With her thesis, Carla Marres hopes to increase knowledge about interventions in colorectal surgery that improve the quality of care by reducing the number of complications. The focus was on interventions that are directly applicable in peripheral hospitals, where the majority of these operations take place.
To reduce complications and thus improve postoperative outcomes, Marres and colleagues investigated the effect of a set of newly introduced measures in a cohort study of 488 patients.
The measures consisted of avoiding the use of NSAIDs, maintaining optimal fluid balance, both peri- and postoperatively, avoiding resection with primary anastomosis if possible in people over 80 with an ASA classification ≥ 3 and the introduction of a standardized protocol with a CRP measurement and, if necessary, a CT scan. The introduction of these relatively simple measures resulted in a significant reduction in serious postoperative complications (from 25.0 to 13.7%) and in mortality (from 8.2 to 2.6%).
A prospective follow-up study investigated the effect of postoperative observation of vulnerable patients for 24 hours in Medium Care. After this intervention there was a significant decrease in serious complications (from 18.6 to 11.9%) and death (from 5.5 to 1.0%).
Bron:
Marres C. Quality enhancement in colorectal surgery in a community hospital. Dissertation, University of Amsterdam, 1 July 2022.
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