Incremental cost of complications in colectomy: a warranty guided approach to surgical quality improvement.

Background: We assessed the warranty cost for colectomy at a single institution, as defined by the additional cost of treating complications distributed across all patients treated.

Methods: All segmental colectomies from July 8 to June 12 were reviewed for 0, 1, 2, and ≥3 complications. Warranty cost is defined as follows: ([mean additional cost of the case with complication(s) - mean base case cost] × number of episodes)/total population.

Risk factors for readmission after elective colectomy: postoperative complications are more important than patient and operative factors.

Background: Colon resections are associated with substantial risk for morbidity and readmissions, and these have become markers for quality of care.

Objective: The purpose of this study was to determine risk factors for readmissions after elective colectomies to improve patient care and better understand the complex issues associated with readmissions.

Design: This was an analysis of the prospective, statewide, multicenter Michigan Surgical Quality Collaborative database.

Continuing medical education, maintenance of certification, and physician reentry.

Continuing medical education serves a central role in the licensure and certification for practicing physicians. This chapter explores the different modalities that constitute CME along with their effectiveness, including simulation and best education practices. The evolution to maintenance of certification and the requirements for both the American Board of Surgery and the American Board of Colon and Rectal Surgery are delineated.

A new concept for the role of ex vivo sentinel lymph nodes in node-negative colorectal cancer.

Background: We recently introduced ex vivo, intra-arterial methylene blue injection as a simple method to improve the lymph node (LN) harvest in gastrointestinal cancer. We now combined it with a novel ex vivo sentinel lymph node (evSLN) mapping technique.

Methods: evSLN mapping was performed by subserosal (n = 20) or submucosal (n = 30) India ink injection.

Injecting methylene blue into the inferior mesenteric artery assures an adequate lymph node harvest and eliminates pathologist variability in nodal staging for rectal cancer.

Purpose: The American Joint Committee on Cancer recommends examination of a minimum of 12 lymph nodes in rectal cancer for accurate staging. Despite this, several studies have demonstrated that nodal harvest is highly variable and often inadequate. This study was designed to determine if staining the nodes with methylene blue dye produced a better and more accurate harvest in comparison with standard pathologic lymph node dissection.

Methylene blue-assisted lymph node dissection in colon specimens: a prospective, randomized study.

Recently, we introduced ex vivo intra-arterial methylene blue injection into the inferior mesenteric artery as a novel method to improve lymph node (LN) harvest in rectal cancer. We have now adapted this method to the other segments of the colon. A total of 60 cases were enrolled.

Elastosis of the colon and the ileum as polyp causing lesions: a study of six cases and review of the literature.

Benign lesions in the gastrointestinal tract characterized by an increase of elastic fibers in the submucosal and mucosal layer are termed elastoma, elastosis, elastofibroma or elastofibromatous change, and present mostly as polyps. Twenty-seven such cases are published in the English and French literature. Some lesions are similar to alterations which are well-known from elastofibroma dorsi of the scapular region.

Methylene blue injection into the rectal artery as a simple method to improve lymph node harvest in rectal cancer.

Adequate lymph node assessment in colorectal cancer is crucial for prognosis estimation and further therapy stratification. However, there is still an ongoing debate on required minimum lymph node numbers and the necessity of advanced techniques such as immunohistochemistry or PCR. It has been proven in several studies that lymph node harvest is often inadequate under routine analysis.