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Mineccia M, Valenti A, Massucco P, Dagatti S, Perotti S, Fazio F, Ferrero A. How to dramatically reduce dehydration-related readmission in patients undergoing restorative surgery with diverting ileostomy for ulcerative colitis. Tech Coloproctol 2024; 28:129. [PMID: 39306805 DOI: 10.1007/s10151-024-03001-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 08/09/2024] [Indexed: 10/23/2024]
Abstract
BACKGROUND Patients affected by ulcerative colitis (UC) often require surgery, involving two or three-stage procedures, including ileostomy creation. While ileostomy has some advantages, it can lead to complications, such as dehydration. The aim of this study was to evaluate the impact of a new individualized stoma-therapeutic-care-pathway (STCP) on dehydration-related readmissions. Secondary endpoints were stoma-related complications. METHODS The study compares two series of consecutive patients with UC undergoing diverting ileostomy during restorative ileo-pouch-anal-anastomosis. The STCP group consists of patients enrolled from January 2020 to December 2021 who followed the pathway. The older group was selected from 2015 to 2017 (control group). Clinical data were collected, including patient characteristics, hospital stay, complications, and readmissions. The study was approved by the local institutional review board. RESULTS Overall, 30-day dehydration-related readmission occurred in one (1.4%) versus nine (15.3%) patients in the STCP group versus control group, respectively (p = 0.005). In-hospital peristomal skin complications were significantly lower in STCP group (6 patients, 8.5%) versus control (35, 59.3%), as well as ostomy complications that occurred in 5 (7%) patients in the STCP group versus 8 (13.5%) in the control group (both p < 0.001). Ostomy complications reduced significantly in the STCP group after discharge (two patients, 2.8% versus eight, 13.5%), p = 0.001, and after 30-days (three patients, 4.2% versus five, 8.5%). CONCLUSIONS This study underscores the effectiveness of STCP in reducing dehydration-related readmissions and stoma-related complications in patients with UC undergoing stoma creation. It emphasizes the significance of patient education, close follow-up, and multidisciplinary care. Further research and standardized stoma education are essential.
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Affiliation(s)
- M Mineccia
- Department of Chirurgia Generale E Oncologica, Ospedale Mauriziano Umberto I, Largo Turati 62, 10100, Turin, Italy.
| | - A Valenti
- Department of Chirurgia Generale E Oncologica, Ospedale Mauriziano Umberto I, Largo Turati 62, 10100, Turin, Italy
| | - P Massucco
- Department of Chirurgia Generale E Oncologica, Ospedale Mauriziano Umberto I, Largo Turati 62, 10100, Turin, Italy
| | - S Dagatti
- Department of Chirurgia Generale E Oncologica, Ospedale Mauriziano Umberto I, Largo Turati 62, 10100, Turin, Italy
- Division of Chirurgia Generale, ASL AT, Ospedale Cardinal Massaia, Corso Dante Alighieri 202, 14100, Asti, Italy
| | - S Perotti
- Department of Chirurgia Generale E Oncologica, Ospedale Mauriziano Umberto I, Largo Turati 62, 10100, Turin, Italy
| | - F Fazio
- Department of Chirurgia Generale E Oncologica, Ospedale Mauriziano Umberto I, Largo Turati 62, 10100, Turin, Italy
| | - A Ferrero
- Department of Chirurgia Generale E Oncologica, Ospedale Mauriziano Umberto I, Largo Turati 62, 10100, Turin, Italy
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Yuan J, Jiang F, Fu X, Hou Y, Hu Y, Yang Q, Liu L, Wang Y, Sheng W, Cao F, He J, Chen G, Peng C, Jiang W. Prospective nutrition-inflammation markers for predicting early stoma-related complications in patients with colorectal cancer undergoing enterostomy. Front Oncol 2024; 14:1409503. [PMID: 39246321 PMCID: PMC11377279 DOI: 10.3389/fonc.2024.1409503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 08/05/2024] [Indexed: 09/10/2024] Open
Abstract
Background Enterostomy is important for radical resection of colorectal cancer (CRC). Nevertheless, the notable occurrence of complications linked to enterostomy results in a reduction in patients' quality of life and impedes adjuvant therapy. This study sought to forecast early stoma-related complications (ESRCs) by leveraging easily accessible nutrition-inflammation markers in CRC patients. Methods This study involved 470 individuals with colorectal cancer who underwent intestinal ostomy at Changhai Hospital Affiliated with Naval Medical University as the internal cohort. Between January 2016 and December 2018, the patients were enrolled and randomly allocated into a primary training group and a secondary validation group, with a ratio of 2:1 being upheld. The research encompassed collecting data on each patient's clinical and pathological status, along with preoperative laboratory results. Independent risk factors were identified through Lasso regression and multivariate analysis, leading to the development of clinical models represented by a nomogram. The model's utility was assessed using decision curve analysis, calibration curve, and ROC curve. The final model was validated using an external validation set of 179 individuals from January 2015 to December 2021. Results Among the internal cohort, stoma complications were observed in 93 cases. Multivariate regression analysis confirmed that age, stoma site, and elevated markers (Mon, NAR, and GLR) in conjunction with diminished markers (GLB and LMR) independently contributed to an increased risk of ESRCs. The clinical model was established based on these seven factors. The training, internal, and external validation groups exhibited ROC curve areas of 0.839, 0.812, and 0.793, respectively. The calibration curve showed good concordance among the forecasted model with real incidence of ostomy complications. The model displayed outstanding predictive capability and is deemed applicable in clinical settings, as evidenced by Decision Curve Analysis. Conclusion This study identified nutrition-inflammation markers (GLB, NAR, and GLR) in combination with demographic data as crucial predictors for forecasting ESRCs in colorectal cancer patients. A novel prognostic model was formulated and validated utilizing these markers.
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Affiliation(s)
- Jie Yuan
- Department of Health Management, Beidaihe Rehabilitation and Recuperation Center of the Chinese People's Liberation Army, Qinhuangdao, China
- Department of Colorectal Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Fan Jiang
- Department of Health Management, Beidaihe Rehabilitation and Recuperation Center of the Chinese People's Liberation Army, Qinhuangdao, China
| | - Xiaochao Fu
- Department of Health Management, Beidaihe Rehabilitation and Recuperation Center of the Chinese People's Liberation Army, Qinhuangdao, China
| | - Yun Hou
- Department of Health Management, Beidaihe Rehabilitation and Recuperation Center of the Chinese People's Liberation Army, Qinhuangdao, China
| | - Yali Hu
- Department of Health Management, Beidaihe Rehabilitation and Recuperation Center of the Chinese People's Liberation Army, Qinhuangdao, China
| | - Qishun Yang
- Department of Health Management, Beidaihe Rehabilitation and Recuperation Center of the Chinese People's Liberation Army, Qinhuangdao, China
| | - Liyang Liu
- Department of Health Management, Beidaihe Rehabilitation and Recuperation Center of the Chinese People's Liberation Army, Qinhuangdao, China
| | - Yufu Wang
- Department of Health Management, Beidaihe Rehabilitation and Recuperation Center of the Chinese People's Liberation Army, Qinhuangdao, China
| | - Wangwang Sheng
- Department of Colorectal Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
- Neuroendocrine Department, 72nd Group Army Hospital, Huzhou University, Huzhou, Zhejiang, China
| | - Fuao Cao
- Department of Colorectal Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Jinghu He
- Department of Colorectal Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
- Depatrment of General Surgery, Shanghai Rongtong 411 Hospital, Shanghai, China
| | - Guanglei Chen
- Department of Health Management, Beidaihe Rehabilitation and Recuperation Center of the Chinese People's Liberation Army, Qinhuangdao, China
| | - Cheng Peng
- Department of Health Management, Beidaihe Rehabilitation and Recuperation Center of the Chinese People's Liberation Army, Qinhuangdao, China
| | - Wei Jiang
- Department of Health Management, Beidaihe Rehabilitation and Recuperation Center of the Chinese People's Liberation Army, Qinhuangdao, China
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Yi X, Yang H, Li H, Feng X, Liao W, Lin J, Chen Z, Diao D, Ouyang M. Analysis of decision-making factors for defunctioning ileostomy after rectal cancer surgery and their impact on perioperative recovery: a retrospective study of 1082 patients. Surg Endosc 2024:10.1007/s00464-024-11149-3. [PMID: 39160312 DOI: 10.1007/s00464-024-11149-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 08/04/2024] [Indexed: 08/21/2024]
Abstract
OBJECTIVE To explore the decision-making factors for defunctioning ileostomy (DI) after rectal cancer surgery and to analyze the impact of the DI on perioperative outcomes. METHODS A retrospective case-control study was conducted that included rectal cancer patients who underwent low anterior resection from January 2013 to December 2023. Among them, 33 patients did not undergo DI but with anastomotic leakage (AL) after surgery, and 1030 patients were without AL. Preoperative, operative and tumor factors between these two groups were compared to explore the decision-making factors for DI. Meanwhile, the differences of perioperative outcomes between the DI group of 381 cases and non-DI group of 701 cases were compared. RESULTS For preoperative factors, the proportions of male patients and preoperative chemoradiotherapy (CRT) in the AL with non-DI group were greater than those in the non-AL group (p < 0.05); for operative factors, the proportion of patients in the AL with non-DI group with a surgical time > 180 min were greater (p < 0.05); for tumor factors, the proportion of T3-4 stage was higher in the AL with non-DI group (p < 0.05). Multiple regression analysis revealed that male sex and preoperative CRT were the independent risk factors affecting DI. For perioperative outcomes, the DI did not reduce the incidence of all and symptomatic AL and non-AL postoperative complications (p > 0.05) but with 12.07% stoma-related complications, and increase hospitalization costs (p < 0.05); however, it can shorten the postoperative hospital stay, pelvic drainage tube removal time, and reduce the anal tube placement rate and readmission rate (all p < 0.05). CONCLUSION Male patients and preoperative CRT were the independent risk factors affect the decision of DI in our study, and DI can shorten the postoperative hospitalization, pelvic drainage tube removal time, and decrease the anal tube placement rate and readmission rate during the perioperative period but with a higher economic cost.
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Affiliation(s)
- Xiaojiang Yi
- Department of Gastrointestinal Surgery, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Shunde, Foshan, 528300, Guangdong, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510080, Guangdong, China
- Department of Gastrointestinal Surgery, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, Guangdong, China
| | - Huaguo Yang
- First Department of General Surgery, Luzhou Hospital of Traditional Chinese Medicine, Luzhou, 646000, Sichuan, China
| | - Hongming Li
- Department of Gastrointestinal Surgery, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, Guangdong, China
| | - Xiaochuang Feng
- Department of Gastrointestinal Surgery, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, Guangdong, China
| | - Weilin Liao
- Department of Gastrointestinal Surgery, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, Guangdong, China
| | - Jiaxin Lin
- Department of Gastrointestinal Surgery, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, Guangdong, China
| | - Zhifeng Chen
- Department of Hepatobiliary Gastrointestinal Thyroid Surgery, Meizhou Hospital of Traditional Chinese Medicine, Meizhou, 514000, Guangdong, China
| | - Dechang Diao
- Department of Gastrointestinal Surgery, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, Guangdong, China.
| | - Manzhao Ouyang
- Department of Gastrointestinal Surgery, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde Foshan), Shunde, Foshan, 528300, Guangdong, China.
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510080, Guangdong, China.
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Shu XP, Lv Q, Li ZW, Liu F, Liu XR, Li LS, Tong Y, Liu XY, Wang CY, Peng D, Cheng Y. Does one-stitch method of temporary ileostomy affect the stoma-related complications after laparoscopic low anterior resection in rectal cancer patients? Eur J Med Res 2024; 29:403. [PMID: 39095909 PMCID: PMC11297555 DOI: 10.1186/s40001-024-01995-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 07/22/2024] [Indexed: 08/04/2024] Open
Abstract
PURPOSE This current study attempted to investigate whether one-stitch method (OM) of temporary ileostomy influenced the stoma-related complications after laparoscopic low anterior resection (LLAR). METHODS We searched for eligible studies in four databases including PubMed, Embase, Cochrane Library, and CNKI from inception to July 20, 2023. Both surgical outcomes and stoma-related complications were compared between the OM group and the traditional method (TM) group. The Newcastle-Ottawa Scale (NOS) was adopted for quality assessment. RevMan 5.4 was conducted for data analyzing. RESULTS Totally 590 patients from six studies were enrolled in this study (272 patients in the OM group and 318 patients in the TM group). No significant difference was found in baseline information (P > 0.05). Patients in the OM group had shorter operative time in both the primary LLAR surgery (MD = - 17.73, 95%CI = - 25.65 to - 9.80, P < 0.01) and the stoma reversal surgery (MD = - 18.70, 95%CI = - 22.48 to -14.92, P < 0.01) than patients in the TM group. There was no significant difference in intraoperative blood loss of the primary LLAR surgery (MD = - 2.92, 95%CI = - 7.15 to 1.32, P = 0.18). Moreover, patients in the OM group had fewer stoma-related complications than patients in the TM group (OR = 0.55, 95%CI = 0.38 to 0.79, P < 0.01). CONCLUSION The OM group had shorter operation time in both the primary LLAR surgery and the stoma reversal surgery than the TM group. Moreover, the OM group had less stoma-related complications.
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Affiliation(s)
- Xin-Peng Shu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Quan Lv
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Zi-Wei Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Fei Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xu-Rui Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Lian-Shuo Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yue Tong
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xiao-Yu Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Chun-Yi Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Dong Peng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yong Cheng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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de la Motte L, Nordenvall C, Martling A, Buchli C. Preoperative use of angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers and diuretics increases the risk of dehydration after ileostomy formation: population-based cohort study. BJS Open 2024; 8:zrae051. [PMID: 38818959 PMCID: PMC11140823 DOI: 10.1093/bjsopen/zrae051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 04/07/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Readmission rates following ileostomy formation are high. Dehydration and consecutive renal failure are common causes of readmission, potentially pronounced by drugs affecting the homeostasis. The aim of the study was to assess the risk of dehydration after ileostomy formation in patients treated with angiotensin-converting enzyme inhibitors (ACEI), angiotensin II receptor blockers (ARB) or diuretics. METHOD This nationwide population-based cohort study used data derived from the Colorectal Cancer Data Base of several Swedish healthcare registers. The study included all patients operated on with elective anterior resection and temporary ileostomy for rectal cancer clinically staged I-III in Sweden in 2007-2016. Exposure was at least two dispensations of ACEI, ARB or diuretics within 1 year prior to surgery. Outcome was 90-day readmission due to dehydration including acute renal failure. RESULTS In total, 3252 patients were included with 1173 (36.1%) exposed to ACEI, ARB or diuretics. The cumulative incidence for 90-day readmission due to dehydration was 29.0% (151 of 520) for exposed versus 13.8% (98 of 712) for unexposed. The proportion of readmissions due to any reason was 44.3% (520 of 1173) for exposed compared to 34.2% (712 of 2079) for unexposed. The incidence rate ratio for readmission due to dehydration was 2.83 (95% c.i. 2.21 to 3.63, P < 0.001). The hazard rate ratio was 2.45 (95% c.i. 1.83 to 3.27, P < 0.001) after adjusting for age, gender and comorbidity. CONCLUSION Medication with ACEI, ARB or diuretics defines a vulnerable patient group with increased risk of readmission due to dehydration after ileostomy formation.
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Affiliation(s)
- Louise de la Motte
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Colorectal Surgery Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Caroline Nordenvall
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Colorectal Surgery Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Martling
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Colorectal Surgery Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Christian Buchli
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Colorectal Surgery Unit, Karolinska University Hospital, Stockholm, Sweden
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Kwik C, El-Khoury T, Pathma-Nathan N, Toh JWT. Endoscopic and trans-anal local excision vs. radical resection in the treatment of early rectal cancer: A systematic review and network meta-analysis. Int J Colorectal Dis 2023; 39:13. [PMID: 38157077 DOI: 10.1007/s00384-023-04584-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE The management of early-stage rectal cancer in clinical practice is controversial. The aim of this network meta-analysis was to compare oncological and postoperative outcomes for T1T2N0M0 rectal cancers managed with local excision in comparison to conventional radical resection. METHODS A systematic review of Medline, Embase and Cochrane electronic databases was performed. Relevant studies were selected using PRISMA guidelines. The primary outcomes measured were 5-year local recurrence and overall survival. Secondary outcomes included rates of postoperative complication, 30-day mortality, positive margin and permanent stoma formation. RESULTS Three randomized controlled trials and 27 observational studies contributed 8570 patients for analysis. Radical resection was associated with reduced 5-year local recurrence in comparison to local excision. This was statistically significant in comparison to trans-anal local excision (odds ratio (OR) 0.23; 95% confidence interval 0.16-0.30) and favourable in comparison to endoscopic techniques (OR 0.40; 95% confidence interval 0.13-1.23) although this did not reach clinical significance. Positive margin rates were lowest for radical resection. However, 30-day mortality rates, perioperative complications and permanent stoma rates all favoured local excision with no statistically significant difference between endoscopic and trans-anal techniques. CONCLUSION Radical resection of early rectal cancer is associated with the lowest 5-year local recurrence rates and the lowest rate of positive margins. However, this must be balanced with its higher 30-day mortality and complication rates as well as the increased risk of permanent stoma. The emerging potential role of neoadjuvant therapy prior to local resection, and the heterogeneity of its use, as an alternative treatment for early rectal cancer further complicates the treatment paradigm and adds to controversy in this field.
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Affiliation(s)
- Charlotte Kwik
- Department of Colorectal Surgery, Westmead Hospital, Cnr Hawkesbury Road and Darcy Road, Westmead, NSW, Australia.
| | - Toufic El-Khoury
- Department of Colorectal Surgery, Westmead Hospital, Cnr Hawkesbury Road and Darcy Road, Westmead, NSW, Australia
| | - Nimalan Pathma-Nathan
- Department of Colorectal Surgery, Westmead Hospital, Cnr Hawkesbury Road and Darcy Road, Westmead, NSW, Australia
| | - James Wei Tatt Toh
- Department of Colorectal Surgery, Westmead Hospital, Cnr Hawkesbury Road and Darcy Road, Westmead, NSW, Australia.
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
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Zhang Q, Sun J, Wang D, Wang Q, Hu H. Knowledge, attitudes, practices and associated factors regarding high output stoma of ileostomy among colorectal surgical nurses: a multicentre cross-sectional study. Support Care Cancer 2023; 32:12. [PMID: 38060050 DOI: 10.1007/s00520-023-08228-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/01/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE High output stoma(HOS) is one of the most common complications after ileostomy, leading to fluid and electrolyte disturbances and renal dysfunction, and increasing the risk of readmission. Routine health education for HOS should be provided, and nurses, as the primary educators, should have adequate knowledge and skills in this area. However, there is a paucity of research on the knowledge and practice of HOS management. This study used the Knowledge, Attitude and Behavioural Practice Model to assess the management of HOS by colorectal surgery nurses and to explore the factors that influence it. METHOD Using a multi-centre, cross-sectional study design, 398 colorectal surgery nurses from 6 hospitals in 6 cities in 6 provinces were surveyed using a structured electronic questionnaire to assess general information and knowledge, attitudes and management practices and training needs related to HOS of ileostomy. RESULTS Colorectal surgery nurses' knowledge and practice of HOS was low. The presence or absence of training is an important factor influencing nurses' knowledge, attitudes and practice, with most nurses having no training and stoma specialist nurses scoring relatively high on knowledge and practice. CONCLUSIONS Nurses play a very important role in the management of HOS, but this study shows that the current level of knowledge and practice of HOS among colorectal surgery nurses is concerning, and whether or not they have received training is the most critical influencing factor; therefore, training related to HOS is urgently needed.
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Affiliation(s)
- Qing Zhang
- Department of Gastrocolorectal Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Jianan Sun
- Department of Gastrocolorectal Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Dongxue Wang
- Department of Gastrocolorectal Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Quan Wang
- Department of Gastrocolorectal Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Haiyan Hu
- Department of Gastrocolorectal Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, 130021, Jilin, China.
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8
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Dietz DW, Padula WV, Zheng H, Monson JRT, Pronovost PJ. Improving Value in Surgery: Opportunities in Rectal Cancer Care. A Surgical Perspective. Ann Surg 2023; 277:e1193-e1196. [PMID: 36538646 DOI: 10.1097/sla.0000000000005751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- David W Dietz
- Division of Colorectal Surgery, University Hospitals, Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - William V Padula
- Department of Pharmaceutical and Health Economics, School of Pharmacy, Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA
| | - Hanke Zheng
- Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, Los Angeles, CA
| | - John R T Monson
- Center for Colon and Rectal Surgery, Digestive Health and Surgery Institute, AdventHealth, Orlando, FL
| | - Peter J Pronovost
- Department of Anesthesia and Critical Care Medicine, School of Medicine, University Hospitals, Case Western Reserve University, Cleveland, OH
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9
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Sato H, Ota H, Munakata K, Matsuura Y, Fujii M, Wada N, Takiuchi D, Hama N, Takachi K, Yukawa M. Perioperative fluid management influences complication rates and length of hospital stay in the enhanced recovery after surgery (ERAS) protocol for patients with colorectal cancer. Surg Today 2023; 53:242-251. [PMID: 35933631 DOI: 10.1007/s00595-022-02568-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/18/2022] [Indexed: 01/28/2023]
Abstract
PURPOSE To evaluate the efficacy and safety of the enhanced recovery after surgery (ERAS) protocol and quantify the impact of each ERAS item on postoperative outcomes. METHODS We used a generalized linear model to compare 289 colorectal cancer patients treated with the ERAS protocol between June, 2015 and April, 2021, with 99 colorectal cancer patients treated with the conventional colorectal surgery pathway between April, 2014 and June, 2015. RESULTS The median length of hospital stay (LOHS) was significantly shorter in the ERAS group, at 9 days (range 3-104 days) vs. 14 days (range 4-44 days) (p < 0.001), but the complication rates (Clavien-Dindo grade 2 or more) were similar (16.6% vs. 22.2%; p = 0.227). However, in the ERAS group, the higher the compliance with ERAS items, the lower the complication rate and LOHS (both p < 0.001). Multiple regression analysis demonstrated that "Discontinuation of continuous intravenous infusion on POD1" and "Avoidance of fluid overload" were significantly associated with the LOHS (p < 0.001 and p = 0.008). CONCLUSION The ERAS protocol is safe and effective for elective colorectal cancer surgery, and compliance with the ERAS protocol contributes to shorter LOHS and fewer complications. Items related to perioperative fluid management had a crucial impact on these outcomes.
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Affiliation(s)
- Hiromichi Sato
- Department of Gastroenterological Surgery, Ikeda City Hospital, Ikeda, Japan
| | - Hirofumi Ota
- Department of Gastroenterological Surgery, Ikeda City Hospital, Ikeda, Japan.
| | - Koji Munakata
- Department of Gastroenterological Surgery, Ikeda City Hospital, Ikeda, Japan
| | - Yusuke Matsuura
- Department of Gastroenterological Surgery, Ikeda City Hospital, Ikeda, Japan
| | - Makoto Fujii
- Division of Health Sciences, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Noriko Wada
- Department of Gastroenterological Surgery, Ikeda City Hospital, Ikeda, Japan
| | - Daisuke Takiuchi
- Department of Gastroenterological Surgery, Ikeda City Hospital, Ikeda, Japan
| | - Naoki Hama
- Department of Gastroenterological Surgery, Ikeda City Hospital, Ikeda, Japan
| | - Kou Takachi
- Department of Gastroenterological Surgery, Ikeda City Hospital, Ikeda, Japan
| | - Masao Yukawa
- Department of General and Breast Surgery, Ikeda City Hospital, Ikeda, Japan
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Tsujinaka S, Suzuki H, Miura T, Sato Y, Shibata C. Obstructive and secretory complications of diverting ileostomy. World J Gastroenterol 2022; 28:6732-6742. [PMID: 36620340 PMCID: PMC9813931 DOI: 10.3748/wjg.v28.i47.6732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/04/2022] [Accepted: 11/26/2022] [Indexed: 12/19/2022] Open
Abstract
This review aimed to highlight the etiology, diagnosis, treatment, and prevention of obstructive and secretory complications associated with diverting ileostomy (DI). Obstructive complications at the stoma site are termed stoma outlet obstruction (SOO) or stoma-related obstruction (SRO). The incidence of SOO/SRO is 5.4%-27.3%, and the risk factors are multifactorial; however, the configuration of the stoma limb and the thickness of the rectus abdominis muscle (RAM) may be of particular concern. Trans-stomal tube decompression is initially attempted with a success rate of 33%-86%. A thick RAM may carry the risk of recurrence. Surgical refinement, including a wider incision of the anterior sheath and adequate stoma limb length, avoids tension and immobility and may decrease SOO/SRO. Secretory complications of DI are termed high output stoma (HOS). Persistent HOS lead to water and sodium depletion, and secondary hyperaldosteronism, resulting in electrolyte imbalances, such as hypomagnesemia. The incidence of HOS is 14%-24%, with an output of 1000-2000 mL/d lasting up to three days. Treatment of HOS is commenced after excluding postoperative complications or enteritis and includes fluid intake restriction, antimotility and antisecretory drug therapies, and magnesium supplementation. Intensive monitoring and surveillance programs have been successful in decreasing readmissions for dehydration.
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Affiliation(s)
- Shingo Tsujinaka
- Department of Gastroenterological Surgery, Tohoku Medical and Pharmaceutical University, Sendai 983-8536, Miyagi, Japan
| | - Hideyuki Suzuki
- Department of Gastroenterological Surgery, Tohoku Medical and Pharmaceutical University, Sendai 983-8536, Miyagi, Japan
| | - Tomoya Miura
- Department of Gastroenterological Surgery, Tohoku Medical and Pharmaceutical University, Sendai 983-8536, Miyagi, Japan
| | - Yoshihiro Sato
- Department of Gastroenterological Surgery, Tohoku Medical and Pharmaceutical University, Sendai 983-8536, Miyagi, Japan
| | - Chikashi Shibata
- Department of Gastroenterological Surgery, Tohoku Medical and Pharmaceutical University, Sendai 983-8536, Miyagi, Japan
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Mineccia M, Valenti A, Gonella F, Palisi M, Massucco P, Ricotti A, Ferrero A. A close adherence to a stoma-therapeutic pathway improves immediate stoma-related outcomes and reduces the length of hospital stay. Int J Colorectal Dis 2022; 37:1719-1725. [PMID: 35688952 DOI: 10.1007/s00384-022-04200-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE New stoma creation is related to a wide range of implications and stoma-related complications could occur frequently. The aim was to assess the impact of a close stoma-therapeutic-care pathway (STCP) in terms of length of stay, autonomy in the management of the pouch, readmission rate, and stoma-related complications. METHODS Patients undergoing surgery for colorectal disease and first stoma creation from January 2017 to December 2020 were analyzed. All patients enrolled had joined the Enhanced Recovery after Surgery (ERAS) protocol. RESULTS Among 143 enrolled, 56 (40%) did not completely follow the STCP (group A), whereas 87 (60%) demonstrated strict compliance (group B). The hospital stay lasted 8 days in group B and 11.5 in group A (p = 0.001). The first look at the stoma needed 1 day in group B and 3 days in group A (p < 0.001), emptying the pouch 2 days in group B and 5 days in group A (p < 0.001). Finally, the ability to change the pouch was 3 days in group B and 6 days in group A (p < 0.001). Nine (16.1%) stoma-related complications were counted in group A and 16 (18.4%) in group B, and 30-day readmission was 10.1% in group B and 11.5% in group A (p = 0.82 and p = 1, respectively, not significant). CONCLUSIONS The STCP has been shown to reduce the hospital stay and to have a protective role making the patient autonomous in the management of the stoma.
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Affiliation(s)
- Michela Mineccia
- Department of Chirurgia Generale E Oncologica, Ospedale Mauriziano Umberto I, Largo Turati 62, 10100, Turin, Italy.
| | - Antonio Valenti
- Department of Chirurgia Generale E Oncologica, Ospedale Mauriziano Umberto I, Largo Turati 62, 10100, Turin, Italy
| | - Federica Gonella
- Department of Chirurgia Generale E Oncologica, Ospedale Mauriziano Umberto I, Largo Turati 62, 10100, Turin, Italy
| | - Marco Palisi
- Department of Chirurgia Generale E Oncologica, Ospedale Mauriziano Umberto I, Largo Turati 62, 10100, Turin, Italy
| | - Paolo Massucco
- Department of Chirurgia Generale E Oncologica, Ospedale Mauriziano Umberto I, Largo Turati 62, 10100, Turin, Italy
| | - Andrea Ricotti
- Clinical Trial Unit, Ospedale Mauriziano Umberto I, Largo Turati 62, 10100, Turin, Italy
| | - Alessandro Ferrero
- Department of Chirurgia Generale E Oncologica, Ospedale Mauriziano Umberto I, Largo Turati 62, 10100, Turin, Italy
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