International Journal of Colorectal Disease最新文献

{"title":"Palliative procedures for advanced obstructive colorectal cancer: a systematic review and meta-analysis.","authors":"Bingqing Ma, Tianxing Ren, Chengjun Cai, Biao Chen, Jinxiang Zhang","doi":"10.1007/s00384-024-04724-6","DOIUrl":"10.1007/s00384-024-04724-6","url":null,"abstract":"<p><strong>Purpose: </strong>Advanced obstructive colorectal cancer (AOCC) presents surgical challenges. Consideration must be given to alleviating symptoms and also quality of life and survival time. This study compared prognostic efficacies of palliative self-expanding metal stents (SEMSs) and surgery to provide insights into AOCC treatment.</p><p><strong>Methods: </strong>PubMed, Web of Science, MEDLINE, and Cochrane Library were searched for studies that met inclusion criteria. Using a meta-analysis approach, postoperative complications, survival rates, and other prognostic indicators were compared between patients treated with SEMSs and those treated surgically. Network meta-analysis was performed to compare prognoses between SEMS, primary tumor resection (PTR), and stoma/bypass (S/B).</p><p><strong>Results: </strong>Twenty-one studies were selected (1754 patients). The odds ratio (OR) of SEMS for clinical success compared with surgery was 0.32 (95% confidence interval [CI] 0.15, 0.65). The ORs for early and late complications were 0.34 (95% CI 0.19, 0.59) and 2.30 (95% CI 1.22, 4.36), respectively. The ORs for 30-day mortality and stoma formation were 0.65 (95% CI 0.42, 1.01) and 0.11 (95% CI 0.05, 0.22), respectively. Standardized mean difference in hospital stay was - 2.08 (95% CI - 3.56, 0.59). The hazard ratio for overall survival was 1.24 (95% CI 1.08, 1.42). Network meta-analysis revealed that SEMS had the lowest incidence of early complications and rate of stoma formation and the shortest hospital stay. PTR ranked first in clinical success rate and had the lowest late-complication rate. The S/B group exhibited the lowest 30-day mortality rate.</p><p><strong>Conclusion: </strong>Among palliative treatments for AOCC, SEMSs had lower early complication, stoma formation, and 30-day mortality rates and shorter hospital stays. Surgery had higher clinical success and overall survival rates and lower incidence of late complications. Patient condition/preferences should be considered when selecting AOCC treatment.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"39 1","pages":"148"},"PeriodicalIF":2.5,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11420309/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142286358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of complications in patients with an ileostomy: an umbrella review of systematic reviews for the EndOTrial Consortium.","authors":"Virginia Solitano, Sudheer Kumar Vuyyuru, Yuhong Yuan, Siddharth Singh, Neeraj Narula, Christopher Ma, Jurij Hanzel, Megan Hutton, Julie Ann Van Koughnett, Florian Rieder, Vipul Jairath","doi":"10.1007/s00384-024-04714-8","DOIUrl":"10.1007/s00384-024-04714-8","url":null,"abstract":"<p><strong>Background: </strong>Standardized clinical care processes for patients with Crohn's disease (CD) and a permanent ileostomy (PI) are lacking. The EndOTrial consortium aims to address this gap by developing pathways for care.</p><p><strong>Methods: </strong>In this umbrella review, we searched major databases for relevant systematic reviews (SRs) or scoping reviews (ScR) published until January 5, 2024. Screening, data extraction, and quality appraisal (AMSTAR 2) were performed by two independent reviewers.</p><p><strong>Results: </strong>Of 1349 screened papers, 22 reviews met our inclusion criteria, including 20 SRs (eight with meta-analysis) and 2 ScRs. None exclusively focused on PI. Furthermore, nine reviews did not mention patients with inflammatory bowel disease (IBD), and only two reviews included patients with high-output ileostomy, highlighting a large evidence gap. The identified reviews covered six categories with nine types of interventions, including ostomy care pathways, peristomal skin care, patient education, clinical management of high-output stoma, management and prevention of postoperative ileus, dietary and nutritional support, nursing and supporting care, telemedicine, and self-management interventions. Most SRs including nursing interventions for stoma care highlighted nurses' role in a variety of standard and specialized treatments. Notably, none of the reviews exclusively examined disease recurrence, stoma pouching systems or adhesives, behavioral interventions, or mental health in patients living with ileostomy.</p><p><strong>Conclusions: </strong>Evidence for best practice interventions to treat complications and improve quality of life in patients living with an ileostomy for CD is limited and heterogeneous. These results outline the need for standardized clinical care processes and pathways tailored to the unique needs of this patient population.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"39 1","pages":"147"},"PeriodicalIF":2.5,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11415412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142286357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and histological impact of diffuse inflammation at pouchoscopy.","authors":"Kenichiro Toritani, Hideaki Kimura, Koki Goto, Mao Matsubayashi, Reiko Kunisaki, Jun Watanabe, Atsushi Ishibe, Masako Otani, Itaru Endo","doi":"10.1007/s00384-024-04723-7","DOIUrl":"https://doi.org/10.1007/s00384-024-04723-7","url":null,"abstract":"<p><strong>Purpose: </strong>The anatomical location of inflammation in and around the ileal pouch affects the pouch survival rate, and diffuse inflammation has poor pouch survival rates. We aimed to clarify the symptoms and histological findings of diffuse inflammation of the pouch.</p><p><strong>Methods: </strong>We evaluated the symptoms, treatment, and histological findings according to the endoscopic phenotypes of diffuse inflammation, focal inflammation, and normal as the pouch body phenotype and afferent limb involvement, inlet involvement, cuffitis, and fistula as the peripheral findings.</p><p><strong>Results: </strong>Of the 318 pouchoscopies, 47 had diffuse inflammation, 201 had focal inflammation, and 70 were normal. Symptomatic patients had diffuse inflammation more frequently (46.8%) than focal inflammation (13.4%) and normal (14.2%), with no difference between focal inflammation and normal. Antibiotics and steroids were higher rate administered in cases of diffuse inflammation, but not in cases of focal inflammation or in normal cases. Histological inflammation, inflammatory bowel disease (IBD)-specific finding, and colonic metaplasia showed severity in the order of diffuse inflammation > focal inflammation > normal. The number of peripheral inflammatory findings overlapped in the following order: diffuse inflammation > focal inflammation > normal. The number of symptomatic patients increased as the number of peripheral inflammatory findings increased.</p><p><strong>Conclusion: </strong>Pouches with diffuse inflammation are more symptomatic, have a higher use of therapeutic agents, and have more severe histological inflammation, IBD-specific finding, and colonic metaplasia accompanying peripheral inflammatory findings than the other groups. The higher the overlap of inflammatory findings in the surrounding tissues, the more symptomatic the patients will appear.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"39 1","pages":"146"},"PeriodicalIF":2.5,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11415464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142286355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lateral pelvic lymph node positivity (LPLNP) score: predictive clinic-radiological model of lateral pelvic lymph node involvement in rectal cancer patients","authors":"Petr Tsarkov, Vladimir Balaban, Harutyun Babajanyan, Abe Fingerhut, Inna Tulina, Mingze He","doi":"10.1007/s00384-024-04717-5","DOIUrl":"https://doi.org/10.1007/s00384-024-04717-5","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>The population in Western countries differs significantly from that in Eastern countries, and the prevalence of lateral pelvic lymph node (LPLN) involvement in Western populations remains largely unknown due to the limited application of LPLN dissection (LPLND). This discrepancy is primarily attributed to the higher body mass index commonly observed in Western populations, which increases the risk of intraoperative complications. Consequently, the aim of this study is to describe a specific Western clinico-radiological selection tool for LPLND, namely, the lateral pelvic lymph node positivity (LPLNP) score.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>This retrospective single center study was designed to elaborate the LPLNP score, which was further tested on a prospective cohort of patients. Clinical and MRI factors associated with LPLN involvement were identified, and logistic regression was used to establish the LPLNP score.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>In the retrospective series, 120 patients underwent lateral pelvic lymph node dissection. After stepwise logistic regression, five parameters were ultimately included in the LPLNP score. When tested on 66 prospectively selected patients, 40 with an LPLNP score &gt; 0.23 (corresponding to the highest sensitivity and specificity) underwent LPLND: 22 patients (55%) had pathologically confirmed positive LPLN. The negative predictive value of the LPLNP score was 96%, with a sensitivity of 95.7% and a specificity of 58.1%.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>The LPLNP score was developed based on the largest group of Western patients with locally advanced rectal cancer. This scoring system demonstrated high sensitivity and specificity during validation on the prospective series, correctly identifying LPLN involvement in 55% of cases.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"23 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142260579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility guideline and considerations for the novel Hugo™ RAS (robotic-assisted surgery) system in colorectal surgery: surgical outcomes and initial experience in a tertiary center","authors":"Antonio Arroyo, Ana Sánchez-Romero, Álvaro Soler-Silva, Saray Quinto, Francisco López-Rodríguez-Arias, María-José Alcaide, Mónica Serrano-Navidad, Elena Miranda, José-Luis Muñoz, Luis Sánchez-Guillén","doi":"10.1007/s00384-024-04715-7","DOIUrl":"https://doi.org/10.1007/s00384-024-04715-7","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>A novel robotic platform—Hugo™ RAS (robotic-assisted surgery) system—has been introduced with several innovations that may prove advantageous for surgeons, such as an open console and four interchangeable modular arms. Our study aims to evaluate this platform’s safety, efficacy, and potential impact on the surgical treatment of colorectal pathology.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>Patients underwent robotic-assisted colorectal procedures with the Hugo™ RAS system at the General University Hospital of Elche from October 2023 to July 2024. Patient characteristics, intraoperative and postoperative variables, and robotic technical issues were recorded.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Forty consecutive patients were included (14 right, 13 left, and 8 rectum neoplasms; 4 left diverticulitis; and 1 ileocecal Crohn’s disease). The patients’ characteristics were as follows: median age, 69.5 years; 24 males and 16 females; 45% ASA III–IV; and Charlson Comorbidity Index &gt; 5:42.5%.</p><p>We recorded four medical (2 anemia, 1 phlebitis, and 1 admission to the intensive care unit) and three surgical (1 hematoma of the incision, 1 intestinal occlusion, and 1 dehiscence of the anastomosis) postoperative complications. We had no conversions neither open nor laparoscopic surgery. The average hospital stay was 3 days, with no mortality or readmission.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>The Hugo™ RAS system is safe and feasible for colorectal procedures. The modularity of the arms provides the versatility of configurations adjusted depending on the patient’s body features and the surgeon’s preferences and greater adaptability to operating rooms. The open console is highly comfortable and ergonomic for the surgeon, allowing communication with the operating room environment.</p><h3 data-test=\"abstract-sub-heading\">Trial registration</h3><p>NCT06512480</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"54 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142260578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the efficacy of polyethylene glycol in combination with different doses of linaclotide in a fractionated bowel preparation for colonoscopy: a prospective randomized controlled study","authors":"Wan-qi Liu, Lei Shu, Xiaoli Zhou, Xiao-feng Wang, Song Liu, Zhao-hong Shi","doi":"10.1007/s00384-024-04718-4","DOIUrl":"https://doi.org/10.1007/s00384-024-04718-4","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background and aim</h3><p>The ideal bowel cleansing program still needs to be explored. The aim was to compare the bowel cleansing effect and patient tolerance of low-dose polyethylene glycol (PEG) combined with different doses of linaclotide in fractionated bowel preparation.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>The subjects were randomly assigned to the 3LPEG group, 2LPEG + 2L group, or 2LPEG + L group. The primary outcome was to use the Ottawa Bowel Preparation Scale (OBPS) to evaluate the efficacy of bowel cleansing, and the secondary outcomes were the detection rate of adenomas and polyps, adverse reactions, tolerance, and defecation dynamics; subsets of patients with chronic constipation and irritable bowel syndrome were also analyzed.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>A total of 753 patients were randomly assigned. In ITT analysis, the success of preparation of the 2LPEG + 2L group was better than that of the 2LPEG + L group or the 3LPEG group (92.0% vs. 82.3% vs. 82.1%; <i>P</i> = 0.002). Compared with the 3LPEG group, the 2LPEG + L group showed similar but non-inferior results (82.3% vs. 82.1%, <i>P</i> &gt; 0.05). The 2LPEG + 2L group was similar to the 2LPEG + L group in terms of adverse reaction, tolerance, willingness to reuse, and sleep quality, but both were superior to the 3LPEG group. In a subgroup analysis of chronic constipation, the 2LPEG + 2L group had the best cleansing effect on the right colon and mid colon, while in the subgroup analysis of irritable bowel syndrome, the tolerance was better in the 2LPEG + 2L group and the 2LPEG + L group than the 3LPEG group.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>2LPEG + 2L is a feasible bowel preparation regimen.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"263 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142260577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The value of SDC2 and Septin9 combined with serum tumor markers in early diagnosis of colorectal cancer","authors":"Chao-Shi Zou, Yu-Ling Xie, Dong-Xu Wang, Yan-Ping Liu, Ming-Qiang Li, Yi Chen, Zhi-Le Su, Kang-hai Liu","doi":"10.1007/s00384-024-04713-9","DOIUrl":"https://doi.org/10.1007/s00384-024-04713-9","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Objective</h3><p>The aim of this study is to evaluate the significance of combined detection of Septin9 and syndecan-2 (SDC2) methylation markers and serum tumor markers for the early diagnosis of colorectal cancer.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>A total of 116 patients diagnosed with colorectal cancer between December 2022 and February 2024 were designated as the colorectal cancer group. Additionally, 31 patients with colorectal adenoma were assigned to the adenoma group, while 44 individuals undergoing routine physical examinations were included in the control group. Concentrations of Septin9, SDC2, fecal occult blood (FOB), and four tumor markers—carcinoembryonic antigen (CEA), carbohydrate antigen 199 (CA199), carbohydrate antigen 125 (CA125), and carbohydrate antigen 724 (CA724)—were measured. Diagnostic performance was assessed using receiver operating characteristic (ROC) curves for Septin9, SDC2, the four tumor markers, FOB, the combination of Septin9 and SDC2, and the combined use of all seven indicators (CEA, CA19-9, CA125, CA72-4, FOB, Septin9, and SDC2).</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>The colorectal cancer group exhibited the highest positive rates for Septin9, SDC2, the four tumor markers, the combined detection of Septin9 and SDC2, and the combined detection of all seven indicators, compared to both the adenoma and control groups (<i>P</i> &lt; 0.05). The adenoma group also showed higher positive rates than the control group (<i>P</i> &lt; 0.05). For patients with stage I–III colorectal cancer, the positive rates for the combined detection of Septin9 and SDC2 were 81.3%, 78.9%, and 90.2%, respectively, surpassing those for the combined detection of the four tumor markers (43.8%, 55.3%, and 61.0%). Additionally, the positive rates for the two-gene combination in stage III colorectal cancer were higher than those for FOB (<i>P</i> &lt; 0.05). The sensitivity and area under the curve (AUC) for SDC2 were 73.3% and 0.855, respectively, exceeding the sensitivity and AUC for the combined four tumor markers, which were 60.3% and 0.734 (<i>P</i> &lt; 0.05). The combined detection of the two methylated genes demonstrated a sensitivity of 86.2% and an AUC of 0.908, outperforming both FOB and the combined detection of the four tumor markers (<i>P</i> &lt; 0.05).</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>The detection of SDC2 exhibits high sensitivity for colorectal cancer, and when combined with Septin9, it significantly enhances the diagnostic accuracy for early-stage colorectal cancer, offering substantial clinical value.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"23 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142260624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Implementing a no‑drain policy for extraperitoneal colorectal anastomosis in a real‑life setting: analysis of outcomes and surgeons' adherence\".","authors":"Mohit Bhatia, Tarun Singhal","doi":"10.1007/s00384-024-04716-6","DOIUrl":"https://doi.org/10.1007/s00384-024-04716-6","url":null,"abstract":"","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"39 1","pages":"141"},"PeriodicalIF":2.5,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11401777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142286356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and risk factors of sleep disorders in inflammatory bowel disease: a cross-sectional study","authors":"Jin-Zhi Zhang, Xiao-Zhen Song, Xiao-Na Song, Ya-Lin Shen, Hong Tang, Hong Li","doi":"10.1007/s00384-024-04712-w","DOIUrl":"https://doi.org/10.1007/s00384-024-04712-w","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Background</h3><p>Sleep disorders are one of the major public health problems, which can potentially induce inflammation and exacerbate disease activity, resulting in compromised sleep quality. This study aimed to investigate the prevalence and risk factors associated with sleep disorders among patients with inflammatory bowel disease (IBD).</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>Between March 2023 and February 2024, the Pittsburgh Sleep Quality Index was employed to assess sleep quality in both IBD patients and healthy control subjects. Univariate and multivariate analysis were performed to identify the risk factors associated with SD in IBD patients.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Overall, 208 IBD patients [150 Crohn’s disease (CD) and 58 ulcerative colitis (UC)] and 199 healthy individuals were included. Sleep disorders were observed in 59.6% of patients with IBD, with a higher prevalence among females (63.5%) compared to males (56.9%) (<i>P</i> = 0.476). The prevalence of sleep disorders in IBD patients was significantly higher than that found in healthy controls (37.7%) (all <i>P</i> &lt; 0.01). The prevalence of sleep disorders among CD and UC patients was 58% and 63.8%, respectively (<i>P</i> = 0.291). The multivariate analysis revealed that older age (<i>OR</i>, 1.070; 95% <i>CI</i>: 1.035–1.105, <i>P</i> = 0.000), smoking (<i>OR</i>, 2.698; 95% <i>CI</i>: 1.089–6.685, <i>P</i> = 0.032), and depression (<i>OR</i>, 4.779; 95% <i>CI</i>: 1.915–11.928, <i>P</i> = 0.001) were risk factors for sleep disorders in IBD patients. However, higher body mass index (<i>OR</i>, 0.879; 95% <i>CI</i>: 0.790–0.977, <i>P</i> = 0.017) was identified as a protective factor.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Sleep disorders are common among IBD patients regardless of activity levels. Smoking and depression are the major risk factors.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"35 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142189220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing dehydration-induced readmissions post-colorectal surgery: the impact of a prevention bundle.","authors":"Ibrahim H Ozata, Tutku Tufekci, Tugce Aksan, Ecem Eren, Salih Nafiz Karahan, Mekselina Kalender, Yasar Baris Gulluoglu, Derya Salim Uymaz, Emre Ozoran, Ayise Karadag, Ahmet Rencuzogullari, Dursun Bugra, Emre Balik","doi":"10.1007/s00384-024-04709-5","DOIUrl":"10.1007/s00384-024-04709-5","url":null,"abstract":"<p><strong>Introduction: </strong>Ileostomy, frequently created after colorectal resections, hinders the physiologic function of the colon and can lead to dehydration and acute kidney injury due to high stoma outputs. This study aimed to evaluate the effectiveness of preventive measures on ileostomy-induced dehydration and related readmissions in a high-volume unit.</p><p><strong>Methods: </strong>In this prospective cohort study at a high-volume colorectal surgery department in Turkiye, the Prospective Ileostomy-induced Dehydration Prevention Bundle Project (PIDBP) was assessed from March 2021 to March 2022. The study enrolled patients undergoing colorectal surgery with ileostomy and involved comprehensive inpatient stoma care, education, and a structured post-discharge follow-up. The follow-up included the \"Hydration follow-up scale\" to monitor ileostomy output and related complications. The primary outcome was the readmission rate due to dehydration-related complications. The patients receiving the bundle intervention were compared with patients treated in the preceding year, focusing on the effectiveness of interventions such as dietary adjustments, fluid therapy, and pharmacological management.</p><p><strong>Results: </strong>In the study, 104 patients were analyzed, divided into 54 pre-bundle and 50 bundle group patients, with no significant differences in patient characteristics. While the overall readmission rate due to dehydration was 12.5%, a significant reduction in dehydration-related readmissions was observed in the bundle group compared to the pre-bundle group (2% vs. 22%, p = 0.002). Univariate analysis identified high stoma output (> 800 ml/24 h) (p < 0.001), chronic renal failure (CRF) (p = 0.01), postoperative ileus (p = 0.03), higher ASA status (p = 0.04), extended hospital stays (p = 0.03), and small bowel resections (especially in J-pouch patients) (p < 0.001) as significant predictors of readmission. Multivariate analysis revealed that the mean ileostomy output before discharge was the sole significant predictor of dehydration-related readmission (OR 1.01), with an optimal cutoff of 877.5 ml/day identified with an area under the curve (AUC) of 0.947, demonstrating high sensitivity (92.3%) and specificity (86.8%) in predicting readmission risk.</p><p><strong>Conclusion: </strong>The Prospective Ileostomy-induced Dehydration Prevention Bundle Project significantly reduced readmission rates after colorectal surgery.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"39 1","pages":"138"},"PeriodicalIF":2.5,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11380635/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}