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Funk Debleds P, Chambrier C, Slim K. Postoperative nutrition in the setting of enhanced recovery programmes. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:106866. [PMID: 36914532 DOI: 10.1016/j.ejso.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 03/03/2023] [Indexed: 03/10/2023]
Abstract
Patients undergoing major surgery for gastrointestinal cancer are at high risk of developing or worsening malnutrition and sarcopenia. In malnourished patients, preoperative nutritional support may not be sufficient and so postoperative support is advised. This narrative review addresses several aspects of postoperative nutritional care in the setting of enhanced recovery programmes. Early oral feeding, therapeutic diet, oral nutritional supplements, immunonutrition, and probiotics are discussed. When postoperative intake is insufficient, nutritional support favouring the enteral route is recommended. Whether this approach should use a nasojejunal tube or jejunostomy is still a matter of debate. In the setting of enhanced recovery programmes with early discharge, nutritional follow-up and care should be continued beyond the short time in hospital. In enhanced recovery programmes, the main specific aspects of nutrition are patient education, early oral intake, and post-discharge care. The other aspects do not differ from conventional care.
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Affiliation(s)
- Pamela Funk Debleds
- Department of Supportive Care, Centre de Lutte Contre le Cancer Léon Bérard, Lyon, France
| | - Cécile Chambrier
- Intensive Clinical Nutrition Department, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, France
| | - Karem Slim
- Department of Digestive Surgery, University Hospital, CHU, Clermont-Ferrand, France; Francophone Group for Enhanced Recovery After Surgery, France.
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Zhang Y, Zhang J, Zhu L, Hao J, He F, Xu T, Wang R, Zhuang W, Wang M. A Narrative Review of Nutritional Therapy for Gastrointestinal Cancer Patients Underwent Surgery. J INVEST SURG 2023; 36:2150337. [DOI: 10.1080/08941939.2022.2150337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Affiliation(s)
- Yujie Zhang
- Center of Gastric Cancer, West China Hospital, Sichuan University, Chengdu, China
| | - Jinglin Zhang
- Center of Gastric Cancer, West China Hospital, Sichuan University, Chengdu, China
- Department of Gastrointestinal Surgery, Yibin Second People’s Hospital, Yibin, China
| | - Lili Zhu
- Center of Gastric Cancer, West China Hospital, Sichuan University, Chengdu, China
| | - Jiaqi Hao
- Center of Gastric Cancer, West China Hospital, Sichuan University, Chengdu, China
| | - Fengjun He
- Center of Gastric Cancer, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Xu
- Center of Gastric Cancer, West China Hospital, Sichuan University, Chengdu, China
- Department of General Surgery, Suining Municipal Hospital of Traditional Chinese Medicine, Suining, China
| | - Rui Wang
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Wen Zhuang
- Center of Gastric Cancer, West China Hospital, Sichuan University, Chengdu, China
| | - Mojin Wang
- Center of Gastric Cancer, West China Hospital, Sichuan University, Chengdu, China
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Lu C, Sun X, Geng Q, Tang W. Early oral feeding following intestinal anastomosis surgery in infants: a multicenter real world study. Front Nutr 2023; 10:1185876. [PMID: 37545580 PMCID: PMC10399449 DOI: 10.3389/fnut.2023.1185876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/05/2023] [Indexed: 08/08/2023] Open
Abstract
Background To prevent postoperative complications, delayed oral feeding (DOF) remains a common model of care following pediatric intestinal anastomosis surgery; however, early oral feeding (EOF) has been shown to be safe and effective in reducing the incidence of complications and fast recovery after pediatric surgery. Unfortunately, the evidence in support of EOF after intestinal anastomosis (IA) in infants is insufficient. Therefore, this study was primarily designed to evaluate the safety and efficacy of EOF. In addition, the current status of EOF application and associated factors that favor or deter EOF implementation were also assessed. Methods A total of 898 infants were divided into two groups (EOF group, n = 182; DOF group, n = 716), and the clinical characteristics were collected to identify the factors associated with EOF in infants. Complications and recovery were also compared to define the safety and efficacy after balancing the baseline data by propensity score matching (PSM) (EOF group, n = 179; DOF group, n = 319). Results The total EOF rate in infants with IA was 20.3%. Multivariate logistic regression revealed significant differences in the EOF rates based on IA site and weight at the time of surgery (OR = 0.652, 95% CI: 0.542-0.784, p < 0.001) and (OR = 1.188, 95% CI: 1.036-1.362, p = 0.013), respectively. The duration of total parenteral nutrition (TPN), parenteral nutrition (PN), and postoperative hospital stay were significantly shorter in the EOF group than the DOF group [2.0 (1.0, 2.0) d vs. 5.0 (3.0, 6.0) d; 6.0 (5.0, 8.0) d vs. 8.0 (6.0, 11.0) d; 10.0 (7.0, 14.0) d vs. 12.0 (9.0, 15.0) d, all p < 0.001]. The rates of abdominal distension and vomiting in the EOF group were significantly higher than the DOF group (17.9% vs. 7.2%, p < 0.001; 7.8% vs. 2.5%, p = 0.006); however, no differences were found in failure to initial OF, diarrhea, hematochezia, and anastomotic leakage between the two groups (p > 0.05). Conclusion The overall rate of EOF in infants following IA was low, and the sites of anastomosis and weight at surgery were two factors associated with EOF. Nevertheless, performing EOF in infants after IA was safe and effective, reduced PN usage, shortened the hospital stay, and did not increase the rate of severe complications.Clinical Trial Registration: ClinicalTrails.gov, identifier NCT04464057.
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Affiliation(s)
- Changgui Lu
- Department of Pediatric Surgery, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Xinhe Sun
- Nanjing Medical University, Nanjing, China
| | - Qiming Geng
- Department of Pediatric Surgery, Children’s Hospital of Nanjing Medical University, Nanjing, China
| | - Weibing Tang
- Department of Pediatric Surgery, Children’s Hospital of Nanjing Medical University, Nanjing, China
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Zhang Y, Tao K, Yu J, Chen C, Zheng Q, Lei S, Zhong X, Liu L, Wang W, Wang Q, Li E, Luo Y, Zhang G, Feng X, Li Y, Wang J. Evaluation of early liquid drinking after radical gastrectomy in gastric cancer: a Chinese multicenter propensity score matching analysis. Gastroenterol Rep (Oxf) 2023; 11:goad029. [PMID: 37304556 PMCID: PMC10250079 DOI: 10.1093/gastro/goad029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 04/14/2023] [Indexed: 06/13/2023] Open
Abstract
Background Enhanced recovery after surgery is used in gastrointestinal surgery. This study aimed to access the effects of early liquid drinking (ELD) on gastrointestinal function recovery in patients with gastric cancer (GC) who underwent radical gastrectomy, as high-quality evidence on the outcomes of ELD after gastrectomy is currently lacking. Methods Clinicopathological data of patients with GC from 11 centers were retrospectively analysed. Clinical outcomes were investigated in 555 patients, including 225 who started drinking liquid within 48 h (ELD group) of surgery and 330 who started drinking liquid after flatus resumption (traditional liquid drinking [TLD] group). Propensity score matching (PSM) analysis was performed using a match ratio of 1:1 and 201 patients were selected from each group for the analysis. Primary outcome was time to first passage of flatus. Secondary outcomes included time to first defecation, post-operative hospitalization days, occurrence of short-term post-operative complications, and hospitalization costs. Results After PSM, baseline characteristics were not significantly different between the two groups. The time to first flatus (2.72 ± 1.08 vs 3.36 ± 1.39 days), first defecation (4.34 ± 1.85 vs 4.77 ± 1.61 days), and post-operative hospital stay (8.27 ± 4.02 vs 12.94 ± 4.43 days) were shorter in the ELD group than in the TLD group (all P < 0.05). The ELD group had lower hospitalization costs than the TLD group ([7.83 ± 2.44 vs 8.78 ± 3.41] × 104 RMB, P = 0.041). No significant differences were observed in the incidence of post-operative complications. Conclusions Compared with TLD, post-operative ELD could promote rapid recovery of gastrointestinal function and reduce hospitalization costs; moreover, ELD does not increase the risk of post-operative complications.
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Affiliation(s)
| | | | | | - Chao Chen
- Department of Gastrointestinal Surgery, Huizhou Municipal Central Hospital, Huizhou, Guangdong, P. R. China
| | - Quan Zheng
- Department of Gastrointestinal Surgery, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, P. R. China
| | - Sanlin Lei
- Department of Gastrointestinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, P. R. China
| | - Xiaogang Zhong
- Department of Surgical Treatment of Gastrointestinal Hernia and Fistula, The People’s Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, Guangxi, P. R. China
| | - Lixin Liu
- Department of General Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, P. R. China
| | - Wei Wang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, P. R. China
| | - Qiang Wang
- Department of Gastrointestinal Surgery, Guangzhou First People’s Hospital, Guangzhou, Guangdong, P. R. China
| | - En Li
- Department of Gastrointestinal Surgery, Meizhou People’s Hospital, Meizhou, Guangdong, P. R. China
| | - Yuwen Luo
- Department of General Surgery, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, P. R. China
| | - Guanrong Zhang
- lnformation and Statistics Center, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, P. R. China
| | - Xingyu Feng
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, P. R. China
- Shantou University Medical College, Shantou, Guangdong, P. R. China
| | - Yong Li
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, P. R. China
- Shantou University Medical College, Shantou, Guangdong, P. R. China
| | - Junjiang Wang
- Corresponding author. Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, No. 106 Zhongshan Second Street, Yuexiu District, Guangzhou 510080, Guangdong, P. R. China. Tel: +86-20-83827812;
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Early and late anastomotic leak after colorectal surgery: A systematic review of the literature. Cir Esp 2023; 101:3-11. [PMID: 35882311 DOI: 10.1016/j.cireng.2022.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 06/24/2022] [Indexed: 01/17/2023]
Abstract
The aim of this study was to review and to assess the quality of the scientific articles regarding early and late anastomotic leak (AL) after colorectal surgery and their risk factors. An electronic systematic search for articles on Colorectal Surgery, AL and its timing was undertaken using the MEDLINE database via PubMed, Cochrane and Embase. The selected articles were thoroughly reviewed and assessed for methodological quality using a validated methodology quality score (MINCIR score). This review was registered in the PROSPERO registry under ID: CRD42022303012. 9 articles were finally reviewed in relation to the topic of early and late anastomotic leak. There is a lack of consensus regarding the exact cut-off in time to define early and late anastomotic leak, but it is clear that they are two differentiated entities. The first, occurring in relation to technical factors; whereas the latter, is related to impaired healing.
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Škrabec CG, Carné AV, Pérez MC, Corral J, Pujol AF, Cuadrado M, Troya J, Ibáñez JFJ, Parés D. Early and late anastomotic leak after colorectal surgery: A systematic review of the literature. Cir Esp 2023. [DOI: 10.1016/j.ciresp.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Robitaille S, Wang A, Liberman AS, Charlebois P, Stein B, Fiore JF, Feldman LS, Lee L. A retrospective analysis of early discharge following minimally invasive colectomy in an enhanced recovery pathway. Surg Endosc 2022; 37:2756-2764. [PMID: 36471062 PMCID: PMC9734303 DOI: 10.1007/s00464-022-09777-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND There is increasing evidence to support discharge prior to gastrointestinal recovery following colorectal surgery. Furthermore, many patients are discharged early despite being excluded from an ambulatory colectomy pathway. The objective of this study was to determine the outcomes of patients discharged early following laparoscopic colectomy in an enhanced recovery pathway (ERP). METHODS A retrospective review of all adult patients undergoing elective laparoscopic colectomy at a single university-affiliated colorectal referral center (08/2017-06/2021) was performed. Patients were included if they had undergone elective laparoscopic colectomy or ileostomy closure and excluded if they had been enrolled in an ambulatory colectomy pathway. Patients were then divided into three groups: LOS =1 day, LOS 2-3 days, and LOS 4+ days. The main outcomes were 30-day emergency room (ER) visits and readmissions. Reasons for inpatient stay per post-operative day (POD) were also recorded. RESULTS A total of 497 patients were included [LOS1 n = 63 (13%), LOS2-3 n = 284 (57%), and LOS4+ n = 150 (30%)]. There were no differences in patient characteristics, diagnosis, or procedure between the groups. Patients were discharged with gastrointestinal recovery (GI-3) in 54% LOS1 vs. 98% LOS2-3 vs. 100% LOS4+ (p<0.001). Shorter procedure duration, transversus abdominus plane block, and lower opioid requirements were associated with shorter LOS (p<0.001). The absence of flatus was the most common reason to keep patients hospitalized: 61% on POD1, 21% on POD2, and 8% on POD3 (p<0.001). There were no differences in 30-day emergency visits, or readmission between the groups. In the LOS1 group, there were no differences in outcomes between patients with full return of bowel function at discharge compared to those without. CONCLUSION Discharge on POD1 was not associated with increased emergency department use, complications, or readmissions. Importantly, full return of bowel function at discharge did not affect outcomes. There may be potential to expand eligibility criteria for ambulatory colectomy protocol.
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Affiliation(s)
- Stephan Robitaille
- Department of Surgery, McGill University Health Centre, Glen Campus – DS1.3310, 1001 Decarie Boulevard, Montreal, QC H3G 1A4 Canada ,Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC Canada
| | - Anna Wang
- Department of Surgery, McGill University Health Centre, Glen Campus – DS1.3310, 1001 Decarie Boulevard, Montreal, QC H3G 1A4 Canada
| | - A. Sender Liberman
- Department of Surgery, McGill University Health Centre, Glen Campus – DS1.3310, 1001 Decarie Boulevard, Montreal, QC H3G 1A4 Canada
| | - Patrick Charlebois
- Department of Surgery, McGill University Health Centre, Glen Campus – DS1.3310, 1001 Decarie Boulevard, Montreal, QC H3G 1A4 Canada
| | - Barry Stein
- Department of Surgery, McGill University Health Centre, Glen Campus – DS1.3310, 1001 Decarie Boulevard, Montreal, QC H3G 1A4 Canada
| | - Julio F. Fiore
- Department of Surgery, McGill University Health Centre, Glen Campus – DS1.3310, 1001 Decarie Boulevard, Montreal, QC H3G 1A4 Canada ,Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC Canada
| | - Liane S. Feldman
- Department of Surgery, McGill University Health Centre, Glen Campus – DS1.3310, 1001 Decarie Boulevard, Montreal, QC H3G 1A4 Canada ,Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC Canada
| | - Lawrence Lee
- Department of Surgery, McGill University Health Centre, Glen Campus – DS1.3310, 1001 Decarie Boulevard, Montreal, QC H3G 1A4 Canada ,Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC Canada
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Tolerating clear fluids diet on postoperative day 0 predicts early recovery of gastrointestinal function after laparoscopic colectomy. Surg Endosc 2022; 36:9262-9272. [PMID: 35254522 DOI: 10.1007/s00464-022-09151-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 02/17/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION A high proportion of colorectal surgery patients within an enhanced recovery pathway (ERP) do not experience complications but remain hospitalized mainly waiting for gastrointestinal (GI) recovery. Accurate identification of these patients may allow discharge prior to the return of GI function. Therefore, the objective of this study is to determine if tolerating clear fluid (CF) on postoperative day (POD) 0 was associated with uncomplicated return of GI function after laparoscopic colorectal surgery. METHODS Pooled data from three prospective studies from a single specialist colorectal referral center were analyzed (2013-2019). The present study included adult patients that underwent elective laparoscopic colectomy without stoma. Postoperative GI symptoms were collected daily in all three datasets. The main exposure variable, whether CF diet was tolerated on POD0, was defined as patients drinking at least 300 mL of CF without any nausea, anti-emetics, or vomiting (CF+ vs CF-). The main outcome measure was time to GI-3 (tolerating solid diet and passage of gas or stools). RESULTS A total of 221 patients were included in this study, including 69% CF+ and 31% CF-. The groups were similar in age, gender, and comorbidities, but the CF- patients were more likely to have surgery for inflammatory bowel disease. CF+ patients had faster time to GI-3 (mean 1.6d (SD 0.7) vs. 2.3d (SD 1.5), p < 0.001). The CF+ group also experienced fewer complications (19% vs. 35%, p = 0.009), shorter mean LOS (mean 3.6d (SD 2.9) vs. 6.2d (SD 9.4), p = 0.002), and were more likely to be discharged by the target LOS (66% vs. 50%, p = 0.024). CONCLUSION Toleration of CF on POD0 was associated with faster return of GI function, fewer complications, and shorter LOS. This may be used as a criteria for potential discharge prior to full return of GI function after laparoscopic colectomy within an ERP.
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McLemore EC, Lee L, Hedrick TL, Rashidi L, Askenasy EP, Popowich D, Sylla P. Same day discharge following elective, minimally invasive, colorectal surgery : A review of enhanced recovery protocols and early outcomes by the SAGES Colorectal Surgical Committee with recommendations regarding patient selection, remote monitoring, and successful implementation. Surg Endosc 2022; 36:7898-7914. [PMID: 36131162 PMCID: PMC9491699 DOI: 10.1007/s00464-022-09606-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 08/28/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND As enhanced recovery programs (ERPs) have continued to evolve, the length of hospitalization (LOS) following elective minimally invasive colorectal surgery has continued to decline. Further refinements in multimodal perioperative pain management strategies have resulted in reduced opioid consumption. The interest in ambulatory colectomy has dramatically accelerated during the COVID-19 pandemic. Severe restrictions in hospital capacity and fear of COVID transmission forced surgical teams to rethink strategies to further reduce length of inpatient stay. METHODS Members of the SAGES Colorectal Surgery Committee began reviewing the emergence of SDD protocols and early publications for SDD in 2019. The authors met at regular intervals during 2020-2022 period reviewing SDD protocols, safe patient selection criteria, surrogates for postoperative monitoring, and early outcomes. RESULTS Early experience with SDD protocols for elective, minimally invasive colorectal surgery suggests that SDD is feasible and safe in well-selected patients and procedures. SDD protocols are associated with reduced opioid use and prescribing. Patient perception and experience with SDD is favourable. For early adopters, SDD has been the natural evolution of well-developed ERPs. Like all ERPs, SDD begins in the office setting, identifying the correct patient and procedure, aligning goals and objectives, and the perioperative education of the patient and their supporting significant others. A thorough discussion with the patient regarding expected activity levels, oral intake, and pain control post operatively lays the foundation for a successful application of SDD programs. These observations may not apply to all patient populations, institutions, practice types, or within the scope of an existing ERP. However, if the underlying principles of SDD can be incorporated into an existing institutional ERP, it may further reduce the incidence of post operative ileus, prolonged LOS, and improve the effectiveness of oral analgesia for postoperative pain management and reduced opioid use and prescribing. CONCLUSIONS The SAGES Colorectal Surgery Committee has performed a comprehensive review of the early experience with SDD. This manuscript summarizes SDD early results and considerations for safe and stepwise implementation of SDD with a specific focus on ERP evolution, patient selection, remote monitoring, and other relevant considerations based on hospital settings and surgical practices.
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Affiliation(s)
- Elisabeth C McLemore
- Bernard J. Tyson Kaiser Permanente School of Medicine, Los Angeles Medical Center, Los Angeles, CA, 90027, USA.
- Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Colon and Rectal Surgery, Los Angeles Medical Center, 4760 Sunset Blvd, 3rd Floor, Los Angeles, CA, 90027, USA.
| | - Lawrence Lee
- Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Traci L Hedrick
- Department of Surgery, University of Virginia Health, Charlottesville, VA, USA
| | | | - Erik P Askenasy
- Division of Colon and Rectal Surgery, University of Texas Health, Houston, TX, USA
| | - Daniel Popowich
- Division of Colon and Rectal Surgery, St. Francis Hospital, New York, NY, USA
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Venara A, Hamel JF, Régimbeau J, Gillet J, Joris J, Cotte E, Slim K. Acute urinary retention and urinary tract infection after short-course urinary drainage in colon or high rectum anastomoses: Post hoc analysis of a multicentre prospective database from the GRACE group. Colorectal Dis 2022; 24:1164-1171. [PMID: 35536237 PMCID: PMC9796259 DOI: 10.1111/codi.16184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/29/2022] [Accepted: 05/01/2022] [Indexed: 01/01/2023]
Abstract
AIM The aim was to define the risk factors for acute urinary retention (AUR) and urinary tract infections (UTIs) in colon or high rectum anastomosis patients based on the absence of a urinary catheter (UC) or the early removal of the UC (<24 h). METHOD This is a multicentre, international retrospective analysis of a prospective database including all patients undergoing colon or high rectum anastomoses. Patients were part of the enhanced recovery programme audit, developed by the Francophone Group for Enhanced Recovery after Surgery, and were included if no UC was inserted or if a UC was inserted for <24 h. RESULTS In all, 9389 patients had colon or high rectum anastomoses using laparoscopy, open surgery or robotic surgery. Among these patients, 4048 were excluded because the UC was left in place >24 h (43.1%) and 97 were excluded because the management of UC was unknown (1%). Among the 5244 colon or high rectum anastomoses patients included, AUR occurred in 5.2% and UTI occurred in 0.7%. UCs were in place for <24 h in 2765 patients (52.7%) and 2479 did not have UCs in place (47.3%). Multivariate analysis showed that management of the UC was not significantly associated with the occurrence of AUR and that risk factors for AUR were male gender, ≥65 years old, having an American Society of Anesthesiologists score ≥3 and receiving epidural analgesia. Conversely, being of male gender was a protective factor of UTI, while being ≥65 years old, having open surgery and receiving epidural analgesia were risk factors for UTIs. The management of the UC was not significantly associated with the occurrence of UTIs but the occurrence of AUR was a more significant risk factor for UTIs. CONCLUSION UCs in place for <24 h did not reduce the occurrence of AUR or UTI compared to the absence of UCs.
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Affiliation(s)
- Aurélien Venara
- Department of Visceral and Endocrinal SurgeryUniversity Hospital of AngersAngers Cedex 9France,Faculty of HealthDepartment of MedicineAngersFrance,Univ Angers, [CHU Angers], HIFIH, SFR ICAT, F‐49000 Angers, FranceUniversity of AngersAngersFrance
| | - Jean François Hamel
- Faculty of HealthDepartment of MedicineAngersFrance,Univ Angers, [CHU Angers], HIFIH, SFR ICAT, F‐49000 Angers, FranceUniversity of AngersAngersFrance,Department of Biostatistics, Maison de la RechercheUniversity Hospital of AngersAngers Cedex 9France
| | - Jean‐Marc Régimbeau
- Service de Chirurgie DigestiveCHU Amiens Picardie et Université de Picardie Jules VerneAmiensFrance,Unité de Recherche Clinique SSPC (Simplifications des Soins des Patients Complexes) UR UPJV 7518Université de Picardie Jules VerneAmiensFrance
| | - Julien Gillet
- Department of Visceral and Endocrinal SurgeryUniversity Hospital of AngersAngers Cedex 9France,Faculty of HealthDepartment of MedicineAngersFrance
| | - Jean Joris
- Department of AnaesthesiologyCHU LiègeLiègeBelgium
| | - Eddy Cotte
- Department of Visceral Surgery, Centre Hospitalier Lyon‐SudCHU LyonPierre‐Bénite CedexFrance,Université de LyonLyonFrance
| | - Karem Slim
- Department of Visceral SurgeryCHU Clermont‐FerrandClermont‐FerrandFrance
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Reducing postoperative fasting times by implementing a food service in the Post Anaesthesia Care Unit (PACU). Clin Nutr ESPEN 2022; 51:280-287. [DOI: 10.1016/j.clnesp.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 08/13/2022] [Indexed: 11/24/2022]
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12
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He FJ, Wang MJ, Yang K, Chen XL, Jin T, Zhu LL, Zhuang W. Effects of Preoperative Oral Nutritional Supplements on Improving Postoperative Early Enteral Feeding Intolerance and Short-Term Prognosis for Gastric Cancer: A Prospective, Single-Center, Single-Blind, Randomized Controlled Trial. Nutrients 2022; 14:nu14071472. [PMID: 35406085 PMCID: PMC9002901 DOI: 10.3390/nu14071472] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Early enteral nutrition (EN) after abdominal surgery can improve the prognosis of patients. However, the high feeding intolerance (FI) rate is the primary factor impeding postoperative EN. METHODS Sixty-seven patients who underwent radical subtotal or total gastrectomy for gastric cancer (GC) were randomly allocated to the preoperative oral nutritional supplement group (ONS group) or dietary advice alone (DA group). Both groups were fed via nasojejunal tubes (NJs) from the first day after surgery to the fifth day. The primary endpoint is the FI rate. RESULTS Of the patients, 66 completed the trial (31 in the ONS group, 35 in the DA group). The FI rate in the ONS group was lower than that in the DA group (25.8% vs. 31.4%, p = 0.249). The postoperative five-day 50% energy compliance rate in the ONS group was higher than that in the DA group (54.8% vs. 48.6%, p = 0.465). The main gastrointestinal intolerance symptoms were distension (ONS vs. DA: 45.2% vs. 62.9, p = 0.150) and abdominal pain (ONS vs. DA: 29.0% vs. 45.7%, p = 0.226). Postoperative nausea/vomiting rate and heartburn/reflux rate were similar between the two groups. We noted no difference in perioperative serum indices, short-term prognosis or postoperative complication rates between the two groups. CONCLUSIONS The study shows that short-term preoperative ONS cannot significantly improve FI and the energy compliance rate in the early stage after radical gastrectomy.
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Affiliation(s)
- Feng-Jun He
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu 610044, China; (F.-J.H.); (T.J.); (L.-L.Z.)
| | - Mo-Jin Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610044, China; (M.-J.W.); (K.Y.); (X.-L.C.)
| | - Kun Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610044, China; (M.-J.W.); (K.Y.); (X.-L.C.)
| | - Xiao-Long Chen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610044, China; (M.-J.W.); (K.Y.); (X.-L.C.)
| | - Tao Jin
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu 610044, China; (F.-J.H.); (T.J.); (L.-L.Z.)
| | - Li-Li Zhu
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu 610044, China; (F.-J.H.); (T.J.); (L.-L.Z.)
| | - Wen Zhuang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610044, China; (M.-J.W.); (K.Y.); (X.-L.C.)
- Correspondence: ; Tel.: +86-189-8060-1497; Fax: +86-28-8542-2708
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13
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Hardy PJ, Tavano A, Jacquet SV, Monseur JJ, Bastin ML, Kohnen LP, Haumann AE, Joris JL. The impact of orthostatic intolerance on early ambulation following abdominal surgery in an enhanced recovery programme. Acta Anaesthesiol Scand 2022; 66:454-462. [PMID: 35118648 DOI: 10.1111/aas.14034] [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: 09/17/2021] [Revised: 01/09/2022] [Accepted: 01/19/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The prevalence of orthostatic intolerance on the day of surgery is more than 50% after abdominal surgery. The impact of orthostatic intolerance on ambulation on the day of surgery has been little studied. We investigated orthostatic intolerance and walking ability after colorectal and bariatric surgery in an enhanced recovery programme. METHODS Eighty-two patients (colorectal: n = 46, bariatric n = 36) were included and analysed in this prospective study. Walk tests for 2 min (2-MWT) and 6 min (6-MWT) were performed before and 24 h after surgery, and 3 h after surgery for 2-MWT. Orthostatic intolerance characterised by presyncopal symptoms when rising was recorded at the same time points. Multivariate binary logistic regressions modelling the probability of orthostatic intolerance and walking inability were performed taking into account potential risk factors. RESULTS Prevalence of orthostatic intolerance and walking inability was, respectively, 65% and 18% 3-hour after surgery. The day after surgery, patients' performance had greatly improved: approximately 20% of the patients experienced orthostatic intolerance, whilst only 5% of the patients were unable to walk. Adjusted binary logistic regressions demonstrated that age (p = .37), sex (p = .39), BMI (p = .74), duration of anaesthesia (p = .71) and type of surgery (p = .71) did not significantly influence walking ability. CONCLUSION Our study confirms that orthostatic intolerance was frequent (~ 60%) 3-hour after abdominal surgery but prevented a 2-MWT only in ~20% of patients. No risk factors for orthostatic intolerance and walking inability were evidenced.
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Affiliation(s)
- Pierre‐Yves J‐P. Hardy
- Department of Anaesthesia and Intensive Care Medicine CHU Liège University of Liège Liège Belgium
- Groupe francophone de réhabilitation améliorée après chirurgie (GRACE; Francophone group for enhanced recovery after surgery) Beaumont France
| | - Alessandro Tavano
- Department of Anaesthesia and Intensive Care Medicine CHU Liège University of Liège Liège Belgium
| | - Sophie V. Jacquet
- Service of Physical Medicine and Rehabilitation CHU Liège University of Liège Liège Belgium
| | - Justine J. Monseur
- Biostatistics Unit Department of Public Health University of Liège Liège Belgium
| | - Marie‐Hélène L. Bastin
- Service of Physical Medicine and Rehabilitation CHU Liège University of Liège Liège Belgium
| | - Laurent P. Kohnen
- Service of Digestive Surgery CHU Liège University of Liège Liège Belgium
| | | | - Jean L. Joris
- Department of Anaesthesia and Intensive Care Medicine CHU Liège University of Liège Liège Belgium
- Groupe francophone de réhabilitation améliorée après chirurgie (GRACE; Francophone group for enhanced recovery after surgery) Beaumont France
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14
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Fabulas F, Paisant P, Dinomais M, Mucci S, Casa C, Le Naoures P, Hamel JF, Perrot J, Venara A. Pre-habilitation before colorectal cancer surgery could improve postoperative gastrointestinal function recovery: a case-matched study. Langenbecks Arch Surg 2022; 407:1595-1603. [PMID: 35260942 DOI: 10.1007/s00423-022-02487-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 03/02/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE While its effect is controverted, multimodal pre-habilitation could be used to improve the postoperative course following colorectal cancer surgery. However, by increasing lean body mass, pre-habilitation could reduce the time needed to recover gastrointestinal (GI) functions. The aim was to assess the impact of pre-habilitation before colorectal cancer surgery on postoperative GI motility recovery. METHODS This is a matched retrospective study based on a prospective database including patients undergoing colorectal surgery without pre-habilitation (NPH) (2016-2018) and with pre-habilitation (PH group) (2018-2019). The main outcome measure was the time to GI-3 recovery (tolerance to solid food and flatus and/or stools). RESULTS One hundred thirteen patients were included, 37 underwent pre-habilitation (32.7%). The patient's age, the surgical procedure, the surgical access, the rate of synchronous metastasis, the rate of preoperative chemoradiotherapy, and the rate of stoma were more important in the PH group. Conversely, the rate of patients with an ASA score of > 2 was higher in the NPH group. By matching patients according to age, gender and surgical procedure, 84 patients were compared (61 in the NPH group and 23 in the PH group). The mean of GI-3 recovery was significantly lower in the PH group. The other endpoints were not significantly different but time to GI function recovery and medical morbidity tended to be higher in the NPH group. Compliance with the enhanced recovery program was significantly higher in the PH group. CONCLUSION Pre-habilitation before colorectal cancer surgery reduced time to GI function recovery and may increase compliance with the enhanced recovery program.
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Affiliation(s)
- F Fabulas
- Department of Visceral Surgery, CHU Angers, 4 rue Larrey, 49933 ANGERS Cedex 9, Angers, France.,Department of Medicine, Faculty of Health of Angers, Angers, France
| | | | - M Dinomais
- Department of Medicine, Faculty of Health of Angers, Angers, France.,CRRRF, Angers, France
| | - S Mucci
- Department of Visceral Surgery, CHU Angers, 4 rue Larrey, 49933 ANGERS Cedex 9, Angers, France
| | - C Casa
- Department of Visceral Surgery, CHU Angers, 4 rue Larrey, 49933 ANGERS Cedex 9, Angers, France
| | - P Le Naoures
- Department of Visceral Surgery, CHU Angers, 4 rue Larrey, 49933 ANGERS Cedex 9, Angers, France
| | - J F Hamel
- Department of Medicine, Faculty of Health of Angers, Angers, France.,Department of Biostatistics, CHU Angers, La Maison de la Recherche4 rue Larrey, 49933 ANGERS Cedex 9, Angers, France
| | - J Perrot
- Department of Medicine, Faculty of Health of Angers, Angers, France.,Department of Biostatistics, CHU Angers, La Maison de la Recherche4 rue Larrey, 49933 ANGERS Cedex 9, Angers, France
| | - Aurélien Venara
- Department of Visceral Surgery, CHU Angers, 4 rue Larrey, 49933 ANGERS Cedex 9, Angers, France. .,Department of Medicine, Faculty of Health of Angers, Angers, France. .,HIFIH, UPRES, Angers, France.
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15
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Leung V, Baldini G, Liberman S, Charlebois P, Stein B, Fiore JF, Feldman LS, Lee L. Trajectory of gastrointestinal function after laparoscopic colorectal surgery within an enhanced recovery pathway. Surgery 2021; 171:607-614. [PMID: 34844751 DOI: 10.1016/j.surg.2021.08.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/26/2021] [Accepted: 08/30/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Early identification of colorectal surgery patients predicted to have uneventful gastrointestinal recovery may allow for early discharge. Our objective was to identify trajectories of gastrointestinal recovery within a colorectal surgery enhanced recovery pathway. METHODS Data from 2 prospective studies enrolling adult patients undergoing elective laparoscopic colorectal resection at a specialist colorectal referral center were analyzed (2013-2019). All patients were managed according to a mature enhanced recovery pathway with a 3-day target length of stay. Postoperative gastrointestinal symptoms were collected daily and expressed using the validated I-FEED score. Latent-class growth curve (trajectory) analysis was used to identify different I-FEED trajectories over the first 3 postoperative days. RESULTS A total of 192 patients were analyzed. Trajectory analysis identified 3 distinct trajectories: trajectory 1 had no gastrointestinal symptoms (41%); trajectory 2 had mild early symptoms with improvement over time (48%); and trajectory 3 had gastrointestinal symptoms that significantly worsened between postoperative days 1 and 2 (11%). I-FEED score ≤1 on postoperative day 1 predicted trajectory 1. Trajectory 1 had the best clinical outcomes, whereas trajectory 3 had the worst. CONCLUSION I-FEED trajectory over postoperative days 1-3 was associated with clinical outcomes and may be used to predict gastrointestinal recovery. Findings from this study may inform clinical decision making regarding early hospital discharge within colorectal enhanced recovery pathways.
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Affiliation(s)
- Vivian Leung
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC
| | - Gabriele Baldini
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC; Department of Anaesthesia, McGill University Health Centre, Montreal, QC
| | - Sender Liberman
- Colon and Rectal Surgery, Department of Surgery, McGill University Health Centre, Montreal, QC
| | - Patrick Charlebois
- Colon and Rectal Surgery, Department of Surgery, McGill University Health Centre, Montreal, QC
| | - Barry Stein
- Colon and Rectal Surgery, Department of Surgery, McGill University Health Centre, Montreal, QC
| | - Julio F Fiore
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC
| | - Liane S Feldman
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC
| | - Lawrence Lee
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC; Colon and Rectal Surgery, Department of Surgery, McGill University Health Centre, Montreal, QC.
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16
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Peng Y, Xiao D, Xiao S, Yang L, Shi H, He Q, Xu H, Zhu X, Zhong W, Yu J. Early enteral feeding versus traditional feeding in neonatal congenital gastrointestinal malformation undergoing intestinal anastomosis: A randomized multicenter controlled trial of an enhanced recovery after surgery (ERAS) component. J Pediatr Surg 2021; 56:1479-1484. [PMID: 33838898 DOI: 10.1016/j.jpedsurg.2021.02.067] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/04/2021] [Accepted: 02/17/2021] [Indexed: 01/19/2023]
Abstract
PURPOSE the aim of this clinical trial was to evaluate the safety and efficacy of early enteral feeding (EEN) following intestinal anastomosis in neonates with congenital gastrointestinal malformation. METHODS a multicenter, prospective, randomized controlled trial (registered under chictr.org.cn Identifier no.ChiCTR-INR-17014179) was conducted between 2018 and 2019. Four centers in China analyzed 156 newborns of congenital gastrointestinal malformation undergoing intestinal anastomosis to EEN group (n = 78) or control (C) group (n = 78). The primary outcomes of this study were length of postoperative stay (LOPS) and time to full feeds. Secondary outcomes included morbidity of complications, parenteral nutrition (PN) duration, feeding intolerance, 30 day mortality rate and 30 day readmission rate. RESULTS the mean time to full feeds and LOPS in the EEN group were 15.0 (9.8-22.8) days and 17.6 (12.0-29.8) days, while that were 18.0 (12.0-24.0) days and 20.0 (15.0-30.3) days in C groups respectively. There was no significant difference between two groups(P >0.05). No significant intergroup difference was found with respect to postoperative morbidity, PN duration or feeding intolerance(P >0.05). CONCLUSIONS early enteral feeding following intestinal anastomosis in neonates with congenital gastrointestinal malformation is safe. Post-operative outcomes demonstrated a trend toward improvement. LEVEL OF EVIDENCE Level Ⅰ.
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Affiliation(s)
- Yanfen Peng
- Department of Neonatal Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Dong Xiao
- Department of General Surgery, Shenzhen Children's Hospital, Shenzhen, China
| | - Shangjie Xiao
- Department of Neonatal Surgery, Guangdong Women and Children's Hospital, Guangdong, China
| | - Liucheng Yang
- Department of General Surgery, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Hui Shi
- Guangzhou Women and Children's Medical Center, Institute of Pediatrics, Guangzhou, China
| | - Qiuming He
- Department of Neonatal Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Haozhong Xu
- Department of General Surgery, Shenzhen Children's Hospital, Shenzhen, China
| | - Xiaochun Zhu
- Department of Neonatal Surgery, Guangdong Women and Children's Hospital, Guangdong, China
| | - Wei Zhong
- Department of Neonatal Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Jiakang Yu
- Department of Neonatal Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China.
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17
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Garnier J, Mokart D, Ewald J, Lelong B, De Chaisemartin C, Marchese U, Meillat H, Guiramand J, Al Faraï A, Delpero J, Turrini O. Aspiration pneumonia following oncologic digestive surgery: Proposal for a classification. Health Sci Rep 2021; 4:e253. [PMID: 33778165 PMCID: PMC7990079 DOI: 10.1002/hsr2.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 01/07/2021] [Accepted: 02/03/2021] [Indexed: 12/08/2022] Open
Affiliation(s)
- Jonathan Garnier
- Department of Surgical OncologyInstitut Paoli‐CalmettesMarseilleFrance
| | - Djamel Mokart
- Department of Intensive CareInstitut Paoli‐CalmettesMarseilleFrance
| | - Jacques Ewald
- Department of Surgical OncologyInstitut Paoli‐CalmettesMarseilleFrance
| | - Bernard Lelong
- Department of Surgical OncologyInstitut Paoli‐CalmettesMarseilleFrance
| | | | - Ugo Marchese
- Department of Surgical OncologyInstitut Paoli‐CalmettesMarseilleFrance
| | - Helene Meillat
- Department of Surgical OncologyInstitut Paoli‐CalmettesMarseilleFrance
| | - Jerome Guiramand
- Department of Surgical OncologyInstitut Paoli‐CalmettesMarseilleFrance
| | - Abdallah Al Faraï
- Department of Surgical OncologyInstitut Paoli‐CalmettesMarseilleFrance
| | | | - Olivier Turrini
- Department of Surgical OncologyAix‐Marseille University, Institut Paoli‐Calmettes, CRCMMarseilleFrance
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Abstract
Mortality after visceral surgery has decreased owing to progress in surgical techniques, anesthesiology and intensive care. Mortality occurs in 5-10% of patients after major surgery and remains a topic of interest. However, the ratio of mortality after postoperative complications in relation to overall complications varies between hospitals because of failure to rescue at the time of the complication. There are multiple factors that lead to complication-related mortality: they are patient-related, disease-related, but are related, above all, to the timeliness of diagnosis of the complication, the organisational aspects of management in private or public hospitals, hospital volume that corresponds to the centralisation of initial management or to the concept of referral centre in case of complications, to the team spirit, to communication between the health care providers and to the management of the complication itself. Several organisational advances are to be considered, such as the development of shorter hospitalisations and notably ambulatory surgery, as well as enhanced recovery programs. Remote monitoring and the contribution of artificial intelligence must also be evaluated in this context. The reduction of mortality after visceral surgery rests on several tactics: prevention of potentially lethal complications, the all-important reduction of failure to rescue, and risk management before, during and after hospitalisations that are increasingly shorter.
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19
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Enhanced recovery after elective surgery. A revolution that reduces post-operative morbidity and mortality. J Visc Surg 2020; 157:487-491. [DOI: 10.1016/j.jviscsurg.2020.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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20
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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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21
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Venara A, Hamel JF, Cotte E, Meillat H, Sage PY, Slim K. Intraoperative nasogastric tube during colorectal surgery may not be mandatory: a propensity score analysis of a prospective database. Surg Endosc 2020; 34:5583-5592. [PMID: 31932940 DOI: 10.1007/s00464-019-07359-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 12/24/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Avoiding the use of nasogastric tubes (NGTs) is recommended after colorectal surgery but there is no consensus on intraoperative gastric decompression using NGTs during colorectal surgery. The objective was to assess the effect of avoiding insertion of NGTs during colorectal surgery for the recovery of gastrointestinal (GI) functions. METHOD 1561 patients undergoing colorectal surgery, for whom information on NGT use was available, were included in this retrospective analysis and propensity score analysis of the prospective GRACE Audit database. Patients who did and did not have an NGT during surgery were compared. RESULTS Among the study population of 1561 patients, 696 patients were matched to correct baseline differences between groups. The no-NGT group significantly improved GI motility impairment (e.g., less postoperative nausea [OR = 0.59; CI 95%: 0.42-0.84] and a better tolerance of early feeding [OR = 2.07; CI 95%: 1.33-3.22]). Such an association was also highlighted for reduced postoperative morbidity [OR = 0.60; CI 95%: 0.43-0.83], and especially pulmonary complications [OR = 0.08; CI 95%: 0.01-0.59], or parietal complications [OR = 0.29; CI 95%: 0.09-0.87]. The risk of postoperative ileus was not significantly reduced in the no-NGT group [OR = 0.67; CI 95%: 0.43-1.06]. CONCLUSION No NGT insertion during colorectal surgery is safe and could improve postoperative GI function recovery.
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Affiliation(s)
- Aurélien Venara
- Department of Visceral and Endocrinal Surgery, CHU Angers, University Hospital of Angers, 4, rue Larrey, 49933, Angers Cedex 9, France. .,TENS, UMR INSERM 1235, 1 Place Alexis Ricordeau, 44000, Nantes, France. .,Department of Medicine, University of Health of Angers, 49000, Angers, France.
| | - Jean-Francois Hamel
- Department of Medicine, University of Health of Angers, 49000, Angers, France.,Institut Paoli-Calmette, 232 boulevard de Sainte Marguerite, 13009, Marseille, France
| | - Eddy Cotte
- Department of Visceral Surgery, CHU Lyon, Centre Hospitalier Lyon-Sud, Université de Lyon, 69495, Pierre-Bénite Cedex, France
| | - Hélène Meillat
- Department of Visceral Surgery, CHU Grenoble, Université de Grenoble, 38700, La Tronche, France
| | - Pierre-Yves Sage
- Department of Endocrinal and Visceral Surgery, University Hospital of Clermont Ferrand, 63003, Clermont Ferrand, France
| | - Karem Slim
- Department of Visceral and Endocrinal Surgery, CHU Angers, University Hospital of Angers, 4, rue Larrey, 49933, Angers Cedex 9, France
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