Study In General Surgery Research Articles

Establishment and implementation of a clinical application and research database for surgical robots in China

AbstractRobots are widely used in surgeries worldwide. To improve robotic surgical treatments, we established a database of clinical applications and research on surgical robots. Robotics‐related literature included in the China national knowledge infrastructure (CNKI), Wanfang, Vipshop, Chinese science citation database (CSCD), Web of Science, EMBASE, PubMed, and Cochrane databases up to September 2022 was searched and entered into the database. Information on all patients who had undergone robotic surgery at our hospital since 2016 was also included. Literature and case information was classified and evaluated according to standard guidelines and statements. The Gansu Provincial Hospital was the first to use evidence‐based medical research methods to successfully establish a database of clinical applications and research on surgical robots. This database comprised literature search, upload, quality evaluation, risk of bias assessment, case information entry, and access functions. Based on the database, we conducted related studies in general surgery, gynecology, urology, thoracic surgery, and cardiovascular surgery, and published 16 meta‐analyses and 15 clinical studies. Establishing this database removes language, retrieval, and evaluation barriers in clinicians' use of clinical evidence and lays the foundation for the efficient and accurate use of clinical data for future research. Further, it facilitates evidence‐based evaluation of the effectiveness of robotic therapy, which may guide future medical practice. This typical case of interdisciplinary research aims to build a platform to disseminate knowledge and technology in robotic surgery.This article is categorized under: Technologies > Computer Architectures for Data Mining Application Areas > Data Mining Software Tools Application Areas > Education and Learning

Surgical site infections caused by multi-drug resistant organisms: a case–control study in general surgery

Multi-drug resistant organisms (MDR-Os) are emerging as a significant cause of surgical site infections (SSI), but clinical outcomes and risk factors associated to MDR-Os-SSI have been poorly investigated in general surgery. Aims were to investigate risk factors, clinical outcomes and costs of care of multi-drug resistant organisms (MDR-Os-SSI) in general surgery. From January 2018 to December 2019, all the consecutive, unselected patients affected by MDR-O SSI were prospectively evaluated. In the same period, patients with non-MDR-O SSI and without SSI, matched for clinical and surgical data were used as control groups. Risk factors for infection, clinical outcome, and costs of care were compared by univariate and multivariate analysis. Among 3494 patients operated on during the study period, 47 presented an MDR-O SSI. Two control groups of 47 patients with non-MDR-O SSI and without SSI were identified. MDR-Os SSI were caused by poly-microbial etiology, meanly related to Gram negative Enterobacteriales. MDR-Os-SSI were related to major postoperative complications. At univariate analysis, iterative surgery, open abdomen, intensive care, hospital stay, and use of aggressive and expensive therapies were associated to MDR-Os-SSI. At multivariate analysis, only iterative surgery and the need of total parenteral and immune-nutrition were significantly associated to MDR-Os-SSI. The extra-cost of MDR-Os-SSI treatment was 150% in comparison to uncomplicated patients. MDR-Os SSI seems to be associated with major postoperative complications and reoperative surgery, they are demanding in terms of clinical workload and costs of care, they are rare but increasing, and difficult to prevent with current strategies.

Value-based Healthcare: Not Going Anywhere-Why Orthopaedic Surgeons Will Continue Using Telehealth in a Post-COVID-19 World.

Value-based Healthcare: Not Going Anywhere-Why Orthopaedic Surgeons Will Continue Using Telehealth in a Post-COVID-19 World.

218. Preoperative opioid use is associated with increased readmission and reoperation rates following lumbar decompression, instrumentation and fusion

BACKGROUND CONTEXT The prescription opioid epidemic and widespread use of narcotic medications has introduced new challenges when treating patients undergoing spine surgery. Recent studies in general surgery, spine and total joint arthroplasty literature demonstrate associations between preoperative opioid use and increased emergency department visits, readmission rates, revision rates and risk of developing chronic opioid dependence. Researchers estimate that 33-70% of patients undergoing spinal surgery use opioids preoperatively. Given the prevalence of preoperative opioid consumption among patients undergoing spine surgery, further research is needed to quantify and stratify perioperative risks in this patient population. PURPOSE The purpose of this study is to compare outcomes of primary one- or two-level lumbar decompression, instrumentation and fusion based on preoperative opioid consumption habits. STUDY DESIGN/SETTING A retrospective chart review was performed on patients who underwent one- to two-level posterior lumbar decompression, instrumentation and fusion from two spine surgeons at a single, tertiary referral center from 2013-2017. PATIENT SAMPLE Inclusion criteria included all patients who underwent a primary one- to two-level decompression (laminectomy or laminotomy) with posterior instrumentation, one- or two-level intertransverse arthrodesis (PLF), one- or two-level transforaminal lumbar interbody fusion (TLIF) or one- or two-level posterior lumbar interbody fusion (PLIF). Exclusion criteria included patients undergoing revision surgery, patients with concomitant malignancy or surgery for neoplastic disease, three- or more-level surgery, anterior or lateral (direct or oblique) interbody fusions, traumatic injuries (acute fractures or ligamentous instability) or other concurrent procedures. Patient opioid use was obtained from electronic medical records (Epic Systems Corporation, Verona, WI) including medication history and preoperative clinical documentation. Patients were divided into chronic opioid therapy (COT; >6 months), acute users (0-6 months) and opiate-naive based on their preoperative opioid usage. OUTCOME MEASURES Primary endpoints included readmission rates within 1 year and reoperation rates within 2 years. METHODS A retrospective chart review was conducted from 2013-2017 and patients who met the inclusion criteria were studied. Patients were divided into three groups based on their aforementioned preoperative opioid consumption status. Demographic information (age, BMI, sex and ethnicity), smoking status and primary outcome measures were identified and recorded based on documentation in the electronic medical record. RESULTS A total of 93 patients met the inclusion and exclusion criteria (57 PLF, 31 TLIF and 5 PLIF). Demographics characteristics were similar between all three groups. Thirty-three patients (35.5%) required COT, 31 patients (33.3%) utilized acute opioid therapy and 29 patients (31.2%) remained opioid naive. Current or former smokers were more likely to utilize acute or COT than never smokers (86% vs 59%; p=0.005). Readmission rates within 1 year for patients in the COT, acute and opioid naive groups were 50%, 41.7% and 8.3%, respectively (p=0.0115). Reoperation rates within 2 years for patients in the COT, acute and opioid naive groups were 54.2%, 33.3% and 12.5%, respectively (p = 0.033). CONCLUSIONS Long-term opiate use is associated with an increased risk for readmission within 1 year and revision within 2 years following a primary posterior decompression, instrumentation and fusion. Numerous data base studies have demonstrated similar, suboptimal outcomes for patients on preoperative opioid therapy compared to nonusers. This retrospective chart review corroborates the findings of these previous studies. Given the prevalence of narcotic usage in the US population, physicians should continue to educate acute or chronic opioid users about increased risk of readmission and revision associated with lumbar decompression and fusion. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Patient Complications after Total Joint Arthroplasty: Does Surgeon Gender Matter?

Recent studies in general surgery and internal medicine have shown that female physicians may have improved morbidity and mortality compared with their male counterparts. In the field of orthopaedic surgery, little is known about the influence of surgeon gender on patient complications. This study investigates patient complications after hip and knee arthroplasty based on the gender of the treating surgeon. Using a risk-adjusted outcomes database of 100% Medicare data from a third party, an analysis of outcomes after primary hip and knee arthroplasty based on surgeon gender was performed. This data set, which provided risk-adjusted complication rates for each surgeon performing at least 20 primary knee or hip arthroplasties from 2009 to 2013, was matched with publically available Medicare data sets to determine surgeon gender, year of graduation, area of practice, and surgical volume. Confounding variables were controlled for in multivariate analysis. Of the 8,965 surgeons with identified gender, 187 (2.0%; 187 of 8,965) were identified as women and performed 21,216 arthroplasties (1.4%; 21,216 of 1,518,419). Overall, female surgeons averaged fewer arthroplasties (total knee arthroplasty: 87.0 versus 124.9 [P < 0.001]; total hip arthroplasty [THA]: 62.8 versus 78.8 [P = 0.02]) and were earlier in their practice (20.6 versus 25.0 years; P < 0.001) compared with their male counterparts. Male and female surgeons had similar adjusted complication rates for THA (2.78% versus 2.84%) and total knee arthroplasty (2.24% versus 2.26%). Multivariate analysis found that the predictors of increased complications were decreased surgeon volume, THA, increased surgeons' years in practice, and geographic region. Overall, female orthopaedic surgeons performed fewer arthroplasties and were earlier in their career. This, however, did not a have a negative impact on their surgical outcomes. Rather, complication rates were dependent on surgeon volume, surgeon experience, and region. Level III-prognostic retrospective case-control study.

MP50-05 IDENTIFYING PRACTICE PATTERNS FOR THROMBOPROPHYLAXIS AFTER RADICAL CYSTECTOMY.

You have accessJournal of UrologyBladder Cancer: Natural History & Pathophysiology1 Apr 2014MP50-05 IDENTIFYING PRACTICE PATTERNS FOR THROMBOPROPHYLAXIS AFTER RADICAL CYSTECTOMY. Amanda VanDlac, MD Nicholas Cowan, MD Yiyi Chen, MD Jeffery La Rochelle, MD Christopher Amling, andMD Theresa KoppieMD Amanda VanDlacAmanda VanDlac More articles by this author , Nicholas CowanNicholas Cowan More articles by this author , Yiyi ChenYiyi Chen More articles by this author , Jeffery La RochelleJeffery La Rochelle More articles by this author , Christopher AmlingChristopher Amling More articles by this author , and Theresa KoppieTheresa Koppie More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1126AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives A retrospective review of the National Surgical Quality Improvement Program database determined the incidence of venous thrombotic events was 6%. While this number is alarming it is similar to previous studies. However the more surprising finding in that study was more than half of those events occurred after discharge (VanDlac et al, 2013). Guidelines have begun to recognize the need for chemical prophylaxis after discharge. Current guidelines from the American College of Chest Physicians (ACCP) recommend “extended-duration pharmacologic prophylaxis with Low molecular weight heparin (LMWH) over limited-duration prophylaxis for high-risk venous thromboembolism (VTE) patients which would include cystectomies. The AUA does not comment on extended duration prophylaxis (AUA guidelines 2011). Both these sets of recommendations rely on extrapolation from studies in general surgery and prostatectomy literature, not cystectomies. Our objective was to identify practice patterns regarding methods and length of thromboprophylaxis for patients undergoing radical cystectomy for bladder cancer. Methods A 12 question survey was distributed at a 2013 Bladder Cancer Think Tank meeting. 37 surveys were completed. Data regarding graduation year, frequency of performing cystectomies, location of practice, strategies for prophylaxis, preoperative and postoperative prophylaxis, timing of prophylaxis, preferred pharmacologic regimen, screening for deep vein thrombosis and length of treatment was collected. This data was analyzed and practice patterns were identified. Results 37 surveys were completed. 24 urologists (65%) prescribe a dose of pharmacologic prophylaxis immediately prior to radical cystectomy. 23 (62%) initated post operative prophylaxis on post operative day 0, 13 (35%) on post operative day 1. 24 (65%) do not screen for DVTs. 19 (51%) used inpatient prophylaxis while 16 (43%) use both inpatient and outpatient prophylaxis. 16 (43%) preferred lovenox as their post-operative pharmacologic prophylaxis regimen while 30 (54%) preferred heparin. 1 week of postoperative prophylaxis was recommended by 5 (14%), 2 weeks by 1 (2.7%), 4 weeks by 15 (43%), and 5 weeks by 1 (2.7%). Conclusions Based on these findings from those considered experts in the field of bladder cancer, urologists should strongly consider post operative prophylactic pharmacology. There is no universally defined length of treatment but considering almost half of this group recommended 4 weeks of prophylaxis,urologists can consider a similar length of course, especially in their higher risk patients. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e495 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Amanda VanDlac More articles by this author Nicholas Cowan More articles by this author Yiyi Chen More articles by this author Jeffery La Rochelle More articles by this author Christopher Amling More articles by this author Theresa Koppie More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Pulse oximetry for perioperative monitoring

This is an update of a review last published in Issue 9, 2009, of The Cochrane Library. Pulse oximetry is used extensively in the perioperative period and might improve patient outcomes by enabling early diagnosis and, consequently, correction of perioperative events that might cause postoperative complications or even death. Only a few randomized clinical trials of pulse oximetry during anaesthesia and in the recovery room have been performed that describe perioperative hypoxaemic events, postoperative cardiopulmonary complications and cognitive dysfunction. To study the use of perioperative monitoring with pulse oximetry to clearly identify adverse outcomes that might be prevented or improved by its use.The following hypotheses were tested.1. Use of pulse oximetry is associated with improvement in the detection and treatment of hypoxaemia.2. Early detection and treatment of hypoxaemia reduce morbidity and mortality in the perioperative period.3. Use of pulse oximetry per se reduces morbidity and mortality in the perioperative period.4. Use of pulse oximetry reduces unplanned respiratory admissions to the intensive care unit (ICU), decreases the length of ICU readmission or both. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2013, Issue 5), MEDLINE (1966 to June 2013), EMBASE (1980 to June 2013), CINAHL (1982 to June 2013), ISI Web of Science (1956 to June 2013), LILACS (1982 to June 2013) and databases of ongoing trials; we also checked the reference lists of trials and review articles. The original search was performed in January 2005, and a previous update was performed in May 2009. We included all controlled trials that randomly assigned participants to pulse oximetry or no pulse oximetry during the perioperative period. Two review authors independently assessed data in relation to events detectable by pulse oximetry, any serious complications that occurred during anaesthesia or in the postoperative period and intraoperative or postoperative mortality. The last update of the review identified five eligible studies. The updated search found one study that is awaiting assessment but no additional eligible studies. We considered studies with data from a total of 22,992 participants that were eligible for analysis. These studies gave insufficient detail on the methods used for randomization and allocation concealment. It was impossible for study personnel to be blinded to participant allocation in the study, as they needed to be able to respond to oximetry readings. Appropriate steps were taken to minimize detection bias for hypoxaemia and complication outcomes. Results indicated that hypoxaemia was reduced in the pulse oximetry group, both in the operating theatre and in the recovery room. During observation in the recovery room, the incidence of hypoxaemia in the pulse oximetry group was 1.5 to three times less. Postoperative cognitive function was independent of perioperative monitoring with pulse oximetry. A single study in general surgery showed that postoperative complications occurred in 10% of participants in the oximetry group and in 9.4% of those in the control group. No statistically significant differences in cardiovascular, respiratory, neurological or infectious complications were detected in the two groups. The duration of hospital stay was a median of five days in both groups, and equal numbers of in-hospital deaths were reported in the two groups. Continuous pulse oximetry has the potential to increase vigilance and decrease pulmonary complications after cardiothoracic surgery; however, routine continuous monitoring did not reduce transfer to an ICU and did not decrease overall mortality. These studies confirmed that pulse oximetry can detect hypoxaemia and related events. However, we found no evidence that pulse oximetry affects the outcome of anaesthesia for patients. The conflicting subjective and objective study results, despite an intense methodical collection of data from a relatively large general surgery population, indicate that the value of perioperative monitoring with pulse oximetry is questionable in relation to improved reliable outcomes, effectiveness and efficiency. Routine continuous pulse oximetry monitoring did not reduce transfer to the ICU and did not decrease mortality, and it is unclear whether any real benefit was derived from the application of this technology for patients recovering from cardiothoracic surgery in a general care area.

Quality assessment of diagnostic accuracy studies in general surgery

Quality assessment of diagnostic accuracy studies in general surgery

Time of year does not influence mortality for vascular operations at academic centers

Studies in general surgery have suggested worse outcomes due to the presence of new trainees. We hypothesized that outcomes for vascular operations would be equal regardless of teaching hospital status or academic quarter within the United States. From 2003 to 2007, 264,374 vascular operations were evaluated using the Nationwide Inpatient Sample database. Patients were stratified according to Non-Teaching (non-Teaching Hospital [NTH], n = 137,406), Teaching (Teaching Hospital [TH], n = 126,968), and Teaching with Vascular Surgery Training Program (VSH, n = 28,730) hospital status. Multivariate analyses were used to examine the effect of academic quarter (AQ) on mortality. Unadjusted mortality was higher at TH compared with NTH (2.5% vs 2.0%; P < .001). Aortic and peripheral vascular operations were more common at TH, while carotid endarterectomy (P < .001) was more frequent at NTH (P < .001). After risk adjustment, the odds of death were significantly (P < .001) increased for aortic and peripheral vascular operations but were similar at both TH (1.11 [0.98-1.25]; P = .10) and VSH (1.16 [0.98-1.37]; P = .08) compared with NTH. Importantly, AQ was not associated with increased risk of mortality at either TH (AQ1 odds ratios [OR] = 0.95 [080-1.13], AQ2 OR = 1.08 [0.91-1.28], AQ3 OR = 1.13 [0.96-1.34], AQ4 = Reference; P = .19) or VSH (AQ1 OR = 1.02 [0.81-1.29], AQ2 OR = 0.99 [0.79-1.25], AQ3 OR = 1.02 [0.81-1.28], AQ4 = Reference; P = .99). Mortality is not significantly influenced by operative time of year following vascular operations at academic centers. TH perform more high-risk operations compared with NTH with similar risk adjusted mortality.

Evaluating Meta-analyses in the General Surgical Literature

To assess the methodologic quality of meta-analyses of general surgery topics published in peer-reviewed journals. Systematic reviews and meta-analysis are used to seek, summarize, and interpret primary studies on a given topic. Accordingly, systematic reviews and meta-analyses of high-quality primary studies may be the highest level of evidence for issues of prevention and treatment in evidence-based medicine. However, not all published meta-analyses are rigorously performed. We searched MEDLINE (from January 1, 1997, to September 1, 2002) and reference lists and solicited general surgery specialists to identify relevant meta-analyses. Inclusion criteria were use of meta-analytic methods to pool the results of primary studies in general surgery on issues of diagnosis, causation, prognosis, or treatment. Our search strategies identified 487 potentially relevant articles. After excluding articles based on a priori criteria, 51 meta-analyses fulfilled eligibility criteria. In duplicate and independently, 2 reviewers assessed the quality of these meta-analyses using a 10-item index called the Overview Quality Assessment Questionnaire. Overall concordance between 2 independent reviewers was good (interobserver agreement 81%, and a kappa of 0.62 (95% CI 0.55-0.69). Of 51 relevant articles, 38 were published in surgical journals. Most studies had major methodologic flaws (median score of 3.3, scale of 1-7). Factors associated with low overall scientific quality included the absence of any prior meta-analyses publications by authors and meta-analyses produced by surgical department members without external collaboration. This critical appraisal of meta-analyses published in the general surgery literature demonstrates frequent methodologic flaws. The quality of these reports limits the validity of the findings and the inferences that can be made about the primary studies reviewed. To improve the quality of future meta-analyses, we recommend following guidelines for the optimal conduct and reporting of meta-analyses in general surgery.

Low Molecular Weight Heparin and Unfractionated Heparin in Thrombosis Prophylaxis: Meta-Analysis Based on Original Patient Data

A meta-analysis (MA) based on original patient data has been performed comparing low molecular weight heparins (LMWH) with unfractionated heparin (UFH) in thrombosis prophylaxis after major surgical interventions. The analyses have been done for the following prespecified groups of studies: all studies, studies in orthopaedic surgery (OS) and studies in general surgery (GS, with further separation into low-dose studies [GS-LD] and high-dose studies [GS-HD]). Deep vein thrombosis (DVT, all locations) and wound haematoma were used as primary endpoints for efficacy and safety, respectively. The analysis confirms the results of previous publication-based meta-analyses. In GS there is no relevant difference between LMWH and UFH regarding efficacy; the safety results strongly depend on the dosage: under low-dose LMWH the risk of wound haematoma is significantly lower, under high-dose LMWH it is significantly higher than under UFH. However, most of the studies in the last group used regimens of LMWH that are not considered appropriate any more. In OS there is a trend towards a better efficacy and safety of LMWH. In addition, LMWHs are superior to UFH, in OS, with respect to the secondary endpoints proximal DVT and pulmonary embolism. The rates of proximal DVT and pulmonary embolism, respectively, are consistently lower under LMWH than under UFH, whereas slightly smaller rates of distal DVT are observed under UFH.

Clinical decision-making: A study of general surgery within trent RHA

Clinical decision-making: A study of general surgery within trent RHA

Clinical decision-making: A study of general surgery within trent RHA

A theory of consultant behaviour is summarized and used to generate three hypotheses on the interrelationship between the level of resources provided and the demand for hospital care. Routine hospital statistical data for General Surgery in Trent RHA provided a means of testing the hypotheses; no evidence was found to disprove them. It is suggested that a 1% increase in the number of consultants per 1000 population will lead to a 1% increase in the size of the waiting list. A measure of met demand such as the number of admissions per 1000 population was found to depend upon the number of available beds per 1000 population. Some possible policy implications for the management of waiting lists in the NHS are considered.