For clinicians, it can feel natural to rely on the best practices they’ve always used. However, applying critical thinking toward each component of care can lead to advances in workflow efficiencies and improved patient outcomes.
Summarizing some of these advancements in colorectal care and advocating for continued research, Vanderbilt University professor of clinical surgery David E. Beck, MD, FACS, delivered yesterday’s Herand Abcarian Lecture, “Perioperative Care: Advances Driven by Critical Thinking.”
Perioperative care can be broken into three stages—preoperative, intraoperative, and postoperative care—and each is critical to the ultimate patient outcome.
“As surgeons, we have to manage patients before and after the operation,” Dr. Beck said. “On many occasions, that care before and after may be more important than the surgery itself.”
One of the challenges in colorectal practice is a lack of conclusive data to guide best practices. These specialists may have local organizational guidelines or discuss different care strategies with their colleagues, but there is not a lot of evidence that shows how the “average” colorectal surgeon operates, Dr. Beck said. Therefore, providers must often rely on their own critical thinking or objective analysis of available facts, evidence, and observations to form a judgment.
“What’s challenging is that we tend to throw a lot of things at the wall and see what works, and we’re not sure which of those components is really critical, unnecessary, or maybe interacting with something else,” Dr. Beck explained.
Without conclusive evidence, the use of certain care techniques has fluctuated over time. Decades ago, mechanical bowel preparation was viewed as a best practice, then it briefly came to be considered an unnecessary step in the perioperative journey, Dr. Beck said, but it is now once again considered an optimal piece of a patient’s care strategy, along with antibiotics. This uncertainty and inconsistency, paired with a deficiency of clinical data, force clinicians to rely on their clinical judgment and experience, he noted.
Despite the shortage of high-level data, many advancements have been made in the colorectal field in a relatively short time. Thirty years ago, patients often were admitted to the hospital 3 or 4 days before an operation and stayed several weeks postoperation. Now, specialists use minimally invasive techniques that have improved elements such as pain management and have led to significantly decreased hospital stays for patients. In light of this progress, Dr. Beck hopes to stimulate continued research among his colleagues to continually analyze and identify components of care that are necessary and useful versus those that are potentially wasteful or harmful.
The Herand Abcarian Lecture was established by the Chicago Society of Colon and Rectal Surgeons in 2006 to honor the outstanding contributions of colon and rectal surgeon Herand Abcarian, MD, FACS, FASCRS, and address topics of relevance to the surgical community-at-large and focus on emerging issues in surgery. After delivering this year’s address, Dr. Beck was presented with a commemorative plaque by Eric G. Weiss, MD, FACS.
“Herand Abcarian is a friend of mine. He’s one of the major figures in our specialty,” Dr. Beck said. “Those of us who know him are honored that we have a lecture named after him.”