scholarly journals P85 Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Keyword(s):  
Colorectal Cancer ◽  
Anastomotic Leak ◽  
Primary Outcome ◽  
Colorectal Cancer Surgery ◽  
Defunctioning Stoma ◽  
Male Sex ◽  
Secondary Outcomes ◽  
The Impact ◽  
Advanced Cancer Stage ◽  
Elective Colon

Abstract Aim This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic. Method This was an international cohort study of patients undergoing elective colon or rectal cancer resection, without preoperative suspicion of SARS-CoV-2. Centres entered data from their first recorded case of COVID-19 until 19 April 2020. The primary outcome was 30-day mortality. Secondary outcomes included anastomotic leak, postoperative SARS-CoV-2, and a comparison with a pre-pandemic European Society of Coloproctology cohort data. Results From 2073 patients in 40 countries, 1.3% (27/2073) had a defunctioning stoma and 3.0% (63/2073) had an end stoma instead of an anastomosis only. 30-day mortality was 1.8% (38/2073), the incidence of postoperative SARS-CoV-2 was 3.8% (78/2073), and the anastomotic leak rate was 4.9% (86/1738). Mortality was lowest in patients without a leak or SARS-CoV2 (14/1601, 0.9%), and highest in patients with both a leak and SARS-CoV-2 (5/13, 38.5%). Mortality was independently associated with an anastomotic leak (adjusted odds ratio 6.01, 95% confidence interval 2.58-14.06), postoperative SARS-CoV-2 (16.90, 7.86-36.38), male sex (2.46, 1.01-5.93), age >70 years (2.87, 1.32-6.20), and advanced cancer stage (3.43, 1.16-10.21). Compared to pre-pandemic data, there were fewer anastomotic leaks (4.9% versus 7.7%), an overall shorter length of stay (6 versus 7 days), but higher mortality (1.7% versus 1.1%). Conclusion Surgeons need to further mitigate against both SARS-CoV-2 and anastomotic leak when offering surgery during current and future COVID-19 waves based on patient, operative, and organisational risks.

The impact of socioeconomic factors on 30-day mortality following elective colorectal cancer surgery: A nationwide study

2009 ◽  
Vol 45 (7) ◽  
pp. 1248-1256 ◽  
Author(s):  
B.L. Frederiksen ◽  
M. Osler ◽  
H. Harling ◽  
Steen Ladelund ◽  
T. Jørgensen
Keyword(s):  
Colorectal Cancer ◽  
Socioeconomic Factors ◽  
Cancer Surgery ◽  
Colorectal Cancer Surgery ◽  
Nationwide Study ◽  
The Impact

scholarly journals Impact of a health literacy intervention combining general practitioner training and a consumer facing intervention to improve colorectal cancer screening in underserved areas: protocol for a multicentric cluster randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Marie-Anne Durand ◽  
Aurore Lamouroux ◽  
Niamh M. Redmond ◽  
Michel Rotily ◽  
Aurélie Bourmaud ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health Literacy ◽  
Normalization Process Theory ◽  
Trial Registration ◽  
Process Theory ◽  
Crc Screening ◽  
Randomized Controlled ◽  
Secondary Outcomes ◽  
The Impact ◽  
Normalization Process

Abstract Background Colorectal cancer (CRC) is a leading cause of cancer burden worldwide. In France, it is the second most common cause of cancer death after lung cancer. Systematic uptake of CRC screening can improve survival rates. However, people with limited health literacy (HL) and lower socioeconomic position rarely participate. Our aim is to assess the impact of an intervention combining HL and CRC screening training for general practitioners (GPs) with a pictorial brochure and video targeting eligible patients, to increase CRC screening and other secondary outcomes, after 1 year, in several underserved geographic areas in France. Methods We will use a two-arm multicentric randomized controlled cluster trial with 32 GPs primarily serving underserved populations across four regions in France with 1024 patients recruited. GPs practicing in underserved areas (identified using the European Deprivation Index) will be block-randomized to: 1) a combined intervention (HL and CRC training + brochure and video for eligible patients), or 2) usual care. Patients will be included if they are between 50 and 74 years old, eligible for CRC screening, and present to recruited GPs. The primary outcome is CRC screening uptake after 1 year. Secondary outcomes include increasing knowledge and patient activation. After trial recruitment, we will conduct semi-structured interviews with up to 24 GPs (up to 8 in each region) and up to 48 patients (6 to 12 per region) based on data saturation. We will explore strategies that promote the intervention’s sustained use and rapid implementation using Normalization Process Theory. We will follow a community-based participatory research approach throughout the trial. For the analyses, we will adopt a regression framework for all quantitative data. We will also use exploratory mediation analyses. We will analyze all qualitative data using a framework analysis guided by Normalization Process Theory. Discussion Limited HL and its impact on the general population is a growing public health and policy challenge worldwide. It has received limited attention in France. A combined HL intervention could reduce disparities in CRC screening, increase screening rates among the most vulnerable populations, and increase knowledge and activation (beneficial in the context of repeated screening). Trial registration Registry: ClinicalTrials.gov. Trial registration number: 2020-A01687-32. Date of registration: 17th November 2020.

scholarly journals 1033. Effectiveness of a Physician-Driven Automated Antibiotic Time Out in the Setting of Gram-negative Bacteremia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S363-S364
Author(s):  
Sana Mohayya ◽  
Navaneeth Narayanan ◽  
Daniel Cimilluca ◽  
Parth Vaidya ◽  
Alexander Malanowski ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Primary Outcome ◽  
Secondary Outcome ◽  
Antibiotic Prescribing ◽  
Gram Negative ◽  
Time Out ◽  
Days Of Therapy ◽  
Gram Negative Bacteremia ◽  
Secondary Outcomes ◽  
The Impact

Abstract Background In an effort to minimize complications associated with over-utilization of antibiotics, many antimicrobial stewardship programs have incorporated an antibiotic time out (ATO). Despite the increasing adoption of the ATO, limited data are available to support its effectiveness. This study was designed to assess the impact of an automated ATO integrated into the electronic medical record (EMR) on the rate of antibiotic modification in patients receiving broad-spectrum antibiotic(s) for Gram-negative bacteremia (GNB). Methods This was a single-center retrospective cohort study of inpatients from January 2017 to June 2018 conducted at a large academic medical center. ATO was implemented on October 31, 2017. Adult patients with GNB who received at least 72 hours of a systemic antibiotic were included. Patients with neutropenia or polymicrobial infections were excluded. The primary outcome was the proportion of patients who received a modification of therapy within 24 hours of final culture results. Secondary outcomes included modification at any point in therapy, time to modification of therapy, time to de-escalation, and days of therapy of broad-spectrum antibiotics. Results There was a total of 88 patients who met inclusion criteria, 37 patients pre-ATO and 51 patients post-ATO. The primary outcome of modification of therapy within 24 hours of final culture results was not significantly different for patients in the pre-ATO and post-ATO groups (19% vs. 20%, P = 0.94, respectively). The secondary outcome of modification of therapy at any point in therapy was not significantly different between the two groups (62% vs. 66%, P = 0.67). Of the 47 patients who received a modification of therapy, the mean time to modification was significantly shorter in the post-ATO group (52.8 hours vs. 45.26 hours, P < 0.05,). All other secondary outcomes were not significantly different between study groups. Conclusion The ATO alert was not associated with a higher rate of antibiotic modification within 24 hours of culture results in patients with GNB, although there was a significant reduction in the time to antibiotic modification. Further efforts are needed to improve the time to modification and optimize antibiotic prescribing practices. Disclosures All authors: No reported disclosures.

scholarly journals Impact of hand dominance on effectiveness of chest compressions in a simulated setting: a randomised, crossover trial

2019 ◽  
Vol 16 ◽  
Author(s):  
Jamie Cross ◽  
Tommy Lam ◽  
Joel Arndell ◽  
John Quach ◽  
Buck Reed ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Crossover Trial ◽  
Recovery Period ◽  
Outcome Data ◽  
Dominant Hand ◽  
Hand Dominance ◽  
Modest Improvement ◽  
Significant Difference ◽  
Secondary Outcomes ◽  
The Impact

Aim External cardiac compressions (ECC) are a critical component in determining the effectiveness of cardiopulmonary resuscitation (CPR). Guidelines prior to the 2010 International Liaison Committee on Resuscitation directed rescuers to place the heel of the dominant hand directly on the chest when performing ECC, however current guidelines are silent on this issue. Existing research is inconsistent in findings, and heterogeneous in design and participants. The aims of this pilot study were to: 1) investigate the impact of hand dominance on effectiveness of ECC; and 2) generate outcome data to inform sample size calculations for a larger future study.Methods This study utilised a single blinded, prospective randomised crossover trial design. Each participant was allocated to a ‘dominant hand on chest’ (DHOC) or ‘non-dominant hand on chest’ (NDHOC) group. On a simulation manikin, participants in the DHOC group performed 3 minutes of ECC with dominant hand on the chest and non-dominant hand supporting, followed by a ‘rest and recovery’ period and then a second 3-minute period of ECC with the hand reversed such that the non-dominant hand was on the chest. The NDHOC group performed the same series of compressions but in reverse order. The primary outcome measure was effectiveness of ECC, determined by a percentage-based ‘CPR score’ (‘CS’). Secondary outcomes were compression depth, rate and release. The Wilcoxon rank-sum (Mann-Whitney) test was used due to the non-normal distribution of the data. Due to the crossover design, hierarchical linear regression was used to assess for a period or cross over effect. Results For the primary outcome of this study, we have found no significant difference in CS between DHOC and NDHOC (69.9% (SD=29.9) vs. 69.1% (SD=34.1); p=0.92), respectively. There were no differences in the secondary outcomes of compression rate and depth, though compression release was improved in the DHOC group (53% vs. 42%; p=0.02).ConclusionIn this randomised crossover study conducted in a simulation context there was no difference in ECC effectiveness measured by an overall effectiveness outcome according to placement of the dominant or non-dominant hand on the chest during compressions. A modest improvement in ECC release was seen in the dominant hand on chest group. While the study was underpowered, the results support an approach involving rescuers placing whichever hand they are most comfortable with on the chest irrespective of handedness.

scholarly journals Risk factors for anastomotic leakage and its impact on long-term survival in left-sided colorectal cancer surgery

2020 ◽  
Author(s):  
Marius Kryzauskas ◽  
Augustinas Bausys ◽  
Austeja Elzbieta Degutyte ◽  
Vilius Abeciunas ◽  
Eligijus Poskus ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Rectal Resection ◽  
Multivariable Analysis ◽  
Long Term Outcomes ◽  
Term Survival ◽  
Long Term Survival ◽  
Male Sex ◽  
The Impact

Abstract Background: Anastomotic leakage (AL) significantly impairs short-term outcomes. The impact on the long-term outcomes remains unclear. This study aimed to identify the risk factors for AL and the impact on long-term survival in patients with left-sided colorectal cancer.Methods: Nine-hundred patients with left-sided colorectal carcinoma who underwent sigmoid or rectal resection were enrolled in the study. Risk factors for AL after sigmoid or rectal resection were identified and long-term outcomes of patients with and without AL were compared.Results: AL rates following sigmoid and rectal resection were 5.1% and 10.7%, respectively. Higher ASA score (III-IV; OR=10.54, p=0.007) was associated with AL in patients undergoing sigmoid surgery on multivariable analysis. Male sex (OR=2.40, p=0.004), CCI score >5 (OR=1.72, p=0.025) and T3/T4 stage tumors (OR=2.25, p=0.017) were risk factors for AL after rectal resection on multivariable analysis. AL impaired disease-free and overall survival in patients undergoing sigmoid (p=0.009 and p=0.001) and rectal (p=0.003 and p=0.014) surgery.Conclusion: ASA score of III-IV is an independent risk factor for AL after sigmoid surgery and male sex, higher CCI score, and advanced T stage are risk factors for AL after rectal surgery. AL impairs the long-term survival in patients undergoing left-sided colorectal surgery.

scholarly journals Performance-Based Outcomes Following Symptomatic Pars Injuries in American Professional Baseball Players

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0040
Author(s):  
Heath P. Gould ◽  
Robert Daniel Winkelman ◽  
Joseph Tanenbaum ◽  
Emily Hu ◽  
Colin M. Haines ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Outcome Measures ◽  
Primary Outcome ◽  
Injury Surveillance ◽  
Professional Baseball ◽  
Post Injury ◽  
Baseball Players ◽  
Secondary Outcomes ◽  
Player Performance ◽  
The Impact

Objectives: Previous studies in the evidence-based literature suggest that lumbar spine injuries can lead to a significant decrease in athletic performance. This phenomenon is particularly evident in sports that require repetitive truncal rotation, such as baseball. Although we have previously characterized the natural history of symptomatic spondylolysis and spondylolisthesis in professional baseball players, no prior study has investigated the impact of pars injuries on player performance in this patient population. The purpose of this study was to report performance-based outcomes following symptomatic pars injuries in elite-level baseball athletes. Methods: A retrospective cohort study was conducted among all professional baseball players who presented with a symptomatic pars defect between 2011 and 2016. Both Major League and Minor League players were enrolled using a de-identified injury surveillance database maintained by the MLB. Lumbar spine imaging reports were reviewed to confirm the radiologic diagnosis of spondylolysis or spondylolisthesis. Players were stratified according to baseball position (pitcher vs. position player). Primary outcome measures for pitchers were earned run average (ERA) and walks plus hits per inning pitched (WHIP), while primary outcomes for position players were batting average (AVG) and on-base plus slugging (OPS). Paired t tests were used to compare pre-injury statistical performance to post-injury performance, with p < 0.05 treated as statistically significant. Results: During the defined study period, 75 players presented with low-back pain in the setting of a pars defect. 47 players were diagnosed with spondylolysis (62.7%), while 28 were diagnosed with spondylolisthesis (37.3%). Of those individuals, 19 players were excluded due to incomplete statistical data in the MLB injury surveillance system. Pre-injury vs. post-injury statistical comparisons are presented in Table 1. Pitching performance after the pars injury did not significantly differ with regard to the primary outcome measures, ERA (3.45 vs. 4.73; p = 0.25) and WHIP (1.28 vs. 1.47; p = 0.26). There was also no significant difference in any of the secondary outcomes - runs per 9 innings (R/9), hits per 9 innings (H/9), walks per 9 innings (BB/9), strikeouts per 9 innings (K/9), home runs per 9 innings (HR/9), and strikeout-to-walk ratio (K/BB). Similarly, batting performance among position players did not significantly differ from pre-injury to post-injury with regard to the primary outcomes, AVG (.261 vs. .256; p = 0.59) and OPS (.672 vs. .667; p = 0.87), or any of the secondary outcomes - on-base percentage (OBP), slugging percentage (SLG), runs per plate appearance (R/PA), hits per plate appearance (H/PA), runs batted in per plate appearance (RBI/PA), extra-base hits per plate appearance (XBH/PA), home runs per plate appearance (HR/PA), and walk-to-strikeout ratio (BB/K). Conclusion: This study represents the most comprehensive analysis of the impact of symptomatic pars injuries on MLB player performance. While previous studies suggest that lumbar injuries lead to shorter careers in both pitchers and position players, our current data demonstrate that pars defects do not cause a significant decrease in performance when MLB athletes return to play following these injury episodes. Given the limitations of our study design, larger prospective investigations are needed to validate these conclusions. [Table: see text]

Factors affecting chemotherapy use and delay (≥ 8 weeks) after colorectal cancer surgery and the impact of chemotherapy delay on survival.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 784-784
Author(s):  
Ik Yong Kim ◽  
Young Wan Kim
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Cancer Surgery ◽  
Stage Ii ◽  
Stage Iii ◽  
Recurrence Free Survival ◽  
Colorectal Cancer Surgery ◽  
Free Survival ◽  
Factors Affecting ◽  
The Impact

784 Background: To date, reasons for adjuvant chemotherapy (AC) omission and delay have not been extensively studies. This study aimed to evaluate factors affecting chemotherapy use and delay (≥8 weeks) after colorectal cancer surgery and their impact on survival. Methods: Between 2008 and 2013, consecutive 584 patients undergoing major resection for stage II and III colorectal cancer in a single tertiary referral center. Results: Among 584 patients with stage II and III diseases, AC was performed in 460 (78.8%) patients. Regimens included fluorouracil with folinic acid (n=257, 55.9%), FOLFOX (n=134, 29.1%), capecitabline (n=62, 13.5%), and tegafur-uracil (n=7, 1.5%). Factors affecting not receiving AC were older age (>80 years), American Society of Anesthesiologists score (≥3), presence of postoperative complication, and not receiving preoperative chemoradiation. Overall survival was 87.2% (AC +) and 58.5% (no AC, p<0.001) in stage II disease, and 79.5% (AC +) and 24.6% (no AC, p<0.001) in stage III disease, respectively. Recurrence-free survival was 83.7% (AC +) and 61.9% (no AC, p=0.003) in stage II disease, and 60.5%(AC +) and 21.8% (no AC, p<0.001) in stage III disease, respectively. Among 460 patients undergoing AC, AC was initiated within 8 weeks in 438 patients (95.2%) and after 8 weeks in 22 patients (4.8%). Factors affecting AC delay were male gender, rectal primary, intraoperative blood loss (>100ml), and presence of postoperative complications. Overall survival was 90.8% (AC +) and 40.0% (no AC, p=0.111) in stage II disease, and 82% (AC +) and 35.6% (no AC, p=0.275) in stage III disease, respectively. Recurrence-free survival 80.1% (AC +) and 54.5% (no AC, p=0.133) in stage II disease, and 64.4% (AC +) and 0.0% (no AC, p=0.014), respectively. Conclusions: In stage II, III patients, it appears that use of AC is more closely related patient’s survival rather than the time of AC initiation. To improve oncologic outcomes after curative resection, it is important to increase the proporation of AC use.

SP4.2.12 The impact of COVID 19 on colorectal cancer diagnosis and surgical oncological provision; A national perspective

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Noel Donlon ◽  
Tim Nugent ◽  
Shane Irwin ◽  
SInead Ramjit ◽  
Maria Davern ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
National Level ◽  
Late Presentation ◽  
Cancer Surgery ◽  
Colorectal Cancer Surgery ◽  
Admission Rates ◽  
Cancer Management ◽  
National Quality ◽  
National Perspective ◽  
The Impact

Abstract Introduction The COVID-19 pandemic has interfered with many aspects of cancer management, including delayed diagnoses, stalled screening programmes, limiting treatment and clinical trials. Colorectal cancer is the second commonest cause of cancer death in Ireland. The objective of the current study is to assess the impact of this pandemic on colorectal cancer diagnoses and surgery, at a national level. Methods Data on endoscopy, emergency and elective colorectal operations nationally in Ireland over a three year period (2018-2020) were obtained from the National Quality Assurance Improvement System. Data relating to cancer surgery only were included and patient demographics, type of surgery (open/laparoscopic), length of stay (LOS), mortality, admission to critical care and re-admission rates were collected and analysed. Results 31.33% less cancers have been diagnosed between March and November 2020 inclusive when compared to the same period over the past two years with 22% less rectal cancers identified. There has been a 34% reduction in colorectal cancer surgeries over the same period with a reduction of 42% at the initial wave during the period March-May and of concern, this trend has continued. Laparoscopic right hemicolectomies have reduced by 41%, anterior resections have reduced by 51% with no change in the number of temporary ileostomies over the three year period. Conclusion The impact of COVID-19 on colorectal cancer surgery nationally has been profound. The reduction in diagnoses and cancer surgery is concerning and may result in increased late or incurable stage disease as a consequence of late presentation and diagnosis.

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