|ASCRS is one of more than 60 leading medical specialty societies to identify over 220 specific tests, procedures, or medication therapies that are commonly ordered but not always necessary and could cause undue harm. ASCRS submitted five recommended interventions to the ABIM Foundation’s Choosing Wisely® campaign, which aims to spark conversations between patients and physicians about what care is really necessary.
The Society’s recommended interventions and supporting statements are:
The Society’s submission, including detailed citation of published resources to document each recommendation, was prepared by Dr. Martin R. Weiser, New York, NY, and reviewed by members of the ASCRS Clinical Practice Guidelines Committee (formerly known as Standards Committee), Dr. Janice F. Rafferty, Cincinnati, OH, Chair, and past Executive Council member. It was approved by the Executive Council.
- Don’t routinely administer postoperative antibiotics for more than one day following colorectal surgery. Support: Administering antibiotics before surgery is important in reducing infections but routine prolonged use of antibiotics is not necessary and can be detrimental.
- Don’t obtain CT or MRI in patients with benign perianal disease before examining the patient. Support: Anal discomfort and pain can be caused by many conditions, including fissures, fistulas, and abscesses. The first step in evaluating a patient with anal discomfort is physical examination. CT scan is useful for those patients with select findings on physical examination. Routine CT scans expose patients to unnecessary radiation exposure.
- Don’t administer antibiotics to patients undergoing elective anal procedures such as hemorrhoidectomy or repair of fistula in ano. Support: Routine use of antibiotics for anal surgery is not necessary, and overuse of antibiotics can be dangerous. Antibiotics are indicated for some immune-compromised patients and patients with prosthetic heart valves.
- Don’t perform colon resection following a single episode of uncomplicated diverticulitis. Support: Inflammation and infection associated with diverticulum of the colon (diverticulitis) is treated with antibiotics and alteration in diet. Patients should undergo colonoscopy, if one has not been done previously, to ensure no other abnormalities. Surgery is not necessary to remove a portion of colon unless there have been multiple episodes of diverticulitis, the patient is immune-compromised, or diverticulitis is complicated with development of large abscess, fistula or stricture.
- Following colon or rectal cancer resection, don’t obtain follow-up routine colonoscopy and imaging (CT scans) in low performance status patients that are not candidates for additional treatment. Support: The role of surveillance colonoscopy and imaging, including CT scan, following colon and rectal cancer surgery is to identify cancer recurrence or a new cancer that would be amenable to additional treatment such as additional surgery, chemotherapy or radiation. If patients are medically unfit for additional treatment, they should not be subjected to additional unnecessary testing.
The mission of the ABIM Foundation is to advance medical professionalism to improve the health care system. The Choosing Wisely campaign, launched in April 2012, is part of a multi-year effort led by the ABIM Foundation to support and engage physicians in being better stewards of finite health care resources.