加速康复理念下结直肠切除术后住院时间延长的风险因素分析

Risk factors for prolonged postoperative length of stay with colorectal resection under the concept of enhanced recovery after surgery

目的分析加速康复外科(ERAS)理念下结直肠切除术后住院时间(PLOS)延长的相关风险因素。方法收集2018年1月至2020年12月行腹腔镜结直肠手术患者,以PLOS>4 d为延迟组,反之为对照组,收集资料:年龄、体重指数、年龄校正Charlson合并症指数(ACCI)、美国麻醉医师协会(ASA)分级、糖尿病、术前血清白蛋白(ALB)、是否行肠造口术、手术时间、麻醉方式、术后并发症Clavien-Dindo分级、术后视觉模拟评分法(VSA)、术后阿片类药物的额外使用、术后首次进食时间、术后首次下床活动时间、腹腔引流管拔除时间、依从性和ERAS执行度。单因素分析采用卡方检验,多因素分析采用Logistic法并计算OR值及95%CI。结果共纳入276例,其中延迟组152例,对照组124例。单因素分析显示,两组患者年龄、ACCI评分、肠造口术、术后并发症Clavien-Dindo分级、术后VAS评分、糖尿病、术后首次进食时间、术后首次下床时间、腹腔引流管拔除时间、依从性、ERAS执行度差异有统计学意义。多因素分析发现ACCI≥4分、肠造口术、术后并发症Clavien-Dindo分级≥Ⅱ级、首次进食时间、首次下床时间、低依从性和ERAS低执行度为PLOS延长的独立风险因素。结论根据ACCI评分、肠造口术、术后并发症Clavien-Dindo分级、首次进食时间、首次下床时间、依从性和ERAS执行度预测患者PLOS,并进行针对性干预,改进并优化ERAS路径,进一步缩短患者PLOS。

To analyze the risk factors for prolonged postoperative length of stay(PLOS)with colorectal resection under the concept of enhanced recovery after surgery(ERAS).Method Patients undergoing laparoscopic colorectal surgery from January 2018 to December 2020 were collected.The patients with PLOS more than four days were assigned to the delayed discharge group,and the others were assigned to the control group.Data collection:age,BMI,age-adjusted Charlson comorbidity index(ACCI),ASA,diabetes,preoperative hemoglobin and albumin,enterostomy,operation duration,anesthesia,complications of Clavien classⅡand above,postoperative Visual Analogue Scale,additional use of opioids,time to first postoperative feeding and off-bed activity,time to removal of abdominal drainage tube,compliance and ERAS implementation.Chi-square test was used for univariate analysis.Logistic regression analysis was used for multivariate analysis and to calculate odds ratios and 95%confidence intervals.Result Among the 276 cases,152 cases in the delayed discharge group,and and 124 cases in the control group.The univariate analysis showed statistically significant differences in age,ACCI score,enterostomy,Clavien class,postoperative VAS score,diabetes,time to first postoperative feeding,time to first off-bed activity,time to removal of abdominal drain,compliance,and ERAS implementation between the two groups.ACCI≥4,enterostomy,complications of Clavien classⅡand above,time to first postoperative feeding and off-bed activity,low compliance and ERAS implementation were independent risk factors for delayed discharge.Conclusion Based on ACCI score,enterostomy,complication of Clavien class,time to first postoperative feeding,time to first off-bed activity,compliance and ERAS implementation,we could predict patient PLOS,perform targeted interventions,improve and optimize ERAS pathways to further shorten patient PLOS.