Objective To systematically review the effect of inspiratory muscle training (IMT) on postoperative clinical outcomes among esophageal cancer patients. Methods The PubMed, EMbase, Web of Science, The Cochrane Library, CNKI, WanFang Data and VIP databases were searched from inception to January 16th, 2022 for randomized controlled trials (RCTs) and cohort studies on the clinical application of IMT among postoperative esophageal cancer patients. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4 software. Results Eight studies were included, including 7 RCTs and 1 cohort study, involving 728 participants. The results of the meta-analysis demonstrated that IMT significantly enhanced postoperative respiratory muscle function [maximum inspiratory pressure (MIP): MD=5.75, 95%CI 0.81 to 10.70, P=0.02; maximum expiratory pressure (MEP): MD=8.19, 95%CI 4.14 to 12.24, P<0.001] and pulmonary function (FEV1%: MD=6.94, 95%CI 5.43 to 8.45, P<0.001; FVC%: MD=4.65, 95%CI 2.70 to 6.60, P<0.001; MVV: MD=8.66, 95%CI 7.17 50 10.14, P<0.001; FEV1/FVC%: MD=8.04, 95%CI 4.68 to 11.40, P<0.001). Additionally, the results indicated that IMT could substantially improve postoperative functional performance [six-minute walk test (6MWT): MD=66.99, 95%CI 10.13 to 123.85, P=0.02; Borg index: MD=−1.03, 95%CI −1.26 to −0.81, P<0.001]. However, no significant reduction in the incidence of postoperative complications was observed. Conclusion IMT can improve the postoperative clinical outcomes of esophageal cancer patients and facilitate patient recovery after surgery, which has high clinical value. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
Objective To analyze the changes of perioperative symptoms of lung cancer patients by using patient-reported outcomes at different time points. MethodsA total of 109 patients who underwent thoracoscopic lung cancer resection in the department of thoracic surgery of our hospital from March to April 2021 were selected, including 55 (50.46%) males and 54 (49.54%) females. The mean age was 55.19±12.12 years. The postoperative symptom scale for lung cancer patients was used to investigate the changes of symptoms before surgery, 1 day after surgery, the day of discharge, and 30 days after surgery. Results The mean hospital stay was 6.89±2.25 days. None of the patients reported any clinical symptoms related to lung cancer before surgery. The most prominent symptoms 1 day after surgery were pain (3.33±0.96 points), nausea (2.81±1.18 points), dizziness (2.00±0.85 points), fatigue (1.89±0.79 points) and shortness of breath (1.79±1.37 points). The patients with dizziness, nausea, fatigue and other symptoms gradually decreased, and the symptoms were relieved significantly (P<0.05). However, the symptoms of conscious pain, cough and shortness of breath lasted for a long time. At 30 days after surgery, 70.64%, 64.22% and 33.03% of patients felt pain, cough and shortness of breath, respectively, and the degree of cough was aggravated (P<0.001). Conclusion Pain, cough, dizziness, shortness of breath and fatigue are the core postoperative symptoms of lung cancer patients. Most postoperative adverse symptoms can be effectively controlled in a short period of time, but pain, cough and shortness of breath still present persistent characteristics, which deserve further study.
Objective To explore the application value of failure mode and effect analysis (FMEA) in the risk management of unplanned extubation after esophageal cancer surgery. Methods A total of 1 140 patients who underwent esophageal cancer surgery in our department from January 2015 to May 2017 were selected as a control group, including 948 males and 192 females with an average age of 64.45±4.53 years. FMEA was used to analyze the risk management process of unplanned extubation. The potential risk factors in each process were found by calculating the risk priority number (RPN) value, and the improvement plan was formulated for the key process with RPN>125 points. Then 1 117 patients who underwent esophageal cancer surgery from June 2017 to December 2019 were selected as a trial group, including 972 males and 145 females with an average age of 64.60±5.22 years, and the FMEA risk management mode was applied.Results The corrective measures were taken to optimize the high-risk process, and the RPN values of 9 high-risk processes were reduced to below 125 points after using FMEA risk management mode. The rate of unplanned extubation in the trial group was lower than that in the control group (P<0.05). Conclusion The application of FMEA in the risk management of unplanned extubation after esophageal cancer surgery can reduce the rate of unplanned extubation, improve the quality of nursing, and ensure the safety of patients.
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 understand the status quo of depression and anxiety emotion in perioperative patients with thoracic neoplasms under the concept of enhanced recovery aftersurgery. Methods Huaxi emotional-distress index scale (HEI) was adopted to investigate the mental status of 195 patients with thoracic neoplasms in Department of Thoracic Surgery, West China Hospital, and the nursing outpatients between September and November in 2016. There were 118 males and 77 females at age of 17–80 (55.72±12.66) years. Results There was significant difference in mental health level between the preoperative patients and the postoperative patients (3.70±3.41vs. 11.01±9.78,P<0.001). The incidence of depression and anxiety emotion in the postoperative patients was significantly higher than that in the preoperative patients (50.00%vs. 9.60%, P<0.001). Besides, there was significant difference of depression and anxiety degree between the preoperative patients and postoperative patients (P<0.001). Moderate to severe depression and anxiety were mostly found in the postoperative patients while mild to moderate depression and anxiety in the preoperative patients. Conclusion Patients with thoracic neoplasms have much emotional obstacle in perioperative period. The incidence and severity degree of depression and anxiety emotion in postoperative patients are higher than those in preoperative patients.
Objective To analyze the current status and difficulties of ERAS applicated in thoracic surgery in different regional hospitals. Methods A total of 773 valid questionnaires were collected during the First West China Forum on Chest ERAS and analyzed by geographical distribution. The content of the questionnaire was divided into two parts, including the respondents’ institute and personal information, as well as 10 questions about ERAS. Results There were 83.57%, 83.82%, 89.58%, 93.75%, 94.74% and 92.86% of surgeons and nurses in Sichuan province, municipalities, the eastern, western, southern and northern respectively who believed that ERAS in all surgeries should be used. There were 61.84%, 60.29%, 65.97%, 81.25%, 73.68% and 75.00% of surgeons and nurses who thought that the concept of ERAS was more in the theory than in the practice; 77.99%, 80.88%, 74.31%, 78.13%, 83.33% and 69.64% of respondents agreed that average hospital stay, patients’ experience and social satisfaction should be the evaluation standard of ERAS practice while 58.50%, 63.24%, 54.86%, 62.50%, 70.18% and 58.93% of respondents believed that immature procedure, lack of consensus and specifications and insecurity for doctors were the reasons for poor compliance of ERAS; 63.23%, 67.65%, 59.72%, 68.75%, 72.81% and 67.86% of respondents thought that the best team of ERAS should be based on the combination of subject integration, surgery orientation and surgeon-nurse teamwork; 43.73%, 44.12%, 43.75%, 46.88%, 59.65% and 41.07% of respondents thought that multidisciplinary cooperation, multi-modality conducted and surgical programming should be the best way for ERAS implementation; 72.98%, 69.12%, 62.50%, 65.63%, 80.70% and 55.36% of responders agreed that the ERAS forum or conference should include the norms and consensus, analysis and implementation of projects and the status and progress of ERAS. Conclusion There are more consistent views on the clinical application of ERAS in all regions. The subject integration, surgeon-nurse teamwork and multidisciplinary, multi-modality cooperation are the best team and best way for ERAS program implementation.
Objective To investigate the current level of resourcefulness and its impact on work engagement among lung cancer patients who have returned to work after video-assisted thoracoscopic surgery (VATS) lung resection. Methods A sample of middle-aged and young lung cancer patients who underwent VATS lung resection at the Department of Thoracic Surgery, West China Hospital of Sichuan University, between March and September 2023 and had returned to work were selected as the study subjects. Data were collected using a general information questionnaire, the Resourcefulness Scale, and the Utrecht Work Engagement Scale (UWES). Univariate analysis and multiple stepwise regression analysis were used to examine the current status of patients’ resourcefulness upon returning to work and its influence on work engagement. Results A total of 219 patients were included in the study, comprising 60 males and 159 females, with a mean age of (43.18±7.55) years. The patients' score for resourcefulness in returning to work was (107.58±14.42) points, and the total score for work engagement was (64.80±12.72) points. A significant positive correlation was observed between the resourcefulness score and the work engagement score (P<0.001). Multiple stepwise regression analysis revealed that factors such as job nature, average monthly household income, postoperative complications, and individuals' level of resourcefulness all significantly influenced the degree of patients' work engagement (all P<0.05).Conclusion The resourcefulness level and work engagement of patients returning to work after VATS lung resection need to be improved.
ObjectiveTo compare the safety and comfort of patients with or without postoperative gastric tube placement after esophageal cancer surgery, and analyze the cost and nursing time of gastric tube placement. Methods The patients with esophageal cancer undergoing minimally invasive surgery in West China Hospital of Sichuan University in 2021 were enrolled. The patients were divided into a gastric tube indwelling group and a non gastric tube indwelling group according to whether the gastric tube was indwelled after the operation. The safety and comfort indicators of the two groups were compared. Results A total of 130 patients were enrolled. There were 66 patients in the gastric tube indwelling group, including 53 males and 13 females, aged 61.80±9.05 years and 64 patients in the non gastric tube indwelling group, including 55 males and 9 females, aged 64.47±8.00 years. Six patients in the non gastric tube indwelling group needed to place gastric tube 1 to 3 days after the operation due to their condition. There was no statistical difference in the incidence of postoperative complications between the two groups (P>0.05). The subjective comfort of patients in the gastric tube indwelling group was significantly lower than that in the non gastric tube indwelling group (P<0.001), and the incidence of foreign body sensation in the throat of patients in the gastric tube indwelling group was higher than that in the non gastric tube indwelling group (P<0.001). The average nursing time in the gastric tube indwelling group was about 59.58 minutes, and the average cost of gastric tube materials and nursing was 378.24 yuan per patient. Conclusion No gastric tube used after operation for appropriate esophageal cancer patients will not increase the incidence of postoperative complications (pulmonary infection, anastomotic leakage, chylothorax), but can increase the comfort of patients, save cost and reduce nursing workload, which is safe, feasible and economical.
ObjectiveTo investigate the current status of outpatient pain management in patients with pulmonary disease after surgery by WeChat and to provide a basis for postoperative pain management.MethodsA total of 449 patients who underwent thoracic surgery in our hospital from December 2017 to May 2018 were enrolled, including 156 males and 293 females with an average age of 22-83 (55.54±11.17) years. Brief Pain Inventory was adopted for pain assessment in 24-48 hours after discharge and 24 hours after removal of from the wound.ResultsTotally 98.22% of the patients reported that they suffered from pain in 24-48 h after discharge, most pain position was still at drainage port (45.21%), the overall pain score was 2.75 (2.00, 3.25) points, and 82.85% of patients adopted physical methods to relieve pain. After removal of stitches at the drainage port, 79.29% of the patients suffered from pain, the pain site was mainly at the drainage port (47.88%), and the overall pain score was 1.75 (1.25, 2.25) points, and 73.94% of patients adopted physical methods to relieve pain. The score of the overall influence degree of pain on patients was 2.29 (1.86, 2.86) points and 1.86 (1.29, 2.43) points, while pain had the greatest influence on sleep and mood. The scores were 4.00 (3.00, 5.00) points, 3.00 (2.00, 4.00) points and 2.00 (1.00, 4.00) points, 3.00 (2.00, 4.00) points, respectively.ConclusionUnder the concept of enhanced recovery after surgery, the overall pain level of patients with pulmonary disease after discharge is mild pain, but the application rate of drug analgesia in patients is low. The overall effect of pain on postoperative patients with lung cancer is low, but it has a great impact on sleep and mood. Medical staff should strengthen the pain education for patients in order to improve their pain self-management ability.
Esophageal carcinoma is a malignant tumor with high morbidity and mortality worldwide, and surgery is the main treatment currently. With the development of patient-centered care, the effect of surgery should not be limited to the improvement of the incidence of postoperative complications, mortality and other indicators. It is also important to provide experience related to disease and surgery from the perspective of patients. Therefore, more and more attention is paid to patient-reported outcomes by scholars. This paper will provide an overview of the international widely used, reliable and effective scales and researches about patient-reported outcomes in esophageal carcinoma.