Effect of fast track surgery care on knee joint function in patients with knee joint replacement surgery: A systematic review

Objective: To assess the effect of fast track surgery care on knee joint function in patients with knee joint replacement surgery. Methods: Eighteen databases were searched for randomized controlled trials, focusing on evaluation of fast track surgery care on knee joint function in patients with knee joint replacement surgery. Two people independently screened literatures and extracted data according to the inclusion criteria. Then the available data were analyzed with RevMan software (version 5.3.0). Descriptive techniques were performed when no available data could be used. Results: A total of 8 studies were included, for a total sample of 635 patients. The results showed that fast track surgery care can improve Hospital for Special Surgery Knee score at 2 months, 3 months, 6 months, and 1 years after operation [after 2 months (weighted mean difference (WMD), 15.2;95%CI, 13.58 to 16.82;P < 0.01);after 3 months (WMD, 9.42;95%CI, 7.80 to 11.04;P < 0.01);after 6 months,(WMD, 11.01;95%CI, 9.73 to 12.28;P < 0.01);after 1 years (WMD, 10.78;95%CI, 9.33 to 12.24;P < 0.01)]. Fast track surgery care can improve the knee score of American Knee Society Knee Score(WMD, 9.23;95%CI,0.86 - 17.6;P < 0.05), and reduce the incidence of postoperative deep vein thrombosis, constipation, pulmonary infection, urinary tract infection and other complications. Conclusion: Fast track surgery care can promote knee joint function recovery, reduce postoperative deep venous thrombosis, constipation, pulmonary infection and urinary tract infection. However, rigorous large sample and multicenter randomized controlled trials are needed for further validation.

Fast track surgery accelerates the recovery of postoperative insulin sensitivity

Background Few clinical studies or randomized clinical trial results have reported the impact of fast track surgery on postoperative insulin sensitivity. This study aimed to investigate the effects of fast track surgery on postoperative insulin sensitivity in patients undergoing elective open colorectal resection. Methods Controlled, randomized clinical trial was conducted from November 2008 to January 2009 with one-month post-discharge follow-up. Seventy patients with colorectal carcinoma requiring colorectal resection were randomized into two groups： a fast track group （35 cases） and a conventional care group （35 cases）. All included patients received elective open colorectal resection with combined tracheal intubation and general anesthesia. Clinical parameters （complication rates, return of gastrointestinal function and postoperative length of stay）, stress index and insulin sensitivity were evaluated in both groups perioperatively. Results Sixty-two patients finally completed the study, 32 cases in the fast-track group and 30 cases in the conventional care group. Our findings revealed a significantly faster recovery of postoperative insulin sensitivity on postoperative day 7 in the fast-track group than that in the conventional care group. We also found a significantly shorter length of postoperative stay and a significantly faster return of gastrointestinal function in patients undergoing fast-track rehabilitation. Conclusion Fast track surgery accelerates the recovery of postoperative insulin sensitivity in elective surgery for colorectal carcinoma with a shorter length of postoperative hospital stay.

Fast track clinical pathway implications in esophagogastrectomy

AIM： To investigate the feasibility of fast track clinica pathway for esophageal tumor resections. METHODS： One hundred and fourteen patients with esophageal carcinoma who underwent esophagogastrectomy from January 2006 to October 2007 in our department were studied. Fast track clinical pathway included analgesia control, fluid infusion volume control, early ambulation and enteral nutrition. Nasogastric tube was removed 3 d after operation and chest tube was removed 4 d after operation as a routine, and full liquid diet 5 d after operation. RESULTS： Among 114 patients （84 men and 30 women）, 26 patients underwent fast track surgery, including 17 patients over 65 years old and 9 under 65 （P = 0.014）; 18 patients who had preoperative complications could not bear fast track surgery （P 〈 0.001）. No significant differences in tolerance of fast track surgery were attributed to differences in gender, differentiated degree or stage of tumor, pathological type of tumor, or operative incision. The median length of hospital stay was 7 d （5-28 d）, 4% patients were readmitted to hospital within 30 d of discharge. Three patients died and postoperative mortality was 2.6%. All 3 patients had no determinacy to fast track surgery approach.CONCLUSION： The majority of patients with esophageal carcinoma can tolerate fast track surgery. Patients younger than 65 or who have no preoperative diseases have the best results. Median length of hospital stay has been reduced to 7 d.

Day surgery in strabismus operation under general anesthesia

Background:The purpose of this study is to summarize the application of day surgery combined with fast track program in strabismus operation under general anesthesia.Methods:The clinical data of 2,000 cases of strabismus patients who had underwent surgery in day surgery or traditional hospitalization in the duration from 2015 to 2016 was retrospectively analyzed.The safety and efficacy were assessed by comparing the average length of stay in hospitals,anesthesia recovery time,patient satisfaction and number of adverse events.Results:Compared with the traditional group,the average length of stay in hospital and recovery time in day surgery group were significantly lower(P<0.001)and the satisfaction of patient was improved(P<0.05),which were statistically significant difference.Moreover,no adverse events occurred among these patients.Conclusions:The application of day surgery in strabismus operation under general anesthesia is feasible,which can reduce the recovery time and shorten the hospital stay of patients safely and effectively,and their satisfaction was improved at the same time.