Differences In Surgical Outcomes Research Articles

Clinical Effectiveness of Total Hip Arthroplasty Compared With Hemiarthroplasty in Adults Undergoing Surgery for Displaced Intracapsular Hip Fracture: A Single-Centre Retrospective Cohort Study.

The National Institute for Health and Care Excellence (NICE) recommends offering total hip arthroplasty (THA) over hemiarthroplasty (HA) for displaced intracapsular hip fractures, taking the premorbid functionality, present co-morbidities, and functional benefit beyond two years into account. Concerns remain whether the higher surgical burden and incidence of complications in THA would outweigh the potential benefits in the elderly. This retrospective cohort study evaluates the differences in surgical outcomes of THA vs HA in 85 patients with displaced intracapsular fractures, based on the time taken for patients to ambulate to walking frame/crutches and wheelchair post-operatively and the incidence of post-operative complications. Patients who received HA were significantly older (p<0.0001, <0.05) and had poorer pre-operative ambulatory function (p=0.032, p<0.05) than those of the THA group. HA patients had a significantly faster recovery to walking frame/crutches (20.2 days) compared to THA patients (47.3 days) (Mann-Whitney U=447.500, n=46, p=0.043, <0.05 two-tailed). While no significant differences were found in deep vein thrombosis (DVT), infected prosthesis, or dislocation incidence, hospital-acquired pneumonia (HAP) was more prevalent in THA patients (p=0.044, <0.05). Time to the walking frame had a significant effect on DVT/PE (p<0.001, <p0.05), the infected prosthesis (p=0.002, <0.05), and HAP (p=0.066, <0.05) incidence, while time to a wheelchair only affected HAP incidence (p<0.001, <0.05). HA patients showed favourable outcomes in time to ambulate post-operatively and incidence of HAP among patients with advanced age and those with poorer pre-operative ambulatory function.

Perioperative Outcomes, Comorbidities, and Complications following Total Shoulder Arthroplasty in Wheelchair Users: A Retrospective Cohort Analysis of a Nationwide Database.

Impaired shoulder function hinders the ability of wheelchair users to maintain independence. The current state of the literature delineates the risks and benefits of surgical techniques for the management of shoulder pathologies. To the best of our knowledge, there is no study that has investigated complications following total shoulder arthroplasty (TSA) in wheelchair users. Utilizing the PearlDiver Mariner national administrative database, 72,108 patients were identified who underwent TSA with a concurrent diagnosis of a rotator cuff tear. Two matched cohorts, one of wheelchair users and one of non-wheelchair users, were created. Due to limitations within PearlDiver, one-year outcomes, including comorbidity and complication rates and readmission statistics, were compared between the two cohorts. Each matched cohort of 869 patients underwent TSA with a concurrent diagnosis of a rotator cuff tear. The rate of readmission in wheelchair users was greater than in non-wheelchair users (24.05% vs. 9.55%, OR: 3.00, CI: 2.279, 3.946). Patients in the wheelchair cohort exhibited higher rates of complications and comorbidities (p < 0.001). Among the most likely to be readmitted after TSA were patients with osteoarthritis, pulmonary heart disease, rheumatoid arthritis, and hypertension (p < 0.05). Significant differences in surgical outcomes existed between wheelchair and non-wheelchair users in terms of preoperative comorbidities, postoperative complications, and readmission rates.

No Difference in Surgical Outcomes Between Stand-Alone Devices and Anterior Plating for 1-2 Level Anterior Cervical Discectomy and Fusion: A 1:1 Exact Matched Analysis.

Retrospective cohort. To compare rates of all-cause surgical and medical complications between zero-profile (ZP; stand-alone) implants versus any graft type with an anterior plate in patients undergoing 1-2 level anterior cervical discectomy and fusion (ACDF) for treatment of degenerative cervical myeloradiculopathy. Degenerative cervical myeloradiculopathy is increasingly prevalent in older adults. ACDF is a common surgical procedure for decompression of neural structures and stabilization and has been shown to have excellent outcomes. Although ACDFs performed with graft and plate have been the gold standard, more recently, ZP implants were developed to decrease implant-related complications, such as severe postoperative dysphagia. However, there is a paucity of papers comparing the surgical and medical complications profile of ZP (stand-alone) implants to grafts with plating systems. Data were extracted from the PearlDiver Mariner Database using Current Procedural Terminology codes to classify patients into 1 level, 2 levels, and a total of 1-2 level ACDFs. Patients undergoing surgery for non-degenerative pathologies such as tumors, trauma, or infection were excluded. 1:1 exact matching created 2 equal groups of 7284 patients who underwent 1-2 level ACDF with either grafting with a plate or ZP (stand-alone) implant. There were no statistically significant differences in all-cause surgical complications, pseudarthrosis rate, dysphagia, or need for revision surgery between both cohorts (risk ratio: 0.99, 95% CI: 0.80-1.21, P = 0.95). In addition, all-cause medical complications were similar between both cohorts (risk ratio: 1.07, 95% CI: 0.862-1.330, P = 0.573) or any specific surgical or medical complication included in this study. After 1:1 exact matching, the results of this study suggest that ZP (stand-alone) implants have similar outcomes compared with grafts with plating systems, with no observed differences in all-cause surgical or medical complications profile.

Does the Severity of Foraminal Stenosis Impact Outcomes of Lumbar Decompression Surgery?

To establish the relationship between the magnitude of foraminal stenosis and 1) improvement in patient-reported outcomes, 2) improvement in motor function after lumbar decompression surgery, and 3) difference in surgical outcomes. Patients who underwent one-level posterior lumbar decompression for radiculopathy were retrospectively identified. Patient demographics and surgical characteristics were collected through a query search and manual chart review of the electronic medical records. Foraminal stenosis was determined on magnetic resonance imaging and graded using Lee etal.'s validated methodology as none, mild, moderate, or severe. Surgical outcomes, motor function, and patient-reported outcome measures (PROMs) were compared based on the amount of stenosis (mild vs. moderate vs. severe). Bivariant and multivariant analyses were performed. Severe stenosis demonstrated more 90-day readmissions (0.00% vs. 0.00% vs. 8.57%, respectively, P= 0.019), though this effect did not remain significant on multivariate analysis (P= 0.068). There was no association between stenosis severity and the degree of functional impairment or PROMs preoperatively. Patients with moderate or severe preoperative foraminal stenosis showed improvement in all PROMs after surgery (P < 0.05) except the mental component of the Short Form 12 survey. Notably, central stenosis grade was insignificantly different between groups (P= 0.358). Multivariable logistic regression analysis did not identify any significant independent predictors of surgical outcomes or changes in PROMs. We demonstrated that regardless of foraminal stenosis severity preoperatively, patients have a similar improvement in PROMs, surgical outcomes, and restoration of motor function after lumbar decompression surgery for radiculopathy.

Comparison of safety and effectiveness between phacoemulsification and suture less small incision procedures in Cataract surgery

BACKGROUND &amp; OBJECTIVE: Cataract is major cause of preventable blindness, worldwide. Phacoemulsification and manual small incision are most common surgical methods of cataract. The objective of our study was to compare surgical outcomes and complications in phacoemulsification (Phaco) and manual small incision cataract surgery (MSICS) patients&#x0D; METHODOLOGY: A Prospective Observational study was conducted at Ophthalmology department of POF Hospital Wah Cantt, Pakistan. Study duration was 6 months (January 2020-June 2020). We calculated sample size of 30 cataract patients. Selection of cataract patients in OPD was done through non probability consecutive sampling technique. Afterwards, they were divided randomly into two different groups using lottery method; Group A patients cataract extraction was done with Phacoemulsification while in group B patients cataract extraction was done with small incision cataract surgery. Patients were followed for 5 weeks. Fisher-exact test and independent and paired T-test was applied to get statistically significant results. P value ≤0.05 was considered significant.&#x0D; RESULTS: Total 30 patients were included in study. There were 19(64.5%) male and 11(35.5%) female. Mean age of patients was 48.3±7.5SD. There was a significant change in pre and post operative visual acuity in both groups (Group A p=0.000 and Group B p=0.000). MSICS showed high surgery duration as compared to phacoemulsification (29.6±1.5 vs 22.2±2.1, p=0.000).&#x0D; CONCLUSION: Phacoemulsification and Manual small incision cataract surgery are safe and clinically effective surgical techniques that did not show any difference in surgical outcomes. However, Phacoemulsification is associated with less post-operative complications as compared to MSICS.

Patient, operative and pain management factors influencing inpatient compared with surgical day care mastectomy procedures at a community hospital.

The COVID-19 pandemic highlighted the importance of maximizing same-day discharge after surgery to mitigate potential patient harms associated with inpatient admission and conserve valuable hospital resources. Adoption of same-day discharge after breast surgery, particularly mastectomy, has been slow despite recent research suggesting the physical and psychological benefits of same-day discharge after surgery. We sought to identify factors associated with inpatient compared with surgical day care mastectomy procedures at a community hospital in Vernon, British Columbia. We conducted a retrospective chart review of all patients who underwent a total mastectomy without reconstruction at Vernon Jubilee Hospital, a 196-bed community hospital, between April 2016 and March 2019. Patient characteristics, operative variables and pain management were compared between inpatient and surgical day care mastectomy procedures. We also compared 7-day readmission, reoperation and complications. A total of 187 mastectomy patients were analyzed with 72 (38.5%) surgical day care procedures. Factors associated with inpatient procedures included longer operative time (66.1 min v. 53.5 min, p = 0.001), bilateral mastectomy (91% v. 9%, p = 0.01) and suspected or confirmed obstructive sleep apnea (32% v. 17%, p = 0.04). Preoperative acetaminophen (83% v. 17%, p < 0.001), multilevel intercostal block (83% v. 17%, p < 0.001) and a prescription for acetaminophen plus tramadol (58% v. 42%, p < 0.001) were associated with day care surgeries. There were no significant differences between the inpatient and surgical day care groups with respect to 7-day readmission, reoperation or postoperative complications. We found no significant differences in surgical outcomes between inpatients and those with same-day discharge after mastectomy procedures. These findings add to the growing body of evidence that surgical day care mastectomy procedures are safe in the community setting.

Is vagotomy necessary in palliative surgery for incurable advanced gastric cancer?: a retrospective case–control study

BackgroundThe interplay between the nervous system and cancer plays an important role in the initiation and progression of gastric cancer. Few studies have presented evidence that the sympathetic nervous system inhibits the occurrence and development of gastric cancer while the parasympathetic nervous system promotes the growth of gastric cancer. To investigate the effect of vagotomy, which is the resection of a parasympathetic nerve innervating the stomach, on the progression of gastric cancer, a retrospective study was conducted comparing the prognosis of simple palliative gastrojejunostomy (PGJ) and palliative gastrojejunostomy with vagotomy (PGJV).MethodsFrom January 01, 2000, to December 31, 2021, the medical records of patients who underwent PGJ or PGJV because of gastric outlet obstruction due to incurable advanced gastric cancer at the Yeungnam University Medical Center were retrospectively reviewed. Patients were divided into two groups: locally unresectable gastric cancer (LUGC) or gastric cancer with distant metastasis (GCDM), according to the reason for gastrojejunostomy, and factors affecting overall survival (OS) were analyzed.ResultsThere was no significant difference in surgical outcomes and postoperative complications between the patients with PGJV and patients with PGJ. In univariate analysis, vagotomy was not a significant factor for OS in the GCDM group (HR 1.14, CI 0.67–1.94, p value 0.642), while vagotomy was a significant factor for OS in the LUGC group (HR 0.38, CI 0.15–0.98, p value 0.045). In multivariate analysis, when vagotomy is performed together with PGJ for LUGC, the OS can be significantly extended (HR 0.25, CI 0.09–0.068, p value 0.007).ConclusionsWhen PGJ for LUGC was performed with vagotomy, additional survival benefits could be achieved with low complication risk. However, to confirm the effect of vagotomy on the growth of gastric cancer, further prospective studies using large sample sizes are essential.

Surgeon Experience Matters: An Exact Matched Analysis of TLIF Outcomes Demonstrates No Difference in Surgical Outcomes Between Experienced Neurosurgeons and Orthopedic Surgeons.

Retrospective cohort study. To compare surgical and medical complications profile between neurosurgeons and orthopedic surgeons after transforaminal lumbar interbody fusion (TLIF) procedures. Studies comparing the impact of spine surgeon specialty (neurosurgery vs. orthopedic spine) on TLIF outcomes have been inconclusive and failed to control for operative learning curves and surgical maturity. Orthopedic spine surgeons perform fewer spine procedures in residency, although these differences may be attenuated by mandatory fellowship before starting practice. Any observed differences are likely attenuated with increasing surgeon experience. Using an all-payer claims database, PearlDiver Mariner, 120 million patient records were analyzed between 2010 and 2022, to identify individuals with lumbar stenosis or spondylolisthesis who underwent index one- to three-level TLIF procedures. International Classification of Diseases-Ninth Edition (ICD-9), International Classification of Diseases-10th Edition (ICD-10) and Current Procedural Terminology (CPT) codes were used to query the database. Only Neurosurgeons and Orthopedic spine surgeons who had performed at least 250 procedures were included in the study. Patients undergoing surgery for tumor, trauma, or infection were excluded. 1:1 exact matching was performed using demographic factors, medical comorbidities, and surgical factors which were significantly associated with all-cause surgical or medical complications in a linear regression model. 1:1 exact matching created two equal groups of 18,195 patients without baseline differences who underwent TLIF procedures by neurosurgeons or orthopedic surgeons. There was no difference in all-cause surgical complications between neurosurgeons and orthopedic spine surgeons (relative risk=1.008, 95% CI: 0.850-1.195, P =0.965). All-cause medical complication rate was higher in the neurosurgery cohort (relative risk=1.144, 95% CI: 1.042-1.258, P =0.005). The results of this study suggest that after accounting for surgical maturity, neurosurgeons and orthopedic spine surgeons have similar surgical outcomes. However, neurosurgeons have higher all-cause medical complication rates compared with orthopedic spine surgeons. Further research is warranted to validate this relationship in other spine procedures and for other outcomes.

Coagulation Dysfunction in Patients with Liver Cirrhosis and Splenomegaly and Its Countermeasures: A Retrospective Study of 1522 Patients.

Patients with cirrhosis and splenomegaly often have coagulation dysfunction which affects treatment and prognosis. This study explores the status, grading, and treatment strategies of coagulation dysfunction in patients with liver cirrhosis and splenomegaly. A retrospective cohort study was conducted on the clinical data on consecutive patients with cirrhosis and splenomegaly treated at Hainan General Hospital, China, from January 2000 to December 2020. Starting research in January 2022. Among 1522 patients included into this study, 297 (19.5%) patients had normal results in all five coagulation tests (prothrombin time, prothrombin activity, activated partial thromboplastin time, thrombin time, and fibrinogen), and 1225 (80.5%) had coagulation dysfunction in at least one of these tests. There were significant differences (P < 0.05) in treatment efficacy on these patients for three of these five coagulation tests, with the exception of prothrombin activity and thrombin time. When coagulation dysfunction was classified into grades I, II, and III based on scores from the three significant coagulation tests, prothrombin time, activated partial thromboplastin time, and fibrinogen, significant differences in surgical outcomes were found among the three grades of coagulation dysfunction and between grades I and III (P < 0.05). The operative mortality rate in patients with grade III in treating liver cancer, portal hypersplenism, and/or splenomegaly was 6.5%. There was no significant difference between patients with grades I and II (P > 0.05). Approximately, 80% of patients with liver cirrhosis and splenomegaly had coagulation dysfunction. Surgery is feasible for grade I and II patients. For grade III patients, nonsurgical treatment should be given first, and surgery should only be considered when the coagulation function returns to normal or near-normal levels after treatment. This trial is registered with MR-46-22-009299.

Single-port endoscopy-assisted thyroidectomy via cervical gas-insufflation approach for papillary thyroid carcinoma: A pilot retrospective comparative study

PurposeThis study aims to investigate the safety and efficacy of our novel technique of single-port endoscopy-assisted thyroidectomy via cervical gas-insufflation approach (SPEAT, also called the Huang procedure) in the treatment of papillary thyroid carcinoma (PTC). Materials and methodsWe perform a retrospective comparative study from a prospectively maintained database. A cohort of 82 patients with PTC who underwent total thyroidectomy and central neck dissection were included. Of these patients, 48 underwent SPEAT and 34 underwent conventional open thyroidectomy (COT). The differences in surgical outcome and oncological completeness were compared. ResultsCompared with the COT group, the SPEAT group had obviously shorter incision (P < 0.001), less postoperative pain (P = 0.036), better cosmetic satisfaction (P = 0.001)and slightly longer operating time (P = 0.041). In intraoperative bleeding, postoperative drainage, postoperative hospital stay, surgical complications, number of dissected or positive lymph nodes per patient, and postoperative non-stimulated or stimulated thyroglobulin levels, there were no significant differences. ConclusionsSPEAT (the Huang procedure) is a minimally invasive, safe and oncologically complete surgical option for PTC in selected patients.

Surgical Treatment at an Academic Medical Center is Associated with Statistically Insignificant Lung Cancer Survival Outcome Differences Related to ZIP Code.

Low socioeconomic status is a well-characterized adverse prognostic factor in large lung cancer databases. However, such characterizations may be confounded as patients of lower socioeconomic status are more often treated at low-volume, non-academic centers.We evaluated whether socioeconomic status, as defined by ZIP code median income, was associated with differences in lung cancer resection outcomes within a high-volume academic medical center. Consecutive patients undergoing resection for non-small cell lung cancer were identified from a prospectively maintained database (2011-18).Patients were assigned an income value based on the median income of their ZIP code as determined by census-based geographic data. We stratified the population into income quintiles representative of SES and compared demographics (chi-square), surgical outcomes, and survival (Kaplan-Meier). We identified 1,693 patients, representing 516 ZIP codes. Income quintiles were Q1: $24,421-53,151; Q2:$53,152-73,982; Q3:$73,983-99,063; Q4:$99,064-123,842; and Q5:$123,843-250,001. Compared to Q5 patients, Q1 patients were younger (median 69 vs. 73, p < 0.001), more likely male (44 vs. 36%, p = 0.035), and more likely Asian, Black, or self-identified as other than white, Asian, or Black. (67 vs. 11%, p = < 0.001). We found minor differences in surgical outcomes and no significant difference in 5-year survival between Q1 and Q5 patients (5-year: 86 vs. 85%, p = 0.886). Surgical care patterns at a high-volume academic medical center are similar among patients from varying ZIP codes.Surgical treatment at such a center is associated with no survival differences based upon socioeconomic status as determined by ZIP code.Centralization of lung cancer surgical care to high-volume centers may reduce socioeconomic outcome disparities.

Comparison of Wiltse Approach of Pedicle Screw Fixation With or Without Vertebroplasty in the Treatment of Genant III Degree Osteoporotic Thoracolumbar Fractures: Analysis of Clinical Findings, Radiographic Parameters, and Follow-Up Complications.

A retrospective case-control study. This study aimed to compare the effects of the Wiltse approach of pedicle screw fixation (PSF) either in combination with or without vertebroplasty (VP) in the treatment of Genant III degree osteoporotic thoracolumbar fractures (Genant III-OTLFs). A retrospective study of Genant III-OTLFs was performed from January 2018 to December 2019, including 54 cases of PSF + VP and 56 cases of PSF. Clinical indicators [visual analog scale (VAS) score, Oswestry disability index (ODI)], radiographic parameters [local kyphosis angle (LKA), percentage of anterior, central, and posterior vertebral heights (AVH%, CVH%, and PVH%, respectively)] and follow-up complications [adjacent vertebral fracture (AVF), residual pain (RP), vertebral height loss (VHL), and internal fixation failure (IFF)] were compared between the 2 groups. No differences in surgical outcomes, clinical indicators, and radiographic parameters were observed between the 2 groups during the preoperation period and 7 days post-operatively (P > .05). However, the VAS score [2.0 (.6), 1.9 (.5)], ODI [23.7 (4.0), 22.6 (3.0)], LKA [9.5 (1.8), 10.6 (3.0)], AVH% [90.1 (2.7), 87.7 (6.0)], CVH% [92.5 (2.6), 91.3 (3.7)], and PVH% [93.4 (2.0), 92.7 (2.4)] at 1 year post-operatively and last follow-up of the PSF + VP group were better than those of the PSF group [2.5 (.8), 3.1 (1.1), 26.6 (3.8), 29.6 (4.6), 12.2 (1.6), 16.6 (3.2), 84.9 (4.0), 69.9 (6.6), 88.1 (3.1), 78.2 (5.1), 89.7 (2.3), 84.8 (4.6)], respectively (P < .001). During follow-up, the incidence of AVF had no difference (P > .05), while that of RP (32.1 vs 14.8%), VHL (33.9 vs 9.3%) and IFF (17.9 vs 5.6%) had statistical differences between them (P < .05). The Wiltse approach of PSF combined with VP for Genant III-OTLFs can not only effectively relieve pain, restore vertebral height, and correcte kyphosis, but also better maintain vertebral height, delay kyphosis progression, and reduce complications during follow-up.

MP07-04 OUTCOMES AND PATIENT CHARACTERISTICS FOR SACROCOLPOPEXIES PERFORMED BY UROLOGY VS GYNECOLOGY

You have accessJournal of UrologyCME1 Apr 2023MP07-04 OUTCOMES AND PATIENT CHARACTERISTICS FOR SACROCOLPOPEXIES PERFORMED BY UROLOGY VS GYNECOLOGY Rishabh Simhal, Kerith Wang, Maria D'Amico, Courtney Capella, Radhika Ragam, Yash Shah, Joon Yau Leong, Whitney Smith, Patrick Shenot, and Alana Murphy Rishabh SimhalRishabh Simhal More articles by this author , Kerith WangKerith Wang More articles by this author , Maria D'AmicoMaria D'Amico More articles by this author , Courtney CapellaCourtney Capella More articles by this author , Radhika RagamRadhika Ragam More articles by this author , Yash ShahYash Shah More articles by this author , Joon Yau LeongJoon Yau Leong More articles by this author , Whitney SmithWhitney Smith More articles by this author , Patrick ShenotPatrick Shenot More articles by this author , and Alana MurphyAlana Murphy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003222.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Sacrocolpopexies (SCP) are performed by both urologists and gynecologists; however, the majority are performed by gynecologists. We aim to elucidate if there is a difference in patient demographics and surgical outcomes based on surgeon specialty. METHODS: Open and minimally invasive SCPs performed between 2006-2020 were identified in the American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database using CPTs 57280 and 57425. Frailty was calculated using the NSQIP modified frailty index (mFI-5), a previously validated 5-item score including points for diabetes, functional status, chronic obstructive pulmonary disease, heart failure, and hypertension, and the revised surgical Risk Analysis Index (RAI-rev), a validated score which accounts for patient comorbidities, age, and functional status. Univariate analysis was performed using student’s t-test and Pearson’s chi-square to compare operative parameters, patient frailty and demographics, surgical outcomes, and mortality. RESULTS: We identified 8,944 SCPs from 2006-2020. Gynecology performed 81% of cases, and urology performed 19% (p<.001). Urologists tended to perform more minimally invasive cases compared to gynecologists (84% vs 77%, p<.001). Between urologists and gynecologists, there were no significant differences in surgical outcomes, minor complications (surgical site infection, pneumonia, urinary tract infection, bleeding, or acute kidney injury), major complications (deep vein thrombosis, stroke, renal failure, myocardial infarction, pulmonary embolism, septic shock, deep wound infections, or cardiac arrest), 30-day reoperations, 30-day hospital readmissions, nor 30-day mortality. However, urology patients tended to be older (65 vs 61 years, p<.001) and frailer by mFI-5 (0.7 vs 0.5, p<.001, higher score indicating more frailty) and RAI-rev (19.4 vs 17.1, p<.001, higher score indicating more frailty). CONCLUSIONS: We found no difference in 30-day surgical outcomes for SCPs performed by urologists compared to gynecologists. However, urologists tend to perform more minimally invasive procedures and operate on older, more frail patients. This finding highlights differences in practice patterns between two specialties and warrants further studies. Source of Funding: n/a © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e85 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rishabh Simhal More articles by this author Kerith Wang More articles by this author Maria D'Amico More articles by this author Courtney Capella More articles by this author Radhika Ragam More articles by this author Yash Shah More articles by this author Joon Yau Leong More articles by this author Whitney Smith More articles by this author Patrick Shenot More articles by this author Alana Murphy More articles by this author Expand All Advertisement PDF downloadLoading ...

PD20-11 A NATIONAL COMPARISON OF MORBIDITY AND OPERATIVE OUTCOMES IN BLACK AND WHITE WOMEN UNDERGOING CYSTECTOMY

You have accessJournal of UrologyCME1 Apr 2023PD20-11 A NATIONAL COMPARISON OF MORBIDITY AND OPERATIVE OUTCOMES IN BLACK AND WHITE WOMEN UNDERGOING CYSTECTOMY Dhaval Jivanji, Elie Kaplan-Marans, Karis Buford, Katiana Vazquez-Rivera, Allison Polland, Varsha Sinha, Ervin Teper, Michael Silver, and Ariel Schulman Dhaval JivanjiDhaval Jivanji More articles by this author , Elie Kaplan-MaransElie Kaplan-Marans More articles by this author , Karis BufordKaris Buford More articles by this author , Katiana Vazquez-RiveraKatiana Vazquez-Rivera More articles by this author , Allison PollandAllison Polland More articles by this author , Varsha SinhaVarsha Sinha More articles by this author , Ervin TeperErvin Teper More articles by this author , Michael SilverMichael Silver More articles by this author , and Ariel SchulmanAriel Schulman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003286.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Racial inequalities are well-documented in many areas of medicine. We used a national database to compare morbidity and operative outcomes in Black and white women undergoing radical cystectomy. METHODS: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify Black and white women who underwent a cystectomy between 2016 and 2020 (Current Procedural Terminology codes: 51570, 51575, 51580, 51585, 51590, 51595, 51596). Demographics, preoperative comorbidities, and operative outcomes were compared. Chi-square was used to analyze categorical variables and the Mann–Whitney U test was used to analyze continuous variables. RESULTS: Of the 2,002 women identified, 1,813 (90.6%) were white and 189 (9.4%) were Black. Black women were younger (66 years old vs. 69 years old, p=0.001) and had higher BMI (29.8 vs. 27.5, p<0.001) compared to white women. Black women had higher rates of non-insulin dependent diabetes (18.0% vs. 8.9%, p<0.001), hypertension (72.0% vs. 53.8%, p<0.001), and smoking (28.0% vs. 21.3%, p=0.04). There was no difference in length of stay (7 days vs. 6 days, p=0.67) or operative time (359 minutes vs. 344 minutes, p=0.06) between the two groups. No significant differences in major Clavien-Dindo complications or 30-day events were seen (Table 1). CONCLUSIONS: Black women who underwent cystectomy were younger; however, had higher rates of diabetes, hypertension, and smoking compared to white women. Importantly, this did not translate to meaningful differences in surgical outcomes observed in our cohort. These findings are encouraging, and further studies exploring surgical outcomes in non-NSQIP participating hospitals are crucial as the racial profiles may differ at these institutions. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e588 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dhaval Jivanji More articles by this author Elie Kaplan-Marans More articles by this author Karis Buford More articles by this author Katiana Vazquez-Rivera More articles by this author Allison Polland More articles by this author Varsha Sinha More articles by this author Ervin Teper More articles by this author Michael Silver More articles by this author Ariel Schulman More articles by this author Expand All Advertisement PDF downloadLoading ...

Outcomes and risk factors for failure of trabeculectomy in glaucomatous patients in Southwest China: a 325 eyes analysis.

To evaluate the outcomes and elucidate the failure factors for trabeculectomy with mitomycin C (MMC) in Southwest Chinese patients. A retrospective correlational study was conducted on the glaucomatous patients who underwent initial trabeculectomy with MMC in Southwest Hospital and had been followed up for 1-3y. A complete success for surgery is defined as a postoperative intraocular pressure (IOP) >5 and ≤21 mm Hg and 20% reduction of IOP compared to preoperative, without IOP-lowering medications. A qualified success for surgery is defined as the abovementioned postoperative IOP with or without IOP-lowering medications. The primary outcomes were IOP, the number of IOP-lowering medications, and cumulative success rate. The secondary outcomes included best corrected visual acuity (BCVA), mean deviation (MD) of visual field, major complications, and risk factors for surgical failure. A total of 325 eyes of 261 glaucomatous patients had been included in our study. Both the mean IOP and the number of IOP-lowering medications were significantly decreased from 32.9±12.0 to 16.4±5.7 mm Hg (P<0.0001) and 3.0±0.9 to 0.9±1.0 (P<0.0001), respectively, at the last visit. The cumulative complete success rate and qualified success rate were 77.8% and 92.0% at 1-year follow-up, and 47.2% and 77.7% at 3-year follow up. There were no significant differences in surgical outcomes between primary angle-closure glaucoma (PACG) and primary open angle glaucoma (POAG). In PACG patients, the success rates of trabeculectomy were comparable with those of phacotrabeculectomy. Hypertension (HR=1.904, P=0.011), encapsulated bleb (HR=2.756, P<0.001), and more preoperative topical medications (HR=2.475, P=0.008) were risk factors for surgical failure. The qualified success rate of trabeculectomy with MMC in glaucomatous patients in the cohort is 92.0% at 1-year, and 77.7% at 3-year follow up. Hypertension, encapsulated bleb, and more preoperative topical medications are associated with surgical failure.

Effect of Preoperative Severity and Location of Lumbar Intervertebral Disc Vacuum Phenomenon on Surgical Outcomes After Single-Level Transforaminal Lumbar Interbody Fusion

This study aimed to examine whether preoperative severity and location of lumbar intervertebral disc vacuum phenomenon (VP) influence surgical outcomes after single-level transforaminal lumbar interbody fusion (TLIF). We included 106 patients (age: 67.4 ± 10.4 years; 51 male/55 female) with lumbar degenerative diseases, who were treated with single-level TLIF. Severity of VP (SVP) score was measured preoperatively. SVP score at fused disc was used as SVP (FS) score, and at non-fused discs was used as SVP (non-FS) score. Surgical outcomes were assessed using Oswestry disability index (ODI) and visual analogue scale (VAS; low back pain (LBP), lower-extremity pain, numbness, LBP in motion, in standing, and in sitting). The patients were divided into Severe VP (FS or non-FS) and Mild VP (FS or non-FS) groups, and surgical outcomes were compared between the two groups. Correlations between each SVP score and surgical outcomes were analyzed. There were no differences in surgical outcomes between the Severe VP (FS) and Mild VP (FS) groups. Postoperative ODI, VAS for LBP, lower-extremity pain, numbness, and LBP in standing were significantly worse in the Severe VP (non-FS) group than in the Mild VP (non-FS) group. SVP (non-FS) scores significantly correlated with postoperative ODI, VAS for LBP, lower extremity pain, numbness, and LBP in standing; however, SVP (FS) scores did not correlate with any surgical outcomes. Preoperative severity of VP at fused disc is not associated with surgical outcomes, however, severity of VP at non-fused discs is correlated with clinical outcomes.

Abstract P2-15-04: Surgical outcomes of ambulatory mastectomy with immediate alloplastic reconstruction for breast cancer or risk reduction

Abstract Purpose: Since 2015, mastectomy with immediate implant-based reconstruction at our institution is an ambulatory “day surgery” procedure. Ambulatory criteria for surgery including ASA level, BMI and major comorbidities were used to screen patients. We aim to evaluate surgical outcomes for women who undergo ambulatory mastectomy with immediate alloplastic reconstruction for breast cancer or risk reduction. Our primary objective was to determine the impact of mastectomy type (nipple- or skin-sparing mastectomy) and device location (subpectoral versus prepectoral plane) on complication rates. Methods: We performed a retrospective cohort study of women receiving immediate alloplastic reconstruction following mastectomy for either breast cancer or risk reduction at Women’s College Hospital in Toronto, Ontario, Canada between 2015 and 2021. We collected demographic data on age, ethnicity, smoking status, and menopausal status. Clinical data collected included breast size, ptosis, surgical indications, laterality, location and type of implant, type of mesh used, and overall complication rate. We used a multivariable logistic regression model to determine the impact of mastectomy type and implant location on complication rates, with age, smoking status, breast size, ptosis, surgical indication, and use of mesh as covariates. Statistical analysis was performed using SAS® OnDemand for Academics and P values &amp;lt; 0.05 were considered statistically significant. Results: 284 women underwent mastectomy with immediate alloplastic reconstruction for risk reduction (130, 45.8%) and breast cancer (154, 54.2%). 134 (47%) underwent skin-sparing mastectomy (SSM) and 149 (53%) underwent nipple-sparing mastectomy (NSM). Demographic and clinical data are presented in Table 1. There was an overall complication rate of 19.4%; women having NSM had a higher crude complication rate compared with SSM (25.5% vs 12.6%, P = 0.006). In our multivariable logistic regression model, there was no interaction between mastectomy type and device location on complication rate (P = 0.5). There was also no difference in complication rates associated with SSM compared with NSM (OR 2.9, 95% CI 0.95 – 9.0, P = .06) or implant location (P = 0.1). Younger age (OR 0.93/year increase in age, 95% CI 0.89-0.98, P = 0.005) and having surgery for breast cancer (OR 3.4, 95% CI 1.1 – 10.2, P = 0.03) were associated with an increased likelihood of complications. Conclusion: In women undergoing ambulatory mastectomy with immediate alloplastic reconstruction for breast cancer or risk reduction, there was no impact of mastectomy type (SSM vs NSM) or implant location (subpectoral vs prepectoral) on complication rates. Non-modifiable factors such as age and having surgery for breast cancer predicted having a complication. Our data suggest that with appropriate patient selection, there is no difference in surgical outcomes between mastectomy types and implant location in the ambulatory surgery setting. Table 1.1 Total Cohort Demographic and Clinical Data Table 1.2 Total Cohort Demographic and Clinical Data Citation Format: Simran Sandhu, Tulin D. Cil, Jaime M. Escallon, Mitchell Brown, John Semple, David Lim. Surgical outcomes of ambulatory mastectomy with immediate alloplastic reconstruction for breast cancer or risk reduction. [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-15-04.

A COMPARATIVE STUDY ON INFERIOR BASED FLAP AND POSTERIOR BASED FLAP AND ITS OUTCOME IN ENDOSCOPIC DACROCYSTORHINOSTOMY IN PATIENTS WITH DACROCYSTITIS ATTENDING TO ENT DEPARTMENT AT TERITIARY CARE HOSPITAL

Occlusion of the nasolacrimal duct (NLD) is a frequent condition that is characterized by tearing1 known as Epiphora. The surgical procedure of diversion of lacrimal ow within a nasal cavity through an articial stula made at the level of a lacrimal sac is called Dacryocystorhinostomy (DCR). This includes complete blockages anywhere from the lacrimal punctum to the nasal cavity. The majority of nasolacrimal system obstruction is unknown. Endoscopic DCR can be done by the creation of a different types of mucosal aps like posteriorly based mucosal ap or inferiorly based mucosal ap. In this study, we compare in detail the Chronic Dacryocystitis disease pattern and difference in surgical outcomes of endoscopic surgical outcomes of endoscopic surgical management with its 3 months follow up

Investigating the accuracy of mandibulectomy and reconstructive surgery using 3D customized implants and surgical guides in a rabbit model

BackgroundThis study aimed to analyze the accuracy of the output of three-dimensional (3D) customized surgical guides and titanium implants in a rabbit model, and of mandibulectomy, reconstructive surgery, and surgical outcome; additionally, the correlation between surgical accuracy and surgical outcomes, including the differences in surgical outcome according to surgical accuracy, was analyzed.ResultsThe output of implants was accurately implemented within the error range (− 0.03–0.03 mm), and the surgical accuracy varied depending on the measured area (range − 0.4–1.1 mm). Regarding surgical outcomes, angle between the mandibular lower borders showed the most sensitive results and distance between the lingual cusps of the first molars represented the most accurate outcomes. A significant correlation was noted between surgical accuracy in the anteroposterior length of the upper borders pre- and postoperatively and the angle between the mandibular lower borders (regression coefficient = 0.491, p = 0.028). In the group wherein surgery was performed more accurately, the angle between the mandibular lower borders was reproduced more accurately (p = 0.021). A selective laser melting machine accurately printed the implants as designed. Considering the positive correlation among surgical accuracy in the mandibular upper borders, angle between the mandibular lower borders, and more accurately reproduced angle between the mandibular lower borders, the angle between the mandibular lower borders is considered a good indicator for evaluating the outcomes of reconstructive surgery.ConclusionTo reduce errors in surgical outcomes, it is necessary to devise a positioner for the surgical guide and design a 3D surgical guide to constantly maintain the direction of bone resection. A fixed area considering the concept of three-point fixation should be selected for stable positioning of the implant; in some cases, bilateral cortical bone fixation should be considered. The angle between the mandibular lower borders is a sensitive indicator for evaluating the outcomes of reconstructive surgery.

Sphincter Pharyngoplasty for Velopharyngeal Dysfunction: Impact of 22q11.2 Deletion Syndrome.

Patients with 22q11.2 deletion syndrome (22q11DelS) often present with velopharyngeal dysfunction (VPD). VPD in patients with 22q11DelS is multifactorial beyond velopharyngeal insufficiency (VPI) alone, and differences in surgical outcomes are poorly understood. Our objective was to determine whether patients with 22q11DelS have an increased risk for persistent VPI after sphincter pharyngoplasty compared to patients without 22q11DelS. We completed a retrospective cohort study of patients with 22q11DelS undergoing sphincter pharyngoplasty between 1995 and 2019 using a VPD clinic database. Patients with 22q11DelS were compared to a cohort of 2:1 frequency-matched (age, degree of velopharyngeal closure) patients without 22q11DelS. Variables included patient characteristics, surgical history, perceptual speech evaluation, and degree of closure on nasopharyngoscopic evaluations. Primary outcomes included postoperative VPI severity and hypernasality. Speech and nasopharyngoscopic characteristics were compared using Fisher's exact test. Postoperative VPI severity and hypernasality were compared between groups via relative risks (RR) from mixed effects Poisson regression models, with random effects of age and velopharyngeal closure. 134 patients (51 22q11DelS, 83 matched) were included, with mean age of 7.3 years (standard deviation 3.0) and 50% male. Cohorts had similar preoperative speech characteristics and nasopharyngoscopic findings. Patients with 22q11DelS had similar postoperative VP function as patients without 22q11DelS (RR 0.85, CI 0.46-1.57 for VPI severity, RR 0.83, CI 0.45-1.53 for hypernasality). Even after adjusting by preoperative variables, no differences were seen between both groups. Matched for age and pre-operative velopharyngeal closure, patients with and without 22q11DelS and VPI had similar benefits after sphincter pharyngoplasty. Non-randomized controlled cohort study, 3 Laryngoscope, 133:2813-2820, 2023.