Background: Endoscopic stenting has demonstrated value over emergent surgery as a palliative intervention for patients with acute large bowel obstruction due to advanced colorectal cancer. However, concerns regarding high reintervention rates and the risk of perforation have brought into question its cost-effectiveness.
Methods: A decision tree analysis was performed to analyze costs and survival in patients with unresectable or metastatic colorectal cancer who present with acute large bowel obstruction. The model was designed with two treatment arms: self-expanding metallic stent (SEMS) placement and emergent surgery. Costs were derived from medicare reimbursement rates (US$), while effectiveness was represented by quality-adjusted life years (QALYs). The primary outcome measure was the incremental cost-effectiveness ratio (ICER). The model was tested for validation using one-way, two-way, and probabilistic sensitivity analyses.
Results: Endoscopic stenting resulted in an average cost of $43,798.06 and 0.68 QALYs. Emergent surgery cost $5865.30 more, while only yielding 0.58 QALYs. This resulted in an ICER of - $58,653.00, indicating that SEMS placement is the dominant strategy. One-way and two-way sensitivity analyses demonstrated that emergent surgery would require an improved survival rate in comparison to endoscopic stenting to become the favored treatment modality. In 100,000 probabilistic simulations, endoscopic stenting was favored 96.3% of the time.
Conclusions: In patients with acute colonic obstruction in the presence of unresectable or metastatic disease, endoscopic stenting is a more cost-effective palliative intervention than emergent surgery. This recommendation would favor surgery over SEMS placement with improved surgical survival, or if the majority of patients undergoing stenting required reintervention.
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http://dx.doi.org/10.1007/s00464-020-07637-x | DOI Listing |
Front Oncol
December 2024
Proctology Department, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
Background: Surgery and chemoradiotherapy are the main clinical treatment methods for colorectal cancer (CRC), but the prognosis is poor. The emergence of nanomedicine brings bright light to the treatment of CRC. However, there has not been a comprehensive and systematic analysis of CRC and nanomedicine by bibliometrics.
View Article and Find Full Text PDFCureus
December 2024
Trauma and Orthopaedics, Buckinghamshire Healthcare NHS Trust, Aylesbury, GBR.
Background Ankle fractures are one of the most common presentations in orthopaedic surgery and represent the third most frequent musculoskeletal injury in the elderly population. Syndesmotic injuries can be associated with ankle fractures, and surgical intervention is critical in these injuries to restore stability and prevent long-term disability. Traditionally, syndesmotic screw fixation has been the standard treatment for acute traumatic syndesmotic injuries, but controversies regarding this fixation method remain.
View Article and Find Full Text PDFTherap Adv Gastroenterol
December 2024
Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, Via Giustiniani, 2, Padua 35128, Italy.
Crohn's disease (CD) is a chronic, complex inflammatory disorder of the gastrointestinal tract that presents significant therapeutic challenges. Despite the availability of a wide range of treatments, many patients experience primary non-response, secondary loss of response, or adverse events, limiting the overall effectiveness of current therapies. Clinical trials often report response rates below 60%, partly due to stringent inclusion criteria.
View Article and Find Full Text PDFDigit Health
December 2024
Department of Biological and Environmental Sciences and Technologies (DiSTeBA), Università del Salento, Lecce, Italy.
Objective: Osteoarthritis (OA), particularly knee OA, is a leading cause of disability and poses significant challenges in healthcare management. Mobile applications (apps) have emerged as potential tools to support therapeutic exercise by providing tailored programs, instructional content, and progress tracking. This systematic review evaluates the efficacy of mobile apps in enhancing therapeutic exercise for knee OA management.
View Article and Find Full Text PDFAnn Surg Open
December 2024
From the Department of Surgery, Brigham & Women's Hospital, Boston, MA.
Background: Surgery has seen limited adoption of 360-degree feedback tools, and no current tools evaluate intraoperative performance from a technical, nontechnical, or teaching skill perspective. We sought to evaluate the overall findings and perceived value of a novel 360-degree feedback tool for surgeons from their operating room colleagues.
Methods: The 'intraoperative 360' (i360) combined 3 previously validated scales of surgeon performance.
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