scholarly journals Fast-track surgery after gynaecological oncological surgery: A Prospective Randomized Trial

2020 ◽  
Author(s):  
Xunwei Shi ◽  
Ling Cui ◽  
Guonan Zhang ◽  
Yu Shi ◽  
Dengfeng Wang ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Randomized Trial ◽  
Fast Track ◽  
Enhanced Recovery ◽  
Prospective Randomized Trial ◽  
Fast Track Surgery ◽  
Oncological Surgery ◽  
Traditional Group ◽  
Traditional Management ◽  
Registration Number

Abstract Background: Fast-track surgery (FTS)or enhanced recovery after surgery have been applied to many surgical procedures. The FTS interventions may lead to a major reduction in the undesirable sequelae of surgical injury with improved recovery and reduction in postoperative morbidity and overall costs. The aim of this study is whether FTS reduces the length of stay in hospital compared to traditional management. The secondary aim is whether FTS is associated with an increase in post-surgical complications compared to traditional management (for both open and laparoscopic surgery).Methods: A prospective randomized trial included 107 patients undergoing gynaecological oncological surgery. The patients were randomized to the FTS group (n=50) and the traditional group (n=57). LOS (Length of stay in hospital), and complications were assessed.Results: No significant differences in LOS were observed between the groups. The total costs of hospitalization (RMB), and CRP (C-Reactive protein mg/l) are less in the FTS group (P < 0.05) and the overall complications were lower in the FTS Group, statistically significantly lower ((P < 0.05). Conclusions: Fast-track surgery after gynaecological oncological surgery is beneficial for patients. Trial registration number: NCT02687412. Approval Number: SCCHEC20160001.Date of registration: registered on 23 February 2016, https://clinicaltrials.gov/ct2/show/NCT02687412.

Enhanced recovery after surgery in advanced ovarian cancer: a prospective randomized trial

2019 ◽  
Author(s):  
JL Sánchez-Iglesias ◽  
M Carbonell Socias ◽  
A Pérez Benavente ◽  
NR Gómez-Hidalgo ◽  
S Manrique Muñoz ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Randomized Trial ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Advanced Ovarian Cancer ◽  
Prospective Randomized Trial

Epidural versus PCA Pain Management after Pectus Excavatum Repair: A Multi-Institutional Prospective Randomized Trial

2019 ◽  
Vol 30 (05) ◽  
pp. 465-471
Author(s):  
Joseph A. Sujka ◽  
Charlene Dekonenko ◽  
Daniel L. Millspaugh ◽  
Nichole M. Doyle ◽  
Benjamin J. Walker ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Length Of Stay ◽  
Minimally Invasive ◽  
Randomized Trial ◽  
Pain Control ◽  
Pectus Excavatum ◽  
Prospective Randomized Trial ◽  
Epidural Group ◽  
Thoracic Epidural ◽  
Pain Scores

Abstract Introduction Postoperative pain control remains the primary reason for inpatient stay after minimally invasive repair of pectus excavatum. In a previous study, our group reported that early pain control was better in patients managed with a thoracic epidural, while late pain control was better in patients managed with patient-controlled analgesia (PCA). After revising our epidural transition and modifying the PCA protocol, we conducted a multi-institutional prospective randomized trial to evaluate these two pain control strategies. Materials and Methods Patients were randomized to epidural or PCA following minimally invasive repair of pectus excavatum with standard protocols for each arm. Primary outcome was length of stay with secondary variables including mean patient pain scores, complications, and parental satisfaction. Scores were pooled for the two groups and reported as means with standard deviation. Results were compared using t-tests and one-way analysis of variance with p-value < 0.05 determining significance. Results Sixty-five patients were enrolled, 32 epidural and 33 PCA. Enrollment was stopped early when we developed an alternative strategy for controlling these patients' pain. There was no difference in length of stay in hours between the two arms; epidural 111.3 ± 18.5 versus PCA 111.4 ± 51.4, p = 0.98. Longer operative time was found in the epidural group. Nine patients in the epidural group (28%) required a PCA in addition to epidural for adequate pain control. Mean pain scores were lower on postoperative day 0 in the epidural group compared with the PCA groups, but were otherwise similar. Conclusion In our prospective randomized trial, PCA is just as effective as thoracic epidural in decreasing early postoperative pain scores after minimally invasive repair of pectus excavatum.

Impact of Enhanced Recovery After Surgery and Fast Track Surgery Pathways on Healthcare-associated Infections

2017 ◽  
Vol 265 (1) ◽  
pp. 68-79 ◽  
Author(s):  
Michael C. Grant ◽  
Dongjie Yang ◽  
Christopher L. Wu ◽  
Martin A. Makary ◽  
Elizabeth C. Wick
Keyword(s):  
Fast Track ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Healthcare Associated Infections ◽  
Fast Track Surgery ◽  
Healthcare Associated

scholarly journals Fast Track Colorectal Surgery for Deep Endometriosis: A Prospective Randomized Trial

2019 ◽  
Vol 5 (2) ◽  
Author(s):  
Irene Gentile ◽  
Roberto Rossini ◽  
Marco Scioscia ◽  
Davide Brunelli ◽  
Marcello Ceccaroni ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Randomized Trial ◽  
Fast Track ◽  
Prospective Randomized Trial ◽  
Deep Endometriosis

Enhanced Recovery after Surgery: Benefits for the Fetal Surgery Patient

2021 ◽  
pp. 1-8
Author(s):  
Mario Patino ◽  
Thien-Duy Tran ◽  
Teniola Shittu ◽  
Margaret Owens-Stuberfield ◽  
Marcie Meador ◽  
...  
Keyword(s):  
Magnesium Sulfate ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Oral Intake ◽  
Respiratory Complications ◽  
Traditional Group ◽  
Traditional Management ◽  
Pain Scores ◽  
Oxygen Requirements ◽  
Eras Protocol

<b><i>Background:</i></b> The fetoscopic approach to the prenatal closure of a neural tube defect (NTD) may offer similar advantages to the newborn compared to prenatal open closure of a NTD, with a reduction in maternal risks. Enhanced recovery after surgery (ERAS) protocols have been applied to different surgical procedures with documented advantages. We modified the perioperative care of patients undergoing in utero repair of myelomeningocele with the goal of enhancing the recovery. A retrospective study comparing traditional management to the ERAS protocol was conducted. <b><i>Aims:</i></b> Primary aim was to evaluate the length of stay (LOS). Secondary outcomes included pain scores, time to oral intake, opioid-induced side effects, and respiratory complications. <b><i>Methods:</i></b> Thirty patients who underwent a mid-gestation fetoscopic closure of a NTD were included. Data analyzed include demographics, comorbidities, LOS, anatomical location of the NTD, magnesium sulfate doses and duration of administration, oxygen requirements, duration of the postoperative epidural infusion, duration of surgery and anesthesia, incidence of postoperative nausea and vomiting, respiratory complications, time to oral intake, pain scores, and sedation scores. Differences between the treatment groups were compared using the independent sample <i>t</i>-test or Mann-Whitney Ʋ test. <b><i>Results:</i></b> Of the 30 patients, 10 patients were managed according to the ERAS protocol and 20 patients according to the traditional management (1:2 ratio). The mean gestational age at the time of intervention for the traditional and ERAS groups was 24.9 ± 0.5 weeks and 24.8 ± 0.5 weeks, respectively. Compared to the traditional group, the LOS was reduced in the ERAS group to 112.5 ± 12.6 h (4.7 ± 0.5 days) from 179.7 ± 87.9 h (7.5 ± 3.7 days) (<i>p</i> = 0.012). The time to oral intake was also shorter 502.6 ± 473.4 min versus 1015.6 ± 698.2 min; <i>p</i> = 0.049. Oxygen requirements were prolonged in the traditional group (1843.7 ± 1262.6 min vs. 1051.7 ± 1078.1 min <i>p</i> = 0.052). The total duration of magnesium sulfate was longer for patients in the traditional group (2125.6 ± 727.1 min vs. 1429.5 ± 553.8 min; <i>p</i> = 0.006). No statistically significant difference in pain scores was observed between the groups. <b><i>Conclusions:</i></b> Establishing an ERAS protocol for fetoscopic in utero repair of NTDs approach is feasible with the advantages of decreased postoperative LOS, reduced oxygen requirements, lower duration of magnesium sulfate infusion, and facilitation of earlier oral intake without compromising the pain scores.

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