Difference In Operative Rate Research Articles

Operative outcomes and fracture patterns in dysmorphic sacrums

IntroductionSacral dysmorphism has been previously reported to occur in 30 % to 40 % of adult patients. It has been described by 6 widely accepted parameters on outlet x-ray views of the pelvis: steep alar slope, retained S1-S2 disk, presence of mamillary bodies, sacralized L5, tongue in groove SI joint, and non-round neural foramina. Studies have focused on the importance of identifying dysmorphism for safe treatment of fractures in pelvises with dysmorphic upper sacral segments. Less is known regarding whether dysmorphism may be protective against trauma. To our knowledge no studies have focused on how dysmorphic sacrums fracture compared to non-dysmorphic (ND) sacrums, and whether operative rates are different. AimsTo assess the rate of operative fixation of sacral fractures between pelvises with dysmorphic and ND sacrums, as well as whether a difference exists in fracture morphology between groups. Design/MethodsThis is a retrospective cohort study out of a single level 1 trauma center. Study participants consisted of those sustaining a pelvic ring injury who were 18 years or older in which orthopaedics was consulted, had CT imaging available, and did not have isolated acetabulum fractures. 355 subjects were included of 671 reviewed pelvic ring injuries. Sacrums were deemed dysmorphic if they met at least one of the six dysmorphic features, and it was determined whether they underwent operative intervention. Fracture classifications and patterning were identified on CT imaging. P values were set <0.05. ResultsWe found that 44 % of inclusions had a dysmorphic sacrum with the most common feature to be a steep alar slope (68 %). 17.17 % of subjects with a ND sacrum underwent treatment versus 16.56 % for dysmorphic sacrums. No statistical difference regarding operative fixation rates was uncovered (p = .879). However, we found a difference in fracture patterns regarding ipsilateral posterior SI joint widening (p = 0.020). ConclusionOur study suggests that sacral dysmorphism is not protective against operative fixation based on no difference in operative rates between groups. However, our data supports that pelvises with dysmorphic sacrums may fracture differently based on the difference observed regarding other pelvic ring injuries.

Clinical utility of a microRNA classifier in cytologically indeterminate thyroid nodules with RAS mutations: A multi-institutional study

BackgroundMolecular testing guides the management of cytologically indeterminate thyroid nodules. We evaluated the real-world clinical benefit of a commercially available thyroid mutation panel plus microRNA risk classifier in classifying RAS-mutated nodules. MethodsWe performed a subgroup analysis of the results of molecular testing of Bethesda III/IV nodules using the ThyGenX/ThyGeNEXT–ThyraMIR platform at 3 tertiary-care centers between 2017 and 2021, defining a positive result as 10% or greater risk of malignancy. ResultsWe identified 387 nodules from 375 patients (70.7% female, median age 59.3 years) who underwent testing. Positive nodules (32.3%) were associated with increased surgical intervention (74.4% vs 14.9%, P < .0001) and carcinoma on surgical pathology (46.4% vs 3.4%, P < .0001) compared to negative modules. RAS mutations were the most common mutations, identified in 71 of 380 (18.7%) nodules, and were classified as ThyraMIR– (28 of 71; 39.4%) or ThyraMIR+ (43 of 71; 60.6%). Among RAS-mutated nodules, there was no significant difference in operative rate (P = .2212) or carcinoma diagnosis (P = .6277) between the ThyraMIR+ and ThyraMIR– groups, and the sensitivity, specificity, negative predictive value, and positive predictive value of ThyraMIR were 64.7%, 34.8%, 40.0%, and 59.5%, respectively. ConclusionAlthough testing positive is associated with malignancy in surgical pathology, the ThyraMIR classifier failed to differentiate between benign and malignant RAS-mutated nodules. Diagnostic lobectomy should be considered for RAS-mutated nodules, regardless of microRNA expression status.

Socioeconomic status does not change decision-making in the treatment of distal radius fractures at a level 1 trauma center.

To compare operative rates, total hospital charges, and length of stay between different socioeconomic cohorts in treating distal radius fractures (DRFs). A retrospective cohort study. Large public level 1 trauma center. A retrospective search of all trauma activations over a 7-year period (2013-2020) yielded 816 adult patients diagnosed with DRF. Patients were separated into cohorts of socioeconomic status based on 2010 US Census data and insurance status. DRFs were treated either nonoperatively using closed reduction and splinting or operatively using open reduction and internal fixation, closed reduction percutaneous pinning, or external fixator application. Operative rates of DRF, total hospital charges, and length of stay. Patients who were uninsured or in the low-income socioeconomic cohort had no significant difference in operative rates, total hospital costs, or length of stay when compared with their respective insured or standard income groups. Younger patients and those with OTA/AO type C, bilateral, or open DRFs were more likely to undergo operative intervention. This study demonstrates that low socioeconomic status based on annual household income and insurance status was not associated with differences in operative rates on DRFs, length of stay, or total hospital charges. These results suggest that outcome disparities between groups may be caused by postoperative differences rather than treatment decision-making. Although this study investigates access to surgical care at a publicly funded level 1 trauma center, disparities may still exist in other models of care. Prognostic Level III.

Evaluation of Pediatric Facial Fracture Patients during the COVID-19 Pandemic

Background: The COVID-19 pandemic has significantly impacted the provision of health care, including the suspension of elective and nonessential surgeries. This study presents an early effect of the COVID-19 pandemic on the surgical care of pediatric patients with facial fractures. Methods: This study presents a retrospective cohort study of pediatric patients with facial fractures who presented to a pediatric level I trauma center before and during the pandemic. Patients were included regardless of treating specialty, treatment modality, or inpatient status. Results: One hundred nine patients met the inclusion criteria. There were 70 patients in the pre-pandemic cohort and 39 in the pandemic cohort. Mean age in the pre-pandemic cohort was 11.6 ± 4.5 years old and 11.1 ± 4.7 in the pandemic cohort ( P = .623). Majority of patients during the pandemic were female (59%), compared to the predominantly male pre-pandemic cohort (25.7%). Motor vehicle accidents were the most common cause of injury during the pandemic (n = 16, 41.0%), compared to sports in pre-pandemic (n = 21, 30.0%). The most common fracture during the pandemic was nasal fracture (n = 26, 66.7%), which was also the most common fracture in pre-pandemic cohort (n = 59, 84.3%). There were significantly more skull fractures (17.9%, P = .02) and orbital fractures (23.1%, P = .02) during the pandemic, as well as more hospital (33.0%, P = .004) and ICU admissions (17.9%, P = .018). There was no difference in operative rate during the pandemic (41.0%) compared to pre-pandemic (48.6%, P = .449). Conclusions: The COVID-19 pandemic caused a global stoppage of sports and outdoor activities. As a result, more of the fractures that presented to the hospital were due to motor vehicle accidents during the pandemic, leading to proportionally greater rates of admissions and neurological associated injuries.

Facial Fractures Have Similar Outcomes When Managed by Either Otolaryngology or Plastic Surgery: Encounters From a Single Level I Trauma Center.

Retrospective cohort. Traumatic facial fractures (FFs) often require specialty consultation with Plastic Surgery (PS) or Otolaryngology (ENT); however, referral patterns are often non-standardized and institution specific. Therefore, we sought to compare management patterns and outcomes between PS and ENT, hypothesizing no difference in operative rates, complications, or mortality. We performed a retrospective analysis of patients with FFs at a single Level I trauma center from 2014 to 2017. Patients were compared by consulting service: PS vs. ENT. Chi-square and Mann-Whitney-U tests were performed. Of the 755 patients with FFs, 378 were consulted by PS and 377 by ENT. There was no difference in demographic data (P > 0.05). Patients managed by ENT received a longer mean course of antibiotics (9.4 vs 7.0 days, P = 0.008) and had a lower rate of open reduction internal fixation (ORIF) (9.8% vs. 15.3%, P = 0.017), compared to PS patients. No difference was observed in overall operative rate (15.1% vs. 19.8%), use of computed tomography (CT) imaging (99% vs. 99%), time to surgery (65 vs. 55 hours, P = 0.198), length of stay (LOS) (4 vs. 4 days), 30-day complication rate (10.6% vs. 7.1%), or mortality (4.5% vs. 2.6%) (all P > 0.05). Our study demonstrated similar baseline characteristics, operative rates, complications, and mortality between FFs patients who had consultation by ENT and PS. This supports the practice of allowing both ENT and PS to care for trauma FFs patients, as there appears to be similar standardized care and outcomes. Future studies are needed to evaluate the generalizability of our findings.

Abstract A105: Racial disparities in reasons for not receiving surgery for gastrointestinal cancer

Abstract Introduction: Differences in rates of surgery performed for gastrointestinal (GI) cancers contribute to racial disparities in cancer mortality. The National Cancer Database (NCDB) contains data obtained from Commission on Cancer-accredited hospital cancer registries and collects reasons for nonreceipt of surgery as a registry item. This study aims to examine whether racial disparities exist in this provided reason for not receiving surgery. Methods: The NCDB was used to obtain data for patients diagnosed with gastric, pancreatic, and colorectal cancer in years 2004-2015. Analysis was limited to patients who were Black or White, and cancers stages 1-3. Unadjusted and adjusted differences between Black and White patients were examined for all variables in the model. Variables included demographics, receipt of surgery, reason for not having surgery, tumor stage and characteristics, and hospital factors. Reasons for patients' not receiving surgery were evaluated with Generalized Linear Modeling regression to see if certain responses, such as “contraindicated due to patient risk factors,”, “not part of the planned first course treatment,” and “refused by the patient” were more frequently assigned to Black compared to White patients. Results: 540,205 patients with stage 1-3 gastrointestinal cancer were included in the study. 43% of the cohort had colon cancer, 24% rectal cancer, 11% gastric cancer, and 22% pancreatic cancer. For stage 1-3 disease, the raw operative rate for Black patients was 0.3%, 6.6%, 2.0%, and 6.7% lower than in White patients for stomach, pancreas, colon, and rectum cancers, respectively. These gaps widened when adjusted for age, comorbidities, and stage. On multivariate regression, Black patients were more likely to be recorded as being denied surgery due to patient risk factors even after controlling for age, stage, comorbidities, tumor characteristics, demographics, and hospital factors: OR 1.03 (95% CI 0.91-1.16), 1.25 (1.18-1.33), 1.43 (1.22-1.66), 1.63 (1.41-1.88) for stomach, pancreas, colon, and rectum cancer, respectively. Similarly, Black patients were more likely to reportedly not receive surgery due to surgery “not being the first course of treatment”: OR 0.99 (0.93-1.05), 1.14 (1.09-1.19), 1.30 (1.21-1.39), 1.33 (1.26-1.41). These two factors explain more than 80% of the difference in operative rates. Lastly, Black patients were disproportionately more likely to be recorded as having refused surgery: OR 1.84 (1.61-2.12), 1.07 (0.96-1.19), 1.59 (1.45-1.75), 1.81 (1.61-2.02). Conclusion: Compared to White patients, Black patients are more likely to be described as not receiving surgery due to patient risk factors, surgery not being part of their first course of treatment, and their having refused surgery. Further studies are needed to evaluate whether the differences in operative rates are attributable to factors not captured in cancer registries, such as frailty and lack of social support. Citation Format: John Bliton, Michael Parides, John McAuliffe, Peter Muscarella, Haejin In. Racial disparities in reasons for not receiving surgery for gastrointestinal cancer [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A105.

Abstract D105: Differences in receipt of surgery contribute to survival disparities in esophageal and gastric cancers

Abstract Introduction: Mortality disparities for gastrointestinal cancers are well described. Differences in rates of surgery across race and ethnicity may contribute to this phenomenon. In order to evaluate this, we assessed the extent to which the mortality disparity among racial/ethnic groups for gastrointestinal cancers are due to differences in operative rates. Methods: Data for patients with stage I-III esophageal and gastric cancer diagnoses between 2004-2015 were obtained from National Cancer Database. Cancers were categorized in 3 groups: mid-esophageal (ME) cancers, distal third of esophagus and cardia gastric cancers (DEC), and non-cardia gastric (NCG) cancers. Variables included demographics, receipt of surgery, tumor stage and characteristics, and hospital factors. The racial disparity in survival was measured as the hazard ratio (HR) for Black, Latinx, and Asian/Pacific Islander patients compared to White patients. A mediation analysis was performed to quantify the contribution of variables to the observed disparity between minority and White patients. The magnitude of the contributions was estimated using two methods: the change in HR with (1) the addition of each variable of interest to a model only adjusted by age and year, and (2) the removal of each variable from a multivariate model that included all variables. Factors associated with undergoing surgery were also examined using a logistic regression model. Results: A total of 124,862 patients were included (20,852 with ME, 74,427 with DEC, and 29,583 with NCG). Black patients were more likely to be from lower-income and urban areas and had lower operative rates in all cancers. The observed HRs for Black patients compared to White patients were 1.42 (95% CI 1.36-1.49) for ME, 1.36 (1.31-1.43) for DEC and 1.01 (0.97-1.05 – no observed disparity) for NCG tumors, adjusting for age and year of diagnosis. Only Black race/ethnicity was associated with a mortality disadvantage compared to White patients. Without adjustment for any additional variables, receipt of surgery accounted for more than half of the observed survival disparity for tumors of the esophagus and cardia (ΔHRs for ME: 0.27, DECS: 0.25 and NCG: 0.07). After adjustment for tumor, patient and hospital factors, receipt of surgery remained the single strongest contributor to the Black/White disparity in survival for all cancers (ΔHRs for ME: 0.070, DEC: 0.091 and NCG: 0.07). On logistic regression, Black patients were less likely to have received surgery after adjusting for other variables compared to White patients (ME aOR: 0.41 (0.37-0.46), DECS aOR: 0.42 (0.39-0.46), and NCG aOR: 0.79 (0.73-0.86)). Conclusions: Observed survival disparities in upper GI cancers may be due to fewer surgeries being performed for Black patients. Addressing differences in receipt of surgery for stage I through III esophageal and proximal stomach cancer has potential to mitigate cancer mortality disparities. Citation Format: John Bliton, Peter Muscarella, Michael Parides, Katia Papalezova, John McAuliffe, Haejin In. Differences in receipt of surgery contribute to survival disparities in esophageal and gastric cancers [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D105.

Abstract A104: Racial disparities in receipt of cancer surgery contribute to worse outcomes for patients with gastrointestinal cancers

Abstract Introduction: Mortality disparities exist in gastrointestinal (GI) cancers among racial/ethnic groups. One potential contributor to this disparity is a gap in who receives surgery. We aim to examine how much of the mortality disparity among racial/ethnic groups for GI cancers is explained by differences in operative rates. Methods: The National Cancer Database was used to obtain data from patients diagnosed with gastric, pancreatic, and colorectal cancer in 2004-2015. Descriptive statistics were used to compare raw differences for variables among races. Variables included demographics, receipt of surgery, tumor stage and characteristics, and hospital factors. The racial disparity in survival was measured as the hazard ratio (HR) for each minority compared to White patients, controlling for age and year in Cox regression. The contributions of the variables, including surgical resection, to the racial disparities were estimated by measuring how inclusion of each of these variables affected the HRs of minorities compared to White patients. The magnitudes of the contributions to the HRs were estimated using two methods: (1) the addition of each variable to the age- and year-controlled model, and (2) the serial removal of each variable from a multivariate model that included all variables. The main analysis was performed excluding patients with unknown stage or disseminated cancer. Results: 1.47 million patients with GI cancer were included in the study: 52% colon, 11% gastric, 21% pancreatic, and 16% rectal. Black patients were more likely to be from lower-income areas, from urban areas, and had lower operative rates in all cancers except gastric cancer. On Cox regression of stage 1-3 disease controlling for age and year of diagnosis, the HRs for Black patients compared to White patients were 1.01 (95% CI 0.97- 1.03), 1.11 (1.09-1.13), 1.22 (1.19-1.24), and 1.28 (1.24-1.32) for stomach, pancreas, colon, and rectum tumors, respectively. Based on the multivariate regression, the factors with the greatest influence on the survival disparity were zip income quartile and receipt of surgery. Receipt of surgery independently accounted for 29%, 11%, and 19% of the survival disadvantage observed in Black compared to White patients for pancreas, colon, and rectum cancer. Zip income quartile accounted for 16%, 18%, and 17%, excluding interactions. In contrast, no gap in operative rates or overall survival was observed for stomach cancer. The significance of surgery to outcomes was most pronounced for pancreatic cancer, where adding receipt of surgery to the age- and year-controlled model reduced the HR from 1.11 to 0.99; for colon and rectal cancer the HR changed from 1.22 to 1.15 and from 1.28 to 1.17. Conclusion: Part of the observed cancer disparities for Black patients may be due to fewer surgeries being performed for Black patients. Correcting the disparities on the receipt of surgery for stage I through III GI cancer would likely have a large impact on mortality disparities. Citation Format: John Bliton, Michael Parides, John McAuliffe, Peter Muscarella, Haejin In. Racial disparities in receipt of cancer surgery contribute to worse outcomes for patients with gastrointestinal cancers [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A104.

Proximal Humerus Fractures in the Elderly: Concomitant Fractures and Management

The purpose of this study was to identify additional injuries commonly seen with proximal humerus fractures experienced by patients 65 years or older and to evaluate discrepancies in the management of these patients with regard to provider type. A retrospective review was conducted of all patients 65 years or older who sustained a proximal humerus fracture. Patient data collected included demographics, injury details, hospital course, and discharge destination. Patients with a concomitant fracture (45.5%, n = 65) had a slightly higher Injury Severity Score (ISS; 8.3 ± 3.0 vs. 6.4 ± 3.0, p < 0.001) and experienced one additional death than those with an isolated fracture (54.5%, n = 78). Slightly more patients were managed by a trauma provider (51.7%, n = 74) than by a non-trauma provider (48.3%, n = 69). Those managed by a trauma provider sustained the most pelvic fractures (12.2% vs. 2.9%, p = 0.038), were more likely to be injured in a motor vehicle collision (8.1% vs. 0%, p = 0.005), had a higher ISS (8.0 ± 3.3 vs. 6.4 ± 2.8, p = 0.003), and had more imaging performed than those treated by a non-trauma provider. There was, however, no difference in operative rates, concomitant injuries, length of stay, or discharge disposition regarding provider type. It is important to recognize proximal humerus fractures as a sign of fragility and to optimize hospital management of these patients.

Adult parapharyngeal and retropharyngeal abscesses:clinical features and their implications for treatment strategy

Objective:To identify the clinical risk factors related to the increased likelihood of surgical drainage and medical therapy failure in parapharyngeal and retropharyngeal abscess. Method:The charts of 93 consecutive patients from January 2006 to April 2017 with parapharyngeal and retropharyngeal abscess were reviewed retrospectively. Logistic regression analysis was used to study the clinical risk factors.Result:A total of 97 adult patients, there were 34 cases in the immediate surgical drainage group and 32 cases in the delayed surgical drainage group and 31 cases treated with medical therapy alone. The rate of operation therapy was 68%,and the success rate of the medical therapy alone was 32%. All patients had successful resolution of their abscesses by medical therapy and(or) surgical drainage. The average length of stay(17.26d) in the surgical drainage group was longer than the medical therapy group(10.26 d), and the difference was statistically significant(P<0.001).The maximum dimension of abscess＞2.37cm is not only the risk factor of increasing likelihood of surgical drainage, but also that of medical therapy failure(P<0.001, P<=0.002).The factors affecting the hospitalization day were whether or not the operation was performed. There was no significant difference in operative rate between diabetic group and nondiabetic group(χ2=0.523,P>0.05).There were no correlation between diabetes mellitus and the multiple space abscesses(r=-0.032,P<=0.760).Conclusion:Although a majority of adult parapharyngeal and retropharyngeal abscesses were treated with surgical drainage and sufficient effective intravenous antibiotics,but not all patients need surgical treatment. The diameter of the abscess is a risk factor affecting the operation or not.For those with larger abscesses,the preoperative preparation should be actively prepared and the operation should be intervened as early as possible;for those with smaller abscess,the treatment can be cured alone, and the surgical incision and drainage should be avoided in order to reduce the complications and shorten the hospital days.

Efficacy of Gastrografin® Compared with Standard Conservative Treatment in Management of Adhesive Small Bowel Obstruction at Mulago National Referral Hospital.

The treatment of adhesive small bowel obstruction is controversial, with both operative and non-operative management practiced in different centers worldwide. Non-operative management is increasingly getting popular, though operative rates still remain high. A study to compare the efficacy of an oral water-soluble medium (Gastrografin®) with standard conservative management, both non-operative methods, in the management of this condition was conducted in a tertiary Sub Saharan hospital. An open randomised controlled clinical trial was conducted between September 2012 and March 2013 at Mulago National Referral and Teaching Hospital, Uganda. Fifty patients of both genders, with adhesive small bowel obstruction, in the hospital's emergency and general surgical wards were included. Randomisation was to Gastrografin® and standard conservative treatment groups. The primary outcomes were: the time interval between admission and relief of obstruction, the length of hospital stay, and the rates of operative surgery. All 50 recruited patients were followed up and analysed; 25 for each group. In the Gastrografin® group, 22 (88%) patients had relief of obstruction following the intervention, with 3 (12%) requiring surgery. The conservative treatment group had 16 (64%) patients relieved of obstruction conservatively, and 9 (36%) required surgery. The difference in operative rates between the two groups was not statistically significance (P = 0.67). Average time to relief of obstruction was shorter in the Gastrografin® group (72.52 hrs) compared to the conservative treatment group (117.75 hrs), a significant difference (P = 0.023). The average length of hospital stay was shorter in the Gastrografin® group (5.62 days) compared to the conservative treatment group (10.88 days), a significant difference (P = 0.04). The use of Gastrografin® in patients with adhesive small bowel obstruction helps in earlier resolution of obstruction and reduces the length of hospital stay compared with standard conservative management. Its role in reducing the rate of laparotomies remains inconclusive.

Prevalence of Intra-abdominal Surgery: What Is an Individual’s Lifetime Risk?

The lifetime risk of intra-abdominal surgery is unknown. The objectives of this study were to derive this information from our local population, and to consider the role of incidental surgery. Over an 8-year period, 2648 autopsy and clinical records from a public and private hospital were reviewed for evidence of intra-abdominal surgery. 2262 (85%) cases were from the public hospital and 386 (15%) from the private hospital. The adjusted intra-abdominal surgical rate was 43.8% in those over the age of 60. With the exception of the age group 21-40, there were no statistical significant differences in operative rates between hospitals. The intra-abdominal surgical rate over the age of 60 was used as an estimate of the lifetime risk of intra-abdominal surgery. The lifetime risk of intra-abdominal surgery can be used to assess the utilization of healthcare among ethnic groups and in considering the role of incidental surgery.