Impact of Surgeon and Hospital Caseload on the Likelihood of Performing Laparoscopic vs Open Sigmoid Resection for Diverticular Disease

Weber, Walter; Güller, Ulrich; Jain, Nitin B.; Pietrobon, Ricardo; Oertli, Daniel

doi:10.1001/archsurg.142.3.253

Cited by 42 publications

(27 citation statements)

References 64 publications

(83 reference statements)

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“…16,17 High-volume centers are more likely to perform laparoscopic surgery than open surgery for diverticulitis. 18 In our data, 22.7% of white patients were admitted to hospitals in the lowest quartile for hospital volume, compared with 35.1% of black patients; 18.6% of private insurance patients were admitted to these hospitals, compared with 39.6% of Medicaid patients and 34.8% of uninsured patients.…”

Section: Discussionmentioning

confidence: 51%

Insurance But Not Race Is Associated With Diverticulitis Mortality in a Statewide Database

Nash²,

Feldman³

et al. 2011

Diseases of the Colon &Amp; Rectum

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Section: Discussionmentioning

confidence: 51%

Insurance But Not Race Is Associated With Diverticulitis Mortality in a Statewide Database

Nash²,

Feldman³

et al. 2011

Diseases of the Colon &Amp; Rectum

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“…13 lower mortality rate, an association between hospital volume and mortality rates was not observed. Furthermore, Weber et al (15) found that diverticulosis and diverticulitis patients undergoing sigmoid colon resection were more likely to receive laparoscopic versus open sigmoid colectomies in high-volume hospitals, although a difference in mortality between the two types of surgery was not demonstrated (16). Thus, the effect of hospital volume on mortality related to surgical and medical management of diverticulitis remains unknown.…”

mentioning

confidence: 99%

Hospital Volume and Other Risk Factors for In-Hospital Mortality among Diverticulitis Patients: A Nationwide Analysis

Diamant

Coward

Buie

et al. 2015

Canadian Journal of Gastroenterology and Hepatology

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BACKGROUND: Previous studies have found that a higher volume of colorectal surgery was associated with lower mortality rates. While diverticulitis is an increasingly common condition, the effect of hospital volume on outcomes among diverticulitis patients is unknown.OBJECTIVE: To evaluate the relationship between hospital volume and other factors on in-hospital mortality among patients admitted for diverticulitis.METHODS: Data from the Nationwide Inpatient Sample (years 1993 to 2008) were analyzed to identify 822,865 patients representing 4,108,726 admissions for diverticulitis. Hospitals were divided into quartiles based on the volume of diverticulitis cases admitted over the study period, adjusted for years contributed to the dataset. Mortality according to hospital volume was modelled using logistic regression adjusting for age, sex, race, comorbidities, health care insurance, admission type, calendar year, colectomy, disease severity and clustering. Risk estimates were expressed as adjusted ORs with 95% CIs.RESULTS: Patients at high-volume hospitals were more likely to be admitted emergently, undergo surgical treatment and have more severe disease. In-hospital mortality was higher among the lowest quartile of hospital volume compared with the highest volume (OR 1.13 [95% CI 1.05 to 1.21]). In-hospital mortality was increased among patients admitted emergently (OR 2.58 [95% CI 2.40 to 2.78]) as well as those receiving surgical treatment (OR 3.60 [95% CI 3.42 to 3.78]).CONCLUSIONS: Diverticulitis patients admitted to hospitals with a low volume of diverticulitis cases had an increased risk for death compared with those admitted to high-volume centres.

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“…Pacientes operados em centros de maior volume também tiveram uma chance maior (três vezes) de serem submetidos à LAP. 21 Comparando o desfecho de pacientes com diverticulite aguda complicada (n = 46) e não complicada (n = 79) submetidos à ressecção laparoscópica, um estudo observou uma taxa global de conversão de 26%, não havendo diferença estatística entre os dois grupos. A presença de cirurgia abdominal prévia foi o único fator estatisticamente significativo associado a uma maior taxa de conversão (37 vs 14%).…”

Section: Acesso Cirúrgico Na Urgênciaunclassified

Atualização no tratamento da diverticulite aguda do cólon

Dias

Gondim

Nahas

2009

Rev bras. colo-proctol.

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RESUMO: Nas últimas décadas a incidência da moléstia diverticular do cólon e de suas complicações tem aumentado. Durante esse período o número de publicações a respeito do tema se expandiu, bem como as opções terapêuticas. Apesar disso, muitas dúvidas persistem e as decisões terapêuticas continuam relativamente imutadas, baseadas muitas vezes em dados antigos e de baixo poder estatístico. Nesta revisão apresentamos as evidências científicas atuais acerca da terapêutica desta complexa patologia. A doença diverticular pode ocorrer em todo o cólon, porém a região mais frequentemente acometida é o sigmoide e raramente há doença abaixo da reflexão peritoneal. A doença diverticular do cólon direito, padrão predominante nas populações asiáticas, raramente acomete a população ocidental. DescritoresEstima-se que 30% da população com mais de 60 anos e 60% dos indivíduos com mais de 80 anos sejam afetados.2 Com o envelhecimento global da população, espera-se que a doença diverticular e suas complicações representem uma porcentagem cada vez maior do atendimento do cirurgião, tanto em consultó-rios como em emergências. 3O foco desta revisão, dentre a miríade de manifestações clínicas possíveis da doença diverticular (ausência de sintomas, queixas vagas e inespecíficas, sangramento intestinal etc.) será o abdome agudo (diverticulite) e os dados mais recentes acerca do tratamento desta que é a manifestação mais grave e mór-bida da diverticulose cólica.Estima-se que 10-25 % dos pacientes com diverticulose cólica evoluirão com diverticulite, sendo que 95% das vezes essa complicação ocorrerá no sigmoide.4,5 Destes, um quarto evoluirá com complicações potencialmente ameaçadoras à vida como: perfuração, fístula, obstrução ou estenose. 3Ainda hoje e apesar de existirem guidelines de diversas sociedades acerca do tratamento da diverticulite aguda, muitas dúvidas persistem: Quando indicar a cirurgia? Qual cirurgia devemos realizar? Qual

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Impact of Surgeon and Hospital Caseload on the Likelihood of Performing Laparoscopic vs Open Sigmoid Resection for Diverticular Disease

Abstract: High-volume surgeons and hospitals are more likely to perform laparoscopic procedures than open procedures for diverticular disease as compared with lowvolume surgeons and hospitals.

Cited by 42 publications

References 64 publications

Insurance But Not Race Is Associated With Diverticulitis Mortality in a Statewide Database

Insurance But Not Race Is Associated With Diverticulitis Mortality in a Statewide Database

Hospital Volume and Other Risk Factors for In-Hospital Mortality among Diverticulitis Patients: A Nationwide Analysis

Atualização no tratamento da diverticulite aguda do cólon

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