Pub Date : 2025-04-01Epub Date: 2025-01-07DOI: 10.1097/DCR.0000000000003516
Samantha Cooley, Brendon M Rosamond, Tiffany L Wong, Gifty Kwakye, Calista M Harbaugh, Aaron J Dawes, Arden M Morris, Ann C Lowry, Krista Baran, Elizabeth C Wick
{"title":"A Summer Research Experience for First-Year Medical Students: The Research Foundation of the American Society of Colon and Rectal Surgeons Diversity and Inclusion in Surgery-Colorectal Opportunity in Research Program.","authors":"Samantha Cooley, Brendon M Rosamond, Tiffany L Wong, Gifty Kwakye, Calista M Harbaugh, Aaron J Dawes, Arden M Morris, Ann C Lowry, Krista Baran, Elizabeth C Wick","doi":"10.1097/DCR.0000000000003516","DOIUrl":"10.1097/DCR.0000000000003516","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"388-391"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01Epub Date: 2025-01-02DOI: 10.1097/DCR.0000000000003635
Grace M Crouch, Amanda M McClure
{"title":"Endoscopic and Transanal Management of Anastomotic Leak.","authors":"Grace M Crouch, Amanda M McClure","doi":"10.1097/DCR.0000000000003635","DOIUrl":"10.1097/DCR.0000000000003635","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"394-397"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01Epub Date: 2024-12-27DOI: 10.1097/DCR.0000000000003612
Huseen Alibrahim, Jessica Pinto, Sarah Sabboobeh, Neyla Boukhili, Marie Demian, Carol-Ann Vasilevsky, Marylise Boutros
<p><strong>Background: </strong>Nonantibiotic outpatient treatment of acute uncomplicated diverticulitis is safe; however, uptake remains low.</p><p><strong>Objective: </strong>To assess the success of nonantibiotic management of uncomplicated diverticulitis through a nurse-led outpatient program.</p><p><strong>Design: </strong>Retrospective audit from June 2022 to March 2024.</p><p><strong>Settings: </strong>Nurse-led outpatient program for nonantibiotic management of acute uncomplicated diverticulitis at a university-affiliated hospital.</p><p><strong>Patients: </strong>Immunocompetent adults with CT-proven acute uncomplicated diverticulitis and C-reactive protein <150 mg/L. Eligible patients not referred to the program but treated in the emergency department during the same period were also reviewed.</p><p><strong>Interventions: </strong>This program included education, diet modification, analgesia, clinic visit, and telephone follow-ups by a nurse.</p><p><strong>Main outcome measures: </strong>The primary outcome was the success of the program, defined as the proportion not requiring an emergency department visit, admissions within 60 days of diagnosis, or need for antibiotics.</p><p><strong>Results: </strong>Of 236 patients referred to the program, 84 met inclusion criteria, of whom 43 patients (51.2%) were started on antibiotics before referral but were treated by the program. Forty-one patients (48.8%) completed the nonantibiotic protocol (48.8%; n = 41), which had a 97.6% success rate. Concurrently, 219 eligible patients were treated in the emergency department but not referred to the program. There was no difference in the number of emergency department visits between the 2 groups (program: n = 7 [8.3%] vs emergency department: n = 27 [12.3%]) within 60 days of diagnosis. Two patients (2.3%) treated in the program required admission, whereas 7 patients (3.2%) in the emergency department group were admitted. Overall, antibiotics were started before referral in 51.2% of patients in the program compared to 92.2% in the emergency department ( p < 0.005).</p><p><strong>Limitations: </strong>Modest sample size, single institutional data, and retrospective design.</p><p><strong>Conclusions: </strong>Implementation of nonantibiotic treatment for mild acute uncomplicated diverticulitis can be successful using an outpatient nurse-led program with referrals from the emergency department and community. See Video Abstract .</p><p><strong>Auditora de un nuevo programa dirigido por enfermeras para el tratamiento sin antibiticos de la diverticulitis aguda no complicada: </strong>ANTECEDENTES:El tratamiento ambulatorio sin antibióticos de la diverticulitis aguda no complicada es seguro; sin embargo, la aceptación sigue siendo baja.OBJETIVO:Evaluar el éxito del manejo sin antibióticos de la diverticulitis no complicada a través de un programa ambulatorio dirigido por enfermeras clínicas.DISEÑO:Auditoría retrospectiva de junio 2022 a marzo 2024.AJUSTE:Prog
{"title":"Audit of a Novel Nurse-Led Program for Nonantibiotic Management of Acute Uncomplicated Diverticulitis.","authors":"Huseen Alibrahim, Jessica Pinto, Sarah Sabboobeh, Neyla Boukhili, Marie Demian, Carol-Ann Vasilevsky, Marylise Boutros","doi":"10.1097/DCR.0000000000003612","DOIUrl":"10.1097/DCR.0000000000003612","url":null,"abstract":"<p><strong>Background: </strong>Nonantibiotic outpatient treatment of acute uncomplicated diverticulitis is safe; however, uptake remains low.</p><p><strong>Objective: </strong>To assess the success of nonantibiotic management of uncomplicated diverticulitis through a nurse-led outpatient program.</p><p><strong>Design: </strong>Retrospective audit from June 2022 to March 2024.</p><p><strong>Settings: </strong>Nurse-led outpatient program for nonantibiotic management of acute uncomplicated diverticulitis at a university-affiliated hospital.</p><p><strong>Patients: </strong>Immunocompetent adults with CT-proven acute uncomplicated diverticulitis and C-reactive protein <150 mg/L. Eligible patients not referred to the program but treated in the emergency department during the same period were also reviewed.</p><p><strong>Interventions: </strong>This program included education, diet modification, analgesia, clinic visit, and telephone follow-ups by a nurse.</p><p><strong>Main outcome measures: </strong>The primary outcome was the success of the program, defined as the proportion not requiring an emergency department visit, admissions within 60 days of diagnosis, or need for antibiotics.</p><p><strong>Results: </strong>Of 236 patients referred to the program, 84 met inclusion criteria, of whom 43 patients (51.2%) were started on antibiotics before referral but were treated by the program. Forty-one patients (48.8%) completed the nonantibiotic protocol (48.8%; n = 41), which had a 97.6% success rate. Concurrently, 219 eligible patients were treated in the emergency department but not referred to the program. There was no difference in the number of emergency department visits between the 2 groups (program: n = 7 [8.3%] vs emergency department: n = 27 [12.3%]) within 60 days of diagnosis. Two patients (2.3%) treated in the program required admission, whereas 7 patients (3.2%) in the emergency department group were admitted. Overall, antibiotics were started before referral in 51.2% of patients in the program compared to 92.2% in the emergency department ( p < 0.005).</p><p><strong>Limitations: </strong>Modest sample size, single institutional data, and retrospective design.</p><p><strong>Conclusions: </strong>Implementation of nonantibiotic treatment for mild acute uncomplicated diverticulitis can be successful using an outpatient nurse-led program with referrals from the emergency department and community. See Video Abstract .</p><p><strong>Auditora de un nuevo programa dirigido por enfermeras para el tratamiento sin antibiticos de la diverticulitis aguda no complicada: </strong>ANTECEDENTES:El tratamiento ambulatorio sin antibióticos de la diverticulitis aguda no complicada es seguro; sin embargo, la aceptación sigue siendo baja.OBJETIVO:Evaluar el éxito del manejo sin antibióticos de la diverticulitis no complicada a través de un programa ambulatorio dirigido por enfermeras clínicas.DISEÑO:Auditoría retrospectiva de junio 2022 a marzo 2024.AJUSTE:Prog","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"437-446"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01Epub Date: 2025-01-07DOI: 10.1097/DCR.0000000000003639
Syed Mohammad Nabeel Aamir, Umer Zada, Fatima Sohail, Saima Syed
{"title":"Comment on \"Risk of Postoperative Venous Thromboembolism After Benign Colorectal Surgery: Systematic Review and Meta-analysis\".","authors":"Syed Mohammad Nabeel Aamir, Umer Zada, Fatima Sohail, Saima Syed","doi":"10.1097/DCR.0000000000003639","DOIUrl":"10.1097/DCR.0000000000003639","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"e156"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01Epub Date: 2025-01-07DOI: 10.1097/DCR.0000000000003641
Yuesheng Yang, Yong Li, Zifeng Yang
{"title":"Reply: TNMF Vs. TNM in Staging of Colorectal Cancer.","authors":"Yuesheng Yang, Yong Li, Zifeng Yang","doi":"10.1097/DCR.0000000000003641","DOIUrl":"10.1097/DCR.0000000000003641","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"e158"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01Epub Date: 2025-01-02DOI: 10.1097/DCR.0000000000003591
Kamil Erozkan, Metincan Erkaya, Mehmet Ayhan Kuzu, Emre Gorgun
{"title":"EndoRobotic Submucosal Dissection After Total Neoadjuvant Treatment in Rectal Cancer.","authors":"Kamil Erozkan, Metincan Erkaya, Mehmet Ayhan Kuzu, Emre Gorgun","doi":"10.1097/DCR.0000000000003591","DOIUrl":"10.1097/DCR.0000000000003591","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"e150"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01Epub Date: 2025-01-02DOI: 10.1097/DCR.0000000000003546
Lester Gottesman
{"title":"To Pimp or Not to Pimp: That Is the Question.","authors":"Lester Gottesman","doi":"10.1097/DCR.0000000000003546","DOIUrl":"10.1097/DCR.0000000000003546","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"385-387"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01Epub Date: 2025-01-02DOI: 10.1097/DCR.0000000000003623
Thomas Couture, Claudya Morin, Janyssa Charbonneau, Émilie Papillon-Dion, Alexandre Bouchard, François Rouleau-Fournier, Philippe Bouchard, François Letarte, Alexis F Turgeon, Sebastien Drolet
<p><strong>Background: </strong>Transanal endoscopic microsurgery is a treatment option for a wide range of rectal lesions. Postoperative urinary retention is a frequently associated complication. Some studies have suggested that the use of alpha-1 blockers may reduce the risk of postoperative urinary retention after hernia and colorectal surgery, but evidence is lacking.</p><p><strong>Objective: </strong>This trial aims to evaluate whether prophylactic use of an alpha-1 blocker reduces the rate of postoperative urinary retention after transanal endoscopic microsurgery.</p><p><strong>Design: </strong>Double-blinded, placebo-controlled trial.</p><p><strong>Settings: </strong>Single high-volume Canadian colorectal center.</p><p><strong>Patients: </strong>Adult male patients awaiting transanal endoscopic microsurgery and not taking alpha-1 blockers were included.</p><p><strong>Intervention: </strong>Patients were allocated to either tamsulosin or placebo from 5 days before surgery to 2 days postoperatively.</p><p><strong>Main outcomes measures: </strong>The primary outcome was the incidence of postoperative urinary retention. Secondary outcomes were urinary retention-related hospitalization, time to removal of a bladder catheter, International Prostate Symptom Score (before and after treatment), and adverse events.</p><p><strong>Results: </strong>158 patients were randomly assigned between October 2017 and July 2022. There was no significant difference in postoperative urinary retention between groups (23% vs 14%; p = 0.16), respectively, in the tamsolusin and placebo groups. Time to removal of bladder catheter was not statistically different between groups (4.8 vs 8.6 days, p = 0.26). No failure of same-day discharge nor readmissions related to urinary retention occurred. International Prostate Symptom Scores were not significantly different at the time of surgery (3.8 vs 5.4; p = 0.11), and reported adverse events did not differ between groups.</p><p><strong>Limitations: </strong>We cannot exclude a potential type II error.</p><p><strong>Conclusions: </strong>Prophylactic use of an alpha-1 blocker for patients undergoing transanal endoscopic microsurgery was not associated with a reduction in postoperative urinary retention. See Video Abstract.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT03314025.</p><p><strong>Tempour un ensayo controlado aleatorizado que evala el uso perioperatorio de un bloqueador alfa para reducir la retencin urinaria posoperatoria despus de microciruga endoscpica transanal: </strong>ANTECEDENTES:La microcirugía endoscópica transanal es una opción de tratamiento para una amplia gama de lesiones rectales. La retención urinaria posoperatoria es una complicación frecuentemente asociada. Algunos estudios han sugerido que el uso de bloqueadores alfa-1 puede reducir el riesgo de retención urinaria posoperatoria después de cirugía colorrectal o de hernia, pero falta evidencia al respecto.OBJETIVO:Este
背景：经肛门内窥镜显微手术是广泛的直肠病变的治疗选择。术后尿潴留是常见的并发症。一些研究表明，使用α -1受体阻滞剂可以降低疝和结直肠手术后尿潴留的风险，但缺乏证据。目的：本试验旨在评估预防性使用α -1受体阻滞剂是否能降低经肛门内镜显微手术后尿潴留的发生率。设计：双盲、安慰剂对照试验。设置：单个高容量的加拿大结直肠癌中心。患者：包括等待经肛门内窥镜显微手术且未使用α -1受体阻滞剂的成年男性患者。干预：从术前5天到术后2天，患者被分配到坦索罗辛或安慰剂组。主要观察指标：主要观察指标为术后尿潴留发生率。次要结局为尿潴留相关住院、拔除膀胱导管时间、国际前列腺症状评分、治疗前后以及不良事件。结果：158例患者在2017年10月至2022年7月期间被随机分组。两组术后尿潴留无显著差异(23% vs 14%；P = 0.16)。两组患者拔除膀胱导管的时间差异无统计学意义（4.8天vs 8.6天，p = 0.26）。无当日出院失败，无尿潴留相关再入院。国际前列腺症状评分在手术时无显著差异(3.8 vs 5.4；P = 0.11)，报告的不良事件组间无差异。局限性：我们不能排除潜在的II型错误。结论：经肛门内镜显微手术患者预防性使用α -1阻滞剂与术后尿潴留的减少无关。参见视频摘要。试验注册：ClinicalTrials.gov标识符：NCT03314025。
{"title":"TEMPOUR: A Randomized Controlled Trial Assessing Perioperative Use of an Alpha-1 Blocker to Reduce Postoperative Urinary Retention After Transanal Endoscopic Microsurgery Procedures.","authors":"Thomas Couture, Claudya Morin, Janyssa Charbonneau, Émilie Papillon-Dion, Alexandre Bouchard, François Rouleau-Fournier, Philippe Bouchard, François Letarte, Alexis F Turgeon, Sebastien Drolet","doi":"10.1097/DCR.0000000000003623","DOIUrl":"10.1097/DCR.0000000000003623","url":null,"abstract":"<p><strong>Background: </strong>Transanal endoscopic microsurgery is a treatment option for a wide range of rectal lesions. Postoperative urinary retention is a frequently associated complication. Some studies have suggested that the use of alpha-1 blockers may reduce the risk of postoperative urinary retention after hernia and colorectal surgery, but evidence is lacking.</p><p><strong>Objective: </strong>This trial aims to evaluate whether prophylactic use of an alpha-1 blocker reduces the rate of postoperative urinary retention after transanal endoscopic microsurgery.</p><p><strong>Design: </strong>Double-blinded, placebo-controlled trial.</p><p><strong>Settings: </strong>Single high-volume Canadian colorectal center.</p><p><strong>Patients: </strong>Adult male patients awaiting transanal endoscopic microsurgery and not taking alpha-1 blockers were included.</p><p><strong>Intervention: </strong>Patients were allocated to either tamsulosin or placebo from 5 days before surgery to 2 days postoperatively.</p><p><strong>Main outcomes measures: </strong>The primary outcome was the incidence of postoperative urinary retention. Secondary outcomes were urinary retention-related hospitalization, time to removal of a bladder catheter, International Prostate Symptom Score (before and after treatment), and adverse events.</p><p><strong>Results: </strong>158 patients were randomly assigned between October 2017 and July 2022. There was no significant difference in postoperative urinary retention between groups (23% vs 14%; p = 0.16), respectively, in the tamsolusin and placebo groups. Time to removal of bladder catheter was not statistically different between groups (4.8 vs 8.6 days, p = 0.26). No failure of same-day discharge nor readmissions related to urinary retention occurred. International Prostate Symptom Scores were not significantly different at the time of surgery (3.8 vs 5.4; p = 0.11), and reported adverse events did not differ between groups.</p><p><strong>Limitations: </strong>We cannot exclude a potential type II error.</p><p><strong>Conclusions: </strong>Prophylactic use of an alpha-1 blocker for patients undergoing transanal endoscopic microsurgery was not associated with a reduction in postoperative urinary retention. See Video Abstract.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT03314025.</p><p><strong>Tempour un ensayo controlado aleatorizado que evala el uso perioperatorio de un bloqueador alfa para reducir la retencin urinaria posoperatoria despus de microciruga endoscpica transanal: </strong>ANTECEDENTES:La microcirugía endoscópica transanal es una opción de tratamiento para una amplia gama de lesiones rectales. La retención urinaria posoperatoria es una complicación frecuentemente asociada. Algunos estudios han sugerido que el uso de bloqueadores alfa-1 puede reducir el riesgo de retención urinaria posoperatoria después de cirugía colorrectal o de hernia, pero falta evidencia al respecto.OBJETIVO:Este","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"475-482"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01Epub Date: 2024-12-27DOI: 10.1097/DCR.0000000000003616
Colleen A Donahue, Daniel L Brinton, Alexander T Booth, Maggie L Westfal, Virgilio George, Pinckney Johnstone Maxwell, Kit N Simpson, Thomas Curran
<p><strong>Background: </strong>Venous thromboembolism after colorectal cancer resection is common and highly morbid. Extended pharmacologic venous thromboembolism prophylaxis after cancer surgery lowers venous thromboembolism risk and is recommended by major professional societies. Adherence is low in contemporary local and regional studies.</p><p><strong>Objective: </strong>Assess patient and hospital factors associated with receipt of prophylaxis after colorectal cancer surgery in a national data set.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Settings: </strong>Surveillance, epidemiology, and end results in a Medicare data set.</p><p><strong>Patients: </strong>Patients older than 64 years undergoing resection for colorectal cancer between 2016 and 2017.</p><p><strong>Main outcome measures: </strong>The primary outcome was the receipt of prophylaxis within 7 days of discharge. Patient and hospital factors associated with receiving prophylaxis were identified using multivariable logistic regression. Secondary outcomes included 30- and 90-day venous thromboembolism.</p><p><strong>Results: </strong>Of 23,527 patients, 4.7% received prophylaxis. Utilization increased from 2016 to 2017 (3.9% vs 5.5%; p < 0.001). Patients treated at National Cancer Institute-designated hospitals received prophylaxis more frequently than teaching, non-National Cancer Institute hospitals and nonteaching, non-National Cancer Institute hospitals (10.2% vs 5.6% vs 1.7%; p < 0.001). Patients receiving care at larger hospitals by bed size quartile were more likely to receive prophylaxis compared to those at smaller hospitals (9.0% vs 4.0% vs 3.4% vs 2.2%; p < 0.01). On multivariable regression, National Cancer Institute status, larger bed size, White race (compared to others), rectal tumor location, and more recent year of treatment were independently associated with prophylaxis utilization. Venous thromboembolism events at 30 and 90 days were 1.87% and 2.63%, respectively. Prophylaxis was associated with decreased 30-day venous thromboembolism (1.26% vs 1.9%; p = 0.1211).</p><p><strong>Limitations: </strong>Retrospective, large database study.</p><p><strong>Conclusions: </strong>Utilization of prophylaxis after colorectal cancer surgery remains limited even in large, specialized hospitals. Further work is needed to understand this departure from guideline-concordant care. See Video Abstract .</p><p><strong>La directriz concordante extendida sobre la utilizacion de profilaxis para la tromboembolia venosa despus de la reseccin del cncer colorrectal es baja independientemente de los factores del paciente o las caractersticas del hospital: </strong>ANTECEDENTES:La tromboembolia venosa tras la resección del cáncer colorrectal es común y presenta una alta morbilidad. La profilaxis farmacológica prolongada indicada para la tromboembolia venosa después de la cirugía del cáncer reduce el riesgo de tromboembolia venosa y es recomendada por las principa
背景：结直肠癌术后静脉血栓栓塞是一种常见且高发病率的疾病。癌症手术后延长药物静脉血栓栓塞预防可降低静脉血栓栓塞的风险，并被主要专业协会推荐。在当代的地方和区域研究中，依从性较低。目的：在全国数据集中评估与结直肠癌手术后接受预防相关的患者和医院因素。设计：回顾性队列研究。设置：监测、流行病学和最终结果医疗保险数据集。患者：2016年至2017年期间接受结直肠癌切除术的64岁以上患者。主要结局指标：主要结局指标为出院后7天内接受预防治疗。使用多变量logistic回归确定与接受预防相关的患者和医院因素。次要结局包括30天和90天静脉血栓栓塞。结果：23,527例患者中，4.7%接受了预防。利用率从2016年到2017年有所增加(3.9%对5.5%；P < 0.001)。在国家癌症研究所指定医院接受治疗的患者接受预防治疗的频率高于教学、非国家癌症研究所医院和非教学、非国家癌症研究所医院(10.2%对5.6%对1.7%；P < 0.001)。按床位大小四分位数划分，在大医院接受治疗的患者比在小医院接受治疗的患者更有可能接受预防(9.0% vs. 4.0% vs. 3.4% vs. 2.2%；P < 0.01)。在多变量回归中，国家癌症研究所的地位、更大的床位、白人种族（与其他种族相比）、直肠肿瘤位置和最近治疗年份与预防使用独立相关。30天和90天静脉血栓栓塞事件分别为1.87%和2.63%。预防与减少30天静脉血栓栓塞相关(1.26% vs 1.9%；P = 0.1211)。局限性：回顾性、大型数据库研究。结论：即使在大型专科医院，结直肠癌手术后预防措施的应用仍然有限。需要进一步的工作来理解这种偏离指南的一致性护理。参见视频摘要。
{"title":"Guideline-Concordant Extended Pharmacologic Venous Thromboembolism Prophylaxis Utilization After Colorectal Cancer Resection Is Low Regardless of Patient Factors or Hospital Characteristics.","authors":"Colleen A Donahue, Daniel L Brinton, Alexander T Booth, Maggie L Westfal, Virgilio George, Pinckney Johnstone Maxwell, Kit N Simpson, Thomas Curran","doi":"10.1097/DCR.0000000000003616","DOIUrl":"10.1097/DCR.0000000000003616","url":null,"abstract":"<p><strong>Background: </strong>Venous thromboembolism after colorectal cancer resection is common and highly morbid. Extended pharmacologic venous thromboembolism prophylaxis after cancer surgery lowers venous thromboembolism risk and is recommended by major professional societies. Adherence is low in contemporary local and regional studies.</p><p><strong>Objective: </strong>Assess patient and hospital factors associated with receipt of prophylaxis after colorectal cancer surgery in a national data set.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Settings: </strong>Surveillance, epidemiology, and end results in a Medicare data set.</p><p><strong>Patients: </strong>Patients older than 64 years undergoing resection for colorectal cancer between 2016 and 2017.</p><p><strong>Main outcome measures: </strong>The primary outcome was the receipt of prophylaxis within 7 days of discharge. Patient and hospital factors associated with receiving prophylaxis were identified using multivariable logistic regression. Secondary outcomes included 30- and 90-day venous thromboembolism.</p><p><strong>Results: </strong>Of 23,527 patients, 4.7% received prophylaxis. Utilization increased from 2016 to 2017 (3.9% vs 5.5%; p < 0.001). Patients treated at National Cancer Institute-designated hospitals received prophylaxis more frequently than teaching, non-National Cancer Institute hospitals and nonteaching, non-National Cancer Institute hospitals (10.2% vs 5.6% vs 1.7%; p < 0.001). Patients receiving care at larger hospitals by bed size quartile were more likely to receive prophylaxis compared to those at smaller hospitals (9.0% vs 4.0% vs 3.4% vs 2.2%; p < 0.01). On multivariable regression, National Cancer Institute status, larger bed size, White race (compared to others), rectal tumor location, and more recent year of treatment were independently associated with prophylaxis utilization. Venous thromboembolism events at 30 and 90 days were 1.87% and 2.63%, respectively. Prophylaxis was associated with decreased 30-day venous thromboembolism (1.26% vs 1.9%; p = 0.1211).</p><p><strong>Limitations: </strong>Retrospective, large database study.</p><p><strong>Conclusions: </strong>Utilization of prophylaxis after colorectal cancer surgery remains limited even in large, specialized hospitals. Further work is needed to understand this departure from guideline-concordant care. See Video Abstract .</p><p><strong>La directriz concordante extendida sobre la utilizacion de profilaxis para la tromboembolia venosa despus de la reseccin del cncer colorrectal es baja independientemente de los factores del paciente o las caractersticas del hospital: </strong>ANTECEDENTES:La tromboembolia venosa tras la resección del cáncer colorrectal es común y presenta una alta morbilidad. La profilaxis farmacológica prolongada indicada para la tromboembolia venosa después de la cirugía del cáncer reduce el riesgo de tromboembolia venosa y es recomendada por las principa","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"417-425"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：