Tag Archives: Health Care Outcome Assessment

Abdominal surgery in neutropenic patients

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Jolissaint JS, et al. Timing and Outcomes of Abdominal Surgery in Neutropenic Patients. J Gastrointest Surg. 2019 Apr;23(4):643-650.

Full-text for Emory users.

Results: Amongst 237 patients, mortality was 11.8% (28/237) and morbidity 54.5% (130/237). Absolute neutrophil count < 500 cells/μL (50% vs. 20.6%, P < 0.01) and perforated viscus (35.7% vs. 14.8%, P = 0.01) were associated with mortality. Perforated viscus (25.4% vs. 7.5%) was also associated with morbidity. Urgent operations were associated with higher morbidity (63.6% vs 34.7%, P < 0.001) and mortality (16.4% vs 1.4%, P = 0.002) when compared to elective operations. Transfer from an outside hospital (22.3% vs. 11.2%, P = 0.02) and longer median time from admission to operation (2 days (IQR 0-6) vs. 1 day (IQR 0-3), P < 0.01) were associated with morbidity. An ANC threshold of 350 provided the best discrimination for mortality.

Conclusions: Elective surgery in the appropriately chosen neutropenic patient is relatively safe. For patients with obvious surgical pathology, we advocate for earlier operation and a lower threshold for surgical consultation in an effort expedite the diagnosis and necessary treatment.

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Total neoadjuvant therapy in rectal cancer

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Petrelli F, et al. Total Neoadjuvant Therapy in Rectal Cancer: A Systematic Review and Meta-analysis of Treatment Outcomes. Ann Surg. 2020 Mar;271(3):440-448.

Full-text for Emory users.

Results: A total of 28 studies (3 retrospective and 25 prospective for a total of 3579 patients) were included in the final analysis (n = 2688 treated with TNT and n = 891 with neoadjuvant chemoradiotherapy therapy). The pooled pCR rate was 22.4% (95% CI 19.4%-25.7%) in all patients treated with TNT (n = 27 studies with data available). In n = 10 comparative studies with data available, TNT was found to increase the odds of pCR by 39% (1.40, 95% CI 1.08-1.81, P = 0.01).

Conclusions: The addition of induction or consolidation chemotherapy to standard neoadjuvant chemoradiotherapy results in a higher pCR rate. Given that the comparative analysis was derived from few randomized publications, large confirmatory trials should be carried out before a strong recommendation is made in favor of TNT.

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Surgical Grand Rounds: Patient Reported Outcomes in Thoracic Surgery – What are our patients really telling us?

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Presented by: Onkar Khullar MD, Assistant Professor of Surgery
Division of Cardiothoracic Surgery, Emory University School of Medicine

This is a collection of articles, resources, and commentary from Dr. Khullar’s presentation on February 13, 2020. 

Articles:

Jensen RE, Rothrock NE, DeWitt EM, et al. The role of technical advances in the adoption and integration of patient-reported outcomes in clinical care. Med Care. 2015 Feb;53(2): 153-9. doi: 10.1097/MLR.0000000000000289. Free full-text.

Colt HG, Murgu SD, Korst RJ, et al. Follow-up and surveillance of the patient with lung cancer after curative-intent therapy: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013 May;143(5 Suppl):e437S-e454S. doi: 10.1378/chest.12-2365. Full-text for Emory users.

Khullar OV, Rajaei MH, Force SD, Binongo JN, Lasanajak Y, Robertson S, Pickens
A, Sancheti MS, Lipscomb J, Gillespie TW, Fernandez FG. Pilot Study to Integrate
Patient Reported Outcomes After Lung Cancer Operations Into The Society of
Thoracic Surgeons Database. Ann Thorac Surg. 2017 Jul;104(1):245-253. doi:
10.1016/j.athoracsur.2017.01.110. Full-text for Emory users.

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