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1.
World J Surg ; 2024 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-39390605

RESUMO

BACKGROUND: Existing studies suggest a positive correlation between high compliance with enhanced recovery programs (ERP) and improved outcomes. While individual outcome measures have advantages, composite benchmarks, such as textbook outcome (TO), offer a more comprehensive assessment of healthcare performance. Given the link between ERP and postoperative outcomes, this study aims to investigate the impact of ERP on TO attainment after liver surgery (LS). METHODS: A prospective multicenter cohort of patients undergoing LS and exposed to ERP from 2016 to 2022 in France was analyzed. The primary outcome was to compare the rates of TO achieved between patients with high ERP compliance (>70%) and those with low ERP compliance (<70%) after LS. RESULTS: A total of 706 patients were included in the study, and 217 (30.7%) achieved TO: 170 patients with high ERP compliance (24%) versus 47 patients (6.6%) with low ERP compliance attained TO (p < 0.001). High ERP compliance was associated to an increased likelihood of achieving TO [odds ratio (OR) = 1.49 (95% CI: 1.01, 2.24); p = 0.049], while cholangiocarcinoma [OR = 0.11 (95% CI: 0.02, 0.39); p = 0.003], high complexity LS [OR = 0.22 (95% CI: 0.13, 0.36); p < 0.001], intraoperative hypotension requiring vasopressors [OR = 0.29 (95% CI: 0.10, 0.68); p = 0.010], and post-operative ileus [OR = 0.08 (95% CI: 0.00, 0.37); p = 0.013] were negatively associated to the likelihood of achieving TO. CONCLUSIONS: Patients with high ERP compliance after LS experience elevated rates of TO, compared to those with low ERP compliance.

2.
Sante Publique ; 36(3): 69-92, 2024.
Artigo em Francês | MEDLINE | ID: mdl-38906816

RESUMO

INTRODUCTION: The aim of this study was to analyze the rate of enhanced recovery programs (ERP) implementation in a range of surgical specialties in both the public and private sectors. METHODS: This was a retrospective longitudinal study based on hospital stays between March to December 2019. We studied thirteen of the activity segments most frequently included in ERP protocol. The procedures selected included digestive, gynecological, orthopedic, thoracic, and urological procedures. The assessment criteria was the rate of ERP. The results were analyzed first overall and then matching ERP stays to non-ERP stays according to type of institution, patient age and sex, month of discharge, and Charlson comorbidity score. RESULTS: We took 420,031 stays into account, of which 78,119 were coded as ERP. There were 62,403 non-ERP stays. Depending on the type of surgery, the implementation rate ranged from 5 percent to 30 percent. The overall rate of ERP implementation was higher in the private sector (21.2 percent) than in the public sector (14.4 percent). The results are reversed for some surgeries, notably for some cancers. Patients had a higher Charlson score in the public sector. CONCLUSIONS: This large-scale national study provides a picture of the degree of diffusion of ERPs in France. Although there are differences between sectors, this diffusion is still insufficient overall. Given the demonstrated benefits of ERPs, more educational efforts are needed to improve their implementation in France.


Assuntos
Recuperação Pós-Cirúrgica Melhorada , Humanos , França , Feminino , Estudos Retrospectivos , Masculino , Estudos Longitudinais , Pessoa de Meia-Idade , Idoso , Adulto , Adulto Jovem , Idoso de 80 Anos ou mais
3.
Colorectal Dis ; 24(10): 1164-1171, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35536237

RESUMO

AIM: The aim was to define the risk factors for acute urinary retention (AUR) and urinary tract infections (UTIs) in colon or high rectum anastomosis patients based on the absence of a urinary catheter (UC) or the early removal of the UC (<24 h). METHOD: This is a multicentre, international retrospective analysis of a prospective database including all patients undergoing colon or high rectum anastomoses. Patients were part of the enhanced recovery programme audit, developed by the Francophone Group for Enhanced Recovery after Surgery, and were included if no UC was inserted or if a UC was inserted for <24 h. RESULTS: In all, 9389 patients had colon or high rectum anastomoses using laparoscopy, open surgery or robotic surgery. Among these patients, 4048 were excluded because the UC was left in place >24 h (43.1%) and 97 were excluded because the management of UC was unknown (1%). Among the 5244 colon or high rectum anastomoses patients included, AUR occurred in 5.2% and UTI occurred in 0.7%. UCs were in place for <24 h in 2765 patients (52.7%) and 2479 did not have UCs in place (47.3%). Multivariate analysis showed that management of the UC was not significantly associated with the occurrence of AUR and that risk factors for AUR were male gender, ≥65 years old, having an American Society of Anesthesiologists score ≥3 and receiving epidural analgesia. Conversely, being of male gender was a protective factor of UTI, while being ≥65 years old, having open surgery and receiving epidural analgesia were risk factors for UTIs. The management of the UC was not significantly associated with the occurrence of UTIs but the occurrence of AUR was a more significant risk factor for UTIs. CONCLUSION: UCs in place for <24 h did not reduce the occurrence of AUR or UTI compared to the absence of UCs.


Assuntos
Retenção Urinária , Infecções Urinárias , Humanos , Masculino , Idoso , Feminino , Retenção Urinária/etiologia , Retenção Urinária/complicações , Reto/cirurgia , Estudos Retrospectivos , Infecções Urinárias/etiologia , Infecções Urinárias/complicações , Colo/cirurgia , Drenagem/efeitos adversos , Anastomose Cirúrgica/efeitos adversos
4.
Langenbecks Arch Surg ; 407(1): 15-23, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34599682

RESUMO

AIM OF THE STUDY: To review and to analyse the feasibility of using no urinary catheter or a catheter for less than 24 h compared with longer post-operative catheter after colorectal surgery with infraperitoneal dissection. METHODS: We performed a systematic review and meta-analysis of studies comparing no urinary catheter or a catheter for less than 24 h (early removal, ER) and urinary catheter drainage for 2 days or longer (late removal, LR) after colorectal surgery with infraperitoneal dissection. Primary endpoint was acute urinary retention (AUR) requiring a re-catheterization. Secondary endpoints were urinary tract infection (UTI), overall morbidity and hospital length of stay. Meta-analysis met the PRISMA criteria, with a random model. RESULTS: Out of 3659 articles found, 82 comparative studies on catheter duration were selected, of which five were in colorectal surgery: three randomized trials, one retrospective and one prospective series. There were 396 ER and 410 LR patients. All had undergone surgery with infraperitoneal dissection. There was no significant difference regarding AUR (OR = 2.09 [95%CI 0.97-4.52]) but significantly less UTI (OR = 0.39 [95%CI 0.22-0.67]) for early urinary catheter removal. The number needed to harm was much higher for AUR than for UTI (23.3 vs. 8). CONCLUSION: This meta-analysis suggests that, in terms of benefit/risk ratio, in colorectal surgery with infraperitoneal anastomosis, early removal (< 24 h) of the urinary catheter would be beneficial (because of a more frequent UTI after LR than AUR after ER) and would reduce the occurrence of UTI if no AUR risk factors are present. However, these findings should be interpreted with caution because of the low quality of evidence.


Assuntos
Cirurgia Colorretal , Infecções Urinárias , Anastomose Cirúrgica/efeitos adversos , Cateteres de Demora , Remoção de Dispositivo , Humanos , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Tempo , Cateterismo Urinário , Cateteres Urinários/efeitos adversos , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia , Infecções Urinárias/prevenção & controle
5.
BMC Health Serv Res ; 21(1): 1341, 2021 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-34906137

RESUMO

BACKGROUND: Study of the medico economic impact of enhanced rehabilitation after surgery (ERAS), by comparing the cost of patient care with or without ERAS, both from the point of view of the hospitals and the Social Security Health Insurance Program. METHODS: Retrospective longitudinal study on matched data from March 1, 2019 to December 31, 2019. The data are extracted from the French prospective payment system. We studied 12 of the most commonly performed in ERAS business segments. The primary outcome was the reduction of the average length of hospital stay and its implications on production costs and excess capacity. We also studied the impact on hospital incomes and Social Security Insurance Program expenses. The potential gain in hospital days was computed by comparing the length of stay of ERAS and non-ERAS cases. The cost reduction was estimated using the mean number of avoidable days of hospitalization, and the mean cost of the stays obtained from the national cost study. Finally, we studied an approximation of the additional expense for the Social Security Health Insurance Program on costs standardized by applying public sector rates. RESULTS: The average length of stay reduction attributed to ERAS is 1.45 (CI 95% 1.42 to 1.48) day per stay, translating to a cost reduction for the hospitals of € 1060 (CI 95% 995 to 1125) per patient and a total of €65 million (CI 95% 61 to 69). At the same time, the additional expenses for the Social Security Insurance Program can conservatively be approximated to € 1.6 million, breaking into a € 2.2 million increase partially compensated by cost savings of € 0.6 million over subsequent stays for complications. Overall, for each percent of additional ERAS activity over the scope of the study, the marginal cost reduction for the hospitals can be estimated to € 1.8 million (CI 95% 1.7 million to 2.0 million). CONCLUSIONS: Associated with previously known clinical benefits for the patients, these convincing results in terms of economic gain strongly support expanding the adoption of ERAS.


Assuntos
Hospitais , Redução de Custos , Humanos , Tempo de Internação , Estudos Longitudinais , Estudos Retrospectivos
6.
J Surg Oncol ; 122(5): 928-933, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32627198

RESUMO

BACKGROUND AND OBJECTIVE: The impact of surgical indication on compliance with enhanced recovery program (ERP) and on outcomes has never been assessed. This study aims to assess the impact of surgical indication (malignant vs benign) on postoperative outcomes and ERP compliance. METHODS: A multicenter nationwide database was analyzed. Patients who underwent colorectal surgery for benign disease and those who underwent colorectal surgery for cancer were compared. Inclusion criteria were elective colorectal resection with anastomosis. ERP components, postoperative morbidity, and hospital length of hospital stay data were collected. RESULTS: Among the 6472 patients registered in the database between October 2012 and June 2018, 4528 patients were included; 2647 in the malignant group and 1881 in the benign group. The ERP compliance over 70% was not different between groups. Postoperative morbidity rate was higher in the malignant group (22.5% vs 19.3%; P = .009) but not confirmed in multivariate analysis. Patients in the malignant group were more often readmitted after discharge, 6.6% vs 4.6% (P = .004). The mean LOS was 6.3 ± 5.0 days in the malignant group and 5.4 ± 4.7 days in the benign group (P < .001). CONCLUSIONS: Indication for colorectal surgery did not significantly influence peri-operative management and postoperative major complications, in patients managed within an enhanced recovery program.


Assuntos
Doenças do Colo/cirurgia , Neoplasias Colorretais/cirurgia , Cooperação do Paciente/estatística & dados numéricos , Doenças Retais/cirurgia , Idoso , Doenças do Colo/psicologia , Neoplasias Colorretais/psicologia , Cirurgia Colorretal/psicologia , Cirurgia Colorretal/normas , Cirurgia Colorretal/estatística & dados numéricos , Bases de Dados Factuais , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Procedimentos Cirúrgicos do Sistema Digestório/normas , Recuperação Pós-Cirúrgica Melhorada , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente/psicologia , Doenças Retais/psicologia , Estudos Retrospectivos
7.
Surg Endosc ; 34(12): 5583-5592, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-31932940

RESUMO

BACKGROUND: Avoiding the use of nasogastric tubes (NGTs) is recommended after colorectal surgery but there is no consensus on intraoperative gastric decompression using NGTs during colorectal surgery. The objective was to assess the effect of avoiding insertion of NGTs during colorectal surgery for the recovery of gastrointestinal (GI) functions. METHOD: 1561 patients undergoing colorectal surgery, for whom information on NGT use was available, were included in this retrospective analysis and propensity score analysis of the prospective GRACE Audit database. Patients who did and did not have an NGT during surgery were compared. RESULTS: Among the study population of 1561 patients, 696 patients were matched to correct baseline differences between groups. The no-NGT group significantly improved GI motility impairment (e.g., less postoperative nausea [OR = 0.59; CI 95%: 0.42-0.84] and a better tolerance of early feeding [OR = 2.07; CI 95%: 1.33-3.22]). Such an association was also highlighted for reduced postoperative morbidity [OR = 0.60; CI 95%: 0.43-0.83], and especially pulmonary complications [OR = 0.08; CI 95%: 0.01-0.59], or parietal complications [OR = 0.29; CI 95%: 0.09-0.87]. The risk of postoperative ileus was not significantly reduced in the no-NGT group [OR = 0.67; CI 95%: 0.43-1.06]. CONCLUSION: No NGT insertion during colorectal surgery is safe and could improve postoperative GI function recovery.


Assuntos
Cirurgia Colorretal , Bases de Dados como Assunto , Intubação Gastrointestinal , Pontuação de Propensão , Feminino , Humanos , Intubação Gastrointestinal/efeitos adversos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Recuperação de Função Fisiológica , Estudos Retrospectivos , Resultado do Tratamento
8.
Langenbecks Arch Surg ; 405(6): 877-878, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32676739

RESUMO

INTRODUCTION: The COVID-19 pandemic is having a deep impact on our surgical practice and scientific publishing output. METHODS: The 100 best-ranked "surgery journals" were selected. The contents of the March, April, May, and June 2020 issues and ahead-of-print articles were screened. The retrieved articles on COVID-19 were separated into two categories: "opinion articles" and "scientific articles," i.e., randomized trials and original articles with structured methods and results. The number of COVID articles published in the TOP-10 journals was compared with that of COVID articles published elsewhere. RESULTS: There were 59 COVID original articles (8%). The great majority of articles were opinion articles (83.4%). Almost 40% of COVID articles were published in the TOP-10 journals. CONCLUSION: Original COVID articles (the core of our knowledge) are scant. Faced with a novel disease, neither the authors nor the editors should be criticized regarding this situation. The future step should be to publish high-quality papers in the setting of a major health crisis.


Assuntos
Betacoronavirus , Bibliometria , Infecções por Coronavirus , Confiabilidade dos Dados , Pandemias , Pneumonia Viral , Atitude , COVID-19 , Humanos , SARS-CoV-2
9.
HPB (Oxford) ; 22(7): 1051-1056, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31974047

RESUMO

BACKGROUND: There is a level-1 evidence indicating that postoperative antibiotics are unnecessary following cholecystectomy for grade I or II acute calculous cholecystitis (ACC). We wanted to evaluate the applications of this recommendation in clinical practice four years after the original publication in ABCAL-participating centers. METHODS: A retrospective analysis of patients operated for grade I or II ACC from January to December 2016 in ABCAL-participating centers was performed. Inclusion criteria were the same as for the ABCAL-study. The primary endpoint was the postoperative antibiotic administration rate. The secondary endpoints were postoperative outcomes. RESULTS: Of the 283 patients included, 64% received postoperative antibiotics. Only 19% received antibiotics after POD1. The perioperative outcomes were similar between those that did or did not receive antibiotics after POD1. The median [range] length of stay was significantly shorter in patients who did not receive postoperative antibiotics (4 days [1-20]) compared to the others (6 days [1-50], p > 0.001). CONCLUSION: Despite strong recommendations included in the Tokyo 2018 guidelines, the results of the ABCAL-study are poorly applied even if the absence of postoperative antibiotics has no impact on morbidity. It is important to stress that postoperative antibiotics are not necessary after cholecystectomy for grade I or II ACC.


Assuntos
Colecistectomia Laparoscópica , Colecistite Aguda , Antibacterianos , Colecistectomia , Colecistite Aguda/diagnóstico , Colecistite Aguda/cirurgia , Humanos , Tempo de Internação , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Estudos Retrospectivos , Resultado do Tratamento
10.
Int J Colorectal Dis ; 34(1): 71-83, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30293140

RESUMO

PURPOSE: Postoperative ileus (POI) occurrence within enhanced recovery programs (ERPs) has decreased. Also, intra-abdominal complications (IAC) such as anastomotic leakage (AL) generally present late. The aim was to characterize the link between POI and the other complications occurring after surgery. METHODS: This retrospective analysis of a prospective database was conducted by the Francophone Group for Enhanced Recovery after Surgery. POI was considered to be present if gastrointestinal functions had not been recovered within 3 days following surgery or if a nasogastric tube replacement was required. RESULTS: Of the 2773 patients who took part in the study, 2335 underwent colorectal resections (83.8%) for cancer, benign tumors, inflammatory bowel disease, and diverticulosis. Among the 2335 patients, 309 (13.2%) experienced POI, including 185 (59.9%) cases of secondary POI. Adjusted for well-known risk factors (male gender, need for stoma, right hemicolectomy, surgery duration, laparotomy, and conversion to open surgery), POI was associated with abdominal complications (OR = 4.55; 95% confidence interval (CI): 3.30-6.28), urinary retention (OR = 1.75; 95% CI: 1.05-2.92), pulmonary complications (OR = 4.55; 95% CI: 2.04-9.97), and cardiological complications (OR = 3.01; 95% CI: 1.15-8.02). Among the abdominal complications, AL and IAC were most strongly associated with POI (respectively, OR = 5.97; 95% CI: 3.74-8.88 and OR = 5.76; 95% CI: 3.56-10.62). CONCLUSION: Within ERPs, POI should not be considered as usual. There is a significant link between POI and IAC. Since POI is an early-onset clinical sign, its occurrence should alert the physician and prompt them to consider performing CT scans in order to investigate other potential morbidities.


Assuntos
Bases de Dados como Assunto , Íleus/etiologia , Complicações Pós-Operatórias/etiologia , Recuperação de Função Fisiológica , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Fatores de Risco
11.
Int J Colorectal Dis ; 34(8): 1509-1514, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31286214

RESUMO

When the original article was first published the given name and family names of Francophone Group for Enhanced Recovery After Surgery (GRACE) individually cited within the author list were inadvertently interchanged. The author list are correctly cited in this Correction.

12.
Ann Surg Oncol ; 25(3): 709-719, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29282602

RESUMO

BACKGROUND: Whether cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) is safe and worthwhile for elderly patients remains unclear. This meta-analysis of outcomes after CRS plus HIPEC for the elderly aimed to generate a higher level of evidence and precise indications for these patients. METHODS: A systematic literature search for studies reporting postoperative outcomes after CRS plus HIPEC for elderly patients was performed in the MEDLINE, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, Web of Knowledge Conference Proceedings Citation Index-Science, and Google Scholar databases. The included studies evaluated the overall 30-day postoperative morbidity, 90-day postoperative mortality, grade 3 or higher postoperative morbidity, rates of anastomotic leaks, reoperation and readmission, and length of hospital stay. RESULTS: The inclusion criteria were met by 13 retrospective studies involving 2544 patients. Considering only comparative studies, the 90-day postoperative mortality was significantly increased for elderly patients [odds ratio (OR), 0.49; 95% confidence interval (CI), 0.27-0.88; I 2 = 79%]. The 30-day grade 3 or higher postoperative morbidity was increased in the patients 70 years of age or older (14.5%; 95% CI 8.1-24.4 vs. 32.3%; 95% CI 22.4-44.0%; p = 0.004; I 2 = 85%). The overall 30-day postoperative morbidity, rates of anastomotic leaks, reoperation and readmission, and length of hospital stay were not affected by age. CONCLUSIONS: Treatment of the elderly with CRS plus HIPEC was associated with increased severe postoperative morbidity and mortality. However, these conclusions should be weighted given the existence of major biases in the included studies. Age alone probably would not be a formal contraindication, but frailty should be taken into account. Further prospective studies are needed.


Assuntos
Quimioterapia do Câncer por Perfusão Regional/mortalidade , Procedimentos Cirúrgicos de Citorredução/mortalidade , Hipertermia Induzida/mortalidade , Neoplasias Peritoneais/mortalidade , Neoplasias Peritoneais/terapia , Idoso , Terapia Combinada , Humanos , Prognóstico , Taxa de Sobrevida
15.
Acta Obstet Gynecol Scand ; 97(2): 158-167, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29143306

RESUMO

INTRODUCTION: Optimal surgical treatment of rectovaginal endometriosis remains a controversial topic. The objective of this study was to evaluate long-term postoperative outcomes after rectal shaving or colorectal resection for rectovaginal endometriosis. MATERIAL AND METHODS: 195 patients underwent surgery (172 managed by shaving, 23 by colorectal resection) between January 2000 and June 2013 for rectovaginal endometriosis (>2 cm) involving at least the serosa of the rectum. Primary outcome measures were pain and fertility. Secondary outcome measures were complications, recurrence rates and quality of life. RESULTS: Mean follow-up was 60 ± 42 months in the shaving group and 67 ± 47 months in the resection group. The mean VAS score for pelvic pain between the pre and postoperative period decreased from 5.5 ± 3.5 (shaving group) and 7.3 ± 2.9 (resection group) to 2.3 ± 2.4 (p < 0.001) and 2.0 ± 1.8 (p < 0.001), respectively. For dysmenorrhea, the mean baseline VAS score fell postoperatively from 7.7 ± 2.8 (shaving group) and 8.2 ± 2.6 (resection group) to 3.3 ± 2.9 (p < 0.001) and 2.7 ± 2.7 (p < 0.001), respectively. Pregnancy rates were 73% for shaving and 69% for resection. Major complications occurred in 4% of patients in the shaving group and in 26% in the resection group (p = 0.001). Thirteen patients (7.6%) from the shaving group and none from the resection group were reoperated for suspicion of endometriosis recurrence (p = 0.37). Postoperative quality of life scores revealed no differences between the two groups. CONCLUSION: Our study demonstrates that rectal shaving, when feasible for rectovaginal nodule (>2 cm) infiltrating the digestive serosa, has equal impact on pain and pregnancy rates compared with colorectal resection at long-term follow-up, with low complication and favorable pregnancy rates.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Endometriose/cirurgia , Terapia a Laser/métodos , Dor Pós-Operatória/etiologia , Qualidade de Vida/psicologia , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Endometriose/patologia , Feminino , Seguimentos , Humanos , Terapia a Laser/efeitos adversos , Recuperação de Função Fisiológica , Estudos Retrospectivos , Resultado do Tratamento
16.
Surgeon ; 16(6): 321-324, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29666000

RESUMO

BACKGROUND: Enhanced recovery programs (ERP) improve post-operative outcomes in proportion to how fully they are implemented. Maintaining an optimal level of application of all the ER components is thus essential. Our aim was to assess the sustainability of ER surgical components 2 years after their first implementation. METHOD: Patients undergoing elective colorectal resections were included in a prospective database. To retrospectively analyze compliance with ERP over a period of 24 months, the following components were considered: colonic preparation, surgical approach, nasogastric tube omission and absence of abdominal drainage. RESULTS: 2565 patients with a mean age of 63.6 ± 14.4 years from 63 colorectal centers were included. There were 1853 (72.2%) colectomies and 558 (21.7%) rectal resections. The median duration of hospital stay was 5 days [Interquartiles 4-8]. Overall morbidity was 21.9%, surgical morbidity was 8.1%, including 2.8% anastomotic fistulae. Overall, the ERP component most often applied with was postoperative nasogastric tube omission (93.6%), followed by laparoscopic approach (81.7%), absence of drainage (74.9%), and colonic preparation omission (67.3%). Implementation of surgical components significantly decreased over time: less laparoscopy (from 86.8% to 76.6%, p < 0.001), less drain omission (from 88.7% to 72%, p < 0.001), less nasogastric tube omission (from 100% to 93.4%, p = 0.002) and less colonic preparation omission (from 73.6% to 65.6%, p = 0.01). CONCLUSION: This large-scale study found that implementation of surgical components in ERP decreased over time. Further efforts are needed to sustain compliance with ERP and surgical teams should focus on repeated audits.


Assuntos
Protocolos Clínicos , Colectomia , Assistência Perioperatória , Reto/cirurgia , Idoso , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
17.
Acta Chir Belg ; 118(2): 73-77, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29334849

RESUMO

INTRODUCTION: Although the concept of enhanced recovery after surgery was introduced more than 20 years ago, its implementation in daily practice still remains difficult. RESULTS: This article addresses bottlenecks and barriers to the development of enhanced recovery programme (ERP). Barriers to the implementation are multifactorial and are raised by the different actors of these programmes: surgeons, anaesthetists, nurses, patients. Solutions and steps that must be respected to succeed in introducing ERP in an hospital are proposed. CONCLUSIONS: Large-scale implementation of ERP continues to face mainly lack of trust and communication. Solutions exist and are based particularly on team work and interdisciplinary collaboration.


Assuntos
Colo/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório , Cuidados Pós-Operatórios/métodos , Avaliação de Programas e Projetos de Saúde/métodos , Recuperação de Função Fisiológica , Reto/cirurgia , Padrão de Cuidado , Fidelidade a Diretrizes , Humanos
18.
Int J Colorectal Dis ; 32(6): 797-803, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28283741

RESUMO

PURPOSE: There is no consensual definition of postoperative ileus (POI), which leads to a lack of reproducibility. The aims of this study were (i) to propose and evaluate a classification of postoperative ileus based on its consequences and (ii) to assess the reproducibility of the classification. METHODS: A national global survey was carried out according to the DELPHI method in order to create a classification of primary POI. The classification was subsequently tested on a cohort of patients who underwent colorectal surgery. Finally, a reproducibility test was performed in five teaching hospitals with junior and senior surgeons. RESULTS: A five-stage classification was proposed: grade A (least) to grade E (worst). For better differentiation, subcategories (D1/D2) were included. Overall, 173 patients were included who underwent colorectal surgery. Forty of them experienced primary postoperative ileus (23.1%). Grade A occurred in 10 cases, grade B in 10 cases, grade C in 14 cases, grade D1 in 2 cases, and grade D2 in 2 cases. POI-related death (grade E) occurred in 2 cases. Patients with grade A POI recovered their gastrointestinal function significantly faster than those with higher grades (p = 0.01), and were more likely to undergo laparoscopic surgery (p = 0.04). The Intraclass Correlation Coefficient (ICC) was 0.83 in the overall population, and 0.83 and 0.82 respectively in the junior and senior surgeon populations. CONCLUSION: This classification is easy to both use and reproduce. It will improve the reproducibility, evaluation, and assessment of POI. These preliminary results should be confirmed in a multi-centric international study.


Assuntos
Cirurgia Colorretal , Íleus/classificação , Íleus/etiologia , Complicações Pós-Operatórias/classificação , Complicações Pós-Operatórias/etiologia , Inquéritos e Questionários , Humanos , Reprodutibilidade dos Testes
20.
J Minim Invasive Gynecol ; 24(5): 717-721, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28087481

RESUMO

STUDY OBJECTIVE: To report a case of a transrectal mesh erosion as complication of laparoscopic promontofixation with mesh repair, necessitating bowel resection and subsequent surgical interventions. INTRODUCTION: Sacrocolpopexy has become a standard procedure for vaginal vault prolapse [1], and the laparoscopic approach has gained popularity owing to more rapid recovery and less morbidity [2,3]. Mesh erosion is a well-known complication of surgical treatment for prolapse as reported in several negative evaluations, including a report from the US Food and Drug Administration in 2011 [4]. Mesh complications are more common after surgeries via the vaginal approach [5]; nonetheless, the incidence of vaginal mesh erosion after laparoscopic procedures is as high as 9% [6]. The incidence of transrectal mesh exposure after laparoscopic ventral rectopexy is roughly 1% [7]. The diagnosis may be delayed because of its rarity and variable presentation. In addition, polyester meshes, such as the mesh used in this case, carry a higher risk of exposure [8]. CASE REPORT: A 57-year-old woman experiencing genital prolapse, with the cervix classified as +3 according to the Pelvic Organ Prolapse Quantification system, underwent laparoscopic standard sacrocolpopexy using polyester mesh. Subtotal hysterectomy and bilateral adnexectomy were performed concomitantly. A 3-year follow-up consultation demonstrated no signs or symptoms of erosion of any type. At 7 years after the surgery, however, the patient presented with rectal discharge, diagnosed as infectious rectocolitis with the isolation of Clostridium difficile. She underwent a total of 5 repair surgeries in a period of 4 months, including transrectal resection of exposed mesh, laparoscopic ablation of mesh with digestive resection, exploratory laparoscopy with abscess drainage, and exploratory laparoscopy with ablation of residual mesh and transverse colostomy. She recovered well after the last intervention, exhibiting no signs of vaginal or rectal fistula and no recurrence of pelvic floor descent. Her intestinal transit was reestablished, and she was satisfied with the treatment. CONCLUSION: None of the studies that represent the specific female population submitted to laparoscopic promontofixation with transrectal mesh erosion describe the need for more than one intervention or digestive resection [9-12]. Physicians dealing with patients submitted to pelvic reconstructive surgeries with mesh placement should be aware of transrectal and other nonvaginal erosions of mesh, even being rare events. Moreover, they should perform an active search for unusual gynecologic and anorectal signs and symptoms. Most importantly, patients undergoing mesh repair procedures must be warned of the risks of the surgery, including the possibility of several subsequent interventions.


Assuntos
Colectomia , Migração de Corpo Estranho/cirurgia , Prolapso de Órgão Pélvico/cirurgia , Reto/cirurgia , Telas Cirúrgicas/efeitos adversos , Anastomose Cirúrgica/efeitos adversos , Feminino , Migração de Corpo Estranho/complicações , Humanos , Histerectomia/efeitos adversos , Laparoscopia/métodos , Pessoa de Meia-Idade , Diafragma da Pelve/cirurgia , Procedimentos de Cirurgia Plástica , Fístula Retovaginal/etiologia , Fístula Retovaginal/cirurgia , Reto/patologia , Reoperação , Resultado do Tratamento , Vagina/patologia , Vagina/cirurgia
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