Enhanced recovery after surgery (ERAS) has been carried out in many surgical fields such as orthopedics, galactophore, cardiothoracic surgery, gastrointestinal surgery, and obstetrics due to its standardized perioperative management process to reduce surgical stress and reduce surgical complications. After more than a decade of development, ERAS has achieved initial results. However, in China, the development of ERAS in orthopedic is still in its infancy. Most of the researches focus on the multidisciplinary management path of perioperative period. How to break through the existing bottlenecks is the key to accelerate the further development of rehabilitation. Therefore, this paper introduces the origin and development of ERAS, analyzes the challenges and opportunities of orthopedic ERAS in clinical advancement, proposes the important measures to promote the accelerated development of orthopedics, and provides new ideas for promoting the in-depth development of orthopedics accelerated rehabilitation.
Objective To identify the prevalence and related factors of emotional disorder of inpatients in Department of Spinal Surgery . Methods A cross-sectional study was conducted from October 2015 to April 2016 to screen 300 patients undergoing spinal surgery. Huaxi Emotional-distress Index was used to assess the emotional status of the patients, and a self-designed general condition questionnaire was used to evaluate the demographic data. Results The prevalence of emotional disorder of patients in Department of Spinal Surgery was 14.3%. Anxiety was the main type of emotional disorder. Logistic regression analysis showed that the education level and pathogeny were the main factors of emotional disorder. Conclusions In Department of Spinal Surgery, the inpatients’ psychological status is poor, and anxiety is the main emotional disorder. Emotional disorder is related to education level and pathogeny. Timely psychological treatment should be used in order to comprehensively improve the level of recovery of the inpatients.
Objectives To explore the application effect of orthopedic psychological sleep management mode based on enhanced recovery after surgery (ERAS) in orthopedic patients. Methods A non-synchronous clinical controlled study was conducted. The intervention group enrolled 118 orthopedic patients who admitted to our hospital between April and June 2017, and the control group enrolled 111 orthopedic patients who admitted to our hospital between January and March 2017. The control group used routine nursing measures during hospitalization, while the intervention group implemented an ERAS-based orthopedic psychological sleep management mode based on routine nursing measures, which included carrying out a new mode of multidisciplinary collaborative management, implementing the normative path of orthopedic psychological sleep management, and implementing the comprehensive psychological sleep management. The mood, sleep quality and satisfaction of the two groups within 24 hours after admission and before discharge were compared. Results Before the intervention, there was no statistically significant difference in general data, mood or sleep quality between the two groups (P>0.05). After the intervention, the median score (the lower and upper quartiles) of the Huaxi Emotional Index of the intervention group was 1 (0, 5), while the score of the control group was 2 (0, 6); the median score (the lower and upper quartiles) of the Pittsburgh Sleep Quality Index was 4 (3, 7) in the intervention group and 6 (4, 9) in the control group; the satisfaction score in the intervention group was better than that in the control group (96.47±2.72vs. 95.52±2.79); the differences between the two groups were statistically significant (P<0.05). Conclusions The ERAS-based orthopedic psychological sleep management mode is beneficial to improve the patients’ emotional disorder, sleep quality and satisfaction. It facilitates the patients’ accelerated recovery.
In recent years, reports of domestic robot-assisted total knee arthroplasty have gradually increased. In response to problems that may arise during the perioperative period, West China Hospital of Sichuan University has adopted measures such as the establishment of multidisciplinary team, adequate preoperative evaluation, precise intraoperative operations, and whole process optimization management (incision management, pain management, functional exercise and follow-up management). Combined with the actual clinical situation, a domestic robot-assisted total knee arthroplasty management program during the perioperative period was explored and formulated to promote the recovery of patients. This article introduces the above-mentioned program, and aims to provide a reference for the management optimization of domestic robot-assisted total knee arthroplasty during the perioperative period.
In addition to implementing a series of measures in the hospital, enhanced recovery after surgery also needs to balance pre-hospital rehabilitation and post-hospital continuation management for patients. In order to optimize the patient management process of hip and knee arthroplasty, the orthopedic team of West China Hospital of Sichuan University has developed a comprehensive management plan for patients undergoing artificial hip and knee arthroplasty based on the latest domestic and foreign literature and previous practice. This article introduces the program from the definition of whole process management, as well as the pre-hospital, in-hospital, and post-hospital management of patients undergoing hip and knee arthroplasty, and aims to provide experience and reference for future clinical practice.
Objective To investigate the effects of online follow-up mode and online + offline follow-up mode on rehabilitation after total hip arthroplasty. Methods Patients who underwent total hip arthroplasty in the Department of Orthopedic Surgery, West China Hospital of Sichuan University between August and December 2022 were selected. According to personal preference, the included patients were divided into an observation group and a control group. The observation group underwent comprehensive follow-up mode, while the control group underwent simple online follow-up mode. Joint function, daily living ability, Huaxi Emotional-distress Index, follow-up satisfaction, complications and readmission were compared between the two groups at 3, 8, 26 and 52 weeks after surgery. Results A total of 83 patients were included. Among them, there were 41 cases in the control group and 42 cases in the observation group. There was no statistically significant difference in personal basic information and disease-related data between the two groups (P>0.05). The joint function and daily living ability of the observation group were better than those of the control group at 8, 26, and 52 weeks after surgery (P<0.05). There was no significant difference between the two groups in Huaxi Emotional-distress Index and follow-up satisfaction at 52 weeks after operation (P>0.05). The incidence of complications in the observation group was lower than that in the control group (P<0.05). Conclusions The comprehensive follow-up model has more advantages in direct physical assessment, wound assessment, in-depth communication, timely feedback and adjustment, which can improve patients’ postoperative joint function, enhance their daily life ability, and reduce the occurrence of postoperative complications.
Objective To integrate augmented reality (AR) into the whole process of health management and observe its application effect in hip replacement patients. Methods Patients undergoing hip replacement in the Department of Orthopedic Surgery of West China Hospital, Sichuan University between April and September 2022 were selected. According to the random number table method, patients were divided into a trial group and a control group. The trial group adopted the whole process AR health management mode, and the control group adopted the conventional health education mode. The joint function score, functional exercise compliance, coping difficulties after discharge, Huaxi Emotional-distress Index and satisfaction of the two groups at different time points were compared. Results A total of 80 patients were included, with 40 patients in each group. At each follow-up time point after surgery, the scores of Harris Hip Score and Post-Discharge Coping Difficulty Scale among trial group patients were better than those of the control group patients (P<0.05). There was no statistically significant difference in the Huaxi Emotional-distress Index scores between the two groups (P>0.05). The compliance rate of functional exercise in the trial group (P=0.025) and the patient satisfaction were higher than those in the control group (Z=−4.918, P<0.05). Conclusions The AR-based whole process health management can make it easier for patients to grasp functional exercise (preoperative pre-exercise, postoperative rehabilitation), post-hospital health guidance and other educational knowledge. This new health management is conducive to enhancing patients’ exercise compliance, strengthening joint function recovery, daily living ability and patient satisfaction.It can be promoted and applied in clinical practice.
Wearable devices, as an important component of digital health, are gradually penetrating into the clinical nursing field. This paper explores the current applications of wearable devices in the field of clinical nursing, with a focus on their significant roles in real-time monitoring of physiological parameters, disease management, functional rehabilitation exercises. Additionally, it analyzes the challenges these devices face, such as the need for standardized development, data security and privacy protection, and cost-benefit analysis. This paper also proposes measures to address these challenges, including enhancing policy formulation, promoting standardization, and fostering technological innovation, with the aim of providing valuable insights for the advancement of high-quality clinical nursing practices.
In order to adapt to the development of the new medical care model, West China Hospital of Sichuan University established a multidisciplinary follow-up team, established follow-up health files, implemented follow-up health management, assessed the risk of abnormal indicators, guided rehabilitation, established green medical treatment channels, managed follow-up data, prevented health management risks, and continuously improved quality. Through these measures, West China Hospital of Sichuan University has established a standardized and systematic follow-up management model for patients with cervical spondylosis after discharge, in order to promote the functional rehabilitation of patients during the perioperative period, and improve patient satisfaction. This article introduces this contract-based follow-up management model, which aims to provide a reference for other medical institutions to establish a good follow-up management system for patients with cervical spondylosis.
In the context of accelerated rehabilitation, nutritional support for patients with orthopedic cervical spondylosis is an important condition for lessening postoperative stress response, reducing postoperative complications, shortening patient’s length of hospital stay, lowering medical expenses, and promoting early recovery of patients. Based on this, West China Hospital of Sichuan University explored and established the West China Hospital program for nutritional management in cervical spondylosis from the aspects of team building, nutritional assessment and monitoring, and nutritional intervention.