Multistate modelling to estimate excess length of stay and risk of death associated with organ/space infection after elective colorectal surgery

2018 ◽  
Vol 100 (4) ◽  
pp. 400-405 ◽  
Author(s):  
E. Shaw ◽  
A. Gomila ◽  
M. Piriz ◽  
R. Perez ◽  
J. Cuquet ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Length Of Stay ◽  
Elective Colorectal Surgery ◽  
Risk Of Death ◽  
Space Infection ◽  
Organ Space Infection

scholarly journals Implementation of an organ space infection prevention bundle reduces the rate of organ space infection after elective colorectal surgery

2021 ◽  
Vol 10 (2) ◽  
pp. e001278
Author(s):  
Ian Faragher ◽  
Nicole Tham ◽  
Michael Hong ◽  
Stephen Guy ◽  
Justin Yeung
Keyword(s):  
Colorectal Surgery ◽  
Compliance Rate ◽  
Mechanical Bowel Preparation ◽  
Cost Effective ◽  
Unintended Consequences ◽  
Successful Implementation ◽  
Elective Colorectal Surgery ◽  
Space Infection ◽  
Organ Space Infection ◽  
Colorectal Resections

BackgroundSurgical site infections (SSIs) are morbid and costly complications after elective colorectal surgery. SSI prevention bundles have been shown to reduce SSI in colorectal surgery, but their impact on organ space infections (OSI) is variable. Adoption of an evidence-based practice without an implementation strategy is often unsuccessful. Our aim was to successfully implement an OSI prevention bundle and to achieve a cost-effective reduction in OSI following elective left-sided colorectal operations.MethodsThe Translating Research into Practice model was used to implement an OSI prevention bundle in all patients undergoing elective left-sided colorectal resections by a single unit from November 2018 to September 2019. The new components included oral antibiotics with mechanical bowel preparation, when required, and use of impermeable surgical gowns. Other standardised components included alcoholic chlorhexidine skin preparation, glove change after bowel handling prior to wound closure with clean instruments. The primary outcome was OSI. Secondary outcomes included bundle compliance, unintended consequences and total patient costs. Outcomes were compared with all patients undergoing elective left-sided colorectal resections at the same institution in 2017.ResultsElective colorectal resections were performed in 173 patients across two cohorts. The compliance rate with bundle items was 63% for all items and 93% for one omitted item. There was a reduction in OSI from 12.9% (11 of 85) to 3.4% (3 of 88, p<0.05) after implementation of the OSI prevention bundle. The average cost of an OSI was $A36 900. The estimated savings for preventing eight OSIs by using the OSI bundle in the second cohort was $A295 198.ConclusionSuccessful implementation of an OSI prevention bundle was associated with a reduced rate of OSI after elective colorectal surgery. The OSI bundle and its implementation were cost-effective. Further study is required to investigate the sustainability of the OSI prevention bundle.

scholarly journals Another Brick in the Wall of an Ongoing Discussion– Reduction of Anastomotic Leaks after Colorectal Resection by Preoperative Mechanical Bowel Preparation in Combination with Oral and Parenteral Antibiotics?–A Clinical Retrospective Single Center Study

2021 ◽  
Vol 8 (5) ◽  
Author(s):  
Safia O ◽  
◽  
Kuebler S ◽  
Mall JW ◽  
Tallbot SR ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Length Of Stay ◽  
Bowel Preparation ◽  
Elective Surgery ◽  
Mechanical Bowel Preparation ◽  
Oral Antibiotic ◽  
Single Center ◽  
Elective Colorectal Surgery ◽  
Single Center Study ◽  
Center Study

Background: In colorectal surgery, postoperative Anastomotic Leak (AL) is a serious complication. Besides the surgeon`s experience, bowel preparation may have an impact on AL, but the published data are still inconclusive. The purpose of this retrospective single center study was to investigate the role of preoperative Mechanical Bowel Preparation (MBP) in combination with Oral Antibiotic Bowel Preparation (OBP) and parenteral antibiotics in a certified highvolume colorectal center. Methods: In the period of January 2017 to December 2019, all colon and rectal surgeries were recorded and separated into emergency and elective surgeries. Patients in the elective surgery group were further divided into two groups: patients with Bowel Preparation (BP) and patients without BP and were evaluated concerning to AL, postoperative hospital length of stay and mortality. Results: Between 2017 to 2019, 625 patients underwent colorectal surgery. 262 patients had emergency operations and were therefore excluded from the study. 363 patients underwent colorectal elective surgery (197men, 166 women). 44.0% received Combined Bowel Preparation (CBP), 46.8% received no BP, 3.3% received OBP only, 4.1% received MBP only, and for 1.1% nothing was documented. CBP was not only associated with a reduction in the rate of AL (P=0.038) (14.1% vs. 4.4%), but also with reduction in mortality (P=0.032) (7.6% vs. 1.2%) and length of stay (P=0.016) (14 vs. 11 days). Conclusion: Our retrospective data showed a significant impact of preoperative intestinal preparation with MBP in combination with OBP and parenteral antibiotics on AL, length of stay and mortality. Therefore we strongly recommend the use of this regimen of preoperative BP in elective colorectal surgery.

Implementation of ERAS protocol in elective colorectal surgery results in reduction in length of stay; discharge within 48 hours is feasible and safe

2019 ◽  
Vol 45 (2) ◽  
pp. e50
Author(s):  
B. Van Den Hengel ◽  
H. Smid-Nanninga ◽  
A.F.T. Olieman ◽  
L.S. Wagenaar ◽  
W. Kelder ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Length Of Stay ◽  
Elective Colorectal Surgery ◽  
Eras Protocol

scholarly journals Reduced length of stay after elective colorectal surgery during the peak phase of Covid-19 pandemic: a positive effect of infection risk awareness?

Surgery ◽  
2020 ◽  
Author(s):  
Antonino Spinelli ◽  
Michele Carvello ◽  
Francesco Maria Carrano ◽  
Francesco Pasini ◽  
Caterina Foppa ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Length Of Stay ◽  
Infection Risk ◽  
Risk Awareness ◽  
Elective Colorectal Surgery ◽  
Positive Effect ◽  
Peak Phase

Laparoscopic approach and patient length of stay in elective colorectal surgery without an enhanced recovery programme

2014 ◽  
Vol 84 (7-8) ◽  
pp. 502-503 ◽  
Author(s):  
Irshad Shaikh ◽  
Mohammed Boshnaq ◽  
Nusrat Iqbal ◽  
Sudhakar Mangam ◽  
George Tsavellas
Keyword(s):  
Colorectal Surgery ◽  
Length Of Stay ◽  
Enhanced Recovery ◽  
Laparoscopic Approach ◽  
Elective Colorectal Surgery ◽  
Enhanced Recovery Programme

scholarly journals Limited preoperative physical capacity continues to be associated with poor postoperative outcomes within a colorectal ERAS programme

2019 ◽  
Vol 101 (4) ◽  
pp. 261-267 ◽  
Author(s):  
E McLennan ◽  
R Oliphant ◽  
SJ Moug
Keyword(s):  
Multivariate Analysis ◽  
Postoperative Complications ◽  
Colorectal Surgery ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Patient Outcomes ◽  
Univariate Analysis ◽  
Lifestyle Factors ◽  
Physical Capacity ◽  
Elective Colorectal Surgery

Aim Enhanced recovery after surgery (ERAS) programmes aim to standardise perioperative care leading to optimal patient outcomes. Despite these programmes, variation in outcomes still persists. This study aimed to assess the influence of lifestyle factors on short-term outcomes after colorectal surgery within this optimal recovery programme. Methods Consecutive patients enrolled on an ERAS pathway who underwent elective colorectal surgery (June 2013 to July 2014) at one site were included. We used data routinely collected by ERAS nurse specialists and during preassessment to analyse association between patient and lifestyle factors and likelihood of developing postoperative complications or having an increased length of stay. Results A total of 199 patients were included: mean age 61.8 years (range 17–90 years) and 53.8% male. Age, sex, deprivation, smoking status, alcohol intake, body mass index or level of comorbidity were not associated with postoperative complications. Patients reporting limited preoperative physical capacity (unable to climb two flights of stairs) were more than four times as likely to have a postoperative complication on univariate analysis and were found to still have increased risk of postoperative complications on multivariate analysis. Patients reporting limited preoperative physical capacity were shown to have significantly longer hospital stay on univariate analysis. In the multivariate analysis, limited physical capacity was not associated with prolonged length of stay due to confounding factors of age and deprivation. Conclusions Limited physical capacity was the only patient and lifestyle factor associated with poorer postoperative complications and prolonged hospital stay after elective colorectal surgery within an ERAS programme. Consideration should be given to individualised prehabilitation that aims to increase physical capacity pre-operatively to improve patient outcomes.

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