Complications following colorectal surgery are a significant health concern, affecting patient recovery and quality of life. While some postoperative outcomes may be unavoidable, a large number of complications can be anticipated and potentially prevented with appropriate measures. In a detailed review published in Clinics in Colon and Rectal Surgery, Lee Sung Gon and Andrew Russ elaborate on the various methods to predict and deter postoperative complications in colorectal surgery. This article will dive deep into the insights provided by the review to help healthcare professionals reduce the occurrence of such complications.
Predictive Models and Their Utility
Predictive models like the American College of Surgeons National Surgery Quality Improvement Program (ACS NSQIP) risk calculator and the Physiological and Operative Severity Score for the enumeration of Mortality and morbidity (POSSUM) have been instrumental in estimating the likelihood of complications. The ACS NSQIP risk calculator, validated by Lubitz et al. (DOI: 10.1016/j.jamcollsurg.2017.06.017), and other studies, has been praised for its ability to assess risk based on a variety of relevant factors known to both patients and surgeons preoperatively.
Nonmodifiable and Modifiable Risk Factors
The review by Gon and Russ underscores the importance of identifying both nonmodifiable and modifiable risk factors. It is essential for surgeons and healthcare professionals to recognize nonmodifiable factors such as age, genetic predispositions, or pre-existing medical conditions. On the other hand, modifiable factors like patient nutritional status, body mass index (BMI), smoking, and alcohol intake, can be addressed preoperatively to minimize risk. Studies like that of Sørensen et al. (DOI: 10.1046/j.1365-2168.1999.01135.x) have shown that addressing modifiable lifestyle factors can significantly reduce the risk of anastomotic leakage, which is a serious postoperative complication.
Preoperative Patient Optimization
A vital component of preoperative care includes optimizing the patient’s general health status. This may involve nutritional support, smoking cessation programs, and exercise or ‘prehabilitation’ programs designed to enhance physical fitness before surgery. The Enhanced Recovery After Surgery (ERAS) guidelines recommend multimodal prehabilitation regimens to improve postoperative outcomes. Nutrition plays a critical role, and research by Carli et al. (DOI: 10.1002/bjs.7084) suggests that preoperative nutritional optimization can lead to better recovery metrics.
Role of Informed Consent and Shared Decision Making
Gon and Russ highlight that informed consent and shared decision-making processes are opportunities to discuss the potential risks and benefits of colorectal surgery. The ACS NSQIP surgical risk calculator can serve as a tool to facilitate these conversations, promoting patient engagement and understanding of their surgical journey.
Surgical Techniques and Postoperative Care
The type of surgical technique used can also influence postoperative outcomes. For example, minimally invasive laparoscopic surgeries have been associated with fewer complications and faster recovery times compared to traditional open surgeries. Furthermore, the implementation of postoperative care protocols, such as early ambulation, proper wound care, and vigilant monitoring for signs of complications, are pivotal in preventing negative postoperative outcomes.
Impact of Research Findings on Clinical Practice
The findings from Gon and Russ’s review have significant implications for clinical practice. By leveraging predictive models, recognizing modifiable risks, and optimizing patient health preoperatively, medical professionals can potentially lower the frequency and severity of complications following colorectal surgery.
1. Colorectal Surgery Complications
2. ACS NSQIP Risk Calculator
3. Postoperative Outcomes Prediction
4. Patient Preoperative Optimization
5. Minimizing Surgical Risk Factors
1. Lubitz A. L., Chan E., Zarif D., et al. (2017). American College of Surgeons NSQIP risk calculator accuracy for emergent and elective colorectal operations. J Am Coll Surg. 225(05):601–611. https://doi.org/10.1016/j.jamcollsurg.2017.06.017
2. Sørensen L. T., Jørgensen T., Kirkeby L. T., Skovdal J., Vennits B., Wille-Jørgensen P. (1999). Smoking and alcohol abuse are major risk factors for anastomotic leakage in colorectal surgery. Br J Surg. 86(07):927–931. https://doi.org/10.1046/j.1365-2168.1999.01135.x
3. Carli F., Charlebois P., Stein B., et al. (2010). Randomized clinical trial of prehabilitation in colorectal surgery. Br J Surg. 97(08):1187–1197. https://doi.org/10.1002/bjs.7084
4. Lee Sung Gon, Russ Andrew. (2019). Predicting and Preventing Postoperative Outcomes. Clin Colon Rectal Surg. 32(03):149-156. https://doi.org/10.1055/s-0038-1677001
5. Schwarze M. L., Brasel K. J., Mosenthal A. C. (2014). Beyond 30-day mortality: aligning surgical quality with outcomes that patients value. JAMA Surg. 149(07):631–632. https://doi.org/10.1001/jamasurg.2014.382
Colorectal surgeries, although beneficial, come with an inherent risk of postoperative complications. Utilizing models like the ACS NSQIP risk calculator, identifying both modifiable and nonmodifiable risk factors, preoperative optimization, and employing meticulous surgical techniques are all strategies highlighted in Gon and Russ’s review that can predict and prevent adverse postoperative outcomes. With ongoing research and adherence to evidence-based practices, the medical community continues to strive for enhanced patient safety and quality of care in colorectal surgical procedures.