Risk of readmission after laparoscopic vs. open colorectal surgery

Esemuede, Iyare; Gabre-Kidan, Alodia; Fowler, Dennis L.; Kiran, Ravi P.

doi:10.1007/s00384-015-2349-9

Cited by 18 publications

(7 citation statements)

References 18 publications

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“…Whilst LoS after colorectal cancer surgery is generally decreasing, readmission remains a common event, and in some cases the incidence may be rising . Readmission rates are reported to be 11–15% within 30 days rising to 22% by 90 days postdischarge .…”

Section: Introductionmentioning

confidence: 99%

Does hospital readmission following colorectal cancer resection and enhanced recovery after surgery affect long term survival?

et al. 2017

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Section: Introductionmentioning

confidence: 99%

Does hospital readmission following colorectal cancer resection and enhanced recovery after surgery affect long term survival?

et al. 2017

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“…Many studies have reported that laparoscopic colectomy is associated with a lower incidence of SSI than open surgery [16][17][18]. In our 2 previous studies [13,14], all patients underwent open surgery for colon cancer.…”

Section: Discussionmentioning

confidence: 79%

Usefulness of Preoperative Mechanical Bowel Preparation in Patients with Colon Cancer who Undergo Elective Surgery: A Prospective Randomized Trial Using Oral Antibiotics

et al. 2019

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Background: To prevent surgical site infection (SSI) in colorectal surgery, the combination of mechanical bowel preparation (MBP), oral antibiotic bowel preparation (OABP), and the intravenous antibiotics have been proposed as standard treatment. We conducted an RCT comparing the incidence of SSI between MBP + OABP and OABP alone after receiving a single dose of intravenous antibiotics. Methods: The study group comprised 254 patients who underwent elective surgery for colon cancer. Patients were randomly assigned to receive MBP + OABP and intravenous antibiotics (MBP + OABP group) or to receive OABP and intravenous antibiotics (OABP alone group). Results: Overall, 125 patients in MBP + OABP group and 126 patients in OABP alone group were eligible. Incisional SSI occurred in 3 patients (2.4%) in MBP + OABP group, and 8 patients (6.3%) in the OABP-alone group. Organ/space SSI developed in 0 patients (0%) and in 4 patients (3.2%) in each group respectively. The OABP-alone group was thus not shown to be noninferior to the MBP + OABP group in the incidences of incisional SSI or organ/ space SSI. Other infectious complications developed in 7 pa-tients (5.6%) and in 6 patients (4.8%) in each group, indicating the non-inferiority of OABP alone to MBP + OABP. Conclusions: MBP combined with oral antibiotics and intravenous antibiotics remains standard in elective colon cancer surgery.

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“…11,12 The open approach (compared with minimally invasive approach) is used as a surrogate of complexity and was associated with surgical site infectionsas well as higher rates of readmission. 12,13 Another surrogate of operative complexity is case duration, and longer cases are also associated with higher rates of readmission. 13 It is inevitable that more difficult cases are at higher risk for surgical complications; therefore, risk adjustment for operative complexity is crucial for making sound policy decisions and drawing conclusions about surgical outcomes and quality.…”

Section: Implications For Surgical Qualitymentioning

confidence: 99%

“…12,13 Another surrogate of operative complexity is case duration, and longer cases are also associated with higher rates of readmission. 13 It is inevitable that more difficult cases are at higher risk for surgical complications; therefore, risk adjustment for operative complexity is crucial for making sound policy decisions and drawing conclusions about surgical outcomes and quality.…”

Section: Implications For Surgical Qualitymentioning

confidence: 99%

Complex and Reoperative Colorectal Surgery: Setting Expectations and Learning from Experience

Kin

2016

Clinics in Colon and Rectal Surgery

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Surgeons who perform colorectal operations are bound to face their share of complex and reoperative cases. For many, these challenging operations are what attracted us to the field. To maximize success and minimize complications in these circumstances, the surgeon must ensure adequate preoperative planning with good imaging and enlistment of help from other specialists, set expectations for the patient and operating room staff, and be aware of his or her own abilities. This issue of Clinics in Colon and Rectal Surgery is meant to serve as a resource so that surgeons and patients may benefit from the lessons learned by our expert contributors over years of experience. From a health systems and policy standpoint, it is important to recognize that these complex and reoperative cases confer a higher risk for morbidity and mortality when reporting quality outcomes, and to consider ways to optimize outcomes by concentrating the experience. Preoperative PreparationPreparation for the operation is often as important as the operation itself and consists of setting expectations for all parties involved-the surgeon and the surgical team, the patient, the operating room staff, and the nursing staff on the surgical ward. Failure to do this may result in significant delays, complications, poor delivery of care, and patient dissatisfaction. Imaging and Preoperative AssessmentOperative planning for complex and reoperative cases consists of obtaining high-quality imaging to reduce the risk of unplanned surgical findings. Other aspects of the workup include an assessment of the patient's risk for undergoing a general anesthetic and a major operation. Older patients are likely to undergo a full cardiopulmonary assessment to assess their readiness for a major operation based on the risk factor of age, and patients who are chronologically young yet frail due to their underlying illness should also undergo evaluation. Simple tools to measure a patient's frailty include gait speed, timed-up-and-go, and administration of screening questionnaires such as the Frail scale. 1-3 Assembling the Operating TeamMany complex and reoperative cases require a multidisciplinary approach, involving collaboration with other specialists including urologists, gynecologists, radiation oncologists, and plastic surgeons. The colorectal surgeon should function as the lead surgeon in these cases and coordinate the other players in the operative plan.Another consideration for a surgeon embarking on a difficult case is to ensure that an experienced colleague is available to help should the need arise. This is especially important for junior surgeons, but even very experienced senior surgeons will face particularly challenging cases where Keywords ► complex surgery ► reoperative surgery ► complications AbstractA range of topics are covered in this issue dedicated to complex and reoperative colorectal surgery, from radiation-induced surgical problems, to enterocutaneous fistulas and locally advanced or recurrent rectal cancer. Common themes include the importanc...

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Risk of readmission after laparoscopic vs. open colorectal surgery

Abstract: Despite its technical complexity, LC can be performed without concerns for increased complications or readmission. The shorter length of stay and the lower risk of readmissions underline the true benefits of the laparoscopic approach for colorectal resection.

Cited by 18 publications

References 18 publications

Does hospital readmission following colorectal cancer resection and enhanced recovery after surgery affect long term survival?

Does hospital readmission following colorectal cancer resection and enhanced recovery after surgery affect long term survival?

Usefulness of Preoperative Mechanical Bowel Preparation in Patients with Colon Cancer who Undergo Elective Surgery: A Prospective Randomized Trial Using Oral Antibiotics

Complex and Reoperative Colorectal Surgery: Setting Expectations and Learning from Experience

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