Objective To explore the effect of restrictive fluid administration on elderly patients with colorectal cancer in fasttrack.Methods From January 2008 to January 2009, the elderly patients (≥60 years old) diagnosed definitely as colorectal cancer were analyzed retrospectively, the clinical effects on post-operative early rehabilitation were studied and the difference between restrictive fluid regimen and tradition fluid regimen was compared. Results The difference of overall incidence of post-operative complications was statistically significant between the two groups (Plt;0.05). The incidences of anastomotic leakage and pulmonary infection of fluid restriction group were lower than those of tradition therapy group (Plt;0.05). The time of vent to normal, defecation to normal and postoperative first eating of fluid restriction group was shorter than those of tradition therapy group, the difference was statistically significant (Plt;0.05). Comparing the biochemical indicators, the difference of preoperative GLU 〔（6.70±2.93） mmol/L vs. （6.33±3.95） mmol/L〕, BUN 〔(5.84±2.03) mmol/L vs. （7.32±10.83） mmol/L〕and CREA 〔(76.19±19.85) μmol/L vs. （85.36±38.02） μmol/L)〕 was statistically significant (Plt;0.05), but the difference of postoperative results had no statistical significance. Conclusion Restrictive fluid regimen can reduce the incidence of common complications after colorectal surgery for elderly patients, and have a certain promoter action to the early rehabilitation after rectal surgery.
ObjectiveTo explore the role of fast-track surgery (FTS) in day-case laparoscopic cholecystectomy (DLC) pain management.
MethodsWe used bidirectional cohort study to investigate the patients undergoing day surgery of laparoscopic cholecystectomy admitted into our department. A total of 143 patients between April and September 2014 receiving routine pain management were chosen to be the control group, and 78 patients between October 2014 and January 2015 receiving FTS pain management were regarded as the FTS group. Postoperative pain, early ambulation, influence of pain on the sleep, patients' satisfaction and prolonged hospital stay rate were compared between the two groups.
ResultsPain scores of patients in the FTS group 0-0.5, 0.5-6, 6-12, and 12-24 hours after surgery were significantly lower than those in the control group (P<0.05). The proportion of patients with early postoperative ambulation and patients' satisfaction rate in the FTS group were significantly higher than the control group (P<0.05).
ConclusionThe FTS pain management model can effectively reduce patients' pain after DLC, accelerate patients' postoperative rehabilitation and increase patients' satisfaction.
Objective To explore the content and scientific evidence of every element of the fast-track programmes in colorectal surgery. Methods The literatures about the applied status and opinion of the modality applied in the surgical treatment of the colorectal cancer and fundament investigation in recent years were collected and reviewed. Results The feasibility of the every fast-track’s element was based on the clinical and fundamental investigaton. Conclusion The advantage of the fast-track programmes in colorectal surgery is confirmed.
Objective
To verify the feasibility and effectiveness of the modified fast-track surgery (FTS) in the perioperative period of open liver resection.
Methods
A prospective randomized controlled trial was carried out in 188 consecutive patients undergoing open liver resection between March and December 2014 in the Department of Liver Surgery of West China Hospital. The modified fast recovery procedure and standard rehabilitation procedure were compared in terms of length of hospital stay after operation, hospitalization cost, complications and readmission rate.
Results
A total of 188 consecutive patients were enrolled in the trial. The analysis included 87 patients in the modified fast recovery group and 89 in the standard rehabilitation group. Compared with the standard rehabilitation group, the modified fast recovery group had a shorter length of hospital stay [(5.70±1.47)vs. (7.26±1.96) days] and a lower cost [(42.7±6.7)vs. (47.3±12.5) thousand yuan], and the differences were statistically significant (P<0.05). There were 20 complication cases in the modified group and 39 in the standard group with significant difference (P=0.003). There was no significant difference in the rate of readmission between the two groups (P=1.000). Compared with the standard group, patients in the modified group had less pain 8 hours, the 1st and 2nd days after surgery, better postoperative activities of daily living, more initiative cough times and off-bed activity times, longer duration of movement, and earlier bowel recovery and exhausting, and all the above differences were significantly different (P<0.05). Stepwise regression analysis showed that postoperative complications and bowel recovery and exhausting time were independent related factors for postoperative hospital stay (P<0.001).
Conclusions
Multimodal analgesia-based fast recovery procedure is feasible and effective in the perioperative period of partial hepatectomy. It can shorten the time of hospitalization and reduce the cost of hospitalization.
Objective To discuss the feasibility and clinical outcomes of fast-track (FT) surgery for elderly patients (≥70 years) with colorectal carcinoma. Methods Between November 2007 and January 2009, 103 elderly patients were analyzed prospectively, who were divided into FT group and traditional group randomly. All 103 patients had completed the entire study. Postoperative complications and early rehabilitations were studied and compared. In addition, completion of FT courses was recorded. Results ① In early rehabilitation, the time of first ambulation was (1.96±0.89) d and (2.92±1.43) d, oral intaking was (2.41±0.92) d and (3.62±1.40) d, and first flatus was (3.88±1.05) d and (4.52±1.29) d in the FT group and the traditional group, respectively. The early rehabilitation indexes in the FT group were significantly earlier than those in the traditional group (Plt;0.05). ② Postoperative hospital stay was (9.27±1.87) d and (12.75±7.05) d in the FT group and the traditional group, respectively, in the FT group which was shorter than that in the traditional group (Plt;0.05). ③ The mortality rate and readmission rate was 0 on 2 weeks after operation in two groups. ④ The total morbidity rate was 11.76% (6/51) in the FT group, in the traditional group was 28.85% (15/52), there was significant difference between two groups (Plt;0.05), while there was no significant difference in general complications and surgical complications between two groups (Pgt;0.05).Conclusions FT surgery for elderly patients with colorectal carcinoma is feasible and could enhance recovery, cut down morbidity rate and shorten postoperative hospital stay. If the FT courses are more completed, the clinical outcomes could be better.
Objective
To illustrate the situation of delayed discharge of patients after total knee arthroplasty (TKA) under fast-track (FT) recovery model, and analyze the reasons.
Methods
We retrospectively analyzed the clinical data of 152 patients who accepted perioperative management under fast-track model from January to December 2014. The reasons for discharging over 72 hours after hospitalization were analyzed.
Results
Among the 152 patients, 119 were discharged over 72 hours after surgery, and the rate was 78.2%. The main reasons for delayed discharge were pain (32.8%), limited range of motion (31.9%) and unwillingness to be discharged (27.7%), respectively.
Conclusion
For patients who have undergone TKA, FT model can shorten hospital stay, save expenses, and accelerate postoperative rehabilitation, but there is still much room for improvement.
Objective To explore the value and clinical safety of low-dose dexamethasone used after operation of anastomotic colorectal resection with fast-track surgery in patients with colorectal cancer. Methods Between January 2008 and December 2009, 470 patients undergoing anastomotic colorectal resection were analyzed retrospectively, who were divided into dexamethasone group and control group according to the use of low-dose dexamethasone treatment or not after operation. Postoperative adverse effect, complications, and early rehabilitations were studied. Results There was no statistical significance in postoperative incidence of adverse effect or complications between two groups (Pgt;0.05). In early rehabilitation, first ambulation of patients in the dexamethasone group was significantly earlier than that in the control group (Plt;0.05), while there was no statistical significance in first time of passing flatus, stool, and oral intake, the retain time of nasogastric tubes, urinary catheter, and drains, and postoperative hospital stay (Pgt;0.05). Conclusion Using low-dose dexamethasone after operation anastomotic colorectal resection in patients with colorectal cancer is safe and may have potential to enhance recovery after operation.
Objective To compare the short-term outcomes between laparoscopic surgery and open surgery with fast-track (FT) in patients with colorectal cancer. Methods Between February 2008 and August 2008, the clinical data of 177 patients with colorectal cancer were analyzed retrospectively, who were divided into open group (n=122) and laparoscopic group (n=55) by surgery methods. Open group was further divided into FT group (n=66) and traditional group (n=56). Early rehabilitations were studied and compared among three groups. Results ① The baseline characteristics of patients among three groups were no significant differences (Pgt;0.05) exclude operation time. ② In early rehabilitation, the first flatus of patients in both the FT group 〔(3.86±1.01) d〕 and the laparoscopic group 〔(3.78±1.10) d〕 was significantly earlier than that in the traditional group 〔(4.43±1.25) d〕, Plt;0.05. ③ The first oral intaking in the FT group 〔(2.52±1.14) d〕 was earlier than that in the traditional group 〔(3.38±1.43) d〕 and the laparoscopic group 〔(5.04±2.24) d〕, Plt;0.05, while in the traditional group was earlier than that in the laparoscopic group (Plt;0.05). ④ For drainage management, both the FT group and the traditional group were significantly earlier than those in the laparoscopic group (Plt;0.05). ⑤ For postoperative hospital stay, in the FT group 〔(8.33±1.98) d〕 was also much shorter than that in the laparoscopic group 〔(10.55±3.14) d〕 and the traditional group 〔(10.82±3.76) d〕, Plt;0.05. ⑥ For the postoperative complications, there was no significant difference among three groups (Pgt;0.05). Conclusions FT surgery and laparoscopic technique could both enhance recovery of bowel function, and FT could also shorten postoperative hospital stay. However, further studies are needed to develop a better management.
Objective To explore the variation about the application of fast-track surgery and laparoscopy in treatment for colorectal cancer in recent years． To investigate the probability of combining protocols of the two for treatment for colorectal cancer. Methods The clinical and basic literatures of related researches about colorectal treatment of laparoscopy and fast-track surgery were collected and reviewed. Results Compared with the traditional treatment modalities, both of fast-track surgery and laparoscopy used for the treatment of colorectal cancer have better clinical effects. Conclusions Fast-track surgery and laparoscopic techniques used for the treatment of colorectal cancer are feasible, but the combination of the two should be confirmed by further randomized controlled trials.
Objective To explore the impact of restrictive fluid administration for patients with colorectal cancer combined diabetes. Methods The clinical data of patients diagnosed definitely as colorectal cancer with diabetes were analyzed retrospectively from January 2007 to October 2009 in this hospital, the clinical effects on postoperative early rehabilitation were studied and the differences between restrictive fluid regimen (fluid restriction group) and tradition fluid regimen (tradition therapy group) were compared. Results The time of first aerofluxus and the first ambulation in fluid restriction group were shorter than those of tradition therapy group, the differences had statistical significances (Plt;0.05). The incidence of wound infection in fluid restriction group was lower than that in tradition therapy group (Plt;0.05). The differences of preoperative hemoglobin (Hb), white blood cell (WBC), glucose (GLU) and blood urea nitrogen (BUN) were not statistically significant between two groups, but the difference of postoperative GLU was statistically significant between two groups (Plt;0.05). Conclusion Restrictive fluid regimen can reduce the incidence of common complications after colorectal surgery for diabetic, and has a certain promoter action to the early rehabilitation after rectal surgery.
