Kecheng Zhang, Canrong Lu, Jianxin Cui, Xiaohui Huang, Lin Chen. Chinese PLA General Hospital
Background: Chinese Society of Surgery and Chinese Society of Anesthesiology has jointly released the Chinese Expert Consensus and Clinical Practice Pathway for Enhanced Recovery After Surgery (ERAS) (2018 edition) in January 2018. We investigated the impact of enhanced recovery protocol on patients receiving 3D laparoscopy-assisted gastrectomy in a single arm case series.
Methods: A prospectively maintained database was retrieved for 3D laparoscopy-assisted gastrectomy in ERAS settings. Patient demographics and perioperative outcomes were collected. ERAS protocol compliance rates were assessed. Patient nutritional status was evaluated by Nutritional Risk Screening 2002 (NRS-2002). Univariate and multivariate binary logistic regression analysis was performed to investigate influential factor for delayed discharge [postoperative hospital stay (PHS) > 7 days].
Results: Between January and June 2018, a total of 84 patients receiving 3D laparoscopy-assisted gastrectomy in ERAS settings were included in the final analysis. The median age was 63.5 years [interquartile range, (IQR): 53.0-66.0] with 16 females (19.0%) and 68 males (81.0%). The median body mass index (BMI) was 24.0 (IQR: 21.0-26.0) kg/m2. Ten patients (11.9%) had NRS-2002 scores ≥ 3. The median operation time for 3D laparoscopy-assisted gastrectomy was 230.0 (IQR: 200.0-250.0) min and median blood loss was 100.0 (IQR: 100.0-100.0) ml. Four patients (4.8%) was converted to open surgery. Eight patients (9.5%) had postoperative complications ≥ grading II and mortality rate was 0%. The median PHS was 7.0 (IQR: 5.0-9.0) days. The ERAS protocol compliance rate was 70.0% (IQR: 50.0%-90.0%). Univariate regression analysis revealed operation time, blood loss and ERAS protocol compliance were significantly associated with delayed discharge (all P < 0.05), while multivariate analysis showed only ERAS protocol compliance was statistically significant [odds ratio (OR): 0.65, P = 0.001]. Correlation analysis has also demonstrated the PHS was negatively correlated with the ERAS compliance (Spearman r = -0.7, P < 0.001). Patients with high compliance rates had significantly less hospital cost (P = 0.031).
Conclusions: ERAS protocol is safe and feasible for patients receiving 3D laparoscopy-assisted gastrectomy. High ERAS compliance accelerates recovery, facilitates early discharge and saves cost.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 92041
Program Number: P479
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster