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Esmer AC, Çolak T, Edizsoy A, Tazeoğlu D, Serdar Karaca A. Current status of laparoscopic surgery usage in Türkiye: A middle-income country. Turk J Surg 2022; 38:353-361. [PMID: 36875273 PMCID: PMC9979558 DOI: 10.47717/turkjsurg.2022.5713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 08/31/2022] [Indexed: 01/12/2023]
Abstract
Objectives This study aimed to determine the usage status of laparoscopic procedures in general surgical practice in Türkiye, which is a sample of middle-income countries. Material and Methods The questionnaire was sent to general surgeons, gastrointestinal surgeons, and surgical oncologists who have completed their residency training and are actively working in university, public or private hospitals. Demographic data, laparoscopy training and the period of education, the rate of laparoscopy use, the type and volume of laparoscopic surgical procedures, their views on the advantages and disadvantages of laparoscopic surgery, and the reasons for preferring laparoscopy were determined with a 30-item questionnaire. Results Two hundred and forty-four questionnaires from 55 different cities of Türkiye were evaluated. The responders were mainly males, younger surgeons (F/M= 11.1/88.9 % and 30-39 y/o), and graduated from the university hospital residence program (56.6%). Laparoscopic training was frequently taken during residency (77.5%) in the younger age group, while the elderly participants mostly received additional training after specialization (91.7%). Laparoscopic surgery was mostly not available in public hospitals for advanced procedures (p <0.0001) but was available for cholecystectomy and appendectomy operations (p= NS). However, participants working in university hospitals mostly stated that the laparoscopic approach was the first choice for advanced procedures. Conclusion The results of this study showed that the surgeons working in MICs spent strong effort to use laparoscopy in daily practice, especially in university and high-volume hospitals. However, inappropriate education, cost of laparoscopic equipment, healthcare policies, and some cultural and social barriers might have negatively impacted the widespread use of laparoscopic surgery and its usage in daily practice in MICs such as Türkiye.
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Affiliation(s)
- Ahmet Cem Esmer
- Department of Surgical Oncology, Mersin University Faculty of Medicine, Mersin, Türkiye
| | - Tahsin Çolak
- Department of Surgical Oncology, Mersin University Faculty of Medicine, Mersin, Türkiye
| | - Akay Edizsoy
- Department of Surgical Oncology, Mersin University Faculty of Medicine, Mersin, Türkiye
| | - Deniz Tazeoğlu
- Department of Surgical Oncology, Mersin University Faculty of Medicine, Mersin, Türkiye
| | - Ahmet Serdar Karaca
- Clinic of General Surgery, Başkent University Faculty of Medicine İstanbul Hospital, İstanbul, Türkiye
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Ibarvo Gracia HM, Saldaña Sanchez IG, Natour AK. On Hereditary Colorectal Cancer: What Is the Appropriate Surgical Technique? CURRENT COLORECTAL CANCER REPORTS 2020. [DOI: 10.1007/s11888-020-00457-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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3
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Farquhar DR, Masood MM, Lenze NR, Sheth S, Patel SN, Lumley C, Zanation AM, Weissler MC, Olshan AF, Hackman TG. Academic Affiliation and Surgical Volume Predict Survival in Head and Neck Cancer Patients Receiving Surgery. Laryngoscope 2020; 131:E479-E488. [PMID: 32449832 DOI: 10.1002/lary.28744] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/03/2020] [Accepted: 04/23/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine whether the academic affiliation or surgical volume affects the overall survival (OS) of human papillomavirus (HPV)-negative head and neck squamous cell carcinoma (HNSCC) patients receiving surgery. METHODS A retrospective study of 39 North Carolina Medical Centers was conducted. Treatment centers were classified as academic hospitals, community cancer centers, or community hospitals and were divided into thirds by volume. The primary outcome was 5-year OS. Hazard ratios (HR) were determined using Cox proportional hazard models, adjusting for demographics, tumor site, stage, insurance status, tobacco use, alcohol use, stage, chemotherapy, and radiation therapy. Patients were also stratified by stage (early stage and advanced stage). RESULTS Patients treated at community cancer centers had significantly better 5-year OS (HR 0.68, 95% confidence interval [CI] = 0.48-0.98), and patients treated at academic hospitals trended toward better 5-year OS (HR 0.72, 95% CI = 0.50-1.04) compared to patients treated at community hospitals. The effect for academic affiliation on survival was more pronounced for patients with advanced stage cancer at diagnosis (HR 0.60, 95% CI = 0.37-0.95). There were no significant survival differences among early stage patients by treatment center type. Top-third (HR = 0.64, 95% CI = 0.42-0.96) centers by surgical volume had significantly better 5-year OS, and middle-third (HR = 0.71, 95% CI = 0.51-1.03) centers by volume trended toward better 5-year OS when compared to the bottom-third centers by volume. CONCLUSION Patients treated at academic hospitals, community cancer centers, and hospitals in the top third by case volume have favorable survival for HPV-negative HNSCC. The effect for academic hospitals is most pronounced among advanced stage patients. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E479-E488, 2021.
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Affiliation(s)
- Douglas R Farquhar
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Maheer M Masood
- Department of Otolaryngology/Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Missouri, U.S.A
| | - Nicholas R Lenze
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Siddharth Sheth
- Department of Hematology/Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Samip N Patel
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Catherine Lumley
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Adam M Zanation
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Mark C Weissler
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Andrew F Olshan
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Trevor G Hackman
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
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Ochoa-Hernandez A, Giron K, Meier J, Charchalac AP. Current Options in the Management of Colorectal Cancer in Developing Countries: Central America Experience. CURRENT COLORECTAL CANCER REPORTS 2020. [DOI: 10.1007/s11888-020-00452-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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5
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Huerta S, Meier J, Emuakhagbon VS, Favela J, Argo M, Polanco PM, Augustine MM, Pham T. A comparative analysis of outcomes of open, laparoscopic, and robotic elective (procto-) colectomies for benign and malignant disease. J Robot Surg 2020; 15:53-62. [PMID: 32297148 DOI: 10.1007/s11701-020-01069-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 03/16/2020] [Indexed: 01/17/2023]
Abstract
Laparoscopy has emerged as a common alternative to the open approach for colorectal operations. Robotic surgery has many advantages, but cost and outcomes are an area of study. There are no randomized-controlled trials of all techniques. The present study evaluated a cohort of veterans undergoing (procto-) colectomy for benign or malignant colorectal disease. This is a single-institution retrospective review. We compared open, laparoscopic, and robotic colectomies. The primary outcome was 30-day mortality. The secondary endpoints included morbidity, operative times, estimated blood loss (EBL), length of stay (LOS), conversion rate, and the learning curve (LC). Subgroup analyses were undertaken for: (1) right hemicolectomies (RHC) and (2) by specific surgeons most familiar with each approach. The cohort included 390 patients (men = 95%, White = 70.8%, BMI = 29.3 ± 6.4 kg/m2, age = 63.7 ± 10.2 years) undergoing (open = 117, laparoscopic = 168, and robotic = 105), colorectal operations for colorectal adenocarcinoma (52.8%) and benign disease. Thirty-day morbidity was similar across all techniques (open = 46.2%, laparoscopic = 42.9%, and robotic = 38.1%; NS). EBL and LOS were decreased with minimally invasive techniques compared to open. Operative time was longer in robotic, but equalized to laparoscopic after 90 cases. The learning curve was reduced to 20 when performed by the surgeon most familiar with the robot. EBL and operative time independently predicted complications for the entire cohort. The best technique for colorectal operations rests on the surgeon's experience, but minimally invasive techniques are gaining momentum over open colectomies. Robotic colectomy is emerging as a non-inferior approach to laparoscopy in terms of outcomes, while maintaining all its technical advantages.
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Affiliation(s)
- Sergio Huerta
- Department of Surgery, VA North Texas Health Care System, University of Texas Southwestern, 4500 S. Lancaster Road, Dallas, TX, 75216, USA. .,Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Jennie Meier
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Valerie-Sue Emuakhagbon
- Department of Surgery, VA North Texas Health Care System, University of Texas Southwestern, 4500 S. Lancaster Road, Dallas, TX, 75216, USA.,Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Juan Favela
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Madison Argo
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Patricio M Polanco
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mathew M Augustine
- Department of Surgery, VA North Texas Health Care System, University of Texas Southwestern, 4500 S. Lancaster Road, Dallas, TX, 75216, USA.,Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Thai Pham
- Department of Surgery, VA North Texas Health Care System, University of Texas Southwestern, 4500 S. Lancaster Road, Dallas, TX, 75216, USA.,Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Notarnicola M, Felli E, Roselli S, Altomare DF, De Fazio M, de'Angelis N, Piardi T, Acquafredda S, Ammendola M, Verbo A, Pessaux P, Memeo R. Laparoscopic liver resection in elderly patients: systematic review and meta-analysis. Surg Endosc 2019; 33:2763-2773. [PMID: 31139986 DOI: 10.1007/s00464-019-06840-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 05/16/2019] [Indexed: 12/11/2022]
Abstract
Laparoscopic liver resection (LLR) is becoming standard practice, replacing the open approach in terms of safety and feasibility. However, few data are available for the elderly. The objective of this study is to assess the feasibility of LLR in elderly patients, by making a comparison with open liver resection (OLR) and with non-elderly patients. Relevant studies found in the Cochrane Library, Embase, PubMed, and Web of Science were used in order to perform a systematic review and meta-analysis. Nine fully extracted comparative studies were included and two groups were identified: Group 1 with a comparison between OLR and LLR in the elderly and Group 2 with a focus on differences after LLR between elderly and non-elderly patients. A total number of 497 elderly patients who underwent LLR were analyzed. A random effect model was used for the meta-analysis. In Group 1, 1025 elderly patients were included: 640 underwent OLR and 385 underwent LLR. LLR was associated with minor blood loss (MD - 240 mL, 95% CI - 416.61, - 63.55; p 0.008; I2 = 96%), less transfusion (8% vs. 13.1%; RR 0.61, 95% CI 0.41, 0.91; p = 0.02; I2 = 0%), fewer postoperative Clavien-Dindo III/IV complications (RR 0.48 in favor of LLR; 95% CI 0.29, 0.77; p = 0.003; I2 = 0%). On the other hand, no significant difference was observed in terms of bile leakage, ascites, mortality, liver failure, or R0 resection. Group 2 included 112 elderly and 276 non-elderly patients who underwent LLR. The meta-analysis showed no significant difference in terms of blood loss, transfusions, liver failure, Clavien-Dindo III/IV complications, postoperative mortality, ascites, bile leak, hospital stay, R0 resection, and operative time. Laparoscopic liver resection is a safe and feasible procedure for elderly patients. However, further randomized studies are required to confirm this.
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Affiliation(s)
- Margherita Notarnicola
- Department of Emergency and Organ Transplantation, Institute of General Surgery and Liver Transplantation, University of Bari, 70124, Bari, Italy
| | - Emanuele Felli
- Hepato-Biliary and Pancreatic Surgical Unit, General, Digestive, and Endocrine Surgery, IRCAD, IHU-Strasbourg (Institute of Image-Guided Surgery), University of Strasbourg, 1 place de l'Hôpital, 67091, Strasbourg, France
| | - Stefania Roselli
- Department of Emergency and Organ Transplantation, Institute of General Surgery and Liver Transplantation, University of Bari, 70124, Bari, Italy
| | - Donato Francesco Altomare
- Department of Emergency and Organ Transplantation, Institute of General Surgery and Liver Transplantation, University of Bari, 70124, Bari, Italy
| | - Michele De Fazio
- Department of Emergency and Organ Transplantation, Institute of General Surgery and Liver Transplantation, University of Bari, 70124, Bari, Italy
| | - Nicola de'Angelis
- Units of Digestive, HPB Surgery and Liver Transplantation, Henri Mondor Hospital, University of Paris-Est, UPEC, Créteil, France
| | - Tullio Piardi
- Department of Surgery, Hôpital Robert Debré, University of Champagne-Ardenne, Reims, France
| | | | - Michele Ammendola
- Department of Medical and Surgical Sciences, Clinical Surgery Unit, "Magna Graecia" University Medical School, Catanzaro, Italy
| | - Alessandro Verbo
- General and Hepatobiliary Unit, Ospedale Regionale F. Miulli, Strada Prov. 127 Acquaviva - Santeramo Km. 4, 100, 70021, Acquaviva delle Fonti, Italy
| | - Patrick Pessaux
- Hepato-Biliary and Pancreatic Surgical Unit, General, Digestive, and Endocrine Surgery, IRCAD, IHU-Strasbourg (Institute of Image-Guided Surgery), University of Strasbourg, 1 place de l'Hôpital, 67091, Strasbourg, France
| | - Riccardo Memeo
- Department of Emergency and Organ Transplantation, Institute of General Surgery and Liver Transplantation, University of Bari, 70124, Bari, Italy.
- General and Hepatobiliary Unit, Ospedale Regionale F. Miulli, Strada Prov. 127 Acquaviva - Santeramo Km. 4, 100, 70021, Acquaviva delle Fonti, Italy.
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Yeo HL, Kaushal R, Kern LM. The Adoption of Surgical Innovations at Academic Versus Nonacademic Health Centers. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:750-755. [PMID: 28953563 DOI: 10.1097/acm.0000000000001932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE The value of the health care services provided by academic health centers (AHCs) in the United States increasingly is being questioned. AHCs play a prominent role in developing new surgical innovations, including new minimally invasive techniques, which are costly up front but can lead to significant benefits like decreased morbidity and lengths of stays. This study explored the role of AHCs in the adoption of these surgical innovations as a novel measure of their value. METHOD The authors combined data from the American Hospital Association and the State Inpatient Databases from California, Florida, Washington State, and New York. They compared the number and percentage of patients who received four new, innovative surgical procedures (vs. those who received the traditional procedures) at Council of Teaching Hospitals (COTH) hospitals to those at non-COTH hospitals from 2009 to 2011. RESULTS Overall, 61.1% (27,175) of the procedures performed at COTH hospitals used new techniques, compared with 47.2% (41,680) at non-COTH hospitals, across all years (P < .0001). The number and percentage of procedures using the new techniques increased in all years and for all procedures. CONCLUSIONS Not only do AHCs play a role in developing surgical innovations but they also adopt these new techniques more quickly than other hospitals, and thereby they provide additional benefits to patients. These findings provide an important and understudied perspective on the value of AHCs.
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Affiliation(s)
- Heather L Yeo
- H.L. Yeo is assistant professor of surgery, Departments of Surgery and Healthcare Policy and Research, Weill Cornell Medical College, and assistant attending surgeon, NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York. R. Kaushal is chair, Department of Healthcare Policy and Research, executive director, Center for Healthcare Informatics and Policy, and Nanette Laitman Distinguished Professor of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York. She is also chief, Healthcare Policy and Research, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York. L.M. Kern is associate professor of medicine, Joan and Sanford I. Weill Department of Medicine, and associate professor of healthcare policy and research, Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York
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Patient, Hospital, and Geographic Disparities in Laparoscopic Surgery Use Among Surveillance, Epidemiology, and End Results-Medicare Patients With Colon Cancer. Dis Colon Rectum 2017; 60:905-913. [PMID: 28796728 PMCID: PMC5643006 DOI: 10.1097/dcr.0000000000000874] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Surgical resection is the primary treatment for colon cancer, but use of laparoscopic approaches varies widely despite demonstrated short- and long-term benefits. OBJECTIVE The purpose of this study was to identify characteristics associated with laparoscopic colon cancer resection and to quantify variation based on patient, hospital, and geographic characteristics. DESIGN Bayesian cross-classified, multilevel logistic models calculated adjusted ORs and CIs for patient, surgeon, hospital, and geographic characteristics and unexplained variability (predicted vs. observed values) using adjusted median odds ratios for hospitals and counties. SETTINGS The Surveillance, Epidemiology, and End Results-Medicare claims database (2008-2011) supplemented with county-level American Community Survey (2008-2012) demographic data was used. PATIENTS A total of 10,618 patients ≥66 years old who underwent colon cancer resection were included. MAIN OUTCOME MEASURES Nonurgent/nonemergent resections for colon cancer patients ≥66 years old were classified as laparoscopic or open procedures. RESULTS Patients resided in 579 counties and used 950 hospitals; 47% of patients underwent laparoscopic surgery. Medicare/Medicaid dual enrollment, age ≥85 years, and higher tumor stage and grade were negatively associated with laparoscopic surgery receipt; proximal tumors and increasing hospital size and surgeon caseload were positively associated. Significant unexplained variability at the hospital (adjusted median OR = 3.31; p < 0.001) and county levels (adjusted median OR = 1.28; p < 0.05) remained after adjustment. LIMITATIONS This was an observational study lacking generalizability to younger patients without Medicare or those with Health Maintenance Organization coverage and data set did not reflect national hospital studies or hospital volume. In addition, we were unable to account for specific types of comorbidities, such as obesity, and had broad categories for surgeon caseload. CONCLUSIONS Determining sources of hospital-level variation among poor insured patients may help increase laparoscopic resection to maximize health outcomes and reduce cost. See Video Abstract at http://links.lww.com/DCR/A363.
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The American Society of Colon and Rectal Surgeons Assessment Tool for Performance of Laparoscopic Colectomy. Dis Colon Rectum 2017; 60:738-744. [PMID: 28594724 DOI: 10.1097/dcr.0000000000000817] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The lack of consensus for performance assessment of laparoscopic colorectal resection is a major impediment to quality improvement. OBJECTIVE The purpose of this study was to develop and assess the validity of an evaluation tool for laparoscopic colectomy that is feasible for wide implementation. DESIGN During the pilot phase, a small group of experts modified previous assessment tools by watching videos for laparoscopic right colectomy with the following categories of experience: novice (less than 20 cases), intermediate (50-100 cases), and expert (more than 500 cases). After achieving sufficient reliability (κ > 0.8), a user-friendly tool was validated among a large group of blinded, trained experts. SETTING The study was conducted through the American Society of Colon and Rectal Surgeons Operative Competency Evaluation Committee. PATIENTS Raters were from the Operative Competency Evaluation Committee of the American Society of Colon and Rectal Surgeons. MAIN OUTCOME MEASURES Assessment tool reliability and internal consistency were measured. RESULTS From October 2014 through February 2015, 4 groups of 5 raters blinded to surgeon skill level evaluated 6 different laparoscopic right colectomy videos (novice = 2, intermediate = 2, expert = 2). The overall Cronbach α was 0.98 (>0.9 = excellent internal consistency). The intraclass correlation for the overall assessment was 0.93 (range, 0.77-0.93) and was >0.74 (excellent) for each step. The average scores (scale, 1-5) for experts were significantly better than those in the intermediate category, with a mean (SD) of 4.51 (0.56) versus 2.94 (0.56; p = 0.003). Videos in the intermediate group scored more favorably than beginner videos for each individual step and overall performance (mean (SD) = 3.00 (0.32) vs 1.78 (0.42); p = 0.006). LIMITATIONS The study was limited by rater bias to technique and style. CONCLUSIONS The unique and robust methodology in this trial produced an assessment tool that was feasible for raters to use when assessing videotaped laparoscopic right hemicolectomies. The potential applications for this new tool are widespread, including both training and evaluation of competence at the attending level. See Video Abstract at http://links.lww.com/DCR/A369, http://links.lww.com/DCR/A370, http://links.lww.com/DCR/A371.
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Abstract
OBJECTIVE The goal of this study was to examine regional variation in use of minimally invasive surgical (MIS) operations. SUMMARY BACKGROUND DATA Regional variation exists in performance of surgical operations. Variation in the use of MIS has not been studied. METHODS Five operations that are performed open or MIS were selected: cholecystectomy, appendectomy, colectomy, antireflux, and bariatric. A 3-state database from 2008 to 2011 was used; states were divided into hospital service areas (HSAs). For each operation, the percentage of MIS operations was calculated. HSAs with less than 50% or more than 150% of the MIS average were considered outliers. Population demographics, geography, and hospital and physician presence were compared between HSAs. Rates of performance by patient disease and the presence of MIS surgeons were also investigated. RESULTS MIS cholecystectomy was performed with low variation; MIS appendectomy, antireflux, and bariatric operations with medium variation; and MIS colectomy with high variation. With the exception of MIS colectomy, there were no differences in the patient demographics, geography, or disease types treated with an MIS approach between HSAs with low-, non-, or high utilization of MIS. There is no correlation between the number of MIS surgeons and the percentage of procedures performed MIS. CONCLUSIONS Variation in utilization of MIS exists and differs by operation. Patient demographics, patient disease, and the ability to access care are associated only with variation in use of MIS for colectomy. For all other operations studied, these factors do not explain variation in MIS use. Further investigation is warranted to identify and eliminate causes of variation.
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Damle R, Alavi K. The University Healthsystem Consortium clinical database: An emerging resource in colorectal surgery research. SEMINARS IN COLON AND RECTAL SURGERY 2016. [DOI: 10.1053/j.scrs.2016.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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12
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Gajendran M, Umapathy C, Loganathan P, Hashash JG, Koutroubakis IE, Binion DG. Analysis of Hospital-Based Emergency Department Visits for Inflammatory Bowel Disease in the USA. Dig Dis Sci 2016; 61:389-99. [PMID: 26423080 DOI: 10.1007/s10620-015-3895-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 09/18/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is a chronic, debilitating condition with high emergency department (ED) utilization. We aimed to investigate the utilization patterns of ED by IBD patients and measure hospitalization and surgical rates following ED visits. METHODS We conducted a cross-sectional study of adults with IBD listed as the primary ED diagnosis from the 2009 to 2011 Nationwide Emergency Department Sample. The characteristics of the IBD-related ED visits in relation to following hospitalizations and surgeries were analyzed. RESULTS Adult IBD patients constitute 0.09 % of the total ED visits. Crohn's disease (CD) contributed to 69 % of the IBD-ED visits. The hospitalization rate from ED was 59.9 % nationally, ranging from 56 % in west to 69 % in northeast. The most significant factors associated with hospitalization were intra-abdominal abscess [odds ratio (OR) 24.22], bowel obstruction (OR 17.77), anemia (OR 7.54), malnutrition (OR 6.29), hypovolemia/electrolyte abnormalities (OR 5.57), and fever/abnormal white cell count (OR 3.18). Patients with CD (OR 0.66), low-income group (OR 0.90), and female gender (OR 0.87) have a lower odds of getting hospitalized. Age above 65 years (OR 1.63), CD (OR 1.89), bowel obstruction (OR 9.24), and intra-abdominal abscess (OR 18.41) were significantly associated with surgical intervention. CONCLUSION The IBD-related ED visits have remained relatively stable from 2009 to 2011. The presence of anemia, malnutrition, hypovolemia, electrolyte abnormalities, fever, abnormal white cell count, bowel obstruction, or intra-abdominal abscess during the ED visit was associated with hospitalization. The presence of bowel obstruction and intra-abdominal abscess was strongly associated with surgical intervention.
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Affiliation(s)
- Mahesh Gajendran
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Priyadarshini Loganathan
- Inflammatory Bowel Disease Center, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Mezzanine Level C Wing, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Jana G Hashash
- Inflammatory Bowel Disease Center, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Mezzanine Level C Wing, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Ioannis E Koutroubakis
- Inflammatory Bowel Disease Center, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Mezzanine Level C Wing, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.,Department of Gastroenterology, University Hospital Heraklion, Crete, Greece
| | - David G Binion
- Inflammatory Bowel Disease Center, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Mezzanine Level C Wing, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
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Shaw JJ, Psoinos C, Emhoff TA, Shah SA, Santry HP. Not just full of hot air: hyperbaric oxygen therapy increases survival in cases of necrotizing soft tissue infections. Surg Infect (Larchmt) 2014; 15:328-35. [PMID: 24786980 PMCID: PMC4696431 DOI: 10.1089/sur.2012.135] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The utility of hyperbaric oxygen therapy (HBOT) in the treatment of necrotizing soft tissue infections (NSTIs) has not been proved. Previous studies have been subject to substantial selection bias because HBOT is not available universally at all medical centers, and there is often considerable delay associated with its initiation. We examined the utility of HBOT for the treatment of NSTI in the modern era by isolating centers that have their own HBOT facilities. METHODS We queried all centers in the University Health Consortium (UHC) database from 2008 to 2010 that have their own HBOT facilities (n=14). Cases of NSTI were identified by International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes, which included Fournier gangrene (608.83), necrotizing fasciitis (728.86), and gas gangrene (040.0). Status of HBOT was identified by the presence (HBOT) or absence (control) of ICD-9 procedure code 93.95. Our cohort was risk-stratified and matched by UHC's validated severity of illness (SOI) score. Comparisons were then made using univariate tests of association and multivariable logistic regression. RESULTS There were 1,583 NSTI cases at the 14 HBOT-capable centers. 117 (7%) cases were treated with HBOT. Univariate analysis showed that there was no difference between HBOT and control groups in hospital length of stay, direct cost, complications, and mortality across the three less severe SOI classes (minor, moderate, and major). However, for extreme SOI the HBOT group had fewer complications (45% vs. 66%; p<0.01) and fewer deaths (4% vs. 23%; p<0.01). Multivariable analysis showed that patients who did not receive HBOT were less likely to survive their index hospitalization (odds ratio, 10.6; 95% CI 5.2-25.1). CONCLUSION At HBOT-capable centers, receiving HBOT was associated with a significant survival benefit. Use of HBOT in conjunction with current practices for the treatment of NSTI can be both a cost-effective and life-saving therapy, in particular for the sickest patients.
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Affiliation(s)
- Joshua J. Shaw
- Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
- Center for Outcomes Research and the Surgical Research Scholars Program, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Charles Psoinos
- Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Timothy A. Emhoff
- Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Shimul A. Shah
- Department of Surgery, University of Cincinnati Medical School, Cincinnati, Ohio
| | - Heena P. Santry
- Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
- Center for Outcomes Research and the Surgical Research Scholars Program, University of Massachusetts Medical School, Worcester, Massachusetts
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Kuwabara K, Matsuda S, Fushimi K, Ishikawa KB, Horiguchi H, Fujimori K. Comparative study of functional outcomes of three laparoscopic intestinal surgical procedures. HEALTH POLICY AND TECHNOLOGY 2013. [DOI: 10.1016/j.hlpt.2013.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Impact of operative duration on postoperative pulmonary complications in laparoscopic versus open colectomy. Surg Endosc 2013; 27:3555-63. [PMID: 23584820 DOI: 10.1007/s00464-013-2949-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 03/22/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND Prolonged operative duration is associated with increased postoperative morbidity and mortality. Although laparoscopic colectomy (LC) is associated with longer operative duration compared with open colectomy (OC), research shows paradoxically decreased morbidity following LC versus OC. The direct impact of operative duration on postoperative pulmonary complications (PPC) following LC versus OC has not been analyzed. METHODS We queried the ACS/NSQIP 2009-2010 Public Use File for patients who underwent elective LC and OC. The associations between operative duration and a PPC (pneumonia, intubation >48 h, and unplanned intubation) were evaluated. Multivariable regression models were created to determine the independent effect of operative time on the development of PPC controlling for LC versus OC. RESULTS A total of 25,419 colectomies (13,741 laparoscopic and 11,678 open) were reviewed; 765 (3 %) patients experienced at least one PPC. Regression modeling demonstrated that for both LC and OC each 60-min increase in operative time up to 480 min was associated with 13 % increased odds of PPC [odds ratio (OR) 1.13; 95 % confidence interval (CI) 1.07-1.19]. Beyond 480 min, each additional 60-min interval was associated with 33 % increased risk of PPC (OR 1.33; 95 % CI 1.12-1.58). Overall, PPCs occurred half as often following LC [270 (2 %) laparoscopic vs. 497 (4.3 %) open; OR 0.45; 95 % CI 0.39-0.53]. CONCLUSIONS Operative duration is independently associated with increased risk of PPC in patients undergoing LC and OC. However, a laparoscopic approach carries half the absolute risk of PPC and, when safe, should be preferentially utilized despite a potential for prolonged operative duration.
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Laparoscopic colon resection trends in utilization and rate of conversion to open procedure: a national database review of academic medical centers. Ann Surg 2012; 256:462-8. [PMID: 22868361 DOI: 10.1097/sla.0b013e3182657ec5] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This study aims to examine trends of utilization and rates of conversion to open procedure for patients undergoing laparoscopic colon resections (LCR). METHODS This study is a national database review of academic medical centers and a retrospective analysis utilizing the University HealthSystem Consortium administrative database-an alliance of more than 300 academic and affiliate hospitals. RESULTS A total of 85,712 patients underwent colon resections between October 2008 and December 2011. LCR was attempted in 36,228 patients (42.2%), with 5751 patients (15.8%) requiring conversion to an open procedure. There was a trend toward increasing utilization of LCR from 37.5% in 2008 to 44.1% in 2011. Attempted laparoscopic transverse colectomy had the highest rate of conversion (20.8%), followed by left (20.7%), right (15.6%), and sigmoid (14.3%) colon resections. The rate of utilization was highest in the Mid-Atlantic region (50.5%) and in medium- to large-sized hospitals (47.0%-49.0%).Multivariate logistic regression has shown that increasing age [odds ratio (OR) = 4.8, 95% confidence interval (CI) = 3.6-6.4], male sex (OR = 1.2, 95% CI = 1.1-1.3), open as compared with laparoscopic approach (OR = 2.6, 95%, CI = 2.3-3.1), and greater severity of illness category (OR = 27.1, 95% CI = 23.0-31.9) were all associated with increased mortality and morbidity and prolonged length of hospital stay. CONCLUSIONS There is a trend of increasing utilization of LCR, with acceptable conversion rates, across hospitals in the United States over the recent years. When feasible, attempted LCR had better outcomes than open colectomy in the immediate perioperative period.
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Mortality after Elective Colon Resection: The Search for Outcomes that Define Quality in Surgical Practice. J Am Coll Surg 2012; 214:436-43; discussion 443-4. [DOI: 10.1016/j.jamcollsurg.2011.12.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 12/15/2011] [Indexed: 11/20/2022]
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Webb S, Rubinfeld I, Velanovich V, Horst HM, Reickert C. Using National Surgical Quality Improvement Program (NSQIP) data for risk adjustment to compare Clavien 4 and 5 complications in open and laparoscopic colectomy. Surg Endosc 2011; 26:732-7. [PMID: 22038161 DOI: 10.1007/s00464-011-1944-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 08/31/2011] [Indexed: 12/17/2022]
Abstract
BACKGROUND Laparoscopic colectomy has been associated with fewer postoperative complications than open colectomy. However, it is unclear whether this is true for the most severe complications typically requiring treatment in an intensive care unit (ICU). The authors hypothesized that laparoscopic colectomy patients have fewer of the most severe complications even after adjustment for comorbidity risk. METHODS Using the National Surgical Quality Improvement Program (NSQIP) public use files for 2005-2008, the authors identified all laparoscopic (n = 12,455) and open (n = 33,190) colectomies by current procedural terminology (CPT) code. Using the Clavien classification for postoperative complications, they identified NSQIP data points most consistent with Clavien grade 4 complications requiring ICU care (postoperative septic shock, postoperative dialysis, pulmonary embolism, myocardial infarction, cardiac arrest, prolonged ventilatory requirements, need for reintubation) or grade 5 complication (mortality). Statistical analysis was performed using SPSS software. Odds ratios were calculated to compare laparoscopic and open colectomy regarding the probability of having any Clavien class 4 or 5 complication. Logistic regression was performed to account for the effect of preoperative conditions (American Society of Anesthesiology class, wound class, gender, preoperative functional status, preoperative albumin level, azotemia, thrombocytopenia, emergency case, and age >70 years) on complications. RESULTS The univariate odds ratio showed a 2.27- to 5.52-fold greater likelihood that a patient would have a complication requiring ICU admission if open rather than laparoscopic surgery was performed (p < 0.001). Multivariate logistic regression accounting for preoperative comorbidities that might affect outcome showed persistence of an increase in complications, with an odds ratio range of 1.63 to 2.21. CONCLUSION Evaluation of the NSQIP database demonstrated that laparoscopic colectomy confers an independent protective effect on the frequency of ICU-level (Clavien grade 4) complications and mortality. The protective effect remained evident after correction for preoperative conditions that might have affected outcome.
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Affiliation(s)
- Shawn Webb
- Division of Colon and Rectal Surgery, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA.
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Learning laparoscopic colectomy during colorectal residency: what does it take and how are we doing? Surg Endosc 2011; 26:488-92. [PMID: 21938581 DOI: 10.1007/s00464-011-1906-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Accepted: 04/26/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND The ability to perform a laparoscopic colectomy is an integral part of a young colorectal surgeon's practice. However, the number of resections required during colorectal residency for a surgeon to be very comfortable performing a laparoscopic colectomy independently is poorly defined. Furthermore, the percentage of trainees that achieve this goal also is unknown. METHODS An electronic survey designed by the Young Surgeon's Committee of the American Society of Colon and Rectal Surgeons (ASCRS) was sent to graduates completing Accreditation Council for Graduate Medical Education (ACGME) colorectal residencies after publication of the Clinical Outcomes Study Group (COST) trial (2004-2009). The data collected included the number of laparoscopic right (LR), laparoscopic left (LL), and laparoscopic hand-assisted left (HAL) colectomies performed during residency. Trainees were asked to assess whether at the completion of their fellowship they with each case were very comfortable (VC, would perform a laparoscopic colectomy independently), somewhat comfortable (SC, would require assistance from colleagues), or not comfortable (NC, would not perform a laparoscopic colectomy). RESULTS Of the 176 (51%) former fellows responding to the survey, 42 (24%) reported performing fewer than 10 LRs, 108 (62%) reported 10 to 30 LRs, and 24 (14%) reported more than 30 LRs during their fellowship. With LR, 13 (7.5%) respondents were NC, 42 (21%) were SC, and 119 (68%) were VC. As reported, 58 fellows (33%) performed fewer than 10 LLs, 92 (53%) performed 10-30 LLs, and 22 (13%) performed more than 30 LLs. With LL, 12.2% were NC, 33.7% were SC, and 54.1% were VC. Most of the fellows (90%) who performed 30 or more LR, LL, or HAL colectomies were VC. On the average, each year's graduating fellows were more comfortable with laparoscopic colectomy than those graduating in previous years (P < 0.002). CONCLUSIONS Performing more than 10 LR colectomies and more than 30 LL colectomies provided the vast majority of colorectal residents with the ability to be very comfortable with these procedures as they entered practice. A concerning number of trainees (46% of LL and 24% of LR trainees) did not reach this benchmark. The new general minimal American Board of Colon and Rectal Surgery (ABCRS) requirement of 50 laparoscopic resections seems appropriate but may require definition regarding the side of the procedure.
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Kaltoft B, Gögenur I, Rosenberg J. Reduced length of stay and convalescence in laparoscopic vs open sigmoid resection with traditional care: a double blinded randomized clinical trial. Colorectal Dis 2011; 13:e123-30. [PMID: 21564464 DOI: 10.1111/j.1463-1318.2011.02550.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
AIM The effect of a laparoscopic technique without a multi-modal rehabilitation programme but with traditional postoperative care was studied in a blinded randomized trial regarding nursing time, hospital stay, pain, fatigue, need for sleep and return to normal daily activities. METHOD Eighteen patients with sigmoid cancer were randomly assigned to laparoscopic (n = 10) and open (n = 8) colonic resection in a double blinded trial. Length of hospital stay, fulfillment of discharge criteria, need for nursing care (information given to the patient, physical care and indirect care) and postoperative pain were recorded. Furthermore, the patients filled out a questionnaire regarding fatigue, need for sleep and return to daily activities 14 and 30 days postoperatively. RESULTS The laparoscopic technique reduced length of hospital stay from 7 to 4.5 days (P = 0.006), although both groups met the discharge criteria on the third postoperative day. There were no significant differences in total need for nursing time during hospitalization between the two groups (P = 0.328). The laparoscopic group had less pain 24 hours after operation (P = 0.040), and reported less fatigue and reduced need for sleep during the day 30 days after surgery when compared with open surgery (P = 0.033 and P = 0.036, respectively). Furthermore, the laparoscopic group returned significantly faster to normal daily activities after surgery (P = 0.023). CONCLUSION Laparoscopic surgery per se reduced hospital stay, pain and convalescence compared with open surgery in patients undergoing colonic resection.These effects were obtained without a fast track programme and without an increase in nursing staff on the general surgical ward.
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Affiliation(s)
- B Kaltoft
- Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
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Impact of nutritional support on clinical outcome in patients at nutritional risk: A multicenter, prospective cohort study in Baltimore and Beijing teaching hospitals. Nutrition 2010; 26:1088-93. [DOI: 10.1016/j.nut.2009.08.027] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Accepted: 09/05/2009] [Indexed: 01/10/2023]
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Varela JE, Nguyen NT. Disparities in access to basic laparoscopic surgery at U.S. academic medical centers. Surg Endosc 2010; 25:1209-14. [PMID: 20848139 DOI: 10.1007/s00464-010-1345-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2010] [Accepted: 08/17/2010] [Indexed: 01/10/2023]
Abstract
BACKGROUND Laparoscopy is the standard approach used for basic gastrointestinal procedures such appendectomy and cholecystectomy. This study determined the disparities in access to laparoscopic surgery for these commonly performed procedures at U.S. academic medical centers. METHODS Using appropriate International Classification of Diseases, 9th ed, Clinical Modification (ICD-9-CM) procedure and diagnosis codes, 112,540 basic gastrointestinal procedures were identified from the University HealthSystem Consortium database over a 4-year period (2005-2009). During this period, 82,062 laparoscopic (72.9%) and 30,478 open (27.1%) procedures were performed. The odds ratios (ORs) for laparoscopic versus open procedures were calculated and stratified for age, gender, race/ethnicity, admission status, severity of illness, and primary payer status. RESULTS Univariate analysis showed that young age (OR, 1.33; 95% confidence interval [CI], 1.27-1.39), white race/ethnicity (OR, 1.07; 95% CI, 1.03-1.11), female gender (OR, 1.79; 95% CI, 1.75-1.84), minor severity of illness (OR, 1.49; 95% CI, 1.44-1.53), and commercial/private payer status (OR, 1.25; 95% CI, 1.21-1.29) increased the likelihood that a laparoscopic approach would be used for the procedures studied. CONCLUSION A disparity in access to basic laparoscopic surgery exists at U.S. academic medical centers based on age, gender, race/ethnicity, severity of illness, and primary payer status.
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Affiliation(s)
- J Esteban Varela
- Department of Minimally Invasive and Bariatric Surgery, Washington University School of Medicine, 660 South Euclid Avenue Box 8109, St Louis, MO 63110, USA.
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Abstract
All colorectal operations carry significant associated risk. To facilitate the best outcomes it is essential to perform a comprehensive evaluation of patient risk preoperatively. Once risk factors are identified the appropriate steps must be taken to minimize their effects. The evaluation of the patient can be broken down by organ systems such as cardiac, pulmonary, hepatic, renal, and gastrointestinal. Additionally, one can assess whether the patient is at risk for infection, hyperglycemia, malnutrition, venous thromboembolism, and anemia. There are many preemptive steps that can be taken to improve patient outcomes in all of these categories.
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Affiliation(s)
- David P Parsons
- Department of Colon and Rectal Surgery, Northwest Permanente, PC, Clackamas, OR 97015, USA.
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Kuwabara K, Matsuda S, Fushimi K, Ishikawa KB, Horiguchi H, Fujimori K. Quantitative comparison of the difficulty of performing laparoscopic colectomy at different tumor locations. World J Surg 2010; 34:133-9. [PMID: 20020298 DOI: 10.1007/s00268-009-0292-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Laparoscopic approaches of colectomy for colonic cancer are increasingly surpassing the mainstream open colectomy approach. Impact of disease variables, such as tumor location, has not been adequately measured in quality improvement initiatives. Quantitative analysis concerning the difficulty performing these procedures and differences in postoperative care depending on tumor site will contribute to the development of training programs and to the assessment of quality of care strategies. METHODS A total of 3,765 cases received laparoscopic colectomy (LC). Patient demographics, weighted comorbidities, procedure-related complications, stapling devices, operating room (OR) time, postoperative length of hospital stay (LOS), or total charges (TC) were categorized and compared based on tumor location: cecum to ascending, transverse, descending, and sigmoid colon. Multivariate analyses determined the impact of tumor location on postoperative LOS, TC, OR time, and complications. RESULTS Sigmoid colon was the most frequent tumor placement (40.5%). Significant differences in age, gender, frequency of blood transfusion, use of stapling devices, OR time, and postoperative LOS were observed among tumor locations. Transverse colon was the most significant determinant of postoperative LOS and TC, whereas descending colon tumors correlated with increased OR time. Greater OR time was associated with more postoperative resource use and complications. CONCLUSIONS Tumor location, complications, and OR time affected postoperative resource use, whereas greater OR time signified an increased occurrence of complications. Developers of LC training programs or healthcare policy makers should consider the quantitative impact of tumor locations when attempting to improve effective skill training or to survey the quality of LC performance.
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Affiliation(s)
- Kazuaki Kuwabara
- Department of Health Care Administration and Management, Kyushu University, Graduate School of Medical Sciences, 3-1-1 Maidashi Higashi-ku, Fukuoka, Japan.
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Warrillow SJ, Weinberg L, Parker F, Calzavacca P, Licari E, Aly A, Bagshaw S, Christophi C, Bellomo R. Perioperative Fluid Prescription, Complications and Outcomes in Major Elective Open Gastrointestinal Surgery. Anaesth Intensive Care 2010; 38:259-65. [DOI: 10.1177/0310057x1003800206] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Perioperative fluid therapy and associated outcomes of patients undergoing major elective open gastrointestinal surgery are poorly understood. This study measured perioperative fluid therapy, complication rates and outcomes for major elective open gastrointestinal surgery in a tertiary care hospital. We obtained demographic data, operative details, fluid prescription, complications and outcomes in 100 patients. Patients were elderly and had multiple comorbidities. Median delivered intraoperative fluid volume was 4.2 litres, followed by 6.3 litres over the subsequent 24 hours. Perioperative fluid prescription was associated with a positive fluid balance. Complications occurred in 57% of patients with 32% experiencing at least one major complication. Serious complications were substantially more frequent in patients having non-colorectal operations. The most common adverse events were pulmonary oedema (21%), ileus (18%), serious sepsis (17%), pneumonia (17%), arrhythmias (14%), delirium (14%) and wound healing problems (infections 13%, anastomotic leaks 12%). Mortality at 30 days was 2%. This study provides planning data for future interventional studies.
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Affiliation(s)
- S. J. Warrillow
- Departments of Intensive Care and Anaesthesia, Austin Hospital, Heidelberg, Victoria, Australia
- Consultant Intensivist, Department of Intensive Care
| | - L. Weinberg
- Departments of Intensive Care and Anaesthesia, Austin Hospital, Heidelberg, Victoria, Australia
- Consultant Anaesthetist, Department of Anaesthesia
| | - F. Parker
- Departments of Intensive Care and Anaesthesia, Austin Hospital, Heidelberg, Victoria, Australia
- Consultant Anaesthetist, Department of Anaesthesia
| | - P. Calzavacca
- Departments of Intensive Care and Anaesthesia, Austin Hospital, Heidelberg, Victoria, Australia
- Senior Registrar, Department of Intensive Care
| | - E. Licari
- Departments of Intensive Care and Anaesthesia, Austin Hospital, Heidelberg, Victoria, Australia
- Senior Registrar, Department of Intensive Care
| | - A. Aly
- Departments of Intensive Care and Anaesthesia, Austin Hospital, Heidelberg, Victoria, Australia
- Consultant Surgeon, Department of Surgery
| | - S. Bagshaw
- Departments of Intensive Care and Anaesthesia, Austin Hospital, Heidelberg, Victoria, Australia
- Senior Registrar, Department of Intensive Care
| | - C. Christophi
- Departments of Intensive Care and Anaesthesia, Austin Hospital, Heidelberg, Victoria, Australia
- Surgery, Austin Health
| | - R. Bellomo
- Departments of Intensive Care and Anaesthesia, Austin Hospital, Heidelberg, Victoria, Australia
- Professor and Head of Research, Department of Intensive Care
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Laparoscopic resection for inflammatory bowel disease: outcomes from a nationwide sample. J Gastrointest Surg 2010; 14:58-65. [PMID: 19760371 DOI: 10.1007/s11605-009-1040-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2009] [Accepted: 09/02/2009] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND AIMS A significant proportion of patients with inflammatory bowel diseases (IBD) require surgery. While the majority of these are open procedures (OP), there is recent interest in laparoscopic resection (LS). There are no nationwide comparison of outcomes between LS and OP. METHODS We used data from the Nationwide Inpatient Sample 2004 and identified patients with IBD who underwent ileocolonic/colonic resection using appropriate ICD-9 codes. Procedures were considered to be laparoscopic if they had concomitant codes for laparoscopy (International Classification of Diseases, Ninth edition, clinical modification 54.21/54.51). Multivariate regression was performed to identify independent predictors and outcomes. RESULTS There were 209,206 IBD hospitalizations included in the study among whom, 884 underwent laparoscopic resections (5.3%). On multivariate analysis, fistulizing disease (odds ratio (OR) 0.35, 95% confidence interval (CI) 0.21-0.59) and emergent admission (OR 0.59, 95% CI 0.39-0.90) were negative while annual hospital IBD surgical volume of >50 procedures (OR 2.0, 95% CI 1.14-3.52) were positively associated with LS. LS was associated with a significantly lower proportion of postoperative complications (27.1% vs 35.4%, p < 0.001) and shorter postoperative length of stay compared to OP (-1.9 days, 95% CI -3.2 to -0.6 days). Propensity score adjustment for nonrandom allocation of patients into the treatment groups neutralized the OR for postoperative complication (OR 0.82) but not length of stay (-1.7 days). CONCLUSION LS had no increase in rate of complications and was associated with a shorter postoperative length of stay.
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Balén-Rivera E, Suárez-Alecha J, Herrera-Cabezón J, Vicente-García F, Miranda-Murúa C, Calvo-Benito A, Zazpe-Ripa C, Lera-Tricas JM. Las estancias de formación con expertos mejoran los resultados en cirugía laparoscópica colorrectal. Cir Esp 2010; 87:13-9. [DOI: 10.1016/j.ciresp.2009.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Revised: 05/19/2009] [Accepted: 05/20/2009] [Indexed: 11/26/2022]
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Kuwabara K, Matsuda S, Fushimi K, Ishikawa KB, Horiguchi H, Fujimori K. Impact of hospital case volume on the quality of laparoscopic colectomy in Japan. J Gastrointest Surg 2009; 13:1619-26. [PMID: 19582520 DOI: 10.1007/s11605-009-0956-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Accepted: 06/12/2009] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The increased use of laparoscopic colectomy for colon cancer requires the evaluation of hospital case volume, quality care, and training systems, considering the difficulty of this surgery for various tumor locations. MATERIALS AND METHODS We assessed the quality of this procedure in Japan, based on hospital case volume and tumor location. A total of 3,765 patients were enrolled across 567 hospitals between July and December 2007. We analyzed patient characteristics, postoperative surgical complications, the administration of stapling devices or chemotherapy, hospital volume and teaching status, postoperative length of stay, total charges, and operating room time. Hospitals were classified into four case-volume categories: high (> or =5 cases per month), intermediate to high (3-4), low to intermediate (1-2), and low (<1). Multivariate analysis was used to test the impact of hospital category and tumor location. RESULTS Ten high-volume hospitals performed 401 cases, while 355 low-volume hospitals did 903. Hospital case volume, operating time, and complications affected postoperative stay and total costs. Longer procedural time was an independent predictor of complications. Tumor location, case volume, and teaching status explained the variations in procedural time individually but not complications. Training systems highlighting the applicability of techniques are important to promote the quality of laparoscopic colectomy.
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Affiliation(s)
- Kazuaki Kuwabara
- Department of Health Care Administration and Management, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan.
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Laparoscopic surgery significantly reduces surgical-site infections compared with open surgery. Surg Endosc 2009; 24:270-6. [DOI: 10.1007/s00464-009-0569-1] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Revised: 04/20/2009] [Accepted: 05/14/2009] [Indexed: 11/30/2022]
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