Применение программы ускоренного выздоровления в урологии. Систематический обзор и метаанализ

Выполнен систематический обзор и метаанализ данных по проблеме ускоренного выздоровления в урологии. Критерии включения – клинические исследования применения программы ускоренного выздоровления в урологии.

Цель исследования – оценка значимости программы ускоренного выздоровления при оказании хирургической помощи по профилю «урология».

Материалы и методы. Систематический обзор выполнен согласно методическим рекомендациям по представлению систематических обзоров и метаанализов PRISMA. Получен регистрационный номер в международной системе Prospero (CRD42022358982). В систематический обзор включены 364 исследования. Онкоурологические исследования из метаанализа были исключены. Проанализировано 15 исследований с участием 2293 субъектов. Выполнено сравнение применения программы ускоренного выздоровления (ПУВ) и стандартного протокола лечения.

Результаты. Применение ПУВ приводит к ожидаемому двухкратному сокращению срока послеоперационного пребывания (ОШ = –1,96; 95% ДИ: –2,56÷–1,36; p < 0,00001). Сокращение сроков госпитализации при применении ПУВ в урологии не приводит к увеличению риска повторного обращения или реоперации (p = 0,35). Риски развития послеоперационных осложнений ≥ 2-го класса по универсальной классификации Clavien – Dindo оказались сопоставимы в обеих группах (p = 0,13). Применение ПУВ повышает предполагаемую успешность проводимого лечения в 1,74 раза (ОШ = 1,74; 95% ДИ: 1,08–2,79; p = 0,02). При применении ПУВ в реконструктивной урологии установлен достоверно меньший риск развития осложнений (p = 0,02).

Заключение. Программа ускоренного выздоровления позволяет сократить сроки и стоимость лечения, уменьшить вероятность повторной госпитализации и добиться лучших результатов лечения. Применение ПУВ не сопровождается увеличением риска развития осложнений > 2-го класса по Clavien – Dindo.

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