Objective To discuss the impacts of completion rate of fast track items on postoperative management of colorectal cancer surgery. Methods Between February 2010 and May 2010, 100 patients (Group “Year 2010”) were analyzed retrospectively, who were compared with 76 patients (Group “Year 2008”) from the same period of 2008. Postoperative recovery indexes, complications, and completion rate of fast track items were studied and compared. Results For major fast track items, the completion rates of restrict rehydration, early out-of-bed mobilization, early oral intaking, and management of gastric tube and drains were significantly higher in Group “Year 2010” than those in Group “Year 2008” (Plt;0.05). Meanwhile, the completion rate of urinary catheter management was significantly higher in Group “Year 2008” than that in Group “Year 2010” (Plt;0.05). In early rehabilitation, the first flatus of patients in Group “Year 2010” 〔(3.86±1.05) d〕 was significantly earlier than that in Group “Year 2008” 〔(4.28±1.22) d〕, Plt;0.05; for postoperative hospital stay, though, there was no statistically significant difference between two groups (Pgt;0.05). As to the complications, there was also no statistically significant difference between two groups (Pgt;0.05). Conclusions As the concepts of fast track surgery became increasingly favorable, completion rates of fast track items are increased. As a result, more and more fast track items turn into regular perioperative care. Although enhanced recovery has been achieved, better collaboration and localilzation are still needed to make the full advantage of fast track surgery.
Objective To investigate the application progress of postoperative fluid administration in colorectal surgery. MethodsLiteratures about the advancement of fluid administration in colorectal surgery were reviewed and analyzed. Results Compared to standard fluid management, restrictive fluid administration could reduce the incidence of complications, the length of stay in hospital and improve postoperative survival rate. Colloid-crystalloid combined therapy was better than that pure crystal therapy. Conclusion Volume and type of rehydration influence postoperative recovery, which is also considered in “fast track” colorectal surgery.
ObjectiveTo investigate the feasibility, safety and effectiveness of video-assisted thoracic surgery (VATS) sympathectomy under monitored anesthesia care (MAC) and local anesthesia (LA) without endotracheal intubation as a new fast track recovery surgical strategy for the treatment of palmar hyperhidrosis. MethodsA total of 124 patients with intermediate or severe hyperhidrosis who were admitted to Guangdong General Hospital were enrolled in this study. With SPSS18 random number generator, all the patients were divided into MAC+LA group and general anesthesia (GA) group with 62 patients in each group. There were 43 males and 19 females in MAC+LA group with their age of 22.25±6.22 years, and 42 males and 20 females in GA group with their age of 23.98±6.67 years. During the surgery, MAC+LA group patients received MAC and oxygen via nasal tube or face mask instead of endotracheal intubation, and GA group patients received GA, endotracheal intubation and controlled ventilation. Clinical outcomes were compared between the 2 groups. ResultsAll the patients received their operations safely. None of MAC+LA group patients received conversion to GA and controlled ventilation. There was statistical difference in operation time (47.18±12.06 minutes vs. 39.33±13.21 minutes, P=0.002) and length of theatre stay 84.52±22.56 minutes vs. 134.68±26.12 minutes, P=0.000) between MAC+LA and GA group patients. There was no statistical difference in blood loss, incidence of intraoperative SpO2 lower than 95% (2 patients vs. 0 patient), postoperative hospital stay, incidence of postoperative compensatory sweating (86.5% vs. 89.0%) and patient satisfaction rate (94.59% vs.95.12%) between the 2 groups. No intraoperative pain, postoperative complication or symptom recurrence was observed in either group. There was statistical difference in anesthetic preparation time (20.52±10.55 minutes vs. 36.47±12.16 minutes), duration between operation finish and returning to ward (11.26±7.09 minutes vs. 59.39±19.89) minutes and hospitalization cost (RMB 6 376.86±746.00 yuan vs. RMB 8 812.04±867.93 yuan) between the 2 groups. The incidence of postoperative sore throat (0% vs. 100%), monitor time (4 hours vs. 12 hours) and time to resume oral intake (2 hours vs. 6 hours) of MAC+LA group were significantly lower or shorter than those of GA group. ConclusionVATS sympathectomy under MAC and LA can avoid complications of GA and endotracheal intubation, and provide a safe, feasible, effective and more minimally invasive fast track alternative for the treatment of palmar hyperhidrosis.
ObjectiveTo investigate the safety, feasibility, and efficacy of fast track surgery (FTS) in gastrointestinal tract injury. MethodsThe data of 61 patients with gastrointestinal tract injury from July 2007 to July 2013 were retrospectively analyzed, among whom 29 patients were received FTS (FTS group) and 32 patients were received conventional care (control group). The first flatus and defecation time, hospital stay, rates of wound infection and lung infection, and the mortality were compared between these two groups. ResultsThe average first flatus and defecation time and the average hospital stay in the FTS group were significantly shorter than those in the control group (2.21 d versus 3.16 d, P=0.000; 7.45 d versus 9.78 d, P=0.000). The rate of lung infection in the FTS group were significantly lower than that in the control group[3.4% (1/29) versus 21.9% (7/32), P=0.033]. The rate of wound infection and the mortality had no significant differences between the FST group and the control group[3.4% (1/29) versus 15.6% (5/32), P=0.111; 0(0/29) versus 3.1% (1/32), P=0.337]. ConclusionsFTS is safe and effective among those gastrointestinal tract injury patients who visited the hospital in time and injury limited. FTS could promote defecate, shorter the hospital stay, and don't increase the complications and mortality.
ObjectiveTo evaluate the effect of fast track surgery (FTS) on clinical parameters and postoperative complications in patients with abdominal aortic aneurysm (AAA). MethodFifty Patients with AAA treated in our hospital between December 2009 and May 2015 were enrolled in this study. Ten patients between December 2009 and December 2012 received conventional standard care (conventional group), while 50 between January 2013 and May 2015 received FTS (FTS group). The first exhaust time, the first time of off-bed activities, the duration of hospital stays, and the complications after AAA surgery were analyzed. ResultsThe first exhaust time of patients in the FTS group and conventional group was (2.5±0.9) and (4.0±1.1) days; the first time of off-bed activities was (2.9±1.0) and (4.1±0.9) days; and the duration of hospital stays was (13.5±2.1) and (17.9±2.8) days. All those differences were significant (P<0.05). The incidences of incision infection, renal inadequacy, lower limb swelling, and weakened gastric function in the FTS group were significantly lower than those in the conventional group (P<0.05). On the third day after surgery, C-reactive protein in the FTS and conventional group was respectively (57.5±9.0) and (65.0±13.1) mg/L, and interleukin-6 was respectively (10.2±3.9) and (15.5±5.1) pg/L, both of which were significantly different between the two groups (P<0.05). ConclusionsFast track surgery is effective and safe in patients with abdominal aortic aneurysm, and it may lower trauma stress after surgery and incidence of postoperative complications.
ObjectiveTo investigate the feasibility and effectiveness of fast track surgery (FTS) in rib fracture fixation. MethodsFifty-two patients with chest trauma who underwent rib fracture fixation surgery in Mingji Affiliated Hospital of Nanjing Medical University from October 2010 to June 2013 were enrolled in this study. All the patients were divided into FTS group and control group. In the FTS group, there were 26 patients including 22 males and 4 females with their age of 45.62±8.20 years, who received FTS strategies. In the control group, there were 26 patients including 21 males and 5 females with their age of 46.42±7.60 years, who received traditional treatment strategies. Postoperative visual analogue scale (VAS), gastrointestinal function recovery time, postoperative hospital stay and hospitalization cost were compared between the 2 groups. ResultsVAS at 6 hours, 24 hours and 48 hours postoperatively of FTS group (4.5±0.3, 4.2±0.2, 3.2±0.1) were significantly lower than those of the control group (6.5±0.1, 6.1±0.3, 4.8±0.2) respectively (P < 0.05). Gastrointestinal function recovery time of FTS group (0.8±0.2 days) was significantly shorter than that of the control group (1.5±0.5 days, P < 0.05). Length of hospital stay (21.0±2.6 days) and hospitalization cost (5.18±0.75 ten thousand yuan) of FTS group were significantly shorter or lower than those of the control group (26.2±3.4 days and 5.78±0.64 ten thousand yuan) respectively (P < 0.05). ConclusionFTS strategies can effectively reduce postoperative VAS, shorten length of hospital stay, decrease hospitalization cost, and promote postoperative recovery of rib fracture patients.
ObjectiveTo investigate the impact of chronic obstructive pulmonary disease (COPD) and surgical approach on postoperative fast track recovery and hospitalization cost of patients undergoing lung cancer resection, and explore clinical pathways and clinical value of fast track recovery. MethodClinical data of 129 consecutive patients undergoing lung cancer resection by one surgical group in West China Hospital from January 2010 to March 2011 were retrospectively analyzed. According to whether the patients had concomitant COPD, all the patients were divided into COPD group including 53 patients (39 males and 14 females) with their average age of 56.31±10.51 years, and non-COPD group including 76 patients (37 males and 39 females) with their average age of 65.92±7.85 years. According to different surgical approaches, all the patients were divided into complete video-assisted thoracoscopic surgery (VATS) group including 83 patients (44 males and 39 females) with their average age of 61.62±10.80 years, and routine thoracotomy group including 46 patients (32 males and 14 females) with their average age of 62.95±9.97 years. Postoperative morbidity, average hospital stay and hospitalization cost were compared between respective groups. ResultsThere was no statistical difference in postoperative morbidity (53% vs. 40%, P=0.134)or average hospital stay[(7.66±2.95) days vs. (7.36±2.74)days, P=0.539] between COPD group and non-COPD group. Postoperative morbidity (34% vs. 65%, P < 0.001)and average hospital stay[(6.67±2.52)days vs. (8.61±3.01) days, P < 0.001] of VATS group were significantly lower or shorter than those of routine thoracotomy group. Total hospitalization cost (￥44 542.26±11 447.50 yuan vs. ￥23 634.13±6 014.35 yuan, P < 0.001) and material cost (￥37 352.53±11 807.81 yuan vs. ￥12 763.08±7 124.76 yuan, P < 0.001) of VATS group were significantly higher than those of routine thoracotomy group. Average medication cost of VATS group was significantly lower than that of routine thoracotomy group (￥7 473.54±4 523.70 vs. ￥10 176.71±6 371.12, P < 0.001). There was no statistical difference in other cost between VATS group and routine thoracotomy group. ConclusionVATS lobectomy can promote postoperative fast track recovery of lung cancer patients, but also increase material cost of the surgery. COPD history does not influence postoperative fast track recovery or hospitalization cost.
ObjectiveTo summary and analyze the actuality of application for the fast track (FT) in China. MethodsThe clinical literatures of FT in China were collected and obtained from the WanFang database and China Hospital Knowledge Database (from Jan. 2006 to Dec. 2014), and then the actuality of application for the 22 items of FT was analyzed. ResultsA total of 62 literatures were collected, and there were 58 hospitals and 2 944 cases who underwent colorectal operation included. In all of the 62 literatures, the programmes were carried out 15 items at most, and there were only 3 items (average 10.06 items) at least. There were some important FT programmes were poorly developed (less than 60.00%) which included:normal preoperative feeding (45.16%, 28/62), intake carbohydrate drinks up until 2 hours before operation (54.84%, 34/62), thoracic epidural analgesia (58.06%, 36/62), avoid the opioids (35.48%, 22/62), minimally invasive operation (58.06%, 36/62), no nasogastric intubation (53.22%, 33/62), establish discharge criteria (27.42%, 17/62), follow-up (14.52%, 9/62), and audit of clinical outcomes (1.61%, 1/62). And that, there were serious distortions to some FT programmes, such as:distorted the surgery with epidural anesthesia to the thoracic epidural analgesia (46.77%, 29/62), distorted the early remove nasogastric intubation postoperative to avoidance the nasogastric intubation (17.74%, 11/62), and the minimally invasive surgery was independent of FT (6.45%, 4/62)/control the fluid therapy intraoperatively only (6.45%, 4/62). ConclusionThe current situation of the FT is not optimistic in China, it has existed that the concept of FT is fuzziness, the measures are not standardized and the application of some important programmes are deficient.
Objective To explore the effect of fast track rehabilitation in patients with gastric cancer during perioperative period. Methods Eighty patients were randomly divided into conventional method group （n=40） and fast track rehabilitation group （n=40）, and to compare the levels of total lymphocyte count （TLC） , C-reaction protein （CRP），IgG， IgM， IgA， CD3＋， CD4＋， CD8＋， and CD4＋/CD8＋ in serum on the days of 1 d before operation and 1 and 3 d after operation，and to record the duration of fever，first ventilation time of flatus， postoperative hospital stay time，and the postoperative complications. Results The first ventilation time after operation was advanced in patients of fast track rehabilitation group， and the postoperative fever time and hospital stay time after operation of patients was shorter in fast track rehabilitation group than that in conventional method group （P＜0.05）. The incidence difference of complications in two groups had not statistic significance （P＞0.05）. The TLC on 1 d after operation were lower than that on 1 d before operation in two groups, and the CRP values of 1 d after operation were higher than that of 1 d before operation in two groups （P＜0.01）. Compared with 1 d before operation, the CRP value on 3 day after operation in fast track rehabilitation group was lower than that in conventional method group, and the levels of IgG, IgM， IgA， CD3＋， CD4＋， CD8＋， and CD4＋/CD8＋ were higher than that in conventional group （P＜0.05）. Conclusions Fast track surgery applied to patients with gastric cancer during perioperative period is safe and efficient， which can mitigate the immunologic impairment of patients and accelerate postoperative rehabilitation．
Objective To explore the advantages of postoperative chest drainage with 16F urinary catheter for video- assisted thoracoscopic surgery (VATS) lobectomy. Methods Data of 102 patients (October to December 2015) who under- went VATS lobectomy of lung disease with insertion of catheter (16 F urinary catheter or 28 F chest tube) were analyzed. The patients were divided into two groups including a 16F group (49 patients, with 16 F urinary catheter) and a 18F group (53 patients, with 18F chest drainage tube).The following post-operative data were evaluated: primary healing of tube inci- sion, chest X ray abnormalities (pneumothorax, pleural effusion, subcutaneous emphysema, and hematoma), drainage time, re-insert the drainage tube, and wound healing at the site of insertion. Results Both groups were similar in age, gender, co-morbidity and pathological evaluation of resected specimens. After adjustment, no statistically significant difference was found between the two groups in pulmonary complications (30.6% vs. 28.3%, P=0.102), subcutaneous emphysema (60.0% vs. 6.7%, P=0.011), required intervention (2.0% vs. 5.7%, P=0.048). The average total drainage volume in the 16F group (587.3±323.7 ml) was less than that of the 28 F group (824.1±444.3 ml, P=0.000). The rate of primary healing at the site of insertion in the 16 F group (100.0%) was higher than that in the 28F group (58.5%, P=0.014). A significant difference was found in the drainage time and post-operative length of stay between the two groups (54.2±28.6 h vs. 95.6±65.5 h，4.2±1.4 d vs. 6.5±3.0 d). Conclusion Since 16F urinary catheter has advantage in fast track rehabilitation and low risk of pulmonary complications, the use of 16F urinary catheter is appropriate after VATS pulmonary lobectomy.