The effect of coffee/caffeine on postoperative ileus following elective colorectal surgery: a meta-analysis of randomized controlled trials

Purpose Postoperative ileus (POI) is the most common complication of elective colon resection. Coffee or caffeine has been reported to be useful in improving gastrointestinal function after abdominal surgery. This study aimed to investigate the effect of coffee/caffeine on POI in patients undergoing elective colorectal surgery. Methods We searched Cochrane library, Embase, PubMed, and ClinicalTrials.gov (until July 2021) to identify randomized controlled trials (RCTs) evaluating the effect of coffee or caffeine on bowel movements and POI in patients undergoing elective colorectal surgery. The mean difference (MD) for continuous outcomes and risk ratio (RR) for dichotomous outcomes were calculated and are presented with 95% confidence intervals (CIs). A random effects model was used in all meta-analyses. Results A total of four RCTs including 312 subjects met the inclusion criteria and were included in the meta-analysis. Postoperative coffee or caffeine consumption decreased the time to first bowel movement (MD, − 10.36 h; 95% CI, − 14.61 to − 6.11), shortened the length of hospital stay (MD, − 0.95 days; 95% CI, − 1.57 to − 0.34), and was associated with a decreased risk of the use of any laxatives after the procedure (RR, 0.64; 95% CI, 0.44 to 0.92). The time to first flatus, time to tolerance of solid food, risk of any postoperative complication, postoperative reinsertion of a nasogastric (NG) tube, and anastomotic leakage showed no statistical differences between groups. Conclusion Postoperative coffee or caffeine consumption improved bowel movement and decreased the duration of hospital stay in patients undergoing elective colorectal surgery. This method is safe and can prevent or treat POI.

The usage of antibiotic therapy for septic complications in colorectal surgery

Over the past few decades, surgeons have made many attempts to reduce the incidence of surgical site infections (SSI) after elective colorectal surgery. Routine faecal diversion is no longer practiced in elective colonic surgery and mechanical bowel preparation is on the verge of being eliminated altogether. Intravenous antibiotics have become the standard of care as prophylaxis against SSI for elective colorectal operations. However, the role of antibiotics is still being debated. The aim of the study was to reduce the proportion of antibiotic-resistant strains of pathogens of infectious complications in colorectal surgery by optimizing the use of antimicrobial drugs. Method: We analyzed data of 135 patients who were operated for colorectal cancer in our general surgery department in between 2019 and 2021. Age, gender, body mass index, presence of chronic pulmonary disease, surgery duration, disease location (colon or rectum), and surgeon volume were evaluated for associations with the development of superficial or deep surgical site infection. Results: All parameters were found to be significant for the development surgical site infection except sex. Cut-off values were 63.5 years for age, 167.5 minutes for surgery duration. Conclusion. The introduction of strict monitoring of compliance with the protocols of antibiotic prophylaxis and antibiotic therapy at the level of a separate surgical unit in a multidisciplinary hospital improves conditions for the rational use of antimicrobial drugs.

Risk factors of early postoperative bowel obstruction for patients undergoing selective colorectal surgeries

Objective Postoperative bowel obstruction was one of the most severe complications in patients who received colorectal surgeries. This study aimed to explore risk factors of early postoperative obstruction and to construct a nomogram to predict the possibility of occurrence. Methods The records of 1437 patients who underwent elective colorectal surgery in Peking University People’s Hospital from 2015 to 2020 were retrospectively collected. Risk factors of early postoperative bowel obstruction were identified by logistic regression analysis and a nomogram was then constructed. Bootstrap was applied to verify the stability of the model. Results COPD, hypothyroidism, probiotic indications, duration of antibiotics, and time to postoperative feeding were identified as independent risk factors and were put into a nomogram for predicting early postoperative bowel obstruction. The nomogram showed robust discrimination, with the area under the receiver operating characteristic curve was 0.894 and was well-calibrated. Conclusion A nomogram including independent risk factors of COPD, hypothyroidism, probiotic indications, duration of antibiotics, and time to postoperative feeding were established to predict the risk of early postoperative bowel obstruction.

Oral Antibiotic Prophylaxis Lowers Surgical Site Infection in Elective Colorectal Surgery: Results of a Pragmatic Cohort Study in Catalonia

Background: The role of oral antibiotic prophylaxis (OAP) and mechanical bowel preparation (MBP) in the prevention of surgical site infection (SSI) after colorectal surgery is still controversial. The aim of this study was to analyze the effect of a bundle including both measures in a National Infection Surveillance Network in Catalonia. Methods: Pragmatic cohort study to assess the effect of OAP and MBP in reducing SSI rate in 65 hospitals, comparing baseline phase (BP: 2007–2015) with implementation phase (IP: 2016–2019). To compare the results, a logistic regression model was established. Results: Out of 34,421 colorectal operations, 5180 had SSIs (15.05%). Overall SSI rate decreased from 18.81% to 11.10% in BP and IP, respectively (OR 0.539, CI95 0.507–0.573, p < 0.0001). Information about bundle implementation was complete in 61.7% of cases. In a univariate analysis, OAP and MBP were independent factors in decreasing overall SSI, with OR 0.555, CI95 0.483–0.638, and OR 0.686, CI95 0.589–0.798, respectively; and similarly, organ/space SSI (O/S-SSI) (OR 0.592, CI95 0.494–0.710, and OR 0.771, CI95 0.630–0.944, respectively). However, only OAP retained its protective effect at both levels at multivariate analyses. Conclusions: oral antibiotic prophylaxis decreased the rates of SSI and O/S-SSI in a large series of elective colorectal surgery.

Impact of Enhanced Recovery Program (ERP) on Clinical Outcomes After Elective Colorectal Surgery in a Rural Hospital: A Prospective Cohort Study with Retrospective Control.

Introduction: The main purpose was to determine the impact on postoperative outcome of a standardized enhanced recovery program (ERP) for elective colorectal surgery in a rural hospital. Methods A prospective series of patients (N = 80) undergoing elective colorectal resection completing a standardized ERP protocol in 2018–2020 (ERP group) was compared to patients (N = 80) operated at the same rural hospital in 2013–2015 (pre-ERP group), before the implementation of the program. The exclusion criteria for both groups were: ASA score IV, TNM stage IV, inflammatory bowel disease, emergency surgery, and rectal cancer. The primary outcome was hospital length of stay (LoS) which was used as an estimate of functional recovery. Secondary outcomes included 30-day readmission and mortality rates as well as factors predicting both postoperative complications and prolonged hospital LoS. Results Baseline characteristics were comparable in both groups. Laparoscopic approach was performed in 95% of patients in the ERP group versus 0% in pre-ERP group. The median adherence to ERP protocol elements was 68% as opposed to 12% in the retrospective control group. The median hospital LoS in the ERP-group was significantly lower than in the pre-ERP group (5 vs. 10 days) with no increase in 30-day readmission and mortality rates. The Body Mass Index ≥ 30 and the traditional perioperative protocol were the independent predictive factors of postoperative complications, while following a traditional peri-operative protocol was the only factor predicting a prolonged hospital LoS. Conclusions Although limited hospital resources are perceived as a barrier to ERP implementation, the current experience demonstrates how adopting an ERP program in a rural area is feasible and effective, despite it requires greater effort. For patients in such areas, colorectal ERP in elective surgery may also reduce time to functional recovery, postoperative hospital LoS and complications, with no increase in mortality and 30-day re-admissions.

Albumin and CRP, Which is the Best Biomarker for Postoperative Complications on Colorectal Surgery? Prospective Cohort Study

Aim Our purpose was to investigate the potential role of albumin variation in comparison to C-reactive protein (CRP) variation as a predictive marker for postoperative complications in colorectal surgery. Methods An prospective cohort study was conducted. Adult patients who underwent elective colorectal surgery between January 2019 and December 2020 were eligible. Serum levels of albumin and CRP were measured preoperatively and on the first 4 postoperative days. Univariate analysis were performed to assess the association of albumin (Alb) and CRP with postoperative complications. Serum albumin variation (ΔAlb) and CRP variation (ΔCRP) were calculated. Receiver operating characteristic curve analysis and the Youden test were used to determine acuity and predictive cut-off values. Results Ninety-three patients were included. A CRP cut-off of 83.4 mg/dL on postoperative day (POD) 4 was the best predictor of postoperative global complications (p<0.001; AUC 0.83, 70% sensitivity, 91% specificity). Major complications were best correlated with ΔAlb on POD 2, 3 and 4 (p<0.001), with a ΔAlb cut-off of 27.4% on POD 2 showing the strongest association with this outcome (AUC 0.834, 83% sensitivity, 90% specificity). Regarding anastomotic leak, CRP on POD 3 showed better predictive values (p=0.037; AUC 0.792) with a cut-off value of 88.7 mg/dL (100% sensitivity, 52% specificity). Discussion Herein, the authors demonstrate there is a role for albumin variation, as an earlier and sensitive marker, to predict major postoperative complications in colorectal surgery. This analysis may be further applied to aid in the early identification of significant causes of re-operation and long-term morbimortality.

iColon, a patient-focused mobile application for perioperative care in colorectal surgery: an observational, real-world study protocol

IntroductionThe enhanced recovery after surgery (ERAS) protocol provides optimised care guidelines for patients undergoing elective colorectal surgery. To ensure high compliance with active ERAS elements, patients must be educated to actively participate in the perioperative care pathway. Mobile health is a rapidly expanding area of the digital health sector that is effective in educating and engaging patients during follow-up. iColon is a mobile application designed by the Operative Unit of General Surgery of IRCCS Sacro Cuore Don Calabria Hospital of Negrar of Valpolicella, which is specifically targeted at patients undergoing elective colorectal surgery. iColon is organised into ERAS phases, and it provides real-time feedback to surgeons about a patient’s adherence to perioperative active ERAS elements.Methods and analysisWe hypothesise that by providing a patient-focused mobile application, compliance with active ERAS elements could be improved.The first coprimary objective is to build patient confidence in using the mobile application, iColon, during perioperative care. The second coprimary objective is to establish patient compliance with active ERAS elements.Secondary objectives include examining: length of stay, 30-day readmission rate, postoperative complications and patient satisfaction of received care.This study is a prospective observational real-world study of patients undergoing elective colorectal surgery who are following the ERAS protocol and using iColon during perioperative periods between September 2020 and December 2022.By educating and engaging patients in the ERAS protocol, the mobile application, iColon, should stimulate patients to be more proactive in managing their healthcare by complying more closely with active ERAS elements.Ethics and disseminationThis study has been approved by the local Ethics Committee with the protocol number 29219 of 25 May 2020. The results will be actively disseminated through peer-reviewed journals, conference presentations and various community engagement activities.