scholarly journals Editorial Commentary: The Latarjet: Increased Shoulder Stability, and Increased Risk of Complications in Low Volume Practitioners

2021 ◽  
Vol 37 (3) ◽  
pp. 814-815 ◽  
Author(s):  
Benjamin G. Guevara
Keyword(s):  
Editorial Commentary ◽  
Increased Risk ◽  
Low Volume ◽  
Shoulder Stability

Can Gleason 7 prostate cancer ever be low-risk? Results from the Shared Equal Access Regional Cancer Hospital (SEARCH) database.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 57-57
Author(s):  
Kathleen F. McGinley ◽  
Xizi Sun ◽  
Lauren E. Howard ◽  
William J. Aronson ◽  
Martha K. Terris ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Low Risk ◽  
Pathological Features ◽  
Inclusion Criteria ◽  
Logistic Regression Models ◽  
Risk Criteria ◽  
Increased Risk ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer ◽  
Low Volume

57 Background: Overtreatment of low-risk prostate cancer (PC) is a major issue. Increasing use of active surveillance (AS) will ease this burden. Limited data are available on including men with intermediate risk PC (i.e. Gleason 7) into AS protocols. We examined if a subset of men with Gleason 7 (3+4) PC could be reasonable AS candidates. Methods: We used SEARCH to identify men who had radical prostatectomy from 2001-13 with >8 cores on biopsy and complete data. We compared men who fulfilled low-risk disease criteria (cT1c/T2a; biopsy Gleason ≤6; PSA ≤10 ng/mL) with the exception of biopsy Gleason 7 (3+4) vs. men who met all 3 low-risk criteria. Logistic regression models were used to test the association between biopsy Gleason 3+4 vs. ≤6 and pathological features. Biochemical recurrence (BCR) was examined using multivariable Cox hazards analysis adjusted for clinical and demographic features. To examine if there was a subset of men with low-volume Gleason 7 who would have comparable outcomes to low-risk men, we repeated all analyses limiting the percent positive cores to ≤ 33% and positive cores to ≤ 4, ≤ 3, or ≤ 2. Results: 885 men met inclusion criteria: 505 had low-risk PC and 380 had Gleason 7 low-risk PC. Overall, the Gleason 7 low-risk men had increased risk of pathological Gleason ≥4+3 (p<0.001), positive margins (p=0.069), extracapsular extension (p<0.001), and seminal vesicle invasion (p<0.001) on univariable analysis. Men in the Gleason 7 low-risk group had significantly higher BCR risk (HR 1.65, p=0.004). Analyses were repeated using increasingly strict definitions of low-volume PC. With the exception of higher pathological Gleason score (p<0.001), at ≤3 positive cores, there was no difference in adverse pathological features between groups (all p>0.1). Among men with ≤3 positive cores who met the other low-risk criteria (cT1c/T2a; PSA ≤10 ng/mL), BCR risk was similar in men with Gleason 6 or Gleason 7 (3+4) (HR 1.30; p=0.347) PC. Conclusions: Among men with PSA≤10 ng/mL and stage cT1c/T2a, those with Gleason 7 (3+4) PC in ≤3 positive cores have similar rates of adverse pathology and BCR as men with Gleason ≤6 PC. This finding may expand inclusion criteria of AS protocols to reduce PC overtreatment.

scholarly journals Association between institutional case volume and mortality following thoracic aorta replacement: A nationwide Korean cohort study

2020 ◽  
Author(s):  
Karam Nam ◽  
Eun Jin Jang ◽  
Jun Woo Jo ◽  
Jae Woong Choi ◽  
Minkyoo Lee ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Thoracic Aorta ◽  
Postoperative Mortality ◽  
Administrative Database ◽  
Case Volume ◽  
Replacement Surgery ◽  
Increased Risk ◽  
Aorta Replacement ◽  
Low Volume ◽  
The Impact

Abstract Background The inverse relationship between case volume and postoperative mortality following high-risk surgical procedures have been reported. Thoracic aorta surgery is associated with one of the highest postoperative mortality. The relationship between institutional case volume and postoperative mortality in patients undergoing thoracic aorta replacement surgery was evaluated. Methods All thoracic aorta replacement surgeries performed in Korea between 2009 and 2016 in adult patients were analyzed using an administrative database. Hospitals were divided into low (<30 cases/year), medium (30–60 cases/year), or high (>60 cases/year) volume centers depending on the annual average number of thoracic aorta replacement surgeries performed. The impact of case volume on in-hospital mortality was assessed using the logistic regression. Results Across 83 hospitals, 4867 cases of thoracic aorta replacement were performed. In-hospital mortality was 8.6% (191/2222), 10.7% (77/717), and 21.9% (422/1928) in high, medium, and low volume centers, respectively. The adjusted risk of in-hospital mortality was significantly higher in medium (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.16–2.11, P = 0.004) and low volume centers (OR, 3.12; 95% CI, 2.54–3.85, P <0.001) compared to high volume centers. Conclusions Patients who had underwent thoracic aorta replacement surgery in lower volume centers had increased risk of in-hospital mortality after surgery compared to those in higher volume centers. Our results may provide the basis for minimum case volume requirement or regionalization in thoracic aorta replacement surgery for optimal patient outcome.

Design of a Muscle-Powered Extra-Aortic Counterpulsation Device for Long-Term Circulatory Support

2017 ◽  
Author(s):  
Edgar Aranda-Michel ◽  
Jooli Han ◽  
Dennis R. Trumble
Keyword(s):  
Heart Failure ◽  
Ventricular Assist Devices ◽  
Blood Pump ◽  
Circulatory Support ◽  
Pump Design ◽  
Persistent Problem ◽  
Therapeutic Benefits ◽  
Increased Risk ◽  
Low Volume

While great strides continue to be made in the treatment of congestive heart failure using mechanical ventricular assist devices (VADs), several longstanding difficulties associated with pumping blood continue to limit their long-term use. Among the most troublesome has been the persistent risk of clot formation at the blood-device interface, which generally requires VAD recipients to undergo costly — and potentially dangerous — anticoagulation therapy for the duration of the implant. Another serious and persistent problem with long-term use of these pumps is the increased risk of infection associated with the use of percutaneous drivelines. To address these issues we are currently exploring a new approach to blood pump design that aims to solve both these problems by avoiding them altogether. Toward that end, we propose to harness the body’s own endogenous energy stores in order to eliminate the need to transmit energy across the skin. Further, we intend to transfer the energy from this internal power source to the circulation without contacting the blood to obviate the thrombogenic risks imposed by devices placed directly into the bloodstream. To power the implant we will employ a device developed previously by our group called a muscle energy converter (MEC), shown in Figure 1. The MEC is, in essence, an implantable hydraulic actuator powered by the latissimus dorsi (LD) muscle with the capacity to transmit up to 1.37 joules of contractile work per stroke [1]. By training the muscle to express fatigue-resistant oxidative fibers and stimulating the LD to contract in coordination with the cardiac cycle, the MEC captures and transmits this contractile energy as a high-pressure low-volume (5 cc) hydraulic pulse that can be used, in principle, to actuate an implanted pulsatile blood pump. The goal of this research is to use the low-volume output of the MEC to drive a polymer-based aortic compression device for long-term circulatory support. In this context it is important to note that the idea of applying a counterpulsation device around the ascending aorta is not new. Indeed, this approach has been validated by clinical trials recently completed by Sunshine Heart Inc. showing that displacing 20 cc of blood at the aortic root has significant therapeutic benefits [2]. Unfortunately, while the pneumatic ‘C-Pulse’ device solves the blood-contacting problem, it suffers from the same limitations as traditional VADs — i.e., driveline infections. The device described here achieves the same volumetric displacement as the SSH device via geometric amplification of MEC outputs. Thus, through this mechanism we believe the low-volume power output of the MEC can be used to support heart failure patients while addressing the major limitations associated with long-term VAD use.

Primary Surgery vs Radiotherapy for Early Stage Oral Cavity Cancer

2017 ◽  
Vol 158 (4) ◽  
pp. 649-659 ◽  
Author(s):  
Mark A. Ellis ◽  
Evan M. Graboyes ◽  
Amy E. Wahlquist ◽  
David M. Neskey ◽  
John M. Kaczmar ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Oral Cavity ◽  
Cox Regression ◽  
Early Stage ◽  
Multivariable Analysis ◽  
Cox Regression Analysis ◽  
Factors Associated ◽  
Primary Surgery ◽  
Increased Risk ◽  
Low Volume

Objective The goal of this study is to determine the effect of primary surgery vs radiotherapy (RT) on overall survival (OS) in patients with early stage oral cavity squamous cell carcinoma (OCSCC). In addition, this study attempts to identify factors associated with receiving primary RT. Study Design Retrospective cohort study. Setting National Cancer Database (NCDB, 2004-2013). Subjects and Methods Reviewing the NCDB from 2004 to 2013, patients with early stage I to II OCSCC were identified. Kaplan-Meier estimates of survival, Cox regression analysis, and propensity score matching were used to examine differences in OS between primary surgery and primary RT. Multivariable logistic regression analysis was performed to identify factors associated with primary RT. Results Of the 20,779 patients included in the study, 95.4% (19,823 patients) underwent primary surgery and 4.6% (956 patients) underwent primary RT. After adjusting for covariates, primary RT was associated with an increased risk of mortality (adjusted hazard ratio [aHR], 1.97; 99% confidence interval [CI], 1.74-2.22). On multivariable analysis, factors associated with primary RT included age ≥70 years, black race, Medicaid or Medicare insurance, no insurance, oral cavity subsite other than tongue, clinical stage II disease, low-volume treatment facilities, and earlier treatment year. Conclusion Primary RT for early stage OCSCC is associated with increased mortality. Approximately 5% of patients receive primary RT; however, this percentage is decreasing. Patients at highest risk for receiving primary RT include those who are elderly, black, with public insurance, and treated at low-volume facilities.

Geographic and racial disparities in the utilization of low-volume cystectomy hospitals for bladder cancer.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 302-302
Author(s):  
Martin Francis Casey ◽  
Tal Gross ◽  
Kristian D. Stensland ◽  
William K. Oh ◽  
Matt D. Galsky
Keyword(s):  
New York ◽  
Bladder Cancer ◽  
Racial Disparities ◽  
High Volume ◽  
The United States ◽  
Travel Distance ◽  
Increased Risk ◽  
Low Volume ◽  
The Impact ◽  
Over Time

302 Background: Extensive research has demonstrated volume-outcome benefits for select cancer surgeries, such as cystectomy. However, barriers to the use of high volume cystectomy hospitals have not been comprehensively explored. Methods: The New York Statewide Planning and Research Cooperative System was utilized to obtain data on all inpatients who underwent cystectomy for bladder cancer from 1997-2011. Volume status was defined by dividing patients into quintiles based on the number of cystectomies performed by each hospital in 1997-2001. Multiple logistic regression was used to assess the impact of distance and race on use of low volume hospitals. Driving distances were calculated using a geographic information system. Race was stratified by the racial profile of a subject’s community to explore the underlying causes of racial disparities. Results: A cohort of 8,712 cystectomy patients was identified. The number of available high volume hospitals increased over time, consistent with regionalization of surgeries. Minimum travel distance to high volume hospitals decreased over time for the general population, but living >21 miles still increased risk for low volume hospital utilization (see Table). Racial disparities were most prominent among blacks living in black communities, despite generally living closer to high volume hospitals (median travel distance of 5.3 miles versus 16.6 miles for whites living in white communities). Conclusions: Regionalization of cystectomies has occurred in New York State, as has been observed in multiple other regions of the United States. However, geographic and racial disparities exist in the use of high volume cystectomy hospitals. [Table: see text]

Factors independently associated with increased risk of pain development after ophthalmic surgery

2004 ◽  
Vol 21 (2) ◽  
pp. 101-106
Author(s):  
D. Henzler ◽  
R. Kramer ◽  
U. H. Steinhorst ◽  
S. Piepenbrock ◽  
R. Rossaint ◽  
...  
Keyword(s):  
Ophthalmic Surgery ◽  
Increased Risk
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