Preoperative Intensive, Community-Based vs. Traditional Stoma Education: A Randomized, Controlled Trial

Chaudhri, Sanjay; Brown, Lesley; Hassan, Iffat; Horgan, Alan

doi:10.1007/s10350-004-0897-0

Cited by 166 publications

(138 citation statements)

References 5 publications

(5 reference statements)

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“…In a randomised study of intensive pre-operative community-based stoma education against conventional post-operative training, Chaudhri et al demonstrated significantly shorter length of stays in the intervention arm. 39 Similar to our results, they noted a median length of stay of 10 days in the control arm. Improved pre-operative stoma training may help further reduce the length of stay of our patients.…”

Section: Vaughan-shaw King Cheung Beck Knight Nichols Nugent Pilkingtsupporting

confidence: 90%

Early experience with laparoscopic extralevator abdominoperineal excision within an enhanced recovery setting: analysis of short-term outcomes and quality of life

Vaughan-Shaw¹,

King²,

Cheung³

et al. 2011

annals

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INTRODUCTION Conventional abdominoperineal excision for low rectal cancer has a higher local recurrence and reduced survival compared to anterior resection. An extralevator abdominoperineal excision (ELAPE) may improve outcome through removal of increased tissue in the distal rectum. Experience with ELAPE is limited and no studies have reported on quality of life (QOL) following this procedure. We describe a minimally invasive approach to ELAPE within an enhanced recovery programme, and present short-term results and QOL analyses. METHODS All laparoscopic ELAPEs were included in a prospective database. Demographics, intra-operative and post-operative outcomes were evaluated. Postoperative QOL was assessed using the European Organisation for Research and Treatment of Cancer (EORTC) questionnaires QLQ-C30 and QLQ-CR29. RESULTS Thirteen laparoscopic ELAPEs were performed over a two-year period. All were enrolled in an enhanced recovery programme. The median age was 76. The median tumour height was 20mm (range: 0–50mm) from the dentate line and all patients received neoadjuvant treatment. The median duration of surgery was 300 minutes (range: 120–488 minutes), the mean blood loss was 150ml and one procedure was converted to open surgery. There was no circumferential resection margin involvement or tumour perforation. The median duration of use of intravenous fluid, patient controlled analgesia and urinary catheterisation was 2, 2 and 2.5 days respectively and the median length of hospital stay was 7.5 days. Two patients developed perineal wound dehiscence. QOL analysis revealed high global health status (90.8), physical (91.3), emotional (98.3) and social functioning (100) scores, which compared favourably with EORTC reference values and published QOL scores following conventional abdominoperineal excision. CONCLUSIONS Laparoscopic ELAPE within an enhanced recovery setting is a feasible and safe approach with acceptable short-term outcomes and post-operative quality of life.

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Section: Vaughan-shaw King Cheung Beck Knight Nichols Nugent Pilkingtsupporting

confidence: 90%

Early experience with laparoscopic extralevator abdominoperineal excision within an enhanced recovery setting: analysis of short-term outcomes and quality of life

Vaughan-Shaw¹,

King²,

Cheung³

et al. 2011

annals

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“…However, some may argue that it may not be the stoma per se but the particular problem that required a stoma such as an anastomotic problem which may prolong LOS. It is notable, however, that a 2004 study reported that intensive preoperative and postoperative training in stoma care led to a 2 day decrease in LOS [11], a similar figure to the benefit of laparoscopic over open colorectal resection in LOS [1]. This suggests that the stoma itself is a major factor in increasing LOS, though we did not expressly document causes of patients LOS in this study.…”

Section: Discussionmentioning

confidence: 56%

A defunctioning stoma significantly prolongs the length of stay in laparoscopic colorectal resection

et al. 2008

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The need for conversion, if performed in a timely and appropriate manner, has little impact on patient outcome compared to those completed laparoscopically, with no significant increase in LOS in our experience. In contrast, a diverting stoma does prolong LOS and some of the benefits of laparoscopic surgery may be lost unless patients requiring a stoma are identified preoperatively and have intensive pre- and postoperative stoma training.

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“…243,244 Preoperative education by an enterostomal therapy nurse (ETN) can also improve health-related quality of life and skill acquisition in the immediate postoperative period and long-term adjustment to an ostomy. 245 With respect to sexuality, patients need to be made aware of the likely consequences of urostomy surgery.…”

Section: Discussionmentioning

confidence: 99%

Recommendations for the improvement of bladder cancer quality of care in Canada: A consensus document reviewed and endorsed by Bladder Cancer Canada (BCC), Canadian Urologic Oncology Group (CUOG), and Canadian Urological Association (CUA), December 2015

Kassouf

Aprikian

Black

et al. 2016

CUAJ

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This initiative was undertaken in response to concerns regarding the variation in management and in outcomes of patients with bladder cancer throughout centres and geographical areas in Canada. Population-based data have also revealed that real-life survival is lower than expected based on data from clinical trials and/or academic centres. To address these perceived shortcomings and attempt to streamline and unify treatment approaches to bladder cancer in Canada, a multidisciplinary panel of expert clinicians was convened last fall for a two-day working group consensus meeting. The panelists included urologic oncologists, medical oncologists, radiation oncologists, patient representatives, a genitourinary pathologist, and an enterostomal therapy nurse. The following recommendations and summaries of supporting evidence represent the results of the presentations, debates, and discussions. Methodology

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Preoperative Intensive, Community-Based vs. Traditional Stoma Education: A Randomized, Controlled Trial

Abstract: Stoma education is more effective if undertaken in the preoperative setting. It results in shorter times to stoma proficiency and earlier discharge from the hospital. It also reduces stoma-related interventions in the community and has no adverse effects on patient well-being.

Cited by 166 publications

References 5 publications

Early experience with laparoscopic extralevator abdominoperineal excision within an enhanced recovery setting: analysis of short-term outcomes and quality of life

Early experience with laparoscopic extralevator abdominoperineal excision within an enhanced recovery setting: analysis of short-term outcomes and quality of life

A defunctioning stoma significantly prolongs the length of stay in laparoscopic colorectal resection

Recommendations for the improvement of bladder cancer quality of care in Canada: A consensus document reviewed and endorsed by Bladder Cancer Canada (BCC), Canadian Urologic Oncology Group (CUOG), and Canadian Urological Association (CUA), December 2015

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