A Prospective Assessment of Clinical and Patient-Reported Outcomes of Initial Non-Operative Management of Ventral Hernias

2017 ◽  
Vol 41 (5) ◽  
pp. 1267-1273 ◽  
Author(s):  
Julie L. Holihan ◽  
Juan R. Flores-Gonzalez ◽  
Jiandi Mo ◽  
Tien C. Ko ◽  
Lillian S. Kao ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Operative Management ◽  
Patient Reported ◽  
Prospective Assessment ◽  
Non Operative Management ◽  
Ventral Hernias

scholarly journals Nonoperative Management of Femoroacetabular Impingement: Clinical Outcomes at 5-Years--A Prospective Study (143)

2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0028
Author(s):  
Andrew Zogby ◽  
James Bomar ◽  
Kristina Johnson ◽  
Kelly Randich ◽  
Vidyadhar Upasani ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Patient Reported Outcomes ◽  
Operative Management ◽  
Activity Level ◽  
Treatment Groups ◽  
Patient Reported ◽  
The Mean ◽  
Non Operative Management ◽  
Fai Syndrome

Objectives: Mid-term and long-term outcomes data on non-operative management of femoroacetabular impingement (FAI) syndrome remains sparse despite expanding research on the topic. Our purpose is to present 5-year outcomes data utilizing a non-operative protocol on a consecutive series of patients with FAI syndrome. Methods: Between 2013 and 2016, patients were prospectively recruited in a non-operative FAI study. The protocol consisted of an initial trial of rest, physical therapy, and activity modification. Patients who remained symptomatic were offered an intra-articular steroid injection. Patients with recurrent symptoms were offered arthroscopic treatment. Patient-reported outcomes including the modified Harris Hip Score (mHHS) and Non-arthritic Hip Score (NAHS) were collected 1-, 2-, and 5-years after enrollment. We present the 5-year data. Statistical analysis was performed to determine outcomes based on FAI type and treatment. Results: 133 hips in 100 patients were enrolled. Sixty-seven hips in 50 patients were available for 5-year follow up. At enrollment, the mean mHHS and NAHS were 69.6±13.1 and 76.3±14.7 respectively. In total, 73% of the cohort was managed non-operatively. Of the 11 patients requiring surgery, six (55%) converted to surgery within one year of enrollment, 4 (36%) converted to surgery between one and 2 years, and one patient converted to surgery between 2 and 5 years. At final follow up, the mean mHHS and NAHS were 89.6±10.7 and 88.0±12.1 respectively. At 1-year follow up, only the activity modification group made a significant increase in mHHS and NAHS (p<0.03), by two year follow up, all three treatment groups had made statistically significant improvements in mHHS and NAHS (p<0.05), by 5-years follow up, the activity modification group and the scope group had maintained their statistically significant improvement in mHHS and NAHS (p<0.03). There was no significant difference in mHHS or NAHS between treatment groups at 5-year follow-up (p>0.4)(Table 1), and no difference in proportion of hips meeting the MCID for mHHS based on treatment course (p=0.961). There was no difference in mHHS or NAHS between FAI types at any time point (p>0.06)(Table 2), or in the proportion of hips that met MCID among FAI types (p=0.511). 72% of patients returned to the same or similar sport/activity level, and there was no difference in the proportion of patients that returned to sports/activities among treatment type (p=0.095) or FAI type (p=0.273). Conclusions: Non-operative management of FAI syndrome is effective in a majority of adolescent patients, with robust improvements in patient-reported-outcomes persisting at 5-year follow-up.

Biologic mesh for repair of ventral hernias in contaminated fields: long-term clinical and patient-reported outcomes

2016 ◽  
Vol 31 (2) ◽  
pp. 861-871 ◽  
Author(s):  
Amin Madani ◽  
Petru Niculiseanu ◽  
Wanda Marini ◽  
Pepa A. Kaneva ◽  
Benjamin Mappin-Kasirer ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Biologic Mesh ◽  
Patient Reported ◽  
Ventral Hernias

scholarly journals Prospective assessment of patient-reported outcomes and estradiol and drug concentrations in patients experiencing toxicity from adjuvant aromatase inhibitors

2017 ◽  
Vol 164 (2) ◽  
pp. 411-419 ◽  
Author(s):  
Kunal C. Kadakia ◽  
Kelley M. Kidwell ◽  
Nicholas J. Seewald ◽  
Claire F. Snyder ◽  
Anna Maria Storniolo ◽  
...  
Keyword(s):  
Aromatase Inhibitors ◽  
Patient Reported Outcomes ◽  
Drug Concentrations ◽  
Patient Reported ◽  
Prospective Assessment

Opioid Use After Inguinal and Ventral Hernia Repair

2020 ◽  
Vol 86 (8) ◽  
pp. 965-970
Author(s):  
Jessica L. Millard ◽  
Robyn Moraney ◽  
Jordan C. Childs ◽  
Joseph A. Ewing ◽  
Alfredo M. Carbonell ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Incisional Hernia ◽  
Hernia Repair ◽  
Ventral Hernia ◽  
Inguinal Hernia Repair ◽  
Patient Reported Outcomes ◽  
Opioid Use ◽  
Patient Reported ◽  
Primary Ventral Hernia ◽  
Ventral Hernias

Background Recent data on opioid consumption indicate that patients typically require far less than is prescribed. Prisma Health Upstate Hernia Center adopted standardized postoperative prescribing after hernia repair and began tracking patient-reported opioid utilization. The aim of this study is to evaluate patient opioid use after hernia repair in order to guide future prescribing. Methods All patients who underwent primary ventral (umbilical and epigastric), incisional, and inguinal hernia repair between February and May 2019 were reviewed. Patients reported the number of opioid pills taken at their first postoperative visit and documented either in the progress note or in the Americas Hernia Society Quality Collaborative (AHSQC) patient-reported outcomes (PRO) questionnaire. All demographic, operative, and outcomes data were captured prospectively in the AHSQC. Opioid use reported as milligram morphine equivalents (MME). Results A total of 162 surgeries were performed during the study period, and 107 had patient-reported opioid use for analysis. Inguinal hernia repair was performed in 36 patients, 10 primary ventral hernia repairs, and 61 incisional hernia repairs. No opioid use was reported in 63.9% of inguinal hernias, 60% of primary ventral hernias, and 20% of incisional hernias. Inguinal hernia patients consumed a mean of 10.5 MME, primary ventral patients 11 MME, and incisional hernia patients 78.5 MME. Conclusion Patients require little to no opioid after primary ventral or inguinal hernia repair and opioid-free surgery is feasible. Incisional hernia is more heterogenous, but the majority of patients still required less opioid than previously thought.

scholarly journals Outcomes Following ACL and Grade III MCL Injuries

2017 ◽  
Vol 5 (3_suppl3) ◽  
pp. 2325967117S0012 ◽  
Author(s):  
Robert W. Westermann ◽  
Kurt P. Spindler ◽  
Carolyn M. Hettrich ◽  
Brian R. Wolf
Keyword(s):  
Acl Reconstruction ◽  
Patient Reported Outcomes ◽  
Operative Management ◽  
Lower Activity ◽  
Study Enrollment ◽  
Patient Reported ◽  
Prospective Longitudinal ◽  
Primary Acl Reconstruction ◽  
Grade Iii

Objectives: Complete disruptions of the medial collateral ligament (MCL) are rare, but do occur with anterior cruciate ligament (ACL) tears. Complete ACL/MCL injuries may be managed with ACL reconstruction and either conservative or operative treatment of the MCL. MCL tear location has also been associated with outcome. We hypothesized that outcomes would be best with acute surgery and worse with proximal MCL tears.We also hypothesized that operative management of MCL injuries would not influence outcome. Methods: Patients enrolled in a multicenter prospective longitudinal cohort who underwent unilateral primary ACL reconstruction between 2002-2008 and who had 2-year follow-up were evaluated. Patients with concomitant grade III MCL injuries treated either operatively or non-operatively were identified. Concurrent injuries (to meniscus or articular cartilage) and subsequent surgeries were documented. Comparisons of surgical chronicity (before and after 30 days from injury) and MCL tear location (femoral or tibial) were performed. Patient reported outcomes (KOOS, IKDC and Marx activity scores) were measured at the time of ACL reconstruction and at 2-year follow-up. Results: Initially, 3028 patients were identified to have undergone primary ACL reconstruction in the cohort during the identified time frame, with 2586 patients completing 2-year follow-up (85%). Complete MCL tears were documented in 1.1% (27/2586) of the cohort: 16 operatively managed patients and 11 conservatively treated MCLs during ACL reconstruction. Concurrent articular pathology was similar between groups. Clinically important differences were seen in baseline KOOS (all subscales) and IKDC scores, with lower scores seen in patients who underwent operative MCL treatment. Reoperation for arthrofibrosis was higher after operative repair of the MCL (19%) versus nonoperative treatment (9%). At 2 years the non-operative MCL cohort maintained significantly better KOOS Sports Rec (88.2 versus 74.4), KOOS QOL (81.3 versus 68.4), and IKDC (87.6 versus 76.0) scores compared to the MCL surgery group. Marx activity scores were equal between groups at the time of study enrollment, however patients who underwent operative MCL management had lower activity scores at 2 years (6.5 versus 10.7). Tibial-sided MCL injuries were associated with worse baseline outcomes compared with femoral-sided MCL injuries in terms of KOOS ADL, Sports Rec, and QOL subscales, but these differences were resolved by 2 years. Surgical chronicity did not influence 2-year outcome. Conclusion: Complete and combined ACL/MCL injuries are rare. Both operative and nonoperative management of MCL tears in our cohort demonstrated clinical improvements between study enrollment and 2-year follow-up. MCL surgery during ACL reconstruction was associated with more frequent stiffness, worse patient-reported outcomes and lower activity at 2 years. There may be a subset of patients with severe combined ACL and medial knee injuries that may benefit from operative management, however, that patient population has yet to be defined.

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