Spotlight Insights Archives

Surgical Spotlight: Right Hemicolectomy

Theator on May 22, 2024

One colorectal procedure, and the postoperative complications that can happen

Right hemicolectomy is a common colorectal surgical procedure to treat both benign and malignant conditions, including inflammatory bowel disease, colon cancer, and diverticulitis. While surgery is often a necessary step in a patient’s treatment plan, these cases don’t always go as planned.

What do we know about postoperative complications with right hemicolectomy? We know they can occur shortly after surgery or later in the postoperative course. We also know that early complications include:

- Anastomotic leaks
- Infections
- Bowel obstruction
- Bleeding
- Cardiopulmonary complications

Many factors can impact whether or not a patient experiences a complication. When looking at the right hemicolectomy surgery itself, there are 6 surgical practices Theator automatically identifies and annotates, all associated with reducing the risk of one or more postoperative complications.

Reducing anastomotic leaks in right hemicolectomies

Let’s dive into one complication, in particular. Anastomotic leaks occur in 6.4% to 8.8% of cases and can contribute to postoperative mortality and the need for revisional surgeries. Anastomotic leaks also increase healthcare costs and can lead to worse functional and oncologic outcomes for patients. Surgeons and hospital administrators want to reduce these, first and foremost to help patients.

What can surgeons do during surgery to reduce the risk of postoperative leaks?

Some literature suggests that performing the anastomosis in right hemicolectomy intracorporeally instead of extracorporeally is associated with several improved outcomes. This includes potentially lower rates of anastomotic leak and reduced rates of incisional hernias, open conversion, reoperation, blood loss, and incision length.

So, we asked the question – how often is intracorporeal anastomosis performed across health systems? The answer is less than you think.

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How often is intracorporeal anastomosis performed in right hemicolectomies?

We did an analysis of 389 right hemicolectomies, how often do you think intracorporeal anastomosis was performed? Flip this card to find out...

Intracorporeal anastomosis was only performed in 54% of cases.

In spite of its reduction of risks, intracorporeal anastomosis was performed in only 54% of the 389 right hemicolectomies analyzed.

Get our right hemicolectomy report >

Theator’s Spotlight database has compiled nearly 400 right hemicolectomy procedures from 6 different health systems to investigate.

This is just one of many surgical practices that Theator’s Surgical Intelligence Platform recognizes, analyzes, and connects to health system outcomes so hospital administrators and surgeons can take a data-driven approach to improving the quality of surgical care.

Curious to know how the adoption of this surgical practice varied between the 6 health systems? What about between hospitals within the same health system? We have answers. Download the full report here.

Surgical Spotlight: Cholecystectomy

Theator on May 14, 2024

Cholecystectomy Insights

Over 500,000 cholecystectomies are performed each year, making it one of the most common surgical procedures. Notably, most cholecystectomies are performed laparoscopically. The most common indication for laparoscopic cholecystectomy is cholelithiasis, but there are additional indications for the procedure in both symptomatic and asymptomatic patients.

Surgical complications occur in some patients who undergo cholecystectomy and include:

- Bile leaks
- Common bile duct injuries
- Hemorrhages
- Retained gallstones
- Wound infections

Although rates of bile duct injuries have decreased during the three decades that laparoscopic cholecystectomies have been performed, they remain a potentially significant and life-threatening complication.

Importantly, the effects of bile duct injuries can be long-lasting and include biliary strictures, cholangitis, cirrhosis, and portal hypertension. In addition to these outcomes’ physical and emotional burden, a substantial cost is also associated with this potentially avoidable complication.

For more laparoscopic cholecystectomy insights, download our procedure spotlight report.

How often is the critical view of safety achieved in cholecystectomies?

We did an analysis of 5,298 cholecystectomies, how often do you think the critical view of safety was achieved?
Flip this card to find out...

ONLY 34%

Achieving the critical view of safety (CVS) in laparoscopic cholecystectomies is widely documented in peer-reviewed journals to reduce the risk of bile duct injury. Despite this, it’s achieved in only 34% of cases.
Download our cholecystectomy report for more insights.

Get the Cholecystectomy Report >

Surgical Practice in Laparoscopic Cholecystectomy

A surgical best practice for preventing bile duct injuries includes the Critical View of Safety technique, which involves purposeful identification three components, one of which is the view of the cystic duct and cystic artery to avoid injury to these structures. The median success rate using this technique for the prevention of bile duct injuries is 95.8%.

Despite utilization of the Critical View of Safety being recommended for over 20 years, Theator’s Surgical Intelligence database of over 5,000 cholecystectomies performed at 15 health systems indicates this is only achieved 34% of the time. Furthermore, there is significant variation across healthcare systems and even within healthcare systems in the adoption of this surgical best practice.

Curious to know what other insights we’ve seen in our database of cholecystectomies? Download the full report here

Surgical Spotlight: Laparoscopic Hysterectomy

Theator on April 17, 2024

Laparoscopic Hysterectomy Insights

Laparoscopic hysterectomy is performed for a variety of indications, the most common of which is symptomatic uterine fibroids. In just over two decades, hysterectomies in the US went from being performed via an open abdominal approach in 70% of cases to being performed laparoscopically 70% of the time.

The laparoscopic approach to hysterectomy offers a number of advantages over open abdominal hysterectomy, including reductions in:

- Recovery time
- Pain
- Blood loss
- Costs

However, like all surgical procedures, laparoscopic hysterectomy has a risk of complications including:

- Urinary tract injury
- Bowel injury
- Vascular injury
- Bleeding

Readmission within 30 days following laparoscopic hysterectomy occurs in 2.6% of patients, with most of these occurring within the first 15 postoperative days. Surgical site infection (28.3%) is the most common reason for readmission. Notably, 51.9% of complications following laparoscopic hysterectomy are related to infections, surgical injuries, and wound complications, which are all potentially preventable outcomes.

These complications can affect patients both physically and emotionally, as well as increase the cost of care.

For more laparoscopic hysterectomy insights, download our procedure spotlight report.

Surgical Practices in Laparoscopic Hysterectomy

Identification of critical anatomic landmarks is an essential step in preventing surgical complications associated with laparoscopic hysterectomy. For example, identification of the bilateral ureters can prevent injury to these structures.

However, this step isn’t universally performed by all surgeons, and rates of bilateral ureter identification vary by institution. Theator’s Surgical Intelligence database has compiled more than 1150 laparoscopic hysterectomies to date from 9 different health systems, and we’ve found rates as low as 37% and as high as 72% for identification of both ureters at different institutions.

This is just one metric that Theator’s Surgical Intelligence Platform recognizes, analyzes, and connects to health system outcomes so hospital administrators and surgeons can take a data-driven approach to improving the quality of surgical care.

Curious to know what other insights we’ve seen in our database of laparoscopic hysterectomies? Download the full report here

Surgical Spotlight: Robot-Assisted Radical Prostatectomy

Theator on February 5, 2024

Robot-Assisted Radical Prostatectomy Insights

Prostate cancer is the second most common cancer in men, with an estimated 288k new cases diagnosed in the US every year, and an estimated 34k deaths per year as a result of it.

Robot-assisted radical prostatectomy (RARP) has been a treatment option for men with intermediate to high-risk prostate cancer since 2001. Theator’s Surgical Intelligence database has compiled more than 750 RARP procedures to date, from 6 different health systems.

Like any surgical procedure, RARP has potential complications, including:

- bleeding/vascular complications (1.9-6.8% of cases)
- urinary incontinence (4-31% of cases)
- erectile dysfunction (10% of cases)

In the 5 years following RARP, 17% of patients are readmitted. The most common reasons are:

- Urinary obstruction (73%)
- Urinary infection (13.5%)
- Bleeding (6%)

In addition to the physical and emotional impact on patients in these cases, hospitals incur significant costs.

For more RARP insights, download our procedure spotlight report >>

Surgical Practices in Robot-assisted Radical Prostatectomies

You might think a surgery that has been done for decades would be standardized with surgeons from all over the world performing the same steps and same surgical practices. Unfortunately, this is far from the truth.

Not only are surgical practices not agreed upon, there’s very little data to support which approach or which techniques consistently optimize outcomes.

For example, one surgical practice, bladder neck suture, is performed 9% of the time at one health system, and 50% of the time at another. Which begs the question: why the variability?

This is just one metric that Theator’s Surgical Intelligence Platform recognizes and analyzes across a health system and connects it to outcomes, so hospital administrators and surgeons alike can take a data-driven approach to improving the quality of surgery.

Curious to know what other insights we’ve seen in our database of RARP surgeries? Download the full report here