Does Postoperative Rehabilitation for Radical Cystectomy Call for Enhanced Recovery after Surgery?A Systematic Review and Metaanalysis

The aim of this review was to systematically compare the outcomes of enhanced recovery after surgery(ERAS)with standard care(SC)after radical cystectomy.We performed a systematic search of PubMed,Ovid?Web of Science,and the Cochrane Library to identify studies published until September 2017 which involved a comparison of ERAS and SC.A meta-analysis was performed to assess the outcomes of ERAS versus SC.Sixteen studies including 8 prospective and 8 retrospective trials met the eligibility criteria.A total of 2100 participants were assigned to ERAS(1258 cases)or SC(842 cases).The time to first flatus passage[WMD=-0.95 days,95%Cl(-1.50,-0.41),P=0.0006],time until return to a regular diet[WMD=-2.15 days,95%Cl(-2.86,—1.45),P<0.00001]and the length of hospital stay[WMD=-3.75 days,95%Cl(-5.13,-2.36),P<0.00001]were significantly shorter,and the incidence of postoperative complications[OR=0.60,95%Cl(0.44,0.83),P=0.002],especially postoperative paralytic ileus[OR=0.43,95%Cl(0.30,0.62),P<0.00001]and cardiovascular complications[OR=0.28,95%Cl(0.09,0.90),P=0.03]was significantly lower in the ERAS group than those in the SC group.This meta-analysis demonstrated that ERAS was associated with a shorter time to first flatus passage,return of bowel fimction,and the length of hospital stay than SC in patients undergoing radical cystectomy,as well as a lower rate of postoperative complications,especially paralytic ileus and cardiovascular complications.

Postoperative ileus: Impact of pharmacological treatment,laparoscopic surgery and enhanced recovery pathways

Almost all patients develop postoperative ileus (POI) after abdominal surgery.POI represents the single largest factor influencing length of stay (LOS) after bowel resection,and has great implications for patients and resource utilization in health care.New methods to treat and decrease the length of POI are therefore of great importance.During the past decade,a substantial amount of research has been performed evaluating POI,and great progress has been made in our understanding and treatment of POI.Laparoscopic procedures,enhanced recovery pathways and pharmacologic treatment have been introduced.Each factor has substantially contributed to decreasing the length of POI and thus LOS after bowel resection.This editorial outlines resource utilization of POI,normal physiology of gut motility and pathogenesis of POI.Pharmacological treatment,fast track protocols and laparoscopic surgery can each have significant impact on pathways causing POI.The optimal integration of these treatment options continues to be assessed in prospective studies.

Optimizing outcomes:Implementing enhanced recovery after surgery in orthopedic surgery

In the realm of orthopedics,the adoption of enhanced recovery after surgery(ERAS)protocols marks a significant stride towards enhancing patient well-being.By embracing a holistic approach that encompasses preoperative counseling,dietary optimization,minimally invasive procedures,and early postoperative mobilization,these protocols have ushered in a new era of surgical care.Despite encountering hurdles like resistance to change and resource allocation challenges,the efficacy of ERAS protocols in improving clinical outcomes is undeniable.Noteworthy benefits include shortened hospital stays and bolstered improved patient-safety measures.Looking ahead,the horizon for ERAS in orthopedics appears bright,with an emphasis on tailoring care to individual needs,integrating cutting-edge technologies,and perpetuating research endeavors.This shift towards a more personalized,streamlined,and cost-efficient model of care underscores the transformative potential of ERAS in reshaping not only orthopedic surgery but also the journey to patient recovery.This editorial details the scope and future of ERAS in the orthopedic specialty.

Study on the Application Effect of Enhanced Recovery After Surgery (ERAS) in Patients Undergoing Spinal Fracture Surgery

Objective:To study the application effect of the Enhanced Recovery After Surgery(ERAS)model in patients undergoing spinal fracture surgery.Methods:A randomized controlled trial was designed,and 86 patients undergoing spinal fracture surgery were randomly divided into the ERAS group and the conventional care group.Postoperative recovery outcomes of the two groups were compared.Results:The ERAS group showed better outcomes in terms of postoperative pain scores,activities of daily living,length of hospital stay,and adherence to rehabilitation training compared to the conventional care group,with shorter hospital stays and lower medical expenses(P<0.05).Conclusion:The ERAS model significantly improves the postoperative recovery quality of patients undergoing spinal fracture surgery,reduces hospital stay and medical costs,and increases patient satisfaction.

Prospective study of the effect of ERAS on postoperative recovery and complications in patients with gastric cancer

Objective:To study the efficacy of the enhanced recovery after surgery(ERAS)program on postoperative recovery and complications in patients with gastric cancer.Methods:Eighty patients in the perioperative period with radical gastrectomy were enrolled and randomly divided into 2 groups,the ERAS group and the non-ERAS group.The differences between the 2 groups in terms of postoperative recoveries and complications rate were determined.According to the body mass index(BMI)level,the ERAS group was divided into 2 subgroups,namely group A(BMI<28 kg/m2,n=16)and group B(BMI≥28 kg/m2,n=24).The non-ERAS group was also divided into group C(BMI<28 kg/m2,n=18)and group D(BMI≥28 kg/m2,n=22).The recovery and complications of each group were then determined.Results:The postoperative length of stay and visual analogue scale pain score were less in the ERAS group than the non-ERAS group(P<0.05).Time to first postoperative exhaustion,first postoperative defecation,returning leukocyte count to normal,and stopping intravenous nutrition were significantly shorter in the ERAS group(n=40),compared to the non-ERAS group(n=40,all P<0.05).The incidence of postoperative lower extremity intramuscular venous thrombosis was significantly higher in group D than in group B(χ2=4.800,P=0.028).In addition,the incidence of lower extremity intermuscular venous thrombosis and lung infection in group D was higher than those in other groups.Conclusions:The perioperative ERAS program was associated with faster recovery in patients undergoing radical gastrectomy.For patients with higher BMI(BMI≥28 kg/m2),the use of the perioperative ERAS program was more advantageous.

Enhanced recovery after surgery programs in patients undergoing hepatectomy:A meta-analysis

AIM:To evaluate the impact of enhanced recovery after surgery(ERAS) programs in comparison with traditional care on liver surgery outcomes.METHODS:The Pub Med,EMBASE,CNKI and Cochrane Central Register of Controlled Trials databases were searched for randomized controlled trials(RCTs) comparing the ERAS program with traditional care in patients undergoing liver surgery. Studies selected for the meta-analysis met all of the following inclusion criteria:(1) evaluation of ERAS in comparison to traditional care in adult patients undergoing elective open or laparoscopic liver surgery;(2) outcome measures including complications,recovery of bowel function,and hospital length of stay; and(3) RCTs. The following exclusion criteria were applied:(1) the study was not an RCT;(2) the study did not compare ERAS with traditional care;(3) the study reported on emergency,non-elective or transplantation surgery; and(4) the study consisted of unpublished studies with only the abstract presented at a national or international meeting. The primary outcomes were complications. Secondary outcomes were length of hospital stay and time to first flatus.RESULTS:Five RCTs containing 723 patients were included in the meta-analysis. In 10/723 cases,patients presented with benign diseases,while the remaining 713 cases had liver cancer. Of the five studies,three were published in English and two were published in Chinese. Three hundred and fifty-four patients were in the ERAS group,while 369 patients were in the traditional care group. Compared with traditional care,ERAS programs were associated with significantly decreased overall complications(RR = 0.66; 95%CI:0.49-0.88; P = 0.005),grade?Ⅰ?complications(RR = 0.51; 95%CI:0.33-0.79; P = 0.003),and hospitallength of stay [WMD =-2.77 d,95%CI:-3.87-(-1.66); P < 0.00001]. Similarly,ERAS programs were associated with decreased time to first flatus [WMD =-19.69 h,95%CI:-34.63-(-4.74); P < 0.0001]. There was no statistically significant difference in grade Ⅱ-Ⅴ complications between the two groups.CONCLUSION:ERAS is a safe and effective program in liver surgery. Future studies should define the active elements to optimize postoperative outcomes for liver surgery.

Impact of enhanced recovery after surgery programs on pancreatic surgery:A meta-analysis

AIM To evaluate the impact of enhanced recovery after surgery(ERAS) programs on postoperative complications of pancreatic surgery. METHODS Computer searches were performed in databases(including PubM ed, Cochrane Library and Embase) for randomized controlled trials or case-control studies describing ERAS programs in patients undergoing pancreatic surgery published between January 1995 and August 2017. Two researchers independently evaluated the quality of the studies' extracted data that met the inclusion criteria and performed a metaanalysis using Rev Man5.3.5 software. Forest plots, demonstrating the outcomes of the ERAS group vs the control group after pancreatic surgery, and funnel plots were used to evaluate potential publication bias.RESULTS Twenty case-control studies including 3694 patients, published between January 1995 and August 2017, were selected for the meta-analysis. This study included the ERAS group(n = 1886) and the control group(n = 1808), which adopted the traditional perioperative management. Compared to the control group, the ERAS group had lower delayed gastric emptying rates [odds ratio(OR) = 0.58, 95% confidence interval (CI): 0.48-0.72, P < 0.00001], lower postoperative complication rates(OR = 0.57, 95%CI: 0.45-0.72, P < 0.00001), particularly for the mild postoperative complications(Clavien-Dindo Ⅰ-Ⅱ)(OR = 0.71, 95%CI: 0.58-0.88, P = 0.002), lower abdominal infection rates(OR = 0.70, 95%CI: 0.54-0.90, P = 0.006), and shorter postoperative length of hospital stay(PLOS)(WMD =-4.45, 95%CI:-5.99 to-2.91, P < 0.00001). However, there were no significant differences in complications, such as, postoperative pancreatic fistulas, moderate to severe complications(Clavien-Dindo Ⅲ-Ⅴ), mortality, readmission and unintended reoperation, in both groups.CONCLUSION The perioperative implementation of ERAS programs in pancreatic surgery is safe and effective, can decrease postoperative complication rates, and can promote recovery for patients.

Enhanced recovery after surgery strategy to shorten perioperative fasting in children undergoing non-gastrointestinal surgery:A prospective study

BACKGROUND Enhanced recovery after surgery strategies are increasingly implemented to improve the management of surgical patients.AIM To evaluate the effects of new perioperative fasting protocols in children≥3 mo of age undergoing non-gastrointestinal surgery.METHODS This prospective pilot study included children≥3 mo of age undergoing nongastrointestinal surgery at the Children’s Hospital(Zhejiang University School of Medicine)from January 2020 to June 2020.The children were divided into either a conventional group or an ERAS group according to whether they had been enrolled before or after the implementation of the new perioperative fasting strategy.The children in the conventional group were fasted using conventional strategies,while those in the ERAS group were given individualized fasting protocols preoperatively(6-h fasting for infant formula/non-human milk/solids,4-h fasting for breast milk,and clear fluids allowed within 2 h of surgery)and postoperatively(food permitted from 1 h after surgery).Pre-operative and postoperative fasting times,pre-operative blood glucose,the incidence of postoperative thirst and hunger,the incidence of perioperative vomiting and aspiration,and the degree of satisfaction were evaluated.RESULTS The study included 303 patients(151 in the conventional group and 152 in the ERAS group).Compared with the conventional group,the ERAS group had a shorter pre-operative food fasting time[11.92(4.00,19.33)vs 13.00(6.00,20.28)h,P<0.001],shorter preoperative liquid fasting time[3.00(2.00,7.50)vs 12.00(3.00,20.28)h,P<0.001],higher preoperative blood glucose level[5.6(4.2,8.2)vs 5.1(4.0,7.4)mmol/L,P<0.001],lower incidence of thirst(74.5%vs 15.3%,P<0.001),shorter time to postoperative feeding[1.17(0.33,6.83)vs 6.00(5.40,9.20),P<0.001],and greater satisfaction[7(0,10)vs 8(5,10),P<0.001].No children experienced perioperative aspiration.The incidences of hunger,perioperative vomiting,and fever were not significantly different between the two groups.CONCLUSION Optimizing fasting and clear fluid drinking before non-gastrointestinal surgery in children≥3 mo of age is possible.It is safe and feasible to start early eating after evaluating the recovery from anesthesia and the swallowing function.

Perioperative nursing principles guided by the concept of enhanced recovery after surgery

Objective:To explore the clinical effect of perioperative nursing guided by the concept of enhanced recovery after surgery and summarize them.Methods:Pubmed,Chinese National Knowledge Infrastructure(CNKI),Chinese Biomedical Literature Database(CBM),Wanfang Database,and VIP Database were searched to obtain the relevant literature involving enhanced recovery after surgery(ERAS)guidance,obtain the effective clinical data,review the reports in literature,and obtain the effective scheme.Results:Compared with the traditional nursing program,perioperative nursing principles guided by the concept of ERAS provide more accurate nursing care to patients and reduce the occurrence of intraoperative stress events through comprehensive nursing measures such as preoperative pre-rehabilitation measures,intraoperative body temperature and fluid management,postoperative analgesia,prevention of nausea and vomiting,early mobilization,catheter nursing,and better out-of-hospital follow-up.Conclusions:Perioperative nursing principles guided by the concept of ERAS can significantly reduce the incidence of perioperative complications,shorten the hospital stay of patients,and promote postoperative rehabilitation of patients.The transformation and implementation of this concept can bring significant benefits to hospitals,medical care,and patients.

Developing an enhanced recovery after surgery program for oncology patients who undergo hip or knee reconstruction surgery

Enhanced recovery after surgery(ERAS)protocols are applied in orthopedic surgery and are intended to reduce perioperative stress by implementing combined evidence-based practices with the cooperation of various health professionals as an interdisciplinary team.ERAS pathways include pre-operative patient counselling,regional anesthesia and analgesia techniques,post-operative pain management,early mobilization and early feeding.Studies have shown improvement in the recovery of patients who followed an ERAS program after hip or knee arthroplasty,compared with those who followed a traditional care approach.ERAS protocols reduce post-operative stress,contribute to rapid recovery,shorten length of stay(LOS)without increasing the complications or readmissions,improve patient satisfaction and decrease the hospital costs.We suggest that the ERAS pathway could reduce the LOS in hospital for patients undergoing total hip replacement or total knee replacement.These programs require good organization and handling by the multidisciplinary team.ERAS programs increase patient's satisfaction due to their active participation which they experience as personalized treatment.The aim of the study was to develop an ERAS protocol for oncology patients who undergo bone reconstruction surgeries using massive endoprosthesis,with a view to improving the surgical outcomes.

Enhanced recovery after surgery in laparoscopic major liver resection: A propensity score matching analysis

Objective:Even though enhanced recovery after surgery(ERAS)has been applied to liver resection worldwide,there is a lack of evidence covering its feasibility in laparoscopic major hepatectomy.This study aimed to preliminarily evaluate the superiority of ERAS in major liver resection.Methods:The data were collected from patients who underwent laparoscopic major hepatectomy from July 2014 to November 2020 in Sir Run Run Shaw Hospital,Zhejiang University School of Medicine.The baseline characteristics,pathological features,surgical outcomes,medical costs,and postoperative pain scores were compared before and after propensity score matching(PSM).The patients were divided into the ERAS group and the routine group based on the treatment protocols.Results:Eighty-one patients who underwent laparoscopic major hepatectomy were retrospectively enrolled in the study.Before PSM,there were differences in pathology(p¼0.037)and surgical extent(p¼0.011)between the ERAS group(n¼42)and routine group(n¼39).After PSM,26 patients from each group were matched.For surgical outcomes,patients in the ERAS group had a significantly lower postoperative complication incidence than patients in the routine group(28.6%vs.53.8%,RR:0.531[0.303,0.929],p¼0.021)before PSM.However,after PSM,superiority was not observed in the ERAS group(30.8%vs.53.8%,RR:0.571[0.290,1.13],p¼0.092).The duration of abdominal tube retention(before PSM:5.0 d vs.10.0 d,p<0.001;after PSM:6.0 d vs.9.0 d,p¼0.001),the duration of urinary tube retention(before PSM:1.0 d vs.2.0 d,p<0.001;after PSM:1.0 d vs.2.0 d,p¼0.002),and hospital stay(before PSM:6.0 d vs.11.0 d,p<0.001;after PSM:7.0 d vs.11.5 d,p<0.001)was significantly shorter in the ERAS group than in the routine group.A significant benefit on postoperative day 3(2 vs.3,p¼0.038)was observed with respect to the alleviation of pain after PSM.Conclusions:Our preliminary study revealed the superiority of ERAS in the setting of major liver resection,although further investigations in a large number of patients from multiple institutions are needed to evaluate the feasibility of ERAS.

Application of multidisciplinary collaborative nursing with family care for enhanced recovery after surgery in children with inguinal hernia

BACKGROUND Perioperative nursing can reduce the stress reaction and improve the prognosis of children.AIM To elucidate the influence of multidisciplinary collaborative nursing for enhanced recovery after surgery(ERAS)with family care in perioperative nursing children with an inguinal hernia and its impact on the prognosis.METHODS The data of 100 children with inguinal hernia were retrospectively analyzed.The participants were divided into three groups according to different nursing methods:Groups A(n=38),B(n=32),and C(n=30).Group A received multidisciplinary collaborative ERAS nursing combined with family care nursing;Group B received multidisciplinary collaborative nursing for ERAS;and Group C received routine nursing.The postoperative recovery results of the three groups were compared,including intraoperative blood loss and postoperative feeding time,time of getting out of bed,hospitalization time,and defecation time.Furthermore,the incidence of common complications was also compared between the three groups.RESULTS There was less intraoperative blood loss in Groups A and B than in Group C(P<0.05),and the time of getting out of bed and postoperative hospitalization and defecation times were also decreased in Group C(P<0.05).There was no significant difference in postoperative feeding time among the three groups(P>0.05).Each index had no statistical significance between Groups A and B(P>0.05).The incidence of urinary retention,infection,hematoma,and hernia recurrence in Group A was less than that in Group C(P<0.05).No significant difference was observed in the overall complication rate between Groups A and B and between Groups B and C(P>0.05).CONCLUSION The application of multidisciplinary collaborative nursing combined with family care in the perioperative care of children with an inguinal hernia for ERAS may promote postoperative rehabilitation for children and reduce the incidence of complications.

Optimizing surgical outcomes for elderly gallstone patients with a high body mass index using enhanced recovery after surgery protocol

BACKGROUND Rehabilitation of elderly patients with a high body mass index(BMI)after cholecystectomy carries risks and requires the adoption of effective perioperative management strategies.The enhanced recovery after surgery(ERAS)protocol is a comprehensive treatment approach that facilitates early patient recovery and reduces postoperative complications.AIM To compare the effectiveness of traditional perioperative management methods with the ERAS protocol in elderly patients with gallbladder stones and a high BMI.METHODS This retrospective cohort study examined data from 198 elderly patients with a high BMI who underwent cholecystectomy at the Shanghai Fourth People's Hospital from August 2019 to August 2022.Among them,99 patients were managed using the traditional perioperative care approach(non-ERAS protocol),while the remaining 99 patients were managed using the ERAS protocol.Relevant indicator data were collected for patients preoperatively,intraoperatively,and postoperatively,and surgical outcomes were compared between the two groups.RESULTS The comparison results between the two groups of patients in terms of age,sex,BMI,underlying diseases,surgical type,and preoperative hospital stay showed no statistically significant differences.However,the ERAS group had a significantly shorter preoperative fasting time than the non-ERAS group(4.0±0.9 h vs 7.6±0.9 h).Regarding intraoperative indicators,there were no significant differences between the two groups of patients.However,in terms of postoperative recovery,the ERAS protocol group exhibited significant advantages over the non-ERAS group,including a shorter hospital stay,lower postoperative pain scores and postoperative hunger scores,and higher satisfaction levels.The readmission rate was lower in the ERAS protocol group than in the non-ERAS group(3.0%vs 8.1%),although the difference was not significant.Furthermore,there were significant differences between the two groups in terms of postoperative nausea and vomiting severity,postoperative abdominal distention at 24 h,and daily life ability scores.CONCLUSION The findings of this study demonstrate that the ERAS protocol confers significant advantages in postoperative outcomes following cholecystectomy,including reduced readmission rates,decreased postoperative nausea and vomiting,alleviated abdominal distension,and enhanced functional capacity.While the protocol may not exhibit significant improvement in early postoperative symptoms,it does exhibit advantages in long-term postoperative symptoms and recovery.These findings underscore the importance of implementing the ERAS protocol in the postoperative management of cholecystectomy patients,as it contributes to improving patients'recovery and quality of life while reducing health care resource utilization.

Application of early enteral nutrition nursing based on enhanced recovery after surgery theory in patients with digestive surgery

BACKGROUND Postoperative nursing can improve the restlessness and gastrointestinal function of patients with tracheal intubation under general anesthesia in digestive surgery.Wide application of various nursing methods and routine nursing in periop-erative nursing of patients with general anesthesia in digestive surgery.AIM To investigate the impact of early postoperative enteral nutrition nursing based on the enhanced recovery after surgery(ERAS)theory on postoperative agitation and gastrointestinal recovery in patients undergoing general anesthesia that experienced tracheal intubation.METHODS The data of 126 patients with digestive surgery from May 2019 to February 2022 were retrospectively analyzed.According to different nursing methods,they were divided into control group and observation group,with 63 cases in observation group and 63 cases in control group.The patients in the control group had standard perioperative nursing care,whereas those in the observation group got enteral nourishment as soon as possible after surgery in accordance with ERAS theory.Both the rate and quality of gastrointestinal function recovery were compared between the two groups after treatment ended.Postoperative anes-thesia-related adverse events were tallied,patients'nutritional statuses were monitored,and the Riker sedation and agitation score(SAS)was used to measure the incidence of agitation.RESULTS When compared to the control group,the awake duration,spontaneous breathing recovery time,extubation time and postoperative eye-opening time were all considerably shorter(P<0.05).There was no significant difference in the recovery time of orientation force between the two groups(P>0.05);however,the observation group had a lower SAS score than the control group(P<0.05).The recovery time for normal intestinal sounds,the time it took to have the first postoperative exhaust,the time it took to have the first postoperative defecation,and the time it took to have the first postoperative half-fluid feeding were all faster in the observation group than in the control group(P<0.05);Fasting blood glucose was lower in the observation group compared to the control group(P<0.05),while the albumin and hemoglobin levels were higher on the first and third postoperative days;however,there was no statistically significant difference in the incidence of anesthesia-related adverse reactions between the two groups(P>0.05).CONCLUSION The extremely early postoperative enteral nutrition nursing based on ERAS theory can reduce the degree of agitation,improve the quality of recovery,promote the recovery of gastrointestinal function,and improve the nutritional status of patients in the recovery period after tracheal intubation under general anesthesia.

Safety of fast-track rehabilitation after gastrointestinal surgery:Systematic review and meta-analysis

AIM: To compare the safety of fast-track rehabilitation protocols (FT) and conventional care strategies (CC), or FT and laparoscopic surgery (LFT) and FT and open surgery (OFT) after gastrointestinal surgery.

Early rehabilitation programs after laparoscopic colorectal surgery:Evidence and criticism

During the past several decades,early rehabilitation programs for the care of patients with colorectal surgery have gained popularity.Several randomized controlled trials and meta-analyses have confirmed that the implementation of these evidence-based detailed perioperative care protocols is useful for early recovery of patients after colorectal resection.Patients cared for based on these protocols had a rapid recovery of bowel movement,shortened length of hospital stay,and fewer complications compared with traditional care programs.However,most of the previous evidence was obtained from studies of early rehabilitation programs adapted to open colonic resection.Currently,limited evidence exists on the effects of early rehabilitation after laparoscopic rectal resection,although this procedure seems to be associated with a higher morbidity than that reported with traditional care.In this article,we review previous studies and guidelines on early rehabilitation programs in patients undergoing rectal surgery.We investigated the status of early rehabilitation programs in rectal surgery and analyzed the limitations of these studies.We also summarized indications and detailed protocol components of current early rehabilitation programs after rectal surgery,focusing on laparoscopic resection.

Analysis of the impact of ERAS-based respiratory function training on older patients’ability to prevent pulmonary complications after abdominal surgery

BACKGROUND In China,as the population grows older,the number of elderly people who have died from respiratory problems has increased.AIM To investigate whether enhanced recovery after surgery(ERAS)-based respiratory function training may help older patients who had abdominal surgery suffer fewer pulmonary problems,shorter hospital stays,and improved lung function.METHODS The data of 231 elderly individuals having abdominal surgery was retrospectively analyzed.Based on whether ERAS-based respiratory function training was provided,patients were divided into ERAS group(n=112)and control group(n=119).Deep vein thrombosis(DVT),pulmonary embolism(PE),and respiratory tract infection(RTI)were the primary outcome variables.Secondary outcome variables included the Borg score Scale,FEV1/FVC and postoperative hospital stay.RESULTS The percentage of 18.75%of ERAS group participants and 34.45%of control group participants,respectively,had respiratory infections(P=0.007).None of the individuals experienced PE or DVT.The ERAS group’s median postoperative hospital stay was 9.5 d(3-21 d)whereas the control groups was 11 d(4-18 d)(P=0.028).The Borg score decreased on the 4th d following surgery in the ERAS group compared to the 2nd d prior(P=0.003).The incidence of RTIs was greater in the control group than in the ERAS group among patients who spent more than 2 d in the hospital before surgery(P=0.029).CONCLUSION ERAS-based respiratory function training may reduce the risk of pulmonary complications in older individuals undergoing abdominal surgery.

Fast-track rehabilitation vs conventional care in laparoscopic colorectal resection for colorectal malignancy: A meta-analysis

AIM:To evaluate the fast-track rehabilitation protocol and laparoscopic surgery(LFT)vs conventional care strategies and laparoscopic surgery(LCC).METHODS:Studies and relevant literature comparing the effects of LFT and LCC for colorectal malignancy were identified in MEDLINE,the Cochrane Central Register of Controlled Trials and EMBASE.The complications and re-admission after approximately 1 mo were assessed.RESULTS:Six recent randomized controlled trials(RCTs)were included in this meta-analysis,which related to 655 enrolled patients.These studies demonstrated that compared with LCC,LFT has fewer complications and a similar incidence of re-admission after approximately 1 mo.LFT had a pooled RR of 0.60(95%CI:0.46-0.79,P<0.001)compared with a pooled RR of 0.69(95%CI:0.34-1.40,P>0.5)for LCC.CONCLUSION:LFT for colorectal malignancy is safe and efficacious.Larger prospective RCTs should be conducted to further compare the efficacy and safety of this approach.

Effect of anesthesia induction with butorphanol on postoperative nausea and vomiting:A randomized controlled trial

BACKGROUND Postoperative nausea and vomiting(PONV)are common complications that affect the recovery and well-being of elderly patients undergoing gastrointestinal laparoscopic surgery.AIM To investigate the effect of butorphanol on PONV in this patient population.METHODS A total of 110 elderly patients(≥65 years old)who underwent gastrointestinal laparoscopic surgery were randomly assigned to receive butorphanol(40μg/kg)or sufentanil(0.3μg/kg)during anesthesia induction in a 1:1 ratio.The measured outcomes included the incidence of PONV at 48 h after surgery,intraoperative dose of propofol and remifentanil,Bruggrmann Comfort Scale score in the postanesthesia care unit(PACU),number of compressions for postoperative patientcontrolled intravenous analgesia(PCIA),and time to first flatulence after surgery.RESULTS The results revealed a noteworthy reduction in the occurrence of PONV at 24 h after surgery in the butorphanol group,when compared to the sufentanil group(T1:23.64%vs 5.45%,T2:43.64%vs 20.00%,P<0.05).However,no significant variations were observed between the two groups,in terms of the clinical characteristics,such as the PONV or motion sickness history,intraoperative and postoperative 48-h total infusion volume and hemodynamic parameters,intraoperative dose of propofol and remifentanil,number of postoperative PCIA compressions,time until the first occurrence of postoperative flatulence,and incidence of PONV at 48 h post-surgery(all,P>0.05).Furthermore,patients in the butorphanol group were more comfortable,when compared to patients in the sufentanil group in the PACU.CONCLUSION The present study revealed that butorphanol can be an efficacious substitute for sufentanil during anesthesia induction to diminish PONV within 24 h following gastrointestinal laparoscopic surgery in the elderly,simultaneously improving patient comfort in the PACU.

Optimizing pain management in elderly patients post-knee surgery:A novel collaborative strategy

Total knee replacement,a common surgery among the elderly primarily necessitated by osteoarthritis,replaces the damaged knee joint with an artificial one.Given the aging population and the increasing prevalence of such surgeries,the article highlights the critical need for effective postoperative care strategies.This editorial provides an overview of rehabilitation care for pain in elderly knee replacement patients,emphasizing the importance of a multimodal approach to postoperative recovery.Furthermore,the article advocates for a patient-centered,comprehensive rehabilitation regimen that enhances recovery and quality of life in elderly patients undergoing knee replacement surgery.