Fast-track surgery could improve postoperative recovery in radical total gastrectomy patients

AIM: To assess the impact of fast-track surgery (FTS) on hospital stay, cost of hospitalization and complications after radical total gastrectomy. METHODS: A randomized, controlled clinical trial was conducted from November 2011 to August 2012 in the Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University. A total of 122 gastric cancer patients who met the selection criteria were randomized into FTS and conventional care groups on the first day of hospitalization. All patients received elective standard D2 total gastrectomy. Clinical outcomes, including duration of flatus and defecation, white blood cell count, postoperative pain, duration of postoperative stay, cost of hospitalization and complications were recorded and evaluated.Two specially trained doctors who were blinded to the treatment were in charge of evaluating postoperative outcomes, discharge and follow-up. RESULTS: A total of 119 patients finished the study, including 60 patients in the conventional care group and 59 patients in the FTS group. Two patients were excluded from the FTS group due to withdrawal of consent. One patient was excluded from the conventional care group because of a non-resectable tumor. Compared with the conventional group, FTS shortened the duration of flatus (79.03 ± 20.26 hvs 60.97 ± 24.40 h, P = 0.000) and duration of defecation (93.03 ± 27.95 h vs 68.00 ± 25.42 h, P = 0.000), accelerated the decrease in white blood cell count [P < 0.05 on postoperative day (POD) 3 and 4], alleviated pain in patients after surgery (P < 0.05 on POD 1, 2 and 3), reduced complications (P < 0.05), shortened the duration of postoperative stay (7.10 ± 2.13 dvs 5.68 ± 1.22 d,P = 0.000), reduced the cost of hospitalization (43783.25 ± 8102.36 RMBvs 39597.62 ± 7529.98 RMB,P = 0.005), and promoted recovery of patients. CONCLUSION: FTS could be safely applied in radical total gastrectomy to accelerate clinical recovery of gastric cancer patients.

Fast-track program vs traditional care in surgery for gastric cancer

AIM:To systematically review the evidence for the effectiveness of fast-track program vs traditional care in laparoscopic or open surgery for gastric cancer.METHODS:PubMed,Embase and the Cochrane library databases were electronically searched for published studies between January 1995 and April 2013,and only randomized trials were included.The references of relevant studies were manually searched for further studies that may have been missed.Search terms included"gastric cancer","fast track"and"enhanced recovery".Five outcome variables were considered most suitable for analysis:postoperative hospital stay,medical cost,duration to first flatus,C-reactive protein(CRP)level and complications.Postoperative hospital stay was calculated from the date of operation to the date of discharge.Fixed effects model was used for meta-analysis.RESULTS:Compared with traditional care,fasttrack program could significantly decrease the postoperative hospital stay[weighted mean difference(WMD)=-1.19,95%CI:-1.79--0.60,P=0.0001,fixed model],duration to first flatus(WMD=-6.82,95%CI:-11.51--2.13,P=0.004),medical costs(WMD=-2590,95%CI:-4054--1126,P=0.001),and the level of CRP(WMD=-17.78,95%CI:-32.22--3.35,P=0.0001)in laparoscopic surgery for gastric cancer.In open surgery for gastric cancer,fast-track program could also significantly decrease the postoperative hospital stay(WMD=-1.99,95%CI:-2.09--1.89,P=0.0001),duration to first flatus(WMD=-12.0,95%CI:-18.89--5.11,P=0.001),medical cost(WMD=-3674,95%CI:-5025--2323,P=0.0001),and the level of CRP(WMD=-27.34,95%CI:-35.42--19.26,P=0.0001).Furthermore,fast-track program did not significantly increase the incidence of complication(RR=1.39,95%CI:0.77-2.51,P=0.27,for laparoscopic surgery;and RR=1.52,95%CI:0.90-2.56,P=0.12,for open surgery).CONCLUSION:Our overall results suggested that compared with traditional care,fast-track program could result in shorter postoperative hospital stay,less medical costs,and lower level of CRP,with no more complications occurring in both laparoscopic and open surgery for gastric cancer.

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.

Effects of multimodal fast-track surgery on liver transplantation outcomes

BACKGROUND: Fast-track surgery and enhanced recovery after surgery have been applied to many surgical procedures; however, data on fast-track surgery and enhanced recovery after surgery following liver transplantation is limited. This study aimed to conduct a prospective study to determine the effects of fast-track surgery on prognosis after liver transplantation. METHODS: This was a prospective, single-blinded, randomized study. One hundred twenty-eight patients undergoing liver transplantation were selected for the fast-track (FT group, n=54) or conventional process (NFT group, n=74). The primary endpoints were intensive care unit (ICU) stay and hospital stay. The secondary endpoints were as follows: operative time, anhepatic phase time, intraoperative blood loss, intraoperative blood transfusion volume, postoperative complications, readmission rate, and postoperative mortality. RESULTS: There was no significant difference in preoperative demographics between the two groups. The median ICU stay was 2 days (range 1-7 days) in the FT group and 5 days (range 3-12 days) in the NFT group (P<0.01). Furthermore, the hospital stay was also significantly reduced in the FT group (P<0.01). The operative time, anhepatic phase time, intraoperative blood loss, and intraoperative blood transfusion volume were decreased in the FT group compared with the NFT group (P<0.05). Based on Spearman correlation analysis, the ICU stay and hospital stay may be positively correlated with operative time, anhepatic phase time and intraoperative blood loss. There were no differences in the incidence of postoperative complications, readmissions, and postoperative mortality between the two groups. CONCLUSION: Fast-track procedures effectively reduce the ICU stay and hospital stay without adversely affecting prognosis. This study demonstrated that fast-track protocols are safe and feasible in liver transplantation.

Fast-track program in laparoscopic liver surgery:Theory or fact?

AIM:To analyze our results after the introduction of a fast-track(FT) program after laparoscopic liver surgery in our Hepatobiliarypancreatic Unit.METHODS:All patients(43) undergoing laparoscopic liver surgery between March 2004 and March 2010 were included and divided into two consecutive groups:Control group(CG) from March 2004 until December 2006 with traditional perioperative cares(17 patients) and fast-track group(FTG) from January 2007 until March 2010 with FT program cares(26 patients).Primary endpoint was the influence of the program on the postoperative stay,the amount of re-admissions,morbidity and mortality.Secondarily we considered duration of surgery,use of drains,conversion to open surgery,intensive cares needs and transfusion.RESULTS:Both groups were homogeneous in age and sex.No differences in technique,time of surgery or conversion to open surgery were found,but more malignant diseases were operated in the FTG,and then transfusions were higher in FTG.Readmissions and morbidity were similar in both groups,without mortality.Postoperative stay was similar,with a median of 3 for CG vs 2.5 for FTG.However,the 80.8% of patients from FTG left the hospital within the first 3 d after surgery(58.8% for CG).CONCLUSION:The introduction of a FT program after laparoscopic liver surgery improves the recovery of patients without increasing complications or re-admissions,which leads to a reduction of the stay and costs.

Fast-track surgery in elderly patients undergoing colorectal cancer radical resection

Purpose:To investigate the efficacy of applying fast-track surgery(FTS)to elderly patients undergoing radical resection of colorectal cancer.Methods:Elderly patients undergoing radical resection of colorectal cancer received FTS(n=31)or routine(n=31)nursing care.The time to first anal exhaust,oral feeding and leaving the bed,duration of postoperative hospital stay and the incidence of complications were compared between the two groups.Results:Patients receiving FTS nursing demonstrated significantly shorter times to exhaust,oral feeding and leaving the bed compared with those receiving routine nursing(all p<0.01).Furthermore,there were significantly fewer incidences of postoperative pulmonary and urinary tract infections and intestinal adhesion in patients receiving FTS nursing(all p<0.05).Conclusion:Application of FTS in elderly patients undergoing radical resection of colorectal cancer facilitates an early rehabilitation after surgery,but places higher demands on nursing care.

Effects of nursing care in fast-track surgery on postoperative pain, psychological state, and patient satisfaction with nursing for glioma

BACKGROUND The brain is the most complex organ in the human body.Treatment for a glioma always involves a multi-disciplinary team.Nursing care in fast-track surgery or enhanced recovery after surgery is such kind of work implemented by an interdisciplinary team to provide services to patients to improve their outcomes.AIM To explore the effects of nursing care in fast-track surgery on postoperative pain,psychological state,and patient satisfaction with nursing for glioma.METHODS From June 2018 to June 2020,138 patients who underwent operation for glioma at Cancer Hospital Affiliated to Chongqing University were selected.They were categorized into groups according to different nursing care that they received.Of them,69 patients receiving nursing care in fast-track surgery were included in an experimental group,and 69 patients receiving conventional postoperative nursing were included in a control group.Visual analogue scale was used to evaluate postoperative pain in the two groups immediately after the operation and at 3 d after the operation.Self-rating anxiety scale(SAS)and self-rating depression scale(SDS)were used to evaluate the psychological status of patients immediately after operation and on the 3rd postoperative day.A self-made satisfaction scale for patient satisfaction with nursing was used to evaluate and compare patient satisfaction with nursing between the two groups.RESULTS Time to excretion,time to out-of-bed activities,and length of hospital stay were significantly shorter in the observation group than in the control group(P<0.05).There was no significant difference in duration of operative time or intraoperative bleeding between the two groups(P>0.05).There was no significant difference in postoperative pain score between the two groups(P>0.05).The pain score was significantly lower in the observation group than in the control group at 3 d after the operation(P<0.05).There was no significant difference in postoperative SAS or SDS score between the two groups(P>0.05).SAS and SDS scores were significantly lower in the observation group than in the control group at 3 d after operation(P<0.05).The rate of patient satisfaction with nursing was 94.2%in the observation group,which was significantly higher than that(81.2%)of the control group(P<0.05).CONCLUSION Nursing care in fast-track surgery can relieve postoperative pain,anxiety,and depression,and improve patient satisfaction with nursing in patients with glioma,which is worthy of clinical application.

Effect of fast-track surgery in gynecological laparoscopy:a randomized controlled trial

Objective:To evaluate the value of fast-track surgery(FTS)in gynecological laparoscopy during the perioperative period.Methods:The clinical data of 234 patients who underwent gynecological laparoscopy from January to December in 2018 were collected.Of note,117 patients received a routine nursing method(control group),and 117 patients received the FTS nursing method(observation group).Results:Compared with the control group,FTS group had a quicker postoperative bowel function recovery,earlier to get out of bed,and a lower anxiety level(P<0.05);The incidence of postoperative nausea and vomiting of two groups had no statistical difference.Conclusions:The application of FTS in gynecological laparoscopy is safe,effective,and worth promoting.

Research Progress on the Application of Fast-track Surgery in Perioperative Nursing

Fast-track surgery is a combination of multiple disciplines,using a series of evidence-based medical measures to promote the recovery of gastrointestinal function,reduce complications and promote the rapid recovery of patients.The concept of accelerated rehabilitation runs through the whole process before,during and after operation,and the perioperative surgical nursing plan is improved,which is expected to provide reference for medical staff to carry out perioperative nursing.

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.

Introducing an enhanced recovery after surgery program in colorectal surgery:A single center experience

AIM: To study the implementation of an enhanced recovery after surgery (ERAS) program at a large University Hospital from &#x0201c;pilot study&#x0201d; to &#x0201c;standard of care&#x0201d;.

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.

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.

IDEAS护理模式访视对普外科日间手术患者术前焦虑的影响研究

目的探讨IDEAS护理模式访视对普外科日间手术患者术前焦虑的影响。方法选取我院普外科(2017年1月~2019年1月)收治的110例手术患者,根据不同术前访视分为两组,对照组(n=55)接受常规术前访视,观察组(n=55)接受IDEAS护理模式访视,对比两组患者干预前后生理指标(疼痛、脉率、血压)和术前焦虑程度。结果干预前两组患者脉率、血压对比无差异(P>0.05);干预后两组患者脉率、血压均明显改善,观察组改善程度更显著(P<0.05)。干预前两组患者信息需求量表、焦虑分量表、APAIS总分对比无差异(P>0.05);干预后两组患者信息需求量表、焦虑分量表、APAIS总分均明显改善,观察组改善程度更显著(P<0.05)。结论IDEAS护理模式提高了普外科日间手术患者的自我情绪管理能力,进而有效缓解焦虑情绪,促进手术顺利进行,改善预后。

Enhanced recovery after surgery pathways for patients undergoing laparoscopic appendectomy:A systematic review and meta-analysis

Objective:To compare the benefits of enhanced recovery after surgery(ERAS)pathways with traditional pathways for adult patients undergoing laparoscopic appendectomy.Methods:We looked for publications using the keywords“Enhanced Recovery After Surgery,”“Fast-track Surgery,”“Laparoscopic Appendectomy,”and“Laparoscopic Appendicectomy”in PubMed/Medline,Embase,and the Cochrane library.Operative time,lesser length of stay,oral intake timing,readmission rate,pain/satisfaction levels,readmission rate,and surgical site infections were recorded and analyzed.Results:A total of 95 articles from registers and 161 articles from databases were identified.Three eligible studies were included.The ERAS pathways had a lesser length of stay[Z=2.06,MD=−1.05,95%CI=(−2.04,−0.05),P=0.04]and an earlier start to postoperative feeds[Z=6.22,MD=−267.49,95%CI=(−351.80,−183.19),P<001].Conclusions:ERAS pathways have a shorter length of stay and earlier postoperative feed initiation for adult patients undergoing laparoscopic appendectomy compared with standard care.Both approaches have similar operative time,surgical site infection incidence,and readmission rate.Clinical registration:This review is registered with INPLASY202280005.

温建民教授中西医结合微创治疗拇外翻学术思想总结

阐述温建民教授中西医结合微创治疗拇外翻的学术思想。温老师治疗拇外翻的核心思想来源于中医的阴阳理论、筋骨理论及天人合一的整体观念,在此基础上凝练出“筋骨并重”“动静结合”及“内外兼治”3条治疗大法,涵盖了微创截骨手法整复、裹帘法外固定、中药内服外用、中西医结合康复调护4个操作环节。温老师传承经典,融贯中西,从中西医结合的角度贡献了“筋”与“骨”伤病的独家治疗经验和学术思想。

快速康复外科理念在结直肠癌患者围手术期中的应用

目的探讨快速康复外科(fast track surgery,FTS)理念在结直肠癌患者围手术期中的应用效果。方法将80例结直肠癌手术患者随机分为观察组和对照组各40例。对照组采取常规护理和指导,观察组实施FTS新理念治疗。比较两组患者术后住院天数、首次肛门排气时间、输液治疗时间、并发症发生率、体重的变化、住院总费用以及患者满意度。结果观察组患者满意度高于对照组;术后住院天数、静脉输液时间短于对照组;首次肛门排气时间早于对照组;体重下降、住院总费用低于对照组,两组比较,均P<0.05,差异具有统计学意义。两组患者术后并发症发生率比较,P>0.05,差异无统计学意义。结论FTS理念可以有效促进结直肠癌患者术后胃肠道功能的恢复,节省住院总费用,提高患者对护理工作的满意度。

普外科病区开展无陪护理的效果评价

目的探讨普外科病区开展无陪护理的效果。方法将2006年9—12月住院并实施无陪护理的521例患者设为实验组，将2006年3-6月住院未实施无陪护理的456例患者设为对照组，对2组患者的平均住院日、住院费用以及综合满意度3方面进行比较。结果实验组患者的平均住院日、住院费用显著低于对照组（P〈0．01），而综合满意度显著高于对照组（P〈0．01）。结论在普外科病区开展无陪护理可有效促进患者的早日康复，缩短患者的平均住院日、降低住院费用、提高综合满意度。

手术室设计新思维、新分类与新措施

在开放手术、微创手术与无创手术共存的时代,微创手术与无创手术不断地替代着开放手术。原有的手术室设计标准以开放手术为主,划分手术室级别的标志性指标是手术切口的位置、大小、深度、手术时间、风险程度等因素,并发展出了不同级别手术室与手术环境控制措施。美国医院设施指南协会(FGI)适应发展趋势提出了手术室分级与环境控制的新思路、新措施,对原有的手术室分类及手术室环境控制是一种冲击,也许会改变医院手术室建设原有的体系。对此,我们应有相应的对策思路。

外科决策的理念、技巧与艺术

影响外科决策的因素很多,每个因素都存在不确定性。在这诸多不确定中作出正确的决策绝非易事。本文提出决策者要有正确的理念,要具备八个要素,要掌握决策的技巧与艺术,才能做好外科决策。为了便于理解,以一个决策案例来说明上述这些问题。