[Enhanced Lung Recovery after Surgery, Is It A Necessary for Precision Therapy?]

[Application of Precision Nursing Based on Multidisciplinary Collaboration Model in Older Patients Undergoing Thoracoscopic Surgery for Lung Cancer]

Objective

To examine the application effect of precision nursing strategies based on multidisciplinary collaboration model in older patients undergoing thoracoscopic surgery for lung cancer.

Methods

A total of 100 patients who were admitted to our hospital for thoracoscopic surgery for lung cancer between July 2022 and March 2023 were prospectively enrolled for the study. They were assigned, with a random number table, to two groups, a control group receiving routine nursing care and an experimental group receiving nursing care based on multidisciplinary collaborative precision nursing strategies. Their lung function, anxiety and depression scores, and quality of life were assessed at three points of time, including upon admission, one week after surgery, and one month after surgery, and comparison was made between the two groups.

Results

There were significant differences in forced expiratory volume in one second (FEV1) at the three time points ( F=156.787, P<0.001) and the ratio of FEV1 to forced vital capacity (FVC) (FEV1/FVC%) at the three time points ( F=25.587, P<0.001) between two groups. There were significant difference between the findings for FEV1, FEV1/FVC%, FVC, and maximum voluntary ventilation (MVV) indexes at 1 week and those at 1 month after surgery in the experimental group ( P<0.05). After the surgery, the pulmonary function of the experimental group was better than that of the control group. The anxiety and depression scores of the experimental group were lower than those of the control group, with the difference being statistically significant ( P<0.05), which suggested that the experimental group showed improvement in anxiety and depression in comparison with the control group. Regarding the quality of life, there were significant differences between the two groups in the scores for the functional dimension ( F=109.798, P<0.001), the symptom dimension ( F=106.936, P<0.001), other items ( F=78.798, P<0.001), and overall health dimensions ( F=174.307, P<0.001). At 1 week and 1 month after surgery, the experimental group had higher scores for the functional dimension and lower scores for the symptom dimension than the control group did, with the differences being statistically significant ( P<0.05). The overall health status of the experimental group was better than that of the control group.

Conclusion

Precision nursing strategies based on multidisciplinary collaboration model can effectively help improve the lung function, the mood, and the quality of life of patients in the short term, showing considerable promise for wide clinical application.

[Investigation and Analysis of the Implementation Status of Enhanced Recovery After Surgery in the Context of Precision Nursing in Xinjiang]

Objective

To investigate the current status of surgical nurses' implementation of enhanced recovery after surgery (ERAS) concepts in the context of precision nursing in Xinjiang and to provide a basis for the development of precision nursing of ERAS.

Methods

By way of convenience sampling, surgical nurses from 8 tertiary-care hospitals were involved in a survey on their ERAS implementation status in March and April 2023 and the results were collected by online questionnaire.

Results

A total of 985 valid questionnaires were collected. Out of the 8 hospitals covered in the survey, the orthopedics departments of 7 hospitals have implemented ERAS concepts, accounting for 87.50%. The average score for the ERAS Knowledge, Attitude, and Practice Questionnaire among the surgical nurses was (182.98±17.69), of which, the average score for ERAS knowledge was (13.08±1.51), the average score for ERAS attitude was (88.75±8.30), and the average score for ERAS practice was (81.15±11.96). A total of 61.02% of the surgical nurses implemented ERAS pathways that concentrated on 4-6 pathways, with the prevention of postoperative ileus after surgery being the most commonly implemented pathway, accounting for 498 (50.56%) surgical nurses. A total of 78.48% of the nurses considered work overload to be the most important obstacle to implementing ERAS in the context of precision nursing. Poor multidisciplinary team collaboration and poor awareness of implementation among the nurses ranked the second and the third, accounting for 74.92% and 71.57%, respectively, of the surgical nurses.

Conclusion

ERAS has won the approval of surgical nurses in Xinjiang, but it is still not widely implemented in all surgical fields. In addition, the quantity and quality of ERAS pathways implemented still need to be further improved. The development of ERAS in the context of precision nursing remains a long-term challenge.

[The Present Situation and Prospect of Day Surgery and Enhanced Recovery after Surgery in Thoracic Surgery]

The good results of enhanced recovery after surgery (ERAS) combined with minimally invasive surgery are reflected in reducing the incidence of perioperative complications and shortening the length of hospitalization (LOS). It has been widely used in surgical fields of different specialties. The implementation of the day surgery mode can shorten the waiting time for patients and reduce the financial burden. Especially in thoracic surgery, the shorter the waiting time in the hospital, the more beneficial for the patient's physical and psychological recovery. With the widespread implementation of minimally invasive technology and accelerated rehabilitation procedures, the application of ERAS in thoracic surgery has made it possible for some thoracic surgery to be completed in the day surgery. This article summarizes the current application of ERAS in the field of thoracic surgery and the development prospects of day surgery models in China.

[Proper Selection of Enhanced Recovery after Surgery Programs between the Medical Service and Medical Intervence - Is It Time to Do?]

加速康复外科（enhanced recovery after surgery, ERAS）理念诞生与微创外科技术进步密切相关。ERAS发展过程中利用技术，又融入人文因素，使其高于技术，而丰富ERAS的内涵和外延。结合近年ERAS在外科各领域的进展，总结ERAS临床应用的现状与策略：一是微创技术进步使ERAS理念的临床应用成为必然；二是外科学理论与技术的发展，深入与扩大了ERAS的内涵与外延；三是ERAS临床应用需要我们更新观念；四是ERAS的临床实践需要在医疗服务和医疗干预之间合理选择；五是ERAS临床应用加减之间应用的现实问题与策略。从而深入理解ERAS的真正临床意义，更好地指导临床实践。

[Evaluation Index of Enhanced Recovery After Surgery: Status and Progress of Patient Report Outcomes in Thoracic Surgery]

加速康复外科临床应用的良好效果体现在降低围手术期并发症的发生率并缩短住院时间，但对围术期的患者症状管理及术后患者生活质量的关注不够高。从患者报告的资料角度评估临床疗效越来越受到重视。结合目前国内外关于病人报告结局的研究成果，本文系统论述了病人报告结局的概念内涵、研究意义及在胸外科的临床应用现状，提出借鉴国外病人报告的临床结局研究模式，开展有中国特色的结合学科特点的相关研究，并对已有的文献报告进行总结及分析。

[What is Enhanced Recovery After Surgery: Humanity or Technology?]

The development of surgical techniques and the innovation of surgical instruments promote the changes in surgical methods, which in turn, leads to the reforms of surgical idea. The concept of enhanced recovery after surgery (ERAS) results in the surgery connotation switching from "to treat an illness" to "to save patients". ERAS also causes the change of surgery denotation from "only operation" to "enhance recovery". The concept of ERAS is derived from but not only restricted to the development of surgical techniques. Also, ERAS pays more attention to patients than disease and thinks more about patient safety and recovery than surgical technique. Specifically, ERAS has three advantages: first, ERAS attaches importance to multidisciplinary assessment (patient-oriented) and select appropriate (personalized) treatment and tries to decrease the rate of complication and mortality. Second, ERAS pays attention to preoperative preparation and high-risk prevention performed by multi-disciplinary collaboration in order to prevent complication and save cost for patients. Third, ERAS always focus on optimizing the process of perioperative period and trying to change the working habits of surgeons and the old cooperation mode among doctors, nurses and rehabilitation physicians. To sum up, the goal is to apply the concept of ERAS to all the links of perioperative period and try hard to decrease patients' stress and pain, which finally helps doctors fulfill the ultimate aims of "no pain and no risk".
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[Establishment and Optimization of Enhanced Recovery after Surgery System for Lung Cancer]

加速康复外科（enhanced recovery after surgery, ERAS）理念应用于不同疾病及学科均有其相应的关键技术及流程与体系。肺癌微创外科的核心是加速肺康复（enhanced lung recovery after surgery, ELRAS），而加速肺康复的关键技术是气道管理和肺保护。气道管理和肺保护的实现需要医、护、康一体及多学科协作，从而形成肺癌患者加速肺康复的完整体系。主要包括以下几方面：一是ERAS方案实施的各个环节均有准确、客观的评估体系；二是ERAS方案简单、易行且具有可重复性；三是ERAS方案临床应用效果具有精准严谨评价体系；四是以问题为导向的团队架构。总之，加速肺康复外科体系需要在临床实践中不断优化与完善。