Effect of an ERAS protocol and laparoscopic surgery on patient safety

A


1.



Quantitative



A


r


t


i


c


l


e

:

Zhu, Y., Xiang, J., Liu, W., Cao, Q., & Zhou, W. (2018). Laparoscopy Combined with Enhanced Recovery Pathway in Ileocecal Resection for Crohn’s Disease: A Randomized Study.

Gastroenterology Research & Practice

, 1–7.


https://doi.org/10.1155/2018/9648674

B


a


c


k


g


r


o


un


d


o


r


I


n


t


r


o


d


u


c


t


i


o


n

The purpose of this article is to study the use of minimally invasive laparoscopic surgery coupled with an ERAS protocol and its effect on patient safety and short-term postoperative outcomes in patients with Crohn’s disease undergoing elective ileocecal resection (Zhu, 2018).

R


e


v


i


e


w


o


f


t


h


e


L


i


t


e


r


a


t


u


r


e

The author cites 23 articles that show the benefits of a laparoscopic versus open approach for colon resection as well as the benefits of using an ERAS protocol versus conventional perioperative care. In spite of the wealth of information available regarding the benefits of the laparoscopic surgical approach over open and the use of the ERAS protocol over conventional care, the researchers found that there was little evidence regarding the use of laparoscopy coupled with ERAS in the treatment of Crohn’s disease (Zhu, 2018).

D


i


s


c


uss


i


o


n


o


f


M


e


t


h


o


d


o


l


o


g


y

This is a quantitative study that consists of a controlled, randomized single-blind trial. A consecutive cohort of 32 patients between the ages of 14 and 70 with histologically confirmed Crohn’s disease isolated to the terminal ileum or ileum and cecum were included. The study participants were randomized into 2 groups: both groups would undergo laparoscopic surgery, but one group would receive conventional perioperative care and the other would receive ERAS. The participants were blinded to which group they were sorted (Zhu, 2018).

D


a


t


a


A


n


a


l


y


s


i


s

The researchers prospectively recorded preoperative, operative, and postoperative data for all patients in both groups including age, BMI, sex, ASA score, length of surgery and complications, preoperative therapy type, compliance, length of stay, morbidity, mortality, hospital costs, and readmission. The intention to treat principle was used to analyze the data obtained, which was then presented as interquartile ranges and medians or means +/- standard deviation. Chi-squared tests were used to compare data and the Mann-Whitney

U

test for abnormal distribution. The independent sample

t

-test was used for data with normal distribution (Zhu, 2018).

Researcher’s Conclusion

The researchers concluded that using the ERAS protocol in conjunction with minimally invasive laparoscopic surgery for patients with Crohn’s disease requiring ileocectomy was safe and effective, and that patients had fewer complications, faster return of bowel function, and shorter hospital lengths of stay (Zhu, 2018).

B


1.



Qualitative



A


r


t


i


c


l


e


:

Chang, Y.-L., & Tsai, Y.-F. (2017). Research paper: Early illness experiences related to unexpected heart surgery: A qualitative descriptive study

.




Australian Critical Care

, 30, 279–285.


https://doi.org/10.1016/j.aucc.2016.11.005

B


a


c


k


g


r


o


un


d


o


r


I


n


t


r


o


d


u


c


t


i


o


n

Many studies exist evaluating patients post discharge after undergoing emergency heart surgery, but very few have been conducted to study patient experiences after transferring out of ICU but prior to discharge. The purpose of this study is to gather information regarding patient’s experiences during this time period of early recovery from emergency heart surgery (Chang, 2017).

R


e


v


i


e


w


o


f


t


h


e


L


i


t


e


r


a


t


u


r


e

The author cites 44 reference articles covering topics ranging from emergency heart surgery and recovery afterwards to communication techniques, rehabilitation, depression, nightmares, memory loss, and the conducting of qualitative research as well as many others. Most of the studies conducted on patients post emergency heart surgery focused on how they were doing 8-18 months after discharge, and there were very few regarding the psychological impact of this life changing event (Chang, 2017).

D


i


s


c


uss


i


o


n


o


f


M


e


t


h


o


d


o


l


o


g


y

The study was conducted under a qualitative descriptive design, meaning there was no control exerted over their behaviors and these were simply documented. 13 participants who underwent emergency cardiac surgery at a hospital in northern Taiwan were included in the study. The participants were over age 20 without cognitive issues who had had emergency heart surgery, an ICU stay of at least 3 days, had been on the surgical ward for at least 6 days, and were due to be discharged within 3 days. The patients were interviewed by a communications-trained cardiovascular nurse practitioner. The transcripts of the interviews were kept confidential by being assigned a number (Chang, 2017).

D


a


t


a


A


n


a


l


y


s


i


s

The conversations were transcribed word-for-word and qualitative content analysis was used to find common experiences in the interviews. The authors read, analyzed and discussed all interviews to reach a consensus on what the common themes were. All data was then translated from Mandarin to English by the first author, and the translated data was then reviewed by a bilingual expert in qualitative research (Chang, 2017).

Researcher’s Conclusion

The researchers concluded that interdisciplinary care and education should be provided early in the recovery period. They also concluded that good family relationships, inclusion of religious beliefs, and a strong relationship with their health care professionals were the biggest motivating factors to adapt healthy lifestyle changes that would improve their length and quality of life (Chang, 2017). They also stress the importance of effective management of pain and delirium, minimizing sedation to reduce ICU psychosis and PTSD, and promoting normal sleep patterns (Chang, 2017).

A


1.



Quantitative



A


r


t


i


c


l


e

:

Zhu, Y., Xiang, J., Liu, W., Cao, Q., & Zhou, W. (2018). Laparoscopy Combined with Enhanced Recovery Pathway in Ileocecal Resection for Crohn’s Disease: A Randomized Study.

Gastroenterology Research & Practice

, 1–7.


https://doi.org/10.1155/2018/9648674

B


a


c


k


g


r


o


un


d


o


r


I


n


t


r


o


d


u


c


t


i


o


n

The purpose of this article is to study the use of minimally invasive laparoscopic surgery coupled with an ERAS protocol and its effect on patient safety and short-term postoperative outcomes in patients with Crohn’s disease undergoing elective ileocecal resection (Zhu, 2018).

R


e


v


i


e


w


o


f


t


h


e


L


i


t


e


r


a


t


u


r


e

The author cites 23 articles that show the benefits of a laparoscopic versus open approach for colon resection as well as the benefits of using an ERAS protocol versus conventional perioperative care. In spite of the wealth of information available regarding the benefits of the laparoscopic surgical approach over open and the use of the ERAS protocol over conventional care, the researchers found that there was little evidence regarding the use of laparoscopy coupled with ERAS in the treatment of Crohn’s disease (Zhu, 2018).

D


i


s


c


uss


i


o


n


o


f


M


e


t


h


o


d


o


l


o


g


y

This is a quantitative study that consists of a controlled, randomized single-blind trial. A consecutive cohort of 32 patients between the ages of 14 and 70 with histologically confirmed Crohn’s disease isolated to the terminal ileum or ileum and cecum were included. The study participants were randomized into 2 groups: both groups would undergo laparoscopic surgery, but one group would receive conventional perioperative care and the other would receive ERAS. The participants were blinded to which group they were sorted (Zhu, 2018).

D


a


t


a


A


n


a


l


y


s


i


s

The researchers prospectively recorded preoperative, operative, and postoperative data for all patients in both groups including age, BMI, sex, ASA score, length of surgery and complications, preoperative therapy type, compliance, length of stay, morbidity, mortality, hospital costs, and readmission. The intention to treat principle was used to analyze the data obtained, which was then presented as interquartile ranges and medians or means +/- standard deviation. Chi-squared tests were used to compare data and the Mann-Whitney

U

test for abnormal distribution. The independent sample

t

-test was used for data with normal distribution (Zhu, 2018).

Researcher’s Conclusion

The researchers concluded that using the ERAS protocol in conjunction with minimally invasive laparoscopic surgery for patients with Crohn’s disease requiring ileocectomy was safe and effective, and that patients had fewer complications, faster return of bowel function, and shorter hospital lengths of stay (Zhu, 2018).

B


1.



Qualitative



A


r


t


i


c


l


e


:

Chang, Y.-L., & Tsai, Y.-F. (2017). Research paper: Early illness experiences related to unexpected heart surgery: A qualitative descriptive study

.




Australian Critical Care

, 30, 279–285.


https://doi.org/10.1016/j.aucc.2016.11.005

B


a


c


k


g


r


o


un


d


o


r


I


n


t


r


o


d


u


c


t


i


o


n

Many studies exist evaluating patients post discharge after undergoing emergency heart surgery, but very few have been conducted to study patient experiences after transferring out of ICU but prior to discharge. The purpose of this study is to gather information regarding patient’s experiences during this time period of early recovery from emergency heart surgery (Chang, 2017).

R


e


v


i


e


w


o


f


t


h


e


L


i


t


e


r


a


t


u


r


e

The author cites 44 reference articles covering topics ranging from emergency heart surgery and recovery afterwards to communication techniques, rehabilitation, depression, nightmares, memory loss, and the conducting of qualitative research as well as many others. Most of the studies conducted on patients post emergency heart surgery focused on how they were doing 8-18 months after discharge, and there were very few regarding the psychological impact of this life changing event (Chang, 2017).

D


i


s


c


uss


i


o


n


o


f


M


e


t


h


o


d


o


l


o


g


y

The study was conducted under a qualitative descriptive design, meaning there was no control exerted over their behaviors and these were simply documented. 13 participants who underwent emergency cardiac surgery at a hospital in northern Taiwan were included in the study. The participants were over age 20 without cognitive issues who had had emergency heart surgery, an ICU stay of at least 3 days, had been on the surgical ward for at least 6 days, and were due to be discharged within 3 days. The patients were interviewed by a communications-trained cardiovascular nurse practitioner. The transcripts of the interviews were kept confidential by being assigned a number (Chang, 2017).

D


a


t


a


A


n


a


l


y


s


i


s

The conversations were transcribed word-for-word and qualitative content analysis was used to find common experiences in the interviews. The authors read, analyzed and discussed all interviews to reach a consensus on what the common themes were. All data was then translated from Mandarin to English by the first author, and the translated data was then reviewed by a bilingual expert in qualitative research (Chang, 2017).

Researcher’s Conclusion

The researchers concluded that interdisciplinary care and education should be provided early in the recovery period. They also concluded that good family relationships, inclusion of religious beliefs, and a strong relationship with their health care professionals were the biggest motivating factors to adapt healthy lifestyle changes that would improve their length and quality of life (Chang, 2017). They also stress the importance of effective management of pain and delirium, minimizing sedation to reduce ICU psychosis and PTSD, and promoting normal sleep patterns (Chang, 2017).