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.
ObjectiveTo explore the clinical value and experience of enhanced recovery after surgery (ERAS) of “LEER” model with “less pain” “early move” “early eat” and “reassuring” as its ultimate goal in perioperative period of laparoscopic anatomical hepatectomy of patients with primary liver cancer.MethodsThe basic clinical data of 98 patients treated in our department from May 2017 to March 2020 who were diagnosed as primary liver cancer and underwent laparoscopic anatomical hepatectomy were retrospectively analyzed. The incidence of postoperative complications, postoperative recovery and patients’ satisfaction were compared between 40 patients managed with traditional model (traditional group) and 58 patients managed with measures of ERAS of “LEER” model (“LEER”-ERAS group).ResultsCompared with the traditional group, the “LEER”-ERAS group had lower postoperative pain scores (t=2.925, P=0.004), earlier postoperative anal exhaustion, bowel movement and normal diet (t=3.071, t=3.770, t=3.232, all P<0.005) , shorter time to postoperative off-bed activity (t=5.025, P<0.001) and earlier postoperative removal time of drainage tube (t=3.232, P=0.001). Postoperative hospital stay was shorter (t=4.831, P<0.001), the cost of hospitalization was lower (t=3.062, P=0.003), and the patient’s satisfaction with medical treatment was higher (χ2=9.267, P=0.002). There were no statistical difference in the operative time, intraoperative blood loss, rate of conversion to laparotomy, blocking time of porta hepatis, postoperative complications and postoperative adverse events between the two groups (P>0.05).ConclusionsCompared with the traditional model, the measures of ERAS of “LEER” model that applied to laparoscopic anatomical hepatectomy of patients with primary liver cancer, is safe and effective, and can relieve postoperative pain, accelerate postoperative rehabilitation, improve satisfaction of patients, shorten hospital stay, and reduce medical costs. It has further promotion and research value.
The concept of enhanced recovery after surgery (ERAS) is composed of multidisciplinary, multimodal, and evidence-based approaches, providing a safe and cost-effective method for perioperative management to improve patient prognosis without increasing the incidence of complications. At present, ERAS for cardiac surgery has developed slowly. This article provides a review of the application and prospects of ERAS concept in the perioperative period of cardiac surgery. The measures for applying ERAS concept to the perioperative period of cardiac surgery are divided into three parts: preoperative, intraoperative, and postoperative. The aim is to provide information for the perioperative management of cardiac surgery patients and assist in their rapid recovery during the perioperative period.
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.
ObjectiveTo investigate the completion of early ambulation in patients with gastric cancer under the enhanced recovery after surgery (ERAS) management mode in the West China Hospital of Sichuan University, and analyze the influencing factors. MethodsFrom November 1, 2021 to March 31, 2022, the patients with gastric cancer who met the inclusion criteria of this study in the West China Hospital of Sichuan University were selected as the survey objects. At 48 h after the operation, the patients were enquired at the bedside and the electronic medical records were accessed to collect the general information, diseases information, etc. of the patients. The postoperative data were also investigated, and the time of early ambulation was investigated, and the influencing factors were analyzed by logistic regression. ResultsAccording to the inclusion and exclusion criteria of this study and the sample size requirements, 140 eligible patients with gastric cancer were investigated, 34 of whom got out of bed early, and the rate of early ambulation was 24.3%. The results of binary logistic regression analysis showed that indwelling urinary catheter within 48 h after operation [OR=10.031, 95%CI（1.037, 97.061）, P=0.046] and American Society of Anaesthesiologists (ASA) grade Ⅲ [OR=4.209, 95%CI（1.792, 9.886）, P=0.001] decreased the probability of early ambulation after operation in patients with gastric cancer. ConclusionsFrom the results of this survey, the completion rate of early ambulation in patients with gastric cancer under ERAS mode is lower, which may be improved by reducing the placement of the urinary catheter or shortening the indwelling time of the urinary catheter. For patients with ASA grade Ⅲ having functional decline before surgery, doctor or nurse needs to evaluate their mobility after surgery and help them to finish early ambulation or exercise on hospital bed within their tolerances.
Objective To evaluate the effect of mediastinal drainage tube placed in the left thoracic cavity after partial resection of the mediastinum pleura in robot-assisted McKeown esophagectomy for esophageal carcinoma, and to compare it with the traditional method of mediastinal drainage tube placed in mediastinum. MethodsWe retrospectively analyzed clinical data of 96 patients who underwent robot-assisted McKeown esophagectomy for esophageal carcinoma by the surgeons in the same medical group in our department between July 2018 and March 2021. There were 78 males and 18 females, aged 52-79 years. Left mediastinum pleura around the carcinoma during operation was resected in all patients. Patients were divided into two groups according to the method of mediastinal drainage tube placement: a control group (placed in mediastinum) and an observation group (placed through the mediastinal pleura into the left thoracic cavity with several side ports distributed in the mediastinum). The incidence of left thoracentesis or catheterization after surgery, anastomotic fistula and anastomotic healing time, other complications such as pneumonia and postoperative pain score were also compared between the two groups. Results There was no statistical difference in baseline data or surgical parameters between the two groups. The percentage of patients in the observation group who needed re-thoracentesis or re-catheterization postoperatively due to massive pleural effusion in the left thoracic cavity was significantly lower than that in the control group (5.6% vs. 21.4%, P=0.020). The incidence of anastomotic leakage (3.7% vs. 7.1%, P=0.651) and the healing time of anastomosis (18.56±4.27 d vs. 24.33±5.48 d, P=0.304) were not statistically different between the two groups, and there was no statistical difference in other complications such as pulmonary infection. Moreover, the postoperative pain score was also similar between the two groups. Conclusion For patients whose mediastinal pleura is removed partially during robot-assisted McKeown esophagectomy for esophageal carcinoma, placing the drainage tube through the mediastinal pleura into the left thoracic cavity can reduce the risk of left-side thoracentesis or catheterization, which may promote the postoperative recovery of patients.
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.
ObjectiveTo investigate the effect of early enteral nutrition (EEN) support in the perioperative period of children with perforated appendicitis based on the enhanced recovery after surgery (ERAS). MethodsThe children with perforated appendicitis were collected as an observation group, who underwent EEN support treatment based on the ERAS mode from January 2021 to December 2022 in the Xuzhou Children’s Hospital. At the same time, the children with perforated appendicitis received conventional nutrition support from January 2019 to December 2020 were matched as a control group according to the principle of balanced and comparable baseline data such as the gender, age, disease course, pathological type, and body mass index with the observation group. The time of first exhaust or defecation and the hospital stay after surgery were compared. Meanwhile, the nutritional indexes [prealbumin (PA), albumin (ALB), hemoglobin (Hb)], immune indexes [immunoglobulin (Ig) A, IgM, IgG], serum inflammatory factors [C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)] before surgery, on day 1 and 7 after surgery were compared. And the adverse effects were observed. ResultsThere were 40 children with perforated appendicitis in the observation group and the control group, respectively. There were no statistical differences in the baseline data such as the gender, age, course of disease, pathological type, and body mass index between the two groups (P>0.05). The time of first exhaust or defecation and the hospital stay after surgery in the observation group were shorter than in the control group (t=3.234, P=0.002; t=5.582, P<0.001). The levels of PA, ALB, Hb, IgA, IgM, and IgG in the observation group were higher than in the control group on day 7 after surgery (P<0.05). The levels of CRP, IL-6, and TNF-α in the observation group were lower than in the control group on day 7 after surgery (P<0.05）. The incidence of adverse reactions in the observation group was lower than that in the control group [5.0% (2/40) vs. 22.5% (9/40), χ2=5.165, P=0.023]. ConclusionsFrom on the results of this study, EEN support based on ERAS during perioperative period of children with perforated appendicitis contributes to recover gastrointestinal function, correct nutritional status, improve immune function, and reduce inflammation, and which has a higher safety for children with perforated appendicitis.
Objective To compare the differences in evaluating readiness for hospital discharge between nurses and colorectal cancer (CRC) patients following enhanced recovery after surgery (ERAS) pathway. Methods A cross-sectional survey was conducted in Department of Gastrointestinal Surgery, West China Hospital, Sichuan University. Patient-reported Readiness for Hospital Discharge Scale (RHDS) and nurse-reported RHDS were delivered to 130 CRC patients and 40 nurses respectively. All patients were followed ERAS pathway during perioperative periods. The differences were compared in evaluating readiness for hospital discharge between nurses and CRC patients. Results This study investigated 130 CRC patients and 40 responsible nurses. The scores of RHDS from nurses and patients were 162.86±27.95 and 149.86±33.65 respectively. When evaluating whether patients were ready to go home after discharge, the consistency between nurses’ results and patients’ results was weak（κ=0.365, P<0.001）. Items in patients’ RHDS scoring ranking from high to low were expected support, coping ability, knowledge, and personal status. Items in nurses’ RHDS scoring ranking from high to low were expected support, knowledge, coping ability, and personal status. Besides the " social support” dimension, the scores of other 3 dimensions from nurses were significantly higher than those from patients (P<0.05). Conclusion There is a gap between the assessment of RHDS from nurses and patients, nurses overestimated patients’ discharge readiness level.
Objective To investigate the clinical effect of digital drainage system (DDS) in patients after robot-assisted lobectomy. MethodsThe clinical data of the patients who underwent da Vinci robot-assisted lobectomy from August 2020 to December 2021 were retrospectively analyzed. The patients were divided into a DDS group and a conventional group (using traditional single thoracic drainage tube device) according to different drainage devices used after operation. The preoperative data, intraoperative blood loss, total drainage volume within 48 h after operation, postoperative extubation time and postoperative hospital stay were compared between the two groups. ResultsFinally, 170 patients were collected, including 76 males and 94 females with an average age of 61.8±8.7 years. Postoperative extubation time [5.53 (6.00, 7.00) days vs. 6.36 (6.00, 8.00) days, Z=–2.467, P=0.014] and postoperative hospital stay [7.80 (8.00, 10.00) days vs. 8.94 (9.00, 10.00) days, Z=–2.364, P=0.018] in the DDS group were shorter than those in the conventional group. For patients with postoperative persistent air leak, postoperative extubation time (Z=–2.786, P=0.005) and postoperative hospital stay (Z=–2.862, P=0.003) in the DDS group were also shorter than those in the conventional group. ConclusionDDS has a positive effect on enhanced recovery after robot-assisted lobectomy, which is safe and stable, and is beneficial to postoperative rehabilitation and shortening the average hospital stay.
