Colorectal Surgery

2019 ◽  
pp. 145-174
Author(s):  
Aaron Persinger ◽  
Jeffrey Gonzales
Keyword(s):  
Side Effects ◽  
Colorectal Surgery ◽  
Enhanced Recovery ◽  
Average Length ◽  
Laparoscopic Approach ◽  
Preoperative Preparation ◽  
Medication Side Effects ◽  
Average Length Of Stay ◽  
Medication Side ◽  
Recovery Program

Over the past 30 years, the average length of stay after colorectal surgery has decreased from 8 to 10 days in the mid-1990s to 1 to 2 days with a laparoscopic approach in the setting of an enhanced recovery program. The time it takes a patient to return to his or her baseline functional status has also been reduced. This has been achieved by comprehensively addressing the negative physiologic effects of the stress response associated with surgery. Properly timed interventions such as preoperative preparation of the patient, various regional anesthesia techniques, avoidance of medication side effects, and avoidance of postoperative complications seem to work synergistically to speed recovery. This chapter outlines preoperative, intraoperative, and postoperative considerations that may help patients make it through their perioperative journey with increased safety, comfort, and efficiency.

Narcotic-Dependent Patients Derive Equal Benefit from Enhanced Recovery

2018 ◽  
Vol 84 (5) ◽  
pp. 609-614
Author(s):  
Julia Ross ◽  
Sandy Fogel
Keyword(s):  
Colorectal Surgery ◽  
Health Outcomes ◽  
Enhanced Recovery ◽  
Average Length ◽  
Surgical Morbidity ◽  
Improvement Program ◽  
Opioid Prescription ◽  
Average Length Of Stay ◽  
Prescription Drug Use ◽  
Physical Classification

Areas of the southeast United States have endemic levels of prescription drug use, diversion, and abuse. Because preoperative narcotics use is associated with increased surgical morbidity and increased readmission rates, there is a compelling need to categorize health outcomes of patients maintaining an active opioid prescription. The purpose of this study is to determine the health outcomes of preoperative narcotic users who undergo colorectal surgery within the enhanced recovery (ER) protocol, a set of multimodal interventions designed to reduce postoperative complications. Five hundred and five colorectal surgery patients were identified within the ER protocol at Carilion Clinic. Opioid dependence was defined as an active prescription for 30 days before surgery. Thirty-day outcome variables were defined by the National Surgical Quality Improvement Program. One hundred and one patients were identified as opioid dependent and 404 as opioid naïve. Groups were comparable in terms of age at surgery, mean body mass index, and presurgical physical classification. Groups fared similarly with regard to readmission (χ2, P > 0.999), reoperation (χ2, P = 0.869), and average length of stay [t(135) = 1.49, P = 0.137]. These preliminary data show that opioid-dependent patients derive benefit equal to opioid-naïve patients within the ER protocol.

PWE-297 Improving compliance and outcomes of an enhanced recovery program (erp) within colorectal surgery – completing the cycle

Gut ◽  
2015 ◽  
Vol 64 (Suppl 1) ◽  
pp. A342.1-A342 ◽  
Author(s):  
CF Thomas ◽  
P Coyne ◽  
T Collins ◽  
S Holtham ◽  
G Odair
Keyword(s):  
Colorectal Surgery ◽  
Enhanced Recovery ◽  
Enhanced Recovery Program ◽  
Recovery Program

Medication side effects

BMJ ◽  
2010 ◽  
Vol 341 (sep15 2) ◽  
pp. c4999-c4999
Keyword(s):  
Side Effects ◽  
Medication Side Effects ◽  
Medication Side

Early Discharge Does Not Increase Readmission Rates After Minimally Invasive Anatomic Lung Resection

2019 ◽  
Vol 14 (3) ◽  
pp. 218-226
Author(s):  
Guillaume S. Chevrollier ◽  
Amanda K. Nemecz ◽  
Courtney Devin ◽  
Kendrick V. Go ◽  
Misung Yi ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Minimally Invasive ◽  
Enhanced Recovery ◽  
Average Length ◽  
Lung Resection ◽  
Multivariable Analysis ◽  
Early Discharge ◽  
Enhanced Recovery Pathway ◽  
Average Length Of Stay ◽  
Anatomic Lung Resection

Objective Enhanced recovery pathways reduce length of stay and costs following lung resection. However, many fear that early discharge may lead to increased hospital readmissions. In this study, we aimed to determine whether early discharge was associated with increased readmission following anatomic lung resection. Methods Using the lung resection database approved by our institutional review board, we identified all patients undergoing minimally invasive lobectomy and segmentectomy between January 2010 and March 2017 at our institution, where an enhanced recovery pathway is well established. Thirty-day readmissions were compared between patients with short- and average length of stay, defined as 1 to 2 days and 3 to 5 days, respectively. Multivariable logistic regression analysis of patients matched by propensity scores was performed to determine odds of 30-day readmission for each group. Significance was set at P < 0.05. Results A total of 296 patients met inclusion criteria. Unadjusted analysis revealed a 3-fold increased rate of readmission in the group with average length of stay (9%, n = 12) versus the group with short length of stay (3%, n = 5; P < 0.01). At baseline, patients with average length of stay had increased rates of preoperative chemotherapy (13%, n = 18 vs. 4%, n = 6; P < 0.01) and radiation (12%, n = 16 vs. 3%, n = 5). Patients with average length of stay also had higher rates of lobectomy (95%, n = 127 vs. 86%, n = 140; P = 0.02) and postoperative complications (31%, n = 41 vs. 4%, n = 7; P < 0.01). On multivariable analysis, patients with average length of stay had a 2.3-fold greater odds of readmission, which was not statistically significant (OR = 2.33; 95% CI, 0.60 to 9.02; P = 0.22). Conclusions Early discharge following minimally invasive anatomic lung resection does not increase the risk of hospital readmission in patients treated within an enhanced recovery pathway.

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