Effects of a fast track surgery nursing program in perioperative care of older patients with a hip fracture

The safety and effectiveness of enhanced recovery after surgery (ERAS) in older patients undergoing orthopedic surgery: a systematic review and meta-analysis

INTRODUCTION

To systematically review and analyze the safety and effectiveness of ERAS in older patients undergoing orthopedic surgeries.

MATERIALS AND METHODS

We searched PubMed, EMBASE, CINAHL, MEDLINE (Ovid), Web of Science, the Cochrane Library, and other databases to identify all randomized controlled studies and cohorts. We used the Cochrane Risk of Bias Assessment Tool and the Newcastle‒Ottawa Scale to assess the study quality. A meta-analysis was performed using the inverse variance weighting method.

RESULTS

This study included 15 studies involving a total of 2591 older patients undergoing orthopedic surgeries with 1480 in the ERAS group. The ERAS group had a lower incidence of postoperative complications than the control group (RR 0.52; 95% CI 0.42-0.65). Length of stay was 3.37 days lower in the ERAS group than in the control group (P < 0.01). And the ERAS protocol reduced the patient's postoperative VAS score (P < 0.01). Meanwhile, there was a lack of evidence of significant differences between the ERAS group and the control group in total bleeding and 30-day readmission rate.

CONCLUSIONS

The implementation of the ERAS program in older patients undergoing orthopedic surgeries is safe and effective. However, there is still a lack of standardization of protocols across institutions and centers for orthopedic surgery for older patients. Identifying ERAS components that are beneficial to older patients and developing ERAS protocols that are appropriate for older adults may further improve outcomes.

Effect of Enhanced Recovery After Surgery on the Prognosis of Patients With Hip Fractures: A Systematic Review and Meta-Analysis

BACKGROUND

Hip fractures, predominantly occurring in the elderly, are a significant public health concern due to associated morbidity, disability, and mortality. Prolonged bed rest following the fracture often leads to complications, further threatening patient health. Enhanced recovery after surgery, a modern approach to postoperative care, is being explored for its potential to improve outcomes and quality of life in hip fracture patients.

OBJECTIVE

This study investigates the impact of enhanced recovery after surgery on hip fracture patients.

METHODS

In this systematic review, we addressed the PICO question: Does the enhanced recovery after surgery program reduce 1-year mortality, readmissions, and postoperative pain and improve Harris Hip Score compared with traditional care in elderly hip fracture patients? We searched key databases and gray literature and analyzed outcomes through a meta-analysis using RevMan, Stata, and the Newcastle-Ottawa Scale for quality assessment.

RESULTS

Nine studies involving 10,359 patients were included. Compared with the control group, the enhanced recovery after surgery group showed significant reduction in length of stay (mean difference [MD] = -2.00; 95% confidence interval [CI] [-2.87, -1.14]; p < .0001) and overall complication rate (risk ratio [RR] = 0.76; 95% CI [0.67, 0.85]; p < .0001), with a lower delirium rate (RR = 0.42; 95% CI [0.26, 0.68]; p = .004). No significant differences were observed in Harris Hip Score, pain score, 1-year mortality, readmission rate, or incidences of urinary tract infection, respiratory tract infection, and deep vein thrombosis.

CONCLUSION

Enhanced recovery after surgery is associated with reduced length of stay, complication rate, and delirium rate in hip fracture patients.

Efficacy of the enhanced recovery after surgery protocol in operating room nursing of patients following single-port video-assisted thoracoscopic lung cancer surgery: A retrospective study

This study assessed the efficacy of the enhanced recovery after surgery (ERAS) protocol in operating room nursing care for patients who underwent single-port video-assisted thoracoscopic lung cancer surgery. The study included 82 surgical lung cancer cases. The patients underwent single-port video-assisted thoracoscopic lung cancer surgery between April 1, 2021, and June 31, 2022. Of the 82 patients, 42 received nursing care under the ERAS protocol (experimental group) and 40 had routine nursing care (control group) in the operation room. Based on the 2 different nursing care approaches, the postoperative functional recovery efficacy, quality of life, postoperative complications, and psychological status were compared between the 2 groups. In our analysis, the mean anal venting time, average early out-of-bed time, the average time to liquid resumption, atelectasis, and pulmonary infection rate were significantly lower in the experimental group than in the control group (P < .05). The Self-Rating Depression Scale (SDS) and the Self-Rating Anxiety Scale (SAS) scores were also significantly lower in the experimental group than in the control group (P < .05). Other indicators were not significantly different between the 2 groups. Our results show that the implementation of an ERAS protocol in operating room nursing care is feasible and should be clinically applied. The ERAS protocol may enhance the recovery of patients who underwent single-port video-assisted thoracoscopic lung cancer surgery.

Fast-track surgery nursing intervention in CRC patients with laparotomy and laparoscopic surgery

In this study, the application effect of fast-track surgery (FTS) nursing intervention in laparotomy and laparoscopic surgery for colorectal cancer (CRC) is investigated, and the optimal perioperative management strategy for CRC surgery is explored. One hundred thirty CRC patients are included in this study, in which 67 patients undergo laparotomy (Group A) and 63 patients undergo laparoscopic surgery (Group B). These patients were also randomly divided into traditional nursing subgroup (Group A1 [n = 33] and Group B1 [n = 31]) and FTS nursing subgroup (Group A2 [n = 34] and Group B2 [n = 32]). The general data of patients, pre-operative preparation, intra-operative data, postoperative recovery data, and postoperative complications are recorded. Both FTS and laparoscopic surgery can advance the anal exhaust time, and shorten postoperative fasting and water deprivation time, and the hospitalization time without increasing the incidence of complications. FTS has advantages in reducing the indwelling time of gastric tube and throat pain. Simultaneous implementation of FTS and laparoscopic surgery has the best effect on the postoperative recovery of CRC patients.

A Study on the Effect of Nursing Intervention Based on Health Behavior Change Integration Theory on Patients with Limb Fracture and Its Effect on Limb Function and Self-Efficacy

Objective

To assess the impact on nursing care based on the theory of health behavior change integration in patients with limb fracture and its effect on limb function and self-efficacy.

Methods

The starting and ending time of this study is from February 2021 to February 2022. In this study, 116 hospitalized patients with limb fracture were selected as the object of study. According to the method of random number table, the patients were divided into study group and control group. The patients of the study cohort were given nursing healthcare based on the theory of health behavior change integration, while those in the control cohort were given common nursing. The scores of self-rating anxiety scale (SAS), self-rating depression scale (SDS), Frankl compliance scale, self-efficacy scale (GSES), activity of daily living scale (ADL), and Fugl-Meyer limb motor function assessment (FMA) were studied before and 3 months after nursing.

Results

After 3 months of nursing, the SAS and SDS scores of the study group were lower than those of the control group, and the difference between groups was statistically significant (p < 0.05). After 3 months of nursing, the scores of Frankl scale, GSES, ADL scale, and FMA scale in the study group were higher than those in the control group, and the difference between groups was statistically significant (p < 0.05).

Conclusion

The value of nursing interventions based on the integration of health behavior change theory is even more significant in patients with limb fractures. It is more helpful in reducing patients' anxiety and depression, increasing compliance and improving limb function. Self-efficacy and daily living skills were also significantly improved.

Effect of Clinical Nursing Pathway Intervention Based on Evidence-Based Medicine on Venous Thrombosis in Long-Term Bedridden Patients

Background

Venous thrombosis is a type of medical condition that establishes as deep vein thrombosis of the limb or pulmonary embolism. This disease arises as a result of interrelating hereditary, ecological, and interactive risk aspects. Clinical nursing pathways also known as critical pathways are pathways that guide nurses when developing a patient's care plan. However, the effect of nursing intervention on venous thrombosis in long-term bedridden patients from the perspective of evidence-based medicine had not been reported.

Methods

A total of 170 patients hospitalized in the hospital from January 2021 to October 2021 were selected, and the bed time was more than 2 weeks. The patients were randomly divided into the control group and observation group. 85 cases in the control group received routine nursing in cardiology, and 85 cases in the observation group received clinical nursing pathway. Venous thrombosis, lower limb pain, swelling, D-dimer level, hemodynamic parameters, and nursing satisfaction were compared in two groups.

Results

The incidence of deep venous thrombosis in the observation group was 8.2%, lower than 24.7% in the control group (P < 0.05). The incidence of lower limb pain and elevated D-dimer in the observation group was lower than that in the control group (P < 0.05). The improvement of hemodynamic parameters such as SBP, DBP, CBV, PR, CI, and CO in the study group was better than that in the control group (P < 0.05). The satisfaction of the observation group was 90.58%, which was higher than that of the control group (82.35%) (P < 0.05).

Conclusion

Clinical nursing pathway can improve patients' nursing efficiency, improve the treatment effect, shorten hospital stay, and improve nursing satisfaction.

Analysis of the Rehabilitation Efficacy and Nutritional Status of Patients After Endoscopic Radical Thyroidectomy by Fast Track Surgery Based on Nutritional Support

Objective

To investigate and analyze the effect of fast track surgery (FTS) based on nutritional support on the improvement of rehabilitation efficacy and nutritional status of patients after radical lumpectomy for thyroid cancer.

Methods

Eighty-six patients admitted to our hospital for radical lumpectomy for thyroid cancer between April 2018 and April 2021 were selected, of which 40 patients admitted between April 2018 and April 2019 were included in the control group with conventional perioperative care. Forty-six patients admitted between May 2019 and April 2021 were included in the trial group with FTS care based on nutritional support. The two groups of patients were compared in terms of postoperative feeding time, length of stay, time out of bed, VAS scores, albumin (ALB), total protein (TP) and prealbumin (PA) levels, negative emotions [Mental Health Test Questionnaire (DCL-90)], quality of life [General Quality of Life Inventory (GQOLI-74)] and complication rates.

Results

The patients in the trial group had shorter feeding time, hospitalization time and time out of bed than the control group (P < 0.05). After the intervention, ALB, TP and PA levels were higher in the trial group than in the control group vs. preoperatively (P < 0.05); VAS scores in the trial group were lower than VAS scores in the control group during the same period (P < 0.05). The postoperative DCL-90 scores of the trial group were lower than those of the control group (P < 0.05); the GQOLI-74 scores and total scores of the trial group were higher than those of the control group at the 3-month postoperative follow-up (P < 0.05). The overall incidence of complications such as hoarseness, choking on water, hand and foot numbness, wound infection, and hypocalemia was lower in the trial group than in the control group (P < 0.05).

Conclusion

The implementation of FTS care based on nutritional support for patients after endoscopic radical thyroidectomyr can effectively improve the postoperative recovery and reduce their pain level, as well as help improve their nutritional status, negative emotions and improve their quality of life, which is worth promoting.

Improvement of Negative Psychological Stress Response in Elderly Patients With Femoral Neck Fracture by Integrated High-Quality Nursing Model of Medical Care

Objective

The objective of this study was to explore the nursing effect and negative psychological stress response of elderly patients with femoral neck fracture by applying the high-quality nursing mode of medical care.

Methods

A total of 130 elderly patients with femoral neck fractures hospitalized in our hospital from January 2020 to June 2021 were randomly divided into the control group and observation group, with 65 patients in each group. The control group adopted the conventional nursing mode, while the observation group adopted the high-quality nursing mode of medical care. The observation indexes selected in this study are nursing satisfaction, hip flexion activity on the 1, 15, and 30 days after the operation, the time when the affected limb was lifted off the bed actively, and the anxiety and depression of patients.

Results

On the 1, 15, and 30 days after the operation, there were statistically significant differences between the two groups in hip flexion activity and the time when the affected limb was lifted off the bed (P < 0.05). The nursing satisfaction of the observation group was 95.38%, which was statistically significant compared with the 80.00% of the control group (P < 0.05). After treatment, the self rating depression scale (SDS) and self rating anxiety scale (SAS) scores in the observation group were lower than those in the control group (P < 0.05).

Conclusion

The high-quality nursing model of medical care can effectively promote the rehabilitation of elderly patients with femoral neck fracture, reduce the negative psychological stress reaction of patients, and improve nursing satisfaction, which has important application value and guiding significance for the nursing of patients with femoral neck fracture.

Unsupervised Data Mining and Effect of Fast Rehabilitation Nursing Intervention in Fracture Surgery

At present, the most commonly used surgical treatment for fractures caused by external force injury is clinical, and unsupervised data mining is more advantageous in the face of the unknown format of perioperative network data. Therefore, this research aims to explore the application effect of unsupervised data mining in the concept of rapid rehabilitation nursing intervention after fracture surgery. 80 patients who underwent fracture surgery in the Department of Orthopedics of XXX Hospital were determined as the subjects, who were rolled into a research group (group R, 40 cases) and a control group (group C, 40 cases) by drawing lots. An unsupervised data mining algorithm based on unsupervised data mining for support vector machines (VDMSVMs) was proposed and applied to two groups of patients undergoing perioperative fracture surgery with the rapid rehabilitation nursing intervention and basic routine nursing. The results showed that the number of important features selected by the VDMSVM algorithm (5) was obviously more than that of the compressed edge fragment sampling (CEFS) algorithm (1) and the multicorrelation forward searching (MCFS) algorithm (2) (P < 0.05). The number of noise features screened by the VDMSVM algorithm (3) was much less in contrast to that of the CEFS algorithm and the MCFS algorithm, which was 8 and 10, respectively (P < 0.05). The Visual Analogue Scale (VAS) scores of the fracture site at the 4th, 8th, 12th, and 16th hour after surgery in group R were all lower than the scores in group C (P < 0.05). The length of hospital stay (LoHS) in group R was greatly shorter than that in group C (P < 0.05). After different nursing methods, the World Health Organization Quality of Life (WHOQOL-BREF) score of patients in group R (89.64 points) was greatly higher than the score in group C (61.45 points) (P < 0.05). The nursing satisfaction score of group R was 92.35 ± 3.65 points, and that in group C was 2.14 ± 1.25 points, respectively (P < 0.05). The test results verified the effectiveness of the feature selection of the VDMSVM algorithm. The rapid rehabilitation nursing intervention was conductive to reducing the postoperative pain of fracture patients, shortening the LoHS of patients, improving the quality of life (QOL) of fracture surgery patients, and increasing the patient's satisfaction with nursing.

Application of Multimode Health Education Combined with Humanistic Care in Pain Management of Patients with Femoral Fracture and Its Influence on VAS Score

Objective

To explore the application of multimode health education combined with humanistic care in pain management of patients with femoral fracture and its influence on VAS score.

Methods

A total of 120 patients with femoral fracture admitted in our hospital (May 2017–May 2021) were selected as the research objects. The patients who received routine health education were included into the routine group, and the patients who received multimode health education combined with humanistic care were included into the combined group, with 60 cases in each group. The pain management effect of the two groups was compared after nursing intervention.

Results

No significant difference was found in age, BMI, fracture sites, gender, education degree, and residence between the two groups (P > 0.05). The awareness rate of health knowledge of the combined group was as high as 93.33%, which was obviously higher than that of the routine group (P < 0.05). Compared with the routine group, excellent rates of sitting durability and joint range of motion in the combined group were obviously higher (P < 0.05), and poor rates of sitting durability and joint range of motion in the combined group were obviously lower (P < 0.05). Compared with the routine group, VAS scores of the combined group at 1 d, 2 d, and 3 d after admission and at 1 d, 2 d, and 3 d after surgery were remarkably lower (P < 0.05). Compared with the routine group, compliance of exercise, medical waist belt using, and working posture of the combined group 1 week, 1 month, and 6 months after surgery was obviously higher (P < 0.05). Compared with the routine group, the scores of Rasmussen and Johner-Wruhs of the combined group 6 months after surgery were conspicuously higher (P < 0.05).

Conclusion

The application of multimode health education combined with humanistic care in pain management of patients with femoral fracture can effectively relieve pain, improve the awareness rate of health knowledge, promote the recovery of lower limb function, and enhance the prognosis of quality of life for patients.

Effectiveness of optimised care chain for hip fractures in elderly Chinese

BACKGROUND

Studies have found that optimised care chain (OCC) can promote the recovery of hip fracture patients. Fast track (FT) has been widely proven to play a good role, but there is no systematic review report.

METHODS

We conducted a comprehensive search and obtained search data as of April 2020. These included randomised controlled trials (RCTs) and cohort trials (CTs). We applied the research input Review Manager 5.3 for data synthesis, and used Stata 12.0 for meta- regression analysis.

RESULTS

This review reported 2200 hip fractures. Our analysis showed that OCC can reduce complications and 1-year mortality, and shorten the length of stay (LOS). After dividing the complications into bed-related complications and other complications, OCC has advantages in reducing bed-related complications, but has no significant effect on other complications. For the conventional care group, the secondary outcome of the OCC group showed there was no significant difference in duration of surgery, and the rest were significantly improved. Subgroup analysis between green channel (GC) and FT showed a shorter LOS for GC.

CONCLUSIONS

This meta-analysis suggests that the use of OCC in China promotes rehabilitation in elderly patients with hip fractures, that FT and GC are similar in effect in China, and that GC shows a greater advantage in reducing LOS.

Clinical application of enhanced recovery after surgery in the treatment of choledocholithiasis by ERCP

This study aims to investigate the effect of applying enhanced recovery after surgery methods (ERAS) in perioperative nursing of choledocholithiasis following endoscopic retrograde cholangiopancreatography (ERCP) for treatment of biliary calculus.Clinical data from 161 patients who underwent ERCP surgery in Wuhan Union Hospital from January 2017 to December 2019 were retrospectively analyzed. A total of 78 patients received perioperative nursing using the ERAS concept (experimental group) and 83 patients received conventional perioperative nursing (control group). Group differences were compared for the time to first postoperative ambulation, exhausting time, time to first defecation and eating, intraoperative blood loss, postoperative complication incidence (pancreatitis, cholangitis, hemorrhage), white blood cell (WBC), and serum amylase (AMS) values at 24 hours, duration of nasobiliary duct indwelling, length of hospital stay, and hospitalization expenses.No significant between-group differences were noted for demographic characteristics (age, sex, BMI, ASA score, and comorbidity) (P > .05). Time to first ambulation, exhausting time, time to defecation and eating, and nasobiliary drainage time were shorter in the experimental group than the control group, and the differences were statistically significant (P < .05). There was no significant between-group difference in postoperative WBC values at 24 hours (P > .05), but the experimental group's AMS values at 24 hours postoperation were significantly lower than those of the controls (154.93 ± 190.01 vs 241.97 ± 482.64, P = .031). Postoperative complications incidence was 9.1% in the experimental group, which was significantly lower than the 20.4% in the control group, and this difference was statistically significant (P = .039). Compared with the control group, nasobiliary drainage time (26.53 ± 7.43 hours vs 37.56 ± 9.91 hours, P < .001), hospital stay (8.32 ± 1.55 days vs 4.56 ± 1.38 days, P < .001), and hospitalization expenses (36800 ± 11900 Yuan vs 28900 ± 6500 Yuan, P = .016) were significantly lower in the experimental group.ERAS is a safe and effective perioperative nursing application in ERCP for treating choledocholithiasis. It can effectively accelerate patients' recovery and reduce the incidence of complications; therefore, it is worthy of being applied and promoted in clinical nursing.

Rapid rehabilitation nursing improves clinical outcomes in postoperative patients with colorectal carcinoma: A protocol for randomized controlled trial

BACKGROUND

Colorectal carcinoma has a high incidence rate and the high mortality rate has always been an important global health challenge. Surgical treatment is widely performed in patients with colorectal carcinoma. Fast track surgery (FTS) applies evidence-based medical concept to optimize the management during the operation, so as to reduce the psychological and physical trauma stress of surgical patients and make them recover rapidly. We perform this protocol for randomized controlled study to evaluate the efficacy of a rapid rehabilitation care in colorectal carcinoma surgery.

METHODS

It is a single-center randomized controlled study to be conducted from January 2021 to December 2021. It was authorized via the Ethics Committee of the Huzhou Central Hospital (20191127-01). Eighty participants who undergo colorectal carcinoma surgery will be included in this research. Patients are randomly assigned to control group (standard management group, including 40 samples) and study group (the FTS group, including 40 samples). The main results are times of postoperative exhaust, first defecation, ambulation, first eating, and postoperative hospital stay. Secondary outcomes are incidence of nausea and emesis, wound infection, urinary tract infection, lung infection, deep vein thrombosis, and rehospitalization rate among the 2 groups. All analyses are conducted using the SPSS for Windows Release 15.0.

RESULTS

Figure 1 shows the clinical results between groups.

CONCLUSION

The research can offer a reliable basis for the effectiveness of a rapid recovery nursing program in patients with colorectal carcinoma.

TRIAL REGISTRATION

This study protocol was registered in Research Registry (researchregistry6038).