Conor P Delaney

Case Western Reserve University School of Medicine, Cleveland, Ohio, United States

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Publications (285)1180.75 Total impact

  • Deborah S Keller · Conor P Delaney · Lobat Hashemi · Eric M Haas
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    ABSTRACT: Background: Surgical value is based on optimizing clinical and financial outcomes. The clinical benefits of laparoscopic surgery are well established; however, many patients are still not offered a laparoscopic procedure. Our objective was to compare the modern clinical and financial outcomes of laparoscopic and open colorectal surgery. Methods: The Premier Perspective database identified patients undergoing elective colorectal resections from January 1, 2013 to December 31, 2013. Cases were stratified by operative approach into laparoscopic and open cohorts. Groups were controlled on all demographics, diagnosis, procedural, hospital characteristics, surgeon volume, and surgeon specialty and then compared for clinical and financial outcomes. The main outcome measures were length of stay (LOS), complications, readmission rates, and cost by surgical approach. Results: A total of 6343 patients were matched and analyzed in each cohort. The most common diagnosis was diverticulitis (p = 0.0835) and the most common procedure a sigmoidectomy (p = 0.0962). The LOS was significantly shorter in laparoscopic compared to open (mean 5.78 vs. 7.80 days, p < 0.0001). The laparoscopic group had significantly lower readmission (5.82 vs. 7.68 %, p < 0.0001), complication (32.60 vs. 42.28 %, p < 0.0001), and mortality rates (0.52 vs. 1.28 %, p < 0.0001). The total cost was significantly lower in laparoscopic than in open (mean $17,269 vs. $20,552, p < 0.0001). By category, laparoscopy was significantly more cost-effective for pharmacy (p < 0.0001), room and board (p < 0.0001), recovery room (p = 0.0058), ICU (p < 0.0001), and laboratory and imaging services (both p < 0.0001). Surgical supplies (p < 0.0001), surgery (p < 0.0001), and anesthesia (p = 0.0053) were higher for the laparoscopic group. Conclusions: Laparoscopy is more cost-effective and produces better patient outcomes than open colorectal surgery. Minimally invasive colorectal surgery is now the standard that should be offered to patients, providing value to both patient and provider.
    No preview · Article · Dec 2015 · Surgical Endoscopy
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    ABSTRACT: Background: Laparoscopic colorectal resection is an index case for advanced skills training, yet many residents struggle to reach proficiency by graduation. Current methods to reduce the learning curve for residents remain expensive, time consuming, and poorly validated. Objective: The purpose of this study was to assess the impact of the addition of a preprocedural instructional video to improve the ability of a general surgery resident to perform laparoscopic right colectomy when compared with standard preparation. Design: This was a single-blinded, randomized control study. Settings: Four university-affiliated teaching hospitals were included in the study. Participants: General surgery residents in postgraduation years 2 through 5 participated. Intervention: Residents were randomly assigned to preparation with a narrated instructional video versus standard preparation. Main outcome measures: Resident performance, scored by a previously validated global assessment scale, was measured. Results: Fifty-four residents were included. Half (n = 27) were randomly assigned to view the training video and half (n = 27) to standard preparation. There were no differences between groups in terms of training level or previous operative experience or in patient demographics (all p > 0.05). Groups were similar in the percentage of the case completed by residents (p = 0.39) and operative time (p = 0.74). Residents in the video group scored significantly higher in total score (mean: 46.8 vs 42.3; p = 0.002), as well as subsections directly measuring laparoscopic skill (vascular control mean: 11.3 vs 9.7, p < 0.001; mobilization mean: 7.6 vs. 7.0, p = 0.03) and overall performance score (mean: 4.0 vs 3.1; p < 0.001). Statistical significance persisted across training levels. Limitations: There is potential for Hawthorne effect, and the study is underpowered at the individual postgraduate year level. Conclusions: The simple addition of a brief, narrated preprocedural video to general surgery resident case preparation significantly increased trainee ability to successfully perform a laparoscopic right colectomy. In an era of shortened hours and less exposure to cases, incorporating a brief but effective instructional video before surgery may improve the learning curve of trainees and ultimately improve safety.
    No preview · Article · Dec 2015 · Diseases of the Colon & Rectum
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    ABSTRACT: Purpose: Small bowel (SB) diverticulosis is a rare disorder that may entail serious complications, including SB diverticulitis. Both are often missed in imaging. Magnetic resonance enterography/enteroclysis (MRE) is increasingly used to assess SB disease; awareness of the appearance of SB diverticulitis is essential to ensure appropriate management. Our aim was to systematically describe imaging characteristics of SB diverticulosis and diverticulitis in MRE. Methods: This retrospective, HIPAA-compliant study identified 186 patients with suspected SB diverticulosis/diverticulitis in medical databases of two tertiary medical centres between 2005 and 2011. Patients with surgically confirmed diagnoses of SB diverticulosis/diverticulitis were included. Two observers analyzed MR images for the presence, location, number, and size of diverticula, wall thickness, and mural and extramural patterns of inflammation. Results: Seven patients were recruited. MRI analysis showed multiple diverticula in all (100 %). Diverticular size ranged from 0.5 to 6 cm. Prevalence of diverticula was higher in the proximal than the distal SB (jejunum 86 %, ileum 57 %, distal ileum43%). Diverticulitis occurred in 3/7 patients (43 %) showing asymmetric bowel wall thickening and focal mesenteric inflammation. Conclusion: SB diverticulitis demonstrates characteristic MRE imaging features to distinguish this rare disorder from more common diseases. Asymmetric, focal mesenteric and mural inflammation and presence of multiple diverticula are keys to diagnosis. Key points: • Small bowel diverticulosis and diverticulitis is rare and often missed in imaging • Acquired small bowel diverticula are variable in size and number • Small bowel diverticulitis demonstrates characteristic features on MR enterography/enteroclysis • A focal or segmental asymmetric small bowel inflammation should prompt the search for diverticula.
    No preview · Article · Nov 2015 · European Radiology
  • Karen M. Brady · Deborah S. Keller · Conor P. Delaney
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    ABSTRACT: Enhanced recovery pathways (ERPs) are standardized, multidisciplinary approaches to caring for patients with a goal of decreasing length of stay and care costs without negatively affecting patient outcomes. One facility successfully implemented ERPs for patients undergoing abdominal surgery. For implementation to be successful, nurses were found to be key in providing education, perioperative care, and postoperative evaluation, as well as cost containment. The implementation team collaborated to define, design, implement, and audit an ERP for surgical services. Initial audits demonstrated an increase in compliance with order set use (61% to 93%) and use of ERPs more than standardized order sets (< 1% to 27%), as well as decreased use of daily laboratory orders (94% to 62%) and elimination of automatically ordered laboratory tests (38% to 0%). These results led to the conclusion that the nurse's role is essential for education and successful use of the pathways and that best practices for developing ERPs requires consistency across the care team, diligence to ensure compliance, and use of an audit tool for quality improvement.
    No preview · Article · Nov 2015 · AORN journal
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    ABSTRACT: Transient ileus is a normal physiologic process after surgery. When prolonged, it is an important contributor to postoperative complications, increased length of stay and increased healthcare costs. Efforts have been made to prevent and manage postoperative ileus; alvimopan is an oral, peripheral μ-opioid receptor antagonist, and the only currently US FDA-approved medication to accelerate the return of gastrointestinal function postoperatively.
    No preview · Article · Oct 2015 · Expert review of gastroenterology & hepatology
  • Susan R Mazanec · Abdus Sattar · Conor P Delaney · Barbara J Daly
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    ABSTRACT: Activation, the state of possessing the skills, knowledge, and confidence to manage one's own health, is associated with positive self-management behaviors in individuals with chronic illness. Little is known about its role in cancer survivorship. The aims of this study were to describe activation in patients with colorectal cancer and their family caregivers, examine the relationship between patient and caregiver activation, and determine whether activation is related to symptom distress, depression, anxiety, fatigue, physical activity, and work productivity. Using a longitudinal, correlational design, a convenience sample of 62 patients and 42 family caregivers completed surveys during postoperative hospitalization, and at 6 weeks and 4 months postop. Activation scores for both patients and caregivers were stable over time, were not correlated, and were at the third level of activation. Linear mixed effects models revealed that negative emotions were associated with less patient activation and lower caregiver self-efficacy for caring for oneself.
    No preview · Article · Sep 2015 · Western Journal of Nursing Research
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    ABSTRACT: The most common sites of colorectal cancer (CRC) recurrence are the local tissues, liver or lungs. The objective was to identify risk factors associated with the primary CRC tumor and cancer recurrence in these anatomical sites. Retrospective, longitudinal analyses of data on CRC survivors. Multivariable Cox regression analysis was performed to examine the association between possible cofounders with recurrence to various anatomical sites. Data for 10,398CRC survivors (tumor location right colon=3870, left colon=2898, high rectum=2569, low rectum=1061) were analyzed; follow up time was up to five years. Mean age at curative surgery was 71.5 (SD 11.8) years, 20.2% received radio-chemotherapy, stage T3 (64.4%) and N0 (65.1%) were most common. Overall 1632 (15.7%) had cancer recurrence (Isolated liver n=412, 3,8%; isolated lung n=252, 2,4%; isolated local n=223, 2.1%). Risk factors associated with recurrent CRC were identified, i.e. isolated liver metastases (male: Adjusted Hazard Ratio (AHR) 1,45; colon left: AHR 1,63; N2 disease: AHR 3,35; T2 disease: AHR 2,82), isolated lung metastases (colon left: AHR 1,53; rectum high: AHR 2,48; rectum low: AHR 2,65; N2 disease 3,76), and local recurrence (glands examined<12: AHR 1,51; CRM <3mm: AHR 1,60; rectum high: AHR 2,15; N2 disease: AHR 2,58) (all p values <0001). Our study finds that the site of the primary CRC tumor is associated with location of subsequent metastasis. Left sided colon cancers have increased risk of metastatic spread to the liver, whereas rectal cancers have increased risk of local recurrence and metastatic spread to the lungs. These results, in combination with other risk factors for CRC recurrence, should be taken into consideration when designing risk adapted post-treatment CRC surveillance programs. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.
    Full-text · Article · Aug 2015
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    ABSTRACT: We report our initial clinical experience from a pilot study to compare the diagnostic accuracy of hybrid PET/MRI with PET/CT in colorectal cancer and discuss potential PET/MRI workflow solutions for colorectal cancer. Patients underwent both FDG PET/CT and PET/MRI (Ingenuity TF PET/MRI, Philips Healthcare) for rectal cancer staging or colorectal cancer restaging. The PET acquisition of PET/MRI was similar to that of PET/CT whereas the MRI protocol was selected individually based on the patient's medical history. One nuclear medicine physician reviewed the PET/CT studies and one radiologist reviewed the PET/MRI studies independently. The diagnostic accuracy of each modality was determined in consensus, using available medical records as a reference. Of the 12 patients enrolled, two were for initial staging and ten for restaging. The median scan delay between the two modalities was 60 min. The initial imaging was PET/CT in nine patients and PET/MRI in three patients. When PET/CT was performed first, the SUV values of the 16 FDG avid lesions were greater at PET/MRI than at PET/CT. In contrast, when PET/MRI was performed first, the SUV values of the seven FDG avid lesions were greater at PET/CT than at PET/MRI. PET/MRI provided more detailed T staging than PET/CT. On a per-patient basis, with both patient groups combined for the evaluation of N and M staging/restaging, the true positive rate was 5/7 (71%) for PET/CT and 6/7 (86%) for PET/MRI, and true negative rate was 5/5 (100%) for both modalities. On a per-lesion basis, PET/CT identified 26 of 29 (90%) tumor lesions that were correctly detected by PET/MRI. Our proposed workflow allows for comprehensive cancer staging including integrated local and whole-body assessment. Our initial experience shows a high diagnostic accuracy of PET/MRI in T staging of rectal cancer compared with PET/CT. In addition, PET/MRI shows at least comparable accuracy in N and M staging as well as restaging to PET/CT. However, the small sample size limits the generalizability of the results. It is expected that PET/MRI would yield higher diagnostic accuracy than PET/CT considering the high soft tissue contrast provided by MRI compared with CT, but larger studies are necessary to fully assess the benefit of PET/MRI in colorectal cancer.
    No preview · Article · Jun 2015 · Abdominal Imaging

  • No preview · Conference Paper · May 2015
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    ABSTRACT: Laparoscopic colectomy is safe and effective in the treatment of many colorectal diseases. However, the effect of increasing use of laparoscopy on overall health care utilization and costs, especially in the long term, has not been thoroughly investigated. To evaluate the effect of laparoscopic vs open colectomy on short- and long-term health care utilization and costs. Retrospective multivariate regression analysis of national health insurance claims data was used to evaluate health care utilization and costs up to 1 year following elective colectomy. Data were obtained from the Truven Health Analytics MarketScan Commercial Claims and Encounters database. Patients aged 18 to 64 years who underwent elective laparoscopic or open colectomy from January 1, 2010, through December 31, 2010, were included. Patients with complex diagnoses that require increased non-surgery-related health care utilization, including malignant neoplasm, inflammatory bowel disease, human immunodeficiency virus, transplantation, and pregnancy, were excluded. Of 25 481 patients who underwent colectomy, 4160 were included in the study. Healthcare utilization, including office, hospital outpatient, and emergency department visits and inpatient services 90 and 365 days after the index procedure; total health care costs; and estimated days off from work owing to health care utilization. Of 25 481 patients who underwent colectomy, 4160 were included in the study (laparoscopic, 45.6%; open, 54.4%). The mean (SD) net and total payments were lower for laparoscopy ($23 064 [$14 558] and $24 196 [$14 507] vs $29 753 [$21 421] and $31 606 [$23 586]). In the first 90 days after surgery, an open approach was significantly associated with a 1.26-fold increase in health care costs (estimated, $1715; 95% CI, $338-$2853), increased use of heath care services, and more estimated days off from work (2.78 days; 95% CI, 1.93-3.59). Similar trends were found in the full postoperative year, with an estimated 1.18-fold increase (95% CI, 1.04-1.35) in health care expenditures and an increase of 1.15 times (95% CI, 1.08-1.23) the number of health care utilization days compared with laparoscopy. Laparoscopic colectomy results in a significant reduction in health care costs and utilization in the short- and long-term postoperative periods.
    Full-text · Article · Mar 2015 · JAMA SURGERY
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    ABSTRACT: Study Shows Patients Who Underwent Laparoscopic Colon Resections Left Hospital Faster, Required Significantly Less Follow Up Care and Fewer Medicines Than Patients Who Underwent Open Surgery DUBLIN-March 25, 2015-Adding to the clinical benefits and improved patient outcomes associated with minimally-invasive surgery (MIS), Medtronic plc (NYSE: MDT) today highlighted new data demonstrating that patients who underwent minimally invasive colon resection procedures were able to leave the hospital faster, visit their doctors less for follow up care and take fewer medicines 1 than those who underwent open surgery. The findings, which were published in the March 25 online edition of JAMA Surgery, suggest that minimally invasive approaches offer compelling near-and long-term cost savings for the healthcare system and less trauma for patients. "We found that the use of minimally-invasive laparoscopic approaches in a select group of patients undergoing colectomy procedures resulted in significantly lower health care costs and resource utilization compared with open surgical approaches. This may expand access and lower the cost of patient care in the long term," said lead author Conor P. Delaney, MD PhD, of University Hospitals Case Medical Center in Cleveland, Ohio. "These results reflect the well-documented benefits of laparoscopic surgery, which include faster recovery, less pain and fewer complications." A colectomy is the surgical removal of part or all of the colon and the rectum and is usually performed to treat several digestive health conditions, including diverticulitis, Crohn's disease, ulcerative colitis and cancer of the colon and rectum.
    Full-text · Article · Mar 2015
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    ABSTRACT: Unexpected variations in postoperative length of stay (LOS) negatively impact resources and patient outcomes. Statistical process control (SPC) measures performance, evaluates productivity, and modifies processes for optimal performance. The goal of this study was to initiate SPC to identify LOS outliers and evaluate its feasibility to improve outcomes in colorectal surgery. Review of a prospective database identified colorectal procedures performed by a single surgeon. Patients were grouped into elective and emergent categories and then stratified by laparoscopic and open approaches. All followed a standardized enhanced recovery protocol. SPC was applied to identify outliers and evaluate causes within each group. A total of 1294 cases were analyzed-83 % elective (n = 1074) and 17 % emergent (n = 220). Emergent cases were 70.5 % open and 29.5 % laparoscopic; elective cases were 36.8 % open and 63.2 % laparoscopic. All groups had a wide range in LOS. LOS outliers ranged from 8.6 % (elective laparoscopic) to 10.8 % (emergent laparoscopic). Evaluation of outliers demonstrated patient characteristics of higher ASA scores, longer operating times, ICU requirement, and temporary nursing at discharge. Outliers had higher postoperative complication rates in elective open (57.1 vs. 20.0 %) and elective lap groups (77.6 vs. 26.1 %). Outliers also had higher readmission rates for emergent open (11.4 vs. 5.4 %), emergent lap (14.3 vs. 9.2 %), and elective lap (32.8 vs. 6.9 %). Elective open outliers did not follow trends of longer LOS or higher reoperation rates. SPC is feasible and promising for improving colorectal surgery outcomes. SPC identified patient and process characteristics associated with increased LOS. SPC may allow real-time outlier identification, during quality improvement efforts, and reevaluation of outcomes after introducing process change. SPC has clinical implications for improving patient outcomes and resource utilization.
    No preview · Article · Feb 2015 · Surgical Endoscopy
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    ABSTRACT: High-resolution anoscopy has been shown to improve identification of anal intraepithelial neoplasia but a reduction in progression to anal squamous-cell cancer has not been substantiated when serial high-resolution anoscopy is compared with traditional expectant management. The aim of this study was to compare high-resolution anoscopy versus expectant management for the surveillance of anal intraepithelial neoplasia and the prevention of anal cancer. This is a retrospective review of all patients who presented with anal squamous dysplasia, positive anal Pap smears, or anal squamous-cell cancer from 2007 to 2013. This study was performed in the colorectal department of a university-affiliated, tertiary care hospital. Included patients had biopsy-proven anal intraepithelial neoplasia from 2007 to 2013. Patients were treated with high-resolution anoscopy with ablation or standard anoscopy with ablation. Both groups were treated with imiquimod and followed every 6 months indefinitely. The incidence of anal squamous-cell cancer in each group was the primary end point. From 2007 to 2013, 424 patients with anal squamous dysplasia were seen in the clinic (high-resolution anoscopy, 220; expectant management, 204). Three patients (high-resolution anoscopy, 1; expectant management, 2) progressed to anal squamous-cell cancer; 2 were noncompliant with follow-up and with HIV treatment, and the third was allergic to imiquimod and refused to take topical 5-fluorouracil. The 5-year progression rate was 6.0% (95% CI, 1.5-24.6) for expectant management and 4.5% (95% CI, 0.7-30.8) for high-resolution anoscopy (p = 0.37). This was a retrospective review. There is potential for selection and referral bias. Because of the rarity of the outcome, the study may be underpowered. Patients with squamous-cell dysplasia followed with expectant management or high-resolution anoscopy rarely develop squamous-cell cancer if they are compliant with the protocol. The cost, morbidity, and value of high-resolution anoscopy should be further evaluated in lieu of these findings.
    No preview · Article · Jan 2015 · Diseases of the Colon & Rectum
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    ABSTRACT: Surgical resection is the mainstay of treatment for rectal cancers. For the vast majority of patients with rectal cancers the tumor is located within the mesorectal fascia and is resected with total mesorectal excision (TME) with excellent clinical outcomes. A small percentage of patients have tumors that extend beyond the mesorectal compartment with invasion into the fascia propria or beyond into surrounding structures or with local lymph node involvement (stage II or III). These patients with locally advanced rectal cancer are difficult to treat with surgery alone due to an increased risk in local disease recurrence. In recent years, new technologies and advances in treatment protocols have resulted in a multidisciplinary approach that has yielded improved clinical and oncological outcomes.
    No preview · Chapter · Jan 2015
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    ABSTRACT: Early discharge following colorectal surgery has become more frequent with increased use of laparoscopy and enhanced recovery pathways (ERP). Discharge within 48 hours of surgery is not routinely achieved, and concerns remain over the safety of such early discharge. We analyzed colectomy patients to identify factors that may lend to expedited recovery, and demonstrate the safety of this approach for suitable patients.
    No preview · Conference Paper · Dec 2014
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    ABSTRACT: Multivisceral resection is often required in the treatment of locally advanced rectal cancers. Such resections are relatively rare and oncologic outcomes, especially when sphincter preservation is performed, are not fully demonstrated. A retrospective review was conducted of patients who underwent multivisceral resection for locally advanced rectal cancer with and without sphincter preservation. Sixty-one patients underwent multivisceral resection for rectal cancer from 2005 to 2013 with a median follow-up of 27.8 months. Five-year overall and disease-free survival were 49.2% and 45.3%, respectively. Thirty-four patients (55.7%) had sphincter-sparing operations with primary coloanal anastomosis and temporary stoma. There was no significant difference in overall or disease-free survival, or recurrence with sphincter preservation compared with those with permanent stoma. Multivisceral resection for locally advanced rectal cancer has acceptable oncologic and clinical outcomes. Sphincter preservation and subsequent reestablishment of gastrointestinal continuity does not impact oncologic outcomes and should be considered in many patients. Copyright © 2015 Elsevier Inc. All rights reserved.
    Full-text · Article · Dec 2014 · The American Journal of Surgery
  • Deborah S. Keller · Bridget O. Ermlich · Conor P. Delaney
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    ABSTRACT: Background Quality improvement in colorectal surgery (CRS) requires implementation of tools to improve patient and financial outcomes, and assessment of results. Our objective was to evaluate the durability of transversus abdominis plane (TAP) blocks and a standardized enhanced recovery protocol (ERP) on a large series of laparoscopic colorectal resections. Study Design 200 consecutive laparoscopic CRS patients received TAP blocks under laparoscopic guidance at the end of their operation. All were managed with a standardized ERP. Demographic, perioperative, and postoperative outcome variables were analyzed. The main outcome measures were length of stay (LOS), readmission, reoperation, morbidity, and mortality rates. Results Of 200 cases, 194 were elective and 6 emergent. The main diagnosis was colorectal cancer (45%). The mean age was 61.2 years, mean BMI was 29.2 kg/m2, and the majority (63%) were ASA class III. The main procedure performed was a segmental colectomy (64%). Mean operative time was 181 minutes. Nine cases (4.5%) were converted to open. The median LOS was 2 days (range, 1-8). 21% were discharged by postoperative day (POD) 1, 41% by POD2, and 77% by POD3. By POD7, 99% were discharged. 12% (n=24) had complications, and 6.5% (n=13) were readmitted. There were 3 unplanned reoperations and no mortalities. Comparing the first and second groups of 100 consecutive patients further tested the consistency of the TAP block benefit. With comparable demographics, there were no significant differences in readmission, complication, or reoperation rates over the entire series. Conclusions Adding TAP blocks to a ERP facilitated shorter LOS with low readmission and reoperation rates when compared to previously published series. The effect appears durable and consistent in a large case series. TAP blocks may be an efficient, cost-effective method for improving laparoscopic CRS results.
    No preview · Article · Dec 2014 · Journal of the American College of Surgeons
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    S E Araujo · B Crawshaw · C R Mendes · C P Delaney
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    ABSTRACT: Achieving a clear distal or circumferential resection margins with laparoscopic total mesorectal excision (TME) may be laborious, especially in obese males and when operating on advanced distal rectal tumors with a poor response to neoadjuvant treatment. Transanal (TaTME) is a new natural orifice translumenal endoscopic surgery modality in which the rectum is mobilized transanally using endoscopic techniques with or without laparoscopic assistance. We conducted a comprehensive systematic review of publications on this new technique in PubMed and Embase databases from January, 2008, to July, 2014. Experimental and clinical studies written in English were included. Experimental research with TaTME was done on pigs with and without survival models and on human cadavers. In these studies, laparoscopic or transgastric assistance was frequently used resulting in an easier upper rectal dissection and in a longer rectal specimen. To date, 150 patients in 16 clinical studies have undergone TaTME. In all but 15 cases, transabdominal assistance was used. A rigid transanal endoscopic operations/transanal endoscopic microsurgery (TEO/TEM) platform was used in 37 patients. Rectal adenocarcinoma was the indication in all except for nine cases of benign diseases. Operative times ranged from 90 to 460 min. TME quality was deemed intact, satisfactory, or complete. Involvement in circumferential resection margins was detected in 16 (11.8 %) patients. The mean lymph node harvest was equal or greater than 12 in all studies. Regarding morbidity, pneumoretroperitoneum, damage to the urethra, and air embolism were reported intraoperatively. Mean hospital stay varied from 4 to 14 days. Postoperative complications occurred in 34 (22.7 %) patients. TaTME with TEM is feasible in selected cases. Oncologic safety parameters seem to be adequate although the evidence relies on small retrospective series conducted by highly trained surgeons. Further studies are expected.
    Full-text · Article · Nov 2014 · Techniques in Coloproctology
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    ABSTRACT: Superior early pain control has been suggested with transversus abdominis plane blocks, but evidence-based recommendations for transversus abdominis plane blocks and their effects on patient outcomes are lacking.
    Full-text · Article · Nov 2014 · Diseases of the Colon & Rectum

  • No preview · Conference Paper · Oct 2014

Publication Stats

9k Citations
1,180.75 Total Impact Points


  • 2007-2015
    • Case Western Reserve University School of Medicine
      • Department of Surgery
      Cleveland, Ohio, United States
    • Cornell University
      • Department of Surgery
      Итак, New York, United States
  • 2005-2015
    • Case Western Reserve University
      • Division of Colorectal Surgery
      Cleveland, Ohio, United States
  • 2013
    • Imperial College London
      Londinium, England, United Kingdom
    • The Ohio State University
      Columbus, Ohio, United States
  • 2005-2013
    • Cleveland State University
      Cleveland, Ohio, United States
  • 2009
    • Concordia University–Ann Arbor
      Ann Arbor, Michigan, United States
  • 2005-2007
    • Cleveland Clinic
      • Department of Cancer Biology
      Cleveland, Ohio, United States
    • Medical University of Ohio at Toledo
      • Department of Surgery
      Toledo, Ohio, United States