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Aubert M, Buscail E, Duchalais E, Cazelles A, Collard M, Charleux-Muller D, Jeune F, Nuzzo A, Pellegrin A, Theuil L, Toutain A, Trilling B, Siproudhis L, Meurette G, Lefevre JH, Maggiori L, Mege D. Management of adult intestinal stomas: The 2023 French guidelines. J Visc Surg 2024; 161:106-128. [PMID: 38448363 DOI: 10.1016/j.jviscsurg.2024.02.002] [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] [Indexed: 03/08/2024]
Abstract
AIM Digestive stoma are frequently performed. The last French guidelines have been published twenty years ago. Our aim was to update French clinical practice guidelines for the perioperative management of digestive stoma and stoma-related complications. METHODS A systematic literature review of French and English articles published between January 2000 and May 2022 was performed. Only digestive stoma for fecal evacuation in adults were considered. Stoma in children, urinary stoma, digestive stoma for enteral nutrition, and rare stoma (Koch, perineal) were not included. RESULTS Guidelines include the surgical landmarks to create digestive stoma (ideal location, mucocutaneous anastomosis, utility of support rods, use of prophylactic mesh), the perioperative clinical practice guidelines (patient education, preoperative ostomy site marking, postoperative equipment, prescriptions, and follow-up), the management of early stoma-related complications (difficulties for nursing, high output, stoma necrosis, retraction, abscess and peristomal skin complications), and the management of late stoma-related complications (stoma prolapse, parastomal hernia, stoma stenosis, late stoma retraction). A level of evidence was assigned to each statement. CONCLUSION These guidelines will be very useful in clinical practice, and allow to delete some outdated dogma.
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Affiliation(s)
- Mathilde Aubert
- Department of Digestive Surgery, hôpital Timone, Aix Marseille University, AP-HM, Marseille, France
| | - Etienne Buscail
- Digestive Surgery Department, hôpital Rangueil, Toulouse, France
| | | | - Antoine Cazelles
- Digestive Surgery Department, hôpital européen Georges-Pompidou, AP-HP, Paris, France
| | - Maxime Collard
- Digestive Surgery Department, hôpital Saint-Antoine, AP-HP, Sorbonne université, 75012, Paris, France
| | | | - Florence Jeune
- Digestive Surgery Department, hôpital Saint-Louis, AP-HP, Paris, France
| | - Alexandre Nuzzo
- Digestive Surgery Department, hôpital Beaujon, AP-HP, Paris, France
| | | | | | - Amandine Toutain
- Digestive Surgery Department, hôpital Saint-Louis, AP-HP, Paris, France
| | | | | | | | - Jérémie H Lefevre
- Digestive Surgery Department, hôpital Saint-Antoine, AP-HP, Sorbonne université, 75012, Paris, France
| | - Léon Maggiori
- Digestive Surgery Department, hôpital Saint-Louis, AP-HP, Paris, France
| | - Diane Mege
- Department of Digestive Surgery, hôpital Timone, Aix Marseille University, AP-HM, Marseille, France.
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Hill SS, Ottaviano KE, Palange DC, Chismark AD, Valerian BT, Canete JJ, Lee EC. Impact of Preoperative Factors in Patients With IBD on Postoperative Length of Stay: A National Surgical Quality Improvement Program-Inflammatory Bowel Disease Collaborative Analysis. Dis Colon Rectum 2024; 67:97-106. [PMID: 37410942 DOI: 10.1097/dcr.0000000000002831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
BACKGROUND Patients with IBD are challenging to manage perioperatively because of disease complexity and multiple comorbidities. OBJECTIVE To identify whether preoperative factors and operation type were associated with extended postoperative length of stay after IBD-related surgery, defined by 75th percentile or greater (n = 926; 30.8%). DESIGN This was a cross-sectional study based on a retrospective multicenter database. SETTING The National Surgery Quality Improvement Program-Inflammatory Bowel Disease Collaborative captured data from 15 high-volume sites. PATIENTS A total of 3008 patients with IBD (1710 with Crohn's disease and 1291 with ulcerative colitis) with a median postoperative length of stay of 4 days (interquartile range, 3-7) from March 2017 to February 2020. MAIN OUTCOME MEASURES The primary outcome was extended postoperative length of stay. RESULTS On multivariable logistic regression, increased odds of extended postoperative length of stay were associated with multiple demographic and clinical factors (model p < 0.001, area under receiver operating characteristic curve = 0.85). Clinically significant contributors that increased postoperative length of stay were rectal surgery (vs colon; OR, 2.13; 95% CI, 1.52-2.98), new ileostomy (vs no ileostomy; OR, 1.50; 95% CI, 1.15-1.97), preoperative hospitalization (OR, 13.45; 95% CI, 10.15-17.84), non-home discharge (OR, 4.78; 95% CI, 2.27-10.08), hypoalbuminemia (OR, 1.66; 95% CI, 1.27-2.18), and bleeding disorder (OR, 2.42; 95% CI, 1.22-4.82). LIMITATIONS Retrospective review of only high-volume centers. CONCLUSIONS Patients with IBD who were preoperatively hospitalized, who had non-home discharge, and who underwent rectal surgery had the highest odds of extended postoperative length of stay. Associated patient characteristics included bleeding disorder, hypoalbuminemia, and ASA classes 3 to 5. Chronic corticosteroid, immunologic, small molecule, and biologic agent use were insignificant on multivariable analysis. See Video Abstract. IMPACTO DE LOS FACTORES PREOPERATORIOS EN PACIENTES CON ENFERMEDAD INFLAMATORIA INTESTINAL EN LA DURACIN DE LA ESTANCIA POSTOPERATORIA UN ANLISIS COLABORATIVO DEL PROGRAMA NACIONAL DE MEJORA DE LA CALIDAD QUIRRGICAENFERMEDAD INFLAMATORIA INTESTINAL ANTECEDENTES:Los pacientes con enfermedad inflamatoria intestinal son difíciles de manejar perioperatoriamente debido a la complejidad de la enfermedad y a múltiples comorbilidades.OBJETIVO:Este estudio tuvo como objetivo identificar si los factores preoperatorios y el tipo de operación se asociaron con una estadía postoperatoria prolongada después de una cirugía relacionada con enfermedad inflamatoria intestinal, definida por el percentil 75 o mayor (n = 926, 30.8%).DISEÑO:Este fue un estudio transversal basado en una base de datos multicéntrica retrospectiva.ESCENARIO:Datos capturados de quince sitios de alto volumen en El Programa Nacional de Mejoramiento de la Calidad de la Cirugía-Enfermedad Intestinal Inflamatoria en colaboración.PACIENTES:Un total de 3,008 pacientes con enfermedad inflamatoria intestinal (1,710 con enfermedad de Crohn y 1,291 con colitis ulcerosa) con una mediana de estancia postoperatoria de 4 días (RIC 3-7) desde marzo de 2017 hasta febrero de 2020.PRINCIPALES MEDIDAS DE RESULTADO:El resultado primario fue la extensión de la estancia postoperatoria.RESULTADOS:En la regresión logística multivariable, el aumento de las probabilidades de prolongar la estancia postoperatoria se asoció con múltiples factores demográficos y clínicos (modelo p<0.001, área bajo la curva ROC - 0.85). Los contribuyentes clínicamente significativos que aumentaron la duración de la estancia postoperatoria fueron la cirugía rectal (frente al colon) (OR 2.13, IC del 95 %: 1.52 a 2.98), una nueva ileostomía (frente a ninguna ileostomía) (OR 1.50, IC del 95 %: 1.15 a 1.97), hospitalización preoperatoria (OR 13.45, IC 95% 10.15-17.84), alta no domiciliaria (OR 4.78, IC 95% 2.27-10.08), hipoalbuminemia (OR 1.66, IC 95% 1.27-2.18) y trastorno hemorrágico (OR 2.42, IC 95% 1.22-4.82).LIMITACIONES:Revisión retrospectiva de solo centros de alto volumen.CONCLUSIONES:Los pacientes con enfermedad inflamatoria intestinal que fueron hospitalizados antes de la operación, que tuvieron alta no domiciliaria y que se sometieron a cirugía rectal tuvieron las mayores probabilidades de prolongar la estancia postoperatoria. Las características asociadas de los pacientes incluyeron trastorno hemorrágico, hipoalbuminemia y clases ASA 3-5. El uso crónico de corticosteroides, inmunológicos, agentes de moléculas pequeñas y de agentes biológicos no fue significativo en el análisis multivariable. (Traducción-Dr. Jorge Silva Velazco ).
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Affiliation(s)
- Susanna S Hill
- Department of Surgery, Section of Colon and Rectal Surgery, Albany Medical Center, Albany, New York
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García-Cabrera AM, de la Portilla de Juan F, Navarro-Morales L, Ribera García S, Durán Ventura MDC, Fernández Luque I, Padillo-Ruiz FJ. Influence of Preoperative Educational Intervention for Patients Undergoing Fecal Ostomy Surgery: A Comparison Cohort Study. J Wound Ostomy Continence Nurs 2023; 50:484-488. [PMID: 37966076 DOI: 10.1097/won.0000000000001020] [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: 11/16/2023]
Abstract
PURPOSE This aim of this study was to compare the impact on hospital stay and short-term overall complications prior to and following the introduction of an outpatient preoperative ostomy education program to an existing inpatient ostomy education program. DESIGN A comparison cohort study. SUBJECTS AND SETTING One hundred thirty-eight consecutive patients undergoing ostomy surgery were included. One group (n = 65, 47%) was given an experimental preoperative ostomy education intervention, along with standard care including a postoperative educational intervention during the initial hospital course. A second group (n = 73, 53%) received the same standardized education in the postoperative period. Data were collected from a single tertiary center located in Seville, Spain, during a 12-month period between July 2014 and June 2015. METHODS Data were collected in 2 phases. Data from participants undergoing postoperative (standard) education were collected retrospectively. Data for the group receiving preoperative education were collective prospectively. Outcome variables were postoperative length of stay, surgical complications (severity was assessed by the Clavien-Dindo grading system), subsequent interventions, and readmission rates. RESULTS Analysis indicated no differences between the average length of postoperative hospital stay (12.32 days in the preoperative education group vs 12.76 days in the postoperative education group, P = .401). In contrast, overall complications, mortality, and readmission rates were significantly higher in the preoperative education program group (P = .027, P = .047, and P = .046, respectively). CONCLUSIONS Delivering a standardized educational intervention during the preoperative period versus postoperative education delivery during the ostomy surgery hospital course did not reduce length of stay. Analysis indicated that overall complications, mortality, and readmission rates were significantly higher in the preoperative education program group but we hypothesize that intervening factors may have influenced these outcomes.
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Affiliation(s)
- Ana María García-Cabrera
- Ana María García-Cabrera, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
- Fernando de la Portilla de Juan, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
- Laura Navarro-Morales, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
- Sebastián Ribera García, CNS, Virgen del Rocío University Hospital, Seville, Spain
- María del Carmen Durán Ventura, CNS, Virgen del Rocío University Hospital, Seville, Spain
- Inés Fernández Luque, CNS, Virgen del Rocío University Hospital, Seville, Spain
- Francisco Javier Padillo-Ruiz, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
| | - Fernando de la Portilla de Juan
- Ana María García-Cabrera, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
- Fernando de la Portilla de Juan, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
- Laura Navarro-Morales, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
- Sebastián Ribera García, CNS, Virgen del Rocío University Hospital, Seville, Spain
- María del Carmen Durán Ventura, CNS, Virgen del Rocío University Hospital, Seville, Spain
- Inés Fernández Luque, CNS, Virgen del Rocío University Hospital, Seville, Spain
- Francisco Javier Padillo-Ruiz, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
| | - Laura Navarro-Morales
- Ana María García-Cabrera, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
- Fernando de la Portilla de Juan, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
- Laura Navarro-Morales, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
- Sebastián Ribera García, CNS, Virgen del Rocío University Hospital, Seville, Spain
- María del Carmen Durán Ventura, CNS, Virgen del Rocío University Hospital, Seville, Spain
- Inés Fernández Luque, CNS, Virgen del Rocío University Hospital, Seville, Spain
- Francisco Javier Padillo-Ruiz, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
| | - Sebastián Ribera García
- Ana María García-Cabrera, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
- Fernando de la Portilla de Juan, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
- Laura Navarro-Morales, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
- Sebastián Ribera García, CNS, Virgen del Rocío University Hospital, Seville, Spain
- María del Carmen Durán Ventura, CNS, Virgen del Rocío University Hospital, Seville, Spain
- Inés Fernández Luque, CNS, Virgen del Rocío University Hospital, Seville, Spain
- Francisco Javier Padillo-Ruiz, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
| | - María Del Carmen Durán Ventura
- Ana María García-Cabrera, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
- Fernando de la Portilla de Juan, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
- Laura Navarro-Morales, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
- Sebastián Ribera García, CNS, Virgen del Rocío University Hospital, Seville, Spain
- María del Carmen Durán Ventura, CNS, Virgen del Rocío University Hospital, Seville, Spain
- Inés Fernández Luque, CNS, Virgen del Rocío University Hospital, Seville, Spain
- Francisco Javier Padillo-Ruiz, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
| | - Inés Fernández Luque
- Ana María García-Cabrera, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
- Fernando de la Portilla de Juan, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
- Laura Navarro-Morales, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
- Sebastián Ribera García, CNS, Virgen del Rocío University Hospital, Seville, Spain
- María del Carmen Durán Ventura, CNS, Virgen del Rocío University Hospital, Seville, Spain
- Inés Fernández Luque, CNS, Virgen del Rocío University Hospital, Seville, Spain
- Francisco Javier Padillo-Ruiz, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
| | - Francisco Javier Padillo-Ruiz
- Ana María García-Cabrera, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
- Fernando de la Portilla de Juan, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
- Laura Navarro-Morales, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
- Sebastián Ribera García, CNS, Virgen del Rocío University Hospital, Seville, Spain
- María del Carmen Durán Ventura, CNS, Virgen del Rocío University Hospital, Seville, Spain
- Inés Fernández Luque, CNS, Virgen del Rocío University Hospital, Seville, Spain
- Francisco Javier Padillo-Ruiz, MD, PhD, Virgen del Rocío University Hospital, Seville, Spain
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Yeo H, Park H. Benefits of a Single-Session, In-Hospital Preoperative Education Program for Patients Undergoing Ostomy Surgery: A Randomized Controlled Trial. J Wound Ostomy Continence Nurs 2023; 50:313-318. [PMID: 37467410 DOI: 10.1097/won.0000000000000991] [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: 07/21/2023]
Abstract
PURPOSE The purpose of this study was to compare the effects of a 45-minute session of video-based preoperative ostomy education on self-care knowledge, self-care proficiency, anxiety, depression, length of hospital stay, and ostomy-related complications to a control group who received 3 postoperative educational sessions. DESIGN This was a randomized controlled trial. SAMPLE AND SETTING The sample comprised 47 patients scheduled to undergo ostomy surgery for colon or rectal cancer surgery at a tertiary referral hospital in Seoul, South Korea, from November 2018 to May 2019. However, 2 participants in the intervention group and 4 in the control group withdrew from the study and data analysis is based on 41 participants who completed study procedures. METHODS Participants were randomly allocated to an intervention group (n = 21) or a control group (n = 20). The intervention group received a single 45-minute session of video-based preoperative ostomy education along with stoma site marking and postoperative education. The control group underwent stoma site marking and 3 postoperative education sessions Self-care knowledge, anxiety, and depression were assessed by validated instruments. Self-care proficiency was assessed via direct observation using a checklist. Ostomy-related complications were evaluated by a WOC nurse. Length of hospital stay and disease-related characteristics were collected from medical records. RESULTS Compared with the control group, the intervention group showed significant improvements in self-care knowledge (P = .001) and self-care proficiency scores (P = .001). Intervention group participants also had lower anxiety scores (P = .025), depression scores (P = .014), shorter hospital stays (P = .008), and fewer ostomy-related complications (P = .001). CONCLUSIONS In patients undergoing ostomy surgery, a single 45-minute session of preoperative video-based ostomy education improved self-care knowledge and proficiency. This intervention also reduced depression, anxiety, and ostomy-related complications.
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Affiliation(s)
- Hyunjung Yeo
- Hyunjung Yeo, MSN, RN, CNS, WOC Nurse, Asan Medical Center, Seoul, Republic of Korea
- Hyojung Park, PhD, RN, Professor College of Nursing, Ewha Womans University, Seoul, Republic of Korea
| | - Hyojung Park
- Hyunjung Yeo, MSN, RN, CNS, WOC Nurse, Asan Medical Center, Seoul, Republic of Korea
- Hyojung Park, PhD, RN, Professor College of Nursing, Ewha Womans University, Seoul, Republic of Korea
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Doucette JE, Mawn BE, Beitz JM, Koren A. Factors Affecting Psychosocial Adjustment in Persons With a Recent Ostomy. J Wound Ostomy Continence Nurs 2023; 50:297-306. [PMID: 37467408 DOI: 10.1097/won.0000000000000986] [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: 07/21/2023]
Abstract
PURPOSE The aim of this study was to examine the influence of personal and clinical factors on psychosocial adjustment in persons living with an ostomy for less than 1 year. DESIGN A cross-sectional survey. SUBJECTS AND SETTING The study sample comprised 183 adult individuals who had a colostomy, ileostomy, or urostomy for less than 1 year, residing in the Northeastern United States. METHODS Data were collected from May through November 2018 using 2 instruments: a sociodemographic questionnaire and the Ostomy Adjustment Inventory-23 (OAI-23). The OAI-23 items measured 4 psychosocial subscales: acceptance, anxious preoccupation, social engagement, and anger. Data were analyzed using analysis of variance, multivariate analysis of variance, Cramer's V correlations, and multiple regression. RESULTS Univariate analysis indicated that factors influencing psychosocial adjustment to an ostomy include age, assistance with care, educational background, stomal type, body mass index, ostomy height, preoperative education, and stoma siting. Multivariate analysis of variance identified that those who reported independence with ostomy care experienced higher levels of adjustment in all areas of the OAI-23. CONCLUSIONS Findings from this study may assist nurses and other care providers to better understand the physical and emotional needs of those with ostomies and to identify interventions to promote optimal health in this population.
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Affiliation(s)
- Jeffrey E Doucette
- Jeffrey E. Doucette, PhD, RN, CWOCN, Senior WOC Nurse, UMass Memorial Medical Center, Worcester, Massachusetts
- Barbara E. Mawn, PhD, RN, Solomont School of Nursing, University of Massachusetts Lowell
- Janice M. Beitz, PhD, RN, CS, CNOR, CWOCN-AP, CRNP, APNC, ANEF, FNAP, FAAN, Rutgers University School of Nursing-Camden, Camden, New Jersey
- Ainat Koren, PhD, DNP, PMHNP, Solomont School of Nursing, University of Massachusetts Lowell
| | - Barbara E Mawn
- Jeffrey E. Doucette, PhD, RN, CWOCN, Senior WOC Nurse, UMass Memorial Medical Center, Worcester, Massachusetts
- Barbara E. Mawn, PhD, RN, Solomont School of Nursing, University of Massachusetts Lowell
- Janice M. Beitz, PhD, RN, CS, CNOR, CWOCN-AP, CRNP, APNC, ANEF, FNAP, FAAN, Rutgers University School of Nursing-Camden, Camden, New Jersey
- Ainat Koren, PhD, DNP, PMHNP, Solomont School of Nursing, University of Massachusetts Lowell
| | - Janice M Beitz
- Jeffrey E. Doucette, PhD, RN, CWOCN, Senior WOC Nurse, UMass Memorial Medical Center, Worcester, Massachusetts
- Barbara E. Mawn, PhD, RN, Solomont School of Nursing, University of Massachusetts Lowell
- Janice M. Beitz, PhD, RN, CS, CNOR, CWOCN-AP, CRNP, APNC, ANEF, FNAP, FAAN, Rutgers University School of Nursing-Camden, Camden, New Jersey
- Ainat Koren, PhD, DNP, PMHNP, Solomont School of Nursing, University of Massachusetts Lowell
| | - Ainat Koren
- Jeffrey E. Doucette, PhD, RN, CWOCN, Senior WOC Nurse, UMass Memorial Medical Center, Worcester, Massachusetts
- Barbara E. Mawn, PhD, RN, Solomont School of Nursing, University of Massachusetts Lowell
- Janice M. Beitz, PhD, RN, CS, CNOR, CWOCN-AP, CRNP, APNC, ANEF, FNAP, FAAN, Rutgers University School of Nursing-Camden, Camden, New Jersey
- Ainat Koren, PhD, DNP, PMHNP, Solomont School of Nursing, University of Massachusetts Lowell
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Patient Education for Stoma Patients. SEMINARS IN COLON AND RECTAL SURGERY 2023. [DOI: 10.1016/j.scrs.2023.100952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
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7
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Rauh EA, Colwell JC. A Stoma Nurse's Wishlist to Surgeons: Tips for Before, During, and After Stoma Creation. SEMINARS IN COLON AND RECTAL SURGERY 2023. [DOI: 10.1016/j.scrs.2023.100951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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8
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He J, Li J, Fan B, Yan L, Ouyang L. Application and evaluation of transitory protective stoma in ovarian cancer surgery. Front Oncol 2023; 13:1118028. [PMID: 37035215 PMCID: PMC10081540 DOI: 10.3389/fonc.2023.1118028] [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: 12/28/2022] [Accepted: 03/15/2023] [Indexed: 04/11/2023] Open
Abstract
Ovarian cancer is the most fatal of all female reproductive cancers. The fatality rate of OC is the highest among gynecological malignant tumors, and cytoreductive surgery is a common surgical procedure for patients with advanced ovarian cancer. To achieve satisfactory tumor reduction, intraoperative bowel surgery is often involved. Intestinal anastomosis is the traditional way to restore intestinal continuity, but the higher rate of postoperative complications still cannot be ignored. Transitory protective stoma can reduce the severity of postoperative complications and traumatic stress reaction and provide the opportunity for conservative treatment. But there are also many problems, such as stoma-related complications and the impact on social psychology. Therefore, it is essential to select appropriate patients according to the indications for the transitory protective stoma, and a customized postoperative care plan is needed specifically for the stoma population.
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Irani JL, Hedrick TL, Miller TE, Lee L, Steinhagen E, Shogan BD, Goldberg JE, Feingold DL, Lightner AL, Paquette IM. Clinical Practice Guidelines for Enhanced Recovery After Colon and Rectal Surgery From the American Society of Colon and Rectal Surgeons and the Society of American Gastrointestinal and Endoscopic Surgeons. Dis Colon Rectum 2023; 66:15-40. [PMID: 36515513 PMCID: PMC9746347 DOI: 10.1097/dcr.0000000000002650] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Jennifer L. Irani
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Traci L. Hedrick
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Timothy E. Miller
- Department of Anesthesiology, Duke University, Durham, North Carolina
| | - Lawrence Lee
- Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Emily Steinhagen
- Department of Surgery, University Hospital Cleveland Medical Center, Cleveland, Ohio
| | - Benjamin D. Shogan
- Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Joel E. Goldberg
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel L. Feingold
- Department of Surgery, Section of Colorectal Surgery, Rutgers University, New Brunswick, New Jersey
| | - Amy L. Lightner
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland Clinic
| | - Ian M. Paquette
- Division of Colon and Rectal Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Irani JL, Hedrick TL, Miller TE, Lee L, Steinhagen E, Shogan BD, Goldberg JE, Feingold DL, Lightner AL, Paquette IM. Clinical practice guidelines for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons and the Society of American Gastrointestinal and Endoscopic Surgeons. Surg Endosc 2023; 37:5-30. [PMID: 36515747 PMCID: PMC9839829 DOI: 10.1007/s00464-022-09758-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2022] [Indexed: 12/15/2022]
Abstract
The American Society of Colon and Rectal Surgeons (ASCRS) and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) are dedicated to ensuring high-quality innovative patient care for surgical patients by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, and anus as well as minimally invasive surgery. The ASCRS and SAGES society members involved in the creation of these guidelines were chosen because they have demonstrated expertise in the specialty of colon and rectal surgery and enhanced recovery. This consensus document was created to lead international efforts in defining quality care for conditions related to the colon, rectum, and anus and develop clinical practice guidelines based on the best available evidence. While not proscriptive, these guidelines provide information on which decisions can be made and do not dictate a specific form of treatment. These guidelines are intended for the use of all practitioners, healthcare workers, and patients who desire information about the management of the conditions addressed by the topics covered in these guidelines. These guidelines should not be deemed inclusive of all proper methods of care nor exclusive of methods of care reasonably directed toward obtaining the same results. The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all the circumstances presented by the individual patient. This clinical practice guideline represents a collaborative effort between the American Society of Colon and Rectal Surgeons (ASCRS) and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and was approved by both societies.
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Affiliation(s)
- Jennifer L Irani
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Traci L Hedrick
- Department of Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Timothy E Miller
- Duke University Medical Center Library, Duke University School of Medicine, Durham, NC, USA
| | - Lawrence Lee
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Emily Steinhagen
- Department of Surgery, University Hospital Cleveland Medical Center, Cleveland, OH, USA
| | - Benjamin D Shogan
- Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Joel E Goldberg
- Department of Surgery, Division of Colorectal Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel L Feingold
- Section of Colorectal Surgery, Rutgers University, New Brunswick, NJ, USA
| | - Amy L Lightner
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland Clinic, Cleveland, USA
| | - Ian M Paquette
- Division of Colon and Rectal Surgery, University of Cincinnati College of Medicine Surgery (Colon and Rectal), 222 Piedmont #7000, Cincinnati, OH, 45219, USA.
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11
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Characteristics, Hospital Length of Stay, and Readmissions Among Individuals Undergoing Abdominal Ostomy Surgery. J Wound Ostomy Continence Nurs 2022; 49:529-539. [DOI: 10.1097/won.0000000000000922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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12
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Archer V, Cloutier Z, Berg A, McKechnie T, Wiercioch W, Eskicioglu C. Short-stay compared to long-stay admissions for loop ileostomy reversals: a systematic review and meta-analysis. Int J Colorectal Dis 2022; 37:2113-2124. [PMID: 36151483 DOI: 10.1007/s00384-022-04256-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE Short-stay admissions, with lengths of stay less than 24 h, are used for various surgeries without increasing adverse events. However, it is unclear if short-stay admissions would be safe for loop ileostomy reversals. This review aimed to compare outcomes between short (≤24 hours) and long (>24 hours) admissions for adults undergoing loop ileostomy reversals. METHODS Medline, Embase, CINAHL, Web of Science, and the Cochrane Library were systematically searched for studies comparing short- to long-stay admissions in adults undergoing loop ileostomy reversals. Meta-analyses were conducted for mortality, reoperation, readmission, and non-reoperative complications. Quality of evidence was assessed with grading of recommendations, assessment, development, and evaluations (GRADE) guidelines. RESULTS Four observational studies enrolling 24,628 patients were included. Moderate certainty evidence suggests there is no difference in readmissions between short- and long-stay admissions (relative risk (RR) 0.98, 95% CI 0.75 to 1.28, p 0.86). Low certainty evidence demonstrates that short stays may reduce non-reoperative complications (RR 0.44, 95% CI 0.31 to 0.62, p < 0.01). Very low certainty evidence demonstrates that there is no difference in reoperations between short and long stays (RR 1.14, 95% CI 0.26 to 5.04, p 0.87). CONCLUSIONS Moderate certainty evidence demonstrates that there is no difference in readmission rates between short- and long-stay admissions for loop ileostomy reversals. Less robust evidence suggests equivalence in reoperations and a decrease in non-reoperative complications. Future prospective trials are required to evaluate the feasibility and efficacy of short-stay admissions. TRIAL REGISTRATION https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=307381 Prospero (CRD42022307381), January 30, 2022.
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Affiliation(s)
- Victoria Archer
- Department of Surgery, Division of General Surgery, McMaster University, Hamilton, ON, Canada. .,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
| | - Zacharie Cloutier
- Department of Surgery, Division of General Surgery, McMaster University, Hamilton, ON, Canada
| | - Annie Berg
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Tyler McKechnie
- Department of Surgery, Division of General Surgery, McMaster University, Hamilton, ON, Canada
| | - Wojtek Wiercioch
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Cagla Eskicioglu
- Department of Surgery, Division of General Surgery, McMaster University, Hamilton, ON, Canada
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13
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The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for Ostomy Surgery. Dis Colon Rectum 2022; 65:1173-1190. [PMID: 35616386 DOI: 10.1097/dcr.0000000000002498] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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14
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Abstract
This integrative literature review summarizes recent literature relating to patient adjustment to stoma. The search strategy included 5 databases (CINAHL Plus, PsychINFO, Web of Science, Scopus, and MEDLINE); 65 articles meeting criteria were retrieved. Eleven were removed as duplicates, and a further 29 were removed when read in full, yielding 25 elements. Three were randomized controlled trials; 2 were prospective descriptive studies; 15 were cross-sectional descriptive studies; and 5 were qualitative studies. The quality of studies was evaluated using the Mixed Methods Appraisal Tool (MMAT). The calculated mean quality score was 97%, and no studies were excluded on quality grounds. Limited evidence suggests that adjustment occurs over time and provides some insight concerning how rehabilitation leads to resumption of an altered normality. Some evidence suggests that long-term adjustment is associated with demographic and pre- and postoperative factors. A knowledge gap was identified regarding the role of support groups, which in other fields has been shown to positively benefit psychological well-being. This review revealed a paucity of interventional studies seeking to test ways to address adjustment-related problems. Longitudinal studies are recommended as ostomy care nurses work to facilitate adjustment in the person with a stoma over time.
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Scientific and Clinical Abstracts From WOCNext® 2022: Fort Worth, Texas ♦ June 5-8, 2022. J Wound Ostomy Continence Nurs 2022; 49:S1-S99. [PMID: 35639023 DOI: 10.1097/won.0000000000000882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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16
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Kalev G, Marquardt C, Schiedeck T. Stomaassoziierte Komplikationen – Vermeidungsstrategie und Therapiekonzepte. COLOPROCTOLOGY 2022. [DOI: 10.1007/s00053-022-00600-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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17
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Carvello M, Watfah J, Spinelli A. The Management of the Hospitalized Ulcerative Colitis Patient, the Medical-Surgical Conundrum. Curr Gastroenterol Rep 2021; 23:25. [PMID: 34716521 DOI: 10.1007/s11894-021-00820-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW In this study we present the evidence based management for patients hospitalized for UC with a special focus on the synergic approach of the two key actors of the inflammatory bowel disease multidisciplinary team (IBD-MDT): gastroenterologist and surgeon. RECENT FINDINGS Focused treatment by a specialized IBD-MDT and early involvement of the colorectal surgeon in the management of hospitalized ulcerative colitis patients is advocated. The colectomy rate has not changed over the years. Moreover delayed surgery after admission is burden by increase complication and mortality. Thus, it is pivotal to identify the patients who are likely to undergo surgery, by mean of predictors of outcome, and to not prolong ineffective medical treatment. The perfect timing based on clinical close monitoring is crucial. Up to 25% of patients with ulcerative colitis (UC) may require hospitalization. The aim of admission is to evaluate severity of the disease, exclude infections and establish proper treatment while monitoring the response. During admission, the patient has to be closely observed for the possible development of toxic megacolon or perforation, which should prompt emergency colectomy. Up to 30% of UC patients will fail to respond to initial intravenous corticosteroid. Non responder or partial responder to medical therapy should be evaluated for timely surgery or could be considered for rescue medical therapy.
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Affiliation(s)
- Michele Carvello
- Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Joseph Watfah
- Department of General Surgery, Northwick Park Hospital, London, UK
| | - Antonino Spinelli
- Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy. .,Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy.
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18
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Kalev G, Marquardt C, Schiedeck T. [Stoma-associated complications-Prevention strategy and treatment concepts]. Chirurg 2021; 93:415-426. [PMID: 34137906 DOI: 10.1007/s00104-021-01438-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
Postoperative complications after the creation of an intestinal stoma have a considerable impact on the patient's quality of life. The accurate surgical technique is very important for their prevention and requires profound surgical knowledge as well as sufficient experience. The importance of the preoperative consultation as well as the postoperative care by stoma therapists is clearly proven. Depending on the severity of the complication, outpatient conservative treatment is initially indicated. A surgical local revision or laparotomy should only be considered if conservative treatment is no longer sufficient, whereby the indications for surgery should be set very cautiously. This article provides an overview of the current evidence regarding the prevention and treatment of postoperative stoma complications.
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Affiliation(s)
- Georgi Kalev
- Klinik für Allgemein‑, Viszeral‑, Thorax- und Kinderchirurgie Klinikum Ludwigsburg, Posilipostraße 4, 71640, Ludwigsburg, Deutschland
| | - Christoph Marquardt
- Klinik für Allgemein‑, Viszeral‑, Thorax- und Kinderchirurgie Klinikum Ludwigsburg, Posilipostraße 4, 71640, Ludwigsburg, Deutschland
| | - Thomas Schiedeck
- Klinik für Allgemein‑, Viszeral‑, Thorax- und Kinderchirurgie Klinikum Ludwigsburg, Posilipostraße 4, 71640, Ludwigsburg, Deutschland.
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Enhanced Recovery after Surgery: History, Key Advancements and Developments in Transplant Surgery. J Clin Med 2021; 10:jcm10081634. [PMID: 33921433 PMCID: PMC8069722 DOI: 10.3390/jcm10081634] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/23/2021] [Accepted: 04/08/2021] [Indexed: 12/13/2022] Open
Abstract
Enhanced recovery after surgery (ERAS) aims to improve patient outcomes by controlling specific aspects of perioperative care. The concept was introduced in 1997 by Henrik Kehlet, who suggested that while minor changes in perioperative practise have no significant impact alone, incorporating multiple changes could drastically improve outcomes. Since 1997, significant advancements have been made through the foundation of the ERAS Society, responsible for creating consensus guidelines on the implementation of enhanced recovery pathways. ERAS reduces length of stay by an average of 2.35 days and healthcare costs by $639.06 per patient, as identified in a 2020 meta-analysis of ERAS across multiple surgical subspecialties. Carbohydrate loading, bowel preparation and patient education in the pre-operative phase, goal-directed fluid therapy in the intra-operative phase, and early mobilisation and enteral nutrition in the post-operative phase are some of the interventions that are commonly implemented in ERAS protocols. While many specialties have been quick to incorporate ERAS, uptake has been slow in the transplantation field, leading to a scarcity of literature. Recent studies reported a 47% reduction in length of hospital stay (LOS) in liver transplantation patients treated with ERAS, while progress in kidney transplantation focuses on pain management and its incorporation into enhanced recovery protocols.
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20
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Cadel L, Guilcher SJT, Kokorelias KM, Sutherland J, Glasby J, Kiran T, Kuluski K. Initiatives for improving delayed discharge from a hospital setting: a scoping review. BMJ Open 2021; 11:e044291. [PMID: 33574153 PMCID: PMC7880119 DOI: 10.1136/bmjopen-2020-044291] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE The overarching objective of the scoping review was to examine peer reviewed and grey literature for best practices that have been developed, implemented and/or evaluated for delayed discharge involving a hospital setting. Two specific objectives were to review what the delayed discharge initiatives entailed and identify gaps in the literature in order to inform future work. DESIGN Scoping review. METHODS Electronic databases and websites of government and healthcare organisations were searched for eligible articles. Articles were required to include an initiative that focused on delayed discharge, involve a hospital setting and be published between 1 January 2004 and 16 August 2019. Data were extracted using Microsoft Excel. Following extraction, a policy framework by Doern and Phidd was adapted to organise the included initiatives into categories: (1) information sharing; (2) tools and guidelines; (3) practice changes; (4) infrastructure and finance and (5) other. RESULTS Sixty-six articles were included in this review. The majority of initiatives were categorised as practice change (n=36), followed by information sharing (n=19) and tools and guidelines (n=19). Numerous initiatives incorporated multiple categories. The majority of initiatives were implemented by multidisciplinary teams and resulted in improved outcomes such as reduced length of stay and discharge delays. However, the experiences of patients and families were rarely reported. Included initiatives also lacked important contextual information, which is essential for replicating best practices and scaling up. CONCLUSIONS This scoping review identified a number of initiatives that have been implemented to target delayed discharges. While the majority of initiatives resulted in positive outcomes, delayed discharges remain an international problem. There are significant gaps and limitations in evidence and thus, future work is warranted to develop solutions that have a sustainable impact.
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Affiliation(s)
- Lauren Cadel
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Rehabiliation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Quality Division, Ontario Health, Toronto, Ontario, Canada
| | | | - Jason Sutherland
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jon Glasby
- School of Social Policy, University of Birmingham, Edgbaston, Birmingham, UK
| | - Tara Kiran
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Quality Division, Ontario Health, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Kerry Kuluski
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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21
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Vilz TO, v. Websky M, Kalff JC, Stoffels B. Intestinale Stomata. COLOPROCTOLOGY 2020. [DOI: 10.1007/s00053-020-00503-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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22
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Veziant J, Poirot K, Mulliez A, Pereira B, Slim K. Is an enhanced recovery program (ERP) after rectal surgery as feasible as after colonic surgery? A multicentre Francophone study of 870 rectal resections. Langenbecks Arch Surg 2020; 405:1155-1162. [PMID: 33057822 DOI: 10.1007/s00423-020-02001-y] [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: 07/03/2020] [Accepted: 09/23/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Enhanced recovery program (ERP) is well-established in colorectal surgery. Rectal surgery (RS) is known to be associated with high morbidity and prolonged hospital stay, which might explain why ERPs are less applied in this specific group of patients. The aim of this large-scale study was to assess the feasibility of an ERP in RS compared with colonic surgery. METHODS This study was a retrospective analysis of a prospective database including 3740 patients eligible for colorectal resection from February 2014 to January 2017 in 75 European Francophone centres. Patients were divided into two groups (colon group C vs. rectum group R). The main endpoint was compliance with ERP components. A subgroup analysis was performed in patients for whom a defunctioning stoma (DS) was required after RS. RESULTS A total of 3740 patients were included. There were 2870 patients in group C and 870 patients in group R. The overall compliance rate for ERPs was 81.71% in group C and 79.09% in group R. Patients were significantly less mobilized within 24 h in group R. Specific recommendations for RS concerning bowel preparation and abdominal drainage were significantly less implemented. Overall morbidity was significantly higher in group R. Mean length of stay (LOS) was significantly shorter in group C. In the sub-group analysis, a DS was significantly associated with fewer compliance with early mobilization and early feeding, leading to significantly longer LOS (group R). CONCLUSION ERP is safe and effective in RS, despite the well-known higher morbidity and LOS compared with colonic surgery. DS could be a limiting factor in ERP implementation after RS.
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Affiliation(s)
- J Veziant
- Department of Digestive and Hepatobiliary Surgery, University Hospital, Clermont-Ferrand, France.
| | - K Poirot
- Department of Digestive and Hepatobiliary Surgery, University Hospital, Clermont-Ferrand, France
| | - A Mulliez
- Biostatistics Unit, Department of Clinical Research and Innovation (DRCI), University Hospital, Clermont Ferrand, France
| | - B Pereira
- Biostatistics Unit, Department of Clinical Research and Innovation (DRCI), University Hospital, Clermont Ferrand, France
| | - K Slim
- Department of Digestive and Hepatobiliary Surgery, University Hospital, Clermont-Ferrand, France
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Abstract
An intestinal stoma (greek στὁμα, stoma: mouth, opening) is a surgically created opening of a gut section through the abdominal wall, which serves as an artificial intestinal exit for excretion of feces (synonym preternatural anus). A stoma of the gastrointestinal (GI) tract is often surgically created at the distal small intestine (ileostomy) and the colon (colostomy). Temporary or permanent deviation of fecal excretion may be required to treat various pathological conditions (e.g. congenital anomalies, ileus, inflammatory bowel diseases, posttraumatic, diverticulitis, colorectal malignancy). The creation of an end vs. a loop stoma is technically different. To achieve sufficient patient satisfaction close collaboration between surgeons, professional stoma care with guidance and training as well as support from self-help groups are required. In this way serious stoma-related complications can be avoided.
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24
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Carvello M, Watfah J, Włodarczyk M, Spinelli A. The Management of the Hospitalized Ulcerative Colitis Patient: the Medical-Surgical Conundrum. Curr Gastroenterol Rep 2020; 22:11. [PMID: 32040642 DOI: 10.1007/s11894-020-0750-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW In this study, we present the evidence-based management for patients hospitalized for ulcerative colitis (UC) with a special focus on the synergic approach of the two key actors of the inflammatory bowel disease multidisciplinary team (IBD-MDT): gastroenterologist and surgeon. RECENT FINDINGS Focused treatment by a specialized IBD-MDT and early involvement of the colorectal surgeon in the management of hospitalized UC patients is advocated. The colectomy rate has not changed over the years. Moreover, delayed surgery after admission is burden by increase complication and mortality rates. Thus, it is pivotal to identify the patients who are likely to undergo surgery, by mean of predictors of outcome, and not to prolong ineffective medical treatment. The perfect timing based on clinical close monitoring is crucial. Up to 25% of patients with ulcerative colitis (UC) may require hospitalization. The aim of admission is to evaluate severity of the disease, exclude infections and establish proper treatment while monitoring the response. During admission, the patient has to be closely observed for the possible development of toxic megacolon or perforation, which should prompt emergency colectomy. Up to 30% of UC patients will fail to respond to initial intravenous corticosteroid. Non-responder or partial responder to medical therapy should be evaluated for timely surgery or could be considered for rescue medical therapy.
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Affiliation(s)
- Michele Carvello
- Colon and Rectal Surgery Division, Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, Rozzano, 20089, Milan, Italy
| | - Joseph Watfah
- Department of General Surgery, Northwick Park Hospital, London, UK
| | - Marcin Włodarczyk
- Department of General and Colorectal Surgery, Medical University of Lodz, Haller 1 Sq, 90-364, Lodz, Poland
| | - Antonino Spinelli
- Colon and Rectal Surgery Division, Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, Rozzano, 20089, Milan, Italy.
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy.
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25
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Hughes MJ, Cunningham W, Yalamarthi S. The effect of preoperative stoma training for patients undergoing colorectal surgery in an enhanced recovery programme. Ann R Coll Surg Engl 2019; 102:180-184. [PMID: 31841027 DOI: 10.1308/rcsann.2019.0145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Stoma formation following colorectal resection is often anticipated prior to surgery. Becoming independent with stoma handling can sometimes delay discharge beyond achievement of discharge criteria. The aim of this study was to assess the impact of preoperative stoma training on length of stay. METHODS Patients undergoing colorectal resection within an enhanced recovery after surgery (ERAS) programme were prospectively entered into a database. Retrospective analysis was performed of those who received a stoma as part of their operation. Patients who underwent preoperative stoma training were compared with those who had conventional postoperative training. The primary outcome measure was length of hospital stay. Secondary outcome measures included overall morbidity, stoma related morbidity, ERAS milestone achievement and readmission rates. RESULTS The median length of stay was improved in the patients receiving preoperative stoma training (8 days [interquartile range: 6-10] vs 9 days [interquartile range: 7-19.5], p=0.025). No statistically significant difference was observed in overall morbidity rates, stoma specific morbidity, ERAS milestones or readmission rates. CONCLUSIONS Preoperative stoma training can reduce length of stay and could be employed routinely for patients who are planned to have colorectal surgery. Such training can be incorporated within ERAS pathways.
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Prolonged Postoperative Ileus Significantly Increases the Cost of Inpatient Stay for Patients Undergoing Elective Colorectal Surgery: Results of a Multivariate Analysis of Prospective Data at a Single Institution. Dis Colon Rectum 2019; 62:631-637. [PMID: 30543534 DOI: 10.1097/dcr.0000000000001301] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Prolonged postoperative ileus is a common major complication after abdominal surgery. Retrospective data suggest that ileus doubles the cost of inpatient stay. However, current economic impact data are based on retrospective studies that rely on clinical coding to diagnose ileus. OBJECTIVE The aim of this study was to determine the economic burden of ileus for patients undergoing elective colorectal surgery. DESIGN Economic data were audited from a prospective database of patients who underwent surgery at Auckland City Hospital between September 2012 and June 2014. SETTINGS Auckland City Hospital is a large tertiary referral center, using an enhanced recovery after surgery protocol. PATIENTS Patients were prospectively diagnosed with prolonged postoperative ileus using a standardized definition. MAIN OUTCOME MEASURES The cost of inpatient stay was analyzed with regard to patient demographics and operative and postoperative factors. A multivariate analysis was performed to determine the cost of ileus when accounting for other significant covariates. RESULTS Economic data were attained from 325 patients, and 88 patients (27%) developed ileus. The median inpatient cost (New Zealand dollars) for patients with prolonged ileus, including complication rates and length of stay, was $27,981 (interquartile range= $20,198 to $42,174) compared with $16,317 (interquartile range = $10,620 to $23,722) for other patients, a 71% increase in cost (p < 0.005). Ileus increased all associated healthcare costs, including medical/nursing care, radiology, medication, laboratory costs, and allied health (p < 0.05). Multivariate analysis showed that ileus remained a significant financial burden (p < 0.005) when considering rates of major complications and length of stay. LIMITATIONS This is a single-institution study, which may impact the generalizability of our results. CONCLUSIONS Prolonged ileus causes a substantial financial burden on the healthcare system, in addition to greater complication rates and length of stay in these patients. This is the first study to assess the financial impact of prolonged ileus, diagnosed prospectively using a standardized definition. See Video Abstract at http://links.lww.com/DCR/A825.
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Cavallaro P, Bordeianou L. Implementation of an ERAS Pathway in Colorectal Surgery. Clin Colon Rectal Surg 2019; 32:102-108. [PMID: 30833858 DOI: 10.1055/s-0038-1676474] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Enhanced Recovery after Surgery (ERAS) protocols have been demonstrated to improve hospital length of stay and outcomes in patients undergoing colorectal surgery. This article presents the specific components of an ERAS protocol implemented at the authors' institution. In particular, details of both surgical and anesthetic ERAS pathways are provided with explanation of all aspects of preoperative, perioperative, and postoperative care. Evidence supporting inclusion of various aspects within the ERAS protocol is briefly reviewed. The ERAS protocol described has significantly benefitted postoperative outcomes in colorectal patients and can be employed at other institutions wishing to develop an ERAS pathway for colorectal patients. A checklist is provided for clinicians to easily reference and facilitate implementation of a standardized protocol.
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Affiliation(s)
- Paul Cavallaro
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Liliana Bordeianou
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
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Zhuang M, Fan W, Xie P, Yuan ST, Liu QH, Zhao C. Evaluation of the safety and quality of day-case cataract surgery based on 4151 cases. Int J Ophthalmol 2019; 12:291-295. [PMID: 30809487 PMCID: PMC6376245 DOI: 10.18240/ijo.2019.02.17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 10/15/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the safety, quality and prospects of day-case cataract surgery performed in a Jiangsu public tertiary hospital. METHODS The general and clinical data for patients who underwent day-case cataract surgery between August 1, 2014 and December 31, 2016 at this hospital were collected. The incidences of intraoperative and postoperative complications, preoperative and postoperative best-corrected visual acuities (BCVAs), delayed discharge rate, rate of unplanned re-admission to hospital, and patient satisfaction were analyzed. RESULTS A total of 4151 patients received cataract phacoemulsification surgery to correct age-related, congenital, traumatic, or complicated cataracts. Of these, age-related cataracts were the most frequently occurring. Patient age ranged from 18 to 101y and the vast majority of patients were between 60 and 80 years old. Of the 4151 patients, 64.73% (2687/4151) had a systemic disease. The number of patients increased over the years, with the average number of patients per month being 90.4, 124.83, and 183.42 in 2014, 2015 and 2016, respectively. The average preoperative BCVA was 0.102±0.057 and average postoperative BCVAs at 1d, 1wk, and 1mo post-surgery were 0.453±0.264, 0.657±0.285, and 0.734±0.244, respectively. For intraoperative complications, 4.12% (171/4151) had posterior capsule rupture, 0.79% (33/4151) had iris or ciliary body injury, and 0.048% (2/4151) had suprachoroidal hemorrhage. For postoperative complications, 4.38% (182/4151) had cornea edema, 7.78% (323/4151) had intraocular hypertension, 0.096% (4/4151) had IOL toxicity syndrome, 0.28% (12/4151) had retained lens cortex, and 0.048% (2/4151) had hyphema. The delayed discharge rate was 0.82% (44/4151) and the unplanned re-admission to the hospital was 0 (0/4151). The patient satisfaction rate was 91.42% (3795/4151). CONCLUSION Day-case cataract surgery is safe and effective with good prospects for development.
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Affiliation(s)
- Min Zhuang
- Department of Ophthalmology, the First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
- Department of Ophthalmology, the Fourth Affiliated Hospital of Nantong University (Yancheng No.1 People's Hospital), Yancheng 224000, Jiangsu Province, China
| | - Wen Fan
- Department of Ophthalmology, the First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Ping Xie
- Department of Ophthalmology, the First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Song-Tao Yuan
- Department of Ophthalmology, the First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Qing-Huai Liu
- Department of Ophthalmology, the First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Chen Zhao
- Department of Ophthalmology, the First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
- Eye Institute, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai 200000, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai 200000, China
- Key Laboratory of Myopia of State Health Ministry (Fudan University), Shanghai 200000, China
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Poinas G, Blache J, Kassab-Chahmi D, Evrard P, Artus P, Alfonsi P, Rébillard X, Beaussier M, Cerantola Y, Coloby P, Drapier É, Houédé N, Masson-Lecomt A, Rouprêt M, Le Normand L, Gamé X, Bosset P, Delaunay L, Fendler J, Ecoffey C, Cuvelier G. Version courte des recommandations de la récupération ameliorée après chirurgie (RAAC) pour la cystectomie : mesures techniques. Prog Urol 2019; 29:63-75. [DOI: 10.1016/j.purol.2018.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 11/28/2018] [Accepted: 12/01/2018] [Indexed: 12/20/2022]
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The Effects of Patient Care Results of Applied Nursing Intervention to Individuals With Stoma According to the Health Belief Model. Cancer Nurs 2018; 43:E87-E96. [PMID: 30543570 DOI: 10.1097/ncc.0000000000000678] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Individuals who have undergone stoma surgery take time to adjust to the stoma, and their quality of life is decreasing. OBJECTIVE The aim of this study was to examine the effects of home-based nursing interventions informed by the Health Belief Model on patient care outcomes for individuals having a stoma. METHODS This pretest, posttest, and semiexperimental design with a control group included adults who underwent a stoma operation in the previous 3 months. In total, 30 were assigned to the experimental group and 31 to the control group. Study forms included a sociodemographic questionnaire, the Stoma Quality of Life Scale, the Ostomy Adjustment Inventory, and the Pittman Complication Severity Index. RESULTS After home nursing interventions, there was a significant difference between the compliance rates of the individuals in the experimental group and the complication rates and cost averages (P < .05) with individuals in the control group; no significant difference in quality-of-life scores was found between the 2 groups. CONCLUSION In order to effectively support postoperative individuals following stoma surgery when they are released from the hospital, postdischarge follow-up care informed by the Health Belief Model components should be offered. IMPLICATIONS FOR PRACTICE We recommend creating hospital-based, home care teams that follow individuals with a stoma for at least 6 months after discharge.
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Parikh RP, Myckatyn TM. Paravertebral blocks and enhanced recovery after surgery protocols in breast reconstructive surgery: patient selection and perspectives. J Pain Res 2018; 11:1567-1581. [PMID: 30197532 PMCID: PMC6112815 DOI: 10.2147/jpr.s148544] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The management of postoperative pain is of critical importance for women undergoing breast reconstruction after surgical treatment for breast cancer. Mitigating postoperative pain can improve health-related quality of life, reduce health care resource utilization and costs, and minimize perioperative opiate use. Multimodal analgesia pain management strategies with nonopioid analgesics have improved the value of surgical care in patients undergoing various operations but have only recently been reported in reconstructive breast surgery. Regional anesthesia techniques, with paravertebral blocks (PVBs) and transversus abdominis plane (TAP) blocks, and enhanced recovery after surgery (ERAS) pathways have been increasingly utilized in opioid-sparing multimodal analgesia protocols for women undergoing breast reconstruction. The objectives of this review are to 1) comprehensively review regional anesthesia techniques in breast reconstruction, 2) outline important components of ERAS protocols in breast reconstruction, and 3) provide evidence-based recommendations regarding each intervention included in these protocols. The authors searched across six databases to identify relevant articles. For each perioperative intervention included in the ERAS protocols, the literature was exhaustively reviewed and evidence-based recommendations were generated using the Grading of Recommendations, Assessment, Development, and Evaluation system methodology. This study provides a comprehensive evidence-based review of interventions to optimize perioperative care and postoperative pain control in breast reconstruction. Incorporating evidence-based interventions into future ERAS protocols is essential to ensure high value care in breast reconstruction.
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Affiliation(s)
- Rajiv P Parikh
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St Louis, MO, USA,
| | - Terence M Myckatyn
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St Louis, MO, USA,
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Measuring In-Hospital Recovery After Colorectal Surgery Within a Well-Established Enhanced Recovery Pathway: A Comparison Between Hospital Length of Stay and Time to Readiness for Discharge. Dis Colon Rectum 2018; 61:854-860. [PMID: 29771797 DOI: 10.1097/dcr.0000000000001061] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Hospital length of stay is often used as a measure of in-hospital recovery but may be confounded by organizational factors. Time to readiness for discharge may provide a superior index of recovery. OBJECTIVE The purpose of this study was to contribute evidence for the construct validity of time to readiness for discharge and length of stay as measures of in-hospital recovery after colorectal surgery in the context of a well-established enhanced recovery pathway. DESIGN This was an observational validation study designed according to the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist. SETTINGS The study was conducted at a university-affiliated tertiary hospital. PATIENTS A total of 100 consecutive patients undergoing elective colorectal resection (mean age = 65 y; 57% men; 81% laparoscopic) who participated in a randomized controlled trial were included. MAIN OUTCOME MEASURES We tested a priori hypotheses that length of stay and time-to-readiness for discharge are longer in patients undergoing open surgery, with lower physical status, with severe comorbidities, with postoperative complications, undergoing rectal surgery, who are older (≥75 y), who have a new stoma, and who have inflammatory bowel disease. RESULTS Median time-to-readiness for discharge and length of stay were both 3 days. For both measures, 6 of 8 construct validity hypotheses were supported (hypotheses 1 and 4-8). LIMITATIONS The use of secondary data from a randomized controlled trial (risk of selection bias) was a limitation. Results may not be generalizable to institutions where patient care is not equally structured. CONCLUSIONS This study contributes evidence to the construct validity of time-to-readiness for discharge and length of stay as measures of in-hospital recovery within enhanced recovery pathways. Our findings suggest that length of stay can be a less resource-intensive and equally construct-valid index of in-hospital recovery compared with time-to-readiness for discharge. Enhanced recovery pathways may decrease process-of-care variances that impact length of stay, allowing more timely discharge once discharge criteria are achieved. See Video Abstract at http://links.lww.com/DCR/A564.
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Borggreve AS, Kingma BF, Domrachev SA, Koshkin MA, Ruurda JP, Hillegersberg R, Takeda FR, Goense L. Surgical treatment of esophageal cancer in the era of multimodality management. Ann N Y Acad Sci 2018; 1434:192-209. [DOI: 10.1111/nyas.13677] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/05/2018] [Accepted: 02/23/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Alicia S. Borggreve
- Department of Surgery, University Medical Center UtrechtUtrecht University Utrecht the Netherlands
- Moscow Clinical Scientific Center Moscow Russia
| | - B. Feike Kingma
- Department of Surgery, University Medical Center UtrechtUtrecht University Utrecht the Netherlands
| | | | | | - Jelle P. Ruurda
- Department of Surgery, University Medical Center UtrechtUtrecht University Utrecht the Netherlands
| | - Richard Hillegersberg
- Department of Surgery, University Medical Center UtrechtUtrecht University Utrecht the Netherlands
| | - Flavio R. Takeda
- Sao Paulo Institute of CancerUniversity of Sao Paulo School of Medicine Sao Paulo Brazil
| | - Lucas Goense
- Department of Surgery, University Medical Center UtrechtUtrecht University Utrecht the Netherlands
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Institution of a Preoperative Stoma Education Group Class Decreases Rate of Peristomal Complications in New Stoma Patients. J Wound Ostomy Continence Nurs 2017; 44:363-367. [PMID: 28549049 DOI: 10.1097/won.0000000000000338] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE The purpose of this study was to compare selected postoperative complications (including stomal and peristomal complications), hospital length of stay, and readmission rates in a group of patients who attended a preoperative educational intervention to a retrospective group of patients who did not receive the intervention. DESIGN Retrospective, comparison cohort study. SUBJECTS AND SETTING The intervention group comprised 124 patients who attended an educational session for persons with fecal ostomies at a single tertiary care center in the Northeastern United States. They were compared to findings from a group of 94 individuals who underwent ostomy surgery during a 1-year period before initiation of the class. Patients undergoing emergent procedures or who had previous stomas were excluded. We found no significant differences between the 2 cohorts with respect to age, gender, comorbidities, open versus minimally invasive procedures, or colorectal diagnoses. METHODS A preoperative 2-hour stoma education class was led by certified WOC nurses for all patients undergoing colorectal surgeries in which the creation of a stoma was anticipated. This session included a didactic portion outlining postoperative expectations in the management of new ostomies (including dietary changes, prevention of dehydration, and an overview of ostomy supplies), as well as a hands-on portion to practice stoma care skills. We compared postoperative complications within 30 days (particularly stoma-related complications, including pouch leakage due to loss of seal, and peristomal skin irritation) between the group attending the education session and the control group. We also compared length of stay and 30-day readmission rates. RESULTS Patients who participated in the educational intervention experienced significantly fewer peristomal complications than did patients in the historic control group (44.7% vs 20.2%, P = .002). Logistic regression analysis revealed that participation in the group was associated with a lower likelihood of peristomal skin complications (odds ratio = 0.35; 95% confidence interval, 0.18-0.67). Their length of stay (median 6 days vs 5 days, P = NS), and the proportion who experienced 30-day readmission (20.2% vs 15.3%, P = NS), did not significantly differ. CONCLUSIONS A preoperative stoma education group class significantly reduced the likelihood of frequent leakage from the ostomy pouching system and peristomal skin irritation.
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Goldblatt J, Buxey K, Paul E, Foot-Connolly R, Leech T, Bell S. Study on the time taken for patients to achieve the ability to self-care their new stoma. ANZ J Surg 2017; 88:E503-E506. [DOI: 10.1111/ans.14195] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 06/29/2017] [Accepted: 07/16/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Joshua Goldblatt
- Department of Colorectal Surgery; The Alfred Hospital; Melbourne Victoria Australia
| | - Ken Buxey
- Department of Colorectal Surgery; The Alfred Hospital; Melbourne Victoria Australia
| | - Eldho Paul
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | | | - Tristan Leech
- Department of General Surgery; Peninsula Health; Melbourne Victoria Australia
| | - Stephen Bell
- Department of Colorectal Surgery; The Alfred Hospital; Melbourne Victoria Australia
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Faury S, Koleck M, Foucaud J, M'Bailara K, Quintard B. Patient education interventions for colorectal cancer patients with stoma: A systematic review. PATIENT EDUCATION AND COUNSELING 2017; 100:1807-1819. [PMID: 28602564 DOI: 10.1016/j.pec.2017.05.034] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/15/2017] [Accepted: 05/25/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To describe the various types of patient education interventions for colorectal cancer patients with stoma and to examine their effects on quality of life, psychosocial skills and self-management skills. METHODS A systematic review was performed. Six electronic databases were searched. Inclusion criteria were: studies about patient education applying quantitative methods including digestive stoma adults with colorectal cancer. The primary outcome was quality of life. Secondary outcomes were psychosocial and self-management skills. RESULTS Thirteen studies were identified and included. Five studies examined quality of life and three reported improvements. Patient education improved some psychosocial and self-management skills. Contrasting findings were reported for specific-disease quality of life, emotional distress, length of hospital stay, stoma complications and readmission rate. CONCLUSIONS Patient education has a positive impact on some psychosocial and self-management skills, indicating that this area should be developed. Contrasting findings were reported for quality of life. Methodologies are heterogeneous making it difficult to produce evidence-based guidelines. This article proposes tools to carry out further studies on this subject and to improve understanding. PRACTICE IMPLICATION Further education intervention for stoma patients with colorectal cancer should be standardized in terms of intervention, duration and outcome measures to compare intervention and determine best practice.
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Affiliation(s)
- Stéphane Faury
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, F-33000 Bordeaux, France.
| | - Michèle Koleck
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, F-33000 Bordeaux, France
| | - Jérôme Foucaud
- "Laboratoire Educations et Pratiques de Santé", EA 3412, Univ. Paris-13 Sorbonne, Paris Cité, 93017 Bobigny, France
| | - Katia M'Bailara
- "Laboratoire de Psychologie", EA 4139, Univ. Bordeaux, Bordeaux, F-33076, France
| | - Bruno Quintard
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, F-33000 Bordeaux, France
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Factors associated with hospital readmission following diverting ileostomy creation. Tech Coloproctol 2017; 21:641-648. [DOI: 10.1007/s10151-017-1667-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 07/08/2017] [Indexed: 12/24/2022]
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38
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Carmichael JC, Keller DS, Baldini G, Bordeianou L, Weiss E, Lee L, Boutros M, McClane J, Steele SR, Feldman LS. Clinical practice guideline for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons (ASCRS) and Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Surg Endosc 2017; 31:3412-3436. [DOI: 10.1007/s00464-017-5722-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 07/10/2017] [Indexed: 12/16/2022]
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Clinical Practice Guidelines for Enhanced Recovery After Colon and Rectal Surgery From the American Society of Colon and Rectal Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons. Dis Colon Rectum 2017; 60:761-784. [PMID: 28682962 DOI: 10.1097/dcr.0000000000000883] [Citation(s) in RCA: 258] [Impact Index Per Article: 36.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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40
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Steenhagen E, van Vulpen JK, van Hillegersberg R, May AM, Siersema PD. Nutrition in peri-operative esophageal cancer management. Expert Rev Gastroenterol Hepatol 2017; 11:663-672. [PMID: 28454509 DOI: 10.1080/17474124.2017.1325320] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Nutritional status and dietary intake are increasingly recognized as essential areas in esophageal cancer management. Nutritional management of esophageal cancer is a continuously evolving field and comprises an interesting area for scientific research. Areas covered: This review encompasses the current literature on nutrition in the pre-operative, peri-operative, and post-operative phases of esophageal cancer. Both established interventions and potential novel targets for nutritional management are discussed. Expert commentary: To ensure an optimal pre-operative status and to reduce peri-operative complications, it is key to assess nutritional status in all pre-operative esophageal cancer patients and to apply nutritional interventions accordingly. Since esophagectomy results in a permanent anatomical change, a special focus on nutritional strategies is needed in the post-operative phase, including early initiation of enteral feeding, nutritional interventions for post-operative complications, and attention to long-term nutritional intake and status. Nutritional aspects of pre-optimization and peri-operative management should be incorporated in novel Enhanced Recovery After Surgery programs for esophageal cancer.
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Affiliation(s)
- Elles Steenhagen
- a Internal Medicine and Dermatology, Department of Dietetics , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Jonna K van Vulpen
- b Julius Center for Health Sciences and Primary Care , University Medical Center Utrecht , Utrecht , The Netherlands
| | | | - Anne M May
- b Julius Center for Health Sciences and Primary Care , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Peter D Siersema
- d Department of Gastroenterology and Hepatology , University Medical Center Utrecht , Utrecht , The Netherlands.,e Department of Gastroenterology and Hepatology , Radboud University Medical Center , Nijmegen , The Netherlands
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41
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Efficacy of preoperative uro-stoma education on self-efficacy after Radical Cystectomy; secondary outcome of a prospective randomized controlled trial. Eur J Oncol Nurs 2017; 28:41-46. [DOI: 10.1016/j.ejon.2017.03.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 03/02/2017] [Accepted: 03/05/2017] [Indexed: 01/26/2023]
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Abstract
Intestinal stomas significantly impact patients' quality of life. Stoma-related complications are common, but even without complications, patients are faced with new challenges in stoma management and daily activities. Preoperative patient education and stoma site marking, in conjunction with conscientious surgical stewardship, are key to patient satisfaction and successful operative outcomes.
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Affiliation(s)
- Molly A Wasserman
- Section of Colon and Rectal Surgery, Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael F McGee
- Section of Colon and Rectal Surgery, Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Tracking Discharge Delays: Critical First Step Toward Mitigating Process Breakdowns and Inefficiencies. J Nurs Care Qual 2016; 31:17-23. [PMID: 26166435 DOI: 10.1097/ncq.0000000000000141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article reports on the development and evaluation of a mechanism designed for real-time tracking of discharge delays by bedside clinicians and the reporting of delays in a manner amenable to action. During the implementation phase, delay time totaled 23.6 days for 114 patients affected by a delay. More than one-half of delays (61.4%) occurred for patients whose discharge disposition was home to self-care.
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Forsmo HM, Pfeffer F, Rasdal A, Sintonen H, Körner H, Erichsen C. Pre- and postoperative stoma education and guidance within an enhanced recovery after surgery (ERAS) programme reduces length of hospital stay in colorectal surgery. Int J Surg 2016; 36:121-126. [PMID: 27780772 DOI: 10.1016/j.ijsu.2016.10.031] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 10/21/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Stoma formation delays discharge after colorectal surgery. Stoma education is widely recommended, but little data are available regarding whether educational interventions are effective. The aim of this prospective study was to investigate whether an enhanced recovery after surgery (ERAS) programme with dedicated ERAS and stoma nurse specialists focusing on counselling and stoma education can reduce the length of hospital stay, re-admission, and stoma-related complications and improve health-related quality of life (HRQoL) compared to current stoma education in a traditional standard care pathway. METHODS In a single-center study 122 adult patients eligible for laparoscopic or open colorectal resection who received a planned stoma were treated in either the ERAS program with extended stoma education (n = 61) or standard care with current stoma education (n = 61). The primary endpoint was total postoperative hospital stay. Secondary endpoints were postoperative hospital stay, major or minor morbidity, early stoma-related complications, health-related quality of life, re-admission rate, and mortality. HRQoL was measured by the generic 15D instrument. RESULTS Total hospital stay was significantly shorter in the ERAS group with education than the standard care group (median [range], 6 days [2-21 days] vs. 9 days [5-45 days]; p < 0.001). Regarding overall major and minor morbidity, re-admission rate, HRQoL, stoma-related complications and 30-day mortality, the two treatment groups exhibited similar outcomes. CONCLUSION Patients receiving a planned stoma can be included in an ERAS program. Pre-operative and postoperative stoma education in an enhanced recovery programme is associated with a significantly shorter hospital stay without any difference in re-admission rate or early stoma-related complications.
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Affiliation(s)
- H M Forsmo
- Department of Gastrointestinal and Emergency Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Norway.
| | - F Pfeffer
- Department of Gastrointestinal and Emergency Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Norway
| | - A Rasdal
- Department of Gastrointestinal and Emergency Surgery, Haukeland University Hospital, Bergen, Norway
| | - H Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - H Körner
- Department of Clinical Medicine, University of Bergen, Norway; Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - C Erichsen
- Department of Gastrointestinal and Emergency Surgery, Haukeland University Hospital, Bergen, Norway
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Hardiman KM, Reames CD, McLeod MC, Regenbogen SE. Patient autonomy-centered self-care checklist reduces hospital readmissions after ileostomy creation. Surgery 2016; 160:1302-1308. [PMID: 27320065 DOI: 10.1016/j.surg.2016.05.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 04/27/2016] [Accepted: 05/07/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND Patients who undergo a colorectal operation that includes a new ileostomy incur high rates of readmission. Ostomates face a steep learning curve to master the skills and knowledge needed for success at home. We designed and implemented a patient-centered checklist promoting independence and validating self-care knowledge and care skills and evaluated its effect on readmissions after ileostomy creation. METHODS On a single inpatient unit, new ileostomy patients were taught and evaluated using a novel postoperative self-care checklist, while perioperative care for ostomates remained unchanged elsewhere in the institution. In a retrospective cohort including all consecutive ileostomy patients from 2 years before (period 1) and 1 year after (period 2) the checklist implementation, we identified univariable predictors of readmission within 30 days of discharge and used a multivariable, difference-in-differences approach to compare trends in readmission between the intervention and control units. RESULTS Of the 430 patients in the study period, there were 116 with readmissions (26%). Readmitted patients had significantly greater all patient refined diagnosis related group weights (3.6 vs 3.3, P = .006) and longer initial duration of stay (13.3 vs 11.3 days, P = .006), and they were more likely to be emergency admissions (49% vs 38%, P = .04). The readmission rate on the intervention unit decreased from 28% in period 1 to 20% in period 2. The logistic regression-based difference-in-differences approach revealed that implementation of the checklist was an independent negative predictor of readmission (P = .04). CONCLUSION Implementation of a patient-centered, self-care-oriented postoperative education checklist was associated with significantly reduced odds of readmission after ileostomy creation.
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Affiliation(s)
- Karin M Hardiman
- Division of Colorectal Surgery, University of Michigan, Ann Arbor, MI.
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Tseng JH, Suidan RS, Zivanovic O, Gardner GJ, Sonoda Y, Levine DA, Abu-Rustum NR, Tew WP, Chi DS, Long Roche K. Diverting ileostomy during primary debulking surgery for ovarian cancer: Associated factors and postoperative outcomes. Gynecol Oncol 2016; 142:217-24. [PMID: 27261325 DOI: 10.1016/j.ygyno.2016.05.035] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 05/27/2016] [Accepted: 05/28/2016] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To examine the use, as well as postoperative and long-term oncologic outcomes of diverting loop ileostomy (DI) during primary debulking surgery (PDS) for ovarian cancer. METHODS Patients with stage II-IV ovarian, fallopian tube, or primary peritoneal carcinoma who underwent colon resection during PDS from 1/2005-1/2014 were identified. Demographic and clinical data were analyzed. RESULTS Of 331 patients, 320 (97%) had stage III/IV disease and 278 (84%) had disease of high-grade serous histology. Forty-four (13%) underwent a DI. There were no significant differences in age, comorbidity index, smoking status, serum albumin, or attending surgeon between the DI and non-DI groups. Operative time (OR=1.21; 95% CI, 1.03-1.42; p=0.02) and length of rectosigmoid resection (OR=1.04; 95% CI, 1.01-1.08; p=0.02) were predictors of DI on multivariable analysis. The overall anastomotic leak rate was 6%. A comparison of groups (DI vs non-DI) showed no significant differences in major complications (30% vs 23%; p=0.41), anastomotic leak rate (5% vs 7%; p=0.60), hospital length of stay (10 vs 9days; p=0.25), readmission rate (23% vs 17%; p=0.33), or interval to postoperative chemotherapy (41 vs 40days; p=0.20), respectively. Ileostomy reversal was successful in 89% of patients. Median follow-up was 52.6months. There were no differences in median progression-free (17.9 vs 18.6months; p=0.88) and overall survival (48.7 vs 63.8months; p=0.25) between the groups. CONCLUSIONS In patients undergoing PDS, those with longer operative time and greater length of rectosigmoid resection more commonly underwent DI. DI does not appear to compromise postoperative outcomes or long-term survival.
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Affiliation(s)
- Jill H Tseng
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rudy S Suidan
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Oliver Zivanovic
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Ginger J Gardner
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Yukio Sonoda
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Douglas A Levine
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - William P Tew
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Dennis S Chi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA
| | - Kara Long Roche
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA.
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Casans Francés R, Ripollés Melchor J, Abad-Gurumeta A, Longás Valién J, Calvo Vecino JM. The role of the anaesthesiologist in enhanced recovery programs. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2016; 63:273-288. [PMID: 26775121 DOI: 10.1016/j.redar.2015.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 11/04/2015] [Accepted: 11/09/2015] [Indexed: 06/05/2023]
Affiliation(s)
- R Casans Francés
- Servicio de Anestesiología, Reanimación y Terapia del Dolor, Hospital Clínico Universitario «Lozano Blesa», Zaragoza, España; Grupo Español de Rehabilitación Multimodal (GERM/ERAS-Spain), España.
| | - J Ripollés Melchor
- Servicio de Anestesiología, Reanimación y Terapia del Dolor, Hospital Universitario «Infanta Leonor», Madrid, España; Grupo Español de Rehabilitación Multimodal (GERM/ERAS-Spain), España
| | - A Abad-Gurumeta
- Servicio de Anestesiología, Reanimación y Terapia del Dolor, Hospital Universitario La Paz, Madrid, España; Grupo Español de Rehabilitación Multimodal (GERM/ERAS-Spain), España
| | - J Longás Valién
- Servicio de Anestesiología, Reanimación y Terapia del Dolor, Hospital Clínico Universitario «Lozano Blesa», Zaragoza, España; Grupo Español de Rehabilitación Multimodal (GERM/ERAS-Spain), España
| | - J M Calvo Vecino
- Servicio de Anestesiología, Reanimación y Terapia del Dolor, Hospital Universitario «Infanta Leonor», Madrid, España; Grupo Español de Rehabilitación Multimodal (GERM/ERAS-Spain), España
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Scientific and Clinical Abstracts From the 2016 WOCN® Society & CAET Joint Conference. J Wound Ostomy Continence Nurs 2016. [DOI: 10.1097/won.0000000000000226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Steenhagen E. Enhanced Recovery After Surgery: It's Time to Change Practice! Nutr Clin Pract 2015; 31:18-29. [PMID: 26703956 DOI: 10.1177/0884533615622640] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Perioperative surgical care is undergoing a paradigm shift. Traditional practices such as prolonged preoperative fasting (nil by mouth from midnight), bowel cleaning, and reintroduction of oral nutrition 3-5 days after surgery are being shunned. These and other similar changes have been formulated into a protocol called Enhanced Recovery After Surgery (ERAS) pathway. It is a multimodal perioperative care pathway designed to achieve early recovery after surgical procedures by maintaining preoperative organ function and reducing the profound stress response following surgery. The key elements of an ERAS protocol include preoperative counseling, optimization of nutrition, standardized analgesic and anesthetic regimes, and early mobilization. The recent literature is heavily influenced by colorectal surgery, but the principles are now being applied to a wide range of disciplines. As they challenge traditional surgical doctrine, the implementation of ERAS guidelines has been slow, despite the significant body of evidence indicating that ERAS guidelines may lead to improved outcomes.
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Affiliation(s)
- Elles Steenhagen
- Internal Medicine and Dermatology, Department of Dietetics, University Medical Center Utrecht, the Netherlands
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Day RW, Aloia TA. Clinical Care Pathways in Cancer Surgery. CURRENT ANESTHESIOLOGY REPORTS 2015. [DOI: 10.1007/s40140-015-0115-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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