Contemporary perioperative care strategies

Abstract

Background: Historically, the preoperative and postoperative care of patients with gastrointestinal cancer was provided by surgeons. Contemporary perioperative care is a truly multidisciplinary endeavour with implications for cancer-specific outcomes.Methods: A literature review was performed querying PubMed and the Cochrane Library for articles published between 1966 to 2012 on specific perioperative interventions with the potential to improve the outcomes of surgical oncology patients. Keywords used were: fast-track, enhanced recovery, accelerated rehabilitation, multimodal and perioperative care. Specific interventions included normothermia, hyperoxygenation, surgical-site infection, skin preparation, transfusion, non-steroidal anti-inflammatory drugs, thromboembolism and antibiotic prophylaxis, laparoscopy, radiotherapy, perioperative steroids and monoclonal antibodies. Included articles had to be randomized controlled trials, prospective or nationwide series, or systematic reviews/meta-analyses, published in English, French or German.Results: Important elements of modern perioperative care that improve recovery of patients and outcomes in surgical oncology include accelerated recovery pathways, thromboembolism and antibiotic prophylaxis, hyperoxygenation, maintenance of normothermia, avoidance of blood transfusion and cautious use of non-steroidal anti-inflammatory drugs, promotion of laparoscopic surgery, chlorhexidine-alcohol skin preparation and multidisciplinary meetings to determine multimodal therapy.Conclusion: Multidisciplinary management of perioperative patient care has improved outcomes.

Systematic review of outcomes used to evaluate enhanced recovery after surgery

“…Major abdominal surgery represents a significant physiological stress and is followed by a period of disability, traditionally termed convalescence. Surgical innovations are often advocated on the basis that they shorten this period of disability and therefore improve recovery. However, accurate measurement of the construct of surgical recovery has been hampered by lack of an accepted definition and lack of instruments validated in this context.…”

“…Enhanced recovery pathways (ERPs) are multidisciplinary clinical care pathways that integrate evidence‐based interventions in all perioperative phases to attenuate the surgical stress response and accelerate recovery in patients undergoing major abdominal surgery. The challenge in evaluating ERPs lies in determining how best to measure the effect of the pathway on the stress response and recovery.…”

Complications Following Surgery for Gastric Cancer: Analysis of Prospectively Collected Data

“…On the contrary, the inverse correlation between transfusions and long-term survival which has been previously shown was not confirmed. However, most studies [24]- [26] have shown that perioperative surgical stress cause immunosuppression, which could be exacerbated by concomitant transfusions. This condition could promote tumor relapse and metastatic process and could be explained by the infusion of an incompatible MHC antigen.…”

Nursing and collaborative diagnoses on perioperative patients with and without using six steps of diagnostic reasoning methods

“…Other caused by factor extrinsic which are the distance between patient"s body and position and also the instruments being used to maintain patient"s position during surgery, friction and also haemodynamic changes. 16 Risk for infection is another nursing diagnosis. Other risk factors for infection are tissue location, contamination degree that will influence surgery infection, nutrition state, radiotherapy before surgery, renal failure, ventilator requirement, using colostomy bag, massive blood transfusion, and hypothermia during surgery.…”