Fast-track Surgery Research Articles

No evidence of cardiac stunning or decoupling immediately after cardiopulmonary bypass for elective coronary surgery.

There is significant uncertainty regarding the timing of onset of cardiovascular stunning after cardiac surgery. Cardiovascular stunning is affecting both contractility (Ees) and arterial load. Arterial load may be represented by arterial elastance (Ea) and participates in ventriculo-arterial coupling through the Ea/Ees ratio, giving information on efficiency and performance. An alternative approach to ventriculo-arterial interaction is oscillatory power fraction (OPF). The aim of this study was to investigate the immediate beat-to-beat effects of on-pump coronary artery bypass graft (CABG) surgery on contractility, cardiac power parameters, arterial load and ventriculo-arterial coupling as well as classical haemodynamic parameters. We included 41 patients scheduled for fast-track CABG surgery. Measurements were taken before and after cardiopulmonary bypass. A flow and pressure curve were recorded from transoesophageal pulsed wave Doppler and a radial artery catheter, respectively. This enabled the calculation of stroke work, total cardiac energy delivery, OPF and Ea/Ees ratio. Routine haemodynamic monitoring provided the classical haemodynamic parameters. Immediately after cardiopulmonary bypass there was no firm evidence for alterations in contractility, stroke work, stroke volume or arterial elastance. Ea/Ees ratio and OPF remained unchanged. There was no evidence for clinically relevant cardiac stunning or altered arterial load immediately after cardiopulmonary bypass for CABG surgery. The unchanged Ea/Ees ratio and OPF are indicating unchanged cardiac efficiency before and after cardiopulmonary bypass. This indicates that in elective CABG patients cardiovascular stunning is perhaps a phenomenon of inflammation and not immediate ischaemia-reperfusion injury or mechanical handling.

Effects of a fast track surgery nursing program in perioperative care of older patients with a hip fracture.

The nursing concept has changed from being "disease centered" to "patient centered". The aim of this study was to explore the clinical effects of a fast track surgery nursing program in the perioperative care of older patients with a hip fracture. Total of 84 patients with hip fracture who were hospitalized in our department were randomly divided into the conventional group (42 cases) and fast track surgery group (42 cases) to compare the psychological state, pain degree, serum inflammatory factors, coagulation, hip function, and incidence of deep venous thrombosis of lower extremities between the groups before and after the nursing program. There were no significant differences between groups as measured by a self-rating anxiety scale, self-rating depression scale, visual analogue score, IL-6, IL-10, TNF-α, coagulation factor level, or Harris score between groups before nursing (P > 0.05). The self-rating anxiety scale, self-rating depression scale, visual analogue score, IL-6, IL-10, TNF-a, coagulation factor level, and deep venous thrombosis in fast track surgery group after nursing were significantly lower than in the conventional group, and the Harris score was significantly higher (P < 0.05). The fast track surgery nursing program can effectively alleviate adverse emotions and pain of patients with a hip fracture, reduce inflammation, improve coagulation and hip function after operation, and reduce the incidence of deep venous thrombosis after operation.

Outcomes of Enhanced Recovery Protocol versus Traditional Methods after Gastrointestinal Surgical Operations

Abstract Background: Enhanced Recovery after Surgery (ERAS) program is a new set of protocols that is applied to the patient in the peri-operative period to fasten the recovery and decrease the convalescence and thus improving the surgical outcome. It is also named as fast track surgery. Aim of Study: The aim of fast tracking is to attenuate stress response to surgical trauma in order to: Reduce mor-bidity, hospital stay, and costs. Enhance early and safe recovery of the patient after a surgical procedure and to allow patients to resume their normal daily activities as quick as possible. Patients and Methods: In our study we had 50 patients underwent various gastrointestinal surgical operations. The ERAS protocol was implemented on group A with multiple pre, intra and post-operative elements, while group B was managed traditionally. Both groups were closely observed and evaluated during the post-operative period and one month after discharge. Results: There were 6 cases that needed readmission during the first month postoperative , 2 cases in group A (8%) and only 4 cases in group B (16%), but this difference is insignificant. there was no obvious and significant earlier unaided mobilization in group A than group B. There was a clear difference between both groups in length of hospital stay. Patients receiving ERAS protocol stayed definitely shorter period post-operatively. There also was noticed a clear and obvious satisfaction between patients of ERAS group in the form of early mobilization, return to normal activities and pain free. Conclusion: Fast track rehabilitation program plays an important role in the recovery of patients after gastrointestinal operations, which can accelerate the restoration of their gastrointestinal function, decrease their post-operative com-plications, and shorten their hospital stay time.

IMPLEMENTATION OF THE CONCEPT OF «FAST-TRACK SURGERY» IN THE TREATMENT OF PATIENTS WITH ACUTE PANCREATITIS ACCORDING TO THE TACTICS «STEP-UP APPROACH»

Summary. The aim of the study – to improve the results of surgical treatment of patients with acute pancreatitis using the “step-up approach” tactics, and justify the feasibility of implementing the concept of “fast-track surgery” in surgical practice using the example of these patients.&#x0D; Matherials and Methods of the study. The results of the treatment of 103 patients with acute pancreatitis who were treated in the surgical department of the Municipal non-commercial enterprise of the Kharkov regional council «Regional Clinical Hospital» 2015 to 2020 were analyzed. All patients were divided into two groups: the main (56 patients) and the comparison group (47 patients). In the main group, the tactics of the “step-up approach” were applied and the principles of the ERAS concept (2018-2020) were implemented. In the comparison group (2015-2017), the ERAS principles were not implemented and the open method was mainly used as the standard surgical treatment.&#x0D; Results of the study. Patients treated using the principles of “fast-track surgery” along with the “step-up approach” tactics, less likely to have postoperative complications and reduced the length of stay in the surgical department.&#x0D; Conclusions. This example confirms the appropriateness of applying the principles of “fast-track surgery” in everyday surgical practice in the complex treatment of patients with acute pancreatitis, as the results of surgical treatment of this category of patients are improved and financial costs for treatment are reduced.

Enhanced recovery after surgery outcomes in minimally invasive nonhysterectomy gynecologic procedures

Improved patient outcomes and satisfaction associated with enhanced recovery after surgery protocols have increasingly replaced traditional perioperative anesthesia care. Fast-track surgery pathways have been extensively validated in patients undergoing hysterectomies, yet the impact on fertility-sparing laparoscopic gynecologic operations, particularly those addressing chronic pain conditions, has not been examined. The objective of the study was to determine the effects of enhanced recovery after surgery pathway implementation compared with conventional perioperative care in women undergoing laparoscopic minimally invasive nonhysterectomy gynecologic procedures. We conducted a retrospective cohort study of women undergoing uterine-sparing laparoscopic gynecologic procedures for benign conditions (tubal/adnexal pathology, endometriosis, or leiomyomas) during a 24 month period before and after enhanced recovery after surgery implementation at a tertiary care center. We compared immediate perioperative outcomes and 30 day complications. The primary outcome was same-day discharge rates. Factors influencing unplanned admissions, postoperative pain, sedation, nausea, and vomiting represented secondary analyses. A total of 410 women (enhanced recovery after surgery, n= 196; conventional perioperative care, n= 214) met inclusion criteria. Following enhanced recovery after surgery implementation, same-day discharge rates increased by 9.4% (P= .001). Reductions in postoperative pain and nausea/vomiting represented the primary driving factor behind lower unplanned admissions. Higher preoperative antiemetic medication administration in the enhanced recovery after surgery group resulted in a 57% reduction in postanesthesia care unit antiemetics (P < .001). Total perioperative narcotic medication use was also significantly reduced by 64% (P < .001), and the enhanced recovery after surgery cohort still demonstrated significantly lower postanesthesia unit care pain scores at hours 2 and 3 (P < .001). A 19 minute shorter postanesthesia care unit stay was noted in the enhanced recovery after surgery cohort (P= .036). Increased same-day discharge did not lead to higher postoperative complications or changes in 30 day emergency department visits or readmissions in patients with enhanced recovery after surgery. Enhanced recovery after surgery implementation resulted in increased same-day discharge rates and improved perioperative outcomes without affecting 30 day morbidity in women undergoing laparoscopic minimally invasive nonhysterectomy gynecologic procedures.

Fast track surgery for knee replacement surgery: a lean six sigma approach

PurposeThe reduction of costs has a more and more relevant role in the healthcare context, therefore, a large effort is done by health providers to this aim, for example, by reducing the length of hospital stay (LOS) of patients undergoing surgery. Fast track surgery fits perfectly this issue and was applied to patients undergoing knee replacement surgery due to Osteoarthritis, one of the most common diseases of aged population. The paper aims to discuss these issues.Design/methodology/approachLean six sigma was applied to analyze the implementation of fast track surgery through the define, measure, analyze, improve, control roadmap, used as a typical problem-solving approach. It is characterized by five operational phases, which make possible the achievement of fixed goals through a rigorous process of defining, measuring, analyzing, improving and controlling business problems.FindingsThe corrective action, consisting in the application of fast track surgery, improved both effectiveness and efficiency of the process of care. The average length of hospital stay (LOS) was reduced from 8.34 to 6.68 days (–19.9 percent) and its standard deviation from 2.41 to 1.99 days (–17.1 percent). The statistical significance of this decrease was verified by means of proper tests. Moreover, some variables influencing the LOS were identified.Research limitations/implicationsThe follow up and the satisfaction of patients were not analyzed and could be a future development of this study.Practical implicationsPatients will experience a faster recovery while the hospital will benefit from a rise of available beds. The effect is a general improvement of hospital management.Originality/valueThe introduction of fast track surgery for patients undergoing knee replacement surgery made significantly reduce LOS and, consequently, costs’ with a money saving of more than 50,000 euro per year.

Effect of low-frequency electrical acupoint stimulation on gastrointestinal motility function following radical gastrectomy in patients with gastric cancer

To observe the effect of low-frequency electrical acupoint stimulation on gastrointestinal motility in patients undergoing radical gastrectomy, and its impact on regulation of inflammatory response, so as to evaluate its clinical value. A total of 177 patients undergoing radical gastrectomy were randomly divided into conventional group (n＝43), low-frequency electrical acupoint stimulation (LEAS) group (n＝45), fast track surgery (FTS) group (n＝46) and FTS＋LEAS group (n＝43). Patients of the conventional group received conventional treatment (pre-surgical mechanical bowel preparation, post-surgical fasting, and indwelling abdominal drainage tube, etc.). Patients in the LEAS group were treated by low-frequency electrical stimulation at bilateral Zusanli (ST36), Shangjuxu(ST37), Xiajuxu(ST39) and Sanyinjiao(SP6) for 30 min, once daily from 1 day after the operation to first postoperative flatus. FTS group was given fast track surgery treatment, such as preoperative education, preoperative nutritional support, early oral feeding, early removal of abdominal drainage tube, etc. The FTS＋LEAS group was given low-frequency electrical acupoint stimulation on the basis of the FTS treatment. Levels of white blood cells (WBC), neutrophils (N), C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) at 1, 3, and 6 d after the operation in the 4 groups were assayed. The first postoperative flatus and defecation time were recorded. After the treatment, the first postoperative flatus and defecation time in the LEAS, FTS and FTS＋LEAS groups were significantly shorter than those of the conventional group (P<0.05), and the first flatus time of the FTS＋LEAS group was even earlier than that of the FTS group (P<0.05). No significant differences were found among the 3 groups in the postoperative defecation time (P>0.05). The CRP levels in the 4 groups on 3 and 6 d after operation were higher than those on the 1st postoperative day, and the highest level was on 3 d after the operation. Compared with the conventional group, CRP level on 3 d and CRP and IL-6 levels on 3 and 6 d in the LEAS and FTS＋LEAS groups were significantly lower (P<0.05). Compared with the LEAS group, the levels of N, CRP on 3 d and the levels of N, CRP, IL-6 on 6 d in the FTS group were significantly increased (P<0.05). Compared with the FTS group, the level of CRP on 3 d and the levels of N, CRP, IL-6 on 6 d in the FTS＋LEAS group were significantly decreased (P<0.05). FTS combined with LEAS is superior to simple FTS or LEAS treatment in shortening the first flatus and defecation time and promoting the recovery of gastrointestinal motility function in patients undergoing radical gastrectomy, which may be associated with its effect in alleviating postoperative inflammatory responses.

The Influence of Surgical Experience on Postoperative Recovery in Fast-Track Bariatric Surgery.

Short duration of surgery is an important aspect in fast-track protocols. Peroperative training of surgical residents could influence the duration of surgery, possibly affecting patient outcome. This study evaluates the influence of the operator's level of experience on patient outcome in fast-track bariatric surgery. Data was analyzed of all patients who underwent a primary laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) between January 2004 and July 2018. Residents were trained according to a stepwise training program. For each operator, learning curves of both procedures were created by dividing the procedures in time-subsequent groups (TSGs). Data was also analyzed by comparing "beginners" with "experienced operators," with a cut-off point at 100 procedures. Primary outcome measure was duration of surgery. Secondary outcome measures were length of hospital stay (LOS), complications, and readmission rate within 30days postoperatively. There were 4901 primary procedures (53.1% LSG) performed by seven surgeons or surgical residents. We found no difference between beginning and experienced operators in complications or readmissions rates. The experience of the operator did not influence LOS (p = 0.201). Comparing each new operator with previous operator(s), the starting point in terms of duration of surgery was shorter, and the learning curve was steeper. The duration of surgery was significantly longer for supervised beginning operators as compared with experienced operators. Within the stepwise training program for residents, there is a slight increase in duration of surgery in the beginning of the learning curve, without affecting the patient outcome.

Historical inspiration and practical thinking of enhanced recovery after surgery

In recent years, enhance recovery after (ERAS) has attracted many attentions in the surgical field. ERAS is a new model of perioperative management, in which more attention is paid to patients′ perception to the medical treatment. This new medical model is different from the past one which is completely led by medical practitioners, thus full of humanistic concerns and rationality. With the premise of medical safety guaranteed, a series of measures, especially evidence-based medical interventions, are implemented to optimize the perioperative management and promote the recovery of patients in ERAS. A certain level of economic and social benefit will be gained with this process. The development history of ERAS was systemically reviewed in current editorial to help the readers to get a better understanding of the origin and evolving process of ERAS. It tracked back to the 1960s when reductions and one guarantee and removal of two tubes and one prohibition were proposed as a revolutional perioperative management mode by the surgical community in our country. The goals pursued and measures implemented by our surgical predecessors back in those days were astonishingly similar to those in today′s ERAS practice. They actually enlightened the initiation of ERAS in China. While ERAS is widely implemented nowadays, this new medical model should be objectively evaluated. A patient-centered medical system should be built, and ERAS should be promoted from an academic perspective, through which the ultimate goal of surgery without danger and pain could be finally achieved. Key words: Treatment outcome; Enhanced recovery after surgery; Fast track surgery; Perioperative management

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.

Quality of recovery after anesthesia for patients undergoing laparoscopic surgery: a prospective, controlled, double-blind randomized study comparing total intravenous anesthesia versus desflurane anesthesia

Background: Fast-track surgery is a multimodal approach to reduce postsurgical organ dysfunction and complications in order to improve patient’s postoperative recovery. The study aimed to compare inhaled anesthesia (IA) and total intravenous anesthesia (TIVA) with regard to quality of recovery, cost-effectiveness, and which anesthetic technique is more suitable for fast-track programs concerning laparoscopic cholecystectomy or pelvic surgery. Methodology: This study was conducted at King Fahd Hospital of the University from December 2019 to March 2020. A total of 50 patients were randomly allocated into two groups; one received IA (desflurane group) and the other TIVA (propofol group). Preoperative and postoperative assessments were carried out using various tools to compare both techniques. Results: The recovery and emergence from anesthesia was more rapid in patients who received IA. The time until patients could answer simple questions was shorter in the IA group. On the contrary, quality of recovery- 15 at 6 hours after surgery was significantly higher in the TIVA group. Similarly, the ability to concentrate and coordinate measured by the Bourdon-Wiersma test was also significantly better in the TIVA group. The ability to retain new facts (anterograde amnesia) as assessed by the picture card test was significantly higher in the TIVA group. Also, postoperative nausea and vomiting were more common with IA. Conclusion: Both IA and TIVA are suitable for fast-track anesthesia. While desflurane group had a rapid emergence and recovery time, the quality of recovery and the ability to concentrate and anterograde amnesia were better in the TIVA group.

Early feeding after colorectal surgery in children: Is it safe?

Aim of the Study:The aim of this study is to assess the role of early feeding after elective colorectal surgery in children and compare the outcome of feeding practice early versus traditional feeding.Study Design:A randomized controlled, single-center study was conducted over a period of 3 years (November 2015–October 2018) at a tertiary care center.Materials and Methods:Patients (n = 147), after colostomy closure (as elective colorectal surgery), were randomly selected for postoperative feeding initiation and were divided into two groups, namely the control (traditional feeding) group and study group (early feeding). In early group, feeding was initiated on the postoperative day 1 after the removal of nasogastric tube (removed after 16 h of surgery). Postoperative hospital stay and complications were compared among them.Statistical Analysis Used:Data were tabulated and analyzed in Microsoft Excel 2010.Results:Among 147 patients (boys[70] and girls [77]), the average age of colostomy closure was 4.36 years. Forty-five patients had early feeding and 102 traditional feeding. Average postoperative hospital stay was noted 5.62 ± 1.11 days for “Study group” and 8.1 ± 1.04 days for “Control group.” Postoperative complications were found in 17 patients; 11 (7.5%) superficial surgical site infection (9 [8.8%] in control and 2 [4.4%] in study group) and 6 (4%) minor fecal fistulae (5 [4.9%] in control group and 1 [2.2%] in study group). None required any further surgical intervention. No mortality was reported.Conclusions:Early feeding initiation after elective colorectal surgery is safe, and postoperative hospital stay is significantly reduced. It is definitely a step forward in the era of fast track surgery in pediatric population.

Treatment of Colorectal Cancer with Natural Anal Passage-based Fast Track Surgery

In this study, 200 patients with colorectal cancer surgery from January 2013 to June 2018 were recruited and divided into the rapid rehabilitation treatment group and the control group. Basic information was collected and albumin expression level is analysed. In addition, the pain grading method was used to grade the postoperative conditions to observe the treatment effect of the rapid rehabilitation treatment group and control group. The results showed that there is no statistical difference between the two groups in the basic situation and previous history of the two groups. In the analysis of albumin expression level, significant statistical differences were found between the two groups and at different time points. And in the analysis of postoperative pain levels of patients in the two groups, it was found that the proportion of taking painkillers in the rapid rehabilitation treatment group is significantly lower, and with the increase of postoperative time, the final pain levels of patients in the two groups show a statistical difference (p<0.05). Therefore, it is found that rapid rehabilitation is indeed better than the traditional perioperative treatment in this study. Although there are some deficiencies in the experimental process, it still provides a new experimental reference basis for the treatment of colorectal cancer in the future.

Comparative analysis of results of radical surgical treatment of patients with cancer of left half of the colon and rectum with laparoscopic and open surgical procedures as part of Fast Track Surgery

Comparative analysis of results of radical surgical treatment of patients with cancer of left half of the colon and rectum with laparoscopic and open surgical procedures as part of Fast Track Surgery

Fast-track Surgery Protocol for Hepatectomy and the Rate of Surgical Site Infections: A Single-center Study

Fast-track Surgery Protocol for Hepatectomy and the Rate of Surgical Site Infections: A Single-center Study

Application of fast-track surgery combined with a clinical nursing pathway in the rehabilitation of patients undergoing total hip arthroplasty

ObjectiveTo explore the effect of fast-track surgery combined with a clinical nursing pathway in the rehabilitation of patients treated with total hip arthroplasty (THA).MethodsWe enrolled 70 patients diagnosed with avascular necrosis who were treated with a THA. All patients were randomly divided into either a control or a study group. The control group received routine nursing during the perioperative period while the study group received a fast-track surgery combined with a clinical nursing pathway.ResultsThere was no significant difference in general condition between the two groups, including the Harris hip score and the SF-36 scale of health. At the third week and the third month after the operation, the Harris hip score and the health SF-36 score of the study group increased significantly compared with the control group. In addition, the study group had a lower incidence of total complications and a shorter hospitalization time, as well as higher satisfaction scores for nursing work compared with the control group.ConclusionFast-track surgery combined with a clinical nursing pathway can effectively improve the clinical symptoms and self-efficacy of patients undergoing THA, and improve the patients' satisfaction with hospitalization.

WAYS OF PREVENTION SYNDROME OF INTRA-ABDOMINAL HYPERTENSION IN BARIATRIC SURGERY

Patients with obesity who have undergone intra-abdominal endoscopic intervention belong to the category of patients with an increased risk of developing the syndrome of intra-abdominal hypertension (SIAH), which dictates the need to develop interventions aimed at its prevention.The OBJECTIVE was to evaluate the effectiveness of complex integrated methods of SIAH prevention in patients with morbid obesity with endoscopic bariatric surgery.MATERIAL AND METHODS. A randomized trial of 69 patients with a body mass index &gt;35 kg/m INTENSIVE 2 was conducted; patients were divided into two groups depending on the type of anesthesia. In the 1st group (n=34), the operation was performed under combined anesthesia based on low-flow inhalation with desflurane in combination with prolonged epidural analgesia (PEA) with ropivacaine. Maintaining a deep level of myorelaxation under the control of acceleromyography in the post-tetanic counts (PTC) mode was achieved by continuous infusion of rocuronium. In the perioperative period, the infusion patients were in the «beach chair» position, and their research was carried out according to the principles of fast track surgery. In the 2nd group (n=35), the operation was performed under combined anesthesia based on lowflow inhalation with desflurane, neuromuscular blockade was performed by bolus injection of rocuronium under the control of acceleromyography in train of four (TOF) mode. Analgesia was provided by systemic administration of opioids. In both groups, markers of kidney injury were investigated, intra-abdominal pressure was monitored, the effectiveness of recovery after surgery and the quality of postoperative analgesia were assessed.RESULTS. A significantly lower level диурез of intra-abdominal pressure (IAP), связь higher compliance evaluation of the anterior crit abdominal внутрибрюшной wall, and a significantly стаканов lower level управляемой of markers of renal study injury in the отмечено postoperative period bariatric were revealed raga in the first дозе group compared to the second group during темпу the perioperative study period. keulenaerСONCLUSION. The effectiveness of using the position of deep muscle relaxation in the continuous infusion mode, adequate analgesia in the perioperative period using neuraxial techniques, using the «beach chair» position on the operating table and in the postoperative period, managing patients using fast track surgery for preventing the development of SIAG was identified.The authors declare no conflict of interest.The authors confirm that they respect the rights of the people participated in the study, including obtaining informed consent when it is necessary, and the rules of treatment of animals when they are used in the study. Author Guidelines contains the detailed information.

Fast Track Program in Conversion Bariatric Surgery, as Safe as in Primary Bariatric Surgery?

Evaluate the safety of fast track (FT) surgery program in patients undergoing primary and revisional bariatric surgery (conversion from one procedure to another); identify limiting factors for early discharge and predictive factors for readmission. This is a retrospective review of 730 consecutive morbidly obese patients who underwent bariatric surgery between January 2016 and December 2017. Fast track protocol was applied on all patients. Target discharge was after one-night stay. The primary end point is length of stay. The secondary end point is frequency of hospital contact after discharge, readmissions and reinterventions within 30 days. Primary procedures (n = 633) were banded Roux-en-Y gastric bypass (BRYGB, 79.3%), sleeve gastrectomy (10.7%), gastric band (4.7%) and others (5.3%). Mean age (± SD) was 44.32 ± 11.26 years, and mean BMI (± SD) was 43.58 ± 6.12 kg/m2. Conversion procedures (n = 97) were gastric band to BRYGB (40.2%), or to adjustable BRYGB (39.2%), Mason to BRYGB (11.3%), sleeve to BRYGB (4.1%) and others (5.2%). Mean age (± SD) was 47.22 ± 9.1 years, and mean BMI (± SD) was 37.9 ± 7.27 kg/m2. Mean LOS in primary patients was 1.3 ± 0.99, and that in conversion patients was 1.5 ± 1.4. Successful discharge at one night or less was achieved in 650 cases (573 primary and 77 conversion). After one-night discharge, incidence of contact to the hospital, readmission and reintervention was 23.9%, 5.9% and 1.9%, in the primary group and 31.2%, 13% and 5.2% in the conversion group. One-night discharge in FT managed conversion procedures is safe, compared to primary procedures. It is associated with higher readmission rates; however, the postdischarge hospital contacts and surgical complications were not statistically significant different.

Validation of a Novel Device for the Knee Monitoring of Orthopaedic Patients.

Fast-track surgery is becoming increasingly popular, whereas the monitoring of postoperative rehabilitation remains a matter of considerable debate. The aim of this study was to validate a newly developed wearable system intended to monitor knee function and mobility. A sensor system with a nine-degree-of-freedom (DOF) inertial measurement unit (IMU) was developed. Thirteen healthy volunteers performed five 10-meter walking trials with simultaneous sensor and motion capture data collection. The obtained kinematic waveforms were analysed using root mean square error (RMSE) and correlation coefficient (CC) calculations. The Bland–Altman method was used for the agreement of discrete parameters consisting of peak knee angles between systems. To test the reliability, 10 other subjects with sensors walked a track of 10 metres on two consecutive days. The Pearson CC was excellent for the walking data set between both systems (r = 0.96) and very good (r = 0.95) within the sensor system. The RMSE during walking was 5.17° between systems and 6.82° within sensor measurements. No significant differences were detected between the mean values observed, except for the extension angle during the stance phase (E1). Similar results were obtained for the repeatability test. Intra-class correlation coefficients (ICCs) between systems were excellent for the flexion angle during the swing phase (F1); good for the flexion angle during the stance phase (F2) and the re-extension angle, which was calculated by subtracting the extension angle at swing phase (E2) from F2; and moderate for the extension angle during the stance phase (E1), E2 and the range of motion (ROM). ICCs within the sensor measurements were good for the ROM, F2 and re-extension, and moderate for F1, E1 and E2. The study shows that the novel sensor system can record sagittal knee kinematics during walking in healthy subjects comparable to those of a motion capture system.

Efficacy and safety of enhanced recovery after surgery in perioperative management of pancreatoduo-denectomy: a Meta analysis

Objective To systematically evaluate the efficacy and safety of recovery after surgery (ERAS) in perioperative management of pancreatoduodenectomy. Methods Literatures were researched using the Cochrane Library, PubMed, Embase, CNKI, VANFUN database, CBM, China Science and Technology Journal Database from June 1979 to June 2019 with the key words including enhanced recovery after surgery, fast-track surgery, fast track multi-disciplinary treatment, pancreatoduodenectomy, laparoscopic pancreatoduodenectomy, whipple surgery, 加速康复外科, 快速康复外科, 加速康复综合治疗模式, 胰十二指肠切除术, 腹腔镜胰十二指肠切除术, whipple手术 . The randomized controlled trial or prospective cohort study about traditional perioperative management versus ERAS in perioperative management of pancreatico-duodenectomy were received and enrolled. The patients receiving ERAS in perioperative management and traditional perioperative management were respectively allocated into ERAS group and control group. Two reviewers independently screened literatures, extracted data and assessed the risk of bias. Count data were described as risk ratio (RR) and 95% confidence interval (CI). Measurement data were represented as mean difference (MD) and 95%CI. The heterogeneity of the studies was analyzed using the I2 test. Funnel plot was used to test potential publication bias if the studies included ≥ 5, and no test was needed if the studies included < 5. Results (1) Document retrieval: a total of 8 randomized controlled trials were included. There were 1 187 patients, including 588 in the ERAS group and 599 in the control group. (2) Results of Meta analysis. ① There was no significant difference in the incidence of postoperative hemorrhage between the two groups (RR=0.79, 95%CI: 0.45-1.37, P>0.05). The bilateral symmetry was presented in the funnel plot based on the 8 studies, suggesting that publication bias had little influence on results of Meta analysis. ② There was no significant difference in the incidence of postoperative pancreatic fistula between the two groups (RR=0.97, 95%CI: 0.67-1.39, P>0.05). ③ There was no significant difference in the incidence of postoperative intra-abdominal infection between the two groups (RR=0.76, 95%CI: 0.51-1.12, P>0.05). The bilateral symmetry was presented in the funnel plot based on the 5 studies, suggesting that publication bias had little influence on results of Meta analysis. ④ There was a significant difference in the incidence of postoperative delayed gastric emptying between the two groups (RR=0.46, 95%CI: 0.31-0.67, P 0.05). The left-right asymmetry was presented in the funnel plot based on the 5 studies, suggesting that publication bias may exist in the included studies. Conclusion ERAS in the perioperative management of pancreatoduodenectomy is safe and effective, which can reduce the incidence of postoperative delayed gastric emptying, shorten the time to postoperative first flatus and duration of hospital stay, and reduce the incidence of postoperative overall complications. Key words: Enhanced recovery after surgery; Pancreatoduodenectomy; Efficacy; Safety; Randomized controlled trials; Meta analysis