1
|
Laparoscopic versus Robotic Hepatectomy: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11195831. [PMID: 36233697 PMCID: PMC9571364 DOI: 10.3390/jcm11195831] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/28/2022] [Accepted: 09/24/2022] [Indexed: 12/02/2022] Open
Abstract
This study aimed to assess the surgical outcomes of robotic compared to laparoscopic hepatectomy, with a special focus on the meta-analysis method. Original studies were collected from three Chinese databases, PubMed, EMBASE, and Cochrane Library databases. Our systematic review was conducted on 682 patients with robotic liver resection, and 1101 patients were operated by laparoscopic platform. Robotic surgery has a long surgical duration (MD = 43.99, 95% CI: 23.45-64.53, p = 0.0001), while there is no significant difference in length of hospital stay (MD = 0.10, 95% CI: -0.38-0.58, p = 0.69), blood loss (MD = -20, 95% CI: -64.90-23.34, p = 0.36), the incidence of conversion (OR = 0.84, 95% CI: 0.41-1.69, p = 0.62), and tumor size (MD = 0.30, 95% CI: -0-0.60, p = 0.05); the subgroup analysis of major and minor hepatectomy on operation time is (MD = -7.08, 95% CI: -15.22-0.07, p = 0.09) and (MD = 39.87, 95% CI: -1.70-81.44, p = 0.06), respectively. However, despite the deficiencies of robotic hepatectomy in terms of extended operation time compared to laparoscopic hepatectomy, robotic hepatectomy is still effective and equivalent to laparoscopic hepatectomy in outcomes. Scientific evaluation and research on one portion of the liver may produce more efficacity and more precise results. Therefore, more clinical trials are needed to evaluate the clinical outcomes of robotic compared to laparoscopic hepatectomy.
Collapse
|
2
|
Wang W, Zhou Z, Dai X, Wang H, Jin J, Min K, Wang Y, Lv M, Liu Y, Zhou Y. LncRNA-ENST00000543604 exerts a tumor-promoting effect via miRNA 564/AEG-1 or ZNF326/EMT and predicts the prognosis of and chemotherapeutic effect in colorectal cancer. Front Oncol 2022; 12:960481. [PMID: 36081570 PMCID: PMC9445881 DOI: 10.3389/fonc.2022.960481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/01/2022] [Indexed: 11/26/2022] Open
Abstract
Objectives Colorectal cancer(CRC) is a common malignant tumor. Recent studies have found that lncRNAs play an important role in the occurrence and development of colorectal cancer. Methods Based on high-throughput sequencing results of fresh CRC tissues and adjacent tissues, we identified lncRNA-ENST00000543604 (lncRNA 604) as the research object by qRT-PCR in CRC tissues and cells. We explored the mechanism of lncRNA 604 action by using luciferin reporter, qRT-PCR and Western blot assays. Kaplan-Meier survival analysis and a Cox regression model were used to analyze the correlation of lncRNA 604 and its regulatory molecules with the prognosis of and chemotherapy efficacy in CRC patients. Results In this study, we found that the expression levels of lncRNA 604 were increased in CRC. LncRNA 604 could promote CRC cell proliferation and metastasis through the miRNA 564/AEG-1 or ZNF326/EMT signaling axis in vivo and in vitro. LncRNA 604 could predict the prognosis of CRC and was an independent negative factor. LncRNA 604 exerted a synergistic effect with miRNA 564 or ZNF326 on the prognosis of CRC. LncRNA 604 could improve chemoresistance by increasing the expression of AEG-1, NF-κB, and ERCC1. Conclusions Our study demonstrated that lncRNA 604 could promote the progression of CRC via the lncRNA 604/miRNA 564/AEG-1/EMT or lncRNA 604/ZNF326/EMT signaling axis. LncRNA 604 could improve chemoresistance by increasing drug resistance protein expression.
Collapse
Affiliation(s)
- Weimin Wang
- Institute of Combining Chinese Traditional and Western Medicine, Medical College, Yangzhou University, Jiangsu, China
- Department of Oncology, Yixing Hospital Affiliated to Medical College of Yangzhou University, Yangzhou University, Jiangsu, China
| | - Zhen Zhou
- Institute of Combining Chinese Traditional and Western Medicine, Medical College, Yangzhou University, Jiangsu, China
- Department of Chinese Medicine, Nanjing University of Chinese Medicine, Jiangsu, Nanjing, China
| | - Xiaojun Dai
- Institute of Combining Chinese Traditional and Western Medicine, Medical College, Yangzhou University, Jiangsu, China
| | - Haibo Wang
- Institute of Combining Chinese Traditional and Western Medicine, Medical College, Yangzhou University, Jiangsu, China
| | - Jun Jin
- Department of Oncology, Yixing Hospital Affiliated to Medical College of Yangzhou University, Yangzhou University, Jiangsu, China
| | - Ke Min
- Department of Oncology, Yixing Hospital Affiliated to Medical College of Yangzhou University, Yangzhou University, Jiangsu, China
| | - Yunfan Wang
- Department of Oncology, Yixing Hospital Affiliated to Medical College of Yangzhou University, Yangzhou University, Jiangsu, China
| | - Mengying Lv
- Institute of Combining Chinese Traditional and Western Medicine, Medical College, Yangzhou University, Jiangsu, China
| | - Yanqing Liu
- Institute of Combining Chinese Traditional and Western Medicine, Medical College, Yangzhou University, Jiangsu, China
- Department of Oncology, Yixing Hospital Affiliated to Medical College of Yangzhou University, Yangzhou University, Jiangsu, China
- *Correspondence: Yanqing Liu, ; Yan Zhou,
| | - Yan Zhou
- Institute of Combining Chinese Traditional and Western Medicine, Medical College, Yangzhou University, Jiangsu, China
- Department of Oncology, Yixing Hospital Affiliated to Medical College of Yangzhou University, Yangzhou University, Jiangsu, China
- *Correspondence: Yanqing Liu, ; Yan Zhou,
| |
Collapse
|
3
|
Naffouje SA, Ali MA, Kamarajah SK, White B, Salti GI, Dahdaleh F. Assessment of Textbook Oncologic Outcomes Following Proctectomy for Rectal Cancer. J Gastrointest Surg 2022; 26:1286-1297. [PMID: 35441331 DOI: 10.1007/s11605-021-05213-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/20/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Outcomes of rectal adenocarcinoma vary considerably. Composite "textbook oncologic outcome" (TOO) is a single metric that estimates optimal clinical performance for cancer surgery. METHODS Patients with stage II/III rectal adenocarcinoma who underwent single-agent neoadjuvant chemoradiation and proctectomy within 5-12 weeks were identified in the National Cancer Database (NCDB). TOO was defined as achievement of negative distal and circumferential resection margin (CRM), retrieval of ≥ 12 nodes, no 90-day mortality, and length of stay (LOS) < 75th percentile of corresponding year's range. Multivariable logistic regression was used to identify predictors of TOO. RESULTS Among 318,225 patients, 8869 met selection criteria. Median age was 62 years (IQR 54-71), and 5550 (62.6%) were males. Low anterior resection was the most common procedure (LAR, 6,037 (68.1%) and 3084 (34.8%) were treated at a high-volume center (≥ 20 rectal resections/year). TOO was achieved in 3967 patients (44.7%). Several components of TOO were achieved commonly, including negative CRM (87.4%), no 90-day mortality (98.0%), no readmission (93.0%), and no prolonged hospitalization (78.8%). Logistic regression identified increasing age, non-private insurance, low-volume centers, open approach, Black race, Charlson score ≥ 3, and abdominoperineal resection (APR) as predictors of failure to achieve TOO. Over time, TOOs were attained more commonly which correlated with increased minimally invasive surgery (MIS) adoption. TOO achievement was associated with improved survival. CONCLUSIONS Rectal adenocarcinoma patients achieve TOO uncommonly. Treatment at high-volume centers and MIS approach were among modifiable factors associated with TOO in this study.
Collapse
Affiliation(s)
- Samer A Naffouje
- Department of Surgical Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Muhammed A Ali
- Department of Surgery, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Trust, Birmingham, UK
| | - Sivesh K Kamarajah
- Department of Surgery, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Trust, Birmingham, UK
| | - Bradley White
- Department of General Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
| | - George I Salti
- Department of General Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA.,Department of Surgical Oncology, Edward-Elmhurst Health, 120 Spalding Drive, Ste 205, Naperville, IL, 60540, USA
| | - Fadi Dahdaleh
- Department of Surgical Oncology, Edward-Elmhurst Health, 120 Spalding Drive, Ste 205, Naperville, IL, 60540, USA.
| |
Collapse
|
4
|
Predicting Hospital Length of Stay at Admission Using Global and Country-Specific Competing Risk Analysis of Structural, Patient, and Nutrition-Related Data from nutritionDay 2007-2015. Nutrients 2021; 13:nu13114111. [PMID: 34836366 PMCID: PMC8624242 DOI: 10.3390/nu13114111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/04/2021] [Accepted: 11/09/2021] [Indexed: 11/23/2022] Open
Abstract
Hospital length of stay (LOS) is an important clinical and economic outcome and knowing its predictors could lead to better planning of resources needed during hospitalization. This analysis sought to identify structure, patient, and nutrition-related predictors of LOS available at the time of admission in the global nutritionDay dataset and to analyze variations by country for countries with n > 750. Data from 2006–2015 (n = 155,524) was utilized for descriptive and multivariable cause-specific Cox proportional hazards competing-risks analyses of total LOS from admission. Time to event analysis on 90,480 complete cases included: discharged (n = 65,509), transferred (n = 11,553), or in-hospital death (n = 3199). The median LOS was 6 days (25th and 75th percentile: 4–12). There is robust evidence that LOS is predicted by patient characteristics such as age, affected organs, and comorbidities in all three outcomes. Having lost weight in the last three months led to a longer time to discharge (Hazard Ratio (HR) 0.89; 99.9% Confidence Interval (CI) 0.85–0.93), shorter time to transfer (HR 1.40; 99.9% CI 1.24–1.57) or death (HR 2.34; 99.9% CI 1.86–2.94). The impact of having a dietician and screening patients at admission varied by country. Despite country variability in outcomes and LOS, the factors that predict LOS at admission are consistent globally.
Collapse
|
5
|
Enhanced Recovery: A Decade of Experience and Future Prospects at the Mayo Clinic. HEALTHCARE (BASEL, SWITZERLAND) 2021; 9:healthcare9050549. [PMID: 34066696 PMCID: PMC8150975 DOI: 10.3390/healthcare9050549] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/26/2021] [Accepted: 04/12/2021] [Indexed: 02/07/2023]
Abstract
This work aims to describe the implementation and subsequent learnings from the first decade after the full implementation of enhanced recovery pathway for colorectal surgery at a single institution. This paper will describe the diffusion efforts and plans through the Define, Measure, Analyze, Improve, Control (DMAIC) process of ongoing quality improvement and through research efforts. The information applies to all readers that provide surgical care within their organization as the fundamental principles of enhanced recovery for surgery are applicable regardless of the setting.
Collapse
|
6
|
Zorrilla-Vaca A, Mena GE, Cata J, Healy R, Grant MC. Enhanced Recovery Programs for Colorectal Surgery and Postoperative Acute Kidney Injury: Results From a Systematic Review and Meta-Analysis of Observational Studies. Am Surg 2020; 87:1444-1451. [PMID: 33375852 DOI: 10.1177/0003134820954846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Enhanced recovery programs (ERPs) for colorectal surgery bundle evidence-based measures to reduce complications, accelerate postoperative recovery, and improve the value of perioperative health care. Despite these successes, several recent studies have identified an association between ERPs and postoperative acute kidney injury (AKI). We conducted a systematic review and meta-analysis to determine the association between ERPs for colorectal surgery and postoperative AKI. METHODOLOGY After conducting a search of major databases (PubMed, Embase, Scopus, Google Scholar, and ScienceDirect), we conducted a meta-analysis of observational studies that reported on the association between ERPs and postoperative AKI. RESULTS Six observational studies (n = 4765 patients) comparing ERP (n = 2140) to conventional care (n = 2625) were included. Overall, ERP patients had a significantly greater odds of developing postoperative AKI (odds ratio [OR] = 1.98, 95% confidence interval [CI] 1.31-3.00, P = .001) than those who received conventional care. There was no evidence of publication bias (Begg's test P = 1.0, Egger's P value = .95). CONCLUSIONS Based upon pooled results from observational studies, ERPs are associated with increased odds of developing postoperative AKI compared to conventional perioperative care. The mechanism for this effect is likely multifactorial. Additional research targeting high risk patient populations should evaluate the role of restrictive fluid administration, hemodynamic goals, and scheduled nephrotoxic agents in ERP protocols.
Collapse
Affiliation(s)
- Andrés Zorrilla-Vaca
- Department of Anesthesiology, MD Anderson Cancer Center, 4002University of Texas, Houston, TX, USA
| | - Gabriel E Mena
- Department of Anesthesiology, MD Anderson Cancer Center, 4002University of Texas, Houston, TX, USA
| | - Juan Cata
- Department of Anesthesiology, MD Anderson Cancer Center, 4002University of Texas, Houston, TX, USA.,Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA
| | - Ryan Healy
- School of Medicine, 1846Boston University, Boston, MA, USA
| | - Michael C Grant
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
7
|
Fahim M, Visser RA, Dijksman LM, Biesma DH, Noordzij PG, Smits AB. Routine postoperative intensive care unit admission after colorectal cancer surgery for the elderly patient reduces postoperative morbidity and mortality. Colorectal Dis 2020; 22:408-415. [PMID: 31696590 DOI: 10.1111/codi.14902] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 10/18/2019] [Indexed: 02/08/2023]
Abstract
AIM Older colorectal cancer (CRC) patients are at increased risk of postoperative morbidity and mortality. Routine postoperative overnight intensive care unit (ICU) admission might reduce this risk. This study aimed to examine the effect of routine overnight ICU admission after CRC surgery on postoperative adverse outcomes and costs in patients aged 80 years or older. METHODS Patients aged 80 years or older who underwent CRC surgery in our centre were included in this observational cohort study. All patients in the period 2014-2017 with routine overnight ICU admission were assigned to the ICU cohort; all patients in the period 2009-2013 were assigned to the non-ICU cohort. Multivariable logistic regression was performed to compare the primary composite end-point (30-day mortality, serious complications and readmission) between the groups. Cost data from the literature were used to perform a cost analysis. RESULTS A total of 242 patients were included, 125 in the ICU cohort and 117 in the non-ICU cohort. Routine overnight ICU admission was associated with a reduced risk of the composite end-point (OR 0.44, 95% CI 0.22-0.87, P = 0.02) after adjusting for important confounders. In the ICU cohort 28% of patients experienced ICU events requiring intervention; this was not associated with postoperative morbidity or mortality. The 9% reduction in the incidence of serious complications in the ICU cohort is sufficient to offset the additional costs of routine overnight ICU admission. CONCLUSION Routine overnight ICU admission after CRC surgery in patients aged 80 years and older is associated with reduced risk of postoperative mortality and morbidity and seems to be cost-effective.
Collapse
Affiliation(s)
- M Fahim
- Department of Value Based Healthcare, St Antonius Hospital, Nieuwegein, The Netherlands.,Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
| | - R A Visser
- Department of Anesthesiology and Intensive Care, St Antonius Hospital, Nieuwegein, The Netherlands
| | - L M Dijksman
- Department of Value Based Healthcare, St Antonius Hospital, Nieuwegein, The Netherlands
| | - D H Biesma
- Department of Value Based Healthcare, St Antonius Hospital, Nieuwegein, The Netherlands
| | - P G Noordzij
- Department of Anesthesiology and Intensive Care, St Antonius Hospital, Nieuwegein, The Netherlands
| | - A B Smits
- Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
| |
Collapse
|
8
|
Grass F, Lovely JK, Crippa J, Hübner M, Mathis KL, Larson DW. Potential Association Between Perioperative Fluid Management and Occurrence of Postoperative Ileus. Dis Colon Rectum 2020; 63:68-74. [PMID: 31633601 DOI: 10.1097/dcr.0000000000001522] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Postoperative ileus remains an issue after colorectal surgery delaying recovery and increasing the length of hospital stay and costs. OBJECTIVE The purpose of this study was to analyze the impact of perioperative fluid management on ileus occurrence after colorectal surgery within a fully implemented enhanced recovery pathway. DESIGN This was a retrospective cohort study of a prospectively maintained institutional database. SETTINGS The study was conducted at a tertiary academic facility with fully implemented standardized enhanced recovery pathway over the entire study period. PATIENTS All of the consecutive elective major colorectal resections for benign or malign indications between 2011 and 2016 were included. MAIN OUTCOME MEASURES Postoperative ileus was defined as the need for nasogastric tube reinsertion. Perioperative fluid management and surgical outcome were compared between patients presenting with ileus and those without. Potential risk factors for ileus were identified through multinomial logistic regression. RESULTS Postoperative ileus occurred in 377 (9%) of 4205 included patients at day 4 (interquartile range, 2-5 d). Intraoperatively, ileus patients received 3.2 ± 2.6 L of fluids, whereas the remaining patients received 2.5 ± 1.7 L (p < 0.001). Weight gain was 3.8 ± 7.1 kg in ileus patients versus 3.0 ± 6.6 kg (p = 0.272) in the remaining patients at postoperative day 1, 4.4 ± 6.5 kg versus 3.1 ± 7.0 kg (p = 0.028) at postoperative day 2, and 1.8 ± 6.0 kg versus 0.0 ± 6.0 kg at discharge (p = 0.002). The multivariable model including all significant (p < 0.05) demographic, fluid management-related, and surgical parameters retained postoperative day 0 fluids of >3 L (OR = 1.65 (95% CI, 1.13-2.41); p = 0.009), postoperative day 2 weight gain of >2.5 kg (OR = 1.49 (95% CI, 1.01-2.21); p = 0.048), and occurrence of postoperative complications (OR = 2.00 (95% CI, 1.39-2.90); p < 0.001) as independent risk factors for ileus. LIMITATIONS This study was limited by its retrospective design. Fluid management depends on patient-, disease-, and surgery-related factors and cannot be generalized and extrapolated. CONCLUSIONS Fluid overload and occurrence of postoperative complications were independent risk factors for postoperative ileus. This calls for action to keep perioperative fluids below suggested thresholds. See Video Abstract at http://links.lww.com/DCR/B54. ASOCIACIÓN POTENCIAL ENTRE EL MANEJO DEL LÍQUIDO PERIOPERATORIO Y EL SUCESO DE ÍLEO POSTOPERATORIO: El íleo postoperatorio sigue siendo un problema después de una cirugía colorrectal que retrasa la recuperación y aumenta la duración de la estancia hospitalaria y los costos.Analizar el impacto del manejo del líquido perioperatorio en la incidencia de íleo después de la cirugía colorrectal dentro de una vía de recuperación mejorada totalmente implementada.Estudio de cohorte retrospectivo de una base de datos institucional mantenida prospectivamente.Centro académico terciario con una ruta de recuperación mejorada estandarizada completamente implementada durante todo el período del estudio.Se incluyeron todas las resecciones colorrectales mayores electivas consecutivas para indicaciones benignas o malignas entre 2011 y 2016.El íleo postoperatorio se definió como la necesidad de reinserción de la sonda nasogástrica. El manejo del líquido perioperatorio y el resultado quirúrgico se compararon entre los pacientes con íleo y los que no. Los posibles factores de riesgo para el íleo se identificaron mediante regresión logística multinominal.El íleo postoperatorio se ocurrió en 377 (9%) de los 4205 pacientes incluidos al cuarto día (RIC 2-5). Intraoperatoriamente, los pacientes con íleo recibieron 3.2 ± 2.6 L de líquidos, mientras que los pacientes restantes recibieron 2.5 ± 1.7 L (p < 0.001). El aumento de peso fue de 3.8 ± 7.1 kg en pacientes con íleo versus 3 ± 6.6 kg (p = 0.272) en los pacientes restantes en el día postoperatorio 1, 4.4 ± 6.5 kg vs. 3.1 ± 7 kg (p = 0.028) en el día postoperatorio 2 y 1.8 ± 6 kg versus a 0 ± 6 kg al tiempo de alta hospitalaria (p = 0.002). El modelo multivariable que incluye todos los parámetros demográficos, del manejo de líquidos y quirúrgicos significativos (p <0.05) mantuvo líquidos del día 0 después de la operación de> 3L (proporción de probabilidad 1.65, intervalo de confianza del 95% 1.13-2.41, p = 0.009), ganancia de peso de > 2.5 kg en el dia postoperatorio 2 (proporción de probabilidad 1.49, 95% intervalo de confianza 1.01-2.21, p = 0.048) y aparición de complicaciones postoperatorias (proporción de probabilidad 2, 95% intervalo de confianza 1.39-2.9, p <0.001) como factores de riesgo independientes para íleo.Diseño retrospectivo. El manejo de líquidos depende de factores relacionados con el paciente, la enfermedad y la cirugía, y no puede generalizarse ni extrapolarse.La sobrecarga de líquidos y la aparición de complicaciones postoperatorias fueron factores de riesgo independientes para el íleo postoperatorio. Esto requiere medidas para mantener los líquidos perioperatorios por debajo de los umbrales sugeridos. Vea el Video del Resumen en http://links.lww.com/DCR/B54.
Collapse
Affiliation(s)
- Fabian Grass
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota.,Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Jenna K Lovely
- Hospital Pharmacy Services, Mayo Clinic, Rochester, Minnesota
| | - Jacopo Crippa
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota
| | - Martin Hübner
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Kellie L Mathis
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota
| | - David W Larson
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
9
|
Vicendese D, Marvelde LT, McNair PD, Whitfield K, English DR, Taieb SB, Hyndman RJ, Thomas R. Hospital characteristics, rather than surgical volume, predict length of stay following colorectal cancer surgery. Aust N Z J Public Health 2019; 44:73-82. [PMID: 31617657 DOI: 10.1111/1753-6405.12932] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/01/2019] [Accepted: 07/01/2019] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Length of hospital stay (LOS) is considered a vital component for successful colorectal surgery treatment. Evidence of an association between hospital surgery volume and LOS has been mixed. Data modelling techniques may give inconsistent results that adversely impact conclusions. This study applied techniques to overcome possible modelling drawbacks. METHOD An additive quantile regression model formulated to isolate hospital contextual effects was applied to every colorectal surgery for cancer conducted in Victoria, Australia, between 2005 and 2015, involving 28,343 admissions in 90 Victorian hospitals. The model compared hospitals' operational efficiencies regarding LOS. RESULTS Hospital LOS operational efficiencies for colorectal cancer surgery varied markedly between the 90 hospitals and were independent of volume. This result was adjusted for pertinent patient and hospital characteristics. CONCLUSION No evidence was found that higher annual surgery volume was associated with lower LOS for patients undergoing colorectal cancer surgery. Our model showed strong evidence that differences in LOS efficiency between hospitals was driven by hospital contextual effects that were not predicted by provider volume. Further study is required to elucidate these inherent differences between hospitals. Implications for public health: Our model indicated improved efficiency would benefit the patient and medical system by lowering LOS and reducing expenditure by more than $3 million per year.
Collapse
Affiliation(s)
- Don Vicendese
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria.,Cancer Strategy and Development, Department of Health and Human Services, Victoria
| | - Luc Te Marvelde
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria.,Cancer Strategy and Development, Department of Health and Human Services, Victoria
| | - Peter D McNair
- The Victorian Agency for Health Information, The Department of Health and Human Services, Victoria.,The Melbourne School of Population and Global Health, The University of Melbourne, Victoria
| | - Kathryn Whitfield
- Cancer Strategy and Development, Department of Health and Human Services, Victoria
| | - Dallas R English
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria.,Centre for Epidemiology and Biostatistics, The University of Melbourne, Victoria
| | - Souhaib Ben Taieb
- Department of Econometrics and Business Statistics, Monash University, Victoria
| | - Rob J Hyndman
- Department of Econometrics and Business Statistics, Monash University, Victoria
| | - Robert Thomas
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria
| |
Collapse
|
10
|
Grass F, Lovely JK, Crippa J, Mathis KL, Hübner M, Larson DW. Early Acute Kidney Injury Within an Established Enhanced Recovery Pathway: Uncommon and Transitory. World J Surg 2019; 43:1207-1215. [PMID: 30684001 DOI: 10.1007/s00268-019-04923-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND The present study aimed to assess the impact of perioperative fluid management on early acute kidney injury (AKI) rate and long-term sequelae in patients undergoing elective colorectal procedures within an enhanced recovery pathway (ERP). METHODS Retrospective analysis of consecutive patients from a prospectively maintained ERP database (2011-2015) is performed. Pre- and postoperative creatinine levels (within 24 h) were compared according to risk (preoperative creatinine rise ×1.5), injury (×2), failure (×3), loss of kidney function and end-stage kidney disease (RIFLE) criteria. Risk factors for early AKI were identified through logistic regression analysis, and long-term outcome in patients with AKI was assessed. RESULTS Out of 7103 patients, 4096 patients (58%) with pre- and postoperative creatinine levels were included. Of these, 104 patients (2.5%) presented postoperative AKI. AKI patients received higher amounts of POD 0 fluids (3.8 ± 2.4 vs. 3.2 ± 2 L, p = 0.01) and had increased postoperative weight gain at POD 2 (6 ± 4.9 vs. 3 ± 2.7 kg, p = 0.007). Independent risk factors for AKI were high ASA score (ASA ≥ 3: OR 1.7; 95% CI 1.1-2.5), prolonged operating time (>180 min: OR 1.9; 95% CI 1.3-2.9) and diabetes mellitus (OR 2.5; 95% CI 1.5-4), while minimally invasive surgery was a protective factor (OR 0.6; 95% CI 0.4-0.9). Five patients (0.1%) developed chronic kidney disease, and two of them needed dialysis after a mean follow-up of 33.7 ± 22.4 months. CONCLUSIONS Early AKI was very uncommon in the present cohort of colorectal surgery patients treated within an ERP, and long-term sequelae were exceptionally low.
Collapse
Affiliation(s)
- Fabian Grass
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Department of Visceral Surgery, Lausanne University Hospital CHUV, Bugnon 46, 1011, Lausanne, Switzerland
| | - Jenna K Lovely
- Hospital Pharmacy Services, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jacopo Crippa
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Kellie L Mathis
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Martin Hübner
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Bugnon 46, 1011, Lausanne, Switzerland
| | - David W Larson
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| |
Collapse
|
11
|
Orive M, Aguirre U, Gonzalez N, Lázaro S, Redondo M, Bare M, Anula R, Briones E, Escobar A, Sarasqueta C, Garcia-Gutierrez S, Quintana JM. Risk factors affecting hospital stay among patients undergoing colon cancer surgery: a prospective cohort study. Support Care Cancer 2019; 27:4133-4144. [PMID: 30793242 DOI: 10.1007/s00520-019-04683-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 09/26/2018] [Indexed: 02/03/2023]
Abstract
PURPOSE To identify and validate risk factors that contribute to prolonged length of hospital stay (LOS) in patients undergoing resection for colorectal cancer. METHODS This prospective cohort study included 1955 patients admitted to 22 hospitals for primary resection of colorectal cancer. Multivariate analyses were used to identify and validate risk factors, randomizing patients into a derivation and a validation cohort. Multiple correspondence and cluster analysis were performed to identify clinical subtypes based on LOS. RESULTS The strongest independent predictors of prolonged LOS were postoperative reintervention, surgical site infection, open surgery, and distant metastasis. The multiple correspondence and cluster analysis provided three groups of patients in relation to prolonged LOS: patients with the longest LOS included the highest percentage of patients with open surgery, distant metastasis, deep surgical site infections, emergency admissions, additional diagnostic factors, and highly contaminated surgical sites. Patients with prolonged LOS (> 14 days) were more likely to develop adverse outcomes within 30 days after discharge. CONCLUSIONS Patients undergoing resection of colorectal cancer cluster into different groups based on LOS of the index admission. Those with prolonged LOS were more likely to develop adverse outcomes within 30 days after discharge. Some of the strongest independent predictors of prolonged LOS, such as surgical infections or open surgery, could be modified to reduce LOS and, in turn, other adverse outcomes. TRIAL REGISTRATION NCT02488161.
Collapse
Affiliation(s)
- Miren Orive
- Research Unit, Hospital Galdakao-Usansolo, B° Labeaga s/n, 48960, Galdakao, Biscay, Spain.
- Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Spain.
| | - Urko Aguirre
- Research Unit, Hospital Galdakao-Usansolo, B° Labeaga s/n, 48960, Galdakao, Biscay, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Spain
| | - Nerea Gonzalez
- Research Unit, Hospital Galdakao-Usansolo, B° Labeaga s/n, 48960, Galdakao, Biscay, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Spain
| | - Santiago Lázaro
- General Surgery Service, Galdakao-Usansolo Hospital, Galdakao, Bizkaia, Spain
| | - Maximino Redondo
- Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Spain
- Research Unit, Hospital Costa del Sol, Málaga, Spain
| | - Marisa Bare
- Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Spain
- Clinical Epidemiology Unit, Corporacio Parc Tauli, Barcelona, Spain
| | - Rocío Anula
- Colorectal Unit, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Antonio Escobar
- Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Spain
- Research Unit, Basurto University Hospital, Basurto, Bilbao, Bizkaia, Spain
| | - Cristina Sarasqueta
- Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Spain
- Research Unit, Donostia University Hospital, Donostia-San Sebastian, Gipuzkoa, Spain
| | - Susana Garcia-Gutierrez
- Research Unit, Hospital Galdakao-Usansolo, B° Labeaga s/n, 48960, Galdakao, Biscay, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Spain
| | - José M Quintana
- Research Unit, Hospital Galdakao-Usansolo, B° Labeaga s/n, 48960, Galdakao, Biscay, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Spain
| |
Collapse
|
12
|
Lovely JK, Hyland SJ, Smith AN, Nelson G, Ljungqvist O, Parrish RH. Clinical pharmacist perspectives for optimizing pharmacotherapy within Enhanced Recovery After Surgery (ERAS ®) programs. Int J Surg 2019; 63:58-62. [PMID: 30665004 DOI: 10.1016/j.ijsu.2019.01.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 01/02/2019] [Accepted: 01/11/2019] [Indexed: 12/15/2022]
Abstract
One of the most durable approaches to perioperative enhanced recovery programming has culminated in the formation of perioperative organizations devoted to improvements in the quality of the surgical patient experience, such as the Enhanced Recovery After Surgery (ERAS®) Society. Members of the American College of Clinical Pharmacy (ACCP) Perioperative Care Practice and Research Network (PRN) and officials from the ERAS® Society present an opinion that: (1) identifies therapeutic options within each pharmacotherapy-intensive area of ERAS®; (2) generates applied research questions that would allow for comparative analyses of pharmacotherapy options within ERAS® programs; (3) proposes collaborative practice opportunities between key stakeholders in the surgical journey and clinical pharmacists to manage drug therapy problems and research questions; and (4) highlights examples of pharmacist-led cost savings attributed to ERAS® implementation. Clinical pharmacists, working in this manner with the perioperative team across the care continuum, have optimized pharmacotherapy towards measurable outcomes improvements, and stand ready to partner with inter-professional stakeholders and organizations to advance the care of our mutual patients.
Collapse
Affiliation(s)
| | | | - April N Smith
- Creighton University School of Pharmacy and Health Professions, Omaha, NE, 68178, USA.
| | - Gregg Nelson
- Departments of Obstetrics & Gynecology and Oncology, Section Chief, Gynecologic Oncology, Secretary, ERAS(®) Society, Tom Baker Cancer Centre, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N2, Canada.
| | - Olle Ljungqvist
- ERAS Society, Faculty of Medicine and Health, School of Health and Medical Sciences, Department of Surgery, Örebro University, Örebro, Sweden.
| | - Richard H Parrish
- St. Christopher's Hospital for Children, Philadelphia, PA, 19134, USA; Virginia Commonwealth University School of Pharmacy, Richmond, VA, 23298, USA.
| |
Collapse
|
13
|
Grass F, Hübner M, Lovely JK, Crippa J, Mathis KL, Larson DW. Ordering a Normal Diet at the End of Surgery-Justified or Overhasty? Nutrients 2018; 10:nu10111758. [PMID: 30441792 PMCID: PMC6266498 DOI: 10.3390/nu10111758] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 11/10/2018] [Accepted: 11/11/2018] [Indexed: 12/14/2022] Open
Abstract
Early re-alimentation is advocated by enhanced recovery pathways (ERP). This study aimed to assess compliance to ERP-set early re-alimentation policy and to compare outcomes of early fed patients and patients in whom early feeding was withhold due to the independent decision making of the surgeon. For this purpose, demographic, surgical and outcome data of all consecutive elective colorectal surgical procedures (2011–2016) were retrieved from a prospectively maintained institutional ERP database. The primary endpoint was postoperative ileus (POI). Surgical 30-day outcome and length of stay were compared between patients undergoing the pathway-intended early re-alimentation pattern and patients in whom early re-alimentation was not compliant. Out of the 7103 patients included, 1241 (17.4%) were not compliant with ERP re-alimentation. Patients with delayed re-alimentation presented with more postoperative complications (37 vs. 21%, p < 0.001) and a prolonged length of hospital stay (8 ± 7 vs. 5 ± 4 days, p < 0.001). While male gender (odds ratio (OR) 1.24; 95% confidence interval (CI) 1.04–1.32), fluid overload (OR 1.38; 95% CI 1.16–1.65) and high American Society of Anaesthesiologists (ASA) score (OR 1.51; 95% CI 1.27–1.8) were independent risk factors for POI, laparoscopy (OR 0.51; 95% CI 0.38–0.68) and ERP compliant diet (OR 0.46; 95% CI 0.36–0.6) were both protective. Hence, this study provides further evidence of the beneficial effect of early oral feeding after colorectal surgery.
Collapse
Affiliation(s)
- Fabian Grass
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
- Department of Visceral Surgery, Lausanne University Hospital CHUV, 1011 Lausanne, Switzerland.
| | - Martin Hübner
- Department of Visceral Surgery, Lausanne University Hospital CHUV, 1011 Lausanne, Switzerland.
| | - Jenna K Lovely
- Hospital Pharmacy Services, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Jacopo Crippa
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Kellie L Mathis
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - David W Larson
- Division of Colon and Rectal Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| |
Collapse
|
14
|
Tebala GD, Gallucci A, Khan AQ. The impact of complications on a programme of enhanced recovery in colorectal surgery. BMC Surg 2018; 18:60. [PMID: 30115063 PMCID: PMC6097404 DOI: 10.1186/s12893-018-0390-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 08/02/2018] [Indexed: 01/22/2023] Open
Abstract
Background The advantages of Enhanced Recovery (ER) programmes are well known, in terms of improved overall experience of the patients, which associates with low morbidity and reduced length of stay. As a result, the pattern of morbidity is changing and some patients may develop complications after discharge. Aim of this work was to evaluate the impact of morbidity and related outcomes such as unplanned readmission and reoperation rate on an ER programme in colorectal surgery. Methods Prospectively collected clinical data of patients who underwent colorectal resection have been retrospectively analysed. Endpoints were: 90-day mortality and morbidity, length of hospital stay (LOS) and rate of unplanned readmissions and reoperations. Results Mortality and morbidity did not change in the analysed period, but LOS reduced significantly. Main determinant of postoperative LOS was the type of surgical approach, laparoscopy being associated with earlier discharge. LOS was longer in patients who developed complications. Morbidity and reoperation rate were significantly higher in patients discharged after day 4. Majority of complications happened in patients who were still in the hospital. However, the few patients who developed complications after discharge did not have a worse outcome if compared to those who had complications in hospital. Conclusions ER protocols must become integral part of the perioperative management of colorectal patients. ER and laparoscopy have a synergic effect to improve the postoperative recovery and reduce morbidity. Early discharge of patients does not affect the outcome of postoperative complications.
Collapse
Affiliation(s)
- Giovanni D Tebala
- Colorectal Team, Noble's Hospital, Douglas, Isle of Man, UK. .,East Kent Hospitals University NHS Foundation Trust, William Harvey Hospital, Kennington Rd, Willesborough, Ashford, Kent, TN24 0LZ, UK.
| | | | - Abdul Q Khan
- Colorectal Team, Noble's Hospital, Douglas, Isle of Man, UK
| |
Collapse
|
15
|
Measuring In-Hospital Recovery After Colorectal Surgery Within a Well-Established Enhanced Recovery Pathway: A Comparison Between Hospital Length of Stay and Time to Readiness for Discharge. Dis Colon Rectum 2018; 61:854-860. [PMID: 29771797 DOI: 10.1097/dcr.0000000000001061] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Hospital length of stay is often used as a measure of in-hospital recovery but may be confounded by organizational factors. Time to readiness for discharge may provide a superior index of recovery. OBJECTIVE The purpose of this study was to contribute evidence for the construct validity of time to readiness for discharge and length of stay as measures of in-hospital recovery after colorectal surgery in the context of a well-established enhanced recovery pathway. DESIGN This was an observational validation study designed according to the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist. SETTINGS The study was conducted at a university-affiliated tertiary hospital. PATIENTS A total of 100 consecutive patients undergoing elective colorectal resection (mean age = 65 y; 57% men; 81% laparoscopic) who participated in a randomized controlled trial were included. MAIN OUTCOME MEASURES We tested a priori hypotheses that length of stay and time-to-readiness for discharge are longer in patients undergoing open surgery, with lower physical status, with severe comorbidities, with postoperative complications, undergoing rectal surgery, who are older (≥75 y), who have a new stoma, and who have inflammatory bowel disease. RESULTS Median time-to-readiness for discharge and length of stay were both 3 days. For both measures, 6 of 8 construct validity hypotheses were supported (hypotheses 1 and 4-8). LIMITATIONS The use of secondary data from a randomized controlled trial (risk of selection bias) was a limitation. Results may not be generalizable to institutions where patient care is not equally structured. CONCLUSIONS This study contributes evidence to the construct validity of time-to-readiness for discharge and length of stay as measures of in-hospital recovery within enhanced recovery pathways. Our findings suggest that length of stay can be a less resource-intensive and equally construct-valid index of in-hospital recovery compared with time-to-readiness for discharge. Enhanced recovery pathways may decrease process-of-care variances that impact length of stay, allowing more timely discharge once discharge criteria are achieved. See Video Abstract at http://links.lww.com/DCR/A564.
Collapse
|
16
|
Garfinkle R, Boutros M, Ghitulescu G, Vasilevsky CA, Charlebois P, Liberman S, Stein B, Feldman LS, Lee L. Clinical and Economic Impact of an Enhanced Recovery Pathway for Open and Laparoscopic Rectal Surgery. J Laparoendosc Adv Surg Tech A 2018; 28:811-818. [PMID: 29451415 DOI: 10.1089/lap.2017.0677] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The short-term benefits of laparoscopy for rectal surgery are equivocal. The objective of this study was to determine the clinical and economic impact of an enhanced recovery pathway (ERP) for laparoscopic and open rectal surgery. MATERIALS AND METHODS All patients who underwent elective rectal resection with primary anastomosis between January 2009 and March 2012 at two tertiary-care, university-affiliated institutions were identified. Patients who met inclusion criteria were divided into four groups, according to surgical approach (laparoscopic [lap] or open) and perioperative management (ERP or conventional care [CC]). Length of stay (LOS), postoperative complications, and hospital costs were compared. RESULTS A total of 381 patients were included in the analysis (201 open-CC, 34 lap-CC, 38 open-ERP, and 108 lap-ERP). Patients were mostly similar at baseline. ERPs significantly reduced median LOS after both open cases (open-CC 10 days versus open-ERP 7.5 days, P = .003) and laparoscopic cases (lap-CC 5 days versus lap-ERP 4.5 days, P = .046). ERPs also reduced variability in LOS compared with CC. There was no difference in postoperative complications with the use of ERPs (open-CC 51% versus open-ERP 50%, P = .419; lap-CC 32% versus lap-ERP 36%, P = .689). On multivariate analysis, both ERP (-3.6 days [95% confidence interval, CI -6.0 to -1.3]) and laparoscopy (-3.6 days [95% CI -5.9 to -1.0]) were independently associated with decreased LOS. Overall costs were only lower when lap-ERP was compared with open-CC (mean difference -2420 CAN$ [95% CI -5628 to -786]). CONCLUSIONS ERPs reduced LOS after rectal resections, and the combination of laparoscopy and ERPs significantly reduced overall costs compared to when neither strategy was used.
Collapse
Affiliation(s)
- Richard Garfinkle
- 1 Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, Department of Surgery, McGill University Health Centre , Montreal, Quebec, Canada
| | - Marylise Boutros
- 2 Division of Colon and Rectal Surgery, Sir Mortimer B. Davis Jewish General Hospital , Montreal, Quebec, Canada
| | - Gabriela Ghitulescu
- 2 Division of Colon and Rectal Surgery, Sir Mortimer B. Davis Jewish General Hospital , Montreal, Quebec, Canada
| | - Carol-Ann Vasilevsky
- 2 Division of Colon and Rectal Surgery, Sir Mortimer B. Davis Jewish General Hospital , Montreal, Quebec, Canada
| | - Patrick Charlebois
- 1 Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, Department of Surgery, McGill University Health Centre , Montreal, Quebec, Canada
| | - Sender Liberman
- 1 Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, Department of Surgery, McGill University Health Centre , Montreal, Quebec, Canada
| | - Barry Stein
- 1 Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, Department of Surgery, McGill University Health Centre , Montreal, Quebec, Canada
| | - Liane S Feldman
- 1 Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, Department of Surgery, McGill University Health Centre , Montreal, Quebec, Canada
| | - Lawrence Lee
- 1 Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, Department of Surgery, McGill University Health Centre , Montreal, Quebec, Canada
| |
Collapse
|
17
|
Zanguie M, Abdollahi A, Salek R, Jangjoo A, Jabbari Nooghabi M, Shabahang H, Golmohammadzadeh H. Three Anastomotic Techniques Following Laparoscopic Rectal Cancer Resection: Our Experience in 155 Patients. Surg Innov 2017; 25:57-61. [DOI: 10.1177/1553350617745976] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Mahtab Zanguie
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Abdollahi
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Roham Salek
- Cancer Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Jangjoo
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehdi Jabbari Nooghabi
- Department of Statistics, Faculty of Mathematical Sciences, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Hosein Shabahang
- Endoscopic and Minimally Invasive Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamed Golmohammadzadeh
- Endoscopic and Minimally Invasive Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
18
|
Sun V, Dumitra S, Ruel N, Lee B, Melstrom L, Melstrom K, Woo Y, Sentovich S, Singh G, Fong Y. Wireless Monitoring Program of Patient-Centered Outcomes and Recovery Before and After Major Abdominal Cancer Surgery. JAMA Surg 2017; 152:852-859. [PMID: 28593266 DOI: 10.1001/jamasurg.2017.1519] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance A combined subjective and objective wireless monitoring program of patient-centered outcomes can be carried out in patients before and after major abdominal cancer surgery. Objective To conduct a proof-of-concept pilot study of a wireless, patient-centered outcomes monitoring program before and after major abdominal cancer surgery. Design, Setting, and Participants In this proof-of-concept pilot study, patients wore wristband pedometers and completed online patient-reported outcome surveys (symptoms and quality of life) 3 to 7 days before surgery, during hospitalization, and up to 2 weeks after discharge. Reminders via email were generated for all moderate to severe scores for symptoms and quality of life. Surgery-related data were collected via electronic medical records, and complications were calculated using the Clavien-Dindo classification. The study was carried out in the inpatient and outpatient surgical oncology unit of one National Cancer Institute-designated comprehensive cancer center. Eligible patients were scheduled to undergo curative resection for hepatobiliary and gastrointestinal cancers, were English speaking, and were 18 years or older. Twenty participants were enrolled over 4 months. The study dates were April 1, 2015, to July 31, 2016. Main Outcomes and Measures Outcomes included adherence to wearing the pedometer, adherence to completing the surveys (MD Anderson Symptom Inventory and EuroQol 5-dimensional descriptive system), and satisfaction with the monitoring program. Results This study included a final sample of 20 patients (median age, 55.5 years [range, 22-74 years]; 15 [75%] female) with evaluable data. Pedometer adherence (88% [17 of 20] before surgery vs 83% [16 of 20] after discharge) was higher than survey adherence (65% to 75% [13 of 20 and 15 of 20] completed). The median number of daily steps at day 7 was 1689 (19% of daily steps at baseline), which correlated with the Comprehensive Complication Index, for which the median was 15 of 100 (r = -0.64, P < .05). Postdischarge overall symptom severity (2.3 of 10) and symptom interference with activities (3.5 of 10) were mild. Pain (4.4 of 10), fatigue (4.7 of 10), and appetite loss (4.0 of 10) were moderate after surgery. Quality-of-life scores were lowest at discharge (66.6 of 100) but improved at week 2 (73.9 of 100). While patient-reported outcomes returned to baseline at 2 weeks, the number of daily steps was only one-third of preoperative baseline. Conclusions and Relevance Wireless monitoring of combined subjective and objective patient-centered outcomes can be carried out in the surgical oncology setting. Preoperative and postoperative patient-centered outcomes have the potential of identifying high-risk populations who may need additional interventions to support postoperative functional and symptom recovery.
Collapse
Affiliation(s)
- Virginia Sun
- Division of Nursing Research and Education, Department of Population Sciences, City of Hope, Duarte, California
| | - Sinziana Dumitra
- Division of Surgical Oncology, Department of Surgery, City of Hope, Duarte, California
| | - Nora Ruel
- Division of Biostatistics, Department of Information Sciences, City of Hope, Duarte, California
| | - Byrne Lee
- Division of Surgical Oncology, Department of Surgery, City of Hope, Duarte, California
| | - Laleh Melstrom
- Division of Surgical Oncology, Department of Surgery, City of Hope, Duarte, California
| | - Kurt Melstrom
- Division of Surgical Oncology, Department of Surgery, City of Hope, Duarte, California
| | - Yanghee Woo
- Division of Surgical Oncology, Department of Surgery, City of Hope, Duarte, California
| | - Stephen Sentovich
- Division of Surgical Oncology, Department of Surgery, City of Hope, Duarte, California
| | - Gagandeep Singh
- Division of Surgical Oncology, Department of Surgery, City of Hope, Duarte, California
| | - Yuman Fong
- Division of Surgical Oncology, Department of Surgery, City of Hope, Duarte, California
| |
Collapse
|
19
|
Horres CR, Adam MA, Sun Z, Thacker JK, Moon RE, Miller TE, Grant SA. Enhanced recovery protocols for colorectal surgery and postoperative renal function: a retrospective review. Perioper Med (Lond) 2017; 6:13. [PMID: 28948012 PMCID: PMC5609048 DOI: 10.1186/s13741-017-0069-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 09/05/2017] [Indexed: 12/20/2022] Open
Abstract
Background While enhanced recovery protocols (ERPs) reduce physiologic stress and improve outcomes in general, their effects on postoperative renal function have not been directly studied. Methods Patients undergoing major colorectal surgery under ERP (February 2010 to March 2013) were compared with a traditional care control group (October 2004 October 2007) at a single institution. Multivariable regression models examined the association of ERP with postoperative creatinine changes and incidence of postoperative acute kidney dysfunction (based on the Risk, Injury, Failure, Loss, and End-stage renal disease criteria). Results Included were 1054 patients: 590 patients underwent surgery with ERP and 464 patients without ERP. Patient demographics were not significantly different. Higher rates of neoplastic and inflammatory bowel disease surgical indications were found in the ERP group (81 vs. 74%, p = 0.045). Patients in the ERP group had more comorbidities (ASA ≥ 3) (62 vs. 40%, p < 0.001). In unadjusted analysis, postoperative creatinine increase was slightly higher in the ERP group compared with control (median 0.1 vs. 0 mg/dL, p < 0.001), but levels of postoperative acute kidney injury were similar in both groups (p = 0.998). After adjustment with multivariable regression, postoperative changes in creatinine were similar in ERP vs. control (p = 0.25). Conclusions ERP in colorectal surgery is not associated with a clinically significant increase in postoperative creatinine or incidence of postoperative kidney injury. Our results support the safety of ERPs in colorectal surgery and may promote expanding implementation of these protocols. Trial registration Not applicable, prospective data collection and retrospective chart review only.
Collapse
Affiliation(s)
- Charles R Horres
- Department of Anesthesiology, Duke University, DUMC 3094, Durham, NC 27710 USA
| | | | - Zhifei Sun
- Department of Surgery, Duke University, Durham, USA
| | | | - Richard E Moon
- Department of Anesthesiology, Duke University, DUMC 3094, Durham, NC 27710 USA
| | - Timothy E Miller
- Department of Anesthesiology, Duke University, DUMC 3094, Durham, NC 27710 USA
| | - Stuart A Grant
- Department of Anesthesiology, Duke University, DUMC 3094, Durham, NC 27710 USA
| |
Collapse
|
20
|
Beckmann K, Moore J, Wattchow D, Young G, Roder D. Short-term outcomes after surgical resection for colorectal cancer in South Australia. J Eval Clin Pract 2017; 23:316-324. [PMID: 27480799 DOI: 10.1111/jep.12612] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/30/2016] [Accepted: 06/30/2016] [Indexed: 12/24/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVE Short-term outcomes (unplanned readmission, post-surgical complication rates, 30-day and 90-day post-surgical mortality) are often used as indicators of quality of surgical care for colorectal cancer (CRC). Differences in these immediate outcomes can highlight disparities in care across patient subpopulations. This study aimed to document short-term outcomes following major surgery for CRC and to identify whether there were any sociodemographic differences across South Australia (SA). METHODS This population-based study included all CRC resections among SA residents diagnosed with CRC aged 50-79 years in 2003-2008 (n = 3940). Clinical, treatment, comorbidity and outcomes data were compiled through linkage of administrative and surveillance datasets across SA. A retrospective cohort design was used to examine short-term outcomes including post-operative complications, 28-day emergency readmission and 30-day and 90-day mortality. We used multivariable logistic regression to identify factors associated with each outcome. RESULTS Post-operative complications occurred in 28% of cases. Thirty-day and ninety-day mortality were 1.3% and 3%, respectively. Later stage, older age, multiple comorbidities and emergency admissions were associated with poorer short-term outcomes. Risk of complications was lower among patients from higher socio-economic areas (OR = 0.77, 95%CI 0.62-0.98). Risk of 30-day mortality was higher among non-metropolitan patients (OR = 2.33, 95%CI 1.22-4.46). Post-operative complications increased the risk of emergency readmission and short-term mortality. CONCLUSIONS Short-term outcomes following CRC surgery may be improved through strategies to increase earlier detection and reduce emergency admissions. Socioeconomic and regional disparities require further examination of health system factors.
Collapse
Affiliation(s)
- Kerri Beckmann
- Centre for Population Health, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - James Moore
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - David Wattchow
- Department of General and Digestive Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Graeme Young
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, South Australia, Australia
| | - David Roder
- Centre for Population Health Research, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| |
Collapse
|
21
|
Feld SI, Tevis SE, Cobian AG, Craven MW, Kennedy GD. Multiple postoperative complications: Making sense of the trajectories. Surgery 2016; 160:1666-1674. [PMID: 27769659 DOI: 10.1016/j.surg.2016.08.047] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 07/05/2016] [Accepted: 08/16/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Many studies have evaluated predictors of postoperative complications, yet little is known about the development of multiple complications. The goal of this study was to assess complication timing in cascades of multiple complications and the risk of future complications given a patient's first complication. METHODS This study includes 30-day, postoperative complications from the American College of Surgeons National Surgical Quality Improvement Program for all patients who underwent major inpatient and outpatient operative procedures from 2005-2013. The timing and sequencing of complications were evaluated using χ2 analysis and pairwise comparisons. RESULTS More severe postoperative complications (cardiac arrest or myocardial infarction, renal insufficiency or failure, stroke, intubation, septic shock, coma) had the greatest impact on the risk for developing further complications, increasing the relative risk of developing future, specific, severe complications by more than 40-fold. These more severe complications occur within a few days of other complications (whether as a preceding factor or an outcome), while less severe complications, such as surgical site infection and urinary tract infection, are linked less tightly to complication cascades. CONCLUSION This analysis highlights both the risk for secondary complications after an initial complication and when those future complications are likely to occur. Physicians can use this information to target interventions to prevent high-risk complications.
Collapse
Affiliation(s)
- Shara I Feld
- Department of Surgery, University of Wisconsin-Madison, Madison, WI
| | - Sarah E Tevis
- Department of Surgery, University of Wisconsin-Madison, Madison, WI
| | - Alexander G Cobian
- Department of Computer Sciences, University of Wisconsin-Madison, Madison, WI; Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI
| | - Mark W Craven
- Department of Computer Sciences, University of Wisconsin-Madison, Madison, WI; Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI
| | - Gregory D Kennedy
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL.
| |
Collapse
|
22
|
Kim JK, Park JS, Han DH, Choi GH, Kim KS, Choi JS, Yoon DS. Robotic versus laparoscopic left lateral sectionectomy of liver. Surg Endosc 2016; 30:4756-4764. [PMID: 26902613 DOI: 10.1007/s00464-016-4803-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 02/03/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND A few studies have reported only short-term outcomes of various robotic and laparoscopic liver resection types; however, published data in left lateral sectionectomy (LLS) have been limited. The aim of this study was to compare the long- and short-term outcomes of robotic and laparoscopic LLS. METHODS We retrospectively compared demographic and perioperative data as well as postoperative outcomes of robotic (n = 12) and laparoscopic (n = 31) LLS performed between May 2007 and July 2013. Resection indications included malignant tumors (n = 31) and benign lesions (n = 12) including intrahepatic duct (IHD) stones (n = 9). RESULTS There were no significant differences in perioperative outcomes of estimated blood loss, major complications, or lengths of stay, but operating time was longer in robotic than in laparoscopic LLS (391 vs. 196 min, respectively) and the operation time for IHD stones did not differ between groups (435 vs. 405 min, respectively; p = 0.190). Disease-free (p = 0.463) and overall (p = 0.484) survival of patients with malignancy did not differ between groups. The 2- and 5-year disease-free survival rates were 63.2 and 36.5 %, respectively. However, robotic LLS costs were significantly higher than laparoscopic LLS costs ($8183 vs. $5190, respectively; p = 0.009). CONCLUSIONS Robotic LLS was comparable to laparoscopic LLS in surgical outcomes and oncologic integrity during the learning curve. Although robotic LLS was more expensive and time intensive, it might be a good option for difficult indications such as IHD stones.
Collapse
Affiliation(s)
- Jae Keun Kim
- Division of Hepatopancreaticobiliary Surgery, Department of Surgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea
| | - Joon Seong Park
- Division of Hepatopancreaticobiliary Surgery, Department of Surgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea
| | - Dai Hoon Han
- Division of Hepatopancreaticobiliary Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Yonsei University Health System, 250 Seongsanno, Seodaemoon-gu, Seoul, 120-752, Korea
| | - Gi Hong Choi
- Division of Hepatopancreaticobiliary Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Yonsei University Health System, 250 Seongsanno, Seodaemoon-gu, Seoul, 120-752, Korea.
| | - Kyung Sik Kim
- Division of Hepatopancreaticobiliary Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Yonsei University Health System, 250 Seongsanno, Seodaemoon-gu, Seoul, 120-752, Korea
| | - Jin Sub Choi
- Division of Hepatopancreaticobiliary Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Yonsei University Health System, 250 Seongsanno, Seodaemoon-gu, Seoul, 120-752, Korea
| | - Dong Sup Yoon
- Division of Hepatopancreaticobiliary Surgery, Department of Surgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea
| |
Collapse
|
23
|
Ortega-Deballon P, Ménégaut L, Fournel I, Orry D, Masson D, Binquet C, Facy O. Are Adiponectin and Leptin Good Predictors of Surgical Infection after Colorectal Surgery? A Prospective Study. Surg Infect (Larchmt) 2015; 16:566-71. [PMID: 26114869 DOI: 10.1089/sur.2014.206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Infections are the most frequent complication after colorectal surgery. It has been suggested that adipose tissue metabolism could be related to the risk of post-operative infection, but this could be partially related to the body-mass index. The aim of this study was to look for a relation between adipocytokine levels and the risk of post-operative infection and its type. METHODS This prospective cohort study was conducted between March 2013 and March 2014 in two French teaching hospitals. Pre-operative plasma levels of adiponectin and leptin were measured in consecutive patients undergoing elective colorectal surgery. All infections in the 30 d following surgery were recorded. RESULTS Among the 142 patients included, 29 (20.4%) presented a post-operative infection: 26 surgical site infections and three extra-abdominal infections. Adiponectin and leptin levels correlated weakly but substantially with the body mass index (rspearman=-0.26 and +0.31, respectively). While there was no substantial difference between patients with and those without post-operative infection for adiponectin, median pre-operative leptin was substantially greater in patients with post-operative infection (8.67 vs. 4.37 ng/mL, p=0.003). A substantial interaction was found between leptin and cancer. In patients operated on for cancer, the area under the receiver-operating characteristic (ROC) curve was lower than in patients with benign diseases (0.597 vs. 0.858, p=0.011). Similar results were observed for intra-abdominal infection and surgical site infection. CONCLUSION Patients with greater levels of leptin before colorectal surgery have an increased risk of post-operative surgical infection. This effect is stronger in patients without cancer. Adiponectin levels are not related to the risk of infection in Western patients.
Collapse
Affiliation(s)
- Pablo Ortega-Deballon
- 1 Department of Digestive Surgery, Clinical Epidemiology/Clinical Trials, University Hospital of Dijon , Dijon, France .,4 INSERM, U866, Dijon, France; University of Burgundy , School of Health, Dijon, France
| | - Louise Ménégaut
- 2 Department of Biochemistry, Clinical Epidemiology/Clinical Trials, University Hospital of Dijon , Dijon, France
| | - Isabelle Fournel
- 3 Department of Clinical Investigation Centre, Clinical Epidemiology/Clinical Trials, University Hospital of Dijon , Dijon, France
| | - David Orry
- 5 Department of Surgical Oncology, Georges-François Leclerc Anticancer Centre , Dijon, France
| | - David Masson
- 2 Department of Biochemistry, Clinical Epidemiology/Clinical Trials, University Hospital of Dijon , Dijon, France .,4 INSERM, U866, Dijon, France; University of Burgundy , School of Health, Dijon, France
| | - Christine Binquet
- 3 Department of Clinical Investigation Centre, Clinical Epidemiology/Clinical Trials, University Hospital of Dijon , Dijon, France .,4 INSERM, U866, Dijon, France; University of Burgundy , School of Health, Dijon, France
| | - Olivier Facy
- 1 Department of Digestive Surgery, Clinical Epidemiology/Clinical Trials, University Hospital of Dijon , Dijon, France .,4 INSERM, U866, Dijon, France; University of Burgundy , School of Health, Dijon, France
| |
Collapse
|
24
|
Girard E, Messager M, Sauvanet A, Benoist S, Piessen G, Mabrut JY, Mariette C. Anastomotic leakage after gastrointestinal surgery: diagnosis and management. J Visc Surg 2014; 151:441-50. [PMID: 25455960 DOI: 10.1016/j.jviscsurg.2014.10.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Anastomotic leakage represents a major complication of gastrointestinal surgery, leading to increased postoperative morbidity; it the foremost cause of mortality after intestinal resection. Identification of risk factors is essential for the prevention of AL. AL can present with various clinical pictures, ranging from the absence of symptoms to life-threatening septic shock. Contrast-enhanced CT scan is the most complete investigation to define AL and its consequences. Early and optimal multidisciplinary management is based on three options: medical management, radiologic or endoscopic intervention, or surgical re-intervention. Prompt treatment should help decrease postoperative morbidity and mortality, with the choice depending on the septic status of the patient. If the patient is asymptomatic, treatment can be medical only, coupled with close surveillance. Interventional management is indicated when the fistula is symptomatic but not life-threatening. On the other hand, when the vital prognosis is engaged, surgery is indicated, emergently, associated with intensive care. Even more than their prevention, early and appropriate management counts most to decrease their consequences.
Collapse
Affiliation(s)
- E Girard
- Service de chirurgie générale, hôpital de la Croix-Rousse, 103, Grande-rue-de-la-Croix-Rousse, 69004 Lyon, France
| | - M Messager
- Service de chirurgie digestive et générale, hôpital Claude-Huriez, centre hospitalier régional et universitaire, place de Verdun, 59037 Lille cedex, France
| | - A Sauvanet
- Service de chirurgie hépatique et pancréatique, hôpital Beaujon, 100, boulevard du Général-Leclerc, 92110 Clichy, France
| | - S Benoist
- Service de chirurgie oncologique et digestive, hôpital Kremlin-Bicêtre, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - G Piessen
- Service de chirurgie digestive et générale, hôpital Claude-Huriez, centre hospitalier régional et universitaire, place de Verdun, 59037 Lille cedex, France
| | - J-Y Mabrut
- Service de chirurgie générale, hôpital de la Croix-Rousse, 103, Grande-rue-de-la-Croix-Rousse, 69004 Lyon, France
| | - C Mariette
- Service de chirurgie digestive et générale, hôpital Claude-Huriez, centre hospitalier régional et universitaire, place de Verdun, 59037 Lille cedex, France.
| |
Collapse
|