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Complementary therapy use in female long-term colorectal cancer survivors
S72
Quality, Outcomes, and Cost II
J Am Coll Surg
conversion rates and percentage of laparoscopic right colon resections (L-RC) and ileal pouch anal anastomosis (L-IPAA) performed of the total (open and laparoscopic) RC and IPAA practice in the 3 time-periods. Mortality was 0.002%. Surgical re-intervention rate for postoperative complications (grade IIIB) were similar (2%, 0.15%, 0.2%). Incidence of grade I and II postoperative complications was (0%, 8%, 11%).
Year
Number Total number of Overall Right colon’s IPAA’s surgeons (% laparoscopic conversion done lap done lap all surgeons) Cases rate, % (%) (%)
1992
1 (16)
28
28
6
0
1998
2 (28)
100
19
22
1
2004
6 (75)
270
8
34
55
CONCLUSIONS: Our experience shows that expansion of a laparoscopic colorectal practice to include 75% of the surgeons is feasible and has resulted in an increase in the number and complexity of LCP being performed without compromising patient and practice outcomes.
Should rural residents with colon cancer travel to urban hospitals for colectomy? Melissa Meyers MD, Samuel RG Finlayson MD, MPH, FACS Dartmouth Medical School, Lebanon, NH INTRODUCTION: Many rural patients travel to urban hospitals expecting better care. Whether rural patients requiring elective colectomy lower their risk of operative mortality by traveling to urban hospitals is unknown. METHODS: We used Medicare claims data to compare mortality rates with colectomy for cancer in rural vs. urban hospitals in the US from 1994 to 1999. Urban and rural designations were based on Rural-Urban Commuting Area codes. Multiple logistic regression was used to describe the relationship between mortality (combined in-hospital and 30 day) and rural/urban hospital location, controlling for patient and hospital characteristics. RESULTS: Adjusted operative mortality in small rural hospitals (6.7%, 95% CI 6.4-7.0) was slightly higher than in urban hospitals (6.4%, 95% CI 6.3-6.5), but this difference was not statistically significant. Nearly 90% of rural hospitals were in the lowest two quintiles of hospital procedure volume (⬍57 colectomies/year), compared to 28% of urban hospitals. Adjusted operative mortality in these low volume rural hospitals (6.6%, 95% CI 6.3-6.9%) was significantly lower than mortality in urban hospitals with similar procedure volume (7.2%, 95% CI 7.0-7.4%). CONCLUSIONS: Rural patients who choose to travel to an urban hospital for colectomy may not experience lower mortality risk. Our finding that low volume urban hospitals have higher mortality rates than low volume rural hospitals suggests that patients who elect to travel to the city for care must choose their providers carefully.
Complementary therapy use in female long-term colorectal cancer survivors Chris M Schu¨ssler-Fiorenza MD, Amy Trentham-Dietz PhD, Tara M Breslin MD, MS, John M Hampton MS, Patrick L Remington MD, MPH University of Wisconsin, Madison, WI INTRODUCTION: The aim of this study was to characterize the use of prayer, complementary and alternative medicine (CAM) in longterm female colorectal cancer survivors. METHODS: Data from a 9 year follow-up questionnaire completed by long term survivors of a population-based sample of female colorectal cancer cases in Wisconsin were analyzed. Analysis with chisquared statistics was conducted on the women (n⫽257) who completed the CAM portion of the questionnaire. RESULTS: We found that 74% of respondents reported using CAM and/or prayer, 68% used prayer, 41% used CAM and 46% of CAM users utilized more than one therapy. The three most common therapies were chiropractic (14.1%), spiritual healing (11.7%) and megavitamin therapy (10.6%). Younger age, higher income, working outside the home, and education were strongly associated with CAM use (p⬍0.05). Depression/anxiety was strongly associated with both mind-body (p⫽0.021) and energy/manual healing therapies. Thinking about being diagnosed with cancer again was the only factor significantly associated with increased use of prayer (p⫽0.0012) and it also influenced rates of mind- body CAM use. (p⫽0.004) Cancer characteristics were less strongly associated with CAM usage, although there was an association between site (colonrectum) and whole-body/biologically based CAM use. (p⫽0.02) CONCLUSIONS: CAM and prayer in colorectal cancer survivors is common and use is influenced by demographic factors, depression/ anxiety and fear of cancer recurrence. Inquiring about CAM use and addressing any associated psychologic factors is an important part of the care of long-term colorectal cancer survivors.
Risk indices predict adverse outcomes after surgery for small bowel obstruction (SBO) Julie A Margenthaler MD, Walter E Longo MD, Katherine S Virgo PhD, Frank E Johnson MD, Erik M Grossman MD, Tracy L Schifftner MS, William G Henderson PhD, Shukri F Khuri MD, FASC Washington University School of Medicine, St. Louis, MO INTRODUCTION: The objective was to construct risk indices predicting adverse outcomes after surgery for SBO. METHODS: The VA NSQIP contains prospectively collected data on ⬎1,000,000 patients. Patients undergoing adhesiolysis only or small bowel resection for SBO between 1991-2002 were selected. Independent variables included 68 presurgical and 12 intraoperative risk factors; dependent variables were 21 adverse outcomes including death. Stepwise logistic regression was used to construct models predicting 30-day morbidity and mortality and to derive risk index values.
Quality, Outcomes, and Cost II
J Am Coll Surg
conversion rates and percentage of laparoscopic right colon resections (L-RC) and ileal pouch anal anastomosis (L-IPAA) performed of the total (open and laparoscopic) RC and IPAA practice in the 3 time-periods. Mortality was 0.002%. Surgical re-intervention rate for postoperative complications (grade IIIB) were similar (2%, 0.15%, 0.2%). Incidence of grade I and II postoperative complications was (0%, 8%, 11%).
Year
Number Total number of Overall Right colon’s IPAA’s surgeons (% laparoscopic conversion done lap done lap all surgeons) Cases rate, % (%) (%)
1992
1 (16)
28
28
6
0
1998
2 (28)
100
19
22
1
2004
6 (75)
270
8
34
55
CONCLUSIONS: Our experience shows that expansion of a laparoscopic colorectal practice to include 75% of the surgeons is feasible and has resulted in an increase in the number and complexity of LCP being performed without compromising patient and practice outcomes.
Should rural residents with colon cancer travel to urban hospitals for colectomy? Melissa Meyers MD, Samuel RG Finlayson MD, MPH, FACS Dartmouth Medical School, Lebanon, NH INTRODUCTION: Many rural patients travel to urban hospitals expecting better care. Whether rural patients requiring elective colectomy lower their risk of operative mortality by traveling to urban hospitals is unknown. METHODS: We used Medicare claims data to compare mortality rates with colectomy for cancer in rural vs. urban hospitals in the US from 1994 to 1999. Urban and rural designations were based on Rural-Urban Commuting Area codes. Multiple logistic regression was used to describe the relationship between mortality (combined in-hospital and 30 day) and rural/urban hospital location, controlling for patient and hospital characteristics. RESULTS: Adjusted operative mortality in small rural hospitals (6.7%, 95% CI 6.4-7.0) was slightly higher than in urban hospitals (6.4%, 95% CI 6.3-6.5), but this difference was not statistically significant. Nearly 90% of rural hospitals were in the lowest two quintiles of hospital procedure volume (⬍57 colectomies/year), compared to 28% of urban hospitals. Adjusted operative mortality in these low volume rural hospitals (6.6%, 95% CI 6.3-6.9%) was significantly lower than mortality in urban hospitals with similar procedure volume (7.2%, 95% CI 7.0-7.4%). CONCLUSIONS: Rural patients who choose to travel to an urban hospital for colectomy may not experience lower mortality risk. Our finding that low volume urban hospitals have higher mortality rates than low volume rural hospitals suggests that patients who elect to travel to the city for care must choose their providers carefully.
Complementary therapy use in female long-term colorectal cancer survivors Chris M Schu¨ssler-Fiorenza MD, Amy Trentham-Dietz PhD, Tara M Breslin MD, MS, John M Hampton MS, Patrick L Remington MD, MPH University of Wisconsin, Madison, WI INTRODUCTION: The aim of this study was to characterize the use of prayer, complementary and alternative medicine (CAM) in longterm female colorectal cancer survivors. METHODS: Data from a 9 year follow-up questionnaire completed by long term survivors of a population-based sample of female colorectal cancer cases in Wisconsin were analyzed. Analysis with chisquared statistics was conducted on the women (n⫽257) who completed the CAM portion of the questionnaire. RESULTS: We found that 74% of respondents reported using CAM and/or prayer, 68% used prayer, 41% used CAM and 46% of CAM users utilized more than one therapy. The three most common therapies were chiropractic (14.1%), spiritual healing (11.7%) and megavitamin therapy (10.6%). Younger age, higher income, working outside the home, and education were strongly associated with CAM use (p⬍0.05). Depression/anxiety was strongly associated with both mind-body (p⫽0.021) and energy/manual healing therapies. Thinking about being diagnosed with cancer again was the only factor significantly associated with increased use of prayer (p⫽0.0012) and it also influenced rates of mind- body CAM use. (p⫽0.004) Cancer characteristics were less strongly associated with CAM usage, although there was an association between site (colonrectum) and whole-body/biologically based CAM use. (p⫽0.02) CONCLUSIONS: CAM and prayer in colorectal cancer survivors is common and use is influenced by demographic factors, depression/ anxiety and fear of cancer recurrence. Inquiring about CAM use and addressing any associated psychologic factors is an important part of the care of long-term colorectal cancer survivors.
Risk indices predict adverse outcomes after surgery for small bowel obstruction (SBO) Julie A Margenthaler MD, Walter E Longo MD, Katherine S Virgo PhD, Frank E Johnson MD, Erik M Grossman MD, Tracy L Schifftner MS, William G Henderson PhD, Shukri F Khuri MD, FASC Washington University School of Medicine, St. Louis, MO INTRODUCTION: The objective was to construct risk indices predicting adverse outcomes after surgery for SBO. METHODS: The VA NSQIP contains prospectively collected data on ⬎1,000,000 patients. Patients undergoing adhesiolysis only or small bowel resection for SBO between 1991-2002 were selected. Independent variables included 68 presurgical and 12 intraoperative risk factors; dependent variables were 21 adverse outcomes including death. Stepwise logistic regression was used to construct models predicting 30-day morbidity and mortality and to derive risk index values.