Objective The objective of this study is to evaluate the effect of enhanced recovery after surgery (ERAS) in the perioperative period of pancreatoduodenectomy. Methods This article conducted the forward-looking analysis on the information of 227 patients undergoing the pancreatoduodenectomy in West China Hospital from January 2016 to June 2017, and then compared the differences between the patients subjected to ERAS (ERAS group) and thosesubjected to regular measures (control group) with respect to time of setting in sickbed, time of mobilizing out ofsickbed, time of starting drink water, time of resumption of diet, exhaust time, defecation time, the time of nasogastric tube, postoperative hospitalization duration and expenses, postoperative complications, and postoperative pain scores. Results ① Postoperative indexes: by comparison of the ERAS group and the control group, it was found that the ERAS group had shorter (or lower) time of setting in sickbed, time of mobilizing out of sickbed, time of starting drink water, time of resumption of diet, exhaust time, defecation time, the time of nasogastric tube, postoperative hospitalization duration and expenses (P<0.05). ② Postoperative complications: of all postoperative complications, including pancreatic fistula, postoperative hemorrhage, delayed gastric emptying, biliary fistula, abdominal infection, incision complication, lung infection, and heart complication were without statistically significant differences (P>0.05) between the 2 groups.③ Reoperation and readmission: there was no significant difference on the incidences of reoperation and readmission between the 2 groups (P>0.05). ④ Postoperative pain scores: except 22 : 00 of the 6-day after operation, the pain scores in the ERAS group were all lower than those in the control group at 2 h and 8 h after operation, and the time points of 1–6 days after operation (8 : 00, 16 : 00, and 22 : 00), with statistically differences (P<0.05). Conclusion Without increasing the incidence of complications, ERAS may speed up the rehabilitation of patients undergoing the pancreatoduodenectomy and mitigate the pain of patients.
Objective To investigate the role of cardiac rehabilitation program in the early recovery after minimally invasive incision coronary artery bypass grafting with general anesthesia. MethodsA retrospective study was performed on the patients who underwent minimally invasive incision coronary artery bypass grafting from January 2015 to January 2020 with general anesthesia in our hospital. The patients were divided into a cardiac rehabilitation group and a control group. The clinical data of the patients were collected in 6 months and 12 months after the beginning of cardiac rehabilitation program and were analyzed by propensity score-matching analysis with a ratio of 1∶1. The main outcomes were the peak oxygen uptake (VO2 peak) of cardiopulmonary function test and the number of patients attending cardiovascular specialties in tertiary hospitals during the follow-up period (20 months). ResultsA total of 600 patients were enrolled, including 200 patients in the cardiac rehabilitation group [137 males and 63 females, aged 61.00 (56.00, 65.00) years] and 400 patients in the control group [285 males and 115 females, aged 60.00 (56.00, 65.00) years]. After matching, 176 patients were included in each group, and the basical clinical data of the pateints were comparable (P>0.05). The VO2 peak of the cardiac rehabilitation group after 6 months and 12 months of cardiac rehabilitation was significantly different from that of the control group [6 months: 1.96 (1.59, 2.38) L/min vs. 1.72 (1.38, 2.12) L/min, P<0.001; 12 months: 2.40 (2.21, 2.63) L/min vs. 2.12 (1.83, 2.45) L/min, P<0.001]. During the follow-up period, there was a statistical difference in the cardiovascular specialist visits in tertiary hospitals (P=0.004). ConclusionCardiac rehabilitation program has a positive effect on the recovery of minimally invasive incision coronary artery bypass grafting with general anesthesia, and can improve the exercise ability of patients.
ObjectiveTo explore the effect of standardized multimodal analgesia (SMA) on opioid consumption after major upper abdominal surgery under enhanced recovery after surgery pathway. MethodsPatients who underwent major upper abdominal surgery in the West China Hospital of Sichuan University between August and November 2020 were included prospectively. The patients were divided into two groups: SMA group (n=175) and control group (n=632). The SMA was defined as preoperative and postoperative use of non-steroidal anti-inflammatory drugs, combined with regional anesthesia, local anesthetic wound infiltration or intrathecal opioid. The postoperative opioid consumption in oral morphine equivalents, the pain scores on movement and at rest, the postoperative rehabilitation were recorded and compared between the two groups. ResultsPatients in the SMA group had a lower opioid consumption during the first 72 h compared to patients in the control group (median: 51 mg vs. 85 mg, P<0.001). The pain scores on movement and at rest at 24, 48, 72 h after surgery in the SMA group were lower than those in the control group (P<0.05). Time to first flatus, time to first ambulation, postoperative hospital stay in the SMA group were significantly shorter than those in the control group (P<0.05), and the quality of life scores at 5 d after surgery increased significantly (P<0.05). The satisfaction with analgesia and the incidence of adverse effects on day 5 after surgery had no statistical significances between the two groups (P>0.05). After controlling for confounding factors, multiple linear regression analysis showed that SMA was associated with less opioid consumption on hour 72 after surgery (P<0.001). ConclusionSMA can reduce postoperative opioid consumption in patients undergoing major upper abdominal surgery.
ObjectiveTo evaluate the risk factors for postoperative indwelling catheter following enhanced recovery after primary unilateral total knee arthroplasty (TKA) under general anesthesia.MethodsPatients who underwent primary unilateral TKA under general anesthesia between January 2017 and August 2018 were enrolled in the study. Among them, 205 patients who met the selection criteria were included in the study, and the clinical data were collected, including gender, age, body mass index, preoperative range of motion, Hospital for Special Surgery (HSS) score, American Society of Anesthesiologists (ASA) score, disease type, comorbidity, hemoglobin, hematocrit, blood volume, length of operation and operation time, whether to keep drainage after surgery, intraoperative blood loss, total blood loss, and preoperative, intraoperative, postoperative fluid infusions, and total fluid infusion on the day of surgery, urine volume on the day of surgery. Univariate analysis and logistic regression analysis were used to screen the risk factors for postoperative indwelling catheter. Length of stay and incidences of complications (intermuscular vein thrombosis, deep vein thrombosis, pulmonary embolism, incision swelling and exudation, electrolyte disorder, nausea and vomiting, and urinary tract infection) were compared between the patients with or without indwelling catheter.ResultsIndwelling catheter occurred in 41 (20%) of 205 patients. Single factor analysis showed that the influence factors were age, gender, keeping drainage after surgery, total fluid infusion and urine volume on the day of surgery (P<0.05). The multiple factors analysis showed that the males and more urine volume on the day of surgery were the significant risk factors for indwelling catheter after primary TKA (P<0.05). In addition, postoperative length of stay was shorter and the incidence of urinary tract infection was lower in non-indwelling catheter group than in indwelling catheter group, showing significant differences (P<0.05).ConclusionThe male patients with more urine on the day of surgery have higher risk for indwelling catheter after primary unilateral TKA under general anesthesia with an enhanced recovery program.
The concept of enhanced recovery after surgery (ERAS) was firstly demonstrated in practice by the Danish scholar Henrik Kehlet in the early 2000s. At present, the ERAS concept has been widely used in a variety of surgical fields, but its application in esophageal cancer surgery is still limited. The new esophageal ERAS guidelines issued by ERAS Association bring new opportunities for the application and promotion of esophageal cancer surgery. Combined with the current situation of esophageal cancer surgery in China and related literature, in this paper we discuss the specific measures of ERAS concept in perioperative application of esophageal cancer in China.
ObjectiveTo investigate the completion of early ambulation in patients with gastric cancer under the enhanced recovery after surgery (ERAS) management mode in the West China Hospital of Sichuan University, and analyze the influencing factors. MethodsFrom November 1, 2021 to March 31, 2022, the patients with gastric cancer who met the inclusion criteria of this study in the West China Hospital of Sichuan University were selected as the survey objects. At 48 h after the operation, the patients were enquired at the bedside and the electronic medical records were accessed to collect the general information, diseases information, etc. of the patients. The postoperative data were also investigated, and the time of early ambulation was investigated, and the influencing factors were analyzed by logistic regression. ResultsAccording to the inclusion and exclusion criteria of this study and the sample size requirements, 140 eligible patients with gastric cancer were investigated, 34 of whom got out of bed early, and the rate of early ambulation was 24.3%. The results of binary logistic regression analysis showed that indwelling urinary catheter within 48 h after operation [OR=10.031, 95%CI（1.037, 97.061）, P=0.046] and American Society of Anaesthesiologists (ASA) grade Ⅲ [OR=4.209, 95%CI（1.792, 9.886）, P=0.001] decreased the probability of early ambulation after operation in patients with gastric cancer. ConclusionsFrom the results of this survey, the completion rate of early ambulation in patients with gastric cancer under ERAS mode is lower, which may be improved by reducing the placement of the urinary catheter or shortening the indwelling time of the urinary catheter. For patients with ASA grade Ⅲ having functional decline before surgery, doctor or nurse needs to evaluate their mobility after surgery and help them to finish early ambulation or exercise on hospital bed within their tolerances.
ObjectiveTo explore the factors that affect the drainage time of da Vinci robot lung cancer surgery, to analyze the coping strategies, and to provide a basis for shortening the drainage time of patients after surgery and speeding up the patients' recovery.MethodsThe clinical data of 131 patients who underwent da Vinci robot lung cancer surgery at the Department of Thoracic Surgery, General Hospital of Northern Theater Command from January 2019 to October 2019 were retrospectively analyzed. Among them, 68 were males and 63 were females, with an average age of 59.84±9.66 years. According to the postoperative thoracic drainage time, the patients were divided into two groups including a group A (drainage time≤ 5 days) and a group B (drainage time >5 days). Univariate analysis and logistic multivariate regression analysis were used to analyze the factors that may affect postoperative drainage time, and the correlation between different influencing factors and thoracic drainage time after da Vinci robot lung cancer surgery.ResultsLogistic multivariate analysis showed that age≥60 years (P=0.014), diabetes mellitus (P=0.035), operation time≥130 min (P=0.018), number of lymph node dissections≥15 (P=0.002), and preoperative albumin<38.45 g/L (P=0.010) were independent factors affecting the drainage time of da Vinci robot lung cancer surgery.ConclusionFor elderly patients with diabetes mellitus during the perioperative period, blood glucose should be actively controlled, reasonable surgical strategies should be formulated to ensure the safety and effectiveness of the operation, while reducing intraoperative damage and shortening the operation time. After the operation, patients should be guided to strengthen active coughing, expectoration and lung expansion. Thereby it can shorten drainage time and speed up the recovery of patients after operation.
In addition to implementing a series of measures in the hospital, enhanced recovery after surgery also needs to balance pre-hospital rehabilitation and post-hospital continuation management for patients. In order to optimize the patient management process of hip and knee arthroplasty, the orthopedic team of West China Hospital of Sichuan University has developed a comprehensive management plan for patients undergoing artificial hip and knee arthroplasty based on the latest domestic and foreign literature and previous practice. This article introduces the program from the definition of whole process management, as well as the pre-hospital, in-hospital, and post-hospital management of patients undergoing hip and knee arthroplasty, and aims to provide experience and reference for future clinical practice.
ObjectiveTo explore the feasibility of decompression without gastric tube after minimally invasive esophageal cancer surgery.MethodsSeventy-two patients who underwent minimally invasive esophageal cancer resection at the Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University from 2016 to 2018 were selected as a trial group including 68 males and 4 females with an average age of 58.5±7.9 years, who did not use gastric tube for gastrointestinal decompression after surgery. Seventy patients who underwent the same operation from 2013 to 2015 were selected as the control group, including 68 males and 2 females, with an average age of 59.1±6.9 years, who were indwelled with gastric tube for decompression after surgery. We observed and compared the intraoperative and postoperative indicators and complications of the two groups.ResultsThere were no significant differences between the two groups in operation time, intraoperative blood loss, postoperative level of serum albumin, postoperative nasal jejunal nutrition, whether to enter the ICU postoperatively, death within 30 days after surgery, anastomotic leakage, lung infection, vomiting, bloating or hoarseness (P>0.05). No gastroparesis occurred in either group. Compared with the control group, the recovery time of the bowel sounds and the first exhaust time after the indwelling in the trial group were significantly shorter, and the total hospitalization cost, the incidence of nausea, sore throat, cough, foreign body sensation and sputum difficulty were significantly lower (P<0.05).ConclusionIt is feasible to remove the gastric tube for gastrointestinal decompression after minimally invasive esophageal cancer surgery, which will not increase the incidence of postoperative complications, instead, accelerate the postoperative recovery of patients.
Objective To compare the effects of anterior mediastinal tumor resection by the Da Vinci robot and video-assisted thoracoscopy via subxiphoid approach. Methods A retrospective cohort study was conducted to continuously enroll patients who underwent anterior mediastinal tumor resection between 2020 and 2021 in our department. They were divided into a robotic group and a subxiphoid thoracoscopic group. The differences of general indexes (intraoperative blood loss, postoperative drainage volume, postoperative catheterization time, postoperative hospital stay), postoperative pain visual analogue scale (VAS), perioperative declining levels of hemoglobin, hematocrit, serum prealbumin and serum albumin were compared and analyzed. Results A total of 113 patients were enrolled. There were 76 patients in the robotic group (46 males and 30 females, median age of 50 years) and 37 patients in the subxiphoid thoracoscopic group (21 males and 16 females, median age of 51 years). Intraoperative blood loss, postoperative drainage volume, postoperative catheterization time and postoperative hospital stay of the robotic group were better than those in the subxiphoid thoracoscopic group (P＜0.05). The postoperative VAS scores in the robotic group were lower than those in the subxiphoid thoracoscopic group, but there was no statistical difference (P＞0.05). Perioperative declining levels of hemoglobin, and hematocrit were not statistically different between the two groups (P＞0.05). Declining levels of serum prealbumin, and serum albumin in the robotic group were lower than those in the subxiphoid thoracoscopic group (P＜0.05). Conclusion Da Vinci robotic and subxiphoid video-assisted thoracoscopic surgeries for the treatment of anterior mediastinal tumors are both safe and reliable, with short postoperative hospital stay, mild postoperative pain and quick recovery. Da Vinci robot surgery has a slight advantage in the treatment outcome.