Ambulatory colectomy: a pathway for advancing the enhanced recovery protocol

Curfman, Karleigh R.; Poola, Ashwini S.; Blair, Gabrielle E.; Kosnik, Callan L.; Pille, Sunshine A.; Hawkins, Melinda; Rashidi, Laila

doi:10.1007/s11701-022-01463-0

Cited by 11 publications

(40 citation statements)

References 20 publications

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“…The incidence of bradycardia was comparable between the propofol and remimazolam groups, a result similar to earlier published findings. 24 , 32 One study had suggested that the administration of remimazolam and propofol had lowered autonomic nerve activity judging by hemodynamic measurements and heart rate variability before and after anesthesia. 33 In patients undergoing cervical conization, bradycardia is a common concern because of the vagal reflex.…”

Section: Discussionmentioning

confidence: 99%

Cardiopulmonary Adverse Events of Remimazolam versus Propofol During Cervical Conization: A Randomized Controlled Trial

Wang¹,

Wang²,

Ma³

et al. 2023

DDDT

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Purpose This study aimed to compare the cardiopulmonary safety of remimazolam and propofol in patients undergoing cervical conization. Methods This was a single-blind, parallel, randomized controlled study. A total of 204 patients scheduled for day surgery of cold knife cervical conization received either remimazolam-alfentanil anesthesia (remimazolam group) or propofol-alfentanil anesthesia (propofol group). The primary outcome was the incidence of intraoperative cardiopulmonary adverse events (a composite outcome of hypotension, bradycardia and hypoxemia). The occurrence of hypotension, bradycardia, hypoxemia and the degree of body movement were secondary outcomes, as well as the moment at which consciousness was lost, the interval between the end of anesthesia and the operating room’s release of the patient, and the overall dosage of alfentanil administered during the procedure. Results The incidence of intraoperative cardiopulmonary adverse events was 45 (44.1%) in the remimazolam group and 72 (70.6%) in the propofol group (absolute risk difference [95% CI], −26.47% [−39.55% to −13.39%]; odds ratio (OR) [95% CI], 0.43 [0.28 to 0.65]; P < 0.001). The remimazolam group showed lower incidences of hypotension and hypoxemia compared to the propofol group ( P = 0.01 for both). No significant differences were observed in the overall alfentanil dosages administered, bradycardia, bodily movement, or time to losing consciousness between the two groups. Conclusion In patients who underwent cold knife cervical conization, remimazolam-alfentanil anesthesia was associated with a reduced incidence of intraoperative cardiopulmonary adverse events compared with propofol-alfentanil anesthesia.

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Section: Discussionmentioning

confidence: 99%

Cardiopulmonary Adverse Events of Remimazolam versus Propofol During Cervical Conization: A Randomized Controlled Trial

Wang¹,

Wang²,

Ma³

et al. 2023

DDDT

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“…We have previously published our clinical algorithm for the SDD pathway. 6,7 Briefly, patients must have adequate social support at home, reliable access to telecommunication, demonstrate a firm understanding of all preoperative counseling and education, and have no need for postoperative new-ostomy teaching. We utilized our SDD protocol, an extension of ERAS, as we have previously reported.…”

Section: Clinical Management and Surgical Techniquementioning

confidence: 99%

“…Along with a few other researchers, our group has previously published the results of our same day discharge (SDD) after minimally invasive colectomies. [4][5][6][7] Yet there is scant examination of postoperative opioid requirements in this specific population and how they affect outcomes such as readmissions. Older work in the past has identified early discharge as a significant risk factor for readmission.…”

mentioning

confidence: 99%

Ambulatory Robotic Colectomy: Factors Affecting and Affected by Postoperative Opioid Use

Vu,

Franko,

Buzadzhi

et al. 2024

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Background: The ongoing opioid crisis demands an investigation into the factors driving postoperative opioid use. Ambulatory robotic colectomies are an emerging concept in colorectal surgery, but concerns persist surrounding adequate pain control for these patients who are discharged very early. We sought to identify key factors affecting recovery room opioid use (ROU) and additional outpatient opioid prescriptions (AOP) after ambulatory robotic colectomies. Methods: This was a single-institution retrospective review of ambulatory robotic colon resections performed between 2019 and 2022. Patients were included if they discharged on the same day (SDD) or postoperative day 1 (POD1). Outcomes of interest included ROU [measured in parenteral morphine milligram equivalents (MMEs)], AOP (written between PODs 2 to 7), postoperative emergency department presentations, and readmissions. Results: Two hundred nineteen cases were examined, 48 of which underwent SDD. The mean ROU was 29.4 MME, and 8.7% of patients required AOP. Between SDD and POD1 patients, there were no differences in postoperative emergency department presentations, readmissions, recovery opioid use, or additional outpatient opioid scripts. Older age was associated with a lower ROU (−0.54 MME for each additional year). Older age, a higher body mass index, and right-sided colectomies were also more likely to use zero ROU. Readmissions were strongly associated with lower ROU. Among SDD patients, lower ROU was also associated with higher rates of AOP. Conclusion: Ambulatory robotic colectomies and SDD can be performed with low opioid use and readmission rates. Notably, we found an association between low ROU and more readmission, and, in some cases, higher AOP. This suggests that adequate pain control during the postoperative recovery phase is a crucial component of reducing these negative outcomes.

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“…25,26,29,31 As for type of procedures, six of the studies included all types of colorectal surgery 22,27,28,30,32 and eight studies included colectomies only. [24][25][26]29,31,[33][34][35] Seven studies assessed safety, feasibility and postoperative morbidity outcomes of twenty-four hours discharge, with or without home surveillance. [25][26][27][30][31][32][33] Seven of the studies assessed preoperative variables to identify patients who would be suitable for 24 hours discharge.…”

Section: Baseline Characteristicsmentioning

confidence: 99%

“…[25][26][27][30][31][32][33] Seven of the studies assessed preoperative variables to identify patients who would be suitable for 24 hours discharge. 22,24,28,29,31,34,35 In-and exclusion criteria from included prospective studies are shown in ►Supplementary Table S2.…”

Section: Baseline Characteristicsmentioning

confidence: 99%

Twenty-four Hours Stay After Colorectal Surgery; A Systematic Review

Smalbroek,

Schuffel,

Weijs

et al. 2023

Journal of Coloproctology

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Introduction The introduction of Enhanced Recovery After Surgery led to increasing twenty-four hours discharge pathways, for example in laparoscopic cholecystectomy and bariatric surgery. However, implementation in colorectal surgery still must set off. This systematic review assesses safety and feasibility of twenty-four hours discharge in colorectal surgery in terms of readmission and complications in current literature. Secondary outcome was identification of factors associated with success of twenty-four hours discharge. Methods Pubmed and EMBASE databases were searched to identify studies investigating twenty-four hours discharge in colorectal surgery, without restriction of study type. Search strategy included keywords relating to ambulatory management and colorectal surgery. Studies were scored according to MINORS score. Results Thirteen studies were included in this systematic review, consisting of six prospective and seven retrospective studies. Number of participants of the included prospective studies ranged from 5 to 157. Median success of discharge was 96% in the twenty-four hours discharge group. All prospective studies showed similar readmission and complication rates between twenty-four hours discharge and conventional postoperative management. Factors associated with success of twenty-four hours discharge were low ASA classification, younger age, minimally invasive approach, and relatively shorter operation time. Conclusions Twenty-four hours discharge in colorectal surgery seems feasible and safe, based on retro- and prospective studies. Careful selection of patients and establishment of a clear and adequate protocol are key items to assure safety and feasibility. Results should be interpreted with caution, due to heterogeneity. To confirm results, an adequately powered prospective randomized study is needed.

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Ambulatory colectomy: a pathway for advancing the enhanced recovery protocol

Cited by 11 publications

References 20 publications

Cardiopulmonary Adverse Events of Remimazolam versus Propofol During Cervical Conization: A Randomized Controlled Trial

Cardiopulmonary Adverse Events of Remimazolam versus Propofol During Cervical Conization: A Randomized Controlled Trial

Ambulatory Robotic Colectomy: Factors Affecting and Affected by Postoperative Opioid Use

Twenty-four Hours Stay After Colorectal Surgery; A Systematic Review

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