Purpose of Review
The goal of this manuscript is to present new and thought-provoking information related to the surgical care of older patients. We focused on four main areas including ...communication, surgical pathways, the care of emergency surgery patients, and functional recovery and quality of life. We sought to answer how these areas have evolved, affecting the care of older patients.
Recent Findings
Older patients with cancer present particular challenges in relation to communication, goals, surgical treatment, and post-surgical outcomes. Communication should be clear early and during the treatment course. A multidisciplinary, multimodality, multi-phase pathway can be utilized to improve the postoperative outcomes of older patients with cancer. Functional recovery and quality of life can and should be measured in this population.
Summary
Communication is complicated in cancer patients, which is made more complex with advancing age. Communication is the cornerstone of the treatment of older patients. Future research should focus on interventions to improve communication and measure quality of life and functional recovery metrics.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Résumé
Les techniques de microchirurgie stagnent depuis les années 1960. Les propriétés de la robotique (disparition du tremblement, magnification du geste opératoire, etc.) permettent de créer un ...nouveau concept : la microchirurgie endoscopique robot-assistée.
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FZAB, GEOZS, IJS, IMTLJ, IZUM, KILJ, KISLJ, MFDPS, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UL, UM, UPUK, VKSCE, ZAGLJ
Abstract
Background
Little is known about the impact of Medicaid expansion on the surgical care of inflammatory bowel disease. We sought to determine whether Medicaid expansion is associated with ...improved postsurgical outcomes for patients with inflammatory bowel disease undergoing a colorectal resection.
Methods
We performed a risk-adjusted difference-in-difference study examining postsurgical outcomes for patients ages 26 to 64 with Crohn’s disease or ulcerative colitis undergoing a colorectal resection across 15 states that did and did not expand Medicaid before (2012-2013) and after (2016-2018) policy reform. Primary study outcomes included 30-day readmission and postoperative complication.
Results
Study population included 11 394 patients with inflammatory bowel disease that underwent a colorectal resection. States that underwent Medicaid expansion were associated with a rise in Medicaid enrollment following policy reform (11.8% pre-Medicaid expansion vs 19.7% post-Medicaid expansion). Difference-in-difference analysis revealed a statistically significant lower odds of 30-day readmission in patients undergoing a colorectal resection in expansion states following policy reform relative to patients in nonexpansion states prior to reform (odds ratio, 0.56; 95% confidence interval, 0.36-0.86). No changes in odds of postoperative complication were noted across expansion and nonexpansion states.
Conclusions
Medicaid expansion is associated with a rise in Medicaid enrollment in expansion states following policy reform. There were greater improvements in postoperative outcomes associated with patients in expansion states following policy reform relative to patients in nonexpansion states prior to reform, which may have been related to improved perioperative care and medical management.
This study examines the reliability and validity of measuring lumbar range of motion with an inclinometer.
To find out whether a manual determination of the reference points for measuring lumbar ...range of motion is as reliable as radiologic determination for positioning the inclinometers, lumbar range of motion was determined in degrees by evaluating radiographs and by using the inclinometer technique of Loebl.
Reliability and validity of the inclinometer technique as a clinical measurement of trunk flexibility were investigated. Fifty-four patients participated in the study.
Lumbar range of motion measurements were taken with and without radiologic control of the T12 and S1 vertebrae as reference points for positioning of the inclinometers. An interrater correlation was done of the inclinometer techniques of a physician and a physiotherapist. Functional radiographs were investigated in a standing position. Lumbar range of motion measurements based on radiographs and those taken using the inclinometer alone were correlated to validate the inclinometer technique.
Lumbar range of motion measurements taken with and without radiologic determination showed a very close correlation (r = 0.93; P < 0.001). Flexion alone also demonstrated a close correlation (r = 0.95; P < 0.001), whereas extension showed a somewhat smaller correlation (r = 0.82; P < 0.001). Total lumbar range of motion (r = 0.94; P < 0.001) and flexion (r = 0.88; P < 0.001) were closely related, as indicated by the interrater correlation, whereas extension (r = 0.42; P < 0.05) showed a lesser correlation. Correlation of the measurements taken radiographically and by inclinometer demonstrated an almost linear correlation for measurements of the total lumbar range of motion (r = 0.97; P < 0.001) and flexion (r = 0.98; P < 0.001), whereas extension (r = 0.75; P < 0.001) did not correlate as well.
The noninvasive inclinometer technique proved to be highly reliable and valid, but the measurement technique for extension needs further refinement.
to determine all-cause mortality and cancer-spesific mortality of colorectal cancer patient with obesity.
a search was conducted on Pubmed, Proquest, Ebsco, Scopus, and Cochrane based on clinical ...query. The screening of title and abstract using inclusion and exclusion criteria, filtering double, and reading full text led to one useful article. This study, which is meta-analysis was critically appraised for its validity, importance and applicability.
the relative risk of colorectal cancer patient with pre-existing obesity having cancer-specific mortality and all-cause mortality is 1.22 (95% CI, 1.003-1.35) and 1.25 CI (95% CI, 1.14-1.3) respectively, when compared with non-obese colorectal cancer patient.
pre-existing obesity is related to increased risk of all-cause mortality and cancer-spesific mortality of in colorectal patient. Control of body weight is recommended in this patient through combination of diet, physical activity, behavior therapy, pharmacotherapy, and surgery.
Background
The American College of Surgeons Commission on Cancer’s (CoC) new operative standards for breast cancer, melanoma, and colon cancer surgeries will require that surgeons provide synoptic ...documentation of essential oncologic elements within operative reports. Prior to designing and implementing an electronic tool to support synoptic reporting, we evaluated current documentation practices at our institution to understand baseline concordance with these standards.
Methods
Applicable procedures performed between 1 January 2018 and 31 December 2018 were included. Two independent reviewers evaluated sequential operative notes, up to a total of 100 notes, for documentation of required elements. Complete concordance (CC) was defined as explicit documentation of all required CoC elements. Mean percentage CC and surgeon-specific CC were calculated for each procedure. Interrater reliability was assessed via Cohen’s kappa statistic.
Results
For sentinel lymph node biopsy, mean CC was 66% (
n
= 100), with surgeon-specific CC ranging from 6 to 100%, and for axillary dissection, mean CC was 12% (
n
= 89) and surgeon-specific CC ranged from 0 to 47%. The single surgeon performing melanoma wide local excision had a mean CC of 98% (
n
= 100). For colon resections, mean CC was 69% (
n
= 96) and surgeon-specific CC ranged from 39 to 94%. Kappa scores were 0.77, 0.78, −0.15, and 0.78, respectively.
Conclusions
We identified heterogeneity in current documentation practices. In our cohort, rates of baseline concordance varied across surgeons and procedures. Currently, documentation elements are interspersed within the operative report, posing challenges to chart abstraction with resulting imperfect interrater reliability. This presents an exciting opportunity to innovate and improve compliance by introducing an electronic synoptic documentation tool.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
The Postpartum Bonding Questionnaire is a self-report questionnaire designed to screen disorders of the mother-infant relationship, which has been adapted to several countries. The aim of this study ...was to investigate validity evidence of the Brazilian version of the Postpartum Bonding Questionnaire (PBQ-Br) based on its internal structure (dimensionality, reliability, and measurement invariance between mothers with and without depressive symptoms) and on relations to other variables (depression). The present study is part of the Ribeirão Preto and São Luís Brazilian Cohort Studies, encompassing data collected from February 2011 to September 2013. Data were available for 2207 mothers from the general population of Ribeirão Preto and São Luís cities, who were assessed using the PBQ and the Edinburgh Postnatal Depression Scale. Regarding internal structure, the results of confirmatory factor analyses did not support the original four-factor model, nor the alternative structures tested. Exploratory factor analysis suggested a one-factor model with eight items for the collected data, accounting for 38.7% of the total variance with good internal consistency (α = 0.83). Concerning validity evidence based on relations to other variables, the mean PBQ-Br score for mothers with depressive symptoms was significantly higher than for mothers with no depressive symptoms. In conclusion, we found good validity evidence and the PBQ-Br proved to be a useful tool for assessing the mother-infant relationship in the Brazilian general population rather than for its original purpose, i.e., assessing bonding disorders. The results also highlight the importance of developing cross-cultural studies in order to provide useful measures for specific populations.
Highlights
PBQ-Br proved to be a useful tool for assessing the mother-infant relationship in Brazil.
PBQ-Br is more suitable for assessing routine issues of the mother-infant relationship rather than for its original purpose, i.e., assessing bonding disorders.
Data for PBQ-Br validity evidence were available for 2207 Brazilian mothers.
The results indicated a one-factor model with eight items as the best factor structure.
The results highlight the importance of developing further cross-cultural research in order to assess this construct and measure it in other contexts.
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DOBA, EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, IZUM, KILJ, KISLJ, MFDPS, NLZOH, NUK, ODKLJ, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, SIK, UILJ, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Background
Simultaneous proctectomy and hepatic resection for stage IV rectal cancer remains controversial due to concerns for increased morbidity and mortality. While small series have described ...simultaneous rectal and hepatic resection, surgical outcomes in a large national cohort have not been described.
Methods
Overall, 9012 patients with stage IV rectal adenocarcinoma with hepatic metastases were identified in the National Cancer Data Base (2010–2015). Associations between treatment selection, tumor and patient characteristics, 30- and 90-day mortality, and factors predictive of survival after surgery were examined. Logistic regression analyses were used to evaluate associations between tumor/patient characteristics, and selection of combined proctectomy and hepatectomy (C-PH). Kaplan–Meier analysis was used to identify median survival stratified by age and other patient-specific factors.
Results
Among patients included for analysis, 1331 (14.8%) underwent C-PH. Factors associated with lower rates of C-PH included increasing age, Black/Hispanic race, increased Charlson comorbidity score, Medicare/Medicaid/uninsured status, and treatment at a community cancer program. Thirty- and 90-day mortality increased with age (Chi square 11.4,
p
< 0.005; and Chi square 23.9,
p
< 0.001, respectively). On multivariate analysis, poorer survival after C-PH was associated with age > 70 years (hazard ratio HR 1.8, 95% confidence interval CI 1.0–2.5,
p
< 0.001), perineural invasion (HR 1.5, 95% CI 1.2–1.9,
p
< 0.001), kras mutation (HR 1.5, 95% CI 1.1–2.1,
p
= 0.006), positive circumferential margin (HR 1.3, 95% CI 1.0–1.7,
p
= 0.03), and omission of postoperative chemotherapy (HR 1.4, 95% CI 1.1–1.7,
p
= 0.002).
Conclusions
C-PH should be utilized with caution in frail, high-risk patients. Such patients may be better served by staged surgical management or nonsurgical therapy.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
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