加速康复外科措施完成率对高龄肺部手术患者临床结局的影响

The influence of completion ratio of enhanced recovery after lung surgery on the prognosis of the elderly patients

目的探讨在胸外科高龄患者中实施加速康复外科(ERAS)理念对术后住院时间、并发症和住院总费用的影响。方法回顾性分析中日友好医院胸外科1999—2016年行肺部手术治疗的194例高龄(≥75岁)患者的临床资料。按照实施围手术期ERAS措施的完成度分为三组,A组(n=81):ERAS措施完成度≤33%;B组(n=54):ERAS措施完成度33%~50%;C组(n=59):ERAS措施完成度≥50%。主要临床结局指标为术后并发症、术后住院时间以及住院总费用。单因素分析三组间临床结局指标的差异,并采用多因素分析影响临床结局指标的可能风险因素。结果术后并发症发生率、术后住院时间、住院总费用均为A组>B组>C组,三组间比较差异均有统计学意义(P<0.01)。单因素分析显示,性别、吸烟、手术方式、手术时间、术中出血量、ERAS完成率与术后并发症发生率、术后住院时间均显著相关(P<0.05)。性别、肺功能、ASA分级、手术时间、手术方式、术中出血量、ERAS完成率与住院总费用相关(P<0.05)。二元Logistic回归模型在调整了性别、吸烟、手术时间、手术方式、术中出血量、ERAS完成率后,结果显示性别和手术时间是术后并发症的危险因素(HR=0.207,95%CI:0.086~0.495,P<0.001;HR=1.346,95%CI:1.095~1.654,P=0.005)。多元线性回归显示,仅ERAS完成率是延长术后住院时间的危险因素(β=-3.933,95%CI:-5.975^-1.892,P<0.001);性别是增加患者住院总费用的危险因素(β=-1.171,95%CI:-2.312^-0.031,P=0.044)。结论 ERAS措施可以缩短高龄肺部手术患者的住院时间。

Objective To evaluate the effects of ERAS （enhanced recovery after surgery） onpostoperative hospitalization time, complications and total cost in the elderly who underwent pulmonary surgery. Methods Retrospective analysis was performed on effects of enhanced recovery after surgery onthe elderly who underwent pulmonary surgery between 1999 and 2016. A total of 194 patients with themedian ageof 76 （75 to 78）years old were included, Bas^d on the completion ratio of ERAS in theperioperative treatments, they were divided into three groups. Group A： 〈33% of all the ERAmeasures were completed among the patients （81 cases） ; Group B： 33%-50% of all the ERAS measures werecompleted （54 cases）; Group C： 〉 5 0% of all the ERAS measures were completed among the patients（59 cases）. Postoperative complications, postoperative hospital stay, and the total cos t wereanalyzed. The differences between postoperative hospital stay, complication rates, and hospitalizationcosts were analyzed between groups with univariate analysis. Multivariate analysis was used the potential risk factors of these clinical outcomes. Results Postoperative complication ratio wassignificantlyhigher ingroupAwhencomparedwi thgroupBandC（P〈0. 01） . Postoperative hospitalstaywas longer ingroup w h en com p a re dw i th g ro u pB a n dC （ P 〈 0. 01）. Total eott was more expensive in group when compared with group B and C（P〈0.01） .Univariate analysis showed gender, smoking history, surgery type, surgery duration, intraoperative blood loss, ERAS completion ratio and postoperative complication ratio were all risk factors of postoperative complications （P〈0. 05）. Gender, pulmonary,ASA score, operation, surgery duration, intraoperative blood loss, and ERAS completionratio were all risk factors of total cost（P〈0. 05）. Binary k）gistic regression showed gender and surgery durationwere risk factors of postoperative complications（-H=0. 207,95% C l： 0. 086-0. 495, P〈0. 001 ; HR=1.346,95% CJ： 1. 095-1. 654, P = 0 . 005）. Linear regression showed ERAS completion ratio was the only risk factor of postoperative hospital stay（β=-3.933,95% CI：-5.975--1.892,P〈0.001） Gender was the only risk factor of total cost（β=-1.171,95% CI：-2.312--0.031,P=0.044）.Conclusions The implementation of ERAS in the elderly can reduce postoperative hospital stay.