Study On The Application Of Enhanced Recovery After Surgery In Perioperative Period Of Acute Appendicitis In Children

Objective The concept of enhanced recovery after surgery was applied to the perioperative period of children with acute appendicitis,and compared with the traditional perioperative group,so as to explore the effect of the application of the concept of enhanced recovery after surgery in the treatment of children with acute appendicitis.Methods1.All hospitalized cases of acute appendicitis aged 0-14 years from November 2019 to January 2021 in the Department of Pediatric Surgery of Ningxia Medical University Hospital were collected and divided into ERAS group and control group according to random number table method before admission.2.The WBC、NEUT%、PLT、and CRP were measured before operation,the first day and the third day after operation and before discharge.The value of blood glucose before operation and the first day after operation,the length of operation,the amount of intraoperative blood loss and the amount of intraoperative infusion.Clinical indexes such as the time of using antibiotics,the time of taking diet for the first time after operation,the time of first defecation after operation,time of stopping infusion after operation,the incidence of postoperative complications,pain score,parents’ satisfaction,hospitalization days,hospitalization expenses,readmission rate and so on.The general data,nutritional indicators,inflammatory indicators,biochemical indicators,and clinical indicators data of the two groups were comprehensively analyzed and compared with the differences between the two groups.3.Logistic regression model was used to analyze the risk factors of postoperative complications in order to determine the factors that had independent influence on the occurrence of postoperative complications.Results1.Preoperative data and Laboratory examination:There was no significant difference in general data between the two groups.The results of two-factor repeated measurement ANOVA of laboratory data showed that the changes of WBC,NEUT %,CRP and PLT levels in the two groups at the time before operation,the first day and the third day after operation and before discharge had statistical significance(P<0.05).The results showed that there were significant differences in WBC,NEUT% and CRP levels between the two groups(P<0.05),while there was no significant difference between the two groups of PLT(P>0.05),and the indexes of ERAS group decreased more significantly.There was no difference in blood glucose between the two groups before surgery,and the blood glucose of the control group was higher than that of the ERAS group at the first day after surgery(P<0.05).2.Intraoperative data: The amount of fluid infusion,blood loss and operation time in ERAS group were significantly lower than those in control group(P < 0.05).3.Postoperative data: Compared with the control group,the postoperative antibiotic use time,the first feeding time,the first defecation time,the postoperative stop of infusion time and the length of hospital stay were significantly shorter in the ERAS group,and the hospitalization cost and pain score were reduced,with statistical significance(P<0.05).Compared with control group,the parental satisfaction rate of ERAS group was higher(96%vs86%,P<0.05).The incidence of postoperative adverse reactions and complications in ERAS group was significantly lower than that in control group(P<0.05).There was no significant difference in readmission rate between the two groups after1 month follow-up(P <0.05).4.Logistic multivariate analysis showed that: Intraoperative blood loss(OR=1.418,95%confidence interval 1.023-1.288,P=0.019)and Preoperative CRP(OR=1.031,95% confidence interval 1.004-1.059,P=0.024)and were independent risk factors for postoperative complications of acute appendicitis.The enhanced recovery after surgery path(OR=0.155,95% confidence interval 0.027-0.888,P=0.036)can significantly reduce the risk of postoperative complications.Conclusion1.The enhanced recovery after surgery can promote postoperative recovery of children,shorten the average hospital stay,reduce medical costs,improve patient satisfaction,and has good clinical application value.2.The implementation of the concept of enhanced recovery after surgery can effectively reduce the risk of postoperative complications of acute appendicitis.The increase in CRP value before surgery and the amount of blood loss during surgery are independent risk factors for postoperative complications.