Standard Perioperative Care Research Articles

Implementation of the Robocare nursing model for patients undergoing da Vinci robot-assisted radical gastrectomy for gastric cancer.

This study aimed to assess the safety and feasibility of the Robocare nursing model in patients undergoing da Vinci robot-assisted radical gastrectomy for gastric cancer. A total of 68 patients who underwent da Vinci robot-assisted radical gastrectomy for gastric cancer in our department from January 2022 to June 2022 were enrolled in this study and were assigned to a control group (n = 34) and an intervention group (n = 34). The control group received standard perioperative nursing care, while the intervention group received the Robocare model along with standard care. We compared the differences in postoperative hospital stay length, the incidence of postoperative complications, readmission rates within one month after discharge, and satisfaction with nursing care between the two groups. Compared to the control group, patients in the intervention group exhibited a significantly shorter postoperative hospital stay (mean 8.94days vs. 9.76days, P < 0.05) without an increase in the incidence of postoperative complications (26.5% vs. 29.4%, P > 0.05). In addition, there was no significant difference in readmission rates within 1month after discharge between the two groups (14.7% vs. 5.9%, P > 0.05). Patient satisfaction was significantly higher in the intervention group compared to the control group (96.34% vs. 91.96%, P < 0.05). The implementation of the Robocare nursing model for patients undergoing da Vinci robot-assisted radical gastrectomy for gastric cancer may reduce the length of postoperative hospital stays without increasing the incidence of postoperative complications, while also enhancing patient satisfaction with nursing care.

STRIVE pilot trial: a protocol for a multicentre pragmatic internal pilot randomised controlled trial of Structured TRaining to Improve fitness in a Virtual Environment (STRIVE) before surgery

IntroductionHome-based, virtually-supported care models may represent the most efficient and scalable approach to delivering prehabilitation services. However, virtual approaches to prehabilitation are understudied. This manuscript describes the protocol for an...

A retrospective cohort study on enhanced recovery after surgery (ERAS) in patients with diabetic foot ulcer

Enhanced recovery after surgery (ERAS) has been successfully integrated into a diverse array of surgical fields to improve the quality and efficacy of treatment intervention. Nonetheless, the application of the ERAS protocol for patients with diabetic foot ulcer (DFU) subsequent to undergoing surgical procedures has not been previously explored. Therefore, this study aimed to investigate the effect of an enhanced recovery protocol on perioperative outcomes in patients with DFU following surgical procedures. A retrospective analysis was conducted on 112 patients with DFU who underwent surgery between January 2020 and December 2021 at a tertiary referral care center. In total, 57 patients received standard perioperative care (the non-ERAS group), and 55 patients received ERAS care (the ERAS group). The primary outcomes included the length of stay (LOS), wound healing time, patient satisfaction, and costs, serving as the basis for assessing the effectiveness of the two approaches. Secondary outcomes included preoperative anxiety (APAIS score), nutritional status (PG-SGA), pain (NRS score), the incidence of lower-extremity deep vein thrombosis (DVT), the reduction in lower-limb circumference, and the activity of daily living scale (Barthel Index). The ERAS group exhibited significantly shorter LOS (11.36 vs. 26.74 days; P < 0.001) and lower hospital costs (CNY 62,165.27 vs. CNY 118,326.84; P < 0.001), as well as a higher patient satisfaction score and Barthel Index score (P < 0.05). Additionally, we found a lower APAIS score, incidence of DVT, and circumference reduction in lower limbs in the ERAS group compared to the non-ERAS group (P < 0.05). In comparison, the wound healing time, nutritional status, and pain levels of participants in both groups showed no significant difference (P > 0.05). By reducing the LOS and hospital costs, and by minimizing perioperative complications, the ERAS protocol improves the quality and efficacy of treatment intervention in patients with DFU who underwent surgical procedures.Trial registration number: ChiCTR 2200064223 (Registration Date: 30/09/2022).

Priorities and strategy for the implementation of enhanced recovery after surgery (ERAS) in thoracic surgery.

Enhanced recovery after surgery (ERAS) is a perioperative care protocol, which was introduced several years ago and has gained increasing importance in thoracic surgery. The aim of this study was to provide guidance through clinical implementation and to identify factors for better compliance. This prospective cohort study collected data between July 2021 and June 2022 at the Department of Thoracic Surgery (University Hospital Regensburg, Germany). A modified enhanced recovery after thoracic surgery (ERATS) protocol with recommendations covering the pre-, intra- and postoperative phases was established and followed. The primary objective was to evaluate the implementation of the ERATS protocol. Secondary, specific and clinically relevant recommendations were analyzed regarding their compliance. The study included 139 patients undergoing elective lung resections. Many ERATS recommendations were already part of standard perioperative care, including perioperative antibiotics, venous thromboembolism prophylaxis and intraoperative warming. Other measures such as anemia management, carbohydrate loading or chest drain management were updated or newly established and standardized according to our ERATS protocol. The recommendations emphasizing early postoperative mobilization were found to be crucial. We identified three groups with significantly different compliance rates: (I) patient-dependent measures which require active participation (49.3%); (II) treatment measures requiring interdisciplinary consensus (85.8%); and (III) surgical measures (88%). The implementation and continuous evaluation of our perioperative ERATS protocol led to a new categorization of targeted measures into three groups with actors of different competencies. The new grouping enables gradual implementation and a step-by-step targeted approach in order to achieve a higher compliance of ERATS in the future as well as long-term sustainability.

Effect of modified opioid sparing anaesthesia on postoperative quality of recovery in patients undergoing laparoscopic bariatric surgery: protocol for a monocentre, double-blind randomised controlled trial – the MOSA study

IntroductionObesity patients undergoing laparoscopic bariatric surgery (LBS) are frequently encountered perioperative adverse events related to opioids-based anaesthesia (OBA) or opioids-free anaesthesia (OFA). While modified opioid-sparing anaesthesia (MOSA) has been shown...

Effect of implementation of Enhanced Recovery After Surgery Protocol on elective open simple nephrectomy in urolithiasis

Objective: To assess the impact of the implementation of an Enhanced Recovery After Surgery (ERAS) protocol in elective open simple nephrectomy in urolithiasis patients. Materials and Methods: Data from 43 patients were collated. Sixteen were in the ERAS group and 27 in the pre-ERAS group, the division created by date of the procedure. The ERAS protocol included preoperative education, standardized perioperative care, early mobilization, and postoperative pain management. Outcomes, including length of hospital stay (LOS), first flatus, first defecation, complications, pain scores, creatinine level (Cr), glomerular filtration rate (GFR) and associated costs, were compared. Results: The ERAS group exhibited significantly lower total LOS (3.19±0.40 days vs. 6.22±1.55 days, p &lt; 0.001), earlier first flatus (1.19±0.40 days vs. 2.66±1.11 days, p &lt; 0.001), first defecation (1.56±0.73 days vs. 3.11±1.28 days, p &lt; 0.001), and lower postoperative ileus rates (12.5% vs. 71.43%, p = 0.01) than the control group. Lower pain scores at 1, 6, 24, and 48 hours post-surgery (p &lt; 0.05) were also recorded in comparison to the control group. No significant differences in Cr and GFR were observed (p &gt; 0.05). Although ERAS treatment costs were marginally lower, the difference was not statistically significant (23,833±3731.48 Baht vs. 23,930±3068.45 Baht, p = 0.927). Conclusion: ERAS implementation in elective open simple nephrectomy for urolithiasis reduces LOS, and postoperative pain, accelerates recovery of bowel function, and allows quicker resumption of normal activities. These benefits come without increased risk of readmission or complications, and without compromising postoperative renal function. All these advantages may also result in cost savings.

Penerapan Intervensi Audiovisual dalam Meningkatkan Kepatuhan Selama Proses Induksi Anestesi pada Anak yang Menjalani Tindakan Operasi

This study aims to evaluate the effectiveness of audiovisual intervention in enhancing compliance during anesthesia induction in children undergoing surgery. The methodology used is a systematic review of several English-language research articles published between 2014 and 2023. Articles were retrieved from five online databases, such as ProQuest, ScienceDirect, Scopus, Ebsco MEDLINE, and Embase. The results of this study demonstrated that the use of audiovisual intervention was effective in enhancing compliance during anesthesia induction in children undergoing surgery. In conclusion, audiovisual intervention can be implemented as part of preoperative preparation programs for children undergoing surgery in order to enhance their levels of compliance during anesthesia induction. Audiovisual interventions can be used to achieve positive postoperative outcomes, either when utilized alone or combined with standard perioperative care practices. Keywords:Audiovisual Intervention, Child, Surgery, Induction Compliance.

The EUropean PErioperative MEdical Networking (EUPEMEN) project and recommendations for perioperative care in colorectal surgery: a quality improvement study.

Despite consensus supporting enhanced recovery programs, their full implementation in such a context is difficult due to conventional practices within various groups of professionals. The goal of the EUropean PErioperative MEdical Networking (EUPEMEN) project was to bring together the expertise and experience of national clinical professionals who have previously helped deliver major change programs in their countries and to use them to spread enhanced recovery after surgery protocols (ERAS) in Europe. The specific aim of this study is to present and discuss the key points of the proposed recommendations for colorectal surgery. Five partners from university hospitals in four European countries developed the project as partners. Following a non-systematic review of the literature, the European consensus panel generated a list of recommendations for perioperative care in colorectal surgery. A list of recommendations was formulated and distributed to collaborators at each center to allow modifications or additional statements. These recommendations were then discussed in three consecutive meetings to share uniform ERAS protocols to be disseminated. The working group developed (1) the EUPEMEN online platform to offer, free of charge, evidence-based standardized perioperative care protocols, learning activities, and assistance to health professionals interested in enhancing the recovery of their patients; (2) the preparation of the EUPEMEN Multimodal Rehabilitation manuals; (3) the training of the trainers to teach future teachers; and (4) the dissemination of the results in five multiplier events, one for each partner, to promote and disseminate the protocols. The EUPEMEN project allowed the sharing of the expertise of many professionals from four different European countries with the objective of training the new generations in the dissemination of ERAS protocols in daily clinical practice through a new learning system. This project was proposed as an additional training tool for all the enhanced recovery program teams.

Analyzing the application of dezocine combined with psychological care in the postoperative pain management of patients with hemifacial spasm

Objective To analyze the application of Dezocine combined with psychological care in the postoperative pain management. Methods This is a retrospective study. A total of 186 HFS patients who underwent Microvascular Decompression (MVD) at First People’s Hospital of Zunyi between January 2020 and January 2022 were selected as the study subjects. Patients were divided into two groups based on different treatment interventions. The control group (n = 93) received routine perioperative care without preemptive analgesia, while the observation group (n = 93) received preemptive analgesia and combined psychological care on the basis of the control group’s intervention. Results At 30 min post-laryngeal mask removal (T3), no significant difference in Ramsay Sedation Scale scores existed between control and observation groups (p > 0.05). The observation group showed significantly lower RSS scores at immediate mask removal (T2) and VAS scores at T3 compared to controls (p < 0.05). Following intervention, the observation group had notably lower SAS and SDS scores than controls (p < 0.05). Baseline (T0) and 5 min pre-removal (T1) exhibited no significant differences in mean arterial pressure (MAP) and heart rate (HR) values between groups (p > 0.05). However, at T2 and T3, the observation group displayed significantly lower MAP and HR values than controls (p < 0.05). No significant differences in pulse oxygen saturation (SpO2) values existed between groups at any time point (p > 0.05). Conclusion Compared to standard perioperative care alone, Dezocine combined with preemptive analgesia and psychological care effectively reduces postoperative pain during the awakening period, lowers the risk of immediate extubation-related agitation, and maintains stable hemodynamics in the postoperative period.

The Impact of an Evidence-Based Bundle on Cesarean Section-Related Surgical Site Infections: A Randomized Clinical Trial

Abstract Objective To compare the effectiveness of an evidence-based bundle in minimizing cesarean section (CS)-related surgical site infections (SSIs) with that of standard routine care. Methods This was a single-center, parallel, and randomized clinical trial conducted at KAHER’s Dr. Prabhakar Kore Charitable Hospital, Belagavi, India, from January 2021 to December 31, 2021. Three hundred twenty women undergoing CS delivery were selected and allocated into two groups (1:1) using simple randomization with fixed allocation. An evidence-based surgical bundle (a combination of more than three perioperative interventions) was used for the intervention group, whereas the control group received routine standard perioperative care. The primary outcome was the incidence of SSI (superficial, deep, and organ or space SSIs) within 6 weeks postpartum in both groups. Categorical and continuous data were analyzed using appropriate statistical tests with a significance threshold set at P &lt; 0.05. Results In this study, 16 and 17 participants each from the control and intervention groups, respectively, were lost to follow-up, resulting in a total of 144 and 143 study participants included in the respective groups. Twenty-eight (19.4%) and 14 (9.8%) women developed SSI in the control and intervention groups, respectively (P = 0.02). Methicillin-resistant Staphylococcus aureus was the most common cause of SSI in both groups (63.6% (7/11) and 100% (3/3) in the control and intervention groups, respectively). Conclusion The use of the evidence-based bundle for CS-related SSI prevention effectively decreased the incidence of SSI by half compared to standard routine practice. Implementing the use of this bundle in routine perioperative care will reduce the cost of CS and improve health outcomes in CS. Trial registration Clinical Trials Registry-India (www.ctri.nic.in). Registration number: CTRI/2020/11/029246.

The need for standardized perioperative care for patients undergoing bariatric and metabolic surgery in the United Kingdom.

Enhanced recovery after surgery (ERAS) protocols are shown to improve patient outcomes and reduce length of hospital stay. However, there is currently limited consensus on the perioperative management of patients undergoing bariatric and metabolic surgery (BMS) in the United Kingdom. This study aims to survey the level of consistency in patient care undergoing BMS. Bariatric nurse specialists from 30 bariatric units completed an anonymised, online survey from 21 December 2022 to 21 February 2023. Most units (77%) have implemented a premade postoperative care bundle protocol including predetermined timing of oral intake (77%) and postoperative day 1 bloods (60%). 63% of units have also established pre-set analgesia and anti-emetic bundles. Date of discharge is variable, ranging from 1 day after surgery (50%) to a 'two night stay' protocol (33%) to within 4 days after surgery (17%). Most follow-up clinics are either led by dietitians (33%) or both bariatric nurse specialists and dietitians collaboratively (57%). Patients are usually established on solid food 6 weeks after surgery in 53% (16/30) units. Chemical venous thromboembolism (VTE) prophylaxis was either given on day of surgery postoperatively (60%), day before (20%) or after (17%) surgery. Our study shows significant variability of care throughout the surgical pathway, in the study population. The results suggest a need for consensus guidelines outlining the best-practice approach to managing patients undergoing BMS; due to the heterogeneity of the patient group, these guidelines should contain overarching generalisable recommendations that can then be tailored to individual patients.

The “Get Moving Trial”: A phase I/II RCT of home-based (P)rehabilitation ((P)REHAB) with ExerciseRx in muscle-invasive bladder cancer (MIBC)—Study protocol for a randomized controlled trial.

TPS706 Background: Patients with MIBC often have a high burden of frailty, sarcopenia, mobility impairment, and multimorbidity, each of which is associated with reduced treatment tolerability. Prehabilitation programs are designed to improve functional capability prior to treatment to mitigate functional decline and optimize outcomes. Barriers to widespread adoption include cost, time, intensity of in-person interventions, and overly restrictive inclusion criteria which would exclude most patients with MIBC. Here, we describe a randomized controlled trial to evaluate the feasibility, usability, and impact of a pragmatic (P)REHAB exercise intervention delivered via the ExerciseRx app in participants with MIBC undergoing neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC). The primary objectives are to evaluate the (P)REHAB intervention vs. standard care (SC) to quantify the efficacy of the intervention to 1) improve or maintain physical function in patients with MIBC undergoing NAC followed by RC, and 2) globally characterize the impact of the (P)REHAB intervention with respect to patient-reported feasibility and acceptability, health-related quality of life, body-composition, frailty, treatment-associated and clinical outcomes. Methods: We will recruit and randomize 102 patients in a 1:1 ratio to the (P)REHAB or SC arms. The (P)REHAB arm will be prescribed a personalized, home exercise program (~20-minutes, 4x weekly) via the ExerciseRx app, during NAC, prior to RC and for 90-days post-RC as well as graded progression in step count. SC participants will receive printed guideline-based recommendations for physical activity during standard perioperative care. ExerciseRx comprises of 1) a provider dashboard integrated into the electronic health record for prescribing exercises and monitoring patient progress, and 2) a patient app, that administers exercise plans and tracks exercise repetitions using sensors in commodity smart devices. Step count in the (P)REHAB and SC arm will be tracked with Fitbit trackers. In the (P)REHAB arm, step count data from the Fitbit will be reviewable in the ExerciseRx provider dashboard and patient app. Eligibility criteria: English-speaking adults (&gt;18 years) with AJCC pT2-4 N0-1 M0 MIBC planning to undergo NAC followed by RC who are willing and able to participate in the trial. Primary outcome: Change in the Short Physical Performance Battery. Secondary outcomes: FitBit-assessed step count and sedentary time, ExerciseRx adherence and usability, patient-reported quality of life (EORTC-QLQ-C30, -BLM30), change in body composition (fat-mass, fat-free mass), frailty (Cancer and Aging Resilience Evaluation), treatment-associated adverse events between baseline and following NAC, and 3 months following RC. Trial enrollment will commence 10/2023. Clinical trial information: NCT06040762 .

Improving patient outcomes with a mobile digital health platform for patients undergoing transcatheter aortic valve replacement.

ManageMySurgery (MMS) is a digital health application (app) for patients undergoing surgery, including Transcatheter Aortic Valve Replacement (TAVR). Patients using MMS review procedure-specific education, view FAQs, and report patient-reported outcomes. This study assessed the impact of app use on postoperative outcomes. Patients who underwent TAVR and invited to use MMS between March 2019 and November 2021 were identified. Patients received standard perioperative care and were defined as App users if they signed into the app at least once and engaged with at least one task or FAQ. Demographics and postoperative outcomes were collected via medical record review. Multivariable logistic regression models were used to determine odds of 90-day readmission, Emergency Room (ER) visits, and complications. 388 patients met inclusion criteria, of which 238 used the app. The average age at surgery was 76.4±7.7 years for users and 78.1±7.6 for non-users. 63.0% of users and 59.3% of non-users were male. App users had significantly lower 90-day readmission rates, (8.8% vs 16.0%, OR=0.51, p=0.0373), ER visit rates (12.6% vs 27.3%, OR=0.36, p=0.0003), and complication rates (Minor: 12.2% vs 20.7%, OR=0.48, P=0.0126; Major: 8.8% vs. 16%, OR=0.47, P=0.0235). In this non-randomized, retrospective study, we found significant decreases in 90-day readmissions, ER visits, and complications in TAVR patients using an app compared to traditional care. By engaging patients throughout their interventional journey with structured education and tasks, mobile health platforms may mitigate unnecessary use of emergency and inpatient care, thereby improving patient well-being and lowering the burden on healthcare resources.

Implementation of Enhanced Recovery after Surgery at a General hospital in Zambia

Background: Enhanced recovery after surgery (ERAS), with its aim of reducing operative stress and accelerating rehabilitation, became a standard perioperative care in multiple surgical specialties in developed world. However, little is known about the implementation of the fast-track pathways in a low-resource environment. The objective of the study was to describe our experience and share lessons obtained in using ERAS protocol in general surgery patients.&#x0D; Methods: In this descriptive study, all consecutive patients with no age restrictions undergoing elective and urgent abdominal surgery were assessed for inclusion in ERAS program. A retrospective analysis encompasses 98 patients aged two weeks to 87 years with male to female ratio of 2.3:1. Outcomes were functional recovery, postoperative complications, and length of hospital stay.&#x0D; Results: All elements of ERAS protocol including minimal incision length laparotomy and accelerated postoperative care were used; however, certain components were modified depending on the availability of the resources and patient’s condition. Postoperative period complicated in 17.4% of cases, seven patients (7.4%) died after urgent operations, and no mortality was recorded after elective procedures. Median length of stay was 4.0 days. Local and systemic septic complications, paralytic ileus and performing of the stoma reversal procedure during the same hospital stay were reasons for delayed discharge.&#x0D; Conclusion: This study indicates that employment of ERAS program for general surgery population at a second level hospital is feasible and safe. Further larger-scale studies are needed.

Effects of Preoperative Use of Povidone-Iodine–Impregnated Dressing on Postoperative Rate of Surgical Site Infection in Patients Undergoing Posterolateral Lumbar Spinal Fusion Surgery: A Randomized, Nonblinded, Active-Controlled Trial

BACKGROUND AND OBJECTIVES: No study has evaluated the efficacy of using preoperative antiseptic dressings in reducing the rate of surgical site infection (SSI) in spine surgery thus far. To investigate the efficacy of the use of preoperative povidone-iodine–impregnated antiseptic dressings in patients undergoing instrumented posterolateral lumbar spinal fusion. METHODS: This was a randomized, nonblinded, active-controlled, parallel-group clinical trial. Patients were randomly assigned to the 2 study groups, including treatment and control. Patients in the treatment group received povidone-iodine–impregnated antiseptic dressing applied to the anticipated incision site 12 hours before the operation. The control group merely received the standard perioperative care with no additional intervention or placebo. Patients were followed up for 90 days, and SSIs were recorded. RESULTS: A total of 200 patients were included in this study (100 in each arm). Three cases of SSI were observed in the treatment group compared with 12 in the control one. A significant reduction in the postoperative rate of SSI was observed in the treatment group compared with the control one (P = .029). In addition to study intervention (P = .029), body mass index (P = .005), smoking status (P = .005), duration of the procedure (P = .003), American Society of Anesthesiologists class (P = .002), and diabetes mellitus (P &lt; .001) were significantly associated with the postoperative rate of SSI. CONCLUSION: To the best of our knowledge, this study for the first time showed that preoperative use of antiseptic dressings is significantly effective in reducing the rate of SSI in instrumented posterior lumbar spinal fusion surgery. Future studies are warranted to evaluate the efficacy of different preparations or the effectiveness of the present one in patients undergoing spine procedures with other surgical characteristics.

Prevention of postoperative stroke in pediatric moyamoya patients: a standardized perioperative care protocol.

Perioperative stroke is a major complication of revascularization surgery in patients with moyamoya. Vomiting is common after neurosurgical procedures and may result in acute changes in intracranial pressure and cerebral blood flow. The authors instituted a standardized perioperative nausea and vomiting protocol for children with moyamoya undergoing indirect bypass surgery at their institution and analyzed its association with perioperative stroke. They hypothesized that instituting a standardized perioperative nausea and vomiting protocol would be associated with reduction in the number of perioperative strokes in children with moyamoya undergoing indirect bypass surgery. The authors retrospectively reviewed consecutive cases of children and young adults with moyamoya who underwent indirect bypass surgery before and after implementation of a new perioperative nausea and vomiting protocol at a single institution. They compared the rate of strokes in the perioperative period (postoperative days 0 and 1) in the 31 months following implementation to 31 months prior to implementation using Fisher's exact test. The median ages pre- and postimplementation were 8.5 (IQR 4-12) years and 8.3 (IQR 5-15) years, respectively. There were no significant differences between the cohorts in disease severity or other potentially confounding factors. In the 31 months prior to initiation of the perioperative nausea and vomiting protocol, there were 5 strokes in 137 surgically treated hemispheres (3.6%). After initiation of the protocol, there were no strokes in 114 surgically treated hemispheres (p = 0.065). Instituting a standardized perioperative nausea and vomiting protocol was associated with reduction in perioperative strokes in children with moyamoya treated with indirect bypass surgery.

Application of early enteral nutrition nursing based on enhanced recovery after surgery theory in patients with digestive surgery.

Postoperative nursing can improve the restlessness and gastrointestinal function of patients with tracheal intubation under general anesthesia in digestive surgery. Wide application of various nursing methods and routine nursing in perioperative nursing of patients with general anesthesia in digestive surgery. To investigate the impact of early postoperative enteral nutrition nursing based on the enhanced recovery after surgery (ERAS) theory on postoperative agitation and gastrointestinal recovery in patients undergoing general anesthesia that experienced tracheal intubation. The data of 126 patients with digestive surgery from May 2019 to February 2022 were retrospectively analyzed. According to different nursing methods, they were divided into control group and observation group, with 63 cases in observation group and 63 cases in control group. The patients in the control group had standard perioperative nursing care, whereas those in the observation group got enteral nourishment as soon as possible after surgery in accordance with ERAS theory. Both the rate and quality of gastrointestinal function recovery were compared between the two groups after treatment ended. Postoperative anesthesia-related adverse events were tallied, patients' nutritional statuses were monitored, and the Riker sedation and agitation score (SAS) was used to measure the incidence of agitation. When compared to the control group, the awake duration, spontaneous breathing recovery time, extubation time and postoperative eye-opening time were all considerably shorter (P < 0.05). There was no significant difference in the recovery time of orientation force between the two groups (P > 0.05); however, the observation group had a lower SAS score than the control group (P < 0.05). The recovery time for normal intestinal sounds, the time it took to have the first postoperative exhaust, the time it took to have the first postoperative defecation, and the time it took to have the first postoperative half-fluid feeding were all faster in the observation group than in the control group (P < 0.05); Fasting blood glucose was lower in the observation group compared to the control group (P < 0.05), while the albumin and hemoglobin levels were higher on the first and third postoperative days; however, there was no statistically significant difference in the incidence of anesthesia-related adverse reactions between the two groups (P > 0.05). The extremely early postoperative enteral nutrition nursing based on ERAS theory can reduce the degree of agitation, improve the quality of recovery, promote the recovery of gastrointestinal function, and improve the nutritional status of patients in the recovery period after tracheal intubation under general anesthesia.

Enhanced recovery after surgery program for patients undergoing isolated elective coronary artery bypass surgery improves postoperative outcomes

ObjectiveTo evaluate the effect of a perioperative systematic standardized enhanced recovery after surgery (ERAS) program for patients undergoing isolated elective coronary artery bypass grafting (CABG) in terms of mortality, hospital morbidities, and length of stay. MethodsFrom January 2015 to September 2020, 1101 patients underwent isolated elective CABG. Our standardized systematic ERAS program was implemented in November 2018. Propensity score matching resulted in well-matched pairs of 362 patients receiving standard perioperative care (control group) and 362 patients on the ERAS program (ERAS group). There were no significant intergroup differences in preoperative and operative data except for the normothermia rate, which was significantly greater in the ERAS group (P < .001). The primary outcome was 3-year mortality. The secondary outcomes were hospital morbidities and length of stay. ResultsIn-hospital and 3-year mortality did not differ between the 2 groups. The ERAS program was associated with a significant relative risk decrease in mechanical ventilation duration (−53.1%, P = .003), length of intensive care unit stay (−28.0%, P = .015), length of hospital stay (−10.5%, P = .046), bronchopneumonia (−51.5%, P < .001), acute respiratory distress syndrome (−50.8%, P = .050), postoperative delirium (−65.4%, P = .011), moderate-to-severe acute kidney injury (−72.0%, P = .009), 24-hour chest tube output (−26.4%, P < .001), and overall red blood cell transfusion rate (−32.4%, P = .005) compared with the control group. ConclusionsA systematic standardized ERAS program for low-risk patients undergoing isolated elective CABG was associated with a significant improvement in postoperative outcomes, reduction in red blood cell transfusion, shorter lengths of intensive care unit and hospital stays, and comparable long-term mortality.

The impact of standardized perioperative care management on improving outcomes in patients with peptic ulcer disease.

The present study investigated the impact of standardized perioperative nursing management on improving outcomes in patients with peptic ulcer disease. A total of 90 patients with peptic ulcers were admitted to the Wuhan Wuchang Hospital between July 2020 to July 2022. These patients were included in the present study. They were divided into 2 groups based on the nursing management that they received, with 45 patients classified into each group. The control group received routine nursing care, while the observation group received standardized perioperative nursing management. The improvement in clinical symptoms, recurrence rate, negative emotions and disease management capacity were compared between the 2 groups. The results demonstrated that the improvement rate of clinical symptom in the observation group was significantly higher as compared with the control group (P < .05). The recurrence rate in the observation group was significantly lower than in the control group (P = .026). Patients in the observation group had better psychological status, and better disease management capacity as compared with those in the control group (P < .05). The application of standardized perioperative nursing management for patients with peptic ulcer can help improve the patients' clinical symptoms, enhance their disease management capacity, reduce anxiety, and ensure the quality of nursing care.

An enhanced recovery programme significantly improves postoperative outcomes after surgical aortic valve replacement.

Evidence regarding the benefits of an enhanced recovery after cardiac surgery (ERACS) programme is lacking. The aim of this study was to analyse the impact of a systematic standardized ERACS programme for patients undergoing isolated elective surgical aortic valve replacement (SAVR) for aortic stenosis in terms of hospital mortality and morbidity, patient blood management and length of stay. Patients undergoing isolated elective SAVR for aortic stenosis between 2015 and 2020 were identified from our database (n = 941). The standardized systematic ERACS programme was implemented in November 2018. Propensity score matching indicated that 259 patients would receive standard perioperative care (control group) and 259 patients would receive the ERACS programme (ERACS group). The primary outcome was hospital mortality. The secondary outcomes were hospital morbidity, patient blood management and length of stay. Both groups had similar hospital mortality rates (0.4%). The ERACS group had a significantly lower troponin I peak level (P < 0.001), a larger proportion of improved perioperative left ventricular ejection fractions (P = 0.001), a lower incidence of bronchopneumonia (P = 0.030), a larger proportion of patients with mechanical ventilation <6 h (P < 0.001), a lower incidence of delirium (P = 0.028) and less acute renal failure (P = 0.013). The ERACS group had a significantly lower rate of red blood cell transfusions (P = 0.002). The intensive care unit stay was significantly shorter in the ERACS group than in the control group (P = 0.039). The standardized systematic ERACS programme significantly improved postoperative outcomes and should become the reference for the perioperative care pathway for patients undergoing SAVR.