Patients Undergoing Colon Surgery Research Articles

Reportable infections following colon surgery in a large public healthcare system in New York City: The consequences of being a level 1 trauma center.

To examine differences in risk factors and outcomes of patients undergoing colon surgery in level 1 trauma centers versus other hospitals and to investigate the potential financial impact of these reportable infections. Retrospective cohort study between 2015 and 2022. Large public healthcare system in New York City. All patients undergoing colon surgery; comparisons were made between (1) all patients undergoing colon surgery at the level 1 trauma centers versus patients at the other hospitals and (2) the nontrauma and trauma patients at the level 1 trauma centers versus the nontrauma patients at other hospitals. Of 5,217 colon surgeries reported, 3,531 were at level 1 trauma centers and 1686 at other hospitals. Patients at level 1 trauma centers had significantly increased American Society of Anesthesiology (ASA) scores, durations of surgery, rates of delayed wound closure, and rates of class 4 wounds, resulting in higher SIRs (1.1 ± 0.15 vs 0.75 ± 0.18; P = .0007) compared to the other hospitals. Compared to the nontrauma patients at the other hospitals, both the nontrauma and trauma patients at the level 1 trauma centers had higher ASA scores, rates of delayed wound closure, and of class 4 wounds. The SIRs of the nontrauma patients (1.16 ± 1.29; P = .008) and trauma patients (1.26 ± 2.69; P = .066) at the level 1 trauma center were higher than the SIRs of nontrauma patients in the other hospitals (0.65 ± 1.18). Patients undergoing colon surgery at level 1 trauma centers had increased complexity of surgery compared to the patients in other hospitals. Until there is appropriate adjustment for these risk factors, the use of infections following colon surgery as a reportable quality measure should be re-evaluated.

Developing and validating a multivariable prediction model for predicting the cost of colon surgery.

Hospitals are burdened with predicting, calculating, and managing various cost-affecting parameters regarding patients and their treatments. Accuracy in cost prediction is further affected when a patient suffers from other health issues that hinder the traditional prognosis. This can lead to an unavoidable deficit in the final revenue of medical centers. This study aims to determine whether machine learning (ML) algorithms can predict cost factors based on patients undergoing colon surgery. For the forecasting, multiple predictors will be taken into the model to provide a tool that can be helpful for hospitals to manage their costs, ultimately leading to operating more cost-efficiently. This proof of principle will lay the groundwork for an efficient ML-based prediction tool based on multicenter data from a range of international centers in the subsequent phases of the study. With a mean absolute percentage error result of 18%-25.6%, our model's prediction showed decent results in forecasting the costs regarding various diagnosed factors and surgical approaches. There is an urgent need for further studies on predicting cost factors, especially for cases with anastomotic leakage, to minimize unnecessary hospital costs.

Cost-effectiveness of the enhanced recovery program in patients undergoing colon surgery. Results of randomized clinical trial

AIM: to evaluate the cost-effectiveness of the enhanced recovery program (ERP).PATIENTS AND METHODS: a randomized clinical trial was carried out. A total of 152 patients were divided into ERP (n = 77) and conventional (n = 75) groups. To study the cost-effectiveness of ERP, direct medical costs were assessed at all stages of treatment (outpatient, inpatient, and also within 30 days after discharge from the hospital). Cost minimization analysis (CMA) was used.RESULTS: the median total costs at the stage of outpatient check-up ERP and conventional groups where comparable (33115-35146 rubles; p = 0.1). The total cost of inpatient treatment in the main group was 175,535 rubles, in the control group — 199,055 rubles (p < 0.0001). The costs of outpatient follow-up in ERP group were significantly higher compared to the conventional group (p = 0.0005). The difference, according to Hodges-Lehmann estimation, was 940.7 rubles. The cost of the entire cycle of treatment in the ERP group was 214805 rubles, in the conventional — 237890 rubles (p < 0.0001). Thus, the total reduction in treatment costs associated with ERP amounted to 23,085 rubles (9.7% expenditures)CONCLUSION: a cost-effectiveness analysis of the implementation of the Enhanced Recovery Program showed an overall cost reduction of 9.7% due to a reduction in costs at the inpatient stage.

Enhanced recovery after gynecologic surgery: review of the literature

Objective: Enhanced Recovery After Surgery (ERAS) includes practices aimed at providing rapid recovery by standardizing pre-and post-surgical care in patients undergoing colon surgery and reducing the metabolic stress response. The ERAS program is a systematic application that includes surgeons, anesthetists, nurses, and assistant healthcare professionals in the care process and has been successfully implemented in the international arena. Studies on ERAS protocols show that this system can be actively applied in different surgical areas. Mechanism: This review article discusses the main reviews and recommendations of the medical community on ERAS and valuable publications in the literature. Findings in brief: Guidelines of the ERAS Society for peri-operative care in gynecological procedures were first published in 2016 and updated in 2019. ERAS Society recommended 12 items for pre-and intra-operative care and 10 post-operative care items. The objectives of these applications are to provide patient education and consultancy services before surgery, to stop oral intake shortly before surgery and to start fast nutrition after surgery, to maintain a balanced body temperature and fluid level to maintain normal physiology, to increase mobilization, to provide pain control with painkillers, prophylaxis of nausea and vomiting and reduction of unnecessary or prolonged use of catheters. Conclusions: Studies suggest that increased compliance with ERAS agents in colon surgery has a positive effect on operation results, but more studies are needed to reach this affirmation in gynecological surgery.

Adherence to a standardized infection reduction bundle decreases surgical site infections after colon surgery: a retrospective cohort study on 526 patients

BackgroundColon surgical site infections (SSI) are detrimental to patient safety and wellbeing. To achieve clinical excellence, our hospital set to improve patient safety for those undergoing colon surgery. Our goal was to implement a perioperative SSI prevention bundle for all colon surgeries to reduce colon surgery SSI rates.MethodsThis retrospective cohort study evaluated the impact of implementing a perioperative SSI prevention bundle in patients undergoing colon surgery at Banner University Medical Center - Tucson. We compared SSI rates between the Pre- (1/1/2016 to 12/31/2016) and post-bundle (1/1/2017 to 12/31/2017) cohorts using a chi-square test.ResultsIn total, we included 526 consecutive patients undergoing colon surgery in our study cohort; 277 pre-bundle and 249 post-bundle implementation. The unadjusted SSI rates were 8.7 % and 1.2 %, pre- and post-bundle, respectively. Our CMS reportable standard infection rate decreased by 85.4 % from 3.08 to 0.45 after implementing our SSI prevention bundle.ConclusionsImplementing a standardized colon SSI prevention bundle reduces the overall 30-day colon SSI rates and national standardized infection rates. We recommend implementing colon SSI reduction bundles to optimize patient safety and minimize colon surgical site infections.

897. Prediction of Surgical Site Infections in Colon Surgery in Belo Horizonte Hospitals

BackgroundIn Belo Horizonte (a 3,000,000 inhabitants city) a survey was carried out in five hospitals, between July 2016 and June 2018, about surgical site infection (SSI) in patients undergoing colon surgery procedures. The general objective is to statistically evaluate such incidences and enable an analysis of the SSI predictive power, through MLP (Multilayer Perceptron) pattern recognition algorithms.MethodsThrough the Hospital Infection Control Committees (CCIH) of the hospitals a data collection on SSI was carried out. Such data was used in the analysis during your routine SSI surveillance procedures. So, three procedures were performed: a treatment of the collected database for use of intact samples; a statistical analysis on the profile of the collected hospitals and; an assessment of the predictive power of five types of MLPs (Backpropagation Standard, Momentum, Resilient Propagation, Weight Decay and Quick Propagation) for SSI prediction. The MLPs were tested with 3, 5, 7 and 10 neurons in the hidden layer and with a division of the database for the resampling process (65% or 75% for testing, 35% or 25% for validation). They were compared by measuring the AUC (Area Under the Curve - ranging from 0 to 1) presented for each of the configurations.ResultsFrom 2126 records, 638 were complete for analysis. It was found: the average age is 55 years (from 1 to 94 years); the surgeries had an average time of approximately 197 minutes; the average hospital stay is 8 days, the death rate reached 5.625% and the SSI rate reached 6%. Regarding the predictive power, a maximum predictive power of 0.8316 was found.ConclusionThere was a loss of 70% of the database samples due to the presence of noise. However, it was possible to have a relevant sample to assess the profile of these five hospitals. The predictive process presented some configurations with results that reached 0.8316, which promises the use of the structure for the monitoring of automated SSI for patients undergoing colon surgeries. To optimize data collection, enable other hospitals to use the prediction tool and minimize noise from the database, two mobile application were developed: one for monitoring the patient in the hospital and the other for monitoring after hospital discharge. The SSI prediction analysis tool is available at www.nois.org.br.Disclosures All Authors: No reported disclosures

Improved Postoperative Outcomes By Utilizing A Comprehensive Perioperative Surgical Site Infection (SSI) Reduction Bundle

Background: Surgical site infections (SSIs) can be attributed to increased patient morbidity and mortality, prolonged hospital stays, and overall increased healthcare costs. The Surgical Care Improvement Project (SCIP) was implemented in 2002 but has made limited impact on SSI rates across our facilities, which has led to the creation of a bundled approach of current evidence-based strategies. Methods: In January 2019, a comprehensive SSI prevention bundle of strategies was implemented across a multihospital health system. The bundle was comprised of 8 interventions focusing on the preoperative, intraoperative, and postoperative continuum of care, and refining documentation in the electronic medical record. From January to September 2019 (preointervention period), data were collected from 7,163 adult inpatient and observation elective patients undergoing colon surgery (COLO), abdominal hysterectomy (HYST), hip arthroplasty (HPRO), knee arthroplasty (KPRO), and cardiac bypass graft (CBGB/CBGC). The preintervention period for SSI standardized infection ratios (SIRs) and retrospective review of process measures was set as January–December 2018 (postintervetnion period). Each process measure had outlined targets along with primary outcome measures of overall SSI SIRs and SIRs for each of the 5 reported procedure categories. SSIs were validated to meet CDC and NHSN surveillance case definitions. Secondary outcomes evaluated included length of stay (LOS), readmission rates, and mortality. Results: Overall SIR for all 5 monitored surgical categories decreased by 5% to 1.131 from January to September 2019, compared to SIR of 1.190 in 2018. Hip and knee arthroplasties demonstrated 40% and 38% reductions after the intervention, respectively. Completion of 7 or 8 interventions of the SSI bundle were correlated with lower readmission rates (P = .0488). When any portion of the bundle was used, this was correlated with shorter LOS (P < .0001). Adherence to standardized antimicrobial prophylaxis was associated with decreased mortality (P = .017), for all 5 surgical categories. Conclusions: With the implementation of a focused SSI reduction bundle, our institution has realized reductions in surgical readmissions, length of stay, and mortality. Additionally, SSI rates in certain procedure categories have shown marked improvement. The initial success of this bundle has garnered development of additional procedure focused supplemental strategies for the future year.Funding: NoneDisclosures: Aarikha D’Souza, Banner Health

Preoperative oral antibiotics and surgical-site infections in colon surgery (ORALEV): a multicentre, single-blind, pragmatic, randomised controlled trial

Previous studies have found that mechanical bowel preparation with oral antibiotics can reduce the incidence of surgical-site infections, but no randomised controlled trial has assessed oral antibiotics alone without mechanical bowel preparation. The aim of this study was to determine whether prophylaxis with oral antibiotics the day before elective colon surgery affects the incidence of postoperative surgical-site infections. In this multicentre, pragmatic, randomised controlled trial (ORALEV), patients undergoing colon surgery were recruited from five major hospitals in Spain and 47 colorectal surgeons at these hospitals participated. Patients were eligible for inclusion if they were diagnosed with neoplasia or diverticular disease and if a partial colon resection or total colectomy was indicated. Participants were randomly assigned (1:1) using online randomisation tables to either administration of oral antibiotics the day before surgery (experimental group) or no administration of oral antibiotics before surgery (control group). For the experimental group, ciprofloxacin 750 mg was given every 12 h (two doses at 1200 h and 0000 h) and metronidazole 250 mg every 8 h (three doses at 1200 h, 1800 h, and 0000 h) the day before surgery. All patients were given intravenous cefuroxime 1·5 g and metronidazole 1 g at the time of anaesthetic induction. The primary outcome was incidence of surgical-site infections. Patients were followed up for 1 month after surgery and all postsurgical complications were registered. This study was registered with EudraCT, 2014-002345-21, and ClinicalTrials.gov, NCT02505581, and is closed to accrual. Between May 2, 2015, and April 15, 2017, we assessed 582 patients for eligibility, of whom 565 were eligible and randomly assigned to receive either no oral antibiotics (n=282) or oral antibiotics (n=282) before surgery. 13 participants in the control group and 16 in the experimental group were subsequently excluded; 269 participants in the control group and 267 in the experimental group received their assigned intervention. The incidence of surgical-site infections in the control group (30 [11%] of 269) was significantly higher than in the experimental group (13 [5%] of 267; χ2 test p=0·013). Oral antibiotics were associated with a significant reduction in the risk of surgical-site infections compared with no oral antibiotics (odds ratio 0·41, 95% CI 0·20-0·80; p=0·008). More complications (including surgical-site infections) were observed in the control group than in the experimental group (76 [28%] vs 51 [19%]; p=0·017), although there was no difference in severity as assessed by Clavien-Dindo score. No differences were noted between groups in terms of local complications, surgical complications, or medical complications that were not related to septic complications. The administration of oral antibiotics as prophylaxis the day before colon surgery significantly reduces the incidence of surgical-site infections without mechanical bowel preparation and should be routinely adopted before elective colon surgery. Fundación Asociación Española de Coloproctología.

Preoperative Oral Antibiotics and Surgical Site Infections in Colon Surgery Without Mechanical Bowel Preparation. A Prospective, Multicentre, Single Blinded, Randomized Trial (ORALEV Study)

Background: Previous studies have found that combined mechanical bowel preparation (MBP) and oral antibiotics (OAB) can reduce the rate of SSI, but no randomized controlled trial has evaluated OAB alone without MBP. The aim of this study was to determine whether prophylaxis with OAB the day before elective colon surgery influences the rate of surgical site infections (SSI) postoperatively. Methods: Randomized controlled multicenter trial at 5 major hospitals with the participation of 47 colorectal surgeons. Patients undergoing colon surgery were randomized into 2 groups, with and without administration of OAB (ciprofloxacin, metronidazole) the day before surgery. All patients received intra-venous antibiotics during surgery. Patients were followed up for 1 month and all postsurgical complications were registered. Findings: A total of 565 patients were randomized to receive either no treatment (n=269) or OAB (n=267). The rate of SSI in the No-OAB group (11.2%) was significantly higher than in the OAB group (4.9%) (p=0.013). OAB were associated with a significant risk reduction compared with No-OAB (OR=0.41, 95%CI=0.20-0.80, p=0.008). We found no statistically significant differences in the types of SSI observed in the two groups. Open surgery versus laparoscopy was an independent risk factor of SSI (OR=2.29, 95% CI=1.16-4.41, p=0.018). Interpretation: The administration of OAB as prophylaxis the day before colon surgery significantly reduces the rate of SSI without MBP and should be routinely adopted before elective colon surgery. Registration Information: The study was registered with EudraCT number 2014-002345-21 and ClinicalTrials.gov identifier NCT02505581. Funding Statement: This study was partly funded by a grant from the Fundacion Asociacion Espanola de Coloproctologia (FAECP). Declaration of Interests: The authors report no conflicts of interest. Ethics Approval Statement: All eligible patients provided written informed consent before undergoing study-related procedures. The study protocol was approved by the Ethics Commission of the Valle de Hebron University Hospital and conducted in accordance with the Declaration of Helsinki (World Medical Association, 2013).

Restricting Intraoperative Fluid Volume Allows Earlier Return of Bowel Function After Colon and Rectal Surgery

BackgroundReturn of bowel function (ROBF) after abdominal surgery is an important determinant of patient outcomes. The role of intraoperative fluids (IOFs) in colon surgery remains unclear. The aim of this study was to assess the impact of IOF on ROBF in patients undergoing colon surgery. We hypothesized that minimizing IOFs allows earlier ROBF. MethodsA 2-year (2016-2017) retrospective analysis of all patients undergoing elective colon resection was performed at our tertiary hospital using a protocol limiting IOF and postoperative narcotics. Patients were divided into two groups: preprotocol (2016) and postprotocol (PoP) (2017). Patients were matched using propensity score matching for age, gender, comorbidities, Anesthesiology Severity Score, indication for procedure, and procedure type. The outcome measured was ROBF. Secondary outcome measures were complication rates and hospital length of stay. ResultsA total of 360 patients were analyzed. After propensity matching, 90 patients (preprotocol: 45; PoP: 45) were included. The mean age was 62.2 ± 14.8 y, 43.3% male, and 44.4% of procedures were performed laparoscopically. There was no difference in demographics and comorbidities between groups. PoP patients received lower IOF (P = 0.036, 2016: 1198.8 ± 1096.5 mL, 2017: 2176.7 ± 1458.3 mL) and lower postoperative narcotics (P = 0.042). PoP patients had earlier ROBF 2[2-4], 4[3-5] (odds ratio: 1.18 [1.05-1.52], P = 0.04), shorter length of stay 3[2-5] d versus 5[4-7] (odds ratio: 1.11 [1.09-1.89], P = 0.043), and trended toward lower complication rates (P = 0.09). ConclusionsIOF volume independently impacts ROBF after colon surgery. Restricting IOF allows for earlier bowel function and shorter hospital stay. Further studies defining optimum fluid management impacting ROBF may help optimize patient care.

Implementation of enhanced recovery after surgery- ERAS, a paradigm shift in surgery

The history of enhanced recovery after surgery (ERAS) has its roots to the earlier ERAS Study Group. This was a collaborative group on peri-operative care to further develop ideas put forth in the 1990’s by Professor Henrik Kehlet of University of Copenhagen. Kehlet reported that the morbidity, mortality and overall costs of surgery requires multimodal interventions to reduce pain; cardiopulmonary, infective and thromboembolic complications; cerebral dysfunction; nausea and gastrointestinal paralysis, fatigue and prolonged recovery. The ERAS Society, registered and based in Stockholm, has over the years developed ‘perioperative care’ strategies to improve recovery after surgery through research, education, audit and implementation of evidence-based practice. An evidence-based consensus protocol for patients undergoing colon surgery was developed and published by the ERAS Study Group3 and later the group showed that just a protocol was not sufficient to change surgical practice in accordance with ERAS. The ‘manual of fast track recovery for colorectal surgery (Springer)’ was published by the ERAS Society as 1st in the series of enhanced recovery. Thereafter various professional societies and organizations around the world have worked together to develop, modify, promote and propagate ERAS. From its original work on colorectal surgery, the ERAS is now implemented in virtually all the disciplines of surgeries and the guidelines are available at ERAS Society website.
 The strategies of ERAS is designed for ‘preoperative, intraoperative and postoperative care’ through multimodal, integrated, multidisciplinary approach from all the stake holders: the patient, surgeons, anaesthesiologists, pain specialists, nursing staff, physical and occupational therapists, social services, and hospital administration. It advocates of the standardized medical care to improve the outcomes and lower the health care costs by minimizing surgical trauma, postoperative pain, complications, length of hospital stay, while expediting recovery and improving the overall outcomes.

A Survey of Enhanced Recovery After Surgery Protocols for Cesarean Delivery in Serbia

Enhanced recovery after surgery (ERAS) protocols have been described for patients undergoing colon surgery. Similar protocols for cesarean delivery (CD) have been developed recently. CD is one of the most commonly performed surgical procedures, and adoption of ERAS protocols following CD might benefit patients and the health-care system. We aimed to determine which Serbian hospitals reported ERAS protocols, which elements of ERAS protocols were used in CD patients, and whether ERAS and non-ERAS hospitals differed. The survey was sent to all hospitals with obstetric services and 46 of 49 responded. The questionnaire asked whether ERAS protocols had been formally adopted for surgical patients and about their use in CD patients. Specific questions on elements described in other obstetric ERAS protocols for CD included preoperative patient preparation, type of anesthesia and temperature monitoring used for CD, maternal/neonatal contact, and time to discharge. ERAS protocols are used in 24% of surveyed hospitals, 84% admit the patient the day before elective CDs, 87% use a maternal bowel preparation morning on the day of CD, and 80% administer maternal deep venous thrombosis prophylaxis. Only 33% remove IV in the first postoperative day, and 89% of women do not eat solid food until the day following their CD. Neuraxial anesthesia is used in 46% of elective CDs in ERAS hospitals compared to 9% in non-ERAS hospitals (P < 0.01), and neuraxial narcotics for post CD analgesia are given more often in ERAS hospitals. Thirty-six percentage of ERAS patients are discharged within 3 days vs. none in the non-ERAS group. Few elements of ERAS protocols reported from other centers outside Serbia are employed in Serbian hospitals performing CD. Despite significant changes that have been made recently in CD care, enhanced recovery after CD could be significantly improved in Serbian hospitals.

Surgical site infection reduction bundle in patients with gynecologic cancer undergoing colon surgery

ObjectiveSurgical site infections (SSIs) can lead to substantial morbidity, prolonged hospitalization, increased costs, and death in patients undergoing colorectal procedures. We sought to investigate the effect of using an SSI reduction bundle on the rate of SSIs in gynecologic cancer patients undergoing colon surgery. MethodsWe identified all gynecologic cancer patients who underwent colon resection at our institution from 2014 to 2016, during which time a service-wide SSI reduction bundle was introduced. The intervention included preoperative oral antibiotics with optional mechanical bowel preparation, skin preparation with antibacterial solution, and the use of a separate surgical closing tray. SSI rates were assessed within 30days post-surgery. ResultsOf 233 identified patients, 115 had undergone colon surgery prior to (PRE) and 118 after (POST) the implementation of the intervention. A low anterior resection was the most common colon surgery in both cohorts. The incidence of SSI within 30days of surgery was 43/115 (37%) in the PRE and 14/118 (12%) in the POST cohorts (p≤0.001). Wound dehiscence was noted in 30/115 (26%) and 2/118 (2%) patients, respectively (p≤0.001). In patients whose operation took longer than 360min, 30-day SSI rates were 37% (28/76) and 12% (8/67), respectively (p≤0.001). In patients with an estimated blood loss >500cm3, SSI rates were 44% (27/62) and 15% (10/67), respectively (p≤0.001). ConclusionsThe implementation of an SSI reduction bundle was associated with a significant reduction in 30-day SSIs in these patients. The intervention remained effective in patients undergoing longer operations and in those with increased blood loss.

Incidence of surgical site infection after implementation of a reduction bundle in gynecologic cancer patients undergoing colon surgery at a comprehensive cancer center

Incidence of surgical site infection after implementation of a reduction bundle in gynecologic cancer patients undergoing colon surgery at a comprehensive cancer center

Validation of surgical site infection surveillance data in colon procedures reported to the Connecticut Department of Public Health

A validation study of 692 patients undergoing colon surgery during the fourth quarter of 2012 identified 102 surgical site infections, of which 34% were not reported to the National Healthcare Safety Network. Possible reasons for underreporting included the misinterpretation of the National Healthcare Safety Network surgical site infection definition and variations in case-finding methods. Colon procedure denominator data were also reviewed to determine inaccuracies. Error rates were highest for implant presence (34%), endoscope use (32%), and procedure duration (33%).

Can specific nutrients stimulate bowel wound healing?

The purpose of review is to provide an overview on specific nutrients which play an important role in bowel wound healing, and to judge the efficacy of supplementation to derive recommendations for clinical practice. Glutamine, arginine, butyrate, ω-3 fatty acids, nucleotides, and several micronutrients are involved in bowel wound healing. However, with regard to clinical trials, the efficacy of supplementation of specific nutrients on bowel wound healing in patients with inflammatory bowel diseases has not been clarified yet. In patients undergoing colon surgery, sufficient evidence exists that the perioperative supply of an enteral immunomodulating formula enriched with arginine, nucleotides, and ω-3 fatty acids may improve intestinal wound healing, considering the lower risk of wound infections, wound dehiscence, and intra-abdominal abscess. Even if a range of nutrients are involved in bowel wound healing, only perioperative supply of an enteral immunomodulating formula to cancer patients undergoing colon surgery, can be recommended. Further randomized controlled trials are needed to elucidate the efficacy of individual nutrients on intestinal wound healing.

Infection control in colon surgery.

The aim of this study is to provide a comprehensive review of strategies that should be employed in the prevention of infection at the surgical site in patients undergoing colon surgery. The world's literature on the pathogenesis and prevention of infections at the surgical site in colon resection were reviewed to identify those methods that are associated with improved rates of infection at the surgical site. The pathogenesis, microbiology, diagnosis, and surveillance of surgical site infection have been reviewed in the context of better understanding the accepted methods for prevention. Recommendations are provided based upon evidence-based information when available. Surgical site infection rates in colon surgery have been reduced consistently over the last 60years of surgical practice. Preoperative and intraoperative techniques are described which have been useful in this improvement, while postoperative methods including the extension of postoperative systemic antibiotics have not been of value. Many methods have been demonstrated to improve surgical site infection rates in colon surgery. However, consistent and standardized applications of these principals in prevention currently do not exist. Application of evidence-based practices can further reduce the morbidity and cost of infection following colon surgery.

Timing of postoperative infections after colectomy: evidence from NSQIP

BackgroundWe studied whether risk factors for infectious complications differed between inpatient (IP) and postdischarge (PD) periods in patients undergoing colon surgery. MethodsAmong partial colon resection patients in the National Surgical Quality Improvement Program (2005 to 2010), we identified risk factors for superficial and deep (D-SSI) surgical site infections and urinary tract infections in the IP and PD phases of care. ResultsObesity was associated with higher risk of both IP superficial surgical site infections and D-SSI (odds ratio [OR] 1.41, P < .0001 and OR 1.28, P < .0001) and increasing to OR 1.73 (P < .0001) and OR 1.83 (P < .0001), respectively, in the PD period. Smoking was associated with development of D-SSI, and this risk increased from IP to PD phases of care (OR 1.15, P = .02 to OR 1.54, P < .0001). ConclusionsRisk factors for infections differ between IP and PD phases of care in colon surgery patients. Earlier discharge from the hospital may shift recognition of an SSI to the outpatient setting.

Surgical site infection and its risk factors in colon surgeries

To identify the occurrence of surgical site infection (SSI) and its risk factors in patients undergoing colon surgery in a tertiary hospital located in the countryside of the state of São Paulo. Retrospective cohort study, with collection of information contained in the medical records of patients undergoing colon surgery in the period between January 2010 and December 2013. The studied variables were the possible risk factors related to the patient, to demographic characteristics and the surgical procedure. In total, were evaluated 155 patients with an overall SSI incidence of 16.7%. A statistically significant association was found both in the univariate as in the multivariate analysis between the SSI and the following variables: male gender, Charlson index and mechanical bowel preparation. The understanding of health professionals about the factors that influence the incidence of SSI in colon surgery may contribute to the quality of care provided to surgical patients, from effective actions to minimize the risk of infections.

Preoperative low-dose ketamine has no preemptive analgesic effect in opioid-naïve patients undergoing colon surgery when nitrous oxide is used - a randomized study

Background: The analgesic properties of ketamine are associated with its non-competitive antagonism of the N-methyl-D-aspartate receptor; these receptors exhibit an excitatory function on pain transmission and this binding seems to inhibit or reverse the central sensitization of pain. In the literature, the value of this anesthetic for preemptive analgesia in the control of postoperative pain is uncertain. The objective of this study was to ascertain whether preoperative low-dose ketamine reduces postoperative pain and morphine consumption in adults undergoing colon surgery. Methods: In a double-blind, randomized trial, 48 patients were studied. Patients in the ketamine group received 0.5 mg/kg intravenous ketamine before surgical incision, while the control group received normal saline. The postoperative analgesia was achieved with a continuous infusion of morphine at 0.015 mg∙kgˉ¹∙hˉ¹ with the possibility of 0.02 mg/kg bolus every 10 min. Pain was assessed using the Visual Analog Scale (VAS), morphine consumption, and hemodynamic parameters at 0, 1, 2, 4, 8, 12, 16, and 24 hours postoperatively. We quantified times to rescue analgesic (Paracetamol), adverse effects and patient satisfaction. Results: No significant differences were observed in VAS scores between groups (P>0.05), except at 4 hours postoperatively (P=0.040). There were no differences in cumulative consumption of morphine at any time point (P>0.05). We found no significant differences in incremental postoperative doses of morphine consumption in bolus, except at 12 h (P =0.013) and 24 h (P =0.002). The time to first required rescue analgesia was 70 ± 15.491 min in the ketamine group and 44 ± 19.494 min in the control (P>0.05). There were no differences in hemodynamic parameters or patient satisfaction (P>0.05). Conclusions: Preoperative low-dose-ketamine did not show a preemptive analgesic effect or efficacy as an adjuvant for decreasing opioid requirements for postoperative pain in patients receiving intravenous analgesia with morphine after colon surgery.