Hidden Morbidity following Colorectal Resection: postoperative evaluation

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Abstract

Introduction: The implementation and evaluation of Enhanced Recovery after Surgery programmes over the past 15 years has ensured the accurate reporting of inpatient morbidity post colorectal resection. However, there is a paucity of audit or research examining post-operative morbidity in the early discharge period.

Method: 142 consecutive patients undergoing elective (n= 98) or emergency (n=44) colorectal resection over a three- month period were invited to attend a nurse-led outpatient clinic at 30 days post-discharge. Audit data were collected at two time-points, discharge from hospital and at clinic. Audit templates were developed using the Postoperative Morbidity Survey (Grocott et al, 2007), Clavien-Dindo classification criteria (Dindo et al, 2004) and modified to include additional colorectal surgery-specific outcomes. Results were recorded and analysed using SPSS.

Results: Unanticipated findings relating to post-discharge morbidity identified through the audit included: 35% (n=32) of infection-free inpatients developed surgical site infections following discharge. 34% (n=47) of all patients had significant urinary symptoms when seen in clinic. Dietary implications at 30 days post-discharge included an appetite of half or less than usual intake in 27% of patients (n=37) and moderate to major changes in dietary intake compared to their pre- operative diet in 30% (n=42). 27% (n=38) of patients had an ileostomy; of those without an ileostomy, 20% (n=21) had four or more daily bowel movements, with 22% (n=23) describing their stool consistency as watery, loose or unsettled. 45% (n=46) of those without an ileostomy reported one or more problematic bowel symptom related to their surgical experience at 30 days post-discharge.

Conclusion: These audit findings suggest that individuals undergoing colorectal resection experience significant levels of post-discharge morbidity, extending the burden on them and the services required to support them for longer than may have been previously anticipated. Nurse-led follow-up using auditable documentation templates facilitates the recognition and reporting of complications following discharge and provides valuable support for patients.

References: Dindo, D. et al (2004) Classification of Surgical Complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Annals of Surgery 240(2):205-213
Grocott MPW et al (2007) The Postoperative Morbidity Survey was validated and used to describe morbidity after pelvic surgery. Journal of Clinical Epidemiology 60: 919-928
Original languageEnglish
Publication statusPublished - 23 Jun 2015
EventDigestive Disorders Federation - Excel, London, United Kingdom
Duration: 22 Jun 201525 Jun 2015

Conference

ConferenceDigestive Disorders Federation
CountryUnited Kingdom
CityLondon
Period22/06/1525/06/15

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