Use of inflammatory markers in the early detection of infectious complications after laparoscopic colorectal cancer surgery with the ERAS protocol.

Wierdak, Mateusz; Pisarska, Magdalena; Kuśnierz-Cabała, Beata; Kisielewski, Michał; Major, Piotr; Witowski, Jan; Ceranowicz, Piotr; Strzałka, Marcin; Budzyński, Andrzej; Pędziwiatr, Michał

doi:10.5114/wiitm.2018.75846

Cited by 16 publications

(19 citation statements)

References 37 publications

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“…It was caused by a lower rate of complications in the IA group. The leak rate in this group corresponds with the leak rate reported by other Polish group [15]. However, in the EA group we noted a high incidence of complication class III, especially anastomosis leak.…”

Section: Discussionsupporting

confidence: 89%

Intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy - single center experience.

Stepińska¹,

Stanowski²,

Paśnik³

et al. 2019

Videosurgery and Other Miniinvasive Techniques

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IntroductionNowadays laparoscopic right hemicolectomy is widely accepted as the standard of care for benign and malignant colon disease. There are wide variations among laparoscopic techniques. One of the most discussed topics is the ileocolic anastomosis. There are two different techniques: intracorporeal anastomosis (IA) and extracorporeal anastomosis (EA).AimTo compare short-term outcomes of performing intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy.Material and methodsA retrospective chart review was performed of 92 consecutive patients who underwent laparoscopic right hemicolectomy, with either an IA or EA, from January 2013 to December 2016.ResultsEighty-five patients were included in the analysis. There were 53 males and 32 females with a mean age of 67.1 ±13.2 years. Mean body mass index (BMI) was 27.7 ±4.8 kg/m2. An intracorporeal anastomosis was performed in 51 patients, while an extracorporeal anastomosis was performed in 34. The duration of operations was significantly longer when intracorporeal anastomosis was performed, taking 154 ±58 min compared to 95 ±34 min (p < 0.001), in the extracorporeal group. No mortality was observed in the IA group. The postoperative mortality in the EA group was 8.8% (p = 0.060). The rate of reoperation in the intracorporeal anastomosis group was 7.8%, whereas in the extracorporeal anastomosis group it was 14.7% (p = 0.474). Length of hospital stay in the IA group was shorter in comparison to the EA group (5.3 ±3.7 vs. 11.2 ±19.8 days, p = 0.022).ConclusionsOur results are encouraging to consider the intracorporeal approach as the better way to fashion the anastomosis after laparoscopic right hemicolectomy.

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Section: Discussionsupporting

confidence: 89%

Intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy - single center experience.

Stepińska¹,

Stanowski²,

Paśnik³

et al. 2019

Videosurgery and Other Miniinvasive Techniques

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“…This suggests that certain relevant clinical parameters may not be captured by previously defined DC. Some studies support the analysis of inflammatory markers to support discharge decisionmaking after colorectal surgery [22]. The inclusion of such markers as additional criteria for hospital discharge should be explored in future research.…”

Section: Discussionmentioning

confidence: 99%

Optimizing discharge decision‐making in colorectal surgery: a prospective cohort study of discharge practices in a recently implemented enhanced recovery pathway

Caminsky

Hamad

et al. 2021

Colorectal Disease

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Aim:The objectives of this project were (1) to compare time to readiness for discharge by set criteria and actual length of stay (LOS) in a newly implemented colorectal enhanced recovery pathway and (2) to identify reasons for delayed hospital discharge. Method:We conducted a prospective cohort study of 73 adult patients (age 67 ± 14 years, 56% men, 51% laparoscopic, 13% stoma creation) undergoing elective colorectal surgery in a university hospital with a recently implemented recovery pathway (<2 years). Time to readiness for discharge (oral intake, flatus, pain control, ability to walk, and no complications) was compared to actual LOS using a correlation-adjusted log-rank test. The treating team was interviewed, and thematic analysis was used to identify reasons for patients remaining in hospital after discharge criteria (DC) were achieved.Results: Median LOS was 6 (4-8) days and median time to readiness for discharge was 5(3-8) days (P < 0.001). Twenty-eight patients (37%) remained in hospital after DC were achieved. Although some delayed discharges were medically justified (e.g., workup [13%] or treatment of complications not captured by DC [2.6%]), unnecessary hospital stays were common (e.g., perceived need for observation [16%], or patients not willing to be discharged [11%]).Conclusions: Unnecessary hospital stays were common within a recently implemented enhanced recovery pathway and represent a target for quality improvement. Efforts should be directed at optimizing patient education regarding discharge expectations, early consultation of the discharge planning team and improving discharge decisionmaking using standardized DC.

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“…Significantly higher CRP levels were found after colorectal surgery as early as POD 1 in patients who later developed intra-abdominal infection, which raises doubts regarding opinions that anastomotic leakage occurs near POD 7 [20,22,24]. A stronger inflammatory response may be both the consequence and the cause of intra-abdominal infection (impaired healing or reflecting ongoing tissue hypoxia leading to anastomotic leakage) [21,25].…”

Section: Discussionmentioning

confidence: 99%

Utility of Inflammatory Markers in Detection of Perioperative Morbidity After Laparoscopic Sleeve Gastrectomy, Laparoscopic Roux-en-Y Gastric Bypass, and One-Anastomosis Gastric Bypass—Multicenter Study

et al. 2020

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Background The most commonly performed bariatric operations are laparoscopic sleeve gastrectomy (LSG) and bypass surgeries (laparoscopic one-anastomosis gastric bypass (OAGB) and laparoscopic Roux-en-Y gastric bypass (LRYGB)), and predicting perioperative morbidity is crucial for early, safe patient discharge. We aimed to determine whether C-reactive protein (CRP) and white blood count (WBC) measured on the first postoperative day predicts perioperative morbidity in the first 30-days after LSG and bypass surgeries. Methods We retrospectively analyzed data for 1400 patients who underwent bariatric surgery in seven bariatric centers from 2014 to 2018. Patients were divided into a complicated group (patients with postoperative complications) and a non-complicated group. We also performed separate analyses for LSG and bypass surgeries. Results Patients were 929 women (66%) and 471 men (34%) with a median age of 42 years (range, 35–51 years); 1192 patients underwent LSG (85%), 120 underwent LRYGB (9%), and 80 underwent OAGB (6%). We performed ROC analyses to set cut-off points, followed by multivariate logistic regressions. CRP > 33.32 mg/L increased the odds ratio (OR) of perioperative complications after LSG 2.27 times, while WBC > 12.15 × 103/μL on postoperative day 1 was associated with a 3.34-times greater or of developing complications. WBC > 13.78 × 103/μL was associated with a 13.34-times higher or of perioperative morbidity in patients undergoing bypass surgeries. Conclusion Even slightly elevated CRP and WBC on postoperative day 1 should alert surgeons to the potential risk of perioperative morbidity.

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Use of inflammatory markers in the early detection of infectious complications after laparoscopic colorectal cancer surgery with the ERAS protocol.

Cited by 16 publications

References 37 publications

Intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy - single center experience.

Intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy - single center experience.

Optimizing discharge decision‐making in colorectal surgery: a prospective cohort study of discharge practices in a recently implemented enhanced recovery pathway

Utility of Inflammatory Markers in Detection of Perioperative Morbidity After Laparoscopic Sleeve Gastrectomy, Laparoscopic Roux-en-Y Gastric Bypass, and One-Anastomosis Gastric Bypass—Multicenter Study

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