Elective Colorectal Surgery Research Articles

Incidence of surgical infection in cefazolin 3 g versus 2 g for colorectal surgery in obese patients.

To compare the incidence of surgical site infection (SSI) between cefazolin 3 g and 2 g surgical prophylaxis in patients weighing ≥120 kg that undergo elective colorectal surgery. A multicenter, retrospective cohort study was performed utilizing a validated database of elective colorectal surgeries in Michigan acute care hospitals. Adults weighing ≥120 kg who received cefazolin and metronidazole for surgical prophylaxis between 7/2012 and 6/2021 were included. The primary outcome was SSI, which was defined as an infection diagnosed within 30 days following the principal operative procedure. Multivariable logistic regression was used to identify variables associated with SSI; the exposure of interest was cefazolin 3 g surgical prophylaxis. A total of 581 patients were included; of these, 367 (63.1%) received cefazolin 3 g, while 214 (36.8%) received 2 g. Patients who received cefazolin 3 g had less optimal antibiotic timing (324 [88.3%] vs 200 [93.5%]; P = .043) and a higher receipt of at least 1 of the prophylaxis antibiotics after incision (22 [6%] vs 5 [2.3%]; P = .043). There was no SSI difference between cefazolin 3 g and 2 g cohorts (23 [6.3%] vs 16 [7.5%], P = .574). When accounting for age, smoking status, and surgical duration, cefazolin 3 g was not associated with a reduction in SSI (adjOR, .64; 95%CI, .32-1.29). Surgical prophylaxis with cefazolin 3 g, in combination with metronidazole, was not associated with decreased SSI compared to 2 g dosing in obese patients undergoing elective colorectal surgery.

Enhanced Recovery After Surgery Protocol Compliance and Early Outcomes for Elective Colorectal Procedures by Race/Ethnicity and Socioeconomic Status.

To explore the association of socioeconomic status (SES) and race/ethnicity with perioperative metrics within the Enhanced Recovery After Surgery (ERAS) framework to identify gaps for equity-informed improvements. Although ERAS pathways improve perioperative outcomes through standardized care, disparities in protocol adherence and postoperative outcomes persist, particularly for vulnerable populations. We conducted a retrospective cohort study using a single-institution database of elective colorectal surgeries (2018-2021). Patients were categorized and assessed by SES and race/ethnicity. Overall, 1,519 patients were analyzed: 180 had low SES (11.8%) and 1,339 - high SES (88.2%). Low SES patients had lower rates of bowel preparation completion, use of the electronic patient portal, and carbohydrate loading pre-surgery. Low SES was associated with a longer median length of stay (LOS) (4 vs. 3 days, P<0.001). Multivariate logistic regression analysis showed low SES was linked to higher odds of infectious (OR 2.46, 95%CI: 1.31-4.63) and all in-hospital complications (OR 1.50, 95%CI: 1.06-2.12). Among racial/ethnic cohorts, Black patients had lower rates of documented preoperative patient education, longer median LOS (5 vs. 3-4 days, P=0.002), and increased odds of respiratory complications (OR 4.11, 95%CI: 1.56-10.85). Low SES was linked to lower compliance with important process measures, higher infectious and all in-hospital complication rates, and longer LOS. Despite high rates of protocol compliance, Black race/ethnicity showed an association with increased odds of respiratory complications and extended LOS. Adjustments to perioperative protocols could address such disparities, helping to improve postoperative outcomes of colorectal surgeries.

Reduction of surgical site infection rates in elective colorectal surgery by means of a nationwide interventional surveillance programme. A cohort study

Reduction of surgical site infection rates in elective colorectal surgery by means of a nationwide interventional surveillance programme. A cohort study

Has the Use of Enhanced Recovery Protocols in Colorectal Surgery Increased Postoperative Bleeding Complications?

Enhanced recovery after surgery (ERAS) protocols are multimodal perioperative care pathways shown to improve postoperative complications and decrease length of stay after surgery. A critical component of an enhanced recovery after surgery protocol is the use of multimodal non-opiate analgesia using non-steroidal anti-inflammatory drugs and COX-2 inhibitors. To compare the incidence of postoperative gastrointestinal bleeding between patients treated with and without an enhanced recovery after surgery protocol. Retrospective review of a prospective maintained colorectal registry. Large colorectal referral center. Preoperative elective colorectal surgery requiring an anastomosis. Standardized enhanced recovery after surgery protocol included celecoxib and ketorolac. Postoperative outcomes included bleeding (+/- sequelae), reduction in hematocrit after operation, intervention for bleeding (transfusion, endoscopy or surgery), length of stay and hospital readmission. The enhanced recovery after surgery group (n = 630) and non-enhanced recovery after surgery groups (n = 739) were comparable in baseline clinical features except for surgical indication, with more inflammatory bowel disease and less malignant disease in the enhanced recovery after surgery group. Minimally invasive surgery was more commonly performed in the enhanced recovery after surgery group. Both bleeding with sequelae (p < 0.0001) and bleeding without sequelae (p = 0.0004) were significantly more common in the enhanced recovery after surgery group compared to the non-enhanced recovery after surgery group. In addition, there was a significantly larger hematocrit decline after operation noted in the enhanced recovery after surgery group (p < 0.0001). Both the need for transfusion and intervention for bleeding however did not significantly differ between patient groups. Factors associated with bleeding were the use of an enhanced recovery after surgery protocol (OR = 2.96; 95% CI, 1.57-5.58; p < 0.001) and performing a small to large bowel anastomosis (OR= 2.68; 95% CI, 1.49-4.81; p < 0.001). Retrospective observational design and inability to determine which component of the enhanced recovery after surgery protocol caused the bleeding. Use of an enhanced recovery after surgery protocol in patients undergoing colorectal surgery with an anastomosis is associated with an increased incidence of bleeding without significant difference in the need for transfusion or intervention. See Video Abstract.

Comparison of early postoperative recovery in patients undergoing elective colorectal surgery before and after ERAS® implementation—a single center three-armed cohort study

PurposeThis study examines the impact of enhanced recovery after surgery (ERAS®) on patient recovery after elective colorectal surgery. The innovative PostopQRS™ tool was used for the analysis of patient recovery.MethodsThis single-center study compares three cohorts: two retrospective cohorts before (A) and after (B) ERAS® implementation and a prospective cohort post-ERAS® implementation (C) using PostopQRS™. The present study was prospectively registered in the German Register of Clinical Trials (DRKS00026903).ResultsA total of 153 patients were included from June 2020 to February 2022. Significant differences were observed in bowel function, oral food intake, opioid use, and PONV (postoperative nausea and vomiting) occurrence. By the day of discharge, 98% in cohorts B and C had bowel movements or stoma output, compared to 66% in cohort A (p < 0.001). Solid food intake on POD1 was higher in cohorts B and C (p = 0.025), while opioid use was lower (p = 0.003 and p < 0.001). Cohort C showed 90% recovery on discharge.ConclusionThis study demonstrates improved early mobility, reduced need for opioids, a higher rate of patients with solid food intake on POD1, and earlier bowel movement as well as excellent recovery following the colorectal ERAS® implementation.

Effects of Enteral Immunonutrition in Laparoscopic versus Open Resections in Colorectal Cancer Surgery: A Meta-analysis of Randomised Controlled Trials

Immunonutrition (IMN) modulates the activity of the immune system. However, the effects of IMN on cancer patients following colorectal surgery is still lacking. We performed a systematic review and meta-analysis to evaluate the outcomes of IMN in patients undergoing laparoscopic versus open colorectal surgery. A systematic search of multiple electronic data sources was conducted in accordance with PRISMA guidelines and included MEDLINE via PubMed, EMBASE, Scopus, and Web of Science. All eligible studies reporting comparative outcomes of immunonutrition in colorectal surgery were included. Subgroup analysis of outcomes of interest was performed and data were analysed using Review Manager (RevMan) Version 5.4.1. Nine randomised controlled trials (RCTs) were identified. The final pooled analysis included 1199 patients (592 IMN group and 592 control group). Of these, 55.3% (655/1184) had open colorectal surgery (OG) and 44.7% (529/1184) underwent laparoscopic colorectal surgery (LG). IMN reduced the risk of wound infection significantly in the OG [risk ratio (RR) 0.48, 95% confidence interval (CI) 0.32 to 0.72; p=0.0005)] and the open and laparoscopic group (OLG) [RR 0.33, 95% CI 0.15 to 0.76; p=0.008]. Moreover, IMN was also associated with a significantly shorter length of hospital stay (MD - 2.37 days, 95% CI-3.39 to -1.36; p<0.0001) in the OG. Other post-operative morbidities (anastomotic leak and ileus) and mortality outcomes in the OG, LG, and OLG were comparable. Pre-operative IMN could reduce the wound infection rate and shorten length of hospital stay in patients following elective colorectal surgery. The benefit of these improved clinical outcomes could be further evaluated with a cost-benefit analysis. IMN should be recommended as nutritional adjunct in the Enhanced Recovery after Surgery (ERAS) pathway following colorectal surgery.

Patient-reported performance status and postoperative complications in elective colorectal cancer surgery

PurposeThe purpose of this study was to evaluate the concordance between patient-reported performance status (prPS) and surgeon-reported performance status (srPS), and to assess the correlation between srPS and prPS and postoperative complications following elective colorectal cancer surgery. Not all patients are deemed suitable for undergoing a surgical procedure. We aimed to assess whether prPS can aid the surgeons’ decision-making prior to surgery.MethodsIn this retrospective study, 524 patients undergoing colorectal cancer surgery were included. prPS were collected via questionnaires, while 30-day postoperative complications were obtained from the Danish Colorectal Cancer Group (DCCG) database. To evaluate the agreement between prPS and srPS, linearly weighted kappa statistics were applied. Rank-biserial correlation analysis was used to calculate the correlation between prPS and srPS with postoperative complications.ResultsIn total, there was an approximate 71% concordance between the assessments. Around 17% of the patients rated themselves with a higher PS status than the surgeons, while 13% of the patients rated themselves with a lower PS. Overall postoperative complications, minor surgical complications, and medical complications were all significantly correlated to both srPS and prPS, while only srPS was correlated with major surgical complications. Neither srPS nor prPS were correlated with overall surgical complications (major and minor collapsed).ConclusionThe agreement between prPS and srPS is poor and in nearly one-third of the cases, disagreement occurs. Overall, both prPS and srPS were correlated to postoperative complications, with srPS demonstrated a slightly higher correlation.

Impact of early oral feeding on postoperative outcomes after elective colorectal surgery: a systematic review and meta-analysis.

This study aimed to evaluate the influence of early oral feeding (EOF), a key component of enhanced recovery after surgery protocols, on postoperative outcomes in patients undergoing elective colorectal surgery. We searched the Medline, Embase, Cochrane Library, and KoreaMed databases to include randomized clinical trials comparing EOF that started on postoperative day 1 and conventional oral feeding that commenced after first flatus. Two authors independently screened the retrieved records and extracted data. The primary outcome was total complications. Data were pooled, and the overall effect size was calculated. We screened 13 studies, and 1,556 patients were included in the analysis. The EOF group exhibited fewer total complications (odds ratio [OR] 0.50; 95% confidence interval [CI] 0.38 to 0.65). Anastomotic leakage was also reduced in the EOF group (OR 0.40; 95% CI 0.19 to 0.83); however, an increased incidence of vomiting (OR 1.58; 95% CI 1.11 to 2.26) as well as a tendency of higher rate of nasogastric tube reinsertion (OR 1.49; 95% CI 0.96 to 2.31) were observed. The EOF group demonstrated a decreased time to flatus (mean difference [MD] -0.87; 95% CI -1.00 to -0.74) and shortened hospital stay (MD -0.76; 95% CI -0.89 to -0.6). No significant difference in mortality was observed between the two groups (OR 0.54; 95% CI 0.15 to 2.01). EOF proved to be a safe and effective practice for patients undergoing elective colorectal surgery. However, the increased incidence of vomiting necessitates careful consideration.

Effects of surgeon specialization on the outcome of emergency colorectal surgery.

Colonic emergencies remain a major life-threatening condition associated with high morbidity and mortality rates. Unlike elective colorectal surgical procedures, a large portion of emergency colorectal surgical procedures are performed by noncolorectal surgeons (NCRS). The impact of specialization on the outcome of emergency colorectal surgery has not yet been well described. The authors aimed to evaluate the impact of surgeon specialization on the outcomes of emergency colorectal surgeries. A retrospective cohort study conducted in a tertiary care center in Riyadh, Saudi Arabia between July 2008 to July 2020. Patients underwent emergency colorectal surgeries and met study inclusion criteria were identified and grouped according to the specialty of the primary surgeon: colorectal surgeons [CRS] or NCRS. Relevant study data was obtained from patient medical files. Bivariate and multivariate regression analyses were used to assess the association between the surgeons' specialty and outcomes. Of 219 included patients, there were 126 men [57.5%] and 93 women [42.4%]. Of all population 128 patients [58%] were operated on by CRS while 91 patients [42%] were operated on by NCRS. Most common procedure performed by CRS was left hemicolectomy [n=45, 67.2%] while the most common procedure performed by NCRS was right hemicolectomy [n=26, 51%]. The most common reason for surgery was malignant pathologies [n=129, 58.9%]. Patients who had their surgeries performed by a CRS had a significant decrease in 30-day mortality [odds ratio [OR] 0.23, 95% CI: 0.065-0.834]. Reoperation also decreased in this group [OR 0.413, 95% CI: 0.179-0.956]. Moreover, both hospital length of stay and ICU length of stay decreased CRS compared with the NCRS [OR 0.636, 95% CI: 0.465-0.869, and OR 0.385, 95% CI: 0.235-0.63, respectively]. Specialization in colorectal surgery has a significant influence on morbidity and mortality after emergency operations. These findings may in improving emergency services and support remodeling the referral system in the institutions.

A causal model for predicting the impact of pharmacotherapy on colorectal surgery outcomes.

Evidence-based principles in enhanced recovery programs (ERPs) demonstrate substantial improvement in patient outcomes. Determining which latent variables predict composite outcomes could refine ERP pharmacotherapy recommendations. Using R, pharmacotherapy data were modeled from an existing dataset of adult elective colorectal surgery patients. Primary composite outcome was absence of surgical site infection, venous thromboembolism, postoperative nausea and vomiting, and other in-hospital postoperative complications (POCs). Secondary composite outcome included no postdischarge POCs, hospital length of stay ≤3days, and no readmission at 7- or 30-days. Variables with greater odds of predicting both positive primary and secondary composite outcomes included prehospital oral iron and oral antibiotic use, postoperative sugammadex and neostigmine use, postoperative morphine milligram equivalents (MME)≤50, and IV fluid stop by postoperative day 2. Preoperative scopolamine patch (OR=0.29 and CI=-0.19-0.77) and perioperative gabapentin (OR=0.46 and CI=0.06-0.83) had lesser odds for both primary and secondary composite outcomes. Ketamine nonanesthetic bolus, ondansetron IV use, and in-hospital enoxaparin use had paradoxical lesser primary but greater odds for secondary composite outcomes. Prehospital oral laxative use (OR=0.61 and CI=0.18-1.04) and postoperative dual IV antibiotics (OR=0.52 and CI=0.10-0.94) had lesser odds for primary, but not secondary, outcome. To improve the odds for positive composite outcomes, oral iron and antibiotics, sugammadex and neostigmine, lower MME, and early IV fluid cessation could be considered essential core items, whereas postoperative dual IV antibiotics and epidural anesthesia might be avoided. Additional research needs to clarify the impacts of in-hospital enoxaparin, ketamine nonanesthetic bolus, and ondansetron use on composite patient outcomes.

Improving Enhanced Recovery after Surgery (ERAS): The Effect of a Patient-Centred Mobile Application and an Activity Tracker on Patient Engagement in Colorectal Surgery.

The Enhanced Recovery After Surgery (ERAS) protocol improved perioperative colorectal care. Although the protocol is firmly implemented across hospital settings, there are benefits to gain by actively involving patients in their recovery. The main objective of this study was to investigate whether compliance with selected items in the ERAS protocol could further improve by using a patient-centred mobile application. This multicentre, randomised controlled trial was conducted between October 2019 and September 2022. Patients aged 18 years or older who underwent elective colorectal surgery, and in possession of a smartphone were included. The intervention group used a mobile application combined with an activity tracker to be guided and supported through the ERAS pathway. The control group received standard care and wore an activity tracker to monitor their daily activities. The primary outcome was overall compliance with selected active elements of the ERAS protocol. In total, 140 participants were randomised to either the intervention (n = 72) or control group (n = 68). The use of the ERAS App demonstrated a significant improvement in overall compliance by 10%, particularly in early solid food intake by 42% and early mobilization by 27%. Postoperative or patient reported outcomes did not differ between groups. The smartphone application 'ERAS App' is able to improve adherence to the active elements of the ERAS protocol for colorectal surgery. This is an important step towards optimizing perioperative care for colorectal surgery patients and enabling patients to optimize being in control of their own recovery. Trial registration: ERAS APPtimize, NTR7314 (https://trialsearch.who.int/Trial2.aspx?TrialID=NL-OMON29410).

“Opioid free colorectal surgery: Outcomes of successful non-opiate colorectal surgery in a rural community teaching hospital”

BackgroundOpiates present challenges due to side effects, including prolonged hospitalization and delayed bowel function. Enhanced Recovery After Surgery (ERAS) protocols advocate for multimodal pain management, yet few studies explore entirely non-opiate approaches. Methods134 elective ERAS colorectal surgery patients were reviewed from January 2019 to June 2020 ​at a single institution, with surgery performed by a single surgeon. Endpoints were pain scores, length of stay (LOS), and mortality. ResultsForty patients were included in the non-opiate cohort. Mann Whitney-U test found that postoperatively, non-opiate patients spent significantly less time in moderate or severe pain (p ​< ​.001). There was no significant difference between study groups (non-opiate and opiate) for the no or mild pain categories, LOS, or mortality. Risk factors for opiate use were younger age and prior opiate use. Gender, ASA class, stoma creation, malignancy, and surgical approach were not associated with increased opiates. ConclusionNon-opiate approaches in colorectal surgery are feasible and comparable to opiate regimens in our patient cohort.

Analysis of ERAS protocol adherence and postoperative outcomes after major colorectal surgery in a community hospital

Despite widespread adoption, the efficacy of Enhanced Recovery After Surgery (ERAS) protocols in community hospital settings remains understudied. This retrospective analysis conducted at a high-volume community hospital aimed to evaluate adherence to ERAS protocols and analyze postoperative outcomes following colorectal surgery. A total of 278 adult patients undergoing elective colorectal surgery between January 2022 and January 2024 were included. Data analysis revealed time to first mobilization proved to be satisfactory in accordance with ERAS hospital guidelines (mean 1.0 ​± ​0.05 days, range 0.1–13.8 days), and furthermore demonstrated a strong positive correlation with both time to first bowel function (r ​= ​0.69, p ​< ​0.0001) and length of stay (r ​= ​0.25, p ​< ​0.0001). Time to urinary catheter removal occurred slightly after guideline-directed removal (mean 1.1 ​± ​0.05 days, range 0.5–12.9 days), however did exhibit a significant positive correlation with length of stay (r ​= ​0.33, p ​< ​0.0001). 10.9 ​% of patients experienced a postoperative complication, while the average length of stay across all procedures was 3.1 ​± ​0.17 days (range 0.9–23.3 days), and the overall 30-day readmission rate stood at 10.43 ​%. This study underscores the need for ongoing evaluation and refinement of ERAS protocols in community hospital settings to enhance surgical care and patient satisfaction.

Opioid use patterns following discharge from elective colorectal surgery: a prospective cohort study.

Opioid overprescription after colorectal surgery can lead to adverse events, persistent opioid use, and diversion of unused pills. This study aims to assess the extent to which opioids prescribed at discharge after elective colorectal surgery are consumed by patients. This prospective cohort study included adult patients (≥ 18yo) undergoing elective colorectal surgery at two academic hospitals in Montreal, Canada. Patients completed preoperative questionnaires and data concerning demographics, surgical details, and perioperative care characteristics (including discharge prescriptions) were extracted from electronic medical records. Self-reported opioid consumption was assessed weekly up to 1-month post-discharge. The total number of opioid pills prescribed and consumed after discharge were compared using the Wilcoxon signed-rank test. Negative binomial regression was used to identify predictors of opioid consumption. We analyzed 344 patients (58 ± 15years, 47% female, 65% laparoscopic, 31% rectal resection, median hospital stay 3days [IQR 1-5], 18% same-day discharge). Most patients received a TAP block (67%). Analgesia prescription at discharge included acetaminophen (92%), NSAIDs (38%), and opioids (92%). The quantity of opioids prescribed at discharge (median 13 pills [IQR 7-20]) was significantly higher than patient-reported consumption at one month (median 0 pills [IQR 0-7]) (p < 0.001). Overall, 51% of patients did not consume any opioids post-discharge, and 63% of the prescribed pills were not used. Increased opioid consumption was associated with younger age (IRR 0.99 [95%CI 0.98-0.99]), higher preoperative anxiety (1.02 [95%CI 1.00-1.04]), rectal resections (IRR 1.45 [95%CI 1.09-1.94]), and number of pills prescribed (1.02 [95%CI 1.01-1.03]). A considerable number of opioid pills prescribed at discharge after elective colorectal surgery are left unused by patients. Certain patient and care characteristics were associated with increased opioid consumption. Our findings indicate that post-discharge analgesia with minimal or no opioids may be feasible and warrants further investigation.

Outcomes reported in elective colorectal cancer surgery research for older patients: A scoping review.

Colorectal cancer rates are increasing in older populations, who often have comorbidities and face higher surgical risks and mortality rates. Therefore, surgical outcomes, such as 5-year mortality rates, may not be appropriate, necessitating a focus on postoperative quality of life. However, determining optimal postoperative outcome measures for older colorectal cancer patients poses a challenge. This scoping review aimed to explore currently available data describing postoperative outcomes used to assess older patients undergoing elective colorectal cancer surgery. We conducted a comprehensive literature search of major electronic databases from inception to March 2023. Studies exploring frail or older individuals with colorectal cancer undergoing elective surgical procedures, and which reported postoperative outcomes, were included. Outcomes were categorized as surgery-specific versus person-centred and summarized using narrative synthesis. The type and rate of surgery-specific outcomes were tabulated. Of 1366 identified citations, 16 studies focused on person-centred outcomes and 66 reported exclusively on surgery-specific outcomes. Nine 'person-centred outcome' studies reported discharge destination, primarily home discharge. Postoperative delirium ranged from 8.2% to 18.1% in six studies. Four studies explored geriatric syndromes, three analysed activities of daily living, and three studies reported significant quality of life improvement. The 66 'surgery-specific outcome' studies assessed mortality (N = 61); length of stay (N = 40); postoperative complications (N = 47); readmission (N = 18); reoperation (N = 16); and survival (N = 42). Person-centred outcomes are underreported, but crucial for guiding patient management. Older patients require adequate information about their postoperative recovery period to enhance wellbeing. Future research must address this gap to improve care for older people undergoing elective colorectal cancer surgery.

Ultrasound Guided Erector Spinae Plane Block versus Oblique Subcostal Transversus Abdominis Plane Block for Postoperative Analgesia in Adults Patients after Laparoscopic Colorectal Surgery

Abstract Background Major abdominal surgery can cause significant post-operative pain and stress. Thoracic epidural analgesia (TEA) remains the gold- standard in its management. However, it is not without side effects or potential risks. Regional techniques might offer an alternative when thoracic epidural analgesia (TEA) is not possible. Aim of the Work The aim of this study is to test the efficacy of ultrasound guided erector spinae plane block versus ultrasound guided oblique subcostal TAP block as regards its efficacy, hemodynamic stability, onset of post-operative pain, amount of post-operative narcotics used. Patients and Methods In the current study, forty patients scheduled for elective laparoscopic colorectal surgery received general anaesthesia were included. Patients were divided randomly into two groups, each group includes 20 patients. Group T: Patients in this group received ultrasound guided OSTAP block after induction of general anaesthesia. Group E: Patients in this group received ultrasound guided ESP block after induction of general anaesthesia. Results As regard the analgesic parameters recorded in the current study; the NRS was significantly lower in Group E (ESP) block when compared with that of Group T (OSTAP) block and showed significant difference between both groups at 4, 6, 8 and 10 hrs postoperatively. Time to rescue analgesia, there was clinically and statistically highly significant longer time to ist rescue analgesic in group E (ESP) block was 15.68+1.50 hours compared to that of group T (OSTAP) block was 9.56+2.41 hours. These findings were in an array with a case series done by Luis-Navarro and his colleagues who reported that the first rescue analgesic was required only at 16 hours after ESP block. In the current study, total meperidine consumption with the mean total consumption in each group was 75+0.37 mg in the ESP block group compared with 125+0.87 mg in the OSTAP block group there was highly statistically significant higher mean of total analgesic consumption in group T compared to group E. Conclusion Erector spinae plane block under ultrasound guidance for laparoscopic colorectal surgery provides a longer duration and better quality of postoperative analgesia, as well as reducing the postoperative analgesic consumption when compared to oblique subcostal transversus abdominis plane block for laparoscopic colorectal surgery. Both blocks are mostly devoid of complications, and they provide reliable and effective postoperative analgesia in patients undergoing laparoscopic colorectal surgery.

Inequalities in quality metrics for colorectal cancer surgery in older adults: A retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program registry

BackgroundWith a growing proportion of patients undergoing surgery for colorectal cancer being older adults, it is unknown whether traditional quality metrics are achieved as often compared with younger adults. This work was done with a view to understand tailoring needs of quality metrics for older adults with colorectal cancer. MethodsThis retrospective cohort study used the American College of Surgeons National Surgical Quality Improvement Program registry to identify adults (≥18 years) between 2016 and 2021 who underwent elective colorectal cancer surgery for nonmetastatic cancer. older adults was defined as adults ≥65 years. The association between older adults and attainment of consensus quality metrics were evaluated using multivariable logistic regression adjusting for patient, cancer, and treatment factors. ResultsOf 46,159 patients undergoing elective colon cancer resection, 18,592 (40.3%) were older adults. Being an older adult was independently associated with a 14% reduction in odds of harvest of ≥12 nodes and 4.3 times increase in odds of 30-day mortality. Of 9,106 patients undergoing elective rectal cancer resection 5,143 (56.5%) were older adults. Being an older adult was independently associated with a 19% reduction in odds of harvest of ≥12 nodes, 2.3 times increase in odds of 30-day mortality and a 44% reduction in odds of receiving neoadjuvant radiation. Findings were robust to sensitivity analyses of alternate methods of handling missing data and alternate analytic approaches. ConclusionGiven unique needs of the older adult population, interpretation of disparities in quality metrics is challenging because of an inability to differentiate between patient factors, tailored care, or bias. Monitoring and reporting of quality metrics for older adults need to be re-evaluated with consideration to stratification, unique benchmarks, and older adult–specific quality metrics.

Preoperative very low-energy diets for obese patients undergoing intra-abdominal colorectal surgery: a retrospective cohort study (RetroPREPARE).

Very low-energy diets (VLEDs) prescribed prior to bariatric surgery have been associated with decreased operative time, technical difficulty, and postoperative morbidity. To date, limited data are available regarding the impact ofVLEDs prior to colorectal surgery. We designed this study to determine whether preoperative VLEDs benefit patients with obesity undergoing colorectal surgery. This is a single-center retrospective cohort study. Individuals undergoing elective colorectal surgery with a body mass index (BMI) of greater than 30kg/m2 from 2015 to 2022 were included. The exposure of interest was VLEDs for 2-4weeks immediately prior to surgery. The control group consisted of patients prior to January 2018 who did not receive preoperative VLED. The primary outcome was 30day postoperative morbidity. Multivariable logistic regression modeling was used to determine associations with 30day postoperative morbidity. Overall, 190 patientswere included, 89 patients received VLEDs (median age: 66years; median BMI: 35.9kg/m2; 48.3% female) and 101 patients did not receive VLEDs (median age: 68years; median BMI: 32.1kg/m2; 44.6% female). One-hundred four (54.7%) patients experienced 30day postoperative morbidity. Multivariable regression analysis identified three variables associated with postoperative morbidity: VLEDs [odds ratio (OR) 0.22, 95% confidence intervals (CI) 0.08-0.61, P < 0.01], Charlson comorbidity index (OR 1.25, 95% CI 1.03-1.52, P = 0.02), and rectal dissections (OR 2.71, 95% CI 1.30-5.65, P < 0.01). The use of a preoperative VLED was associated with a significant reduction in postoperative morbidity in patients with obesity prior to colorectal surgery. A high-quality randomized controlled trial is required to confirm these findings.

Analyzing the Role of Mechanical Bowel Preparation on Surgical Outcomes in Colorectal Surgery

Despite improved postoperative recovery from the use of minimally invasive procedures and enhanced recovery after surgery protocols in recent decades, colectomy is still associated with morbidity. Surgical site infections range from trivial wound infections to potentially deadly colonic anastomotic leaks. Objectives: To compare the outcome results regarding postoperative complications of Mechanical Bowel Preparation and Non-Medical Bowel Preparation groups in elective colorectal surgery at a Tertiary Care Hospital in Peshawar, Pakistan. Methods: The research was a quasi-experimental study. In this study, 210 patients were included; they were divided into 2 groups: Mechanical Bowel Preparation Group and the Non-Mechanical Bowel Preparation Group. Data were collected through electronic health records. The data were analysed using SPSS software version 26.0. Descriptive statistics, such as the Chi-Square test, were applied to the results. Results: There was no statistically significant difference regarding the surgical outcomes and the demographics between the Mechanical Bowel Preparation and Mechanical Bowel Preparation groups. The escalation of the surgical site infection looked lower when the Mechanical Bowel Preparation was not in use i.e 20 (19.05%) in the Mechanical Bowel Preparation group and 14 (13.33%) in the Non-Mechanical Bowel Preparation group, but it did not seem to be, statistically significant; p-value=0.261014. The anastomotic leak rates and intra-abdominal collection rates do not differ significantly between the two groups; p&gt;0.05. Conclusions: It was concluded that there was no statistical significance between the groups of mechanical bowel preparation and non-mechanical bowel preparation concerning surgical site infections, anastomotic leakages, and other colorectal surgery complications.

Determinants of late recovery following elective colorectal surgery.

Despite the implementation of enhanced recovery protocols, a significant proportion of patients experience delayed recovery. Identifying potential determinants of delayed recovery is crucial for optimizing perioperative protocols and tailoring patient pathways. This study aims to identify possible determinants of delayed recovery. Retrospective observational study based on a prospectively collected dedicated register spanning from 2015 to 2022. Twenty-two Italian hospitals specializing in high-volume colorectal surgery and trained in enhanced recovery protocols. Patients undergoing elective colorectal resection for cancer or benign disease. Recovery status on postoperative day 2. Late recovery was defined as the failure to meet at least two indicators of postoperative recovery (oral feeding, removal of the urinary catheter, cessation of intravenous fluids, and mobilization) on postoperative day 2. A total of 1535 patients were analyzed. The median overall adherence to pre- and intraoperative enhanced recovery protocol items was 75.0% (range: 66.6%-83.3%). Delayed recovery was observed in 487 (31.7%) patients. Multiple regression analysis revealed six enhanced recovery protocol items that independently positively influenced postoperative recovery: pre-admission counseling (adjusted odds ratio [aOR] 2.596), a preoperative carbohydrate drink (aOR 1.948), intraoperative fluid infusions < 7ml/kg/h (aOR 1.662), avoidance of thoracic epidural analgesia (aOR 2.137), removal of nasogastric tube at the end of surgery (aOR 4.939), and successful laparoscopy (aOR 2.341). The rate of delayed recovery progressively decreased with increasing adherence to these six positive items, reaching 13.0% when all items were applied (correlation coefficient [r] = - 0.99, p < 0.001). This study is limited by its retrospective analysis of a register containing data from multiple centers and a diverse patient population. Adherence to specific pre- and intraoperative enhanced recovery protocol items, including counseling, preoperative carbohydrate intake, restrictive intraoperative fluid management, avoidance of thoracic epidural analgesia, early removal of nasogastric tube, and successful laparoscopy, appears crucial for promoting early recovery following elective colorectal resection.