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1.
Can J Surg ; 63(5): E475-E482, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33107818

RESUMO

BACKGROUND: American studies have shown that higher provider and hospital volumes are associated with reduced risk of mortality following colorectal surgical interventions. Evidence from Canada is limited, and to our knowledge only a single study has considered outcomes other than death. We describe associations between provider surgical volume and all-cause mortality and postoperative complications following colorectal surgical interventions in New Brunswick. METHODS: We used hospital discharge abstracts linked to vital statistics, the provincial cancer registry and patient registry data. We considered all admissions for colorectal surgeries from 2007 through 2013. We used logistic regression to identify odds of dying and odds of complications (from any of anastomosis leak, unplanned colostomy, intra-abdominal sepsis or pneumonia) within 30 days of discharge from hospital according to provider volume (i.e., total interventions performed over the preceding 2 years) adjusted for personal, contextual, provider and hospital characteristics. RESULTS: Overall, 9170 interventions were performed by 125 providers across 18 hospitals. We found decreased odds of experiencing a complication following colorectal surgery per increment of 10 interventions performed per year (odds ratio 0.94, 95% confidence interval 0.91-0.96). We found no associations with mortality. Associations remained consistent across models restricted to cancer patients or to interventions performed by general surgeons and across models that also considered overall hospital volumes. CONCLUSION: Our results suggest that increased caseloads are associated with reduced odds of complications, but not with all-cause mortality, following colorectal surgery in New Brunswick. We also found no evidence of volume having differential effects on outcomes from colon and rectal procedures.


Assuntos
Doenças do Colo/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Doenças Retais/cirurgia , Carga de Trabalho/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Colo/cirurgia , Doenças do Colo/mortalidade , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Feminino , Mortalidade Hospitalar , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Hospitais com Baixo Volume de Atendimentos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Novo Brunswick/epidemiologia , Razão de Chances , Complicações Pós-Operatórias/etiologia , Doenças Retais/mortalidade , Reto/cirurgia , Sistema de Registros/estatística & dados numéricos , Resultado do Tratamento
2.
Nihon Shokakibyo Gakkai Zasshi ; 117(9): 802-810, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32908111

RESUMO

While hospitalized due to severe aortic stenosis, an 84-year-old woman developed repeated bleeding from angiodysplasia in the stomach leading to a diagnosis of Heyde syndrome. Following transcatheter aortic valve implantation (TAVI), there was no recurrence of bleeding from the angiodysplasia, and the decrease in von Willebrand factor levels that caused Heyde syndrome also improved. It was felt that the TAVI was able to prevent the recurrence of gastrointestinal bleeding due to angiodysplasia in Heyde syndrome.


Assuntos
Angiodisplasia/cirurgia , Estenose da Valva Aórtica/cirurgia , Doenças do Colo/cirurgia , Substituição da Valva Aórtica Transcateter , Idoso de 80 Anos ou mais , Feminino , Hemorragia Gastrointestinal , Humanos
4.
Am Surg ; 86(9): 1091-1093, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32804548

RESUMO

OBJECTIVES: The highest rates of surgical site infections (SSIs) are associated with colorectal operations (up to 30%). A sentinel paper showed that the use of intravenous (IV) cefazolin and metronidazole was associated with decreased rates of SSI compared with cefoxitin (6% vs 13%). We reviewed the association of SSI with prophylactic antibiotic choice. We specifically investigated the regimens of ceftriaxone and metronidazole IV, cefoxitin IV, or ertapenem. METHODS: We conducted a retrospective review of 532 colon surgeries between 2016 and 2018. Inclusion criteria were patients 18-89 years of age undergoing elective colon surgery who received ceftriaxone/metronidazole, cefoxitin, or ertapenem for prophylaxis. All emergent cases were excluded. This resulted in 241 elective colon cases for review. The primary endpoint was to determine if the use of ceftriaxone/metronidazole decreased the rate of SSI. RESULTS: In total, there were 241 elective colon cases with 21 SSI. We compared SSI rates in the ceftriaxone/metronidazole group to those patients receiving either cefoxitin or ertapenem (4.5% vs 12.2%; P = .035). We then compared SSI in ceftriaxone/metronidazole to SSI in cefoxitin (4.5% vs 10%; P = .13). Finally, we compared SSI in the ceftriaxone/metronidazole group to SSI in the ertapenem group (4.5% vs 14%; P = .03). Comorbidities and underlying factors were similar across all antibiotic groups. CONCLUSION: In our experience, the use of ceftriaxone/metronidazole is associated with a decreased SSI rate. Furthermore, ceftriaxone/metronidazole use is superior to the use of ertapenem, with a trend toward superiority over cefoxitin. Based on this study, we recommend ceftriaxone/metronidazole as antibiotic prophylaxis for elective colon surgery.


Assuntos
Antibacterianos/uso terapêutico , Antibioticoprofilaxia/métodos , Colectomia/efeitos adversos , Doenças do Colo/cirurgia , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Assistência Perioperatória/métodos , Infecção da Ferida Cirúrgica/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
5.
Khirurgiia (Mosk) ; (7): 54-60, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32736464

RESUMO

OBJECTIVE: To analyze the results of minimally invasive surgical treatment of patients with urgent colon diseases. MATERIAL AND METHODS: There were 89 patients with urgent colon diseases. All patients were divided into 2 groups: the main group - 31 patients who underwent laparoscopic surgeries, the control group - 58 patients operated via open access. Both groups were comparable by age and underlying disease. However, significant differences in gender, severity of comorbidities and complications of the underlying disease were observed. RESULTS: Surgery time, postoperative morbidity (9.7% vs. 6.9%) and postoperative hospital-stay were similar in both groups. Quality of life was significantly better in the main group compared with the control group if colostomy was absent. In case of stoma, there were no between-group differences. CONCLUSION: Laparoscopic surgery is associated with reduced need for analgesics, similar duration of intervention and postoperative morbidity. Complete restoration of quality of life in these patients is observed in 6 months after surgery. Colostomy results similar quality of life after laparoscopic and open surgery.


Assuntos
Doenças do Colo/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Laparoscopia , Qualidade de Vida , Colostomia/efeitos adversos , Humanos , Resultado do Tratamento
8.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(Z1): 21-26, 2020 Jul 10.
Artigo em Chinês | MEDLINE | ID: mdl-32594721

RESUMO

Colorectal surgery is a major therapeutic approach for various colorectal diseases. Surgery and perioperative management, such as fasting, mechanical bowel preparation, and antibiotics use, have an impact on the composition and function of gut microbiome. Abnormal microbiome reconstruction may lead to multiple complications, including infection, gastrointestinal dysfunction, anastomotic leak and disease recurrence. The aim of this review is to elucidate the roles and mechanisms of perioperative interventions of colorectal surgery on gut microbiome, which may provide a novel insight into the microbe-based therapies in the perioperative period of colorectal surgery.


Assuntos
Doenças do Colo/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Microbioma Gastrointestinal/fisiologia , Assistência Perioperatória/efeitos adversos , Doenças Retais/cirurgia , Fístula Anastomótica , Doenças do Colo/microbiologia , Doenças do Colo/fisiopatologia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Humanos , Assistência Perioperatória/métodos , Doenças Retais/microbiologia , Doenças Retais/fisiopatologia
9.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(Z1): 32-37, 2020 Jul 10.
Artigo em Chinês | MEDLINE | ID: mdl-32594723

RESUMO

Colorectal surgery patients have severe intestinal flora disorders and antibiotic resistant bacteria due to the disease itself and preoperative treatment, as well as the influence of dietary structure and environmental factors. Perioperative anesthesia and operative stress can cause gastrointestinal motility disorders. In addition, the widespread use of prophylactic broad-spectrum antibiotics and antiacids aggravate intestinal flora disorders and induces severe postoperative infectious diarrhea, such as pseudomembranous enteritis and fatal enteritis. The clinical manifectation are severe infectious diarrhea with high fever and abdominal distension after surgery. The disease progresses rapidly. When the diagnosis and treatment are delayed, the patient can quickly develop shock and other serious complications such as anastomotic leakage, even die of multiple organ failure. Therefore, early diagnosis and treatment are crucial.


Assuntos
Doenças do Colo/cirurgia , Diarreia/diagnóstico , Diarreia/terapia , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Doenças Retais/cirurgia , Doenças do Colo/microbiologia , Doenças do Colo/fisiopatologia , Diarreia/etiologia , Diarreia/microbiologia , Humanos , Infecções/diagnóstico , Infecções/etiologia , Infecções/microbiologia , Infecções/terapia , Intestinos/microbiologia , Intestinos/fisiopatologia , Cuidados Pré-Operatórios/efeitos adversos , Doenças Retais/microbiologia
11.
Chirurgia (Bucur) ; 115(2): 148-154, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32369718

RESUMO

This work's objective was to review the entire literature on colorectal surgery in order to best define the surgical indications and their management specificities. The literature analysis was carried out according to High Authority for Health (HAS) methodology, by consulting the PubMed database (Medline), from the beginning of January 1995 until the end of June 2015.


Assuntos
Colectomia/métodos , Doenças do Colo/cirurgia , Intestino Grosso/cirurgia , Cirrose Hepática/complicações , Protectomia/métodos , Doenças Retais/cirurgia , Colo/cirurgia , Doenças do Colo/complicações , Humanos , Doenças Retais/complicações , Reto/cirurgia
12.
Endoscopy ; 52(5): 414, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32321188
13.
Ulus Travma Acil Cerrahi Derg ; 26(2): 255-259, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32185770

RESUMO

BACKGROUND: This study evaluated the outcome of the reversal of Hartmann's procedure based on preoperative and intraoperative risk factors. METHODS: We retrospectively reviewed 78 cases, whom we applied the Hartmann's procedure either electively or under emergency conditions in our clinic between the years 2010 and 2016. RESULTS: Of the cases reviewed in this study, 45 patients were males, and 33 patients were females. Of all cases included in this study, 32 cases were operated due to malignancies, 15 cases were operated due to a perforated diverticulum, and 11 cases were operated due to sigmoid volvulus. Reversal of Hartmann's was performed in 32 cases. The morbidity and mortality rates for the reversal of Hartmann's procedure were 37.5% and 0.0%,respectively. CONCLUSION: The reversal of Hartmann's procedure appears to be a safe operation with acceptable morbidity rates. If the correct patient selection, correct operation timing and meticulous surgical preparation are performed, the risk of morbidity and mortality of the reversal of Hartmann's procedure can be minimized.


Assuntos
Colectomia , Colostomia , Reoperação , Colectomia/efeitos adversos , Colectomia/métodos , Doenças do Colo/cirurgia , Colostomia/efeitos adversos , Colostomia/métodos , Feminino , Humanos , Masculino
14.
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
15.
Clinics (Sao Paulo) ; 75: e1353, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31939559

RESUMO

OBJECTIVE: Stoma prolapse is an intussusception of the bowel through a mature stoma. It can be caused by increased intra-abdominal pressure, excessively mobile bowel mesentery and/or a large opening in the abdominal wall at the time of stoma formation. It occurs predominantly in loop stomas, and correction methods include conservative modalities, such as local reduction to the prolapsed bowel, or surgical treatment. The purpose of this study was to describe our experience with the treatment of colostomy prolapse using a novel mesh strip technique. METHODS: Between February 2009 and March 2018, ten consecutive male patients underwent correction of colostomy prolapse under local anesthesia by peristomal placement of a polypropylene mesh strip. Operation time, short- and long-term complications, and recurrence rates were recorded and analyzed. RESULTS: No postoperative complications, morbidity or mortality were observed. The median length of the prolapse ranged from 6-20 cm, and the median operative time was 30 minutes. The median duration of follow-up was 25 months (range, 12-89 months). No relapse, mesh strip extrusion, local infection or granuloma formation were found. CONCLUSION: A simple, fast, and low-cost operation under local anesthesia using a mesh strip is a valuable option to treat colostomy prolapse.


Assuntos
Doenças do Colo/cirurgia , Colostomia/reabilitação , Complicações Pós-Operatórias/cirurgia , Telas Cirúrgicas , Estomas Cirúrgicos/efeitos adversos , Parede Abdominal , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prolapso , Resultado do Tratamento
16.
Int J Colorectal Dis ; 35(3): 445-453, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31897650

RESUMO

BACKGROUND: ERAS implementation improved outcomes in patients undergoing colorectal surgery. The process of incorporating this pathway in clinical practice may be challenging. This observational study investigated the impact of systematic ERAS implementation on surgical outcomes in patients undergoing colorectal resections in a regional network of 10 institutions. METHODS: Implementation of ERAS pathway was designed using regular audits and a common protocol. All patients undergoing elective colorectal surgery between 2016 and 2017 were considered eligible. A collective database including 18 ERAS items, clinical and surgical data, and outcomes was designed. Univariate and multivariate analyses were performed for the following outcomes: morbidity, anastomotic leak, reinterventions, hospital stay, and readmissions. RESULTS: A total of 827 patients were included, and a mean of 11.3 ERAS items applied/patient was reported. Logistic regression indicated that an increased number of ERAS items applied reduced overall and severe morbidity (OR 0.86 and 0.87, respectively 95%CI 0.8197-0.9202 and 95%CI 0.7821-0.9603), hospitalization (OR 0.53 95%CI 0.4917-0.5845) and reinterventions (OR 0.84 95%CI 0.7536-0.9518) in the entire series. The same results were obtained for a prolonged hospitalization differentiating right-sided (OR 0.48 95%CI 0.4036-0.5801), left-sided (OR 0.48 95%CI 0.3984-0.5815), and rectal resections (OR 0.46 95%CI 0.3753-0.5851). An inverse correlation was found between the application of ERAS items and morbidity in right-sided and rectal procedures (OR 0.89 and 0.84, respectively 95%CI 0.7976-0.9773 and 95%CI 0.7418-0.9634). CONCLUSIONS: Systematic implementation of the ERAS pathway using multi-institutional audits can increase protocol adherence and improve surgical outcomes in patients undergoing colorectal surgery.


Assuntos
Doenças do Colo/cirurgia , Procedimentos Clínicos/organização & administração , Avaliação de Resultados da Assistência ao Paciente , Assistência Centrada no Paciente/organização & administração , Doenças Retais/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Humanos , Itália , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Avaliação de Programas e Projetos de Saúde , Reoperação , Adulto Jovem
17.
JAMA Surg ; 155(3): 206-215, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31913422

RESUMO

Importance: Bridge to elective surgery using self-expandable metal stent (SEMS) placement is a debated alternative to emergency resection for patients with left-sided obstructive colon cancer because of oncologic concerns. A decompressing stoma (DS) might be a valid alternative, but relevant studies are scarce. Objective: To compare DS with SEMS as a bridge to surgery for nonlocally advanced left-sided obstructive colon cancer using propensity score matching. Design, Setting, and Participants: This national, population-based cohort study was performed at 75 of 77 hospitals in the Netherlands. A total of 4216 patients with left-sided obstructive colon cancer treated from January 1, 2009, to December 31, 2016, were identified from the Dutch Colorectal Audit and 3153 patients were studied. Additional procedural and intermediate-term outcome data were retrospectively collected from individual patient files, resulting in a median follow-up of 32 months (interquartile range, 15-57 months). Data were analyzed from April 7 to October 28, 2019. Exposures: Decompressing stoma vs SEMS as a bridge to surgery. Main Outcomes and Measures: Primary anastomosis rate, postresection presence of a stoma, complications, additional interventions, permanent stoma, locoregional recurrence, disease-free survival, and overall survival. Propensity score matching was performed according to age, sex, body mass index, American Society of Anesthesiologists score, prior abdominal surgery, tumor location, pN stage, cM stage, length of stenosis, and year of resection. Results: A total of 3153 of the eligible 4216 patients were included in the study (mean [SD] age, 69.7 [11.8] years; 1741 [55.2%] male); after exclusions, 443 patients underwent bridge to surgery (240 undergoing DS and 203 undergoing SEMS). Propensity score matching led to 2 groups of 121 patients each. Patients undergoing DS had more primary anastomoses (104 of 121 [86.0%] vs 90 of 120 [75.0%], P = .02), more postresection stomas (81 of 121 [66.9%] vs 34 of 117 [29.1%], P < .001), fewer major complications (7 of 121 [5.8%] vs 18 of 118 [15.3%], P = .02), and more subsequent interventions, including stoma reversal (65 of 113 [57.5%] vs 33 of 117 [28.2%], P < .001). After DS and SEMS, the 3-year locoregional recurrence rates were 11.7% for DS and 18.8% for SEMS (hazard ratio [HR], 0.62; 95% CI, 0.30-1.28; P = .20), the 3-year disease-free survival rates were 64.0% for DS and 56.9% for SEMS (HR, 0.90; 95% CI, 0.61-1.33; P = .60), and the 3-year overall survival rates were 78.0% for DS and 71.8% for SEMS (HR, 0.77; 95% CI, 0.48-1.22; P = .26). Conclusions and Relevance: The findings suggest that DS as bridge to resection of left-sided obstructive colon cancer is associated with advantages and disadvantages compared with SEMS, with similar intermediate-term oncologic outcomes. The existing equipoise indicates the need for a randomized clinical trial that compares the 2 bridging techniques.


Assuntos
Doenças do Colo/etiologia , Doenças do Colo/cirurgia , Neoplasias do Colo/complicações , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Stents Metálicos Autoexpansíveis , Estomas Cirúrgicos , Idoso , Idoso de 80 Anos ou mais , Doenças do Colo/mortalidade , Feminino , Humanos , Obstrução Intestinal/mortalidade , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Pontuação de Propensão , Estudos Retrospectivos , Taxa de Sobrevida
18.
Ann R Coll Surg Engl ; 102(1): 28-35, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31232611

RESUMO

INTRODUCTION: Enhanced recovery programmes are established as an essential part of laparoscopic colorectal surgery. Optimal pain management is central to the success of an enhanced recovery programme and is acknowledged to be an important patient reported outcome measure. A variety of analgesia strategies are employed in elective laparoscopic colorectal surgery ranging from patient-controlled analgesia to local anaesthetic wound infiltration catheters. However, there is little evidence regarding the optimal analgesia strategy in this cohort of patients. The LapCoGesic study aimed to explore differences in analgesia strategies employed for patients undergoing elective laparoscopic colorectal surgery and to assess whether this variation in practice has an impact on patient-reported and clinical outcomes. MATERIALS AND METHODS: A prospective, multicentre, observational cohort study of consecutive patients undergoing elective laparoscopic colorectal resection was undertaken over a two-month period. The primary outcome measure was postoperative pain scores at 24 hours. Data analysis was conducted using SPSS version 22. RESULTS: A total of 103 patients undergoing elective laparoscopic colorectal surgery were included in the study. Thoracic epidural was used in 4 (3.9%) patients, spinal diamorphine in 56 (54.4%) patients and patient-controlled analgesia in 77 (74.8%) patients. The use of thoracic epidural and spinal diamorphine were associated with lower pain scores on day 1 postoperatively (P < 0.05). The use of patient-controlled analgesia was associated with significantly higher postoperative pain scores and pain severity. DISCUSSION: Postoperative pain is managed in a variable manner in patients undergoing elective colorectal surgery, which has an impact on patient reported outcomes of pain scores and pain severity.


Assuntos
Analgesia/métodos , Doenças do Colo/cirurgia , Laparoscopia/métodos , Padrões de Prática Médica/estatística & dados numéricos , Doenças Retais/cirurgia , Idoso , Analgesia/estatística & dados numéricos , Analgesia Controlada pelo Paciente/estatística & dados numéricos , Analgésicos Opioides/uso terapêutico , Conversão para Cirurgia Aberta/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Humanos , Cuidados Intraoperatórios/métodos , Cuidados Intraoperatórios/estatística & dados numéricos , Laparoscopia/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Medição da Dor , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Cuidados Pós-Operatórios/métodos , Cuidados Pós-Operatórios/estatística & dados numéricos , Estudos Prospectivos , Reoperação/estatística & dados numéricos , Resultado do Tratamento
19.
Ann Surg ; 271(1): 114-121, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-29864092

RESUMO

OBJECTIVE: The purpose of this study was to evaluate the impact of optimization of preoperative comorbidities by nonsurgical clinicians on short-term postoperative outcomes. SUMMARY BACKGROUND DATA: Preoperative comorbidities can have substantial effects on operative risk and outcomes. The modifiability of these comorbidity-associated surgical risks remains poorly understood. METHODS: We identified patients with a major comorbidity (eg, diabetes, heart failure) undergoing an elective colectomy in a multipayer national administrative database (2010-2014). Patients were included if they could be matched to a preoperative surgical clinic visit within 90 days of an operative intervention by the same surgeon. The explanatory variable of interest ("preoperative optimization") was defined by whether the patient was seen by an appropriate nonsurgical clinician between surgical consultation and subsequent surgery. We assessed the impact of an optimization visit on postoperative complications with use of propensity score matching and multilevel, multivariable logistic regression. RESULTS: We identified 4531 colectomy patients with a major potentially modifiable comorbidity (propensity weighted and matched effective sample size: 6037). After matching, the group without an optimization visit had a higher rate of complications (34.6% versus 29.7%, P = 0.001). An optimization visit conferred a 31% reduction in the odds of a complication (P < 0.001) in an adjusted analysis. Median preoperative costs increased by $684 (P < 0.001) in the optimized group, and a complication increased total costs of care by $14,724 (P < 0.001). CONCLUSIONS AND RELEVANCE: We demonstrated an association between use of nonsurgical clinician visits by comorbid patients prior to surgery and a significantly lower rate of complications. These findings support the prospective study of preoperative optimization as a potential mechanism for improving postoperative outcomes.


Assuntos
Colectomia/efeitos adversos , Doenças do Colo/cirurgia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Colectomia/economia , Doenças do Colo/economia , Doenças do Colo/epidemiologia , Comorbidade , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Procedimentos Cirúrgicos Eletivos/economia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/economia , Pontuação de Propensão , Estudos Prospectivos , Fatores de Risco , Estados Unidos/epidemiologia
20.
Ann R Coll Surg Engl ; 102(2): 141-143, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31660754

RESUMO

INTRODUCTION: Colonic stent insertion has been shown to be an effective treatment for patients with acute large bowel obstruction, either as a bridge to surgery or as definitive treatment. However, little is known of the role of secondary stent insertion following primary stent failure in patients considered inappropriate or high risk for emergency surgery. METHODS: Fourteen patients presenting with acute large bowel obstruction who had previously been treated with colonic stent insertion were studied. All underwent attempted placement of a secondary stent. RESULTS: Technical deployment of the stent was accomplished in 12 patients (86%) but only 9 (64%) achieved clinical decompression. Successful deployment and clinical decompression of a secondary stent was associated with older age (p=0.038). Sex, pathology, site of obstruction, duration of efficacy of initial stent and cause of primary failure were unrelated to outcome. No procedure related morbidity or mortality was noted following repeated intervention. CONCLUSIONS: Secondary colonic stent insertion appears an effective, safe treatment in the majority of patients presenting with acute large bowel obstruction following failure of a primary stent.


Assuntos
Doenças do Colo/cirurgia , Descompressão Cirúrgica/instrumentação , Obstrução Intestinal/cirurgia , Complicações Pós-Operatórias/epidemiologia , Stents , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Descompressão Cirúrgica/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Retratamento/instrumentação , Falha de Tratamento , Resultado do Tratamento
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