Evidence-Based Care After Colonic Surgery
Evidence-Based Care After Colonic Surgery
Kehlet H, Büchler MW, Beart RW, Billingham RP, Williamson R
J Am Coll Surg. 2006;202:45-54
The aim of this study was to determine the extent to which "evidence-based" principles are being used in the care of patients undergoing bowel surgery. The study was based on a survey of 1082 patients in 52 American and 295 European hospitals. Bowel preparation was widely used in all countries, despite increasing reports that it may be unnecessary; laparoscopy was infrequently performed; epidural anesthesia, which can reduce anesthetic complications, was infrequently used in Europe. Regardless of the lack of evidence for their effectiveness, nasogastric tubes were used in > 50% of European patients and about 40% of US patients. Early feeding, which can reduce sepsis and hasten the return of bowel function, was rare.
One of the drawbacks to this study was the low response rate (49% in Europe, 12% in the United States) to the survey instrument. Nevertheless, there is clear evidence from the responding institutions that there is considerable room for improvement in the perioperative and postoperative care of patients undergoing colonic surgery. Improving standards of care is likely to reduce mortality, morbidity, and the length of stay after colonic surgery.
Abstract
Kehlet H, Büchler MW, Beart RW, Billingham RP, Williamson R
J Am Coll Surg. 2006;202:45-54
The aim of this study was to determine the extent to which "evidence-based" principles are being used in the care of patients undergoing bowel surgery. The study was based on a survey of 1082 patients in 52 American and 295 European hospitals. Bowel preparation was widely used in all countries, despite increasing reports that it may be unnecessary; laparoscopy was infrequently performed; epidural anesthesia, which can reduce anesthetic complications, was infrequently used in Europe. Regardless of the lack of evidence for their effectiveness, nasogastric tubes were used in > 50% of European patients and about 40% of US patients. Early feeding, which can reduce sepsis and hasten the return of bowel function, was rare.
One of the drawbacks to this study was the low response rate (49% in Europe, 12% in the United States) to the survey instrument. Nevertheless, there is clear evidence from the responding institutions that there is considerable room for improvement in the perioperative and postoperative care of patients undergoing colonic surgery. Improving standards of care is likely to reduce mortality, morbidity, and the length of stay after colonic surgery.
Abstract
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