Application of enhanced recovery after surgery in perioperative period of traditional open surgery and laparoscopic cholecystectomy plus common bile duct exploration in elderly patients

Abstract

Objective To analyze the application and value of enhanced recovery after surgery(ERAS) in the elderly patients with open cholecystectomy plus common bile duct exploration and laparoscopic cholecystectomy plus common bile duct exploration in the perioperative period. Methods A total of 113 elderly patients undergoing cholecystectomy plus common bile duct exploration were selected from January 2012 to April 2016 in the Inner Mongolia People′s Hospital. All the patients were divided into 60 patients with open cholecystectomy and common bile duct exploration (O-group) and 53 patients with laparoscopic cholecystectomy and common bile duct exploration (L-group) according to random number table method. The two groups of patients were further divided into 4 subgroups by using random number table method, and the ERAS and traditional measures were respectively implemented, namely [L-ERAS group(27 patients), O-ERAS group(30 patients)] and [L-Control group(26 patients), O-Control group(30 patients)]. The O-group underwent open cholecystectomy plus common bile duct exploration, and the L-group underwent laparoscopic cholecystectomy plus common bile duct exploration. The patients in the ERAS group were treated with ERAS, and the control group was treated by traditional method. The operative time, intraoperative blood loss, postoperative exhaust time, the length of postoperative hospital stay, the hospitalization expenese in different groups were compared. Data were processed with t test. Results The operative time of O-Control group was (2.3±0.7) h, the intraoperative bleeding volume was (81.0±77.7) mL, postoperative exhaust time was (3.4±1.0) d, postoperative hospital stay was(12.9±4.0) d. And the operative time of O-ERAS group was(1.9±0.5) h, the intraoperative bleeding volume was (48.0±24.1) mL, postoperative exhaust time was (2.8±0.9) d, postoperative hospital stay was(10.5±4.1) d. Compare with the O-Control group, the latter with less amount of bleeding, the operative time, the time of postoperative exhaust time, the time of post-operative hospitalization were shortened, and the differences were statistically significant(t=-2.008, -2.099, -2.734, -2.233; with P values below 0.05). The hospitalization expenses of the two groups were(22 246.9±13 344.3) , (20 194.4±2 828.2) yuan, the difference was not statistically significant(P>0.05). The operative time of L-Control group was(2.2±0.6) h, the intraoperative bleeding volume was (54.0±32.1) mL, postoperative exhaust time was (2.9±0.9) d, postoperative hospital stay was(7.0±2.0) d, the operative time of L-ERAS group was(1.8±0.5) h, the intraoperative bleeding volume was (37.0±26.3) mL, postoperative exhaust time was(2.4±0.8) d, postoperative hospital stay was(5.7±1.1) d. Compare with the L-Control group, the latter with less amount of bleeding, the operative time, the time of postoperative exhaust time, the time of post-operative hospitalization were shortened, and the differences were statistically significant(t=-2.179, -2.214, -2.197, -2.660; with P values below 0.05). The hospitalization expenses of the two groups were (22 672.6±5 446.9), (22 404.3±8 482.4) yuan, the difference was not statistically significant(P>0.05). Compared with the O-ERAS group, the L-ERAS group with less amount of bleeding , the operative time, the time of postoperative exhaust time, the time of post-operative hospitalization were shortened, and the differences were statistically significant(with P values below 0.05); however, there was no significant difference in hospitalization expenses between the two groups (P>0.05). Conclusions ERAS in elderly patients with cholecystectomy plus common bile duct exploration can promote the rehabilitation of elderly patients after surgery. And laparoscopic cholecystectomy plus common bile duct exploration is more conducive to rapid postoperative recovery, the effect of clinical application is obvious and can be promoted in clinic. Key words: Cholecystectomy; Cholecystectomy, laparoscopic; Aged; Common bile duct; Enhanced recovery after surgery; Perioperative period