Faculty Bibliography

INTRODUCTION/BACKGROUND:The goal of modern medical treatment is to provide high quality medical care in a cost-effective environment. AIM/OBJECTIVE:To assess the cost-effectiveness of laparoscopic colorectal surgery combined with the enhanced recovery after surgery protocol (ERP) in Poland. MATERIAL AND METHODS/METHODS:We designed a single-centre, case-matched study. Economic and clinical data were collected in 3 groups of patients (33 patients in each group): group 1 - patients undergoing laparoscopy with ERP; group 2 - laparoscopy without ERP; group 3 - open resection without ERP. An independent administrative officer, not involved in the treatment process, matched patients for age, sex and type of resection. Primary outcome was cost analysis. It was carried out incorporating institutional costs: hospital bed stay, anaesthesia, surgical procedure and equipment, drugs and complications. Secondary outcomes were length of stay (LOS), readmission and complication rate. RESULTS:Cost of laparoscopic procedure alone was significantly more expensive than open resection. However, implementation of the ERAS protocol reduced additional costs. Total cost per patient in group 1 was significantly lower than in groups 2 and 3 (EUR 1826 vs. EUR 2355.3 vs. EUR 2459.5, p < 0.0001). Median LOS was 3, 6 and 9 days in groups 1, 2 and 3 respectively (p < 0.001). Postoperative complications were noted in 5 (15.2%), 6 (18.2%) and 13 (39.4%) patients in groups 1, 2, 3 respectively (p = 0.0435). CONCLUSIONS:In a low medical care expenditure country, minimally invasive surgery combined with ERP can be a safe and a cost-effective alternative to open surgery with traditional perioperative care.

BACKGROUND:home enteral nutrition (HEN) is the best option for chronic. patients without the ability to swallow, but with intact digestive tract. Despite the increasing use of home enteral tube feeding (HETF), there is little published information about the types of patients receiving home enteral nutrition. The purpose of this paper to present the evolution of HETF. MATERIAL AND METHODS/METHODS:the retrospective multicenter observational study was performed using questionnaires, which were distributed among the biggest Polish HEN centres. The study covered all patients treated between January, 2007 and January, 2014. RESULTS:in total 196 adult patients in 2008 (M:104. F: 92, mean age 58.1 [41-75]) and 2842 in 2013 (M: 1541, F: 1301, mean age 61.4 range: 1-91) were assessed. The number of patients grew significantly between 2008 and 2013 (p < 0.05), rising from 196 up to 2 842 (and 1 716 at the moment of study). The predominant primary disease was neurology in both time periods, but the profile switched from neurovascular to neurodegenerative (p > 0.05). Percutaneous endoscopic gastrostomy was the most common GI access ( > 60%), its use and the use of gastrostomies increased significantly since 2008 (p < 0.05). Although the reimbursement for HETF started in 2007, HEN centres expressed doubts about unclear rules for the qualification to HEN and its use. CONCLUSIONS:HETF is a safe, well-tolerated and cost-effective procedure. The profile of patients and techniques may vary at the beginning, but becomes similar to other HETF countries relatively soon. The number of patients grows quickly, and that fact suggests that the prevalence of HETF is similar in all countries.

BACKGROUND & AIMS/OBJECTIVE:Intestinal failure (IF) is not included in the list of PubMed Mesh terms, as failure is the term describing a state of non functioning of other organs, and as such is not well recognized. No scientific society has yet devised a formal definition and classification of IF. The European Society for Clinical Nutrition and Metabolism guideline committee endorsed its "home artificial nutrition and chronic IF" and "acute IF" special interest groups to write recommendations on these issues. METHODS:After a Medline Search, in December 2013, for "intestinal failure" and "review"[Publication Type], the project was developed using the Delphi round methodology. The final consensus was reached on March 2014, after 5 Delphi rounds and two live meetings. RESULTS:The recommendations comprise the definition of IF, a functional and a pathophysiological classification for both acute and chronic IF and a clinical classification of chronic IF. IF was defined as "the reduction of gut function below the minimum necessary for the absorption of macronutrients and/or water and electrolytes, such that intravenous supplementation is required to maintain health and/or growth". CONCLUSIONS:This formal definition and classification of IF, will facilitate communication and cooperation among professionals in clinical practice, organization and management, and research.

BACKGROUND:Obese patients are a very large high-risk group for complications after surgical procedures. In this group, optimized perioperative care and a faster recovery to full activity can contribute to a decreased rate of postoperative complications. The introduction of ERAS®-based protocol is now even more important in bariatric surgery centers. The results of our study support the idea of implementation of ERAS®-based protocol in this special group of patients. MATERIAL AND METHODS/METHODS:This analysis included 170 patients (62 male/108 female, mean BMI 46.7 kg/m2) who had undergone laparoscopic bariatric surgery, and whose perioperative care was conducted according to a protocol inspired by ERAS® principles. Examined factors included oral nutrition tolerance, time until mobilization after surgery, requirements for opioids, duration of hospitalization, and readmission rate. RESULTS:During the first 24 postoperative hours, oral administration of liquid nutrition was tolerated by 162 (95.3%) patients and 163 (95.8%) were fully mobile. In 44 (25.8%) patients it was necessary to administer opioids to relieve pain. Intravenous liquid supply was discontinued within 24 hours in 145 (85.3%) patients. The complication rate was 10.5% (mainly rhabdomyolysis and impaired passage of gastric contents). The average time of hospitalization was 2.9 days and the readmission rate was 1.7%. CONCLUSIONS:The introduction of an ERAS® principles-inspired protocol in our center proved technically possible and safe for our patients, and allowed for reduced hospitalization times without increased rate of complications or readmissions.

BACKGROUND AND AIM/OBJECTIVE:Many techniques have been tested to reduce the incidence of catheter-relater bloodstream infections (CRBSIs) during home parenteral nutrition (HPN). One of these methods, taurolidine lock, has shown some potential in several studies, but it has been studied primarily in patients with a relatively high CRBSI rate. Therefore, the aim of this study was to analyze the clinical value of taurolidine in patients receiving HPN who have a low infection rate. METHODS:The CRBSI ratio at the Skawina HPN center has remained at 0.3-0.4 episodes/patient/y for the past 7 years. In November 2012, 30 patients (17 men, 13 women, mean age 52.3 years) were randomized to 1 of 3 groups: 2% taurolidine lock (group A), 1.35% taurolidine + citrate lock (B), and control-saline flush (C). Patients were observed for 12 consecutive months for catheter-related complications. Blood cultures were collected in each case in which an infection was suspected. RESULTS:The total number of catheter days reached 10,968, with the following number of days per group: group A, 3658; group B, 3650; and group C, 3660. No complications were observed in the control group, while patients in the study groups had 1 catheter infection (group A) and 1 occlusion (group B). The CRBSIs were treated successfully with antibiotics. The cost of treatment in groups A and B was significantly higher than that in group C (P < .05). CONCLUSION/CONCLUSIONS:The study did not observe any additional clinical value of taurolidine in patients receiving HPN who have a low infection rate and found low cost-effectiveness. Taurolidine should most likely be used only in patients with a high CRBSI rate.