Journal ArticleDOI
Identification of consensus-based quality end points for colorectal surgery.
Mark L. Manwaring,Clifford Y. Ko,James W. Fleshman,David E. Beck,David J. Schoetz,Anthony J. Senagore,Rocco Ricciardi,Larissa K. Temple,Arden M. Morris,Conor P. Delaney +9 more
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TLDR
A consensus-derived ranked list of 89 process and outcome measures was developed in 6 key areas of colorectal surgery to provide a framework for development of guideline standards for case-reporting program development initiatives for colon and rectal surgery.Abstract:
BACKGROUND: Process and outcome measures for quality assessment of colorectal surgical care are poorly defined. OBJECTIVE: The aim of this study was to develop candidate end points for use in surgeon-specific registries designed for case reporting and quality improvement program development. DESIGN: The study design was based on modified Delphibased development of consensus quality end points. SETTING: This study was undertaken by the American Society of Colon and Rectal Surgeons Executive Council, Quality Committee, and by the ColoRectal Education System Template Committee, American Board of Colon and Rectal Surgery. PATIENTS: No patients were included in this study. INTERVENTIONS: Six areas of colorectal surgery were defined by members of the American Society of Colon and Rectal Surgeons' Executive Council and the American Board of Colon and Rectal Surgery to cover areas of importance for colorectal surgeons. These included colectomy, rectal cancer, hemorrhoidectomy, anal fistula and abscess, colonoscopy, and rectal prolapse. Relevant American Society of Colon and Rectal Surgeons' committee members through a series of 4 panel discussions identified important demographic, process, and outcome measures in each of these 6 areas that might be suitable for the American College of Surgeons case log. Panel size was sequentially expanded from 8 members to 28 members to include all active committee members. Panelists contributed additional process and outcome measures for inclusion during each discussion. Modified Delphi methodology was used to generate consensus, and, after each panel discussion, members rated the relative importance of each end point from 1 (least important) to 4 (most important). MAIN OUTCOME MEASURES: The mean rating for each process and outcome measure after each round was recorded with the use of standardized definitions for relevant variables. RESULTS: Eighty-nine process and outcome measures were compiled and rated. Mean scores following the final round ranged from a low of 1.3 (anal fistula/abscess, preoperative imaging) to a high of 4.0 (colectomyanastomotic leak). LIMITATIONS: The limitations of this study involved the use of consensus, small study size, and the fact that no end points were excluded. CONCLUSIONS: With the use of modified Delphi methodology, a consensus-derived ranked list of 89 process and outcome measures was developed in 6 key areas of colorectal surgery. These data provide a framework for development of guideline standards for case-reporting program development initiatives for colon and rectal surgery.read more
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Journal ArticleDOI
Anastomotic leak after colorectal resection: A population-based study of risk factors and hospital variation.
Vahagn C. Nikolian,Neil Kamdar,Scott E. Regenbogen,Arden M. Morris,John C. Byrn,Pasithorn A. Suwanabol,Darrell A. Campbell,Samantha Hendren +7 more
TL;DR: It is suggested that anastomotic leak can serve as a valid metric that can identify opportunities for quality improvement in colorectal operations and risk factors including male sex, obesity, tobacco use, immunosuppression, thrombocytosis, greater operative duration, and urgent/emergency operation predict most of the variation in anastOMotic leak rates.
Journal ArticleDOI
Use of a modified Delphi approach to develop research priorities for the association of coloproctology of Great Britain and Ireland.
J. Tiernan,Andrew Cook,I. Geh,Bruce George,Laura Magill,John M. A. Northover,Azmina Verjee,J. Wheeler,Nicola S Fearnhead +8 more
TL;DR: The modified Delphi approach is used to survey the entire membership of the Association of Coloproctology of Great Britain and Ireland to reach a consensus on prioritizing clinical research questions in colorectal disease.
Journal ArticleDOI
Associations of Specific Postoperative Complications With Outcomes After Elective Colon Resection: A Procedure-Targeted Approach Toward Surgical Quality Improvement.
TL;DR: The findings of this study support the adoption of a procedure-targeted approach to surgical quality improvement and describe a practical method for assessing complication effect.
Journal ArticleDOI
Predictors of Anastomotic Leak in Elderly Patients After Colectomy: Nomogram-Based Assessment From the American College of Surgeons National Surgical Quality Program Procedure-Targeted Cohort.
Ahmet Rencuzogullari,Cigdem Benlice,Michael A. Valente,Maher A. Abbas,Feza H. Remzi,Emre Gorgun +5 more
TL;DR: An accurate prediction of anastomotic leak affecting morbidity and mortality after colorectal surgery using the proposed nomogram may facilitate decision making in elderly patients for healthcare providers.
Journal ArticleDOI
Reducing the Burden of Postoperative ileus: Evaluating and Implementing an Evidence-based Strategy
TL;DR: This narrative review focuses on interventions aimed to prevent and treat postoperative ileus while presenting a step-by-step process for implementation of an evidenced-based strategy.
References
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Journal ArticleDOI
Crossing the Quality Chasm: A New Health System for the 21st Century
TL;DR: Analyzing health care organizations as complex systems, Crossing the Quality Chasm also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change.
Journal ArticleDOI
Consensus methods for medical and health services research.
Jeremy Jones,Duncan Hunter +1 more
TL;DR: Two consensus methods commonly adopted in medical, nursing, and health services research--the Delphi process and the nominal group technique (also known as the expert panel)--are described, together with the most appropriate situations for using them.
Journal ArticleDOI
Does surgical quality improve in the American College of Surgeons National Surgical Quality Improvement Program: an evaluation of all participating hospitals.
Bruce L. Hall,Barton H. Hamilton,Karen Richards,Karl Y. Bilimoria,Mark E. Cohen,Clifford Y. Ko,Clifford Y. Ko +6 more
TL;DR: ACS-NSQIP indicates that surgical outcomes improve across all participating hospitals in the private sector, and improvement is reflected for both poor- and well-performing facilities.
Journal ArticleDOI
Adherence to surgical care improvement project measures and the association with postoperative infections.
Jonah J. Stulberg,Conor P. Delaney,Duncan Neuhauser,David C. Aron,David C. Aron,Pingfu Fu,Siran M. Koroukian +6 more
TL;DR: Among hospitals in the Premier Inc Perspective Database reporting SCIP performance, adherence measured through a global all-or-none composite infection-prevention score was associated with a lower probability of developing a postoperative infection, however, adherence reported on individual SCIP measures, which is the only form in which performance is publicly reported, was notassociated with a significantly lower probabilities of infection.
Journal ArticleDOI
Development of an American College of Surgeons National Surgery Quality Improvement Program: morbidity and mortality risk calculator for colorectal surgery.
Mark E. Cohen,Karl Y. Bilimoria,Karl Y. Bilimoria,Clifford Y. Ko,Clifford Y. Ko,Bruce L. Hall +5 more
TL;DR: The ACS NSQIP colorectal risk calculator allows surgeons to preoperatively provide patients with detailed information about their personal risks of overall morbidity, serious morbidity and mortality.
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