Clin Colon Rectal Surg 2023; 36(03): 218-222
DOI: 10.1055/s-0043-1761157
Review Article

Practical Considerations of Perioperative Assessment and Optimization in Major Colorectal Surgery

Alexander T. Hawkins
1   Division of General Surgery, Section of Colon & Rectal Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
,
Matthew D. McEvoy
2   Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
› Author Affiliations
Funding None.

Abstract

Successful outcomes after colorectal surgery result not only from technique in the operating room, but also from optimization of the patient prior to surgery. This article will discuss the role of preoperative assessment and optimization in the colorectal surgery patient. Through discussion of the various clinical models, readers will understand the range of options available for optimization. This study will also present information on how to design a preoperative clinic and the barriers to success.



Publication History

Article published online:
24 January 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Cui HW, Turney BW, Griffiths J. The preoperative assessment and optimization of patients undergoing major urological surgery. Curr Urol Rep 2017; 18 (07) 54
  • 2 Grocott MPW, Edwards M, Mythen MG, Aronson S. Peri-operative care pathways: re-engineering care to achieve the ‘triple aim’. Anaesthesia 2019; 74 (Suppl. 01) 90-99
  • 3 Aronson S, Murray S, Martin G. et al; Perioperative Enhancement Team (POET). Roadmap for transforming preoperative assessment to preoperative optimization. Anesth Analg 2020; 130 (04) 811-819
  • 4 Norris CM, Close JCT. Prehabilitation for the frailty syndrome: improving outcomes for our most vulnerable patients. Anesth Analg 2020; 130 (06) 1524-1533
  • 5 Dimick JB, Chen SL, Taheri PA, Henderson WG, Khuri SF, Campbell Jr DA. Hospital costs associated with surgical complications: a report from the private-sector National Surgical Quality Improvement Program. J Am Coll Surg 2004; 199 (04) 531-537
  • 6 Kehlet H, Mythen M. Why is the surgical high-risk patient still at risk?. Br J Anaesth 2011; 106 (03) 289-291
  • 7 Nguyen C, Boutron I, Roren A. et al. Effect of prehabilitation before total knee replacement for knee osteoarthritis on functional outcomes: a randomized clinical trial. JAMA Netw Open 2022; 5 (03) e221462
  • 8 Mendez CE, Wainaina N, Walker RJ. et al. Preoperative diabetes optimization program. Clin Diabetes 2018; 36 (01) 68-71
  • 9 Davis BR, Valente MA, Goldberg JE, Lightner AL, Feingold DL, Paquette IM. Prepared on behalf of the Clinical Practice Guidelines Committee of the American Society of Colon and Rectal Surgeons. The American Society of Colon and Rectal Surgeons clinical practice guidelines for ostomy surgery. Dis Colon Rectum 2022; 65 (10) 1173-1190
  • 10 Aronson S, Westover J, Guinn N. et al. A perioperative medicine model for population health: an integrated approach for an evolving clinical science. Anesth Analg 2018; 126 (02) 682-690
  • 11 Bartels K, Karhausen J, Clambey ET, Grenz A, Eltzschig HK. Perioperative organ injury. Anesthesiology 2013; 119 (06) 1474-1489
  • 12 Partridge JS, Harari D, Martin FC. et al. Randomized clinical trial of comprehensive geriatric assessment and optimization in vascular surgery. Br J Surg 2017; 104 (06) 679-687
  • 13 Buehler L, Fayfman M, Alexopoulos AS. et al. The impact of hyperglycemia and obesity on hospitalization costs and clinical outcome in general surgery patients. J Diabetes Complications 2015; 29 (08) 1177-1182
  • 14 Fleisher LA, Linde-Zwirble WT. Incidence, outcome, and attributable resource use associated with pulmonary and cardiac complications after major small and large bowel procedures. Perioper Med (Lond) 2014; 3: 7
  • 15 Hobson C, Ozrazgat-Baslanti T, Kuxhausen A. et al. Cost and mortality associated with postoperative acute kidney injury. Ann Surg 2015; 261 (06) 1207-1214
  • 16 Robinson TN, Wu DS, Pointer L, Dunn CL, Cleveland Jr JC, Moss M. Simple frailty score predicts postoperative complications across surgical specialties. Am J Surg 2013; 206 (04) 544-550
  • 17 Sankar A, Beattie WS, Wijeysundera DN. How can we identify the high-risk patient?. Curr Opin Crit Care 2015; 21 (04) 328-335
  • 18 Zywiel MG, Hurley RT, Perruccio AV, Hancock-Howard RL, Coyte PC, Rampersaud YR. Health economic implications of perioperative delirium in older patients after surgery for a fragility hip fracture. J Bone Joint Surg Am 2015; 97 (10) 829-836
  • 19 Tohme S, Varley PR, Landsittel DP, Chidi AP, Tsung A. Preoperative anemia and postoperative outcomes after hepatectomy. HPB (Oxford) 2016; 18 (03) 255-261
  • 20 Phan K, Dunn AE, Kim JS. et al. Impact of preoperative anemia on outcomes in adults undergoing elective posterior cervical fusion. Global Spine J 2017; 7 (08) 787-793
  • 21 Liu X, Qiu H, Huang Y. et al. Impact of preoperative anemia on outcomes in patients undergoing curative resection for gastric cancer: a single-institution retrospective analysis of 2163 Chinese patients. Cancer Med 2018; 7 (02) 360-369