Level of Digitization in Dutch Hospitals and the Lengths of Stay of Patients with Colorectal Cancer

A substantial amount of research has been published on the association between the use of electronic medical records (EMRs) and quality outcomes in U.S. hospitals, while limited research has focused on the Western European experience. The purpose of this study is to explore the association between the use of EMR technologies in Dutch hospitals and length of stay after colorectal cancer surgery. Two data sets were leveraged for this study; the HIMSS Analytics Electronic Medical Record AdoptionModel (EMRAMSM) and the Dutch surgical colorectal audit (DSCA). The HIMSS Analytics EMRAM score was used to define a Dutch hospital's electronic medical records (EMR) capabilities while the DSCA was used to profile colorectal surgery quality outcomes (specifically total length of stay (LOS) in the hospital and the LOS in ICU). A total of 73 hospitals with a valid EMRAM score and associated DSCA patients (n = 30.358) during the study period (2012-2014) were included in the comparative set. A multivariate regression method was used to test differences adjusted for case mix, year of surgery, surgical technique and for complications, as well as stratifying for academic affiliated hospitals and general hospitals. A significant negative association was observed to exist between the total LOS (relative median LOS 0,974, CI 95% 0.959-0,989) of patients treated in advanced EMR hospitals (high EMRAM score cohort) versus patients treated at less advanced EMR care settings, once the data was adjusted for the case mix, year of surgery and type of surgery (laparoscopy or laparotomy). Adjusting for complications in a subgroup of general hospitals (n = 39) yielded essentially the same results (relative median LOS 0,934, CI 95% 0,9150,954). No consistent significant associations were found with respect to LOS on the ICU. The findings of this study suggest advanced EMR capabilities support a healthcare provider's efforts to achieve desired quality outcomes and efficiency in Western European hospitals

Laparoscopic conversion in colorectal cancer surgery; is there any improvement over time at a population level?

Conversion of laparoscopic colorectal cancer resection has been associated with worse outcome, but this might have been related to a learning curve effect. This study aimed to evaluate incidence, predictive factors and outcomes of laparoscopic conversion after the implementation phase of laparoscopic surgery at a population level. Patients undergoing elective resection of non-locally advanced, non-metastatic colorectal cancer between 2011 and 2015 were included. Data were extracted from the Dutch Surgical Colorectal Audit. Patients were grouped as laparoscopic completed (LR), laparoscopic converted (CONV) with further specification of timing (within or after 30 min) as registered in the DSCA, and open resection (OR). Uni- and multi-variate analyses were used to determine predictors of conversion and outcome (complicated course and mortality), with evaluation of trends over time. A total of 23,044 patients with colon cancer and 11,324 with rectal cancer were included. Between 2011 and 2015, use of laparoscopy increased from 55 to 84% in colon cancer, and from 49 to 89% in rectal cancer. Conversion rates decreased from 11.8 to 8.6% and from 13 to 8.0%, respectively. Laparoscopic hospital volume was independently associated with conversion rate. Only for colon cancer, the rate of complicated course was significantly higher after CONV compared to OR (adjusted odds ratio 1.486; 95% CI 1.298-1.702), and significantly higher after late (> 30 min) compared to early conversion (adjusted odds ratio 1.341; 1.046-1.719). There was no impact of CONV on mortality in both colon and rectal cancer. The use of laparoscopic colorectal cancer surgery increased to more than 80% at a national level, accompanied by a decrease in conversion which is significantly related to the laparoscopic hospital volume. Conversion was only associated with complicated course in colon cancer, especially when the reason for conversion consisted of an intra-operative complication, without affecting mortalit

Surgery for colorectal cancer since the introduction of the Netherlands national screening programme Investigations into changes in number of resections & waiting times for surgery

Objective To investigate the impact of the Netherlands national colorectal cancer screening programme on the number of surgical resections for colorectal carcinoma and on waiting times for surgery. Design Descriptive study. Method Data were extracted from the Dutch Surgical Colorectal Audit. Patients with primary colorectal cancer surgery between 20112015 were included. The volume and median waiting times for the years 20112015 are described. Waiting times from first tumor positive biopsy until the operation (biopsyoperation) and first preoperative visit to the surgeon until the operation (visitoperation) are analyzed with a univariate and multivariate linear regression analysis. Separate analysis was done for visitoperation for academic and nonacademic hospitals and for screening compared to nonscreening patients. Results In 2014 there was an increase of 1469 (15%) patients compared to 2013. In 2015 this increase consisted of 1168 (11%) patients compared to 2014. In 2014 and 2015, 1359 (12%) and 3111 (26%) patients were referred to the surgeon through screening, respectively. The median waiting time of biopsyoperation significantly decreased (ß: 0.94, 95%BI) over the years 20142015 compared to 20112013. In nonacademic hospitals, the waiting time visitoperation also decreased significantly (ß: 0.89, 95%BI 0.870.90) over the years 20142015 compared to 20112013. No difference was found in waiting times between patients referred to the surgeon through screening compared to nonscreening. Conclusion There is a clear increase in volume since the introduction of the colorectal cancer screening programme without an increase in waiting time until surgery.</p

Darmkankerchirurgie sinds het bevolkingsonderzoek: Veranderingen in volume en wachttijden onderzocht

Objective To investigate the impact of the Netherlands national colorectal cancer screening programme on the number of surgical resections for colorectal carcinoma and on waiting times for surgery. Design Descriptive study. Method Data were extracted from the Dutch Surgical Colorectal Audit. Patients with primary colorectal cancer surgery between 20112015 were included. The volume and median waiting times for the years 20112015 are described. Waiting times from first tumor positive biopsy until the operation (biopsyoperation) and first preoperative visit to the surgeon until the operation (visitoperation) are analyzed with a univariate and multivariate linear regression analysis. Separate analysis was done for visitoperation for academic and nonacademic hospitals and for screening compared to nonscreening patients. Results In 2014 there was an increase of 1469 (15%) patients compared to 2013. In 2015 this increase consisted of 1168 (11%) patients compared to 2014. In 2014 and 2015, 1359 (12%) and 3111 (26%) patients were referred to the surgeon through screening, respectively. The median waiting time of biopsyoperation significantly decreased (ß: 0.94, 95%BI) over the years 20142015 compared to 20112013. In nonacademic hospitals, the waiting time visitoperation also decreased significantly (ß: 0.89, 95%BI 0.870.90) over the years 20142015 compared to 20112013. No difference was found in waiting times between patients referred to the surgeon through screening compared to nonscreening. Conclusion There is a clear increase in volume since the introduction of the colorectal cancer screening programme without an increase in waiting time until surgery

Additional file 33 of Implicating genes, pleiotropy, and sexual dimorphism at blood lipid loci through multi-ancestry meta-analysis

Additional file 33: Table S22. Mouse genes with lipid phenotypes (silver set)