required to be able to contrast outcomes.
Resumen Introducción: los programas de recuperación intensificada postoperatoria (Enhanced Recovery After Surgery (ERAS)) reducen la estancia hospitalaria, sin aumentar la tasa de complicaciones ni de reingresos a los 30 días tras el alta, pero hay poca información acerca del grado de satisfacción de los pacientes. Objetivo: conocer la satisfacción de nuestros pacientes tras la aplicación de un protocolo ERAS en cirugía electiva colorrectal. Materiales y métodos: cuatro días tras el alta, se realizó una encuesta telefónica basada en la encuesta de la guía clínica RICA (Recuperación Intensificada en Cirugía Abdominal) a los 55 primeros pacientes con edad mayor o igual a 70 años operados de cirugía electiva colorrectal según un protocolo ERAS. Es un estudio analítico transversal. Resultados: la mayor parte de nuestros pacientes están muy satisfechos con la asistencia y con el trato recibido por el personal sanitario durante su ingreso hospitalario, y se volverían a operar siguiendo este protocolo. La mayoría consideran que la información recibida en la consulta de preanestesia y cirugía es muy buena, y valoran esta consulta como uno de los aspectos más positivos del protocolo. Más de la mitad de los pacientes no tuvieron náuseas ni vómitos y calificaron su dolor como <3 (mínimo 0 y máximo 10). La mayoría consideraron el inicio de tolerancia oral y deambulación como a tiempo o algo pronto. Conclusiones: Los pacientes ancianos operados de cirugía electiva colorrectal según un protocolo ERAS están muy satisfechos con la asistencia prestada. Se necesitan encuestas estandarizadas para poder comparar resultados.
