Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2021; 9(33): 10151-10160
Published online Nov 26, 2021. doi: 10.12998/wjcc.v9.i33.10151
Effectiveness of enhanced recovery after surgery in the perioperative management of patients with bone surgery in China
Li-Yan Zhao, Xiong-Tao Liu, Zhi-Li Zhao, Ru Gu, Xiu-Mei Ni, Rui Deng, Xiao-Ying Li, Ming-Ji Gao, Wei-Na Zhu
Li-Yan Zhao, Xiong-Tao Liu, Ru Gu, Xiu-Mei Ni, Rui Deng, Xiao-Ying Li, Ming-Ji Gao, Department of Anesthesiology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi'an 710004, Shaanxi Province, China
Zhi-Li Zhao, Wei-Na Zhu, Department of Anesthesiology, PLA Air Force 986 Hospital, Xi'an 710054, Shaanxi Province, China
Author contributions: Zhao LY and Zhu WN were responsible for conceptualization, data analysis, methodology, and wrote the original draft; Liu XT, Zhao ZL, Gu R and Ni XM were responsible for data collection, visualization and software; Deng R, Li XY and Gao MJ were responsible for validation, reviewing and editing the manuscript; Zhu WN was responsible for supervision; all authors have read and approved the final version.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Second Affiliated Hospital of Xi’an Jiaotong University.
Informed consent statement: Written informed consent was provided for all participants.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei-Na Zhu, BMed, Chief Physician, Department of Anesthesiology, PLA Air Force 986 Hospital, No. 6 Jianshe West Road, Xincheng District, Xi'an 710054, Shaanxi Province, China. 15771762307@163.com
Received: July 27, 2021
Peer-review started: July 27, 2021
First decision: August 19, 2021
Revised: September 7, 2021
Accepted: September 29, 2021
Article in press: September 29, 2021
Published online: November 26, 2021
Abstract
BACKGROUND

Enhanced recovery after surgery (ERAS) was introduced in China in 2007. Over time, the scope of ERAS has expanded from abdominal surgery to orthopedics, urology and other fields. Continuous development and research has contributed to progress of ERAS in China. In 2019, to promote the application of ERAS in bone tumor surgery, we formed the “Consensus of Experts on Perioperative Management of Accelerated Rehabilitation in Major Surgery of Bone Tumors in China”.

AIM

To evaluate the effect of enhanced recovery after bone tumor surgery in perioperative management in China.

METHODS

One hundred and seven patients who underwent bone tumor surgery at the Second Affiliated Hospital of Xi’an Jiaotong University between May 2019 and April 2021 were randomized into a study group (53 cases) and a control group (54 cases). The study group adopted the ERAS protocol and the control group adopted conventional care. Main outcome measures included postoperative length of stay (LOS), postoperative complications, mortality, and 30-d readmission rates. Secondary outcomes included postoperative visual analog scale (VAS) score of pain, number of blood transfusions, drainage volume in 24 h after operation, patient satisfaction 30 d after discharge, VAS score at 30 d after discharge, and daily standing walking time.

RESULTS

There were no significant differences in the baseline data, clinical features and surgical site between the two groups. The LOS in the study group with the ERAS protocol was 7.72 ± 3.34 d compared with 10.28 ± 4.27 d in the control group who followed conventional care. The incidence of postoperative nausea and vomiting (PONV) in the study group was 19% and 37% in the control group. The VAS scores of pain on postoperative day 1 (POD1) and POD3 in the study group were 4.79 ± 2.34 and 2.79 ± 1.53 compared with 5.28 ± 3.27 and 3.98 ± 2.27 in the control group. The drainage volume in 24 h after the operation was 124.36 ± 23.43 mL in the study group and 167.43 ± 30.87 mL in the control group. The number of blood transfusions in the study group was also lower. The patient satisfaction rate was higher in the study group than in the control group.

CONCLUSION

The ERAS protocol in the perioperative period of bone tumor surgery can decrease LOS, PONV, and postoperative pain, blood transfusion and 24-h drainage, improve patient satisfaction and accelerate recovery.

Keywords: Enhanced recovery after surgery, Bone tumor surgery, Perioperative management, Effect evaluation, Clinical application

Core Tip: In 2019, the consensus of Chinese experts was proposed for perioperative management of accelerated rehabilitation in major surgery of bone tumors. In order to form a realistic, feasible enhanced recovery after surgery (ERAS) concept, the clinical effect of the ERAS protocol was evaluated retrospectively. The ERAS protocol can shorten hospital stay, reduce the incidence of postoperative nausea and vomiting, reduce postoperative pain, postoperative blood transfusion and postoperative 24-h drainage, and improve patient satisfaction and accelerate recovery. It is worth continuing to improve and popularize ERAS in China.