How Far Are Patients Willing to Travel for Gastrectomy?

Alvino, Donna Marie L. BA^*; Chang, David C. PhD, MPH, MBA^*; Adler, Joel T. MD, MPH^*; Noorbakhsh, Abraham BS^†; Jin, Ginger MS^*; Mullen, John T. MD^*

Annals of Surgery: June 2017 - Volume 265 - Issue 6 - p 1172–1177

doi: 10.1097/SLA.0000000000001826

Original Articles

Objective: To determine travel patterns for patients undergoing gastrectomy for cancer and to identify factors associated with patient decision.

Background: Support for regionalization of complex surgery grows; however, little is known about the willingness of patients to travel for care. Furthermore, utilization of outcomes data in patients’ hospital selection processes is not well understood.

Results: Total study population was 10,022. Majority (67.1%) of patients underwent gastrectomy at the nearest providing hospitals. Distance traveled to destination hospitals in California averaged 17.04 miles. Bypassing patients traveled approximately 16 miles beyond the nearest hospitals to receive care, selecting lower volume destination hospitals in 27.9% of cases. Annual gastrectomy volumes for nearest and for destination hospitals averaged 4.4 and 6.8 cases, respectively, and inhospital mortality rates were 5.9% and 4.8%, respectively. A few patients (19.2%) sought care at teaching hospitals. Rural county residence significantly reduced the likelihood of bypass (P < 0.001). High volume (>7 cases) and teaching status of destination hospitals (both P < 0.001) were predictive of hospital bypass, though no significant association between mortality rate and bypass was identified.

Conclusions: The majority of gastric cancer patients underwent gastrectomy at providing hospitals nearest to home, reflecting little regionalization of gastrectomy in California. Patients’ hospital selection appears not to be driven by outcomes data.
http://journals.lww.com/annalsofsurgery/Abstract/2017/06000/How_Far_Are_Patients_Willing_to_Travel_for.23.aspx

Individualized Venous Thromboembolism Risk Stratification Using the 2005 Caprini Score to Identify the Benefits and Harms of Chemoprophylaxis in Surgical Patients: A Meta-analysis

Pannucci, Christopher J. MD, MS^*; Swistun, Lukasz MD^†; MacDonald, John K. MA^‡; Henke, Peter K. MD^§; Brooke, Benjamin S. MD, PhD^¶

Annals of Surgery: June 2017 - Volume 265 - Issue 6 - p 1094–1103

doi: 10.1097/SLA.0000000000002126

Meta-Analyses

Objective: We performed a meta-analysis to investigate benefits and harms of chemoprophylaxis among surgical patients individually risk stratified for venous thromboembolism (VTE) using Caprini scores.

Summary of Background Data: Individualized VTE risk stratification may identify high risk surgical patients who benefit from peri-operative chemoprophylaxis.

Conclusions: The benefit of peri-operative VTE chemoprophylaxis was only found among surgical patients with Caprini scores ≥7. Precision medicine using individualized VTE risk stratification helps ensure that chemoprophylaxis is used only in appropriate surgical patients and may minimize bleeding complications.

http://journals.lww.com/annalsofsurgery/Abstract/2017/06000/Individualized_Venous_Thromboembolism_Risk.12.aspx

Perioperative Pharmacological Thromboprophylaxis in Patients With Cancer: A Systematic Review and Meta-analysis

Guo, Qiang MD; Huang, Bin MD; Zhao, Jichun MD; Ma, Yukui MD; Yuan, Ding MD; Yang, Yi MD; Du, Xiaojiong MD

Annals of Surgery: June 2017 - Volume 265 - Issue 6 - p 1087–1093

doi: 10.1097/SLA.0000000000002074

Meta-Analyses

Methods: We searched multiple electronic databases (up to March 31, 2016) for trials of cancer patients undergoing surgery that assessed the relative benefits and harms of perioperative pharmacological thromboprophylaxis. Relative risks (RRs) with 95% confidence intervals (CI) were estimated.

Conclusions: Routine pharmacological thromboprophylaxis for cancer patients undergoing surgery needs to be carefully considered, because although thromboprophylaxis is associated with lower VTE events, there is a higher incidence of clinically significant bleeding events. If pharmacological thromboprophylaxis is to be used, extended thromboprophylaxis started preoperatively with LWMH might be the most effective strategy.

http://journals.lww.com/annalsofsurgery/Abstract/2017/06000/Perioperative_Pharmacological_Thromboprophylaxis.11.aspx

Differential Prognostic Implications of Gastric Signet Ring Cell Carcinoma: Stage Adjusted Analysis From a Single High-volume Center in Asia

Chon, Hong Jae MD^*,†; Hyung, Woo Jin MD, PhD^‡; Kim, Chan MD, PhD^*; Park, Sohee PhD^§; Kim, Jie-Hyun MD^||; Park, Chan Hyuk MD^¶; Ahn, Joong Bae MD, PhD^**; Kim, Hyunki MD^††; Chung, Hyun Cheol MD, PhD^**; Rha, Sun Young MD, PhD^**; Noh, Sung Hoon MD, PhD^‡; Jeung, Hei-Cheul MD, PhD^||

Annals of Surgery: May 2017 - Volume 265 - Issue 5 - p 946–953

doi: 10.1097/SLA.0000000000001793

Original Articles

Objective: The aim of this study was to analyze the clinicopathologic characteristics and prognosis of signet ring cell carcinoma (SRC) according to disease status (early vs advanced gastric cancer) in gastric cancer patients.

Results: SRC patients have younger age distribution and female predominance compared with other histologic subtypes. Notably, the distribution of T stage of SRC patients was distinct, located in extremes (T1: 66.2% and T4: 20%). Moreover, the prognosis of SRC in early gastric cancer and advanced gastric cancer was contrasting. In early gastric cancer, SRC demonstrated more favorable prognosis than WMD after adjusting for age, sex, and stage. In contrast, SRC in advanced gastric cancer displayed worse prognosis than WMD. As stage increased, survival outcomes of SRC continued to worsen compared with WMD.

Conclusions: Although conferring favorable prognosis in early stage, SRC has worse prognostic impact as disease progresses. The longstanding controversy of SRC on prognosis may result from disease status at presentation, which leads to differing prognosis compared with tubular adenocarinoma.

http://journals.lww.com/annalsofsurgery/Fulltext/2017/05000/Differential_Prognostic_Implications_of_Gastric.17.aspx