Annals of Coloproctology

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Impact of Patient’s Pain and Fatigue on Decision of Discharge After Laparoscopic Surgery for Colorectal Cancer: Gyeora Lee, Jun-Suh Lee, Ji Hoon Kim, Duk Yeon Hwang, Yoon-Suk Lee; Ann Coloproctol. 2019;35(4):209-215. Published online August 31, 2019; DOI: https://doi.org/10.3393/ac.2018.11.29

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Purpose
Hospital stays after laparoscopic surgery for colorectal cancer tend to be much shorter than those after conventional open surgery. Many factors, including surgical outcomes and complications, are associated with patient discharge planning. However, few studies have analyzed the impact of patient subjective discomfort (including pain and fatigue) on the decision to discharge after surgery. Therefore, the purpose of this study was to determine how patient pain and fatigue play a role in the decision to discharge after laparoscopic surgery for colorectal cancer.
Methods
Between March 2014 and February 2015, we conducted a questionnaire survey of 91 patients who underwent laparoscopic surgery for colorectal cancer to estimate the expectation criteria for discharge and patient subjective discomfort at that time. Patients were divided into the following 2 groups: group A, those who complied with the medical professional’s decision to discharge; and group B, those who refused discharge despite the medical professional’s decision. The participants’ subjective factors were analyzed.
Results
Preoperatively, 78 of 91 patients (85.7%) identified activity level, amount of food (tolerance), and bowel movements as important factors that should be considered in the decision to discharge a patient postoperatively. Postoperatively, 17 patients (18.7%) refused discharge despite a discharge recommendation. Subjective pain and fatigue were significantly different in linear-by-linear association between the group of patients who agreed to be discharge and those who disagreed. Despite this difference, there was no significant difference in mean length of hospital stay between the 2 groups.
Conclusion
A patient’s subjective feelings of pain and fatigue can impact their decision regarding hospital discharge.

Citations

Citations to this article as recorded by

Effect of continuous wound infiltration on patients using intravenous patient-controlled analgesia for pain management after reduced-port laparoscopic colorectal surgery
Hyeon Deok Choi, Sung Uk Bae
Annals of Coloproctology.2024; 40(6): 564. CrossRef
The Impact of an Enhanced Recovery Protocol in a High-Risk Population Undergoing Colon Cancer Surgery
Denise L. Wong, Alexis Holland, Mehmet Kocak, Mace Coday, Caroline Brown, Justin J. Monroe, Nathan M. Hinkle, Jeremiah L. Deneve, Evan S. Glazer, David Shibata
The American Surgeon™.2023; 89(11): 4485. CrossRef
Effectiveness of Aromatherapy on Ameliorating Fatigue in Adults: A Meta-Analysis
Qiuting Wang, Lin Wei, Yueming Luo, Lijun Lin, Chong Deng, Ping Hu, Lijia Zhu, Yangchen Liu, Meizhen Lin, Azizah Ugusman
Evidence-Based Complementary and Alternative Medicine.2022; 2022: 1. CrossRef
Reducing hospital stay for colorectal surgery in ERAS setting by means of perioperative patient education of expected day of discharge
Thaís T. T. Tweed, Carmen Woortman, Stan Tummers, Maikel J. A. M. Bakens, James van Bastelaar, Jan H. M. B. Stoot
International Journal of Colorectal Disease.2021; 36(7): 1535. CrossRef
The Impact of Patient’s Pain and Fatigue on the Discharge Decision After Laparoscopic Surgery for Colorectal Cancer
Won Beom Jung
Annals of Coloproctology.2019; 35(4): 158. CrossRef

Re-evaluation of the Clinical Significance of the Fatigue Rate Index in the External Anal Sphincter.: Seong, Moo Kyung , Shim, Jin Suk; J Korean Soc Coloproctol. 2009;25(2):75-80.; DOI: https://doi.org/10.3393/jksc.2009.25.2.75

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3 Citations

Abstract PDF

PURPOSE
The fatigue rate index (FRI) has been developed to access sustained voluntary contraction of the external anal sphincter. This study is designed to refine the technical aspects of measuring the FRI and to re-evaluate its clinical significance. METHODS: Thirty-eight patients with fecal incontinence (19 males, 19 females) and 37 (21 males, 16 females) controls were studied. Anal manometry was performed by using standard protocols. Fatigue was measured over a 20-sec squeeze at a high-pressure zone. The FRI was calculated from the maximum squeeze pressure (MXSP) and the fatigue rate. For the accuracy of the calculation, the mean resting pressure (MRP) was calibrated to zero before the metric procedure, representative segments of the calculation were selectively designated as those denoting sustained squeeze, and representative channels were designated from among 8 channels by using 3 or more of those showing typical sustaining-pressure curves. RESULTS: No difference in demographic factors was detected between the two groups. Basic manometric parameters were significantly different between the two groups (MRP, 29.4+/-21.3 vs. 44.4+/-17.8 mmHg, P=0.0015; MXSP, 205.9+/-98.0 vs. 274.2+/-106.5 mmHg, P=0.0051). The FRI was also significantly different (29.8+/-14.3 vs. 86.3+/-127.1 sec, P=0.0108). The areas under the receptor operating-characteristic curves for the MRP, the MXSP, and the FRI were 0.72, 0.69, and 0.84, respectively. The sensitivity and the specificity of the FRI for detecting fecal incontinence were 80% and 65% at 40 sec as a cut-off point. CONCLUSION: The FRI was proven to be more accurate than the MRP and the MXSP in detecting incontinence. With adequate modifications of the measuring method, measurement of the FRI could be done more easily and conveniently, but its cut-off point for detecting fecal incontinence was lower than previously reported.

Citations

Citations to this article as recorded by

Anal sphincter fatigability in assessing anal incontinence: A systematic review
Dakshitha Wickramasinghe, Nilanka Wickramasinghe, Sohan Anjana Kamburugamuwa, Nandadeva Samarasekera, Janindra Warusavitarne, Carolynne Vaizey
Neurogastroenterology & Motility.2022;[Epub] CrossRef
Increased fatigability of external anal sphincter in inflammatory bowel disease: Significance in fecal urgency and incontinence
Athanasios A. Papathanasopoulos, Konstantinos H. Katsanos, Athina Tatsioni, Dimitrios K. Christodoulou, Epameinondas V. Tsianos
Journal of Crohn's and Colitis.2010; 4(5): 553. CrossRef
Effects of Age and Sex on Anorectal Manometry
Seung Chul Heo, Sung-Bum Kang, Kyu-Joo Park, Jae-Gahb Park
Journal of the Korean Society of Coloproctology.2009; 25(5): 285. CrossRef

Measurement of External Anal Sphincter Function by Fatigue Rate Index.: Seong, Moo Kyung , Yoo, Young Bum; J Korean Soc Coloproctol. 2002;18(3):184-189.

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23 Download

Abstract PDF: PURPOSE
Fatigue rate index (FRI) is one of relatively unknown parameters of anal manometry. It was devised to assess sustained voluntary contractibility of external anal sphincter muscle. We designed this study to determine the predictability of FRI in evaluating patients with symptoms of fecal incontinence.
METHODS
Consecutive male patients with fecal incontinence, those with prolapsed hemorrhoids but without any kind of incontinence symptom, and male healthy volunteers who have no anal symptom were grouped as A, B, C. Anal manometric parameters including FRI were measured and compared statistically among them.
RESULTS
All subjects were 84. Group A 27, Group B 33, and Group C 24. Their ages were 33.33+/-2.91 (mean SE), 39.27+/-2.80, and 50.81+/-4.33, respectively. Mean resting pressures (mmHg) were 78.11 6.56 for group A, 81.18+/-7.19 for group B, and 57.81+/-7.80 for group C. Maximum resting pressures (mmHg) were 98.67+/-9.69, 100.82+/-8.49, 78.13+/-10.26. Mean squeeze pressures (mmHg) were 229.11+/-18.72, 248.18+/-23.03, 156.94+/-17.89. Maximum squeeze pressures (mmHg) were 286.50+/-33.76, 298.59+/-27.83, 187.38+/-21.08. Resting radial asymmetries (%) were 18.85+/-2.81, 19.85+/-2.31, 28.70+/-4.79. Squeeze radial asymmetries were 15.73+/-2.90, 16.29+/-1.96, 16.47+/-2.95. Fatigue rates were 0.90+/-0.21, 1.17+/-0.15, 1.38+/-0.40. Fatigue rate indices (min.) were 3.76+/-0.41, 2.63+/-0.20, 1.94+/-0.26, respectively. Differences between group A and group C were statistically significant in mean squeeze pressure (P=0.0093), maximum squeeze pressure (P= 0.0190) and FRI (P=0.0008). Those between group B and group C were significant also in mean squeeze pressure (P=0.005), maximum squeeze pressure (P=0.0051), and FRI (P=0.0396). Multiple logistic regression analysis revealed that independently significant parameters were age (P= 0.002) and FRI (P=0.007). Cut-off point of FRI for incontinence with maximum sensitivity and specificity was 2.4min. by ROC (receiver operating characteristics) analysis.
CONCLUSION
FRI is a meaningful parameter in predicting fecal incontinence, which can be used in assessment of sphincter function and future treatment protocols.

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