Perioperative care multimodal protocol significantly improve outcome in surgery.<\/p>\n\n\n\n
To investigate risk factors to various endpoints in patients submitted to elective colorectal operations under the ACERTO protocol.<\/p>\n\n\n\n
Cohort study analyzing through a logistic regression model able to assess independent risk factors for morbidity and mortality, patients submitted to elective open colon and\/or rectum resection and primary anastomosis who were either exposed or non-exposed to demographic, clinical, and ACERTO interventions.<\/p>\n\n\n\n
Two hundred thirty four patients were analyzed and submitted to 156 (66.7%) rectal and 78 (33.3%) colonic procedures. The length of hospital postoperative stay (LOS) \u2265 7 days was related to rectal surgery and high NNIS risk index; preoperative fasting \u22644 h (OR=0.250; CI95=0.114-0.551) and intravenous volume of crystalloid infused > 30ml\/kg\/day (OR=0.290; CI95=0.119-0.706). The risk of postoperative site infection (SSI) was approximately four times greater in malnourished; eight in rectal surgery and four in high NNIS index. The duration of preoperative fasting \u22644 h was a protective factor by reducing by 81.3% the risk of surgical site infection (SSI). An increased risk for anastomotic fistula was found in malnutrition, rectal surgery and high NNIS index. Conversely, preoperative fasting \u22644 h (OR=0.11; CI95=0.05-0.25; p<0.0001) decreased the risk of fistula. Factors associated with pneumonia-atelectasis were cancer and rectal surgery, while preoperative fasting \u2264 4 h (OR=0.10; CI95=0.04-0.24; p<0.0001) and intravenous crystalloid \u2264 30 ml\/kg\/day (OR=0.36; CI95=0.13-0.97, p=0.044) shown to decrease the risk. Mortality was lower with preoperative fasting \u22644 h and intravenous crystalloids infused \u226430 ml\/kg\/day.<\/p>\n\n\n\n
This study allows to conclude that rectal procedures, high NNIS index, preoperative fasting higher than 4 h and intravenous fluids greater than 30 ml\/kg\/day during the first 48 h after surgery are independent risk factors for: 1) prolonged LOS; 2) surgical site infection and anastomotic fistula associated with malnutrition; 3) postoperative pneumonia-atelectasis; and 4) postoperative mortality.<\/p>","protected":false},"excerpt":{"rendered":"
Background: Perioperative care multimodal protocol significantly improve outcome in surgery. Aim: To investigate risk factors to various endpoints in patients submitted to elective colorectal operations under the ACERTO protocol. Methods: Cohort study analyzing through a logistic regression model able to assess independent risk factors for morbidity and mortality, patients submitted to elective open colon and\/or […]<\/p>","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[9],"tags":[297,594,618,619,30,620,412],"class_list":["post-2367","post","type-post","status-publish","format-standard","hentry","category-original-article","tag-colorectal-surgery","tag-mortality","tag-multimodal-treatment","tag-postoperative-care-2","tag-postoperative-complications","tag-preoperative-care","tag-risk-factors"],"acf":[],"modified_by":"Doris","_links":{"self":[{"href":"https:\/\/revistaabcd.org.br\/pt-br\/wp-json\/wp\/v2\/posts\/2367"}],"collection":[{"href":"https:\/\/revistaabcd.org.br\/pt-br\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/revistaabcd.org.br\/pt-br\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/revistaabcd.org.br\/pt-br\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/revistaabcd.org.br\/pt-br\/wp-json\/wp\/v2\/comments?post=2367"}],"version-history":[{"count":0,"href":"https:\/\/revistaabcd.org.br\/pt-br\/wp-json\/wp\/v2\/posts\/2367\/revisions"}],"wp:attachment":[{"href":"https:\/\/revistaabcd.org.br\/pt-br\/wp-json\/wp\/v2\/media?parent=2367"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/revistaabcd.org.br\/pt-br\/wp-json\/wp\/v2\/categories?post=2367"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/revistaabcd.org.br\/pt-br\/wp-json\/wp\/v2\/tags?post=2367"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}