A perioperative consult service results in reduction in cost and length of stay for colorectal surgical patients: evidence from a healthcare redesign project

McEvoy, Matthew D.; Wanderer, Jonathan P.; King, Adam; Geiger, Timothy M.; Tiwari, Vikram; Terekhov, Maxim A.; Ehrenfeld, Jesse M.; Furman, William R.; Lee, Lorri A.; Sandberg, Warren S.

doi:10.1186/s13741-016-0028-1

Cited by 41 publications

(37 citation statements)

References 33 publications

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“…A limitation of our study is that the comparison group is a historical group and not a synchronous group, which should encourage caution in the final conclusions. Nevertheless, similar results have been published regarding laparoscopic colorectal surgery [4]. Various studies of laparoscopic left colon resection for diverticular disease described a median hospital stay of 7 days, with 4% of redo surgery (8 patients/205) [11], or an average hospital stay of 9 days, with 3% of suture leak and 2% of redo surgery [12].…”

Section: Discussionsupporting

confidence: 64%

“…By rethinking the management of patients and introducing a CP specific to laparoscopic left colectomy, we have shown that the quality of care is increased, without affecting the rate of complications which remains low compared to those published in the literature [4,8,[11][12][13][14], and the hospital stay is significantly reduced (Tables 5 and 6). A limitation of our study is that the comparison group is a historical group and not a synchronous group, which should encourage caution in the final conclusions.…”

Section: Discussionmentioning

confidence: 99%

“…This chapter describes our first CP implemented in abdominal surgery in 2009 for the management of patients undergoing a colectomy. Such pathways of care in colorectal surgery were initiated in the 1990s [1] and are still the subject of numerous publications [2][3][4]. Left colon resections are performed in case of infection, tumor (benign or malignant) or inflammatory diseases.…”

Section: Proctological Diseases In Surgical Practicementioning

confidence: 99%

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Clinical Pathway Evaluation for Left and Sigmoid Colectomy in Abdominal Surgery

Mattart¹,

Stevens²,

Magis

et al. 2018

Proctological Diseases in Surgical Practice

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At the end of 2008, a new left colon clinical pathway was implemented in our hospital and set up by a multidisciplinary team, monitored by a clinical pathway coordinator. Our aim was to evaluate the quality of left and sigmoid colectomy management, to simplify the clinical pathway and to assess its impact on the patient, the medical and nursing staffs.A sample of 290 patients with benign or malignant disease requiring a laparoscopic of laparotomy left colon resection (mainly sigmoid) was included in this clinical pathway during the years 2009-2017. Our analysis focused particularly on the compliance with the protocol, the pain felt, the suture leak rate, the hospital stay, the re-hospitalization rate and redo surgery within 30 days. Our work leads to the conclusion that the introduction of a clinical pathway, when it is well prepared and brings together all the implicated persons with the same goal, is feasible with convincing results. These are directly beneficial to the patient and to the quality of its management.

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Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Proctological Diseases In Surgical Practicementioning

confidence: 99%

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Clinical Pathway Evaluation for Left and Sigmoid Colectomy in Abdominal Surgery

Mattart¹,

Stevens²,

Magis

et al. 2018

Proctological Diseases in Surgical Practice

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“…This is especially true as some ERPs may attempt to avoid IV-PCA opioids and thus use opioids only as PRN rescue, as recommended in Part 2 (McEvoy et al 2016; Wu et al 2015). It should be explained to patients that opioids still remain an important option for postoperative pain management; however, the precise role of opioids in ERPs is currently not clearly defined, and expectations surrounding their use in the perioperative, along with the goals of delivering optimal analgesia, should be clarified preoperatively.…”

Section: Resultsmentioning

confidence: 99%

American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on optimal analgesia within an enhanced recovery pathway for colorectal surgery: part 1—from the preoperative period to PACU

et al. 2017

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BackgroundWithin an enhanced recovery pathway (ERP), the approach to treating pain should be multifaceted and the goal should be to deliver “optimal analgesia,” which we define in this paper as a technique that optimizes patient comfort and facilitates functional recovery with the fewest medication side effects.MethodsWith input from a multi-disciplinary, international group of clinicians, and through a structured review of the literature and use of a modified Delphi method, we achieved consensus surrounding the topic of optimal analgesia in the perioperative period for colorectal surgery patients.DiscussionAs a part of the first Perioperative Quality Improvement (POQI) workgroup meeting, we sought to develop a consensus document describing a comprehensive, yet rational and practical, approach for developing an evidence-based plan for achieving optimal analgesia, specifically for a colorectal surgery ERP. The goal was two-fold: (a) that application of this process would lead to improved patient outcomes and (b) that investigation of the questions raised would identify knowledge gaps to aid the direction for research into analgesia within ERPs in the years to come. This document details the evidence for a wide range of analgesic components, with particular focus from the preoperative period to the post-anesthesia care unit. The overall conclusion is that the combination of analgesic techniques employed in the perioperative period is not important as long as it is effective in delivering the goal of optimal analgesia as set forth in this document.

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“…As recent evidence shows that massive reductions in perioperative opioid use are not only possible but also associated with improved outcomes, 18 it is time for our specialty to lead the way in promoting a safe pathway for low or no-opioid perioperative analgesia. The evidence espousing the dangers of the status quo use of opioids as a primary analgesic in the postoperative period continues to mount.…”

mentioning

confidence: 99%