Differences In Surgical Outcomes Research Articles

Does Obesity Affect Clinical and Radiological Outcomes in Minimally Invasive Total Knee Arthroplasty? Minimum 5-Year Follow-up of Minimally Invasive TKA in Obese Patients.

BackgroundThe aim of this study was to evaluate the clinical and radiological outcomes of minimally invasive total knee arthroplasty (MIS-TKA) in obese patients.MethodsWe examined the records of 371 cases of MIS-TKA performed using the mini-midvastus approach from January 2006 to December 2006. According to body mass index (BMI), the cases were classified into group A (BMI < 25 kg/m2, 114 knees), group B (25 kg/m2 ≤ BMI < 30 kg/m2, 179 knees), and group C (BMI ≥ 30 kg/m2, 78 knees). Clinical outcomes were measured with the Hospital for Special Surgery Score and Knee Society Score. Radiological evaluation included measurements of knee alignment.ResultsMIS-TKA was performed on all patients. The skin incision size in group A, group B, and group C was 8.2 ± 0.8 cm, 8.3 ± 0.8 cm, and 8.5 ± 0.9 cm, respectively, and the operation time was 86.4 ± 10.4 minutes, 85.9 ± 11.3 minutes, and 89.0 ± 11.4 minutes, respectively, indicating no significant difference among the groups (p > 0.05). There was no difference in terms of the accuracy of the tibial implant alignment, with 97.6%, 95.2%, and 93.4% of each group showing 90° ± 3° varus angulation (p > 0.05). With respect to the accuracy of the femorotibial angle, 93.9%, 94.6%, and 90.2% of each group had 6° ± 3° valgus angulation, with group C demonstrating the lowest level of accuracy (p < 0.05). The preoperative range of motion and Knee Society Score of group C were less than those of groups A and B (p < 0.05), but there was no notable difference among groups at the postoperative 3-month and 1-year follow-ups (p > 0.05).ConclusionsMIS-TKA in obese patients showed satisfactory clinical and radiological results without significant difference in surgical results compared to nonobese patients.

Complicated appendicitis: Risk factors and outcomes of laparoscopic appendectomy - Polish laparoscopic appendectomy results from a multicenter, large-cohort study.

Preoperative classification of complicated and uncomplicated appendicitis (AA) is challenging. However, the differences in surgical outcomes necessitate the establishment of risk factors in developing, complicated AA. This study was an analysis of the clinical outcomes of laparoscopic appendectomies (LA), as well as preoperative risk factors for the development of complicated AA. The data of 618 patients who underwent LA in 18 surgical units across Poland and Germany were collected in an online web-based database created by the Polish Videosurgery Society. The surgical outcomes of patients with complicated and uncomplicated appendicitis were compared. Uni- and multivariate logistic regression models were used to establish risk factors for the development of complicated appendicitis. In all, 1269 (27.5%) patients underwent LA for complicated appendicitis (Group 1) and 3349 (72.5%) for uncomplicated appendicitis (Group 2). The conversion rate, number of intra-operative adverse events, re-intervention rate, postoperative complications, and readmission rate was greater in Group 1. The preoperative risk factors associated with complicated appendicitis were: female sex (Odds ratio [OR]: 1.58), obesity (OR: 1.51), age >50 years (OR: 1.51), symptoms >48 hours (OR: 2.18), high Alvarado score (OR: 1.29 with every point), and C-reactive protein level >100 mg/L (OR: 3.92). Several demographic and clinical risk factors for complicated AA were identified. LA for complicated appendicitis was associated with poorer outcomes.

Surgical outcome and predictive factors of epilepsy surgery in pediatric isolated focal cortical dysplasia

ObjectiveFocal cortical dysplasia (FCD) is a common cause of medically intractable epilepsy in children. Epilepsy surgery has been a valuable treatment option to achieve seizure freedom in these intractable epilepsy patients. We aimed to present long-term surgical outcome, in relation to pathological severity, and to assess predictive factors of epilepsy surgery in pediatric isolated FCD. MethodsWe retrospectively analyzed the data of 58 children and adolescents, with FCD International League Against Epilepsy (ILAE) task force classification types I and II, who underwent resective epilepsy surgery and were followed for at least 2 years after surgery. ResultsThe mean age at epilepsy onset was 4.3 years (0–14.2 years), and mean age at epilepsy surgery was 9.4 years (0.4–17.5 years). The mean duration of postoperative follow-up was 5.1±2.6 years (2–12.4 years). Of 58 patients, 62% of patients achieved Engel class I at 2 years postoperatively, 58% at 5 years postoperatively, and 53% at the last follow up. Forty eight percent of our cohort successfully discontinued antiepileptic medication. Of 30 patients with seizure recurrence, 83% of seizures recurred within 2 years after surgery. We observed that FCD type IIb was significantly associated with a better surgical outcome. At fifth postoperative year, 88% of FCD IIb patients were seizure free compared with 21% of type I and 57% of type IIa patients (P=0.043). By multivariate analysis, lesion on MRI (P=0.02) and complete resection (P<0.01) were the most important predictive factors for a seizure-free outcome. SignificanceEpilepsy surgery is highly effective; more than half of medically intractable epilepsy patients achieved seizure freedom after surgery. In addition, we found significant difference in surgical outcomes according to the ILAE task force classification. Lesion on MRI and complete resection were the most important predictive factors for favorable seizure outcome in isolated FCD patients.

Surgical Outcomes of Bony Batten Grafting to Correct Caudal Septal Deviation in Septoplasty.

Correction of caudal septal deviation with a batten graft has been popularized recently. However, few reports have documented the surgical outcomes of this technique, especially the use of bony batten grafts in septoplasty. To evaluate the surgical outcomes of bony batten grafting for the management of caudal septal deviation in endonasal septoplasty. This retrospective cohort study evaluates the medical records of 141 patients with caudal septal deviation who underwent septoplasty using bony batten grafts from September 1, 2011, through February 29, 2016, at a tertiary referral hospital. Patients were divided into primary and secondary surgery groups. Patients were also divided into the septoplasty plus turbinate surgery and the septoplasty only group. Endoscopic assessment of deviation correction was performed, and postoperative complications were analyzed. Patient satisfaction and symptom improvement were evaluated via telephone interviews by using the Nasal Obstruction Symptoms Evaluation (NOSE) scores. Of the 141 patients (24 women [17%] and 117 men [83%]; mean [SD] age, 32.8 [12.9] years), 86 (61%) rated their symptoms in the postoperative survey as much improved; 50 (35.5%), improved; 4 (2.8%), no change; and 1 (0.7%), worse. All patients had significantly improved mean (SD) postoperative NOSE scores (28.7 [22.0]; 95% CI, 25.0-32.4) compared with preoperative scores (70.5 [26.7]; 95% CI, 66.0-75.0; P < .001). No significant intergroup differences were observed in surgical outcome between the 116 patients undergoing primary surgery (mean [SD] NOSE score, 28.2 [21.9]) and 25 undergoing secondary surgery (mean [SD] NOSE score, 30.8 [24.3]; P = .34). No significant difference in surgical outcome was found between the 102 patients in the turbinate surgery group (mean [SD] NOSE score, 28.1 [20.8]) and 39 in the septoplasty only group (mean [SD] NOSE score, 30.4 [23.7]; P = .65). On endoscopic examination for surgical outcome, 128 patients (90.8%) had a straight septum and 13 (9.2%) had improved but residual caudal deviation. Postoperative complications included septal hematoma in 4 patients, hyposmia in 2, and chondritis in 1; all patients were treated successfully. Four patients required revision surgery because of incomplete functional correction or a desire for rhinoplasty. Septoplasty using bony batten grafts is useful for correcting caudal septal deviation with favorable surgical outcomes and an acceptable complication rate. 3.

Gender and racial differences in surgical outcomes among adult patients with acute heart failure

BackgroundApproximately three million U.S. adult women have heart failure (HF), increasing their risk of adverse perioperative outcomes. While gender and racial differences are reported in surgical outcomes, less is known about 30-day perioperative outcomes in HF patients. ObjectivesTo characterize and compare gender and racial differences in 30-day perioperative outcomes in adults with new or acute/worsening HF. MethodsThe 2012–2013 American College of Surgeons National Surgical Quality Improvement Program database of surgical patients (n = 9458) with HF was analyzed. Logistic regression was used to adjust for gender and racial differences in baseline covariates. ResultsNo gender difference in mortality (odds ratio = 0.922, 95% confidence interval = 0.0792–1.073, p = 0.294) was noted. Whites were more likely than Blacks to die 30 days after surgery (14% vs 9%, p < 0.001); after adjustment, Blacks were more likely to experience complications and be readmitted compared to Whites. ConclusionsThere was no gender difference in mortality. White patients with HF were more likely to die after surgery than Black patients.

Comparative Study on Clinical Results of Arthroscopic Repair of Anteroinferior, Superior, and Combined Glenoid Labral Tear: A Two-Year Follow-Up Study

This study is first of its kind that compared clinical results of arthroscopic repair of anteroinferior, superior, or combined anteroinferior and superior labral lesion. The most significant finding is that 2-year outcomes of the three lesions are comparable, in terms of pain, shoulder functional scores, ROM, and failure rate. However, patients with superior labral lesion were older at surgery. Anteroinferior and superior glenoid labra are common anatomical locations susceptible to traumatic injuries which lead to shoulder instability. Both can be repaired arthroscopically, however, differences in surgical outcomes were largely unknown, especially on the association and difference between type II superior labral tear from anterior to posterior (SLAP) lesion and combined anteroinferior and superior labral lesion. The objective of this study is to compare and correlate the clinical results of arthroscopic repair of combined labral lesion with those of anteroinferior labral lesion and type II SLAP lesion. A comparative study, involving patients who underwent primary arthroscopic labral repairs by two fellowship-trained Sports surgeons was conducted. Patients below 40 year-old, who were admitted between 2010 and 2014 and have been followed up for at least 2 years, were included in the study. Patients with associated rotator cuff injury, posterior labrum injury, significant bony defect or humeral avulsion of glenohumeral ligament injury were excluded. They were divided into 3 groups based on arthroscopic findings: Group A consisted of 61 patients with anteroinferior labral lesion, Group B consisted of 16 patients with type II SLAP lesion, and Group C consisted of 19 patients with combined labral lesion. The outcomes measured in the study were pain score, shoulder functional scores (Constant Shoulder Score, UCLA Shoulder Score, and Oxford Instability Score), range of motion (ROM, in both forward flexion and abduction directions), and failure rate (re-dislocation or subluxation) at 2-year follow-up. Kruskal Wallis Test and Fisher’s Exact Test were applied for continuous and categorical variables, respectively. Except that patients from Group B were older (28.8 vs. 22.2 for Group A and 22.0 for Group C) at the time of surgery, no significant differences exist among the three groups in patients’ demographics and relevant clinical data. Pain scores were comparable, with a slightly higher reported value for Group B at 2-year. There were no differences among the three groups in shoulder functional scores. Slightly higher improvements in functional scores were observed in Group B compared to the other two groups, without statistical significance. Both forward flexion and abduction ROMs have improved significantly from pre-operative values, for all three groups; however, they were not significantly different among each other at the 2-year follow-up. Improvements in ROM were highest in Group C, but these did not achieve statistical significance. Failure rate was also similar in all groups, regardless of the types of lesion. This study is first of its kind, which tries to establish the relationship of combined labral lesion with either anteroinferior or superior labral lesion, in terms of clinical results of arthroscopic repair. Patients with type II SLAP lesion underwent surgery at an older age. Combined labral lesion is a potential concomitant lesion in anteroinferior labral lesion or SLAP lesion, and comparable results can be expected in terms of pain, shoulder functional scores, ROM, and failure rate, despite the more extensive lesion size. Combined anteroinferior and superior labral lesion behaves more like isolated anteroinferior labral lesion than superior labral lesion.

Comparison of Biopsy Results and Surgical Outcomes of Magnetic Resonance Imaging-Guided and Transrectal Ultrasonography-Guided Repeat Biopsy

Purpose We compared biopsy results and surgical outcomes of magnetic resonance imaging (MRI)-guided biopsy with transrectal ultrasonography (TRUS)-guided biopsy to demonstrate efficacy of MRI-guided biopsy on previous biopsy negative patients. Materials and Methods We retrospectively reviewed data of 120 patients who were categorized into MRI-guided biopsy groups (n=20) and TRUS-guided biopsy groups (n=100). All patients were diagnosed with prostate cancer (PCa) and had undergone radical prostatectomy (RP) after MRI-guided or TRUS-guided repeat biopsy between January 2010 and March 2016. Detection rate of significant cancer and Gleason score upgrading and downgrading were examined, in addition to biopsy results and subsequent RP outcomes. Results Median values for prostate-specific antigen level of the TRUS-guided biopsy group and the MRI-guided biopsy group were 6.67 and 5.86 ng/mL (p=0.303), respectively. Median prostate volume of each group (34.1 mL vs. 23.5 mL, p=0.007), number of positive cores (2.0 vs. 3.0, p=0.001) and maximum cancer/core rate (30.0% vs. 60.0%, p<0.001) were statistically different. Positive core rates of each group were 21.9% and 87.1%, respectively. Pathologic T stage was the only variable that showed difference in surgical outcomes (p=0.002). Most of PCa was confirmed as clinically significant PCa after RP in MRI-guided biopsy group (95%). Conclusions MRI-guided biopsy showed higher positive core rate and detection rate of clinically significant PCa than TRUS-guided biopsy in repeat biopsy setting. Prospective multicenter large-scale study and accumulation of data is expected to further define superiority of the MRI-guided biopsy. Key Words: Prostatic neoplasms; Repeat biopsy; Magnetic resonance imaging; Transrectal ultrasonography; Outcomes.

Advantages of Single-Port Laparoscopic Myomectomy Compared with Conventional Laparoscopic Myomectomy: A Randomized Controlled Study

Study ObjectiveTo compare operative outcomes of single-port laparoscopic myomectomy (SP-LM) vs conventional laparoscopic myomectomy (CLM), including subjective and objective cosmetic aspects. DesignProspective randomized controlled trial (Canadian Task Force classification I). SettingUniversity hospital. PatientsWomen with uterine myoma scheduled for laparoscopic myomectomy. InterventionsSixty-six women were assigned at random to either the SP-LM or CLM group. Surgical outcomes, including patient and observer scar assessments, were evaluated between the groups according to the intention-to-treat principle. Measurements and Main ResultsThere were no significant differences in demographic characteristics and properties of myomectomy between the groups. There also were no differences in surgical outcomes, such as operation time, estimated blood loss, and complications, between the 2 groups. The mean total score of the Observer Scar Assessment Scale was lower in the SP-LM group at 1 week (13.0 ± 3.2 vs 18.3 ± 4.8; p < .001) and 8 weeks (9.9 ± 3.2 vs 14.3 ± 3.8; p < .001) after discharge. Similar results were obtained for the Patient Scar Assessment Scale at 1 week (11.6 ± 7.2 vs 18.5 ± 12.8; p = .024) and 8 weeks (9.5 ± 6.0 vs 18.8 ± 9.1; p < .001) after discharge. Postoperative pain and analgesic consumption did not differ between the groups, except in patient-controlled analgesia consumption at 6 hours after operation, which was lower in the SP-LM group (12.7 ± 6.3 mL vs 16.4 ± 6.2 mL; p = .039). Operative outcomes were similar in the 2 groups. ConclusionSP-LM is associated with more favorable cosmetic outcomes and better patient satisfaction compared with CLM. There were no differences in operative outcomes and complications between the 2 modalities.

Reflector-guided breast tumor localization versus wire localization for lumpectomies: A comparison of surgical outcomes

PurposeTo compare surgical outcomes of SAVI SCOUT reflector localization (SSL) versus wire localization (WL) for breast tumors. MethodsRetrospective review of 42 SSL cases and 42 WL cases. WL patients were consecutively matched for clinical-pathologic features. Final surgical outcome measures were tumor specimen volume, margin status, and re-excision rates. ResultsNo significant differences were present in median specimen volumes (SSL-15.2cm3 vs. WL-16.3cm3), positive margin rate (SSL-9.5% vs. WL-7.1%), close margin rate (SSL-7.1% vs. WL-11.9%) or re-excision rate (SSL-7.1% vs. WL-9.5%). ConclusionSSL is an acceptable alternative to WL with no significant differences in surgical outcomes.

Current Techniques and Role of Drug-Induced Sleep Endoscopy for Obstructive Sleep Apnea

Drug-induced sleep endoscopy (DISE) was developed for dynamic evaluation of the airway collapse under simulated sleep conditions. DISE has been extensively studied in the last 25 years to standardize the procedures and classification as well as its role in non-surgical and surgical management. The goal of this study is to determine current techniques and recommendations regarding DISE. Current research suggests that standardization with target-controlled infusion and bispectral analysis may be safer and more reproducible. The velum, oropharyngeal, tongue base, epiglottis classification remains the most commonly used to describe the obstruction. While DISE changes surgical management in 50% of patients, there are few studies to evaluate differences in surgical outcomes with and without DISE. Emerging evidence suggests complete collapse of the velum and hypopharyngeal obstruction are associated with poor surgical outcomes. Going forward, more information is required to determine how well DISE mimics natural sleep and its role in decision-making for patients seeking alternatives to continuous positive airway pressure.

Information for Contributors

The purpose of this study is to compare the efficacy of single 2 mm locking miniplates versus two 2 mm non-locking (conventional) miniplates in symphysis and parasymphysis fracture of mandible.This present study included 40 patients of maxillofacial trauma having mandibular symphysis/parasymphysis fractures in which open reduction and internal fixation is indicated. Patients were selected according to the inclusion criteria and divided into two groups, i.e. Group 1: consisted of 20 patients, requiring open reduction and internal fixation with 2 mm two non-locking titanium plate and Group 2: consisted of 20 patients, requiring open reduction and internal fixation with 2.0 mm single ultra-locking titanium plate. Fracture was then stabilized and postoperative clinical examination was carried out on 3rd day, 1st, 2nd, 4th, and 8th week.Results of this study suggested that the use of single 2.0 mm locking miniplate could be a viable option instead of using two miniplates in anterior mandibular fracture as advocated by Champy, as it provides equally good outcome along with placement of lesser implant material.Single locking miniplates give the advantage of equally good stability and early restoration of function with almost similar results as seen in osteosynthesis with two miniplates. It was also found that less precision was required in plate adaptation when using single locking miniplate. This study suggests that there is not much difference in surgical outcome with the use of either single locking miniplate or two conventional miniplates in anterior mandibular region.

Mechanisms underlying different onset patterns of focal seizures.

Focal seizures are episodes of pathological brain activity that appear to arise from a localised area of the brain. The onset patterns of focal seizure activity have been studied intensively, and they have largely been distinguished into two types—low amplitude fast oscillations (LAF), or high amplitude spikes (HAS). Here we explore whether these two patterns arise from fundamentally different mechanisms. Here, we use a previously established computational model of neocortical tissue, and validate it as an adequate model using clinical recordings of focal seizures. We then reproduce the two onset patterns in their most defining properties and investigate the possible mechanisms underlying the different focal seizure onset patterns in the model. We show that the two patterns are associated with different mechanisms at the spatial scale of a single ECoG electrode. The LAF onset is initiated by independent patches of localised activity, which slowly invade the surrounding tissue and coalesce over time. In contrast, the HAS onset is a global, systemic transition to a coexisting seizure state triggered by a local event. We find that such a global transition is enabled by an increase in the excitability of the “healthy” surrounding tissue, which by itself does not generate seizures, but can support seizure activity when incited. In our simulations, the difference in surrounding tissue excitability also offers a simple explanation of the clinically reported difference in surgical outcomes. Finally, we demonstrate in the model how changes in tissue excitability could be elucidated, in principle, using active stimulation. Taken together, our modelling results suggest that the excitability of the tissue surrounding the seizure core may play a determining role in the seizure onset pattern, as well as in the surgical outcome.

A comparison between reduced-port robotic surgery and multiport robot-assisted laparoscopy for myomectomy

ObjectiveTo compare the surgical outcomes between reduced-port robotic surgery (RPRS) using the Octo-Port channel and multiport robot-assisted laparoscopy for myomectomy. Study designThis prospective study compared and analyzed data from 15 consecutive women who underwent RPRS for myomectomy and 15 consecutive women who underwent multiport robot-assisted laparoscopy to treat symptomatic uterine myoma from January 2016 to June 2016. The patients were treated by two surgeons at two institutions. ResultsThe two study groups did not differ demographically. The differences in surgical outcomes, such as docking time, console time, hospital stay, estimated blood loss, Hb change, myoma count, and weight, also did not differ between the two groups. On the contrary, the number of port site was only 2 in RPRS compared with 4–5 in multiport robot-assisted laparoscopic myomectomy. ConclusionRPRS for myomectomy seems technically feasible and safe, with short-term perioperative outcomes similar to those from multiport robot-assisted laparoscopic myomectomy.

Comparing outcomes of pediatric and adult external dacryocystorhinostomy in Nepal: Is age a prognostic factor?

ABSTRACTWe determine whether age is a prognostic factor for surgical outcomes of external dacryocystorhinostomy (Ex-DCR). This retrospective cohort study conducted at Tilganga Institute of Ophthalmology (Kathmandu, Nepal) compared pediatric Ex-DCR procedures (age ≤ 15 years) to adult Ex-DCR procedures (age > 15 years) and was performed between January 2013 and December 2013, with a minimum follow-up period of 6 months. Primary outcome measure was rate of success, defined as complete resolution of subjective symptom(s) of epiphora (subjective success), combined with patent lacrimal passage on syringing (anatomical success) at last follow-up visit. Other outcome measures included clinical presentation, diagnosis, intraoperative complications and post-operative complications. In total, 154 Ex-DCR procedures were included, with an age range of 8 months to 81 years (mean age 36.4 ± 21.0 years). In all, 38 pediatric Ex-DCR procedures were compared to 116 adult procedures. Success rates were 97% in the pediatric group and 95% in the adult group, with no clinically or statistically significant difference in success rate or complication rate between groups (p > 0.05). Our study yielded high success rates of Ex-DCR in both pediatric and adult age groups suggesting that Ex-DCR remains an optimal treatment choice for all age groups. With no difference in surgical outcomes between pediatric and adult patients, including complication rate, we conclude that age is not a prognostic factor for Ex-DCR failure. We do not recommend adjuvant therapy for pediatric patients.

ROBOT-ASSISTED RADICAL PROSTATECTOMY FOR MEN AGE 75 AND OLDER

(Objectives) Surgical treatment prostate cancer in elderly patients is controversial. However, robot-assisted radical prostatectomy (RARP) is a less invasive procedure than conventional surgery. Therefore, we perform RARP for elderly patients whose general condition is good (Performance status ≤1). The aim of this study is to evaluate surgical, oncological and functional outcomes for RARP in men age 75 and older. (Patients and methods) From July 2013 to April 2016, 300 patients underwent RARP at our institution. They were divided into two groups: an older patient group (≥75 years) and a younger patient group (<75 years). Treatment outcomes for each group, including surgical, oncological and functional outcomes, were compared. (Results) There were no statistically significant differences in surgical outcomes with the exception of nerve sparing rates (older patients: 5.9% vs. younger patients: 17.7%, P=0.0192). Importantly, intra- and postoperative complication rates were similar in both groups (minor complication: 7.4% vs. 3.9%, P=0.322, major complication: 0.0% vs. 2.2%, P=0.592). Regarding oncological outcomes, including positive surgical margin rate and PSA failure (PSA>0.2 ng/ml) at 12 months after surgery, no significant differences existed. Lastly, functional outcomes between the groups, including continence (≤1 pads/day) at 12 months after surgery, had no significant differences. (Conclusions) Our data suggests that RARP can be performed safely for men age 75 and older, and can become a good option for older patients with prostate cancer.

Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI) Combined with Positron Emission Tomography-Computed Tomography (PET-CT) and Video-Electroencephalography (VEEG) Have Excellent Diagnostic Value in Preoperative Localization of Epileptic Foci in Children with Epilepsy.

BackgroundTo investigate the effect that dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) has on surgical decision making relative to video-electroencephalography (VEEG) and positron emission tomography-computed tomography (PET-CT), and if the differences in these variables translates to differences in surgical outcomes.Material/MethodsA total of 166 children with epilepsy undergoing preoperative DCE-MRI, VEEG, and PET-CT examinations, surgical resection of epileptic foci, and intraoperative electrocorticography (ECoG) monitoring were enrolled. All children were followed up for 12 months and grouped by Engles prognostic classification for epilepsy. Based on intraoperative ECoG as gold standard, the diagnostic values of DCE-MRI, VEEG, PET-CT, DCE-MRI combined with VEEG, DCE-MRI combined with PET-CT, and combined application of DCE-MRI, VEEG, and PET-CT in preoperative localization for epileptic foci were evaluated.ResultsThe sensitivity of DCE-MRI, VEEG, and PET-CT was 59.64%, 76.51%, and 93.98%, respectively; the accuracy of DCE-MRI, VEEG, PET-CT, DCE-MRI combined with VEEG, and DCE-MRI combined with PET-CT was 57.58%, 67.72%, 91.03%, 91.23%, and 96.49%, respectively. Localization accuracy rate of the combination of DCE-MRI, VEEG, and PET-CT was 98.25% (56/57), which was higher than that of DCE-MRI combined with VEEG and of DCE-MRI combined with PET-CT. No statistical difference was found in the accuracy rate of localization between these three combined techniques. During the 12-month follow-up, children were grouped into Engles grade I (n=106), II (n=31), III (n=21), and IV (n=8) according to postoperative conditions.ConclusionsAll DCE-MRI combined with VEEG, DCE-MRI combined with PET-CT, and DCE-MRI combined with VEEG and PET-CT examinations have excellent accuracy in preoperative localization of epileptic foci and present excellent postoperative efficiency, suggesting that these combined imaging methods are suitable for serving as the reference basis in preoperative localization of epileptic foci in children with epilepsy.

Opportunistic Salpingectomy Does Not Affect Ovarian Reserve or Surgical Outcomes in Patients Undergoing Laparoscopic Myomectomy

Objective: To determine whether opportunistic salpingectomy in patients undergoing laparoscopic myomectomy has any deleterious effects on ovarian reserve and surgical risk. Study Design: We performed a retrospective review of patients who had no desire for future child bearing and who were undergoing laparoscopic myomectomy for symptomatic myomas at 4 institutions. Among them, 41 patients concurrently underwent opportunistic salpingectomy (the opportunistic salpingectomy group) and 65 patients did not undergo salpingectomy at the time of laparoscopic myomectomy (the no-salpingectomy group). The primary and secondary outcome measures were change of ovarian reserve determined by the rate of decline in the anti-Müllerian hormone (AMH) level from before surgery to 3 months post-surgery, and surgical outcomes. Results: Baseline characteristics were similar between groups. There were also no differences in surgical outcomes, such as operative time, operative bleeding, hospital stay, or complications between groups. The decline rate in AMH was 18.6% (interquartile range (IQR) 2.6-46.8%) in the opportunistic salpingectomy group and 10.4% (IQR 2.6-46.8%) in the no-salpingectomy group, with no significant difference between groups (p = 0.593). Conclusion: Opportunistic salpingectomy at the time of laparoscopic myomectomy was not associated with negative effects on ovarian reserve or increased surgical risk.

Abstract 12189: Gender Differences in Intra-Operative Blood Transfusions: Analysis of 54,122 Coronary Artery Bypass (CABG) Procedures

Background/Hypothesis: Women have higher morbidity and mortality associated with CABG procedures than men. The extent intra-operative red blood cell (RBC) transfusions contribute to gender differences in surgical outcomes is not established. We hypothesized that women are at increased risk for RBC transfusions due to lower pre-op hematocrit (Hct) and blood volume, but that other factors may also contribute. Methods: Consecutive, non-reoperative CABG procedures from 189 institutions (2012 -2015) were reviewed. Gender differences and odds ratios for intra-operative transfusion were evaluated with logistic regression models adjusting for age, blood volume (Nadler formula-to normalize for height and weight), procedure acuity, net extracorporeal circuit prime volume, use of retrograde autologous priming, first Hct in OR, nadir Hct on cardiopulmonary bypass (CPB), volume added on CPB, ultra-filtration volume, urine output on CPB, and procedure duration. Results: Among 54,122 patients (25.3% female), 21.9% (n=11,901) received a RBC transfusion. Compared to men, female patients were older (66 yrs vs. 64 yrs, p&lt;.001), had lower blood volumes (4.3L vs. 5.6L, p&lt;.001), and lower pre-op Hct (32.9% vs. 37.2%, p&lt;.001). Transfusion rates were 3-fold higher in women vs. men (45.1% vs 13.7%, p&lt;.001). Even after adjustment for independent predictors of intra-operative transfusion, women remained at increased risk vs men (OR = 1.3, 95% CI = 1.2 -1.4). No gender differences in transfusion rates were observed for Hct 21%-23% (Figure). Conclusions: Women have an increased risk of intra-operative RBC transfusion vs men. After adjusting for height and weight, much of this risk is due to gender differences in pre-op Hct and blood volume, however a residual significant risk remained after adjustment. Perfusion strategies aimed at gender differences may minimize unnecessary transfusions. Future study on the impact of gender on transfusion practice in cardiac surgery is warranted.

Percutaneous Nephrolithotomy in the Superobese: A Comparison of Outcomes Based on Body Mass Index.

Percutaneous nephrolithotomy (PCNL) is considered the gold standard for treatment of large renal calculi. Although several investigators have examined the feasibility and outcomes associated with PCNL in obese patients, these studies have been limited by small sample size, lack of a comparator group, or few patients at body mass index (BMI) extremes. We thus compared outcomes of superobese (BMI >50) patients undergoing PCNL vs both an "overweight" and "ideal" cohort. We used a prospectively maintained database to identify ideal (BMI 18.5-25), overweight (BMI 25.1-49.9), and superobese (BMI ≥50) patients who underwent PCNL. Our primary objective was to compare surgical outcomes between groups measured by the percent of patients who required secondary PCNL. We then compared complication rates, need for transfusion, and length of stay (LOS) using chi-square testing and ANOVA where appropriate. A total of 1152 patients were identified of which 254 were classified as ideal, 840 as overweight, and 58 as superobese. The overweight cohort had a higher mean age and greater proportion of males, whereas staghorn stones were more common in the superobese group. Comorbid conditions were more commonly observed in the superobese cohort. Otherwise, the groups were similar. Surgical outcomes were comparable with 47.2%, 42.0%, and 38.0% of ideal, overweight, and superobese patients requiring secondary PCNL (p = 0.25) with no difference in complication rates, need for transfusion, or LOS. PCNL can be effectively and safely performed in superobese patients with no difference in surgical outcomes or complications when compared to ideal or overweight patient cohorts.

Septuagenarians and Older Patients are at a Higher Risk of Mortality with Adrenal Metastasectomy: An Analysis of the HCUP-NIS Database From 1992 to 2011.

Small institutional studies have shown that adrenalectomy to remove solitary metastases to the adrenal gland is safe and can improve overall survival for selective primary tumors. However, outcomes of adrenal metastasectomy have not been evaluated using large, national databases. All cases of adrenal metastasectomies from 1992 to 2011 were identified in the HCUP-NIS database. The primary endpoint analyzed was death during the same hospitalization. Secondary outcomes included length of stay (LOS), blood loss requiring transfusion, surgical infection, cardiac complications, and respiratory complications. A sub-analysis of 428 patients stratified by primary tumor (where data were available) was also performed. Statistical analysis was performed using chi-square, ANOVA, and logistic regression using Stata software, significance was set atpvalue of 0.05. A total of 2,057 cases of adrenal metastasectomies were identified. Median age of the patients was 62±13.2years (49.9% men, 69.7% Caucasian). Over the study period, there was a general increase in the number of cases performed and the number performed by minimally invasive approaches. There was also a decrease in LOS and number of deaths. However, age≥71years predicted a significantly higher rate of mortality (OR=6.0, CI 1.3-26.5) when controlled for race, procedure type, year of surgery, and primary tumor in multivariable analysis. This age group had a higher number of cardiac complications (5.4%, p=0.005) that potentially contributed to the higher mortality rate. In addition, there was no difference in surgical outcomes when stratified by primary tumor type for the entire cohort of patients. Adrenal metastasectomy is a safe procedure with decreasing same-hospitalization mortality from 1992 to 2011. However, age≥71years is a significant risk factor for same-hospitalization mortality. This increased risk should be considered when discussing adrenal metastasectomy in this age population.