Hematoma Rate Research Articles

Current trends in the management of acute type A aortic intramural hematoma

Within the spectrum of acute aortic syndromes, intramural hematoma (IMH) is a distinct lesion that is characterized by crescentic or circumferential thickening of the aortic wall in the absence of an intimal defect. The reported incidence of IMH among all type A acute aortic syndromes ranges from 3.5% to 28.3%. As compared with acute aortic dissection, IMH is a disease of the elderly, and it tends to have reduced rates of malperfusion syndromes, aortic insufficiency, and root dilation, yet also tends to have increased rates of pericardial effusion, cardiac tamponade, and periaortic hematoma. With respect to natural history, IMH may progress to classic dissection, frank rupture, or aneurysmal dilation; yet, IMH may also regress and be completely resorbed. However, studies disagree over the rates of progression or regression; as such, few studies agree on the short-term and long-term prognosis associated with IMH. American and European guidelines advocate emergent surgery for all acutely presenting type A IMH. At a minimum, supracoronary replacement of the aorta with hemiarch reconstruction is the preferred extent of operative repair to reduce rates of long-term reintervention for disease progression. However, valve and/or root procedures may be necessary proximally, while total arch reconstruction or hybrid procedures for the descending aorta may be necessary distally. Much remains unknown for IMH, including the ideal extent of aortic repair, risk-stratification for elderly patients, and the optimal treatment paradigm for stable, uncomplicated IMH. As such, IMH remains a diagnostic and therapeutic challenge for the cardiovascular surgeon.

Our Experience with the Treatment of Hydrocephalus in infants: Endoscopic Third Ventriculostomy versus Ventriculo-Peritoneal Shunt: A retrospective comparative study

Background: Hydrocephalus is the commonest pediatric neurological disorder and usually treated by cerebrospinal fluid (CSF) diversion. This diversion accomplished by third ventriculostomy or ventriculo-peritoneal shunt. However, the optimal management is still controversial. Aim of the work: To compare the endoscopic third ventriculostomy (ETV) to ventriculo-peritoneal (VP) shunt in management of Infantile hydrocephalus. Patients and Methods:We conducted a retrospective analysis for 40 infants with hydrocephalus. The treatment used was CSF diversion by ETV or VP shunt. Results: oth treatment groups were comparable regarding age, gender, cause of hydrocephalus, incidence of postoperative re-obstruction, OFC change, hematoma, revision surgery, mortality or success rate. However, the operative time was significantly reduced among ETV when compared to VP shunt group (48.80±9.13 vs 66.75±7.65 minutes, respectively). The rate of postoperative infection was significantly decreased in ETV when compared to VP shunt groups (15.0% vs 45.0% respectively). Finally, the overall mortality during postoperative one year follow up duration was 42.5% with no significant difference between ETV and VP shunt groups (35.0% vs 50.0% respectively). In addition, the overall failure rate was 50.0%, which was lower among ETV when compared to V shunt groups (35.0% vs 65.0% respectively) with no significant difference. Conclusion: Endoscopic third ventriculostomy is effective and safe intervention for treatment of infantile hydrocephalus (for infants between 6 and 3 years of age). It is superior to VP shunt as it is associated with lower postoperative infection and shorter operation time, when compared to shunt.

The complication trends of adult spinal deformity surgery in Japan – The Japanese Scoliosis Society Morbidity and Mortality survey from 2012 to 2017

BackgroundThe Japanese Scoliosis Society Morbidity & Mortality Committee performed a longitudinal nationwide complication survey of spinal deformity surgery from 2012 to 2017. The present study aimed to analyze the survey results and report the complication trends of adult spinal deformity surgery in Japan. MethodsAll Japanese Scoliosis Society members were invited to participate in the survey. Adult spinal deformity was categorized into three groups by age: 20–39 years, 40–64 years and ≥65 years. Complications were grouped into death, blindness, neurological deficits (motor/sensory), infection, massive bleeding, hematoma, pneumonia, cardiac failure, deep vein thrombosis/pulmonary embolism, gastrointestinal perforation, and instrumentation failure. ResultsThe surveys were performed in 2012, 2014, and 2017. The overall complication rates were 21.6%, 26.0%, and 25.4%, respectively. The complication rates differed significantly by age group in all years such that older patients had a higher complication rate than younger patients. The rate of neurological deficits, particularly motor deficits, significantly increased in 2014 (3.1%–5.5%), and decreased in 2017 (4.3%). Massive bleeding and postoperative hematoma decreased significantly year by year (8.0%, 4.8%, 2.5% and 1.3%, 0.5%, 0.3%, respectively). The complication rate of instrumentation failure remained high, increasing without significant difference (5.2%, 5.8%, 6.5%, respectively), and was more common in the middle-aged and older patients. ConclusionsSurgical complication rates in patients with adult spinal deformity remain high, especially neurological deficits and instrumentation failure in patients aged over 40 years. However, the complication rates of massive bleeding and postoperative hematoma decreased over this period.

The Analgesic Efficacy of Transversus Abdominis Plane Block After Bariatric Surgery: a Systematic Review and Meta-analysis with Trial Sequential Analysis.

The transversus abdominis plane (TAP) block has been used to relieve pain after bariatric surgery but with conflicting data on its analgesic efficacy. We conducted this systematic review and meta-analysis with trial sequential analysis to clarify whether TAP block provides effective postoperative analgesia in patients undergoing bariatric surgery. We systematically searched the literature for any trials comparing TAP block with a control group (no block or sham injection). The primary outcome was pain scores at rest (analog scale, 0-10) at 2 postoperative hours. Secondary pain-related outcomes included pain scores at rest at 12 and 24h and both dynamic pain scores and intravenous morphine equivalent consumption at 2, 12 and 24h. Additional secondary outcomes sought were rates of postoperative infection, haematoma, visceral injury and local anaesthetic systemic toxicity. Thirteen trials totalling 1025 patients were identified. Pain scores at rest at 2 postoperative hours were significantly lower in the TAP block group compared with the control group, with a mean (95% CI) difference of - 1.8 (- 2.5, - 1.1); I2 = 85%; p< 0.00001. All other secondary pain-related outcomes were also significantly lower in the intervention group with the exception of dynamic pain scores and intravenous morphine equivalent consumption at 2 postoperative hours. Rates of block-related complications were not significantly different between groups. The overall quality of evidence was moderate-to-low. There is moderate-to-low level evidence that the TAP block improves postoperative analgesia after bariatric surgery up to 24 postoperative hours, when compared with a control group, without major reported complications. Clinical Trial NumberPROSPERO - registration number: CRD42019136542.

General Anesthesia Versus Conscious Sedation and Local Anesthesia During Thrombectomy for Acute Ischemic Stroke.

As numerous questions remain about the best anesthetic strategy during thrombectomy, we assessed functional and radiological outcomes in stroke patients treated with thrombectomy in presence of general anesthesia (GA) versus conscious sedation (CS) and local anesthesia (LA). We conducted a cohort study on prospectively collected data from 4429 patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke. GA was used in 2013 patients, CS in 1285 patients, and LA in 1131 patients. The rates of 3-month modified Rankin Scale score of 0-1 were 32.7%, 33.7%, and 38.1% in the GA, CS, and LA groups: GA versus CS: odds ratios after adjustment for unbalanced variables (adjusted odds ratio [aOR]), 0.811 (95% CI, 0.602-1.091); and GA versus LA: aOR, 0.714 (95% CI, 0.515-0.990). The rates of modified Rankin Scale score of 0-2 were 42.5%, 46.6%, and 52.4% in the GA, CS, and LA groups: GA versus CS: aOR, 0.902 (95% CI, 0.689-1.180); and GA versus LA: aOR, 0.769 (95% CI, 0.566-0.998). The rates of 3-month death were 21.5%, 19.7%, and 14.8% in the GA, CS, and LA groups: GA versus CS: aOR, 0.872 (95% CI, 0.644-1.181); and GA versus LA: aOR, 1.235 (95% CI, 0.844-1.807). The rates of parenchymal hematoma were 9%, 12.6%, and 11.3% in the GA, CS, and LA groups: GA versus CS: aOR, 0.380 (95% CI, 0.262-0.551); and GA versus LA: aOR, 0.532 (95% CI, 0.337-0.838). After model of adjustment for predefined variables (age, sex, thrombolysis, National Institutes of Health Stroke Scale, onset-to-groin time, anterior large vessel occlusion, procedure time, prestroke modified Rankin Scale score of <1, antiplatelet, and anticoagulant), differences were found also between GA versus CS as regards modified Rankin Scale score of 0-2 (aOR, 0.659 [95% CI, 0.538-0.807]) and GA versus LA as regards death (aOR, 1.413 [95% CI, 1.095-1.823]). GA during thrombectomy was associated with worse 3-month functional outcomes, especially when compared with LA. The inclusion of an LA arm in future randomized clinical trials of anesthesia strategy is recommended.

Indications and Outcomes of Mohs Micrographic Surgery Using a Multidisciplinary Approach: A Decade of Experience.

Traditional approaches of staged outpatient Mohs Micrographic Surgery (MMS) in nonmelanoma skin cancer (NMSC) followed by reconstruction is not possible in a subset of patients. Assess the indications and outcomes of a multidisciplinary approach MMS. Retrospective, single-surgeon, single Mohs specialist, university-based tertiary care referral practice, including all MMS performed in the operating room setting with concurrent reconstruction in patients from 2008 to 2018 with minimum follow-up of 6 months. Patients with NMSCs who completed multidisciplinary MMS approach were included. Number of Mohs stages, duration of procedure, reconstruction techniques, and complications including flap loss, bleeding, hematoma, wound infections, dehiscence, and local recurrence rates were reviewed. Three hundred twenty patients were included, 160 male and 160 female with mean ages of 71.6 and 72.1 years, respectively. Indications for a multidisciplinary approach MMS were as follows: neuro/psych 22.5%, extensive anticipated defect size 55%, patient request/convenience 4.4%, medical intolerance 5%, multiple reasons 8.1%, and unknown in 5%. Average stage required to clear margins was 1.57 ± 0.64. Mean operative times by increasing Mohs stages up to 3 including reconstruction were 125.1, 159.3, and 195.5 minutes, respectively (p < .00001). Indications for a multidisciplinary approach MMS were extensive defects and neuro/psych issues. Advantages include patient tolerance and single-stage procedure.

Outcomes after completion thyroidectomy versus total thyroidectomy for differentiated thyroid cancer: A single-center experience.

Thyroid cancer diagnoses are often discovered after diagnostic thyroid lobectomy. Completion thyroidectomy (CT) may be indicated for intermediate or high-risk tumors to facilitate surveillance and/or adjuvant treatment. The completeness of thyroid resection and the safety of CT compared to total thyroidectomy (TT) is unclear. We assessed outcomes after TT or CT to determine completeness of resection and risk of complications. Patients undergoing TT or CT between 2000 and 2018 were retrospectively reviewed. Pathology, unstimulated thyroglobulin (uTg), parathyroid hormone (PTH), rates of hematoma, and recurrent laryngeal nerve (RLN) injury were compared. Differentiated thyroid cancer (DTC) was identified in 954 patients undergoing TT and 142 patients undergoing CT. Postoperative uTg at 6 months was not different between TT and CT, 0.2 vs 0.2 ng/mL, P = .37. Transient hypoparathyroidism with immediate postoperative PTH less than 10 was more common after TT, 14.3 vs 6.0% (P = .009). No differences were noted regarding postoperative hematoma, transient RLN injury, permanent hypoparathyroidism, and permanent RLN injury. If CT is required for DTC, a complete resection, as assessed by postoperative uTg, can be achieved. Furthermore, CT is significantly less likely to result in transient hypoparathyroidism and poses no additional risk of RLN injury, hematoma, or permanent hypoparathyroidism.

Prepectoral 2-stage Breast Reconstruction with Carbon Dioxide Tissue Expansion.

Background:Roughly 80% of patients undergoing mastectomy in the United States opt for reconstruction with implants. The introduction of acellular dermal matrices has allowed for placement of breast prostheses in the prepectoral plane, while a new carbon dioxide tissue expander (TE) (AeroForm) allows for needle-free, patient-controlled expansion. These 2 novel technologies have ushered in a new patient-centered era of breast reconstruction, with the possibility of reducing patient morbidity for the first time in decades. We hypothesize that AeroForm expanders placed in the prepectoral plane reduce time to second-stage reconstruction, reduce the number of clinic visits, and have lower complications than traditional saline TEs.Methods:This is a retrospective review of all patients undergoing breast mastectomy and TE placement in the prepectoral plane over a 21-month period (169 patients, 267 breasts), comparing AeroForm expanders to TEs.Results:The AeroForm group (n = 57) had a shorter period to second-stage reconstruction than the TE group (n = 210) (135.4 versus 181.7 days; P = 0.01) and required fewer clinic visits (5.1 versus 6.9; P < 0.01). Partial thickness (25.6% versus 12.3%, P = 0.03) and full thickness (8.7% versus 0.0%, P = 0.02) necrosis were more common in the saline cohort. The rates of infection, hematoma, and seroma requiring drainage were not statistically significant between the 2 groups.Conclusions:Two-staged breast reconstruction with the use of AeroForm expanders in the prepectoral space marks progress in improving care for breast cancer patients by demonstrating a reduction in some adverse events, the number of clinic visits, and the time to second-stage reconstruction.

Middle meningeal artery embolization reduces the post-operative recurrence rate of at-risk chronic subdural hematoma

BackgroundEmbolization of the middle meningeal artery (MMA) has emerged as a potential treatment of chronic subdural hematomas (CSDHs).ObjectiveTo evaluate the impact on recurrence rate of postsurgical embolization of CSDH in...

Influence of gender on discharge disposition after spinal fusion for adult spine deformity correction

ObjectivesGender has been shown to impact several aspects of spine surgical care. However, the influence of gender disparities on discharge disposition after adult spine deformity correction (ASD) is relatively understudied. The aim of this study was to investigate the influence of gender on discharge disposition after elective spinal fusion involving ≥4 levels for ASD correction. Patients and methodsThe Nationwide Inpatient Sample database (2011–2014) was queried for patients with ASD (≥26 years-old) and elective spine fusion surgery involving ≥4 levels using ICD-9 codes. Patients were stratified by gender: Male or Female. Multivariate linear and logistic regressions were used to assess the impact of gender on length of hospital stay and discharge disposition. ResultsA total of 4972 patients were identified of which 3282 (66.0%) were Female and 1690 (34.0%) were Male. The Male cohort had a higher prevalence of comorbidities than the Female cohort. There was a difference in the number of levels operated on between cohorts, with the Female cohort having fewer 4−8-level fusions (77.6% vs. 86.8%) and more 9+-level fusions (23.0% vs. 13.6%) compared to Males. The Female cohort had greater rates of postoperative UTI (5.5% vs. 2.5%) and surgical site hematomas (2.6% vs. 1.3%), while the Male cohort had more postoperative MI (5.4% vs. 1.5%). The Female cohort spent slightly more time in the hospital than Male cohort (6.2 days vs. 5.9 days, P = 0.035). Female patients had a significantly greater proportion of non-routine discharge disposition (F: 48.5% vs. M: 40.3%, P < 0.001) compared to Male patients. However, in a multivariate analysis including patient and hospital factors, gender was not an independent predictor of discharge disposition (OR: 0.976, CI: 0.865–1.101, P = 0.688), but was independently associated with increased LOS [female (RR: 0.331, CI: 0.106−0.556, P = 0.004)]. Conclusion: Our study suggests gender disparities may not have a significant impact on discharge disposition after spinal fusion for ASD involving four levels or greater. Further studies are necessary to understand risk factors for non-routine discharges in ASD patients to improve quality of patient care and reduced healthcare costs.

Laparoscopic versus open mesh repair for the treatment of recurrent inguinal hernia: a systematic review and meta-analysis.

Inguinal hernia repair is a common surgical procedure; however, the effects of laparoscopic and open mesh repair in the treatment of recurrent inguinal hernia are unclear. This study aimed to evaluate the effects of laparoscopic and open mesh repair in the treatment of recurrent inguinal hernia by conducting a meta-analysis of randomized controlled trials (RCTs). A comprehensive, meta-analysis of RCTs on the effects of laparoscopic and open mesh repair in the treatment of recurrent inguinal hernia was performed. English- and Chinese-language studies published up to December 30, 2017 were identified via a systematic search of the PubMed, Embase, Science Direct, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure (CNKI), and Wanfang databases. Summary odd ratios or weighted mean differences (MDs) with 95% confidence intervals (CIs) were adopted to calculate each outcome using a fixed or random effects model. Ten RCTs involving a total of 1,017 patients were included. There was no statistically significant difference in the rate of recurrence (P=0.23; OR: 0.74, 95% CI: 0.45-1.21), hematoma (P=0.47; OR: 0.71, 95% CI: 0.28-1.79), urinary retention (P=0.94; OR: 0.97, 95% CI: 0.46-2.07) and acute pain (P=0.71; OR: 0.74, 95% CI: 0.14-3.76) between the laparoscopic and open mesh repair groups. The incision infection rate (P=0.02; OR: 0.28, 95% CI: 0.10-0.81) of the laparoscopic group was lower and the length of hospital stay (P<0.0001; MD: -3.65, 95% CI: -4.76 to -2.53) was significantly shorter than those of the open repair group. However, the laparoscopic group had a longer operative time (P=0.0002; MD: 20.30, 95% CI: 9.60-31.01). The laparoscopic approach is superior to the open mesh approach for the repair of recurrent inguinal hernia in some aspects, including the incision infection rate and length of hospital stay. However, more high-quality studies on the effects of laparoscopic and open mesh repair for the treatment of recurrent inguinal hernia are warranted.

Effect of endovenous ablation assessment stratified by great saphenous vein size, gender, clinical severity, and patient-reported outcomes

ObjectiveThe policies of insurance carriers have used the truncal vein size as a criterion for coverage. The objective of the present study was to compare the effect of great saphenous vein (GSV) size ≥5 mm vs <5 mm on patient presentation and clinical outcomes. MethodsPatients in a national cohort were prospectively captured in the Vascular Quality Initiative Varicose Vein Registry. From January 2015 to October 2017, the Vascular Quality Initiative Varicose Vein Registry database was queried for all patients who had undergone varicose vein procedures. The CEAP (clinical, etiologic, anatomic, pathophysiologic) classification, Venous Clinical Severity Score, and patient-reported outcomes were compared by GSV size (<5 mm, group 1; ≥5 mm, group 2) before and after the procedures. A 2-sample Wilcoxon test was performed to assess the differences between the 2 groups stratified by GSV size. To assess for postoperative improvement, a matched-pairs Wilcoxon signed rank test was performed for each group separately. ResultsDuring the study period, 5757 vein ablation procedures had been performed for GSV: 770 for GSV size <5 mm and 4987 for GSV size ≥5 mm. Patients in group 1 were more likely to be women (81.7% vs 68.4%; P = .001) and older (56.8 vs 55.6 years; P = .012). The CEAP clinical class was more advanced in group 2 than in group 1 (P = .001). The maximal GSV diameter in group 2 was significantly greater than in group 1 (8.32 vs 3.86 mm; P = .001); 64% of group 2 and 59.2% of group 1 had undergone radiofrequency thermal ablation (P = .001). No mortalities occurred in either group. Group 2 had more complications postoperatively (0.6% vs 0%; P = .027), required postoperative anticoagulation (8.8% vs 5%, P = .001), developed partial recanalization (0.8% vs 0.3%; P = .001), and missed more work days (2.32 vs 1.6 days) compared with group 1. A similar rate of hematoma developed in both groups, but group 1 had a higher rate of paresthesia. Both groups had improvement in the Venous Clinical Severity Score and HASTI (heaviness, achiness, swelling, throbbing, itching) score. The degree of symptomatic improvement between the 2 groups was similar. ConclusionsAll patients demonstrated improvement in both clinical outcomes and patient-reported outcomes after endovenous ablation, regardless of GSV size. Patients with a preoperative GSV size ≥5 mm experienced similar improvement in symptoms but an increased complication rate. Patients with a smaller vein size should not be denied intervention or coverage by vein size.

Indocyanine green angiography for preventing postoperative mastectomy skin flap necrosis in immediate breast reconstruction.

Indocyanine green angiography for preventing postoperative mastectomy skin flap necrosis in immediate breast reconstruction.

Outcomes of Immediate Titanium Cranioplasty Following Post-Craniotomy Infection.

When craniotomy complicated by secondary infection requires debridement and craniectomy, the bony defect is typically not reconstructed immediately. Due to concerns about placing a prosthetic material in an infected field, cranioplasty has traditionally been delayed by weeks or months after craniectomy. However, surgeons have begun performing single-stage cranioplasty after craniectomy in an effort to reduce the morbidity associated with multiple procedures and reduce overall healthcare costs. The purpose of this systematic review is to analyze outcomes of immediate cranioplasty performed after bone flap debridement secondary to infection. A literature review from January 1, 1998 through January 1, 2019 was conducted, examining the data on immediate titanium cranioplasty and its complication and reoperation rates. A meta-analysis of these articles was then performed. Variables studied included incidence of infection post-cranioplasty, wound healing complications, need for unplanned reoperation, and mortality. In total, there were 40 patients who underwent immediate cranioplasty after bone flap debridement. Overall, there was a 5% rate of postoperative infection, a 12.5% rate of unplanned return to the operating room, 7.5% rate of CSF fistula or leak, a 2.5% rate of hematoma, and a 2.5% rate of mortality within the immediate post-op period. Although there are insufficient data in the literature to rigorously compare these immediate cranioplasties in a direct way with the more traditional delayed type; the outcomes of immediate cranioplasty procedures secondary to craniectomy for infection were similar to the outcomes of delayed cranioplasty after craniectomy for any reason. Given these results, immediate titanium cranioplasty should be considered in select patients.

Association of upper extremity and neck access with stroke in endovascular aortic repair

ObjectiveUpper extremity and neck access is commonly used for complex endovascular aortic repairs. We sought to compare perioperative stroke and other complications of (1) arm/neck (AN) and femoral or iliac access versus femoral/iliac (FI) access alone, (2) right- versus left-sided AN, and (3) specific arm versus neck access sites. MethodsPatients entered in the thoracic endovascular aortic repair/complex endovascular aortic repair registry in the Vascular Quality Initiative from 2009 to 2018 were analyzed. Patients with a missing access variable and aortic arch proximal landing zone were excluded. The primary outcome was perioperative in-hospital stroke. Secondary outcomes were other postoperative complications and 1-year survival. Kaplan-Meier curves and log-rank test were used for survival analysis. ResultsOf 11,621 patients with 11,774 recorded operations, 6691 operations in 6602 patients met criteria for analysis (1418 AN, 5273 FI). AN patients had a higher rate of smoking history (83.6% vs 76.1%; P < .0001), and prior stroke (12.6% vs 10.1%; P = .01). Operative time (280 ± 124 minutes vs 157 ± 102 minutes; P < .0001), contrast load (141 ± 82 mL vs 103 ± 67 mL; P < .0001), and estimated blood loss (300 mL vs 100 mL; P < .0001) were larger in the AN group, indicative of greater complexity cases. Overall, AN had a higher rate of stroke (3.1% vs 1.8%; P = .003) compared with FI and on multivariable analysis AN access was found to be an independent risk factor for stroke (odds ratio, 1.97; P = .0003). There was no difference in stroke when comparing right- and left-sided AN access (2.8% vs 3.2%; P = .71). Stroke rates were similar between arm, axillary, and multiple access sites, but were significantly higher in patients with carotid access (2.6% vs 3.5% vs 13% vs 3.7%; P = .04). AN also had higher rates of puncture site hematoma, access site occlusion, arm ischemia, and in-hospital mortality (7.1% vs 4.2%; P < .0001). At 1 year, AN had a lower survival rate (85.1% vs 88.1%; P = .03). ConclusionsUpper extremity and neck access for complex aortic repairs has a higher risk of stroke compared with femoral and iliac access alone. Right-sided access does not have a higher stroke rate than left-sided access. Carotid access has a higher stroke rate than axillary, arm, and multiple arm/neck access sites.

PD20-12 SAFETY PROFILE OF COUNTER INCISION FOR RESERVOIR PLACEMENT DURING INFLATABLE PENILE PROSTHESIS SURGERY

INTRODUCTION AND OBJECTIVE: Non-traditional reservoir placement is increasingly popular during penile prosthesis (PP) surgery to prevent intraperitoneal positioning and bowel, bladder, or vascular injury. A variety of locations have been described including submuscular, high-submuscular, and subcutaneous. In this study we present our experiences using a counter incision for submuscular reservoir placement and compare these to patients who underwent traditional reservoir placement. METHODS: A single institution database of PP surgeries was queried for use of a counter incision (CI) during reservoir placement from July 2011 to 2019. Demographic, medical, and surgical histories as well as 90-day outcome data were extracted. Primary outcome was device infections, with secondary outcomes including cellulitis, reservoir herniation, hematoma, device malfunction rates, and operative times. Additionally, a descriptive analysis of the reasons for CI was performed. Groups were compared using Kruskal Wallis and Fisher’s exact tests for continuous and categorical variables respectively. RESULTS: A total of 432 cases met inclusion criteria of which 46 (10.6%) used a CI for reservoir placement. Twenty-six CI patients (56.5%) had undergone a prior prostatectomy compared to 108 (28.0%) non-CI patients (p<0.001). The CI cohort included significantly more removal and replacement procedures, 54.3% vs. 26.4% (p<0.001). Most common reasons for CI were prior prostatectomy and inguinal hernia repair. Device infection rates were similar between groups (CI 2.2 vs. non CI 3.6%), as were rates of hematoma (2.2 vs 3.6%), cellulitis (4.3 vs 0.5%), and device malfunction (0.0 vs 0.7%). An internal iliac artery injury, one intravesical reservoir placement, and one reservoir herniation were seen in the non-CI cohort, but no similar complications occurred in the CI group. Of wound complications, only one was of the CI with a total CI wound complication rate of 1/46 (2.2%). Median operative time was 15 minutes longer in the CI cohort (69.6 vs 84.0 minutes, p = 0.007). CONCLUSIONS: Use of a CI is a safe and effective means of reservoir placement in patients with a compromised space of Retzius, albeit with a slightly higher operative time. Complication rates were similar between groups, even in a subset where approximately half the cases were removal and replacements. Of wound complications, the vast majority did not occur at the CI, rather at the penoscrotal or infrapubic incisions. Source of Funding: None

PD20-04 CONTINUATION OF BASELINE ANTITHROMBOTIC THERAPY IN MEN UNDERGOING INFLATABLE PENILE PROSTHESIS SURGERY: AN UPDATE ON OUTCOMES

You have accessJournal of UrologySexual Function/Dysfunction: Surgical Therapy I (PD20)1 Apr 2020PD20-04 CONTINUATION OF BASELINE ANTITHROMBOTIC THERAPY IN MEN UNDERGOING INFLATABLE PENILE PROSTHESIS SURGERY: AN UPDATE ON OUTCOMES Kevin Hebert*, David Yang, Matthew Ziegelmann, Jack Andrews, Madeleine Manka, Kevin Wymer, Matthew Houlihan, Masaya Jimbo, Ross Avant, Zachary Pfeifer, Landon Trost, and Tobias Kohler Kevin Hebert*Kevin Hebert* More articles by this author , David YangDavid Yang More articles by this author , Matthew ZiegelmannMatthew Ziegelmann More articles by this author , Jack AndrewsJack Andrews More articles by this author , Madeleine MankaMadeleine Manka More articles by this author , Kevin WymerKevin Wymer More articles by this author , Matthew HoulihanMatthew Houlihan More articles by this author , Masaya JimboMasaya Jimbo More articles by this author , Ross AvantRoss Avant More articles by this author , Zachary PfeiferZachary Pfeifer More articles by this author , Landon TrostLandon Trost More articles by this author , and Tobias KohlerTobias Kohler More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000870.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with erectile dysfunction frequently have cardiovascular/cerebrovascular risk factors requiring antithrombotics (anticoagulation/antiplatelets). Limited data are available on perioperative morbidity associated with discontinuation and continuation of antithrombotics at time of IPP surgery. We sought to identify the incidence of postoperative cardiovascular and cerebrovascular events in patients holding antithrombotics at time of IPP surgery while assessing risk of postoperative morbidity in men continuing antithrombotics. METHODS: We reviewed a prospectively collected database of men undergoing IPP surgery at our institution. Statistical analysis was performed to evaluate differences in scrotal drain output, hematoma formation, and postoperative morbidity among patients who continued versus held antithrombotics. RESULTS: 219 patients, median 66 years (IQR 59,72) underwent IPP surgery between July 2017 and June 2019. 118 patients (54%) reported baseline antithrombotic use. 77 of 118 patients (65%) continued antithrombotics through IPP surgery (aspirin 81mg, n=62; aspirin 325mg, n=7; clopidogrel, n=4; apixaban, n=4; warfarin, n=9; rivaroxaban, n=1; and combination therapy, n=8). On univariate analysis, no statistically significant difference (p=0.2) in median postoperative day zero drain output was identified between men continuing antithrombotics versus those not on antithrombotics at surgery, 85 mL (IQR 40, 123) vs 85 mL (IQR 59, 125), respectively. A statistically significant difference in self-resolving hematoma rates were seen in those continuing antithrombotics, 6 of 72 (8%), versus those not on antithrombotics, 3 of 135 (2%), p=0.04. 41 of 118 patients (35%) held antithrombotics with 3 of 41 (7%) experiencing a postoperative cardiovascular or cerebrovascular event. No patients continuing antithrombotic therapy (n=77) through the perioperative period experienced a cardiovascular or cerebrovascular event. CONCLUSIONS: In a small operative series, continuing antithrombotics at the time of IPP surgery increased the rate of postoperative self-resolving hematomas compared to those not on antithrombotics, however holding antithrombotics is not without risk of perioperative cerebrovascular and cardiac events. This data suggests judicious consideration of continuing antithrombotics at the time of IPP surgery and require further validation. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e448-e448 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Hebert* More articles by this author David Yang More articles by this author Matthew Ziegelmann More articles by this author Jack Andrews More articles by this author Madeleine Manka More articles by this author Kevin Wymer More articles by this author Matthew Houlihan More articles by this author Masaya Jimbo More articles by this author Ross Avant More articles by this author Zachary Pfeifer More articles by this author Landon Trost More articles by this author Tobias Kohler More articles by this author Expand All Advertisement PDF downloadLoading ...

Comparison of safety and efficacy between total endoscopic resection and conventional open surgery for malignant thyroid tumors: a meta-analysis.

BackgroundEndoscopic thyroidectomy (ET) has been widely accepted as a surgical option for benign thyroid lesions, yet remains controversial in the treatment of malignant thyroid because of concerns with the safety and efficacies. This paper aims at systematically evaluating the advantages and disadvantages of ET in malignant thyroid tumors through meta-analyses.MethodsMeta-analysis was conducted by retrieving all studies on the treatment of malignant thyroid carcinomas released in database, including PubMed, Web of Science, Cochrane and Google scholar, from January 2005 to January 2019. Then the safety and efficacies were compared between the two surgical modalities based on current reports.ResultsTotally, 3,482 cases were included in 11 related studies. Most adverse outcomes by ET were involved in transient or permanent recurrent laryngeal nerve paralysis (RLN) and hypocalcemia, postoperative total complications, hemorrhage, hematoma at the incision, and total relapse rate following surgery. Besides, ET led to higher incidence of transient RLN palsy, yet significantly lower transient hypocalcemia than conventional open thyroidectomy (COT). The difference was insignificant regarding transient or permanent RLN and hypocalcemia, total postoperative complications, postoperative hemorrhage, incisional hematoma and total recurrent rate between the two procedures. Secondary outcomes consisted of operative time, hospital stay and cosmetic results, by which COT was superior to ET, yet cosmetic incision was better by ET than by COT. There was no significant difference in hospital stay.ConclusionsET can be feasible and safe surgical option for malignant thyroid lesions, with better cosmetic effect.

Effect of Local Tranexamic Acid on Hemostasis in Rhytidectomy.

Importance: Hematoma is the most common complication in rhytidectomy. Tranexamic acid (TXA) is an antifibrinolytic that may be a useful tool to reduce intraoperative bleeding and postoperative hematoma risk. Objective: To determine whether local TXA reduces intraoperative bleeding and postoperative drain output in rhytidectomy. Design, Setting, and Participants: Retrospective cohort study of patients undergoing deep plane rhytidectomy with platysmaplasty. Beginning January 1, 2019, we began adding 1 cc (100 mg) of TXA to every 10 cc of local anesthetic and tumescent solution. Patients were, therefore, separated into two cohorts: control and TXA. Primary outcomes include postoperative day 1 (POD1) drain output, days to drain removal, percentage drains removed POD1, and percentage POD1 drain output <25 cc. Secondary outcomes include minor hematoma, major hematoma, Nitro-bid use, intraoperative estimated blood loss (EBL), and thromboembolic events. Results: POD1 drain output reduced from 50.4 cc in control group versus 14.8 cc with TXA (p < 0.001). Average day of drain removal reduced from 1.8 days in control group versus 1.2 days with TXA (p = 0.001). Percentage of drains removed on POD1 was increased from 34.4% in control group to 77.3% with TXA (p < 0.001). Percentage of POD1 drain output <25 cc was increased from 21.9% in control group to 95.5% with TXA (p < 0.001). Intraoperative EBL <50 cc increased from 25% in control group to 75% with TXA (p < 0.001). No statistically significant difference was observed between control and TXA in rates of minor hematoma, major hematoma, Nitro-bid use, or thromboembolic events. Conclusions and Relevance: Local TXA used in rhytidectomy significantly reduces intraoperative blood loss, postoperative drain output, and time to drain removal. No significant difference was observed in postoperative complication rates.

Total thyroidectomy: Safe and curative treatment option for hyperthyroidism.

While use of total thyroidectomy has increased in management of hyperthyroidism, concerns exist about increased surgical complication rates; most notably, hematoma, recurrent laryngeal nerve (RLN) injury, and hypocalcemia. Retrospective cohort study of 454 patients undergoing total thyroidectomy between 2003 and 2015. All patients had surgery for hyperthyroidism, benign euthyroid disease, or thyroid malignancy. Total thyroidectomy for hyperthyroidism was not associated with an increased risk for any postoperative complication. Transient hypocalcemia, temporary dysphonia, and postoperative hematoma rates were not significantly different for patients with hyperthyroid (n = 91), euthyroid benign (n = 237), and malignant (n = 126) disease. Permanent hypocalcemia and recurrent laryngeal nerve injury were not noted in any hyperthyroid patients. Complication rates were similar for hyperthyroid patients with Graves' disease vs toxic multinodular goiter. This study affirms safety and efficacy of total thyroidectomy as standard treatment for hyperthyroidism.