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  • 1
    Language: English
    In: Gastroenterology, April 2016, Vol.150(4), pp.S1242-S1242
    Description: To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/S0016-5085(16)34195-6 Byline: Deborah Keller, Sergio Ibarra, Juan R. Flores, Eric M. Haas
    Keywords: Medicine
    ISSN: 0016-5085
    E-ISSN: 1528-0012
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  • 2
    Language: English
    In: Gastroenterology, April 2016, Vol.150(4), pp.S1189-S1189
    Description: To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/S0016-5085(16)34025-2 Byline: Deborah Keller, Sergio Ibarra, Juan R. Flores, Eric M. Haas
    Keywords: Medicine
    ISSN: 0016-5085
    E-ISSN: 1528-0012
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  • 3
    Language: English
    In: Gastroenterology, 2011, Vol.140(5), pp.S-1029-S-1029
    Keywords: Medicine
    ISSN: 0016-5085
    E-ISSN: 1528-0012
    Source: ScienceDirect Journals (Elsevier)
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  • 4
    Language: English
    In: AORN Journal, November 2015, Vol.102(5), pp.469-481
    Description: Enhanced recovery pathways (ERPs) are standardized, multidisciplinary approaches to caring for patients with a goal of decreasing length of stay and care costs without negatively affecting patient outcomes. One facility successfully implemented ERPs for patients undergoing abdominal surgery. For implementation to be successful, nurses were found to be key in providing education, perioperative care, and postoperative evaluation, as well as cost containment. The implementation team collaborated to define, design, implement, and audit an ERP for surgical services. Initial audits demonstrated an increase in compliance with order set use (61% to 93%) and use of ERPs more than standardized order sets (〈 1% to 27%), as well as decreased use of daily laboratory orders (94% to 62%) and elimination of automatically ordered laboratory tests (38% to 0%). These results led to the conclusion that the nurse’s role is essential for education and successful use of the pathways and that best practices for developing ERPs requires consistency across the care team, diligence to ensure compliance, and use of an audit tool for quality improvement.
    Keywords: Enhanced Recovery ; Care Pathway ; Erp ; Colorectal Surgery ; Patient Education ; Nursing
    ISSN: 0001-2092
    E-ISSN: 1878-0369
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  • 5
    Language: English
    In: World journal of gastroenterology, 14 January 2016, Vol.22(2), pp.659-67
    Description: Single incision laparoscopic surgery (SILS) is a minimally invasive platform with specific benefits over traditional multiport laparoscopic surgery. The safety and feasibility of SILS has been proven, and the applications continue to grow with experience. After 500 cases at a high-volume, single-institution, we were able to standardize instrumentation and operative steps, as well as develop adaptations in technique to help overcome technical and ergonomic challenges. These technical adaptations have allowed the successful application of SILS to technically difficult patient populations, such as pelvic cases, inflammatory bowel disease cases, and high body mass index patients. This review is a frame of reference for the application and wider integration of the single incision laparoscopic platform in colorectal surgery.
    Keywords: Laparoscopic Colectomy ; Minimally Invasive Colorectal Surgery ; Single-Incision Laparoscopic Surgery ; Laparoscopy ; Colectomy -- Methods ; Colon -- Surgery ; Rectum -- Surgery
    ISSN: 10079327
    E-ISSN: 2219-2840
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  • 6
    Language: English
    In: The American Journal of Surgery, September 2016, Vol.212(3), pp.433-439
    Description: The American College of Surgeons Surgical Risk Calculator was developed to improve risk stratification and surgical quality but has not been studied at the institutional level for specific disease states, like ulcerative colitis (UC). UC patients undergoing colorectal resection had predicted risk calculator data compared with actual outcomes for length of stay (LOS), complications, reoperation, and death. Main outcome measures were the difference in actual vs predicted outcomes. Seventy patients were evaluated. The actual and predicted mean LOS was identical, but not representative of the actual LOS picture, which had 10 LOS outliers (14.3%). The actual incidence of any complication ( 〈 .001) and major complications ( 〈 .001) was higher than predicted. The most common complications actually encountered-intrabdominal abscess (14.3%), postoperative ileus (7.2%), and anastomotic leak (5.7%), were not even calculated by the tool. For UC, the calculator poorly evaluates relevant risks, complications, and is greatly impacted by outliers. These limitations caution use for surgical quality reporting and determining specific patient outcomes, at least in UC.
    Keywords: Nsqip ; ACS Surgical Risk Calculator ; Patient Outcomes ; Quality Measures ; Laparoscopic Colorectal Surgery ; Inflammatory Bowel Disease
    ISSN: 0002-9610
    E-ISSN: 1879-1883
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  • 7
    Language: English
    In: The American Journal of Surgery, October 2014, Vol.208(4), pp.650-655
    Description: Our objective was to evaluate ileostomy reversal patients managed with a standardized enhanced recovery pathway to identify factors associated with readmissions. Prospective review database identified ileostomy reversal patients. Variables for the index admission and readmission were evaluated. Three hundred thirty-two patients were analyzed. The primary diagnosis was colorectal cancer (57.6%). Thirteen percent of the patients were discharged by postoperative day (POD) 1, 47% by POD 2, and 65% by POD 3. The complication rate was 16.8%. The main complication was ileus/small bowel obstruction ( = 27). Thirty-day readmission rate was 12.4% ( = 41); small bowel obstruction ( = 27) was the most frequent readmission diagnosis. The median readmission POD was 7. Only 1 patient had a follow-up visit before readmission. The median readmission length of stay was 4 days. Most ileostomy reversal readmissions occur before the first follow-up and stem from preventable causes. An enhanced recovery pathway modification may improve outcomes and utilization in this group.
    Keywords: Ileostomy ; Enhanced Recovery Pathways ; Patient Outcomes ; Readmission Rates ; Colorectal Surgery
    ISSN: 0002-9610
    E-ISSN: 1879-1883
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  • 8
    Language: English
    In: The American Journal of Surgery, October 2017, Vol.214(4), pp.604-609
    Description: Despite advances with Enhanced Recovery Pathways(ERP), some patients have unexpected prolonged lengths of stay(LOS). Our goal was to identify the patient and procedural variables associated with delayed discharge despite an established ERP. A divisional database was reviewed for minimally invasive colorectal resections with a multimodal ERP(8/1/13–7/31/15). Patients were stratified into ERP success or failure based on length of stay ≥5 days. Logistic regression modeling identified variables predictive of ERP failure. 274 patients were included- 229 successes and 45 failures. Groups were similar in demographics. Failures had higher rates of preoperative anxiety(p = 0.0352), chronic pain(p = 0.0040), prior abdominal surgery(p = 0.0313), and chemoradiation(p = 0.0301). Intraoperatively, failures had higher conversion rates(13.3% vs. 1.7%, p = 0.0002), transfusions(p = 0.0032), and longer operative times(219.8 vs. 183.5min,p = 0.0099). Total costs for failures were higher than successes($22,127 vs. $13,030,p = 0.0182). Variables independently associated with failure were anxiety(OR 2.28, p = 0.0389), chronic pain(OR 10.03, p = 0.0045), and intraoperative conversion(OR 8.02, p = 0.0043). Identifiable factors are associated with delayed discharge in colorectal surgery. By prospectively preparing for patient factors and changing practice to address procedural factors and ERP adherence, postoperative outcomes could be improved.
    Keywords: Laparoscopic Colorectal Surgery ; Minimally Invasive Colorectal Surgery ; Enhanced Recovery After Surgery ; Length of Stay ; Readmission ; Healthcare Outcomes
    ISSN: 0002-9610
    E-ISSN: 1879-1883
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  • 9
    Language: English
    In: Journal of Gastrointestinal Surgery, 2013, Vol.17(10), pp.1857-1862
    Description: Byline: Deborah S. Keller (1), Conor P. Delaney (1) Keywords: Natural orifice translumenal endoscopic surgery (NOTES); Minimally invasive surgery Abstract: Background Natural orifice translumenal endoscopic surgery (NOTES) is a technique that uses transvisceral access to perform surgical procedures entirely through a natural orifice. Despite the increasing awareness of NOTES, there remain obstacles to its technical feasibility and widespread acceptance. Furthermore, with the paucity of high-level supporting evidence, NOTES currently remains an experimental technique. Objective This article reviews the goals, applications, technical and practical challenges, and future direction of NOTES in gastrointestinal surgery. Author Affiliation: (1) Division of Colorectal Surgery, Department of Surgery, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Ave., Cleveland, OH, 44106-5047, USA Article History: Registration Date: 24/06/2013 Received Date: 04/06/2013 Accepted Date: 24/06/2013 Online Date: 17/07/2013
    Keywords: Natural orifice translumenal endoscopic surgery (NOTES) ; Minimally invasive surgery
    ISSN: 1091-255X
    E-ISSN: 1873-4626
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  • 10
    Language: English
    In: Gastroenterology, April 2015, Vol.148(4), pp.S-1121-S-1122
    Description: To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/S0016-5085(15)33822-1 Byline: Nisreen Madhoun, Deborah Keller, Jean-Paul J. LeFave, Madhu Ragupathi, Juan R. Flores, Sergio Ibarra, Eric M. Haas
    Keywords: Medicine
    ISSN: 0016-5085
    E-ISSN: 1528-0012
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