2020年 · 第100卷第37期

The Accelerated Rehabilitation Surgery (ERAS) pathway reduces hospital stay length and expense and improves patient satisfaction. However, prospective studies on accelerated rehabilitation after spinal surgery are rare. In this paper, the ERAS approach to improve the quality of rehabilitation after single and double-level lumbar fusion was studied and analyzed. Patients received accelerated rehabilitation (17 preoperative, intraoperative, and postoperative treatment measures based on evidence-based medical evidence) or conventional treatment through a double-blind patient and evaluator randomized study of 56 patients. The quality of rehabilitation-40 score (40-200 points) on the 3rd postoperative day was taken as the main outcome measure. A difference in scores>12 points was defined as having a clinically significant difference. Secondary outcome measures included quality of rehabilitation-40 score on postoperative days 0-2, 14 and 56; Recovery diet time and physical therapy end time; Day of hospitalization; Pain score (0 to 10); Opioid consumption (morphine equivalent); Patient-controlled duration of intravenous analgesic drug use; Markers of complications and surgical stress (interleukin-6, cortisol and C-reactive protein). The study included 25 ERAS-treated patients and 26 routine-treated patients. On postoperative day 3, the quality of rehabilitation-40 score was significantly higher in the ERAS treatment group than in the conventional treatment group [(179 ± 14) versus (170 ± 16) points,P=0.041]。 There was no statistically significant difference between the two groups at postoperative days 0, 1, 2, 14 and 56. The comfort dimension score of the quality of rehabilitation-40 score was higher in the ERAS treatment group (P=0.008), time to return to diet and patient-controlled intravenous analgesic use were shorter (bothP<0.05）； Opioid use was lower on postoperative day 1 and did not reversely affect pain scores; C-reactive protein was lower on postoperative day 3. The results of the study confirm that the ERAS pathway can enable patients to obtain significant benefits in the early stage of recovery. However, significant clinical effects have not been confirmed in this study.

The medical and economic implications of the treatment of intertrochanteric fractures of the femur are increasingly evident. This study looked at the effect of treatment of intertrochanteric fractures of the femur under the concept of Accelerated Rehabilitation Surgery (ERAS) without compromising the quality of treatment on the length of hospital stay. A prospective, observational, single-center cohort study was conducted to compare the differences between the ERAS-treated group and the control group in cases of proximal femoral fractures of AO type A1 or A2 who underwent intramedullary nailing surgery and were treated with post-acute phase rehabilitation (PAR) at Angers Teaching Hospital, France, from 2014 to 2016. The ERAS-treated group entered the PAR pathway on the postoperative day. Patients in the control group underwent routine postoperative management in the surgical room before entering the PAR pathway. The main outcome measure of this study was total length of stay, including preoperative and PAR treatment stay. Secondary outcome measures were immediate patient survival, 1-year postoperative survival, postoperative complications, and mean hospitalization costs. After screening, 54 paired patients (27 pairs) were selected for inclusion in the study from 109 patients initially enrolled. Patients in the ERAS-treated group had (45.85 ± 19.24) d and (48.56 ± 19.36) d of PAR treatment and total hospital stay, respectively (n=27), and the PAR treatment and total hospital stay in the control group were (68.41 ± 48.77) d and (77.85 ± 48.80) d, respectively (n=27）。 Patients in the ERAS treatment group significantly decreased the length of stay and total length of stay for PAR treatment (bothP<0.05）。 There were no statistically significant differences in the number of early deaths, complication rates, and 1-year survival without rehospitalization between the two groups. The average hospitalization cost of patients in the ERAS treatment group was lower. The ERAS therapeutic pathway has been implemented in orthopedics. For patients with hip fractures, the ERAS pathway can reduce the total length of hospital stay in patients with intertrochanteric fractures without increasing mortality and complication rates. The 1-year postoperative survival rates were comparable in both groups. At the same time, this process does not negatively affect the quality of treatment.