Our Summary

This research paper is about a study that examined the impact of using a checklist for colectomy surgeries (a procedure to remove part or all of the colon). The researchers wanted to see if there was a connection between the use of the checklist, the rate of surgical site infections (SSIs) after the surgery, and whether or not surgeons were following the checklist correctly.

To do this, they used data from the National Health Safety Network (NHSN) to get a baseline of how many SSIs happened after colectomy surgeries from 2016 to 2019. Then they used a checklist for 1694 random colectomy surgeries, and checked each month to see how well the checklist was being followed and what the infection rates were.

The results showed that the use of the checklist improved and that there were fewer SSIs, particularly in surgeries that were planned in advance. In fact, the rate of SSIs in elective surgeries decreased by 33% overall, and 45% for organ space infections. The rates of different types of SSIs (in the outer layers of skin, in deeper tissues, and in the abdomen) also decreased significantly.

Interestingly, the researchers found that surgeons with higher rates of SSIs were less likely to use oral antibiotics and mechanical bowel prep (two items on the checklist) correctly.

The study concludes that using a colectomy checklist can decrease the rate of SSIs, particularly if it is followed correctly more than 95% of the time. The researchers recommend focusing on surgeons who have higher infection rates and making sure they are following the checklist correctly, particularly when it comes to using oral antibiotics and mechanical bowel prep.

FAQs

  1. What is the purpose of the colectomy checklist monitoring system in the study?
  2. How did compliance with the colectomy checklist affect post-colectomy surgical site infection rates?
  3. What factors differentiated high infection rate surgeons from low infection rate surgeons in the study?

Doctor’s Tip

One helpful tip a doctor might tell a patient about colectomy is to follow the preoperative checklist guidelines provided by the healthcare team. This may include instructions on oral antibiotics and mechanical bowel preparation, which have been shown to reduce the risk of surgical site infections. By following these guidelines, patients can help ensure a successful recovery after colectomy surgery.

Suitable For

Patients who are typically recommended colectomy include those with:

  1. Severe ulcerative colitis or Crohn’s disease that is not responding to medication
  2. Colon cancer or precancerous polyps
  3. Diverticulitis that is recurrent or severe
  4. Familial adenomatous polyposis (FAP) or hereditary nonpolyposis colorectal cancer (HNPCC)
  5. Chronic constipation or megacolon
  6. Intestinal obstruction or perforation
  7. Inflammatory bowel disease with complications such as fistulas or strictures

These patients may benefit from colectomy to remove part or all of the colon to improve their quality of life and reduce the risk of complications such as infections or cancer.

Timeline

Before colectomy:

  1. Patient undergoes pre-operative evaluation and preparation, including medical history review, physical examination, and possibly diagnostic tests.
  2. Patient may be required to follow a special diet or bowel prep regimen to clean out the colon before surgery.
  3. Patient meets with the surgical team to discuss the procedure, potential risks and benefits, and post-operative care.
  4. Patient may undergo additional tests or imaging studies to further evaluate the colon and surrounding structures.

After colectomy:

  1. Patient undergoes the surgical procedure to remove part or all of the colon.
  2. Patient is closely monitored in the recovery room for any immediate post-operative complications.
  3. Patient is transferred to a hospital room for further monitoring and recovery.
  4. Patient may experience pain, discomfort, and fatigue in the immediate post-operative period.
  5. Patient is gradually advanced to a regular diet as tolerated and encouraged to walk and move around to aid in recovery.
  6. Patient may be discharged from the hospital once medically stable and able to manage at home.
  7. Patient will have follow-up appointments with the surgical team to monitor healing, address any concerns, and discuss long-term care and follow-up.

What to Ask Your Doctor

  1. How can a colectomy checklist help reduce the risk of post-operative surgical site infections?
  2. What specific items are included in the colectomy checklist and how are they monitored for compliance?
  3. What is the baseline incidence of post-colectomy surgical site infections at the hospital?
  4. How have infection rates changed since implementing the colectomy checklist?
  5. Are there specific items on the checklist that are more crucial for reducing infections than others?
  6. How does checklist compliance differ between elective and emergency colectomies?
  7. What actions are taken if a surgeon’s checklist compliance is consistently low?
  8. How can patients ensure that their surgeon is following the colectomy checklist to reduce infection risk?
  9. How often is the checklist reviewed and updated based on new research or best practices?
  10. Are there any additional steps or precautions that patients can take before undergoing a colectomy to reduce their risk of infection?

Reference

Authors: Antonacci AC, Antonacci CL, Dechario SP, Husk G, Schilling ME, Cifu-Tursellino K, Armellino D, Coppa G, Jarrett M. Journal: Surg Endosc. 2022 Aug;36(8):6049-6058. doi: 10.1007/s00464-022-09234-6. Epub 2022 May 5. PMID: 35511342