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1.
J Surg Res ; 257: 153-160, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32828999

RESUMO

BACKGROUND: The effect of an enhanced recovery protocol including preoperative carbohydrate loading on patients with diabetes is unclear. This study investigated the effect of both on perioperative glucose management and postoperative outcomes in patients with diabetes undergoing colorectal surgery. MATERIALS AND METHODS: A retrospective study was conducted on patients undergoing elective colorectal surgery before and after implementation of an enhanced recovery protocol. Ninety-nine patients with type 2 diabetes (DM, 41 control versus 58 enhanced recovery) and 366 patients without diabetes (NDM, 158 control versus 158 enhanced recovery) were included. Multivariate analyses were run to compare mean peak perioperative serum glucose and postoperative outcomes in enhanced recovery and control cohorts with (DM) and without diabetes (NDM). RESULTS: Mean peak preoperative glucose was elevated in DM enhanced recovery compared with DM control patients (192.2 [72.2] versus 139.8 [41.4]; P < 0.001). Mean peak intraoperative (162.3 [43.1] versus 163.8 [39.6]; P = 0.869) and postoperative glucose (207.7 [75.8] versus 217.8 [78.5]; P = 0.523) were similar in DM enhanced recovery compared with DM control group. Enhanced recovery led to decreased LOS in DM (P = 0.001) and NDM enhanced recovery patients (P < 0.000) compared with their control groups. CONCLUSIONS: An enhanced recovery protocol may lead to increased peak preoperative glucose levels and 30-d readmissions in patients with type 2 diabetes undergoing colorectal surgery. However, the ultimate clinical significance of transiently elevated preoperative glucose in DM patients is uncertain. Our results suggest that an enhanced recovery protocol and preoperative carbohydrate loading does not lead to poorer postoperative glycemic control overall in patients with diabetes undergoing colorectal surgery.


Assuntos
Cirurgia Colorretal/métodos , Diabetes Mellitus Tipo 2/complicações , Recuperação Pós-Cirúrgica Melhorada , Idoso , Glicemia/análise , Estudos de Coortes , Dieta da Carga de Carboidratos/métodos , Procedimentos Cirúrgicos Eletivos , Feminino , Hemoglobina A Glicada/análise , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Resultado do Tratamento
2.
Am Surg ; 86(7): 848-855, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32726131

RESUMO

OBJECTIVES: Colorectal care bundles for surgical site infections (CRCB-SSIs) have been shown to reduce SSIs following elective colorectal surgery (CRS). There are limited data evaluating the effect of CRCB-SSI at Academic Disproportionate Share Hospitals (ADSH) with significant rates of urgent and emergent cases. METHODS: A CRCB-SSI was implemented in April 2016. We reviewed medical records of all patients undergoing colon resections between August 2015 and December 2017. Patients were divided into preimplementation and postimplementation groups. The primary endpoint was the SSI rate, and the secondary endpoint included types of SSI (superficial, deep, organ space). Univariable and multivariable analyses were performed. A subset analysis was performed in elective cases. RESULTS: We analyzed a total of 417 patients. Of these, 116 (28%) and 301 (72%) patients were in the preimplementation and postimplementation groups, respectively. The rate of SSI decreased from 30.1% to 15.9% in the postimplementation group (P = .0012); however, it was not statistically significant after adjusting for baseline differences (relative risk [RR] 0.65; 95% CI 0.41-1.02).The elective subset included 219 patients. The rate of SSI in this cohort decreased from 25% to 10.5% in the postimplementation group (P = .0012) and remained significant following multivariable analysis (RR 0.41, 95% CI 0.19- 0.88). There were no differences in the subtypes of SSI. DISCUSSION: While the CRCB-SSI was effective in decreasing the postoperative SSI rate for elective cases, its effect on the overall patient population was limited. CRCB-SSIs are not enough to bring SSI rates to accepted rates in high-risk patients such as those seen at ADSH.


Assuntos
Neoplasias Colorretais/cirurgia , Cirurgia Colorretal/efeitos adversos , Custos Hospitalares , Avaliação de Resultados em Cuidados de Saúde , Pacotes de Assistência ao Paciente/economia , Infecção da Ferida Cirúrgica/epidemiologia , Centros Médicos Acadêmicos , Adulto , Idoso , Análise de Variância , Estudos de Coortes , Neoplasias Colorretais/economia , Cirurgia Colorretal/economia , Cirurgia Colorretal/métodos , Bases de Dados Factuais , Procedimentos Cirúrgicos Eletivos/economia , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Humanos , Tempo de Internação/economia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Cuidados Pós-Operatórios/economia , Cuidados Pós-Operatórios/métodos , Melhoria de Qualidade , Estudos Retrospectivos , Medição de Risco , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/terapia , Estados Unidos
4.
Rev. argent. coloproctología ; 31(2): 63-69, jun. 2020. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-1117012

RESUMO

Introducción: La introducción del sistema Da Vinci, ha revolucionado el campo de la cirugía mínima invasiva en el cual el cirujano tiene control de la cámara 3D y los instrumentos son de gran destreza y confort ergonómico, acortando la curva de aprendizaje quirúrgica. Objetivo: Describir nuestra experiencia inicial de cirugía robótica colorectal en un hospital de comunidad cerrada de la Ciudad Autónoma de Buenos Aires. Materiales y Método: Estudio retrospectivo descriptivo sobre una base prospectiva de cirugías colorectales robóticas realizadas por el mismo equipo quirúrgico desde mayo de 2016 a abril de 2019. Resultados: Se operaron 41 pacientes. Trece de ellos fueron colectomías derechas, 17 colectomías izquierdas y 11 cirugías de recto. El tiempo quirúrgico promedio fue de 170 minutos (90-330), la estadía hospitalaria de 4 días (3-30), la tasa de conversión de 7,31% (3/41 pacientes) y la tasa de dehiscencia anastomótica del 9,75% (4/41 pacientes). Morbilidad global del 19.5% (8/41 pacientes). Conclusión: Hemos repasado los resultados iniciales de nuestra experiencia en cirugía robótica colorectal en un número reducido de casos, pero suficiente para evaluar la seguridad y reproducibilidad del método al comienzo de una curva de aprendizaje.


Introduction: The introduction of the Da Vinci System, has revolved the field of invasive minimal surgery in which the surgeon has control of the 3d camera and the instruments are of great strength and ergonomic comfort by cutting the surgical learning curve. Objective: Of this preliminary presentation is to describe our initial experience of colorectal robotic surgery in a closed community hospital of the Autonomous City of Buenos Aires. Materials and Method: Retrospective descriptive study on a prospective basis of robotic colorectal surgeries performed by the same surgical team from May 2016 to April 2019.Results: 41 patients were operated. 13 of them were right colectomies, 17 left colectomies and 11 rectum surgeries. The average surgical time was 170 minutes (90-330), the average hospital stay of 4 days (3-30), the conversion rate of 7.31% (3/41 patients) and the anastomotic dehiscence rate of 9 , 75% (4/41 patients). Overall morbidity of 19.5% (8/41 patients).Conclusion: We have reviewed the initial results of our experience in colorectal robotic surgery in a reduced number of cases but sufficient to evaluate the security and reproducibility of the methodic learning of a learning curve.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Neoplasias Colorretais/cirurgia , Cirurgia Colorretal/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Reto/cirurgia , Estudos Retrospectivos , Colectomia/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Protectomia/métodos , Hospitais Comunitários
8.
PLoS One ; 15(4): e0231447, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32302336

RESUMO

BACKGROUND: The enhanced recovery after surgery (ERAS) protocol for colorectal cancer resection recommends balanced perioperative fluid therapy. According to recent guidelines, zero-balance fluid therapy is recommended in low-risk patients, and immediate correction of low urine output during surgery is discouraged. However, several reports have indicated an association of intraoperative oliguria with postoperative acute kidney injury (AKI). We investigated the impact of intraoperative oliguria in the colorectal ERAS setting on the incidence of postoperative AKI. PATIENTS AND METHODS: From January 2017 to August 2019, a total of 453 patients underwent laparoscopic colorectal cancer resection with the ERAS protocol. Among them, 125 patients met the criteria for oliguria and were propensity score (PS) matched to 328 patients without intraoperative oliguria. After PS matching had been performed, 125 patients from each group were selected and the incidences of AKI were compared between the two groups. Postoperative kidney function and surgical outcomes were also evaluated. RESULTS: The incidence of AKI was significantly higher in the intraoperative oliguria group than in the non-intraoperative oliguria group (26.4% vs. 11.2%, respectively, P = 0.002). Also, the eGFR reduction on postoperative day 0 was significantly greater in the intraoperative oliguria than non-intraoperative oliguria group (-9.02 vs. -1.24 mL/min/1.73 m2 respectively, P < 0.001). In addition, the surgical complication rate was higher in the intraoperative oliguria group than in the non-intraoperative oliguria group (18.4% vs. 9.6%, respectively, P = 0.045). CONCLUSIONS: Despite the proven benefits of perioperative care with the ERAS protocol, caution is required in patients with intraoperative oliguria to prevent postoperative AKI. Further studies regarding appropriate management of intraoperative oliguria in association with long-term prognosis are needed in the colorectal ERAS setting.


Assuntos
Lesão Renal Aguda/etiologia , Neoplasias Colorretais/cirurgia , Oligúria/complicações , Complicações Pós-Operatórias/etiologia , Cirurgia Colorretal/métodos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Feminino , Hidratação/métodos , Humanos , Incidência , Laparoscopia/métodos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória/métodos , Período Pós-Operatório , Pontuação de Propensão , Estudos Retrospectivos , Medição de Risco , Fatores de Risco
9.
Anticancer Res ; 40(4): 1891-1896, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32234877

RESUMO

BACKGROUND/AIM: Advances in stapling devices have led to their widespread use in colorectal surgery. We compared the strength of four types of anastomoses using bursting pressure. MATERIALS AND METHODS: We created stapled anastomosis models [double stapling technique (DST), functional end-to-end anastomosis (FEEA) unbuttressed or buttressed, and triangulating anastomosis (TA) with two- or three-row stapling] and a hand-sewn anastomosis model. Bursting pressures of each method were measured. The primary end point was the bursting pressure. The effectiveness of buttressing and three-row stapling were the secondary endpoints. RESULTS: The DST group had significantly lower bursting pressure than TA with three-row stapling, FEEA buttressed, and hand-sewn groups. No significant difference was found between the bursting pressure of the FEEA unbuttressed and FEEA buttressed groups and that of the TA with two-row and three-row stapling groups. CONCLUSION: DST has the lowest bursting pressure compared to other anastomotic techniques. Buttressing suture and three-row stapling have no effect on the strength of anastomosis.


Assuntos
Anastomose Cirúrgica/métodos , Neoplasias Colorretais/cirurgia , Cirurgia Colorretal/métodos , Grampeamento Cirúrgico/métodos , Neoplasias Colorretais/patologia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Humanos , Técnicas de Sutura
10.
Surg Clin North Am ; 100(2): 337-360, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32169183

RESUMO

The role of robotics in colon and rectal surgery has been established as an important and effective tool for the surgeon. Its inherent technologies have provided for increased visualization and ease of dissection in the minimally invasive approach to surgery. The value of the robot is apparent in the more challenging aspects of colon and rectal procedures, including the intracorporeal anastomosis for right colectomies and the low pelvic dissection for benign and malignant diseases.


Assuntos
Doenças do Colo/cirurgia , Cirurgia Colorretal/métodos , Doenças Retais/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Colectomia/métodos , Humanos , Laparoscopia/métodos
11.
Sci Rep ; 10(1): 1687, 2020 02 03.
Artigo em Inglês | MEDLINE | ID: mdl-32015374

RESUMO

Anastomotic leakage is a complication of colorectal surgery. C-reactive protein (CRP) is an acute-phase marker that can indicate surgical complications. We determined whether serum CRP levels in patients who had undergone colorectal surgery can be used to exclude the presence of anastomotic leakage and allow safe early discharge. We included 90 patients who underwent colorectal surgery with primary anastomosis. Serum CRP levels were measured retrospectively on postoperative days (PODs) 1 - 7. Patients with anastomotic leakage (n = 11) were compared to those without leakage (n = 79). We statistically analysed data and plotted receiver operating characteristic curves. The incidence of anastomotic leakage was 12.2%. Diagnoses were made on PODs 3 - 24. The overall mortality rate was 3.3% (18.2% in the leakage group, 1.3% in the non-leakage group; P < 0.045). CRP levels were most accurate on POD 4, with a cutoff level of 180 mg/L, showing an area under the curve of 0.821 and a negative predictive value of 97.2%. Lower CRP levels after POD 2 and levels <180 mg/L on POD 4 may indicate the absence of anastomotic leakage and may allow safe discharge of patients who had undergone colorectal surgery with primary anastomosis.


Assuntos
Fístula Anastomótica/sangue , Fístula Anastomótica/metabolismo , Biomarcadores/sangue , Biomarcadores/metabolismo , Proteína C-Reativa/metabolismo , Adulto , Idoso , Anastomose Cirúrgica/métodos , Cirurgia Colorretal/métodos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Feminino , Humanos , Contagem de Leucócitos/métodos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Valor Preditivo dos Testes , Curva ROC , Estudos Retrospectivos
12.
Rev. cir. (Impr.) ; 72(1): 48-58, feb. 2020. tab, ilus
Artigo em Espanhol | LILACS | ID: biblio-1092890

RESUMO

Resumen Introducción Los protocolo ERAS recomiendan la detección y optimización de la anemia preoperatoria. Objetivo Evaluar si la implantación de un protocolo de corrección de anemia preoperatoria en cirugía colorrectal electiva con un protocolo ERAS (grupo ERAS) reduce las transfusiones con respecto a un grupo de pacientes operado de la misma patología previo a su implantación (grupo preERAS). Objetivos secundarios Valorar estancia hospitalaria, complicaciones y reingresos a los 30 días tras el alta. Materiales y Método Comparamos los primeros 121 pacientes consecutivos que participaron en un protocolo ERAS con un protocolo corrección de anemia preoperatoria con los 135 previos a su implantación. Se consideraron resultados significativos p < 0,05. Resultados Se redujo el número de pacientes transfundidos en el grupo ERAS (31 (22,96%) vs 15 (12,4%), p = 0,028) y el número total de concentrados de hematíes transfundidos (3 ± 1,57 vs 1,8 ± 0,56, p < 0,001) con la aplicación del protocolo. No se encontraron diferencias estadísticamente significativas en los pacientes que recibieron hierro oral, pero sí en los que recibieron hierro intravenoso (3 vs 31, p < 0,001). Se redujo la estancia hospitalaria (11 ± 3,8 vs 9,8 ± 3,7, p = 0,018), sin aumentar la tasa de complicaciones ni los reingresos a los 30 días. Conclusión La aplicación de un protocolo de optimización de anemia preoperatoria en pacientes sometidos a cirugía colorrectal electiva siguiendo las guías ERAS redujo el número total de pacientes transfundidos, el número de concentrados de hematíes trasfundidos y la estancia hospitalaria.


Introduction An enhanced recovery after surgery (ERAS) protocol, recommends detection and optimization in treatment of preoperative anemia. Aim Evaluate if introducing a preoperative anemia correcting protocol in elective colorectal surgery, by means of an ERAS protocol (ERAS Group), reduces the need for transfusions with regards to a group of patients undergoing surgery for the same pathology before the protocol´s implementation (ERAS Group). Secondary objectives Evaluate length of stay, complications and readmission rates 30 days post discharge. Materials and Method We compared the first 121 consecutive patients who participated in an ERAS protocol with a preoperative correcting anemia protocol, with the previous 135 patients operated on before the protocol was introduced. A value of p < 0.05 was considered significant. Results The number of patients who needed a transfusion was reduced in the ERAS group (31 (22.96%) vs 15 (12.4%), p = 0.028) as was the total number of red blood cells transfused (3 ± 1.57 vs 1.8 ± 0.56, p < 0.001) with the use of the protocol. No statistical differences were noted in the patients who received oral iron although there was in those who received intravenous iron. (3 vs 31, p < 0.001). Overall length of stay was reduced (11 ± 3.8 vs 9.8 ± 3.7, p = 0.018), but no increase in complications or readmission rates at 30 days. Conclusions The implementation of an optimization in the treatment of preoperative anemia protocol in patients undergoing elective colorectal surgery following the ERAS guidelines, reduced the total number of patients who needed transfusions, the total concentrate of red blood cells transfused, and the length of stay.


Assuntos
Humanos , Masculino , Feminino , Cirurgia Colorretal/métodos , Anemia/prevenção & controle , Procedimentos Cirúrgicos Eletivos/métodos , Cirurgia Colorretal/efeitos adversos , Período Perioperatório , Anemia/complicações
13.
Medicine (Baltimore) ; 99(2): e18560, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914032

RESUMO

INTRODUCTION: Anastomotic leakage (AL) remains one of the most threatening complications in colorectal surgery with the incidence of up to 20%. The aim of the study is to evaluate the safety and feasibility of novel - trimodal intraoperative colorectal anastomosis testing technique. METHODS AND ANALYSIS: This multi-center prospective cohort pilot study will include patients undergoing colorectal anastomosis formation below 15 cm from the anal verge. Trimodal anastomosis testing will include testing for blood supply by ICG fluorescence trans-abdominally and trans-anally, testing of mechanical integrity of anastomosis by air-leak and methylene blue leak tests and testing for tension. The primary outcome of the study will be AL rate at day 60. The secondary outcomes will include: the frequency of changed location of bowel resection; ileostomy rate; the rate of intraoperative AL; time, taken to perform trimodal anastomosis testing; postoperative morbidity and mortality; quality of life. DISCUSSION: Trimodal testing of colorectal anastomosis may be a novel and comprehensive way to investigate colorectal anastomosis and to reveal insufficient blood supply and integrity defects intraoperatively. Thus, prevention of these two most common causes of AL may lead to decreased rate of leakage. STUDY REGISTRATION: Clinicaltrials.gov (https://clinicaltrials.gov/): NCT03958500, May, 2019.


Assuntos
Anastomose Cirúrgica/métodos , Fístula Anastomótica/prevenção & controle , Cirurgia Colorretal/métodos , Anastomose Cirúrgica/efeitos adversos , Cirurgia Colorretal/efeitos adversos , Humanos , Ileostomia/estatística & dados numéricos , Azul de Metileno , Duração da Cirurgia , Projetos Piloto , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos
14.
Female Pelvic Med Reconstr Surg ; 26(2): 86-91, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31990793

RESUMO

BACKGROUND: The rapid uptake of robotic surgery has largely been driven by the improved technical aspects of minimally invasive surgery including improved ergonomics, wristed instruments, and 3-dimensional vision. However, little attention has been given to the effect of physical separation of the surgeon from the rest of the operating team. PURPOSE: The aim of this study was to examine in depth how this separation affected team dynamics and staff emotions. METHODS: Robotic procedures were observed in 2 tertiary hospitals, and laparoscopic/open procedures were added for comparison; field notes were taken instantaneously. One-to-one interviews with theater team members were audio recorded and transcribed verbatim. Qualitative analysis was conducted via grounded theory approach using NVIVO11. RESULTS: Twenty-nine participants (26 interviewed) were recruited to the study (11 females) and 134 (109 robotic) hours of observation were completed across gynecology, urology, and colorectal surgery.The following 3 main themes emerged with compounding factors identified: (a) communication challenge, (b) immersion versus distraction, and (c) emotional impact. Compounding factors included the following: individual and team experience, staffing levels, and the physical theater environment. CONCLUSIONS: Our emergent theory is that "surgeon-team separation in robotic theaters poses communication challenges which impacts on situational awareness and staff emotions." These can be ameliorated by staff training, increased experience, and team/procedure consistency.


Assuntos
Barreiras de Comunicação , Comunicação Interdisciplinar , Equipe de Assistência ao Paciente/organização & administração , Procedimentos Cirúrgicos Robóticos , Procedimentos Cirúrgicos Operatórios , Adulto , Atitude do Pessoal de Saúde , Cirurgia Colorretal/métodos , Cirurgia Colorretal/tendências , Feminino , Humanos , Masculino , Salas Cirúrgicas/organização & administração , Pesquisa Qualitativa , Melhoria de Qualidade , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/psicologia , Procedimentos Cirúrgicos Robóticos/normas , Robótica/métodos , Procedimentos Cirúrgicos Operatórios/métodos , Procedimentos Cirúrgicos Operatórios/psicologia , Procedimentos Cirúrgicos Operatórios/normas , Procedimentos Cirúrgicos Urogenitais/métodos , Procedimentos Cirúrgicos Urogenitais/tendências
15.
Postgrad Med ; 132(3): 256-262, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31525304

RESUMO

BACKGROUND: Surgery remains the only known treatment option for rectal prolapse. Although over 100 abdominal and perineal procedures are available, there is no consensus as to which intervention is best suited for an individual. This retrospective cohort study describes the patient- and disease-related factors involved in making surgical recommendations around rectal prolapse in a single surgeon experience. METHODS: 91 consecutive patients ≥18 years old diagnosed with external and/or high-grade internal rectal prolapse were assessed and were prospectively entered into an IRB approved registry. Information on patient symptoms, comorbidities, exam findings, surgeon judgment, and patient preference was collected. Treatment recommendations (abdominal, perineal, or no operation) were analyzed and compared. RESULTS: Surgical intervention was recommended to 93% of patients. Of those, 66% were recommended robotic abdominal procedures: 75%, robotic ventral mesh rectopexies; 16%, resection rectopexies; and 9%, suture rectopexies. On univariate analysis, patients with older age, higher ASA scores, presence of cardiopulmonary morbidity, pain as a primary rectal prolapse symptom, rectal prolapse always descended, and surgeon concern for frailty and general anesthesia were associated with recommendations for perineal operations (p < 0.05 for all). However, on multivariate analysis, only age and concern over prolonged anesthesia remained correlated with a recommendation for perineal surgery. Of patients >80 years of age, 15% were recommended an abdominal approach. CONCLUSIONS: With multiple options available for the treatment of rectal prolapse, treatment recommendations remain surgeon-dependent and may be influenced by many factors. In our practice, robotic ventral mesh rectopexy was the most commonly recommended operation and was offered to carefully selected patients of advanced age. Although robotic surgery and ventral mesh rectopexy may not be accessible to all patients and surgeons, this represents a single surgeon's practice bias. This study reinforces the importance of perineal procedures for higher-risk individuals.


Assuntos
Tomada de Decisão Clínica , Cirurgia Colorretal/métodos , Prolapso Retal/cirurgia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Anestesia/psicologia , Cirurgia Colorretal/psicologia , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Preferência do Paciente , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/psicologia , Índice de Gravidade de Doença , Telas Cirúrgicas
16.
Am J Surg ; 220(1): 187-190, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31735257

RESUMO

BACKGROUND: Modified frailty index (mFI) has been proposed as a reliable tool in predicting postoperative outcomes after surgery. This study aims to evaluate whether mFI could be utilized to predict readmissions after colorectal resection for patients with cancer by using nationwide cohort. METHODS: Patients undergoing elective abdominal colorectal resection for colorectal cancer were reviewed from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) procedure-targeted database (2010-2012). A previously described mFI was calculated. Demographics, comorbidities, and 30-day postoperative complications were compared between patients who were readmitted or not after colorectal surgery. RESULTS: A total of 7337 patients were identified with a mean age of 65.8(±13.6) years. Eight hundred seventy-one (11.8%) patients were readmitted at least once within 30 days. Age, gender, BMI, and other comorbidities were comparable between the groups. O approach, current smoking, mFI(>3/11), disseminating cancer, bleeding disorder and longer operative time were found to independently associated with readmission. CONCLUSIONS: An 11-point modified frailty index as measured in NSQIP correlates with readmissions after colorectal resection in patients with colon and rectal cancer.


Assuntos
Neoplasias Colorretais/cirurgia , Cirurgia Colorretal/métodos , Fragilidade/diagnóstico , Readmissão do Paciente/tendências , Melhoria de Qualidade , Medição de Risco , Idoso , Neoplasias Colorretais/epidemiologia , Comorbidade , Bases de Dados Factuais , Feminino , Fragilidade/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Estados Unidos/epidemiologia
17.
Br J Surg ; 107(3): 167-170, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31872429

RESUMO

An analysis of the results and conclusions from the most recent RCTs of the role of mechanical bowel preparation before colonic surgery is presented. The results indicate a wide disparity in the methods, results and conclusion of these studies, and the lack of microbial culture confirmation to advance understanding of how to move the field forward. Controversy on bowel preparation in colorectal surgery.


Assuntos
Colo/cirurgia , Cirurgia Colorretal/métodos , Procedimentos Cirúrgicos do Sistema Digestório , Cuidados Pré-Operatórios/métodos , Procedimentos Cirúrgicos Eletivos/métodos , Humanos
18.
Nutr Clin Pract ; 35(2): 306-314, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31144380

RESUMO

BACKGROUND: After lower gastrointestinal surgery, few patients start eating within timeframes outlined by evidence-based guidelines or meet their nutrition requirements in hospital. The present study explored hospital staffs' perceptions of factors influencing timely and adequate feeding after colorectal surgery to inform future interventions for improving postoperative nutrition practices and intakes. METHODS: This qualitative exploratory study was conducted at an Australian hospital where Enhanced Recovery After Surgery guidelines had not been formally implemented. One-on-one semistructured interviews were conducted with hospital staff who provided care to patients undergoing colorectal surgery. Interviews lasted from 21 to 47 minutes and were audio recorded and transcribed verbatim. Data were analyzed using inductive thematic analysis. Emergent themes and subthemes were discussed by all investigators to ensure consensus of interpretation. RESULTS: Eighteen staff participated in interviews, including 9 doctors, 5 nurses, 2 dietitians, and 2 foodservice staff. Staffs' responses formed 3 themes: (1) variability in perceived acceptability of postoperative feeding; (2) improving dynamics and communication within the treating team; and (3) optimizing dietary intakes with available resources. CONCLUSION: Staff and organizational factors need to be considered when attempting to improve postoperative nutrition among patients who undergo colorectal surgery. Introducing a feeding protocol, enhancing intraprofessional and interdisciplinary communication, and ensuring the availability of appropriate, nutrient-dense foods are pivotal to improve nutrition practices and intakes.


Assuntos
Atitude do Pessoal de Saúde , Cirurgia Colorretal/métodos , Terapia Nutricional/métodos , Cuidados Pós-Operatórios/métodos , Austrália , Recuperação Pós-Cirúrgica Melhorada , Feminino , Pessoal de Saúde/psicologia , Hospitais , Humanos , Comunicação Interdisciplinar , Entrevistas como Assunto , Masculino , Necessidades Nutricionais , Estado Nutricional , Pesquisa Qualitativa
19.
Arq Bras Cir Dig ; 32(4): e1477, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31859930

RESUMO

BACKGROUND: Perioperative care multimodal protocol significantly improve outcome in surgery. AIM: To investigate risk factors to various endpoints in patients submitted to elective colorectal operations under the ACERTO protocol. METHODS: Cohort study analyzing through a logistic regression model able to assess independent risk factors for morbidity and mortality, patients submitted to elective open colon and/or rectum resection and primary anastomosis who were either exposed or non-exposed to demographic, clinical, and ACERTO interventions. RESULTS: Two hundred thirty four patients were analyzed and submitted to 156 (66.7%) rectal and 78 (33.3%) colonic procedures. The length of hospital postoperative stay (LOS) ≥ 7 days was related to rectal surgery and high NNIS risk index; preoperative fasting ≤4 h (OR=0.250; CI95=0.114-0.551) and intravenous volume of crystalloid infused > 30ml/kg/day (OR=0.290; CI95=0.119-0.706). The risk of postoperative site infection (SSI) was approximately four times greater in malnourished; eight in rectal surgery and four in high NNIS index. The duration of preoperative fasting ≤4 h was a protective factor by reducing by 81.3% the risk of surgical site infection (SSI). An increased risk for anastomotic fistula was found in malnutrition, rectal surgery and high NNIS index. Conversely, preoperative fasting ≤4 h (OR=0.11; CI95=0.05-0.25; p<0.0001) decreased the risk of fistula. Factors associated with pneumonia-atelectasis were cancer and rectal surgery, while preoperative fasting ≤ 4 h (OR=0.10; CI95=0.04-0.24; p<0.0001) and intravenous crystalloid ≤ 30 ml/kg/day (OR=0.36; CI95=0.13-0.97, p=0.044) shown to decrease the risk. Mortality was lower with preoperative fasting ≤4 h and intravenous crystalloids infused ≤30 ml/kg/day. CONCLUSION: This study allows to conclude that rectal procedures, high NNIS index, preoperative fasting higher than 4 h and intravenous fluids greater than 30 ml/kg/day during the first 48 h after surgery are independent risk factors for: 1) prolonged LOS; 2) surgical site infection and anastomotic fistula associated with malnutrition; 3) postoperative pneumonia-atelectasis; and 4) postoperative mortality.


Assuntos
Cirurgia Colorretal/métodos , Fidelidade a Diretrizes/estatística & dados numéricos , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Cirurgia Colorretal/efeitos adversos , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Adulto Jovem
20.
Medicine (Baltimore) ; 98(52): e18448, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876726

RESUMO

BACKGROUND: This study aimed to compare the quadratus lumborum block (QLB) method with transversus abdominis plane block (TAPB) for postoperative pain management in patients undergoing laparoscopic colorectal surgery. METHODS: Seventy-four patients scheduled for laparoscopic colorectal surgery were randomly assigned into 2 groups. After surgery, patients received bilateral ultrasound-guided single-dose of QLB or TAPB. Each side was administered with 20 ml of 0.375% ropivacaine. All patients received sufentanil as patient-controlled intravenous analgesia (PCIA). Resting and moving numeric rating scale (NRS) were assessed at 2, 4, 6, 24, 48 hours postoperatively. The primary outcome measure was sufentanil consumption at predetermined time intervals after surgery. RESULTS: Patients in the QLB group used significantly less sufentanil than TAPB group at 24 and 48 hours (P < .05), but not at 6 hours (P = .33) after laparoscopic colorectal surgery. No significant differences in NRS results were found between the two groups at rest or during movement (P > .05). Incidence of dizziness in the QLB group was lower than in TAPB group (P < .05). CONCLUSIONS: The QLB is a more effective postoperative analgesia as it reduces sufentanil consumption compared to TAPB in patients undergoing laparoscopic colorectal surgery.


Assuntos
Músculos Abdominais/inervação , Músculos Abdominais Oblíquos/inervação , Cirurgia Colorretal/métodos , Laparoscopia/métodos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/terapia , Anestésicos Locais/administração & dosagem , Neoplasias Colorretais/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Ropivacaina/administração & dosagem , Sufentanil/administração & dosagem , Ultrassonografia de Intervenção
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