Perianal application of 0.2 percent nitroglycerin ointment after hemorrhoidectomy significantly reduced narcotic requirements on the second postoperative day. Headaches and a subsequent need for nonnarcotic medications may limit benefits of nitroglycerin.

Perianal application of 2 percent diltiazem ointment after hemorrhoidectomy significantly reduces postoperative pain and is perceived as beneficial, with no increase in associated morbidity. Patients using a placebo ointment tend to take more prescription narcotics for pain relief postoperatively, with a similar usage of nonsteroidal anti-inflammatory drugs and acetaminophen, although differences were not significant.

Multidisciplinary clinic management of colorectal cancer is associated with a significantly more complete preoperative evaluation as well as improved access to multimodal therapy.

To determine the risk factors in diabetic patients that are associated with increased postcolectomy mortality and anastomotic leak. Design: A prospectively acquired statewide database of patients who underwent colectomy was reviewed. Primary risk factors were diabetes mellitus, hyperglycemia (glucose level Ն140 mg/dL), steroid use, and emergency surgery. Categorical analysis, univariate logistic regression, and multivariate regression were used to evaluate the effects of these risk factors on outcomes. Setting: Participating hospitals within the Michigan Surgical Quality Collaborative. Patients: Database review of patients from hospitals within the Michigan Surgical Quality Collaborative. Main Outcome Measures: Anastomotic leak and 30day mortality rate. Results: Of 5123 patients, 153 (3.0%) had leaks and 153 (3.0%) died. Preoperative hyperglycemia occurred in 15.6% of patients, only 54% of whom were known to have diabetes. Multivariate analysis showed that the risk of leak for patients with and without diabetes increased only by preoperative steroid use (PϽ .05). Mortality among diabetic patients was associated with emergency surgery (P Ͻ.01) and anastomotic leak (PϽ .05); it was not associated with hyperglycemia. Mortality among nondiabetic patients was associated with hyperglycemia (P Ͻ .005). The presence of an anastomotic leak was associated with increased mortality among diabetic patients (26.3% vs 4.5%; P Ͻ .001) compared with nondiabetic patients (6.0% vs 2.5%; PϽ .05). Conclusions: The presence of diabetes did not have an effect on the presence of an anastomotic leak, but diabetic patients who had a leak had more than a 4-fold higher mortality compared with nondiabetic patients. Preoperative steroid use led to increased rates of anastomotic leak in diabetic patients. Mortality was associated with hyperglycemia for nondiabetic patients only. Improved screening may identify high-risk patients who would benefit from perioperative intervention.

We reviewed our experience with same hospitalization resection in the treatment of acute diverticulitis (AD) and compared outcomes with patients admitted for elective resection. From January 1987 through December 1996, 20 patients (Group 1) were admitted with AD and were operated on during the same hospital admission. During that same time period, 22 patients (Group 2) were admitted for elective resection and found to have an abscess intraoperatively. Thirty patients had elective resection with no abscess found (Group 3), and 10 patients were found to have a fistula to adjacent structures during elective resection (Group 4). Demographics and type of procedure done were similar in all groups. Fifteen patients (75%) in Group 1 had an abscess; eight were pericolic, and seven were pelvic. In contrast, all Group 2 abscesses were pericolic (P < 0.001). There was no mortality or major morbidity in any group. Patients in Groups 1 and 4 had higher fluid requirements (not significant), estimated blood loss (P < 0.01), and longer operative times (P < 0.05) when compared with the other groups. Postoperative and total hospital stay was significantly longer in Group 1. We conclude that hospitalized patients with AD who meet indications for surgery can be operated on during the same hospitalization without an increase in morbidity, compared with those patients discharged and later readmitted for elective resection.