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2.
Minerva Chir ; 74(2): 160-164, 2019 Apr.
Article in English | MEDLINE | ID: mdl-30037174

ABSTRACT

Although mortality rates attributable to colon cancer have significantly improved over the past decades, it is still one of the leading causes of death in the USA. As newer technology and surgical techniques and concepts are being introduced, substantial confusion and dissenting opinions have come into fray as well. Naturally, different practice patterns emerged in Asia, Western Europe as well as in the USA. In this special article, we focus on the right colon and examine the unique challenges and oddities of practicing academic colorectal surgery in the New York metropolitan area.


Subject(s)
Colectomy/legislation & jurisprudence , Colonic Neoplasms/surgery , Colorectal Surgery/legislation & jurisprudence , Malpractice/legislation & jurisprudence , Practice Patterns, Physicians'/legislation & jurisprudence , Colectomy/adverse effects , Colectomy/methods , Colonic Neoplasms/blood supply , Colonic Neoplasms/pathology , Colorectal Surgery/adverse effects , Humans , Informed Consent , Liability, Legal/economics , Lymph Node Excision/standards , Malpractice/economics , Metaphor , New York , New York City , Practice Patterns, Physicians'/trends , Randomized Controlled Trials as Topic
5.
Ann Surg ; 263(6): 1126-32, 2016 Jun.
Article in English | MEDLINE | ID: mdl-27167562

ABSTRACT

CONTEXT: The US medical malpractice system is designed to deter negligence and encourage quality of care through threat of liability. OBJECTIVE: To examine whether state-level malpractice environment is associated with outcomes and costs of colorectal surgery. DESIGN, SETTING, AND PATIENTS: Observational study of 116,977 Medicare fee-for-service beneficiaries who underwent colorectal surgery using administrative claims data. State-level malpractice risk was measured using mean general surgery malpractice insurance premiums; paid claims per surgeon; state tort reforms; and a composite measure. Associations between malpractice environment and postoperative outcomes and price-standardized Medicare payments were estimated using hierarchical logistic regression and generalized linear models. MAIN OUTCOME MEASURES: thirty-day postoperative mortality; complications (pneumonia, myocardial infarction, venous thromboembolism, acute renal failure, surgical site infection, postoperative sepsis, any complication); readmission; total price-standardized Medicare payments for index hospitalization and 30-day postdischarge episode-of-care. RESULTS: Few associations between measures of state malpractice risk environment and outcomes were identified. However, analyses using the composite measure showed that patients treated in states with greatest malpractice risk were more likely than those in lowest risk states to experience any complication (OR: 1.31; 95% CI: 1.22-1.41), pneumonia (OR: 1.36; 95%: CI, 1.16-1.60), myocardial infarction (OR: 1.44; 95% CI: 1.22-1.70), venous thromboembolism (OR:2.11; 95% CI: 1.70-2.61), acute renal failure (OR: 1.34; 95% CI; 1.22-1.47), and sepsis (OR: 1.38; 95% CI: 1.24-1.53; all P < 0.001). There were no consistent associations between malpractice environment and Medicare payments. CONCLUSIONS: There were no consistent associations between state-level malpractice risk and higher quality of care or Medicare payments for colorectal surgery.


Subject(s)
Colorectal Surgery/economics , Colorectal Surgery/legislation & jurisprudence , Colorectal Surgery/standards , Malpractice/economics , Medicare/economics , Quality Assurance, Health Care , Colorectal Surgery/mortality , Episode of Care , Humans , Insurance, Liability/economics , Patient Readmission/statistics & numerical data , Postoperative Complications/economics , Postoperative Complications/epidemiology , Risk , United States/epidemiology
7.
J Surg Res ; 199(2): 351-6, 2015 Dec.
Article in English | MEDLINE | ID: mdl-26117229

ABSTRACT

BACKGROUND: Medical malpractice has become a rising concern for physicians, affecting the cost and delivery of health care. Colorectal procedures account for 24% of all general surgery cases, a high-risk specialty, with 15% of its physicians facing malpractice suit annually. METHODS: The Westlaw legal database was used to identify colorectal malpractice cases. RESULTS: In all, 122 of 230 lawsuits were included in this study. A majority of 65.6% were physician verdicts, 19.7% plaintiff verdicts, and 14.8% reached a settlement. Plaintiff payments were found to be significantly higher than settlement awards. The most common cause of alleged malpractice was failure to recognize a complication in a timely manner (45.1%), followed by damage to surrounding tissues (36.1%). CONCLUSIONS: The most common cause of alleged malpractice was failure to recognize a complication in a timely manner, followed by damage to surrounding tissue. Plaintiff awards were significantly higher than settlement payments. It is important to understand the mechanism of malpractice allegations to better prevent litigation and improve patient care.


Subject(s)
Colorectal Surgery/legislation & jurisprudence , Malpractice/statistics & numerical data , Humans
9.
Zentralbl Chir ; 138(1): 38-44, 2013 Feb.
Article in German | MEDLINE | ID: mdl-22083348

ABSTRACT

In this contribution the rational of colorectal cancer centre certification is discussed on the basis of previously published literature and several unsettled factors which are not yet considered as influencing the quality of cancer treatment. The representation of the theme cannot be comprehensive or complete. The readers should be stimulated by one or the other topic to reach their own critical assessment. Due to several limitations of the published literature and the various unsettled aspects, the purpose of colorectal cancer centre certification is called into question.


Subject(s)
Cancer Care Facilities/organization & administration , Cancer Care Facilities/standards , Certification/organization & administration , Certification/standards , Colorectal Neoplasms/surgery , Colorectal Surgery/organization & administration , Colorectal Surgery/standards , Cancer Care Facilities/legislation & jurisprudence , Certification/legislation & jurisprudence , Colorectal Neoplasms/mortality , Colorectal Surgery/legislation & jurisprudence , Ethics, Medical , Germany , Health Services Needs and Demand/legislation & jurisprudence , Health Services Needs and Demand/organization & administration , Health Services Needs and Demand/standards , Humans , National Health Programs/legislation & jurisprudence , National Health Programs/standards , Outcome Assessment, Health Care/legislation & jurisprudence , Outcome Assessment, Health Care/organization & administration , Outcome Assessment, Health Care/standards , Quality Indicators, Health Care/legislation & jurisprudence , Quality Indicators, Health Care/organization & administration , Quality Indicators, Health Care/standards , Survival Rate
10.
Rev. argent. coloproctología ; 22(3): 127-254, sept. 2010. ilus, tab, graf
Article in Spanish | LILACS | ID: lil-648817

ABSTRACT

Las complicaciones intraabdominales de la cirugía colorrectal constituyen aún hoy un desafío para todo cirujano. Durante el desarrollo del Relato son evaluadas las distintas alternativas diagnósticas y terapéuticas para resolución de las mismas con sus variantes técnicas. Se pone énfasis en su prevención, elemento relevante para lograr la disminución de su incidencia. El aporte de la cirugía miniinvasiva ha modificado conductas, tácticas y tratamientos, con resultados actuales similares a los procedimientos convencionales. Este tipo de cirugía debe ser encarado por equipos entrenados, especializados y con infraestructura acorde a la complejidad de la patología a tratar.


Intra-abdominal complications of colorectal surgery are a challenge for every surgeon. During the development of this lecture several diagnostic and therapeutic alternatives are evaluated to resolve them with several and different techniques. The emphasis is on prevention to achieve minimal incidence. The contribution of minimally invasive surgery has changed behavior, tactics and treatments, with current results, similar to conventional procedures. This sort of surgery must be performed by trained, specialized teams with adequate infraestucture according the complexity of the disease.


Subject(s)
Colorectal Surgery/adverse effects , Colorectal Surgery/methods , Colon/surgery , Intraoperative Complications , Postoperative Complications , Rectum/surgery , Anastomosis, Surgical/adverse effects , Colorectal Surgery/legislation & jurisprudence , Colon/injuries , Colonoscopy/adverse effects , Drainage/methods , Ostomy/adverse effects , Postoperative Hemorrhage , Gastrointestinal Motility , Proctocolectomy, Restorative/adverse effects , Rectal Prolapse/surgery , Blood Loss, Surgical , Robotics , Urogenital System/injuries , Abdominal Injuries
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