Enhanced recovery after surgery program in patients from Tibet Plateau undergoing surgeries for hepatic alveolar echinococcosis.

BACKGROUND: Hepatic alveolar echinococcosis (HAE) is a severe and common parasitic disease in Tibetan Plateau of China. The infected patients have to move to plain areas to receive treatments due to the poor medical conditions in plateau areas. Our aim was to investigate the application of Enhanced Recovery after Surgery (ERAS) program in perioperative management for HAE patients from Tibet Plateau and the notes for patients with landform changes.

MATERIAL AND METHODS: A total of 89 HAE patients from Tibet Plateau (altitude: average of 4500 m) prior received adaptive treatments at the cooperative hospital (altitude: 1500-2000 m) and accepted surgery at plain regions (altitude: 200-400 m). The patients in ERAS group received ERAS program care and patients in conventional management group received conventional care during perioperative period.

RESULTS: Patients in ERAS group displayed significant shorter hospital stay and shorter time for recovery of gurgling compared with conventional management group (ERAS group versus conventional management group: 10.48 ± 3.525 d versus 20.29 ± 8.632 d; 1.56 ± 1.236 d versus 2.8 ± 1.19 d; all P < 0.01). The number of patients with complications of bloating, nausea/vomiting, pulmonary infection, urinary tract infection, upper gastrointestinal hemorrhage, and pulmonary edema was remarkably reduced (number, ERAS group versus conventional management group: 14 versus 24; 5 versus 16; 7 versus 24; 4 versus 13; 0 versus 10; all P < 0.05), and the visual analog scale scores in postoperative days 1 and 2 were obviously decreased in patients of ERAS group (score, ERAS group versus conventional management group: 2.5 ± 1.288 versus 3.83 ± 1.87; 2.25 ± 0.838 versus 3.51 ± 1.468; all P < 0.01).

CONCLUSIONS: Patients from Tibet Plateau need to receive adaptive treatments for landform changes before receiving surgeries at plain regions. ERAS program is effective and safe for Tibetan HAE patients during perioperative period.