[Implementation of fast-track measures in colorectal resections : A survey among members of the DGAI]. / Umsetzung anästhesiologischer Fast-Track-Maßnahmen bei kolorektalen Resektionen : Eine Umfrage unter Mitgliedern der DGAI.

PURPOSE: The fast-track (FT) concept is a multimodal, interdisciplinary approach to perioperative patient care intended to reduce postoperative complications. Despite good evidence implementation seems to need improvement, whereby almost all studies focused on the implementation of surgical modules regardless of the interdisciplinary aspect. Adherence to the anesthesiological measures (prehabilitation, premedication, volume and temperature management, pain therapy), on the other hand, has been insufficiently studied. To assess the status quo a survey on the implementation of anesthesiological FT measures was conducted among members of the German Society of Anesthesiology and Intensive Care Medicine (DGAI) to analyze where potential for improvement exists. METHODS: Using the SurveyMonkey® online survey tool, 28 questions regarding perioperative anesthesiological care of colorectal surgery patients were sent to DGAI members in order to analyze adherence to FT measures. RESULTS: While some of the FT measures (temperature management, PONV prophylaxis) are already routinely used, there is a divergence between current recommendations and clinical implementation for other components. In addition to premedication, interdisciplinary measures (prehabilitation) and measures that affect multiple interfaces (operating theatre, recovery room, ward), such as volume management or perioperative pain management, are particularly affected. CONCLUSION: The anesthesiological recommendations of the FT concept are only partially implemented in Germany. This particularly affects the interdisciplinary components as well as measures at the operating theatre, recovery room and ward interfaces. The establishment of an interdisciplinary FT team and interdisciplinary development of SOPs can optimize adherence, which in turn improves the short-term and long-term outcome of patients.

[Mechanical bowel obstruction in geriatric patients : Etiology and perioperative morbidity/mortality compared with a younger cohort]. / Der mechanische Ileus bei geriatrischen Patienten : Ätiologie und perioperative Morbidität/Mortalität im Vergleich zu einer jüngeren Patientenkohorte.

BACKGROUND: Mechanical bowel obstruction is a common condition in geriatric patients in the emergency department. It accounts for up to 50% of all emergency surgeries in the elderly. In recent years, diagnosis and treatment of mechanical bowel obstruction has improved, but little is known whether elderly patients benefit from modern treatment approaches. OBJECTIVE: The aim of the work is to generate knowledge about possible improvement of diagnosis and treatment of mechanical bowel obstruction in the elderly. METHODS: A retrospective review of 132 patients was performed comparing geriatric (>80 years of age) and nongeriatric patients (50-70 years of age) admitted with mechanical bowel obstruction. Etiology, time from first contact to operation, bowel resection rate and morbidity/mortality were compared. Data analysis included Fisher's test and Student t­test. RESULTS: In patients under 70 years of age it took 18.23 ± 0.79 h from first contact until laparotomy in the operating room (OR) vs. 43.38 ± 12.08 h in patients above 80 years of age (p = 0.0111). In 58.9% of geriatric patients, resection of bowel was necessary, while only 35.3% of <70-year-old patients needed bowel resection (p = 0.0401). In all, 50% of geriatric patients experienced major complications (Dindo/Clavien >IIIB) vs. only 12.7% of 50- to 70-year-old patients (p = 0.0002). Postoperative stay in the intensive care unit was significantly prolonged in geriatric patients compared to younger patients (93.97 ± 17.36 h vs. 26.11 ± 3.73 h, p < 0.0001). CONCLUSIONS: Time from first contact in the emergency department until laparotomy in the OR is prolonged in geriatric patients, leading to a higher probability of bowel resection with greater morbidity and mortality. Diagnostics should be intensified and accelerated in geriatric patients. Emergency surgery should be considered earlier.