American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on prevention of postoperative infection within an enhanced recovery pathway for elective colorectal surgery.
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BACKGROUND: Colorectal surgery (CRS) patients are an at-risk population who are particularly vulnerable to postoperative infectious complications. Infectious complications range from minor infections including simple cystitis and superficial wound infections to life-threatening situations such as lobar pneumonia or anastomotic leak with fecal peritonitis. Within an enhanced recovery pathway (ERP), there are multiple approaches that can be used to reduce the risk of postoperative infections. METHODS: With input from a multidisciplinary, international group of experts and through a focused (non-systematic) review of the literature, and use of a modified Delphi method, we achieved consensus surrounding the topic of prevention of postoperative infection in the perioperative period for CRS patients. DISCUSSION: As a part of the first Perioperative Quality Initiative (POQI-1) workgroup meeting, we sought to develop a consensus statement describing a comprehensive, yet practical, approach for reducing postoperative infections, specifically for CRS within an ERP. Surgical site infection (SSI) is the most common postoperative infection. To reduce SSI, we recommend routine use of a combined isosmotic mechanical bowel preparation with oral antibiotics before elective CRS and that infection prevention strategies (also called bundles) be routinely implemented as part of colorectal ERPs. We recommend against routine use of abdominal drains. We also give consensus guidelines for reducing pneumonia, urinary tract infection, and central line-associated bloodstream infection (CLABSI).
Catheter or line-associated bloodstream infection
Enhanced recovery pathway
Enhanced recovery protocol
Mechanical bowel preparation
Surgical site infection
Urinary tract infection
Published Version (Please cite this version)10.1186/s13741-017-0059-2
Publication InfoGan, Tong Joo; Gupta, R; Hamilton, M; Hedrick, T; Holubar, SD; Kellum, J; ... Shaw, Andrew David (2017). American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on prevention of postoperative infection within an enhanced recovery pathway for elective colorectal surgery. Perioper Med (Lond), 6. pp. 4. 10.1186/s13741-017-0059-2. Retrieved from https://hdl.handle.net/10161/13944.
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Consulting Professor in the Department of Anesthesiology
My current research interests include postoperative nausea and vomiting (PONV), acute postoperative pain, clinical pharmacology of anesthetic drugs and resuscitation fluids as well as database research in postoperative outcomes. Improving Outcome in Surgical Patients: Nausea and vomiting is regarded as one of the most unpleasant experiences in postoperative recovery. To date, there is no single antiemetic which can satisfactorily control PONV. My interests concentrate o
This author no longer has a Scholars@Duke profile, so the information shown here reflects their Duke status at the time this item was deposited.
Associate Professor of Anesthesiology
Clinical and research interests are Enhanced Recovery and Perioperative Medicine; with particular interests in fluid management, and perioperative optimization of the high-risk non-cardiac surgery patient.
Adjunct Professor in the Department of Anesthesiology
Main area of research interest is the role of gut mucosal hypoperfusion in the pathogenesis of post-operative organ dysfunction. On-going projects include: i) the effects of temperature on gut perfusion during cardiopulmonary by-pass, ii) the relationship between cerebral and splanchnic hypoperfusion during cardiac surgery, iii) the relationship between gut mucosal hypoperfusion and outcome in patients admitted for surgical intensive care, iv) the effects of enteral feeding on gut perfusion and
Adjunct Associate Professor in the Department of Anesthesiology
Dr Shaw is an Associate Professor of Anesthesiology and Critical Care Medicine at Duke University Medical Center. He is a Fellow of the Royal College of Anaesthetists (UK) and a Fellow of the American College of Critical Care Medicine. He has practiced cardiothoracic anesthesiology and critical care medicine for more than 15 years in the UK and USA, has authored 3 textbooks and more than 100 original papers. He currently runs the iPEGASUS initiative, an international surgical outcomes conso
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American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Postoperative Gastrointestinal Dysfunction Within an Enhanced Recovery Pathway for Elective Colorectal Surgery. Thacker, Julie; Miller, Timothy; Wischmeyer, Paul; Hedrick, Traci L; McEvoy, Matthew D; Mythen, Michael Monty G; Bergamaschi, Roberto; ... (25 authors) (Anesthesia and analgesia, 2018-06)The primary driver of length of stay after bowel surgery, particularly colorectal surgery, is the time to return of gastrointestinal (GI) function. Traditionally, delayed GI recovery was thought to be a routine and unavoidable ...
Miller, Timothy; Gan, Tong J; Scott, Michael; Thacker, Julie; Hedrick, Traci; Thiele, Robert H (Anesthesia and analgesia, 2018-06)As the population ages, the increasing surgical volume and complexity of care are expected to place additional care delivery burdens in the perioperative setting. In this age of integrated multidisciplinary care of the surgical ...
American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Patient-Reported Outcomes in an Enhanced Recovery Pathway. Miller, Timothy; Thacker, Julie; Wischmeyer, Paul; Abola, Ramon E; Bennett-Guerrero, Elliott; Kent, Michael L; Feldman, Liane S; ... (25 authors) (Anesthesia and analgesia, 2018-06)Patient-reported outcomes (PROs) are measures of health status that come directly from the patient. PROs are an underutilized tool in the perioperative setting. Enhanced recovery pathways (ERPs) have primarily focused on ...