M Osseis1, J Weyrech2, E Gayat3, S Dagois4, R Lo Dico1, M Pocard5, C Eveno6. 1. Digestive and Oncology Surgery Department, Lariboisiere Hospital, Assistance publique - Hôpitaux de Paris, 2 rue Ambroise-Paré, 75010 Paris, France. 2. Fernand Widal Hospital - Service: Rééducation fonctionnelle, Assistance publique - Hôpitaux de Paris, 75010 Paris, France. 3. Department of Anesthesia, Lariboisiere Hospital, Assistance publique - Hôpitaux de Paris, 2 rue Ambroise-Paré, 75010 Paris, France; UMR INSERM 942, Lariboisiere Hospital, 2 rue Amboise Paré, 75010 Paris, France; Paris Diderot University, USPC, Sorbonne Paris Cité, F-74575 Paris, France. 4. Department of Anesthesia, Lariboisiere Hospital, Assistance publique - Hôpitaux de Paris, 2 rue Ambroise-Paré, 75010 Paris, France. 5. Digestive and Oncology Surgery Department, Lariboisiere Hospital, Assistance publique - Hôpitaux de Paris, 2 rue Ambroise-Paré, 75010 Paris, France; Paris Diderot University, USPC, Sorbonne Paris Cité, F-74575 Paris, France; UMR INSERM 965, Angiogenesis and Translational Research Department, Lariboisiere Hospital, 2 rue Amboise Paré, 75010 Paris, France. 6. Digestive and Oncology Surgery Department, Lariboisiere Hospital, Assistance publique - Hôpitaux de Paris, 2 rue Ambroise-Paré, 75010 Paris, France; Paris Diderot University, USPC, Sorbonne Paris Cité, F-74575 Paris, France; UMR INSERM 965, Angiogenesis and Translational Research Department, Lariboisiere Hospital, 2 rue Amboise Paré, 75010 Paris, France. Electronic address: clarisse.eveno@gmail.com.
Abstract
BACKGROUND: Although Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) confers health benefits in peritoneal carcinomatosis (PC) treatment, it is associated with significant postoperative morbidity and mortality rate with increased length of hospital stay. The goal of this study is to determine whether a new comprehensive physiotherapy program including epidural loco-regional analgesia can improve the quality of care and patients recovery. METHODS: Between 2009 and 2013, 124 patients with PC were operated for CRS and HIPEC procedures. These patients were analyzed and divided in 2 groups by means of time. No Physio group included patients operated from 2009 to 2011 (n = 57) having a thoracic patient controlled epidural analgesia (PCEA) but no preoperative physiotherapy program. The Physio group included patients operated from 2012 to 2013 (n = 67) having both a PCEA with a preoperative physiotherapy program. RESULTS: The mortality rate was 1.6% (n = 2). The median length of stay in the intensive care unit (ICU) was lower in the Physio group, 2 days vs. 0 for No Physio group (p < 0.0001). The first time of mobilization after surgery was shorter in the Physio group (day 3 vs. 2, p = 0.0043). The overall satisfaction in the Physio group was achieved in 93% of patients, helping in decreasing fear of surgery and mobilization in 70% and 84% of cases respectively. CONCLUSION: Our study demonstrates that a clear pre-operative information and education by a physiotherapist, associated with a PCEA-pain management significantly benefits the patient's post-operative recovery and reduces the length of stay in the ICU.
BACKGROUND: Although Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) confers health benefits in peritoneal carcinomatosis (PC) treatment, it is associated with significant postoperative morbidity and mortality rate with increased length of hospital stay. The goal of this study is to determine whether a new comprehensive physiotherapy program including epidural loco-regional analgesia can improve the quality of care and patients recovery. METHODS: Between 2009 and 2013, 124 patients with PC were operated for CRS and HIPEC procedures. These patients were analyzed and divided in 2 groups by means of time. No Physio group included patients operated from 2009 to 2011 (n = 57) having a thoracic patient controlled epidural analgesia (PCEA) but no preoperative physiotherapy program. The Physio group included patients operated from 2012 to 2013 (n = 67) having both a PCEA with a preoperative physiotherapy program. RESULTS: The mortality rate was 1.6% (n = 2). The median length of stay in the intensive care unit (ICU) was lower in the Physio group, 2 days vs. 0 for No Physio group (p < 0.0001). The first time of mobilization after surgery was shorter in the Physio group (day 3 vs. 2, p = 0.0043). The overall satisfaction in the Physio group was achieved in 93% of patients, helping in decreasing fear of surgery and mobilization in 70% and 84% of cases respectively. CONCLUSION: Our study demonstrates that a clear pre-operative information and education by a physiotherapist, associated with a PCEA-pain management significantly benefits the patient's post-operative recovery and reduces the length of stay in the ICU.
Authors: Doralina L Anghelescu; Christina-Lin Brown; Andrew J Murphy; Andrew M Davidoff; Paxton V Dickson; Evan S Glazer; Zachary E Stiles; Michael W Bishop; Luke Douthitt; Jeremiah L Deneve Journal: Ann Surg Oncol Date: 2018-10-23 Impact factor: 5.344
Authors: Engy T Said; Jacklynn F Sztain; Wendy B Abramson; Minhthy N Meineke; Timothy J Furnish; Ulrich H Schmidt; Gerard R Manecke; Rodney A Gabriel Journal: Anesth Analg Date: 2018-10 Impact factor: 5.108