Impact of perioperative care on the post-operative recovery of women undergoing surgery for gynaecological tumours

Effect of comprehensive perioperative nursing on pain intensity, complication rates, and comfort levels in patients undergoing gallstone surgery

BACKGROUND

Surgery is the gold standard for gallstone treatment. Nevertheless, the complications associated with the surgical procedure can exert diverse and adverse impacts on patients’ health and quality of life to varying extents. Hence, it is essential to offer perioperative care to patients undergoing gallstone surgery.

AIM

To examine the impact of perioperative comprehensive nursing on pain intensity, complication rates, and patient comfort in individuals undergoing gallstone surgery.

METHODS

From February 2022 to February 2024, 195 patients who underwent gallstone surgery at Sanmen People’s Hospital were selected and divided into two groups: A control group receiving routine nursing care (95 patients) and a research group receiving perioperative comprehensive nursing (100 patients). Key postoperative recovery indicators, including time to first postoperative anal exhaust, oral food intake, and ambulation, were observed, along with pain intensity (measured by the numeric rating scale), complication rate (bleeding, incision infection, recurrence), patient comfort (assessed using the visual analogue scale), and quality of life (measured by the World Health Organization Quality of Life-BREF).

RESULTS

The research group showed significantly shorter times to first postoperative anal exhaust, oral intake, and ambulation. Moreover, numeric rating scale pain scores in the research group were markedly lower post-nursing, and the total complication rate was significantly reduced compared to the control group. Furthermore, comfort levels improved considerably in the research group, and World Health Organization Quality of Life-BREF scores across the physical, psychological, social, and environmental domains were significantly higher compared to the control group following nursing care.

CONCLUSION

Perioperative comprehensive nursing effectively enhances postoperative recovery in patients undergoing gallstone surgery, reducing pain, lowering complications, and improving patient comfort and quality of life, which deserves clinical application.

Prospective study on the effects of mechanical bowel preparation under the enhanced recovery after surgery concept on electrolyte disturbances and functional recovery after robotic surgery for urologic tumors in older adults

BACKGROUND

Mechanical bowel preparation (MBP) involves the cleansing of bowel excreta and secretions using methods such as preoperative oral laxatives, retrograde enemas, and dietary adjustments. When combined with oral antibiotics, preoperative MBP can effectively lower the risk of anastomotic leakage, minimize the occurrence of postoperative infections, and reduce the likelihood of other complications. To study the effects of MBP under the Enhanced Recovery After Surgery (ERAS) concept on postoperative electrolyte disorders and functional recovery in older people with urological tumors undergoing robot-assisted surgery.

METHODS

Older people with urological tumors undergoing robot-assisted surgery were randomly divided into two groups. The experimental group (n = 76) underwent preoperative MBP, while the control group (n = 72) did not. The differences in electrolyte levels and functional recovery between the two groups after radical surgery for urological tumors were observed.

RESULTS

The incidence of postoperative electrolyte disorders was significantly higher in the experimental group compared to the control group, with incidence rates of 42.1% and 19.4%, respectively (P < 0.05). Subgroup analysis showed that the electrolyte disorder was age-related (P < 0.05). There were no significant differences between the two groups in terms of postoperative complications, gastrointestinal function recovery, laboratory indicators of infection, body temperature, and length of hospital stay (P > 0.05).

CONCLUSION

Under the accelerated recovery background, preoperative MBP increases the risk of postoperative electrolyte disorders in older people with urological tumors and does not reduce the incidence of postoperative complications or promote postoperative functional recovery.

Determining pre-procedure fasting alert time using procedural and scheduling data

Before a medical procedure requiring anesthesia, patients are required to not eat or drink non-clear fluids for 6 h and not drink clear fluids for 2 h. Fasting durations in standard practice far exceed these minimum thresholds due to uncertainties in procedure start time. The aim of this retrospective, observational study was to compare fasting durations arising from standard practice with different approaches for calculating the timepoint at which patients are instructed to stop eating and drinking. Scheduling data for procedures performed in the cardiac catheterization laboratory of an academic hospital in Canada (January 2020 to April 2022) were used. Four approaches utilizing machine learning (ML) and simulation were used to predict procedure start times and calculate when patients should be instructed to start fasting. Median fasting duration for standard practice was 10.08 h (IQR 3.5) for both food and clear fluids intake. The best performing alternative approach, using tree-based ML models to predict procedure start time, reduced median fasting from food/non-clear fluids to 7.7 h (IQR 2) and clear liquids fasting to 3.7 h (IQR 2.4). 97.3% met the minimum fasting duration requirements (95% CI 96.9% to 97.6%). Further studies are required to determine the effectiveness of operationalizing this approach as an automated fasting alert system.

Controversies in preoperative bowel preparation in gynecologic and gynecologic oncology surgery: a review of the literature

PURPOSE

The purpose of this review is to assess the impact of mechanical and oral antibiotics bowel preparation on surgical performance and to investigate their role before gynecologic surgical procedures regarding the infection rates. We also aim to study the updated evidence regarding the use of these different types of bowel preparation, as well as the current preoperative practice applied.

METHODS

An extensive search of the literature was conducted with Medline/PubMed, and the Cochrane Library Database of Systematic Reviews being used for our primary search.

RESULTS

To date, due to the conflicting guidelines by the scientific societies, surgeons do not use a specific pattern of bowel preparation regimen. There are no strong evidence supporting mechanical bowel preparation, but instead, in many cases, patients' adverse effects, both physiological and psychological have been noted. On the other hand, the combined use of oral antibiotic and mechanical bowel preparation has been proven beneficial in colorectal surgery in reducing postoperative morbidities.

CONCLUSION

Based on current literature, in gynecologic surgeries with minimal probability of intraluminal entry, a regimen without any bowel preparation should be applied. The combined administration of both mechanical and oral antibiotic bowel preparation, or even the use of the oral antibiotics alone, should be preserved for cases of increased complexity, where bowel involvement is highly anticipated, such as in gynecologic oncology, as stated in the ERAS protocols. Nonetheless, further research specific to gynecologic surgery is required.