scholarly journals Enhanced Recovery Protocol Versus Conventional Perioperative Management For Three-Dimensional Laparoscopy-Assisted Gastrectomy: A Prospective Cohort Study

2020 ◽  
Author(s):  
Kecheng Zhang ◽  
Canrong Lu ◽  
Jianxin Cui ◽  
Zhi Qiao ◽  
Lin Chen
Keyword(s):  
Multivariate Analysis ◽  
Hospital Stay ◽  
Prospective Cohort ◽  
Perioperative Management ◽  
Enhanced Recovery ◽  
Three Dimensional ◽  
Operation Time ◽  
Postoperative Hospital Stay ◽  
3D Laparoscopy ◽  
Enhanced Recovery Protocol

Abstract Background: It remains unclear whether patients undergoing three-dimensional (3D) laparoscopy-assisted gastrectomy could benefit from enhanced recovery protocol. The aim of present study is to compare enhanced recovery protocol and the conventional perioperative management after 3D laparoscopy-assisted gastrectomy in gastric cancer.Methods: A prospective cohort of patients received 3D laparoscopy-assisted gastrectomy were enrolled between 2017 and 2018. A hospital-based enhanced recovery protocol was established and implemented. Patient’s clinic-pathological characteristics and perioperative outcomes were compared between enhanced recovery group (ERG) and conventional group (CG). ER protocol compliance rate was calculated for patients in ERG. Univariate and multivariate binary logistic regression analysis were performed to investigate influential factors for delayed discharge and for postoperative complications.Results: One hundred and eighty-seven patients received 3D laparoscopy-assisted gastrectomy in ERG and 111 patients in CG were enrolled in the final analysis. Patients had comparable baseline characteristic between groups. However, patients in ERG had shorter time to oral feeding, reduced postoperative hospital stay and less medical cost (all P < 0.05). The postoperative complication rate were 10.7% for ERG and 10.8% for CG respectively. Regarding individual items in enhanced recovery protocols, prevention of postoperative nausea and vomiting had the highest compliance of 100% (187/187) while ambulation on postoperative day one had the lowest compliance of 32.1% (60/187). Univariate logistic regression analysis revealed operation time (P < 0.001), blood loss (P = 0.007), intraoperative transfusion (P = 0.003) and compliance (P < 0.001) were correlated with delayed discharge, while multivariate analysis demonstrated that only compliance [odds ratio (OR), 0.939; P < 0.001] and operation time (OR, 1.010; P = 0.048) were statistically significant. Additionally, univariate analysis showed blood loss (OR, 1.002; P = 0.028) and compliance (OR, 0.978; P = 0.030) were associated with postoperative complications, but multivariate analysis showed neither was statistically significant. Spearman correlation analysis revealed compliance was negatively correlated with postoperative hospital stay (Spearman r = -0.64, P < 0.001) and with medical cost (Spearman r = -0.26, P < 0.001).Conclusion: The present prospective cohort study suggests it is safe and feasible to incorporate 3D laparoscopic gastrectomy into enhanced recovery settings. Furthermore, improving compliance with enhanced recovery protocol may shorten hospital stay and promote postoperative recovery.

scholarly journals P382 Application of enhanced recovery after surgery in single-port laparoscopic partial small intestine resection in the treatment of Crohn’s disease

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S357-S357
Author(s):  
Y LI ◽  
Z Zhou ◽  
D Yao ◽  
L Zheng ◽  
Y Duan ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Laparoscopic Surgery ◽  
Crohn's Disease ◽  
Hospital Stay ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Operation Time ◽  
Postoperative Hospital Stay ◽  
Control Group ◽  
Single Incision Laparoscopic Surgery

Abstract Background Single-incision laparoscopic surgery (SILS) with enhanced recovery after surgery (ERAS) can reduce operation trauma and accelerate postoperative rehabilitation. This study aims to investigate the safety and feasibility of SILS with ERAS in the treatment of Crohn’s disease. Methods Thirty patients with Crohn’s disease were randomly assigned to receive traditional laparoscopic surgery plus ERAS (n = 20) and SILS plus ERAS (n = 18)，respectively. Comparisons and analysis were made between the two groups in the perioperative conditions. Results There were significant differences in the mean operation time between the two groups (p &lt; 0.01)，There were no significant differences in the intra-operative blood loss, postoperative complications rates, the time to first flatus and treatment cost (p &gt; 0.05). There were significant differences in the postoperative hospital stay between the two groups (p &lt; 0.05). WBC, CRP and PCT in SILS plus ERAS group were lower than those in the control group at the first days and the third days after operation, the differences were statistically significant (p &lt; 0.05). Conclusion SILS plus ERAS can shorten postoperative hospital stay and facilitate bowel function recovery in the treatment of Crohn’s disease. It is worthwhile to mention the nice cosmetic benefits of SILS, the perioperative SILS plus ERAS program is safe and effective and should be popularised in Crohn’s disease.

Abstract 2270: Preoperative Metabolic Therapy Improves Cardiac Surgical Outcomes: A Prospective Randomized Clinical Trial

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Franklin L Rosenfeldt ◽  
Jee Y Leong ◽  
Salvatore Pepe ◽  
Juliana Van der Merwe ◽  
Donald S Esmore ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Multivariate Analysis ◽  
Cardiac Surgery ◽  
Hospital Stay ◽  
Lipoic Acid ◽  
Troponin I ◽  
Myocardial Damage ◽  
Postoperative Hospital Stay ◽  
Postoperative Atrial Fibrillation ◽  
Metabolic Therapy

In the current era the typical patient presenting for cardiac surgery is elderly with multiple co-morbidities. These high-risk patients contribute disproportionately to postoperative morbidity and mortality. We have shown that metabolic therapy with antioxidants such as coenzyme Q 10 (Co Q 10 ) and lipoic acid as well as energy substrate precursors such as orotate have protective effects on the stressed myocardium. We postulated that such therapy would reduce myocardial damage and improve post-operative recovery. Aim: To assess the effects of perioperative metabolic therapy on clinical and biochemical outcomes of cardiac surgery. Methods: Patients ( n =117), mean age 65 years, 74% male, undergoing elective coronary artery bypass graft (CABG) or valve surgery were randomised to receive daily for a minimum of 2 weeks before, and 4 weeks after surgery, metabolic therapy consisting of CoQ 10 300mg, magnesium orotate 1.2g, alpha lipoic acid 300mg, fish oil 999 mg and selenium 200 μg or placebo. Results: In the whole group, metabolic therapy vs placebo was associated (multivariate analysis) with lower 24-hour postoperative plasma troponin I (1.44 ± 0.25 vs 2.65 ± 0.61 ug/L, p =0.003) and reduced postoperative hospital stay (6.9± 0.04 vs 8.1 ± 0.04 days, p =0.002). In CABG alone group (n=70), metabolic therapy reduced the incidence of postoperative atrial fibrillation (23% vs 46%, p =0.04, multivariate analysis). Conclusions: Metabolic therapy before cardiac surgery is associated with: Reduced myocardial damage (troponin I release); Shortened postoperative hospital stay; Reduced incidence of postoperative atrial fibrillation in CABG patients. Clinical and economic benefits may be expected from general application of this therapy.

scholarly journals Enhanced Recovery After Colorectal Surgery (ERAS) in Elderly Patients Is Feasible and Achieves Similar Results as in Younger Patients

2017 ◽  
Vol 3 ◽  
pp. 233372141770629 ◽  
Author(s):  
Håvard Mjørud Forsmo ◽  
Christian Erichsen ◽  
Anne Rasdal ◽  
Hartwig Körner ◽  
Frank Pfeffer
Keyword(s):  
Colorectal Surgery ◽  
Elderly Patients ◽  
Hospital Stay ◽  
Enhanced Recovery ◽  
Patient Adherence ◽  
Controlled Trial ◽  
Age Groups ◽  
Postoperative Hospital Stay ◽  
Younger Patients ◽  
Eras Protocol

Aim: Enhanced recovery after surgery (ERAS) is a multimodal approach that aims to optimize perioperative treatment. Whether elderly patients receiving colorectal surgery can adhere to and benefit from an ERAS approach is uncertain. The aim of this study was to compare patients in different age groups participating in an ERAS program. Method: In this substudy of a randomized controlled trial, we analyzed the interventional ERAS arm of adult patients eligible for laparoscopic or open colorectal resection with regard to the importance of age. Patients were divided into three groups based on age: ≤65 years ( n = 79), 66-79 years ( n = 56), and ≥80 years ( n = 19). The primary end point was total postoperative hospital stay (THS). Secondary end points were postoperative hospital stay, postoperative complications, postoperative C-reactive protein levels, readmission rate, mortality, and patient adherence to the different ERAS elements. All parameters and measuring the adherence to the ERAS protocol were recorded before surgery, on the day of the operation, and daily until discharge. Results: There were no significant differences in length of THS between age groups (≤65 years, median 5 [range 2-47] days; 66-79 years, median 5.5 [range 2-36] days; ≥80 years, median 7 [range 3-50] days; p = .53). All secondary outcomes were similar between age groups. Patient adherence to the ERAS protocol was as good in the elderly as it was in the younger patients. Conclusion: Elderly patients adhered to and benefited from an ERAS program, similar to their younger counterparts.

scholarly journals Laparoscopy Combined with Enhanced Recovery Pathway in Ileocecal Resection for Crohn’s Disease: A Randomized Study

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Yibin Zhu ◽  
Jianjian Xiang ◽  
Wei Liu ◽  
Qian Cao ◽  
Wei Zhou
Keyword(s):  
Hospital Stay ◽  
Standard Care ◽  
Enhanced Recovery ◽  
Hospital Costs ◽  
Laparoscopic Approach ◽  
Postoperative Hospital Stay ◽  
Ileocecal Resection ◽  
Care Group ◽  
Standard Care Group ◽  
Enhanced Recovery Pathway

Background and Aims. Laparoscopic approach is recommended as the first-choice option for simple ileocecal resections. However, there are no randomized trials that have focused on patients with Crohn’s disease (CD) treated by laparoscopy and enhanced recovery pathway. The aim of the present study is to prospectively evaluate the feasibility, safety, and short-term outcomes of laparoscopy with enhanced recovery pathway for CD patients undergoing ileocecal resection. Methods. A consecutive cohort of 32 CD patients who underwent laparoscopic ileocecal resection between December 2015 and December 2016 was randomized to enhanced recovery after surgery (ERAS) group or standard care group. Primary outcome was total postoperative hospital stay. Secondary outcomes were time to first flatus and stool, pain scores, morbidity, reoperation rate, readmission rate, and in-hospital costs. Results. Compliance with the ERAS was high for all items (≥90%) except the items of abdominal drains and early fluid intake. A significantly earlier return of bowel function was observed in the ERAS group. Compared with the standard care group, patients in the ERAS group had shorter postoperative hospital stay and lower in-hospital costs (5.19 ± 1.28 versus 9.94 ± 3.33 days, P<0.001; 2.70 ± 0.50 versus 3.73 ± 0.75 ten thousand RMB, P<0.001, respectively). Other parameters did not show any significant differences between the two groups. Conclusions. Laparoscopic approach within an ERAS perioperative care program is a safe and effective treatment combination for CD patients requiring ileocecal resection. This study is registered at ClinicalTrials.gov (NCT02777034).

Impact of double-flap technique for reconstruction after proximal gastrectomy.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 134-134
Author(s):  
Kazuki Asanuma ◽  
Hirofumi Kawakubo ◽  
Shuhei Mayanagi ◽  
Rieko Nakamura ◽  
Tomoyuki Irino ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Gastroesophageal Reflux ◽  
Hospital Stay ◽  
Proximal Gastrectomy ◽  
Operation Time ◽  
Postoperative Hospital Stay ◽  
Endoscopic Findings ◽  
Flap Technique ◽  
Postoperative Reflux ◽  
One Year

134 Background: Proximal gastrectomy (PG) has been performed for proximal early gastric cancer as a minimally invasive procedure. In PG, gastroesophageal reflux disease (GERD) becomes problem, thus several techniques have been reported to reduce GERD. So far, we have mainly performed the method of anastomosis based on double stapling technique (DST) using a trans-oral anvil delivery system for reconstruction after PG. For preventing GERD, we recently introduced double-flap technique (DFT) reported to be more physiological anti-reflux reconstruction which can prevent GERD. So, this study shows superiority of DFT compared to DST. Methods: Patients who have undergone PG for proximal gastric cancer during Jan. 2012 to Jul. 2017 in our hospital were reviewed as candidates. Operation time, blood loss, postoperative anastomotic complication, postoperative hospital stay, postoperative reflux symptom or endoscopic findings, intake of proton pump inhibitor (PPI) at 1 year after the operation, and postoperative nutritional status were retrospectively investigated. Results: DFT was performed in 26 patients whereas DST was performed in 38 patients. Average operation time and postoperative hospital stay was not significant in both groups (DFT group; 275.8±41.4 minutes, 13.6±8.9 days, DST group; 252.2±82.9 minutes, 15.2±7.2 days, respectively). As for postoperative complications higher than Clavien-Dindo Grade III, one case of suture failure was observed in DFT group. Postoperative reflux symptoms and endoscopic findings of gastroesophageal reflux were significantly frequent in DST group compared to DFT group (Reflux symptoms, DFT group : DST group = 0 : 7(p = 0.03), Endoscopic findings, DFT group : DST group = 1 : 11(p < 0.01) , respectively). There were significantly more cases of PPI taking one year after the operation in DST group(DFT group : DST group = 8 : 28 (p < 0.01) ). Average weight loss at one year after the operation and serum level of albumin of in DFT group were 6.0±4.7kg and 4.11±0.29 g/dL, respectively and DST group were 7.6±5.3kg and 3.95±0.39 g/dL, respectively and there were no significance between two groups. Conclusions: DFT is superior to DST as a reconstruction method after PG in terms of suppressing GERD.

PD18-06 DECREASING LENGTH OF HOSPITAL STAY FOLLOWING RADICAL CYSTECTOMY USING MULTIMODAL ENHANCED RECOVERY PROTOCOL

2014 ◽  
Vol 191 (4S) ◽  
Author(s):  
Hooman Djaladat ◽  
Hamed Ahmadi ◽  
Gus Miranda ◽  
Anne Schuckman ◽  
Siamak Daneshmand
Keyword(s):  
Hospital Stay ◽  
Radical Cystectomy ◽  
Enhanced Recovery ◽  
Length Of Hospital Stay ◽  
Enhanced Recovery Protocol

scholarly journals The Impact of Enhanced Recovery after Surgery Protocol on Postoperative Hospital Stay

2013 ◽  
Vol 74 (8) ◽  
pp. 2043-2050
Author(s):  
Yoshihide NANNO ◽  
Fumitaka NAKAMURA ◽  
Minori ISHII ◽  
Toru SHIMIZU ◽  
Naoya OKADA ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Postoperative Hospital Stay ◽  
The Impact

scholarly journals Comparison of Perioperative Outcomes in Open and Laparoscopic Radical Cystectomy with Modified Ureterosigmoidostomy (MainzII): A Retrospective Analysis

2021 ◽  
Author(s):  
Bin Zhang ◽  
Yang He ◽  
Duo Zheng ◽  
Junyao Liu ◽  
Peng Qi ◽  
...  
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Open Surgery ◽  
Operation Time ◽  
Laparoscopic Group ◽  
Postoperative Hospital Stay ◽  
Intraoperative Blood Loss

Abstract Background: To analyze perioperative conditions and long-term efficacy of open modified ureterosigmoidostomy urinary diversion (OMUUD) in patients with bladder cancer who underwent open radical cystectomy (ORC) and laparoscopic radical cystectomy (LRC).Methods: In this retrospective study, the clinical data of patients who underwent open and laparoscopic radical cystectomy plus open modified ureterosigmoidostomy urinary diversion in our hospital were collected from January 2011 to December 2019. In addition, perioperative data of 56 patients who underwent ORC and OMUUD were compared with those of 118 patients who underwent laparoscopic radical cystectomy (LRC) plus OMUUD. A long-term follow-up was performed to compare the overall survival (OS) and progression-free survival (PFS) rate between the two groups.Results: Results showed that there was no significant difference between ORC+OMUUD group and LRC+OMUUD group in terms of gender, age, body index, pre-operative ASA grade, history of transurethral resection of bladder tumor (TURBT) before surgery, tumor T stage, lymph node dissection range, pathological grade, and positive postoperative surgical margin. The mean operation time in the open group was shorter than that in the laparoscopic group （P<0.001）. Moreover, the estimated intraoperative blood loss（P<0.001）and postoperative hospital stay（P=0.023）were better in the laparoscopic group than in the open group. The incidence of complications between 30 days (P=0.665) and 90 days (P=0.211) time-points after surgery was not significantly different. Similarly, the OS (P=0.237) and PFS (P=0.307) between the two groups were comparable.Conclusion: This study shows that the LRC group has long operation time, but less estimated intraoperative blood loss, short postoperative hospital stay, small trauma, and fast postoperative recovery compared to open surgery. Moreover, the incidence of complications at 30 - and 90-days postoperation, as well as the OS and PFS is not different between laparoscopy and open surgery.

scholarly journals Flexible Ureteroscopic Lithotripsy Based on the Concept of Enhanced Recovery After Surgery

2021 ◽  
Author(s):  
Ling Shu ◽  
Ping Ao ◽  
Zhenxing Zhang ◽  
Dong Zhuo ◽  
Changbin Dong ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Hospital Stay ◽  
Operative Time ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Postoperative Hospital Stay ◽  
Control Group ◽  
Ureteroscopic Lithotripsy ◽  
Total Cost ◽  
Stone Removal

Abstract Background: To evaluate the efficacy of flexible ureteroscopic lithotripsy (FURSL) based on the concept of enhanced recovery after surgery (ERAS).Methods: 435 patients with upper urinary calculi between 2017-2020 were retrospectively analysed and assigned to ERAS group (ERAS management) and control group (traditional management). Operative time, postoperative ambulation time, postoperative hospital stay, total cost of hospitalization, postoperative complications and stone removal were compared. Results: 427 cases were successfully performed FURSL procedure with 4 cases of ERAS group (n = 216) and 4 cases of control group (n = 219) failed respectively. No postoperative complications occurred in either group except for fever and hematuria. There were no significant difference in postoperative fever and stone removal between the two groups (all p > 0.05). The patients in ERAS group had shorter operative time, shorter postoperative ambulation time, less postoperative severe hematuria, shorter postoperative hospital stay and lower total cost of hospitalization than those in control group (all p < 0.05).Conclusions: FURSL based on the concept of ERAS for the treatment of upper urinary tract calculi is safe and reliable, with rapid postoperative recovery, low cost of hospitalization and worthy of clinical promotion.

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