Division of General Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
World J Emerg Surg. 2014 Mar 21;9(1):19. doi: 10.1186/1749-7922-9-19.
Emergency colorectal cancer (CRC) is a complex disease that requires multidisciplinary approaches for management. However, it is unclear whether acute care surgery (ACS) services can expedite the workup and treatment of complex surgical diseases such as emergency CRC. We sought to assess the impact of an Acute Care and Emergency Surgery Service (ACCESS) on wait-times for inpatient colonoscopy and surgical resection among emergency CRC patients.
This retrospective case-control study was conducted at a tertiary-care, university-affiliated, cancer centre in London, Ontario, Canada. All patients aged 18 or older who presented to the emergency department with a recent (within 48 hours) diagnosis of CRC, or were diagnosed with CRC after admission, were included in the study. Patients were either in the pre-ACCESS (July 1, 2007-June 31, 2010) or post-ACCESS (July 1, 2010-June 30, 2012) groups. A third group of emergency CRC patients treated at an adjacent cancer centre that lacked ACCESS (non-ACCESS) was evaluated separately. The primary outcome was time from admission to colonoscopy and surgery.
A total of 149 patients (47 pre-ACCESS, 37 post-ACCESS, and 65 non-ACCESS) were identified. Only 19% (n = 9) of pre-ACCESS patients underwent inpatient colonoscopy, compared to 38% (n = 14) in the post-ACCESS group (p = 0.023). Additionally, 100% of patients in the post-ACCESS era underwent inpatient colonoscopy and surgery during the same admission, compared to only 44% of pre-ACCESS patients (p = 0.006). Median wait-times for inpatient colonoscopy (2.0 and 1.8 days for pre- and post-ACCESS groups respectively, p = 0.08) and surgical resection (1.6 and 2.3 days for pre- and post-ACCESS groups respectively, p = 0.40) were similar.
Patients admitted to ACCESS underwent more inpatient colonoscopies and were more likely to have definitive surgery on that admission. ACS services can facilitate the workup and management of complex surgical diseases such as emergency CRC without delaying treatment.
紧急结直肠癌（CRC）是一种复杂的疾病，需要多学科方法进行管理。然而，急性护理外科（ACS）服务是否能加快复杂外科疾病（如紧急 CRC）的检查和治疗，目前尚不清楚。我们旨在评估急性护理和急诊外科服务（ACCESS）对急诊 CRC 患者住院结肠镜检查和手术切除等待时间的影响。
这是一项在加拿大安大略省伦敦市的一家三级保健、大学附属癌症中心进行的回顾性病例对照研究。所有年龄在 18 岁或以上、最近（48 小时内）诊断为 CRC 或入院后诊断为 CRC 的患者均纳入研究。患者分为 ACCESS 前（2007 年 7 月 1 日至 2010 年 6 月 31 日）和 ACCESS 后（2010 年 7 月 1 日至 2012 年 6 月 30 日）两组。另外，还评估了在相邻癌症中心接受治疗但缺乏 ACCESS（非 ACCESS）的第三组急诊 CRC 患者。主要结局是从入院到结肠镜检查和手术的时间。
共确定了 149 名患者（47 名 ACCESS 前、37 名 ACCESS 后和 65 名非 ACCESS）。只有 19%（n=9）的 ACCESS 前患者接受了住院结肠镜检查，而 ACCESS 后组为 38%（n=14）（p=0.023）。此外，ACCESS 后时代的所有患者都在同一住院期间接受了住院结肠镜检查和手术，而 ACCESS 前组只有 44%的患者接受了这一治疗（p=0.006）。住院结肠镜检查的中位等待时间（ACCESS 前和后组分别为 2.0 天和 1.8 天，p=0.08）和手术切除的中位等待时间（ACCESS 前和后组分别为 1.6 天和 2.3 天，p=0.40）相似。
入住 ACCESS 的患者接受了更多的住院结肠镜检查，并且更有可能在该住院期间进行确定性手术。ACS 服务可以促进复杂外科疾病（如紧急 CRC）的检查和管理，而不会延迟治疗。
