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Die Chirurgie
Erschienen in: Die Chirurgie 5/2021

22.01.2021 | Ösophagusresektion | Leitthema

Beschleunigte Genesung nach Operationen – Hält das „ERAS“-Konzept, was es verspricht?

verfasst von: Prof. Dr. med. Wolfgang Schwenk, FACS

Erschienen in: Die Chirurgie | Ausgabe 5/2021

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Zusammenfassung

Einleitung

Perioperative ERAS(„enhanced recovery after surgery“)-Konzepte sollen die Genesung der Patienten beschleunigen, Komplikationen vermeiden und den Krankenhausaufenthalt der Patienten verkürzen.

Methodik

Elektronische Literaturdatenbanksuche zur Identifikation systematischer Reviews mit Metaanalysen (SR) vergleichender Studien zu ERAS oder traditioneller Behandlung.

Ergebnisse

Die dargestellten SR untersuchten 70 randomisierte, kontrollierte Studien (RCT) mit 12.986 Patienten und 93 Nicht-RCT (24.335 Patienten) mit viszeral-, thorax- und gefäßchirurgischen sowie orthopädischen Operationen. Die Komplikationsraten waren unter ERAS nach kolorektalen Ösophagus‑, Leber- und Lungenresektionen sowie Implantationen von Hüftgelenksendoprothesen deutlich niedriger als unter traditioneller Therapie. Pulmonale Komplikationen wurden nach ERAS-Ösophagus‑, Magen- und Lungenresektionen seltener beobachtet. Der erste Stuhlgang trat nach kolorektalen Resektionen unter ERAS früher auf. Eine verzögerte Magenentleerung wurde nach ERAS-Pankreasresektionen seltener beobachtet. Nach ERAS-Fast-track-Ösophagusresektionen wurden Anastomoseninsuffizienzen und nach ERAS-Lungenresektionen chirurgische Komplikationen seltener diagnostiziert. In der Metaanalyse aller Studien orthopädischer Operationen und der Studien mit alleiniger Hüftgelenks- oder Kniegelenksendoprothetik senkte ERAS die Häufigkeit postoperativer Transfusionen. In allen Patientengruppen verkürzte ERAS die stationäre Verweildauer, ohne dass es zu häufigeren stationären Wiederaufnahmen kam.

Zusammenfassung

Zahlreiche klinische Studien belegen, dass ERAS in fast allen Bereichen der Chirurgie die postoperative Morbidität senkt, die Krankenhausverweildauer verkürzt und die Rekonvaleszenz beschleunigt, ohne dass es zu erhöhten Wiederaufnahmeraten kommt.
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Fußnoten
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Metadaten
Titel
Beschleunigte Genesung nach Operationen – Hält das „ERAS“-Konzept, was es verspricht?
verfasst von
Prof. Dr. med. Wolfgang Schwenk, FACS
Publikationsdatum
22.01.2021
Verlag
Springer Medizin
Erschienen in
Die Chirurgie / Ausgabe 5/2021
Print ISSN: 2731-6971
Elektronische ISSN: 2731-698X
DOI
https://doi.org/10.1007/s00104-020-01328-y

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