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Mota BBL, Macedo TJB, Parra RS, Rocha JJRDA, Feres O, Feitosa MR. Retrospective analysis of surgical and oncological results of laparoscopic surgeries performed by residents of coloproctology. Rev Col Bras Cir 2023; 50:e20233404. [PMID: 37222382 PMCID: PMC10508675 DOI: 10.1590/0100-6991e-20233404-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/29/2022] [Indexed: 05/25/2023] Open
Abstract
INTRODUCTION with the improvement and wide acceptance of laparoscopy in colorectal operations, there was a need for specific training of surgeons in training. There are few studies evaluating the postoperative results of laparoscopic colectomies performed by resident physicians and their impact on patient safety. PURPOSE to analyze the surgical and oncological results of laparoscopic colectomies performed by coloproctology residents and compare them with data in the literature. METHODS this is a retrospective analysis of patients undergoing laparoscopic colorectal surgery performed by resident physicians at the Hospital das Clínicas de Ribeirão Preto, between 2014 and 2018. The clinical characteristics of the patients were studied, as well as the main surgical and oncological aspects in a period of one year. RESULTS we analyzed 191 operations, whose main surgical indication was adenocarcinoma, most of them stage III. The mean duration of surgeries was 210±58 minutes. There was a need for a stoma in 21.5% of the patients, mainly loop colostomy. The conversion rate was 23%, with 79.5% due to technical difficulties, and the main predictors of conversion were obesity and intraoperative accidents. The median length of stay was 6 days. Preoperative anemia was associated with a higher rate of complications (11.5%) and reoperations (12%). Surgical resection margins were compromised in 8.6% of cases. The one-year recurrence rate was 3.2% and the mortality rate was 6.3%. CONCLUSIONS videolaparoscopic colorectal surgery performed by residents showed efficacy and safety similar to data found in the literature.
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Affiliation(s)
- Bárbara Bianca Linhares Mota
- - Hospital das Clínicas da Faculdade de Medicina de RIbeirão Preto - USP, Departamento de anatomia e cirurgia, divisão de coloproctologia - Ribeirao Preto - SP - Brasil
| | - Tarcísio Junior Bittencourt Macedo
- - Hospital das Clínicas da Faculdade de Medicina de RIbeirão Preto - USP, Departamento de anatomia e cirurgia, divisão de coloproctologia - Ribeirao Preto - SP - Brasil
| | - Rogério Serafim Parra
- - Hospital das Clínicas da Faculdade de Medicina de RIbeirão Preto - USP, Departamento de anatomia e cirurgia, divisão de coloproctologia - Ribeirao Preto - SP - Brasil
| | - José Joaquim Ribeiro DA Rocha
- - Hospital das Clínicas da Faculdade de Medicina de RIbeirão Preto - USP, Departamento de anatomia e cirurgia, divisão de coloproctologia - Ribeirao Preto - SP - Brasil
| | - Omar Feres
- - Hospital das Clínicas da Faculdade de Medicina de RIbeirão Preto - USP, Departamento de anatomia e cirurgia, divisão de coloproctologia - Ribeirao Preto - SP - Brasil
| | - Marley Ribeiro Feitosa
- - Hospital das Clínicas da Faculdade de Medicina de RIbeirão Preto - USP, Departamento de anatomia e cirurgia, divisão de coloproctologia - Ribeirao Preto - SP - Brasil
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Aggarwal A, Han L, Boyle J, Lewis D, Kuyruba A, Braun M, Walker K, Fearnhead N, Sullivan R, van der Meulen J. Association of Quality and Technology With Patient Mobility for Colorectal Cancer Surgery. JAMA Surg 2023; 158:e225461. [PMID: 36350616 PMCID: PMC9647575 DOI: 10.1001/jamasurg.2022.5461] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Importance Many health care systems publish hospital-level quality measures as a driver of hospital performance and to support patient choice, but it is not known if patients with cancer respond to them. Objective To investigate hospital quality and patient factors associated with treatment location. Design, Setting, and Participants This choice modeling study used national administrative hospital data. Patients with colon and rectal cancer treated in all 163 English National Health Service (NHS) hospitals delivering colorectal cancer surgery between April 2016 and March 2019 were included. The extent to which patients chose to bypass their nearest surgery center was investigated, and conditional logistic regression was used to estimate the association of additional travel time, hospital quality measures, and patient characteristics with treatment location. Exposures Additional travel time in minutes, hospital characteristics, and patient characteristics: age, sex, cancer T stage, socioeconomic status, comorbidity, and rural or urban residence. Main Outcomes and Measures Treatment location. Results Overall, 44 299 patients were included in the final cohort (mean [SD] age, 68.9 [11.6] years; 18 829 [42.5%] female). A total of 8550 of 31 258 patients with colon cancer (27.4%) and 3933 of 13 041 patients with rectal cancer (30.2%) bypassed their nearest surgical center. Travel time was strongly associated with treatment location. The association was less strong for younger, more affluent patients and those from rural areas. For rectal cancer, patients were more likely to travel to a hospital designated as a specialist colorectal cancer surgery center (odds ratio, 1.45; 95% CI, 1.13-1.87; P = .004) and to a hospital performing robotic surgery for rectal cancer (odds ratio, 1.43; 95% CI, 1.11-1.86; P = .007). Patients were less likely to travel to hospitals deemed to have inadequate care by the national quality regulator (odds ratio, 0.70; 95% CI, 0.50-0.97; P = .03). Patients were not more likely to travel to hospitals with better 2-year bowel cancer mortality outcomes. Conclusions and Relevance Patients appear responsive to hospital characteristics that reflect overall hospital quality and the availability of robotic surgery but not to specific disease-related outcome measures. Policies allowing patients to choose where they have colorectal cancer surgery may not result in better outcomes but could drive inequities in the health care system.
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Affiliation(s)
- Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom,Clinical Effectiveness Unit, Royal College of Surgeons of England, London, United Kingdom
| | - Lu Han
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jemma Boyle
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom,Clinical Effectiveness Unit, Royal College of Surgeons of England, London, United Kingdom
| | - Daniel Lewis
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Angela Kuyruba
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, United Kingdom
| | - Michael Braun
- Department of Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom,School of Medical Sciences, University of Manchester, United Kingdom
| | - Kate Walker
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom,Clinical Effectiveness Unit, Royal College of Surgeons of England, London, United Kingdom
| | - Nicola Fearnhead
- Department of Colorectal Surgery, Cambridge University Hospitals, Cambridge, United Kingdom
| | - Richard Sullivan
- Institute of Cancer Policy, King’s College London, London, United Kingdom,Department of Oncology, Guy’s & St Thomas’ NHS Trust, London, United Kingdom
| | - Jan van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Bayat Z, Guidolin K, Elsolh B, De Castro C, Kennedy E, Govindarajan A. Impact of surgeon and hospital factors on length of stay after colorectal surgery systematic review. BJS Open 2022; 6:6704875. [PMID: 36124901 PMCID: PMC9487584 DOI: 10.1093/bjsopen/zrac110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/10/2022] [Indexed: 11/22/2022] Open
Abstract
Background Although length of stay (LOS) after colorectal surgery (CRS) is associated with worse patient and system level outcomes, the impact of surgeon and hospital-level factors on LOS after CRS has not been well investigated. The aim of this study was to synthesize the evidence for the impact of surgeon and hospital-level factors on LOS after CRS. Methods A comprehensive database search was conducted using terms related to LOS and CRS. Studies were included if they reported the effect of surgeon or hospital factors on LOS after elective CRS. The evidence for the effect of each surgeon and hospital factor on LOS was synthesized using vote counting by direction of effect, taking risk of bias into consideration. Results A total of 13 946 unique titles and abstracts were screened, and 69 studies met the inclusion criteria. All studies were retrospective and assessed a total of eight factors. Surgeon factors such as increasing surgeon volume, colorectal surgical specialty, and progression along a learning curve were significantly associated with decreased LOS (effect seen in 87.5 per cent, 100 per cent, and 93.3 per cent of studies respectively). In contrast, hospital factors such as hospital volume and teaching hospital status were not significantly associated with LOS. Conclusion Provider-related factors were found to be significantly associated with LOS after elective CRS. In particular, surgeon-related factors related to experience specifically impacted LOS, whereas hospital-related factors did not. Understanding the mechanisms underlying these relationships may allow for tailoring of interventions to reduce LOS.
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Affiliation(s)
- Zubair Bayat
- Division of General Surgery, Department of Surgery, University of Toronto , Toronto, Ontario , Canada
- Institute of Health Policy Management and Evaluation, University of Toronto , Toronto, Ontario , Canada
- Sinai Health System , Toronto, Ontario , Canada
| | - Keegan Guidolin
- Division of General Surgery, Department of Surgery, University of Toronto , Toronto, Ontario , Canada
| | - Basheer Elsolh
- Division of General Surgery, Department of Surgery, University of Toronto , Toronto, Ontario , Canada
| | | | - Erin Kennedy
- Division of General Surgery, Department of Surgery, University of Toronto , Toronto, Ontario , Canada
- Institute of Health Policy Management and Evaluation, University of Toronto , Toronto, Ontario , Canada
- Sinai Health System , Toronto, Ontario , Canada
| | - Anand Govindarajan
- Division of General Surgery, Department of Surgery, University of Toronto , Toronto, Ontario , Canada
- Institute of Health Policy Management and Evaluation, University of Toronto , Toronto, Ontario , Canada
- Sinai Health System , Toronto, Ontario , Canada
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Welten VM, Wanis KN, Madenci AL, Fields AC, Lu PW, Malizia RA, Yoo J, Goldberg JE, Irani JL, Bleday R, Melnitchouk N. The Effect of Facility Volume on Survival Following Proctectomy for Rectal Cancer. J Gastrointest Surg 2022; 26:150-160. [PMID: 34291364 DOI: 10.1007/s11605-021-05092-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/01/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Prior studies assessing colorectal cancer survival have reported better outcomes when operations are performed at high-volume centers. These studies have largely been cross-sectional, making it difficult to interpret their estimates. We aimed to assess the effect of facility volume on survival following proctectomy for rectal cancer. METHODS Using data from the National Cancer Database, we included all patients with complete baseline information who underwent proctectomy for non-metastatic rectal cancer between 2004 and 2016. Facility volume was defined as the number of rectal cancer cases managed at the treating center in the calendar year prior to the patient's surgery. Overall survival estimates were obtained for facility volumes ranging from 10 to 100 cases/year. Follow-up began on the day of surgery and continued until loss to follow-up or death. RESULTS A total of 52,822 patients were eligible. Patients operated on at hospitals with volumes of 10, 30, and 50 cases/year had similar distributions of grade, clinical stage, and neoadjuvant therapies. 1-, 3-, and 5-year survival all improved with increasing facility volume. One-year survival was 94.0% (95% CI: 93.7, 94.3) for hospitals that performed 10 cases/year, 94.5% (95% CI: 94.2, 94.7) for 30 cases/year, and 94.8% (95% CI: 94.5, 95.0) for 50 cases/year. Five-year survival was 68.9% (95% CI: 68.0, 69.7) for hospitals that performed 10 cases/year, 70.8% (95% CI: 70.1, 71.5) for 30 cases/year, and 72.0% (95% CI: 71.2, 72.8) for 50 cases/year. CONCLUSIONS Treatment at a higher volume facility results in improved survival following proctectomy for rectal cancer, though the small benefits are less profound than previously reported.
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Affiliation(s)
- Vanessa M Welten
- Division of General and Gastrointestinal Surgery, Department of Surgery Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, MA, 02115, Boston, USA. .,Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont St, MA, 02120, Boston, USA.
| | - Kerollos N Wanis
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, MA, 02115, Boston, USA
| | - Arin L Madenci
- Division of General and Gastrointestinal Surgery, Department of Surgery Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, MA, 02115, Boston, USA
| | - Adam C Fields
- Division of General and Gastrointestinal Surgery, Department of Surgery Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, MA, 02115, Boston, USA
| | - Pamela W Lu
- Division of General and Gastrointestinal Surgery, Department of Surgery Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, MA, 02115, Boston, USA
| | - Robert A Malizia
- Division of General and Gastrointestinal Surgery, Department of Surgery Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, MA, 02115, Boston, USA
| | - James Yoo
- Division of General and Gastrointestinal Surgery, Department of Surgery Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, MA, 02115, Boston, USA
| | - Joel E Goldberg
- Division of General and Gastrointestinal Surgery, Department of Surgery Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, MA, 02115, Boston, USA
| | - Jennifer L Irani
- Division of General and Gastrointestinal Surgery, Department of Surgery Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, MA, 02115, Boston, USA
| | - Ronald Bleday
- Division of General and Gastrointestinal Surgery, Department of Surgery Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, MA, 02115, Boston, USA
| | - Nelya Melnitchouk
- Division of General and Gastrointestinal Surgery, Department of Surgery Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, MA, 02115, Boston, USA.,Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont St, MA, 02120, Boston, USA
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