Doubly committed sub-arterial ventricular septal defect (VSD) is a unique type of VSD which is located beneath both the aortic and pulmonary valve. Open-heart repair is traumatic especially for pediatric patient while trans-catheter device closure is also not suitable for this type of VSD. Minimally invasive per-ventricular device closure has been introduced as an alternative method in the treatment of doubly committed VSD with encouraging results. In the review, we will illustrate the surgical technique as well as perioperative management strategy as for this technique in treating doubly committed VSD.
The concept of enhanced recovery after surgery(ERAS) has been well accepted by medical providers, which can be realized by a multidisciplinary team approach and minimally invasive surgical technology performed during perioperative periods. As the outcomes of the ERAS protocols, well effects are anticipated, and consistent outcomes are actually obtained. At the same time, there are some aspects which are not consistent including ① the evolution and challenge of ERAS concept:connotation and extension, ② consensus and arguments on the evaluation standard of ERAS protocol, ③ the cause of poorly compliance in medical providers and patient, ④ the function of multimodal programme and multidisciplinary team approach in ERAS protocol, which one is better? ⑤ methods and barriers of implementing enhanced recovery in clinic application.
Objective To review the adverse event of hysterectomy caused by postoperative infection after cesarean section, formulate prevention and control strategies in combination with risk assessment tools, promote the standardization of perioperative management, reduce the medical burden on pregnant women, and improve patient satisfaction. Methods The two adverse events of hysterectomy caused by postoperative infection after cesarean section that occurred in the obstetrics ward between October and November 2024 were selected as the research objects. A root cause analysis and risk assessment team composed of personnel from multiple departments was established. Through interviews, observations, and data review, the potential failure modes and causes were sorted out. The risk priority number (RPN) was calculated to determine the high-risk factors. Improvement strategies were formulated and implemented. After two-month implementation, the RPN scores and the compliance of various measures before and after the implementation were compared. Results Before the improvement, the total RPN of the healthcare failure mode and effects analysis was 367.8. When rechecked in January 2025, the total RPN after the improvement dropped to 105.7, and no serious adverse events occurred again. The compliance and passing rates of various operations significantly increased: the intervention rate for maternal malnutrition rose from 17.5% to 48.6%, the passing rate of appropriate timing for prophylactic use of antimicrobial agents before surgery increased from 50.5% to 81.0%, the compliance rate of scrubbing the vagina with disinfectant before surgery increased from 15.0% to 60.0%, the implementation rate of standardized skin disinfection during surgery rose from 66.7% to 95.2%, the passing rate of aseptic techniques and hand hygiene operations during surgery increased from 75.0% to 95.2%, and the timely submission rate of specimens from infected patients increased from 29.4% to 47.6%, and all these differences were statistically significant (P<0.05). Conclusion The combination of healthcare failure mode and effect analysis and root cause analysis can effectively improve adverse events during the perioperative period, optimize the perioperative management of cesarean section, and reduce the risk of infection.
Since December 2019, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection has gradually spread all over the world. With the implementation of class B infectious disease management policy for coronavirus disease 2019 (COVID-19), China has experienced a pandemic. For patients receiving a time-sensitive or emergency surgery, SARS-CoV-2 infection may increase the risk of postoperative pulmonary complications. An appropriate perioperative mechanical ventilation strategy, such as lung protective ventilation strategy, is particularly important for preventing postoperative pulmonary complications in patients undergoing general anesthesia. In addition, how to protect medical personnel from being infected is also the focus we need to pay attention to. This article will discuss the perioperative mechanical ventilation strategy for COVID-19 patients and the protection of medical personnel, in order to provide reference for the development of guidelines.
Inherited retinal diseases (IRDs) are a group of severe retinal degenerative diseases leading to permanent visual impairment. IRDs are the major cause of irreversible blindness in children and working age groups. Gene therapy is a new clinical treatment method and currently the only clear and effective treatment for IRDs, while, there are still risks in clinical research and application. How to standardize perioperative management and reduce the potential risks of treatment is one of the keys to ensure the safety and effectiveness of treatment. However, there is no systematic and standardized guidance on the perioperative management for IRDs gene therapy. Therefore, in order to standardize the perioperative management, the Fundus Disease Group of Ophthalmology Society of Chinese Medical Association and Chinese Medical Doctor Association organized domestic experts to put forward standardized opinions on the perioperative management of IRDs gene therapy in China after repeated discussion and combined with domestic and foreign research experience, so as to provide clinicians with reference and application in clinical research and practice.
Objective To illustrate the situation of delayed discharge of patients after total knee arthroplasty (TKA) under fast-track (FT) recovery model, and analyze the reasons. Methods We retrospectively analyzed the clinical data of 152 patients who accepted perioperative management under fast-track model from January to December 2014. The reasons for discharging over 72 hours after hospitalization were analyzed. Results Among the 152 patients, 119 were discharged over 72 hours after surgery, and the rate was 78.2%. The main reasons for delayed discharge were pain (32.8%), limited range of motion (31.9%) and unwillingness to be discharged (27.7%), respectively. Conclusion For patients who have undergone TKA, FT model can shorten hospital stay, save expenses, and accelerate postoperative rehabilitation, but there is still much room for improvement.
ObjectiveTo explore the clinical effect of applying the concept of enhanced recovery after surgery (ERAS) to the perioperative management of elderly patients with intertrochanteric fractures.MethodsThe clinical data of 64 elderly patients with intertrochanteric fractures admitted to West China Hospital of Sichuan University from January 2016 to December 2017 were retrospectively analyzed. Among them, 32 patients admitted from January to December in 2017 were in ERAS group, and 32 patients admitted from January to December 2016 were in control group. The control group used conventional orthopedic perioperative management measures, and the ERAS group combined the ERAS concept on the basis of conventional treatment measures for perioperative management. The incidence of perioperative complications, Visual Analogue Scale score, modified Barthel Index score, inpatient satisfaction and length of hospital stay were compared between the two groups.ResultsThere was no significant difference in age, gender, American Society of Anesthesiologists grade, combined disease, modified Barthel Index or Visual Analogue Scale score at admission, or time from injury to surgery between the two groups (P>0.05). The total incidence of perioperative complications (12.5% vs. 37.5%) and length of hospital stay [(8.09±2.33) vs. (10.41±3.63) d] in the ERAS group were lower than those in the control group (P<0.05). The Visual Analogue Scale scores of the two groups of patients before operation, on the first day and the third day after operation were lower than those at admission (P<0.05). The comparison between the two groups at each time point showed that the Visual Analogue Scale scores of patients in the ERAS group were lower than those in the control group before operation, on the first day and the third day after operation, and the differences were statistically significant (P<0.05). The modified Barthel Index scores of the two groups of patients on the third day, and 1 month, 3 months and 6 months after operation showed a rising trend with time. The modified Barthel Index scores of the ERAS group were better than those of the control group on the third day, and 1 month and 3 months after operation (P<0.05). There was no significant difference between the two groups 6 months after operation (P>0.05). The hospitalization satisfaction score of the ERAS group was 95.56±5.12, which was higher than that of the control group (92.84±5.62), and the difference was statistically significant (P<0.05).ConclusionsThe implementation of ERAS perioperative management for elderly patients with intertrochanteric fractures may reduce the incidence of perioperative complications, relieve patient pain, promote the short-term recovery of activities of daily living of patients, improve the inpatient satisfaction and shorten the length of hospital stay.
Objective To discuss the impacts of completion rate of fast track items on postoperative management of colorectal cancer surgery. Methods Between February 2010 and May 2010, 100 patients (Group “Year 2010”) were analyzed retrospectively, who were compared with 76 patients (Group “Year 2008”) from the same period of 2008. Postoperative recovery indexes, complications, and completion rate of fast track items were studied and compared. Results For major fast track items, the completion rates of restrict rehydration, early out-of-bed mobilization, early oral intaking, and management of gastric tube and drains were significantly higher in Group “Year 2010” than those in Group “Year 2008” (Plt;0.05). Meanwhile, the completion rate of urinary catheter management was significantly higher in Group “Year 2008” than that in Group “Year 2010” (Plt;0.05). In early rehabilitation, the first flatus of patients in Group “Year 2010” 〔(3.86±1.05) d〕 was significantly earlier than that in Group “Year 2008” 〔(4.28±1.22) d〕, Plt;0.05; for postoperative hospital stay, though, there was no statistically significant difference between two groups (Pgt;0.05). As to the complications, there was also no statistically significant difference between two groups (Pgt;0.05). Conclusions As the concepts of fast track surgery became increasingly favorable, completion rates of fast track items are increased. As a result, more and more fast track items turn into regular perioperative care. Although enhanced recovery has been achieved, better collaboration and localilzation are still needed to make the full advantage of fast track surgery.
Objective To analyze the perioperative efficacy of enhanced recovery after surgery (ERAS) in the treatment of lumbar disc herniation using unilateral biportal endoscopy technique. Methods A total of 55 patients who received unilateral biportal endoscopy technique for the treatment of lumbar disc herniation in Tianjin Hospital between January and December 2020 were selected and randomly divided into the traditional group and the ERAS group according to random number table method. The routine inpatient care management was adopted in the traditional group, while the holistic integrated care plan was formulated in the ERAS group according to the multidisciplinary collaboration of the accelerated rehabilitation plan. The first postoperative exhaust time, the first time out of bed, length of hospital stay, hospital costs, Visual Analogue Scale (VAS) scores before operation, one day and three days after operation, Oswestry Disability Index (ODI) scores before operation and one month after operation, and the excellent and good rate of modified MacNab efficacy one month after operation were compared between the two groups. Results There were 28 cases in the traditional group and 27 cases in the ERAS group. The first postoperative exhaust time [(2.31±1.02) vs. (3.19±0.87) h], the first postoperative ambulation time [(1.06±0.40) vs. (2.00±0.53) d], length of hospital stay [(3.8±0.8) vs. (4.6±0.8) d], and hospital cost [(32.18±9.10) thousand yuan vs. (39.81±11.10) thousand yuan] in the ERAS group were all less than those in the traditional group, and the differences were statistically significant (P<0.05). The VAS scores of the ERAS group one day after operation (3.2±0.8 vs. 4.1±0.8) and three days after operation (1.4±0.5 vs. 1.7±0.5) were lower than those of the traditional group (P<0.05). The ODI scores of the ERAS group one month after operation was lower than that of the traditional group (13.3±4.0 vs. 16.6±4.8, P<0.05). In the modified MacNab efficacy evaluation one month after surgery, there was no significant difference in the excellent and good rate between the ERAS group and the traditional group (96.3% vs. 96.4%, P>0.05). Conclusions ERAS regimen can significantly accelerate the patients’ recovery, including shortening the first exhaust time, facilitating early ambulation, and reducing the hospital stay and hospitalization expenses. Meanwhile, ERAS regimen can effectively reduce the postoperative pain of the patients, and promote early functional recovery.