Aplicação de protocolo de aceleração da recuperação pós-operatória em cirurgias de colectomia retossigmoidectomia, pancreatectomia e hepatectomia: experiência de hospital terciário

Abstract

Introduction: Postoperative recovery of patients undergoing surgical procedures has been a focus of attention in recent years. Positive results from the Enhanced Recovery Based on the favorable results of the Enhanced Recovery After Surgery (ERAS) protocol, the ACERTO (Aceleração da Recuperação Total pós-operatória) protocol was designed in Brazil. This protocol defines some perioperative routines, such as nutritional therapy, decreased preoperative fasting period, early postoperative feeding, decreased venous hydration, among others, with favorable impact on postoperative recovery. The aim of this study was to compare the response of patients undergoing surgical procedures following or not a pilot protocol for accelerating postoperative recovery. Methods: A case-control study nested in a cross-sectional study reviewing medical records of patients hospitalized for colectomy, rectosigmoidectomy, pancreatectomy, and hepatectomy procedures between 2016 and 2017. The patients were divided into intervention and control group. Main endpoints analyzed were: length of postoperative hospital stay, hospitalization outcomes, rate of readmission within 30 days, and hospital costs. Results: 76 patients were enrolled (30 in intervention group and 46 in control group). The median length of in-hospital stay was 6.5 days for the intervention group and 13.5 days for the control group (p =0.0001). Rate of readmission within 30 days was 5.3 times lower in the intervention group in comparison to control group (p=0.02). Cost analysis showed a median per-patient cost of R$ 15.493,91 in the intervention group compared to a median per-patient cost of R$ 25.929,19 in the control group (p=0.0036). Conclusion: Patients who underwent the intervention of the postoperative recovery acceleration multimodal protocol presented shorter hospital stay, lower readmission rate at 30 days and lower hospital costs when compared to patients in the control group.