Comparison of Systematic Video Documentation With Narrative Operative Report in Colorectal Cancer Surgery.

Importance: Despite ongoing advances in the field of colorectal surgery, the quality of surgical treatment is still variable. As an intrinsic part of surgical quality, the technical information regarding the surgical procedure is reflected only by the narrative operative report (NR), which has been found to be subjective and regularly omits important information. Objective: To investigate systematic video recording (SVR) as a potential improvement in quality and safety with regard to important information in colorectal cancer surgery. Design, Setting, and Participants: The Imaging for Quality Control Trial was a prospective, observational cohort study conducted between January 12, 2016, and October 30, 2017, at 3 centers in the Netherlands. The study group consisted of 113 patients 18 years or older undergoing elective laparoscopic surgery for colorectal cancer. These patients were case matched and compared with cases from a historical cohort that received only an NR. Interventions: Among study cases, participating surgeons were requested to systematically capture predefined key steps of the surgical procedure intraoperatively on video in short clips. Main Outcomes and Measures: The SVRs and NRs were analyzed for adequacy with respect to the availability of important information regarding the predefined key steps. Adequacy of the reported information was defined as the proportion of key steps with available and sufficient information in the report. Adequacy of the SVR and NR was compared between the study and control groups, with the SVR alone and as an adjunct to the NR in the study group vs NR alone in the control group. Results: Of the 113 study patients, 69 women (61.1%) were included; mean (SD) age was 66.3 (9.8) years. In the control group, a mean (SD) of 52.5% (18.3%) of 631 steps were adequately described in the NR. In the study group, the adequacy of both the SVR (78.5% [16.5%], P < .001) and a combination of the SVR with NR (85.1% [14.6%], P < .001) was significantly superior to NR alone. The only significant difference between the study and historical control groups regarding postoperative and pathologic outcomes was a shorter postoperative mean (SD) length of stay in favor of the study group (8.0 [7.7] vs 8.6 [6.8] days; P = .03). Conclusions and Relevance: Use of SVR in laparoscopic colorectal cancer surgery as an adjunct to the NR might be superior in documenting important steps of the operation compared with NR alone, adding to the overall availability of necessary intraoperative information and contributing to quality control and objectivity.

Patient-reported outcome after treatment of urinary incontinence in a multidisciplinary pelvic care clinic.

OBJECTIVES: To assess patient-reported outcome and satisfaction regarding urinary incontinence 1 year after the end of treatment in a multidisciplinary pelvic care clinic. METHODS: A total of 647 patients with urinary incontinence seen in an academic multidisciplinary pelvic care clinic were prospectively included in a specific triage system. Patient-reported improvement of urinary incontinence and patient satisfaction were assessed by telephone survey 1 year after the end of treatment. RESULTS: Just 15.6% of patients presented with one single pelvic floor problem, most had two or three pelvic functional disorders simultaneously, such as urinary incontinence, pelvic organ prolapse and constipation or fecal incontinence. One year after the end of treatment, of 440 responders (68%), 18.2% reported no remaining complaints, and 33.4% reported only one complaint. Patients reported a significant improvement of the mean severity (scale 0-10) of urinary incontinence from 7.2 ±1.6 pretreatment (=T0) to 4.3 ± 3.0 1 year after the end of treatment (P < 0.001). A total of 20.6% of patients reported no urinary incontinence after 1 year (P < 0.001), and 27.6% (P < 0.001) stopped using incontinence pads. Patients claimed high satisfaction with the clinic and care received, with 35.8% being "satisfied" and 45.5% "very satisfied." CONCLUSION: At 1 year after the end of treatment, one out of five patients with urinary incontinence recovered completely, and more than one out of four stopped using incontinence absorption pads. One out of three patients went from having a multifactorial health problem to a monofactorial health problem. High satisfaction rates were reported by more than four out of five patients.