sutures newsletter


P & T Approvals, FDA Warning About Hepatitis Drugs, Statement About Plavix

Pharmacy Focus

See highlights of the October meeting of the Pharmacy and Therapeutics Committee. Also, the U.S. Food and Drug Administration has released a warning regarding the risk of serious liver injury with use of hepatitis treatments Viekira Pak and Technivie, and the agency says long-term use of Plavix does not change the risk of death for patients with heart disease.

Mark Your Calendar

Surgery Grand Rounds

Click the "read more" to see information about upcoming Surgery Grand Rounds.

Grand Rounds

Click here to view a schedule of all upcoming grand rounds.

Education Schedule

Click the PDF links below to see the Department of Surgery's education schedule.

Education Schedule - December 2015 (PDF)  

Surgery Scheduling

Click the "read more" for hours and contact information for surgery scheduling.

Share Your News

Know an interesting colleague we should profile? A story we should tell? Submit your ideas, meetings and events for consideration.

Click here to submit your news to Sutures

Research to Improve Outcomes After Colorectal Surgery

By Karen Zaghiyan, MD, and Phillip Fleshner, MD
Division of Colorectal Surgery

Striving to improve the care we provide our patients, the Cedars-Sinai Division of Colorectal Surgery continues to focus on research investigating clinical outcomes after major colorectal surgery.

We recently completed a large prospective randomized trial evaluating the efficacy of preoperative vs. postoperative subcutaneous heparin for deep vein thrombosis (DVT) prophylaxis in over 400 patients undergoing major colorectal surgery. The results of this study are being considered for presentation at the American Surgical Association annual meeting in 2016.

Our focus has now shifted to another randomized prospective study evaluating transversus abdominis plane (TAP) block after colorectal surgery. With multimodal enhanced recovery after surgery (ERAS) pathways becoming increasingly important in the care of our colorectal surgery patients, this study was designed to evaluate a key component of our ERAS pathway here at Cedars-Sinai: the TAP block.

While traditionally performed by our colleagues in the Department of Anesthesia using ultrasound guidance at the conclusion of the operation, laparoscopic-guided TAP block has been performed elsewhere with good results. As it is unclear which technique is superior, we embarked on this study with our Anesthesia colleagues to evaluate narcotic utilization and overall recovery in patients undergoing ultrasound-guided vs. laparoscopic-guided TAP block after major colorectal surgery. Recruitment is ongoing with a plan to enroll 250 patients.

Another important question in the field of colorectal surgery is timing of urinary catheter removal after pelvic surgery, i.e., low anterior resection, abdominoperineal resection and ileal pouch anal anastomosis. Traditional teaching is to delay removal of the urinary catheter for several days after pelvic dissection. The rationale for this practice is to prevent urinary retention related to bladder manipulation and trauma to the pelvic sympathetic and parasympathetic nerve fibers during pelvic dissection.

However, prolonged urinary catheterization predisposes to urinary tract infections and may interfere with early ambulation, leading to DVT and longer hospital stay. In addition, driven in part by the Centers for Medicare and Medicaid Services reimbursement schema now penalizing hospitals for catheter-associated urinary tract infections and Surgical Care Improvement Project measures requiring removal of the urinary catheter on or before postoperative day 2 unless medically indicated, the standard practice of prolonged urinary catheterization is being challenged.

While alpha-1-adrenergic stimulation may play a role in early postoperative urinary retention, the utility of alpha-1-adrenergic blockade in preventing postoperative urinary retention is unclear. In an ongoing, noninferiority, randomized prospective study, we are evaluating the incidence of urinary retention with an alpha-1-adrenergic antagonist given six hours before urinary catheter removal on postoperative day one vs. urinary catheter removal on postoperative day three.

Quality surgical care is not only dependent on precise surgical technique, but also relies heavily on the perioperative care we provide. Through these studies, we challenge ourselves to a higher bar with respect to the day-to-day perioperative care of our patients.