Napolitano Michael A, Skancke Matthew, Walters Jarvis, Michel Lynn, Randall J Alex, Brody Fredrick J, Duncan James E
Department of Surgery, Veterans Affairs Medical Center, Washington, DC.
Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA.
J Laparoendosc Adv Surg Tech A. 2020 Apr;30(4):378-382. doi: 10.1089/lap.2019.0739. Epub 2020 Feb 10.
The past decade has witnessed numerous advances in colorectal surgery secondary to minimally invasive surgery, evidence-based enhanced recovery programs, and a growing emphasis on patient-centered outcomes. The purpose of this study is to benchmark outcomes and experiences of patients undergoing colorectal surgery at a tertiary Veterans Affairs Medical Center for a 10-year period. Veterans who underwent nonemergent colorectal procedures between 2008 and 2018 were identified using targeted Current Procedural Terminology (CPT) codes and the Computerized Patient Record System. Patient outcomes were captured using the Veterans Affairs Surgical Quality Improvement Program and focused on length of stay and aggregate postoperative morbidity profiles. SAS Version 9.4 (SAS Institute Inc., Cary, NC) was used for all data analysis with < .05 used to indicate significance. In total, 327 patients underwent colon/rectal resection at our medical center. Of whom 95% of patients were male and the average age was 66 years. The median length of stay after surgery was 8 days. Within the 30-day postoperative period, the composite morbidity score was 24.1%: most notable being superficial surgical site infections (6.5%), wound dehiscence (4.6%), and pneumonia (3.1%). Over the course of the study period, the laparoscopic approach increased in utilization, with 22.2% of cases performed laparoscopically in 2008 that rose to 61.1% in 2018. Cataloging this decade of practice provides a foundation for future changes in the field of colorectal surgery and in the treatment of veterans. Understanding historical outcomes should help identify areas for ongoing process improvement and guide targeted approaches to quality metrics.
在过去十年中，由于微创手术、循证强化康复计划以及对以患者为中心的治疗结果的日益重视，结直肠手术取得了诸多进展。本研究的目的是对一家三级退伍军人事务医疗中心10年间接受结直肠手术患者的治疗结果和经历进行基准评估。通过使用目标现行程序编码术语（CPT）和计算机化患者记录系统，确定了2008年至2018年间接受非急诊结直肠手术的退伍军人。使用退伍军人事务部手术质量改进计划获取患者治疗结果，重点关注住院时间和术后总体发病情况。所有数据分析均使用SAS 9.4版（SAS Institute Inc.，北卡罗来纳州卡里），P值<0.05表示具有统计学意义。在我们医疗中心，共有327例患者接受了结肠/直肠切除术。其中95%为男性，平均年龄为66岁。术后中位住院时间为8天。在术后30天内，综合发病评分率为24.1%：最常见的是浅表手术部位感染（6.5%）、伤口裂开（4.6%）和肺炎（3.1%）。在研究期间，腹腔镜手术的使用率有所增加，2008年22.2%的病例采用腹腔镜手术，到2018年这一比例升至61.1%。记录这十年的实践情况为结直肠手术领域以及退伍军人治疗的未来变革奠定了基础。了解历史治疗结果应有助于确定持续改进的领域，并指导针对质量指标的目标方法。
