Urgent focus on enhanced recovery after surgery of AIDS patients with limb fractures: evidence from the Chinese Medical Centre for Infectious Diseases
Aims: The incidence of limb fractures in patients living with HIV (PLWH) is increasing. However, due to their immunodeficiency status, the operation and rehabilitation of these patients present unique challenges. Currently, it is urgent to establish a standardized perioperative rehabilitation plan...
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The British Editorial Society of Bone & Joint Surgery
2024-11-01
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| Series: | Bone & Joint Research |
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| Online Access: | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2046-3758.1311.BJR-2024-0247.R1 |
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| author | Kangpeng Li Qiang Zhang |
| author_facet | Kangpeng Li Qiang Zhang |
| author_sort | Kangpeng Li |
| collection | DOAJ |
| description | Aims: The incidence of limb fractures in patients living with HIV (PLWH) is increasing. However, due to their immunodeficiency status, the operation and rehabilitation of these patients present unique challenges. Currently, it is urgent to establish a standardized perioperative rehabilitation plan based on the concept of enhanced recovery after surgery (ERAS). This study aimed to validate the effectiveness of ERAS in the perioperative period of PLWH with limb fractures. Methods: A total of 120 PLWH with limb fractures, between January 2015 and December 2023, were included in this study. We established a multidisciplinary team to design and implement a standardized ERAS protocol. The demographic, surgical, clinical, and follow-up information of the patients were collected and analyzed retrospectively. Results: Compared with the control group, the ERAS group had a shorter operating time, hospital stay, preoperative waiting time, postoperative discharge time, less intraoperative blood loss, and higher albumin and haemoglobin on the first postoperative day. The time to removal of the urinary catheter/drainage tube was shortened, and the drainage volume was also significantly reduced in the ERAS group. There was no significant difference in the visual analogue scale (VAS) scores on postoperative return to the ward, but the ERAS group had lower scores on the first, second, and third postoperative days. There were no significant differences in the incidence of complications, other than 10% more nausea and vomiting in the control group. The limb function scores at one-year follow-up were similar between the two groups, but time to radiological fracture union and time to return to physical work and sports were significantly reduced in the ERAS group. Conclusion: The implementation of a series of perioperative nursing measures based on the concept of ERAS in PLWH with limb fracture can significantly reduce the operating time and intraoperative blood loss, reduce the occurrence of postoperative pain and complications, and accelerate the improvement of the functional status of the affected limb in the early stage, which is worthy of applying in more medical institutions. Cite this article: Bone Joint Res 2024;13(11):647–658. |
| format | Article |
| id | doaj-art-7a91d1a30f5e4b1aa382f28f0505eb8c |
| institution | Kabale University |
| issn | 2046-3758 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | The British Editorial Society of Bone & Joint Surgery |
| record_format | Article |
| series | Bone & Joint Research |
| spelling | doaj-art-7a91d1a30f5e4b1aa382f28f0505eb8c2024-12-12T12:45:23ZengThe British Editorial Society of Bone & Joint SurgeryBone & Joint Research2046-37582024-11-01131164765810.1302/2046-3758.1311.BJR-2024-0247.R1Urgent focus on enhanced recovery after surgery of AIDS patients with limb fractures: evidence from the Chinese Medical Centre for Infectious DiseasesKangpeng Li0https://orcid.org/0009-0008-8406-5990Qiang Zhang1https://orcid.org/0009-0000-4136-5637 Department of Orthopaedics, Beijing Ditan Hospital, Capital Medical University, Beijing, China Department of Orthopaedics, Beijing Ditan Hospital, Capital Medical University, Beijing, China Aims: The incidence of limb fractures in patients living with HIV (PLWH) is increasing. However, due to their immunodeficiency status, the operation and rehabilitation of these patients present unique challenges. Currently, it is urgent to establish a standardized perioperative rehabilitation plan based on the concept of enhanced recovery after surgery (ERAS). This study aimed to validate the effectiveness of ERAS in the perioperative period of PLWH with limb fractures. Methods: A total of 120 PLWH with limb fractures, between January 2015 and December 2023, were included in this study. We established a multidisciplinary team to design and implement a standardized ERAS protocol. The demographic, surgical, clinical, and follow-up information of the patients were collected and analyzed retrospectively. Results: Compared with the control group, the ERAS group had a shorter operating time, hospital stay, preoperative waiting time, postoperative discharge time, less intraoperative blood loss, and higher albumin and haemoglobin on the first postoperative day. The time to removal of the urinary catheter/drainage tube was shortened, and the drainage volume was also significantly reduced in the ERAS group. There was no significant difference in the visual analogue scale (VAS) scores on postoperative return to the ward, but the ERAS group had lower scores on the first, second, and third postoperative days. There were no significant differences in the incidence of complications, other than 10% more nausea and vomiting in the control group. The limb function scores at one-year follow-up were similar between the two groups, but time to radiological fracture union and time to return to physical work and sports were significantly reduced in the ERAS group. Conclusion: The implementation of a series of perioperative nursing measures based on the concept of ERAS in PLWH with limb fracture can significantly reduce the operating time and intraoperative blood loss, reduce the occurrence of postoperative pain and complications, and accelerate the improvement of the functional status of the affected limb in the early stage, which is worthy of applying in more medical institutions. Cite this article: Bone Joint Res 2024;13(11):647–658.https://online.boneandjoint.org.uk/doi/epdf/10.1302/2046-3758.1311.BJR-2024-0247.R1erasenhanced recovery after surgeryhivfracturesurgerylimb fracturesaidshiv infectionvisual analogue scale (vas)intraoperative blood lossalbuminpostoperative paincatheteranaesthesiologistsdeep vein thrombosis |
| spellingShingle | Kangpeng Li Qiang Zhang Urgent focus on enhanced recovery after surgery of AIDS patients with limb fractures: evidence from the Chinese Medical Centre for Infectious Diseases Bone & Joint Research eras enhanced recovery after surgery hiv fracture surgery limb fractures aids hiv infection visual analogue scale (vas) intraoperative blood loss albumin postoperative pain catheter anaesthesiologists deep vein thrombosis |
| title | Urgent focus on enhanced recovery after surgery of AIDS patients with limb fractures: evidence from the Chinese Medical Centre for Infectious Diseases |
| title_full | Urgent focus on enhanced recovery after surgery of AIDS patients with limb fractures: evidence from the Chinese Medical Centre for Infectious Diseases |
| title_fullStr | Urgent focus on enhanced recovery after surgery of AIDS patients with limb fractures: evidence from the Chinese Medical Centre for Infectious Diseases |
| title_full_unstemmed | Urgent focus on enhanced recovery after surgery of AIDS patients with limb fractures: evidence from the Chinese Medical Centre for Infectious Diseases |
| title_short | Urgent focus on enhanced recovery after surgery of AIDS patients with limb fractures: evidence from the Chinese Medical Centre for Infectious Diseases |
| title_sort | urgent focus on enhanced recovery after surgery of aids patients with limb fractures evidence from the chinese medical centre for infectious diseases |
| topic | eras enhanced recovery after surgery hiv fracture surgery limb fractures aids hiv infection visual analogue scale (vas) intraoperative blood loss albumin postoperative pain catheter anaesthesiologists deep vein thrombosis |
| url | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2046-3758.1311.BJR-2024-0247.R1 |
| work_keys_str_mv | AT kangpengli urgentfocusonenhancedrecoveryaftersurgeryofaidspatientswithlimbfracturesevidencefromthechinesemedicalcentreforinfectiousdiseases AT qiangzhang urgentfocusonenhancedrecoveryaftersurgeryofaidspatientswithlimbfracturesevidencefromthechinesemedicalcentreforinfectiousdiseases |