EP.WE.467A Snapshot Audit on the Compliance of Postoperative ERAS Protocol Following the Resumption of Elective Colorectal Surgical Operations in the COVID-19 era

Abstract Aim The COVID-19 pandemic has put a pause on most elective surgical procedures nationally. Although the efficacy of ERAS protocol has been well established, its compliance following the resumption of elective services is unknown. Our study aims to assess the level of adherence in the postoperative arm of ERAS in a large district general hospital (DGH). Methods Patients who underwent elective colorectal surgery were audited prospectively between 1st September 2020 and 15th October 2020. Results The mean age (SD) of the 23 patients audited [11(48%) male] was 65 (16) years. Of the cases audited, 17 (74%) had malignant pathology and 6 (26%) were benign. The overall mean compliance score was 4.91 out of 7 (70%). Nasogastric tube was not used in most patients [22(96%)]. However, compliance was poor with regards to opioid avoidance [2(8%)]. Majority of cases complied with early discontinuation of intravenous fluids administration and catheter removal, 14 (61%) and 13 (57%) respectively. 18 patients (78%) resumed oral intake by the first day after surgery and 21 patients (91%) mobilised by the third postoperative day. Higher compliance was significantly associated with decreased length of stay (p = 0.01) but did not reveal significant association with 30-day morbidity. Conclusion Although the compliance to postoperative ERAS protocol is generally good, our study highlighted a strong need to improve the postoperative practice of opioid avoidance. Stricter adherence should be aimed for as it is associated with shorter hospital stay which is particularly important in the COVID-19 pandemic era.

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129 Compliance with The ERAS Protocol Amongst Colorectal Surgery Junior Doctors at Gloucester Royal Hospital

British Journal of Surgery ◽

10.1093/bjs/znab259.008 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

L Brennan

Keyword(s):

Colorectal Surgery ◽

Enhanced Recovery ◽

Length Of Hospital Stay ◽

Intravenous Fluid ◽

Junior Doctors ◽

Intravenous Fluids ◽

Elective Colorectal Surgery ◽

Royal Hospital ◽

Elective Surgical Procedures ◽

Eras Protocol

Abstract Background Enhanced recovery after surgery (ERAS) is an evidence-based protocol aiming to expedite recovery following elective surgical procedures. ERAS has shown to reduce the length of hospital stay, complications, readmissions, and costs. The junior doctor’s role in ERAS centres around admission, preoperative nutritional care, and ERAS compliance. This audit aimed to review prescribing of perioperative nutritional drinks (NutriciaPreop© and Fortisips) and intravenous fluids for patients undergoing elective colorectal surgery at Gloucester Royal Hospital. Method An 80% standard was set for this audit. A full audit cycle was completed. Drug and intravenous fluid charts were analysed for correct prescribing of NutriciaPreop© and intravenous fluids pre-operatively, and peri operative Fortisips. Improvement measures included ward posters and education to incoming junior doctors. Results Initial data collection showed that 70% of patients received a correct intravenous fluid prescription pre-operatively. 24% of patients were prescribed NutriciaPreop© and 18% were prescribed Fortisips. During re-auditing intravenous fluids were correctly prescribed in 80% of patients, NutriciaPreop© in 67% of patients and Fortisips in 60%. Conclusions This audit emphasises the importance of good quality inductions for junior doctors and how simple measures improve prescribing of essential peri-operative nutrition. Additionally, the value of multidisciplinary team involvement in junior doctor training has been highlighted.

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Operating Rooms efficiency: leveraging data to improve management of elective surgery

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.528 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

C Quercioli ◽

G A Carta ◽

G Cevenini ◽

G Messina ◽

N Nante ◽

...

Keyword(s):

Historical Data ◽

Elective Surgery ◽

District General Hospital ◽

Operating Rooms ◽

Accurate Estimation ◽

Surgical Time ◽

Accurate Analysis ◽

Management Efficiency ◽

Scheduling Model ◽

The Mean

Abstract Background Careful scheduling of elective surgery Operating Rooms (ORs) is crucial for their efficient use, to avoid low/over utilization and staff overtime. Accurate estimation of procedures duration is essential to improve ORs scheduling. Therefore analysis of historical data about surgical times is fundamental to ORs management. We analyzed the effect, in a real setting, of an ORs scheduling model based on estimated optimum surgical time in improving ORs efficiency and decreasing the risk of overtime. Methods We studied all the 2014-2019 elective surgery sessions (3,758 sessions, 12,449 interventions) of a district general hospital in Siena's Province, Italy. The hospital had3 ORs open 5 days/week 08:00-14:00. Surgery specialties were general surgery, orthopedics, gynecology and urology. Based on a pilot study conducted in 2016, which estimated a 5 times greater risk of having an OR overtime for sessions with a surgical time (incision-suture)>200 minutes, from 2017 all the ORs were scheduled using a maximum surgical time of 200 minutes calculated summing the mean surgical times for intervention and surgeon (obtained from 2014-2016 data). We carried out multivariate logistic regression to calculate the probability of ORs overtime (of 15 and 30 minutes) for the periods 2014-2016 and 2017-2019adjusting for raw ORs utilization. Results The 2017-2019 risk of an OR overtime of 15 minutes decreased by 25% compared to the 2014-2016 period (OR = 0.75, 95%CI=0.618-0.902, p = 0.003); the risk of a OR overtime of 30 minutes decreased by 33% (OR = 0.67, 95%CI= 0.543-0.831, p < 0.001). Mean raw OR utilization increase from 62% to 66% (p < 0.001). Mean number of interventions per surgery sessions increased from 3.1 to 3.5 (p < 0.001). Conclusions This study has shown that an analysis of historical data and an estimate of the optimal surgical time per surgical session could be helpful to avoid both a low and excessive use of the ORs and therefore to increase the efficiency of the ORs. Key messages An accurate analysis of surgical procedures duration is crucial to optimize operating room utilization. A data-based approach can improve OR management efficiency without extra resources.

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Comparison of stapler and handsewn anastomosis techniques in creating an ileal conduit following radical cystectomy

10.31083/jomh.2021.107 ◽

2021 ◽

pp. 1

Keyword(s):

Postoperative Complications ◽

Ileal Conduit ◽

Perioperative Complications ◽

Movement Time ◽

Oral Intake ◽

Total Cost ◽

Handsewn Anastomosis ◽

Significant Difference ◽

The Mean ◽

Mean Time

Background and objective: Ileal conduit for urinary diversion can be completed using either end-to-end handsewn or stapled anastomosis. This study aimed to compare stepled and handsewn anastomosis methods in terms of complications, hospitalization and cost. Materials and methods: Forty-three patients were included in the hand-sewn and 44 patients in the stapler group. After creating an ileal conduit, continuity of the loop was achieved either with handsewn or stapler method. Patients' demographic data, time to onset of bowel movement, time to transit to oral intake, time to removal of the drain, perioperative and postoperative complications, mortality and total costs were retrospectively recorded and compared between the two groups. Results: There was no statistically significant difference between the groups in terms of the mean to the onset of bowel movements (p = 0.51) and the mean time to transit to oral intake (p = 0.23). The mean time to removal of the drain was significantly lower in the stapler group (p = 0.023). Perioperative complications were seen in eight patients in the handsewn group, while none of the patients in the stapler group developed perioperative complication (p = 0.003). Postoperative complications were similar between both groups (p = 0.75). The duration of hospitalization was statistically significantly lower in the stapler group (p = 0.004) and the mean total cost was statistically significantly more advantageous (p < 0.001). Conclusion: No significant difference was found between stapler and handsewn anastomosis techniques in terms of postoperative complications. On the other hand, hospitalization and total cost were in favour of stapler technique, showing that this technique can be used safely.

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A Study of the Metabolism of Fibrinogen after Surgical Operations

Clinical Science ◽

10.1042/cs0410141 ◽

1971 ◽

Vol 41 (2) ◽

pp. 141-152 ◽

Cited By ~ 14

Author(s):

J. A. Hickman

Keyword(s):

Venous Thrombosis ◽

Disseminated Intravascular Coagulation ◽

Half Life ◽

Plasma Fibrinogen ◽

Intravascular Coagulation ◽

Plasma Loss ◽

The Mean ◽

Chronic Disorders ◽

Contrast Group ◽

Surgical Operations

1. The turnover of fibrinogen was studied in twenty-eight patients after moderate and major surgical operations and in a contrast group of thirteen patients suffering from miscellaneous chronic disorders. 2. After operation the mean biological half-life of fibrinogen was 60.1 h (SD 16.4) and the mean plasma loss of fibrinogen was 40.1% (SD 12.6) of the intravascular fibrinogen pool each 24 h. In the contrast group, respective values of 96.2 h (SD 13.1) and 22.5% (SD 2.0) were obtained, which are in agreement with published values for the normal catabolism of fibrinogen. 3. When the post-operative increase in the plasma fibrinogen pool was taken into account, a massive increase in the absolute plasma loss of fibrinogen was observed with values approaching those reported for albumin turnover. 4. Possible sites of loss and the relevance of this investigation to the detection of disseminated intravascular coagulation and venous thrombosis are discussed.

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The Quality of Life Chronic Renal Failure (CRF) Patients in Hemodialysis Unit at District General Hospital Pringsewu Regency Lampung Province in 2018

E3S Web of Conferences ◽

10.1051/e3sconf/20186801009 ◽

2018 ◽

Vol 68 ◽

pp. 01009

Author(s):

Virna Widora Saputri ◽

Rico Januar Sitorus ◽

H. M. Zulkarnain

Keyword(s):

Quality Of Life ◽

Family Support ◽

General Hospital ◽

Emotional Health ◽

Sampling Technique ◽

District General Hospital ◽

Cross Sectional ◽

Hemodialysis Unit ◽

The Mean

The purpose of this study was to determine the factors that affect the quality of life of CRF patients in Hemodialysis Unit at Pringsewu District General Hospital. This study was conducted from February to May 2018 with cross sectional study design. The sampling technique using total sampling technique. Measurement of quality of life using KDQOL-SFTM version 1.3. The results found that quality of life scores were quite low in some domains and subscales. The mean of total score was 55.70 ± 21.30 with mean of Physical Health Composite (PHC) = 38.85 ± 9.26 and mean of Mental Health Composite (MHC) = 36.13 ± 7.08. Regarding the targeted area of ESRD, the scale of renal disease burden and occupational status scale resulted in the lowest score. The sleep quality scale score was 56.18 ± 20.72. Only 61 patients responded to questions of sexual activity with a score of 55.53 ± 27.44 on the scale of sexual function. In the 36-item health survey, the mean total score was 45.90 ± 21.95. The lowest score represented the limitations of roles caused by physical and emotional health problems. The result of statistical test showed that the variables significantly related to the quality of life of CRF patients were age, income, duration of hemodialysis and family support. Thus, family support was the variable that had the greatest impact on determining the quality of life of CRF patients. The CRF patients who lacked family support were 4.6 times more likely to lead poorer life compared to CRF patients who received good family support after being controlled by age, income, duration of hemodialysis, gender, working status, and diabetes mellitus variables.

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Management of wound infection after appendectomy: are parenteral antibiotics useful?

Eastern Mediterranean Health Journal ◽

10.26719/2002.8.4-5.638 ◽

2021 ◽

Vol 8 (4-5) ◽

pp. 638-644

Author(s):

B. Harahsheh ◽

B. Hiyasat ◽

A. Abulail ◽

M. Al Basheer

Keyword(s):

Povidone Iodine ◽

Perforated Appendicitis ◽

Length Of Hospital Stay ◽

District General Hospital ◽

Antibiotic Use ◽

Wound Infections ◽

Perforated Appendix ◽

The Mean ◽

To Receive ◽

Single Blind

This study investigated the use of antibiotics in the treatment of wound infections after appendectomy. The subjects were 72 patients with post-operative wound infections at a district general hospital in Jordan. All patients received daily antiseptic dressings with povidone-iodine 10% in alcohol. The patients were randomized in a single-blind trial to receive either no antibiotics or parenteral antibiotics metronidazole and cefoxitin. There was no significant effect of antibiotic use in patients with early inflamed or severely inflamed appendicitis. However, for patients with perforated appendicitis the mean length of hospital stay and the mean frequency of change of dressings were significantly reduced. We conclude that antibiotics do not offer any advantage in post-appendectomy wound infections except for cases of perforated appendix

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Open and laparoscopic approaches are associated with comparable 90-day morbidity and mortality following ERAS protocol

10.1101/2020.04.08.20057521 ◽

2020 ◽

Author(s):

Bhavin B. Vasavada ◽

Hardik Patel

Keyword(s):

Multivariate Analysis ◽

Operative Time ◽

Univariate Analysis ◽

Operating Time ◽

Morbidity And Mortality ◽

Morbidity Rate ◽

Blood Products ◽

Mortality And Morbidity ◽

The Mean ◽

Eras Protocol

ABSTRACTIntroductionThe aim of this study is to compare 90-day mortality and morbidity between open and laparoscopic surgeries performed in one centre since the introduction of ERAS protocols.Material and MethodsAll gastrointestinal surgeries performed between April 2016 and March 2019 at our institution after the introduction of ERAS protocols have been analysed for morbidity and mortality. The analysis was performed in a retrospective manner using data from our prospectively maintained database.ResultsWe performed 245 gastrointestinal and hepatobiliary surgeries between April 2016 and March 2019. The mean age of patients was 50.96 years. 135 were open surgeries and 110 were laparoscopic surgeries. The mean ASA score was 2.4, the mean operative time was 111 minutes and the mean CDC grade of surgery was 2.56. 40 were emergency surgeries and 205 were elective surgeries. Overall the 90-day mortality rate was 8.5% and the morbidity rate was around 9.79%. On univariate analysis morbidity was associated with a higher CDC grade of surgeries, a higher ASA grade, longer operating time, the use of more blood products, a longer hospital stay and open surgeries. HPB surgeries and luminal surgeries (non hpb gastrointestinal surgeries) were associated with 90 day post operative morbidity. On multivariate analysis no factors independently predicted morbidity. On univariate analysis 90-day mortality was predicted by the grade of surgeries, a higher ASA grade, longer operative time, the use of more blood products, open surgeries and emergency surgeries. However on multivariate analysis only the use of more blood products was independently associated with mortalityConclusionThe 90-day mortality and morbidity rates between open and laparoscopic surgeries after the introduction of ERAS protocol were similar.

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The correlation between the three-dimensional radiolucency area around the crown of impacted maxillary canines and dentigerous cysts

Dentomaxillofacial Radiology ◽

10.1259/dmfr.20190402 ◽

2020 ◽

Vol 49 (4) ◽

pp. 20190402

Author(s):

Junliang Chen ◽

Dongmei Lv ◽

MingXia Li ◽

Wei Zhao ◽

Yun He

Keyword(s):

Cone Beam Ct ◽

Dentigerous Cyst ◽

Three Dimensional ◽

Cone Beam ◽

Hard Tissue ◽

Mean Values ◽

Dentigerous Cysts ◽

Impacted Canine ◽

The Mean ◽

Surgical Operations

This study aimed to reveal the correlation between the radiolucency area around the crown of impacted maxillary canines and dentigerous cysts using cone beam CT (CBCT). CBCT data were obtained from patients with impacted maxillary canines. Three points of five areas (tooth cusp area and buccal, lingual, mesial and distal areas of the crown) were randomly selected, and the distance between the point and the surrounding hard tissue was measured respectively. The mean values were recorded as the radiolucency area. These results were compared with the occurrence of dentigerous cysts during surgery. 58 patients with 76 impacted maxillary canines were included. 14 of the 76 impacted canines were accompanied by cysts (18.42%). With the increase in the thickness of the radiolucency area, the incidence of cysts was significantly increased (p < 0.05). No cysts were found in the compacted canines with 0–1 mm thickness of the radiolucency area. The highest incidence (71.43%) was observed in canines with 3–4 mm thickness of the radiolucency area. This study found that the thickness of the radiolucency area around the crown of the maxillary impacted canine was closely related to the occurrence of dentigerous cysts. CBCT can be used to estimate the occurrence possibility of dentigerous cyst and guide surgical operations.

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T model partition of lung and respiratory system impedances

Journal of Applied Physiology ◽

10.1152/jappl.1995.78.3.938 ◽

1995 ◽

Vol 78 (3) ◽

pp. 938-947 ◽

Cited By ~ 5

Author(s):

M. Rotger ◽

R. Farre ◽

R. Peslin ◽

D. Navajas

Keyword(s):

Respiratory System ◽

Frequency Range ◽

Tissue Impedance ◽

Gas Compression ◽

Thoracic Gas Volume ◽

The Mean ◽

Gas Volume ◽

Mean Compliance ◽

Gas Compressibility ◽

Shunt Impedance

The aim of this work was to demonstrate that the three compartments of the lung T network and the chest wall impedance (Zcw) can be identified from input and transfer impedances of the respiratory system if the pleural pressure is recorded during the measurements. The method was tested in six healthy volunteers in the range of 8–32 Hz. The impedances resulting from the decomposition confirm the adequacy of the monoalveolar structure commonly used in healthy subjects. Indeed, the T shunt impedance is well modeled by a purely compliant element, the mean compliance [0.038 +/- 0.081 (SD) l/kPa], which coincides within 9.5 +/- 6.3% of the alveolar gas compressibility derived from thoracic gas volume (0.036 +/- 0.011 l/kPa). The results obtained provide experimental evidence that the alveolar gas compression is predominantly isothermal and that lung tissue impedance is negligible throughout the whole frequency range. The shape of Zcw is consistent with a low compliance-low inertance pathway in parallel with a high compliance-high inertance pathway. We conclude that the proposed method is able to reliably identify the T network featuring the lung and Zcw.

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PS01.155: ANALYSIS ON THE INCIDENCE AND RISK FACTOR OF READMISSION AFTER ESOPHAGECTOMY FOR ESOPHAGEAL CANCER FOR ESOPHAGEAL CANCER

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.155 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 93-93

Author(s):

Seong Yong Park ◽

Dae Joon Kim ◽

Jee Won Suh ◽

Go Eun Byun

Keyword(s):

Esophageal Cancer ◽

Anastomotic Leakage ◽

Conflicts Of Interest ◽

Anastomotic Stricture ◽

Oral Intake ◽

Vocal Cord Palsy ◽

Jejunostomy Tube ◽

The Mean ◽

Secondary Hospital ◽

Wound Problem

Abstract Background Esophageal complications consensus group (ECCG) recommended that readmissions to primary or secondary hospital within 30 days of discharge after esophagectomy can be an important quality outcome indicator for esophagectomy. This retrospective study was performed to investigate the frequencies and risk factors for readmission after esophagectomy. Methods We retrospectively reviewed 291 patients who received the esophagectomy and mediastinal lymphadenectomy for curative aim from January 2006 to June 2017. Results The mean age was 63.02 ± 8.02 years and male patients were 264 (90.7%). Thirty-nine (13.4%) patients readmit within 30 days after discharge. The mean readmission day after discharge was 14.76 ± 8.84. The common causes of readmission were anastomotic stricture requiring the ballooning (12, 30.7%), wound problem (7, 17.9%), pneumonia (6, 15.4%), and poor oral intake (4, 10.2%). Other causes of readmission were delayed gastric emptying (3), jejunostomy tube problem (2), ileus (2), pain (1), pneumothorax (1) and pleural effusion (1). On multivariate analysis, anastomotic leakage (odd ratio = 2.872, P = 0.022) were related to readmission, whereas age, pathologic stage, vocal cord palsy and neoadjuvant therapy were not related to readmission. In 30 patients with postoperative anastomotic leakage, the frequency of readmission due to wound problem (13.3% vs. 1.1%, P = 0.003) and anastomotic stricture (13.3% vs. 3.4%, P = 0.034) were significantly higher. Conclusion The incidence of readmission within 30 days after discharge was 13.4% and postoperative anastomotic leakage was related to the readmission, and it might be related to the wound problem and anastomotic stricture. Disclosure All authors have declared no conflicts of interest.

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