التفاصيل البيبلوغرافية
| العنوان: |
Adoption of Laparoscopy for Elective Colorectal Resection: A Report from the Surgical Care and Outcomes Assessment Program |
| المؤلفون: |
Kwon, Steve1, Billingham, Richard2, Farrokhi, Ellen3, Florence, Michael2, Herzig, Daniel4, Horvath, Karen1, Rogers, Terry3, Steele, Scott5, Symons, Rebecca1, Thirlby, Richard6, Whiteford, Mark7, Flum, David R.1 daveflum@u.washington.edu |
| المصدر: |
Journal of the American College of Surgeons. Jun2012, Vol. 214 Issue 6, p909-918.e1. 0p. |
| مصطلحات موضوعية: |
*COLON cancer, *HOSPITAL care, *TREATMENT effectiveness, *ADVERSE health care events, *BODY mass index, *LAPAROSCOPIC surgery, *SURGICAL excision |
| مستخلص: |
Background: The purpose of this study was to evaluate the adoption of laparoscopic colon surgery and assess its impact in the community at large. Study Design: The Surgical Care and Outcomes Assessment Program (SCOAP) is a quality improvement benchmarking initiative in the Northwest using medical record–based data. We evaluated the use of laparoscopy and a composite of adverse events (ie, death or clinical reintervention) for patients undergoing elective colorectal surgery at 48 hospitals from the 4th quarter of 2005 through 4th quarter of 2010. Results: Of the 9,705 patients undergoing elective colorectal operations (mean age 60.6 ± 15.6 years; 55.2% women), 38.0% were performed laparoscopically (17.8% laparoscopic procedures converted to open). The use of laparoscopic procedures increased from 23.3% in 4th quarter of 2005 to 41.6% in 4th quarter of 2010 (trend during study period, p < 0.001). After adjustment (for age, sex, albumin levels, diabetes, body mass index, comorbidity index, cancer diagnosis, year, hospital bed size, and urban vs rural location), the risk of transfusions (odds ratio [OR] = 0.52; 95% CI, 0.39−0.7), wound infections (OR = 0.45; 95% CI, 0.34−0.61), and composite of adverse events (OR = 0.58; 95% CI, 0.43−0.79) were all significantly lower with laparoscopy. Within those hospitals that had been in SCOAP since 2006, hospitals where laparoscopy was most commonly used also had a substantial increase in the volume of all types of colon surgery (202 cases per hospital in 2010 from 112 cases per hospital in 2006, an 80.4% increase) and, in particular, the number of resections for noncancer diagnoses and right-sided pathology. Conclusions: The use of laparoscopic colorectal resection increased in the Northwest. Increased adoption of laparoscopic colectomies was associated with greater use of all types of colorectal surgery. [ABSTRACT FROM AUTHOR] |
| قاعدة البيانات: |
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