Antimicrobial Bowel Preparation for Elective Colon Surgery

2016 ◽  
Vol 17 (3) ◽  
pp. 269-274 ◽  
Author(s):  
Donald E. Fry
Keyword(s):  
Bowel Preparation ◽  
Colon Surgery ◽  
Elective Colon Surgery ◽  
Elective Colon

scholarly journals The Prevention of Surgical Site Infection in Elective Colon Surgery

Scientifica ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-19 ◽  
Author(s):  
Donald E. Fry
Keyword(s):  
Surgical Site Infection ◽  
Bowel Preparation ◽  
Mechanical Bowel Preparation ◽  
Local Environment ◽  
Colon Surgery ◽  
Colon Resection ◽  
Oral Antibiotic ◽  
Site Infection ◽  
Elective Colon Surgery ◽  
Elective Colon

Infections at the surgical site continue to occur in as many as 20% of elective colon resection cases. Methods to reduce these infections are inconsistently applied. Surgical site infection (SSI) is the result of multiple interactive variables including the inoculum of bacteria that contaminate the site, the virulence of the contaminating microbes, and the local environment at the surgical site. These variables that promote infection are potentially offset by the effectiveness of the host defense. Reduction in the inoculum of bacteria is achieved by appropriate surgical site preparation, systemic preventive antibiotics, and use of mechanical bowel preparation in conjunction with the oral antibiotic bowel preparation. Intraoperative reduction of hematoma, necrotic tissue, foreign bodies, and tissue dead space will reduce infections. Enhancement of the host may be achieved by perioperative supplemental oxygenation, maintenance of normothermia, and glycemic control. These methods require additional research to identify optimum application. Uniform application of currently understood methods and continued research into new methods to reduce microbial contamination and enhancement of host responsiveness can lead to better outcomes.

Bowel preparation or not in elective colon surgery

2012 ◽  
Author(s):  
Erik Nilsson
Keyword(s):  
Bowel Preparation ◽  
Colon Surgery ◽  
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.

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