scholarly journals Thyroidectomy in a Surgical Volunteerism Mission: Analysis of 464 Consecutive Cases

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Rifat Latifi ◽  
Mahir Gachabayov ◽  
Shekhar Gogna ◽  
Renato Rivera
Keyword(s):  
Thyroid Surgery ◽  
Length Of Hospital Stay ◽  
Complication Rates ◽  
Risk Calculator ◽  
Improvement Program ◽  
Female Ratio ◽  
Surgical Risk ◽  
Surgical Mission ◽  
Safety Endpoint ◽  
Male To Female

Although surgical volunteer missions (SVMs) have become a popular approach for reducing the burden of surgical disease worldwide, the outcomes of specific procedures in the context of a mission are underreported. The aim of this study was to evaluate outcomes and efficiency of thyroid surgery within a surgical mission. This was a retrospective analysis of medical records of all patients who underwent thyroid surgery within a SVM from 2006 to 2019. Postoperative complication rate was the safety endpoint, whereas length of hospital stay (LOS) was the efficiency endpoint. Serious complications were defined as Clavien–Dindo class 3–5 complications. Expected safety and efficiency outcomes were calculated using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) surgical risk calculator and compared to their observed counterparts. A total of 464 thyroidectomies were performed during the study period. Mean age of the patients was 40.3 ± 10.8 years, and male-to-female ratio was 72 : 392. Expected overall (p=0.127) and serious complication rates (p=0.738) were not significantly different from their observed counterparts. Expected LOS was found to be significantly shorter as compared to its observed counterpart (0.6 ± 0.2 vs. 2.5 ± 1.0 days; p<0.001). This study found thyroid surgery performed within a surgical mission to be safe. NSQIP surgical risk calculator underestimates the LOS following thyroidectomy in surgical missions.

Examining the validity of the ACS-NSQIP Risk Calculator in plastic surgery: lack of input specificity, outcome variability and imprecise risk calculations

2016 ◽  
Vol 65 (3) ◽  
pp. 722-725 ◽  
Author(s):  
Cassandra Johnson ◽  
Insiyah Campwala ◽  
Subhas Gupta
Keyword(s):  
Plastic Surgery ◽  
Surgical Site Infections ◽  
Average Risk ◽  
Complication Rates ◽  
Risk Calculator ◽  
Improvement Program ◽  
Surgical Risk ◽  
Acs Nsqip ◽  
Study Population ◽  
The Difference

American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) created the Surgical Risk Calculator, to allow physicians to offer patients a risk-adjusted 30-day surgical outcome prediction. This tool has not yet been validated in plastic surgery. A retrospective analysis of all plastic surgery-specific complications from a quality assurance database from September 2013 through July 2015 was performed. Patient preoperative risk factors were entered into the ACS Surgical Risk Calculator, and predicted outcomes were compared with actual morbidities. The difference in average predicted complication rate versus the actual rate of complication within this population was examined. Within the study population of patients with complications (n=104), the calculator accurately predicted an above average risk for 20.90% of serious complications. For surgical site infections, the average predicted risk for the study population was 3.30%; this prediction was proven only 24.39% accurate. The actual incidence of any complication within the 4924 patients treated in our plastic surgery practice from September 2013 through June 2015 was 1.89%. The most common plastic surgery complications include seroma, hematoma, dehiscence and flap-related complications. The ACS Risk Calculator does not present rates for these risks. While most frequent outcomes fall into general risk calculator categories, the difference in predicted versus actual complication rates indicates that this tool does not accurately predict outcomes in plastic surgery. The ACS Surgical Risk Calculator is not a valid tool for the field of plastic surgery without further research to develop accurate risk stratification tools.

Comparative Analysis of Laparoscopic and Open Approaches in Emergency Abdominal Surgery

2017 ◽  
Vol 83 (10) ◽  
pp. 1089-1094
Author(s):  
Anaar Siletz ◽  
Jonathan Grotts ◽  
Catherine Lewis ◽  
Areti Tillou ◽  
Henry Magill Cryer ◽  
...  
Keyword(s):  
Open Surgery ◽  
Univariate Analysis ◽  
Length Of Hospital Stay ◽  
Complication Rates ◽  
Nursing Facilities ◽  
Improvement Program ◽  
Surgical Quality ◽  
Skilled Nursing ◽  
Academic Center ◽  
Indications For Operation

The objective of this study was to evaluate usage and outcomes of emergency laparoscopic versus open surgery at a single tertiary academic center. Over a three-year period 165 patients were identified retrospectively using National Surgical Quality Improvement Program results. Appendectomies and cholecystectomies were excluded. Open and laparoscopic approaches were compared regarding preoperative and operative characteristics, the development of postoperative complications, 30-day mortality, and length of hospital stay. Indications for operation were similar between groups. Patients who underwent open surgery had more severe comorbidities and higher ASA class. Laparoscopy was associated with reduced complication rates, operative time, length of stay, and discharges to skilled nursing facilities on univariate analysis. In a multivariate model, surgical approach was not associated with the development of complications. Older age, dependent status, and dyspnea were predictors of conversion from attempted laparoscopic to open approaches.

Assessment of the NSQIP Surgical Risk Calculator in Predicting Microvascular Head and Neck Reconstruction Outcomes

2018 ◽  
Vol 160 (1) ◽  
pp. 100-106 ◽  
Author(s):  
Yue Ma ◽  
Benjamin M. Laitman ◽  
Vir Patel ◽  
Marita Teng ◽  
Eric Genden ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Head And Neck ◽  
Area Under The Curve ◽  
Free Flaps ◽  
Hospital Length Of Stay ◽  
Head And Neck Reconstruction ◽  
Risk Calculator ◽  
Improvement Program ◽  
Surgical Risk ◽  
Neck Reconstruction

Objective This study evaluated the accuracy of the Surgical Risk Calculator (SRC) of the ACS NSQIP (American College of Surgeons National Surgical Quality Improvement Program) in predicting head and neck microvascular reconstruction outcomes. Study Design Retrospective analysis. Setting Tertiary medical center. Subjects and Methods A total of 561 free flaps were included in the analysis. The SRC-predicted 30-day rates of postoperative complications, hospital length of stay (LOS), and rehabilitation discharge were compared with the actual rates and events. The SRC’s predictive value was examined with Brier scores and receiver operating characteristic area under the curve. Results A total of 425 myocutaneous, 134 osseous (84 fibula, 47 scapula, and 3 iliac crest), and 2 omental free flaps were included in this study. All perioperative complications evaluated had area under the curve values ≤0.75, ranging from 0.480 to 0.728. All but 2 postoperative complications had Brier scores >0.01. SRC-predicted LOS was 9.4 ± 2.38 days (mean ± SD), which did not strongly correlate with the actual LOS of 11.98 ± 9.30 days ( r = 0.174, P < .0001). Conclusion The SRC is a poor predictor for surgical outcome among patients undergoing microvascular head and neck reconstruction.

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