Objective To analyze the changes of perioperative symptoms of lung cancer patients by using patient-reported outcomes at different time points. MethodsA total of 109 patients who underwent thoracoscopic lung cancer resection in the department of thoracic surgery of our hospital from March to April 2021 were selected, including 55 (50.46%) males and 54 (49.54%) females. The mean age was 55.19±12.12 years. The postoperative symptom scale for lung cancer patients was used to investigate the changes of symptoms before surgery, 1 day after surgery, the day of discharge, and 30 days after surgery. Results The mean hospital stay was 6.89±2.25 days. None of the patients reported any clinical symptoms related to lung cancer before surgery. The most prominent symptoms 1 day after surgery were pain (3.33±0.96 points), nausea (2.81±1.18 points), dizziness (2.00±0.85 points), fatigue (1.89±0.79 points) and shortness of breath (1.79±1.37 points). The patients with dizziness, nausea, fatigue and other symptoms gradually decreased, and the symptoms were relieved significantly (P<0.05). However, the symptoms of conscious pain, cough and shortness of breath lasted for a long time. At 30 days after surgery, 70.64%, 64.22% and 33.03% of patients felt pain, cough and shortness of breath, respectively, and the degree of cough was aggravated (P<0.001). Conclusion Pain, cough, dizziness, shortness of breath and fatigue are the core postoperative symptoms of lung cancer patients. Most postoperative adverse symptoms can be effectively controlled in a short period of time, but pain, cough and shortness of breath still present persistent characteristics, which deserve further study.
Objective To systematically review the effect of inspiratory muscle training (IMT) on postoperative clinical outcomes among esophageal cancer patients. Methods The PubMed, EMbase, Web of Science, The Cochrane Library, CNKI, WanFang Data and VIP databases were searched from inception to January 16th, 2022 for randomized controlled trials (RCTs) and cohort studies on the clinical application of IMT among postoperative esophageal cancer patients. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4 software. Results Eight studies were included, including 7 RCTs and 1 cohort study, involving 728 participants. The results of the meta-analysis demonstrated that IMT significantly enhanced postoperative respiratory muscle function [maximum inspiratory pressure (MIP): MD=5.75, 95%CI 0.81 to 10.70, P=0.02; maximum expiratory pressure (MEP): MD=8.19, 95%CI 4.14 to 12.24, P<0.001] and pulmonary function (FEV1%: MD=6.94, 95%CI 5.43 to 8.45, P<0.001; FVC%: MD=4.65, 95%CI 2.70 to 6.60, P<0.001; MVV: MD=8.66, 95%CI 7.17 50 10.14, P<0.001; FEV1/FVC%: MD=8.04, 95%CI 4.68 to 11.40, P<0.001). Additionally, the results indicated that IMT could substantially improve postoperative functional performance [six-minute walk test (6MWT): MD=66.99, 95%CI 10.13 to 123.85, P=0.02; Borg index: MD=−1.03, 95%CI −1.26 to −0.81, P<0.001]. However, no significant reduction in the incidence of postoperative complications was observed. Conclusion IMT can improve the postoperative clinical outcomes of esophageal cancer patients and facilitate patient recovery after surgery, which has high clinical value. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
Objective To investigate the current level of resourcefulness and its impact on work engagement among lung cancer patients who have returned to work after video-assisted thoracoscopic surgery (VATS) lung resection. Methods A sample of middle-aged and young lung cancer patients who underwent VATS lung resection at the Department of Thoracic Surgery, West China Hospital of Sichuan University, between March and September 2023 and had returned to work were selected as the study subjects. Data were collected using a general information questionnaire, the Resourcefulness Scale, and the Utrecht Work Engagement Scale (UWES). Univariate analysis and multiple stepwise regression analysis were used to examine the current status of patients’ resourcefulness upon returning to work and its influence on work engagement. Results A total of 219 patients were included in the study, comprising 60 males and 159 females, with a mean age of (43.18±7.55) years. The patients' score for resourcefulness in returning to work was (107.58±14.42) points, and the total score for work engagement was (64.80±12.72) points. A significant positive correlation was observed between the resourcefulness score and the work engagement score (P<0.001). Multiple stepwise regression analysis revealed that factors such as job nature, average monthly household income, postoperative complications, and individuals' level of resourcefulness all significantly influenced the degree of patients' work engagement (all P<0.05).Conclusion The resourcefulness level and work engagement of patients returning to work after VATS lung resection need to be improved.
Esophageal carcinoma is a malignant tumor with high morbidity and mortality worldwide, and surgery is the main treatment currently. With the development of patient-centered care, the effect of surgery should not be limited to the improvement of the incidence of postoperative complications, mortality and other indicators. It is also important to provide experience related to disease and surgery from the perspective of patients. Therefore, more and more attention is paid to patient-reported outcomes by scholars. This paper will provide an overview of the international widely used, reliable and effective scales and researches about patient-reported outcomes in esophageal carcinoma.
ObjectiveTo investige the effects of multidisciplinary perioperative nutrition management on nutrition and postoperative complications of patients with esophageal cancer.MethodsA total of 239 patients with esophageal cancer who received elective surgical treatment were included in the study. They were divided into a trial group (120 patients) and a control group (119 patients) according to the random number table method. There were 97 males and 23 females in the trial group with an average age of 63.78±9.13 years, and 94 males and 25 females in the control group with an average age of 64.12±7.91 years. The control group received routine diet management, and the trial group received multidisciplinary perioperative nutrition management. The differences of nutrition and postoperative complications between the two groups were compared.ResultsThe total protein and albumin levels on postoperative days 3 and 7 in the trial group were higher than those in the control group (P<0.05), patients' postoperative anal exhaust time was shorter than that in the control group (P<0.05), the incidence of postoperative gastrointestinal adverse reactions, lung infection, postoperative anastomotic fistula, hypoproteinemia on postoperative days 3 and 7 was lower than that in the control group (P<0.05), and hospitalization cost was lower than that in the control group (P<0.05).ConclusionMultidisciplinary nutrition management can effectively improve the nutrition of patients, promote the rapid recovery of postoperative gastrointestinal function, reduce postoperative complications, and reduce hospitalization costs. It has high clinical reference and promotion value.
Objective To explore the application value of failure mode and effect analysis (FMEA) in the risk management of unplanned extubation after esophageal cancer surgery. Methods A total of 1 140 patients who underwent esophageal cancer surgery in our department from January 2015 to May 2017 were selected as a control group, including 948 males and 192 females with an average age of 64.45±4.53 years. FMEA was used to analyze the risk management process of unplanned extubation. The potential risk factors in each process were found by calculating the risk priority number (RPN) value, and the improvement plan was formulated for the key process with RPN>125 points. Then 1 117 patients who underwent esophageal cancer surgery from June 2017 to December 2019 were selected as a trial group, including 972 males and 145 females with an average age of 64.60±5.22 years, and the FMEA risk management mode was applied.Results The corrective measures were taken to optimize the high-risk process, and the RPN values of 9 high-risk processes were reduced to below 125 points after using FMEA risk management mode. The rate of unplanned extubation in the trial group was lower than that in the control group (P<0.05). Conclusion The application of FMEA in the risk management of unplanned extubation after esophageal cancer surgery can reduce the rate of unplanned extubation, improve the quality of nursing, and ensure the safety of patients.
Objective To investigate the status quo and influencing factors of depression and anxiety in postoperative patients with thoracic neoplasms. Methods The general information questionnaire and Huaxi emotional-distress index scale (HEI) were adopted to survey 70 patients after surgery of thoracic neoplasms at the thoracic nursing outpatients from September to November 2016. There were 43 males and 27 females with age of 18-78 (56.20±11.34) years. Results The prevalence rate of depression and anxiety among postoperative patients with thoracic neoplasms was 50.0%, and moderate to severe negative emotions predominated. There was significant difference in educational levels, postoperative hospitalization and postoperative complications (P<0.05), while no significant difference in age, gender, disease types, complicated diseases, surgical procedures, pathological stages and hospitalization expenditures between patients with unhealthy emotions and normal emotions (P>0.05). Conclusion There is a high prevalence rate of negative emotion among postoperative patients with thoracic neoplasms. Educational levels, postoperative hospitalization and postoperative complications are important factors for negative emotion.
The severe situation of the spread of novel coronavirus pneumonia (COVID-19) poses a huge challenge to the admission and management of patients undergoing selective thoracic surgery. In order to ensure that patients can receive surgical treatment in time, and we can effectively prevent the outbreak and spread of the disease in the surgical department, the department should comb the relevant content from multiple aspects in accordance with the specific situation. It is necessary to adopt a new admission process of patients undergoing selective surgery and COVID-19 investigation process for patients and their families during the epidemics. We should improve the companion and suspected patient management system during the epidemic. Patients who are planning to undergo surgery need to be strictly checked for COVID-19 infection before surgery. The treatment and management strategies of patients undergoing thoracic surgery in our department are summarized in this paper.
Objective To understand the status quo of depression and anxiety emotion in perioperative patients with thoracic neoplasms under the concept of enhanced recovery aftersurgery. Methods Huaxi emotional-distress index scale (HEI) was adopted to investigate the mental status of 195 patients with thoracic neoplasms in Department of Thoracic Surgery, West China Hospital, and the nursing outpatients between September and November in 2016. There were 118 males and 77 females at age of 17–80 (55.72±12.66) years. Results There was significant difference in mental health level between the preoperative patients and the postoperative patients (3.70±3.41vs. 11.01±9.78,P<0.001). The incidence of depression and anxiety emotion in the postoperative patients was significantly higher than that in the preoperative patients (50.00%vs. 9.60%, P<0.001). Besides, there was significant difference of depression and anxiety degree between the preoperative patients and postoperative patients (P<0.001). Moderate to severe depression and anxiety were mostly found in the postoperative patients while mild to moderate depression and anxiety in the preoperative patients. Conclusion Patients with thoracic neoplasms have much emotional obstacle in perioperative period. The incidence and severity degree of depression and anxiety emotion in postoperative patients are higher than those in preoperative patients.