Multimodal protocols such as Acceleration of Total Postoperative Recovery and Enhanced Recovery After Surgery propose a set of pre- and post-operative care to accelerate the recovery of surgical patients. However, in clinical practice, simple care such as early refeeding and use of drains are often neglected by multidisciplinary teams.
Investigate whether early postoperative refeeding determines benefits in colorectal oncological surgery; whether the patients’ clinical conditions preoperatively and the use of a nasogastric tube and abdominal drain delay their recovery.
Retrospective cohort carried out at the Cascavel Uopeccan Cancer Hospital, including adult cancer patients (age ≥18 years), from the Unified Health System (SUS), who underwent colorectal surgeries from January 2018 to December 2021.
275 patients were evaluated. Of these, 199 (75.4%) were refed early. Late refeeding (odds ratio — OR=2.1; p=0.024), the use of nasogastric tube (OR=2.72; p=0.038) and intra-abdominal drain (OR=1.95; p=0.054) increased the chance of infectious complication. Multivariate analysis showed that receiving a late postoperative diet is an independent risk factor for infectious complications. Late refeeding (p=0.006) after the operation and the placement of an intra-abdominal drain (p=0.007) are independent risk factors for remaining hospitalized for more than five days postoperatively.
Refeeding early in the postoperative period reduces the risk of infectious complications. Using abdominal drains and refeeding late (>48h) for cancer patients undergoing colorectal surgery are risk factors for hospital stays longer than five days.
INTRODUCTION: Fasting in the night before elective surgery has been established to prevent pulmonary complications, vomiting, regurgitation and aspiration of gastric contents. The year of 2005 was developed the project ACERTO. It consists in a multidisciplinary team that aims to recover the surgical patient by administering two our six hours before surgery, a carbohydrate-rich beverage (12.5% dextrinomaltose). The multidisciplinary team consists of anesthesiologists, surgeons, nutritionists, nurses and physiotherapists. METHODS: Literature review of preoperative fasting conducted during September and October of 2011 in Scielo and PubMed. CONCLUSION: Reducing the time of preoperative fasting with high carbohydrate solution until two hours before the operation as early feeding postoperatively, bring numerous benefits to the patient. The ACERTO project has shown good results and these new behaviors should be encouraged, thereby reducing the recovery time of the surgical patient.
After the publication of the first recommendations of ERAS Society regarding colonic surgery, the proposal of surgical stress reduction, maintenance of physiological functions and optimized recovery was expanded to other surgical specialties, with minimal variations.
To analyze the implementation of ERAS protocols for liver surgery in a tertiary center.
Fifty patients that underwent elective hepatic surgery were retrospectively evaluated, using medical records data, from June 2014 to August 2016. After September 2016, 35 patients were prospectively evaluated and managed in accordance with ERAS protocol.
There was no difference in age, type of hepatectomy, laparoscopic surgery and postoperative complications between the groups. In ERAS group, it was observed a reduction in preoperative fasting and in the length of hospital stay by two days (p< 0.001). Carbohydrate loading, j-shaped incision, early oral feeding, postoperative prevention of nausea and vomiting and early mobilization were also significantly related to ERAS group. Oral bowel preparation, pre-anesthetic medication, sub-costal incision, prophylactic nasogastric intubation and abdominal drainage were more common in control group.
Implementation of ERAS protocol is feasible and beneficial for health institutions and patients, without increasing morbidity and mortality.
HEADINGS:
Hepatectom, Length of Sta, Recovery of Functio, Postoperative Care,
Desenvolvido por Surya MKT