SURG-07. ERAS IN NEURO-ONCOLOGY

Abstract BACKGROUND We performed a retrospective study assesses the efficacy and safety of a protocol for the enhanced clinical recovery of neuro-oncology patients undergoing surgery for supratentorial gliomas and metastasis. The protocol developed and applied to the Ca'Foncello Hospital in Treviso starts from the recommendations on the subject that the medical literature reported up to December 2018. Briefly, three main sections:1) preoperative functional status evaluation, preoperative oral carbohydrate loading; 2) minimally invasive surgery, scalp incision anesthesia, nonopioid analgesia; 3) early urinary-catheter removal, standing and feeding resumption within 3-4 hours from surgery. METHODS We collected and analyzed data on 28 patients operated on ERAS protocol and compared them to a control group (22 patients). The main clinical variables are: Charlson comorbidity index; times urinary-catether removal, adherence ambulation, taking food by mouth; hospital long of stay (LOS). We also collected studies from 2016 to 2020 describing data about ERAS and craniotomy and we pooled these into a meta-analysis. RESULTS Times urinary-catheter removal (3.1 vs 25 hours.), adherence to ambulation (4 vs 25 hours) and taking food by mouth (5.25 vs 23.72 hours) were significantly (p< 0.001) reduced in the ERAS group. Median hospital LOS was 2.85 days in the ERAS group and 4.77 days in the control group (p< 0.001). Our results overlapped those of the literature; the same trend was highlighted by our meta-analysis, with postoperative pain rates and hospital LOS significantly lower in ERAS patients (7.9 vs. 2.9 days, p < 0.001). A further important finding was that elderly patients (≥ 65 years) got the same outcomes as younger ones. CONCLUSIONS Our protocol for ERAS in neuro-oncology appears to have significant benefits over conventional management: it may improve patient outcomes, accelerate functional recovery, decrease length of stay, and enable patients to begin adjuvant chemotherapy and/or radiation in a more expeditious manner.

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Interventions to Improve Patient Comprehension in Informed Consent for Medical and Surgical Procedures: An Updated Systematic Review

Medical Decision Making ◽

10.1177/0272989x19896348 ◽

2020 ◽

Vol 40 (2) ◽

pp. 119-143 ◽

Cited By ~ 6

Author(s):

Johanna Glaser ◽

Sarah Nouri ◽

Alicia Fernandez ◽

Rebecca L. Sudore ◽

Dean Schillinger ◽

...

Keyword(s):

Informed Consent ◽

Data Extraction ◽

Meta Analysis ◽

Size Control ◽

Group Processes ◽

Future Research ◽

Control Group ◽

Test Feedback ◽

Patient Comprehension ◽

Improve Patient

Background. Patient comprehension is fundamental to valid informed consent. Current practices often result in inadequate patient comprehension. Purpose. An updated review to evaluate the characteristics and outcomes of interventions to improve patient comprehension in clinical informed consent. Data Sources. Systematic searches of MEDLINE and EMBASE (2008–2018). Study Selection. We included randomized and nonrandomized controlled trials evaluating interventions to improve patient comprehension in clinical informed consent. Data Extraction. Reviewers independently abstracted data using a standardized form, comparing all results and resolving disagreements by consensus. Data Synthesis. Fifty-two studies of 60 interventions met inclusion criteria. Compared with standard informed consent, a statistically significant improvement in patient comprehension was seen with 43% (6/14) of written interventions, 56% (15/27) of audiovisual interventions, 67% (2/3) of multicomponent interventions, 85% (11/13) of interactive digital interventions, and 100% (3/3) of verbal discussion with test/feedback or teach-back interventions. Eighty-five percent of studies (44/52) evaluated patients’ understanding of risks, 69% (41/52) general knowledge about the procedure, 35% (18/52) understanding of benefits, and 31% (16/52) understanding of alternatives. Participants’ education level was reported heterogeneously, and only 8% (4/52) of studies examined effects according to health literacy. Most studies (79%, 41/52) did not specify participants’ race/ethnicity. Limitations. Variation in interventions and outcome measures precluded conduct of a meta-analysis or calculation of mean effect size. Control group processes were variable and inconsistently characterized. Nearly half of studies (44%, 23/52) had a high risk of bias for the patient comprehension outcome. Conclusions. Interventions to improve patient comprehension in informed consent are heterogeneous. Interactive interventions, particularly with test/feedback or teach-back components, appear superior. Future research should emphasize all key elements of informed consent and explore effects among vulnerable populations.

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Optimal timing of urinary catheter removal following pelvic colorectal surgery: a systematic review and meta-analysis

International Journal of Colorectal Disease ◽

10.1007/s00384-019-03404-0 ◽

2019 ◽

Vol 34 (12) ◽

pp. 2011-2021 ◽

Cited By ~ 4

Author(s):

Yung Lee ◽

Tyler McKechnie ◽

Jeremy E. Springer ◽

Aristithes G. Doumouras ◽

Dennis Hong ◽

...

Keyword(s):

Systematic Review ◽

Colorectal Surgery ◽

Urinary Catheter ◽

Meta Analysis ◽

Catheter Removal ◽

Optimal Timing

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A Meta-Analysis of the Efficacy of Acupuncture in Treating Dysphagia in Patients with a Stroke

Acupuncture in Medicine ◽

10.1136/acupmed-2012-010155 ◽

2012 ◽

Vol 30 (4) ◽

pp. 291-297 ◽

Cited By ~ 19

Author(s):

Yao-Bin Long ◽

Xiao-Ping Wu

Keyword(s):

Acupuncture Treatment ◽

Meta Analysis ◽

Alternative Therapy ◽

Cochrane Library ◽

Control Group ◽

Complementary And Alternative Therapy ◽

Dichotomous Data ◽

Biological Medicine ◽

The Subject ◽

Randomised Controlled

Background Dysphagia, or deglutition difficulty, is a common manifestation in patients with a stroke and its management is an important aspect of rehabilitation. Acupuncture, a complementary and alternative therapy, is the subject of growing public interest for treatment of stroke. Objective A meta-analysis was performed to study the effect of acupuncture for treatment of dysphagia in patients affected by a stroke. Methods Randomised controlled trials (RCTs) comparing acupuncture treatment with non-acupuncture treatment of dysphagia in patients with a stroke were identified from the databases of PubMed, Embase, Cochrane Library and CBM disc (China Biological Medicine Database). Eligible investigations were included and data on the effectiveness of acupuncture were extracted and synthesised by meta-analysis using RevMan 5.1.4. Results were expressed as OR for dichotomous data; 95% CIs were also calculated. Results Seventy-two RCTs (3208 patients in the treatment group and 2926 patients in the control group) were identified. Details of randomisation and blinding were not reported and information on withdrawals and dropouts was missing in most of included reports. Meta-analysis showed that the effectiveness of treatment in the group receiving acupuncture was higher than that in the non-acupuncture group (OR=5.17, 95% CI 4.18 to 6.38; p<0.00001). However, the study quality was generally low and of insufficient quality to make recommendations about using acupuncture in the rehabilitation of patients with dysphagia due to stroke. Conclusions Acupuncture might be beneficial in the rehabilitation of patients with dysphagia caused by stroke, and the evidence justifies future high-quality studies.

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Early recovery after surgery in elective obstetrics-gynaecology surgeries: prospective single-center pilot study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20212166 ◽

2021 ◽

Vol 10 (6) ◽

pp. 2302

Author(s):

Ritu V. Jain ◽

Vaibhav Jain

Keyword(s):

Pilot Study ◽

Postoperative Complications ◽

Hospital Stay ◽

Urinary Catheter ◽

Enhanced Recovery ◽

Statistical Significance ◽

Catheter Removal ◽

Control Group ◽

Early Recovery ◽

Oral Analgesia

Background: Enhanced recovery after surgery (ERAS) programmes employed in elective colorectal, vascular, urologic and orthopaedic surgery has provided strong evidence for decreased hospital stay without increase in postoperative complications. The aim of the study was to explore role and benefits, if any, of ERAS/ERP (early recovery protocols) implemented in patients undergoing elective obstetrics-gynaecological surgeries.Methods: Prospective cohort of 48 consecutive patients undergoing elective obstetrics-gynaecological surgeries were included. ERP included early feeding, urinary catheter removal, mobilisation/physiotherapy, intravenous line removal and optimal oral analgesia. This was compared to control group of 50 patients undergoing similar operations prior to introduction of ERP, SPC group-standard perioperative care. Demographics and indications of surgeries were similar for both groups. The primary end-points were length of stay (LOS) and incidence of complications (Clavien-Dindo classification). Difference in means was tested using the t test assuming unequal variances. Statistical significance was defined as p<0.05.Results: Two groups, A (non-ERAS/SPC) and B (ERAS) were comparable with regards to demographics and indication of surgery. The mean time to solid diet, urinary catheter removal, mobilization, iv fluid removal and shift to oral analgesia was 2.57, 1.13 (p<0.00001), 1.99 ,1.03 (p<0.00268), 1.63, 1.2 (p<0.00001), 1.72, 1.14 (p<0.00001), 1.8, 1.37 (p<0.00001) days respectively. There were 31 and 21 complications in both groups, respectively (p<0.0097). Hospital stay was significantly shorter in the ERAS group, 2.87, 2.61 (p<0.0378).Conclusions: This pilot study shows that ERPs can be successfully implemented with significant shorter hospital stays without increase in postoperative complications in elective obstetrics-gynecology patients.

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