3 research outputs found
P4‐378: A MULTI‐DOMAIN VIRTUAL COGNITIVE HEALTH PROGRAM REDUCES SYMPTOMS OF DEPRESSION AND ANXIETY: SIX‐MONTH RESULTS FROM A SINGLE‐ARM LONGITUDINAL STUDY
No full textERAS protocol in colorectal surgery is effective in octogenarians: A retrospective cohort study
No full textPurpose: Evaluate the effectiveness of implementing an ERAS protocol in octogenarians. Methods: This retrospective cohort study analyzed patients undergoing colorectal surgery under the ERAS protocol at Boca Raton Regional Hospital from December 1, 2019 to October 30, 2021. Patients under the age of 18, undergoing emergency surgery, and with incomplete data were excluded. A p < 0.05 was considered statistically significant and analyses were done using EZR and R software. Results: 299 patients met inclusion criteria with 60 (20.1 %) over the age of 80 and 239 (79.9 %) younger than 80. 140 (46.8 %) of the cohort were male. When comparing octogenarians with younger patients there were no differences in compliance with ERAS protocols such as pre-operative medication (p = 1) and oral carbohydrate drink consumption (p = 0.574), oral intake in PACU (p = 0.832), PACU sit and dangle (p = 0.619), or adherence to a narcotic sparing regimen (p = 0.365). Additionally, there were no differences in complications (p = 1), time until bowel function (p = 0.401), or time to first ambulation (p = 0.883). Octogenarians were more likely to have a longer LOS (4.89 v 3.0 days; p = 0.006), disposition requiring either home health care or a skilled nursing facility (SNF) (52.5 % v 28.3 %; p = 0.008), and readmission (42.3 % v 20.8 %; p = 0.042). Conclusion: The ERAS protocol is safe and effective when used in the octogenarian without decreased compliance or increased complications. Increased LOS, care needed on disposition, and readmission are in-line with other published data of all patients and are likely related to increased frailty among this group and not to the addition of the ERAS protocol
Global treatment of haemorrhoids—A worldwide snapshot audit conducted by the International Society of University Colon and Rectal Surgeons
No full textAim: There is no universally accepted treatment consensus for haemorrhoids, and thus, management has been individualized all over the world. This study was conducted to assess a global view of how surgeons manage haemorrhoids. Methods: The research panel of the International Society of University Colon and Rectal Surgeons (ISUCRS) developed a voluntary, anonymous questionnaire evaluating surgeons' experience, volume and treatment approaches to haemorrhoids. The 44 multiple-choice questionnaire was available for one month via the ISUCRS email database and the social media platforms Viber and WhatsApp. Results: The survey was completed by 1005 surgeons from 103 countries; 931 (92.6%) were in active practice, 819 (81.5%) were between 30 and 60 years of age, and 822 (81.8%) were male. Detailed patient history (92.9%), perineal inspection (91.2%), and digital rectal examination (91.1%) were the most common assessment methods. For internal haemorrhoids, 924 (91.9%) of participants graded them I–IV, with the degree of haemorrhoids being the most important factor considered to determine the treatment approach (76.3%). The most common nonprocedural/conservative treatment consisted of increased daily fibre intake (86.9%), increased water intake (82.7%), and normalization of bowel habits/toilet training (74.4%). Conservative treatment was the first-line treatment for symptomatic first (92.5%), second (72.4%) and third (47.3%) degree haemorrhoids; however, surgery was the first-line treatment for symptomatic fourth degree haemorrhoids (77.6%). Rubber band ligation was the second-line treatment in first (50.7%) and second (47.2%) degree haemorrhoids, whereas surgery was the second-line treatment in third (82.9%) and fourth (16.7%) degree symptomatic haemorrhoids. Rubber band ligation was performed in the office by 645(64.2%) of the participants. The most common surgical procedure performed for haemorrhoids was an excisional haemorrhoidectomy for both internal (87.1%) and external (89.7%) haemorrhoids – with 716 (71.2%) of participants removing 1, 2 or 3 sectors as necessary. Conclusion: Although there is no global haemorrhoidal treatment consensus, there are many practice similarities among the different cultures, resources, volume and experience of surgeons around the world. With additional studies, a consensus statement could potentially be developed
