Implementation of enhanced recovery after surgery in patients undergoing radical cystectomy: A retrospective cohort study

Zhang, Hao; Zhu, Minmin; Xu, Zheng; Shen, Yijun; Zhu, Yiping; Xu, Yajun; Chen, Wankun; Chen, Miao

doi:10.1016/j.ejso.2019.07.021

Cited by 24 publications

(16 citation statements)

References 40 publications

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“…Instead, choosing the short procedure in daycare setting might be a more relevant options rather than simply omitting GA. One feasible measure of shortening the procedure is integrating daycare surgery with the ERAS model. ERAS model is the integration of perioperative concepts using a series of tools proven effective by evidence-based medicine to intervene in perioperative patients to reduce surgical stress and complications, shorten hospital stays, reduce financial costs, and accelerate postoperative recovery [ 43 – 45 ]. It makes it possible to have breast cancer surgery in daycare setting, especially with technique of minimally invasive surgery.…”

Section: Discussionmentioning

confidence: 99%

Prediction of total hospital expenses of patients undergoing breast cancer surgery in Shanghai, China by comparing three models

Chen

Zhang

et al. 2021

BMC Health Serv Res

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Background Breast cancer imposes a considerable burden on both the health care system and society, and becomes increasingly severe among women in China. To reduce the economic burden of this disease is crucial for patients undergoing the breast cancer surgery, hospital managers, and medical insurance providers. However, few studies have evidenced the prediction of the total hospital expenses (THE) for breast cancer surgery. The aim of the study is to predict THE for breast cancer surgery and identify the main influencing factors. Methods Data were retrieved from the first page of medical records of 3699 patients undergoing breast cancer surgery in one tertiary hospital from 2017 to 2018. Multiple liner regression (MLR), artificial neural networks (ANNs), and classification and regression tree (CART) were constructed and compared. Results The dataset from 3699 patients were randomly divided into training and test sets at a 70:30 ratio (2599 and 1100 records, respectively). The average total hospital expenses were 12520.54 ± 7844.88 ¥ (US$ 1929.20 ± 1208.11). MLR results revealed six factors to be significantly associated with THE: age, LOS, type of disease, having medical insurance, minimally invasive surgery, and receiving general anesthesia. After comparing three models, ANNs was the best model to predict THEs in patients undergoing breast cancer surgery, and its strong predictive performance was also validated. Conclusions To reduce the THEs, more attention should be paid to related factors of LOS, major and minimally invasive surgeries, and general anesthesia for these patient groups undergoing breast cancer surgery. This may reduce the information asymmetry between doctors and patients and provide more reliable cost, practical inpatient medical consumption standards and reimbursement standards reference for patients, hospital managers, and medical insurance providers ,respectively.

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Section: Discussionmentioning

confidence: 99%

Prediction of total hospital expenses of patients undergoing breast cancer surgery in Shanghai, China by comparing three models

Chen

Zhang

et al. 2021

BMC Health Serv Res

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“…First, our institution implements a robust perioperative pain management program that incorporates an ERAS protocol, which emphasizes multimodal analgesia. This protocol effectively controls pain and promotes early recovery in many surgical patients, including those undergoing urologic procedures 9,16,17 . Our institution's ERAS protocol includes encouraging regular activity and good nutrition preoperatively, clear liquids up to 3 hours before surgery, and gabapentin and acetaminophen in the preoperative holding area.…”

Section: Discussionmentioning

confidence: 99%

Large reduction in opioid prescribing by a multipronged behavioral intervention after major urologic surgery

Jacobs

Rogers

Yabes

et al. 2020

Cancer

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BackgroundSurgeons play a pivotal role in combating the opioid crisis that currently grips the United States. Changing surgeon behavior is difficult, and the degree to which behavioral science can steer surgeons toward decreased opioid prescribing is unclear.MethodsThis was a single‐institution, single‐arm, pre‐ and postintervention study examining the prescribing of opioids by urologists for adult patients undergoing prostatectomy or nephrectomy. The primary outcome was the quantity of opioids prescribed in oral morphine equivalents (OMEs) after hospital discharge. The primary exposure was a multipronged behavioral intervention designed to decrease opioid prescribing. The intervention had 3 components: 1) formal education, 2) individual audit feedback, and 3) peer comparison performance feedback. There were 3 phases to the study: a pre‐intervention phase, an intervention phase, and a washout phase.ResultsThree hundred eighty‐two patients underwent prostatectomy, and 306 patients underwent nephrectomy. The median OMEs decreased from 195 to 19 in the prostatectomy patients and from 200 to 0 in the nephrectomy patients (P < .05 for both). The median OMEs prescribed did not increase during the washout phase. Prostatectomy patients discharged with opioids had higher levels of anxiety than patients discharged without opioids (P < .05). Otherwise, prostatectomy and nephrectomy patients discharged with and without opioids did not differ in their perception of postoperative pain management, activity levels, psychiatric symptoms, or somatic symptoms (P > .05 for all).ConclusionsImplementing a multipronged behavioral intervention significantly reduced opioid prescribing for patients undergoing prostatectomy or nephrectomy without compromising patient‐reported outcomes.

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“…Moreover, numerous studies have demonstrated that perioperative ERAS management facilitates gastrointestinal recovery and wound healing and can reduce the incidence of pulmonary infection and deep vein thrombosis. 9,11 By selective use of certain ERAS measurements, we have initially verified its effectiveness and safety for patients undergoing TLNU and RLNU, and we believe that our patients benefitted from these treatments.…”

Section: Discussionmentioning

confidence: 67%

Modified transperitoneal versus retroperitoneal laparoscopic radical nephroureterectomy in the management of upper urinary tract urothelial carcinoma: Best practice in a single center with updated results

Zhong

Zhu

et al. 2020

J Int Med Res

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Objective Radical nephroureterectomy remains the gold standard for the surgical treatment of upper urinary tract urothelial carcinoma (UTUC). Based on previous research, we prospectively compared the advantages of transperitoneal laparoscopic radical nephroureterectomy (TLNU) with a three-port technique in a single position versus retroperitoneal laparoscopic radical nephroureterectomy (RLNU). Methods We evaluated 48 patients diagnosed with UTUC at our institution from January 2015 to October 2019. The patients underwent either TLNU (n = 24) or RLNU (n = 24). We randomly assigned the patients to each technique group based on their body mass index because our experience has shown that the body mass index is the main interfering factor for this surgery. The baseline characteristics and perioperative outcomes were compared between the groups. Results We found no significant differences in the baseline characteristics, time until recovery of intestinal function, or postoperative hospital stay between the two groups. However, the TLNU group had a shorter operation time and better postoperative pain control than the RLNU group. Conclusion Modified TLNU is associated with a shorter operative time and less severe postoperative pain compared with RLNU. Both techniques are safe and reliable with adequate management, and their therapeutic effects are comparable in other aspects.

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Implementation of enhanced recovery after surgery in patients undergoing radical cystectomy: A retrospective cohort study

Cited by 24 publications

References 40 publications

Prediction of total hospital expenses of patients undergoing breast cancer surgery in Shanghai, China by comparing three models

Prediction of total hospital expenses of patients undergoing breast cancer surgery in Shanghai, China by comparing three models

Large reduction in opioid prescribing by a multipronged behavioral intervention after major urologic surgery

Modified transperitoneal versus retroperitoneal laparoscopic radical nephroureterectomy in the management of upper urinary tract urothelial carcinoma: Best practice in a single center with updated results

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