Perioperative care in colorectal surgery: current practice patterns and opinions.
Objective Evidence regarding perioperative care in colorectal surgery has recently increased, leading to changes in classical clinical procedures that make the perioperative period safer and shorter. This survey aimed to evaluate the opinions of Spanish colorectal surgeons on the perioperative management of their patients. Method Emailed surveys submitted to the members of Spanish Coloproctological Associations. Results One hundred and thirty-one (31.7%) of the 413 members participated in the study and responded thus: 21% use clinical pathways and 8% use fast track (FT); 36% use epidural analgesia in colonic surgery and 57% in rectal; 40% use warm air and 23% warm fluids to maintain intraoperative normothermia; 53% prescribe >/= 3000 ml. of iv fluids on the first postoperative day and 6.2%</= 2000 ml; 43% never use nasogastric tubes. Oral intake was initiated by 23.5% on the first day, and by 50% when peristalsis began, with an earlier tendency in laparoscopic surgery; 43% believed oral intake reduces ileus, but 12% considered it dangerous. Board accreditation and experience in Coloproctology were significantly associated with a lesser use of nasogastric tubes and earlier feeding. Sixty-nine per cent considered FT reduces postoperative stay and 44% thought that it minimizes complications. Conclusion Spanish surgeons maintain a classical procedural policy, but show tendencies towards optimizing patients' care.
Roig
J V
JV
Coloproctology Unit, Department of General and Digestive Surgery, Consorcio Hospital General Universitario de Valencia, Avda Tres Cruces 2, E46014 Valencia, Spain. roig_jvi@gva.es
García-Fadrique
A
A
Redondo
C
C
Villalba
F L
FL
Salvador
A
A
García-Armengol
J
J
D000328:Adult; D003106:Colon / Q000601:surgery*; D019091:Critical Pathways; D003625:Data Collection; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D019990:Perioperative Care; D010818:Practice Patterns, Physicians'; D012007:Rectum / Q000601:surgery*; D013030:Spain