Search

Low salinity Waterflooding (LSWF) is a proven EOR technique which has emerged in the last few decades. In this, the salinity of the injected water is reduced. Studies have unveiled that the LSWF can improve about 5–38% of oil recovery. This work aims to study the effectiveness of LSWF by modeling Sea waterflooding (SWF) and LSWF using a commercial reservoir simulator and justifying the proposed mechanisms responsible for the incremental oil recovery due to LSWF. A critical parametric study has been undertaken, which led us to conclude that LSWF is a cost-effective, and environment-friendly method that results in additional oil recovery for sandstone reservoirs. [ABSTRACT FROM AUTHOR]

A comprehensive preoperative assessment is imperative for patients undergoing lung surgery, ideally by way of a multidisciplinary team approach. This not only allows for clinicians to risk stratify patients and gain informed consent, but also to explore avenues in optimizing patients prior to surgery and plan for the delivery of the most appropriate postoperative care. A tripartite risk assessment combining risks of operative mortality, perioperative adverse cardiac events and postoperative dyspnoea should be assessed and discussed with patients. Those patients who continue towards surgical management may then be optimized with patient education addressing nutritional status, smoking cessation and alcohol dependency as well as the management of anaemia and physiological prehabilitation. This article aims to review existing guidelines for preoperative assessment in thoracic surgery as well as the latest preoperative guidance for enhanced recovery specific to thoracic surgery. [ABSTRACT FROM AUTHOR]

Fast-track or enhanced recovery after surgery (ERAS) is a care pathway for surgical patients based on a multidisciplinary team approach aimed at optimising recovery without increasing risk with protocols based on scientific evidence, which is monitored continuously to ensure compliance and improvement. These protocols have been shown to reduce the duration of postoperative mechanical ventilation and intensive care unit (ICU) length of stay (LOS) following paediatric cardiac surgery. We present the first structured implementation of ERAS in paediatric cardiac surgery in Australia. All patients enrolled in the ERAS pathway between October 2019 and July 2023 were identified. Demographic and perioperative data were collected retrospectively from hospital records for patients operated before June 2021 and prospectively from June 2021. A control group (non-ERAS) was identified using propensity matching from patients who underwent similar procedures and were not enrolled in the ERAS pathway (prior to October 2019). Patients were matched for age, weight, and comprehensive Aristotle score. Outcomes of interest were duration of postoperative mechanical ventilation, ICU LOS, readmission to the ICU, hospital LOS, cardiac reintervention rate, postoperative complication rate, and number of 30-day readmissions. Of 1,084 patients who underwent cardiac surgery during the study period (October 2019–July 2023), 121 patients (11.2%) followed the ERAS pathway. The median age at the time of surgery was 4.8 years (interquartile range [IQR] 2.8–8.8 years). The most common procedure was the closure of atrial septal defect (n=58, 47.9%). The median cardiopulmonary bypass and cross-clamp times were 40 min (IQR 28–53.5 minutes) and 24.5 min (IQR 13–34 minutes) respectively. The majority were extubated in the operating theatre (n=108, 89.3%). The median ICU and hospital LOS were 4.5 hrs (IQR 4.1–5.6 hours) and 4 days (IQR 4–5 days) respectively. None of the patients required readmission to the ICU within 24 hrs of discharge from the ICU. Three (3) patients (2.5%) required reintervention. When compared with the non-ERAS group, the duration of postoperative mechanical ventilation, ICU and hospital LOS were significantly lower in the ERAS group. There was no significant difference in the ICU readmission rate, reintervention rate, complication rate, and number of 30-day readmissions between both groups. ERAS after paediatric cardiac surgery is feasible and safe in select patients with low preoperative risk. This pathway reduces the duration of postoperative mechanical ventilation, ICU and hospital LOS without increasing risks, enabling the optimisation of resources. [ABSTRACT FROM AUTHOR]

Background: Same-day discharge after colectomy in enhanced recovery pathways has been shown to be feasible. It is not clear how early patients with rectal resections may be safely discharged. The study aim was to determine if patients discharged ≤ 3 days after rectal resections are associated with increased rates of emergency department (ED) visits and hospital readmissions. Methods: Retrospective analysis of enhanced recovery low anterior resection, abdominoperineal resection, and proctocolectomy patients in a prospectively maintained single institution colorectal surgery database from 01/01/2018 to 07/15/2022. Clinic visits were scheduled within 4–7 days and at 30 days after discharge, and every 1–2 weeks for stoma patients until no longer needed. Logistic regression models were used to analyze the association of discharge on postoperative days (POD)-1–3, POD-4–5, and POD ≥ 6 days with incidence of ED visits and readmissions. Results: A total of 118 patients met inclusion criteria, 76 with stomas. Median postoperative length of stay was 5 [IQR 6.5] days. Mean age was 58.6 years; 59.3% were ASA-3; and 69.5% had a minimally invasive surgical approach. ED visits were not significantly different between discharge-day groups (p = 0.096). No patients were discharged same-day, one without a stoma was discharged on POD-1, ten patients (2 with stomas) on POD-2, and twenty-four patients (13 with stomas) on POD-3. ED visits were lowest for the POD-1–3 group (14.3%) but not significantly different than later discharge groups (p = 0.166). Readmission rate was also lowest for the POD-1–3 group (11.4%) and also not significantly different than later discharge groups (p = 0.261) and this was confirmed with logistic regression. Complication rate was lowest in the POD-1–3 group (p < 0.001). Conclusion: Early discharge after enhanced recovery partial or complete proctectomy is not associated with increased ED visits and readmissions. Follow up studies should identify post-discharge resources that allow safe early discharge and that may be standardized and generalizable. [ABSTRACT FROM AUTHOR]

Since reservoirs with permeability less than 10 mD are characterized by high injection difficulty, high-pressure drop loss, and low pore throat mobilization during the water drive process, CO2 is often used for development in actual production to reduce the injection difficulty and carbon emission simultaneously. However, microfractures are usually developed in low-permeability reservoirs, which further reduces the injection difficulty of the driving medium. At the same time, this makes the injected gas flow very fast, while the gas utilization rate is low, resulting in a low degree of recovery. This paper conducted a series of studies on the displacement effect of CO2-soluble foaming systems in low-permeability fractured reservoirs (the permeability of the core matrix is about 0.25 mD). For the two CO2-soluble blowing agents CG-1 and CG-2, the effects of the CO2 phase state, water content, and oil content on static foaming performance were first investigated; then, a more effective blowing agent was preferred for the replacement experiments according to the foaming results; and finally, the effects of the blowing agents on sealing and improving the recovery degree of a fully open fractured core were investigated at different injection rates and concentrations, and the injection parameters were optimized. The results show that CG-1 still has good foaming performance under low water volume and various oil contents and can be used in subsequent fractured core replacement experiments. After selecting the injection rate and concentration, the blowing agent can be used in subsequent fractured cores under injection conditions of 0.6 mL/min and 2.80%. In injection conditions, the foaming agent can achieve an 83.7% blocking rate and improve the extraction degree by 12.02%. The research content of this paper can provide data support for the application effect of a CO2-soluble blowing agent in a fractured core. [ABSTRACT FROM AUTHOR]

Multimodal analgesia is central to pain management after total knee arthroplasty (TKA). This study aimed to evaluate the efficacy of adding oral nefopam to multimodal analgesia for post-TKA pain management. In this prospective, double-blind, placebo-controlled, randomized trial, 100 patients who underwent TKA at our hospital were randomized to either the nefopam or the control group. After surgery, patients in the nefopam group received 200 mg of celecoxib, 150 mg of pregabalin, and 40 mg of nefopam twice daily to control postoperative pain. Patients in the control group received 200 mg of celecoxib, 150 mg of pregabalin, and a placebo. Oxycodone hydrochloride (10 mg) was used as the rescue analgesic. If the pain remained poorly controlled, 10 mg of morphine hydrochloride was injected subcutaneously as a secondary rescue analgesic. The primary outcome was the postoperative consumption of oxycodone and morphine as rescue analgesics. Secondary outcomes were postoperative pain assessed using the visual analogue scale (VAS), functional recovery assessed by the range of knee motion and ambulation distance, time until hospital discharge, indicators of liver function, and complication rates. Patients in the nefopam group had significantly lower postoperative oxycodone and morphine consumption within 24 hours after surgery and during hospitalization, lower VAS pain scores at rest and during motion within 24 h after surgery, better functional recovery on postoperative days 1 and 2, and a shorter hospital stay. However, the absolute reduction in 0 to 24 h opioid consumption, VAS pain scores, and knee range of motion did not exceed the reported minimal clinically important difference. Both groups had similar indicators of liver function and complication rates. Adding oral nefopam to multimodal analgesia resulted in statistically significant improvements in opioid consumption, VAS pain scores, and functional recovery. However, the amount of improvement may not be clinically important. [ABSTRACT FROM AUTHOR]

To explore the association between intraoperative methadone use, postoperative pain, and opioid consumption after coronary artery bypass grafting (CABG) surgery. Retrospective cohort study. Single academic medical center. Patients undergoing isolated CABG over a 5-year period. None. Demographic data, comorbidities, and intraoperative anesthetic medications were recorded. Primary study outcomes were average and maximum pain scores and morphine milligram equivalent consumption on the first 2 postoperative days (PODs). Linear mixed-effects regression models were used to examine the effect of intraoperative methadone use on study outcomes. Among 1,338 patients, 78.6% received intraoperative methadone (0.2 mg/kg). Patients who did not receive methadone had higher average (estimated [Est], 0.48; 95% confidence interval [CI], 0.22-0.73; p < 0.001) and maximum postoperative (Est, 0.49; 95% CI, 0.23-0.75; p < 0.001) pain scores over PODs 0 to 2. For postoperative opioid consumption, there was a significant intraoperative methadone use–time interaction effect on postoperative opioid use (odds ratio [OR], 2.21; 95% CI, 1.74-2.80; p < 0.001). Across PODs 0 to 2, patients who received intraoperative methadone had a faster decline in postoperative opioid use than those who did not receive intraoperative methadone. Patients who did not receive intraoperative methadone were extubated slightly faster (OR, 0.82; 95% CI, 0.72-0.93; p < 0.01). Our data suggest that the use of intraoperative methadone is safe, reduces postoperative pain, and expedites weaning from postoperative opioids after CABG surgery. [ABSTRACT FROM AUTHOR]

Enhanced Recovery After Surgery (ERAS) represents evidence-based transformation in perioperative care, which has been demonstrated to reduce both recovery times and postoperative complication rates. The aim of the present study was to evaluate the clinical significance of the ERAS program in comparison with conventional postoperative care. This longitudinal cohort observational study enrolled 120 consecutive patients diagnosed with intestinal obstruction caused by colorectal cancers, with 40 patients in the ERAS group and 80 patients receiving conventional postoperative care forming the non-ERAS group. Our study compares the effectiveness of ERAS protocols to non-ERAS methods, focusing on the time to first flatus, defecation, the resumption of normal diet, and early mobilization. The main endpoints are morbidity and hospitalization length. The results showed that despite a longer admission-to-surgery interval in the ERAS group, median hospitalization was significantly shorter compared to the non-ERAS group (p = 0.0002). The ERAS group showed a tendency towards a lower incidence of overall postoperative complications, indicating that implementing the ERAS protocol does not increase the risk of postoperative complications, ensuring the safety of enhanced recovery strategies for patients. Also, ERAS patients had notably fewer stomas than those in the non-ERAS group, indicating the potential effectiveness of reducing stoma necessity. This study shows that ERAS surpasses conventional care for colonic or rectal surgery patients, reducing hospital stays and costs while enhancing recovery. This highlights the comprehensive advantages of adopting ERAS in surgical settings. [ABSTRACT FROM AUTHOR]

Background: Postoperative management after surgery for perforated peptic ulcer is still burdened by old traditions. All available data for fast‐track recovery in this setting are either very unspecific or underpowered. The aim of this study was to evaluate fast‐track recovery in this diagnosis‐specific context in a larger sample. Methods: Electronic data sources were searched. Eligible studies were randomized controlled trials (RCTs) comparing fast‐track recovery and traditional management after surgery for perforated peptic ulcer in adults. A systematic review and meta‐analysis was performed. The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines regulated the process. Quality and risk of bias assessments of individual RCTs were performed by means of the Let Evidence Guide Every New Decision criteria and the Cochrane risk‐of‐bias tool. Primary endpoints were length of hospital stay and risk of complications. Random or fixed effects modeling were applied as indicated. Outcomes were measured by mean difference and risk difference. Results: Six RCTs with a total cohort of 356 patients were included. Results of our meta‐analysis showed significantly shortened length of hospital stay (mean difference −3.50 days [95% CI ‐4.51 to −2.49], p ≤ 0.00001), significantly less superficial and deep surgical‐site infections (risk differences −0.12 [95% CI −0.20, −0.05], p = 0.002 and −0.03 [95% CI −0.09, 0.03], and p = 0.032, respectively), and significantly fewer pulmonary complications (risk difference −0.10 [95% CI −0.17, −0.03], p = 0.004) in the fast‐track group. Conclusion: This systematic review and meta‐analysis shows that fast‐track recovery after surgery for perforated peptic ulcer significantly shortened hospital stay in the studied cohort without increasing the risk of postoperative complications. [ABSTRACT FROM AUTHOR]

Enhanced Recovery After Surgery (ERAS) protocols have changed perioperative care, aiming to optimize patient outcomes. This study assesses ERAS implementation effects on postoperative complications, length of hospital stay (LOS), and mortality in colorectal cancer (CRC) patients. A retrospective real-world analysis was conducted on CRC patients undergoing surgery within a Northern Italian Cancer Registry. Outcomes including complications, re-surgeries, 30-day readmission, mortality, and LOS were assessed in 2023, the year of ERAS protocol adoption, and compared with data from 2022. A total of 158 surgeries were performed, 77 cases in 2022 and 81 in 2023. In 2023, a lower incidence of postoperative complications was observed compared to that in 2022 (17.3% vs. 22.1%), despite treating a higher proportion of patients with unfavorable prognoses. However, rates of reoperations and readmissions within 30 days post-surgery increased in 2023. Mortality within 30 days remained consistent between the two groups. Patients diagnosed in 2023 experienced a statistically significant reduction in LOS compared to those in 2022 (mean: 5 vs. 8.1 days). ERAS protocols in CRC surgery yield reduced postoperative complications and shorter hospital stays, even in complex cases. Our study emphasizes ERAS’ role in enhancing surgical outcomes and recovery.

The aim: To study the effectiveness of the enhanced recovery after surgery (ERAS) protocol for laparoscopic hernioplasty (LH) in patients with ventral hernias (VH). Materials and methods: 190 patients with VH after laparoscopic prosthetic hernioplasty with intraperitoneal mesh placement (IPOM) were included in the study and divided into two groups. The study group (ERAS group) included 92 (48.4%) patients to whom the ERAS protocol was applied, the control group (preERAS group) – 98 (51.6%) patients. The width of the hernia was more than 10 cm in 25 (13.2%) patients of the ERAS group. For them botulinum toxin type A (BTA) was injected into the muscles of the anterior abdominal wall 4 weeks before the operation. In the postoperative period, the duration of the operation, hospital length of stay, the intensity of the pain syndrome and well-being, the level of C-reactive protein (CRP) and interleukin-6 (IL-6) on the first postoperative day were evaluated. Results: After the introduction of BTA in 25 patients of ERAS group, the hernial defect decreased by an average of 4.6±0.62 mm and in all cases became less than 10 cm (р

Background: Postoperative atrial fibrillation (POAF) is a prevalent complication following cardiac surgery that is associated with increased adverse events. Several guidelines and expert consensus documents have been published addressing the prevention and management of POAF. We aimed to develop an order set to facilitate widespread implementation and adoption of evidence-based practices for POAF following cardiac surgery. Methods: Subject matter experts were consulted to translate existing guidelines and literature into a sample turnkey order set (TKO) for POAF. Orders derived from consistent class I or IIA or equivalent recommendations across referenced guidelines and consensus manuscripts appear in the TKO in bold type. Selected orders that were inconsistently class I or IIA, class IIB, or supported by published evidence appear in italic type. Results: Preoperatively, the recommendation is to screen patients for paroxysmal or chronic atrial fibrillation and initiate appropriate treatment based on individual risk stratification for the development of POAF. This may include the administration of beta-blockers or amiodarone, tailored to the patient's specific risk profile. Intraoperatively, surgical interventions such as posterior pericardiotomy should be considered in selected patients. Postoperatively, it is crucial to focus on electrolyte normalization, implementation strategies for rate or rhythm control, and anticoagulation management. These comprehensive measures aim to optimize patient outcomes and reduce the occurrence of POAF following cardiac surgery. Conclusions: Despite the well-established benefits of implementing a multidisciplinary care pathway for POAF in cardiac surgery, its adoption and implementation remain inconsistent. We have developed a readily applicable order set that incorporates recommendations from existing guidelines.

Objective Methods Results Conclusion In this study, we investigated the safety and practicability of ultra‐fast track anesthesia (UFTA) for endoscopic thoracic sympathectomy (ETS).A total of 72 patients with palmar hyperhidrosis undergoing ETS were randomly divided into three groups: the UFTA group (group I), the group undergoing single‐lumen tracheal intubation with local infiltration anesthesia technique (group II), and the group undergoing single‐lumen tracheal intubation with routine anesthesia (group III). Mean arterial pressure (MAP) and heart rate (HR) were recorded for all three groups at the following six time points: Before anesthetics administration (T0), the time of intubating or inserting laryngeal mask airway (T1), the time of incising skin (T2), the time of disconnecting of the right sympathetic nerve (T3), the time of disconnecting of the left sympathetic nerve (T4), the time of withdrawing the tracheal tube or laryngeal mask airway (T5), and the time of transferring the patient to a post‐anesthesia care unit (PACU) (T6). The three groups were compared from the following perspectives: surgery duration; anesthesia recovery duration, that is, the duration from discontinuation of anesthesia to extubating the tracheal tube; the dose of propofol and remifentanil per kilogram body mass per unit time interval (the time at the end of the procedure, which lasted from anesthesia induction to incision suturing); and the visual analog scale (VAS) in the resting state in the PACU.Based on pairwise comparisons, the average HR and average MAP values of the three groups differed significantly from T2 to T6 (p < 0.05). As demonstrated by the correlation analysis between remifentanil and propofol with HR and MAP, the doses of the total amount of remifentanil and propofol were lower, and group I used less remifentanil and propofol than group II. No patient in group I experienced throat discomfort following surgery. Patients in groups II and III experienced a range of postoperative discomfort. The VAS scores of groups I and II were significantly lower than those of group III, with group I lower than group II.When utilized in ETS, UFTA can provide effective anesthesia for minor traumas. It is safe, effective, and consistent with the enhanced recovery philosophy of fast‐track surgery departments. [ABSTRACT FROM AUTHOR]

Background: Many different regimes of intravenous and local tranexamic acid (TXA) reduce total blood loss (TBL) in patients undergoing total knee arthroplasty (TKA). However, the most effective TXA regime in reducing blood loss might not be most beneficial for the patient. The aim of the present study was to investigate the effect of commonly used TXA regimes on blood loss and on early clinical outcomes. Methods: We performed this monocentric retrospective study in patients undergoing primary TKA. Primary outcome was the estimated TBL. Secondary outcomes were the rates of adverse events (AE) as well as the range of motion (ROM), mobility and pain intensity during the first three physiotherapy sessions (PTS). Results: We analysed the data of 1250 TKAs. 5 different TXA regimes were applied. TBL (mean ± SE) was 953 ± 64 ml (2xiv), 999 ± 19 ml (2xiv + 1xlocal), 1075 ± 19 ml (1xiv + 1xlocal), 1191 ± 39 ml (1xlocal) and 1241 ± 48 ml (1xiv) (p < 0.01). In the linear regression model for TBL a lower number of TXA applications was a predictor for increased blood loss (p < 0.01). AE rates were lowest under 2xiv (0%) and 2xiv + 1xlocal (4.8%). Highest mobility and lowest pain intensity were observed under 1x iv and 2x iv. The largest portions of fully mobile patients on day three were observed under 1xiv (100%), 2xiv (100%) and 2xiv + 1local TXA (86.9%). Conclusion: Our results suggest that multiple applications of TXA are more effective in decreasing blood loss than excessive dosing of TXA. Interestingly, local use of TXA might be associated with higher pain intensity and decreased mobility on the first days after surgery. [ABSTRACT FROM AUTHOR]

Enhanced Recovery After Surgery (ERAS) protocols have changed perioperative care, aiming to optimize patient outcomes. This study assesses ERAS implementation effects on postoperative complications, length of hospital stay (LOS), and mortality in colorectal cancer (CRC) patients. A retrospective real-world analysis was conducted on CRC patients undergoing surgery within a Northern Italian Cancer Registry. Outcomes including complications, re-surgeries, 30-day readmission, mortality, and LOS were assessed in 2023, the year of ERAS protocol adoption, and compared with data from 2022. A total of 158 surgeries were performed, 77 cases in 2022 and 81 in 2023. In 2023, a lower incidence of postoperative complications was observed compared to that in 2022 (17.3% vs. 22.1%), despite treating a higher proportion of patients with unfavorable prognoses. However, rates of reoperations and readmissions within 30 days post-surgery increased in 2023. Mortality within 30 days remained consistent between the two groups. Patients diagnosed in 2023 experienced a statistically significant reduction in LOS compared to those in 2022 (mean: 5 vs. 8.1 days). ERAS protocols in CRC surgery yield reduced postoperative complications and shorter hospital stays, even in complex cases. Our study emphasizes ERAS' role in enhancing surgical outcomes and recovery. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Anaesthesia / Journal Canadien d'Anesthésie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Shale oil is stored in nanoscale shale reservoirs. To explore enhanced recovery, it is essential to characterize the flow of hydrocarbons in nanopores. Molecular dynamics simulation is required for high-precision and high-cost experiments related to nanoscale pores. This technology is crucial for studying the kinetic characteristics of substances at the micro- and nanoscale and has become an important research method in the field of micro-mechanism research of shale oil extraction. This paper presents the principles and methods of molecular dynamics simulation technology, summarizes common molecular models and applicable force fields for simulating shale oil flow and enhanced recovery studies, and analyzes relevant physical parameters characterizing the distribution and kinetic properties of shale oil in nanopores. The physical parameters analyzed include interaction energy, density distribution, radial distribution function, mean-square displacement, and diffusion coefficient. This text describes how molecular dynamics simulation explains the mechanism of oil driving in CO2 injection technology and the factors that influence it. It also summarizes the advantages and disadvantages of molecular dynamics simulation in CO2 injection for enhanced recovery of shale oil. Furthermore, it presents the development trend of molecular dynamics simulation in shale reservoirs. The aim is to provide theoretical support for the development of unconventional oil and gas. [ABSTRACT FROM AUTHOR]

Optimal pain control following esophagectomy remains a topic of contention. The aim was to perform a systematic review and network meta-analysis (NMA) of randomized clinical trials (RCTs) evaluating the analgesia strategies post-esophagectomy. A NMA was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-NMA guidelines. Statistical analysis was performed using Shiny and R. Fourteen RCTs which included 565 patients and assessed nine analgesia techniques were included. Relative to systemic opioids, thoracic epidural analgesia (TEA) significantly reduced static pain scores at 24 hours post-operatively (mean difference (MD): −13.73, 95% Confidence Interval (CI): −27.01–0.45) (n  = 424, 12 RCTs). Intrapleural analgesia (IPA) demonstrated the best efficacy for static (MD: −36.2, 95% CI: −61.44–10.96) (n = 569, 15 RCTs) and dynamic (MD: −42.90, 95% CI: −68.42–17.38) (n  = 444, 11 RCTs) pain scores at 48 hours. TEA also significantly reduced static (MD: −13.05, 95% CI: −22.74–3.36) and dynamic (MD: −18.08, 95% CI: −31.70–4.40) pain scores at 48 hours post-operatively, as well as reducing opioid consumption at 24 hours (MD: −33.20, 95% CI: −60.57–5.83) and 48 hours (MD: −42.66, 95% CI: −59.45–25.88). Moreover, TEA significantly shortened intensive care unit (ICU) stays (MD: −5.00, 95% CI: −6.82–3.18) and time to extubation (MD: −4.40, 95% CI: −5.91–2.89) while increased post-operative forced vital capacity (MD: 9.89, 95% CI: 0.91–18.87) and forced expiratory volume (MD: 13.87, 95% CI: 0.87–26.87). TEA provides optimal pain control and improved post-operative respiratory function in patients post-esophagectomy, reducing ICU stays, one of the benchmarks of improved post-operative recovery. IPA demonstrates promising results for potential implementation in the future following esophagectomy. [ABSTRACT FROM AUTHOR]

Enhanced Recovery After Surgery (ERAS) programs have been widely adopted in bariatric surgery. However, not all patients are successfully managed in the ERAS setting and there is currently little way of predicting the patients who will deviate from the program. Early identification of these patients could allow for more tailored protocols to be implemented preoperatively to address the issues, thereby improving patient outcomes. The aim of this study was to elucidate the factors which preclude discharge by comparing patients who were successfully discharged by the end of the first postoperative day (POD 0/1) to those who stayed longer, including revisional surgery in this analysis. A tertiary, high-volume Bariatric Centre, United Kingdom. A retrospective analysis was performed of all patients undergoing bariatric surgery in a single centre in 1 year. Multivariate analyses compared patient and operative variables between patients who were discharged on POD 0/1 and those who stayed longer. A total of 288 bariatric operations were performed: 78% of operations performed were laparoscopic Roux-en-Y gastric bypass; 22% laparoscopic sleeve gastrectomy. Of these cases, 13% were revisional operations. Four patients returned to theatre on the index admission. 81% of patients were discharged by POD 0/1. A re-presentation within 30 days was seen in 6% of patients. There was no significant difference in length of stay for the type of operation performed (P =.86). Patients who had a revisional procedure were not more likely to stay longer. Length of stay was also independent of age, BMI, and comorbidities. Caucasian patients were more likely to be discharged on POD 0/1 than those of other ethnicities (90% versus 78%; P =.02). Operations performed by trainee surgeons, under consultant supervision, were significantly more likely to be discharged on POD 0/1 (P =.03). However, a logistic regression analysis was unable to predict patients who had a prolonged stay. Patient length of stay is independent of BMI, operation, and comorbidities and these factors do not need special consideration in ERAS pathways. Patients undergoing revisional procedures can be managed in the same way as those having primary procedures, with a routine POD 0/1 discharge. However, the impact of individual patient factors, and their interaction, is complex and cannot predict overstay. • 81% of patients were discharged on the first post-operative day. • Revisional cases are not more likely to have a prolonged stay. • Length of stay is independent of operation, BMI and comorbidities. [ABSTRACT FROM AUTHOR]

• Electroacupuncture shortens the time to first flatus and defecation in patients receiving thoracoscopic lung surgery. • Electroacupuncture reduced incidences of abdominal distension and PONV postoperative 24 h in patients receiving thoracoscopic lung surgery. • Electroacupuncture may be considered as an adjunct strategy in enhanced recovery protocols in thoracoscopic lung surgery. To study whether perioperative electroacupuncture (EA) can improve postoperative gastrointestinal recovery in patients receiving thoracoscopic lung surgery. This study was a single-center, prospective, randomized open-label trial. 180 patients who underwent video-assisted thoracoscopic segmentectomy or lobectomy were randomized to EA group (three sessions, 24 h prior to surgery, postoperative 4 h and 24 h) or usual care group (UC group). The primary outcomes were time to first flatus and defecation. Secondary outcomes included incidence and degree of abdominal distention, postoperative nausea and vomiting (PONV) and pain scores within 72 h after surgery, postoperative morphine use, time to ambulation, and length of hospital stay. Time to first flatus (15.4 ± 3.2 h vs. 17.0 ± 3.7 h, P = 0.004) and time to first defecation (75.9 ± 7.9 vs. 79.7 ± 8.1 h, P = 0.002) in the EA group were significantly shorter than the UC group. The incidences of abdominal distension and PONV postoperative 24 h were significantly reduced in the EA group (P < 0.05). There was no difference in postoperative pain intensity, morphine use, time to ambulation, and length of hospital stay between the two groups (P>0.05). Electroacupuncture is a simple intervention for accelerating postoperative gastrointestinal recovery and may be considered as an adjunct strategy in enhanced recovery protocols in thoracoscopic lung surgery. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to explore barriers and facilitators to implementing enhanced recovery pathways, with a focus on identifying factors that distinguished hospitals achieving greater levels of implementation success. Background: Despite the clinical effectiveness of enhanced recovery pathways, the implementation of these complex interventions varies widely. While there is a growing list of contextual factors that may affect implementation, little is known about which factors distinguish between higher and lower levels of implementation success. Methods: We conducted in-depth interviews with 168 perioperative leaders, clinicians, and staff from 8 US hospitals participating in the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery. Guided by the Consolidated Framework for Implementation Research, we coded interview transcripts and conducted a thematic analysis of implementation barriers and facilitators. We also rated the perceived effect of factors on different levels of implementation success, as measured by hospitals’ adherence with 9 process measures over time. Results: Across all hospitals, factors with a consistently positive effect on implementation included information-sharing practices and the implementation processes of planning and engaging. Consistently negative factors included the complexity of the pathway itself, hospitals’ infrastructure, and the implementation process of “executing” (particularly in altering electronic health record systems). Hospitals with the greatest improvement in process measure adherence were distinguished by clinicians’ positive knowledge and beliefs about pathways and strong leadership support from both clinicians and executives. Conclusion: We draw upon diverse perspectives from across the perioperative continuum of care to qualitatively describe implementation factors most strongly associated with successful implementation of enhanced recovery pathways. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic sleeve gastrectomy (LSG) is the most common surgical treatment for morbid obesity. While certain specialized ambulatory surgery centers offer LSG on an outpatient basis, patients undergoing LSG at most academic centers are admitted to hospital for initial postoperative convalescence and monitoring. Our institution has begun to offer LSG with same-day discharge (SDD) in select patients. We aimed to compare the perioperative outcomes and costs for patients undergoing LSG with inpatient admission versus SDD. Methods: All patients enrolled in the SDD program from December 2020 through July 2022 were identified from a prospectively maintained database. Patients enrolled in this pathway were analyzed on an intention-to-treat basis even if ultimately admitted postoperatively. Propensity scoring was used to match these patients 1:1 to those with planned inpatient recovery based on age, BMI, and ASA classification. Results: Seventy-five patients were enrolled in the LSG with SDD program during the study period. Among these, 62 patients (82.7%) had successful immediate postoperative discharge. Reasons for cancelation of planned SDD included anxiety (n = 5), pain (n = 3), nausea (n = 2), and one patient each with hypotension, urinary retention, and bleeding. After matching, there were no differences in age, BMI, or ASA classification in a comparison group of patients with planned inpatient recovery. There were no differences in perioperative complications. There were no readmissions or requirements for outpatient intravenous fluids among patients with SDD, compared to n = 3 (4.0%) and n = 2 (2.7%) in the inpatient cohort, respectively. The total perioperative cost for patients undergoing LSG with planned SDD was 6.8% less than those with inpatient recovery. Conclusion: With appropriate protocols, LSG with same-day discharge can safely be performed at large academic surgery centers without increased morbidity or need for additional services in the perioperative period. SDD may be associated with decreased costs and allows for more efficient hospital bed allocation. [ABSTRACT FROM AUTHOR]

Background: Compliance to the entire Enhanced Recovery after Surgery (ERAS) protocol improves surgical recovery, where higher compliance improves outcomes. However, specific items may predict improved recovery more than others. Studies have evaluated the impact of individual ERAS recommendations though they are either single center, not based in the United States (US), or focus on colorectal procedures only. This study aims to evaluate compliance on surgical outcomes in two large healthcare systems in the US across four surgery types. Methods: Compliance to individual recommendations, limited patient characteristics, and outcomes data from two US ERAS Centers of Excellence (CoE) for hepatectomy, pancreatectomy, radical cystectomy, and head and neck (HN) resections were evaluated. Outcomes included 30‐day Clavien–Dindo≥3, readmission, mortality, and length of stay (LOS). Multivariate regressions were performed as appropriate for the data for each surgery type. Clavien≥3 was included to control for severity of complications, and the CoE variable was force‐retained. Results: A total of 2886 records were analyzed. Controlling for CoE and severity of patient complications, early removal of Foley catheter was associated with significant reductions in LOS in the liver, pancreas, and HN procedures and reductions in complications in the liver and pancreas. Limited use of NG tubes reduced LOS in the pancreas and complications in urology. Oral carbohydrate loading reduced LOS in the pancreas, and patient education reduced mortality in HN patients. Conclusions: This study reports the effect of ERAS compliance on outcomes, by surgery type, in a multi‐institutional US setting. Future studies should validate these findings and consider surgery‐specific predictive models comprised of individual ERAS recommendations in real‐world applications. [ABSTRACT FROM AUTHOR]

The environmental impact of healthcare is an issue currently examined with increased scrutiny and on a global scale with multiple stakeholders seeking to identify the appropriate interventions to reduce it. Interestingly, a significant portion of healthcare's environmental impact stems from intensive modalities of treatment for chronic disease. There is no better example than End-Stage Renal Disease (ESRD), where dialysis or transplantation are the modalities of treatment offered to the vast majority of these patients. Kidney transplantation (KTx) offers a longer life expectancy and improved quality of life in comparison to dialysis. Cost-effectiveness analyses have proven its financial superiority, as well. PubMed and EMBASE literature search using keywords "kidney transplantation", "carbon footprint", "sustainability" showed that there is no published work in the field of environmental sustainability in kidney transplantation. Relevant literature was identified for surgical services and applied to transplantation. Assuming its environmental superiority to dialysis, maximising KTx rate would be an important action towards "green" renal care services. That could be achieved through living organ donation, systematic use of machine perfusion for extended criteria deceased donors and individualised immune risk stratification techniques. All these measures aim towards implementing enhanced recovery protocols and two vital steps can be taken towards assessing their value. The first step is a detailed audit of the environmental impact of these novel techniques and secondly their impact in reducing the length of hospital stay and its subsequent environmental impact. Another key element is delivering appropriate post-operative care, substituting allograft biopsy with non-invasive techniques and reducing physical outpatient follow-up, using telemedicine. The gap in quantifying KTx services environmental impact needs to be addressed urgently, with development of strategies within the multidisciplinary transplant team. Introducing novel technologies can lead to donor pool expansion and improved organ utilisation rates, transforming transplant services in "green" hubs. [Display omitted] • Kidney transplantation offers improved survival and quality of life compared to dialysis. • Kidney transplantation is financially more sustainable than dialysis services. • Haemodialysis and Peritoneal dialysis have heavy composite environmental footprints. • There is no current knowledge of the carbon footprint of kidney transplantation. • There are novel technologies that can help provide "greener" transplant services. • These technologies apply to pathways from pre-transplant assessment to post-transplant care. [ABSTRACT FROM AUTHOR]

Objective To observe the effect of low-frequency electrical stimulation on the rehabilitation of patients after gynecological abdominal surgery. Methods Sixty-three patients who underwent open surgery in gynecology department of Taixing Clinical College of Bengbu Medical College from June 2021 to July 2022 were selected. The patients were randomly divided into control group (31 cases) and a low-frequency electrical stimulation group (32 cases). The low-frequency electrical stimulation group was subjected to stimulation within the patient's tolerable range once a day for 30 minutes each time, and the intensity of each stimulation was adjusted based on clinical situation. The control group selected the same acupoints and pasted electrodes, connected to the treatment device but no electrical stimulation. The electrode strip was removed after 30 minutes,then record the postoperative Visual Analog Scale (VAS) score as well as the time from the end of the surgery to the first discharge and defecation. Results The VAS score at 48 hours after surgery showed a low degree of pain in the low-frequency electrical stimulation group (3.6±1.2) compared to that in control group (4.5±1.4); After 72 hours of surgery, the VAS score was lower in the low-frequency electrical stimulation group (1.7±0.9) compared to the control group (3.3±1.4), indicating a lower degree of pain. The first exhaust time (26.9±6.7)h vs. (35.5±13.0)h was shorter in the low-frequency electrical stimulation group; The first bowel movement time (49.0±5.4)h vs. (64.4±13.8)h was shorter in the low-frequency electrical stimulation group compared to the control group. Conclusions Low frequency electro-physiological stimulation can alleviate post-operative pain and shorten exhaust and defecation time in patients undergoing gynecological open surgery.

Background: Enhanced recovery after surgery (ERAS) is a new and evolving concept whereby strategies are put in place in the perioperative period to ensure better and accelerated patient recovery with fewer complications. Being a new protocol in our milieu, the need for pre-implementation trials motivated our study in elective caesarean section (CS) in the Yaoundé Gyneco-Obstetric and Pediatric Hospital (YGOPH). Aims: To analyse the benefits of the enhanced recovery after caesarean section program (ERAS) over standard care in women undergoing elective caesarean section in the Yaoundé Gyneco – Obstetric and Paediatric Hospital. Materials and Methods: A single-blinded randomized controlled trial, in the ratio 1:1, from December 2020 to August 2021, compared the ERAS in caesarean section (ERAS-CS) treatment package, with our standard care package (Non-ERAS group).The ERAS-CS package included pre-operative counselling, reduced pre-operative fast, warming of fluids intraoperatively, use of Dexamethasone and Ondansetron (to prevent post-operative nausea and vomiting) and early oral feeding as well as early mobilisation. Satisfaction 24 hours after surgery as well as complications were evaluated in both groups. Data analysis was with STATA. Results: We enrolled 42 women , 21 in each arm. Average age of participants was 31.9 years. A body temperature drop of 0.6 degree Celsius in the ERAS group versus 1.7 degree Celsius in N-ERAS group, p=0.001 was noted. Intraoperative nausea and vomiting (IONV) was significantly decreased in the ERAS group (p=0.038) as well as per-operative hunger and cold. ERAS patients felt significantly more capable of looking after their personal toileting and hygiene, and in control with a greater feeling of well-being than those in the N-ERAS group, 24 hours after surgery. Conclusion: The ERAS-CS program led to fewer per and post-operative complications, and faster recovery of patients.

A sufficient omega-3 index may enhance cardiovascular function, enhance performance, and decrease inflammation. However, most collegiate athletes are deficient in omega-3s, requiring supplementation. A new type of omega-3 (N3) supplement, Enhanced Recovery™ (ER), claims to improve N3 index while addressing the current issues with traditional supplementation. The purpose of this study was to determine if ER improves N3 status and enhances compliance compared with the current standard in collegiate Division I Track and Field and cross-country athletes during a competitive season. Twenty-five (male = 15 and female = 10) athletes completed this longitudinal, randomized controlled crossover trial. Measurements of N3 status were collected at baseline prior to supplementation, and every 2 weeks for 6 weeks with a 33- to 36-day washout period before crossing over. Supplement compliance and dietary intake of N3 rich foods were collected throughout. Visual analog scales and an exit survey asked questions regarding each treatment. Results showed that N3 index increases within 6 weeks (p <.001) for ER (+37.5%) and control (CON; +55.1%), with small differences between treatments at Weeks 4 (ER = 7.3 ± 1.0; CON = 7.7 ± 1.1; p =.043) and 6 (ER = 7.4 ± 1.2; CON = 7.9 ± 1.2; p =.043). Dietary intake of N3-rich foods and supplement compliance were significant drivers of improvements in N3 status (p <.050). Compliance was not different between treatments but was affected by sex (males = 90.0 ± 17.0% and females = 76.5 ± 21.0%; p =.040), likability (p =.001; r =.77, p <.001), ease (p =.023; r =.53, p =.006), and supplement preference (p =.004), which appeared to favor ER. We conclude that consumption of N3-rich foods and consistent supplementation should be implemented for improvements in N3 status in collegiate athletes, but taste tests/trial periods with ER or CON may help determine preference and improve compliance. [ABSTRACT FROM AUTHOR]

Objective Acute type A aortic dissection (ATAAD) is a devastating cardiovascular disease with extraordinary morbidity and mortality. Prolonged mechanical ventilation (PMV) is a common complication following ATAAD surgery, leading to adverse outcomes. This study aimed to investigate the correlation between mechanical ventilation time (MVT) and prognosis and to devise a nomogram for predicting PMV after ATAAD surgery.Methods This retrospective study enrolled 1049 ATAAD patients from 2011 to 2019. Subgroups were divided into < 12 h, 12 h to < 24 h, 24 h to < 48 h, 48 h to < 72 h, and ≥ 72 h according to MVT. Clinical characteristics and outcomes were compared among the groups. Using multivariable logistic regression analyses, we investigated the relationship between each stratification of MVT and mortality. A nomogram was constructed based on the refined multivariable logistic regression model for predicting PMV.Results The total mortality was 11.8% (124/1049). The results showed that the groups with MVT 48 h to < 72 h and ≥ 72 h had significantly higher operative mortality compared to other MVT categories. Multivariate logistic regression analysis showed that MVT ≥72 h was significantly associated with higher short-term mortality. Thus, a nomogram was presented to elucidate the association between PMV (MVT ≥72 h) and risk factors including advanced age, preoperative cerebral ischemia, ascending aorta replacement, concomitant coronary artery bypass grafting (CABG), longer cardiopulmonary bypass (CPB), and large-volume intraoperative fresh frozen plasma (FFP) transfusion. The nomogram exhibited strong predictive performance upon validation.Conclusions Safely extubating patients within 72 h after ATAAD surgery is crucial for achieving favorable outcomes. The developed and validated nomogram provides a valuable tool for predicting PMV and optimizing postoperative care to improve patient prognosis. This novel nomogram has the potential to guide clinical decision-making and resource allocation in the management of ATAAD patients.

This study explored the safety and efficacy of Enhanced Recovery After Surgery (ERAS) together with a Day-surgery protocol on some commonly used selection criteria for expedited discharge after Total Knee Arthroplasty (TKA). ERAS Day surgery TKA performed between Aug 2020 to July 2021 were included in this study. Discharge within 24 h was considered passing protocol. Complications such as infection, re-admission, and re-operation within 30-days were recorded. Patient demographics, medical comorbidities, and outcome measures at 6-month post-operatively were analysed between those who were successfully discharged within 24 h and those with prolong admission. A total of 342 patients were included in the study. 315 patients (92.1 %) were discharged within 24 h s. Inadequately controlled pain was the most common reason for delayed discharge (17.9 %). No statistically significant difference in gender, age, Charlson Comorbidity Index (CCI), Body Mass Index (BMI), and American Society of Anaesthesiologist Classification (ASA) were noted between patients who failed protocol and those who passed. Readmission rate within 30days was 2.6 %. Infection occurred in 5 cases, including 2 prosthetic joint infection (PJI) requiring debridement, antibiotics, and implant retention (DAIR), 2 surgical site infection treated with antibiotics, and 1 pneumonia. No 30-days complication occurred in patients who initially failed ERAS Day-surgery protocol. Binary logistic regression was statistically insignificant on effect of gender, age, CCI, BMI, and ASA on passing protocol or 30-days complications. Propensity score matching of patients with prolong stay of more than 24 h did not demonstrate any difference in 6-month outcome. Patient characteristics such as gender, age, CCI, BMI, and ASA did not influence successful completion of ERAS Day-surgery protocol. Even if patients were initially enrolled in ERAS Day-surgery protocol but failed to be discharged within 24 h, this did not predispose them to increased 30-days complication or poorer 6-month outcome. III. [ABSTRACT FROM AUTHOR]

Copyright of Anaesthesiologie & Intensivmedizin is the property of DGAI e.V. - Deutsche Gesellschaft fur Anasthesiologie und Intensivmedizin e.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Enhancing oil recovery in shale is a critical technology for improving shale oil extraction efficiency. It is essential to develop a comprehensive set of physical simulation methods that are coherent and aligned with practical field operations. This paper establishes an integrated experimental approach, encompassing the entire Injecting-Stewing-Producing cycle, to simulate the actual Huff-n-Puff process accurately. Initially, the fracturing and flowback states are simulated by injecting an imbibition fluid, followed by a 48 h well-soaking process using CO2. The extraction is then carried out under various pressures. The microtransportation of crude oil across different pore sizes and the extent of extraction during shale oil Huff-n-Puff are investigated using Nuclear Magnetic Resonance technology. The results suggest that there was an initial increase in crude oil within pores smaller than 20 nm at the beginning of the Huff-n-Puff process. In Contrast, crude oil in pores larger than 200 nm was preferentially extracted, with oil in smaller pores (<200 nm) migrating to larger pores before extraction. After the initial Huff-n-Puff cycle, the extraction efficiency of the shale oil core reaches 29.55%, constituting 63.3% of the total extraction achieved over three Huff-n-Puff cycles. This study also identifies a critical pressure drop to 60% of the initial pressure as the optimal point for injection in subsequent Huff-n-Puff cycles. These experimental insights provide valuable guidance for the practical implementation of enhanced oil recovery techniques in shale formations. [ABSTRACT FROM AUTHOR]

The present review discusses restrictive perioperative fluid protocols within enhanced recovery after surgery (ERAS) pathways. Standardized definitions of a restrictive or liberal fluid regimen are lacking since they depend on conflicting evidence, institutional protocols, and personal preferences. Challenges related to restrictive fluid protocols are related to proper patient selection within standardized ERAS protocols. On the other hand, invasive goal-directed fluid therapy (GDFT) is reserved for more challenging disease presentations and polymorbid and frail patients. While the perfusion rate (mL/kg/h) appears less predictive for postoperative outcomes, the authors identified critical thresholds related to total intravenous fluids and weight gain. These thresholds are discussed within the available evidence. The authors aim to introduce their institutional approach to standardized practice. [ABSTRACT FROM AUTHOR]

Objective To observe the effect of low-frequency electrical stimulation on the rehabilitation of patients after gynecological abdominal surgery. Methods Sixty-three patients who underwent open surgery in gynecology department of Taixing Clinical College of Bengbu Medical College from June 2021 to July 2022 were selected. The patients were randomly divided into control group (31 cases) and a low-frequency electrical stimulation group (32 cases). The low-frequency electrical stimulation group was subjected to stimulation within the patient's tolerable range once a day for 30 minutes each time, and the intensity of each stimulation was adjusted based on clinical situation. The control group selected the same acupoints and pasted electrodes, connected to the treatment device but no electrical stimulation. The electrode strip was removed after 30 minutes,then record the postoperative Visual Analog Scale (VAS) score as well as the time from the end of the surgery to the first discharge and defecation. Results The VAS score at 48 hours after surgery showed a low degree of pain in the low-frequency electrical stimulation group (3.6±1.2) compared to that in control group (4.5±1.4); After 72 hours of surgery, the VAS score was lower in the low-frequency electrical stimulation group (1.7±0.9) compared to the control group (3.3±1.4), indicating a lower degree of pain. The first exhaust time (26.9±6.7)h vs. (35.5±13.0)h was shorter in the low-frequency electrical stimulation group; The first bowel movement time (49.0±5.4)h vs. (64.4±13.8)h was shorter in the low-frequency electrical stimulation group compared to the control group. Conclusions Low frequency electro-physiological stimulation can alleviate post-operative pain and shorten exhaust and defecation time in patients undergoing gynecological open surgery. [ABSTRACT FROM AUTHOR]

Purpose: The study aims to analyze the enhanced recovery protocol's (ERP) effectiveness in a comparative study of elective surgeries for ureteropelvic junction obstruction (UPJO). Methods: The prospective study included 30 patients with UPJO who underwent laparoscopic pyeloplasty in 2018-2021. Results: Postoperative complications developed rarely, and their frequency and severity were comparable. Independent predictors of UPJO recurrence were the spine osteochondrosis >II period (HR 13.97; 95% CI 1.26; 154.8; p=0.032), the concretions self-discharge (HR 28.49; 95% CI 1.78; 455.62; p=0.018), surgical operation duration > 110 minutes (HR 44.7; 95% CI 3.95; 505.4; p=0.002) and previous nephrostomy (HR 1.07; 95% CI 1.02; 1.13; p=0.002). Conclusions: In the surgical treatment of UPJO, it is advisable to use ERPs, as this allows achieving a better treatment quality with comparable results. [ABSTRACT FROM AUTHOR]

This retrospective study aimed to examine the safety and clinical outcomes of enhanced recovery after single-site robotic staging surgery in patients with endometrial cancer. Data were collected from Seoul St. Mary's Hospital's electronic medical records between July 2017 and August 2021. All the included endometrial cancer patients underwent single-site robotic staging surgery followed by enhanced recovery after surgery based on the guidelines for enhanced recovery after surgery society recommendations. The factors assessed were survival outcomes, complications and postoperative adjuvant therapy. Of the 60 patients included in this study, four (6.7%) experienced grade III postoperative complications within 30 days after surgery. Additionally, there were five cases (8.3%) that required a visit to the emergency room and two cases (3.3%) that necessitated readmission. Seventeen patients (28.3%) received postoperative adjuvant therapy, with treatment initiated 8 weeks after staging surgery in 14 patients (23.3%) and over 8 weeks in three patients (5.0%). The follow-up duration averaged 32.0 months (range, 3 to 60 months). No mortality was recorded during the follow-up period after staging surgery. The recurrence rate was 5.0% (n = 3), and the 3- year progression-free survival rate for the endometrioid type was 94.3%. These findings suggest that enhanced recovery after single-site robotic staging surgery is feasible for patients with endometrial cancer, yielding similar clinical outcomes and manageable complications without extending the time to adjuvant therapy initiation. However, further studies are necessary to investigate the long-term survival outcomes associated with enhanced recovery after surgery application. [ABSTRACT FROM AUTHOR]

Laparoscopic sleeve gastrectomy (LSG) is an effective bariatric surgery option for managing extreme obesity in most patients. While non-steroidal anti-inflammatory drugs (NSAIDs) promise postoperative pain management after bariatric surgeries, their safety in LSG remains unexplored. In this systematic review, we studied the safety of NSAIDs following LSG reported by six studies involving 588 patients. Our study demonstrated that NSAIDs effectively alleviated the postoperative pain after LSG without major safety concerns. Most reported (>20% incidence) adverse events included postoperative nausea and vomiting (PONV, 21%). For patients undergoing LSG, NSAIDs offer a valuable option for pain management and improved care, potentially reducing opioid consumption. However, additional research is required to optimize NSAID usage and ensure safety, especially concerning renal and gastrointestinal issues. [ABSTRACT FROM AUTHOR]

Introduction: Femoral stem subsidence can lead to aseptic loosening after total hip arthroplasty (THA). Low bone mineral density (BMD) is a risk factor for stem subsidence as it can affect the initial stability and osteointegration. We evaluated whether reduced bone mineral density is related to higher subsidence of the femoral stem after primary cementless THA with enhanced recovery rehabilitation. Methods: 79 patients who had undergone primary cementless THA with enhanced recovery rehabilitation were analyzed retrospectively. Subsidence of the femoral stem was measured on standing pelvic anterior–posterior radiographs after 4–6 weeks and one year. Patient individual risk factors for stem subsidence (stem size, canal flare index, canal fill ratio, body mass index (BMI), demographic data) were correlated. Dual X-ray absorptiometry (DXA) scans were performed of the formal neck and the lumbar spine including the calculation of T-score and Z-score. Patient-reported outcome measures were evaluated 12 months postoperatively. Results: Stem subsidence appeared regardless of BMD (overall collective 2.3 ± 1.64 mm). Measure of subsidence was even higher in patients with normal BMD (2.8 ± 1.7 mm vs. 2.0 ± 1.5 mm, p = 0.05). High BMI was correlated with increased stem subsidence (p = 0.015). Subsidence had no impact on improvement of patient-related outcome measures (WOMAC, EQ-5D-5L and EQ-VAS) after THA. Patients with low BMD reported lower quality of life 12 month postoperatively compared to patients with normal BMD (EQ-5D-5L 0.82 vs. 0.91, p = 0.03). Conclusion: Stable fixation of a cementless stem succeeds also in patients with reduced BMD. Regarding stem subsidence, enhanced recovery rehabilitation can be safely applied in patients with low BMD. [ABSTRACT FROM AUTHOR]

Background: With the Covid-19 pandemic reducing the capacity to perform elective bariatric surgical cases, a multidisciplinary approach to reducing length of stay has been essential to continue providing this service. In conjunction with the use of our local ERAS protocols, same day discharge (SDD) and early next day discharge (NDD) for bariatric surgery is becoming more of a reality. Objectives: To evaluate the effectiveness of our new protocols targeted at reducing length of stay (LOS) for our bariatric surgery patients during the pandemic. Secondary outcomes included comparisons of readmission and complications compared to baseline data. Methods: The MBSAQIP data set was analyzed identifying patients who underwent laparoscopic roux-en- Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (SG) from April to November 2021. Mean LOS and complication rates including re-admission in this baseline group were documented. This was compared to a cohort who underwent the surgeries between December 2021 and February 2022 under our new protocols for early discharge. Results: 195 patients underwent bariatric surgery in the baseline group and 87 patients in the early discharge cohort were included. There was a statistically significant decrease in mean LOS comparing baseline group (34.5 h) and next day PACU discharges (25 h) with P = 0.004. No increase in complication rate from the early discharge cohort against the baseline group. (P = 0.014). Conclusion: SDD and NDD in carefully selected bariatric surgery patients is feasible with good outcomes. With ERAS protocols as a foundation and a multidisciplinary approach, this can be achieved in spite of pressures placed on bariatric units by the pandemic. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess sleep quality in patients undergoing total hip arthroplasty (THA) from preoperatively to 12 weeks postoperatively and to establish a risk predictor for postoperative sleep disturbance to enable early care and intervention. A self-designed data collection form was used. Patients were assessed preoperatively and at 5 postoperative time points using visual analog scale (VAS) for pain, sleep quality and neuropsychological status with the following assessment tools: the Chinese versions of the Pittsburgh Sleep Quality Index (CPSQI), the Epworth Sleepiness Scale (CESS), the Zung Self-Rating Anxiety Scale (ZSAS) and the Epidemiological Studies Depression Scale (CESD). Univariate and multivariate logistic regression analysis was used for the identification of risk factors for postoperative sleep disturbance. The receiver operating characteristic (ROC) curve was plotted to evaluate the regression model. Of the 290 eligible patients, 193 (133 women) were included in the study. There was a 60.6% prevalence of preoperative sleep disturbance. The CPSQI score increased significantly at 2 weeks postoperatively compared to preoperative baseline, but appeared to decrease at 4 weeks postoperatively. Multivariate logistic regression analysis showed that pain (VAS score: OR = 1.202 [95% CI = 1.002–1.446, P < 0.05]), daytime sleepiness (CESS score: OR = 1.134 [95% CI = 1.015–1.267, P < 0.05]) and anxiety (ZSAS score: OR = 1.396 [95% CI = 1.184–1.645, P < 0.001]) were risk factors associated with postoperative sleep disturbance at 2 weeks. The ROC curve showed that the AUC was 0.762, the sensitivity was 83.19% and the specificity was 64.86%. Postoperative sleep disturbance is highly prevalent in the first 2 weeks after THA. The risk prediction model constructed according to the above factors has good discriminant ability for the risk prediction of sleep disturbance after THA. The use of this risk prediction model can improve the recognition of patients and medical providers and has good ability to guide clinical nursing observation and early screening of sleep disturbance after THA. [ABSTRACT FROM AUTHOR]

Objective To explore the safety and efficacy of single-port laparoscopic choledochal cyst excision and Roux-en-Y hepaticojejunostomy (SPCH). Methods Between January 1, 2018, and December 31, 2022, 62 consecutive cases of choledochal cysts were recruited. The procedure was either SPCH (n=43) or multiple-port laparoscopic choledochal cysts excision and Roux-en-Y hepaticojejunostomy (MPCH) (n=19). Magnetic resonance cholangiopancreatography (MRCP) was performed. Baseline clinical characteristics, short-term efficacy and safety outcomes were examined through reviewing the relevant medical records. Results No significant inter-group differences existed in such baseline clinical characteristics as gender, operative age, Todani classification, clinical presentation, prenatal diagnosis & longest diameter of cyst. Average postoperative hospitalization stay of SPCH group was shorter than that of MPCH group (7. 14±2. 70 vs. 7. 58±3. 27 day, P=0. 892). However, the inter-group difference was not statistically significant. Operative duration (266. 79±69. 39 vs. 277. 32±90. 23 min, P=0. 913) and volume of blood loss (8. 88±12. 37 vs. 16. 68±34. 84 mL, P=0. 758) were similar between two groups. MPCH group had a significantly higher number of drainage tubing than SPCH group (11 vs. 7;P=0. 0009). One child in SPCH group developed stenosis after hepaticojejunostomy. During follow-ups, no other complications occurred. Conclusions SPCH is as safe and effective as MPCH for choledochal cysts. It helps to lower the difficulty of single-incision laparoscopy. [ABSTRACT FROM AUTHOR]

Mobilisation difficulties, due to muscle weakness, and urinary retention are common reasons for prolonged admission following hip and knee arthroplasty procedures. Whether spinal anaesthesia is detrimental to early mobilisation is controversial. Previous studies have reported differences in post‐operative recovery between spinal anaesthesia and general anaesthesia; however, up‐to‐date comparisons in fast‐track setups are needed. Our randomized, single‐blinded, multi‐centre, clinical trials aim to compare the post‐operative recovery after total hip (THA), total knee (TKA), and unicompartmental knee arthroplasties (UKA) respectively when using either spinal anaesthesia (SA) or general anaesthesia (GA) in a fast‐track setup. Included patients (74 THA, 74 TKA, and 74 UKA patients) are randomized (1:1) to receive either SA (2 mL 0.5% Bupivacaine) or GA (Induction: Propofol 1.0–2.0 mg/kg iv with Remifentanil 3–5 mcg/kg iv. Infusion: Propofol 3–5 mg/kg/h and Remifentanil 0.5 mcg/kg/min iv). Patients undergo standard primary unilateral hip and knee arthroplasty procedures in an optimized fast‐track setup with intraoperative local infiltrative analgesia in TKA and UKA, post‐operative multimodal opioid sparing analgesia, immediate mobilisation with full weightbearing, no drains and in‐hospital only thromboprophylaxis. Data will be collected on the day of surgery and until patients are discharged. The primary outcome is the ability to be safely mobilised during a 5‐m walking test within 6 h of surgery. Secondary outcomes include fulfilment of discharge criteria, post‐operative pain, dizziness, and nausea as well as patient reported recovery and opioid related side effects. Data will also be gathered on all hospital contacts within 30‐days of surgery. This study will offer insights into advantages and disadvantages of anaesthetic methods used in fast‐track arthroplasty surgery. [ABSTRACT FROM AUTHOR]