FACTORS RELATED TO THE REDUCTION OF THE RISK OF COMPLICATIONS IN COLORECTAL SURGERY WITHIN PERIOPERATIVE CARE RECOMMENDED BY THE ACERTO PROTOCOL

FACTORS RELATED TO THE REDUCTION OF THE RISK OF COMPLICATIONS IN COLORECTAL SURGERY WITHIN PERIOPERATIVE CARE RECOMMENDED BY THE ACERTO PROTOCOL

Perioperative care multimodal protocol significantly improve outcome in surgery. To investigate risk factors to various endpoints in patients submitted to elective colorectal operations under the ACERTO protocol. Cohort study analyzing through a logistic regression model able to assess independent r...

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Published in:Arquivos brasileiros de cirurgia digestiva : ABCD Vol. 32; no. 4; p. e1477
Main Authors: Bicudo-Salomão, Alberto, Salomão, Rosana de Freitas, Cuerva, Mariani Parra, Martins, Michelle Santos, Dock-Nascimento, Diana Borges, Aguilar-Nascimento, José Eduardo de
Format: Journal Article
Language:English
Published: Brazil Colégio Brasileiro de Cirurgia Digestiva 01-01-2019
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Cohort Studies
Colorectal surgery
Colorectal Surgery - adverse effects
Colorectal Surgery - methods
Female
Guideline Adherence - statistics & numerical data
Humans
Length of Stay
Male
Middle Aged
Mortality
Multimodal treatment
Original
Perioperative Care - methods
Postoperative care
Postoperative complications
Postoperative Complications - prevention & control
Preoperative care
Prospective Studies
Risk Factors
Young Adult
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Summary:Perioperative care multimodal protocol significantly improve outcome in surgery. To investigate risk factors to various endpoints in patients submitted to elective colorectal operations under the ACERTO protocol. 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. 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) ≥ 7 days was related to rectal surgery and high NNIS risk index; preoperative fasting ≤4 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 ≤4 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 ≤4 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 ≤ 4 h (OR=0.10; CI95=0.04-0.24; p<0.0001) and intravenous crystalloid ≤ 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 ≤4 h and intravenous crystalloids infused ≤30 ml/kg/day. 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.
Bibliography:Conflict of interest: none
ISSN:0102-6720
2317-6326
DOI:10.1590/0102-672020190001e1477