Diseases of the colon and rectum
-
The main predictor of long-term survival in patients with recurrent rectal cancer is surgical resection with a clear resection margin. MRI plays a role in patient selection and surgical planning. ⋯ MRI findings can be used to help predict resection margin. Prospective work with MRI interpretation and close correlation and involvement by pathologists is needed to address imaging and surgical limitations at the pelvic sidewall and high posterior margin.
-
Hospital readmission rates are an increasingly important quality metric since enactment of the 2012 Hospital Readmissions Reduction Program. The proliferation of enhanced recovery protocols and earlier discharge raises concerns for increased readmission rates. ⋯ These data suggest that use of a standardized enhanced recovery protocol significantly reduces length of stay and readmission rates in an elective colorectal surgery population. However, the presence of an ileostomy maintains a high association with readmission, serving as a significant burden to patients and providers alike. Ongoing efforts are needed to further improve the management of patients undergoing ileostomy in the outpatient setting after discharge to prevent readmissions.
-
Enhanced recovery protocols frequently use multimodal postoperative analgesia to improve postoperative outcomes in patients undergoing colorectal surgery. ⋯ Attenuated pain scores observed with liposomal bupivacaine use were associated with significantly lower intravenous opioid and ketorolac use, suggesting that liposomal bupivacaine-containing transversus abdominis plane blocks are well aligned with the opioid-reducing goals of many enhanced recovery protocols.
-
The impact of process improvement through surgeon feedback on outcomes is unclear. ⋯ Nearly complete adherence to process measures for deep vein thrombosis and surgical site infection did not lead to measureable outcomes improvement. Process measure adherence was associated with decreased rate of anastomotic leak and urinary tract infection. Biannual surgeon-specific feedback of outcomes was associated with improved process measure adherence and improvement in surgical quality.