Estimated blood loss and blood transfusion are significant predictors of hospital length of stay and long-term survival in patients undergoing pancreatectomy

142 Background: Survival after multimodality treatment of localized esophageal cancer depends upon complex interactions between the patient, tumor biology, and treatment factors. The National Cancer Database (NCDB) was used to analyze prognostic factors to identify areas for treament optimization. Methods: 8,072 patients with localized esophageal cancer treated with neoadjuvant therapy undergoing surgical resection between 2004 and 2006 were identified from the NCDB. Covariates were analyzed for association with survival using univariate and multivariate Cox models. Results: A multiviariate Cox proportional hazards model was constructed, with the following significant factors predictive of survival. (See Table.) Survival varied markedly based upon the annual surgical volume of esophageal resection performed at the hospital. For hospitals performing 5 or fewer esophageal resections per year (15% of cases), 5-year survival was 40.0%, compared with 48.6% for hospitals performing 20 or greater (26% of cases). Hospital length of stay after surgery also profoundly affected survival. For patients with a post-operative length of stay of less than 14 days, 5-year survival was 40% and median survival 39.1 months. Median survival was 28 months, 19 months, and 15 months in patients with a hospital length of stay of 14-21 days, 21-28 days, and greater than 28 days, respectively. Conclusions: Data from the NCDB confirms the association between perioperative events and long-term survival after resection for esophageal cancer. Given the wide variance in outcomes based upon perioperative treatment factors, future improvements in outcomes are unlikely to be dramatically influenced by optimization of chemotherapy and radiation therapy. Improvement in outcomes of the treatment of esophageal cancer will likely require understanding how the perioperative period influences long-term survival, which should drive priorities for research and treatment improvement. [Table: see text]

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Endoscopic transnasal/transoral odontoid resection in children: results of a combined neurosurgical and otolaryngological protocolized, institutional approach

Journal of Neurosurgery Pediatrics ◽

10.3171/2020.12.peds20729 ◽

2021 ◽

pp. 1-8

Author(s):

Rajiv R. Iyer ◽

J. Fredrik Grimmer ◽

Douglas L. Brockmeyer

Keyword(s):

Length Of Stay ◽

Blood Loss ◽

Pediatric Population ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Endoscopic Endonasal ◽

Sleep Study ◽

Average Hospital ◽

Institutional Approach ◽

Estimated Blood Loss

OBJECTIVE Odontogenic ventral brainstem compression can be a source of significant morbidity in patients with craniocervical disease. The most common methods for odontoidectomy are the transoral and endoscopic endonasal routes. In this study, the authors investigated the use of an institutional protocol for endoscopic transnasal/transoral odontoidectomy in the pediatric population. METHODS From 2007 to 2017, a multidisciplinary institutional protocol was developed and refined for the evaluation and treatment of pediatric patients requiring odontoidectomy. Preoperative assessment included airway evaluation, a sleep study (if indicated), discussion of possible tonsillectomy/adenoidectomy, and thorough imaging review by the neurosurgery and otolaryngology teams. Further preoperative anesthesia consultation was obtained for difficult airways. Intraoperatively, adenoidectomy was performed at the discretion of otolaryngology. The odontoidectomy was performed as a combined procedure. Primary posterior pharyngeal closure was performed by the otolaryngologist. The postoperative protocol called for immediate extubation, advancement to a soft diet at 24 hours, and no postoperative antibiotics. Outcome variables included time to extubation, operative time, estimated blood loss, hospital length of stay, and postoperative complications. RESULTS A total of 13 patients underwent combined endoscopic transoral/transnasal odontoid resection with at least 3 years of follow-up. All patients had stable to improved neurological function in the postoperative setting. All patients were extubated immediately after the procedure. The average operative length was 201 ± 46 minutes, and the average estimated blood loss was 44.6 ± 40.0 ml. Nine of 13 patients underwent simultaneous tonsillectomy and adenoidectomy. The average hospital length of stay was 6.6 ± 5 days. The first patient in the series required revision surgery for removal of a small residual odontoid. One patient experienced pharyngeal flap dehiscence requiring revision. CONCLUSIONS A protocolized, institutional approach for endoscopic transoral/transnasal odontoidectomy is described. The use of a combined, multidisciplinary approach leads to streamlined patient management and favorable outcomes in this complex patient population.

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