Objective: With the aging population and changes in lifestyle, lumbar spinal stenosis has become a common spinal disorder. Treatment modalities have been advancing, and the application of Enhanced Recovery After Surge...Objective: With the aging population and changes in lifestyle, lumbar spinal stenosis has become a common spinal disorder. Treatment modalities have been advancing, and the application of Enhanced Recovery After Surgery (ERAS) principles provides a new approach to postoperative recovery in patients. This study aims to investigate the clinical application effects of ERAS principles in single-level lumbar spinal stenosis surgery. Methods: This study included 64 patients who underwent lumbar fusion surgery in the Spinal Surgery Department of Baise People’s Hospital from July 2022 to July 2024. These patients were divided into an experimental group (ERAS group, 33 cases) and a control group (conventional group, 31 cases) based on perioperative care, receiving ERAS principles and traditional treatment, respectively. A comparison was made between the two groups in terms of gender, age, BMI, intraoperative blood loss, postoperative length of hospital stay, postoperative complications, hospital costs, VAS scores (preoperative/postoperative day 3), and ODI scores (preoperative/postoperative day 3). Results: There were no significant differences in gender, age, and BMI between the ERAS group and the conventional group (gender: χ2 = 0.5008, P = 0.4792;age: 54.55 ± 8.51 years vs. 57.39 ± 8.16 years, P = 0.0892;BMI: 25.11 ± 2.70 vs. 24.77 ± 2.75, P = 0.3098). However, during surgery, patients in the ERAS group had significantly less blood loss than those in the conventional group (197.58 ± 195.51ml vs. 438.71 ± 349.22 ml, P = 0.0006), and the postoperative length of hospital stay was significantly shorter (7.00 ± 2.24 days vs. 11.55 ± 5.23 days, P = 0.0000). On postoperative day 3, VAS scores were significantly better in the ERAS group compared to the conventional group (3.70 ± 0.88 vs. 4.32 ± 0.87, P = 0.0031), and the ODI scores showed significant improvement as well (46.00 ± 3.04 vs. 48.00 ± 3.39, P = 0.0078). Although there were no significant differences in postoperative complications and hospital costs (complications: 3 cases vs. 0 cases, P = 0.2154;hospital costs: 63524.29 ± 17891.80 RMB vs. 58733.84 ± 13280.82 RMB, P = 0.1154), ERAS demonstrated better postoperative recovery outcomes in single-level lumbar spinal stenosis surgery. Conclusion: The study results support the implementation of ERAS principles in single-level lumbar spinal stenosis surgery to promote rapid recovery, reduce healthcare resource consumption, and improve overall patient satisfaction.展开更多
The concept of enhanced recovery after surgery(ERAS)has been practiced for decades and has been implemented in numerous surgical specialties.ERAS is a global surgical quality improvement initiative,and it is an elemen...The concept of enhanced recovery after surgery(ERAS)has been practiced for decades and has been implemented in numerous surgical specialties.ERAS is a global surgical quality improvement initiative,and it is an element in the field of perioperative care.ERAS had shown significant clinical outcomes,patientreported satisfaction,and improvements in medical service cost.ERAS has been developed for specific surgical procedures,but with the fast progress of newly introduced surgical procedures,the original ERAS have been developed and modified.Recently appearing Topics and future research trends encompass ERAS protocols for other types of surgery and the enhancement of perioperative status,including but not limited to pediatric surgery,laparoscopic and robotic assisted surgery,bariatric surgery,thoracic surgery,and renal transplantation.The elements and pathways of ERAS have been developed with the introduction of up-to-date methodologies in the pre-operative,operative,and post-operative pathways.ERAS costs are higher than traditional care,but the patient’s clinical outcome and satisfaction are higher.ERAS is in progress in the fields of anesthetic tasks,pediatric surgery,and organ transplantation.Although ERAS has shown significant clinical outcomes,there are needs to modify the protocol for specific cases,hospital facilities,resources,and nurses training on elements of ERAS.Several challenges and limitations exist in the implementation of ERAS that deserve consideration,it includes:Frailty,maximizing nutrition,prehabilitation,treating preoperative anemia,and enhancing ERAS adoption globally are all included.展开更多
Background: The enhanced recovery after surgery (ERAS) protocol is an evidence-based perioperative care program aimed at reducing surgical stress response and accelerating recovery. However, a small propor- tion of pa...Background: The enhanced recovery after surgery (ERAS) protocol is an evidence-based perioperative care program aimed at reducing surgical stress response and accelerating recovery. However, a small propor- tion of patients fail to bene t from the ERAS program following pancreaticoduodenectomy. This study aimed to identify the risk factors associated with failure of ERAS program in pancreaticoduodenectomy. Methods: Between May 2014 and December 2017, 176 patients were managed with ERAS program fol-lowing pancreaticoduodenectomy. ERAS failure was indicated by prolonged hospital stay, unplanned read- mission or unplanned reoperation. Demographics, postoperative recovery and compliance were compared of those ERAS failure groups to the ERAS success group. Results: ERAS failure occurred in 59 patients, 33 of whom had prolonged hospital stay, 18 were readmitted to hospital within 30 days after discharge, and 8 accepted reoperation. Preoperative American Society of Anesthesiologists (ASA) score of ≥III (OR = 2.736;95% CI: 1.276 6.939;P=0.028) and albumin (ALB) level of <35g/L (OR=3.589;95% CI: 1.403 9.181;P=0.008) were independent risk factors associated with prolonged hospital stay. Elderly patients (>70 years) were on a high risk of unplanned reoperation (62.5% vs. 23.1%, P=0.026). Patients with prolonged hospital stay and unplanned reoperation had delayed intake and increased intolerance of oral foods. Prolonged stay patients got off bed later than ERAS success patients did (65h vs. 46h, P =0.012). Unplanned reoperation patients tended to experience severer pain than ERAS success patients did (3 score vs. 2 score, P =0.035). Conclusions: Patients with high ASA score, low ALB level or age >70 years were at high risk of ERAS failure in pancreaticoduodenectomy. These preoperative demographic and clinical characteristics are important determinants to obtain successful postoperative recovery in ERAS program.展开更多
BACKGROUND Enhanced recovery after surgery(ERAS) reduces hospitalization and complication following colorectal surgery. Whether the experience of multidisciplinary ERAS team affects patients' outcomes is unknown.A...BACKGROUND Enhanced recovery after surgery(ERAS) reduces hospitalization and complication following colorectal surgery. Whether the experience of multidisciplinary ERAS team affects patients' outcomes is unknown.AIM To evaluate and establish a learning curve of ERAS program for open colorectal surgery.METHODS This was a review of prospectively collected database of 380 "unselected"patients undergoing elective "open" colectomy and/or proctectomy under ERAS protocol from 2011(commencing ERAS application) to 2017 in a university hospital. Patients were divided into 5 chronological groups(76 cases per quintile). Surgical outcomes and ERAS compliance among quintiles were compared. Learning curves were calculated based on criteria of optimal recovery:defined as absence of major postoperative complications, discharge by postoperative day 5, and no 30-d readmission.RESULTS Hospitalization more than 5 d occurred in 22.6%(n = 86), major complication was present in 2.9%(n = 11) and 30-d readmission rate was 2.4%(n = 9) accounting for unsuccessful recovery of 25%(n = 95). Conversely, the overall rate of optimal recovery was 75%. The optimal recovery significantly increased from 57.9% in 1 st quintile to 72.4%-85.5% in the following quintiles(P < 0.001). Average compliance with ERAS protocol gradually increased over the time-from 68.6% in 1 st quintile to 75.5% in 5 th quintile(P < 0.001). The application of preoperative counseling,nutrition support, goal-directed fluid therapy, O-ring wound protector and scheduled mobilization significantly increased over the study period.CONCLUSION A number of 76 colorectal operations are required for a multidisciplinary team to achieve a significantly higher rate of optimal recovery and high compliance with ERAS program for open colorectal surgery.展开更多
目的分析基于加速康复外科(enhanced recovery after surgery,ERAS)理念的手术室护理干预在关节置换术中的应用价值。方法方便选取2022年1月—2023年10月泰州市第二人民医院收治的76例行关节置换术患者为研究对象,按照不同护理干预分为...目的分析基于加速康复外科(enhanced recovery after surgery,ERAS)理念的手术室护理干预在关节置换术中的应用价值。方法方便选取2022年1月—2023年10月泰州市第二人民医院收治的76例行关节置换术患者为研究对象,按照不同护理干预分为研究组和对照组,各38例。对照组实施常规围术期护理,研究组实施ERAS理念的手术室护理干预,分析两组患者术后生活质量、疼痛情况、并发症发生率及满意度。结果研究组躯体功能、心理功能、社会功能、物质生活等生活质量评分均优于对照组,差异有统计学意义(P均<0.05)。研究组总满意率高于对照组,并发症总发生率低于对照组,差异有统计学意义(P均<0.05)。研究组术后疼痛评分为(2.05±0.96)分,低于对照组的(3.44±1.22)分,差异有统计学意义(t=5.519,P<0.05)。结论基于ERAS理念的手术室护理干预可显著提高患者康复效果以及生活质量,切实保障患者健康。展开更多
Twenty-three recommendations were summarized by the Enhanced Recovery After Surgery(ERAS)society for liver surgery.The aim was to validate the protocol especially with regard to adherence and the impact on morbidity.M...Twenty-three recommendations were summarized by the Enhanced Recovery After Surgery(ERAS)society for liver surgery.The aim was to validate the protocol especially with regard to adherence and the impact on morbidity.Methods:Using the ERAS Interactive Audit System(EIAS),ERAS items were evaluated in patients undergoing liver resection.Over a period of 26 months,304 patients were prospectively enrolled in an observational study(DRKS00017229).Of those,51 patients(non-ERAS)were enrolled before and 253 patients(ERAS)after the implementation of the ERAS protocol.Perioperative adherence and complications were compared between the two groups.Results:Overall adherence increased from 45.2%in the non-ERAS group to 62.7%in the ERAS group(P<0.001).This was associated with significant improvements in the preoperative and postoperative phase(P<0.001),rather than in the outpatient and intraoperative phase(both P>0.05).Overall complications decreased from 41.2%(n=21)in the non-ERAS group to 26.5%(n=67)in the ERAS group(P=0.0423),which was mainly due to the reduction of grade 1-2 complications from 17.6%(n=9)to 7.6%(n=19)(P=0.0322).As for patients undergoing open surgery,implementation of ERAS lead to a reduction of overall complications in patients scheduled for minimally invasive liver surgery(MILS)(P=0.036).Conclusions:Implementation of the ERAS protocol for liver surgery according to the ERAS guidelines of the ERAS Society reduced Clavien-Dindo grade 1-2 complications particularly in patients who underwent MILS.The ERAS guidelines are beneficial for the outcome,while adherence to the various items has not yet been satisfactorily defined.展开更多
文摘Objective: With the aging population and changes in lifestyle, lumbar spinal stenosis has become a common spinal disorder. Treatment modalities have been advancing, and the application of Enhanced Recovery After Surgery (ERAS) principles provides a new approach to postoperative recovery in patients. This study aims to investigate the clinical application effects of ERAS principles in single-level lumbar spinal stenosis surgery. Methods: This study included 64 patients who underwent lumbar fusion surgery in the Spinal Surgery Department of Baise People’s Hospital from July 2022 to July 2024. These patients were divided into an experimental group (ERAS group, 33 cases) and a control group (conventional group, 31 cases) based on perioperative care, receiving ERAS principles and traditional treatment, respectively. A comparison was made between the two groups in terms of gender, age, BMI, intraoperative blood loss, postoperative length of hospital stay, postoperative complications, hospital costs, VAS scores (preoperative/postoperative day 3), and ODI scores (preoperative/postoperative day 3). Results: There were no significant differences in gender, age, and BMI between the ERAS group and the conventional group (gender: χ2 = 0.5008, P = 0.4792;age: 54.55 ± 8.51 years vs. 57.39 ± 8.16 years, P = 0.0892;BMI: 25.11 ± 2.70 vs. 24.77 ± 2.75, P = 0.3098). However, during surgery, patients in the ERAS group had significantly less blood loss than those in the conventional group (197.58 ± 195.51ml vs. 438.71 ± 349.22 ml, P = 0.0006), and the postoperative length of hospital stay was significantly shorter (7.00 ± 2.24 days vs. 11.55 ± 5.23 days, P = 0.0000). On postoperative day 3, VAS scores were significantly better in the ERAS group compared to the conventional group (3.70 ± 0.88 vs. 4.32 ± 0.87, P = 0.0031), and the ODI scores showed significant improvement as well (46.00 ± 3.04 vs. 48.00 ± 3.39, P = 0.0078). Although there were no significant differences in postoperative complications and hospital costs (complications: 3 cases vs. 0 cases, P = 0.2154;hospital costs: 63524.29 ± 17891.80 RMB vs. 58733.84 ± 13280.82 RMB, P = 0.1154), ERAS demonstrated better postoperative recovery outcomes in single-level lumbar spinal stenosis surgery. Conclusion: The study results support the implementation of ERAS principles in single-level lumbar spinal stenosis surgery to promote rapid recovery, reduce healthcare resource consumption, and improve overall patient satisfaction.
文摘The concept of enhanced recovery after surgery(ERAS)has been practiced for decades and has been implemented in numerous surgical specialties.ERAS is a global surgical quality improvement initiative,and it is an element in the field of perioperative care.ERAS had shown significant clinical outcomes,patientreported satisfaction,and improvements in medical service cost.ERAS has been developed for specific surgical procedures,but with the fast progress of newly introduced surgical procedures,the original ERAS have been developed and modified.Recently appearing Topics and future research trends encompass ERAS protocols for other types of surgery and the enhancement of perioperative status,including but not limited to pediatric surgery,laparoscopic and robotic assisted surgery,bariatric surgery,thoracic surgery,and renal transplantation.The elements and pathways of ERAS have been developed with the introduction of up-to-date methodologies in the pre-operative,operative,and post-operative pathways.ERAS costs are higher than traditional care,but the patient’s clinical outcome and satisfaction are higher.ERAS is in progress in the fields of anesthetic tasks,pediatric surgery,and organ transplantation.Although ERAS has shown significant clinical outcomes,there are needs to modify the protocol for specific cases,hospital facilities,resources,and nurses training on elements of ERAS.Several challenges and limitations exist in the implementation of ERAS that deserve consideration,it includes:Frailty,maximizing nutrition,prehabilitation,treating preoperative anemia,and enhancing ERAS adoption globally are all included.
基金supported by grants from the Project of Medical and Health Technology Platform of Zhejiang Province(2017RC003)the National High Technology Research and Development Pro-gram of China(SS2015AA020405)+4 种基金the General Program of the National Natural Science Foundation of China(81871925)the General Program of the National Natural Science Foundation of China(81672337)the Key Innovative Team for the Diagnosis and Treatment of Pancreatic Cancer of Zhejiang Province(2013TD06)the Key Program of National Natural Science Foundation of China(81530079)the Key Research and Development Project of Zhejiang Province(2015C03044)
文摘Background: The enhanced recovery after surgery (ERAS) protocol is an evidence-based perioperative care program aimed at reducing surgical stress response and accelerating recovery. However, a small propor- tion of patients fail to bene t from the ERAS program following pancreaticoduodenectomy. This study aimed to identify the risk factors associated with failure of ERAS program in pancreaticoduodenectomy. Methods: Between May 2014 and December 2017, 176 patients were managed with ERAS program fol-lowing pancreaticoduodenectomy. ERAS failure was indicated by prolonged hospital stay, unplanned read- mission or unplanned reoperation. Demographics, postoperative recovery and compliance were compared of those ERAS failure groups to the ERAS success group. Results: ERAS failure occurred in 59 patients, 33 of whom had prolonged hospital stay, 18 were readmitted to hospital within 30 days after discharge, and 8 accepted reoperation. Preoperative American Society of Anesthesiologists (ASA) score of ≥III (OR = 2.736;95% CI: 1.276 6.939;P=0.028) and albumin (ALB) level of <35g/L (OR=3.589;95% CI: 1.403 9.181;P=0.008) were independent risk factors associated with prolonged hospital stay. Elderly patients (>70 years) were on a high risk of unplanned reoperation (62.5% vs. 23.1%, P=0.026). Patients with prolonged hospital stay and unplanned reoperation had delayed intake and increased intolerance of oral foods. Prolonged stay patients got off bed later than ERAS success patients did (65h vs. 46h, P =0.012). Unplanned reoperation patients tended to experience severer pain than ERAS success patients did (3 score vs. 2 score, P =0.035). Conclusions: Patients with high ASA score, low ALB level or age >70 years were at high risk of ERAS failure in pancreaticoduodenectomy. These preoperative demographic and clinical characteristics are important determinants to obtain successful postoperative recovery in ERAS program.
文摘BACKGROUND Enhanced recovery after surgery(ERAS) reduces hospitalization and complication following colorectal surgery. Whether the experience of multidisciplinary ERAS team affects patients' outcomes is unknown.AIM To evaluate and establish a learning curve of ERAS program for open colorectal surgery.METHODS This was a review of prospectively collected database of 380 "unselected"patients undergoing elective "open" colectomy and/or proctectomy under ERAS protocol from 2011(commencing ERAS application) to 2017 in a university hospital. Patients were divided into 5 chronological groups(76 cases per quintile). Surgical outcomes and ERAS compliance among quintiles were compared. Learning curves were calculated based on criteria of optimal recovery:defined as absence of major postoperative complications, discharge by postoperative day 5, and no 30-d readmission.RESULTS Hospitalization more than 5 d occurred in 22.6%(n = 86), major complication was present in 2.9%(n = 11) and 30-d readmission rate was 2.4%(n = 9) accounting for unsuccessful recovery of 25%(n = 95). Conversely, the overall rate of optimal recovery was 75%. The optimal recovery significantly increased from 57.9% in 1 st quintile to 72.4%-85.5% in the following quintiles(P < 0.001). Average compliance with ERAS protocol gradually increased over the time-from 68.6% in 1 st quintile to 75.5% in 5 th quintile(P < 0.001). The application of preoperative counseling,nutrition support, goal-directed fluid therapy, O-ring wound protector and scheduled mobilization significantly increased over the study period.CONCLUSION A number of 76 colorectal operations are required for a multidisciplinary team to achieve a significantly higher rate of optimal recovery and high compliance with ERAS program for open colorectal surgery.
文摘目的分析基于加速康复外科(enhanced recovery after surgery,ERAS)理念的手术室护理干预在关节置换术中的应用价值。方法方便选取2022年1月—2023年10月泰州市第二人民医院收治的76例行关节置换术患者为研究对象,按照不同护理干预分为研究组和对照组,各38例。对照组实施常规围术期护理,研究组实施ERAS理念的手术室护理干预,分析两组患者术后生活质量、疼痛情况、并发症发生率及满意度。结果研究组躯体功能、心理功能、社会功能、物质生活等生活质量评分均优于对照组,差异有统计学意义(P均<0.05)。研究组总满意率高于对照组,并发症总发生率低于对照组,差异有统计学意义(P均<0.05)。研究组术后疼痛评分为(2.05±0.96)分,低于对照组的(3.44±1.22)分,差异有统计学意义(t=5.519,P<0.05)。结论基于ERAS理念的手术室护理干预可显著提高患者康复效果以及生活质量,切实保障患者健康。
文摘Twenty-three recommendations were summarized by the Enhanced Recovery After Surgery(ERAS)society for liver surgery.The aim was to validate the protocol especially with regard to adherence and the impact on morbidity.Methods:Using the ERAS Interactive Audit System(EIAS),ERAS items were evaluated in patients undergoing liver resection.Over a period of 26 months,304 patients were prospectively enrolled in an observational study(DRKS00017229).Of those,51 patients(non-ERAS)were enrolled before and 253 patients(ERAS)after the implementation of the ERAS protocol.Perioperative adherence and complications were compared between the two groups.Results:Overall adherence increased from 45.2%in the non-ERAS group to 62.7%in the ERAS group(P<0.001).This was associated with significant improvements in the preoperative and postoperative phase(P<0.001),rather than in the outpatient and intraoperative phase(both P>0.05).Overall complications decreased from 41.2%(n=21)in the non-ERAS group to 26.5%(n=67)in the ERAS group(P=0.0423),which was mainly due to the reduction of grade 1-2 complications from 17.6%(n=9)to 7.6%(n=19)(P=0.0322).As for patients undergoing open surgery,implementation of ERAS lead to a reduction of overall complications in patients scheduled for minimally invasive liver surgery(MILS)(P=0.036).Conclusions:Implementation of the ERAS protocol for liver surgery according to the ERAS guidelines of the ERAS Society reduced Clavien-Dindo grade 1-2 complications particularly in patients who underwent MILS.The ERAS guidelines are beneficial for the outcome,while adherence to the various items has not yet been satisfactorily defined.
文摘目的 探究基于加速康复外科(ERAS)理念的静脉血栓栓塞症(VTE)预防方案在肝癌手术患者围手术期的应用效果。方法 选取2020年6月至2021年12月146例原发性肝癌行择期手术的住院患者作为观察对象,按区组随机化法分为观察组和对照组,每组73例。观察组采用围手术期VTE预防方案进行干预,对照组采用传统围手术期管理方案进行干预。比较两组患者术后排便时间、通气时间、住院时间、住院费用、再入院率情况差异;比较两组术后第1、3天患者疼痛和睡眠质量情况;比较两组术后第3天凝血功能[血浆纤维蛋白原(FIB)、D-二聚体(D-D)、血浆抗凝血酶原Ⅲ(AT-Ⅲ)]水平差异;比较两组术后1个月内VTE发生风险。结果 观察组患者术后排便时间[(73.48±13.39)h vs (98.27±15.04)h]、通气时间[(51.68±10.27) vs (62.72±13.81)h]、住院时间[(9.21±1.20)d vs (11.42±1.25)d]、住院费用[(3.09±0.33)万元vs (3.79±0.42)万元]均明显低于对照组(均P<0.05),两组再入院率差异无统计学意义(P>0.05)。观察组术后第3天NRS评分[(2.32±0.52)分vs (2.74±0.58)分]和PSQI评分[(0.67±0.32)分vs (0.89±0.34)分]均明显低于对照组(均P<0.05),AT-Ⅲ水平明显高于对照组[(85.49±12.32)%vs(81.38±11.65)%,P<0.05];术后观察组VTE中危及以上发生风险低于对照组(50.68%vs 67.12%,P<0.05)。结论 基于ERAS理念的VTE预防方案能够加快肝癌患者术后康复,降低VTE发生风险,减轻患者经济负担。
