Abstract:
PURPOSE:Resource limitations are a concern in most modern public hospital systems. The aim of this study is to prospectively quantify the total caseload of a tertiary colorectal surgery unit to identify areas of redundancy. METHODS:Data was collected prospectively at all points of clinical care (outpatient clinic, inpatient referrals, operating theatre and endoscopy) between March 2014 and March 2015 using specifically designed templates. The final data was analysed using descriptive statistics. RESULTS:During the study period, 4012 patient episodes were recorded: 2871 in outpatient clinic, 186 as emergency patient referrals, 541 at colonoscopy and 414 at surgery. The largest component of the caseload was made up primarily of colonoscopy results follow-up, protocol review for previous cancer or polyps and post-operative review. Sixty-eight percent of these episodes did not result in any active intervention such as further tests or surgery. Most new outpatient referrals were undifferentiated, with the most common indications being minor rectal bleeding, non-specific gastrointestinal symptoms, and minor non-bleeding anorectal problems. Of the new referrals, 56 % were booked for a colonoscopy, and only 13.3 % were booked directly for elective surgery. CONCLUSION:A large component of the caseload of a tertiary colorectal surgery unit is made up of post-colonoscopy, post-operative, and surveillance protocol follow-up, with a significant proportion of patients not requiring any active intervention. The majority of new referrals are undifferentiated and result in a low rate of direct booking for operative intervention. Rationalisation of this resource using evidence-based methods could reduce redundancy, workload, and cost.
journal_name
Int J Colorectal Disjournal_title
International journal of colorectal diseaseauthors
Sammour T,Macleod A,Chittleborough TJ,Chandra R,Shedda SM,Hastie IA,Jones IT,Hayes IPdoi
10.1007/s00384-016-2556-zsubject
Has Abstractpub_date
2016-06-01 00:00:00pages
1141-8issue
6eissn
0179-1958issn
1432-1262pii
10.1007/s00384-016-2556-zjournal_volume
31pub_type
杂志文章abstract::Rectopexy in the sacral hollow or to the promontory with synthetic material is the most efficient method of reducing and fixing a complete rectal prolapse. However, this distressing condition occurs frequently in elderly patients, often with high operative risk. In these some surgeons have advocated a perineal approac...
journal_title:International journal of colorectal disease
pub_type: 杂志文章
doi:10.1007/BF01647997
更新日期:1987-08-01 00:00:00
abstract:PURPOSE:Postoperative ileus (POI) is one of the complications that can occur after every surgical procedure including arthroplasty. It can have detrimental consequences for the patient and portrays an economic burden on health care systems. The risk factors for POI after arthroplasty described in the literature are sca...
journal_title:International journal of colorectal disease
pub_type: 杂志文章
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更新日期:2019-02-01 00:00:00
abstract:PURPOSE:The Bethesda guidelines suggest to perform microsatellite instability (MSI) test in early onset rectal cancer and not in patients>50 years with proximal colon cancer. The aim of the study was to evaluate whether the risk of high MSI (MSI-H) is greater in proximal colon cancer of patients 51-60 years old than in...
journal_title:International journal of colorectal disease
pub_type: 杂志文章
doi:10.1007/s00384-008-0484-2
更新日期:2008-08-01 00:00:00
abstract:BACKGROUND:In colitis, iron therapy may be given to treat anemia, but it may also be detrimental based on our previous studies using a rat model with colitis where iron supplementation increased disease activity and oxidative stress. This effect was partially reduced by an antioxidant. AIMS:The aim of this study was t...
journal_title:International journal of colorectal disease
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更新日期:2006-05-01 00:00:00
abstract:PURPOSE:The UK government target expects all suspected colorectal cancer (CRC) patients to be seen within the Two-Week Referral (TWR) system made by general practitioners. These guidelines originally derived from only level 5 evidence. However, this has significant impact on the workload for colorectal surgeons. The ai...
journal_title:International journal of colorectal disease
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doi:10.1007/s00384-013-1730-9
更新日期:2013-11-01 00:00:00
abstract:BACKGROUND:Patients with Lynch syndrome (LS) are at an increased risk of developing gastric cancer. In 2010, a guideline that recommended to screen all patients for Helicobacter pylori was implemented in the Netherlands. H. pylori is an important risk factor in the development of gastric cancer in the general populatio...
journal_title:International journal of colorectal disease
pub_type: 杂志文章
doi:10.1007/s00384-016-2524-7
更新日期:2016-03-01 00:00:00
abstract:BACKGROUNDS AND AIMS:There is increasing evidence that gut-derived intraepithelial lymphocytes have potent cytolytic and immunoregulatory functions, which they use to sustain epithelial integrity. The aims of this study were to investigate the roles of small intestinal intraepithelial lymphocytes (SI-IELs) in oral tole...
journal_title:International journal of colorectal disease
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更新日期:2012-05-01 00:00:00
abstract:BACKGROUND AND AIMS:Inpatients developing upper gastrointestinal (GI) haemorrhage are at increased risk of death. This study was performed to elucidate differences in inpatients and outpatients. PATIENTS/METHODS:Three hundred and sixty-two patients who needed esophagogastroduodenoscopy for upper GI bleeding were ident...
journal_title:International journal of colorectal disease
pub_type: 杂志文章
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更新日期:2005-07-01 00:00:00
abstract::Colorectal surgery is still associated with a significant morbidity and mortality rate, mostly related to suture failure. We have carried out a randomized experimental study in dogs on colonic anastomoses exposed to a number of anastomotic risk situations. A total of 42 dogs was used. They were divided into three stud...
journal_title:International journal of colorectal disease
pub_type: 杂志文章
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更新日期:1992-02-01 00:00:00
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journal_title:International journal of colorectal disease
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journal_title:International journal of colorectal disease
pub_type: 杂志文章
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更新日期:2008-07-01 00:00:00
abstract:PURPOSE:Anastomotic leakage after low anterior resection for rectal cancer is a critical problem. Many risk factors have been suggested and surgical techniques have improved, but anastomotic leakage remains a major postoperative challenge. This study sought to create a nomogram for precise prediction of anastomotic lea...
journal_title:International journal of colorectal disease
pub_type: 杂志文章
doi:10.1007/s00384-018-2970-5
更新日期:2018-04-01 00:00:00
abstract::Familial adenomatous polyposis (FAP), is a genetic premalignant condition which, if untreated, will ultimately manifest with the development of colorectal carcinoma. It is a disease of young adulthood. Rectal and colonic polyps are seldom seen before 10 years of age. Screening of clinically asymptomatic relatives thus...
journal_title:International journal of colorectal disease
pub_type: 杂志文章
doi:10.1007/BF00341240
更新日期:1991-08-01 00:00:00
abstract:BACKGROUND:Chemokines and their receptors have been proposed to distinctly contribute to tumor growth, dissemination, and local immune escape. The aim of this study was to evaluate the relevance of the chemokine receptor CCR5 expression for the progression of human colorectal cancer. METHODS:CCR5 expression was assess...
journal_title:International journal of colorectal disease
pub_type: 杂志文章
doi:10.1007/s00384-009-0868-y
更新日期:2010-04-01 00:00:00
abstract::A combined manometric and radioisotope study is described which was designed to investigate the motility characteristics of induced defaecation in the colon, rectum and anal canal, in patients with severe constipation. Five women with severe idiopathic constipation, aged 30-45 years, were studied. A multiple channel w...
journal_title:International journal of colorectal disease
pub_type: 杂志文章
doi:10.1007/BF00341220
更新日期:1992-12-01 00:00:00
abstract:BACKGROUND:The prognostic significance of anti-53 autoantibody in colorectal cancer (CRC) patients is unclear due to measurement of overall rather than disease-specific survival and generally short follow-up periods in many studies. We aim to investigate prognostic significance of anti-p53 auto-antibodies in a study wi...
journal_title:International journal of colorectal disease
pub_type: 杂志文章
doi:10.1007/s00384-008-0458-4
更新日期:2008-06-01 00:00:00
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journal_title:International journal of colorectal disease
pub_type: 杂志文章
doi:10.1007/s00384-020-03668-x
更新日期:2020-10-01 00:00:00
abstract:PURPOSE:Restoration of continence remains a major challenge in patients after abdominoperineal rectal excision (APE) or with end-stage fecal incontinence. A new surgical technique, the neurostimulated levator augmentation, was introduced for pelvic floor augmentation using dynamic graciloplasty in order to restore anor...
journal_title:International journal of colorectal disease
pub_type: 杂志文章
doi:10.1007/s00384-015-2134-9
更新日期:2015-04-01 00:00:00
abstract:AIM:The aim of this study was to analyze the results of nonoperative management of patients with perforated acute diverticulitis with extraluminal air and to identify risk factors that may lead to failure and necessity of surgery. METHODS:Methods included observational retrospective cohort study of patients between 20...
journal_title:International journal of colorectal disease
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更新日期:2017-10-01 00:00:00
abstract::A new case of benign lymphoid polyposis of the colon in an adult is presented. Relatively frequent in childhood, this disease remains exceptional in adults. The main concern is differentiation from adenomatous polyposis; the differential diagnosis can be particularly difficult for complex forms of polyposis with coexi...
journal_title:International journal of colorectal disease
pub_type: 杂志文章
doi:10.1007/BF00341239
更新日期:1991-08-01 00:00:00
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journal_title:International journal of colorectal disease
pub_type: 杂志文章,评审
doi:10.1007/s00384-018-3218-0
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journal_title:International journal of colorectal disease
pub_type: 杂志文章
doi:10.1007/s003840000247
更新日期:2000-11-01 00:00:00
abstract::In 15 patients suffering from idiopathic faecal incontinence and in 15 matched controls, manometric studies of anorectal pressure and studies of the rectoanal reflex and rectal sensitivity were carried out. Patients with idiopathic faecal incontinence had normal resting pressure but reduced squeeze and stress pressure...
journal_title:International journal of colorectal disease
pub_type: 杂志文章
doi:10.1007/BF01647996
更新日期:1987-08-01 00:00:00
abstract:INTRODUCTION:One of the main uses of robotic assisted abdominal surgery is the mesorectal excision in patients with rectal cancer. The aim of the present study is to analyse the learning curve for robotic assisted laparoscopic resection of rectal cancer. PATIENTS AND METHODS:We included in our study 43 consecutive rec...
journal_title:International journal of colorectal disease
pub_type: 杂志文章
doi:10.1007/s00384-012-1620-6
更新日期:2013-06-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to evaluate the effect of intrahepatic microvascular and lymphatic infiltration on survival in cases of colorectal liver metastases. MATERIALS AND METHODS:Prospectively collected data of 331 patients were analyzed for microvascular invasion (V), lymphatic infiltration (L), and r...
journal_title:International journal of colorectal disease
pub_type: 临床试验,杂志文章
doi:10.1007/s00384-009-0674-6
更新日期:2009-07-01 00:00:00
abstract:PURPOSE:Laparoscopic surgery for colorectal cancer has spread globally. The usefulness of laparoscopic surgery for elderly patients was initially indicated by comparison with open surgery. However, whether the procedure is safe for elderly as well as non-elderly patients with colorectal cancer remains unclear. METHODS...
journal_title:International journal of colorectal disease
pub_type: 杂志文章,meta分析
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更新日期:2019-03-01 00:00:00
abstract:PURPOSE:In this double-blind randomized trial, we aimed to compare the postoperative pain, complications, and length of hospital stay in patients undergoing open hemorrhoidectomy under spinal anesthesia with or without the pudendal nerve block. METHODS:Patients undergoing Milligan-Morgan hemorrhoidectomy under spinal ...
journal_title:International journal of colorectal disease
pub_type: 杂志文章
doi:10.1007/s00384-020-03630-x
更新日期:2020-09-01 00:00:00
abstract::Enterovesical fistula is a relatively rare condition in Crohn's disease. This study was undertaken to examine clinicopathological features and management of enterovesical fistula complicating Crohn's disease. Thirty patients with enterovesical fistula complicating Crohn's disease, treated between 1970 and 1997, were r...
journal_title:International journal of colorectal disease
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更新日期:2000-08-01 00:00:00
abstract:PURPOSE:Anastomotic leak (AL) in colorectal surgery leads to significant morbidity, mortality and poorer oncological outcomes. Diagnosis of AL is frequently delayed as current methods of detection are not 100% sensitive or specific. 'Biomarkers', such as cytokines and markers of ischaemia, from the milieu of the anasto...
journal_title:International journal of colorectal disease
pub_type: 杂志文章,meta分析,评审
doi:10.1007/s00384-017-2799-3
更新日期:2017-07-01 00:00:00
abstract:BACKGROUND:The traditional therapy for perforated sigmoid diverticulitis with peritonitis is emergency colectomy usually with colostomy. We report laparoscopic exploration with peritoneal lavage as an alternative in seven patients who required emergency surgery for diverticulitis. METHODS:Six patients presented with d...
journal_title:International journal of colorectal disease
pub_type: 杂志文章
doi:10.1007/s00384-009-0641-2
更新日期:2009-07-01 00:00:00