Dataset Information

[The Present Situation and Prospect of Day Surgery and Enhanced Recovery?after Surgery in Thoracic Surgery].

ABSTRACT: The good results of enhanced recovery after surgery (ERAS) combined with minimally invasive surgery are reflected in reducing the incidence of perioperative complications and shortening the length of hospitalization (LOS). It has been widely used in surgical fields of different specialties. The implementation of the day surgery mode can shorten the waiting time for patients and reduce the financial burden. Especially in thoracic surgery, the shorter the waiting time in the hospital, the more beneficial for the patient's physical and psychological recovery. With the widespread implementation of minimally invasive technology and accelerated rehabilitation procedures, the application of ERAS in thoracic surgery has made it possible for some thoracic surgery to be completed in the day surgery. This article summarizes the current application of ERAS in the field of thoracic surgery and the development prospects of day surgery models in China.

SUBMITTER: Shen C

PROVIDER: S-EPMC7519962 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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[The Present Situation and Prospect of Day Surgery and Enhanced Recovery after Surgery in Thoracic Surgery].

Shen Cheng C Chang Shuai S Zhou Kun K Che Guowei G

Zhongguo fei ai za zhi = Chinese journal of lung cancer 20200805 9

The good results of enhanced recovery after surgery (ERAS) combined with minimally invasive surgery are reflected in reducing the incidence of perioperative complications and shortening the length of hospitalization (LOS). It has been widely used in surgical fields of different specialties. The implementation of the day surgery mode can shorten the waiting time for patients and reduce the financial burden. Especially in thoracic surgery, the shorter the waiting time in the hospital, the more ben ...[more]

PMID: 32752581

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Project description:ObjectivesThis study aims to elucidate determinants for succesful implementation of the Enhanced Recovery After Thoracic Surgery (ERATS) protocol for perioperative care for surgical lung cancer patients in the Netherlands.SettingLung cancer operations are performed in both academic and regional hospitals, either by cardiothoracic or general thoracic surgeons. Limiting the impact of these operations by optimising and standardising perioperative care with the ERATS protocol is thought to enable reduction in length of stay, complications and costs.ParticipantsA broad spectrum of stakeholders in perioperative care for patients with lung resection participated in this study, ranging from patient representatives, healthcare professionals to an insurance company representative.InterventionsSemistructured interviews (N=14) were conducted with the stakeholders (N=18). The interviews were conducted one on one by telephone and two times, face to face, in small groups. Verbatim transcriptions of these interviews were coded for the purpose of thematic analysis.Outcome measuresDeterminants for successful implementation of the ERATS protocol in the Netherlands.ResultsSeveral determinants correspond with previous publications: having a multidisciplinary team, leadership from a senior clinician and support from an ERAS-coordinator as facilitators; lack of feedback on performance and absence of management support as barriers. Our study underscores the potential detrimental effect of inconsistent communication, the lack of support in the transition from hospital to home and the barrier posed by lack of accessible audit data.ConclusionsBased on a structured problem analysis among a wide selection of stakeholders, this study provides a solid basis for choosing adequate implementation strategies to introduce the ERATS protocol in the Netherlands. Emphasis on consistent and sufficient communication, support in the transition from hospital to home and adequate audit and feedback data, in addition to established implementation strategies for ERAS-type programmes, will enable a tailored approach to implementation of ERATS in the Dutch context.

Project description:Importance:Enhanced Recovery After Surgery (ERAS) care has been reported to be associated with improvements in outcomes after colorectal surgery compared with traditional care. Objective:To determine the association between ERAS protocols and outcomes in patients undergoing elective colorectal surgery. Design, Setting, and Participants:The Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol (POWER) Study is a multicenter, prospective cohort study of 2084 consecutive adults scheduled for elective colorectal surgery who received or did not receive care in a self-declared ERAS center. Patients were recruited from 80 Spanish centers between September 15 and December 15, 2017. All patients included in this analysis had 1 month of follow-up. Exposures:Colorectal surgery and perioperative management were the exposures. Twenty-two individual ERAS items were assessed in all patients, regardless of whether they were included in an established ERAS protocol. Main Outcomes and Measures:The primary study outcome was moderate to severe postoperative complications within 30 days after surgery. Secondary outcomes included ERAS adherence, mortality, readmissions, reoperation rates, and hospital length of stay. Results:Between September 15 and December 15, 2017, 2084 patients were included in the study. Of these, 1286 individuals (61.7%) were men; mean age was 68 years (interquartile range [IQR], 59-77). A total of 879 patients (42.2%) presented with postoperative complications and 566 patients (27.2%) developed moderate to severe complications. The number of patients with moderate or severe complications was lower in the ERAS group (25.2% vs 30.3%; odds ratio [OR], 0.77; 95% CI, 0.63-0.94; P?=?.01). The overall rate of adherence to the ERAS protocol was 63.6% (IQR, 54.5%-77.3%), and the rate for patients from hospitals self-declared as ERAS was 72.7% (IQR, 59.1%-81.8%) vs non-ERAS institutions, which was 59.1% (IQR, 50.0%-63.6%; P?<?.001). Adherence quartiles among patients receiving the highest and lowest ERAS components showed that the patients with the highest adherence rates had fewer moderate to severe complications (OR, 0.34; 95% CI, 0.25-0.46; P?<?.001), overall complications (OR, 0.33; 95% CI, 0.26-0.43; P?<?.001), and mortality (OR, 0.27; 95% CI, 0.07-0.97; P?=?.06) compared with those who had the lowest adherence rates. Conclusions and Relevance:An increase in ERAS adherence appears to be associated with a decrease in postoperative complications.

Dataset Information

[The Present Situation and Prospect of Day Surgery and Enhanced Recovery?after Surgery in Thoracic Surgery].

Publications

[The Present Situation and Prospect of Day Surgery and Enhanced Recovery after Surgery in Thoracic Surgery].

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[The Present Situation and Prospect of Day Surgery and Enhanced Recovery after Surgery in Thoracic Surgery].