Page 67 - Read Online

Aslam et al. Mini-invasive Surg 2018;2:10 I http://dx.doi.org/10.20517/2574-1225.2017.42 Page 5 of 7

status. More patients in the control period had open operations and more had conversions from laparoscopic
to open procedures that during the CO measurement period. Patients in the earlier period may have required
more advanced care because of the higher level of invasiveness of the operation. These differences alone
would explain a large percentage of the change in level 2/3 care required in the earlier period, and not the
implementation of CO monitoring. Due to the lack of data about the precise decision for admission in ICU/
HDU in the control group did not allow analysis for these co-founders. The authors did not notice a change
in practice for the use of bowel preparation for colon surgery patients. No mechanical bowel preparation is
used at the unit for right colonic surgery and only Phosphate enema is used for left sided colonic and rectal
surgery. Enhanced recovery protocols have recommended the elimination of mechanical bowel preparation
which would reduce IV volume support for patients undergoing colorectal surgery. Though practice for
bowel preparation did not change in study period, a lack of data in the consistency in bowel preparation
over the entire time of the study highlights the issue that even a minor change in practice combined with
less invasive surgical procedures makes the postoperative care of the patients in the two periods of time very
different.

Intra-operative indices of tissue hypo-perfusion resulting in gastrointestinal dysfunction are the most
common post-operative complications in patients undergoing moderate-to high risk emergency GI surgery.
Intra-operative CO optimisation and GDFT for patients undergoing colorectal surgery reduces the post-
[9]
operative morbidity, mortality and length of hospital stay . GDFT has also been shown to be cost effective
in reducing hospital stays and the surgical complications [32,33] . It would be interesting to extend this study to
use intra-operative cardiac output monitoring for patients undergoing emergency laparotomy and to assess
the outcomes through the National Emergency Laparotomy Audit.

In conclusion, the use of intra-operative cardiac monitoring does not significantly alter the immediate post-
operative outcomes; however, it reduces the need for admission to level 2/3 care facilities post-operatively.
Intra-operative cardiac output monitoring might become an effective way to reduce the need for higher
level critical care beds in patients undergoing elective colorectal surgery. A larger cohort study is needed to
further confirm these findings and account for any co-founders.

DECLARATIONS
Authors’ contributions
Conception and design: Merchant J, Evans R, Ihedioha U, Kang P
Acquisition of data: Aslam MI, Smith H, Akhtar N
Analysis and interpretation of data: Aslam MI
Article drafting: Aslam MI, Smith H, Akhtar N
Revision for important intellectual content: Currow C, Merchant J, Evans R, Ihedioha U, Kang P
Final approval: Aslam MI, Smith H, Currow C, Akhtar N, Merchant J, Evans R, Ihedioha U, Kang P

Financial support and sponsorship
None.

Conflicts of interest
There are no conflicts of interest.

Patient consent
No personal information for patients involved in the article.

Ethics approval
Ethics review was not required by the institution for a retrospective analysis for prospectively maintained
database.