Background Centralization of care to “centers of excellence” in Europe has led to improved oncologic outcomes; however, little is known regarding the impact of nonmandated regionalization of rectal ...cancer care in the United States. Methods The Statewide Planning and Research Cooperative System (SPARCS) was queried for elective abdominoperineal and low anterior resections for rectal cancer from 2000 to 2011 in New York with the use of International Classification of Diseases, Ninth Revision codes. Surgeon volume and hospital volume were grouped into quartiles, and high-volume surgeons (≥10 resections/year) and hospitals (≥25 resections/year) were defined as the top quartile of annual caseload of rectal cancer resection and compared with the bottom 3 quartiles during analyses. Bivariate and multilevel regression analyses were performed to assess factors associated with restorative procedures, 30-day mortality, and temporal trends in these endpoints. Results Among 7,798 rectal cancer resections, the overall rate of no-restorative proctectomy and 30-day mortality decreased by 7.7% and 1.2%, respectively, from 2000 to 2011. In addition, there was a linear increase in the proportion of cases performed by both high-volume surgeons and high-volume hospitals and a decrease in the number of surgeons and hospitals performing rectal cancer surgery. High-volume surgeons at high-volume hospitals were associated independently with both less nonrestorative proctectomies (odds ratio 0.65, 95% confidence interval 0.48–0.89) and mortality (odds ratio 0.43, 95% confidence interval 0.21–0.87) rates. No patterns of significant improvement within the volume strata of the surgeon and hospitals were observed over time. Conclusion This study suggests that the current trend toward regionalization of rectal cancer care to high-volume surgeons and high-volume centers has led to improved outcomes. These findings have implications regarding the policy of health care delivery in the United States, supporting referral to high-volume centers of excellence.
This study investigates the rates of obesity-related cancers in patients undergoing vertical sleeve gastrectomy (VSG), Roux-en-Y gastric bypass (RYGB), or no surgical intervention.
Obesity has been ...previously associated with increased rates of cancers; however, weight loss surgeries have not been explored to demonstrate their potential risk reduction impact.
Patients meeting bariatric eligibility criteria between January 2010 and December 2018 were identified. Exact 1:1:1 matching based on baseline patient demographics and comorbidities was used to create 3 groups with identical covariates: patients undergoing VSG, RYGB, and no surgery.
A total of 28, bariatric-eligible patients equally split into patients undergoing VSG (n = 9636, 33.3%), RYGB (n = 9636, 33.3%), and those with no surgical intervention (n = 9636, 33.3%). Bariatric-eligible patients that did not undergo surgical intervention had significantly higher rates and odds of developing numerous cancer types included in our study when compared to either surgical cohorts, with any cancer type (4.61%), uterine (0.86%), colorectal (0.57%), and lung cancers (0.50%) being most common. Individuals undergoing RYGB were significantly less likely to develop colorectal cancer compared to patients without any surgical intervention odds ratio (OR) 0.47, 95% confidence interval (CI) 0.30-0.75. Additionally, those undergoing VSG were significantly less likely to develop lung cancer than the bariatric eligible no surgery cohort (OR 0.42, 95% CI 0.25-0.70).
Postoperative rates of any cancer type, lung, ovarian, and uterine cancer were significantly lower in obese patients undergoing either vertical sleeve gastrectomy (VSG) or RYGB compared to bariatric-eligible patients without any surgical intervention.
Aim
Patients with rectal cancer often undergo faecal diversion, yet the existing literature cursorily reports renal sequelae by the type of ostomy. We aimed to determine whether the presence of an ...ileostomy or colostomy was associated with postoperative renal morbidity.
Methods
We identified patients with rectal cancer undergoing elective resection with primary anastomosis without diversion, with an ileostomy and with a colostomy by 21 possible procedures in the colectomy‐ and proctectomy‐specific National Surgical Quality Improvement Program files. The odds of major renal events (renal failure dialysis initiated or progressive renal insufficiency >2 mg/dl increase in creatinine without dialysis), progressive renal insufficiency alone and readmissions were assessed using propensity score weighting and logistic regression.
Results
Of 15 075 patients (63.7% Stage II–III, 85.7% creatinine values obtained ≤30 days preoperatively), 37.7% were not diverted, 39.5% had an ileostomy and 22.9% a colostomy. Compared to non‐diverted patients, diversion was associated with major renal events (ileostomy, odds ratio OR 2.1, 95% confidence interval CI 1.6–2.9; colostomy, OR 1.8, 95% CI 1.3–2.5), progressive renal insufficiency (ileostomy, OR 2.5, 95% CI 1.7–3.5; colostomy, OR 2.0, 95% CI 1.4–2.9), readmissions for renal failure (ileostomy, OR 3.2, 95% CI 2.1–5.0; colostomy, OR 2.5, 95% CI 1.6–4.1) and readmissions for fluid/electrolyte abnormalities (ileostomy, OR 2.3, 95% CI 1.6–3.3; colostomy, OR 1.8, 95% CI 1.2–2.6).
Conclusion
Diverting ostomies after elective rectal cancer resection are strongly associated with renal morbidity. The decision to divert is complex, and it is unclear whether select patients may benefit from a colostomy from a renal perspective.
Given scarce data regarding the relationship among age, complications, and survival beyond the 30-day postoperative period for oncology patients in the United States, this study identified ...age-related differences in complications and the rate and cause of 1-year mortality following colon cancer surgery.
The NY State Cancer Registry and Statewide Planning and Research Cooperative System identified stage I-III colon cancer resections (2004-2011). Multivariable logistic regression and survival analyses assessed the relationship among age (<65, 65-74, ⩾75), complications, 1-year survival, and cause of death.
Among 24 426 patients surviving >30 days, 1-year mortality was 8.5%. Older age groups had higher complication rates, and older age and complications were independently associated with 1-year mortality (P<0.0001). Increasing age was associated with a decrease in the proportion of deaths from colon cancer with a concomitant increase in the proportion of deaths from cardiovascular disease. Older age and sepsis were independently associated with higher risk of colon cancer-specific death (65-74: HR=1.59, 95% CI=1.26-2.00; ⩾75: HR=2.57, 95% CI=2.09-3.16; sepsis: HR=2.58, 95% CI=2.13-3.11) and cardiovascular disease-specific death (65-74: HR=3.72, 95% CI=2.29-6.05; ⩾75: HR=7.02, 95% CI=4.44-11.10; sepsis: HR=2.33, 95% CI=1.81-2.99).
Older age and sepsis are associated with higher 1-year overall, cancer-specific, and cardiovascular-specific mortality, highlighting the importance of geriatric assessment, multidisciplinary care, and cardiovascular optimisation for older patients and those with infectious complications.
Background Many rectal cancer patients experience tumor downstaging and some are found to achieve a pathologic complete response (pCR) after neoadjuvant chemoradiotherapy (nCRT). Previous data ...suggest that there is an association between the time interval from nCRT completion to surgery and tumor response rates, including pCR. However, these studies have been primarily from single institutions with small sample sizes. The aim of this study was to examine the relationship between a longer interval after nCRT and pCR in a nationally representative cohort of rectal cancer patients. Study Design Clinical stage II to III rectal cancer patients undergoing nCRT with a documented surgical resection were selected from the 2006 to 2011 National Cancer Data Base. Multivariable logistic regression analysis was used to assess the association between the nCRT–surgery interval time (<6 weeks, 6 to 8 weeks, >8 weeks) and the odds of pCR. The relationship between nCRT–surgery interval, surgical morbidity, and tumor downstaging was also examined. Results Overall, 17,255 patients met the inclusion criteria. An nCRT–surgery interval time >8 weeks was associated with higher odds of pCR (odds ratio OR 1.12, 95% CI 1.01 to 1.25) and tumor downstaging (OR 1.11, 95% CI 1.02 to 1.25). The longer time delay was also associated with lower odds of 30-day readmission (OR 0.82, 95% CI 0.70 to 0.92). Conclusions An nCRT–surgery interval time >8 weeks results in increased odds of pCR, with no evidence of associated increased surgical complications compared with an interval of 6 to 8 weeks. These data support implementation of a lengthened interval after nCRT to optimize the chances of pCR and perhaps add to the possibility of ultimate organ preservation (nonoperative management).
Abstract
Increasing participation by promoting diversity and inclusion in professional society membership has become an important topic for many scientific fields. In a recent issue of the Journal, ...DeVilbiss et al. (Am J Epidemiol. 2020;189(10):998–1010) reported results from a survey conducted by the Society for Epidemiologic Research (SER) Diversity and Inclusion Committee by which several aspects of participation by sociodemographic and cultural variables among its members were measured. Here, we summarize the major findings of the survey, put the authors’ results within the greater context of the epidemiology workforce, and provide suggestions on how the Committee could expand its influence by considering measuring variables related to career outcomes and trajectories. This suggestion is based on an attempt to link the interventions being facilitated by SER, the participation indices it is trying to improve, and the greater mission of SER to build sustainable career trajectories that produce the best science that will improve the health of human populations.
Background
“Textbook oncologic outcome” (TOO) is a composite quality measure representing the “ideal” outcome for patients undergoing cancer surgery. This study sought to assess the validity of TOO ...as a metric to evaluate hospital quality.
Methods
Patients who underwent curative-intent resection of gastric, pancreatic, colon, rectal, lung, esophageal, bladder, or ovarian cancer were identified in the National Cancer Database (2006–2017). Cancer site-specific TOO was defined as adequate lymph node yield, R0 resection, non-length-of-stay outlier, no hospital readmission, and receipt of guideline-concordant chemotherapy and/or radiation. Mixed-effects analyses estimated the adjusted TOO rate for each hospital stratified by cancer site. The association between hospital adjusted TOO rates and 5-year overall survival was assessed using mixed-effects Cox proportional hazards analyses.
Results
Among 852,988 cancer resections, the TOO rate varied across cancer sites as follows: stomach (31.8%), pancreas (25%), colon (66.9%), rectum (33.6%), lung (35.1%), esophagus (31.2%), bladder (43%), and ovary (44.7%). After characterization of adjusted hospital TOO rates into quintiles, an incremental improvement in overall survival was observed, with higher adjusted TOO rates. Similarly, with the adjusted hospital TOO rate treated as a continuous variable, there was a significant 4% to 12% improvement in overall survival for every 10% increase in the adjusted hospital TOO rate for gastric (hazard ratio HR, 0.88; 95% confidence interval CI, 0.85–0.91), pancreatic (HR, 0.90; 95% CI, 0.88–0.93), colon (0.93; 95% CI, 0.91–0.94), rectal (HR, 0.90; 95% CI, 0.87–0.93), lung (HR, 0.96; 95% CI, 0.95–0.97), esophageal (HR, 0.93; 95% CI, 0.90–0.95), bladder (HR, 0.94; 95% CI, 0.91–0.97), and ovarian (HR, 0.96; 95% CI, 0.94–0.98) cancer.
Conclusions
A direct association exists between adjusted hospital TOO rates and survival after high-risk cancer procedures. As a valid hospital metric, TOO can be used to compare the overall quality of cancer care across hospitals.
Objectives
As the volume of research publications in the field of otolaryngology has increased, so has the need to qualify articles through bibliometric analyses to identify the most important and ...impactful work in the field. Herein, we aim to identify the 100 most disruptive articles in ENT over a 60‐year period and examine how disruption index (DI) compares with other bibliometrics in identifying impactful works in the field.
Methods
In this cross‐sectional bibliometric analysis, articles published between 1954 and 2014 in commonly referenced otolaryngology‐head and neck surgery (OHNS) journals were queried in PubMed. Publications were characterized by DI, journal, subspecialty discipline, and status as an impactful article in the field as determined by other bibliometrics such as citation count, the “Sleeping Beauty Index,” and those derived by the modified Delphi process.
Results
Of the 122,094 articles queried, 67,561 (55.3%) had available citation count as well as disruption score data, meeting inclusion criteria. The most represented subspecialty disciplines within the top 100 most disruptive articles were Otology/Neurotology (28%), General (Comprehensive) (27%), Head and Neck Surgery (12%), and Laryngology (11%). Fifty percent of articles identified as Sleeping Beauties and impactful via modified Delphi approach had scores in the top 86th percentile.
Conclusion
DI in otolaryngology can be appreciated as an added dimension to existing indices and can unearth seminal research, which serve as early foundations of evidence‐based management in the field of OHNS today.
Level of Evidence
NA Laryngoscope, 134:629–636, 2024
As the literature grows in the field of otolaryngology, there is an increased need to surface those which have significantly altered the course or developed the field. We applied a recently developed bibliometric index (Disruption Index) to the otolaryngology literature. Herein, we report the publications with the highest disruption index and those with significant overlap with other bibliometric indices.
Background
The rapid spread of COVID‐19 has placed tremendous strain on the American healthcare system. Few prior studies have evaluated the well‐being of or changes to training for American resident ...physicians during the COVID‐19 pandemic. We aim to study predictors of trainee well‐being and changes to clinical practice using an anonymous survey of American urology residents.
Methods
An anonymous, voluntary, 47‐question survey was sent to all ACGME‐accredited urology programmes in the United States. We executed a cross‐sectional analysis evaluating risk factors of perception of anxiety and depression both at work and home and educational outcomes. Multiple linear regressions models were used to estimate beta coefficients and 95% confidence intervals.
Results
Among ~1800 urology residents in the USA, 356 (20%) responded. Among these respondents, 24 had missing data leaving a sample size of 332. Important risk factors of mental health outcomes included perception of access to PPE, local COVID‐19 severity and perception of susceptible household members. Risk factors for declination of redeployment included current redeployment, having children and concerns regarding ability to reach case minimums. Risk factors for concern of achieving operative autonomy included cancellation of elective cases and higher level of training.
Conclusions
Several potential actions, which could be taken by urology residency programme directors and hospital administration, may optimise urology resident well‐being, morale, and education. These include advocating for adequate access to PPE, providing support at both the residency programme and institutional levels, instituting telehealth education programmes, and fostering a sense of shared responsibility of COVID‐19 patients.
Objectives
Carcinoembryonic antigen (CEA) is a reliable tumor marker for the management and surveillance of colon cancer. However, limitations in previous studies have made it difficult to elucidate ...whether CEA should be established as a prognostic indicator. This study examines the association between elevated preoperative CEA levels and overall survival in colon cancer patients using a national population-based registry.
Methods
Stage I–III colon cancer patients were identified from the 2004–2006 National Cancer Database. A multivariable Cox proportional hazards model was used to estimate the association between elevated CEA levels and overall survival after controlling for important patient, hospital, and tumor characteristics. A Monte Carlo Markov Chain was used to impute the large degree of missing CEA data. All models controlled for the propensity score in order to account for selection bias.
Results
A total of 137,381 patients met the inclusion criteria. Overall, 34 % of patients had an elevated CEA level and 66 % had a normal CEA level, with a median survival of 70 and 100 months, respectively. Patients with an elevated CEA level had a 62 % increase in the hazard of death (HR 1.62, 95 % CI 1.53–1.74) compared with patients with a normal CEA level.
Conclusions
Preoperative CEA was an independent predictor of overall survival across all stages. The results support recommendations to include CEA levels as another high-risk feature that clinicians can use to counsel patients on adjuvant chemotherapy, especially for stage II patients.
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