Role for colorectal teams to support non-colorectal teams to improve clinical outcomes and adherence to ERAS guidelines for segmental colectomy: a cohort study

Mallard, Simonette R.; Clifford, Kari; Park, R.; Cousins, Kim; Patton, Ann; Woodfield, John C.; Thompson‐Fawcett, Mark

doi:10.1186/s12893-021-01149-8

Cited by 7 publications

(3 citation statements)

References 22 publications

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“…Further, although several retrospective studies have also assessed the impact of the type of anastomosis on postoperative outcomes within an ERAS protocol, these studies did not specify protocol compliance. 16,17 However, the impact of the ERAS program is directly proportional to the compliance rate, 18 which makes the interpretation of the impact of the type of anastomosis difficult. Our study had a high compliance rate ( > 90%) regardless of the type of anastomosis.…”

Section: Discussionmentioning

confidence: 99%

Intracorporeal Anastomosis and ERAS Program: The Winning Combination of Optimized Postoperative Outcomes After Laparoscopic Right Colectomy

Meillat,

Du Castel,

Aubert

et al. 2023

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Background: Laparoscopic technique and the enhanced recovery after surgery (ERAS) protocol have become the standard of care in patients undergoing right colon cancer surgery, reducing hospital stay and postoperative morbidity. However, the optimal anastomosis technique [intracorporeal anastomosis (ICA) or extracorporeal anastomosis (ECA)] remains debated. This study aimed to determine the optimal perioperative approach (ICA vs. ECA combined with the ERAS program vs. standard care) for patients undergoing laparoscopic right colectomy for cancer. Materials and Methods: This single-center, retrospective study evaluated all consecutive patients who underwent laparoscopic right hemicolectomy for cancer between January 2012 and June 2021. Patient data were analyzed in 4 treatment groups according to the type of anastomosis and the care protocol. The primary endpoint was total postoperative hospital stay (THS). The secondary endpoints were recovery time and overall morbidity rate. Results: The baseline characteristics of the 373 included patients were comparable between the 4 groups. THS was significantly shorter in the ICA/ERAS group than in the ECA/standard and ICA/standard groups (P<0.01), but there was no significant difference between the ICA/ERAS and ECA/ERAS groups (5.7 vs. 6.4 d; P=0.17). Recovery time was significantly shorter in the ICA/ERAS group (P<0.01). The overall morbidity rate, including anastomotic morbidity, was comparable among the 4 groups. Regression analysis showed that ICA and the ERAS program were both predictive factors to reduce the THS and recovery time. Conclusions: ICA combined with the ERAS program achieves the best outcomes and thus seems to be the optimal approach for the management of patients undergoing laparoscopic right colectomy for cancer.

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Section: Discussionmentioning

confidence: 99%

Intracorporeal Anastomosis and ERAS Program: The Winning Combination of Optimized Postoperative Outcomes After Laparoscopic Right Colectomy

Meillat,

Du Castel,

Aubert

et al. 2023

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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show abstract

“…The use of ERAS for laparoscopic colorectal cancer resection has become a popular topic recently [5][6][7]. Previous studies [4,[8][9][10][11] have shown that many factors were associated with PLOS after abdominal surgery, including age, smoking status, American Society of Anesthesiologists (ASA) physical status, preexisting medical conditions, surgical approach, length of operation, surgical team's expertise, blood loss, blood transfusion, surgical complications, early postoperative mobilization, and postoperative nutritional status. However, the factors that in uence prolonged hospitalization after laparoscopic colorectal cancer resection remain unclear.…”

Section: Introductionmentioning

confidence: 99%

Factors associated with prolonged postoperative length of hospital stay after laparoscopic colorectal cancer resection: a secondary analysis of a randomized controlled trial

Li¹,

Luo²,

Zhang³

et al. 2022

Preprint

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Background: The postoperative length of hospital stay (PLOS) is an important indicator of surgical quality. We identified perioperative factors that affect prolonged PLOS (PPLOS) after laparoscopic colorectal cancer resection, which is the preferred surgical approach for colorectal cancer (the third most common cancer).Methods: This study was a secondary analysis of a randomized trial (PROtective Ventilation using Open Lung approach Or Not) that included 280 patients who underwent laparoscopic colorectal cancer resection. The primary outcome was PPLOS, defined as a PLOS that was longer than the median PLOS. Perioperative factors, including baseline characteristics, anesthesia, and surgical variables, were included in the univariate and multivariate analyses to identify factors influencing PPLOS.Results: The median PLOS was 10 days, and 117 patients had PPLOS. We identified six influencing factors for PPLOS: preoperative pulse oxygen saturation <96% (odds ratio [OR], 3.09 [95% confidence interval [CI], 1.38–6.92]; P = 0.006), tumor metastasis (OR, 0.34 [95% CI, 0.13–0.91]; P = 0.031), Mile’s operation and left hemicolectomy (OR, 4.51 [95% CI, 1.67–12.18]; P = 0.003), perioperative surgical events (OR, 2.44 [95% CI, 1.25–4.76]; P = 0.009), postoperative albumin infusion (OR, 2.19 [95% CI, 1.14–4.19]; P = 0.018), and postoperative early ambulation (OR, 0.35 [95% CI, 0.18–0.68]; P = 0.002). Further stratified analysis also showed that postoperative albumin infusion might be a risk factor for PPLOS, even in patients with a preoperative albumin level <40 g/L (OR, 2.29 [95% CI, 0.98–5.34]; P = 0.056) or duration of surgery ≥3 hours (OR, 2.52 [95% CI, 1.08–5.87]; P = 0.032).Conclusions: A low pulse oximetry reading, complex surgical approach, perioperative surgical events, and postoperative albumin infusion may be predictors of PPLOS after laparoscopic colorectal cancer resection, whereas tumor metastasis and postoperative early ambulation might be protective factors. The association between postoperative albumin infusion (a modifiable factor) and PLOS or clinical outcomes warrants further investigation.

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“…The use of ERAS for laparoscopic colorectal cancer resection has become a popular topic recently [5][6][7]. Previous studies [4,[8][9][10][11][12] have shown that numerous factors were associated with PLOS after abdominal surgery, including age, smoking status, American Society of Anesthesiologists (ASA) physical status, preexisting medical conditions, surgical approach, duration of surgery, intraoperative lung-protective ventilation, surgical team's expertise, blood loss, blood transfusion, surgical complications, early postoperative mobilization, and postoperative nutritional status. However, factors that influence prolonged hospitalization after laparoscopic colorectal cancer resection remain unclear.…”

Section: Introductionmentioning

confidence: 99%

Factors associated with prolonged postoperative length of hospital stay after laparoscopic colorectal cancer resection: a secondary analysis of a randomized controlled trial

Luo

Zhang

et al. 2022

BMC Surg

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Background The postoperative length of hospital stay (PLOS) is an important indicator of surgical quality. We identified perioperative factors that affect prolonged PLOS (PPLOS) after laparoscopic colorectal cancer resection, which is the preferred surgical approach for colorectal cancer, the third most common cancer. Methods This study was a secondary analysis of a randomized trial (clinicaltrials.gov ID: NCT03160144) that included 280 patients who underwent laparoscopic colorectal cancer resection. The primary outcome was a PPLOS, defined as a PLOS that was longer than the median PLOS. Baseline, anesthetic, surgical, and postoperative management factors were included in the univariate and multivariate analyses to identify factors influencing PPLOS. Results The median PLOS was 10 days, and 117 patients had a PPLOS. We identified six influencing factors for PPLOS: preoperative pulse oxygen saturation < 96% (odds ratio [OR], 3.09 [95% confidence interval (CI) 1.38–6.92]; P = 0.006), distant tumor metastasis (OR, 0.34 [95% CI 0.13–0.91]; P = 0.031), the Miles procedure or left hemicolectomy (OR, 4.51 [95% CI 1.67–12.18]; P = 0.003), perioperative surgical events (OR, 2.44 [95% CI 1.25–4.76]; P = 0.009), postoperative albumin infusion (OR, 2.19 [95% CI 1.14–4.19]; P = 0.018), and postoperative early ambulation (OR, 0.35 [95% CI 0.18–0.68]; P = 0.002). Further stratified analysis showed that postoperative albumin infusion might be a risk factor for PPLOS, even in patients with a preoperative albumin level < 40 g/L (OR, 2.29 [95% CI 0.98–5.34]; P = 0.056) or duration of surgery ≥ 3 h (OR, 2.52 [95% CI 1.08–5.87]; P = 0.032). Conclusions A low preoperative pulse oximetry reading, complex surgical procedures, perioperative surgical events, and postoperative albumin infusion may be risk factors for PPLOS after laparoscopic colorectal cancer resection, whereas distant tumor metastasis and postoperative early ambulation might be protective factors. The association between postoperative albumin infusion, a modifiable factor, and PLOS or clinical outcomes warrants further investigation.

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Role for colorectal teams to support non-colorectal teams to improve clinical outcomes and adherence to ERAS guidelines for segmental colectomy: a cohort study

Cited by 7 publications

References 22 publications

Intracorporeal Anastomosis and ERAS Program: The Winning Combination of Optimized Postoperative Outcomes After Laparoscopic Right Colectomy

Intracorporeal Anastomosis and ERAS Program: The Winning Combination of Optimized Postoperative Outcomes After Laparoscopic Right Colectomy

Factors associated with prolonged postoperative length of hospital stay after laparoscopic colorectal cancer resection: a secondary analysis of a randomized controlled trial

Factors associated with prolonged postoperative length of hospital stay after laparoscopic colorectal cancer resection: a secondary analysis of a randomized controlled trial

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