Additional Procedures Performed During Elective Colon Surgery and Their Adverse Impact on Postoperative Outcomes

2014 ◽  
Vol 19 (3) ◽  
pp. 527-534 ◽  
Author(s):  
Imran Hassan ◽  
Paul E. Pacheco ◽  
Stephen J. Markwell ◽  
Sajida Ahad
Keyword(s):  
Colon Surgery ◽  
Adverse Impact ◽  
Postoperative Outcomes ◽  
Elective Colon Surgery ◽  
Elective Colon

Emergent and Elective Colon Surgery in the Extreme Elderly: Do the Results Warrant the Operation?

2008 ◽  
Vol 74 (7) ◽  
pp. 614-619 ◽  
Author(s):  
Bryan C. Morse ◽  
William S. Cobb ◽  
John D. Valentine ◽  
Anna L. Cass ◽  
Richard H. Roettger
Keyword(s):  
Risk Factors ◽  
Significant Risk ◽  
The Elderly ◽  
Operative Management ◽  
Colon Surgery ◽  
Elderly Age ◽  
Hospital System ◽  
Elective Colon Surgery ◽  
Emergent Surgery ◽  
Elective Colon

With the elderly population rising continuously, surgeons are increasingly confronted by the dilemma of operative management in these patients, which frequently encompasses end-of-life issues. Increasing age and emergent surgery are known risk factors for poor outcomes in colon surgery. The purpose of this study is to delineate differences in outcomes between emergent and elective colon surgery and identify risk factors that can guide the surgeon in caring for the extreme elderly (age 80 years or older). From 2001 to 2006, a retrospective review of the resident database at Greenville Hospital System identified 104 extreme elderly patients who underwent colon surgery (65 elective, 39 emergent). Comparing elective and emergent operations, results showed substantial differences in morbidity (20% vs 51.2%, P < 0.001), 30-day mortality rate (7.7% vs 30.7%, P < 0.005), and length of stay (13.6 days vs 21.6 days, P < 0.004). Percentage of patients discharged to home was significantly less in the emergent group (13% vs 59%, P < 0.001). Evaluation of the emergent surgery group revealed male gender, history of smoking, and ischemic changes on pathologic examination were statistically significant risk factors for failure of surgery. As a result of the high-risk nature of emergent colon operations in the extreme elderly, it is important that surgeons carefully assess the benefits in relation to the risks and functional outcomes of surgery when planning patient care and providing informed consent.

scholarly journals The Financial and Clinical Impact of an Electronic Health Record Integrated Pathway in Elective Colon Surgery

2020 ◽  
Vol 11 (01) ◽  
pp. 095-103
Author(s):  
Jonathan S. Austrian ◽  
Frank Volpicelli ◽  
Simon Jones ◽  
Mitchell A. Bernstein ◽  
Jane Padikkala ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Electronic Health Record ◽  
Enhanced Recovery ◽  
Colon Surgery ◽  
Control Group ◽  
Health Record ◽  
Elective Colorectal Surgery ◽  
Electronic Health ◽  
Elective Colon Surgery ◽  
Elective Colon

Abstract Background Enhanced Recovery after Surgery (ERAS) pathways have been shown to reduce length of stay, but there have been limited evaluations of novel electronic health record (EHR)-based pathways. Compliance with ERAS in real-world settings has been problematic. Objective This article evaluates a novel ERAS electronic pathway (E-Pathway) activity integrated with the EHR for patients undergoing elective colorectal surgery. Methods We performed a retrospective cohort study of surgical patients age ≥ 18 years hospitalized from March 1, 2013 to August 31, 2016. The primary cohort consisted of patients admitted for elective colon surgery. We also studied a control group of patients undergoing other elective procedures. The E-Pathway was implemented on March 2, 2015. The primary outcome was variable costs per case. Secondary outcomes were observed to expected length of stay and 30-day readmissions. Results We included 823 (470 and 353 in the pre- and postintervention, respectively) colon surgery patients and 3,415 (1,819 and 1,596 in the pre- and postintervention) surgical control patients in the study. Among the colon surgery cohort, there was statistically significant (p = 0.040) decrease in costs of 1.28% (95% confidence interval [CI] 0.06–2.48%) per surgical encounter per month over the 18-month postintervention period, amounting to a total savings of $2,730 per patient at the 1-year postintervention period. The surgical control group had a nonsignificant (p = 0.231) decrease in monthly costs of 0.57% (95% CI 1.51 to – 0.37%) postintervention. For the 30-day readmission rates, there were no statistically significant changes in either cohort. Conclusion Our study is the first to report on the reduced costs after implementation of a novel sophisticated E-Pathway for ERAS. E-Pathways can be a powerful vehicle to support ERAS adoption.

Antimicrobial prophylaxis in elective colon surgery

1984 ◽  
Vol 147 (5) ◽  
pp. 633-637 ◽  
Author(s):  
James J. Peck ◽  
Peter C. Fuchs ◽  
Marie E. Gustafson
Keyword(s):  
Antimicrobial Prophylaxis ◽  
Colon Surgery ◽  
Elective Colon Surgery ◽  
Elective Colon

Preoperative Blood Ordering in Elective Colon Surgery: Requirement or Routine?

2014 ◽  
Vol 92 (1) ◽  
pp. 44-51
Author(s):  
Francesc Feliu ◽  
Juan C. Rueda ◽  
Laia Ramiro ◽  
Montserrat Olona ◽  
Jorge Escuder ◽  
...  
Keyword(s):  
Colon Surgery ◽  
Elective Colon Surgery ◽  
Elective Colon

scholarly journals Prospective randomised controlled trial using the REthinking Clinical Trials (REaCT) platform and National Surgical Quality Improvement Program (NSQIP) to compare no preparation versus preoperative oral antibiotics alone for surgical site infection rates in elective colon surgery: a protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e036866
Author(s):  
Sameer S Apte ◽  
Husein Moloo ◽  
Ahwon Jeong ◽  
Michelle Liu ◽  
Lisa Vandemeer ◽  
...  
Keyword(s):  
Data Collection ◽  
Trial Design ◽  
Colon Surgery ◽  
Oral Antibiotics ◽  
Rate Reduction ◽  
Improvement Program ◽  
Surgical Quality ◽  
Randomised Controlled ◽  
Elective Colon Surgery ◽  
Elective Colon

IntroductionDespite 40 randomised controlled trials (RCTs) investigating preoperative oral antibiotics (OA) and mechanical bowel preparation (MBP) to reduce surgical site infection (SSI) rate following colon surgery, there has never been an RCT published comparing OA alone versus no preparation. Of the four possible regimens (OA alone, MBP alone, OA plus MBP and no preparation), randomised evidence is conflicting for studied groups. Furthermore, guidelines vary, with recommendations for OA alone, OA plus MBP or no preparation. The National Surgical Quality Improvement Program (NSQIP) has automated data collection for surgical patients. Similarly, the ‘REthinking Clinical Trials’ (REaCT) platform increases RCT enrolment by simplifying pragmatic trial design. In this novel RCT protocol, we combine REaCT and NSQIP to compare OA alone versus no preparation for SSI rate reduction in elective colon surgery. To our knowledge, this is the first published RCT protocol that leverages NSQIP for data collection. In our feasibility study, 67 of 74 eligible patients (90%) were enrolled and 63 of 67 (94%) were adherent to protocol. The ‘REaCT–NSQIP’ trial design has great potential to efficiently generate level I evidence for other perioperative interventions.Methods and analysisSSI rates following elective colorectal surgery after preoperative OA or no preparation will be compared. We predict 45% relative rate reduction of SSI, improvement in length of stay, reduced costs and increased quality of life, with similar antibiotic-related complications. Consent, using the ‘integrated consent model’, and randomisation on a mobile device are completed by the surgeon in a single clinical encounter. Data collection for the primary end point is automatic through NSQIP. Analysis of cost per weighted case, cost utility and quality-adjusted life years will be done.Ethics and disseminationThis study is approved by The Ontario Cancer Research Ethics Board. Results will be disseminated in surgical conferences and peer-reviewed journals.Trial registration numberNCT03663504; Pre-results, recruitment phase.

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