Colorectal Resection In Patients Research Articles

Clinical Progression of Colorectal Resection in Gynecologic Cancer Patients: Does the Risk of Anastomotic Leakage Increase after Surgery?

This research aimed to examine the clinicopathological results of colorectal resection in patients with advanced gynecological cancers. We retrospectively reviewed the medical records of 104 patients with gynecological cancer who underwent colorectal resection from December 2008 to August 2020 at a single hospital (PNUYH). Using descriptive statistics, variables for risk factors and surgical complications were compared. We eliminated instances with malignancies originating from organs other than the female genitalia, benign gynecological illnesses, primary stoma formation, and any other bowel procedures outside colon resection. The average age of 104 patients was determined to be 62.0years. The most prevalent gynecological cancer was ovarian cancer (85 patients, 81.7%), and the most frequent procedure was low anterior resection (80 patients, 76.9%). There were postoperative problems in 61 patients (58.7%), while there was anastomotic leaking in just 3 patients (2.9%). Among the risk factors, only preoperative albumin was statistically significant (p=0.019). Our findings imply that colorectal resection can be performed safely and effectively on individuals with advanced gynecological cancer.

Surgical Site Infections in Colorectal Resections: What is the Cost?

IntroductionAlthough surgical site infections (SSIs) associated with colectomy are tracked by the National Healthcare Safety Network/Center for Disease Control, untracked codes, mainly related to patients undergoing proctectomy, are not. These untracked codes are performed less often yet they may be at a greater risk of SSI due to their greater complexity. Determining the impact and predictors of SSI are critical in the development of quality improvement initiatives. MethodsFollowing an institutional review board approval, National Surgery Quality Improvement Program, institutional National Surgery Quality Improvement Program, and financial databases were queried for tracked colorectal resections and untracked colorectal resections (UCR). National data were obtained for January 2019-December 2019, and local procedures were identified between January 2013 and December 2019. Data were analyzed for preoperative SSI predictors, operative characteristics, outcomes, and 30-day postdischarge costs (30dPDC). ResultsNationally, 71,705 colorectal resections were identified, and institutionally, 2233 patients were identified. UCR accounted for 7.9% nationally and 11.8% of all colorectal resections institutionally. Tracked colorectal resection patients had a higher incidence of SSI predictors including sepsis, hypoalbuminemia, coagulopathy, hypertension, and American Society of Anesthesiologists class. UCR patients had a higher rate of SSIs [12.9% (P < 0.001), 15.2% (P = 0.064)], readmission, and unplanned return to the operating room. Index hospitalization and 30dPDC were significantly higher in patients experiencing an SSI. ConclusionsSSI was associated with nearly a two-fold increase in index hospitalization costs and six-fold in 30dPDC. These data suggest opportunities to improve hospitalization costs and outcomes for patients undergoing UCR through protocols for SSI reduction and preventing readmissions.

Warmed and humidified insufflation to prevent perioperative hypothermia and improve the quality of recovery in elective laparoscopic colorectal resection patients: a feasibility study for a triple-blind randomized controlled trial.

The use of standard CO2 for insufflation during laparoscopic colorectal surgery may be associated with cooling and drying of the peritoneal cavity, contributing to perioperative hypothermia. The aim of this work was the assess the feasibility of a study to compare insufflation of warmed, humidified CO2 (WHCO2) (using HumiGard, Fisher and Paykel Healthcare) with standard measures and its impact on the quality of recovery of surgical patients. A single-centre, triple-blind, feasibility, randomized controlled trial (RCT) of adults scheduled for planned laparoscopic colorectal surgery. The primary outcome was recruitment. Secondary outcomes included feasibility of blinding, acceptability to patients and suitability of objective measures: patient-reported quality of recovery using a validated questionnaire (QoR-40), patient pain scores and semi-continuous core temperature measurements. Thirty-nine participants were randomized to either the WHCO2 group (n=19) or standard care alone (n=20). Recruitment to the study was successful and acceptable to patients. Blinding of the surgeons, patients and assessors was effective. Response rates to QoR-40 were high but ceiling effects were observed, indicating that the tool was unsuitable in this population. Fewer patients in the WHCO2 group reported postoperative nausea and vomiting (PONV) at days 1 (53% vs. 65%) and 3 (37% vs. 60%). The median hospital length of stay was 5.5days in the standard care group and 4days in the WHCO2 group. A study of WHCO2 for insufflation in laparoscopic colorectal surgery would be highly acceptable to both patients and researchers. Potential reductions in PONV and hospital length of stay in patients treated with WHCO2 merit further investigation. The design of the full-scale RCT will benefit from this feasibility study.

The impact of quality on hospital choice. Which information affects patients\u2019 behavior for colorectal resection or knee replacement?

Quality competition among hospitals, induced by patients freely choosing their hospital in a price regulated market, can only be realized if quality differences between hospitals are transparent, understandable, and thus influence patients’ hospital choice. We use data from ~145,000 German patients and ~ 900 hospitals for colorectal resections and knee replacements to investigate whether patients value quality and specialization when choosing their hospital. Using a random utility choice model, we estimate patients’ marginal utilities, willingness to travel and change in hospital demand for quality improvements. Patients respond to service quality and specialization and thus, quality competition seems to be present. Colorectal resection patients are willing to travel longer for more specialized hospitals (+9% for procedure volume, +9% for certification). Knee replacement patients travel longer for hospitals with better service quality (+6%) and higher procedure volume (+12%). However, clinical quality indicators, often difficult to access and interpret, barely play a role in patients’ hospital choice. Furthermore, we find that competition on quality for colorectal resection is rather local, whereas for knee replacement we observe regional competition patterns.

Do patients value similar hospital characteristics and quality metrics for different treatments?

Abstract Quality competition among hospitals, induced by patients freely choosing their hospital in a price regulated market, can only be realized if quality differences between hospitals are transparent, understandable, and thus influence patients' hospital choice. We use data from ∼145,000 German patients and ∼900 hospitals for colorectal resections and knee replacements to investigate whether patients value quality and specialization when choosing their hospital. Using a random utility choice model, we estimate patients' marginal utilities, willingness to travel and change in hospital demand for quality improvements. Patients respond to service quality and specialization and thus, quality competition seems to work. Colorectal resection patients are willing to travel longer for more specialized hospitals (+9% for procedure volume, +9% for certification). Knee replacement patients travel longer for hospitals with better service quality (+6%) and higher procedure volume (+12%). However, clinical quality indicators, often difficult to access and interpret, barely play a role in patients' hospital choice. Furthermore, we find that competition on quality for colorectal resection is rather local, whereas for knee replacement we observe regional competition patterns. Consequently, future quality transparency initiatives need to entail the development and publication of understandable outcome quality indicators (e.g. patient reported outcome measures). Moreover, clinical quality indicators need to be explained and presented more intuitively. Key messages Quality competition among hospitals is beneficial for all participants in the health care system. Our paper reveals the quality information that is decisive in the patient’s decision making process. Accessibility and comprehensibility of quality information plays a large role in its impact on patient hospital choice. Thus, policy makers need to raise quality transparency and patient emancipation.

4182 Use of Machine Learning for Surgical Outcomes Research: what are the clinical implications?

OBJECTIVES/GOALS: Multivariate regression is used for surgical outcomes analyses; but does not allow for evaluation of all variables. Machine learning could be the perfect alternative to address this issue. Our aim was to evaluate whether machine learning is a feasible alternative to evaluate surgical outcomes. METHODS/STUDY POPULATION: H-CUP National Inpatient Sample database was queried for adult patients with colorectal cancer who underwent colorectal resection, while the NSQIP database was queried for adult patients with rectal cancer who underwent proctectomy. A multivariate regression analysis was performed to assess risk factors associated with 30-day complications following those procedures. Subsequently, machine learning techniques of under-sampling and oversampling were applied to the same datasets for the evaluation of risk factors for the same outcome. These techniques were used to achieve a larger population sample size and to detect statistical significance. Results between the two methodologies were compared. RESULTS/ANTICIPATED RESULTS: Multivariate regression revealed that open approach, gender, race, geographic location, number of comorbidities, and type of insurance was associated with increased 30-day mortality in colorectal resection patients. Conversely, the use of machine learning revealed that preoperative weight loss, preexistent chest heart failure, renal failure or perivascular disease were strongly associated with 30-day mortality. For proctectomy patients, multivariate regression found no association between surgical approach and 30-day mortality. However, machine learning revealed gender, hypertension, and reoperation to be strongly associated with 30-day mortality. DISCUSSION/SIGNIFICANCE OF IMPACT: Machine learning enabled multiple combinations that were not possible to examine in a conventional multivariate regression analysis. Machine learning compared to traditional multivariate regression produced significantly different outcomes, highlighting the need for in depth of these methodologies.

P184 Temporary defunctioning ileostomy in therapy refractory Crohn’s colitis: A viable alternative to immediate colorectal resection?

Abstract Background The faecal stream is one of many factors influencing the pathogenesis of Crohn’s disease. Previous research demonstrated some Crohn’s patients benefit from temporary faecal diversion. This study aims to determine the role of temporary faecal diversion by means of a defunctioning ileostomy in treating patients with therapy refractory Crohn’s colitis. Methods Data were retrieved by retrospectively assessing patient records. All patients receiving a temporary ileostomy for therapy refractory Crohn’s colitis from three Dutch hospitals between 2010 and 2018 were included. Patients with previous colorectal resection or malignancy were excluded. Stoma reversal, permanent stoma and extension of colorectal resection at follow-up were determined as primary outcomes. Results Thirty-six patients received a temporary defunctioning ileostomy for therapy refractory Crohn’s colitis. Stoma reversal was attempted in 20 (56%) patients after a mean period of 1 year of which nine underwent additional resection during stoma reversal. After a mean follow-up of 4.2 years, resection was performed in 29 (81%) patients of which 14 (39%) had reduced resection in comparison with the necessary resection at the time of faecal diversion. Among the 14 (39%) patients with restored continuity, three patients remained with full preservation of the colon. Moreover, the presence of proctitis was associated with low stoma reversal rates (p = .007). Conclusion Temporary faecal diversion is associated with reduced resection and reduced risk of permanent ileostomy; therefore, it may be a decent alternative for immediate colorectal resection for patients with isolated Crohn’s colitis. Unfortunately, temporary defunctioning ileostomy is not a viable alternative for resection in Crohn’s patients suffering from proctitis.

Modified frailty index predicts high-risk patients for readmission after colorectal surgery for cancer

BackgroundModified frailty index (mFI) has been proposed as a reliable tool in predicting postoperative outcomes after surgery. This study aims to evaluate whether mFI could be utilized to predict readmissions after colorectal resection for patients with cancer by using nationwide cohort. MethodsPatients undergoing elective abdominal colorectal resection for colorectal cancer were reviewed from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) procedure-targeted database (2010–2012). A previously described mFI was calculated. Demographics, comorbidities, and 30-day postoperative complications were compared between patients who were readmitted or not after colorectal surgery. ResultsA total of 7337 patients were identified with a mean age of 65.8(±13.6) years. Eight hundred seventy-one (11.8%) patients were readmitted at least once within 30 days. Age, gender, BMI, and other comorbidities were comparable between the groups. O approach, current smoking, mFI(>3/11), disseminating cancer, bleeding disorder and longer operative time were found to independently associated with readmission. ConclusionsAn 11-point modified frailty index as measured in NSQIP correlates with readmissions after colorectal resection in patients with colon and rectal cancer.

Visceral obesity is a preoperative risk factor for postoperative ileus after surgery for colorectal cancer: Single-institution retrospective analysis.

AimVisceral obesity (VO) reportedly has a stronger association with complications after colorectal surgery than does body mass index. Here, we retrospectively assessed VO as a risk factor for postoperative ileus (POI) after colorectal resection in patients with colorectal cancer.MethodsThis study included 417 consecutive patients with colorectal cancer who underwent elective surgery at our institute from January 2010 to December 2012. Visceral fat area (VFA) was calculated by image analysis software. VO was defined as VFA ≥100 cm2. We assessed 49 factors, including VO, comorbidities, surgical procedure, and postoperative complications. Data were analyzed using a propensity score‐matching strategy.ResultsPostoperative ileus occurred in 18 patients (4.3%) from the entire cohort, and in 14 (5.5%) of the 256 matched patients. Multivariate analysis (n = 417 patients) showed that significant risk factors for POI included VO (OR 7.9, 95% confidence interval [CI] 1.9‐32.1, P = .004), open surgery (OR 6.4, 95% CI 1.6‐26.7, P = .010), and pelvic/intra‐abdominal abscess (OR 11.0, 95% CI 1.1‐110.2, P = .041). Propensity score matching showed two independent risk factors in the multivariate analysis: VO (OR 6.2, 95% CI 1.3‐30.4, P = .025) and open surgery (OR 9.1, 95% CI 2.0‐40.5, P = .004).ConclusionVisceral obesity may be an independent risk factor for POI in patients with colorectal cancer.

Protein intakes are associated with reduced length of stay: a comparison between Enhanced Recovery After Surgery (ERAS) and conventional care after electivecolorectal surgery

Background: Protein can modulate the surgical stress response and postoperative catabolism. Enhanced Recovery After Surgery (ERAS) protocols are evidence-based care bundles that reduce morbidity.Objective: In this study, we compared protein adequacy as well as energy intakes, gut function, clinical outcomes, and how well nutritional variables predict length of hospital stay (LOS) in patients receiving ERAS protocols and conventional care.Design: We conducted a prospective cohort study in adult elective colorectal resection patients after conventional (n = 46) and ERAS (n = 69) care. Data collected included preoperative Malnutrition Screening Tool (MST) score, 3-d food records, postoperative nausea, LOS, and complications. Multivariable regression analysis assessed whether low protein intakes and the MST score were predictive of LOS.Results: Total protein intakes were significantly higher in the ERAS group due to the inclusion of oral nutrition supplements (conventional group: 0.33 g · kg-1 · d-1; ERAS group: 0.54 g · kg-1 · d-1; P < 0.02). This group difference in protein intake was maintained in a multivariable model that controlled for differences between baseline and surgical variables (P = 0.001). Oral food intake did not differ between the 2 groups. The ERAS group had shorter LOS (P = 0.049) and fewer total infectious complications (P = 0.01). Nausea was a predictor of protein intake. Nutrition variables were independent predictors of earlier discharge after potential confounders were controlled for. Each unit increase in preoperative MST score predicted longer LOSs of 2.5 d (95% CI: 1.5, 3.5 d; P < 0.001), and the consumption of ≥60% of protein requirements during the first 3 d of hospitalization was associated with a shorter LOS of 4.4 d (95% CI: -6.8, -2.0 d; P < 0.001).Conclusions: ERAS patients consumed more protein due to the inclusion of oral nutrition supplements. However, total protein intake remained inadequate to meet recommendations. Consumption of ≥60% protein needs after surgery and MST scores were independent predictors of LOS. This trial was registered at clinicaltrials.gov as NCT02940665.

Anastomotic leak after colorectal resection: A population-based study of risk factors and hospital variation

Anastomotic leak is a major source of morbidity in colorectal operations and has become an area of interest in performance metrics. It is unclear whether anastomotic leak is associated primarily with surgeons' technical performance or explained better by patient characteristics and institutional factors. We sought to establish if anastomotic leak could serve as a valid quality metric in colorectal operations by evaluating provider variation after adjusting for patient factors. We performed a retrospective cohort study of colorectal resection patients in the Michigan Surgical Quality Collaborative. Clinically relevant patient and operative factors were tested for association with anastomotic leak. Hierarchical logistic regression was used to derive risk-adjusted rates of anastomotic leak. Of 9,192 colorectal resections, 244 (2.7%) had a documented anastomotic leak. The incidence of anastomotic leak was 3.0% for patients with pelvic anastomoses and 2.5% for those with intra-abdominal anastomoses. Multivariable analysis showed that a greater operative duration, male sex, body mass index >30kg/m2, tobacco use, chronic immunosuppressive medications, thrombocytosis (platelet count >400×109/L), and urgent/emergency operations were independently associated with anastomotic leak (C-statistic=0.75). After accounting for patient and procedural risk factors, 5 hospitals had a significantly greater incidence of postoperative anastomotic leak. This population-based study shows that risk factors for anastomotic leak include male sex, obesity, tobacco use, immunosuppression, thrombocytosis, greater operative duration, and urgent/emergency operation; models including these factors predict most of the variation in anastomotic leak rates. This study suggests that anastomotic leak can serve as a valid metric that can identify opportunities for quality improvement.

Safety of Laparoscopic Colorectal Resection in Patients With Severe Comorbidities.

We aimed to assess the safety of laparoscopic colorectal resection in patients with severe comorbidities. High operative risk was defined as an American Society of Anesthesiologists (ASA) class 3 score. Outcomes in 34 patients with an ASA score of 3 undergoing laparoscopic surgery (LAP3) were compared with 172 laparoscopic surgery patients with an ASA score ≤2 (LAP2) and 32 laparotomy patients with an ASA score of 3 (OP3). The postoperative complication rate in LAP3 was similar to that seen in LAP2 and significantly lower than that seen in OP3 (LAP2, 4.0%; LAP3, 5.9%; OP3, 31.2%). The incidence of postoperative hemorrhage, infection, ileus, and anastomotic leakage was similar between LAP3 and LAP2 and between LAP3 and OP3. However, the systemic complication rate in LAP3 was similar to that seen in LAP2 and significantly lower than that seen in OP3. Laparoscopic colorectal resection can be performed safely in patients with severe comorbidities.

Laparoscopic Colorectal Resection in Patients with Sarcopenia: A Retrospective Case-Control Study.

Previous study has reported that sarcopenia increases the risk of postoperative complications following open colorectal resection. The aim of this retrospective case-control study was to evaluate the feasibility of laparoscopic colorectal resection in patients with sarcopenia. We retrospectively analyzed 60 patients who underwent laparoscopic colorectal resection for primary colorectal cancer between April 2012 and March 2015 at our institution. The patients were divided into two groups: sarcopenia group (normalized total psoas muscle area in males, <538 mm/m(2); in females, <346 mm/m(2); n = 20) and nonsarcopenia group (n = 40). No significant differences in the overall rate of postoperative complications (20% vs. 20%) or major postoperative complications of Clavien-Dindo Grade III or more (5% vs. 5%) were observed between the patients in the sarcopenia and nonsarcopenia groups. Sarcopenia was not found to be a predictor of postoperative complications by univariate analysis. Laparoscopic colorectal resection was feasible in patients with sarcopenia.

Restoration of normal colonic motor patterns and meal responses after distal colorectal resection.

Colorectal resections alter colonic motility, including disruption of control by neural or bioelectrical cell networks. The long-term impact of surgical resections and anastomoses on colonic motor patterns has, however, never been assessed accurately. Fibreoptic high-resolution colonic manometry was employed to define motility in patients who had undergone distal colorectal resection. Recruited patients had undergone distal colorectal resections more than 12 months previously, and had normal bowel function. Manometry was performed in the distal colon (36 sensors; 1-cm intervals), with 2-h recordings taken before and after a meal, with comparison to controls. Analysis quantified all propagating events and frequencies (cyclical, short single, and long single motor patterns), including across anastomoses. Fifteen patients and 12 controls were recruited into the study. Coordinated propagating events directly traversed the healed anastomoses in nine of 12 patients with available data, including antegrade and retrograde cyclical, short single and long single patterns. Dominant frequencies in the distal colon were similar in patients and controls (2-3 cycles/min) (antegrade P = 0·482; retrograde P = 0·178). Compared with values before the meal, the mean(s.d.) number of dominant cyclical retrograde motor patterns increased in patients after the meal (2·1(2·7) versus 32·6(31·8) in 2 h respectively; P < 0·001), similar to controls (P = 0·178), although the extent of propagation was 41 per cent shorter in patients, by a mean of 3·4 cm (P = 0·003). Short and long single propagating motor patterns were comparable between groups in terms of frequency, velocity, extent and amplitude. Motility patterns and meal responses are restored after distal colorectal resection in patients with normal bowel function. Coordinated propagation across healed anastomoses may indicate regeneration of underlying cellular networks.

Effect of postoperative use of diclofenac on pharyngocutaneous fistula development after primary total laryngopharyngectomy: Results of a single-center retrospective study.

Primary total laryngopharyngectomy is the treatment of choice in many cases of locally advanced hypopharyngeal and laryngeal cancer. Development of pharyngocutaneous fistulae is the most common postoperative complication. A recent Danish study showed significantly increased rates of anastomosal leakage after colorectal resection in patients receiving diclofenac treatment. We retrospectively analyzed 67 patients after primary total laryngopharyngectomy to determine whether diclofenac increases the risk for development of pharyngocutaneous fistula analogously to leakage in the colorectal area. The fistula rate in the total study population (n = 67) was 19.4%. In the group receiving diclofenac postoperatively (n = 31), the fistula rate was 25.8%. In the patient group not receiving diclofenac (n = 36), the fistula rate was 13.9% (p = .219). Our results suggest that cyclooxygenase-2 (COX-2) selective nonsteroidal anti-inflammatory drugs (NSAIDs) should be administered with caution after laryngopharyngectomy. Additional studies on larger cohorts are required to further evaluate our findings. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1515-E1520, 2016.

Laparoscopic Colorectal Resection in Patients With Previous Abdominal and Colonic Surgery

Background: Previous abdominal surgery and its related adhesions are usually a relative contraindication for laparoscopic surgery or reason for conversion. Objectives: This study aim to identify patients with previous abdominal surgery and compare the clinical outcomes in patients with and without previous abdominal surgery. Patients and Methods: Data was collected prospectively from September 2006 to Dec 2010 of all laparoscopic colorectal resections done for both benign and malignant diseases. Results: Out of 718 patients 476 had no previous abdominal surgery (Group A), whilst 190 patients had previous abdominal surgery not involving colonic surgery (Group B), and 52 had previous bowel surgery (Group C). The conversion rate was 4% for all groups, the readmission rate was 11.8% for Group A, 12.6% for Group B and 9.6% for Group C, the median length of stay was 4 days for Groups A and B and 5 days for Group C. There was no statistically significant difference between groups for any of the above measures. However, there was a statistically significant difference in the length of operative time between groups. Patients in Group A and Group B requiring a median of 180 minutes, whilst Group C required a median of 210 minutes of operative time. (P = 0.026 and 0.002, respectively). Conclusions: Previous abdominal surgery, including previous colonic surgery, confers no added risk of conversion to an open operation, morbidity or mortality for patients undergoing laparoscopic colorectal surgery. The operative time however is longer (30 minutes) for patients with previous colonic surgery.

755 Complications After Hospital Discharge Leading to Readmission in Colorectal Resection Patients: A Review of the ACS-NSQIP Database

755 Complications After Hospital Discharge Leading to Readmission in Colorectal Resection Patients: A Review of the ACS-NSQIP Database

Short-Term Outcomes of Laparoscopic Colorectal Resection in Patients with Previous Abdominal Operations

Laparoscopic colorectal procedures (LCPs) are technically demanding; previous abdominal surgery may add to their complexity. The aim of our study was to assess the effect of previous abdominal surgery (PAS) on laparoscopic colorectal surgery. A prospective database was used to record LCPs between 2001 and 2011. Patients were divided into two groups: Group A consisted of patients with no PAS, and Group B of patients with PAS. Data collected included prior abdominal operations, type of LCP, operative time, and conversions. Operative mortality, morbidity, and ward stay in both groups were compared. Statistical analysis was performed using Fisher's exact test and Student's t test. One hundred eighty-one patients underwent LCPs: 113 in Group A and 68 in Group B. Mean operative time in Group A and Group B was 216.5 (range, 60-520) minutes and 233.2 (range, 114-544) minutes, respectively (P = .17). In the first 90 cases, the mean operative time was significantly lower for Group A (203 minutes) than in Group B (236.5 minute) (P = .02). The rate of conversion was 10.6% (12/113) in Group A and 13.2% (9/68) in Group B (P = .6). Two patients in Group B had small bowel enterotomies (1 missed on the operating table) compared with none in Group A. Morbidities were comparable in both groups. Median hospital stay was 4.5 and 4 days in Groups A and B, respectively (P=.9). There were 3 deaths in Group A (2 due to medical causes and 1 surgical-related). One surgical-related death (missed enterotomy) occurred in Group B. Short-term outcomes of laparoscopic colorectal surgery in patients with PAS are acceptable. There is no significant difference in conversion rate, hospital stay, morbidity, or mortality. The difference in the operative time is significant only in the early part of the learning curve. Meticulous adhesiolysis to avoid and recognize enterotomy is of paramount importance.

How often do patients return to the operating room after colorectal resections?

We sought to identify the rate of re-operation after an index colorectal surgical procedure and potential contributing risk factors. This is a retrospective cohort study from the American College of Surgeons National Surgical Quality Improvement Program. We identified all patients who either returned or did not return to the operating room after any colorectal resection from January 2005 to December 2008. From a total cohort of 635, 265 patients included in the National Surgical Quality Improvement Program over the 4-year study period, we identified 54, 237 patients who underwent colorectal operations. A return to the operating room was coded in 5.4 ± 0.1% of non colorectal resection patients and 7.6 ± 0.2% of colorectal resection patients (P < 0.001). The multivariate model identified patients with postoperative diagnostic codes for abdominal cavity hernia or colostomy complication as having the highest odds of return to the operating room within 30 days. Patients returning to the operating room had longer length of stay and higher overall mortality compared with those patients who did not return to the operating room. Return to the operating room is a relatively common occurrence after colorectal resections, with an associated high rate of mortality. Given the association between return to the operating room and adverse patient outcomes, emphasis should be placed on determining strategies to reduce the need for return to the operating room.

Altered plasma albumin characteristics and lymphocyte populations in gastrointestinal cancer patients: Detection using modified fluorescence responses

The fluorescent probe ABM (an amino derivative of benzanthrone) developed at Riga Technical University (Riga, Latvia) was used to characterize the blood plasma albumin of cancer patients (46 gastrointestinal cancer patients—30 with colorectal cancer in Stages II–IV and 16 with gastric cancer in Stage III) and of healthy controls. The fluorescence intensity of ABM in the blood plasma decreased from the control mean value and showed specific differences in the patients before (i.e., 24 hr pre-) and after (i.e., 10 day post-) they underwent a medically indicated surgical treatment, i.e., a gastric resection or gastroectomy for patients in the gastric cancer group or a colorectal resection for patients in the colorectum cancer group. The significant decrease in the ABM fluorescence in the blood plasma could be explained, in part, by a diminished binding capacity of the albumin of these patients. In fact, before surgery, there was a strong reduction in binding constant (Ka) value for the probe observed in the plasma samples from these patients as compared with the value obtained with the plasma of the healthy donors. The lymphocyte distribution among the subsets also differed between the groups. Surgical treatment affected several immunological parameters and appeared to elevate the functional status of lymphocytes. Interestingly, the ABM fluorescence in the blood plasma was also seen to correlate with select immunological parameters (CD4+:CD8+ ratios, levels of CD38+ cells, etc.) both before and after the patients’ operations. The results in the present study suggest that measures of ABM fluorescence intensity values for plasma albumin and/or especially of lymphocytes (as reflections of their functional activity) might be a useful tool in the evaluation of the immune status of gastrointestinal cancer patients.