2 research outputs found
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
- Author
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- Zammit M.
- Zapolskiy A.
- Zawadzki M.
- Zerpa Martin C.
- Zimmerman D.
- Zmora O.
- Zmora O.
- Publication venue
- 'Wiley'
- Publication date
- 15/09/2017
- Field of study
Get PDFAim: 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\u2013Dindo 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\u20134.97), urgent/expedited surgical intervention (OR 2.00, 95% CI 1.13\u20133.55) and unplanned intra-operative adverse events (OR 2.30, 95% CI 1.20\u20134.45). The postoperative length of stay in hospital was prolonged in patients who received preoperative parenteral nutrition (OR 31, 95% CI 1.08\u20131.61) and those who had urgent/expedited operations (OR 1.21, 95% CI 1.07\u20131.37). 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
Outcomes from elective colorectal cancer surgery during the SARSâCoVâ2 pandemic
- Author
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- Provozina A
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- Qatora MS
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- Qureshi A
- Qureshi Ahmad
- R\uedo Lafuente FD
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- Rai L
- Rajaretnam N
- Rakvin I
- Ramachandran A
- Ramamoorthy R
- Ramcharan S
- Ramesh P
- Ramirez Faraco M
- Ramos Bonilla A
- Ramos\u2010De la Medina Antonio
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- Ramwell A
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- Rashid A
- Rashid MM
- Rasoaherinomenjanahary F
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- Ravindrakumar S
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- Rossi S
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- Royle T
- Rubio\u2010Perez I
- Ruivo A
- Ruiz Escobar A
- Ruiz Soriano M
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- Ruteg\ue5rd M
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- Ryan \uc9
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- Ryska O
- S\ue1nchez del Pueblo C
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- Sallam I
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- Santos R
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- Sapienza P
- Sapre D
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- Sarantitis I
- Sarigul M
- Sarin A
- Sarjanoja E
- Sarma DR
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- Scalabre A
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- Scotton G
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- Seebah K
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- Serevina OL
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- Shortland T
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- Silva N
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- Smart Neil J
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- Tebala GD
- Teixeira J
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- Townend D
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- Tribillon E
- Troncoso Pereira P
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- Trujillo D\uedaz J
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- Tsiamalou I
- Tsiaoussis I
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- Vaccarella G
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- Vallance Abigail
- Vallance Abigail
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- van Ramshorst Gabrielle H
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- Vidya Raghavan
- Vieira Caro\ue7o T
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- Vieira A
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- Villalabeitia Ateca I
- Vimalachandran D
- Vimalachandran Dale
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- Vimalchandran Dale
- Violante T
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- Vitali A
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- Yetkin SG
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- Yousof EA
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- Zafar SN
- Zakaria AD
- Zakaria Z
- Zambon M
- Zanus G
- Zegarac M
- Zeli\u107 M
- Zengin AK
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- Zervas K
- Zese M
- Zhang H
- Zizzo M
- Zografos C
- Zorrilla Ort\ufazar J
- Zourntou S
- Zubaidi AM
- Publication venue
- 'Wiley'
- Publication date
- 01/01/2020
- Field of study
Get PDFAim
This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic.
Method
This was an international cohort study of patients undergoing elective resection of colon or rectal cancer without preoperative suspicion of SARS-CoV-2. Centres entered data from their first recorded case of COVID-19 until 19 April 2020. The primary outcome was 30-day mortality. Secondary outcomes included anastomotic leak, postoperative SARS-CoV-2 and a comparison with prepandemic European Society of Coloproctology cohort data.
Results
From 2073 patients in 40 countries, 1.3% (27/2073) had a defunctioning stoma and 3.0% (63/2073) had an end stoma instead of an anastomosis only. Thirty-day mortality was 1.8% (38/2073), the incidence of postoperative SARS-CoV-2 was 3.8% (78/2073) and the anastomotic leak rate was 4.9% (86/1738). Mortality was lowest in patients without a leak or SARS-CoV-2 (14/1601, 0.9%) and highest in patients with both a leak and SARS-CoV-2 (5/13, 38.5%). Mortality was independently associated with anastomotic leak (adjusted odds ratio 6.01, 95% confidence interval 2.58â14.06), postoperative SARS-CoV-2 (16.90, 7.86â36.38), male sex (2.46, 1.01â5.93), age >70 years (2.87, 1.32â6.20) and advanced cancer stage (3.43, 1.16â10.21). Compared with prepandemic data, there were fewer anastomotic leaks (4.9% versus 7.7%) and an overall shorter length of stay (6 versus 7 days) but higher mortality (1.7% versus 1.1%).
Conclusion
Surgeons need to further mitigate against both SARS-CoV-2 and anastomotic leak when offering surgery during current and future COVID-19 waves based on patient, operative and organizational risks
