ELECTROACUPUNCTURE COMBINED WITH FAST-TRACK PERIOPERATIVE PROGRAM FOR REDUCING DURATION OF POSTOPERATIVE ILEUS AND HOSPITAL STAY AFTER LAPAROSCOPIC COLORECTAL SURGERY: A RANDOMIZED CONTROLLED TRIAL
Simon S. Ng*, Wing Wa Leung, Tony Mak, Kaori Futaba, Sophie S. Hon, Dennis Ngo, Simon Chu, Man Fung Ho, Oky C. Lam, Yee Ni C. Wong, Janet F. Lee
Surgery, The Chinese University of Hong Kong, Hong Kong , Hong Kong
Background and Objectives: Postoperative ileus (POI) remains a significant medical problem after colorectal surgery that adversely influences patients' recovery. Our previous study demonstrated that electroacupuncture (EA) reduces the duration of POI (defined by the time to first defecation) and hospital stay after laparoscopic colorectal surgery within a traditional perioperative care setting. Recent evidence also suggested that a 'fast-track' (FT) perioperative program may help accelerate recovery after colorectal surgery. It is uncertain whether the combination of EA and FT program will result in faster recovery after laparoscopic colorectal surgery when compared with FT program alone. This prospective, randomized, superiority trial aimed to compare the efficacy of EA combined with FT program vs. FT program alone in reducing the duration of POI and hospital stay after laparoscopic colorectal surgery.
Methods: Between July 2018 and October 2019, 72 consecutive patients undergoing elective laparoscopic resection of colonic and upper rectal cancer without conversion were randomized to receive either EA + FT program or FT program alone (36 per group). The primary outcome was time to defecation. Secondary outcomes were hospital stay, time to resume diet, pain scores, 30-day morbidity, quality of life, and medical costs. Data were analyzed by the intention-to-treat principle.
Results: The demographic data of the two groups were comparable. The mean time to defection was significantly shorter in the EA + FT group when compared with the FT group (44.5 '± 14.9 hours vs. 63.9 '± 30.1 hours; P = 0.001). The time to first passing flatus was also significantly shorter in the EA + FT group when compared with the FT group (1.4 '± 0.6 days vs. 1.8 '± 0.9 days; P = 0.011). Multiple linear regression analysis revealed that the addition of EA to the FT program (P = 0.001) and the absence of postoperative complications (P = 0.002) were independent predictors of shorter duration of POI. Other clinical outcomes including pain scores, hospital stay, overall morbidity rate, and short-term quality of life did not differ between the two groups. There was also no significant difference in the total direct cost between the two groups. No adverse event related to the use of EA was reported.
Conclusions: EA combined with FT program is more effective than FT program alone in reducing the duration of POI after laparoscopic colorectal surgery. The addition of EA to the FT program is an independent predictor of shorter duration of POI. The use of EA doesn't significantly increase the total direct cost of the perioperative strategy. The incorporation of EA into any clinical practice guidelines on Enhanced Recovery After Surgery or FT perioperative program should be considered to benefit more patients by minimizing the development of POI. (ClinicalTrials.gov number, NCT04090073)
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