Skip to Main Content

++

Overview

++

Initiative sponsored by several organizations to improve the surgical care and reduce preventable surgical complications (morbidity and mortality). Linked to pay-for-performance quality parameters.

++

Four major targets for prevention:

++

  • • Surgical site infections.
  • • Venous thromboembolism.
  • • Cardiac morbidity.
  • • Respiratory morbidity.

++

Prevention of Surgical Site Infection

++

Surgical site infection is responsible for 15% of all nosocomial infections: 2–5% of clean extra-abdominal cases and up to 20% of intra-abdominal cases.

++

Measures:

++

  • • Appropriate selection of prophylactic antibiotics: eg, cephalosporin + metronidazole, ertanpenem, fluorochinolone + metronidazole. Betalactam allergy: fluoroquinolone + metronidazole, clindamycin + fluoroquinolone, clindamycin + aztreonam, etc.
  • • Prophylactic antibiotics received within 1 hour before surgical incision.
  • • Prophylactic antibiotics limited to 24 hours (longer duration okay for therapeutic indication).
  • • Appropriate hair removal for surgical field preparation (clipper, no razor).
  • • Monitoring and correction of peri-postoperative glucose levels.
  • • Maintenance of peri-/postoperative normothermia.

++

Prevention of Venous Thromboembolism

++

Without appropriate prophylaxis, DVT is a complication in 20–50% of major operations → pulmonary embolism in 10–30%.

++

Measures:

++

  • • Recommended DVT prophylaxis ordered.
  • • Appropriate DVT prophylaxis initiated within 24 hours before surgery to 24 hours after surgery.

++

Prevention of Adverse Cardiac Events

++

Adverse cardiac events (eg, myocardial infarction, sudden cardiac death, congestive heart failure) complicate 2–5% of noncardiac surgeries overall, causing increased mortality rate, length of stay, cost.

++

Measures:

++

  • • Perioperative β-blocker administration if previously required (eg, for angina, hypertension, arrhythmias).

++

Prevention of Respiratory Complications

++

Patients on respirator with mechanical ventilation are at increased risk of ventilator-associated pneumonia (10–30%), stress ulcer disease, and GI bleeding.

++

Suggested (but not yet approved) measures:

++

  • • Elevation of head of bed.
  • • Provision of stress ulcer disease prophylaxis.
  • • Use of ventilator weaning protocols to reduce duration of mechanical ventilation.

++

Cross-Reference

++ ++ ++ ++
++

Overview

++

Colorectal surgery encompasses an enormously broad spectrum of diseases and conditions through all age and risk groups. Treatment equally varies in a wide range of approaches and is delivered in several different settings (office, OR, endoscopy suite, outpatient/inpatient).

++

Hence, management is not “one-size-fits-all.” Nonetheless, a few principles have evolved that should be considered in the perioperative management of a patient undergoing an abdominal procedure.

++

Risk Assessment

++

  • • < 40 years, no risk factors/symptoms → no specific workup needed.
  • • > 40 years, no risk factors → ECG, chest x-ray, basic set of lab work.
  • • Any age, specific risk factors/symptoms → ECG, chest x-ray, basic set of ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessSurgery Full Site: One-Year Subscription

Connect to the full suite of AccessSurgery content and resources including more than 160 instructional videos, 16,000+ high-quality images, interactive board review, 20+ textbooks, and more.

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessSurgery

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.