AIM: To study the implementation of an enhanced recovery after surgery (ERAS) program at a large University Hospital from “pilot study” to “standard of care”.
Background: Enhanced recovery after surgery(ERAS) protocol is a multimodal, multidisciplinary and evidence-based approach to reduce surgical stress and enhance recovery in the postoperative period. This study aimed to...Background: Enhanced recovery after surgery(ERAS) protocol is a multimodal, multidisciplinary and evidence-based approach to reduce surgical stress and enhance recovery in the postoperative period. This study aimed to analyze the outcome of ERAS protocol in patients after pancreaticoduodenectomy(PD). Methods: A total of 50 consecutive patients with pancreatic/periampullary cancer who underwent PD between January 2016 to August 2017 were included in the study. As per the institute ERAS protocol, nasogastric tube(NGT) was removed on postoperative day(POD) 1 if output was less than 200 mL and oral sips were allowed; oral liquids were allowed on POD2; semisolid diet by POD3; abdominal drain was removed on POD 4 if output was less than 100 mL with no evidence of postoperative pancreatic fistula(POPF); normal diet was allowed on POD5. Discharge criteria on POD6 were afebrile, tolerating oral normal diet, pain free and no surgery related complications(defined as per the ISGPS definitions). Results: NGT was removed on POD1 in 45(90%) patients, abdominal drain removed by POD4 in 41(82%) and 43(86%) patients were discharged on POD6. There was no 30-day postoperative mortality. Three(6%) patients had delayed gastric emptying(DGE). None had postoperative hemorrhage and POPF. Readmission rate was 8%. A significant relation was found between the length of hospital stay(LOS) with age( P < 0.05) and a marginal relation between LOS and postoperative albumin( P = 0.05). Conclusions: ERAS protocol can be safely followed in the perioperative care of patients who undergo PD. Early removal of NGT and allowing oral diet restore bowel function early. ERAS decreases the LOS and postoperative complications.展开更多
BACKGROUND There is still large debate on feasibility and advantages of fast-track protocols in elderly population after colorectal surgery.AIM To investigate the impact of age on feasibility and short-term results of...BACKGROUND There is still large debate on feasibility and advantages of fast-track protocols in elderly population after colorectal surgery.AIM To investigate the impact of age on feasibility and short-term results of enhanced recovery protocol(ERP)after laparoscopic colorectal resection.METHODS Data from 225 patients undergoing laparoscopic colorectal resection and ERP between March 2014 and July 2018 were retrospectively analyzed.Three groups were considered according to patients’age:Group A,65 years old or less,Group B,66 to 75 years old and Group C,76 years old or more.Clinic and pathological data were compared amongst groups together with post-operative outcomes including post-operative overall and surgery-specific complications,mortality and readmission rate.Differences in post-operative length of stay and adherence to ERP’s items were evaluated in the three study groups.RESULTS Among the 225 patients,112 belonged to Group A,57 to Group B and 56 to Group C.Thirty-day overall morbidity was 32.9%whilst mortality was nihil.Though the percentage of complications progressively increased with age(25.9%vs 36.8%vs 42.9%),no differences were observed in the rate of major complications(4.5%vs 3.5%vs 1.8%),prolonged post-operative ileus(6.2%vs 12.2%vs 10.7%)and anastomotic leak(2.7%vs 1.8%vs 1.8%).Significant differences in recovery outcomes between groups were observed such as delayed urinary catheter removal(P=0.032)and autonomous deambulation(P=0.013)in elderly patients.Although discharge criteria were achieved later in older patients(3 d vs 3 d vs 4 d,P=0.040),post-operative length of stay was similar in the 3 groups(5 d vs 6 d vs 6 d).CONCLUSION ERPs can be successfully and safely applied in elderly undergoing laparoscopic colorectal resection.展开更多
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 ...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 distentio展开更多
加速康复外科(enhanced recovery after surgery,ERAS)的临床实践已有充分的证据改变了外科手术的结果,缩短住院日并节约费用。但是目前ERAS无论是被应用的广度还是深度却远远不够,原因何在呢?我们分析可能主要原因是缺少"可操作...加速康复外科(enhanced recovery after surgery,ERAS)的临床实践已有充分的证据改变了外科手术的结果,缩短住院日并节约费用。但是目前ERAS无论是被应用的广度还是深度却远远不够,原因何在呢?我们分析可能主要原因是缺少"可操作、可评估、可重复"的临床方案。可操作主要是指临床方案简单易行,团队和患者依从性均好;可评估是指方案应用前、中、后均有客观评估标准及处理方案;可重复是临床方案在本单位及推广过程中重复性好。展开更多
BACKGROUND Fascia iliaca compartment blocks(FIBs) have been used to provide postoperative analgesia after total hip arthroplasty(THA). However, evidence of their efficacy remains limited. While pain control appears to...BACKGROUND Fascia iliaca compartment blocks(FIBs) have been used to provide postoperative analgesia after total hip arthroplasty(THA). However, evidence of their efficacy remains limited. While pain control appears to be satisfactory, quadriceps weakness may be an untoward consequence of the block. Prior studies have shown femoral nerve blocks and fascia iliaca blocks as being superior for pain control and ambulation following THA when compared to standard therapy of parenteral pain control. However, most studies allowed patients to ambulate on post-operative day(POD) 2-3, whereas new guidelines suggest ambulation on POD 0 is beneficial.AIM To determine the effect of FIB after THA in patients participating in an enhanced recovery after surgery(ERAS) program.METHODS We conducted a retrospective analysis of patients undergoing THA with or without FICBs and their ability to ambulate on POD 0 in accordance with ERAS protocol. Perioperative data was collected on 39 patients who underwent THA.Demographic data, anesthesia data, and ambulatory outcomes were compared.RESULTS Twenty patients had FIBs placed at the conclusion of the procedure, while 19 did not receive a block. Of the 20 patients with FIB, only 1 patient was able to ambulate. Of the 19 patients without FIB blocks, 17 were able to ambulate. All patients worked with physical therapy 2 h after arriving in the post-anesthesia care unit on POD 0.CONCLUSION Our data suggests an association between FIB and delayed ambulation in the immediate post-operative period.展开更多
文摘AIM: To study the implementation of an enhanced recovery after surgery (ERAS) program at a large University Hospital from “pilot study” to “standard of care”.
文摘Background: Enhanced recovery after surgery(ERAS) protocol is a multimodal, multidisciplinary and evidence-based approach to reduce surgical stress and enhance recovery in the postoperative period. This study aimed to analyze the outcome of ERAS protocol in patients after pancreaticoduodenectomy(PD). Methods: A total of 50 consecutive patients with pancreatic/periampullary cancer who underwent PD between January 2016 to August 2017 were included in the study. As per the institute ERAS protocol, nasogastric tube(NGT) was removed on postoperative day(POD) 1 if output was less than 200 mL and oral sips were allowed; oral liquids were allowed on POD2; semisolid diet by POD3; abdominal drain was removed on POD 4 if output was less than 100 mL with no evidence of postoperative pancreatic fistula(POPF); normal diet was allowed on POD5. Discharge criteria on POD6 were afebrile, tolerating oral normal diet, pain free and no surgery related complications(defined as per the ISGPS definitions). Results: NGT was removed on POD1 in 45(90%) patients, abdominal drain removed by POD4 in 41(82%) and 43(86%) patients were discharged on POD6. There was no 30-day postoperative mortality. Three(6%) patients had delayed gastric emptying(DGE). None had postoperative hemorrhage and POPF. Readmission rate was 8%. A significant relation was found between the length of hospital stay(LOS) with age( P < 0.05) and a marginal relation between LOS and postoperative albumin( P = 0.05). Conclusions: ERAS protocol can be safely followed in the perioperative care of patients who undergo PD. Early removal of NGT and allowing oral diet restore bowel function early. ERAS decreases the LOS and postoperative complications.
文摘BACKGROUND There is still large debate on feasibility and advantages of fast-track protocols in elderly population after colorectal surgery.AIM To investigate the impact of age on feasibility and short-term results of enhanced recovery protocol(ERP)after laparoscopic colorectal resection.METHODS Data from 225 patients undergoing laparoscopic colorectal resection and ERP between March 2014 and July 2018 were retrospectively analyzed.Three groups were considered according to patients’age:Group A,65 years old or less,Group B,66 to 75 years old and Group C,76 years old or more.Clinic and pathological data were compared amongst groups together with post-operative outcomes including post-operative overall and surgery-specific complications,mortality and readmission rate.Differences in post-operative length of stay and adherence to ERP’s items were evaluated in the three study groups.RESULTS Among the 225 patients,112 belonged to Group A,57 to Group B and 56 to Group C.Thirty-day overall morbidity was 32.9%whilst mortality was nihil.Though the percentage of complications progressively increased with age(25.9%vs 36.8%vs 42.9%),no differences were observed in the rate of major complications(4.5%vs 3.5%vs 1.8%),prolonged post-operative ileus(6.2%vs 12.2%vs 10.7%)and anastomotic leak(2.7%vs 1.8%vs 1.8%).Significant differences in recovery outcomes between groups were observed such as delayed urinary catheter removal(P=0.032)and autonomous deambulation(P=0.013)in elderly patients.Although discharge criteria were achieved later in older patients(3 d vs 3 d vs 4 d,P=0.040),post-operative length of stay was similar in the 3 groups(5 d vs 6 d vs 6 d).CONCLUSION ERPs can be successfully and safely applied in elderly undergoing laparoscopic colorectal resection.
基金the Hongkou District Health Committee,No.Hong Wei 2002-08and Discipline Promotion Program of Shanghai Fourth People's Hospital,No.SY-XKZT-2020-1021.
文摘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 distentio
文摘加速康复外科(enhanced recovery after surgery,ERAS)的临床实践已有充分的证据改变了外科手术的结果,缩短住院日并节约费用。但是目前ERAS无论是被应用的广度还是深度却远远不够,原因何在呢?我们分析可能主要原因是缺少"可操作、可评估、可重复"的临床方案。可操作主要是指临床方案简单易行,团队和患者依从性均好;可评估是指方案应用前、中、后均有客观评估标准及处理方案;可重复是临床方案在本单位及推广过程中重复性好。
文摘BACKGROUND Fascia iliaca compartment blocks(FIBs) have been used to provide postoperative analgesia after total hip arthroplasty(THA). However, evidence of their efficacy remains limited. While pain control appears to be satisfactory, quadriceps weakness may be an untoward consequence of the block. Prior studies have shown femoral nerve blocks and fascia iliaca blocks as being superior for pain control and ambulation following THA when compared to standard therapy of parenteral pain control. However, most studies allowed patients to ambulate on post-operative day(POD) 2-3, whereas new guidelines suggest ambulation on POD 0 is beneficial.AIM To determine the effect of FIB after THA in patients participating in an enhanced recovery after surgery(ERAS) program.METHODS We conducted a retrospective analysis of patients undergoing THA with or without FICBs and their ability to ambulate on POD 0 in accordance with ERAS protocol. Perioperative data was collected on 39 patients who underwent THA.Demographic data, anesthesia data, and ambulatory outcomes were compared.RESULTS Twenty patients had FIBs placed at the conclusion of the procedure, while 19 did not receive a block. Of the 20 patients with FIB, only 1 patient was able to ambulate. Of the 19 patients without FIB blocks, 17 were able to ambulate. All patients worked with physical therapy 2 h after arriving in the post-anesthesia care unit on POD 0.CONCLUSION Our data suggests an association between FIB and delayed ambulation in the immediate post-operative period.
