Objective To systematically review the effects of enteral immunonutrition (EIN) on postoperative infection and the length of hospital stay in patients with gastrointestinal cancer after surgery, in order to provide high quality evidence for the rational perioperation nutrition plan for patients with malignant gastrointestinal tumor. Methods Randomized controlled trials (RCTs) published in English about application of EIN vs. general treatment for gastrointestinal surgery published from Jan. 1st, 1997 to Oct. 31st 2012 were retrieved in the following databases: PubMed, Ovid, and EMbase. References of the included studies were also retrieved. According to the inclusion and exclusion criteria, two reviewers independently screened studies, extracted data, and evaluated the methodological quality. Then, meta-analysis was conducted using RevMan 5.2 software. Results 19 RCTs involving 2 298 patients were included. The results of meta-analysis showed that: there was no significant difference between the postoperative EIN group and the control group in reducing the risk of postoperative infection (OR=0.91, 95%CI 0.56 to 1.47, P=0.70); But postoperative and perioperative EIN had reduced the risk of postoperative infection with a significant difference (OR=0.57, 95%CI 0.39 to 0.82, P=0.002; OR=0.52, 95%CI 0.35 to 0.76, P=0.000 9). Additionally, the results of sensitivity analysis revealed that: no matter when EIN was used (during preoperative, postoperative, or perioperative periods), it reduced the length of postoperative hospital stay with significant differences, compared to the standard nutrition group (OR= −2.39, 95%CI −3.28 to −1.49, Plt;0.000 01; OR= −2.42, 95%CI −4.07 to −0.78, P=0.004; OR= −2.76, 95%CI −3.46 to −2.06, Plt;0.000 01). Conclusion Current evidence shows that perioperative EIN can decrease postoperative infection and reduce the length of hospital stay of patients with malignant gastrointestinal tumor. Due to the limited quantity and quality of the included studies, high quality RCTs are needed to verify the above conclusion.
Objective To analyze the risk factors for postoperative length of stay (PLOS) after mediastinal tumor resection by robot-assisted non-endotracheal intubation and to optimize the perioperative process. MethodsThe clinical data of patients who underwent Da Vinci robot-assisted mediastinal tumor resection with non-endotracheal intubation at the Department of Thoracic Surgery, General Hospital of Northern Theater Command from 2016 to 2019 were retrospectively analyzed. According to the median PLOS, the patients were divided into two groups. The univariate analysis and multivariate logistic regression were used to analyze risk factors for prolonged PLOS (longer than median PLOS). ResultsA total of 190 patients were enrolled, including 92 males and 98 females with a median age of 51.5 (41.0, 59.0) years. The median PLOS of all patients was 3.0 (2.0, 4.0) d. There were 71 patients in the PLOS>3 d group and 119 patients in the PLOS≤3 d group. Multivariate logistic regression showed that indwelled thoracic catheter [OR=11.852, 95%CI (2.384, 58.912), P=0.003], preoperative symptoms of muscle weakness [OR=4.814, 95%CI (1.337, 17.337), P=0.016] and postoperative visual analogue scale>5 points [OR=6.696, 95%CI (3.033, 14.783), P<0.001] were independent factors for prolonged PLOS. Totally no tube (TNT) allowed patients to be discharged on the first day after surgery. ConclusionRobot-assisted mediastinal tumor resection with non-endotracheal intubation can promote rapid recovery. The methods of optimizing perioperative process are TNT, controlling muscle weakness symptoms and postoperative pain relief.
ObjectiveTo investigate the predictive value of a new nutritional index, triglycerides-total cholesterol-body mass index (TCBI), for prolonged postoperative hospital stay in patients undergoing coronary artery bypass grafting surgery (CABG). MethodsA retrospective analysis was conducted on the clinical data of CABG patients admitted to Wuhan Asian Heart Hospital, Wuhan University of Science and Technology from January 2022 to March 2024. Based on the postoperative hospital stay duration of CABG patients, they were divided into two groups: normal hospital stay group (≤14 days) and prolonged hospital stay group (>14 days). Univariate and multivariate logistic regression analyses were used to identify independent factors associated with prolonged postoperative hospital stay in CABG patients. The receiver operating characteristic (ROC) curve was employed to evaluate the predictive value of TCBI for prolonged postoperative hospital stay. ResultsA total of 460 patients were included, with 289 males (62.8%) and 171 females (37.2%), with an average age of 67 years (range 35-83 years). The TCBI level in the prolonged hospital stay group was significantly lower than that in the normal hospital stay group [1161.71 (825.36, 1511.78) vs. 1777.60 (1354.53, 2448.60), P<0.001]. Multivariate logistic regression analysis revealed that drinking history (OR=2.222, P=0.022), low absolute lymphocyte count (OR=0.169, P<0.001), low serum albumin (OR=0.624, P<0.001), and low TCBI (OR=0.816, P<0.001) were independent risk factors for prolonged postoperative hospital stay in CABG patients. ROC curve results showed that the area under the curve for TCBI to predict prolonged hospital stay was 0.808, with a sensitivity of 72.8% and specificity of 70.9% at a cutoff value of 1446.11. ConclusionTCBI is an effective predictive indicator for prolonged postoperative hospital stay in CABG patients, and the risk of prolonged postoperative hospital stay is higher in CABG patients with TCBI ≤1446.11.