Objective To compare the differences in evaluating readiness for hospital discharge between nurses and colorectal cancer (CRC) patients following enhanced recovery after surgery (ERAS) pathway. Methods A cross-sectional survey was conducted in Department of Gastrointestinal Surgery, West China Hospital, Sichuan University. Patient-reported Readiness for Hospital Discharge Scale (RHDS) and nurse-reported RHDS were delivered to 130 CRC patients and 40 nurses respectively. All patients were followed ERAS pathway during perioperative periods. The differences were compared in evaluating readiness for hospital discharge between nurses and CRC patients. Results This study investigated 130 CRC patients and 40 responsible nurses. The scores of RHDS from nurses and patients were 162.86±27.95 and 149.86±33.65 respectively. When evaluating whether patients were ready to go home after discharge, the consistency between nurses’ results and patients’ results was weak（κ=0.365, P<0.001）. Items in patients’ RHDS scoring ranking from high to low were expected support, coping ability, knowledge, and personal status. Items in nurses’ RHDS scoring ranking from high to low were expected support, knowledge, coping ability, and personal status. Besides the " social support” dimension, the scores of other 3 dimensions from nurses were significantly higher than those from patients (P<0.05). Conclusion There is a gap between the assessment of RHDS from nurses and patients, nurses overestimated patients’ discharge readiness level.
ObjectiveTo explore the influence of enhanced recovery after surgery (ERAS) on intestinal flora in patients with colorectal cancer.MethodsBy convenient sampling method, 60 patients with colorectal cancer were selected from August 2018 to December 2019 in the Department of Gastrointestinal Surgery of West China Hospital of Sichuan University and randomly divided into ERAS group and traditional treatment group (traditional group). Among them, the perioperative clinical management was carried out according to the ERAS management and traditional treatment process in the the ERAS group and in the traditional group, respectively. The fresh fecal samples were collected within 24 h after admission and the first natural defecation after operation. The bacterial 16 Sr DNA V3–V4 region was sequenced by Illumina MiSeq sequencer, and the results were analyzed by bioinformatics.ResultsA total of 60 patients with colorectal cancer were included, 30 cases in the traditional group and 27 cases in the ERAS group (3 people temporarily withdrew from the study). There were no significant differences in the basic informations between the two groups (P>0.05). ① Before or after operation, there were no significant differences in Shannon index and Simpson index between the two groups. The difference between preoperative and postoperative comparison in the same group was also not statistically significant (P>0.05). ② Beta diversity analysis showed that there was no significant difference in community composition between the traditional group and the ERAS group before operation, and there was a clear boundary between the traditional group and the ERAS group after operation. ③ At the phylum level, compared with the preoperative abundance, the postoperative abundance Firmicutes decreased by 26.5% and 5.5% in the traditional and ERAS group, respectively; Bacteroidetes increased by 21.6% and 4.7% in the traditional and ERAS group, respectively; Proteobacteria increased by 7.2% and 2.2% in the traditional and ERAS group, respectively. At the genus level, compared with the preoperative abundance, the postoperative abundance of Bacteroides in the traditional group increased by 17.6% and in the ERAS group decreased by 1.6%; Bifidobacterium decreased by 1.8% and 1.3% in the traditional group and in the ERAS group, respectively.ConclusionsERAS does not affect species diversity of intestinal flora. Although ERAS has some damage to structure of intestinal flora, it is weaker than traditional process, so it is more conducive to reconstruction and restoration of intestinal microecological environment.
ObjectiveTo explore the current situation of the readiness for hospital discharge and the quality of discharge teaching in lung cancer patients based on enhanced recovery after surgery, and to analyze their correlation.MethodsWe conducted a cross-sectional study and 141 postoperative patients with lung cancer in our hospital from July to August 2018 were investigated by general information questionnaire, readiness for hospital discharge scale and quality of discharge teaching scale. There were 65 males and 76 females at age of 18-85 (55.35±12.15) years.ResultsTotally 88.65% of postoperative patients with lung cancer reported that they were ready for discharge, and the total score of readiness for hospital discharge was 78.36±16.48, and the total score of quality of discharge teaching was 90.94±18.62. There was a positive correlation between the readiness for hospital discharge and the quality of discharge teaching in postoperative patients with lung cancer (r=0.57, P<0.01).ConclusionThe readiness for hospital discharge of postoperative patients with lung cancer keeps in medium level, while the quality of discharge teaching is good, and the readiness for hospital discharge is positively correlated with the quality of discharge teaching. Medical staff should pay more attention to the cognitive level of lung cancer patients' disease-related information and their physical function recovery, and enrich the discharge guidance content, in order to improve the readiness of postoperative patients with lung cancer.
Objective To explore the effect of self-assessment of pain in perioperative pain management of total knee arthroplasty (TKA). Methods A total of 140 patients undergoing TKA from March 2016 to March 2017 were randomly divided into the control group and the trial group. The patients in the two groups were received the same education relating to pain knowledge. The intensity of pain was assessed by nurses in the control group, while in the trial group, it was assessed by patients themselves. According to the assessment of pain, treatments were given to both groups. Time of pain assessment, types and frequencies of temporary rescue medicine, pain intensity, the score of Self-efficacy for Rehabilitation Outcome Scale (SER) and the range of motion (ROM) of knee were observed and recorded. Results There were 132 patients who completed the final observation, with 67 in the trial group and 65 in the control group. There were significant differences between the two groups in evaluation time of pain (t=–2.736, P=0.007), types and frequencies of temporary rescue medicine (χ2=10.276, P<0.05), the overall postoperative pain score (Z=–2.146, P=0.032), average hospitalization time after surgery (t=–2.468, P=0.015), SER scores 7 days after surgery (F=2.390, P=0.018) and 14 days after surgery (F=3.427, P=0.001), and ROM at the postoperative day 7 (F=2.109, P=0.037); there were no significant differences in postoperative daily pain scores (Z=–1.779, P=0.077), SER scores at the postoperative day 3 (F=1.010, P=0.314), ROM at the postoperative day 1 (F=1.319, P=0.189) and day 14 (F=1.603, P=0.111). Conclusion Self-assessment of pain can motivate TKA patients to take part in pain management, and more accurate response to the pain intensity will help to optimize the management of perioperative pain and reduce the workload of the health staff, thereby contributing to enhanced recovery.
ObjectiveTo investigate the effect of enhanced recovery after surgery (ERAS) combined with preoperative oral nutrition supplement (EnsourceTM) in patients with rectal cancer and its effect on postoperative stress response.MethodsFrom January 2018 to August 2018, 80 patients with laparoscopic assisted radical resection of rectal cancer in our hospital were divided into two groups according to different perioperative management. Forty patients who had used enhanced recovery after surgery combine preoperative application of tumor total nutrition formula enteral nutrition solution were as observation group, while other 40 patients who only had used enhanced recovery after surgery in perioperative as control group. We observed the stress response (mean systolic blood pressure, mean diastolic blood pressure, mean heart rate, mean blood oxygen saturation, pain score and fasting blood glucose) at 24 hours after surgery and the time of the first anal exhaust, complication rate, hospitalization time, and hospitalization cost after surgery in both groups. We also compared the early postoperative (on the second day after operation) nutritional status of the two groups like the levels of serum total protein, albumin and proalbumin.ResultsThe mean systolic blood pressure, mean diastolic blood pressure, mean heart rate, mean blood oxygen saturation, pain score and fasting blood glucose of the observation group at 24 hours after surgery were significantly lower than those of the control group (P<0.05), while the total serum protein, albumin and prealbumin concentrations of the observation group were significantly higher than those of the control group on the second day after surgery (P<0.05). Postoperative hospitalization time and hospitalization cost in the observation group were also shorter or less than those in the control group (P<0.05). Compared with the control group, the first postoperative anal exhaust time was earlier and the incidence of postoperative complications was reduced in the observation group, but the difference was not statistically significant (P>0.05).ConclusionsERAS combined with preoperative application of tumor total nutrition formula enteral nutrition fluid (EnsourceTM) can reduce the postoperative stress response and the postoperative complication rate of patients with rectal cancer, and also improve the postoperative nutrition status of patients and promote the rapid recovery of patients after sugery.
Objective To investigate the effects of enhanced recovery after surgery (ERAS) on postoperative function and pain in total hip arthroplasty (THA) patients with high comorbidity. Methods Patients with THA who were admitted between January 2020 and January 2022 were selected as the study objects, and a total of 223 patients with high comorbidity met the selection criteria. Patients were randomly divided into two groups using the random envelope method. During perioperative period, 112 cases in the ERAS group were treated according to the ERAS protocol and 111 cases in the control group with the traditional protocol. There was no significant difference in gender, age, body mass index, Charlson comorbidity index, preoperative diagnosis, the type and number of the comorbidities, preoperative visual analogue scale (VAS) score between the two groups (P>0.05). However, the Harris score of ERAS group was significantly lower than that of control group before operation (P<0.05). Preoperative and postoperative hospital stays were recorded. The VAS score was used to evaluate the pain before operation, at 1 day after operation, at the leaving bed time, at the day after discharge, and at 2 weeks after operation. Harris score was used to evaluate hip function before operation and at 2 weeks, 1 month, 3 months, 6 months, and 12 months after operation. The incidence of complications, 30-day readmission rate, mortality rate, and patient’s satisfaction were recorded. Results The length of preoperative hospital stay in ERAS group was significantly shorter than that in control group (P<0.05). But there was no significant difference in the length of postoperative hospital stay between groups (P>0.05). All patients in the two groups were followed up 12 months. The VAS score in the two groups after operation was lower than that before operation, and showed a gradually trend with the extension of time, with significant differences between different time points (P<0.05). VAS scores of ERAS group were significantly lower than those of control group at different time points after operation (P<0.05). The postoperative Harris scores in both groups were higher than those before operation, and showed a gradually increasing trend with the extension of time, with significant differences between different time points (P<0.05). Harris scores of ERAS group at 2 weeks, 1 month, and 3 months after operation were significantly higher than those of control group (P<0.05). Complications occurred in 2 cases (1.79%) of the ERAS group and 6 cases (5.41%) of the control group, with no significant difference in incidence (P>0.05). In the control group, 1 case was readmitted within 30 days after operation, and 1 case died of severe pneumonia within 1 year of follow-up. There was no readmission or death in ERAS group, and there was no significant difference in the above indexes between the two groups (P>0.05). At last follow-up, the satisfaction rate of patients in ERAS group was slightly higher than that in control group, but the difference was not significant (P>0.05). Conclusion For THA patients with high comorbidity, ERAS protocol can shorten preoperative waiting time, better reduce pain, and improve hip function.
ObjectiveTo explore the correlation between readiness for hospital discharge and short-term quality of life among colorectal cancer (CRC) patients following enhanced recovery after surgery (ERAS) mode.MethodsSurveys of 127 CRC patients following ERAS mode were conducted in the West China Hospital of Sichuan University. The Readiness for Hospital Discharge Scale and EORTC QLQ-C30 Scale were issued at the discharge and 1 month after the operation, respectively.ResultsThe total score of RHDS was 149.43±33.25. The score of global quality of life was 66.80±18.84. Correlation analysis showed that the total score of RHDS was positively correlated with the score of global quality of life (r=0.220, P=0.013), and negatively correlated with the scores of fatigue, nausea and vomiting, pain, loss of appetite (r=–0.304, P=0.001; r=–0.189, P=0.033; r=–0.257, P=0.004; r=–0.254, P=0.004). The score of personal status dimension were positively correlated with the score of global quality of life and emotional function (r=0.213, P=0.016; r=0.197, P=0.027), and negatively correlated with scores of fatigue, pain and insomnia (r=–0.311, P=0.000; r=–0.264, P=0.003; r=–0.257, P=0.004). The score of knowledge dimension was negatively correlated with nausea and vomiting, pain and loss of appetite (r=–0.212, P=0.017; r=–0.182, P=0.040; r=–0.239, P=0.007). The score of coping ability dimension was positively correlated with the score of global quality of life and physical function (r=0.204, P=0.021; r=0.204, P=0.021), while negatively correlated with scores of fatigue, pain, insomnia and loss of appetite (r=–0.349, P=0.000; r=–0.240, P=0.007; r=–0.202, P=0.022; r=–0.201, P=0.024). The score of expected support was positively correlated with the score of global quality of life (r=0.220, P=0.013), and negatively correlated with scores of fatigue and loss of appetite (r=–0.249, P=0.005; r=–0.227, P=0.010).ConclusionsThe short term quality of life among CRC patients following ERAS keeps at upper middle level, and positively correlated with the readiness for hospital discharge. It is suggested that discharge preparation service is of great significance to improve the quality of life of patients.
ObjectiveTo investigate the preoperative psychological state of patients with pulmonary nodules in order to make the content of the education more "individualized and humanized".MethodsWe conducted a consecutive questionnaire study for 107 patients who were planning to undergo pulmonary resection surgery from May 2018 to July 2018 in our department. There were 54 males and 53 females with an average age of 56.8±11.2 years. The questionnaire content included two parts: personal basic information and 20 questions about surgery, complications, follow-up and hospitalization expense.ResultsThere were 60.7% of the patients diagnosed with pulmonary nodules by CT scan during physical examination, and 52.3% of the patients had strong will to undergo pulmonary surgery to resect nodules; 64.5% of patients wanted doctors to tell them the extent of the disease and whether the tumor could be cured by surgery, and 30.0% of patients concerned whether chief surgeon would complete the whole surgery. The surgery risk and postoperative complications were ignored by patients easily (5.6% and 14.9% respectively). The hospital expenses were not the primary concern of patients. Only 1.9% of patients believed that doctors used nonessentials which deliberately led to increased costs. Network follow-up was accepted by most patients (94.4%).ConclusionIt will contribute to improve preoperative education rationality and effectiveness by understanding true psychological state of patients.
ObjectiveTo explore the effect of standardized multimodal analgesia (SMA) on opioid consumption after major upper abdominal surgery under enhanced recovery after surgery pathway. MethodsPatients who underwent major upper abdominal surgery in the West China Hospital of Sichuan University between August and November 2020 were included prospectively. The patients were divided into two groups: SMA group (n=175) and control group (n=632). The SMA was defined as preoperative and postoperative use of non-steroidal anti-inflammatory drugs, combined with regional anesthesia, local anesthetic wound infiltration or intrathecal opioid. The postoperative opioid consumption in oral morphine equivalents, the pain scores on movement and at rest, the postoperative rehabilitation were recorded and compared between the two groups. ResultsPatients in the SMA group had a lower opioid consumption during the first 72 h compared to patients in the control group (median: 51 mg vs. 85 mg, P<0.001). The pain scores on movement and at rest at 24, 48, 72 h after surgery in the SMA group were lower than those in the control group (P<0.05). Time to first flatus, time to first ambulation, postoperative hospital stay in the SMA group were significantly shorter than those in the control group (P<0.05), and the quality of life scores at 5 d after surgery increased significantly (P<0.05). The satisfaction with analgesia and the incidence of adverse effects on day 5 after surgery had no statistical significances between the two groups (P>0.05). After controlling for confounding factors, multiple linear regression analysis showed that SMA was associated with less opioid consumption on hour 72 after surgery (P<0.001). ConclusionSMA can reduce postoperative opioid consumption in patients undergoing major upper abdominal surgery.