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Discussion of the experience and improvement of an enhanced recovery after surgery procedure for minimally invasive lobectomy: a cohort study.

ABSTRACT:

Background

It is of great significance to explore a path for expedited recovery from thoracic surgery for patients undergoing minimally invasive lobectomy to ensure their rapid and smooth recovery and to conserve medical resources.

Methods

We analyzed 629 cases from the Department of Thoracic Surgery, First Affiliated Hospital of Soochow University from January 2018 to January 2020. According to the length of postoperative stay (LOS) and perioperative management, the 629 patients were divided into group A [routine management group (RMG)], group B [rapidly recovery group (RRG), LOS >72 h], and group C (RRG, LOS ≤72 h). The t-test and chi-square test were used to compare the postoperative complications (PC), chest tube indwelling time (CTIT), LOS, postoperative opioid dosages (POD), and total costs (TC) of the 3 groups.

Results

Compared with the RMG, the LOS, PC, CTIT, POD, and TC of the RRG were statistically significantly ameliorated (P<0.05). When compared with group A, the PC (18.9% vs. 38.8%), LOS (2.74±0.80 vs. 5.70±1.10 d), CTIT (46.1±18.5 vs. 123.6±34.8 h), and TC (¥51,517±7,217 vs. ¥65,781±8,200) of group C were all decreased. Compared with group A, group B had more preoperative complications, less CTIT, but no significant difference in LOS, PC, and TC during hospital stay. Compared with group B, group C had less preoperative complications, and reduced LOS, CTIT, and TC. The POD in group A was significantly higher than that in groups B and C.

Conclusions

Use of an enhanced recover after surgery (ERAS) protocol can reduce the postoperative complications and shorten the LOS. Some high-risk patients cannot be discharged within 72 h after surgery, but their incidence of grade II postoperative lung complications can be decreased and they can benefit from ERAS. Single intercostal nerve block, COX-2 selective inhibitor, and removal of the chest tube as early as possible can improve the ERAS.

Keywords

Enhanced recover after surgery (ERAS); video-assisted thoracic surgery (VATS); minimally invasive lobectomy.

SUBMITTER: Ni H

PROVIDER: S-EPMC8756218 | biostudies-literature | 2021 Dec

REPOSITORIES: biostudies-literature

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Publications

Discussion of the experience and improvement of an enhanced recovery after surgery procedure for minimally invasive lobectomy: a cohort study.

Ni Haoxiang H Li Peng P Meng Zhe Z Huang Tianwei T Shi Liang L Ni Bin B

Annals of translational medicine 20211201 24

<h4>Background</h4>It is of great significance to explore a path for expedited recovery from thoracic surgery for patients undergoing minimally invasive lobectomy to ensure their rapid and smooth recovery and to conserve medical resources.<h4>Methods</h4>We analyzed 629 cases from the Department of Thoracic Surgery, First Affiliated Hospital of Soochow University from January 2018 to January 2020. According to the length of postoperative stay (LOS) and perioperative management, the 629 patients ...[more]

PMID: 35071486

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Project description:Objectives: Having achieved a consolidated in-hospital experience with enhanced recovery after cardiac surgery, we explored the feasibility of expanding our protocol to pre-admission and post-discharge periods. Methods: A multidisciplinary team including cardiac surgeons, anaesthetists/intensivists, physiatrists, physiotherapists, perfusionists, nurses, psychiatrists, and engineers, elaborated a new therapeutic offer, based on current ERAS evidence and using telerehabilitation, to enhance preoperative communication and education and improve pre- and postoperative health and psychological state. Results: An institutional web-based platform for remote rehabilitation will host digital content that covers three main areas, including information and communication, prehabilitation and rehabilitation with the offer of respiratory and muscular exercises and aerobic activities, and psychological and patient experience evaluations. These interventions will be achieved through purposely developed video tutorials that present the hospital environments, the relevant healthcare personnel, and their role during the in-hospital patient's journey, and illustrate tailored prehabilitation activities. A series of questionnaires will be administered to evaluate and follow the patient's psychological state and collect patient-reported experience measures. The platform was activated in September 2024 and this service will initially involve 100 patients undergoing minimally invasive mitral valve surgery. A first review of compliance and engagement will be carried out after four months and a complete review of the results after the first year. Conclusions: ERAS is associated with improved surgical outcomes. A person-centred treatment should also address the health and psychological difficulties that patients face before hospitalisation and after discharge. Telemedicine is a valid tool to expand treatment and monitoring outside the hospital. This experience may give new insights into the feasibility and effectiveness of providing home-based remote interventions aimed at a global improvement in results throughout the overall cardiac surgery journey.

Project description:Objectives: Although previous studies have shown the feasibility of non-intubated techniques, it is unknown whether avoiding urinary catheters can enhance recovery. This study aimed to determine whether the tubeless urinary catheter protocol is feasible and beneficial for minimally invasive lung surgery. Methods: Patients were randomized to the control group, completely tubeless group, and partially tubeless group. A propensity score-matched (PSM) analysis was performed to balance the non-random baseline characteristics. Complications and postoperative recovery were compared. Regression analysis was performed to identify the independent predictors of complications. A nomogram for predicting the risk of non-automatic micturition was constructed and internally validated. Results: One hundred fifty-nine patients were enrolled. The incidence rates of urinary irritation and urinary tract infection (UTI) were significantly lower in the tubeless groups (74.4 vs. 39.5%, p < 0.001; 28.2 vs. 8.6%, p = 0.001, respectively). The tubeless group had a higher proportion of 0-degree discomfort (81.5 vs. 30.8%, p = 0.001) and shorter duration of postoperative hospital stay than the control group (4.59 vs. 5.53 days, p < 0.001). No difference was observed in terms of urination retention and urinary incontinence between the tubeless group and the control group. After PSM, the advantages of the tubeless group still existed, and comparing to the partially tubeless group, the completely tubeless group was of even less UTI and more 0-degree discomfort (18.5 vs. 0.0%, p = 0.019; 96.3 vs. 59.3%, p = 0.002). The tubeless protocol was the only independent protective factor of urinary complications. A nomogram was constructed and showed good predictive ability. Conclusions: The tubeless catheterization protocol led to fewer complications, better compliance, and shorter hospital length of stay. The advantages were more significant with the completely tubeless protocol. The utility of our nomogram can assist clinicians in avoiding risks in performing the tubeless protocol.

Project description:BackgroundEnhanced Recovery After Surgery Programs (ERP) includes multimodal approaches of perioperative patient's clinical pathways designed to achieve early recovery after surgery and a decreased length of hospital stay (LOS).MethodsThis observational study evaluated the implementation of ERP in gynaecologic oncological surgery in a minimally invasive techniques (MIT) expert center with more than 85% of procedures done with MIT. We compared a prospective cohort of 100 patients involved in ERP between December 2015 and June 2016 to a 100 patients control group, without ERP, previously managed in the same center between April 2015 and November 2015. All the included patients were referred for hysterectomy and/or pelvic or para-aortic lymphadenectomy for gynaecological cancer. The primary objective was to achieve a significant decrease of median LOS in the ERP group. Secondary objectives were decreases in proportion of patients achieving target LOS (2 days), morbidity and readmissions.ResultsExcept a disparity in oncological indications with a higher proportion of endometrial cancer in the group with ERP vs. the group without ERP (42% vs. 22%; p = 0.003), there were no differences in patient's characteristics and surgical procedures. ERP were associated with decreases of median LOS (2.5 [0 to 11] days vs. 3 [1 to 14] days; p = 0.002) and proportion of discharged patient at target LOS (45% vs. 24%; p = 0.002). Morbidities occurred in 25% and 26% in the groups with and without ERP and readmission rates were respectively of 6% and 8%, without any significant difference.ConclusionERP in gynaecologic oncological surgery is associated with a decrease of LOS without increases of morbidity or readmission rates, even in a center with a high proportion of MIT. Although it is already widely accepted that MIT improves early recovery, our study shows that the addition of ERP's clinical pathways improve surgical outcomes and patient care management.

Dataset Information

Discussion of the experience and improvement of an enhanced recovery after surgery procedure for minimally invasive lobectomy: a cohort study.

Background

Methods

Results

Conclusions

Keywords

Publications

Discussion of the experience and improvement of an enhanced recovery after surgery procedure for minimally invasive lobectomy: a cohort study.

Similar Datasets

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