Recuperación postquirúrgica mejorada (fast-track) versus el cuido convencional en pacientes adultos mayores sometidos a cirugía gastrointestinal: Metaanálisis

Araní Guánchez Mercado; Erika Cyrus Barker; Anthony García; Gustavo Jiménez Ramírez

2016, Number 1

<< Back Next >>

Rev Clin Esc Med 2016; 6 (1)

Recuperación postquirúrgica mejorada (fast-track) versus el cuido convencional en pacientes adultos mayores sometidos a cirugía gastrointestinal: Metaanálisis

Guánchez MA, Cyrus BE, García A, Jiménez RG

Full text

How to cite this article

Language: Spanish
References: 26
Page: 39-48
PDF size: 1163.02 Kb.

ABSTRACT

The elderly patient has complex medical problems that need to be addressed in a multidisciplinary matter. The protocol known as enhanced recovery after surgery (ERAS) and fast track (FT) is a protocol used in the pre, trans, and postsurgical stages with the purpose to improve the result of the interventions they are summited to. In the present paper a comparison is made between the ERAS and the conventional care (CC) protocol in a populations with median age of 60 years or older, that underwent gastrointestinal surgery with laparoscopic, open or both. The analysis is based on 16 case control studies published and selected from the PubMed and EBSCOhost databases. The variables used as outcome measures were hospital stay, readmission in 30 days and complications. To determine if there was an effect from the use of the ERAS protocol, a T Student test was ran along with descriptive statistic tests. The mean age (standard deviation (SD)) was 66.7 (4.34) years and there was no statistical difference between the ERAS and CC group. There was a significant improvement (P<0.05) in hospital stay between the ERAS and CC group of 2.91 (1.64) days, and a 13.26% (13.26) reduction in complications. There was no significant reduction in the 30 days readmission to a 30 day period between the ERAS and CC group.

REFERENCES

1) Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. British Journal of Anaesthesia, 1997; 78: 606-617.
2) Kehlet H. Fast-track colorectal surgery. The Lancet. 2008; 371(9615): 791-793.
3) Kehlet H Wilmore DW. Evidence-Based Surgical Care and the Evolution of Fast- Track Surgery. Annals of Surgery. 2008; 248: 189-198.
4) Murray D Dodds C. Perioperative Care of the Elderly. British Journal of Anaesthesia. 2004; 4(6): 193-196.
5) Wilmore DW. Recent advances: Management of patients in fast track surgery. British Medical Journal. 2001; 322(7284): 473-476.
6) Grigoras I. Fast-Track Surgery, A New Concept, The perioperative Anaesthetic Management. Jurnalul de Chirurgie. 2007; 3: 92-98.
7) Thompson EGE Gower ST Beilby DS et al. Enhanced Recovery after surgery program for elective abdominal surgery at three Victorian Hospitals. Anaesthesia and Intensive Care. 2012; 40(3): 450-459.
8) Roser L Muñoz Y Martínez J et al. La salud de las personas adultas mayores en Costa Rica. Ministerio de salud organización panamericana de la salud oficina regional de la organización mundial de la salud. 2004.
9) Rodríguez R Lazcano B. Práctica de la geriatría. McGraw-Hill Interamericana. 2007: 8.
10) Bojórquez Molina JA López Aranda L Hérnandez Flores ME Jiménez López E. (2013). Utilización del alfa de Cronbach para validar la confiabilidad de un instrumento de medición de satisfacción del estudiante en el uso del software Minitab. Eleventh LACCEI Latin American and Caribbean Conference for Engineering and Technology. 2013.
11) Higgins J Green S. Cochrane handbook for systematic reviews of interventions. General methods for Cochrane reviews, selecting studies and collecting data. The Cochrane collaboration. 2011; version 5.1.0: Part 2, chapter 7.3.5.
12) Larson DW Batdorf N Touzios JG Cima RR Chua HK Pemberton JH Dozois EJ. A Fast-Track Recovery Protocol Improves Outcomes In Elective Laparoscopic Colectomy For Diverticulitis. American College of Surgeons, Elsevier Inc. 2010; 10(1016): 1072-7515.
13) Esteban F Cerdan FJ García-Alonso M et al. A multicentre comparison of a fast track or conventional postoperative protocol following laparoscopic or open elective surgery for colorectal cancer. Colorectal Disease, The Association of Coloproctology of Great Britain and Ireland. 2016; 16(2): 134-132.
14) Compagna R Aprea G DeRosa D et al.Fast-track for elderly patient: Is it feasible for colorectal surgery? International Journal of Surgery. 2014; 12: 20-22.
15) Collazo FE García M Sanz R et al. Resultados de la implantación de un protocolo de fast-track en una unidad de cirugía colorrectal: estudio comparativo. Cirugía Española. 2012; 90(7): 434-439.
16) Gustafsson UO Hausel J Thorell, ALjungqvist O Soop M Nygren, J. Adherence to the Enhanced Recovery After Surgery Protocol and Outcomes After Colorectal Cancer Surgery. Archives of Surgery. 2011; 146: 571-577.
17) Alcántara-Moral M Serra-Aracil X Gil- Egea MJ et al. Observational crosssectional study of compliance with the fast track protocol in elective surgery for colon cancer in Spain. International Journal Colorectal Disease. 2014; 29(4): 477-483.
18) Khoo CK Vickery CJ Forsyth N Vinall NS Eyre-Brook IA. A Prospective Randomized Controlled Trial of Multimodal Perioperative Management Protocol in Patients Undergoing Elective Colorectal Resection for Cancer. Annals of Surgery. 2007; 245(6): 867–872.
19) Mari GM Costanzi A Maggioni D et al.Fast-Track Versus Standard Care in Laparoscopic High Anterior Resection: A Prospective, Randomized-Controlled Trial. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 2014; 24(3): 118-121.
20) Muller S Zalunardo MP Hubner M Clavien PA Demartines N. A Fast-Track Program Reduces Complications and Length of Hospital Stay After Open Colonic Surgery. Gastroenterology. 2009; 136: 842-847.
21) Lee TG Kang SB Kim DW Hong S, Heo SC Park KJ. Comparison of Early Mobilization and Diet Rehabilitation Program With Conventional Care After Laparoscopic Colon Surgery: A Prospective Randomized Controlled Trial. Disease of the Colon and Rectum 2011; 54: 21-28.
22) King PM Blazeby JM Ewings P et al.The influence of an enhanced recovery programme on clinical outcomes, costs and quality of life after surgery for colorectal cancer. Colorectal Disease. 2006; 8: 506- 513.
23) Gatt, M Anderson AD Reddy BS Hayward- Sampson P Tiring, IC MacFie, J. Randomized clinical trial of multimodal optimization of surgical care in patients undergoing major colonic resection. British Journal of Surgery Society. 2005; 92: 1354-1362.
24) Balzano G Zerbi A Braga M et al.Fasttrack recovery programme after pancreatico- duodenectomy reduces delayed gastric emptying. British Journal of Surgery. 2008; 95: 1387–1393.
25) Ionescu D Iancu C Ion D et al.Implementing Fast-Track Protocol for Colorectal Surgery: A Prospective Randomized Clinical Trial. World Journal of Surgery. 2009; 33:2433–2438.
26) R development core team. R: A language and environment for statistical computing. R foundation for statistical computing, Vienna, Australia. 2008; ISBN 3-900051- 07-0, URL http://www.R-project.org.