Single Surgery Center Research Articles

Incidence of Diabetes Mellitus and Its Impact on Outcomes in Patients Undergoing Surgical Pancreatectomy for Non-Malignant and Malignant Pancreatobiliary Diseases-A Retrospective Analysis.

Diabetes mellitus (DM) is a prominent risk factor for malignant and non-malignant pancreatic diseases. Furthermore, the presence of DM predicts an unfavourable outcome in people with pancreatic cancer. This retrospective observational study investigated 370 patients who underwent pancreatic resection surgery for various indications (84.3% in malignant indication) in a single surgery centre in Graz, Austria. The preoperative and postoperative diabetes statuses were evaluated according to surgery method and disease entity and predictors for diabetes development after surgery, as well as outcomes (survival and cancer recurrence) according to diabetes status, were analysed. In the entire cohort, the postoperative diabetes (postopDM) incidence was 29%. PostopDM occurred significantly more frequently in malignoma patients than in those with benign diseases (31.3% vs. 16.7%; p = 0.040, OR = 2.28). In the malignoma population, BMI, longer surgery duration, and prolonged ICU and hospital stay were significant predictors of diabetes development. The 1- and 2-year follow-ups showed a significantly increased mortality of people with postopDM in comparison to people without diabetes (HR 1-year = 2.02, p = 0.014 and HR 2-years = 1.56, p = 0.034). Local cancer recurrence was not influenced by the diabetes status. Postoperative new-onset diabetes seems to be associated with higher mortality of patients with pancreatic malignoma undergoing pancreatobiliary surgery.

Influence of Preoperative Parameters on the Ratio of Keratometric Change per Diopter of Attempted Spherical Equivalent (∆K/∆SEQ) for Myopic Correction Within LASIK, PRK, and SMILE.

To compare 3 of the most common corneal refractive procedures; PRK, LASIK, and SMILE assessing ΔK/ΔSEQ ratio and its correlation with preoperative demographics including age, keratometry, pachymetry, cylinder value, and attempted myopic correction. The goal was to analyze the relative strength of each preoperative parameter in accounting for changes in ∆K/∆SEQ. A total of 370 eyes from 102 male and 97 female patients (173 eyes PRK, 153 LASIK, and 44 SMILE) with ages ranging from 20 to 51 underwent refractive surgery for myopia between -0.25 and -7.71 D manifest refraction spherical equivalent (MRSE). All surgeries were performed at a single surgery center in Draper, Utah. The Pentacam was used for all optical measurements and data were gathered pre-operatively and then again 1-year post-operatively. Only patients who achieved emmetropia at a visual acuity of 20/25 or better were included. The mean ΔK/ΔSEQ ratio for LASIK (0.839 ± 0.020) was significantly greater than that of PRK (0.775 ± 0.022) and SMILE (0.709 ± 0.046). Age was found to negatively correlate with ΔK/ΔSEQ for both LASIK (r = -0.177) and SMILE (r = -0.451) procedures. Pre-op keratometry was found to negatively correlate with ΔK/ΔSEQ for LASIK (r = -0.202) but not for PRK or SMILE. Pre-op pachymetry was not correlated with ΔK/ΔSEQ for any of the procedures. Attempted myopic spherical equivalent (SEQ) correction was positively correlated with ΔK/ΔSEQ for LASIK (r = 0.236), PRK (r = 0.459), and SMILE (r = 0.304). Lastly, pre-op cylinder value was found to be correlated to ΔK/ΔSEQ in SMILE (r = -0.367), but not in LASIK or PRK. The ΔK/ΔSEQ ratio not only differs depending on the procedure being done but also by pre-operative factors such as age, keratometry, attempted correction, and cylinder value. Multiple linear regression analysis revealed that the attempted correction had the greatest effect on ∆K/∆SEQ out of all parameters in LASIK and PRK. For SMILE, age had the greatest predictive value of the change in ∆K/∆SEQ. While the exact effect of these parameters will vary by surgeon, all of these should be factored into a refractive surgeon's nomograms in order to achieve optimal visual outcomes for their patients.

Supine Elbow Arthroscopy: A decade of results with a vertical humerus and a free forearm

Background Elbow arthroscopy has been in existence for decades, but to date little innovation in elbow positioning for arthroscopy has occurred. After experiencing disadvantages with lateral decubitus, prone, and supine suspended positioning techniques, the author has changed to a supine positioning technique that stabilizes the humerus vertically while leaving the forearm free for all elbow arthroscopy procedures. Methods A retrospective review was conducted for arthroscopic elbow surgeries performed by a single surgeon in a single surgery center in the supine elbow arthroscopy (SEA) position from 2011 to 2021. Efficiency, safety, and versatility of elbow arthroscopy performed in the SEA position were analyzed. Results In 298 relevant arthroscopic surgical procedures performed on 289 patients, the average total procedural time was 52.2 minutes, with an average arthroscopic (surgical) time of 31.2 minutes. No complications were found in the review of medical records. Conclusions SEA promotes safe, technically easier, and more efficient elbow arthroscopy with improved surgical access, intraoperative flexibility, and accelerated procedural times compared with other current techniques.

Laparoscopic Hysterectomy for Uteri >250g: Analysis of Outcomes in a Single Surgery Center

<h3>Study Objective</h3> There is conflicting data regarding the safety of hysterectomy performed on large uteri. This study aims to examine the outcomes of laparoscopic and robotic hysterectomies for large uteri in a referral tertiary academic center. <h3>Design</h3> This is a retrospective chart review study examining surgical characteristics and complications of laparoscopic/robotic hysterectomies performed for large uteri over a year-long period. <h3>Setting</h3> The setting for the study is tertiary academic institution. <h3>Patients or Participants</h3> A total of 67 laparoscopic/robotic hysterectomy cases with final pathological evaluation yielding a specimen weight of >250g were examined. <h3>Interventions</h3> The interventions for the study included laparoscopic/robotic hysterectomy. <h3>Measurements and Main Results</h3> All procedures were completed in a minimally invasive fashion. Patient characteristics included a median BMI of 31.8 (range 21-64). Average pre-operative uterine size was 16.5 weeks. The final specimen weight ranged from 255g to 2825g. The mean procedure time was 195 minutes (SD 69 minutes). Intraoperative complications included three serosal injuries and six vaginal/peroneal lacerations. In 76% of the cases, the uterine artery was ligated at the origin to minimize the blood loss. The estimated blood loss for surgery ranged from 25 to 600cc, with a median blood loss of 150cc. All the specimens were removed vaginally. Morcellation was completed in a contained fashion within a bag. The median post-operative stay in the hospital was 0 days (range 0-2 days). Post operatively, three patients had vaginal cuff dehiscence's with only one patient requiring readmission and reoperation. There were two admissions for post-operative small bowel obstruction vs ileus which were managed conservatively, and one readmission for post-operative pain. Final pathological evaluation of specimens showed leiomyomata in 91% of cases, adenomyosis in 51%, endometriosis in 18%, and malignancy in 1%. <h3>Conclusion</h3> The findings from this study add to existing data confirming that laparoscopic/robotic hysterectomy for large uteri is a feasible surgical approach without compromising patient safety or increasing surgical risks.

Distal biceps tendon repair: cost analysis of single- versus double-incision techniques in an ambulatory surgery center

The purpose of this study was to compare the cost differences for single- versus double-incision distal biceps repair at an ambulatory surgery center (ASC) given that similar clinical outcomes have been reported between these methods. A retrospective review of financial and medical records was completed for patients who underwent distal biceps tendon repair over a three-year period at a single private orthopedic practice. Variables analyzed include the cost to the ASC of operative time and the cost of differential surgical supplies, specifically implants and disposable supplies. A total of 10 surgeons performed 104 repairs. Nine surgeons performed repairs through a single incision with use of cortical button or suture anchor fixation, and one surgeon performed transosseous suture fixation through a double-incision approach. The median tourniquet time and procedure length were 31 (interquartile range [IQR] 27-40) and 44 (IQR 39-54) minutes for single-incision repairs and 68 minutes (IQR 61-75) and 110 minutes (IQR 103-113) for double-incision repairs which were significantly different across groups (P < .001, P < .001). The total surgical cost (operative time, implants, and disposables) for single-incision repairs was a median of $758 (IQR 732-803) compared with $606 (IQR 567-629) for double-incision repairs (P < .001). However, the procedure cost with implants (not including disposables) was not significantly different for single- (median [Mdn]= $500 [IQR 475-552]) and double-incision repairs (Mdn $552 [IQR 514-564]) (P= .14) although the procedure cost with disposables (not including implant costs) favored single-incision repairs (Mdn= $478 [IQR 452-523]) over double-incision repairs (Mdn= $606 [IQR 567-629]) (P < .001). In a single surgery center, single-incision distal biceps repairs utilizing an implant were performed more expeditiously than double-incision repairs with a transosseous technique but incurred greater surgical costs. Differences in surgical time cost between the two approaches could be consequential for ASCs and other stakeholders.

Wound Dehiscence Following Upper Blepharoplasty: A Review of 2,376 Cases.

There have been limited studies evaluating specifically the incidence of wound dehiscence following isolated upper blepharoplasty. This is a large-scale upper blepharoplasty review to evaluate the rate of wound dehiscence, to assess risk factors, and to analyze management outcomes. A retrospective review was performed of all patients who underwent upper blepharoplasty at a single surgery center. All incisions were closed using either 6-0 fast-absorbing plain gut or polypropylene suture in a running fashion, with an additional interrupted suture near the lateral wound edge. Incidence of wound dehiscence was determined and further assessed by patient age (≤67 or >67 years), gender, preexisting medical conditions, smoking history, and suture type. A total of 1,190 patients (2,376 eyelids) met inclusion criteria. In total, there were 34 instances (1.4%) of wound dehiscence in 32 patients at an average 9 days (range, 0-30 days) following surgery. Evaluation of wound dehiscence rates by demographic factors revealed male gender to be a significant predictor of wound dehiscence (p = 0.0062). Age, hypertension, heart disease, and diabetes were not predictors of wound dehiscence. Lifetime smoking history increased risk for wound dehiscence (p < 0.0001). Use of fast-absorbing plain gut suture was also significantly associated with dehiscence, when compared with polypropylene (p = 0.0025). Multivariate analysis revealed male gender and fast-absorbing plain gut suture to be independent risk factors for wound dehiscence. Seventeen eyelids with wound separation were observed for second-intention healing, 1 underwent delayed scar revision. Fourteen eyelids were repaired primarily using suture and 3 with cyanoacrylate surgical skin adhesive. All patients reported satisfaction with their final outcome, and objective final healing was deemed satisfactory. Wound dehiscence following isolated upper blepharoplasty is rare and associated with male gender and fast-absorbing plain gut suture. Patients with wound separation may be successfully managed with individualized care.

Success of combined cataract extraction plus excimer laser trabeculotomy exceeds that of combined ab interno trabeculectomy with the trabectome or cataract extraction alone.

To determine the efficacy of cataract surgery alone and combined with two minimally invasive glaucoma surgery (MIGS) procedures (phaco-ELT and phaco-aiT). Data was collected from 12/2007 to 02/2012 in this retrospective, non-randomized, comparative single surgery center study. Reduction in IOP and hypotensive medication (AGD), change in visual acuity, success rates, and complications were computed by comparing preoperative data with data at 1year postoperatively. A total of 245 eyes of 245 subjects were included. Study eyes underwent phaco alone (38 eye) or combined phaco-ELT (105 eye) and phaco-aiT (102 eye). Phaco alone, combined phaco-ELT, and combined phaco-aiT lowered IOP by 1.5 ± 4.0mmHg, 4.3 ± 5.6, and 5.3 ± 4.5mmHg, respectively (P < 0.01). Survival time of phaco-ELT outreached survival time of phaco alone and combined phaco-aiT (20.6 ± 1.0 vs. 13.2 ± 0.4 and 12.9 ± 0.6month, respectively). No serious complications or adverse events occurred. None of the cases required a subsequent procedure within the first year to lower IOP further. All three surgical procedures lowered IOP and reduced medication. However, the IOP-lowering efficacy of the two combined MIGS procedures exceeded the effect of phaco alone. A combined phaco and MIGS procedures seem reasonable to consider whenever a cataract surgery in an eye with glaucoma or ocular hypertension is considered. In addition, the combined MIGS procedure effectively lowers IOP whenever a target IOP in the mid-teens is sufficient. In this study, the nonthermal phaco-ELT procedure showed superior efficacy at 1year over phaco alone and phaco-aiT in the Kaplan-Meier statistics.

The learning curve of laparoscopic pancreaticoduodenectomy based on the initial 112 patients

Objective To study the learning curve of laparoscopic pacreaticoduodenectomy (LPD) with a view to find an appropriate way to develop LPD step by step. Methods 112 consecutive patients who completely underwent LPD in a single surgery center at the First People’s Hospital of Changzhou from December 2015 to February 2018 were retrospectively reviewed. By using both the cumulative sum (CUSUM) and the risk-adjusted CUSUM (RA-CUSUM) methods to analyze the perioperative data of these patients, the learning curve of LPD was studied in a more scientific way. Results The learning curve could be divided into three phases: Phase 1, the initial period (the initial 45 patients); Phase 2, the enhancement period (the subsequent 31 patients); Phase 3, the maturation period (the remaining patients). For these 3 phases, the corresponding operative times were (448.4±75.0), (381.3±74.3), and (336.2±52.1) min, respectively (P<0.05). The intraoperative blood losses were (373.3±250.1), (332.3±211.6), and (265.3±253.2) ml, respectively (P<0.05). The times to oral intake were 6.0(5.0, 8.0), 5.0(3.0, 6.0), and 3.0(3.0, 5.0) days, respectively (P<0.05). The number of lymph nodes harvested were (10.0±7.0), (8.8±4.3), and (13.3±6.2), respectively (P<0.05). All these showed significant improvement through the 3 phases. On the other hand, the postoperative stays, the postoperative pancreatic fistula rates were also decreased. But these failed to reach statistical significance. Vascular reconstruction was carried out in the 48th patient in phase 2 of the study. Conclusions The initial phase of LPD passed after LPD for 46 patients, but the maturation phase occurred after LPD on 76 patients. Vascular reconstruction should be considered as passing through the learning phase rather than reaching the maturity phase. Adjustments made in the enhancement phase helped to get through the maturation phase earlier. Key words: Laparoscopy; Pancreaticoduodenectomy; Pancreatic neoplasms; Bile duct neoplasms; Learning curve; Treatment outcome

Clavicle and coracoid process periprosthetic fractures as late post-operative complications in arthroscopically assisted acromioclavicular joint stabilization.

Arthroscopic-assisted stabilization surgery for acute acromioclavicular joint (ACJ) disruption shows excellent and reliable clinical outcomes. However, characteristic complications such as fracture of the clavicle and coracoid have been reported to occur during the early post-operative period. The main goal of this study was to highlight the occurrence of fractures as a late post-operative complication. The secondary goals were to describe possible fracture morphologies and treatment outcomes. Patient records from a single surgery centre were searched for all patients presenting with late fracture complication following arthroscopically assisted acromioclavicular stabilization. Medical reports including the operative notes and pre- and post-operative X-rays were reviewed. A telephone interview was conducted with each patient to access the American Shoulder and Elbow Surgeons shoulder score. A total of four patients presented with late fracture complication following arthroscopic-assisted ACJ stabilization surgery. All patients were males and presented following trauma at a median duration of 19.5months after the index surgery. Fracture morphology differed between patients; the treatment was conservative in three patients, while one patient underwent osteosynthesis. Traumatic peri-implant fractures can occur, even 2years after arthroscopically assisted ACJ reconstruction. This needs to be considered when planning for surgical intervention in acute ACJ disruption, especially in a high-risk population. Therapeutic study, Level IV.

Decrease in Hematoma Rate after Adopting Bloodless Atraumatic Technique (Bat): A Single Surgery Center Experience of 305 Facelifts over 6 Years

Decrease in Hematoma Rate after Adopting Bloodless Atraumatic Technique (Bat): A Single Surgery Center Experience of 305 Facelifts over 6 Years

Commentary on: Decrease in Seroma Rate After Adopting Progressive Tension Sutures Without Drains: A Single Surgery Center Experience of 451 Abdominoplasties Over 7 Years.

Congratulations to the authors1 on contributing further evidence supporting the use of progressive tension sutures (PTS) in abdominoplasty. Since we initially introduced the concept of advancement and fixation of the abdominal flap to the abdominal wall in abdominoplasty into the literature in 20002 we have been surprised at how slow it has been for, what we believed to be a very empirically logical idea, to disseminate into common use. However, it became clear that simply being “empirically logical” was not adequate and that more clinical data were needed. Over the subsequent years, many contributions to the body of data on progressive tension suture in abdominoplasty have accumulated in the literature. First, we should point out that Baroudi3 independently preceded our paper publishing a hundred cases of “Quilting sutures” in abdominoplasty which is essentially the same concept and gives the same results. Additionally, Mladick,4 in a brief communication, pointed out that his mentor, Nicholas Georgiade, taught a similar technique at Duke and it was included in a chapter of his textbook. This goes to show that good ideas are rarely of one source. Since then, many articles have addressed the progressive tension suture/quilting suture concept from a variety of perspectives. Nahas et al5 used ultrasound to assess volumes of fluid that accumulated when PTS are used. He looked at 21 consecutive abdominoplasties between postoperative day 15 and 18 finding an average fluid volume of 8.2 cc. Only two patients had more than 20 cc (25 and 47 …

Decrease in Seroma Rate After Adopting Progressive Tension Sutures Without Drains: A Single Surgery Center Experience of 451 Abdominoplasties Over 7 Years.

Abdominoplasty is a common aesthetic procedure in the United States. Pollock and Pollock described their progressive tension technique in 2000 and published a series of 597 patients in 2012 of their experience. The reported seroma rate in the literature ranges from 2% to 26% with drains and 0.1% to 4% with progressive tension sutures (PTS) without drains. Given these data, we decided to use PTS and forego drains in abdominoplasty. Here we present our experience with the transition. This is a retrospective chart review of 451 abdominoplasties performed at our outpatient surgery center over a 7-year period (2009-2015). We gathered data on patient demographics, concomitant liposuction, and complications and length of follow up. Five main differences were examined in PTS vs traditional abdominoplasty using drains groups. These included rate of seroma, wound complication, scar revision, hematoma, and follow up. We found a decreased rate of seroma in the PTS group, 2% vs 9%. Wound complications were similar. Scar revision was slightly higher in the PTS group at 17% vs 10% in traditional abdominoplasty, this association had a P value of .048. The rates of hematoma were similar (0% vs 1%). The mean follow up was 6 months in PTS and 9 months in traditional abdominoplasty. Addition of liposuction did not increase the rate of seroma. PTS without drains significantly decreased the seroma rate in our practice. Our experience adds to the mounting evidence that surgeons should consider using the PTS technique and abandon the use of drains in abdominoplasty. A well powered, multicenter, randomized controlled study is needed in order to definitively lay this question to rest. 4 Therapeutic.

Surgical Glove-Associated Diffuse Lamellar Keratitis

To demonstrate a potential cause of a prolonged epidemic of diffuse lamellar keratitis (DLK). This retrospective review analyzed an epidemic of diffuse lamellar keratitis over a 3-year period in a single surgery center. Altering the brand of surgical gloves used during surgery was associated with an elimination of the DLK epidemic. Optical microscopy, scanning electron microscopy-energy dispersive spectroscopy (SEM-EDS), and Fourier transform infrared (FTIR) spectroscopy were performed on both brands of surgical gloves to allow for comparisons and determine possible surface contaminants responsible for the DLK outbreaks. The incidence of DLK during the epidemic ranged from 2% to 38% on a quarterly basis for the 3-year period. A change in the brand of surgical gloves resulted in a cessation of DLK. Surface analysis of both brands of gloves revealed extensive silicone oil contamination on the internal and external surfaces of the DLK-associated gloves and insignificant amounts of silicone oil on the external surface of the DLK-free gloves. Silicone oil contamination of surgical gloves appears to be associated with epidemic DLK.