Data validation in an economic evaluation of surgery for colon cancer

Objectives:This study aimed to validate the accuracy of data retrieved in a prospective multicenter trial, the purpose of which was an economic evaluation of two techniques of surgery for colon cancer.Methods:Within the Swedish contribution of the COLOR trial (Colon Cancer Open or Laparoscopic Resection), an economic evaluation of open versus laparoscopic surgical techniques was conducted. Data were collected by case record forms (CRF), patient diaries, and telephone surveys every 2 weeks. The study period was 12 weeks, and the perspective was societal. Data from the first consecutive forty patients to complete the health economic study protocol were validated. Retrieved data were compared with data from medical records and data from local social security offices for agreement.Results:Statistically significant differences were found for duration of anesthesia, length of surgery, number of outpatient consultations by doctors and district nurses, complication rate, and the use of central venous lines. No significant differences were observed concerning length of hospital stay, disposable instruments cost, and time off work, all of which heavily influence total costs.Conclusions:The present method of data collection regarding resources used in this setting seems to produce accurate data for economic evaluation; however, relative to complication rates, the method did not retrieve accurate data.

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Behandeling van lumbale discushernia: open versus endoscopische discectomie?

Tijdschrift voor Geneeskunde ◽

10.47671/tvg.77.21.025 ◽

2021 ◽

Author(s):

J. SYS ◽

A. VERVAECKE

Keyword(s):

Cost Benefit Analysis ◽

Lumbar Disc ◽

Length Of Hospital Stay ◽

Cost Benefit ◽

Complication Rates ◽

Patient Morbidity ◽

Endoscopic Discectomy ◽

Theoretical Advantage ◽

Open Versus ◽

The Cost

Open (micro) discectomie is a routine treatment for patients with a lumbar disc hernia and incapacitating sciatica, resistant to conservative treatment. Alternatively, the full-endoscopic discectomy has been increasingly performed over the past years. While the surgical instrumentation for this approach has improved and the necessary specialized training is widely available, the technique remains challenging for the surgeon and the assumed/theoretical advantage regarding patient morbidity is still unproven. When compared to open (micro) discectomie, the existing literature fails to attribute significant decreases in length of hospital stay or complication rates to the full-endoscopic approach, therefore making the cost-benefit analysis uninteresting due to the higher associated cost. The structural lack of financing of Belgian hospitals leads to intrinsic budgetary limitations which are emphasized if the hospitals have to carry the extra costs related to endoscopic disc surgery themselves.

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Transvaginal Appendectomy: A Systematic Review

Minimally Invasive Surgery ◽

10.1155/2014/384706 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 5

Author(s):

Mehmet Ali Yagci ◽

Cuneyt Kayaalp

Keyword(s):

Comparative Studies ◽

Operating Time ◽

Surgical Techniques ◽

Length Of Hospital Stay ◽

Minimal Invasive ◽

Morbidly Obese ◽

Complication Rates ◽

Study Selection ◽

History Of ◽

Patient Selection Criteria

Background. Natural orifice transluminal endoscopic surgery (NOTES) is a new approach that allows minimal invasive surgery through the mouth, anus, or vagina.Objective. To summarize the recent clinical appraisal, feasibility, complications, and limitations of transvaginal appendectomy for humans and outline the techniques.Data Sources. PubMed/MEDLINE, Cochrane, Google-Scholar, EBSCO, clinicaltrials.gov and congress abstracts, were searched.Study Selection. All related reports were included, irrespective of age, region, race, obesity, comorbidities or history of previous surgery. No restrictions were made in terms of language, country or journal.Main Outcome Measures. Patient selection criteria, surgical techniques, and results.Results. There were total 112 transvaginal appendectomies. All the selected patients had uncomplicated appendicitis and there were no morbidly obese patients. There was no standard surgical technique for transvaginal appendectomy. Mean operating time was 53.3 minutes (25–130 minutes). Conversion and complication rates were 3.6% and 8.2%, respectively. Mean length of hospital stay was 1.9 days.Limitations.There are a limited number of comparative studies and an absence of randomized studies.Conclusions. For now, nonmorbidly obese females with noncomplicated appendicitis can be a candidate for transvaginal appendectomy. It may decrease postoperative pain and enable the return to normal life and work off time. More comparative studies including subgroups are necessary.

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Impact of an acute Care Surgery Model on the Management of acute Appendicitis in South Korea: A Retrospective Cohort Study

10.21203/rs.3.rs-111093/v2 ◽

2021 ◽

Author(s):

Gun-Hee Yi ◽

Hak-Jae Lee ◽

Seul Lee ◽

Jong-Hee Yoon ◽

Suk-Kyung Hong

Keyword(s):

Acute Appendicitis ◽

South Korea ◽

Hospital Stay ◽

Acute Care ◽

Surgical Techniques ◽

Length Of Hospital Stay ◽

Acute Care Surgery ◽

Medical Procedure ◽

Complication Rates ◽

Care Surgery

Abstract Background The acute care surgery (ACS) system is a new model for the prompt management of diseases that require rapid treatment in patients with acute abdomen. This study compared the outcomes and characteristics of the ACS system and traditional on-call system (TROS) for acute appendicitis in South Korea. Methods This single-center, retrospective study included all patients (aged ≥18 years) who underwent surgery for acute appendicitis in 2016 and 2018. The TROS and ACS system were used for the 2016 and 2018 groups, respectively. We retrospectively obtained data on each patient from the electrical medical records. The independent samples t-test and Mann-Whitney U-test were used for continuous and non-normally distributed data, respectively.Results In total, 126 patients were included. The time taken to get from the emergency room admission to the operating room, operation times, and postoperative complication rates were similar between both groups. However, the length of the hospital stay was shorter in the ACS group than in the TROS group (4.3±3.2 days vs. 7.2±9.6 days, p=0.039).Conclusions Since the introduction of the ACS system, the length of hospital stay for surgical patients has decreased. This may be due to the application of an integrated medical procedure, such as a new clinical pathway, rather than differences in the surgical techniques.Trial registration: Retrospectively registered.

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Posthysterectomy vault prolapse of vaginal walls: Choice of operating procedure

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1210666a ◽

2012 ◽

Vol 140 (9-10) ◽

pp. 666-672 ◽

Cited By ~ 1

Author(s):

Rajka Argirovic

Keyword(s):

Pelvic Floor ◽

Negative Impact ◽

Surgical Techniques ◽

Length Of Hospital Stay ◽

Vaginal Vault ◽

Clear Understanding ◽

Complication Rates ◽

Vault Prolapse ◽

Ureteric Injury ◽

Abdominal Sacrocolpopexy

Post-hysterectomy vaginal vault prolapse is a common complication following different types of hysterectomy with a negative impact on the woman?s quality of life due to associated urinary, anorectal and sexual dysfunction. A clear understanding of the supporting mechanisms for the uterus and vagina is important in order to make the right choice of the corrective procedure and also to minimize the risk of posthysterectomy occurrence of vault prolapse. Preexisting pelvic floor defect prior to hysterectomy is the single most important risk factor for vault prolapse. Various surgical techniques have been advanced in hysterectomy to prevent vault prolapse. Vaginal vault repair can be carried out abdominally or vaginally. Sacrospinous fixation and abdominal sacrocolpopexy are the commonly performed procedures. The vaginal approach for vault prolapse is superior to the abdominal approach in terms of complication rates, blood loss, postoperative discomfort, length of hospital stay and costeffectiveness. Moreover, it allows the simultaneous repair of all coexistent pelvic floor defects, such as cystocele, enterocele and rectocele. Abdominal sacrocolpopexy is associated with a lower rate of recurrent vault prolapse and dyspareunia than the vaginal sacrospinous colpopexy. Other less commonly performed procedures include uterosacral ligament suspension and illeococcygeal fixation with a high risk of ureteric injury. Surgical mesh of non-absorbent material is gaining in popularity and preliminary data from vaginal mesh procedures is encouraging.

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Impact of an Acute Care Surgery Model on the Management of Acute Appendicitis in South Korea: A Retrospective Cohort Study

Emergency Medicine International ◽

10.1155/2021/5522523 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Gun-Hee Yi ◽

Hak-Jae Lee ◽

Seul Lee ◽

Jong-Hee Yoon ◽

Suk-Kyung Hong

Keyword(s):

Acute Appendicitis ◽

South Korea ◽

Hospital Stay ◽

Acute Care ◽

Surgical Techniques ◽

Length Of Hospital Stay ◽

Acute Care Surgery ◽

Medical Procedure ◽

Complication Rates ◽

Care Surgery

Background. The acute care surgery (ACS) system is a new model for the prompt management of diseases that require rapid treatment in patients with acute abdomen. This study compared the outcomes and characteristics of the ACS system and traditional on-call system (TROS) for acute appendicitis in South Korea. Methods. This single-center, retrospective study included all patients (aged ≥18 years) who underwent surgery for acute appendicitis in 2016 and 2018. The TROS and ACS system were used for the 2016 and 2018 groups, respectively. We retrospectively obtained data on each patient from the electrical medical records. The independent samples t-test and Mann–Whitney U-test were used for continuous and nonnormally distributed data, respectively. Results. In total, 126 patients were included. The time taken to get from the emergency room admission to the operating room, operation times, and postoperative complication rates were similar between both groups. However, the length of the hospital stay was shorter in the ACS group than in the TROS group (4.3 ± 3.2 days vs. 7.2 ± 9.6 days, p = 0.039 ). Conclusions. Since the introduction of the ACS system, the length of hospital stay for surgical patients has decreased. This may be due to the application of an integrated medical procedure, such as a new clinical pathway, rather than differences in the surgical techniques.

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Impact of an acute Care Surgery Model on the Management of acute Appendicitis in South Korea: A Retrospective Cohort Study

10.21203/rs.3.rs-111093/v3 ◽

2021 ◽

Author(s):

Gun-Hee Yi ◽

Hak-Jae Lee ◽

Seul Lee ◽

Jong-Hee Yoon ◽

Suk-Kyung Hong

Keyword(s):

Acute Appendicitis ◽

South Korea ◽

Hospital Stay ◽

Acute Care ◽

Surgical Techniques ◽

Length Of Hospital Stay ◽

Acute Care Surgery ◽

Medical Procedure ◽

Complication Rates ◽

Care Surgery

Abstract BackgroundThe acute care surgery (ACS) system is a new model for the prompt management of diseases that require rapid treatment in patients with acute abdomen. This study compared the outcomes and characteristics of the ACS system and traditional on-call system (TROS) for acute appendicitis in South Korea.MethodsThis single-center, retrospective study included all patients (aged ≥18 years) who underwent surgery for acute appendicitis in 2016 and 2018. The TROS and ACS system were used for the 2016 and 2018 groups, respectively. We retrospectively obtained data on each patient from the electrical medical records. The independent samples t-test and Mann-Whitney U-test were used for continuous and non-normally distributed data, respectively.ResultsIn total, 126 patients were included. The time taken to get from the emergency room admission to the operating room, operation times, and postoperative complication rates were similar between both groups. However, the length of the hospital stay was shorter in the ACS group than in the TROS group (4.3±3.2 days vs. 7.2±9.6 days, p=0.039).ConclusionsSince the introduction of the ACS system, the length of hospital stay for surgical patients has decreased. This may be due to the application of an integrated medical procedure, such as a new clinical pathway, rather than differences in the surgical techniques.Trial registration: Retrospectively registered.

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Impact of an acute Care Surgery Model on the Management of acute Appendicitis in South Korea: A Retrospective Cohort Study

10.21203/rs.3.rs-111093/v1 ◽

2020 ◽

Author(s):

Gun-Hee Yi ◽

Hak-Jae Lee ◽

Seul Lee ◽

Jong-Hee Yoon ◽

Suk-Kyung Hong

Keyword(s):

Acute Appendicitis ◽

South Korea ◽

Hospital Stay ◽

Acute Care ◽

Surgical Techniques ◽

Length Of Hospital Stay ◽

Acute Care Surgery ◽

Medical Procedure ◽

Complication Rates ◽

Care Surgery

Abstract BackgroundThe acute care surgery (ACS) system is a new model for the prompt management of diseases that require rapid treatment in patients with acute abdomen. This study compared the outcomes and characteristics of the ACS system and traditional on-call system (TROS) for acute appendicitis in South Korea. MethodsThis single-center, retrospective study included all patients (aged ≥18 years) who underwent surgery for acute appendicitis in 2016 and 2018. The TROS and ACS system were used for the 2016 and 2018 groups, respectively. We retrospectively obtained data on each patient from the electrical medical records. The independent samples t-test and Mann-Whitney U-test were used for continuous and non-normally distributed data, respectively.ResultsIn total, 126 patients were included. The time taken to get from the emergency room admission to the operating room, operation times, and postoperative complication rates were similar between both groups. However, the length of the hospital stay was shorter in the ACS group than in the TROS group (4.3±3.2 days vs. 7.2±9.6 days, p=0.039).ConclusionsSince the introduction of the ACS system, the length of hospital stay for surgical patients has decreased. This may be due to the application of an integrated medical procedure, such as a new clinical pathway, rather than differences in the surgical techniques.Trial registration: Retrospectively registered.

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Implementation of enhanced recovery after surgery in gynecological operations: a randomized controlled trial

Ain-Shams Journal of Anesthesiology ◽

10.1186/s42077-020-00116-4 ◽

2020 ◽

Vol 12 (1) ◽

Author(s):

Amr Nady Abdelrazik ◽

Ahmad Sameer Sanad

Keyword(s):

Hospital Stay ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Controlled Trial ◽

Length Of Hospital Stay ◽

Gynecologic Surgery ◽

Complication Rates ◽

Control Groups ◽

Analog Scale ◽

Randomized Controlled

Abstract Background To investigate the effects of enhanced recovery after surgery (ERAS) in patients undergoing gynecologic surgery on length of hospital stay, pain management, and complication rate. Results The length of hospital stay was reduced in ERAS groups when compared with the control groups (3.46 days vs 2.28 days; P < 0.0001; CI − 1.5767 to − 0.7833 for laparotomy groups and 2.18 vs 1.76 days; P = 0.0115; CI − 0.7439 to − 0.0961 for laparoscopy groups respectively). Intraoperative fluid use was reduced in both ERAS groups compared to the two control groups (934 ± 245 ml and 832 ± 197 ml vs 1747 ± 257 ml and 1459 ± 304 respectively; P < 0.0001) and postoperative fluid use was also less in the ERAS groups compared to the control groups (1606 ± 607 ml and 1210 ± 324 ml vs 2682 ± 396 ml and 1469 ± 315 ml respectively; P < 0.0001). Pain score using visual analog scale (VAS) on postoperative day 0 was 4.8 ± 1.4 and 4.1 ± 1.2 (P = 0.0066) for both laparotomy control and ERAS groups respectively, while in the laparoscopy groups, VAS was 3.8 ± 1.1 and 3.2 ± 0.9 (P = 0.0024) in control and ERAS groups respectively. Conclusion Implementation of ERAS protocols in gynecologic surgery was associated with significant reduction in length of hospital stay, associated with decrease intravenous fluids used and comparable pain control without increase in complication rates.

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Activity Tracking After Surgery: Does It Correlate With Postoperative Complications?

The American Surgeon ◽

10.1177/0003134820988818 ◽

2021 ◽

pp. 000313482098881

Author(s):

Yehonatan Nevo ◽

Tali Shaltiel ◽

Naama Constantini ◽

Danny Rosin ◽

Mordechai Gutman ◽

...

Keyword(s):

Postoperative Complications ◽

Enhanced Recovery ◽

Length Of Hospital Stay ◽

Inverse Correlation ◽

Complication Rates ◽

Activity Tracking ◽

Primary Endpoints ◽

Specific Complication ◽

Secondary Endpoints ◽

Enhanced Recovery Programs

Background Postoperative ambulation is an important tenet in enhanced recovery programs. We quantitatively assessed the correlation of decreased postoperative ambulation with postoperative complications and delays in gastrointestinal function. Methods Patients undergoing major abdominal surgery were fitted with digital ankle pedometers yielding continuous measurements of their ambulation. Primary endpoints were the overall and system-specific complication rates, with secondary endpoints being the time to first passage of flatus and stool, the length of hospital stay, and the rate of readmission. Results 100 patients were enrolled. We found a significant, independent inverse correlation between the number of steps on the first and second postoperative days (POD1/2) and the incidence of complications as well as the recovery of GI function and the likelihood of readmission ( P < .05). POD2 step count was an independent risk factor for severe complications ( P = .026). Discussion Digitally quantified ambulation data may be a prognostic biomarker for the likelihood of severe postoperative complications.

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Remeex® System Effectiveness in Male Patients with Stress Urinary Incontinence

Journal of Clinical Medicine ◽

10.3390/jcm10102121 ◽

2021 ◽

Vol 10 (10) ◽

pp. 2121

Author(s):

Gerardo-Alfonso Márquez-Sánchez ◽

Bárbara-Yolanda Padilla-Fernández ◽

Miguel Perán-Teruel ◽

Pedro Navalón-Verdejo ◽

Sebastián Valverde-Martínez ◽

...

Keyword(s):

Urinary Incontinence ◽

Stress Urinary Incontinence ◽

Surgical Techniques ◽

High Survival ◽

Complication Rates ◽

Exact Test ◽

Number Of Patients ◽

Male Stress Urinary Incontinence ◽

Group B

Background: When conservative management fails, patients with stress urinary incontinence (SUI) are considered for surgical treatment. Simpler, more economical and less invasive surgical techniques, such as the Remeex® system, have been developed. Objectives: To analyze the objective effectiveness of the Remeex® system in the treatment of male stress urinary incontinence. To study survival and complication rates of the Remeex® system in male SUI patients. Materials and methods: Prospective observational study between July 2015 and May 2020. Group A (n = 7; GA) patients with mild SUI. Group B (n = 22; GB) patients with moderate SUI. Group C (n = 18; GC) patients with severe SUI. Effectiveness was assessed by the number of patients achieving complete and partial dryness. Complete dryness was defined as patients using 0–1 safety pads per day; partial dryness as a >50% reduction in the number of pads used. Results were analyzed using descriptive statistics, Student’s t-test. Chi2, Fisher’s exact test, ANOVA, and multivariate analysis. Significance was set at p < 0.05. Results: Mean age 69.76 years, mean follow-up 33.52 months. Objective effectiveness was observed in 89.36% of patients with incontinence. The effectiveness was 85.71% in GA, 90.91% in GB and 88.89% in GC. There were no significant differences among groups (p = 1.0000). 34.04% of patients with an implant required at least one readjustment, while 66.00% did not require any. There were no significant differences among groups (p = 0.113) Chi2 = 4.352. 95.74% of implants remained in place by the end of follow-up. We observed complications in 17.02% of patients. Conclusions: Remeex® system is an effective and safe method for male stress urinary incontinence treatment, regardless of the severity of the incontinence, with high survival and low complication and removal rates. System readjustments are required in one-third of the cases.

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