901
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Rodrigues Pessoa R, Urkmez A, Kukreja N, Baack Kukreja J. Enhanced recovery after surgery review and urology applications in 2020. BJUI COMPASS 2020; 1:5-14. [PMID: 35474909 PMCID: PMC8988792 DOI: 10.1002/bco2.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 01/28/2020] [Accepted: 01/28/2020] [Indexed: 02/01/2023] Open
Abstract
Purpose: To explore enhanced recovery after surgery (ERAS) components and their current application to major urologic surgeries, barriers to implementation and maintenance of the associated quality improvement. Data Identification: An English language literature search was done using PubMed. Study Selection: After independent review, 55 of the original 214 articles were selected to specifically address the stated purpose. Data Extraction: Clinical trials were included, randomized trials were prioritized, but robust observational studies were also included. Results of Data Synthesis: Many ERAS components have good data to support usage in radical cystectomy (RC) patients. Most ERAS programs include multidisciplinary teams carrying out multimodal pathways to hasten recovery after a major operation. ERAS components generally include preoperative counseling and medical optimization, venous thromboembolism prophylaxis, ileus prevention, avoidance of fluid overload, normothermia maintenance, early mobilization, pain control and early feeding, all leading to early discharge without increased complications or readmissions. Although there may not be specific data pertaining to other major urologic operations, the principles remain similar and ERAS is easily applicable. Conclusion: The benefits of ERAS programs are well established for RC and principles are easily applicable to other major urology operations. Barriers to implantation and maintenance of ERAS must be recognized to continue to maintain the benefits of these programs.
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Affiliation(s)
| | - Ahmet Urkmez
- Department of Urology University of Texas MD Anderson Cancer Center Houston TX USA
| | - Naveen Kukreja
- Department of Anesthesia University of Colorado Aurora CO USA
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902
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Beal EW, Ahmed A, Grotz T, Leiting J, Fournier KF, Lee AJ, Dineen S, Dessureault S, Baumgartner JM, Veerapong J, Clarke C, Strong E, Maithel SK, Zaidi MY, Patel S, Dhar V, Hendrix R, Lambert L, Johnston F, Fackche N, Raoof M, LaRocca C, Ronnekleiv-Kelly S, Pokrzywa C, Pawlik TM, Abdel-Misih S, Cloyd JM. Trends in the indications for and short-term outcomes of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Am J Surg 2020; 219:478-483. [DOI: 10.1016/j.amjsurg.2019.09.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/13/2019] [Accepted: 09/16/2019] [Indexed: 11/25/2022]
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903
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Enhanced recovery after surgery: A clinical review of implementation across multiple surgical subspecialties. Am J Surg 2020; 219:530-534. [DOI: 10.1016/j.amjsurg.2019.11.009] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/06/2019] [Accepted: 11/07/2019] [Indexed: 01/15/2023]
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904
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Transversus Abdominis Plane Block Reduced Early Postoperative Pain after Robot-assisted Prostatectomy: a Randomized Controlled Trial. Sci Rep 2020; 10:3761. [PMID: 32111916 PMCID: PMC7048721 DOI: 10.1038/s41598-020-60687-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 02/12/2020] [Indexed: 12/05/2022] Open
Abstract
Analgesic effect of transversus abdominis plane block (TAP block) in lower major abdominal laparoscopic surgery with about 5 cm of maximum surgical scar has been controversial. We hypothesized that TAP block has benefits, so the analgesic effect of TAP block after robot-assisted laparoscopic prostatectomy (RALP) was evaluated. One hundred patients were enrolled in this prospective, double-blinded, randomized study. Standardized general anesthesia with wound infiltration on camera port and fentanyl dose limit of 3 µg/kg was provided. Ultrasound-guided, single-shot subcostal TAP block with either 0.375% ropivacaine (Ropivacaine group, 48 patients) or normal saline (Control group, 52 patients) was performed by anesthesiologist in charge (34 anesthesiologists) after surgical procedure. Pain score using numerical rating scale (NRS) and postoperative intravenous fentanyl were evaluated for the first 24 postoperative hours. Median values (interquartile range) of NRS scores when the patients were transferred to post-anesthesia care unit (PACU) were 5 (2–7) in Ropivacaine group and 6 (4–8) in Control group at rest (P = 0.03), 5 (2–8) in Ropivacaine group and 7 (5–8) in Control group during movement (P < 0.01). These significant differences disappeared at the time of discharging PACU. Fentanyl doses for the first 24 postoperative hours were 210 µg (120–360) in Ropivacaine group and 200 µg (120–370) in Control group (P = 0.79). These results indicated that subcostal TAP block by anesthesiologists of varied level of training reduced postoperative pain immediate after RALP. TAP block had fundamental analgesic effect, but this benefit was too small to reduce postoperative 24-hour fentanyl consumption.
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905
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Grass F, Hübner M, Mathis KL, Hahnloser D, Dozois EJ, Kelley SR, Demartines N, Larson DW. Challenges to accomplish stringent fluid management standards 7 years after enhanced recovery after surgery implementation-The surgeon's perspective. Surgery 2020; 168:313-319. [PMID: 32122658 DOI: 10.1016/j.surg.2020.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/13/2020] [Accepted: 01/24/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND This study aimed to analyze fluid management standards in 2 high-volume, enhanced recovery after surgery institutions 7 years after implementation. METHODS Retrospective analysis of consecutive patients undergoing elective, segmental colonic and extensive colorectal resections for benign and malignant pathology (2011-2017). Administration and composition of intravenous fluids, postoperative weight gain, and factors impeding compliance to preidentified fluid thresholds (3L fluid administration, 2.5 kg weight gain) were assessed. Multivariable logistic regression was performed to identify risk factors for postoperative adverse events. RESULTS A total of 5,155 patients were included. Among them, 2,320 patients (45.1%) received >3 L intravenous fluids at postoperative day 0. Fluid totals remained unchanged over the 7-year observation period. Fluid overload was independently associated with postoperative weight gain ≥2.5 kg at postoperative day 2 (odds ratio 1.34, P < .001). Patients with high American Society of Anesthesiologists score (≥3) undergoing open and longer (≥180 minutes) procedures were more likely to exceed both thresholds according to multivariable analysis (all P < .001). Other than open surgery, American Society of Anesthesiologists score ≥3, contamination class ≥3, and malignancy, both thresholds (≥3 L: odds ratio 1.76, 95% confidence interval 1.44-2.15, ≥ 2.5 kg: odds ratio 1.62, 95% confidence interval 1.33-1.97) were independent risk factors for postoperative adverse outcomes (occurring in 28.1% of patients). CONCLUSION Compliance with fluid thresholds appears to be challenging in patients with comorbidities undergoing open and long procedures. Efforts are encouraged because both thresholds are linked to adverse outcomes and appear to be potentially modifiable in selected patients.
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Affiliation(s)
- Fabian Grass
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN; Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Martin Hübner
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Kellie L Mathis
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN
| | - Dieter Hahnloser
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Eric J Dozois
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN
| | - Scott R Kelley
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - David W Larson
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN.
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906
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Crucitti A, Mazzari A, Tomaiuolo PM, Dionisi P, Diamanti P, Di Flumeri G, Donini LM, Bossola M. Enhanced Recovery After Surgery (ERAS) is safe, feasible and effective in elderly patients undergoing laparoscopic colorectal surgery: results of a prospective single center study. MINERVA CHIR 2020; 75:157-163. [PMID: 32083412 DOI: 10.23736/s0026-4733.20.08275-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND It is still unknown whether ERAS program is safe, feasible and effective in elderly patients undergoing laparoscopic colorectal surgery. In addition, the definition of the "old patient" in terms of age varies across the studies and different age cut-off, such as 65, 70, and 75 years have been used worldwide. METHODS All adult patients undergoing primary, elective colorectal laparoscopic surgery between January 2017 and December 2018 were considered eligible to follow the ERAS protocol according to the Enhanced Recovery After Surgery (ERAS) Society guidelines. Elderly were defined according three different cut-off values: <65 and ≥65 years, <70 and ≥70 years, <75 and ≥75 years. RESULTS One hundred and eight patients were included in the study. Adherence to protocol did not differ significantly between younger and older patients, for most of the items. Thirty-day mortality was absent. The frequency of postoperative complications globally considered and the frequency of the various single complications did not differ significantly between younger and older patients, independently of the cutoff considered to define the older age. Similarly, the frequency of re-intervention and readmission was similar in younger and older patients. Time to flatus and time to stool were similar in young and older patients, independently of the age cut-off used. Time to oral liquid diet was similar in patients with age <65 and ≥65 years while it was moderately longer in patients ≥70 years (1.5±1.1 days;) than in those <70 years (1.1±0.4 days; P=0.030) as well as in patients ≥75 years with respect to the younger ones (1.2±0.5 vs. 1.6±1.2 days; P=0.045). The time to oral solid feeding was similar in young and old patients, independently of the age cut-off used. Time to bladder catheter removal was significantly longer in older patients, independently of the age cut-off used, although the differences do not seem to be clinically relevant. The length of stay was significantly higher in older patients, when the cutoff of 70 years or 75 years was used, but did not differ significantly when the cut-off of 65 years was used. CONCLUSIONS The present study shows that the ERAS protocol is safe, feasible, and effective in elderly patients as in the young ones, undergoing laparoscopic elective colorectal surgery. This suggests that the ERAS program can be applied usefully to elderly patients in the routine clinical practice.
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Affiliation(s)
- Antonio Crucitti
- General and Minimally Invasive Surgery Unit, Cristo Re Hospital, Rome, Italy - .,Institute of General Surgery, Catholic University, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy -
| | - Andrea Mazzari
- General and Minimally Invasive Surgery Unit, Cristo Re Hospital, Rome, Italy
| | | | - Paolo Dionisi
- Department of Anesthesiology, Cristo Re Hospital, Rome, Italy
| | - Paolo Diamanti
- Department of Anesthesiology, Cristo Re Hospital, Rome, Italy
| | - Giada Di Flumeri
- General and Minimally Invasive Surgery Unit, Cristo Re Hospital, Rome, Italy
| | - Lorenzo M Donini
- Food Science and Human Nutrition Research Unit, Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Maurizio Bossola
- Hemodialysis Unit, Institute of Clinical Surgery, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
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907
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Migliore M, Giuffrida MC, Marano A, Pellegrino L, Giraudo G, Barili F, Borghi F. Robotic versus laparoscopic right colectomy within a systematic ERAS protocol: a propensity-weighted analysis. Updates Surg 2020; 73:1057-1064. [PMID: 32086772 DOI: 10.1007/s13304-020-00722-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 02/08/2020] [Indexed: 02/06/2023]
Abstract
The purpose of this study is to compare the early postoperative and pathological outcomes of robotic right colectomy (RRC) to those of laparoscopic right colectomy (LRC) with intracorporeal anastomosis (IA) within the systematic application of an enhanced recovery after surgery (ERAS) program. A single-institution prospective database of patients who underwent elective RRC or LRC with IA for neoplastic lesions between April 2010 and June 2018 was retrospectively reviewed. The patients' demographic characteristics, and perioperative and pathological outcomes were analyzed. Propensity-weighted analysis was employed to address potential selection biases of treatment allocation. A total of 216 patients (46 RRC, 170 LRC) were included. RRC demonstrated a significantly longer operative time (mean 242.43 min, SD 47.51) compared to LRC (mean 187.60 min, SD 56.60) (p = 0.001), confirmed by the propensity-weighted analysis (Coefficient 50.65; p < 0.001). Conversion rate between the two groups was comparable (p = 0.99). Median length of hospital stay (LOS) was the same in the RRC and the LRC group (4 days, p = 0.35). Readmission rate within 30 days in the RRC and LRC group was 2.2% and 2.4%, respectively (p = 0.99). Overall 30-day morbidity and 30-day mortality was 32.6% versus 27.1% (p = 0.46), and 0% versus 1.2% (p = 0.99) in the robotic and laparoscopic groups, respectively. No difference was found in the number of harvested lymph nodes (p = 0.75). In an ERAS environment, without the bias of mixed techniques of anastomosis, RRC had similar postoperative and pathological outcomes compared to the laparoscopic approach, but was associated with a longer operative time.
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Affiliation(s)
- Marco Migliore
- Department of Surgery, General and Oncologic Surgery Unit, Santa Croce e Carle Hospital, 12100, Cuneo, Italy
| | - Maria Carmela Giuffrida
- Department of Surgery, General and Oncologic Surgery Unit, Santa Croce e Carle Hospital, 12100, Cuneo, Italy
| | - Alessandra Marano
- Department of Surgery, General and Oncologic Surgery Unit, Santa Croce e Carle Hospital, 12100, Cuneo, Italy
| | - Luca Pellegrino
- Department of Surgery, General and Oncologic Surgery Unit, Santa Croce e Carle Hospital, 12100, Cuneo, Italy
| | - Giorgio Giraudo
- Department of Surgery, General and Oncologic Surgery Unit, Santa Croce e Carle Hospital, 12100, Cuneo, Italy
| | - Fabio Barili
- Department of Cardiac Surgery, Santa Croce e Carle Hospital, 12100, Cuneo, Italy
| | - Felice Borghi
- Department of Surgery, General and Oncologic Surgery Unit, Santa Croce e Carle Hospital, 12100, Cuneo, Italy.
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908
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Licina A, Silvers A, Laughlin H, Russell J, Wan C. Proposed pathway for patients undergoing enhanced recovery after spinal surgery: protocol for a systematic review. Syst Rev 2020; 9:39. [PMID: 32085813 PMCID: PMC7035675 DOI: 10.1186/s13643-020-1283-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/22/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The best evidence-enhanced recovery care pathway is yet to be defined for patients undergoing spinal surgery. Minimally invasive surgery, multimodal analgesia, early mobilization, and early postoperative nutrition have been considered as critical components of enhanced recovery in spinal surgery (ERSS). The objective of this study will be to synthesize the evidence underpinning individual components of a proposed multidisciplinary enhanced recovery pathway for patients undergoing spinal surgery. METHODS This is the study protocol for a systematic review of complex interventions. Our team identified 22 individual care components of a proposed pathway based on clinical practice guidelines and published reviews. We will include systematic reviews and meta-analysis, randomized controlled trials, non-randomized controlled trials, and observational studies in adults or pediatric patients evaluating any one of the pre-determined care components. Our primary outcomes will be all-cause mortality, morbidity outcomes (e.g., pulmonary, cardiac, renal, surgical complications), patient-reported outcomes and experiences (e.g., pain, quality of care experience), and health services outcomes (e.g., length of stay and costs). We will search the following databases (1990 onwards) MEDLINE, EMBASE, and Cochrane Library (Cochrane Database of Systematic Reviews and CENTRAL). Two reviewers will independently screen all citations, full-text articles, and abstract data. Potential conflicts will be resolved through discussion. The risk of bias for individual studies will be appraised using appropriate tools. A narrative synthesis will be provided with the information presented in the text and tables to summarize and explain the characteristics and findings of the included studies. Due to clinical and methodological heterogeneity, we do not anticipate to conduct meta-analyses. Confidence in cumulative evidence for each component of care will be classified according to the GRADE system. DISCUSSION This systematic review will identify, evaluate, and integrate the evidence underpinning individual components of a pathway for patients undergoing spinal surgery. The formation of an evidence-based pathway will allow for the standardization of clinical care delivery within the context of enhanced recovery in spinal surgery. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019135289.
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Affiliation(s)
- Ana Licina
- Austin Health, 145 Studley Road, Heidelberg, Victoria 3084 Australia
| | | | - Harry Laughlin
- Austin Health, 145 Studley Road, Heidelberg, Victoria 3084 Australia
| | - Jeremy Russell
- Austin Health, 145 Studley Road, Heidelberg, Victoria 3084 Australia
| | - Crispin Wan
- St Vincent’s Health, 41 Victoria Parade, Fitzroy, Victoria 3065 Australia
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909
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Zheng Y, Mao M, Ji M, Zheng Q, Liu L, Zhao Z, Wang H, Wei X, Wang Y, Chen J, Zhou H, Liang Q, Chen Y, Zhang X, Wang L, Cheng Y, Zhang X, Teng M, Lu X. Does a pulmonary rehabilitation based ERAS program (PREP) affect pulmonary complication incidence, pulmonary function and quality of life after lung cancer surgery? Study protocol for a multicenter randomized controlled trial. BMC Pulm Med 2020; 20:44. [PMID: 32070326 PMCID: PMC7029521 DOI: 10.1186/s12890-020-1073-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 01/31/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Lung cancer surgery is associated with a high incidence of postoperative pulmonary complications (PPCs). Preliminary evidence suggests that ERAS processes can reduce overall incidence of PPCs as short- and long-term recovery improved by supporting units to adopt evidence-based care. However, the evidence is inconclusive due to insufficient high-level studies in this research field. No well-designed, adequately powered, randomized controlled trials (RCTs) have investigated the effects of pulmonary rehabilitation based ERAS program (PREP) on post-operative pulmonary complications, pulmonary function, and health related quality of life following lung cancer surgery. METHODS The PREP trial is a pragmatic, investigator-initiated, multi-center, randomized controlled, parallel group, clinical trial. Five hundred patients scheduled for minimally invasive pulmonary resection at six hospitals in China will be randomized with concealed allocation to receive either i) a pre-operative assessment and an information booklet or ii) a pre-operative assessment, an information booklet, plus an additional education, a 30-min pulmonary rehabilitation training session and the post-operative pulmonary rehabilitation program. The primary outcome is incidence of PPCs defined with the Melbourne Group Scale diagnostic scoring tool. Secondary outcomes include incidence of cardiopulmonary and other complications, pulmonary function, cardiopulmonary endurance, muscle strength, activity level, health-related quality of life (HRQoL), pre- and post-operative hospital length of stay (LOS), and total hospital LOS. DISCUSSION The PREP trial is designed to verify the hypothesis that pulmonary rehabilitation based ERAS program reduces incidence of PPCs and improves pulmonary function and HRQoL in patients following lung cancer surgery. This trial will furthermore contribute significantly to the limited knowledge about the pulmonary rehabilitation based ERAS program following lung cancer surgery, and may thereby form the basis of future recommendations in the surgical community. TRIAL REGISTRATION Chinese Clinical Trial Registry: ChiCTR1900024646, 21 July 2019.
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Affiliation(s)
- Yu Zheng
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing, 210029, China
| | - Mao Mao
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing, 210029, China
| | - Meifang Ji
- Department of Rehabilitation Therapy, the Second Affiliated Hospital of Hainan Medical University, No. 368 Yehai Road, Haikou, 570100, China
| | - Qiugang Zheng
- Department of Rehabilitation Therapy, the Second Affiliated Hospital of Hainan Medical University, No. 368 Yehai Road, Haikou, 570100, China
| | - Liang Liu
- Department of Rehabilitation Medicine, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210008, China
| | - Zhigang Zhao
- Department of Rehabilitation Medicine, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210008, China
| | - Haiming Wang
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Zhengzhou University, No. 1 East of Jianshe Road, Zhengzhou, 450052, China
| | - Xiangyang Wei
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Zhengzhou University, No. 1 East of Jianshe Road, Zhengzhou, 450052, China
| | - Yulong Wang
- Department of Rehabilitation Medicine, Shenzhen Dapeng New District Nan'ao People's Hospital, No. 6 Renmin Road, Dapeng New District, Shenzhen, 518000, China
| | - Jiamin Chen
- Department of Rehabilitation Medicine, Shenzhen Dapeng New District Nan'ao People's Hospital, No. 6 Renmin Road, Dapeng New District, Shenzhen, 518000, China
| | - Huiqing Zhou
- Department of Rehabilitation Therapy, Taizhou Enze Medical Center, Enze Hospital, No. 1 East of Tongyang Road, Taizhou, 318050, China
| | - Qiaoqiao Liang
- Department of Rehabilitation Therapy, Taizhou Enze Medical Center, Enze Hospital, No. 1 East of Tongyang Road, Taizhou, 318050, China
| | - Ying Chen
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing, 210029, China
| | - Xintong Zhang
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing, 210029, China
| | - Lu Wang
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing, 210029, China
| | - Yihui Cheng
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing, 210029, China
| | - Xiu Zhang
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing, 210029, China
| | - Meiling Teng
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing, 210029, China
| | - Xiao Lu
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing, 210029, China.
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910
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Rollins KE, Mathias NC, Lobo DN. Authors' reply: Meta-analysis of goal-directed fluid therapy using transoesophageal Doppler in patients undergoing elective colorectal surgery. BJS Open 2020; 4:165. [PMID: 32011824 PMCID: PMC6996629 DOI: 10.1002/bjs5.50228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 08/29/2019] [Indexed: 11/23/2022] Open
Affiliation(s)
- K E Rollins
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - N C Mathias
- University of Exeter Medical School, Exeter, UK
| | - D N Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK.,MRC Arthritis Research UK Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
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911
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Labalde Martínez M, García Borda FJ, Alcalde Escribano J, Nevado García C, Rubio González E, García Villar O, Peláez Torres P, de la Cruz Vigo F, Ferrero Herrero E. Transanal total mesorectal excision and adverse conditions for laparoscopic total mesorectal excision. Eur Surg 2020. [DOI: 10.1007/s10353-019-00626-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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912
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High compliance to ERAS protocol does not improve overall survival in patients treated for resectable advanced gastric cancer. Wideochir Inne Tech Maloinwazyjne 2020; 15:553-559. [PMID: 33294069 PMCID: PMC7687667 DOI: 10.5114/wiitm.2020.92833] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/04/2020] [Indexed: 02/06/2023] Open
Abstract
Introduction The ERAS (Enhanced Recovery after Surgery) protocol revolutionized perioperative care for gastrointestinal surgical procedures. However, little is known about the association between adherence to the ERAS protocol in gastric cancer surgery and the oncological outcome. Aim To explore the relation between adherence to the ERAS protocol and the oncological outcome in gastric cancer patients. Material and methods We performed a retrospective analysis of a prospectively collected database of patients treated for gastric cancer between 2013 and 2016. All patients were treated perioperatively with a 14-item ERAS protocol. Every patient underwent regular follow-up every 3 months for 3 years after surgery. 80% compliance to the ERAS protocol was the goal during perioperative care. Based on the level of compliance, patients were divided into group 1 and group 2 (compliance of ≥ 80% and < 80%, respectively). Results Compliance to the ERAS protocol was not a risk factor for diminished overall survival – probability of 3-year survival was 63% in group 1 and 56% in group 2 (p = 0.75). The proportional Cox model revealed that only stage III gastric cancer was a risk factor of poor prognosis in patients operated on for gastric cancer (HR = 7.89, 95% CI: 2.96–20.89; p = 0.0001). Conclusions High adherence to the ERAS protocol did not improve overall survival in our 3-year observation. Only the stage of the disease, according to the AJCC classification, was identified as a risk factor for poor prognosis.
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913
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Brindle M, Nelson G, Lobo DN, Ljungqvist O, Gustafsson UO. Recommendations from the ERAS® Society for standards for the development of enhanced recovery after surgery guidelines. BJS Open 2020; 4:157-163. [PMID: 32011810 PMCID: PMC6996628 DOI: 10.1002/bjs5.50238] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 10/22/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND ERAS® Society guidelines are holistic, multidisciplinary tools designed to improve outcomes after surgery. The enhanced recovery after surgery (ERAS) approach was initially developed for colorectal surgery and has been implemented successfully across a large number of settings, resulting in improved patient outcomes. As the ERAS approach is increasingly being adopted worldwide and new guidelines are being generated for new populations, there is a need to define an ERAS® Society guideline and the methodology that should be followed in its development. METHODS The ERAS® Society recommended approach for developing new guidelines is based on the creation of multidisciplinary guideline development groups responsible for defining topics, planning the literature search, and assessing the quality of the evidence. RESULTS Clear definitions for the elements of an ERAS guideline involve multimodal and multidisciplinary approaches impacting on multiple patient outcomes. Recommended methodology for guideline development follows a rigorous approach with systematic identification and evaluation of evidence, and consensus-based development of recommendations. Guidelines should then be evaluated and reviewed regularly to ensure that the best and most up-to-date evidence is used consistently to support surgical patients. CONCLUSION There is a need for a standardized, evidence-informed approach to both the development of new ERAS® Society guidelines, and the adaptation and revision of existing guidelines.
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Affiliation(s)
- M. Brindle
- Department of SurgeryAlberta Children's HospitalCalgaryAlbertaCanada
- Department of Community Health SciencesAlberta Children's HospitalCalgaryAlbertaCanada
| | - G. Nelson
- Division of Gynecologic OncologyTom Baker Cancer CentreCalgaryAlbertaCanada
| | - D. N. Lobo
- Gastrointestinal SurgeryNottingham Digestive Diseases Centre and National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical CentreNottinghamUK
- Medical Research Council–Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life SciencesUniversity of Nottingham, Queen's Medical CentreNottinghamUK
| | - O. Ljungqvist
- Department of SurgeryÖrebro University and University HospitalÖrebroSweden
- Institute of Molecular Medicine and Surgery, Karolinska InstitutetStockholmSweden
| | - U. O. Gustafsson
- Department of SurgeryDanderyd HospitalStockholmSweden
- Department of Clinical SciencesDanderyd Hospital, Karolinska InstitutetStockholmSweden
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914
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Pysyk CL. Epidural Catheter Use and Further Issues in Patients With Atrial Fibrillation Receiving a Direct Oral Anticoagulant. JAMA Intern Med 2020; 180:332. [PMID: 32011629 DOI: 10.1001/jamainternmed.2019.5861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Christopher L Pysyk
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
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915
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Cortés-Guiral D, Mohamed F, Glehen O, Passot G. Prehabilitation of patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal malignancy. Eur J Surg Oncol 2020; 47:60-64. [PMID: 32063398 DOI: 10.1016/j.ejso.2020.01.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/14/2020] [Accepted: 01/27/2020] [Indexed: 12/15/2022] Open
Abstract
Treatment of peritoneal malignancy with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) is often undertaken in patients who have nutritional, physical and psychological challenges as a result of advanced disease. Prehabilitation is a multimodal approach that helps optimize postoperative recovery and reduce morbidity and may be of benefit in this group of patients. It begins once the decision to operate is made and continues until recovery to baseline health. Here we present recommendations on Prehabilitation for patients undergoing cytoreductive surgery and HIPEC following discussion at the 10th Peritoneal Malignancy Workshop in Paris September 2018.
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Affiliation(s)
- Delia Cortés-Guiral
- Department of Surgical Oncology, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, GECOP Grupo Español de Cirugía Oncológica Peritoneal, Madrid, Spain.
| | - Faheez Mohamed
- Peritoneal Malignancy Department, Basingstoke and North Hampshire Hospitals, Basingstoke, UK
| | - Olivier Glehen
- Department of Surgical Oncology, CHU Lyon Sud, Hospices Civils de Lyon, University of Lyon, France
| | - Guillaume Passot
- Department of Surgical Oncology, CHU Lyon Sud, Hospices Civils de Lyon, University of Lyon, France
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916
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van Zelm R, Coeckelberghs E, Sermeus W, Wolthuis A, Bruyneel L, Panella M, Vanhaecht K. Effects of implementing a care pathway for colorectal cancer surgery in ten European hospitals: an international multicenter pre-post-test study. Updates Surg 2020; 72:61-71. [PMID: 31993994 DOI: 10.1007/s13304-020-00706-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 01/15/2020] [Indexed: 01/28/2023]
Abstract
Adherence to evidence-based recommendations is variable and generally low. This is also followed in colorectal surgery, despite the availability of the ERAS® protocol. The aim of the study was to evaluate the effect of implementing a care pathway for perioperative care in colorectal cancer surgery on outcomes and protocol adherence. So, we performed an international pre-test-post-test multicenter study, performed in ten hospitals in four European countries. The measures used included length of stay, morbidity and mortality, and documentation and adherence on intervention and patient level. Unadjusted pre-test-post-test differences were analyzed following an analysis adjusted for patient-mix variables. Importance-performance analysis was used to map the relationship between importance and performance of individual interventions. In total, 381 patients were included. Length of stay decreased from 12.6 to 10.7 days (p = 0.0230). Time to normal diet and walking also decreased significantly. Protocol adherence improved from 56 to 62% (p < 0.00001). Adherence to individual interventions remained highly variable. Importance-performance analysis showed 30 interventions were scored as important, of which 19 had an adherence < 70%, showing priorities for improvement. Across hospitals, change in protocol adherence ranged from a 13% decrease to a 22% increase. Implementing a care pathway for colorectal cancer surgery reduced length of stay, time to normal diet and walking. Documentation and protocol adherence improved after implementing the care pathway. However, not in all participating hospitals protocol adherence improved. Only in 25% of patients, protocol adherence of ≥ 70% was achieved, suggesting a large group is at risk for underuse. Importance-performance analysis showed which interventions are important, but have low adherence, prioritizing improvement efforts.
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Affiliation(s)
- Ruben van Zelm
- Leuven Institute for Healthcare Policy, KU Leuven, Kapucijnenvoer 35/3, 3000, Louvain, Belgium. .,European Pathway Association, Louvain, Belgium.
| | - Ellen Coeckelberghs
- Leuven Institute for Healthcare Policy, KU Leuven, Kapucijnenvoer 35/3, 3000, Louvain, Belgium
| | - Walter Sermeus
- Leuven Institute for Healthcare Policy, KU Leuven, Kapucijnenvoer 35/3, 3000, Louvain, Belgium.,European Pathway Association, Louvain, Belgium
| | - Albert Wolthuis
- Department of Abdominal Surgery, University Hospital Leuven, KU Leuven, Louvain, Belgium
| | - Luk Bruyneel
- Leuven Institute for Healthcare Policy, KU Leuven, Kapucijnenvoer 35/3, 3000, Louvain, Belgium.,University Hospitals Leuven, Louvain, Belgium
| | - Massimiliano Panella
- European Pathway Association, Louvain, Belgium.,Department of Translational Medicine, University of Eastern Piemonte (UPO), Novarra, Italy
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, KU Leuven, Kapucijnenvoer 35/3, 3000, Louvain, Belgium.,European Pathway Association, Louvain, Belgium.,Department of Quality, University Hospital Leuven, Louvain, Belgium
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917
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Venara A, Hamel JF, Cotte E, Meillat H, Sage PY, Slim K. Intraoperative nasogastric tube during colorectal surgery may not be mandatory: a propensity score analysis of a prospective database. Surg Endosc 2020; 34:5583-5592. [PMID: 31932940 DOI: 10.1007/s00464-019-07359-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 12/24/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Avoiding the use of nasogastric tubes (NGTs) is recommended after colorectal surgery but there is no consensus on intraoperative gastric decompression using NGTs during colorectal surgery. The objective was to assess the effect of avoiding insertion of NGTs during colorectal surgery for the recovery of gastrointestinal (GI) functions. METHOD 1561 patients undergoing colorectal surgery, for whom information on NGT use was available, were included in this retrospective analysis and propensity score analysis of the prospective GRACE Audit database. Patients who did and did not have an NGT during surgery were compared. RESULTS Among the study population of 1561 patients, 696 patients were matched to correct baseline differences between groups. The no-NGT group significantly improved GI motility impairment (e.g., less postoperative nausea [OR = 0.59; CI 95%: 0.42-0.84] and a better tolerance of early feeding [OR = 2.07; CI 95%: 1.33-3.22]). Such an association was also highlighted for reduced postoperative morbidity [OR = 0.60; CI 95%: 0.43-0.83], and especially pulmonary complications [OR = 0.08; CI 95%: 0.01-0.59], or parietal complications [OR = 0.29; CI 95%: 0.09-0.87]. The risk of postoperative ileus was not significantly reduced in the no-NGT group [OR = 0.67; CI 95%: 0.43-1.06]. CONCLUSION No NGT insertion during colorectal surgery is safe and could improve postoperative GI function recovery.
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Affiliation(s)
- Aurélien Venara
- Department of Visceral and Endocrinal Surgery, CHU Angers, University Hospital of Angers, 4, rue Larrey, 49933, Angers Cedex 9, France. .,TENS, UMR INSERM 1235, 1 Place Alexis Ricordeau, 44000, Nantes, France. .,Department of Medicine, University of Health of Angers, 49000, Angers, France.
| | - Jean-Francois Hamel
- Department of Medicine, University of Health of Angers, 49000, Angers, France.,Institut Paoli-Calmette, 232 boulevard de Sainte Marguerite, 13009, Marseille, France
| | - Eddy Cotte
- Department of Visceral Surgery, CHU Lyon, Centre Hospitalier Lyon-Sud, Université de Lyon, 69495, Pierre-Bénite Cedex, France
| | - Hélène Meillat
- Department of Visceral Surgery, CHU Grenoble, Université de Grenoble, 38700, La Tronche, France
| | - Pierre-Yves Sage
- Department of Endocrinal and Visceral Surgery, University Hospital of Clermont Ferrand, 63003, Clermont Ferrand, France
| | - Karem Slim
- Department of Visceral and Endocrinal Surgery, CHU Angers, University Hospital of Angers, 4, rue Larrey, 49933, Angers Cedex 9, France
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918
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Small C, Laycock H. Acute postoperative pain management. Br J Surg 2020; 107:e70-e80. [DOI: 10.1002/bjs.11477] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 11/22/2019] [Indexed: 12/16/2022]
Abstract
AbstractBackgroundAcute postoperative pain is common. Nearly 20 per cent of patients experience severe pain in the first 24 h after surgery, a figure that has remained largely unchanged in the past 30 years. This review aims to present key considerations for postoperative pain management.MethodsA narrative review of postoperative pain strategies was undertaken. Searches of the Cochrane Library, PubMed and Google Scholar databases were performed using the terms postoperative care, psychological factor, pain management, acute pain service, analgesia, acute pain and pain assessment.ResultsInformation on service provision, preoperative planning, pain assessment, and pharmacological and non-pharmacological strategies relevant to acute postoperative pain management in adults is presented, with a focus on enhanced recovery after surgery pathways.ConclusionAdequate perioperative pain management is integral to patient care and outcomes. Each of the biological, psychological and social dimensions of the pain experience should be considered and understood in order to provide optimum pain management in the postoperative setting.
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Affiliation(s)
- C Small
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - H Laycock
- Department of Anaesthetics, Pain Medicine and Intensive Care, Imperial College London, London, UK
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919
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Ohlsson‐Nevo E, Andersson G, Nilsing Strid E. In the hands of nurses: A focus group study of how nurses perceive and promote inpatients' needs for physical activity. Nurs Open 2020; 7:334-344. [PMID: 31871718 PMCID: PMC6917955 DOI: 10.1002/nop2.401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 08/29/2019] [Accepted: 09/09/2019] [Indexed: 01/02/2023] Open
Abstract
Aims To describe how nurses perceive and promote inpatients' needs for physical activity during their stay at the ward. Design A qualitative descriptive design was employed providing an exploration of how nurses perceive and promote inpatients' need for physical activity. Methods Seven semi-structured focus group discussions were held between November 2016 and February 2017 with 29 nurses in three hospitals in Sweden. Both interaction analysis and content analysis of the data were conducted. Results Patients are dependent on nurses' prioritizations and promotions to be sufficiently physically active during their stay at the ward. The external environment and the integration of physical activity affected the promotion of physical activity. The nurses perceived that understanding the patient's expectations was important and that promotion of physical activity was a joint responsibility of patient, relatives and healthcare professionals. The interaction analysis revealed no clear hierarchical pattern as all members in each focus group took initiative to open the discussions. The Registered Nurses contributed with more new ideas.
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Affiliation(s)
- Emma Ohlsson‐Nevo
- Department of SurgeryÖrebro UniversityÖrebroSweden
- Faculty of Medicine and HealthUniversity Health Care Research CentreÖrebro UniversityÖrebroSweden
| | - Gunnel Andersson
- Faculty of Medicine and HealthSchool of Health SciencesÖrebro UniversityÖrebroSweden
| | - Emma Nilsing Strid
- Faculty of Medicine and HealthUniversity Health Care Research CentreÖrebro UniversityÖrebroSweden
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920
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Safety and efficacy of non-steroidal anti-inflammatory drugs to reduce ileus after colorectal surgery. Br J Surg 2020; 107:e161-e169. [PMID: 31595986 DOI: 10.1002/bjs.11326] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/06/2019] [Accepted: 07/04/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Ileus is common after elective colorectal surgery, and is associated with increased adverse events and prolonged hospital stay. The aim was to assess the role of non-steroidal anti-inflammatory drugs (NSAIDs) for reducing ileus after surgery. METHODS A prospective multicentre cohort study was delivered by an international, student- and trainee-led collaborative group. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The primary outcome was time to gastrointestinal recovery, measured using a composite measure of bowel function and tolerance to oral intake. The impact of NSAIDs was explored using Cox regression analyses, including the results of a centre-specific survey of compliance to enhanced recovery principles. Secondary safety outcomes included anastomotic leak rate and acute kidney injury. RESULTS A total of 4164 patients were included, with a median age of 68 (i.q.r. 57-75) years (54·9 per cent men). Some 1153 (27·7 per cent) received NSAIDs on postoperative days 1-3, of whom 1061 (92·0 per cent) received non-selective cyclo-oxygenase inhibitors. After adjustment for baseline differences, the mean time to gastrointestinal recovery did not differ significantly between patients who received NSAIDs and those who did not (4·6 versus 4·8 days; hazard ratio 1·04, 95 per cent c.i. 0·96 to 1·12; P = 0·360). There were no significant differences in anastomotic leak rate (5·4 versus 4·6 per cent; P = 0·349) or acute kidney injury (14·3 versus 13·8 per cent; P = 0·666) between the groups. Significantly fewer patients receiving NSAIDs required strong opioid analgesia (35·3 versus 56·7 per cent; P < 0·001). CONCLUSION NSAIDs did not reduce the time for gastrointestinal recovery after colorectal surgery, but they were safe and associated with reduced postoperative opioid requirement.
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921
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Lindberg M, Franklin O, Svensson J, Franklin KA. Postoperative pain after colorectal surgery. Int J Colorectal Dis 2020; 35:1265-1272. [PMID: 32318795 PMCID: PMC7320040 DOI: 10.1007/s00384-020-03580-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Postoperative pain is a keystone in perioperative programs, as pain negatively impacts recovery. This study aimed to evaluate pain after elective colorectal surgery and to identify risk factors for postoperative pain. METHODS This prospective cohort study comprised consecutive patients undergoing elective colorectal surgery within the Enhanced Recovery after Surgery (ERAS) perioperative program between March 2013 and April 2017. The numeric rating scale (NRS) was used to estimate maximum pain. Logistic regression was used to model associations with the type of surgery, age, gender, and comorbidities. RESULTS The cohort comprised 434 of 459 eligible patients. On the day of surgery to postoperative day 3, 50-64% of patients reported moderate to severe pain (NRS 4-10). Postoperative pain was similar for open and minimally invasive rectal surgery, while patients undergoing minimally invasive colonic surgery experienced more pain on the day of surgery and less pain on postoperative days 2 and 3 vs. open colonic surgery. Younger age was associated with more pain every postoperative day and by 0.7 NRS/10 years (95% CI 0.5-0.9, P < 0.001) on the day of surgery, while having diabetes type 2 was associated with less postoperative pain by - 1.3 NRS (95% CI - 2.4 to - 0.2) on the day of surgery. CONCLUSIONS The majority, and young patients in particular, experience moderate to severe pain after open and minimally invasive colorectal surgery, despite following ERAS perioperative program. There is a need for effective and individualized analgesia after colorectal surgery, since the individual pain response to surgery is difficult to predict.
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Affiliation(s)
- Margaretha Lindberg
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, SE-901 85 Umeå, Sweden
| | - Oskar Franklin
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, SE-901 85 Umeå, Sweden
| | - Johan Svensson
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, SE-901 85 Umeå, Sweden ,Department of Statistics, Umeå School of Business, Economics and Statistics, Umeå University, Umeå, Sweden
| | - Karl A. Franklin
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, SE-901 85 Umeå, Sweden
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922
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Dru RC, Curtis NJ, Court EL, Spencer C, El Falaha S, Dennison G, Dalton R, Allison A, Ockrim J, Francis NK. Impact of anaemia at discharge following colorectal cancer surgery. Int J Colorectal Dis 2020; 35:1769-1776. [PMID: 32488418 PMCID: PMC7415032 DOI: 10.1007/s00384-020-03611-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Preoperative anaemia is common in patients with colorectal cancer and increasingly optimised prior to surgery. Comparably little attention is given to the prevalence and consequences of postoperative anaemia. We aimed to investigate the frequency and short- or long-term impact of anaemia at discharge following colorectal cancer resection. METHODS A dedicated, prospectively populated database of elective laparoscopic colorectal cancer procedures undertaken with curative intent within a fully implemented ERAS protocol was utilised. The primary endpoint was anaemia at time of discharge (haemoglobin (Hb) < 120 g/L for women and < 135 g/L for men). Patient demographics, tumour characteristics, operative details and postoperative outcomes were captured. Median follow-up was 61 months with overall survival calculated with the Kaplan-Meier log rank method and Cox proportional hazard regression based on anaemia at time of hospital discharge. RESULTS A total of 532 patients with median 61-month follow-up were included. 46.4% were anaemic preoperatively (cohort mean Hb 129.4 g/L ± 18.7). Median surgical blood loss was 100 mL (IQR 0-200 mL). Upon discharge, most patients were anaemic (76.6%, Hb 116.3 g/L ± 14, mean 19 g/L ± 11 below lower limit of normal, p < 0.001). 16.7% experienced postoperative complications which were associated with lower discharge Hb (112 g/L ± 12 vs. 117 g/L ± 14, p = 0.001). Patients discharged anaemic had longer hospital stays (7 [5-11] vs. 6 [5-8], p = 0.037). Anaemia at discharge was independently associated with reduced overall survival (82% vs. 70%, p = 0.018; HR 1.6 (95% CI 1.04-2.5), p = 0.034). CONCLUSION Anaemia at time of discharge following elective laparoscopic colorectal cancer surgery and ERAS care is common with associated negative impacts upon short-term clinical outcomes and long-term overall survival.
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Affiliation(s)
- Rebecca C. Dru
- Department of General Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, Somerset BA21 4AT UK ,University Hospitals Bristol NHS Foundation Trust, Marlborough Street, Bristol, BS1 3NU UK
| | - Nathan J. Curtis
- Department of General Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, Somerset BA21 4AT UK ,Department of Surgery and Cancer, Imperial College London, Praed Street, London, W2 1NY UK
| | - Emma L. Court
- Department of General Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, Somerset BA21 4AT UK
| | - Catherine Spencer
- Department of General Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, Somerset BA21 4AT UK
| | - Sara El Falaha
- Department of General Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, Somerset BA21 4AT UK
| | - Godwin Dennison
- Department of General Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, Somerset BA21 4AT UK
| | - Richard Dalton
- Department of General Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, Somerset BA21 4AT UK
| | - Andrew Allison
- Department of General Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, Somerset BA21 4AT UK
| | - Jonathan Ockrim
- Department of General Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, Somerset BA21 4AT UK
| | - Nader K. Francis
- Department of General Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, Somerset BA21 4AT UK ,Division of Surgery and Interventional Science, University College London, London, UK ,Northwick Park Institute of Medical Research, Y Block, Northwick Park Hospital, Harrow, HA1 3UJ UK
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923
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Qu L, Liu B, Zhang H, Sankey EW, Chai W, Wang B, Li Z, Niu J, Zhao B, Jiang X, Ye L, Zhao L, Zhang Y, Zheng T, Xue Y, Chen L, Chen L, Han H, Liu W, Li R, Gao G, Wang X, Wang Y, He S. Management of Postoperative Pain after Elective Craniotomy: A Prospective Randomized Controlled Trial of a Neurosurgical Enhanced Recovery after Surgery (ERAS) Program. Int J Med Sci 2020; 17:1541-1549. [PMID: 32669957 PMCID: PMC7359387 DOI: 10.7150/ijms.46403] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/09/2020] [Indexed: 12/13/2022] Open
Abstract
Objective: To prospectively evaluate the efficacy of a neurosurgical enhanced recovery after surgery (ERAS) protocol on the management of postoperative pain after elective craniotomies. Methods: This randomized controlled trial was conducted in the neurosurgical center of Tangdu Hospital (Fourth Military Medical University, Xi'an, China). A total of 129 patients undergoing craniotomies between October 2016 and July 2017 were enrolled in a randomized clinical trial comparing an ERAS protocol to a conventional postoperative care regimen. The primary outcome was the postoperative pain score assessed by a verbal numerical rating scale (NRS). Results: Patients in the ERAS group had a significant reduction in their postoperative pain scores on POD 1 compared to patients in the control group (p < 0.05). More patients (n = 44, 68.8%) in the ERAS group experienced mild pain (NRS: 1 to 3) on POD1 compared with patients (n = 23, 35.4%) in the control group (p < 0.05). A further reduction in pain scores was also observed on POD 2 and maintained on POD 3 in the ERAS group compared with that in the control group. In addition, the median postoperative length of hospital stay was significantly decreased with the incorporation of the ERAS protocol compared to controls (ERAS: 4 days, control: 7 days, P<0.001). Conclusion: The implementation of a neurosurgical ERAS protocol for elective craniotomy patients has significant benefits in alleviating postoperative pain and enhancing recovery leading to early discharge after surgery compared to conventional care. Further evaluation of this protocol in larger, multi-center studies is warranted.
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Affiliation(s)
- Liang Qu
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University. Xi'an, China
| | - Bolin Liu
- Department of Neurosurgery, Xi'an International Medical Center, Xi'an, Shaanxi, China
| | - Haitao Zhang
- Department of Respiratory and Critical Care Medicine, Tangdu Hospital, Fourth Military Medical University. Xi'an, China
| | | | - Wei Chai
- Department of Anesthesiology, Xi'an International Medical Center, Xi'an, Shaanxi, China
| | - Binrong Wang
- Department of Anesthesiology, Xi'an International Medical Center, Xi'an, Shaanxi, China
| | - Zhengmin Li
- Department of Anesthesiology, Tangdu Hospital, Fourth Military Medical University. Xi'an, China
| | - Jiangtao Niu
- Department of Anesthesiology, Tangdu Hospital, Fourth Military Medical University. Xi'an, China
| | - Binfang Zhao
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University. Xi'an, China
| | - Xue Jiang
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University. Xi'an, China
| | - Lin Ye
- Department of Nutrition, Tangdu Hospital, Fourth Military Medical University. Xi'an, China
| | - Lanfu Zhao
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University. Xi'an, China
| | - Yufu Zhang
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University. Xi'an, China
| | - Tao Zheng
- Department of Neurosurgery, Xi'an International Medical Center, Xi'an, Shaanxi, China
| | - Yafei Xue
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University. Xi'an, China
| | - Lei Chen
- Department of Neurosurgery, Xi'an International Medical Center, Xi'an, Shaanxi, China
| | - Long Chen
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University. Xi'an, China
| | - Haijing Han
- Department of Neurosurgery, Xi'an International Medical Center, Xi'an, Shaanxi, China
| | - Wenjuan Liu
- Department of Neurosurgery, Xi'an International Medical Center, Xi'an, Shaanxi, China
| | - Ruigang Li
- Department of Neurosurgery, Xi'an International Medical Center, Xi'an, Shaanxi, China
| | - Guodong Gao
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University. Xi'an, China
| | - Xuelian Wang
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University. Xi'an, China
| | - Yuan Wang
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University. Xi'an, China
| | - Shiming He
- Department of Neurosurgery, Xi'an International Medical Center, Xi'an, Shaanxi, China
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924
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Jamjittrong S, Matsuda A, Matsumoto S, Kamonvarapitak T, Sakurazawa N, Kawano Y, Yamada T, Suzuki H, Miyashita M, Yoshida H. Postoperative non-steroidal anti-inflammatory drugs and anastomotic leakage after gastrointestinal anastomoses: Systematic review and meta-analysis. Ann Gastroenterol Surg 2020; 4:64-75. [PMID: 32021960 PMCID: PMC6992684 DOI: 10.1002/ags3.12300] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 09/18/2019] [Accepted: 10/22/2019] [Indexed: 12/18/2022] Open
Abstract
AIM Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to control postoperative pain; however, their postoperative use has been associated with anastomotic leakage after gastrointestinal surgery. This systematic review and meta-analysis aimed to determine the correlation between the use of NSAIDs and anastomotic leakage. METHODS We conducted a comprehensive electronic literature search up to August 2018 to identify studies comparing anastomotic leakage in patients with and without postoperative NSAID use following gastrointestinal surgery. We then carried out a meta-analysis using random-effects models to calculate odds ratios (OR) with 95% confidence intervals (CI). RESULTS Twenty-four studies were included in this meta-analysis, including a total of 31 877 patients. Meta-analysis showed a significant association between NSAID use and anastomotic leakage (OR 1.73; 95% CI = 1.31-2.29, P < .0001). Subgroup analyses showed that non-selective NSAIDs, but not selective cyclooxygenase-2 inhibitors, were significantly associated with anastomotic leakage. However there was no significant subgroup difference between selective and non-selective NSAIDs. CONCLUSION Results of this meta-analysis indicate that postoperative NSAID use is associated with anastomotic leakage following gastrointestinal surgeries. Caution is warranted when using NSAIDs for postoperative analgesic control in patients with gastrointestinal anastomoses.
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Affiliation(s)
- Supaschin Jamjittrong
- Department of SurgeryNippon Medical School Chiba Hokusoh HospitalChibaJapan
- Department of SurgeryQueen Savang Vadhana Memorial HospitalSri RachaThailand
| | - Akihisa Matsuda
- Department of SurgeryNippon Medical School Chiba Hokusoh HospitalChibaJapan
| | - Satoshi Matsumoto
- Department of SurgeryNippon Medical School Chiba Hokusoh HospitalChibaJapan
| | - Tunyaporn Kamonvarapitak
- Department of SurgeryNippon Medical School Chiba Hokusoh HospitalChibaJapan
- Department of SurgeryQueen Savang Vadhana Memorial HospitalSri RachaThailand
| | | | - Youichi Kawano
- Department of SurgeryNippon Medical School Chiba Hokusoh HospitalChibaJapan
| | - Takeshi Yamada
- Department of Gastrointestinal Hepato‐Biliary‐Pancreatic SurgeryNippon Medical SchoolTokyoJapan
| | - Hideyuki Suzuki
- Department of SurgeryNippon Medical School Chiba Hokusoh HospitalChibaJapan
| | - Masao Miyashita
- Department of SurgeryNippon Medical School Chiba Hokusoh HospitalChibaJapan
| | - Hiroshi Yoshida
- Department of Gastrointestinal Hepato‐Biliary‐Pancreatic SurgeryNippon Medical SchoolTokyoJapan
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925
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Fields AC, Weiner SG, Maldonado LJ, Cavallaro PM, Melnitchouk N, Goldberg J, Stopfkuchen-Evans MF, Baker O, Bordeianou LG, Bleday R. Implementation of liposomal bupivacaine transversus abdominis plane blocks into the colorectal enhanced recovery after surgery protocol: a natural experiment. Int J Colorectal Dis 2020; 35:133-138. [PMID: 31797098 DOI: 10.1007/s00384-019-03457-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) programs are now standard of care for colorectal surgery. Efforts have been aimed at decreasing postoperative opioid consumption. The goal of this study is to evaluate the effect of liposomal bupivacaine transversus abdominis plane (TAP) blocks on opioid use and its downstream effect on rates of ileus and hospital length of stay (LOS). METHODS We performed a retrospective pre- and postintervention time-trend analysis (2016-2018) of ERAS patients undergoing laparoscopic colorectal surgery at two academic medical centers within the same hospital system. The intervention was liposomal bupivacaine TAP blocks versus standard local infiltration with bupivacaine with a primary outcome of total morphine milligram equivalents (MME) administered within 72 h of surgery. Secondary outcomes included hospital LOS and rate of postoperative ileus. RESULTS There were 556 patients included at the control hospital, and 384 patients were included at the treatment hospital. Patients at both hospitals were similar with regard to age, body mass index, comorbidities, and surgical indication. In an adjusted time-trend analysis, the treatment hospital was associated with a significant decrease in MME administered (- 15.9 mg, p = 0.04) and hospital LOS (- 0.8 days, p < 0.001). There was no significant decrease in the rate of ileus at the treatment hospital (- 6.9%, p = 0.08). CONCLUSIONS In a time-trend analysis, the addition of liposomal bupivacaine TAP blocks into the ERAS protocol resulted in significantly reduced opioid use and shorter hospital LOS for patients undergoing surgery at the treatment hospital. Liposomal bupivacaine TAP blocks should be considered for inclusion in the standard ERAS protocol.
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Affiliation(s)
- Adam C Fields
- Division of Colorectal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Department of Quality and Safety, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Scott G Weiner
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Luisa J Maldonado
- Division of Colorectal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Paul M Cavallaro
- Division of Colorectal Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Nelya Melnitchouk
- Division of Colorectal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joel Goldberg
- Division of Colorectal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Olesya Baker
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Liliana G Bordeianou
- Division of Colorectal Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ronald Bleday
- Division of Colorectal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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926
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Aroni P, Fonseca LF, Ciol MA, Margatho AS, Galvão CM. The use of mentholated popsicle to reduce thirst during preoperative fasting: A randomised controlled trial. J Clin Nurs 2019; 29:840-851. [DOI: 10.1111/jocn.15138] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/17/2019] [Accepted: 11/19/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Patricia Aroni
- Department of Nursing State University of Londrina Londrina Brazil
| | - Ligia F. Fonseca
- Department of Nursing State University of Londrina Londrina Brazil
| | - Marcia A. Ciol
- Department of Rehabilitation Medicine School of Medicine University of Washington Seattle WA USA
| | - Amanda S. Margatho
- General and Specialized Nursing Department Ribeirão Preto College of Nursing University of São Paulo Ribeirão Preto Brazil
| | - Cristina M. Galvão
- General and Specialized Nursing Department Ribeirão Preto College of Nursing University of São Paulo Ribeirão Preto Brazil
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927
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Karachun A, Panaiotti L, Chernikovskiy I, Achkasov S, Gevorkyan Y, Savanovich N, Sharygin G, Markushin L, Sushkov O, Aleshin D, Shakhmatov D, Nazarov I, Muratov I, Maynovskaya O, Olkina A, Lankov T, Ovchinnikova T, Kharagezov D, Kaymakchi D, Milakin A, Petrov A. Short-term outcomes of a multicentre randomized clinical trial comparing D2 versus D3 lymph node dissection for colonic cancer (COLD trial). Br J Surg 2019; 107:499-508. [PMID: 31872869 DOI: 10.1002/bjs.11387] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/04/2019] [Accepted: 09/11/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND It remains unclear whether extended lymphadenectomy provides oncological advantages in colorectal cancer. This multicentre RCT aimed to address this issue. METHODS Patients with resectable primary colonic cancer were enrolled in four hospitals registered in the COLD trial, and randomized to D2 or D3 dissection in a 1 : 1 ratio. Data were analysed to assess the safety of D3 dissection. RESULTS The study included the first 100 patients randomized in this ongoing trial. Ninety-nine patients were included in the intention-to-treat (ITT) analysis (43 D2, 56 D3). Ninety-two patients received the allocated treatment and were included in the per-protocol (PP) analysis: 39 of 43 in the D2 group and 53 of 56 in the D3 group. There were no deaths. The 30-day postoperative morbidity rate was 47 per cent in the D2 group and 48 per cent in the D3 group, with a risk ratio of 1·04 (95 per cent c.i. 0·68 to 1·58) (P = 0·867). There were two anastomotic leaks (5 per cent) in the D2 group and none in the D3 group. Postoperative recovery, complication and readmission rates did not differ between the groups in ITT and PP analyses. Mean lymph node yield was 26·6 and 27·8 in D2 and D3 procedures respectively. Good quality of complete mesocolic excision was more frequently noted in the D3 group (P = 0·048). Three patients in the D3 group (5 per cent) had metastases in D3 lymph nodes. D3 was never the only affected level of lymph nodes. N-positive status was more common in the D3 group (46 per cent versus 26 per cent in D2), with a risk ratio of 1·81 (95 per cent c.i. 1·01 to 3·24) (P = 0·044). CONCLUSION D3 lymph node dissection is feasible and may be associated with better N staging. Registration number: NCT03009227 ( http://www.clinicaltrials.gov).
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Affiliation(s)
- A Karachun
- Surgical Department of Abdominal Oncology, N. N. Petrov National Medical Research Centre of Oncology, Saint Petersburg, Russia
| | - L Panaiotti
- Surgical Department of Abdominal Oncology, N. N. Petrov National Medical Research Centre of Oncology, Saint Petersburg, Russia
| | - I Chernikovskiy
- Clinical Research Centre of Specialized Kinds of Medical Care (Oncology), Saint Petersburg, Russia.,City Oncology Hospital No. 62, Moscow, Russia
| | - S Achkasov
- Oncology and Colon Surgery Department, State Scientific Centre of Coloproctology, Moscow, Russia
| | - Y Gevorkyan
- Rostov Research Institute of Oncology, Rostov-on-Don, Russia
| | - N Savanovich
- Clinical Research Centre of Specialized Kinds of Medical Care (Oncology), Saint Petersburg, Russia.,City Oncology Hospital No. 62, Moscow, Russia
| | - G Sharygin
- Clinical Research Centre of Specialized Kinds of Medical Care (Oncology), Saint Petersburg, Russia
| | - L Markushin
- Clinical Research Centre of Specialized Kinds of Medical Care (Oncology), Saint Petersburg, Russia.,City Oncology Hospital No. 62, Moscow, Russia
| | - O Sushkov
- Oncology and Colon Surgery Department, State Scientific Centre of Coloproctology, Moscow, Russia
| | - D Aleshin
- Operational Unit, Oncology and Colon Surgery Department, State Scientific Centre of Coloproctology, Moscow, Russia
| | - D Shakhmatov
- Oncology and Colon Surgery Department, State Scientific Centre of Coloproctology, Moscow, Russia
| | - I Nazarov
- Oncology and Colon Surgery Department, State Scientific Centre of Coloproctology, Moscow, Russia
| | - I Muratov
- Oncology and Colon Surgery Department, State Scientific Centre of Coloproctology, Moscow, Russia
| | - O Maynovskaya
- Pathology Department, State Scientific Centre of Coloproctology, Moscow, Russia
| | - A Olkina
- Surgical Department of Abdominal Oncology, N. N. Petrov National Medical Research Centre of Oncology, Saint Petersburg, Russia
| | - T Lankov
- Surgical Department of Abdominal Oncology, N. N. Petrov National Medical Research Centre of Oncology, Saint Petersburg, Russia
| | - T Ovchinnikova
- Pathology Department, N. N. Petrov National Medical Research Centre of Oncology, Saint Petersburg, Russia
| | - D Kharagezov
- Rostov Research Institute of Oncology, Rostov-on-Don, Russia
| | - D Kaymakchi
- Rostov Research Institute of Oncology, Rostov-on-Don, Russia
| | - A Milakin
- Rostov Research Institute of Oncology, Rostov-on-Don, Russia
| | - A Petrov
- Surgical Department of Abdominal Oncology, N. N. Petrov National Medical Research Centre of Oncology, Saint Petersburg, Russia
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928
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Molenaar CJL, Papen-Botterhuis NE, Herrle F, Slooter GD. Prehabilitation, making patients fit for surgery - a new frontier in perioperative care. Innov Surg Sci 2019; 4:132-138. [PMID: 33977122 PMCID: PMC8059351 DOI: 10.1515/iss-2019-0017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 12/09/2019] [Indexed: 02/07/2023] Open
Abstract
Optimizing a patients’ condition before surgery to improve the postoperative outcome can be achieved by using prehabilitation; preoperative interventions focusing on modifiable risk factors to improve the physical, nutritional, and mental status of the patient. A multimodal, multidisciplinary approach induces a synergistic effect between the various interventions and affects the outcome postoperatively. While awaiting higher-quality evidence, the worldwide implementation of prehabilitation programs has started, resulting in a true revolution in perioperative care.
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Affiliation(s)
| | | | - Florian Herrle
- Department of Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Gerrit D Slooter
- Department of Surgical Oncology, Máxima MC, 5500MB, Veldhoven, the Netherlands, E-mail:
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929
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[Oral antibiotic prophylaxis for bowel decontamination before elective colorectal surgery : Current body of evidence and recommendations]. Chirurg 2019; 91:128-133. [PMID: 31828386 DOI: 10.1007/s00104-019-01079-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Despite a growing body of evidence from randomized controlled studies, register data and meta-analyses, there is an ongoing controversy about decontamination of the digestive tract before elective colorectal surgery. Currently, mechanical bowel preparation alone can no longer be recommended as there is a lack of evidence for an advantage in terms of risk reduction for infectious complications, anastomotic leakage, morbidity and mortality. In contrast, the administration of oral antibiotics in addition to the obligatory intravenous single shot antibiotic prophylaxis has shown an additive reduction of the risk of up to 50% for the occurrence of postoperative infectious complications; however, due to a lack of data it is unclear if mechanical bowel preparation could even improve the positive effects of combined intravenous and oral antibiotics. Therefore, further studies are necessary. At the current time the occurrence of anastomotic leakage cannot be prevented, independent of whether preoperative bowel decontamination is performed.
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930
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Reply to: bilateral subcostal transversus abdominis plane block as a component of multimodal analgesia. Eur J Anaesthesiol 2019; 37:59-60. [PMID: 31794534 DOI: 10.1097/eja.0000000000001079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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931
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Weimann A. Is there a rationale for perioperative nutrition therapy in the times of ERAS? Innov Surg Sci 2019; 4:152-157. [PMID: 33977125 PMCID: PMC8059352 DOI: 10.1515/iss-2019-0012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 09/16/2019] [Indexed: 12/13/2022] Open
Abstract
In order to increase patient compliance in Enhanced Recovery after Surgery (ERAS) programs, assessment and monitoring of functional and nutritional status should be routinely performed. Sarcopenic obesity is frequently underestimated and has been shown to be a significant risk factor for the development of postoperative complications. With special regard to gastrointestinal cancer patients undergoing neoadjuvant treatment, nutritional deficiencies may develop stepwise and increase during therapy. In the case of proven deficits, recent strategies including "prehabilitation" focus on making the patient fit for an ERAS program. Evidence-based guidelines for perioperative nutrition therapy have been available.
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Affiliation(s)
- Arved Weimann
- Klinik für Allgemein-, Viszeral- und Onkologische Chirurgie mit Abteilung Klinische Ernährung, Klinikum St. Georg gGmbH Leipzig, Delitzscher Str. 141, 04129 Leipzig, Germany
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932
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Dean HF, Carter F, Francis NK. Modern perioperative medicine - past, present, and future. Innov Surg Sci 2019; 4:123-131. [PMID: 33977121 PMCID: PMC8059350 DOI: 10.1515/iss-2019-0014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 09/16/2019] [Indexed: 12/11/2022] Open
Abstract
Modern perioperative medicine has dramatically altered the care for patients undergoing major surgery. Anaesthetic and surgical practice has been directed at mitigating the surgical stress response and reducing physiological insult. The development of standardised enhanced recovery programmes combined with minimally invasive surgical techniques has lead to reduction in length of stay, morbidity, costs, and improved outcomes. The enhanced recovery after surgery (ERAS) society and its national chapters provide a means for sharing best practice in this field and developing evidence based guidelines. Research has highlighted persisting challenges with compliance as well as ensuring the effectiveness and sustainability of ERAS. There is also a growing need for increasingly personalised care programmes as well as complex geriatric assessment of frailer patients. Continuous collection of outcome and process data combined with machine learning, offers a potentially powerful solution to delivering bespoke care pathways and optimising individual management. Long-term data from ERAS programmes remain scarce and further evaluation of functional recovery and quality of life is required.
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Affiliation(s)
- Harry F. Dean
- Department of General Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, UK
| | - Fiona Carter
- Enhanced Recovery after Surgery Society (UK) c.i.c., Yeovil, UK
| | - Nader K. Francis
- Department of General Surgery, Yeovil District Hospital, Higher Kingston, Yeovil BA21 4AT, UK
- Enhanced Recovery after Surgery Society (UK) c.i.c., Yeovil BA20 2RH, UK
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK, Tel.: (01935) 384244
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933
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Recovery and discharge criteria after ambulatory anesthesia: can we improve them? Curr Opin Anaesthesiol 2019; 32:698-702. [DOI: 10.1097/aco.0000000000000784] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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934
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Duggan E, Chen Y. Glycemic Management in the Operating Room: Screening, Monitoring, Oral Hypoglycemics, and Insulin Therapy. Curr Diab Rep 2019; 19:134. [PMID: 31749027 DOI: 10.1007/s11892-019-1277-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW This review provides a literature update and practical outline for the management of diabetes and stress hyperglycemia for adult surgical patients in the pre- and intraoperative settings. RECENT FINDINGS Hyperglycemia in surgical patients has been associated with increased risk of complication in both diabetic and non-diabetic patients in the perioperative setting. While current recommended perioperative blood glucose target is < 180 mg/dL (10 mmol/L), optimal outcomes may require different treatment targets for diabetic versus non-diabetic patients. Hemoglobin A1C level is associated with elevated risk of hyperglycemia and adverse outcomes, but there is insufficient evidence to recommend routine preoperative testing or optimal values in elective surgical patients. Day of surgery blood glucose testing and treatment are recommended in the perioperative period, and anesthetic management includes appropriate patient selection for use of subcutaneous insulin, intravenous insulin infusions, and insulin pumps. Additionally, administration of both intravenous and perineural dexamethasone is associated with increased blood glucose levels and clinicians should consider the risk benefit ratio in surgical patients. For enhanced recovery after surgery protocols, further evidence is needed to support routine use of carbohydrate loading in diabetic patients. Optimal perioperative care includes screening at-risk patients, use of preoperative oral hypoglycemics and home insulin, anesthetic type and medication selection, blood glucose testing, and treatment for hyperglycemia in the operating room. Partnerships with surgery and endocrinology teams aid optimal postoperative management and discharge planning.
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Affiliation(s)
- Elizabeth Duggan
- Department of Anesthesiology, Emory University School of Medicine, 1364 Clifton Road, Atlanta, GA, 30322, USA.
| | - York Chen
- Department of Anesthesiology, Emory University School of Medicine, 1364 Clifton Road, Atlanta, GA, 30322, USA
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935
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Anania G, Agresta F, Artioli E, Rubino S, Resta G, Vettoretto N, Petz WL, Bergamini C, Arezzo A, Valpiani G, Morotti C, Silecchia G. Laparoscopic right hemicolectomy: the SICE (Società Italiana di Chirurgia Endoscopica e Nuove Tecnologie) network prospective trial on 1225 cases comparing intra corporeal versus extra corporeal ileo-colic side-to-side anastomosis. Surg Endosc 2019; 34:4788-4800. [PMID: 31741153 PMCID: PMC7572335 DOI: 10.1007/s00464-019-07255-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 11/11/2019] [Indexed: 02/07/2023]
Abstract
Background While laparoscopic approach for right hemicolectomy (LRH) is considered appropriate for the surgical treatment of both malignant and benign diseases of right colon, there is still debate about how to perform the ileo-colic anastomosis. The ColonDxItalianGroup (CoDIG) was designed as a cohort, observational, prospective, multi-center national study with the aims of evaluating the surgeons’ attitude regarding the intracorporeal (ICA) or extra-corporeal (ECA) anastomotic technique and the related surgical outcomes. Methods One hundred and twenty-five Surgical Units experienced in colorectal and advanced laparoscopic surgery were invited and 85 of them joined the study. Each center was asked not to change its surgical habits. Data about demographic characteristics, surgical technique and postoperative outcomes were collected through the official SICE website database. One thousand two hundred and twenty-five patients were enrolled between March 2018 and September 2018. Results ICA was performed in 70.4% of cases, ECA in 29.6%. Isoperistaltic anastomosis was completed in 85.6%, stapled in 87.9%. Hand-sewn enterotomy closure was adopted in 86%. Postoperative complications were reported in 35.4% for ICA and 50.7% for ECA; no significant difference was found according to patients’ characteristics and technologies used. Median hospital stay was significantly shorter for ICA (7.3 vs. 9 POD). Postoperative pain in patients not prescribed opioids was significantly lower in ICA group. Conclusions In our survey, a side-to-side isoperistaltic stapled ICA with hand-sewn enterotomy closure is the most frequently adopted technique to perform ileo-colic anastomosis after any indications for elective LRH. According to literature, our study confirmed better short-term outcomes for ICA, with reduction of hospital stay and postoperative pain. Trial registration Clinical trial (Identifier: NCT03934151).
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Affiliation(s)
- Gabriele Anania
- Division of General Surgery, S. Anna University Hospital of Ferrara, via Aldo Moro 8, Cona, FE, Italy. .,Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy.
| | - Ferdinando Agresta
- Department of General Surgery, ULSS5 Polesana del Veneto, Adria, RO, Italy
| | - Elena Artioli
- Division of General Surgery, S. Anna University Hospital of Ferrara, via Aldo Moro 8, Cona, FE, Italy.,Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Serena Rubino
- Division of General Surgery, S. Anna University Hospital of Ferrara, via Aldo Moro 8, Cona, FE, Italy.,Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Giuseppe Resta
- Division of General Surgery, S. Anna University Hospital of Ferrara, via Aldo Moro 8, Cona, FE, Italy.,Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Nereo Vettoretto
- Montichiari Surgery, ASST Spedali Civili Brescia, Montichiari, BS, Italy
| | - Wanda Luisa Petz
- Division of Gastrointestinal Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Carlo Bergamini
- Department of Emergency Surgery, University Hospital of Careggi, Florence, Italy
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | - Giorgia Valpiani
- MsC in Statistics at Research Innovation Office, S. Anna University Hospital of Ferrara, Ferrara, Italy
| | - Chiara Morotti
- MsC in Statistics at Research Innovation Office, S. Anna University Hospital of Ferrara, Ferrara, Italy
| | - Gianfranco Silecchia
- Department of Medical Surgical Science and Biotechnologies, Faculty Pharmacy and Medicine, Sapienza University of Rome, Rome, Italy
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936
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High symptom burden is associated with impaired quality of life in colorectal cancer patients during chemotherapy:A prospective longitudinal study. Eur J Oncol Nurs 2019; 44:101679. [PMID: 31751848 DOI: 10.1016/j.ejon.2019.101679] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 10/12/2019] [Accepted: 10/23/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE Multiple symptoms can have a negative impact on quality of life (QoL), but there is little information about the impact of multiple symptoms on QoL of patients with colorectal cancer (CRC) during outpatient chemotherapy. Therefore, the purpose was to assess the physical and mental QoL in CRC patients over six months of chemotherapy, to evaluate the association of QoL with the presence of multiple symptoms, and to determine which demographic and clinical characteristics are associated with physical and mental QoL scores. METHODS Outpatients with CRC (N = 120) completed the Medical Outcomes Study Short Form (SF-12) and Memorial Symptom Assessment Scale (MSAS) at eight time points during six months of chemotherapy. Linear mixed models for repeated measures were used to analyse QoL over time; and its association with demographic and clinical characteristics; and with the presence of multiple symptoms (e.g., 'numbness/tingling' and 'problems with sexual interest'). RESULTS The CRC patients had worse physical and mental QoL scores than the general population at all time points. Impaired physical QoL was significantly associated with psychological symptom burden (p < 0.001) and numbness/tingling (p < 0.027). Impaired mental QoL was associated with physical symptom burden (p < 0.001), with being female (p < 0.009), younger age (p < 0.024), and having problems with sexual interest (p < 0.009). CONCLUSIONS Impaired QoL was associated with symptoms in CRC outpatients. This information about the symptoms and characteristics associated with worse QoL during chemotherapy may help clinicians identify and inform at-risk patients.
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937
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Balfour A, Burch J, Fecher-Jones I, Carter FJ. Exploring the fundamental aspects of the Enhanced Recovery After Surgery nurse's role. Nurs Stand 2019; 34:e11437. [PMID: 31709787 DOI: 10.7748/ns.2019.e11437] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2019] [Indexed: 06/10/2023]
Abstract
Enhanced Recovery After Surgery (ERAS) is a multimodal, multidisciplinary programme that aims to limit surgical stress during the perioperative period. The importance of a facilitator to improve patients' compliance with the ERAS pathway and ensure its successful implementation is described in the literature. This role is commonly undertaken by a nurse, but it is unclear what their role entails in practice. AIM To investigate the common aspects of the role of the ERAS nurse, and similar roles. METHOD A modified Delphi technique was used to explore the opinions of ERAS nurses, facilitators and their colleagues in the UK. A series of consensus statements on the role of the ERAS nurse were produced that were voted on and agreed via an online survey, then subsequently voted on at the seventh ERAS UK conference. RESULTS Six consensus statements were proposed and agreed in the second round of voting. In the final round of voting, consensus was reached on four of the six statements related to data collection, patient education, staff education and patient support throughout the pathway. The two statements that did not reach consensus were related to leadership and project management. CONCLUSION It is hoped that by producing these consensus statements, the role of the ERAS nurse will be better understood by all members of multidisciplinary ERAS teams, particularly managers and decision-makers, and can be supported in the future.
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Affiliation(s)
| | - Jennie Burch
- Academic Institute, St Mark's Hospital, London, England
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938
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Jia J. Combined use of intravenous and topical tranexamic acid in patients aged over 70 years old undergoing total hip arthroplasty. J Orthop Surg Res 2019; 14:345. [PMID: 31699131 PMCID: PMC6836663 DOI: 10.1186/s13018-019-1384-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 09/20/2019] [Indexed: 12/11/2022] Open
Abstract
Purpose The present study was designed to evaluate the efficacy and safety of combined use of intravenous (IV) TXA administration and topical intraarticular tranexamic acid (TXA) strategy in patients aged over 70 undergoing total hip arthroplasty (THA). Methods One hundred eighty patients were randomized into three groups, including an IV group, a local group, and a combined group. Patients were administrated with 15 mg/kg of IV-TXA in the IV group, 2 g TXA in the topical group, or 15 mg/kg IV-TXA combined with 2 g TXA in the combined group. Total blood loss (TBL), maximum hemoglobin drop, the transfusion rate and the number of allogeneic blood units, and the incidence of deep venous thrombosis (DVT), and pulmonary embolism (PE) were recorded and analyzed. Results TBL was 757.75 ± 188.95 mL in the combined group, which was significantly lower than in the IV group (892.75 ± 218.47) or the topical group (1015.75 ± 288.71) (p = 0.015, p = 0.001 respectively). The mean values of maximum hemoglobin drop in the combined, IV, and topical groups were 2.67 ± 0.42, 3.28 ± 0.52, and 3.75 ± 0.62 g/dL, respectively, with a significant intergroup difference (p < 0.001 for all). PE was not detected within 1 month after the surgery. Asymptomatic DVT was reported in 1 patient of the IV group, and in 2 patients from the combined group, while the difference was not statistically significant. Conclusions Compared to intravenous or topical use of TXA, the combined therapy effectively decreased total blood loss and reduced the transfusion rate, simultaneously possessed the same degree of safety in primary THA patients aged over 70.
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Affiliation(s)
- Junqing Jia
- Department of Orthopedics, Shanxi Great hospital, Taiyuan, 030032, Shanxi Province, China.
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939
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Abstract
PURPOSE OF REVIEW Preoperative nutrition support has been extensively studied; however, data on the timing of postoperative nutrition initiation are scarce. The current review focuses on the importance of early nutritional support in surgical patients and their impact on outcomes. RECENT FINDINGS Early nutrition support during the postoperative course may be the most important step that can be taken toward preventing subsequent malnutrition-related complications. European Society for Parenteral and Enteral Nutrition guidelines recommends early nutrition to improve outcomes after surgery and accelerates the recovery. Moreover, nutritional support should be personalized, and disease process-based. SUMMARY Existing studies appear to focus mostly on abdominal and gastrointestinal surgery. Further prospective observational and randomized clinical trials across different surgical populations will aid surgeons to better understand how early feeds in either form can reduce morbidity, quality of life, and increase recovery rates.
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940
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Donlon NE, Boland PA, Kelly ME, Schmidt K, Cooke F, Neary PM, Barry KM, Reynolds JV. Prophylactic negative wound therapy in laparotomy wounds (PROPEL trial): randomized controlled trial. Int J Colorectal Dis 2019; 34:2003-2010. [PMID: 31529194 DOI: 10.1007/s00384-019-03398-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Superficial surgical site infections are a common post-operative complication. They also place a considerable financial burden on healthcare. The use of prophylactic negative pressure wound therapy has been advocated to reduce wound infection rates. However, there is debate around its routine use. The purpose of this trial is to determine if prophylactic negative pressure wound therapy reduces post-operative wound complications in patients undergoing laparotomy. METHODS/DESIGN This multi-centre randomised controlled trial will compare standard surgical dressings (control) to two competing negative pressure wound therapy dressings (Prevena™ and PICO™). All patients will be over 18 years, who are undergoing an emergency or elective laparotomy. It is intended to enrol a total of 271 patients for the trial. DISCUSSION The PROPEL trial is a multi-centre randomised controlled trial of patients undergoing laparotomy. The comparison of standard treatment to two commercially available NPWT will help provide consensus on the routine management of laparotomy wounds. TRIAL REGISTRATION This study is registered with ClinicalTrials.gov (NCT number NCT03871023).
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Affiliation(s)
| | - P A Boland
- Department of Surgery, St James Hospital, Dublin 8, Ireland
| | - M E Kelly
- Department of Surgery, St James Hospital, Dublin 8, Ireland
| | - K Schmidt
- Department of Surgery, Wexford General Hospital, Wexford, Ireland
| | - F Cooke
- Department of Surgery, University Hospital Waterford, Waterford, Ireland
| | - P M Neary
- Department of Surgery, University Hospital Waterford, Waterford, Ireland
| | - K M Barry
- Department of Surgery, Mayo University Hospital, Mayo, Ireland
| | - J V Reynolds
- Department of Surgery, St James Hospital, Dublin 8, Ireland
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941
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Brethauer SA, Grieco A, Fraker T, Evans-Labok K, Smith A, McEvoy MD, Saber AA, Morton JM, Petrick A. Employing Enhanced Recovery Goals in Bariatric Surgery (ENERGY): a national quality improvement project using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Surg Obes Relat Dis 2019; 15:1977-1989. [DOI: 10.1016/j.soard.2019.08.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 08/14/2019] [Accepted: 08/23/2019] [Indexed: 12/11/2022]
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942
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Ackerman RS, Tufts CW, DePinto DG, Chen J, Altshuler JR, Serdiuk A, Cohen JB, Patel SY. How Sweet Is This? A Review and Evaluation of Preoperative Carbohydrate Loading in the Enhanced Recovery After Surgery Model. Nutr Clin Pract 2019; 35:246-253. [PMID: 31637778 DOI: 10.1002/ncp.10427] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Preoperative carbohydrate loading is a contemporary element of the enhanced recovery after surgery (ERAS) paradigm. In addition to intraoperative surgical and anesthetic modifications and postoperative care practices, preoperative optimization is essential to good postsurgical outcomes. What was long held as dogma, a period of prolonged fasting prior to the administration of anesthesia, was later re-examined and challenged. Along with the proposed physiologic effects of decreasing the surgical stress response and insulin resistance, preoperative carbohydrate loading was also demonstrated to improve patient satisfaction and well-being, without an increase in perioperative complications. The benefits are most strongly observed in abdominal and cardiac surgery patients, but there has also been data which support its use in other specialties and surgeries. Barriers to the adoption of perioperative carbohydrate loading are few, but importantly include overcoming the inertia to modify older and more restrictive fasting guidelines and achieving the multidisciplinary consensus necessary to implement such changes. Despite these challenges, and with an existing body of evidence supporting its benefits, preoperative carbohydrate loading presents a significant contribution to the ERAS programs.
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Affiliation(s)
- Robert S Ackerman
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Christopher W Tufts
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David G DePinto
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jeffrey Chen
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jaclyn R Altshuler
- Department of Anesthesiology, Baylor College of Medicine, Houston, Texas, USA
| | - Andrew Serdiuk
- Department of Anesthesiology, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
| | - Jonathan B Cohen
- Department of Anesthesiology, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
| | - Sephalie Y Patel
- Department of Anesthesiology, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
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943
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Golder AM, Steele CW, Conn D, MacKay GJ, McMillan DC, Horgan PG, Roxburgh CS, McSorley ST. Effect of preoperative oral antibiotics in combination with mechanical bowel preparation on inflammatory response and short-term outcomes following left-sided colonic and rectal resections. BJS Open 2019; 3:830-839. [PMID: 31832590 PMCID: PMC6887908 DOI: 10.1002/bjs5.50224] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 08/15/2019] [Indexed: 12/24/2022] Open
Abstract
Background Preoperative oral antibiotics in addition to intravenous antibiotics and mechanical bowel preparation (MBP) may influence the gut microbiome and reduce both the postoperative systemic inflammatory response to surgery and postoperative infective complications following colorectal resection. This propensity score‐matched study compared outcomes of patients undergoing left‐sided colonic or rectal resection with or without a combination of oral antibiotics and MBP. Methods The addition of oral antibiotics and MBP to prophylactic intravenous antibiotics in left‐sided colonic and rectal resections was introduced in 2015–2016 at a single institution. Propensity score matching was undertaken to compare the effects of oral antibiotics plus MBP versus neither oral antibiotics nor MBP on the postoperative systemic inflammatory response and short‐term outcomes in patients undergoing left‐sided colonic or rectal resection between 2013 and 2018. Results Of 396 patients who had propensity score matching for host, anaesthetic and operative factors, 204 matched patients were identified. The addition of oral antibiotics and MBP was associated with a significantly reduced postoperative inflammatory response (reduced postoperative Glasgow Prognostic Score) on day 3 (odds ratio (OR) 0·66, 95 per cent c.i. 0·44 to 0·99; P = 0·013) and day 4 (OR 0·46, 0·30 to 0·71; P = 0·001). Significantly reduced overall complications (OR 0·31, 0·17 to 0·56; P < 0·001), infective complications (OR 0·41, 0·22 to 0·77; P = 0·011), surgical‐site infection (OR 0·37, 0·17 to 0·83; P = 0·024) and postoperative length of hospital stay (median 7 days versus 8 days in patients who had intravenous antibiotics alone; P = 0·050) were also observed. Conclusion Preoperative oral antibiotics and MBP in addition to prophylactic intravenous antibiotics were associated with a reduction in the postoperative systemic inflammatory response and postoperative complications in patients undergoing resectional left‐sided colonic or rectal surgery.
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Affiliation(s)
- A M Golder
- Academic Unit of Surgery, Glasgow Royal Infirmary Glasgow UK
| | - C W Steele
- Academic Unit of Surgery, Glasgow Royal Infirmary Glasgow UK
| | - D Conn
- Academic Unit of Surgery, Glasgow Royal Infirmary Glasgow UK
| | - G J MacKay
- Academic Unit of Surgery, Glasgow Royal Infirmary Glasgow UK
| | - D C McMillan
- Academic Unit of Surgery, Glasgow Royal Infirmary Glasgow UK
| | - P G Horgan
- Academic Unit of Surgery, Glasgow Royal Infirmary Glasgow UK
| | - C S Roxburgh
- Academic Unit of Surgery, Glasgow Royal Infirmary Glasgow UK
| | - S T McSorley
- Academic Unit of Surgery, Glasgow Royal Infirmary Glasgow UK
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944
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Hamamoto H, Yamamoto M, Masubuchi S, Ishii M, Osumi W, Tanaka K, Okuda J, Uchiyama K. Male sex and anterior wall tumor location as risk factors for urinary dysfunction after laparoscopic rectal surgery. Surg Endosc 2019; 34:3567-3573. [DOI: 10.1007/s00464-019-07186-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 10/01/2019] [Indexed: 01/13/2023]
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945
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Mari GM, Achilli P, Maggioni D, Crippa J, Costanzi ATM, Scotti MA, Giardini V, Garancini M, Cocozza E, Borroni G, Benzoni I, Martinotti M, Totaro L, Origi M, Mazzola M, Ferrari G, Ziccarelli A, Petri R, Bagnardi V, Pugliese G, Forgione A, Pugliese R. Creation of a rectal cancer registry in Italy by the Advanced International Mini-Invasive Surgery (AIMS) academy clinical research network. F1000Res 2019; 8:1736. [PMID: 31723425 PMCID: PMC6833985 DOI: 10.12688/f1000research.20702.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2019] [Indexed: 12/13/2022] Open
Abstract
Background: The management of rectal cancer is multimodal and involves a multidisciplinary team of cancer specialists with expertise in medical oncology, surgical oncology, radiation oncology and radiology. It is crucial for highly specialized centers to collaborate via networks that aim to maintain uniformity in every aspect of treatment and rigorously gather patients’ data, from the first clinical evaluation to the last follow-up visit. The Advanced International Mini-Invasive Surgery (AIMS) academy clinical research network aims to create a rectal cancer registry. This will prospectively collect the data of patients operated on for non-metastatic rectal cancer in high volume colorectal surgical units through a well design pre-fashioned database for non-metastatic rectal cancer, in order to take all multidisciplinary aspects into consideration. Methods/Design: The protocol describes a multicenter prospective observational cohort study, investigating demographics, frailty, cancer-related features, surgical and radiological parameters, and oncological outcomes among patients with non-metastatic rectal cancer who are candidates for surgery with curative intent. Patients enrolled in the present registry will be followed up for 5 years after surgery. Discussion: Standardization and centralization of data collection for neoplastic diseases is a virtuous process for patient care. The creation of a register will allow the control of the quality of treatments provided and permit prospective and retrospective studies to be carried out on complete and reliable high quality data. Establishing data collection in a prospective and systematic fashion is the only possibility to preserve the enormous resource that each patient represents.
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Affiliation(s)
- Giulio M Mari
- General Surgery Department, Desio Hospital, Desio, Italy
| | - Pietro Achilli
- General Surgery Residency Program, University of Milan, Milan, Italy
| | - Dario Maggioni
- General Surgery Department, Desio Hospital, Desio, Italy
| | - Jacopo Crippa
- General Surgery Residency Program, University of Milan, Milan, Italy
| | | | - Mauro A Scotti
- General Surgery Department, San Gerardo Hospital, Monza, Italy
| | | | | | | | | | | | | | - Luigi Totaro
- Department of Surgery, Cremona Hospital, Cremona, Italy
| | - Matteo Origi
- General Surgery Department, Niguarda Hospital, Milan, Italy
| | | | | | | | - Roberto Petri
- General Surgery Department, AOU "SSMM della Misericordia", Udine, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Giacomo Pugliese
- AIMS Academy Clinical Research Network, Advanced International Mini-Invasive Surgery (AIMS) Academy, Milan, Italy
| | | | - Raffaele Pugliese
- AIMS Academy Clinical Research Network, Advanced International Mini-Invasive Surgery (AIMS) Academy, Milan, Italy
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946
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Bruintjes MHD, Langenhuijsen JF, Kusters A, Hilbrands LB, d'Ancona FCH, Warlé MC. Double J stent is superior to externally draining ureteric stent in enhancing recovery after kidney transplantation - A prospective cohort study. Int J Surg 2019; 71:175-181. [PMID: 31600570 DOI: 10.1016/j.ijsu.2019.09.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 09/15/2019] [Accepted: 09/27/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Routine intraoperative ureteric stenting lowers the rate of urological complications after kidney transplantation. However, there is no consensus about the optimal stent design and duration. The aim of this prospective cohort study was to compare the influence of double J (JJ) stents and externally draining percutaneous (PC) stents on the early quality of recovery after living donor kidney transplantation. MATERIALS AND METHODS A prospective cohort study was performed in two consecutive cohorts of 40 patients who underwent living donor kidney transplantation at the Radboud university medical center between April 2016 and October 2017. The first cohort of 40 patients received a 6-French externally draining PC stent. The second cohort of 40 patients received a 6-French/14 cm JJ stent. We compared the influence of the stent design on the quality of early post-operative recovery (measured by the Quality of Recovery-40 questionnaire) and the length of hospital stay. RESULTS Patients with a JJ stent scored significantly better on the Quality of Recovery score on the third and fifth postoperative day, when compared to patients with a PC stent. Furthermore, in comparison to patients with a PC stent, patients with a JJ stent were earlier mobilising and independent in daily activities, resulting in a shorter length of hospital stay. The number of postoperative urological complications was comparable between the two groups. CONCLUSION The use of JJ stents during living donor kidney transplantations improves the postoperative recovery and shortens the length of hospital stay, when compared to PC stents without compromising the number of postoperative urological complications.
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Affiliation(s)
- Moira H D Bruintjes
- Department of Surgery, Radboud University Medical Center Nijmegen, the Netherlands; Department of Urology, Radboud University Medical Center Nijmegen, the Netherlands.
| | | | - Anneke Kusters
- Department of Urology, Queen Beatrix Regional Hospital Winterswijk, the Netherlands.
| | - Luuk B Hilbrands
- Department of Nephrology, Radboud University Medical Center Nijmegen, the Netherlands.
| | - Frank C H d'Ancona
- Department of Urology, Radboud University Medical Center Nijmegen, the Netherlands.
| | - Michiel C Warlé
- Department of Surgery, Radboud University Medical Center Nijmegen, the Netherlands.
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947
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Homsi J, Brovman EY, Rao N, Whang EE, Urman RD. The Association Between Potential Opioid-Related Adverse Drug Events and Outcomes in Colorectal Surgery. J Laparoendosc Adv Surg Tech A 2019; 29:1436-1445. [PMID: 31556797 DOI: 10.1089/lap.2019.0408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Introduction: Major colorectal surgery procedures are complex operations that can result in significant postoperative pain and complications. More evidence is needed to demonstrate how opioid-related adverse drug events (ORADEs) after colorectal surgery can affect hospital length of stay (LOS), hospital revenue, and what their association is with clinical conditions. By understanding the clinical and economic impact of potential ORADEs within colorectal surgery, we hope to further guide approaches to perioperative pain management in an effort to improve patient care and reduce hospital costs. Materials and Methods: We conducted a retrospective study utilizing the Centers for Medicare and Medicaid Services (CMS) Administrative Database to analyze Medicare discharges involving three colorectal surgery diagnosis-related groups (DRGs) to identify potential ORADEs. The impact of potential ORADEs on mean hospital LOS and hospital revenue was analyzed. Results: The potential ORADE rate in patients undergoing colorectal surgery was 23.92%. The mean LOS for discharges with a potential ORADE was 5.35 days longer than without an ORADE. The mean hospital revenue per day with a potential ORADE was $418 less than without an ORADE. Any type of open surgery had a statistically significant higher potential ORADE rate than the matched laparoscopic case (P < .001). Clinical conditions most strongly associated with ORADEs in colorectal surgery included septicemia, pneumonia, shock, and fluid and electrolyte disorders. Conclusion: The incidence of ORADEs in colorectal surgery is high and is associated with longer hospital stays and reduced hospital revenue. Reducing the use of opioids in the perioperative setting, such as using multimodal analgesia strategies, may lead to positive outcomes with shorter hospital stays, increased hospital revenue, and improved patient care.
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Affiliation(s)
- Joseph Homsi
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ethan Y Brovman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Center for Perioperative Research, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Edward E Whang
- Center for Perioperative Research, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Center for Perioperative Research, Brigham and Women's Hospital, Boston, Massachusetts
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948
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Jung WB. The Impact of Patient's Pain and Fatigue on the Discharge Decision After Laparoscopic Surgery for Colorectal Cancer. Ann Coloproctol 2019; 35:158-159. [PMID: 31487761 PMCID: PMC6732322 DOI: 10.3393/ac.2019.07.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Won Beom Jung
- Department of Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
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949
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Postoperative pain management in the era of ERAS: An overview. Best Pract Res Clin Anaesthesiol 2019; 33:259-267. [DOI: 10.1016/j.bpa.2019.07.016] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 07/19/2019] [Indexed: 02/07/2023]
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950
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Cata JP, Corrales G, Speer B, Owusu-Agyemang P. Postoperative acute pain challenges in patients with cancer. Best Pract Res Clin Anaesthesiol 2019; 33:361-371. [DOI: 10.1016/j.bpa.2019.07.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 07/19/2019] [Indexed: 12/13/2022]
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