Impact of Nutrition Adequacy in Patients after Elective Colorectal Surgery on Clinical Outcomes: A Pilot Study

2021 ◽  
Vol 121 (9) ◽  
pp. A25
Author(s):  
R. Murray ◽  
K. Willcutts ◽  
M. Hershey ◽  
B. Sarosiek ◽  
B. Turrentine ◽  
...  
Keyword(s):  
Pilot Study ◽  
Colorectal Surgery ◽  
Clinical Outcomes ◽  
Elective Colorectal Surgery

scholarly journals The relationship of preoperative versus postoperative hyperglycemia on clinical outcomes after elective colorectal surgery

Surgery ◽  
2019 ◽  
Vol 166 (4) ◽  
pp. 655-662 ◽  
Author(s):  
Edmund B. Chen ◽  
Michael J. Nooromid ◽  
Irene B. Helenowski ◽  
Nathaniel J. Soper ◽  
Amy L. Halverson
Keyword(s):  
Colorectal Surgery ◽  
Clinical Outcomes ◽  
Elective Colorectal Surgery ◽  
Relationship Of ◽  
The Relationship

scholarly journals Impact of Enhanced Recovery Program on Clinical Outcomes after Elective Colorectal Surgery in a Rural Hospital

2021 ◽  
Vol 233 (5) ◽  
pp. e25
Author(s):  
Antonio Pesce ◽  
Mattia Portinari ◽  
Nicolò Fabbri ◽  
Valeria Sciascia ◽  
Lisa Uccellatori Ms ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Clinical Outcomes ◽  
Enhanced Recovery ◽  
Rural Hospital ◽  
Elective Colorectal Surgery ◽  
Enhanced Recovery Program ◽  
Recovery Program

A Prospective Randomized Pilot Study of Near-Infrared Spectroscopy-Directed Restricted Fluid Therapy versus Standard Fluid Therapy in Patients Undergoing Elective Colorectal Surgery

2010 ◽  
Vol 76 (12) ◽  
pp. 1384-1392 ◽  
Author(s):  
Stephen M. Cohn ◽  
Ronald G. Pearl ◽  
Shirley M. Acosta ◽  
Marilyn U. Nowlin ◽  
Antonio Hernandez ◽  
...  
Keyword(s):  
Pilot Study ◽  
Colorectal Surgery ◽  
Fluid Therapy ◽  
Near Infrared ◽  
Tissue Oxygen Saturation ◽  
Standard Group ◽  
Elective Colorectal Surgery ◽  
Restricted Group ◽  
American Society ◽  
American Society Of Anesthesiologists

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.

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

Nutrition ◽  
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

scholarly journals A Protocol is not Enough: Enhanced Recovery Program-Based Care and Clinician Adherence Associated with Shorter Stay After Colorectal Surgery

2020 ◽  
Vol 45 (2) ◽  
pp. 347-355
Author(s):  
Ben E. Byrne ◽  
Omar D. Faiz ◽  
Alex Bottle ◽  
Paul Aylin ◽  
Charles A. Vincent
Keyword(s):  
Factor Analysis ◽  
Colorectal Surgery ◽  
Length Of Stay ◽  
Clinical Outcomes ◽  
Enhanced Recovery ◽  
Care Providers ◽  
Elective Colorectal Surgery ◽  
Enhanced Recovery Program ◽  
Care Protocol ◽  
Recovery Program

Abstract Background Randomised trials have shown an Enhanced Recovery Program (ERP) can shorten stay after colorectal surgery. Previous research has focused on patient compliance neglecting the role of care providers. National data on implementation and adherence to standardised care are lacking. We examined care organisation and delivery including the ERP, and correlated this with clinical outcomes. Methods A cross-sectional questionnaire was administered to surgeons and nurses in August–October 2015. All English National Health Service Trusts providing elective colorectal surgery were invited. Responses frequencies and variation were examined. Exploratory factor analysis was performed to identify underlying features of care. Standardised factor scores were correlated with elective clinical outcomes of length of stay, mortality and readmission rates from 2013–15. Results 218/600 (36.3%) postal responses were received from 84/90 (93.3%) Trusts that agreed to participate. Combined with email responses, 301 surveys were analysed. 281/301 (93.4%) agreed or strongly agreed that they had a standardised, ERP-based care protocol. However, 182/301 (60.5%) indicated all consultants managed post-operative oral intake similarly. After factor analysis, higher hospital average ERP-based care standardisation and clinician adherence score were significantly correlated with reduced length of stay, as well as higher ratings of teamwork and support for complication management. Conclusions Standardised, ERP-based care was near universal, but clinician adherence varied markedly. Units reporting higher levels of clinician adherence achieved the lowest length of stay. Having a protocol is not enough. Careful implementation and adherence by all of the team is vital to achieve the best results.

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