Huang Shoujiang,Lv Chengjie,Qian Yunzhong,et al.Application of enhanced recovery after surgery for infantile inguinal hernia undergoing ambulatory surgery[J].Journal of Clinical Pediatric Surgery,,18():261-266.[doi:10.3969/j.issn.1671-6353.2019.04.003]
Application of enhanced recovery after surgery for infantile inguinal hernia undergoing ambulatory surgery
- Keywords:
- Hernia Inguinal/SU; Enhanced Recovery After Surgery; Intraoperative Period; Stress; Hernia Inguinal
- CLC:
- R729;R493;R656.2+1
- Abstract:
- Objective To evaluate the effect of enhanced recovery after surgery (ERAS) guideline implementation on hospitalization stay,patient outcomes and hospitalization expense in infantile inguinal hernia.Methods A retrospective analysis was conducted for 571 infants with inguinal hernia from February 2015 to November 2018.In this cohort,233 patients underwent ambulatory surgery (AS group) and another 338 patients were treated conventionally (control group).AS and control groups were both comprised of two subgroups (laparoscopy subgroup comprised of patients with laparoscopic hernia repair and open subgroup with open hernia repair).Age at herniorrhaphy showed no significant deference between laparoscopy AS and laparoscopy control subgroups (8.2±2.6 vs 8.9±2.4 months,P=0.126); the age of open AS subgroup at herniorrhaphy was elder than that of open control subgroup (8.7±2.8 vs 7.1±3.6 months,P<0.001).The ratios of bilateral inguinal hernia of laparoscopy AS subgroup (34.14%) vs laparoscopy control subgroup (40.76%) and open AS subgroup (16.67%) vs open control subgroup (21.26%) showed no significant difference (P=0.428 and P=0.301 respectively).The length of stay,hospitalization expense and patient outcomes were compared between groups.Results The hospitalization stay of laparoscopy AS subgroup was shorter than that of laparoscopy control subgroup (1 vs 4.6±1.5 days,P<0.001) and open AS subgroup versus open control subgroup (1 vs 4.5±1.7 days,P<0.001).Hospitalization expense of laparoscopy AS subgroup was lower than that of laparoscopy control subgroup (8 439±2 492 vs 10 645±2 014 yuan,P<0.001) and open AS subgroup versus open control subgroup (4 654±1 418 vs 6437±1 716 yuan,P<0.001).The cancellations on day of surgery was lower in AS group than that in control group (4.72% vs 13.31%,P=0.001).The duration of preoperative water fasting was shorter in AS group than that in control group (132±5 vs 148±13 min,P<0.001).The duration of postoperative water/milk intake was also shorter in AS group than that in control group (49±7 vs 142±10 min,124±12 vs 305±35 min respectively,both P<0.001).The incidence of postoperative fever of AS group was lower than that of control group (5.15% vs 10.36%,P=0.026).The incidence of postoperative omit of AS group was lower than that of control group (3.00% vs 11.83%,P<0.001).The incidence of non-programmed consultation showed no significant deference between AS and control groups (2.15% vs 2.07%,P=0.951).No hospital readmission was found for either group.There was only 1 recurrent case in control group while no recurrence in AS group.Conclusion ERAS guideline implementation during ambulatory surgery is both safe and preferred for infantile inguinal hernia.
References:
1 Wang JH,Zhang W,Tou JF,et al.Incidence of pediatric metachronous contralateral inguinal hernia in children aged>/=1 year[J].World J Pediatr,2012,8(3):256-259.DOI:10.1007/s12519-012-0367-z.
2 尹强,周小渔,张甜,等.小儿腹股沟斜疝日间手术分析2532例[J].中华腔镜外科杂志(电子版),2013,6(4):298-299.DOI:10.3877/cma.j.issn.1674-6899.2013.04.016. Yin Q,Zhou XY,Zhang T,et al.Analysis of [2532] cases of indirect inguinal hernia in children by day operation[J].Chin J Laparoscopic Surg (Electronic Edition),2013,6(4):298-299.DOI:10.3877/cma.j.issn.1674-6899.2013.04.016.
3 马洪升,蒋丽莎,刘洋,等.快速康复外科理念在日间手术中的实践[J].中国普外基础与临床杂志,2015,22(11):1384-1385.DOI:10.7507/1007-9424.20150364. Ma HS,Jiang LS,Liu Y,et al.The practice of the concept of fast track surgery in daytime surgery[J].Chin J Bases Clin General Surg,2015,22(11):1384-1385.DOI:10.7507/1007-4848.20160024.
4 马洪升,程南生,朱涛,等.华西医院日间手术快速康复(ERAS)规范[J].中国胸心血管外科临床杂志,2016,23(2):104-106.DOI:10.7507/1007-4848.20160024. Ma HS,Cheng NS,Zhu T,et al.Standard of enhanced recovery after surgery for day surgery in West China Hospital[J].Chin J Clin Thorac Cardiovasc Surg,2016,23(2):104-106.DOI:10.7507/1007-4848.20160024.
5 Jawaha K,Scarisbrick AA.Parental perceptions in pediatric cardiac fast-track surgery[J].AORN J,2009,89(4):725-731.DOI:10.1016/j.aorn.2008.11.029.
6 Vrecenak JD,Mattei P.Fast-track management is safe and effective after bowel resection in children with Crohn’s disease[J].J Pediatr Surg,2014,49(1):99-102.DOI:10.1016/j.jpedsurg.2013.09.038.
7 Itou K,Fukuyama T,Sasabuchi Y,et al.Safety and efficacy of oral rehydration therapy until 2 h before surgery:a multicenter randomized controlled trial[J].J Anesth,2012,26(1):20-27.DOI:10.1007/s00540-011-1261-x.
8 Rawlinson A,Kitchingham N,Hart C,et al.Mechanisms of reducing postoperative pain,nausea and vomiting:a systematic review of current techniques[J].Evid Based Med,2012,17(5):75-80.DOI:10.1136/ebmed-2011-100265.
9 De Mattia AL,Barbosa MH,de Freitas Filho JP,et al.Warmed intravenous infusion for controlling intraoperative hypothermia[J].Rev Lat Am Enfermagem,2013,21(3):803-810.DOI:10.1590/S0104-11692013000300021.
10 江志伟,李宁,黎介寿.快速康复外科的概念及临床意义[J].中国实用外科杂志,2007,27(2):131-133.DOI:10.3321/j.issn:1005-2208.2007.02.013. Jiang ZW,Li N,Li JS.Concept and clinical significance of fast track surgery[J].Chin J Practical Surg,2007,27(2):131-133.DOI:10.3321/j.issn:1005-2208.2007.02.013.
11 刘子嘉,黄宇光.临床麻醉在快速康复外科方面新进展[J].中国医学科学院学报,2015,37(06):750-754.DOI:10.3881/j.issn.1000-503X.2015.06.021. Liu ZJ,Huang YG.Anesthesia update in enhanced recovery after surgery[J].Acta Acad Med Sin,2015,37(6):750-754.DOI:10.3881/j.issn.1000-503X.2015.06.021.
12 Reismann M,von Kampen M,Laupichler B,et al.Fast track surgery in infants and children[J].J Pediatr Surg,2007,42(1):234-238.DOI:10.1016/j.jpedsurg.2006.09.022.
13 潘茜恒,汪玉雯,陈永权.多模式围术期处理在小儿加速康复外科中的应用[J].临床麻醉学杂志,2018,34(8):773-776.DOI:10.12089/jca.2018.08.010. Pan XH,Wang YW,Chen YQ.Application of multimodal perioperative treatment of enhanced recovery after surgery in pediatric surgery[J].J Clin Anesthesiol,2018,34(8):773-776.DOI:10.12089/jca.2018.08.010.
14 Reismann M,Arar M,Hofmann A,et al.Feasibility of fast-track elements in pediatric surgery[J].Eur J Pediatr Surg,2012,22(1):40-44.DOI:10.1055/s-0031-1284422.
15 Baumann LM,Williams K,Ghomrawi H,et al.Current practice patterns for postoperative activity restrictions in children[J].J Pediatr Surg,2018,pii:S0022-3468(18)30402-0.DOI:10.1016/j.jpedsurg.2018.06.025.
16 何威,李国新.加速康复外科的临床应用进展[J].国际外科学杂志,2008,35(6):416-419.DOI:10.3760/cma.j.issn.1673-4203.2008.06.021. He W,Li GX.CliIlical progress on the fast-track surgery[J].International Journal of Surgery,2008,35(6):416-419.DOI:10.3760/cma.j.issn.1673-4203.2008.06.021.
Memo
收稿日期:2018-10-10。
基金项目:浙江省医药卫生科技计划项目（编号：2013KYB151）
通讯作者:钭金法,Email:toujinfa@zju.edu.cn