The Affection Of Functional Rehabilitation For Patients Undergiong Radical Operation With Enhanced Recovery After Surgery Pathway

PART 1 FEASIBILITY AND SAFETY OF ERAS PATHWAY USING IN CLINIC FOR GASTRIC CANCER1.Objective To evaluate the feasibility and safety of ERAS pathway using for patients undergoing gastric cancer.2.Methods Collect the data of patients undergoing limited radical gastrectomy for cancer in our department from January 2016 to November 2016 were collected.All the patients were divided into standard care(SC)and Enhanced Recovery After Surgery(ERAS)groups to be layering researched.There are four groups: open gastrectomy(OG)with SC(OG + SC group,n=44);open gastrectomy(OG)with ERAS(OG + ERAS group,n =57);laparoscopic gastrectomy(LG)with ERAS group(LG +ERAS group,n=50);robot-assisted gastrectomy(RG)with ERAS(RG+ERAS group,n=21).we observe the length of hospital stay after operation、first venting/defecation time、first mobilization time、hospitalization cost、level of prealbumin and complication rate.3.Results Compared with OG+SC group,OG+ERAS group、LG+ERAS group、RG+ERAS group has a shorter time of first venting(84.09±24.73 h in OG+SC group and 44.93±13.02 h in OG +ERAS group and 44.68±15.33 h in LG+ERAS group and 43.52±13.64 h in RG +ERAS group)、oral intake(116.91±31.22 h in OG+SC group and 39.63±13.92 h in OG +ERAS group and 41.12±14.16 h in LG+ERAS group and 37.19±11.79 h in RG +ERAS group)、mobilization time(78.73±27.70 h in OG+SC group and 28.07±10.61 h h in OG +ERAS group and 28.28±13.56 h in LG+ERAS group and 26.81±11.35 h in RG +ERAS group),respectively all P<0.001.For hospitalization cost,RG+ERAS showed the highest cost(74269.86±9165.08Yuan),while the cost of OG+SC group 、OG+ERAS group 、 LG+ERAS group are 71011.82±13505.14 Yuan 、61276.32±6814.46 Yuan、61252.36±6444.84 Yuan,respectively all P<0.001.OG+SC group showed the longest postoperative hospital stay(11.05±4.02d),while OG+ERAS group、LG+ERAS group、RG+ERAS group has a shorter length of hospital stay(7.88±1.88 d and 7.64±2.30 d and 7.67±4.49 d,respectively all P<0.001).And there is no significant difference between OG+SC group,OG+ERAS group、LG+ERAS group、RG+ERAS group of incidence rate of complication(P>0.05),the rate of OG+SC group,OG+ERAS group and LG+ERAS group、RG+ERAS group was 6.8%、5.3% 、6.8%、4.8%.Compare to OG+SC group,there is a significant reduce of the score of postoperative pain in OG+ERAS group、LG+ERAS group and RG+ERAS group.The VAS score of OG+SC group、OG+ERAS group、LG+ERAS group、RG+ERAS group at postoperation day 1:2.32±0.82、1.07±1.01、1.28±1.00、1.29±1.12;day 2:1.95±0.42、0.51±0.73、0.78±0.86、0.86±0.94;day 3:1.70±0.69、0.32±0.65、0.38±0.69、0.24±0.61 and day 4:0.98±0.81、0.05±0.29、0.06±0.31、0±0 all respective P<0.001.4.Conclusion 1.ERAS pathway is feasible and safe for clinical practice using for gastric cancer,it can reduce the length of postoperative hospital stay、enhance the recovery of gastric-intestinal function and reduce the pain of patients at postoperation period.Otherwise it shows no increase of the risk of compliance.PART 2 INITIAL EXPLORE OF EVALUATION SYSTEM OF ERAS PATHWAY FOR GASTRIC CANCER1.Obejetive Evaluate valve patient-reported outcomes system.And compare the affection of recovery of patients undergoing different perioperative period treatment.2.Methods The data of patients undergoing limited radical gastrectomy for cancer in our department from August 2016 to November 2016 were collected.All the patients were divided into OG+SC group(n=21)、OG/LG+ERAS group(n=26)、RG+ERAS group(n=21).The patients assessment in preoperation day 、postoperation week 3 and assessment out of hospital was present at Qo R-40 scale.And the condition of patients after surgery was checked by Qo R-40 scale.The score of scale include comfort(60)、emotions(45)、Physical Independence(25)、Patient Support(35)and pain(35).Different degree corresponding to score 1-5.And the recovery of patients was checked by comparing the level ofQo R-40 scale and the period before sugery.3.Results Compared with OG+SC group,OG/LG+ERAS group、RG+ERAS group has no significant of Qo R-40 score preoperation period(P>0.05),but they have a significant increase of Qo R-40 grade in the postoperation day 3 and post operation week 3(P<0.001).The score of OG+SC group、OG/LG+ERAS group、RG+ERAS group preoperation day are 175.15±2.82、176.19±3.50、175.71±2.46.OG+SC group showed the lowest grade in post operation day 1 and post operation week 3(147.06±4.45,162.62±1.59),while OG/LG+ERAS group、RG+ERAS showed(157.47±2.05,170.21±2.49)and(166.53±0.93,173.33±5.76).4.Conclusion(1)ERAS pathway can improve postoperation quality of life faster.(2)Robot-Assistant operation can significantly increase the post operation quality of life.PART3 DISSCUSSION ABOUT A FEW PROBLEM IN PERIOPERATIVE PERIOD1.Objective To evaluate the affection of ERAS pathway by age and intra-operative fluid intake.2.Methods Collect the date from gastric cancer patients under going limited radical gastrectomy for cancer from January 2016 to December 2016 ingastric-intestinal department.The patients who undergoing ERAS pathway were included.2.1 Divided on the basis of age In order to evaluate the affection of ERAS pathway by age,we divided patients into three groups: the patients who were younger than 40 years old were distribute to “Young Age Group”(YAG),who were older than 60 years old were distribute to “Old Age Group”(OAG),and the patients between 40 and 60 years old were distribute to “Middle Age Group”(MAG).2.2 Divided on the basis of intraoperative fluid intake depend on quartile of volume intake.Less than the 25 th percentile called Low Volume Group(LVG,fluid intake < 8.73ml/h.kg),between the 25 th percentile and the 75 th percentile called Medium Volume Group(LVG,fluid intake 8.73-14.75 ml/h.kg),more than the 75 th percentile called High Volume Group(HVG,fluid intake >14.75 ml/h.kg).3.Results 3.1 Affection of ERAS pathway by different age The first venting time of YAG group、MAG group、OAG group are 45.90±15.42h、44.61±13.97h、43.98±13.53h;the first time to mobilization are 26.65±8.99h、28.73±12.87h、27.33±11.62h;the first time for oral intake are 39.85±10.93h、41.73±13.48h、36.79±14.79h;the length of postoperative hospital stay of OAG group、MAG group、YAG group are 6.60±1.57d、7.85±2.98d、8.14±2.24 d,there is no significant difference between each group(all P>0.05).The rate of OAG group、MAG group、YAG group are 10%、3%、7.1%,The complications showed no signifcant differences between the four groups(all P > 0.05)3.1 Affection of ERAS pathway by different intraoperation fluid intakeThe first venting time of LVG group、MVG group、HVG group are 45.91±14.93h、45.82±12.72h、40.71±15.14h;the first time to mobilization are 30.72±13.56h、27.98±11.27h、25.00±10.94h;the first time for oral intake are 38.59±15.49、40.35±12.94、39.94±13.49h;the length of postoperative hospital stay of OAG group、MAG group、YAG group are 8.03±2.57、7.62±2.93d、7.74±1.88,there is no significant difference between each group(all P>0.05).The rate of OAG group、MAG group、YAG group are 6.3%、4.6%、6.5%,The complications showed no signifcant differences between the four groups(all P > 0.05)4.Conclusion(1)Intraoperation fluid intake doesn’t affect the recovery of digestive tract undergoing ERAS pathway.(2)Age doesn’t affect the recovery of digestive tract undergoing ERAS pathway.