Perioperative positioning management in gynecologic cancer surgery: A national NOGGO-AGO intergroup survey.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e17046-e17046
Author(s):  
Mareike Sporkmann ◽  
Jenny Katharina Wagner ◽  
Rolf Richter ◽  
Alexander Burges ◽  
Barbara Schmalfeldt ◽  
...  
Keyword(s):  
Gynecologic Oncology ◽  
Gynecologic Cancer ◽  
High Volume ◽  
Postoperative Management ◽  
Cancer Surgery ◽  
Current Guideline ◽  
Case Examples ◽  
Structure Reliability ◽  
Team Time Out ◽  
Practice Methods

e17046 Background: Perioperative positioning injuries occur in approximately 4% of all medical complications. The aim of the present survey was the analysis of positioning-management in gynecologic-oncological surgery, the process- and structure-reliability and the implementation of current guidelines into daily clinical practice. Methods: A multiple-choice anonymous questionnaire about the perioperative positioning management in gynecologic oncology was sent to all gynecological departments in Germany. Sixty questions were divided into five different parts: 1) descriptive information about the department, 2) focus on the pre- and 3) postoperative management, 4) on the quality management, and 5) information regarding the management of positioning in the operation room based on two fictional case examples in gynecologic oncology procedures. Results: 184 of 633 departments participated in the survey between June and September 2016. Complications related to intraoperative positioning occurred in 48.4% of all participating departments, independent from department size. Knowledge of the current guideline on positioning did not impact the incidence of complications. The positioning of the patient was mentioned in the team-time-out procedure in 66.1% of the participating departments. No difference was found between high-volume and low-volume gynecologic oncologic operative departments with regard to the use of supportive tools such as anti-thrombotic leg pumps. The vast majority with 92.7% included information of positioning injuries into the written informed consent. Knowledge of the guideline or a previous legal dispute did not influence the willingness to inform about possible positioning-related complications. Conclusions: Our survey shows, that the awareness of perioperative positioning management in gynecologic cancer surgery is high throughout all sizes departments in Germany. Almost half of all 184 participating departments report positioning-related complications in the previous 12 months, stressing the importance of this often underrated topic.

A "continuously connected team support" model to facilitate high-quality gynecologic cancer care in rural and remote regions.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 51-51
Author(s):  
David F. Silver ◽  
Steven M. Aukers ◽  
Melissa A. Simon
Keyword(s):  
Cancer Care ◽  
Gynecologic Oncology ◽  
Gynecologic Cancer ◽  
High Volume ◽  
Healthcare Services ◽  
Rural And Remote ◽  
High Quality ◽  
High Performing ◽  
Continuous Quality ◽  
Innovative Solution

51 Background: Quality gynecologic cancer care (GCC) in rural and remote regions (RRR) of the U.S. is limited by poor access to gynecologic oncology expertise (GOE). While a variety of telehealth programs in other specialties have enhanced healthcare in RRR, none have resulted in provision of the comprehensive medical and surgical services required to treat gynecologic cancer patients. We propose a model to improve access and quality for comprehensive GCC in RRR. Methods: PubMed, Medline, and Google searches identified and characterized: 1) core quality components of GCC models; 2) RRR lacking GOE; and 3) current models for delivering healthcare services in remote regions. A new model was developed addressing needs of RRR. Results: Characteristics observed in high-performing GCC models include: 1) gynecologic oncologists (GO) guide all aspects of GCC, 2) care is performed by high-volume providers (HVP), and 3) multidisciplinary provider teams (MDT) address all patient needs. Without equal access to GO, HVP, or MDT, patients in RRR do not share benefits of high-quality outcomes. Integrating components of successful telementoring models with identified high-quality characteristics of traditional GCC, our model is developed to address the comprehensive and ongoing unique GCC needs of RRR. This Continuously Connected Team Support (CCTS) model utilizes a semi-remote GO to facilitate quality GCC through mentorship and education of a local MDT, transforming it into a transdisciplinary team (TDT). Off-site activities include 24/7 availability via phone or HIPAA-compliant videoconferencing. The GO’s on-site activities include proctoring the TDT in surgeries, mentoring and educating in clinical conferences, and continuous quality improvement activities. Long-term, regular on-site and remote interactions with the local TDT makes CCTS unique in its commitment and service beyond that of itinerant surgeons, locum tenens, international surgical charity efforts or established telehealth programs. Conclusions: Deployment of CCTS in RRR offers an innovative solution for the facilitation of high-quality comprehensive GCC in RRR lacking GOE. Further outcomes research is warranted.

The effects of centralizing cancer surgery on postoperative mortality: A systematic review and meta-analysis

2021 ◽  
pp. 135581962110089
Author(s):  
Roberto Grilli ◽  
Federica Violi ◽  
Maria Chiara Bassi ◽  
Massimiliano Marino
Keyword(s):  
Evaluation Studies ◽  
Meta Analysis ◽  
Postoperative Mortality ◽  
Interrupted Time Series ◽  
High Volume ◽  
Cancer Surgery ◽  
Interrupted Time Series Analysis ◽  
Meta Regression ◽  
Meta Regression Analysis ◽  
After Cancer

Objectives To review the evidence of the effects of centralization of cancer surgery on postoperative mortality. Methods We searched Medline, Embase, Cinahl, Cochrane and Scopus (up to November 2019) for studies that (i) assessed the effects of centralization of cancer surgery policies on in-hospital or 30-day mortality, or (ii) described changes in both postoperative mortality for a surgical intervention and degree of centralization using reduction in the number of hospitals or increases in the proportion of patients undergoing cancer surgery at high volume hospitals as proxy. PRISMA guidelines were followed. We estimated pooled odds ratios (OR) and conducted meta-regression to assess the relationship between degree of centralization and mortality. Results A total of 41 studies met our inclusion criteria of which 15 evaluated the effect of centralization policies on postoperative mortality after cancer surgery and 26 described concurrent changes in the degree of centralization and postoperative mortality. Policy evaluation studies mainly used before-after designs (n = 13) or interrupted time series analysis (n = 2), mainly focusing on pancreatic, oesophageal and gastric cancer. All but one showed some degree of reduction in postoperative mortality, with statistically significant effects demonstrated by six studies. The pooled odds ratio for centralization policy effect was 0.68 (95% Confidence interval: 0.54–0.85; I2 = 80%). Meta-regression analysis of the 26 descriptive studies found that an increase of the proportion of patients treated at high volume hospitals was associated with greater reduction in postoperative mortality. Conclusions Centralization of cancer surgery is associated with reduced postoperative mortality. However, existing evidence tends to be of low quality and estimates of the effect size are likely inflated. There is a need for prospective studies using more robust approaches, and for centralization efforts to be accompanied by well-designed evaluations of their effectiveness.

scholarly journals Major Vascular Injury During Gynecologic Cancer Surgery

2021 ◽  
pp. 100815
Author(s):  
Andrea L Buras ◽  
Jing Yi Chern ◽  
Hye Sook Chon ◽  
Mian M Shahzad ◽  
Robert M Wenham ◽  
...  
Keyword(s):  
Vascular Injury ◽  
Gynecologic Cancer ◽  
Cancer Surgery ◽  
Major Vascular Injury

scholarly journals Center-Level Procedure Volume Does Not Predict Failure-to-Rescue After Severe Complications of Oncologic Colon and Rectal Surgery

2021 ◽  
Author(s):  
Miriam Lillo-Felipe ◽  
Rebecka Ahl Hulme ◽  
Maximilian Peter Forssten ◽  
Gary A. Bass ◽  
Yang Cao ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Postoperative Complications ◽  
High Volume ◽  
Cancer Surgery ◽  
Colon And Rectal Surgery ◽  
Surgical Volume ◽  
Failure To Rescue ◽  
Colorectal Cancer Surgery ◽  
Procedure Volume ◽  
Low Volume

Abstract Background The relationship between hospital surgical volume and outcome after colorectal cancer surgery has thoroughly been studied. However, few studies have assessed hospital surgical volume and failure-to-rescue (FTR) after colon and rectal cancer surgery. The aim of the current study is to evaluate FTR following colorectal cancer surgery between clinics based on procedure volume. Methods Patients undergoing colorectal cancer surgery in Sweden from January 2015 to January 2020 were recruited through the Swedish Colorectal Cancer Registry. The primary endpoint was FTR, defined as the proportion of patients with 30-day mortality after severe postoperative complications in colorectal cancer surgery. Severe postoperative complications were defined as Clavien–Dindo ≥ 3. FTR incidence rate ratios (IRR) were calculated comparing center volume stratified in low-volume (≤ 200 cases/year) and high-volume centers (> 200 cases/year), as well as with an alternative stratification comparing low-volume (< 50 cases/year), medium-volume (50–150 cases/year) and high-volume centers (> 150 cases/year). Results A total of 23,351 patients were included in this study, of whom 2964 suffered severe postoperative complication(s). Adjusted IRR showed no significant differences between high- and low-volume centers with an IRR of 0.97 (0.75–1.26, p = 0.844) in high-volume centers in the first stratification and an IRR of 2.06 (0.80–5.31, p = 0.134) for high-volume centers and 2.15 (0.83–5.56, p = 0.116) for medium-volume centers in the second stratification. Conclusion This nationwide retrospectively analyzed cohort study fails to demonstrate a significant association between hospital surgical volume and FTR after colorectal cancer surgery. Future studies should explore alternative characteristics and their correlation with FTR to identify possible interventions for the improvement of quality of care after colorectal cancer surgery.

Association of social vulnerability with the use of high-volume and Magnet recognition hospitals for hepatopancreatic cancer surgery

Surgery ◽  
2021 ◽  
Author(s):  
Adrian Diaz ◽  
J. Madison Hyer ◽  
Rosevine Azap ◽  
Diamantis Tsilimigras ◽  
Timothy M. Pawlik
Keyword(s):  
Social Vulnerability ◽  
High Volume ◽  
Cancer Surgery ◽  
Magnet Recognition

Quality of training in cervical cancer radical surgery: a survey from the European Network of Young Gynaecologic Oncologists (ENYGO)

2022 ◽  
pp. ijgc-2021-002812
Author(s):  
Nicolò Bizzarri ◽  
Andrei Pletnev ◽  
Zoia Razumova ◽  
Kamil Zalewski ◽  
Charalampos Theofanakis ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Minimally Invasive ◽  
Radical Surgery ◽  
Gynecologic Oncology ◽  
Laparoscopic Approach ◽  
High Volume ◽  
Lymph Node Biopsy ◽  
European Network ◽  
Before And After ◽  
Level Of Training

BackgroundThe European Society of Gynaecological Oncology (ESGO) and partners are committed to improving the training for gynecologic oncology fellows. The aim of this survey was to assess the type and level of training in cervical cancer surgery and to investigate whether the Laparoscopic Approach to Cervical Cancer (LACC) trial results impacted training in radical surgery for gynecologic oncology fellows.MethodsIn June 2020, a 47-question electronic survey was shared with European Network of Young Gynaecologic Oncologists (ENYGO) members. Specialist fellows in obstetrics and gynecology, and gynecologic oncology, from high- and low-volume centers, who started training between January 1, 2017 and January 1, 2020 or started before January 1, 2017 but finished their training at least 6 months after the LACC trial publication (October 2018), were included.Results81 of 125 (64.8%) respondents were included. The median time from the start of the fellowship to completion of the survey was 28 months (range 6–48). 56 (69.1%) respondents were still fellows-in-training. 6 of 56 (10.7%) and 14 of 25 (56.0%) respondents who were still in training and completed the fellowship, respectively, performed ≥10 radical hysterectomies during their training. Fellows trained in an ESGO accredited center had a higher chance to perform sentinel lymph node biopsy (60.4% vs 30.3%; p=0.027). There was no difference in the mean number of radical hysterectomies performed by fellows during fellowship before and after the LACC trial publication (8±12.0 vs 7±8.4, respectively; p=0.46). A significant reduction in number of minimally invasive radical hysterectomies was noted when comparing the period before and after the LACC trial (38.5% vs 13.8%, respectively; p<0.001).ConclusionExposure to radical surgery for cervical cancer among gynecologic oncology fellows is low. Centralization of cervical cancer cases to high-volume centers may provide an increase in fellows’ exposure to radical procedures. The LACC trial publication was associated with a decrease in minimally invasive radical hysterectomies performed by fellows.

Sign in / Sign up

Export Citation Format

Share Document