Objective To analyze the perioperative efficacy of enhanced recovery after surgery (ERAS) in the treatment of lumbar disc herniation using unilateral biportal endoscopy technique. Methods A total of 55 patients who received unilateral biportal endoscopy technique for the treatment of lumbar disc herniation in Tianjin Hospital between January and December 2020 were selected and randomly divided into the traditional group and the ERAS group according to random number table method. The routine inpatient care management was adopted in the traditional group, while the holistic integrated care plan was formulated in the ERAS group according to the multidisciplinary collaboration of the accelerated rehabilitation plan. The first postoperative exhaust time, the first time out of bed, length of hospital stay, hospital costs, Visual Analogue Scale (VAS) scores before operation, one day and three days after operation, Oswestry Disability Index (ODI) scores before operation and one month after operation, and the excellent and good rate of modified MacNab efficacy one month after operation were compared between the two groups. Results There were 28 cases in the traditional group and 27 cases in the ERAS group. The first postoperative exhaust time [(2.31±1.02) vs. (3.19±0.87) h], the first postoperative ambulation time [(1.06±0.40) vs. (2.00±0.53) d], length of hospital stay [(3.8±0.8) vs. (4.6±0.8) d], and hospital cost [(32.18±9.10) thousand yuan vs. (39.81±11.10) thousand yuan] in the ERAS group were all less than those in the traditional group, and the differences were statistically significant (P<0.05). The VAS scores of the ERAS group one day after operation (3.2±0.8 vs. 4.1±0.8) and three days after operation (1.4±0.5 vs. 1.7±0.5) were lower than those of the traditional group (P<0.05). The ODI scores of the ERAS group one month after operation was lower than that of the traditional group (13.3±4.0 vs. 16.6±4.8, P<0.05). In the modified MacNab efficacy evaluation one month after surgery, there was no significant difference in the excellent and good rate between the ERAS group and the traditional group (96.3% vs. 96.4%, P>0.05). Conclusions ERAS regimen can significantly accelerate the patients’ recovery, including shortening the first exhaust time, facilitating early ambulation, and reducing the hospital stay and hospitalization expenses. Meanwhile, ERAS regimen can effectively reduce the postoperative pain of the patients, and promote early functional recovery.
Objective
To evaluate the effectiveness and safety of restrictive fluid therapy combined with preoperative urination training during perioperative period in an enhanced recovery after surgery (ERAS) program for primary total hip arthroplasty (THA).
Methods
A retrospective study were conducted in 73 patients who underwent unilateral THA with liberal intravenous fluid therapy on the day of surgery between April 2015 and March 2016 (control group) and in 70 patients with restrictive fluid therapy and preoperative urination training between November 2016 and April 2017 (trial group). There was no significant difference in gender, age, weight, height, body mass index, primary disease, and complications between 2 groups (P>0.05). Perioperative related indexes were recorded and compared between 2 groups, including operation time; pre-, intra-, post-operative intravenous fluid volumes, overall intravenous fluid volume on the surgery day; postoperative urine volume per hour after surgery; blood volume; total blood loss during perioperative period; usage rates of diuretics and urine tube; the incidences of hypotension, nausea and vomiting, hyponatremia, and hypokalemia after surgery; postoperative length of stay; and the expressions of inflammatory factors [C reaction protein (CRP), interleukin-6 (IL-6)] before sugery and at 1st and 2nd days after surgery.
Results
The pre-, intra-, post-operative intravenous fluid volumes and the overall intravenous fluid volume on the surgery day in trial group were significantly lower than those in control group (P<0.05). There was no significant difference in operation time, blood volume, total blood loss during perioperative period, and postoperative urine volume per hour after surgery between 2 groups (P>0.05). The usage rates of diuretics and urine tube in trial group were significantly lower than those in control group (P<0.05), while the differences in incidences of hypotension, nausea and vomiting, hyponatremia, and hypokalemia after surgery of 2 groups were insignificant (P>0.05). The level of inflammation factors (CRP, IL-6) at 1st and 2nd days was significant lower in trial group than in control group (P<0.05), with shorter postoperative length of stay (t=–5.529, P=0.000).
Conclusion
It is safe and effective to adopt restrictive fluid therapy and preoperative urination training during perioperative period (intravenous fluid volume controls in about 1 200 mL on the day of surgery) following ERAS in primary THA. However, prospective studies with large-scale are still in demand for further confirming the conclusion.
ObjectiveTo explore the current situation of the readiness for hospital discharge and the quality of discharge teaching in lung cancer patients based on enhanced recovery after surgery, and to analyze their correlation.MethodsWe conducted a cross-sectional study and 141 postoperative patients with lung cancer in our hospital from July to August 2018 were investigated by general information questionnaire, readiness for hospital discharge scale and quality of discharge teaching scale. There were 65 males and 76 females at age of 18-85 (55.35±12.15) years.ResultsTotally 88.65% of postoperative patients with lung cancer reported that they were ready for discharge, and the total score of readiness for hospital discharge was 78.36±16.48, and the total score of quality of discharge teaching was 90.94±18.62. There was a positive correlation between the readiness for hospital discharge and the quality of discharge teaching in postoperative patients with lung cancer (r=0.57, P<0.01).ConclusionThe readiness for hospital discharge of postoperative patients with lung cancer keeps in medium level, while the quality of discharge teaching is good, and the readiness for hospital discharge is positively correlated with the quality of discharge teaching. Medical staff should pay more attention to the cognitive level of lung cancer patients' disease-related information and their physical function recovery, and enrich the discharge guidance content, in order to improve the readiness of postoperative patients with lung cancer.
ObjectiveTo investigate the safety and feasibility of enhanced recovery after surgery (ERAS) in radical gastrectomy.
MethodsThe Cochrane library, PubMed, EMBASE, and Chinese biomedical literature databases were searched to identify randomized controlled trails including patients undergoing radical gastrectomy surgery who were treated by ERAS or traditional methods.The five outcome variables were the time to passage of first flatus and first defecation, the length of postoperative hospital stay, medical cost, and postoperative complications.
ResultsFifteen published reports involving 1 533 participants met the inclusion criteria.Compared with traditional methods, ERAS had better outcomes with shorter time to the passage of flatus (WMD=-26.557 hours, 95%CI:-34.097～-19.018, P < 0.05), shorter time to the passage of defecation (WMD=-34.071 hours, 95%CI:-53.449～-14.693, P < 0.05), shorter postoperative hospital stay (WMD=-2.824 days, 95%CI:-3.638～-2.010, P < 0.05), less medical cost (WMD=-0.342 ten thousand yuan, 95%CI:-0.501～-0.184, P < 0.05), and lower postoperative complication rate (RR=0.597, 95%CI: 0.435-0.820, P < 0.05).Especially, ERAS had a significant lower rate of postoperative digestive tract complications (RR=0.492, 95%CI: 0.350-0.693, P < 0.05).However, there were no significant differences between two methods in the incidence of complications including postoperative pulmonary infection, infection or liquefaction of incision, fistula of anastomosis, and postoperative readmission rate (P > 0.05).
ConclusionsThe application of ERAS in the perioperated period of radical gastrectomy surgery shortens the time to passage of first flatus and first defecation, the postoperative hospital stay, as well as lowers the medical cost, and the postoperative complication rate.The results suggest that ERAS is safe and effective in perioperated period of radical gastrectomy and it is very promising in clinical application.
Objective
To explore the effect of self-assessment of pain in perioperative pain management of total knee arthroplasty (TKA).
Methods
A total of 140 patients undergoing TKA from March 2016 to March 2017 were randomly divided into the control group and the trial group. The patients in the two groups were received the same education relating to pain knowledge. The intensity of pain was assessed by nurses in the control group, while in the trial group, it was assessed by patients themselves. According to the assessment of pain, treatments were given to both groups. Time of pain assessment, types and frequencies of temporary rescue medicine, pain intensity, the score of Self-efficacy for Rehabilitation Outcome Scale (SER) and the range of motion (ROM) of knee were observed and recorded.
Results
There were 132 patients who completed the final observation, with 67 in the trial group and 65 in the control group. There were significant differences between the two groups in evaluation time of pain (t=–2.736, P=0.007), types and frequencies of temporary rescue medicine (χ2=10.276, P<0.05), the overall postoperative pain score (Z=–2.146, P=0.032), average hospitalization time after surgery (t=–2.468, P=0.015), SER scores 7 days after surgery (F=2.390, P=0.018) and 14 days after surgery (F=3.427, P=0.001), and ROM at the postoperative day 7 (F=2.109, P=0.037); there were no significant differences in postoperative daily pain scores (Z=–1.779, P=0.077), SER scores at the postoperative day 3 (F=1.010, P=0.314), ROM at the postoperative day 1 (F=1.319, P=0.189) and day 14 (F=1.603, P=0.111).
Conclusion
Self-assessment of pain can motivate TKA patients to take part in pain management, and more accurate response to the pain intensity will help to optimize the management of perioperative pain and reduce the workload of the health staff, thereby contributing to enhanced recovery.
Enhanced recovery after surgery (ERAS) has been carried out in many surgical fields such as orthopedics, galactophore, cardiothoracic surgery, gastrointestinal surgery, and obstetrics due to its standardized perioperative management process to reduce surgical stress and reduce surgical complications. After more than a decade of development, ERAS has achieved initial results. However, in China, the development of ERAS in orthopedic is still in its infancy. Most of the researches focus on the multidisciplinary management path of perioperative period. How to break through the existing bottlenecks is the key to accelerate the further development of rehabilitation. Therefore, this paper introduces the origin and development of ERAS, analyzes the challenges and opportunities of orthopedic ERAS in clinical advancement, proposes the important measures to promote the accelerated development of orthopedics, and provides new ideas for promoting the in-depth development of orthopedics accelerated rehabilitation.
ObjectiveTo explore the clinical effect of applying the concept of enhanced recovery after surgery (ERAS) to the perioperative management of elderly patients with intertrochanteric fractures.MethodsThe clinical data of 64 elderly patients with intertrochanteric fractures admitted to West China Hospital of Sichuan University from January 2016 to December 2017 were retrospectively analyzed. Among them, 32 patients admitted from January to December in 2017 were in ERAS group, and 32 patients admitted from January to December 2016 were in control group. The control group used conventional orthopedic perioperative management measures, and the ERAS group combined the ERAS concept on the basis of conventional treatment measures for perioperative management. The incidence of perioperative complications, Visual Analogue Scale score, modified Barthel Index score, inpatient satisfaction and length of hospital stay were compared between the two groups.ResultsThere was no significant difference in age, gender, American Society of Anesthesiologists grade, combined disease, modified Barthel Index or Visual Analogue Scale score at admission, or time from injury to surgery between the two groups (P>0.05). The total incidence of perioperative complications (12.5% vs. 37.5%) and length of hospital stay [(8.09±2.33) vs. (10.41±3.63) d] in the ERAS group were lower than those in the control group (P<0.05). The Visual Analogue Scale scores of the two groups of patients before operation, on the first day and the third day after operation were lower than those at admission (P<0.05). The comparison between the two groups at each time point showed that the Visual Analogue Scale scores of patients in the ERAS group were lower than those in the control group before operation, on the first day and the third day after operation, and the differences were statistically significant (P<0.05). The modified Barthel Index scores of the two groups of patients on the third day, and 1 month, 3 months and 6 months after operation showed a rising trend with time. The modified Barthel Index scores of the ERAS group were better than those of the control group on the third day, and 1 month and 3 months after operation (P<0.05). There was no significant difference between the two groups 6 months after operation (P>0.05). The hospitalization satisfaction score of the ERAS group was 95.56±5.12, which was higher than that of the control group (92.84±5.62), and the difference was statistically significant (P<0.05).ConclusionsThe implementation of ERAS perioperative management for elderly patients with intertrochanteric fractures may reduce the incidence of perioperative complications, relieve patient pain, promote the short-term recovery of activities of daily living of patients, improve the inpatient satisfaction and shorten the length of hospital stay.
The concept of "enhanced recovery after surgery (ERAS)" has been well known by care providers. Implementation of the ERAS principles requires minimally invasive surgical technology in conjunction with multidisciplinary teamwork. Only if these two aspects of peri-operative care regime optimization and "all-in-one model in medical" care were linked up associatelly, ERAS could be realized. Thoracoscopic surgery was a milestone in thoracic surgery. The successful application of such a recovery program requires the foundation of pain and risk free ward in perioperative period and improving quality of life post discharge. This review summarizes the peri-operative regimen care optimization regarding the utility of ERAS in the VATS lobectomy of patients with lung cancer. The first one is preoperative evaluation issues. It involves conditioning the patient and implementing a pre-operative exercise and a physical therapy regimen. The second one is operative and individual anesthetic maneuvers and the selective use of tube in the post-operative period. The third one is the foundation of pain and risk free ward:what are methods optimum of post operative management? The fourth one is medical management of patient's outcomes and the ERAS regimen continuing optimum. The fifth one is the importance of function of multi-departmental coordination in ERAS.
Objective
To analyze the nurses' current view and perceptions of enhanced recovery after surgery (ERAS) by a questionnaire and to promote the clinical application of ERAS.
Methods
We conducted a questionnaire study for nurses who attended the First West China Forum on Chest ERAS in Chengdu during September 26-27, 2016 and 259 questionnaires were collected for descriptive analysis.
Results
(1) The application status of ERAS: There were 13.5% responders whose hospital took a wait-an-see attitude, while the others' hospital took different actions for ERAS; 85.7% of nurses believed that ERAS in all surgeries should be used; 58.7% of nurses believed that the concept of ERAS was more in theory than in the practice; 40.2% of nurses thought that all patients were suitable for the application of ERAS; (2) 81.9% of nurses believed that the evaluation criteria of ERAS should be a combination of the average hospital stay, patients’ comprehensive feelings and social satisfaction; (3) 70.7% of nurses thought that the combination of subjects integration, surgery orientation and surgeon-nurse teamwork was the best model of ERAS; 44.8% of nurses thought the hospital administration was the best way to promote ERAS applications; (4) 69.1% of responders believed that immature plan, no consensus and norms and insecurity for doctors were the reasons for poor compliance of ERAS; 79.5% of nurses thought that the ERAS meeting should include the publicity of norms and consensus, analysis and implementation of projects and the status and progress of ERAS.
Conclusion
ERAS concept has been recognized by most nurses. Multidisciplinary collaboration and hospital promotion is the best way to achieve clinical applications.
In recent years, enhanced recovery after surgery (ERAS) has been widely used in spine surgery and achieved satisfactory results. In order to standardize the ERAS implementation process and application in percutaneous endoscopic interlaminar lumbar decompression/discectomy (PEID), we reviewed the literatures and cited evidence-based medicine data, and had a national comprehensive discussion among experts of the Group of Minimally Invasive Spinal Surgery and Enhanced Recovery, Professional Committee of Orthopedic Surgery and Enhanced Recovery, Association of China Rehabilitation Technology Transformation and Promotion. Altogether, the up-to-date expert consensus have been achieved. The consensus may provide the reference for clinical treatment in aspect of the standardization of surgical operations, the reduction of surgical trauma and complications, the optimization of perioperative pain and sleep management, the prevention of venous thrombosis, and the guidance of patients’ functional training and perioperative education.
