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Impact of procedure volumes and focused practice on short-term outcomes of elective and urgent colon cancer resection in Italy.

ABSTRACT: The relationship between hospital volumes and short-term patients' outcomes of colon cancer (CC) surgery is not well established in the literature. Moreover, evidence about short-term outcomes of urgent compared with elective CC procedures is scanty. The aims of this study are 1) to determine whether caseloads and other hospital characteristics are associated with short-term outcomes of CC surgery; 2) to compare the outcomes of urgent and elective CC surgery.A total of 14,200 patients undergoing CC surgery between 2005 and 2010 in the General Surgery Units (GSUs) of the hospitals of Emilia-Romagna region, Northern Italy, were identified from the hospital discharge records database. The outcomes of interest were 30-day in-hospital mortality, re-intervention and 30-day re-admission. Using multilevel analysis, we analyzed the relationship of GSU volumes and focused practice, defined as the percentage of CC operations over total operations, with the three outcomes.High procedure volumes were associated with a lower risk of 30-day in-hospital mortality, after adjusting for patients' characteristics [aOR (95% CI)?=?0.51 (0.33-0.81)]. Stratified analyses for elective and urgent surgery showed that high volumes were associated with a lower 30-day mortality for elective patients [aOR (95% CI)?=?0.35 (0.17-0.71)], but not for urgent patients [aOR (95% CI)?=?0.72 (0.42-1.24)]. Focused practice was an independent predictor of re-intervention [aOR (95% CI)?=?0.67 (0.47-0.97)] and re-admission [aRR (95% CI)?=?0.88 (0.78-0.98)].The present study adds evidence in support of the notion that patients with CC undergoing surgery at high-volume and focused surgical units experience better short-term outcomes.

SUBMITTER: Lenzi J

PROVIDER: S-EPMC3656123 | biostudies-literature | 2013

REPOSITORIES: biostudies-literature

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Impact of procedure volumes and focused practice on short-term outcomes of elective and urgent colon cancer resection in Italy.

Lenzi Jacopo J Lombardi Raffaele R Gori Davide D Zanini Nicola N Tedesco Dario D Masetti Michele M Jovine Elio E Fantini Maria Pia MP

PloS one 20130516 5

<h4>Background</h4>The relationship between hospital volumes and short-term patients' outcomes of colon cancer (CC) surgery is not well established in the literature. Moreover, evidence about short-term outcomes of urgent compared with elective CC procedures is scanty. The aims of this study are 1) to determine whether caseloads and other hospital characteristics are associated with short-term outcomes of CC surgery; 2) to compare the outcomes of urgent and elective CC surgery.<h4>Methods</h4>A ...[more]

PMID: 23696873

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Project description:ImportanceDiverticulitis has a tendency to recur and affect quality of life.ObjectiveTo assess whether sigmoid resection is superior to conservative treatment in improving quality of life of patients with recurrent, complicated, or persistent painful diverticulitis.Design, setting, and participantsThis open-label randomized clinical trial assessed for eligibility 128 patients with recurrent, complicated, or persistent painful diverticulitis in 6 Finnish hospitals from September 29, 2014, to October 10, 2018. Exclusion criteria included age younger than 18 years or older than 75 years; lack of (virtual) colonoscopy or sigmoidoscopy data within 2 years, or presence of cancer, contraindication to laparoscopy, or fistula. Outcomes were assessed using intention-to-treat analysis. A prespecified interim analysis was undertaken when 66 patients had been randomized and their 6-month follow-up was assessable. Data were analyzed from June 2018 to May 2020.InterventionsLaparoscopic sigmoid resection or conservative treatment.Main outcomes and measuresThe primary outcome was difference in Gastrointestinal Quality of Life Index (GIQLI) score between randomization and 6 months.ResultsOf 128 patients assessed for eligibility, 90 were randomized (28 male [31%]; mean [SD] age, 54.11 [11.9] years; 62 female [69%]; mean [SD] age, 57.13 [7.6] years). A total of 72 patients were included in analyses for the primary outcome (37 in the surgery group and 35 in the conservative treatment group), and 85 were included in analyses for clinical outcomes (41 in the surgery group and 44 in the conservative treatment group). The difference between GIQLI score at randomization and 6 months was a mean of 11.96 points higher in the surgery group than in the conservative treatment group (mean [SD] of 11.76 [15.89] points vs -0.2 [19.07] points; difference, 11.96; 95% CI, 3.72-20.19; P = .005). Four patients (10%) in the surgery group and no patients in the conservative treatment group experienced major complications (Clavien-Dindo grade III or higher). There were 2 patients (5%) in the surgery group and 12 patients (31%) in the conservative treatment group who had new episodes of diverticulitis within 6 months.Conclusions and relevanceIn this randomized clinical trial, elective laparoscopic sigmoid resection improved quality of life in patients with recurrent, complicated, or persistent painful diverticulitis but carried a 10% risk of major complications.Trial registrationClinicalTrials.gov Identifier: NCT02174926.

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Impact of procedure volumes and focused practice on short-term outcomes of elective and urgent colon cancer resection in Italy.

Publications

Impact of procedure volumes and focused practice on short-term outcomes of elective and urgent colon cancer resection in Italy.

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