None listed
Conditions
Brief summary
Failure of healing bowel joints after surgery constitutes a serious clinical problem. The purpose of this study is to assess if a quality improvement program at the Karolinska University Hospital can reduce the risk for complications after bowel surgery. The hypothesis is that structured changes in clinical practice can reduce the risk of leakage in surgically constructed bowel joints. The different components that constitutes the program have been suggested to improve surgical outcomes in previous studies. The outcomes for patients operated before and after the implementation of the quality improvement program will be compared.
Interventions
A quality improvement program for all patients undergoing colorectal resections at the Karolinska University Hospital (Section of coloproctology). The program contains three key elements and was implemented in January 2010. The post implementation study period was January 2010-December 2013.
1. Exclusion of nonsteroidal anti-inflammatory drugs peri-operatively from 5 days before surgery to 7 days after surgery..
2. Introduction of intra-operative goal-directed fluid therapy. This was managed by
A quality improvement program for all patients undergoing colorectal resections at the Karolinska University Hospital (Section of coloproctology). The program contains three key elements and was implemented in January 2010. The post implementation study period was January 2010-December 2013. 1. Exclusion of nonsteroidal anti-inflammatory drugs peri-operatively from 5 days before surgery to 7 days after surgery.. 2. Introduction of intra-operative goal-directed fluid therapy. This was managed by stroke volume optimization using esphageal Doppler (CardioQ-ODM, Deltex Medical, Chichester, UK). 3. Avoidance of primary anastomoses in emergency resections. Surgeons were instructed to avoid emergency oncological resections of obstructing cancers by instead performing temporary defunctioning ostomies or avoid primary anastomosis if emergency resection was unavoidable (i.e. bowel perforation or severe bleeding).
Sponsors
Henrik Iversen
Eligibility
Sex/Gender
All
Age
16 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Consecutive patients operated with colorectal resections with primary anastomosis at the Section of coloproctology at the Karolinska University Hospital during four years up to the implementation of a quality improvement program, and during four years after the implementation.
Exclusion criteria
No patients are excluded if they meet the inclusion criteria
Outcome results
None listed