ArticleArquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery2019
FACTORS RELATED TO THE REDUCTION OF THE RISK OF COMPLICATIONS IN COLORECTAL SURGERY WITHIN PERIOPERATIVE CARE RECOMMENDED BY THE ACERTO PROTOCOL.
Article in Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
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8 citing papers in PubMed, 1 synthesis or guideline pooled it, 17 citations in OpenAlex.
- PERIOPERATIVE CARE IN DIGESTIVE SURGERY: THE ERAS AND ACERTO PROTOCOLS - BRAZILIAN COLLEGE OF DIGESTIVE SURGERY POSITION PAPER.Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery · 2024Guideline
- ROUX-IN-Y GASTROJEJUNAL BYPASS: WHICH ANESTHETIC TECHNIQUE HAS BEST RESULTS?Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery · 2021Trial
- Enhanced Recovery After Surgery (ERAS) in Latin America and the Caribbean: A Scoping Review of Implementation Strategies, Clinical Outcomes, and Health System Impact.World journal of surgery · 2026Article
- EARLY REFEEDING AFTER COLORECTAL CANCER SURGERY REDUCES COMPLICATIONS AND LENGTH OF HOSPITAL STAY.Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery · 2025Article
- Association between preoperative fasting time and clinical outcomes in surgical patients in a private general hospital.Acta cirurgica brasileira · 2024Observational
- ANTIBIOTIC PROPHYLAXIS FOR ABDOMINAL SURGERY: WHEN TO RECOMMEND? BRAZILIAN COLLEGE OF DIGESTIVE SURGERY POSITION PAPER.Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery · 2023Article
- COST-EFFECTIVENESS OF THE USE OF ACERTO PROTOCOL IN MAJOR DIGESTIVE SURGERY.Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery · 2022Article
- ACERTO Project - 15 years changing perioperative care in Brazil.Revista do Colegio Brasileiro de Cirurgioes · 2021Article
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6 authors at 1 institution in 1 country.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundPerioperative care multimodal protocol significantly improve outcome in surgery.
aimTo investigate risk factors to various endpoints in patients submitted to elective colorectal operations under the ACERTO protocol.
methodsCohort study analyzing through a logistic regression model able to assess independent risk factors for morbidity and mortality, patients submitted to elective open colon and/or rectum resection and primary anastomosis who were either exposed or non-exposed to demographic, clinical, and ACERTO interventions.
resultsTwo hundred thirty four patients were analyzed and submitted to 156 (66.7%) rectal and 78 (33.3%) colonic procedures. The length of hospital postoperative stay (LOS) ≥ 7 days was related to rectal surgery and high NNIS risk index; preoperative fasting ≤4 h (OR=0.250; CI95=0.114-0.551) and intravenous volume of crystalloid infused > 30ml/kg/day (OR=0.290; CI95=0.119-0.706). The risk of postoperative site infection (SSI) was approximately four times greater in malnourished; eight in rectal surgery and four in high NNIS index. The duration of preoperative fasting ≤4 h was a protective factor by reducing by 81.3% the risk of surgical site infection (SSI). An increased risk for anastomotic fistula was found in malnutrition, rectal surgery and high NNIS index. Conversely, preoperative fasting ≤4 h (OR=0.11; CI95=0.05-0.25; p<0.0001) decreased the risk of fistula. Factors associated with pneumonia-atelectasis were cancer and rectal surgery, while preoperative fasting ≤ 4 h (OR=0.10; CI95=0.04-0.24; p<0.0001) and intravenous crystalloid ≤ 30 ml/kg/day (OR=0.36; CI95=0.13-0.97, p=0.044) shown to decrease the risk. Mortality was lower with preoperative fasting ≤4 h and intravenous crystalloids infused ≤30 ml/kg/day.
conclusionThis study allows to conclude that rectal procedures, high NNIS index, preoperative fasting higher than 4 h and intravenous fluids greater than 30 ml/kg/day during the first 48 h after surgery are independent risk factors for: 1) prolonged LOS; 2) surgical site infection and anastomotic fistula associated with malnutrition; 3) postoperative pneumonia-atelectasis; and 4) postoperative mortality.
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