Differences in organization of care are associated with mortality, severe complication and failure to rescue in emergency colon cancer surgery

Abstract Background Emergency colon cancer surgery is associated with increased mortality and complication risk, which can be due to differences in the organization of hospital care. This study aimed. Objective To explore which structural factors in the preoperative, perioperative and postoperative periods influence outcomes after emergency colon cancer surgery. Methods An observational study was performed in 30 Dutch hospitals. Medical records from 1738 patients operated in the period 2012 till 2015 were reviewed on the type of referral, intensive care unit (ICU) level, surgeon specialization and experience, duration of surgery and operating room time, blood loss, stay on specialized postoperative ward, complication occurrence, reintervention and day of surgery and linked to case-mix data available in the Dutch Colorectal Audit. Multivariate logistic regression analysis was used to estimate the influence of these factors on 30-day mortality, severe complication and failure to rescue (FTR), after adjustment for case-mix. Results Patients operated by a non-Gastro intestinal/oncology specialized surgeon have significantly increased mortality (Odds Ratio (OR) 2.28 [95% confidence interval (95% CI) 1.23–4.23]) and severe complication risk (OR 1.61 [95% CI 1.08–2.39]). Also, duration of stay in the operating room was significantly associated with increased risk on severe complication (OR 1.03 [95% CI 1.01–1.06]). Patients admitted to a non-specialized ward have significantly increased mortality (OR 2.25 [95% CI 1.46–3.47]) and FTR risk (OR 2.39 [95% CI 1.52–3.75]). A low ICU level (basic ICU) was associated with a lower severe complication risk (OR 0.72 [95% CI 0.52–1.00]). Surgery on Tuesday was associated with a higher mortality risk (OR 2.82 [95% CI 1.24–6.40]) and a severe complication risk (OR 1.77, [95% CI 1.19–2.65]). Conclusion This study identified a non-specialized surgeon and ward, operating room, time and day of surgery to be risk factors for worse outcomes in emergency colon cancer surgery.

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Do Outcomes in Elective Colon and Rectal Cancer Surgery Differ by Weekday? An Observational Study Using Data From the Dutch ColoRectal Audit

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2018.7282 ◽

2019 ◽

Vol 17 (7) ◽

pp. 821-828

Author(s):

Daniëlle D. Huijts ◽

Onno R. Guicherit ◽

Jan Willem T. Dekker ◽

Julia T. van Groningen ◽

Leti van Bodegom-Vos ◽

...

Keyword(s):

Rectal Cancer ◽

Elective Surgery ◽

Cancer Surgery ◽

Case Mix ◽

Rectal Cancer Surgery ◽

Failure To Rescue ◽

Complication Risk ◽

Colon And Rectal Cancer ◽

Case Mix Adjustment ◽

Elective Colon

AbstractBackground: Previous studies showing higher mortality after elective surgery performed on a Friday were based on administrative data, known for insufficient case-mix adjustment. The goal of this study was to investigate the risk of adverse events for patients with colon and rectal cancer by day of elective surgery using clinical data from the Dutch ColoRectal Audit. Patients and Methods: Prospectively collected data from the 2012–2015 Dutch ColoRectal Audit (n=36,616) were used to examine differences in mortality, severe complications, and failure to rescue by day of elective surgery (Monday through Friday). Monday was used as a reference, analyses were stratified for colon and rectal cancer, and case-mix adjustments were made for previously identified variables. Results: For both colon and rectal cancer, crude mortality, severe complications, and failure-to-rescue rates varied by day of elective surgery. After case-mix adjustment, lower severe complication risk was found for rectal cancer surgery performed on a Friday (odds ratio, 0.84; 95% CI, 0.72–0.97) versus Monday. No significant differences were found for colon cancer surgery performed on different weekdays. Conclusions: No weekday effect was found for elective colon and rectal cancer surgery in the Netherlands. Lower severe complication risk for elective rectal cancer surgery performed on a Friday may be caused by patient selection.

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From Classroom to Operating Room, Time Management Matters

Biomedical Instrumentation & Technology ◽

10.2345/0899-8205(2007)41[201:fctort]2.0.co;2 ◽

2007 ◽

Vol 41 (3) ◽

pp. 201-203

Author(s):

Charles Taylor

Keyword(s):

Operating Room ◽

Time Management ◽

Room Time ◽

Operating Room Time

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Physical Activity and Its Impact on Colon Cancer Surgery

Case Medical Research ◽

10.31525/ct1-nct03947840 ◽

2019 ◽

Author(s):

Keyword(s):

Physical Activity ◽

Colon Cancer ◽

Cancer Surgery ◽

Colon Cancer Surgery

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Factors associated with diet failure after colon cancer surgery

Surgical Endoscopy ◽

10.1007/s00464-021-08575-y ◽

2021 ◽

Author(s):

Kiho You ◽

Dae Kyung Sohn ◽

Sung Sil Park ◽

Sung Chan Park ◽

Jae Hwan Oh ◽

...

Keyword(s):

Colon Cancer ◽

Cancer Surgery ◽

Factors Associated ◽

Colon Cancer Surgery

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A case of portal venous gas after obstructive transverse colon cancer surgery

Surgical Case Reports ◽

10.1186/s40792-019-0729-z ◽

2019 ◽

Vol 5 (1) ◽

Author(s):

Yuichiro Furutani ◽

Chikashi Hiranuma ◽

Masakazu Hattori ◽

Kenji Doden ◽

Yasuo Hashizume

Keyword(s):

Colon Cancer ◽

Conservative Treatment ◽

Anastomotic Leakage ◽

Transverse Colon ◽

Cancer Surgery ◽

Transverse Colon Cancer ◽

Bowel Necrosis ◽

Entire Area ◽

Portal Venous Gas ◽

Colon Cancer Surgery

Abstract Background Portal venous gas has traditionally been considered an inevitable harbinger of death due to its association with bowel necrosis. Recently, an increasing number of cases of portal venous gas have been reported in patients with various clinical conditions and without bowel necrosis. We herein report the case of a patient in whom portal venous gas developed after transverse colon cancer surgery. Case presentation A 69-year-old man who had transverse colon cancer underwent insertion of a transanal ileus tube for decompression. Transverse colon resection was performed on the 11th day after the insertion of the transanal ileus tube. The patient had a high fever on the 6th day after the operation. Computed tomography showed portal venous gas over the entire area of the liver and pneumatosis intestinalis in the wall of the ascending colon. There were no signs of anastomotic leakage or bowel necrosis, so we decided to use conservative therapy with fasting and antibiotics. The portal venous gas disappeared on the 19th day after the operation. The patient was discharged in good condition on the 29th day after the operation. Conclusions Conservative treatment for portal venous gas is reasonable for patients without signs of anastomotic leakage or bowel necrosis. However, it is important to carefully observe patients with portal venous gas during conservative treatment because portal venous gas may be life-threatening.

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