Perioperative care in colorectal surgery: current practice patterns and opinions

Abstract

Objective Evidence regarding perioperative care in colorectal surgery has recently increased, leading to changes in classical clinical procedures that make the perioperative period safer and shorter. This survey aimed to evaluate the opinions of Spanish colorectal surgeons on the perioperative management of their patients. Method Emailed surveys submitted to the members of Spanish Coloproctological Associations. Results One hundred and thirty-one (31.7%) of the 413 members participated in the study and responded thus: 21% use clinical pathways and 8% use fast track (FT); 36% use epidural analgesia in colonic surgery and 57% in rectal; 40% use warm air and 23% warm fluids to maintain intraoperative normothermia; 53% prescribe >/= 3000 ml. of iv fluids on the first postoperative day and 6.2%</= 2000 ml; 43% never use nasogastric tubes. Oral intake was initiated by 23.5% on the first day, and by 50% when peristalsis began, with an earlier tendency in laparoscopic surgery; 43% believed oral intake reduces ileus, but 12% considered it dangerous. Board accreditation and experience in Coloproctology were significantly associated with a lesser use of nasogastric tubes and earlier feeding. Sixty-nine per cent considered FT reduces postoperative stay and 44% thought that it minimizes complications. Conclusion Spanish surgeons maintain a classical procedural policy, but show tendencies towards optimizing patients' care.

Pain control for laparoscopic colectomy: an analysis of the incidence and utility of epidural analgesia compared to conventional analgesia

“…This suggests that most hospitals and most practicing surgeons within the USA do not utilize EA for laparoscopic colorectal surgery. However, analysis of European trends in colorectal surgery has found EA usage rates of 36 % in Spain and 75 % in Austria and Germany, making appraisal of its role important internationally [31,32].…”

Fast-track surgery for colonic and rectal resections in Austria – Results from a survey on the perioperative anaesthesia management

“…With the exception of Scotland, where only 11% use epidurals routinely, 83-96% of the institutions in Scandinavia and the Netherlands report the use of epidural analgesia after colonic resections. The most recent survey by Roig et al showed that 57% of the Spanish surgeons use epidural analgesia after rectal resections and 38% after colonic resections [36].…”

Association of Operating Time and Gastrectomy with Initiation of Postoperative Oral Food Intake

“…Meanwhile, multimodal perioperative care strategies have resulted in expedited recovery of gastrointestinal functions [7,8,9,10]. In general, laparoscopic intestinal surgery requires longer OT than conventional open surgery [4,6].…”

“…The administrative database we used enrolled data about the date or quantity of every care item delivered in FT programs, such as preoperative hydration and mechanical preparation, perioperative intravenous fluid administration, and the use of drains [10]. A study that monitors adherence to FT programs would be possible and promising in the future.…”

“…Laparoscopic surgery has resulted in early patient recovery and enabled them to return to activities of daily life, including earlier recommencement of oral food intake. A promising treatment strategy called fast-track (FT) has also been assessed and initiated in patients who have undergone laparoscopic and open intestinal surgery [7,8,9,10]. …”