Clinical pathway combined with enhanced recovery after surgery in patients with chronic cholecystitis and gallstones

Abstract

Objective To investigate the effect of enhanced recovery after surgery (ERAS) on the clinical pathway of laparoscopic cholecystectomy in patients with chronic cholecystitis and gallstones. Methods From June 2017 to December 2017, 94 patients with chronic cholecystitis and cholecystolithiasis underwent laparoscopic cholecystectomy in the Department of General Surgery of First Hospltal of Huainan City were analyzed retrospectively. All patients were included in clinical pathway management. According to whether the perioperative period was combined with ERAS, there were 45 cases in the study group and 49 cases in the control group. The study group was combined with ERAS during perioperative period, while the control group received traditional perioperative management. The preoperative hospitalization days, operative time, intraoperative bleeding volume, total hospitalization days, postoperative complications, hospitalization costs, postoperative hospitalization days, clinical pathway completion rate and positive and negative variation rates were compared between the two groups. The measurement data were expressed by (Mean±SD), and the comparisons between groups were performed by t test; Comparisons of count data were analyzed using chi-square test or Fisher exact probability. Results Preoperative hospitalization days, operation time, intraoperative bleeding volume, total hospitalization days and postoperative complications in the study group were (3.3±1.2) d, (63.1±24.3) min, (9.4±3.9) ml, (7.1±1.5) d and 1 case respectively, while those in the control group were (3.2±1.5) d, (68.4±25.4) min, (9.5±2.9) ml, (8.4±1.8) d and 2 cases respectively, and the differences between the two groups ware not statistically significant (P>0.05). Postoperative hospitalization days, hospitalization expenses and shortened hospitalization days in the study group were (2.9±0.8) d, (9 407.2±500.9) yuan and 64.4%(29/45) respectively, while those in the control group were (4.5±1.1) d, (10 594.9±792.3) yuan and 36.7%(18/49) respectively. The difference between the two groups was statistically significant (P<0.05). Conclusion Laparoscopic cholecystectomy for chronic cholecystitis with cholecystolithiasis combined with ERAS during the implementation of clinical pathway can shorten postoperative hospital stay, reduce hospitalization costs, increase the positive variation rate of clinical pathway without increasing postoperative complications. Key words: Enhanced recovery after surgery; Cholecystolithiasis; Clinical pathway