Research On Application Of Enhanced Recovery After Surgery In Gynecological Benign Diseases

Background and ObjectiveEnhanced recovery after surgery(ERAS)was first proposed by Professor Henrik Kehlet of the University of Copenhagen,Denmark in 1997.It is a new perioperative treatment concept with evidence-based medical evidence.After more than 20 years of clinical application,it is currently accepted by more countries and regions.ERAS is patient-centered and requires the cooperation of various disciplines such as surgery,anesthesia,nutrition,taking some perioperative optimization measures proven by evidence-based medicine,and nursing to promote rapid recovery of patients after surgery,improve the quality of life of patients,and ultimately benefit patients.ERAS was first used in gastrointestinal surgery,and has been widely used in gastrointestinal surgery,hepatobiliary surgery,cardiothoracic surgery and other fields.Its application in gynecology started relatively late,and there is less research in gynecology.Recently,more and more obstetricians and gynecologists pay attention to the ERAS concept,and the application of the ERAS concept in gynecology is gradually increasing.In this paper,patients with benign gynecological diseases undergoing surgical treatment are randomly divided into groups to compare the effects of the perioperative treatment of enhanced recovery after surgery and the conventional perioperative treatment,Safety and feasibility.Materials and methods1.MaterialsA total of 156 patients with benign gynecological diseases who underwent surgical treatment at the Second Affiliated Hospital of Zhengzhou University from June 2018 to November 2019 were selected.They were divided into ERAS group with a total of 78 cases.The perioperative period was treated with enhanced recovery after surgery.The control group was with a total of 78 cases.The perioperative period was treated with conventional perioperative treatment.The surgical methods include laparoscopic myomectomy,laparoscopic hysterectomy,and laparoscopic ovarian cyst excision.Gynecological benign diseases include:benign ovarian tumors,uterine myoma,adenomyosis,abnormal uterine bleeding,endometriosis,and pelvic organ prolapse.2.MethodsContrast ERAS group and the control group of general information(age,disease diagnosis,etc.),preoperative and postoperative Anxiety score(Self-rating Anxiety Scale,SAS),operation time,intraoperative blood loss,postoperative day 1 C-reactive protein(C-reactive protein,CRP),for the first time the exhaust time,defecation time,bed time for the first time,for the first time back to normal eating time,postoperative complications,and postoperative day 1,day 2 pain score(using Visual analog pain assessment component Visual Analogue,VAS),preoperative,day of surgery,postoperative day 1 and postoperative day 3 quality of life scores,patient satisfaction,and hospitalization costs.Statistical methodsNormally distributed continuous numerical variables are expressed as mean ±standard deviation(x±s),skewed distributed numerical variables are expressed as median and quartile M(P25,P75),count data are described by percentage,multiple groups One-way analysis of variance was used for the comparison between the two;the t test was used for measurement data with normal distribution and homogeneity of variance,and the rank variables test was adopted for numerical variables with significant skew distribution.χ2 test was used to compare the count data between groups;P<0.05 was considered statistically significant.The data were statistically analyzed using SPSS 22.0 statistical software.Results1.There was no statistical difference in age,BMI,disease type,and surgical method between the two groups(P>0.05).2.The preoperative and postoperative anxiety scores of the ERAS group were smaller than those of the control group,and the difference was statistically significant(P=0.000、P=0.000);the average operation time of the ERAS group was 84.12±8.42min,the amount of bleeding during the operation was 44.94±4.81ml,and the operation time of the control group The average was 83.64 ± 5.12min,and the blood loss during the operation was 44.54±5.34ml.There was no significant difference in the operation time and blood loss between the two groups(P=0.671、P=0.626).3.The CRP of the ERAS group was smaller than that of the control group on the first day after surgery.The differences between the two groups were statistically significant(P=0.001).The first exhaust time,the first defecation time,the first time to get out of bed,and the time to return to normal eating after the ERAS group were all significant.Earlier than the control group,the difference between the two groups was statistically significant(P<0.05).4.The common postoperative complications in the ERAS group were less than those in the control group.There were significant differences in nausea,vomiting,electrolyte disturbances,abdominal distension and urinary infections(P<0.05).There was no significant difference in fever and lower limb venous thrombosis(P=0.348、P=0.477).5.The pain score of the ERAS group on the first day after surgery was smaller than that of the control group,and the difference was statistically significant(P=0.000);the pain score(VAS)on the second day was not statistically significant(P>0.05).The patient satisfaction rate in the ERAS group was 94.87%,and the control group was 84.62%,and the difference was statistically significant(P=0.035).The hospitalization cost of the ERAS group was lower than that of the control group,and the difference between the two groups was statistically significant(P=0.000).6.There were no significant differences in the quality of life scores before surgery and the day of surgery in the two groups(P=0.833、P=0.120),The quality of life scores on the first and third days after surgery in the ERAS group were higher than those in the control group,and the differences were statistically significant.Conclusions1.The application of enhanced recovery after surgery in gynecological benign diseases is safe and feasible,and can be used for perioperative management of gynecological benign diseases surgery.2.Enhanced recovery after surgery in gynecological benign diseases can speed up postoperative recovery and reduce the number of hospital stays and costs3.The application of enhanced recovery after surgery in gynecological benign diseases can reduce the pain of patients on the first day after surgery and improve the quality of life on the first and third days after surgery.