Objective To analyze the progress of evaluation indexes for enhanced recovery after surgery (ERAS) model at home and abroad, and to propose suggestions for constructing systematic evaluation model of ERAS. Methods Atfirst checked the Chinese and English databases, including Medline, Embase, Sciencedirect, ACP Journal Club, BioMed Central, the Cochrane Central Register of Controlled Trials (CENTRAL), Science Citation Index Expanded, Cochrane Library, NHS Economic Evaluation Database, CNKI, VIP, and Wanfang databases (retrieval time was from January 1997 to December 2017), and then filtered the literatures, excluded duplicate documents, a total of 1 020 English literatures and 786 Chinese literatures were enrolled eventually to make an review. Results The literatures showed that, at present, there was no comprehensive and systematic evaluation index system about ERAS at home and abroad. The existing evaluation indexes mainly included the following deficiencies: localization and fragmentation of evaluation indicators, lack of evaluation indicators of ERAS organizational framework and process management, as well as lack of standardized operational definition of evaluation indicators. Conclusions The evaluation indexes of ERAS at home and abroad do not constitute a systematic evaluation index system according to scientific principles, which will restrict the standardization of accelerated surgical rehabilitation in our country. To establish a multidimensional and comprehensive quality evaluation index system based on multi-evaluation of hospital, patient, social, and medical management institutions, which covers ERAS organizational structure, process management, and clinical outcomes, is a necessary condition for the development of ERAS model.
ObjectiveTo investigate the prevalence of preoperative intestinal dysbacteriosis in colorectal cancer patients and its risk factors.MethodsFrom March 2016 to December 2017, patients who received colorectal cancer surgery in the Department of Gastrointestinal Surgery in West China Hospital were prospectively recruited in the study. Fresh fecal samples were collected on the day of admission for gram-stainsmears. The diet, preexisted diseases, medication, and treatment before admission were investigated by a self-designed semi-structured questionnaire.ResultsSum to 257 patients were recruited, 123 patients (47.9%) of them had normal intestinal bacterial, 48 patients (18.7%) were in preoperative dysbacteriosis grade Ⅰ, 61 patients (23.7%) were in gradeⅡ, 25 patients (9.7%) were in grade Ⅲ. Orderly logistic regression showed that patients who received antibiotics for 30 days or more per year had a higher risk of preoperative dysbacteriosis than those who did not receive antibiotics (OR=3.38, P=0.025). Patients with BMI≥24.0 kg/m2 had a lower risk of dysbacteriosis than patients with BMI<18.5 kg/m2 (BMI 24.0～27.9 kg/m2, OR=0.36, P=0.030; BMI≥28.0 kg/m2, OR=0.23, P=0.032).ConclusionMore than half of colorectal cancer patients have intestinal dysbacteriosis prior to surgery, which may be associated with exposure to antibiotics before admission and low BMI.
ObjectiveTo explore gut microbiome influences on anastomotic healing following gastrointestinal surgery and its mechanism.MethodThe relevant literatures about gut microbiome and its impact on healing of gastrointestinal anastomosis and their mechanisms were reviewed.ResultsSeveral symbiotic intestinal microbiota such as the Enterococcus faecalis, Pseudomonas aeruginosa, Serratia marcescens, etc. could transform into the pathogenic bacteria with high toxic phenotype in an inflammatory environment in the body, and dissolve the extracellular matrix by degrading collagen or activating matrix metalloproteinase 9, resulting in the anastomotic leak.ConclusionIn general, exploring of effect of intestinal microbiome on healing process of anastomotic stoma is just beginning, conditions and mechanisms for transformation of bacteria from symbiotic to pathogenic still need to be explored.