Search

Postoperative recovery depends on a complex interplay of patient-related factors of which mobility is an essential part. The aim of this study is to evaluate correlations between perioperative physical activity, quality of life, and postoperative nursing workload in colorectal surgery. A prospective study was used to assess footsteps, quality of life, and nursing workload. Number of footsteps was recorded from preoperative day 5 to postoperative day 3. Patients with reduced and good mobilization were compared, and the cut-off defined by the median daily preoperative footsteps. Quality of life was assessed by the Cleveland Global Quality of Life (CGQL). Nursing workload was calculated using the Project Research in Nursing (PRN) score. Statistical correlation was measured by use of the Pearson coefficient. Fifty patients were included. Mean age was 59 years, mean body mass index was 25 kg/m2, and 68% of them were males. Demographics, surgical details, and clinical outcomes were comparable between the group of patients with poor mobilization compared to those with good mobilization. No correlation was found between pre- or post-operative footsteps and CGQL (r = − 0.072, p = 0.640 and r = − 0.127, p = 0.407), as well as between the number of pre- or post-operative footsteps and PRN (r = 0.060, p = 0.687 and r = − 0.095, p = 0531). In conclusion, no correlation was found between the number of perioperative footsteps, quality of life, and nursing workload after colorectal surgery. [ABSTRACT FROM AUTHOR]

Rationale: The aim of this study was to identify temporal readmission patterns according to baseline disease categories to provide opportunities for targeted interventions. Methods: Retrospective analysis of consecutive adult (≥18 years) patients who underwent elective colorectal resections (2011‐2017) at Mayo Clinic Rochester, MN. A prospective administrative database including patient demographics, procedure characteristics, discharge information and specifics on 30‐day readmissions (to index facility) including timing and reasons was utilized. The ICD‐9 codes were regrouped into the main pathologies Cancer, Crohn's disease (CD)/chronic ulcerative colitis (CUC), and diverticular disease. Results: In total, 521 (7.2%) out of 7245 patients undergoing inpatient colorectal surgery were readmitted. In all increments of time from discharge (0‐2 days: 31.3% of all readmissions, 3‐7 days: 32.4% of all readmissions, 8‐14 days: 18% of all readmissions, and 15‐30 days: 18.3% of all readmissions), reasons for readmission differed significantly (all P < 0.001). Across all disease categories, early readmissions (within 2 days of discharge) were most likely due to ileus/obstruction (53.4% of early readmissions), whereas with 42.5%, infection was the most common cause for late readmissions (>7 days). Patients with home discharge were more likely to be readmitted earlier within the 30‐day observation period (P = 0.099), whereas patients with a longer length of index hospital stay (>7 days) were readmitted later (P = 0.080). Conclusions: Reasons for readmission appear to be universal across different disease categories. Targeted educational and collaborative measures may help to mitigate the burden of hospital readmissions to index facilities. [ABSTRACT FROM AUTHOR]

Background: Enhanced Recovery After Surgery (ERAS) guidelines advocate early postoperative mobilisation to counteract catabolic changes due to immobilisation and maintain muscle strength. The present study aimed to assess compliance to postoperative mobilisation according to ERAS recommendations.Materials and Methods: This is a retrospective cohort study on consecutive colorectal surgical procedures treated within an established ERAS protocol within a single center between May 2011 and May 2017. Demographics, surgical details, ERAS related items and surgical outcome were prospectively assessed in a dedicated database and compared between ambulant patients (at least 6 h out of bed at postoperative day (POD) 1) vs. patients not meeting the target (delayed mobilisation). Risk factors for decreased postoperative mobilisation were identified through multivariable logistic regression.Results: 1170 patients were retained. 676 patients (58%) did not mobilise as recommended by ERAS protocol at POD1. Emergency operation (Odds Ratio (OR) 0.40; 95% Confidence Interval (CI) 0.18-0.91, p = 0.028), age > 70 years (OR 0.69; 95% CI 0.47-1.00, p = 0.050) and intraoperative total fluids > 2000 mL (OR 0.59; 95% CI 0.37-0.93, p = 0.025) were independent risk factors for delayed mobilisation. Patients with delayed mobilisation had significantly more overall (Clavien grade IV) (55% vs. 29%, p=<0.001), major (Clavien grade IIIb-V) (16% vs. 7%, p=<0.001) and respiratory (12% vs. 4%, p=<0.001) complications, as well as longer length of stay (12 ± 14 vs. 6±7days, p=<0.001).Conclusions: More than half of patients did not mobilise as recommended by ERAS guidelines. Emergency surgery, advanced age and fluid overload were independent risk factors for delayed mobilisation, which was associated with increased postoperative complications. [ABSTRACT FROM AUTHOR]

Background. The present study aimed to evaluate a potential effect of ERAS on surgical site infections (SSI). Methods. Colonic surgical patients operated between May 2011 and September 2015 constituted the cohort for this retrospective analysis. Over 100 items related to demographics, surgical details, compliance, and outcome were retrieved from a prospectively maintained database. SSI were traced by an independent National surveillance program. Risk factors for SSI were identified by univariate and multinomial logistic regression. Results. Fifty-four out of 397 patients (14%) developed SSI. Independent risk factors for SSI were emergency surgery (OR 1.56; 95% CI 1.09–1.78, p=0.026), previous abdominal surgery (OR 1.7; 95% CI 1.32–1.87, p=0.004), smoking (OR 1.71; 95% CI 1.22–1.89, p=0.014), and oral bowel preparation (OR 1.86; 95% CI 1.34–1.97, p=0.013), while minimally invasive surgery (OR 0.3; 95% CI 0.16–0.56, p<0.001) protected against SSI. Compliance to ERAS items of >70% was not retained as a protective factor for SSI after multivariate analysis (OR 0.94; 95% CI 0.46–1.92, p=0.86). Conclusions. Smoking, open and emergency surgery, and bowel preparation were risk factors for SSI. ERAS pathway had no independent impact while minimally invasive approach did. This study was registered under ResearchRegistry.com (UIN researchregistry2614). [ABSTRACT FROM AUTHOR]

Background: Enhanced recovery protocols have been proven to decrease complications and hospital stay following elective colorectal surgery. However, these principles have not yet been reported for urgent surgery procedures. We aimed to assess our initial experience with urgent colectomies performed within an established enhanced recovery pathway. Methods: In a prospective cohort study, all patients undergoing colonic resection between April 2012 and March 2013 were treated according to a standardized enhanced recovery protocol. Urgent surgeries were compared with the elective procedures with regards to baseline characteristics, compliance with enhanced recovery items, and clinical outcome. Results: Patients ( N = 28) requiring urgent colonic resection were included and compared with patients undergoing elective colectomy ( N = 63). Overall compliance with the protocol was 57 % for the urgent compared with 77 % for the elective procedures ( p = 0.006). The pre-operative compliance was 64 versus 96 % ( p < 0.001), the intra-operative compliance was 77 versus 86 % ( p = 0.145), and the post-operative compliance was 49 versus 67 % ( p = 0.015), for the urgent and elective resections, respectively. Overall, 18 urgent patients (64 %) and 32 elective patients (51 %) developed postoperative complications ( p = 0.261). Median postoperative length of stay was 8 days in the urgent setting compared with 5 days in the elective setting ( p = 0.006). Conclusions: Many of the intra-operative and post-operative enhanced recovery items can also be applied to urgent colectomy, entailing outcomes that approach the results achieved in the elective setting. [ABSTRACT FROM AUTHOR]

Background: Intrathecal analgesia and avoidance of perioperative fluid overload are key items within enhanced recovery pathways. Potential side effects include hypotension and renal dysfunction. Study Design: From January 2010 until May 2010, all patients undergoing colorectal surgery within enhanced recovery pathways were included in this retrospective cohort study and were analyzed by intrathecal analgesia (IT) vs none (noIT). Primary outcomes measures were systolic and diastolic blood pressure, mean arterial pressure, and heart rate for 48 hours after surgery. Renal function was assessed by urine output and creatinine values. Results: One hundred and sixty-three consecutive colorectal patients (127 IT and 36 noIT) were included in the analysis. Both patient groups showed low blood pressure values within the first 4 to 12 hours and a steady increase thereafter before return to baseline values after about 24 hours. Systolic and diastolic blood pressure and mean arterial pressure were significantly lower until 16 hours after surgery in patients having IT compared with the noIT group. Low urine output (<0.5 mL/kg/h) was reported in 11% vs 29% (IT vs noIT; p = 0.010) intraoperatively, 20% vs 11% (p = 0.387), 33% vs 22% (p = 0.304), and 31% vs 21% (p = 0.478) for postanesthesia care unit and postoperative days 1 and 2, respectively. Only 3 of 127 (2.4%) IT and 1 of 36 (2.8%) noIT patients had a transitory creatinine increase >50%; no patients required dialysis. Conclusions: Postoperative hypotension affects approximately 10% of patients within an enhanced recovery pathway and is slightly more pronounced in patients with IT. Hemodynamic depression persists for <20 hours after surgery; it has no measurable negative impact and therefore cannot justify detrimental postoperative fluid overload. [ABSTRACT FROM AUTHOR]

Background: The present study was designed to evaluate surgeons' strategies and adherence to preventive measures against surgical site infections (SSIs). Materials and methods: All surgeons participating in a prospective Swiss multicentric surveillance program for SSIs received a questionnaire developed from the 2008 National (United Kingdom) Institute for Health and Clinical Excellence (NICE) clinical guidelines on prevention and treatment of SSIs. We focused on perioperative management and surgical technique in hernia surgery, cholecystectomy, appendectomy, and colon surgery (COL). Results: Forty-five of 50 surgeons contacted (90%) responded. Smoking cessation and nutritional screening are regularly propagated by 1/3 and 1/2 of surgeons, respectively. Thirty-eight percent practice bowel preparation before COL. Preoperative hair removal is routinely (90%) performed in the operating room with electric clippers. About 50% administer antibiotic prophylaxis within 30 min before incision. Intra-abdominal drains are common after COL (43%). Two thirds of respondents apply nonocclusive wound dressings that are manipulated after hand disinfection (87%). Dressings are usually changed on postoperative day (POD) 2 (75%), and wounds remain undressed on POD 2-3 or 4-5 (36% each). Conclusions: Surgeons' strategies to prevent SSIs still differ widely. The adherence to the current NICE guidelines is low for many procedures regardless of the available level of evidence. Further research should provide convincing data in order to justify standardization of perioperative management. [ABSTRACT FROM AUTHOR]

Résumé: ERAS (Enhanced Recovery After Surgery – réhabilitation améliorée) est un concept multimodal pour diminuer le stress chirurgical et les complications postopératoires. Comme effet secondaire, ERAS réduit la durée d’hospitalisation et les coûts de la chirurgie colorectale et est donc considéré comme standard. Les récentes recommandations ERAS fournissent un aperçu complet des mesures fondées sur des preuves. Sa mise en œuvre nécessite une équipe pluridisciplinaire dédiée, de contrôler sa mise en place ainsi que les progrès réalisés et de signaler les problèmes rencontrés (audit). [ABSTRACT FROM AUTHOR]

Background: Reported incidence of surgical site infections (SSI) after colonic surgery varies widely. These variations depend not only on patient- and surgery-related parameters but are influenced by type and quality of follow-up. The aim of the study was to compare SSI assessed by two independent prospective surveillance systems, a national surveillance program based on recommendations of the National Healthcare Safety Network (Swissnoso) versus an international audit system, the ERAS® Interactive Audit System (EIAS; Encare, Stockholm, Sweden).Methods: Comparative study of a consecutive cohort of colonic resections at a single institution from September 2015 to March 2017. Independent prospective SSI monitoring was available from Swissnoso and EIAS. Inter-observer reliability was calculated using Cohen k. Sensitivity, specificity, and accuracy of EIAS in assessing SSI was compared with Swissnoso, considered as gold standard.Results: The final sample included 143 patients. Of these, 136 (95.1%) were classified into the same category by both systems, identifying 17 patients (12.5%) with SSI and 119 patients (87.5%) without SSI, respectively. Discrepant results were found for the remaining seven patients (4.9%) with four SSI categorization according to Swissnoso but not EIAS, and three SSI categorization in EIAS but not in Swissnoso; all miscategorized patients presented superficial SSI. Sensitivity, specificity, and accuracy of EIAS for SSI recording was 81%, 97.5%, and 95.1%, respectively. Inter-observer agreement was high (Cohen k value of 0.801, p < 0.001). Case-by-case analysis of discrepant findings revealed mainly discrepant interpretation of clinical symptoms and erroneous labeling of non-procedure-related infections.Conclusions: Surgical site infection recording by two independent systems showed high concordance and good inter-rater reliability. [ABSTRACT FROM AUTHOR]