The Value Of Enhanced Recovery After Surgery In ERCP For Elderly Patients With Choledocholithiasis

Background: There are many surgical methods for the treatment of common bile duct stones,Retrograde Cholangipancreatography(ERCP)is the most used type of surgery because of its advantages of less trauma,less complications,and faster recovery.It reduces the risk of surgery and can achieve the same therapeutic effect as surgery,It is becoming the best surgical treatment for most patients with common bile duct stones.The elderly people(age?65 years old)are high-risk with bile duct stones,Because of its age-related physiological and pathological factors,the incidence of perioperative complications of ERCP were increased,of which the incidence of intraoperative hypoxemia is the most common,which can cause myocardial ischemia and hypoxia,and increase the incidence of intraoperative cardiopulmonary complications in elderly patients,In addition,long preoperative fasting and prolonged postoperative feeding time can increase patients' sense of thirst and hunger,thus reducing the perioperative comfort degree.Enhanced Recovery After Surgery(ERAS)has been shown to reduce the incidence of perioperative complications,increase comfort,have shorten hospital stays,and reduce hospitalization costs.It has been widely used in a variety of surgical procedures,including preoperative counseling and health education,Psychological intervention,optimization of preoperative nutrition,shortening of fasting and banned drinking time,intraoperative warmth and early recovery of diet after surgery.However,the application of EARS in ERCP has rarely been reported in our country and abroad,and its safety and effectiveness are still unclear.Objective: This study aimed to analyze the ERAS in elderly patients who underwent ERCP in the ERCP Training Center of the First Hospital of Lanzhou University through a prospective randomized controlled trial,Whether perioperative implementation of ERAS measures can reduce perioperative complications,promote postoperative recovery and increase perioperative comfortable.To evaluate the safety and effectiveness of ERAS in elderly patients with choledocholithiasis whounderwent ERCP lithotomy.Methods: 80 cases elderly patients(age?65 years old,according to the World Health Organization(WHO))who underwent ERCP in the ERCP Training Center,general surgery department,first hospital of Lanzhou University since January 2018 to November 2018.they were randomly divided into the ERAS group(n=39 cases)and the control group(n=41 cases)using a computer-generated random number table.ERAS group implement ERAS measures,while the control group adopted traditional measures during the perioperative period.Comparison of changes in perioperative vital signs between the two groups:including respiratory,heart rate,blood pressure,and oxygen saturation;Intraoperative complications: hypoxemia,tachycardia,bradycardia,elevated blood pressure,lower blood pressure;Postoperative functional recovery: first exhaust time,first defecation time,first time to get out of bed,first time to eat;Perioperative comfort: the sleep time,Visual analogue scale(VAS),Degree of thirst and fatigue;Anxiety score;Serum amylase,Urine amylase and grading of 6hours after operation;Perioperative blood glucose changes;C-Reactive Protein 24 hours after operation;Postoperative complications: postoperative pancreatitis,nausea,vomiting,abdominal pain;hospitalization time,hospitalization cost.Data analysis was performed using SPSS 22.0 statistical software.Results: The effect of ERAS measures on perioperative vital signs: There were significant differences in oxygen saturation between the two groups at different time,and in interaction between groups and time(P<0.001);here were significant differences of perioperative heart rate between at the different time and groups and in interaction between groups and time(P<0.001),However,there was no significant difference between the groups comparision;Respiratory frequency were significant differences between groups and at different time comparision(P<0.05),there no significant differences in the interaction between groups and time;There were significant differences in systolic blood pressure at different time and in interaction between groups and time(P<0.05),there was no significant difference between the groups comparision.Intraoperative complications: The incidence of hypoxemia in the ERAS group was significantly lower than that in the control group(P=0.001),and the incidence of intraoperative hypertension was also lower than that in the control group,the difference has statistical significance(P=0.049),ther were no differences in tachycardia,bradycardia and lower blood pressure.Influence of postoperative functional recovery time: The ERAS group had significantly shorter time of feeding,defecating and getting out of bed after operation significant differences in tachycardia,bradycardia and lower blood pressure(P>0.05);Influence of postoperative functional recovery time: The ERAS group had significantly shorter time of feeding,defecating and getting out of bed after operation than that the control group,the difference were statistically significant(P<0.001),but there was no significant difference in the first exhaust time;The effect of comfort: The perioperative sleep time of ERAS group was significantly longer than that of control group,and the incidence of different degrees of thirst was also significantly lower than the control group(P<0.001),the incidence of fatigue on the first postoperative day was lower than that of the control group(P=0.011).The effect of anxiety: the perioperative anxiety scores of ERAS group were significantly lower than that of the control group(P<0.01);Influence of postoperative complications: There were no significant differences in the incidence of postoperative abdominal pain,nausea,vomiting and Post-ERCP Pancreatitis between the two groups;There were no statistically significant difference in hematuria amylase concentration between the two groups at 6 h after surgery,nor was there statistically significant difference in hematuria amylase grading;There were no significant difference in hospitalization time and cost between the two groups.Conclusions: Perioperative ERAS in elderly patients with choledocholithiasis did not increased the incidence of postoperative abdominal pain,nausea,vomiting,and postoperative hematuria amylase concentration.ERAS measures can reduced the incidence of hypoxemia and blood pressure in ERCP,make intraoperative oxygen saturation more stable,promote postoperative functional recovery,increase perioperative comfort and palliation anxiety,and reduce post-operative stress response.ERAS measures are safe and effective in elderly patients with common bile ducts who underwent ERCP.