Cost of organ/space infection in elective colorectal surgery. Is it just a problem of rates?

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.

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THE FEASIBILITY OF FAST TRACK PROTOCOL FOR ELDERELY PATIENTS WITH COLORECTAL CANCER

Koloproktologia ◽

10.33878/2073-7556-2016-0-1-26-29 ◽

2016 ◽

pp. 26-29

Author(s):

D. . Zitta ◽

V. . Subbotin ◽

Y. . Busirev

Keyword(s):

Colorectal Cancer ◽

Colorectal Surgery ◽

Blood Loss ◽

Elderly Patients ◽

Fast Track ◽

Randomized Study ◽

Conventional Group ◽

Intraoperative Blood Loss ◽

Elective Colorectal Surgery ◽

Complications Rate

Fast track protocol is widely used in major colorectal surgery. It decreases operative stress, shortens hospital stay and reduces complications rate. However feasibility and safety of this approach is still controversial in patients older than 70 years. The AIM of the study was to estimate the safety and effectiveness of fast track protocol in elderly patients with colorectal cancer. MATERIALS AND METHODS. Prospective randomized study included 138 elective colorectal resectionfor cancer during period from 1.01.10 till 1.06.15. The main criteria for the patients selection were age over 70 years and diagnosis of colorectal cancer. 82 of these patients received perioperative treatment according to fast track protocol, other 56 had conventional perioperative care. Patients underwent following procedures: right hemicolectomy (n=7), left hemicolectomy (n=12), transverse colectomy (n=1), sigmoidectomy (n=23), abdomeno-perineal excision (n=19) and low anterior resection of rectum (n=76). Following data were analized: duration of operation, intraoperative blood loss, time offirst flatus and defecation, complications rates. RESULTS. Mean age was 77,4 ± 8 years. There were no differences in gender, co morbidities, body mass index, types of operations between groups. Duration of operations didn't differ significantly between 2 groups. Intraoperative blood loss was higher in conventional group. The time of first flatus and defecation were better in FT-group. There was no mortality in FT-group vs 1,8 %o mortality in conventional group. Complications rate was lower in FT-group: wound infections 3,6% vs 9 %, anastomotic leakage 4,8 %o vs 9 %o, ileus 1,2 vs 5,4 %o, peritonitis 2,4 %o vs 3,6%o, bowel obstruction caused by the adhesions 6 % vs 5,3 %. Reoperation rate was similar 4,8 % vs 3,6 %. CONCLUSION. Fast track protocol in major elective colorectal surgery can be safely applied in elderly patients. The application of fast track protocol in elderly patients improves the restoration of bowel function and reduces the risk of postoperative complication.

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Faculty Opinions recommendation of Association of mechanical bowel preparation and oral antibiotics before elective colorectal surgery with surgical site infection.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.734249120.793551951 ◽

2018 ◽

Author(s):

Eloy Espín Basany

Keyword(s):

Colorectal Surgery ◽

Surgical Site Infection ◽

Bowel Preparation ◽

Mechanical Bowel Preparation ◽

Site Infection ◽

Oral Antibiotics ◽

Elective Colorectal Surgery

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Risk Factors for Prolonged Postoperative Ileus in Adult Patients Undergoing Elective Colorectal Surgery: An Observational Cohort Study

Reviews on Recent Clinical Trials ◽

10.2174/1574887113666180521111153 ◽

2018 ◽

Vol 13 (4) ◽

pp. 295-304 ◽

Cited By ~ 4

Author(s):

Andrea Pisani Ceretti ◽

Nirvana Maroni ◽

Marco Longhi ◽

Marco Giovenzana ◽

Roberto Santambrogio ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Colorectal Surgery ◽

Postoperative Ileus ◽

Observational Cohort Study ◽

Adult Patients ◽

Elective Colorectal Surgery ◽

Observational Cohort ◽

Prolonged Postoperative Ileus

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P7: ACUTE KIDNEY INJURY AFTER ELECTIVE COLORECTAL SURGERY: RESULTS OF A NATIONAL CLOSED-LOOP AUDIT

British Journal of Surgery ◽

10.1093/bjs/znab117.092 ◽

2021 ◽

Vol 108 (Supplement_1) ◽

Author(s):

Keyword(s):

Acute Kidney Injury ◽

Quality Improvement ◽

Colorectal Surgery ◽

Prognostic Score ◽

Univariate Analysis ◽

Kidney Injury ◽

Elective Colorectal Surgery ◽

National Quality ◽

Significant Difference ◽

The Uk

Abstract Introduction The aim of this study was to re-audit the rates of acute kidney injury (AKI) after elective colorectal surgery, following local presentations of results. Method Outcomes After Kidney injury in Surgery (OAKS) and Ileus Management International (IMAGINE), were prospective multicentre audits on consecutive elective colorectal resections, in the UK and Ireland. These were performed over 3-month periods in 2015 and 2018 respectively. During the interim period, results were presented at participating centres to stimulate local quality improvement initiatives. Risk-adjusted 7-day postoperative AKI rates were calculated through multilevel logistic regression based on the OAKS prognostic score. Result Of the 4,917 patients included, 3,133 (63.7%) originated from OAKS and 1,784 (36.3%) from IMAGINE. On univariate analysis, there was no significant difference (p=0.737) in the 7-day AKI rate between OAKS (n=346, 11.8%) and IMAGINE (n=205, 11.5%). However, the risk-adjusted AKI rate in IMAGINE was significantly lower compared to OAKS (-1.8%, 95% CI: -2.3% to -1.3%, p<0.001). Of 47 centres (40.1%) with a recorded local presentation, there was no significant difference in the subsequent AKI rate in IMAGINE (-0.7%, -2.0% to 0.6%, p=0.278). Conclusion Rates of AKI after elective colorectal surgery significantly reduced on re-audit. However, this may be related to increased awareness from participation or national quality improvement initiatives, rather than local presentation of results. Abbrev. AKI - Acute Kidney Injury, OAKS - Outcomes After Kidney injury in Surgery, IMAGINE - Ileus Management International Take-home message Risk-adjusted AKI rates significantly reduced on re-audit, however, this was most likely due to factors separate from the local presentation of initial results.

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Defining standards in colorectal optimisation: a Delphi study protocol to achieve international consensus on key standards for colorectal surgery prehabilitation

BMJ Open ◽

10.1136/bmjopen-2020-047235 ◽

2021 ◽

Vol 11 (3) ◽

pp. e047235

Author(s):

Iona Pearson ◽

Sue Blackwell ◽

Rebecca Fish ◽

Sarah Daniels ◽

Malcolm West ◽

...

Keyword(s):

Systematic Review ◽

Colorectal Surgery ◽

Outcome Measures ◽

Delphi Study ◽

Public Involvement ◽

Healthcare Professionals ◽

Patient And Public Involvement ◽

International Consensus ◽

Elective Colorectal Surgery ◽

Patient Related Outcome

IntroductionPrehabilitation in colorectal surgery is evolving and may minimise postoperative morbidity and mortality. With many different healthcare professionals contributing to the prehabilitation literature, there is significant variation in reported primary endpoints that restricts comparison. In addition, there has been limited work on patient-related outcome measures suggesting that patients with colorectal cancer needs and issues are being overlooked. The Defining Standards in Colorectal Optimisation Study aims to achieve international consensus from all stakeholders on key standards to provide a framework for reporting future prehabilitation research.Methods and analysisA systematic review will identify key standards reported in trials of prehabilitation in colorectal surgery. Standards that are important to patients will be identified by a patient and public involvement (PPI) event. The longlist of standards generated from the systematic review and PPI event will be used to develop a three-round online Delphi process. This will engage all stakeholders (healthcare professionals and patients) both nationally and internationally. The results of the Delphi will be followed by a face-to-face interactive consensus meeting that will define the final standards for prehabilitation for elective colorectal surgery.Ethics and disseminationThe University of Glasgow College of Medical, Veterinary and Life Sciences Ethics Committee has approved this protocol, which is registered as a study (200190120) with the Core Outcome Measures in Effectiveness Trials Initiative. Publication of the standards developed by all stakeholders will increase the potential for comparative research that advances understanding of the clinical application of prehabilitation.PROSPERO registration numberCRD42019120381.

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