The anesthetic work of day surgery should be guided by the standardized perioperative evaluation system. The evaluation methods and standards with strong operability and repeatability are the prerequisites to ensure the safety and efficiency of day surgery. For the assessment of patients’ preoperative physiological status, preoperative preparation and postoperative rehabilitation, standardized work procedures should be established to ensure patients’ medical safety to the greatest extent. Through summarizing the advanced management experience of day surgery anesthesia at home and abroad, and combining with the principled suggestions in The Consensus of Chinese Experts on Anaesthesia for Day Surgery, the First Affiliated Hospital of Dalian Medical University has repeatedly revised the perioperative anesthesia evaluation methods in practice, and gradually explored a comprehensive, rigorous and standardized perioperative anesthesia evaluation system. This paper will focus on the evaluation of perioperative anesthesia and postoperative follow-up procedures in day surgery.
Objective To investigate the perioperative clinical effects and follow-up results of minimally invasive coronary artery bypass grafting (MICS CABG) versus conventional coronary artery bypass grafting (CABG) in thoracotomy. Methods The patients who received off-pump CABG in Beijing Anzhen Hospital from January 2017 to October 2021 were collected. Among them, the patients receiving MICS CABG performed by the same surgeon were divided into a minimally invasive group, and the patients receiving median thoracotomy were into a conventional group. By propensity score matching, preoperative data were balanced. Perioperative and postoperative follow-up data of the two groups were compared. Results A total of 890 patients were collected. There were 211 males and 28 females, aged 60.54±9.40 years in the minimally invasive group, and 487 males and 164 females, aged 62.31±8.64 years in the conventional group. After propensity score matching, there were 239 patients in each group. Compared with the conventional group, patients in the minimally invasive group had longer operation time, shorter drainage duration, less drainage volume on the first postoperative day, shorter postoperative hospital stay, and lower rate of positive inotropenic drugs use, while there was no statistical difference in the mean number of bypass grafts, ICU stay, ventilator-assisted time, blood transfusion rate or perioperative complications (P＞0.05). During the median follow-up of 2.25 years, there was no statistical difference in major adverse cardiovascular and cerebrovascular events, including all-cause death, stroke or revascularization between the two groups (P＞0.05). ConclusionReasonable clinical strategies can ensure perioperative and mid-term surgical outcomes of MICS CABG not inferior to conventional CABG. In addition, MICS CABG has the advantages in terms of postoperative hospital stay, postoperative drainage volume, and rate of positive inotropic drugs use.
Objective To explore the factors associated with clinic follow-up of old patients with colorectal cancer and provide more evidence to improve the efficiency and quality of clinic follow-up after sugery. Methods The data of 253 patients who were underwent sugery because of old colorectal cancer in our hospital from January 2009 to May 2010 were reviewed. Data about the rate and times of clinic follow-up within 6 months after operation were collected via Hospital Information Systerm,??then the follow-up rate was calculated,??and to analyse the possible factors associated with follow-up times and rate. Results The total follow-up rate was 84.2%（213/253）,??and the total times of follow-up was between 0 to 24 times per one,??（4.08±0.03）times on average. On the times of follow-up,??patients inside the city was higher than that outside,??patients with medical or postoperative complications were higher than those without,??and patients with a stoma was lower than that without,??and the differences were statistically significant （P＜0.05）.While on the follow-up rate,??patients underwent a radical sugery or with a stoma were lower than those not or without,??and the differences were statistically significant （P＜0.05）. Conclusions The clinic follow-up of old colorectal cancer patients is not satisfactory,??and the possible factors associated with follow-up times or rate are the distance between residence and hospital,?have medical complications or not,??have postoperative complications or not,??radical sugery or not,??and with a stoma or without.
ObjectiveTo compare the 5-year survival rates between two different follow-up patterns of postoperative stage Ⅰ-ⅢA non-small cell lung cancer (NSCLC) patients.MethodsPathological stage Ⅰ-ⅢA NSCLC 11 958 patients who underwent surgical resection and received follow-up within 6 months after initial diagnosis through telephone follow-up system were included in nine hospitals from July 2014 to July 2020. The patients were divided into two groups including a proactive follow-up group (n=3 825) and a passive follow-up group (n=8133) according to the way of following-up. There were 6 939 males and 5 019 females aged 59.8±9.5 years. The Kaplan-Meier and Cox proportional hazards regression model were used.ResultsThe median follow-up frequency was 8.0 times in the proactive follow-up group and 7.0 times in the passive follow-up group. The median call duration was 3.77 minutes in the proactive follow-up group and 3.58 minutes in the passive follow-up group. The 5-year survival rate was 81.8% and 74.2% (HR=0.60, 95CI 0.53-0.67, P<0.001) in the proactive follow-up group and the passive follow-up group, respectively. Multivariate analysis showed that follow-up pattern, age, gender and operation mode were independent prognostic factors, and the results were consistent in all subgroups stratified by clinical stages.ConclusionThe proactive follow-up leads to better overall survival for resected stage Ⅰ-ⅢA NSCLC patients, especially in the stage ⅢA.
In order to adapt to the development of the new medical care model, West China Hospital of Sichuan University established a multidisciplinary follow-up team, established follow-up health files, implemented follow-up health management, assessed the risk of abnormal indicators, guided rehabilitation, established green medical treatment channels, managed follow-up data, prevented health management risks, and continuously improved quality. Through these measures, West China Hospital of Sichuan University has established a standardized and systematic follow-up management model for patients with cervical spondylosis after discharge, in order to promote the functional rehabilitation of patients during the perioperative period, and improve patient satisfaction. This article introduces this contract-based follow-up management model, which aims to provide a reference for other medical institutions to establish a good follow-up management system for patients with cervical spondylosis.
To summarize the medium-term cl inical result of bio-derived bone transplantation in orthopedics with tissue engineering technique. Methods From December 2000 to June 2001, 10 cases of various types of bone defect were treated with tissue engineered bone, which was constructed in vitro by allogenous osteoblasts from periosteum (1 × 106/ mL) with bio-derived bone scaffold following 3 to 7 days co-culture. Six men and 4 women were involved in this study, aged from 14 to 70 years with a median of 42 years. Among them, there were 2 cases of bone cyst, 1 case of non-union of old fracture, 6 cases of fresh comminuted fracture with bone defect, and 1 case of chronic suppurative ostemyel itis. The total weight of tissue engineered bone was 3-15 g in all the cases, averaged 7.3 g in each case. Results The wound in all the case healed by first intention. For 7 year follow up, bone union was completed within 3.0 to 4.5 months in 9 cases, but loosening occurred and the graft was taken out 1 year after operation in 1 case. The X-ray films showed that 9 cases achieved union except one who received resection of the head of humerus. No obvious abnormities were observed, and the function of affected l imbs met daily l ife and work. Conclusion Bio-derived tissue engineered bone has good osteogenesis. No obvious rejection and other compl ications are observed in the cl inical appl ication.
ObjectiveTo evaluate the long-term efficacy and influencing factors of cervical artificial disc replacement (CADR) for patients with cervical spondylotic radiculopathy (CSR).MethodsThe data of 29 CSR patients who underwent Bryan artificial disc replacement between December 2003 and December 2007 and followed up more than 10 years were retrospectively analysed. There were 16 males and 13 females with an average age of 54.1 years (range, 40-70 years). The disease duration was 2-144 months (mean, 19.2 months). CT and MRI were performed before operation to identify the compression segments (C3, 4 in 2 cases, C4, 5 in 6 cases, C5, 6 in 18 cases, C6, 7 in 3 cases) and the compression factors. According to the compression factor, the patients were divided into 2 groups: 14 patients with cervical disc herniation were in the group A and 15 patients combined with osteophyte were in the group B. There was no significant difference in gender, age, disease duration, and compressed level between 2 groups (P>0.05). The radiographic and clinical evaluation indexes were recorded before operation and at last follow-up. The radiographic evaluation indexes included the global cervical and segmental range of motion (ROM), loss of ROM (ROM<3°) at last follow-up, Cobb angle and incidence of local kyphosis, paravertebral ossification (PO) grading. The clinical evaluation indexes included neck disability index (NDI) and overall efficacy (Odom’s score).ResultsAll patients were followed up 121-153 months (mean, 130 months). The results of radiographic evaluation indexes showed that within group comparison, except that the Cobb angle of the operated level was significantly decreased (P<0.05) in both 2 groups, there was no significant difference in global cervical ROM and segmental ROM between preoperation and last follow-up (P>0.05). Except that the loss of ROM (ROM<3°) at last follow-up and high-grade PO at last follow-up in group B were significantly higher than those in group A (P<0.05), there was no significant difference in other radiographic evaluation indexes between 2 groups (P>0.05). The results of clinical evaluation indexes showed that the NDI was significantly improved in both groups (P<0.05) at last follow-up. There was no significant difference in the NDI at preoperation and at last follow-up, the decline of NDI at last follow-up, and the overall efficacy evaluated by Odom’s score between 2 groups (P>0.05). The excellent and good rate of overall efficacy reached 100% in both groups.ConclusionCADR has satisfied long-term efficacy in treating CSR. The maintenance of segmental mobility was better in patients with disc herniation than in patients with disc herniation and osteophyte.
ObjectiveTo understand the follow-up needs of postoperative patients with thyroid cancer and analyze its influencing factors, so as to provide a reference for the establishment of a follow-up management system for patients with thyroid cancer.MethodsConvenience sampling was used to conduct a questionnaire survey on the follow-up need, recovery, anxiety, and stress of patients after thyroid cancer surgery in 2 tertiary A hospitals from March to April in 2020. The self-designed follow-up needs questionnaire, the Quality of Recovery Questionnaire 15 (QoR-15), the Generalized Anxiety Disorder-7 (GAD-7), and the Perceived Stress Scale (PSS-4) were scored. The higher score, the higher need, the better recovery, and the more serious anxiety and stress.ResultsIn this study, 382 questionnaires were distributed, which of 351 were returned and of 349 were valid, the valid callback rate was 99.4% (349/351). ① Follow-up needs. Follow-up form: Online platform was the preferred follow-up method (72.2%), the most patients hoped that the follow-up would be conducted by a doctor (82.5%) and hoped to start the follow-up at 1 month after the operation (67.6%) and in the afternoon (50.7%), the duration of each follow-up was 10–15 min (47.3%), and accepted the follow-up frequency of 1 times per month (41.3%) and the lifetime follow-up (69.9%). Needs degree of follow-up contents: There were 13 follow-up items requiring more than 80% of patients. The top 5 items with the higher follow-up needs score were the question on test results, returning visit guidance, knowledges of metastasis and recurrence, medication guidance, and issuance of inspection orders, and their scores were 4.78±0.47, 4.70±0.51, 4.70±0.57, 4.65±0.59, 4.57±0.64, respectively. The results of multiple linear regression analysis were found that the age (young), marital status (unmarried), medical payment method (with medical insurance), and postoperative interval (<1 month) were closely related to the follow-up needs score (P<0.05). ② Recovery, anxiety, and stress statuses: The total QoR-15 score of patients was 79.87±29.95, which was positively correlated with the total score of follow-up needs (72.93±8.52, r=0.131, P=0.014). No significant correlation was found between the total score of GAD-7 (4.77±3.59) or PSS-4 (6.51±3.10) and the total score of follow-up needs (r=0.068, P=0.207; r=0.008, P=0.881).ConclusionsYoung, unmarried, medically insured, and early postoperative patients with thyroid cancer have higher follow-up needs. Patients with better recovery after surgery have a higher follow-up needs. Medical staff should pay attention to follow-up services after discharge, rationally arrange content, frequency, and time period of follow-up according to follow-up needs of patients, so as to improve quality of medical services.
The main purpose of this study is to observe and analyze the characteristics and the clinical significance of long-term echocardiogram data in patients after mechanical aortic valve replacement operation. Fifty-five cases were recruited over 5 years after mechanical aortic valve replacement operation, with complete echocardiogram examination profiles. The 55 subjects were divided into predominate aortic stenosis group and predominate aortic regurgitation group, based on preoperative examinations. And another way of division was also carried out that according to the effective orifice area index (EOAI), the subjects were divided into three groups, i.e., severe prosthesis-patient mismatch (PPM) group, moderate PPM group, and non PPM group. Characteristics of long-term echocardiogram data of the subjects were analyzed. Patients with aortic stenosis showed significantly decreased thickness of intraventricular septum and left ventricular posterior wall about half a year after operation (P<0.05). Half a year after operation, patients with aortic regurgitation showed decreased left ventricular internal dimension diastole and left ventricular internal dimension systole, and increased ejection fraction (P<0.05). Differences in mean aortic valve pressure gradient, forward blood flow across the aortic valves, and ejection fraction were not significant among those with severe PPM, moderate PPM, and non PPM groups (P>0.05). Number of cases of ascending aorta dimension increased as time goes on and pathogenesis of other valve diseases. A conclusion could be drawn that the heart function of patients with aortic valve disease could be improved after mechanical aortic valve replacement operation, but pathologies in other valves and ascending aorta might be increased, and therefore periodical postoperative echocardiogram evaluation with long tem pharmaceutical therapy could be necessary.
At present, the whole lifecycle management of vascular access for hemodialysis in China is still in its early stages. Faced with a large group of chronic kidney disease patients, hospitals at all levels lack systematic and continuous nursing management models. To address the issue of lacking continuous and effective nursing management of vascular access for dialysis during the period from hospitalization for autologous arteriovenous fistula surgery to outpatient maintenance hemodialysis treatment, this article introduces the background, specific implementation methods, and preliminary results of the new model of integrated medical and nursing follow-up management of vascular access for patients with hemodialysis during hospitalization and outpatient period constructed by the Wenjiang Hemodialysis Center of West China Hospital, Sichuan University. The purpose is to explore a new model for continuous and effective management of vascular access for hemodialysis patients.