Permanent stoma: a quality outcome in treatment of rectal cancer and its impact on length of stay

Abstract Background This study aimed to identify socioeconomic predictors of permanent stoma in rectal cancer treatment and examine its association with length of stay at the treatment facility. Methods Rectal cancer patients who underwent elective surgery between January 2015 and December 2018 were identified from the Agency for Health Care Administration Florida Hospital Inpatient Discharge Dataset. Multivariate regression models were utilized to identify demographic and socioeconomic factors associated with receiving a permanent stoma as well as the associated length of stay of these patients. Results Of 2630 rectal cancer patients who underwent surgery for rectal cancer, 21% had a permanent stoma. The odds of receiving permanent stoma increased with higher Elixhauser score, metastatic disease, advanced age, having open surgery, residence in Southwest Florida, and having Medicaid insurance or no insurance/self-payers (p < 0.05). Patients with a permanent stoma had a significantly extended stay after surgery (p < 0.001). Conclusions Patients with a permanent stoma following cancer resection were more likely to have open surgery, had more comorbidities, and had a longer length of stay. Having permanent stoma was higher in patients living in South West Florida, patients with Medicaid insurance, and in the uninsured. Additionally, the payer type significantly affected the length of stay.

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Permanent Stoma: A Quality Outcome in Treatment of Rectal Cancer and Its Impact on Length of Stay

10.21203/rs.3.rs-145240/v1 ◽

2021 ◽

Author(s):

Riccardo Lemini ◽

Iktej Singh Jabbal ◽

Krystof Stanek ◽

Shalmali R. Borkar ◽

Aaron C. Spaulding ◽

...

Keyword(s):

Rectal Cancer ◽

Length Of Stay ◽

Cancer Patients ◽

Multivariate Regression ◽

Regression Models ◽

Health Care Administration ◽

Hospital Inpatient ◽

Southwest Florida ◽

Permanent Stoma ◽

Rectal Cancer Treatment

Abstract Background This study aimed to identify socioeconomic predictors of permanent stoma in rectal cancer treatment and examine its association with length of stay at the treatment facility.MethodsRectal cancer patients were identified from the Agency for Health Care Administration Florida Hospital Inpatient Discharge Dataset. Multivariate regression models were utilized to identify demographic, and socioeconomic factors associated with receiving a permanent stoma as well as the associated length of stay of these patients.ResultsOf 2,630 rectal cancer patients who underwent surgery for rectal cancer, 21% had a permanent stoma. The odds of receiving permanent stoma increased with higher Elixhauser score, metastatic disease, residing in Southwest Florida, and having Medicaid insurance or no insurance/self-payers (p<0.05). Patients with a permanent stoma had a significantly extended stay after surgery (p<0.001). ConclusionsPatients with a permanent stoma following cancer resection were more likely to have open surgery, had more comorbidities, and had a longer length of stay. Additionally, the payer type significantly affected the length of stay and odds of receiving a permanent stoma.

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Experiences of a “COVID protected” robotic surgical centre for colorectal and urological cancer in the COVID-19 pandemic

Journal of Robotic Surgery ◽

10.1007/s11701-021-01199-3 ◽

2021 ◽

Author(s):

Jeremy R. Huddy ◽

Matthew Crockett ◽

A Shiyam Nizar ◽

Ralph Smith ◽

Manar Malki ◽

...

Keyword(s):

Rectal Cancer ◽

Robotic Surgery ◽

Length Of Stay ◽

Elective Surgery ◽

Standard Operating Procedure ◽

Major Surgery ◽

Renal Surgery ◽

Increased Risk ◽

Acute Hospitals ◽

Da Vinci Si

AbstractThe recent COVID-19 pandemic led to the cancellation of elective surgery across the United Kingdom. Re-establishing elective surgery in a manner that ensures patient and staff safety has been a priority. We report our experience and patient outcomes from setting up a “COVID protected” robotic unit for colorectal and renal surgery that housed both the da Vinci Si (Intuitive, Sunnyvale, CA, USA) and the Versius (CMR Surgical, Cambridge, UK) robotic systems. “COVID protected” robotic surgery was undertaken in a day-surgical unit attached to the main hospital. A standard operating procedure was developed in collaboration with the trust COVID-19 leadership team and adapted to national recommendations. 60 patients underwent elective robotic surgery in the initial 10-weeks of the study. This included 10 colorectal procedures and 50 urology procedures. Median length of stay was 4 days for rectal cancer procedures, 2 days less than prior to the COVID period, and 1 day for renal procedures. There were no instances of in-patient coronavirus transmission. Six rectal cancer patients waited more than 62 days for their surgery because of the initial COVID peak but none had an increase T-stage between pre-operative staging and post-operative histology. Robotic surgery can be undertaken in “COVID protected” units within acute hospitals in a safe way that mitigates the increased risk of undergoing major surgery in the current pandemic. Some benefits were seen such as reduced length of stay for colorectal patients that may be associated with having a dedicated unit for elective robotic surgical services.

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ASO Visual Abstract: Health Care Costs of Laparoscopic Versus Open Surgery for Rectal Cancer Patients in the First 12 Months: A Secondary End-Point Analysis of the Australasian Laparoscopic Cancer of the Rectum Trial (ALaCaRT)

Annals of Surgical Oncology ◽

10.1245/s10434-021-10972-5 ◽

2022 ◽

Author(s):

Chi Kin Law ◽

Andrew R. L. Stevenson ◽

Michael Solomon ◽

Wendy Hague ◽

Kate Wilson ◽

...

Keyword(s):

Health Care ◽

Rectal Cancer ◽

Cancer Patients ◽

Health Care Costs ◽

Open Surgery ◽

Cancer Of The Rectum ◽

End Point ◽

Point Analysis ◽

Care Costs

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Liberal perioperative fluid administration is an independent risk factor for morbidity and is associated with longer hospital stay after rectal cancer surgery

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2016.0280 ◽

2017 ◽

Vol 99 (2) ◽

pp. 113-116 ◽

Cited By ~ 9

Author(s):

MR Boland ◽

I Reynolds ◽

N McCawley ◽

E Galvin ◽

S El-Masry ◽

...

Keyword(s):

Rectal Cancer ◽

Risk Factor ◽

Length Of Stay ◽

Hospital Stay ◽

Independent Risk Factor ◽

Elective Surgery ◽

Cancer Surgery ◽

Rectal Cancer Surgery ◽

Major Morbidity ◽

Grade Iii

INTRODUCTION Recent studies have advocated the use of perioperative fluid restriction in patients undergoing major abdominal surgery as part of an enhanced recovery protocol. Series reported to date include a heterogenous group of high- and low-risk procedures but few studies have focused on rectal cancer surgery alone. The aim of this study was to assess the effects of perioperative fluid volumes on outcomes in patients undergoing elective rectal cancer resection. METHODS A prospectively maintained database of patients with rectal cancer who underwent elective surgery over a 2-year period was reviewed. Total volume of fluid received intraoperatively was calculated, as well as blood products required in the perioperative period. The primary outcome was postoperative morbidity (Clavien-Dindo grade I–IV) and the secondary outcomes were length of stay and major morbidity (Clavien–Dindo grade III–IV). RESULTS Over a 2-year period (2012–2013), 120 patients underwent elective surgery with curative intent for rectal cancer. Median total intraoperative fluid volume received was 3680ml (range 1200–9670ml); 65/120 (54.1%) had any complications, with 20/120 (16.6%) classified as major (Clavien–Dindo grade III–IV). Intraoperative volume >3500ml was an independent risk factor for the development of postoperative all-cause morbidity (P=0.02) and was associated with major morbidity (P=0.09). Intraoperative fluid volumes also correlated with length of hospital stay (Pearson’s correlation coefficient 0.33; P<0.01). CONCLUSIONS Intraoperative fluid infusion volumes in excess of 3500ml are associated with increased morbidity and length of stay in patients undergoing elective surgery for rectal cancer.

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