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White B, Naffouje S, Grunvald M, Bhama A, Dahdaleh F. Effect of prolonged operative time on short-term outcomes of open vs minimally invasive proctectomy. J Gastrointest Surg 2024; 28:141-150. [PMID: 38445935 DOI: 10.1016/j.gassur.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/19/2023] [Accepted: 11/30/2023] [Indexed: 03/07/2024]
Abstract
BACKGROUND Minimally invasive proctectomy (MIP) may offer advantages over open proctectomy (OP). Increased operative times (OTs) are linked to inferior outcomes for various operations; however, the interplay between OT and approach for proctectomy is not well-established. This study aimed to evaluate associations of increasing OT on 30-day morbidity in OP and MIP cohorts. METHODS The American College of Surgeons National Quality Improvement Program Targeted Proctectomy Dataset was used to identify patients undergoing proctectomy. Cases were stratified by open or minimally invasive surgical approach and following propensity score matching between the groups, and OT quartiles were established for each group. Perioperative outcomes were compared among quartiles, and multivariate regression was used to identify factors associated with prolonged OT. RESULTS The median OT was longer for MIP (271 vs 232 min; P < .01). Although increased OT was associated with higher overall morbidity for both open and minimally invasive approaches, this effect was more pronounced in OP than in MIP (63.2% vs 38.4%, respectively; P < .001). Factors associated with prolonged OT included the procedure performed, male sex, higher body mass index scores, diverting ileostomy, and, in malignant disease, mid or lower and T4 tumors (all P < .05). CONCLUSION Herein, prolonged OT was associated with worse short-term outcomes for both OP and MIP cases; however, its detrimental effect was more pronounced for open surgery than for minimally invasive surgery. Our data suggested that MIP may offer short-term advantages for demanding cases requiring longer OTs.
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Affiliation(s)
- Bradley White
- Department of Surgery, University of Illinois Chicago, Chicago, Illinois, United States
| | - Samer Naffouje
- Department of Surgery, Cleveland Clinic, Cleveland, Ohio, United States
| | - Miles Grunvald
- Department of Surgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Anurhada Bhama
- Department of Surgery, Cleveland Clinic, Cleveland, Ohio, United States
| | - Fadi Dahdaleh
- Department of Surgical Oncology, Edward-Elmhurst Health, Naperville, Illinois, United States.
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Unruh KR, Bastawrous AL, Kanneganti S, Kaplan JA, Moonka R, Rashidi L, Sillah A, Simianu VV. The Impact of Prolonged Operative Time Associated With Minimally Invasive Colorectal Surgery: A Report From the Surgical Care Outcomes Assessment Program. Dis Colon Rectum 2024; 67:302-312. [PMID: 37878484 DOI: 10.1097/dcr.0000000000002925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
BACKGROUND Increased operative time in colorectal surgery is associated with worse surgical outcomes. Laparoscopic and robotic operations have improved outcomes, despite longer operative times. Furthermore, the definition of "prolonged" operative time has not been consistently defined. OBJECTIVE The first objective was to define prolonged operative time across multiple colorectal operations and surgical approaches. The second was to describe the impact of prolonged operative time on length of stay and short-term outcomes. DESIGN A retrospective cohort study. SETTING Forty-two hospitals in the Surgical Care Outcomes Assessment Program from 2011 to 2019. PATIENTS There were a total of 23,098 adult patients (age 18 years or older) undergoing 6 common, elective colorectal operations: right colectomy, left/sigmoid colectomy, total colectomy, low anterior resection, IPAA, or abdominoperineal resection. MAIN OUTCOME MEASURES Prolonged operative time defined as the 75th quartile of operative times for each operation and approach. Outcomes were length of stay, discharge home, and complications. Adjusted models were used to account for factors that could impact operative time and outcomes across the strata of open and minimally invasive approaches. RESULTS Prolonged operative time was associated with longer median length of stay (7 vs 5 days open, 5 vs 4 days laparoscopic, 4 vs 3 days robotic) and more frequent complications (42% vs 28% open, 24% vs 17% laparoscopic, 27% vs 13% robotic) but similar discharge home (86% vs 87% open, 94% vs 94% laparoscopic, 93% vs 96% robotic). After adjustment, each additional hour of operative time above the median for a given operation was associated with 1.08 (1.06-1.09) relative risk of longer length of stay for open operations and 1.07 (1.06-1.09) relative risk for minimally invasive operations. LIMITATIONS Our study was limited by being retrospective, resulting in selection bias, possible confounders for prolonged operative time, and lack of statistical power for subgroup analyses. CONCLUSIONS Operative time has consistent overlap across surgical approaches. Prolonged operative time is associated with longer length of stay and higher probability of complications, but this negative effect is diminished with minimally invasive approaches. See Video Abstract . EL IMPACTO DEL TIEMPO OPERATORIO PROLONGADO ASOCIADO CON LA CIRUGA COLORRECTAL MNIMAMENTE INVASIVA UN INFORME DEL PROGRAMA DE EVALUACIN DE RESULTADOS DE ATENCIN QUIRRGICA ANTECEDENTES:El aumento del tiempo operatorio en la cirugía colorrectal se asocia con peores resultados quirúrgicos. Las operaciones laparoscópicas y robóticas han mejorado los resultados, a pesar de los tiempos operatorios más prolongados. Además, la definición de tiempo operatorio "prolongado" no se ha definido de manera consistente.OBJETIVO:Primero, definir el tiempo operatorio prolongado a través de múltiples operaciones colorrectales y enfoques quirúrgicos. En segundo lugar, describir el impacto del tiempo operatorio prolongado sobre la duración de la estancia y los resultados a corto plazo.DISEÑO:Estudio de cohorte retrospectivo.ESCENARIO:42 hospitales en el Programa de Evaluación de Resultados de Atención Quirúrgica de 2011-2019.PACIENTES:23 098 pacientes adultos (de 18 años de edad y mayores), que se sometieron a seis operaciones colorrectales electivas comunes: colectomía derecha, colectomía izquierda/sigmoidea, colectomía total, resección anterior baja, anastomosis ileoanal con bolsa o resección abdominoperineal.PRINCIPALES MEDIDAS DE RESULTADO:Tiempo operatorio prolongado definido como el cuartil 75 de tiempos operatorios para cada operación y abordaje. Los resultados fueron la duración de la estancia hospitalaria, el alta domiciliaria y las complicaciones. Se usaron modelos ajustados para tener en cuenta los factores que podrían afectar tanto el tiempo operatorio como los resultados en los estratos de abordajes abiertos y mínimamente invasivos.RESULTADOS:El tiempo operatorio prolongado se asoció con una estancia media más prolongada (7 vs. 5 días abiertos, 5 vs. 4 días laparoscópicos, 4 vs. 3 días robóticos), complicaciones más frecuentes (42 % vs. 28 % abiertos, 24 % vs. 17 % laparoscópica, 27% vs. 13% robótica), pero similar alta domiciliaria (86% vs. 87% abierta, 94% vs. 94% laparoscópica, 93% vs. 96% robótica). Después del ajuste, cada hora adicional de tiempo operatorio por encima de la mediana para una operación determinada se asoció con un riesgo relativo de 1,08 (1,06, 1,09) de estancia hospitalaria más larga para operaciones abiertas y un riesgo relativo de 1,07 (1,06, 1,09) para operaciones mínimamente invasivas.LIMITACIONES:Nuestro estudio estuvo limitado por ser retrospectivo, lo que resultó en un sesgo de selección, posibles factores de confusión por un tiempo operatorio prolongado y falta de poder estadístico para los análisis de subgrupos.CONCLUSIONES:El tiempo operatorio tiene una superposición constante entre los enfoques quirúrgicos. El tiempo operatorio prolongado se asocia con una estadía más prolongada y una mayor probabilidad de complicaciones, pero este efecto negativo disminuye con los enfoques mínimamente invasivos. ( Traducción-Dr. Mauricio Santamaria ).
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Affiliation(s)
- Kenley R Unruh
- Department of Surgery, Virginia Mason Franciscan Health, Seattle, Washington
| | - Amir L Bastawrous
- Swedish Cancer Institute, Swedish Medical Center, Seattle, Washington
| | - Shalini Kanneganti
- Franciscan Surgical Associates at St Joseph Hospital, Tacoma, Washington
| | - Jennifer A Kaplan
- Department of Surgery, Virginia Mason Franciscan Health, Seattle, Washington
| | - Ravi Moonka
- Department of Surgery, Virginia Mason Franciscan Health, Seattle, Washington
| | - Laila Rashidi
- MultiCare Colon and Rectal Surgery, Tacoma, Washington
| | - Arthur Sillah
- School of Public Health, University of Washington, Seattle, Washington
- Surgical Care Outcomes Assessment Program, Seattle, Washington
| | - Vlad V Simianu
- Department of Surgery, Virginia Mason Franciscan Health, Seattle, Washington
- Surgical Care Outcomes Assessment Program, Seattle, Washington
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Al-Juhani A, Sharaf GF, Alyaseen EM, Alkurdi A, Azhari AS, Alshaiban SH, Otaif AA, Abumadian AW, Alshawi AJ, Aldarami YA. Banded Versus Non-banded Sleeve Gastrectomy: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e52799. [PMID: 38389592 PMCID: PMC10883259 DOI: 10.7759/cureus.52799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
Standard bariatric surgeries include biliopancreatic diversion (BPD), sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and adjustable gastric banding (AGB). Laparoscopic sleeve gastrectomy (LSG) is currently favored due to safety, efficacy, and shorter operation time. However, previous literature shows 75.6% weight regain post LSG. Introducing Laparoscopic band sleeve gastrectomy (LBSG) to maintain pouch size is proposed to improve outcomes and reduce weight regain. This study aims to compare the safety and efficacy of LSG vs. LBSG in obese patients. A comprehensive search strategy was executed to identify pertinent literature comparing LBSG and LSG in obese patients. Eligible studies underwent independent screening, and pertinent data were systematically extracted. The analysis employed pooled risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous variables, each accompanied by their respective 95% confidence intervals (CI). Our systematic review and meta-analysis included 15 studies encompassing 3929 patients. Regarding body mass index (BMI), at six, 12, and 24 months, no substantial differences were found between LBSG and LSG groups (p < 0.05). Still, at 36 months, LBSG exhibited significantly lower BMI than LSG (MD = -2.07 [-3.84, -0.29], p = 0.02). Excess Weight Loss (EWL) favored LBSG at 12, 24, and 36 months with MD of 3.30 [0.42, 6.18], 4.13 [1.44, 6.81], and 18.43 [9.44, 27.42], p = 0.02, 0.003, < 0.00001, respectively). Operative time did not significantly differ between the procedures (MD = 2.95, 95%CI [-0.06, 5.95], p = 0.05). Resolution of comorbidities, overall complications, post-operative bleeding, reflux, and early complications did not significantly differ between LBSG and LSG. However, LBSG showed higher post-operative regurgitation than LSG (RR = 2.38, 95%CI [1.25, 4.54], p = 0.008). LBSG showed a substantial decrease in BMI at three-year follow-up and higher EWL at one, two, and three years. However, LBSG procedures exhibited a higher incidence of post-operative regurgitation symptoms than LSG. No substantial differences were noted in BMI at six, 12, or 24 months, EWL at six months, operative time, bleeding, reflux, or overall complications.
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Affiliation(s)
| | | | - Eman M Alyaseen
- Medicine and Medical Science, Arabian Gulf University, Manama, BHR
| | | | | | | | | | | | - Alaa J Alshawi
- Medicine, Ibn Sina National College For Medical Studies, Jeddah, SAU
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Amari T, Matta D, Makita Y, Fukuda K, Miyasaka H, Kimura M, Sakamoto Y, Shimo S, Yamaguchi K. Early Ambulation Shortened the Length of Hospital Stay in ICU Patients after Abdominal Surgery. Clin Pract 2023; 13:1612-1623. [PMID: 38131690 PMCID: PMC10742920 DOI: 10.3390/clinpract13060141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/03/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
The optimal time to ambulation remains unclear for intensive care unit (ICU) patients following abdominal surgery. While previous studies have explored various mobilization techniques, a direct comparison between ambulation and other early mobilization methods is lacking. Additionally, the impact of time to ambulation on complications and disuse syndrome prevention requires further investigation. This study aimed to identify the optimal time to ambulation for ICU patients after abdominal surgery and considered its potential influence on complications and disuse syndrome. We examined the relationship between time to ambulation and hospital length of stay (LOS). Patients were categorized into the nondelayed (discharge within the protocol time) and delayed (discharge later than expected) groups. Data regarding preoperative functioning, postoperative complications, and time to discharge were retrospectively collected and analyzed. Of the 274 postsurgical patients managed in the ICU at our hospital between 2018 and 2020, 188 were included. Time to ambulation was a significant prognostic factor for both groups, even after adjusting for operative time and complications. The area under the curve was 0.72, and the cutoff value for time to ambulation was 22 h (sensitivity, 68%; specificity, 77%). A correlation between time to ambulation and complications was observed, with both impacting the hospital LOS (model 1: p < 0.01, r = 0.22; model 2: p < 0.01, r = 0.29). Specific cutoff values for time to ambulation will contribute to better surgical protocols.
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Affiliation(s)
- Takashi Amari
- Department of Rehabilitation, Health Science University, 7187 Kodachi, Fujikawaguchiko, Yamanashi 401-0380, Japan; (K.F.); (Y.S.); (S.S.)
- Department of Anatomy and Life Structure, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Daiki Matta
- Department of Rehabilitation, Ageo Central General Hospital, 1-10-10 Kashiwaza, Ageo, Saitama 362-8588, Japan; (D.M.); (Y.M.); (H.M.); (M.K.)
| | - Yukiho Makita
- Department of Rehabilitation, Ageo Central General Hospital, 1-10-10 Kashiwaza, Ageo, Saitama 362-8588, Japan; (D.M.); (Y.M.); (H.M.); (M.K.)
| | - Kyosuke Fukuda
- Department of Rehabilitation, Health Science University, 7187 Kodachi, Fujikawaguchiko, Yamanashi 401-0380, Japan; (K.F.); (Y.S.); (S.S.)
- Department of Rehabilitation, Ageo Central General Hospital, 1-10-10 Kashiwaza, Ageo, Saitama 362-8588, Japan; (D.M.); (Y.M.); (H.M.); (M.K.)
| | - Hiroki Miyasaka
- Department of Rehabilitation, Ageo Central General Hospital, 1-10-10 Kashiwaza, Ageo, Saitama 362-8588, Japan; (D.M.); (Y.M.); (H.M.); (M.K.)
| | - Masami Kimura
- Department of Rehabilitation, Ageo Central General Hospital, 1-10-10 Kashiwaza, Ageo, Saitama 362-8588, Japan; (D.M.); (Y.M.); (H.M.); (M.K.)
| | - Yuta Sakamoto
- Department of Rehabilitation, Health Science University, 7187 Kodachi, Fujikawaguchiko, Yamanashi 401-0380, Japan; (K.F.); (Y.S.); (S.S.)
- Graduate School of Health and Sciences, Kyorin University, 5-4-1 Shimorenjaku, Mitaka-shi, Tokyo 181-8612, Japan
| | - Satoshi Shimo
- Department of Rehabilitation, Health Science University, 7187 Kodachi, Fujikawaguchiko, Yamanashi 401-0380, Japan; (K.F.); (Y.S.); (S.S.)
| | - Kenichiro Yamaguchi
- Department of Rehabilitation, Sainokuni Higashi Omiya Medical Center, 1522 Toro-cho, Kita-ku, Saitama-shi 331-8577, Japan;
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Arakawa K, Sako A. Well-leg compartment syndrome after robot assisted laparoscopic surgery for rectal cancer: A case report. Int J Surg Case Rep 2023; 104:107924. [PMID: 36801764 PMCID: PMC9958421 DOI: 10.1016/j.ijscr.2023.107924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/06/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023] Open
Abstract
INTRODUCTION Lower limb compartment syndrome caused by improper positioning during surgery is called well-leg compartment syndrome. Although well-leg compartment syndrome has been reported in urological and gynecological patients, there have been no reports of well-leg compartment syndrome in patients who have undergone robot-assisted surgery for rectal cancer. PRESENTATION OF CASE A 51-year-old man was diagnosed with lower limb compartment syndrome by an orthopedic surgeon due to pain in both of his lower legs immediately following robot-assisted surgery for rectal cancer. Due to this, we started placing the patient in the supine position during these surgeries, and repositioned the patient to the lithotomy position following intestinal tract cleansing after rectal movement in the latter half of the surgery. This avoided the long-term effects of being in the lithotomy position. We compared the operation time and complications before and after the above measures were changed, in 40 cases of robot-assisted anterior rectal resection for rectal cancer performed at our hospital from 2019 to 2022. We found no extension of operation time and no occurrence of lower limb compartment syndrome. DISCUSSION There have been several reports describing the risk reduction of WLCS using intraoperative postural changes. An intraoperative postural change from a natural supine position without pressure which we reported is considered to be a simple preventive method for WLCS. CONCLUSION Changing the patient from the supine position to the lithotomy position during surgery may be a clinically acceptable countermeasure to prevent lower limb compartment syndrome.
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Affiliation(s)
| | - Akihiro Sako
- Department of Surgery, Hitachi General Hospital, Japan.
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Clapp B, Marrero K, Corbett J, Sharma I, Hage K, Vierkant RA, McKenzie T, Davis SS, Ghanem OM. Effect of operative times in bariatric surgery on outcomes: a matched analysis of the MBSAQIP database. Surg Endosc 2023:10.1007/s00464-023-09927-6. [PMID: 36752855 DOI: 10.1007/s00464-023-09927-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/28/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND The implications of operative time (OT) have been studied in different surgical specialties, showing a correlation with higher incidence rates of postoperative complications. However, the impact of OT on bariatric surgery complications is not well elucidated. METHODS A retrospective review of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database between 2015 and 2019 was performed. A total of 358,382 SG patients and 123,357 RYGB patients were included. The median OT was 68 min (10-720) and 113 min (10-640) for the sleeve gastrectomy (SG) group and the Roux-en-Y gastric bypass group, respectively. The groups were subdivided into two subgroups based on OT in comparison to the median time of each group. The subgroups were compared for surgical complications and outcomes. To reduce selection bias and risk of confounders, we performed a propensity score matching (PSM) for 22 variables. RESULTS In the PSM-matched cohort, 18,915 SG and 6,495 RYGB patients were included in each subgroup. The SG cohort showed higher rates of Clavien-Dindo Class 1, 2, 3a, 4, and 5 complications as well as higher rates of readmission, reoperation, and reintervention in the longer OT group before matching. After PSM, the subgroup with longer times continued to have higher rates of Clavien-Dindo Class 2 complications and higher rates of readmission and reoperation. Similarly, there were higher rates of all Clavien-Dindo class complications as well as readmission, reoperation, and reintervention in the RYGB group with higher OT. After PSM, there were still higher rates of Clavien-Dindo Class 3a complications as well as readmission and reintervention in the RYGB subgroup with prolonged OT. CONCLUSION In both SG and RYGB, longer OT was associated with increased rates of complications as well as readmission, reoperation, and reintervention. Surgeons should be cognizant of the increased rates of complications when operative times are longer.
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Affiliation(s)
- Benjamin Clapp
- Department of Surgery, Texas Tech HSC Paul Foster School of Medicine, El Paso, TX, USA
| | - Katie Marrero
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - John Corbett
- Department of Surgery, Texas Tech HSC Paul Foster School of Medicine, El Paso, TX, USA
| | - Ishna Sharma
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Karl Hage
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Scott S Davis
- Division of General and GI Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN, USA. .,Endocrine and Metabolic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Rovers MM, Wijn SRW, Grutters JPC, Metsemakers SJJPM, Vermeulen RJ, van der Pennen R, Berden BJJM, Gooszen HG, Scholte M, Govers TM. Development of a decision analytical framework to prioritise operating room capacity: lessons learnt from an empirical example on delayed elective surgeries during the COVID-19 pandemic in a hospital in the Netherlands. BMJ Open 2022; 12:e054110. [PMID: 35396284 PMCID: PMC8995574 DOI: 10.1136/bmjopen-2021-054110] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To develop a prioritisation framework to support priority setting for elective surgeries after COVID-19 based on the impact on patient well-being and cost. DESIGN We developed decision analytical models to estimate the consequences of delayed elective surgical procedures (eg, total hip replacement, bariatric surgery or septoplasty). SETTING The framework was applied to a large hospital in the Netherlands. OUTCOME MEASURES Quality measures impacts on quality of life and costs were taken into account and combined to calculate net monetary losses per week delay, which quantifies the total loss for society expressed in monetary terms. Net monetary losses were weighted by operating times. RESULTS We studied 13 common elective procedures from four specialties. Highest loss in quality of life due to delayed surgery was found for total hip replacement (utility loss of 0.27, ie, 99 days lost in perfect health); the lowest for arthroscopic partial meniscectomy (utility loss of 0.05, ie, 18 days lost in perfect health). Costs of surgical delay per patient were highest for bariatric surgery (€31/pp per week) and lowest for arthroscopic partial meniscectomy (-€2/pp per week). Weighted by operating room (OR) time bariatric surgery provides most value (€1.19/pp per OR minute) and arthroscopic partial meniscectomy provides the least value (€0.34/pp per OR minute). In a large hospital the net monetary loss due to prolonged waiting times was €700 840 after the first COVID-19 wave, an increase of 506% compared with the year before. CONCLUSIONS This surgical prioritisation framework can be tailored to specific centres and countries to support priority setting for delayed elective operations during and after the COVID-19 pandemic, both in and between surgical disciplines. In the long-term, the framework can contribute to the efficient distribution of OR time and will therefore add to the discussion on appropriate use of healthcare budgets. The online framework can be accessed via: https://stanwijn.shinyapps.io/priORitize/.
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Affiliation(s)
- Maroeska M Rovers
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Stan RW Wijn
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Janneke PC Grutters
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Sanne JJPM Metsemakers
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Robin J Vermeulen
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Ron van der Pennen
- Elisabeth-TweeSteden Ziekenhuis, Tilburg, Noord-Brabant, The Netherlands
| | - Bart JJM Berden
- Elisabeth-TweeSteden Ziekenhuis, Tilburg, Noord-Brabant, The Netherlands
- IQ healthcare, Radboud Insititute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hein G Gooszen
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Mirre Scholte
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Tim M Govers
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
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A J, Zhang J, Chai J, Zhao S, Wang H, A X, Yang J. Comparison of the Efficacy of Anatomic and Non-anatomic Hepatectomy for Hepatic Alveolar Echinococcosis: Clinical Experience of 240 Cases in a Single Center. Front Public Health 2022; 9:816704. [PMID: 35211454 PMCID: PMC8863048 DOI: 10.3389/fpubh.2021.816704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 12/31/2021] [Indexed: 11/17/2022] Open
Abstract
Background Hepatic alveolar echinococcosis (AE) is a zoonotic parasitic disease. There are more than 16,000 new cases each year, approximately 60 million people are threatened, and the annual direct economic loss is RMB 3 billion. The prevalence of AE in some areas of the Qinghai–Tibet Plateau is as high as 6.0%. Radical resection, including anatomic and non-anatomic hepatectomy, for advanced AE can significantly prolong the survival time of patients. However, there is no literature compared the efficacy of anatomic and non-anatomic hepatectomy. Therefore, by comparing various clinical evaluation indices between anatomic and non-anatomic hepatectomy, this study explored the short-term and long-term efficacy of these two surgical methods for AE. Methods The clinical data of patients with AE who underwent radical hepatectomy at Qinghai Provincial People's Hospital from January 2015 to January 2021 were retrospectively analyzed. The patients were divided into two groups by surgical method, that were, non-anatomic hepatectomy group and anatomic hepatectomy group. We compared these two groups focusing on basic preoperative data, such as age, sex, lesion size, and liver function parameters; main intraoperative evaluation indices, such as operation time, intraoperative porta hepatis occlusion time, intraoperative blood loss, and blood transfusion; and postoperative recovery evaluation indicators, such as postoperative liver function, incidence of surgical complications, and AE recurrence. Results A total of 240 patients were enrolled in this study, including 123 in anatomic hepatectomy group and 117 in non-anatomic hepatectomy group. There were no significant differences (P > 0.05) between baseline characteristics. Anatomic hepatectomy group was advantageous than non-anatomic hepatectomy group regarding intraoperative blood loss (P < 0.001), blood transfusion (P < 0.001), and porta hepatis occlusion time (P < 0.001). There were statistically significant differences in postoperative liver function (aspartate aminotransferase: P < 0.001; alanine aminotransferase: P < 0.001), surgical complications (P < 0.001), and AE recurrence rate (P = 0.003). The median survival of patients in the anatomic hepatectomy group was 66 months, compared to 65 months in the non-anatomic hepatectomy group (χ2 = 4.662, P = 0.031). Conclusions Anatomic hepatectomy was not only safe for AE but also showed better short-term and long-term superiority than non-anatomic hepatectomy.
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Affiliation(s)
- Jide A
- Medical College of Soochow University, Suzhou, China
- Department of Hepatic Hydatidosis, Qinghai Provincial People's Hospital, Xining, China
| | - Jingni Zhang
- Department of Hepatic Hydatidosis, Qinghai Provincial People's Hospital, Xining, China
| | - Jinping Chai
- Department of Internal Medicine-Cardiovascular, Qinghai Provincial People's Hospital, Xining, China
| | - Shunyun Zhao
- Department of Hepatic Hydatidosis, Qinghai Provincial People's Hospital, Xining, China
| | - Hao Wang
- Intensive Care Unit, Qinghai Provincial People's Hospital, Xining, China
| | - Xiangren A
- Department of Clinical Laboratory, Qinghai Province Key Laboratory of Laboratory Medicine, Qinghai Clinical Medical Research Center, Qinghai Provincial People's Hospital, Xining, China
- Xiangren A
| | - Jinyu Yang
- Department of Hepatic Hydatidosis, Qinghai Provincial People's Hospital, Xining, China
- *Correspondence: Jinyu Yang
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Guidolin K, Spence RT, Azin A, Hirpara DH, Lam-Tin-Cheung K, Quereshy F, Chadi S. The effect of operative duration on the outcome of colon cancer procedures. Surg Endosc 2021; 36:5076-5083. [PMID: 34782967 DOI: 10.1007/s00464-021-08871-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 11/07/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Prolonged operative duration has been associated with increased post-operative morbidity in numerous surgical subspecialties; however, data are limited in operations for colon cancer specifically and existing literature makes unwarranted methodological assumptions of linearity. We sought to assess the effects of extended operative duration on perioperative outcomes in those undergoing segmental colectomy for cancer using a methodologically sound approach. METHODS We conducted a retrospective cohort study of patients undergoing segmental colectomy for cancer between 2014 and 2018, logged in the National Surgical Quality Improvement Program datasets. Our primary outcome was a composite of any complication within 30 days; secondary outcomes included length of stay and discharge disposition. Our main factor of interest was operative duration. RESULTS We analyzed 26,380 segmental colectomy cases, the majority of which were approached laparoscopically (64.95%) and were right sided (62.93%). Median operative duration was 152 (95% CI 112-206) minutes. On multivariable regression, increased operative duration was linearly associated with any complication (OR = 1.003, 95% CI 1.003-1.003, p < 0.0001) in the overall cohort, as was length of stay (p < 0.0001). All subgroups except for the laparoscopic left colectomy group were linearly associated with operative duration. In the laparoscopic left colectomy group, an inflection point in the odds of any complication was found at 176 min (OR = 1.39, 95% CI 1.20-1.61, p < 0.0001). CONCLUSIONS This study suggests that the risk of perioperative complications increases linearly with increasing operative duration, where each additional 30 min increases the odds of complication by 10%. In those undergoing laparoscopic left colectomy, the risk of complications sharply increases after ~ 3 h, suggesting that surgeons should aim to complete these procedures within 3 h where possible.
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Affiliation(s)
- Keegan Guidolin
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Richard T Spence
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Arash Azin
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | | | | | - Fayez Quereshy
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Department of Surgery, University Health Network, Toronto, ON, Canada
| | - Sami Chadi
- Department of Surgery, University of Toronto, Toronto, ON, Canada.
- Department of Surgery, University Health Network, Toronto, ON, Canada.
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Ramos-Zabala F, Parra-Blanco A, Beg S, Rodríguez-Pascual J, Cárdenas Rebollo JM, Cardozo-Rocabado R, Moreno-Almazán L. The impact of submucosal fatty tissue during colon endoscopic submucosal dissection in a western center. Eur J Gastroenterol Hepatol 2021; 33:1063-1070. [PMID: 33867446 DOI: 10.1097/meg.0000000000002146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Obesity is associated with submucosal fatty tissue. The main aim of this study was to assess the impact of submucosal fatty tissue on the success of colonic endoscopic submucosal dissection (C-ESD) in a western population. METHODS This was a retrospective analysis of 125 consecutive C-ESDs performed between October 2015 and July 2017. Fatty tissue sign was defined as positive when the submucosal layer was covered with fatty tissue. The complexity of performing an ESD was assessed by the performing endoscopist, defined by the occurrence of intraprocedural perforation, inability to complete an en-bloc resection or a procedure time exceeding 180 min. RESULTS Fatty tissue sign positive was present in 44.8% of the procedures. There were 28 (22.4%) c-ESD defined as complex. Factors associated with complex ESD included; fatty tissue sign [odds ratio (OR) 12.5; 95% confidence interval (CI), 1.9-81.9; P = 0.008], severe fibrosis (OR 148.6; 95% CI, 6.6-3358.0; P = 0.002), poor maneuverability (OR 267.4; 95% CI, 11.5-6212.5; P < 0.001) and polyp size ≥35 mm (OR 17.2; 95% CI, 2.6-113.8; P = 0.003). In patients demonstrating the fatty tissue sign, BMI and waist-to-height ratio (WHtR) were higher (27.8 vs. 24.7; P < 0.001 and 0.56 vs. 0.49; P < 0.001, respectively) and en-bloc resection was achieved less frequently (76.8 vs. 97.1%, P = 0.001). Multivariate analysis revealed higher risk of fatty tissue sign positive associated with WHtR ≥0.52 (OR 26.10, 95% CI, 7.63-89.35, P < 0.001). CONCLUSION This study demonstrates that the fatty tissue sign contributes to procedural complexity during C-ESD. Central obesity correlates with the likelihood of submucosal fatty tissue and as such should be taken into account when planning procedures.
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Affiliation(s)
- Felipe Ramos-Zabala
- Departamento de Gastroenterología, Hospital Universitario HM Montepríncipe, HM Hospitales, Boadilla del Monte
- Departamento de Ciencias Médicas Clínicas, Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Madrid, España
| | - Adolfo Parra-Blanco
- Department of Gastroenterology, NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Sabina Beg
- Department of Gastroenterology, NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Jesús Rodríguez-Pascual
- Departamento de Ciencias Médicas Clínicas, Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Madrid, España
- Departamento de Oncología Médica
| | - José Miguel Cárdenas Rebollo
- Departamento de Ciencias Médicas Clínicas, Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Madrid, España
| | - Rocío Cardozo-Rocabado
- Departamento de Anatomía Patológica, Hospital Universitario HM Puerta del Sur, HM Hospitales, Moóstoles, Madrid, España
| | - Luis Moreno-Almazán
- Departamento de Gastroenterología, Hospital Universitario HM Montepríncipe, HM Hospitales, Boadilla del Monte
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Donlon NE, Nugent TS, Free R, Hafeez A, Kalbassi R, Neary PC, O'Riordain DS. Robotic versus laparoscopic anterior resections for rectal and rectosigmoid cancer: an institutional experience. Ir J Med Sci 2021; 191:845-851. [PMID: 33846946 DOI: 10.1007/s11845-021-02625-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 04/08/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Colorectal surgery has evolved with the advent of laparoscopic techniques and now robotic-assisted surgery. There is significant literature supporting the use of laparoscopic techniques over open surgery with evidence of enhanced post-operative recovery, reduced use of opioids, smaller incisions and equivalent oncological outcomes. Robotic minimally invasive surgery addresses some of the limitations of laparoscopic surgery, providing surgical precision and improvements in perception and dexterity with a resulting decrease in tissue damage. METHODS We retrospectively reviewed the medical records of patients who underwent robotic-assisted anterior resection for cancer of the rectum or rectosigmoid junction in our institution since our robotic programme began in 2017. Patient demographics were identified via electronic databases and patient charts. A matched cohort of laparoscopic cases was identified. RESULTS A total of 51 consecutive robotic-assisted anterior resections were identified and case matched with laparoscopic resections for comparison. Robotic-assisted surgery was associated with a shorter length of stay (p = 0.04), reduced initial post-operative analgesia requirements (p < 0.01) and no significant difference in time to bowel movement or stoma functioning (p = 0.84). All patients had an R0 resection, and there was no statistical difference in lymph node yield between the groups (p = 0.14). Robotic surgery was associated with a longer operative duration (p < 0.001). CONCLUSION In this early experience, robotic surgery has proven feasible and safe and is comparable to laparoscopic surgery in terms of completeness of resection and recovery. As costs and operating times decline and as technology progresses, robotic surgery may one day replace traditional laparoscopic techniques.
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Affiliation(s)
- Noel E Donlon
- Department of Colorectal Surgery, Beacon Hospital, Dublin, Ireland.
| | - Tim S Nugent
- Department of Colorectal Surgery, Beacon Hospital, Dublin, Ireland
| | - Ross Free
- Department of Colorectal Surgery, Beacon Hospital, Dublin, Ireland
| | - Adnan Hafeez
- Department of Colorectal Surgery, Beacon Hospital, Dublin, Ireland
| | - Resa Kalbassi
- Department of Colorectal Surgery, Beacon Hospital, Dublin, Ireland
| | - Paul C Neary
- Department of Colorectal Surgery, Beacon Hospital, Dublin, Ireland
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12
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Ratcliff CG, Deavers F, Tullos EA, Christensen MR, Ricardo MM, Dindo L, Cully JA. Brief Behavioral Intervention for Distressed Patients Undergoing Cancer Surgery: A Case Series. COGNITIVE AND BEHAVIORAL PRACTICE 2020. [DOI: 10.1016/j.cbpra.2020.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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13
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Francis N, Penna M, Carter F, Mortensen NJ, Hompes R, Bandyopadhyay D, Black J, Campbell K, Chadwick M, Chase K, Chitsabesen P, Coleman M, Dalton S, Doeve J, Hendrickse C, Katory M, Knol J, Lee L, McArthur D, Miles T, Miskovic D, Ng P, Nicol D, Samad A, Talwar A, Kochupapy RT, Theobald I, Wegstapel H, West N, Wood S, Wynn G, Ziyaie D. Development and early outcomes of the national training initiative for transanal total mesorectal excision in the UK. Colorectal Dis 2020; 22:756-767. [PMID: 32065425 DOI: 10.1111/codi.15022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 02/11/2020] [Indexed: 12/17/2022]
Abstract
AIM Transanal total mesorectal excision (TaTME) has attracted substantial interest amongst colorectal surgeons but its technical challenges may underlie the early reports of visceral injuries and oncological concerns. The aim of this study was to report on the feasibility, development and the outcome of the national pilot training initiative for TaTME-UK. METHODS TaTME-UK was successfully launched in September 2017 in partnership with the healthcare industry and endorsed by the Association of Coloproctology of Great Britain and Ireland. This multi-modal training curriculum consisted of three phases: (i) set-up; (ii) selection of pilot sites; and (iii) formal proctorship programme. Bespoke Global Assessment Scoring (GAS) forms were designed and completed by both trainees and mentors. Data were collected on patient demographics, tumour characteristics and perioperative clinical and histological outcomes. RESULTS Twenty-four proctored cases were performed by 10 colorectal surgeons from five selected pilot sites. Median operative time was 331 ± 90 (195-610) min which was reduced to 283 ± 62 (195-340) min in the final case. Independent performance (GAS score of 5) was achieved for most operative steps by case 5. There was one conversion (4.2%), but no visceral injuries. Pathological data confirmed no bowel perforation and intact quality of the mesorectal TME specimens with clear distal margin in all cases and circumferential margins in 23/24 cases (96%). CONCLUSION This exploratory study demonstrates acceptable early outcomes in a small cohort suggesting that a competency-based multi-modal training programme for TaTME can be feasible and safe to implement at a national level.
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Affiliation(s)
- N Francis
- Department of Colorectal Surgery, Yeovil District Hospital Foundation Trust, Yeovil, UK.,Division of Surgery and Interventional Science, University College London, London, UK.,Faculty of Science, University of Bath, Bath, UK
| | - M Penna
- Department of Colorectal Surgery, Churchill Hospital, University Hospitals of Oxford, Oxford, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - F Carter
- South West Surgical Training Network c.i.c., Yeovil, UK
| | - N J Mortensen
- Department of Colorectal Surgery, Churchill Hospital, University Hospitals of Oxford, Oxford, UK
| | - R Hompes
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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14
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Faust K, Schneider GH, Vajkoczy P. Utilization of the Intraoperative Mobile AIRO® CT Scanner in Stereotactic Surgery: Workflow and Effectiveness. Stereotact Funct Neurosurg 2020; 97:303-312. [PMID: 31962324 DOI: 10.1159/000504945] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 11/13/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND In frame-based stereotactic surgery, intraoperative imaging is crucial. It generally follows a workflow including preoperative MRI and intraoperative frame-based CT. The intraoperative transport of the anesthetized and intubated patient to and from the CT unit can be time-consuming and cumbersome. Here, we report the first 50 patients who underwent stereotactic biopsies using the mobile AIRO® intraoperative CT (iCT) scanner. METHODS A conventional stereotactic frame was mounted to the AIRO® carbon table via carbon adapter. 0°gantry thin-slice iCT was performed. The imaging data were transferred to a conventional stereotaxy working unit. After fusion of the preoperative MRI and AIRO® iCT, the stereotactic system was built based on the iCT, and trajectories were calculated accordingly. RESULTS The frame-based stereotactic iCT was easy to implement and successfully accomplished in all patients. The MRI/iCT image fusion was feasible in all of the studies. A conclusive histological result was obtained in 46 of the 50 cases included. There was no bleeding complication. Net surgery time was reduced by 38 min, on average. CONCLUSION We conclude that the AIRO® system is a safe, easy-to-use, and sufficiently accurate iCT for CT frame-based stereotactic biopsy planning that results in a considerable reduction of surgery time. In the future, it remains to be evaluated if the accuracy rates and intraoperative workflow will permit its application in deep brain stimulation and other functional procedures as well.
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Affiliation(s)
- Katharina Faust
- Department of Neurosurgery, Charité University Hospital, Berlin, Germany,
| | | | - Peter Vajkoczy
- Department of Neurosurgery, Charité University Hospital, Berlin, Germany
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15
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Dru RC, Curtis NJ, Court EL, Spencer C, El Falaha S, Dennison G, Dalton R, Allison A, Ockrim J, Francis NK. Impact of anaemia at discharge following colorectal cancer surgery. Int J Colorectal Dis 2020; 35:1769-1776. [PMID: 32488418 PMCID: PMC7415032 DOI: 10.1007/s00384-020-03611-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Preoperative anaemia is common in patients with colorectal cancer and increasingly optimised prior to surgery. Comparably little attention is given to the prevalence and consequences of postoperative anaemia. We aimed to investigate the frequency and short- or long-term impact of anaemia at discharge following colorectal cancer resection. METHODS A dedicated, prospectively populated database of elective laparoscopic colorectal cancer procedures undertaken with curative intent within a fully implemented ERAS protocol was utilised. The primary endpoint was anaemia at time of discharge (haemoglobin (Hb) < 120 g/L for women and < 135 g/L for men). Patient demographics, tumour characteristics, operative details and postoperative outcomes were captured. Median follow-up was 61 months with overall survival calculated with the Kaplan-Meier log rank method and Cox proportional hazard regression based on anaemia at time of hospital discharge. RESULTS A total of 532 patients with median 61-month follow-up were included. 46.4% were anaemic preoperatively (cohort mean Hb 129.4 g/L ± 18.7). Median surgical blood loss was 100 mL (IQR 0-200 mL). Upon discharge, most patients were anaemic (76.6%, Hb 116.3 g/L ± 14, mean 19 g/L ± 11 below lower limit of normal, p < 0.001). 16.7% experienced postoperative complications which were associated with lower discharge Hb (112 g/L ± 12 vs. 117 g/L ± 14, p = 0.001). Patients discharged anaemic had longer hospital stays (7 [5-11] vs. 6 [5-8], p = 0.037). Anaemia at discharge was independently associated with reduced overall survival (82% vs. 70%, p = 0.018; HR 1.6 (95% CI 1.04-2.5), p = 0.034). CONCLUSION Anaemia at time of discharge following elective laparoscopic colorectal cancer surgery and ERAS care is common with associated negative impacts upon short-term clinical outcomes and long-term overall survival.
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Affiliation(s)
- Rebecca C. Dru
- Department of General Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, Somerset BA21 4AT UK ,University Hospitals Bristol NHS Foundation Trust, Marlborough Street, Bristol, BS1 3NU UK
| | - Nathan J. Curtis
- Department of General Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, Somerset BA21 4AT UK ,Department of Surgery and Cancer, Imperial College London, Praed Street, London, W2 1NY UK
| | - Emma L. Court
- Department of General Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, Somerset BA21 4AT UK
| | - Catherine Spencer
- Department of General Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, Somerset BA21 4AT UK
| | - Sara El Falaha
- Department of General Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, Somerset BA21 4AT UK
| | - Godwin Dennison
- Department of General Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, Somerset BA21 4AT UK
| | - Richard Dalton
- Department of General Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, Somerset BA21 4AT UK
| | - Andrew Allison
- Department of General Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, Somerset BA21 4AT UK
| | - Jonathan Ockrim
- Department of General Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, Somerset BA21 4AT UK
| | - Nader K. Francis
- Department of General Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, Somerset BA21 4AT UK ,Division of Surgery and Interventional Science, University College London, London, UK ,Northwick Park Institute of Medical Research, Y Block, Northwick Park Hospital, Harrow, HA1 3UJ UK
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Wang W, He Y, Wu L, Ye L, Yao L, Tang Z. Efficacy of extended versus standard lymphadenectomy in pancreatoduodenectomy for pancreatic head adenocarcinoma. An update meta-analysis. Pancreatology 2019; 19:1074-1080. [PMID: 31668841 DOI: 10.1016/j.pan.2019.10.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 09/18/2019] [Accepted: 10/14/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Surgical resection is the only possible cure for pancreatic cancer, it remains controversial whether extend lymphadenectomy in pancreatoduodenectomy (EPD) is better than standard lymphadenectomy in pancreatoduodenectomy (SPD). The aim of this study was to compare the efficacy of EPD with SPD for pancreatic head adenocarcinoma. METHODS A specific search of online databases including PubMed, Web of Science, Embase, and Cochrane library was conducted from January 1990 to October 2018. Relative perioperative outcomes were synthesized. Single-arm meta-analysis was also performed. RESULTS A total of eight studies involving 687 (342 vs 345) patients were included for analysis in our study. The number of lymph nodes harvested [24.54 vs 13.29; weighted mean difference (WMD) -10.69, P = 0.000], operative time (469.84 min vs 354.85 min; WMD -99.09, P = 0.000), and diarrhea (postoperative three months) [45.1% vs 18.2%; odds radio (OR) 0.20, P = 0.014] were significantly higher in patients who underwent EPD than SPD. The perioperative complications (35% vs 28.8%; OR 0.79, P = 0.186), tumor size (3.27 cm vs 3.248 cm; WMD -0.11, P = 0.256), lymph node metastasis (66% vs 55.9%; OR 0.71, P = 0.105), and positive margin (10.4% vs 11.3%; OR 1.28, P = 0.392) were no significant differences between EPD group and SPD group. Extended lymphadenectomy in pancreatoduodenectomy dose not contribute to the overall survival of patients with adenocarcinoma of the pancreatic head [hazard ratio (HR) 0.95; 95% CI 0.78-1.15; P = 0.61]. CONCLUSION The update meta-analysis shows that EPD failed to improve the overall survival, may even lead to increased morbidity.
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Affiliation(s)
- Wei Wang
- Department of Pancreatic Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei Province, PR China
| | - Ying He
- School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, Hubei Province, PR China
| | - Lun Wu
- Department of Pancreatic Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei Province, PR China
| | - Lin Ye
- Department of Pancreatic Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei Province, PR China
| | - Lichao Yao
- Department of Pancreatic Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei Province, PR China
| | - Zhigang Tang
- Department of Pancreatic Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei Province, PR China.
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Wang X, Yao Y, Qian H, Li H, Zhu X. Longer Operating Time During Gastrectomy Has Adverse Effects on Short-Term Surgical Outcomes. J Surg Res 2019; 243:151-159. [PMID: 31176285 DOI: 10.1016/j.jss.2019.05.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 04/16/2019] [Accepted: 05/08/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Gastric cancer continues to be one of the malignant tumor types with high morbidity and mortality worldwide. Although remarkable improvements have been made to combat gastric cancer, surgery is still the first choice of treatment for gastric cancer. METHODS This was a single-center and retrospective study. A total of 110 patients who underwent radical gastrectomy with D2 lymph node dissection between 2014 and 2017 were included in this study, and all patients were treated by the same medical staff. Based on the median operating time, patients were grouped into a long-time group (>180 min) and a short-time group (≤180 min). Influences of operating time on outcomes of patients in the short-term and long-term groups were analyzed. RESULTS The long-time group showed a higher incidence of postoperative complications compared with the short time group (P < 0.01) with a significant decrease in serum albumin and the prognostic nutritional index value. Moreover, a long operating time was often caused by the operating start time (P < 0.001), excision difficulty caused by lager tumor size (P < 0.001), worse tumor differentiation, and deeper tumor invasion (P < 0.05). However, length of operating time did not significantly influence overall survival of patients who underwent radical gastrectomy. CONCLUSIONS The results suggested that operating time might be an indicator of the incidence of postoperative complication and that several important variables, such as prognostic nutritional index, serum albumin, operating start time, and excision time, could be intervened in the perioperative period to help patients gain a better outcome after gastrectomy.
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Affiliation(s)
- Xuchao Wang
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yizhou Yao
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Huan Qian
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hao Li
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xinguo Zhu
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China.
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Trends and outcomes in laparoscopic versus open surgery for rectal cancer from 2005 to 2016 using the ACS-NSQIP database, a retrospective cohort study. Int J Surg 2019; 63:71-76. [PMID: 30771485 DOI: 10.1016/j.ijsu.2019.02.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 01/25/2019] [Accepted: 02/08/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is controversy regarding the use of laparoscopy for rectal cancer, especially after the ACOSOG Z6051 Randomized Clinical Trial determined that laparoscopy failed to meet non-inferiority compared with open surgery. With these new recommendations, the current practices for the treatment of rectal cancer across the country are unknown. METHODS Using the ACS-NSQIP database from 2005 to 2016, resections for rectal cancer were studied. The proportion of laparoscopic versus open surgeries performed was determined by year, and 16 30-day outcomes were studied in each group. Multiple logistic regression was utilized to determine the association between laparoscopic and open technique as well as odds of outcome over time. RESULTS A total of 31,795 resections were performed, 12,371 (38.9%) laparoscopically. Laparoscopy increased yearly from 9.8% in 2005 to 52.8% in 2016. All 30-day outcomes tended to favor laparoscopy with the exception of operating room time. CONCLUSIONS These data suggest that laparoscopic surgery has been widely adopted for treating patients with rectal cancer, and the trend continues despite the ACOSOG Z6051 recommendations suggesting that laparoscopic resection may not be best technique for resection. Stronger recommendations are needed to change current trends if laparoscopic surgery is not the appropriate treatment method for rectal cancer.
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Epidural analgesia in the era of enhanced recovery: time to rethink its use? Surg Endosc 2018; 33:2197-2205. [DOI: 10.1007/s00464-018-6505-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 10/11/2018] [Indexed: 01/27/2023]
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Romanzini AE, Pereira MDG, Guilherme C, Cologna AJ, de Carvalho EC. Predictors of well-being and quality of life in men who underwent radical prostatectomy: longitudinal study1. Rev Lat Am Enfermagem 2018; 26:e3031. [PMID: 30183870 PMCID: PMC6136529 DOI: 10.1590/1518-8345.2601.3031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 05/06/2018] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE to identify socio-demographic, clinical and psychological predictors of well-being and quality of life in men who underwent radical prostatectomy, in a 360-day follow-up. METHOD longitudinal study with 120 men who underwent radical prostatectomy. Questionnaires were used for characterization and clinical evaluation of the participant, as well as the instruments Visual Analog Scale for Pain, The Ways of Coping Questionnaire, Hospital Depression and Anxiety Scale, Satisfaction with Social Support Scale, Marital Satisfaction Scale, Subjective Well-Being Scale and Expanded Prostate Cancer Index. For data analysis, the linear mixed-effects model was used. RESULTS the socio-demographic factors age and race were not predictors of the dependent variables; time of surgery, problem-focused coping, and anxiety were predictors of subjective well-being; pain, anxiety and depression were negative predictors of quality of life; emotion-focused coping was a positive predictor. Marital dissatisfaction was a predictor of both variables. CONCLUSION predictor variables found were different from the literature: desire for changes in marital relationship presented a positive association with quality of life and well-being; emotion-focused coping was a predictor of quality of life; and anxiety was a predictor of subjective well-being.
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Affiliation(s)
| | | | - Caroline Guilherme
- PhD, Adjunct Professor, Curso de Enfermagem e Obstetrícia,
Universidade Federal do Rio de Janeiro, Macaé, RJ, Brazil
| | - Adauto José Cologna
- PhD, Senior Professor, Faculdade de Medicina de Ribeirão Preto,
Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Emilia Campos de Carvalho
- PhD, Senior Professor, Escola de Enfermagem de Ribeirão Preto,
Universidade de São Paulo, PAHO/WHO Collaborating Centre for Nursing Research
Development, Ribeirão Preto, SP, Brazil
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Pike TW, Mushtaq F, Mann RP, Chambers P, Hall G, Tomlinson JE, Mir R, Wilkie RM, Mon‐Williams M, Lodge JPA. Operating list composition and surgical performance. Br J Surg 2018; 105:1061-1069. [PMID: 29558567 PMCID: PMC6032881 DOI: 10.1002/bjs.10804] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 10/30/2017] [Accepted: 11/27/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Recent reviews suggest that the way in which surgeons prepare for a procedure (warm up) can affect performance. Operating lists present a natural experiment to explore this phenomenon. The aim was to use a routinely collected large data set on surgical procedures to understand the relationship between case list order and operative performance. METHOD Theatre lists involving the 35 procedures performed most frequently by senior surgeons across 38 private hospitals in the UK over 26 months were examined. A linear mixed-effects model and matched analysis were used to estimate the impact of list order and the cost of switching between procedures on a list while controlling for key prognosticators. The influence of procedure method (open versus minimally invasive) and complexity was also explored. RESULTS The linear mixed-effects model included 255 757 procedures, and the matched analysis 48 632 pairs of procedures. Repeating the same procedure in a list resulted in an overall time saving of 0·98 per cent for each increase in list position. Switching between procedures increased the duration by an average of 6·48 per cent. The overall reduction in operating time from completing the second procedure straight after the first was 6·18 per cent. This pattern of results was consistent across procedure method and complexity. CONCLUSION There is a robust relationship between operating list composition and surgical performance (indexed by duration of operation). An evidence-based approach to structuring a theatre list could reduce the total operating time.
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Affiliation(s)
- T. W. Pike
- Faculty of Medicine and HealthUniversity of LeedsLeedsUK
- Leeds Teaching Hospitals NHS TrustLeedsUK
| | - F. Mushtaq
- Faculty of Medicine and HealthUniversity of LeedsLeedsUK
| | - R. P. Mann
- School of MathematicsUniversity of LeedsLeedsUK
| | - P. Chambers
- Leeds Institute for Data Analytics, University of LeedsLeedsUK
| | - G. Hall
- Leeds Institute for Data Analytics, University of LeedsLeedsUK
- Leeds Teaching Hospitals NHS TrustLeedsUK
| | - J. E. Tomlinson
- Department of OrthopaedicsSheffield Teaching HospitalsSheffieldUK
- Department of Medical EducationSheffield UniversitySheffieldUK
| | - R. Mir
- Faculty of Medicine and HealthUniversity of LeedsLeedsUK
- Leeds Teaching Hospitals NHS TrustLeedsUK
| | - R. M. Wilkie
- Faculty of Medicine and HealthUniversity of LeedsLeedsUK
| | | | - J. P. A. Lodge
- Faculty of Medicine and HealthUniversity of LeedsLeedsUK
- Leeds Teaching Hospitals NHS TrustLeedsUK
- Spire Healthcare, Spire Leeds HospitalLeedsUK
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22
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Francis NK, Curtis NJ, Crilly L, Noble E, Dyke T, Hipkiss R, Dalton R, Allison A, Salib E, Ockrim J. Does the number of operating specialists influence the conversion rate and outcomes after laparoscopic colorectal cancer surgery? Surg Endosc 2018; 32:3652-3658. [PMID: 29442241 DOI: 10.1007/s00464-018-6097-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 02/07/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Laparoscopic techniques in colorectal surgery have been widely utilised due to short-term patient benefits but conversion to open surgery is associated with adverse short- and long-term patient outcomes. The aim of this study was to investigate the influence of dual specialist operating on the conversion rate and patient outcomes following laparoscopic colorectal surgery. METHODS A prospectively populated colorectal cancer surgery database was reviewed. Cases were grouped into single or dual consultant procedures. Cluster analysis and odds ratio (OR) were used to identify risk factors for conversion. Primary outcome measures were conversion to open and five year overall survival (OS) calculated using the Kaplan-Meier log-rank method. RESULTS 750 patients underwent laparoscopic colorectal cancer resection between 2002 and 2015 (median age 73, 319 (42.5%) female, 282 (37.6%) rectal malignancies, 135 patients (18%) had two consultants). The single surgeon conversion rate was 20.4% compared to 5.5% for dual operating (OR 4.4, 95% CI 1.87-10.2, p < 0.001). There were no demographic or tumour differences between the laparoscopic/converted and number of surgeon groups. Two-step cluster analysis identified cluster I (lower risk) 406 patients, 8% converted and cluster II (higher risk) 261 patients, conversion rate 30%. Median follow-up was 48 months (range 0-168). Five-year OS was significantly inferior for both converted and single surgeon cases (63% vs. 77%, p < 0.001 and 61% vs. 70%, p = 0.033, respectively). CONCLUSION In selected colorectal cancer patients operated by fully trained laparoscopic surgeons, we observed a reduction in conversion with associated long-term survival benefit from dual operating specialists.
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Affiliation(s)
- Nader K Francis
- Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Higher Kingston, Yeovil, BA21 4AT, UK. .,Faculty of Science, University of Bath, Wessex House 3.22, Bath, BA2 7AY, UK.
| | - Nathan J Curtis
- Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Higher Kingston, Yeovil, BA21 4AT, UK.,Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, Level 10, Praed Street, London, W2 1NY, UK
| | - Louise Crilly
- Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Higher Kingston, Yeovil, BA21 4AT, UK
| | - Emma Noble
- Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Higher Kingston, Yeovil, BA21 4AT, UK
| | - Tamsin Dyke
- Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Higher Kingston, Yeovil, BA21 4AT, UK
| | - Rob Hipkiss
- Information Management Team, Yeovil District Hospital NHS Foundation Trust, Higher Kingston, Yeovil, BA21 4AT, UK
| | - Richard Dalton
- Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Higher Kingston, Yeovil, BA21 4AT, UK
| | - Andrew Allison
- Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Higher Kingston, Yeovil, BA21 4AT, UK
| | - Emad Salib
- Faculty of Health and Life Sciences, University of Liverpool, Brownlow Hill, Liverpool, L69 3BX, UK.,Aidmedical Statistical Support
| | - Jonathan Ockrim
- Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Higher Kingston, Yeovil, BA21 4AT, UK
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Kalsekar I, Hsiao CW, Cheng H, Yadalam S, Chen BPH, Goldstein L, Yoo A. Economic burden of cancer among patients with surgical resections of the lung, rectum, liver and uterus: results from a US hospital database claims analysis. HEALTH ECONOMICS REVIEW 2017; 7:22. [PMID: 28577182 PMCID: PMC5457371 DOI: 10.1186/s13561-017-0160-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 05/18/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To determine hospital resource utilization, associated costs and the risk of complications during hospitalization for four types of surgical resections and to estimate the incremental burden among patients with cancer compared to those without cancer. METHODS Patients (≥18 years old) were identified from the Premier Research Database of US hospitals if they had any of the following types of elective surgical resections between 1/2008 and 12/2014: lung lobectomy, lower anterior resection of the rectum (LAR), liver wedge resection, or total hysterectomy. Cancer status was determined based on ICD-9-CM diagnosis codes. Operating room time (ORT), length of stay (LOS), and total hospital costs, as well as frequency of bleeding and infections during hospitalization were evaluated. The impact of cancer status on outcomes (from a hospital perspective) was evaluated using multivariable generalized estimating equation models; analyses were conducted separately for each resection type. RESULTS Among the identified patients who underwent surgical resection, 23 858 (87.9% with cancer) underwent lung lobectomy, 13 522 (63.8% with cancer) underwent LAR, 2916 (30.0% with cancer) underwent liver wedge resection and 225 075 (11.3% with cancer) underwent total hysterectomy. After adjusting for patient, procedural, and hospital characteristics, mean ORT, LOS, and hospital cost were statistically higher by 3.2%, 8.2%, and 9.2%, respectively for patients with cancer vs. no cancer who underwent lung lobectomy; statistically higher by 6.9%, 9.4%, and 9.6%, respectively for patients with cancer vs. no cancer who underwent LAR; statistically higher by 4.9%, 14.8%, and 15.7%, respectively for patients with cancer vs. no cancer who underwent liver wedge resection; and statistically higher by 16.0%, 27.4%, and 31.3%, respectively for patients with cancer vs. no cancer who underwent total hysterectomy. Among patients who underwent each type of resection, risks for bleeding and infection were generally higher among patients with cancer as compared to those without cancer. CONCLUSIONS In this analysis, we found that patients who underwent lung lobectomy, lower anterior resection of the rectum (LAR), liver wedge resection or total hysterectomy for a cancer indication have significantly increased hospital resource utilization compared to these same surgeries for benign indications.
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Affiliation(s)
- Iftekhar Kalsekar
- Medical Devices- Epidemiology, Johnson & Johnson, New Brunswick, NJ, USA.
| | - Chia-Wen Hsiao
- Franchise Health Economics and Market Access, Ethicon, Inc, Cincinnati, OH, USA
| | - Hang Cheng
- Franchise Health Economics and Market Access, Ethicon, Inc, Cincinnati, OH, USA
| | - Sashi Yadalam
- Medical Devices- Epidemiology, Johnson & Johnson, New Brunswick, NJ, USA
| | - Brian Po-Han Chen
- Franchise Health Economics and Market Access, Ethicon, Inc, Cincinnati, OH, USA
| | - Laura Goldstein
- Franchise Health Economics and Market Access, Ethicon, Inc, Cincinnati, OH, USA
| | - Andrew Yoo
- Medical Devices- Epidemiology, Johnson & Johnson, New Brunswick, NJ, USA
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The robotic approach significantly reduces length of stay after colectomy: a propensity score-matched analysis. Int J Colorectal Dis 2017; 32:1415-1421. [PMID: 28685223 DOI: 10.1007/s00384-017-2845-1] [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] [Accepted: 06/20/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE Robotic surgery has helped overcome several of the inherent limitations of conventional laparoscopy. The aim of this study is to identify any short-term advantage of robotic-assisted (RC) over laparoscopic colectomy (LC) using standardized nationwide data. METHODS Patients from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) 2012-2014 datasets who underwent elective LC or RC were compared for patient demographics, comorbidity, diagnosis, extent of colon resection, operative duration, and conversion rates. Thirty-day postoperative complications and post-discharge utilization of resources, readmission, and discharge to another facility were also evaluated. Propensity score matching was used to balance the sample size in the two groups. RESULTS Of 35,839 LC and RC procedures, 2482 cases were eligible for propensity score matching for the statistically significant variables (standardized difference > 0.10) and 1241 colectomy procedures were assigned to each group. Most of the major, minor surgical, and medical postoperative complications were comparable between the two groups. However, RC was associated with reduced 30-day postoperative septic complications (2.3 vs. 4%, p = 0.02), hospital stay (mean: 4.8 vs. 6.3 days, p = 0.001), and discharge to another facility (3.5 vs. 5.8%, p = 0.01). RC was, however, associated with readmission within 30 days after surgery (9.4 vs. 9.1%, p = 0.049). Postoperative ileus, anastomotic leak, reoperation, reintubation, and mortality were equivalent between RC and LC. CONCLUSION This propensity score-matched analysis suggests that RC is associated with some recovery benefits over LC. Greater experience with the technique may allow these advantages to counter some of the cost-related concerns that have deterred the more widespread utilization of robotic technology for colectomy.
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25
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Protocol for enhanced recovery after surgery improves short-term outcomes for patients with gastric cancer: a randomized clinical trial. Gastric Cancer 2017; 20:861-871. [PMID: 28062937 DOI: 10.1007/s10120-016-0686-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 12/22/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND The feasibility of the use of the enhanced recovery after surgery (ERAS) protocol in patients with gastric cancer remains unclear. METHODS This study was a single-center, prospective randomized trial involving patients with gastric cancer undergoing curative gastrectomy. The primary end point was the length of postoperative hospital stay. Secondary end points were the postoperative complication rate, admission costs, weight loss, and amount of physical activity. RESULTS From July 2013 to June 2015, we randomized 148 patients into an ERAS protocol group (n = 73) and a conventional protocol group (n = 69); six patients withdrew from the study. The hospital stay was significantly shorter in the ERAS protocol group than in the conventional protocol group (9 days vs 10 days; P = 0.037). The ERAS protocol group had a significantly lower rate of postoperative complications of grade III or higher (4.1% vs 15.4%; P = 0.042) and reduced costs of hospitalization (JPY 1,462,766 vs JPY 1,493,930; P = 0.045). The ratio of body weight to preoperative weight at 1 week and 1 month after the operation was higher in the ERAS protocol group (0.962 vs 0.957, P = 0.020, and 0.951 vs 0.937, P = 0.021, respectively). The ERAS protocol group recorded more physical activity in the first week after surgery. CONCLUSIONS The ERAS protocol is safe and efficient, and seems to improve the postoperative course of patients with gastric cancer.
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26
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Braga M, Borghi F, Scatizzi M, Missana G, Guicciardi MA, Bona S, Ficari F, Maspero M, Pecorelli N. Impact of laparoscopy on adherence to an enhanced recovery pathway and readiness for discharge in elective colorectal surgery: Results from the PeriOperative Italian Society registry. Surg Endosc 2017; 31:4393-4399. [PMID: 28289972 DOI: 10.1007/s00464-017-5486-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 02/20/2017] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Previous studies reported that laparoscopic surgery (LPS) improved postoperative outcomes in patients undergoing colorectal surgery within an enhanced recovery program (ERP). However, the effect of minimally invasive surgery on each ERP item has not been clarified, yet. The aim of this study is to assess the impact of LPS on adherence to ERP items and recovery as measured by time to readiness for discharge (TRD). METHODS Prospectively collected data entered in an electronic Italian registry specifically designed for ERP were reviewed. Patients undergoing elective colorectal surgery were divided into three groups: successful laparoscopy, conversion to open surgery, primary open surgery. Adherence to 19 ERP elements and postoperative outcomes were compared among groups. Multivariate regression analysis was used to identify whether LPS had an independent role to improve ERP adherence and postoperative outcomes. RESULTS 714 patients (successful LPS 531, converted 42, open 141) underwent elective colorectal surgery within an ERP. Epidural analgesia was used in the 75.1% of open group patients versus 49.9% of LPS group patients (p = 0.012). After surgery, oral feeding recovery, i.v. fluids suspension, removal of both urinary and epidural catheters occurred earlier in the LPS group both in the overall series and in uneventful patients only. Mean TRD and length of hospital stay were significantly shorter in the LPS group (p < 0.001 for both). Overall morbidity rate was 18.7% in the LPS group versus 32.6% in the open group (p = 0.001). At multivariate analysis, LPS was significantly associated to an increased adherence to postoperative ERP items, a shorter TRD, and a reduced overall morbidity, whereas rectal surgery and new stoma formation impaired postoperative recovery. CONCLUSIONS The present study showed that a successful laparoscopic procedure had an independent role to increase the adherence to postoperative ERP and to improve short-term postoperative outcome.
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Affiliation(s)
- Marco Braga
- Department of Surgery, Vita-Salute University, San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy.
| | | | | | | | | | - Stefano Bona
- Department of Surgery, Humanitas Hospital IRCCS, Rozzano, Italy
| | - Ferdinando Ficari
- Department of Surgery, Careggi Hospital, University of Florence, Florence, Italy
| | - Marianna Maspero
- Department of Surgery, Vita-Salute University, San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy
| | - Nicolò Pecorelli
- Department of Surgery, Vita-Salute University, San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy
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27
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Altobelli E, Buscarini M, Gill HS, Skinner EC. Readmission Rate and Causes at 90-Day after Radical Cystectomy in Patients on Early Recovery after Surgery Protocol. Bladder Cancer 2017; 3:51-56. [PMID: 28149935 PMCID: PMC5271433 DOI: 10.3233/blc-160061] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Radical cystectomy (RC) is associated with high risk of early and late perioperative complications, and readmissions. The Enhanced Recovery After Surgery (ERAS) protocol has been applied to RC showing decreased hospital stay without increased morbidity. Objective: To evaluate the specific causes of hospital readmissions in RC patients treated before and after adoption of an ERAS protocol at our institution. Methods: We retrospectively evaluated the outcome of 207 RC patients on ERAS protocol at the Stanford University Hospital from January 2012 to December 2014. We focused on early (30-day) and late (90-day) postoperative readmission rate and causes. Results were compared with a pre-ERAS consecutive series of 177 RC patients from January 2009 to December 2011. Results: In the post-ERAS time period a total of 56 patients were readmitted, 41 within the first 30 days after surgery (20%) and 15 within the following 60 days (7%). Fever, often associated with dehydration, was the most common reason for presentation to the hospital, accounting for 57% of all readmissions. At 90 days infection accounted for 53% of readmissions. Of all the patients readmitted during the first 90 days after surgery, 32 had positive urine cultures, mostly caused by Enterococcus faecalis isolated in 18 (56%). Readmission rates did not increase since the introduction of the ERAS protocol, with an incidence of 27% in the post-ERAS group versus 30% in the pre-ERAS group. Conclusions: Despite accurate adherence to most recent perioperative antibiotic guidelines, the incidence of readmissions after RC due to infection still remains significant.
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Affiliation(s)
- Emanuela Altobelli
- Department of Urology, Campus Biomedico University of Rome , Rome, Italy
| | - Maurizio Buscarini
- Department of Urology, Campus Biomedico University of Rome , Rome, Italy
| | - Harcharan S Gill
- Department of Urology, Stanford University School of Medicine , Stanford, CA, USA
| | - Eila C Skinner
- Department of Urology, Stanford University School of Medicine , Stanford, CA, USA
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Yang Y, Zuo HQ, Li Z, Qin YZ, Mo XW, Huang MW, Lai H, Wu LC, Chen JS. Comparison of efficacy of simo decoction and acupuncture or chewing gum alone on postoperative ileus in colorectal cancer resection: a randomized trial. Sci Rep 2017; 7:37826. [PMID: 28102199 PMCID: PMC5244388 DOI: 10.1038/srep37826] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 11/02/2016] [Indexed: 01/21/2023] Open
Abstract
To compared the ability of chewing gum or simo decoction (SMD) and acupuncture to reduce incidence of postoperative ileus (POI) after colorectal cancer resection, patients with colorectal cancer undergoing open or laparoscopic resection were randomized to receive SMD and acupuncture (n = 196), chewing gum alone (n = 197) or no intervention (n = 197) starting on postoperative day 1 and continuing for 5 consecutive days. Patients treated with SMD and acupuncture experienced significantly shorter hospital stay, shorter time to first flatus and shorter time to defecation than patients in the other groups (all P < 0.05). Incidence of grade I and II complications was also significantly lower in patients treated with SMD and acupuncture. Patients who chewed gum were similar to those who received no intervention in terms of hospital stay, incidence of complications, and time to first bowel motion, flatus, and defecation (all P > 0.05). The combination of SMD and acupuncture may reduce the incidence of POI and shorten hospital stay for patients with colorectal cancer after resection. In contrast, chewing gum does not appear to affect recovery of bowel function or hospital stay, though it may benefit patients who undergo open resection. (Clinicaltrials.gov registration number: NCT02813278).
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Affiliation(s)
- Yang Yang
- Department of Gastrointestinal Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, PR China
| | - Hong-Qun Zuo
- Department of Gastrointestinal Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, PR China
| | - Zhao Li
- Department of Gastrointestinal Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, PR China
| | - Yu-Zhou Qin
- Department of Gastrointestinal Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, PR China
| | - Xian-Wei Mo
- Department of Gastrointestinal Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, PR China
| | - Ming-Wei Huang
- Department of Gastrointestinal Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, PR China
| | - Hao Lai
- Department of Gastrointestinal Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, PR China
| | - Liu-Cheng Wu
- Department of Gastrointestinal Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, PR China
| | - Jian-Si Chen
- Department of Gastrointestinal Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, PR China
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Protocol for enhanced recovery after surgery improves short-term outcomes for patients with gastric cancer: a randomized clinical trial. GASTRIC CANCER : OFFICIAL JOURNAL OF THE INTERNATIONAL GASTRIC CANCER ASSOCIATION AND THE JAPANESE GASTRIC CANCER ASSOCIATION 2017. [PMID: 28062937 DOI: 10.1007/s10120-016-0686–1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The feasibility of the use of the enhanced recovery after surgery (ERAS) protocol in patients with gastric cancer remains unclear. METHODS This study was a single-center, prospective randomized trial involving patients with gastric cancer undergoing curative gastrectomy. The primary end point was the length of postoperative hospital stay. Secondary end points were the postoperative complication rate, admission costs, weight loss, and amount of physical activity. RESULTS From July 2013 to June 2015, we randomized 148 patients into an ERAS protocol group (n = 73) and a conventional protocol group (n = 69); six patients withdrew from the study. The hospital stay was significantly shorter in the ERAS protocol group than in the conventional protocol group (9 days vs 10 days; P = 0.037). The ERAS protocol group had a significantly lower rate of postoperative complications of grade III or higher (4.1% vs 15.4%; P = 0.042) and reduced costs of hospitalization (JPY 1,462,766 vs JPY 1,493,930; P = 0.045). The ratio of body weight to preoperative weight at 1 week and 1 month after the operation was higher in the ERAS protocol group (0.962 vs 0.957, P = 0.020, and 0.951 vs 0.937, P = 0.021, respectively). The ERAS protocol group recorded more physical activity in the first week after surgery. CONCLUSIONS The ERAS protocol is safe and efficient, and seems to improve the postoperative course of patients with gastric cancer.
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30
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Macciò A, Lavra F, Chiappe G, Kotsonis P, Sollai G, Zamboni F, Madeddu C. Combined laparoscopic excisional surgery for synchronous endometrial and rectal adenocarcinoma in an obese woman. J OBSTET GYNAECOL 2016; 36:1012-1015. [PMID: 27750462 DOI: 10.1080/01443615.2016.1234444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Antonio Macciò
- a Department of Gynaecologic Oncology , Azienda Ospedaliera Brotzu , Cagliari , Italy
| | - Fabrizio Lavra
- a Department of Gynaecologic Oncology , Azienda Ospedaliera Brotzu , Cagliari , Italy
| | - Giacomo Chiappe
- a Department of Gynaecologic Oncology , Azienda Ospedaliera Brotzu , Cagliari , Italy
| | - Paraskevas Kotsonis
- a Department of Gynaecologic Oncology , Azienda Ospedaliera Brotzu , Cagliari , Italy
| | - Giuseppe Sollai
- b Department of Oncological Surgery , Azienda Ospedaliera Brotzu , Cagliari , Italy
| | - Fausto Zamboni
- c Department of General Surgery , Azienda Ospedaliera Brotzu , Cagliari , Italy
| | - Clelia Madeddu
- d Department of Medical Sciences 'Mario Aresu' , University of Cagliari , Cagliari , Italy
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Thorn CC, White I, Burch J, Malietzis G, Kennedy R, Jenkins JT. Active and passive compliance in an enhanced recovery programme. Int J Colorectal Dis 2016; 31:1329-39. [PMID: 27112591 DOI: 10.1007/s00384-016-2588-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/08/2016] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Enhanced recovery after surgery (ERAS) is a well-established and accepted practice following colorectal surgery and has been demonstrated to reduce hospital length of stay (LOS) and 30-day morbidity. Despite evidence to support the individual elements on which the programme is based, there remains uncertainty as to how many and which of these are required to realise its benefits. Furthermore, elements of an ERAS programme might either precipitate or reflect recovery, in which case compliance could have a role in the improvement or prediction of outcome. MATERIALS AND METHODS A multidimensional prospective database of 799 consecutive patients undergoing colorectal surgery within an established ERAS programme at a single institution was interrogated. After application of exclusion criteria, 614 patients were studied. The novel concept of 'active compliance' is introduced. An ERAS element is classified as 'active' if the participation of the patient is required to achieve its compliance. This contrasts with 'passive' compliance, where an intervention is delivered to the patient without their direct contribution. The short-term surgical outcomes of this cohort are reported with reference to ERAS protocol compliance. RESULTS Compliance with the passive elements of the programme was higher than with the active elements. Univariate and multivariate analyses demonstrate that poor compliance with active but not passive elements of the programme was significantly associated with major morbidity. Receiver operator characteristic curve analysis demonstrated active compliance to be a stronger predictor of both major morbidity (AUC 0.71 vs. AUC 0.56) and length of stay (AUC 0.83 vs. 0.57) when compared with passive compliance. CONCLUSION The results suggest that poor active compliance may be a surrogate marker of morbidity which can be recognised in the early post-operative period. This implies the potential for timely diagnosis and intervention. This aspect of ERAS compliance is clinically relevant yet has achieved scant attention. Independent validation of our observations is required.
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Affiliation(s)
| | - Ian White
- St. Mark's Hospital, Watford Road, Harrow, London, HA1 3UJ, UK
| | - Jennie Burch
- St. Mark's Hospital, Watford Road, Harrow, London, HA1 3UJ, UK
| | | | - Robin Kennedy
- St. Mark's Hospital, Watford Road, Harrow, London, HA1 3UJ, UK
| | - John T Jenkins
- St. Mark's Hospital, Watford Road, Harrow, London, HA1 3UJ, UK.
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32
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Evaluation and Impact of Workflow Interruptions During Robot-assisted Surgery. Urology 2016; 92:33-7. [DOI: 10.1016/j.urology.2016.02.040] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 02/24/2016] [Accepted: 02/26/2016] [Indexed: 11/22/2022]
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