Diseases of the colon and rectum
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Stress dose steroids are administered during the perioperative period to prevent complications of secondary hypoadrenalism, which can occur after long-term steroid treatment. Steroids also increase postoperative morbidity. Patients with ulcerative colitis often require steroid therapy before definitive surgery and often receive perioperative steroids in a variety of doses. ⋯ Although administration of stress dose steroids is not related to increased postoperative complications, the steroids do not appear to affect adrenal insufficiency outcomes. Patients who were treated with steroids for ulcerative colitis should be monitored carefully in the perioperative and early postoperative periods for signs of adrenal insufficiency, regardless of the steroid regimen used.
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Randomized Controlled Trial
Preoperative oral antibiotics and intravenous antimicrobial prophylaxis reduce the incidence of surgical site infections in patients with ulcerative colitis undergoing IPAA.
The usefulness of preoperative oral antibiotics for the prevention of surgical site infection in elective colorectal surgery remains controversial. ⋯ Combined oral and intravenous antimicrobial prophylaxis in patients with ulcerative colitis undergoing restorative proctocolectomy with IPAA contributed to the prevention of surgical site infection.
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No immediate surgery (Watch and Wait) has been considered in select patients with complete clinical response after neoadjuvant chemoradiation to avoid postoperative morbidity and functional disorders after radical surgery. ⋯ Extended chemoradiation therapy with additional chemotherapy cycles and 54 Gy of radiation may result in over 50% of sustained (>12 months) complete clinical response rates that may ultimately avoid radical rectal resection. Local failures occur more frequently during the initial 12 months of follow-up in up to 17% of cases, whereas late recurrences are less common but still possible, leading to 50% of patients who never required surgery. Strict follow-up may allow salvage therapy in the majority of these patients (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A113.).
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Hospital readmission is increasingly perceived as a marker of quality and is poorly investigated in patients receiving colorectal surgery. ⋯ Predictors of readmission were major complications and immediate preoperative condition of the patients. Comorbidity profiling does not capture readmission risk. Because most readmissions relate to complications, further efforts to prevent these will improve readmission rates.