LOMBER MİKRODİSKEKTOMİ AMELİYATINDA AMELİYAT SONRASI HIZLANDIRILMIŞ İYİLEŞME (ERAS) PROTOKOLLERİNİN ETKİNLİĞİ

Yıl 2023, Cilt: 6 Sayı: 2, 229 - 234, 31.08.2023

Murat Türkeün Ilgınel , Kadir Oktay , Özge Özden , Demet Laflı Tunay , Ebru Biricik , Feride Karacaer , Mazhar Özsoy , Nuri Eralp Çetinalp , Yasemin Güneş

https://doi.org/10.36516/jocass.1286977

Öz

Giriş: Bu çalışma, lomber diskektomi ameliyatlarında ameliyat sonrası hızlandırılmış iyileşme (ERAS) protokollerinin etkinliğini değerlendirmeyi amaçladı.
Gereç ve Yöntemler: Ocak 2021-Ocak 2023 tarihleri arasında tek merkezde lomber mikrodiskektomi ameliyatı uygulanan 92 hastadan elde edilen veriler toplandı. Daha sonra hastalar ERAS protokol grubu (n=60) ve konvansiyonel cerrahi grubu (n=32) olmak üzere iki gruba ayrıldı.
Sonuç: Hastaların yaş ortalaması 49.4±14 idi. Bunların 31'i kadın, 61'i erkekti. İki grubun demografik, cerrahi ve sonuç parametreleri karşılaştırıldı. ERAS protokol grubunda yatış süresi ve spondilodiskit oranlarında istatistiksel olarak anlamlı düşüşler saptandı. Kalış süresi ERAS grubunda 25,52±12,53 saat, konvansiyonel cerrahi grubunda 34±20,06 saat bulundu (p=0,002). Spondilodiskit oranları ERAS ve konvansiyonel cerrahi gruplarında sırasıyla %3,3 ve %15,6 idi (p=0,034).
Tartışma: Bu çalışma, ERAS protokolünün lomber mikrodiskektomi cerrahisinde hastanede kalış süresini ve spondilodiskit oranlarını azalttığını ortaya koydu. Omurga cerrahilerinde ERAS protokollerinin teşvik edilmesi ve daha yaygın uygulanması gerektiği kanaatindeyiz.

Anahtar Kelimeler

Ameliyat sonrası hızlandırılmış iyileşme, ERAS, omurga, lomber mikrodiskektomi, spondilodiskit

Efficacy of Enhanced Recovery after Surgery (ERAS) Protocols in Lumbar Microdiscectomy Surgery

Öz

Aim: This study aimed to asses the efficacy of enhanced recovery after surgery (ERAS) protocols in the lumbar discectomy surgeries.
Methods: Data obtained from 92 patients who underwent lumbar microdiscectomy surgery at a single institution between January 2021 and January 2023. Then, the patients were divided into two groups: ERAS protocol group (n=60), and conventional surgery group (n=32).
Results: The mean age of the patients was 49.4±14 years. Among these, 31 were females, and 61 were males. The demographic, surgical and outcome parameters of two groups were compared. There were statistically significant decreases in length of stay and spondylodiscitis rates in the ERAS protocol group. Length of stay was found 25.52±12.53 hours in ERAS group, and 34±20.06 hours in conventional surgery group (p=0.002). Spondylodiscitis rates were 3.3% and 15.6% in the ERAS and conventional surgery groups, respectively (p=0.034).
Conclusions: This study revealed that ERAS protocol reduces length of stay in hospital, and spondylodiscitis rates in lumbar microdiscectomy surgery. We conclude that ERAS protocols should be encouraged and applied more widely in spine surgeries.

Anahtar Kelimeler

Enhanced recovery after surgery, ERAS, spine, lumbar microdiscectomy, spondylodiscitis

Kaynakça

• 1.Debono B, Wainwright TW, Wang MY, et al. Consensus statement for periop¬erative care in lumbar spinal fusion: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Spine J. 2021; 21(5): 729-52. https://doi.org/10.1016/j.spinee.2021.01.001
• 2.Dietz N, Sharma M, Adams S, et al. Enhanced Recovery After Surgery (ERAS) for Spine Surgery: A Systematic Review. World Neurosurg. 2019; 130: 415-26. https://doi.org/10.1016/j.wneu.2019.06.181
• 3.Kehlet H. Multimodal approach to control postoperative pathophysi-ology and rehabilitation. Br J Anaesth. 1997; 78(5): 606-17. https://doi.org/10.1093/bja/78.5.606
• 4.Fearon KC, Ljungqvist O, Von Meyenfeldt M, et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr. 2005; 24(3): 466-77. https://doi.org/10.1016/j.clnu.2005.02.002
• 5.Grasu RM, Cata JP, Dang AQ, et al. Implementation of an Enhanced Re-covery After Spine Surgery program at a large cancer center: a prelimi-nary analysis. J Neurosurg Spine. 2018; 29(5): 588-98. https://doi.org/10.3171/2018.4.SPINE171317
• 6.Agarwal P, Frid I, Singer J, et al. Neurosurgery perception of Enhanced Re¬covery After Surgery (ERAS) protocols. J Clin Neurosci. 2021; 92: 110-4. https://doi.org/10.1016/j.jocn.2021.07.044
• 7.Ayyadhah Alanazi A. Reducing anxiety in preoperative patients: a sys-tematic review. Br J Nurs. 2014; 23(7): 387-93. https://doi.org/10.12968/bjon.2014.23.7.387
• 8.Gan TJ, Habib AS, Miller TE, et al. Incidence, patient satisfaction, and percep¬tions of post-surgical pain: results from a US national survey. Curr Med Res Opin. 2014; 30(1): 149-60. https://doi.org/10.1185/03007995.2013.860019
• 9.Wilson CJ, Mitchelson AJ, Tzeng TH, et al. Caring for the surgically anx-ious patient: a review of the interventions and a guide to optimizing sur-gical out¬comes. Am J Surg. 2016; 212(1): 151-9. https://doi.org/10.1016/j.amjsurg.2015.03.023
• 10.Bluman LG, Mosca L, Newman N, et al. Preoperative smoking habits and postoperative pulmonary complications. Chest. 1998; 113(4): 883-9. https://doi.org/10.1378/chest.113.4.883
• 11.Hounsome J, Lee A, Greenhalgh J, et al. A systematic review of infor-mation format and timing before scheduled adult surgery for peri-operative anxiety. Anaesthesia. 2017; 72(10): 1265-72. https://doi.org/10.1111/anae.14018
• 12.Wong J, Lam DP, Abrishami A, et al. Short-term preoperative smoking ces¬sation and postoperative complications: a systematic review and meta-analy¬sis. Can J Anaesth. 2012; 59(3): 268-79. https://doi.org/10.1007/s12630-011-9652-x
• 13.Jie B, Jiang ZM, Nolan M, et al. Impact of preoperative nutritional sup-port on clinical outcome in abdominal surgical patients at nutritional risk. Nutri¬tion. 2012; 28(10): 1022-7. https://doi.org/10.1016/j.nut.2012.01.017
• 14.Baron DM, Hochrieser H, Posch M, et al; European Surgical Outcomes Study (EuSOS) group for Trials Groups of European Society of Intensive Care Medi¬cine; European Society of Anaesthesiology. Preoperative ane-mia is associated with poor clinical outcome in non-cardiac surgery patients. Br J Anaesth. 2014; 113(3): 416-23 https://doi.org/10.1093/bja/aeu098
• 15.Smilowitz NR, Oberweis BS, Nukala S, et al. Association Between Anemia, Bleeding, and Transfusion with Long-term Mortality Following Noncardiac Surgery. Am J Med. 2016; 129(3): 315-23.e2. https://doi.org/10.1016/j.amjmed.2015.10.012
• 16.Gustafsson UO, Scott MJ, Hubner M, et al. Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS®) So¬ciety Recommendations: 2018. World J Surg. 2019; 43(3): 659-95. https://doi.org/10.1007/s00268-018-4844-y
• 17.Sanders G, Arthur CH, Hosie KB, et al. Is patient outcome affected by the administration of intravenous fluid during bowel preparation for colonic sur¬gery? Ann R Coll Surg Engl. 2007; 89(5): 487-9. https://doi.org/10.1308/003588407X202047
• 18.Nygren J. The metabolic effects of fasting and surgery. Best Pract Res Clin Anaesthesiol. 2006; 20(3): 429-38. https://doi.org/10.1016/j.bpa.2006.02.004
• 19.Myles PS, Leslie K, Chan MT, et al; ANZCA Trials Group for the ENIGMA-II investigators. The safety of addition of nitrous oxide to gen-eral anaesthesia in at-risk patients having major non-cardiac surgery (ENIGMA-II): a randomised, single-blind trial. Lancet. 2014; 384(9952): 1446-54. https://doi.org/10.1016/S0140-6736(14)60893-X
• 20.Wigmore TJ, Mohammed K, Jhanji S. Long-term Survival for Patients Un¬dergoing Volatile versus IV Anesthesia for Cancer Surgery: A Retro-spective Analysis. Anesthesiology. 2016; 124(1): 69-79. https://doi.org/10.1097/ALN.0000000000000936
• 21.Elayat A, Jena SS, Nayak S, et al. Enhanced recovery after surgery - ERAS in elective craniotomies-a non-randomized controlled trial. BMC Neurol. 2021; 21(1): 127. https://doi.org/10.1186/s12883-021-02150-7
• 22. Hagan KB, Bhavsar S, Raza SM, et al. Enhanced recovery after surgery for oncological craniotomies. J Clin Neurosci. 2016; 24: 10-6. https://doi.org/10.1016/j.jocn.2015.08.013
• 23.Wang Y, Liu B, Zhao T, et al. Safety and efficacy of a novel neurosurgical enhanced recovery after surgery protocol for elective craniotomy: a pro¬spective randomized controlled trial. J Neurosurg. 2018; 1: 1-12.
• 24.Andersen HK, Lewis SJ, Thomas S. Early enteral nutrition within 24h of colorectal surgery versus later commencement of feeding for postop-era¬tive complications. Cochrane Database Syst Rev. 2006; (4): CD004080. https://doi.org/10.1002/14651858.CD004080.pub2
• 25.Smedley F, Bowling T, James M, et al. Randomized clinical trial of the effects of preoperative and postoperative oral nutritional supplements on clinical course and cost of care. Br J Surg. 2004; 91(8): 983-90. https://doi.org/10.1002/bjs.4578
• 26.Joshi GP, Kehlet H. Postoperative pain management in the era of ERAS: An overview. Best Pract Res Clin Anaesthesiol. 2019; 33(3):259-67. https://doi.org/10.1016/j.bpa.2019.07.016
• 27.Rasmussen MS, Jørgensen LN, Wille-Jørgensen P. Prolonged thrombo-prophylaxis with low molecular weight heparin for abdominal or pelvic surgery. Cochrane Database Syst Rev. 2009; (1): CD004318. https://doi.org/10.1002/14651858.CD004318.pub2