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Implementation and achievements of enhanced recovery after surgery program in perioperative management of gastric cancer patients† Cover

Implementation and achievements of enhanced recovery after surgery program in perioperative management of gastric cancer patients†

Open Access
|Dec 2023

Figures & Tables

Postoperative outcomes_

Programsn (%)
Postoperative complications
  Gastroplegia8 (2.4)
  Pulmonary complication1 (0.3)
  Anastomotic leakage1 (0.3)
  Bleeding1 (0.3)
Unplanned reoperation1 (0.3)
Costs (in thousands, ¥)59.5 ± 14.5
Hospital stay (d)12 (5, 36)
Mortality0

Characteristics of the gastric cancer patients_

Variablesn (%)
Gender
  Male252 (76.6)
  Female77 (23.4)
Age (years)63.8 ± 10.6
Height (cm)166.2 ± 7.5
Body weight (kg)63.6 ± 11.0
Education background
  Senior high school or below287 (87.2)
  Junior college19 (5.8)
  Bachelor degree or above23 (7.0)
Economic status
  Below local level55 (16.7)
  In line with the local level250 (76.0)
  Above local level24 (7.3)
Diseases history
  Hypertension127 (38.6)
  Diabetes mellitus34 (10.3)
  Heart disease22 (6.7)
  Others34 (10.3)
Number of complications
  1106 (32.2)
  247 (14.3)
  ≥317 (5.2)
Number of previous surgeries
  1110 (33.4)
  220 (6.1)
  ≥39 (2.7)
Family history
  Yes13 (4.0)
  No316 (96.0)
Radiotherapy
  Yes5 (1.5)
  No324 (98.5)
Chemotherapy
  Yes22 (6.7)
  No307 (93.3)
Smoking
  Yes133 (40.4)
  No196 (59.6)
Drinking
  Yes103 (31.3)
  No226 (68.7)

Implementation of ERAS protocols during postoperative period (N=329)_

ProgramsValue, n (%)
Postoperative oxygen therapy (h)27.0 ± 18.4
Thromboprophylaxis
  Compression stocking8 (2.4)
  Low-molecular-weight heparin214 (65.0)
  Combined107 (32.5)
Antibiotics (days after operation)
  1116 (35.3)
  273 (22.2)
  ≥3140 (42.5)
Postoperative diet initiation (days after operation)
  1–20 (0)
  34 (1.2)
  457 (17.3)
  Upon gas passage268 (81.5)
Intravenous fluid administration (days after operation)
  1–30 (0)
  49 (2.7)
  ≥5320 (97.3)
Early mobilization on the bed (hours after operation)9.5 ± 12.3
Early ambulation (hours after operation)39.5 ± 12.5
Respiratory function training
  Conventional method292 (88.8)
  Respiratory training device37 (11.2)
  Nutritional support after surgery329 (100)
Passage of flatus (days after surgery)
  1–27 (2.1)
  359 (17.9)
  ≥4263 (79.9)
Removal of nasogastric tube (days after surgery)
  151 (15.5)
  277 (23.4)
  369 (21.0)
  ≥4132 (40.1)
Removal of urinary catheter (days after surgery)
  10 (0)
  24 (1.2)
  3108 (32.8)
  ≥4217 (66.0)

Implementation of ERAS programs during preoperative period_

Programsn (%)
Smoking cessation (weeks) (n = 133)
  No41 (30.8)
  <846 (34.6)
  ≥846 (34.6)
Drinking cessation (weeks) (n = 103)
  No30 (29.1)
  <435 (34.0)
  ≥438 (36.9)
Preoperative patient education and counseling329 (100)
Avoidance of preoperative mechanical bowel preparation80 (24.3)
Preoperative fasting (before surgery) (h)
  ≥2411 (3.3)
  12–24202 (61.4)
  6–12116 (35.3)
Administration of carbohydrate-rich drink before surgery
  Yes2 (0.6)
  No327 (99.4)
Nutritional support before surgery
  Yes124 (37.7)
  No205 (62.3)
Caprini score before surgery
  0–1 (extremely low-risk)8 (2.4)
  2 (low-risk)31 (9.4)
  3–4 (medium-risk)204 (62.0)
  ≥5 (high-risk)86 (26.1)
Thromboprophylaxis
  No196 (59.6)
  Compression stocking115 (35.0)
  Low-molecular-weight heparin18 (5.4)
Respiratory function training
  Yes37 (11.2)
  No292 (88.8)

Implementation of ERAS programs during operation (N=329)_

Programsn (%)
Type of operation
  Proximal gastrectomy31 (9.4)
  Distal gastrectomy172 (52.3)
  Total gastrectomy126 (38.3)
  Maintaining normothermia329 (100)
Prophylactic antibiotics
  Yes38 (11.6)
  No291 (88.4)
Nasogastric tube insertion329 (100)
Abdominal drainage329 (100)
Urinary drainage tube329 (100)
Pain control
  Epidural analgesia268 (81.5)
  Intravenous analgesia61 (18.5)
Blood transfusion
  Yes17 (5.2)
  No312 (94.8)
Combined viscerectomy
  Yes26 (7.9)
  No303 (92.1)
Thromboprophylaxis
  No196 (59.6)
  Compression stocking133 (40.4)
Fluid management329 (100)
DOI: https://doi.org/10.2478/fon-2023-0046 | Journal eISSN: 2544-8994 | Journal ISSN: 2097-5368
Language: English
Page range: 437 - 443
Submitted on: Nov 25, 2022
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Accepted on: Feb 2, 2023
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Published on: Dec 18, 2023
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year

© 2023 Ya-Min Yan, Yan Hu, Jing-Jing Lu, Jia-Wen Yuan, Xiao-Hong Ni, Li-Rong Shi, Zheng-Hong Yu, published by Shanxi Medical Periodical Press
This work is licensed under the Creative Commons Attribution 4.0 License.