Abstract
IntroductionEmergency colorectal cancer (CRC) is a complex disease that requires multidisciplinary approaches for management. However, it is unclear whether acute care surgery (ACS) services can expedite the workup and treatment of complex surgical diseases such as emergency CRC. We sought to assess the impact of an Acute Care and Emergency Surgery Service (ACCESS) on wait-times for inpatient colonoscopy and surgical resection among emergency CRC patients.MethodsThis retrospective case–control study was conducted at a tertiary-care, university-affiliated, cancer centre in London, Ontario, Canada. All patients aged 18 or older who presented to the emergency department with a recent (within 48 hours) diagnosis of CRC, or were diagnosed with CRC after admission, were included in the study. Patients were either in the pre-ACCESS (July 1, 2007-June 31, 2010) or post-ACCESS (July 1, 2010-June 30, 2012) groups. A third group of emergency CRC patients treated at an adjacent cancer centre that lacked ACCESS (non-ACCESS) was evaluated separately. The primary outcome was time from admission to colonoscopy and surgery.ResultsA total of 149 patients (47 pre-ACCESS, 37 post-ACCESS, and 65 non-ACCESS) were identified. Only 19% (n = 9) of pre-ACCESS patients underwent inpatient colonoscopy, compared to 38% (n = 14) in the post-ACCESS group (p = 0.023). Additionally, 100% of patients in the post-ACCESS era underwent inpatient colonoscopy and surgery during the same admission, compared to only 44% of pre-ACCESS patients (p = 0.006). Median wait-times for inpatient colonoscopy (2.0 and 1.8 days for pre- and post-ACCESS groups respectively, p = 0.08) and surgical resection (1.6 and 2.3 days for pre- and post-ACCESS groups respectively, p = 0.40) were similar.ConclusionsPatients admitted to ACCESS underwent more inpatient colonoscopies and were more likely to have definitive surgery on that admission. ACS services can facilitate the workup and management of complex surgical diseases such as emergency CRC without delaying treatment.
Highlights
Emergency colorectal cancer (CRC) is a complex disease that requires multidisciplinary approaches for management
The two centres receive referrals from 33 regional hospitals from 7 counties, covering a catchment area of 3 million [22]. Both hospitals within London Health Sciences Centre (LHSC) perform a high volume of colorectal cancer surgeries: University Hospital (UH), which lacks an acute care surgery (ACS) service, and Victoria Hospital (VH), where ACCESS was implemented in July 2010
We identified a total of 149 patients in our study: 47 (32%) were treated in the pre-ACCESS era; 37 (25%) patients were treated in the post-ACCESS era; and 65 (44%) patients were treated in the non-ACCESS hospital
Summary
Emergency colorectal cancer (CRC) is a complex disease that requires multidisciplinary approaches for management. It is unclear whether acute care surgery (ACS) services can expedite the workup and treatment of complex surgical diseases such as emergency CRC. We sought to assess the impact of an Acute Care and Emergency Surgery Service (ACCESS) on wait-times for inpatient colonoscopy and surgical resection among emergency CRC patients. Colorectal cancer (CRC) is the third most commonly diagnosed cancer in the world, and one of the leading causes of cancer-related mortality [1]. Fifteen to thirty percent of CRCs present as a surgical emergency, with the most common causes being obstruction, perforation, or bleeding [2,3].
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