Similar Rates Of Postoperative Complications Research Articles

Abdominoplasty in Anchor with Staged Skin Resection: Evaluation of Outcomes

Conventional abdominoplasty in anchor (with “en bloc” resection of the vertical and horizontal skin components) for patients after massive weight loss is related to some disadvantages. This study aimed to evaluate the outcomes of patients undergoing abdominoplasty in anchor with staged skin resection. This was a retrospective case series based on clinical evaluation of patients undergoing abdominoplasty in anchor with the technique of staged skin resection (first the vertical skin component followed by the horizontal component). We evaluated patient data, postoperative complications, patient satisfaction, and esthetic analysis of the postoperative outcomes using photographs at 12 months after surgery (performed by three independent plastic surgeons through a scale from 0 to 10, in which scores were assigned to the visual parameters). The 24 patients included in this study had a mean age of 42.58 years and a pre-abdominoplasty body mass index of 26.94 kg/m2. The overall mean of complications was 45.8%; the most common postoperative complication was seroma (n = 6), followed by infection (n = 3), dehiscence (n = 2), hematoma (n = 2), hypertrophic scar (n = 2), unaesthetic scar (n = 1), and retraction of the umbilicus (n = 1). Postoperative esthetic evaluation provided an average score of 5.61 for these patients. Compared with the literature about the conventional technique of en bloc resection, abdominoplasty in anchor with staged skin resection showed a similar rate of postoperative complications, and the esthetic evaluation of postoperative outcomes was considered satisfactory.

Abdominoperineal excision or extralevator abdominoperineal excision: which is the best oncological treatment?

Surgery of tumors of the lower third of the rectum is particularly difficult due to the complex anatomy of the pelvis, which can lead to an incomplete radical resection. Abdominoperineal excision (APE) is the operation of choice for tumors of the low rectum that infiltrate levatorani or sphincter muscles. Regardless, APE causes an important morbidity, a higher incidence of circumferential resection margin (CRM) infiltration, iatrogenic tumor perforation incidence and worsens the mesorectum quality due to the conicity induced during surgery while dissection between both distal mesorectum and levatorani planes is performed. An extralevator abdominoperineal excision (ELAPE), which involves a broader resection of the pelvic floor muscles, would theoretically reduce the risk of CRM infiltration and tumor perforation rate, independently from the position (prone vs . supine) or the approach (open vs . laparoscopic). This review is focused on the analysis of the scientific evidence published so far comparing both techniques, APE or ELAPE. In spite of some publications observe a possible benefit in terms of reduction in CRM involvement, iatrogenic perforations or local recurrence, there is not enough evidence to affirm the superiority of ELAPE compared to conventional APE in terms of oncological results. In general, similar rates of postoperative complications are described for both techniques. Further prospective, controlled and randomized studies are needed to conclude which of the two techniques is the best oncological treatment.

Does previous abdominal surgery affect the course and outcomes of laparoscopic bariatric surgery?

BackgroundGlobal experiences in general surgery suggest that previous abdominal surgery may negatively influence different aspects of perioperative care. As the incidence of bariatric procedures has recently increased, it is essential to assess such correlations in bariatric surgery. ObjectivesTo assess whether previous abdominal surgery influences the course and outcomes of laparoscopic bariatric surgery. SettingSeven referral bariatric centers in Poland. MethodsWe conducted a retrospective analysis of 2413 patients; 1706 patients who underwent laparoscopic sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) matched the inclusion criteria. Patients with no history of abdominal surgery were included as group 1, while those who had undergone at least 1 abdominal surgery were included as group 2. ResultsGroup 2 had a significantly prolonged median operation time for RYGB (P = .012), and the longest operation time was observed in patients who had previously undergone surgeries in both the upper and lower abdomen (P = .002). Such a correlation was not found in SG cases (P = .396). Groups 1 and 2 had similar rates of intraoperative adverse events and postoperative complications (P = .562 and P = .466, respectively). Group 2 had a longer median duration of hospitalization than group 1 (P = .034), while the readmission rate was similar between groups (P = .079). There was no significant difference between groups regarding the influence of the long-term effects of bariatric treatment on weight loss (percentage of follow-up was 55%). ConclusionsPrevious abdominal surgery prolongs the operative time of RYGB and the duration of postoperative hospitalization, but does not affect the long-term outcomes of bariatric treatment.

Abdominal Exploration in Neonates Using Transumbilical Exposure Compared with Transverse Laparotomies.

The vertical transumbilical incision (TU) technique during neonatal abdominal exploration involves dissection and ligation of umbilical vessels, which allow access to all quadrants of the abdomen and complete bowel evisceration with minimal violation to the anterior abdominal wall. We compared patient characteristics and outcomes for neonates undergoing TU with standard transverse exploration. A single-center retrospective review of neonates who underwent abdominal exploration between January 2010 and September 2015 was conducted after obtaining Institutional Review Board approval. Data included patient demographics, indication for operative intervention, operative details, complications, including incisional hernias, and long-term outcomes. There were 88 neonates under 4 months of age who underwent abdominal exploration, with a median age of 5.5 ± 17 days and a median gestational age of 32.8 ± 16 weeks. Exploration was emergent in 38 patients (43%) and 49 (56%) required ostomy formation. A transverse incision (TV) was used in 30 patients and a TU in 58 patients. Both groups had similar postoperative complication rates; 27 (47%) in the TU group and 11 (36%) in the TV group, P = .51. Median length of follow-up in the TU group was 5.1 ± 18 months and 6.2 ± 16 months in the TV group, P = .48. The TU group had 4 incisional/umbilical hernias (7%), none have required repair. TUs for abdominal explorations in neonates have similar outcomes as the standard TV while preserving the integrity of the anterior abdominal wall.

Retrospective analysis of 1211 operated patients due to groin hernia with open surgical approach - single center experience

Bacground/Aim. Groin hernias are common pathology among men population. Only curative treatment is surgical reparation with various surgical procedures for groin hernia solving. The aim of this study was to evaluate the most prevalent surgical procedures and early postoperative complications after groin hernia reparation in large series of operated patients, and to assess the morphologic characteristics of groin hernias. Methods. The retrospective study included all patients with groin hernia who underwent surgical reparation from 2009 to 2012. In all patients a demographic characteristics, including gender and age, clinical characteristics and hernia type were analyzed. The surgical procedure for hernia solving and early postoperative complications were assessed. Results. The study included 1,211 patients. The male/female ratio was 1,127/84 (p < 0.001). Inguinal hernia was found in 1,195 patients (94.5% males). Femoral hernia was found in 16 patients (25% males and 75% females). Significant difference in distribution of inguinal and femoral hernia between genders was found (p < 0.001). In males right sided inguinal hernia was present in 57.6%. In females right sided inguinal hernia was present in 7 and left sided in 5 patients. Sixsten patients had bilateral inguinal hernia, all in males. There was no significant difference in side of inguinal hernia occurrence and gender. Right sided and left sided femoral hernias were present in the same percent in males. In females a higher occurrence in femoral hernia was found on the right side then on the left one (7:5) without significant difference. There were 71.1% of patients in the age group of 51?80 and 27.2% of patients in the age group of 61?70. Surgical procedures included: Lichtenstein in 51.2% of patients, nylondarn in 29.6% of patients, Bassini in 16.2% of patients, Lothaissen in 1.7% of patients, and Halsted in 1.4% of patients. Overall, postoperative complications were present in 78 (6.4%) of patients. Wound infection was the most common complication, occurred in 2.4% of patients. Conclusion. Prevalence of inguinal hernias is higher in men population, while femoral hernias are more common in females. The most affected population is at the age between 61 and 80 years. The most commonly used open surgical procedures for groin hernia reparation are Lichtenstein and nylon-darn. Both methods have low and similar incidence rates of postoperative complications.

Evaluation of Low Tidal Volume During General Anesthesia in Prone Position on Respiratory Functions

<i>Background:</i> Surgery is accompanied by postoperative pulmonary functions impairment especially in the prone position. There is evidence suggested that using low tidal volume during general anesthesia may decrease post-operative lung injury. This study aimed to evaluate the effect of low tidal volume on lung functions during mechanical ventilation for general anesthesia while patients lying in the prone position. A prospective clinical trial was performed on 88 patients ASA I&II scheduled for elective surgery while patients lying prone and were randomly assigned to either protective ventilation group A with tidal volume; 5-7 ml/kg, 10 cm H₂O positive end expiratory pressure (PEEP) with recruitment maneuver (RM) or conventional group B with Tidal Volume; 10-12 ml/kg, without both PEEP and RM. The primary efficacy variables were assessed by pulmonary function tests, performed before surgery, and 6, 12 and 24 hours postoperatively. Improvement of lung functions were found in the first post-operative 6 and 12 hours in the low tidal volume group and significant difference was found in all parameters P value 0.001 except PaO₂/FIO₂ ratio P value 0.4. After 24 hours there were significant difference in the FVC, predicted FEV1 and FVC and FEV1/FVC ratio being higher in the low tidal volume group with P value 0.001. Patients in both groups showed similar rates of postoperative chest complications without significant difference. Lung protective ventilation improved lung functions in the first post-operative 24 hours. There was no significant postoperative chest complications difference between the two groups.

Outcomes of Adolescent and Young Adults Receiving High Ligation and Mesh Repairs: A 16-Year Experience.

Interestingly, the pediatric and adult surgeons perform vastly different operations in similar patient populations. Little is known about long-term recurrence and quality of life (QOL) in adolescents and young adults undergoing inguinal hernia repair. We evaluated long-term patient-centered outcomes in this population to determine the optimal operative approach. The medical records of patients 12-25 years old at the time of a primary inguinal hernia repair at our institution from 2000 to 2016 were retrospectively reviewed. Patients then completed a phone survey of their postoperative courses and QOL. Outcomes of high ligation performed by pediatric surgeons were compared to those of mesh repairs by adult general surgeons. The primary outcome was recurrence. Secondary outcomes included time to recurrence, postoperative complications, and patient-centered outcomes. A Cox regression analysis was used to determine associations for recurrence. Of 213 patients identified, 143 (67.1%) were repaired by adult surgeons and 70 (32.9%) repaired by pediatric surgeons. Overall recurrence rate for the entire cohort was 5.7% with a median time to recurrence of 3.5 years (interquartile range 120-2155 days). High ligation and mesh repairs had similar rates of recurrence (6.3 versus 5.8, P = .57) and postoperative complications (17% versus 16%, P = .45). 101/213 (47%) patients completed the phone survey. Of those surveyed, 20% reported postoperative pain, 10% had residual numbness and tingling, and 10% of patients complained of intermittent bulging. Overall, a survey comparison showed no differences among subgroups. In adolescents and young adults, the long-term recurrence rate after inguinal hernia repair is ∼6% with time to recurrence approaching 4 years. Outcomes of high ligation and mesh repair are similar, highlighting the need for individualized approaches for this unique population.

Comparison of elliptical excision versus punch incision for the treatment of epidermal inclusion cysts: A prospective, randomized study

Comparison of elliptical excision versus punch incision for the treatment of epidermal inclusion cysts: A prospective, randomized study

Assessing the Different Oncologic Disease Distribution and Postoperative Complications of Octogenarian and Nonagenarian Head and Neck Oncology Patients

The admission rate of patients aged 80years or older (oldest-old) with head and neck (HN) oncologic disease is on the rise. Our goal was to study the demographic characteristics, reasons for admission, types of surgical procedures, and postoperative complications of the oldest-old patients with HN malignancy. We conducted a retrospective cohort study including all inpatients aged 80years or older who were admitted to the department of otolaryngology-head and neck surgery or department of oral and maxillofacial surgery because of HN oncologic disease between 2009 and 2013. The control group was composed of a matched number of randomly selected patients aged 60 to 79years. We compared the demographic characteristics, diagnoses, comorbidities, surgical interventions, and postoperative complications of the 2 age groups to characterize the oldest-old patients' admissions and determine whether age alone increases the risk of postoperative complications. The study included 109 oldest-old patients (median age, 83years) and 107 patients in the control group (median age, 68years). Although the oldest-old patients had significantly more underlying diseases (4.41 vs 2.86) and drugs prescribed (4.76 vs 3.21), similar rates of postoperative complications occurred in both groups. An important finding was that ischemic heart disease and chronic lung disease were the only significant risk factors for postoperative complications among the oldest-old patients (odds ratio on multivariate analysis of 5.5 and 4.5, respectively). Although comorbidities and prescribed drugs are more prevalent in the oldest-old patients, the rate of postoperative complications did not differ between the age groups, suggesting that age alone should not be a factor in the surgical treatment of HN malignancies.

Impact of body mass index on surgical outcomes, narcotics consumption, and hospital costs following anterior cervical discectomy and fusion.

OBJECTIVE Given the increasing prevalence of obesity, more patients with a high body mass index (BMI) will require surgical treatment for degenerative spinal disease. In previous investigations of lumbar spine pathology, obesity has been associated with worsened postoperative outcomes and increased costs. However, few studies have examined the association between BMI and postoperative outcomes following anterior cervical discectomy and fusion (ACDF) procedures. Thus, the purpose of this study was to compare surgical outcomes, postoperative narcotics consumption, complications, and hospital costs among BMI stratifications for patients who have undergone primary 1- to 2-level ACDF procedures. METHODS The authors retrospectively reviewed a prospectively maintained surgical database of patients who had undergone primary 1- to 2-level ACDF for degenerative spinal pathology between 2008 and 2015. Patients were stratified by BMI as follows: normal weight (< 25.0 kg/m2), overweight (25.0-29.9 kg/m2), obese I (30.0-34.9 kg/m2), or obese II-III (≥ 35.0 kg/m2). Differences in patient demographics and preoperative characteristics were compared across the BMI cohorts using 1-way ANOVA or chi-square analysis. Multivariate linear or Poisson regression with robust error variance was used to determine the presence of an association between BMI category and narcotics utilization, improvement in visual analog scale (VAS) scores, incidence of complications, arthrodesis rates, reoperation rates, and hospital costs. Regression analyses were controlled for preoperative demographic and procedural characteristics. RESULTS Two hundred seventy-seven patients were included in the analysis, of whom 20.9% (n = 58) were normal weight, 37.5% (n = 104) were overweight, 24.9% (n = 69) were obese I, and 16.6% (n = 46) were obese II-III. A higher BMI was associated with an older age (p = 0.049) and increased comorbidity burden (p = 0.001). No differences in sex, smoking status, insurance type, diagnosis, presence of neuropathy, or preoperative VAS pain scores were found among the BMI cohorts (p > 0.05). No significant differences were found among these cohorts as regards operative time, intraoperative blood loss, length of hospital stay, and number of operative levels (p > 0.05). Additionally, no significant differences in postoperative narcotics consumption, VAS score improvement, complication rates, arthrodesis rates, reoperation rates, or total direct costs existed across BMI stratifications (p > 0.05). CONCLUSIONS Patients with a higher BMI demonstrated surgical outcomes, narcotics consumption, and hospital costs comparable to those of patients with a lower BMI. Thus, ACDF procedures are both safe and effective for all patients across the entire BMI spectrum. Patients should be counseled to expect similar rates of postoperative complications and eventual clinical improvement regardless of their BMI.

Reduced Impact of Smoking Status on 30-Day Complication and Readmission Rates After Elective Spinal Fusion (≥3 Levels) for Adult Spine Deformity: A Single Institutional Study of 839 Patients.

Smoking status has been shown to affect postoperative outcomes after surgery. The aim of this study was to determine whether patients' smoking status impacts 30-day complication and readmission rates after elective complex spinal fusion (≥3 levels). The medical records of 839 adult spinal deformity patients undergoing elective complex spinal fusion (≥3 levels) at a major academic institution from 2005 to 2015 were reviewed. We identified 124 (14.8%) smokers and 715 (85.2%) nonsmokers. Patient demographics, comorbidities, intraoperative and postoperative complications, and 30-day readmission rates were collected for each patient. The primary outcome investigated in this study was the rate of 30-day postoperative complication and readmission rates. Patient demographics and comorbidities were similar between both groups, including age, sex, and body mass index. Median [interquartile] number of fusion levels and operative time were similar between the cohorts (smoker: 5 [4-7] vs. nonsmoker: 5 [4-8], P= 0.58) and (smoker: 309.6 ± 157.9 minutes vs. nonsmoker: 287.5 ± 131.7 minutes, P= 0.16), respectively. Both cohorts had similar postoperative complication rates and lengths of hospital stay. There was no significant difference in 30-day readmission between the cohorts (smoker: 12.9% vs. nonsmoker: 10.8%, P= 0.48). There were no observed differences in 30-day complication rates, including pain (P= 0.46), UTI (P= 0.54), hardware failure (P= 0.36), wound dehiscence (P= 0.29), and wound drainage (P=0.86). Smokers had greater rates of 30-day cellulitis (smoker: 1.6% vs. nonsmoker: 0.3%, P= 0.05) and DVT (smoker: 0.8% vs. nonsmoker: 0.0%, P= 0.02). Our study suggests that smoking does not significantly affect 30-day readmission rates after complex spinal surgery requiring ≥3 levels of fusion. Further studies are necessary to corroborate our findings.

Safety and Feasibility of Umbilical Diverting Loop Ileostomy for Patients with Rectal Tumor.

Fashioning an ileostomy in the umbilicus and combining the trauma from extraction of colorectum with that from ileostomy should be less invasive and lead to improved cosmetic outcomes. However, there are only a few reports regarding umbilical ileostomy. We retrospectively collected data for 121 consecutive patients with rectal tumor who underwent elective laparoscopic rectal resection with diverting loop ileostomy between 2010 and 2015 at Osaka University Hospital, Japan. The safety and feasibility of umbilical diverting loop ileostomy and its influence on stoma care were investigated. A total of 83 patients were included in this study; of these, 30 underwent umbilical diverting loop ileostomy and 53 underwent conventional diverting loop ileostomy, which was created in the right lower quadrant of the abdomen. The umbilical and conventional groups showed similar rates of postoperative and stoma-related complications (26.7 vs. 32.1%, p=0.804 and 3.3 vs. 3.8%, p=1.000, respectively). Level of parastomal dermatitis was evaluated by DET score at three time points (stoma self-management establishment, first outpatient review post-discharge, and just before stoma closure). DET scores at any time points did not differ significantly between the two groups. Umbilical diverting loop ileostomy is comparable to conventional ileostomy with regard to safety and feasibility. Our methods for umbilical ileostomy using the umbilical skin flap were less invasive and did not have a negative impact on stoma care and parastomal dermatitis. Umbilical ileostomy may be a promising alternative to conventional ileostomy in selected cases.

A systematic review of suture-button versus syndesmotic screw in the treatment of distal tibiofibular syndesmosis injury

BackgroundNow, using a suture-button device to treat distal tibiofibular syndesmotic injuries is overwhelming due to its advantages over screw fixation. Current systematic review was conducted to make a comparison between suture-button fixation and traditionally screw fixation in the treatment of syndesmotic injuries. The outcomes included functional outcomes, implant removal, implant failure, malreduction, post-operative complications (except implant failure and malreduction), and cost-effectiveness aspects.MethodA literature search in the electronic databases of Medline, Embase, the Cochrane Library, Web of Science was conducted to identify studies until March 2017. The references of the included articles were also checked for potentially relevant studies. Only English articles were included. We followed the Preferred Reporting Items for Systematics reviews and Meta-Analysis (PRISMA) guidelines in this review.ResultsFinally, 10 studies were identified, encompassing a total of 390 patients. The mean American Orthopaedic Foot and Ankle Society ankle score (AOFAS) score of 150 patients treated with the suture-button device was 91.06 points, with an average follow-up of 17.58 months, and the mean AOFAS score of 150 patients treated with syndesmotic screws was 87.78 points, with an average follow-up of 17.73 months. Implant removal was reported in 5 of 134 (3.7%) patients treated with the suture-button device, and in 54 of 134 (40.2%) patients treated with the syndesmotic screw. No patient in the suture-button fixation group had implant failure, however the rate of implant failure in the screw fixation group was 30.9%. Malreduction was reported in 1 of 93 (1.0%) patients treated with the suture-button device, and in 12 of 95 (12.6%) patients treated with the syndesmotic screw. The rate of post-operative complications in the suture-button fixation group was 12.0% and 16.4% in the screw fixation group. There was only one publication demonstrated about cost-effectiveness aspects, it showed that patients treated with the suture-button device spent on average $1482 less and had a higher quality of life by 0.058 quality-adjusted life-year compared with patients who received fixation with 2 syndesmotic screws in supination-external rotation type 4 injuries.ConclusionBased on our research, though the suture-button fixation group had similar functional outcome (measured on the AOFAS score) and post-operative complication rate compared with the syndesmotic screw fixation group, the suture-button device could lead to better objective range of motion (ROM) measurements and earlier return to work. Besides, the suture-button fixation group had lower rate of implant removal, implant failure, and malreduction. However, high-quality randomized controlled trials with more uniformity in outcome reporting are desirable to determine the long-term effects and cost-effectiveness of the suture-button device.

Long-term Outcomes of Single-Site Laparoscopic Colectomy With Complete Mesocolic Excision for Colon Cancer: Comparison With Conventional Multiport Laparoscopic Colectomy Using Propensity Score Matching.

Complete mesocolic excision has been suggested to improve oncological outcomes for patients with colon cancer. However, the long-term outcomes of single-site laparoscopic colectomy with complete mesocolic excision remain unclear. We evaluated the long-term outcomes of single-site laparoscopic colectomy with complete mesocolic excision compared with conventional multiport laparoscopic colectomy for colon cancer, as well as the short-term outcomes. This is a single-center, retrospective study. The study was conducted at Osaka University Hospital in Japan. A total of 971 consecutive patients who underwent laparoscopic surgery for colon cancer between 2008 and 2014 were included. Of these patients, 517 were analyzed using propensity score matching (231 with single-site laparoscopic colectomy and 286 with conventional multiport laparoscopic colectomy). Recurrence, survival, intraoperative morbidity, and postoperative complications were analyzed. Before propensity score matching, the single-site laparoscopic colectomy group had greater proportions of women and of patients with right-sided and early stage tumors compared with the conventional multiport laparoscopic colectomy group. After matching, the 2 groups each included 200 patients and did not significantly differ in any patient characteristics. The median follow-up period was 41.4 months. The 2 groups showed similar rates of intraoperative morbidity (p = 0.22) and postoperative complications (p = 0.87). Rates of 3-year disease-free and overall survival in single-site laparoscopic colectomy and conventional, multiport, laparoscopic colectomy groups were 95.5% and 91.3% (p = 0.44) and 100.0% and 98.7% (p = 0.24). The 3-year disease-free and overall survival rates in each stage did not significantly differ between the 2 groups. This study was limited by its retrospective nature. Single-site laparoscopic colectomy with complete mesocolic excision for colon cancer provided acceptable perioperative outcomes and oncological outcomes, similar to those achieved with conventional multiport laparoscopic colectomy. Evidence accumulation from randomized controlled trials will be necessary to promote the wide acceptance of single-site laparoscopic colectomy. See Video Abstract at http://links.lww.com/DCR/A326.

A comparison of left ventricular function in patients undergoing beating heart bypass surgery using mixed versus pure venous conduits

Background: The pathophysiology of coronary artery disease was established in 1876 by Adam Hammer when he postulated that angina is caused by interruption of coronary blood supply and that myocardial infarction occurred after the occlusion of at least one coronary artery. Aims of the study were to compare the left ventricular function in patients who have undergone beating heart bypass surgery using mixed (internal mammary artery and venous conduits) versus pure Venous conduits, and to compare the incidence of postoperative complications.Methods: It was an observational, analytical study. All patients admitted with triple vessel disease requiring CABG (n=50), with ejection fraction &gt;30%, were subjected to either left internal mammary artery and venous conduits (group A, n=25) or only venous conduits (group B, n=25). Patient who had undergone prior surgical myocardial revascularization, preexisting valvular disease, any evidence of raised pulmonary arterial pressure more than 40/15 mmHg, operated using cardiopulmonary bypass machine, pre-operative use of Intra-Aortic Balloon Pump, any history of neurological dysfunction/Transient ischemic attack, left atrium size more than 5.5 cm were excluded from the studyResults: Improvement in left ventricular function after coronary artery bypass grafting was objectively demonstrated in both the groups. There was a statistically significant increase in mean LVEF in group B (56.16±4.13) compared to group A (51.96±5.30) at 3 months of follow up (p=0.009). The most common complication in both the groups were atrial fibrillation group A=36% (n=9), group= B 16 % (n=4), renal failure group A=12% and group B=8% and sternal wound infection. The post-operative bleeding (Drain output) in first 24 hours was similar in both the groups, 295.56 ml in group A and 265.20ml in group B (p=) with similar hospital stay (group A=9days, group B=8.5days).Conclusions: Patients with venous conduits have better postoperative LVEF as compared to Mixed conduit with similar rate of post-operative complications.

Introduction of robot-assisted radical hysterectomy for early stage cervical cancer: impact on complications, costs and oncologic outcome.

The objective was to assess the impact of robot-assisted radical hysterectomy (RRH) on surgical and oncologic outcome and costs compared with open radical hysterectomy (ORH) at a tertiary referral center in Sweden. In this retrospective analysis all patients treated with radical hysterectomy and pelvic lymphadenectomy for early stage uterine cervical cancer during 2006-2015 were included (n = 304). The patients were divided into two groups, ORH (n = 155) and RRH (n = 149). Patient characteristics, FIGO stage, histology, adjuvant therapy, operation time, length of stay (LOS), lymph node yield, recurrence rate and survival were retrieved from medical records. Complications were graded according to the Clavien-Dindo classification. In addition, costs related to the surgical treatments were calculated. Blood loss, LOS and intraoperative complications were significantly lower as well as lymph node yield after RRH. No differences in postoperative complications or costs were observed between the two groups. Recurrence of disease was detected in 13.4 and 10.3% after RRH and ORH, respectively. Regression analysis demonstrated that histology, tumor size, positive lymph nodes and type of operation (RRH) were significantly associated with recurrence. The introduction of RRH was accompanied by similar postoperative complication rates and costs but lower LOS compared with ORH. An initial learning curve may account for the higher recurrence rate observed after RRH. These data reinforce the need for structured training and monitoring of outcomes when novel treatment modalities are introduced.

Perioperative opioid administration in children with and without developmental delay undergoing outpatient dental surgery

Study objectivePrior research has indicated that children with developmental delay (DD) experience qualitative and quantitative differences in health care (Boulet et al., 2009). In the perioperative setting, there is concern that children with DD may be more likely to experience postoperative complications including agitation and nausea/vomiting than typically developing patients (TDP). Differences in the administration and dosage of perioperative opioids may contribute to this, however, empirical investigations are lacking. The purpose of this research was to compare the experience of postoperative nausea/vomiting and agitation, as well as to examine perioperative opioid administration, among children with DD as compared to TDP. DesignRetrospective original research. SettingOperating room, postanesthesia care unit. Patients1145 patients (1–20.9years, ASA I-III, 23.9% with a history of DD) who had undergone outpatient dental surgery involving extraction/restorations under general anesthesia. MeasurementsData was obtained and analyzed from the medical records of both DD and TDP across a five-year period. Data included the experience of agitation, nausea/vomiting, as well as perioperative medication administration. Main resultsPostoperative agitation and nausea/vomiting did not differ significantly between the DD and TDP groups. Children with DD were significantly less likely to receive opioids during both the intra and postoperative period (χ2=10.02, p=0.001 and χ2=8.08, p=0.003, respectively). Further, higher dosage of intraoperative opioids was predictive of reduced administration of postoperative opioids among TDP; however, no significant association was observed between the dosage of intraoperative opioids and administration of postoperative opioids in the DD group. ConclusionsChildren with DD experience similar rates of postoperative complications including nausea/vomiting and agitation as TDP. DD children were less likely to receive both intra and postoperative opioids than TDP. Importantly, while the dosage of intraoperative opioids was predictive of administration of postoperative opioids in the TDP group, this was not the case for the DD group. Clinical implications are discussed.

Propensity-matched comparison of video-assisted thoracoscopic with thoracotomy lobectomy for locally advanced non–small cell lung cancer

ObjectiveWe evaluated whether video-assisted thoracoscopic lobectomy for locally advanced non–small cell lung cancer could be performed safely and with acceptable long-term outcomes by our improved technique and compared with standard thoracotomy lobectomy in a well-balanced population. MethodsPatients with clinical stage II and III A non–small cell lung cancers who received lobectomy were reviewed. Video-assisted thoracoscopic lobectomies were all performed with Wang's technique by the surgeons who had overcome the learning curve and achieved proficiency. By using propensity-matched analysis, perioperative outcomes and long-term survival were compared. ResultsMatching based on propensity scores produced 120 patients in each group. Conversion rate to thoracotomy was 11.7%. After thoracoscopic lobectomy, hospital length of stay was shorter compared with thoracotomy (9.2 vs 12 days; P = .014) despite similar rates of postoperative complications (30/125 [25%] vs 34/125 [28.3%]; P = .56). Disease-free survival (49.1% vs 42.2%; P = .40) and overall survival (55.0% vs 57.1%; P = .73) at 5 years were similar between groups. Although advanced pathologic stage (hazard ratio [HR], 2.018; 95% confidence interval [CI], 1.330-3.062) and no postoperative chemotherapy (HR, 1.880; 95% CI, 1.236-2.858) were independently associated with increased hazard of death in multivariable Cox regression at each time point in follow-up, thoracoscopic lobectomy was not (HR, 1.075; 95% CI, 0.714-1.620; P = .73). ConclusionsWith continued experience and optimized technique, video-assisted thoracoscopic lobectomy can be performed in the majority of cases without compromising perioperative outcomes and oncologic efficacy.

Acute Appendicitis During Pregnancy: Different from the Nonpregnant State?

Acute appendicitis is the most common nonobstetric indication for surgical intervention during pregnancy. However, the current literature is scarce and composed of relatively small case series. We aimed to compare the presentation, management, and surgical outcomes of presumed acute appendicitis between a contemporary cohort of pregnant women and nonpregnant women of reproductive age. The study group included 92 pregnant patients who underwent appendectomy for presumed acute appendicitis at a single tertiary medical center in 2000-2014. Preoperative, operative, and postoperative clinical data were derived from medical records and compared to data for 494 nonpregnant patients of reproductive age who underwent appendectomy in 2004-2007 at the same institution. Median age was 28years (range 25-33) in the study group and 26years (range 20-34) in the control group (P=0.1). There were no between-group differences in mean white blood cell count, patient interval, hospital interval, or operative time. Preoperative abdominal ultrasound was used in a significantly higher proportion of patients in the pregnant group than in the nonpregnant group (73 and 27%, respectively, P<0.001) and computed tomography, in a significantly lower proportion of patients (1 vs. 16%, respectively, P<0.001) . The two groups had similar rates of negative appendectomy (23 and 22%, P=0.9), complicated appendicitis (12 and 11%, P=0.9), and overall postoperative complications (15 and 12%, P=0.3). The clinical presentation and outcome of presumed acute appendicitis are similar in pregnant women and nonpregnant women of reproductive age. Therefore, similar perioperative management algorithms may be applied in both patient populations.

Donor BMI >30 Is Not a Contraindication for Live Liver Donation.

The increased prevalence of obesity worldwide threatens the pool of living liver donors. Although the negative effects of graft steatosis on liver donation and transplantation are well known, the impact of obesity in the absence of hepatic steatosis on outcome of living donor liver transplantation (LDLT) is unknown. Consequently, we compared the outcome of LDLT using donors with BMI <30 versus donors with BMI ≥30. Between April 2000 and May 2014, 105 patients received a right-lobe liver graft from donors with BMI ≥30, whereas 364 recipients were transplanted with grafts from donors with BMI <30. Liver steatosis >10% was excluded in all donors with BMI >30 by imaging and liver biopsies. None of the donors had any other comorbidity. Donors with BMI <30 versus ≥30had similar postoperative complication rates (Dindo-Clavien ≥3b: 2% vs. 3%; p=0.71) and lengths of hospital stay (6 vs. 6 days; p=0.13). Recipient graft function, assessed by posttransplant peak serum bilirubin and international normalized ratio was identical. Furthermore, no difference was observed in recipient complication rates (Dindo-Clavien ≥3b: 25% vs. 20%; p=0.3) or lengths of hospital stay between groups. We concluded that donors with BMI ≥30, in the absence of graft steatosis, are not contraindicated for LDLT.