Effect of Enhanced Recovery After Surgery Protocol on Patients Who Underwent Off-Pump Coronary Artery Bypass Graft

Factors Influencing Postoperative Recovery Time of Patients With Gastric Cancer

BACKGROUND

To explore the factors associated with prolonged enhanced recovery after surgery (ERAS) time in gastric cancer patients who underwent gastrectomy.

METHODS

This was a retrospective of patients with gastric cancer who received ERAS at our hospital between 01/2014 and 01/2022. The outcome was prolonged ERAS time. Factors associated with prolonged ERAS time of patients undergoing gastric cancer surgery were analyzed by logistic regression.

RESULTS

Among 663 patients, 182 (27.6%) patients had a prolonged ERAS time. The postoperative time to the first flatus time was 2.8 ± 1.2 days. There were 41 (6.2%) patients with intestinal obstruction, 25 (3.8%) with abdominal infection, and four (0.5%) with anastomotic leakage. The multivariable analysis showed that age >80 years (OR = 1.57, 95% CI: 1.31-4.40, P = 0.048), laparoscopic surgery (OR = 0.45, 95% CI: 0.21-0.95, P = 0.035), intraoperative jejunostomy (OR = 334.60, 95% CI: 2.81-39,831.90, P = 0.017), postoperative time to the first flatus time (OR = 3.79, 95% CI: 1.23-11.68, P = 0.021), total gastrectomy (OR = 0.08, 95% CI: 0.01-0.94, P = 0.044), and patient compliance with ERAS (OR = 0.01, 95% CI: 0-0.09, P < 0.001) were independently associated with prolonged ERAS time.

CONCLUSIONS

Age >80 years, laparoscopic surgery, intraoperative jejunostomy, postoperative time to the first flatus time, total gastrectomy, and patient compliance with ERAS might be factors associated with prolonged ERAS time in gastric cancer patients.

Elements not Graded in the Cardiac Enhanced Recovery After Surgery Guidelines Might Improve Postoperative Outcome: A Comprehensive Narrative Review

Enhanced Recovery Programs (ERPs) are protocols involving the whole patient surgical journey. These protocols are based on multimodal, multidisciplinary, evidence-based, and patient-centered approaches aimed at improving patient recovery after a surgical intervention. Such programs have shown striking positive results in different surgical specialties. However, only a few research groups have incorporated preoperative, intraoperative, and postoperative evidence-based interventions in bundles used to standardize care and build cardiac surgery ERPs. The Enhanced Recovery After Surgery Society recently published evidence-based recommendations for perioperative care in cardiac surgery. Their recommendations included 22 perioperative interventions that may be part of any cardiac ERP. However, various components integrated in already-published cardiac ERPs were neither graded nor reported in these recommendations. The goals of the current review are to present published cardiac ERPs and their effects on patient outcomes and reported components incorporated into these ERPs and to discuss the objectives and scope of cardiac ERPs.

Intraoperative thermal insulation in off-pump coronary artery bypass grafting surgery: a prospective, double blind, randomized controlled, single-center study

Background

About 50% patients who underwent off-pump coronary artery bypass grafting (OPCAB) experienced perioperative hypothermia. Pre-warming and intraoperative infusion of amino acid injection are the most popular perioperative insulation measures in recent years, but neither of them can completely prevent intraoperative hypothermia. The objective is to investigate the effect of preoperative warming and/or intraoperative infusion of amino acid injection on body temperature in patients undergoing OPCAB.

Methods

A prospective, double blind, randomized controlled, single-center study. Seventy-two patients were randomly divided into 4 groups: control group, pre-warming group, amino-acid group and multi-mode group. Pre-warming and multi-mode group were pre-heated with warming blankets and forced-air warming system before induction. After that, amino-acid and multi-mode group were infused with 18-amino acid solution. The perioperative temperature and complications were monitored.

Results

The temperature of control and amino-acid group decreased significantly, but amino-acid group recovered to preoperative level faster. The temperature of pre-warming group was stable, and that in multi-mode group increased at 60 min after the start of surgery. There was a significant difference in temperature at each time, and no difference in the incidence of complications between the groups.

Conclusions

Preoperative warming and/or intraoperative infusion of amino acid injection can effectively reduce hypothermia in OPCAB surgery. Pre-warming before anesthesia is more effective, and the combination of the two methods has the best effect.