Impacts of the implementation of multimodal perioperative care protocols in Brazil in collectomies from 2008 to 2022
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Abstract
Objective: To identify the epidemiological characteristics of hospitalizations following colectomy procedures recorded in the Hospital Information System (Sistema de Informações Hospitalares) in Brazil, from January 2008 to December 2021. Method: This was an epidemiological, observational, and analytical study with a cross-sectional design, based on data obtained from the Hospital Information System (Sistema de Informações Hospitalares). It included hospitalizations of individuals aged 18 years or older who underwent either open or video laparoscopic colectomy procedures.
Results: A total of 213,132 hospitalizations were analyzed in Brazil, involving patients with a mean age of 60 years and a slight predominance of males. The Southeast region accounted for the majority of hospitalizations. All procedures showed a reduction in average length of stay from 2015 to 2022. Regarding ICU utilization, a significant reduction was observed among patients who underwent video laparoscopic colectomy. A statistically significant reduction in mortality was also observed in this group. Conclusion: This study demonstrated a significant increase in the use of video-assisted surgery and a reduction in both hospital stay and associated costs. These findings align with practices promoted by international protocols, which emphasize reduced preoperative fasting, early postoperative feeding, and the use of minimally invasive surgical techniques.
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References
DE-Aguilar-Nascimento JE, Salomão AB, Caporossi C, Dock- Nascimento DB, Eder Portari-Filho P, Campos ACL, et al. ACERTO Project - 15 years changing perioperative care in Brazil. Rev Col Bras Cir 2021;48:e20202832. http://doi.org/10.1590/0100- 6991e-20202832. PMid:33503143. DOI: https://doi.org/10.1590/0100-6991e-20202832
Kaye AD, Urman RD, Cornett EM, Hart BM, Chami A, Gayle JA, et al. Enhanced recovery pathways in orthopedic surgery. J Anaesthesiol Clin Pharmacol 2019;35(5, Suppl 1):S35-9. http:// doi.org/10.4103/joacp.JOACP_35_18. PMid:31142957. DOI: https://doi.org/10.4103/joacp.JOACP_35_18
Singh SM, Liverpool A, Romeiser JL, Miller JD, Thacker J, Gan TJ, et al. A U.S. survey of pre-operative carbohydrate-containing beverage use in colorectal enhanced recovery after surgery (ERAS) programs. Perioper Med (Lond) 2021;10(1):19. http:// doi.org/10.1186/s13741-021-00187-3. PMid:34044894. DOI: https://doi.org/10.1186/s13741-021-00187-3
Hadaya J, Sanaiha Y, Juillard C, Benharash P. Impact of frailty on clinical outcomes and resource use following emergency general surgery in the United States. PLoS One 2021;16(7):e0255122. http://doi.org/10.1371/journal.pone.0255122. PMid:34297772. DOI: https://doi.org/10.1371/journal.pone.0255122
Coelho JCU, Pinho RV, de Macedo JJM, Andriguetto PC, Campos ACL. Colectomia laparoscópica: revisão retrospectiva de 120 casos. Rev Col Bras Cir 2009;36(2):144-7. http://doi.org/10.1590/ S0100-69912009000200010. PMid:20076886. DOI: https://doi.org/10.1590/S0100-69912009000200010
Vu JV, Li J, Likosky DS, Norton EC, Campbell DA Jr, Regenbogen SE. Achieving the high-value colectomy: preventing complications or improving efficiency. Dis Colon Rectum. 2020;63(1):84- 92. http://doi.org/10.1097/DCR.0000000000001523. PMid:31633600. DOI: https://doi.org/10.1097/DCR.0000000000001523
Bicudo-Salomão A, Salomão RF, Cuerva MP, Martins MS, Dock-Nascimento DB, Aguilar-Nascimento JE. Factors related to the reduction of the risk of complications in colorectal surgery within perioperative care recommended by The ACERTO Protocol. Arq Bras Cir Dig. 2019;32(4):e1477. http:// doi.org/10.1590/0102-672020190001e1477. PMid:31859930. DOI: https://doi.org/10.1590/0102-672020190001e1477
Taurchini M, Del Naja C, Tancredi A. Enhanced Recovery After Surgery: a patient centered process. J Vis Surg. 2018;4:40. http://doi.org/10.21037/jovs.2018.01.20. DOI: https://doi.org/10.21037/jovs.2018.01.20
Brasil. Ministério da Saúde. Orientações técnicas para operacionalização do sih durante o estado de emergência de saúde pública por coronavírus [Internet]. Brasília: Ministério da Saúde; 2020 [cited 2006 Nov 2]. Available from: http://sihd. datasus.gov.br.
Saldanha RF, Bastos RR, Barcellos C. Microdatasus: pacote para download e pré-processamento de microdados do Departamento de Informática do SUS (DATASUS). Cad Saude Publica. 2019;35(9):e00032419. http://doi.org/10.1590/0102- 311x00032419. PMid:31531513. DOI: https://doi.org/10.1590/0102-311x00032419
de Aguilar-Nascimento JE, Bicudo-Salomão A, Ribeiro MRR, Dock-Nascimento DB, Caporossi C. Cost-effectiveness of the use of acerto protocol in major digestive surgery. Arq Bras Cir Dig. 2022;35:e1660. http://doi.org/10.1590/0102- 672020210002e1660. PMid:35766605. DOI: https://doi.org/10.1590/0102-672020210002e1660
McLean RC, Young J, Musbahi A, Lee JX, Hidayat H, Abdalla N, et al. A single-centre observational cohort study to evaluate volume and severity of emergency general surgery admissions during the COVID-19 pandemic: Is there a “lockdown” effect? Int J Surg. 2020;83:259-66. http://doi.org/10.1016/j.ijsu.2020.09.011. PMid:32931980. DOI: https://doi.org/10.1016/j.ijsu.2020.09.011
Ali AB, Shaikh A, Maghami N, Zia M, Wolf DA, Bonville DJ. Impact of Covid-19 pandemic on volume and surgeon professional fees generated by emergency general surgery procedures. Surg Endosc. 2022;36(12):9297-303. http://doi.org/10.1007/ s00464-022-09168-z. PMid:35296948. DOI: https://doi.org/10.1007/s00464-022-09168-z
Ahmad G, Baker J, Finnerty J, Phillips K, Watson A. Laparoscopic entry techniques. Cochrane Database Syst Rev. 2019;1(1):CD006583. http://doi.org/10.1002/14651858. CD006583.pub5. PMid:30657163. DOI: https://doi.org/10.1002/14651858.CD006583.pub5
Senagore AJ, Erwin-Toth P. Care of the laparoscopic colectomy patient. Adv Skin Wound Care. 2002;15(6):277-83, quiz 284-5. http://doi.org/10.1097/00129334-200211000-00009. PMid:12477980. DOI: https://doi.org/10.1097/00129334-200211000-00009
Sheetz KH, Norton EC, Regenbogen SE, Dimick JB. An instrumental variable analysis comparing medicare expenditures for laparoscopic vs open colectomy. JAMA Surg. 2017;152(10):921-9. http://doi.org/10.1001/jamasurg.2017.1578. PMid:28614579. DOI: https://doi.org/10.1001/jamasurg.2017.1578
Anderson C, Uman G, Pigazzi A. Oncologic outcomes of laparoscopic surgery for rectal cancer: a systematic review and meta-analysis of the literature. Eur J Surg Oncol. 2008;34(10):1135-42. http://doi.org/10.1016/j.ejso.2007.11.015. PMid:18191529. DOI: https://doi.org/10.1016/j.ejso.2007.11.015
Veldkamp R, Kuhry E, Hop WCJ, Jeekel J, Kazemier G, Bonjer HJ, et al. Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol. 2005;6(7):477-84. http://doi.org/10.1016/S1470- 2045(05)70221-7. PMid:15992696. DOI: https://doi.org/10.1016/S1470-2045(05)70221-7
Nelson H, Sargent DJ, Wieand HS, Fleshman J, Anvari M, Stryker SJ, et al. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. 2004;350(20):2050-9. http://doi.org/10.1056/NEJMoa032651. PMid:15141043. DOI: https://doi.org/10.1056/NEJMoa032651