scholarly journals Proposal and Validation of a New Classification of Surgical Outcomes after Colorectal Resections within an Enhanced Recovery Programme

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Giovanni D. Tebala ◽  
Waseem Hameed ◽  
Salomone Di Saverio ◽  
Gaetano Gallo ◽  
Giles Bond-Smith
Keyword(s):  
Colorectal Surgery ◽  
Surgical Outcomes ◽  
Enhanced Recovery ◽  
Positive Outcome ◽  
Uneventful Recovery ◽  
New Classification ◽  
Totally Positive ◽  
Class 1 ◽  
Comprehensive Classification ◽  
Colorectal Resections

Background. Advantages of Enhanced Recovery (ER) programmes in colorectal surgery have already been demonstrated, but heterogeneity exists with respect to the choice of compared outcomes. A comprehensive classification aimed at standardizing the reporting of surgical outcomes has been proposed and validated. Method. Clinical variables of 231 patients who underwent colorectal resections within an ER programme from 2013–2018 were analysed. Their outcomes have been reported according to a new classification in 5 classes and 11 subclasses. Prognostic variables have been identified. Results. Seventy-nine patients (34.2%) had an optimal class 1 outcome. Almost half of the patients had an uneventful recovery after being discharged after day 4 (2a). Only two patients (0.9%) were discharged early and then readmitted for a minor ailment (2b). Total morbidity was 12.6% (3a–5). Perioperative mortality was 2.6% (5). Young age, laparoscopic resection, and years of experience with ER have been identified as independent prognostic factors towards a totally positive outcome. Conclusions. The proposed outcome classification is a simple and objective tool to report the surgical outcome in clinical studies. Its implementation seems to be appropriate, in particular, in the field of ER protocols in colorectal surgery, but it can have a wider application in any other surgical subspeciality.

scholarly journals Could Telephone Reviews Reduce Read Mission Rates After Laparoscopic Colorectal Surgery?

2012 ◽  
Vol 94 (5) ◽  
pp. 162-164 ◽  
Author(s):  
J Stewart ◽  
GM Lloyd ◽  
JK Smith ◽  
AG Acheson ◽  
JP Williams ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Colorectal Surgery ◽  
Original Work ◽  
Enhanced Recovery ◽  
Laparoscopic Colorectal Surgery ◽  
Enhanced Recovery After Surgery ◽  
Length Of Hospital Stay ◽  
Oncological Outcome ◽  
Open Approach ◽  
Colorectal Resections

Significant advances have been made recently in the management of patients undergoing colorectal surgery. demonstration of the advantages of laparoscopic colorectal surgery over the open approach in terms of faster patient recovery, shorter length of hospital stay, less pain and fewer wound problems with identical oncological outcome has led to the widespread adoption of the technique. Simultaneously, based on the original work of Kehlet, enhanced recovery after surgery (ERAS) programmes that capitalise on the reduced physiological insult stimulated by laparoscopic surgery have gained in popularity. Coupled, laparoscopic surgery and ERAS allow many patients undergoing major colorectal resections to be discharged from hospital on the first to third post-operative day.

scholarly journals Contemporary Opportunity for Prehabilitation as Part of an Enhanced Recovery after Surgery Pathway in Colorectal Surgery

2019 ◽  
Vol 32 (02) ◽  
pp. 095-101 ◽  
Author(s):  
Zhi Ven Fong ◽  
David Chang ◽  
Keith Lillemoe ◽  
Ryan Nipp ◽  
Kenneth Tanabe ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Colorectal Surgery ◽  
Surgical Outcomes ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery

AbstractThe implementation of upfront, preoperative habilitation (“prehabilitation”), as opposed to postoperative habilitation (rehabilitation), provides a unique opportunity to optimize surgical outcomes, while ensuring that patients receive necessary conditioning that may otherwise be significantly delayed by postoperative complications. In this review, opportunities to design, implement, monitor, and evaluate a surgical prehabilitation program in colorectal surgery are discussed, and broken down to include emotional, physical, and nutritional aspects of care in the preoperative setting.

scholarly journals Smartband Use During Enhanced Recovery After Surgery Facilitates Inpatient Recuperation Following Minimally Invasive Colorectal Surgery

2021 ◽  
Vol 7 ◽  
Author(s):  
Tzu-Chieh Yin ◽  
Ching-Wen Huang ◽  
Hsiang-Lin Tsai ◽  
Wei-Chih Su ◽  
Cheng-Jen Ma ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Minimally Invasive ◽  
Perioperative Care ◽  
Surgical Outcomes ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Early Mobilization ◽  
Quality Of Recovery ◽  
Minimally Invasive Colorectal Surgery

Background: Enhanced recovery after surgery (ERAS) is valuable in perioperative care for its ability to improve short-term surgical outcomes and facilitate patient recuperation after major surgery. Early postoperative mobilization is a vital component of the integrated care pathway and is a factor strongly associated with successful outcomes. However, early mobilization still has various definitions and lacks specific strategies.Methods: Patients who underwent minimally invasive surgery for colorectal cancer followed our perioperative ERAS program, including mobilization from the first postoperative day. After perioperative care skills were improved in our well-established program, compliance, inpatient surgical outcomes, and complications associated with adding smartband use were evaluated and compared with the outcomes for standard protocol. Quality of recovery was evaluated using patient-rated QoR-40 questionnaires the day before surgery, on postoperative days 1 and 3, and on the day of discharge.Results: Smartband use after minimally invasive colorectal surgery failed to increase compliance with early mobilization or reduce the occurrence of postoperative complications significantly compared with standard ERAS protocol. However, when smartbands were utilized, quality of recovery was optimized and patients returned to their preoperative status earlier, at postoperative day 3. The length of hospital stay, as defined by discharge criteria, and hospital stay of patients without complications was reduced by 1.1 and 0.9 days, respectively (P = 0.009 and 0.049, respectively).Conclusions: Smartbands enable enhanced communication between patients and surgical teams and strengthen self-management in patients undergoing minimally invasive colorectal resection surgery. Accelerated recovery to preoperative functional status can be facilitated by integrating smartbands into the process of early mobilization during ERAS.

scholarly journals Compliance with enhanced recovery protocols in elderly patients undergoing colorectal resection

2018 ◽  
Vol 100 (7) ◽  
pp. 570-579 ◽  
Author(s):  
S Hallam ◽  
F Rickard ◽  
N Reeves ◽  
D Messenger ◽  
J Shabbir
Keyword(s):  
Multivariate Analysis ◽  
Colorectal Surgery ◽  
Elderly Patients ◽  
Open Surgery ◽  
Enhanced Recovery ◽  
Age Groups ◽  
Conversion To Open Surgery ◽  
Delayed Discharge ◽  
Significant Difference ◽  
Colorectal Resections

Introduction Enhanced recovery after surgery (ERAS) is associated with reduced length of stay (LOS) and improved outcomes in colorectal surgery. It is unclear whether ERAS can be safely implemented in elderly patients undergoing complex colorectal resections. The aim of this study was to evaluate the feasibility of ERAS in patients of all ages undergoing colorectal surgery. Methods A prospective database of a consecutive series of patients undergoing colorectal resections with ERAS between August 2012 and December 2014 was evaluated. Patients were divided into four age groups. Outcomes studied were compliance with ERAS elements, LOS, morbidity and mortality. Results Of the 294 patients in the study cohort, 79 were <60 years, 81 were 60–69 years, 86 were 70–79 years and 48 were ≥80 years of age. There was no significant difference between age groups in compliance with ERAS elements. Age was not predictive of delayed discharge (LOS >6 days) or morbidity. Factors that were predictive of delayed discharge on multivariate analysis were open surgery (odds ratio [OR]: 2.23, p=0.003), conversion to open surgery (OR: 3.23, p=0.017), stoma formation (OR: 2.10, p=0.019) and chronic obstructive pulmonary disease (OR: 4.12, p=0.038). Factors predictive of morbidity on multivariate analysis comprised conversion to open surgery (OR: 7.72, p=0.004), high creatinine (OR: 1.03 per unit increase in creatinine, p=0.008) and stoma education (OR: 0.31, p=0.030). Conclusions ERAS can be successfully implemented in older patients. There was equal compliance with the ERAS programme across the four age groups and no significant effect of age on LOS or morbidity.

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