通过实施ERAS方案缩短漏斗胸修复术住院时间
Decreasing Length of Stay for Pectus Excavatum Repair by Implementing an ERAS Protocol.
作者
作者单位
- Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205.
- Center for Clinical Excellence, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205.
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205.
- Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205. Electronic address: sara.mansfield@nationwidechildrens.org.
摘要
中文
加速康复外科（ERAS）方案是一种多学科方法，旨在加快康复同时减少并发症。肋间神经冷冻消融显著改善了微创漏斗胸修复术（Nuss手术）的疼痛控制。为进一步加快康复，我们实施了ERAS路径，目标是在2024年底将住院时间（LOS）从3.0天缩短至1.4天并维持一年。利益相关者会议确定了患者教育、疼痛管理、肋间神经阻滞联合冷冻消融以及术后物理治疗的关键组成部分。所有接受Nuss手术的患者均被纳入。ERAS于2024年3月启动。将患者与冷冻消融使用前（2014-2020年）和引入冷冻消融但无其他ERAS组件的队列（2018-2023年）进行比较。平衡措施包括30天并发症和再入院。共纳入97例患者：冷冻消融前队列33例，仅冷冻消融组31例，ERAS组33例。分别比较冷冻消融前队列、仅冷冻消融组和ERAS队列时，ERAS患者的手术时间（小时）（2:17 vs. 2:47 vs. 1:35，p<0.0001）、阿片类药物用量（MME/kg）（10.39 vs. 3.33 vs. 0.000，p<0.0001）、住院时间（天）（4.39 vs. 3.00 vs. 1.17，p<0.0001）和住院费用（$64,961.06 vs. $59,071.10 vs. $46,839.45，p<0.0001）均显著降低。ERAS启动导致LOS的中心线移位超出冷冻消融引入后的水平。实施后无钢板移位，仅1例再入院。标准化ERAS方案用于漏斗胸修复术可显著降低LOS和阿片类药物使用，且不增加再入院或钢板移位。
English
Enhanced recovery after surgery (ERAS) protocols are multi-disciplinary approaches aimed at expediting recovery while minimizing complications. Intercostal nerve cryoablation has markedly improved pain control during minimally invasive pectus excavatum repair (Nuss procedure). To further enhance recovery, we implemented an ERAS pathway focused on decreasing length of stay (LOS) from 3.0 to 1.4 days by the end of 2024 and maintaining for one year. Stakeholder meetings determined the key components of patient education, pain management, intercostal nerve blocks with cryoablation, and post-operative physical therapy. All patients undergoing Nuss procedure were included. ERAS was initiated in March 2024. Patients were compared to pre-cryoablation cohorts prior to cryoablation use (2014-2020) and after cryoablation introduction but without other ERAS components (2018-2023). Balancing measures included 30-day complications and readmissions. Ninety-seven patients were included: 33 in the pre-cryoablation cohort, 31 in the cryoablation-only group, and 33 in the ERAS group. When comparing the pre-cryoablation cohort, the cryoablation-only cohort, and the ERAS-cohort respectively, ERAS patients had significantly decreased operating time (hours) (2:17 vs. 2:47 vs. 1:35, p<0.0001), opioid usage (MME/kg) (10.39 vs. 3.33 vs. 0.000, p<0.0001), LOS (days) (4.39 vs. 3.00 vs. 1.17, p<0.0001), and inpatient encounter charges ($64,961.06 vs. $59,071.10 vs. $46,839.45, p<0.0001). ERAS initiation resulted in a center line shift for LOS beyond that seen after cryoablation introduction. No bar migrations and only one readmission occurred following implementation. Implementation of a standardized ERAS protocol for pectus excavatum repair was associated with a significant decrease in LOS and opioid use without an increase in readmissions or bar migrations.
分类与指标
- 研究类型
- 临床研究
- 病种
- 气胸·外伤·胸壁
- JCR 分区
- Q2
- 影响因子
- 2.3
- 新锐分区
- 2区