Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Oct 27, 2023; 15(10): 2191-2200
Published online Oct 27, 2023. doi: 10.4240/wjgs.v15.i10.2191
Optimizing surgical outcomes for elderly gallstone patients with a high body mass index using enhanced recovery after surgery protocol
Yue-Xia Gu, Xin-Yu Wang, Yang Chen, Jun-Xiu Shao, Shen-Xian Ni, Xiu-Mei Zhang, Si-Yu Shao, Yu Zhang, Wen-Jing Hu, Ying-Ying Ma, Meng-Yao Liu, Hua Yu
Yue-Xia Gu, Shen-Xian Ni, Xiu-Mei Zhang, Si-Yu Shao, Yu Zhang, Wen-Jing Hu, Department of Nursing, Shanghai Fourth People’s Hospital Affiliated to Tongji University School of Medicine, Shanghai 200434, China
Xin-Yu Wang, Yang Chen, Hua Yu, Department of General Surgery, Shanghai Fourth People’s Hospital School of Medicine Tongji University, Shanghai 200434, China
Jun-Xiu Shao, Ying-Ying Ma, Meng-Yao Liu, Department of Nursing, Shanghai Xuhui Central Hospital, Shanghai 200031, China
Author contributions: Gu YX and Wang XY contributed equally in analysis of the data and writing of the manuscript; Yu H designed the study; Chen Y, Shao JX, Ni SX, Zhang XM, Shao SY, Zhang Y, Hu WJ, Ma YY, and Liu MY collected the data and corrected the paper; all authors have read and approved the final manuscript.
Supported by the Hongkou District Health Committee, No. Hong Wei 2002-08; and Discipline Promotion Program of Shanghai Fourth People's Hospital, No. SY-XKZT-2020-1021.
Institutional review board statement: The study was reviewed and approved by the Shanghai Fourth People’s Hospital Institutional Review Board (Approval No. 2019047).
Informed consent statement: Patients were not required to give informed consent to the study because it is a retrospective study and the data came from electronic medical records in the hospital.
Conflict-of-interest statement: The authors declare no conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hua Yu, MM, Associate Chief Physician, Department of General Surgery, Shanghai Fourth People’s Hospital School of Medicine Tongji University, No. 1279 Sanmen Road, Hongkou District, Shanghai 200434, China. luckyyuhua@163.com
Received: May 27, 2023
Peer-review started: May 27, 2023
First decision: June 14, 2023
Revised: June 23, 2023
Accepted: August 17, 2023
Article in press: August 17, 2023
Published online: October 27, 2023
ARTICLE HIGHLIGHTS
Research background

The rehabilitation of elderly patients with a high body mass index (BMI) after cholecystectomy poses risks and requires effective perioperative management strategies. The enhanced recovery after surgery (ERAS) protocol is a comprehensive treatment approach that promotes early patient recovery and reduces postoperative complications.

Research motivation

The aim of this study was to compare the effectiveness of traditional perioperative management methods with the ERAS protocol in elderly patients with gallbladder stones and a high BMI.

Research objectives

The study aimed to assess and compare the outcomes of elderly patients with a high BMI undergoing cholecystectomy using the ERAS protocol and traditional perioperative care, focusing on various indicators, including fasting time, surgical outcomes, hospital stay, pain scores, satisfaction levels, readmission rates, postoperative symptoms, and functional capacity.

Research methods

A retrospective cohort study design was employed, involving 198 elderly patients with a high BMI who underwent cholecystectomy. The patients were divided into two groups: One managed using traditional perioperative care (non-ERAS protocol) and the other managed using the ERAS protocol. Data on relevant indicators were collected preoperatively, intraoperatively, and postoperatively, and a comparison of surgical outcomes was conducted.

Research results

The comparison results showed no statistically significant differences between the two groups in terms of age, sex, BMI, underlying diseases, surgical type, and preoperative hospital stay. However, the ERAS group had a significantly shorter preoperative fasting time. In terms of postoperative recovery, the ERAS protocol group exhibited significant advantages over the non-ERAS group, including shorter hospital stay, lower postoperative pain scores, hunger scores, and higher satisfaction levels. The readmission rate was also significantly lower in the ERAS protocol group. Furthermore, there were significant differences in postoperative nausea and vomiting (PONV) severity, postoperative abdominal distention at 24 h, and daily life ability scores between the two groups.

Research conclusions

The study findings demonstrate that the ERAS protocol provides significant benefits in postoperative outcomes following cholecystectomy. It reduces readmission rates, improves PONV, alleviates abdominal distension, and enhances patients' functional capacity. Although the ERAS protocol may not show significant improvement in early postoperative symptoms, it exhibits advantages in long-term postoperative symptoms and recovery. Implementing the ERAS protocol in postoperative management is crucial for improving patients' recovery and quality of life while reducing health care resource utilization.

Research perspectives

The results highlight the importance of incorporating the ERAS protocol in the postoperative management of cholecystectomy patients. Further research can explore the long-term effects of the ERAS protocol on patient outcomes and assess its applicability in other surgical procedures or patient populations.