Issue link: https://viewer.e-digitaledition.com/i/1487073
How Hospitals Can Do More for Less Invasive Colorectal Surgery VLAD SIMIANU, MD, MPH, FACS, FASCRS, Medical Director of Colon and Rectal Disorders for the Center of Digestive Health at Virginia Mason Medical Center in Seattle, sees an opportunity for hospitals to facilitate the use of minimally invasive approaches in emergent colorectal surgery. "There are times when it's not safe to do minimally invasive surgery, and it's not feasible for the few specialty-trained surgeons out there to do all these cases either," Dr. Simianu says. "However, it probably means there's an opportunity to make sure this technology is available, and that when hospitals are hiring [surgeons] to be on call, they're thinking … If we hire someone with the skill set to do minimally invasive surgery, that might mean even our emergency patients can get out of the hospital sooner and have better outcomes." surgery are typically sicker than elective surger y patients, which increases the likelihood of adverse events. " W hat was striking was how big the benef its [of minima lly invasive surger y] were," he says. "Even if you do minima lly invasive surgery in an emergency setting, it 's ha rd because you ca n't control a ll of the things that happen w ith patients. Maybe they didn't do bowel prep or stop a blood thinner, [which a re] things you can do in an elective setting, so we would expect them to do worse. But even then, minima lly invasive surger y had a pretty dra matic impact." W hy, t hen, such a low rate of usa ge? QUESTIONS OF TIMING, TR AINING AND PERCEPTIONS OF PATIENT TOLER ANCE Dr. Simianu observed that studies like this one can raise new questions. For example, the authors assumed most emergency surgeries would take place at night. They wrote, "Potential barriers to [minimally invasive surgery] use may come in the form of access to equipment or experi- enced teams with [minimally invasive surgery] technology based on the time of day the procedure is performed. Disease acuity may mandate a middle of the night operation. Accordingly, the lowest use of minima lly invasive surgery during this study was at night." Howe ver, 70 % of emer gent c a s e s occurred from 6 a.m. to 6 p.m. when, the- oretica lly, the personnel and equipment to perform minima lly invasive surgery should have been available. During prime operating hours, less than 40% of patients underwent minima lly invasive surgery, and the reasons are unclear. Another potential barrier to minimally invasive surgery: On-ca ll surgeons may h ave le s s ex per ienc e at per for m i n g colorecta l surgery and using minima lly invasive techniques than surgeons who perform elective operations. M i n i m a l ly i nv a s iv e s u r ger y w a s more li kely in patients younger tha n 65, perhaps, Dr. Simia nu says, due to misperceptions about older patients' ability to tolerate these procedures. "[W]hen you account for how sick the patient was, what time of day it was, all of these factors, there are many cases that could be done sa fely using minima lly invasive surger y," he says. "I think it 's a bi g oppor t u n it y because t hese a re patients who don't bounce back from surgery quite as quickly as their younger counter pa r ts, so minima l ly inva sive surgery might have a significant benefit [for them]." n M D N E W S . C O M /// M D N E W S C E N T R A l P E N N S y lVA N i A ■ 2 0 2 2 1 5