ObjectiveTo investigate the status of urination in post-spineoperative (cervical thoracic and lumber verteb) patients under the enhanced recovery after surgery (ERAS) mode.MethodsPatients who were admitted to the West China Hospital of Sichuan University from October 2018 to February 2019 were enrolled. The urination status of the patients was collected by using questionnaires. All patients were divided into normal urinating group, induced urinating group and catheterization group according to their urination status after returning to the ward.ResultsA total of 106 patients were included, including 78 (73.6%) who urinated smoothly [the first urinating time (72.18±36.33) min], 20 (18.9%) who urinated after induction [the first urinating time (81.50±41.68) min], and 8 (7.5%) who received catheters after induction failure [the first urinating time (162.50±84.52) min]. The different operation, operation time, position of urination, and postoperative pain degree affecting the placement of urethral catheter differed from each other significantly (P<0.05). Among the three groups, the differences were statistically significant in operation time, operation methods, position of urination (except for the induced urination group vs. catheterization group) and postoperative pain degree (except for the induced urination group vs. catheterization group) in pairs (P<0.05). There was no significant difference in other factors among three groups in pairs (P>0.05).ConclusionsMost post-spineoperative patients can autonomously urinate without catheter under the ERAS mode, which bases on operation methods, operation time, and the first urinating posture after the surgery. Early attention should be paid to patients with dysuresia to promote their early rehabilitation.
Esophageal cancer threatens the lives and health of humans for a long time owing to its high morbidity and mortality. Surgical treatment is still the first choice for early-stage esophageal cancer now, but its high mortality and complication rate during perioperative period cause a huge physiological and psychological burden on patients. The concept of enhanced recovery after surgery (ERAS) was first proposed for colorectal surgery, and later promoted to other surgical fields. Its application in esophagectomy successfully reduces the high mortality and complication rate in the perioperative stage and promotes the rapid recovery of patients. However, the application of ERAS in the field of esophageal cancer is relatively late, and its promotion and application are relatively limited compared to other surgical procedures. In this paper, we review the relevant literature at home and abroad in combination with the current progress of ERAS application of esophageal cancer in China. We also summarize the relevant problems related to the implementation of ERAS, in order to help the promotion and application of ERAS in the surgical treatment of esophageal cancer.
Objective To explore the application effect of same-day surgery mode in adult patients with inguinal hernia repair under enhanced recovery after surgery mode. Methods The perioperative data of adults undergoing inguinal hernia repair in the Day Surgery Center of West China Hospital, Sichuan University between August 2020 and March 2022 were analyzed retrospectively. The adult patients with inguinal hernia repair who received routine daytime surgery were taken as the control group (routine group), and the adult patients with inguinal hernia repair who received same-day surgery were selected as the trial group (same-day group). The differences in safety, cost and patient experience between the two groups were compared and analyzed. Results A total of 319 patients were included, including 152 in the routine group and 167 in the same-day group. There was no significant difference in gender, education level, occupation and hernia ring diameter between the two groups (P>0.05). The age of the patients in the same-day group was older than that in the routine group [(49.49±12.88) vs. (46.41±14.12) years, P<0.05]. The hernia position of the two groups was mostly on the right side, but there was a difference in the hernia position (P<0.05). In terms of safety indicators, the majority of patients in the two groups used local anesthesia. The proportion of local anesthesia (98.2% vs. 76.3%), the amount of intraoperative bleeding [2.8 (2.0, 5.0) vs. 1.3 (0.0, 5.0) mL] in the same-day group were higher than those in the routine group, and the operation time [25.2 (20.0, 33.0) vs. 32.3 (26.0, 40.7) min] in the same-day group was shorter than that in the routine group (P<0.05). There was no significant difference between the two groups in the time of getting out of bed and the complications rate on the 3rd and 28th days after operation (P>0.05). There were no intraoperative complications in both groups. In terms of cost indicators, there was no significant difference between the two groups in the hospitalization cost (P>0.05). The surgery cost of the same-day group was higher than that of the routine group [1472.0 (1438.1, 1614.6) vs. 1450.3 (1428.1, 1438.1) yuan, P<0.05]. The drug cost [109.2 (81.3, 138.7) vs. 255.8 (127.0, 261.6) yuan] and the total medical cost [8418.5 (8207.4, 9129.9) vs. 8912.1 (8325.9, 9177.9) yuan] in the same-day group were lower than those in the routine group (P<0.05). In terms of patient experience indicators, the postoperative pain score [0.3 (0.0, 1.0) vs. 0.2 (0.0, 0.0)] and satisfaction score [3.3 (3.0, 4.0) vs. 3.0 (3.0, 3.0)] of the same-day group were higher than those of the routine group (P<0.05). Conclusion Both the same-day surgery mode and the routine surgery mode of adult patients with inguinal hernia repair have high safety, but the same-day surgery mode is more economical and patient satisfaction is higher than the routine surgery mode, which suggest that the same-day surgery mode of adult patients with inguinal hernia repair under enhanced recovery after surgery mode is feasible, safe and economic, and further optimizes and improves the content and quality of daytime surgical medical services.
Objective We conducted a questionnaire study who attended the First West China Forum on Chest Enhanced Recovery after Surgery (ERAS) in order to analyze whether it can improve the knowledge of ERAS and how to organize an effective meeting. Methods We analyzed 188 questionnaires from the representatives of the First West China Forum on Chest ERAS after the meeting which included two parts: one was the personal basic information and institution of respondents, and the other was the opinion of the content setting and suggestion for the next forum. Results A percentage of 97.7% of participants believed that this forum contributed to improving their understanding of ERAS and 65.3% of them will put the concept of ERAS into practice after the meeting. The exchange of experience and project communication of ERAS were the most useful agendas approved by representatives while expert lectures should be more appropriate (18.1%). Arrangement for topic discussion and enough time for discussion were supported by 93.1% and 98.9% of the representatives respectively. Multi-center project discussion (80.9%) and interactive sessions especially WeChat interaction (74.0%) should be added on ERAS forum. Conclusion Reasonable agenda settings are beneficial to improve the understanding and compliance of application of ERAS.
Objective To evaluate the safety and necessity of shortening the time of preoperative fasting and fluid limitation in lumber disc herniation patients undergoing minimally invasive surgery. Methods A total of 141 eligible patients were assigned into the control group (n=70) and the intervention group (n=71) between April and September 2015. The control group received traditional fasting method while the intervention group received new preoperative fasting method. The time of fasting food and fluid limitation, the incidences of hunger, thirsty, aspiration, postoperative nausea and vomiting, postoperative abdominal distension, and length of stay and the subjective feeling in hospital were compared between the two groups. Results The average time of preoperative fasting and fluid limitation were (13.09±2.30) and (7.84±2.10) hours in the control group and (6.88±0.96) and (4.68±1.08) hours in the intervention group. The incidence of thirsty in the intervention group was shorter than that in the control group, and the subjective feeling in hospital of the intervention group was better than that in the control group (P<0.05). There were no significant differences in the incidence of postoperative nausea and vomiting, the incidence of postoperative abdominal distension, and length of hospital stay between the two groups (P>0.05). Conclusions Shortening the time of preoperative fasting and fluid limitation can improve the subjective feeling in hospital of lumber disc herniation patients undergoing minimally invasive surgery, not increasing the incidences of complications. It can be applied gradually.
Objective To compare the effect of uniportal and multiportal thoracoscopic lobectomy, and to explore the advantages and applications of uniportal thoracoscopic lobectomy in enhanced recovery after surgery. Methods Totally 169 patients with video-assisted thoracoscopic lobectomy in Department of Thoracic Surgery of Sichuan Cancer Hospital from January to December 2016 were enrolled. There were 99 males and 70 females with age of 60.83±7.24 years. Patients were divided into two groups: a uniportal group (78 patients) and a multiportal group (91 patients) . Patients’ clinical and pathological materials were collected. Postoperative pain, complications and hospital stay, etc of the two groups were compared. Results All patients were successfully discharged without serious postoperative complication or death. Patients in the multiportal group had smaller surgical incisions than that in the uniportal group (3.12±0.73 cm vs. 6.38±1.50 cm, P=0.016). Pain scores at postoperative 24 and 48 hours of the uniportal group were less than those of multiportal group (4.18±1.67 vs. 6.54±1.83, 3.05±1.47 vs. 4.68±1.64, P<0.05). Operation data, postoperative complications and hospital stay were similar in both groups. Conclusion Uniportal video-assisted thoracoscopic lobectomy makes smaller incisions and can further reduce postoperative pain and dosage of morphine. The operation is safe and worthy of wide application in enhanced recoveryafter surgery.
ObjectiveTo examine the effect of preoperative adverse emotion on rehabilitation outcomes in lung cancer patients undergoing thoracoscopic major pulmonary resection.MethodsWe retrospectively analyzed the clinical data of 1 438 patients with lung cancer who underwent thoracoscopic lobectomy and segmentectomy in West China Hospital of Sichuan University from February 2017 to July 2018 including 555 males and 883 females. All patients were assessed by Huaxi emotional-distress index scoring, and were divided into three groups including a non-negative emotion group, a mild negative emotion group, and a moderate-severe negative emotion group. All patients underwent thoracoscopic lobectomy or segmentectomy plus systematic lymph node dissection or sampling. The volume of postoperative chest drainage, postoperative lung infection rate, time of chest tube intubation and postoperative duration of hospitalization were compared among these three groups.ResultsThere were different morbidities of adverse emotion in age, sex, education level and smoking among patients before operation (P<0.05). Univariate analysis showed that there was no statistical difference in the duration of indwelling drainage tube, drainage volume, postoperative pulmonary infection rate or the incidence of other complications among these three groups, but the duration of hospitalization in the latter two groups was less than that in the first group with a statistical difference (P<0.05). After correction of confounding factors by multiple regression analysis, there was no statistical difference among the three groups.ConclusionYoung patients are more likely to develop bad emotions, women are more likely to develop serious bad emotions, highly educated patients tend to develop bad emotions, and non-smoking patients tend to develop bad emotions. There is no effect of preoperative adverse emotions on the rapid recovery of lung cancer patients after minimally invasive thoracoscopic surgery.
Objective To explore the clinical efficacy of nursing measures based on the concept of enhanced recovery after surgery (ERAS) for patients undergoing day surgery of inguinal hernia repair. Methods A total of 120 patients scheduled for day surgery of inguinal hernia repair between January and June 2015 were randomized into ERAS group (n=60) and control group (n=60). Patients in the ERAS group received nursing optimized by the idea of ERAS during the perioperative period, while those in the control group received traditional routine nursing intervention. Postoperative visual analogue scale (VAS) scores, adverse responses, early ambulation, influence of pain on patients’ sleep, satisfaction of the patients and prolonged hospital stay rate were analyzed and compared between the two groups. Results VAS scores during hours 0-2, 2-4, 4-8, and 8-12 in the ERAS group were significantly lower than those in the control group (P < 0.05). Between hour 12 and 24, the VAS sco res were not significantly different between the two groups of patients (P > 0.05). Early postoperative ambulation, influence of pain on the sleep, and patients’ satisfaction on pain control and nursing care in the ERAS group were all significantly better than those in the control group (P <0.05). Conclusion Based on the concept of ERAS nursing intervention model, we can effectively reduce postoperative complications after inguinal hernia repair, accelerate patients’ postoperative rehabilitation, and increase patients’ satisfaction.
Objective To describe the situation of postoperative pain management in colorectal cancer patient in enhanced recovery after surgery (ERAS) mode, and explore its influenceing factors. Methods From March to December 2017, colorectal cancer patients in ERAS mode in Department of Gastrointestinal Surgery, West China Hospital of Sichuan University were selected. On the third day after surgery, a total of 74 patients with acute pain completed a questionnaire, which was composed of a demographic form, the Houston Pain Outcome Instrument (HPOI), Self-Rating Anxiety Scale, and Social Support Rating Scale. Mean±standard deviation and percentage were used to describe the total score of pain experience, t test, analysis of variance, Spearman correlation analysis were used for single-factor analysis, and multiple linear regression was used for multi-factor analysis. Results The mean total score of pain experience was 15.1±3.8. Single-factor analysis results showed that the affection of pain on daily life (rs=0.270, P=0.020), satisfaction of pain controlling education (rs=–0.283, P=0.015), subjective support (rs=–0.326, P=0.005), and social support utilization (rs=–0.253, P=0.029) were correlated with the total score of pain experience. Multi-factor analysis results showed that satisfaction of pain controlling education (P<0.001) and subjective support (P=0.005) were negative influencing factors of postoperative pain experience score, and severe anxiety (P=0.001) and pain expectation after surgery (P=0.016) were positive influencing factors of postoperative pain experience score. Conclusions Pain management situation is not so bad in these patients. High satisfaction of pain controlling education and high subjective social support are helpful to decrease pain. The medical staff should pay more attention to patients with severe anxiety, and help patients to establish reasonable pain expectation after surgery.
ObjectiveTo investigate the safety and feasibility of enhanced recovery after surgery (ERAS) in radical gastrectomy. MethodsThe Cochrane library, PubMed, EMBASE, and Chinese biomedical literature databases were searched to identify randomized controlled trails including patients undergoing radical gastrectomy surgery who were treated by ERAS or traditional methods.The five outcome variables were the time to passage of first flatus and first defecation, the length of postoperative hospital stay, medical cost, and postoperative complications. ResultsFifteen published reports involving 1 533 participants met the inclusion criteria.Compared with traditional methods, ERAS had better outcomes with shorter time to the passage of flatus (WMD=-26.557 hours, 95%CI:-34.097～-19.018, P < 0.05), shorter time to the passage of defecation (WMD=-34.071 hours, 95%CI:-53.449～-14.693, P < 0.05), shorter postoperative hospital stay (WMD=-2.824 days, 95%CI:-3.638～-2.010, P < 0.05), less medical cost (WMD=-0.342 ten thousand yuan, 95%CI:-0.501～-0.184, P < 0.05), and lower postoperative complication rate (RR=0.597, 95%CI: 0.435-0.820, P < 0.05).Especially, ERAS had a significant lower rate of postoperative digestive tract complications (RR=0.492, 95%CI: 0.350-0.693, P < 0.05).However, there were no significant differences between two methods in the incidence of complications including postoperative pulmonary infection, infection or liquefaction of incision, fistula of anastomosis, and postoperative readmission rate (P > 0.05). ConclusionsThe application of ERAS in the perioperated period of radical gastrectomy surgery shortens the time to passage of first flatus and first defecation, the postoperative hospital stay, as well as lowers the medical cost, and the postoperative complication rate.The results suggest that ERAS is safe and effective in perioperated period of radical gastrectomy and it is very promising in clinical application.