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Perioper Med (Lond). 2017 Mar 3;6:4. doi: 10.1186/s13741-017-0059-2. eCollection 2017.

American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on prevention of postoperative infection within an enhanced recovery pathway for elective colorectal surgery.

Author information

1
Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH USA.
2
Department of Surgery, University of Virginia Health System, Charlottesville, VA USA.
3
Department of Anesthesiology, Stony Brook School of Medicine, Stony Brook, NY USA.
4
Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA USA.
5
Department of Intensive Care Medicine and Anaesthesia, St. George's Hospital and Medical School, London, UK.
6
Department of Anesthesia, UCL/UCLH National Institute of Health Research Biomedical Research Centre, London, UK.
7
Department of Anesthesiology, Vanderbilt University, Nashville, TN USA.
8
Department of Anesthesiology, Duke University Medical Center, Durham, NC USA.

Abstract

BACKGROUND:

Colorectal surgery (CRS) patients are an at-risk population who are particularly vulnerable to postoperative infectious complications. Infectious complications range from minor infections including simple cystitis and superficial wound infections to life-threatening situations such as lobar pneumonia or anastomotic leak with fecal peritonitis. Within an enhanced recovery pathway (ERP), there are multiple approaches that can be used to reduce the risk of postoperative infections.

METHODS:

With input from a multidisciplinary, international group of experts and through a focused (non-systematic) review of the literature, and use of a modified Delphi method, we achieved consensus surrounding the topic of prevention of postoperative infection in the perioperative period for CRS patients.

DISCUSSION:

As a part of the first Perioperative Quality Initiative (POQI-1) workgroup meeting, we sought to develop a consensus statement describing a comprehensive, yet practical, approach for reducing postoperative infections, specifically for CRS within an ERP. Surgical site infection (SSI) is the most common postoperative infection. To reduce SSI, we recommend routine use of a combined isosmotic mechanical bowel preparation with oral antibiotics before elective CRS and that infection prevention strategies (also called bundles) be routinely implemented as part of colorectal ERPs. We recommend against routine use of abdominal drains. We also give consensus guidelines for reducing pneumonia, urinary tract infection, and central line-associated bloodstream infection (CLABSI).

KEYWORDS:

Abdominal abscess; Anastomotic leak; Carepath; Catheter or line-associated bloodstream infection; Colorectal surgery; Enhanced recovery; Enhanced recovery pathway; Enhanced recovery protocol; Infection prevention; Mechanical bowel preparation; Pelvic abscess; Pneumonia; Surgical site infection; Urinary tract infection

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