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Caprice C. Greenberg - One of the best experts on this subject based on the ideXlab platform.
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Associations of Specific Postoperative Complications With Outcomes After Elective Colon Resection: A Procedure-Targeted Approach Toward Surgical Quality Improvement.
JAMA surgery, 2017Co-Authors: John Scarborough, Jessica R. Schumacher, K. Craig Kent, Charles P. Heise, Caprice C. GreenbergAbstract:Numerous quality initiatives have been implemented in an effort to minimize the onus of postoperative complications on clinical and economic outcomes after major surgery. It is unknown which complications have the greatest overall effect on these outcomes. To quantify the associations of specific postoperative complications with outcomes after elective Colon Resection. Patients undergoing elective Colon Resection between January 1, 2012, and December 31, 2013, who were included in the Colectomy-Targeted American College of Surgeons National Surgical Quality Improvement Program were assessed for the development of specific types of postoperative complications. The overall contributions of these complications to subsequent clinical and resource use outcomes were assessed. The main outcomes were 30-day mortality, end-organ dysfunction, reoperation, prolonged hospitalization, nonroutine discharge status, and hospital readmission. Risk-adjusted population attributable fractions were estimated for each complication-outcome pair. The population attributable fractions for a specific complication represented the percentage reduction in a given outcome that would be expected if exposure to that complication was completely eliminated. A total of 26 682 patients undergoing elective Colon Resection were included for analysis; 13 870 patients were women (52.0%) and 15 088 (56.5%) were younger than 65 years. The most common index complications were ileus (n = 3140; 11.8%), bleeding (n = 2032; 7.6%), and incisional surgical site infection (n = 1873; 7.0%). Anastomotic leak was associated with the incidence of end-organ dysfunction, mortality, reoperation, and hospital readmission, with estimated population attributable fractions of 33.3% (95% CI, 29.6-36.8), 20.0% (95% CI, 14.0-25.7), 48.4% (95% CI, 45.7-51.0), and 20.6% (95% CI, 19.1-22.1) for each of these respective outcomes. The effect of complications, such as urinary tract infection, venous thromboembolism, and myocardial infarction, on these outcomes was comparatively small. Anastomotic leak has a large overall effect on 30-day clinical and economic outcomes after elective Colon Resection. The findings of our study support the adoption of a procedure-targeted approach to surgical quality improvement and describe a practical method for assessing complication effect.
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associations of specific postoperative complications with outcomes after elective Colon Resection a procedure targeted approach toward surgical quality improvement
JAMA Surgery, 2017Co-Authors: John Scarborough, Jessica R. Schumacher, Charles P. Heise, Craig K Kent, Caprice C. GreenbergAbstract:Importance Numerous quality initiatives have been implemented in an effort to minimize the onus of postoperative complications on clinical and economic outcomes after major surgery. It is unknown which complications have the greatest overall effect on these outcomes. Objective To quantify the associations of specific postoperative complications with outcomes after elective Colon Resection. Design, Setting, and Participants Patients undergoing elective Colon Resection between January 1, 2012, and December 31, 2013, who were included in the Colectomy-Targeted American College of Surgeons National Surgical Quality Improvement Program were assessed for the development of specific types of postoperative complications. The overall contributions of these complications to subsequent clinical and resource use outcomes were assessed. Main Outcomes and Measures The main outcomes were 30-day mortality, end-organ dysfunction, reoperation, prolonged hospitalization, nonroutine discharge status, and hospital readmission. Risk-adjusted population attributable fractions were estimated for each complication-outcome pair. The population attributable fractions for a specific complication represented the percentage reduction in a given outcome that would be expected if exposure to that complication was completely eliminated. Results A total of 26 682 patients undergoing elective Colon Resection were included for analysis; 13 870 patients were women (52.0%) and 15 088 (56.5%) were younger than 65 years. The most common index complications were ileus (n = 3140; 11.8%), bleeding (n = 2032; 7.6%), and incisional surgical site infection (n = 1873; 7.0%). Anastomotic leak was associated with the incidence of end-organ dysfunction, mortality, reoperation, and hospital readmission, with estimated population attributable fractions of 33.3% (95% CI, 29.6-36.8), 20.0% (95% CI, 14.0-25.7), 48.4% (95% CI, 45.7-51.0), and 20.6% (95% CI, 19.1-22.1) for each of these respective outcomes. The effect of complications, such as urinary tract infection, venous thromboembolism, and myocardial infarction, on these outcomes was comparatively small. Conclusions and Relevance Anastomotic leak has a large overall effect on 30-day clinical and economic outcomes after elective Colon Resection. The findings of our study support the adoption of a procedure-targeted approach to surgical quality improvement and describe a practical method for assessing complication effect.
John Scarborough - One of the best experts on this subject based on the ideXlab platform.
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Associations of Specific Postoperative Complications With Outcomes After Elective Colon Resection: A Procedure-Targeted Approach Toward Surgical Quality Improvement.
JAMA surgery, 2017Co-Authors: John Scarborough, Jessica R. Schumacher, K. Craig Kent, Charles P. Heise, Caprice C. GreenbergAbstract:Numerous quality initiatives have been implemented in an effort to minimize the onus of postoperative complications on clinical and economic outcomes after major surgery. It is unknown which complications have the greatest overall effect on these outcomes. To quantify the associations of specific postoperative complications with outcomes after elective Colon Resection. Patients undergoing elective Colon Resection between January 1, 2012, and December 31, 2013, who were included in the Colectomy-Targeted American College of Surgeons National Surgical Quality Improvement Program were assessed for the development of specific types of postoperative complications. The overall contributions of these complications to subsequent clinical and resource use outcomes were assessed. The main outcomes were 30-day mortality, end-organ dysfunction, reoperation, prolonged hospitalization, nonroutine discharge status, and hospital readmission. Risk-adjusted population attributable fractions were estimated for each complication-outcome pair. The population attributable fractions for a specific complication represented the percentage reduction in a given outcome that would be expected if exposure to that complication was completely eliminated. A total of 26 682 patients undergoing elective Colon Resection were included for analysis; 13 870 patients were women (52.0%) and 15 088 (56.5%) were younger than 65 years. The most common index complications were ileus (n = 3140; 11.8%), bleeding (n = 2032; 7.6%), and incisional surgical site infection (n = 1873; 7.0%). Anastomotic leak was associated with the incidence of end-organ dysfunction, mortality, reoperation, and hospital readmission, with estimated population attributable fractions of 33.3% (95% CI, 29.6-36.8), 20.0% (95% CI, 14.0-25.7), 48.4% (95% CI, 45.7-51.0), and 20.6% (95% CI, 19.1-22.1) for each of these respective outcomes. The effect of complications, such as urinary tract infection, venous thromboembolism, and myocardial infarction, on these outcomes was comparatively small. Anastomotic leak has a large overall effect on 30-day clinical and economic outcomes after elective Colon Resection. The findings of our study support the adoption of a procedure-targeted approach to surgical quality improvement and describe a practical method for assessing complication effect.
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associations of specific postoperative complications with outcomes after elective Colon Resection a procedure targeted approach toward surgical quality improvement
JAMA Surgery, 2017Co-Authors: John Scarborough, Jessica R. Schumacher, Charles P. Heise, Craig K Kent, Caprice C. GreenbergAbstract:Importance Numerous quality initiatives have been implemented in an effort to minimize the onus of postoperative complications on clinical and economic outcomes after major surgery. It is unknown which complications have the greatest overall effect on these outcomes. Objective To quantify the associations of specific postoperative complications with outcomes after elective Colon Resection. Design, Setting, and Participants Patients undergoing elective Colon Resection between January 1, 2012, and December 31, 2013, who were included in the Colectomy-Targeted American College of Surgeons National Surgical Quality Improvement Program were assessed for the development of specific types of postoperative complications. The overall contributions of these complications to subsequent clinical and resource use outcomes were assessed. Main Outcomes and Measures The main outcomes were 30-day mortality, end-organ dysfunction, reoperation, prolonged hospitalization, nonroutine discharge status, and hospital readmission. Risk-adjusted population attributable fractions were estimated for each complication-outcome pair. The population attributable fractions for a specific complication represented the percentage reduction in a given outcome that would be expected if exposure to that complication was completely eliminated. Results A total of 26 682 patients undergoing elective Colon Resection were included for analysis; 13 870 patients were women (52.0%) and 15 088 (56.5%) were younger than 65 years. The most common index complications were ileus (n = 3140; 11.8%), bleeding (n = 2032; 7.6%), and incisional surgical site infection (n = 1873; 7.0%). Anastomotic leak was associated with the incidence of end-organ dysfunction, mortality, reoperation, and hospital readmission, with estimated population attributable fractions of 33.3% (95% CI, 29.6-36.8), 20.0% (95% CI, 14.0-25.7), 48.4% (95% CI, 45.7-51.0), and 20.6% (95% CI, 19.1-22.1) for each of these respective outcomes. The effect of complications, such as urinary tract infection, venous thromboembolism, and myocardial infarction, on these outcomes was comparatively small. Conclusions and Relevance Anastomotic leak has a large overall effect on 30-day clinical and economic outcomes after elective Colon Resection. The findings of our study support the adoption of a procedure-targeted approach to surgical quality improvement and describe a practical method for assessing complication effect.
Karl-hermann Fuchs - One of the best experts on this subject based on the ideXlab platform.
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Transanal hybrid Colon Resection: techniques and outcomes for benign colorectal diseases.
Surgical endoscopy, 2019Co-Authors: Karl-hermann Fuchs, Wolfram Breithaupt, Gabor Varga, Thomas Schulz, Ryan C. Broderick, B. Babic, Santiago HorganAbstract:Transanal hybrid rectal and Colon Resection have been introduced in recent years at dedicated surgical centers. The anus is used as a natural orifice for large size access. The use of transanal hybrid colectomy techniques is still in its infancy with outcomes and unique complications being identified. The purpose of this work is the evaluation of outcomes for transanal hybrid Colon Resections (ta-CR), including intra operative and postoperative complications, results, and advantages. A prospectively maintained database was analyzed. Inclusion criteria were any patient who underwent ta-CR for rectal prolapse, slow transit, obstructive defaecation, and chronic sigmoid diverticulitis. Patients were excluded from ta-CR if BMI > 30, major previous abdominal surgery, or presence of a large inflammatory mass in diverticulitis. Transanal access was used for all operative steps requiring access of more than 5 mm, such as staplers, large graspers, and specimen retrieval. Data acquisition and analysis was performed for operative time, complications, and postoperative quality of life. From 2012 to 2017, 82 patients underwent ta-CR [33 males, 49 females, median age 58 (24-80)]. Transanal-subtotal colectomy and ta-CR for constipation was performed in 12 patients; ta-CR and rectopexy in 31, and ta-CR for diverticulitis was performed in 39 patients. Conversion to traditional approach was required in 3 cases (3.6%). Intraoperative complication included 1 rectal tear requiring intervention. Post-op complications included 3 leaks requiring laparoscopic and 1 open revision, the latter developed wound infection and an incisional hernia. Gastrointestinal Quality of Life Index (GIQLI) improved significantly from preoperative 89 to postoperative 119 (p < 0.001). No patients with ta-CR without open revision developed a hernia post-op with median 18 months follow-up. ta-CR is a safe and effective NOTES Hybrid technique for colorectal procedures in selected patients with benign Colon disorders. GIQLI shows improvement and this technique can have the potential in preventing wound and hernia complications.
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Transanal hybrid Colon Resection: from laparoscopy to NOTES.
Surgical endoscopy, 2012Co-Authors: Karl-hermann Fuchs, Wolfram Breithaupt, Gabor Varga, Thomas Schulz, Alexander Reinisch, Nenad JosipovicAbstract:Reducing access size and trauma are important issues in natural orifice transluminal endoscopic surgery (NOTES). The combination of experience with laparoscopic colorectal surgery and transanal endoscopic microsurgery has helped in the use of the transanal approach as a realistic option of NOTES techniques to introduce transanal hybrid laparoscopic-assisted Colon Resection into clinical practice. The purpose of this study was to assess the clinical introduction of transanal hybrid Colon Resection in terms of feasibility and patient safety. Patients with pelvic floor disorders, prolapse, and slow-transit constipation in whom a Colon Resection was indicated were recruited. Patients were followed prospectively with a postoperative well-being score, a pain score, and a quality-of-life score. All complications were prospectively documented. The essential change was the reduction of the number and size of ports by using the transanal route. A camera and two 5-mm ports for grasping forceps and delivering ultrasonic energy were the laparoscopic components. All tasks requiring a port diameter of >5 mm were applied via the transanal route, such as positioning of the proximal stapler anvil, application of linear stapling for Resection, specimen retrieval, stapler anastomosis, and closing the bowel. Fifteen patients with benign colorectal disease underwent transanal hybrid Colon Resection, and 11 had additional rectopexy. All patients were women with a mean age of 61 (range, 28-86) years and a body mass index of 26 kg/m(2). One patient was converted to full laparoscopy. One complication--bleeding that required no reintervention--was recorded. The procedure lasted a mean of 131 (range, 55-184) min. The Gastrointestinal Quality of Life Index was 96 before surgery and 117 after surgery. From this initial experience, transanal hybrid Colon Resection seems a feasible and safe hybrid NOTES procedure that can be usefully introduced into clinical practice.
Martin K. Schilling - One of the best experts on this subject based on the ideXlab platform.
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One-stage Sigmoid Colon Resection for Perforated Sigmoid Diverticulitis (Hinchey Stages III and IV)
World journal of surgery, 2006Co-Authors: Sven Richter, Christoph A. Maurer, Otto Kollmar, Werner Lindemann, G. Pistorius, Martin K. SchillingAbstract:Introduction Guidelines for the treatment of complicated sigmoid diverticulitis recommend Hartmann’s procedure or anastomosis with protective colostomy for Hinchey stage III diverticulitis and Hartmann’s procedure only for Hinchey stage IV diverticulitis. We evaluated the outcome of patients with perforated sigmoid diverticulitis Hinchey III/IV undergoing one-stage Colon Resection and primary anastomosis without protective colostomy.
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primary vs secondary anastomosis after sigmoid Colon Resection for perforated diverticulitis hinchey stage iii and iv a prospective outcome and cost analysis
Diseases of The Colon & Rectum, 2001Co-Authors: Martin K. Schilling, Christoph A. Maurer, Otto Kollmar, Markus W. BüchlerAbstract:PURPOSE: Our hypothesis was that in patients with perforated sigmoid Colon diverticulitis and peritonitis (Hinchey Stage III and IV) a one-stage sigmoid Colon Resection is safe and cost effective when performed by an experienced colorectal surgeon. We evaluated outcome and cost of one-stagevs. two-stage sigmoid Colon Resection after diverticulitis perforation and peritonitis. METHODS: Patients undergoing emergency Resection for perforated sigmoid Colon diverticulitis and peritonitis (Hinchey Stage III and IV). Outcome, costs, and insurers reimbursement were compared between 13 patients undergoing sigmoid Colon Resection and primary anastomosis (Group A) and 42 patients undergoing sigmoid Colon Resection with Hartmann's procedure and secondary descendorectostomy (Group B). RESULTS: Group A patients were comparable to Group B patients in age, gender, preoperative risk and severity of peritonitis (Mannheim Peritonitis Index and C-reactive protein). Operating room time for sigmoid Colon Resection with primary anastomosis (3.3±1.2 hours) was identical to the time for sigmoid Colon Resection with colostomy (3.3±1 hour), and morbidity and mortality, intensive care unit, and in-hospital stay were not significantly different between the two groups. In Group B patients' intestinal continuity was restored 169±74 days after the primary Resection in 32 of 42 patients only (78 percent). The second procedure took on average 1.4 hours longer than the first procedure. Patients in Group B received more antibiotics (2.2vs. 2) albeit for a shorter period of time (4.5vs. 5.7 days,P = not significant). Overall expenses for restoration of intestinal continuity were between 74 and 229 percent higher for Group B patients than for Group A patients. Reimbursement was 18,191±16,761 SFr (Group A) and 41,321±26,983 SFr (Group B) respectively. CONCLUSION: With meticulous surgical technique and extensive intraoperative lavage, perforated sigmoid Colon diverticulitis with peritonitis can be treated by a one-stage sigmoid Colon Resection and anastomosis with a low mortality and morbidity. A one-stage procedure is considerably cheaper and patients are rehabilitated faster and to a higher percentage.
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Primary vs. secondary anastomosis after sigmoid Colon Resection for perforated diverticulitis (Hinchey Stage III and IV): a prospective outcome and cost analysis.
Diseases of the colon and rectum, 2001Co-Authors: Martin K. Schilling, Christoph A. Maurer, Otto Kollmar, Markus W. BüchlerAbstract:Our hypothesis was that in patients with perforated sigmoid Colon diverticulitis and peritonitis (Hinchey Stage III and IV) a one-stage sigmoid Colon Resection is safe and cost effective when performed by an experienced colorectal surgeon. We evaluated outcome and cost of one-stage vs. two-stage sigmoid Colon Resection after diverticulitis perforation and peritonitis. Patients undergoing emergency Resection for perforated sigmoid Colon diverticulitis and peritonitis (Hinchey Stage III and IV). Outcome, costs, and insurers reimbursement were compared between 13 patients undergoing sigmoid Colon Resection and primary anastomosis (Group A) and 42 patients undergoing sigmoid Colon Resection with Hartmann's procedure and secondary descendorectostomy (Group B). Group A patients were comparable to Group B patients in age, gender, preoperative risk and severity of peritonitis (Mannheim Peritonitis Index and C-reactive protein). Operating room time for sigmoid Colon Resection with primary anastomosis (3.3 +/- 1.2 hours) was identical to the time for sigmoid Colon Resection with colostomy (3.3 +/- 1 hour), and morbidity and mortality, intensive care unit, and in-hospital stay were not significantly different between the two groups. In Group B patients' intestinal continuity was restored 169 +/- 74 days after the primary Resection in 32 of 42 patients only (78 percent). The second procedure took on average 1.4 hours longer than the first procedure. Patients in Group B received more antibiotics (2.2 vs. 2) albeit for a shorter period of time (4.5 vs. 5.7 days, P = not significant). Overall expenses for restoration of intestinal continuity were between 74 and 229 percent higher for Group B patients than for Group A patients. Reimbursement was 18,191 +/- 16,761 SFr (Group A) and 41,321 +/- 26,983 SFr (Group B) respectively. With meticulous surgical technique and extensive intraoperative lavage, perforated sigmoid Colon diverticulitis with peritonitis can be treated by a one-stage sigmoid Colon Resection and anastomosis with a low mortality and morbidity. A one-stage procedure is considerably cheaper and patients are rehabilitated faster and to a higher percentage.
Roberto Bergamaschi - One of the best experts on this subject based on the ideXlab platform.
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Right Colon Resection: Evolution and Surgical Technique.
Surgical technology international, 2020Co-Authors: Mahir Gachabayov, Ryan Bendl, Rifat Latifi, Roberto BergamaschiAbstract:This review aims to provide succinct insight into the past, present and near-future of right Colon Resection. The history of right Colon Resection as well as the evolution of a laparoscopic approach are described. Standardization of the surgical technique, indications for medial-to-lateral and lateral-to medial mobilization, D2 and D3 lymphadenectomy, iso-peristaltic and antiperistaltic anastomotic configurations, intracorporeal and extracorporeal anastomosis, totally stapled and stapled handsewn techniques, laparoscopic and robotic suturing, mucosa eversion and inversion, and specimen extraction sites are discussed. In addition, totally intracorporeal robotic right colectomy for cancer is described. This review concludes that, whether it is hindered or assisted, gasless or "con gas", multiple- or single-port, extra- or intracorporeal, iso- or anti-peristaltic, right Colon Resection is still evolving.
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Nonrestoration of pneumoperitoneum in laparoscopic-assisted left Colon Resection.
American journal of surgery, 2000Co-Authors: Roberto BergamaschiAbstract:Laparoscopic-assisted left Colon Resection entails reestablishing pneumoperitoneum and laparoscopic colorectal anastomosing, if performed through a left lower-quadrant incision. A horizontal suprapubic incision allows direct view of the colorectal anastomosis obviating the need for reestablishing pneumoperitoneum. Performing colorectal anastomoses in an open fashion via a suprapubic incision and with nonrestoration of pneumoperitoneum will contain operating time in laparoscopic-assisted left colectomy.
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Laparoscopic left Colon Resection and colorectal anastomosis: a totally intracorporeal approach
Techniques in Coloproctology, 1999Co-Authors: Roberto Bergamaschi, R. Mårvik, Donato F. Altomare, Jean-pierre ArnaudAbstract:Colorectal anastomoses after laparoscopic left Colon Resection are accomplished intracorporeally due to the fixity of the rectum. A variety of procedures sharing the potential disadvantages of operating with an open rectal stump have been reported. The approach described herein entails only a change of access to the well-known double-stapling technique. A 33 mm suprapubic port allowed insertion of the anvil of a circular stapler into the proximal Colon for intracorporeal fashioning of the purse-string suture, and specimen delivery. Fifty-six selected patients with benign disease of the left Colon were operated on; there were no deaths. Median operating time was 135 (range 80–240) min. Complete proximal and distal doughnuts were obtained in 55 of 56 patients. Anastomoses were all air or methylene blue tight. Oral solid food intake was resumed at a median of 3.7 (range 2–5) days. Median hospital stay was 4 (range 3–7) days. Morbidity (9%) included wound hematoma (n = 1), wound infection (n = 1), pleural effusion (n = 1), and urinary retention (n = 1). Conversion rate was 4% and elective. After laparoscopic left Colon Resection, intracorporeal fashioning of the proximal purse-string suture and specimen delivery both through a suprapubic incision resulted in a safe procedure.
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Intracorporeal colorectal anastomosis following laparoscopic left Colon Resection
Surgical endoscopy, 1997Co-Authors: Roberto Bergamaschi, Jean-pierre ArnaudAbstract:The aim of this study was to assess the impact of an intracorporeal double-stapled colorectal anastomosis upon the outcome of laparoscopic left Colon Resection. Fifty-four selected patients underwent elective laparoscopic left Colon Resection for benign disease. Once Resection was completed, a 33-mm suprapubic port allowed insertion of the anvil of a circular stapler into the Colon, which was closed by a handsewn purse-string suture using the T-needle technique. The circular stapler was passed transanally to perform a double-stapled anastomosis. Specimens were delivered in a plastic bag via the suprapubic port. There were no deaths. Minor intraoperative and postoperative complications occurred in 3.7% and 9.2% of the patients, respectively. Median operating time was 125 min (range 80-210 min). Complete proximal and distal doughnuts were obtained in all patients and anastomoses were all methylene blue tight. Median hospital stay was 4 (range 3-7) days. Fashioning double-stapled colorectal anastomoses intracorporeally is feasable and safe.