An acute care surgery service expedites the treatment of emergency colorectal cancer: a retrospective case-control study.
An acute care surgery service expedites the treatment of emergency colorectal cancer: a retrospective case-control study.
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DOI：
10.1186/1749-7922-9-19
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发表时间：
2014-03-21
期刊：
影响因子：
--
通讯作者：
Leslie K
中科院分区：
文献类型：
--
作者：
Anantha RV;Brackstone M;Parry N;Leslie K
急诊结直肠癌（CRC）是一种复杂的疾病，需要多学科方法进行管理。然而，目前还不清楚急性护理手术（ACS）服务是否可以加快复杂外科疾病（如急诊CRC）的检查和治疗。我们试图评估急诊护理和急诊手术服务（ACCESS）对急诊结直肠癌患者住院结肠镜检查和手术切除等待时间的影响。这项回顾性病例对照研究是在加拿大安大略伦敦的一所大学附属癌症中心进行的。所有年龄在18岁或以上的最近（48小时内）诊断为CRC或入院后诊断为CRC的急诊科患者均纳入本研究。患者分为ACCESS前（2007年7月1日至2010年6月31日）或ACCESS后（2010年7月1日至2012年6月30日）组。第三组急诊CRC患者在邻近的癌症中心接受治疗，缺乏访问（非访问）进行了单独评估。主要结果是从入院到结肠镜检查和手术的时间。共确定了149例患者（ACCESS前47例，ACCESS后37例，非ACCESS 65例）。仅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，100%的后ACCESS时代患者在同一入院期间接受住院结肠镜检查和手术，而前ACCESS时代患者仅为44%（p = 0.006）。住院结肠镜检查（ACCESS术前和术后组分别为2.0天和1.8天，p = 0.08）和手术切除（ACCESS术前和术后组分别为1.6天和2.3天，p = 0.40）的中位等待时间相似。入住ACCESS的患者接受了更多的住院结肠镜检查，并且更有可能在入院时进行明确的手术。ACS服务可以促进复杂外科疾病的检查和管理，如急诊CRC，而不会延误治疗。
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.
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影响因子：
8.8
作者：
McPhail, S.;Elliss-Brookes, L.;Shelton, J.;Ives, A.;Greenslade, M.;Vernon, S.;Morris, E. J. A.;Richards, M.
通讯作者：
Richards, M.
影响因子：
3.9
作者：
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通讯作者：
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影响因子：
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通讯作者：
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影响因子：
3.7
作者：
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通讯作者：
D'Angelica, Michael
影响因子：
2.8
作者：
Kelly M;Sharp L;Dwane F;Kelleher T;Comber H
通讯作者：
Comber H