Estudio sobre la adherencia al protocolo de rehabilitación multimodal en cirugía colorrectal electiva del grupo español de rehabilitación multimodal

Resumen

HIPÓTESIS Y OBJETIVOS: Dentro de un programa de RHMM en cirugía colorrectal electiva, no todos los ítems del programa se asocian con una mejora de los resultados clínicos, El objetivo principal del estudio fue la determinación del peso específico de cada ítem en la mejora de los resultados clínicos, en cuanto a resultados de disminución de las complicaciones postoperatorias y de la estancia hospitalaria. MATERIAL Y MÉTODOS: Estudio analítico, observacional y prospectivo sobre la adherencia al programa de RHMM en cirugía colorrectal electiva en el HCU de Zaragoza durante 18 meses consecutivos. Fueron incluidos todos los pacientes mayores de edad intervenidos de resección colorrectal electiva por patología tanto benigna como maligna. Fueron excluidos los pacientes ASA IV, los que recibieron neoadyuvancia o se les practicó una AAP. Fue determinada la adherencia a 17 ítems del programa ERAS: información, educación sanitaria y asesoramiento preoperatorios; optimización preoperatoria; no preparación sistemática intestinal; ayuno y empleo de bebidas carbohidratadas preoperatorios, profilaxis de la ETEV; profilaxis antimicrobiana y preparación de la piel; profilaxis de las NVPO; cirugía laparoscópica y modificación de los accesos quirúrgicos; no uso sistemático de drenajes y sondas; prevención intraoperatoria de la hipotermia; manejo restrictivo de la fluidoterapia; retirada precoz de la SV y de la fluidoterapia; analgesia epidural; nutrición temprana y movilización temprana. RESULTADOS: Fueron incluidos un total de 121 pacientes, varones (61,98%) mayoritariamente y de con una edad media de 70,86 años (DE=11,50) años. La indicación fundamental de cirugía fue el CCR. Se registró una adherencia global media de 67,72% (DE=14,45). 6 ítems se cumplen universalmente. Un aumento de la adherencia mejora los resultados clínicos, disminuyendo la estancia hospitalaria y el desarrollo de complicaciones durante el postoperatorio. CONCLUSIONES: La implementación de un programa de RHMM en cirugía colorrectal es compleja a pesar de haberse demostrado una mejoría en los resultados clínicos postoperatorios. La identificación de los ítem que mayor influencia tienen en los resultados puede facilitar la creación de un protocolo más fácil de aplicar e igualmente efectivo. La mejora en la adherencia a los elementos perioperatorios mejora los resultados clínicos postoperatorios. El cumplimiento de los ítems postoperatorios se ha relacionado con una mejora de los resultados clínicos postoperatorios. La obtención de mejores resultados precisa de la necesaria y estrecha colaboración por parte de todos los miembros del equipo multidisciplinar. La aplicación de programas de RHMM en cirugía colorrectal es segura en pacientes de edad avanzada y pluripatológicos. 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