Structured Abstract Background There is a continuing debate on the best approach for endoscopically benign large polyps that are unsuitable for conventional endoscopic resection. This study aims to ...estimate the cancer risk in patients with endoscopically benign unresectable colonic polyps referred for surgery. Study Design Patients with an endoscopic diagnosis of benign adenoma deemed not amenable for endoscopic removal who underwent colectomy between 1997- 2012 were accessed. Patients with preoperative diagnoses of cancer, inherited polyposis syndrome, inflammatory bowel disease, and synchronous pathology requiring surgery were excluded. Results 439 patients 220(50.1%) men; median age 67(27-97) years underwent colectomy. Of 439 patients, 346(79%) underwent preoperative endoscopy at our institution for all polyps preoperative biopsy was benign. Most of the polyps were located in the right colon (394/439, 89.7%) with majority being in the cecum (199/394, 45.3%). Polyp morphology was as follows: sessile (n=252, 57.4 %), pedunculated (n=109, 24.8%) and flat (n=78, 17.8%). Endoscopic pathology revealed high-grade dysplasia in 88 (20%) patients. Mean colonoscopic and postoperative polyp sizes were 3.0 cm (range, 0.3-10) and 2.7 cm (range, 0-11) cm, respectively (p<0.001). Final surgical pathology revealed cancer in 37 patients (8%). Polyp location, morphology and histologic types were similar between the benign and malignant polyps. Cancer stages were: stage I (23 patients), stage II (11), and stage III (3). Conclusions For the majority of endoscopically benign colonic polyps an oncologic colonic resection may be unnecessary hence adaption of advanced endoscopic resection techniques or laparoscopic assisted polypectomy should be considered. When bowel resection is needed, the resection should be performed obeying oncologic principles and techniques.
Elderly patients undergoing colorectal surgery have increasingly become under scrutiny by accounting for the largest fraction of geriatric postoperative deaths and a significant proportion of all ...postoperative complications, including anastomotic leak.
This study aimed to determine predictors of anastomotic leak in elderly patients undergoing colectomy by creating a novel nomogram for simplistic prediction of anastomotic leak risk in a given patient.
This study was a retrospective review.
The database review of the American College of Surgeons National Surgical Quality Improvement Program was conducted at a single institution.
Patients aged ≥65 years who underwent elective segmental colectomy with an anastomosis at different levels (abdominal or low pelvic) in 2012-2013 were identified from the multi-institutional procedure-targeted database.
We constructed a stepwise multiple logistic regression model for anastomotic leak as an outcome; predictors were selected in a stepwise fashion using the Akaike information criterion. The validity of the nomogram was externally tested on elderly patients (≥65 years of age) from the 2014 American College of Surgeons National Surgical Quality Improvement Program colectomy-targeted database.
A total of 10,392 patients were analyzed, and anastomotic leak occurred in 332 (3.2%). Of the patients who developed anastomotic leak, 192 (57.8%) were men (p < 0.001). Based on unadjusted analysis, factors associated with an increased risk of anastomotic leak were ASA score III and IV (p < 0.001), chronic obstructive pulmonary disease (p = 0.004), diabetes mellitus (p = 0.003), smoking history (p = 0.014), weight loss (p = 0.013), previously infected wound (p = 0.005), omitting mechanical bowel preparation (p = 0.005) and/or preoperative oral antibiotic use (p < 0.001), and wounds classified as contaminated or dirty/infected (p = 0.008). Patients who developed anastomotic leak had a longer length of hospital stay (17 vs 7 d; p < 0.001) and operative time (191 vs 162 min; p < 0.001). A multivariate model and nomogram were created.
This study was limited by its retrospective nature and short-term follow-up (30 d).
An accurate prediction of anastomotic leak affecting morbidity and mortality after colorectal surgery using the proposed nomogram may facilitate decision making in elderly patients for healthcare providers.
Modified frailty index (mFI) has been proposed as a reliable tool in predicting postoperative outcomes after surgery. This study aims to evaluate whether mFI could be utilized to predict readmissions ...after colorectal resection for patients with cancer by using nationwide cohort.
Patients undergoing elective abdominal colorectal resection for colorectal cancer were reviewed from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) procedure-targeted database (2010–2012). A previously described mFI was calculated. Demographics, comorbidities, and 30-day postoperative complications were compared between patients who were readmitted or not after colorectal surgery.
A total of 7337 patients were identified with a mean age of 65.8(±13.6) years. Eight hundred seventy-one (11.8%) patients were readmitted at least once within 30 days. Age, gender, BMI, and other comorbidities were comparable between the groups. O approach, current smoking, mFI(>3/11), disseminating cancer, bleeding disorder and longer operative time were found to independently associated with readmission.
An 11-point modified frailty index as measured in NSQIP correlates with readmissions after colorectal resection in patients with colon and rectal cancer.
•mFI is a quick and simple tool that can predict readmissions after colorectal surgery.•Open approach, current smoking, disseminating cancer are associated with readmission.•Bleeding disorder and longer operative time are associated with readmission.
Abstract Background The perioperative outcomes of patients who underwent straight laparoscopic (LAP) vs hand-assisted laparoscopic (HALS) surgery were compared using a recently released ...procedure-targeted database. Methods The 2012 colectomy-targeted American College of Surgeons National Surgical Quality Improvement Program database was used and patients were classified into 2 groups according to the final surgical approach: LAP vs HALS. Demographics, comorbidities, and 30-day outcomes were compared. Results A total of 7,843 patients met the inclusion criteria. There were 4,656 (59%) patients in LAP colectomy and 3,187 (41%) in HALS colectomy groups. Groups were comparable in terms of preoperative characteristics and demographics. Mean operative time was slightly longer in LAP group (178 ± 86 vs 171 ± 84 minutes, P < .001). After covariate-adjustment analysis, the overall morbidity, superficial surgical site infection, and ileus rates remained slightly higher in HALS group. Conclusions Both straight laparoscopic and hand-assisted approaches are used in colorectal surgery and may complement each other in challenging cases. Implementing the best approach to decrease postoperative complication rates and increase use of minimally invasive techniques may play a role in improving patient care and overall quality.
Abstract
Background
Pilonidal sinus is a common health problem. The current study aimed to compare the impact of autologous platelet-rich plasma (PRP) with that of minimally invasive techniques in ...terms of pain reduction, return to daily activities, quality of life, and duration of wound healing after open excision and secondary closure.
Methods
Patients who were over 18 years old and had chronic PS disease between March 2018 and January 2019 were enrolled and randomly divided into three groups. Open surgery and moist dressings were applied to patients in group A. Open surgery followed by PRP application was performed on patients in group B. Group C underwent curettage of the sinus cavity followed by application of PRP. In this prospective randomized controlled study, patients completed questionnaires (including the Nottingham Health Profile (NHP), Short Form-36 (SF-36) and clinical information) before and after surgery. Demographics, preoperative characteristics, healing parameters, and quality-of-life scores were evaluated and calculated before and after surgery.
Results and conclusion
The cavity volume and wound-healing time were compared among the groups on postoperative days 0, 2, 3, 4, and 21. Each patient was followed up throughout the process of wound healing, and follow-up was continued afterward to monitor the patients for recurrence. Due to the nature of the treatment that group C received, this group achieved shorter healing times and smaller cavity volume than the other groups. In contrast, the recovery time per unit of cavity volume was significantly faster in group B than in the other groups. Overall postoperative pain scores were significantly lower for both PRP groups (open surgery, group B; minimally invasive surgery, group C) than for group A (p < 0.001) and showed different time courses among the groups. In the treatment of PS disease, PRP application improves postoperative recovery in that it speeds patients’ return to daily activities, reduces their pain scores and increases their quality of life.
Trial registration
The current study is registered on the public website ClinicalTrials.gov (ClinicalTrials.gov identifier number: NCT04697082; date: 05/01/2021).
Purpose The aim of this study is to determine if resident involvement in a large cohort of laparoscopic colorectal surgery (LCS) cases negatively impacts outcomes and ultimately increases costs. ...Methods The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients who underwent LCS between 2005 and 2010. Patients were classified into two groups: postgraduate year (PGY; resident involvement) or Attending Only. A subgroup analysis was then conducted among the individual PGY levels (1–2, 3–5, ≥6) and Attending Only group. Results A total of 4,836 patients were included in the PGY group and 2,418 in the Attending Only group. Mean operative time (163.9 ± 66.7 vs. 140.7 ± 67.2 minutes, P < .001) and length of hospital stay (5.8 ± 5.4 vs. 5.6 ± 5.4 days, P = .015) were significantly longer in the PGY group. Surgical and nonsurgical complications and overall morbidity and mortality rates were similar between the two groups. Each individual PGY group was associated with longer operative time ( P < .001), and PGY ≥ 6 was associated with an increased length of stay ( P < .001). Conclusion Although resident participation in LCS does not affect overall mortality or morbidity, it may negatively impact hospital costs through increased operative time and length of hospital stay. Early and intensive laparoscopy training may be necessary for improving residents' laparoscopy skills before their involvement in LCS.
Abstract Background The aim of this study is to evaluate the impact of concurrent mesh herniorrhaphy on short-term outcomes of colorectal surgery by using a large, nationwide database. Methods ...Patients who underwent simultaneous ventral hernia repair (VHR) and colorectal surgery between 2005 and 2010 were identified from the American College of Surgeons National Surgical Quality Improvement Program. Patients who underwent VHR with mesh repair were case matched with patients who underwent VHR without mesh based on the type of colorectal procedure, diagnosis, and American Society of Anesthesiologists score. Results Two hundred sixty-two patients who underwent VHR with mesh were case matched with 524 patients who underwent VHR without mesh. Mean operating time was significantly longer in patients who underwent VHR with mesh (195.8 ± 98.7 vs 164.3 ± 84.4 minutes, P < .001). Postoperative morbidity ( P = .58), mortality ( P = .27), superficial surgical site infection (SSI) ( P = .14), deep SSI ( P = .38), organ space SSI ( P = .17), wound disruption ( P > .99), reoperation ( P = .48), and length of hospital stay ( P = .71) were comparable between the groups. Conclusion The American College of Surgeons National Surgical Quality Improvement Program data suggest that VHR with mesh does not increase 30-day mortality, medical or surgical morbidity in colorectal surgery setting.
Abstract Prevention of surgical site infection (SSI) has become one of the primary objectives of national quality improvement programs in U.S. hospitals. This article would discuss the impact of ...participation in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) on the outcomes and our experience for SSI reduction. Since 2005, our institution has been an active participant of the ACS-NSQIP, and our SSI rates have been compared with other NSQIP centers; in 2006, we were found to be a high outlier institution for SSI. ACS-NSQIP greatly facilitated our understanding of the reasons for high SSI rates and patient profile that is associated with high risks for SSIs and how we can make improvements. Thus, our department initiated an SSI reduction strategy program called the “CORS SSI Prevention Bundle Project” in 2014. This effort was resulted in a statistically significant decrease in overall SSI rates from 11.8% to 6.5% after colorectal surgery. In conclusion, participation in the ACS-NSQIP offers the opportunity to compare institutional SSI rates with those of other and recognize the facts for improvement. By using this data, a bundled approach improved clinical outcomes in our experience and this was attributed to multifaceted initiatives stemming from multiple team members and comprehensive data utilization.
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