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Abstracts
radiology database and hospital coding via the hospital’s informatics system.
Results Over the 13-year review period, a primary SEMS was
attempted in 143 patients, median age 72 (range 25–108) years,
sex ratio 83 males: 60 females. Indications for SEMS were palliative treatment of colorectal cancer (CRC) 101; as bridging
prior to resectional surgery for CRC 14; extrinsic compression
in 19 and for benign disease in 8 patients. SEMS placement was
successful in 110 (77%) patients: in 83 (82%) palliative; 13
(93%) bridging; 12 (63%) compression and 2 (25%) benign
groups. 85% of SEMS were placed in the distal colon. In the
bridged patients 54% did not require a stoma at subsequent surgery. 91(83%) patients successfully stented had no complication.
Of the complications that occurred, 13(15.7%) occurred in palliative, 3(23.1%) bridging, and 3(25%) compression groups.
Early complications (<48hrs) occurred in 8 patients: 3 perforations; 4 failures to open; 1 migration and 1 PR bleed. There was
1 death and 7 proceeded to surgery. There were 6 late complications (<1 month): 5 perforations and 1 reobstruction, of which
there were 2 deaths and 4 had surgery. Delayed complications
(>1 month) occurred in 4 patients, 3 required surgery. Overall
median survival post SEMS was 212 days. According to indication for SEMS, 30- and 90-day survival was respectively: palliative 81.2% and 68.2%; bridging 92.3%; compressive 50% and
33.3% and benign 100%. Median (IQR) survival was: palliative
205 (49–425); bridging 766 (408–960) and compression 27
(12–158) days.
Conclusion The commonest indication for SEMS placement was
malignant LBO from CRC. In palliative patients it has a good
success rate and avoids the need for surgery in patients with a
limited median survival. As a bridge to surgery in patients undergoing subsequent surgery it has a high success rate but does not
always avoid the need for a stoma.
Disclosure of interest None Declared.
(19%). Approach was laparoscopic in 95/231 (41%) cases; conversion rate 21% (20/95). OD was utilised in 117/231 (51%)
cases and was associated with a mean rise in IV fluid given of
702ml (P = 0.004, t-test). Thoracic epidural was placed in 37/
231 (16%) patients. Overall complication rate was 94/231
(41%); surgical complications were seen in 32%, renal 9%, respiratory 8% and cardiac 4%.
Multivariate analysis independently linked increased LOS
with surgical complications (P < 0.0001), renal complications (P
= 0.0001), longer operating times (P = 0.0047), creation of
stoma (P = 0.0259) and non-compliance with ERAS protocol (P
= 0.056). ERAS compliance did not significantly affect LOS in
the laparoscopic cohort, whereas in the open group this retained
significance (P = 0.0107).
Development of any complication was associated with ASA
grade of >2 (P = 0.001), use of IV opiates >48 hrs (P =
0.0120) and rectal surgery (P = 0.0879). In the laparoscopic
cohort, only higher intra-op fluid volume (P = 0.0444) and IV
opiates (P = 0.0169) correlated with complication rate. In this
cohort, fluid volume predicted complications in the non-OD
group (n = 41; P = 0.0253), but not the OD group (n = 52, P
= 0.8863).
Conclusion Compliance with the ERAS protocol reduced LOS
in patients having open surgery. Boosting outpatient support for
patients with new stomas may reduce LOS. OD and epidural
were not correlated with LOS. In the laparoscopic cohort, higher
complication rates were seen with use of IV opiates >48 hrs and
greater volumes of fluid intra-op. IN this group of patients, OD
may safely identify patients who require fluid resuscitation whilst
avoiding overload.
Disclosure of interest None Declared.
PWE-316 INCIDENCE AND MANAGEMENT OF IATROGENIC
PERFORATIONS IN THE WELSH BOWEL SCREENING
PROGRAMME
PWE-315 SUPERFLUOUS IV FLUIDS INCREASE COMPLICATION
RATE IN LAPAROSCOPIC COLORECTAL SURGERY
1
F Dewi*, 2H Heard, 2M Davies, 2S Dolwani, 2J Torkington, Bowel Screening Wales.
Foundation Programme, Wales Deanery; 2Bowel Screening Wales, Cardiff, UK
1
E Tweedle*, J Whiteley, F McNicol, PS Rooney. Colorectal Surgery, Royal Liverpool
Unversity Hospital, Liverpool, UK
10.1136/gutjnl-2015-309861.761
Introduction Our hospital has an established ERAS protocol for
colorectal patients. We aimed to assess whether Oesophageal
Doppler (OD) and thoracic epidural affected length of stay
(LOS) or complications rates.
Method We analysed a prospectively-collected database of
patients undergoing colorectal surgery from 25/11/11 to 14/08/
13. There were 231 patients; 121 M: 110 F with a median age
of 62 yrs (range 18–92). LOS was typically left-skewed and was
transformed using log. Ordinal Least Squares regression was conducted with log[LOS] as the dependant variable. Logistic regression was used to identify factors associated with complications.
Variables were analysed separately; those with an association at
P < 0.10 were combined in a multivariate analysis in a forward
stepwise approach.
Results Our ERAS protocol routinely utilised 11 constituents of
the ERAS compliance group guidelines. Epidural and IV fluid
use were under investigation. The median no of ERAS elements
per patient was 9 (IQR 7–10). Patients were dichotomised into
ERAS compliant (‡9) 143/231 (62%) or ERAS non-compliant
(<9) 88/231 (38%). Resections were classified as colonic 105/
231 (45%), rectal/combined 83/231 (36%) or none 43/231
Gut 2015;64(Suppl 1):A1–A584
10.1136/gutjnl-2015-309861.762
Introduction Iatrogenic perforation is a rare but serious complication of colonoscopy. Reported incidence varies between
0.005% and 0.629%, and is mostly based on diagnostic and
therapeutic rather than screening colonoscopies. The British
Society of Gastroenterology (BSG) has set a target of no more
than one perforation in every 1000 screening colonoscopies.
Method All cases of iatrogenic perforations within the Bowel
Screening Wales programme between January 2009 and December 2014 were identified. As part of a robust Quality Assurance
programme, a policy of detailed root cause analysis was introduced in 2011; this was subsequently performed for all cases
and outcomes recorded.
Results 17,699 screening colonoscopies were performed within
the specified time period, of which 10,688 proceeded to polypectomy (60.4%). There were 13 perforations (0.073%), of
which 11 underwent root cause analysis. Of these, nine cases
were following polypectomy, one was following negotiation
around a splenic flexure malignant tumour and one was during a
difficult colonoscopy in the context of multiple adhesions and
diverticular disease. Almost all were managed with emergency
surgery (n = 10). There was one fatality as a result of colonoscopy (0.006%).
A349
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