The health status, health needs and demands as well as the concept of health itself have changes dramatically in the last one hundred years, the organizational and institutional evolutions of health system took place accordingly. To adapt the changes of health system, medical education has experienced three generations of major reform in the last century: the science-based curricula, problem-based instruction, system-based and competence-oriented education. At the same time the organization of medical education evolved from academic medicine to academic health center to academic health system. This article briefly describes the process of this evolution and presents author’s personal views on academic health system.
Objective To evaluate the association between intraoperative fluid management and prolonged postoperative ileus (PPOI) after colorectal surgery. Methods We reviewed the data of 980 patients who underwent elective colorectal surgery in West China Hospital of Sichuan University between July and December 2016. The primary outcome was PPOI. The association of intraoperative fluid volume and fluid balance with PPOI were analyzed. Results Nine hundred and eighty patients undergoing elective colorectal surgery were included, and the incidence of PPOI was 31.1% (305/980). Compared with non-PPOI patients, patients with PPOI had longer postoperative hospital stay and increased total hospital cost (P<0.05). Multivariate logistic regression analysis did not find intraoperative fluid volume and fluid balance were associated with PPOI in patients undergoing colorectal surgery (P>0.05). Conclusions There is no clinically relevant association between intraoperative fluid management and PPOI in adult patients underwent colorectal surgery. However, the occurrence of PPOI may prolong postoperative hospital stay and increase hospitalization cost.
Cardiac surgery has always been one of the major specialties in the development of “fast track surgery”. Enhanced recovery after surgery (ERAS) has become a widespread topic in perioperative medicine over the past 20 years, and it results in substantial improvements in clinical outcomes and cost savings. This frontier concept has also been increasingly applied and promoted in cardiac surgery. However, compared with other surgical fields, current studies regarding cardiac surgery are still limited in quantity, scale and universality of application. Therefore, this review focuses on current concept and progress of ERAS in adult patients undergoing cardiac surgery with cardiopulmonary bypass, aiming to provide guidance for the establishment of a better framework.
ObjectiveTo explore the incidence and influencing factors of moderate-to-poor quality of recovery (QoR) in patients undergoing minimally invasive esophagectomy (MIE). MethodsA secondary analysis was conducted based on data from a randomized controlled study on the effects of different anesthesia methods on postoperative pulmonary complications after MIE. Patients who underwent elective MIE at West China Hospital of Sichuan University from May 2019 to December 2021 were included. The QoR-15 scale was used to assess the QoR 30 days postoperatively, and logistic regression analysis was performed to identify factors affecting moderate-to-poor QoR (defined as a QoR-15 score≤121). ResultsA total of 541 patients were included, including 426 males and 115 females, with an average age of (63.0±8.3) years. At 30 days postoperatively, the numbers of patients with excellent, good, moderate, and poor QoR were 101 (18.7%), 273 (50.5%), 147 (27.2%), and 20 (3.7%), respectively. Multivariate logistic regression analysis indicated that preoperative pain [OR=1.527, 95%CI (1.032, 2.258), P=0.034] and a nutrition risk screening-2002 score≥3 [OR=1.617, 95%CI (1.069, 2.447), P=0.023] were influencing factors for moderate-to-poor QoR 30 days postoperatively. ConclusionAbout 30.9% of patients undergoing MIE have a moderate-to-poor QoR 30 days postoperatively. Improving preoperative pain management and nutritional status may enhance postoperative QoR.
Objective To analyze the incidence and possible risk factors of the chronic postsurgical pain (CPSP) in patients undergoing cardiac surgery with cardiopulmonary bypass via median sternotomy. Methods A total of 248 cardiac surgery patients (104 males, 144 females with age of 20–74 years) were enrolled in this single-center, prospective observational study. The severity of acute postoperative pain at first 7 days was evaluated by numeric rating scale (NRS) and pain at 30 days after surgery and CPSP at 3 and 6 months after surgery was evaluated with modified brief pain inventory. Results The CPSP at postoperative 6 months occurred in 45.2% (112/248) patients and 24.1% of them suffered moderate to severe pain (NRS≥4). The CPSP at postoperative 3 months occurred in 60.9% (151/248) patients and 25.8% of them suffered moderate to severe pain. Moderate to severe postoperative pain at postoperative 30 days and 3 months, and intraoperative remifentanil infusion were the risk factors of the CPSP at postoperative 6 months. Conclusion CPSP is common in patients undergoing cardiac surgery with median sternotomy. Moderate to severe postoperative pain at 30 days and 3 months, and intraoperative remifentanil infusion can predict the presence of CPSP at 6 months.
[Abstract]The number of lung transplantation is gradually increasing worldwide, which brings new challenges to the multi-disciplinary team of lung transplantation. The prognosis of lung transplant recipients is seriously affected by the pathophysiological state of specific lung diseases and perioperative risk factors. It is of great significance for these patients to optimize perioperative management according to these factors. Recently, several expert consensus have been published regarding anesthesia management of lung transplantation. Based on the current evidence and clinical practice of West China Hospital, this review summarizes the key points of anesthesia management for lung transplant recipients to guide anesthesiologists' clinical practice.
Lidocaine is an amide local anaesthetic. In recent years, clinical evidence shows that perioperative intravenous lidocaine injection plays an active role in anti-inflammation, analgesia, anti-tumor and organ protection. Postoperative pain is severe in patients after thoracic surgery, and the incidence of pulmonary complications and cognitive impairment is high. These adverse reactions and complications are closely related to the inflammatory reaction after thoracic surgery. Intravenous infusion of lidocaine may have some effects on alleviating these adverse reactions and complications. Thus, this article reviews the current status of intravenous lidocaine injection in thoracic surgery and explores the related mechanisms to optimize the management of anaesthesia during the perioperative period of thoracic surgery.
Objective To summarize the research progress of acute kidney injury after liver transplantation. Method The literatures on acute kidney injury after liver transplantation was collected and reviewed. Results Acute kidney injury after liver transplantation was associated with multiple risk factors. Early prevention and treatment of risk factors in perioperative period was the main measure to reduce acute kidney injury after liver transplantation. Early postoperative diagnosis and timely intervention could reduce the incidence of chronic kidney disease and improve the long-term prognosis of liver transplantation recipients. Conclusion Acute kidney injury is a common complication after liver transplantation which affects prognosis and long-term survival of patients.
ObjectiveTo evaluate the correlation between positive end-expiratory pressure (PEEP) level and postoperative pulmonary complications (PPCs) in patients undergoing thoracoscopic lung surgery. MethodsThe clinical data of patients who underwent elective thoracoscopic lung surgery at West China Hospital of Sichuan University from January 2022 to June 2023 were retrospectively analyzed. Patients were divided into 2 groups according to intraoperative PEEP levels: a PEEP 5 cm H2O group and a PEEP 10 cm H2O group. The incidence of PPCs in the two groups after matching was compared using a nearest neighbor matching method with a ratio of 1∶1, setting the clamp value as 0.02. ResultsA total of 538 patients were screened, and after propensity score-matching, a total of 229 pairs (458 patients) were matched, with an average age of 53.9 years and 69.4% (318/458) females. A total of 118 (25.8%) patients had PPCs during hospitalization after surgery, including 60 (26.2%) patients in the PEEP 5 cm H2O group and 58 (25.3%) patients in the PEEP 10 cm H2O group, with no statistically significant difference between the two groups [OR=0.997, 95%CI (0.495, 1.926), P=0.915]. Multivariate logistic regression analysis showed that PEEP was not an independent risk factor for PPCs [OR=0.920, 95%CI (0.587, 1.441), P=0.715]. ConclusionFor patients undergoing thoracoscopic lung surgery, intraoperative PEEP (5 cm H2O or 10 cm H2O) is not associated with the risk of PPCs during hospitalization after surgery, which needs to be further verified by prospective, large-sample randomized controlled studies.