Postoperative Colorectal Patients Research Articles

Risk factors for post-operative VTE following colorectal surgery: Is caprini score enough?

BackgroundPost-operative colorectal venous thromboembolism (VTE) rates range between 1-3%. Often, surgeons utilize risk assessment models, like the modified Caprini, to determine need for prophylaxis. However, studies reveal additional unaccounted risk factors like preoperative serum albumin level, perioperative blood transfusion, emergency surgery, and preoperative steroid use. MethodsThis was a multicenter, retrospective study conducted between January 2021–December 2021. The primary endpoint was to assess the VTE rate within 30 days post-operatively. ResultsOverall, incidence rate was 1.75%. Of these, 53% underwent urgent/emergent surgery and 60% had perioperative blood transfusions. Twelve patients had a known preoperative serum albumin level, with 66% being less than 3.5 g/dL. Only 30% of patients had a high Caprini risk score. No patient had preoperative steroid use. ConclusionThe study suggests considering urgent/emergent surgeries, low preoperative albumin levels, and blood transfusions for enhanced VTE screening and prophylaxis in post-operative colorectal patients.

Development of a predictive model for surgical site infections in colorectal patients based on butyrylcholinesterase plasma levels

Background: The present study is the first to evaluate the use of BChE as an indicator of infectious ailments, and more specifically surgical site infections (SSI) in postoperative colorectal patients.

An evaluation of the nutritional requirements of post-operative colorectal patients

Rationale: Early nutrition is a key aspect of the ERAS pathway, and post-operative nutritional support is vital in maintaining nutritional status during the catabolic post-operative period. The evidence for early resumption of oral intake along with oral nutritional supplements after surgery, is now realised to be safe and vital for optimising post-operative outcomes as part of the ERAS Pathway (1). The aim of this study is to evaluate the nutritional requirements of post-operative patients and to determine if current hospital practices are in line with the ERAS recommendations.

Peritoneal cytokines as a predictor of colorectal anastomotic leaks on postoperative day 1: a systematic review and meta-analysis

Anastomotic leakage (AL) is a major complication of colorectal surgery resulting in morbidity, mortality and poorer quality of life. The early diagnosis of AL is challenging due to the poor positive predictive value of tests available and reliance on clinical presentation which may be delayed. The aim of this systematic review was to assess the applicability of peritoneal cytokine levels as an early predictive test of AL in postoperative colorectal cancer patients. A comprehensive literature search was performed from inception to January 2021, in MEDLINE and EMBASE databases using MeSH and non-MeSH terms in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All studies evaluating peritoneal cytokines in the context of AL were included in this review. Two hundred ninety-two abstracts were screened, 30 full manuscripts evaluated, and 12 prospective studies were included. There were 8 peritoneal cytokines evaluated (interleukin [IL]-1β, IL-6, IL-8, IL-10, vascular endothelial growth factor [VEGF], tumour necrosis factor alpha [TNF alpha] and matrix metalloproteinase [MMP]2 and MMP9) between AL and non-AL groups on postoperative day 1. Those that included IL-6 (7 studies), IL-10 (4 studies), TNF alpha (6 studies) and MMP9 (2 studies) were included in the meta-analysis. IL-10 was the only cytokine in the meta-analysis that was significantly (p < 0.05) raised in drain fluid on postoperative day 1 in AL patients. Peritoneal IL-10 was significantly raised on postoperative day 1 in patients who subsequently developed AL. This may be a useful early predictor of AL and aid in an earlier diagnosis for postoperative colorectal patients. The range of cytokines investigated within the literature is limited and from heterogeneous studies which suggests more research is needed.

Evaluation of an intervention to improve nutrition intake in patients undergoing elective colorectal surgery: A mixed-methods pilot study

ObjectivesTimely and adequate nutrition after surgery is important. The aim of this study was to evaluate the effects of an intervention, developed using an integrated knowledge translation approach, designed to improve oral intake among postoperative colorectal patients. MethodsA pre/post, mixed-methods pilot study was undertaken at a tertiary teaching hospital in Australia. Patients who had undergone elective colorectal surgery and were admitted to the ward where 10 nutrition-related strategies had been implemented were included. Quantitative data, including patient demographics, timing and type of nutrition consumed, and protein and energy intake were collected pre- and post-intervention via chart audits, direct observations, and verbal clarification. Qualitative data on patient (n = 18) responses to the intervention were collected through one-on-one, semistructured interviews and analyzed using inductive content analysis. ResultsSixty-four patients were observed (30 pre- and 34 post-intervention). Significant improvements were seen for the following outcomes (presented as median [interquartile range], pre- versus post-intervention): time (h) to first dietary intake (15.7 [7.4–22.5] versus 4.9 [3.7–14.2]); patient energy intakes (kJ) on day 1 (1719 [947–2200] versus 3530 [2192–5169]) and day 2 (2506 [1071–3749] versus 4144 [2987–5889]); and patient protein intake (g) on day 1 (3.3 [1.8–11.2] versus 30.3 [20–45]) and day 2 (10.8 [3.5–29.9] versus 39.6 [30.7–59]). Prescription of free fluids as first diet type increased from 13% to 79% pre- and post-intervention, respectively. There were no significant differences in time (h) to first solid dietary intake (86.1 [60.1–104] versus 69.2 [46.1–115.5]) and overall proportion of patients who met both their estimated energy and protein requirements while in hospital pre- and post-intervention (22 versus 37%). Patients reported positive experiences with the intervention. ConclusionA multifaceted intervention developed using an integrated knowledge translation approach has the potential to improve oral intake in patients who undergo colorectal surgery. A larger-scale trial is required to confirm these findings and assess the effects of the intervention on clinical outcomes and costs.

Inter-disciplinary team approach towards feasibility of nurse-led early mobilisation for post-operative colorectal patients

Inter-disciplinary team approach towards feasibility of nurse-led early mobilisation for post-operative colorectal patients

Characteristic proteins in the plasma of postoperative colorectal and liver cancer patients with Yin deficiency of liver-kidney syndrome.

Systems biology and bioinformatics provide the feasibility for the basic research associated with “same traditional Chinese medicine (TCM) syndrome in different diseases”. In this study, the plasma proteins in postoperative colorectal (PCC) and postoperative liver cancer (PLC) patients with YDLKS (Yin deficiency of liver-kidney syndrome) were screened out using iTRAQ combined with LC-MS/MS technology. The results demonstrated that, KNG1, AMBP, SERPING1, etc, were all differentially expressed in both PCC and PLC patients with YDLKS, and associated closely with complement and coagulation cascades pathway. C7 and C2 were another two representative factors involving in former pathway. Further validation showed that, the C7 levels were increased significantly in PLC (P < 0.05) and PCC (P < 0.05) with YDLKS group compared to those of NS (no obvious TCM syndromes) group. The AMBP levels were down-regulated significantly in PLC with YDLKS group compared to those of PCC with YDLKS group (P < 0.05). The significant differences of SERPING1 levels (and C2 levels) were shown between YDLKS and NS in PCC (P < 0.01). There were also significant differences of C2 levels between PCC and PLC patients with YDLKS (P < 0.05). Moreover, significant differences of C2 levels were also found between PLC and PCC patients with YDLKS (P < 0.01). ROC curves indicated that, C7 and SERPING1 independently had a potential diagnostic value in distinguishing YDLKS from NS in PLC and PCC, providing the evidences for the material basis of “same TCM syndrome in different diseases” in PCC and PLC patients with YDLKS.

PWE-298 Ct usage for the detection of post-operative colorectal complications: impact on radiological and surgical services

Introduction Detecting surgical complications early is a persistent challenge. The aim of this study was to evaluate the use of abdominal and pelvic computed tomography (CTAP) in postoperative colorectal patients, exploring the impact on subsequent clinical management and on hospital resources. Method Data were collected on all patients undergoing elective colorectal surgery within an enhanced recovery programme over a two-year period (January 2011–December 2012). Those patients who had a diagnostic postoperative CTAP during their first admission were identified and their case notes analysed. Results Three hundred and fifty patients were identified, of which 166 (47%) had undergone laparoscopic procedures. Thirty-nine patients (11%) had a total of 40 diagnostic postoperative CTAP scans. Of these, 15 (38%) had had laparoscopic operations. Median time to imaging was 8 days post-operation. Anastomotic leak was noted in 5 patients undergoing scans (13%); 2 had percutaneous drainage and 3 were managed conservatively with intravenous antibiotics. Collections were identified in 10 patients (25%) of which 1 patient returned to theatre, 3 had percutanous drainage and 6 were managed conservatively. Bowel obstruction was reported in 3 patients (7%) and paralytic ileus in 14 (37%). One patient had a second scan due to further clinical deterioration which suggested likely ischaemic bowel changes, resulting in a return to theatre. No intra-abdominal complications were reported in seven patients (18%). Three patients returned to theatre without any imaging. Conclusion There was a high threshold for imaging colorectal patients in the postoperative period with 11% undergoing scans. There was no difference in the proportion undergoing scans between laparoscopic and open procedures. Septic pathology (leak or collection) was identified in a significant proportion (38%) but only 1.4% (5/350) of the overall number underwent radiological intervention. This study shows that CTAP is useful in detecting postoperative complications but has minimal impact on radiological services. Disclosure of interest None Declared.

P02.81. Symptom management with massage in postoperative colorectal patients: a randomized controlled trial

Methods A randomized-controlled trial was designed for colorectal abdominal surgery patients. Patients were randomized to either receive a 20 minute massage on POD 1 and 2, 20 minutes of ambulation, or a visit by the massage therapist (no massage). Baseline physiologic data (HR, SBP/DBP, RR) were collected 30 minutes prior to and after either intervention. A standardized assessment of patient perception of pain, tension, anxiety, satisfaction with overall care, and relaxation level utilizing a visual analog scale (10 point Likert scale) was obtained before and after the intervention. The IRB approved study was powered to detect a difference at the 80% level. Repeated measures models were used to compare the symptom scores at different time points. T-tests were used to compare same day pre-post intervention changes.