Safety profile of a multimodal fail-safe model to minimize postoperative complications in oncologic colorectal resections—a cohort study
Abstract Background Despite innovations in surgical techniques, major complications following colorectal surgery still lead to a significant morbidity and mortality. There is no standard protocol for perioperative management of patients with colorectal cancer. This study evaluates the effectiveness...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-03-01
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| Series: | Perioperative Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13741-023-00291-6 |
| _version_ | 1797864004913201152 |
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| author | Shahram Khadem Jonas Herzberg Human Honarpisheh Robert Maximilian Jenner Salman Yousuf Guraya Tim Strate |
| author_facet | Shahram Khadem Jonas Herzberg Human Honarpisheh Robert Maximilian Jenner Salman Yousuf Guraya Tim Strate |
| author_sort | Shahram Khadem |
| collection | DOAJ |
| description | Abstract Background Despite innovations in surgical techniques, major complications following colorectal surgery still lead to a significant morbidity and mortality. There is no standard protocol for perioperative management of patients with colorectal cancer. This study evaluates the effectiveness of a multimodal fail-safe model in minimizing severe surgical complications following colorectal resections. Methods We compared major complications in patients with colorectal cancers who underwent surgical resections with anastomosis during 2013–2014 (control group) with patients treated during 2015–2019 (fail-safe group). The fail-safe group had preoperative bowel preparation and a perioperative single dose of antibiotics, on-table bowel irrigation and early sigmoidoscopic assessment of anastomosis in rectal resections. A standard surgical technique for tension-free anastomosis was adapted in the fail-safe approach. The chi-square test measured relationships between categorical variables, t-test estimated the probability of differences, and the multivariate regression analysis determined the linear correlation among independent and dependent variables. Results A total of 924 patients underwent colorectal operations during the study period; however, 696 patients had surgical resections with primary anastomoses. There were 427 (61.4%) laparoscopic and 230 (33.0%) open operations, while 39 (5.6%) laparoscopic procedures were converted. Overall, the rate of major complications (Dindo-Clavien grade IIIb–V) significantly reduced from 22.6% for the control group to 9.8% for the fail-safe group (p < 0.0001). Major complications mainly occurred due to non-surgical reasons such as pneumonia, heart failure, or renal dysfunction. The rates of anastomotic leakage (AL) were 11.8% (22/186) and 3.7% (n = 19/510) for the control and fail-safe groups, respectively (p < 0.0001). Conclusion We report an effective multimodal fail-safe protocol for colorectal cancer during the pre-, peri-, and postoperative period. The fail-safe model showed less postoperative complications even for low rectal anastomosis. This approach can be adapted as a structured protocol during the perioperative care of patients for colorectal surgery. Trial registration This study was registered in the German Clinical Trial Register (Study ID: DRKS00023804 ). |
| first_indexed | 2024-04-09T22:44:37Z |
| format | Article |
| id | doaj.art-3126bd77d04643e596807f9a38bd0318 |
| institution | Directory Open Access Journal |
| issn | 2047-0525 |
| language | English |
| last_indexed | 2024-04-09T22:44:37Z |
| publishDate | 2023-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Perioperative Medicine |
| spelling | doaj.art-3126bd77d04643e596807f9a38bd03182023-03-22T11:54:38ZengBMCPerioperative Medicine2047-05252023-03-0112111210.1186/s13741-023-00291-6Safety profile of a multimodal fail-safe model to minimize postoperative complications in oncologic colorectal resections—a cohort studyShahram Khadem0Jonas Herzberg1Human Honarpisheh2Robert Maximilian Jenner3Salman Yousuf Guraya4Tim Strate5Department of Surgery, Krankenhaus Reinbek St. Adolf-StiftDepartment of Surgery, Krankenhaus Reinbek St. Adolf-StiftDepartment of Surgery, Krankenhaus Reinbek St. Adolf-StiftDepartment of Surgery, Krankenhaus Reinbek St. Adolf-StiftClinical Sciences Department, College of Medicine, University of SharjahDepartment of Surgery, Krankenhaus Reinbek St. Adolf-StiftAbstract Background Despite innovations in surgical techniques, major complications following colorectal surgery still lead to a significant morbidity and mortality. There is no standard protocol for perioperative management of patients with colorectal cancer. This study evaluates the effectiveness of a multimodal fail-safe model in minimizing severe surgical complications following colorectal resections. Methods We compared major complications in patients with colorectal cancers who underwent surgical resections with anastomosis during 2013–2014 (control group) with patients treated during 2015–2019 (fail-safe group). The fail-safe group had preoperative bowel preparation and a perioperative single dose of antibiotics, on-table bowel irrigation and early sigmoidoscopic assessment of anastomosis in rectal resections. A standard surgical technique for tension-free anastomosis was adapted in the fail-safe approach. The chi-square test measured relationships between categorical variables, t-test estimated the probability of differences, and the multivariate regression analysis determined the linear correlation among independent and dependent variables. Results A total of 924 patients underwent colorectal operations during the study period; however, 696 patients had surgical resections with primary anastomoses. There were 427 (61.4%) laparoscopic and 230 (33.0%) open operations, while 39 (5.6%) laparoscopic procedures were converted. Overall, the rate of major complications (Dindo-Clavien grade IIIb–V) significantly reduced from 22.6% for the control group to 9.8% for the fail-safe group (p < 0.0001). Major complications mainly occurred due to non-surgical reasons such as pneumonia, heart failure, or renal dysfunction. The rates of anastomotic leakage (AL) were 11.8% (22/186) and 3.7% (n = 19/510) for the control and fail-safe groups, respectively (p < 0.0001). Conclusion We report an effective multimodal fail-safe protocol for colorectal cancer during the pre-, peri-, and postoperative period. The fail-safe model showed less postoperative complications even for low rectal anastomosis. This approach can be adapted as a structured protocol during the perioperative care of patients for colorectal surgery. Trial registration This study was registered in the German Clinical Trial Register (Study ID: DRKS00023804 ).https://doi.org/10.1186/s13741-023-00291-6Colorectal cancerPerioperative complicationAnastomotic leakageColorectal resectionMultimodal approachLaparoscopic surgery |
| spellingShingle | Shahram Khadem Jonas Herzberg Human Honarpisheh Robert Maximilian Jenner Salman Yousuf Guraya Tim Strate Safety profile of a multimodal fail-safe model to minimize postoperative complications in oncologic colorectal resections—a cohort study Perioperative Medicine Colorectal cancer Perioperative complication Anastomotic leakage Colorectal resection Multimodal approach Laparoscopic surgery |
| title | Safety profile of a multimodal fail-safe model to minimize postoperative complications in oncologic colorectal resections—a cohort study |
| title_full | Safety profile of a multimodal fail-safe model to minimize postoperative complications in oncologic colorectal resections—a cohort study |
| title_fullStr | Safety profile of a multimodal fail-safe model to minimize postoperative complications in oncologic colorectal resections—a cohort study |
| title_full_unstemmed | Safety profile of a multimodal fail-safe model to minimize postoperative complications in oncologic colorectal resections—a cohort study |
| title_short | Safety profile of a multimodal fail-safe model to minimize postoperative complications in oncologic colorectal resections—a cohort study |
| title_sort | safety profile of a multimodal fail safe model to minimize postoperative complications in oncologic colorectal resections a cohort study |
| topic | Colorectal cancer Perioperative complication Anastomotic leakage Colorectal resection Multimodal approach Laparoscopic surgery |
| url | https://doi.org/10.1186/s13741-023-00291-6 |
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