Effect of clinical cluster management during perioperative period on esophageal cancer in elderly patients aged 75 years and over / 中华老年医学杂志

ABSTRACT

Objective To explore the applicative effect of the clinical cluster management during perioperative period on esophageal cancer in elderly patients aged 75 years and over.Methods A total of 36 cases with esophageal cancer aged 75 years and over admitted into Thoracic Surgery Department in our hospital from January 2010 to February 2015 were divided into experimental and control group.Patients in experimental group received clinical cluster management including preoperative therapy for improvement of heart and lung function, selective protection during operation, strengthening support after operation and early nasal tube nutrition.Patients in control group received routine treatment for esophageal carcinoma during perioperative period.The postoperative complications, intensive care unit (ICU) stay, the incidence of anastomotic leakage,postoperative feeding time, postoperative hospitalization time and other indicators were observed.Results Among 20 patients in the experimental group, postoperative cardiopulmonary complications were found in 6 cases, postoperative cardiovascular complications in 3 cases and anastomotic leakage in 2 cases.Among 16 patients in the control group, postoperative cardiopulmonary complications were found in 12 cases, postoperative cardiovascular complications in 10 cases and anastomotic leakage in 5 cases.The incidences of postoperative cardiopulmonary and cardiovascular complications were lower in experimental group than in control group (x2 =7.200 and 8.693, P =0.007 and 0.003).The incidence of anastomotic leakage showed no significant difference between the two groups (x2 =2.562,P=0.109).The mean duration of ICU stay and postoperative hospitalization time were shorter in experimental group than in control group[(5.6±2.7) d vs.(9.8±4.9) d, (15.4±4.5) d vs.(20.6±5.5) d, t=3.208 and 3.125, P=0.003 and 0.004].There was no significant difference in postoperative feeding time between the two groups [(8.4±1.5)d vs.(9.1±1.1)d, t=1.569, P=0.126].Conclusions A tightly clustered clinical managements during perioperative period can minimize the incidences of postoperative complications and mortality rate in elderly patients with esophageal carcinoma.