Inclusion and exclusion criteria
The study was approved by the Institutional Ethics Committee of Changzheng Hospital. The inclusion criterias were as follows: (1) patients were diagnosed as with spinal primary malignant tumors or metastatic tumors; (2) survival is expected to be longer than six months. The exclusion criterias were as follows: (1) patients with malignant metastatic tumors who cannot tolerate surgery or undergo palliative surgery; (2) having metastases in the lungs or other organs; (3) survival is expected to be less than six months. All the surgeries were performed by the same group of surgeons.
The MNIP multi-disciplinary team comprised of spine surgeons, anesthesiologists, physiotherapists, and nurses finalized the MNIP. This led us to selected 2 periods of 1 year, before (Group No-MNIP, from May 2019 to Apr 2020, n = 120 patients) and after implementing of the ERAS (Group MNIP, from May 2020 to Apr 2020, n = 120 patients).
Multi-mode nursing insulation program
Before the patient arrived in the operating room, the room temperature was preheated at 22–24 °C, and the specially-made segmented nine-holes with a length of 1.2 m and width of 1.0 m were preheated and covered to keep warm; the pre-heated segmented thermal insulation surgical gown was used during the operation. Used air heaters to heat and inflatable heat preservation, adjust at any time according to the patient's body temperature, to ensured that the patient's body temperature was above 36 °C; used an infusion warming instrument for infusion; recorded the disinfection time, the amount of input and output, the temperature of the rinsing solution, and implement targeted preventive measures for patients who were prone to hypothermia. Active warmth and passive warmth were synchronized; body thermometers were continuously monitored.
Evaluation outcome
Patient demographics, clinical history, comorbidities, and operative details were noted from the hospital records. The outcome measures for the study were as following:
Temperature changes during surgery
The rectal temperature was recorded after induction of anesthesia (T1), 30 min (T2), 60 min (T3), 90 min (T4), 120 min (T5), 150 min (T6), and 1 day after operation (T7).
Evaluation of anesthesia recovery effect
The Steward recovery score was used to evaluate the anesthesia recovery effect of the two groups of patients after the operation, and the time for the patients to recover from anesthesia after the operation was recorded. Only patients with a score of 4 or more could be allowed to leave the operating room or recovery room. Patients with intraoperative hypothermia could cause prolonged recovery time of anesthesia, and the recovery time of patients after surgery was generally within 60–90 min. If the recovery time exceeded this time limit, it would be regarded as delayed recovery.
Incidence of postoperative wound infection and length of hospital stay
Closely observed the wound healing of patients after surgery, and recorded the number of delayed wound healing and infections, as well as the number of days the patient was hospitalized.
Complications
Closely observed the patient's reaction, whether there were lung infections, urinary tract infections, bedsores, deep vein thrombosis, pulmonary embolism, cerebral vascular accident, gastrointestinal and myocardial infarction, establish an adverse reaction observation table, record the adverse events and their manifestations, start time, stop time and remission reasons.
Satisfactions
The satisfactions of patients were surveyed by telephone or email according to a Likert scale.
Statistical analysis
SPSS 22.0 statistical software (SPSS Inc., Chicago, Illinois) was used. Efficacy and safety analyses will be conducted according to the intention-to-treat principle using the “last observation carried forward” rule. A P value of less than 0.05 is defined as statistically significant with 2-sided 90% CIs.