加速康复外科临床路径对正颌手术患者结局的影响:一项回顾性研究

Effects of enhanced recovery after surgery clinical pathways on the outcomes of orthognathic surgery:a retrospective study

目的 探究加速康复外科(ERAS)临床路径干预对正颌手术(OS)患者术后住院时间、患者满意度和术后并发症等术后结局的影响。方法 采用回顾性研究方法,将2018年3月至2022年3月在空军军医大学口腔医院接受OS的患者作为研究对象,整理归纳患者的个人基本信息、围术期管理、术后住院时间、患者满意度和术后并发症等信息,按是否实施ERAS干预措施将患者分为ERAS组和非ERAS组。用t检验和χ^(2)检验分析评估ERAS措施对患者术后结局的影响。随后,将ERAS组患者按干预措施依从性的四分位数分为4组。用负二项回归来模拟术后住院时间与ERAS实施依从性之间的关系。此外,还拟合了手术时间、术中出血和手术方式与ERAS依从性的交互作用模型。结果 共收集接受OS患者686例,符合纳入标准658例,排除数据缺失者170例,最终选取研究对象ERAS组362例,非ERAS组126例。ERAS组按照依从性再分组,各亚组样本量分别为107例(依从率≤18.50%)、89例(18.50%<依从率≤74.07%)、89例(74.07%<依从率≤85.19%)、77例(依从率>85.19%)。患者的平均年龄(23.0±4.2)岁,60%为女性,各组间患者的基线资料无统计学差异。ERAS干预措施能够缩短OS患者的术后住院时间,减少患者的术后并发症,增加患者的满意度。并且ERAS组患者的依从性越好,术后住院时间越短。在接受时间长的相对复杂手术的患者中,术后住院时间缩短更明显。结论 OS患者的ERAS临床路径干预与术后住院时间、患者满意度和减少术后并发症具有相关性。OS中增加ERAS方案依从性可显著降低患者术后住院时间。

Objective To explore the effects of enhanced recovery after surgery(ERAS)clinical pathways on the postoperative outcomes of orthognathic surgery(OS)patients,including postoperative hospital stay,patient satisfaction and postoperative complications.Methods In a retrospective study,patients who received OS in Stomatological Hospital,Air Force Medical University from March 2018 to March 2022 were selected as research objects,and their personal basic information,perioperative management,postoperative hospital stay,patient satisfaction,postoperative complications and other information were summarized.Patients were divided into ERAS group and non-ERAS group according to whether ERAS intervention measures were implemented.T-test and chi-square test were used to evaluate the effects of ERAS measures on postoperative outcomes.Then,patients in ERAS group were divided into four subgroups according to the quartile of intervention compliance.Negative binomial regression was used to simulate the relationship between postoperative hospital stay and ERAS compliance.Besides,the interaction model between ERAS compliance and operative time,intraoperative bleeding and operation mode was also fitted.Results A total of 686 patients receiving OS were collected,among which 658 patients met the inclusion criteria,and 170 patients with missing data were excluded.Finally,362 patients in ERAS group and 126 patients in non-ERAS group were selected as subjects.According to compliance,the sample sizes of ERAS subgroups were 107 cases(compliance rate≤18.50%),89 cases(18.50%<compliance rate≤74.07%),89 cases(74.07%<compliance rate≤85.19%)and 77 cases(compliance rate>85.19%),respectively.The average age of patients was(23.0±4.2)years,60%of them were female,and there was no statistical difference in the baseline data between the groups.ERAS intervention could shorten postoperative hospital stay in OS patients,reduce postoperative complications,and increase patient satisfaction.The better the compliance of patients in ERAS group,the shorter the postoperative hospital stay.For patients undergoing relatively complicated surgeries with a long operative time,the postoperative hospital stay was shortened more significantly.Conclusion ERAS clinical pathway intervention in OS patients is correlated with postoperative hospital stay,patient satisfaction and reduction of postoperative complications.Increasing ERAS compliance in OS significantly reduces postoperative hospital stay.