Objective To explore the application of enhanced recovery after surgery (ERAS) in pain management after knee arthroplasty (TKA). Methods Doctor-nurse pain management team was established based on ERAS between June and July 2016, and the pain management was carried out after training the doctors and nurses. According to the formula of two-sample mean comparison and inclusion and exclusion criteria, 60 TKA patients admitted to the hospital from March to May 2016 were assigned into the control group (before intervention) and 60 TKA patients admitted from August to October 2016 were assigned into the trial group (after intervention). The patients in the control group received routine pain management. In the trial group, preventive analgesia was performed, pain health education paths were built and ISBAR communication mode was made preoperatively; anesthesia protocols were optimized intraoperatively; multimodal analgesia based on time-demand was used postoperatively; continuing analgesia program was provided at the discharge. The pain score, Hospital for Special Surgery (HSS) knee score, average length of stay (ALOS) and average hospitalization cost (excluding materials) were compared between the two groups. Results The pain scores between the two groups at the admission and 6 hours after surgery were not statistically different (P>0.05), and the pain scores in the trial group 24, 48, 72 hours after surgery were significantly lower than those in the control group (P<0.05). The HSS scores between the two groups at the admission were not statistically different (P>0.05), and the HSS scores in the trial group 3 days, 1 week, and 1 month after surgery were significantly higher than those in the control group (P<0.05). And ALOS and average hospitalization cost (excluding materials) in the trial group were significantly lower than those in the control group (P<0.05). Conclusion The application of ERAS in pain management after TKA can effectively alleviate the postoperative pain, improve the patients’ knee function, shorten the ALOS, and decrease the average hospitalization cost.
ObjectiveTo examine the effect of preoperative adverse emotion on rehabilitation outcomes in lung cancer patients undergoing thoracoscopic major pulmonary resection.MethodsWe retrospectively analyzed the clinical data of 1 438 patients with lung cancer who underwent thoracoscopic lobectomy and segmentectomy in West China Hospital of Sichuan University from February 2017 to July 2018 including 555 males and 883 females. All patients were assessed by Huaxi emotional-distress index scoring, and were divided into three groups including a non-negative emotion group, a mild negative emotion group, and a moderate-severe negative emotion group. All patients underwent thoracoscopic lobectomy or segmentectomy plus systematic lymph node dissection or sampling. The volume of postoperative chest drainage, postoperative lung infection rate, time of chest tube intubation and postoperative duration of hospitalization were compared among these three groups.ResultsThere were different morbidities of adverse emotion in age, sex, education level and smoking among patients before operation (P<0.05). Univariate analysis showed that there was no statistical difference in the duration of indwelling drainage tube, drainage volume, postoperative pulmonary infection rate or the incidence of other complications among these three groups, but the duration of hospitalization in the latter two groups was less than that in the first group with a statistical difference (P<0.05). After correction of confounding factors by multiple regression analysis, there was no statistical difference among the three groups.ConclusionYoung patients are more likely to develop bad emotions, women are more likely to develop serious bad emotions, highly educated patients tend to develop bad emotions, and non-smoking patients tend to develop bad emotions. There is no effect of preoperative adverse emotions on the rapid recovery of lung cancer patients after minimally invasive thoracoscopic surgery.
Music has a powerful influence on people’s psychology and emotions. Many clinical research reports confirm that music therapy can directly affect and improve people’s psychological and physiological status, alleviate patients’anxiety and other adverse physiological emotions, improve the effectiveness of surgical treatment, and promote rapid recovery. Lung cancer surgery has the characteristics of great trauma, high incidence of postoperative complications and poor prognosis. Therefore, music therapy has its unique advantages for lung cancer. With the rapid development of thoracic surgery (ERAS), as an important part of psychological intervention, music therapy plays an irreplaceable role in the surgical treatment of lung cancer. This article reviews the impact of music therapy on anxiety in lung cancer surgery.
With the continuous deepening of the practice related to the concept of enhanced recovery after surgery, patients with cervical spondylosis have higher expectations and requirements for postoperative rehabilitation. In order to improve the rehabilitation of patients with cervical spondylosis, and increase patient satisfaction, the orthopedics team of West China Hospital of Sichuan University has formulated a program for early ambulation after anterior cervical spine surgery based on the concept of enhanced recovery after surgery. This article introduces the program from the definition, background, feasibility, significance, and specific content of early ambulation for patients undergoing anterior cervical spine surgery, and aims to provide experience and reference for future clinical practice.
Objective To analyze the nurses' current view and perceptions of enhanced recovery after surgery (ERAS) by a questionnaire and to promote the clinical application of ERAS. Methods We conducted a questionnaire study for nurses who attended the First West China Forum on Chest ERAS in Chengdu during September 26-27, 2016 and 259 questionnaires were collected for descriptive analysis. Results (1) The application status of ERAS: There were 13.5% responders whose hospital took a wait-an-see attitude, while the others' hospital took different actions for ERAS; 85.7% of nurses believed that ERAS in all surgeries should be used; 58.7% of nurses believed that the concept of ERAS was more in theory than in the practice; 40.2% of nurses thought that all patients were suitable for the application of ERAS; (2) 81.9% of nurses believed that the evaluation criteria of ERAS should be a combination of the average hospital stay, patients’ comprehensive feelings and social satisfaction; (3) 70.7% of nurses thought that the combination of subjects integration, surgery orientation and surgeon-nurse teamwork was the best model of ERAS; 44.8% of nurses thought the hospital administration was the best way to promote ERAS applications; (4) 69.1% of responders believed that immature plan, no consensus and norms and insecurity for doctors were the reasons for poor compliance of ERAS; 79.5% of nurses thought that the ERAS meeting should include the publicity of norms and consensus, analysis and implementation of projects and the status and progress of ERAS. Conclusion ERAS concept has been recognized by most nurses. Multidisciplinary collaboration and hospital promotion is the best way to achieve clinical applications.
Enhanced recovery after surgery (ERAS) is a protocol designed to improve perioperative outcomes by multidisciplinary team with evidence-based interventions. The implementation of ERAS concept has been proved to reduce postoperative complications and hospital stay. The anesthesia management under the concept of ERAS is the basis of safe and smooth ambulatory surgical protocol. This article summarizes the latest clinical evidence at home and abroad, and reviews the preoperative optimization, anesthesia mode selection, ventilation strategies, fluid management, temperature support, pain management, postoperative nausea and vomiting prevention, postoperative nutritional support, and postoperative sleep improvement in the management of anesthesia under ERAS concept, in order to provide a reference for anesthesia management in ambulatory surgery.
The concept of enhanced recovery after surgery(ERAS) has been well accepted by medical providers, which can be realized by a multidisciplinary team approach and minimally invasive surgical technology performed during perioperative periods. As the outcomes of the ERAS protocols, well effects are anticipated, and consistent outcomes are actually obtained. At the same time, there are some aspects which are not consistent including ① the evolution and challenge of ERAS concept:connotation and extension, ② consensus and arguments on the evaluation standard of ERAS protocol, ③ the cause of poorly compliance in medical providers and patient, ④ the function of multimodal programme and multidisciplinary team approach in ERAS protocol, which one is better? ⑤ methods and barriers of implementing enhanced recovery in clinic application.
Objective We conducted a questionnaire study who attended the First West China Forum on Chest Enhanced Recovery after Surgery (ERAS) in order to analyze whether it can improve the knowledge of ERAS and how to organize an effective meeting. Methods We analyzed 188 questionnaires from the representatives of the First West China Forum on Chest ERAS after the meeting which included two parts: one was the personal basic information and institution of respondents, and the other was the opinion of the content setting and suggestion for the next forum. Results A percentage of 97.7% of participants believed that this forum contributed to improving their understanding of ERAS and 65.3% of them will put the concept of ERAS into practice after the meeting. The exchange of experience and project communication of ERAS were the most useful agendas approved by representatives while expert lectures should be more appropriate (18.1%). Arrangement for topic discussion and enough time for discussion were supported by 93.1% and 98.9% of the representatives respectively. Multi-center project discussion (80.9%) and interactive sessions especially WeChat interaction (74.0%) should be added on ERAS forum. Conclusion Reasonable agenda settings are beneficial to improve the understanding and compliance of application of ERAS.
ObjectiveTo investigate the safety and feasibility of enhanced recovery after surgery (ERAS) in radical gastrectomy. MethodsThe Cochrane library, PubMed, EMBASE, and Chinese biomedical literature databases were searched to identify randomized controlled trails including patients undergoing radical gastrectomy surgery who were treated by ERAS or traditional methods.The five outcome variables were the time to passage of first flatus and first defecation, the length of postoperative hospital stay, medical cost, and postoperative complications. ResultsFifteen published reports involving 1 533 participants met the inclusion criteria.Compared with traditional methods, ERAS had better outcomes with shorter time to the passage of flatus (WMD=-26.557 hours, 95%CI:-34.097～-19.018, P < 0.05), shorter time to the passage of defecation (WMD=-34.071 hours, 95%CI:-53.449～-14.693, P < 0.05), shorter postoperative hospital stay (WMD=-2.824 days, 95%CI:-3.638～-2.010, P < 0.05), less medical cost (WMD=-0.342 ten thousand yuan, 95%CI:-0.501～-0.184, P < 0.05), and lower postoperative complication rate (RR=0.597, 95%CI: 0.435-0.820, P < 0.05).Especially, ERAS had a significant lower rate of postoperative digestive tract complications (RR=0.492, 95%CI: 0.350-0.693, P < 0.05).However, there were no significant differences between two methods in the incidence of complications including postoperative pulmonary infection, infection or liquefaction of incision, fistula of anastomosis, and postoperative readmission rate (P > 0.05). ConclusionsThe application of ERAS in the perioperated period of radical gastrectomy surgery shortens the time to passage of first flatus and first defecation, the postoperative hospital stay, as well as lowers the medical cost, and the postoperative complication rate.The results suggest that ERAS is safe and effective in perioperated period of radical gastrectomy and it is very promising in clinical application.
Objective To analyze the current status and difficulties of ERAS applicated in thoracic surgery in different regional hospitals. Methods A total of 773 valid questionnaires were collected during the First West China Forum on Chest ERAS and analyzed by geographical distribution. The content of the questionnaire was divided into two parts, including the respondents’ institute and personal information, as well as 10 questions about ERAS. Results There were 83.57%, 83.82%, 89.58%, 93.75%, 94.74% and 92.86% of surgeons and nurses in Sichuan province, municipalities, the eastern, western, southern and northern respectively who believed that ERAS in all surgeries should be used. There were 61.84%, 60.29%, 65.97%, 81.25%, 73.68% and 75.00% of surgeons and nurses who thought that the concept of ERAS was more in the theory than in the practice; 77.99%, 80.88%, 74.31%, 78.13%, 83.33% and 69.64% of respondents agreed that average hospital stay, patients’ experience and social satisfaction should be the evaluation standard of ERAS practice while 58.50%, 63.24%, 54.86%, 62.50%, 70.18% and 58.93% of respondents believed that immature procedure, lack of consensus and specifications and insecurity for doctors were the reasons for poor compliance of ERAS; 63.23%, 67.65%, 59.72%, 68.75%, 72.81% and 67.86% of respondents thought that the best team of ERAS should be based on the combination of subject integration, surgery orientation and surgeon-nurse teamwork; 43.73%, 44.12%, 43.75%, 46.88%, 59.65% and 41.07% of respondents thought that multidisciplinary cooperation, multi-modality conducted and surgical programming should be the best way for ERAS implementation; 72.98%, 69.12%, 62.50%, 65.63%, 80.70% and 55.36% of responders agreed that the ERAS forum or conference should include the norms and consensus, analysis and implementation of projects and the status and progress of ERAS. Conclusion There are more consistent views on the clinical application of ERAS in all regions. The subject integration, surgeon-nurse teamwork and multidisciplinary, multi-modality cooperation are the best team and best way for ERAS program implementation.