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Kanneganti P, Verma A, Mandelia A, Upadhyaya VD, Kumar B, Kumar T, Agarwal N, Kannojia A. Safety and Efficacy of Enhanced Recovery after Surgery Protocol in Pediatric Patients Undergoing Hepato-Pancreatico-Biliary Surgery: A Prospective Randomized Control Study. J Indian Assoc Pediatr Surg 2024; 29:240-244. [PMID: 38912029 PMCID: PMC11192251 DOI: 10.4103/jiaps.jiaps_238_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/09/2024] [Accepted: 01/21/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction Enhanced recovery after surgery (ERAS) is a multidisciplinary approach to optimize patient care. The goal of this approach is to reduce the body's reaction to surgical stress by optimizing the perioperative nutritional status, promoting analgesia without opioids, and early postoperative feeding. In pediatric patients, very limited literature is available for the application of ERAS protocol. This study was done to evaluate the application of ERAS protocol in pediatric hepatobiliary and pancreatic patients. Materials and Methods This is a randomized prospective study conducted over a period of 2 years at a tertiary center in North India. A total of 40 hepatobiliary and pancreatic patients who were willing to participate in the study were included in the study. Patients were randomized by computer-generated method and data were collected regarding demography, clinical diagnosis, preoperative and postoperative workup, and peri-operative care including analgesia, pain scores, postoperative recovery, hospital stay, and complications. These patients were followed for 6 months postoperatively and the results were evaluated using SPSS software. Results The study included 20 patients each in both the conventional and ERAS group with median ages of 11.5 years and 7.1 years, respectively. The data analysis showed that the ERAS group of patients had better outcomes in terms of hospital stay and drain removal time with significant statistical differences. Pain scores and complications are almost the same in both groups. Conclusion Principles of ERAS can be safely applied in pediatric patients undergoing major surgery in the present era of emerging infections and also increasing patient burden without morbidity.
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Affiliation(s)
- Pujana Kanneganti
- Department of Paediatric Surgery Superspecialties, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Utter Pradesh, India
| | - Anju Verma
- Department of Paediatric Surgery Superspecialties, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Utter Pradesh, India
| | - Ankur Mandelia
- Department of Paediatric Surgery Superspecialties, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Utter Pradesh, India
| | - Vijai Datta Upadhyaya
- Department of Paediatric Surgery Superspecialties, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Utter Pradesh, India
| | - Basant Kumar
- Department of Paediatric Surgery Superspecialties, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Utter Pradesh, India
| | - Tarun Kumar
- Department of Paediatric Surgery Superspecialties, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Utter Pradesh, India
| | - Nishant Agarwal
- Department of Paediatric Surgery Superspecialties, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Utter Pradesh, India
| | - Ashish Kannojia
- Department of Anaesthesia, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Utter Pradesh, India
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Shi H, Zheng C, Zhu B. Effects of Preoperative Oral Carbohydrate on Perioperative Maternal Outcomes Undergoing Cesarean Section: A Systematic Review and Meta-Analysis. Anesthesiol Res Pract 2024; 2024:4660422. [PMID: 38586152 PMCID: PMC10999288 DOI: 10.1155/2024/4660422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/18/2024] [Accepted: 03/23/2024] [Indexed: 04/09/2024] Open
Abstract
Purpose Preoperative oral carbohydrate (CHO) is a rapid postoperative rehabilitation protocol that improves perioperative outcomes and is widely used in adult surgical patients. However, pregnant women are excluded because of the possibility of aspiration due to delayed gastric emptying. This meta-analysis was conducted to evaluate the efficacy of preoperative oral CHO in elective cesarean section. Methods PubMed, Embase, Web of Science, and the Cochrane Library were searched from inception to July 2023. Randomized controlled trials were included. The risk of bias was assessed using the Cochrane tool. Risk ratios and 95% confidence intervals were calculated. Meta-analysis was performed using random-effects models to estimate risk ratios and mean differences (MDs) with 95% confidence intervals (CIs). The outcomes included thirst and hunger scores, incidence of vomiting and nausea, time to flatus, and homeostatic model assessment of insulin resistance (HOMA-IR). Results A total of nine studies with 1211 patients were included in the analysis. The levels of thirst and hunger were evaluated using a 10-point visual analog scale, with 0 representing the best and 10 representing the worst. The severity of hunger (weighted mean difference (WMD: -2.34, 95% CI: -3.13 to -1.54), time to flatus (WMD: -3.51 hours, 95% CI: -6.85 to -0.17), and HOMA-IR (WMD: -1.04, 95% CI: -1.31 to -0.77) were significantly lower in the CHO group compared to the control group. However, there were no significant differences in the severity of thirst or the incidence of vomiting and nausea between the CHO and control groups. Conclusion Preoperative oral CHO during cesarean section alleviates thirst and hunger, shortens the time of postoperative flatus, and reduces HOMA-IR. However, the available evidence is insufficient to reach a clear consensus on the benefits or harms of preoperative oral CHO during cesarean section. Therefore, it is premature to make a definitive recommendation for or against its routine use.
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Affiliation(s)
- Haibin Shi
- Department of Anesthesiology, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou, Zhejiang, China
| | - Caihong Zheng
- Department of Anesthesiology, Hangzhou Women's Hospital, Hangzhou, Zhejiang, China
| | - Bin Zhu
- Department of Anesthesiology, Hangzhou Women's Hospital, Hangzhou, Zhejiang, China
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Huang HY, Lin SP, Wang HY, Liou JY, Chang WK, Ting CK. Logistic Regression Is Non-Inferior to the Response Surface Model in Patient Response Prediction of Video-Assisted Thoracoscopic Surgery. Pharmaceuticals (Basel) 2024; 17:95. [PMID: 38256927 PMCID: PMC10819298 DOI: 10.3390/ph17010095] [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: 11/22/2023] [Revised: 12/24/2023] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
Response surface models (RSMs) are a new trend in modern anesthesia. RSMs have demonstrated significant applicability in the field of anesthesia. However, the comparative analysis between RSMs and logistic regression (LR) in different surgeries remains relatively limited in the current literature. We hypothesized that using a total intravenous anesthesia (TIVA) technique with the response surface model (RSM) and logistic regression (LR) would predict the emergence from anesthesia in patients undergoing video-assisted thoracotomy surgery (VATS). This study aimed to prove that LR, like the RSM, can be used to improve patient safety and achieve enhanced recovery after surgery (ERAS). This was a prospective, observational study with data reanalysis. Twenty-nine patients (American Society of Anesthesiologists (ASA) class II and III) who underwent VATS for elective pulmonary or mediastinal surgery under TIVA were enrolled. We monitored the emergence from anesthesia, and the precise time point of regained response (RR) was noted. The influence of varying concentrations was examined and incorporated into both the RSM and LR. The receiver operating characteristic (ROC) curve area for Greco and LR models was 0.979 (confidence interval: 0.987 to 0.990) and 0.989 (confidence interval: 0.989 to 0.990), respectively. The two models had no significant differences in predicting the probability of regaining response. In conclusion, the LR model was effective and can be applied to patients undergoing VATS or other procedures of similar modalities. Furthermore, the RSM is significantly more sophisticated and has an accuracy similar to that of the LR model; however, the LR model is more accessible. Therefore, the LR model is a simpler tool for predicting arousal in patients undergoing VATS under TIVA with Remifentanil and Propofol.
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Affiliation(s)
- Hui-Yu Huang
- Department of Anesthesiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei 112201, Taiwan; (H.-Y.H.); (S.-P.L.); (H.-Y.W.)
| | - Shih-Pin Lin
- Department of Anesthesiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei 112201, Taiwan; (H.-Y.H.); (S.-P.L.); (H.-Y.W.)
| | - Hsin-Yi Wang
- Department of Anesthesiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei 112201, Taiwan; (H.-Y.H.); (S.-P.L.); (H.-Y.W.)
| | - Jing-Yang Liou
- Department of Anesthesiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei 112201, Taiwan; (H.-Y.H.); (S.-P.L.); (H.-Y.W.)
| | - Wen-Kuei Chang
- Department of Anesthesiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei 112201, Taiwan; (H.-Y.H.); (S.-P.L.); (H.-Y.W.)
| | - Chien-Kun Ting
- Department of Anesthesiology, Taipei Veterans General Hospital and National Yang Ming Chiao Tung University, Taipei 112201, Taiwan; (H.-Y.H.); (S.-P.L.); (H.-Y.W.)
- Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
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Ma MKI, Chung PHY, Yeung F, Wong KKY. Analysing Factors Prolonging Hospital Stay After Excision of Choledochal Cyst-A Pathway Towards Enhanced Recovery After Surgery. World J Surg 2023; 47:3012-3019. [PMID: 37816975 DOI: 10.1007/s00268-023-07206-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND To evaluate factors affecting length of stay (LOS) after choledochal cyst resection in paediatric patients. METHODS This was a retrospective study on patients operated between 2004 and 2021. Associations between clinical factors and LOS were evaluated by bivariate analysis, multiple regression, and equivalence test. RESULTS Sixty-two patients were included. Twenty-four underwent hepaticoduodenostomy as biliary reconstruction. Five suffered from major complications. The median (25th-75th percentile) operation time was 279 (182-378) min. Median LOS, time to enteral feeding, and time to abdominal drain removal were 8(6-10), 2(1-3), and 5(4-7) days, respectively. Seven factors were found significantly associated with a shorter LOS in bivariate analysis and were included in multiple regression. It revealed that early abdominal drain removal (p < 0.001), early enteral feeding (p = 0.042), and the absence of major complications (p < 0.001) were significantly associated with shorter LOS. Equivalence test suggested that age and preoperative cholangitis had no practical effect on LOS. CONCLUSIONS Early enteral feeding, early drain removal, and avoidance of major complications are associated with a shorter LOS.
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Affiliation(s)
- Marco King In Ma
- Division of Paediatric Surgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Room 1540, Floor 15, Block K, Queen Mary Hospital, Pokfulam, Hong Kong, China
| | - Patrick Ho Yu Chung
- Division of Paediatric Surgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Room 1540, Floor 15, Block K, Queen Mary Hospital, Pokfulam, Hong Kong, China.
| | - Fanny Yeung
- Division of Paediatric Surgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Room 1540, Floor 15, Block K, Queen Mary Hospital, Pokfulam, Hong Kong, China
| | - Kenneth Kak Yuen Wong
- Division of Paediatric Surgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Room 1540, Floor 15, Block K, Queen Mary Hospital, Pokfulam, Hong Kong, China
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Wang F, Xiao C, Jia T, Pan L, Du F, Wang Z. Hepatobiliary surgery based on intelligent image segmentation technology. Open Life Sci 2023; 18:20220674. [PMID: 37671090 PMCID: PMC10476479 DOI: 10.1515/biol-2022-0674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/01/2023] [Accepted: 07/12/2023] [Indexed: 09/07/2023] Open
Abstract
Liver disease is an important disease that seriously threatens human health. It accounts for the highest proportion in various malignant tumors, and its incidence rate and mortality are on the rise, seriously affecting human health. Modern imaging has developed rapidly, but the application of image segmentation in liver tumor surgery is still rare. The application of image processing technology represented by artificial intelligence (AI) in surgery can greatly improve the efficiency of surgery, reduce surgical complications, and reduce the cost of surgery. Hepatocellular carcinoma is the most common malignant tumor in the world, and its mortality is second only to lung cancer. The resection rate of liver cancer surgery is high, and it is a multidisciplinary surgery, so it is necessary to explore the possibility of effective switching between different disciplines. Resection of hepatobiliary and pancreatic tumors is one of the most challenging and lethal surgical procedures. The operation requires a high level of doctors' experience and understanding of anatomical structures. The surgical segmentation is slow and there may be obvious complications. Therefore, the surgical system needs to make full use of the relevant functions of AI technology and computer vision analysis software, and combine the processing strategy based on image processing algorithm and computer vision analysis model. Intelligent optimization algorithm, also known as modern heuristic algorithm, is an algorithm with global optimization performance, strong universality, and suitable for parallel processing. This algorithm generally has a strict theoretical basis, rather than relying solely on expert experience. In theory, the optimal solution or approximate optimal solution can be found in a certain time. This work studies the hepatobiliary surgery through intelligent image segmentation technology, and analyzes them through intelligent optimization algorithm. The research results showed that when other conditions were the same, there were three patients who had adverse reactions in hepatobiliary surgery through intelligent image segmentation technology, accounting for 10%. The number of patients with adverse reactions in hepatobiliary surgery by conventional methods was nine, accounting for 30%, which was significantly higher than the former, indicating a positive relationship between intelligent image segmentation technology and hepatobiliary surgery.
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Affiliation(s)
- Fuchuan Wang
- Faculty of Hepatology Medicine, Chinese People’s Liberation Army (PLA) General Hospital, Beijing100039, China
| | - Chaohui Xiao
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People’s Liberation Army (PLA) General Hospital, Beijing100853, China
| | - Tianye Jia
- Department of Laboratory, Fifth Medical Center, Chinese People’s Liberation Army (PLA) General Hospital, Beijing100039, China
| | - Liru Pan
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People’s Liberation Army (PLA) General Hospital, Beijing100853, China
| | - Fengxia Du
- Faculty of Hepatology Medicine, Chinese People’s Liberation Army (PLA) General Hospital, Beijing100039, China
| | - Zhaohai Wang
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People’s Liberation Army (PLA) General Hospital, Beijing100853, China
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Rattanakanlaya K, Vuttanon N, Noppakun L, Sangwattanarat W, Boonyu N, Iamruksa S. Readiness for hospital discharge post-initial invasive percutaneous transhepatic biliary drainage: A mixed-methods study. Heliyon 2023; 9:e15341. [PMID: 37144202 PMCID: PMC10151257 DOI: 10.1016/j.heliyon.2023.e15341] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 04/02/2023] [Accepted: 04/03/2023] [Indexed: 05/06/2023] Open
Abstract
This study explores perceptions regarding hospital discharge readiness among patients with post-first invasive percutaneous transhepatic biliary drainage (PTBD), family caregivers, and healthcare providers who are involved during the discharge period. A convergent mixed-method design was applied. A purposive sample of 30 patients completed a scale measuring readiness for hospital discharge, and 30 participants, including patients, family caregivers, and healthcare providers, participated in in-depth interviews. Descriptive analyses were combined with quantitative data, thematic analyses with qualitative data, and joint displays with mixed analyses. Findings indicate that readiness for hospital discharge was high, the expected support subscale was at the highest possible level, and the personal status subscale was at the lowest level. Three main themes emerged from an analysis of the interview transcripts: improved health conditions, self-care knowledge, and homecare preparedness. Self care knowledge had three sub-themes: taking care of biliary drainage, consuming a suitable diet, and observation of abnormal symptoms. Being ready for hospital discharge contributes to a safer transition from hospital to home. Healthcare providers need to reconsider the criteria for discharge and clarify patients' individual needs. Patients, family caregivers, and healthcare providers need to be prepared for hospital discharge.
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Affiliation(s)
- Kanittha Rattanakanlaya
- Division of Surgical Nursing, Faculty of Nursing, Chiang Mai University, 110/406 Intrawarorot Rd, Suthep, Muanf, Chiang Mai, 50200, Thailand
- Corresponding author.
| | - Nuttamon Vuttanon
- Division of Surgical Nursing, Faculty of Nursing, Chiang Mai University, 110/406 Intrawarorot Rd, Suthep, Muanf, Chiang Mai, 50200, Thailand
| | - Lalida Noppakun
- Division of Surgical Nursing, Faculty of Nursing, Chiang Mai University, 110/406 Intrawarorot Rd, Suthep, Muanf, Chiang Mai, 50200, Thailand
| | - Wantanee Sangwattanarat
- Maharaj Nakorn Chiang Mai Hospital, Faculty of Medicine, Chiang Mai University, 110 Intrawarorot Rd, Sriphum, Muang, Chiang Mai 50200, Thailand
| | - Nongnuch Boonyu
- Maharaj Nakorn Chiang Mai Hospital, Faculty of Medicine, Chiang Mai University, 110 Intrawarorot Rd, Sriphum, Muang, Chiang Mai 50200, Thailand
| | - Srisuda Iamruksa
- Division of Surgical Nursing, Faculty of Nursing, Chiang Mai University, 110/406 Intrawarorot Rd, Suthep, Muanf, Chiang Mai, 50200, Thailand
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Lidocaine Intraoperative Infusion Pharmacokinetics during Partial Hepatectomy for Living Liver Donation. Anesthesiology 2023; 138:71-81. [PMID: 36512707 DOI: 10.1097/aln.0000000000004422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Postoperative pain associated with open partial hepatectomy can be intense and persistent. The multimodal approach used to lessen this problem includes an intraoperative intravenous infusion of lidocaine hydrochloride. Decreased hepatic metabolism after resection raises concerns about safe lidocaine dosing in this patient population. The hypothesis was that the elimination clearance of lidocaine and its metabolites, monoethylglycinexylidide and glycinexylidide, is reduced after a partial hepatectomy, as reflected by observed plasma concentrations that are higher and have a longer half-life than expected based on pharmacokinetic modeling (estimated for normal liver function). Secondarily, this study postulated that plasma concentrations of lidocaine, monoethylglycinexylidide, and glycinexylidide do not reach toxic concentrations with institutional protocol up to 24 h after surgery. METHODS Blood samples were collected from 15 patients undergoing a partial hepatectomy for living liver donation, at the following specific time points: before and immediately after induction of anesthesia, during hepatectomy, 30 min after hepatectomy completion, at case end, and 24 h after the end of surgery. Plasma concentrations of lidocaine and metabolites were measured by liquid chromatography-mass spectrometry. The population lidocaine pharmacokinetics were estimated, and total body weight and the fraction of remaining liver mass as potential model covariates were evaluated. The detection of any lidocaine, monoethylglycinexylidide, or glycinexylidide toxic plasma concentrations at any time point during and after hepatectomy were also evaluated. RESULTS The typical value for lidocaine elimination clearance was 0.55 ± 0.12 l/min (± standard error of the estimate) which, on average, was reduced to about one third of the baseline clearance, 0.17 ± 0.02 l/min, once the donor graft was surgically isolated, and remained so for 24 h according to the current data and model. The fraction of remaining liver was a significant covariate for the posthepatectomy lidocaine clearance' such that if 50% of the liver is removed the clearance is reduced by approximately 60%. Plasma concentrations of lidocaine and its metabolites remained below their theoretical combined toxic threshold concentrations throughout the surgical and postoperative course in all patients, with one exception obtained near induction of anesthesia. Plasma lidocaine concentrations decreased at case end and postoperatively, while metabolite concentrations continued to rise at the end of surgery with reduction postoperatively. Pharmacokinetic modeling revealed that the only significant covariate in the model was the fraction of liver remaining after isolation of the donor graft. CONCLUSIONS Intravenous lidocaine infusions are an acceptable option for multimodal pain management in patients undergoing a hepatectomy for living donation if the lidocaine infusion is stopped when the liver resection is complete. Clearance of lidocaine is decreased proportionally to the remaining liver mass, which should guide lidocaine infusion administration or dosing adjustments for patients undergoing liver resection surgery. EDITOR’S PERSPECTIVE
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Chen J, Huang X, Li F. Effects of fast track surgery on perioperative recovery, stress indicators and swallowing function in patients with thyroid cancer. Am J Transl Res 2022; 14:7109-7118. [PMID: 36398216 PMCID: PMC9641477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/27/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To explore the effects of fast track surgery (FTS) on perioperative recovery, stress indicators and swallowing function in patients with thyroid cancer. METHODS One hundred and thirty patients with thyroid cancer admitted to Huzhou Central Hospital, Zhejiang University Huzhou Hospital, Affiliated Hospital of Huzhou Normal University from January 2019 to December 2020 were retrospectively included as study subjects, and were divided into a control group (n = 63, conventional nursing) and a study group (n = 67, FTS). The perioperative recovery indicators, complications, stress response, and swallowing function were compared between the two groups. Logistic regression analysis was used to analyze the risk factors for accelerating postoperative recovery. RESULTS No statistically significant differences were observed in the scores of Kubota drinking test and Ichiro Fujishima rating scale (IFRS) between the two groups before intervention (P > 0.05). After nursing, the study group had lower scores of Kubota drinking test and higher scores of IFRS than the control group (P < 0.05). The time to drainage tube removal, time to first anal exhaust, time to first getting out of bed activity, length of hospitalization, and medical costs in the study group were lower than those in the control group (P < 0.05). The study group showed lower incidence of postoperative complications than the control group (8.96% vs. 28.57%, P < 0.05). The postoperative C-reactive protein, glucose, epinephrine, cortisol levels and numerical rating scale scores in the study group were lower than those in the control group (P < 0.05). Logistic regression analysis showed that age was an important negative factor for accelerating postoperative recovery of patients with thyroid cancer, and the length of postoperative hospital stay increased significantly with age (P < 0.05). CONCLUSION The intervention of FTS in the perioperative period for thyroid cancer patients can improve the swallowing function, shorten the recovery time and reduce the incidence of complications, which may be related to the improvement of the perioperative stress response of patients with FTS.
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Affiliation(s)
- Junjing Chen
- Department of Hepatobiliary Surgery, Huzhou Central Hospital, Zhejiang University Huzhou Hospital, Affiliated Hospital of Huzhou Normal University Huzhou 313000, Zhejiang, China
| | - Xiaoqing Huang
- Department of Hepatobiliary Surgery, Huzhou Central Hospital, Zhejiang University Huzhou Hospital, Affiliated Hospital of Huzhou Normal University Huzhou 313000, Zhejiang, China
| | - Feifei Li
- Department of Hepatobiliary Surgery, Huzhou Central Hospital, Zhejiang University Huzhou Hospital, Affiliated Hospital of Huzhou Normal University Huzhou 313000, Zhejiang, China
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Hanna DN, McKay KG, Ghani MO, Correa H, Zamora IJ, Lovvorn HN. Elective choledochal cyst excision is associated with improved postoperative outcomes in children. Pediatr Surg Int 2022; 38:817-824. [PMID: 35338382 DOI: 10.1007/s00383-022-05108-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/27/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE The majority of pediatric patients with choledochal cysts (CDC) are symptomatic prior to undergoing CDC excision. This study investigated the impact of surgical timing of CDC excision on postoperative outcomes among children. METHODS We performed a retrospective review of 59 patients undergoing open CDC excision with Roux-Y hepaticojejunostomy between 2000 and 2020. Patients were grouped based on whether they underwent an electively scheduled or urgent CDC excision, as defined as CDC excision within the same admission due to CDC-related symptoms. Patient characteristics and perioperative data were compared between the two groups. RESULTS Patients who underwent an elective surgery were older, had more Todani-type 1 CDC, and had decreased postoperative hospital length of stay and opioid use compared to patients who underwent CDC excision within the same admission due to CDC-related symptoms. No significant differences emerged regarding postoperative complications. Multivariable analysis showed that elective cyst excision (HR = 0.55, p = 0.04; HR = 0.59, p = 0.008) and type 1 CDC (HR = 0.32, p = 0.03; HR = 0.12, p < 0.001) were independently associated with decreased opioid use and postoperative hospital length of stay. CONCLUSIONS Elective CDC excision is associated with shortened hospital stay and decreased opioid use among children compared to patients who undergo a CDC excision during the same admission for CDC-related symptoms.
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Affiliation(s)
- David N Hanna
- Section of Surgical Sciences, Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Katlyn G McKay
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Muhammad O Ghani
- Section of Surgical Sciences, Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hernan Correa
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Irving J Zamora
- Section of Surgical Sciences, Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Harold N Lovvorn
- Section of Surgical Sciences, Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN, USA. .,Department of Pediatric Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt Nashville, Doctor's Office Tower 2220 Children's Way, Nashville, TN, 37232, USA.
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Greenbaum A, Wilcox H, Teng CH, Petersen T, Billstrand M, Campbell R, Bordegaray N, Nir I. Use of Erector Spinae Fascial Plane Blocks in Enhanced Recovery for Open Abdominal Surgery. J Surg Res 2021; 268:673-680. [PMID: 34482007 DOI: 10.1016/j.jss.2021.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 07/14/2021] [Accepted: 08/04/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Bilateral erector spinae fascial plane blocks (ESPB) offers a novel, alternative method of regional post-operative pain control to thoracic epidural analgesia (TEA). The aim of this study was to compare rates of postoperative hypotension, and other standard enhanced recovery after surgery (ERAS) endpoints, in patients receiving ESPB versus TEA for open hepatopancreaticobiliary (HPB) surgery. MATERIALS AND METHODS This retrospective analysis compared historical controls of ERAS patients undergoing open HPB surgery with TEA versus ESPB. The incidence of postoperative hypotension and clinical outcomes, including opioid requirements, were compared. RESULTS Forty patients receiving TEA were compared to 27 ESPB patients. Return of bowel function and length of stay (mean 7.2 versus7.4 days; P = 0.83) were similar. ESPB patients received less intraoperative colloid (142cc versus 340cc; P = 0.01) and had less postoperative hypotension versus TEA (22% versus 55%; P = 0.03). No ESPB patient required patient-controlled analgesia (versus 32.5% TEA; P< 0.001). ESPB MME requirements decreased over time, while TEA MME requirements increased over 72 hours (P = 0.019). CONCLUSIONS ESPB is a novel method that shows promising outcomes in improving enhanced recovery parameters and minimizing opioid administration in open HPB surgery.
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Affiliation(s)
- Alissa Greenbaum
- University of New Mexico Health Sciences Center, Department of Surgery, Albuquerque, New Mexico
| | - Hannah Wilcox
- University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Christine H Teng
- University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Timothy Petersen
- University of New Mexico Health Science Center, Department of Anesthesiology, Albuquerque, New Mexico
| | - Mary Billstrand
- University of New Mexico Health Science Center, Department of Anesthesiology, Albuquerque, New Mexico
| | - Rachel Campbell
- University of New Mexico Health Science Center, Department of Anesthesiology, Albuquerque, New Mexico
| | - Nichole Bordegaray
- University of New Mexico Health Science Center, Department of Anesthesiology, Albuquerque, New Mexico
| | - Itzhak Nir
- University of New Mexico Health Sciences Center, Department of Surgery, Albuquerque, New Mexico.
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Willis MA, Schwenk W, Post S, Nothacker M, Follmann M, Vilz TO. [Background, Necessity and Methodology of the S3 Guideline "Perioperative Management of Gastrointestinal Tumours (POMGAT)"]. Zentralbl Chir 2021; 146:241-248. [PMID: 34154005 DOI: 10.1055/a-1481-9394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Malignancies are among the most common diseases, especially in old age, and are responsible for 25% of all deaths in Germany. Especially carcinomas of the gastrointestinal tract can be cured in most cases only through extensive surgery with significant morbidity. About 25 years ago, the multimodal, perioperative Fast Track (FT) concept for reducing postoperative complications was introduced and additional elements were added in the following years. Meanwhile, there is growing evidence that adherence to the key elements of more than 70% leads to reduction in postoperative adverse events as well as a shorter hospital stay and could be associated with an improved oncological outcome. Despite the high level of awareness and the proven advantages of the FT concept, the implementation and maintenance of the measures is difficult and results in an adherence of only 20 - 40%. There are many reasons for this: In addition to a lack of interdisciplinary and interprofessional cooperation and the time consuming and extended logistical efforts, limited human resources are often listed as one of the main causes. We took these aspects as an opportunity and started to develop a S3 guideline for perioperative treatment to accelerate the recovery of patients with gastrointestinal malignancies. By creating a consensus- and evidence-based, multidisciplinary guideline, many of the problems listed above could probably be solved by optimising and standardising interdisciplinary care, which is particularly important in a setting with many different disciplines and their competing interests. Furthermore, the standardisation of the perioperative procedures will reduce the time and logistical effort. The presentation of the evidence allows increased transparency and justifies the additional personnel expenditure on hospital medicine and health insurance companies. In addition, the evidence-based quality indicators generated during the development of the guideline make it possible to include perioperative standards in certification systems and thus to measure and check the quality of perioperative care.
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Affiliation(s)
- Maria A Willis
- Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Deutschland
| | | | - Stefan Post
- ehemals Chirurgische Klinik, Universitätsklinikum Mannheim, Mannheim, Deutschland
| | - Monika Nothacker
- Philipps-Universität Marburg, Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V., Marburg, Deutschland
| | - Markus Follmann
- Office des Leitlinienprogrammes Onkologie, Deutsche Krebsgesellschaft e. V., Berlin, Deutschland
| | - Tim O Vilz
- Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Deutschland
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Chang SH, Chang TC, Chen MY, Chen WC, Chou HH. Comparison of the Efficacy and Safety of Dinalbuphine Sebacate, Patient-Controlled Analgesia, and Conventional Analgesia After Laparotomy for Gynecologic Cancers: A Retrospective Study. J Pain Res 2021; 14:1763-1771. [PMID: 34163233 PMCID: PMC8214537 DOI: 10.2147/jpr.s314304] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 05/25/2021] [Indexed: 12/13/2022] Open
Abstract
Objective We aimed to investigate the effects of dinalbuphine sebacate (DNS), fentanyl-based patient-controlled analgesia (PCA), and conventional analgesia (CA) for pain management after laparotomy for gynecologic cancers. Methods A total of 137 eligible patients who underwent laparotomy through a midline incision wound for gynecologic cancer between July 2019 and June 2020 were retrospectively evaluated. The patients were divided into three groups as follows: the intramuscular DNS, intravenous PCA, and CA groups. Postoperative pain (POP) intensity as measured with a numerical rating scale (NRS), total consumption of analgesics, and incidence of treatment-emergent adverse events were compared between the three groups. Results The DNS group showed significant reduction in NRS pain intensity than the PCA and CA groups on day 1 (4.8 vs 6.2, p < 0.01 and 6.2, p < 0.05, respectively), day 2 (3.0 vs 4.7, p < 0.01 and 4.8, p < 0.001, respectively), day 3 (2.0 vs 3.9, p < 0.001 and 3.5, p < 0.001, respectively), day 4 (1.1 vs 3.1, p < 0.001 and 2.9, p < 0.001, respectively), and day 5 (0.7 vs 2.3, p < 0.001 and 2.4, p < 0.001, respectively). The total consumption of morphine equivalents per day was similar between the DNS and PCA groups (142.8 ± 7.3 mg vs 137.7 ± 70.0 mg, p = 0.8032) and lowest in the CA group (11.7 ± 30.7 mg, p < 0.0001). The overall safety profile was comparable between the DNS, PCA, and CA groups. The patients in the DNS group complained less of dizziness postoperatively than those in the PCA group (27% vs 47%) and had less nausea than those in the CA group (13% vs 33%). Conclusion A single DNS injection was more effective for relieving POP than PCA and CA in the patients who had a longitudinal incision for gynecologic cancer surgery. DNS was well tolerated and had less adverse effects than PCA and CA.
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Affiliation(s)
- Shu-Han Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
| | - Ting-Chang Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan.,Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Min-Yu Chen
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
| | - Wei-Chun Chen
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan.,Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Keelung Branch, Keelung, Taiwan
| | - Hung-Hsueh Chou
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan.,Chang Gung University, College of Medicine, Taoyuan, Taiwan
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Newhook TE, Aloia TA. Guide to Enhanced Recovery for Cancer Patients Undergoing Liver Surgery. Ann Surg Oncol 2021; 28:6970-6973. [PMID: 33851311 DOI: 10.1245/s10434-021-09954-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/19/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Timothy E Newhook
- Department of Surgical Oncology Unit 1484, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Thomas A Aloia
- Department of Surgical Oncology Unit 1484, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Elango M, Papalois V. Working towards an ERAS Protocol for Pancreatic Transplantation: A Narrative Review. J Clin Med 2021; 10:1418. [PMID: 33915899 PMCID: PMC8036565 DOI: 10.3390/jcm10071418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 03/24/2021] [Accepted: 03/27/2021] [Indexed: 12/11/2022] Open
Abstract
Enhanced recovery after surgery (ERAS) initially started in the early 2000s as a series of protocols to improve the perioperative care of surgical patients. They aimed to increase patient satisfaction while reducing postoperative complications and postoperative length of stay. Despite these protocols being widely adopted in many fields of surgery, they are yet to be adopted in pancreatic transplantation: a high-risk surgery with often prolonged length of postoperative stay and high rate of complications. We have analysed the literature in pancreatic and transplantation surgery to identify the necessary preoperative, intra-operative and postoperative components of an ERAS pathway in pancreas transplantation.
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Affiliation(s)
- Madhivanan Elango
- Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK;
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15
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Qian J, Qian M, Ren Y, Ye L, Qian F, Jin L, Chen L, Xu H. Readiness for hospital discharge and influencing factors: a cross-sectional study on patients discharged with tubes from the department of hepatobiliary surgery. BMC Surg 2021; 21:121. [PMID: 33685424 PMCID: PMC7941921 DOI: 10.1186/s12893-021-01119-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 02/23/2021] [Indexed: 11/16/2022] Open
Abstract
Background To investigate the readiness for hospital discharge of patients discharged with tubes from the department of hepatobiliary surgery and to explore the influencing factors. Methods A cross-sectional survey was conducted for the 161 patients with tubes who were discharged from the department of hepatobiliary surgery of Shaoxing Second Hospital by using the modified Chinese version of Readiness for Hospital Discharge Scale (RHDS) and Quality of Discharge Teaching Scale (QDTS). General data of the patients, such as gender, age, BMI (body mass index), and educational level, were collected. Results According to the statistical results, the total score of the RHDS was 142.40 ± 23.98, and that of the QDTS was 148.14 ± 17.74. Multiple linear step-wise regression analysis revealed that the total score of the QDTS, residence and educational level were the independent influencing factors of the readiness for hospital discharge (p < 0.05). Conclusion The level of the readiness for hospital discharge of the 161 discharged patients with tubes from the department of hepatobiliary surgery was in the middle and lower level. For the patients who are far away from the hospital and have a low education level, we should pay more attention to health education and discharge teaching, so as to improve the readiness for hospital discharge of relatively vulnerable patients, reduce the incidence of adverse events after discharge with tubes, and ensure the health and safety of patients.
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Affiliation(s)
- Jingyu Qian
- Department of Hepatobiliary Surgery, Shaoxing Second Hospital, Zhejiang, Shaoxing, China
| | - Miaofang Qian
- Department of Hepatobiliary Surgery, Shaoxing Second Hospital, Zhejiang, Shaoxing, China
| | - Yanyan Ren
- Department of Hepatobiliary Surgery, Shaoxing Second Hospital, Zhejiang, Shaoxing, China
| | - Linyan Ye
- Department of Hepatobiliary Surgery, Shaoxing Second Hospital, Zhejiang, Shaoxing, China
| | - Fangfang Qian
- Department of Operation Rooms, Shaoxing People's Hospital, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Zhejiang, Shaoxing, China
| | - Linlin Jin
- Department of Operation Rooms, Shaoxing People's Hospital, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Zhejiang, Shaoxing, China
| | - Lili Chen
- Department of Operation Rooms, Shaoxing People's Hospital, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Zhejiang, Shaoxing, China
| | - Haixia Xu
- Department of General Surgery, Shaoxing People's Hospital, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), 568 Zhongxing North Road, Shaoxing, 312000, Zhejiang, China.
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Patel S, Suz P, Powers BD, Anaya DA. Epidural analgesia for hepatopancreatobiliary operations and postoperative urinary tract infections: an unrecognized association of "best-practices" and adverse outcomes. HPB (Oxford) 2021; 23:71-79. [PMID: 32414659 DOI: 10.1016/j.hpb.2020.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/03/2020] [Accepted: 04/20/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Thoracic epidural analgesia (TEA) is considered "best-practices" for pain-control following HPB operations. It is unknown if TEA increases the risk of UTI. We sought to examine the association of TEA and UTI following HPB operations. METHODS A retrospective cohort study of patients undergoing elective HPB operations was performed (ACS-NSQIP [2014-2016]). Patients were categorized by TEA utilization. The primary outcome was UTI. Multivariable logistic regression models were created to examine the association of TEA with UTI; including sensitivity and interaction analyses for age and gender. RESULTS Among 28,571 patients included, 5764 (20.2%) had TEA. UTI occurred more frequently with TEA (3.5% vs. 2.2%, p < 0.01). After multivariable analysis, TEA was associated with increased risk of UTI (1.59 [1.34-1.89]); when stratified by age and gender, the association persisted with an incremental increased risk observed in males over 70 years (1.91 [1.41-2.59]). UTI was associated with increased risk of sepsis (16.8% vs. 5.6%, P < 0.001), LOS (9 versus 6 days, P < 0.001) and readmission rates (21.4% vs. 12.3%, P < 0.001). CONCLUSION Despite TEA recommended as a best-practice standard for HPB operations, the increased risk of UTI calls for evaluation of current practices and consideration of alternative strategies for high-risk vulnerable populations - elderly males.
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Affiliation(s)
- Sephalie Patel
- Department of Anesthesiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Pilar Suz
- Department of Anesthesiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Benjamin D Powers
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Daniel A Anaya
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.
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Gabel SA, Morrison ZD, Sharma R, Wernberg JA. Resident Participation as Co-Surgeon Does Not Adversely Impact Patient Outcomes in Pancreatic Surgery. JOURNAL OF SURGICAL EDUCATION 2020; 77:1528-1533. [PMID: 32457000 DOI: 10.1016/j.jsurg.2020.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/13/2020] [Accepted: 04/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE In academic settings, surgical residents often serve as co-surgeon in complex operations such as pancreatic resections. These operations are typically performed by fellowship-trained primary surgeons with extensive experience in the field. Our study aimed to evaluate how the participation of general surgery residents in these complex operations affected patient outcomes. Our hypothesis was that resident involvement as co-surgeon would not adversely impact key patient outcomes including complications, readmission, and mortality. DESIGN A REDCap database of perioperative variables for patients undergoing pancreatic resection was established at a single independent academic medical center. The database was populated via retrospective chart review. Patient demographics, surgical indications, operative time, estimated blood loss, postoperative hospital length of stay, intensive care unit length of stay, postoperative complications, and 30- and 90-day survival for patients with and without cancer were reviewed. We further categorized the data based on the designation of a general surgery resident or a second staff surgeon as co-surgeon in each operation. SETTING The study was performed at the Marshfield Clinic Health System-Marshfield Medical Center, an independent academic medical center located in central Wisconsin. PARTICIPANTS Data were abstracted from the medical records of all adult patients (18 years of age and older) who underwent pancreatic resection from 2007 to 2018 (n = 173). RESULTS 173 pancreatic resections were performed by 8 different primary staff surgeons over 10.5 years. All co-surgeons were either another staff surgeon or a senior-level (postgraduate year 4 or 5) general surgery resident. Perioperative and postoperative patient outcomes were statistically similar in both groups. CONCLUSIONS Resident involvement as co-surgeon in complex pancreatic resections constituted no increased risk for patients at our institution. Senior residents should continue to operate on these important learning cases under appropriate staff supervision.
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Affiliation(s)
- Shelley A Gabel
- Department of General Surgery - Oncology, Marshfield Clinic Health System, Marshfield Medical Center, Marshfield, Wisconsin
| | - Zachary D Morrison
- Department of General Surgery - Oncology, Marshfield Clinic Health System, Marshfield Medical Center, Marshfield, Wisconsin
| | - Rohit Sharma
- Department of General Surgery - Oncology, Marshfield Clinic Health System, Marshfield Medical Center, Marshfield, Wisconsin
| | - Jessica A Wernberg
- Department of General Surgery - Oncology, Marshfield Clinic Health System, Marshfield Medical Center, Marshfield, Wisconsin.
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Navarro-Martínez S, Sebastián-Tomás JC, Diez Ares JÁ, Peris Tomás N, Periañez Gómez MD, Martínez Mas E, Trullenque Juan R, Armañanzas Villena E. Enhanced recovery after bariatric surgery (ERABS) protocol implementation in a laparoscopic center. MINIM INVASIV THER 2020; 31:269-275. [PMID: 32716664 DOI: 10.1080/13645706.2020.1796708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Enhanced recovery after bariatric surgery (ERABS) protocols consist of a combination of several preoperative, intraoperative and postoperative methods for the management of the surgical patient. The aim of this study was to evaluate the impact of the ERABS protocol on length of hospital stay (LOS) and postoperative complications. MATERIAL AND METHODS Retrospective study of patients who underwent elective Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) between 2015 and 2018. From 2015 to 2017, patients received traditional management (pre-ERABS group). Those who underwent surgery during 2018 were managed with our ERABS protocol (ERABS group). The primary outcome was LOS. Secondary outcomes were readmission rate and 30-day postoperative complications. RESULTS A total of 200 patients who received RYGB and SG between 2015 and 2018 were retrospectively analyzed; we included 120 patients in the pre-ERABS group and 80 in the ERABS group. The median LOS was four days [2-49] in the pre-ERABS group, as compared with two days [1-26] in the ERABS group (p < .0001). No significant differences were found in postoperative complication rates, readmissions, and mortality. CONCLUSION Implementation of the ERABS protocol is related to a better postoperative recovery and allows an early discharge without increasing postoperative complications, readmissions or mortality.
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Affiliation(s)
| | | | - José Ángel Diez Ares
- Department of Digestive Surgery, Doctor Peset University Hospital, Valencia, Spain
| | - Nuria Peris Tomás
- Department of Digestive Surgery, Doctor Peset University Hospital, Valencia, Spain
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Lillemoe HA, Newhook TE, Aloia TA, Grubbs EG, Chang GJ, Katz MHG, Vauthey JN, Lee JE, Tzeng CWD. Perceptions of opioid use and prescribing habits in oncologic surgery: A survey of the society of surgical oncology membership. J Surg Oncol 2020; 122:1066-1073. [PMID: 32632993 DOI: 10.1002/jso.26106] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 06/27/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND The objective of this study was to assess current perceptions surrounding opioid prescribing in surgical oncology to inform perioperative quality improvement initiatives. METHODS After the Society of Surgical Oncology (SSO) approval, a survey was distributed to its membership. Five sample procedures were used to assess provider perceptions and prescribing habits. Data were summarized and compared by self-reported demographics. RESULTS One hundred and seventy-five participants completed the survey: 149 (85%) faculty, 24 (14%) trainees, and 2 (1%) advanced practice providers. Most participants (76%) practiced in academic programs and 21% practiced in non-US locations. Few differences were identified based on clinical role, academic rank, or practice years. Compared with non-US providers, US providers expected higher pain scores at discharge, recommended greater opioid prescriptions, and estimated more days of opioid use for almost every procedure. More non-US providers believed discharge opioids should not be distributed to patients who are opioid-free in their last 24 inpatient hours (80% vs 50%, P = .001). All providers ranked education as "very important" for reducing opioid prescriptions. CONCLUSIONS Compared with their international counterparts, US surgical oncology providers expected greater opioid needs and recommended higher prescription numbers. Educating providers on multimodal opioid-sparing bundles, accelerated weaning protocols, and standardized discharge prescribing habits could have a positive impact the US opioid epidemic.
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Affiliation(s)
- Heather A Lillemoe
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Timothy E Newhook
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Thomas A Aloia
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Elizabeth G Grubbs
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - George J Chang
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Matthew H G Katz
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey E Lee
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ching-Wei D Tzeng
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Fung AKY, Chong CCN, Lai PBS. ERAS in minimally invasive hepatectomy. Ann Hepatobiliary Pancreat Surg 2020; 24:119-126. [PMID: 32457255 PMCID: PMC7271107 DOI: 10.14701/ahbps.2020.24.2.119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/23/2020] [Accepted: 01/29/2020] [Indexed: 02/07/2023] Open
Abstract
Open hepatectomy is associated with significant post-operative morbidity and mortality profile. The use of minimally invasive approach for hepatectomy can reduce the post-operative complication profile and total length of hospital stay. Enhanced recovery after surgery (ERAS) programs involve evidence-based multimodal care pathways designed to achieve early recovery for patients undergoing major surgery. This review will discuss the published evidence, challenges and future directions for ERAS in minimally invasive hepatectomy.
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Affiliation(s)
- Andrew K Y Fung
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Charing C N Chong
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Paul B S Lai
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
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Duzgun O. Evaluation of Enhanced Recovery After Following a Surgical Protocol for Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis. Med Arch 2020; 73:331-337. [PMID: 31819307 PMCID: PMC6885212 DOI: 10.5455/medarh.2019.73.331-337] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Introduction: Cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy (CRS ± HIPEC) has positive effects on the survival of patients with peritoneal carcinomatosis (PC) due to intra-abdominal tumors. Currently, the available literature on the safety of the Enhanced Recovery After Surgery (ERAS) protocol for PC, which is associated with severe morbidity and mortality, is insufficient. Aim: This study aimed to present our results from treating patients using the ERAS protocol for PC that developed due to intra-abdominal tumors. Material and Methods: The data of 120 consecutive patients with PC due to different etiologies of abdominal origin and who underwent CRS ± HIPEC were analyzed. The patients were divided into two groups according to whether the ERAS protocol was applied. Information on demographics, length of hospital stay, cost, morbidity, and mortality was statistically compared between groups. Results: A total of 102 patients were included in the study. The first 40 patients did not undergo the ERAS protocol, whereas 62 patients did undergo the protocol. The mean length of hospital stay was 10 days in the non-ERAS group and 7 days in the ERAS group. The ERAS group was observed to have earlier mobilization, earlier gas and stool release, lower oral intake, and fewer respiratory problems than the non-ERAS group. Conclusion: CRS ± HIPEC has a positive effect on survival. The simultaneous application of the ERAS protocol with the aforementioned procedure has positive effects on intestinal motility and postoperative outcomes. In addition, this protocol may reduce costs by shortening the length of hospital stay.
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Affiliation(s)
- Ozgul Duzgun
- Department of Surgical Oncology, Health Sciences University, Umraniye Training and Research Hospital, Umraniye/Istanbul, Turkey
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Abstract
OBJECTIVES The value of robotic pancreaticoduodenectomy (RPD) remains undefined. The aim of this retrospective study was to compare and assess clinical outcomes and financial variables of patients undergoing RPD versus open pancreaticoduodenectomy (OPD) at a single high-volume center. METHODS The study design is a retrospective analysis of a prospectively maintained database of consecutive PD patients from 2013 to 2019. Clinical variables and total hospital charges were evaluated as an unadjusted and adjusted intention-to-treat analysis. RESULTS A total of 156 patients (54 OPD, 102 RPD) were identified. In the RPD group, patients were significantly older (P = 0.0304) and had shorter length of stay (mean, 7 vs 11.8 days; P < 0.0001) and longer operative times (mean, 352.7 vs 211.5 minutes; P < 0.0001) compared with OPD. There was no significant difference in 90-day readmissions, bleeding, or complications between OPD and RPD. Adjusted charge analyses show no difference in total charges (P = 0.057). CONCLUSIONS Robotic pancreaticoduodenectomy is safe, feasible, and valid alternative to OPD. Because of comparable results within each group, randomized trials may be indicated. High-volume RPD centers should collaborate to better understand the differences and advantages over laparoscopic or OPD.
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Elsarrag M, Soldozy S, Patel P, Norat P, Sokolowski JD, Park MS, Tvrdik P, Kalani MYS. Enhanced recovery after spine surgery: a systematic review. Neurosurg Focus 2020; 46:E3. [PMID: 30933920 DOI: 10.3171/2019.1.focus18700] [Citation(s) in RCA: 134] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 01/25/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVEEnhanced recovery after surgery (ERAS) is a multidimensional approach to improving the care of surgical patients using subspecialty- and procedure-specific evidence-based protocols. The literature provides evidence of the benefits of ERAS implementation, which include expedited functional recovery, decreased postoperative morbidity, reduced costs, and improved subjective patient experience. Although extensively examined in other surgical areas, ERAS principles have been applied to spine surgery only in recent years. The authors examine studies investigating the application of ERAS programs to patients undergoing spine surgery.METHODSThe authors conducted a systematic review of the PubMed and MEDLINE databases up to November 20, 2018.RESULTSTwenty full-text articles were included in the qualitative analysis. The majority of studies were retrospective reviews of nonrandomized data sets or qualitative investigations lacking formal control groups; there was 1 protocol for a future randomized controlled trial. Most studies demonstrated reduced lengths of stay and no increase in rates of readmissions or complications after introduction of an ERAS pathway.CONCLUSIONSThese introductory studies demonstrate the potential of ERAS protocols, when applied to spine procedures, to reduce lengths of stay, accelerate return of function, minimize postoperative pain, and save costs.
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