Extended Length of Stay in Elderly Patients after Anterior Cervical Discectomy and Fusion Is Not Attributable to Baseline Illness Severity or Postoperative Complications

2018 ◽  
Vol 115 ◽  
pp. e552-e557 ◽  
Author(s):  
Owoicho Adogwa ◽  
Daniel T. Lilly ◽  
Victoria D. Vuong ◽  
Shyam A. Desai ◽  
Bichun Ouyang ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Length Of Stay ◽  
Elderly Patients ◽  
Illness Severity ◽  
Anterior Cervical Discectomy ◽  
Cervical Discectomy ◽  
Extended Length

Outcomes of elderly stage I lung cancer patients treated with segmentectomy via video assisted thoracoscopic surgery or open resection.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 7543-7543 ◽  
Author(s):  
Cardinale B. Smith ◽  
Grace Mhango ◽  
Juan P. Wisnivesky
Keyword(s):  
Lung Cancer ◽  
Postoperative Complications ◽  
Length Of Stay ◽  
Propensity Score ◽  
Elderly Patients ◽  
Stage I ◽  
Oncologic Outcomes ◽  
Perioperative Mortality ◽  
Icu Admission ◽  
Extended Length

7543 Background: Video-assisted thoracic surgery (VATS) is considered an alternative to open lobectomy for the treatment of non-small cell lung cancer (NSCLC). Limited data is available however, regarding the equivalence of open vs. VATS segmental resections, particularly among elderly patients. In this study, we used population-based data to compare postoperative and oncologic outcomes following open vs. VATS segmentectomy for early NSCLC. Methods: We identified all stage I NSCLC patients >65 year treated with VATS or open segmentectomy from the Surveillance, Epidemiology, and End Results registry linked to Medicare claims. We used propensity score methods to control for differences in the baseline characteristics of patients. Overall and lung cancer-specific survival of patients treated with VATS vs. open segmentectomy was compared after adjusting, stratifying, or matching patients based on their propensity score. We performed secondary analyses evaluating perioperative complications, need for intensive care unit (ICU) admission, extended length of stay, and perioperative mortality. These were repeated adjusting for physician characteristics (sociodemographics, specialty, and procedure volume). Results: Of the 577 study patients, 27% underwent VATS resection. VATS were mostly performed by high volume surgeons (p<0.001). Overall (hazard ratio [HR]: 0.80, 95% CI: 0.60-1.06) and lung cancer-specific (HR: 0.71, 95% CI: 0.45-1.12) survival was similar among treatment groups. VATS-treated patients had lower rates of postoperative complications (odds ratio [OR]: 0.55, 95% confidence interval [CI]: 0.37-0.83), need for ICU admission (OR: 0.18, 95% CI: 0.12-0.28), and decreased length of stay (OR: 0.41, 95% CI: 0.41-0.81) after adjusting for propensity scores. The distribution of all postoperative complications, ICU admission, extended length of stay, and perioperative mortality was not significantly different across groups after adjusting for surgeon characteristics. Conclusions: VATS segmentectomy can be safely performed among elderly patients with early stage NSCLC and is associated with equivalent postoperative and long-term oncologic outcomes.

Anterior Cervical Discectomy and Fusion Provides Better Surgical Outcomes Than Posterior Laminoplasty in Elderly Patients With C3-4 Level Myelopathy

Spine ◽  
2017 ◽  
Vol 42 (8) ◽  
pp. 548-555 ◽  
Author(s):  
Koji Tamai ◽  
Hidetomi Terai ◽  
Akinobu Suzuki ◽  
Hiromitsu Toyoda ◽  
Masatoshi Hoshino ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Surgical Outcomes ◽  
Anterior Cervical Discectomy ◽  
Cervical Discectomy

Neuraxial anaesthesia is associated with improved outcomes and reduced postoperative complications in patients undergoing aseptic revision total hip arthroplasty

2020 ◽  
pp. 112070002097574
Author(s):  
Chapman Wei ◽  
Alex Gu ◽  
Arun Muthiah ◽  
Safa C Fassihi ◽  
Peter K Sculco ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Total Hip Arthroplasty ◽  
Length Of Stay ◽  
General Anaesthesia ◽  
Hip Arthroplasty ◽  
Postoperative Outcomes ◽  
Complication Rates ◽  
Total Hip ◽  
Neuraxial Anaesthesia ◽  
Extended Length

Background: As the incidence of primary total hip arthroplasty (THA) continues to increase, revision THA (rTHA) is becoming an increasingly common procedure. rTHA is widely regarded as a more challenging procedure, with higher complication rates and increased medical, social and economic burdens when compared to its primary counterpart. Given the complexity of rTHA and the projected increase in incidence of these procedures, patient optimisation is becoming of interest to improve outcomes. Anaesthetic choice has been extensively studied in primary THA as a modifiable risk factor for postoperative outcomes, showing favourable results for neuraxial anaesthesia compared to general anaesthesia. The impact of anaesthetic choice in rTHA has not been studied previously. Methods: A retrospective study was performed using the American College of Surgeons National Surgical Quality Improvement Program database. Patients who underwent rTHA between 2014 and 2017 were divided into 3 anaesthesia cohorts: general anaesthesia, neuraxial anaesthesia, and combined general-regional (neuraxial and/or peripheral nerve block) anaesthesia. Univariate and multivariate analyses were used to analyse patient characteristics and 30-day postoperative outcomes. Bonferroni correction was applied for post-hoc analysis. Results: In total, 5759 patients were identified. Of these, 3551 (61.7%) patients underwent general anaesthesia, 1513 (26.3%) patients underwent neuraxial anaesthesia, and 695 (12.1%) patients underwent combined general-regional anaesthesia. On multivariate analysis, neuraxial anaesthesia was associated with decreased odds for any-one complication (OR 0.635; p  < 0.001), perioperative blood transfusion (OR 0.641; p  < 0.001), and extended length of stay (OR 0.005; p = 0.005) compared to general anaesthesia. Conclusions: Relative to those receiving general anaesthesia, patients undergoing neuraxial anaesthesia are at decreased risk for postoperative complications, perioperative blood transfusions, and extended length of stay. Prospective controlled trials should be conducted to verify these findings.

Comparative analysis of anterior cervical discectomy and fusion in the inpatient versus outpatient surgical setting

2019 ◽  
Vol 31 (2) ◽  
pp. 255-260 ◽  
Author(s):  
Dil V. Patel ◽  
Joon S. Yoo ◽  
Brittany E. Haws ◽  
Benjamin Khechen ◽  
Eric H. Lamoutte ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Setting ◽  
Outpatient Setting ◽  
Anterior Cervical Discectomy ◽  
Cervical Discectomy ◽  
Arm Pain ◽  
Pain Scores ◽  
Comorbidity Burden ◽  
Chi Square Analysis ◽  
Surgical Setting

OBJECTIVEIn a large, consecutive series of patients treated with anterior cervical discectomy and fusion (ACDF) performed by a single surgeon, the authors compared the clinical and surgical outcomes of patients who underwent ACDF in an inpatient versus outpatient setting.METHODSPatients undergoing primary ACDF were retrospectively reviewed and stratified by surgical setting: hospital or ambulatory surgical center (ASC). Data regarding perioperative characteristics, including hospital length of stay and complications, were collected. Neck Disability Index (NDI) and visual analog scale (VAS) scores were used to analyze neck and arm pain in the preoperative period and at 6 weeks, 3 months, 6 months, and 12 months postoperatively. Postoperative outcomes were compared using chi-square analysis and linear regression.RESULTSThe study included 272 consecutive patients undergoing a primary ACDF, of whom 172 patients underwent surgery at a hospital and 100 patients underwent surgery at an ASC. Patients undergoing ACDF in the hospital setting were older, more likely to be diabetic, and had a higher comorbidity burden. Patients receiving treatment in the ASC were more likely to carry Workers’ Compensation insurance. Patients in the hospital cohort were more likely to have multilevel procedures, had greater blood loss, and experienced a longer length of stay. In the hospital cohort, 48.3% of patients were discharged within 24 hours, while 43.0% were discharged between 24 and 48 hours after admission. Both cohorts had similar VAS pain scores on postoperative day (POD) 0; however, the hospital cohort consumed more narcotics on POD 0. One patient in the ASC cohort had a pretracheal hematoma that was evacuated immediately in the same surgical center. There were 8 cases of dysphagia in the hospital cohort and 3 cases in the ASC cohort, all of which resolved before the 6-month follow-up. Both cohorts demonstrated similar NDI and VAS neck and arm pain scores preoperatively and at every postoperative time point.CONCLUSIONSAlthough patients undergoing ACDF in the hospital setting were older, had a greater comorbidity burden, and underwent surgery on more levels than patients undergoing ACDF at an outpatient center, this study demonstrated comparable surgical and clinical outcomes for both patient groups. Based on the results of this single surgeon’s experience, 1- to 2-level ACDFs may be performed successfully in the outpatient setting in appropriately selected patient populations.

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