Predictors for Unfavorable Early Outcomes in Elective Total Hip Arthroplasty: Does Extreme Body Mass Index Matter?

Background. Studies of previous cohorts have demonstrated a controversial association between extreme body mass index (BMI) and complication rates following total hip arthroplasty (THA). The purpose of this study was to compare 30-day perioperative complications in underweight (BMI <18.50 kg/m2), normal-weight (BMI 18.50–24.99 kg/m2), overweight (BMI 25.00–29.99 kg/m2), class I obesity (BMI 30.00–34.99 kg/m2), and morbidly obese (BMI ≥35.00 kg/m2) groups. Methods. We performed a cohort study including patients who underwent unilateral primary THA by a single surgeon between January 2010 and December 2015 at our institution. We assessed 30-day complications, operation time, operative blood loss, and length of hospital stay. Results. We identified 1565 primary THAs that were performed in patients with varying BMI levels. Compared with the normal-weight patients, the morbidly obese group had a higher 30-day complication rate (8.9% vs. 2.4%), longer operative time (79 minutes vs. 70 minutes), and more blood loss (376 mL vs. 302 mL). Underweight patients did not present any 30-day complications, and there were no differences among underweight and normal-weight patients regarding complication rates, operative time, or blood loss. The mean length of hospital stay was comparable among the different BMI groups. In the multivariate regression model, higher BMI was not associated with a higher risk of 30-day complications. Independent risk factors for 30-day complications were advanced age, prolonged operative time, and cardiovascular comorbidities. Conclusion. Although increased operative time, blood loss, and perioperative complications were seen in the morbidly obese patients, BMI alone was not an independent risk factor for a higher 30-day complication rate. Therefore, our data suggest clinicians should make elderly patients aware of increased 30-day complications before the procedure, particularly those with cardiovascular comorbidities. Withholding THA solely on the basis of BMI is not justified.

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The impact of surgeon experience on perioperative complications and operative measures following thoracolumbar 3-column osteotomy for adult spinal deformity: overcoming the learning curve

Journal of Neurosurgery Spine ◽

10.3171/2019.7.spine19656 ◽

2020 ◽

Vol 32 (2) ◽

pp. 207-220 ◽

Cited By ~ 4

Author(s):

Darryl Lau ◽

Vedat Deviren ◽

Christopher P. Ames

Keyword(s):

Blood Loss ◽

Operative Time ◽

Surgical Complication ◽

Perioperative Complications ◽

Adult Spinal Deformity ◽

Neurological Deficits ◽

Complication Rates ◽

Years Of Experience ◽

Surgeon Experience ◽

Operative Measures

OBJECTIVEPosterior-based thoracolumbar 3-column osteotomy (3CO) is a formidable surgical procedure. Surgeon experience and case volume are known factors that influence surgical complication rates, but these factors have not been studied well in cases of adult spinal deformity (ASD). This study examines how surgeon experience affects perioperative complications and operative measures following thoracolumbar 3CO in ASD.METHODSA retrospective study was performed of a consecutive cohort of thoracolumbar ASD patients who underwent 3CO performed by the senior authors from 2006 to 2018. Multivariate analysis was used to assess whether experience (years of experience and/or number of procedures) is associated with perioperative complications, operative duration, and blood loss.RESULTSA total of 362 patients underwent 66 vertebral column resections (VCRs) and 296 pedicle subtraction osteotomies (PSOs). The overall complication rate was 29.4%, and the surgical complication rate was 8.0%. The rate of postoperative neurological deficits was 6.2%. There was a trend toward lower overall complication rates with greater operative years of experience (from 44.4% to 28.0%) (p = 0.115). Years of operative experience was associated with a significantly lower rate of neurological deficits (p = 0.027); the incidence dropped from 22.2% to 4.0%. The mean operative time was 310.7 minutes overall. Both increased years of experience and higher case numbers were significantly associated with shorter operative times (p < 0.001 and p = 0.001, respectively). Only operative years of experience was independently associated with operative times (p < 0.001): 358.3 minutes from 2006 to 2008 to 275.5 minutes in 2018 (82.8 minutes shorter). Over time, there was less deviation and more consistency in operative times, despite the implementation of various interventions to promote fusion and prevent construct failure: utilization of multiple-rod constructs (standard, satellite, and nested rods), bone morphogenetic protein, vertebroplasty, and ligament augmentation. Of note, the use of tranexamic acid did not significantly lower blood loss.CONCLUSIONSSurgeon years of experience, rather than number of 3COs performed, was a significant factor in mitigating neurological complications and improving quality measures following thoracolumbar 3CO for ASD. The 3- to 5-year experience mark was when the senior surgeon overcame a learning curve and was able to minimize neurological complication rates. There was a continuous decrease in operative time as the surgeon’s experience increased; this was in concurrence with the implementation of additional preventative surgical interventions. Ongoing practice changes should be implemented and can be done safely, but it is imperative to self-assess the risks and benefits of those practice changes.

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Evaluating the safety of two human experimental intestinal ischemia reperfusion models: A retrospective observational study

PLoS ONE ◽

10.1371/journal.pone.0253506 ◽

2021 ◽

Vol 16 (6) ◽

pp. e0253506

Author(s):

Inca H. R. Hundscheid ◽

Dirk H. S. M. Schellekens ◽

Joep Grootjans ◽

Marcel Den Dulk ◽

Ronald M. Van Dam ◽

...

Keyword(s):

Colorectal Surgery ◽

Blood Loss ◽

Hospital Stay ◽

Pancreatic Surgery ◽

Intestinal Ischemia ◽

Operative Time ◽

Ischemia Reperfusion ◽

Length Of Hospital Stay ◽

Secondary Outcome ◽

Complication Rates

Background We developed a jejunal and colonic experimental human ischemia-reperfusion (IR) model to study pathophysiological intestinal IR mechanisms and potential new intestinal ischemia biomarkers. Our objective was to evaluate the safety of these IR models by comparing patients undergoing surgery with and without in vivo intestinal IR. Methods A retrospective study was performed comparing complication rates and severity, based on the Clavien-Dindo classification system, in patients undergoing pancreatoduodenectomy with (n = 10) and without (n = 20 matched controls) jejunal IR or colorectal surgery with (n = 10) and without (n = 20 matched controls) colon IR. Secondary outcome parameters were operative time, blood loss, 90-day mortality and length of hospital stay. Results Following pancreatic surgery, 63% of the patients experienced one or more postoperative complications. There was no significant difference in incidence or severity of complications between patients undergoing pancreatic surgery with (70%) or without (60%, P = 0.7) jejunal IR. Following colorectal surgery, 60% of the patients experienced one or more postoperative complication. Complication rate and severity were similar in patients with (50%) and without (65%, P = 0.46) colonic IR. Operative time, amount of blood loss, postoperative C-reactive protein, length of hospital stay or mortality were equal in both intervention and control groups for jejunal and colon IR. Conclusion This study showed that human experimental intestinal IR models are safe in patients undergoing pancreatic or colorectal surgery.

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Anterior Thoracolumbar Corpectomies: Approach Morbidity With and Without an Access Surgeon

Neurosurgery ◽

10.1227/neu.0b013e31820eb287 ◽

2011 ◽

Vol 68 (5) ◽

pp. 1220-1226 ◽

Cited By ~ 9

Author(s):

Seunggu J. Han ◽

Darryl Lau ◽

Daniel C. Lu ◽

Pierre Theodore ◽

Dean Chou

Keyword(s):

Blood Loss ◽

Complication Rate ◽

Operative Time ◽

Length Of Hospital Stay ◽

Final Analysis ◽

Senior Author ◽

Neurological Function ◽

Complication Rates ◽

Significant Morbidity ◽

Neurological Outcomes

Abstract BACKGROUND: Anterior approaches for thoracolumbar corpectomies can have significant morbidity. Spine surgeons have historically performed their own anterior approaches, but recently access surgeons are being used more frequently. OBJECTIVE: To evaluate the morbidity rates of approaches performed by an access surgeon and by an approach-trained spinal neurosurgeon. METHODS: From 2004 to 2008, 46 patients undergoing anterior thoracolumbar corpectomies (levels T2-L5) by the senior author (D.C.) were identified and subdivided into 2 groups based on whether an access surgeon was involved. Nine patients were excluded, leaving 37 patients in the final analysis. Blood loss, operative times, length of hospital stay, complications, and neurological outcomes were evaluated. RESULTS: Eighteen patients had anterior spinal access by an approach-trained spinal neurosurgeon, and 19 patients underwent the approach by an access surgeon. Surgeries performed by the spinal neurosurgeon alone were comparable to those performed by an access surgeon with respect to operative time, days spent in the hospital, blood loss, complication rates, and improvement in neurological function. CONCLUSION: There appears to be no increased morbidity of anterior approaches performed by an approach-trained spinal neurosurgeon compared with approaches performed by an access surgeon in terms of operative time, complication rate, and improvement in neurological function.

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The Impact of Body Mass Index on Perioperative Outcomes of Robotic Adrenalectomy: An Update

Surgical Innovation ◽

10.1177/1553350619858854 ◽

2019 ◽

Vol 26 (6) ◽

pp. 687-691 ◽

Cited By ~ 2

Author(s):

Orhan Agcaoglu ◽

Melis Akbas ◽

Murat Ozdemir ◽

Ozer Makay

Keyword(s):

Body Mass Index ◽

Robotic Surgery ◽

Blood Loss ◽

Operative Time ◽

Length Of Hospital Stay ◽

Perioperative Outcomes ◽

Total Operative Time ◽

Estimated Blood Loss ◽

Robotic Adrenalectomy ◽

The Impact

Background. Robotic surgery has gained increasing popularity over the past 2 decades. However, factors including patient comorbidities and tumor characteristics are still crucial factors for outcomes of surgery. In this study, we evaluated the impact of body mass index (BMI) on perioperative outcomes in patients who underwent robotic adrenal surgery. Methods. Between May 2012 and November 2017, 66 consecutive patients who underwent robotic adrenalectomy were included in this study. Patients were divided into 2 groups based on their BMI: nonobese (<30 kg/m2) and obese (≥30 kg/m2). Additionally, patient demographics, tumor size, total operative time, docking time, console time, estimated blood loss, conversion to open, complications, additional analgesia requirement, length of hospital stay, and rough costs were evaluated. Results. Of the 66 patients, a total of 26 patients were obese (30%). Between study groups, the median BMI was calculated as 26 (18-29) and 33 (30-57). The groups were similar in terms of age, gender, American Society of Anesthesiologists scores, and previous history of abdominal surgery. Likewise, there were no significant differences between groups regarding total operative time ( P = .085), docking time ( P = .196), console time ( P = .211), estimated blood loss ( P = .180), complications ( P = .991), length of hospital stay ( P = .598), and rough costs ( P = .468). Five cases were converted to open surgery. Nonobese cases required additional analgesia ( P = .007). We had no unexpected hospitalizations in either group. Conclusion. Guidelines express the advantages of robotic surgery in obese patients. No statistically significant differences were detected between the 2 groups except for the additional analgesia required in nonobese patients.

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Body mass index and in-hospital postoperative complications following primary total hip arthroplasty

Hip International ◽

10.1177/1120700017754058 ◽

2018 ◽

Vol 28 (6) ◽

pp. 613-621 ◽

Cited By ~ 4

Author(s):

Usha Gurunathan ◽

Cameron Anderson ◽

Kate E Berry ◽

Sarah L Whitehouse ◽

Ross W Crawford

Keyword(s):

Body Mass Index ◽

Postoperative Complications ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Perioperative Complications ◽

Operating Time ◽

Normal Weight ◽

Cardiac Complications ◽

Lower Odds ◽

Obese Class

Background: The influence of obesity measured in terms of body mass index (BMI) on the complication rates following total hip arthroplasty (THA) is a matter of debate. Methods: This retrospective study conducted at a tertiary referral centre at Brisbane, Australia, examines the association between BMI and in-hospital postoperative complications, length of operating time and duration of hospital stay in 964 patients, who underwent THA from 2006 to 2010. Results: Amongst patients undergoing primary THA, when compared to the normal weight patients, those with BMI between 25 kg/m2 and 29.9 kg/m2 (overweight) and those with BMI between 35 kg/m2 and 39.9 kg/m2 (obese class II) had lower odds of perioperative complications (odds ratio [OR]: 0.62 (95% confidence intervals [CI], 0.43–0.92, p = 0.016) and OR: 0.60 (95% CI, 0.36– 0.99, p = 0.047 respectively). Patients with BMI less than or equal to 40 kg/m2 were also associated with significantly lower odds of cardiac complications ( p = 0.02). With unadjusted regression analysis, it was noted that those with BMI ≥40 kg/m2 had the highest odds of developing infectious complications (OR 2.68, 95% CI, 1.08–6.65, p < 0.05). As the BMI increased, there was a statistically significant increase in length of operating time ( p < 0.001). Conclusion: There is a significant impact of BMI on the occurrence of perioperative complications following THA. Compared to normal weight category, the overweight and obese class II patients had a lower likelihood of developing overall, especially cardiac complications. Length of operating time increases along with an increase in BMI.

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The effect of body mass index on 30-day complications after total hip arthroplasty

Hip International ◽

10.1177/1120700019826482 ◽

2019 ◽

Vol 30 (2) ◽

pp. 125-134 ◽

Cited By ~ 3

Author(s):

William Scully ◽

Nicolas S Piuzzi ◽

Nipun Sodhi ◽

Assem A Sultan ◽

Jaiben George ◽

...

Keyword(s):

Body Mass Index ◽

Total Hip Arthroplasty ◽

Body Mass ◽

Hip Arthroplasty ◽

Surgical Complications ◽

Joint Infection ◽

Continuous Variable ◽

Normal Weight ◽

Morbidly Obese ◽

Total Hip

Background:Evaluating body mass index (BMI) as a continuous variable eliminates the potential pitfalls of only considering BMI as a binary or categorical variable, as most studies do when correlating BMI and total hip arthroplasty (THA) outcomes. Therefore, the objective of this study was to correlate the effect of continuous BMI on 30-day complications post-THA. Specifically, we correlated BMI to: (1) 30-day readmissions and reoperations; (2) medical complications; and (3) surgical complications in: (a) normal-weight; (b) over-weight; (c) obese; and (d) morbidly obese patients.Methods:Using the NSQIP database, 93,598 primary THAs were identified. 30-day rates of readmissions, reoperations, and medical/surgical complications as well as patient BMI data were extrapolated. A comparative analysis using univariate, multivariate, and spline regression models adjusting for demographics and comorbidities were created to study the continuous effect of BMI on different outcomes.Results:Readmission ( p < 0.001), reoperation ( p = 0.007), superficial infection ( p = 0.003), prosthetic joint infection ( p < 0.001), and sepsis ( p = 0.026) had a J-shaped relationship with BMI, with the lowest rates seen in patients with BMI around 28 kg/m2. The risks of mortality ( p = 0.007) and transfusion ( p < 0.001) had a reverse J-shaped relationship, with the risk steadily decreasing for BMIs in the normal weight and overweight range, and then flattening afterwards.Conclusion:This data proposes a multifactorial effect of BMI on post-THA complications. Considering BMI as a continuous variable allows for a better assessment when considering the interplay between modifiable risk factors, such as smoking or alcohol use, as well as multiple comorbidities.

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Diabetes is predictive of longer hospital stay and increased rate of Clavien complications in spinal surgery in the UK

Annals of The Royal College of Surgeons of England ◽

10.1308/003588413x13511609958299 ◽

2013 ◽

Vol 95 (4) ◽

pp. 275-279 ◽

Cited By ~ 7

Author(s):

A Sharma ◽

R Muir ◽

R Johnston ◽

E Carter ◽

G Bowden ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Spinal Surgery ◽

Operative Time ◽

Length Of Hospital Stay ◽

Complication Rates ◽

Co Morbidity ◽

Patients With Diabetes ◽

Clavien Grade ◽

The Uk

Introduction Diabetes is a common co-morbidity of patients undergoing spinal surgery in the UK but there are no published studies from the UK, particularly with respect to length of hospital stay and complications. The aims of this study were to identify complications and length of hospital stay in patients with diabetes undergoing spinal surgery. Methods Data were collected retrospectively for 111 consecutive patients with diabetes (and 97 age and sex matched control patients, identified using computer records) who underwent spinal surgery between 2004 and 2010 in a single centre. The data collected included operative time, blood loss, details of surgery, Clavien complications and length of hospital stay. Results No significant differences were found by group in operative time, blood loss, instrumentation, use of graft or revision surgery. Overall complication rates were higher in the patients with diabetes than in the controls (28.8% vs 15.5%). The mean hospital stay was significantly longer for patients with diabetes than for control patients (4.6 vs 3.2 days, p<0.001). Conclusions This study identified a significantly higher Clavien grade I complication rate and length of hospital stay in patients with diabetes undergoing spinal surgery than control patients (p=0.02). This has resulted in a predictive model being generated. Of note, no infections were seen in patients with diabetes, suggesting that infection rates in this particular group of patients undergoing spinal surgery might not be as high as considered previously.

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Minimally Invasive versus Open Approach for Cervical Laminoforaminotomy

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100011446 ◽

2011 ◽

Vol 38 (2) ◽

pp. 262-267 ◽

Cited By ~ 37

Author(s):

Mark J. Winder ◽

Kenneth C. Thomas

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Hospital Stay ◽

Operative Time ◽

Length Of Hospital Stay ◽

Radicular Pain ◽

Complication Rates ◽

Open Approach ◽

Cervical Foraminotomy ◽

Analgesic Use

Background:Minimally invasive posterior cervical foraminotomy for radicular symptoms has become more prevalent. The reported experience with microscopic tubular assisted posterior cervical laminoforaminotomy (MTPF) for the treatment of radicular pain is lacking. Tubular assisted techniques have been considered to offer significant benefit, over open procedures, in terms of minimizing tissue damage, operative time, blood loss, analgesic requirements and length of hospital stay. We hypothesized that MTPF reduces post-operative analgesic requirements and length of hospital stay over the traditional open laminoforaminotomy, with no difference in complication rates and, secondly, that MTPF is comparable to endoscopic posterior foraminotomy (EPF).Methods:We conducted a retrospective review of 107 patients who underwent posterior cervical laminoforaminotomy for radicular pain between 1999 and 2009. Patient demographics, intra-operative parameters, length of hospitalization, post-operative analgesic use, complications and short-term neurological outcome were compared between groups.Results:Between 1999 and 2009, a total of 107 patients were identified to have undergone a cervical foraminotomy. An open approach was used in 65 patients, while 42 underwent MTPF. Operative time and complications were comparable between groups. Significant differences favoring MTPF were observed in operative blood loss, post-operative analgesic use and length of hospital stay (p<0.001). All results were comparable to previous reports utilizing EPF.Conclusions:MTPF for the treatment of cervical radiculopathy significantly reduces blood loss, post-operative analgesic use and length of hospital stay compared to the standard open approach. Operative time and complication rates were comparable between both techniques, whilst MTPF offered similar results compared to EPF.

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Robotically Assisted Hysterectomy versus Vaginal Hysterectomy for Benign Disease: A Prospective Study

Minimally Invasive Surgery ◽

10.1155/2013/429105 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

M. Carbonnel ◽

H. Abbou ◽

H. T. N’Guyen ◽

S. Roy ◽

G. Hamdi ◽

...

Keyword(s):

Blood Loss ◽

Prospective Study ◽

Hospital Stay ◽

Vaginal Hysterectomy ◽

Operative Time ◽

Group Versus ◽

Length Of Hospital Stay ◽

Benign Disease ◽

Post Surgery ◽

A Prospective Study

Objectives. A prospective study was carried out to compare vaginal hysterectomy (VH) and robotically assisted hysterectomy (RH) for benign gynecological disease.Materials and Methods. All patients who underwent hysterectomy from March 2010 to March 2012 for a benign disease were included. Patients’ demographics per and post surgery results were collected from medical files. A questionnaire was also conducted 2 months after surgery.Results. Sixty patients were included in the RH group and thirty four in the VH one. Operative time was significantly longer in the RH group ( versus min; ). Blood loss and length of hospital stay were significantly reduced: versus ml; , and versus days; , respectively. Less pain was reported at D1 and D2 by RH patients, and levels of analgesia were lower compared to those observed in the VH group. No differences were found regarding the rate of conversion to laparotomy, intra- or postoperative complications.Conclusion. Robotically assisted hysterectomy appears to reduce blood loss, postoperative pain, and length of hospital stay, but it is associated with longer operative time and higher cost. Specific indications for RH remain to be defined.

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STANDARD OPEN MICRODISCECTOMY VERSUS MINIMAL ACCESS TROCAR MICRODISCECTOMY

Neurosurgery ◽

10.1227/01.neu.0000311075.56486.c5 ◽

2008 ◽

Vol 62 (1) ◽

pp. 174-182 ◽

Cited By ~ 71

Author(s):

Yu-Mi Ryang ◽

Markus F. Oertel ◽

Lothar Mayfrank ◽

Joachim M. Gilsbach ◽

Veit Rohde

Keyword(s):

Blood Loss ◽

Visual Analog Scale ◽

Oswestry Disability Index ◽

Operative Time ◽

Short Form ◽

Lumbar Disc ◽

Complication Rates ◽

Minimal Access ◽

Analog Scale ◽

Short Form 36

Abstract OBJECTIVE Minimal access surgery as a less invasive alternative to standard macro- and microsurgical approaches is becoming increasingly popular in the management of traumatic and degenerative spine diseases. However, data is lacking if minimal access spine surgery is indeed beneficial. This prospective randomized study was conducted to compare efficiency, safety, and outcome of standard open microsurgical discectomy (SOMD) for lumbar disc herniation with microsurgical discectomy using an 11.5 mm trocar system for minimal access to the spine. METHODS Sixty patients were randomized to two groups of 30 patients each. Group 1 was treated by SOMD, and Group 2 was treated by minimal access microsurgical discectomy (MAMD). Perioperative parameters and pre- and postoperative clinical findings including sensory or motor deficits and pain according to the visual analog scale, Oswestry Disability Index scores, and Short Form-36 results were assessed. All patients were followed for at least 6 months postoperatively (mean, 16 mo). RESULTS Preoperatively, no statistically significant intergroup differences could be detected proving the comparability of both groups. Postoperatively, significant improvement of neurological symptoms and pain as measured by the visual analog scale, Oswestry Disability Index, and Short Form-36 scores could be achieved in both groups. In regard to operative time, intraoperative blood loss, and complication rate, slightly better results were observed in the MAMD group. CONCLUSION SOMD and MAMD allow achievement of significant improvement of pain and neurological deficits in patients with lumbar disc herniations. Differences in operative time, blood loss, and complication rates were statistically not significant in MAMD compared with SOMD, indicating that, at least in lumbar disc surgery, minimal access trocar techniques are a viable alternative to standard spinal approaches.

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