Effect of Pharmacoprophylaxis on Postoperative Outcomes in Adult Elective Colorectal Surgery: A Multi-Center Retrospective Cohort Study within an Enhanced Recovery after Surgery Framework.

Autor:	Blair WO; Department of Biomedical Sciences, School of Medicine, Mercer University, Columbus Campus, Columbus, GA 31902, USA., Ellis MA; Department of Pharmacy, University of Kentucky Medical Center, Lexington, KY 40536, USA., Fada M; Heritage School of Osteopathic Medicine, Ohio University, Athens, OH 45701, USA., Wiggins AA; Department of Biomedical Sciences, School of Medicine, Mercer University, Columbus Campus, Columbus, GA 31902, USA., Wolfe RC; Department of Pharmacy Services, Barnes-Jewish Hospital, St. Louis, MO 63110, USA., Patel GP; Department of Pharmacy Services, University of Chicago Hospitals, Chicago, IL 60637, USA., Brockhaus KK; Department of Pharmacy Services and Surgery, Trinity Health Ann Arbor Hospital, Ann Arbor, MI 48104, USA., Droege M; Department of Pharmacy Services, University of Cincinnati Medical Center, Cincinnati, OH 45219, USA., Ebbitt LM; Department of Pharmacy, University of Kentucky Medical Center, Lexington, KY 40536, USA., Kramer B; Department of Pharmacy Services, OhioHealth/Grant Medical Center, Columbus, OH 43215, USA., Likar E; Department of Pharmacy Services, West Virginia University Medicine, Morgantown, WV 26506, USA., Petrucci K; Department of Pharmacy Services, University of Chicago Hospitals, Chicago, IL 60637, USA., Shah S; Department of Pharmacy Services, Beaumont Hospital-Troy, Troy, MI 48085, USA., Taylor J; Department of Pharmacy Services, Legacy Good Samaritan Hospital, Portland, OR 97210, USA., Bingham P; Department of Pharmacy Services, University of Cincinnati Medical Center, Cincinnati, OH 45219, USA., Krabacher S; Department of Pharmacy Services, University of Cincinnati Medical Center, Cincinnati, OH 45219, USA., Moon JH; Department of Biomedical Sciences, School of Medicine, Mercer University, Columbus Campus, Columbus, GA 31902, USA., Rogoz M; Department of Pharmacy Services, Legacy Good Samaritan Hospital, Portland, OR 97210, USA., Jean-Jacques E; Department of Biomedical Sciences, School of Medicine, Mercer University, Columbus Campus, Columbus, GA 31902, USA., Cleary RK; Department of Pharmacy Services and Surgery, Trinity Health Ann Arbor Hospital, Ann Arbor, MI 48104, USA., Eke R; Department of Biomedical Sciences, School of Medicine, Mercer University, Columbus Campus, Columbus, GA 31902, USA., Findley R; Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada., Parrish RH 2nd; Department of Biomedical Sciences, School of Medicine, Mercer University, Columbus Campus, Columbus, GA 31902, USA.
Jazyk:	angličtina
Zdroj:	Healthcare (Basel, Switzerland) [Healthcare (Basel)] 2023 Nov 28; Vol. 11 (23). Date of Electronic Publication: 2023 Nov 28.
DOI:	10.3390/healthcare11233060
Abstrakt:	Background: The application of enhanced recovery after surgery principles decreases postoperative complications (POCs), length of stay (LOS), and readmissions. Pharmacoprophylaxis decreases morbidity, but the effect of specific regimens on clinical outcomes is unclear. Methods and Materials: Records of 476 randomly selected adult patients who underwent elective colorectal surgeries (ECRS) at 10 US hospitals were abstracted. Primary outcomes were surgical site infection (SSI), venous thromboembolism (VTE), postoperative nausea and vomiting (PONV), pain, and ileus rates. Secondary outcomes included LOS and 7- and 30-day readmission rates. Results: POC rates were SSI (3.4%), VTE (1.5%), PONV (47.9%), pain (58.1%), and ileus (16.1%). Cefazolin 2 g/metronidazole 500 mg and ertapenem 1 g were associated with the shortest LOS; cefotetan 2 g and cefoxitin 2 g with the longest LOS. No SSI occurred with ertapenem and cefotetan. More Caucasians than Blacks received oral antibiotics before intravenous antibiotics without impact. Enoxaparin 40 mg subcutaneously daily was the most common inpatient and discharge VTE prophylaxis. All in-hospital VTEs occurred with unfractionated heparin. Most received rescue rather than around-the-clock antiemetics. Scopolamine patches, spinal opioids, and IV lidocaine continuous infusion were associated with lower PONV. Transversus abdominis plane block with long-acting local anesthetics, celecoxib, non-anesthetic ketamine bolus, ketorolac IV, lidocaine IV, and pregabalin were associated with lower in-hospital pain severity rates. Gabapentinoids and alvimopan were associated with lower ileus rates. Acetaminophen, alvimopan, famotidine, and lidocaine patches were associated with shorter LOS. Conclusions: Significant differences in pharmacotherapy regimens that may improve primary and secondary outcomes in ECRS were identified. In adult ECRS, cefotetan or ertapenem may be better regimens for preventing in-hospital SSI, while ertapenem or C/M may lead to shorter LOS. The value of OA to prevent SSI was not demonstrated. Inpatient enoxaparin, compared to UFH, may reduce VTE rates with a similar LOS. A minority of patients had a documented PONV risk assessment, and a majority used as-needed rather than around-the-clock strategies. Preoperative scopolamine patches continued postoperatively may lower PONV and PDNV severity and shorter LOS. Alvimopan may reduce ileus and shorten LOS. Anesthesia that includes TAP block, ketorolac IV, and pregabalin use may lead to reduced pain rates. Acetaminophen, alvimopan, famotidine, and lidocaine patches may shorten LOS. Given the challenges of pain management and the incidence of PONV/PDNV found in this study, additional studies should be conducted to determine optimal opioid-free anesthesia and the benefit of newer antiemetics on patient outcomes. Moreover, future research should identify latent pharmacotherapy variables that impact patient outcomes, correlate pertinent laboratory results, and examine the impact of order or care sets used for ECRS at study hospitals.
Databáze:	MEDLINE
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