Higher Total Complication Rate Research Articles

Versatility of the Pedicled Buccal Fat Flap.

The pedicled buccal fat flap (PBFF) is a versatile and robust regional flap used for a variety of maxillofacial reconstructions. However, recent literature has questioned the popularity of this flap. The goal of this single-instruction, retrospective study is to review the outcomes and complications of the PBFF. Our study included 27 patients and 28 PBFFs with 13 males, 14 females, and an average age of 68. The most common primary pathologies included squamous cell carcinoma and a fistula (oroantral or oronasal). Persistent postoperative complications were experienced in 31.3% of the cohort. The most common subsite was the retromolar trigone, and the higher complication rates per subsite were noted in the hard and soft palate groups (66.7% each). Higher total complication rates were seen in cases of SCC and fistula (33.3% each). Our study demonstrates the low morbidity and high tolerance of the procedure despite a patient having older age, significant comorbidities (67.9%), smoking history (60.7%), preoperative radiation (17.9%), and postoperative radiation (28.6%). The authors conclude the PBFF remains a durable and reliable reconstructive option in a variety of patient cases.

Preexisting pulmonary hypertension impact on in-hospital outcomes of cardiac implantable electrical device implantation

Abstract Background Preexisting pulmonary hypertension (PH) is associated with unfavorable in-hospital outcomes in cardiac as well as non-cardiac surgeries and procedures. However, its impact on cardiac implantable electronic device (CIED) implantations is not established. We investigated the extent of preexisting PH among patients undergoing CIED implantations and evaluated its effect on in-hospital outcomes. Methods Using the National Inpatient Sample (NIS) database, we identified patients who were hospitalized in the US between 2016-2019 and underwent CIED implantation with a preexisting diagnosis of PH. Patients with any CIED in-situ were excluded. Sociodemographic, clinical data, in-hospital procedures and outcomes as well as in-hospital mortality were collected. Multivariable logistic regression models were used to identify predictors of in-hospital complications. Results An estimated total of 718,980 patients underwent CIED implantation during the study period. Of them, 74,150 patients (10.3%) had preexisting PH diagnosis. Compared with non-PH patients, PH patients were older, had higher Charlson Comorbidity Index, and more often implanted with implantable cardioverter defibrillators and cardiac resynchronization therapy devices. Higher rate of total complications was observed in PH patients (14.5% versus 9.9%; P<0.001) driven mainly by respiratory complications as well as in-hospital mortality (2.3% versus 1.2%; P<0.001). Multivariable analyses confirmed PH as an independent predictor for respiratory complications, total complications and in-hospital mortality. Conclusion Preexisting PH in patients undergoing CIED implantation was associated with increased risk for respiratory complications as well as in-hospital mortality in a US nationwide, all-comer registry.

Atrial Fibrillation Catheter Ablation among Cancer Patients: Utilization Trends and In-Hospital Outcomes.

Background: Atrial fibrillation (AF) catheter ablation in cancer patients has been evaluated in very few studies. We aimed to investigate utilization trends and in-hospital outcomes of AF catheter ablation among cancer patients in a large US inpatient registry. Methods: Utilizing the National Inpatient Sample (NIS) database, patients who underwent AF catheter ablation between 2012 and 2019 were identified. Sociodemographic, clinical data, in-hospital procedures and outcomes were collected. Baseline characteristics and in-hospital outcomes were compared between patients with and without cancer. Results: An estimated total of 67,915 patients underwent AF catheter ablation between 2012 and 2019 in the US. Of them, 950 (1.4%) had a cancer diagnosis. Patients with a cancer diagnosis were older and had higher Charlson Comorbidity Index, CHA2DS2-VASc and ATRIA bleeding indices scores. A higher rate of total complications was observed in cancer patients (10.5% vs. 7.9, p < 0.001), driven mainly by more bleeding and infectious complications. However, no significant differences in cardiac or neurological complications as well as in-hospital mortality rates were observed and were relatively low in both groups. Conclusions: AF catheter ablation in cancer patients is associated with higher bleeding and infectious complication rates, but not with increased cardiac complications or in-hospital mortality in a US nationwide, all-comer registry.

Utilization and complications of atrial fibrillation catheter ablation among cancer patients

Abstract Background Atrial fibrillation (AF) catheter ablation among cancer patients was evaluated only in a few small studies. We investigated the extent and in-hospital outcomes of AF catheter ablation procedures among cancer patients. Methods Using the National Inpatient Sample (NIS) database, patients who underwent AF catheter ablations in the US between 2016 and 2019 were identified using ICD-10 codes. Sociodemographic, clinical data, in-hospital procedures and outcomes as well as in-hospital mortality and length-of-stay (LOS) were collected. Baseline characteristics and in-hospital outcomes comparison between patients with and without cancer was performed. Results An estimated total of 36630 patients underwent AF catheter ablation between 2016-2019 in the US. Of them, 585 (1.6%) had cancer diagnosis. Compared with non-cancer patients, patients with cancer were older, had higherCharlson Comorbidity Index, as well as CHA2DS2-VASc and ATRIA bleeding indices scores (Table 1). Higher rate of total complications was observed in cancer patients (10.3% vs 7.0 , p=0.002) driven mainly by more bleeding and infectious complications. LOS was also significantly longer in cancer patients (5.5 + 6.3 vs. 3.1 + 3.4 days, p&amp;lt;0.001). However, no significant differences in cardiac or neurological complications as well as in-hospital mortality rates were observed and were relatively low in both groups (Table 2). Conclusion AF catheter ablation in cancer patients is associated with higher bleeding and infectious complication rates, but not with increased cardiac complications or in-hospital mortality rates in a nationwide, all-comer registry.

Preoperative Halo-Gravity Traction for Severe Pediatric Spinal Deformity: Can it Replace a Vertebral Column Resection?

Background: While vertebral column resections (VCRs) are an effective means for correcting severe spine deformities, these complex procedures are associated with high rates of complications. We hypothesized that preoperative halo-gravity traction (HGT) followed by spinal fusion without VCRs can produce equivalent outcomes with less risk than a VCR in complex pediatric spinal deformity.Methods: This was a retrospective review of prospectively collected data of pediatric patients who underwent spinal fusion for severe spinal deformity. Patients treated with either 1) preoperative HGT without VCRs or 2) VCRs without preoperative HGT were included. Patients with congenital etiology and those with prior surgery were excluded. Comparisons were made between cohorts with respect to preoperative, intraoperative, and postoperative (2 years) demographic, radiographic, and health-related quality of life (HRQoL) variables. The rate of revision surgery and any treatment complications were also compared.Results: We identified 49 patients (mean age 16+2.9 years; 54% males) who underwent VCR (17/49; 35%) or preoperative HGT (32/49; 65%) for severe spinal deformities. Those in the HGT cohort had more severe deformity at baseline based on radiographic variables, including maximum Cobb angle, maximum kyphosis, major coronal Cobb angle, and apical vertebral translation. They also had greater residual deformities at 2 years postoperatively, though percent correction of the major deformity magnitude (p=0.28), major (p=0.54) and minor (p=0.91) coronal curve, and apical vertebral translation (p=0.66) was similar to the VCR cohort. Operative time (p=.18), estimated blood loss (0.37), hospitalization length (0.52), and ICU stay (0.12) were similar between cohorts, though patients who underwent VCR had higher rates of total complications (47% vs. 3%; p<0.01). There were no significant differences between cohorts with respect to percent change in HRQoL outcomes from baseline to 2 years postoperatively.Conclusion: Our study suggests that in patients without congenital deformities undergoing primary deformity correction, preoperative HGT followed by spinal fusion produces radiographic outcomes that are similar to VCRs with fewer perioperative complications. Thus, preoperative HGT for severe pediatric deformities may lessen the need to perform higher risk VCRs.Level of Evidence: Level IIIKey Concepts•This study aimed to determine the impact that preoperative halo-gravity traction (HGT) followed by a spinal fusion without vertebral column resection (VCR) has on patients with complex pediatric spinal deformities.•Compared to patients treated with VCR, patients in the HGT cohort experienced similar deformity correction, fewer total perioperative complications, and similar improvements in HRQoL scores 2 years postoperatively.•VCR may increase the risk of perioperative complications relative to management of severe deformities with HGT.

Comparison Among Endoscopic, Laparoscopic, and Open Resection for Relatively Small Gastric Gastrointestinal Stromal Tumors (&lt;5 cm): A Bayesian Network Meta-Analysis

BackgroundEndoscopic resection (ESR) is a novel minimally invasive procedure for superficial tumors. Its safety, efficiency, and outcome for gastric gastrointestinal stromal tumors (gGISTs) less than 5 cm remains unclear compared to laparoscopic resection (LAR) and open resection (ONR). The current network meta-analysis aimed to review and analyze the available evidence of this question.MethodsPubMed, Embase, Cochrane Library, and Web of Science databases were searched to identify eligible studies published up to July 6, 2020. The perioperative and long-term oncological outcomes among ESR, LAR, and ONR for gGIST (<5 cm) were estimated through the Bayesian network meta-analysis with a random-effect model.ResultsFifteen studies with 1,631 patients were included. ESR was associated with a shorter operative time [mean difference, MD: -36; 95% confidence interval, CI (-55, -16)], a higher rate of positive margin [odds ratio, OR: 5.1 × 1010, 95% CI (33, 2.5 × 1032)], and less costs [MD: -1 × 104, 95% CI (-1.6 × 104, -4.4 × 103)] but similar time to resume flatus [MD: 0.52, 95% CI (-0.16, 1.1)] and diet [MD: -3.5, 95% CI (-5.6, -1.6)] compared to LAR. A higher rate of total complications [OR: 11, 95% CI (1.2, 140)] was observed in patients who received ESR compared to patients who received LAR. After excluding perforation from the total complication category, the difference of complication between ESR and LAR disappeared [OR: 0.87, 95% CI (0.22, 2.3)]. The recurrence rate [OR: 1.3, 95% CI (0.40, 4.5)] and disease-free survival [hazard ratio: 1.26, 95% CI (0.60, 2.63)] showed no significant difference between ESR and LAR. ESR was associated with better or equivalent perioperative and long-term outcomes compared to ONR, except for positive margin. A subgroup analysis (<2 and 2–5 cm) showed no significantly different results among these three procedures either.ConclusionESR was shown to be a safe and efficient alternative procedure to both LAR and ONR for gGISTs less than 2 cm and within 2–5 cm, respectively, without worsening the oncologic outcomes. However, preoperative assessment of tumor site is of importance for the determination of procedures regarding the increased incidence of a positive margin related to ESR.

1042 The Effect of Breast Reconstruction Type on Complication Rates and Patient Satisfaction in The Setting of Postmastectomy Radiotherapy (PMRT)

Abstract Introduction The National Institute for Health and Care Excellence recommend offering post mastectomy radiotherapy (PMRT) to people with involved resection margins. With increasing evidence supporting the effectiveness of PMRT, it is important to optimise the outcomes of breast reconstruction in women receiving PMRT. Method A search was conducted in the PubMed database. The exclusion criteria were patients undergoing neoadjuvant radiotherapy and patients with metastases. The primary outcomes were patient satisfaction and complication rates. Results A meta-analysis (N = 380) found prosthetic reconstructions were 5 times more likely to develop complications than autologous reconstructions in the setting of PMRT (OR = 0.20, 95% CI = 0.1-0.4). A systematic review (N = 5437) had higher rates of total complications in prosthetic reconstructions compared to autologous reconstructions (41.3% vs 30.9%) with PMRT. Similarly, a retrospective study of PMRT patients (N = 622) had higher rates of complications with prosthetic reconstructions compared to autologous reconstructions (OR = 0.47, 95% CI = 0.27-0.82, P = 0.007). The adjusted mean satisfaction score (AMSS) of patients with autologous and prosthetic reconstructions receiving PMRT in a study (N = 54) was 4.4 and 2.8, respectively. Patient-reported satisfaction in a study (N = 622) was higher in patients with autologous (AMSS=63.5, 95% CI = 55.9-71.1) compared to prosthetic reconstructions (AMSS=47.7, 95% CI = 40.2-55.2) (all P = 0.002) with PMRT. Conclusions Existing data suggests that autologous tissue reconstructions tend to be more compatible with PMRT than prosthetic reconstructions in terms of patient satisfaction and complication rates. Although more research is needed to support these findings, current data can help patients and physicians make informed decisions regarding the type of breast reconstruction to use with PMRT.

Decreased Complications After Total Laryngectomy Using a Clinical Care Pathway.

Background: Complications following total laryngectomy can lead to increased hospital length of stay (LOS) and increased health care costs. Our objective was to determine the efficacy of a clinical care pathway for improving outcomes for patients following total laryngectomy.Methods: This quality improvement study included all adult patients undergoing total laryngectomy—either primary or salvage—at a tertiary referral center between January 2013 and December 2018. The primary outcome was hospital LOS measured in postoperative days. The total and specific postoperative complication frequencies were evaluated, as well as 30-day readmission rates and intensive care unit (ICU) LOS.Results: Sixty-three patients were included in the study: 29 (46.0%) patients before the pathway implementation and 34 (54.0%) patients after pathway implementation. Demographic characteristics between the groups were similar. The prepathway cohort had a higher rate of total complications compared to the postpathway group (relative risk=0.5; 95% CI 0.3-1.0), although the differences in individual complications were similar. The median LOS of 10 days was the same for the 2 cohorts. The median ICU LOS was 1 day greater in the postpathway cohort, but no difference was seen in rates of ICU readmission in the 2 groups. The 30-day readmission rate also was not significant between the 2 groups.Conclusion: Implementation of a postoperative order set pathway for patients undergoing laryngectomy is associated with decreased overall complication rates. Use of a clinical care pathway may improve outcomes in patients undergoing total laryngectomy.

Distal Radius Fractures in Diabetic Patients: An Analysis of Surgical Timing and Other Factors That Affect Complication Rate.

While not studied for distal radius fractures, the effect of surgical timing on complication rate has been extensively analyzed in the treatment of pilon fractures. The primary aim of this study was to identify any effect surgical timing has on postoperative complication rates after surgical fixation of distal radius fractures in diabetic patients. All patients who underwent surgical fixation of distal radius fractures at a single suburban academic hospital between 2012 and 2019 were reviewed. For each patient, demographics, comorbidities, injury details, fixation method, and postoperative complications were noted. The effect surgical delay, among other factors, had on complication rate in diabetic and nondiabetic patients was explored. Overall, 124 diabetic and 371 nondiabetic distal radius fractures were included. While diabetics had a statistically higher rate of total complications (21.0 vs. 13.5%, P = .045) but similar major complications requiring surgery (P = .12), there was no difference in surgical delay between groups among patients who had total (P = .31) or major (P = .69) complications. Surgical timing was not a risk factor for total (P = .50) or major complications (P = .32) in diabetic fracture bivariate or multivariate analysis. Only younger age and higher energy injuries were significant risk factors for total complications in bivariate (P = .02, P = .03) and multivariate (P = .04, P < .05) analysis. Complication rates after surgically stabilized distal radius fractures in diabetic patients are higher than in nondiabetic patients. However, this rate is not affected by surgical timing. Instead, surgeons should consider factors such as diabetic control in an effort to maximize outcomes and decrease complications. Prognostic Level III.

Volar, Splitting, and Collapsed Type of Die-Punch Fracture Treated by Volar Locking Plate (VLP): A Retrospective Study.

ObjectiveTo compare the results of different types of die‐punch fractures treated by volar locking plate (VLP).MethodsBetween January 2013 and February 2018, a total of 71 patients with die‐punch fracture of distal radius were treated by VLP and their medical records were retrospectively reviewed. Of them, 18 were classified as volar type, 24 as splitting type, and 28 as collapsed type of fracture, based on the preoperative radiographs and CT scans. The minimum follow‐up period was 12 months. Radiological parameters, wrist function, range of motion (ROM), and complications were evaluated and compared. Pearson chi‐square test was used to assess the difference of gender distribution, injury side, dominance, mechanism, type and classification of fracture, and postoperative complications, when necessary (P < 0.05), followed by pairwise comparisons using partitions of chi‐square test. Two‐tailed P value <0.05 was considered as statistically significant. For pairwise comparisons, adjustment of statistical level as P < 0.017 (0.05/3) was used. SPSS 21.0 was used to perform all the analyses.ResultsThe mean follow‐up time was 14.5 months, and at the mean of postoperative 8 weeks all patients obtained bony union, without delayed or non‐union. The grip strength was 26.6 ± 7.9 kg for patients in volar fracture group, 27.0 ± 9.4 kg in splitting group, and 26.2 ± 9.4 kg in collapsed group, without significant difference (P = 0.628).The disabilities of the arm, shoulder, and hand (DASH) (9.2 ± 10.0 for volar group, 8.8 ± 7.9 for splitting group, and 10.6 ± 8.7 for collapsed group) or Gartland–Werley score (5.1 ± 2.8 for volar group, 4.8 ± 3.2 for splitting group, and 6.4 ± 2.7 for collapsed group) either did not differ among the three groups (all P > 0.05). There was a poorer ROM in the group of collapsed fractures, but the difference was non‐significant for any parameter (P > 0.05). As for radiographic parameters, we did not find any significant difference for volar tilt, radial inclination, radial height, and ulnar variance (all P > 0.05), except for articular step‐off (P < 0.001). Pairwise comparisons showed a significantly greater step‐off (1.2 mm vs 0.4 mm, 0.5 mm) and higher rate of total complications in group of collapsed fracture (39.3%), compared to either volar (10.5%) or splitting type (12.5%).ConclusionsThe collapsed type of die‐punch fracture posed a greater articular step‐off and a higher rate of complications, especially secondary wrist osteoarthritis, which deserved more attention in clinical treatment.

Patient-Reported Outcomes and Perioperative Complications of Total Hip Arthroplasty Following Joint Preservation Surgery for Hip Dysplasia

BackgroundThere is growing recognition of the importance of patient-reported outcome measures and assessment of patient satisfaction in the evaluation of outcomes following surgical interventions. This study aimed to evaluate patient-reported outcomes and complication rates after total hip arthroplasty following joint preservation surgery for hip dysplasia. MethodsPatient-reported outcomes and complication rates of 85 hips with previous joint preservation surgery (salvage group) were compared with those of 1279 hips without joint preservation surgery (primary arthroplasty group). As a patient-reported outcome measure, the Japanese Orthopedic Association Hip Disease Evaluation Questionnaire was used to evaluate the hip condition both preoperatively and 12 months postoperatively. Operative data and postoperative (within 12 months) complications were investigated. ResultsThe salvage group had a longer operative time (56.8 vs 44.9 minutes, P < .001) and a higher total complication rate (5.9% vs 1.1%, P < .001). Additionally, the salvage group exhibited a lower degree of improvement in the visual analog scale value for satisfaction (75.1 vs 83.1 mm, P = .011), the pain and movement category scores, and the total score of the Japanese Orthopedic Association Hip Disease Evaluation Questionnaire (14.2 vs 16.2, P = .031; 13.7 vs 16.0, P = .005; and 42.3 vs 47.9, P = .007, respectively) compared with the primary arthroplasty group. ConclusionThis study demonstrated a lower rate of improvement in patient satisfaction and worse self-reported outcomes in the salvage group. Furthermore, these patients had a longer operative time and a higher risk of operative complications.

The effect of age on short-term postoperative complications following arthroscopic rotator cuff repair

HypothesisThe purpose of this study was to assess short-term outcomes, including the rates of medical complications, non-home discharge, overnight hospital stay, and 30-day readmission, associated with patient age at the time of rotator cuff repair.MethodsThis study used National Surgical Quality Improvement Program data from 2005 to 2016 to analyze patients who underwent arthroscopic rotator cuff repair (ARCR). Patients were stratified into age cohorts of younger than 55 years, between 55 and 65 years, or older than 65 years. Outcomes including postoperative complications, discharge destination, and readmission were compared between the age cohorts using multivariate analysis.ResultsWe identified 23,974 patients undergoing ARCR: 8344 patients (34.8%) were younger than 55 years, 9166 (38.4%) were aged between 55 and 65 years, and 6434 (26.8%) were older than 65 years. Older patients were more likely to be female patients and to have a lower body mass index, more medical comorbidities, shorter operative duration, dependent functional status, and higher American Society of Anesthesiologists classification. Patients older than 65 years had a higher rate of total complications (odds ratio [OR], 1.99; P = .003), respiratory complications (OR, 2.99; P = .023), urinary tract infections (OR, 6.94; P < .001), overnight hospital stay (OR, 1.49; P < .001), and unplanned hospital readmission (OR, 1.50; P = .040) relative to patients younger than 55 years. There was no increase in complication rates for patients aged between 55 and 65 years.ConclusionsPatients older than 65 years have nearly double the odds of having a postoperative complication following ARCR and nearly 3 and 6 times the odds of having a respiratory complication and a urinary tract complication, respectively. Thorough preoperative optimization, including respiratory and urinary care, may be able to decrease complications in select, high-risk patients.

Two-Staged Implant-Based Breast Reconstruction: A Long-Term Outcome Study in a Young Population

Background and objectives: Differences in patient anatomy and physiology exist between young and older patients undergoing breast reconstruction after mastectomy. Breast cancer has been described as being more aggressive, more likely to receive radiation, contralateral mastectomy, as well as bilateral reconstruction in young patients. Our purpose is to report long-term experience on two-staged implant-based breast reconstruction (IBR) in young females, with complication sub-analysis based on obesity and adjuvant radiation. Materials and Methods: Retrospective chart review of all consecutive young patients who underwent two-staged IBR at our institution, between 2000 and 2016, was performed. Patients between 15 and 40 years old with least 1-year follow-up were included. Univariate logistic regression models and receiver operating characteristic (ROC) curves were created. Results: Overall 594 breasts met our inclusion criteria. The mean age was 34 years, and the median follow-up was 29.6 months. Final IBR was achieved in 98% of breasts. Overall, 12% of breasts had complications, leading to explantations of 5% of the devices. Adjuvant radiation was followed by higher rates of total device explantations (p = 0.003), while obese patients had higher rates of total complications (p < 0.001). For each point increase in BMI, the odds of developing complications increased 8.1% (p < 0.001); the cutoff BMI to predict higher complications was 24.81 kg/m2. Conclusions: This population demonstrates high successful IBR completion and low explantation rates. These data suggest that obese women and those with planned adjuvant radiation deserve special counseling about their higher risk of complications.

Early postoperative fluid retention is a strong predictor for complications after pancreatoduodenectomy

BackgroundPerioperative fluid overload has been reported to increase complications after a variety of operative procedures. This study was conducted to investigate the incidence of fluid retention after pancreatic resection and its association with postoperative complications. MethodsData from 1174 patients undergoing pancreatoduodenectomy between 2010 and 2016 were collected from the Swedish National Pancreatic and Periampullary Cancer Registry. Early postoperative fluid retention was defined as a weight gain ≥2 kg on postoperative day 1. Outcome measures were overall complications, as well as procedure-specific complications. ResultsThe weight change on postoperative day 1 ranged from −1 kg to +9 kg. A total of 782 patients (66.6%) were considered to have early fluid retention. Patients with fluid retention had significantly higher rates of total complications (p = 0.002), surgical complications (p = 0.001), pancreatic anastomotic leakage (p = 0.018) and wound infection (p = 0.023). Multivariable logistic regression confirmed early fluid retention as an independent risk factor for total complications (OR 1.46; p = 0.003), surgical complications (OR 1.49; p = 0.002), pancreatic anastomotic leakage (OR 1.48; p = 0.027) and wound infection (OR 1.84; p = 0.023). ConclusionsFluid retention is common after elective pancreatic resection, and its associated with an increased rate of postoperative complications.

Photodynamic therapy plus biliary stenting versus biliary stenting alone to treat nonresectable ductal cholangiocarcinoma: a Meta-analysis

Objective To compare the therapeutic results of photodynamic therapy (PDT) combined with biliary stenting versus biliary stenting alone in the treatment of nonresectable bile duct cholangiocarcinoma. Methods The PubMed, CBM, CNKI, VIP and WanFang Data were searched from January 1990 to December 2017. Two researchers independently screened the literatures, extracted the data and performed the quality evaluation. The meta-analysis was carried out using the RevMan software 5.3.0. Results Eleven controlled clinical trials were included in the meta-analysis. There were only two randomized controlled trials. The remaining studies were non-randomized controlled trials. Finally, 659 patients were enrolled in this study. 293 patients were treated with photodynamic therapy and biliary stenting while 366 patients were treated with stenting alone. Analysis showed that photodynamic therapy combined with stenting significantly extended the overall survival when compared with stenting alone (P 0.05), but PDT and stenting had a significantly higher total complication rate (P<0.05). Conclusions This meta-analysis showed that photodynamic therapy combined with stenting significantly improved the survival rate of patients with nonresectable ductal cholangiocarcinoma when compared with stenting alone. Photodynamic therapy did not increase the incidence of cholangitis. Key words: Photodynamic therapy; Cholangiocarcinoma, unresectable; Biliary stenting drai-nage; Meta-analysis

The Effect of Smoking on 30-Day Complications Following Radical Prostatectomy

ObjectiveThe purpose of this study was to determine if smoking status is associated with 30-day postoperative complications following radical prostatectomy. MethodsFrom the American College of Surgeons National Surgical Quality Improvement Program's (NSQIP) 2005-2013 database, we identified patients who underwent prostatectomy for treatment of prostate cancer. The cohort was stratified into current smokers, former smokers, and never smokers. Bivariable and multivariable analysis was utilized to assess the association between smoking status and risk of complications. ResultsWe identified 22,802 patients who underwent malignancy-related prostatectomy and met inclusion criteria. Based on reported smoking history, 2799 (12.3%) were current smokers, 1879 (8.2%) were former smokers, and 18,124 (79.5%) were never smokers. Current smokers had a higher rate of total complications (5.7%) in comparison with former (4.8%) and never smokers (4.6%; P = .050). Postoperative pneumonia was more frequent in current smokers (0.4%) compared with former smokers (0.2%) and never smokers (0.2%; P = .039). Unplanned intubation occurred more frequently in current smokers (0.4%) when compared with former smokers (0.3%) and never smokers (0.1%; P = .002). Multivariable analysis found that current smoking status was an independent predictor of an increased risk of unplanned intubation (odds ratio, 5.87; 95% confidence interval, 2.18-15.8; P < .001). ConclusionSmoking status influences the risk of postoperative complications following prostatectomy. Specifically, current smoking status is an independent predictor of unplanned intubation within 30 days of the procedure.

Surgical management of midshaft clavicle nonunions is associated with a higher rate of short-term complications compared with acute fractures

Little is known about the perioperative complication rates of the surgical management of midshaft clavicle nonunions. The purpose of the current study was to report on the perioperative complication rates after surgical management of nonunions and to compare them with complication rates of acute fractures using a population cohort. The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify patients who had undergone open reduction-internal fixation of midshaft clavicle fractures between 2007 and 2013. Patients were stratified by operative indication: acute fracture or nonunion. Patient characteristics and 30-day complication rates were compared between the 2 groups using univariate and multivariate analyses. A total of 1215 patients were included in our analysis. Of these, 1006 (82.8%) were acute midshaft clavicle fractures and 209 (17.2%) were midshaft nonunions. Patients undergoing surgical fixation for nonunion had a higher rate of total complications compared with the acute fracture group (5.26% vs. 2.28%; P = .034). On multivariate analysis, patients with a nonunion were at a >2-fold increased risk of any postsurgical complication (odds ratio, 2.29 [95% confidence interval, 1.05-5.00]; P = .037) and >3-fold increased risk of a wound complication (odds ratio, 3.22 [95% confidence interval, 1.02-10.20]; P = .046) compared with acute fractures. On the basis of these findings, patients undergoing surgical fixation for a midshaft clavicle nonunion are at an increased risk of short-term complications compared with acute fractures. This study provides additional information to consider in making management decisions for these common injuries.

MP57-14 DOES DEHYDRATED AMNIOTIC/CHORION HUMAN MEMBRANE (DACHM), ACCELERATES THE RETURN TO POTENCY FOLLOWING ROBOT-ASSISTED RADICAL PROSTATECTOMY REGARDLESS THE DEGREE OF NERVE SPARING?: PROPENSITY SCORE-MATCHED ANALYSIS

RESULTS: We identified 22,802 patients that met the inclusion criteria for undergoing malignancy-related prostatectomy. Based on reported smoking history, 2,799 (12.3%) were identified to be current smokers, 2,557 (8.2%) were former smokers, and 17,446 (79.5%) were never smokers. Current smokers were found to have a higher rate of total complications (5.7%) in comparison to former (4.8%) and never smokers (4.6%; P 1⁄4 0.050). Notably, post-operational pneumonia was more frequent in current smokers (0.4%) when compared to former smokers (0.2%) and never smokers (0.2%; P1⁄4 0.039). Unplanned intubation was also found to occur more frequently in current smokers (0.4%) when compared to former smokers (0.3%) and never smokers (0.1%; P 1⁄4 0.002). Multivariate analysis that included smoking status, demographic factors, and preoperative comorbidities found that current smoking status wasan independent predictor of increased risk of total complications (OR, 1.27 [95% CI, 1.06 to 1.53]; P 1⁄4 0.011) and occurrence of unplanned intubation (OR, 5.87 [95% CI, 2.18 to 15.8]; P < 0.001). CONCLUSIONS: In those undergoing prostatectomy, current smoking status influences the risk postoperative complications. Moreover, smoking within the year prior to surgery is an independent predictor of total complications and unplanned intubation within 30 days of the procedure.

Methylprednisolone for the Treatment of Patients with Acute Spinal Cord Injuries: A Propensity Score-Matched Cohort Study from a Canadian Multi-Center Spinal Cord Injury Registry.

In prior analyses of the effectiveness of methylprednisolone for the treatment of patients with acute traumatic spinal cord injuries (TSCIs), the prognostic importance of patients' neurological levels of injury and their baseline severity of impairment has not been considered. Our objective was to determine whether methylprednisolone improved motor recovery among participants in the Rick Hansen Spinal Cord Injury Registry (RHSCIR).We identified RHSCIR participants who received methylprednisolone according to the Second National Spinal Cord Injury Study (NASCIS-II) protocol and used propensity score matching to account for age, sex, time of neurological exam, varying neurological level of injury, and baseline severity of neurological impairment. We compared changes in total, upper extremity, and lower extremity motor scores using the Wilcoxon signed-rank test and performed sensitivity analyses using negative binomial regression.Forty-six patients received methylprednisolone and 1555 received no steroid treatment. There were no significant differences between matched participants for each of total (13.7 vs. 14.1, respectively; p=0.43), upper extremity (7.3 vs. 6.4; p=0.38), and lower extremity (6.5 vs. 7.7; p=0.40) motor recovery. This result was confirmed using a multivariate model and, as predicted, only cervical (C1–T1) rather than thoracolumbar (T2–L3) injury levels (p<0.01) and reduced baseline injury severity (American Spinal Injury Association [ASIA] Impairment Scale grades; p<0.01) were associated with greater motor score recovery. There was no in-hospital mortality in either group; however, the NASCIS-II methylprednisolone group had a significantly higher rate of total complications (61% vs. 36%; p=0.02)NASCIS-II methylprednisolone did not improve motor score recovery in RHSCIR patients with acute TSCIs in either the cervical or thoracic spine when the influence of anatomical level and severity of injury were included in the analysis. There was a significantly higher rate of total complications in the NASCIS-II methylprednisolone group. These findings support guideline recommendations against routine administration of methylprednisolone in acute TSCI.

The Effect of Smoking on Short-Term Complications Following Total Hip and Knee Arthroplasty.

Total joint arthroplasty is the most frequently performed orthopaedic procedure in the United States. The purpose of the present study was to identify differences in thirty-day morbidity and mortality following primary total hip and total knee arthroplasty according to smoking status and pack-year history of smoking. We queried the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database to identify patients who had undergone primary total hip or total knee arthroplasty between 2006 and 2012. Patients were stratified by smoking status and pack-year history of smoking. Thirty-day rates of mortality, wound complications, and total complications were compared with use of univariate and multivariate analyses. We identified 78,191 patients who had undergone primary total hip or total knee arthroplasty. Of these, 81.8% (63,971) were nonsmokers, 7.9% (6158) were former smokers, and 10.3% (8062) were current smokers. Current smokers had a higher rate of wound complications (1.8%) compared with former smokers and nonsmokers (1.3% and 1.1%, respectively; p < 0.001). Former smokers had a higher rate of total complications (6.9%) compared with current smokers and nonsmokers (5.9% and 5.4%, respectively; p < 0.001). Multivariate analysis identified current smokers as being at increased risk of wound complications (odds ratio [OR], 1.47; 95% confidence interval [CI], 1.21 to 1.78), particularly deep wound infection, while both current smokers (OR, 1.18; 95% CI, 1.06 to 1.31) and former smokers (OR, 1.20; 95% CI, 1.08 to 1.34) were at increased total complication risk. Increasing pack-year history of smoking resulted in increasing total complication risk. On the basis of our findings, current smokers have an increased risk of wound complications and both current and former smokers have an increased total complication risk following total hip or total knee arthroplasty.