scholarly journals Conditions associated with worse acceptance of a simplified accelerated recovery after surgery protocol in laparoscopic colorectal surgery

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fábio Lopes de Queiroz ◽  
Antonio Lacerda-Filho ◽  
Adriana Cherem Alves ◽  
Fábio Henrique de Oliveira ◽  
Paulo Rocha França Neto ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Enhanced Recovery ◽  
Laparoscopic Colorectal Surgery ◽  
Surgical Stress ◽  
Operating Time ◽  
Stoma Creation ◽  
Number Of Patients ◽  
Poor Tolerance ◽  
Recovery Program ◽  
Operative Measures

Abstract Background Enhanced Recovery Surgical Programs were initially applied to colorectal procedures and used as multimodal approach to relieve the response to surgical stress. An important factor that negatively impacts the success of these programs is the poor tolerance of these patients to certain items in the adopted protocol, especially with regard to post-operative measures. The identification of these factors may help to increase the success rate of such programs, ensuring that benefits reach a greater number of patients and that resources are better allocated. Thus, the aims of this study were to assess the results of the implementation of a Simplified Accelerated Recovery Protocol (SARP) and to identify possible factors associated with failure to implement postoperative protocol measures in patients submitted to laparoscopic colorectal surgery. Methods 161 patients were randomly divided into two groups. The SARP group (n = 84) was submitted to the accelerated recovery program and the CC group (n = 77), to conventional postoperative care. The SARP group was further divided into two subgroups: patients who tolerated the protocol (n = 51) and those who did not (n = 33), in order to analyze factors contributing to protocol nontolerance. Results The groups had similar sociodemographic and clinical characteristics. The SARP group had a shorter hospital stay, better elimination of flatus, was able to walk and to tolerate a diet sooner (p < 0.0001). Complications rates and readmissions to emergency room were similar between groups. Multivariate analysis revealed that prolonged operating time, stoma creation and rates of surgical complications were independently associated with poor adherence to SARP (p < 0.0001). Conclusions The use of our SARP resulted in improved recovery from laparoscopic colorectal surgery and proved to be safe for patients. Extensive surgeries, occurrence of complications, and the need for ostomy were variables associated with poor program adhesion. Trial registration Trial Registry: RBR2b4fyr—Date of registration: 03 October 2017.

Conditions Associated with Worse Acceptance of a Simplified Accelerated Recovery after Surgery Protocol in Laparoscopic Colorectal Surgery: A Randomized Controlled Trial.

2020 ◽  
Author(s):  
Fabio Lopes Queiroz ◽  
Antonio Lacerda-Filho ◽  
Adriana Alves Cherem ◽  
Fabio Henrique Oliveira ◽  
Paulo Rocha França Neto ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Laparoscopic Colorectal Surgery ◽  
Surgical Stress ◽  
Controlled Trial ◽  
Postoperative Recovery ◽  
Stoma Creation ◽  
Number Of Patients ◽  
Care Approach ◽  
Multimodal Care ◽  
Recovery Program

Abstract Background: Accelerated Recovery after Surgery Programs were initially applied to colorectal surgery and used a multimodal care approach to relieve the response to surgical stress. An important factor that negatively impacts the success of these programs is the non-tolerance of patients to certain items in the adopted protocol, especially with regard to post-operative measures. The identification of these factors may help to increase the success rate of such programs, ensuring that benefits reach a greater number of patients and that resources are better allocated. Thus, the aims of this study were to assess the results of the implementation of a Simplified Accelerated Recovery Protocol (SARP) and to identify possible factors associated with failure to implement postoperative protocol measures in patients submitted to laparoscopic colorectal surgery.Methods: 161 patients were randomly divided into two groups. The SARP group (n = 84) was submitted to the accelerated recovery program and the CC group (n = 77), to conventional postoperative care. The SARP group was further divided into two subgroups: patients who tolerated the protocol (n=51) and those who did not (n=33), in order to analyze factors contributing to protocol nontolerance.Results: The groups had similar sociodemographic and clinical characteristics. The SARP group had a shorter hospital stay, better elimination of flatus, was able to walk and to tolerate a diet sooner (p < 0.0001). The rates of complications and of returns to the emergency room were similar between groups. In the multivariate analysis of the subgroups, we found that prolonged surgical time, stoma creation, and the development of complications were variables that placed program acceptance at risk (p < 0.0001).Conclusions: The accelerated postoperative recovery program that was adopted, although simplified, was able to improve recovery from laparoscopic colorectal surgery and proved to be safe for patients. Extensive surgeries, occurrence of complications, and the need for ostomy were variables associated with program non-acceptance. Trial registration: Trial Registry: RBR2b4fyr - Date of registration: 03 October 2017.

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

scholarly journals Operative Time and Outcome of Enhanced Recovery After Surgery After Laparoscopic Colorectal Surgery

2014 ◽  
Vol 18 (2) ◽  
pp. 265-272 ◽  
Author(s):  
Oliver J. Harrison ◽  
Neil J. Smart ◽  
Paul White ◽  
Adela Brigic ◽  
Elinor R. Carlisle ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Operative Time ◽  
Enhanced Recovery ◽  
Laparoscopic Colorectal Surgery ◽  
Enhanced Recovery After Surgery

Goal-directed Fluid Therapy Does Not Reduce Primary Postoperative Ileus after Elective Laparoscopic Colorectal Surgery

2017 ◽  
Vol 127 (1) ◽  
pp. 36-49 ◽  
Author(s):  
Juan C. Gómez-Izquierdo ◽  
Alessandro Trainito ◽  
David Mirzakandov ◽  
Barry L. Stein ◽  
Sender Liberman ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Fluid Therapy ◽  
Postoperative Ileus ◽  
Enhanced Recovery ◽  
Laparoscopic Colorectal Surgery ◽  
Enhanced Recovery After Surgery ◽  
Therapy Group ◽  
Control Group ◽  
Goal Directed Fluid Therapy ◽  
The Impact

Abstract Background Inadequate perioperative fluid therapy impairs gastrointestinal function. Studies primarily evaluating the impact of goal-directed fluid therapy on primary postoperative ileus are missing. The objective of this study was to determine whether goal-directed fluid therapy reduces the incidence of primary postoperative ileus after laparoscopic colorectal surgery within an Enhanced Recovery After Surgery program. Methods Randomized patient and assessor-blind controlled trial conducted in adult patients undergoing laparoscopic colorectal surgery within an Enhanced Recovery After Surgery program. Patients were assigned randomly to receive intraoperative goal-directed fluid therapy (goal-directed fluid therapy group) or fluid therapy based on traditional principles (control group). Primary postoperative ileus was the primary outcome. Results One hundred twenty-eight patients were included and analyzed (goal-directed fluid therapy group: n = 64; control group: n = 64). The incidence of primary postoperative ileus was 22% in the goal-directed fluid therapy and 22% in the control group (relative risk, 1; 95% CI, 0.5 to 1.9; P = 1.00). Intraoperatively, patients in the goal-directed fluid therapy group received less intravenous fluids (mainly less crystalloids) but a greater volume of colloids. The increase of stroke volume and cardiac output was more pronounced and sustained in the goal-directed fluid therapy group. Length of hospital stay, 30-day postoperative morbidity, and mortality were not different. Conclusions Intraoperative goal-directed fluid therapy compared with fluid therapy based on traditional principles does not reduce primary postoperative ileus in patients undergoing laparoscopic colorectal surgery in the context of an Enhanced Recovery After Surgery program. Its previously demonstrated benefits might have been offset by advancements in perioperative care.

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