A Cross-sectional Survey Of Perioperative Lung Protection In Gastrointestinal Surgery In Mainland China

BackgroundPerioperative pulmonary complications(PCC)are the main causes of prolonged hospital stay and increased mortality in gastrointestinal surgery patients.Experienced respiratory therapists(RT)can significantly reduce PCC with systemic perioperative lung protection(PLP).MethodThe hospital in which the investigator worked was taken as the initiator,and the questionnaire of WeChat was issued to doctors in the departments of gastrointestinal surgery and critical care medicine(ICU)of hospitals all in mainland China with more than two years’ working experience,as well as RT and RTRP with unlimited years’ working experience.Two rounds of investigation were conducted for initial screening and WeChat follow-up.Target(1)To understand the discipline construction of respiratory therapy department(RTD)in hospitals in mainland China;(2)To understand the status of PLP among gastrointestinal surgery patients in mainland China;(3)To understand the degree of concern and the depth of intervention of RT on gastrointestinal surgery patients in mainland China;(4)To understand the cognition of gastrointestinal surgeons in mainland China on PCC,respiratory therapy(RC)and RT;(5)To understand the management of gastrointestinal surgery patients in ICU in mainland China.ResultsA total of 136 valid questionnaires were collected and 75 hospitals in 24 provinces,autonomous regions and municipalities were investigated.There are 57 Sanjia hospitals(57/75,76%),8 Sanyi hospitals(8/75,10.67%)and 10 Erjia hospitals(8/75,13.33%).Among them,5 hospitals had gastrointestinal surgery ICU(5/75,6.67%),25 hospitals had surgery ICU(25/75,33.33%),61 hospitals had comprehensive ICU(61/75,81.35%),and 2 had no ICU(2/75,2.67%).In addition to the 5 hospitals with an ICU of gastrointestinal surgery and 2 hospitals without an ICU,the remaining 68 hospitals mainly have ICU physicians for the management of gastrointestinal surgery patients(65/68,95.58%).Respondents of 20 hospitals with initial screening considered that their hospitals had independent RTD(20/75,26.67%),only 3 hospitals with independent RTD after follow-up(3/75,4%),and the difference between the results of initial screening and follow-up was significant(χ2 =14.84,P<0.005).Among the hospitals surveyed,30 hospitals did not have RT(30/75,40%)and 45 hospitals had RT(45/75,60%).Among them,there were 26 hospitals with 2 or less RT(26/45,57.78%).Only 6 hospitals had full-time RT(6/75,8%).There were no significant differences in the number of RT and years of service in RT between hospitals of all grades and categories(P>0.05).Hospitals with RT mainly serve ICU and respiratory departments.Of the 45 hospitals surveyed with RT,only 7 hospitals had gastrointestinal surgery patients who received RT frequently during the perioperative period(7/45,15.56%).Of the 53 gastrointestinal surgeons surveyed,34 knew about RT(34/53,64.15%)and 19 did not(19/53,35.85%).Of the 53 gastrointestinal surgeons surveyed,45 considered PCC to be the most important perioperative complication of gastrointestinal surgery patients(45/53,84.61%).ConclusionPCC is the most important perioperative complication of gastrointestinal surgery patients,but there is a serious lack of RT support in gastrointestinal surgery patients in mainland China.The main reasons are not only the small number of RT practitioners and the insufficient attention paid by RT to gastrointestinal surgery,but also the insufficient cognition and attention paid by gastrointestinal surgeons to RT and RC.It is suggested that more attention should be paid to the cultivation of RT and PLP in gastrointestinal surgery patients in mainland China.