Research theme
Surgical quality and outcomes
[TK]
42 articles, newest first
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Minimally Invasive/Robotic Surgery for Colorectal Liver Metastasis
This review outlines minimally invasive (laparoscopic and robotic) surgery for colorectal cancer that has spread to the liver, which complete removal can potentially cure, emphasizing decision-making across specialties, patient selection and planning around surgery.
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This review suggests minimally invasive surgery for pancreatic cancer can match open surgery on margin status and lymph node yield, with less blood loss, shorter hospital stays and faster recovery, most consistently for distal pancreatectomy.
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This commentary argues that minimally invasive surgery is safe and effective for selected pancreatic cancer patients, but wider use depends on training, access to technology and overcoming high costs and disparities in care.
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Liver transplantation for nonresectable colorectal liver metastases: a new therapeutic horizon
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Among Medicare patients having common operations, higher scores on a new machine-learning index of social risk were associated with lower odds of a “textbook outcome” and higher odds of complications, longer stays, readmission and death.
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In interviews, most community members who qualified for weight-loss surgery but had never considered it, a majority of them Black, questioned its legitimacy as medical treatment, and many had not heard of it from doctors.
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Fragmentation of practice: The adverse effect of surgeons moving around
Among Medicare patients having elective inpatient operations, those whose surgeons’ practice was most versus least fragmented across hospitals had lower odds of an ideal outcome and higher odds of complications, longer stays, readmission and death.
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For Medicare patients having planned liver or pancreas surgery, those from low- rather than high-social-vulnerability areas, and those with high- rather than low-volume surgeons, scored better on a new measure ranking outcomes by importance.
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Do all Patients Get the Same Care Across Hospitals?
This review describes evidence that surgery use and outcomes vary across US areas, access and outcomes by race, and possibly by social factors; it argues those affected must decide together how much variation is acceptable.
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For Medicare patients having pancreas surgery, the chance of an ideal recovery, free of complications, long hospital stays, readmission and death, varied markedly by individual surgeon, even after accounting for patient and procedure factors.
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Among patients having planned liver surgery, the timing and severity of complications were each associated with death within 30 days, and risk was higher when multiple severe complications occurred within the first week.
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Among Medicare patients having pancreas, liver or colon cancer surgery, fewer than two-thirds had an ideal recovery, though this share rose over time, and an ideal recovery was associated with better survival.
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Among Medicare patients having complex digestive-tract surgery, those who developed a blood clot around the time of surgery had a higher risk of later clots, especially if the first clot was in the lungs.
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Age-Based Left-Digit Bias in the Management of Acute Cholecystitis
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Impact of Psychiatric Illness on Survival among Patients with Hepatocellular Carcinoma
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For Medicare patients having liver or pancreas surgery, treatment at hospitals with a higher case mix index, a freely available hospital measure, was associated with a higher chance of an ideal recovery and fewer deaths.
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Among Medicare patients who had surgery to remove liver cancer from 2004 to 2015, fewer were discharged to a nursing facility or with home health services over time, while readmissions within 90 days also declined.
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In-house intensivist presence does not affect mortality in select emergency general surgery patients
In emergency surgery for life-threatening conditions, patients at hospitals without a protocol for following sepsis guidelines had higher odds of death; results suggest sepsis treatment, not round-the-clock on-site intensive care doctors, is key to outcomes.
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Among Medicare patients having liver cancer surgery, those treated at National Cancer Institute-designated hospitals had better survival, and fewer complications and deaths after major operations, than those at Commission on Cancer-accredited hospitals, at similar cost.
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For colorectal cancer that had spread to the liver at diagnosis, removing the bowel and liver tumors in one operation was increasingly common and linked to more complications than separate operations, but similar survival.
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Postoperative imaging surveillance for hepatocellular carcinoma: How much is enough?
Among Medicare patients treated for liver cancer, frequent follow-up scans became less common over time, and more intensive scanning was not associated with longer survival.
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Importance of Radiologists in Optimizing Outcomes for Older Americans with Acute Abdomen
For older Medicare patients having emergency surgery for life-threatening abdominal conditions, treatment at hospitals where urgent radiologist scan readings were rarely or never available within 2 hours was associated with more complications and deaths.
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For patients having surgery intended to cure liver cancer, tumor burden and blood alpha-fetoprotein levels were both important predictors of survival, and higher alpha-fetoprotein predicted worse outcomes among patients with similar tumor burden.
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Mental illness is associated with increased risk of suicidal ideation among cancer surgical patients
Among Medicare patients having surgery for lung, esophageal, pancreatic, colon or rectal cancer, those previously diagnosed with anxiety, depression, bipolar disorder or schizophrenia were more likely to have suicidal thoughts.
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COVID-19 pandemic and mental health: The surgeon's role in re-engaging patients
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This paper describes how a 2015 national survey of hospitals’ emergency general surgery resources and practices was combined with hospital and patient records to study which features may be tied to better outcomes.
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Among Medicare patients having operations such as colon surgery, heart bypass, joint replacement or lung surgery, a preexisting mental illness diagnosis was associated with more complications, longer stays, more readmissions and more suicidal thoughts.
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For Medicare patients having liver surgery, the odds of minimally invasive surgery varied almost two-fold by surgeon, and such operations by high-volume minimally invasive surgeons were linked to lower odds of death within 90 days.
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Among patients at multiple centers having surgery intended to cure liver cancer, about one in three waited 90 days or more for surgery, and this delay was not associated with worse survival or cancer-free survival.
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Most patients hospitalized with small bowel obstruction were treated without an operation; among those who had surgery, very late operations were associated with higher odds of complications and death than early ones.
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Surveyed hospitals using an acute care surgery model for emergency general surgery were more likely than those relying on an on-call general surgeon to have 24-hour intensive care coverage and in-house intensive care doctors.
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Among patients at multiple centers having surgery for bile duct cancer inside the liver, a machine learning analysis using only information available before surgery sorted patients into three distinct groups with different survival.
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Elective surgery in the time of COVID-19
This editorial notes that the COVID-19 pandemic is straining US health care and elective (planned) surgery is rapidly decreasing, and argues that surgical leaders should develop a framework for elective surgery decisions as information evolves.
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Nationally, patients having liver, pancreas or bile duct surgery at hospitals in socioeconomically distressed communities were more likely to be Black or Hispanic and had higher odds of in-hospital death despite similar complication rates.
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Among general surgery trainees completing residency between 2000 and 2018, most graduated with a low number of liver, pancreas and complex bile duct operations, and trends suggested growing variation among trainees.
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Women surgeons and the emergence of acute care surgery programs
In a national survey of hospitals providing emergency general surgery, many had no women surgeons, and hospitals with acute care surgery programs had a higher share of women surgeons than other hospitals.
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Papillary lesions of the breast: To excise or observe?
At one institution, when a breast needle biopsy showed a milk duct growth (papilloma) with atypical cells, surgery found cancer in more than 30% of cases, much more often than for papillomas without such cells.
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In a small study of adults with severe to profound hearing loss in one ear, tinnitus (ringing in the ears) decreased over the year after they received a bone-anchored hearing implant.