Implementation of an ERAS program in patients undergoing thoracic surgery at a third-level university hospital. An ambispective cohort study
Implementação de um programa ERAS em pacientes submetidos a cirurgia torácica em um hospital universitário de terceiro nível. Um estudo de coorte ambispectivo
Soledad Bellas-Cotán, Rubén Casans-Francés, Cristina Ibáñez, Ignacio Muguruza, Luis E. Muñoz-Alameda
Abstract
Objective
To analyze the effects of an ERAS program on complication rates, readmission, and length of stay in patients undergoing pulmonary resection in a tertiary university hospital.
Methods
Ambispective cohort study with a prospective arm of 50 patients undergoing thoracic surgery within an ERAS program (ERAS group) versus a retrospective arm of 50 patients undergoing surgery before the protocol was implemented (Standard group). The primary outcome was the number of patients with 30-day surgical complications. Secondary outcomes included ERAS adherence, non-surgical complications, mortality, readmission, reintervention rate, pain, and hospital length of stay. We performed a multivariate logistic analysis to study the correlation between outcomes and ERAS adherence.
Results
In the univariate analysis, we found no difference between the two groups in terms of surgical complications (Standard 18 [36%] vs. ERAS 12 [24%], p = 0.19). In the ERAS group, only the readmission rate was significantly lower (Standard 15 [30%] vs. ERAS 6 [12%], p = 0.03). In the multivariate analysis, ERAS adherence was the only factor associated with a reduction in surgical complications (OR [95% CI] = 0.02 [0.00, 0.59], p = 0.03) and length of stay (HR [95% CI] = 18.5 [4.39, 78.4], p < 0.001).
Conclusions
The ERAS program significantly reduced the readmission rate at our hospital. Adherence to the ERAS protocol reduced surgical complications and length of stay.
Keywords
Resumo
Introdução
Analisar os efeitos de um programa ERAS nas taxas de complicações, reinternação e tempo de internação em pacientes submetidos à ressecção pulmonar em um hospital universitário terciário.
Métodos
Estudo de coorte ambispectivo com um braço prospectivo de 50 pacientes submetidos a cirurgia torácica dentro de um programa ERAS (grupo ERAS) versus um braço retrospectivo de 50 pacientes submetidos a cirurgia antes da implementação do protocolo (grupo padrão). O desfecho primário foi o número de pacientes com complicações cirúrgicas em 30 dias. Os desfechos secundários incluíram adesão ao ERAS, complicações não cirúrgicas, mortalidade, reinternação, taxa de reintervenção, dor e tempo de permanência hospitalar. Realizamos uma análise logística multivariada para estudar a correlação entre os resultados e a adesão ao ERAS.
Resultados
Na análise univariada, não encontramos diferença entre os dois grupos quanto às complicações cirúrgicas (Padrão 18 [36%] vs. ERAS 12 [24%],p = 0,19). No grupo ERAS, apenas a taxa de reinternação foi significativamente menor (Padrão 15 [30%] vs. ERAS 6 [12%], p = 0,03). Na análise multivariada, a adesão ao ERAS foi o único fator associado à redução de complicações cirúrgicas (OR [95% CI] = 0,02 [0,00, 0,59], p = 0,03) e tempo de internação (HR [95% CI] = 18,5 [4,39, 78,4], p < 0,001).
Conclusões
O programa ERAS reduziu significativamente a taxa de reinternação em nosso hospital. A adesão ao protocolo ERAS reduziu as complicações cirúrgicas e o tempo de internação.
References
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