Fast Track Colorectal Surgery A new era of perioperative care. Jauch, LMU Grosshadern,, Munich
|
|
- Hilary Reeves
- 6 years ago
- Views:
Transcription
1 Fast Track Colorectal Surgery A new era of perioperative care P. Rittler,, Karl-Walter Jauch, LMU Grosshadern,, Munich
2 FAST Track = ERAS(Enhanced Enhanced Recovery After Surgery) ) = Multimodal Rehabilitation Pathophysiological Principle Minimisation of Stress/Surgical Surgical Traumareaction Aim(Patient oriented) Reduction of postoperative Morbidity Enhanced Recovery Shorter Length of Hospital Stay Economic Effect Cost savings
3 Complications in Colonresection Conventional, N=2293 Patients general Complications: 27% pulmonary Complicatios: 11% cardial Complications : 7% Urinary Tract Infections: 4% Laparoscopic, N=1311 Patients general Complications: 11% cardiopulmonary Complications: 4% UTI: 4% Marusch et al. Surg.Endosc. 2001:116 Marusch et al. Chirurg 2002:138
4 Surgical Trauma / perioperative Stress Factors Anxiousness Operative procedure Pain Hypothermia Fluid overload Hypoxemia Nausea, Vomiting (PONV) Ileus Immobilisation perioperative Fasting Stress induced catabolism immun function pulmonary function cardiac distress thrombembolism
5 Minimisation of Surgical Trauma No bowel irrigation preop. Glucose Minimal Invasive Surgery Oblique Incision No drainages, tubes OP-TRAUMA Rehabilitation PDA COX-II-Inhibitors Early enteral nutrition Mobilisation Volume restriction
6 Periop. Tradition Preoperative/Ad mission in-hospital evaluation e.g. colonoscopy 1-2 fasting days Bowel lavage Operation Day opiates Fluid loading Drainages and tubes immobilisation 1.-x. POP-Day nasogastric tube nil per mouth parenteral nutrition CV catheter urinary cath. Fasted without glykogen-depots into sport event???
7 European Survey on Perioperative Care in Colorectal Surgery 243 hospitals, 850 patients in 2 weeks Bowel preparation 86%(UK) 95%(G) NG-tube day % (day 3: 40-70%) 1st tolerated liquids day2 10% (day 4: 50%) Solid food day1 10% (day 5: 25-50%) LOS (days) 11,2 (I); 11,7(F); 12,2(UK); 14.2(G) Williamson, Büchler, Kehlet 2004
8 FAST Track = ERAS(Enhanced Enhanced Recovery After Surgery) ) = Multimodal Rehabilitation Preop Smoking and alcohol abstinence Malnutrition screening and treatment Patient information No Fasting,, No bowel lavage Periop 1) Preop Glucose 2) Anästhesia (Peridural Anaest.) 3) Volume restriction 4) MIC (?) 5) Normothermie,, O 2 Postop Pain control Mobilisation Drainage Oral Nutrition Epidural (T COX-2-Inh. (T 8-12 )
9 Orthograde Bowel Lavage ±Bowel Lavage Metaanalysis - + Wound infections 7% 6% Anastomotic insufficiency 3% 6% * Peritonitis 3% 5% Wille-Jørgensenet al. Dis Colon Rectum 2003
10 PREOPERATIVE GLUKOSE LOADING -Glycogen depot augmented - Stress reaction (catecholamine) reduced -Metabolic stress, insulin resistance reduced -Hunger, nausea, fatigue, anxiousness reduced Bolder 1998 Nygren, Thorell 1999 Hausel 2001
11 E.R.A.S.: Preoperativ Glucose Isotop-activity in the stomach [%] 120 * 100 * Safety KH-Sol., n=6 Water, n=6 * * * Minutes after ingestion 120 Nygren et al. Ann.Surg. 1995:728
12 E.R.A.S.: Preoperative Carbohydrates Insulin resistance 0 %-Alterations vs. preop # # # CHE Kolorektal Gelenkersatz KH-Lsg. Kontrolle Ljungqvist et al. Proc.Nutr.Soc. 2002:329
13 Preoperative Carbohydrates Hospital Stay CH-Lsg. vs. NPO Open CHE Hip-Replacement Colorectal Surgery All Interventions Reduction of LOS [Days] -0.71± ± ± ±0.40 p Ljungqvist et al Clin Nutr 1998:65
14 Thoracic Peridural Anästhesia Reduction of Morbidity Ileus Pneumonia, respiratory -2 Tage Insufficiency, Pulm.Embolism % Myocardial Infarction -30% Transfusion of RBC % Renal Failure -30%
15 Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: : a randomised controlled trial Lobo et al, Lancet 2002
16 Effects of intravenous fluid restriction on postoperative complications Randomised Multicenter Trial 8 Hospitals in DK Standard n=72 Restrictiv n=69 OP Day 5388ml 2740ml Complications 51% 33% Cardiopulmonary 17 5 Woundhealing Brandstrup et al Ann Surg 2003,
17 Colon and Rectal Anastomoses do not Require Routine Drainage Urbach et al, Ann Surg 1999
18 Integration of new Standards A bavarian beer drinker after hemicolectomy
19 A Meta-Analysis of Selective Versus Routine Nasogastric Decompression after Elective Laparotomy Selective Routine p-value Rel Risk Patients Tubes replaced Complications Pneumonia Atelectasis Fever Vomiting Nausea Oral feeding (postop day) 3,5 4, Cheatham ML etal, Ann Surg1995;
20 Anastomotic Insufficiency withenteral vs Parenteral Nutrition Author enteral parenteral Odds ratio Schroeder 0/16 0/16 - Stewart 1/40 0/ Sagar 0/15 1/ Hartseil 0/29 1/ Reissmann 0/80 1/ Watters 1/15 4/ Beier-Holgerson 2/30 4/ Heslin 3/97 4/ Ortiz 2/95 4/ Bozzetti 7/159 10/ Braga 9/126 11/ Pacelli 10/119 14/ All 35/821 54/ Schwenk et al, Viszeralchir 2004
21 E.R.A.S.: Enhanced enteral nutrition Complication rate LOS infections woundhealing problems anastomotic dehiscence Loss of muscle mass Fatigue Letality Quality of life Lewis et al. B.M.J. 2001:773 Anastomosenheilung? Ileus?
22 Introduction Fast Tract Concept Feasibility study (20 patients/group) Reduction of preoperative starvation (2 hrs) bowel preparation postoperative i.v. fluids Oral carbohydrates (Pre Op ) Oral protein drink Epidural anesthesia Early mobilization
23 Fast Track Protocol präop: Aufklärung Tagebuch reduzierte Nahrungskarenz Kohlenhydrat Getränk ml ml bis 2 Std präop intraop: Schmerzthe- rapiecox- II-Hemmer und PDA Wärme Querlaparotomie postop: O 2 Schmerztherapie Neostigmin Mobilisation 2 Std. Tee 2 Joghurt Wichmann et al Viszeralchirurgie 2003:329
24 Fast Track Protocol Tag 1 postop: DK, Abd.- Drain entfernen Neostigmin Mobilisation 8 Std (?) Tee, LVK (1/3) 2-3 Joghurt Tag 2 postop: PDK entfernen COX-II-Inh. Metamizol b.bedarf Neostigmin s.c. bei Bedarf Tee, LVK Tag 4 postop: Entlassung planen Patientengespräch Tag 5 postop: Entlassung Tag 8 postop: ambulante Kontrolle Wichmann et al Viszeralchirurgie 2003:329
25 Introduction Patients Fast Track Conv. Care Age 58.5±3.4 yrs 64.2±2.4 yrs Male gender 75% 47% Malignancy 75% 71% MIS 13% 65%
26 Immunological Results E.R.A.S. Pilot Study (n=40) IL-6 T-H-cells CD4/CD8-Ratio Fast Track Conv. Care [pg/ml] [% lymphocytes] *+ * * 3 * * Fast Track Conv. Care 1 Fast Track Conv. Care 0 preop postop 1 postop 3 postop 5 0 preop postop 1 postop 3 postop 5 0 preop postop 1 postop 3 postop 5 + p<0.05 vs. preop. *p<0.05 Fast Track vs. Conv. Care; + p<0.05 vs. preop. * p<0.05 Fast Track vs. Conv. Care
27 Clinical Results Removal Fast Track Conv. Care epidural catheter: 3.0±0 3.2±0.6 abdominal drain: 1.4± ±1.0 (p=0.001) Complete oral feeding: 2.6± ±0.6 (p=0.001) Hospital stay: 7.0± ±0.7 (p=0.03) Adverse Events 0 18%
28 Results of Fast Track Colon Resection 64 patients, 63% malignant 30 conventional OP, 34 laparoscopic OP Oral Nutrition Tea/Yoghourt postop day 0 Solid food postop day 1 1. defecation postop day 2 Dischargepostop day 4 Readmission N=7 (11%) Schwenk et al. Chirurg 2004:508
29 Results of Fast Track Colon Resection Complications local N=5 (8%) Anastomotic insufficiency N=2 (3%) Ileus N=1 (2%) general N=5 (8%) UrinarytractinfectionN=2 (3%) Pneumonia N=0 Letality N=1 (2%) Schwenk et al. Chirurg 2004:508
30 Fast Track in Open vs Lap. Resection Open Laparoscopic Age Defecation day 2 day 2 LOS 3,8 3,9 days Complications 8/60 6/60 Basse et al Ann Surg 2004 in press
31 Fast Track -Perspectives Implementationas Standard in ColorectalSurgery Evaluation in Pankreatic, Liver-, Gastric-Resection Studyon preop Glucose, Bowel Lavageon Volume Regulation and Bowel Motility EconomicEvaluation Psychological Evaluation Multimodal Treatment and Fast Track
32 Thanks for Your Attention Invitation to Visit Surgical Department, LMU Grosshadern, Munich
ANICOLAU.RO. Enhanced Recovery after Colorectal Surgery. Irina Grecu, Alexandru E. Nicolau, Olle Ljungqvist*
Enhanced Recovery after Colorectal Surgery Irina Grecu, Alexandru E. Nicolau, Olle Ljungqvist* Clinical Emergency Hospital of Bucharest, Romania *Karolinska Institute, Stockholm, Sweden ERAS - Enhanced
More informationLaparoscopic Colorectal Surgery
Laparoscopic Colorectal Surgery 20 th November 2015 Dr Adam Cichowitz General Surgeon Laparoscopic Colorectal Surgery Introduced in early 1990s Uptake slow Steep learning curve Requirement for equipment
More informationGastrointestinal Feedings Post Op: What s the deal on beginning oral feedings?
Gastrointestinal Feedings Post Op: What s the deal on beginning oral feedings? Kate Willcutts, DCN, RD, CNSC University of Virginia Health System Charlottesville, VA kfw3w@virginia.edu Objectives 1. Discuss
More informationEnhanced Recovery after Surgery - A Colorectal Perspective. R Sim Centre for Advanced Laparoscopic Surgery, TTSH
Enhanced Recovery after Surgery - A Colorectal Perspective R Sim Centre for Advanced Laparoscopic Surgery, TTSH Conventional Surgery Postop care Nasogastric tube Enteral feeds when ileus resolves Opioid
More informationFast Track Surgery and Surgical Carepath in Optimising Colorectal Surgery. R Sim Centre for Advanced Laparoscopic Surgery, TTSH
Fast Track Surgery and Surgical Carepath in Optimising Colorectal Surgery R Sim Centre for Advanced Laparoscopic Surgery, TTSH Conventional Surgery Postop care Nasogastric tube Enteral feeds when ileus
More informationESPEN Congress Vienna Nutrition after discharge from hospital: The surgeon s responsability. O. Ljungqvist (Sweden)
ESPEN Congress Vienna 2009 Nutrition after discharge from hospital: The surgeon s responsability O. Ljungqvist (Sweden) Nutrition after discharge from hospital: The surgeon s responsability Olle Ljungqvist
More informationNutritional Support in the Perioperative Period
Nutritional Support in the Perioperative Period Topic 17 Module 17.3 Nutritional Support in the Perioperative Period Ken Fearon Learning Objectives Understand the principles behind nutritional care for
More informationNutritional Support in the Perioperative Period
Nutritional Support in the Perioperative Period Topic 17 Module 17.6 Facilitating Oral or Enteral Nutrition in the Postoperative Period Mattias Soop Learning Objectives To review the causes of postoperative
More informationTo staple or to sew. Zeng Xuan Hu
To staple or to sew Zeng Xuan Hu Fast Track Surgery Multimodal Rehabilitation Accelerated recovery Accelerated rehabilitation Enhanced recovery Optimize perioperative care by reducing the expected stress
More information7/31/2015. Enhanced Recovery After Surgery: Change Your Mind, Change Your Practice. Objectives. Enhanced Recovery Society
Enhanced Recovery After Surgery: Change Your Mind, Change Your Practice Margaret Odhner MS, ANP-BC, COCN Kim Meacham, MSN FNP-C, CWON Objectives 1. Describe the Enhanced Recover After Surgery (ERAS) pathway.
More informationFluid Balance in an Enhanced Recovery Pathway. Edwin Itenberg, DO, FACS, FASCRS St. Joseph Mercy Oakland MSQC/ASPIRE Meeting April 28, 2017
Fluid Balance in an Enhanced Recovery Pathway Edwin Itenberg, DO, FACS, FASCRS St. Joseph Mercy Oakland MSQC/ASPIRE Meeting April 28, 2017 No Disclosures 2 Introduction The optimal intravenous fluid regimen
More informationCurrent perioperative management of elective colorectal resections in Ireland: When is the ideal time to introduce feeding post operatively?
Original Article Current perioperative management of elective colorectal resections in Ireland: When is the ideal time to introduce feeding post operatively? Tahir Yasin Khan, Tariq Wahab Khanzada, J.B.O
More informationANICOLAU.RO. What is ERAS? Enhanced Recovery After Surgery. A.E.Nicolau*,Irina Grecu** Spitalul Clinic de Urgenta
Spitalul Clinic de Urgenta ANICOLAU.RO What is ERAS? Enhanced Recovery After Surgery A.E.Nicolau*,Irina Grecu** *Clinica de Chirurgie **Clinica de Anestezie Terapie Intensiva ERAS = Fast-track surgery
More informationERAS. Presented by Timothy L. Beard MD, FACS, CPI Bend Memorial Clinic
ERAS Presented by Timothy L. Beard MD, FACS, CPI Bend Memorial Clinic Outline Definition Justification Ileus Pain Outline Specifics Data BMC Data Worldwide Data Implementation What is ERAS? AKA Fast-track
More informationOptimising Perioperative Pain Management And Surgical Outcomes
Optimising Perioperative Pain Management And Surgical Outcomes Dr Chew Ghee Kheng MBBS FRCOG MD FAMS Senior Consultant Gynaecologist Subspecialist in Gynaecology Oncology Surgery Singapore General Hospital
More informationPerioperative pathophysiology and the objectives behind Enhanced Recovery Care
Perioperative pathophysiology and the objectives behind Enhanced Recovery Care Francesco Carli, MD, MPhil McGill University Montreal, Canada franco.carli@mcgill.ca 60 patients (74 yo) Open colon resection
More informationStellenwert der prä- und postoperativen Sicht des Chirurgen
Interdisziplinäre Chirurgie Stellenwert der prä- und postoperativen Ernährung Sicht des Chirurgen Kantonsspital Luzern 24.11.2005 Prof. L. Krähenbühl Chirurgische Klinik Hôpital Cantonal Fribourg Problems
More informationThe effect of laxative use in length of hospital stay and complication rate in patients undergoing elective colorectal surgery within an ERAS setting.
The effect of laxative use in length of hospital stay and complication rate in patients undergoing elective colorectal surgery within an ERAS setting. { Thalia Petropoulou, Clinical Fellow Paul Hainsworth,Colorectal
More informationFast-Track Colonic Surgery: Status and Perspectives
Fast-Track Colonic Surgery: Status and Perspectives Henrik Kehlet H. Kehlet ( ) Section for Surgical Pathophysiology, Rigshospitalet, Section 4074, Blegdamsvej 9, 2100 Copenhagen, Denmark e-mail: henrik.kehlet@rh.dk
More informationIntro Who should read this document 2 Key practice points 2 What is new in this version 3 Background 3 Guideline Subsection headings
Enhanced Recovery for Major Urology and Gynaecological Classification: Clinical Guideline Lead Author: Dr Dominic O Connor Additional author(s): Jane Kingham Authors Division: Anaesthesia Unique ID: DDCAna3(12)
More informationEvaluation of Enhanced Recovery Protocol for Elective Colorectal Surgical Operations in Assiut University Hospital
Med. J. Cairo Univ., Vol. 85, No. 5, September: 1911-1916, 2017 www.medicaljournalofcairouniversity.net Evaluation of Enhanced Recovery Protocol for Elective Colorectal Surgical Operations in Assiut University
More informationSenior Visceral Surgery Fast-Track in Colorectal Surgery The anesthetist s point of view
Senior Visceral Surgery Fast-Track in Colorectal Surgery The anesthetist s point of view 1st Geneva International SCIENTIFIC DAY February 3 rd 2010 E. Schiffer Dept APSI, HUG 1 Fast-Track in colorectal
More informationFTS Oesophagectomy: minimal research to date 3,4
Fast Track Programme in patients undergoing Oesophagectomy: A Single Centre 5 year experience Sullivan J, McHugh S, Myers E, Broe P Department of Upper Gastrointestinal Surgery Beaumont Hospital Dublin,
More informationBasic pathophysiology of recovery: the role of endocrine metabolic response. Franco Carli McGill University Montreal, Canada
Basic pathophysiology of recovery: the role of endocrine metabolic response Franco Carli McGill University Montreal, Canada ASER, Washington, 2016 postoperative recovery, 1950 Loss of body weight, less
More informationIf you reduce variability in volume administration, HOW. you can reduce post-surgical complications, LOS and associated costs 1-4
A large body of clinical evidence* demonstrates If you reduce variability in volume administration, you can reduce post-surgical complications, LOS and associated costs 1-4 Complications Too Dry Too Wet
More informationMultimodal Approach for Managing Postoperative Ileus: Role of Health- System Pharmacists (ACPE program H01P)
1. In the normal gastrointestinal tract, what percent of nutrient absorption occurs in the jejunum? a. 20%. b. 40%. c. 70%. d. 90%. 2. According to Dr. Erstad, the four components of gastrointestinal control
More informationShow Me the Evidence: Epidurals, PVBs, TAP Blocks Christopher L. Wu, MD Professor of Anesthesiology The Johns Hopkins Hospital
Show Me the Evidence: Epidurals, PVBs, TAP Blocks Christopher L. Wu, MD Professor of Anesthesiology The Johns Hopkins Hospital Overview Review overall (ERAS and non-eras) data for EA, PVB, TAP Examine
More informationMalnutrition: An independent Risk Factor for Postoperative Complications
Malnutrition: An independent Risk Factor for Postoperative Complications Bryan P. Hooks, D.O. University of Pittsburgh-Horizon June 24, 2017 Orthopedic Surgeon-Adult Reconstruction Disclosures: None Objectives:
More informationSimone Targa. Impact of an ERAS Colorectal Program on clinical outcomes and costs
Impact of an ERAS Colorectal Program on clinical outcomes and costs Simone Targa U.O. di Clinica Chirurgica Azienda Ospedaliero-Universitaria di Ferrara Arcispedale S. Anna ERAS Protocol ENHANCED RECOVERY
More informationObjectives 9/7/2012. Optimizing Analgesia to Enhance the Recovery After Surgery CME FACULTY DISCLOSURE
Optimizing Analgesia to Enhance the Recovery After Surgery Francesco Carli, M.D.. McGill University, Montreal, QC, Canada. ASPMN, Baltimore, 2012 CME FACULTY DISCLOSURE Francesco Carli has no affiliation
More informationPostoperative Ileus. UCSF Postgraduate Course in General Surgery Maui, HI March 20, 2011
Postoperative Ileus UCSF Postgraduate Course in General Surgery Maui, HI March 20, 2011 Hobart W. Harris, MD, MPH Introduction Pathophysiology Clinical Research Management Summary Postoperative Ileus:
More informationERAS: Enhanced Recovery After Surgery. Christopher L. Wu, M.D. Professor of Anesthesiology The Johns Hopkins University; Baltimore, Maryland
ERAS: Enhanced Recovery After Surgery Christopher L. Wu, M.D. Professor of Anesthesiology The Johns Hopkins University; Baltimore, Maryland Overview History and basic principles of ERAS Review published
More informationEMERGING EVIDENCE AND BEST PRACTICES TO PREVENT SSI IN COLON PROCEDURES
EMERGING EVIDENCE AND BEST PRACTICES TO PREVENT SSI IN COLON PROCEDURES Clifford Ko, MD, MS, MSHS, FACS, FASCRS Professor of Surgery UCLA Director, ACS NSQIP, American College of Surgeons EVIDENCE Ban
More informationEnhanced Recovery After Discharge: does it happen?
Enhanced Recovery After Discharge: does it happen? Nader K Francis ERAS-UK Southampton 14 th November 2014 BJS 2014 Functional / symptoms Length of hospital stay 37 Readmission 29 Pain 16 Fatigue 9 BJS
More informationAPPLYING ENHANCED RECOVERY PRINCIPLES: EARLY TESTING IN UPPER GI CANCER
APPLYING ENHANCED RECOVERY PRINCIPLES: EARLY TESTING IN UPPER GI CANCER William Allum Consultant Surgeon, Royal Marsden NHS Foundation Trust ? POSSIBLE Major procedure Painful Anastomotic complications
More informationWith joy and great relief
Ulf Gustafsson All previously published papers and figures were reproduced with permissions from the publishers Published by Karolinska Institutet Printed by Larserics Digital Print AB Ulf Gustafsson,
More informationPrevent gastric distention and vomiting after surgery
Remove toxic and unwanted substances from the stomach Administration of enteral nutrition, drugs and so on It favors lung expansion in mechanically unconscious and ventilated subjects Aspiration gastric
More informationOperational Efficiency in Colon Surgery Enhanced Recovery Pathways: 23 hour laparoscopic colectomy
Enhanced Recovery Pathways: 23 hour laparoscopic colectomy Conor P. Delaney MD MCh PhD Chairman, Digestive Disease Institute Professor of Surgery, Cleveland, Ohio Disclosure Slide Conor Delaney MD PhD
More informationCase discussion. Anastomotic leakage. intern superviser
Case discussion Anastomotic leakage intern superviser Basic data Name : XX ID: M101881671 Age:51 Y Gender: male Past history: Hospitalized for acute diverticulitis on 2004/7/17, 2005/5/28 controlled by
More informationTAP blocks vs wound infiltration in laparoscopic colectomies Results of a Randomised Controlled Clinical Trial
TAP blocks vs wound infiltration in laparoscopic colectomies Results of a Randomised Controlled Clinical Trial Kim Gorissen Frederic Ris Martijn Gosselink Ian Lindsey Dept of Colorectal Surgery Dept of
More informationPre-operative Assessment
Pre-operative Assessment Dr Craig Taylor Andrea Harris On behalf of the WM RTC Audit Group A good example of an audit cycle...... or is it!!?? Identify Better Blood Transfusion 2002 2007 West Midlands
More informationHemodynamic Optimization HOW TO IMPLEMENT?
Hemodynamic Optimization HOW TO IMPLEMENT? Why Hemodynamic Optimization? Are post-surgical complications exceptions? Patients undergoing surgery may develop post-surgical complications. The morbidity rate,
More informationEnhanced Recovery after Surgery
Enhanced Recovery after Surgery AKA ERAS What is Enhanced Recovery (ER)? Paradigm shift in surgery and surgical care of the patient Philosophy of care Perioperative continuum Multidisciplinary Patient
More informationEnhanced Recovery After Colorectal Surgery at Royal Inland Hospital Kamloops, BC. Our Data Experience
Enhanced Recovery After Colorectal Surgery at Royal Inland Hospital Kamloops, BC Our Data Experience No Disclosures 1/26/2015 2 Purpose To tell our story of how we collect and share our ERACS data 1/26/2015
More informationR Sim, D Cheong, KS Wong, B Lee, QY Liew Tan Tock Seng Hospital Singapore
Prospective randomized, double-blind, placebo-controlled study of pre- and postoperative administration of a COX-2- specific inhibitor as opioid-sparing analgesia in major colorectal resections R Sim,
More informationERAS Society. Enhanced Recovery After Surgery & how metabolism is key State of the art lecture
ERAS Society Enhanced Recovery After Surgery & how metabolism is key State of the art lecture Olle Ljungqvist MD, PhD Professor of Surgery Örebro University Hospital & Karolinska Institutet, Sweden IrSPEN
More informationFast Track Surgery at the University Teaching Hospital of Kigali: A Randomized Controlled Trial Study in Abdominal Surgery
12 Fast Track Surgery at the University Teaching Hospital of Kigali: A Randomized Controlled Trial Study in Abdominal Surgery L Ndayizeye, A K Kiswezi University Teaching Hospital of Butare, Rwanda. Correspondence
More informationEnhanced Recovery in Pediatric Surgery
Enhanced Recovery in Pediatric Surgery Diana L Diesen, M.D., FACS Assistant Professor, Department of Surgery University of Texas Southwestern Medical Center Children s Health Dallas Dallas, Tx Disclosures
More informationNasogastric Tube Decompression in Stomach and Small Bowel Surgery
Original Article Nasogastric Tube Decompression in Stomach and Small Bowel Surgery Pokharel N,* Adhikari S,** *Resident, ** Professor, NAMS Bir Hospital, Kathmandu, Nepal ABSTRACT: INTRODUCTION: The use
More informationOriginal Article Perioperative fast-track rehabilitation protocol contributes to recovery after laparoscopic resection of colorectal cancer
Int J Clin Exp Med 2017;10(7):10952-10958 www.ijcem.com /ISSN:1940-5901/IJCEM0052356 Original Article Perioperative fast-track rehabilitation protocol contributes to recovery after laparoscopic resection
More informationPostoperative Ultrasound Evaluation of Gastric Distension; A Pilot study
Postoperative Ultrasound Evaluation of Gastric Distension; A Pilot study M Jaronczyk MD, W Boyan Jr. MD, M Goldfarb MD. FACS. MMC Dept of Surgery Nausea and vomiting are common complaints of postoperative
More informationEducational Learning Objectives. Evidence into Practice. Audience. Case Presentation. Outline. Multimodal Approach to Colorectal Surgery
Educational Learning Objectives Multimodal Approach to Colorectal Surgery Value and Impact of Nutrition Interventions May 5, 2011 Dr. Corilee A. Watters, MSc, RD, PhD, CNSC Asst. Prof, Nutrition, University
More informationFast-track surgery and anaesthesia
Andrew J Kitching FRCA Sarah S O Neill FRCA Major surgery induces profound physiological responses; frequent sequelae include pain, nausea, ileus, increased cardiac demands, and impaired pulmonary function.
More informationEnhanced Recovery after Surgery Guideline
Administrative Office: 600 University Ave, 449 Toronto, ON M5G 1X5 T: 416.586.4800 x8534 F: 416.586.8644 E: epearsall@mtsinai.on.ca W: www.bpigs.ca Steering Committee Robin McLeod, Chair Mount Sinai Hospital
More informationHow to Address an Inappropriately high Mortality Rate? Joe Sharma, MD Associate Professor of Surgery NSQIP Surgical Champion
How to Address an Inappropriately high Mortality Rate? Joe Sharma, MD Associate Professor of Surgery NSQIP Surgical Champion Disclosure Slide No COI and no disclosures. Hospital Mortality rate : is it
More informationNational Horizon Scanning Centre. Methylnaltrexone (MOA-728) for postoperative ileus. April 2008
(MOA-728) for postoperative ileus April 2008 This technology summary is based on information available at the time of research and a limited literature search. It is not intended to be a definitive statement
More informationUniversity of Cape Town
Enhanced recovery after surgery (ERAS) in penetrating abdominal trauma Dr Mahammed Riyaad Moydien MBChB (UCT) Student Number: MYDMAH001 A dissertation submitted in fulfilment of the requirements for the
More informationCOLORECTAL RESECTIONS
COLORECTAL RESECTIONS What is a colorectal (bowel) resection? Surgery to remove a part of the large bowel is called a resection. Different parts of the colon require different operations and have different
More informationColorectal Surgery in the Elderly. Stephen Smith
Colorectal Surgery in the Elderly Stephen Smith Scope WHO >65 Social definition No COI Age specific incidence of CRC in Australia 2016 (new cases/100,000) My data: elective bowel resections
More informationEnhanced Recovery After Surgery Getting it Right
Enhanced Recovery After Surgery Getting it Right Aalok Agarwala, M.D., M.B.A. Division Chief, General Surgery Anesthesia Associate Director, Quality and Safety, MGH DACCPM Assistant Professor, Harvard
More informationFAST TRACK MANAGEMENT OF PANCREATIC CANCER
FAST TRACK MANAGEMENT OF PANCREATIC CANCER Jawad Ahmad Consultant Hepatobiliary Surgeon University Hospital Coventry and Warwickshire NHS Trust Part 1. Fast Track Surgery for Pancreatic Cancer Part 2.
More informationCreating an Early Recovery Order Set for Colorectal Surgery-It s the Journey as well as the Destination
Creating an Early Recovery Order Set for Colorectal Surgery-It s the Journey as well as the Destination Jason D. Sciarretta, MD, FACS Grand Strand Medical Center, Myrtle Beach, SC University of South Carolina
More informationThe safety and feasibility of early postoperative oral nutrition on the first postoperative day after gastrectomy for gastric carcinoma
Gastric Cancer (2014) 17:324 331 DOI 10.1007/s10120-013-0275-5 ORIGINAL ARTICLE The safety and feasibility of early postoperative oral nutrition on the first postoperative day after gastrectomy for gastric
More informationCurrent evidence in acute pain management. Jeremy Cashman
Current evidence in acute pain management Jeremy Cashman Optimal analgesia Best possible pain relief Lowest incidence of side effects Optimal analgesia Best possible pain relief Lowest incidence of side
More informationThe Roles and Responsibilities of Nurse Before and After Laparoscopic Urologic Surgery
+ The Roles and Responsibilities of Nurse Before and After Laparoscopic Urologic Surgery Elif GEZGINCI Gulhane Military Medical Academy School of Nursing Ankara 1 + 2 PREOPERATİVE + Preoperative (Patient
More informationPreoperative Optimization and Surgical Site Infection Reduction
Preoperative Optimization and Surgical Site Infection Reduction David Evans, MD Medical Director of Trauma Services Associate Professor Department of Surgery Division of Trauma, Critical Care and Burn
More informationPreoperative Optimization and Surgical Site Infection Reduction
Preoperative Optimization and Surgical Site Infection Reduction David Evans, MD Medical Director of Trauma Services Associate Professor Department of Surgery Division of Trauma, Critical Care and Burn
More informationOriginal article Postoperative ileus in colorectal surgery: is there any difference between laparoscopic and open surgery?
Gastroenterology Report 1 (2013) 138 143, doi:10.1093/gastro/got008 Advance access publication 4 April 2013 Original article Postoperative ileus in colorectal surgery: is there any difference between laparoscopic
More informationBalanced Analgesia With NSAIDS and Coxibs. Raymond S. Sinatra MD, Ph.D
Balanced Analgesia With NSAIDS and Coxibs Raymond S. Sinatra MD, Ph.D Prostaglandins and Pain The primary noxious mediator released from damaged tissue is prostaglandin (PG) PG is responsible for nociceptor
More informationClick to edit Master subtitle style
Does Enhanced Recovery Improve Outcomes? Click to edit Master subtitle style Kaare Weber, MD Director of Surgery Associate Medical Director, Surgery A MEMBER OF THE MONTEFIORE HEALTH SYSTEM mes? Click
More informationPerceptions of the application of fast-track surgical principles by general surgeons
The Royal College of Surgeons of England AUDIT doi 10.1308/003588406X94940 Perceptions of the application of fast-track surgical principles by general surgeons CATHERINE JANE WALTER, ADRIAN SMITH, PIERRE
More informationNutrition Support. John Cha Department of Surgery DHMC/UCHSC
Nutrition Support John Cha Department of Surgery DHMC/UCHSC Overview Why? When? How much? What route? Fancy stuff: enhanced nutrition Advantages of Nutrition Decreased catabolism Improved wound healing
More information5 th ERAS UK Conference. Advances in Pain Management. Jayne Balson Advanced Nurse Specialist Pain Management Western General Hospital Edinburgh
5 th ERAS UK Conference Advances in Pain Management Jayne Balson Advanced Nurse Specialist Pain Management Western General Hospital Edinburgh Pre-op information Optimised organ function No nutritional
More informationRisk factors for fatal outcome in surgical patients with postoperative. aspiration pneumonia
Original article Risk factors for fatal outcome in surgical patients with postoperative aspiration pneumonia Peter Studer 1, Genevieve Räber 1, Daniel Ott 2, Daniel Candinas 1, Beat Schnüriger 1 1 Department
More informationClinical Quality Measures for PQRS. Last Updated: June 4, 2014
Clinical Quality Measures for PQRS Last Updated: June 4, 2014 The Michigan Bariatric Surgery Collaborative (MBSC) Quality Clinical Data Registry will submit the following measures outlined below on behalf
More informationThe Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (8), Page
The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (8), Page 5122-5129 Enhanced Recovery Program (ERP) versus Traditional care after Elective Left Side Colorectal Cancer Surgery Ahmad Aboelkassem
More informationConflicts of Interest
Anesthesia for Major Abdominal Cancer Resection John E. Ellis MD Adjunct Professor University of Pennsylvania johnellis1700@gmail.com Conflicts of Interest 1 Upper Abdominal Surgery Focus on oncologic
More informationJejunostomy after oesophagectomy, how and why I do it
Jejunostomy after oesophagectomy, how and why I do it Graeme Couper. Consultant Oesophago-gastric Surgeon, The Royal Infirmary of Edinburgh BAPEN Conference 2010 2nd & 3rd November Harrogate International
More informationA high-volume surgical unit experience with enhanced recovery after surgery (ERAS)
A high-volume surgical unit experience with enhanced recovery after surgery (ERAS) Catalina Mosquera, Nicholas J. Koutlas, Nasreen A. Vohra, Emmanuel E. Zervos, Timothy L. Fitzgerald East Carolina University,
More informationClinical Nutrition xxx (2012) 1e16. Contents lists available at SciVerse ScienceDirect. Clinical Nutrition
Clinical Nutrition xxx (2012) 1e16 Contents lists available at SciVerse ScienceDirect Clinical Nutrition journal homepage: http://www.elsevier.com/locate/clnu Guidelines for perioperative care in elective
More informationFast-track laparoscopic surgery: A better option for treating colorectal cancer than conventional laparoscopic surgery
ONCOLOGY LETTERS 10: 443-448, 2015 Fast-track laparoscopic surgery: A better option for treating colorectal cancer than conventional laparoscopic surgery YERLAN TAUPYK *, XUEYUAN CAO *, YINQUAN ZHAO, CHAO
More informationDisclosures. Personalized Approaches to Gastrointestinal Cancers. Objectives. What is personalized cancer care. Go through some genomic studies
Personalized Approaches to Gastrointestinal Cancers Emily Groves, MD Colorectal Surgery Assistant Professor, Division of Surgical Oncology Disclosures None Objectives What is personalized medicine and
More informationAchieving 23 hour hospital stay after colorectal resection. Professor Tim Rockall, Guildford, UK
Achieving 23 hour hospital stay after colorectal resection Professor Tim Rockall, Guildford, UK History Outcomes from open colorectal surgery 10 to 14 days in hospital 10% wound infection 2-10%+ anastomotic
More informationLONG TERM OUTCOME OF ELECTIVE SURGERY
LONG TERM OUTCOME OF ELECTIVE SURGERY Roberto Persiani Associate Professor Mini-invasive Oncological Surgery Unit Institute of Surgical Pathology (Dir. prof. D. D Ugo) Dis Colon Rectum, March 2000 Dis
More informationFrederic J., Gerges MD. Ghassan E. Kanazi MD., Sama, I. Jabbour-Khoury MD. Review article from Journal of clinical anesthesia 2006.
Frederic J., Gerges MD. Ghassan E. Kanazi MD., Sama, I. Jabbour-Khoury MD. Review article from Journal of clinical anesthesia 2006 Introduction Laparoscopic surgery started in the mid 1950s. In recent
More informationPerioperative Pulmonary Management. Objectives
Citywide Resident Perioperative Medical Consult Conference Perioperative Pulmonary Management Frank Jacono, MD May 5, 2017 Objectives Definition of post-operative pulmonary complications (PPC) Risk factors
More informationFeasibility Study of Early Oral Intake after Gastrectomy for Gastric Carcinoma
J Gastric Cancer 2011;11(2):101-108 DOI:10.5230/jgc.2011.11.2.101 Original Article Feasibility Study of Early Oral Intake after Gastrectomy for Gastric Carcinoma Dong Hoon Jo, Oh Jeong, Jang Won Sun, Mi
More informationGuidelines for Perioperative Care for Pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS Ò ) Society Recommendations
World J Surg (2013) 37:240 258 DOI 10.1007/s00268-012-1771-1 Guidelines for Perioperative Care for Pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS Ò ) Society s Kristoffer Lassen Marielle
More informationSafety of short stay Hospitalization in Reversal of Loop Ileostomy
Original Article Safety of short stay Hospitalization in Reversal of Loop Ileostomy Tayyab Abbas, Abid Nazir, Muhammad Lateef, Faisal Rauf, Zafar Ali Choudhary Abstract Study Design: Prospective, randomized
More informationThe impact of early nutrition on metabolic response and postoperative ileus Maria Isabel Toulson Davisson Correia and Rodrigo Gomes da Silva
The impact of early nutrition on metabolic response and postoperative ileus Maria Isabel Toulson Davisson Correia and Rodrigo Gomes da Silva Purpose of review Early nutrition has been evaluated and used
More informationThoracic epidural versus patient-controlled analgesia in elective bowel resections Paulsen E K, Porter M G, Helmer S D, Linhardt P W, Kliewer M L
Thoracic epidural versus patient-controlled analgesia in elective bowel resections Paulsen E K, Porter M G, Helmer S D, Linhardt P W, Kliewer M L Record Status This is a critical abstract of an economic
More informationEnhanced Recovery After Surgery: Where Do Pharmacists Come In?
Enhanced Recovery After Surgery: Where Do Pharmacists Come In? Melinda C. Joyce, Pharm.D., FAPhA, FACHE Vice President, Corporate Support Services Med Center Health Bowling Green, Kentucky Annual Meeting
More informationDIVERTICULAR DISEASE. Dr. Irina Murray Casanova PGY IV
DIVERTICULAR DISEASE Dr. Irina Murray Casanova PGY IV Diverticular Disease Colonoscopy Abdpelvic CT Scan Surgical Indications Overall, approximately 20% of patients with diverticulitis require surgical
More informationThe Surgical Patient. Objectives:
The Surgical Patient Objectives: 1. Discuss the effect of surgery on the body systems. 2. Explain the etiological factors, nursing assessment, and management of potential problems during the postoperative
More informationORIGINAL ARTICLE. Adherence to the Enhanced Recovery After Surgery Protocol and Outcomes After Colorectal Cancer Surgery
ONLINE FIRST ORIGINAL ARTICLE Adherence to the Enhanced Recovery After Surgery Protocol and Outcomes After Colorectal Cancer Surgery Ulf O. Gustafsson, MD, PhD; Jonatan Hausel, MD; Anders Thorell, MD,
More informationSmall Bowel and Colon Surgery
Small Bowel and Colon Surgery Why Do I Need a Small Bowel Resection? A variety of conditions can damage your small bowel. In severe cases, your doctor may recommend removing part of your small bowel. Conditions
More informationRepeat Single Incision Laparoscopic Surgery after Primary Single Incision Laparoscopic Surgery for Colorectal Disease
ORIGINAL ARTICLE pissn 2234-778X eissn 2234-5248 J Minim Invasive Surg 2018;21(1):38-42 Journal of Minimally Invasive Surgery Repeat Single Incision Laparoscopic Surgery after Primary Single Incision Laparoscopic
More informationDemographics. MBSAQIP Case Number: *ACS NSQIP Case Number: *LMRN: *DOB: / / *Gender: Male Female
Demographics MBSAQIP Case Number: *IDN: *ACS NSQIP Case Number: Name: *LMRN: *DOB: / / *Gender: Male Female *Race: White Black or African American American Indian or Alaska Native Native Hawaiian/Other
More informationNutrition in the perioperative period Topic 17
Nutrition in the perioperative period Topic 17 Module 17.1 Metabolic Responses to Surgical Stress Olle Ljungqvist Learning Objectives Understand how the body reacts to injury and surgery; Have knowledge
More information