Caregiver Burden and Emergency Room Utilization for Enhanced Recovery Surgery Cancer Patients

Advances in surgical technique and medical management have led to fundamental changes in surgical care allowing for a paradigm shift from inpatient to outpatient surgery. Enhanced recovery pathways have moved surgical recovery from inpatient to outpatient settings requiring informal caregiver support. The purpose of this study was to determine the prevalence of caregiver burden in this patient population and to explore whether caregiver burden contributes to preventable use of emergency room services. The conceptual framework supporting this retrospective cross-sectional study was Andersen\u27s behavioral model of health services utilization. Data collected from 28 urologic patient/caregiver pairs were analyzed using descriptive statistics and linear and logistic regression. Findings indicated measurable caregiver burden in 2 of the 5 Caregiver Reaction Assessment (CRA) subscales: impact on schedule and impact on health. Findings also indicated a measurable protective effect of high socioeconomic status of caregivers and the CRA subscale of impact on finances, and a possible protective effect of caregiver self-esteem as measured by the CRA subscale and emergency room utilization within the first 30 days after enhanced recovery surgery. Social change implications include improving the surgical experience of patients and caregivers and enhancing the use of health care resources

Preoperative Chemoprophylaxis Is Safe in Major Oncology Operations and Effective at Preventing Venous Thromboembolism

BACKGROUND: We prospectively evaluated the safety and efficacy of adding pre-operative chemoprophylaxis to our institution’s operative venous thromboembolism (VTE) prophylaxis policy as part of a physician led quality improvement initiative. STUDY DESIGN: Patients undergoing major cancer surgery between August 2013 and January 2014 were screened according to service-specific eligibility criteria and targeted to receive pre-operative VTE chemoprophylaxis. Bleeding, transfusion, and VTE rates were compared to historical controls who had not received pre-operative chemoprophylaxis. RESULTS: The 2,058 eligible patients who underwent operation between August 2013 and January 2014 (post-intervention) were compared to a cohort of 4,960 patients operated on between January 2012 and June 2013 that did not receive pre-operative VTE chemoprophylaxis (pre-intervention). In total, 71% of patients in the post-intervention group were screened for eligibility; 82% received pre-operative anticoagulation. When compared to the pre-intervention group, the post-intervention group had significantly lower transfusion rates (pre vs. post-intervention, 17% vs 14%; difference 3.5%, 95% CI: 1.7% – 5%, p=0.0003) without significant difference in major bleeding (difference 0.3%, 95% CI: −0.1% – 0.7%, p=0.2). Rates of deep venous thrombosis (1.3% vs 0.2%; difference 1.1%, 95% CI: 0.7% – 1.4%, p <0.0001) and pulmonary embolus (1.0% vs 0.4%; difference 0.6%, 95% CI: 0.2% – 1%, p=0.017) were significantly lower in the post-intervention group CONCLUSIONS: In patients undergoing major cancer surgery, institution of a single dose of pre-operative chemoprophylaxis, as part of a physician led quality improvement initiative, did not increase bleeding or blood transfusions and was associated with a significant decrease in VTE rates

Risk of Surgical Site Infection (SSI) following Colorectal Resection Is Higher in Patients With Disseminated Cancer: An NCCN Member Cohort Study.

BACKGROUNDSurgical site infections (SSIs) following colorectal surgery (CRS) are among the most common healthcare-associated infections (HAIs). Reduction in colorectal SSI rates is an important goal for surgical quality improvement.OBJECTIVETo examine rates of SSI in patients with and without cancer and to identify potential predictors of SSI risk following CRSDESIGNAmerican College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) data files for 2011-2013 from a sample of 12 National Comprehensive Cancer Network (NCCN) member institutions were combined. Pooled SSI rates for colorectal procedures were calculated and risk was evaluated. The independent importance of potential risk factors was assessed using logistic regression.SETTINGMulticenter studyPARTICIPANTSOf 22 invited NCCN centers, 11 participated (50%). Colorectal procedures were selected by principal procedure current procedural technology (CPT) code. Cancer was defined by International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes.MAIN OUTCOMEThe primary outcome of interest was 30-day SSI rate.RESULTSA total of 652 SSIs (11.06%) were reported among 5,893 CRSs. Risk of SSI was similar for patients with and without cancer. Among CRS patients with underlying cancer, disseminated cancer (SSI rate, 17.5%; odds ratio [OR], 1.66; 95% confidence interval [CI], 1.23-2.26; P=.001), ASA score ≥3 (OR, 1.41; 95% CI, 1.09-1.83; P=.001), chronic obstructive pulmonary disease (COPD; OR, 1.6; 95% CI, 1.06-2.53; P=.02), and longer duration of procedure were associated with development of SSI.CONCLUSIONSPatients with disseminated cancer are at a higher risk for developing SSI. ASA score &gt;3, COPD, and longer duration of surgery predict SSI risk. Disseminated cancer should be further evaluated by the Centers for Disease Control and Prevention (CDC) in generating risk-adjusted outcomes.Infect Control Hosp Epidemiol 2018;39:555-562