The Application Of Fast Track Surgery In Elderly Patients With Laparoscopic Gallbladder Surgery

Objectives The effects of fast track surgery in elderly patients with laparoscopicgallbladder surgery were explored.Methods1According to the inclusion and exclusion criteria,326elderly gallstonepatients (≥60years old), hospitalized from2011.01to2012.06for selective LC inKailuan General Hospital of Hepatobiliary Surgery were selected as the observed crew.Based on their arrival date, they are randomly divided into FTS group and control group(163members for each), the former of which accepts FTS caring program and latteraccepts traditional nursing program.2Patients of both groups were tested the Self-RatingAnxiety Scale (SAS) questionnaire respectively on their hospital day, the day beforesurgery and two days after the surgery. We assessed anxiety degree of two groups bycomparing their SAS average score and anxiety incidence rate at different hospitalizingperiods.3We assessed health-related status and compared their respective healthrecovery of two groups by issuing the Short Form36Health Survey Questionnaire (SF-36) on the hospital day and1week after their hospital day.4Patients of two groups wereassessed in terms of their pain rate on their arrival day and2hours after they were fullyawake from anesthesia. Then we compared two groups’ pain and pain control situation byFace Pain Scale-Revised (FPS).5We compared two groups’ hospital stay length,postoperative rehydration time, first exhaust time, hospital costs and postoperativecomplication rates.6We used Excel to establish the database for all the data. SPSS13.0statistical software to process the date and t-test to make comparison of two groups’average. Count data was expressed by n (%) and χ2test was for rates comparison. AndP<0.05(two-tailed) was considered statistically significant.Results1This study selects326cases of gallstone elderly patients for selective LC as theobserved crew,156of which are male and170are female, aging an average68.62±6.84years old. FTS group includes163cases with an average68.25±6.89years old,76ofwhich are male and87female.8(4.9%) of preoperative cases have diabetes,9(5.5%)have hypertension grade three,7(4.3%) chronic bronchitis or lung emphysema,8(4.9%)abnormal electrocardiogram and4(2.5%) benign prostatic hyperplasia. The control groupincludes163cases with an average69.10±6.79years old,80of which are male and83female.3of preoperative cases (1.8%) have diabetes,9(5.5%) have hypertension gradethree,10(6.1%) chronic bronchitis or lung emphysema,5(3.1%) abnormalelectrocardiogram and7(4.3%) benign prostatic hyperplasia. Two groups’ basicinformation such as age, gender, co-existed underlying diseases is of no statisticalsignificance (P>0.05), so it’s worth of comparison.2Compared with the control group,FTS group enjoys an early postoperative exhaust, a shorter postoperative rehydration andhospitalized time, lower hospitalization expenses and lower incidence rate of postoperative pulmonary complications. Group differences have statistical significance(P<0.05), while group differences of postoperative nausea and vomit as well as deep veinthrombosis incidence are of no statistical significance (P>0.05).3Comparison of painscores that before preoperative between the two groups shows no significant difference(P>0.05). Cases in FTS group with postoperative painlessness and mild pain outnumberthose of the control group while FTS cases with moderate and severe pain are less thanthose of the control group. Differences have statistical significance (P<0.05).4Comparison of the incidence of anxiety and SAS score of the hospital date between FTSgroup and control group have no difference statistically significant (P>0.05). SAS scoresin patients of two groups at the points: the arrival day, the day before surgery and twodays after the surgery are higher than the Chinese norm mean. The difference wasstatistically significant (P<0.05). FTS group’s data on the day before surgery and twodays after surgery are significantly lower than that of control group. Group differenceshave statistical significance (P<0.05).5Two groups’ SF-36score in8dimensions whichis assessed on their hospital day is of no statistical significance (P>0.05). Two groups ofpatients’ preoperative healthy living status is of no difference. Thus they are comparable.In the eight dimensions of SF-36questionnaire submitted a week after the operation, fiveof them score higher in FTS group, namely physiological function, body pain, generalhealth, vigor and mental health. Statistical significance exists (P<0.05), while nostatistical significance exists in dimensions of physical role, social function andemotional role (P>0.05).Conclusions1Gallstones can make anxiety in elderly patients. FTS mental nursing canalleviate such anxiety during the perioperative period of a LC.2The methods of Fast-track surgery: such as preoperative shortening fasting, shortening drinking time,indwelling drainage tube unusually, early postoperative feeding, early postoperativeactivity etc. can reduce postoperative complications: pulmonary in elderly patients.Meanwhile, these methods can shorter hospital stays, reduce hospital costs, speed up therehabilitation of elderly patients, which is safe and effective.3Incorporating fast-tracksurgery with LC in cholecystectomies for aged patients can promote their life quality andrehabilitation.