Concept Of Fast Track Surgery Research Articles

Perioperative neuropathic and positional problems: literature review

At present, an increasing number of specialists prefer the fast-track surgery concept. One of the significant perioperative complications that can affect the rate and quality of postoperative rehabilitation is the development of neuropathy, which can be the result of improper patient positioning on the operating table, and direct intraoperative damage to the nerve / trunk / plexus. Physical (mechanical compression, stretching, and partial / complete intersection of the nerve with a needle, scalpel, or electrode) and chemical (toxicity of local anesthetics and chemically active liquid effects) mechanisms for neuropathy formation can be described. To prevent the development of a neurological deficit, both the anesthesiologist and surgeon must take all the necessary measures to prevent neuropathies and begin appropriate treatment as soon as possible in the case of its occurrence. This article discusses the anatomy, physiology, and pathophysiology of the peripheral nerve, mechanisms of compression-ischemic neuropathy formation, and perioperative positional problems. Existing recommendations for the treatment of peripheral neuropathic were assessed and proposed for use not only with conservative therapy methods but also with interventional methods for the treatment of established perioperative neurological complications. A summary table of the possible clinical manifestations of postoperative neuropathic is presented.

Implementation of holistic nursing interventions based on fast track surgery concept in patients with lower extremity arterial occlusive disease.

Lower Extremity Arterial Occlusive Disease (LEAOD) is a prevalent condition affecting many patients worldwide, which requires careful management and patient cooperation. This study aimed to evaluate the effectiveness of holistic nursing interventions based on the Fast Track Surgery (FTS) concept in patients with LEAOD. A retrospective analysis of 92 LEAOD patients, randomized into control and experimental groups, was performed. Conventional rehabilitation nursing interventions were applied to the control group, while the experimental group received holistic rehabilitation nursing interventions based on the FTS concept. Patient adherence was assessed before and after the intervention using a hospital survey, and sleep quality was evaluated using the Pittsburgh Sleep Quality Index on days 3, 7, and 15 post-interventions. Post-intervention, the experimental group exhibited significantly improved adherence to balanced diet, regular exercise, timely medication, and regular review visits compared to the control group (P < .05). Further, Pittsburgh Sleep Quality Index scores indicated significantly better sleep quality over time in the experimental group than in the control group (P < .05). The implementation of holistic nursing interventions based on the FTS concept significantly improved patient adherence and sleep quality in LEAOD patients. These findings highlight the potential benefits of integrating such interventions in the management of LEAOD patients, potentially enhancing postoperative recovery and overall health outcomes.

Fast track surgery for children with congenital pseudarthrosis of the tibia: A prospective interventional study

ObjectiveThe purpose of this study was to explore the effect of fast-track surgery combined with a clinical nursing pathway on the recovery and complications of congenital pseudarthrosis of tibia. Methods82 children with congenital pseudarthrosis of tibia admitted from January 2019 to December 2020 were selected as the study subjects. The control group received routine clinical nursing pathway while the intervention group received a fast-track surgery combined with a clinical nursing pathway. The fasting and water deprivation time were arranged according to the pre operation time, and the accelerated rehabilitation nursing models such as progressive diet management, multi-functional analgesia, and early sequential functional exercise were given after the operation. After collecting data on perioperative diet, postoperative recovery, postoperative complications, and family satisfaction from both groups of patients in a large hospital in China, a comparative analysis was conducted. ResultsThe retention time of negative pressure drainage tube, urinary catheter and hospital stay in the intervention group were shorter than those in the control group (P < 0.05); The incidence of complications in the intervention group (5%) was significantly lower than that in the control group (21.42%) (P = 0.029). The family satisfaction of the intervention group (95.00%) was higher than that of the control group (80.95%). ConclusionStrengthening the concept of fast-track surgery nursing in the combined operation of congenital pseudarthrosis of tibia can shorten the hospitalization time of children, reduce the occurrence of postoperative complications and improve their family satisfaction.

Retracted: Effects of the Concept of Fast-Track Surgery Combined with Empathic Nursing on Perioperative Complication Prevention and Postoperative Recovery of Gynecological Malignant Tumor Patients.

[This retracts the article DOI: 10.1155/2022/4381297.].

Nursing measures in the fast-track surgery on negative emotions in breast cancer patients: A meta-analysis.

To critically evaluate the effects of different nursing measures based on the concept of fast-track surgery (FTS) on the negative emotions of patients with breast cancer. A systematic search of 8 databases, namely PubMed, Cochrane Library, Embase, Psycho info, China national knowledge infrastructure, Wanfang, China science and technology journal database, and China biomedical literature database, was performed to find randomized controlled trials from inception to April 2023. Two reviewers critically and independently assessed the risk of bias using Cochrane Collaboration criteria and extracted correlated data using the designed form. All analyses were performed with Review Manager 5.3. Ten studies were included in the systematic review, with a total of 830 patients (FTS group: 415; control group: 415). The results showed that different nursing measures based on the concept of FTS could significantly reduce anxiety (MD = -1.74, 95% confidence intervals [-2.41, -1.08], P < .00001) and depression (MD = -1.98, 95% confidence intervals [-2.44, -1.51], P < .00001) in patients after modified breast cancer surgery compared with the control group. Based on the concept of FTS, the nursing measures such as reducing preoperative fasting time, posture management, preventive analgesia, and early functional exercise can effectively reduce the anxiety and depression of patients during the perioperative period.

Application of the concept of fast-track surgery in pediatric ophthalmic surgery

To explore the effects of the fast-track surgery (FTS) approach during the perioperative period of ophthalmic surgery in pediatric patients. A bidirectional cohort design was applied in this study. The traditional nursing mode was followed in relation to 40 pediatric patients admitted for ophthalmic surgery in March 2018 (control group), whereas the FTS mode was followed with regard to 40 pediatric patients admitted for ophthalmic surgery in April 2018 (observation group). The effects of the FTS mode were determined by comparing the postoperative pain score, restlessness score, and the incidence of postoperative nausea and vomiting between the two groups. The pain and restlessness scores of the patients at 4hours after surgery in the observation group were significantly decreased compared with those in the control group (P<0.01). The incidence of postoperative nausea and vomiting in the observation group was also slightly lower than that in the control group (P>0.05). A perioperative FTS-based nursing mode can effectively alleviate the postoperative pain and restlessness of pediatric patients without increasing their stress response.

Effects of Nursing Care Using a Fast-Track Surgery Approach in 49 Patients with Early-Stage Hepatocellular Carcinoma Undergoing First-Line Treatment with Radiofrequency Ablation: A Retrospective Study.

BACKGROUND Fast-track surgery (FTS), also known as enhanced recovery after surgery (ERAS), includes a coordinated perioperative approach to patient care that aims to facilitate postoperative recovery. The role of nursing care is central to the concept of FTS. This retrospective study aimed to evaluate the effects of nursing care using an FTS approach in 49 patients with early-stage hepatocellular carcinoma (HCC) undergoing first-line treatment with radiofrequency ablation (RFA). MATERIAL AND METHODS A retrospective analysis was made of 49 patients with early-stage hepatocellular carcinoma who underwent first-line treatment with radiofrequency ablation in the Department of Hepatobiliary Surgery in our hospital from January 2020 to December 2021. The nurses have been nursing the patients in accordance with the requirements of FTS from 2021. Compared with the data of patients receiving traditional nursing, the detailed differences in postoperative recovery, pain score, complication rate, liver and kidney function, and nursing satisfaction were analyzed. RESULTS After applying the FTS nursing model, the patients had significantly shorter time to first flatus, infusion, postoperative hospital stay, and lower total hospitalization expenses (P<0.05). Moreover, the Numerical Pain Rating Scale score was lower than that in the control group, the postoperative complications in the 2021 group were lower than those in the 2020 group, and the nursing satisfaction was also better than that of the 2020 group (P<0.05). CONCLUSIONS Nursing care using a fast-track surgery approach with early-stage hepatocellular carcinoma patients undergoing first-line treatment with radiofrequency ablation is better than conventional nursing, and improves recovery of patients.

Perioperative Fast-Track Surgery Nursing Intervention for Patients with Kidney Stone Disease under Computed Tomography Imaging.

This research aims to analyze the clinical intervention effect of perioperative fast-track surgery (FTS) nursing on patients with kidney stone disease (KSD) under computed tomography (CT) imaging. One-hundred KSD patients were selected as research objects and grouped after CT examination. These objects were randomly divided into a research group (FTS nursing intervention, n = 50) and a control group (general routine nursing intervention, n = 50). The preoperative psychological status of patients was compared between the two groups, using Self-rating Anxiety Scale and Self-rating Depression Scale. The hunger and thirst situations were compared using Numerical Rating Scale; postoperative recovery time, incidence of complications, and nursing satisfaction were also compared. The high-density shadow could be clearly observed in the right kidney of the patients in the CT imaging examination. The nursing outcomes suggested that there was no notable difference in hunger between the two groups, and anxiety, depression, and thirst in the research group were highly better than those in the control group (P < 0.01). The time of the first exhaust, the time of body temperature returning to normal, the time of getting out of bed, and the length of hospital stay in the research group were all shorter than those in the control group (P < 0.05). The total postoperative satisfaction of the research group (98.00%) was greatly better than the 88.00% in the control group (P < 0.05). As the FTS concept was applied in the perioperative nursing of KSD patients under CT imaging, the preoperative and postoperative negative emotions of patients could be improved. Thereby, the postoperative recovery rate of patients was promoted, postoperative complications and patients' pain were reduced, and the postoperative quality of life of patients was also improved.

Integrating the Fast-Track surgery concept into the surgical treatment of gynecomastia

Background: The use of fast-track surgery pathway has been reported to reduce the stress of operation and accelerate rehabilitation in various surgical specialties. However, there has been a relative dearth of research on this subject for surgical treatment of gynecomastia. Materials and methods: The gynecomastia was treated by liposuction plus pull-through technique. The safety and recovery profiles were retrospectively compared between the patients in a standard pathway (including general anesthesia and postoperative drainage) and those in a fast-track pathway (including patient education, local tumescent anesthesia, no drainage, and effective pain control). Registered outcomes included postoperative complications, time to normal life, length of stay, patient satisfaction, etc. Results: From October of 2017 to October of 2021, 126 gynecomastia patients with Simon’s grade I or II who underwent the surgical treatments were included in the study, of which 25 patients were treated according to standard pathway, and 101 patients underwent the fast-track pathway. During the follow-up, there was no difference between the cohorts in the incidence of postoperative complications. Both the time to normal life and length of stay significantly decreased to 0 after the introduction of fast-track pathway. Overall, 94.1% of the patients ranked the fast-track surgical pathway as ‘great’ or ‘moderate' at the 3-month follow-up. Conclusions: The proposed fast-track pathway is feasible for surgical treatment of gynecomastia, leading to an enhanced recovery and high patient satisfaction without increasing the rate of complications. The fast-track surgery concept with implementation of local anesthetic techniques should be given serious consideration in gynecomastia management.

Effect of integrated perioperative rehabilitation intervention under the fast-track surgery concept on stress and complications in patients undergoing craniocerebral injury surgery.

To observe the intervention effect of perioperative rehabilitation intervention of integrated medical care the concept of FTS on stress response and postoperative complications in patients undergoing craniocerebral injury surgery. 70 patients with Traumatic brain injury (TBI) admitted to the Department of Neurosurgery of our Hospital from January 2019 to December 2021 were as the research objects and were divided into general group and FTS group according to the random number table method, with 35 cases in each group. The general group was intervened with perioperative basic nursing measures for TBI, and the FTS group was intervened with perioperative rehabilitation model of integrated medical care under the concept of FTS on the basis of the general group. The two groups of patients were compared in hemodynamic indexes (heart rate, mean arterial pressure), stress hormone levels (CORT, GLU, E), changes in motor neurological function (GCS score, NHISS score, FMA score), occurrence of postoperative complications (infection, pressure sores, rebleeding, central hyperthermia), short-term quality of life (SF-36) before and after the intervention. After intervention, the levels of HR, MAP, COR, GLU, and E were significantly lower in FTS group than in the general group (all P < 0.05). After intervention, the Fugl-Meyer score and Barthel index score of upper and lower extremities in both groups were significantly higher than those before intervention, and the FTS group was higher than the general group, and the difference was statistically significant (P < 0.05). After the intervention, the NIHSS scores were significantly lower in both groups than before the intervention, and the FTS group was lower than the general group, and the differences were statistically significant (P < 0.05). Short-term physical function, somatic pain, physical function, general health status, social function, energy, mental health, and emotional function scores were significantly higher in the FTS group than in thegeneral group, and all differences were statistically significant (P < 0.05). The total incidence of infection, pressure ulcers, rebleeding, central high fever and other complications in the FTS group was significantly lower than that in the general group (P < 0.05). The implementation of integrated perioperative rehabilitation interventions under the concept of FTS for patients with TBI can significantly alleviate patients' stress, promote recovery, reduce the incidence of complications, and improve short-term quality of life, which is worthy of clinical promotion.

Knowledge, attitude and application towards fast track surgery among operating room paramedics: a cross-sectional study

BackgroundFast track surgery has shown its effectiveness to accelerate recovery and gained acceptance in many operations. However, data for paramedics using fast track surgery are limited in China. The aims of our study are to evaluate the knowledge, attitude and application status of fast track surgery in paramedics and to provide suggestions for the better application of fast track surgery.MethodsTwo Hundred Ninety-one operating room paramedics were investigated by simple random sampling from October 20 to December 20, 2019 time. A self-reported questionnaire was used to collect data with five dimensions: demographic data, cognitive level, knowledge, attitude and application of fast track surgery. Data were analyzed using qualitative and quantitative methods.Results19.93% of participants never heard fast track surgery and only 3.32% of participants were very familiar with it. Gender (0.702, 95% CI 0.109–1.294), technical title (0.342, 95% CI 0.126–0.558) and awareness of the concept of fast track surgery (0.471, 95% CI 0.165–0.776) had a correlation with the knowledge level of paramedics towards fast track surgery. In terms of attitude towards fast track surgery, gender (− 1.944, 95% CI -3.830- -0.058), age (0.303, 95% CI 0.021–0.585) and knowledge score of fast track surgery (0.426, 95% CI 0.014–0.838) are related. Half of the paramedics believe the most difficult problem in the application of fast track surgery was the lack of multi-team communication and cooperation.ConclusionThe knowledge of fast track surgery among paramedics in Wuhan is poor, and some paramedics have a negative attitude towards it. As the attitude is positively correlated with the knowledge, it is necessary to improve the knowledge level of fast track surgery among paramedics in Wuhan.

Analysis of the Effect of Fast Recovery Surgery Concept on Perioperative Nursing Care of Patients with Radical Resection of Cervical Cancer and Its Influence on Psychological Status.

Objective To explore the applied effect of fast-track surgery concept in the perioperative nursing of patients undergoing radical cervical cancer surgery and its influence on mental state. Methods The clinical data of 110 patients undergoing radical cervical cancer surgery in our hospital from May 2015 to May 2017 were retrospectively analyzed, and they were randomly divided into a research group (n = 55) and a reference group (n = 55). The reference group received routine clinical nursing, and the research group received fast-track surgical nursing. Then, we compared their nursing effect and influence on the mental state of patients in the two groups. Results The Karnofsky performance status (KPS) scores of patients in the two groups after intervention were significantly lower than those before the intervention (P < 0.001), and after intervention, patients in the research group had significantly lower KPS scores as compared to patients in the reference group (P < 0.001). There was a significant decrease in the self-rating anxiety scale (SAS) scores and self-rating depression scale (SDS) scores of patients in the two groups after intervention in comparison with before intervention (P < 0.001), and patients in the research group after intervention had significantly lower SAS and SDS scores compared to the reference group (P < 0.001). Patients in the research group spent short time on expelling gas, eating, and getting out of bed as compared to the reference group (P < 0.001); after intervention, compared to patients in the reference group, patients in the research group had significantly higher scores in cognitive function, emotional function, social function, and physical function (P < 0.05). There was no significant difference in IgA, IgM, and IgG levels before intervention (P > 0.05). After intervention, the IgA, IgM, and IgG levels of patients in the two groups were all lower than before intervention, and patients in the research group had significantly higher IgA, IgM, and IgG levels as compared to the reference group (P < 0.001); the complication rate of patients in the research group was significantly lower than that in the reference group (P < 0.05). Conclusion The fast-track surgery concept effectively helps improve the negative emotion of patients, shorten recovery time, improve quality of life, and reduce the impact on immune function in the radical cervical cancer surgery, and it is worthy of promotion and application, with a high safety.

Effects of the Concept of Fast-Track Surgery Combined with Empathic Nursing on Perioperative Complication Prevention and Postoperative Recovery of Gynecological Malignant Tumor Patients.

Objective This study is aimed at exploring the effects of the concept of fast-track surgery (FTS) combined with empathic nursing on perioperative complication prevention and postoperative recovery of gynecological malignant tumor patients. Methods A total of 180 patients with gynecological malignant tumor treated by surgery in our hospital from September 2018 to October 2021 were randomly divided into three groups: group A, group B, and group C, with 60 patients in each group. Group C was given conventional nursing intervention, group B was given FTS intervention, and group A was given FTS intervention combined with empathic care. Psychological stress state (systolic blood pressure, diastolic blood pressure, and heart rate), postoperative recovery indicators (time of first anal exhaust, time of first defecation, time of getting out of bed, and length of postoperative hospital stay), postoperative complications, and psychological state (Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS)) levels of patients in the three groups were compared. Results Systolic blood pressure, diastolic blood pressure, and heart rate in group A were lower than those in group B, and those in group B were lower than those in group C (all P < 0.05). The time of first anal exhaust, time of first defecation, time of getting out of bed, and postoperative hospital stay in groups A and B were shorter than those in group C (all P < 0.05).The incidence of postoperative complications in groups A and B was 8.33% and 8.33%, respectively, lower than 23.33% in group C (both P < 0.05). SAS and SDS scores of group A were lower than those of groups B and C after intervention (all P < 0.05). Conclusion The concept of FTS combined with empathic nursing is beneficial to reduce the stress response of patients with gynecological malignant tumor before surgery, reduce the risk of postoperative complications, improve patients' mood, and speed up the rehabilitation process of patients.

ERAS protocol in practice of general surgeon. Our experience.

the concept of Fast track surgery involves long-term reduction of the stress response on the surgery. During a pandemic, the ERAS principles of surgery offer even more relevance, in order to reduce hospital stay and thus reduce the risk of infection. In this study used the method of survey and comparison of data of patients treated at the Department of General Surgery №2 NMU named after O.O. Bogomolets in the period from September 2011 to May 2019, namely - 569 patients who underwent elective surgery using ERAS protocols and minimally invasive surgical interventions. With the using of ERAS protocols was showed that average bed-day was 1.73 days in LHE, 1.43 in LGP, 4.99 in LBI and 4.3 in LOC. Sampling was also performed for different types of surgical interventions: LGP and "open" GP were compared, the average operation time was 117 +/- 35 min and 145 +/- 41 min, respectively, relative to the time spent by the patient in the hospital, the following data were obtained: LGP-2,65 +/- 1, 21 days, and at "open" GP-7,91 +/- 1,52 days. Conclusions: Application of ERAS protocols: reduces pain for the all period of the patient's stay in the hospital, reduces hospital stay, accelerates the return to normal quality of life, reduces the risk of postoperative complications.

Impacts of the perioperative fast track surgery concept on the physical and psychological rehabilitation of total hip arthroplasty: A prospective cohort study of 348 patients.

Studies have shown that rapid rehabilitation surgery has a positive effect on recovery after major orthopedic surgery. However, very few studies have examined the impact of fast track surgery on physical and psychological rehabilitation in patients who have undergone total hip replacement.This study aimed to investigate the value of the rapid rehabilitation surgical model for patients undergoing total hip arthroplasty during the perioperative period.We conducted a prospective cohort study that included patients who underwent total hip arthroplasty at our hospital from January 2015 to December 2018. We divided the patients into 2 groups – the rapid rehabilitation group and the conventional rehabilitation group – and compared their length of hospital stay, time to off-bed activity, pain score, Self-Rating Anxiety Scale scores, Self-Rating Depression Scale scores, complication rate, and rate of satisfaction during hospitalization.A total of 348 patients were included in the study. Of these, 180 received rapid rehabilitation nursing and 168 patients received conventional nursing. Compared with the patients in the conventional rehabilitation group, those in the rapid rehabilitation group had shorter hospital stays (11.5 ± 1.2 day vs 15.5 ± 2.3 day, P = .021), resumed off-bed activities sooner (20.5 ± 3.4 hours vs 61.8 ± 4.7 hours, P = .001, had less postoperative pain (4.0 ± 1.2 vs 6.5 ± 1.1, P < .001), and lower anxiety and depression scores (anxiety score: 24.4 ± 2.1 vs 47.9 ± 2.9; depression score: 25.8 ± 1.8 vs 43.7 ± 1.7, P < .001).The application of rapid rehabilitation surgery in total hip arthroplasty can accelerate patients’ postoperative recovery, relieve anxiety and depression, and increase the patient's satisfaction with the treatment.

Postoperative drainage of the pleural cavity with aspiration of the contents by high-tech mobile devices

Between May and September 2021, 65 patients aged from 23 to 88 years with various oncological and non-oncological diseases of the thoracic cavity followed by drainage underwent resection operations with a volume less than pneumonectomy or lung decortication for empyema, parietal pleurectomy for recurrent pneumothorax. Six patients (4 after pneumonectomy and one with postoperative complications (1 after retoracotomy for hemothorax and 1 after laparoscopic cholecystectomy for acute destructive cholecystitis in the immediate postoperative period) were excluded from the study. The patients were divided into 2 groups. The first group consisted of 22 patients in whom in the early postoperative period we used continuous active pleural content aspiration with the help of high-tech mobile devices Atmos. The second group included 37 patients in whom we used drainage by means of medical suction of Lavrinovich or Visma-Planar design (Belarus). Soft drainage by modern systems of pleural cavity content evacuation provides the best conditions for stopping air leakage from the lung tissue as well as for preventing pneumothorax when transporting a patient from the operating room and around the clinic for examination. The early activation of the patient with the connected mobile digital aspirator not only promotes the Fast-track surgery concept but also the ERAS program, i.e. accelerated rehabilitation, as recommended by the European Society of Thoracic Surgeons (ESTS). These designs also have advantages over stationary devices, such as subjective factors based on the relative ease of operation of mobile systems in their use, accessibility not only for medical staff, but also for the patient himself.

Survey on the Readiness for Hospital Discharge and Its Influencing Factors among Patients with Cardiac Valve Replacement

Background: There are about 200,000 patients in China who need to undergo valve replacement surgery each year. With the promotion and application of the Fast-Track Surgery concept and the increase in hospital bed turnover rate, the average hospital stay of patients undergoing CVR surgery has been significantly shortened, and thus the patients are still in the recovery stage rather than fully recovered when they are discharged from the hospital. Good preparation for discharge can improve patients’ post-discharge self-care ability, reduce the risk of re-admission, and save medical resources. Objective: To describe the status of readiness for hospital discharge among postoperative patients that have undergone CVR, and to explore its influencing factors. Methods: The general information questionnaire, the Readiness for Hospital Discharge Scale and the Quality of discharge Teaching Scale were utilized to investigate 130 post-CVR patients admitted to the Cardiothoracic Surgery Department of a tertiary A-Class hospital in Guangzhou from July 2019 to October 2020. Results: The Readiness for Hospital Discharge Scale was at a moderate level with a total score of 163.88 ± 39.082, while the Quality of Discharge Teaching Scale was also at a moderate level with a total score of 194.09 ± 40.643. Multiple linear regression analysis revealed that the quality of discharge guidance, gender, and occupation were the influencing factors of CVR patient’s readiness for hospital discharge. These three variables jointly explained 45.8% of the total variation. Conclusion: The level of CVR patients’ readiness for hospital discharge is at a moderate level, and the quality of discharge guidance positively affects patients’ readiness for discharge. Therefore, in clinical work, attention should be paid to patient discharge guidance. Personalized health education should be implemented to improve the quality of patient guidance.

Application of Concept of Fast-Track Surgery in Ophthalmic Surgery for Children

Purpose: To explore the application effect of concept of fast-track surgery (FTS) in perioperative period of ophthalmic surgery. Methods: Bidirectional cohort study design was used in this study. Traditional nursing mode was applied in 40 children patients admitted in Mar. 2018 (control group) in the intraoperative period, and FTS mode was used in 40 children patients admitted in Apr. 2018 (observation group) in the intraoperative period. The postoperative pain scores, restlessness scores, and incidences of nausea and vomiting were compared between the two groups. Results: The pain scores and restlessness scores at 4 h after the surgery in the observation group were significantly decreased (P 0.05). Conclusions: The perioperative nursing mode based on FTS can effectively alleviate the postoperative pain and restlessness of children patients, and cannot increase the stress response. Funding Statement: None. Declaration of Interests: The authors declare that they had no competing interests. Ethics Approval Statement: The present study was approved by the Ethics Committee of children's hospital affiliated to Nanjing medical university. The written informed consent to participate and publish for all the subjects in this study was provided by their parents, guardians or next of kin.

Evolution of approaches in treatment of acute pain syndrome (review)

In recent years, the treatment of acute pain syndrome has been considered as an independent direction in anesthesiology and intensive care. New schemes of postoperative analgesia and new drugs developed by pharmacologists are actively being introduced. One of the newer regimens for pain relief is patient-controlled analgesia (CPA) or on-demand analgesia. The development of the concept of fast track surgery, one of the most widely discussed areas for the development of innovative technologies in modern surgery, from the point of view of the anesthesiologist of the resuscitation specialist, minimizes the stress response of the body to surgical aggression at all stages of the perioperative period. Increasingly, the method of preemptive analgesia is used more widely, based on the use of analgesics before the start of the operation, which helps to prevent the occurrence of peripheral and central sensitization.

Safety and Costs Analysis of a Fast-track Algorithm for Early Hospital Discharge After Brain Tumor Surgery

Abstract INTRODUCTION Until the 1990 s, perioperative care was based on empirical concepts and common practice, in part due to the paucity of scientific evidence. With the need of improving patient outcomes and reducing costs, the concern of developing safe and effective standards in postoperative care emerged. Recently, our institution has adopted a daily algorithm for hospital discharge (DAHD), which is a key point in the concept of Fast-Track Surgery. Thus, we designed a study to evaluate whether there was a difference in length of stay (LOS), rate of complications, and hospital costs after the introduction of the DAHD in the postoperative management of patients who underwent brain tumor resection. METHODS This is a retrospective cohort study. All consecutive patients who underwent brain tumor resection in 2017 by a single neurosurgeon were analyzed. Demographic and procedure-related variables, clinical outcomes, and healthcare costs within 30 d after surgery were collected and compared in patients before (preimplementation) and after (postimplementation) the daily algorithm for hospital discharge (DAHD). RESULTS About 61 patients who had been submitted to brain tumor resection were studied (preimplementation 32, postimplementation 29). The baseline demographic characteristics were similar between the groups. After the DAHD implementation, LOS after surgery in days decreased significantly (median 5 vs 3 days; P = .001). The proportion of patients who were discharged within day 1 or 2 after surgery was significantly higher after DAHD protocol (3.1% vs 44.8%; P &lt; .001). Major and minor complications rates, readmission rate, and unplanned return to hospital in 30-day follow-up were comparable between the groups. There was a significant reduction in the median costs of hospitalization in DAHD group (US$2135 vs US$2765, P = .043), mainly due to a reduction in median ward costs (US$922 vs US$1623, P = .009). CONCLUSION Early discharge after brain tumor surgery was safe, inexpensive, reduced the LOS, and hospitalization costs without increase in readmission rate or postoperative complications.