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Walker RJB, Stukel TA, de Mestral C, Nathens A, Breau RH, Hanna WC, Hopkins L, Schlachta CM, Jackson TD, Shayegan B, Pautler SE, Karanicolas PJ. Hospital learning curves for robot-assisted surgeries: a population-based analysis. Surg Endosc 2024; 38:1367-1378. [PMID: 38127120 DOI: 10.1007/s00464-023-10625-6] [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: 09/07/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Robot-assisted surgery has been rapidly adopted. It is important to define the learning curve to inform credentialling requirements, training programs, identify fast and slow learners, and protect patients. This study aimed to characterize the hospital learning curve for common robot-assisted procedures. STUDY DESIGN This cohort study, using administrative health data for Ontario, Canada, included adult patients who underwent a robot-assisted radical prostatectomy (RARP), total robotic hysterectomy (TRH), robot-assisted partial nephrectomy (RAPN), or robotic portal lobectomy using four arms (RPL-4) between 2010 and 2021. The association between cumulative hospital volume of a robot-assisted procedure and major complications was evaluated using multivariable logistic models adjusted for patient characteristics and clustering at the hospital level. RESULTS A total of 6814 patients were included, with 5230, 543, 465, and 576 patients in the RARP, TRH, RAPN, and RPL-4 cohorts, respectively. There was no association between cumulative hospital volume and major complications. Visual inspection of learning curves demonstrated a transient worsening of outcomes followed by subsequent improvements with experience. Operative time decreased for all procedures with increasing volume and reached plateaus after approximately 300 RARPs, 75 TRHs, and 150 RPL-4s. The odds of a prolonged length of stay decreased with increasing volume for patients undergoing a RARP (OR 0.87; 95% CI 0.82-0.92) or RPL-4 (OR 0.77; 95% CI 0.68-0.87). CONCLUSION Hospitals may adopt robot-assisted surgery without significantly increasing the risk of major complications for patients early in the learning curve and with an expectation of increasing efficiency.
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Affiliation(s)
- Richard J B Walker
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
| | - Thérèse A Stukel
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
| | - Charles de Mestral
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Division of Vascular Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Avery Nathens
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Rodney H Breau
- Division of Urology, Department of Surgery, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Waël C Hanna
- Division of Thoracic Surgery, Department of Surgery, McMaster University, Hamilton, Canada
| | - Laura Hopkins
- Division of Oncology, Saskatchewan Cancer Agency, Saskatoon, Canada
| | | | - Timothy D Jackson
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Bobby Shayegan
- Juravinski Cancer Centre, McMaster University, Hamilton, Canada
| | - Stephen E Pautler
- Divisions of Urology and Surgical Oncology, Departments of Surgery and Oncology, Western University, London, Canada
| | - Paul J Karanicolas
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada.
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
- Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada.
- Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room T2 16, Toronto, ON, M4N 3M5, Canada.
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2
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Hallet J, Rousseau M, Gupta V, Hirpara D, Zhao H, Coburn N, Darling G, Kidane B. Long-term Functional Outcomes Among Older Adults Undergoing Video-assisted Versus Open Surgery for Lung Cancer: A Population-based Cohort Study. Ann Surg 2023; 277:e1348-e1354. [PMID: 35129475 DOI: 10.1097/sla.0000000000005387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the long-term healthcare dependency outcomes of older adults undergoing VATS compared to open lung cancer resection. SUMMARY OF BACKGROUND DATA Although the benefits of VATS for lung cancer resection have been reported, there is a knowledge gap related to long-term functional outcomes central to decision-making for older adults. METHODS We conducted a population-based retrospective comparative cohort study of patients ≥70 years old undergoing lung cancer resection between 2010 and 2017 using linked administrative health databases. VATS was compared to open surgery for lung cancer resection. Outcomes were receipt of homecare and high time-at-home, defined as <14 institution-days within 1 year, in 5 years after surgery. We used time-to-event analyses. Homecare was analyzed as recurrent dichotomous outcome with Andersen-Gill multivariable models, and high time-at-home with Cox multivariable models. RESULTS Of 4974 patients, 2951 had VATS (59.3%). In the first three months postoperatively, homecare use ranged from 17.5% to 34.4% for VATS and 23.0% to 36.6% for open surgery. VATS was independently associated with lower need for postoperative homecare over 5 years (hazard ratio 0.82, 95% confidence interval 0.74-0.92). 1- and 5-year probability of high "time-at-home" were superior for VATS (74.4% vs 66.7% and 55.6% vs 45.4%, p < 0.001). VATS was independently associated with higher probability of high "time-at-home" (hazard ratio 0.81, 95% confidence interval 0.74-0.89) compared to open surgery. CONCLUSIONS Compared to open surgery, VATS was associated with lower homecare needs and higher probability of high "time-at-home," indicating reduced long-term functional dependence. Those important patient-centered endpoints reflect the overall long-term treatment burden on mortality and morbidity that can inform surgical decision-making.
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Affiliation(s)
- Julie Hallet
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Surgical Oncology, Odette Cancer Center - Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Mathieu Rousseau
- Department of Thoracic Surgery, Université de Montréal, Montréal, Québec, Canada
| | - Vaibhav Gupta
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Dhruvin Hirpara
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Natalie Coburn
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Surgical Oncology, Odette Cancer Center - Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Gail Darling
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Thoracic Surgery, Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | - Biniam Kidane
- Section of Thoracic Surgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
- Research Institute in Oncology and Hematology, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
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3
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Behman R, Chesney T, Coburn N, Haas B, Bubis L, Zuk V, Ashamalla S, Zhao H, Mahar A, Hallet J. Minimally Invasive Compared to Open Colorectal Cancer Resection for Older Adults: A Population-based Analysis of Long-term Functional Outcomes. Ann Surg 2023; 277:291-298. [PMID: 34417359 DOI: 10.1097/sla.0000000000005151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We sought to compare long-term healthcare dependency and time-at-home between older adults undergoing minimally invasive surgery (MIS) for colorectal cancer (CRC) and those undergoing open resection. BACKGROUND Although the benefits of MIS for CRC resection are established, data specific to older adults are lacking. Long-term functional outcomes, central to decision-making in the care for older adults, are unknown. METHODS We performed a population-based analysis of patients ≥70years old undergoing CRC resection between 2007 to 2017 using administrative datasets. Outcomes were receipt of homecare and "high" time-at-home, which we defined as years with ≤14 institution-days, in the 5years after surgery. Homecare was analyzed using time-to-event analyses as a recurrent dichotomous outcome with Andersen-Gill multivariable models. High timeat-home was assessed using Cox multivariable models. RESULTS Of 16,479 included patients with median follow-up of 4.3 (interquartile range 2.1-7.1) years, 7822 had MIS (47.5%). The MIS group had lower homecare use than the open group with 22.3% versus 31.6% at 6 months and 14.8% versus 19.4% at 1 year [hazard ratio 0.87,95% confidence interval (CI) 0.83-0.92]. The MIS group had higher probability ofhigh time-at-home than open surgery with 54.9% (95% CI 53.6%-56.1%) versus 41.2% (95% CI 40.1%-42.3%) at 5years (hazard ratio 0.71, 95% CI 0.68-0.75). CONCLUSIONS Compared to open surgery, MIS for CRC resection was associated with lower homecare needs and higher probability of high time-at-home in the 5 years after surgery, indicating reduced long-term functional dependence. These are important patient-centered endpoints reflecting the overall long-term treatment burden to be taken into consideration in decision-making.
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Affiliation(s)
- Ramy Behman
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Tyler Chesney
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, Saint Michael's Hospital - Unity Health, Toronto, Ontario, Canada
| | - Natalie Coburn
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada; Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Inter-departmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario; and
| | - Barbara Haas
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada; Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Inter-departmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario; and.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lev Bubis
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Victoria Zuk
- Inter-departmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario; and
| | - Shady Ashamalla
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Haoyu Zhao
- ICES, Toronto, Ontario, Canada; Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Alyson Mahar
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Julie Hallet
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada; Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Inter-departmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario; and
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Effectiveness of Training Workshop on ICD-10 Cancer Coding Guidelines for Clinical Coders. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2022. [DOI: 10.5812/ijcm.116346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: The accurate retrieval of cancer data in health information systems depends on the correct coding and classification of data. Thus, it is essential to provide continuous training for clinical coders and ensure the effectiveness of this training to achieve high-quality data. Objectives: The present study aimed at evaluating the effectiveness of the training workshop on ICD-10 cancer coding guidelines for clinical coders. Methods: The present study was performed to evaluate the effectiveness of coding guidelines training regarding the second chapter of ICD-10 (2016 ed.). Forty-five clinical coders have participated in the study. A researcher-made questionnaire was provided for guidelines data gathering, with the scoring system of Likert (0 to 5 points) at the reaction level, and by and pre-and post-test questionnaires at the learning level. The descriptive statistics were applied on the reaction level and the paired sample t-test was performed on the reaction level data. Results: The results of descriptive statistics revealed that the learners had 84.4% of the average satisfaction with the training courses The paired-samples test indicated that, at the learning level, a significant difference (P = 0.000) existed between the mean pre-and post-test scores. Conclusions: Based on Kirkpatrick’s model, the training program resulted in satisfaction and improved the clinical coders skills regarding cancer coding. It is recommended that health information managers hold effective training courses to enhance the coders’ knowledge and skills.
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Altoijry A, Lindsay TF, Johnston KW, Mamdani M, Al-Omran M. Vascular injury-related in-hospital mortality in Ontario between 1991 and 2009. J Int Med Res 2021; 49:300060520987728. [PMID: 33512260 PMCID: PMC7871087 DOI: 10.1177/0300060520987728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Trauma-related vascular injuries are major contributors to morbidity and mortality worldwide. We conducted a retrospective, population-based, cross-sectional study to examine temporal trends and factors associated with traumatic vascular injury-related in-hospital mortality in Ontario, Canada from 1991 to 2009. METHODS We obtained data on Ontario hospital admissions for traumatic vascular injury, including injury mechanism and body region; and patient age, sex, socioeconomic status, and residence from the Canadian Institute for Health Information Discharge Abstract Database and Registered Persons Database from fiscal years 1991 to 2009. We performed time series analysis of vascular injury-related in-hospital mortality rates and multivariable logistic regression analysis to identify significant mortality-associated factors. RESULTS The overall in-hospital mortality rate for trauma-related vascular injury was 5.5%. A slight but non-significant decline in mortality occurred over time. The likelihood of vascular injury-related in-hospital mortality was significantly higher for patients involved in transport-related accidents (odds ratio [OR[=2.21, 95% confidence interval [CI], 1.76-2.76), age ≥65 years (OR = 4.34, 95% CI, 2.25-8.38), or with thoracic (OR = 2.24, 95% CI, 1.56-3.20) or abdominal (OR = 2.45, 95% CI, 1.75-3.42) injuries. CONCLUSIONS In-hospital mortality from traumatic vascular injury in Ontario was low and stable from 1991 to 2009.
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Affiliation(s)
- Abdulmajeed Altoijry
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Thomas F Lindsay
- Division of Vascular Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - K Wayne Johnston
- Division of Vascular Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Muhammad Mamdani
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Mohammed Al-Omran
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Canada.,Division of Vascular Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
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Hallet J, Jerath A, Turgeon AF, McIsaac DI, Eskander A, Zuckerman J, Zuk V, Sohail S, Darling GE, Dharma C, Coburn NG, Sutradhar R. Association Between Anesthesiologist Volume and Short-term Outcomes in Complex Gastrointestinal Cancer Surgery. JAMA Surg 2021; 156:479-487. [PMID: 33729435 DOI: 10.1001/jamasurg.2021.0135] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Intraoperative anesthesiology care is crucial to high-quality surgical care. The clinical expertise and experience of anesthesiologists may decrease the risk of adverse outcomes. Objective To examine the association between anesthesiologist volume and short-term postoperative outcomes for complex gastrointestinal (GI) cancer surgery. Design, Setting, and Participants This population-based cohort study used administrative health care data sets from various data sources in Ontario, Canada. Adult patients who underwent esophagectomy, pancreatectomy, or hepatectomy for GI cancer from January 1, 2007, to December 31, 2018, were eligible. Patients with an invalid identification number, a duplicate surgery record, and missing primary anesthesiologist information were excluded. Exposures Primary anesthesiologist volume was defined as the annual number of procedures of interest (esophagectomy, pancreatectomy, and hepatectomy) supported by that anesthesiologist in the 2 years before the index surgery. Volume was dichotomized into low-volume and high-volume categories, with 75th percentile or 6 or more procedures per year selected as the cutoff point. Main Outcome and Measures The primary outcome was a composite of 90-day major morbidity (with a Clavien-Dindo classification grade 3-5) and readmission. Secondary outcomes were individual components of the primary outcome. The association between exposure and outcomes was examined using multivariable logistic regression models, accounting for potential confounders. Results Of the 8096 patients included, 5369 were men (66.3%) and the median (interquartile range [IQR]) age was 65 (57-72) years. Operations were supported by 842 anesthesiologists and performed by 186 surgeons, and the median (IQR) anesthesiologist volume was 3 (1.5-6) procedures per year. A total of 2166 patients (26.7%) received care from high-volume anesthesiologists. Primary outcome occurred in 36.3% of patients in the high-volume group and 45.7% of patients in the low-volume group. After adjustment, care by high-volume anesthesiologists was independently associated with lower odds of the primary outcome (adjusted odds ratio [aOR], 0.85; 95% CI, 0.76-0.94), major morbidity (aOR, 0.83; 95% CI, 0.75-0.91), unplanned intensive care unit admission (aOR, 0.84; 95% CI, 0.76-0.94), but not readmission (aOR, 0.87; 95% CI, 0.73-1.05) or mortality (aOR, 1.05; 95% CI, 0.84-1.31). E-values analysis indicated that an unmeasured variable would unlikely substantively change the observed risk estimates. Conclusions and Relevance This study found that, among adults who underwent complex gastrointestinal cancer surgery, those who received care from high-volume anesthesiologists had a lower risk of adverse postoperative outcomes compared with those who received care from low-volume anesthesiologists. These findings support organizing perioperative care to increase anesthesiologist volume to optimize patient outcomes.
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Affiliation(s)
- Julie Hallet
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Measurement, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Angela Jerath
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Measurement, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Alexis F Turgeon
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, Québec, Canada.,CHU de Québec-Université Laval Research Centre, Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Université Laval, Québec City, Québec, Canada
| | - Daniel I McIsaac
- Department of Anesthesiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Antoine Eskander
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Measurement, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology, Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jesse Zuckerman
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Measurement, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Victoria Zuk
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Safa Sohail
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Gail E Darling
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Natalie G Coburn
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Measurement, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Measurement, and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Evans CCD, Li W, Seitz D. Injury-related deaths in the Ontario provincial trauma system: a retrospective population-based cohort analysis. CMAJ Open 2021; 9:E208-E214. [PMID: 33688029 PMCID: PMC8034298 DOI: 10.9778/cmajo.20200209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Although Ontario has an established trauma system, it experiences a substantial burden of morbidity and mortality from injury. Our objective was to describe patterns of fatal injury in Ontario, with a focus on location of death (out of hospital, trauma or non-trauma centre) and receipt of surgical intervention before death. METHODS We conducted a retrospective population-based cohort study using linked administrative data on fatal injuries in children and adults (no age restrictions) in Ontario between 2000 and 2016. We identified injury-related deaths in the Ontario Registrar General Death database. We developed descriptive statistics for injury characteristics and causes of death. We calculated the fatal injury incidence rate for each year of the study. The primary outcome was cause of death; the secondary outcome was receipt of surgical intervention. RESULTS The analysis included 19 408 people. The mean annual incidence of fatal injury averaged 8.7 (95% confidence interval 7.7-9.6) per 100 000. The most common mechanisms of injury were motor vehicle collisions (12 065, 62.2%), followed by gunshot wounds (3134, 16.1%) and falls (2387, 12.3%). Deaths frequently occurred out of hospital (72.6%), rather than at a trauma centre (14.2%) or non-trauma centre (13.2%). Patients treated at trauma centres were significantly more likely to receive a surgical intervention (standardized difference 0.6) than those treated at non-trauma centres. INTERPRETATION Most injury deaths in Ontario occur in the out-of-hospital setting or are managed at non-trauma centres; many patients receive no surgical intervention before death. There are likely opportunities to improve access to specialized injury care in Ontario's trauma system.
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Affiliation(s)
- Christopher C D Evans
- Department of Emergency Medicine (Evans), Queen's University; ICES Queen's (Evans, Li), Kingston, Ont.; Department of Psychiatry (Seitz), University of Calgary, Calgary, Alta.
| | - Wenbin Li
- Department of Emergency Medicine (Evans), Queen's University; ICES Queen's (Evans, Li), Kingston, Ont.; Department of Psychiatry (Seitz), University of Calgary, Calgary, Alta
| | - Dallas Seitz
- Department of Emergency Medicine (Evans), Queen's University; ICES Queen's (Evans, Li), Kingston, Ont.; Department of Psychiatry (Seitz), University of Calgary, Calgary, Alta
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8
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Pregnancy rates and perinatal outcomes in women with systemic lupus erythematosus: data from the Korean national health claims database. Clin Rheumatol 2020; 40:2243-2250. [PMID: 33184707 DOI: 10.1007/s10067-020-05496-4] [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: 06/03/2020] [Revised: 10/31/2020] [Accepted: 11/02/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION/OBJECTIVES The pregnancy rate in systemic lupus erythematosus (SLE) is not fully understood and comparisons of adverse pregnancy outcomes (APOs) with SLE versus the general population are limited. This study aimed to estimate the pregnancy rate and APOs in Korean SLE compared to those without SLE. METHOD Pregnant women were identified using the ICD-10 codes for delivery and abortion in the Korean national health claims database (2013-2015). APOs were classified as fetal loss, intrauterine growth retardation (IUGR), pre-eclampsia/eclampsia, and gestational diabetes. Annual incidence rates (IRs) of pregnancy and APOs were calculated in women with SLE and the general population without SLE and the two groups were compared using age-adjusted incidence rate ratios (IRRs). Age-stratified IRRs were further analyzed. RESULTS The annual IRs of pregnancy in SLE were 29.54-30.70 per 1000 persons. The IRRs were lower in women with SLE than in the general population: 0.68 (0.61-0.76), 0.66 (0.60-0.74), and 0.74 (0.66-0.82) in each respective year. The IRRs of fetal loss, IUGR, and pre-eclampsia/eclampsia were 1.30 (1.14-1.49), 4.65 (3.55-6.09), and 3.43 (2.70-4.36), respectively. However, the IRR of gestational diabetes in SLE did not significantly differ from that of women without SLE. Among the APOs, fetal loss, IUGR, and pre-eclampsia/eclampsia showed decreasing tendencies as age increased. CONCLUSIONS Pregnancy rates in SLE were approximately 30% lower than those in the general population. Except for gestational diabetes, fetal loss, IUGR, and pre-eclampsia/eclampsia were higher in SLE and showed a decreasing tendency with age. Key Points • This population-based cohort study showed that pregnancy rates in SLE were approximately 30% lower than those in the general population. • SLE had a 1.3-fold higher rate of fetal loss, more than 4-fold higher IUGR rate, and more than 3-fold pre-eclampsia or eclampsia rate compared with the general population. • Adverse pregnancy outcomes in SLE showed a decreasing tendency with age.
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9
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Zuckerman J, Coburn N, Callum J, Mahar AL, Zuk V, Lin Y, McLeod R, Turgeon AF, Zhao H, Pearsall E, Martel G, Hallet J. Declining Use of Red Blood Cell Transfusions for Gastrointestinal Cancer Surgery: A Population-Based Analysis. Ann Surg Oncol 2020; 28:29-38. [PMID: 33165719 DOI: 10.1245/s10434-020-09291-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/30/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Gastrointestinal cancer surgery patients often develop perioperative anemia commonly treated with red blood cell (RBC) transfusions. Given the potential associated risks, evidence published over the past 10 years supports restrictive transfusion practices and blood conservation programs. Whether transfusion practices have changed remains unclear. We describe temporal RBC transfusion trends in a large North American population who underwent gastrointestinal cancer surgery. METHODS We conducted a population-based retrospective cohort study of patients who underwent gastrointestinal cancer resection between 2007 and 2018 using health administrative datasets. The outcome was RBC transfusion during hospitalization. Temporal transfusion trends were analyzed with Cochran-Armitage tests. Multivariable regression assessed the association between year of diagnosis and likelihood of RBC transfusion while controlling for confounding. RESULTS Of 79,764 patients undergoing gastrointestinal cancer resection, the median age was 69 years old (interquartile range (IQR) 60-78 years) and 55.5% were male. The most frequent procedures were colectomy (52.8%) and proctectomy (23.0%). A total of 18,175 patients (23%) received RBC transfusion. The proportion of patients transfused decreased from 26.5% in 2007 to 18.9% in 2018 (p < 0.001). After adjusting for patient, procedure, and hospital factors, the most recent time period (2015-2018) was associated with a reduced likelihood of receiving RBC transfusion [relative risk 0.86 (95% confidence interval: 0.83-0.89)] relative to the intermediate time period (2011-2014). CONCLUSION Over 11 years, we observed decreased RBC transfusion use and reduced likelihood of transfusion in patients undergoing gastrointestinal cancer resection. This information provides a foundation to further examine transfusion appropriateness or explore if additional transfusion minimization in surgical patients can be achieved.
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Affiliation(s)
- Jesse Zuckerman
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Natalie Coburn
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.,Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada.,Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada
| | - Jeannie Callum
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Alyson L Mahar
- Department of Community Health Sciences, Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada
| | - Victoria Zuk
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada
| | - Yulia Lin
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Robin McLeod
- Department of Surgery, University of Toronto, Toronto, Canada
| | - Alexis F Turgeon
- CHU de Québec - Université Laval Research Centre, Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), Université Laval, Québec City, Canada.,Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Université Laval, Québec City, Canada
| | | | - Emily Pearsall
- Department of Surgery, University of Toronto, Toronto, Canada
| | | | - Julie Hallet
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada. .,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada. .,Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada. .,Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada.
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Abstract
BACKGROUND Gun injury accounts for substantial acute mortality worldwide and many others survive with lingering disabilities. We investigated whether additional health losses beyond mortality can also arise for patients who survive with long-term disability. METHODS We conducted a population-based individual patient analysis of adults injured by firearms who had received emergency medical care in Ontario, Canada, from Apr. 1, 2002, to Apr. 1, 2019. Longitudinal cohort analyses were evaluated through deterministic linkages of individual electronic patient files. The primary outcome was death or subsequent application for long-term disability in the years after hospital discharge. RESULTS In total, 8313 patients were injured from firearms, of which 3020 were injured from intentional incidents and 5293 were injured from unintentional incidents. A total of 2657 (88.0%) patients with intentional gun injury and 5089 (96.1%) patients with unintentional gun injury survived initial injuries. After a mean 7.75 years of follow-up, patients surviving intentional injuries had a disability rate twice as high as patients surviving unintentional injuries (19.7% v. 10.1%, p < 0.001), equivalent to a hazard ratio of 2.01 (95% confidence interval 1.80-2.25). The higher risk of long-term disability for survivors after intentional gun injury was not explained by demographic characteristics, extended to survivors treated and released from the emergency department, and was observed regardless of whether the incident was self-inflicted or from interpersonal assault. Half of the disability cases were identified after the first year. Additional predictors of long-term disability included a lower socioeconomic status, an urban home location, arrival by ambulance transport, a history of mental illness and a diagnosis of substance use disorder. INTERPRETATION Our study shows that gun death statistics underestimate the extent of health losses from long-term disability, particularly for those with intentional injuries. Additional and sustainable follow-up medical care might improve patient outcomes.
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Affiliation(s)
- Sheharyar Raza
- Department of Medicine (Raza, Redelmeier), University of Toronto; Evaluative Clinical Sciences (Raza, Thiruchelvam, Redelmeier), Sunnybrook Research Institute; ICES in Ontario (Thiruchelvam); Institute of Health Policy, Management and Evaluation (Redelmeier), Toronto, Ont
| | - Deva Thiruchelvam
- Department of Medicine (Raza, Redelmeier), University of Toronto; Evaluative Clinical Sciences (Raza, Thiruchelvam, Redelmeier), Sunnybrook Research Institute; ICES in Ontario (Thiruchelvam); Institute of Health Policy, Management and Evaluation (Redelmeier), Toronto, Ont
| | - Donald A Redelmeier
- Department of Medicine (Raza, Redelmeier), University of Toronto; Evaluative Clinical Sciences (Raza, Thiruchelvam, Redelmeier), Sunnybrook Research Institute; ICES in Ontario (Thiruchelvam); Institute of Health Policy, Management and Evaluation (Redelmeier), Toronto, Ont.
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11
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Fung BSC, Behman R, Nguyen MA, Nathens AB, Look Hong NJ, Pechlivanoglou P, Karanicolas PJ. Longer Trials of Non-operative Management for Adhesive Small Bowel Obstruction Are Associated with Increased Complications. J Gastrointest Surg 2020; 24:890-898. [PMID: 31062274 DOI: 10.1007/s11605-019-04156-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 02/05/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Current guidelines for the management of adhesive small bowel obstruction suggest a limited trial of non-operative management, often of 3-5 days. A longer delay to operation may worsen post-operative outcomes in patients who ultimately require operation. Our objective was to evaluate the impact of time to operation on post-operative outcomes in patients who undergo operation following a trial of non-operative management for adhesive small bowel obstruction. METHODS We used health administrative data to identify patients with adhesive small bowel obstruction who underwent operative management following a trial of non-operative management from 2005 to 2014 in the province of Ontario, Canada. We used multivariable logistic regression to examine the relationship between the time from admission to operation with rates of 30-day mortality, serious complication, and bowel resection. RESULTS Three thousand five hundred sixty-three patients underwent operation after a trial of non-operative management for adhesive small bowel obstruction. Older patients, patients with a high comorbidity burden, and patients with a lower socioeconomic status were more likely to experience a longer pre-operative period. After adjusting for covariates, each additional day from admission to operation increased odds of serious complication (OR = 1.07, 95% CI = 1.03-1.11) and bowel resection (OR = 1.06, 95% CI = 1.03-1.98). Longer times to operation were not associated with greater adjusted odds of 30-day mortality. CONCLUSION Each additional day from admission to operation is associated with greater odds of adverse outcomes. Clinical practice guidelines should emphasize strategies that identify patients who will ultimately require operation.
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Affiliation(s)
- Benjamin S C Fung
- Division of General Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, T2-016, Toronto, ON, M4N3M5, Canada
| | - Ramy Behman
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - May-Anh Nguyen
- Division of General Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, T2-016, Toronto, ON, M4N3M5, Canada
| | - Avery B Nathens
- Division of General Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, T2-016, Toronto, ON, M4N3M5, Canada
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Nicole J Look Hong
- Division of General Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, T2-016, Toronto, ON, M4N3M5, Canada
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Petros Pechlivanoglou
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Paul J Karanicolas
- Division of General Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, T2-016, Toronto, ON, M4N3M5, Canada.
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
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12
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Behman R, Nathens AB, Mason S, Byrne JP, Hong NL, Pechlivanoglou P, Karanicolas P. Association of Surgical Intervention for Adhesive Small-Bowel Obstruction With the Risk of Recurrence. JAMA Surg 2020; 154:413-420. [PMID: 30698610 DOI: 10.1001/jamasurg.2018.5248] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance Adhesive small-bowel obstruction (aSBO) is a potentially chronic, recurring surgical illness. Although guidelines suggest trials of nonoperative management, the long-term association of this approach with recurrence is poorly understood. Objective To compare the incidence of recurrence of aSBO in patients undergoing operative management at their first admission compared with nonoperative management. Design, Setting, and Participants This longitudinal, propensity-matched, retrospective cohort study used health administrative data for the province of Ontario, Canada, for patients treated from April 1, 2005, through March 31, 2014. The study population included adults aged 18 to 80 years who were admitted for their first episode of aSBO. Patients with nonadhesive causes of SBO were excluded. A total of 27 904 patients were included and matched 1:1 by their propensity to undergo surgery. Factors used to calculate propensity included patient age, sex, comorbidity burden, socioeconomic status, and rurality of home residence. Data were analyzed from September 10, 2017, through October 4, 2018. Exposures Operative vs nonoperative management for aSBO. Main Outcomes and Measures The primary outcome was the rate of recurrence of aSBO among those with operative vs nonoperative management. Time-to-event analyses were used to estimate hazard ratios of recurrence while accounting for the competing risk of death. Results Of 27 904 patients admitted with their first episode of aSBO, 6186 (22.2%) underwent operative management. Mean (SD) patient age was 61.2 (13.6) years, and 51.1% (14 228 of 27 904) were female. Patients undergoing operative management were younger (mean [SD] age, 60.2 [14.3] vs 61.5 [13.4] years) with fewer comorbidities (low burden, 382 [6.2%] vs 912 [4.2%]). After matching, those with operative management had a lower risk of recurrence (13.0% vs 21.3%; hazard ratio, 0.62; 95% CI, 0.56-0.68; P < .001). The 5-year probability of experiencing another recurrence increased with each episode until surgical intervention, at which point the risk of subsequent recurrence decreased by approximately 50%. Conclusions and Relevance According to this study, operative management of the first episode of aSBO is associated with significantly reduced risk of recurrence. Guidelines advocating trials of nonoperative management for aSBO may assume that surgery increases the risk of recurrence putatively through the formation of additional adhesions. The long-term risk of recurrence of aSBO should be considered in the management of this patient population.
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Affiliation(s)
- Ramy Behman
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Avery B Nathens
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Mason
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - James P Byrne
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Nicole Look Hong
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Petros Pechlivanoglou
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Paul Karanicolas
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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13
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Surgery for adhesive small-bowel obstruction is associated with improved long-term survival mediated through recurrence prevention: A population-based, propensity-matched analysis. J Trauma Acute Care Surg 2020; 87:636-644. [PMID: 31095068 DOI: 10.1097/ta.0000000000002366] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Adhesive small-bowel obstruction (aSBO) is among the most common reasons for admission to a surgical service. While operative intervention for aSBO is associated with a lower risk of recurrence, current guidelines continue to advocate a trial of nonoperative management. The impact of the increased risk for recurrence on long-term survival is unknown. We sought to explore the potential for improved survival with operative management through the prevention of admissions for recurrence of aSBO and the associated risks. METHODS This is a population-based retrospective cohort study using administrative data. We identified patients admitted to hospital for their first episode of aSBO from 2005 to 2014 and created a propensity-matched cohort to compare survival of patients managed operatively with those managed nonoperatively. To test whether survival differences were mediated by recurrence prevention, a competing risk regression was used to model the subdistribution hazard of death when accounting for the risk of recurrence. An instrumental variable approach was used as a secondary analysis to compare survival while accounting for unmeasured confounding. RESULTS There were 27,904 patients admitted for their first episode of aSBO between 2005 and 2014. The mean age was 61.2 years (std dev, 13.6), and 51% were female. Operative management was associated with a significantly lower risk of death (hazard ratio, 0.80; 95% confidence interval, 0.75-0.86), which was robust to instrumental variable analyses, and a lower risk of recurrence (hazard ratio, 0.59; 95% confidence interval, 0.54-0.65). When adjusting for the risk of recurrence, operative intervention was not associated with improved survival, suggesting that the survival benefit is mediated through prevention of recurrences of aSBO. CONCLUSION In patients admitted for their first episode of aSBO, operative intervention is associated with a significant long-term survival benefit. This survival benefit appears to be mediated through the prevention of recurrences of aSBO. STUDY TYPE Retrospective cohort study. LEVEL OF EVIDENCE Therapeutic study, Level II.
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14
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Kreutzburg T, Peters F, Rieß HC, Hischke S, Marschall U, Kriston L, L'Hoest H, Sedrakyan A, Debus ES, Behrendt CA. Editor's Choice – Comorbidity Patterns Among Patients with Peripheral Arterial Occlusive Disease in Germany: A Trend Analysis of Health Insurance Claims Data. Eur J Vasc Endovasc Surg 2020; 59:59-66. [DOI: 10.1016/j.ejvs.2019.08.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 08/06/2019] [Accepted: 08/11/2019] [Indexed: 02/06/2023]
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15
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Hospital-level Variation in the Management and Outcomes of Patients With Adhesive Small Bowel Obstruction. Ann Surg 2019; 274:e1063-e1070. [DOI: 10.1097/sla.0000000000003739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Behman R, Nathens AB, Haas B, Look Hong N, Pechlivanoglou P, Karanicolas P. Population-based study of the impact of small bowel obstruction due to adhesions on short- and medium-term mortality. Br J Surg 2019; 106:1847-1854. [PMID: 31397896 DOI: 10.1002/bjs.11284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/20/2019] [Accepted: 05/23/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND Small bowel obstruction due to adhesions (aSBO) is a common indication for admission to a surgical unit. Despite the prevalence of this condition, the short- and medium-term survival of this patient population has not been well described. The purpose of this study was to measure the short- and medium-term survival of patients admitted to hospital with aSBO. METHODS Linked administrative data were used to identify patients admitted to hospital in Ontario, Canada, for aSBO between 2005 and 2011. Patients were divided into two groups: those aged less than 65 years (younger group) and those aged 65 years and older (older group). Thirty-day, 90-day and 1-year mortality rates were estimated. One-year mortality was compared with that in the general population, adjusting for age and sex. The timing of deaths in relation to admission was assessed, as well as the proportion of patients discharged before experiencing short-term mortality. RESULTS There were 22 197 patients admitted to hospital for aSBO for the first time in the study interval. Mean age was 64·5 years and 52·2 per cent of the patients were women. Overall, the 30-day, 90-day and 1-year mortality rates for the cohort were 5·7 (95 per cent c.i. 5·4 to 6·0), 8·7 (8·3 to 9·0) and 13·9 (13·4 to 14·3) per cent respectively. For both groups, the 1-year risk of death was significantly greater than that of the age-matched general population. The majority of deaths (62·5 per cent) occurred within 90 days of admission, with 36·4 per cent occurring after discharge from the aSBO admission. CONCLUSION Patients admitted with aSBO have a high short-term mortality rate. Increased monitoring of patients in the early period after admission is advisable.
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Affiliation(s)
- R Behman
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - A B Nathens
- 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.,Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - B Haas
- 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.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - N Look Hong
- 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.,Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - P Pechlivanoglou
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
| | - P Karanicolas
- 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.,Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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17
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Evolving Management Strategies in Patients with Adhesive Small Bowel Obstruction: a Population-Based Analysis. J Gastrointest Surg 2018; 22:2133-2141. [PMID: 30051307 DOI: 10.1007/s11605-018-3881-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 07/10/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND In patients with adhesive small bowel obstruction (aSBO), the decision to operate as well as the timing and technique of surgery have significant impacts on clinical outcomes. Trends in the management of aSBO have not been described at the population level and guideline adherence is unknown. We sought to evaluate the secular trends in the management of aSBO in a large North American population. METHODS We used administrative data to identify patients admitted to hospital for their first episode of aSBO over 2005-2014. We evaluated temporal trends in admission for aSBO and in management practices using Cochran-Armitage tests. Multivariable logistic regressions were used to assess trends when controlling for potential confounders. RESULTS Patients (40,800) were admitted with their first episode of aSBO. The mean age was 68.5 years and 55% of patients were female. The population-based rate of admission for aSBO decreased over the study period, from 39.1 to 38.1 per 100,000 persons per year. There was a significant increase in the proportion of patients who underwent surgery for aSBO (19 to 23%, p < 0.0001). Among those who underwent surgery, there were significant increases in the proportions of patients who underwent laparoscopic procedures (4 to 14%, p < 0.0001) and who underwent surgery within 1 day of admission (51 to 60%, p < 0.0001). CONCLUSION Between 2005 and 2014, there was a decrease in the population-based rate of aSBO, which may reflect increased utilization of minimally invasive techniques. There were significant trends towards increased operative intervention, with surgery occurring earlier and increasingly using laparoscopic approach.
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18
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The Strengths and Limitations of Claims Based Research in Countries With Fee for Service Reimbursement. Eur J Vasc Endovasc Surg 2018; 56:615-616. [DOI: 10.1016/j.ejvs.2018.06.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 06/01/2018] [Indexed: 11/15/2022]
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19
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Bubis LD, Davis L, Mahar A, Barbera L, Li Q, Moody L, Karanicolas P, Sutradhar R, Coburn NG. Symptom Burden in the First Year After Cancer Diagnosis: An Analysis of Patient-Reported Outcomes. J Clin Oncol 2018; 36:1103-1111. [DOI: 10.1200/jco.2017.76.0876] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Purpose Improvement in the quality of life of patients with cancer requires attention to symptom burden across the continuum of care, with the use of patient-reported outcomes key to achieving optimal care. Yet there have been few studies that have examined symptoms in the early postdiagnosis period during which suboptimal symptom control may be common. A comprehensive analysis of temporal trends and risk factors for symptom burden in newly diagnosed patients with cancer is essential to guide supportive care strategies. Methods A retrospective observational study was performed of patients who were diagnosed with cancer between January 2007 and December 2014 and who survived at least 1 year. Patient-reported Edmonton Symptom Assessment System scores, which are prospectively collected at outpatient visits, were linked to provincial administrative health care data. We described the proportion of patients who reported moderate-to-severe symptom scores by month during the first year after diagnosis according to disease site. Multivariable logistic regression models were constructed to identify risk factors for moderate-to-severe symptom scores. Results Of 120,745 patients, 729,861 symptom assessments were recorded within 12 months of diagnosis. For most symptoms, odds of elevated scores were highest in the first month, whereas nausea had increased odds of elevated scores up to 6 months after diagnosis. On multivariable analysis, cancer site, younger age, higher comorbidity, female sex, lower income, and urban residence were associated with significantly higher odds of elevated symptom burden. Conclusion A high prevalence of moderate-to-severe symptom scores was observed in cancers of all sites. Patients are at risk of experiencing multiple symptoms in the immediate postdiagnosis period, which underscores the need to address supportive care requirements early in the cancer journey. Patient subgroups who are at higher risk of experiencing moderate-to-severe symptoms should be targeted for tailored supportive care interventions.
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Affiliation(s)
- Lev D. Bubis
- Lev D. Bubis, Lisa Barbera, Lesley Moody, Paul Karanicolas, Rinku Sutradhar, and Natalie G. Coburn, University of Toronto; Laura Davis, Alyson Mahar, Paul Karanicolas, and Natalie G. Coburn, Sunnybrook Health Sciences Centre; Lisa Barbera, Qing Li, and Rinku Sutradhar and Natalie G. Coburn, Institute for Clinical Evaluative Sciences; Lisa Barbera and Lesley Moody, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Laura Davis
- Lev D. Bubis, Lisa Barbera, Lesley Moody, Paul Karanicolas, Rinku Sutradhar, and Natalie G. Coburn, University of Toronto; Laura Davis, Alyson Mahar, Paul Karanicolas, and Natalie G. Coburn, Sunnybrook Health Sciences Centre; Lisa Barbera, Qing Li, and Rinku Sutradhar and Natalie G. Coburn, Institute for Clinical Evaluative Sciences; Lisa Barbera and Lesley Moody, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Alyson Mahar
- Lev D. Bubis, Lisa Barbera, Lesley Moody, Paul Karanicolas, Rinku Sutradhar, and Natalie G. Coburn, University of Toronto; Laura Davis, Alyson Mahar, Paul Karanicolas, and Natalie G. Coburn, Sunnybrook Health Sciences Centre; Lisa Barbera, Qing Li, and Rinku Sutradhar and Natalie G. Coburn, Institute for Clinical Evaluative Sciences; Lisa Barbera and Lesley Moody, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Lisa Barbera
- Lev D. Bubis, Lisa Barbera, Lesley Moody, Paul Karanicolas, Rinku Sutradhar, and Natalie G. Coburn, University of Toronto; Laura Davis, Alyson Mahar, Paul Karanicolas, and Natalie G. Coburn, Sunnybrook Health Sciences Centre; Lisa Barbera, Qing Li, and Rinku Sutradhar and Natalie G. Coburn, Institute for Clinical Evaluative Sciences; Lisa Barbera and Lesley Moody, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Qing Li
- Lev D. Bubis, Lisa Barbera, Lesley Moody, Paul Karanicolas, Rinku Sutradhar, and Natalie G. Coburn, University of Toronto; Laura Davis, Alyson Mahar, Paul Karanicolas, and Natalie G. Coburn, Sunnybrook Health Sciences Centre; Lisa Barbera, Qing Li, and Rinku Sutradhar and Natalie G. Coburn, Institute for Clinical Evaluative Sciences; Lisa Barbera and Lesley Moody, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Lesley Moody
- Lev D. Bubis, Lisa Barbera, Lesley Moody, Paul Karanicolas, Rinku Sutradhar, and Natalie G. Coburn, University of Toronto; Laura Davis, Alyson Mahar, Paul Karanicolas, and Natalie G. Coburn, Sunnybrook Health Sciences Centre; Lisa Barbera, Qing Li, and Rinku Sutradhar and Natalie G. Coburn, Institute for Clinical Evaluative Sciences; Lisa Barbera and Lesley Moody, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Paul Karanicolas
- Lev D. Bubis, Lisa Barbera, Lesley Moody, Paul Karanicolas, Rinku Sutradhar, and Natalie G. Coburn, University of Toronto; Laura Davis, Alyson Mahar, Paul Karanicolas, and Natalie G. Coburn, Sunnybrook Health Sciences Centre; Lisa Barbera, Qing Li, and Rinku Sutradhar and Natalie G. Coburn, Institute for Clinical Evaluative Sciences; Lisa Barbera and Lesley Moody, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Rinku Sutradhar
- Lev D. Bubis, Lisa Barbera, Lesley Moody, Paul Karanicolas, Rinku Sutradhar, and Natalie G. Coburn, University of Toronto; Laura Davis, Alyson Mahar, Paul Karanicolas, and Natalie G. Coburn, Sunnybrook Health Sciences Centre; Lisa Barbera, Qing Li, and Rinku Sutradhar and Natalie G. Coburn, Institute for Clinical Evaluative Sciences; Lisa Barbera and Lesley Moody, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Natalie G. Coburn
- Lev D. Bubis, Lisa Barbera, Lesley Moody, Paul Karanicolas, Rinku Sutradhar, and Natalie G. Coburn, University of Toronto; Laura Davis, Alyson Mahar, Paul Karanicolas, and Natalie G. Coburn, Sunnybrook Health Sciences Centre; Lisa Barbera, Qing Li, and Rinku Sutradhar and Natalie G. Coburn, Institute for Clinical Evaluative Sciences; Lisa Barbera and Lesley Moody, Cancer Care Ontario, Toronto, Ontario, Canada
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20
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Laparoscopic Surgery for Adhesive Small Bowel Obstruction Is Associated With a Higher Risk of Bowel Injury. Ann Surg 2017; 266:489-498. [DOI: 10.1097/sla.0000000000002369] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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21
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Altoijry A, Al-Omran M, Johnston KW, Mamdani M, Lindsay TF. Temporal trends in vascular trauma in Ontario, 1991-2009: a population-based study. CMAJ Open 2016; 4:E309-15. [PMID: 27398379 PMCID: PMC4933644 DOI: 10.9778/cmajo.20150046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Vascular injuries add substantial complexity to trauma care, yet Canadian epidemiologic data on such injuries are not readily available. We conducted a retrospective cross-sectional study to examine temporal trends in the rate of hospital admissions for vascular injuries from 1991 to 2009 in Ontario. METHODS Individuals of any age admitted to hospital because of vascular trauma in Ontario were included. Details of vascular injury and patient demographic characteristics were recorded, hospital admission rates estimated and analyses stratified by sex, age, mechanism of injury, economic status and geographic location. Time-series analysis was used to examine trends in hospital admission rates. RESULTS Of the 8252 hospital admissions for vascular trauma, 4287 (52.0%) involved injuries to the upper limb and 1819 (22.0%) were due to transport-related causes. Overall, the annual rate declined significantly over time, from 3.3 per 100 000 in 1991 to 2.7 per 100 000 in 2009 (p < 0.01). The subgroups with the highest rates were young men, patients with a low economic status and those living in a rural location. Declines occurred in both sexes and in all age groups except those 65 years and older. The rates of vascular injury to the neck, thorax, upper limbs and lower limbs declined over time, but not the rate of abdominal vascular injury. Although the rate of non-transport-related vascular injuries declined, the rate of transport-related vascular injuries did not change significantly over time. Decreases in annual rates occurred in both low- and high-economic status groups and in urban populations but not in rural populations. INTERPRETATION Overall, the annual rate of hospital admissions for vascular trauma declined significantly in Ontario over the study period. Our findings have important implications for public health and the development of injury-prevention strategies, particularly for population subgroups at high risk of vascular injury.
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Affiliation(s)
- Abdulmajeed Altoijry
- Li Ka Shing Knowledge Institute (Altoijry, Mamdani), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Division of Vascular Surgery (Altoijry, Al-Omran), Department of Surgery, King Saud University, Riyadh, Saudi Arabia; Division of Vascular Surgery (Al-Omran), St. Michael's Hospital; Division of Vascular Surgery (Johnston, Lindsay), Toronto General Hospital, University of Toronto, Toronto, Ont
| | - Mohammed Al-Omran
- Li Ka Shing Knowledge Institute (Altoijry, Mamdani), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Division of Vascular Surgery (Altoijry, Al-Omran), Department of Surgery, King Saud University, Riyadh, Saudi Arabia; Division of Vascular Surgery (Al-Omran), St. Michael's Hospital; Division of Vascular Surgery (Johnston, Lindsay), Toronto General Hospital, University of Toronto, Toronto, Ont
| | - K Wayne Johnston
- Li Ka Shing Knowledge Institute (Altoijry, Mamdani), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Division of Vascular Surgery (Altoijry, Al-Omran), Department of Surgery, King Saud University, Riyadh, Saudi Arabia; Division of Vascular Surgery (Al-Omran), St. Michael's Hospital; Division of Vascular Surgery (Johnston, Lindsay), Toronto General Hospital, University of Toronto, Toronto, Ont
| | - Muhammad Mamdani
- Li Ka Shing Knowledge Institute (Altoijry, Mamdani), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Division of Vascular Surgery (Altoijry, Al-Omran), Department of Surgery, King Saud University, Riyadh, Saudi Arabia; Division of Vascular Surgery (Al-Omran), St. Michael's Hospital; Division of Vascular Surgery (Johnston, Lindsay), Toronto General Hospital, University of Toronto, Toronto, Ont
| | - Thomas F Lindsay
- Li Ka Shing Knowledge Institute (Altoijry, Mamdani), St. Michael's Hospital, University of Toronto, Toronto, Ont.; Division of Vascular Surgery (Altoijry, Al-Omran), Department of Surgery, King Saud University, Riyadh, Saudi Arabia; Division of Vascular Surgery (Al-Omran), St. Michael's Hospital; Division of Vascular Surgery (Johnston, Lindsay), Toronto General Hospital, University of Toronto, Toronto, Ont
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