Patient symptoms after colonic surgery in the era of enhanced recovery – a long‐term follow‐up

Wennström, Berith; Stomberg, Margareta Warrén; Modin, Marina; Skullman, S.

doi:10.1111/j.1365-2702.2009.03099.x

Cited by 36 publications

(43 citation statements)

References 16 publications

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“…We did not perform mechanical bowel preparation in accordance with the current guidelines [9,10]. The patient was admitted to the surgery at 7 am, fasting except for oral intake of 400 mL of sweetened clear liquids two hours before surgery [11][12][13]. Pre-operative analgesic medication (level 1 non-sedating) 1 gm of paracetamol was administered systematically.…”

Section: Methodsmentioning

confidence: 99%

Outpatient colectomy within an enhanced recovery program

Gignoux¹,

Pasquer²,

Vulliez³

et al. 2015

Journal of Visceral Surgery

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Introduction: The application of a fast-track recovery program after surgery can decrease the physiological impact of surgery and reduce the duration of hospitalisation compared to conventional care. This program has permitted us to consider the performance of colectomy on an outpatient basis. Method: After analyzing the recommendations for fast-track recovery, we developed and validated a specific protocol. Drawing on extensive experience in ambulatory surgery (inguinal hernia, cholecystectomy, adjustable gastric-banding), we formalized a protocol for outpatient colectomy. Patient selection criteria were the absence of serious or decompensated comorbidity, very good general condition, and full patient understanding of the procedure. Discharge was authorized if the patient met the exit criteria according to the Chung score. Postoperative surveillance was provided by regular home visits of a nurse trained in enhanced recovery, every afternoon until day 10. Results: Five patients underwent this management strategy (4 men and 1 woman, mean age 64 years, range: 59-69), for indications including cancer of the rectosigmoid junction (1 case), sigmoid diverticulitis (3 cases), and volvulus. The postoperative course was simple and uncomplicated except for two patients who had dysuria and an incisional hematoma, respectively. Conclusion: To our knowledge, these are the first cases of colectomy performed strictly on an outpatient basis (i.e., stay < 12 h). We demonstrated the feasibility of outpatient colectomy when integrated into a protocol of enhanced recovery for selected patients provided that athome monitoring was available.

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Section: Methodsmentioning

confidence: 99%

Outpatient colectomy within an enhanced recovery program

Gignoux¹,

Pasquer²,

Vulliez³

et al. 2015

Journal of Visceral Surgery

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“…In a study of patients following a colorectal enhanced recovery programme, it was found that the majority of patients had ongoing symptoms and concerns four weeks following surgery. 14 The authors recommended the use of nurse driven telephone contact lines to allow patients easy access to advice in an attempt to reduce acute hospital admissions. Further preparation of the patient for discharge with detailed information regarding the postoperative recovery has been recommended following other major procedures.…”

mentioning

confidence: 99%

Reduction in length of stay for patients undergoing oesophageal and gastric resections with implementation of enhanced recovery packages

Tang

Humes

Gemmil

et al. 2013

annals

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INTRODUCTIONThe high mortality and morbidity associated with resection for oesophagogastric malignancy has resulted in a conservative approach to the postoperative management of this patient group. In August 2009 we introduced an enhanced recovery after surgery (ERAS) pathway tailored to patients undergoing resection for oesophagogastric malignancy. We aimed to assess the impact of this change in practice on standard clinical outcomes. METHODS Two cohorts were studied of patients undergoing resection for oesophagogastric malignancy before (August 2008 -July 2009) and after (August 2009 -July 2010) the implementation of the ERAS pathway. Data were collected on demographics, interventions, length of stay, morbidity and in-hospital mortality. RESULTS There were 53 and 55 oesophagogastric resections undertaken respectively for malignant disease in each of the study periods. The median length of stay for both gastric and oesophageal resection decreased from 15 to 11 days (MannWhitney U, p<0.001) following implementation of the ERAS pathway. There was no significant increase in morbidity (gastric resection 23.1% vs 5.3% and oesophageal resection 25.9% vs 16.7%) or mortality (gastric resection no deaths and oesophageal resection 1.8% vs 3.6%) associated with the changes. There was a significant decrease in the number of oral contrast studies used following oesophageal resection, with a reduction from 21 (77

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“…The proportions of changes also indicated that the patients generally improved significantly in most items. In the study by Wennström et al [17], patients recovering from sigmoid resection or from a right hemicolectomy reported minor problems with pain one week postoperatively. The first and second weeks, problems were also reported with nausea, vomiting, defecation, and fatigue.…”

Section: Time Of Measurementmentioning

confidence: 99%

“…Problems with nausea, vomiting, defecation, and most dominantly fatigue were also reported one to two weeks postoperatively. Five weeks after surgery, fatigue was still the most disturbing symptom, whereas the other symptoms had decreased or even disappeared [17].…”

Section: Introductionmentioning

confidence: 98%

Patient-reported recovery after enhanced colorectal cancer surgery: a longitudinal six-month follow-up study

Jakobsson

Idvall

Wann-Hansson

2014

Int J Colorectal Dis

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1 AbstractPurpose. The concept of enhanced recovery after surgery (ERAS) is a modern regime of care, and numerous studies have proved its beneficial impact on recovery after colorectal surgery. However, little is known about patients' continuing recovery after discharge. Therefore, the purpose of this study was to describe patientreported recovery after colorectal cancer surgery in the context of ERAS from the day of discharge until one month and six months after surgery.Method. Assessments were made at discharge, at one month, and at six months after surgery using the questionnaire Postoperative Recovery Profile (PRP). In all, 119 patients recovering from abdominoperineal resection, rectal resection, or colonic resection completed all three assessments.Results. The global score of recovery showed that no patient experienced being fully recovered at discharge. After rectal resection, patients frequently reported being not at all recovered. One month after surgery, patients recovering from colonic resection reported significant improvements regarding 11 of 17 questionnaire items, whereas abdominoperineal resection patients reported no significant improvements regarding any item. Instead, significantly higher levels of problems were reported in the items fatigue, muscle weakness, and feeling down. Rectal resection patients reported significant improvements between one and six months after surgery regarding 7 of 19 items. However, the item gastrointestinal function distinguished, as patients reported significant deterioration towards higher levels of problems six months after surgery.Conclusion. This study elucidates the difference between groups of colorectal patients and the diverse patterns of their recovery, implying different needs in terms of prolonged support after discharge.

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Patient symptoms after colonic surgery in the era of enhanced recovery – a long‐term follow‐up

Abstract: Clinical guidelines for patient's discharge planning can be performed based on the results from this study. Further improvement regarding the epidural anaesthesia is needed to reduce minor side effects.

Cited by 36 publications

References 16 publications

Outpatient colectomy within an enhanced recovery program

Outpatient colectomy within an enhanced recovery program

Reduction in length of stay for patients undergoing oesophageal and gastric resections with implementation of enhanced recovery packages

Patient-reported recovery after enhanced colorectal cancer surgery: a longitudinal six-month follow-up study

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