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.
ObjectiveTo explore the influence of enhanced recovery after surgery (ERAS) on intestinal flora in patients with colorectal cancer.MethodsBy convenient sampling method, 60 patients with colorectal cancer were selected from August 2018 to December 2019 in the Department of Gastrointestinal Surgery of West China Hospital of Sichuan University and randomly divided into ERAS group and traditional treatment group (traditional group). Among them, the perioperative clinical management was carried out according to the ERAS management and traditional treatment process in the the ERAS group and in the traditional group, respectively. The fresh fecal samples were collected within 24 h after admission and the first natural defecation after operation. The bacterial 16 Sr DNA V3–V4 region was sequenced by Illumina MiSeq sequencer, and the results were analyzed by bioinformatics.ResultsA total of 60 patients with colorectal cancer were included, 30 cases in the traditional group and 27 cases in the ERAS group (3 people temporarily withdrew from the study). There were no significant differences in the basic informations between the two groups (P>0.05). ① Before or after operation, there were no significant differences in Shannon index and Simpson index between the two groups. The difference between preoperative and postoperative comparison in the same group was also not statistically significant (P>0.05). ② Beta diversity analysis showed that there was no significant difference in community composition between the traditional group and the ERAS group before operation, and there was a clear boundary between the traditional group and the ERAS group after operation. ③ At the phylum level, compared with the preoperative abundance, the postoperative abundance Firmicutes decreased by 26.5% and 5.5% in the traditional and ERAS group, respectively; Bacteroidetes increased by 21.6% and 4.7% in the traditional and ERAS group, respectively; Proteobacteria increased by 7.2% and 2.2% in the traditional and ERAS group, respectively. At the genus level, compared with the preoperative abundance, the postoperative abundance of Bacteroides in the traditional group increased by 17.6% and in the ERAS group decreased by 1.6%; Bifidobacterium decreased by 1.8% and 1.3% in the traditional group and in the ERAS group, respectively.ConclusionsERAS does not affect species diversity of intestinal flora. Although ERAS has some damage to structure of intestinal flora, it is weaker than traditional process, so it is more conducive to reconstruction and restoration of intestinal microecological environment.
ObjectiveTo investigate the clinical effect of metal supported multi-sided versus ordinary ultra-fine drainage tube in the uniportal video-assisted thoracic surgery (VATS) lower pulmonary lobectomy. MethodsFrom January 2021 to June 2022, the clinical data of patients who underwent uniportal VATS lower lobectomy in our hospital were retrospectively analyzed. According to the different types of ultra-fine drainage tubes used in the surgery, the patients were divided into an experimental group (using multi-sided hole 10F ultra-fine drainage tubes with metal support) and a control group (using ordinary 12F ultra-fine drainage tubes). The clinical data of the two groups were compared. ResultsA total of 190 patients were enrolled, including 108 males and 82 females. There were 90 patients in the experimental group aged 56.60±10.14 years; and 100 patients in the control group aged 57.07±11.04 years. The incidences of postoperative lung infection and pleural effusion in the experimental group were lower than those in the control group, with statistically significant differences (P<0.05). The postoperative visual analogue scale score, the need to adjust the chest drainage tube after the surgery, the need for chest puncture after the surgery, the time of postoperative chest tube removal, and the hospitalization cost were statistically different (P<0.05). There was no statistical difference in the length of postoperative hospital stay or the incidences of postoperative lung leakage, arrhythmia, and atelectasis complications (P>0.05). ConclusionCompared with the ordinary ultra-fine drainage tubes, multi-sided hole ultra-fine drainage tubes with metal support can reduce the incidences of lung infection and pleural effusion complications after the uniportal VATS lower lobectomy, reduce the pain and economic burden, which can be applied in the uniportal VATS lower lobectomy.
ObjectiveTo investigate the effect of enhanced recovery after surgery (ERAS) combined with preoperative oral nutrition supplement (EnsourceTM) in patients with rectal cancer and its effect on postoperative stress response.MethodsFrom January 2018 to August 2018, 80 patients with laparoscopic assisted radical resection of rectal cancer in our hospital were divided into two groups according to different perioperative management. Forty patients who had used enhanced recovery after surgery combine preoperative application of tumor total nutrition formula enteral nutrition solution were as observation group, while other 40 patients who only had used enhanced recovery after surgery in perioperative as control group. We observed the stress response (mean systolic blood pressure, mean diastolic blood pressure, mean heart rate, mean blood oxygen saturation, pain score and fasting blood glucose) at 24 hours after surgery and the time of the first anal exhaust, complication rate, hospitalization time, and hospitalization cost after surgery in both groups. We also compared the early postoperative (on the second day after operation) nutritional status of the two groups like the levels of serum total protein, albumin and proalbumin.ResultsThe mean systolic blood pressure, mean diastolic blood pressure, mean heart rate, mean blood oxygen saturation, pain score and fasting blood glucose of the observation group at 24 hours after surgery were significantly lower than those of the control group (P<0.05), while the total serum protein, albumin and prealbumin concentrations of the observation group were significantly higher than those of the control group on the second day after surgery (P<0.05). Postoperative hospitalization time and hospitalization cost in the observation group were also shorter or less than those in the control group (P<0.05). Compared with the control group, the first postoperative anal exhaust time was earlier and the incidence of postoperative complications was reduced in the observation group, but the difference was not statistically significant (P>0.05).ConclusionsERAS combined with preoperative application of tumor total nutrition formula enteral nutrition fluid (EnsourceTM) can reduce the postoperative stress response and the postoperative complication rate of patients with rectal cancer, and also improve the postoperative nutrition status of patients and promote the rapid recovery of patients after sugery.
Objective To investigate the effects of enhanced recovery after surgery (ERAS) on postoperative function and pain in total hip arthroplasty (THA) patients with high comorbidity. Methods Patients with THA who were admitted between January 2020 and January 2022 were selected as the study objects, and a total of 223 patients with high comorbidity met the selection criteria. Patients were randomly divided into two groups using the random envelope method. During perioperative period, 112 cases in the ERAS group were treated according to the ERAS protocol and 111 cases in the control group with the traditional protocol. There was no significant difference in gender, age, body mass index, Charlson comorbidity index, preoperative diagnosis, the type and number of the comorbidities, preoperative visual analogue scale (VAS) score between the two groups (P>0.05). However, the Harris score of ERAS group was significantly lower than that of control group before operation (P<0.05). Preoperative and postoperative hospital stays were recorded. The VAS score was used to evaluate the pain before operation, at 1 day after operation, at the leaving bed time, at the day after discharge, and at 2 weeks after operation. Harris score was used to evaluate hip function before operation and at 2 weeks, 1 month, 3 months, 6 months, and 12 months after operation. The incidence of complications, 30-day readmission rate, mortality rate, and patient’s satisfaction were recorded. Results The length of preoperative hospital stay in ERAS group was significantly shorter than that in control group (P<0.05). But there was no significant difference in the length of postoperative hospital stay between groups (P>0.05). All patients in the two groups were followed up 12 months. The VAS score in the two groups after operation was lower than that before operation, and showed a gradually trend with the extension of time, with significant differences between different time points (P<0.05). VAS scores of ERAS group were significantly lower than those of control group at different time points after operation (P<0.05). The postoperative Harris scores in both groups were higher than those before operation, and showed a gradually increasing trend with the extension of time, with significant differences between different time points (P<0.05). Harris scores of ERAS group at 2 weeks, 1 month, and 3 months after operation were significantly higher than those of control group (P<0.05). Complications occurred in 2 cases (1.79%) of the ERAS group and 6 cases (5.41%) of the control group, with no significant difference in incidence (P>0.05). In the control group, 1 case was readmitted within 30 days after operation, and 1 case died of severe pneumonia within 1 year of follow-up. There was no readmission or death in ERAS group, and there was no significant difference in the above indexes between the two groups (P>0.05). At last follow-up, the satisfaction rate of patients in ERAS group was slightly higher than that in control group, but the difference was not significant (P>0.05). Conclusion For THA patients with high comorbidity, ERAS protocol can shorten preoperative waiting time, better reduce pain, and improve hip function.
ObjectiveTo explore the correlation between readiness for hospital discharge and short-term quality of life among colorectal cancer (CRC) patients following enhanced recovery after surgery (ERAS) mode.MethodsSurveys of 127 CRC patients following ERAS mode were conducted in the West China Hospital of Sichuan University. The Readiness for Hospital Discharge Scale and EORTC QLQ-C30 Scale were issued at the discharge and 1 month after the operation, respectively.ResultsThe total score of RHDS was 149.43±33.25. The score of global quality of life was 66.80±18.84. Correlation analysis showed that the total score of RHDS was positively correlated with the score of global quality of life (r=0.220, P=0.013), and negatively correlated with the scores of fatigue, nausea and vomiting, pain, loss of appetite (r=–0.304, P=0.001; r=–0.189, P=0.033; r=–0.257, P=0.004; r=–0.254, P=0.004). The score of personal status dimension were positively correlated with the score of global quality of life and emotional function (r=0.213, P=0.016; r=0.197, P=0.027), and negatively correlated with scores of fatigue, pain and insomnia (r=–0.311, P=0.000; r=–0.264, P=0.003; r=–0.257, P=0.004). The score of knowledge dimension was negatively correlated with nausea and vomiting, pain and loss of appetite (r=–0.212, P=0.017; r=–0.182, P=0.040; r=–0.239, P=0.007). The score of coping ability dimension was positively correlated with the score of global quality of life and physical function (r=0.204, P=0.021; r=0.204, P=0.021), while negatively correlated with scores of fatigue, pain, insomnia and loss of appetite (r=–0.349, P=0.000; r=–0.240, P=0.007; r=–0.202, P=0.022; r=–0.201, P=0.024). The score of expected support was positively correlated with the score of global quality of life (r=0.220, P=0.013), and negatively correlated with scores of fatigue and loss of appetite (r=–0.249, P=0.005; r=–0.227, P=0.010).ConclusionsThe short term quality of life among CRC patients following ERAS keeps at upper middle level, and positively correlated with the readiness for hospital discharge. It is suggested that discharge preparation service is of great significance to improve the quality of life of patients.
ObjectiveTo analyze the current situation of enhanced recovery after surgery (ERAS) application in colorectal surgery in China, and summarize the existing problems.MethodsAfter the questionnaire was developed, members of the Chinese Society of Colorectal Cancer were selected as respondents and results were collected by online questionnaire. All the respondents volunteered to visit the homepage of the questionnaire through the link address. After completing the questionnaire, they were saved and submitted.ResultsA total of 120 questionnaires were sent out and finally 107 respondents completed the electronic questionnaire survey. Among them, 73 (68.2%) routinely carried out ERAS programmes and 34 (31.8%) didn’t carry out ERAS programmes. Among the 11 ERAS programmes, most surgeons carried out 3–7 ERAS programmes, among which 4 ERAS programmes was the most (25 surgeons, 23.4%). The survey results for different ERAS programmes showed that only 4 out of 11 ERAS programmes had implemented more than half of the respondents. Respondents with older than 45 years old were more inclined not to undergo mechanical bowel preparation before surgery (P<0.001) and were more likely early postoperative oral intake (P=0.008), respondents with more than 1 000 hospital beds were more likely to select preoperative oral carbohydrate (P=0.012) and postoperative multimodal analgesia (P<0.001), respondents with more than 200 cases of colorectal surgery per year were more inclinedto take oral carbohydrate before surgery (P=0.018), and respondents whose rate of minimally invasive surgery was higher than 50% were more inclined to choose multimode analgesia (P=0.047). On the contrary, the respondents in the tumor hospitals recommended shortening the length of postoperative hospital stay and recommending early discharge (P=0.014). Hospitals that routinely performed ERAS (P<0.001), preoperative oral carbohydrate (P<0.001), without preoperative gastric tube (P=0.019), early postoperative drinking water (P=0.012), and early postoperative oral feeding (P=0.038) were associated with a shorter average postoperative hospital stay.ConclusionERAS has not been popularized in the field of colorectal surgery in China, and there are differences between different doctors and between different hospitals, which still need to be promoted continuously.
ObjectiveTo evaluate the risk factors for postoperative indwelling catheter following enhanced recovery after primary unilateral total knee arthroplasty (TKA) under general anesthesia.MethodsPatients who underwent primary unilateral TKA under general anesthesia between January 2017 and August 2018 were enrolled in the study. Among them, 205 patients who met the selection criteria were included in the study, and the clinical data were collected, including gender, age, body mass index, preoperative range of motion, Hospital for Special Surgery (HSS) score, American Society of Anesthesiologists (ASA) score, disease type, comorbidity, hemoglobin, hematocrit, blood volume, length of operation and operation time, whether to keep drainage after surgery, intraoperative blood loss, total blood loss, and preoperative, intraoperative, postoperative fluid infusions, and total fluid infusion on the day of surgery, urine volume on the day of surgery. Univariate analysis and logistic regression analysis were used to screen the risk factors for postoperative indwelling catheter. Length of stay and incidences of complications (intermuscular vein thrombosis, deep vein thrombosis, pulmonary embolism, incision swelling and exudation, electrolyte disorder, nausea and vomiting, and urinary tract infection) were compared between the patients with or without indwelling catheter.ResultsIndwelling catheter occurred in 41 (20%) of 205 patients. Single factor analysis showed that the influence factors were age, gender, keeping drainage after surgery, total fluid infusion and urine volume on the day of surgery (P<0.05). The multiple factors analysis showed that the males and more urine volume on the day of surgery were the significant risk factors for indwelling catheter after primary TKA (P<0.05). In addition, postoperative length of stay was shorter and the incidence of urinary tract infection was lower in non-indwelling catheter group than in indwelling catheter group, showing significant differences (P<0.05).ConclusionThe male patients with more urine on the day of surgery have higher risk for indwelling catheter after primary unilateral TKA under general anesthesia with an enhanced recovery program.
In the context of accelerated rehabilitation, nutritional support for patients with orthopedic cervical spondylosis is an important condition for lessening postoperative stress response, reducing postoperative complications, shortening patient’s length of hospital stay, lowering medical expenses, and promoting early recovery of patients. Based on this, West China Hospital of Sichuan University explored and established the West China Hospital program for nutritional management in cervical spondylosis from the aspects of team building, nutritional assessment and monitoring, and nutritional intervention.