Is mechanical bowel preparation necessary to reduce surgical site infection following colon surgery? Protocol for a multicentre Canadian randomized controlled trial.

AIM: There is significant practice variation with respect to the use of bowel preparation to reduce surgical site infection (SSI) following colon surgery. Although intravenous antibiotics + mechanical bowel preparation + oral antibiotics (IVA + MBP + OA) has been shown to be superior to IVA + MBP and IVA, there are insufficient high-quality data from randomized controlled trails (RCTs) that directly compare these options. This is an important question, because if IVA + OA has similar effectiveness to IVA + MBP + OA, mechanical bowel preparation can be safely omitted, and the associated side effects avoided. The aim of this work is to compare rates of SSI following IVA + OA + MBP (MBP) versus IVA + OA (OA) for elective colon surgery. METHOD: This is a multicentre, parallel, two-arm, noninferiority RCT comparing IVA + OA + MBP versus IVA + OA. The primary outcome is the overall rate of SSI 30 days following surgery. Secondary outcomes are length of stay and 30-day emergency room visit and readmission rates. The planned sample size is 1062 subjects with four participating high-volume centres. Overall SSI rates 30 days following surgery between the treatment groups will be compared using a general linear model. Secondary outcomes will be analysed with linear regression for continuous outcomes, logistic regression for binary outcomes and modified Poisson regression for count data. CONCLUSION: It is expected that IVA + OA will work similarly to IVA + MBP + OA and that this work will provide definitive evidence showing that MBP is not necessary to reduce SSI. This is highly relevant to both patients and physicians as it will have the potential to significantly change practice and outcomes following colon surgery in Canada and beyond.

Quality assessment of surgery for colorectal cancer: Where do we stand?

Quality assurance in surgery has been one of the most important topics of debate among colorectal surgeons in the past decade. It has produced new surgical standards that led in part to the impressive oncological outcomes we see in many units today. Total mesorectal excision, complete mesocolic excision (CME), and the Japanese D3 lymphadenectomy are now benchmark techniques embraced by many surgeons and widely recommended by surgical societies. However, there are still ongoing discrepancies in outcomes largely based on surgeon performance. This is one of the main reasons why many countries have shifted colorectal cancer surgery only to high volume centers. Defining markers of surgical quality is thus a perquisite to ensure that standards and oncological outcomes are met at an institutional level. With the evolution of CME surgery, various quality markers have been described, mostly based on measurements on the surgical specimen and lymph node yield, while others have proposed radiological markers (i.e. arterial stumps) measured on postoperative scans as part of the routine cancer follow-up. There is no ideal marker; however, taken together and assembled into a new score or set of criteria may become a future point of reference for reporting outcomes of colorectal cancer surgery in research studies and defining subspecialization requirements both at an individual and hospital level.

Hip prosthesis and colon surgery, a decade of surveillance on surgical site infections in Italy, a prospective cohort study: rates, trends, and disease burden in DALYs.

BACKGROUND: Surveillance programs are a key element of interventions aiming to reduce rates of surgical site infections (SSIs). The aim of this study was to evaluate rates and trends of SSIs following hip arthroplasty and colon surgery procedures in Piedmont, a region in North-western Italy, from 2010 to 2019. Further, we aimed to assess the burden of SSIs in terms of Disability-Adjusted Life-Years (DALYs). METHODS: A prospective cohort study was conducted among 42 hospitals participating in the surveillance system. Procedure-specific SSI rates were calculated and the 2010 - 2019 trend was evaluated using Spearman's Rho test. Patients were stratified according to age, sex and infection risk index according to life expectancy in order to calculate DALYs, using a modified version of the ECDC's BCoDE toolkit: disease models for both procedure types were adapted to incorporate long-term disability associated with SSIs. RESULTS: Overall, 20,356 hip arthroplasty and 11,011 colon surgery procedures were monitored over 10 years and were included in our analyses. Hip arthroplasty and colon surgery cumulative SSIs rates were 1.5% and 8% respectively. Using the Spearman's Rho test, we evaluated a significant downward trend from 2010 to 2019 for colon surgery interventions (Rs - 0.7, p < 0.05), while there was no difference for hip arthroplasty. (Rs - 0.04, p > 0.05). Regarding disease burden, a total of 955.3 (95%CI 837.7-1102.98) and 208.65 (95%CI 180.87-240.90) DALYs were calculated for SSIs following hip arthroplasty, whilst 76.58 (95%CI 67.15-90.71) and 38.62 (95% CI 33.09-45.36) DALYs for SSIs in colon surgery, in 2010 and 2019, respectively. CONCLUSIONS: The significant decrease both in terms of incidence and DALYs found in this study for colon surgery and the stability for hip arthroplasty support the role of surveillance networks in improving quality of care. Despite the smaller SSI rate, the burden associated with SSIs following hip arthroplasty was higher, which is important to consider in light of the aging population in Italy.

Closed-incision negative-pressure wound therapy reduces superficial surgical site infections after open colon surgery: an NSQIP Colectomy Study.

BACKGROUND: The use of closed-incision negative-pressure wound therapy (iNPWT) has increased in the last decade across surgical fields, including colectomy. AIM: To compare postoperative outcomes associated with use of iNPWT following open colectomy from a large national database. METHODS: A retrospective review of patients who underwent operations from 2015 to 2020 was performed using the National Surgical Quality Improvement Program (NSQIP) Targeted Colectomy Database. Intraoperative placement of iNPWT was identified in patients undergoing open abdominal operations with closure of all wound layers including skin. Propensity score matching was performed to define a control group who underwent closure of all wound layers without iNPWT. Patients were matched in a 1:4 (iNPWT vs control) ratio and postoperative rates of superficial, deep and organ-space surgical site infection (SSI), wound disruption, and readmission. FINDINGS: A matched cohort of 1884 was selected. Patients with iNPWT had longer median operative time (170 (interquartile range: 129-232) vs 161 (114-226) min; P<0.05). Compared to patients without iNPWT, patients with iNPWT experienced a lower rate of 30-day superficial incisional SSI (3% vs 7%; P<0.05) and readmissions (10% vs 14%; P<0.05). iNPWT did not decrease risk of deep SSI, organ-space SSI, or wound disruption. CONCLUSION: Although there is a slightly increased operative time, utilization of iNPWT in open colectomy is associated with lower odds of superficial SSI and 30-day readmission. This suggests that iNPWT should be routinely utilized in open colon surgery to improve patient outcomes.

A prospective randomized study of multimodal analgesia combined with single injection transversus abdominis plane block versus epidural analgesia against postoperative pain after laparoscopic colon cancer surgery.

PURPOSE: Transversus abdominis plane (TAP) block is a safe, effective, and promising analgesic procedure, but TAP block only cannot overcome postoperative pain. We conducted a prospective randomized study to evaluate postoperative pain control using multimodal analgesia (MA) combined with a single injection TAP block compared with epidural analgesia (EA) after laparoscopic colon cancer surgery. METHODS: Sixty-seven patients scheduled for elective laparoscopic colon cancer surgery were enrolled in this study and randomized into EA and MA groups. The primary endpoint was the frequency of additional analgesic use until postoperative day (POD) 2. The VAS score, blood pressure, time to bowel movement, time to mobilization, postoperative complications, and length of hospital stay were also compared between the two groups. RESULTS: Sixty-four patients (EA group, n = 33; MA group, n = 31) were analyzed. The patient characteristics did not differ markedly between the two groups. The frequency of additional analgesic use was significantly lower in the MA group than in the EA group (P < 0.001), whereas the VAS score did not differ markedly between the two groups. The postoperative blood pressure on the day of surgery was significantly lower in the MA group than in the EA group (P = 0.016), whereas urinary retention was significantly higher in the EA group than in the MA group (P < 0.001). CONCLUSION: MA combined with a single injection TAP block after laparoscopic colon cancer surgery may be comparable to EA in terms of analgesia and superior to EA in terms of urinary retention.

Diet-induced shifts in the gut microbiota influence anastomotic healing in a murine model of colonic surgery.

Host diet and gut microbiota interact to contribute to perioperative complications, including anastomotic leak (AL). Using a murine surgical model of colonic anastomosis, we investigated how diet and fecal microbial transplantation (FMT) impacted the intestinal microbiota and if a predictive signature for AL could be determined. We hypothesized that a Western diet (WD) would impact gut microbial composition and that the resulting dysbiosis would correlate with increased rates of AL, while FMT from healthy, lean diet (LD) donors would reduce the risk of AL. Furthermore, we predicted that surgical outcomes would allow for the development of a microbial preclinical translational tool to identify AL. Here, we show that AL is associated with a dysbiotic microbial community characterized by increased levels of Bacteroides and Akkermansia. We identified several key taxa that were associated with leak formation, and developed an index based on the ratio of bacteria associated with the absence and presence of leak. We also highlight a modifiable connection between diet, microbiota, and anastomotic healing, potentially paving the way for perioperative modulation by microbiota-targeted therapeutics to reduce AL.

Early postoperative parastomal evisceration after explorative laparotomy: case report of a rare and potentially life-threatening surgical complication.

BACKGROUND: Parastomal evisceration represents a preventable surgical complication that should not occur with appropriate technical diligence and surgical skills. While late parastomal hernias are well described in the literature, there is a paucity of reports on the early postoperative occurrence of parastomal intestinal evisceration. CASE PRESENTATION: An urgent laparotomy was performed on a 58-year-old female patient for an acute cecal perforation with generalized peritonitis related to underlying colon cancer. Intraoperative revelations necessitated a carcinologic right colectomy and the creation of an end-loop ileocolostomy. Following six sessions of adjuvant chemotherapy, Computed tomography scans raised uncertainties about the presence of peritoneal carcinomatosis. Consequently, a collaborative decision was reached in a multidisciplinary discussion to conduct a surgical biopsy of these deposits before reinstating digestive continuity. The surgical procedure started with stoma mobilization. However, adhesions and a relatively confined aperture curtailed a comprehensive peritoneal cavity exploration. Thus, a midline incision was executed. The verdict from the frozen section examination affirmed metastatic presence, prompting the retention of the stoma. Within 48 h post-surgery, an early-stage parastomal evisceration occurred, stemming from an inadequately sealed aponeurotic sheath. The exposed bowel surface was encased in fibrin, necessitating meticulous irrigation with a warm saline solution before repositioning it within the peritoneal cavity. Accurate adjustment of the aponeurosis closure ensued, coupled with a meticulous reconstitution of the stoma. The postoperative course was uneventful. The patient was subsequently referred for hyperthermic intraperitoneal chemotherapy. CONCLUSIONS: Preventing parastomal evisceration requires adherence to established stoma-creation protocols, including creating a properly sized fascial opening and secure fixation. In instances of excessive fascial opening, ensuring a tension-free and meticulous closure is imperative.

Assessing Changes in Colon Cancer Care during the COVID-19 Pandemic: A Four-Year Analysis at a Romanian University Hospital.

This retrospective study investigates the impact of the COVID-19 pandemic on the surgical management of patients with colon cancer in a tertiary University Hospital in Timisoara, Romania. Data from 867 patients who underwent surgical interventions for this condition between 26 February 2019 and 25 February 2023 were meticulously analyzed to evaluate substantial shifts in the management and outcomes of these patients in comparison to the pre-pandemic era. The results reveal a substantial decrease in elective surgical procedures (p < 0.001) and a significant increase in emergency interventions (p < 0.001). However, postoperative mortality did not show significant variations. Of concern is the diagnosis of patients at more advanced stages of colon cancer, with a significant increase in Stage IV cases in the second year of the pandemic (p = 0.045). Average hospitalization durations recorded a significant decrease (p < 0.001) during the pandemic, and an inverse correlation between patient age and surgery duration was reported (p = 0.01, r = -0.088). This analysis provides a comprehensive perspective on how the pandemic has influenced the management of colon cancer, highlighting significant implications for the management and outcomes of these patients.

Assessment of the efficacy of Handmade Vacuum-Assisted Sponge Drain for Treatment of Anastomotic leakage after Low Anterior Rectal Resection.

Anastomotic leakage is one of the major complications of colorectal surgery, which might lead to reoperation, increased hospital stays, further intervention and mortality. Vacuum-assisted closure by devices such as Endo-SPONGE® produced by (B-Braun Medical B.V.) is currently being used to treat leakage and fistula. In this study, we aimed to assess the handmade vacuum-assisted sponge drain for anastomotic leakage following low anterior resection. This prospective study included 22 patients who had undergone sponge drain placement to treat anastomotic leakage. All patients had anastomotic leaks or defects after left anterior rectal resection (LAR) without ileostomy. They were treated with neo-adjuvant chemotherapy before the surgery and then subjected to rigid recto-sigmoidoscopy for 30 days following the operation. Any sign of leakage, such as perianal and pelvic pain, was immediately identified and followed up with a CT scan and another recto-sigmoidoscopy. Twenty-two patients were enrolled in this study, 12 men (54.5%) and 10 women (47.4%). All patients had received neo-adjuvant chemotherapy with an average follow-up of 22.30 ± 3.81. 75% of patients (15 cases) were successfully treated, and 17 patients (85%) underwent successful ostomy closure. Treatment failed in 5 patients (25%), including three men and two women. This study shows that handmade vacuum-assisted sponge drain is a cost-effective method of anastomotic leakage management with efficacy similar to that of Endo-SPONGE®.

Laparoscopic and robotic intracorporeal resection and end-to-end anastomosis in left colectomy: a prospective cohort study - stage 2a IDEAL framework for evaluating surgical innovation.

PURPOSE: To analyze the safety and feasibility of intracorporeal resection and anastomosis in upper rectum, sigmoid, and left colon surgery, via both laparoscopic and robotic approaches. The secondary aim was to assess possible short-term differences between laparoscopic versus robotic surgery. METHODS: A prospective observational cohort study according to IDEAL framework exploration and assessment stage (Development, stage 2a), evaluating and comparing the laparoscopic approach and the robotic approach in left colon, sigmoid, and upper rectum surgery with intracorporeal resection and end-to-end anastomosis. Demographic, preoperative, surgical, and postoperative variables of patients undergoing laparoscopic and robotic surgery are described and compared according to the surgical technique used. RESULTS: Between May 2020 and March 2022, seventy-nine patients were consecutively included in the study, 41 operated via laparoscopy (laparoscopic left colectomy: LLC) and 38 by robotic surgery (robotic left colectomy: RLC). There were no statistically significant differences between the two groups in terms of demographic variables. In surgical variables, the median surgical times differed significantly: 198 min (SD 48 min) for LLC vs. 246 min (SD 72 min) for RLC (p = 0.01, 95% CI: - 75.2 to - 20.5)). The only significant difference regarding postoperative complications was a higher degree of relevant morbidity in the LLC (Clavien-Dindo > II (14.6% vs. 0%, p = 0.03) and Comprehensive Complication Index (IQR 22 vs. IQR 0, p = 0.03). The pathological results were similar in both approaches. CONCLUSION: Laparoscopic and robotic intracorporeal resection and anastomosis are feasible and safe, and obtain similar surgical, postoperative, and pathological results than described in literature. However, morbidity seems to be higher in LLC group with fewer relevant postoperative complications. The results of this study enable us to proceed to stage 2b of the IDEAL framework. CLINICAL TRIAL REGISTRATIONS: The study is registered in Clinical trials with the registration code NCT0445693.

Racial Disparities in Surgical Outcomes of Acute Diverticulitis: Have We Moved the Needle?

INTRODUCTION: There has been increasing national attention on reducing healthcare disparities. Prior studies cite worse surgical outcomes and less use of laparoscopy for Black patients with diverticulitis. Re-evaluation of these disparities is lacking despite national initiatives to improve health equity. This study aimed to evaluate the association of race with short-term outcomes and surgical approaches in patients with acute diverticulitis. METHODS: The National Surgical Quality Improvement Program database was queried for patients who underwent nonelective surgery for acute diverticulitis from 2015 to 2019. Severity of presentation, morbidity, mortality, surgical approach, and ostomy creation were compared by race. RESULTS: Of the 13,996 patients included in the study, 82.4% were White, 7.6% were Black, 1.1% Asian, 0.61% American Indian/Alaska Native, and 0.20% Native Hawaiian/Pacific Islander (NH/PI). Overall 30-day morbidity was 44.3% and 30-day mortality was 3.9%. In a multivariate logistic regression analysis, compared to Whites, Black race was independently associated with higher 30-day morbidity (Odds Ratio: 1.24, 95% confidence interval: 1.07-1.43, P = 0.003) and NH/PI race was independently associated with higher mortality (Odds Ratio: 5.35, 95% confidence interval: 1.32-21.6, P = 0.019). There was no difference in complicated disease (abscess or perforation), use of laparoscopy, or ostomy creation among races. CONCLUSIONS: Despite national efforts to achieve equity in healthcare, disparities persist in surgical outcomes for those with diverticulitis. Black and NH/PI race are independently associated with increased morbidity and mortality, respectively. Use of laparoscopy, however, is no longer different by race suggesting some gaps may be closing.

5 year oncological outcomes of the HIGHLOW randomized clinical trial.

INTRODUCTION: The oncological outcomes of low ligation (LL) compared to high ligation (HL) of the inferior mesenteric artery (IMA) during low-anterior rectal resection (LAR) with total mesorectal excision are still debated. The aim of this study is to report the 5 year oncologic outcomes of patients undergoing laparoscopic LAR with either HL vs. LL of the IMA MATERIALS AND METHODS: Between June 2014 and December 2016, patients who underwent elective laparoscopic LAR + TME in 6 Italian non-academic hospitals were randomized to HL or LL of IMA after meeting the inclusion criteria (HighLow trial; ClinicalTrials.gov Identifier NCT02153801). We analyzed the rate of local recurrence, distant metastasis, overall survival, disease-specific survival, and disease-free survival at 5 years of patients previously enrolled. RESULTS: Five-year follow up data were available for 196 patients. Recurrence happened in 42 (21.4%) of patients. There was no statistically significant difference in the distant recurrence rate (15.8% HL vs. 18.9% LL; P = 0.970) and pelvic recurrence rate (4,9% HL vs 3,2% LL; P = 0.843). No statistically significant difference was found in 5-year OS (p = 0.545), DSS (p = 0.732) or DFS (p = 0.985) between HL and LL. Low vs medium and upper rectum site of tumor, conversion rate, Clavien-Dindo post-operative grade ≥3 complications and tumor stage were found statistically significantly associated to poor oncological outcomes in univariate analysis; in multivariate analysis, however, only conversion rate and stage 3 cancer were found to be independent risk factors for poor DFS at 5 years. CONCLUSION: We confirmed the results found in the previous 3-year survival analysis, the level of inferior mesenteric artery ligation does not affect OS, DSS and DFS at 5-year follow-up.

Acupoint Stimulation for Enhanced Recovery After Colon Surgery: A Prospective Multicenter Randomized Controlled Trial.

Purpose: The aim of this study was to evaluate the efficacy of transcutaneous electrical acupoint stimulation (TEAS) in improving bowel function and thus shortening hospital stay after laparoscopic colon surgery within the ERAS pathway. Patients and Methods: From November 2016 to March 2018, 100 patients who underwent elective colon surgery were enrolled and 94 finished study (n = 47 for each) in three university hospitals. Patients in the TEAS group received TEAS 30 min before surgery and once a day for 3 days after surgery, while those in the Control Group received no stimulation. Primary outcome was the time to discharge. Results: Compared with standardized postoperative care, TEAS resulted in a shorter time to first flatus (P=0.03) and time to first defecation (P=0.03), as well as a reduction in the length of hospital stay (P=0.02). Median patient-controlled analgesia (PCA) deliveries and PCA attempts at 24h, 48h and 72h after surgery were less in the TEAS group (P<0.01). No evidence of significant advantages in postoperative pain intensity, nausea, vomiting, sleeping quality and expenses was found in the TEAS group. Conclusion: Perioperative TEAS further shortens the time to meet discharge criteria after laparoscopic colon surgery in patients under ERAS strategy.

Programa para mejorar la recuperación posoperatoria en intervenciones electivas de colon / A Program for Improving Postoperative Recovery in Elective Colon Surgeries

Introducción: Los programas de recuperación mejorada después de cirugía constituyen un conjunto de acciones aplicadas al paciente quirúrgico en el período perioperatorio, que se enfoca en reducir el impacto de la cirugía en la respuesta metabólica y endocrina y así lograr una recuperación más temprana de mayor calidad. Objetivo: Evaluar los resultados de la aplicación del protocolo de recuperación mejorada después de la cirugía en procedimientos quirúrgicos mayores electivos del colon. Métodos: Se realizó un estudio descriptivo longitudinal y prospectivo con 163 pacientes con indicación de intervenciones quirúrgicas mayores electivas del colon en el Hospital Clínico Quirúrgico "Hermanos Ameijeiras", durante el período 2017-2020 y se les aplicó el programa ERAS implementado. Resultados: La edad media de los pacientes fue de 65,4±13,2 años con predominio del sexo femenino (57,7 por ciento). El 78,5 por ciento de los pacientes toleraban dieta blanda y expulsaban gases o heces por el recto al segundo día de la operación. La estadía posoperatoria promedio fue de 4,9 ± 3,4 días y en pacientes sin complicaciones se redujo a 4,0±1,0 días. La mortalidad reportada fue de un 3,1 por ciento (5 casos). Se complicó el 20,2 por ciento de los pacientes. El 6,7 por ciento de los pacientes requirió reingreso durante los primeros 30 días. Conclusiones: La implementación de un programa para mejorar la recuperación posoperatoria de pacientes con intervenciones electivas de colon demuestra resultados satisfactorios y mejora los resultados históricos del Hospital Clínico Quirúrgico "Hermanos Ameijeiras", en cuanto a complicaciones, estadía y mortalidad(AU)

Introduction: Enhanced recovery after surgery (ERAS) programs are a set of actions applied to the surgical patient in the perioperative period, focusing on reducing the impact of surgery on the metabolic and endocrine response, with the aim of achieving an earlier recovery of higher quality. Objective: To evaluate the results of the application of the enhanced recovery protocol after surgery in elective major surgical procedures of the colon. Methods: A descriptive, longitudinal and prospective study was conducted with 163 patients indicated for elective major surgery of the colon at Hospital Clínico Quirúrgico "Hermanos Ameijeiras", during the period 2017-2020, and who were applied the implemented ERAS program. Results: The mean age of the patients was 65.4 ± 13.2 years, with a predominance of the female sex (57.7 percent). 78.5 the patients tolerated a soft diet and expelled gases or faces througth the rectum at two days after the operation. The average postoperative stay was 4.9 ± 3.4 days and, in patients without complications, it was reduced to 4.0 ± 1.0 days. Reported mortality was 3.1 percent (five cases). Complications occurred in 20.2 percent of the patients. 6.7 percent of patients required readmission during the first thirty days. Conclusions: The implementation of a program for improving postoperative recovery of patients with elective interventions of the colon shows satisfactory results and improves the historical results of Hospital Clínico Quirúrgico "Hermanos Ameijeiras" in terms of complications, length of stay and mortality(AU)

Eficacia de la analgesia peridural continua con bupivacaína y fentanilo en la cirugía de colon / Efficacy of continuous peridural analgesia with bupivacaine and fentanyl in colon surgery

Introducción: En la cirugía de colon se persigue lograr una recuperación acelerada y se debate el método analgésico más ventajoso. Objetivo: Comparar la eficacia analgésica de la infusión continua peridural con bupivacaína y fentanilo frente a la analgesia parenteral en este tipo de intervención. Métodos: Se realizó un estudio cuasi-experimental, prospectivo y longitudinal, en 30 pacientes operados de colon entre agosto 2018 agosto 2019 en el Hospital Militar Central Dr. Carlos J. Finlay; divididos de forma no aleatoria en grupo analgesia peridural y grupo analgesia multimodal endovenosa. Resultados: La demora en despertar y extubar en el grupo peridural fue inferior (1,6-1,8 min) a los 4,9-5,0 min en el multimodal, igual ocurrió con la estadía en Unidad Cuidados Intensivos Quirúrgicos y hospitalaria aunque con discreta diferencia. El 60 por ciento de los pacientes en el grupo peridural presentaron ruidos hidroaéreos en las primeras 24 h y el 80 por ciento expulsó gases a las 48 h o antes, con marcada diferencia del multimodal. La analgesia fue buena en ambos grupos, valores de escala visual análoga inferiores en el grupo peridural, solo el 13,3 por ciento necesitó dosis rescate frente al 26,7 por ciento en el multimodal. Las complicaciones más frecuentes fueron hipotensión (23,3 por ciento) y bradicardia (10 por ciento), sin diferencias entre grupos. La analgesia aceleró la recuperación en el 87,5 por ciento de los casos en el grupo peridural superior al 76 por ciento del grupo multimodal. Conclusiones: La analgesia peridural continua con bupivacaína y fentanilo es más eficaz que la analgesia multimodal endovenosa en la cirugía de colon y acelera la recuperación posoperatoria(AU)

Introduction: In colon surgery, accelerated recovery is pursued and the most advantageous analgesic method is still under debate. Objective: To compare the analgesic efficacy of continuous epidural infusion with bupivacaine and fentanyl versus parenteral analgesia in this type of operation. Methods: A quasiexperimental, prospective and longitudinal study was carried out with thirty patients who underwent colon surgery, between August 2018 and August 2019 at Dr. Carlos J. Finlay Central Military Hospital, nonrandomly divided into an epidural analgesia group and a multimodal intravenous analgesia group. Results: The awakening and extubation time in the epidural group was lower (1.6 -1.8 min) than the 4.9 to 5.0 min for the multimodal group. The same happened with intensive care unit and hospital stay, although with a discrete difference. 60 percent of the patients from the epidural group presented hydroaerial noise within the first 24 hours and 80 percent expelled gasses at 48 hours or earlier, with a marked difference in the multimodal group. Analgesia was good in both groups, with lower visual analog scale values in the peridural group; only 13.3 percent required rescue doses compared to 26.7 percent in the multimodal group. The most frequent complications were hypotension (23.3 percent ) and bradycardia (10 percent ), without differences between groups. Analgesia accelerated recovery for 87.5 percent of cases in the epidural group, compared to 76 percent in the multimodal group. Conclusions: Continuous epidural analgesia with bupivacaine and fentanyl is more effective than multimodal intravenous analgesia in colon surgery and accelerates postoperative recovery(AU)

Developing and validating a multivariable prediction model for predicting the cost of colon surgery.

Hospitals are burdened with predicting, calculating, and managing various cost-affecting parameters regarding patients and their treatments. Accuracy in cost prediction is further affected when a patient suffers from other health issues that hinder the traditional prognosis. This can lead to an unavoidable deficit in the final revenue of medical centers. This study aims to determine whether machine learning (ML) algorithms can predict cost factors based on patients undergoing colon surgery. For the forecasting, multiple predictors will be taken into the model to provide a tool that can be helpful for hospitals to manage their costs, ultimately leading to operating more cost-efficiently. This proof of principle will lay the groundwork for an efficient ML-based prediction tool based on multicenter data from a range of international centers in the subsequent phases of the study. With a mean absolute percentage error result of 18%-25.6%, our model's prediction showed decent results in forecasting the costs regarding various diagnosed factors and surgical approaches. There is an urgent need for further studies on predicting cost factors, especially for cases with anastomotic leakage, to minimize unnecessary hospital costs.

Evaluación de la infección de localización quirúrgica en cirugía de colon y adecuación de la profilaxis antibiótica: estudio multicéntrico de incidencia / Assessment of the surgical site infection in colon surgery and antibiotic prophylaxis adequacy: A multi-center incidence study

Introducción: Las infecciones de localización quirúrgica (ILQ) son un importante problema que limita los beneficios de las intervenciones quirúrgicas. Se evaluó la incidencia acumulada de ILQ en cirugía de colon y el cumplimiento de la profilaxis antibiótica, así como las causas de su incumplimiento. Métodos: Estudio prospectivo observacional multicéntrico entre los años 2012 y 2019 en 7 hospitales del Servicio Canario de Salud mediante un sistema de vigilancia epidemiológica activa. Se definió ILQ de acuerdo con los criterios de los Centers for Disease Control and Prevention. Resultados: En el año 2019 la incidencia acumulada de ILQ fue del 10,6% (n=80), lo que supone mantener la tendencia descendente desde el año 2012. La aparición de ILQ fue más frecuente durante el ingreso (76%). La profilaxis quirúrgica fue adecuada en el 81,2%, siendo las principales causas de inadecuación la duración excesiva de la prescripción del antimicrobiano (49%) y los fallos en la indicación (33%). La incidencia ha sido superior en el grupo de ILQ órgano-espacio (53,75% del total) en comparación con las superficiales o profundas. Conclusión: La incidencia acumulada de ILQ obtenida es similar a la calculada en otros estudios realizados en condiciones semejantes. La quimioprofilaxis preoperatoria fue adecuada en la mayoría de intervenciones. (AU)

Introduction: Surgically site infections (SSIs) are a major problem that limits the benefits of surgical interventions. The cumulative incidence of SSIs in colon surgery and compliance with antibiotic prophylaxis as well as the causes of non-compliance were evaluated. Methods: Multi-centre prospective surveillance study between 2012 and 2019 in seven hospitals of the Canary Health Service using an active epidemiological surveillance system. SSIs was defined according to the criteria of the Centers for Disease Control and Prevention. Results: In 2019, the cumulative incidence of SSIs was 10.6% (n=80), which implies maintaining the downward trend since 2012. The appearance of SSIs was more frequent during admission (76%). Surgical prophylaxis was adequate in 81.2%, the main causes of inadequacy being the excessive duration of the antimicrobial prescription (49%) and failure in the indication (33%). The incidence was higher in the group of organ-space infections (53.75% of the total) compared to superficial and deep infections. Conclusion: The cumulative incidence of SSIs obtained is similar to that calculated in other studies carried out under similar conditions. Preoperative chemoprophylaxis was adequate in most of the interventions. (AU)

Enfermedad Diverticular: análisis de defunciones según sexo, grupo etario y regiones en Chile

Objetivo: Describir las defunciones por enfermedad diverticular de intestino en el período 2016 - 2020 en Chile según sexo, grupo etario y región. Material y Método: Estudio descriptivo. Se describieron 406 defunciones por enfermedad diverticular según sexo, grupo etario y región entre los años 2016-2020, realizando un análisis estadístico con el software IBM SPSS Statistics ® que incluyó una Prueba Binomial para análisis de defunciones según "sexo" y la Prueba de Kruskal Wallis para el estudio de significancia entre las variables "sexo" y "grupo etario". Se utilizó un intérvalo de confianza del 99% (p < 0,01). Resultados: se obtuvo una tasa de mortalidad 0,46/100.000 habitantes para el período estudiado. El sexo femenino fue predominante con una relación cercana a 3:1 (p < 0,01). Las defunciones aumentaron con la edad y el grupo etario con mayor número de defunciones fue el de 80-89. Se demostró relación entre sexo y grupo etario (p < 0,01). Las regiones con mayor tasa de mortalidad observada fueron Magallanes, Valparaíso y Maule. Discusión: La tasa de mortalidad es similar a la reportada a nivel mundial. Las mujeres mueren en una proporción mayor que los hombres, tal como es descrito en otros estudios. La mayor tasa de mortalidad observada en algunas regiones del país se podría asociar a la elevada prevalencia de factores de riesgo para la enfermedad. Conclusión: Las defunciones por enfermedad diverticular disminuyeron desde el año 2018, se evidencia que las mujeres presentan un número significativamente mayor de defunciones que los hombres y que existieron diferencias por región.

Aim: To describe deaths from diverticular bowel disease in the period 2016-2020 in Chile according to sex, age group and region. Material and Method: Descriptive study. 406 deaths due to diverticular disease were described according to sex, age group and region between the years 2016-2020, performing a statistical analysis with the IBM SPSS Statistics ® software that included a Binomial Test for analysis of deaths according to "sex" and the Kruskal Wallis Test for the study of significance between the variables "sex" and "age group". A 99% confidence interval (p < 0.01) was used. Results: A mortality rate of 0.46/100,000 inhabitants was obtained for the period. The female sex was predominant in a ratio close to 3:1 (p < 0.01). Deaths increased with age and the age group with the higher number of deaths was 80-89. A relationship between sex and age group was demonstrated (p < 0.01). The regions with the highest observed mortality rate were Magallanes, Valparaíso and Maule. Discussion: The mortality rate is similar to that reported worldwide. Women die at a higher rate than men, as described in other studies. The higher mortality rate observed in some regions of the country could be associated with the high prevalence of risk factors for the disease. Conclusion: Deaths from diverticular disease decreased since 2018, in conjunction with showing that women present a significantly higher number of deaths than men and that there were differences by region.

Recurrent diverticulitis after elective surgery.

PURPOSE: Elective sigmoid resection is proposed as a treatment for symptomatic diverticular disease for the possible improvement in quality of life achievable. Albeit encouraging results have been reported, recurrent diverticulitis is still a concern deeply affecting quality of life. The aim of this study is to determine the rate of recurrent diverticulitis after elective sigmoid resection and to look for possible perioperative risk factors. METHODS: Patients who underwent elective resection for DD with at least a 3-year follow-up were included. Postoperative recurrence was defined as left-sided or lower abdominal pain, with CT scan-confirmed findings of diverticulitis. RESULTS: Twenty of 232 (8.6%) patients developed CT-proven recurrent diverticulitis after elective surgery. All the 20 recurrent diverticulitis were uncomplicated and did not need surgery. Eighty-five percent of the recurrences occurred in patients with a preoperative diagnosis of uncomplicated DD, 70% in patients who had at least 4 episodes of diverticulitis, and 70% in patients with a history of diverticulitis extended to the descending colon. Univariate analysis showed that recurrence was associated with diverticulitis of the sigmoid and of the descending colon (p = 0.04), with a preoperative diagnosis of IBS (p = 0.04) and with a longer than 5 years diverticular disease (p = 0.03). Multivariate analysis was not able to determine risks factors for recurrence. CONCLUSION: Our study showed that patients with a preoperative diagnosis of IBS, diverticulitis involving the descending colon, and a long-lasting disease are more likely to have recurrent diverticulitis. However, these variables could not be assumed as risk factors.