Role for colorectal teams to support non-colorectal teams to improve clinical outcomes and adherence to ERAS guidelines for segmental colectomy: a cohort study.

BACKGROUND: To identify whether compliance with Enhanced Recovery After Surgery (ERAS) Society recommendations is associated with length of stay (LOS) in a New Zealand hospital for patients undergoing segmental colectomy in mixed acute and elective general surgery wards. METHODS: Consecutive elective colorectal surgeries (n = 770) between October 2012 and February 2019 were audited. Patients with non-segmental colectomies, multi-organ surgeries, LOS > 14 days, and those who died were excluded. Logistic regression was used to determine the relationship between patient demographics, compliance with ERAS guidelines, and suboptimal LOS (> 4 days). RESULTS: Analysis included 376 patients. Age, surgery prior to 2014, surgical approach, non-colorectal surgical team, operation type, and complications were significantly associated with suboptimal LOS. Non-compliance with ERAS recommendations for laparoscopy [OR 8.9, 95% CI (4.52, 19.67)], removal of indwelling catheters (IDC) [OR 3.14, 95% CI (1.85, 5.51)], use of abdominal drains [OR 4.27, 95% CI (0.99, 18.35)], and removal of PCA [OR 8.71, 95% CI (1.78, 157.27)], were associated with suboptimal LOS (univariable analysis). Multivariable analysis showed that age, surgical team, late removal of IDC, and open approach were independent predictors of suboptimal LOS. CONCLUSIONS: Non-compliance with ERAS guidelines for laparoscopic approach and early removal of IDC was higher among procedures performed by non-colorectal surgery teams, and was also associated with adverse postoperative events and suboptimal LOS. This study demonstrates the importance of the surgical team's expertise in affecting surgical outcomes, and did not find significant independent associations between most individual ERAS guidelines and suboptimal LOS once adjusting for other factors.

Before the storm : Pre-flood mitigation planning in Tulsa, Oklahoma

The best time to stop a flood-or at least to cut your losses-is before the storm. That's why the City of Tulsa, Oklahoma, is doing its flood hazard mitigation planning now, before the water rises again. Flood hazard mitigation has many current shades of meaning. As used in the Tulsa program and this paper, flood hazard mitigation is defined as "acquisition, relocation, floodproofing, and related actions taken before, during, and after a flood to reduce future danger, damage, trauma, and loss". It is also called "nonstructural mitigation". The planning is under direction of the Tulsa Mitigation Team (TMT). The TMT has found few model plans from other communities, although emerging federal policies tout the benefits of pre-disaster plannning and nonstructural mitigation. This paper highlights the Tulsa mitigation planning process, progress, and learned, which we hope may prove useful to others