Uptake of Total Mesorectal Excision and Total Mesorectal Excision Grading for Rectal Cancer: A Statewide Study.

Background: Total mesorectal excision is associated with decreased local recurrence and improved disease-free survival following rectal cancer resection. The extent to which total mesorectal excision has been adopted in the United States is unknown.

Objective: We sought to assess trends in total mesorectal excision performance and grading in Michigan hospitals.

The benefits of a low dose complex carbohydrate/citrulline electrolyte solution for preoperative carbohydrate loading: Focus on glycemic variability.

Background: Perioperative insulin resistance is associated with significant hyperglycemia-related morbidity in patients undergoing major surgery. We sought to assess the effect of preoperative loading with a low-dose maltodextrin/citrulline solution compared to a commercially available sports drink on glycemic levels in an established colorectal enhanced recovery program.

Methods: Retrospective analysis was undertaken of elective non-diabetic colectomies and enterectomies from January 2016-March 2017.

High-definition colonoscopy increases adenoma detection rate.

Background: The adenoma detection rate (ADR) is a quality indicator for colonoscopy. High-definition (HD) imaging has been reported to increase polyp detection rates.

Objective: The primary objective of this study was to compare polyp detection rate (PDR) and adenoma detection rate (ADR) before and after the implementation of HD colonoscopy.

Incremental cost of complications in colectomy: a warranty guided approach to surgical quality improvement.

Background: We assessed the warranty cost for colectomy at a single institution, as defined by the additional cost of treating complications distributed across all patients treated.

Methods: All segmental colectomies from July 8 to June 12 were reviewed for 0, 1, 2, and ≥3 complications. Warranty cost is defined as follows: ([mean additional cost of the case with complication(s) - mean base case cost] × number of episodes)/total population.

Risk factors for readmission after elective colectomy: postoperative complications are more important than patient and operative factors.

Background: Colon resections are associated with substantial risk for morbidity and readmissions, and these have become markers for quality of care.

Objective: The purpose of this study was to determine risk factors for readmissions after elective colectomies to improve patient care and better understand the complex issues associated with readmissions.

Design: This was an analysis of the prospective, statewide, multicenter Michigan Surgical Quality Collaborative database.

Laparoscopic proctectomy: oncologic considerations.

The role of laparoscopic proctectomy in rectal cancer has not clearly been defined. Publications on long-term outcomes after laparoscopic proctectomy is lacking and there is a wide variation of practice patterns of rectal cancer management. Current data supports the feasibility of laparoscopic proctectomy for rectal cancer but due to surgeon, patient and tumor related factors open technique may be favored.

Hidradenitis suppurativa and pruritus ani.

Hidradenitis suppurativa (HS) is a chronic debilitating disorder that can affect any areas bearing apocrine glands. Perineal HS is associated with high morbidity compared with other anatomic regions. Early-stage disease may mimic various other forms of cutaneous disorders, but as HS progresses pathognomonic skin changes occur.

Outcomes of ileocolic resection and right hemicolectomies for Crohn's patients in comparison with non-Crohn's patients and the impact of perioperative immunosuppressive therapy with biologics and steroids on inpatient complications.

Background: The purpose of this study was to compare medication use and complication rates between Crohn's disease (CD) and non-CD patients undergoing ileocolic resections and right hemicolectomies.

Methods: A review of patients who underwent ileocolic resections and right hemicolectomies from January 1, 2003, through December 31, 2010, was performed. Data collected included demographics and clinical information, biologics use (eg, infliximab, adalimumab), other medication use (eg, steroids), complications, and mortality.

Citrulline: a potential immunomodulator in sepsis.

Background: Sepsis leads to a complex systemic response of cytokines (both pro- and anti-inflammatory) and more recently recognized adipokine mediators. Endothelial nitric oxide (NO) may be a key component in regulating this response, but the pharmacologic manipulation of endothelial NO via L-arginine supplementation or inhibitors has provided inconsistent clinical data related to outcomes. These failures are related to the metabolism of L-arginine in the liver, toxicity of L-arginine, and asymmetric dimethylarginine inhibition, all of which may explain the "arginine paradox.

Introduction of alvimopan into an enhanced recovery protocol for colectomy offers benefit in open but not laparoscopic colectomy.

Introduction: Alvimopan coupled with an enhanced recovery protocol (ERP) has been shown to reduce length of stay (LOS) after open colectomy, but its role after laparoscopy remains unknown. This study evaluated alvimopan with an established ERP for laparoscopic (LAP), hand-assisted laparoscopic (HAL), and open colectomy.

Materials And Methods: Consecutive patients who underwent elective colectomy by any technique were retrospectively identified.

Serum adiponectin, resistin, and circulating soluble receptor for advanced glycation end products in colectomy patients.

Aim: Surgical trauma and associated complications are frequently related to physiological stress during colectomy. This study evaluated the response of adiponectin, resistin, and circulating soluble receptor for advanced glycation end products (sRAGE) in colectomy patients with or without an enhanced recovery protocol.

Method: Serum samples were collected from 44 colectomy patients at 3 timframes.

Influence of intravenous opioid dose on postoperative ileus.

Background: Intravenous opioids represent a major component in the pathophysiology of postoperative ileus (POI). However, the most appropriate measure and threshold to quantify the association between opioid dose (eg, average daily, cumulative, maximum daily) and POI remains unknown.

Objective: To evaluate the relationship between opioid dose, POI, and length of stay (LOS) and identify the opioid measure that was most strongly associated with POI.

Optimal follow-up to curative colon and rectal cancer surgery: how and for how long?

In 2009, the projected incidence for colon and rectal cancers in the United States was 106,100 and 40,870, respectively, and approximately 75% of these patients were treated with curative intent. Surveillance or follow-up after colon and rectal cancer resection serves multiple purposes; however, the primary argument supporting the validity of surveillance is the detection of metachronous and recurrent cancers amenable to curative treatment. The surveillance may provide some comfort for cancer survivors who can be informed that they have no evidence of disease.

Postoperative ileus: it costs more than you expect.

Background: The clinical impact of postoperative ileus (POI) after colectomy is difficult to quantify financially because of administrative coding limitations. Accurate data are important to allow pharmaco-economic analysis of methods aimed at reducing POI. The aim of this study was to assess the financial impact of POI for the 30-day episode of care for colectomy.