Enhanced Recovery after Surgery

Lsmu, Algimantas Tamelis; klinika, Chirurgijos; nuskausminimas, Parenterinis; skysčių, Intraveninė; dėl, terapija; disfunkcijos, žarnyno; režimas, Lovos; judrumo, dėl apriboto; operacijų, didelių; pokytis, paradigmos; keičiama, praktika; praktika, mokslu grindžiama; trukmę, badavimo; protokolas, Eras; įdiegimas, Eras; centrai, Exellence; mechaninio, Vengti; išvalymo, žarnyno; tropmbozės, Giliųjų venų; Mmmh, profilaktika; prevencija, Hipotermijos; skysčių, Tikslinė; metu, terapija operacijos; pjūviai, skersiniai; pooperacinių, Vengti; drenų,; zondo, nazogastrinio; blokas, vietinis; rekomendacijos, Pooperacinės; pooperacinių, Ribotas; kiekis, v skysčių; auditas, Reguliarus; konsultavimas, Priešoperacinis; operacija, Apie; nuskausminimą, Apie; laikotarpį, Apie pooperacinį; paaiškinimas, Operacijos; pooperacinis, Ankstyvas; aktyvumas, fizinis; kontrolė, Skausmo; duomenų, patvirtinančių; optimizavimas, Medikamentinis; ligonių, Tinkamas; užtikrinimas, mitybos būklės; laikotarpį, ligoninėje; Varadhan, Krishna K.; Andersen, Henning; Lewis, Stephen J.; Thomas, Steve; mityba, Nepakankama; iš, Vienas; veiksnių, svarbiausių; pooperacinių, įtakojančių; atsiradimą, komplikacijų; ligoniams, beveik visiems; virškinimo, sergantiems; ligomis, organų navikinėmis; Cerantola, Yannick; dėl, Mitybos sutrikimo; mechanizmai, ligos

doi:10.1007/978-981-10-6796-9

Cited by 3 publications

(1 citation statement)

References 31 publications

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“…The currently available data shows that placement of a nasogastric tube does not prevent POI and may even increase the risk of other complications [ 5 ]. For this reason, the current recommendation is to avoid routine NGT insertion and to ensure early removal for those in whom it is deemed necessary [ 6 ]. Multiple preventive and treatment measures for POI have been studied over the years but the currently recommended measure is adherence to enhanced recovery after surgery (ERAS) protocols [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of Chewing Gum on Duration of Postoperative Ileus Following Laparotomy for Gastroduodenal Perforations: Protocol for a Randomized Controlled Trial

Muhumuza¹,

Molen²,

Mauricio³

et al. 2023

International Journal of Surgery Protocols

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Background: Prolonged post-operative ileus is associated with increased risk of other complications, length of hospital stays and health care related costs. Chewing gum has been shown to reduce duration of ileus in many elective surgeries, but there is a paucity of randomised controlled trials (RCTs) on its effect on duration of ileus among patients undergoing emergency surgery, specifically patients with peritonitis. The aim of this study is to determine the effect of chewing gum on duration of postoperative ileus following laparotomy for gastroduodenal perforations.Methods: This will be a randomised controlled trial done in 3 hospitals. Fifty-two patients will be randomised to 2 groups. Group A will receive chewing gum in addition to routine care, whereas group B will receive routine care only. The duration of postoperative ileus in the two groups which is the primary outcome, will be compared using the independent samples t-test in SPSS version 22. The length of hospital stay, in-hospital morbidity and mortality will be the secondary outcomes. This trial has been approved by Kampala International University research and Ethics committee (Ref No. KIU-2021-60) and Uganda national council of science and technology (Ref No. HS1665ES). Retrospective registration with the research registry has also been done (UIN: researchregistry8565). Highlights• Prolonged post-operative ileus significantly contributes to adverse surgical outcomes• Chewing gum has been shown to reduce duration of ileus in many elective surgeries• There is paucity of RCTs on role of chewing gum following surgery for peritonitis

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Section: Introductionmentioning

confidence: 99%

Effect of Chewing Gum on Duration of Postoperative Ileus Following Laparotomy for Gastroduodenal Perforations: Protocol for a Randomized Controlled Trial

Muhumuza¹,

Molen²,

Mauricio³

et al. 2023

International Journal of Surgery Protocols

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Influences on surgical antimicrobial prophylaxis decision making by surgical craft groups, anaesthetists, pharmacists and nurses in public and private hospitals

et al. 2019

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BackgroundSurgical antimicrobial prophylaxis (SAP) is a leading indication for antibiotic use in the hospital setting, with demonstrated high rates of inappropriateness. Decision-making for SAP is complex and multifactorial. A greater understanding of these factors is needed to inform the design of targeted antimicrobial stewardship interventions and strategies to support the optimization of SAP and its impacts on patient care.MethodsA qualitative case study exploring the phenomenon of SAP decision-making. Focus groups were conducted with surgeons, anaesthetists, theatre nurses and pharmacists across one private and two public hospitals in Australia. Thematic analysis was guided by the Theoretical Domains Framework (TDF) and the Capabilities, Opportunities, Motivators-Behaviour (COM-B) model.ResultsFourteen focus groups and one paired interview were completed. Ten of the fourteen TDF domains were identified as relevant. Thematic analysis revealed six significant themes mapped to the COM-B model, and subthemes mapped to the relevant TDF domains in a combined framework. Key themes identified were: 1) Low priority for surgical antimicrobial prophylaxis prescribing skills; 2) Prescriber autonomy takes precedence over guideline compliance; 3) Social codes of prescribing reinforce established practices; 4) Need for improved communication, documentation and collection of data for action; 5) Fears and perceptions of risk hinder appropriate SAP prescribing; and 6) Lack of clarity regarding roles and accountability.ConclusionsSAP prescribing is a complex process that involves multiple professions across the pre-, intra- and post-operative surgical settings. The utilisation of behaviour change frameworks to identify barriers and enablers to optimal SAP prescribing supports future development of theory-informed antimicrobial stewardship interventions. Interventions should aim to increase surgeon engagement, enhance the prioritisation of and accountability for SAP, and address the underlying social factors involved in SAP decision-making, such as professional hierarchy and varied perceptions or risks and fears.

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A 5-Year Review of Gynaecological Oncology Patients Managed by a Fast Track Surgery Program

Carter¹,

Philp²,

O’Connell³

2014

IJCM

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Introduction: The aim of this study is to provide a comprehensive 5-year audit of patients undergoing laparotomy for suspected or confirmed gynaecological malignancy to document the frequency and incidence of adverse events and to investigate factors associated with shorter length of stay and readmission to hospital. Methods: A 5-year surgical audit of the period commencing 2008 and concluding 2012. All patients undergoing laparotomy were included in the audit without exclusions. Approval was granted by the local Ethics Review Committee. Results: Four hundred and twenty-seven patients underwent laparotomy for suspected or confirmed gynaecological malignancy and were managed by Fast Track Surgery (FTS) principles. Average age was 54.8 years and average weight and BMI were 73.4 kg and 28.1 respectively. Ultimately 254 (59%) patients had confirmed malignancy. Average surgery duration was 2.36 hours and average estimated blood loss (EBL) at surgery was 262 mL. Median and mean LOS was 3.0 and 3.5 days respectively with 125 (29%) patients discharged on day 2. Overall transfusion rate was 5%. Other adverse events in decreasing frequency were hospital readmission (3.7%), significant wound infection (3%) and unplanned High Dependency Unit (HDU) admission (1.4%). All other adverse events were uncommon with rates <0.5%. Factors associated with a short LOS included year of surgery, age, performance status, malignant vs benign pathology, the use of COX-2 inhibitors, operation time, incision type, transfusion, and radical hysterectomy, at least 1 complication, if patients tolerated early oral feeding (EOF). In multivariable analysis, year, age, performance status, the use of COX-2 inhibitors, operation time and incision type were significant. Factors associated with readmission included the use of COX-2 inhibitors, operation time, performance of a lymph node dissection, return to operating theatre, operation category at least 1 complication, and in multivariable analysis lymph node dissection and the occurrence of at least 1 complication were significant. Conclusions: This 5-year audit is important in establishing a contemporary incidence and the prevalence rate of serious adverse events for patients with suspected or confirmed gynaecological cancer undergoing laparotomy and managed by FTS principles. The community can be reassured that the incidence of serious adverse events is low when managed by FTS principles.

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Enhanced Recovery after Surgery

Cited by 3 publications

References 31 publications

Effect of Chewing Gum on Duration of Postoperative Ileus Following Laparotomy for Gastroduodenal Perforations: Protocol for a Randomized Controlled Trial

Effect of Chewing Gum on Duration of Postoperative Ileus Following Laparotomy for Gastroduodenal Perforations: Protocol for a Randomized Controlled Trial

Influences on surgical antimicrobial prophylaxis decision making by surgical craft groups, anaesthetists, pharmacists and nurses in public and private hospitals

A 5-Year Review of Gynaecological Oncology Patients Managed by a Fast Track Surgery Program

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