Care after Colonic Operation—Is it Evidence-Based? Results from a Multinational Survey in Europe and the United States

Kehlet, Henrik; Büchler, Markus W.; Beart, Robert W.; Billingham, Richard P.; Williamson, Russell

doi:10.1016/j.jamcollsurg.2005.08.006

Cited by 248 publications

(178 citation statements)

References 29 publications

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“…A study involving nearly 300 hospitals in Europe and the United States found that in 96% of patients admitted for colorectal procedure the mechanical bowel preparation was used preoperatively (25) . Reports of Switzerland and New Zealand are more in line with the recommendations to abandon the practice, with less than half of doctors reporting the use of preparation in colon procedures.…”

Section: Discussionmentioning

confidence: 99%

Surgical site infection and its risk factors in colon surgeries

Fusco

Massarico

Alves

et al. 2016

Rev. esc. enferm. USP

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Objective:To identify the occurrence of surgical site infection (SSI) and its risk factors in patients undergoing colon surgery in a tertiary hospital located in the countryside of the state of São Paulo. Method: Retrospective cohort study, with collection of information contained in the medical records of patients undergoing colon surgery in the period between January 2010 and December 2013. The studied variables were the possible risk factors related to the patient, to demographic characteristics and the surgical procedure. Results: In total, were evaluated 155 patients with an overall SSI incidence of 16.7%. A statistically significant association was found both in the univariate as in the multivariate analysis between the SSI and the following variables: male gender, Charlson index and mechanical bowel preparation. Conclusion: The understanding of health professionals about the factors that influence the incidence of SSI in colon surgery may contribute to the quality of care provided to surgical patients, from effective actions to minimize the risk of infections. DESCRIPTORSSurgical Wound Infection; Colorectal Surgery; Perioperative Nursing. Surgical site infection and its risk factors in colon surgeriesInfecção de sítio cirúrgico e seus fatores de risco em cirurgias de cólon Infección de sitio quirúrgico y sus factores de riesgo en cirugías de colon

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Section: Discussionmentioning

confidence: 99%

Surgical site infection and its risk factors in colon surgeries

Fusco

Massarico

Alves

et al. 2016

Rev. esc. enferm. USP

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“…Colorectal surgery is classically associated with a postoperative hospital stay of 8-10 days. 1 The introduction of thoracic epidural analgesia and the endoscopic approach to surgical resection. 2,3 can accelerate the return of bowel function and decrease length of hospital stay with moderate success.…”

Section: Résumémentioning

confidence: 99%

An integrated multidisciplinary approach to implementation of a fast-track program for laparoscopic colorectal surgery

Carli

Charlebois

Baldini

et al. 2009

Can J Anesth/J Can Anesth

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Background Enhanced perioperative care programs have been developed in order to attenuate the impact of surgical stress on organ dysfunction, thereby accelerating hospital discharge and reducing morbidity. The implementation of a fast-track program for laparoscopic colorectal surgery is reported. Methods We report on a series of patients who entered a coordinated program based on preoperative patient education and counseling, a laparoscopic approach, provision of postoperative epidural analgesia, early food intake and mobilization, and structured surgical and nursing care practices. The program was introduced in September 2006 and adapted to our institutional needs. Outcome measures included length of hospital stay, return of bowel function, incidences of postoperative complications, and rate of readmission to hospital. Results Twenty-five patients were selected by the surgeons for the accelerated laparoscopic colorectal pathway. The median duration of hospital stay was 3 (95% confidence interval, 3-4) days. Sixteen patients (64%) were discharged from hospital on day 3. Nine patients failed the pathway for various reasons (social indications, poor pain relief, wound infection, anemia, urinary retention) and were discharged later (six patients on day 4, two patients on day 5, and one patient on day 6). Times to recover bowel function and to resume a full diet were all within the first 36 hr from time of surgery. There were two readmissions. Conclusion This early clinical experience demonstrates the feasibility of a fast-track program for colonic surgery and the requirement for an integrated multidisciplinary approach to perioperative care. RésuméContexte Des programmes de soins pe´riope´ratoires ame´liore´s ont e´te´e´labore´s afin d'atte´nuer l'impact du stress chirurgical sur la de´faillance syste´mique, ce qui a permis d'acce´le´rer le conge´de l'hôpital et de re´duire la morbidite´. La mise en oeuvre d'un programme acce´le´re´pour la chirurgie colorectale par laparoscopie est de´crite ici. Méthode Nous pre´sentons une se´rie de patients ayant participe´a`un programme coordonne´et de´crivons la formation et la consultation pre´ope´ratoire des patients, l'approche par laparoscopie, la prestation d'une analge´sie pe´ridurale postope´ratoire, l'absorption de nourriture et la mobilisation pre´coce, et les pratiques structure´es de soins chirurgicaux et infirmiers. Le programme a e´te´mis en place en septembre 2006 et adapte´pour re´pondre aux besoins de notre institution. Nous avons mesure´la dure´e du se´jour a`l'hôpital, la restauration de la fonction intestinale, l'incidence de complications postope´ratoires et le taux de re´admission a`l'hôpital.

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“…However, this tendency of adhering to the traditional approaches does not seem endemic to the Turkish surgeons, as shown by the previously noted low confidence of the general surgeons in clinical practice guidelines (17). There is also evidence that many crucial components of ERAS are not applied in the western world either, and even in centers where ERAS protocol is practiced, there is considerable variation in the compliance to the components of the protocol (22)(23)(24). Depending on the data from the present study and the literature, it can be concluded that the widespread implementation of evidence-based perioperative practices including the curtailed preoperative fast needs more time and effort.…”

Section: Discussionmentioning

confidence: 99%

Surgeons’ approach toward clinical nutrition: A survey-based study

et al. 2017

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Surgeons' approach toward clinical nutrition: A survey-based study INTRODUCTIONIt is a well-known fact that surgical patients with a suboptimal nutritional status have impaired wound healing, impaired immune responses, increased organ dysfunction, delayed recovery, and increased morbidity and mortality (1, 2). However, even though the prevalence of malnutrition is high and may exceed 60% in patients undergoing gastrointestinal or major elective surgeries, many cases of malnutrition probably go unnoticed and untreated in surgical wards (3-6). As the attending specialist, the surgeon must organize nutritional screening and treatment of the patients in a surgical clinic. This necessitates surgeons to have sufficient knowledge of nutrition and to be very sensitive about the nutritional status of their patients. Unfortunately, limited data on the degree of attention paid to this important subject by surgeons suggests that the awareness of nutritional principles may be insufficient among this group of clinicians (5-7). This study displays the results of a survey designed to define the current attitudes of Turkish surgeons toward nutritional screening and support. MATERIAL AND METHODSA questionnaire consisting of 13 multiple choice questions was designed by the study authors to investigate the surgeons' approaches to perioperative nutritional screening and therapy of the general surgery patient (Appendix). This survey was e-mailed to 1500 general surgeons, all of whom had already finished the training program in surgery and were working in different hospitals in the Turkish Republic. A cover letter that stood for an informed consent was also attached to this e-mail explaining the purpose of this project and assuring the participants of anonymity.Since this study was based on a survey answered by doctors, no approval was obtained from any ethics committees; however, the study was conducted according to the Helsinki Declaration.Only the surgeons who stated that they screened the nutritional status of their patients were asked to answer the questions from 5 to 11 as it was essential to take part in nutritional screening in daily clinical practice to answer these questions.The answers of each surgeon were stored in a database and cross-queries were made over these responses. The surgeons who were working in state hospitals were compared with the surgeons working in teaching Objective: Although many surgical patients face postoperative problems due to a poor nutritional status, there is evidence that many cases of malnutrition still go unnoticed and untreated in surgical wards. This study aims to define the current attitudes of surgeons toward nutritional screening and support. Material and Methods:A questionnaire with 13 questions was e-mailed to 1500 surgeons. Cross-queries were made over the responses. Results:The response rate was 20.9%. Most of the respondents (89.5%) implemented nutritional screening. However, only 24.6% of these surgeons screened every patient for malnutrition. The time to initiate nutritional suppor...

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Care after Colonic Operation—Is it Evidence-Based? Results from a Multinational Survey in Europe and the United States

Cited by 248 publications

References 29 publications

Surgical site infection and its risk factors in colon surgeries

Surgical site infection and its risk factors in colon surgeries

An integrated multidisciplinary approach to implementation of a fast-track program for laparoscopic colorectal surgery

Surgeons’ approach toward clinical nutrition: A survey-based study

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