| Autor: |
Larson, D. W., Lovely, J. K., Cima, R. R., Dozois, E. J., Chua, H., Wolff, B. G., Pemberton, J. H., Devine, R. R., Huebner, M. |
| Předmět: |
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| Zdroj: |
British Journal of Surgery; Jul2014, Vol. 101 Issue 8, p1023-1030, 8p |
| Abstrakt: |
Background The aim of the study was to assess which aspects of an enhanced recovery programme are associated with better outcomes following laparoscopic colorectal surgery. Methods A database of laparoscopic colorectal procedures performed in 2011 was reviewed. Elements of the enhanced recovery programme and compliance were evaluated for short-term (30-day) outcomes. Individual elements included gabapentin, celecoxib, intrathecal analgesia, diet, postoperative fluids, and paracetamol/non-steroidal anti-inflammatory drug pain management. Results Five hundred and forty-one consecutive procedures were included. Compliance with the enhanced recovery programme elements ranged from 82·4 to 99·3 per cent. Median length of hospital stay was 3 (i.q.r. 2-5) days, with 25·9 per cent of patients discharged within 48 h. Patients without complications had a median length of stay of 3 (i.q.r. 2-4) days if compliant and 3 (3-5) days if not ( P < 0·001). Low oral opiate intake (oral morphine equivalent of less than 30 mg) (odds ratio ( OR) 1·97, 95 per cent confidence interval 1·29 to 3·03; P = 0·002), full compliance ( OR 2·36, 1·42 to 3·90; P < 0·001) and high surgeon volume (more than 100 cases per year) ( OR 1·50, 1·19 to 1·89; P < 0·001) were associated with discharge within 48 h. Compliance with the elements of oral intake and fluid management in the first 48 h was associated with a reduced rate of complications (8·1 versus 19·6 per cent; P = 0·001). Median oral opiate intake was 37·5 (i.q.r. 0-105) mg in 48 h, with 26·2 per cent of patients receiving no opiates. Conclusion Compliance with an enhanced recovery pathway was associated with less opiate use, fewer complications and a shorter hospital stay. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
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