The Humoral Response After Laparoscopic Versus Open Colorectal Surgery: A Meta-Analysis

Sammour, Tarik; Kahokehr, Arman; Chan, S. Y. E.; Booth, Roger J.; Hill, Andrew G.

doi:10.1016/j.jss.2010.05.046

Cited by 69 publications

(39 citation statements)

References 89 publications

(147 reference statements)

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“…The identification of planned open surgery as a risk factor reflects the physiological insult and inflammatory response associated with open surgery23, which may contribute to AKI and potentiate the adverse systemic sequelae of AKI24. The present findings suggest that, even if pneumoperitoneum during laparoscopic surgery reduces renal perfusion25, this does not necessarily translate to a greater AKI risk.…”

Section: Discussionmentioning

confidence: 67%

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study

Collaborative¹

2018

BJS Open

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BackgroundAcute illness, existing co‐morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery.MethodsThis prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2‐week blocks over a continuous 3‐month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation.ResultsA total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30‐day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30‐day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin‐converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c‐statistic 0·65).DiscussionFollowing major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability.

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Section: Discussionmentioning

confidence: 67%

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study

Collaborative¹

2018

BJS Open

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“…It is well established that this may reduce pain and inflammatory responses especially proinflammatory cytokines (IL-6 etc.) [25]. Minimal invasive surgery on a procedure-specific basis therefore represent a major opportunity to further enhance recovery and reduce morbidity in the future, especially when combined with other aspects of the fast-track methodology (see below).…”

Section: Surgical Stressmentioning

confidence: 99%

Fast-track surgery—an update on physiological care principles to enhance recovery

Kehlet

2011

Langenbecks Arch Surg

156

109

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“…This has been shown to reduce morbidity and length of stay (LOS) for both open and laparoscopic colorectal [1,3,4,5,6,7,8], liver [9,10,11,12] and oesophagogastric [13,14,15,16,17] surgery.…”

Section: Introductionmentioning

confidence: 99%

Adherence to Enhanced Recovery after Surgery Protocols across a High-Volume Gastrointestinal Surgical Service

Hammond

Humphries²,

Simson³

et al. 2014

Dig Surg

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Background and Aims: Enhanced recovery after surgery (ERAS) has been shown to improve outcomes for patients following gastrointestinal surgery. Data on protocol adherence and how this impacts on outcome are limited. This study examines how protocol adherence changes over time and determines how this impacts on outcome across a large-volume gastrointestinal surgical service. Materials and Methods: A prospective review of patients eligible for colorectal, liver and oesophagogastric ERAS over two 3-month periods in 2010 and 2011 was performed. End points included: length of stay (LOS), overall protocol adherence, individual modality adherence, reason for pathway deviation and patient outcomes. Results: 172 patients (110 colorectal, 31 liver and 31 oesophagogastric) were evaluated. For each sub-speciality, the introduction of ERAS led to significant reductions in LOS that were sustained for the duration of the study. Adherence was achieved across 60% (colorectal), 75% (liver) and 88% (oesophagogastric) of individual pathway modalities. The major causes of pathway deviation were: post-operative nausea and vomiting (colorectal), pain (liver) and pulmonary complications (oesophagogastric). Conclusions: Large-scale implementation of ERAS at a high-volume centre is feasible and offers many of the benefits demonstrated in controlled trials, but adherence may diminish over time.

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The Humoral Response After Laparoscopic Versus Open Colorectal Surgery: A Meta-Analysis

Cited by 69 publications

References 89 publications

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study

Fast-track surgery—an update on physiological care principles to enhance recovery

Adherence to Enhanced Recovery after Surgery Protocols across a High-Volume Gastrointestinal Surgical Service

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