Secondary outcomes
We observed no significant differences between the two groups regarding duration of the operation (defined as the time from intubation to extubation), diminution in hemoglobin, fentanyl dosage, overall or severe morbidity, readmission rate, or in-hospital costs (Table 3).
Patients in the intervention group exhibited a lower narcotic consumption rate (1.4% in the full ERAS program compared with 17.4% receiving limited ERAS management, P = .001), and reported that improved postoperative pain management as denoted by NRS scores within 72 hours after surgery was significantly lower in the intervention group than in the control arm. In both the groups, the NRS score was the highest at 2 hours postoperatively and gradually diminished over time (Table 3). Multivariate analysis showed that the use of preoperative analgesics (B = 12.95; 95% CI, 4.28–39.17; P < .001) was the only independent factor associated with better pain control (defined as an NRS score ≤ 3 points) at 24 hours postoperatively.
There was no statistical difference in the overall PONV incidence (38.6% in the intervention group versus 44.9% in the control arm,P = .447), or severe PONV incidence (defined as a PONV score ≥ 5 points; 8.6% versus 15.9%, respectively; P = .185). Multivariate regression analysis identified the absence of previous PONV history (B = 14.86; 95% CI, 1.50–146.85; P = .021), operation duration < 3 hours (B = 5.85; 95% CI, 1.07–31.98; P = .041), absence of narcotics (B = 4.23; 95% CI,1.11–16.15; P = .035), and utilization of TIVA (B = 3.37; 95% CI, 0.85–13.40; P= .084) as the independent factors for improved PONV management.
Compared with patients in the control group, those in the full ERAS program were more likely to produce early flatus: 775.0 min (563.8–1004.8 min) versus 1022.5min (833.8–1248.8 min), respectively (P < .001); they also enjoyed a better and faster recovery as demonstrated by the QoR-15 scale on POD 3: 137.0 (127.3–141.0) in the intervention group compared with 130.0 (124.0–138.8) in the control group (P = .020).