Objective To investigate the safety and feasibility of day surgery for patients with palmar hyperhidrosis based on the principles of enhanced recovery after surgery (ERAS). Methods We retrospectively reviewed the medical records of consecutive patients who underwent endoscopic thoracic sympathicotomy (ETS) in the First Affiliated Hospital of Xi'an Jiaotong University from March 2020 to December 2021. Patients were divided into a day surgery group and a conventional group according to their perioperative management methods. The patients in the day surgery group underwent an optimized perioperative procedure under the guidance of ERAS, and were ventilated with a laryngeal or face mask during the operation. The patients in the conventional group completed the preoperative examination, operation and postoperative observation according to the conventional procedures, and were intubated with a single-lumen endotracheal tube. The demographic characteristics, operation time, hospital stay, postoperative complications, and hospitalization cost were compared between the two groups. Results Finally 172 patients were collected, including 90 males and 82 females, with an average age of 25.97±7.43 years. There were 86 patients in each group. All patients ceased suffering from palmar sweating after surgery. No patient experienced massive bleeding or conversion to thoracotomy. There was no statistical difference in operation time between the two groups (P=0.534). Patients in the day surgery group were discharged within 24 hours. The average hospital stay in the conventional group was 2.09±0.41 days. Incidence of postoperative respiratory complications, and the hospitalization cost of the day surgery group were significantly lower than those of the conventional group (P＜0.001). The satisfaction rate in both groups was greater than 95%. Conclusion Day surgery for patients with palmar hyperhidrosis based on the principles of ERAS is safe and feasible, which can reduce postoperative complications, shorten the length of hospital stay and save the cost of hospitalization.
Objective To explore the perioperative safety of video-assisted thoracic surgery (VATS) in Day Care Unit and the risk factors for delayed discharge under centralized management model. MethodsThe patients with VATS managed by the Day Care Unit of the Drum Tower Hospital Affiliated to Nanjing University Medical School in 2021 were retrospectively collected. The patients’ postoperative data and risk factors for delayed discharge were analyzed. ResultsA total of 383 patients were enrolled, including 179 males and 204 females with an average age of 46.09±14.82 years. Eleven (2.87%) patients developed grade 3-4 postoperative complications during the hospitalization. Eighteen (4.70%) patients visited unscheduled outpatient clinic within 7 days, and 6 (1.57%) patients were re-hospitalized within 30 days after discharge. The remaining patients had no significant adverse events during the 30-day follow-up. The average length of hospital stay was 2.27±0.35 d. The length of hospital stay was over 48 h in 48 (12.53%) patients. The independent risk factor for delayed discharge was lobectomy or combined resection (OR=3.015, 95%CI 1.174-7.745, P=0.022). ConclusionVATS can be safely conducted under the centralized management in Day Care Unit. The risk factor for delayed discharge is the extent of surgical resection.
Objective To explore the feasibility and safety of tension-free vaginal tape-obturator for female stress urinary incontinence under the daytime surgical mode based on the concept of enhanced recovery after surgery. Methods The clinical data of female patients with stress urinary incontinence at the First Affiliated Hospital of Kunming Medical University between June 2019 and June 2023 were retrospectively analyzed. According to the perioperative management mode of patients, they were divided into daytime surgery group and routine surgery group. The basic, intraoperative, and postoperative conditions of two groups of patients were compared. Results Finally, 183 patients were included, including 91 in the routine surgery group and 92 in the daytime surgery group. All patients successfully completed the surgery. There was no statistically significant difference in age, preoperative comorbidities, surgeon in chief, or operation duration between the two groups of patients (P>0.05). The preoperative waiting time after hospitalization [(0.00±0.00) vs. (2.42±0.58) d], hospitalization expenses [(13815.10±2906.01) vs. (18095.21±3586.67) yuan], total surgical expenses [(3961.36±707.35) vs. (4440.19±1016.31) yuan], anesthesia expenses [(718.53±61.06) vs. (755.30±74.65) yuan], western medicine expenses [(818.07±259.30) vs. (1282.14±460.75) yuan], total hospitalization duration [(1.11±0.31) vs. (5.77±1.30) d], and postoperative hospitalization duration [(1.11±0.31) vs. (3.35±1.42) d] in the daytime surgery group were lower than those in the routine surgery group (P<0.05). There was no significant difference between the two groups in postoperative complications (respiratory complications, fever, nausea and vomiting, vaginal bleeding, urinary retention, peritonitis), satisfaction, postoperative pain or self perception of symptom improvement (P>0.05). Conclusion The daytime surgery for female stress urinary incontinence based on the concept of enhanced recovery after surgery is safe and feasible, which can shorten hospitalization duration and reduce hospitalization costs.
ObjectiveTo review the effect and safety of enhanced recovery after surgery (ERAS) in liver transplant recipients.MethodsA comprehensive literature search of Pubmed, Embase, CNKI, etc. was performed using keywords “ERAS” or “fast track” and “liver transplantation” (cut-off date June 3, 2020). The relevant literatures on researches of ERAS in liver transplant recipients at home and abroad in recent years were summarized.ResultsERAS effectively could promote the functional recovery of postoperative food intake and physical activities through systemic perioperative measures different from conventional management among the liver transplant recipients. In addition, loads of studies had revealed that ERAS was safe for liver transplant recipients with positive effects in different dimensions such as controlling complications, shortening hospital stays, and reducing medical expenses, etc.ConclusionERAS can effectively promote functional recovery of liver transplant recipients without increasing risk.
Objective
To investigate the status quo and influencing factors of depression and anxiety in postoperative patients with thoracic neoplasms.
Methods
The general information questionnaire and Huaxi emotional-distress index scale (HEI) were adopted to survey 70 patients after surgery of thoracic neoplasms at the thoracic nursing outpatients from September to November 2016. There were 43 males and 27 females with age of 18-78 (56.20±11.34) years.
Results
The prevalence rate of depression and anxiety among postoperative patients with thoracic neoplasms was 50.0%, and moderate to severe negative emotions predominated. There was significant difference in educational levels, postoperative hospitalization and postoperative complications (P<0.05), while no significant difference in age, gender, disease types, complicated diseases, surgical procedures, pathological stages and hospitalization expenditures between patients with unhealthy emotions and normal emotions (P>0.05).
Conclusion
There is a high prevalence rate of negative emotion among postoperative patients with thoracic neoplasms. Educational levels, postoperative hospitalization and postoperative complications are important factors for negative emotion.
Objective To report our experience with enhanced recovery after surgery (ERAS) protocol in patients undergoing transapical transcatheter aortic valve implantation (TAVI) and to determine perioperative predictors for ERAS failure. Methods Between May 2018 and January 2019, 80 patients undergoing TAVI in our hospital were recruited. Among them, 40 patients (24 males, 16 females, aged 73.0±5.0 years) successfully received ERAS, defined as successful extubation in operating room (an ERAS group) and the other 40 patients (28 males, 12 females, aged 73.0±7.0 years, a non-ERAS group) failed to perform ERAS. Results Compared with the non-ERAS group, patients in the ERAS group were associated with a significantly lower incidence of postoperative complications (30.0% vs. 52.5%, P=0.04), shorter postoperative ICU stay (2.2±0.4 d vs. 4.0±4.8 d, P=0.00) and hospital stay (7.0±2.3 d vs. 9.5±4.8 d, P=0.00), and less medical cost (311±20 thousand yuan vs. 347±80 thousand yuan, P=0.00). Independent predictors of ERAS failure were poor preoperative heart function and elevated B-type natriuretic peptides. Conclusion ERAS protocol is feasible and effective in patients undergoing TAVI. Poor preoperative heart function is an independent predictor of failure in early extubation which, in turn, is associated with prolonged ICU and hospital stay and dramatic worsening of patient outcomes.
ObjectiveTo explore the effect of standardized multimodal analgesia (SMA) on opioid consumption after major upper abdominal surgery under enhanced recovery after surgery pathway. MethodsPatients who underwent major upper abdominal surgery in the West China Hospital of Sichuan University between August and November 2020 were included prospectively. The patients were divided into two groups: SMA group (n=175) and control group (n=632). The SMA was defined as preoperative and postoperative use of non-steroidal anti-inflammatory drugs, combined with regional anesthesia, local anesthetic wound infiltration or intrathecal opioid. The postoperative opioid consumption in oral morphine equivalents, the pain scores on movement and at rest, the postoperative rehabilitation were recorded and compared between the two groups. ResultsPatients in the SMA group had a lower opioid consumption during the first 72 h compared to patients in the control group (median: 51 mg vs. 85 mg, P<0.001). The pain scores on movement and at rest at 24, 48, 72 h after surgery in the SMA group were lower than those in the control group (P<0.05). Time to first flatus, time to first ambulation, postoperative hospital stay in the SMA group were significantly shorter than those in the control group (P<0.05), and the quality of life scores at 5 d after surgery increased significantly (P<0.05). The satisfaction with analgesia and the incidence of adverse effects on day 5 after surgery had no statistical significances between the two groups (P>0.05). After controlling for confounding factors, multiple linear regression analysis showed that SMA was associated with less opioid consumption on hour 72 after surgery (P<0.001). ConclusionSMA can reduce postoperative opioid consumption in patients undergoing major upper abdominal surgery.
Objective
To analyze the progress of evaluation indexes for enhanced recovery after surgery (ERAS) model at home and abroad, and to propose suggestions for constructing systematic evaluation model of ERAS.
Methods
Atfirst checked the Chinese and English databases, including Medline, Embase, Sciencedirect, ACP Journal Club, BioMed Central, the Cochrane Central Register of Controlled Trials (CENTRAL), Science Citation Index Expanded, Cochrane Library, NHS Economic Evaluation Database, CNKI, VIP, and Wanfang databases (retrieval time was from January 1997 to December 2017), and then filtered the literatures, excluded duplicate documents, a total of 1 020 English literatures and 786 Chinese literatures were enrolled eventually to make an review.
Results
The literatures showed that, at present, there was no comprehensive and systematic evaluation index system about ERAS at home and abroad. The existing evaluation indexes mainly included the following deficiencies: localization and fragmentation of evaluation indicators, lack of evaluation indicators of ERAS organizational framework and process management, as well as lack of standardized operational definition of evaluation indicators.
Conclusions
The evaluation indexes of ERAS at home and abroad do not constitute a systematic evaluation index system according to scientific principles, which will restrict the standardization of accelerated surgical rehabilitation in our country. To establish a multidimensional and comprehensive quality evaluation index system based on multi-evaluation of hospital, patient, social, and medical management institutions, which covers ERAS organizational structure, process management, and clinical outcomes, is a necessary condition for the development of ERAS model.
Objective To analyze the risk factors for postoperative length of stay (PLOS) after mediastinal tumor resection by robot-assisted non-endotracheal intubation and to optimize the perioperative process. MethodsThe clinical data of patients who underwent Da Vinci robot-assisted mediastinal tumor resection with non-endotracheal intubation at the Department of Thoracic Surgery, General Hospital of Northern Theater Command from 2016 to 2019 were retrospectively analyzed. According to the median PLOS, the patients were divided into two groups. The univariate analysis and multivariate logistic regression were used to analyze risk factors for prolonged PLOS (longer than median PLOS). ResultsA total of 190 patients were enrolled, including 92 males and 98 females with a median age of 51.5 (41.0, 59.0) years. The median PLOS of all patients was 3.0 (2.0, 4.0) d. There were 71 patients in the PLOS>3 d group and 119 patients in the PLOS≤3 d group. Multivariate logistic regression showed that indwelled thoracic catheter [OR=11.852, 95%CI (2.384, 58.912), P=0.003], preoperative symptoms of muscle weakness [OR=4.814, 95%CI (1.337, 17.337), P=0.016] and postoperative visual analogue scale>5 points [OR=6.696, 95%CI (3.033, 14.783), P<0.001] were independent factors for prolonged PLOS. Totally no tube (TNT) allowed patients to be discharged on the first day after surgery. ConclusionRobot-assisted mediastinal tumor resection with non-endotracheal intubation can promote rapid recovery. The methods of optimizing perioperative process are TNT, controlling muscle weakness symptoms and postoperative pain relief.
Some complex surgical procedures allow for day surgery benefited from the advancement of the concept of enhanced recovery after surgery and minimally invasive surgical techniques. Shanghai Chest Hospital has set up thoracic day surgery ward incorporating some lung tumor surgeries into day surgery. Through process innovation, model innovation and management innovation, relying on the full-process closed-loop day surgery management system, the day surgery ward runs efficiently. It can help effectively alleviate the difficulty of admission and operation, and improve hospital operation efficiency as well as reduce the economic burden of disease. At the same time, we hope to explore an innovative development path for the possibility of day surgery in complex thoracic surgery, and create a new mode of day surgery that can be replicated and promoted.
