Publications (3)10.31 Total impact
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ABSTRACT: The risk index category is a tool to predict and compare surgical site infection rates among surgeons and hospitals. However, the accuracy of the index in colorectal surgery has been questioned because the index was validated in a patient population with lower surgical site infection rates than recently reported in the literature. This study aims to validate the risk index category as a predictor of surgical site infection in a cohort of patients who underwent colorectal operations and were prospectively surveyed for surgical site infection. Demographics, preoperative characteristics, and surgical data were obtained from 491 consecutive patients undergoing elective colorectal resections at a colorectal unit from April 2006 to July 2008. Surgical site infections were prospectively collected and stratified according to the Centers for Disease Control and Prevention criteria. Association of variables with surgical site infection was determined by univariate and multivariate analyses. A total of 95 (19.3%) patients developed surgical site infections. The rate of infection increased in each index category, from 13% for category 0 to 27% for category 3. Risk factors for surgical site infection in univariate analysis were as follows: high American Society of Anesthesiologists' scores, obesity, open surgery, and high index categories. Risk index category > or =2 (OR, 2.3; CI, 1.4-3.9; P < .01) was the only independent risk factor associated with infection in multivariate analysis. The risk index category is a strong predictor for the development of surgical site infection in colorectal surgery patients when infections are prospectively collected and should be used to stratify patients when reporting infection rates in elective colorectal surgery.
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ABSTRACT: The primary goal of the Surgical Care Improvement Project is to improve quality of care by implementing evidence-based health care practices that prevent surgical complications. This study was designed to test the hypothesis that an increase in compliance with quality process measures decreases the rate of surgical site infections in patients undergoing colorectal surgeries. A multidisciplinary task force implemented and monitored compliance with individual quality measures in patients undergoing elective colorectal resections at a tertiary institution. Individual compliance rates and infections were collected prospectively and reviewed monthly. For data analysis, patients were assigned to 2 consecutive 14-month periods: period A (April 1, 2006 to May 31, 2007) and period B (June 1, 2007 to July 31, 2008). Comparisons between periods were performed to determine the association of compliance with process measures and outcomes in infections. A total of 491 consecutive patients were treated during the study periods (period A: n = 238; period B: n = 253). There were no statistically significant differences in patient characteristics, diagnoses, or surgical procedures between periods. Compliance with all process measures significantly increased within periods except for perioperative glucose control. Global compliance (compliance with all measures per patient) significantly improved from period A to B (40%-68%, respectively; P < .001). In total, 99 patients (19%) developed surgical site infections (period A, 18.9%; period B, 19.4%). An increase in compliance with the Surgical Care Improvement Project aimed to prevent surgical site infections does not translate into a significant reduction of surgical site infections in patients undergoing colorectal resections.
Article: Local Excision for Rectal Carcinoma[Show abstract] [Hide abstract]
ABSTRACT: Local excision is an alternative approach to radical proctectomy for rectal cancer, but from an oncologic standpoint, it is a compromise, and its role remains controversial. Careful patient selection is essential because local excision is generally considered only for early rectal cancer with no evidence of nodal metastasis, parameters that can be predicted by clinical examination, and various radiologic modalities with variable accuracy. In this review, we present the literature evaluating the oncologic adequacy of local excision, including transanal endoscopic microsurgery and the results of salvage surgery after local excision. An overview of local excision in the context of perioperative adjuvant therapies is included. Finally, we suggest a treatment algorithm for local excision in rectal cancer.
University of California, San Francisco
San Francisco, California, United States
- Department of Surgery