Multimodal approach in colorrectal surgery without mechanical bowel cleansing.
OBJECTIVE
To evaluate the outcomes after the implementation of a multimodal protocol (ACERTO protocol) with patients undergoing colorectal operations.


METHODS
Fifty-three patients (37 M and 16 F; 57 [18-82] years old) submitted to various colorectal operations were prospectively studied in two different periods of time: from January 2004 through July 2005 (n=25, conventional group) and from August 2005 through June 2008 (n=28; ACERTO group). The patients received either the traditional perioperative management (including mechanical bowel cleansing) or a multidisciplinary protocol of perioperative care (without mechanical bowel cleansing) established by the ACERTO protocol. We looked at morbidity and mortality rates and length of hospital stay for comparisons between the groups.


RESULTS
Mortality was 3.8% (2 patients) without difference between groups. Preoperative fasting and postoperative feeding were shortened and intravenous fluids were diminished in patients operated under the ACERTO protocol (p<0.05). Postoperative morbidity (36% vs. 28.6%; p=0.56) and the incidence of anastomotic leak (12 vs. 10.7%; p=1.00) were similar. The number of complications per patient with any complication was lower in the ACERTO group (p=0.01). Changing protocols reduced the length of hospital stay by 4.5 days (12 [4-43] vs. 7.5 [3-47] days, p= 0.04).


CONCLUSIONS
The multidisciplinary routines of the ACERTO protocol are safe and enhanced recovery in colorectal surgery by reducing both hospitalization and the severity of postoperative morbidity.
de Aguilar-Nascimento
José Eduardo
JE
Department of Surgery of Faculdade de Ciências Médicas da Universidade Federal do Mato Grosso, MT, Brazil. aguilar@terra.com.br
Bicudo-Salomão
Alberto
A
Caporossi
Cervantes
C
Silva
Raquel de Melo
Rde M
Cardoso
Eduardo Antonio
EA
Santos
Tiago Pádua
TP
Diniz
Breno Nadaf
BN
Hartmann
Arthur André
AA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003107:Colorectal Surgery / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care; D011446:Prospective Studies; D055815:Young Adult