Colorectal Procedures

INTRODUCTION With the development of a new curriculum, workplace based assessments such as procedure-based assessment (PBA) are becoming increasingly common within surgical training. However, there have been concerns about the impact of these assessments on clinical practice. This study assessed the time taken to complete PBA forms to determine whether it is feasible in clinical practice. MATERIALS AND METHODS PBAs for three colorectal procedures (anterior resection, right hemicolectomy and anal fistula) were undertaken by various trainers and trainees. A pilot study was performed to identify potential reasons for incomplete forms and procedural modifications subsequently applied in the main study. Times taken to complete the consenting and operative components of the forms were recorded. RESULTS Incomplete forms in the pilot were mainly attributable to time constraints. In the main study, all assessments were completed within 30 min. Assessment times increased with complexity of the procedure. Median times for completing the consenting and operative components in anterior resection were 13 min (range, 8–15 min) and 15 min (range, 10–18 min), respectively. CONCLUSIONS PBAs are feasible in clinical practice and are valued by trainees as a means of enabling focused feedback and targeted training. Commitment from trainers and trainees will be required but, with adequate planning, the assessment tool is effective with minimal impact on clinical practice.

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An Expanded Preoperative Component within an Enhanced Recovery Protocol Improves Outcomes in Colorectal Surgery

The American Surgeon ◽

10.1177/000313481708300849 ◽

2017 ◽

Vol 83 (8) ◽

pp. 928-934

Author(s):

Nathan M. Johnson ◽

Sandy L. Fogel

Keyword(s):

Colorectal Surgery ◽

Length Of Stay ◽

Enhanced Recovery ◽

Statistical Significance ◽

Current Evidence ◽

P Value ◽

Postoperative Length ◽

Enhanced Recovery Protocol ◽

Recovery Protocols ◽

Colorectal Procedures

Enhanced Recovery Protocols (ERPs) have been shown to lead to quicker recovery in colorectal surgery, with reduced postoperative length of stay (LOS). ERPs could potentially be improved with an expanded preoperative component reflecting current evidence. We hypothesize that an ERP with an expanded preoperative component will reduce LOS consistent with or exceeding that seen with traditional ERPs. Our ERP was implemented in June of 2014. Data was collected for two full years from July 2014 through June 2016. The protocol was employed in colorectal cases, both elective and emergent. Data from ERP cases were compared with contemporaneous controls that did not go through the ERP. Patients who underwent colorectal procedures and participated in the ERP with the expanded preoperative component had an average LOS of 5.33 days, whereas controls stayed for an average of 7.93 days (P value, <0.01). ERP cases also experienced fewer read-missions and complications, although statistical significance could not be established. The results demonstrate that an ERP with an enhanced preoperative component significantly reduces LOS and potentially decreases the rate of readmissions and total complications.

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Laparoscopic surgery reduces the incidence of surgical site infections compared to the open approach for colorectal procedures: a meta-analysis

Techniques in Coloproctology ◽

10.1007/s10151-020-02293-8 ◽

2020 ◽

Vol 24 (10) ◽

pp. 1017-1024

Author(s):

N. Kulkarni ◽

T. Arulampalam

Keyword(s):

Laparoscopic Surgery ◽

Meta Analysis ◽

Surgical Site Infections ◽

Open Approach ◽

Colorectal Procedures

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Acute Acalculous Cholecystitis after Gastrointestinal Surgery

The American Surgeon ◽

10.1177/000313481207800242 ◽

2012 ◽

Vol 78 (2) ◽

pp. 220-224 ◽

Cited By ~ 6

Author(s):

Lya Crichlow ◽

Sarah Walcott-Sapp ◽

Joshua Major ◽

Bernard Jaffe ◽

Charles F. Bellows

Keyword(s):

Postoperative Period ◽

Medical Center ◽

English Literature ◽

Gastrointestinal Surgery ◽

Acalculous Cholecystitis ◽

Acute Acalculous Cholecystitis ◽

Left Hemicolectomy ◽

High Level ◽

Calculous Cholecystitis ◽

Colorectal Procedures

Acute acalculous cholecystitis has been identified as a rare but potentially devastating entity after trauma, and burns, as well as in critically ill patients, and in the postoperative period. Gastrointestinal surgery is most frequently implicated in postoperative acute acalculous cholecystitis, especially after gastric and colorectal procedures. Review of the English literature identified 28 articles reporting 76 cases of acute acalculous cholecystitis after gastrointestinal operations, which included a case from Tulane University Medical Center of a 64-year-old man who developed postoperative acute acalculous cholecystitis after elective left hemicolectomy. A total of 52.4 per cent of the patients developed gangrenous acute acalculous cholecystitis, with a mortality rate of 21.1 per cent, much higher than that reported in postoperative calculous cholecystitis. This emphasizes the need for a high level of suspicion and early detection in the postoperative period to avoid devastating consequences.

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1100. Facility Factors Are a Stronger Driver of Peri-Operative Vancomycin Use Than Patient Risk Factors

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.964 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S391-S391

Author(s):

Westyn Branch-Elliman ◽

William O’Brien ◽

Judith Strymish ◽

Kamal Itani ◽

Kalpana Gupta

Keyword(s):

High Risk ◽

Total Joint Replacement ◽

High Risk Patient ◽

High Rate ◽

Common Reason ◽

Surgical Prophylaxis ◽

Medical Centers ◽

Facility Level ◽

Manual Review ◽

Colorectal Procedures

Abstract Background Prior reports suggest that the use of vancomycin for surgical prophylaxis is common and increasing. However, rates of administration and reasons for choosing vancomycin are unknown. Thus, we sought to quantify the frequency of vancomycin as a surgical prophylaxis agent and to determine drivers of use. Methods All Veteran patients undergoing major cardiac, orthopedic total joint, vascular, or colorectal procedures and entered into the VA External Peer Review Program (EPRP) database during the period from October 1, 2008 to September 30, 2013 were included. EPRP includes a manual review of surgical cases to measure type of prophylaxis, and, in the case of vancomycin, clinician-documented reasons for vancomycin use (β-lactam allergy, patient at high risk of methicillin-resistant Staphylococcus aureus (MRSA), facility high rate of MRSA). Descriptive statistics were used to evaluate findings. Results Among 79, 058 surgical procedures at 109 different medical centers, 20,349 (25.7%) received vancomycin either alone or in combination with another agent for prophylaxis. Rates of vancomycin use were the highest for cardiac surgeries (10,455/21,396, 48.9%), followed by orthopedic total joint replacement surgeries (8,044/38,675, 20.8%), vascular surgeries (1,504/8,177, 18.4%) and colorectal surgeries (346/10,810, 3.2%). The most common reason for vancomycin use was a perceived high facility rate of MRSA (7,367, 36.2%) followed by β-lactam allergy (4,855, 23.9%) and high-risk patient (1,420/20,349, 7.0%). There was no reason documented in 5,194 (25.5%). The most common reason for vancomycin use differed by surgical type. Among cardiac and orthopedic cases, high facility rate was the most commonly reported reason, but β-lactam allergy was the most common driver among vascular and colorectal procedures. Conclusion Facility factors are a major driver of peri-operative vancomycin use, more so than β-lactam allergy or patient-level factors, particularly in cardiac and orthopedic surgery. These data suggest that facility-level interventions, such as implementation of specific guidelines, may be helpful for limiting vancomycin use in this population. Disclosures All authors: No reported disclosures.

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