Risk factors for unfavourable postoperative outcome in patients with Crohn's disease undergoing right hemicolectomy or ileocaecal resection An international audit by ESCP and S-ECCO

Background Patient and disease-related factors, as well as operation technique all have the potential to impact on postoperative outcome in Crohn's disease. The available evidence is based on small series and often displays conflicting results. Aim To investigate the effect of pre- and intra-operative risk factors on 30-day postoperative outcome in patients undergoing surgery for Crohn's disease. Method International prospective snapshot audit including consecutive patients undergoing right hemicolectomy or ileocaecal resection. This study analysed a subset of patients who underwent surgery for Crohn's disease. The primary outcome measure was the overall Clavien-Dindo postoperative complication rate. The key secondary outcomes were anastomotic leak, re-operation, surgical site infection and length of stay at hospital. Multivariable binary logistic regression analyses were used to produce odds ratios (OR) and 95% confidence intervals (CI). Results Three hundred and seventy five resections in 375 patients were included. The median age was 37 and 57.1% were female. In multivariate analyses, postoperative complications were associated with preoperative parenteral nutrition (OR 2.36 95% CI 1.10-4.97)], urgent/expedited surgical intervention (OR 2.00, 95% CI 1.13-3.55) and unplanned intraoperative adverse events (OR 2.30, 95% CI 1.20-4.45). The postoperative length of stay in hospital was prolonged in patients who received preoperative parenteral nutrition (OR 31, CI [1.08-1.61]) and those who had urgent/expedited operations (OR 1.21, CI [1.07-1.37]). Conclusion Preoperative parenteral nutritional support, urgent/expedited operation and unplanned intraoperative adverse events were associated with unfavourable postoperative outcome. Enhanced preoperative optimization and improved planning of operation pathways and timings may improve outcomes for patients

O que dizem os enfermeiros sobre observação Lo que dicen los enfermeros sobre observación What nurses say about observation

Este estudo teve por objetivo caracterizar o que os enfermeiros docentes e assistenciais entendem por Observação na sua atuação profissional. Foram realizadas entrevistas com 11 profissionais, e para análise os dados foram agrupados em categorias. Foi possível identificar a importância que lhe atribuem, como instrumento essencial na administração da assistência de enfermagem, no levantamento de dados no planejamento das intervenções assim como na avaliação dos resultados.<br>Este estudio tuvo como objetivo caracterizar lo que los enfermeros docentes y asistenciales entienden por Observación en su ámbito profesional. Fueron realizadas entrevistas con once profesionales, para analizar los datos fueron agrupados en categorías. Fue posible identificar la importancia que le atribuyen como instrumento escencial en la administración de la asistencia de enfermería, en la obtención de datos para planear las intervenciones, asi como en la evaluación de los resultados.<br>The purpose of this study was to characterize what faculty and clinical nurses understand about Observation at their professional activities. Eleven nurses were interviewed, and the data were joined in categories in order to be analized. It was possible to realize that they regard it with extreme importance at their professional activities, as an essential instrument of nursing care administration, assessment, planning interventions and evaluating results

Risk factors for unfavourable postoperative outcome in patients with Crohn's disease undergoing right hemicolectomy or ileocaecal resection An international audit by ESCP and S-ECCO

Aim: Patient- and disease-related factors, as well as operation technique, all have the potential to impact on postoperative outcome in Crohn's disease. The available evidence is based on small series and often displays conflicting results. The aim was to investigate the effect of preoperative and intra-operative risk factors on 30-day postoperative outcome in patients undergoing surgery for Crohn's disease. Method: This was an international prospective snapshot audit including consecutive patients undergoing right hemicolectomy or ileocaecal resection. The study analysed a subset of patients who underwent surgery for Crohn's disease. The primary outcome measure was the overall Clavien–Dindo postoperative complication rate. The key secondary outcomes were anastomotic leak, reoperation, surgical site infection and length of stay in hospital. Multivariable binary logistic regression analyses were used to produce odds ratios and 95% confidence intervals. Results: In all, 375 resections in 375 patients were included. The median age was 37 and 57.1% were women. In multivariate analyses, postoperative complications were associated with preoperative parenteral nutrition (OR 2.36, 95% CI 1.10–4.97), urgent/expedited surgical intervention (OR 2.00, 95% CI 1.13–3.55) and unplanned intra-operative adverse events (OR 2.30, 95% CI 1.20–4.45). The postoperative length of stay in hospital was prolonged in patients who received preoperative parenteral nutrition (OR 31, 95% CI 1.08–1.61) and those who had urgent/expedited operations (OR 1.21, 95% CI 1.07–1.37). Conclusion: Preoperative parenteral nutritional support, urgent/expedited operation and unplanned intra-operative adverse events were associated with unfavourable postoperative outcome. Enhanced preoperative optimization and improved planning of operation pathways and timings may improve outcomes for patients. Colorectal Disease © 2017 The Association of Coloproctology of Great Britain and Irelan