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Pregernig A, Beck-Schimmer B. Which Anesthesia Regimen Should Be Used for Lung
Surgery? CURRENT ANESTHESIOLOGY REPORTS 2019. [DOI: 10.1007/s40140-019-00356-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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52
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Li J, Zhu H, Liao R. Enhanced recovery after surgery (ERAS) pathway for primary hip and knee arthroplasty: study protocol for a randomized controlled trial. Trials 2019; 20:599. [PMID: 31640757 PMCID: PMC6805414 DOI: 10.1186/s13063-019-3706-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 09/06/2019] [Indexed: 02/05/2023] Open
Abstract
Background With the substantially growing trend of the aging populations in China and the rest of the world, the number of total hip and total knee arthroplasty (THA and TKA) cases are increasing dramatically. It is important to develop practical strategies to improve the quality of healthcare and better outcome for patients undergoing THA and TKA. Enhanced recovery after surgery (ERAS) pathways have been reported to promote earlier recovery and be beneficial for patients. We propose the hypothesis that the ERAS pathway could reduce the length of stay (LOS) in hospital for patients undergoing primary THA or TKA. Methods/Design This trial is a prospective, open-labelled, multi-centered, randomized controlled trial that will test the superiority of the ERAS pathway in term of LOS in hospital for the patients undergoing primary THA or TKA compared to current non-ERAS clinical practice. A total of 640 patients undergoing primary THA or TKA will be randomly allocated to either ERAS pathway (ERAS group) or conventional care according to individual participating center (non-ERAS group). The primary outcome is the total LOS in hospital; the secondary outcomes include postoperative LOS, all-cause mortality by 30 days after operation, in-hospital complications, early mobilization, postoperative pain control, total in-hospital cost, and readmission rate by 30 days after discharge from the hospital. Discussion This trial is designed to evaluate the superiority of the ERAS pathway to conventional non-ERAS clinical practice in reducing the LOS. The results may provide new insight into the clinical applications of the ERAS pathway for THA and TKA. Trial registration National Institutes of Health Clinical Trials Registry, NCT03517098. Registered on 4 May 2018.
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Affiliation(s)
- Jingyi Li
- Department of Dermatovenereology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Haibei Zhu
- Division of Anaesthesiology & Perioperative Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Ren Liao
- Department of Anesthesiology, West China Hospital of Sichuan University, 37 Guoxue Lane, Chengdu, 610041, China.
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Kim M, Mun H, Sung CO, Cho EJ, Jeon HJ, Chun SM, Jung DJ, Shin TH, Jeong GS, Kim DK, Choi EK, Jeong SY, Taylor AM, Jain S, Meyerson M, Jang SJ. Patient-derived lung cancer organoids as in vitro cancer models for therapeutic screening. Nat Commun 2019; 10:3991. [PMID: 31488816 PMCID: PMC6728380 DOI: 10.1038/s41467-019-11867-6] [Citation(s) in RCA: 389] [Impact Index Per Article: 77.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 08/06/2019] [Indexed: 12/16/2022] Open
Abstract
Lung cancer shows substantial genetic and phenotypic heterogeneity across individuals, driving a need for personalised medicine. Here, we report lung cancer organoids and normal bronchial organoids established from patient tissues comprising five histological subtypes of lung cancer and non-neoplastic bronchial mucosa as in vitro models representing individual patient. The lung cancer organoids recapitulate the tissue architecture of the primary lung tumours and maintain the genomic alterations of the original tumours during long-term expansion in vitro. The normal bronchial organoids maintain cellular components of normal bronchial mucosa. Lung cancer organoids respond to drugs based on their genomic alterations: a BRCA2-mutant organoid to olaparib, an EGFR-mutant organoid to erlotinib, and an EGFR-mutant/MET-amplified organoid to crizotinib. Considering the short length of time from organoid establishment to drug testing, our newly developed model may prove useful for predicting patient-specific drug responses through in vitro patient-specific drug trials.
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Affiliation(s)
- Minsuh Kim
- Asan Center for Cancer Genome Discovery, Asan Institute for Life Sciences, Seoul, South Korea
| | - Hyemin Mun
- Asan Center for Cancer Genome Discovery, Asan Institute for Life Sciences, Seoul, South Korea
| | - Chang Oak Sung
- Asan Center for Cancer Genome Discovery, Asan Institute for Life Sciences, Seoul, South Korea
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Eun Jeong Cho
- Asan Center for Cancer Genome Discovery, Asan Institute for Life Sciences, Seoul, South Korea
| | - Hye-Joon Jeon
- Asan Center for Cancer Genome Discovery, Asan Institute for Life Sciences, Seoul, South Korea
| | - Sung-Min Chun
- Asan Center for Cancer Genome Discovery, Asan Institute for Life Sciences, Seoul, South Korea
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Da Jung Jung
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Seoul, South Korea
| | - Tae Hoon Shin
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Seoul, South Korea
| | - Gi Seok Jeong
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Seoul, South Korea
| | - Dong Kwan Kim
- Department of Thoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Eun Kyung Choi
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seong-Yun Jeong
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Alison M Taylor
- Department of Medical Oncology and Center for Cancer-Genome Discovery, Dana-Farber Cancer Institute and Department of Pathology, Harvard Medical School, Boston, MA, USA
| | - Sejal Jain
- Department of Medical Oncology and Center for Cancer-Genome Discovery, Dana-Farber Cancer Institute and Department of Pathology, Harvard Medical School, Boston, MA, USA
| | - Matthew Meyerson
- Department of Medical Oncology and Center for Cancer-Genome Discovery, Dana-Farber Cancer Institute and Department of Pathology, Harvard Medical School, Boston, MA, USA
| | - Se Jin Jang
- Asan Center for Cancer Genome Discovery, Asan Institute for Life Sciences, Seoul, South Korea.
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
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54
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Li S, Zhang W, Yang Z, Li Y, Du H, Che G. Systemic Inflammation Score as a Novel Prognostic Indicator for Patients Undergoing Video-Assisted Thoracoscopic Surgery Lobectomy for Non-Small-Cell Lung Cancer. J INVEST SURG 2019; 34:428-440. [PMID: 31304810 DOI: 10.1080/08941939.2019.1641169] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND To evaluate the prognostic significance of systemic inflammation score (SIS) for patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy for non-small-cell lung cancers (NSCLCs). Methods: This retrospective cohort study was conducted on the prospectively maintained database in our institution during the study period. Preoperative SIS comprising serum albumin (sALB) and lymphocyte-to-monocyte ratio (LMR) was graded into 0, 1 and 2. Survival analysis was performed to distinguish differences in postoperative survival between three groups of SIS. Finally, multivariate Cox proportional hazards regression analyses were conducted to determine independent prognostic factors. Results: There were 390 patients with operable NSCLCs included. We applied sALB at 40 g/L and our median LMR at 3.91 as the cutoffs for modified SIS scoring criteria. Both overall survival (OS) and disease-free survival (DFS) were significantly shortened in a step-wise fashion with each 1-point increase in SIS (Log-rank p < .001). There was a significant step-wise decline in both OS and DFS rates in proportion to SIS (p < .001). No difference was found in postoperative complications between three groups of SIS. Multivariate analyses finally demonstrated that both SIS = 1 and SIS = 2 could be independent prognostic factors for unfavorable OS and DFS of NSCLCs. Conclusions: SIS can serve as a novel risk stratification tool to refine the prognostic prediction for surgical NSCLCs.
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Affiliation(s)
- Shuangjiang Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Wenbiao Zhang
- Department of Radiology, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Sun Yat-Sen University, Guangzhou, PR China
| | - Zhang Yang
- Division of General Thoracic Surgery, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Yongjiang Li
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Heng Du
- Division of Pulmonary Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, PR China
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55
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In-Hospital Mobilization, Physical Fitness, and Physical Functioning After Lung Cancer Surgery. Ann Thorac Surg 2019; 107:1639-1646. [DOI: 10.1016/j.athoracsur.2018.12.045] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 11/15/2018] [Accepted: 12/18/2018] [Indexed: 12/25/2022]
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56
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Shen C, Li J, Li P, Che G. [Evaluation Index of Enhanced Recovery After Surgery: Status and Progress of Patient Report Outcomes in Thoracic Surgery]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2019; 22:161-166. [PMID: 30909996 PMCID: PMC6441120 DOI: 10.3779/j.issn.1009-3419.2019.03.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
加速康复外科临床应用的良好效果体现在降低围手术期并发症的发生率并缩短住院时间,但对围术期的患者症状管理及术后患者生活质量的关注不够高。从患者报告的资料角度评估临床疗效越来越受到重视。结合目前国内外关于病人报告结局的研究成果,本文系统论述了病人报告结局的概念内涵、研究意义及在胸外科的临床应用现状,提出借鉴国外病人报告的临床结局研究模式,开展有中国特色的结合学科特点的相关研究,并对已有的文献报告进行总结及分析。
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Affiliation(s)
- Cheng Shen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jue Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Pengfei Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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Comacchio GM, Monaci N, Verderi E, Schiavon M, Rea F. Enhanced recovery after elective surgery for lung cancer patients: analysis of current pathways and perspectives. J Thorac Dis 2019; 11:S515-S522. [PMID: 31032070 DOI: 10.21037/jtd.2019.01.99] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The concept of enhanced recovery after surgery (ERAS), initially introduced in the field of colorectal surgery, has been developed in order to optimize the postoperative course. In recent years the number of authors analyzing the role of ERAS in lung cancer surgery is increasing, highlighting several interventions with positive effects on the postoperative course. Yet it is still difficult to draw definite conclusions and specific guidelines, as most of these studies largely differ for their methodological aspects and study populations. Herein we focus on the key elements of each single intervention, trying to identify what we can apply in a common pathway, and which aspects are still to be evaluated for the validation of an ERAS program.
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Affiliation(s)
- Giovanni Maria Comacchio
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Nicola Monaci
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Enrico Verderi
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Marco Schiavon
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
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58
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59
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Li S, Che G, Shen C, Zhou K. Current situation and consideration on the enhanced recovery protocols in lung cancer surgery. J Thorac Dis 2018; 10:S3855-S3858. [PMID: 30631497 DOI: 10.21037/jtd.2018.09.72] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Shuangjiang Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Cheng Shen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Kun Zhou
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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60
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Eustache J, Ferri LE, Feldman LS, Lee L, Spicer JD. Enhanced recovery after pulmonary surgery. J Thorac Dis 2018; 10:S3755-S3760. [PMID: 30505562 DOI: 10.21037/jtd.2018.09.61] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The concept of surgical recovery encompasses the entire perioperative phase of the patient, beginning with the preoperative baseline and culminating in the long-term rehabilitation of the patient in the post-operative phase. Enhanced recovery pathways (ERPs) aim to encompass all phase of the patient trajectory, including the preoperative, perioperative, and postoperative management of surgical patients. While significant literature exists on standardizing and optimizing the perioperative phase, standardizing the pre and post-operative phases remains a topic of debate. Furthermore, with regards to pulmonary surgery, the available data on enhanced recovery remains limited, with no consensus on which components to include within the ERP. The difficulty in identifying specific factors to include within a pathway is in part due to the lack of representative metrics of recovery. Secondly, the strength of ERPs usually lies in the agglomeration of multiple components rather than the individual components themselves. This review provides a brief review on current developments in ERPs in pulmonary surgery, emphasizing novel components in the pre and post-operative care of patients. Furthermore, we discuss the limitations of current metrics used to study recovery, and what steps can be taken to direct future studies that aim to enhance patient recovery after pulmonary surgery.
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Affiliation(s)
- Jules Eustache
- Department of General Surgery, McGill University Health Centre, Montreal, Canada
| | - Lorenzo E Ferri
- Division of Thoracic Surgery, McGill University Health Centre, Montreal, Canada
| | - Liane S Feldman
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Canada
| | - Lawrence Lee
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Canada
| | - Jonathan D Spicer
- Division of Thoracic Surgery, McGill University Health Centre, Montreal, Canada
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61
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Mayor MA, Khandhar SJ, Chandy J, Fernando HC. Implementing a thoracic enhanced recovery with ambulation after surgery program: key aspects and challenges. J Thorac Dis 2018; 10:S3809-S3814. [PMID: 30505568 DOI: 10.21037/jtd.2018.10.106] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Enhanced recovery after surgery (ERAS) protocols aim to improve operative outcomes by focusing on perioperative care, including early mobilization, limitation of narcotics, and maintenance of fluid balance. We implemented a T-ERAAS (Thoracic-Early Recovery with Ambulation After Surgery) protocol which focused on early ambulation, with the rationale that a patient's mobility may be a reproducible and measurable metric for their overall status-pain control, respiratory function, cardiac function, and patient satisfaction. We set a benchmark distance of 250 feet for our early ambulation goal and redefined "early" as within the first hour post extubation. We describe some of the major aspects to our program as well as some of the challenges and successes during our 8-year experience following the implementation of this program.
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Affiliation(s)
- Marissa A Mayor
- Inova Cardiac and Thoracic Surgery, Department of Surgery, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Sandeep J Khandhar
- Inova Cardiac and Thoracic Surgery, Department of Surgery, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Joby Chandy
- Inova Cardiac and Thoracic Surgery, Department of Surgery, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Hiran C Fernando
- Inova Cardiac and Thoracic Surgery, Department of Surgery, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
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62
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Gagné S, McIsaac DI. Modifiable risk factors for patients undergoing lung cancer surgery and their optimization: a review. J Thorac Dis 2018; 10:S3761-S3772. [PMID: 30505563 DOI: 10.21037/jtd.2018.10.04] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Enhanced recovery after surgery (ERAS) programs include a variety of pre-, intra- and post-operative interventions that seek to decrease the stress response to surgery and facilitate the recovery of surgical patients. There are a number of patient factors that may increase the risk of postoperative complications (POC) after lung cancer surgery and delay recovery. Some of these factors may be amenable to optimization preoperatively and potentially decrease the incidence of these complications. We have chosen to discuss the incidence and complications associated with factors we felt were both relatively common and significant contributors to POCs. For each of these factors we discuss potential avenues for optimization and the evidence for the resulting decrease in complications.
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Affiliation(s)
- Sylvain Gagné
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Daniel I McIsaac
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Batchelor TJP, Rasburn NJ, Abdelnour-Berchtold E, Brunelli A, Cerfolio RJ, Gonzalez M, Ljungqvist O, Petersen RH, Popescu WM, Slinger PD, Naidu B. Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg 2018; 55:91-115. [DOI: 10.1093/ejcts/ezy301] [Citation(s) in RCA: 461] [Impact Index Per Article: 76.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/31/2018] [Indexed: 02/06/2023] Open
Affiliation(s)
- Timothy J P Batchelor
- Department of Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Neil J Rasburn
- Department of Anaesthesia, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | | | - Robert J Cerfolio
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, USA
| | - Michel Gonzalez
- Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Olle Ljungqvist
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - René H Petersen
- Department of Thoracic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Wanda M Popescu
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA
| | - Peter D Slinger
- Department of Anesthesia, University Health Network – Toronto General Hospital, Toronto, ON, Canada
| | - Babu Naidu
- Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Birmingham, UK
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Gonzalez M, Abdelnour-Berchtold E, Perentes JY, Doucet V, Zellweger M, Marcucci C, Ris HB, Krueger T, Gronchi F. An enhanced recovery after surgery program for video-assisted thoracoscopic surgery anatomical lung resections is cost-effective. J Thorac Dis 2018; 10:5879-5888. [PMID: 30505496 DOI: 10.21037/jtd.2018.09.100] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background Enhanced recovery after surgery (ERAS) programs have been reported to decrease complications and shorten hospital stays after lung resections, but their implementation requires time and financial investment with dedicated staff. The aim of this study was to evaluate the clinical and economic outcomes of video-assisted thoracoscopic surgery (VATS) anatomical pulmonary resections before and after implementation of an ERAS program. Methods The first 50 consecutive patients undergoing VATS lobectomy or segmentectomy for malignancy after implementation of an ERAS program were compared with 50 consecutive patients treated before its introduction. The ERAS protocol included preoperative counseling, reduced preoperative fasting with concomitant carbohydrate loading, avoidance of premedication, standardized surgery, anesthesia and postoperative analgesia, early removal of chest tube, nutrition and mobilization. Length of stay, readmissions and cardio-pulmonary complications within 30 days were compared. Total costs were collected for each patient and a cost-minimization analysis integrating ERAS-specific costs was performed. Results Both groups were similar in terms of demographics and surgical characteristics. The ERAS group had significantly shorter postoperative length of stay (median: 4 vs. 7 days, P<0.0001), decreased pulmonary complications (16% vs. 38%; P=0.01) and decreased overall post-operative complications (24% vs. 48%, P=0.03). One patient in each group was readmitted and there was no 30-day mortality. ERAS-specific costs were calculated at €729 per patient including the clinical nurse and database costs. Average total hospitalization costs were significantly lower in ERAS group (€15,945 vs. €20,360, P<0.0001), mainly due to lower costs during the post-operative period (€7,449 vs. €11,454, P<0.0001) in comparison with the intra-operative period (€8,496 vs. €8,906, P=0.303). Cost-minimization analysis showed a mean saving in the ERAS group of €3,686 per patient. Conclusions An ERAS program for VATS anatomical lung resection is cost-effective and is associated with a lower complication rate and a shorter postoperative hospitalization.
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Affiliation(s)
- Michel Gonzalez
- Service of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | - Jean Yannis Perentes
- Service of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Valérie Doucet
- Service of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Mathieu Zellweger
- Service of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Carlos Marcucci
- Service of Anesthesiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Hans-Beat Ris
- Service of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Thorsten Krueger
- Service of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Fabrizio Gronchi
- Service of Anesthesiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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65
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Grande B, Loop T. Anaesthesia management for bronchoscopic and surgical lung volume reduction. J Thorac Dis 2018; 10:S2738-S2743. [PMID: 30210826 DOI: 10.21037/jtd.2018.02.46] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Optimizing the patient's condition before the lung volume reduction (LVR) according to recommendations by American College of Cardiology/American Heart Association (ACC/AHA) guideline on perioperative cardiovascular evaluation is mandatory. Implementation of a multimodal analgesia concept and the use short-acting anaesthetics enhances recovery and avoids postoperative pulmonary complications. Normovolemia, normothermia, lung protective ventilation and an evidence-based concept of airway management (i.e., double-lumen tube, bronchus blocker) are suggested for intraoperative management of surgical lung volume reduction (SLVR). General anaesthesia (using remifentanil, propofol and mivacurium) with an i-gel® supraglottic airway device should be used for bronchoscopic lung volume reduction (BLVR). Jet ventilation through rigid bronchoscopy or with a jet catheter may be an alternative concept. Experienced consultants should perform anaesthesia for LVR.
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Affiliation(s)
- Bastian Grande
- Institute of Anaesthesiology, University Hospital Zurich, Switzerland
| | - Torsten Loop
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center, Freiburg, Germany
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66
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Che G. [What is Enhanced Recovery After Surgery: Humanity or Technology?]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 21:168-172. [PMID: 29587933 PMCID: PMC5973029 DOI: 10.3779/j.issn.1009-3419.2018.03.08] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The development of surgical techniques and the innovation of surgical instruments promote the changes in surgical methods, which in turn, leads to the reforms of surgical idea. The concept of enhanced recovery after surgery (ERAS) results in the surgery connotation switching from "to treat an illness" to "to save patients". ERAS also causes the change of surgery denotation from "only operation" to "enhance recovery". The concept of ERAS is derived from but not only restricted to the development of surgical techniques. Also, ERAS pays more attention to patients than disease and thinks more about patient safety and recovery than surgical technique. Specifically, ERAS has three advantages: first, ERAS attaches importance to multidisciplinary assessment (patient-oriented) and select appropriate (personalized) treatment and tries to decrease the rate of complication and mortality. Second, ERAS pays attention to preoperative preparation and high-risk prevention performed by multi-disciplinary collaboration in order to prevent complication and save cost for patients. Third, ERAS always focus on optimizing the process of perioperative period and trying to change the working habits of surgeons and the old cooperation mode among doctors, nurses and rehabilitation physicians. To sum up, the goal is to apply the concept of ERAS to all the links of perioperative period and try hard to decrease patients' stress and pain, which finally helps doctors fulfill the ultimate aims of "no pain and no risk".
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Affiliation(s)
- Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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Jing X, Zhang B, Xing S, Tian L, Wang X, Zhou M, Li J. Cost-benefit analysis of enhanced recovery after hepatectomy in Chinese Han population. Medicine (Baltimore) 2018; 97:e11957. [PMID: 30142819 PMCID: PMC6113004 DOI: 10.1097/md.0000000000011957] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) programs have been proved effective for enhancing the clinical healing rate and reducing hospitalization cost in most countries of the world. It's a multi-model approach that designed to optimize perioperative pathway, attenuate the surgical stress response, and decrease postoperative complications. OBJECTIVE The economic benefit from the application of ERAS to colorectal surgery has been demonstrated in China. However, such economic benefit of ERAS programs for hepatectomy hasn't been clarified yet. This study was carried out to explore the clinical efficacy and cost effectiveness of ERAS in Chinese Han population after hepatectomy. METHODS ERAS program was implemented in our department for hepatectomy in December 2016. In total, 79 consecutive patients after hepatectomy were chosen as ERAS group (ERAS protocol) in coming half year while 121 consecutive patients after hepatectomy were chosen as Pre-ERAS group (traditional protocol) in past half year. The operation time, intraoperative blood loss, length of hospital stay (LOS), complication, readmission, and hospitalization cost of 2 groups were compared. RESULTS The LOS of ERAS group was 5.81 ± 1.79 days, significantly shorter than that of Pre-ERAS group (8.06 ± 3.40 d) (P = .000). The operation time was 168.03 ± 46.20 minutes for ERAS group and 175.41 ± 64.64 minutes for Pre-ERAS group respectively (P = .417). The intraoperative blood loss was 166.58 ± 194.13 mL (ERAS group) and 205.45 ± 279.63 mL (Pre-ERAS group) (P = .293). It should be noted that the hospitalization cost of ERAS group was 51556.18 ± 8926.05 Yuan (7835.05 ± 1355.45 US dollars), significantly less than that of Pre-ERAS group 60554.66 ± 15615.31 Yuan (9202.56 ± 2371.24 US dollars) (P = .000). The application of ERAS effectively saved 8998.48 Yuan (1367.51 US dollars) for each patient. CONCLUSIONS ERAS implementation for hepatectomy surgery is safe and feasible for Chinese Han population. It eventually enhanced the clinical healing rate. The benefits from such programs include a reduction of the LOS, complication, and readmission rates. So each patient has access to better medical service. It effectively relieved the financial burden of patients. The benefits from such programs include a reduction of the hospitalization cost, especially in medication cost. So each patient can afford the diseases.
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Cata JP, Lasala JD, Williams W, Mena GE. Myasthenia Gravis and Thymoma Surgery: A Clinical Update for the Cardiothoracic Anesthesiologist. J Cardiothorac Vasc Anesth 2018; 33:2537-2545. [PMID: 30219643 DOI: 10.1053/j.jvca.2018.07.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Indexed: 12/17/2022]
Abstract
Myasthenia gravis (MG) is a rare neuromuscular disorder characterized by skeletal muscle weakness. Patients with MG who have thymoma and thymic hyperplasia have indications for thymectomy. The perioperative care of patients with MG scheduled for thymus resection should be focused on optimizing their neuromuscular function, identifying factors related to postoperative mechanical ventilation, and avoiding of triggers associated with myasthenic or cholinergic crisis. Minimally invasive surgical techniques, use of regional analgesia, and avoidance or judicious administration of neuromuscular blocking drugs (NMBs) is recommended during the perioperative period. If NMBs are used, sugammadex appears to be the drug of choice to restore adequately the neuromuscular transmission. In patients with postoperative myasthenic crisis, plasma exchange or intravenous immune globulin and mechanical support is recommended.
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Affiliation(s)
- Juan P Cata
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX; Anesthesiology and Surgical Oncology Research Group, Houston, TX.
| | - Javier D Lasala
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX; Anesthesiology and Surgical Oncology Research Group, Houston, TX
| | - Wendell Williams
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX; Anesthesiology and Surgical Oncology Research Group, Houston, TX
| | - Gabriel E Mena
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX; Anesthesiology and Surgical Oncology Research Group, Houston, TX
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Malik PRA, Fahim C, Vernon J, Thomas P, Schieman C, Finley CJ, Agzarian J, Shargall Y, Farrokhyar F, Hanna WC. Incentive Spirometry After Lung Resection: A Randomized Controlled Trial. Ann Thorac Surg 2018; 106:340-345. [PMID: 29702071 DOI: 10.1016/j.athoracsur.2018.03.051] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 02/26/2018] [Accepted: 03/22/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Incentive spirometry (IS) is thought to reduce the incidence of postoperative pulmonary complications (PPC) after lung resection. We sought to determine whether the addition of IS to routine physiotherapy following lung resection results in a lower rate of PPC, as compared with physiotherapy alone. METHODS A single-blind prospective randomized controlled trial was conducted in adults undergoing lung resection. Individuals with previous lung surgery or home oxygen were excluded. Participants randomized to the control arm (PHY) received routine physiotherapy alone (deep breathing, ambulation and shoulder exercises). Those randomized to the intervention arm (PHY/IS) received IS in addition to routine physiotherapy. The trial was powered to detect a 10% difference in the rate of PPC (β = 80%). Student's t test and chi-square were utilized for continuous and categorical variables, respectively, with a significance level of p = 0.05. RESULTS A total of 387 participants (n = 195 PHY/IS; n = 192 PHY) were randomized between 2014 and 2017. Baseline characteristics were comparable for both arms. The majority of patients underwent a pulmonary lobectomy (PHY/IS = 59.5%, PHY = 61.0%; p = 0.84), with no difference in the rates of minimally invasive and open procedures. There were no differences in the incidence of PPC at 30 days postoperatively (PHY/IS = 12.3%, PHY = 13.0%; p = 0.88). There were no differences in rates of pneumonia (PHY/IS = 4.6%, PHY = 7.8%; p = 0.21), mechanical ventilation (PHY/IS = 2.1%, PHY = 1.0%; p = 0.41), home oxygen (PHY/IS = 13.8%, PHY = 14.6%; p = 0.89), hospital length of stay (PHY/IS = 4 days, PHY = 4 days; p = 0.34), or rate of readmission to hospital (PHY/IS = 10.3%, PHY = 9.9%; p = 1.00). CONCLUSIONS The addition of IS to routine postoperative physiotherapy does not reduce the incidence of PPC after lung resection.
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Affiliation(s)
- Peter R A Malik
- Division of Thoracic Surgery, McMaster University, Hamilton, Canada
| | - Christine Fahim
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Jordyn Vernon
- Division of Thoracic Surgery, McMaster University, Hamilton, Canada
| | - Priya Thomas
- Division of Thoracic Surgery, McMaster University, Hamilton, Canada
| | - Colin Schieman
- Section of Thoracic Surgery, University of Calgary, Calgary, Canada
| | | | - John Agzarian
- Division of Thoracic Surgery, McMaster University, Hamilton, Canada
| | - Yaron Shargall
- Division of Thoracic Surgery, McMaster University, Hamilton, Canada
| | - Forough Farrokhyar
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Waël C Hanna
- Division of Thoracic Surgery, McMaster University, Hamilton, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
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Vannucci J, Costi S, Matricardi A, Scarnecchia E, Droghetti A. VATS Group ERAS Registry. J Thorac Dis 2018; 10:S571-S577. [PMID: 29629204 DOI: 10.21037/jtd.2018.02.56] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Enhanced recovery after surgery (ERAS) is a multimodal, polyhedral approach to surgical management for patients undergoing surgical therapy. Since ERAS is not a specific procedure, these protocols are not exclusively created for particular clinical settings but they are prone to be adapted to a large variety of healthcare programs after surgery. ERAS Society was the platform in which a new multidisciplinary methodology to promote a fast recovery, a considerable patient involvement and resource optimization has been developed. ERAS Society has also produced guidelines for different surgical specialties and has already generated some evidence regarding preoperative, intraoperative and postoperative practice. ERAS in Thoracic Surgery has had a slow-growing development but some hints suggest that introducing ERAS methodology in pulmonary resections for cancer could be feasible and effective with potential tangible benefits for patients, families, caregivers and welfare. There is no evidence yet concerning ERAS principles in Thoracic Surgery; for this reason, a new possibility for prospective data collection and analysis is created using the VATS Group Web Registry in which additional records, documents and facts have now the possibility to be registered and eventually explored to possibly adjust the ERAS protocols to major pulmonary resections.
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Affiliation(s)
- Jacopo Vannucci
- Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy
| | | | - Alberto Matricardi
- Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy
| | - Elisa Scarnecchia
- Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy.,Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Policlinico Sant'Orsola Malpighi, Bologna, Italy
| | - Andrea Droghetti
- Division of Thoracic Surgery, Carlo Poma Hospital, Mantova, Italy
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Taurchini M, Del Naja C, Tancredi A. Enhanced Recovery After Surgery: a patient centered process. J Vis Surg 2018; 4:40. [PMID: 29552522 DOI: 10.21037/jovs.2018.01.20] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 01/22/2018] [Indexed: 12/28/2022]
Abstract
The Enhanced Recovery After Surgery (ERAS) is a model of care introduced in 1997 by a group of general surgeons from Northern Europe led by Henrik Kehlet. The core of this approach is to produce improvements in surgical patient outcomes, especially in the reduction of hospital stay, complications rate, early recovery and reduction of economic burdens. Simply elaborating and establishing a protocol is not enough and much more efforts and changes are needed to achieve the aim to offer a sustainable improvement in the overall quality of patient care, therefore, ERAS is not a single and rigid protocol but is a method, a "modus operandi", a new way of multidisciplinary teamwork with readiness to make changes as knowledge evolves, i.e., a revolution of medical-scientific thought: we have to move from the concept of "management of disease" to that of "health promotion".
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Affiliation(s)
- Marco Taurchini
- Thoracic Surgery Unit, IRCCS "Casa Sollievo della Sofferenza" Hospital, Viale Cappuccini, San Giovanni Rotondo, Foggia, Italy
| | - Carlo Del Naja
- Thoracic Surgery Unit, IRCCS "Casa Sollievo della Sofferenza" Hospital, Viale Cappuccini, San Giovanni Rotondo, Foggia, Italy
| | - Antonio Tancredi
- Thoracic Surgery Unit, IRCCS "Casa Sollievo della Sofferenza" Hospital, Viale Cappuccini, San Giovanni Rotondo, Foggia, Italy.,Department of Emergency, IRCCS "Casa Sollievo della Sofferenza" Hospital, Viale Cappuccini, San Giovanni Rotondo, Foggia, Italy
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