Seminars in Colon & Rectal Surgery RSS feed: Current Issue. Seminars in Colon and Rectal Surgery offers a comprehensive and coordinated review of a single, timely topic related to the diagnosis and treatment of proctologic diseases. Each issue is an organized compendium of practical information that serves as a lasting reference for colorectal surgeons, general surgeons, surgeons in training and their colleagues in medicine with an interest in colorectal disorders. 2010 Topics March Pelvic Floor Evaluation Tracy Hull June Reducing Morbidity Warren Enker http://www.seminarscolonrectalsurgery.com/?rss=yesElsevier Inc.en © 2011 Elsevier Inc. All rights reserved. Seminars in Colon & Rectal Surgery1043-1489224December 2011 © 2011 Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.seminarscolonrectalsurgery.com/article/PIIS1043148911000558/abstract?rss=yesMore than 20 years have passed since the publication of Avedis Donabedian's classic article describing a framework for understanding quality of care in 3 domains: structure, process, and outcomes. In Donabedian's conceptual framework, structure corresponded to attributes of the setting of care; process measures defined actions in giving and receiving care; and outcomes were the effects of care on the health status of patients and populations. While the domains of quality are clearly interlinked, each has its own implications. For example, changing structure may be cumbersome, but measuring structural elements, such as case volume, has been used to optimize referral patterns in rectal cancer care. Identifying and measuring the most effective processes of care, such as guideline-concordant colorectal cancer care, can be exported to a variety of settings and broadly raise the bar for quality. Perhaps most importantly, feasible and appropriate outcome measures reflect the end results of care, and therefore, are imperative for quality assessment and quality improvement.IntroductionArden M. Morris10.1053/j.scrs.2011.06.001Seminars in Colon & Rectal Surgery 22, 4 (2011)2011-12-01Seminars in Colon & Rectal Surgery2011-12-01224S1043-1489(11)X0005-2Non-Traditional Outcomes in Colon and Rectal Surgery189191http://www.seminarscolonrectalsurgery.com/article/PIIS104314891100056X/abstract?rss=yesQuality improvement has become an increasingly important focus of health care over the last decade. In an effort to systematically improve quality, several organizations and programs have been developed, each known by a different acronym. This article describes the origins, mission, and methodology of the organizations and programs that have been established to standardize performance and improve quality. The role of these programs in health care, and the way they affect individual surgeons in practice, is then discussed.Quality Improvement and Efficiency of Care: Are Acronyms Really the Way of the Future?Conor P. Delaney10.1053/j.scrs.2011.06.002Seminars in Colon & Rectal Surgery 22, 4 (2011)2011-12-01Seminars in Colon & Rectal Surgery2011-12-01224S1043-1489(11)X0005-2Non-Traditional Outcomes in Colon and Rectal Surgery192196http://www.seminarscolonrectalsurgery.com/article/PIIS1043148911000571/abstract?rss=yesIn recent years the public, politicians, and physicians themselves have increasingly become aware of the importance and relevance of quality and value in health care. It is important for colon and rectal surgeons to understand cost-based comparative effectiveness studies pertaining to their specialty. These studies provide evidence to assist health care policymakers as well as clinicians and their patients in making well-informed decisions. The aim of this review is to familiarize colorectal surgeons with such research by providing definitions and examples from the colorectal literature. As this type of research gains greater attention among research funding agencies and health care policymakers, it is becoming increasingly important for colon and rectal surgeons to understand these methodologies as well as their limitations. With greater understanding, colorectal surgeons are better positioned to critically assess cost-based comparative effectiveness studies of colorectal procedures and choose the most appropriate treatments for their patients.Cost-Based Comparative-Effectiveness Research in Colon and Rectal SurgeryStefan D. Holubar, Abhishek Chatterjee, Samuel R.G. Finlayson10.1053/j.scrs.2011.06.003Seminars in Colon & Rectal Surgery 22, 4 (2011)2011-12-01Seminars in Colon & Rectal Surgery2011-12-01224S1043-1489(11)X0005-2Non-Traditional Outcomes in Colon and Rectal Surgery197202http://www.seminarscolonrectalsurgery.com/article/PIIS1043148911000583/abstract?rss=yesShort-term complications are common after colorectal resection, affecting approximately one quarter of our patients. This article reviews the common types of nonfatal adverse events after colorectal resection, the monetary and long-term patient costs of these events, as well as some of the technical difficulties with valid measurement and comparison of complication rates. We review evidence suggesting that risk-adjusted complication rates vary by hospital, and may be improved by quality improvement initiatives. Promising strategies for decreasing nonfatal adverse events following colorectal operations include: the National Surgical Quality Improvement Program and regional collaborative programs, such as the Keystone Collaboratives and the Michigan Surgical Quality Collaborative.Nonfatal Adverse Events After Colorectal OperationsSamantha Hendren, Darrell A. Campbell10.1053/j.scrs.2011.06.004Seminars in Colon & Rectal Surgery 22, 4 (2011)2011-12-01Seminars in Colon & Rectal Surgery2011-12-01224S1043-1489(11)X0005-2Non-Traditional Outcomes in Colon and Rectal Surgery203209http://www.seminarscolonrectalsurgery.com/article/PIIS1043148911000662/abstract?rss=yesColorectal resections account for a disproportionate burden of morbidity within general surgery, and most major complications probably originate in the operating room. A number of intraoperative factors are known to contribute to outcomes in colorectal surgery and yet no generally accepted metrics exist to evaluate the safety and quality of intraoperative care. Some composite performance scores have been described but are not commonly in use. Experiences from other surgical specialties can inform future efforts to develop, validate, and implement intraoperative quality indicators for colorectal surgery.Intraoperative Performance Evaluation in Colorectal SurgeryScott E. Regenbogen10.1053/j.scrs.2011.06.012Seminars in Colon & Rectal Surgery 22, 4 (2011)2011-12-01Seminars in Colon & Rectal Surgery2011-12-01224S1043-1489(11)X0005-2Non-Traditional Outcomes in Colon and Rectal Surgery210216http://www.seminarscolonrectalsurgery.com/article/PIIS1043148911000595/abstract?rss=yesThe list of ambulatory procedures has grown considerably in the last half century. Colorectal procedures are particularly amenable to the ambulatory setting because of the volume of cases, minimally invasive techniques employed, and relatively quick recovery. Although we know that colon and rectal surgeons perform an increasing number of anorectal and endoscopic procedures in ambulatory surgery centers, useful metrics for outcomes assessment are lacking in this arena. In this review, we have summarized the data regarding outcomes assessment in ambulatory colorectal surgery, delineated the complexities of outcomes measurement, and suggested strategies for future assessment.Measuring Outcomes in Ambulatory SurgeryTodd Francone, Rocco Ricciardi10.1053/j.scrs.2011.06.005Seminars in Colon & Rectal Surgery 22, 4 (2011)2011-12-01Seminars in Colon & Rectal Surgery2011-12-01224S1043-1489(11)X0005-2Non-Traditional Outcomes in Colon and Rectal Surgery217221http://www.seminarscolonrectalsurgery.com/article/PIIS1043148911000601/abstract?rss=yesThe treatment of patients with colon and rectal cancer frequently involves multiple disciplines of medicine, including surgery, radiation, and chemotherapy. Timely treatment is widely accepted as a cornerstone of quality of care, with the goal of arresting progression of disease and alleviating patient anxiety. Existing research, however, has had difficulties with characterizing the relationship between delays in treatment and short- or long-term outcomes. In this review we examine reasons for this and propose that, despite these difficulties, timely treatment is an appropriate target for efforts in quality assessment and quality improvement.Timeliness of CareDavid A. Etzioni10.1053/j.scrs.2011.06.006Seminars in Colon & Rectal Surgery 22, 4 (2011)2011-12-01Seminars in Colon & Rectal Surgery2011-12-01224S1043-1489(11)X0005-2Non-Traditional Outcomes in Colon and Rectal Surgery222225http://www.seminarscolonrectalsurgery.com/article/PIIS1043148911000613/abstract?rss=yesHealth-related quality of life is increasingly recognized as an important factor in evaluating the impact of a disease on an individual or assessing the risks and benefits of a treatment. Investigators have developed numerous instruments that aim to assess global quality of life and disease-specific quality of life. Colorectal cancer, inflammatory bowel disease, and Hirschsprung's disease are 3 colorectal conditions that have been the subject of much quality of life-related investigation. In addition to symptomatology, patients' social support structures, expectations, and level of communication with caregivers are all factors that impact an individual's perceived quality of life in colorectal disease.Health-Related Quality of Life in Colon and Rectal DiseaseAmanda Hayman, Amy L. Halverson10.1053/j.scrs.2011.06.007Seminars in Colon & Rectal Surgery 22, 4 (2011)2011-12-01Seminars in Colon & Rectal Surgery2011-12-01224S1043-1489(11)X0005-2Non-Traditional Outcomes in Colon and Rectal Surgery226230http://www.seminarscolonrectalsurgery.com/article/PIIS1043148911000625/abstract?rss=yesRecent efforts in improving health care quality have focused on patient satisfaction. The use of patient-reported outcomes is becoming increasingly common and gaining in importance as a measure of quality of care. Patient satisfaction, the best illustration of the patient-reported outcomes, is a complex concept. The advantages of measuring patient satisfaction are clear, and there are ongoing efforts to measure it in a standardized fashion. Several health care organizations have adopted measures to accomplish this goal, both in the United States and abroad. Despite the increasing number of instruments, the concept of patient satisfaction is still poorly understood and therefore frequently incorrectly measured.Patient Satisfaction and Surgery: Can It Be Measured?Karim Alavi, J. Andres Cervera-Servin10.1053/j.scrs.2011.06.008Seminars in Colon & Rectal Surgery 22, 4 (2011)2011-12-01Seminars in Colon & Rectal Surgery2011-12-01224S1043-1489(11)X0005-2Non-Traditional Outcomes in Colon and Rectal Surgery231234http://www.seminarscolonrectalsurgery.com/article/PIIS1043148911000637/abstract?rss=yesImpaired bowel function can profoundly affect quality of life. Multiple studies have looked at contributing factors to bowel function after rectal cancer surgery, using various measures in its assessment. The objective of this article was to review and summarize existing studies in the literature on bowel function after rectal cancer surgery. The major contributing factors to bowel function are reconstructive techniques and radiation therapy. Colonic J-pouch has been thoroughly studied and provides the best functional outcome, particularly with regard to bowel frequency. This technique may be impossible in obese patients with a narrow pelvis. Radiation therapy has an adverse effect on bowel outcomes, in particular, incontinence and bowel frequency, despite proven benefits in decreasing the risk of local recurrence. There is limited information on preoperative chemoradiation, but information to date suggests it is no different from short-course radiation. It is unclear whether a colonic J-pouch may compensate for radiation therapy's impact on bowel function. Bowel function can be improved by creating a colonic J-pouch. More research with detailed and standardized questionnaires is needed on patients who undergo radiation therapy, in particular, preoperative chemoradiation.Bowel Function After Rectal Cancer Surgery: A Review of the EvidenceMary R. Kwaan10.1053/j.scrs.2011.06.009Seminars in Colon & Rectal Surgery 22, 4 (2011)2011-12-01Seminars in Colon & Rectal Surgery2011-12-01224S1043-1489(11)X0005-2Non-Traditional Outcomes in Colon and Rectal Surgery235242http://www.seminarscolonrectalsurgery.com/article/PIIS1043148911000649/abstract?rss=yesRectal resection may impact the sexual function of both men and women. Postoperative sexual dysfunction occurs in as many as 60% of patients, depending upon the specific symptom studied. Studying the issue is complex because the underlying disease process, surgical technique, need for a stoma, adjuvant therapy, and preoperative sexual function all affect postoperative sexual function. The quality of the literature is limited by the lack of studies in which the authors use validated instruments. Even in that context, information on female patients is more limited than data on male patients. Improvements in surgical technique may help reduce postoperative sexual dysfunction while more complete information would improve patient counseling.Postoperative Sexual FunctionJennifer L. Irani, Ann C. Lowry10.1053/j.scrs.2011.06.010Seminars in Colon & Rectal Surgery 22, 4 (2011)2011-12-01Seminars in Colon & Rectal Surgery2011-12-01224S1043-1489(11)X0005-2Non-Traditional Outcomes in Colon and Rectal Surgery243248http://www.seminarscolonrectalsurgery.com/article/PIIS1043148911000650/abstract?rss=yesPhysicians who care for patients of childbearing potential of both genders who require pelvic surgery must have a clear understanding of the best-available evidence with regards to infertility as an outcome in this cohort. More specifically, colorectal surgeons must clearly understand the ramifications of altered anatomy on fertility and be able to adequately counsel patients. In this article we provide definitions associated with fertility and review the best-available literature regarding the impact of medical therapy for inflammatory bowel disease on fertility and both female and male infertility after proctectomy for chronic ulcerative colitis and rectal cancer. Finally, we review techniques for optimization of fertility as well as available options and treatments for those who have difficulty conceiving.Prevention and Treatment of Postproctectomy InfertilityStefan D. Holubar, Sunanda Kane10.1053/j.scrs.2011.06.011Seminars in Colon & Rectal Surgery 22, 4 (2011)2011-12-01Seminars in Colon & Rectal Surgery2011-12-01224S1043-1489(11)X0005-2Non-Traditional Outcomes in Colon and Rectal Surgery249254