scholarly journals Realistic Advantages of Early Surgical Drain Removal after Pancreatoduodenectomy: A Single-Institution Retrospective Study

2021 ◽  
Vol 10 (12) ◽  
pp. 2716
Author(s):  
So-Jeong Yoon ◽  
So-Kyung Yoon ◽  
Ji-Hye Jung ◽  
In-Woong Han ◽  
Dong-Wook Choi ◽  
...  
Keyword(s):  
Enhanced Recovery ◽  
Single Institution ◽  
Early Removal ◽  
Drain Removal ◽  
Early Return ◽  
Drain Fluid ◽  
Pancreatic Fistulas ◽  
Hospital Stays ◽  
Removal Group ◽  
Surgical Drain

The latest guidelines from the Enhanced Recovery After Surgery (ERAS®) Society stated that early drain removal after pancreatoduodenectomy (PD) is beneficial in decreasing complications including postoperative pancreatic fistulas (POPFs). This study aimed to ascertain the actual benefits of early drain removal after PD. The data of 450 patients who underwent PD between 2018 and 2020 were retrospectively reviewed. The surgical outcomes were compared between patients whose drains were removed within 3 postoperative days (early removal group) and after 5 days (late removal group). Logistic regression analysis was performed to identify the risk factors for clinically relevant POPFs (CR-POPFs). Among the patients with drain fluid amylase < 5000 IU on the first postoperative day, the early removal group had fewer complications and shorter hospital stays than the late removal group (30.9% vs. 54.5%, p < 0.001; 9.8 vs. 12.5 days, p = 0.030, respectively). The incidences of specific complications including CR-POPFs were comparable between the two groups. Risk factor analysis showed that early drain removal did not increase CR-POPFs (p = 0.163). Although early drain removal has not been identified as apparently beneficial, this study showed that it may contribute to an early return to normal life without increasing complications.

Realistic Advantages of Early Surgical Drain Removal after Pancreatoduodenectomy: A Single-institution Retrospective Study

2021 ◽  
Author(s):  
So Jeong Yoon ◽  
Sang Hyun Shin ◽  
So Kyung Yoon ◽  
Ji Hye Jung ◽  
In Woong Han ◽  
...  
Keyword(s):  
Enhanced Recovery ◽  
Incidence Rates ◽  
Early Removal ◽  
Drain Removal ◽  
Early Return ◽  
Drain Fluid ◽  
Pancreatic Fistulas ◽  
Hospital Stays ◽  
Removal Group ◽  
Surgical Drain

Abstract The latest guidelines from the Enhanced Recovery After Surgery (ERAS®) Society stated that early drain removal after pancreatoduodenectomy (PD) is beneficial in decreasing the complications including postoperative pancreatic fistulas (POPFs). This study aimed to ascertain the actual benefits of early drain removal after PD. The data of 450 patients who underwent PD between 2018 and 2020 were retrospectively reviewed. The surgical outcomes were compared between patients whose drains were removed within postoperative 3 days (early removal group) and after 5 days (late removal group). Logistic regression analysis was performed to identify the risk factors for clinically relevant POPFs (CR-POPFs). Among 338 patients with drain fluid amylase levels of less than 5000 IU on the first day after surgery, the early removal group (n=81) had fewer complications and shorter hospital stays than the late removal group (n=257) (30.9% vs 54.5%, p < 0.001; 9.8 days vs 12.5 days, p = 0.030, respectively). The incidence rates of specific complications including CR-POPFs were comparable between the two groups. Risk factor analysis showed that early drain removal did not increase the risk of CR-POPFs (p = 0.163). Although early drain removal after PD has not been identified as apparently beneficial, this study showed that it may contribute to an early return to normal life without increasing complications.

Early and Standard Urinary Catheter Removal After Gynecological Surgery for Benign Lesions: A Quasi-Experimental Study

2021 ◽  
pp. 105477382110445
Author(s):  
Shu Fen Chen ◽  
Peng-Hui Wang ◽  
Shu-Chen Kuo ◽  
Yin-Chen Chen ◽  
Huei-Jhen Sia ◽  
...  
Keyword(s):  
Experimental Study ◽  
Foley Catheter ◽  
Catheter Removal ◽  
Optimal Timing ◽  
Gynecological Surgery ◽  
Early Removal ◽  
Quasi Experimental ◽  
Hospital Stays ◽  
Tract Infections ◽  
Removal Group

Patients undergoing gynecological surgery commonly receive indwelling transurethral Foley catheters, however duration of catheterization is associated with risk of urinary tract infections and other adverse effects. Early removal of catheters is encouraged, however optimal timing postsurgery remains unclear. This quasi-experimental study compared outcomes for women after removal of a Foley catheter at two different times following benign gynecological surgery. Participants received either early catheter removal, within 6 hours of surgery ( n = 38) or standard catheter removal, within 12 to 24 hours of surgery ( n = 45). There were no significant differences in outcomes for discomfort scores or re-catheterization rates between groups. However, the early removal group had a significantly shorter time to first ambulation and shorter hospital stays. Early removal of Foley catheters in patients who underwent gynecological surgery did not increase adverse events. Early removal of catheters after gynecological surgery may decrease re-catheterization rates and increase patient satisfaction.

scholarly journals State-of-the-art colorectal disease: postoperative ileus

2021 ◽  
Author(s):  
Nils P. Sommer ◽  
Reiner Schneider ◽  
Sven Wehner ◽  
Jörg C. Kalff ◽  
Tim O. Vilz
Keyword(s):  
Postoperative Ileus ◽  
Enhanced Recovery ◽  
Treatment Strategies ◽  
Colorectal Disease ◽  
Opioid Receptor Antagonists ◽  
Hospital Stays ◽  
Definition Of ◽  
Meta Analyses ◽  
Epidural Catheters ◽  
Prolonged Hospital

Abstract Purpose Postoperative Ileus (POI) remains an important complication for patients after abdominal surgery with an incidence of 10–27% representing an everyday issue for abdominal surgeons. It accounts for patients’ discomfort, increased morbidity, prolonged hospital stays, and a high economic burden. This review outlines the current understanding of POI pathophysiology and focuses on preventive treatments that have proven to be effective or at least show promising effects. Methods Pathophysiology and recommendations for POI treatment are summarized on the basis of a selective literature review. Results While a lot of therapies have been researched over the past decades, many of them failed to prove successful in meta-analyses. To date, there is no evidence-based treatment once POI has manifested. In the era of enhanced recovery after surgery or fast track regimes, a few approaches show a beneficial effect in preventing POI: multimodal, opioid-sparing analgesia with placement of epidural catheters or transverse abdominis plane block; μ-opioid-receptor antagonists; and goal-directed fluid therapy and in general the use of minimally invasive surgery. Conclusion The results of different studies are often contradictory, as a concise definition of POI and reliable surrogate endpoints are still absent. These will be needed to advance POI research and provide clinicians with consistent data to improve the treatment strategies.

Pancreaticogastrostomy after Pancreaticoduodenectomy Using Twin Square Wrapping with Duct-to-Mucosa Anastomosis

2015 ◽  
Vol 55 (1-2) ◽  
pp. 109-118 ◽  
Author(s):  
Kosei Maemura ◽  
Yuko Mataki ◽  
Hiroshi Kurahara ◽  
Shinichiro Mori ◽  
Naotomo Higo ◽  
...  
Keyword(s):  
Operating Time ◽  
Conventional Group ◽  
C Reactive Protein ◽  
Pancreatic Anastomosis ◽  
Pancreatic Stump ◽  
Reactive Protein ◽  
Significant Difference ◽  
Pancreatic Fistulas ◽  
Hospital Stays ◽  
Blood Loss Volume

Background/Purpose: This study aimed to evaluate the feasibility and safety of a novel pancreaticogastrostomy technique for diminishing pancreatic fistulas after pancreaticoduodenectomy using gastric wrapping of the pancreatic stump with a twin square-shaped horizontal mattress and a suture fixing the main pancreatic duct to the gastric mucosa anastomosis [twin square wrapping (TSW) method]. Methods: Fifty-three patients undergoing pancreaticogastrostomy after pancreaticoduodenectomy were included in the study and chronologically divided into a conventional group (n = 32) and a TSW group (n = 21). The perioperative factors and the postoperative outcomes were retrospectively analyzed. Results: The operating time for the pancreatic anastomosis, the total operating time, and the blood loss volume in the TSW group were lower than in the conventional group, but without a statistically significant difference. The TSW group had a significantly lower postoperative white blood cell count and C-reactive protein level, with a reduced intra-abdominal fluid accumulation as assessed by computed tomography on postoperative day 7, had a lower incidence of postoperative complications and pancreatic fistulas, and achieved a shorter duration of drain placement and shorter postoperative hospital stays as compared to the conventional group. Conclusions: The TSW technique should be considered for reducing pancreatic fistulas by diminishing the postoperative inflammatory response and improving patient outcomes without increasing the operating time.

A Single Institution Analysis of Targeted Colorectal Surgery Enhanced Recovery Pathway Strategies That Decrease Readmissions

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Stevie-Jay Stapler ◽  
Kara K. Brockhaus ◽  
Michael A Battaglia ◽  
Stephen T. Mahoney ◽  
Amanda M. McClure ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Enhanced Recovery ◽  
Single Institution ◽  
Enhanced Recovery Pathway

scholarly journals 320 Enhanced Recovery Protocol for Lumbar Fusion: A Comparative Single Institution Experience

Neurosurgery ◽  
2018 ◽  
Vol 65 (CN_suppl_1) ◽  
pp. 129-129
Author(s):  
G. Damian Brusko ◽  
Karthik Madhavan ◽  
Richard Epstein ◽  
John Paul G Kolcun ◽  
Jay Grossman ◽  
...  
Keyword(s):  
Enhanced Recovery ◽  
Lumbar Fusion ◽  
Single Institution ◽  
Enhanced Recovery Protocol

scholarly journals Many small steps to reducing length of stay: A visit to the DH pilot enhanced recovery scheme

2010 ◽  
Vol 92 (8) ◽  
pp. 266-268
Author(s):  
Matthew Worrall
Keyword(s):  
Length Of Stay ◽  
Health Service ◽  
Patient Experience ◽  
Enhanced Recovery ◽  
Enhanced Recovery Programme ◽  
Department Of Health ◽  
Recovery Scheme ◽  
Hospital Stays ◽  
Improve Patient

Enhanced recovery (ER) is one of the current buzz terms in the health service but it seems to mean a different thing depending on to whom you speak. The Department of Health (DH) invited applications from acute trusts across England to become 'innovation sites' for the enhanced recovery programme. These sites are supported by DH as they implement a defined programme that aims to improve patient experience through shorter hospital stays. The Bulletin spent a day at one of them, West Hertfordshire Hospitals NHS Trust, to witness the changes made.

714 UTILITY, TECHNIQUES, AND OUTCOMES FOR THORACIC DRAINAGE AFTER OESOPHAGECTOMY: A SYSTEMATIC REVIEW

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Charles Bull ◽  
Philip H Pucher ◽  
James Gossage
Keyword(s):  
Enhanced Recovery ◽  
Cochrane Collaboration ◽  
Patient Comfort ◽  
Effusion Rate ◽  
Thoracic Drainage ◽  
Drain Fluid ◽  
Position Type ◽  
Oesophageal Surgery ◽  
Recovery Protocols

Abstract   The routine use of post-operative drains in surgery continues to evolve as part of modern practices. Modern enhanced recovery protocols eschew using abdominal drains due to their impact on patient comfort, mobility, and recovery. This change in practice has not applied to thoracic drainage after oesophagectomy, where one or multiple drains are routinely placed. The aim of this study was to determine the evidence for, and how best to use drains during oesophageal surgery. Methods A systematic literature search was performed in Medline, Embase and Cochrane collaboration databases until Jan 25th, 2021. All studies which compared outcomes for different types or uses of thoracic drainage, or reported outcomes directly related to chest drains in oesophageal surgery were included. Studies were collated into domains based on variations in number, position, type, removal criteria, diagnostic use and complications of drains. Methodological quality was assessed by the Newcastle-Ottawa and Jadad Scores. Results 28 studies met the inclusion criteria. Four studies compared drain numbers, three showed similar outcomes and pain reduction using one. A single study showed that another, ‘anastomotic drain’ aided diagnosis and reduced leak mortality. Transhiatal drains had less pain and similar outcomes compared to intercostal drains. Drain fluid amylase aids leak diagnosis, however, accuracy requires drains to remain for 6 days. Removal of drains with daily volumes of less than 300 mL did not impact effusion rate. Complications can arise from drains with a 7% chance of drains migrating into the lumen of a leak and a risk of drain-site metastasis. Conclusion Drain use is a small facet of oesophageal surgery that can have a significant impact on outcomes. There is no evidence for non-drain use. A single transhiatal drain reduces pain without impacting on outcomes. Drains can have a role in diagnosing and managing anastomotic leaks, however, to be accurate drains have to stay in situ for longer. This extends patients discomfort and moves away from ERP trends and other surgical specialities.

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