We would like to introduce a semi-automated registration system for the National Clinical Database. Japan Surgery Society runs the National Clinical Database since January 2011. And automated registration system is long-...We would like to introduce a semi-automated registration system for the National Clinical Database. Japan Surgery Society runs the National Clinical Database since January 2011. And automated registration system is long-awaited due to the number of cases and diverse items to register. Well-known database management system, FileMakerPro enabled collecting and registering the items to the web-site automatically. Still some items need to copy one by one, but after filling the data, all data would be input to the web page for registration. Merit for this automated system is increasing not only the efficiency of administration work but the quality and the usefulness of this database. This paper is to report the outline of the registration system to the NCD database.
Early ambulation following a surgical procedure is a central concept in fast-track surgery according to Enhanced Recovery after Surgery protocols. Although a shorter hospital stay is reported to be a benefit of periopera...Early ambulation following a surgical procedure is a central concept in fast-track surgery according to Enhanced Recovery after Surgery protocols. Although a shorter hospital stay is reported to be a benefit of perioperative rehabilitation, its effect on patient metabolism has not been fully explored. Thirty-eight patients who had undergone esophagectomy, a highly stressful surgery, received intensive rehabilitation (group R) with regular evaluation of their metabolic parameters compared with 41 control group patients (group C) who received conventional care without such rehabilitation. Nitrogen balances calculated daily were significantly higher in group R on the third postoperative day. Fluid retention after surgery improved earlier in group R than in group C. Liver dysfunction occurred 1 week after surgery in group C but was avoided in group R. Total lymphocyte counts decreased after surgery in both groups, but their recovery was observed earlier in group R. Early mobility after esophagectomy is thought to avoid disuse atrophy of skeletal muscles in postsurgical patients. Fluid retention and immune dysfunction are also improved through perioperative rehabilitation. The biological mechanisms underlying the benefits of rehabilitation should be further elucidated for its clinical application in all surgical care pathways.
Preoperative carbohydrate loading has been adopted as an integral part of many enhanced-recovery or fast-track surgery programs. The main aim is to reduce postoperative insulin resistance (IR), thereby allowing for effec...Preoperative carbohydrate loading has been adopted as an integral part of many enhanced-recovery or fast-track surgery programs. The main aim is to reduce postoperative insulin resistance (IR), thereby allowing for effective postoperative nutrition with more anabolic properties and less risk of hyperglycemia, which may improve postoperative outcomes. Based on the mechanism underlying postoperative IR, preoperative carbohydrate loading can inhibit only the exacerbating peripheral IR caused by excessive circulating concentrations of free fatty acids secondary to starvation but not the peripheral and central IR induced by stress hormones and inflammatory cytokines released as part of the surgical stress response, suggesting that preoperative carbohydrate loading may have only limited benefit. The Cochrane review of the effects of preoperative carbohydrate treatment (published in 2014) provided results that were completely consistent with the legitimate expectation described above, i.e., a small reduction of uncertain clinical significance in the length of hospital stay and little or no effect on postoperative complications or other important clinical outcomes, despite increased postoperative peripheral insulin sensitivity. Because preoperative carbohydrate loading has only limited benefit both theoretically and clinically, we should complement its effect through the introduction of a less-invasive approach capable of attenuating surgical stress-mediated IR.
Pain is a sensation associated with subjective factors, making it difficult to measure and assess. Currently, there is no widely accepted method of objectively assessing pain, and therefore subjective assessments such as...Pain is a sensation associated with subjective factors, making it difficult to measure and assess. Currently, there is no widely accepted method of objectively assessing pain, and therefore subjective assessments such as the Visual Analogue Scale (VAS) are generally used. The PainVision system has been developed for the quantitative analysis of pain and comparison of postoperative pain intensity. In this study, we investigated whether postoperative pain could be objectively assessed using this system in digestive tract surgery patients. Pain scores were measured with the VAS, the PainVision system, and the short-form McGill Pain Questionnaire in patients undergoing open or laparoscopic hepatectomy, open or laparoscopic gastrectomy, and laparoscopic cholecystectomy. As measured using the PainVision system, postoperative pain intensity was lower in patients who underwent laparoscopic surgery compared with open hepatectomy. In open hepatectomy patients, pain intensity measured by the PainVision system was significantly lower on postoperative days (POD) 7 and 10 than on POD 1. Preemptive use of nonsteroidal antiinflammatory drugs significantly reduced postoperative pain in open hepatectomy patients. The results showed that PainVision effectively quantifies pain intensity after digestive tract surgery. Objective assessment of postoperative pain may lead to earlier mobility and improved quality of life.
In programs to enhance patient recovery after surgery, anesthesiologists play an important role. In conventional management, patients managed with the "starvation, stress, and drowning" regimen experience delays in the r...In programs to enhance patient recovery after surgery, anesthesiologists play an important role. In conventional management, patients managed with the "starvation, stress, and drowning" regimen experience delays in the recovery process. In contrast, anesthesiologists in the current perioperative management scenario reduce the fasting period, maintain sufficient depth of anesthesia, and administer appropriate infusion levels. In particular, three major factors inhibiting postoperative recovery are known to be pain, gastrointestinal dysfunction, and immobility. To prevent these, anesthesiologists should emphasize pain control and manage patient care with the goals of early oral intake and early mobility. It is important for surgeons and anesthesiologists to share information and techniques to promote postoperative recovery. Multidisciplinary cooperation can be expected to have synergistic effects leading to improved safety, better treatment outcomes, and smooth perioperative management.
Preoperative preparation of the bowel includes two methods, mechanical bowel preparation (MBP) to remove gross feces and oral antibiotic bowel preparation (OABP) to reduce the colonic bacterial load. MBP and OABP have be...Preoperative preparation of the bowel includes two methods, mechanical bowel preparation (MBP) to remove gross feces and oral antibiotic bowel preparation (OABP) to reduce the colonic bacterial load. MBP and OABP have been performed since the 1940s to 1950s. MBP is routinely performed to reduce the morbidity and mortality of elective colorectal surgery and has been a surgical dogma since the early 1970s. However, numerous prospective, randomized, controlled trials and meta-analyses have questioned the need for MBP in elective colorectal surgery, and a meta-analysis showed that significantly more anastomotic leaks were found after MBP. OABP decreases postoperative infectious complications considerably, although the results differ with the type of antibiotic used. Recently, several large retrospective studies have demonstrated that MBP plus OABP is associated with reduced postoperative infectious complications including surgical site infection rates after elective colorectal surgery. Further prospective, randomized trials of MBP and OABP alone and in combination should be conducted.
In conventional postoperative management, early oral feeding after preoperative oral supplementary water and gastrointestinal tract anastomosis was contraindicated for two main reasons. Primarily, it was believed that it...In conventional postoperative management, early oral feeding after preoperative oral supplementary water and gastrointestinal tract anastomosis was contraindicated for two main reasons. Primarily, it was believed that it would be dangerous because the gastrointestinal tract was in a physiological state of paralytic ileus for 3-5 days after open surgery. The second reason for concern was the risk of causing anastomotic suture rupture if patients did not rest quietly until sufficient secondary wound healing of the gastrointestinal anastomosis had occurred. However, this was counter to common sense, and the current Enhanced Recovery after Surgery (ERAS) protocols recommend early oral intake after preoperative oral supplementary water. This stimulates intestinal tract motility and decreases complications. The ERAS protocols appear safe for patient management after surgery involving the large intestine and are now being assessed for patients undergoing upper gastrointestinal tract procedures.