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Fan S, Liu H, Zhu Y, Zheng Z, Cui Q. Effect of fast-track surgery on postoperative wound pain in patients with prostate cancer: A meta-analysis. Int Wound J 2023; 21:e14417. [PMID: 37737032 PMCID: PMC10824699 DOI: 10.1111/iwj.14417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 09/23/2023] Open
Abstract
Fast track surgery (FTS) is widely used in many procedures and has been shown to reduce complications and accelerate recovery. However, no studies have been conducted to assess their effectiveness in treating wounds after radical prostatectomy (RP). The objective of this study was to evaluate the impact of FTS on RP. We went through 4 major databases. A study was conducted by PubMed, the Cochrane Library, Embase, and the Web of Science to determine the effect of comparison of FTS versus conventional surgery in RP on postoperative wound complications as of 1 July 2023. Based on the review of literature, data extraction and literature quality assessment, we conducted meta-analyses with RevMan 5.3. In the course of the study, the researchers selected 6 of the 404 studies to be analysed according to exclusion criteria. Data analysis showed that the FTS method reduced the postoperative pain associated with VAS and also decreased the rate of postoperative complications in post-surgical patients. However, there was no significant difference between FTS and conventional surgery in terms of blood loss, operation time, and postoperative infection rate. Therefore, generally speaking, FTS has less impact on postoperative complications in patients with minimal invasive prostatic cancer, but it does reduce postoperative pain and total postoperative complications.
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Affiliation(s)
- Shicheng Fan
- Department of UrologyThe Third People's Hospital of Yunnan ProvinceKunmingChina
| | - Haolin Liu
- Department of UrologyInstitute of Urology, West China Hospital, Sichuan UniversityChengduChina
| | - Yuanquan Zhu
- Department of UrologyThe Third People's Hospital of Yunnan ProvinceKunmingChina
| | - Zhiqiang Zheng
- Department of UrologyThe Third People's Hospital of Yunnan ProvinceKunmingChina
| | - Qingpeng Cui
- Department of UrologyThe Third People's Hospital of Yunnan ProvinceKunmingChina
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2
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Zhang M, Wang X, Chen X, Song Z, Wang Y, Zhou Y, Zhang D. A Scientometric Analysis and Visualization Discovery of Enhanced Recovery After Surgery. Front Surg 2022; 9:894083. [PMID: 36090333 PMCID: PMC9450939 DOI: 10.3389/fsurg.2022.894083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/19/2022] [Indexed: 11/30/2022] Open
Abstract
Background Enhanced recovery after surgery (ERAS), a new clinical surgical concept, has been applied in many surgical disciplines with good clinical results for the past 20 years. Bibliometric analysis is an effective method to quantitatively evaluate the academic productivity. This report aimed to perform a scientometric analysis of the ERAS research status and research hotspots. Methods Comprehensive scientific mapping analysis of a wide range of literature metadata using the scientometric tools, including the Bibliometrix R Package, Biblioshiny, and CiteSpace. Data were retrieved from the Web of Science Core Collection database of original articles from 2001 to 2020. Specific indicators and maps were analyzed to show the co-authorship, co-institute, co-country, co-citation, and international cooperation. Automatic literature screening, unsupervised cluster filtering, and topic cluster identification methods were used to display the conceptual framework and thematic evolution. Results A total of 1,403 research projects drafted by 6,966 authors and published in 413 sources were found. There was an exponential growth in the number of publications on ERAS. There were 709 collaborations between authors from different countries, and the US, China, and the UK had the greatest number of publications. The WORLD JOURNAL OF SURGERY, located in Bradford’s Law 1, had the highest number of published articles (n = 1,276; total citations = 3,193). CiteSpace network analysis revealed 15 highly correlated cluster ERAS studies, and the earliest study was on colonic surgery, and ERAS was recently applied in cardiac surgery. The etiology of ERAS is constantly evolving, with surgery and length of hospital as the main topics. Meta-analyses and perioperative care have tended to decline. Conclusion This is the first scientometric analysis of ERAS to provide descriptive quantitative indicators. This can provide a better understanding of how the field has evolved over the past 20 years, help identify research trends, and provide insights and research directions for academic researchers, policymakers, and medical practitioners who want to collaborate in these areas in the future.
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Affiliation(s)
- Mingjie Zhang
- Department of Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiaoxue Wang
- Department of Health Management, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xueting Chen
- Department of Health Management, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zixuan Song
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yuting Wang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yangzi Zhou
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Dandan Zhang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
- Correspondence: Dandan Zhang
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3
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Yu J, Lin X, Chen H. Study on the Application Effect of Fast Track Surgery Care Combined With Continuous Care After Discharge in Patients With Laparoscopic Cholecystectomy. Front Surg 2022; 9:848234. [PMID: 35265663 PMCID: PMC8898931 DOI: 10.3389/fsurg.2022.848234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To explore the application effect of fast track surgery (FTS) care combined with continuous care after discharge in patients with laparoscopic cholecystectomy (LC). Methods Two hundred patients treated with LC in our hospital from May 2020 to September 2021 were selected and divided into the routine group receiving routine care (n = 100) and the combined group receiving FTS care combined with continuous care after discharge (n = 100) according to their care methods. We observed the care effect, surgical stress levels [epinephrine, cortisol, Hamilton anxiety scale (HAMA)], postoperative recovery (time to first exhaust, time to first meal, time to first getting out of bed, time to hospitalization), complications, SF-36 scores after discharge, and care satisfaction in both groups. Results The total efficiency of care in the combined group was better than that in the routine group (P < 0.05). At 1 d after surgery, the levels of epinephrine and cortisol in both groups were significantly higher than those at 1 h before surgery, and the HAMA scores were significantly lower than those at 1 h before surgery, and the combined group was lower than the routine group (P < 0.05). The time to first exhaustion, time to first meal, time to first getting out of bed, and time to hospitalization were shorter in the combined group than in the routine group (P < 0.05). The overall complication rate in the combined group was lower than that in the routine group (P < 0.05). The each item of SF-36 scores after discharge were higher in the combined group than in the routine group (P < 0.05). The total satisfaction with care was higher in the combined group than in the routine group (P < 0.05). Conclusion The implementation of FTS care combined with continuous care after discharge in LC patients is ideal, which can significantly reduce the level of surgical stress, accelerate the recovery process, and reduce the occurrence of complications, and improve the postoperative quality of life of patients significantly, and with high satisfaction, which is worthy of application.
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4
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Steffens D, Solomon MJ, Beckenkamp PR, Koh CE, Yeo D, Sandroussi C, Hancock MJ. Individualised, targeted step count intervention following gastrointestinal cancer surgery: The Fit-4-Home randomised clinical trial. ANZ J Surg 2021; 92:703-711. [PMID: 34553480 DOI: 10.1111/ans.17212] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND To determine the effectiveness of an individualised, daily targeted step count intervention and usual care compared with usual care alone on improving surgical and patient reported outcomes. METHODS The Fit-4-Home trial was a pragmatic, randomised controlled trial conducted from April 2019 to February 2021. Patients undergoing elective surgery for liver, stomach or pancreatic cancer in two Australian hospitals were recruited. Participants were randomly allocated to receive an individualised, targeted step count intervention and usual care (intervention) or usual care alone (control). A wearable activity tracker was provided to the intervention group to monitor their daily step count target. Primary outcome was the length of stay in the gastrointestinal ward. Secondary outcomes included postoperative complication rates, discharge destination, quality of life, physical activity, pain, fatigue, distress and hospital re-admission within 30 days. Outcome measures were compared between groups using non-parametric statistics. RESULTS Of the 96 patients recruited, 47 were randomised to the intervention group and 49 were randomised to the control group. The median (interquartile) length of stay in the ward was 7 days (5.0-13.0) in the intervention group and 7 days (5.0- 12.0) in the control group (p = 0.330). Fatigue scores were worse in the intervention group when compared to control (p = 0.018). No other differences between groups were observed. CONCLUSIONS An individualised, daily targeted step count intervention and usual care did not confer additional benefits in reducing the length of stay in the ward compared to usual care alone for patients undergoing gastrointestinal cancer surgery. TRIAL REGISTRATION Registered with the Australia and New Zealand Clinical Trials Registry (ACTRN12619000194167).
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Affiliation(s)
- Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, Australia.,Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia
| | - Michael J Solomon
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, Australia.,Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia.,Institiute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, Australia
| | - Paula R Beckenkamp
- Faculty of Medicine and Health, Discipline of Physiotherapy, The University of Sydney, Sydney, Australia
| | - Cherry E Koh
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, Australia.,Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia.,Institiute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, Australia
| | - David Yeo
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, Australia.,Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia.,Institiute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, Australia
| | - Charbel Sandroussi
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, Australia.,Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia.,Institiute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Mark J Hancock
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
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Tejedor A, Deiros C, García M, Vendrell M, Gómez N, Gómez E, Masdeu J. Comparison between epidural technique and mid-axillary ultrasound-guided TAP block for postoperative analgesia of laparoscopic radical prostatectomy: a quasi-randomized clinical trial. Braz J Anesthesiol 2021; 72:253-260. [PMID: 33915192 PMCID: PMC9373262 DOI: 10.1016/j.bjane.2021.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/14/2021] [Accepted: 03/19/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Our goal was to evaluate whether TAP block offers the same analgesic pain control compared to epidural technique in laparoscopic radical prostatectomy surgery through the morphine consumption in the first 48 hours. METHODS In this study, 45 patients were recruited and assigned to either TAP or epidural. The main study outcome was morphine consumption during the first 48 hours after surgery. Other data recorded were pain at rest and upon movement, technique-related complications and adverse effects, surgical and postoperative complications, length of surgery, need for rescue analgesia, postoperative nausea and vomiting, start of intake, sitting and perambulation, first flatus, and length of in-hospital stay. RESULTS From a total of 45 patients, two were excluded due to reconversion to open surgery (TAP group = 20; epidural group = 23). There were no differences in morphine consumption (0.96 vs. 0.8 mg; p = 0.78); mean postoperative VAS pain scores at rest (0.7 vs. 0.5; p = 0.72); or upon movement (1.6 vs. 1.6; p = 0.32); in the TAP vs. epidural group, respectively. Sitting and perambulation began sooner in TAP group (19 vs. 22 hours, p = 0.03; 23 vs. 32 hours, p = 0.01; respectively). The epidural group had more technique-related adverse effects. CONCLUSION TAP blocks provide the same analgesic quality with optimal pain control than epidural technique, with less adverse effects.
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Affiliation(s)
- Ana Tejedor
- Hospital Sant Joan Despí Moisès Broggi, Departamento de Anestesiología, Barcelona, Spain.
| | - Carme Deiros
- Hospital Sant Joan Despí Moisès Broggi, Departamento de Anestesiología, Barcelona, Spain
| | - Marta García
- Hospital Sant Joan Despí Moisès Broggi, Departamento de Anestesiología, Barcelona, Spain
| | - Marina Vendrell
- Hospital Clínic de Barcelona, Departamento de Anestesiología, Barcelona, Spain
| | - Nuria Gómez
- Hospital Sant Joan Despí Moisès Broggi, Servicio de Enfermería, Barcelona, Spain
| | - Esther Gómez
- Hospital Sant Joan Despí Moisès Broggi, Departamento de Urología, Barcelona, Spain
| | - Josep Masdeu
- Hospital Sant Joan Despí Moisès Broggi, Departamento de Anestesiología, Barcelona, Spain
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6
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Xu Y, Liu A, Chen L, Huang H, Gao Y, Zhang C, Xu Y, Huang D, Xu D, Zhang M. Enhanced recovery after surgery (ERAS) pathway optimizes outcomes and costs for minimally invasive radical prostatectomy. J Int Med Res 2021; 48:300060520920072. [PMID: 32485118 PMCID: PMC7273798 DOI: 10.1177/0300060520920072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective To evaluate the impact of an enhanced recovery after surgery (ERAS) pathway
on patients undergoing minimally invasive radical prostatectomy at a single
institute. Methods In this retrospective study, 301 patients who underwent laparoscopic or
robot-assisted laparoscopic radical prostatectomy from May 2014 to September
2018 were consecutively recruited. Before April 2017, the patients were
treated with conventional care; all patients were treated with the ERAS
pathway thereafter. The primary outcome was the postoperative length of
hospital stay (LOS). The secondary outcomes were hospitalization costs and
postoperative complications. Results In total, 138 patients were treated with the ERAS pathway, and the remaining
patients underwent conventional care. The postoperative LOS was
significantly shorter in the ERAS group than in the conventional group
(median, 6 vs. 8 days). The hospitalization costs were also significantly
lower in the ERAS group ($4086 vs. $5530). Ten (6.1%) patients in the ERAS
group and 17 (12.3%) patients in the conventional group developed
postoperative complications. The multivariable analysis showed that ERAS
care was a significant independent predictive factor for a shortened LOS and
reduced hospitalization costs. Conclusions The ERAS pathway was associated with a shortened LOS and reduced
hospitalization costs for patients undergoing minimally invasive radical
prostatectomy.
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Affiliation(s)
- Ying Xu
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ao Liu
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lu Chen
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hai Huang
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Gao
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chuanjie Zhang
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yang Xu
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Da Huang
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Danfeng Xu
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Zhang
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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7
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Lv Z, Cai Y, Jiang H, Yang C, Tang C, Xu H, Li Z, Fan B, Li Y. Impact of enhanced recovery after surgery or fast track surgery pathways in minimally invasive radical prostatectomy: a systematic review and meta-analysis. Transl Androl Urol 2020; 9:1037-1052. [PMID: 32676388 PMCID: PMC7354299 DOI: 10.21037/tau-19-884] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background The enhanced recovery after surgery (ERAS) and fast track surgery (FTS) protocols have been applied to a variety of surgeries and have been proven to reduce complications, accelerate rehabilitation, and reduce medical costs. However, the effectiveness of these protocols in minimally invasive radical prostatectomy (miRP) is still unclear. Thus, this study aimed to evaluate the impact of ERAS and FTS protocols in miRP. Methods We searched PubMed, Cochrane Library, Embase, and Web of Science databases to collect randomized and observational studies comparing ERAS/FTS versus conventional care in miRP up to July 1, 2019. After screening for inclusion, data extraction, and quality assessment by two independent reviewers, the meta-analysis was performed with the RevMan 5.3 and STATA 15.1 software. Results were expressed as risk ratio (RR) and weighted mean difference (WMD) with 95% confidence intervals (CIs). Results In total, 11 studies involving 1,207 patients were included. Pooled data showed that ERAS/FTS was associated with a significant reduction in length of stay (LOS) (WMD: -2.41 days, 95% CI: -4.00 to -0.82 days, P=0.003), time to first anus exhaust (WMD: -0.74 days, 95% CI: -1.14 to -0.34 days, P=0.0003), and lower incidence of postoperative complications (RR: 0.70, 95% CI: 0.53 to 0.92, P=0.01). No significant differences were found between groups for operation time, estimated blood loss, postoperative pain, blood transfusion rate, and readmission rate (P>0.01). Conclusions Our meta-analysis suggests that the ERAS/FTS protocol is safe and effective in miRP. However, more extensive, long-term, prospective, multicenter follow-up studies, and randomized controlled trials (RCTs) are required to validate our findings.
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Affiliation(s)
- Zhengtong Lv
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yi Cai
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Huichuan Jiang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Changzhao Yang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Congyi Tang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Haozhe Xu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Zhi Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Benyi Fan
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yuan Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Abstract
PurposeThe reduction of costs has a more and more relevant role in the healthcare context, therefore, a large effort is done by health providers to this aim, for example, by reducing the length of hospital stay (LOS) of patients undergoing surgery. Fast track surgery fits perfectly this issue and was applied to patients undergoing knee replacement surgery due to Osteoarthritis, one of the most common diseases of aged population. The paper aims to discuss these issues.Design/methodology/approachLean six sigma was applied to analyze the implementation of fast track surgery through the define, measure, analyze, improve, control roadmap, used as a typical problem-solving approach. It is characterized by five operational phases, which make possible the achievement of fixed goals through a rigorous process of defining, measuring, analyzing, improving and controlling business problems.FindingsThe corrective action, consisting in the application of fast track surgery, improved both effectiveness and efficiency of the process of care. The average length of hospital stay (LOS) was reduced from 8.34 to 6.68 days (–19.9 percent) and its standard deviation from 2.41 to 1.99 days (–17.1 percent). The statistical significance of this decrease was verified by means of proper tests. Moreover, some variables influencing the LOS were identified.Research limitations/implicationsThe follow up and the satisfaction of patients were not analyzed and could be a future development of this study.Practical implicationsPatients will experience a faster recovery while the hospital will benefit from a rise of available beds. The effect is a general improvement of hospital management.Originality/valueThe introduction of fast track surgery for patients undergoing knee replacement surgery made significantly reduce LOS and, consequently, costs’ with a money saving of more than 50,000 euro per year.
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9
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Nunns M, Shaw L, Briscoe S, Thompson Coon J, Hemsley A, McGrath JS, Lovegrove CJ, Thomas D, Anderson R. Multicomponent hospital-led interventions to reduce hospital stay for older adults following elective surgery: a systematic review. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07400] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BackgroundElective older adult inpatient admissions are increasingly common. Older adults are at an elevated risk of adverse events in hospital, potentially increasing with lengthier hospital stay. Hospital-led organisational strategies may optimise hospital stay for elective older adult inpatients.ObjectivesTo evaluate the effectiveness and cost-effectiveness of hospital-led multicomponent interventions to reduce hospital stay for older adults undergoing elective hospital admissions.Data sourcesSeven bibliographic databases (MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, Health Management Information Consortium, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature and Allied and Complementary Medicine Database) were searched from inception to date of search (August 2017), alongside carrying out of web searches, citation searching, inspecting relevant reviews, consulting stakeholders and contacting authors. This search was duplicated, with an additional cost-filter, to identify cost-effectiveness evidence.Review methodsComparative studies were sought that evaluated the effectiveness or cost-effectiveness of relevant interventions in elective inpatients with a mean or median age of ≥ 60 years. Study selection, data extraction and quality assessment were completed independently by two reviewers. The main outcome was length of stay, but all outcomes were considered. Studies were sorted by procedure, intervention and outcome categories. Where possible, standardised mean differences or odds ratios were calculated. Meta-analysis was performed when multiple randomised controlled trials had the same intervention, treatment procedure, comparator and outcome. Findings were explored using narrative synthesis.FindingsA total of 218 articles were included, with 80 articles from 73 effectiveness studies (n = 26,365 patients) prioritised for synthesis, including 34 randomised controlled trials conducted outside the UK and 39 studies from the UK, of which 12 were randomised controlled trials. Fifteen studies included cost-effectiveness data. The evidence was dominated by enhanced recovery protocols and prehabilitation, implemented to improve recovery from either colorectal surgery or lower limb arthroplasty. Six other surgical categories and four other intervention types were identified. Meta-analysis found that enhanced recovery protocols were associated with 1.5 days’ reduction in hospital stay among patients undergoing colorectal surgery (Cohen’sd = –0.51, 95% confidence interval –0.78 to –0.24;p < 0.001) and with 5 days’ reduction among those undergoing upper abdominal surgery (Cohen’sd = –1.04, 95% confidence interval –1.55 to –0.53;p < 0.001). Evidence from the UK was not pooled (owing to mixed study designs), but it echoed findings from the international literature. Length of stay usually was reduced with intervention or was no different. Other clinical outcomes also improved or were no worse with intervention. Patient-reported outcomes were not frequently reported. Cost and cost-effectiveness evidence came from 15 highly heterogeneous studies and was less conclusive.LimitationsStudies were usually of moderate or weak quality. Some intervention or treatment types were under-reported or absent. The reporting of variance data often precluded secondary analysis.ConclusionsEnhanced recovery and prehabilitation interventions were associated with reduced hospital stay without detriment to other clinical outcomes, particularly for patients undergoing colorectal surgery, lower limb arthroplasty or upper abdominal surgery. The impacts on patient-reported outcomes, health-care costs or additional service use are not well known.Future workFurther studies evaluating of the effectiveness of new enhanced recovery pathways are not required in colorectal surgery or lower limb arthroplasty. However, the applicability of these pathways to other procedures is uncertain. Future studies should evaluate the implementation of interventions to reduce service variation, in-hospital patient-reported outcomes, impacts on health and social care service use, and longer-term patient-reported outcomes.Study registrationThis study is registered as PROSPERO CRD42017080637.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Michael Nunns
- Exeter Health Services and Delivery Research Evidence Synthesis Centre, Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Liz Shaw
- Exeter Health Services and Delivery Research Evidence Synthesis Centre, Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Simon Briscoe
- Exeter Health Services and Delivery Research Evidence Synthesis Centre, Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Jo Thompson Coon
- Exeter Health Services and Delivery Research Evidence Synthesis Centre, Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Anthony Hemsley
- Department of Healthcare for Older People, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - John S McGrath
- Exeter Health Services and Delivery Research Evidence Synthesis Centre, Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
- Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Christopher J Lovegrove
- Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
- School of Health Professions, Faculty of Health & Human Sciences, University of Plymouth, Plymouth, UK
| | - David Thomas
- Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Rob Anderson
- Exeter Health Services and Delivery Research Evidence Synthesis Centre, Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK
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10
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Expérience de la prostatectomie totale robot-assistée ambulatoire. À propos de 32 cas. Prog Urol 2019; 29:619-626. [DOI: 10.1016/j.purol.2019.08.260] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 07/21/2019] [Accepted: 08/06/2019] [Indexed: 11/24/2022]
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11
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Debono B, Corniola MV, Pietton R, Sabatier P, Hamel O, Tessitore E. Benefits of Enhanced Recovery After Surgery for fusion in degenerative spine surgery: impact on outcome, length of stay, and patient satisfaction. Neurosurg Focus 2019; 46:E6. [DOI: 10.3171/2019.1.focus18669] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 01/17/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVEEnhanced Recovery After Surgery (ERAS) proposes a multimodal, evidence-based approach to perioperative care. Thanks to the improvement in care protocols and the fluidity of the patient pathway, the first goal of ERAS is the improvement of surgical outcomes and patient experience, with a final impact on a reduction in the hospital length of stay (LOS). The implementation of ERAS in spinal surgery is in the early stages. The authors report on their initial experience in applying an ERAS program to several degenerative spinal fusion procedures.METHODSThe authors selected two 2-year periods: the first from before any implementation of ERAS principles (pre-ERAS years 2012–2013) and the second corresponding to a period when the paradigm was applied widely (post-ERAS years 2016–2017). Patient groups in these periods were retrospectively compared according to three degenerative conditions requiring fusion: anterior cervical discectomy and fusion (ACDF), anterior lumbar interbody fusion (ALIF), and posterior lumbar fusion. Data were collected on patient demographics, operative and perioperative data, LOSs, 90-day readmissions, and morbidity. ERAS-trained nurses were involved to support patients at each pre-, intra-, and postoperative step with the help of a mobile application (app). A satisfaction survey was included in the app.RESULTSThe pre-ERAS group included 1563 patients (159 ALIF, 749 ACDF, and 655 posterior fusion), and the post-ERAS group included 1920 patients (202 ALIF, 612 ACDF, and 1106 posterior fusion). The mean LOS was significantly shorter in the post-ERAS group than in the pre-ERAS group for all three conditions. It was reduced from 6.06 ± 1.1 to 3.33 ± 0.8 days for the ALIF group (p < 0.001), from 3.08 ± 0.9 to 1.3 ± 0.7 days for the ACDF group (p < 0.001), and from 6.7 ± 4.8 to 4.8 ± 2.3 days for posterior fusion cases (p < 0.001). There was no significant difference in overall complications between the two periods for the ALIF (11.9% pre-ERAS vs 11.4% post-ERAS, p = 0.86) and ACDF (6.0% vs 8.2%, p = 0.12) cases, but they decreased significantly for lumbar fusions (14.8% vs 10.9%, p = 0.02). Regarding satisfaction with overall care among 808 available responses, 699 patients (86.5%) were satisfied or very satisfied, and regarding appreciation of the mobile e-health app in the perceived optimization of care management, 665 patients (82.3%) were satisfied or very satisfied.CONCLUSIONSThe introduction of the ERAS approach at the authors’ institution for spinal fusion for three studied conditions resulted in a significant decrease in LOS without causing increased postoperative complications. Patient satisfaction with overall management, upstream organization of hospitalization, and the use of e-health was high. According to the study results, which are consistent with those in other studies, the whole concept of ERAS (primarily reducing complications and pain, and then reducing LOS) seems applicable to spinal surgery.
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Affiliation(s)
- Bertrand Debono
- 1Department of Neurosurgery, CAPIO-Clinique des Cèdres, Cornebarrieu, France; and
| | - Marco V. Corniola
- 2Department of Neurosurgery, Spine Unit, Geneva University Hospitals, Geneva, Switzerland
| | - Raphael Pietton
- 1Department of Neurosurgery, CAPIO-Clinique des Cèdres, Cornebarrieu, France; and
| | - Pascal Sabatier
- 1Department of Neurosurgery, CAPIO-Clinique des Cèdres, Cornebarrieu, France; and
| | - Olivier Hamel
- 1Department of Neurosurgery, CAPIO-Clinique des Cèdres, Cornebarrieu, France; and
| | - Enrico Tessitore
- 2Department of Neurosurgery, Spine Unit, Geneva University Hospitals, Geneva, Switzerland
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Reynolds BR, Bulsara C, Zeps N, Codde J, Lawrentschuk N, Bolton D, Vivian J. Exploring pathways towards improving patient experience of robot-assisted radical prostatectomy (RARP): assessing patient satisfaction and attitudes. BJU Int 2019; 121 Suppl 3:33-39. [PMID: 29603580 DOI: 10.1111/bju.14226] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To determine patient satisfaction and experience after robot-assisted radical prostatectomy (RARP) for prostate cancer, using a convergent mixed-method qualitative analysis approach. PATIENTS AND METHODS 412 patients who underwent RARP between January 2014 and June 2016 were mailed questionnaires and invited to participate in focus groups. Qualitative data was thematically analysed using NVivo. Descriptive statistics were obtained from the questionnaire using SPSS. RESULTS 214 patients responded (52% of sample size) of whom 97.6% were satisfied and 91.1% would likely recommend RARP. Key themes from the qualitative data highlighted the psychosocial impacts of the diagnosis and RARP process. The importance of early recovery, the benefits of pelvic floor exercises and educational resources were emphasised. CONCLUSION Patients were overwhelmingly satisfied with RARP, largely due to relevance and timeliness of the information and support provided both before and after surgery. With an increased understanding of the factors and outcomes that are most important to patients regarding all aspects of hospital care, we can create more targeted care pathways. Key themes will help inform the implementation of an enhanced recovery after surgery (ERAS) protocol to further improve recovery and early return to function.
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Affiliation(s)
- Bradley R Reynolds
- School of Medicine, University of Notre Dame Fremantle, Fremantle, WA, Australia.,Department of Medical Research, St John of God Subiaco Hospital, Subiaco, WA, Australia
| | - Caroline Bulsara
- Institute for Health Research, University of Notre Dame Fremantle, Fremantle, WA, Australia
| | - Nik Zeps
- School of Medicine, University of Notre Dame Fremantle, Fremantle, WA, Australia.,Department of Medical Research, St John of God Subiaco Hospital, Subiaco, WA, Australia
| | - Jim Codde
- Institute for Health Research, University of Notre Dame Fremantle, Fremantle, WA, Australia
| | | | - Damien Bolton
- Department of Urology, Austin Health, Melbourne, Vic., Australia
| | - Justin Vivian
- Department of Urology, St John of God Subiaco Hospital, Subiaco, WA, Australia
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Li Z, Zhao Q, Bai B, Ji G, Liu Y. Enhanced Recovery After Surgery Programs for Laparoscopic Abdominal Surgery: A Systematic Review and Meta-analysis. World J Surg 2018; 42:3463-3473. [PMID: 29750324 DOI: 10.1007/s00268-018-4656-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) protocols or laparoscopic technique has been applied in various surgical procedures. However, the clinical efficacy of combination of the two methods still remains unclear. Thus, our aim was to assess the role of ERAS protocols in laparoscopic abdominal surgery. METHODS We performed a systematic literature search in various databases from January 1990 to October 2017. The results were analyzed according to predefined criteria. RESULTS In the present meta-analysis, the outcomes of 34 comparative studies (15 randomized controlled studies and 19 non-randomized controlled studies) enrolling 3615 patients (1749 in the ERAS group and 1866 in the control group) were pooled. ERAS group was associated with shorter hospital stay (WMD - 2.37 days; 95% CI - 3.00 to - 1.73; P 0.000) and earlier time to first flatus (WMD - 0.63 days; 95% CI - 0.90 to - 0.36; P 0.000). Meanwhile, lower overall postoperative complication rate (OR 0.62; 95% CI 0.51-0.76; P 0.000) and less hospital cost (WMD 801.52 US dollar; 95% CI - 918.15 to - 684.89; P 0.000) were observed in ERAS group. Similar readmission rate (OR 0.73, 95% CI 0.52-1.03, P 0.070) and perioperative mortality (OR 1.33; 95% CI 0.53-3.34; P 0.549) were found between the two groups. CONCLUSIONS ERAS protocol for laparoscopic abdominal surgery is safe and effective. ERAS combined with laparoscopic technique is associated with faster postoperative recovery without increasing readmission rate and perioperative mortality.
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Affiliation(s)
- Zhengyan Li
- Department of Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, No. 127 Changle West Road, Xian, 710032, China.
| | - Qingchuan Zhao
- Department of Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, No. 127 Changle West Road, Xian, 710032, China.
| | - Bin Bai
- Department of Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, No. 127 Changle West Road, Xian, 710032, China
| | - Gang Ji
- Department of Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, No. 127 Changle West Road, Xian, 710032, China
| | - Yezhou Liu
- Department of Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, No. 127 Changle West Road, Xian, 710032, China
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Comparison of Fast-Track Versus Conventional Surgery Protocol for Patients Undergoing Robot-Assisted Laparoscopic Radical Prostatectomy: A Chinese Experience. Sci Rep 2018; 8:8017. [PMID: 29789672 PMCID: PMC5964157 DOI: 10.1038/s41598-018-26372-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 05/11/2018] [Indexed: 12/11/2022] Open
Abstract
Fast-track surgery (FTS), which includes a series of evidence-based adjustments, is expected to reduce complications, relieve surgical stress reaction, accelerate recovery, and shorten hospitalization, as well as improve safety. The aim of this study was to critically evaluate the safety and effectiveness of FTS in Chinese prostate cancer (Pca) patients who underwent robot-assisted laparoscopic prostatectomy (RALP). A retrospective analysis was performed on 73 consecutive Chinese Pca patients who underwent RALP and who were divided into two groups: conventional surgery (CS) and FTS. Preoperative clinical data, intraoperative characteristics, postoperative outcomes and incidence of complications were compared between the two groups. No significant differences in preoperative parameters were observed between the two groups. Compared with the CS group, the FTS group showed a significantly shorter time to first flatus, time to regular diet, postoperative hospitalization time, lower incidence of complications, and lower reactions of postoperative stress and pain. Our study demonstrates that FTS is feasible and safe for Chinese Pca patients undergoing RALP and that it accelerates recovery, attenuates surgical stress response, and reduces morbidity compared to CS.
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Vukovic N, Dinic L. Enhanced Recovery After Surgery Protocols in Major Urologic Surgery. Front Med (Lausanne) 2018; 5:93. [PMID: 29686989 PMCID: PMC5900414 DOI: 10.3389/fmed.2018.00093] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 03/23/2018] [Indexed: 01/31/2023] Open
Abstract
The purpose of the review The analysis of the components of enhanced recovery after surgery (ERAS) protocols in urologic surgery. Recent findings ERAS protocols has been studied for over 20 years in different surgical procedures, mostly in colorectal surgery. The concept of improving patient care and reducing postoperative complications was also applied to major urologic surgery and especially procedure of radical cystectomy. This procedure is technically challenging, due to a major surgical resection and high postoperative complication rate that may reach 65%. Several clinical pathways were introduced to improve perioperative course and reduce the length of hospital stay. These protocols differ from ERAS modalities in other surgeries. The reasons for this are longer operative time, increased risk of perioperative transfusion and infection, and urinary diversion achieved using transposed intestinal segments. Previous studies in this area analyzed the need for mechanical bowel preparation, postoperative nasogastric tube decompression, as well as the duration of urinary drainage. Furthermore, the attention has also been drawn to perioperative fluid optimization, pain management, and bowel function. Summary Notwithstanding partial resemblance between the pathways in major urologic surgery and other pelvic surgeries, there are still scarce guidelines for ERAS protocols in urology, which is why further studies should assess the importance of preoperative medical optimization, implementation of thoracic epidural anesthesia and analgesia, and perioperative nutritional management.
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Affiliation(s)
- Natalija Vukovic
- Anesthesiology and Reanimation Center, Clinical Center Nis, Nis, Serbia
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Enhanced Recovery After Surgery for Noncolorectal Surgery?: A Systematic Review and Meta-analysis of Major Abdominal Surgery. Ann Surg 2017; 267:57-65. [PMID: 28437313 DOI: 10.1097/sla.0000000000002267] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the impact of enhanced recovery after surgery (ERAS) protocols across noncolorectal abdominal surgical procedures. BACKGROUND ERAS programs have been studied extensively in colorectal surgery and adopted at many centers. Several studies testing such protocols have shown promising results in improving postoperative outcomes across various surgical procedures. However, surgeons performing major abdominal procedures have been slower to adopt these ERAS protocols. METHODS A systematic review was performed using "enhanced recovery after surgery" or "fast track" as search terms and excluded studies of colorectal procedures. Primary endpoints for the meta-analysis include length of stay (LOS) and complication rate. Secondary endpoints were time to first flatus, readmission rate, and costs. RESULTS A total of 39 studies (6511 patients) met inclusion and exclusion criteria. Among them 14 studies were randomized trials, and the remaining 25 studies were cohort studies. Meta-analysis showed a decrease in LOS of 2.5 days (95% confidence interval, CI: 1.8-3.2, P < 0.001) and a complication rate of 0.70 (95% CI: 0.56-0.86, P = 0.001) for patient treated in ERAS programs. There was also a significant reduction in time to first flatus of 0.8 days (95% CI: 0.4-1.1, P < 0.001) and cost reduction of $5109.10 (95% CI: $4365.80-$5852.40, P < 0.001). There was no significant increase in readmission rate (OR 1.03, 95% CI: 0.84-1.26, P = 0.80) in our analysis. CONCLUSIONS ERAS protocols decreased length of stay and cost by not increasing complications or readmission rates. This study adds to the evidence that ERAS protocols are safe to implement and are beneficial to surgical patients and the healthcare system across multiple abdominal procedures.
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Ding J, Sun B, Song P, Liu S, Chen H, Feng M, Guan W. The application of enhanced recovery after surgery (ERAS)/fast-track surgery in gastrectomy for gastric cancer: a systematic review and meta-analysis. Oncotarget 2017; 8:75699-75711. [PMID: 29088903 PMCID: PMC5650458 DOI: 10.18632/oncotarget.18581] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 03/10/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The study aimed to compare the safety and effectiveness of Enhanced recovery after surgery (ERAS) with conventional care in gastrectomy for gastric cancer. METHODS Search strategy from Pubmed, Embase, Web of science, Cochrane library and reference lists was performed. The collected studies were randomized controlled trials and published only in English, and undergoing ERAS in gastrectomy for gastric cancer from January 1994 to August 2016. RESULTS A total of eight studies including 801 patients were included. There were 399 cases in the ERAS and 402 cases in the conventional care groups. Meta-analysis showed that time to first passage of flatus (weighted mean difference (WMD) -14.57; 95% confidence interval (CI) -20.31 to -8.83, p<0.00001), level of C-reaction protein (WMD -19.46; 95 % CI -21.74 to -17.18, p<0.00001) and interleukin-6 (WMD-32.16; 95 % CI -33.86 to -30.46,p<0.00001) on postoperative days, postoperative hospital stay (WMD -1.85; 95 % CI -2.35 to -1.35, p<0.00001), hospital charge (WMD -0.94, 95 % CI, -1.40 to 0.49, p<0.0001) were significantly decreased for ERAS, but increased readmission rates (odds ratio (OR), 3.42, 95 % CI, 1.43 to 8.21, P=0.006). There were no statistically significant differences in intraoperative blood loss, operation time, number of retrieved lymph nodes, duration of foley catheter and postoperative complications (p>0.05). CONCLUSIONS ERAS is considered to be safe and effective in gastrectomy for gastric cancer. Further larger, multicenter and randomized trials were needed to beresearched.
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Affiliation(s)
- Jie Ding
- Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008 China
| | - Benlong Sun
- Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008 China
| | - Peng Song
- Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008 China
| | - Song Liu
- Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008 China
| | - Hong Chen
- Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008 China
| | - Min Feng
- Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008 China
| | - Wenxian Guan
- Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008 China
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Enhanced recovery after urologic surgery-Current applications and future directions. J Surg Oncol 2017; 116:630-637. [DOI: 10.1002/jso.24821] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 08/07/2017] [Indexed: 12/20/2022]
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Impact of Enhanced Recovery After Surgery and Fast Track Surgery Pathways on Healthcare-associated Infections. Ann Surg 2017; 265:68-79. [DOI: 10.1097/sla.0000000000001703] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Cascales-Campos P, Sánchez-Fuentes P, Gil J, Gil E, López-López V, Rodriguez Gomez-Hidalgo N, Fuentes D, Parrilla P. Effectiveness and failures of a fast track protocol after cytoreduction and hyperthermic intraoperative intraperitoneal chemotherapy in patients with peritoneal surface malignancies. Surg Oncol 2016; 25:349-354. [DOI: 10.1016/j.suronc.2016.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/03/2016] [Accepted: 08/12/2016] [Indexed: 12/27/2022]
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Lau CSM, Chamberlain RS. Enhanced Recovery After Surgery Programs Improve Patient Outcomes and Recovery: A Meta-analysis. World J Surg 2016; 41:899-913. [DOI: 10.1007/s00268-016-3807-4] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Ruffion A, de la Taille A. [The ambulatory is it future of radical prostatectomy? Probably not…]. Prog Urol 2015; 26:14-5. [PMID: 26621768 DOI: 10.1016/j.purol.2015.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 10/04/2015] [Indexed: 11/15/2022]
Affiliation(s)
- A Ruffion
- Service d'urologie, université Claude-Bernard Lyon I, centre hospitalier Lyon Sud, Hospices Civils de Lyon, 69310 Pierre-Bénite, France; Centre de recherche en cancérologie de Lyon - Inserm 1052 CNRS 5286, centre Léon-Bérard, université Lyon 1, 69373 Lyon cedex 08, France.
| | - A de la Taille
- Service d'urologie CHU Mondor, Assistante publique des Hôpitaux de Paris, Créteil, France; Inserm U955Eq07, faculté de médecine de Créteil, Créteil, France
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Meta-analysis of efficacy and safety of fast-track surgery in gastrectomy for gastric cancer. World J Surg 2015; 38:3142-51. [PMID: 25228170 DOI: 10.1007/s00268-014-2690-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Fast-track surgery (FTS) is a promising program for surgical patients and has been applied to several surgical diseases. FTS is much superior to conventional perioperative care. Our aim was to evaluate and compare the safety and efficacy of FTS and conventional perioperative care for patients undergoing gastrectomy using a systematic review. METHODS We searched the literature in PubMed, SCOPUS, and EMBASE up to November 2013. No language restriction was applied. Weighted mean differences (WMDs) and odds ratios (ORs) with their 95 % confidence intervals (CIs) were used for analysis by a fixed or a random effects model according to the heterogeneity assumption. RESULTS In the present meta-analysis, we included five randomized controlled trials and one controlled clinical trial from five studies. Compared with conventional care, FTS shortened the duration of flatus (WMD -21.08; 95 % CI -27.46 to -14.71, z = 6.48, p < 0.00001 in the open surgery group; WMD -8.20; 95 % CI -12.87 to -3.53, z = 3.44, p = 0.0006 in the laparoscopic surgery group), accelerated the decrease in C-reactive protein (WMD -15.56; 95 % CI 21.28 to 9.83, z = 5.33, p < 0.00001), shortened the postoperative stay (WMD -2.00; 95 % CI -2.69 to -1.30, z = 5.64, p < 0.00001), and reduced hospitalization costs (WMD -447.72; 95 % CI -615.92 to -279.51, z = 5.22, p < 0.00001). FTS made no significant difference in operation times (p = 0.93), intraoperative blood loss (p = 0.79), or postoperative complications (p = 0.07). CONCLUSIONS Based on current evidence, the FTS protocol was feasible for gastric cancer patients who underwent gastrectomy (distal subtotal gastrectomy, proximal subtotal gastrectomy, or radical total gastrectomy) via open or laparoscopic surgery. Larger studies are needed to validate our findings.
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Enhancing surgical performance outcomes through process-driven care: a systematic review. World J Surg 2015; 38:1362-73. [PMID: 24370544 DOI: 10.1007/s00268-013-2424-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Recent evidence has demonstrated the variability in quality of postoperative care, as measured by rates of failure to rescue (FTR). The identification of structure- and process-related factors affecting the quality of postoperative care is the first step towards understanding and improving outcomes. The aim of this review is to review current evidence for structure and process factors affecting postoperative care. METHODS A systematic review was conducted. Studies were selected that examined structure or process variables affecting FTR rates and postoperative outcomes. Quality analysis with Jadad and Newcastle-Ottawa scales was conducted and poor-quality studies were excluded. RESULTS Thirty-seven studies were included in final analysis. Of these, 23 were related to enhanced recovery protocols in seven surgical specialties. Twenty-one of these 23 studies reported decreases in length of stay. Six studies also reported decreases in morbidity. No studies reported increases in stay duration or morbidity. Of the 16 studies that examined other structural and process factors, the strongest evidence was for the association between nursing ratios and FTR rates. The effects of hospital size, resources, and subspecialist care processes were less clear. CONCLUSION Process-led care represents a clear, evidence-based approach that can be integrated on a local scale, without necessitating major structural or organisational change, to improve outcomes and may also be cost effective. To foster success, process improvement must be driven on a local level and backed up by appropriate understanding, education, and multidisciplinary involvement.
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Abou-Haidar H, Abourbih S, Braganza D, Qaoud TA, Lee L, Carli F, Watson D, Aprikian AG, Tanguay S, Feldman LS, Kassouf W. Enhanced recovery pathway for radical prostatectomy: Implementation and evaluation in a universal healthcare system. Can Urol Assoc J 2015; 8:418-23. [PMID: 25553155 DOI: 10.5489/cuaj.2114] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Enhanced recovery pathways are standardized, multidisciplinary, consensus-based tools that provide guidelines for evidence-based decision-making. This study evaluates the impact of the implementation of a clinical care pathway on patient outcomes following radical prostatectomy in a universal healthcare system. METHODS Medical charts of 200 patients with prostate cancer who underwent open and minimally invasive radical prostatectomy at a single academic hospital from 2009 to 2012 were reviewed. A group of 100 consecutive patients' pre-pathway implementation was compared with 99 consecutive patients' post-pathway implementation. Duration of hospital stay, complications, post-discharge emergency department visits and readmissions were compared between the 2 groups. RESULTS Length of hospital stay decreased from a median of 3 (inter-quartile range [IQR] 4 to 3 days) days in the pre-pathway group to a median of 2 (IQR 3 to 2 days) days in the post-pathway group regardless of surgical approach (p < 0.0001). Complication rates, emergency department visits and hospital readmissions were not significantly different in the pre- and post-pathway groups (17% vs. 21%, p = 0.80; 12% vs. 12%, p = 0.95; and 3% vs. 7%, p = 0.18, respectively). These findings were consistent after stratification by surgical approach. Limitations of our study include lack of assessment of patient satisfaction, and the retrospective study design. CONCLUSIONS The implementation of a standardized, multidisciplinary clinical care pathway for patients undergoing radical prostatectomy improved efficiency without increasing complication rates or hospital readmissions.
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Affiliation(s)
| | - Samuel Abourbih
- Department of Surgery (Urology), McGill University Health Centre, Montreal, QC
| | | | - Talal Al Qaoud
- Department of Surgery (Urology), McGill University Health Centre, Montreal, QC
| | - Lawrence Lee
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, Department of Surgery, McGill University Health Centre, Montreal, QC
| | - Franco Carli
- Department of Anesthesia, McGill University Health Centre, Montreal, QC
| | - Deborah Watson
- Department of Nursing, McGill University Health Centre, Montreal, QC
| | - Armen G Aprikian
- Department of Surgery (Urology), McGill University Health Centre, Montreal, QC
| | - Simon Tanguay
- Department of Surgery (Urology), McGill University Health Centre, Montreal, QC
| | - Liane S Feldman
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, Department of Surgery, McGill University Health Centre, Montreal, QC
| | - Wassim Kassouf
- Department of Surgery (Urology), McGill University Health Centre, Montreal, QC
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Guan X, Liu L, Lei X, Zu X, Li Y, Chen M, Wang L, Qi L. A comparative study of fast-track versus [corrected] conventional surgery in patients undergoing laparoscopic radical cystectomy and ileal conduit diversion: Chinese experience. Sci Rep 2014; 4:6820. [PMID: 25352195 PMCID: PMC4212226 DOI: 10.1038/srep06820] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 10/10/2014] [Indexed: 12/19/2022] Open
Abstract
Fast-track surgery (FTS), which combines various techniques with evidence-based adjustments, is aimed to reduce postoperative morbidity, attenuate surgical stress response, thereby accelerating recovery and shorting length of stay. To further investigate the effectiveness of fast-track surgery, we compared the short-term outcomes of laparoscopic radical cystectomy and ileal conduit diversion for Chinese bladder cancer patients with FTS or with CS in our hospital. Patients with bladder cancer were included and divided into two consecutive groups: CS group and FTS group. Duration to first flatus and regular diet, postoperative hospital days, hospital expense, incidence of complications and postoperative surgical stress response were compared. There was no significant difference between the two groups in age, sex, BMI and postoperative TNM classification. Compared with the CS group, the FTS group had significantly shorter duration to first flatus, time to regular diet, postoperative hospital days and hospital expense, less complications, lower white blood count (WBC) and serum of C-reactive protein (CRP) on postoperative day 5 and 7. Our study indicates that FTS program is safe and efficacious for Chinese patients undergoing laparoscopic radical cystectomy and ileal conduit diversion. It can accelerate recovery, reduce stress action, shorten postoperative hospitals days and reduce hospital expenses.
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Affiliation(s)
- Xiao Guan
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan Province, PRC China
| | - Longfei Liu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan Province, PRC China
| | - Xiang Lei
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan Province, PRC China
| | - Xiongbing Zu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan Province, PRC China
| | - Yuan Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan Province, PRC China
| | - Mingfen Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan Province, PRC China
| | - Long Wang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan Province, PRC China
| | - Lin Qi
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan Province, PRC China
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Han Y, Qu XL, Fu H. Gastric cancer surgery without nasogastric decompression. Shijie Huaren Xiaohua Zazhi 2014; 22:4075-4080. [DOI: 10.11569/wcjd.v22.i27.4075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Nasogastric decompression (ND) has been used worldwide in gastric cancer surgery as a traditional way since Hunter pioneered. Most surgeons believe that using ND in abdominal surgery could relieve the internal pressure of anastomosis and reduce the incidence of anastomotic leakage. However, there has no strict scientific evidence for this obtained from medical studies, especially prospective studies. In recent years, several studies have shown that routine use of ND after surgery could not prevent anastomotic leakage or accelerate the recovery of bowel function, and surgery without ND did not increase the risk of anastomotic leakage. All kinds of gastric cancer surgery could be performed safely without ND, which greatly reduces the suffering of the patients, accelerates postoperative recovery, and reduces the workload significantly. If patients with pyloric obstruction or bleeding receive ND before surgery, nasogastric tube could be removed after they waked up. Gastric cancer surgery without ND is safe and deserves clinical popularization. This review summarizes the safety and significance of gastric cancer surgery without ND.
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Paton F, Chambers D, Wilson P, Eastwood A, Craig D, Fox D, Jayne D, McGinnes E. Initiatives to reduce length of stay in acute hospital settings: a rapid synthesis of evidence relating to enhanced recovery programmes. HEALTH SERVICES AND DELIVERY RESEARCH 2014. [DOI: 10.3310/hsdr02210] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BackgroundThere has been growing interest in the NHS over recent years in the use of enhanced recovery programmes for elective surgery to deliver productivity gains through reduced length of stay, fewer postoperative complications, reduced readmissions and improved patient outcomes.ObjectivesTo evaluate the clinical effectiveness and cost-effectiveness of enhanced recovery programmes for patients undergoing elective surgery in acute hospital settings. To identify and critically describe key factors associated with successful adoption, implementation and sustainability of enhanced recovery programmes in UK settings. To summarise existing knowledge about patient experience of enhanced recovery programmes in UK settings.Data sourcesEight databases, including Database of Abstracts of Reviews and Effects, International Prospective of Systematic Reviews, NHS Economic Evaluation Database and MEDLINE, were searched from 1990 to March 2013 without language restrictions. Relevant reports and guidelines and reference lists of retrieved articles were scanned to identify additional studies.Review methodsSystematic reviews, randomised controlled trials (RCTs), economic evaluations, and UK NHS cost analysis studies were included if they evaluated the impact of enhanced recovery programmes on any health- and cost-related outcomes. Eligible studies included patients undergoing elective surgery in an acute hospital setting. Implementation case studies and surveys of patient experience in a UK setting were also eligible for inclusion. Quality assessment of systematic reviews, RCTs and economic evaluations was based on existing Centre for Reviews and Dissemination processes. All stages of the review process were performed by one researcher and checked by a second with discrepancies resolved by consensus. The type and range of evidence precluded meta-analysis and we therefore performed a narrative synthesis, differentiating between clinical effectiveness and cost-effectiveness, implementation case studies and evidence on patient experience.ResultsSeventeen systematic reviews of varying quality were included in this report. Twelve additional RCTs were included; all were considered at high risk of bias. Most of the evidence focused on colorectal surgery. Fourteen innovation case studies and 15 implementation case studies undertaken in NHS settings were identified and provide descriptions of factors critical to the success of an enhanced recovery programme. Ten relevant economic evaluations were identified evaluating costs and outcomes over short time horizons. Despite the plethora of studies, robust evidence was sparse. Evidence for colorectal surgery suggests that enhanced recovery programmes may reduce hospital stays by 0.5–3.5 days compared with conventional care. There were no significant differences in reported readmission rates. Other surgical specialties showed greater variation in reported reductions in length of stay reflecting the limited evidence identified.LimitationsFindings relating to other clinical outcomes, cost-effectiveness, implementation and patient experience were hampered by a lack of robust evidence and poor reporting.ConclusionsThere is consistent, albeit limited, evidence that enhanced recovery programmes may reduce length of patient hospital stay without increasing readmission rates. The extent to which managers and clinicians considering implementing enhanced recovery programmes can realise reductions and cost savings will depend on length of stays achieved under their existing care pathway. RCTs comparing an enhanced recovery programme with conventional care continue to be conducted and published. Further single-centre RCTs of this kind are not a priority. Rather, what is needed is improved collection and reporting of how enhanced recovery programmes are implemented, resourced and experienced in NHS settings.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Fiona Paton
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Duncan Chambers
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Paul Wilson
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Alison Eastwood
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Dawn Craig
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Dave Fox
- Centre for Reviews and Dissemination, University of York, York, UK
| | - David Jayne
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Carter J, Elliott S, Kaplan J, Lin M, Posselt A, Rogers S. Predictors of hospital stay following laparoscopic gastric bypass: analysis of 9,593 patients from the National Surgical Quality Improvement Program. Surg Obes Relat Dis 2014; 11:288-94. [PMID: 25443054 DOI: 10.1016/j.soard.2014.05.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 04/29/2014] [Accepted: 05/08/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Bariatric centers face pressure to reduce hospitalization to contain costs, and some centers have sought to develop "fast-track" protocols. There is limited data to identify which patients require a longer hospital stay after gastric bypass, and therefore would be inappropriate for fast tracking. The objectives of this study were to determine (1) whether most patients in the United States who underwent laparoscopic gastric bypass required>1 day of hospitalization to recover; (2) whether hospital length of stay can be predicted by factors known before or after the operation. METHODS We reviewed all laparoscopic gastric bypass operations reported to the American College of Surgeons National Surgical Quality Improvement Program in 2011. Revision and open procedures were excluded. Patient and procedural characteristics, length of stay, readmissions, and 30-day morbidity and mortality were reviewed. Predictors of longer hospitalization (defined as≥3 days) were identified by multivariate analysis. RESULTS Of 9,593 laparoscopic gastric bypass operations, median length of stay was 2 days (range 0-544) and 26% of patients required≥3 days of hospitalization. In multivariate analysis, longer hospitalization was predicted by diabetes, chronic obstructive pulmonary disease, bleeding diathesis, renal insufficiency, hypoalbuminemia, prolonged operating time, and resident involvement with the procedure, but not by patient age, sex, body mass index, and other co-morbidities. CONCLUSION Patient characteristics and operative details predict length of hospitalization after laparoscopic gastric bypass. Such data can be used to identify patients inappropriate for fast-track protocols.
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Affiliation(s)
- Jonathan Carter
- Department of Surgery, University of California-San Francisco, San Francisco, California.
| | - Steven Elliott
- Department of Surgery, University of California-San Francisco, San Francisco, California
| | - Jennifer Kaplan
- Department of Surgery, University of California-San Francisco, San Francisco, California
| | - Matthew Lin
- Department of Surgery, University of California-San Francisco, San Francisco, California
| | - Andrew Posselt
- Department of Surgery, University of California-San Francisco, San Francisco, California
| | - Stanley Rogers
- Department of Surgery, University of California-San Francisco, San Francisco, California
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Nicholson A, Lowe MC, Parker J, Lewis SR, Alderson P, Smith AF. Systematic review and meta-analysis of enhanced recovery programmes in surgical patients. Br J Surg 2014; 101:172-88. [PMID: 24469618 DOI: 10.1002/bjs.9394] [Citation(s) in RCA: 307] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2013] [Indexed: 01/30/2023]
Abstract
BACKGROUND Enhanced recovery programmes (ERPs) have been developed over the past 10 years to improve patient outcomes and to accelerate recovery after surgery. The existing literature focuses on specific specialties, mainly colorectal surgery. The aim of this review was to investigate whether the effect of ERPs on patient outcomes varies across surgical specialties or with the design of individual programmes. METHODS MEDLINE, Embase, CINAHL and the Cochrane Central Register of Controlled Trials were searched from inception to January 2013 for randomized or quasi-randomized trials comparing ERPs with standard care in adult elective surgical patients. RESULTS Thirty-eight trials were included in the review, with a total of 5099 participants. Study design and quality was poor. Meta-analyses showed that ERPs reduced the primary length of stay (standardized mean difference -1·14 (95 per cent confidence interval -1·45 to -0·85)) and reduced the risk of all complications within 30 days (risk ratio (RR) 0·71, 95 per cent c.i. 0·60 to 0·86). There was no evidence of a reduction in mortality (RR 0·69, 95 per cent c.i. 0·34 to 1·39), major complications (RR 0·95, 0·69 to 1·31) or readmission rates (RR 0·96, 0·59 to 1·58). The impact of ERPs was similar across specialties and there was no consistent evidence that elements included within ERPs affected patient outcomes. CONCLUSION ERPs are effective in reducing length of hospital stay and overall complication rates across surgical specialties. It was not possible to identify individual components that improved outcome. Qualitative synthesis may be more appropriate to investigate the determinants of success.
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Affiliation(s)
- A Nicholson
- Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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Lu G, Yan Q, Huang Y, Zhong Y, Shi P. Prevention and control system of hypokalemia in fast recovery after abdominal surgery. Curr Ther Res Clin Exp 2014; 74:68-73. [PMID: 24384576 PMCID: PMC3862196 DOI: 10.1016/j.curtheres.2013.02.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2013] [Indexed: 11/21/2022] Open
Abstract
Background Blood potassium levels were very important during perioperative management of patients undergoing abdominal surgery. According to various worldwide studies on the causes of hypokalemia and fast-track surgeries, prehospital hypokalemia was ignored. Objective The aim of this study to construct a prevention and control system of hypokalemia through proper clinical pathways and investigate the effects in terms of fast postoperative recovery of patients undergoing open abdominal surgery. Methods A total of 104 patients were randomized to an observation group or a control group. The prevention and control system of hypokalemia was constructed; it was composed of 3 major modules: blood potassium monitoring, etiologic intervention, and treatment of hypokalemia. In the observation group, blood was sampled at scheduled time points (the blood potassium monitoring module) and interventions involved the preadmission and pre- and postoperative periods (etiologic intervention module). In the control group, blood sampling was delayed until after admission (blood potassium monitoring module) and interventions were only performed during the pre- and postoperative periods (etiologic intervention module). In terms of blood potassium, indices regarding gastrointestinal motility and postoperative complications were compared. Results The severity of hypokalemia, postoperative defecation time, arrhythmia, fatigue syndrome, and urine retention differed statistically between the 2 groups (P < 0.05). The times to detect hypokalemia and resolve the blood condition before and after the surgery and at the first bowel sound, defecation and evacuation times differed significantly between the 2 groups (P < 0.01). Conclusions The prevention and control system of hypokalemia with the starting point being before admission was more effective and allows early prevention, detection, correction, surgery, and recovery of patients undergoing open abdominal surgeries and also could be used in other specialized nursing fields.
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Affiliation(s)
- Guanzhen Lu
- Affiliated Central Hospital of Huzhou Teachers College, Huzhou, Zhe Jiang Province, China
| | - Qiang Yan
- Affiliated Central Hospital of Huzhou Teachers College, Huzhou, Zhe Jiang Province, China
| | - Yutao Huang
- Affiliated Central Hospital of Huzhou Teachers College, Huzhou, Zhe Jiang Province, China
| | - Yan Zhong
- Affiliated Central Hospital of Huzhou Teachers College, Huzhou, Zhe Jiang Province, China
| | - Ping Shi
- Nursing Department, Huzhou Teachers College, Huzhou, Zhe Jiang Province, China
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Drapier E, De Poncheville L, Dannappel T, Clerc P, Smirnoff A. Prise en charge ambulatoire de la promontofixation laparoscopique pour prolapsus génital. Prog Urol 2014; 24:51-6. [DOI: 10.1016/j.purol.2013.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Revised: 06/13/2013] [Accepted: 07/03/2013] [Indexed: 11/30/2022]
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Blick C, Hadway P, Patel N, Lal S, Kelleher JP, Haldar N, Muneer A. The use of a multimodal enhanced recovery program for patients undergoing radical cystectomy. JOURNAL OF CLINICAL UROLOGY 2013. [DOI: 10.1177/2051415813480776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Radical cystectomy is a major oncological procedure, which is associated with a morbidity rate of 30% and a hospital stay of approximately 15 days. The aim of this study was to examine the effect of a multimodal enhanced recovery program on the post-operative recovery period. Patients: Forty-six patients underwent radical cystectomy for invasive or high-grade bladder cancer with curative intent at a single urology unit between June 2005 and March 2009. All patients were placed on an enhanced recovery pathway, which included a change in the surgical technique and alterations in pre-, peri- and post-operative management. The main outcome measures were length of stay, time to full diet, transfusion requirement, complications and readmission rates. Results: The median length of stay in this unit was reduced from 17 to eight days (range 6–22). There were five major complications and a readmission rate of 10.6%. Transfusion rates were not affected and there were no deaths within three months of surgery. Conclusions: We have demonstrated that this multimodal pathway, which also utilises a modification in the surgical technique, is both feasible and effective in order to improve the post-operative recovery and shorten hospital stay.
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Affiliation(s)
- C Blick
- Department of Urology, Wycombe General Hospital, UK
| | - P Hadway
- Department of Urology, Wycombe General Hospital, UK
| | - N Patel
- Department of Urology, Wycombe General Hospital, UK
| | - S Lal
- Intestinal Failure Unit, Salford Royal NHS Foundation Trust, UK
| | - JP Kelleher
- Department of Urology, Wycombe General Hospital, UK
| | - N Haldar
- Department of Urology, Wycombe General Hospital, UK
| | - A Muneer
- Department of Urology, University College London Hospitals NHS Foundation Trust, UK
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Ansari D, Gianotti L, Schröder J, Andersson R. Fast-track surgery: procedure-specific aspects and future direction. Langenbecks Arch Surg 2012; 398:29-37. [PMID: 23014834 DOI: 10.1007/s00423-012-1006-9] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 09/14/2012] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Fast-track (FT) surgery can be defined as a coordinated perioperative approach aimed at reducing surgical stress and facilitating postoperative recovery. The objective of this review was to examine the literature on the procedure-specific application of FT surgery. DISCUSSION The concept of FT rehabilitation has been applied mainly in colorectal surgery, but positive data have appeared also in other areas such as orthopedic, hepatopancreaticobiliary, urological, upper gastrointestinal, gynecological, thoracic, vascular, endocrine, breast, and pediatric surgeries. There is very little experience with comprehensive FT programs in cardiac surgery or trauma. Quantitative analysis from randomized trials and cohort studies suggest that FT is effective in reducing hospital stay without increased adverse events. Other benefits of the FT approach include a reduction in complications, ileus, fatigue, pain, and hospital expenses. However, despite clear benefits of FT care, implementation in daily practice has been slow. Further efforts must be undertaken to secure implementation in routine clinical practice. Standardized FT protocols should be provided on a procedure-specific basis.
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Affiliation(s)
- Daniel Ansari
- Department of Surgery, Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
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Magheli A, Knoll N, Lein M, Hinz S, Kempkensteffen C, Gralla O. Impact of Fast-Track Postoperative Care on Intestinal Function, Pain, and Length of Hospital Stay After Laparoscopic Radical Prostatectomy. J Endourol 2011; 25:1143-7. [DOI: 10.1089/end.2011.0020] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ahmed Magheli
- Department of Urology, Charité University Medicine, Campus Mitte, Berlin, Germany
| | - Nina Knoll
- Department of Medical Psychology, Charité University Medicine, Campus Mitte, Berlin, Germany
| | - Michael Lein
- Department of Urology, Charité University Medicine, Campus Mitte, Berlin, Germany
| | - Stefan Hinz
- Department of Urology, Charité University Medicine, Campus Mitte, Berlin, Germany
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Perioperative fast track program in intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery in advanced ovarian cancer. Eur J Surg Oncol 2011; 37:543-8. [DOI: 10.1016/j.ejso.2011.03.134] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Revised: 01/13/2011] [Accepted: 03/17/2011] [Indexed: 01/31/2023] Open
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Laroche J, Walz J, Marcy M, Salem N, Gravis G, Savoie PH, Methorst C, Karsenty G, Bladou F. [Robot-assisted radical prostatectomy: Perioperative complications, pathological results and functional results during the learning curve]. Prog Urol 2010; 20:590-6. [PMID: 20832037 DOI: 10.1016/j.purol.2010.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Revised: 03/10/2010] [Accepted: 03/25/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE We report our experiences regarding the peri- and postoperative complications as well as pathological and functional results of robot-assisted radical prostatectomy during the implementation phase and the learning curve of the technique. MATERIAL All clinical, paraclinical, as well as peri- and postoperative events of the first 102 patients were filed. Postoperative complications were classified according to the Clavien classification. Regarding functional results, continence was defined as the use of 0 pads or one pad for security reasons. Erectile function was classified into absence of spontaneous erections, erections insufficient for sexual intercourse and erections sufficient for sexual intercourse. RESULTS Median procedure time was 240min, blood-loss 400mL and transfusion rate 2%. Overall, 7.8% of all patients had perioperative complications, 13.7% had minor and 4.9% had mayor post operative complications. The overall positive surgical margin rate was 16.0%. At 12month, 87% of all patients were continent and 21.1% had spontaneous erections and 47.4% had sexual intercourse. CONCLUSION Patients treated during the implementation phase of robot-assisted radical prostatectomy show rates of peri- and postoperative complications, as well as pathological and functional results comparable to the results of centers of excellence published in the literature.
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Affiliation(s)
- J Laroche
- Service d'urologie, institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, BP 156, 13273 Marseille, France
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Varadhan KK, Lobo DN, Ljungqvist O. Enhanced Recovery After Surgery: The Future of Improving Surgical Care. Crit Care Clin 2010; 26:527-47, x. [DOI: 10.1016/j.ccc.2010.04.003] [Citation(s) in RCA: 104] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Abstract
Vascular comorbidities are common in vascular surgery, being associated with perioperative complications. Since it was demonstrated that the postoperative course could be optimized by introduction of the fast track concept in general surgery, application to vascular surgery may also be of benefit. The fast track concept was introduced in our institution on May 1st 2008 with special adjustments for vascular surgery. The authors describe the development and implementation of a clinical pathway, which proved to be of value in vascular surgery.
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Affiliation(s)
- E S Debus
- Abt. für Allgemein-, Viszeral- und Gefässchirurgie mit GefässCentrum Hamburg, Asklepios Klinik Harburg, Eissendorfer Pferdeweg 52, Hamburg, Germany.
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Balzano G, Zerbi A, Braga M, Rocchetti S, Beneduce AA, Di Carlo V. Fast-track recovery programme after pancreatico- duodenectomy reduces delayed gastric emptying. Br J Surg 2008; 95:1387-93. [PMID: 18844251 DOI: 10.1002/bjs.6324] [Citation(s) in RCA: 192] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Data on enhanced recovery programmes after pancreatic surgery are sparse. This retrospective cohort study, using historical controls, aimed to evaluate the impact of a fast-track programme after pancreaticoduodenectomy (PD). METHODS Between 2004 and 2007, 252 patients undergoing PD were treated by a fast-track programme that included earlier postoperative feeding and mobilization. The patients were compared with an equally sized control group that received a traditional programme from 2000 to 2004. Outcome measures were morbidity, length of stay and readmission rate. RESULTS The rates of pancreatic fistula and other intra-abdominal complications were similar in the two groups. Delayed gastric emptying (DGE) was significantly reduced in the fast-track group (13.9 versus 24.6 per cent; P = 0.004). The independent effect of the fast-track protocol in reducing DGE was confirmed by the multiple regression analysis (adjusted odds ratio 0.477, P = 0.005). Length of stay was reduced with the fast-track protocol (median 13 versus 15 days; P < 0.001), without increasing the readmission rate (7.1 versus 6.3 per cent; P = 0.865). CONCLUSION A fast-track programme after PD improves gastric emptying and reduces postoperative stay.
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Affiliation(s)
- G Balzano
- Pancreas Unit, Department of Surgery, San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy.
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