Escalation of Commitment in the Surgical ICU.

Objectives: Escalation of commitment is a business term that describes the continued investment of resources into a project even after there is objective evidence of the project's impending failure. Escalation of commitment may be a contributor to high healthcare costs associated with critically ill patients as it has been shown that, despite almost certain futility, most ICU costs are incurred in the last week of life. Our objective was to determine if escalation of commitment occurs in healthcare settings, specifically in the surgical ICU.

Association of high-volume hospitals with greater likelihood of discharge to home following colorectal surgery.

Importance: Discharge disposition is a patient-centered quality metric that reflects differences in quality of life and recovery following surgery. The effect of hospital volume on quality of recovery measured by rates of successful discharge to home remains unclear.

Objective: To test the hypothesis that patients having colorectal surgery at high-volume hospitals would more likely be discharged to home rather than discharged to skilled rehabilitation facilities to complete recovery.

Hand-assisted laparoscopy leads to efficient colorectal cancer surgery.

Background: Laparoscopic-assisted (LA) colorectal resections have improved short-term outcomes compared with open resections. Lack of tactile feedback, though, has led to lengthy operations and high conversion rates with attendant adverse effects on patients. Hand-assisted laparoscopy (HAL), in contrast, provides tactile feedback while still being minimally invasive.

Disparities in the use of minimally invasive surgery for colorectal disease.

Background: Morbidity and mortality rates for major surgical procedures are decreased in high-volume hospitals (HVH). Additionally, HVH are often leaders in the utilization of novel surgical technology such as minimally invasive surgery (MIS). Although HVH often serve diverse patient populations, it is unknown if there are disparities in the application of new surgical technologies within these hospitals.

Minimally invasive surgery in colon cancer patients leads to improved short-term outcomes and excellent oncologic results.

Background: Minimally invasive surgery (MIS) techniques are beneficial compared with open techniques. There is a paucity of data of the potential advantages of MIS in colon cancer surgery for veterans. Therefore, we hypothesize that use of MIS in colon cancer resections in a Veterans Affairs Medical Center will lead to improved short-term outcomes without compromising oncologic outcomes.

Depression is associated with prolonged and complicated recovery following colorectal surgery.

Background: There are little data regarding the impact of depression on outcomes after gastrointestinal surgery. We hypothesize that depression would be associated with prolonged hospital stay and changes in discharge disposition for patients undergoing colon and rectal surgery.

Methods: We identified 292,191 patients undergoing colon and rectal surgery using the 2008 Nationwide Inpatient Sample.

A multidisciplinary cancer center maximizes surgeons' impact.

Background: Colorectal cancer patients require care across different disciplines. Integration of multidisciplinary care is critical to accomplish excellent oncologic results. We hypothesized that the establishment of a dedicated colorectal cancer center (CRCC) around specialty-trained surgeons will lead to increased multidisciplinary management and improved outcomes in colorectal cancer patients.

Minimally invasive surgery improves short-term outcomes in elderly colorectal cancer patients.

Background: Minimally invasive surgery (MIS) for colorectal resection has been shown to improve short-term outcomes compared with open surgery in patients with colorectal cancer. Currently, there is a paucity of data demonstrating similar efficacy between MIS and open colorectal resection in the elderly population. We hypothesized that minimally invasive surgery provides improved short-term outcomes in elderly patients with colorectal cancer.

Minimally invasive surgery is underutilized for colon cancer.

Background: The Clinical Outcomes of Surgical Therapy Group (COST) trial published in 2004 demonstrated that minimally invasive surgery (MIS) for colorectal cancer provided equivalent oncologic results and better short-term outcomes when compared to open surgery. Before this, MIS comprised approximately 3% of colorectal cancer cases. We hypothesized that there would be a dramatic increase in the use of MIS for colon cancer after this publication.

Ethnic disparities are reduced in VA colon cancer patients.

Background: Inequalities in access to care have been hypothesized to be the cause of ethnic disparities in colon cancer. The aim of this study was to determine if ethnic disparities in the outcomes of colon cancer patients exist in a system with equal access.

Methods: A review of 214 consecutive patients who underwent elective colon resection for adenocarcinoma at 1 institution was conducted.

Establishment of a minimally invasive surgery program leads to decreased inpatient cost of care in veterans with colon cancer.

Background: The objective of this study was to evaluate the establishment of a minimally invasive surgery program on the cost of care at the investigators' institution. It was hypothesized that a minimally invasive surgery program would decrease overall inpatient treatment costs for veterans with colon cancer.

Methods: All patients who were admitted for colon cancer surgery in fiscal year 2009 were included in this study.

The VA is critical to academic development.

Background: A principal responsibility for surgical chairs is the development of academic programs. This has been challenging in light of the current economic downturn, declining reimbursement, and changes in funding. The aim of this study was to determine the importance that surgical chairs place on the US Department of Veterans Affairs (VA) regarding their ability to develop academic programs.

Waist circumference predicts increased complications in rectal cancer surgery.

Background: The impact of obesity on development of postoperative complications after gastrointestinal surgery remains controversial. This may be due to the fact that obesity has been calculated by body mass index, a measure that does not account for fat distribution. We hypothesized that waist circumference, a measure of central obesity, would better predict complications after high-risk gastrointestinal procedures.