Feasibility and Outcomes of Modified Enhanced Recovery After Surgery for Nursing Management of Aged Patients Undergoing Esophagectomy

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the ONA take:

According to a study published in the Journal of Thoracic Disease, elderly patients with esophageal cancer who undergo esophagectomy may have improved surgical recovery outcomes and quality of life if their care follows a modified enhanced recovery after surgery (mERAS) protocol.

Previous studies have shown that the ERAS protocol — a multidisciplinary method to improve the quality of recovery among surgery patients — is effective for various disease states. Esophagectomy is associated with high rates of postsurgery complications, but the feasibility and effectiveness of the ERAS protocol has not been widely studied in this patient population.

For this study, researchers randomly assigned 110 elderly patients with esophageal cancer to standard care or mERAS after esophagectomy, and assessed their mental health status, quality of life, surgical outcomes, and postoperative complications.

The authors conclude that “application of mERAS protocols to perioperative nursing care in aged patients who undergo esophagectomy could reduce the incidence of postoperative complications. It could also relieve patients’ psychological distress and improve their [quality of life].”

Journal of Thoracic Disease
Journal of Thoracic Disease

Background: The aim of this study was to determine whether a modified enhanced recovery after surgery (mERAS) protocol has a positive effect on the recovery of aged patients with esophageal cancer undergoing esophagectomy.

Methods: Consecutive patients were selected between January 2015 and June 2016 and were randomly assigned to a control group (traditional nursing care) or an observation group (mERAS protocol). We analyzed the outcomes of the patients, including surgical outcomes, postoperative complications, mental health status, and quality of life (QOL).

Results: Altogether, 110 patients who were >60 years of age were included in the study. They were evenly divided into two groups, with 55 patients in each. For the observation group, the thoracic drainage time was 1.07±0.26 days, first jejunal feeding time was at 11.71±1.81 h, time of first postoperative flatus was at 12.00±1.75 h, and length of postoperative stay was 8.31±1.25 days. There was no anastomotic leakage in the observation group, and the incidence of postoperative pulmonary infection was 5.45%. All the above indexes in the observation group were better than those for the patients receiving traditional nursing care. In addition, patients in the observation group had a lower level of mental suffering (P<0.05) and higher QOL (P<0.05).

Conclusions: mERAS protocols could result in better postoperative recovery and reduce postoperative complications in aged patients undergoing esophagectomy. Hence, mERAS protocols could be useful in reducing patients' mental suffering and improving their QOL.


Keywords: Esophageal cancer; modified enhanced recovery after surgery (mERAS); aged patient; mental status; quality of life (QOL)

Submitted Jul 27, 2017. Accepted for publication Nov 10, 2017.

doi: 10.21037/jtd.2017.11.110 


INTRODUCTION

The enhanced recovery after surgery (ERAS) protocol is an effective method that aims to relieve surgical stress, reduce surgery-related complications, and enhance postoperative recovery during the perioperative period. The ERAS protocol has been successfully implemented in patients with various surgically treated diseases, especially following colorectal surgery (1-3).

Esophageal cancer is a common malignancy in China, and esophagectomy is associated with a high incidence of postoperative complications. Few studies, however, reported the use of this protocol in patients undergoing esophagectomy. In recent years, based on previous reports and our own experience, we have modified the ERAS protocol in many aspects for aged patients who are physically weaker and at more risk than younger patients when undergoing surgery. Also, their postoperative quality of life (QOL) is expected to be poor.

This prospective randomized controlled study aimed to analyze the short-term outcomes, QOL after survival, and the mental status of aged patients with esophageal cancer who underwent esophagectomy and postoperative care with our modified enhanced recovery after surgery (mERAS) protocol. The goal was to study the feasibility and application of the mERAS protocol for nursing management of aged patients who undergo esophagectomy.  

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