Annals of the Royal College of Surgeons of England
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Ann R Coll Surg Engl · Jan 2012
Paediatric admissions to the British military hospital at Camp Bastion, Afghanistan.
International humanitarian law requires emergency medical support for both military personnel and civilians, including children. Here we present a detailed review of paediatric admissions with the pattern of injury and the resources they consume. ⋯ Paediatric admissions make up a small but significant part of admissions to the hospital at Camp Bastion. The proportion of serious injuries is very high in comparison with admissions to a UK paediatric emergency department. The concentration of major injuries means that lessons learnt in terms of teamwork, the speed of transfer to theatre and massive transfusion protocols could be applied to UK paediatric practice.
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Ann R Coll Surg Engl · Nov 2011
ReviewA systematic review of enhanced recovery protocols in colorectal surgery.
Colorectal surgery has been associated with a complication rate of 15-20% and mean post-operative inpatient stays of 6-11 days. The principles of enhanced recovery after surgery (ERAS) are well established and have been developed to optimise peri-operative care and facilitate discharge. The purpose of this systematic review is to present an updated review of peri-operative care in colorectal surgery from the available evidence and ERAS group recommendations. ⋯ Reviewing the data reveals that ERAS protocols have a role in reducing post-operative morbidity and result in an accelerated recovery following colorectal surgery. Similarly, both primary and overall hospital stays are reduced significantly. However, the available evidence suggests that ERAS protocols do not reduce hospital readmissions or mortality. These findings help to confirm that ERAS protocols should now be implemented as the standard approach for peri-operative care in colorectal surgery.
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Ann R Coll Surg Engl · Nov 2011
The range of the Oxford Shoulder Score in the asymptomatic population: a marker for post-operative improvement.
The Oxford Shoulder Score (OSS) is a validated scoring system used to assess the degree of pain and disability caused by shoulder pathology. To date there is no knowledge of the range of the OSS in the healthy adult population. This study aimed to establish the range in asymptomatic individuals. ⋯ This study has established the range of OSS in the asymptomatic adult population. Symptom scores can only be used effectively when the range in the asymptomatic population is known. This is so that disease severity can be gauged in the context of the normal population and post-operative improvements can be forecast more accurately.
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Ann R Coll Surg Engl · Oct 2011
ReviewThe role of carbohydrate drinks in pre-operative nutrition for elective colorectal surgery.
Traditionally, patients have been fasted from midnight on the night before elective surgery. With the advent of the enhanced recovery programme for elective colorectal surgery, there has been a major change in established practice with patients able to continue with clear fluids up to two hours prior to surgery and solids up to six hours prior to surgery. It has been suggested that nutritional supplements in the immediate pre-operative period enhance post-operative recovery. The aim of this review was therefore critically to appraise the evidence available regarding the use of pre-operative carbohydrate (CHO) supplements for elective colorectal surgery. ⋯ The use of CHO drinks pre-operatively in colorectal surgery is both safe and effective. There is no increased risk of aspiration and it results in a shorter hospital stay, a quicker return of bowel function and less loss of muscle mass. On the basis of this evidence, the use of pre-operative CHO drinks should be standard in elective colorectal patients. Further research is nevertheless required for those with diabetes mellitus.