O-P02 A fast-track surgery programme leads to timelier treatment and higher resection rates in pancreatic cancer

Background Pancreatic cancer is currently the fourth most common cause of cancer-related mortality in the economically developed world and is set to become the second most common cause of cancer-related mortality within the next few years. NICE guidance makes a strong recommendation to offer up-front surgery to people with resectable pancreatic cancer, without preoperative biliary drainage, if sufficiently fit for surgery. The aim of this study was to perform a propensity-matched comparison of patients with pancreatic cancer undergoing surgery, with and without biliary stenting, to examine perioperative outcomes and to perform an intention to treat analysis to evaluate long-term survival between the two groups. Methods This was an observational study of a cohort of consecutive patients presenting with obstructive jaundice and undergoing pancreatoduodenectomy for pancreatic and periampullary malignancies between November 2015 and May 2019. Data related to patient and tumour characteristics, biliary drainage, surgery and histopathology were gathered and analysed from a prospectively maintained electronic database. Post-operative complications were defined and graded according to the definitions of the International Study Group on Pancreatic Surgery (ISGPS) and the Clavien-Dindo system. Data related to adjuvant treatment, disease recurrence and overall survival were also analysed. Results In this retrospective study of 216 consecutive operable patients, 70 followed the fast-track (FT) pathway and 146 had pre-operative biliary drainage (PBD). All 70 patients in the fast-track group and 122 out of 146 in the PBD group proceeded to surgery (100% and 83.6% respectively, p = 0.001). Interval time from diagnostic CT scan to surgery and from MDT decision to treat to surgery was much shorter in the FT group (median range) 8 vs 43 days p < 0.001 and 3 vs 36 days p < 0.001 respectively) as was the overall time from diagnostic CT to adjuvant treatment (88 vs 121 days p < 0.001). Postoperative outcomes including in-hospital stay, number and grading of complications, readmission rate and mortality rates were comparable in the two groups. There was no difference in survival between the two groups. Conclusions These data strengthen the existing evidence that, for a person with pancreatic cancer who is proceeding to surgery, the best approach is to avoid pre-operative biliary drainage. The optimal comparison to the neoadjuvant approach is upfront fast-track surgery without biliary drainage followed by adjuvant therapy.

Application of Music Therapy in General Surgical Treatment

With the increasing application of music therapy in clinical practice, the effectiveness of music therapy in improving the negative emotions of patients, relieving pain, and adjusting the physiological state has also been receiving increasing recognization. Moreover, music therapy as adjuvant therapy for conventional treatment can achieve a better improvement in patient satisfaction and facilitate the acceptance of make music therapy by the medical industry. In addition to inevitable trauma, general surgery is criticized for its long treatment cycles and postoperative pain. With the continuous development of fast-track surgery (FTS), music therapy has received more attention in general surgical treatment. This study reviews the development history and prospects of music therapy in general surgery.

Імплементація програми “fast track surgery” в хірургічному лікуванні первинного хронічного захворювання вен під час вагітності

Мета роботи: підвищення безпеки та ефективності відкритого мініінвазивного хірургічного лікування первинного, прогресуючого варикозного розширення вен нижніх кінцівок, промежини, пахового каналу та зовнішніх статевих органів та їх поєднаних форм під час вагітності на основі принципів “fast track surgery”. Матеріали і методи. У період із ІІ кварталу 2015 року до І кварталу 2020 року на базі відділення екстрагенітальної патології КНП “Обласний перинатальний центр” Рівненської обласної ради обстежено та хірургічно проліковано 840 вагітних у другому–третьому триместрі з різними формами первинного хронічного захворювання вен нижніх кінцівок, промежини, пахового каналу та зовнішніх статевих органів та їх поєднаних форм. У хірургічному лікуванні використовували метод селективної мініфлебектомії – ASVAL, гемодинамічний метод – CHIVA в різних варіантах та поєднаннях. Результати досліджень та їх обговорення. Оптимізовано мультидисциплінарну програму в периопераційному періоді. Запропонована в периопераційному періоді мультидисциплінарна програма “fast track surgery” дала можливість забезпечити у 89,29 % випадків пологів природним шляхом без кровотеч та зменшити число тромботичних ускладнень у 2 рази.

AN INTEGRATED APPROACH TO THE TREATMENT OF PATIENTS WITH ACUTE PANCREATITIS

The aim of the study – to improve the results of surgical treatment of patients with acute pancreatitis. Matherials and methods of the study. The results of the treatment of 103 patients with acute pancreatitis who were treated in the surgical department of the Municipal non-commercial enterprise of the Kharkov regional council «Regional Clinical Hospital» 2015 to 2020 were analyzed. All patients were divided into two groups: the main (56 patients) and the comparison group (47 patients). In the main group, the tactics of the “step-up approach” were applied and the principles of the ERAS concept (2018-2020) were implemented. In the comparison group (2015-2017), the ERAS principles were not implemented and the open method was mainly used as the standard surgical treatment. Results of the study. Patients treated using the principles of “fast-track surgery” along with the “step-up approach” tactics, less likely to have postoperative complications and reduced the length of stay in the surgical department. Conclusions. This example confirms the appropriateness of applying the principles of “fast-track surgery” in everyday surgical practice in the complex treatment of patients with acute pancreatitis, as the results of surgical treatment of this category of patients are improved and financial costs for treatment are reduced.

Pathophysiological aspects as the object of the treatment tactics in acute pancreatitis (review)

The review presents a modern view on the features of the course and treatment of acute pancreatitis, based on a cascade of pathophysiological mechanisms of this disease. A number of concepts of development and course of acute pancreatitis on the basis of randomized prospective and retrospective researches devoted to this problem are considered. Attention is paid to the mechanisms of development of organ failure in acute pancreatitis. In accordance with the above, the main positions of treatment measures for acute pancreatitis, which are based on the principles of tactics "step-up approach" were highlighted. Among them, attention is focused on the features of the conservative treatment program, minimally invasive surgical interventions, as well as the management of the postoperative period of patients. Minimally invasive surgical interventions perform the main tasks of surgical treatment in acute pancreatitis, but significantly reduce surgical trauma compared to "open" methods. Adequate management of the postoperative period of patients is carried out through the implementation of protocols "fast-track surgery".

Implementing fast track surgery in hip and knee arthroplasty using the lean Six Sigma methodology

PurposeOne of the biggest challenges in the health sector is that of costs compared to economic resources and the quality of services. Hospitals register a progressive increase in expenditure due to the aging of the population. In fact, hip and knee arthroplasty surgery are mainly due to primary osteoarthritis that affects the elderly population. This study was carried out with the aim of analysing the introduction of the fast track surgery protocol, through the lean Six Sigma, on patients undergoing knee and hip prosthetic replacement surgery. The goal was to improve the arthroplasty surgery process by reducing the average length of stay (LOA) and hospital costsDesign/methodology/approachLean Six Sigma was applied to evaluate the arthroplasty surgery process through the DMAIC cycle (define, measure, analyse, improve and control) and the lean tools (value stream map), adopted to analyse the new protocol and improve process performance. The dataset consisted of two samples of patients: 54 patients before the introduction of the protocol and 111 patients after the improvement. Clinical and demographic variables were collected for each patient (gender, age, allergies, diabetes, cardiovascular diseases and American Society of Anaesthesiologists (ASA) score).FindingsThe results showed a 12.70% statistically significant decrease in LOS from an overall average of 8.72 to 7.61 days. Women patients without allergies, with a low ASA score not suffering from diabetes and cardiovascular disease showed a significant a reduction in hospital days with the implementation of the FTS protocol. Only the age variable was not statistically significant.Originality/valueThe introduction of the FTS in the orthopaedic field, analysed through the LSS, demonstrated to reduce LOS and, consequently, costs. For each individual patient, there was an economic saving of € 445.85. Since our study takes into consideration a dataset of 111 patients post-FTS, the overall economic saving brought by this study amounts to €49,489.35.