دورية أكاديمية
The impact of surgeon volume on colostomy reversal outcomes after Hartmann's procedure for diverticulitis.
| العنوان: | The impact of surgeon volume on colostomy reversal outcomes after Hartmann's procedure for diverticulitis. |
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| المؤلفون: | Aquina CT; Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY. Electronic address: christopher_aquina@urmc.rochester.edu., Probst CP; Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY., Becerra AZ; Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY., Hensley BJ; Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY., Iannuzzi JC; Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY., Noyes K; Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY., Monson JR; Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY; Center for Colon and Rectal Surgery, Florida Hospital Medical Group, University of Central Florida College of Medicine, Orlando, FL., Fleming FJ; Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY. |
| المصدر: | Surgery [Surgery] 2016 Nov; Vol. 160 (5), pp. 1309-1317. Date of Electronic Publication: 2016 Jul 07. |
| نوع المنشور: | Evaluation Study; Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Mosby Country of Publication: United States NLM ID: 0417347 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-7361 (Electronic) Linking ISSN: 00396060 NLM ISO Abbreviation: Surgery Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: St. Louis, MO : Mosby Original Publication: St. Louis. |
| مواضيع طبية MeSH: | Colostomy/*adverse effects , Diverticulitis/*surgery , Diverticulum, Colon/*complications , Reoperation/*adverse effects , Surgeons/*statistics & numerical data, Acute Disease ; Aged ; Cohort Studies ; Colectomy/methods ; Colostomy/methods ; Colostomy/mortality ; Databases, Factual ; Diverticulitis/etiology ; Diverticulitis/mortality ; Diverticulitis/physiopathology ; Diverticulum, Colon/surgery ; Female ; Hospitals, High-Volume ; Humans ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Multivariate Analysis ; Postoperative Complications/mortality ; Postoperative Complications/physiopathology ; Prognosis ; Reoperation/methods ; Retrospective Studies ; Risk Assessment ; Severity of Illness Index ; Survival Rate ; Treatment Outcome |
| مستخلص: | Background: Colostomy reversal after Hartmann's procedure for diverticulitis is a morbid procedure, and studies investigating factors associated with outcomes are lacking. This study identifies patient, surgeon, and hospital-level factors associated with perioperative outcomes after stoma reversal. Methods: The Statewide Planning and Research Cooperative System was queried for urgent/emergency Hartmann's procedures for diverticulitis between 2000-2012 in New York State and subsequent colostomy reversal within 1 year of the procedure. Surgeon and hospital volume were categorized into tertiles based on the annual number of colorectal resections performed each year. Bivariate and mixed-effects analyses were used to assess the association between patient, surgeon, and hospital-level factors and perioperative outcomes after colostomy reversal, including a laparoscopic approach; duration of stay; intensive care unit admission; complications; mortality; and 30-day, unscheduled readmission. Results: Among 10,487 patients who underwent Hartmann's procedure and survived to discharge, 63% had the colostomy reversed within 1 year. After controlling for patient, surgeon, and hospital-level factors, high-volume surgeons (≥40 colorectal resections/yr) were independently associated with higher odds of a laparoscopic approach (unadjusted rates: 14% vs 7.6%; adjusted odds ratio = 1.84, 95% confidence interval = 1.12, 3.00), shorter duration of stay (median: 6 versus 7 days; adjusted incidence rate ratio = 0.87, 95% confidence interval = 0.81, 0.95), and lower odds of 90-day mortality (unadjusted rates: 0.4% vs 1.0%; adjusted odds ratio = 0.30, 95% confidence interval = 0.10, 0.88) compared with low-volume surgeons (1-15 colorectal resections/yr). Conclusion: High-volume surgeons are associated with better perioperative outcomes and lower health care utilization after Hartmann's reversal for diverticulitis. These findings support referral to high-volume surgeons for colostomy reversal. (Copyright © 2016 Elsevier Inc. All rights reserved.) |
| تواريخ الأحداث: | Date Created: 20160711 Date Completed: 20170630 Latest Revision: 20191210 |
| رمز التحديث: | 20240628 |
| DOI: | 10.1016/j.surg.2016.05.008 |
| PMID: | 27395762 |
| قاعدة البيانات: | MEDLINE |
Full Text via ClinicalKey 
Full Text Finder | تدمد: | 1532-7361 |
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| DOI: | 10.1016/j.surg.2016.05.008 |