• The benefit of an enhanced recovery programme following elective laparoscopic sigmoid colectomy.

      Al Chalabi, Hasan; Kavanagh, Dara O; Hassan, Lana; Donnell, Kate O; Nugent, Emmeline; Andrews, Emmet; Keane, Frank B V; O'Riordain, Diarmuid S; Miller, Andrew; Neary, Paul; et al. (2012-02-01)
      BACKGROUND: Enhanced recovery programmes (ERPs) have demonstrated reduced morbidity and length of hospital stay in patients undergoing open elective colorectal resections. The application of laparoscopic techniques to colorectal surgery is associated with shorter length of stay and morbidity compared to open resections. In the setting of laparoscopic surgery, it is unclear whether there is an additive effect on length of stay and morbidity by combining these. The current study addresses the benefit of an ERP (RAPID protocol) in a cohort of matched patients undergoing laparoscopic sigmoid colon resection MATERIALS AND METHODS: Consecutive patients over a 40-month period who underwent laparoscopic sigmoid colon resection were assigned either to the RAPID protocol (group 1) or traditional post operative care (group 2) in a non-randomised manner. Analysis was on an "intention to treat" basis. Primary and secondary endpoints were identified; primary endpoints included length of hospital stay and readmission rate. Secondary endpoints included morbidity and mortality rate. RESULTS: Seventy-three consecutive patients were included. Group 1 included 37 patients. Group 2 included 36 patients. Median length of hospital stay in groups 1 and 2 was 5 and 8 days, respectively (p = 0.01). Readmission rate in groups 1 and 2 was 8.1% and 8.3%, respectively (p = 0.98). Morbidity rate in groups 1 and 2 was 30% and 22%, respectively (p = 0.61); there was one mortality in each group. CONCLUSION: The application of the ERP (RAPID) to patients undergoing laparoscopic sigmoid colon resection results in a significant improvement in length of hospital stay, with comparable morbidity and readmission rates.
    • Impact of a new electronic handover system in surgery.

      Ryan, S; O'Riordan, J M; Tierney, S; Conlon, K C; Ridgway, P F; Department of Surgery, University of Dublin, Trinity College, Adelaide & Meath Hospital Incorporating National Children's Hospital, Tallaght, Dublin 24, Ireland. (International journal of surgery, 2011)
      Accurate handover of clinical information is imperative to ensure continuity of patient care, patient safety and reduction in clinical errors. Verbal and paper-based handovers are common practice in many institutions but the potential for clinical errors and inefficiency is significant. We have recently introduced an electronic templated signout to improve clarity of transfer of patient details post-surgical take. The aim of this study was to prospectively audit the introduction of this new electronic handover in our hospital with particular emphasis regarding efficacy and efficiency. The primary surrogate chosen to assess efficacy and efficiency was length of stay for those patients admitted through the emergency department. To do this we compared two separate, two-week periods before and after the introduction of this new electronic signout format. Users were not informed of the study. Information recorded on the signout included details of the emergency admissions, consults received on call and any issues with regard to inpatients. ASA grade, time to first intervention and admission diagnosis were also recorded. Our results show that introduction of this electronic signout significantly reduced median length of stay from five to four days (P=0.047). No significant difference in ASA grades, time to first intervention or overall admission diagnosis was obtained between the two time periods. In conclusion, this is the first study to show that the introduction of electronic signout post-call was associated with a significant reduction in patient length of stay and provided better continuity of care than the previously used paper-based handover.
    • Is simple nephrectomy truly simple? Comparison with the radical alternative.

      Connolly, S S; O'Brien, M Frank; Kunni, I M; Phelan, E; Conroy, R; Thornhill, J A; Grainger, R; Department of Urology, Trinity College Dublin, Adelaide and Meath incorporating National Children's Hospital, Tallaght, Dublin 24, Ireland. steconnolly@rcsi.ie (2011-03)
      The Oxford English dictionary defines the term "simple" as "easily done" and "uncomplicated". We tested the validity of this terminology in relation to open nephrectomy surgery.
    • Laparoscopic colonic resection in inflammatory bowel disease: minimal surgery, minimal access and minimal hospital stay.

      Boyle, E; Ridgway, P F; Keane, F B; Neary, P; Division of Colorectal Surgery, Minimally Invasive Surgery Tallaght, Adelaide, Ireland. (Colorectal disease : the official journal of the Association, 2008-11)
      Laparoscopic surgery for inflammatory bowel disease (IBD) is technically demanding but can offer improved short-term outcomes. The introduction of minimally invasive surgery (MIS) as the default operative approach for IBD, however, may have inherent learning curve-associated disadvantages. We hypothesise that the establishment of MIS as the standard operative approach does not increase patient morbidity as assessed in the initial period of its introduction into a specialised unit, and that it confers earlier postoperative gastrointestinal recovery and reduced hospitalisation compared with conventional open resection.
    • Laparoscopic nephrectomy: initial experience with 120 cases.

      Cheema, I A; Manecksha, R P; Murphy, M; Flynn, R; Urology Department, The Adelaide and Meath Hospital, Tallaght, Dublin 24., ijazacheema@hotmail.com (2012-02-01)
      Laparoscopic nephrectomy for both benign and malignant diseases of kidney is increasingly being performed. We report our experience with the first 120 consecutive laparoscopic nephrectomy performed in our hospital. It is the retrospective analysis of a prospectively maintained database of 4 years period. The parameters examined included age, gender, indications, operative time, blood loss, intraoperative and post operative complications. Mean age of surgery was 59 years (rang 19-84years). The indications for surgery included solid renal masses (71 patients), non-functioning kidneys (43), and collecting system tumours (6). The mean operating time was 132 minutes (range 75-270), average blood loss was 209 ml (range 0-1090) and average hospital stay was 4.7days (range 2-20). Bleeding, bowel injury and poor progression of laparoscopic procedure were the reasons in 7 (5.8%) cases converted to open surgery. There was 1 (0.8%) perioperative mortality. Eight (6.6%) patients developed post operative complications. Laparoscopic nephrectomy has inherent benefits and may be considered an alternate therapeutic option for kidney diseases with acceptable morbidity
    • Liaison neurologists facilitate accurate neurological diagnosis and management, resulting in substantial savings in the cost of inpatient care.

      Costelloe, L; O'Rourke, D; Monaghan, T S; McCarthy, A J; McCormack, R; Kinsella, J A; Smith, A; Murphy, R P; McCabe, D J H; Department of Neurology, The Adelaide and Meath Hospital, Dublin, Incorporating, the National Children's Hospital, Trinity College Dublin, Tallaght, Dublin 24,, Ireland. (2012-02-01)
      BACKGROUND: Despite understaffing of neurology services in Ireland, the demand for liaison neurologist input into the care of hospital inpatients is increasing. This aspect of the workload of the neurologist is often under recognised. AIMS/METHODS: We prospectively recorded data on referral and service delivery patterns to a liaison neurology service, the neurological conditions encountered, and the impact of neurology input on patient care. RESULTS: Over a 13-month period, 669 consults were audited. Of these, 79% of patients were seen within 48 h and 86% of patients were assessed by a consultant neurologist before discharge. Management was changed in 69% cases, and discharge from hospital expedited in 50%. If adequate resources for neurological assessment had been available, 28% could have been seen as outpatients, with projected savings of 857 bed days. CONCLUSIONS: Investment in neurology services would facilitate early accurate diagnosis, efficient patient and bed management, with substantial savings.
    • Peritoneal dialysis in an ageing population: a 10-year experience.

      Smyth, Andrew; McCann, Evonne; Redahan, Lynn; Lambert, Barbara; Mellotte, George J; Wall, Catherine A; Department of Nephrology, Adelaide & Meath Hospital, Dublin 24, Tallaght, Ireland. andrewsmyth@physicians.ie (2012-02)
      Chronic kidney disease (CKD) is becoming increasingly prevalent and there are increasing numbers of older patients with advanced CKD. Peritoneal dialysis (PD) is a potential treatment. This study aims to compare PD outcomes in age-defined populations in the largest PD centre in the Republic of Ireland over 10 years.
    • Randomized controlled trial of oral vs intravenous therapy for the clinically diagnosed acute uncomplicated diverticulitis.

      Ridgway, P F; Latif, A; Shabbir, J; Ofriokuma, F; Hurley, M J; Evoy, D; O'Mahony, J B; Mealy, K; Department of Surgery, Wexford General Hospital, Ireland. p.ridgway@imperial.ac.uk (Colorectal disease : the official journal of the Association of Coloproctology, 2009-11)
      Despite the high prevalence of hospitalization for left iliac fossa tenderness, there is a striking lack of randomized data available to guide therapy. The authors hypothesize that an oral antibiotic and fluids are not inferior to intravenous (IV) antibiotics and 'bowel rest' in clinically diagnosed acute uncomplicated diverticulitis.
    • The RAPID protocol enhances patient recovery after both laparoscopic and open colorectal resections.

      Lloyd, G M; Kirby, R; Hemingway, D M; Keane, F B; Miller, A S; Neary, P; Department of Surgery, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, UK. GMLloyd@doctors.org.uk (Surgical endoscopy, 2010-06)
      Enhanced recovery after surgery (ERAS) programs can accelerate recovery and shorten the hospital stay after colorectal resections. The RAPID (remove, ambulate, postoperative analgesia, introduce diet) protocol is a simplified ERAS program that consists of a simplified, user-friendly single-page pro forma schedule. This study aimed to evaluate the impact of the RAPID protocol on patients undergoing both laparoscopic and open colorectal resections in two specialized colorectal units.
    • Rectal cancer surgery: volume-outcome analysis.

      Nugent, Emmeline; Neary, Paul; National Surgical Training Centre, Royal College of Surgeons Ireland, 121 St. Stephen's Green, Dublin 2, Ireland. emmelinenugent@rcsi.ie (International journal of colorectal disease, 2010-12)
      There is strong evidence supporting the importance of the volume-outcome relationship with respect to lung and pancreatic cancers. This relationship for rectal cancer surgery however remains unclear. We review the currently available literature to assess the evidence base for volume outcome in relation to rectal cancer surgery.