Affect Complication Rates Research Articles

Abstract 06: Expediting Tissue Expansion in Implant Based Breast Reconstruction: A Comparative Study of Prepectoral and Subpectoral Expander Placement

PURPOSE: A disadvantage of expander-based breast reconstruction (EBBR) that impacts patients and healthcare costs is the numerous visits required for expansion. This study aimed to determine if prepectoral EBBR offers expedited tissue expansion compared to subpectoral EBBR without affecting complication rates. METHODS: Consecutive patients who had undergone immediate EBBR from January 2016 to July 2017 by a single-surgeon were grouped into subpectoral (partial submuscular/partial acellular dermal matrix) or prepectoral EBBR and reviewed. The primary outcomes were total days and number of visits to expansion completion. Groups were compared by univariate analysis with significance set at p<0.05. RESULTS: In total, 101 patients (subpectoral=69, prepectoral=32) underwent 184 EBBR (subpectoral=124, prepectoral=60). There was no difference in age, body mass index, smoking or diabetes between the groups (all p>0.05). Between prepectoral and subpectoral patients there was similar postoperative total morphine equivalents (22.6 ± 18.5 vs. 30.4 ± 19.6;p=0.062). Prepectoral patients took fewer days to complete expansion(40.4 ± 37.8days vs. 62.5 ± 50.2days;p=0.032), fewer office visits to complete expansion(2.3 ± 1.7 vs. 3.9 ± 1.8;p<0.001), and were expanded to greater final volumes than subpectoral patients(543.7 ± 122.9ml vs. 477.5 ± 159.6ml;p=0.046). Between prepectoral and subpectoral there were similar rates of minor complications(25% vs. 18.5%;p=0.311), readmission(5% vs. 2.4%;p=0.393), seroma(8.3% vs. 5.6%;p=0.489), reoperation for hematoma(3.3% vs. 1.6%;p=0.597), explantation(5% vs. 2.4%;p=0.393), and length of follow up(179.3 ± 98.2days vs. 218.3 ± 119.8days;p=0.111). CONCLUSION: This study demonstrates that prepectoral EBBR facilitates decreased time and number of visits to complete expansion compared to subpectoral EBBR, without increasing complication rates. These benefits of prepectoral EBBR may have downstream effects on improved patient satisfaction and healthcare costs, which merits further prospective study. B.A. Wormer: None. A.C. Valmadrid: None. N. Ganesh Kumar: None. S. Al Kassis: None. T.M. Rankin: None. K.K. Higdon: None.

Palatal Fistula Risk after Primary Palatoplasty

Humanitarian surgical organizations provide palatoplasties for patients without access to surgical care. Few organizations have evaluated the outcomes of these trips. This study evaluates the palatal fistula rate in patients from two cohorts in rural China and one in the United States. This study compared the odds of fistula formation among three cohorts whose palates were repaired between 2005 and 2009. One cohort included 97 Chinese patients operated on by teams from the United States and Canada under the auspices of Resurge International. They were compared to cohorts at Huaxi Stomatology Hospital and the University of California San Francisco (UCSF). Age, fistula presence, and Veau class were compared among cohorts using Chi-square tests. Logistic regression was used to analyze predictors of fistula formation. The fistula risk was 35.4% in patients treated by humanitarian teams, 12.8% at Huaxi University Hospital and 2.5% at UCSF ( P < 0.001). Age and Veau class were associated with fistula formation (Age P = 0.0015; Veau P < 0.001). ReSurge and Huaxi patients had 20.2 and 5.6 times the odds of developing a fistula, respectively, compared to UCSF patients ( P < 0.01, both). A multivariable model controlling for surgical group, age, and gender showed an association between Veau class and the odds of fistula formation. Chinese children undergoing palatoplasty by international teams had higher odds of palatal fistula than children treated by Chinese surgeons in established institutions and children treated in the United States. More research is required to identify factors affecting complication rates in low-resource environments.

11: Does trainee involvement during pelvic reconstructive surgery affect complication rates?

11: Does trainee involvement during pelvic reconstructive surgery affect complication rates?

Does Obesity Affect Perioperative and Postoperative Morbidity and Complication Rates After Minimal Access Spinal Technologies in Surgery for Lumbar Degenerative Disc Disease.

The impact of obesity on spine surgery has been studied extensively, but only a few investigations have been focused on minimally invasive spinal fusion techniques and complication rates in normal-weight, preobese, or obese patients. Obesity was found to be a risk factor for intraoperative complications. Published data tend to favor minimal access surgery techniques (MAST) for obese patients. In a prospective study, we assessed the perioperative and postoperative complications of MAST in a large population of 187 patients. We evaluated perioperative and postoperative complication rates in minimally invasive surgery (MIS) fusion techniques of the lumbar spine in obese, preobese, and normal-weight patients, classified by body mass index (BMI). Lumbar MIS fusion was performed by interbody fusion procedures and posterolateral fusion. In cases of spinal stenosis, a laminotomy was performed (146 patients). Any harmful event occurring during or after surgery was included in the statistical analysis. No infection or severe wound healing disorder was encountered in the series. No significant difference in terms of cerebrospinal fluid leakage, blood loss, drainage, or length of hospital stay between the 3 BMI groups was encountered. More clinically insignificant hematomas were encountered in the preobese and obese groups (P= 0.013) than in the normal-weight patients. No significant difference was registered between the BMI or age groups regarding overall complication rates. We conclude that preobese and obese patients are good candidates for MAST because BMI did not affect complication rates or duration of surgery.

Comparison of Adjuvant Radiation Therapy Before or After Artificial Urinary Sphincter Placement: A Multi-Institutional, Retrospective Analysis

To determine if the timing of radiation therapy on artificial urinary sphincter (AUS) impacts complication rates, revision rates, and number of pads per day after placement. A retrospective review was conducted of men with prostate cancer who underwent AUS placement and radiation therapy between 1987 and 2016. Of 306 men, 292 (95.4%) received radiation before AUS placement (group 1) and 14 (4.6%) received radiation after AUS placement (group 2). Median follow-up was 30 months after AUS placement. Group 1 had 32 of 292 (11.0%) patients suffer from erosion, compared with 0 of 14 (0.0%) patients in group 2 (P = .191). None of the patients in group 2 had infection or mechanical failure. The number of patients who received revision in group 1 was 91 of 292 (31.2%) and in group 2 was 2 of 14 (14.3%) (P = .180). The number of pads used per day in group 1 before and after AUS placement was 5.24 ± 3.12 and 1.13 ± 1.31, respectively (P <.001). In group 2, the number of pads used per day before and after AUS placement was 6.09 ± 1.97 and 1.53 ± 0.99, respectively (P <.001). There was no significant difference in the average number of postoperative pads used per day between group 1 and group 2 (P = .907). The timing of radiation therapy does not appear to significantly affect complication rates or urinary continence, as measured in pads used after AUS placement. This multi-institutional retrospective analysis showed similar erosion and revision rates when radiation occurred after AUS placement and demonstrates preliminary safety and feasibility of the administration of radiation after AUS placement.

Intraoperative pedicle screw navigation does not significantly affect complication rates after spine surgery

Various forms of intraoperative computer-assisted navigation technologies exist, and have consistently been shown to improve pedicle screw accuracy. However, the overall clinical effects of inaccurate pedicle screw placement have been debated. We examined the clinical effects of improved pedicle screw accuracy with computer navigation technology in reducing complication rates in patients undergoing multi-level spinal fusion. We retrospectively reviewed the ACS-NSQIP registry utilizing Current Procedural Terminology (CPT) codes 22843 + 22844 to identify patients undergoing spinal instrumentation of greater than 7 levels, as well as the CPT code 61783 to denote the use of intraoperative computer-assisted navigation. The data were then subdivided to into cohorts consisting of instrumentation cases with and without navigation. Demographic information, as well as intraoperative and postoperative complications, were compared between groups. A total of 3168 patients met our inclusion criteria. There were no statistically significant differences in preoperative population data. Surgical time was significantly longer in the navigation group (391.41 versus 350.3 min), but there were no significant improvements in complication rates with the use of navigation. We found that the mean operative time was significantly increased for patients undergoing spinal instrumentation with computer navigation. This increase in operative time was not associated with any increase in surgical or medical complications. However, in this large series, we were unable to show any clinical benefit to intraoperative navigation, and no reductions in short term complications or rates of return to surgery were observed.

Ten years transmission of the new variant of Chlamydia trachomatis in Sweden: prevalence of infections and associated complications

ObjectivesIn 2006, a new variant of Chlamydia trachomatis (nvCT) was discovered in Sweden. It has a deletion in the plasmid resulting in failed detection by the single target systems from...

Contemporary Trends in Utilization and Perioperative Outcomes of Percutaneous Nephrolithotomy in the United States from 2003 to 2014.

To investigate the contemporary trends and perioperative outcomes of percutaneous nephrolithotomy (PCNL) by using a population-based cohort. Using the Premier Healthcare Database, we identified 225,321 patients in whom kidney/ureteral calculi were diagnosed and who underwent PCNL at 447 different hospitals across the United States from 2003 to 2014. Outcomes included 90-day postoperative complications (as classified by the Clavien-Dindo system), prolonged hospital length of stay, operating room time, blood transfusions, and direct hospital costs. Temporal trends were quantified by estimated annual percentage change (EAPC) by using least-squares linear regression analysis. Multivariable logistic regression was performed to identify predictors of outcomes. PCNL utilization rates initially increased from 6.7% (2003) to 8.9% (2008) (EAPC: +5.60%, p = 0.02), before plateauing at 9.0% (2008-2011), and finally declining to 7.2% in 2014 (EAPC: -4.37%, p = 0.02). Overall (Clavien ≥1) and major complication (Clavien ≥3) rates rose significantly (EAPC: +12.2% and +16.4%, respectively, both p < 0.001). Overall/major complication and blood transfusion rates were 23.1%/4.8% and 3.3%, respectively. Median operating room time and 90-day costs were 221 minutes (interquartile range [IQR] 4) and $12,734 (IQR $9419), respectively. Significant predictors of overall complications include higher Charlson comorbidity index (CCI) (CCI ≥2: odds ratio [OR] 2.08, p < 0.001) and more recent year of surgery (2007-2010: OR 3.20, 2011-2014: OR 4.39, both p < 0.001). Higher surgeon volume was significantly associated with decreased overall (OR 0.992, p < 0.001) and major (OR 0.991, p = 0.01) complications. Our contemporary analysis shows a decrease in the utilization of PCNL in recent years, along with an increase in complication rates. Numerous patient, hospital, and surgical characteristics affect complication rates.

The yield and complications of amniocentesis performed after 24 weeks of gestation.

This study assessed the use and complications of late amniocentesis (AC) and analyzed factors that affect complication rate. A retrospective analysis of 167 genetic AC performed after 24weeks during a 10-year period in two medical centers was conducted. Data regarding the indications for AC, genetic work-up, and pregnancy outcomes were retrieved from patient medical records and telephone-based questionnaires. Mean gestational age (GA) at the time of AC was 31.7±2.7weeks; 104 procedures were performed at ≤32weeks, including 24 at ≤30weeks. The overall pregnancy complication rate occurring at any time after the procedure was 6.6% (11). Of these, 4.8% (8) occurred within a month after AC, including 2.4% (4) that occurred within a week. An additional three occurred after 30days. There were no differences in the total complication rate and in the rate of specific complications of procedures performed at ≤32weeks or at ≤30weeks. Maternal age did not affect outcomes. Genetic testing was abnormal in five cases (3%). Amniocyte culture failed in 3 cases (2.3%), with no technical failures in 52 chromosomal microarray tests. The complication rate of AC performed after 24weeks was 4.8%, which is significantly higher than that of second trimester AC. GA and maternal age did not affect the complication rate.

Effect of maternal age and cardiac disease severity on outcome of pregnancy in women with congenital heart disease

BackgroundThere is an increasing prevalence of women with congenital heart defects reaching childbearing age. In western countries women tend to give birth at a higher age compared to some decades ago. We evaluated the CARdiac disease in PREGnancy (CARPREG) and modified World Health Organization (mWHO) risk classifications for cardiac complications during pregnancies in women with congenital heart defects and analyzed the impact of age on risk of obstetric and fetal outcome. MethodsA single-center observational study of cardiac, obstetric, and neonatal complications with data from cardiac and obstetric records of pregnancies in women with congenital heart disease. Outcomes of 496 pregnancies in 232 women, including induced abortion, miscarriage, stillbirth, and live birth were analyzed regarding complications, maternal age, mode of delivery, and two risk classifications: CARPREG and mWHO. ResultsThere were 28 induced abortions, 59 fetal loss, 409 deliveries with 412 neonates. Cardiac (14%), obstetric (14%), and neonatal (15%) complications were noted, including one maternal death and five stillbirths. The rate of cesarean section was 19%. Age above 35years was of borderline importance for cardiac complications (p=0.054) and was not a significant additional risk factor for obstetric or neonatal complications. Both risk classifications had moderate clinical utility, with area under the curve (AUC) 0.71 for CARPREG and 0.65 for mWHO on cardiac complications. ConclusionsPregnancy complications in women with congenital heart disease are common but severe complications are rare. Advanced maternal age does not seem to affect complication rate. Existing risk classification systems are insufficient in predicting complications.

MP59-03 MAY ROBOT-ASSISTED PARTIAL NEPHRECTOMY BE TAUGHT TO FELLOWS WITHOUT AFFECTING PERIOPERATIVE OUTCOMES?

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy IV1 Apr 2017MP59-03 MAY ROBOT-ASSISTED PARTIAL NEPHRECTOMY BE TAUGHT TO FELLOWS WITHOUT AFFECTING PERIOPERATIVE OUTCOMES? Zine-Eddine KHENE, Benoit Peyronnet, Elise Bosquet, Benjamin Pradère, Gregory Verhoest, Romain Mathieu, Solène-Florence Kammerer-Jacquet, Nathalie Rioux-Leclercq, and Karim Bensalah Zine-Eddine KHENEZine-Eddine KHENE More articles by this author , Benoit PeyronnetBenoit Peyronnet More articles by this author , Elise BosquetElise Bosquet More articles by this author , Benjamin PradèreBenjamin Pradère More articles by this author , Gregory VerhoestGregory Verhoest More articles by this author , Romain MathieuRomain Mathieu More articles by this author , Solène-Florence Kammerer-JacquetSolène-Florence Kammerer-Jacquet More articles by this author , Nathalie Rioux-LeclercqNathalie Rioux-Leclercq More articles by this author , and Karim BensalahKarim Bensalah More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1819AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Surgical teaching may potentially influence patient care. A safe, high-quality surgery practice requires dedicated and specialized training commonly acquired during a fellowship. The purpose of this study was to determine whether robot-assisted partial nephrectomy (RAPN) may be taught to fellows without influencing operative outcomes. METHODS We analyzed 276 patients who underwent RAPN for a small renal tumour. We stratified our cohort in two groups according to the involvement or not of a surgeon in training during the procedure: expert surgeon operating alone (expert group) or surgeon in training operating under the supervision of the expert surgeon (fellow group). Patients who underwent RAPN during the early learning curve of the expert surgeon (first 60 NPRA) were excluded. Peri-operative data were compared between the two groups. Linear and logistic regression analyses were performed to assess the impact of fellows involvement on perioperative and postoperative outcomes. RESULTS Fellows were involved in a total of 89 procedures (41 %) and 127 (59 %) of cases were done by the expert surgeon alone. The patients characteristics were comparable in both groups. Operative time (OT) and warm ischemia time (WIT) were longer in the fellow group (188.2 vs. 129.9 min; p < 0.001, and 17.7 vs. 14.8 min; p<0.001, respectively) as was LOS (5 vs. 4.3; p = 0.05). Patients in the fellow group had a higher blood loss (491.8 vs.409.6 ml ; p = 0.01) but this had no impact on the transfusion rate (14 vs. 11%; p =0.43). Positive surgical margin rates were similar between expert and fellow groups (6.9 vs. 5.8%; p = 0.78). The major complications rate was higher in the fellow group (12%) but this difference did not reach statistical significance (p= 0.12). In multivariable analysis, fellow involvement was predictive of increased WIT ([beta]=0.21;p<0.004) and OT ([beta]=0.49;p<0.0001) but was not associated with LOS ([beta]=0.12, p=0.11). CONCLUSIONS Fellows involvement in RAPN is associated with increased OT and WIT. However, it does not adversely affect complication rates or surgical margins. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e781 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Zine-Eddine KHENE More articles by this author Benoit Peyronnet More articles by this author Elise Bosquet More articles by this author Benjamin Pradère More articles by this author Gregory Verhoest More articles by this author Romain Mathieu More articles by this author Solène-Florence Kammerer-Jacquet More articles by this author Nathalie Rioux-Leclercq More articles by this author Karim Bensalah More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Fast-track recovery technique applied to primary total hip and knee replacement surgery. Analysis of costs and complications

PurposeTo determine the cost reduction and complication rates of using an enhanced recovery pathway (Fast-track) when compared to traditional recovery in primary total hip replacement (THR) and total knee replacement (TKR), as well as to determine if there were significant differences in complication rates. Materials and methodsRetrospective review of 100 primary total arthroplasties using the Fast-track recovery system and another 100 using conventional recovery. Gender, Charlston comorbidity index, ASA score, length of stay and early complications were measured, as well in-hospital complications and those in the first six months, re-admissions and transfusion rates. The total and daily cost of stay was determined and the cost reduction was calculated based on the reduction in the length of stay found between the groups. ResultsBoth groups where comparable as regards age, gender, ASA score, and Charlston index. The mean reduction in length of stay was 4.5 days for TKR and 2.1 days for THR. The calculated cost reduction was 1266euros for TKR and 583euros for THR. There were no statistically significant differences between groups regarding in-hospital complications, transfusion requirements, re-admissions and complication rates in the first six months. DiscussionThere are few publications in the literature reviewed that analyse the cost implications of using fast-track recovery protocols in arthroplasty. Several published series comparing recovery protocols found no significant differences in complication rates either. The use of a fast-track recovery protocol resulted in a significant cost reduction of 1266euros for the TKR group and 583 for the THR group, without affecting complication rates.

Patient, tumour and treatment factors affect complication rates in soft tissue sarcoma flap reconstruction in a synergistic manner

IntroductionFlap reconstruction plays an essential role in the management of soft tissue sarcoma, facilitating wide resection while maximizing preservation of function. The addition of reconstruction increases the complexity of the surgery and identification of patients who are at high risk for post-operative complications is an important part of the preoperative assessment. This study examines predictors of complications in these patients. Methods294 patients undergoing flap reconstruction following sarcoma resection were evaluated. Data on patient, tumour and treatment variables as well as post-operative complications were collected. Bivariate and multivariate regression analysis was performed to identify independent predictors of complications. Analysis of synergistic interaction between key patient and tumour risk factors was subsequently performed. ResultsA history of cerebrovascular events or cardiac disease were found to be the strongest independent predictors of post-operative complications (OR 14.84, p = 0.003 and OR 5.71, p = 0.001, respectively). Further strong independent tumour and treatment-related predictors were high grade tumours (OR 1.91, p = 0.038) and the need for additional reconstructive procedures (OR 2.78, p = 0.001). Obesity had significant synergistic interaction with tumour resection diameter (RERI 1.1, SI 1.99, p = 0.02) and high tumour grade (RERI 0.86, SI 1.5, p = 0.01). Comorbidities showed significant synergistic interaction with large tumour resections (RERI 0.91, SI 1.83, p = 0.02). ConclusionPatient, tumour and treatment-related variables contribute to complications following flap reconstruction of sarcoma defects. This study highlights the importance of considering the combined effect of multiple risk factors when evaluating and counselling patients as significant synergistic interaction between variables can further increase the risk of complications.

Técnica de recuperación acelerada (fast-track) aplicada a cirugía protésica primaria de rodilla y cadera. Análisis de costos y complicaciones

PurposeTo determine the cost reduction and complication rates of using an enhanced recovery pathway (Fast-track) when compared to traditional recovery in primary total hip replacement (THR) and total knee replacement (TKR), as well as to determine if there were significant differences in complication rates. Material and methodsRetrospective review of 100 primary total arthroplasties using the Fast-track recovery system and another 100 using conventional recovery. Gender, Charlston comorbidity index, ASA score, length of stay and early complications were measured, as well in-hospital complications and those in the first six months, re-admissions and transfusion rates. The total and daily cost of stay was determined and the cost reduction was calculated based on the reduction in the length of stay found between the groups. ResultsBoth groups where comparable as regards age, gender, ASA score, and Charlston index. The mean reduction in length of stay was 4.5 days for TKR and 2.1 days for THR. The calculated cost reduction was 1266 euros for TKR and 583 euros for THR. There were no statistically significant differences between groups regarding in-hospital complications, transfusion requirements, re-admissions and complication rates in the first six months. DiscussionThere are few publications in the literature reviewed that analyse the cost implications of using fast-track recovery protocols in arthroplasty. Several published series comparing recovery protocols found no significant differences in complication rates either. The use of a fast-track recovery protocol resulted in a significant cost reduction of 1266 euros for the TKR group and 583 for the THR group, without affecting complication rates.

Early Stage Results in the Treatment of Intra-Articular Calcaneus Fractures and the Factors Affecting Complication Rates

Early Stage Results in the Treatment of Intra-Articular Calcaneus Fractures and the Factors Affecting Complication Rates

Effect of Patient Age on Outcomes in Breast Reconstruction: Results from a Multicenter Prospective Study

Although >40% of new breast cancer diagnoses in the US are in older women, few studies have assessed the outcomes of post-mastectomy reconstruction in this population. Our objective was to evaluate age effects on postoperative complications and patient-reported outcomes in women undergoing breast reconstruction, and to investigate whether age effects differ between reconstructive procedure types. Eligible patients in the Mastectomy Reconstruction Outcomes Consortium study from 11 institutions (57 providers) in North America were analyzed. Two-year complications and patient-reported outcomes via BREAST-Q domains were compared across younger (younger than 45years), middle-aged (45 to 60 years), and older (older than 60 years) women. Mixed-effects regression models were used, controlling for a range of demographic and clinical covariates. A total of 1,531 patients were studied: 494 younger, 803 middle-aged, and 234 older. Age was not a significant predictor of complications. For sexual well-being 2 years post-reconstruction, older women reported 4.25 (p= 0.04) higher mean scores with implant procedures, and 10.39 (p < 0.01) higher mean scores with autologous procedures compared with younger women. No age effect was seen with implant procedures with regard to physical and psychosocial well-being; however, older women who underwent autologous procedures reported 6.07 (p < 0.01) higher physical, and 8.21 (p < 0.01) higher psychosocial well-being scores than younger women. Age did not significantly affect complication rates. Older women demonstrated higher sexual well-being for both procedures, and better satisfaction and physical and psychosocial well-being than younger women with autologous procedures. Post-mastectomy reconstruction is a viable option for older patients, with risks and benefits comparable with those in younger women.

Factors impacting complication rates for catheter ablation of atrial fibrillation from 2003 to 2015.

Complications from catheter ablation for atrial fibrillation (AF) are well described. Changing aspects of AF ablation including patient populations referred, institutional experience, and emerging catheter and pharmacological options may impact complication rates. We assessed procedural complication trends in AF ablation patients from 2003–2015 to identify what factors affect adverse event rates. We evaluated consecutively enrolled patients undergoing initial AF ablation from 2003 through 2015. Statistical analyses were performed to identify predictors of increased risk for major complications, which were defined as death, stroke, atrio-oesophageal fistula, phrenic nerve injury, cardiovascular events requiring blood transfusions or procedural interventions, or non-cardiovascular events requiring intervention. A total of 1475 patients (mean age 59.5 ± 10.5, 82% male) were evaluated. Major complications occurred in 3.9% (n = 58) of cases, including vascular access-site haematoma (1.3%), cardiac tamponade (1.1%), and cerebrovascular accident (CVA) (0.9%). Univariate analysis revealed increased risk of complications associated with hypertension (P = 0.048), CHA2DS2VASc score ≥1 (P = 0.015), and early institutional experience (P = 0.003). Populations with higher CHA2DS2VASc scores underwent AF ablation more frequently over time (P < 0.001). Novel catheters and anticoagulants did not appreciably affect complication rates. Multivariate analysis adjusting for hypertension, CHA2DS2VASc score, and institutional experience showed that higher CHA2DS2VASc score and early institutional experience were independent predictors of adverse events. Patient characteristics reflected in CHA2DS2VASc scoring and early institutional experience predict increased complication rates following AF ablation. Despite more patients with higher CHA2DS2VASc scores undergoing AF ablation, complication rates fell over time as institutional experience increased.

Factors affecting complication rates of retrograde flexible ureterorenoscopy: analysis of 1571 procedures-a single-center experience.

To evaluate the factors affecting complication rates of flexible ureteroscopy and laser lithotripsy (FURSL). Data on a total of 1395 patients, with 1411 renal units underwent 1571 procedures with FURSL for renal and/or proximal ureteral stones between April 2012 and January 2016, were retrospectively analyzed. Complications were assessed using the Satava and modified Clavien systems. Univariate and multivariate analyses were done to determine predictive factors affecting complication rates. The mean patient age in the total procedures was 45.68±14.00years (range 2-86years), and the mean stone size was 15.15±8.32mm (range 5-75mm). The overall success rate was 95.6%. A total of 209 (13.3%) cases suffered from complications with intraoperative complications rates of 5.9% and postoperative complication rates of 7.3%. Univariate analysis revealed no significant difference in complication rates in respect of age, gender, body mass index, use of ureteral access sheath, operation time, bleeding disorder, solitary kidney, preoperative stenting, American Society of Anesthesiologists score, repeated procedure or location of stones (all p value >0.05). Complication rates were determined to be significantly affected by stone size (p=0.026), multiplicity (p=0.028) and the presence of congenital renal abnormality (p<0.01). The only significant factor in multivariate analysis was the presence of congenital renal abnormalities (p=0.02). The results of the current study indicated that stone size, stone number and the presence of congenital renal abnormalities were factors affecting complication rates after FURSL, although congenital renal abnormality was the only independent predictor among these risk factors.

Post-operative medical and surgical complications after primary total joint arthroplasty in solid organ transplant recipients: a case series.

In a series of solid organ transplant (SOT) recipients who underwent a subsequent primary total joint arthroplasty (TJA) procedure, this study aimed to determine: (1) 90-day morbidity and mortality after primary total knee or hip arthroplasty (TKA and THA), (2) overall post-operative infection rates, and (3) how complication and infection rates compared across primary TJA procedure and type of transplant organ. The University of Michigan Health System database was retrospectively searched using current procedural terminology codes for any primary TKA or THA performed at the institution in years 2000-2012 in a patient who previously received a successful SOT at any hospital. The search yielded 44 arthroplasties performed in 29 SOT recipients (average age 54.8 years, average follow-up about 30 months for both groups). No deaths were reported, but 13/27 (48.1%) THA patients and 2/6 (33.3%) TKA patients experienced a total of 29 complications within 90 days of surgery. One patient (3.7%) [1/27 patients, 1/37 joints] underwent revision hip arthroplasty to correct limb length. One THA patient and two TKA patients developed infection requiring revision surgery (3.7% and 33%, respectively). Type of transplant did not affect complication rates (P=0.65), and infection was more common after TKA (P=0.01). A series of SOT recipients demonstrated increased rates of infection and other complications following TJA. Surgical and medical teams should work closely to optimize this population for TJA surgery and minimize peri-operative complications. Level IV, Prognostic Case-Series.

Quantification of the Effect of Diabetes Mellitus on Ventral Hernia Repair: Results from Two National Registries

Two national databases were analyzed to determine the effect of varying severity of diabetes mellitus (DM) on ventral hernia repair (VHR) outcomes. The National Surgical Quality Improvement Program (NSQIP) and the National Inpatient Sample (NIS) were queried for patients with and without DM who underwent elective VHR between 2005 to 2012 and 1998 to 2011, respectively. In addition, patients with insulin dependent versus noninsulin-dependent DM were compared in NSQIP; complicated and uncomplicated diabetics were compared in NIS. Univariate and multivariate analyses were used. In NSQIP, 25,819 of 219,625 patients undergoing VHR were diabetic. In open VHR (OVHR), DM patients had an increased complication rate (P < 0.0001); DM patients requiring insulin had increased odds of wound, minor, and major complications (P < 0.0001). For laparoscopic VHR (LVHR), insulin dependence did not affect complication rates (P > 0.05). In NIS, 45,248 of 238,627 patients undergoing VHR were diabetic. In OVHR, patients with complicated diabetes had higher rates of minor complications (17.3% vs 12.7%, P < 0.0001) and had 58 per cent greater odds of major complications than patients with uncomplicated diabetes. LVHR had no difference in complications for complicated versus uncomplicated DM (P > 0.05). After multivariate analysis, insulin-dependent or complicated DM undergoing OVHR had significantly worse outcomes compared with noninsulin-dependent and uncomplicated diabetics. Preoperative optimization and LVHR should be considered in diabetic patients.