Multidisciplinary program reduces GI complications after orthopedic surgery

Last updated: 05-29-2020

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Multidisciplinary program reduces GI complications after orthopedic surgery

SAN ANTONIO — Implementing a multidisciplinary improvement program helped reduce bowel complications among patients recovering from orthopedic surgery, according to study results presented at the American College of Gastroenterology Annual Meeting.

Melissa Latorre, MD, MS, from NYU Langone Health, said GI complications in patients who undergo orthopedic surgery are common but underreported. Among the most common complications are constipation, ileus and bowel obstruction.

After a surge of adverse events early last year, Latorre and colleagues conducted an analysis to find the root causes of these issues and identified several major factors that were contributing to the cluster of adverse events, including excessive use of ineffective laxatives and lack of follow-up on post-operative digestive issues.

“We subsequently developed a multidisciplinary quality improvement initiative to reduce GI complications in patients admitted to our orthopedic hospital following joint and spine surgery,” Latorre said in her presentation. “The QI team consisted of a GI attending, orthopedic surgery faculty, residents and physician extenders.”

The program included four components; a didactic lecture delivered by the GI attending to the other staff, a post-procedure bowel assessment, a redesign of the electronic medical record change in laxative order sets to standing with an option to be held for diarrhea, and a post-operative call.

The proportion of total and individual GI complications identified in the first quarter of 2018 (before program implementation) compared with the first quarter of 2019 (after implementation) served as the primary outcome.

Latorre and colleagues found that after implementing the QI program, they achieved a 71% reduction in overall bowel complications (P < .05), with the biggest reduction coming from the decrease in incidence of ileus (81% reduction; P < .05).

Additionally, investigators found that there was just one reported incident of perforation — representing a 50% reduction from 2018 — and no deaths.

“We sparked multidisciplinary engagement and improved outcomes for our patients,” Latorre said. – by Alex Young

Latorre M, et al. Abstract 67. Presented at: American College of Gastroenterology Annual Meeting; Oct. 25-30, 2019; San Antonio.

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