Association Between Anesthesiologist Volume and Short-term Outcomes in Complex Gastrointestinal Cancer Surgery.

Importance: Intraoperative anesthesiology care is crucial to high-quality surgical care. The clinical expertise and experience of anesthesiologists may decrease the risk of adverse outcomes. Objective: To examine the association between anesthesiologist volume and short-term postoperative outcomes for complex gastrointestinal (GI) cancer surgery. Design, Setting, and Participants: This population-based cohort study used administrative health care data sets from various data sources in Ontario, Canada. Adult patients who underwent esophagectomy, pancreatectomy, or hepatectomy for GI cancer from January 1, 2007, to December 31, 2018, were eligible. Patients with an invalid identification number, a duplicate surgery record, and missing primary anesthesiologist information were excluded. Exposures: Primary anesthesiologist volume was defined as the annual number of procedures of interest (esophagectomy, pancreatectomy, and hepatectomy) supported by that anesthesiologist in the 2 years before the index surgery. Volume was dichotomized into low-volume and high-volume categories, with 75th percentile or 6 or more procedures per year selected as the cutoff point. Main Outcome and Measures: The primary outcome was a composite of 90-day major morbidity (with a Clavien-Dindo classification grade 3-5) and readmission. Secondary outcomes were individual components of the primary outcome. The association between exposure and outcomes was examined using multivariable logistic regression models, accounting for potential confounders. Results: Of the 8096 patients included, 5369 were men (66.3%) and the median (interquartile range [IQR]) age was 65 (57-72) years. Operations were supported by 842 anesthesiologists and performed by 186 surgeons, and the median (IQR) anesthesiologist volume was 3 (1.5-6) procedures per year. A total of 2166 patients (26.7%) received care from high-volume anesthesiologists. Primary outcome occurred in 36.3% of patients in the high-volume group and 45.7% of patients in the low-volume group. After adjustment, care by high-volume anesthesiologists was independently associated with lower odds of the primary outcome (adjusted odds ratio [aOR], 0.85; 95% CI, 0.76-0.94), major morbidity (aOR, 0.83; 95% CI, 0.75-0.91), unplanned intensive care unit admission (aOR, 0.84; 95% CI, 0.76-0.94), but not readmission (aOR, 0.87; 95% CI, 0.73-1.05) or mortality (aOR, 1.05; 95% CI, 0.84-1.31). E-values analysis indicated that an unmeasured variable would unlikely substantively change the observed risk estimates. Conclusions and Relevance: This study found that, among adults who underwent complex gastrointestinal cancer surgery, those who received care from high-volume anesthesiologists had a lower risk of adverse postoperative outcomes compared with those who received care from low-volume anesthesiologists. These findings support organizing perioperative care to increase anesthesiologist volume to optimize patient outcomes.

The Quality of Online Information for an Uncommon Malignancy-Neuroendocrine Tumours (NETs).

BACKGROUND: Patient information is critical in shared decision-making and patient-centred management for neuroendocrine tumours (NETs). Most adults search the internet for health issues, with over half considering such information to be credible. Therefore, we evaluated the quality of online information on NETs. METHODS: Searching for "Neuroendocrine Tumours", the top 20 websites from Google and top 10 from Yahoo and Bing were identified. Open-access websites written in English were included. Websites indicated as advertisements or directed towards healthcare providers were excluded. Each website was evaluated using the JAMA benchmarks, DISCERN instrument, and the Health on the Internet (HONCode) seal by two independent reviewers. RESULTS: We included 16 unique websites after removing duplicates. Four were education pages from healthcare institutions, 10 were Cancer Society pages, and 2 were general information pages. The average score for JAMA benchmarks was 2.3, with 19% of websites receiving the highest score of 4. Specifically, 31% met the benchmark for authorship, 69% for attribution, 94% for disclosure, and 44% for currency. The average score for the DISCERN instrument was 46.5, with no website achieving the maximum of 80 points. The HONCode seal was present in 3 out of 16 websites (18%). CONCLUSIONS: We identified major issues with the quality of online information for NETs using validated instruments. The majority of websites identified through common search engines are low-quality. Patients should be informed of the limited quality of online information on NETs. High-quality online information is needed to ensure that patients can avoid misinformation and actively participate in their care.