Risk factors for postoperative complications after fast‐track abdominal hysterectomy

Nilsson, Lena; Wodlin, Ninnie Borendal; Kjølhede, Preben

doi:10.1111/j.1479-828x.2011.01395.x

Cited by 24 publications

(31 citation statements)

References 26 publications

(39 reference statements)

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“…These rates are comparable to those in the FINHYST study, which examined complications in 5,279 hysterectomies for benign conditions performed in hospitals in Finland in 2006 [26]. In the study by Nilson et al [25], the risk of postoperative complications was higher in women with obesity (odds ratio [OR], 8.83), prior laparotomy (OR, 2.92), increase in body weight on the first postoperative day (OR, 1.52), longer duration of hospital stay, or longer time with a urinary catheter. The readmission rate was 2.5%.…”

Section: Resultssupporting

confidence: 73%

“…Nilson et al [25] prospectively investigated the incidence and type of postoperative complications in 162 women undergoing abdominal hysterectomy for benign conditions in an ERAS program. The authors reported that 25% of patients developed minor postoperative complications, mostly infections and wound healing problems, and 9.7% of patients developed major complications.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

A call for new standard of care in perioperative gynecologic oncology practice: Impact of enhanced recovery after surgery (ERAS) programs

Miralpeix

Nick

Cata

et al. 2016

Gynecologic Oncology

134

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Enhanced recovery after surgery (ERAS) programs aim to hasten functional recovery and improve postoperative outcomes. However, there is a paucity of data on ERAS programs in gynecologic surgery. We reviewed the published literature on ERAS programs in colorectal surgery, general gynecologic surgery, and gynecologic oncology surgery to evaluate the impact of such programs on outcomes, and to identify key elements in establishing a successful ERAS program. ERAS programs are associated with shorter length of hospital stay, a reduction in overall health care costs, and improvements in patient satisfaction. We suggest an ERAS program for gynecologic oncology practice involving preoperative, intraoperative, and postoperative strategies including; preadmission counseling, avoidance of preoperative bowel preparation, use of opioid-sparing multimodal perioperative analgesia (including loco-regional analgesia), intraoperative goal-directed fluid therapy (GDT), and use of minimally invasive surgical techniques with avoidance of routine use of nasogastric tube, drains and/or catheters. Postoperatively, it is important to encourage early feeding, early mobilization, timely removal of tubes and drains, if present, and function oriented multimodal analgesia regimens. Successful implementation of an ERAS program requires a multidisciplinary team effort and active participation of the patient in their goal-oriented functional recovery program. However, future outcome studies should evaluate the efficacy of an intervention within the pathway, include objective measures of symptom burden and control, study measures of functional recovery, and quantify outcomes of the program in relation to the rates of adherence to the key elements of care in gynecologic oncology such as oncologic outcomes and return to intended oncologic therapy (RIOT).

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Section: Resultssupporting

confidence: 73%

Section: Resultsmentioning

confidence: 99%

A call for new standard of care in perioperative gynecologic oncology practice: Impact of enhanced recovery after surgery (ERAS) programs

Miralpeix

Nick

Cata

et al. 2016

Gynecologic Oncology

134

View full text Add to dashboard Cite

show abstract

“…Accordingly, there is not much knowledge in the field of perioperative fluid regulation in fast‐track gynecological surgery. A modest increase in postoperative relative weight gain the first postoperative day seemed to increase the risk of postoperative complications after fast‐track hysterectomy (39).…”

Section: Resultsmentioning

confidence: 99%

“…Several studies in general surgery support the belief that early oral nutrition is to be preferred to parenteral nutrition as a factor in improving surgical outcomes (21,64,65). In a fast‐track setting, less than 2% of women in one study received intravenous fluids after the day of abdominal hysterectomy (39). Early mobilization in the postoperative period aims to preventing wasting and fatigue, decrease duration of postoperative ileus and to mitigate impaired pulmonary function and thromboembolic complications.…”

Section: Resultsmentioning

confidence: 99%

The development of fast‐track principles in gynecological surgery

Wodlin

Nilsson

2012

Acta Obstet Gynecol Scand

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Fast-track is a multimodal strategy aimed at reducing the physiological burden of surgery to achieve an enhanced postoperative recovery. The strategy combines unimodal evidence-based interventions in the areas of preoperative preparation, anesthesia, surgical factors and postoperative care. The advantages of fast-track most likely extend to gynecology, although so far have scarcely been reported. This review summarizes current evidence concerning use of fast-track in general and in gynecological surgery. The main findings of this review are that there are benefits within elective gynecological surgery, but studies of quality of life, patient satisfaction and health economics in elective surgery are needed. Studies of fast-track within the field of non-elective gynecological surgery are lacking. Widespread education is needed to improve the rate of implementation of fast-track. Close involvement of the entire surgical team is imperative to ensure a structured perioperative care aiming for enhanced postoperative recovery.

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“…A single study reported a modest increase in weight gain on the first POD, possibly due to excessive fluid infusions, being associated with complications in a fast‐track hysterectomy (Nilsson et al . ). Moreover, the increase in the total IV hydration and the infusion of crystalloids during the intraoperative period were significantly associated with the occurrence of abdominal distension on the first and second PODs.…”

Section: Discussionmentioning

confidence: 97%

Impact of perioperative care on the post-operative recovery of women undergoing surgery for gynaecological tumours

2016

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To assess perioperative care in patients undergoing abdominal surgery for gynaecological tumours and how it relates to post-operative (PO) complications and oral PO feeding. Ninety-one women undergoing major abdominal surgery for gynaecological tumours were enrolled. Data included mechanical bowel preparation (MBP), prescribed diet, length of fast, start date of oral diet and progression of food consistency, anaesthetic technique, use of opioids and intravenous hydration (IH). Outcomes evaluated were nausea, vomiting and abdominal distension. The median pre-operative length of fast was 11.4 h. PO digestive complications occurred in 46.2% of the patients. Median intraoperative total IH and crystalloids were significantly higher in patients with abdominal distension during the first and second PO day. MBP with mannitol implied greater intraoperative IH and was significantly associated with a higher incidence of immediate PO nausea. Post-operative IH was also associated with gastrointestinal complications. The best cut-off point for the cumulative fluid load PO for determining a longer PO hospital stay was 4 L. Performing MBP before surgery and excessive IH are factors related to major digestive complications in our study population. Changes in pre-operative fasting time and PO refeeding should be considered to reduce the gastrointestinal complications and PO recovery time.

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Risk factors for postoperative complications after fast‐track abdominal hysterectomy

Cited by 24 publications

References 26 publications

A call for new standard of care in perioperative gynecologic oncology practice: Impact of enhanced recovery after surgery (ERAS) programs

A call for new standard of care in perioperative gynecologic oncology practice: Impact of enhanced recovery after surgery (ERAS) programs

The development of fast‐track principles in gynecological surgery

Impact of perioperative care on the post-operative recovery of women undergoing surgery for gynaecological tumours

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