Complications in Surgery – Let’s Face Them

Obertop, H.; Gouma, Dirk J.

doi:10.1159/000052015

Cited by 8 publications

(9 citation statements)

References 14 publications

(13 reference statements)

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“…The use of disposable instruments might also contribute to the lower complication rate in this study. Although the complication rate was small, the present study still found that higher complication rates were associated with the severity of illness and operating hours, a finding which is consistent with other studies [25, 26]. …”

Section: Discussionsupporting

confidence: 93%

Influence of Surgeon Volume on Clinical and Economic Outcomes of Laparoscopic Cholecystectomy

Lee

Chang²,

Huang³

et al. 2004

Dig Surg

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Background and Purpose: The volume-outcome effect has been well documented in both medical treatment and surgery. The relationship of volume-outcome utilization in laparoscopic cholecystectomy has not been studied. The aims of this study were to examine whether the operational volume of individual surgeons is associated with the clinical and economic outcomes of patients with gallbladder diseases undergoing laparoscopic cholecystectomy. Methods: A retrospective study was made of all patients who underwent elective laparoscopic cholecystectomy in the Department of Surgery, Kaohsiung Medical University Hospital between January 1998 and April 2002. In total, 916 patients were operated on by 4 surgeons and the volume for each surgeon was 502, 192, 147, and 75 cases, respectively. Clinical and economic information for each patient was abstracted from medical charts and the financial division. Multiple logistic and linear regression models were used to examine the relationship between three outcome variables, complications, length of stay, total hospital charges, and surgeon volume while controlling for the severity of illness and other selected covariates (morbidity index). Results: Overall, a complication rate of 1.2% was identified. On average, the patient’s stay in hospital was 4.7 days, and the average total hospital charge was TWD 49,581. After adjusting for covariates, three regression models indicated that the surgeon with the highest volume had the lowest complication rate, shortest length of stay, and lowest hospital charges. Conclusions: The operative volume of individual surgeons not only had a positive impact on clinical outcomes, it also had greater effect on conservation of health care resources. The findings validate the theory of practice makes perfect.

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Section: Discussionsupporting

confidence: 93%

Influence of Surgeon Volume on Clinical and Economic Outcomes of Laparoscopic Cholecystectomy

Lee

Chang²,

Huang³

et al. 2004

Dig Surg

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“…Pertinent studies focus on 30 DM as outcome parameter [68]. In our study, over-all 30 DM exceeded RBDrange-medians for rectal-, stomach-, gall bladder, lung and pancreatic/periampullary cancer; it should be kept in mind, however, that the length of the study period and unavailability of interventional endoscopic palliation for frail end-stage patients during the first half influenced mortality.…”

Section: Discussionmentioning

confidence: 51%

“…The majority of published data corroborates that individual expertise of the surgeon influences surgical complication rate and oncologic long-term outcome [5,95] with only minor effects on postoperative mortality [27,37,68]. Evidence is accumulating that hospital volume is the decisive parameter [5,27,85].…”

Section: Discussionmentioning

confidence: 84%

“…Evidence is accumulating that hospital volume is the decisive parameter [5,27,85]. This correlation is evident for major surgery with emphasis on esophageal and pancreatic resection [68,85] despite some equivocal data [24,56], but also -less pronounced -for gastric and colon surgery [3,27,82]. High volume surgeons working in low volume hospitals had the twofold mortality of low volume surgeons in high volume hospitals [27].…”

Section: Discussionmentioning

confidence: 99%

“…A compromise could propose minimum infrastructural standards and strategies of evidence-based risk adjustment for district hospitals [82]. The analysis of our mortality data shows that cardiac and pulmonary comorbidity with pertinent medical complications are of central concern [19,68]. The structural deficits identified in this study include occasionally unreliable medical risk assessment and unavailability of interdisciplinary intensive care.…”

Section: What Are the Consequences?mentioning

confidence: 94%

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Is oncologic surgery in a low-volume district general hospital justified? A critical 24-year audit

Szecsi¹

2004

Eur Surg

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Darf onkologische Chirurgie an regionalen Standardkrankenhäusern vorgenommen werden? Eine kritische 24-Jahres-Bilanz Zusammenfassung. Grundlagen: Eine aktuelle Diskussion thematisiert die Zentralisation onkologischer Chirurgie sowie die Auswirkungen chirurgischer und institutioneller Fallzahlen auf die Ergebnisse, -wobei onkologische Eingriffe an Standardkrankenhäusern mit geringer Fallzahl infragegestellt werden. Methodik: Die Daten von 543 operierten onkologischen Patienten des Zeitraumes 03/78 bis 12/2001 wurden in ein Register eingebracht. Endpunkte waren 30-Tage-Letalität sowie die Rate lokoregionärer Rezidive, des Gesamtüber-lebens, tumorspezifischen Überlebens von Entitätsgruppen und UICC-Stadien sowie krankheitsfreien Überlebens. Die Daten wurden durch Referenzzahlen validiert.Ergebnisse: Nach Abzug von Patienten mit prozeduralem Minimalrisiko betrug die 30-Tage Letalität 11 %, -8,1 % nach Elektiveingriffen und 8 % nach R0-Resektionen. Die Letalität durch chirurgische Komplikationen betrug 0,7 % bzw. 0,8 % und 0,3 %, die Letalität durch Allgemeinkomplikationen 10,3 % (5,1 % kardial, 2,0 % pulmonal und 3,2 % andere) bzw. 7,2 % und 7,6 %. Lokalrezidiv-, Gesamtüberlebens-, tumorspezifische Überlebens-und krankheitsfreie Überlebensraten waren gut bis exzellent.Schlussfolgerungen: Chirurgische Kompetenz konnte in einem Regionalspital mit niedriger Fallzahl aufrechterhalten werden. Die Ergebnisse wurden jedoch durch eine vergleichsweise hohe Letalität infolge Allgemeinkomplikationen beeinträchtigt, was die Bedeutung von Risikoevaluierung und institutioneller interdisziplinärer Infrastruktur unterstreicht. Es bietet sich somit eine Strategie selektiver Zentralisation an. Häufige onkologische Erkrankungen mit akzeptabler Begleitmorbidität können mit gleichwertigen Ergebnissen an Regionalspitälern behandelt werden, die sich somit für ihre Integration in den Verbund kooperierender virtueller Regionalzentren qualifizieren.Schlüsselwörter: Onkologische Chirurgie, "low volume"-Krankenhäuser, chirurgische Ergebnisqualität, 30-Tage Letalität, Strukturqualität.Summary. Background: An ongoing discussion focusses on centralization of oncologic surgery and effects of surgical and institutional volumes on outcome, -questioning if oncologic surgery in low volume district general hospitals is justified.Methods: Data of 543 patients undergoing surgery for various cancer entities from 03/1978 until 12/2001 were entered in a prospectively maintained database. Endpoints were 30-day mortality (30 DM), the rate of locoregional recurrence (LR), overall survival (OAS), cause-specific survival (CSS) of entity-and UICC-stage-groups and disease-free survival (DFS). Data were benchmarked.Results: After censoring patients undergoing minimalrisk surgery, 30 DM comprised 11 % for all patients, -8.1 % for patients after elective surgery and 8 % after R0-resection. 30 DM caused by surgical complications was 0.7 %, 0.8 % and 0.3 %, respectively, 30 DM caused by medical causes 10.3 % (cardiac in 5.1 %, pulmonary in 2.0 % and other causes in 3.2 ...

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Classifying Surgical Complications

Veen¹

2005

Arch Surg

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Complications in Surgery – Let’s Face Them

Cited by 8 publications

References 14 publications

Influence of Surgeon Volume on Clinical and Economic Outcomes of Laparoscopic Cholecystectomy

Influence of Surgeon Volume on Clinical and Economic Outcomes of Laparoscopic Cholecystectomy

Is oncologic surgery in a low-volume district general hospital justified? A critical 24-year audit

Classifying Surgical Complications

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