Annals of Coloproctology

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Risk factors for prolonged hospitalization and delayed treatment completion after laparoscopic appendectomy in patients with uncomplicated acute appendicitis: Jiyoung Shin, Myong Hoon Ihn, Kyung Sik Kim, Sang Hyun Kim, Jihyoun Lee, Sangchul Yun, Sung Woo Cho; Ann Coloproctol. 2023;39(1):50-58. Published online November 18, 2021; DOI: https://doi.org/10.3393/ac.2021.00773.0110

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Purpose
We sought to identify the risk factors for prolonged hospitalization and delayed treatment completion after laparoscopic appendectomy in patients with uncomplicated acute appendicitis.
Methods
The study retrospectively analyzed 497 patients who underwent laparoscopic appendectomies for uncomplicated appendicitis between January 2018 and December 2020. The patients were divided into an early discharge group (≤2 days) and a late discharge group (>2 days) based on the length of hospital stay (LOS). The patients were also divided into uneventful and complicated groups according to the need for additional treatment after standard follow-up.
Results
Thirty-seven patients (7.4%) were included in the late discharge group. The mean LOS of the late discharge groups was 3.9 days. There were significant differences according to age, preoperative C-reactive protein (CRP), and operative time between the 2 groups. Only operative time was significantly associated with prolonged LOS in multivariate analysis. Thirty-five patients (7.0%) were included in the complicated group. The mean duration of treatment in the uneventful and complicated groups was 7.4 and 25.3 days, respectively. Significant differences existed between the uneventful and complicated groups in preoperative body temperature, preoperative CRP levels, maximal appendix diameter, and the presence of appendicoliths. In multivariate analysis, preoperative CRP levels and maximal appendix diameter were independent predictors of delayed treatment completion.
Conclusion
Shorter operative time is desirable to ensure minimal hospital stay in patients with uncomplicated appendicitis. Further efforts are needed to ensure that patients with uncomplicated appendicitis do not experience delayed treatment completion after laparoscopic appendectomies.

Citations

Citations to this article as recorded by

Safety and Efficacy of Same‐Day Discharge After Laparoscopic Appendicectomy: An Australian First Prospective Cohort Study
Prithvi Santana, Odette Pheiffer, Wing Yin Lau, Eoghan Blount, Megan Courtney, Edward Tong, Selwyn Selvendran, Neil Merrett, Devesh Kaushal
ANZ Journal of Surgery.2026;[Epub] CrossRef
Association between preoperative neutrophil-to-lymphocyte ratio and length of stay in pediatric patients undergoing laparoscopic appendectomy: a retrospective cohort study
Ming Liu, Yunpeng Gou, Ping Yang
BMC Pediatrics.2025;[Epub] CrossRef
Comparative Outcomes of Immediate and Delayed Wound Closure Techniques in Appendectomies for Gangrenous Appendicitis
Anzar Usman, Esha Akbar, Aliha Mukhtar, Iqra Nasir, Usama Rehman, Adil Iqbal, Muhammad Umar Umar
DEVELOPMENTAL MEDICO-LIFE-SCIENCES.2024; 1(3): 18. CrossRef
Non-linear association between C-reactive protein levels and length of stay in pediatric appendicitis patients undergoing laparoscopic appendectomy
Ming Liu, Ping Yang, Yunpeng Gou
Frontiers in Pediatrics.2024;[Epub] CrossRef
Nomogram prediction model for length of hospital stay following laparoscopic appendectomy in pediatric patients: a retrospective study
Ming Liu, Ping Yang, Yunpeng Gou, Qiang Chen, Dong Xu
Frontiers in Pediatrics.2024;[Epub] CrossRef

Malignant disease, Functional outcomes,Postoperative outcome & ERAS

Improved outcomes with implementation of an Enhanced Recovery After Surgery pathway for patients undergoing elective colorectal surgery in the Philippines: Mayou Martin T. Tampo, Mark Augustine S. Onglao, Marc Paul J. Lopez, Marie Dione P. Sacdalan, Ma. Concepcion L. Cruz, Rosielyn T. Apellido, Hermogenes J. Monroy III; Ann Coloproctol. 2022;38(2):109-116. Published online September 18, 2020; DOI: https://doi.org/10.3393/ac.2020.09.02

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8 Web of Science
8 Citations

Abstract PDF Supplementary Material

Purpose
This study aims to evaluate surgical outcomes (i.e. length of stay [LOS], 30-day morbidity, mortality, reoperation, and readmission rates) with the use of the Enhanced Recovery After Surgery (ERAS) pathway, and determine its association with the rate of compliance to the different ERAS components.
Methods
This was a prospective cohort of patients, who underwent the following elective procedures: stoma reversal (SR), colon resection (CR), and rectal resection (RR). The primary endpoint was to determine the association of compliance to an ERAS pathway and surgical outcomes. These were then retrospectively compared to outcomes prior to the implementation of ERAS.
Results
A total of 267 patients were included in the study. The overall compliance to the ERAS component was 92.0% (SR, 91.8%; CR, 93.1%; RR, 90.7%). There was an associated decrease in morbidity rates across all types of surgery, as compliance to ERAS increased. The average total LOS decreased in all groups but was only found to have statistical significance in SR (12.1±6.7 days vs. 10.0±5.4 days, P=0.002) and RR (19.9±11.4 days vs. 16.9±10.5 days, P=0.04) groups. Decreased postoperative LOS was noted in all groups. Morbidity rates were significantly higher after ERAS implementation, but reoperation and mortality rates were found to be similar.
Conclusion
Increased compliance to ERAS protocol is associated with a decrease in morbidity across all surgery types. The implementation of an ERAS protocol significantly decreased mean hospital LOS, without any increase in major surgical complications. Having your own hospital ERAS pathway improves documentation and accuracy of reporting surgical complications.

Citations

Citations to this article as recorded by

Enhanced recovery after surgery (ERAS) in stoma reversal surgery: a systematic review and meta-analysis
Túlio Pimentel, Dante L. S. Souza, Ivonne Zuniga, Maria Clara Faveri, Julia Canfild, Paula Motta Pauperio, Hamza Guend
Updates in Surgery.2025; 77(2): 297. CrossRef
Surgical Enhanced Recovery: Where Are We Now?
Anika Tahmeed, Juan P. Cata, Tong J. Gan
International Anesthesiology Clinics.2025; 63(2): 62. CrossRef
Lessons following implementation of a colorectal enhanced recovery after surgery (ERAS) protocol in a rural hospital setting
Stephen Tolmay, Jamie‐Lee Rahiri, Kim Snoep, Gillian Fewster, Rachel Kee, Yukai Lim, Bridget Watson, Konrad Klaus Richter
ANZ Journal of Surgery.2024; 94(5): 910. CrossRef
Sex Disparities in Rectal Cancer Surgery: An In-Depth Analysis of Surgical Approaches and Outcomes
Chungyeop Lee, In Ja Park
The World Journal of Men's Health.2024; 42(2): 304. CrossRef
Influence of additional prophylactic oral antibiotics during mechanical bowel preparation on surgical site infection in patients receiving colorectal surgery
Hayoung Lee, Jong Lyul Lee, Ji Sung Lee, Chan Wook Kim, Yong Sik Yoon, In Ja Park, Seok‐Byung Lim
World Journal of Surgery.2024; 48(6): 1534. CrossRef
Clinical outcomes and future directions of enhanced recovery after surgery in colorectal surgery: a narrative review
Ji Hyeong Song, Minsung Kim
The Ewha Medical Journal.2024;[Epub] CrossRef
The Latest Results and Future Directions of Research for Enhanced Recovery after Surgery in the Field of Colorectal Surgery
Min Ki Kim
The Ewha Medical Journal.2023;[Epub] CrossRef
Influence of the COVID-19 Pandemic on the Treatment Patterns and Outcomes of Colorectal Cancer
In Ja Park
The Ewha Medical Journal.2023;[Epub] CrossRef

Malignant disease, Rectal cancer

Influence of the Enhanced Recovery After Surgery Protocol on Postoperative Inflammation and Short-term Postoperative Surgical Outcomes After Colorectal Cancer Surgery: Heba Essam Jaloun, In Kyu Lee, Min Ki Kim, Na Young Sung, Suhail Abdullah Al Turkistani, Sun Min Park, Dae Youn Won, Sang Hyun Hong, Bong-Hyeon Kye, Yoon Suk Lee, Hae Myung Jeon; Ann Coloproctol. 2020;36(4):264-272. Published online May 15, 2020; DOI: https://doi.org/10.3393/ac.2020.03.25

12,382 View
196 Download
23 Web of Science
24 Citations

Abstract PDF

Purpose
Many studies have shown that the enhanced recovery after surgery (ERAS) protocols improve postoperative surgical outcomes. The purpose of this study was to observe the effects on postoperative inflammatory markers and to explore the effects of a high degree of compliance and the use of epidural anesthesia on inflammation and surgical outcomes.
Methods
Four hundred patients underwent colorectal cancer surgery at 2 hospitals during 2 different periods, namely, from January 2006 to December 2009 and from January 2017 to July 2017. Data related to the patient’s clinicopathological features, inflammatory markers, percentage of compliance with elements of the ERAS protocol, and use of epidural anesthesia were collected from a prospectively maintained database.
Results
The complication rate and the length of hospital stay (LOS) were less in the ERAS group than in the conventional group (P = 0.005 and P ≤ 0.001, respectively). The postoperative white blood cell count and the duration required for leukocytes to normalize were reduced in patients following the ERAS protocol (P ≤ 0.001). Other inflammatory markers, such as lymphocyte count (P = 0.008), neutrophil/lymphocyte ratio (P = 0.032), and C-reactive protein level (P ≤ 0.001), were lower in the ERAS protocol group. High compliance ( ≥ 70%) was strongly associated with the complication rate and the LOS (P = 0.008 and P ≤ 0.001, respectively).
Conclusion
ERAS protocols decrease early postoperative inflammation and improves short-term postoperative recovery outcomes such as complication rate and the LOS. High compliance ( ≥ 70%) with the ERAS protocol elements accelerates the positive effects of ERAS on surgical outcomes; however, the effect on inflammation was very small.

Citations

Citations to this article as recorded by

Role and importance of quality control in improving compliance of enhanced recovery after surgery to overcome postoperative complications
In Kyeong Kim, Jung Hoon Bae, Soo Ji Park, Yoon Suk Lee, In Kyu Lee
BMC Surgery.2026;[Epub] CrossRef
Robotics versus open surgery: the impact on cytokine release and patient outcomes
Sidharth Misra, Zainab Yusufali Motiwala, Aditya Puniyani, Laaiba Shamsi, Fatima Nadeem, Danny Darlington Carbin
Journal of Robotic Surgery.2025;[Epub] CrossRef
Effect of ERAS pathway nursing on postoperative rehabilitation of patients undergoing gastrointestinal surgery: a meta-analysis
Fengying Dong, Yan Li, Wenxia Jin, Zhebing Qiu
BMC Surgery.2025;[Epub] CrossRef
Remimazolam-Based Anesthesia and Systemic Inflammatory Biomarkers in Relation to Postoperative Delirium in Elderly Patients: A Retrospective Cohort Study
Hayoung Lee, Keunyoung Kim, Cheol Lee
Medicina.2025; 61(6): 1023. CrossRef
Initial experience of pure robotic single incision TME with SST technique for middle-low rectal cancer using the da Vinci SP system
Choi Nim, Kuok Chi Ian
Intelligent Surgery.2025; 8: 70. CrossRef
Effects of early activity intervention on intestinal motility recovery in patients after colorectal cancer surgery
Xiu-Lian Zhang, Ai-Ping Lin, Tian-Sheng Lin, You-Qing Huang
World Journal of Gastrointestinal Surgery.2025;[Epub] CrossRef
Challenging issues of implementing enhanced recovery after surgery programs in South Korea
Soo-Hyuk Yoon, Ho-Jin Lee
Anesthesia and Pain Medicine.2024; 19(1): 24. CrossRef
Effect of different anesthetic modalities with multimodal analgesia on postoperative pain level in colorectal tumor patients
Ji-Chun Tang, Jia-Wei Ma, Jin-Jin Jian, Jie Shen, Liang-Liang Cao
World Journal of Gastrointestinal Oncology.2024; 16(2): 364. CrossRef
Dysregulation of systemic immunity in colorectal cancer and its clinical applications as biomarkers and therapeutics
Changqin Li, Jian Li
Critical Reviews in Oncology/Hematology.2024; 204: 104543. CrossRef
The role of robotic-assisted surgery in the management of rectal cancer: a systematic review and meta-analysis
Chenxiong Zhang, Hao Tan, Han Xu, Jiaming Ding
International Journal of Surgery.2024; 110(10): 6282. CrossRef
Enhancing recovery and reducing inflammation: the impact of enhanced recovery after surgery recommendations on inflammatory markers in laparoscopic surgery—a scoping review
Carlos Darcy Alves Bersot, Lucas Ferreira Gomes Pereira, Victor Gabriel Vieira Goncho, José Eduardo Guimarães Pereira, Luiz Fernando dos Reis Falcão
Frontiers in Surgery.2024;[Epub] CrossRef
Enhanced recovery pathway in open and minimally invasive colorectal cancer surgery: a prospective study on feasibility, compliance, and outcomes in a high-volume resource limited tertiary cancer center
Martin Thomas, Vandana Agarwal, Ashwin DeSouza, Riddhi Joshi, Minal Mali, Karuna Panhale, Omkar K. Salvi, Reshma Ambulkar, Shailesh Shrikhande, Avanish Saklani
Langenbeck's Archives of Surgery.2023;[Epub] CrossRef
Initial experience of abdominal total mesorectal excision for rectal cancer using the da Vinci single port system
Wed Alshalawi, Chul Seung Lee, In Kyeong Kim, Yoon Suk Lee
Journal of Minimally Invasive Surgery.2023; 26(4): 208. CrossRef
Association between enrollment in an enhanced recovery program for colorectal cancer surgery and long‐term recurrence and survival
Andres Zorrilla‐Vaca, Javier Ripolles‐Melchor, Ane Abad‐Motos, Inés Rubiera Mingu, Nekane Moreno‐Jurado, Fátima Martínez‐Durán, Isabel Pérez‐Martínez, Alfredo Abad‐Gurumeta, María L. FuenMayor‐Varela, Gabriel E. Mena, Michael C. Grant
Journal of Surgical Oncology.2022; 125(8): 1269. CrossRef
Implementation and improvement of Enhanced Recovery After Surgery protocols for colorectal cancer surgery
Bo Yoon Choi, Jung Hoon Bae, Chul Seung Lee, Seung Rim Han, Yoon Suk Lee, In Kyu Lee
Annals of Surgical Treatment and Research.2022; 102(4): 223. CrossRef
Effect of Enhanced Recovery after Surgery with Integrated Traditional Chinese and Western Medicine on Postoperative Stress Response of Patients with Gastrointestinal Tumors
Haiping Zhao, Wenhui Sun, Tao Huang
Computational and Mathematical Methods in Medicine.2022; 2022: 1. CrossRef
Multidisciplinary treatment strategy for early colon cancer
Gyung Mo Son, Su Bum Park, Tae Un Kim, Byung-Soo Park, In Young Lee, Joo-Young Na, Dong Hoon Shin, Sang Bo Oh, Sung Hwan Cho, Hyun Sung Kim, Hyung Wook Kim
Journal of the Korean Medical Association.2022; 65(9): 558. CrossRef
Robotic surgery for colorectal cancer
Sung Uk Bae
Journal of the Korean Medical Association.2022; 65(9): 577. CrossRef
Commentary: Preoperative neutrophil to lymphocyte ratio predicts complications after esophageal resection that can be used as inclusion criteria for enhanced recovery after surgery
Cheng Shen, Qiang Pu, Guowei Che
Frontiers in Surgery.2022;[Epub] CrossRef
Multidisciplinary Treatment Strategy for Early Colon Cancer: A Review-An English Version
Gyung Mo Son, Su Bum Park, Tae Un Kim, Byung-Soo Park, In Young Lee, Joo-Young Na, Dong Hoon Shin, Sang Bo Oh, Sung Hwan Cho, Hyun Sung Kim, Hyung Wook Kim
Journal of the Anus, Rectum and Colon.2022; 6(4): 203. CrossRef
Current Status and Future of Robotic Surgery for Colorectal Cancer-An English Version
Sung Uk Bae
Journal of the Anus, Rectum and Colon.2022; 6(4): 221. CrossRef
A propensity score-matched analysis of advanced energy devices and conventional monopolar device for colorectal cancer surgery: comparison of clinical and oncologic outcomes
Woo Jin Song, Sung Uk Bae, Woon Kyung Jeong, Seong Kyu Baek
Annals of Surgical Treatment and Research.2022; 103(5): 290. CrossRef
Enhanced recovery after surgery: importance of compliance audits
Jung Hoon Bae
Journal of the Korean Medical Association.2021; 64(12): 820. CrossRef
Effect of the Enhanced Recovery After Surgery protocol After Colorectal Cancer Surgery
Dae Ro Lim
Annals of Coloproctology.2020; 36(4): 209. CrossRef

The Postoperative Impact of Co-morbidity in Colorectal Cancer Surgery.: Suh, Hee Seok , Lee, Kang Hong , Kim, Hee Cheol , Yu, Chang Sik , Kim, Jin Cheon; J Korean Soc Coloproctol. 2003;19(5):299-306.

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Abstract PDF: PURPOSE
Co-morbidity is the presence of co-existing or additional diseases during the initial diagnosis. It may be used as a prognostic indicator for the postoperative outcomes in most cancers, including colorectal cancers. The impact of respective co-morbidities in colorectal cancer surgeries were evaluated to identify their outcomes regarding complications and hospital stay.
METHODS
The medical records of 2,242 colorectal cancer patients, who had had curative operations between Jan. 1997 and Dec. 2001, were reviewed to evaluate the prevalence of co-morbidities. All co-morbidities were adequately evaluated and managed preoperatively.
RESULTS
Co-morbidities were observed in 789 out of the 2,242 (35.2%) patients. Hypertension was the most frequent (340, 15.2%), with diabetes (210, 9.4%) and cardiovascular diseases (124, 5.5%) following. Early stages (0~II) were more frequently associated with co-morbidities, compared to late stages (III~IV) (P<0.001). Hypertension and cerebrovascular diseases were significantly associated with postoperative complications (P<0.05). Postoperative complications occurred in 578 out of the 2242 (25.8%) patients: e.g., ileus (10.2%), voiding difficulty (4.4%), wound problems (4.3%), etc. Pulmonary complications occurred more often in patients with cerebrovascular diseases, hypertension, and asthma. Wound complications were observed in patients with hypertension, cerebrovascular diseases, chronic obstructive pulmonary disease, and chronic renal failure (P<0.05). Patients with more than one co-morbidity were closely associated with frequent postoperative co-mplications (P<0.05). However, comorbidities did not seem to affect the duration of the postoperative hospital stay.
CONCLUSIONS
Postoperative complications frequently occur in colorectal cancer patients with specific co- morbidities, especially in those with more than one. An adequate management of the co-morbidities preoperatively leads to a good outcome.

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