Advertisement

Der Chirurg

pp 1–6 | Cite as

Evidenzbasierte perioperative Medizin

  • P. Probst
  • R. Klotz
  • F. J. Hüttner
  • J. C. Harnoss
  • M. K. DienerEmail author
Leitthema
  • 80 Downloads

Zusammenfassung

Perioperative medizinische Interventionen sind fester Bestandteil des modernen chirurgischen Managements. Chirurgen sollten neben dem handwerklichen Kerngeschäft auch die prä- und postoperative Medizin beherrschen. Dies gilt für die Indikationsstellung zur perioperativen Antikoagulation, die Handhabung von Drainagen, das Einstellen der perioperativen Analgesie, das Verordnen einer antibiotischen Prophylaxe sowie für die Entscheidung, ob eine präoperative Darmspülung durchgeführt wird. Dieser Artikel thematisiert exemplarisch einige Spannungsfelder der perioperativen Medizin. Basierend auf der bestverfügbaren Evidenz sollte stets kritisch beurteilt werden, ob diese perioperativen Interventionen wirklich zum Behandlungserfolg beitragen.

Schlüsselwörter

Antikoagulation Drainagen Analgesie Antibiotische Prophylaxe Darmspülung 

Evidence-based perioperative medicine

Abstract

Perioperative medical interventions are an integral part of modern surgical management. In addition to the main manual aspects of surgical interventions, surgeons must also be familiar with preoperative and postoperative medical interventions. This ranges from the indications for perioperative anticoagulation, handling of drainage, adjusting the perioperative analgesia, prescribing an antibiotic prophylaxis to deciding whether a preoperative bowel preparation is necessary. Therefore, this article exemplifies some areas in perioperative medicine. Based on the best available evidence, it should always be critically assessed whether these perioperative interventions really contribute to the success of the treatment.

Keywords

Anticoagulation Drainages Analgesia Antibiotic prophylaxis Bowel preparation solutions 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

P. Probst, R. Klotz, F.J. Hüttner, J.C. Harnoss und M.K. Diener geben an, dass gemäß den Richtlinien der ICMJE kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Literatur

  1. 1.
    AWMF Guideline S3-Leitlinie Prophylaxe der venösen Thromboembolie (VTE) 2. komplett überarbeitete Auflage, Stand: 15. Okt. 2015.Google Scholar
  2. 2.
    Moreano EH, Hutchison JL, McCulloch TM et al (1998) Incidence of deep venous thrombosis and pulmonary embolism in otolaryngology-head and neck surgery. Otolaryngol Head Neck Surg 118(6):777–784CrossRefGoogle Scholar
  3. 3.
    Leonardi MJ, McGory ML, Ko CY (2007) A systematic review of deep venous thrombosis prophylaxis in cancer patients: implications for improving quality. Ann Surg Oncol 14(2):929–936CrossRefGoogle Scholar
  4. 4.
    Collins R, Scrimgeour A, Yusuf S et al (1988) Reduction in fatal pulmonary embolism and venous thrombosis by perioperative administration of subcutaneous heparin. Overview of results of randomized trials in general, orthopedic, and urologic surgery. N Engl J Med 318(18):1162–1173CrossRefGoogle Scholar
  5. 5.
    Lyman GH, Khorana AA, Falanga A et al (2007) American Society of Clinical Oncology guideline: recommendations for venous thromboembolism prophylaxis and treatment in patients with cancer. J Clin Oncol 25(34):5490–5505CrossRefGoogle Scholar
  6. 6.
    Bridging; AWMF-Registernr. 053/027; Klasse S1.Google Scholar
  7. 7.
    Cerise EJ, Pierce WA, Diamond DL (1970) Abdominal drains: their role as a source of infection following splenectomy. Ann Surg 171:764–769CrossRefGoogle Scholar
  8. 8.
    Karayiannakis AJ, Bolanaki H, Tsalikidis C, Simopoulos C (2010) Cutaneous metastasis at a surgical drain site after gastric cancer resection. Case Rep Oncol 3:495–497CrossRefGoogle Scholar
  9. 9.
    Gilbert A, Ortega-Deballon P, Di Giacomo G et al (2018) Intraperitoneal drains move. J Visc Surg 155:105–110CrossRefGoogle Scholar
  10. 10.
    Gurusamy KS, Samraj K (2007) Routine abdominal drainage for uncomplicated open cholecystectomy. Cochrane Database Syst Rev:CD6003.  https://doi.org/10.1002/14651858.CD006003.pub2 CrossRefPubMedGoogle Scholar
  11. 11.
    Allen PJ (2011) Operative drains after pancreatic resection—the Titanic is sinking. HPB (Oxford) 13:595CrossRefGoogle Scholar
  12. 12.
    Buchler MW, Friess H (2006) Evidence forward, drainage on retreat: still we ignore and drain!? Ann Surg 244:8–9CrossRefGoogle Scholar
  13. 13.
    Schorn S, Nitsche U, Demir IE et al (2018) The impact of surgically placed, intraperitoneal drainage on morbidity and mortality after pancreas resection—A systematic review & meta-analysis. Pancreatology 18:334–345CrossRefGoogle Scholar
  14. 14.
    Gurusamy KS, Koti R, Davidson BR (2013) Routine abdominal drainage versus no abdominal drainage for uncomplicated laparoscopic cholecystectomy. Cochrane Database Syst Rev:CD6004.  https://doi.org/10.1002/14651858.CD006004.pub4 CrossRefPubMedGoogle Scholar
  15. 15.
    Yong L, Guang B (2016) Abdominal drainage versus no abdominal drainage for laparoscopic cholecystectomy: a systematic review with meta-analysis and trial sequential analysis. Int J Surg 36:358–368CrossRefGoogle Scholar
  16. 16.
    Li Z, Zhao L, Cheng Y et al (2018) Abdominal drainage to prevent intra-peritoneal abscess after open appendectomy for complicated appendicitis. Cochrane Database Syst Rev 5:CD10168PubMedGoogle Scholar
  17. 17.
    Rolph R, Duffy J, Alagaratnam S et al (2016) Intra-abdominal drains for the prophylaxis of anastomotic leak in elective colorectal surgery. Cochrane Database Syst Rev.  https://doi.org/10.1002/14651858.CD002100.pub2 CrossRefGoogle Scholar
  18. 18.
    Zhang HY, Zhao CL, Xie J et al (2016) To drain or not to drain in colorectal anastomosis: a meta-analysis. Int J Colorectal Dis 31:951–960CrossRefGoogle Scholar
  19. 19.
    Guerra F, Giuliani G, Coletta D et al (2018) A Meta-analysis of randomized controlled trials on the use of suction drains following rectal surgery. Dig Surg 35:482–490CrossRefGoogle Scholar
  20. 20.
    Wang Z, Chen J, Su K, Dong Z (2015) Abdominal drainage versus no drainage post-gastrectomy for gastric cancer. Cochrane Database Syst Rev:CD8788.  https://doi.org/10.1002/14651858.CD008788.pub3 CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Gurusamy KS, Samraj K, Davidson BR (2007) Routine abdominal drainage for uncomplicated liver resection. Cochrane Database Syst Rev:CD6232.  https://doi.org/10.1002/14651858.CD006232.pub2 CrossRefPubMedGoogle Scholar
  22. 22.
    Gavriilidis P, Hidalgo E, de’Angelis N et al (2017) Re-appraisal of prophylactic drainage in uncomplicated liver resections: a systematic review and meta-analysis. HPB (Oxford) 19:16–20CrossRefGoogle Scholar
  23. 23.
    Zhang W, He S, Cheng Y et al (2018) Prophylactic abdominal drainage for pancreatic surgery. Cochrane Database Syst Rev 6:CD10583PubMedGoogle Scholar
  24. 24.
    Hüttner FJ, Probst P, Knebel P et al (2017) Meta-analysis of prophylactic abdominal drainage in pancreatic surgery. Br J Surg 104(6):660–668CrossRefGoogle Scholar
  25. 25.
    Wu CL, Rowlingson AJ, Partin AW, Kalish MA, Courpas GE, Walsh PC et al (2005) Correlation of postoperative pain to quality of recovery in the immediate postoperative period. Reg Anesth Pain Med 30(6):516–522CrossRefGoogle Scholar
  26. 26.
    Kehlet H, Dahl JB (2003) Anaesthesia, surgery, and challenges in postoperative recovery. Lancet 362(9399):1921–1928CrossRefGoogle Scholar
  27. 27.
    Kehlet H, Wilmore DW (2002) Multimodal strategies to improve surgical outcome. Am J Surg 183(6):630–641CrossRefGoogle Scholar
  28. 28.
    Deutsche Interdisziplinäre Vereinigung für Schmerztherapie (DIVS). S3-Leitlinie. Behandlung akuter perioperativer und posttraumatischer Schmerzen. (AWMF-Register Nr. 041/001). Stand: 21.05.2007 inkl. Änderungen vom 20.04.2009Google Scholar
  29. 29.
    Pöpping DM, Elia N, Marret E, Remy C, Tramèr MR (2008) Protective effects of epidural analgesia on pulmonary complications after abdominal and thoracic surgery: a meta-analysis. Arch Surg 143(10):990–999CrossRefGoogle Scholar
  30. 30.
    Guay J, Nishimori M, Kopp S (2016) Epidural local anaesthetics versus opioid-based analgesic regimens for postoperative gastrointestinal paralysis, vomiting and pain after abdominal surgery. Cochrane Libr.  https://doi.org/10.1213/ANE.0000000000001628 CrossRefGoogle Scholar
  31. 31.
    Salicath JH, Yeoh EC, Bennett MH (2018) Epidural analgesia versus patient-controlled intravenous analgesia for pain following intra-abdominal surgery in adults. Cochrane Database Syst Rev 8.  https://doi.org/10.1002/14651858.CD010434.pub2 CrossRefPubMedGoogle Scholar
  32. 32.
    Klotz R, Hofer S, Schellhaaß A, Dörr-Harim C, Tenckhoff S, Bruckner T et al (2016) Intravenous versus epidural analgesia to reduce the incidence of gastrointestinal complications after elective pancreatoduodenectomy (the PAKMAN trial, DRKS 00007784): study protocol for a randomized controlled trial. Trials 17(1):194CrossRefGoogle Scholar
  33. 33.
    Ma N, Duncan JK, Scarfe AJ, Schuhmann S, Cameron AL (2017) Clinical safety and effectiveness of transversus abdominis plane (TAP) block in post-operative analgesia: a systematic review and meta-analysis. J Anesth 31(3):432–452CrossRefGoogle Scholar
  34. 34.
    Charlton S, Cyna AM, Middleton P, Griffiths JD (2010) Perioperative transversus abdominis plane (TAP) blocks for analgesia after abdominal surgery. Cochrane Database Syst Rev 12.  https://doi.org/10.1002/14651858.CD007705.pub2 CrossRefPubMedGoogle Scholar
  35. 35.
    Cruse PJE, Foord R (1980) The epidemiology of wound infection: a 10 year old prospective study of 62,939 wounds. Surg Clin North Am 60:27–40CrossRefGoogle Scholar
  36. 36.
    Wacha H, Hoyme U, Isenmann R, Kujath P, Lebert C, Naber K, Salzberger B (2010) Peripoperative Antibiotika-Prophylaxe, Empfehlungen einer Expertenkommission der Paul-Ehrlich-Gesellschaft für Chemotherapie e. V. Chemother J 19(3):70–84Google Scholar
  37. 37.
    Perioperative Antibiotikaprophylaxe, Arbeitskreis „Krankenhaus- und Praxishygiene“ der AWMF, Leitlinie 029-022, AWMF 2012Google Scholar
  38. 38.
    Global Guidelines for the prevention of surgical site infection, WHO, 2016Google Scholar
  39. 39.
    Classen DC, Evans RS, Pestotnik SC, Horn SD, Menlove RL, Burke JP (1992) The timing of prophylactic administration of antibiotics and the risk of surgical wound infections. N Engl J Med 326:281–286CrossRefGoogle Scholar
  40. 40.
    Güenaga KF, Matos D, Wille-Jørgensen P (2011) Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev 9.  https://doi.org/10.1002/14651858.CD001544.pub4 CrossRefPubMedGoogle Scholar
  41. 41.
    Rollins KE, Javanmard-Emamghissi H, Lobo DN (2018) Impact of mechanical bowel preparation in elective colorectal surgery: a meta-analysis. World J Gastroenterol 24(4):519–536CrossRefGoogle Scholar
  42. 42.
    Ohman KA, Wan L, Guthrie T, Johnston B, Leinicke JA, Glasgow SC et al (2017) Combination of oral antibiotics and mechanical bowel preparation reduces surgical site infection in colorectal surgery. J Am Coll Surg 225(4):465–471CrossRefGoogle Scholar
  43. 43.
    Kiran RP, Murray AC, Chiuzan C, Estrada D, Forde K (2015) Combined preoperative mechanical bowel preparation with oral antibiotics significantly reduces surgical site infection, anastomotic leak, and ileus after colorectal surgery. Ann Surg 262(3):416–425CrossRefGoogle Scholar
  44. 44.
    Scarborough JE, Mantyh CR, Sun Z, Migaly J (2015) Combined mechanical and oral antibiotic bowel preparation reduces incisional surgical site infection and anastomotic leak rates after elective colorectal resection. Ann Surg 262(2):331–337CrossRefGoogle Scholar
  45. 45.
    Mulder T, Crolla R, Kluytmans-van den Bergh MF, van Mourik MS, Romme J, van der Schelling GP et al (2018) Preoperative oral antibiotic prophylaxis reduces surgical site infections after elective Colorectal surgery: results from a before-after study. Clin Infect Dis.  https://doi.org/10.1093/cid/ciy839 CrossRefPubMedGoogle Scholar
  46. 46.
    Garfinkle R, Abou-Khalil J, Morin N, Ghitulescu G, Vasilevsky C‑A, Gordon P et al (2017) Is there a role for oral antibiotic preparation alone before colorectal surgery? ACS-NSQIP analysis by coarsened exact matching. Dis Colon Rectum 60(7):729–737CrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  • P. Probst
    • 1
    • 2
  • R. Klotz
    • 1
    • 2
  • F. J. Hüttner
    • 1
    • 2
  • J. C. Harnoss
    • 1
    • 2
  • M. K. Diener
    • 1
    • 2
    Email author
  1. 1.Klinik für Allgemein‑, Viszeral- und TransplantationschirurgieUniversitätsklinikum HeidelbergHeidelbergDeutschland
  2. 2.Studienzentrum der Deutschen Gesellschaft für Chirurgie und CHIR-Net KoordinationszentraleHeidelbergDeutschland

Personalised recommendations