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Carannante F, Capolupo GT, Barberio M, Altamura A, Miacci V, Scopigno MZ, Circhetta E, Costa G, Caricato M, Viola MG. Evaluation of Short-Term Effects on Colorectal Surgery Elective Patients after Implementing a Patient Blood Management Program: A Multicenter Retrospective Analysis. J Clin Med 2024; 13:4447. [PMID: 39124714 PMCID: PMC11313079 DOI: 10.3390/jcm13154447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/11/2024] [Accepted: 07/13/2024] [Indexed: 08/12/2024] Open
Abstract
Introduction: Patients who undergo surgery may require a blood transfusion and patients undergoing major colorectal surgery are more prone to preoperative and perioperative anemia. Blood transfusions have, however, long been associated with inflammatory and oncological complications. We aim to investigate the effects of an optimal implementation of a patient blood management (PBM) program in our hospital. Methods: This study retrospectively reviewed data from two different prospectively maintained databases of all patients undergoing elective major colorectal surgery with either a laparoscopic, open, or robotic approach from January 2017 to December 2022 at two different high-volume colorectal surgery Italian centers: the Colorectal Surgery Unit of Fondazione Policlinico Campus Bio-Medico in Rome and the Colorectal Surgery Unit of Fondazione Cardinale Panico in Tricase (Lecce). Our study compares the first group, also known as pre-PBM (January 2017-December 2018) and the second group, known as post-PBM (January 2021-December 2022). Results: A total of 2495 patients, who satisfied the inclusion and exclusion criteria, were included in this study, with, respectively, 1197 patients in the pre-PBM group and 1298 in the post- PBM group. The surgical approach was similar amongst the two groups, while the operative time was longer in the pre-PBM group than in the post-PBM group (273.0 ± 87 vs. 215.0 ± 124 min; p < 0.001). There was no significant difference in preparatory Hb levels (p = 0.486), while anemia detection was significantly higher post-PBM (p = 0.007). However, the rate of transfusion was drastically reduced since the implementation of PBM, with p = 0.032 for preoperative, p = 0.025 for intraoperative, and p < 0.001 for postoperative. Conclusions: We confirmed the need to reduce blood transfusions and optimize transfusion procedures to improve short-term clinical outcomes of patients. The implementation of the PBM program was associated with a significant reduction in the rate of perioperative transfusions and an increase in only appropriate transfusions.
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Affiliation(s)
- Filippo Carannante
- Colorectal Surgery Clinical and Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico, University Campus Bio-Medico, Via Àlvaro del Portillo 200, 00128 Rome, Italy; (G.T.C.); (V.M.); (M.Z.S.); (G.C.); (M.C.)
- Research Unit of Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Gabriella Teresa Capolupo
- Colorectal Surgery Clinical and Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico, University Campus Bio-Medico, Via Àlvaro del Portillo 200, 00128 Rome, Italy; (G.T.C.); (V.M.); (M.Z.S.); (G.C.); (M.C.)
- Research Unit of Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Manuel Barberio
- General Surgery Department, Ospedale Card. G. Panico, 73039 Tricase, Italy; (M.B.); (A.A.); (M.G.V.)
| | - Amedeo Altamura
- General Surgery Department, Ospedale Card. G. Panico, 73039 Tricase, Italy; (M.B.); (A.A.); (M.G.V.)
| | - Valentina Miacci
- Colorectal Surgery Clinical and Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico, University Campus Bio-Medico, Via Àlvaro del Portillo 200, 00128 Rome, Italy; (G.T.C.); (V.M.); (M.Z.S.); (G.C.); (M.C.)
- Research Unit of Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Martina Zenobia Scopigno
- Colorectal Surgery Clinical and Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico, University Campus Bio-Medico, Via Àlvaro del Portillo 200, 00128 Rome, Italy; (G.T.C.); (V.M.); (M.Z.S.); (G.C.); (M.C.)
| | - Erika Circhetta
- Haematology and Stem Cell Transplant Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Àlvaro del Portillo 200, 00128 Rome, Italy;
| | - Gianluca Costa
- Colorectal Surgery Clinical and Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico, University Campus Bio-Medico, Via Àlvaro del Portillo 200, 00128 Rome, Italy; (G.T.C.); (V.M.); (M.Z.S.); (G.C.); (M.C.)
- Department of Life Science, Health and Health Professions, Link Campus University, 00165 Roma, Italy
| | - Marco Caricato
- Colorectal Surgery Clinical and Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico, University Campus Bio-Medico, Via Àlvaro del Portillo 200, 00128 Rome, Italy; (G.T.C.); (V.M.); (M.Z.S.); (G.C.); (M.C.)
- Research Unit of Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Massimo Giuseppe Viola
- General Surgery Department, Ospedale Card. G. Panico, 73039 Tricase, Italy; (M.B.); (A.A.); (M.G.V.)
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Gosgnach M, Chasserant P, Raux M. Opioid free analgesia after return home in ambulatory colonic surgery patients: a single-center observational study. BMC Anesthesiol 2024; 24:260. [PMID: 39075360 PMCID: PMC11285406 DOI: 10.1186/s12871-024-02651-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 07/22/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Because of the adverse effects of morphine and its derivatives, non-opioid analgesia procedures are proposed after outpatient surgery. Without opioids, the ability to provide quality analgesia after the patient returns home may be questioned. We examined whether an opioid-free strategy could ensure satisfactory analgesia after ambulatory laparoscopic colectomy. METHODS We performed a retrospective observational single-center study (of prospective collected database) including all patients eligible for scheduled outpatient colectomy. Postoperative analgesia was provided by paracetamol and nefopam. Postoperative follow-up included pain at mobilization (assessed by a numerical rating scale, NRS), hemodynamic variables, temperature, resumption of transit and biological markers of postoperative inflammation. The primary outcome was the proportion of patients with moderate to severe pain (NRS > 4) the day after surgery. RESULTS Data from 144 patients were analyzed. The majority were men aged 59 ± 12 years with a mean BMI of 27 [25-30] kg/m2. ASA scores were 1 for 14%, 2 for 59% and 3 for 27% of patients. Forty-seven patients (33%) underwent surgery for cancer, 94 for sigmoiditis (65%) and 3 (2%) for another colonic pathology. Postoperative pain was affected by time since surgery (Q3 = 52.4,p < 0.001) and decreased significantly from day to day. The incidence of moderate to severe pain at mobilization (NRS > 4) on the first day after surgery was (0.19; 95% CI, 0.13-0.27). CONCLUSION Non-opioid analgesia after ambulatory laparoscopic colectomy seems efficient to ensure adequate analgesia. This therapeutic strategy makes it possible to avoid the adverse effects of opioids. TRIAL REGISTRATION The study was retrospectively registered and approved by the relevant institutional review board (CERAR) reference IRB 00010254-2018 - 188). All patients gave written informed consent for analysis of their data. The anonymous database was declared to the French Data Protection Authority (CNIL) (reference 221 2976 v0 of April 12, 2019).
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Affiliation(s)
- Marilyn Gosgnach
- Department of Anesthesia and Intensive Care, Hôpital Privé de l'Estuaire, 505 rue Irene Joliot Curie, Le Havre, 76620, France.
- Département d'Anesthésie-Réanimation, Centre Hospitalier Intercommunal de Fréjus Saint-Raphaël, 240 Avenue de Saint Lambert, Fréjus, 83600, France.
| | - Philippe Chasserant
- Digestive Surgery Department, Hôpital Privé de l'Estuaire, 505 rue Irene Joliot Curie, Le Havre, 76620, France.
- Surgery Department, Centre Hospitalier Albertville-Moutiers, Albertville, 73200, France.
| | - Mathieu Raux
- UMRS 1158 Experimental and Clinical Respiratory Neurophysiology, Faculté de Médecine, INSERM, Sorbonne Université, 91Bd de l'Hôpital, Paris, 75013, France
- Department of Anesthesia and Intensive Care, APHP-Sorbonne Université, Hôpital Pitié- Salpêtrière, 47-83 Bd de l'Hôpital, Paris, 75013, France
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Stanton AN, Yan SC, Mohamed B, Hoh DJ, Porche K. Frailty, Myelopathy, and Enhanced Recovery after Surgery in Patients Undergoing Posterior Cervical Fusion. World Neurosurg 2024:S1878-8750(24)01253-1. [PMID: 39053851 DOI: 10.1016/j.wneu.2024.07.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Revised: 07/14/2024] [Accepted: 07/15/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND The enhanced recovery after surgery (ERAS) protocol is a proven method to improve postsurgical outcomes. While recent studies have shown the benefit of ERAS even in frail patient populations, myelopathy is another factor affecting outcomes in patients undergoing posterior cervical fusion (PCF). This study evaluated the benefit of an ERAS protocol in frail patients undergoing PCF. METHODS A retrospective chart review identified consecutive patients undergoing PCF by a single surgeon from August 2015-July 2021, with implementation of ERAS in December 2018. Outcome measures included length of stay (LOS), nonhome discharge disposition, complications, return of physiologic function, and severe pain score. A mFI-5 score of ≥ 2 and a Nurick score of ≥ 3 defined frail and myelopathic patients, respectively. Univariate analysis (P < 0.05) and multivariate analyses using mixed-effect models (P < 0.0125) were performed. RESULTS There were a total of 174 patients, 71 frail (41%). Of the frail patients, 61% were also myelopathic, and 56% underwent ERAS. Of the nonfrail patients, 43% were myelopathic, and 57% underwent ERAS. On univariate analyses, frail patients with ERAS had less drains placed (P < 0.0001), decreased urinary retention (P = 0.0002), decreased LOS (P = 0.013), and were less likely to have a nonhome discharge (P = 0.001). On multivariate analysis, LOS (P = 0.0003), time to return of physiologic function (P = 0.004), complications (P = 0.001), and nonhome discharges (P < 0.0001) were decreased with ERAS, irrespective of groups. CONCLUSIONS ERAS is an effective protocol in PCF patients that may expedite return of physiologic function, lessen LOS, decrease the number of nonhome discharges, and reduce complications, irrespective of frailty or myelopathy status.
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Affiliation(s)
- Amanda N Stanton
- College of Medicine, University of Florida, Gainesville, Florida, USA; Lillian S. Wells Department of Neurosurgery, University of Florida, Gainvesille, Florida, USA.
| | - Sandra C Yan
- College of Medicine, University of Florida, Gainesville, Florida, USA; Lillian S. Wells Department of Neurosurgery, University of Florida, Gainvesille, Florida, USA
| | - Basma Mohamed
- College of Medicine, University of Florida, Gainesville, Florida, USA; Department of Anesthesiology, University of Florida, Gainesville, Florida, USA
| | - Daniel J Hoh
- College of Medicine, University of Florida, Gainesville, Florida, USA; Lillian S. Wells Department of Neurosurgery, University of Florida, Gainvesille, Florida, USA
| | - Ken Porche
- College of Medicine, University of Florida, Gainesville, Florida, USA; Lillian S. Wells Department of Neurosurgery, University of Florida, Gainvesille, Florida, USA
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Costi R, Amato A, Annicchiarico A, Montali F, Binda GA. Acute diverticulitis management: evolving trends among Italian surgeons. A survey of the Italian Society of Colorectal Surgery (SICCR). Updates Surg 2024:10.1007/s13304-024-01927-y. [PMID: 39044095 DOI: 10.1007/s13304-024-01927-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 06/21/2024] [Indexed: 07/25/2024]
Abstract
Acute diverticulitis (AD) is associated with relevant morbidity/mortality and is increasing worldwide, thus becoming a major issue for national health systems. AD may be challenging, as clinical relevance varies widely, ranging from asymptomatic picture to life-threatening conditions, with continuously evolving diagnostic tools, classifications, and management. A 33-item-questionnaire was administered to residents and surgeons to analyze the actual clinical practice and to verify the real spread of recent recommendations, also by stratifying surgeons by experience. CT-scan remains the mainstay of AD assessment, including cases presenting with recurrent mild episodes or women of child-bearing age. Outpatient management of mild AD is slowly gaining acceptance. A conservative management is preferred in non-severe cases with extradigestive air or small/non-radiologically drainable abscesses. In severe cases, a laparoscopic approach is preferred, with a non-negligible number of surgeons confident in performing emergency complex procedures. Surgeons are seemingly aware of several options during emergency surgery for AD, since the rate of Hartmann procedures does not exceed 50% in most environments and damage control surgery is spreading in life-threatening cases. Quality of life and history of complicated AD are the main indications for delayed colectomy, which is mostly performed avoiding the proximal vessel ligation, mobilizing the splenic flexure and performing a colorectal anastomosis. ICG is spreading to check anastomotic stumps' vascularization. Differences between the two experience groups were found about the type of investigation to exclude colon cancer (considering the experience only in terms of number of colectomies performed), the size of the peritoneal abscess to be drained, practice of damage control surgery and the attitude towards colovesical fistula.
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Affiliation(s)
- Renato Costi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Department of General Surgery, Vaio Hospital, Fidenza, Italy
| | - Antonio Amato
- Department of Coloproctology, Sanremo Hospital, Sanremo, IM, Italy
| | - Alfredo Annicchiarico
- Department of Medicine and Surgery, University of Parma, Parma, Italy.
- Department of General Surgery, Vaio Hospital, Fidenza, Italy.
| | - Filippo Montali
- Department of General Surgery, Vaio Hospital, Fidenza, Italy
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Iresjö BM, Smedh U, Engström C, Persson J, Mårtensson C, Lundholm K. A randomized translational study on protein- and glucose metabolism in skeletal muscles evaluated by gene-ontology, following preoperative oral carbohydrate loading compared to overnight peripheral parenteral nutrition (PPN) before major cancer surgery. J Transl Med 2024; 22:675. [PMID: 39039509 PMCID: PMC11265369 DOI: 10.1186/s12967-024-05484-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 07/03/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Effects of preoperative drinks on muscle metabolism are unclear despite general recommendations. The aim of the present study was therefore to compare metabolic effects of a preoperative oral nutrition drink, recommended by protocols for enhanced recovery after surgery (ERAS), compared to overnight preoperative peripheral total parenteral nutrition (PPN) on skeletal muscle metabolism in patients aimed at major gastrointestinal cancer surgery. METHODS Patients were randomized, based on diagnosis and clinical characteristics, to receive either a commercial carbohydrate-rich nutrition drink (Drink); or overnight (12 h) peripheral parenteral nutrition (PPN) as study regimens; compared to isotone Ringer-acetate as Control regimen. Arterial blood- and abdominal muscle tissue specimens were collected at start of surgery. Blood chemistry included substrate- and hormone concentrations. Muscle mRNA transcript analyses were performed by microarray and evaluated for changes in gene activities by Gene Ontology algorithms. RESULTS Patient groups were comparable in all measured preoperative assessments. The Nutrition Drink had significant metabolic alterations on muscle glucose metabolism (p < 0.05), without any significant effects on amino acid- and protein metabolism. PPN showed similar significant effects on glucose metabolism as Drinks (p < 0.05), but indicated also major positive effects on amino acid- (p < 0.001) and protein anabolism (p < 0.05), particularly by inhibition of muscle protein degradation, related to both ubiquitination of proteins and autophagy/lysosome pathways (p < 0.05). CONCLUSION Conventional overnight preoperative PPN seems effective to induce and support improved muscle protein metabolism in patients aimed at major cancer surgery while preoperative oral carbohydrate loading, according to ERAS-protocols, was ineffective to improve skeletal muscle catabolism and should therefore not be recommended before major cancer surgery. Trial registration Clinical trials.gov: NCT05080816, Registered June 10th 2021- Retrospectively registered. https://clinicaltrials.gov/study/NCT05080816.
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Affiliation(s)
- Britt-Marie Iresjö
- Institute of Clinical Sciences, Department of Surgery, Surgical Metabolic Research Lab, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
| | - Ulrika Smedh
- Institute of Clinical Sciences, Department of Surgery, Surgical Metabolic Research Lab, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Cecilia Engström
- Institute of Clinical Sciences, Department of Surgery, Surgical Metabolic Research Lab, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jan Persson
- Department of Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christian Mårtensson
- Department of Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kent Lundholm
- Institute of Clinical Sciences, Department of Surgery, Surgical Metabolic Research Lab, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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Dourado J, Rogers P, Horesh N, Emile SH, Aeschbacher P, Wexner SD. Low-pressure versus standard-pressure pneumoperitoneum in minimally invasive colorectal surgery: a systematic review, meta-analysis, and meta-regression analysis. Gastroenterol Rep (Oxf) 2024; 12:goae052. [PMID: 39036068 PMCID: PMC11259227 DOI: 10.1093/gastro/goae052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 01/11/2024] [Accepted: 02/17/2024] [Indexed: 07/23/2024] Open
Abstract
Background We aimed to assess the efficacy and safety of low-pressure pneumoperitoneum (LPP) in minimally invasive colorectal surgery. Methods A PRISMA-compliant systematic review/meta-analysis was conducted, searching PubMed, Scopus, Google Scholar, and clinicaltrials.gov for randomized-controlled trials assessing outcomes of LPP vs standard-pressure pneumoperitoneum (SPP) in colorectal surgery. Efficacy outcomes [pain score in post-anesthesia care unit (PACU), pain score postoperative day 1 (POD1), operative time, and hospital stay] and safety outcomes (blood loss and postoperative complications) were analyzed. Risk of bias2 tool assessed bias risk. The certainty of evidence was graded using GRADE. Results Four studies included 537 patients (male 59.8%). LPP was undertaken in 280 (52.1%) patients and associated with lower pain scores in PACU [weighted mean difference: -1.06, 95% confidence interval (CI): -1.65 to -0.47, P = 0.004, I 2 = 0%] and POD1 (weighted mean difference: -0.49, 95% CI: -0.91 to -0.07, P = 0.024, I 2 = 0%). Meta-regression showed that age [standard error (SE): 0.036, P < 0.001], male sex (SE: 0.006, P < 0.001), and operative time (SE: 0.002, P = 0.027) were significantly associated with increased complications with LPP. In addition, 5.9%-14.5% of surgeons using LLP requested pressure increases to equal the SPP group. The grade of evidence was high for pain score in PACU and on POD1 postoperative complications and major complications, and blood loss, moderate for operative time, low for intraoperative complications, and very low for length of stay. Conclusions LPP was associated with lower pain scores in PACU and on POD1 with similar operative times, length of stay, and safety profile compared with SPP in colorectal surgery. Although LPP was not associated with increased complications, older patients, males, patients undergoing laparoscopic surgery, and those with longer operative times may be at risk of increased complications.
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Affiliation(s)
- Justin Dourado
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA
| | - Peter Rogers
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA
| | - Nir Horesh
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA
- Department of Surgery and Transplantation, Sheba Medical Center, Ramat-Gan, Israel
| | - Sameh Hany Emile
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA
- Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt
| | - Pauline Aeschbacher
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Steven D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA
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Park I, Park JH, Koo CH, Kim JH, Koo BW, Ryu JH, Oh AY. Modified Thoracoabdominal Nerves Block Through Perichondral Approach: A Systematic Review and Meta-analysis. J Perianesth Nurs 2024:S1089-9472(24)00110-2. [PMID: 39023478 DOI: 10.1016/j.jopan.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/17/2024] [Accepted: 03/18/2024] [Indexed: 07/20/2024]
Abstract
PURPOSE This systematic review and meta-analysis aimed to investigate the postoperative analgesic efficacy and safety of the modified thoracoabdominal nerve block through the perichondral approach (M-TAPA) in abdominal surgeries. DESIGN Systematic review and meta-analysis. METHODS We searched electronic databases to identify relevant studies comparing M-TAPA with conventional analgesic techniques. The primary outcome was the requirement for rescue analgesia at 12 and 24 hours postsurgery. Secondary outcomes included the 11-point numerical rating scale pain scores at 0, 1, 2, 4, 6, 8, 12, and 24 hours following surgery, global quality of recovery scores, and postoperative adverse events. FINDINGS Five randomized controlled trials involving 308 patients were analyzed. M-TAPA showed no significant difference in the requirement for rescue analgesia at 12 hours (relative risk [RR]: 0.87; 95% confidence interval [CI]: 0.62, 1.22; P = .424; I2 = 40.7%; Ph = .185) and 24 hours (RR: 0.67; 95% CI: 0.22, 1.99; P = .252; I2 = 90.3%; Ph < .001) postsurgery compared to non-M-TAPA. No significant differences in numerical rating scale pain scores or global quality of recovery scores were found between the two groups (all P < .05). However, M-TAPA was associated with a lower occurrence of nausea (RR: 0.37; 95% CI: 0.22, 0.68; P < .001; I2 = 0%; Ph = .834), vomiting (RR: 0.32; 95% CI: 0.17, 0.62; P < .001; I2 = 0%; Ph = .884), and itching (RR: 0.38; 95% CI: 0.21, 0.70; P = .002; I2 = 0%; Ph = .826). CONCLUSIONS There was no significant difference in analgesic efficacy and safety between M-TAPA and non-M-TAPA techniques.
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Affiliation(s)
- Insun Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea; Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicines, Seoul, Republic of Korea
| | - Jae Hyon Park
- Department of Radiology, The Armed Forces Daejeon Hospital, Daejeon, Republic of Korea
| | - Chang-Hoon Koo
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea
| | - Jin-Hee Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea
| | - Bon-Wook Koo
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea
| | - Jung-Hee Ryu
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea; Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicines, Seoul, Republic of Korea
| | - Ah-Young Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea; Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicines, Seoul, Republic of Korea.
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Crippa J, Luberto A, Magistro C, Carvello M, Carnevali P, Maroli A, Ferrari GC, Spinelli A. Implementing a no-drain policy for extraperitoneal colorectal anastomosis in a real-life setting: analysis of outcomes and surgeons' adherence. Int J Colorectal Dis 2024; 39:109. [PMID: 39008120 PMCID: PMC11249572 DOI: 10.1007/s00384-024-04681-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2024] [Indexed: 07/16/2024]
Abstract
AIM Recent evidence has questioned the usefulness of anastomotic drain (AD) after low anterior resection (LAR). However, the implementation and adoption of a no-drain policy are still poor. This study aims to assess the clinical outcomes of the implementation of a no-drain policy for rectal cancer surgery into a real-life setting and the adherence of the surgeons to such policy. METHOD A retrospective analysis was conducted on patients who underwent elective minimally invasive LAR between January 2015 and December 2019 at two tertiary referral centers. In 2017, both centers implemented a policy aimed at reducing the use of AD. Patients were retrospectively categorized into two groups: the drain policy (DP) group, comprising patients treated before 2017, and the no-drain policy (NDP) group, consisting of patients treated from 2017 onwards. The endpoints were the rate of anastomotic leak (AL) and of related interventions. RESULTS Among the 272 patients included, 188 (69.1%) were in the NDP group, and 84 (30.9%) were in the DP group. Baseline characteristics were similar between the two groups. AL rate was 11.2% in the NDP group compared to 10.7% in the DP group (p = 1.000), and the AL grade distribution (grade A, 19.1% (4/21) vs 28.6% (2/9); grade B, 28.6% (6/21) vs 11.1% (1/9); grade C, 52.4% (11/21) vs 66.7% (6/9), p = 0.759) did not significantly differ between the groups. All patients with symptomatic AL and AD underwent surgical treatment for the leak, while those with symptomatic AL in the NPD group were managed with surgery (66.7%), endoscopic (19.0%), or percutaneous (14.3%) interventions. Postoperative outcomes were similar between the groups. Three years after implementing the no-drain policy, AD was utilized in only 16.5% of cases, compared to 76.2% at the study's outset. CONCLUSION The introduction of a no-drain policy received a good adoption rate and did not affect negatively the surgical outcomes.
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Affiliation(s)
- Jacopo Crippa
- Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56 Rozzano, 20089, Milan, Italy
| | - Antonio Luberto
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4 Pieve Emanuele, 20072, Milan, Italy
- Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56 Rozzano, 20089, Milan, Italy
| | - Carmelo Magistro
- Division of Minimally Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Michele Carvello
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4 Pieve Emanuele, 20072, Milan, Italy
- Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56 Rozzano, 20089, Milan, Italy
| | - Pietro Carnevali
- Division of Minimally Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Annalisa Maroli
- Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56 Rozzano, 20089, Milan, Italy
| | - Giovanni Carlo Ferrari
- Division of Minimally Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4 Pieve Emanuele, 20072, Milan, Italy.
- Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56 Rozzano, 20089, Milan, Italy.
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Zhang Y, Guo Y, Gong C, Fu J, Chen L. Influence of Transverse Abdominis Plane Block on Intraoperative Diaphragmatic and Respiratory Functions in Patients Receiving Laparoscopic Colorectal Surgery. Ther Clin Risk Manag 2024; 20:413-426. [PMID: 39045135 PMCID: PMC11265371 DOI: 10.2147/tcrm.s462688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 06/06/2024] [Indexed: 07/25/2024] Open
Abstract
Background The positive roles of deep muscle relaxation in abdominal surgeries and transversus abdominis plane block (TAPB) in the postoperative analgesia. This study aimed to discuss the effects of TAPB on abdominal muscle relaxation, the intraoperative diaphragmatic, and the respiratory functions. Methods The patients were randomly divided into the TAPB group who received single-shot TAPB bilaterally (n=30), and the control group who did not receive TAPB (n=30). Both groups keep the same steps for other procedures in the surgeries and anesthesia. Four time points for monitoring were defined: The moment when pneumoperitoneum pressure stabilized following endotracheal intubation and anesthetic induction (T0), appearance of the first incisure in the pressure-volume (P-V) loop (T1), appearance of the second incisure in the P-V loop (T2), and the moment with single stimulation (SS) =20% (T3). Primary observation parameters were SS1 measured by muscle relaxation monitoring at T1, and SS2 at T2. Secondary observation parameters included surgeon's satisfaction with surgical field and respiratory dynamics at the four time points. Results The two groups were comparable in age, gender, BMI, ASA grade, and operation time. The TAPB group had a dramatic reduction in the total dose of intraoperative sufentanil (0.73±0.21 ug/kg) compared with the control group (0.87±0.18 ug/kg) (P=0.023); Other use of drug did not differ between the two groups. The two groups did not differ significantly in SS at either T1 (SS1) or T2 (SS2). In either group, surgeon's satisfaction with surgical field at T1 and T2 decreased dramatically compared with T0 and T3 (all P<0.05). At each time point, the respiratory dynamics and the surgeon's satisfaction with surgical field did not differ significantly between the two groups. Conclusion TAPB reduced the use of intraoperative analgesics without altering the degree of abdominal relaxation, or affecting surgeon's satisfaction with surgical field in the patients receiving laparoscopic colorectal surgery.
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Affiliation(s)
- Yi Zhang
- Department of Anesthesiology, Shanghai General Hospital of Nanjing Medical University, Shanghai, 200080, People’s Republic of China
| | - Yiqing Guo
- Department of Anesthesiology, Shanghai General Hospital of Nanjing Medical University, Shanghai, 200080, People’s Republic of China
| | - Chao Gong
- Department of Anesthesiology, Shanghai General Hospital of Nanjing Medical University, Shanghai, 200080, People’s Republic of China
| | - Junzuo Fu
- Department of Anesthesiology, Shanghai General Hospital of Nanjing Medical University, Shanghai, 200080, People’s Republic of China
| | - Lianhua Chen
- Department of Anesthesiology, Shanghai General Hospital of Nanjing Medical University, Shanghai, 200080, People’s Republic of China
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60
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Poylin VY, Tyselskyi V, Pereyra MN, Kebkalo A. You don't need to be a millionaire: pragmatic approach to implementing infection control and bowel recovery pathways in low resource environment. Surg Endosc 2024:10.1007/s00464-024-11031-2. [PMID: 38987481 DOI: 10.1007/s00464-024-11031-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/30/2024] [Indexed: 07/12/2024]
Affiliation(s)
- Vitaliy Y Poylin
- Division of Gastrointestinal Surgery, Northwestern University Feinberg School of Medicine, Northwestern Medical Group, Northwestern Medicine, 676 N. St. Clair St., Suite 650, Chicago, IL, 60611, USA.
| | - Volodymyr Tyselskyi
- Department of Endoscopic and Robotic Surgery, Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine
| | - Maria Navaez Pereyra
- Department of Surgery, Northwestern Feinberg School of Medicine, 676 N. St. Clair St., Suite 650, Chicago, IL, 60611, USA
| | - Andrey Kebkalo
- Department of Endoscopic and Robotic Surgery, Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine
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61
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Tunc Tuna P. Bibliometric Analysis on Cholecystectomy Surgery in the Nursing Field. J Perianesth Nurs 2024:S1089-9472(24)00122-9. [PMID: 38980238 DOI: 10.1016/j.jopan.2024.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 03/26/2024] [Accepted: 03/29/2024] [Indexed: 07/10/2024]
Abstract
PURPOSE This study aimed to bibliometrically examine nursing publications regarding cholecystectomy surgery. DESIGN The study is a bibliometric analysis. METHODS The study was conducted in the Web of Science database. The keywords "cholecystectomy AND nursing" were used during the scanning. The data were evaluated in quantitative aspects. FINDINGS In the study, 481 publications were identified, publications were made between 1987 and 2023, the average number of years since the release of the publication was 10.2, and the annual increase rate was 8.19%. The most active country was the United States, and the journal most often published in was the "Journal of Perianesthesia Nursing." In the last 3 years, the themes of "meta-analysis, complication, pain, anxiety, quality of life" have been trending, the most working and continuing to develop our "laparoscopic cholecystectomy" and "pain" themes, and the leading theme in the field was "anxiety". CONCLUSIONS This study is the first bibliometric study examining nursing studies on cholecystectomy and provides a comprehensive overview of cholecystectomy and nursing issues over 36 years. In quantitative data, it was concluded that although studies in this field have a long history, the number of publications is low, and the annual growth rate is low. According to the quantitative evaluation results, it was found that the most studied topic in this field was laparoscopic cholecystectomy and pain, minimally invasive intervention and perioperative period topics remained isolated, and computerized tomography and gallbladder themes were among the newly emerging themes.
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Affiliation(s)
- Pinar Tunc Tuna
- Nursing Department, Selcuk University, Selçuklu, Konya, Turkey.
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Shim JW, Shin D, Hong SH, Park J, Hong SH. Efficacy of Multimodal Analgesia with Transversus Abdominis Plane Block in Comparison with Intrathecal Morphine and Intravenous Patient-Controlled Analgesia after Robot-Assisted Laparoscopic Partial Nephrectomy. J Clin Med 2024; 13:4014. [PMID: 39064054 PMCID: PMC11277915 DOI: 10.3390/jcm13144014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/21/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Robot-assisted laparoscopic partial nephrectomy (RAPN) for renal tumor treatment provides ergonomic advantages to surgeons and improves surgical outcomes. However, moderate-to-severe pain is unavoidable even after minimally invasive surgery. Despite the growing interest in multimodal analgesia, few studies have directly compared its efficacy with intrathecal morphine, a traditional opioid-based analgesic. Methods: We retrospectively investigated the efficacy of multimodal analgesia compared with that of intrathecal analgesia and intravenous patient-controlled analgesia (IV-PCA) in patients who underwent transperitoneal RAPN at our institute between 2020 and 2022. Among the 334 patients who met the inclusion criteria, intrathecal analgesia using morphine 200 µg was performed in 131 patients, and multimodal analgesia, including transversus abdominis plane block and intraoperative infusion of paracetamol 1 g and nefopam 20 mg, was administered to 105 patients. The remaining 98 patients received postoperative IV-PCA alone. Results: As the primary outcome, the area under the curve of pain scores over 24 h was significantly lower in the intrathecal analgesia and multimodal analgesia groups than in the IV-PCA group (89 [62-108] vs. 86 [65-115] vs. 108 [87-126] h, p < 0.001). Cumulative opioid requirements were also significantly lower in the intrathecal analgesia and multimodal analgesia groups at 24 h after surgery (p < 0.001). However, postoperative nausea and vomiting were significantly increased in the intrathecal analgesia group (27.5% vs. 13.3% vs. 13.3%, p = 0.005). Conclusions: Multimodal analgesia with a transversus abdominis plane block is an efficient analgesic method with fewer adverse effects compared to other analgesic methods. Our findings suggest the efficacy and safety of a multimodal approach for opioid-sparing analgesia after RAPN in the current opioid epidemic.
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Affiliation(s)
- Jung-Woo Shim
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (J.-W.S.)
| | - Dongho Shin
- Department of Urology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Sung-Hoo Hong
- Department of Urology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Jaesik Park
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (J.-W.S.)
| | - Sang Hyun Hong
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (J.-W.S.)
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Kara S, Ozturk G, Demir Yetis Z, Korkut E, Aksungur N, Altundas N, Dogan N, Ozden K. The Effect of Enhanced Recovery After Surgery Protocol on Surgical Site Infections in Liver Transplantation. Surg Infect (Larchmt) 2024. [PMID: 38959241 DOI: 10.1089/sur.2024.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024] Open
Abstract
Background: Liver surgeries are treatment modalities that require careful pre- and postoperative follow-up for both the surgeon and the patient. Infections are the leading causes of morbidity and mortality after liver transplantation. Infections are the most frequent cause of death between 30 and 180 days after liver transplantation. We aimed to investigate the effect of the Enhanced Recovery After Surgery (ERAS) protocol on the prevention of infections in liver transplant patients. Patients and Methods: The study included patients who underwent liver transplantation in Ataturk University Organ Transplantation Center between 2017 and 2022. Two patient groups with and without ERAS were formed. Blood and urine cultures were collected retrospectively, and those with positive blood cultures for bacteremia were recorded as infection development. The development of infection between the two groups was statistically compared. Also, all patients' length of intensive care stay, length of hospital stay, and duration of antibiotic use were recorded. These parameters were compared between both groups. Results: There was a statistically significant difference between the two groups in terms of infection development (p: 0.01). There was a statistically significant difference between the two groups in terms of duration of antibiotic use and length of hospital stay (Mann-Whitney U test; p: 0.00, p: 0.04, respectively). There was no statistically significant difference between the two groups in terms of length of intensive care stay. Conclusion: We concluded that the introduction of an ERAS protocol was associated with fewer infections, thus shortening the duration of antibiotic therapy and length of hospital stay, although the standardization of the protocols is difficult, especially in liver transplants.
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Affiliation(s)
- S Kara
- Faculty of Medicine, Department of Transplantation Center, Ataturk University, Erzurum, Turkey
| | - G Ozturk
- Faculty of Medicine, Department of Transplantation Center, Ataturk University, Erzurum, Turkey
| | - Z Demir Yetis
- Faculty of Medicine, Department of Transplantation Center, Ataturk University, Erzurum, Turkey
| | - E Korkut
- Faculty of Medicine, Department of Transplantation Center, Ataturk University, Erzurum, Turkey
| | - N Aksungur
- Faculty of Medicine, Department of Transplantation Center, Ataturk University, Erzurum, Turkey
| | - N Altundas
- Faculty of Medicine, Department of Transplantation Center, Ataturk University, Erzurum, Turkey
| | - N Dogan
- Faculty of Medicine, Department of Anesthesiology, Ataturk University, Erzurum, Turkey
| | - K Ozden
- Faculty of Medicine, Department of Infectious Diseases, Ataturk University, Erzurum, Turkey
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Trilling B, Tidadini F, Lakkis Z, Jafari M, Germain A, Rullier E, Lefevre J, Tuech JJ, Kartheuser A, Leonard D, Prudhomme M, Piessen G, Regimbeau JM, Cotte E, Duprez D, Badic B, Panis Y, Rivoire M, Meunier B, Portier G, Bosson JL, Vilotitch A, Foote A, Caspar Y, Rouanet P, Faucheron JL. Suprapubic versus transurethral catheterization for bladder drainage in male rectal cancer surgery (GRECCAR10), a randomized clinical trial. Tech Coloproctol 2024; 28:77. [PMID: 38954131 DOI: 10.1007/s10151-024-02950-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 05/25/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Bladder drainage is systematically used in rectal cancer surgery; however, the optimal type of drainage, transurethral catheterization (TUC) or suprapubic catheterization (SPC), is still controversial. The aim was to compare the rates of urinary tract infection on the fourth postoperative day (POD4) between TUC and SPC, after rectal cancer surgery regardless of the day of removal of the urinary drain. METHODS This randomized clinical trial in 19 expert colorectal surgery centers in France and Belgium was performed between October 2016 and October 2019 and included 240 men (with normal or subnormal voiding function) undergoing mesorectal excision with low anastomosis for rectal cancer. Patients were followed at postoperative days 4, 30, and 180. RESULTS In 208 patients (median age 66 years [IQR 58-71]) randomized to TUC (n = 99) or SPC (n = 109), the rate of urinary infection at POD4 was not significantly different whatever the type of drainage (11/99 (11.1%) vs. 8/109 (7.3%), 95% CI, - 4.2% to 11.7%; p = 0.35). There was significantly more pyuria in the TUC group (79/99 (79.0%) vs. (60/109 (60.9%), 95% CI, 5.7-30.0%; p = 0.004). No difference in bacteriuria was observed between the groups. Patients in the TUC group had a shorter duration of catheterization (median 4 [2-5] vs. 4 [3-5] days; p = 0.002). Drainage complications were more frequent in the SPC group at all followup visits. CONCLUSIONS TUC should be preferred over SPC in male patients undergoing surgery for mid and/or lower rectal cancers, owing to the lower rate of complications and shorter duration of catheterization. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT02922647.
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Affiliation(s)
- B Trilling
- Colorectal Unit, Department of Surgery, Grenoble Alpes University Hospital, 38000, Grenoble, France
- TIMC-IMAG - CNRS UMR 5525, University Grenoble Alpes, 38000, Grenoble, France
| | - F Tidadini
- Colorectal Unit, Department of Surgery, Grenoble Alpes University Hospital, 38000, Grenoble, France
- Lyon Center for Innovation in Cancer, Lyon 1 University, EA 3738, Lyon, France
| | - Z Lakkis
- Department of Surgical Oncology, Besancon University Hospital, Besancon, France
| | - M Jafari
- Department of Digestive and Oncological Surgery, Oscar Lambret Center, Lille, France
| | - A Germain
- Digestive Surgery Department, University Hospital of Nancy, Nancy, France
| | - E Rullier
- Digestive Surgery Department, Bordeaux University Hospital, Bordeaux, France
| | - J Lefevre
- Digestive Surgery Department, Saint-Antoine Hospital, APHP, Paris, France
| | - J J Tuech
- Digestive Surgery Department, Rouen University Hospital, Rouen, France
| | - A Kartheuser
- Department of Medical Oncology, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - D Leonard
- Department of Medical Oncology, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - M Prudhomme
- Department of Digestive Surgery, Nîmes, University Hospital, Nîmes, France
| | - G Piessen
- Digestive Surgery Department, University Hospital of Lille, Lille, France
| | - J M Regimbeau
- Department of Digestive Surgery, Amiens University Hospital, Amiens, France
| | - E Cotte
- Digestive Surgery Department, Lyon-Sud University Hospital, Pierre-Bénite, France
| | - D Duprez
- Digestive Surgery Department, Annecy-Genevois Hospital, Metz-Tessy, France
| | - B Badic
- Department of General and Digestive Surgery, Brest, University Hospital, Brest, France
| | - Y Panis
- Department of Colorectal Surgery, Beaujon Hospital, AP-HP, Clichy, France
| | - M Rivoire
- Department of Surgical Oncology, Léon Bérard Center, Lyon, France
| | - B Meunier
- Department of Hepatobiliary and Digestive Surgery, Rennes University Hospital, Rennes, France
| | - G Portier
- Department of Digestive Surgery, Toulouse Purpan University Hospital, Toulouse, France
| | - J L Bosson
- Department of Medical Information, Grenoble-Alpes University Hospital, Grenoble, France
- Colorectal Unit, Department of Surgery, Hôpital Michallon, CHU de Grenoble-Alpes, CS 10217, 38043, Grenoble Cedex, France
| | - A Vilotitch
- Department of Medical Information, Grenoble-Alpes University Hospital, Grenoble, France
| | - A Foote
- Colorectal Unit, Department of Surgery, Grenoble Alpes University Hospital, 38000, Grenoble, France
| | - Y Caspar
- Laboratory of Bacteriology, Grenoble-Alpes University Hospital, Grenoble, France
| | - P Rouanet
- Surgical Oncology Department, Montpellier Cancer Institute (ICM), Montpellier, France
| | - J L Faucheron
- Colorectal Unit, Department of Surgery, Grenoble Alpes University Hospital, 38000, Grenoble, France.
- TIMC-IMAG - CNRS UMR 5525, University Grenoble Alpes, 38000, Grenoble, France.
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65
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Cirocco WC. The Lost Science Supporting Bowel Preparation For Elective Colorectal Operations: From Poth to Nichols-Condon. Dis Colon Rectum 2024; 67:e1460. [PMID: 38479017 DOI: 10.1097/dcr.0000000000003343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
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Stringfield SB, Waddimba AC, Criss KM, Burgess B, Dosselman LJ, Fichera A, Wells KO, Fleshman J. Ketamine intolerance in patients on enhanced recovery after surgery protocols undergoing colorectal operations. J Gastrointest Surg 2024; 28:1009-1016. [PMID: 38523035 DOI: 10.1016/j.gassur.2024.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/12/2024] [Accepted: 02/24/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Ketamine is used in enhanced recovery after surgery (ERAS) protocols because of its beneficial antihyperalgesic and antitolerance effects. However, adverse effects such as hallucinations, sedation, and diplopia could limit ketamine's utility. The main objective of this study was to identify rates of ketamine side effects in postoperative patients after colorectal surgery and, secondarily, to compare short-term outcomes between patients receiving ketamine analgesia and controls. METHODS This was a retrospective observational cohort study. Subjects were adults who underwent ERAS protocol-guided colorectal surgery at a large, integrated health system. Patients were grouped into ketamine-receiving and preketamine cohorts. Patients receiving ketamine were divided into tolerant and intolerant groups. Propensity score-adjusted models tested multivariate associations of ketamine tolerance/intolerance vs control group. RESULTS A total of 732 patients underwent colorectal surgery within the ERAS program before ketamine's introduction (control). After ketamine's introduction, 467 patients received the medication. Intolerance was seen in 29% of ketamine recipients, and the most common side effect was diplopia. Demographics and surgical variables did not differ between cohorts. Multivariate models revealed no significant differences in hospital stays. Pain scores in the first 24 hours after surgery were slightly higher in patients receiving ketamine. Opiate consumption after surgery was lower for both ketamine tolerant and ketamine intolerant cohorts than for controls. CONCLUSION Rates of ketamine intolerance are high, which can limit its use and potential effectiveness. Ketamine analgesia significantly reduced opiate consumption without increasing hospital stays after colorectal surgery, regardless of whether it was tolerated.
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Affiliation(s)
- Sarah B Stringfield
- Department of Surgery, Baylor University Medical Center, Dallas, Texas, United States.
| | - Anthony C Waddimba
- Department of Surgery, Baylor University Medical Center, Dallas, Texas, United States; Baylor Scott and White Research Institute, Dallas, Texas, United States
| | - Keirsyn M Criss
- College of Medicine, Texas A & M University Health Science Center, Dallas, Texas, United States
| | - Brooke Burgess
- College of Medicine, Texas A & M University Health Science Center, Dallas, Texas, United States
| | - Luke J Dosselman
- University of Texas (UT) Southwestern Medical School, Dallas, Texas, United States
| | - Alessandro Fichera
- Department of Surgery, Baylor University Medical Center, Dallas, Texas, United States
| | - Katerina O Wells
- Department of Surgery, Baylor University Medical Center, Dallas, Texas, United States
| | - James Fleshman
- Department of Surgery, Baylor University Medical Center, Dallas, Texas, United States
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67
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Stanton E, Buser Z, Mesregah MK, Hu K, Pickering TA, Schafer B, Hah R, Hsieh P, Wang JC, Liu JC. The impact of enhanced recovery after surgery (ERAS) on opioid consumption and postoperative pain levels in elective spine surgery. Clin Neurol Neurosurg 2024; 242:108350. [PMID: 38788543 DOI: 10.1016/j.clineuro.2024.108350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/17/2024] [Accepted: 05/21/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVE Enhanced Recovery after Surgery (ERAS) protocols were developed to counteract the adverse effects of the surgical stress response, aiming for quicker postoperative recovery. Initially applied in abdominal surgeries, ERAS principles have extended to orthopedic spine surgery, but research in this area is still in its infancy. The current study investigated the impact of ERAS on postoperative pain and opioid consumption in elective spine surgeries. METHODS A single-center retrospective study of patients undergoing elective spine surgery from May 2019 to July 2020. Patients were categorized into two groups: those enrolled in the ERAS pathway and those adhering to traditional surgical protocols. Data on demographics, comorbidities, length of stay (LOS), surgical procedures, and postoperative outcomes were collected. Postoperative pain was evaluated using the Numerical Rating Scale (NRS), while opioid utilization was quantified in morphine milligram equivalents (MME). NRS and MME were averaged for each patient across all days under observation. Differences in outcomes between groups (ERAS vs. treatment as usual) were tested using the Wilcoxon rank sum test for continuous variables and Pearson's or Fisher's exact tests for categorical variables. RESULTS The median of patient's mean daily NRS scores for postoperative pain were not statistically significantly different between groups (median = 5.55 (ERAS) and 5.28 (non-ERAS), p=.2). Additionally, the median of patients' mean daily levels of MME were similar between groups (median = 17.24 (ERAS) and 16.44 (non-ERAS), p=.3) ERAS patients experienced notably shorter LOS (median=2 days) than their non-ERAS counterparts (median=3 days, p=.001). The effect of ERAS was moderated by whether the patient had ACDF surgery. ERAS (vs. non-ERAS) patients who had ACDF surgery had 1.64 lower average NRS (p=.006). ERAS (vs. non-ERAS) patients who had a different surgery had 0.72 higher average NRS (p=.02) but had almost half the length of stay, on average (p<.001). CONCLUSIONS The current study underscores the dynamic nature of ERAS protocols within the realm of spine surgery. While ERAS demonstrates advantages such as reduced LOS and improved patient-reported outcomes, it requires careful implementation and customization to address the specific demands of each surgical discipline. The potential to expedite recovery, optimize resource utilization, and enhance patient satisfaction cannot be overstated. However, the fine balance between achieving these benefits and ensuring comprehensive patient care, especially in the context of postoperative pain management, must be maintained. As ERAS continues to evolve and find its place in diverse surgical domains, it is crucial for healthcare providers to remain attentive to patient needs, adapting ERAS protocols to suit individual patient populations and surgical contexts.
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Affiliation(s)
- Eloise Stanton
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, United States
| | - Zorica Buser
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, United States; Department of Orthopedic Surgery, Grossman School of Medicine, New York University, New York, United States; Gerling Institute, Brooklyn, NY, United States.
| | - Mohamed Kamal Mesregah
- Department of Orthopaedic Surgery, Menoufia University Faculty of Medicine, Shebin El-Kom, Menoufia, Egypt
| | - Kelly Hu
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, United States
| | - Trevor A Pickering
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, United States
| | - Betsy Schafer
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, United States
| | - Raymond Hah
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, United States
| | - Patrick Hsieh
- Department of Orthopedic Surgery, Grossman School of Medicine, New York University, New York, United States
| | - Jeffrey C Wang
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, United States
| | - John C Liu
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, United States
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68
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Boden I. Physiotherapy management of major abdominal surgery. J Physiother 2024; 70:170-180. [PMID: 38902197 DOI: 10.1016/j.jphys.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 06/05/2024] [Indexed: 06/22/2024] Open
Affiliation(s)
- Ianthe Boden
- Department of Physiotherapy, University of Tasmania, Launceston, Australia.
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Refugia JM, Thakker PU, Roebuck E, Brownstead HA, Rodriguez AR, Tsivian M. Surgeon-administered regional nerve blocks during radical cystectomy: a feasibility study. Int Urol Nephrol 2024; 56:2227-2234. [PMID: 38316683 DOI: 10.1007/s11255-023-03939-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 12/28/2023] [Indexed: 02/07/2024]
Abstract
OBJECTIVE To describe the technique for surgeon-administered, ultrasound-guided transversus abdominis plane (SU-TAP) blocks performed during radical cystectomy as a component of multimodal, perioperative pain management. METHODS Retrospective, case series of patients receiving SU-TAP blocks just prior to incision for RC. TAP blocks were performed by the surgeon with a standard technique using US guidance to instill an anesthetic solution. The primary outcome was opioid consumption at the intervals of 0-12, 12-24, 24-36, and 36-48 h postoperatively. Opioid consumption was reported as oral morphine milligram equivalents (MME). Secondary outcomes included time to perform SU-TAP blocks, and safety of block procedure. RESULTS 34 patients were included. During the median length of stay of 4 days (interquartile range [IQR] 3-7), only 30/34 (88%) of patients required opioids within the first 12 h post-op, decreasing to 38% by 48 h post-op. The median consumption decreased in the first 48 h from 21 MMEs (IQR 9-38) to 10 MMEs (IQR 8-15) at the 0-12 and 36-48 h intervals, respectively. The median time to perform block procedure was 6 min (IQR 4-8 min) and there were no safety events related to the SU-TAP blocks. Limitations include no comparative arm for opioid consumption. CONCLUSION Our data suggest that urologists may feasibly perform US-guided TAP blocks as a practical, efficient, and safe method of regional anesthesia. SU-TAP blocks should be considered in ERAS protocols for RC. Future comparative studies on opioid consumption compared to local infiltration and alternative block techniques are warranted.
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Affiliation(s)
- Justin M Refugia
- Department of Urology, Atrium Health Wake Forest Baptist Health, 140 Charlois Boulevard, Winston-Salem, NC, 27103, USA.
| | - Parth U Thakker
- Department of Urology, Atrium Health Wake Forest Baptist Health, 140 Charlois Boulevard, Winston-Salem, NC, 27103, USA
| | - Emily Roebuck
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Hilary A Brownstead
- Department of Anesthesiology, Atrium Health Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Alejandro R Rodriguez
- Department of Urology, Atrium Health Wake Forest Baptist Health, 140 Charlois Boulevard, Winston-Salem, NC, 27103, USA
| | - Matvey Tsivian
- Department of Urology, Atrium Health Wake Forest Baptist Health, 140 Charlois Boulevard, Winston-Salem, NC, 27103, USA
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70
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Fernandez CC, Ruiz MG. Telesurgery and telementoring. Cir Esp 2024; 102 Suppl 1:S23-S29. [PMID: 38430960 DOI: 10.1016/j.cireng.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 01/22/2024] [Indexed: 03/05/2024]
Abstract
Telemedicine has revolutionized the field of surgery, with telemonitoring and telesurgery being 2 of its most promising applications. Telesurgery and telemonitoring are revolutionary applications that have the potential to change the way surgical operations are performed. These applications can allow surgeons to perform operations, enable surgeons to perform operations by assisting or supervising others through mentoring from a different location (telementoring). Despite the potential benefits of telemedicine and telementoring, there are still challenges that must be overcome before they can be widely used in clinical practice. For example, latency in data transmission can be a problem in telemedicine, as even a small delay in data transmission can affect the accuracy of the operation. Additionally, a sophisticated and expensive technological infrastructure is required, which can limit their use in some clinical settings. Although we need to work on its development technologically, ethically and legally, it is a promising tool.
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Affiliation(s)
- Carmen Cagigas Fernandez
- Servicio Cirugía General Hospital Universitario Marques de Valdecilla, Santander, Spain; Grupo de Investigación e Innovación en Cirugía, IDIVAL, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - Marcos Gómez Ruiz
- Servicio Cirugía General Hospital Universitario Marques de Valdecilla, Santander, Spain; Grupo de Investigación e Innovación en Cirugía, IDIVAL, Hospital Universitario Marqués de Valdecilla, Santander, Spain
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71
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Hubble T, Huseyin A, Kersey J, Bath MF, Nair M. Impact of intra-abdominal drains in emergency gastrointestinal surgery: a scoping review. ANZ J Surg 2024; 94:1240-1246. [PMID: 38775095 DOI: 10.1111/ans.19096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 04/14/2024] [Accepted: 05/07/2024] [Indexed: 08/28/2024]
Abstract
INTRODUCTION Intra-abdominal drains are often placed in emergency gastrointestinal surgery procedures with the aim to prevent the formation of intra-abdominal collections (IAC) and aid in their early detection. However, the evidence for this is debated. This scoping review aims to evaluate the current evidence for their use in this setting. METHODS A literature search was performed using MEDLINE via PubMed, Scopus, Web of Science, Cochrane Library, and ClinicalTrials.gov. Primary studies published between January 2000 and September 2023 that assessed intra-abdominal drain placement and post-operative IAC formation in emergency gastrointestinal surgery were included. RESULTS A total of 26 articles were identified. There was no strong evidence to suggest that prophylactic intra-abdominal drain placement influences the formation of IAC in emergency gastrointestinal procedures. There was a suggestion that drain placement may increase the rate of surgical site infection and length of hospital stay. However, current studies on the topic are of poor quality and high risk of bias. CONCLUSION The undifferentiated use of drains in emergency gastrointestinal surgery should not be encouraged. Drain placement should be specific to the clinical context. Higher quality research is warranted to better understand the influence drain placement has on post-operative outcomes.
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Affiliation(s)
- T Hubble
- Department of Surgery, North Middlesex University Hospital, London, UK
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, UK
| | - A Huseyin
- Department of Surgery, North Middlesex University Hospital, London, UK
| | - J Kersey
- Department of Surgery, North Middlesex University Hospital, London, UK
| | - Michael F Bath
- Department of Surgery, North Middlesex University Hospital, London, UK
- Department of Engineering, University of Cambridge, Cambridge, UK
| | - M Nair
- Department of Surgery, North Middlesex University Hospital, London, UK
- St Georges University School of Medicine, St. George's University, St. George's, Grenada
- University College London Medical School, University College London, London, UK
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72
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Quinn JA, Nanda M. Hypoxemic Cardiac Arrest from Aspiration of a Cracker in the Postanesthesia Care Unit: A Case Report. A A Pract 2024; 18:e01819. [PMID: 39046179 DOI: 10.1213/xaa.0000000000001819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
A 71-year-old woman with coronary artery disease presented for carotid artery revascularization. After general anesthesia, the patient arrived in stable condition to the postanesthesia care unit. While awaiting transfer to her inpatient room, telemetry alarms alerted her nurse, who found the patient unresponsive, cyanotic, and pulseless. Advanced cardiovascular life support was initiated, with return of spontaneous circulation obtained after 1 round of chest compressions. On oropharyngeal examination, food particles were observed and suctioned. The patient then coughed up additional cracker pieces. This case highlights the risk of aspiration from dry, solid foods in the elderly during the postanesthesia recovery period.
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Affiliation(s)
- Jacqueline A Quinn
- From the Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina
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73
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Maheta B, Shehabat M, Khalil R, Wen J, Karabala M, Manhas P, Niu A, Goswami C, Frezza E. The Effectiveness of Patient Education on Laparoscopic Surgery Postoperative Outcomes to Determine Whether Direct Coaching Is the Best Approach: Systematic Review of Randomized Controlled Trials. JMIR Perioper Med 2024; 7:e51573. [PMID: 38935953 PMCID: PMC11240078 DOI: 10.2196/51573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 12/10/2023] [Accepted: 05/06/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND As of 2022, patient adherence to postoperative guidelines can reduce the risk of complications by up to 52.4% following laparoscopic abdominal surgery. With the availability of various preoperative education interventions (POEIs), understanding which POEI results in improvement in patient outcomes across the procedures is imperative. OBJECTIVE This study aims to determine which POEI could be the most effective on patient outcomes by systematically reviewing all the POEIs reported in the literature. METHODS In total, 4753 articles investigating various POEIs (eg, videos, presentations, mobile apps, and one-on-one education or coaching) were collected from the PubMed, Embase, and Scopus databases. Inclusion criteria were adult patients undergoing abdominal laparoscopic surgery, randomized controlled trials, and studies that provided postoperative outcomes. Exclusion criteria included studies not published in English and with no outcomes reported. Title and abstract and full-text articles with POEI randomized controlled studies were screened based on the above criteria through a blinded, dual review using Covidence (Veritas Health Innovation). Study quality was assessed through the Cochrane Risk of Bias tool. The included articles were analyzed for educational content, intervention timing, intervention type, and postoperative outcomes appropriate for a particular surgery. RESULTS Only 17 studies matched our criteria, with 1831 patients undergoing laparoscopic cholecystectomy, bariatric surgery (gastric bypass and gastric sleeve), and colectomy. In total, 15 studies reported a statistically significant improvement in at least 1 patient postoperative outcome. None of these studies were found to have an overall high risk of bias according to Cochrane standards. In total, 41% (7/17) of the included studies using direct individual education improved outcomes in almost all surgery types, while educational videos had the greatest statistically significant impact for anxiety, nausea, and pain postoperatively (P<.01). Direct group education demonstrated significant improvement in weight, BMI, exercise, and depressive symptoms in 33% (2/6) of the laparoscopic gastric bypass studies. CONCLUSIONS Direct education (individual or group based) positively impacts postoperative laparoscopic surgery outcomes. TRIAL REGISTRATION PROSPERO CRD42023438698; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=438698.
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Affiliation(s)
- Bhagvat Maheta
- California Northstate University College of Medicine, Elk Grove, CA, United States
| | - Mouhamad Shehabat
- California Northstate University College of Medicine, Elk Grove, CA, United States
| | - Ramy Khalil
- California Northstate University College of Medicine, Elk Grove, CA, United States
| | - Jimmy Wen
- California Northstate University College of Medicine, Elk Grove, CA, United States
| | - Muhammad Karabala
- California Northstate University College of Medicine, Elk Grove, CA, United States
| | - Priya Manhas
- California Northstate University College of Medicine, Elk Grove, CA, United States
| | - Ashley Niu
- California Northstate University College of Medicine, Elk Grove, CA, United States
| | - Caroline Goswami
- California Northstate University College of Medicine, Elk Grove, CA, United States
| | - Eldo Frezza
- California Northstate University College of Medicine, Elk Grove, CA, United States
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Long SX, Wang XN, Tian SB, Bi YF, Gao SS, Wang Y, Guo XB. Robotic-assisted low anterior resection for rectal cancer shows similar clinical efficacy to laparoscopic surgery: A propensity score matched study. World J Gastrointest Surg 2024; 16:1558-1570. [PMID: 38983340 PMCID: PMC11230029 DOI: 10.4240/wjgs.v16.i6.1558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/09/2024] [Accepted: 04/22/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Rectal cancer ranks as the second leading cause of cancer-related mortality worldwide, necessitating surgical resection as the sole treatment option. Over the years, there has been a growing adoption of minimally invasive surgical techniques such as robotic and laparoscopic approaches. Robotic surgery represents an innovative modality that effectively addresses the limitations associated with traditional laparoscopic techniques. While previous studies have reported favorable perioperative outcomes for robot-assisted radical resection in rectal cancer patients, further evidence regarding its oncological safety is still warranted. AIM To conduct a comparative analysis of perioperative and oncological outcomes between robot-assisted and laparoscopic-assisted low anterior resection (LALAR) procedures. METHODS The clinical data of 125 patients who underwent robot-assisted low anterior resection (RALAR) and 279 patients who underwent LALAR resection at Shandong Provincial Hospital Affiliated to Shandong First Medical University from December 2019 to November 2022 were retrospectively analyzed. After performing a 1:1 propensity score matching, the patients were divided into two groups: The RALAR group and the LALAR group (111 cases in each group). Subsequently, a comparison was made between the short-term outcomes within 30 d after surgery and the 3-year survival outcomes of these two groups. RESULTS Compared to the LALAR group, the RALAR group exhibited a significantly earlier time to first flatus [2 (2-2) d vs 3 (3-3) d, P = 0.000], as well as a shorter time to first fluid diet [4 (3-4) d vs 5 (4-6) d, P = 0.001]. Additionally, the RALAR group demonstrated reduced postoperative indwelling catheter time [2 (1-3) d vs 4 (3-5) d, P = 0.000] and decreased length of hospital stay after surgery [5 (5-7) d vs 7(6-8) d, P = 0.009]. Moreover, there was an observed increase in total cost of hospitalization for the RALAR group compared to the LALAR group [10777 (10780-11850) dollars vs 10550 (8766-11715) dollars, P = 0.012]. No significant differences were found in terms of conversion rate to laparotomy or incidence of postoperative complications between both groups. Furthermore, no significant disparities were noted regarding the 3-year overall survival rate and 3-year disease-free survival rate between both groups. CONCLUSION Robotic surgery offers potential advantages in terms of accelerated recovery of gastrointestinal and urologic function compared to LALAR resection, while maintaining similar perioperative and 3-year oncological outcomes.
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Affiliation(s)
- Shen-Xiang Long
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - Xin-Ning Wang
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - Shu-Bo Tian
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - Yu-Fang Bi
- Department of Nursing, The People’s Hospital of Zhangqiu Area, Jinan 250200, Shandong Province, China
| | - Shen-Shuo Gao
- Medical Center for Gastrointestinal Surgery, Weifang People’s Hospital, Weifang 261000, Shandong Province, China
| | - Yu Wang
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - Xiao-Bo Guo
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
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Kerroum A, Rosner L, Scala E, Kirsch M, Tozzi P, Courbon C, Rusca M, Abramavičius S, Andrijauskas P, Marcucci C, Rancati V. Intraoperative Dexmedetomidine Use for Enhanced Recovery after Surgery (ERAS) in Cardiac Surgery-Single Center Retrospective Observational Cohort Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1036. [PMID: 39064465 PMCID: PMC11278979 DOI: 10.3390/medicina60071036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/08/2024] [Accepted: 06/19/2024] [Indexed: 07/28/2024]
Abstract
Background and Objectives: Dexmedetomidine, an alpha-2 agonist, is used as an adjunct to anesthesia in enhanced recovery after surgery (ERAS) programs. One of its advantages is the opioid-sparing effect which can facilitate early extubation and recovery. When the ERAS cardiac society was set in 2017, our facility was already using the ERAS program, in which the "fast-track Anesthesia" was facilitated by the intraoperative infusion of dexmedetomidine. Our objective is to share our experience and investigate the potential impact of intraoperative dexmedetomidine use as a part of the ERAS program on patient outcomes in elective cardiac surgery. Materials and Methods: An observational retrospective cohort study was conducted at a university hospital in Switzerland. The patients who underwent elective cardiac surgery with cardiopulmonary bypass between 1 June 2017 and 31 August 2018 were included in this analysis (n = 327). Regardless of the surgery type, all the patients received a standardized fast-track anesthesia protocol inclusive of dexmedetomidine infusion, reduced opioid dose, and parasternal nerve block. The primary outcome was the postoperative time when the criteria for extubation were met. Three groups were identified: group 0-(extubated in the operating room), group < 6 (extubated in less than 6 h), and group > 6 (extubated in >6 h). The secondary outcomes were adverse events, length of stay in ICU and in hospital, and total hospitalization costs. Results: Dexmedetomidine was well-tolerated, with no significant adverse events reported. Early extubation was performed in 187 patients (57%). Group 3 had a significantly longer length of stay in the ICU (median: 70 h vs. 25 h) and in hospital (17 vs. 12 days), and consequently higher total hospitalization costs (CHF 62,551 vs. 38,433) compared to the net data from the other two groups (p < 0.0001). Conclusions: Our findings suggest that dexmedetomidine can be safely used as part of the opioid-sparing anesthesia protocol in patients undergoing elective cardiac surgery with cardiopulmonary bypass with the potential to facilitate early extubation, shorter ICU and hospital stays, and reduced hospitalization costs.
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Affiliation(s)
- Axel Kerroum
- Department of Anesthesiology, Lausanne University Hospital, 1005 Lausanne, Switzerland (C.M.); (V.R.)
| | - Lorenzo Rosner
- Department of Anesthesiology, Lausanne University Hospital, 1005 Lausanne, Switzerland (C.M.); (V.R.)
| | - Emmanuelle Scala
- Department of Anesthesiology, Lausanne University Hospital, 1005 Lausanne, Switzerland (C.M.); (V.R.)
| | - Matthias Kirsch
- Department of Cardiac Surgery, Lausanne University Hospital, 1005 Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, 1015 Lausanne, Switzerland
| | - Piergiorgio Tozzi
- Department of Cardiac Surgery, Lausanne University Hospital, 1005 Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, 1015 Lausanne, Switzerland
| | - Cécile Courbon
- Department of Anesthesiology, Lausanne University Hospital, 1005 Lausanne, Switzerland (C.M.); (V.R.)
| | - Marco Rusca
- Faculty of Biology and Medicine, University of Lausanne, 1015 Lausanne, Switzerland
- Department of Intensive Care Medicine, Lausanne University Hospital, 1005 Lausanne, Switzerland
| | - Silvijus Abramavičius
- Institute of Physiology and Pharmacology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Povilas Andrijauskas
- II Department of Anaesthesiology and Intensive Care, Vilnius University Hospital Santaros Clinics, 08661 Vilnius, Lithuania
| | - Carlo Marcucci
- Department of Anesthesiology, Lausanne University Hospital, 1005 Lausanne, Switzerland (C.M.); (V.R.)
- Faculty of Biology and Medicine, University of Lausanne, 1015 Lausanne, Switzerland
| | - Valentina Rancati
- Department of Anesthesiology, Lausanne University Hospital, 1005 Lausanne, Switzerland (C.M.); (V.R.)
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Zhao X, Jin S, Peng M, Wang J. A retrospective study on the efficacy of the ERAS protocol in patients who underwent laparoscopic left and right colectomy surgeries. Front Surg 2024; 11:1395271. [PMID: 38983588 PMCID: PMC11231639 DOI: 10.3389/fsurg.2024.1395271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 04/25/2024] [Indexed: 07/11/2024] Open
Abstract
Objective Retrospective analysis and comparison of the effects of Enhanced Recovery After Surgery (ERAS) protocol for patients having left and right colectomy surgeries. Method Out of the patients admitted to Chengdu Shang Jin Nan Fu Hospital and West China Hospital from December 2019 to December 2022, a total of 498 who met the inclusion criteria were selected, 255 with right colectomy(RC) and 243 with left colectomy (LC). Under the conditions of strict compliance with ERAS protocol, the relevant physical indexes of RC and LC, including postoperative rehabilitation (especially median post-operative stay) and complications (especially prolonged postoperative ileus, PPOI), were statistically analyzed and compared. Results In terms of intraoperative variables, fluid doses were higher in the LC group than in the RC group (P < 0.05), and there was no significant difference between them in terms of operative time, blood loss, need for open surgery, peritoneal contamination, epidural catheter placement, or opioid use (P > 0.05). Compared with the RC group, the LC group had a higher intake of oral liquid at the second postoperative day (POD), and faster first flatulence (P < 0.05). 30 (11.76%) RC patients required nasogastric tube insertion, while only 3 (1.23%) patients in the LC group required the same (P < 0.05). Prolonged postoperative ileus (PPOI) occurred in 48 (18.82%) and 29 (11.93%) patients in the RC and LC groups, respectively (P < 0.05). No significant differences in terms of postoperative complications or length of hospital stay (LoS). stay were observed. Conclusion As the location of colon cancer changes, the effectiveness of ERAS also varies. More personalized and precise ERAS protocols can reduce the incidence of postoperative complications and promote rapid recovery after surgery.
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Affiliation(s)
- Xuemei Zhao
- Outpatient Department, Chengdu Shang Jin Nan Fu Hospital/Shang Jin Hospital of West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Siyu Jin
- Outpatient Department, Chengdu Shang Jin Nan Fu Hospital/Shang Jin Hospital of West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Mingxiu Peng
- Outpatient Department, Chengdu Shang Jin Nan Fu Hospital/Shang Jin Hospital of West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jingjing Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Tsai PL, Chen JS, Lin CH, Hsu TC, Lin YW, Chen MJ. Abdominal wound length influences the postoperative serum level of interleukin-6 and recovery of flatus passage among patients with colorectal cancer. Front Surg 2024; 11:1400264. [PMID: 38978990 PMCID: PMC11228254 DOI: 10.3389/fsurg.2024.1400264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 06/10/2024] [Indexed: 07/10/2024] Open
Abstract
Introduction A mini-laparotomy for colorectal cancer (CRC) has been reported to shorten postoperative ileus (POI) and hospital stay. Interleukin-6 (IL-6) plays a role in intestinal tissue inflammation, leading to POI. This study investigated the effects of abdominal wounds and IL-6 levels on POI in patients having CRC surgery. Materials and methods Forty-three patients with CRC underwent bowel resection. Serum samples were collected preoperatively and at 2, 24, and 48 h after surgery for cytokine quantification by ELISA. Clinical data, including time from surgery to first passage of flatus and postoperative hospital stay, demographic and pathological data, and routine blood tests, were compared statistically with abdominal wound length and the postoperative increments of cytokines (designated as Δ). Results The length of the abdominal wound showed a significant correlation with clinical variables (length of operation time, time of first flatus passage, and length of postoperative hospital stay) and cytokine variables (IL-6(Δ2 h), IL-8(Δ2 h) and IL-10(Δ2 h). Linear regression analysis showed that the abdominal wound length significantly influenced the operation time, time of first flatus passage, and length of postoperative hospital stay (p < 0.001). The length of the abdominal wound showed a significant influence on the IL-6(Δ2 h) and IL-8(Δ2 h) (p < 0.001, respectively) but no influence on IL-10(Δ2 h). IL-6(Δ2 h), but not IL-8(Δ2 h), significantly influenced the time to first flatus passage and length of hospital stay (p = 0.007, p = 0.006, respectively). The mini-laparotomy approach (wound length <7 cm) led to significantly shortened operation time, time of first flatus passage, length of postoperative stay (p = 0.004, p = 0.003, p = 0.006, respectively) as well as reduced postoperative increment of IL-6(Δ2 h) (p = 0.015). The mini-laparotomy for anterior resection surgery significantly influenced operation time, time of first passage of flatus, length of postoperative stay, and IL-6(Δ2 h). Conclusion Our study is the first to report the complex interaction among the length of the abdominal wound, IL-6 serum level, recovery of the first passage of flatus, and postoperative hospital stay. These results suggest that smaller abdominal wounds and smaller postoperative IL-6 increments were associated with faster recovery of flatus passage and shorter hospital stays.
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Affiliation(s)
- Po-Li Tsai
- Department of Surgery, Division of Colorectal Surgery, Mackay Memorial Hospital, New Taipei City, Taiwan
- Department of Medical Research, Mackay Memorial Hospital, New Taipei City, Taiwan
| | - Jian-Syun Chen
- Department of Surgery, Division of Colorectal Surgery, Mackay Memorial Hospital, New Taipei City, Taiwan
- Department of Medical Research, Mackay Memorial Hospital, New Taipei City, Taiwan
| | - Chi-Hsin Lin
- Department of Medical Research, Mackay Memorial Hospital, New Taipei City, Taiwan
- Department of Bioscience Technology, Chung Yuan Christian University, Taoyuan, Taiwan
| | - Tzu-Chi Hsu
- Department of Surgery, Division of Colorectal Surgery, Mackay Memorial Hospital, New Taipei City, Taiwan
| | - Yu-Wen Lin
- Department of Medical Research, Mackay Memorial Hospital, New Taipei City, Taiwan
| | - Ming-Jen Chen
- Department of Surgery, Division of Colorectal Surgery, Mackay Memorial Hospital, New Taipei City, Taiwan
- Department of Medical Research, Mackay Memorial Hospital, New Taipei City, Taiwan
- Department of Medicine and Institute of Biomedical Sciences, Mackay Medical College, New Taipei City, Taiwan
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M L, G B, F F, M B, M D, E PS, Jf H, A V. Enhanced recovery programs following adhesive small bowel obstruction surgery are feasible and reduce the rate of postoperative ileus: a preliminary study. Langenbecks Arch Surg 2024; 409:191. [PMID: 38900305 DOI: 10.1007/s00423-024-03389-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 06/17/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE The recovery of gastrointestinal function and postoperative ileus are the leading goals for clinicians following surgery for adhesive small bowel obstruction. While enhanced recovery programs may improve recovery, their feasibility in emergency surgery has not yet been proven. We sought to assess the incidence of postoperative ileus in patients following surgery for ASBO and the feasibility of enhanced recovery programs, including their benefits in the recovery of gastrointestinal functions and reducing the length of hospitalization. METHODS This prospective study includes the first 50 patients surgically treated for ASBO between June 2021 and November 2022. Their surgery was performed either as an emergency procedure or after a short course of medical treatment. The main aim was to compare the observed rate of postoperative ileus with a theoretical rate, set at 40%. The study protocol was registered in clinicaltrials.gov under the number NCT04929275. RESULTS Among the 50 patients included in this study, it reported postoperative ileus in 16%, which is significantly lower than the hypothetical rate of 40% (p = 0.0004). The median compliance with enhanced recovery programs was 75% (95%CI: 70.1-79.9). The lowest item observed was the TAP block (26%) and the highest observed items were preoperative counselling and compliance with analgesic protocols (100%). The overall morbidity was 26.5%, but severe morbidity (Dindo-Clavien > 3) was observed in only 3 patients (6%). Severe morbidity was not related with the ERP. CONCLUSION Enhanced recovery programs are feasible and safe in adhesive small bowel obstruction surgery patients and could improve the recovery of gastrointestinal functions. CLINICAL TRIAL REGISTRY NCT04929275. WHAT DOES THE STUDY CONTRIBUTE TO THE FIELD?: Perioperative management of adhesive small bowel obstruction (ASBO) surgery needs to be improved in order to reduce morbidity. Enhanced recovery programs (ERP) are both feasible and safe following urgent surgery for ASBO. ERPs may improve the recovery of gastrointestinal (GI) functions.
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Affiliation(s)
- Loison M
- Faculty of Health, Department of Medicine, University of Angers, ANGERS Cedex 9, France
- Department of Visceral and Endocrinal Surgery, University Hospital of Angers, 4 rue Larrey, ANGERS Cedex 9, 49933, France
| | - Bouhours G
- Department of Anesthesia and Intensive Care Unit, University Hospital of Angers, 4 rue Larrey, ANGERS Cedex 9, 49933, France
| | - Fabulas F
- Faculty of Health, Department of Medicine, University of Angers, ANGERS Cedex 9, France
- Department of Visceral and Endocrinal Surgery, University Hospital of Angers, 4 rue Larrey, ANGERS Cedex 9, 49933, France
| | - Bougard M
- Faculty of Health, Department of Medicine, University of Angers, ANGERS Cedex 9, France
- Department of Visceral and Endocrinal Surgery, University Hospital of Angers, 4 rue Larrey, ANGERS Cedex 9, 49933, France
| | - Delestre M
- Faculty of Health, Department of Medicine, University of Angers, ANGERS Cedex 9, France
- Department of Visceral and Endocrinal Surgery, University Hospital of Angers, 4 rue Larrey, ANGERS Cedex 9, 49933, France
| | - Parot-Schinkel E
- Biostatistics and Methodology Department, University Hospital of Angers, 4 rue Larrey, ANGERS Cedex 9, 49933, France
| | - Hamel Jf
- Faculty of Health, Department of Medicine, University of Angers, ANGERS Cedex 9, France
- Biostatistics and Methodology Department, University Hospital of Angers, 4 rue Larrey, ANGERS Cedex 9, 49933, France
| | - Venara A
- Faculty of Health, Department of Medicine, University of Angers, ANGERS Cedex 9, France.
- Department of Visceral and Endocrinal Surgery, University Hospital of Angers, 4 rue Larrey, ANGERS Cedex 9, 49933, France.
- UPRES EA 3859, IHFIH, University of Angers, Angers, France.
- The Enteric Nervous System in Gut and Brain Disorders, Université de Nantes, INSERM, TENS, Nantes, F-44000, IMAD, France.
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Hwang SS, Oh HK, Shin HR, Lee TG, Choi MJ, Jo MH, Ahn HM, Park H, Sim HH, Ji E, Singhi AN, Kim DW, Kang SB. Effect of prophylactic abdominal drainage on postoperative pain in laparoscopic hemicolectomy for colon cancer: a single-center observational study in Korea. JOURNAL OF MINIMALLY INVASIVE SURGERY 2024; 27:76-84. [PMID: 38886999 PMCID: PMC11187612 DOI: 10.7602/jmis.2024.27.2.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 06/05/2024] [Accepted: 06/08/2024] [Indexed: 06/20/2024]
Abstract
Purpose This study aimed to evaluate the effect of prophylactic abdominal drainage (AD) in laparoscopic hemicolectomy, focusing on assessing postoperative pain outcomes. Methods Patients were categorized into two groups: those with and without AD (AD group vs. no-AD group). A numerical rating scale (NRS) was used to assess postoperative pain on each postoperative day (POD). Further, the inverse probability of treatment weighting (IPTW) method was used to reduce intergroup bias. Results In total, 204 patients who underwent laparoscopic hemicolectomies by a single surgeon between June 2013 and September 2022 at a single institution were retrospectively reviewed. After adjusting for IPTW, NRS scores on POD 2 were significantly lower in the no-AD group (3.2 ± 0.8 vs. 3.4 ± 0.8, p = 0.043). Further examination of postoperative outcomes showed no statistically significant differences in complications between the AD (17.3%) and no-AD (12.4%) groups (p = 0.170). The postoperative length of hospital stay was 7.3 ± 2.8 days in the AD group and 6.9 ± 3.0 days in the no-AD group, with no significant difference (p = 0.298). Time to first flatus was 3.0 ± 0.9 days in the AD group and 2.7 ± 0.9 days in the no-AD group, with no significant difference (p = 0.078). Regarding readmission within 1 month, there were four cases each in the AD (2.3%) and no-AD (1.7%) groups, with no significant difference (p = 0.733). Conclusion Laparoscopic hemicolectomy without AD resulted in no significant differences in postoperative clinical outcomes, except for postoperative pain. This finding suggests that prophylactic AD may exacerbate postoperative pain.
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Affiliation(s)
- Sung Seo Hwang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Heung-Kwon Oh
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hye-Rim Shin
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tae-Gyun Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Mi Jeong Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Min Hyeong Jo
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hong-min Ahn
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyeonjeong Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyun Hee Sim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eunjeong Ji
- Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Anuj Naresh Singhi
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of General Surgery, Saifee Hospital, Mumbai, India
| | - Duck-Woo Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sung-Bum Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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80
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Park SH, Kim DJ. Comments on "Impact of nasogastric tube exclusion after minimally invasive esophagectomy for esophageal cancer: a single-center retrospective study in India". JOURNAL OF MINIMALLY INVASIVE SURGERY 2024; 27:72-73. [PMID: 38886997 PMCID: PMC11187605 DOI: 10.7602/jmis.2024.27.2.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 06/03/2024] [Indexed: 06/20/2024]
Affiliation(s)
- Sin Hye Park
- Department of Gastrointestinal Surgery, Eunpyeong St. Mary’s Hospital, The College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Dong Jin Kim
- Department of Gastrointestinal Surgery, Eunpyeong St. Mary’s Hospital, The College of Medicine, Catholic University of Korea, Seoul, Korea
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81
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O'Connor GD, Taplin R, Murphy C. Assessment of pre-, peri-, and post-surgical practices for elective colorectal patients in a model 4 hospital in Ireland. Ir J Med Sci 2024:10.1007/s11845-024-03731-4. [PMID: 38850352 DOI: 10.1007/s11845-024-03731-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 05/30/2024] [Indexed: 06/10/2024]
Abstract
INTRODUCTION The ERAS protocol is a set of international guidelines established to expedite patients' discharge after colorectal surgery. It does this by aiming to prevent postoperative complications early, and return the patient to normal function allowing earlier discharge. Complications such as PONV, DVT, ileus and pain are common after surgery to name a few, and delay discharge. Early treatment and prevention of these complications however is suggested to aid a patients' return to home at earlier rates than traditional practice. METHODS A prospective chart review and questionnaire was performed on patients undergoing colorectal surgery in UHL in a 6-month period from February to September 2023. Patients were approached on the 3rd day postoperatively and informed about the project. Exclusion criteria included patients who went to HDU or ICU postoperatively. RESULTS In total, 33 patients were recruited. A target of greater than 70% compliance was reached for a variety of the elements of the ERAS protocol such as laparoscopic surgery, preoperative assessments, nutritional drinks, LMWH, oral intake within 24 h of surgery, and intraoperative antiemetics. Unsatisfactory compliance was found with documentation of postoperative antibiotics use of preoperative gabapentin. CONCLUSION UHL has a satisfactory compliance of over 70% with a large variety of elements of the ERAS protocol. Areas of improvement required include postoperative antibiotic and preoperative gabapentin usage. With the collective effort of the multidisciplinary team, along with education, the ERAS protocol can successfully be applied and implemented in a model 4 hospital in Ireland.
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Affiliation(s)
- Gavin David O'Connor
- University Hospital Limerick, Limerick, Ireland.
- University College Cork, Cork, Ireland.
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Fiorindi C, Giudici F, Testa GD, Foti L, Romanazzo S, Tognozzi C, Mansueto G, Scaringi S, Cuffaro F, Nannoni A, Soop M, Baldini G. Multimodal Prehabilitation for Patients with Crohn's Disease Scheduled for Major Surgery: A Narrative Review. Nutrients 2024; 16:1783. [PMID: 38892714 PMCID: PMC11174506 DOI: 10.3390/nu16111783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/25/2024] [Accepted: 06/05/2024] [Indexed: 06/21/2024] Open
Abstract
Approximately 15-50% of patients with Crohn's disease (CD) will require surgery within ten years following the diagnosis. The management of modifiable risk factors before surgery is essential to reduce postoperative complications and to promote a better postoperative recovery. Preoperative malnutrition reduced functional capacity, sarcopenia, immunosuppressive medications, anemia, and psychological distress are frequently present in CD patients. Multimodal prehabilitation consists of nutritional, functional, medical, and psychological interventions implemented before surgery, aiming at optimizing preoperative status and improve postoperative recovery. Currently, studies evaluating the effect of multimodal prehabilitation on postoperative outcomes specifically in CD are lacking. Some studies have investigated the effect of a single prehabilitation intervention, of which nutritional optimization is the most investigated. The aim of this narrative review is to present the physiologic rationale supporting multimodal surgical prehabilitation in CD patients waiting for surgery, and to describe its main components to facilitate their adoption in the preoperative standard of care.
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Affiliation(s)
- Camilla Fiorindi
- Department of Health Science, University of Firenze, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy; (S.R.); (C.T.); (G.M.); (F.C.); (A.N.); (G.B.)
- Multimodal Prehabilitation Center, Azienda Ospedaliera Universitaria Careggi, Largo Brambilla 6, 50135 Florence, Italy; (G.D.T.); (L.F.)
| | - Francesco Giudici
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 6, 50135 Florence, Italy; (F.G.); (S.S.)
| | - Giuseppe Dario Testa
- Multimodal Prehabilitation Center, Azienda Ospedaliera Universitaria Careggi, Largo Brambilla 6, 50135 Florence, Italy; (G.D.T.); (L.F.)
- Division of Geriatric and Intensive Care Medicine, University of Florence, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy
| | - Lorenzo Foti
- Multimodal Prehabilitation Center, Azienda Ospedaliera Universitaria Careggi, Largo Brambilla 6, 50135 Florence, Italy; (G.D.T.); (L.F.)
- Section of Anesthesiology and Intensive Care, University of Florence, Largo Brambilla 3, 50139 Florence, Italy
| | - Sara Romanazzo
- Department of Health Science, University of Firenze, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy; (S.R.); (C.T.); (G.M.); (F.C.); (A.N.); (G.B.)
- Multimodal Prehabilitation Center, Azienda Ospedaliera Universitaria Careggi, Largo Brambilla 6, 50135 Florence, Italy; (G.D.T.); (L.F.)
| | - Cristina Tognozzi
- Department of Health Science, University of Firenze, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy; (S.R.); (C.T.); (G.M.); (F.C.); (A.N.); (G.B.)
- Multimodal Prehabilitation Center, Azienda Ospedaliera Universitaria Careggi, Largo Brambilla 6, 50135 Florence, Italy; (G.D.T.); (L.F.)
| | - Giovanni Mansueto
- Department of Health Science, University of Firenze, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy; (S.R.); (C.T.); (G.M.); (F.C.); (A.N.); (G.B.)
- Multimodal Prehabilitation Center, Azienda Ospedaliera Universitaria Careggi, Largo Brambilla 6, 50135 Florence, Italy; (G.D.T.); (L.F.)
| | - Stefano Scaringi
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 6, 50135 Florence, Italy; (F.G.); (S.S.)
| | - Francesca Cuffaro
- Department of Health Science, University of Firenze, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy; (S.R.); (C.T.); (G.M.); (F.C.); (A.N.); (G.B.)
| | - Anita Nannoni
- Department of Health Science, University of Firenze, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy; (S.R.); (C.T.); (G.M.); (F.C.); (A.N.); (G.B.)
| | - Mattias Soop
- Department for IBD and Intestinal Failure Surgery, Karolinska University Hospital, SE 177 76 Stockholm, Sweden;
| | - Gabriele Baldini
- Department of Health Science, University of Firenze, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy; (S.R.); (C.T.); (G.M.); (F.C.); (A.N.); (G.B.)
- Multimodal Prehabilitation Center, Azienda Ospedaliera Universitaria Careggi, Largo Brambilla 6, 50135 Florence, Italy; (G.D.T.); (L.F.)
- Section of Anesthesiology and Intensive Care, University of Florence, Largo Brambilla 3, 50139 Florence, Italy
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Ismail MI, Al-Gharaibeh OR, Talafha L, Gammaldi D, Varrassi G, Grasso G. Anesthetic Management of a Patient With Wolff-Parkinson-White Syndrome Undergoing Gynecological Robotic Surgery. Cureus 2024; 16:e62842. [PMID: 39036161 PMCID: PMC11260423 DOI: 10.7759/cureus.62842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/20/2024] [Indexed: 07/23/2024] Open
Abstract
Robotic surgery provides precision and safety for minimally invasive gynecological operations but introduces unique anesthetic challenges, especially for individuals with pre-existing conditions like Wolff-Parkinson-White (WPW) syndrome. This case report addresses the anesthetic management of a 32-year-old female with WPW syndrome undergoing a myomectomy. A thorough pre-operative evaluation, including an ECG, echocardiogram, and Holter monitoring, was performed to assess the anesthetic and cardiac risks. The patient was administered a combination of loco-regional and general anesthesia, with an emphasis on neuromuscular monitoring, antiarrhythmic preparedness, and pain management to effectively manage the complexities introduced by WPW syndrome and robotic surgery. The anesthetic protocol comprised premedication with midazolam, induction using sufentanil, propofol, and rocuronium, and maintenance with desflurane, along with techniques to mitigate the effects of pneumoperitoneum and Trendelenburg positioning. Employing these strategies, the surgery concluded successfully without any anesthetic or surgical complications. The patient experienced a rapid and complete awakening, achieved optimal pain control, and was able to mobilize early, leading to her discharge 24 hours post-surgery. This case demonstrates the essential nature of customized anesthetic management for patients with WPW syndrome undergoing robotic surgery. It underscores the necessity of an exhaustive pre-operative assessment, diligent intraoperative monitoring, and active postoperative care to ensure patient safety and promote swift recovery.
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Affiliation(s)
| | | | - Lana Talafha
- Clinical Sciences, Faculty of Medicine, Yarmouk University, Irbid, JOR
| | | | | | - Giovanna Grasso
- Anesthesiology, Azienda Ospedaliera Universitaria (AOU) Federico II, Napoli, ITA
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84
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Kim JS, Lee CS, Bae JH, Han SR, Lee DS, Lee IK, Lee YS, Kim IK. Clinical impact of a multimodal pain management protocol for loop ileostomy reversal. Ann Coloproctol 2024; 40:210-216. [PMID: 38946091 PMCID: PMC11362762 DOI: 10.3393/ac.2022.01137.0162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/23/2023] [Accepted: 02/01/2023] [Indexed: 07/02/2024] Open
Abstract
PURPOSE As introduced, multimodal pain management bundle for ileostomy reversal may be considered to reduce postoperative pain and hospital stay. The aim of this study was to evaluate clinical efficacy of perioperative multimodal pain bundle for ileostomy. METHODS Medical records of patients who underwent ileostomy reversal after rectal cancer surgery from April 2017 to March 2020 were analyzed. Sixty-seven patients received multimodal pain bundle protocol with ileostomy reversal (group A) and 41 patients underwent closure of ileostomy with conventional pain management (group B). RESULTS Baseline characteristics, including age, sex, body mass index, American Society of Anesthesiologists classification, diabetes mellitus, and smoking history, were not significantly different between the groups. The pain score on postoperative day 1 was significant lower in group A (visual analog scale, 2.6 ± 1.3 vs. 3.2 ± 1.2; P = 0.013). Overall consumption of opioid in group A was significant less than group B (9.7 ± 9.5 vs. 21.2 ± 8.8, P < 0.001). Hospital stay was significantly shorter in group A (2.3 ± 1.5 days vs. 4.1 ± 1.5 days, P < 0.001). There were no significant differences between the groups in postoperative complication rate. CONCLUSION Multimodal pain protocol for ileostomy reversal could reduce postoperative pain, usage of opioid and hospital stay compared to conventional pain management.
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Affiliation(s)
- Jeong Sub Kim
- Department of Colorectal Surgery, Hansol Hospital, Seoul, Korea
| | - Chul Seung Lee
- Department of Colorectal Surgery, Hansol Hospital, Seoul, Korea
| | - Jung Hoon Bae
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Rim Han
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Do Sang Lee
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In Kyu Lee
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoon Suk Lee
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In Kyeong Kim
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Ten Cate DWG, Molenaar CJL, Garcia RS, Bojesen RD, Tahasildar BLR, Jansen L, López-Baamonde M, Feo CV, Martínez-Palli G, Gögenur I, Carli F, Slooter GD. Multimodal prehabilitation in elective oncological colorectal surgery enhances postoperative functional recovery: A secondary analysis of the PREHAB randomized clinical trial. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108270. [PMID: 38520782 DOI: 10.1016/j.ejso.2024.108270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 03/11/2024] [Indexed: 03/25/2024]
Abstract
INTRODUCTION Colorectal cancer (CRC) ranks as the second leading cause of cancer-related deaths. The PREHAB trial revealed that prehabilitation in colorectal surgery leads to a reduction of severe complications and enhanced functional capacity. Nevertheless, risk selection for prehabilitation and the potential benefits for patients without postoperative complications remains unclear. This study aims to assess postoperative functional capacity, also in patients without postoperative complications. MATERIALS & METHODS This study was a secondary analysis of the PREHAB trial. Functional capacity tests, including cardiopulmonary exercise testing (CPET), steep ramp test (SRT), 6-min walking test (6MWT), stair climb test (SCT), 30" sit-to-stand test (STS), timed-up-and-go test (TUG), and muscle strength assessments, were conducted at baseline (T0) and 4 weeks postoperatively (T3). The primary outcome was the relative change in functional capacity from baseline to postoperative (ΔT0-T3) per group (i.e., prehabilitation vs control). Secondary, identical analysis were performed for patients without postoperative complications in each group. RESULTS Intention-to-treat analysis included 251 patients. For postoperative functional capacity, prehabilitation patients showed improvements in VO2peak (p = 0.024), VO2AT (p = 0.017), SRT (p = 0.001), 6MWT (p = 0.049), SCT (p = 0.012), and STS (p = 0.001) compared to the control group. Regarding muscle strength, prehabilitation patients showed improvements in estimated 1RM lateral pull down (p = 0.016), 1RM chest press (p = 0.001), 1RM leg press (p = 0.001) and HGS (p = 0.005) compared to controls. Additionally, prehabilitation patients more often reached baseline levels at T3 in VO2AT (p = 0.037), SRT (p = 0.008), 6MWT (p = 0.013), STS (p = 0.012), estimated 1RM lateral pull down (p = 0.002), 1RM chest press (p = 0.001) and 1RM leg press (p = 0.001) compared to controls. Moreover, even patients without postoperative complications in the prehabilitation group showed better postoperative functional capacity and more often reached baseline levels at T3, compared to controls. CONCLUSION Multimodal prehabilitation in CRC surgery is associated with improved postoperative functional capacity, even in patients without postoperative complications.
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Affiliation(s)
- David W G Ten Cate
- Department of Surgery, Máxima Medical Center, De Run 4600, 5504 DB, Veldhoven, the Netherlands; Department of Surgery, School of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 50, 6629 ER, Maastricht, the Netherlands.
| | - Charlotte J L Molenaar
- Department of Surgery, Máxima Medical Center, De Run 4600, 5504 DB, Veldhoven, the Netherlands
| | - Raquel Sebio Garcia
- Physical Medicine and Rehabilitation Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Rasmus D Bojesen
- Center for Surgical Science, Zealand University Hospital, Roskilde, Denmark; Department of Surgery, Slagelse Hospital, Slagelse, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Loes Jansen
- Department of Surgery, Máxima Medical Center, De Run 4600, 5504 DB, Veldhoven, the Netherlands
| | - Manuel López-Baamonde
- Department of Anesthesia, Hospital Clinic Barcelona, FRCB-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Carlo Vittorio Feo
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy; Unit of Provincial General Surgery, Azienda Unità Sanitaria Locale Ferrara, Ferrara, Italy
| | - Graciela Martínez-Palli
- Department of Anesthesia, Hospital Clinic Barcelona, FRCB-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Ismail Gögenur
- Center for Surgical Science, Zealand University Hospital, Roskilde, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Surgery, Zealand University Hospital, Køge, Denmark
| | - Francesco Carli
- Department of Anesthesia, Montreal General Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Gerrit D Slooter
- Department of Surgery, Máxima Medical Center, De Run 4600, 5504 DB, Veldhoven, the Netherlands
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Griffiths CD, D'Souza D, Rodriguez F, Park LJ, Serrano PE. Quality of life following perioperative optimization with nutritional supplements in patients undergoing gastrointestinal surgery for cancer: A randomized, placebo-controlled feasibility clinical trial. J Surg Oncol 2024; 129:1289-1294. [PMID: 38504604 DOI: 10.1002/jso.27624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/22/2024] [Accepted: 03/09/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Up to two thirds of patients presenting for abdominal cancer surgery are malnourished pre-operatively. Perioperative nutritional supplementation has been proposed to improve surgical outcomes, though its effect on quality of life (QoL) is not yet understood. METHODS A randomized controlled feasibility trial for perioperative nutrition among patients undergoing major abdominal cancer surgery was conducted. Participants in the intervention group received supplements for 30 days before surgery. Participants completed two QoL questionnaires (EORTC-QLQ-C-30 and FACT-G) at baseline, then 4 and 12 weeks postoperatively. Participants were compared between and within groups at baseline, Weeks 4, and 12 using t tests. Minimal clinically important differences (MCIDs) were considered as a 10-point worsening from baseline. RESULTS Sixty-six participants were available for analysis in this study, including 33 in the intervention and 30 in the control arms. Baseline demographics were balanced between groups except for different rates of pancreas cancer (36% intervention vs. 9% control) and colorectal cancer (19% intervention vs. 34% control). At baseline, participants in the intervention group had lower overall QoL (59% vs. 77%, p = 0.01), role functioning (72% vs 88%, p = 0.045), and cognitive functioning (79% vs 90%, p = 0.047). Following surgery, role and physical functioning worsened in the control group, without significant differences between groups. Role functioning was persistently worsened at 12 weeks in the control group. The rates of MCIDs were similar between both intervention and control groups. DISCUSSION Perioperative nutrition was associated with preservation of QoL in the postoperative period following major abdominal cancer surgery compared to placebo. SUMMARY Among patients undergoing surgery for cancer, the majority present at high risk for malnutrition. In this placebo-controlled randomized trial among patients undergoing major abdominal surgery for cancer, preoperative nutrition supplementation was associated with the preservation of QoL in the postoperative period.
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Affiliation(s)
| | - Daniel D'Souza
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Felipe Rodriguez
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Lily J Park
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Pablo E Serrano
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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Cuijpers ACM, Lubbers T, Dronkers JJ, Heldens AFJM, Zoethout SB, Leistra D, van Kuijk SMJ, van Meeteren NLU, Stassen LPS, Bongers BC. Development and external validation of preoperative clinical prediction models for postoperative outcomes including preoperative aerobic fitness in patients approaching elective colorectal cancer surgery. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108338. [PMID: 38728861 DOI: 10.1016/j.ejso.2024.108338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/01/2024] [Accepted: 04/09/2024] [Indexed: 05/12/2024]
Abstract
INTRODUCTION Preoperative aerobic fitness is associated with postoperative outcomes after elective colorectal cancer (CRC) surgery. This study aimed to develop and externally validate two clinical prediction models incorporating a practical test to assess preoperative aerobic fitness to distinguish between patients with and without an increased risk for 1) postoperative complications and 2) a prolonged time to in-hospital recovery of physical functioning after elective colorectal cancer (CRC) surgery. MATERIALS AND METHODS Models were developed using prospective data from 256 patients and externally validated using prospective data of 291 patients. Postoperative complications were classified according to Clavien-Dindo. The modified Iowa level of assistance scale (mILAS) was used to determine time to postoperative in-hospital physical recovery. Aerobic fitness, age, sex, body mass index, American Society of Anesthesiologists (ASA) classification, neoadjuvant treatment, surgical approach, tumour location, and preoperative haemoglobin level were potential predictors. Areas under the curve (AUC), calibration plots, and Hosmer-Lemeshow tests evaluated predictive performance. RESULTS Aerobic fitness, sex, age, ASA, tumour location, and surgical approach were included in the final models. External validation of the model for complications and postoperative recovery presented moderate to fair discrimination (AUC 0.666 (0.598-0.733) and 0.722 (0.651-0.794), respectively) and good calibration. High sensitivity and high negative predictive values were observed in the lower predicted risk categories (<40 %). CONCLUSION Both models identify patients with and without an increased risk of complications or a prolonged time to in-hospital physical recovery. They might be used for improving patient-tailored preoperative risk assessment and targeted and cost-effective application of prehabilitation interventions.
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Affiliation(s)
- Anne C M Cuijpers
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Surgery, GROW, Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands.
| | - Tim Lubbers
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Surgery, GROW, Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands.
| | - Jaap J Dronkers
- Expertise Centre Healthy Urban Living, Research Group Innovation of Human Movement Care, HU University of Applied Sciences Utrecht, Utrecht, the Netherlands.
| | - Aniek F J M Heldens
- Department of Physical Therapy, Maastricht University Medical Centre, Maastricht, the Netherlands.
| | - Siebrand B Zoethout
- Department of Physical Therapy, Deventer Hospital, Deventer, the Netherlands.
| | - Duncan Leistra
- Department of Physical Therapy, Nij Smellinghe Hospital, Drachten, the Netherlands.
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre, Maastricht, the Netherlands.
| | - Nico L U van Meeteren
- Top Sector Life Sciences and Health (Health∼Holland), The Hague, the Netherlands; Department of Anesthesiology, Erasmus Medical Centre, Rotterdam, the Netherlands.
| | - Laurents P S Stassen
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Surgery, NUTRIM, Institute of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.
| | - Bart C Bongers
- Department of Surgery, NUTRIM, Institute of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands; Department of Nutrition and Movement Sciences, NUTRIM, Institute of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.
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88
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Yun DH, Plymale MA, Oyler DR, Slavova SS, Davenport DL, Roth JS. Predictors of postoperative opioid use in ventral and incisional hernia repair. Surg Endosc 2024; 38:3052-3060. [PMID: 38609586 DOI: 10.1007/s00464-024-10808-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/21/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND One in two ventral and incisional hernia repair (VIHR) patients have preoperative opioid prescription within a year before procedure. The study's aim was to investigate risk factors of increased postoperative prescription filling in patients with or without preoperative opioid prescription. METHODS VIHR cases from 2013 to 2017 were reviewed. State prescription drug monitoring program data were linked to patient records. The primary endpoint was cumulative opioid dose dispensed through post-discharge day 45. Morphine milligram equivalent (MME) was used for uniform comparison. RESULTS 205 patients were included in the study (average age 53.5 years; 50.7% female). Over 35% met criteria for preoperative opioid use. Preoperative opioid tolerance, superficial wound infection, current smoking status, and any dispensed opioids within 45 days of admission were independent predictors for increased postoperative opioid utilization (p < 0.001). CONCLUSION Preoperative opioid use during 45-day pre-admission correlated strongly with postoperative prescription filling in VIHR patients, and several independent risk factors were identified.
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Affiliation(s)
- Do Hyun Yun
- College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Margaret A Plymale
- Division of General, Endocrine and Metabolic Surgery, Department of Surgery, University of Kentucky, 800 Rose Street, C-240, Lexington, KY, 40536, USA
| | - Douglas R Oyler
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Svetla S Slavova
- Department of Biostatistics, University of Kentucky, Lexington, KY, USA
| | - Daniel L Davenport
- Department of Surgery, Division of Healthcare Outcomes and Optimal Patient Services, University of Kentucky, Lexington, KY, USA
| | - John Scott Roth
- Division of General, Endocrine and Metabolic Surgery, Department of Surgery, University of Kentucky, 800 Rose Street, C-240, Lexington, KY, 40536, USA.
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89
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Muneeb Akhtar SM, Fareed A, Afzal U, Asghar MS, Mumtaz M, Faraz F, Naeem H, Vaid R. Effectiveness of erector spinae plane block in reducing opioid consumption after colorectal surgery: A comprehensive meta-analysis. Am J Surg 2024; 232:31-44. [PMID: 38336575 DOI: 10.1016/j.amjsurg.2024.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/24/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024]
Abstract
Despite the life-saving nature of colorectal surgeries, patients often experience intra and post-operative problems, especially pain and discomfort. This meta-analysis aimed to evaluate the effectiveness of erector spinae plane block (ESP block) in postoperative pain management for patients undergoing colorectal surgeries. A comprehensive systematic literature search was conducted in PubMed and Cochrane Library databases from inception until December 2023. Eight studies were deemed appropriate for inclusion. The pooled analysis demonstrated a significant decrease with the ESP block compared to the control group in postoperative opioid consumption [MD = -15.96 mg; 95 % CI (-28.74 to -3.18); p = 0.014, I2 = 87 %], intraoperative opioid consumption [MD = -35.51 mg; 95 % CI (-62.63 to -8.40); p = 0.010, I2 = 87 %], pain scores [MD = -0.94; 95 % CI (-1.27 to -0.60); p < 0.000001, I2 = 86 %], with a significantly shorter duration of hospital stay [MD = -1.25 days; 95 % CI (-2.02 to -0.48); p = 0.002, I2 = 23 %]. This meta-analysis support the use of erector spinae plane block (ESP) for postoperative pain management in colorectal surgeries. ESP shows significant reductions in opioid consumption, pain scores and hospital stay.
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Affiliation(s)
| | - Areeba Fareed
- Department of Medicine, Karachi Medical and Dental College, Karachi, Pakistan.
| | - Urwah Afzal
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
| | | | - Munazza Mumtaz
- Department of Obstetrics and Gynecology, Civil Hospital, Karachi, Pakistan.
| | - Fatima Faraz
- Department of Medicine, Rawalpindi Medical University, Pakistan.
| | - Huda Naeem
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
| | - Rayyan Vaid
- Department of Medicine, Karachi Medical and Dental College, Karachi, Pakistan.
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90
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Kokotovic D, Schucany A, Soylu L, Fenger AQ, Puggard I, Ekeloef S, Gögenur I, Burcharth J. Association between reduced physical performance measures and short-term consequences after major emergency abdominal surgery: a prospective cohort study. Eur J Trauma Emerg Surg 2024; 50:821-828. [PMID: 38177561 PMCID: PMC11249428 DOI: 10.1007/s00068-023-02408-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 11/19/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Major emergency abdominal surgery is associated with high morbidity with outcomes worse than for similar elective surgery, including complicated physical recovery, increased need for rehabilitation, and prolonged hospitalisation. PURPOSE To investigate whether low physical performance test scores were associated with an increased risk of postoperative complications, and, furthermore, to investigate the feasibility of postoperative performance tests in patients undergoing major emergency abdominal surgery. We hypothesize that patients with low performance test scores suffer more postoperative complications. METHODS The study is a prospective observational cohort study including all patients who underwent major abdominal surgery at the Department of Surgery at Zealand University Hospital between 1st March 2017 and 31st January 2019. Patients were evaluated with De Morton Mobility Index (DEMMI) score, hand grip strength, and 30-s chair-stand test. RESULTS The study included 488 patients (median age 69, 50.6% male). Physiotherapeutic evaluation including physical performance tests with DEMMI and hand grip strength in the immediate postoperative period were feasible in up to 68% of patients undergoing major emergency abdominal surgery. The 30-s chair-stand test was less viable in this population; only 21% of the patients could complete the 30-s chair-stand test during the postoperative period. In logistic regression models low DEMMI score (< 40) and ASA classification and low hand grip strength (< 20 kg for women, < 30 kg for men were independent risk factors for the development of postoperative severe complications Clavien-Dindo (CD) grade ≥ 3. CONCLUSIONS In patients undergoing major emergency surgery low performance test scores (DEMMI and hand grip strength), were independently associated with the development of significant postoperative complications CD ≥ 3.
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Affiliation(s)
- Dunja Kokotovic
- Department of Gastrointestinal Surgery, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark.
- Emergency Surgery Research Group (EMERGE) Copenhagen, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark.
| | - Aide Schucany
- Department of Gastrointestinal Surgery, North Zealand University Hospital, Hillerød, Denmark
| | - Liv Soylu
- Department of Gastrointestinal Surgery, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
| | - Andreas Q Fenger
- Department of Gastrointestinal Surgery, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
| | - Iben Puggard
- Department of Physiotherapy, Zealand University Hospital, Køge, Denmark
| | - Sarah Ekeloef
- Center for Surgical Science, Zealand University Hospital, Køge, Denmark
| | - Ismail Gögenur
- Center for Surgical Science, Zealand University Hospital, Køge, Denmark
| | - Jakob Burcharth
- Department of Gastrointestinal Surgery, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
- Emergency Surgery Research Group (EMERGE) Copenhagen, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
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91
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Li SQ, Luo CL, Qiu H, Liu YX, Chen JM. Effect of Orem's self-care model on discharge readiness of patients undergoing enterostomy: A randomized controlled trial. Eur J Oncol Nurs 2024; 70:102549. [PMID: 38692158 DOI: 10.1016/j.ejon.2024.102549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/18/2024] [Accepted: 03/03/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE To evaluate the effectiveness of Orem's self-care model in preparing hospitals for the discharge of patients with colorectal cancer who undergo enterostomy. METHODS 92 patients with enterostomy were recruited between February 2022 and February 2023 from a general tertiary hospital. The participants were assigned to either the intervention group or the control group randomly. The intervention group received Orem's self-care program and a three-month follow-up, whereas the control group received only routine care and a three-month follow-up. Discharge readiness, self-care ability, and stoma-quality-of-life data were collected at hospital discharge (T1), 30 days (T2), and 90 days (T3) after discharge. RESULTS The intervention group had substantially higher discharge readiness (knowledge, p < 0.001; coping ability, p = 0.006; personal status, p = 0.001; expected support, p = 0.021; total score, p < 0.001), better self-care ability at T1 (self-care knowledge, p < 0.001; self-care skills, p = 0.010), better total quality of life (QoL) at T1, T2, and T3 (p < 0.001; p = 0.006; p = 0.014); better stoma management and daily routine at T1 (p = 0.004; p < 0.001); and better daily routine at T2 (p = 0.009) than the control group. CONCLUSIONS The designed discharge readiness program based on Orem's self-care could promote effective patient discharge readiness, self-care knowledge, self-care skills, and QoL. TRIAL REGISTRATION The trial number ChiCTR2200056302 registered on ClinicalTrials.gov.
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Affiliation(s)
- Si-Qing Li
- Department of Gastroenterology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 51900, PR China.
| | - Cui-Lian Luo
- Department of Gastroenterology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 51900, PR China.
| | - Hong Qiu
- Department of Gastroenterology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 51900, PR China.
| | - Yu-Xia Liu
- Department of Gastroenterology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 51900, PR China.
| | - Jian-Min Chen
- Department of Gastroenterology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 51900, PR China.
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92
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Theja S, Mishra S, Bhoriwal S, Garg R, Bharati SJ, Kumar V, Gupta N, Vig S, Kumar S, Deo SVS, Bhatnagar S. Feasibility of the ERAS (Enhanced Recovery After Surgery) Protocol in Patients Undergoing Gastrointestinal Cancer Surgeries in a Tertiary Care Hospital-A Prospective Interventional Study. Indian J Surg Oncol 2024; 15:304-311. [PMID: 38741624 PMCID: PMC11088603 DOI: 10.1007/s13193-024-01897-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 02/02/2024] [Indexed: 05/16/2024] Open
Abstract
Enhanced Recovery After Surgery (ERAS) protocols have emerged as a promising approach to optimize perioperative care and improve outcomes in various surgical specialties. Despite feasibility studies on ERAS in various surgeries, there remains a paucity of research focusing on gastrointestinal cancer surgeries in the Indian context. The primary objective is to evaluate the compliance rate of the ERAS protocol and secondary objectives include the compliance rate of individual components of the protocol, the complications, the length of hospital stay, and the challenges faced during implementation in patients undergoing gastrointestinal cancer surgeries in our tertiary care cancer center. In this prospective interventional study (CTRI/2022/04/041657; registered on 05/04/2022), we evaluated 50 patients aged 18 to 70 years undergoing surgery for gastrointestinal malignancies and implemented a refined ERAS protocol tailored to our institutional resources and conditions based on standard ERAS society recommendations for gastrointestinal surgeries and specific recommendations for colorectal, pancreatic, and esophageal surgeries.Our study's mean overall compliance rate with the ERAS protocol was 88.54%. We achieved a compliance rate of 91.98%, 81.66%, and 92.00% for pre-operative, intraoperative, and post-operative components respectively. Fourteen (28%) patients experienced complications during the study. The median length of stay was 6.5 days (5.25-8). Challenges were encountered during the preoperative, intraoperative, and postoperative phases. The study highlighted the feasibility of implementing the ERAS protocol in a cancer institute, but specific challenges need to be addressed for its optimal success in gastrointestinal cancer surgeries. Supplementary Information The online version contains supplementary material available at 10.1007/s13193-024-01897-y.
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Affiliation(s)
- Surya Theja
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. BRAIRCH, AIIMS, New Delhi, India
| | - Seema Mishra
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. BRAIRCH, AIIMS, Room No. 249, Second Floor, New Delhi, Delhi India
| | - Sandeep Bhoriwal
- Department of Surgical Oncology, Dr. BRAIRCH, AIIMS, New Delhi, Delhi India
| | - Rakesh Garg
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. BRAIRCH, AIIMS, New Delhi, India
| | - Sachidanand Jee Bharati
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. BRAIRCH, AIIMS, New Delhi, India
| | - Vinod Kumar
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. BRAIRCH, AIIMS, New Delhi, India
| | - Nishkarsh Gupta
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. BRAIRCH, AIIMS, New Delhi, India
| | - Saurabh Vig
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. BRAIRCH, AIIMS, New Delhi, India
| | - Sunil Kumar
- Department of Surgical Oncology, Dr. BRAIRCH, AIIMS, New Delhi, Delhi India
| | - S. V. S. Deo
- Department of Surgical Oncology, Dr. BRAIRCH, AIIMS, New Delhi, Delhi India
| | - Sushma Bhatnagar
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. BRAIRCH, AIIMS, New Delhi, India
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McIlroy DR, Feng X, Shotwell M, Wallace S, Bellomo R, Garg AX, Leslie K, Peyton P, Story D, Myles PS. Candidate Kidney Protective Strategies for Patients Undergoing Major Abdominal Surgery: A Secondary Analysis of the RELIEF Trial Cohort. Anesthesiology 2024; 140:1111-1125. [PMID: 38381960 DOI: 10.1097/aln.0000000000004957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
BACKGROUND Acute kidney injury (AKI) is common after major abdominal surgery. Selection of candidate kidney protective strategies for testing in large trials should be based on robust preliminary evidence. METHODS A secondary analysis of the Restrictive versus Liberal Fluid Therapy in Major Abdominal Surgery (RELIEF) trial was conducted in adult patients undergoing major abdominal surgery and randomly assigned to a restrictive or liberal perioperative fluid regimen. The primary outcome was maximum AKI stage before hospital discharge. Two multivariable ordinal regression models were developed to test the primary hypothesis that modifiable risk factors associated with increased maximum stage of postoperative AKI could be identified. Each model used a separate approach to variable selection to assess the sensitivity of the findings to modeling approach. For model 1, variable selection was informed by investigator opinion; for model 2, the Least Absolute Shrinkage and Selection Operator (LASSO) technique was used to develop a data-driven model from available variables. RESULTS Of 2,444 patients analyzed, stage 1, 2, and 3 AKI occurred in 223 (9.1%), 59 (2.4%), and 36 (1.5%) patients, respectively. In multivariable modeling by model 1, administration of a nonsteroidal anti-inflammatory drug or cyclooxygenase-2 inhibitor, intraoperatively only (odds ratio, 1.77 [99% CI, 1.11 to 2.82]), and preoperative day-of-surgery administration of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker compared to no regular use (odds ratio, 1.84 [99% CI, 1.15 to 2.94]) were associated with increased odds for greater maximum stage AKI. These results were unchanged in model 2, with the additional finding of an inverse association between nadir hemoglobin concentration on postoperative day 1 and greater maximum stage AKI. CONCLUSIONS Avoiding intraoperative nonsteroidal anti-inflammatory drugs or cyclooxygenase-2 inhibitors is a potential strategy to mitigate the risk for postoperative AKI. The findings strengthen the rationale for a clinical trial comprehensively testing the risk-benefit ratio of these drugs in the perioperative period. EDITOR’S PERSPECTIVE
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Affiliation(s)
- David R McIlroy
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee; Monash University, Melbourne, Australia
| | - Xiaoke Feng
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee
| | - Matthew Shotwell
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee
| | - Sophia Wallace
- Monash University, Melbourne, Australia; Department of Anaesthesia and Perioperative Medicine, Alfred Hospital, Melbourne, Australia
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Hospital, Melbourne, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University School of Public Health and Preventive Medicine, Melbourne, Australia; Department of Critical Care Critical Care, Department of Medicine and Radiology, University of Melbourne, Melbourne, Australia; Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Australia
| | - Amit X Garg
- Division of Nephrology, Departments of Medicine, Epidemiology and Biostatistics, Schulich School of Medicine Dentistry, and the London Health Sciences Centre, London, Canada
| | - Kate Leslie
- Department of Critical Care, University of Melbourne, Melbourne, Australia; Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Australia
| | - Philip Peyton
- Department of Critical Care, University of Melbourne, Melbourne, Australia; Department of Anaesthesia, Austin Hospital, Melbourne, Australia
| | - David Story
- Department of Critical Care, University of Melbourne, Melbourne, Australia
| | - Paul S Myles
- Monash University, Melbourne, Australia; Department of Anaesthesia and Perioperative Medicine, Alfred Hospital, Melbourne, Australia
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McKechnie T, Tessier L, Archer V, Park L, Cohen D, Levac B, Parpia S, Bhandari M, Dionne J, Eskicioglu C. Enhanced recovery after surgery protocols following emergency intra-abdominal surgery: a systematic review and meta-analysis. Eur J Trauma Emerg Surg 2024; 50:679-704. [PMID: 37985500 DOI: 10.1007/s00068-023-02387-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/21/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE The aim of this systematic review and meta-analysis was to evaluate whether Enhanced Recovery After Surgery (ERAS) protocols for patients undergoing emergency intra-abdominal surgery improve postoperative outcomes as compared to conventional care. METHODS MEDLINE, EMBASE, WoS, CENTRAL, and Pubmed were searched from inception to December 2022. Articles were eligible if they were randomized controlled trials (RCT) or non-randomized studies comparing ERAS protocols to conventional care for patients undergoing emergency intra-abdominal surgery. The outcomes included postoperative length of stay (LOS), postoperative morbidity, prolonged postoperative ileus (PPOI), and readmission. An inverse variance random effects meta-analysis was performed. A risk of bias was assessed with Cochrane tools. Certainty of evidence was assessed with GRADE. RESULTS After screening 1018 citations, 20 studies with 1615 patients in ERAS programs and 1933 patients receiving conventional care were included. There was a reduction in postoperative LOS in the ERAS group for patients undergoing upper gastrointestinal (GI) surgery (MD3.35, 95% CI 2.52-4.17, p < 0.00001) and lower GI surgery (MD2.80, 95% CI 2.62-2.99, p < 0.00001). There was a reduction in postoperative morbidity in the ERAS group for patients undergoing upper GI surgery (RR0.56, 95% CI 0.30-1.02, p = 0.06) and lower GI surgery (RR 0.66, 95%CI 0.52-0.85, p = 0.001). In the upper and lower GI subgroup, there were nonsignificant reductions in PPOI in the ERAS groups (RR0.59, 95% CI 0.30-1.17, p = 0.13; RR0.49, 95% CI 0.21-1.14, p = 0.10). There was a nonsignificant increased risk of readmission in the ERAS group (RR1.60, 95% CI 0.57-4.50, p = 0.50). CONCLUSION There is low-to-very-low certainty evidence supporting the use ERAS protocols for patients undergoing emergency intra-abdominal surgery. The currently available data are limited by imprecision.
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Affiliation(s)
- Tyler McKechnie
- Division of General Surgery Department of Surgery, McMaster University, St. Joseph's Healthcare, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Léa Tessier
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Victoria Archer
- Division of General Surgery Department of Surgery, McMaster University, St. Joseph's Healthcare, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Lily Park
- Division of General Surgery Department of Surgery, McMaster University, St. Joseph's Healthcare, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Dan Cohen
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Brendan Levac
- Division of General Surgery Department of Surgery, McMaster University, St. Joseph's Healthcare, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
| | - Sameer Parpia
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Mohit Bhandari
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Joanna Dionne
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Cagla Eskicioglu
- Division of General Surgery Department of Surgery, McMaster University, St. Joseph's Healthcare, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada.
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
- Division of General Surgery, Department of Surgery, St. Joseph Healthcare, Hamilton, ON, Canada.
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95
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Tariq M, Novak Z, Spangler EL, Passman MA, Patterson MA, Pearce BJ, Sutzko DC, Brokus SD, Busby C, Beck AW. Clinical Impact of an Enhanced Recovery Program for Lower-extremity Bypass. Ann Surg 2024; 279:1077-1081. [PMID: 38258556 DOI: 10.1097/sla.0000000000006212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
OBJECTIVE To determine the association of Enhanced Recovery Program (ERP) implementation with length of stay (LOS) and perioperative outcomes after lower-extremity bypass (LEB). BACKGROUND ERPs have been shown to decrease hospital LOS and improve perioperative outcomes, but their impact on patients undergoing vascular surgery remains unknown. METHODS Patients undergoing LEB who received or did not receive care under the ERP were included; pre-ERP (January 1, 2016-May 13, 2018) and ERP (May 14, 2018-July 31, 2022). Clinicopathologic characteristics and perioperative outcomes were analyzed. RESULTS Of 393 patients who underwent LEB [pre-ERP: n = 161 (41%); ERP: n = 232 (59%)], most were males (n = 254, 64.6%), White (n = 236, 60%), and government-insured (n = 265, 67.4%). Pre-ERP patients had higher Body Mass Index (28.8 ± 6.0 vs 27.4 ± 5.7, P = 0.03) and rates of diabetes (52% vs 36%, P = 0.002). ERP patients had a shorter total [6 (3-13) vs 7 (5-14) days, P = 0.01) and postoperative LOS [5 (3-8) vs 6 (4-8) days, P < 0.001]. Stratified by indication, postoperative LOS was shorter in ERP patients with claudication (3 vs 5 days, P = 0.01), rest pain (5 vs 6 days, P = 0.02), and tissue loss (6 vs 7 days, P = 0.03). ERP patients with rest pain also had a shorter total LOS (6 vs 7 days, P = 0.04) and lower 30-day readmission rates (32%-17%, P = 0.02). After ERP implementation, the average daily oral morphine equivalents decreased [median (interquartile range): 52.5 (26.6-105.0) vs 44.12 (22.2-74.4), P = 0.019], while the rates of direct discharge to home increased (83% vs 69%, P = 0.002). CONCLUSIONS This is the largest single-center cohort study evaluating ERP in LEB, showing that ERP implementation is associated with shorter LOS and improved perioperative outcomes.
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Affiliation(s)
- Marvi Tariq
- Department of Surgery, Heersink School of Medicine, University of Alabama, Birmingham, Alabama, USA
| | - Zdenek Novak
- Department of Surgery, Heersink School of Medicine, University of Alabama, Birmingham, Alabama, USA
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Emily L Spangler
- Department of Surgery, Heersink School of Medicine, University of Alabama, Birmingham, Alabama, USA
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Marc A Passman
- Department of Surgery, Heersink School of Medicine, University of Alabama, Birmingham, Alabama, USA
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mark A Patterson
- Department of Surgery, Heersink School of Medicine, University of Alabama, Birmingham, Alabama, USA
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Benjamin J Pearce
- Department of Surgery, Heersink School of Medicine, University of Alabama, Birmingham, Alabama, USA
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Danielle C Sutzko
- Department of Surgery, Heersink School of Medicine, University of Alabama, Birmingham, Alabama, USA
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sara Danielle Brokus
- Department of Surgery, Heersink School of Medicine, University of Alabama, Birmingham, Alabama, USA
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Courtney Busby
- Department of Surgery, Heersink School of Medicine, University of Alabama, Birmingham, Alabama, USA
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Adam W Beck
- Department of Surgery, Heersink School of Medicine, University of Alabama, Birmingham, Alabama, USA
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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96
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Dederichs R, Voß J, Falz R. [eHealth applications for promotion of physical activity after visceral surgery : A systematic review]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:443-450. [PMID: 38459189 DOI: 10.1007/s00104-024-02060-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/09/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND eHealth applications can support early mobilization and physical activity (PA) after surgery. This systematic review provides an overview of eHealth services to enhance or record PA after visceral surgery interventions. METHODS Two electronic databases (MEDLINE PubMed and Web of Science) were systematically searched (November 2023). Articles were considered eligible if they were controlled trials and described digital devices used to promote PA after visceral surgery. The Cochrane risk of bias (RoB-2) tool was used to determine the methodological quality of studies. RESULTS A total of nine randomized controlled studies (RCT) were included in this systematic review. The studies differed with respect to the interventions, surgical indications and evaluation variables. The risk of bias of the individual studies was moderate. The six studies using activity trackers (AT) predominantly showed insignificant improvements in the postoperative step count. The more complex fitness applications could partially reveal significant advantages compared to the control groups and the home-based online training also showed a significant increase in functional capacity. CONCLUSION Activity tracking alone has so far failed to show clinically relevant effects. In contrast, the more complex eHealth applications revealed advantages compared to usual postoperative care. More high-quality studies are needed for evidence-based recommendations for eHealth services in conjunction with visceral surgery.
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Affiliation(s)
- Rebecca Dederichs
- Institut für Sportmedizin und Prävention, Universität Leipzig, Rosa-Luxemburg-Str. 20-30, 04103, Leipzig, Deutschland
| | - Johannes Voß
- Institut für Sportmedizin und Prävention, Universität Leipzig, Rosa-Luxemburg-Str. 20-30, 04103, Leipzig, Deutschland
| | - Roberto Falz
- Institut für Sportmedizin und Prävention, Universität Leipzig, Rosa-Luxemburg-Str. 20-30, 04103, Leipzig, Deutschland.
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97
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Qin X, Sun J, Liu M, Zhang L, Yin Q, Chen S. The effects of oral nutritional supplements interventions on nutritional status in patients undergoing colorectal cancer surgery: A systematic review. Int J Nurs Pract 2024; 30:e13226. [PMID: 38128910 DOI: 10.1111/ijn.13226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 10/10/2023] [Accepted: 11/26/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The high incidence of malnutrition in patients undergoing colorectal cancer surgery can lead to unplanned weight loss, sarcopenia and reduced grip strength to the extent that it can seriously affect the prognosis of colorectal cancer patients. OBJECTIVE This study investigated the effect of oral nutritional supplements (ONS) on the prevalence of grip strength, unplanned weight loss and sarcopenia in patients undergoing colorectal cancer surgery. METHODS We systematically searched randomized controlled studies from CINAHL, PubMed, Embase, Cochrane and Web of Science and three Chinese databases (CNKI, Wan-Fang database, VIP database) from database creation to September 2023. The risk of bias in individual studies was assessed using the Cochrane Collaboration tool, and the certainty of evidence was assessed using the five GRADE criteria. Statistical analysis was performed using the RevMan 5.3 software, and information that could not be meta-analysed was reviewed in the form of a literature summary. RESULTS Eleven papers met the inclusion criteria with a combined sample size of 1070 cases, including 532 cases in the trial group and 538 cases in the control group. Four papers reported the effect of ONS on grip strength and included very low-quality evidence supporting no effect of ONS on grip strength. Ten studies reported the effect of ONS on body weight and body mass index (BMI) and included very low-quality evidence supporting a positive ONS on weight and BMI changes. Meta-analysis showed a significant reduction in weight loss (12-15 weeks) and BMI loss (12-15 weeks) in patients with colorectal cancer in the ONS group. The effect of ONS on the prevalence of sarcopenia after hospital discharge was reported in two studies, and meta-analysis showed a significant reduction in the prevalence of postoperative sarcopenia in colorectal cancer patients in the ONS group, but the quality of evidence was low. CONCLUSIONS This study showed that the use of ONS in patients undergoing surgery for colorectal cancer improved patient weight loss and BMI reduction and reduced the prevalence of postoperative sarcopenia but did not improve patient grip strength. The quality of evidence for inclusion in the article was low or very low, and further studies are needed to provide better evidence.
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Affiliation(s)
- Xiaohong Qin
- The First Hospital of Jilin University, Changchun, Jilin, China
| | - Jiao Sun
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Meiling Liu
- The First Hospital of Jilin University, Changchun, Jilin, China
| | - Lianjie Zhang
- The First Hospital of Jilin University, Changchun, Jilin, China
| | - Qing Yin
- The First Hospital of Jilin University, Changchun, Jilin, China
| | - Si Chen
- The First Hospital of Jilin University, Changchun, Jilin, China
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98
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Dost B. Enhancing Perioperative Pain Management: Focus on Fascial Plane Blocks and Complication Management. J Perianesth Nurs 2024; 39:491-492. [PMID: 38823965 DOI: 10.1016/j.jopan.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 03/25/2024] [Indexed: 06/03/2024]
Affiliation(s)
- Burhan Dost
- Department of Anaesthesiology and Reanimation, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey.
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99
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Crestani A, Merlot B, Goualard PH, Grigoriadis G, Chanavaz Lacheray I, Dennis T, Roman H. Bowel endometriosis: Surgical customization is demanding. Best Pract Res Clin Obstet Gynaecol 2024; 94:102495. [PMID: 38593673 DOI: 10.1016/j.bpobgyn.2024.102495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 02/20/2024] [Accepted: 03/20/2024] [Indexed: 04/11/2024]
Abstract
Bowel endometriosis is the most common form of severe deep endometriosis. Surgery is an option in case of infertility and/or chronic pain or in the presence of a stenotic lesion. Clinical examination and preoperative imaging must provide an identity card of the lesion so that customized surgery can be proposed. The primary objective of this tailor-made surgery will always be to preserve the organ. The surgeon then has three options: shaving, discoid resection and segmental resection. The more extensive the resection, the greater the risk of severe short- and long-term complications. Surgery must therefore be adapted to the patient's specific situation and needs. Moreover, personalized care must extend beyond surgery. It must begin before the operation, preparing the patient for the operation like an athlete before a race, and continue afterwards by adapting the follow-up to the surgery performed.
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Affiliation(s)
- Adrien Crestani
- Institut Franco-Europeen Multidisciplinaire d'Endometriose (IFEMEndo), Endometriosis Centre, CliniqueTivoli-Ducos, 33000, Bordeaux, France.
| | - Benjamin Merlot
- Institut Franco-Europeen Multidisciplinaire d'Endometriose (IFEMEndo), Endometriosis Centre, CliniqueTivoli-Ducos, 33000, Bordeaux, France; Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Middle East Clinic, Burjeel Medical City, Abu Dhabi, 7400, United Arab Emirates
| | - Paul-Henri Goualard
- Institut Franco-Europeen Multidisciplinaire d'Endometriose (IFEMEndo), Endometriosis Centre, CliniqueTivoli-Ducos, 33000, Bordeaux, France
| | | | - Isabelle Chanavaz Lacheray
- Institut Franco-Europeen Multidisciplinaire d'Endometriose (IFEMEndo), Endometriosis Centre, CliniqueTivoli-Ducos, 33000, Bordeaux, France
| | - Thomas Dennis
- Institut Franco-Europeen Multidisciplinaire d'Endometriose (IFEMEndo), Endometriosis Centre, CliniqueTivoli-Ducos, 33000, Bordeaux, France
| | - Horace Roman
- Institut Franco-Europeen Multidisciplinaire d'Endometriose (IFEMEndo), Endometriosis Centre, CliniqueTivoli-Ducos, 33000, Bordeaux, France; Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Middle East Clinic, Burjeel Medical City, Abu Dhabi, 7400, United Arab Emirates; Department of Obstetrics and Gynecology, Aarhus University, 8000, Aarhus, Denmark
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100
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Burton BN, Adeola JO, Do VM, Milam AJ, Cannesson M, Norris KC, Lopez NE, Gabriel RA. Differences in the Receipt of Regional Anesthesia Based on Race and Ethnicity in Colorectal Surgery. Jt Comm J Qual Patient Saf 2024; 50:416-424. [PMID: 38433070 DOI: 10.1016/j.jcjq.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 12/19/2023] [Accepted: 01/02/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Health equity in pain management during the perioperative period continues to be a topic of interest. The authors evaluated the association of race and ethnicity with regional anesthesia in patients who underwent colorectal surgery and characterized trends in regional anesthesia. METHODS Using the American College of Surgeons National Surgical Quality Improvement Program database from 2015 to 2020, the research team identified patients who underwent open or laparoscopic colorectal surgery. Associations between race and ethnicity and use of regional anesthesia were estimated using logistic regression models. RESULTS The final sample size was 292,797, of which 15.6% (n = 45,784) received regional anesthesia. The unadjusted rates of regional anesthesia for race and ethnicity were 15.7% white, 15.1% Black, 12.8% Asian, 29.6% American Indian or Alaska Native, 16.3% Native Hawaiian or Pacific Islander, and 12.4% Hispanic. Black (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.90-0.96, p < 0.001) and Asian (OR 0.76, 95% CI 0.71-0.80, p < 0.001) patients had lower odds of regional anesthesia compared to white patients. Hispanic patients had lower odds of regional anesthesia compared to non-Hispanic patients (OR 0.72, 95% CI 0.68-0.75, p < 0.001). There was a significant annual increase in regional anesthesia from 2015 to 2020 for all racial and ethnic cohorts (p < 0.05). CONCLUSION There was an annual increase in the use of regional anesthesia, yet Black and Asian patients (compared to whites) and Hispanics (compared to non-Hispanics) were less likely to receive regional anesthesia for colorectal surgery. These differences suggest that there are racial and ethnic differences in regional anesthesia use for colorectal surgery.
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