加速康复外科模式在全髋关节置换术围术期管理中的临床研究

Clinical Study of Enhanced Recovery after Surgery in Peri-operative Management of Total Hip Arthroplasty

目的评价加速康复外科(enhanced recovery after surgery, ERAS)模式在全髋关节置换术围术期管理中的临床效果及康复效益。方法回顾性提取2013~2016年四川大学华西医院生物医学大数据研究中心数据库中行全髋关节置换术病例的数据,比较采用ERAS模式(ERAS组)与采用传统模式(传统组)管理围术期全髋关节置换术患者康复质量指标、康复效率指标、住院费用指标的差异。结果纳入全髋关节置换术患者共915例,其中ERAS组497例,传统组418例;与传统模式相比,ERAS模式能够降低全髋关节置换术总体并发症发生率(8.6%vs.4.8%,P<0.05),也能降低深静脉血栓及肺部感染发生率(3.1%、0.8%vs.2.4%、0.6%,P<0.05);可以缩短平均住院时间[(10.9±2.9) d vs.(7.6±2.0) d,P=0.039];术后平均住院时间更低[(8.6±2.0) d vs.(5.6±0.9) d,P=0.028)];降低住院总费用4.8%~7.1%(P<0.05),其中药品费降幅达17.2%~24.9%(P<0.05)。结论 ERAS模式能够促进患者术后安全快速康复,减少住院费用,控制医疗成本。

Objective To evaluate the clinical effect and rehabilitation benefit of enhanced recovery after surgery(ERAS) model in perioperative management of total hip arthroplasty(THA). Methods A retrospective study were conducted in THA patients from the database of big data Research Center of Biomedicine, West China Hospital of Sichuan University from 2013 to 2016. The differences of rehabilitation quality, rehabilitation efficiency and hospitalization cost between ERAS model(ERAS group) and traditional model(traditional group) were compared. Results 915 THA patients were included in the study, of which 497 patients were given ERAS peri-operative management and 418 patients in the traditional group. The rate of overall complications in the ERAS group was significantly lower than that in the traditional group(4.8% vs. 8.6%,P<0.05), with lower rate of deep venous thrombosis(0.8% vs. 3.1%) and pulmonary infection(0.6% vs. 2.4%) in the ERAS group. Compared with the traditional group, the average length of stay in hospital was shorter in the ERAS group [(7.6±2.0) d vs.(10.9±2.9) d, P=0.039], as well as postoperative length of stay in hospital [(5.6±0.9) d vs.(8.6±2.0) d, P=0.028)]. And the ERAS model reduced the total hospitalization cost by 4.8% to 7.1%(P<0.05), of which the drug cost decreased by 17.2% to 24.9%(P<0.05). Conclusion ERAS model in THA is safe and effective. It can reduce hospitalization cost and help to control medical cost.