Comparative Outcomes by Surgical Approach in Patients with Malignant Sinonasal Disease

2021 ◽  
Author(s):  
Nicholas R. Lenze ◽  
Carolyn Quinsey ◽  
Deanna Sasaki-Adams ◽  
Matthew G. Ewend ◽  
Brian D. Thorp ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Surgical Approach ◽  
Complication Rate ◽  
Perioperative Complications ◽  
Intraoperative Complications ◽  
Care Center ◽  
Tertiary Care ◽  
Undifferentiated Carcinoma ◽  
Open Approach ◽  
Sinonasal Disease

Abstract Objective There is a paucity of data on comparative outcomes for open versus endoscopic surgery for patients with malignant sinonasal pathology. Most of the available studies are limited by a sample size <100 patients. Design This is a retrospective cohort study. Setting The findings of this study come from a single-institution tertiary care center from 2008 to 2019. Participants In total, 199 patients who underwent surgery for malignant sinonasal disease participated in this study. Main Outcome Measures The main outcome measures were perioperative complications and reoperation. Results Patients in our sample had a mean age of 59.7 years (SD, 20.4). In total, 62% were male and 72% were white. An endoscopic-only approach was used in 41% of patients and an open or combined approach in 59% of patients. Squamous cell carcinoma was the most common pathology (43.0%), followed by sarcoma (9.5%), skin cancer (6.5%), sinonasal undifferentiated carcinoma (6.5%), and adenocarcinoma (5.5%). The all-cause complication rate was 14.6%. Patients with an open resection had a higher rate of intraoperative complications (5.9 vs. 0%; p = 0.043), postoperative complications (19.5 vs. 3.7%; p = 0.001), and all-cause complications (21.0 vs. 3.7%; p < 0.001). The likelihood of early reoperation (<6 months) or late reoperation (>6 months) did not significantly differ by surgical approach (p = 1.000 and 0.741, respectively). Conclusion The endoscopic approach for resection of malignant sinonasal disease is viable for select patients and may be associated with a favorable complication rate compared with the open approach.

Complications related to instrumentation in spine surgery: a prospective analysis

2011 ◽  
Vol 31 (4) ◽  
pp. E10 ◽  
Author(s):  
Peter G. Campbell ◽  
Sanjay Yadla ◽  
Jennifer Malone ◽  
Mitchell G. Maltenfort ◽  
James S. Harrop ◽  
...  
Keyword(s):  
Spinal Fusion ◽  
Spine Surgery ◽  
Perioperative Complications ◽  
Care Center ◽  
Tertiary Care ◽  
Benefit Analysis ◽  
History Of ◽  
Perioperative Complication ◽  
Definition Of ◽  
Risk Benefit Analysis

Object Prospective examination of perioperative complications in spine surgery is limited in the literature. The authors prospectively collected data on patients who underwent spinal fusion at a tertiary care center and evaluated the effect of spinal fusion and comorbidities on perioperative complications. Methods Between May and December 2008 data were collected prospectively in 248 patients admitted to the authors' institution for spine surgery. The 202 patients undergoing spine surgery with instrumentation were further analyzed in this report. Perioperative complications occurring within the initial 30 days after surgery were included. All adverse occurrences, whether directly related to surgery, were included in the analysis. Results Overall, 114 (56.4%) of 202 patients experienced at least one perioperative complication. Instrumented fusions were associated with more minor complications (p = 0.001) and more overall complications (0.0024). Furthermore, in the thoracic and lumbar spine, complications increased based on the number of levels fused. Advanced patient age and certain comorbidities such as diabetes, cardiac disease, or a history of malignancy were also associated with an increased incidence of complications. Conclusions Using a prospective methodology with a broad definition of complications, the authors report a significantly higher perioperative incidence of complications than previously indicated after spinal fusion procedures. Given the increased application of instrumentation, especially for degenerative disease, a better estimate of clinically relevant surgical complications could aid spine surgeons and patients in an individualized complication index to facilitate a more thorough risk-benefit analysis prior to surgery.

scholarly journals Short-term complication rate following orthopedic surgery in a tertiary care center in Argentina

SICOT-J ◽  
2018 ◽  
Vol 4 ◽  
pp. 26 ◽  
Author(s):  
Gaston Camino Willhuber ◽  
Joaquin Stagnaro ◽  
Matias Petracchi ◽  
Agustin Donndorff ◽  
Daniel Godoy Monzon ◽  
...  
Keyword(s):  
Orthopedic Surgery ◽  
Complication Rate ◽  
Care Center ◽  
Critical Role ◽  
Tertiary Care ◽  
Additional Treatment ◽  
Clinical Severity ◽  
Type I ◽  
Short Term ◽  
Start Time

Introduction: Registration of adverse events following orthopedic surgery has a critical role in patient safety and has received increasing attention. The purpose of this study was to determine the prevalence and severity of postoperative complications in the department of orthopedic unit in a tertiary hospital. Methods: A retrospective review from the postoperative complication registry of a cohort of consecutive patients operated in the department of orthopedic surgery from May 2015 to June 2016 was performed. Short-term complications (3 months after surgery), age gender, types of surgery (elective, scheduled urgency, non-scheduled urgency, and emergency), operative time, surgical start time (morning, afternoon or evening), American Society of Anesthesiologists score and surgeon's experience were assessed. Complications were classified based on their severity according to Dindo-Clavien system: Grade I complications do not require alterations in the postoperative course or additional treatment; Grade II complications require pharmacological treatment; Grade III require surgical, endoscopic, or radiological interventions without (IIIa) or with (IIIb) general anesthesia; Grade IV are life-threatening with single (IVa) or multi-organ (IVb) dysfunction(s), and require ICU management; and Grade V result in death of the patient. Complications were further classified in minor (Dindo I, II, IIIa) and major (Dindo IIIb, IVa, IVb and V), according to clinical severity. Results: 1960 surgeries were performed. The overall 90-day complication rate was 12.7% (249/1960). Twenty-three complications (9.2 %) were type I, 159 (63.8%) type II, 9 (3.6%) type IIIa, 42 (16.8%) type IIIb, 7 (2.8%) type IVa and 9 (3.6%) were grade V according to Dindo-Clavien classification (DCC). The most frequent complication was anemia that required blood transfusion (27%) followed by wound infection (15.6%) and urinary tract infection (6%). Discussion: The overall complication rate after orthopedic surgery in our department was 12.7%. The implementation of the DCC following orthopedic surgery was an important tool to measure the standard of care.

scholarly journals Open surgical approach to management of rhino-orbito-cerebral mucormycosis

2021 ◽  
Vol 8 (1) ◽  
pp. 64
Author(s):  
Sunil K. C. ◽  
Praveen Kumar B. Y. ◽  
Ramesh Bhoomannavar ◽  
Rishabh Jain
Keyword(s):  
Surgical Approach ◽  
Effective Means ◽  
Tertiary Care ◽  
Wound Dehiscence ◽  
Open Approach ◽  
Cross Sectional ◽  
Temporal Fossa ◽  
Co Morbidity ◽  
Facial Swelling ◽  
Open Surgical Approach

<p class="abstract"><strong>Background: </strong>Since December 2019, when novel corona virus (COVID 19) was reported, it has spread widely to cause a pandemic. Rhino-orbito-cerebral Mucormycosis (ROCM), an opportunistic fungal infection caused by the order Mucorales and class Zygomycetes has led to an epidemic in our country.</p><p class="abstract"><strong>Methods: </strong>This prospective cross sectional study was conducted at a 1200 bed tertiary care teaching hospital in Mysore. All patients of ROCM who presented to us for treatment were selected for the study after informed consent. Only those patients who were operated via open approach were included.</p><p class="abstract"><strong>Results:</strong> Median age of the patients was 50 years (SD±10). 49 were male patients (67.1%). Diabetes mellitus was the most common underlying co-morbidity seen in 71 patients (97.3%). Facial pain (100%) and facial swelling (90.4%) were the most common presenting complaint. KOH positivity from nasal swab for Mucormycosis was positive in only 37 patients (50.7%). Traditional inaccessible areas to endoscope like the premaxilla, lateral orbit cavity, infra temporal fossa and hard palate were tackled by the open surgical approach route. Advantages of open surgical approach being the access to areas which are traditionally difficult to approach via the endoscope, aggressive debridement is possible which might be challenging endoscopically. Complications like wound dehiscence, oro-antral fistula, osteomyelitis and abscess were noted in our study.</p><p class="abstract"><strong>Conclusions: </strong>Open surgical approach offers a very viable, affordable and a very effective means for aggressive surgical debridement of infection and reduce mortality associated with ROCM.</p><p> </p>

scholarly journals Single-site laparoscopy in gynecology: preliminary study of a series of 50 cases

2014 ◽  
Vol 60 (6) ◽  
pp. 548-554
Author(s):  
Admário Silva Santos Filho ◽  
Maurício Bechara Noviello ◽  
Rachel Cruz Fraga Damasceno ◽  
Evilane do Carmo Patrício ◽  
Lara Rodrigues Félix ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Single Port ◽  
Perioperative Complications ◽  
Care Center ◽  
Tertiary Care ◽  
Case Series ◽  
Invasive Technique ◽  
Surgical Morbidity ◽  
Single Port Laparoscopy ◽  
The Mean

Objective: to describe the initial experience of a gynecology team, at a tertiary care center, when performing single-port laparoscopic surgery. Methods: this is a retrospective study reviewing the medical records of 50 patients treated at the outpatient gynecology clinic of our institution between June 2012 and July 2013 who underwent single-port laparoscopic surgery. This study was approved by the institution’s Ethics in Research Committee. Results: the mean age of patients is 37.8 years, ranging from 18 to 70 years, and the most frequent surgical indications were adnexal mass (72%) and chronic pelvic pain (24%). The mean operative time was 94.4 minutes with a mean hospital stay of 25.8 hours. There were no perioperative complications. We recorded two conversions to laparotomy due to technical difficulties during the procedure. All cases of conversion had pelvic adhesions. All operative complications were successfully treated and none were considered severe. Conclusion: this is one of the largest case series in the literature regarding surgical treatment by single-port laparoscopy in gynecology and presents evidence on reduction of surgical morbidity and satisfactory cosmetic results. We conclude that single-port laparoscopy is a viable minimally invasive technique, and that it contributes to the construction of a new scenario in modern gynecological surgery.

Complications Related to Latarjet Shoulder Stabilization: A Systematic Review

2021 ◽  
pp. 036354652110423
Author(s):  
Chul-Hyun Cho ◽  
Sang Soo Na ◽  
Byung-Chan Choi ◽  
Du-Han Kim
Keyword(s):  
Systematic Review ◽  
Complication Rate ◽  
Shoulder Instability ◽  
Intraoperative Complications ◽  
Cochrane Library ◽  
Anterior Shoulder Instability ◽  
Complication Rates ◽  
Open Approach ◽  
Latarjet Procedure ◽  
Intraoperative Complication

Background: In cases of recurrent anterior shoulder instability with a glenoid defect, Latarjet procedures are widely used for stabilization. Although complications with this procedure have been reported, few studies have comprehensively analyzed issues related to the Latarjet procedure. Purpose: To identify the overall complication rate of the Latarjet procedure used for anterior shoulder instability and to compare the rate of complications between arthroscopic and open approaches. Study Design: Systematic review; Level of evidence, 4. Methods: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed by using the PubMed, EMBASE, Scopus, and Cochrane Library databases. Data on complications were extracted and classified as intraoperative, postoperative, or instability-related for further analysis. Quality assessments were performed with criteria from the Methodological Index for Nonrandomized Studies (MINORS). A quantitative synthesis of data was conducted to compare the complication rates between arthroscopic and open approaches. Results: A total of 35 articles were included in this analysis. The MINORS score was 11.89. A total 2560 Latarjet procedures (2532 patients) were included. The overall complication rate was 16.1% (n = 412). The intraoperative complication rate was 3.4% (n = 87) and included a 1.9% (n = 48) incidence of nerve injuries and a 1.0% (n = 25) incidence of iatrogenic fractures. Screw problems, vascular injuries, and conversion arthroscopic to open surgery each occurred at a rate of <1%. The postoperative complication rate was 6.5% (n = 166), and the most common complication was nonunion (1.3%; n = 33). The instability-related complication rate was 6.2% (n = 159) and included a 1.5% (n = 38) rate of redislocation, a 2.9% (n = 75) rate of positive apprehension test, and a 1.0% (n = 26) rate of instability. Overall, 2.6% (n = 66) of patients required an unplanned secondary operation after the initial surgery. The arthroscopic approach was associated with a higher rate of intraoperative complications compared with the open approach (5.0% vs 2.9%; P =.020) and a lower rate of instability-related complications (3.1% vs 7.2%; P < .001). Conclusion: The Latarjet procedure for anterior shoulder instability results in an overall complication rate of 16.1% and a reoperation rate of 2.6%. However, serious complications at short-term follow-up appear rare. When the arthroscopic approach was used, the rate of intraoperative complications was higher, although instability-related complications were lower when compared with the open approach.

scholarly journals Pregnancy Rate after Controlled Ovarian Hyperstimulation and Intrauterine Insemination for the Treatment of Endometriosis following Surgery

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Attila Keresztúri ◽  
Zoltan Kozinszky ◽  
József Daru ◽  
Norbert Pásztor ◽  
János Sikovanyecz ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Outcome Measures ◽  
Live Birth ◽  
Intrauterine Insemination ◽  
Care Center ◽  
Tertiary Care ◽  
Controlled Ovarian Hyperstimulation ◽  
Control Group ◽  
Ovarian Hyperstimulation ◽  
Significant Difference

Objective. To compare pregnancy rate after controlled ovarian hyperstimulation and intrauterine insemination (COH-IUI) with no treatment in patients with endometriosis-associated infertility treated with laparoscopy.Design. A clinical cohort study.Setting. University-level tertiary care center.Patients. 238 women with various stages of endometriosis after laparoscopic treatment.Interventions. Either COH-IUI or follow-up for 12 months.Main Outcome Measures. The primary outcome measures were clinical pregnancy and live birth rate. Predictive factors evaluated were female age, maternal BMI, and duration of infertility.Results. The pregnancy rate attained after the integrated laparoscopy–COH-IUI approach was 53.4%, while it was significantly lower (38.5%) in the control group. Similarly, a significant difference was observed in live births (48.3% versus 34.2%). Patients with severe endometriosis were less likely to achieve pregnancy (38%) and live birth (35%) than their counterparts with milder forms (57% and 53%).Conclusions. In patients with endometriosis-based infertility, surgery followed by COH-IUI is more effective than surgery alone.

Hypospadias Repair at a Tertiary Care Center: Long-Term Followup is Mandatory to Determine the Real Complication Rate

2013 ◽  
Vol 189 (6) ◽  
pp. 2276-2281 ◽  
Author(s):  
Anne-Françoise Spinoit ◽  
Filip Poelaert ◽  
Luitzen-Albert Groen ◽  
Erik Van Laecke ◽  
Piet Hoebeke
Keyword(s):  
Complication Rate ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
Hypospadias Repair ◽  
The Real

Three-Dimensional Exoscopic Temporal Bone Resections for Advanced Head and Neck Cancer

2021 ◽  
Author(s):  
Mallory Raymond ◽  
Roberto M. Soriano ◽  
Ryan Belcher ◽  
Gustavo Pradilla ◽  
C. Arturo Solares
Keyword(s):  
Head And Neck ◽  
Temporal Bone ◽  
Intraoperative Complications ◽  
Care Center ◽  
Tertiary Care ◽  
Three Dimensional ◽  
Case Series ◽  
Oncologic Outcomes ◽  
Recurrence Time ◽  
Operative Microscope

Abstract Objectives The three-dimensional (3D) exoscope has several advantages over the operative microscope (OM) but has not been extensively reported for its use in malignant temporal bone resections (TBR). We sought to demonstrate the feasibility of performing TBR, both lateral (LTBR) and subtotal (STBR), using the 3D exoscope for head and neck cancers. Design present study is a retrospective chart review from August 2016 until August 2019. Setting The study was conducted at a tertiary care center. Participants Patients were undergoing TBR with the Karl Storz VITOM 3D exoscope. Main Outcome Measures Demographics, tumor and surgical characteristics, patient outcomes were the primary measurements of this study. Results Fifty-five patients underwent 3D exoscopic TBR from 2016 through 2019 of which 18% (n = 10) underwent STBR. The 3D exoscope was used uninterruptedly in all procedures with no intraoperative complications. Most tumors were primarily T3 (42%, n = 23) or T4 (55%, n = 30) and of cutaneous (62%, n = 34) and parotid (27%, n = 15) origin. These TBR were often accompanied by infratemporal fossa resections (87%, n = 48), auriculectomies (47%, n = 26), mandibulectomies (53%, n = 29), and parotidectomies (96%, n = 53). On final pathology, 24% (n = 13) had microscopically positive margins. Over the study period, 20% (n = 11) of patients had recurrences with a median recurrence time of 5 months (range: 2–30 months). Conclusion In the largest case series of LTBR and STBR under exclusive 3D exoscopic visualization to date, we demonstrate the 3D exoscope is a feasible alternative to the operative microscope for LTBR and STBR. While oncologic outcomes remain to be clarified, it carries significant potential for use in complex oncologic procedures.

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