Enhanced Recovery After Surgery Is Still Powerful for Colorectal Cancer Patients in COVID-19 Era

Safety and efficacy of the enhanced recovery after surgery protocol in hepatectomy for liver cancer

PURPOSE

The aim of this research was to evaluate the efficacy and safety of enhanced recovery after surgery (ERAS) protocol in hepatectomy patients with liver cancer.

MATERIALS AND METHODS

We searched three databases, including PubMed, Embase, and the Cochrane Library database, from inception to April 25, 2023. The outcomes were postoperative complications, and postoperative length of stay (PLOS). This study was performed by Stata (V. 16.0) software.

RESULTS

Twelve investigations involving 1,892 patients were included in this study. The ERAS group had lower overall postoperative complications [odds ratio (OR) = 0.49, I² = 54.89 %, 95 % confidence interval (CI) = 0.33-0.74, P = 0.00], postoperative Clavien-Dindo Grade 1-2 complications (OR = 0.39, I² = 55.14 %, 95 %CI = 0.23-0.69, P = 0.00), Clavien-Dindo Grade 3-4 complications (OR = 0.56, I² = 0.00 %, 95 %CI = 0.38-0.83, P = 0.00) , pneumonia (OR = 0.34, I² = 0.00 %, 95 %CI = 0.15-0.76, P = 0.01), ascites (OR = 0.25, I² = 0.00 %, 95 %CI = 0.09-0.68, P = 0.01), vomit (OR = 0.39, I² = 0.00 %, 95 %CI = 0.21-0.73, P = 0.00), intraoperative blood loss [mean difference (MD) = 1.69, I² = 0.00 %, 95 %CI = 1.15-2.47, P = 0.01], PLOS (MD = -0.42, I² = 94.87 %, 95 %CI = -0.86-0.03, P = 0.07), duration of abdominal drain (MD = -1.23, I² = 96.96 %, 95 %CI = -2.04 to -0.42, P = 0.00), and hospital readmission (OR = 0.44, I² = 0.00 %, 95 %CI = 0.23-0.85, P = 0.01) compared to the non-ERAS group.

CONCLUSION

For patients with liver cancer treated with ERAS. The ERAS protocol reduces the percentage of overall postoperative complications. Moreover, ERAS does not increase the rate of blood transfusions, hospital readmission, reoperation, or mortality.

Enhanced recovery after surgery from 1997 to 2022: a bibliometric and visual analysis

Enhanced recovery after surgery (ERAS) is a multimodal perioperative management concept, but there is no article to comprehensively review the collaboration and impact of countries, institutions, authors, journals, references, and keywords on ERAS from a bibliometric perspective. This study assessed the evolution of clustering of knowledge structures and identified hot trends and emerging topics. Articles and reviews related to ERAS were retrieved through subject search from the Web of Science Core Collection. We used the following strategy: "TS = Enhanced recovery after surgery" OR "Enhanced Postsurgical Recovery" OR "Postsurgical Recoveries, Enhanced" OR "Postsurgical Recovery, Enhanced" OR "Recovery, Enhanced Postsurgical" OR "Fast track surgery" OR "improve surgical outcome". Bibliometric analyses were conducted on Excel 365, CiteSpace, VOSviewer, and Bibliometrics (R-Tool of R-Studio). Totally 3242 articles and reviews from 1997 to 2022 were included. These publications were mainly from 684 journals in 78 countries, led by the United States and China. Kehlet H published the most papers and had the largest number of co-citations. Analysis of the journals with the most outputs showed that most journals mainly cover Surgery and Oncology. The hottest keyword is "enhanced recovery after surgery". Later appearing topics and keywords indicate that the hotspots and future research trends include ERAS protocols for other types of surgery and improving perioperative status, including "bariatric surgery", "thoracic surgery", and "prehabilitation". This study reviewed the research on ERAS using bibliometric and visualization methods, which can help scholars better understand the dynamic evolution of ERAS and provide directions for future research.

Changes in frailty among patients hospitalized for spine pathologies during the COVID-19 pandemic in Germany-a nationwide observational study

PURPOSE

In spine care, frailty is associated with poor outcomes. The aim of this study was to describe changes in frailty in spine care during the coronavirus disease 2019 (COVID-19) pandemic and their relation to surgical management and outcomes.

METHODS

Patients hospitalized for spine pathologies between January 1, 2019, and May 17, 2022, within a nationwide network of 76 hospitals in Germany were retrospectively included. Patient frailty, types of surgery, and in-hospital mortality rates were compared between pandemic and pre-pandemic periods.

RESULTS

Of the 223,418 included patients with spine pathologies, 151,766 were admitted during the pandemic and 71,652 during corresponding pre-pandemic periods in 2019. During the pandemic, the proportion of high-frailty patients increased from a range of 5.1-6.1% to 6.5-8.8% (p < 0.01), while the proportion of low frailty patients decreased from a range of 70.5-71.4% to 65.5-70.1% (p < 0.01). In most phases of the pandemic, the Elixhauser comorbidity index (ECI) showed larger increases among high compared to low frailty patients (by 0.2-1.8 vs. 0.2-0.8 [p < 0.01]). Changes in rates of spine surgery were associated with frailty, most clearly in rates of spine fusion, showing consistent increases among low frailty patients (by 2.2-2.5%) versus decreases (by 0.3-0.8%) among high-frailty patients (p < 0.02). Changes in rates of in-hospital mortality were not associated with frailty.

CONCLUSIONS

During the COVID-19 pandemic, the proportion of high-frailty patients increased among those hospitalized for spine pathologies in Germany. Low frailty was associated with a rise in rates of spine surgery and high frailty with comparably larger increases in rates of comorbidities.