Technical efficiency evaluation of colorectal cancer care for older patients in Dutch hospitals

Background Preoperative colorectal cancer care pathways for older patients show considerable practice variation between Dutch hospitals due to differences in interpretation and implementation of guideline-based recommendations. This study aims to report this practice variation in preoperative care between Dutch hospitals in terms of technical efficiency and identifying associated factors. Methods Data on preoperative involvement of geriatricians, physical therapists and dieticians and the clinicians’ judgement on prehabilitation implementation were collected using quality indicators and questionnaires among colorectal cancer surgeons and specialized nurses. These data were combined with registry-based data on postoperative outcomes obtained from the Dutch Surgical Colorectal Audit for patients aged ≥75 years. A two-stage data envelopment analysis (DEA) approach was used to calculate bias-corrected DEA technical efficiency scores, reflecting the extent to which a hospital invests in multidisciplinary preoperative care (input) in relation to postoperative outcomes (output). In the second stage, hospital care characteristics were used in a bootstrap truncated regression to explain variations in measured efficiency scores. Results Data of 25 Dutch hospitals were analyzed. There was relevant practice variation in bias-corrected technical efficiency scores (ranging from 0.416 to 0.968) regarding preoperative colorectal cancer surgery. The average efficiency score of hospitals was significantly different from the efficient frontier (p = <0.001). After case-mix correction, higher technical efficiency was associated with larger practice size (p = <0.001), surgery performed in a general hospital versus a university hospital (p = <0.001) and implementation of prehabilitation (p = <0.001). Conclusion This study showed considerable variation in technical efficiency of preoperative colorectal cancer care for older patients as provided by Dutch hospitals. In addition to higher technical efficiency in high-volume hospitals and general hospitals, offering a care pathway that includes prehabilitation was positively related to technical efficiency of hospitals offering colorectal cancer care.

PROPER—PRehabilitatiOn Plus Enhanced Recovery after surgery versus enhanced recovery after surgery in gynecologic oncology: a randomized clinical trial

BackgroundPrehabilitation is a process that occurs before surgery and aims to improve patient functional capacity and enhance surgical recovery. This process includes medical, nutritional, physical, and psychological interventions that may reduce the duration of hospital stay and provide postoperative physical benefits.Primary ObjectiveTo evaluate the impact of a prehabilitation program on postoperative recovery time for patients who will undergo gynecological surgery following the Enhanced Recovery After Surgery (ERAS) guidelines.Study HypothesisA multidisciplinary, preoperative prehabilitation program for patients who will undergo gynecological surgery leads to a reduction in the length of hospital stay and improves patient functional capacity.Trial DesignProspective, interventionist, and randomized controlled trial in a 1:1 ratio, open to multidisciplinary team and patients, blinded to surgeons and anesthesiologists. The control group will undergo ERAS standard preoperative care while the intervention group will have ERAS standard preoperative care plus prehabilitation.Major Inclusion CriteriaPatients scheduled to undergo gynecologic surgery performed by laparotomy with a preoperative schedule that allows prehabilitation intervention for 2 to 3 weeks.Primary EndpointTo compare time between surgery and the day the patient is ready for discharge in patients who underwent the prehabilitation process versus those who did not. Readiness for discharge is defined as the ability to take care of one’s-self, to walk alone, and to ingest at least 75% of daily recommended calorie intake.Sample Size194 participantsEstimated Dates for Completing Accrual and Presenting ResultsAt present, 30 patients have been recruited. Accrual should be completed by 2023–24.Trial RegistrationThe study is approved by the IBCC – São Camilo Oncologia ethics committee (reference number 4.256.553) and is registered at clinicaltrials.gov (NCT04596800).

Principles of surgery

This chapter examines the principles of surgery. It begins by explaining the process of history taking and case presentation, and outlining the common surgical symptoms. The chapter then looks at the process of examination and investigation of the patient. It details the evaluation of breast disease, the neck, the abdomen, pelvic disease, peripheral vascular disease, and the skin and subcutaneous tissue disease. The chapter also considers preoperative care, pre-optimisation of the patient, perioperative care, and post-operative management. Finally, it discusses the management of the critically ill surgical patient. The first step is recognising compensated critical illness (e.g. shock compensated by tachycardia and peripheral shutdown or respiratory failure compensated by unsustainable respiratory effort). The surgical team should consider using critical care services for both elective and emergency surgical patients.

Novel stoma appliances to minimise complications and improve patient outcomes

Stomas are created for a number of reasons and, if they are formed without the opportunity for preoperative care and consideration, such as siting, stoma care needs can be more complex in the long term. Patient quality of life can be negatively affected by the incidence of stoma related complications, such as leakage or sore skin. A new range of products, Aura Plus, distributed by CliniMed Ltd in the UK, were evaluated on more than 200 patients with a stoma and assessed for comfort, ease of application, security and leakage. Case studies highlight positive patient outcomes following the use of Aura Plus, and demonstrate how Aura Plus can benefit patients experiencing different needs with their stoma care, such as leakage, peristomal skin complications or a parastomal hernia.

Necessidades humanas básicas: cuidados pré-operatórios de enfermagem na cirurgia bariátrica

Objetivo: identificar os indicadores empíricos disponíveis na literatura científica, a partir da teoria das Necessidades Humanas Básicas de Wanda Horta. Método: revisão integrativa da literatura. Foram selecionados artigos nos idiomas português, inglês e espanhol, publicados entre os anos de 2013 à 2018, disponíveis nas bases de dados: LILACS, BDENF, MEDLINE consultada por meio do PubMed, BVS, SciELO, CINAHL, SCOPUS, Web of Science e Science Direct. Resultados: a busca resultou em 136 artigos dos quais foram selecionados 11 estudos e levantados 72 indicadores empíricos, distribuídos nas respectivas Necessidades Humanas Básicas propostas por Wanda Horta. Discussão: os indicadores empíricos levantados obtiveram representatividade nos três níveis de necessidades humanas básicas demonstrando a aplicabilidade da teoria no direcionamento de cuidados pré-operatório da cirurgia bariátrica. Conclusão: o levantamento dos indicadores empíricos permite direcionar a prática de cuidado fundamentando-a em conhecimento científico. Objective: to identify the empirical indicators available in the scientific literature, based on Wanda Horta's theory of Basic Human Needs. Method: integrative literature review. Articles were selected in Portuguese, English and Spanish languages, published between the years 2013 to 2018, available in the databases: LILACS, BDENF, MEDLINE consulted through PubMed, BVS, SciELO, CINAHL, SCOPUS, Web of Science and Science Direct. Results: the search resulted in 136 articles from which 11 studies were selected and 72 empirical indicators were raised, distributed in the respective Basic Human Needs proposed by Wanda Horta. Discussion: the empirical indicators obtained representativeness in the three levels of basic human needs demonstrating the applicability of the theory in directing preoperative care of bariatric surgery. Conclusion: The survey of empirical indicators allows directing the practice of care based on scientific knowledge.