We compared patients whose care took place at VH between July 1, 2007 and June 30, 2010 (pre-ACCESS), and from July 1, 2010 to June 30, 2012
(post-ACCESS) as well as those treated at UH (non- ACCESS) from July 1, 2007 to June 30, 2012. The patients’ primary presenting complaints, reasons for admission, time to inpatient colonoscopy, and time to operative treatment were recorded. We assessed wait-times for inpatient endoscopy services (which are performed by gastroenterologists in both hospitals at LHSC) as a surrogate for examining the coordination of multiple specialties in the care of emergency CRC. We also reviewed characteristics of the malignancy such as the stage and tumour location, as well as patient outcomes, P505-15 including disease-free and overall survival. Patients who underwent urgent diagnostic colonoscopy because of symptoms that suggested the presence Selleckchem GF120918 of colon cancer (rectal bleeding, symptoms of obstruction, anemia, and weight loss) were considered to have had an inpatient colonoscopy if they were admitted for treatment within 48 hours of their colonoscopy. If patients were admitted to hospital
more than 48 hours after their colonoscopy, they were considered to have had an outpatient colonoscopy. Because many of these patients had their colonoscopy at peripheral hospitals, or private endoscopy clinics outside of LHSC, we were unable to accurately ascertain the timing of their outpatient colonoscopy. We excluded appendiceal neoplasms,
carcinoid tumours, and goblet cell cancers since their management differs from the treatment of adenocarcinoma. We also excluded patients who had a previous history of CRC or inflammatory bowel disease as they undergo surveillance colonoscopy many more frequently than the general population . We also excluded patients who underwent colonic stenting, because of a lack of data pertaining to the placement of stents during the study period, and because of a lack of consensus regarding the use of stents in emergency CRC patients who are otherwise amenable to surgery [24, 25]. Statistical analysis was performed using PCI-32765 supplier Graphpad Prism (Graphpad, La Jolla, California). Survival curves were compared by the Kaplan-Meier method. Continuous variables were compared between groups by Kruskal-Wallis one-way ANOVA with post hoc comparison between pre- and post-ACCESS groups by Dunn’s test . Discontinuous variables were compared using Pearson chi-squared test. P values less than 0.05 were considered statistically significant. Results 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. There were no differences in the distribution of symptoms that led patients to present to the Emergency Department (p = 0.