1
|
Kato A, Numata M, Izukawa S, Ohgimi T, Okamoto H, Atsumi Y, Kazama K, Asari M, Numata K, Sawazaki S, Watanabe T, Mikayama Y, Godai T, Higuchi A, Saeki H, Hatori S, Mushiake H, Matsumoto S, Rino Y, Saito A, Shiozawa M. Prospective observational study comparing the perioperative outcomes of laparoscopic colectomy with or without epidural anesthesia: the Kanagawa Yokohama Colorectal Cancer Study Group (KYCC) 1806. Surg Today 2024:10.1007/s00595-024-02856-4. [PMID: 38702438 DOI: 10.1007/s00595-024-02856-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/31/2024] [Indexed: 05/06/2024]
Abstract
PURPOSE There have been no adequate comparisons of the efficacy, safety, and efficiency of analgesia after laparoscopic colorectal resection (LAC), with and without epidural anesthesia (EDA). METHODS This was a multicenter prospective observational study of patients undergoing LAC. The primary end point was the mean visual analog scale (VAS) score on postoperative days (PODs) 1-7. The secondary end points were the highest VAS, complication rate, days to first ambulation and fatigue, length of hospital stay, and time to commencement of surgery. RESULTS We compared an EDA group (Group E, n = 48) and a no-EDA group (Group O, n = 48) after matching. The mean VAS was not significantly different between the groups (28.7 vs. 30.1, p = 0.288). On assessing the secondary end points, the highest VAS was not significantly different between the groups. In fact, the VAS was lower in Group E only on POD 2. There was no difference in the incidence of complications, the time to first postoperative evacuation was shorter in Group E, and postoperative hospitalization was similar. The time to surgery was shorter in Group O. CONCLUSION These results suggest that LAC without EDA is a feasible option, but with the early and regular use of adjunctive measures to provide more stable analgesia.
Collapse
Affiliation(s)
- Aya Kato
- Department of Gastroenterological Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, Kanagawa, 241-8515, Japan
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Masakatsu Numata
- Department of Gastroenterological Surgery, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.
| | - Shota Izukawa
- Department of Surgery, Saiseikai Yokohama Nanbu Hospital, 3-2-10 Konandai, Konan-ku, Yokohama, Kanagawa, 234-0054, Japan
| | - Takashi Ohgimi
- Department of Gastroenterological Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, Kanagawa, 241-8515, Japan
| | - Hironao Okamoto
- Department of Surgery, Hiratsuka Kyosai Hospital, 9-11 Oiwake, Hiratsuka, Kanagawa, 254-8502, Japan
| | - Yosuke Atsumi
- Department of Gastroenterological Surgery, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Keisuke Kazama
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Masahiro Asari
- Department of Gastroenterological Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, Kanagawa, 241-8515, Japan
| | - Koji Numata
- Department of Gastroenterological Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, Kanagawa, 241-8515, Japan
| | - Sho Sawazaki
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Takuo Watanabe
- Department of Surgery, Saiseikai Yokohama Nanbu Hospital, 3-2-10 Konandai, Konan-ku, Yokohama, Kanagawa, 234-0054, Japan
| | - Yo Mikayama
- Department of Gastroenterological Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, Kanagawa, 241-8515, Japan
| | - Teni Godai
- Department of Surgery, Fujisawa Shonandai Hospital, 2345 Takakura, Fujisawa, Kanagawa, 252-0802, Japan
| | - Akio Higuchi
- Department of Surgery, Yokohama Minami Kyosai Hospital, 1-21-1 Mutsuurahigasi, Kanazawa-ku, Yokohama, Kanagawa, 236-0037, Japan
| | - Hiroyuki Saeki
- Department of Surgery, Yokohama Minami Kyosai Hospital, 1-21-1 Mutsuurahigasi, Kanazawa-ku, Yokohama, Kanagawa, 236-0037, Japan
| | - Shinsuke Hatori
- Department of Surgery, Hiratsuka Kyosai Hospital, 9-11 Oiwake, Hiratsuka, Kanagawa, 254-8502, Japan
| | - Hiroyuki Mushiake
- Department of Surgery, Saiseikai Yokohama Nanbu Hospital, 3-2-10 Konandai, Konan-ku, Yokohama, Kanagawa, 234-0054, Japan
| | - Satomi Matsumoto
- Department of Surgery, Yokohama Minami Kyosai Hospital, 1-21-1 Mutsuurahigasi, Kanazawa-ku, Yokohama, Kanagawa, 236-0037, Japan
| | - Yasushi Rino
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Aya Saito
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Manabu Shiozawa
- Department of Gastroenterological Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, Kanagawa, 241-8515, Japan
| |
Collapse
|
2
|
Ferrari D, Violante T, Bin Zubair A, Rumer KK, Shawki SF, Merchea A, Stocchi L, Behm KT, Lovely JK, Larson DW. Rethinking postoperative care: same-day ileostomy closure discharge improves patient outcomes. J Gastrointest Surg 2024; 28:667-671. [PMID: 38704204 DOI: 10.1016/j.gassur.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/19/2024] [Accepted: 02/07/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND The evolution of enhanced recovery pathways (ERPs) in colon and rectal surgery has led to the development of same-day discharge (SDD) procedures for selected patients. Early discharge after diverting loop ileostomy (DLI) closure was first described in 2003. However, its widespread adoption remains limited, with SDD accounting for only 3.2% of all DLI closures in 2005-2006, according to the American College of Surgeons National Surgical Quality Improvement Program database, and rising to just 4.1% by 2016. This study aimed to compare the outcomes of SDD DLI closure with those of DLI closure after the standard ERP. METHODS A retrospective case-matched study compared 125 patients undergoing SDD DLI closure with 250 patients undergoing DLI closure after the standard ERP based on age (±1 year), sex, American Society of Anesthesiologists score, body mass index, surgery date (±2 months), underlying disease, and hospital site. The primary outcome was comparative 30-day complication rates. RESULTS Patients in the traditional ERP group received more intraoperative fluids (1221.1 ± 416.6 vs 1039.0 ± 368.3 mL, P < .001) but had similar estimated blood loss. Ten patients (8%) in the SDD-ERP group failed SDD. The 30-day postoperative complication rate was significantly lower in the SDD group (14.8%) than the standard ERP group (25.7%, P = .025). This difference was primarily driven by a lower incidence of ileus in the SDD group (9.6% vs 14.8%, P = .034). There were no significant differences in readmission rate (9.6% of SDD-ERP vs 9.2% of standard ERP, P = .900) and reoperation rates (3.2% of SDD-ERP vs 2.4% of standard ERP, P = .650). CONCLUSION SDD ileostomy closure is a safe, feasible, and effective procedure associated with fewer complications than the present study's standard ERP. This could represent a new standard of care. Further prospective trials are required to confirm the findings of this study.
Collapse
Affiliation(s)
- Davide Ferrari
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, United States; General Surgery Residency Program, University of Milan, Milan, Italy
| | - Tommaso Violante
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, United States; Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Abdullah Bin Zubair
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Kristen K Rumer
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Sherief F Shawki
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Amit Merchea
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, Jacksonville, Florida, United States
| | - Luca Stocchi
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, Jacksonville, Florida, United States
| | - Kevin T Behm
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Jenna K Lovely
- Department of Pharmacy Services, Mayo Clinic, Rochester, Minnesota, United States
| | - David W Larson
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, United States.
| |
Collapse
|
3
|
Han T, Liu S. A commentary on 'Short-term outcomes following intracorporeal vs. extracorporeal anastomosis after laparoscopic right and left-sided colectomy: a propensity score-matched study'. Int J Surg 2024; 110:3130-3131. [PMID: 38363997 DOI: 10.1097/js9.0000000000001217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 02/04/2024] [Indexed: 02/18/2024]
Affiliation(s)
| | - Shuai Liu
- Department of Gastrointestinal Surgery, Taizhou Hospital of Zhejiang Province, affiliated to Wenzhou Medical University, Taizhou, People's Republic of China
| |
Collapse
|
4
|
Liu S, Huang N, Wei C, Wu Y, Zeng L. Is mechanical bowel preparation mandatory for elective colon surgery? A systematic review and meta-analysis. Langenbecks Arch Surg 2024; 409:99. [PMID: 38504007 DOI: 10.1007/s00423-024-03286-z] [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: 09/27/2023] [Accepted: 03/09/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Growing evidence demonstrates minimal impact of mechanical bowel preparation (MBP) on reducing postoperative complications following elective colectomy. This study investigated the necessity of MBP prior to elective colonic resection. METHOD A systematic literature review was conducted across PubMed, Ovid, and the Cochrane Library to identify studies comparing the effects of MBP with no preparation before elective colectomy, up until May 26, 2023. Surgical-related outcomes were compiled and subsequently analyzed. The primary outcomes included the incidence of anastomosis leakage (AL) and surgical site infection (SSI), analyzed using Review Manager Software (v 5.3). RESULTS The analysis included 14 studies, comprising seven RCTs with 5146 participants. Demographic information was consistent across groups. No significant differences were found between the groups in terms of AL ((P = 0.43, OR = 1.16, 95% CI (0.80, 1.68), I2 = 0%) or SSI (P = 0.47, OR = 1.20, 95% CI (0.73, 1.96), I2 = 0%), nor were there significant differences in other outcomes. Subgroup analysis on oral antibiotic use showed no significant changes in results. However, in cases of right colectomy, the group without preparation showed a significantly lower incidence of SSI (P = 0.01, OR = 0.52, 95% CI (0.31, 0.86), I2 = 1%). No significant differences were found in other subgroup analyses. CONCLUSION The current evidence robustly indicates that MBP before elective colectomy does not confer significant benefits in reducing postoperative complications. Therefore, it is justified to forego MBP prior to elective colectomy, irrespective of tumor location.
Collapse
Affiliation(s)
- Sheng Liu
- Department of General Surgery, Jiangyou Fourth People's Hospital, Jiangyou, China
| | - Ning Huang
- Department of Stomatology, Jiangyou Fourth People's Hospital, Jiangyou, China
| | - Changcheng Wei
- Department of General Surgery, Jiangyou Fourth People's Hospital, Jiangyou, China
| | - Yuehong Wu
- Department of General Surgery, Jiangyou Fourth People's Hospital, Jiangyou, China
| | - Lin Zeng
- Department of General Surgery, Jiangyou Fourth People's Hospital, Jiangyou, China.
| |
Collapse
|
5
|
Shoucair S, Alnajjar S, Sattari A, Almanzar A, Lisle D, Gupta VK. Impact of Surgical Resident Education and EMR Standardization in Enhancing ERAS Adherence and Outcomes in Colorectal Surgery. JOURNAL OF SURGICAL EDUCATION 2024; 81:257-266. [PMID: 38160116 DOI: 10.1016/j.jsurg.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/09/2023] [Accepted: 10/13/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Our study aimed at investigating the degree of adherence to ERAS pathway at our institution and to evaluate the role of providing resident education and a standardized EMR order set in improving adherence and patient surgical outcomes. DESIGN The study is prospective in nature and consists of two phases with a preintervention cohort to assess adherence to ERAS protocol and a postintervention cohort to evaluate improvement in adherence and patient outcomes. Adherence with the ERAS protocol was assessed across preoperative, intraoperative, and postoperative phases. SETTING The study took place at MedStar Franklin Square Medical Center in Baltimore, Maryland, involving inpatient care at a surgical ward. PARTICIPANTS During the preintervention phase, patients undergoing elective colorectal surgery were identified over 6 months (N = 77), and their adherence to the ERAS protocol was assessed. Following the intervention of surgical resident and faculty education sessions on the ERAS protocol and the implementation of a standardized order set in the Electronic Medical Record, a postintervention cohort (N = 54) was selected for comparison over another 6 months. RESULTS Among 77 patients who underwent elective colorectal surgery, the adherence rate to ERAS protocol was notably below 80% for most elements of the postoperative phase. When pre- and postintervention cohorts were compared, there were no significant differences in the baseline demographics and perioperative variables. After the implementation of our intervention, adherence rates were significantly improved in 7 out of 8 ERAS protocol elements of the postintervention phase. Among primary outcome measures, readmission rate (24.7% vs.9.4%; p = 0.022) and length of stay (7.3 ± 4.5 vs. 5.5 ± 3.6; p = 0.014) were significantly lower in the postintervention cohort. Although the rate of postoperative complications did not decrease significantly (33.8% vs. 31.5%; p = 0.284), there were fewer patients with postoperative ileus and surgical site infections. Outcomes were evaluated based on an 8-point score of postoperative ERAS elements. A significant decrease in mean length of stay and readmission rates is observed when at least 5 elements are completed, emphasizing the ERAS pathway's importance as a complementary bundle. CONCLUSION Our study highlights the impact of resident education and electronic medical record standardization on ERAS adherence in colorectal surgery. This multidisciplinary approach improves adherence, reduces hospital stay, and enhances communication among healthcare providers for better patient outcomes.
Collapse
Affiliation(s)
- Sami Shoucair
- Department of Surgery, MedStar Franklin Square Medical Center, Baltimore, Maryland
| | - Said Alnajjar
- Department of Surgery, MedStar Franklin Square Medical Center, Baltimore, Maryland
| | - Ali Sattari
- Department of Surgery, Saint Agnes Hospital, Baltimore, Maryland
| | - Anyelin Almanzar
- Department of Surgery, MedStar Franklin Square Medical Center, Baltimore, Maryland
| | - David Lisle
- Department of Surgery, MedStar Franklin Square Medical Center, Baltimore, Maryland
| | - Vinay K Gupta
- Department of Surgery, MedStar Franklin Square Medical Center, Baltimore, Maryland.
| |
Collapse
|
6
|
Tan JKH, Koh WL, Peh CH, Lee AWX, Lau J, Chee C, Tan KK. Surgical High Dependency Admissions after Elective Laparoscopic Colorectal Resections: Is It Truly Necessary? J Intensive Care Med 2024; 39:153-158. [PMID: 37583284 DOI: 10.1177/08850666231194258] [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: 08/17/2023]
Abstract
BACKGROUND Surgical high dependency (SHD) allows for intermediate care provision between general ward (GW) and intensive care unit (ICU) for surgical patients but no universally accepted admission criteria exists. Unnecessary SHD admissions should be minimized to limit resource wastage and maintain spare critical care capacity. This study evaluates the utility of SHD admissions following elective laparoscopic colectomy by comparing post-operative outcomes and interventions performed between SHD and GW patients. METHODOLOGY A retrospective review of all colorectal cancer patients who underwent elective laparoscopic colectomy in our institution between January 2019 and December 2021 was conducted. Patients converted to open surgery or admitted to IC post-operatively were excluded. Peri-operative parameters and outcomes between patients admitted to GW and SHD post-operatively were evaluated. RESULTS The cohort comprised 393 patients. There were 153 patients (38.93%) who required SHD admission. SHD patients had higher American Society of Anesthesiology (ASA) scores, body mass index, age and intra-operative blood loss. Majority of post-operative morbidity were minor (Clavien-Dindo II or lower) in both groups and the interventions required were safely instituted in both SHD and GW. None of the patients in the cohort required inotropic or ventilatory support in the SHD. CONCLUSIONS GW patients were "healthier" but post-operative morbidity and interventions required were similar to the SHD group. Nonetheless, treatment delays, absence of continuous monitoring, and decreased nurse-to-patient ratio may be significant for patients with limited physiological reserves. Further studies should evaluate safety and cost-effectiveness of managing high risk surgical patients in GW using continuous remote vital signs monitoring.
Collapse
Affiliation(s)
- Jarrod K H Tan
- Department of Surgery, National University Hospital, Singapore
| | - Wei-Ling Koh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Cherie Hui Peh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ailica W X Lee
- Department of Surgery, National University Hospital, Singapore
| | - Jerrald Lau
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Corissa Chee
- Department of Surgery, National University Hospital, Singapore
| | - Ker-Kan Tan
- Department of Surgery, National University Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| |
Collapse
|
7
|
Guadagni S, Catarci M, Masedu F, Karim ME, Clementi M, Ruffo G, Viola MG, Borghi F, Baldazzi G, Scatizzi M, Pirozzi F, Delrio P, Garulli G, Marini P, Campagnacci R, De Luca R, Ficari F, Sica G, Scabini S, Liverani A, Caricato M, Patriti A. Abdominal drainage after elective colorectal surgery: propensity score-matched retrospective analysis of an Italian cohort. BJS Open 2024; 8:zrad107. [PMID: 38170895 PMCID: PMC10763998 DOI: 10.1093/bjsopen/zrad107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/05/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND In Italy, surgeons continue to drain the abdominal cavity in more than 50 per cent of patients after colorectal resection. The aim of this study was to evaluate the impact of abdominal drain placement on early adverse events in patients undergoing elective colorectal surgery. METHODS A database was retrospectively analysed through a 1:1 propensity score-matching model including 21 covariates. The primary endpoint was the postoperative duration of stay, and the secondary endpoints were surgical site infections, infectious morbidity rate defined as surgical site infections plus pulmonary infections plus urinary infections, anastomotic leakage, overall morbidity rate, major morbidity rate, reoperation and mortality rates. The results of multiple logistic regression analyses were presented as odds ratios (OR) and 95 per cent c.i. RESULTS A total of 6157 patients were analysed to produce two well-balanced groups of 1802 patients: group (A), no abdominal drain(s) and group (B), abdominal drain(s). Group A versus group B showed a significantly lower risk of postoperative duration of stay >6 days (OR 0.60; 95 per cent c.i. 0.51-0.70; P < 0.001). A mean postoperative duration of stay difference of 0.86 days was detected between groups. No difference was recorded between the two groups for all the other endpoints. CONCLUSION This study confirms that placement of abdominal drain(s) after elective colorectal surgery is associated with a non-clinically significant longer (0.86 days) postoperative duration of stay but has no impact on any other secondary outcomes, confirming that abdominal drains should not be used routinely in colorectal surgery.
Collapse
Affiliation(s)
| | - Marco Catarci
- General Surgery Unit, Sandro Pertini Hospital, ASL Roma 2, Roma, Italy
- General Surgery Unit, ‘C.&G. Mazzoni’ Hospital, Ascoli Piceno, Italy
| | - Francesco Masedu
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, L'Aquila, Italy
| | - Mohammad Ehsanul Karim
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
- Centre for Health Evaluation and Outcome Sciences, St.Paul’s Hospital, Vancouver, BC, Canada
| | - Marco Clementi
- General Surgery Unit, University of L’Aquila, L'Aquila, Italy
| | - Giacomo Ruffo
- General Surgery Unit, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella (VR), Italy
| | | | - Felice Borghi
- Oncologic Surgery Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
- General & Oncologic Surgery Unit, Department of Surgery, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Gianandrea Baldazzi
- General Surgery Unit, ASST Ovest Milanese, Legnano, Italy
- General Surgery Unit, ASST Nord Milano, Sesto San Giovanni, Italy
| | - Marco Scatizzi
- General Surgery Unit, Santa Maria Annunziata & Serristori Hospital, Firenze, Italy
| | - Felice Pirozzi
- General Surgery Unit, ASL Napoli 2 Nord, Pozzuoli, Italy
| | - Paolo Delrio
- Colorectal Surgical Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori, ‘Fondazione Giovanni Pascale IRCCS-Italia’, Napoli, Italy
| | | | - Pierluigi Marini
- General & Emergency Surgery Unit, San Camillo-Forlanini Hospital, Roma, Italy
| | | | - Raffaele De Luca
- Department of Surgical Oncology, IRCCS Istituto Tumori ‘Giovanni Paolo II’, Bari, Italy
| | - Ferdinando Ficari
- General Surgery and IBD Unit, Careggi University Hospital, Firenze, Italy
| | - Giuseppe Sica
- Minimally Invasive Surgery Unit, Policlinico Tor Vergata University Hospital, Roma, Italy
| | - Stefano Scabini
- General & Oncologic Surgery Unit, IRCCS ‘San Martino’ National Cancer Center, Genova, Italy
| | - Andrea Liverani
- General Surgery Unit, Regina Apostolorum Hospital, Albano Laziale, Italy
| | - Marco Caricato
- Colorectal Surgery Unit, Policlinico Campus BioMedico, Roma, Italy
| | - Alberto Patriti
- Department of Surgery, Marche Nord Hospital, Pesaro e Fano, Italy
| |
Collapse
|
8
|
Zheng V, Wee IJY, Abdullah HR, Tan S, Tan EKW, Seow-En I. Same-day discharge (SDD) vs standard enhanced recovery after surgery (ERAS) protocols for major colorectal surgery: a systematic review. Int J Colorectal Dis 2023; 38:110. [PMID: 37121985 PMCID: PMC10149457 DOI: 10.1007/s00384-023-04408-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/10/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) programs are well-established, resulting in improved outcomes and shorter length of hospital stay (LOS). Same-day discharge (SDD), or "hyper-ERAS", is a natural progression of ERAS. This systematic review aims to compare the safety and efficacy of SDD against conventional ERAS in colorectal surgery. METHODS The protocol was prospectively registered in PROSPERO (394793). A systematic search was performed in major databases to identify relevant articles, and a narrative systematic review was performed. Primary outcomes were readmission rates and length of hospital stay (LOS). Secondary outcomes were operative time and blood loss, postoperative pain, morbidity, nausea or vomiting, and patient satisfaction. Risks of bias was assessed using the ROBINS-I tool. RESULTS Thirteen studies were included, with five single-arm and eight comparative studies, of which one was a randomised controlled trial. This comprised a total of 38,854 patients (SDD: 1622; ERAS: 37,232). Of the 1622 patients on the SDD pathway, 1590 patients (98%) were successfully discharged within 24 h of surgery. While most studies had an overall low risk of bias, there was considerable variability in inclusion criteria, types of surgery or anaesthesia, and discharge criteria. SDD resulted in a significantly reduced postoperative LOS, without increasing risk of 30-day readmission. Intraoperative blood loss and postoperative morbidity rates were comparable between both groups. Operative duration was shorter in the SDD group. Patient-reported satisfaction was high in the SDD cohort. CONCLUSION SDD protocols appear to be safe and feasible in selected patients undergoing major colorectal operations. Randomised controlled trials are necessary to further substantiate these findings.
Collapse
Affiliation(s)
- V Zheng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - I J Y Wee
- Department of Colorectal Surgery, Singapore General Hospital, Singapore City, Singapore
| | - H R Abdullah
- Department of Anaesthesiology, Singapore General Hospital, Singapore City, Singapore
| | - S Tan
- Department of Anaesthesiology, Singapore General Hospital, Singapore City, Singapore
| | - E K W Tan
- Department of Colorectal Surgery, Singapore General Hospital, Singapore City, Singapore
| | - I Seow-En
- Department of Colorectal Surgery, Singapore General Hospital, Singapore City, Singapore.
| |
Collapse
|