scholarly journals TP6.2.4 Emergency colorectal resections: do colorectal surgeons achieve better outcomes than non-colorectal surgeons?

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Diana Wu ◽  
Isabel Gartner ◽  
Nikola Henderson
Keyword(s):  
Colorectal Surgery ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Outcome Data ◽  
Strong Argument ◽  
Parametric Data ◽  
Chi Squared ◽  
Colorectal Surgeons ◽  
Emergency Colorectal Surgery ◽  
Colorectal Resections

Abstract Aim Patients requiring emergency colorectal surgery in Tayside are managed by general surgeons who may or may not have subspecialist training in colorectal surgery. We investigated whether surgeon subspecialisation influences outcomes after emergency colorectal resections. Methods All patients undergoing emergency colorectal resections between 01/01/14 and 31/10/20 were included. Demographic, clinical, operative and outcome data were collected from hospital electronic records. Outcomes were compared for patients treated by colorectal versus non-colorectal surgeons. The primary outcome was 30-day post-operative mortality. Adjusted mortality was calculated using logistic regression. Secondary outcomes included rates of laparoscopic surgery, stomas, complications, readmissions and length of hospital stay. Categorical data were compared by chi-squared tests and non-parametric data by Wilcoxon tests. Results Of the 177 operations performed, 104 (58.8%) were performed by colorectal surgeons. Overall 30 day mortality was 5.1%, which was significantly lower for colorectal versus non-colorectal surgeons (1.0% vs 11.0%, p = 0.003), this remained significant after multivariate adjustment (Odds ratio 0.10, 95% confidence interval 0.01-0.86, p = 0.036). The proportion of laparoscopic cases was significantly higher for colorectal compared with non-colorectal surgeons (54.8% vs 4.1%, p < 0.0001). There were no significant differences in stoma rates (76.0% vs 63.0%, p = 0.063), further procedures (5.8% vs 8.2%, p = 0.523), anastomotic leaks (1.9% vs 4.1%, p = 0.387), readmission within 30 days (12.5% vs 13.7%, p = 0.815) or median length of hospital stay (16 vs 18 days, p = 0.375). Conclusion Mortality rates at 30 days after emergency colorectal surgery are significantly lower for patients treated by subspecialist colorectal surgeons. This provides a strong argument for a subspecialist on-call rota.

scholarly journals BOWEL PREPERATION;

2017 ◽  
Vol 24 (05) ◽  
pp. 702-706
Author(s):  
Syed Kashif Ali Shah ◽  
Gulshan Ali Memon ◽  
Habib-ur- Rehman ◽  
Rafiq Ahmed Sahito ◽  
Shahnawaz Leghari ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Hospital Stay ◽  
Mechanical Bowel Preparation ◽  
Length Of Hospital Stay ◽  
Main Concern ◽  
Wound Infections ◽  
Elective Colorectal Surgery ◽  
Group A ◽  
Colorectal Surgeons ◽  
Surgical Unit

Introduction: The cleansing of intestinal contents, were considered the mostimportant factor in the prevention of complications by most of the surgeons. While morbidityand mortality have been a matter of main concern in colorectal surgery during the past severaldecades. Despite these drawbacks mechanical bowel preparation is till practiced by most ofthe colorectal surgeons worldwide in elective colorectal surgery. So the aims of this study wereto find out the frequencies of wound infections, hospital stay, anastomotic leak and wounddehiscence’s in patients of two cohorts underwent elective colorectal surgery. Study Design:Prospective randomized control trial (RCT) study after having informed consent of participationas per described policy. Setting: Surgical Unit – I of People’s University of Medical and HealthSciences Nawabshah. Period: January 2012 to March 2016. Methods: 112 patients of bothgenders from 20-65 years in age, who underwent for Elective open colorectal surgery. In MBP,Sulphate and electrolyte free 136gm of polyethylence glycol (PEG) / two sachets with three litersof water were begun over 12 to 16 hours, the day before surgery in cohorts A only. Results:Regarding outcomes, wound infections were 12.5% and 16% in group A & B respectively. Therewas no remarkable difference in post-operative length of hospital stay with mean stay of 8+2and 9+2 in group A & B respectively. While disruption of anastomosis were 5.3% and 9% ingroup A & B respectively, while the frequency of incisional hernia was same in both groups.Conclusion: There is no benefit of enduring MBP in Elective Colorectal Surgery and can safelybe performed without it.

scholarly journals Cognitive impairment in older patients undergoing colorectal surgery

2018 ◽  
Vol 63 (1) ◽  
pp. 11-15 ◽  
Author(s):  
Jonathan Hewitt ◽  
Margaret Marke ◽  
Calum Honeyman ◽  
Simon Huf ◽  
Aida Lai ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Colorectal Surgery ◽  
Hospital Stay ◽  
Cognitive Assessment ◽  
Length Of Hospital Stay ◽  
Montreal Cognitive Assessment ◽  
Demographic Information ◽  
Elective Colorectal Surgery ◽  
Chi Squared ◽  
Surgical Pathway

Background With increasing numbers of older people being referred for elective colorectal surgery, cognitive impairment is likely to be present and affect many aspects of the surgical pathway. This study is aimed to determine the prevalence of cognitive impairment and assess it against surgical outcomes. Methods The Montreal Cognitive Assessment (MoCA) was carried out in patients aged more than 65 years. We recorded demographic information. Data were collected on length of hospital stay, complications and 30-day mortality. Results There were 101 patients assessed, median age was 74 years (interquartile range = 68–80), 54 (53.5%) were women. In total, 58 people (57.4%) ‘failed’ the Montreal Cognitive Assessment test (score ≤ 25). There were two deaths (3.4%) within 30 days of surgery in the abnormal Montreal Cognitive Assessment group and none in the normal group. Twenty-nine (28.7%) people experienced a complication. The percentage of patients with complications was higher in the group with normal Montreal Cognitive Assessment (41.9%) than abnormal Montreal Cognitive Assessment (19.9%) ( p = 0.01) and the severity of those complications were greater (chi-squared for trend p = 0.01). The length of stay was longer in people with an abnormal Montreal Cognitive Assessment (mean 8.1 days vs. 5.8 days, p = 0.03). Conclusion Cognitive impairment was common, which has implications for informed consent. Cognitive impairment was associated with less postoperative complications but a longer length of hospital stay.

Fast Track Postoperative Management after Elective Colorectal Surgery: A Controlled Trail

2009 ◽  
Vol 75 (12) ◽  
pp. 1247-1251 ◽  
Author(s):  
Carlo V. Feo ◽  
Serena Lanzara ◽  
Davide Sortini ◽  
Riccardo Ragazzi ◽  
Mario De Pinto ◽  
...  
Keyword(s):  
Epidural Analgesia ◽  
Hospital Stay ◽  
Fast Track ◽  
Length Of Hospital Stay ◽  
Oral Feeding ◽  
Control Group ◽  
Intestinal Function ◽  
Elective Colorectal Surgery ◽  
Early Ambulation ◽  
Colorectal Resections

In the attempt to reduce postoperative complications and costs and improve outcomes, the concept of fast track surgery has been proposed. Improvements in anesthesia techniques and a better understanding of the pathophysiologic events occurring during and after surgery have made it possible. A group of patients undergoing colorectal resections with a fast track approach were investigated; specifically, the effects on postoperative morbidity, resumption of intestinal function, and duration of hospitalization. Fifty patients were managed according to a protocol, which included epidural analgesia, early ambulation, and oral feeding (fast track group); they were compared with 50 patients managed with a different protocol: no epidural analgesia, early ambulation, and early oral diet (control group). Primary outcome end-points reported include morbidity, time to passage of flatus and stool, and length of hospital stay. Fourteen complications occurred in the fast track group and 13 in the control group ( P = not significant (NS)). Resumption of intestinal function occurred after 3 days, and length of hospital stay was 5 days in the fast track group compared with 4 and 7 days respectively in control patients ( P = NS, P < 0.01). Patients undergoing elective colorectal resections can be managed safely with fast track protocols reducing hospital stay.

scholarly journals Thirty-Day Postoperative Outcomes Following Sugammadex Use in Colorectal Surgery Patients; Retrospective Study

2019 ◽  
Vol 8 (1) ◽  
pp. 97 ◽  
Author(s):  
Yun Chae ◽  
Han Joe ◽  
Juyeon Oh ◽  
Eunyoung Lee ◽  
In Yi
Keyword(s):  
Retrospective Study ◽  
Colorectal Surgery ◽  
Hospital Stay ◽  
Acetylcholinesterase Inhibitor ◽  
Length Of Hospital Stay ◽  
Postoperative Hospital Stay ◽  
Postoperative Outcomes ◽  
Total Length ◽  
Delayed Discharge ◽  
Postanesthetic Care Unit

Purpose: Sugammadex rapidly reverses muscle relaxation compared to acetylcholinesterase inhibitors. The long-term outcomes of sugammadex, however, are not well known. We compared 30-day postoperative outcomes following sugammadex and acetylcholinesterase inhibitor use in colorectal surgery patients. Patients and methods: Colorectal surgical patients older than 21 were included in this retrospective study, and were dichotomized according to use of reversal agents, sugammadex (group S), and acetylcholinesterase inhibitor (group A). We assessed 30-day postoperative outcomes, including total length of hospital stay, length of postoperative hospital stay, readmission rate, and delayed discharge rate. Additional parameters included postanesthetic care unit stay time, time to first successful oral intake, unforeseen intensive care unit (ICU) admission rate, postoperative pulmonary complications, and mortality. Results: Among a total of 585 patients, 157 patients remained in each group after propensity score matching. Total length of hospital stay, length of postoperative hospital stay, and readmission rates did not differ between the two groups, while the incidence of delayed discharge was significantly lower in group S (23 (15%) vs. 40 (25%), p = 0.017). Other outcomes did not differ between the two groups. Conclusion: We found no difference in 30-day postoperative outcomes following sugammadex and acetylcholinesterase inhibitor use. The only difference between these treatments was the associated incidence of delayed discharge, which was lower in group S.

scholarly journals Routine measurement of serum procalcitonin allows antibiotics to be safely withheld in patients admitted to hospital with SARS-CoV-2 infection

2020 ◽  
Author(s):  
Emma J. Williams ◽  
Luke Mair ◽  
Thushan I. de Silva ◽  
Dan J. Green ◽  
Philip House ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Antibiotic Consumption ◽  
Outcome Data ◽  
Teaching Hospitals ◽  
Inclusion Criteria ◽  
Diagnostic Challenge ◽  
Intensive Care Admission ◽  
Routine Measurement ◽  
Polymerase Chain

ABSTRACTBackgroundIt can be a diagnostic challenge to identify COVID-19 patients without bacterial co-infection in whom antibiotics can be safely stopped. We sought to evaluate the validity of a guideline that recommends withholding antibiotics in patients with a low serum procalcitonin (PCT).MethodsWe retrospectively collected 28-day outcome data on patients admitted to Sheffield Teaching Hospitals NHS Foundation Trust, UK, between 5 March and 15 April 2020, with a positive SARS-CoV-2 polymerase chain reaction (PCR) and PCT within 48 hours of diagnosis. PCT was considered negative if ≤0.25ng/ml and positive if >0.25ng/ml. Primary outcomes included antibiotic consumption, mortality, intensive care admission and length of hospital stay.Results368 patients met the inclusion criteria; 218 (59%) had a negative PCT and 150 (41%) positive. At 48 hours post-diagnosis, 73 (33%) of those with a negative PCT were receiving antimicrobials compared to 126 (84%) with a positive PCT (p<0.001), with a corresponding reduction in antimicrobial usage over 28 days (median DDD of 3.0 vs 6.8 (p<0.001); median DOT 2 vs 5 days (p<0.001) between the negative and positive PCT groups.) In the negative PCT group, there were fewer deaths (62 (28%) vs. 54 (36%), (p=0.021)) and critical care admissions (19 (9%) vs. 28 (19%), (p=0.007)) than in the positive PCT group. Median length of hospital stay was 8.7 and 9 days in the negative and positive PCT groups respectively.ConclusionsProcalcitonin is a valuable tool in the assessment of patients with SARS-CoV-2 infection, safely reducing the potential burden of unnecessary antibiotic usage.

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