The Clinical Applicability And Evidence-based Medical Study Of The Enhanced Recovery After Surgery Protocol In Elderly Patients With Acute Cholecystitis During Perioperative Period

Since the enhanced recovery after surgery protocol was proposed,it has been widely used in various surgical fields,but there are few studies on elderly patients with acute cholecystitis.We conducted clinical research and evidence-based medical research on perioperative applicability in elderly patients with acute cholecystitis,in order to provide beneficial guidance for perioperative treatment of patients.PartⅠ The enhanced recovery after surgery protocol in elderly patients with acute cholecystitis undergoing laparoscopic cholecystectomyObjective:This study aimed to evaluate the clinical value of the ERAS protocol during the perioperative period of laparoscopic cholecystectomy in elderly patients with acute cholecystitis.Methods:We collected medical data from 126 elderly patients with acute cholecystitis from October 2018 to September 2021 in the affiliated hospital of Chengde Medical College.Among the 126 patients,70 were included in the ERAS group and 56 in the traditional group.We recorded the clinical data: age,gender,time of onset,ASA score,operation time,gallbladder pathological type,and postoperative recovery indicators: postoperative time to first flatus,first time to ambulation,first time to solid intake,length of hospital stay,VAS score and the postoperative complications in 2 groups,and then carried out statistical analysis.Results:1.No significant differences were observed regarding the general characteristics of the 2 groups(P > 0.05).2.The ERAS group had significantly earlier time to first flatus(24.04±2.20 h vs.28.45±3.95h),time to first ambulation(7.44±2.21 h vs.17.28±6.86h),and time to solid intake(1.21±0.42 d vs.1.87±0.79d)compared with the traditional group(P<0.05);additionally,the ERAS group had significantly shorter stay(3.17±0.92 d vs.4.23±1.29d)and gentler feeling of postoperative pain(2.99±0.83 vs.4.23±0.95)(P<0.05).3.The ERAS group had significant incidences of lower postoperative lung infection(14 vs.21,P = 0.029)and abdominal cavity infection(3 vs.9,P = 0.025)compared to the traditional group.No significant difference was observed regarding the incidences of other postoperative complications(bile leakage,urinary tract infection,incision infection,death)between the 2groups(P > 0.05).Conclusion:The ERAS protocol helps reduce elderly patients’ stress reactions,accelerate postoperative recovery and reduce the incidence of postoperative complications.PartⅡ The evidence-based medical study of the enhanced recovery after surgery protocol in elderly patients with acute cholecystitis during perioperative periodObjective:We collected Relevant literatures at home and abroad and conducted meta-analysis to provide evidence-based medical basis for the perioperative application of ERAS concept in elderly patients with acute cholecystitis.Methods:Literature on perioperative application of ERAS in elderly patients with acute cholecystitis was systematically searched and screened from Chinese and foreign medical databases(China National Knowledge Infrastructure full-text database,Wanfang Data Knowledge Service Platform,VIP database,Pub Med and Cochrane library).Review Manager5.3 software was used for meta-analysis of the included literature.Results:7 Chinese literatures were included,involving 1 randomized controlled clinical trial and 6 case-control trials,with a total of 509 patients,including257 patients in the experimental group(ERAS group)and 252 patients in the control group.The results of meta-analysis showed that the postoperative time to first flatus [SMD=-2.62,95%CI(-3.77,-1.47),P<0.05],time to solid intake [SMD=-4.24,95%CI(-6.70,-1.78),P<0.05],time to ambulation[SMD=-4.06,95%CI(-5.79,-2.33),P<0.05],length of hospital stay[SMD=-1.67,95%CI(-2.36,-0.98),P < 0.05] and postoperative complications [OR=-3.63,95%CI(0.18,0.55),P<0.05] were significantly reduced in ERAS group,and the differences were statistically significant.Conclusion:Compared with traditional perioperative treatment,patients in ERAS group had shorter postoperative time to first flatus,time to solid intake,time to ambulation,length of hospital stay and a lower incidence of postoperative complications.It is effective,beneficial and safe to implement ERAS protocol during the perioperative period of elderly patients with acute cholecystitis.