Reasons for delay in time to initiation of adjuvant chemotherapy (AC) for colon cancer (CC).

e14553 Background: AC improves survival among patients with colon cancer. Two meta-analyses have demonstrated a decrease in survival with increasing time to AC (TTAC). Here, we examine the predominant factors leading to delay in TTAC. Methods: Individual medical records of 565 patients with CC who initiated AC Aug 2005-Nov 2010 in Eastern Ontario were reviewed to capture patient and treatment characteristics including: medical comorbidities, post-operative complications, the reason if AC was not ordered after initial medical oncology (MO) consultation, dates of surgery, referral to MO, MO consult, central venous catheter (CVC) insertion, and first cycle of AC. Patients were then categorized into two groups: (i) medical/surgical reason for delay (MSRD), defined as post-operative complications or intercurrent illness, and (ii) No MSRD. No MSRD patients were further subcategorized as post-MO delay (PMOD), defined as AC deferred at time of consultation due to patient preference or further investigations required, vs. No PMOD. A multivariate logistic regression model was used to determine factors associated with TTAC > 8 weeks (w). Results: In the No MSRD group (n= 423), 25% (n=107) were subdivided into the PMOD subgroup. On multivariate analysis, TTAC >8w was significantly associated with the presence of a MSRD [OR = 2.4 (1.6-3.9), p = <0.001] or PMOD [OR = 3.3 (1.9-5.6), p = <0.001]. No other significant associations were found, including oral vs. IV AC. Proportion of cases with TTAC >8w in the subgroups were: MSRD 76.1% (n = 108); PMOD 80.4% (n = 86); No PMOD 57.6% (n = 182). Conclusions: MSRD and PMOD are strong predictors of increased TTAC; however, the majority of patients have no MSRD or PMOD. TTAC in this group is 9 weeks. This suggests that TTAC is modifiable, and likely reflects delays in referral, consultation, and chemotherapy booking. [Table: see text]

Download Full-text

Reasons for delay in time to initiation of adjuvant chemotherapy (AC) for colon cancer (CC).

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.4_suppl.548 ◽

2013 ◽

Vol 31 (4_suppl) ◽

pp. 548-548

Author(s):

David Warren Wasserman ◽

Christopher M. Booth ◽

Wilma Hopman ◽

Abdullah Al Sharm ◽

James Joseph Biagi

Keyword(s):

Colon Cancer ◽

Medical Condition ◽

Strong Predictor ◽

Multivariate Logistic Regression Model ◽

Medical Illness ◽

Factors Associated ◽

Operative Complications ◽

Group 2 ◽

Group 1 ◽

Post Operative Complications

548 Background: AC improves survival among patients with colon cancer. Two meta-analyses have demonstrated a decrease in survival with increasing time to AC (TTAC). In this study, we examined individual patient charts to determine reasons for delay in AC. Methods: Medical records of patients with CC who initiated AC Aug 2005-Nov 2010 at the Cancer Centre of Southeastern Ontario were reviewed to capture patient, disease, and treatment characteristics including: medical comorbidities, post-operative complications, whether AC was or was not ordered after initial consultation, and the reasons behind the decision. Dates of surgery, referral, consult, central venous catheter (CVC) insertion, and first cycle of AC were recorded. Patients were then categorized into Group 1-medical/surgical reason for delay (MSRD), defined as presence of post-operative complications or intercurrent medical illness, and Group 2–no MSRD. In Group 2, patients were further categorized as having a non-MSRD, defined as patients in whom AC was deferred at time of consultation due to patient preference and/or further investigations required, vs none. A multivariate logistic regression model was used to determine factors associated with TTAC > 8 weeks (w). Results: For 171 patients: Mean age - 67; 52% male; 79% stage 3; IV AC – 80%, Oral AC – 20%. TTAC for all cases was 8.3 ± 2.3w. Mean intervals ± SD between surgery and TTAC in weeks were: surgery to referral 3.1 ± 2.0; referral to consult 2.5 ± 2.3; consult to oral AC 2.0 ± 2.1; for IV AC, consult to CVC 2.2 ± 1.3, and CVC to AC 0.7 ± 0.8. TTAC did not differ between patients with comorbidities (N= 89) and those without (N=82), p= 0.64, but was greater for patients in Group 1 (N=41 with MSRD) vs Group 2 (N = 130), p= 0.002. In Group 2, 43.8% (N=57) had TTAC > 8w while only 20% of cases (n=26) had a non-MSRD. Factors associated with TTAC>8w were MSRD [OR=5.6 (2.3-13.7), p = <0.001] and non-MSRD [OR=6.7 (2.3-19.5), p = <0.001]. Conclusions: Although medical/surgical complications are a strong predictor of delayed TTAC, this only applies to a small proportion of cases. Accordingly, in most patients TTAC>8w is unrelated to their post-operative medical condition and likely reflects health system and logistical issues.

Download Full-text

Increased use of pre-operative imaging and laparoscopy has no impact on clinical outcomes in patients undergoing appendicectomy

Annals of The Royal College of Surgeons of England ◽

10.1308/003588411x13165261994076 ◽

2011 ◽

Vol 93 (8) ◽

pp. 620-623 ◽

Cited By ~ 11

Author(s):

SR Markar ◽

A Karthikesalingam ◽

J Cunningham ◽

C Burd ◽

G Bond-Smith ◽

...

Keyword(s):

Multivariate Analysis ◽

Acute Appendicitis ◽

Medical Records ◽

Operative Time ◽

University Teaching ◽

Complication Rates ◽

Operative Complications ◽

Negative Appendicectomy ◽

Appendiceal Perforation ◽

Post Operative Complications

INTRODUCTION The aim of this study was to review changes in the management of acute appendicitis in a ten-year period at a large university teaching hospital in London. METHODS This was a retrospective cohort study reviewing the medical records of patients who underwent an appendicectomy over a period of 12 months either in 1999 or 2009. Data collected included use of radiological investigations (ultrasonography, computed tomography [CT]), technique of appendicectomy (open [OA] or laparoscopic [LA]), operative time, histopathology and post-operative complications. Univariate and multivariate analysis was performed to assess the influence of variables on the incidence of negative appendicectomy, appendiceal perforation and post-operative complications. RESULTS All of the patients operated on in 1999 (n=109) had OA. Of the patients operated on in 2009 (n=164), 67 had OA, 91 had LA and 6 had LA converted to OA. None of the patients in 1999 had CT whereas in 2009 26% of patients had CT (sensitivity 94.7%, specificity 75.0%). This increased use of pre-operative imaging had no effect on negative appendicectomy (25.7% vs 12.8%, p=0.445), perforation (30.0% vs 21.3%, p=0.308) or complication rates (9.2% vs 10.4%). The complication rate was also similar regardless of whether patients had OA or LA (11.9% vs 9.9%). Multivariate analysis revealed that age was the only predictor of negative appendicectomy (p=0.029) or perforation (p=0.014). CONCLUSIONS This study shows that significant increase in the use of pre-operative imaging and laparoscopy in the management of patients with acute appendicitis failed to reduce negative appendicectomy, perforation and complications rates. The patient's age was the only predictor of negative appendicectomy and perforation.

Download Full-text

Integrated post-surgical colon cancer care planning at the Rutgers Cancer Institute of New Jersey and Robert Wood Johnson University Hospital.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.7_suppl.75 ◽

2016 ◽

Vol 34 (7_suppl) ◽

pp. 75-75

Author(s):

Teresa V. Brown ◽

Kristen Donohue ◽

Sondra Patella ◽

Viktor Y. Dombrovskiy ◽

Rebecca Anne Moss ◽

...

Keyword(s):

Colon Cancer ◽

Adjuvant Chemotherapy ◽

Medical Oncology ◽

University Hospital ◽

Pathology Report ◽

Care Planning ◽

Time To Initiation ◽

Central Access ◽

Chemotherapy Initiation ◽

Colon Cancer Care

75 Background: Colorectal cancer is the second leading cause of cancer death in the United States each year. The use of adjuvant chemotherapy after surgical resection of colon cancer has been associated with a survival benefit. Timely initiation of adjuvant chemotherapy has been shown to have an effect on overall and disease-free survival. There is no integrated post-surgical colon cancer care planning for patients who have surgery at our institution. Poor understanding on the part of patients and ancillary providers regarding appropriate follow up may cause delay in time to adjuvant chemotherapy initiation. Methods: Baseline data was obtained for the ASCO Quality Training Program. Chart review was conducted on patients with stage III colorectal cancer that were treated at the Cancer Institute of New Jersey and Robert Wood Johnson University Hospital to identify average time to adjuvant chemotherapy initiation and factors which were thought to have a strong influence on chemotherapy initiation. Time to initiation of adjuvant chemotherapy, pathology report resulting, central access obtainment, and outpatient medical oncology appointment was abstracted from patient charts. Other factors including the presence of intraoperative or postoperative complications, type of surgeon, academic versus private medical oncologist, and the presence of an inpatient medical oncology consult were also identified and reviewed. Results: 128 patient charts were reviewed. Mean number of days from surgery to adjuvant chemotherapy (n = 79) was 49.6, to pathology report resulting (n = 70) was 4.92, to central access obtainment (n = 49) was 40, and to outpatient medical oncology appointment (n = 38) was 30. The presence of intraoperative (p < 0.059) and postoperative complications (p < 0.0155) was found to have a statistically significant effect on time to initiation of adjuvant chemotherapy. Conclusions: While there are some uncontrollable factors like operative complications that delay time to initiation of chemotherapy, engaging the patient may help decrease the time to adjuvant chemotherapy by increasing patient awareness of the importance of seeking aggressive postoperative care.

Download Full-text

Peritonsillar infiltration of lidocaine with adrenaline is associated with increased risk of secondary post-tonsillectomy haemorrhage

The Journal of Laryngology & Otology ◽

10.1017/s0022215118001731 ◽

2018 ◽

Vol 132 (10) ◽

pp. 911-922 ◽

Cited By ~ 1

Author(s):

H K Tolska ◽

A J Takala ◽

J Jero

Keyword(s):

Paediatric Patient ◽

Medical Records ◽

Odds Ratio ◽

Common Complication ◽

Peritonsillar Infiltration ◽

Haemostatic Agents ◽

Increased Risk ◽

Operative Complications ◽

Grade Iii ◽

Post Operative Complications

AbstractObjectivesIn order to evaluate the safety of tonsillectomy among children, we retrospectively studied the incidence of post-operative complications, adverse events and their association with peri-operative medication.MethodsData were collected from the medical records of 691 patients aged 1–16 years, including details of post-operative complications (any unplanned contact with the hospital), analgesics, dexamethasone, 5-HT3 antagonists, local anaesthetic and haemostatic agents.ResultsRecovery was complicated in 13.6 per cent of patients, of whom 8.4 per cent were re-admitted to the ward. The most common complication was post-tonsillectomy haemorrhage, experienced by 7.1 per cent of patients. Re-operation under general anaesthesia (for grade III post-tonsillectomy haemorrhage) was required by 4.2 per cent of patients. Peritonsillar infiltration of lidocaine with adrenaline increased the risk of post-tonsillectomy haemorrhage (odds ratio = 4.1; 95 per cent confidence interval = 2.1 to 8.3).ConclusionEvery seventh paediatric patient experienced a complicated recovery after tonsillectomy, caused by post-tonsillectomy haemorrhage in most cases. Local peritonsillar infiltration of lidocaine with adrenaline was associated with an increased risk of post-tonsillectomy haemorrhage.

Download Full-text

Pelvic Canal Narrowing Caused by Triple Pelvic Osteotomy in the Dog

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1633130 ◽

1994 ◽

Vol 07 (03) ◽

pp. 110-113 ◽

Cited By ~ 6

Author(s):

D. L. Holmberg ◽

M. B. Hurtig ◽

H. R. Sukhiani

Keyword(s):

Postoperative Complications ◽

Pelvic Osteotomy ◽

Cross Sectional Area ◽

Sectional Area ◽

Cross Sectional ◽

Canal Width ◽

Operative Complications ◽

Post Operative Complications

SummaryDuring a triple pelvic osteotomy, rotation of the free acetabular segment causes the pubic remnant on the acetabulum to rotate into the pelvic canal. The resulting narrowing may cause complications by impingement on the organs within the pelvic canal. Triple pelvic osteotomies were performed on ten cadaver pelves with pubic remnants equal to 0, 25, and 50% of the hemi-pubic length and angles of acetabular rotation of 20, 30, and 40 degrees. All combinations of pubic remnant lengths and angles of acetabular rotation caused a significant reduction in pelvic canal-width and cross-sectional area, when compared to the inact pelvis. Zero, 25, and 50% pubic remnants result in 15, 35, and 50% reductions in pelvic canal width respectively. Overrotation of the acetabulum should be avoided and the pubic remnant on the acetabular segment should be minimized to reduce postoperative complications due to pelvic canal narrowing.When performing triple pelvic osteotomies, the length of the pubic remnant on the acetabular segment and the angle of acetabular rotation both significantly narrow the pelvic canal. To reduce post-operative complications, due to narrowing of the pelvic canal, overrotation of the acetabulum should be avoided and the length of the pubic remnant should be minimized.

Download Full-text