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Objective:To analyze the incidence and mortality trends of female breast cancer in China from 1990 to 2019 and the impact of age-period-cohort (APC) on it.Methods:The incidence and mortality of breast cancer of Chinese women aged 20-95 years from 1990 to 2019 were collected from the Global Burden of Disease (GBD) in 2019. Joinpoint software was used to estimate the average annual percentage change rate (AAPC) of age standardized incidence and mortality, and analyze the changing trend of disease burden of breast cancer in Chinese women from 1990 to 2019. The R language based APC model developed by the National Cancer Institute of the United States was used to analyze the impact of age, period and cohort on their changes.Results:From 1990 to 2019, the age standardized incidence of female breast cancer in China showed an upward trend, from 17.07/100 000 in 1990 to 35.61/100 000 in 2019, with an average annual increase of 2.59% (95% CI: 2.45%-2.73%, P<0.001) , which was higher than the global level (AAPC=0.47%, 95% CI: 0.31%-0.63%, P<0.001) . The standardized mortality showed a slight downward trend, from 9.16/100 000 in 1990 to 9.01/100 000 in 2019, with a decrease of 0.05% (95% CI: -0.20%-0.09%, P=0.479) , but there was not a statistically significant difference. APC model results showed that the incidence and mortality of female breast cancer increased with age. With the passage of time, the incidence from 1990 to 2019 showed an upward trend, and the incidence risk rose to 1.49 in the 2015-2019 period (95% CI: 1.42-1.57, P<0.001) . The mortality showed a downward trend, and the death risk was the highest in the 1990-1994 period ( RR=0.79, 95% CI: 0.74-0.83, P<0.001) . Cohort effect results showed that the later the women were born, the higher the risk of morbidity. The women born in the cohort from 1995 to 1999 had the highest risk ( RR=3.12, 95% CI: 1.82-5.33, P<0.001) . The risk of death showed a unimodal distribution, showing a trend of first increasing and then decreasing, the later the women were born, the lower the risk of death. The birth cohort from 1950 to 1954 had the highest risk of death ( RR=1.04, 95% CI: 0.98-1.09, P<0.001) , and then showed a downward trend, falling to 0.48 (95% CI: 0.19-1.24, P<0.001) in the birth cohort from 1995 to 1999. Conclusion:From 1990 to 2019, the incidence of breast cancer in Chinese women shows an upward trend, which is significantly higher than the global increase, and the mortality tends to stabilize. APC model analysis finds that the incidence and mortality increase with age, and the period and cohort effects show that the incidence risk of breast cancer in Chinese women gradually increases with the passage of the period and cohort. The period effect of mortality shows a downward trend, and the cohort effect of mortality shows a unimodal distribution, showing a trend of first increasing and then decreasing.
ABSTRACT
Objective@#To investigate the feasibility and safety of the concept of enhanced recovery after surgery (ERAS) in the perioperative application of ambulatory laparoscopic cholecystectomy (ALC).@*Methods@#A retrospective analysis was made on 168 patients (ALC group) undergoing ALC in the daytime ward from Aug 2017 to Aug 2018 in our hospital vs conventional laparoscopic cholecystectomy CLC in the general ward in 165 patients (CLC group) . Clinical data, operation time, intraoperative blood loss, conversion to laparotomy, postoperative complication, readmission, pain score after 6h, patient satisfaction, first postoperative anal exhaust, average length of hospital stay, and hospitalization expenses were compared between the two groups.@*Results@#In the ALC group, the pain score, the first anal exhaust time, the average length of hospital stay, and the hospitalization cost were significantly lower than those in the CLC group. Compared with the CLC group, the satisfaction of patients in the ALC group was significantly improved. There was no significant difference in the incidence of postoperative complications (biliary leakage, postoperative bleeding, bile duct injury, infection of the incision) and readmission rate.@*Conclusion@#Use of enhanced recovery after surgery in laparoscopic cholecystectomy in day surgery is safe and feasible. It has many advantages such as reducing hospitalization costs and postoperative pain and accelerating postoperative recovery.
ABSTRACT
Objective To investigate the feasibility and safety of the concept of enhanced recovery after surgery (ERAS) in the perioperative application of ambulatory laparoscopic cholecystectomy (ALC).Methods A retrospective analysis was made on 168 patients (ALC group) undergoing ALC in the daytime ward from Aug 2017 to Aug 2018 in our hospital vs conventional laparoscopic cholecystectomy CLC in the general ward in 165 patients (CLC group).Clinical data,operation time,intraoperative blood loss,conversion to laparotomy,postoperative complication,readmission,pain score after 6h,patient satisfaction,first postoperative anal exhaust,average length of hospital stay,and hospitalization expenses were compared between the two groups.Results In the ALC group,the pain score,the first anal exhaust time,the average length of hospital stay,and the hospitalization cost were significandy lower than those in the CLC group.Compared with the CLC group,the satisfaction of patients in the ALC group was significantly improved.There was no significant difference in the incidence of postoperative complications (biliary leakage,postoperative bleeding,bile duct injury,infection of the incision) and readmission rate.Conclusion Use of enhanced recovery after surgery in laparoscopic cholecystectomy in day surgery is safe and feasible.It has many advantages such as reducing hospitalization costs and postoperative pain and accelerating postoperative recovery.
