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1
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EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones. J Hepatol 2016; 65:146-181. [PMID: 27085810 DOI: 10.1016/j.jhep.2016.03.005] [Citation(s) in RCA: 329] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 03/09/2016] [Indexed: 02/06/2023]
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Dent BT, Fosgate GT, Hettlich BF. Minimally invasive approach to lumbosacral decompression in a cadaveric canine model. N Z Vet J 2015; 64:71-5. [DOI: 10.1080/00480169.2015.1064042] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Schnitzbauer AA, Proneth A, Pengel L, Ansorg J, Anthuber M, Bechstein WO, Schlitt HJ, Geissler EK. Evidence-based medicine in daily surgical decision making: a survey-based comparison between the UK and Germany. Eur Surg Res 2014; 54:14-23. [PMID: 25322938 DOI: 10.1159/000367940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 08/26/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Evidence-based medicine (EbM) is a vital part of reasonable and conclusive decision making for clinicians in daily clinical work. To analyze the knowledge and the attitude of surgeons towards EbM, a survey was performed in the UK and Germany. METHODS A web-based questionnaire was distributed via mailing lists from the Royal College of Surgeons of England (RCSE) and the Berufsverband Deutscher Chirurgen (BDC). Our primary aim was to get information about knowledge of EbM amongst German and British surgeons. RESULTS A total of 549 individuals opened the questionnaire, but only 198 questionnaires were complete and valid for analysis. In total, 40,000 recipients were approached via the mailing lists of the BDC and RCSE. The response rate was equally low in both countries. On a scale from 1 (unimportant) to 10 (very important), all participants rated EbM as very important for daily clinical decision making (7.3 ± 1.9) as well as for patients (7.8 ± 1.9) and the national health system (7.8 ± 1.9). On a scale from 1 (unimportant) to 5 (very important), systematic reviews (4.6 ± 0.6) and randomized controlled trials (4.6 ± 0.6) were identified as the highest levels of study designs to enhance evidence in medicine. British surgeons considered EbM to be more important in daily clinical work when compared to data from German surgeons (7.9 ± 1.6 vs. 6.7 ± 2.1, p < 0.001). Subgroup analysis showed different results in some categories; however, a pattern to explain the differences was not evident. Personal requirements expressed in a free text field emphasized the results and reflected concerns such as broad unwillingness and lack of interdisciplinary approaches for patients (n = 59: 25 in the UK and 34 in Germany). CONCLUSION The overall results show that EbM is believed to be important by surgeons in the UK and Germany. However, perception of EbM in the respective health system (UK vs. Germany) may be different. Nonetheless, EbM is an important tool to navigate through daily clinical problems although a discrepancy between the knowledge of theoretical abstract terms and difficulties in implementing EbM in daily clinical work has been detected. The provision of infrastructure, courses and structured education as a permanent instrument will advance the knowledge, application and improvement of EbM in the future.
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Affiliation(s)
- Andreas A Schnitzbauer
- Department of General and Visceral Surgery, Frankfurt University Hospitals, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
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Bianchi PP, Petz W, Luca F, Biffi R, Spinoglio G, Montorsi M. Laparoscopic and robotic total mesorectal excision in the treatment of rectal cancer. Brief review and personal remarks. Front Oncol 2014; 4:98. [PMID: 24834429 PMCID: PMC4018567 DOI: 10.3389/fonc.2014.00098] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 04/20/2014] [Indexed: 12/11/2022] Open
Abstract
The current standard treatment for rectal cancer is based on a multimodality approach with preoperative radiochemotherapy in advanced cases and complete surgical removal through total mesorectal excision (TME). The most frequent surgical approach is traditional open surgery, as laparoscopic TME requires high technical skill, a long learning curve, and is not widespread, still being confined to centers with great experience in minimally invasive techniques. Nevertheless, in several studies, the laparoscopic approach, when compared to open surgery, has shown some better short-term clinical outcomes and at least comparable oncologic results. Robotic surgery for the treatment of rectal cancer is an emerging technique, which could overcome some of the technical difficulties posed by standard laparoscopy, but evidence from the literature regarding its oncologic safety and clinical outcomes is still lacking. This brief review analyses the current status of minimally invasive surgery for rectal cancer therapy, focusing on oncologic safety and the new robotic approach.
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Affiliation(s)
- Paolo Pietro Bianchi
- Unit of Minimally Invasive Surgery, European Institute of Oncology , Milan , Italy
| | - Wanda Petz
- Unit of Minimally Invasive Surgery, European Institute of Oncology , Milan , Italy
| | - Fabrizio Luca
- Unit of Abdominal Integrated Surgery, European Institute of Oncology , Milan , Italy
| | - Roberto Biffi
- Division of Abdomino-Pelvic Surgery, European Institute of Oncology , Milan , Italy
| | - Giuseppe Spinoglio
- Department of General and Oncologic Surgery, Azienda Ospedaliera SS Antonio e Biagio , Alessandria , Italy
| | - Marco Montorsi
- Division of General Surgery, Istituto Clinico Humanitas, School of Medicine, University of Milan , Rozzano , Italy
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Kwon S, Billingham R, Farrokhi E, Florence M, Herzig D, Horvath K, Rogers T, Steele S, Symons R, Thirlby R, Whiteford M, Flum DR. Adoption of laparoscopy for elective colorectal resection: a report from the Surgical Care and Outcomes Assessment Program. J Am Coll Surg 2012; 214:909-18.e1. [PMID: 22533998 DOI: 10.1016/j.jamcollsurg.2012.03.010] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 03/05/2012] [Accepted: 03/07/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the adoption of laparoscopic colon surgery and assess its impact in the community at large. STUDY DESIGN The Surgical Care and Outcomes Assessment Program (SCOAP) is a quality improvement benchmarking initiative in the Northwest using medical record-based data. We evaluated the use of laparoscopy and a composite of adverse events (ie, death or clinical reintervention) for patients undergoing elective colorectal surgery at 48 hospitals from the 4th quarter of 2005 through 4th quarter of 2010. RESULTS Of the 9,705 patients undergoing elective colorectal operations (mean age 60.6 ± 15.6 years; 55.2% women), 38.0% were performed laparoscopically (17.8% laparoscopic procedures converted to open). The use of laparoscopic procedures increased from 23.3% in 4th quarter of 2005 to 41.6% in 4th quarter of 2010 (trend during study period, p < 0.001). After adjustment (for age, sex, albumin levels, diabetes, body mass index, comorbidity index, cancer diagnosis, year, hospital bed size, and urban vs rural location), the risk of transfusions (odds ratio [OR] = 0.52; 95% CI, 0.39-0.7), wound infections (OR = 0.45; 95% CI, 0.34-0.61), and composite of adverse events (OR = 0.58; 95% CI, 0.43-0.79) were all significantly lower with laparoscopy. Within those hospitals that had been in SCOAP since 2006, hospitals where laparoscopy was most commonly used also had a substantial increase in the volume of all types of colon surgery (202 cases per hospital in 2010 from 112 cases per hospital in 2006, an 80.4% increase) and, in particular, the number of resections for noncancer diagnoses and right-sided pathology. CONCLUSIONS The use of laparoscopic colorectal resection increased in the Northwest. Increased adoption of laparoscopic colectomies was associated with greater use of all types of colorectal surgery.
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Affiliation(s)
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- Department of Surgery, University of Washington, Seattle, WA 98195-6410, USA
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Rábago LR, Ortega A, Chico I, Collado D, Olivares A, Castro JL, Quintanilla E. Intraoperative ERCP: What role does it have in the era of laparoscopic cholecystectomy? World J Gastrointest Endosc 2011; 3:248-255. [PMID: 22195234 PMCID: PMC3244943 DOI: 10.4253/wjge.v3.i12.248] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2011] [Revised: 08/24/2011] [Accepted: 12/01/2011] [Indexed: 02/05/2023] Open
Abstract
In the treatment of patients with symptomatic cholelithiasis and choledocholithiasis (CBDS) detected during intraoperative cholangiography (IOC), or when the preoperative study of a patient at intermediate risk for CBDS cannot be completed due to the lack of imaging techniques required for confirmation, or if they are available and yield contradictory radiological and clinical results, patients can be treated using intraoperative endoscopic retrograde cholangiopancreatography (ERCP) during the laparoscopic treatment or postoperative ERCP if the IOC finds CBDS. The choice of treatment depends on the level of experience and availability of each option at each hospital. Intraoperative ERCP has the advantage of being a single-stage treatment and has a significant success rate, an easy learning curve, low morbidity involving a shorter hospital stay and lower costs than the two-stage treatments (postoperative and preoperative ERCP). Intraoperative ERCP is also a good salvage treatment when preoperative ERCP fails or when total laparoscopic management also fails.
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Affiliation(s)
- Luis R Rábago
- Luis R Rábago, Alejandro Ortega, Inmaculada Chico, David Collado, Ana Olivares, Jose Luis Castro, Elvira Quintanilla, Department of Gastroenterology, Severo Ochoa Hospital, Leganes, 28911 Madrid, Spain
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Costo-efectividad de la colecistectomía laparoscópica y de la abierta en una muestra de población colombiana. BIOMEDICA 2011. [DOI: 10.7705/biomedica.v31i4.405] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Tittelbach-Helmrich D, Abegg L, Wellner U, Makowiec F, Hopt UT, Keck T. [Insurance costs in pancreatic surgery : does the pecuniary aspect indicate formation of centers?]. Chirurg 2011; 82:154-9. [PMID: 20628857 DOI: 10.1007/s00104-010-1953-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Pancreatic resections in specialized centers are associated with low mortality, however, still with high morbidity. The complication rate can be reduced by long-term experience in high volume centers. In this study the influence of complications on costs in the German DRG system were analyzed. PATIENTS AND METHODS Data regarding operation time, hospital stay, complications and costs of 36 patients undergoing pancreatic head resection in the years 2005 and 2006 were collected and analyzed retrospectively. Statistical analysis was performed using the Mann-Whitney U-test. A p-value of p<0.05 was considered statistically significant. RESULTS Postoperative complications caused an increase in the duration of hospital stay from a median of 16 (range 11-38) to 33 (10-69) days. Costs, especially for ICU treatment and radiographic diagnostics, rose significantly. The average overall costs were 10,015 EUR (range 8,099-14,785 EUR) in patients without complications (n = 21) and 15,340 EUR (9,368-31,418 EUR) in patients with complications (n = 15). In contrast, according to the German DRG system 13,835 EUR (10,441-15,062 EUR) and 15,062 EUR (10,441-33,217 EUR) were refunded on average, respectively. CONCLUSIONS This case-cost calculation proves that pancreatic surgery in the context of the German DRG system can only be performed economically neutral in centers with low complications rates. The concentration of pancreatic surgery to centers with low complications rates, namely high volume centers, must be recommended from an economic point of view.
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Affiliation(s)
- D Tittelbach-Helmrich
- Abteilung Allgemein- und Viszeralchirurgie, Universitätsklinikum Freiburg, Deutschland
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Rosén HI, Bergh IHE, Lundman BM, Mårtensson LB. Patients' experiences and perceived causes of persisting discomfort following day surgery. BMC Nurs 2010; 9:16. [PMID: 20979624 PMCID: PMC2988024 DOI: 10.1186/1472-6955-9-16] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Accepted: 10/27/2010] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The aim of this study was to describe patients' experiences and perceived causes of persisting discomfort following day surgery. Earlier research has mainly covered symptoms and signs during a recovery period of up to one month, and not dealt with patients' perceptions of what causes persisting, longer-term discomfort. METHODS This study is a part from a study carried out during the period May 2006 to May 2007 with a total of 298 day surgery patients. Answers were completed by 118 patients at 48 hours, 110 at seven days and 46 at three months to one open-ended question related to discomfort after day surgery constructed as follows: If you are still experiencing discomfort related to the surgery, what is the reason, in your opinion? Data was processed, quantitatively and qualitatively. Descriptive, inferential, correlation and content analyses were performed. RESULTS The results suggest that patients suffer from remaining discomfort e.g. pain and wound problem, with effects on daily life following day surgery up to three months. Among patients' perceptions of factors leading to discomfort may be wrongful or suboptimal treatment, type of surgery or insufficient access to provider/information. CONCLUSIONS The results have important implications for preventing and managing discomfort at home following day surgery, and for nursing interventions to help patients handle the recovery period better.
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Affiliation(s)
- Helena I Rosén
- School of Life Sciences, University of Skövde, Box 408, Skövde, (SE-541 28), Sweden
- College of Nursing, University of Rhode Island, (2 Heathman Road), Kingston, (RI 02881-2021), USA
| | - Ingrid HE Bergh
- School of Life Sciences, University of Skövde, Box 408, Skövde, (SE-541 28), Sweden
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Box 457, Gothenburg, (SE-405 30), Sweden
- College of Nursing, University of Rhode Island, (2 Heathman Road), Kingston, (RI 02881-2021), USA
| | - Berit M Lundman
- School of Life Sciences, University of Skövde, Box 408, Skövde, (SE-541 28), Sweden
- Institute of Nursing, Umeå University, (SE-901 87), Umeå, Sweden
| | - Lena B Mårtensson
- School of Life Sciences, University of Skövde, Box 408, Skövde, (SE-541 28), Sweden
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Box 457, Gothenburg, (SE-405 30), Sweden
- College of Nursing, University of Rhode Island, (2 Heathman Road), Kingston, (RI 02881-2021), USA
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Kuwabara K, Matsuda S, Fushimi K, Ishikawa KB, Horiguchi H, Hayashida K, Fujimori K. Impact of timing of bile duct interventions on resource use and clinical outcome of cholecystectomy patients in Japan. J Eval Clin Pract 2010; 16:802-10. [PMID: 20557412 DOI: 10.1111/j.1365-2753.2009.01205.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
AIMS Laparoscopic cholecystectomy (LC) is increasingly used for acute cholecystitis, in conjunction with staged bile duct interventions (BDIs). However, few studies have evaluated the impact of BDI timing on costs and clinical outcomes during hospitalization. This study assessed the effects of several types of BDI and their timing on resource utilization and complications. METHODS A total of 13,738 cholecystectomy patients were treated for benign gallbladder diseases in 66 academic and 376 community hospitals in Japan in 2006. Variables analysed included: BDIs including endoscopic retrograde cholangiopancreatography (ERCP), percutaneous gallbladder or common bile duct drainage (external drainage), endoscopic sphincterotomy, clearance of choledocholithiasis (internal drainage); and length of stay (LOS), total charges (TCs), procedure-related complications, and hospital function. Multivariate analysis was used to determine the impact of LC or BDIs on LOS, TCs and complications. RESULTS A total of 11,690 (85.1%) patients underwent LC. Inflammation was diagnosed in 70.7% of open cholecystectomy (OC) and 42.1% of LC patients. Complications were 7.7% in OC and 5.4% in LC patients. LC was associated with reduced LOS and TCs. BDIs were performed in more OC than LC patients. Preoperative was more costly than postoperative ERCP. Postoperative external drainage was significantly associated with LOS, TCs and complications. Advantages of pre- or postoperative internal drainage were not proven. CONCLUSIONS External drainage should be completed preoperatively. Postoperative ERCP may be preferable for bile duct scrutiny alone. Further evaluation of the timing of cholecystectomy will determine precisely the superiority of pre- or postoperative BDIs in terms of quality of care for complicated patients.
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Affiliation(s)
- Kazuaki Kuwabara
- Kyushu University, Graduate School of Medical Sciences, Department of Health Care Administration and Management, Fukuoka, Japan.
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Lubansu A. [Minimally invasive spine arthrodesis in degenerative spinal disorders]. Neurochirurgie 2010; 56:14-22. [PMID: 20116076 DOI: 10.1016/j.neuchi.2009.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Accepted: 02/17/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE As in many other surgical fields, new minimally invasive techniques have been developed over the past 20 years, with reducing the muscular trauma associated with the traditional surgical approach and reducing related morbidity as the main goals. Initially limited to the laparoscopic or video-assisted approaches of the anterior spine, these techniques have been extended to the posterior transmuscular access of the lumbar spine. This article reviews the value of these approaches in the treatment of degenerative lumbar spine disorders. METHODS We describe the main techniques used in minimally invasive lumbar spine surgery, including posterior pedicle screwing as well as anterior (ALIF), posterior (PLIF), transforaminal (TLIF), extreme lateral (XLIf), and presacral (AxiaLIF) interbody fusion. The results of recently published series are reported. RESULTS Percutaneous pedicle screwing is reported to be an effective technique of lumbar spine arthrodesis associated with a low rate of screw misplacement. Minimally invasive PLIF, TLIF, and ALIF have been associated with shorter mean operative time, less postoperative pain, reduction of the estimated blood loss, a shorter hospital stay, and quicker functional recovery. Despite these encouraging early clinical results, no prospective, randomized published scientific study has proved that minimally invasive techniques are better than standard techniques. Larger clinical series with a longer follow-up could fill this gap.
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Affiliation(s)
- A Lubansu
- Service de neurochirurgie, hôpital Erasme, université libre de Bruxelles, route de Lennik, 808, 1070 Bruxelles, Belgique.
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12
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Kuwabara K, Matsuda S, Fushimi K, Ishikawa KB, Horiguchi H, Hayashida K, Fujimori K. Contribution of bile duct drainage on resource use and clinical outcome of open or laparoscopic cholecystectomy in Japan. J Eval Clin Pract 2010; 16:31-8. [PMID: 20367813 DOI: 10.1111/j.1365-2753.2008.01109.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
AIMS Laparoscopic cholecystectomy (LC) is replacing conventional open cholecystectomy (OC) as a preferred surgical method for treating complicated biliary tract disorders. However, there have been few studies assessing the impact of staged bile duct drainage (BDD) on costs and clinical outcomes for either surgical approach. This study evaluated the impact of surgical technique and BDD on resource utilization and complication rates. METHODS This study included 2778 cholecystectomy patients treated for benign biliary tract diseases in 80 academic and 81 community hospitals. For both OC and LC patients, the following variables were analysed: demographics, clinical data, length of stay (LOS), total charges (TC; US$), procedure-related complications and hospital type. Multivariate analyses were used to determine the impact of BDD on LOS, TC and complication rates. RESULTS Of the 2778 cholecystectomy patients in the study, 2255 (81.2%) underwent LC. Inflammation was diagnosed in 55.6% of OC patients and 36.0% of LC patients. Complication was 9.4% in OC cases and 4.7% in LC cases. BDD was performed in 14.5% of OC cases and in 7.6% of LC cases. Diagnosis of inflammation, presence of co-morbidities and BDD each had a significant impact on LOS and TC. After risk adjustment, LC was associated with a reduction in LOS and TC, while BDD resulted in greater LOS and TC. LC and BDD were significantly associated with complications. CONCLUSIONS The study suggested that BDD utilized more resources and had higher rates of complications. LC remains an appropriate procedure for cholecystectomy patients. Further study will be needed to evaluate the effect of pre-operative or post-operative BDD on quality of care.
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Affiliation(s)
- Kazuaki Kuwabara
- Kyushu University, Graduate School of Medical Sciences, Department of Health Care Administration and Management, 3-1-1 Maidashi Higashi-ku Fukuoka, 812-8582, Japan.
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Allvin R, Ehnfors M, Rawal N, Svensson E, Idvall E. Development of a questionnaire to measure patient-reported postoperative recovery: content validity and intra-patient reliability. J Eval Clin Pract 2009; 15:411-9. [PMID: 19366398 DOI: 10.1111/j.1365-2753.2008.01027.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIMS AND OBJECTIVES In this study we describe the development of a short, easy-to-use questionnaire to measure postoperative recovery and evaluate its content validity and intra-patient reliability. The questionnaire is designed to evaluate the progress of postoperative recovery and the long-term follow-up of possible effects of interventions during recovery. METHODS The study involved four steps. (1) A conceptualization and item definitions were based on a theoretical framework and a description of patients' postoperative recovery from the perspective of patients, registered nurses and surgeons; (2) Content validity of items was tested through expert judgements; (3) A test run of the questionnaire was performed to confirm its feasibility and workload requirement; and (4) The stability of the questionnaire was evaluated through intra-patient reliability assessment. RESULTS As a result of the operationalization process of the concept postoperative recovery, five dimensions (physical symptoms, physical functions, psychological, social, activity) and 19 items were identified. Each item was formulated as a statement in the questionnaire. Content validity was judged to be high. After the pre-test of the questionnaire a revision with refinements in the layout was made. The vast majority of items showed a high level of intra-patient reliability. CONCLUSION Based on a theoretical framework and empirical data, we developed a short and easy-to-use tentative questionnaire to measure patient-reported postoperative recovery. Initial support for content validity was established. The vast majority of items showed a high level of test-retest reliability.
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Affiliation(s)
- Renée Allvin
- Department of Anaesthesiology and Intensive Care, Orebro University Hospital, Orebro, Sweden.
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Gunnarsson C, Rizzo JA, Hochheiser L. The effects of laparoscopic surgery and nosocomial infections on the cost of care: evidence from three common surgical procedures. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2009; 12:47-54. [PMID: 18657101 DOI: 10.1111/j.1524-4733.2008.00422.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To examine the cost of care for laparoscopic versus open surgery and the added cost of nosocomial infections for three common surgical procedures: cholecystectomy, hysterectomy, and appendectomy. METHODS The Cardinal Health database repository was utilized to extract reimbursement data for laparoscopic and open cholecystectomy, hysterectomy, and appendectomy surgical procedures. Utilizing a 22-hospital sample and a Health Insurance Portability and Accountability Act compliant clinical data extraction technique, the Cardinal Health database repository produced a Nosocomial Infection Marker to identify and track nosocomial infection rates for these procedures. ICD-9 codes were utilized to identify 10,731 patients who had undergone these procedures between September 2004 and December 2006. Multivariable linear regression models were estimated to isolate the effects of laparoscopic versus open surgery and nosocomial infections on the cost of care. RESULTS Laparoscopic surgery significantly reduces the overall cost of care for cholecystectomies, hysterectomies, and appendectomies. Controlling for the cost of nosocomial infection, incremental cost savings from laparoscopic versus open surgery for all three procedures average $1608. Cholecystectomy has the largest savings ($3299), followed by hysterectomy ($1385) and appendectomy ($1032). These cost savings in part reflect that patients undergoing laparoscopic procedures have shorter lengths of stay. In contrast, nosocomial infection increases costs substantially for each surgery type, raising costs for cholecystectomy by $4794, hysterectomy by $4528, and appendectomy by $6108. CONCLUSION The cost of care for laparoscopic surgery is lower than open surgery for cholecystectomy, hysterectomy, and appendectomy. This conclusion is based on actual hospital reimbursement data.
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Kuwabara K, Matsuda S, Fushimi K, Ishikawa KB, Horiguchi H, Fujimori K, Hayashida K. Impact of timing of cholecystectomy and bile duct interventions on quality of cholecystitis care. Int J Surg 2009; 7:243-9. [DOI: 10.1016/j.ijsu.2009.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2009] [Revised: 03/24/2009] [Accepted: 04/05/2009] [Indexed: 10/20/2022]
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16
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Allvin R, Ehnfors M, Rawal N, Idvall E. Experiences of the postoperative recovery process: an interview study. Open Nurs J 2008; 2:1-7. [PMID: 19319214 PMCID: PMC2582826 DOI: 10.2174/1874434600802010001] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2007] [Revised: 11/15/2007] [Accepted: 11/30/2007] [Indexed: 01/05/2023] Open
Abstract
Few researchers have described postoperative recovery from a broad, overall perspective. In this article the authors describe a study focusing on patient and staff experiences of postoperative recovery using a qualitative descriptive design to obtain a description of the phenomenon. They performed 10 individual interviews with patients who had undergone abdominal or gynecological surgery and 7 group interviews with registered nurses working on surgical and gynecological wards and in primary care centers, surgeons from surgical and gynecological departments, and in-patients from a gynecological ward. The authors analyzed data using qualitative content analysis. Postoperative recovery is described as a Dynamic Process in an Endeavour to Continue With Everyday Life. This theme was further highlighted by the categories Experiences of the core of recovery and Experiences of factors influencing recovery. Knowledge from this study will help caregivers support patients during their recovery from surgery.
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Affiliation(s)
- R Allvin
- Department of Anesthesiology and Intensive Care, Orebro University Hospital, Sweden
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Abstract
To reduce the complication rate associated with laparoscopic surgery and to improve training, several simulators have been incorporated into training curricula and skills courses. We discuss the advantages and disadvantages and compare the different types of simulators available. We also reviewed the literature to assess the acquisition of skills using these simulators and their transfer to real operations. It is important to realize that currently, any form of simulation is merely an adjunct to, and not a replacement for, traditional methods of training and that supervision and feedback are essential. More collaboration is needed between urologists and simulator companies to produce operation-specific simulated modules for urologic procedures.
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Affiliation(s)
- Shabnam Undre
- Department of Bio-Surgery and Surgical Technology, Imperial College, St. Mary's Hospital, London, U.K.
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Roumm AR, Pizzi L, Goldfarb NI, Cohn H. Minimally invasive: minimally reimbursed? An examination of six laparoscopic surgical procedures. Surg Innov 2006; 12:261-87. [PMID: 16224649 DOI: 10.1177/155335060501200313] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
It is generally believed that minimally invasive surgery (MIS) results in less postoperative pain, fewer complications, and shorter recovery periods compared with open procedures. Yet despite these benefits, the level of reimbursement assigned to the surgeon by United States health-care payers is often lower than that for open procedures. Furthermore, the cost of performing a MIS may be higher vs an open procedure because specialized equipment, increased surgical time, or both may be required. In this report, we examine the issue by comparing reimbursements for MIS with open procedures, summarizing the medical literature on MIS vs open surgical procedures, and offering recommendations for payers who establish reimbursement policies. The review is focused on six MIS procedures where outcomes data exist: laparoscopic cholecystectomy (lap chole), laparoscopic colectomy (LC), laparoscopic fundoplication (LF), laparoscopic hysterectomy (LH), laparoscopic ventral hernia repair (LVHR), and laparoscopic appendectomy (LA). Outcomes summarized were length of hospital stay (LOS), operating room time, operating room costs, complications, and return to work or normal activities. The level of scientific evidence was assigned to each study using predetermined criteria. A total of 112 articles were reviewed: 14 for lap chole, 26 for LC, 7 for LF, 19 for LH, 9 for LVHR, and 37 for LA. The data demonstrate that these procedures result in reduced hospital stay, reduced hospital costs, and faster return to work or normal activities. Yet, the operating room time and costs are frequently higher for MIS. These findings suggest that as both the outcomes value and level of operating room resources are greater, MIS warrants reimbursement that meets or exceeds that of open procedures.
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Affiliation(s)
- Adam R Roumm
- Department of Health Policy, Jefferson Medical College, Philadelphia, PA 19107, USA
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Teerawattananon Y, Mugford M. Is it worth offering a routine laparoscopic cholecystectomy in developing countries? A Thailand case study. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2005; 3:10. [PMID: 16259625 PMCID: PMC1291381 DOI: 10.1186/1478-7547-3-10] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2005] [Accepted: 10/31/2005] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE The study aims to investigate whether laparoscopic cholecystectomy (LC) is a cost-effective strategy for managing gallbladder-stone disease compared to the conventional open cholecystectomy (OC) in a Thai setting. DESIGN AND SETTING Using a societal perspective a cost-utility analysis was employed to measure programme cost and effectiveness of each management strategy. The costs borne by the hospital and patients were collected from Chiang Rai regional hospital while the clinical outcomes were summarised from a published systematic review of international and national literature. Incremental cost per Quality Adjusted Life Year (QALY) derived from a decision tree model. RESULTS The results reveal that at base-case scenario the incremental cost per QALY of moving from OC to LC is 134,000 Baht under government perspective and 89,000 Baht under a societal perspective. However, the probabilities that LC outweighed OC are not greater than 95% until the ceiling ratio reaches 190,000 and 270,000 Baht per QALY using societal and government perspective respectively. CONCLUSION The economic evaluation results of management options for gallstone disease in Thailand differ from comparable previous studies conducted in developed countries which indicated that LC was a cost-saving strategy. Differences were due mainly to hospital costs of post operative inpatient care and value of lost working time. The LC option would be considered a cost-effective option for Thailand at a threshold of three times per capita gross domestic product recommended by the committee on the Millennium Development Goals.
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Affiliation(s)
- Yot Teerawattananon
- International health Policy Program, Bureau of Policy and Strategy, Ministry of Public Health, Nonthaburi, Thailand
- School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK
| | - Miranda Mugford
- School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK
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Abstract
STUDY DESIGN Review article. OBJECTIVES To provide an overview of current minimally invasive lumbar fusion techniques. SUMMARY OF BACKGROUND DATA Minimally invasive lumbar fusion techniques have only recently been developed. The goals of these procedures are to reduce approach-related soft tissue injury while allowing the surgery to be conducted in an effective manner. METHODS.: Pertinent literature and the authors' clinical experience are reviewed. RESULTS Minimally invasive techniques have been developed for intertransverse process, posterior lumbar interbody, and transforaminal lumbar interbody fusions. The indications, advantages, and disadvantages of each technique are described. It is emphasized that while they appear promising, the clinical results of these techniques remain preliminary with few long-term studies available for critical review. CONCLUSIONS Preliminary clinical evidence suggests that minimally invasive lumbar fusion techniques will benefit patients with spinal disorders.
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Affiliation(s)
- John W German
- Department of Neurosurgery, University of Tennessee, Memphis, TN, USA
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Wölnerhanssen BK, Ackermann C, Guenin MO, Kern B, Tondelli P, von Flüe M, Peterli R. [Twelve years of laparoscopic cholecystectomy]. Chirurg 2005; 76:263-9. [PMID: 15502891 DOI: 10.1007/s00104-004-0928-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
UNLABELLED We studied developments in indication, operation time, conversion rate, morbidity, and mortality from the beginning of laparoscopic cholecystectomy. Between 1990 and 2002 we prospectively evaluated 4498 patients undergoing cholecystectomy (CE), of whom 79% were treated laparoscopically (lap). In 6.6%, the procedure had to be converted from laparoscopic to open cholecystectomy (con), and 14% were performed open from the beginning (open). During the above time period, the rate of open CE decreased steadily (49% in 1990 to 7.2% in 2002). The average operation time of lap CE remained constant with an average of 74 min (range 20-330). The conversion rate decreased in spite of broader indication for lap CE in even more complicated gallstone diseases, from an initial 9.4% to 2.5%. Among intraoperative complications in lap and con, bile duct lesions remained constant with 5/3856 (0.1%), bleeding which led to conversion decreased from 1.9% to 0.3%, and the rate of gall bladder perforation increased from 12% to 20.5%. Thirty-day morbidity was 2% in lap CE, 5% in con, and 11.5% in open. The mortality was 0% in lap, 0.7% in con, and 1% in open. CONCLUSION Since the introduction of laparoscopic cholecystectomy the indication for this minimal-invasive operation steadily increased, the conversion-rate decreased and the complication-rate could be held low. Even with fast laparoscopic experience 7% of all cholecystectomies are technically difficult and remain to be carried out primarily in an open technique. The laparoscopic cholecystectomy has become the gold standard in the therapy of gallstone disease.
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Hirose M, Imanaka Y, Ishizaki T, Sekimoto M, Harada Y, Kuwabara K, Hayashida K, Oh EH, Evans SE. Profiling Hospital Performance of Laparoscopic Cholecystectomy Based on the Administrative Data of Four Teaching Hospitals in Japan. World J Surg 2005; 29:429-35; discussion 436. [PMID: 15770381 DOI: 10.1007/s00268-004-7535-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Over the last decade in Japan, laparoscopic cholecystectomy (LC) has replaced traditional open cholecystectomy as the standard of elective surgery for cholelithiasis. The laparoscopic approach has a clinical course relatively easier to standardize among the different types of intraabdominal surgery. However, significant practice variation is suspected in Japan, but there has been little demonstration or discussion based on empirical data. Through the analysis of 1589 elective LC cases from four leading teaching hospitals in Japan between 1996 and 2000, this study aims to demonstrate the surgical variations and to investigate their determinants regarding the length of hospital stay and the health care charge. Substantially and significantly large variation existed among the hospitals in terms of the length of hospital stay and the total health care charge, even after the differences in patient factors were adjusted. Particularly, the combined drug and exam charge per day was strikingly different among the four hospitals, which indicated that the daily process also varied widely, as did the total course of inpatient care. In addition, intra-hospital variation was also remained very large even after adjusting for all the potential correlates studied. This study alarmingly points out great room for improvement in the efficiency of health care resource use and potentially in the quality of care through standardization of LC. It has serious implications for the national policy and individual providers under the on-going health care reforms directed toward higher efficiency and quality.
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Affiliation(s)
- Masahiro Hirose
- Department of Healthcare Economics and Quality Management, School of Public Health, Graduate School of Medicine, Kyoto University, Yoshida-Konoe-Chou, 606-8501, Sakyou-Ku, Kyoto, Japan
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Abstract
STUDY DESIGN Review article. OBJECTIVES To provide an overview of current techniques for minimally invasive lumbar fusion. SUMMARY OF BACKGROUND DATA Minimally invasive techniques have revolutionized the management of pathologic conditions in various surgical disciplines. Although these same principles have been used in the treatment of lumbar disc disease for many years, minimally invasive lumbar fusion procedures have only recently been developed. The goals of these procedures are to reduce the approach-related morbidity associated with traditional lumbar fusion, yet allow the surgery to be performed in an effective and safe manner. METHODS The authors' clinical experience with minimally invasive lumbar fusion was reviewed, and the pertinent literature was surveyed. RESULTS Minimally invasive approaches have been developed for common lumbar procedures such as anterior and posterior interbody fusion, posterolateral onlay fusion, and internal fixation. As with all new surgical techniques, minimally invasive lumbar fusion has a learning curve. As well, there are benefits and disadvantages associated with each technique. However, because these techniques are new and evolving, evidence to support their potential benefits is largely anecdotal. Additionally, there are few long-term studies to document clinical outcomes. CONCLUSIONS Preliminary clinical results suggest that minimally invasive lumbar fusion will have a beneficial impact on the care of patients with spinal disorders. Outcome studies with long-term follow-up will be necessary to validate its success and allow minimally invasive lumbar fusion to become more widely accepted.
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Affiliation(s)
- Kevin T Foley
- Image-Guided Surgery Research Center, Methodist Hospitals of Memphis, Semmes-Murphey Clinic and the Department of Neurosurgery, University of Tennessee, Memphis 38104, USA.
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Terjung B, Neubrand M, Sauerbruch T. [Acute biliary colic. Etiology, diagnosis and therapy]. Internist (Berl) 2003; 44:570-6, 578-84. [PMID: 12966786 DOI: 10.1007/s00108-003-0915-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Acute biliary pain represents the main symptom of gallbladder stones, less frequently of common bile duct stones or functional disorders of the biliary tract. The pain lasts at least 15 minutes, is typically localized to the epigastrium or the right upper quadrant of the abdomen and my radiate to the right shoulder. Diagnosis of biliary pain is primarily based on clinical criteria, ultrasound allows detection of causative gallstones with high sensitivity and specificity. Analgesics and laparoscopic cholecystectomy are widely accepted as standard therapy for the majority of patients.
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Affiliation(s)
- Birgit Terjung
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Bonn.
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Luo K, Li JS, Li LT, Wang KH, Shun JM. Operative stress response and energy metabolism after laparoscopic cholecystectomy compared to open surgery. World J Gastroenterol 2003; 9:847-50. [PMID: 12679946 PMCID: PMC4611463 DOI: 10.3748/wjg.v9.i4.847] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the least invasive surgical procedure by comparing the levels of operative stress hormones, response-reactive protein (CRP) and rest energy expenditure (REE) after laparoscopic (LC) and open cholecystectomy (OC).
METHODS: Twenty-six consecutive patients with noncomplicated gallstones were randomized for LC (14) and OC (12). Plasma concentrations of somatotropin, insulin, cortisol and CRP were measured. The levels of REE were determined.
RESULTS: In the third postoperative day, the insulin levels were lower compared to that before operation (P < 0.05). In the first postoperative day, the levels of somatotropin and cortisol were higher in OC than those in LC. After operation the parameters of somatotropin, CRP and cortisol increased, compared to those in the preoperative period in the all patients (P < 0.05). In the all-postoperative days, the CRP level was higher in OC than that in LC (7.46 ± 0.02; 7.38 ± 0.01, P < 0.05). After operation the REE level all increased in OC and LC (P < 0.05). In the all-postoperative days, the REE level was higher in OC than that in LC (1438.5 ± 418.5; 1222.3 ± 180.8, P < 0.05).
CONCLUSION: LC results in less prominent stress response and smaller metabolic interference compared to open surgery. These advantages are beneficial to the restoration of stress hormones, the nitrogen balance, and the energy metabolism. However, LC can also induce acidemia and pulmonary hypoperfusion because of the penumoperitonium it uses during surgery.
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Affiliation(s)
- Kai Luo
- Research Institute of General Surgery, Nanjing General Hospital, Nanjing Command of People's Liberation Army, and Clinical School of Medical College, Nanjing University, Nanjing 210002, Jiangsu Province, China.
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