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Specific warning signs of complications in colorectal surgical patients released

tandardized, Dr. Li said the wide spectrum of opinions underscored why the study was necessary. "Everyone seemed to have a different definition of the same symptom," Dr. Li said. "When we were talking about a fever, the temperature could be 101, 102, or 100.4."

"One of the interesting things about the Delphi process is that we summarize what everyone says," Dr. Li added. "So if you were the only one who said a fever is 102, but everyone else thinks it's 100.4, you might join the group or explain why on the next round of feedback."

After five rounds, between February and July 2012, the panel of surgeons came up with 10 symptoms that should prompt patients to contact their surgeons:

  • wound drainage, opening, or redness (all three of these signs can indicate an infection)
  • no bowel movement or lack of gas/stool from any ostomy for more than 24 hours
  • increasing abdominal pain
  • vomiting
  • abdominal swelling
  • high ostomy output and/or dark urine or no urine
  • fever greater than 101.5
  • not being able to take anything by mouth for more than 24 hours

The panel also identified two symptoms that are serious enough to warrant a trip to the nearest emergency department:

  • chest pain
  • shortness of breath

Dr. Li said the study is the first step toward incorporating these warning signs into already established discharge instruction tools. This surgical patient education process should help colorectal surgical patients have clear, open communication with surgeons when they feel something is wrong. "Regarding health care use," the authors wrote, "all panelists agreed that warning signs should decrease emergency care visits and readmission, triage the level of health care accessed, and increase patient-to-provider communication."

Other participants in the study included Whitney L. Mills, PhD; Amanda M. Gutierrez; Levi I. Herman, BS; David H. Berger, MD, MHCM, FACS; and Aanand D

Contact: Sally Garneski
American College of Surgeons

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