scholarly journals Anal Sphincteroplasty in the Minimally Invasive Era: Assessment of National Trends and Complications

2019 ◽  
Vol 85 (1) ◽  
pp. 46-51 ◽  
Author(s):  
Evgeniy I. Kreydin ◽  
Zaid Q. Chaudhry ◽  
Kevork K. Kazanjian ◽  
Anne Y. Lin
Keyword(s):  
Fecal Incontinence ◽  
Wound Dehiscence ◽  
Patient Characteristics ◽  
The United States ◽  
Perioperative Outcomes ◽  
National Study ◽  
Wound Complications ◽  
Patient Counseling ◽  
Novel Therapy ◽  
Anal Sphincteroplasty

Fecal incontinence is a debilitating and underreported condition. Despite introduction of novel therapies in recent years, anal sphincteroplasty (AS) remains the surgical choice for certain patients. Previous reports have primarily focused on single-surgeon or single-center experience with AS. The purpose of this study was to assess patient characteristics and perioperative outcomes of AS using a national cohort. Patients (n = 586) who underwent AS as a primary procedure between 2009 and 2015 were identified by the CPT code as recorded in the study and were evaluated and examined for association with 30-day complications. The number of sphincteroplasties performed decreased seven-fold between 2009 and 2015. Wound infection, wound dehiscence, and urinary tract infection were the most common complications, occurring in 30 (5.1%), 12 (2.1%), and 6 (1%) patients, respectively. Preoperative steroid use and surgeon specialty were associated with wound complications on multivariate analysis. We present the first national study of patients undergoing AS and identify factors that predispose to wound complications. In addition, we demonstrate that the number of anal sphincteroplasties performed in the United States is decreasing dramatically, likely because of novel therapy for fecal incontinence. We hope that this study will assist in patient counseling and call attention to preserving surgical training as utilization of AS rapidly declines.

scholarly journals P100 EARLY POSTOPERATIVE WOUND COMPLICATIONS AFTER MIDLINE LAPAROTOMY CLOSURE WITH SMALL BITES TECHNIQUE: EXPERIENCE FROM A TERTIARY REFERRAL CENTRE

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Adomas Gudelis ◽  
Gintaras Simutis ◽  
Julius Pacevicius
Keyword(s):  
Abdominal Wall ◽  
Surgical Site Infections ◽  
Wound Dehiscence ◽  
Patient Characteristics ◽  
University Hospital ◽  
Wound Complications ◽  
Tertiary Referral Centre ◽  
Midline Laparotomy ◽  
Group A ◽  
Wound Length

Abstract Aim To analyze the incidence and risk factors of surgical site infections (SSI) and wound dehiscence (WD) after closure of primary midline laparotomies with small-bites (SB) technique. Material and Methods Retrospective analysis using hospital prospective database of all midline abdominal wall closures (AWC) with SB technique performed in a University Hospital between December 2019 and February 2021. To achieve a proper protocol of AWC with SB technique, it is advised to have suture/wound length (SL/WL) – ratio of more than 4:1. Statistical analysis of the incidence of SSI and AWD, comparing the results when the protocol was properly used (A group) or not (B group), was performed. Between groups, no relevant differences were observed for patient characteristics. Results A total of 108 midline laparotomies were included for analysis. 55.5% of patients were male. The mean age was 62.8 years, mean body mass index was 24.3 kg/m2. 78.7% (85/108) were operated electively. SSI and WD have been recorded in 7 (6.5%) and 8 (7,4%) cases respectively. In 65 (60,2%) patients abdominal wall closure after primary laparotomy was achieved with proper protocol (group A). Median SL/WL in A and B group was 4.57 and 3.43 respectively. The rate of WD in A group (n = 1, 1,5%) was significantly (P=.006) lower than in B group (n = 7, 16,3%). Incidence of SSI was 7,7% (n = 5, A group) vs. 4,7% (n = 2; B group) (P=.420). Conclusions Using a proper AWC protocol has been effective to prevent WD in midline laparotomy.

Tissue Oximetry Readings Accurately Predict Late Complications in Patients Undergoing Free Flap Breast Reconstruction: Exploring the Optimal Cut Point Value

2020 ◽  
Vol 36 (07) ◽  
pp. 534-540 ◽  
Author(s):  
Noah Saad ◽  
Howard Wang ◽  
Efstathios Karamanos
Keyword(s):  
Breast Reconstruction ◽  
Free Flap ◽  
Free Tissue Transfer ◽  
Wound Dehiscence ◽  
The United States ◽  
Late Complications ◽  
Wound Complications ◽  
The Mean ◽  
Initial Reading ◽  
Tissue Oximetry

Abstract Background The use of tissue oximetry for monitoring following free tissue transfer has become a common practice across the United States to facilitate early detection of poor flap perfusion in the postoperative setting. There is no consensus on the optimal value, below which there is a higher chance of wound complications in patients undergoing free flap breast reconstruction. Methods Patients undergoing free flap breast reconstruction from 2015 to 2018 were retrospectively reviewed. Patients who returned to the operating room for a revision of the anastomosis were excluded from analysis. Patients were divided in two groups based on the development of late complications. Those were defined as fat necrosis, wound dehiscence, or distal flap ischemia/necrosis that developed after discharge from the hospital. Mean percutaneous oximetry readings of the first 24 hours were recorded and the mean change from the initial reading was calculated. The correlation between tissue oximetry change and development of complications was explored. Results A total of 120 patients were identified. The mean age was 53, while the mean body mass index was 33. A total of 38 patients developed late wound complication. History of smoking, diabetes mellitus, neoadjuvant radiation therapy, and the mean change of the tissue oximetry reading were identified as independent predictors of wound complications. The absolute number of the tissue oximetry reading did not predict late complications. A multivariate analysis revealed that patients who experienced a mean decrease < 15% from the initial reading during the first 24 hours were significantly more likely to develop late flap-related wound complications. Conclusion In patients undergoing free tissue breast reconstruction, tissue oximetry readings do not predict late wound complications. However, the mean change at 24 hours from the initial reading does. A decrease of <15% in tissue perfusion was associated with a significant increase in the probability of developing flap-related wound complications.

scholarly journals Surgery for primary supratentorial brain tumors in the United States, 2000–2009: effect of provider and hospital caseload on complication rates

2015 ◽  
Vol 122 (2) ◽  
pp. 280-296 ◽  
Author(s):  
Victoria T. Trinh ◽  
Jason M. Davies ◽  
Mitchel S. Berger
Keyword(s):  
Brain Tumors ◽  
Hospital Mortality ◽  
High Volume ◽  
Patient Characteristics ◽  
The United States ◽  
Hospital Charges ◽  
Wound Complications ◽  
Complication Rates ◽  
Primary Brain Tumors ◽  
Supratentorial Brain Tumors

OBJECT The object of this study was to examine how procedural volume and patient demographics impact complication rates and value of care in those who underwent biopsy or craniotomy for supratentorial primary brain tumors. METHODS The authors conducted a retrospective cohort study using data from the Nationwide Inpatient Sample (NIS) on 62,514 admissions for biopsy or resection of supratentorial primary brain tumors for the period from 2000 to 2009. The main outcome measures were in-hospital mortality, routine discharge proportion, length of hospital stay, and perioperative complications. Associations between these outcomes and hospital or surgeon case volumes were examined in logistic regression models stratified across patient characteristics to control for presentation of disease and comorbid risk factors. The authors further computed value of care, defined as the ratio of functional outcome to hospital charges. RESULTS High-case-volume surgeons and hospitals had superior outcomes. After adjusting for patient characteristics, high-volume surgeon correlated with reduced complication rates (OR 0.91, p = 0.04) and lower in-hospital mortality (OR 0.43, p < 0.0001). High-volume hospitals were associated with reduced in-hospital mortality (OR 0.76, p = 0.003), higher routine discharge proportion (OR 1.29, p < 0.0001), and lower complication rates (OR 0.93, p = 0.04). Patients treated by high-volume surgeons were less likely to experience postoperative hematoma, hydrocephalus, or wound complications. Patients treated at high-volume hospitals were less likely to experience mechanical ventilation, pulmonary complications, or infectious complications. Worse outcomes tended to occur in African American and Hispanic patients and in those without private insurance, and these demographic groups tended to underutilize high-volume providers. CONCLUSIONS A high-volume status for hospitals and surgeons correlates with superior value of care, as well as reduced in-hospital mortality and complications. These findings suggest that regionalization of care may enhance patient outcomes and improve value of care for patients with primary supratentorial brain tumors.

scholarly journals Association between hospital surgical volume and perioperative outcomes of fertility-sparing trachelectomy for cervical cancer: A national study in the United States

2020 ◽  
Vol 157 (1) ◽  
pp. 173-180 ◽  
Author(s):  
Koji Matsuo ◽  
Shinya Matsuzaki ◽  
Rachel S. Mandelbaum ◽  
Kazuhide Matsushima ◽  
Maximilian Klar ◽  
...  
Keyword(s):  
United States ◽  
Cervical Cancer ◽  
The United States ◽  
Perioperative Outcomes ◽  
National Study ◽  
Surgical Volume ◽  
Fertility Sparing

Migration for Mission

2019 ◽  
Author(s):  
Mary Johnson ◽  
Patricia Wittberg ◽  
Mary Gautier ◽  
Thu Do
Keyword(s):  
United States ◽  
Qualitative Data ◽  
The United States ◽  
National Study ◽  
Catholic Sisters ◽  
Long Line ◽  
Catholic Organizations ◽  
To Come ◽  
Washington University ◽  
The Trinity

This book presents quantitative and qualitative data from the first-ever national study of international Catholic sisters in the United States, the Trinity Washington University/CARA Study. International sisters are defined as those born outside the United States and currently ministering, studying, or in residence in this country. The book begins with a chapter that locates current international sisters in the long line of sisters who have come to this country since the eighteenth century. The book identifies the sisters of today, describes the pathways they used to come here, their levels of satisfaction, their concerns and contributions, the issue of immigration status, the challenges of sister students, and the role and mission of Catholic organizations assisting immigrants in general, and international sisters in particular. The book ends with implications of the research and recommendations regarding resources, ministries, and structures of support for international sisters.

The Oxford Handbook of Integrative Health Science

2018 ◽  
Keyword(s):  
Adult Life ◽  
The United States ◽  
Sociodemographic Factors ◽  
Population Based ◽  
Health Science ◽  
National Study ◽  
Integrative Health ◽  
Social Structural ◽  
Research Population ◽  
Psychosocial Influences

This handbook signals a paradigm shift in health research. Population-based disciplines have employed large national samples to examine how sociodemographic factors contour rates of morbidity and mortality. Behavioral and psychosocial disciplines have studied the factors that influence these domains using small, nonrepresentative samples in experimental or longitudinal contexts. Biomedical disciplines, drawing on diverse fields, have examined mechanistic processes implicated in disease outcomes. The collection of chapters in this handbook embraces all such prior approaches and, via targeted questions, illustrates how they can be woven together. Diverse contributions showcase how social structural influences work together with psychosocial influences or experiential factors to impact differing health outcomes, including profiles of biological risk across distinct physiological systems. These varied biopsychosocial advances have grown up around the Midlife in the United States (MIDUS) national study of health, begun over 20 years ago and now encompassing over 12,000 Americans followed through time. The overarching principle behind the MIDUS enterprise is that deeper understanding of why some individuals remain healthy and well as they move across the decades of adult life, while others succumb to differing varieties of disease, dysfunction, or disability, requires a commitment to comprehensiveness that attends to the interplay of multiple interacting influences. Put another way, all of the disciplines mentioned have reliably documented influences on health, but in and of themselves, each is inherently limited because it neglects factors known to matter for health outside the discipline’s purview. Integrative health science is the alternative seeking to overcome these limitations.

scholarly journals Abdominal Flap Necrosis and Wound Dehiscence following a Medical Tourist Tummy Tuck

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Vladislav Pavlovich Zhitny ◽  
Noama Iftekhar ◽  
Peter Caravella ◽  
Jake Patrick Young ◽  
Barry Zide ◽  
...  
Keyword(s):  
Skin Necrosis ◽  
Wound Dehiscence ◽  
The United States ◽  
Abdominal Wound ◽  
Flap Necrosis ◽  
Aesthetic Result ◽  
Self Image ◽  
To Receive ◽  
Medical Tourist ◽  
Incision Drainage

Abdominoplasty is a major surgical procedure met with high rates of patient satisfaction and improved self-image. While many patients are lured abroad due to discounted prices for such highly requested procedures, unfortunately, there are also associated complications. A 47-year-old woman presented due to abdominal scar dehiscence due to skin necrosis secondary to a discounted abdominoplasty in Mexico. The patient had been turned away by several local surgical centers for treatment of the necrosis. The patient underwent incision, drainage, and two debridements before her abdominal wound was eventually closed. Patient recovered well postoperatively with improved aesthetic result. With the rise of social media advertisements, more patients elect to receive plastic surgery abroad. Unfortunately, many of these practices are not accurately vetted and this can complicate the postoperative care especially upon return to the United States.

Increased Prevalence, Complications, and Costs of Smokers Undergoing Total Knee Arthroplasty

2020 ◽  
Author(s):  
Sean S. Rajaee ◽  
Eytan M. Debbi ◽  
Guy D. Paiement ◽  
Andrew I. Spitzer
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Smoking Status ◽  
Hospital Costs ◽  
Patient Characteristics ◽  
The United States ◽  
Bundled Payment ◽  
Vein Thrombosis ◽  
Total Knee ◽  
Payment Models

AbstractGiven a national push toward bundled payment models, the purpose of this study was to examine the prevalence as well as the effect of smoking on early inpatient complications and cost following elective total knee arthroplasty (TKA) in the United States across multiple years. Using the nationwide inpatient sample, all primary elective TKA admissions were identified from 2012 to 2014. Patients were stratified by smoking status through a secondary diagnosis of “tobacco use disorder.” Patient characteristics as well as prevalence, costs, and incidence of complications were compared. There was a significant increase in the rate of smoking in TKA from 17.9% in 2012 to 19.2% in 2014 (p < 0.0001). The highest rate was seen in patients < 45 years of age (27.3%). Hospital resource usage was significantly higher for smokers, with a length of stay of 3.3 versus 2.9 days (p < 0.0001), and hospital costs of $16,752 versus $15,653 (p < 0.0001). A multivariable logistic model adjusting for age, gender, and comorbidities showed that smokers had an increased odds ratio for myocardial infarction (5.72), cardiac arrest (4.59), stroke (4.42), inpatient mortality (4.21), pneumonia (4.01), acute renal failure (2.95), deep vein thrombosis (2.74), urinary tract infection (2.43), transfusion (1.38) and sepsis (0.65) (all p < 0.0001). Smoking is common among patients undergoing elective TKA, and its prevalence continues to rise. Smoking is associated with higher hospital costs as well as higher rates of immediate inpatient complications. These findings are critical for risk stratification, improving of bundled payment models as well as patient education, and optimization prior to surgery to reduce costs and complications.

Robotic Pneumonectomy for Lung Cancer: Perioperative Outcomes and Factors Leading to Conversion to Thoracotomy

2021 ◽  
pp. 155698452097822
Author(s):  
Byron D. Patton ◽  
Daniel Zarif ◽  
Donna M. Bahroloomi ◽  
Iam C. Sarmiento ◽  
Paul C. Lee ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Statistical Significance ◽  
Patient Characteristics ◽  
Perioperative Outcomes ◽  
Safe Procedure ◽  
Open Approach ◽  
Robotic Approach ◽  
Robotic Group ◽  
Robot Assisted ◽  
Estimated Blood Loss

Objective In the tide of robot-assisted minimally invasive surgery, few cases of robot-assisted pneumonectomy exist in the literature. This study evaluates the perioperative outcomes and risk factors for conversion to thoracotomy with an initial robotic approach to pneumonectomy for lung cancer. Methods This study is a single-center retrospective review of all pneumonectomies for lung cancer with an initial robotic approach between 2015 and 2019. Patients were divided into 2 groups: surgeries completed robotically and surgeries converted to thoracotomy. Patient demographics, preoperative clinical data, surgical pathology, and perioperative outcomes were compared for meaningful differences between the groups. Results Thirteen total patients underwent robotic pneumonectomy with 8 of them completed robotically and 5 converted to thoracotomy. There were no significant differences in patient characteristics between the groups. The Robotic group had a shorter operative time ( P < 0.01) and less estimated blood loss ( P = 0.02). There were more lymph nodes harvested in the Robotic group ( P = 0.08) but without statistical significance. There were 2 major complications in the Robotic group and none in the Conversion group. Neither tumor size nor stage were predictive of conversion to thoracotomy. Conversions decreased over time with a majority occurring in the first 2 years. There were no conversions for bleeding and no mortalities. Conclusions Robotic pneumonectomy for lung cancer is a safe procedure and a reasonable alternative to thoracotomy. With meticulous technique, major bleeding can be avoided and most procedures can be completed robotically. Larger studies are needed to elucidate any advantages of a robotic versus open approach.

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