Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida.
Department of Surgery, University Health Network and the University of Toronto, Toronto, Ontario, Canada.
Dis Colon Rectum. 2019 Mar;62(3):343-347. doi: 10.1097/DCR.0000000000001204.
Anorectal surgery encompasses a wide range of procedures with varying complexity. The Accreditation Council for Graduate Medical Education Review Committee for Colon and Rectal Surgery recommends minimum case numbers (60) for 1-year specialty trainees in 6 categories of anorectal surgery, with definitions for procedural complexity.
The purpose of this study was to assess the scope of anorectal procedures and propose a stratification of procedures based on a consensus of levels of difficulty, as well as to identify a predictive charge cutoff suggestive of procedural complexity.
This was a retrospective review.
The study was conducted at a tertiary academic center.
Patients undergoing anorectal procedures between January 2011 and December 2014 identified by Current Procedural Terminology coding were entered into 6 categories. Codes were stratified as routine or complex based on an assessment of perioperative care and technical expertise required. Patients with an abdominal portion to any procedure were excluded.
The study measured distribution of complexity in anorectal surgical procedures and procedural charge associated with differentiating routine from complex procedures.
Seven colorectal surgeons performed 2483 anorectal procedures (mean = 620 per year). Mean age was 48 ± 16 years. Forty six (64%) of 71 procedures were classified as routine and 25 (36%) of 71 as complex. Most disease processes had subsets with routine or complex procedures, whereas all of the procedures performed for fecal incontinence or advanced anorectal techniques were considered complex. Fistula procedures and transanal excisions were most heterogeneous, with a high procedural complexity rate (37% and 50%). After a procedural complexity rating, intraclass correlation by 6 surgeons was 0.70, demonstrating good correlation. Receiver operating curve assessments of consensus categorization according to billing codes revealed $553 as the optimal cutoff between routine and complex procedures.
This was a single-institution retrospective review.
Colorectal residents may benefit from anorectal case stratification, because it serves as a dialogue for those interested in complex anorectal surgery during training. Surgeon categorization of procedures correlates well with a charge-based model of complexity. See Video Abstract at http://links.lww.com/DCR/A806.
肛门直肠手术涵盖了广泛的具有不同复杂程度的程序。毕业后医学教育认证委员会结肠和直肠外科学评审委员会建议，在肛门直肠手术的 6 个类别中，每位专科住院医师每年至少应完成 60 例手术，同时还对手术的复杂程度进行了定义。
本研究旨在评估肛门直肠手术的范围，并根据手术难度的共识对手术进行分类，同时确定提示手术复杂性的预测费用阈值。
这是一项回顾性研究。
该研究在一家三级学术中心进行。
通过当前操作术语代码识别，2011 年 1 月至 2014 年 12 月期间接受肛门直肠手术的患者被归入 6 个类别。根据围手术期护理和所需技术专长的评估，将代码分为常规或复杂。任何手术都有腹部部分的患者均被排除。
本研究测量了肛门直肠手术复杂性的分布情况，以及区分常规手术和复杂手术的手术费用。
7 名结直肠外科医生共完成了 2483 例肛门直肠手术（平均每年 620 例）。患者平均年龄为 48±16 岁。71 例手术中有 46 例（64%）被归类为常规手术，25 例（36%）为复杂手术。大多数疾病过程都有常规或复杂的手术子集，而所有用于治疗肛门失禁或先进肛门直肠技术的手术都被认为是复杂的。瘘管手术和经肛门切除术最为复杂，其手术复杂性比例分别为 37%和 50%。在进行手术复杂程度评分后，6 名外科医生的组内相关系数为 0.70，表明相关性良好。根据计费代码对共识分类进行接收器操作曲线评估显示，553 美元是常规和复杂手术之间的最佳分界点。
这是一项单机构回顾性研究。
肛肠住院医师可能受益于肛门直肠病例分层，因为它可以为那些在培训期间对复杂肛门直肠手术感兴趣的人提供对话。外科医生对手术的分类与基于费用的复杂程度模型密切相关。详见视频摘要，网址：http://links.lww.com/DCR/A806。
