Pre-emptive antibiotic treatment vs ‘standard’ treatment in patients with elevated serum procalcitonin levels after elective colorectal surgery: a prospective randomised pilot study

There are substantial data supporting the concept that algorithms that effectively limit fluid volumes to patients undergoing elective surgery, particularly intraoperatively, significantly reduce perioperative morbidity. We hypothesized that intraoperative fluid limitation could be safely accomplished when guided by near-infrared spectroscopy (NIRS) monitoring, and that this fluid restriction regimen would result in a reduction in postoperative morbidity when compared with standard monitoring and fluid therapy. The intent of this pilot study was to demonstrate the feasibility and ease of conduct of this study protocol before expanding to the multicenter pivotal trial. We performed a prospective, (2:1) randomized, pilot study at two centers. A total enrollment of 24 fully evaluable patients undergoing elective open colorectal surgery (16 restricted, 8 standard) was planned. After providing informed consent, patients were randomized to standard fluid resuscitation (500 LR induction bolus, then LR 7 mL/kg/h X 1 h, then 5 mL/kg/h) or restricted fluid resuscitation (no induction bolus, then LR 2 mL/kg/h). Subsequent fluid bolus infusions were guided by physiologic parameters (systolic blood pressure < 90 mm Hg, heart rate > 100 bpm, or oliguria) in the standard group, and by tissue oxygen saturation from NIRS (tissue oxygen saturation (StO2) < 75%, or 20% below baseline; or the same physiologic parameters) in the restricted group. Primary endpoints were major postoperative complications. A total of 27 patients were randomized (18 restricted, 9 standard). Age, gender, ethnicity, past medical history, and body mass index were similar. American Society of Anesthesiologists class was somewhat higher in the restricted group (American Society of Anesthesiologists class 3 in 77% of restricted vs 44% of standard patients; P = 0.194). Median total intraoperative fluids were less in the restricted group (1300 mL) when compared with the standard group (3014 mL) ( P = 0.021). Total fluids for the hospitalization were also statistically significantly decreased in the restricted group. Complications occurred in about two-thirds of patients, and complication rates were not statistically different between groups (1.6/restricted patient vs 2.1/standard patient; P = 0.333). Primary indications for boluses (n = 93) given to study patients were: hypotension (69%); oliguria (15%); and tachycardia (14%), with multiple indications per bolus. In only two instances did the StO2 drop to less than 75 per cent, or decrease by 20 per cent from baseline in the 3 minutes before bolus as an indication for fluid administration. Patients undergoing elective colorectal surgery with a fluid restricted strategy had only rare episodes of decreased StO2, suggesting that adequate tissue perfusion was maintained in this group. As a result, NIRS monitoring did not significantly influence intraoperative fluid management of patients undergoing colorectal surgery.

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Evaluation of an intervention to improve nutrition intake in patients undergoing elective colorectal surgery: A mixed-methods pilot study

Nutrition ◽

10.1016/j.nut.2020.111015 ◽

2020 ◽

pp. 111015

Author(s):

Megan Rattray ◽

Ben Desbrow ◽

Andrea P. Marshall ◽

Michael von Papen ◽

Shelley Roberts

Keyword(s):

Mixed Methods ◽

Pilot Study ◽

Colorectal Surgery ◽

Elective Colorectal Surgery ◽

Nutrition Intake

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Diagnostic accuracy of C-reactive protein and procalcitonin in the early detection of infection after elective colorectal surgery – a pilot study

BMC Infectious Diseases ◽

10.1186/1471-2334-14-444 ◽

2014 ◽

Vol 14 (1) ◽

Cited By ~ 25

Author(s):

Joana Silvestre ◽

Jorge Rebanda ◽

Carlos Lourenço ◽

Pedro Póvoa

Keyword(s):

Pilot Study ◽

Colorectal Surgery ◽

Early Detection ◽

Diagnostic Accuracy ◽

C Reactive Protein ◽

Elective Colorectal Surgery ◽

Reactive Protein

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THE FEASIBILITY OF FAST TRACK PROTOCOL FOR ELDERELY PATIENTS WITH COLORECTAL CANCER

Koloproktologia ◽

10.33878/2073-7556-2016-0-1-26-29 ◽

2016 ◽

pp. 26-29

Author(s):

D. . Zitta ◽

V. . Subbotin ◽

Y. . Busirev

Keyword(s):

Colorectal Cancer ◽

Colorectal Surgery ◽

Blood Loss ◽

Elderly Patients ◽

Fast Track ◽

Randomized Study ◽

Conventional Group ◽

Intraoperative Blood Loss ◽

Elective Colorectal Surgery ◽

Complications Rate

Fast track protocol is widely used in major colorectal surgery. It decreases operative stress, shortens hospital stay and reduces complications rate. However feasibility and safety of this approach is still controversial in patients older than 70 years. The AIM of the study was to estimate the safety and effectiveness of fast track protocol in elderly patients with colorectal cancer. MATERIALS AND METHODS. Prospective randomized study included 138 elective colorectal resectionfor cancer during period from 1.01.10 till 1.06.15. The main criteria for the patients selection were age over 70 years and diagnosis of colorectal cancer. 82 of these patients received perioperative treatment according to fast track protocol, other 56 had conventional perioperative care. Patients underwent following procedures: right hemicolectomy (n=7), left hemicolectomy (n=12), transverse colectomy (n=1), sigmoidectomy (n=23), abdomeno-perineal excision (n=19) and low anterior resection of rectum (n=76). Following data were analized: duration of operation, intraoperative blood loss, time offirst flatus and defecation, complications rates. RESULTS. Mean age was 77,4 ± 8 years. There were no differences in gender, co morbidities, body mass index, types of operations between groups. Duration of operations didn't differ significantly between 2 groups. Intraoperative blood loss was higher in conventional group. The time of first flatus and defecation were better in FT-group. There was no mortality in FT-group vs 1,8 %o mortality in conventional group. Complications rate was lower in FT-group: wound infections 3,6% vs 9 %, anastomotic leakage 4,8 %o vs 9 %o, ileus 1,2 vs 5,4 %o, peritonitis 2,4 %o vs 3,6%o, bowel obstruction caused by the adhesions 6 % vs 5,3 %. Reoperation rate was similar 4,8 % vs 3,6 %. CONCLUSION. Fast track protocol in major elective colorectal surgery can be safely applied in elderly patients. The application of fast track protocol in elderly patients improves the restoration of bowel function and reduces the risk of postoperative complication.

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Faculty Opinions recommendation of Association of mechanical bowel preparation and oral antibiotics before elective colorectal surgery with surgical site infection.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.734249120.793551951 ◽

2018 ◽

Author(s):

Eloy Espín Basany

Keyword(s):

Colorectal Surgery ◽

Surgical Site Infection ◽

Bowel Preparation ◽

Mechanical Bowel Preparation ◽

Site Infection ◽

Oral Antibiotics ◽

Elective Colorectal Surgery

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Risk Factors for Prolonged Postoperative Ileus in Adult Patients Undergoing Elective Colorectal Surgery: An Observational Cohort Study

Reviews on Recent Clinical Trials ◽

10.2174/1574887113666180521111153 ◽

2018 ◽

Vol 13 (4) ◽

pp. 295-304 ◽

Cited By ~ 4

Author(s):

Andrea Pisani Ceretti ◽

Nirvana Maroni ◽

Marco Longhi ◽

Marco Giovenzana ◽

Roberto Santambrogio ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Colorectal Surgery ◽

Postoperative Ileus ◽

Observational Cohort Study ◽

Adult Patients ◽

Elective Colorectal Surgery ◽

Observational Cohort ◽

Prolonged Postoperative Ileus

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P7: ACUTE KIDNEY INJURY AFTER ELECTIVE COLORECTAL SURGERY: RESULTS OF A NATIONAL CLOSED-LOOP AUDIT

British Journal of Surgery ◽

10.1093/bjs/znab117.092 ◽

2021 ◽

Vol 108 (Supplement_1) ◽

Author(s):

Keyword(s):

Acute Kidney Injury ◽

Quality Improvement ◽

Colorectal Surgery ◽

Prognostic Score ◽

Univariate Analysis ◽

Kidney Injury ◽

Elective Colorectal Surgery ◽

National Quality ◽

Significant Difference ◽

The Uk

Abstract Introduction The aim of this study was to re-audit the rates of acute kidney injury (AKI) after elective colorectal surgery, following local presentations of results. Method Outcomes After Kidney injury in Surgery (OAKS) and Ileus Management International (IMAGINE), were prospective multicentre audits on consecutive elective colorectal resections, in the UK and Ireland. These were performed over 3-month periods in 2015 and 2018 respectively. During the interim period, results were presented at participating centres to stimulate local quality improvement initiatives. Risk-adjusted 7-day postoperative AKI rates were calculated through multilevel logistic regression based on the OAKS prognostic score. Result Of the 4,917 patients included, 3,133 (63.7%) originated from OAKS and 1,784 (36.3%) from IMAGINE. On univariate analysis, there was no significant difference (p=0.737) in the 7-day AKI rate between OAKS (n=346, 11.8%) and IMAGINE (n=205, 11.5%). However, the risk-adjusted AKI rate in IMAGINE was significantly lower compared to OAKS (-1.8%, 95% CI: -2.3% to -1.3%, p<0.001). Of 47 centres (40.1%) with a recorded local presentation, there was no significant difference in the subsequent AKI rate in IMAGINE (-0.7%, -2.0% to 0.6%, p=0.278). Conclusion Rates of AKI after elective colorectal surgery significantly reduced on re-audit. However, this may be related to increased awareness from participation or national quality improvement initiatives, rather than local presentation of results. Abbrev. AKI - Acute Kidney Injury, OAKS - Outcomes After Kidney injury in Surgery, IMAGINE - Ileus Management International Take-home message Risk-adjusted AKI rates significantly reduced on re-audit, however, this was most likely due to factors separate from the local presentation of initial results.

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