Colonic Surgery With Accelerated Rehabilitation or Conventional Care

Basse, Linda; Thorbøl, Jens Erik; Løssl, Kristine; Kehlet, Henrik

doi:10.1007/s10350-003-0055-0

Cited by 374 publications

(344 citation statements)

References 24 publications

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“…The studies met with positive results. 5,6 Recently, a randomized controlled trial and a systematic review showed benefits of fast-track colorectal surgery. 7,8 In 2005, a team comprised of surgeons, anesthesiologists, nurses, physiotherapists, nutritionists, and epidemiologists of the McGill University Health Centre (MUHC) developed a multidisciplinary approach to colon resection with the intent to implement a fast-track program in this institution.…”

Section: Résumémentioning

confidence: 99%

An integrated multidisciplinary approach to implementation of a fast-track program for laparoscopic colorectal surgery

Carli

Charlebois

Baldini

et al. 2009

Can J Anesth/J Can Anesth

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Background Enhanced perioperative care programs have been developed in order to attenuate the impact of surgical stress on organ dysfunction, thereby accelerating hospital discharge and reducing morbidity. The implementation of a fast-track program for laparoscopic colorectal surgery is reported. Methods We report on a series of patients who entered a coordinated program based on preoperative patient education and counseling, a laparoscopic approach, provision of postoperative epidural analgesia, early food intake and mobilization, and structured surgical and nursing care practices. The program was introduced in September 2006 and adapted to our institutional needs. Outcome measures included length of hospital stay, return of bowel function, incidences of postoperative complications, and rate of readmission to hospital. Results Twenty-five patients were selected by the surgeons for the accelerated laparoscopic colorectal pathway. The median duration of hospital stay was 3 (95% confidence interval, 3-4) days. Sixteen patients (64%) were discharged from hospital on day 3. Nine patients failed the pathway for various reasons (social indications, poor pain relief, wound infection, anemia, urinary retention) and were discharged later (six patients on day 4, two patients on day 5, and one patient on day 6). Times to recover bowel function and to resume a full diet were all within the first 36 hr from time of surgery. There were two readmissions. Conclusion This early clinical experience demonstrates the feasibility of a fast-track program for colonic surgery and the requirement for an integrated multidisciplinary approach to perioperative care. RésuméContexte Des programmes de soins pe´riope´ratoires ame´liore´s ont e´te´e´labore´s afin d'atte´nuer l'impact du stress chirurgical sur la de´faillance syste´mique, ce qui a permis d'acce´le´rer le conge´de l'hôpital et de re´duire la morbidite´. La mise en oeuvre d'un programme acce´le´re´pour la chirurgie colorectale par laparoscopie est de´crite ici. Méthode Nous pre´sentons une se´rie de patients ayant participe´a`un programme coordonne´et de´crivons la formation et la consultation pre´ope´ratoire des patients, l'approche par laparoscopie, la prestation d'une analge´sie pe´ridurale postope´ratoire, l'absorption de nourriture et la mobilisation pre´coce, et les pratiques structure´es de soins chirurgicaux et infirmiers. Le programme a e´te´mis en place en septembre 2006 et adapte´pour re´pondre aux besoins de notre institution. Nous avons mesure´la dure´e du se´jour a`l'hôpital, la restauration de la fonction intestinale, l'incidence de complications postope´ratoires et le taux de re´admission a`l'hôpital.

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Section: Résumémentioning

confidence: 99%

An integrated multidisciplinary approach to implementation of a fast-track program for laparoscopic colorectal surgery

Carli

Charlebois

Baldini

et al. 2009

Can J Anesth/J Can Anesth

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“…78 One hundred thirty consecutive patients receiving conventional care (group 1) in one hospital were compared with 130 consecutive patients receiving multimodal fast-track rehabilitation (group 2) in another hospital. Outcomes were the time to first defecation after surgery, postoperative LOS, and morbidity during the first postoperative month.…”

Section: Multimodal Strategiesmentioning

confidence: 99%

Complication avoidance and management in anterior lumbar interbody fusion

Than

Wang

Rahman

et al. 2011

FOC

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The goal of this study was to review the literature to compare strategies for avoiding and treating complications from anterior lumbar interbody fusion (ALIF), and thus provide a comprehensive aid for spine surgeons. A thorough review of databases from the US National Library of Medicine and the National Institutes of Health was conducted. The complications of ALIF addressed in this paper include pseudarthrosis and subsidence, vascular injury, retrograde ejaculation, ileus, and lymphocele (chyloretroperitoneum). Strategies identified for improving fusion rates included the use of frozen rather than freeze-dried allograft, cage instrumentation, and bone morphogenetic protein. Lower cage heights appear to reduce the risk of subsidence. The most common vascular injury is venous laceration, which occurs less frequently when using nonthreaded interbody grafts such as iliac crest autograft or femoral ring allograft. Left iliac artery thrombosis is the most common arterial injury, and its occurrence can be minimized by intermittent release of retraction intraoperatively. The risk of retrograde ejaculation is significantly higher with laparoscopic approaches, and thus should be avoided in male patients. Despite precautionary measures, complications from ALIF may occur, but treatment options do exist. Bowel obstruction can be treated conservatively with neostigmine or with decompression. In cases of postoperative lymphocele, resolution can be attained by creating a peritoneal window. By recognizing ways to minimize complications, the spine surgeon can safely use ALIF procedures.

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“…e 3 o . dias pós-operatórios 33 . Essa prática diminui o desconforto dos doentes, o tempo de internação e conseqüentemente, os custos hospitalares.…”

Section: Correia Et Alunclassified

Paradigmas e evidências da nutrição peri-operatória

Correia

Silva

2005

Rev. Col. Bras. Cir.

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Conflito de interesse: nenhum Fonte de financiamento: nenhuma Trabalho realizado no Instituto Alfa de Gastroenterologia do Hospital das Clínicas da UFMG. IntroduçãoA abordagem nutricional de pacientes cirúrgicos é aspecto fundamental no cuidado dos mesmos. Múltiplos estudos randomizados, meta-análises e revisões têm abordado o tema. No entanto, alguns aspectos ainda continuam a ser alvo de inúmeras controvérsias, especialmente no tocante ao período adequado de jejum pré-operatório e à liberação da dieta no pós-operatório. Esses aspectos envolvem alguns dos paradigmas existentes em Medicina, mais propriamente em Cirurgia, que geram, por sua vez, angústia e medo aos profissionais envolvidos no tratamento de pacientes operados.Operações eletivas são, em geral, realizadas após 10 a 16 horas de jejum. A rotina é manter-se o paciente sem comer desde a noite anterior ao ato operatório. Esse período é tido como fundamental para que no momento da indução anestésica o estômago esteja completamente vazio e o risco de aspiração seja mínimo. No entanto, esse tempo é suficientemente longo do ponto de vista metabólico, levando a depleção do estoque de glicogênio, o que tem impacto na resposta orgânica ao estresse, além de gerar desconforto a vários pacientes 1 ,2 . A resposta orgânica apresenta-se aumentada em pacientes submetidos a jejum noturno, quando comparada a pacientes que receberam infusão de carboidratos 1,2 . Logo, o jejum pré-operatório aumenta o estresse metabólico induzido pelo tratamento cirúrgico.A liberação da dieta no pós-operatório é outro ponto controverso que tem gerado inúmeras discussões. Em geral, os cirurgiões aguardam a resolução do chamado íleo pós-operatório, ou seja, eliminação de flatos ou evacuação, para a liberação da dieta. Isso ocorre por volta do terceiro ou quarto dia pós-operatório. Além disso, a tradição cirúrgica orienta a oferta escalonada ou progressiva da dieta líquida, pastosa até à sólida. Essa prática não só pode contribuir com a piora do estado nutricional de pacientes previamente desnutridos, como aumenta o tempo de internação hospitalar 3 . Por outro lado, pacientes submetidos a grandes intervenções e alimentados precocemente apresentam melhor oxigenação da mucosa intestinal 4 , diminuição da resposta orgânica e do número de complicações no pós-operatório 5 -7 , assim como redução do tempo de dismotilidade intestinal 8,9 . É nosso objetivo nesta revisão abordar o impacto do jejum pré-operatório e da nutrição precoce no pós-operatório, do ponto de vista metabólico e da associação com complicações, tempo de internação, custos e conforto do paciente. Assim sendo, paradigmas que até hoje são a rotina cirúrgica pré e pós-operatória serão, seguramente, colocados em questionamento. Jejum pré e pós operatório versus resposta orgânica ao estresseA necessidade de jejum prolongado, desde a noite que antecede a operação, tem sido questionada e, novas condutas têm sido adotadas [10][11][12] . Na verdade, essa prática foi iniciada, quando as técnicas anestésicas ainda eram rudimentares o que au...

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Colonic Surgery With Accelerated Rehabilitation or Conventional Care

Abstract: Time to first defecation, hospital stay, and morbidity may be reduced after colonic resection with fast-track multimodal rehabilitation.

Cited by 374 publications

References 24 publications

An integrated multidisciplinary approach to implementation of a fast-track program for laparoscopic colorectal surgery

An integrated multidisciplinary approach to implementation of a fast-track program for laparoscopic colorectal surgery

Complication avoidance and management in anterior lumbar interbody fusion

Paradigmas e evidências da nutrição peri-operatória

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