Unplanned Reoperation Rate Research Articles

Applying unsupervised machine learning approaches to characterize autologous breast reconstruction patient subgroups: an NSQIP analysis of 14,274 patients

BackgroundAutologous breast reconstruction is composed of diverse techniques and results in a variety of outcome trajectories. We propose employing an unsupervised machine learning method to characterize such heterogeneous patterns in large-scale datasets. MethodsA retrospective cohort study of autologous breast reconstruction patients was conducted through the National Surgical Quality Improvement Program database. Patient characteristics, intraoperative variables, and occurrences of acute postoperative complications were collected. The cohort was classified into patient subgroups via the K-means clustering algorithm, a similarity-based unsupervised learning approach. The characteristics of each cluster were compared for differences from the complementary sample (p < 2 ×10−4) and validated with a test set. ResultsA total of 14,274 female patients were included in the final study cohort. Clustering identified seven optimal subgroups, ordered by increasing rate of postoperative complication. Cluster 1 (2027 patients) featured breast reconstruction with free flaps (50%) and latissimus dorsi flaps (40%). In addition to its low rate of complications (14%, p < 2 ×10−4), its patient population was younger and with lower comorbidities when compared with the whole cohort. In the other extreme, cluster 7 (1112 patients) almost exclusively featured breast reconstruction with free flaps (94%) and possessed the highest rates of unplanned reoperations, readmissions, and dehiscence (p < 2 ×10−4). The reoperation profile of cluster 3 was also significantly different from the general cohort and featured lower proportions of vascular repair procedures (p < 8 ×10−4). ConclusionsThis study presents a novel, generalizable application of an unsupervised learning model to organize patient subgroups with associations between comorbidities, modality of breast reconstruction, and postoperative outcomes.

Postoperative Outcomes for Spinal Fusion Procedures in Pediatric Patients with Anemia: A Retrospective and Multivariate Analysis

BackgroundPre-operative anemia is known to be associated with perioperative complications in many surgical interventions. Here, we examine the effects of pre-operative anemia on peri-operative complications and post-operative outcomes in pediatric patients undergoing spinal fusion. MethodsRetrospective analysis was conducted using the American College of Surgeons Pediatric National Surgery Quality Improvement Program Database between 2012-2020. Current Procedural Terminology codes 22800, 22802, 22804, 22840, 22842, 22843, and 22844 were included to represent all primary spinal fusion procedures performed. Patients without pre-operative hematocrit (HCT) levels were excluded. Classification of anemia was determined via age- and sex-adjusted HCT levels. Patient demographics, pre-operative comorbidities and risk factors, and 30-day post-operative outcomes were compared between the two cohorts using univariate analysis. Multivariate logistic regressions were performed to determine if anemia severity was independently associated with worse post-operative outcomes. ResultsA total of 30,243 pediatric patients were included in this study, with 26,621 not having pre-operative anemia and 3,622 having pre-operative anemia. Pediatric patients with anemia have increased length of stay (6.7 ± 9.6 vs. 5 ± 6, P < 0.001), 30-day unplanned reoperation rate (4% vs 2.8%, P <0.001), and total blood transfused (489.9 ± 497.8 vs. 423.4 ± 452.6, P <0.001). Multivariate analysis supported anemia and degree of its severity as an independent predictor of increased length of stay, reoperation rate, and post-operative complications. ConclusionPreoperative anemia leads to worse outcomes in pediatric spinal fusion procedures. Utilizing HCT recordings could be factored into the equation for optimal patient selection and prevention of post-operative complications.

Early versus late surgical treatment of pelvic and acetabular fractures a five-year follow-up of 419 patients

BackgroundSurgical treatment of pelvic and acetabular fractures is an advanced intervention with a high risk of subsequent complications. These patients are often polytrauma patients with multiple injuries in several organ systems. The optimal timing for the definitive surgery of these fractures has been debated. The primary aim of this study was to investigate the influence of timing of definitive surgery on the rate of unplanned reoperations. Secondary aims included its influence on the occurrence of adverse events and mortality.MethodsAll patients from 18 years with a surgically treated pelvic or acetabular fracture operated at the Karolinska University Hospital in Sweden during 2010 to 2019 were identified and included. Data was collected through review of medical records and radiographs. Logistic regression analysis was performed to evaluate factors associated with unplanned reoperations and other adverse events.ResultsA total of 419 patients with definitive surgical treatment within 1 month of a pelvic (n = 191, 46%) or an acetabular (n = 228, 54%) fracture were included. The majority of the patients were males (n = 298, 71%) and the mean (SD, range) age was 53.3 (19, 18–94) years. A total of 194 (46%) patients had their surgery within 72 h (early surgery group), and 225 (54%) later than 72 h (late surgery group) after the injury. 95 patients (23%) had an unplanned reoperation. There was no difference in the reoperation rate between early (n = 44, 23%) and late (n = 51, 23%) surgery group (p = 1.0). A total of 148 patients (35%) had any kind of adverse event not requiring reoperation. The rate was 32% (n = 62) in the early, and 38% (n = 86) in the late surgery group (p = 0.2). When adjusting for relevant factors in regression analyses, no associations were found that increased the risk for reoperation or other adverse events. The 30-day mortality was 2.1% (n = 4) for the early and 2.2% (n = 5) for the late surgery group (p = 1.0). The 1-year mortality was 4.1% (n = 8) for the early and 7.6% (n = 17) for the late surgery group (p = 0.2).ConclusionsEarly (within 72 h) definitive surgery of patients with pelvic or acetabular fractures seems safe with regard to risk for reoperation, other adverse events and mortality.

Nipple-Sparing Mastectomy With Immediate Reconstruction After Breast-Conserving Therapy and Radiation: Complications and Oncologic Safety.

Nipple-sparing mastectomy (NSM) offers improved, patient-centered outcomes with demonstrated oncologic safety (Ann Surg Oncol 2020;27:344-351). Indications for NSM continue to expand to patients outside of the traditional eligibility criteria, including those with prior breast-conserving therapy (BCT) with radiotherapy. Currently, limited data exist evaluating both short- and long-term outcomes in patients proceeding to NSM after prior BCT. All patients undergoing bilateral NSM in a single institution from 2002 through 2017 with history of prior BCT were included in the final cohort, without exclusions. A retrospective chart review was performed to identify patient demographics, operative details, and complications. Outcomes assessed included early complications (<30 days from NSM), late complications (>30 days), rates of prosthetic failure, unplanned reoperations, and reconstructive failures, as well as oncologic safety. Student t, χ2, and Fisher exact tests were used to analyze outcomes of paired (BCT vs non-BCT) breasts within each patient. A total of 17 patients undergoing 34 NSMs were included. Each had a history of BCT and either ipsilateral breast recurrence (64.7%), risk-reducing NSM (23.5%), or a new contralateral primary cancer (11.8%). The cohort had a mean age of 51.1 years. With regard to acute complications (ischemia, infection, nipple-areolar complex or flap ischemia or necrosis, and wound dehiscence), there was no significant difference noted between breasts with prior BCT versus no prior BCT overall (41.2% vs 35.3%, respectively; P = 0.724). Complications occurring after 30 days postoperatively (capsular contracture, contour abnormality, animation deformity, bottoming out, rotation, and rippling) in prior BCT breasts versus no prior BCT had no significant differences overall (58.8% vs 41.2% respectively; P = 0.303). The mean follow-up was 5.5 years, during which no patients had a reported locoregional or distant recurrence in either breast. No significant differences in early or late complications were identified between breasts in patients undergoing bilateral NSM with a history of unilateral BCT and XRT. In the 5.5 years of follow-up, there were no recurrences, lending support to NSM for management of recurrent disease in addition to National Comprehensive Cancer Network-recommended total mastectomy. We propose that NSM should not be contraindicated in patients exposed to radiation with BCT.

The double-face onlay-tube-onlay transverse preputial flap: An advantageous alternative to the two-stage hypospadias repair?

To compare the surgical outcomes and complications of boys who underwent double-face onlay-tube-onlay transverse preputial island flap (DFOTO) one-stage repair vs. two-stage repair for proximal hypospadias. Males with proximal hypospadias who underwent DFOTO or two-stage repair at a single institution from 2008 to 2021 were identified. Patients who had prior hypospadias surgery were excluded. Outcomes were surgical complications, number of surgical procedures, operative time, and post-operative uroflowmetry results. Fifty-three males who underwent DFOTO and 39 who underwent two-stage repair were included. Median age at surgery was 1.1 years (IQR 0.83-1.6) and median follow-up was 3.0 years (IQR 1.2-6.8). Although not statistically significant, the DFOTO group had higher rates of urethrocutaneous fistula (30% vs. 15%, p=0.10), urethral stricture (15% vs. 3%, p=0.07) and urethral diverticulum (8% vs. 3%, p=0.39). Although the unplanned re-operation rate was higher in DFOTO (58% vs. 33%, p=0.02), the mean number of procedures and median total surgical time were lower in DFOTO (1.8±0.9 vs. 2.4±0.8, p=0.0004; 337min [IQR 278-460] vs. 468 min [IQR 400-563], p=0.008). There were no significant differences between groups for mean peak flow rates and post void residuals. In males who underwent DFOTO, 42% achieved completion of their proximal hypospadias repair with one operation, while the remainder had largely minor complications. Accounting for reoperation rates, the mean number of procedures per patient was lower in the DFOTO group. Comparable results can be achieved with both techniques; the risks of higher unplanned operation rates in the DFOTO group should be considered with the benefit of fewer total procedures.

Debranching abdominal aortic hybrid surgery for aortic diseases involving the visceral arteries.

Aortic diseases involving branches of the visceral arteries mainly include thoracoabdominal aortic aneurysm (TAAA), aortic dissection (AD) and abdominal aortic aneurysm (AAA). The focus of treatment is to reconstruct the splanchnic arteries and restore blood supply to the organs. Commonly used methods include thoracoabdominal aortic replacement, thoracic endovascular aortic repair and hybrid approaches. Hybrid surgery for aortic disease involving the visceral arteries, consisting of visceral aortic debranching with retrograde revascularization of the celiac trunk and renal arteries and using stent grafts, has been previously described and may be considered particularly appealing in high-risk patients. This study retrospectively analyzed recorded data of patients and contrasted the outcomes with those of a similar group of patients who underwent conventional open repair surgery. Between 2019 and 2022, 72 patients (52 men) with an average age of 61.57 ± 8.66 years (range, 36-79 years) underwent one-stage debranching abdominal aortic hybrid surgery. These patients, the hybrid group, underwent preoperative Computed Tomographic Angiography (CTA) and had been diagnosed with aortic disease (aneurysm or dissection) involving the visceral arteries and were at high risk for open repair. The criteria used to define these patients as high-risk group who are in the need of hybrid treatment were American Society of Anesthesiologists (ASA) class 3 or 4. In all cases, we accomplished total visceral aortic debranching through a previous visceral artery retrograde revascularization with synthetic grafts (customized Y or four-bifurcated grafts), and aortic endovascular repair with one of two different commercially produced stent grafts (Medtronic® and Lifetech®). In some cases, we chose to connect the renal artery to the artificial vessel with a stent graft (Viabahn) and partly or totally anastomosed. We analyzed the results and compared the outcomes of the hybrid group with those of a similar group of 46 patients (36 men) with an average age 54.15 ± 12.12 years (range, 32-76). These 46 patients, the conventional open group, were selected for having had thoracoabdominal aortic replacement between 2019 and 2022. In the hybrid group, 72 visceral bypasses were completed, and endovascular repair was successful in all cases. No intraoperative deaths occurred. Perioperative mortality was 2.78%, and perioperative morbidity was 9.72% (renal insufficiency in 1, unilateral renal infarction in 5, Intestinal ischemia in 1). At 1-month postoperative CTA showed 2 endoleaks, one of which was intervened. At follow-up, there were unplanned reoperation rate of 4.29% and 5 (7.14%) deaths. The remaining patients' grafts were patent at postoperative CTA and no endoleak or stent graft migration had occurred. In the conventional open group, 1 died intraoperatively, 4 died perioperatively, perioperative mortality was 10.87% and complications were respiratory failure in 5, intestinal paralysis/necrosis in 4, renal insufficiency in 17, and paraplegia in 2. At follow-up, 5 (12.20%) patients presented with synthetic grafts hematoma 4 (9.76%) patient died, and 6 (14.63%) patients required unplanned reoperation intervention. Hybrid surgery is technically feasible in selected cases. For aortic diseases involving the visceral arteries, the application of hybrid abdominal aorta debranching can simplify the operation process, decrease the risks of mortality and morbidity in high-risk and high-age populations and decrease the incidence of various complications while achieving ideal early clinical efficacy. However, a larger series is required for valid statistical comparisons, and longer follow-ups are necessary to evaluate the long-term efficacy of hybrid surgery.

Outcomes following acute versus staged fixation of complete articular tibial plafond fractures.

To determine outcomes following acute versus staged fixation of complete articular tibial plafond fractures. Retrospective cohort study. Single Level 1 Trauma center. 98 skeletally mature patients with OTA/AO 43C type fractures who underwent definitive fixation with plate and screw constructs and had minimum 6 month follow up. Acute (aORIF) versus staged (sORIF) definitive fixation. Rates of wound dehiscence/necrosis and deep infection. Acute (N=40) versus staged (N=58) ORIF groups had comparable rates of vascular disease, renal disease, and substance/nicotine use, but aORIF patients had higher rates of diabetes mellitus (10% vs 0%, p<0.001), which correlated with higher ASA scores (>ASA 3: 37.5% vs 13.8%, p=0.02). Both groups achieved anatomic/good reductions, as determined by post-operative CT scans, at rates greater than 90%; however, the sORIF group required modestly longer operative times to achieve this outcome (aORIF vs sORIF: 121 vs 146 minutes, p=0.02). Post-operatively, both groups had similar rates of wound dehiscence (2.5% vs 6.9%, p=0.65), superficial (10% vs 17.2%, p=0.39), and deep (10% vs 8.6%, p=0.99) infections. While the injury pattern itself required free flap coverage in 1 patient in each group, unplanned free flap coverage occurred in 10.0% and 10.3% of aORIF and sORIF groups, respectively. Overall, rates of unplanned reoperations, excluding ankle arthrodesis, did not differ between groups (aORIF vs sORIF:12.5% vs 25.9%, p=0.13). In select patients managed by fellowship trained Orthopaedic traumatologists, acute definitive pilon fixation can produce acceptable outcomes.

How Postoperative Infection Affects Reoperations after Implant-based Breast Reconstruction: A National Claims Analysis of Abandonment of Reconstruction.

We conducted a retrospective cohort study using Optum's de-identifed Clinformatics Data Mart Database to analyze women undergoing implant breast reconstruction from 2003 to 2019. Unplanned reoperations were identified via Current Procedural Terminology (CPT) codes. Outcomes were analyzed via multivariate linear regression with Poisson distribution to determine statistical significance at P < 0.00625 (Bonferroni correction). In our national claims-based dataset, post-IBR infection rate was 8.53%. Subsequently, 31.2% patients had an implant removed, 6.9% had an implant replaced, 3.6% underwent autologous salvage, and 20.7% discontinued further reconstruction. Patients with a postoperative infection were significantly associated with increased incidence rate of total reoperations (IRR, 3.11; 95% CI, 2.92-3.31; P < 0.001) and total hospital length of stay (IRR, 1.55; 95% CI, 1.48-1.63; P < 0.001). Postoperative infections were associated with significantly increased odds of abandoning reconstruction (OR, 2.92; 95% CI, 0.081-0.11; P < 0.001). Unplanned reoperations impact patients and healthcare systems. This national, claims-level study shows that post-IBR infection was associated with a 3.11× and 1.55× increase in the incidence rate of unplanned reoperations and length of stay. Post-IBR infection was associated with 2.92× increased odds of abandoning further reconstruction after implant removal.

Retained Functional Antibiotic Hip Spacers Have High Rates of Stem Loosening, Subsidence, and Reoperation

BackgroundFunctional antibiotic hip spacers for treatment of periprosthetic joint infection may be retained in patients deemed too sick for reimplantation, or who elect to forego additional surgery. Our aim was to characterize reoperations, modes of failure, and function outcomes in patients who have retained hip spacers. MethodsWe performed a retrospective review of 43 hips that underwent placement of an articulating hip spacer between January 1, 2014 and November 30, 2021. There were 28 hips that completed 2-stage exchange (TS group) and were reimplanted at mean 4 months (range, 2 to 10). The other 15 hips underwent planned spacer retention (RS group). Mean follow-up was 2.9 years (range, 1 to 6.1 years). The RS group was older (74 versus 66 years, P = .005) and had a higher age-adjusted Charlson Comorbidity Index (4.4 versus 3.3, P = .04) compared with the TS group. ResultsOverall survivorship free of reinfection was 91% at 1 year and 86% at 5 years. There were 6 RS hips that underwent reimplantation for spacer failure at a mean of 23 months (range, 6 to 71 months) and 8 had radiographic stem loosening/subsidence. Patients who had a retained spacer at final follow-up were more likely to require a walker (P = .005) or wheelchair (P = .049) compared with patients who underwent reimplantation. ConclusionsRetained hip spacers can decrease overall surgical burden, but are associated with high rates of stem loosening, subsidence, and unplanned reoperation. Planned spacer retention should be undertaken with caution in patients healthy enough to undergo reimplantation.

Immediate Breast Reconstruction After Neoadjuvant Chemotherapy: Factors Associated With Surgical Selection and Complications.

Breast reconstruction has become an integral component of breast cancer treatment, especially for patients who are unable to undergo breast-conserving surgery after neoadjuvant chemotherapy (NAC). We analyzed factors influencing the type of immediate reconstruction surgery after NAC, as well as the complication rates for each surgery type. The study included patients with breast cancer who underwent mastectomy following NAC from 2010 to 2021. Clinicopathological characteristics, unplanned reoperation rates, and the duration of postoperative hospitalization were analyzed in patients undergoing autologous tissue reconstruction (ATR, n = 127), implant-based reconstruction (IBR, n = 60), and combined autologous tissue and implant reconstruction (n = 60). A total of 1651 patients who received NAC before mastectomy were enrolled. Among them, 247 (15.0%) patients underwent immediate reconstruction (IR), whereas 1404 underwent mastectomy only. Patients in the IR group were younger (P < 0.001), had lower body mass index (P < 0.001), and exhibited earlier clinical (P = 0.003) and nodal (P < 0.001) stage than those in the non-IR group. Patients in the ATR group were older (P < 0.001) and had higher body mass index (P = 0.007), larger tumor size (P = 0.024), and more frequent childbearing history (P = 0.011) than those in the other groups. Complications resulting in unplanned reoperations were more frequent in the IBR group (P = 0.039). The duration of postoperative hospitalization was longest after ATR (P = 0.008). Age and clinical tumor/nodal stage at presentation are associated with IR for patients undergoing mastectomy after NAC. For patients undergoing IR after NAC, ATR may be safer and more suitable than IBR.

Incidences, causes and risk factors of unplanned reoperation within 30days of craniovertebral junction surgery: a single-center experience.

To investigate the incidences, causes, and risk factors for unplanned reoperation within 30days of craniovertebral junction (CVJ) surgery. From January 2002 to December 2018, a retrospective analysis of patients who underwent CVJ surgery at our institution was conducted. The demographics, history of the disease, medical diagnosis, approach and type of operation, surgery duration, blood loss, and complications were recorded. Patients were divided into the no-reoperation group and the unplanned reoperations group. Comparison between two groups in noted parameters was analyzed to identify the prevalence and risk factors of unplanned revision and a binary logistic regression was performed to confirm the risk factors. Of 2149 patients included, 34(1.58%) required unplanned reoperation after the initial surgery. The causes for unplanned reoperation contained wound infection, neurologic deficit, improper screw placement, internal fixation loosens, dysphagia, cerebrospinal fluid leakage, and posterior fossa epidural hematomas. No statistical difference was found in demographics between two groups (P > 0.05). The incidence of reoperation of OCF was significantly higher than that of posterior C1-2 fusion (P = 0.002). In terms of diagnosis, the reoperation rate of CVJ tumor patients was significantly higher than that of malformation patients, degenerative disease patients, trauma patients, and other patients (P = 0.043). The binary logistic regression confirmed that different disease, fusion segment (posterior) and surgery time were independent risk factors. The unplanned reoperation rate of CVJ surgery was 1.58% and the major causes were implant-related failures and wound infection. Patients with posterior occipitocervical fusion or diagnosed with CVJ tumors had an increased risk of unplanned reoperation.

A Systematic Review and Meta-Analysis Comparing the Clinical Outcomes of Profunda Artery Perforator Versus Gracilis Thigh Flap as a Second Choice for Autologous Breast Reconstruction.

Autologous breast reconstruction remains a versatile option to produce a natural appearing breast after mastectomy. The deep inferior epigastric perforator remains the most commonly used flap choice, but when this donor site is unsuitable or unavailable, the transverse upper gracilis (TUG) or profunda artery perforator (PAP) flaps are popular secondary alternatives. We conduct a meta-analysis to better understand patient outcomes and adverse events in secondary flap selection in breast reconstruction. A systematic search was conducted on MEDLINE and Embase for all articles published on TUG and/or PAP flaps for oncological breast reconstruction in postmastectomy patients. A proportional meta-analysis was conducted to statistically compare outcomes between PAP and TUG flaps. The TUG and PAP flaps were noted to have similar reported rates of success and incidences of hematoma, flap loss, and flap healing (P > 0.05). The TUG flap was noted to have significantly more vascular complications (venous thrombosis, venous congestion, and arterial thrombosis) than the PAP flap (5.0% vs 0.6%, P < 0.01) and significantly greater rates of unplanned reoperations in the acute postoperative period (4.4% vs 1.8%, P = 0.04). Infection, seroma, fat necrosis, donor healing complications, and rates of additional procedures all exhibited high degree of heterogeneity precluding mathematical synthesis of outcomes across studies. Compared with TUG flaps, PAP flaps have fewer vascular complications and fewer unplanned reoperations in the acute postoperative period. There is need for greater homogeneity in reported outcomes between studies to enable for synthesis of other variables important in determining flap success.

PC3. A Nationally Validated Risk Assessment Score for Predicting Unplanned Reoperations in Hand Surgery

PURPOSE: To present a validated model that reliably predicts unplanned reoperation after upper extremity/hand surgery. METHODS: A total of 83,409 hand surgery patients were identified using the 2012-2019 ACS-NSQIP databases. Thirty-day unplanned reoperation was defined as unexpected reoperation for a postoperative occurrence related to the principal hand surgery. Independent predictors of 30-day unplanned reoperation were identified using multivariable logistic regression with backward variable selection on the testing sample. Subsequently, the predictors were weighted according to β-coefficients to generate an integer-based Novel Risk Score (NRS) predictive of reoperation. The NRS was then validated 1000 bootstrapped replications of the original sample, and validated on NSQIP patients who had undergone hand surgery in 2020 (n = 15,247). The NRS was compared to two other widely used risk scores with receiver operating characteristics (ROC) analysis. RESULTS: The rate of 30-day unplanned reoperation in the 2020 cohort was 1.1%. Independent risk factors included male gender, inpatient status, smoking, dialysis dependence, transfusion within 72 hours of surgery, wound classification, ASA Class, diabetes mellitus, CHF, sepsis or septic shock, emergent case, and long initial operative time (all P < 0.05). ROC analysis of the testing (2020) cohort rendered an area under the curve of 0.730, which demonstrates the accuracy of this prediction model. The mFI-5 and mCCI rendered AUCs of 0.580 and 0.585, respectively. CONCLUSION: We present a validated risk stratification tool for unplanned reoperations following hand surgery. Future studies should determine if implementation of this NRS optimizes safety and reduces reoperation rates in hand surgery patients.

Risk Factors for 30-Day Unplanned Re-Operation in Pediatric Upper Extremity Surgery: A National Surgical Quality Improvement Program (NSQIP)-Pediatric Analysis.

Introduction The unplanned re-operation rate has been used as one marker of procedure quality in numerous surgical sub-fields. The purpose of this study was to determine independent risk factors for unplanned re-operations within 30 days following pediatric upper extremity surgery. Methods Pediatric patients who had a primary upper extremity procedure from 2012 to 2019 were identified in the National Surgical Quality Improvement Program-Pediatric database. The procedures included percutaneous fixation of supracondylar humerus fractures, open treatment of humeral condylar fractures, tendon sheath incision, repair of syndactyly, and reconstruction of polydactyly. Patients were categorized by those who had unplanned return to the operating room within 30 days and patients who did not. Patient demographics, clinical characteristics, and medical co-morbidities were evaluated for their association with re-operation using bivariate and multivariate analysis. Results A total of 27,536 pediatric patients underwent primary upper extremity surgeries; of these, 290 (1.1%) required an unplanned re-operation. After controlling for potential confounding variables on multivariable regression analysis, American Society of Anesthesiologists (ASA) class III-V (OR 15.89; p<0.001), inpatient procedure (OR 1.29; p=0.044), emergent/urgent triage (OR 3.75; p<0.001), longer operative time (OR 1.01; p<0.001), and prolonged hospital stay (OR 1.01; p=0.010) were independent predictors for re-operation. Conclusion This study demonstrates that the national rate of 30-day unplanned re-operation in pediatric upper extremity surgeries is low overall. The greatest risk factors for unplanned re-operation were ASA class III-V, inpatient setting, emergent/urgent triage, longer operative time, and prolonged hospital stay. This knowledge can help further improve patient outcomes through risk stratification and preoperative planning.

Safety of Prepping the External Fixator In Situ During Staged Internal Fixation of Pilon Fractures: A Retrospective Comparative Cohort Study.

(1) To assess the rate of fracture-related infection (FRI) and unplanned reoperation of disinfecting and prepping in the external fixator (Ex-Fix) instrument during definitive open reduction and internal fixation (ORIF) of pilon fractures treated by a staged protocol and (2) to determine whether the amount of time from external fixation to ORIF influences the risk of FRI. Retrospective cohort study. Level 1 academic trauma center. One hundred thirty-three patients who underwent operative treatment for pilon fracture between 2010 and 2020. External fixation and ORIF with or without the Ex-Fix prepped in situ during definitive fixation. FRI and unplanned reoperation rates. 133 patients were enrolled, of which 47 (35.3%) had Ex-Fix elements prepped in situ. There was an overall infection rate of 23.3% and unplanned reoperation rate of 11.3%, and there was no significant difference in rates between the 2 cohorts. Patients with Ex-Fix elements prepped in situ who developed an FRI had a higher rate of MRSA and MSSA . Diabetes ( P = 0.0019), open fracture ( P = 0.0014), and longer (≥30 days) interval to ORIF ( P = 0.0001) were associated with postoperative FRI. Prepping elements of the Ex-Fix in situ did not lead to an increase in rates of FRI or unplanned reoperation. Although diabetes and open fracture were associated with FRI risk, a stronger association was a longer interval of Ex-Fix utilization before definitive internal fixation, specifically 30 days or greater. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

56 Using machine learning to predict 30-day readmission and reoperation following resection of supratentorial high-grade gliomas: A national analysis of 9,418 patients.

OBJECTIVES/GOALS: High-grade gliomas (HGG) are among the rarest, most aggressive tumors in neurosurgical practice. We aimed to identify the clinical predictors for 30-day readmission and reoperation following HGGs surgery using the NSQIP database and seek to create web-based applications predicting each outcome. METHODS/STUDY POPULATION: We conducted a retrospective, multicenter cohort analysis of patients who underwent resection of supratentorial HGG between January 1, 2016, and December 31, 2020, using the NSQIP database. Demographics and comorbidities were extracted. The primary outcomes were 30-day unplanned readmission and reoperation. A stratified 80:20 split of the available data was carried out. Supervised machine learning algorithms were trained to predict 30-day outcomes. RESULTS/ANTICIPATED RESULTS: A total of 9,418 patients were included in our cohort. The rate of unplanned readmission within 30 days of surgery was 14.9%.Weight, chronic steroid use, pre-operative BUN, and WBC count were associated with a higher risk of readmission. The rate of early unplanned reoperation was 5.47%. Increased weight, higher operative time, and a longer period between hospital admission and the operation were linked to increased risk of early reoperation. Our Random Forest algorithm showed the highest predictive performance for early readmission (AUC = 0.967), while the XG Boost algorithm showed the highest predictive performance for early reoperation (AUC = 0.985).Web-based tools for both outcomes were deployed: https://glioma-readmission.herokuapp.com/, https://glioma-reoperation.herokuapp.com/. DISCUSSION/SIGNIFICANCE: A high fraction of documented early unplanned readmission and reoperation were considered preventable and related to surgery. Machine learning allows better prediction of resected HGG’s prognosis based on findings from baseline methods leading to more personalized patient care.

MP19-10 FEASIBILITY AND COMPLICATIONS OF OUTPATIENT ROBOTIC RADICAL PROSTATECTOMY WITH LYMPH NODE DISSECTION

You have accessJournal of UrologyCME1 Apr 2023MP19-10 FEASIBILITY AND COMPLICATIONS OF OUTPATIENT ROBOTIC RADICAL PROSTATECTOMY WITH LYMPH NODE DISSECTION Spencer Liem, Dhaval Jivanji, Timothy Demus, Shuwei Peter Chang, Shimron Brown, and Jorge Pereira Spencer LiemSpencer Liem More articles by this author , Dhaval JivanjiDhaval Jivanji More articles by this author , Timothy DemusTimothy Demus More articles by this author , Shuwei Peter ChangShuwei Peter Chang More articles by this author , Shimron BrownShimron Brown More articles by this author , and Jorge PereiraJorge Pereira More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003244.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostate cancer is one of most common cancers in men. Outpatient robotic radical prostatectomy (RRP) is currently a topic of interest because of its ability to minimize costs while minimizing complications. However, few studies have analyzed the differences in outpatient RRP in patients undergoing concurrent lymph node dissections (LND) versus those without. As such, we compare the complication rates of inpatient versus outpatient RRP both with and without LND. METHODS: Using the National Surgical Quality Improvement Program Database (NSQIP), we identified total RRP with and without LND by current procedural terminology code, and reported patient co-morbidities, intra-operative or post-operative complications, and 30-day complication events from 2010-2020. We further divided this data into inpatient and outpatient surgeries. RESULTS: Between 2010-2020, a total of 79381 RRP were performed, 98.2% inpatient and 1.7% outpatient, of which 50% and 54% had LND respectively. Comparing patients undergoing outpatient RRP with LND versus those without LND, patients with LND had an average age of 63±7 years while patients without LND averaged 62±7 years. Mean operative time was 180.5±63.2 minutes and 187.6±72.9 minutes respectively. Patients undergoing outpatient RRP with LND were less likely to have an active smoking history (7.5% vs. 10.7%), or a history of hypertension (45.1% vs. 50.6%) but had higher rates of sepsis (0.8% vs. 0%) and superficial incisional infection (1.4% vs. 0.2%) when compared those without LND. All other complications and 30-day events such as unplanned readmission, reoperation rates, and mortality were similar in both groups. CONCLUSIONS: Patients undergoing outpatient RRP with LND had similar overall age and operative times as outpatient RRP without LND. Patients that had outpatient RRP with LND were less likely to have an active smoking history and hypertension but had higher rates of sepsis and superficial incisional infections. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e268 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Spencer Liem More articles by this author Dhaval Jivanji More articles by this author Timothy Demus More articles by this author Shuwei Peter Chang More articles by this author Shimron Brown More articles by this author Jorge Pereira More articles by this author Expand All Advertisement PDF downloadLoading ...

Risk factors for reoperation to promote union in 1,111 distal femur fractures.

To identify modifiable and non-modifiable risk factors for reoperation to promote union after distal femur fracture. Multicenter retrospective cohort study. Ten Level-I trauma centers. Patients with OTA/AO 33A or C distal femur fractures (n = 1,111). Surgical fixation of distal femur fracture. Fixation constructs were classified as lateral plate, dual plate, nail, or nail plate combination. The outcome of interest was unplanned reoperation to promote union. There was an 11% (121/1111) rate of unplanned reoperation to promote union. In the multivariate analysis, predictive factors included BMI (odds ratio [OR] = 1.18; 95% confidence interval [CI]: 1.06 - 1.32; p < 0.01), intra-articular fracture (OR = 1.57; 95% CI: 1.01 - 2.45; p = 0.04), type III open injury (OR = 2.29; 95% CI: 1.41 - 3.72; p < 0.01), the presence of medial comminution (OR = 1.85; 95% CI: 1.14 - 3.06; p = 0.01), and medial translation on post-operative radiographs (OR = 1.23 per one tenth of condylar width; 95% CI: 1.01 - 1.48; p = 0.03). Construct type was not significantly predictive. 11% of distal femur fractures underwent unplanned reoperation to promote union. BMI, intra-articular fracture, type III open injury, medial comminution, and medial translation on postoperative radiographs were predictive factors. Construct type was not associated with unplanned reoperation, however this conclusion was limited by small numbers in the dual plate and nail plate groups. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Trend of unplanned reoperation rates after lumbar degenerative surgery from 2011 to 2019: a large patient population study.

Unplanned reoperation is commonly performed due to postoperative complications. Previous studies have reported the incidence of unplanned reoperation following lumbar spinal surgery. But few study focused on the trend of reoperation rates, and the reasons of unplanned reoperation were not clear. In this study, we conducted a retrospective study to determine the trend of unplanned reoperation rates after degenerative lumbar spinal surgery from 2011 to 2019, and the reasons and risk factors of unplanned reoperation were also determined. Data of patients who were diagnosed with degenerative lumbar spinal disease and underwent posterior lumbar spinal fusion surgery in our institution from January 2011 to December 2019 were reviewed. Those who received unplanned reoperation during the primary admission were identified. The demographics, diagnosis, surgical segments and postoperative complications of these patients were recorded. The rates of unplanned reoperation from 2011 to 2019 were calculated, and the reasons of unplanned reoperation were statistically analysed. A total of 5289 patients were reviewed. Of them, 1.91% (n = 101) received unplanned reoperation during the primary admission. The unplanned reoperation rates of degenerative lumbar spinal surgery firstly increased from 2011 to 2014, with a peak rate in 2014 (2.53%). Then, the rates decreased from 2014 to 2019, with the lowest one in 2019 (1.46%). Patients with lumbar spinal stenosis have a higher rate of unplanned reoperation (2.67%) compared with those diagnosed as lumbar disc herniation (1.50%) and lumbar spondylolisthesis (2.04%) (P < 0.05). The main reasons for unplanned reoperation were wound infection (42.57%), followed by wound hematoma (23.76%). Patients who underwent 2-segment spinal surgery had a higher unplanned reoperation rate (3.79%) than those receiving other segments surgery (P < 0.001). And different spine surgeons had different reoperation rates. The rates of unplanned reoperation after lumbar degenerative surgery increased at first and then decreased during past 9 years. Wound infection was the major reason for unplanned reoperation. 2-segment surgery and surgeon's surgical skills were related to the reoperation rate.

Medial and lateral dual plating of native distal femur fractures: a systematic literature review.

Lateral locked plating (LLP) development has improved outcomes for distal femur fractures. However, there is still a modest rate of nonunion in fractures treated with LLP alone, with higher nonunion risk in high-energy fractures, intra-articular involvement, poor bone quality, severe comminution, or bone loss. Several recent studies have demonstrated both the safety and the biomechanical advantage of dual medial and lateral plating (DP). The purpose of this study was to evaluate the clinical outcomes of DP for native distal femoral fractures by performing a systematic review of the literature. Studies reporting clinical outcomes for DP of native distal femur fractures were identified and systematically reviewed. Publications without full-text manuscripts, those solely involving periprosthetic fractures, or fractures other than distal femur fractures were excluded. Fracture type, mean follow-up, open versus closed fracture, number of bone grafting procedures, nonunion, reoperation rates, and complication data were collected. Methodologic study quality was assessed using the Coleman methodology score. The initial electronic review and reverse inclusion protocol identified 1484 publications. After removal of duplicates and abstract review to exclude studies that did not discuss clinical treatment of femur fractures with dual plating, 101 potential manuscripts were identified and manually reviewed. After final review, 12 studies were included in this study. There were 199 fractures with average follow-up time of 13.72 months. Unplanned reoperations and nonunion occurred in 19 (8.5%) and 9 (4.5%) cases, respectively. The most frequently reported complications were superficial infection (n = 6, 3%) and deep infection (n = 5, 2.5%) postoperatively. Other complications included delayed union (n = 6, 3%) not requiring additional surgical treatment and knee stiffness in four patients (2%) necessitating manipulation under anesthesia or lysis of adhesions. The average Coleman score was 50.5 (range 13.5-72), suggesting that included studies were of moderate-to-poor quality. Clinical research interest in DP of distal femoral fractures has markedly increased in the past few decades. The current data suggest that DP of native distal femoral fractures is associated with favorable nonunion and reoperation rates compared with previously published rates associated with LLP alone. In the current review, DP of distal femoral fractures was associated with acceptable rates of complications and generally good functional outcomes. More high-quality, directly comparable research is necessary to validate the conclusions of this review.