Impact of Patient's Pain and Fatigue on Decision of Discharge After Laparoscopic Surgery for Colorectal Cancer

Effect of Lavender Aromatherapy on Anxiety and Fatigue in Hemodialysis Patients: A Systematic Review and Meta-Analysis

Background

Several studies have evaluated the effects of lavender essential oil on the anxiety of hemodialysis (HD) patients, but most of them did not estimate the pooled effect size. The current systematic review and meta-analysis was conducted to evaluate the effects of lavender on anxiety and fatigue among HD patients.

Methods

Eligible studies were selected based on the PRISMA steps and protocol. Literature was retrieved from PubMed, Web of Science, Scopus databases, Cochrane, ClinicalTrials.gov, and Google Scholar Search Engines until Sep 2022. The risk of bias and analysis were evaluated using version 2 of the Cochrane risk-of-bias tool and STATA v.14 software, respectively. Effect sizes were pooled using random effect models.

Results

Nine studies were included. Lavender oil significantly reduced the average anxiety of HD patients compared to the control group (SMD: -2.51, 95% CI: [-3.56, -1.45], Z=4.67, P<0.001, I2 :89.9%). Also, it significantly reduced the average fatigue compared to the control group (SMD: -1.56, 95% CI: [-2.49, -0.63], Z=3.29, P=0.001, I2:92.2%). Subgroup analysis indicated controversial results regarding session frequency and drop number of lavender oil.

Conclusion

Using Lavender oil significantly reduced fatigue and anxiety in HD patients.

The Impact of an Enhanced Recovery Protocol in a High-Risk Population Undergoing Colon Cancer Surgery

OBJECTIVE

Enhanced Recovery ERP protocols (ERP) have improved surgical outcomes in patients undergoing elective colon cancer (CC) surgery; however, efficacy in different populations may vary. We examined the impact of an ERP in a population with high rates of obesity and multiple comorbidities.

METHODS

We performed a retrospective analysis of factors associated with postoperative complications (PoC) and length of stay (LOS) following CC surgery from 2011 to 2019 in a 5-hospital healthcare system which serves a population with higher rates of obesity (body mass index ≥30kg/m2) and multi-comorbidities, as compared to published studies. Univariable and multivariable analyses were performed.

RESULTS

A total of 408 elective CC surgery patients with complete oncologic surgical data were identified. Of these, 191 (46.81%) were under ERP. Factors independently associated with PoC included obesity (OR=1.66, P=.029), laparoscopic (OR=.52, P=.020), and hybrid (OR=.38, P=.012) versus open surgery and ASA (American Society of Anesthesiologists) class ≥3 (OR=1.98, P=.006). ERP did not impact PoC but was associated with a reduction in LOS (β=-1.02 days, 95%CI: -1.75 - -.30, P=.006). ERP had an impact on LOS in both the non-obese and obese groups (P<.001 and P=.034, respectively). PoC significantly increased LOS (β=6.67 days, 95%CI: 5.41-7.03, P<.001).

CONCLUSIONS

Following elective CC surgery, obesity and medical comorbidities were associated with increased PoC and in turn, as expected, increased LOS. ERP was associated with a reduction in LOS in both obese and non-obese patients. In high-risk populations, application of ERP may be particularly important to optimize surgical outcomes following CC surgery.

Effectiveness of Aromatherapy on Ameliorating Fatigue in Adults: A Meta-Analysis

Background

Fatigue is a common symptom in adults that may cause physical and psychological problems and reduce quality of life. Aromatherapy could possibly provide relief for those suffering from fatigue. Here, we evaluated the effect of aromatherapy on fatigue in adults.

Methods

We searched the PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Chinese Biomedical Literature, SinoMed, Wanfang, and Chinese Scientific Journal Database databases for randomized controlled trials of aromatherapy treatment for fatigue in adults from their inception to June 2021. Two reviewers searched independently, extracted the characteristics of the studies, and assessed the risk of bias using the Cochrane risk-of-bias tool and Stata v. 14.0.

Results

Nineteen studies were included in this systematic review. Aromatherapy had a significant effect on fatigue (standardized mean difference −0.64, 95% confidence interval−1.14, −0.15, I² 94.4%, P < 0.001). Subgroup analysis according to aromatic type, substance, frequency, treatment duration, intervention, outcomes measurement, and population type showed that aromatherapy had a significantly greater effect in the intervention group, compared to the control group. Funnel plots and Egger's test indicated no significant publication bias.

Conclusion

Our results suggest that aromatherapy ameliorates fatigue in adults who suffer from chronic diseases. A rigorous intervention program and larger randomized controlled trials are needed.

Reducing hospital stay for colorectal surgery in ERAS setting by means of perioperative patient education of expected day of discharge

PURPOSE

Despite the enhanced recovery after surgery (ERAS) protocol, length of stay (LOS) after colorectal surgery varies considerably. The majority of longer admissions is often not medically necessary. We aimed to investigate possible reduction of LOS by perioperative education with an expected discharge date (EDD).

METHODS

This single-centre retrospective study included 578 patients who underwent surgery for colorectal cancer in 2016 with standard care (ERAS) and in 2018 with the addition of EDD education program (ERAS+). A comparison was made of a 1-year period prior to and following the implementation of EDD. The EDD was discussed at the outpatient clinic, preoperatively and during admission (with both the patient and family members daily). Standard EDD varied between 3 and 5 days depending on the resection type. Primary outcome was LOS; secondary outcomes were readmission, serious complications and 90-day mortality.

RESULTS

Patients in ERAS+ (n = 242) had a shorter median LOS (4.0 vs. 5.0, p < 0.001) compared to patients in the regular ERAS group (n = 336). Fewer patients of ERAS+ experienced postoperative complications (71 (29.3%) vs. 198 (58.9%), p < 0.001). No difference was found in the number of readmissions (23 (9.5%) vs. 34 (10.1%), p = 0.807), reinterventions (25 (10.3%) vs. 30 (8.9%), p = 0.571) or mortality (5 (2.1%) vs. 9 (2.7%), p = 0.261) between the two groups.

CONCLUSION

It is possible to reduce LOS within the ERAS program, by better perioperative education and expectation management of patients with use of an EDD. This program ensures better understanding, faster discharge and lower costs for the hospital without added risk of readmissions or complications.