Implementation of laparoscopic colectomy with fast-track care in an academic medical center : benefits of a fully ascended learning curve and specialty expertise
Identifieur interne :
000436 ( PascalFrancis/Curation );
précédent :
000435;
suivant :
000437
Implementation of laparoscopic colectomy with fast-track care in an academic medical center : benefits of a fully ascended learning curve and specialty expertise
Auteurs : Raul M. Bosio [
États-Unis] ;
Bryan M. Smith [
États-Unis] ;
Pablo Serrano Aybar [
États-Unis] ;
Anthony J. Senagore [
États-Unis]
Source :
-
The American journal of surgery [ 0002-9610 ] ; 2007.
RBID : Pascal:07-0174385
Descripteurs français
- Pascal (Inist)
- Implémentation,
Laparoscopie,
Colectomie,
Radiobiologie,
Soin,
Centre hospitalier universitaire,
Apprentissage,
Courbe,
Expertise,
Durée,
Temps séjour,
Analyse coût,
Economie santé,
Médecine,
Chirurgie,
Côlon,
Traitement,
Séjour.
- Wicri :
English descriptors
- KwdEn :
- Care,
Colectomy,
Colon,
Cost analysis,
Curve,
Duration,
Expertise,
Health economy,
Implementation,
Laparoscopy,
Learning,
Medicine,
Radiobiology,
Residence time,
Surgery,
Teaching hospital,
Treatment.
Abstract
Background: There are few data describing successful institutional "conversion" from open colectomy/ standard care techniques to laparoscopic colectomy/fast-track care. Purpose: To assess the benefits of transitioning an institution from open to laparoscopic colectomy with fast-track care while avoiding a learning curve. Method: Twenty consecutive laparoscopic colorectal resections (LCRs) performed by a colorectal surgeon were compared with 20 matched open colorectal resections (OCRs) performed by general surgeons before the arrival of the colorectal surgeon. Results: Surgical procedures were as follows: sigmoidectomy: OCR 16 and LCR 11; right colectomy: OCR 3 and LCR 8; and total colectomy: OCR 1 and LCR 1. The mean operative time for sigmoidectomy was 250 and 109 minutes for OCR and LCR, respectively, and for right colectomy 181 and 97 minutes for OCR and LCR, respectively (P <.001). Morbidity was OCR 45% versus LCR 25%. There was no mortality. LCR showed significantly lower length of stay and direct cost (3.6 vs. 8.3 days;$4,993 vs. $11,383; both P <.001). Conclusions: The data clearly show an institutional benefit for the implementation of specialty-based advanced laparoscopic procedures.
| pA |
| A01 | 01 | 1 | | @0 0002-9610 |
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| A03 | | 1 | | @0 Am. j. surg. |
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| A05 | | | | @2 193 |
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| A06 | | | | @2 3 |
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| A08 | 01 | 1 | ENG | @1 Implementation of laparoscopic colectomy with fast-track care in an academic medical center : benefits of a fully ascended learning curve and specialty expertise |
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| A09 | 01 | 1 | ENG | @1 Papers from the Midwest Surgical Association, 49th annual meeting, Mackinac Island, Michigan, August 6-9, 2006 |
|---|
| A11 | 01 | 1 | | @1 BOSIO (Raul M.) |
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| A11 | 02 | 1 | | @1 SMITH (Bryan M.) |
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| A11 | 03 | 1 | | @1 AYBAR (Pablo Serrano) |
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| A11 | 04 | 1 | | @1 SENAGORE (Anthony J.) |
|---|
| A14 | 01 | | | @1 Department of Surgery, University of Toledo, 3065 Arlington Avenue, Dowling Hall @2 Toledo, OH 43614-5807 @3 USA @Z 1 aut. @Z 2 aut. @Z 3 aut. @Z 4 aut. |
|---|
| A18 | 01 | 1 | | @1 Midwest Surgical Association @2 West Des Moines, IA @3 USA @9 org-cong. |
|---|
| A20 | | | | @1 413-416 |
|---|
| A21 | | | | @1 2007 |
|---|
| A23 | 01 | | | @0 ENG |
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| A43 | 01 | | | @1 INIST @2 5070 @5 354000146931630250 |
|---|
| A44 | | | | @0 0000 @1 © 2007 INIST-CNRS. All rights reserved. |
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| A45 | | | | @0 34 ref. |
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| A47 | 01 | 1 | | @0 07-0174385 |
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| A60 | | | | @1 P @2 C @3 AR @3 CT |
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| A61 | | | | @0 A |
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| A64 | 01 | 1 | | @0 The American journal of surgery |
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|---|
| C01 | 01 | | ENG | @0 Background: There are few data describing successful institutional "conversion" from open colectomy/ standard care techniques to laparoscopic colectomy/fast-track care. Purpose: To assess the benefits of transitioning an institution from open to laparoscopic colectomy with fast-track care while avoiding a learning curve. Method: Twenty consecutive laparoscopic colorectal resections (LCRs) performed by a colorectal surgeon were compared with 20 matched open colorectal resections (OCRs) performed by general surgeons before the arrival of the colorectal surgeon. Results: Surgical procedures were as follows: sigmoidectomy: OCR 16 and LCR 11; right colectomy: OCR 3 and LCR 8; and total colectomy: OCR 1 and LCR 1. The mean operative time for sigmoidectomy was 250 and 109 minutes for OCR and LCR, respectively, and for right colectomy 181 and 97 minutes for OCR and LCR, respectively (P <.001). Morbidity was OCR 45% versus LCR 25%. There was no mortality. LCR showed significantly lower length of stay and direct cost (3.6 vs. 8.3 days;$4,993 vs. $11,383; both P <.001). Conclusions: The data clearly show an institutional benefit for the implementation of specialty-based advanced laparoscopic procedures. |
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| C03 | 01 | X | SPA | @0 Implementación @5 02 |
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| C03 | 02 | X | FRE | @0 Laparoscopie @5 03 |
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| C03 | 02 | X | ENG | @0 Laparoscopy @5 03 |
|---|
| C03 | 02 | X | SPA | @0 Laparoscopia @5 03 |
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| C03 | 03 | X | FRE | @0 Colectomie @5 05 |
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| C03 | 03 | X | ENG | @0 Colectomy @5 05 |
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| C03 | 03 | X | SPA | @0 Colectomía @5 05 |
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| C03 | 04 | X | FRE | @0 Radiobiologie @5 06 |
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| C03 | 05 | X | SPA | @0 Cuidado @5 08 |
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| C03 | 06 | X | FRE | @0 Centre hospitalier universitaire @5 09 |
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| C03 | 06 | X | ENG | @0 Teaching hospital @5 09 |
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| C03 | 06 | X | SPA | @0 Centro hospitalario universitario @5 09 |
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| C03 | 07 | X | FRE | @0 Apprentissage @5 11 |
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| C03 | 07 | X | ENG | @0 Learning @5 11 |
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| C03 | 07 | X | SPA | @0 Aprendizaje @5 11 |
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| C03 | 08 | X | FRE | @0 Courbe @5 12 |
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| C03 | 08 | X | ENG | @0 Curve @5 12 |
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| C03 | 08 | X | SPA | @0 Curva @5 12 |
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| C03 | 09 | X | FRE | @0 Expertise @5 14 |
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| C03 | 09 | X | ENG | @0 Expertise @5 14 |
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| C03 | 09 | X | SPA | @0 Peritaje @5 14 |
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| C03 | 10 | X | FRE | @0 Durée @5 15 |
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| C03 | 10 | X | ENG | @0 Duration @5 15 |
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| C03 | 10 | X | SPA | @0 Duración @5 15 |
|---|
| C03 | 11 | X | FRE | @0 Temps séjour @5 17 |
|---|
| C03 | 11 | X | ENG | @0 Residence time @5 17 |
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| C03 | 11 | X | SPA | @0 Tiempo estancia @5 17 |
|---|
| C03 | 12 | X | FRE | @0 Analyse coût @5 18 |
|---|
| C03 | 12 | X | ENG | @0 Cost analysis @5 18 |
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| C03 | 12 | X | SPA | @0 Análisis costo @5 18 |
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| C03 | 13 | X | FRE | @0 Economie santé @5 19 |
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| C03 | 13 | X | ENG | @0 Health economy @5 19 |
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| C03 | 13 | X | SPA | @0 Economía salud @5 19 |
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| C03 | 14 | X | FRE | @0 Médecine @5 20 |
|---|
| C03 | 14 | X | ENG | @0 Medicine @5 20 |
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| C03 | 14 | X | SPA | @0 Medicina @5 20 |
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| C03 | 15 | X | FRE | @0 Chirurgie @5 21 |
|---|
| C03 | 15 | X | ENG | @0 Surgery @5 21 |
|---|
| C03 | 15 | X | SPA | @0 Cirugía @5 21 |
|---|
| C03 | 16 | X | FRE | @0 Côlon @5 25 |
|---|
| C03 | 16 | X | ENG | @0 Colon @5 25 |
|---|
| C03 | 16 | X | SPA | @0 Colón @5 25 |
|---|
| C03 | 17 | X | FRE | @0 Traitement @5 26 |
|---|
| C03 | 17 | X | ENG | @0 Treatment @5 26 |
|---|
| C03 | 17 | X | SPA | @0 Tratamiento @5 26 |
|---|
| C03 | 18 | X | FRE | @0 Séjour @4 INC @5 86 |
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| C07 | 01 | X | FRE | @0 Endoscopie @5 37 |
|---|
| C07 | 01 | X | ENG | @0 Endoscopy @5 37 |
|---|
| C07 | 01 | X | SPA | @0 Endoscopía @5 37 |
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| N21 | | | | @1 121 |
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| N44 | 01 | | | @1 OTO |
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| N82 | | | | @1 OTO |
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|
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| pR |
| A30 | 01 | 1 | ENG | @1 Midwest Surgical Association. Annual meeting @2 49 @3 Mackinac Island, MI USA @4 2006-08-06 |
|---|
|
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Le document en format XML
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<author><name sortKey="Bosio, Raul M" sort="Bosio, Raul M" uniqKey="Bosio R" first="Raul M." last="Bosio">Raul M. Bosio</name>
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<s2>Toledo, OH 43614-5807</s2>
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</affiliation><author><name sortKey="Aybar, Pablo Serrano" sort="Aybar, Pablo Serrano" uniqKey="Aybar P" first="Pablo Serrano" last="Aybar">Pablo Serrano Aybar</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Department of Surgery, University of Toledo, 3065 Arlington Avenue, Dowling Hall</s1>
<s2>Toledo, OH 43614-5807</s2>
<s3>USA</s3>
<sZ>1 aut.</sZ>
<sZ>2 aut.</sZ>
<sZ>3 aut.</sZ>
<sZ>4 aut.</sZ>
</inist:fA14><country>États-Unis</country>
</affiliation><author><name sortKey="Senagore, Anthony J" sort="Senagore, Anthony J" uniqKey="Senagore A" first="Anthony J." last="Senagore">Anthony J. Senagore</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Department of Surgery, University of Toledo, 3065 Arlington Avenue, Dowling Hall</s1>
<s2>Toledo, OH 43614-5807</s2>
<s3>USA</s3>
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<sZ>2 aut.</sZ>
<sZ>3 aut.</sZ>
<sZ>4 aut.</sZ>
</inist:fA14><country>États-Unis</country>
</affiliation><series><title level="j" type="main">The American journal of surgery</title>
<title level="j" type="abbreviated">Am. j. surg.</title>
<idno type="ISSN">0002-9610</idno>
<imprint><date when="2007">2007</date>
</imprint><seriesStmt><title level="j" type="main">The American journal of surgery</title>
<title level="j" type="abbreviated">Am. j. surg.</title>
<idno type="ISSN">0002-9610</idno>
</seriesStmt><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Care</term>
<term>Colectomy</term>
<term>Colon</term>
<term>Cost analysis</term>
<term>Curve</term>
<term>Duration</term>
<term>Expertise</term>
<term>Health economy</term>
<term>Implementation</term>
<term>Laparoscopy</term>
<term>Learning</term>
<term>Medicine</term>
<term>Radiobiology</term>
<term>Residence time</term>
<term>Surgery</term>
<term>Teaching hospital</term>
<term>Treatment</term>
</keywords><keywords scheme="Pascal" xml:lang="fr"><term>Implémentation</term>
<term>Laparoscopie</term>
<term>Colectomie</term>
<term>Radiobiologie</term>
<term>Soin</term>
<term>Centre hospitalier universitaire</term>
<term>Apprentissage</term>
<term>Courbe</term>
<term>Expertise</term>
<term>Durée</term>
<term>Temps séjour</term>
<term>Analyse coût</term>
<term>Economie santé</term>
<term>Médecine</term>
<term>Chirurgie</term>
<term>Côlon</term>
<term>Traitement</term>
<term>Séjour</term>
</keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Radiobiologie</term>
<term>Médecine</term>
<term>Chirurgie</term>
</keywords><front><div type="abstract" xml:lang="en">Background: There are few data describing successful institutional "conversion" from open colectomy/ standard care techniques to laparoscopic colectomy/fast-track care. Purpose: To assess the benefits of transitioning an institution from open to laparoscopic colectomy with fast-track care while avoiding a learning curve. Method: Twenty consecutive laparoscopic colorectal resections (LCRs) performed by a colorectal surgeon were compared with 20 matched open colorectal resections (OCRs) performed by general surgeons before the arrival of the colorectal surgeon. Results: Surgical procedures were as follows: sigmoidectomy: OCR 16 and LCR 11; right colectomy: OCR 3 and LCR 8; and total colectomy: OCR 1 and LCR 1. The mean operative time for sigmoidectomy was 250 and 109 minutes for OCR and LCR, respectively, and for right colectomy 181 and 97 minutes for OCR and LCR, respectively (P <.001). Morbidity was OCR 45% versus LCR 25%. There was no mortality. LCR showed significantly lower length of stay and direct cost (3.6 vs. 8.3 days;$4,993 vs. $11,383; both P <.001). Conclusions: The data clearly show an institutional benefit for the implementation of specialty-based advanced laparoscopic procedures.</div>
</front><inist><standard h6="B"><pA><fA01 i1="01" i2="1"><s0>0002-9610</s0>
</fA01><fA02 i1="01"><s0>AJSUAB</s0>
</fA02><fA03 i2="1"><s0>Am. j. surg.</s0>
</fA03><fA05><s2>193</s2>
</fA05><fA08 i1="01" i2="1" l="ENG"><s1>Implementation of laparoscopic colectomy with fast-track care in an academic medical center : benefits of a fully ascended learning curve and specialty expertise</s1>
</fA08><fA09 i1="01" i2="1" l="ENG"><s1>Papers from the Midwest Surgical Association, 49th annual meeting, Mackinac Island, Michigan, August 6-9, 2006</s1>
</fA09><fA11 i1="01" i2="1"><s1>BOSIO (Raul M.)</s1>
</fA11><fA11 i1="02" i2="1"><s1>SMITH (Bryan M.)</s1>
</fA11><fA11 i1="03" i2="1"><s1>AYBAR (Pablo Serrano)</s1>
</fA11><fA11 i1="04" i2="1"><s1>SENAGORE (Anthony J.)</s1>
</fA11><fA14 i1="01"><s1>Department of Surgery, University of Toledo, 3065 Arlington Avenue, Dowling Hall</s1>
<s2>Toledo, OH 43614-5807</s2>
<s3>USA</s3>
<sZ>1 aut.</sZ>
<sZ>2 aut.</sZ>
<sZ>3 aut.</sZ>
<sZ>4 aut.</sZ>
</fA14><fA18 i1="01" i2="1"><s1>Midwest Surgical Association</s1>
<s2>West Des Moines, IA</s2>
<s3>USA</s3>
<s9>org-cong.</s9>
</fA18><fA20><s1>413-416</s1>
</fA20><fA21><s1>2007</s1>
</fA21><fA23 i1="01"><s0>ENG</s0>
</fA23><fA43 i1="01"><s1>INIST</s1>
<s2>5070</s2>
<s5>354000146931630250</s5>
</fA43><fA44><s0>0000</s0>
<s1>© 2007 INIST-CNRS. All rights reserved.</s1>
</fA44><fA45><s0>34 ref.</s0>
</fA45><fA47 i1="01" i2="1"><s0>07-0174385</s0>
</fA47><fA60><s1>P</s1>
<s2>C</s2>
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</fA60><fA64 i1="01" i2="1"><s0>The American journal of surgery</s0>
</fA64><fA66 i1="01"><s0>USA</s0>
</fA66><fC01 i1="01" l="ENG"><s0>Background: There are few data describing successful institutional "conversion" from open colectomy/ standard care techniques to laparoscopic colectomy/fast-track care. Purpose: To assess the benefits of transitioning an institution from open to laparoscopic colectomy with fast-track care while avoiding a learning curve. Method: Twenty consecutive laparoscopic colorectal resections (LCRs) performed by a colorectal surgeon were compared with 20 matched open colorectal resections (OCRs) performed by general surgeons before the arrival of the colorectal surgeon. Results: Surgical procedures were as follows: sigmoidectomy: OCR 16 and LCR 11; right colectomy: OCR 3 and LCR 8; and total colectomy: OCR 1 and LCR 1. The mean operative time for sigmoidectomy was 250 and 109 minutes for OCR and LCR, respectively, and for right colectomy 181 and 97 minutes for OCR and LCR, respectively (P <.001). Morbidity was OCR 45% versus LCR 25%. There was no mortality. LCR showed significantly lower length of stay and direct cost (3.6 vs. 8.3 days;$4,993 vs. $11,383; both P <.001). Conclusions: The data clearly show an institutional benefit for the implementation of specialty-based advanced laparoscopic procedures.</s0>
</fC01><fC02 i1="01" i2="X"><s0>002B01</s0>
</fC02><fC02 i1="02" i2="X"><s0>002B24E06</s0>
</fC02><fC03 i1="01" i2="X" l="FRE"><s0>Implémentation</s0>
<s5>02</s5>
</fC03><fC03 i1="01" i2="X" l="ENG"><s0>Implementation</s0>
<s5>02</s5>
</fC03><fC03 i1="01" i2="X" l="SPA"><s0>Implementación</s0>
<s5>02</s5>
</fC03><fC03 i1="02" i2="X" l="FRE"><s0>Laparoscopie</s0>
<s5>03</s5>
</fC03><fC03 i1="02" i2="X" l="ENG"><s0>Laparoscopy</s0>
<s5>03</s5>
</fC03><fC03 i1="02" i2="X" l="SPA"><s0>Laparoscopia</s0>
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<s5>05</s5>
</fC03><fC03 i1="03" i2="X" l="ENG"><s0>Colectomy</s0>
<s5>05</s5>
</fC03><fC03 i1="03" i2="X" l="SPA"><s0>Colectomía</s0>
<s5>05</s5>
</fC03><fC03 i1="04" i2="X" l="FRE"><s0>Radiobiologie</s0>
<s5>06</s5>
</fC03><fC03 i1="04" i2="X" l="ENG"><s0>Radiobiology</s0>
<s5>06</s5>
</fC03><fC03 i1="04" i2="X" l="SPA"><s0>Radiobiología</s0>
<s5>06</s5>
</fC03><fC03 i1="05" i2="X" l="FRE"><s0>Soin</s0>
<s5>08</s5>
</fC03><fC03 i1="05" i2="X" l="ENG"><s0>Care</s0>
<s5>08</s5>
</fC03><fC03 i1="05" i2="X" l="SPA"><s0>Cuidado</s0>
<s5>08</s5>
</fC03><fC03 i1="06" i2="X" l="FRE"><s0>Centre hospitalier universitaire</s0>
<s5>09</s5>
</fC03><fC03 i1="06" i2="X" l="ENG"><s0>Teaching hospital</s0>
<s5>09</s5>
</fC03><fC03 i1="06" i2="X" l="SPA"><s0>Centro hospitalario universitario</s0>
<s5>09</s5>
</fC03><fC03 i1="07" i2="X" l="FRE"><s0>Apprentissage</s0>
<s5>11</s5>
</fC03><fC03 i1="07" i2="X" l="ENG"><s0>Learning</s0>
<s5>11</s5>
</fC03><fC03 i1="07" i2="X" l="SPA"><s0>Aprendizaje</s0>
<s5>11</s5>
</fC03><fC03 i1="08" i2="X" l="FRE"><s0>Courbe</s0>
<s5>12</s5>
</fC03><fC03 i1="08" i2="X" l="ENG"><s0>Curve</s0>
<s5>12</s5>
</fC03><fC03 i1="08" i2="X" l="SPA"><s0>Curva</s0>
<s5>12</s5>
</fC03><fC03 i1="09" i2="X" l="FRE"><s0>Expertise</s0>
<s5>14</s5>
</fC03><fC03 i1="09" i2="X" l="ENG"><s0>Expertise</s0>
<s5>14</s5>
</fC03><fC03 i1="09" i2="X" l="SPA"><s0>Peritaje</s0>
<s5>14</s5>
</fC03><fC03 i1="10" i2="X" l="FRE"><s0>Durée</s0>
<s5>15</s5>
</fC03><fC03 i1="10" i2="X" l="ENG"><s0>Duration</s0>
<s5>15</s5>
</fC03><fC03 i1="10" i2="X" l="SPA"><s0>Duración</s0>
<s5>15</s5>
</fC03><fC03 i1="11" i2="X" l="FRE"><s0>Temps séjour</s0>
<s5>17</s5>
</fC03><fC03 i1="11" i2="X" l="ENG"><s0>Residence time</s0>
<s5>17</s5>
</fC03><fC03 i1="11" i2="X" l="SPA"><s0>Tiempo estancia</s0>
<s5>17</s5>
</fC03><fC03 i1="12" i2="X" l="FRE"><s0>Analyse coût</s0>
<s5>18</s5>
</fC03><fC03 i1="12" i2="X" l="ENG"><s0>Cost analysis</s0>
<s5>18</s5>
</fC03><fC03 i1="12" i2="X" l="SPA"><s0>Análisis costo</s0>
<s5>18</s5>
</fC03><fC03 i1="13" i2="X" l="FRE"><s0>Economie santé</s0>
<s5>19</s5>
</fC03><fC03 i1="13" i2="X" l="ENG"><s0>Health economy</s0>
<s5>19</s5>
</fC03><fC03 i1="13" i2="X" l="SPA"><s0>Economía salud</s0>
<s5>19</s5>
</fC03><fC03 i1="14" i2="X" l="FRE"><s0>Médecine</s0>
<s5>20</s5>
</fC03><fC03 i1="14" i2="X" l="ENG"><s0>Medicine</s0>
<s5>20</s5>
</fC03><fC03 i1="14" i2="X" l="SPA"><s0>Medicina</s0>
<s5>20</s5>
</fC03><fC03 i1="15" i2="X" l="FRE"><s0>Chirurgie</s0>
<s5>21</s5>
</fC03><fC03 i1="15" i2="X" l="ENG"><s0>Surgery</s0>
<s5>21</s5>
</fC03><fC03 i1="15" i2="X" l="SPA"><s0>Cirugía</s0>
<s5>21</s5>
</fC03><fC03 i1="16" i2="X" l="FRE"><s0>Côlon</s0>
<s5>25</s5>
</fC03><fC03 i1="16" i2="X" l="ENG"><s0>Colon</s0>
<s5>25</s5>
</fC03><fC03 i1="16" i2="X" l="SPA"><s0>Colón</s0>
<s5>25</s5>
</fC03><fC03 i1="17" i2="X" l="FRE"><s0>Traitement</s0>
<s5>26</s5>
</fC03><fC03 i1="17" i2="X" l="ENG"><s0>Treatment</s0>
<s5>26</s5>
</fC03><fC03 i1="17" i2="X" l="SPA"><s0>Tratamiento</s0>
<s5>26</s5>
</fC03><fC03 i1="18" i2="X" l="FRE"><s0>Séjour</s0>
<s4>INC</s4>
<s5>86</s5>
</fC03><fC07 i1="01" i2="X" l="FRE"><s0>Endoscopie</s0>
<s5>37</s5>
</fC07><fC07 i1="01" i2="X" l="ENG"><s0>Endoscopy</s0>
<s5>37</s5>
</fC07><fC07 i1="01" i2="X" l="SPA"><s0>Endoscopía</s0>
<s5>37</s5>
</fC07><fN21><s1>121</s1>
</fN21><fN44 i1="01"><s1>OTO</s1>
</fN44><fN82><s1>OTO</s1>
</fN82><pR><fA30 i1="01" i2="1" l="ENG"><s1>Midwest Surgical Association. Annual meeting</s1>
<s2>49</s2>
<s3>Mackinac Island, MI USA</s3>
<s4>2006-08-06</s4>
</fA30>
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