Open Placement Research Articles

111 Interspinous Process Device Utilization and Reimbursement Vary by Provider Specialty and Care Setting

INTRODUCTION: Interspinous process devices (IPDs) are a popular less invasive treatment option for lumbar degenerative disease. Studies suggest they may yield initial symptomatic relief but are not better than traditional surgery in improving function or quality of life and may increase reoperation and costs. Ideal indications remain contested. METHODS: Centers for Medicare and Medicaid Services Physician/Supplier Procedure Summary data sets (2017-2020) were queried by CPT codes for lumbar interlaminar/interspinous process stabilization/distraction devices without fusion. Utilization rates were normalized per 10,000 lumbar fusions. RESULTS: IPD utilization increased by 329% from 2017-2020. Percutaneous IPD utilization increased to 31.8 (+1,267%), while open procedures decreased to 4.4 (-27%). Pain management/anesthesia placed the majority of IPDs and increased utilization the most (27.4, +1,387%). Physical medicine and rehabilitation (PM&R) had the second-highest rate of utilization (3.5, +1,492%). Neurosurgery (2.3, -15%) and orthopedics (0.7, -63%) decreased utilization. Ambulatory surgical centers (ASCs) increased utilization the most (25.8, +907%). Outpatient procedures increased (9.2, +162%), while inpatient procedures decreased (1.2, -49%). IPD reimbursements decreased to $400 (-44.6%), with decreasing trends in percutaneous ($364, -28.6%) and open placement ($776, -6.8%). Reimbursements were highest for orthopedics ($800, +0.6%) and lowest for pain management/anesthesiology ($362, -26.7%). Reimbursements decreased across all settings, especially outpatient (-48.8%) and inpatient (-35.9%). CONCLUSIONS: Despite uncertainty of indications for IPDs, utilization increased by 329% when normalized to lumbar fusions to account for changes in disease prevalence. IPDs are increasingly placed by PM&R and pain management in ASCs and outpatient settings. Utilization does not seem to be driven by reimbursement rates. It is unknown how the rapid increase in IPDs has affected clinical outcomes. Given the magnitude of increased utilization and limited data on the safety and efficacy of IPDs, closer examination of indications is warranted.

Robotic Versus Open Hepatic Arterial Infusion Pump Placement for Unresectable Intrahepatic Cholangiocarcinoma.

Hepatic arterial infusion pump (HAIP) chemotherapy is an effective treatment for patients with unresectable intrahepatic cholangiocarcinoma (iCCA). HAIP chemotherapy requires a catheter inserted in the gastroduodenal artery and a subcutaneous pump. The catheter can be placed using an open or robotic approach. This study aimed to compare perioperative outcomes of robotic versus open HAIP placement in patients with unresectable iCCA. We analyzed patients with unresectable iCCA included in the PUMP-II trial from January 2020 to September 2022 undergoing robotic or open HAIP placement at Amsterdam UMC, Erasmus MC, and UMC Utrecht. The primary outcome was time to functional recovery (TTFR). In total, 22 robotic and 28 open HAIP placements were performed. The median TTFR was 2days after robotic placement versus 5 days after open HAIP placement (p<0.001). One patient (4.5%) in the robotic group underwent a conversion to open because of a large bulky tumor leaning on the hilum immobilizing the liver. Postoperative complications were similar-36% (8/22) after robotic placement versus 39% (11/28) after open placement (p=1.000). The median length of hospital stay was shorter in the robotic group-3 versus 5 days (p<0.001). All 22 robotic patients initiated HAIP chemotherapy post-surgery, i.e. 93% (26/28) in the open group (p=0.497). The median time to start HAIP chemotherapy was 14 versus 18 days (p=0.153). Robotic HAIP placement in patients with unresectable iCCA is a safe and effective procedure and is associated with a significantly shorter TTFR and hospital stay than open HAIP placement.

Robotic versus open placement of hepatic artery infusion pumps: a bi-institutional propensity score matching weights analysis

Robotic versus open placement of hepatic artery infusion pumps: a bi-institutional propensity score matching weights analysis

ID: 221335 Laminectomy for Dorsal Root Ganglion Stimulation Lead Placement: Outcomes and Surgical Technique

Dorsal root ganglion (DRG) stimulation for chronic pain has been supported by level I evidence and has been designed for percutaneous placement. Open placement of DRG leads via laminectomy has been rarely reported. We describe our early experience with open DRG lead placement via laminectomy.

138 Open Dorsal Root Ganglion Lead Placement After Percutaneous Trialing: A Case Series

INTRODUCTION: Dorsal root ganglion (DRG) stimulation is a newer mode of neurostimulation for neuropathic pain in which individual electrodes are placed over the dorsal root ganglion (DRG). Although designed for percutaneous placement, open placement of DRG has been described in small case series and case reports when percutaneous placement failed or was anatomically not considered feasible. This is the largest series of open DRG stimulator placement and the first performed after successful percutaneous trialing. METHODS: We present a case series of N = 6 patients who underwent successful DRG stimulator placement via open laminotomy/laminectomy technique after a successful percutaneous DRG stimulator trial performed by a pain management physician. RESULTS: At a median 7.3 months status post implant, all patients continue to report significant relief of pain with their stimulator. There were no serious adverse events. Mean fluoroscopy time/case was 49.7 seconds. Technical nuances of open DRG stimulator placement will be discussed. CONCLUSIONS: This is the largest series of open DRG stimulator placement that has been reported. We have observed good patient pain relief and no serious adverse events. Although more invasive, potential advantages of open DRG stimulator placement include direct anchoring technique and lower radiation exposure times for patients and staff. Open DRG stimulator technique via laminectomy/laminotomy may also improve adoption of DRG stimulation by spinal surgeons who are familiar with exposing the DRG with open technique.

Comparison of Characteristics, Inpatient Outcomes, and Trends in Percutaneous Versus Open Placement of Spinal Cord Stimulators

ObjectivesSpinal cord stimulation (SCS) is an effective treatment modality for chronic pain conditions for which other treatment modalities have failed to provide relief. Ample prospective studies exist supporting its indications for use and overall efficacy. However, less is known about how SCS is used at the population level. Our objective is to understand the demographics, clinical characteristics, and utilization patterns of open and percutaneous SCS procedures. Materials and MethodsThe Nationwide Inpatient Sample data base of 2016–2019 was queried for cases of percutaneous or open placement (through laminotomy/laminectomy) of SCS (excluding SCS trials) using International Classification of Disease (ICD), 10th revision, procedure coding system. Baseline demographic characteristics, complications, ICD-Clinical Modification, Diagnosis Related Group, length of stay (LOS), and yearly implementation data were collected. Complications and outcomes were evaluated in total and between the open and percutaneous SCS groups. ResultsA total of 2455 inpatients had an SCS placed, of whom 1970 (80.2%) received SCS through open placement. Placement of open SCS was associated with Caucasian race (odds ratio [OR] = 1.671, p < 0.001), private insurance (OR = 1.332, p = 0.02), and age more than 65 years (OR = 1.25, p = 0.034). The most common diagnosis was failed back surgery syndrome (23.8%). Patients with percutaneous SCS were more likely to have a hospital stay of < 1 day (OR = 2.318; 95% CI, 1.586–3.387; p < 0.001). Implant complications during the inpatient stay were positively associated with open SCS placement and reported in 9.4% of these cases (OR = 3.247, p < 0.001). ConclusionsPatients who underwent open SCS placement were more likely to be older, Caucasian, and privately insured. Open SCS placement showed greater LOS and implant-related complications during their hospital stay. These findings highlight both potential socioeconomic disparities in health care access for chronic pain relief and the importance of increasing age and medical comorbidities as important factors that can influence SCS implants in the inpatient setting.

Recent Trends in Medicare Utilization and Reimbursement for Spinal Cord Stimulators: 2000–2019

Spinal cord stimulators (SCS) allow spine surgeons to provide relief for patients who suffer from chronic pain due to several disorders, such as failed back surgery syndrome, complex regional pain syndrome, and neuropathy. Despite this, there remains a paucity of data regarding the utilization and reimbursement of SCS. Therefore, the purpose of this study is to evaluate the monetary and procedural trends of spinal cord stimulators among the Medicare database from 2000 to2019. Medicare Part B National Summary Data files, which are publicly available, were used. These files contain data from the years 2000-2019 on all services billed to Medicare within that time frame. Each service is given a Current Procedural Terminology (CPT) code and the number of times that service was performed, as well as the total physician Medicare charges and reimbursements for each service annually are included in that data set. The CPT codes for percutaneous and open placement of spinal cord stimulators were identified: 63650 and 63655, respectively. The total allowed services allowed charges and actual payments were isolated from the data set for each year for each CPT code. The total allowed charges and actual payments for the year were then divided by the total allowed services to find and trend the allowed charges and actual payment for each individual service performed for both percutaneous and open placement of spinal cord stimulators. There were 992,372 Medicare-approved total percutaneous spinal cord stimulator operations and 99,736 Medicare-approved total open spinal cord stimulator operations from 2000 to 2019. Medicare paid $1.02 billion (2019 U.S. dollars) in reimbursement to physicians for percutaneous spinal cord stimulator operations and nearly $145 million (2019 U.S. dollars) in reimbursement to physicians for open spinal cord stimulator operations. From the years 2000 to 2019, there was an average 21.9% increase annually in Medicare-approved percutaneous spinal stimulator placement operations and a 18.4% increase annually in Medicare-approved open spinal stimulator placement operations. During this time, there was also an average 8.7% increase annually in Medicare reimbursement per each percutaneous spinal stimulator placement operation and a 9.1% increase annually in Medicare reimbursement per each open spinal stimulator placement operation. The results of this study show that the number of percutaneous and open procedures have steadily increased from 2000 to 2019. Reimbursement per procedure has also increased steadily over this time. Identifying these trends is important to promote research into costs of these surgeries and ensure adequate resource allocation.

Comparison of Arthroscopic versus Open Placement of the Fibular Tunnel in Posterolateral Corner Reconstruction.

Precise fibular tunnel placement in posterolateral corner (PLC) reconstruction is crucial in restoring rotational and lateral stability. Despite the recent progress of arthroscopic PLC reconstruction techniques, landmarks for arthroscopic fibular tunnel placement and a comparison to open tunnel placement have not yet been described. This study aimed to (1) identify reasonable soft-tissue and bony landmarks, which can be identified by either arthroscopy, fluoroscopy, or open surgery in anatomic fibular tunnel placement and (2) to compare accuracy and reliability of arthroscopic fibular tunnel placement with open surgery. In a retrospective study, 41 magnetic resonance images (MRIs) of the knee were analyzed with emphasis on distances of an ideal anatomic fibular tunnel to 11 soft-tissue and bony landmarks. Subsequently, in eight cadaver knees, the ideal fibular tunnel was created arthroscopically and with a standard open technique from antero-latero-inferior to postero-medio-superior with a 2-mm K-wire. Positions of both tunnels were compared on postinterventional computed tomography scans. Based on MRI measurements, the anatomic tunnel entry should be 14.50 (±2.18) mm distal to the tip of the fibular styloid and 10.76 (±1.37) mm posterior to the anterior edge of the fibula. The anatomic fibular tunnel exit was located 12.89 (±2.35) mm below the tip of the fibular head. Arthroscopic fibular tunnel placement was reliable in all cases. Instead, in five out of the eight cases with open surgery, the fibular tunnel crossed the defined safety distance to the closest cortical edge/tibiofibular joint (distance < 8 mm). Reliable soft-tissue and bony landmarks of the fibular head allow arthroscopic anatomic fibular tunnel placement in PLC surgery, which shows a lower risk of tunnel malposition compared with open surgical techniques. Future studies will have to show whether clinical results of arthroscopic PLC reconstruction are in line with this study's technical results. Level III.

Strategi Penataan Permukiman Nelayan Keberlanjutan di Tepi Sungai Kaliyasa

The Kaliyasa River is a vital means for fishermen, especially traditional fishermen who live around the river. Since the construction of the Cilacap Fishing Port, many migrants started to settle and overtime the population crowded the area uncontrollably and marginalized. This study focused on the strategy of reorganizing fishermen’s settlements with a sustainable development and waterfront development approach as well as the regulation of PERMEN no. 28 of 2015, Descriptive-qualitative method has being used to explain the conditions in the study area, The data collection using desk study and field study methods, from the findings confirmed by the theory of waterfront and sustainable development in order to obtain the right reorganizing strategy. The result of this research is a settlement reorganizing strategy that applies the principle of waterfront development. This principle is applied through social aspects by creating open public spaces, piers placement, and public counseling about river border regulations. Environmental aspects with the arrangement of trash bins on the banks of the river as well as the establishment of waste management institution, management of green open spaces, and solution for illegal buildings in river bank areas. Economic aspects by improving dock infrastructure to support fishing activities, as well as reorganizing marine product trade zone. The preservation aspect aims to preserve the identity of the Kaliyasa river as water transportation route and fishermen's settlements.

The impact of social networks on youth activity

The article explores the problems of using social networks for the formation of an individual's personality, the influence of social networks on the development of social activity of young people. The effectiveness of various forms of information exchange (public or anonymous) is evaluated. The purpose of this article is to study the impact of social media on the social activity of young people, which includes billions of users in the global information space. Determining the inclination of young people to participate in specific social activities through the forms of expressing their opinions in social networks. The value of the study lies in determining the ability of social media to change the worldview, life values ​​and interests of the individual, develop new ideas and directions, and correctly form life guidelines. The empirical basis of the study was the social research conducted by the Friedrich Ebert Foundation in Kazakhstan. The content of the accounts of Kazakhstani politicians, public figures, representatives of business and culture in social networks such as VK, Instagram, Facebook, Youtube and Twitter was also studied; a content analysis was carried out. The study also used the results of survey conducted by the author of the article among students, undergraduates. An experimental survey aimed at determining the degree of influence of important social events on the activity of young people yielded unexpected results. It was revealed that meaningful and thoughtful in the form of implementation of online initiatives, petitions, increase youth activity in real public life. The main results of the study helped to identify the following pattern: people who use public and open placement of their opinions in social networks are more committed to real participation in public actions. Conversely, anonymous support for socially beneficial events reduces the commitment to further real actions. At the end of the article, the following conclusions were formulated: the social activity of young people should be directed not only to a specific person, but also must serve the interests of the state and society. In general, the Internet and virtual communities play a positive role in solving social problems, problems among the youth. Keywords: social media, slacktivism, online activity, youth, politics. &nbsp

Modified Seldinger technique for internal jugular open central venous line insertion in neonates: merging two different manoeuvers

BackgroundCentral venous line insertion in neonates is an important and lifesaving procedure. It can carry significant risks and complications, including death, at the time of insertion or later. We aimed to retrospectively assess the modified Seldinger technique for open placement of a central venous catheter in neonates, regarding its safety, feasibility, operative time, and preservation of the patency of the internal jugular vein. This study was conducted on 120 neonates from March 2018 to March 2020. We closely monitored the pulse for the detection of arrhythmia or bradycardia, which might be caused during the insertion of the guide wire or the tip of the catheter. Post-operative X-ray was done immediately after the end of the procedure for all cases, to determine the site of the central venous catheter and to detect the presence of pneumothorax.ResultsArrhythmia was observed in 9 cases (7.5%), and blood oozing in 5 cases (4.1%). There were 3 cases of pneumothorax (2.5%), 2 cases of neck hematoma in two cases (1.6%), 6 cases of internal jugular vein thrombosis (5%), and dislodging of the catheter in 3 cases (2.5%). There were no cases of arterial puncture, failure of cannulation, or haemothorax in our study.ConclusionsThe modified Seldinger technique insertion for open central venous line in neonates is a safe, accessible, and feasible method, especially in centers that lack the experience of ultrasound-guided insertion in neonates.

Open Cholecystostomy Under Local Anesthesia for Acute Cholecystitis in the Elderly and High-Risk Surgical Patients.

The morbidity and mortality rates associated with cholecystectomy for acute cholecystitis are higher in the critically ill elderly population. As an alternative to cholecystectomy, we report the results of treatment of acute cholecystitis in the elderly after open cholecystolithotomy with cholecystostomy tube placement under local anesthesia. A case series was performed on 5 patients from August 2007 to April 2010 who presented with acute cholecystitis and underwent an open cholecystolithotomy and tube placement. Thirty-day mortality, intra- and immediate-postoperative complications, clinical improvement after drainage, additional biliary procedures needed, and outcome after cholecystostomy tube removal were recorded. Open cholecystolithotomy and tube placement were performed successfully in all patients and permitted resolution of the acute attack in all after a mean period of 3.75days. Thirty-day mortality was 0%. Patients did not experience any intraoperative complications. We observed 100% rate of successful short-term outcomes in our patients including resolution pain, and objectively, normalization of leukocytosis, and defervescence. None of the patients required emergency cholecystectomy. All patients had their cholecystostomy tubes removed at a mean postoperative day 27. There were no cases of biliary leakage or tube dislodgement. There were no recurrences of acute cholecystitis within the mean follow-up of 20.75months. Emergency open cholecystolithotomy and cholecystostomy tube placement represent an effective, safe, and definitive alternative treatment strategy for acute gallstone cholecystitis in selected elderly patients with a mortality rate of 0% in the authors' experience.

Differences in Outcome Between Open vs Laparoscopic Insertion of Ventriculoperitoneal Shunts.

Abdominal access during ventriculoperitoneal (VP) shunt insertion has historically been obtained by neurosurgeons via an open abdominal approach. With recent advances in laparoscopy, neurosurgeons frequently consult general surgery for aid during the procedure. The goal of this study is to identify if laparoscopic assistance improves the overall outcomes of the procedure. This retrospective study included all patients who underwent open or laparoscopic VP shunt placement between September 2012 and August 2020 at our tertiary referral hospital. Patient demographics, comorbidities, prior history of abdominal surgery, open vs. laparoscopic insertion, operation time, and complications within 30days were obtained. Neurosurgery placed 107 shunts using an open abdominal technique and general surgery placed 78 using laparoscopy. The average OR time in minutes was 75.5minutes for the open cohort and 61.8 for the laparoscopic cohort (p = 0.006). In patients without a history of abdominal surgery, the average OR time in minutes was 79.4 in the open cohort and 57.1 in the laparoscopic cohort (p = 0.015). The postoperative shunt infection rate was 10.2% in the open group and 3.8% in the laparoscopic group (p = 0.077). Laparoscopic placement of VP shunts is a reasonable alternative to open placement and results in shorter OR times. There is also a trend toward few infections in the laparoscopic placement. There appears to be an advantage with a team approach and laparoscopic placement of the peritoneal portion of the shunt.

OWNERSHIP RELATIONS AS PRECONDITIONS FOR THE EMERGANCE OF LEGAL RELATIONSHIP IN JOINT-STOCK COMPANIES

The authors of the article have analyzed the understanding of ownership as a central entity and the main regulator of economic relations within a joint-stock company. It has been stated that ownership is associated with such categories as «property» and «right», which raises a considerable number of methodological issues originated by the formation of joint-stock companies’ ownership and shareholders rights in relation to the ownership. Particular attention has been paid to the fact that ownership in such a company as an economic category performs a certain function, which consists in the formation of a considerable amount of capital on the most profitable for all persons involved in this process, in order to its maximum profitable use. It has been noted that if we talk about the ownership of a joint-stock company, then it is formed by the issue of shares, and accordingly, the company, which is interested in attracting significant funds, conducts open placement, the proceeds of which are accumulated to use in its business activities. The authors have provided arguments in favor of other positive aspects of stock ownership that make it universal and capable of application wherever there is the need to accumulate significant amounts of funds and limit the scope of liability.&#x0D; It has been concluded that ownership in a joint-stock company as an economic category performs a certain function, which makes it not only an economic, but also a legal category. This function is to generate a large amount of capital in the most profitable terms for all persons involved in this process, for its maximum profitable use. The category of «stock ownership» is used when referring to the legal regime of ownership in a joint-stock company — the ownership rights of the shareholders for the shares and the ownership rights of the company for the property, which in their implementation intersect and affect one another.&#x0D; It has been supposed that the most appropriate model, to which stock ownership tends, is confidential property, ideology and practices of trusts. However, it is quite clear that its application in Ukraine in the present state of legal regulation is hardly worth supporting.

Surgical Outcomes of Pediatric Peritoneal Dialysis Catheter Function in a Referral Center

Peritoneal dialysis (PD) is used in children with end-stage renal disease (ESRD) for renal replacement therapy. However, it can be associated with the risk of post-surgical complications. The objectives of this study were to report our experience with the placement of PD catheters for 14 years and to assess the incidence of PD malfunction and other PD-related complications, including the effect of adopting minimally invasive techniques for catheter placement. The objectives of this study were to report our experience with placement of PD catheters for 14-year period and to assess the incidence of PD-related complications and the effect of adopting minimally invasive techniques for catheter placement. It is a retrospective cohort study at the department of pediatric surgery and pediatric nephrology, dialysis, and transplant in Jeddah, Saudi Arabia. We reviewed the records of all children who had PD catheter placements between 2005 and 2019. The data included demographics, the surgical technique, the performance of omentectomy, duration of PD catheter, and complication rates. Sixty-five patients had PD catheter insertion during the study period; 16 (24.6%) of them were placed in other institutions then referred to us. Thirty-five patients had no complications. Omentectomy during the first procedure was performed in 53 patients (81.54%). Early dialysate leaking occurred in six patients (9.3%); none were treated with surgical revisions. Four leaks resolved spontaneously, and hemodialysis (HD) was needed in two patients. The median PD catheter duration was 29 months (25th-75th percentiles: 21-41). Sixteen patients required revision (24.62%), and mortality occurred in five patients (7.69%). PD is a safe option in children with ESRD. Open placement with omentectomy in a specialized center could reduce leakage,help to start dialysis early, and decrease the conversion to HD.

Laparoscopic vs. open shunt placement: a two-year single centre experience

Laparoscopic vs. open shunt placement: a two-year single centre experience

THE HISTORICAL CONTEXT OF THE FORMATION OF AN ENTERPRISE WITH A STRICT TECHNOLOGICAL REGIME

The study allows us to present the historical conditions for the emergence and development of enterprises of a rigid technological structure in the context of the socio-political processes of the post-war era in Ukraine, as well as to identify the potential opportunities for their modernization in modern conditions. A special place in the historical and architectural study of the formation of enterprises with a strict technological regime and a pronounced large-scale engineering infrastructure is occupied by metallurgical, petrochemical, coke-chemical, as well as heat and hydropower enterprises, and the like. It should be determined that today they for the most part do not meet the environmental requirements, run counter to the idea of consistency in the urban planning environment and generally need comprehensive modernization. The architecture of industrial enterprises was formed on the basis of typology, unification and modular coordination, as well as the open placement of a powerful engineering infrastructure, which ultimately formed a new aesthetics of industrial culture. Cooling towers, gas holders, chimneys, overhead pipelines, distribution blocks and power lines became the embodiment of the iconic system of aesthetics of the industrial period, an integral part of the image of an industrial enterprise and the industrial landscape of the then cities. In the aesthetics of the modern, we see that the romanticization of production in the 20th century (before the war and post-war times), which was reflected in the artistic images of painting, cinema and, thanks to the poeticization and heroization of the images of the working profession, a talented artistic interpretation of the production environment, and contributed to the formation of a positive attitude towards the new industrial aesthetics.

Unexpected tunnelled central venous access demise: a single institutional study from the UK.

To explore the factors involved in the demise of tunnelled central vascular access devices (CVADs) in children and describe patterns of failure. A retrospective study including children under 16years of age undergoing CVAD insertion in a tertiary centre between October 2014 and December 2019. The Kaplan-Meier estimator was used to study CVAD survival and piecewise exponential curves to approximate hazard rates. Related factors were analysed using multivariable regression. Totally, 684 CVADs were inserted in 499 children. Devices were in situ for 213,821days (median 244.5). Of those, 261 CVADs (38.2%) failed prematurely; 176 (67%) required replacement. Tunnelled external lines (TELs) failed more frequently than totally implantable devices (p < 0.005).TEL displacement occurred in two high-risk phases, falling to baseline after 90days. Low age at device insertion and open placement were strongly associated with an increased failure rate. Previous CVAD failure did not increase subsequent failure rate. Premature failure increased procedural cost by £153,949 per year. TIDs should be placed in preference to TELs where appropriate. TELs are at highest risk of displacement for 90days and must be well secured for this duration. Meticulous line care offers significant potential cost savings by reducing line replacements. Level III.

Hybrid versus open retromuscular abdominal wall repair: early outcomes.

The hybrid approach to abdominal wall reconstruction (AWR) for abdominal wall hernias combines minimally invasive posterior component separation and retromuscular dissection with open fascial closure and mesh implantation. This combination may enhance patient outcomes and recovery compared to the open approach alone. The purpose of this study is to evaluate the operative outcomes of hybrid vs. open abdominal wall reconstruction. A retrospective review was conducted to compare patients who underwent open versus hybrid AWR between September 2015 and August of 2018 at Anne Arundel Medical Center. Patient demographics and perioperative data were collected and analyzed using univariate analysis. Sixty-five patients were included in the final analysis: 10 in the hybrid and 55 in the open groups. Mean age was higher in the hybrid vs. open group (65.1 vs. 56.2years, p < 0.05). The hybrid and open groups were statistically similar (p > 0.05) in gender distribution, mean BMI, and ASA score. Intraoperative comparison found hybrid patients parallel to open patients (p > 0.05) in mean operative time (294.5 vs. 267.5min), defect size (14.4 vs. 13.6cm), mesh area, and drain placement. The mean total hospital cost was lower in the hybrid group compared to the open group ($16,426 vs. $19,054, p = 0.43). The hybrid group had a shorter length of stay (5.3 vs. 3.6days, p = 0.03) after surgery and was followed for a similar length of time (12.3 vs. 12.6months, p = 0.91). The hybrid group showed a lower trend of seroma, hematoma, wound infection, ileus, and readmission rates after surgery. A review of patient outcomes after hybrid AWR highlights a trend towards shorter length of stay, lower hospital cost, and fewer complications without significant addition to operative time. Long-term studies on a larger number of patients are definitively needed to characterize the comprehensive benefits of this approach.

Comparison of outcomes following thoracoscopic versus thoracotomy closure for persistent patent ductus arteriosus.

Patent ductus arteriosus closure is traditionally performed by thoracotomy approach. Video-assisted thoracoscopic surgery is a less frequently utilised alternative. We sought to compare elective surgical outcomes between the two methods via a single-centre retrospective cohort analysis. All patients >3.2 kg undergoing surgical patent ductus arteriosus ligation at a single institution from 2000 to 2018 were retrospectively reviewed. Propensity matching for age, weight, diuretic usage, and preterm status was conducted to adjust for differences in baseline patient characteristics. Outcome measures included operative time, hospitalisation duration, post-operative complications, and re-operation. A total of 173 patients were included, 127 thoracoscopy and 46 thoracotomy. In the unmatched cohorts, no significant difference in closure success was found (94% thoracoscopy versus 100% thoracotomy, p = 0.192). Although median operative time was longer for thoracoscopy (87 versus 56 minutes, p < 0.001), hospitalisation duration was shorter (1.05 versus 2.41 days, p < 0.001), as was ICU stay (0.00 versus 0.75 days, p < 0.001). There were no significant differences in re-operation or complication rates, except chest tube placement (11% thoracoscopy versus 50% thoracotomy, p < 0.001). After matching (69 thoracoscopy versus 20 thoracotomy), these differences persisted, including median operative time (81 versus 56 minutes, p = 0.007; thoracoscopy versus thoracotomy), hospitalisation duration (1.25 versus 2.27 days, p < 0.001), and chest tube placement (17% versus 60%, p < 0.001). There remained no significant difference in complications or re-operations. Thoracoscopic ligation was associated with shorter ICU and hospital stays and less frequent chest tube placement, but longer operative times. Other risks, including bleeding, chylothorax, and recurrent laryngeal nerve injury, were similar.