Effect of Enhanced Recovery After Surgery on Postoperative Recovery and Quality of Life in Patients Undergoing Laparoscopic Partial Nephrectomy

Abstract

Patients who underwent laparoscopic partial nephrectomy from the First Affiliated Hospital of Nanjing Medical University from May 2016 to May 2019 were randomly divided into enhanced recovery after surgery (ERAS) and control groups. The clinical indicators, preoperative and postoperative anxiety, depression, and postoperative quality of life were compared between the two groups. The recovery time, hospitalization cost, incidence of complications, and postoperative anxiety of patients in the ERAS group were lower than those of the control group. The satisfaction during hospitalization, scores of physical function, role function, emotional function, and general health status of the ERAS group were also significantly increased. Applying the ERAS to patients undergoing laparoscopic partial nephrectomy can improve their prognosis, experience of medical treatment, and life quality after surgery as well as have certain economic advantages.

Enhanced recovery after surgery in patients undergoing laparoscopic partial nephrectomy. Results from a real-world randomized controlled trial.

“…In this study, prophylactic anti-nausea drugs were provided to patients on a routine basis rather than the traditional demanding-prescription mode. The results indicated that the early incidence (postoperative 0-6 h) of nausea in the ERAS group was significantly lower, while the late incidence of PONV in the two groups showed no significant difference, which was consistent with previous studies [10]. We considered that these different results were partly because of the nature of retroperitoneal surgery; namely, the vasovagal reflex might be calmed in the first 6 h after surgery by anti-nausea drugs, while later with the return of patients' water intake and upcoming PONV pathophysiological climax (24 h postoperatively), cases of PONV occurred more often and intensively [19,20].…”

“…We were initially surprised because the ERAS group should theoretically recover better and faster than the traditional group and therefore should have shorter postoperative LOS and lower hospital costs [4,7]. Through an in-depth literature study, we found that the medical expenses in our medical center were much lower than those extracted from other studies in the same country, either in the traditional group or the ERAS group [10,11]. Moreover, the LOS of both groups in our medical center was similar to that in the reported ERAS cohorts.…”

“…Reasons for these situations might be that the control group in most ERAS studies was "idealized and traditionalized". For example, in some study designs [10,11], patients with LPN in the control group were required to stay in bed for 1-2 weeks before they could walk for the first time, while in real-world circumstances this is less likely to happen. For those patients, their hospitalization days and expenses would inevitably be different.…”

“…Note that the routine protocol in the control group varied considerably from hospital to hospital; for instance, postoperative patients were strictly confined to bed for 1-2 weeks after surgery in some other studies [10,11], while they were routinely required to start ambulation on postoperative day (POD) 2 in our hospital since years ago, to say nothing of the removal of the ureter catheter or drainage tube. This…”

Effectiveness of the Tailored, Early Comprehensive Rehabilitation Program (t-ECRP) based on ERAS in improving the physical function recovery for patients following minimally invasive esophagectomy: a prospective randomized controlled trial

“…ERAS can effectively shorten the lengths of time to first postoperative flatus and bowel movement, and improve the physical functions of patients [18,19]. However, ERAS combines a series of evidence-based perioperative optimization measures, including preoperative prehabilitation, early ambulation, early eating, and pain control.…”