Analysis of influencing factors for prolonged postoperative hospital stay after Da Vinci robot-assisted mediastinal tumor resection with non-endotracheal intubation and the process optimization / 中国胸心血管外科临床杂志

@# Objective     To analyze the risk factors for postoperative length of stay (PLOS) after mediastinal tumor resection by robot-assisted non-endotracheal intubation and to optimize the perioperative process. Methods    The clinical data of patients who underwent Da Vinci robot-assisted mediastinal tumor resection with non-endotracheal intubation at the Department of Thoracic Surgery, General Hospital of Northern Theater Command from 2016 to 2019 were retrospectively analyzed. According to the median PLOS, the patients were divided into two groups. The univariate analysis and multivariate logistic regression were used to analyze risk factors for prolonged PLOS (longer than median PLOS). Results    A total of 190 patients were enrolled, including 92 males and 98 females with a median age of 51.5 (41.0, 59.0) years. The median PLOS of all patients was 3.0 (2.0, 4.0) d. There were 71 patients in the PLOS>3 d group and 119 patients in the PLOS≤3 d group. Multivariate logistic regression showed that indwelled thoracic catheter [OR=11.852, 95%CI (2.384, 58.912), P=0.003], preoperative symptoms of muscle weakness [OR=4.814, 95%CI (1.337, 17.337), P=0.016] and postoperative visual analogue scale>5 points [OR=6.696, 95%CI (3.033, 14.783), P<0.001] were independent factors for prolonged PLOS. Totally no tube (TNT) allowed patients to be discharged on the first day after surgery. Conclusion    Robot-assisted mediastinal tumor resection with non-endotracheal intubation can promote rapid recovery. The methods of optimizing perioperative process are TNT, controlling muscle weakness symptoms and postoperative pain relief.

Analysis of the effects of different nutritional support methods on postoperative recovery in patients with gastric cancer / 中华肿瘤杂志

Objective@#To assess the effects of different nutritional support methods on postoperative recovery in patients with gastric cancer.@*Methods@#98 patients who received radical gastrectomy were divided into three groups: parenteral nutrition group (PN group) (n=36), early enteral nutrition group (EEN group) (n=33) and early oral feeding group (EON group) (n=29). Tolerance of enteral nutrition, postoperative recovery and economic indicators were compared.@*Results@#The number of laparoscopic-assisted surgeries was 18, 17 and 25 in PN group, EEN group and EON group, respectively. There was no significant difference in sex, age and body mass index(BMI) among the three groups. Gastrointestinal function recovered slowly in 3 cases, including 2 cases in EEN group and 1 case in EON group. 1 case in EON group had abdominal hemorrhage. Median postoperative hospital stay in PN, EEN and EON group was 11.0, 11.0 and 8.0 days respectively, and significant reduction can be found in EON group(P<0.001). The complication rates were 30.5% (11 cases), 12.1% (4 cases), and 13.8% (4 cases), respectively, with no statistically significant difference(P=0.102). The median nutritional support costs for PN group, EEN group, and EON group were 4 543.3, 974.2, and 265.0 yuan, respectively. The median albumin consumption was 90.0, 40.0, and 0 g, respectively. The EON groups were significantly lower (P<0.001). The results of the laparoscopic assisted subgroup and the ones of whole group were consistent.@*Conclusion@#Compared with parenteral nutrition and early enteral nutrition, early oral feeding can reduce the amount of albumin consumption, decrease the cost of nutrition support and shorten the average hospital stay after surgey without increasing the incidence of complications.

Application value of enhanced recovery after surgery in minimally invasive radical resection of esophageal cancer / 中华消化外科杂志

Objective To investigate the application value of enhanced recovery after surgery with no gastrointestinal decompression tube and with early postoperative oral feeding in minimally invasive radical resectionof esophageal cancer.Methods The retrospective cohort study was conducted.The clinicopathological data of 126 patients who underwent minimally invasive McKeown surgery in the General Hospital of Southern Theatre Command of PLA between March 2016 and October 2017 were collected.There were 80 males and 46 females,aged from 52 to 82 years,with an average age of 64 years.Of 126 patients,82 undergoing "li's anastomosis" with no gastrointestinal decompression tube and receiving early postoperative oral feeding were allocated into non-tube no fasting group,and 44 undergoing end-to-side gastroesophageal anastomosis with tubular stapler,conventionally indwelling gastrointestinal decompression tube,and beginning oral feeding at 1 week after surgery were allocated into traditional treatment group.Observation indicators:(1) surgical and postoperative recovery situations;(2) results of pathological examination;(3) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect the postoperative tumor recurrence and metastasis up to October 2018.Measurement data with normal distribution were represented as Mean ± SD,and comparison between groups was analyzed using independent sample t test.Measurement data with skewed distribution were expressed as M (range),and comparison between groups was analyzed by rank sum test.Count data were described as absolute number or percentage,and comparison between groups was analyzed using chi-square test.Ordinal data were analyzed by rank sum test.Results (1) Surgical and postoperative recovery situations:patients in the two groups underwent minimally invasive McKeown surgery successfully.Operation time,volume of intraoperative blood loss,incidence of anastomotic fistula,incidence of pulmonary complications,and duration of postoperative hospital stay were respectively (326±41) minutes,(225±96) ml,7.3 ％ (6/82),24.4％ (20/82),and 10 days (range,6-90 days) in the non-tube no fasting group and (317± 37) minutes,(214 ± 66) mL,9.1％ (4/44),20.5％ (9/44),and 14 days (range,10-42 days) in the traditional treatment group;there was a statistically significant difference in duration of postoperative hospital stay between the two groups (Z =-7.129,P ＜ 0.05) and no statistically significant difference in operation time,volume of intraoperative blood loss,incidence of anastomotic fistula,and incidence of pulmonary complications between the two groups (t =1.311,0.703,x2 =0.000,0.077,P＞0.05).(2) Results of pathological examination:the number of lymph node dissected,cases in postoperative TNM stage Ⅰ,Ⅱ and Ⅲ were respectively 27±5,12,55,15 in the non-tube no fasting group and 26±5,9,28,7 in the traditional treatment group,with no statistically significant difference between the two groups (t =0.549,Z =-0.747,P＞0.05).(3) Follow-up:of 126 patients,116 were followed up for 12-31 months,with a median time of 20 months,including 76 in the non-tube no fasting group and 40 in the traditional treatment group.During the follow-up,no tumor recurrence or metastasis was found in the 116 patients.Conclusion The enhanced recovery after surgery with no gastrointestinal decompression tube and with early postoperative oral feeding is safe and feasible in the McKeown surgery,which can significantly shorten the postoperative hospitalization time compared with the traditional treatment.

Efficacy analysis of bloodless surgery in patients with congenital heart disease / 中国输血杂志

Objective To improve the clinical blood level Through explore the feasibility of blood free surgery for congenital heart disease.Methods Collected 160 patients with congenital heart disease during January 2014 to December 2016 in our hospital,patients were divided into bloodless surgery experimental group (n =69) and blood transfusion treatment group (n=91) according to perioperative blood use.The basic data which including age,weight and GCS score,preoperative and postoperative hemoglobin(Hb),operation and postoperative pleural effusion drainage,intraoperative extracorporeal circulation time,mechanical ventilation time and blocking time,ICU stay,postoperative hospital stay,total hospital stay,reintubation and re-surgery of the two groups were compared.To investigate the effect of the implementation of bloodless surgical strategy for patients with congenital heart disease.Results 1) The difference between the two groups in age,body weight and GCS was not statistically significant (P＞0.05);2) The differences of Hb and intraoperative and postoperative pleural effusion drainage between two groups were not statistically significant (P＞0.05);3) The differences with cardiopulmonary bypass time,mechanical ventilation time,blocking time,re-intubation,re-surgery and ICU days of two groups were also not statistically significant (P ＞ 0.05);but bloodless surgery patients' postoperative hospitalization days and total hospitalization time was significantly lower than the control group (P＜0.05).Conclusion The implementation of bloodless surgery in congenital heart disease is safe and feasible.It can shorten the patient's hospitalization time.It is worth popularizing in clinical surgical treatment.

Effect of Hyperglycemia on the Length of Postoperative Hospital Stay / 대한마취과학회지

BACKGROUND: Diabetes mellitus is the most common endocrinopathy encountered in the perioperative period and has long been assumed to increase perioperative risk. However, when diabetes mellitus was segregated from old age and the complications of it, it was questioned that diabetes mellitus itself increased perioperative risk. In this study, we investigated the influence of hyperglycemia on the length of postoperative hospital stay. METHODS: We studied 100 patients undergone intra-abdominal operations with general anesthesia. These patients were divided into the hyperglycemic group (n = 20) with postoperative blood glucose level higher than 10 mM and the non-hyperglycemic group (n = 80) with glucose level lower than 10 mM and we investigated the length of postoperative hospital stay, serum electrolyte, serum chemistry, arterial blood gas values, and base excess by unmeasured anions. We also divided these patients into the diabetic patients group (n = 15) and the non-diabetic patients group (n = 85) and compared the same variables. RESULTS: The length of postoperative hospital stay was significantly prolonged in the hyperglycemic group (20.9 +/- 9.0 days) compared with the non-hyperglycemic group (16.2 +/-8.5 days), and the cumulative postoperative hospital stay curves based on Kaplan-Meier method also showed significant difference between the two groups. When we compared the length of postoperative hospital stay between the diabetic and the non-diabetic patients, there was no significant difference. CONCLUSIONS: This study demonstrated that hyperglycemia prolonged the length of postoperative hospital stay. This finding suggests that the patient's glucose level should be monitored and controlled within an adequate range perioperatively.

Influence of Unmeasured Anions Identified by Stewart Principle on the Length of Postoperative Hospital Stay / 대한구급학회지

BACKGROUND: Calculation of the base excess (BE) and the anion gap (AG) is commonly used to identify the presence and to analyze the cause of metabolic acidosis in critically ill patients. However, the calculation of BE assumes normal water content, electrolytes, and albumin, changes in these values will change the calculated BE. Calculation of the AG does not control for changes in albumin and cannot distinguish plasma concentration changes of negatively charged protein (albumin) from that of other anions. Based on Stewart's physicochemical principles, Gilfix et al developed equations to calculate the BE caused by unmeasured anions (BEua) taking into account changes in free water, chloride, albumin, and PCO2 that theoretically should reflect metabolic changes better than the less complete biochemical measurements. This study was designed to evaluate the influence of BEua and other variables on the length of postoperative hospital stay. METHODS: The data from 100 consecutive patients were collected prospectively in patients who underwent intra-abdominal operations under general anesthesia and admitted to the adult intensive care unit. All samples were routine samples taken from arterial lines postoperatively and analyzed for arterial blood gas, plasma electrolytes, inorganic phosphates and albumin concentrations. BEua was calculated from the equations developed by Gilfix et al. We also calculated AGNa, K (Na++K+-Cl--HCO3-) and AGNa (Na+-Cl--HCO3-). Correlations between the length of postoperative hospital stay and these variables were studied using linear regression analysis. RESULTS: BEua and BE were significantly correlated with the length of ICU stay (r=0.295, p<0.01 and r=0.249, p<0.05). Neither AGNa, K nor AGNa was correlated with the length of ICU stay. Significant correlation was observed between the length of postoperative hospital stay and BEua (r=0.316, p<0.01), BE (r=0.288, p<0.01), AGNa, K (r=0.284, p<0.01), and AGNa (r=0.263, p<0.05). CONCLUSIONS: In this study BEua was significantly correlated with the length of ICU stay and postoperative hospital stay compared with other variables. This finding suggests that BEua may be used as a more reliable predictor of outcome in ICU patients.