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Jiang M, Liu S, Deng H, Liang X, Bo Z. The efficacy and safety of fast track surgery (FTS) in patients after hip fracture surgery: a meta-analysis. J Orthop Surg Res 2021; 16:162. [PMID: 33639957 PMCID: PMC7913454 DOI: 10.1186/s13018-021-02277-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 02/01/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Fast track surgery (FTS) has been gradually applied in perioperative management of orthopedic surgery, but there still some research suspected that the prognosis of patients is not as expected and the cost is high, the effect of the FTS still urgently needed for support by evidence-based medicine. METHODS We retrieved RCTs from medical research literature databases. Risk ratios (RR), standard mean difference (SMD), and 95% confidence intervals (CI) were calculated to compare the primary and safety endpoints. RESULTS Overall, a total of 8886 patients were retrieved from 57 articles, of which 4448 patients (50.06%) were randomized to experimental group whereas 4438 patients (49.94%) were randomized to control group. The result showed that FTS could significantly shorten the length of stay (LOS), decrease the visual analog scale (VAS), reduce the leaving bed time and the hospitalization costs, and improve Harris hip joint function score. The incidence of complications such as respiratory system infection, urinary system infection, venous thrombus embolism (VTE), pressure sore, incision infection, constipation, and prosthesis dislocation also has been decreased significantly. Meanwhile, FTS improved patients' satisfaction apparently. CONCLUSIONS This meta-analysis reveals that FTS could significantly shorten the length of stay, alleviate the pain, reduce the leaving bed time and the hospitalization costs, and improve hip function. The incidence of complications also has been decreased significantly. Meanwhile, FTS has been spoken highly in patients in terms of nursing satisfaction. Its efficacy and safety were proved to be reliable.
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Affiliation(s)
- Mingyang Jiang
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Siyi Liu
- Guangxi Medical University, Nanning, Guangxi, China
| | - Huachu Deng
- Guangxi Medical University, Nanning, Guangxi, China
| | - Xuzhi Liang
- Guangxi Medical University, Nanning, Guangxi, China
| | - Zhandong Bo
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
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Tampo MMT, Onglao MAS, Lopez MPJ, Sacdalan MDP, Cruz MCL, Apellido RT, Monroy HIJ. IMPROVED OUTCOMES WITH IMPLEMENTATION OF AN ENHANCED RECOVERY AFTER SURGERY (ERAS) PATHWAY FOR PATIENTS UNDERGOING ELECTIVE COLORECTAL SURGERY IN THE PHILIPPINES. Ann Coloproctol 2020; 38:109-116. [PMID: 32972103 PMCID: PMC9021849 DOI: 10.3393/ac.2020.09.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 09/02/2020] [Indexed: 10/29/2022] Open
Abstract
Objective This study aims to evaluate surgical outcomes (i.e. length of stay, 30-day morbidity, mortality, reoperation, and readmission rates) with the use of the ERAS pathway, and determine its association with the rate of compliance to the different ERAS components. Methodology This was a prospective cohort of patients, who underwent the following elective procedures: stoma reversal (SR), colon resection (CR), and rectal resection (RR). The primary endpoint was to determine the association of compliance to an ERAS pathway and surgical outcomes. These were then compared to outcomes prior to the implementation of ERAS. Results A total of 267 patients were included in the study. The overall compliance to the ERAS component was 92% (SR:91.75%, CR:93.06%, RR:90.65%). There was an associated decrease in morbidity rates across all types of surgery, as compliance to ERAS increased. The average total LOS decreased in all groups but was only found to have statistical significance in SR (12.06 ± 6.67 vs 10.02 ± 5.43 days; p=0.002) and RR (19.85 ± 11.38 vs 16.85 ± 10.45 days; p=0.04) groups. Decreased postoperative LOS was noted in all groups. Morbidity rates were significantly higher after ERAS implementation, but reoperation and mortality rates were found to be similar. Conclusion Implementation of ERAS improved outcomes, particularly length of stay. Although an actual increase in morbidity was noted, that may be explained by the improved reporting and documentation that accompanied the implementation of the protocol, a decreased likelihood of developing complications is foreseen with increased compliance to ERAS.
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Affiliation(s)
- Mayou Martin T Tampo
- Division of Colorectal Surgery, Philippine General Hospital, University of the Philippines Manila
| | - Mark Augustine S Onglao
- Division of Colorectal Surgery, Philippine General Hospital, University of the Philippines Manila
| | - Marc Paul J Lopez
- Division of Colorectal Surgery, Philippine General Hospital, University of the Philippines Manila
| | - Marie Dione P Sacdalan
- Division of Colorectal Surgery, Philippine General Hospital, University of the Philippines Manila
| | - Ma Concepcion L Cruz
- Department of Anesthesiology, Philippine General Hospital, University of the Philippines Manila
| | - Rosielyn T Apellido
- Division of Colorectal Surgery, Philippine General Hospital, University of the Philippines Manila
| | - Hermogenes Iii J Monroy
- Division of Colorectal Surgery, Philippine General Hospital, University of the Philippines Manila
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Stojanovic MD, Markovic DZ, Vukovic AZ, Dinic VD, Nikolic AN, Maricic TG, Janković RJ. Enhanced Recovery after Vascular Surgery. Front Med (Lausanne) 2018; 5:2. [PMID: 29404329 PMCID: PMC5785721 DOI: 10.3389/fmed.2018.00002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 01/03/2018] [Indexed: 12/22/2022] Open
Abstract
The beginnings of the enhanced recovery after surgery (ERAS) program were first developed for patients in colorectal surgery, and after it was established as the standard of care in this surgical field, it began to be applied in many others surgical areas. This is multimodal, evidence-based approach program and includes simultaneous optimization of preoperative status of patients, adequate selection of surgical procedure and postoperative management. The aim of this program is to reduce complications, the length of hospital stay and to improve the patients outcome. Over the past decades, special attention was directed to the postoperative management in vascular surgery, especially after major vascular surgery because of the great risk of multiorgan failure, such as: respiratory failure, myocardial infarction, hemodynamic instability, coagulopathy, renal failure, neurological disorders, and intra-abdominal complications. Although a lot of effort was put into it, there is no unique acceptable program for ERAS in this surgical field, and there is still a need to point out the factors responsible for postoperative outcomes of these patients. So far, it is known that special attention should be paid to already existing diseases, type and the duration of the surgical intervention, hemodynamic and fluid management, nutrition, pain management, and early mobilization of patients.
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Affiliation(s)
- Milena D Stojanovic
- Center for Anesthesiology, Reanimatology and Intensive Care, Clinical Center Nis, Nis, Serbia
| | - Danica Z Markovic
- Center for Anesthesiology, Reanimatology and Intensive Care, Clinical Center Nis, Nis, Serbia
| | - Anita Z Vukovic
- Center for Anesthesiology, Reanimatology and Intensive Care, Clinical Center Nis, Nis, Serbia
| | - Vesna D Dinic
- Center for Anesthesiology, Reanimatology and Intensive Care, Clinical Center Nis, Nis, Serbia
| | - Aleksandar N Nikolic
- Center for Anesthesiology, Reanimatology and Intensive Care, Clinical Center Nis, Nis, Serbia
| | - Tijana G Maricic
- Center for Anesthesiology, Reanimatology and Intensive Care, Clinical Center Nis, Nis, Serbia
| | - Radmilo J Janković
- Center for Anesthesiology, Reanimatology and Intensive Care, Clinical Center Nis, Nis, Serbia.,School of Medicine, University of Nis, Nis, Serbia
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Fast-Track Surgery in Intestinal Deep Infiltrative Endometriosis. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2017. [DOI: 10.5301/jeppd.5000308] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Fast-track (FT), also known as enhanced recovery after surgery (ERAS), is an integrated management of patients undergoing surgery, which is focused on optimal recovery and improvement of the overall quality of care. Minimally invasive surgery is the gold standard to diagnose and treat endometriosis, and its beneficial role within the FT program was reviewed. A search was performed for recent medical literature regarding the findings of the FT approach applied to intestinal deep infiltrative endometriosis surgery. This pathway comprises a diverse number of procedures arranged in preoperative, intraoperative, and postoperative settings. Evidence-based findings in randomized clinical trials have repeatedly shown that these protocols lead to enhanced recovery after surgery, reduced morbidity and mortality with a reduction in postoperative complications, and with readmission rates similar to conventional regimes.
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Poland F, Spalding N, Gregory S, McCulloch J, Sargen K, Vicary P. Developing patient education to enhance recovery after colorectal surgery through action research: a qualitative study. BMJ Open 2017; 7:e013498. [PMID: 28667197 PMCID: PMC5577868 DOI: 10.1136/bmjopen-2016-013498] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To understand the role of preoperative education for patients undergoing colorectal surgery by involving patients, carers and staff in: (1) identifying its perceived value and deficits for enhanced recovery; (2) modifying current education practices to address educational deficits; and (3) evaluating these changes for preparing patients to enhance their recovery. DESIGN Qualitative study of three cycles of action research using mixed methods within a 24-month naturalistic enquiry to identify, implement and evaluate changes through observations, questionnaires, semistructured longitudinal interviews, focus groups and documentation review. SETTING A UK 1200-bed National Health Service (NHS) hospital providing colorectal surgery in a small city in a rural county. PARTICIPANTS Ninety-sevenpatients having colorectal surgery, 19 carers and 22 clinical staff. RESULTS Themes identified were: (1) knowledge and engagement; (2) situated understanding and confidence building; and (3) partnership and proactive involvement in enhancing recovery. All patients articulated needs to prepare mentally and physically to plan for colorectal surgery and rehabilitation. Patients and carers wanted to counter uncertainty about medical procedures: likely bodily changes, recovery timescales and future. They therefore sought as much personalised, relevant information as possible about their disease, planned surgery and recovery. Staff implemented preoperative education to more specifically inform and respond multimodally to individual needs. CONCLUSIONS Patients wanted to be proactively involved in managing their recovery to re-engage with their everyday lives. Preoperative education supported this through developing patients' situated understanding of hospital and bodily processes related to colorectal surgery. Situated understanding was achieved through educational product to give knowledge and processes promoting engagement. Multimodal, comprehensive and timely preoperative education on the whole patient pathway facilitates active engagement. Situated understanding increased patients' confidence to work in partnership with healthcare professionals and proactively self-manage recovery.
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Affiliation(s)
- Fiona Poland
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Nicola Spalding
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Sheila Gregory
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Jane McCulloch
- Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Kevin Sargen
- Chesterfield Royal Hospital, Chesterfield, Calow, Derbyshire, UK
| | - Penny Vicary
- School of Health Sciences, University of East Anglia, Norwich, UK
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Enhanced Recovery After Surgery in the Setting of the Perioperative Surgical Home. Int Anesthesiol Clin 2017; 55:135-147. [DOI: 10.1097/aia.0000000000000160] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Abstract
Purpose
– The purpose of this paper is to understand and develop ways to enhance patients’ experiences of preoperative education received prior to surgery for colorectal cancer.
Design/methodology/approach
– Based in the UK, three-action research cycles were undertaken to evaluate preoperative education, identify changes seen by patients and staff as likely to improve the service and to re-evaluate such changes following implementation. Data in each cycle were collected from: observations of clinic interactions; patient questionnaires; individual semi-structured interviews with multidisciplinary colorectal unit staff; longitudinal semi-structured interviews with patients and carers pre-surgery, two weeks post-surgery and 12 weeks post-surgery; patient and carer focus groups post-surgery; and existing educational material.
Findings
– In total, 138 participants shared their experiences of either giving or receiving preoperative education. Findings were themed into why patients want preoperative education, and patients’ views of the educational processes.
Practical implications
– Patients emphasised the need for educational provision to be fully understandable, comprehensive and client-centred using a range of communication processes. Patients emphasised the need for educational provision to be more fully understandable, comprehensive and client-centred and that important messages should be reinforced using a range of media. At a time of many uncertainties for patients’ lives, such education needed to encompass the experiences patients could expect, delivered by confident healthcare professionals.
Originality/value
– Contextualising understanding and facilitating their own actions, enabled patients to regain control in circumstances particularly disruptive of bodily and other life routines. Establishing a sense of control is confirmed as important for patient's wellbeing in preparing for surgery and postoperative rehabilitation.
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Pozzi G, Falcone A, Sabbatino F, Solej M, Nano M. "Fast track surgery" in the north-west of Italy: influence on the orientation of surgical practice. Updates Surg 2012; 64:131-44. [PMID: 22527810 DOI: 10.1007/s13304-012-0154-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 03/30/2012] [Indexed: 01/24/2023]
Abstract
Fast track surgery is a peri-operative management model, including different strategies to improve patients' convalescence, avoid metabolic alterations, reduce complications, and shorten hospital stay. Prerequisite is coordination between different practitioners (surgeon, anaesthetist, nurse, nutritionist, physiotherapist). The purpose of our investigation is to understand the level of fast track surgery application in Piedmont and to evidence analogies and differences among departments. We projected an investigation proposing, to every surgery department in Piedmont, a multiple-choice questionnaire evaluating the level of fast track surgery peri-operative interventions' application. Data analysis was conducted in two points of view: the transversal one with an overview of answer's percentages, the longitudinal one correlating data through Pearson's index (r). We collected answers by 78 % of balloted departments (38 on 49). Transversal analysis, including the evaluation of percentages of each question, shows that intra-operative period is the most influenced by fast track principles, and that only 12 departments of 38 apply complete protocols. Longitudinal analysis, estimating the whole of each department's answers, demonstrates the absence of statistical significance in the correlation between fast track surgery application and territorial (r = 0.18), economic (r = 0.31), or age (r = 0.06) variables. Influence of fast track surgery is significantly present in our territory, even though it is not fully concretized in protocols. The choice of fast track depends on the instruction, the environment and the sensibility of each surgeon. Knowledge of geographic distribution of departments applying this model can be useful to organize common protocols, starting from more experienced hospitals.
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Affiliation(s)
- G Pozzi
- Clinical and Biological Department, University of Turin, Orbassano, Turin, Italy.
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Geiger TM, MacKay G, Ricciardi R. Outcomes of Fast-Track Pathways for Open and Laparoscopic Surgery. SEMINARS IN COLON AND RECTAL SURGERY 2010. [DOI: 10.1053/j.scrs.2010.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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10
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The impact and safety of preoperative oral or intravenous carbohydrate administration versus fasting in colorectal surgery--a randomized controlled trial. Wien Klin Wochenschr 2010; 122:23-30. [PMID: 20177856 DOI: 10.1007/s00508-009-1291-7] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2008] [Accepted: 10/16/2009] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS Increasing evidence suggests that preoperative fasting, as was the clinical practice for many decades, might be associated with untoward consequences and that a standardized preoperative intake of nutrients might be advantageous; this is a component of the enhanced recovery after surgery (ERAS) concept. Thus, in a randomized controlled trial we compared preoperative fasting with preoperative preparation with either oral or intravenous intake of carbohydrates, minerals and water. Biochemical, psychosomatic, echocardiographic and muscle-power parameters were assessed in surgical patients with colorectal diseases during the short-term perioperative period. We also assessed the safety of peroral intake shortly before surgery. METHODS A total of 221 elective colorectal surgery patients in this bicentric, randomized, prospective and blinded clinical trial were divided into three groups: A - patients fasting from midnight (control group); B - patients supported preoperatively by glucose, magnesium and potassium administered intravenously; C - patients supported preoperatively by oral consumption of a specifically composed solution (potion). RESULTS The general perioperative clinical status of patients in groups C and B was significantly better than those in group A. Psychosomatic conditions postoperatively were found to be best in group C (P < 0.029). The rise in the index of insulin resistance (QUICKI) from the preoperative to the postoperative state was significant in group A (P < 0.05). The systolic and diastolic function of the left ventricle improved postoperatively in group C vs. group A (P < 0.04), and the ejection fraction was also significantly higher postoperatively in group C vs. group A (P < 0.03). The gastric residual volume was 5 ml and the pH of stomach juice was 3.5-5 in all groups without statistically significant difference. No difference was found in the length of hospital stay or the rate of complications. CONCLUSIONS Preoperative fasting does not confer any benefit or advantage for surgical patients. In contrast, consumption of an appropriate potion composed of water, minerals and carbohydrates offers some protection against surgical trauma in terms of metabolic status, cardiac function and psychosomatic status. Peroral intake shortly before surgery did not increase gastric residual volume and was not associated with any risk.
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Parental perceptions in pediatric cardiac fast-track surgery. AORN J 2009; 89:725-31. [PMID: 19348820 DOI: 10.1016/j.aorn.2008.11.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Revised: 11/09/2008] [Accepted: 11/23/2008] [Indexed: 01/11/2023]
Abstract
This project investigated parents' and caregivers' perceptions of the fast-track surgery process with regard to their child's surgical procedure and hospital stay. The goal of this project was to review and improve the fast-track process. Participants were parents/caregivers of pediatric patients (ie, younger than 18 years) who had undergone a low-complexity cardiac surgical procedure on a fast-track basis at Great Ormond Street Hospital for Children, London, United Kingdom, between January 2006 and January 2008. Findings suggest that parents/caregivers overestimate the time it takes for several key milestones in the fast-track process to occur and that there is a need for preoperative and preadmission education that will allow parents/caregivers to be more involved in their child's care.
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MacKay G, Molloy RG, O’Dwyer PJ. Fast-Track Colorectal Surgery and Perioperative Outcomes. SEMINARS IN COLON AND RECTAL SURGERY 2008. [DOI: 10.1053/j.scrs.2008.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Frileux P, Rives B, Burdy G, Dalban-Sillas B. [Fast track rehabilitation using a multimodality protocol in colorectal surgery]. ACTA ACUST UNITED AC 2006; 30:567-73. [PMID: 16733380 DOI: 10.1016/s0399-8320(06)73229-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Abstract
Many initiatives have been introduced in the past decades to standardize and improve clinical perioperative care and thereby improve patient care. Clinical pathways (also known as integrated care pathways, critical pathways, critical paths, care paths) are structured multidisciplinary care plans that detail essential steps in the care of patients with a specific clinical problem. They are designed to support the implementation and translation of national guidelines into local protocols and their subsequent application to clinical practice. In surgery, clinical pathways are standardized protocols for the management of patients who have common conditions undergoing common surgical procedures.
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Affiliation(s)
- Lena M Napolitano
- University of Michigan School of Medicine, Ann Arbor, MI 48109-0033, USA.
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