scholarly journals Does a prior hysterectomy complicate transvaginal/transumbilical hybrid NOTES cholecystectomy?—a comparative analysis of prospectively collected data

2021 ◽  
Author(s):  
Dirk R. Bulian ◽  
Axel Sauerwald ◽  
Panagiotis Thomaidis ◽  
Claudia S. Seefeldt ◽  
Dana C. Richards ◽  
...  
Keyword(s):  
Urinary Bladder ◽  
Length Of Stay ◽  
Postoperative Complication ◽  
Complication Rate ◽  
Hospital Length Of Stay ◽  
Complication Rates ◽  
Comprehensive Complication Index ◽  
Asa Classification ◽  
Bladder Catheterization ◽  
Hybrid Notes

Abstract Purpose Hysterectomy alters the anatomy of the posterior vaginal vault used as access for transvaginal/transumbilical hybrid NOTES cholecystectomy (NC), creating potential consequences for the feasibility and complication rate of the procedure. Therefore, the aim of our retrospective analysis of prospectively collected data was to analyze the postoperative course after NC in previously hysterectomized (PH) patients compared with patients who had not undergone hysterectomy (NH). Methods A total of 126 NH patients and 50 PH patients aged over 42 who had an NC from 12/2008 to 04/2021 were compared regarding age, body mass index (BMI), ASA classification, number of percutaneous trocars, need for intraoperative urinary bladder catheterization, length of procedure, conversion rate, and intraoperative and postoperative complication rate according to the Clavien/Dindo classification, Comprehensive Complication Index (CCI), mortality, and hospital length of stay. Results PH patients were older than NH patients (63.0 vs 51.5 years; P < 0.001) but did not differ significantly in ASA classification (P = 0.595) and BMI (26.8 vs 27.9 kg/m2; P = 0.480). They required more percutaneous trocars (P = 0.047) and longer procedure time (66.0 vs. 58.5 min; P = 0.039). Out of all 287 scheduled NC only one had to be “converted” to traditional laparoscopic cholecystectomy. Intraoperative and postoperative complication rates, Clavien/Dindo classification, CCI, need for intraoperative urinary bladder catheterization, and length of stay did not differ significantly. Conclusion Our results indicate an increased degree of difficulty of NC in PH patients, although there is no major impact on intraoperative and postoperative complication rates. Urinary bladder perforation is a specific access-related complication in PH patients.

Prospective review of a single center's general pediatric neurosurgical intraoperative and postoperative complication rates

2014 ◽  
Vol 13 (1) ◽  
pp. 107-113 ◽  
Author(s):  
Erik J. van Lindert ◽  
Hans Delye ◽  
Jody Leonardo
Keyword(s):  
Mortality Rate ◽  
Adverse Events ◽  
Postoperative Complication ◽  
Complication Rate ◽  
Surgical Procedure ◽  
Neurosurgical Procedures ◽  
Complication Rates ◽  
Tumor Surgery ◽  
Infection Rates ◽  
Targeted Interventions

Object The authors conducted a study to compare the complication rate (CR) of pediatric neurosurgical procedures in a general neurosurgery department to the CRs that are reported in the literature and to establish a baseline of CR for further targeted improvement of quality neurosurgical care. Methods The authors analyzed the prospectively collected data from a complication registration of 1000 consecutive pediatric neurosurgical procedures in 581 patients from the beginning of the registration in January 2004 through August 2008. A pediatric neurosurgeon was involved in 50.5% of the procedures. All adverse events (AEs) from induction of anesthesia until 30 days postoperatively were recorded. Results Overall, 229 complications were counted in 202 procedures. The overall CR was 20.2%, with a 2.7% intraoperative CR and a 17.5% postoperative CR. Tumor surgery was associated with the highest CR (32.7%), followed by CSF disorders (21.8%). The mortality rate was 0.3%. An unplanned return to the operating room in relation to an AE happened in 10.5% of all procedures and in 52% of procedures associated with AEs, the majority of which were related to CSF disorders. Conclusions The CR in pediatric neurosurgical procedures was significant, and more than half of the patients with an AE required a repeat surgical procedure. Analysis of CRs should be a prerequisite for the prevention of complications and for the development of targeted interventions to reduce the CR (for example, infection rates).

scholarly journals Robotic nipple-sparing mastectomy complication rate compared to traditional nipple-sparing mastectomy: a systematic review and meta-analysis

2021 ◽  
Author(s):  
M. D. Filipe ◽  
E. de Bock ◽  
E. L. Postma ◽  
O. W. Bastian ◽  
P. P. A. Schellekens ◽  
...  
Keyword(s):  
Postoperative Complication ◽  
Complication Rate ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Complication Rates ◽  
Flap Necrosis ◽  
Postoperative Complication Rate ◽  
Common Cancer ◽  
Nipple Sparing Mastectomy ◽  
Nipple Sparing

AbstractBreast cancer is worldwide the most common cause of cancer in women and causes the second most common cancer-related death. Nipple-sparing mastectomy (NSM) is commonly used in therapeutic and prophylactic settings. Furthermore, (preventive) mastectomies are, besides complications, also associated with psychological and cosmetic consequences. Robotic NSM (RNSM) allows for better visualization of the planes and reducing the invasiveness. The aim of this study was to compare the postoperative complication rate of RNSM to NSM. A systematic search was performed on all (R)NSM articles. The primary outcome was determining the overall postoperative complication rate of traditional NSM and RNSM. Secondary outcomes were comparing the specific postoperative complication rates: implant loss, hematoma, (flap)necrosis, infection, and seroma. Forty-nine studies containing 13,886 cases of (R)NSM were included. No statistically significant differences were found regarding postoperative complications (RNSM 3.9%, NSM 7.0%, p = 0.070), postoperative implant loss (RNSM 4.1%, NSM 3.2%, p = 0.523), hematomas (RNSM 4.3%, NSM 2.0%, p = 0.059), necrosis (RNSM 4.3%, NSM 7.4%, p = 0.230), infection (RNSM 8.3%, NSM 4.0%, p = 0.054) or seromas (RNSM 3.0%, NSM 2.0%, p = 0.421). Overall, there are no statistically significant differences in complication rates between NSM and RNSM.

scholarly journals Is it a matter of time? The effect of transfer time on femur fracture outcomes

2021 ◽  
Vol 6 (1) ◽  
pp. e000701
Author(s):  
Leah E Larson ◽  
Melissa L Harry ◽  
Paul K Kosmatka ◽  
Kristin P Colling
Keyword(s):  
Length Of Stay ◽  
Trauma Center ◽  
Femur Fracture ◽  
Fracture Repair ◽  
Hospital Length Of Stay ◽  
Complication Rates ◽  
Transfer Time ◽  
Femur Fractures ◽  
Initial Hospital ◽  
Level 1

BackgroundTrauma systems in rural areas often require longdistance transfers for definitive care. Delays in care, such as delayed femurfracture repair have been reported to be associated with poorer outcomes, butlittle is known about how transfer time affects time to repair or outcomesafter femur fractures.MethodsWe conducted a retrospective review of all trauma patients transferred to our level 1 rural trauma center between May 1, 2016-April 30, 2019. Patient demographics and outcomes were abstracted from chart and trauma registry review. All patients with femur fractures were identified. Transfer time was defined as the time from admission at the initial hospital to admission at the trauma center, and time to repair was defined as time from admission to the trauma center until operative start time. Our outcome variables were mortality, in-hospital complications, and hospital length of stay (LOS).ResultsOver the study period1,887 patients were transferred to our level 1 trauma center and 398 had afemur fracture. Compared to the entire transfer cohort, femur fracture patientswere older (71 versus 57 years), and more likely to be female (62% versus 43%).The majority (74%) of patients underwent fracture repair within 24hours. Delay in fracture fixation >24 hours wasassociated with increased length of stay (5 days versus 4 days; p<0.001),higher complication rates (23% versus 12%; p=0.01), and decreased dischargehome (19% vs. 32%, pp=0.02), but was not associated with mortality (6% versus5%; p=0.75). Transfer time and time at the initial hospital were not associatedwith mortality, complication rate, or time to femur fixation.DiscussionFixation delay greater than 24 hours associated with increased likelihood of in-hospital complications, longer length of stay, and decreased likelihood of dischargehome. Transfer time not related to patient outcomes or time to femur fixation.Level of evidenceLevel III; therapeutic/care management.

Natural Orifice Transluminal Endoscopic Surgery: Long-Term Experience with Hybrid Transvaginal Cholecystectomies

2020 ◽  
pp. 155335062093240
Author(s):  
Fabian Rössler ◽  
Andreas Keerl ◽  
Uwe Bieri ◽  
Juliette Slieker ◽  
Antonio Nocito
Keyword(s):  
Endoscopic Surgery ◽  
Special Focus ◽  
Complication Rates ◽  
Natural Orifice ◽  
Comprehensive Complication Index ◽  
Transvaginal Cholecystectomy ◽  
Gynecological Examination ◽  
Transvaginal Access ◽  
Standard Laparoscopic Cholecystectomy ◽  
Hybrid Notes

Objective. To assess outcome and safety of 571 hybrid natural orifice transluminal endoscopic surgery (NOTES) cholecystectomies. Methods. We retrospectively analyzed all consecutive NOTES cholecystectomies performed at our center between June 2009 and January 2018. All procedures were performed using a hybrid transvaginal technique, including an umbilical small-size trocar. End points, calculated at discharge, 30 and up to 90 days postoperatively, included intra- and postoperative morbidity assessed by the validated Clavien–Dindo classification and the Comprehensive Complication Index (CCI). Special focus was held on outcome and necessity of pre- and postoperative gynecological examinations. Results. We performed 571 hybrid NOTES cholecystectomies within 9 years. The vast majority were elective, 9.6% were emergency cholecystectomies. 6.7% of patients developed at least one complication until discharge, most of them minor (≤grade II). 30- and 90-day complication rates were 10.7% and 11%, respectively. Mean CCI at discharge and postoperative days 30 and 90 was 1.45 (±6.4), 2.3 (±7.7), and 2.4 (±7.8), respectively. Major complications (≥grade IIIa) occurred in 1.6% of patients, and 4 patients required emergency reoperation. No mortality was observed. In 9.8%, an additional abdominal trocar was placed. All patients underwent routine gynecological examination, whereof only 5 were rejected for transvaginal access preoperatively. In no case transvaginal access was discontinued intraoperatively due to gynecological disease. Conclusion. Hybrid NOTES transvaginal cholecystectomy represents a safe and feasible alternative to standard laparoscopic cholecystectomy. Preoperative gynecological examination is no longer routinely necessary, as intraoperative assessment is adequate.

Perioperative complication rates following neoadjuvant therapy in pancreatic adenocarcinoma.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 688-688
Author(s):  
Christopher R. Deig ◽  
Blake Beneville ◽  
Amy Liu ◽  
Aasheesh Kanwar ◽  
Alison Grossblatt-Wait ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Neoadjuvant Therapy ◽  
Pancreatic Adenocarcinoma ◽  
Locally Advanced ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Complication Rates ◽  
Significant Difference ◽  
Perioperative Complication ◽  
The Impact

688 Background: Whether upfront resection or total neoadjuvant therapy is superior for the treatment of potentially resectable pancreatic adenocarcinoma (PDAC) remains controversial. The impact of neoadjuvant treatment on major perioperative complication rates for patients (pts) undergoing resection for PDAC is commonly debated. We hypothesized that rates would be comparable among patients receiving neoadjuvant chemoradiation (neo-CRT), neoadjuvant chemotherapy alone (neo-CHT), or upfront surgery. Methods: This is a retrospective study of 208 pts with PDAC who underwent resection within a multidisciplinary pancreatico-biliary program at an academic tertiary referral center between 2011-2018. Data were abstracted from the medical record, an institutional cancer registry and NSQIP databases. Outcomes were assessed using χ2, Fisher’s exact test and two-tailed Student’s t-tests. Results: 208 pts were identified: 33 locally advanced, borderline or upfront resectable pts underwent neo-CRT, 35 borderline or resectable pts underwent neoadjuvant-CHT, and 140 resectable pts did not undergo neoadjuvant therapy. There were no statistically significant differences in major perioperative complication rates between groups. Overall rates were 36.4%, 34.3%, and 26.4% for pts who underwent neo-CRT, neo-CHT alone, or upfront resection, respectively (p = 0.38). No significant difference were observed in complication rates (35.3% v. 26.4%; p = 0.19) or median hospital length of stay (10 days v. 10 days; p = 0.87) in pts who received any neoadjuvant therapy versus upfront resection. There were two perioperative deaths in the neo-CRT group (6.1%), zero in the neo-CHT group, and four in the upfront resection group (2.9%); p = 0.22. Conclusions: There were no significant differences in major perioperative complication rates, hospital length of stay, or post-operative mortality in pts who underwent neoadjuvant therapy (neo-CRT or neo-CHT alone) versus upfront surgery. Notably, neo-CRT had comparable perioperative complication rates to neo-CHT alone, which suggests neoadjuvant radiation therapy may not pose additional surgical risk.

The influence of social determinants of health on single-level anterior cervical discectomy and fusion outcomes

2021 ◽  
pp. 1-6
Keyword(s):  
Length Of Stay ◽  
Postoperative Complication ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Revision Surgery ◽  
Determinants Of Health ◽  
Anterior Cervical Discectomy ◽  
Complication Rates ◽  
Cervical Discectomy ◽  
Single Level

OBJECTIVE Methods of reducing complications in individuals electing to undergo anterior cervical discectomy and fusion (ACDF) rely upon understanding at-risk patient populations, among other factors. This study aims to investigate the interplay between social determinants of health (SDOH) and postoperative complication rates, length of stay, revision surgery, and rates of postoperative readmission at 30 and 90 days in individuals electing to have single-level ACDF. METHODS Using MARINER30, a database that contains claims information from all payers, patients were identified who underwent single-level ACDF between 2010 and 2019. Identification of patients experiencing disparities in 1 of 6 categories of SDOH was completed using ICD-9 and ICD-10 (International Classifications of Diseases, Ninth and Tenth Revisions) codes. The population was propensity matched into 2 cohorts based on comorbidity status: those with SDOH versus those without. RESULTS A total of 10,030 patients were analyzed; there were 5015 (50.0%) in each cohort. The rates of any postoperative complication (12.0% vs 4.6%, p < 0.001); pseudarthrosis (3.4% vs 2.6%, p = 0.017); instrumentation removal (1.8% vs 1.2%, p = 0.033); length of stay (2.54 ± 5.9 days vs 2.08 ± 5.07 days, p < 0.001 [mean ± SD]); and revision surgery (9.7% vs 4.2%, p < 0.001) were higher in the SDOH group compared to patients without SDOH, respectively. Patients with any SDOH had higher odds of perioperative complications (OR 2.8, 95% CI 2.43–3.33), pseudarthrosis (OR 1.3, 95% CI 1.06–1.68), revision surgery (OR 2.4, 95% CI 2.04–2.85), and instrumentation removal (OR 1.4, 95% CI 1.04–2.00). CONCLUSIONS In patients who underwent single-level ACDF, there is an association between SDOH and higher complication rates, longer stay, increased need for instrumentation removal, and likelihood of revision surgery.

S111 – Monitoring Frequency: A Determinant in Free Tissue Transfer

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P114-P114
Author(s):  
Joshua D Hornig
Keyword(s):  
Length Of Stay ◽  
Group Versus ◽  
Free Tissue Transfer ◽  
Hospital Length Of Stay ◽  
Complication Rates ◽  
Success Rates ◽  
Minimal Group ◽  
Tissue Transfer ◽  
Flap Loss ◽  
Flap Monitoring

Objectives 1) To compare the success rates of free tissue transfer (FTT) between a cohort of patients who underwent frequent scheduled checks to a cohort who received checks on an as-needed basis. 2) To compare the overall flap survival, ICU stay, in-hospital stay, complications, and cost. Methods Patients meeting the criteria for free tissue transfer were divided into 2 cohorts: minimal FTT monitoring and frequent scheduled FTT monitoring. In August 2005, frequent scheduled flap monitoring was instituted. The study was set up to identify if this method impacted overall patient outcomes. The 2 groups were compared over several dimensions: overall flap outcome, total vs. partial flap loss, length of stay in hospital, revision procedures, and complications. Results A total of 212 patients were identified. 107 of the patients were in the frequent, scheduled group and 105 were in the minimal group. The overall FTT success rates were significantly higher in the frequently scheduled group versus the minimal group (100% vs 89%). The rates of partial flap loss and total flap loss were higher in the minimal group (11% vs 4%). The overall length of stay in the hospital, length of stay in the ICU, and complication rates were nonsignificant between the 2 groups. However, the number of revision procedures were significantly lower in the frequently scheduled FTT group. Conclusions The implementation of frequent scheduled flap monitoring significantly improves free tissue transfer survival in head and neck patients and decreases the number of revision procedures that need to be performed.

A Quantified Scoring System for Postoperative Complication Severity Compared to the Clavien-Dindo Classification

2015 ◽  
Vol 32 (5) ◽  
pp. 361-366 ◽  
Author(s):  
Annelijn E. Slaman ◽  
Sjoerd M. Lagarde ◽  
Suzanne S. Gisbertz ◽  
Mark I. van Berge Henegouwen
Keyword(s):  
Length Of Stay ◽  
Postoperative Complication ◽  
Scoring System ◽  
Reoperation Rate ◽  
Severe Complication ◽  
Surgical Patient ◽  
High Morbidity ◽  
Comprehensive Complication Index ◽  
Patient Groups ◽  
Prospective Database

Background/Aims: Esophagectomies are associated with high morbidity. To assess the complication severity, the Clavien-Dindo classification (CDC) grades the most severe complication. However, it ignores additional complications that are equal or less severe. The comprehensive complication index (CCI) incorporates all complication severities. It might therefore be a better system to assess the severities. The aim of this study was to validate the CCI compared to the CDC. Methods: A prospective database was used to analyze 621 patients, who underwent an esophagectomy between 1993 and 2005. The CCI was calculated and the relation with traditional parameters was assessed and compared to the relation of the CDC with these parameters. Results: Complications occurred in 429 patients (69.1%). The correlation between the CCI and the CDC was r = 0.987, p < 0.01. The relation of the CCI with 3 out of 7 parameters was not significantly different compared to the relation of the CDC (p > 0.05). There was a significantly stronger relation (p < 0.05) of the CCI with length of stay (LOS) (r = 0.663 vs. 0.646), a prolonged LOS (r = 0.542 vs. 0.530), reintervention, (r = 0.437 vs. 0.422) and reoperation rate (0.489 vs. 0.471) than the CDC. Conclusion: Therefore, the CCI could be a promising scoring system that could be used to identify risks in surgical patient groups.

ERAS Protocols for Thyroid and Parathyroid Surgery: A Systematic Review and Meta-analysis

2021 ◽  
pp. 019459982110196
Author(s):  
Kevin Chorath ◽  
Neil Luu ◽  
Beatrice C. Go ◽  
Alvaro Moreira ◽  
Karthik Rajasekaran
Keyword(s):  
Length Of Stay ◽  
Odds Ratio ◽  
Perioperative Management ◽  
Meta Analysis ◽  
Hospital Costs ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Complication Rates ◽  
Parathyroid Surgery ◽  
Inclusion Criteria

Objective Enhanced recovery after surgery (ERAS) protocols are evidenced-based multidisciplinary programs implemented in the perioperative setting to improve postoperative recovery and attenuate the surgical stress response. However, evidence on their effectiveness in thyroid and parathyroid surgery remains sparse. Therefore, our goal was to investigate the clinical benefits and cost-effectiveness of ERAS protocols for the perioperative management of thyroidectomy and parathyroidectomy. Data Source A systematic review of Medline, Scopus, Embase, and gray literature was performed to identify studies of ERAS or clinical care protocols for thyroidectomy and parathyroidectomy. Review Methods Two reviewers screened studies using predetermined inclusion criteria. Our primary outcomes included hospital length of stay and hospital costs. Readmission and postoperative complication rates composed our secondary outcomes. Meta-analysis was performed to compare outcomes for patients enrolled in the ERAS protocol versus standard of care. Results A total of 450 articles were identified; 7 (1.6%) met inclusion criteria with a total of 3082 patients. Perioperative components in ERAS protocols varied across the studies. Nevertheless, patients enrolled in ERAS protocols had reduced hospital length of stay (mean difference, –0.64 days [95% CI, −0.92 to −0.37]) and hospital costs (in US dollars; mean difference, –307.70 [95% CI, −346.49 to −268.90]), without an increase in readmission (odds ratio, 0.75 [95% CI, 0.29-1.94]) or complication rates (odds ratio, 1.14 [95% CI, 0.82-1.57]). Conclusion There is growing literature supporting the role of ERAS protocols for the perioperative management of thyroidectomy and parathyroidectomy. These protocols significantly reduce hospital length of stay and costs without increasing complications or readmission rates.

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