Higher Postoperative Quality Of Life Research Articles

The Cost-Effectiveness of Robotic-Assisted Versus Manual Total Knee Arthroplasty: A Markov Model-Based Evaluation.

The purpose of this study was to investigate the cost-effectiveness of robotic-assisted total knee arthroplasty (TKA) versus conventional manual TKA in patients with knee osteoarthritis. A Markov model simulated the lifetime outcomes of TKA of patients at average age 60 years. Costs of robotic-assisted TKA included a preoperative CT scan and the costs for acquisition and use of robotic equipment (average $706,250). We used three institutional case volumes to generate average per-case robotic costs: low volume (10 cases, $71,025 per case), mid volume (100 cases, $7,463 per case), and high volume (200 cases, $3,931 per case). Systematic reviews were used to determine early (≤1 year) and late (> 1 year) revision rates after robotic-assisted TKA (0.3 and 0.6%, respectively) and conventional TKA (0.78% and 1.5%, respectively). Outcomes were total costs and health outcomes measured in quality-adjusted life-years (QALYs). Costs and QALYs were organized into incremental cost-effectiveness ratios (ICERs). A procedure was considered cost-effective if its ICER fell below willingness-to-pay (WTP) thresholds of $50,000 and $100,000/QALY. Sensitivity analyses evaluated the effect of data uncertainty. Robotic-assisted TKA produced 13.55 QALYs versus 13.29 QALYs for conventional TKA. Total costs per case for robotic-assisted TKA were $92,823 (low volume), $29,261 (mid volume), and $25,730 (high volume) compared with $25,113 for conventional. The ICERs for robotic-assisted TKAs were $256,055/QALY (low volume), $15,685/QALY (mid volume), and $2,331/QALY (high volume). ICERs for mid- and high-volume institutions were below WTP. Average number needed to treat was >42 and >24 robotic-assisted TKAs for cost-effectiveness at the $50,000 and $100,000/QALY WTP. Robotic-assisted TKAs remained cost-effective when annual revision rates <1.6% and quality of life values were >0.85. With lower annualized revision rates and higher postoperative quality of life, robotic-assisted TKAs potentially offer improved health outcomes, especially when annual institutional case volume >24 cases per year. Continued prospective investigation will be crucial to demonstrate the value of this new technology.

Progress in adjuvant therapy decision-making after endoscopic resection of early esophageal cancer

Both endoscopic resection and surgery are the common treatment modes for early esophageal cancer. Compared with radical surgery, endoscopic resection has the advantages of less trauma, quicker recovery, lower cost, less complications, the preservation of the normal anatomy, the physiological function of the esophagus, and higher postoperative quality of life. For patients with a high risk of lymph node metastasis, endoscopic resection alone can lead to inadequate treatment, which need adjuvant therapies. Currently, the common adjuvant therapies consist of adjuvant radiochemotherapy and adjuvant radiochemotherapy combined with surgery. How to combine endoscopic resection with adjuvant therapy to bring maximal benefits to patients has become the hot topic in the field of clinical researches. In this article, the current research status, progress and challenges in the combination of endoscopic resection and adjuvant therapy for the treatment of high-risk patients were reviewed. Key words: Esophageal neoplasm/endoscopic resection; Esophageal neoplasm/surgery; Esophageal neoplasms/chemoradiotherapy; Progress

Comparison between Cyanoacrylate, Sutureless and Polypropylene Sutures in Mesh Fixation on Lichtenstein Tension free in repair of Open Inguinal Hernia

Background: inguinal hernia repair is one of the most common operations in general surgery. The Lichtenstein tension-free operation has become gold standard in open inguinal hernia repair. Despite the low recurrence rates; postoperative pain and discomfort remain a problem for a large number of patients. Aim of the work: the aim of this study is to compare between cyanoacrylate, sutureless and polypropylene sutures in mesh fixation on lichtenstein tension free in repair of open inguinal hernia regard as postoperative pain, infection, recurrence,& cost benefit. Methods: a total of thirty patients with primary unilateral uncomplicated inguinal hernia were randomized to undergo lichtenstein tension free hernioplasty, and were randomized using close envelope into three groups: Group A: Inguinal hernioplasty with mesh fixation using polypropylene sutures (10 patients), Group B: Inguinal hernioplasty with mesh fixation using cyanoacrylate glue (10 patients) and Group C: Inguinal hernioplasty with mesh placement without sutures (10 patients). Primary outcome was early and late postoperative pain. Secondary endpoints were use of painkillers after 24 hours, morbidity rate and recurrence rate. Follow-up time was 6 months. Results: significantly, less postoperative pain was reported in group B compared to the other two groups (A&C). Additionally, trends toward a higher postoperative quality of life, a faster surgical procedure, and a shorter hospital stay and earlier return to daily activities were seen in patients within group(B).Clinical recurrence was reported in only one patient in Group C after a period of four months follow up postoperatively. Conclusion: cyanoacrylate glue seemed to be a simple, original, reasonable, feasible, reproducible technique and competitive alternative to the standard tissue-penetrating meshfixation devices in open inguinal hernioplasty. It is accompanied by a reduction in chronic inguinal pain, with no increase in the early recurrence rate.

Quality of life after functional aesthetic septorhinoplasty in primary surgery vs. revision surgery-a monocentric study

Subjective assessments of quality of life (QOL) as an important aspect of outcome research have gained in importance over the past few decades. The number of prospective studies on postoperative QOL in septorhinoplasty using disease-specific instruments is sparse. The aim was to assess and compare patient QOL after primary and revision septorhinoplasty performed by asingle surgeon in an ENT center. All patients completed two disease-specific QOL instruments preoperatively and at least 1 year postoperatively: the Rhinoplasty Outcome Evaluation (ROE) and the Nasal Obstruction Symptoms Evaluation (NOSE) scores. General demographic and clinical information (age, gender, medical and surgical history) were collected from all patients. All operations were performed by a single surgeon (F. R.). A total of 237 patients were included in the study, 208 (87.8%) female and 29 (12.2%) male. The average age was 30.3 ± 8.9years. The average observation period was 19.3 ± 7.4months. Using the measurement tool NOSE there was asignificant improvement in obstruction in the overall collective (preoperative 49.8 ± 26.2, postoperative 19.1 ± 21.3; p < 0.001) with no significant difference in primary versus revision surgery. The ROE score showed a significant improvement and both collectives (primary and secondary surgery) showed a significant improvement after the intervention. The patients with a primary intervention had a significantly higher postoperative QOL (p < 0.001). The disease-specific QOL showed asignificant increase after primary septorhinoplasty as well as after revision surgery. The NOSE score increased significantly in both intervention groups postoperatively.

Patient-reported quality of life after bariatric surgery: a single institution analysis

BackgroundBariatric surgery is an effective weight loss and comorbidity treatment among severely obese patients. However, there are limited data describing its impact on patient-reported quality of life (QoL). We examined patient-reported QoL after bariatric surgery and analyzed variables associated with higher postoperative QoL. MethodsPatient demographics, comorbidities, and weight loss data were obtained from our institutional database for patients who underwent bariatric surgery from January 2010 to December 2012. QoL scores were obtained during preoperative and postoperative visits (2, 6, 12, 24, 52, and 104 wk) from the Moorehead-Ardelt Quality of Life Questionnaire II. Multivariable logistic regression was performed to generate odds ratios for variables hypothesized a priori to be associated with higher postoperative QoL. ResultsA total of 209 patients were included in the study. Patients lost an average of 59.1% (±19.0) of excess body weight 1 y after surgery. One-year postoperative QoL scores were available for 42% of patients. Mean QoL scores improved from 0.82 preoperatively to 1.66 1 y postoperatively (P = 0.004). Patients scored higher in all individual areas of Moorehead-Ardelt Quality of Life Questionnaire II: self-esteem (0.22 versus 0.36), physical activity (0.11 versus 0.31), social life (0.28 versus 0.36), work ability (0.07 versus 0.22), sexual functioning (0.04 versus 0.16), and approach to food (0.11 versus 0.26; all P values <0.05). On multivariable analysis, higher QoL was associated with private insurance/self-pay versus Medicare (odds ratio 4.20 [95% confidence interval 1.39-12.68]). ConclusionsBariatric surgery patients experienced significant improvement in QoL 1 y after surgery. Identifying modifiable predictors of high QoL after bariatric surgery requires additional investigation.

Comparison of modified limberg flap and modified elliptical rotation flap for pilonidal sinus surgery: A retrospective cohort study

BackgroundAlthough various surgical procedures have been described for pilonidal sinus disease, the best surgical technique is still controversial. Aim of this study was to compare the short term results of modified limberg flap (MLF) and modified elliptical rotation flap (MERF) for pilonidal sinus disease in terms of postoperative complications, recurrence and patient satisfaction. Materials and methodTwo hundred and thirty six patients (43 female, 193 male) who were operated on for sacrococcygeal pilonidal sinus disease between January 2010 to December 2013 were retrospectively analyzed. 115 patients underwent Modified limberg flap (MLF) procedure and 121 patients underwent modified elliptical rotation flap (MERF) procedure. The median follow-up period was 22 months (range, 4–34). Complication and recurrence rate were the mean end points of the study. ResultsSurgical area related complications were lower in MERF group than in MLF group, but the difference was not statistically significant. Patients in the modified elliptical rotation flap group had shorter operation time, better cosmetic results and earlier return to normal social life than modified limberg flap group. There were no recurrences in MERF group but one recurrence in MLF group. ConclusionModified limberg flap reconstruction is still one of the most commonly performed procedures for pilonidal sinus disease because of its low complication and recurrence rate and higher postoperative quality of life. This study shows that modified elliptical rotation flap technique is at least effective as modified limberg flap reconstruction. Further prospective clinical trials are needed to show the effectiveness of this technique on long term.

Assessment of Pain and Quality of Life in Lichtenstein Hernia Repair Using a New Monofilament PTFE Mesh: Comparison of Suture vs. Fibrin-Sealant Mesh Fixation.

Background: Inguinal hernia repair is one of the most common operations in general surgery. The Lichtenstein tension-free operation has become the gold standard in open inguinal hernia repair. Despite the low recurrence rates, pain and discomfort remain a problem for a large number of patients. The aim of this study was to compare suture fixation vs. fibrin sealing by using a new monofilament PTFE mesh, i.e., the Infinit® mesh by W. L. Gore & Associates.Methods: This study was designed as a controlled prospective single-center two-cohort study. A total of 38 patients were enrolled and operated in Lichtenstein technique either standard suture mesh fixation or fibrin-sealant mesh fixation were used as described in the TIMELI trial. Primary outcome parameters were postoperative complications with the new mesh (i.e., seroma, infection), pain, and quality of life evaluated by the VAS and the SF-36 questionnaire. Secondary outcome was recurrence assessed by ultrasound and physical examination. Follow-up time was 1 year.Results: Significantly, less postoperative pain was reported in the fibrin-sealant group compared to the suture group at 6 weeks (P = 0.035), 6 months (P = 0.023), and 1 year (P = 0.011) postoperatively. Additionally, trends toward a higher postoperative quality of life, a faster surgical procedure, and a shorter hospital stay were seen in the fibrin-sealant group.Conclusion: Fibrin-sealant mesh fixation in Lichtenstein hernioplasty effectively reduces acute and chronic postoperative pain. Monofilament, macro-porous, knitted PTFE meshes seem to be a practicable alternative to commonly used polypropylene meshes in open inguinal hernia repair.

Impact of personality traits on choice and perceptions of autologous breast reconstruction.

There is little data examining the psychosocial characteristics of women who choose a type of autologous postmastectomy reconstruction. This study sought to investigate the role of personality on decision making and postoperative satisfaction in autologous breast reconstruction. A retrospective survey of 120 consecutive patients who had undergone transverse rectus abdominis myocutaneous (TRAM) or perforator flap (PF) reconstruction over a 4-year period by a single surgeon at a single academic institution. All patients underwent similar preoperative consultations and were categorized into one of four groups based on surgical procedure they chose and their PF candidacy as determined by body mass index, age, and laterality. The survey packet included three validated measures of personality indices and a quality-of-life questionnaire. Intergroup analysis was performed using the Wilcoxon rank sum test. The overall survey response rate was 52.5%. PF patients were younger (p = 0.007) and more likely to undergo bilateral reconstruction (p = 0.0009) relative to TRAM patients. Comparisons between the two most clinically extreme groups showed significant results with regard to personality testing. Patients who were deemed not ideal PF candidates but nevertheless chose PF reconstruction were shown to be more narcissistic (p = 0.033), extroverted (p = 0.024), and having a higher postoperative quality of life (p = 0.021) than those who were deemed ideal PF candidates but ended up choosing pedicled TRAM reconstruction. Specific personality traits play a role in the patients' choice of a reconstructive option and their overall postoperative satisfaction. Clinicians should be aware of the possible influence of personality type on surgery selection.

A study on quality of life after thoracoscopic assistant lobectomy for lung cancer

背景与目的传统的肺癌根治手术创伤大，胸腔镜下手术能减少手术创伤，有望改善肺癌患者术后生命质量（quality of life, QOL）。本研究旨在探讨胸腔镜下肺癌根治术对患者QOL的影响。方法使用由欧洲癌症研究与治疗组织（European Organization for Research and Treatment, EORTC）开发的质量核心问卷量表（Quality of Life-Core 30 Questionnaire, QLQ-C30）和针对肺癌患者的补充量表（Quality of Life-Lung Cancer 13 Questionnaire, QLQ-LC13）对60例分别接受胸腔镜和常规开胸肺癌根治术的非小细胞肺癌（non-small cell lung cancer, NSCLC）患者从术前3天至术后24周内的QOL进行评价。结果60例患者一共收回问卷215份，其余25份失访。所有患者的QOL在术后3天时均出现明显下降，常规开胸组和胸腔镜组术前、后3天的总体QOL平均得分分别为：87.8±10.3 vs 38.3±13.1（P < 0.001）和82.7±9.6 vs 56.3±14.8（P < 0.001）。随后，所有患者的QOL开始回升。常规开胸组患者的QOL下降更为明显，术后3天的总体QOL得分明显低于胸腔镜组（P=0.012, 9），术后24周时仍然不能恢复至术前水平（P=0.0124）。胸腔镜组术后QOL下降相对较小，术后24周时大部分指标恢复至术前水平。结论胸腔镜下肺癌根治术创伤小，恢复快，术后QOL高于传统开胸手术，是一种较为可取的肺癌术式。

Prospective Comparison of Laparoscopic Incisional Ventral Hernia Repair and Chevrel Technique

Laparoscopic incisional hernia repair has become an attractive and widely adopted alternative to open procedures. The Chevrel technique is still frequently performed, owing to its safety and effectiveness. Our study prospectively compares the new and the old technique. We prospectively collected data from laparoscopic and open incisional ventral hernia repairs performed from January 2006 to December 2008. Twenty-one patients were ultimately enrolled in the open and 20 in the video-laparoscopic (VL) group for the statistical analysis. Open and VL groups were homogeneous for demographics and size of parietal defect. No differences were observed in operating time and postoperative pain, although in the VL group, we found a tendency toward shorter hospital stays and higher postoperative quality of life. We reported a significantly higher rate of wound complications in the open group (7 vs. 1; P=0.03). Both techniques proved to be effective, although Chevrel presented a high rate of wound complications.