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Objective:To explore whether the degree of skeletal muscle atrophy in obese individuals under the influence of colorectal cancer is more severe than that in non-obese individuals.Methods:The clinical data of patients who underwent radical resection of colorectal cancer in our department from Jul 2020 to Dec 2021 was collected. Sixty-four obese patients were included and 64 non-obese patients were matched according to propensity score. At the same time, 51 obese patients were collected from non-tumor patients and matched with 51 non-obese patients. The psoas muscle index (PMI) of included patients was analyzed and compared.Results:The PMI of patients with colorectal cancer was significantly lower than that of corresponding non-tumor patients, regardless of gender and body weight (both P<0.05). The PMI of obese patients with colorectal cancer was significantly lower than that of non-obese patients ( P<0.05). Conclusions:The impact of colorectal cancer on skeletal muscle atrophy in obese individuals is greater than that in normal weight individuals. Therefore, the skeletal muscle status of obese patients with colorectal cancer should be evaluated more comprehensively.
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Objective:To investigate the application value of ambulatory surgery mode in inguinal hernia repair.Methods:The retrospective and descriptive study was conducted. The clinical data of 416 patients with inguinal hernia who were admitted to the Meishan People′s Hospital, West China Hospital of Sichuan University from January 2020 to January 2022 were collected. There were 374 males and 42 females, aged 52(range, 25-70)years. All patients underwent inguinal hernia repair with the ambulatory surgery mode. Observation indicators: (1) surgical situations; (2) follow-up. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1) Surgical situations. Of the 416 patients, 258 patients underwent laparoscopic transabdominal preperitoneal inguinal hernia repair (TAPP) under general anesthesia and 158 patients underwent open inguinal hernia repair under local anesthesia (98 cases of Lichtenstein repair and 60 cases of preperitoneal repair). The intraoperative measured diameter of hernia ring defect and operation time of the 416 patients were 1.9 (range, 0.9-3.2)cm and 52 (range, 35-80)minutes. The duration of hospital stay of the 416 patients <48 hours, including 395 cases with the duration of hospital stay <24 hours. There were 21 patients with delayed discharge including 12 cases as post-operative pain, 8 cases as adverse reactions to general anesthesia, and 1 case as postoperative seroma. (2) Follow-up. All 416 patients were followed up for 12 months after surgery. During the follow-up period, there was no serious complication such as recurrent inguinal hernia, wound infection, intestinal fistula or obstruction. At 1 month after surgery, ultrasound examination of the inguinal area did not reveal any serum swelling or seroma. The postoperative visual analogue scale of pain in patients undergoing laparoscopic TAPP was 2.70±0.10 at postoperative 3 days and 0 at postoperative 12 months. The above indicator in patients undergoing Lichtenstein repair and pre-peritoneal repair was from 3.20±0.20 and 3.00±0.10 at postoperative 3 days to 0 and 0 at post-operative 12 months, respectively. All patients did not experience chronic pain for more than 3 months. All 416 patients conducted satisfaction surveys over the phone, and all of them were very satisfied or satisfied, with a satisfaction rate as 100.00%(416/416).Conclusion:Ambulatory surgery mode in inguinal hernia repair is safe and feasible.
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As a new type of medical service mode, day surgery significantly alleviates the contradiction between supply and demand of medical resources. Since 2009, day surgery center in West China Hospital of Sichuan University has gradually carried out endoscopic gastrointestinal(GI) polypectomy, continuously explored and practiced the centralized management mode of GI polyps. The integrated management process included pre-hospital management, clinical pathway during hospitalization, and extended service after discharge. The overall-management database for day surgery patients was established, guiding the clinical practice and standardizing clinical behavior based on various clinical studies, which help day surgery managers make clinical decisions, and achieve the management objectives of fine management, quality and safety normalization for day surgery.
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Consultation system is one of the eighteen core systems. Excellent consultation supervision can assist clinical departments to maximize cooperation efficiency. This article, concentrating on timeliness, built an individual-group-organization model based on the organizational behavior theory and actual conditions, and took management actions from three aspects, including changing personal behavior attitude, adjusting organizational performance plan and establishing task-based groups. Timeliness data in October and November 2018 were selected retrospectively one month before and one month after the new actions. The timely rate of consultation increased from 76.69% to 82.62% with a significant difference(P=0.000 2).
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Objective To explore the clinical feasibility of ambulatory surgery for inguinal hernia in 70 years of age or older patients.Methods The retrospective cohort study was adopted.The clinical data of 675 patients undergoing ambulatory surgery for inguinal hernia and 464 patients (age ≥ 70 years) undergoing inpatient surgery for inguinal hernia who were admitted to the West China Hospital of Sichuan University from January 2015 to May 2016 were collected.Of 675 patients undergoing ambulatory surgery,594 patients with age ＜ 70 years and 81 with age≥70 years were respectively allocated into the under 70 years group and 70 years or older group.Four hundred sixty-four patients undergoing inpatient surgery with age ≥ 70 years were allocated into the inpatient surgery group.Observation indicators included:(1) efficacies of patients undergoing ambulatory surgery:① type of anesthesia,surgical procedures and operation time,② cases with delayed discharge and cases with unplanned readmission,③postoperative complications,including wound infection and dehiscence,edema of scrotum,urinary retention,chronic pain and patch infection.(2) Efficacies of patients with inpatient surgery:①type of anesthesia,surgical procedures and operation time,② postoperative complications,including wound infection and dehiscence,edema of scrotum,urinary retention,chronic pain and patch infection,③ duration of postoperative hospital stay.(3) Follow-up.Patients were regularly followed up using telephone interview at postoperative day 1,2,3,and using outpatient examination and telephone interview at postoperative week 2 and month 3,6,12 up to July 2016.Follow-up included the survival of patients,recurrence of hernia and number of readmission.Measurement data with normal distribution were represented as （x） ± s and comparison between groups was evaluated with the t test.Comparison of count data were analyzed using the chi-square or Fisher exact probability.Results (1) Efficacies of patients undergoing ambulatory surgery:① type of anesthesia,surgical procedures and operation time:patients in the under 70 years group and 70 years or older group underwent tensionfree repair under local anesthesia.The operation time in the under 70 years group and 70 years or older group was respectively (29 ± 11) minutes and (28 ± 10) minutes,with no statistically significant difference between 2 groups (t =0.378,P ＞ 0.05).② The cases with delayed discharge and with unplanned readmission:there were 2 patients with delayed discharge and 1 with unplanned readmission in the under 70 years group and no case in the 70 years older group,with no statistically significant difference between the 2 groups (x2=0.601,0.137,P ＞ 0.05).③ The postoperative complications:wound infection and dehiscence,edema of scrotum,urinary retention and chronic pain were detected in 4,2,1,3 patients in the under 70 years group and 1,0,0,1 patients in the70 years or older group,respectively,showing no statistically significant difference between the 2 groups (P ＞ 0.05).No patch infection occurred.(2) Efficacies of patients undergoing inpatient surgery:① type of anesthesia,surgical procedures and operation time:patients in the inpatient surgery group underwent tension-free repair under local anesthesia and operation time was (29 ± 10) minutes.There was no statistically significant difference in operation time between the inpatient surgery group and 70 years or older group (t =0.806,P ＞ 0.05).② The wound infection and dehiscence,edema of scrotum,urinary retention and chronic pain in the inpatient surgery group were respectively detected in 3,1,1,2 patients,showing no statistically significant difference between the inpatient surgery group and 70 years or older group (P ＞ 0.05).No patch infection occurred.③ Duration of postoperative hospital stay was less than 1 day in 439 patients and more than 1 day in 25 patients in the inpatient surgery group,respectively.(3) Follow-up:625 of 675 patients undergoing ambulatory surgery were followed up for a median time of 9 months (range,2-18 months).One patient in the under 70 years group was complicated with recurrence of hernia and then was cured by reoperation.There was no recurrence of hernia in the 70 years or older group.Of 464 patients in the inpatient surgery group,432 were followed up for a median time of 9 months (range,2-18 months),and 1 patient with recurrence of hernia was cured by reoperation.Conclusion Ambulatory surgery for inguinal hernia is feasible in 70 years or older patients.
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Objective To explore the clinical efficacies of ambulatory surgery for inguinal hernia.Methods The clinical data of 1 892 patients with inguinal hernia who underwent ambulatory surgery at the West China Hospital of Sichuan University from November 2009 to June 2015 were retrospectively analyzed.Preoperative examinations including blood routine test, blood bio-chemistry checking, blood electrolytes, coagulation convention, pre-transfusion test, blood type, chest X-ray, electrocardiogram were applied to patients.Operation time was rescheduled after abnormal indexes were corrected for elective surgery.Preventive use of antibiotics was not needed.Preperitoneal space tension-free repair or Bassini method was adopted after local infiltration anesthesia.Anesthesia method, operation method, patching material, operation time, number of patients transferred to inpatient department and reasons and treatment expense were recorded.Ambulatory surgery center did satisfaction survey on patients at the discharge.Patients were followed up at postoperative month 1, 3, 6, 12 regularly by the doctor responsible for the surgery till July 2015, including occurrence of complications and chronic pain, recurred hernia, number of readmission and reasons.Measurement data with normal distribution were presented as x ± s.Results Among 1 892 patients, 1 889 patients underwent operation under local anesthesia and 3 patients were transferred to general anesthesia.There were 1 874 patients undergoing tension-free repair including 1 592 using the material of ultrapro hernia system (UHS) , 264 of ultrapro plug (UPP), 8 of prolene hernia system (PHS), 6 of Gore hernia patch, 4 of 3-dimensional plug (3DP), and 18 patients underwent Bassini without preoperative death.The operation time of 1 892 patients was (28 ± 12) minutes.Three patients were transferred to inpatient department for postoperative cut incision pain, ecchymoma, abdominal distention after satiation and discharged from hospital after treatment.Among 26 patients with complications after discharge, 12 had superficial incision infection and recovered after dressing change without removal of patches, 5 had edema in scrotum and inguinal region, 3 had ecchymoma, 2 had nausea and vomiting, 2 had urinary retention, 2 had disruption of wound, and they all recovered smoothly after symptomatic treatment.Treatment expense of the 1 892 patients was (6 956 ± 249) yuan per hermia.Satisfaction rate of patients was 99.049％ (1 874/1 892) when discharged.The follow-up rate was 86.152％ (1 630/1 892).The follow-up time was 1-67 months with a median time of 35 months.During the follow-up, 4 patients had chronic pain and recovered after analgesia and physiotherapy, 3 patients had recurrence of inguinal hernia including 1 case of recurrent hernia and 2 cases of huge hernia.Conclusion Ambulatory surgery for inguinal hernia is safe and effective, with the advantages of few complications, high satisfactory rate and low hospital expenses.