Assessing National Utilization Trends and Outcomes of Robotic and Endoscopic Thyroidectomy in the United States

Objective We aimed to evaluate trends and outcomes of surgical approaches to thyroid surgery. We hypothesized that there have been changes over time in the utilization of approaches to thyroidectomy, including endoscopic, robotic, and open approaches, and that patient outcomes may differ between open surgery and endoscopic or robotic approaches. Study Design Retrospective analysis. Setting The National Cancer Database (NCDB) was queried between 2010 and 2016. Subjects and Methods National cohort of patients. Descriptive statistics were performed using χ2 test, Mann-Whitney U test, t test and analysis of variance. To investigate complication rates, patient matching was performed with subsequent analysis using simple and multivariable logistic regressions. Results We identified 217,938 patients within the NCDB. While endoscopic thyroid surgery increased, relatively, in use over time (0.93% to 2.34% of cases in 2010 and 2016, respectively), robotic thyroid surgery started to decline relatively to other approaches from 2013 to 2016 (0.39% to 0.25% of cases, respectively). The endoscopic approach was performed more commonly than the robotic approach within individual facilities that have reported both procedures ( P = .025). Robotic thyroid surgery was associated with increased risk of positive margins ( P = .046), while endoscopic thyroid surgery was associated with a higher rate of unplanned hospital readmission (OR, 1.55; 95% CI, 1.09-2.22), longer inpatient stays (OR, 1.55; 95% CI, 1.19-2.02), and higher 90-day postoperative mortality (OR, 4.45; 95% CI, 1.58-12.6). Conclusion Endoscopic thyroid surgery has increased in utilization since 2004 but may have worse morbidity and mortality outcomes compared to open surgery.

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Biopsychosocial Patterning of Multimorbidity and Its Consequences

The Oxford Handbook of Integrative Health Science ◽

10.1093/oxfordhb/9780190676384.013.14 ◽

2018 ◽

pp. 220-236

Author(s):

Elliot Friedman ◽

Beth LeBreton ◽

Lindsay Fuzzell ◽

Elizabeth Wehrpsann

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Functional Outcomes ◽

The United States ◽

Chronic Medical Conditions ◽

Quality Of Life Research ◽

Increased Risk ◽

Over Time

By many estimates the majority of adults over age 65 have two or more chronic medical conditions (multimorbidity) and are consequently at increased risk of adverse functional outcomes. Nonetheless, many older adults with multimorbidity are able to maintain high levels of function and retain good quality of life. Research presented here is designed to understand the influences that help ensure better functional outcomes in these older adults. This chapter presents findings that draw on data from the Midlife in the United States study. The independent and interactive contributions of diverse factors to multimorbidity and changes in multimorbidity over time are reviewed. The degree that multimorbidity increases risk of cognitive impairment and disability is examined. The role of inflammation as a mediator is considered. Multimorbidity is increasingly the norm for older adults, so better understanding of factors contributing to variability in multimorbidity-related outcomes can lead to improved quality of life.

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Comparing quality of life between patients undergoing trans-areola endoscopic thyroid surgery and trans-oral endoscopic thyroid surgery

BMC Surgery ◽

10.1186/s12893-021-01267-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shuang Shen ◽

Xiaochi Hu ◽

Rui Qu ◽

Youming Guo ◽

Libo Luo ◽

...

Keyword(s):

Quality Of Life ◽

Thyroid Surgery ◽

Short Form ◽

Endoscopic Thyroidectomy ◽

Operation Time ◽

Endoscopic Thyroid Surgery ◽

Sf 36 ◽

Areola Approach ◽

High Level

Abstract Background Compared with conventional open surgery, endoscopic thyroidectomy via the oral vestibular approach (ETVOA) and endoscopic thyroidectomy via the areola approach (ETAA) avoided scarring of the skin, which may help patients achieve a better quality of life (QOL). However, the benefit of the QOL from this technique has not been adequately investigated, therefore this study compared the QOL outcomes between ETVOA and ETAA. Methods 131 patients were enrolled in this study. ETAA surgery and ETVOA surgery were performed in 74 patients and 57 patients, respectively. These patients were followed up at 2 weeks, 4 weeks, and 8 weeks, and their QOL was evaluated using a thyroid surgery-specific questionnaire and a short-form health survey (SF-36). Results There were no differences in clinical characteristics such as gender, age, body mass index (BMI), and tumor size between the two groups. The volume of intraoperative blood loss, cost of hospitalization, and complications between the two procedures showed no differences. Compared with ETAA, ETVOA has a longer operation time, no drainage, and shorter hospital stay. In the QOL questionnaire, several parameters in ETVOA were better. The satisfaction scores of patients undergoing ETVOA were higher. In addition, the cosmetic satisfaction in patients who received ETOVA was significantly better than that of patients who underwent ETAA. The degree of neck movement disorder in patients with ETVOA was milder. Patients who received ETVOA had higher score on the SF-36. Conclusions The trans-oral endoscopic approach can acquire better cosmetic results and achieved high-level QOL.

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Trends in factors indicating increased risk for STI among key subpopulations in the United States, 2002–2015

Sexually Transmitted Infections ◽

10.1136/sextrans-2019-054045 ◽

2019 ◽

Vol 96 (2) ◽

pp. 121-123 ◽

Cited By ~ 3

Author(s):

Jami S Leichliter ◽

Patricia J Dittus ◽

Casey E Copen ◽

Sevgi O Aral

Keyword(s):

Risk Factors ◽

National Survey ◽

Temporal Trends ◽

Male Partner ◽

The United States ◽

High Risk Factors ◽

Increased Risk ◽

The Usa ◽

Sex With Men ◽

Over Time

ObjectivesWithin the context of rising rates of reportable STIs in the USA, we used national survey data to examine temporal trends in high-risk factors that indicate need for STI/HIV preventive services among key subpopulations with disproportionate STI rates.MethodsWe used data from the 2002 (n=12 571), 2006–2010 (n=22 682) and 2011–2015 (n=20 621) National Survey of Family Growth (NSFG). NSFG is a national probability survey of 15–44 year olds living in US households. We examined STI risk factors among sexually active men who have sex with men (MSM) and Hispanic, non-Hispanic black, 15–19 year old, 20–24 year old, and 25–29 year old women who have sex with men (WSM) and men who have sex with women (MSW). Risk behaviours included: received money or drugs for sex, gave money or drugs for sex, partner who injected drugs, partner who has HIV, non-monogamous partner (WSM, MSW only) and male partner who had sex with other men (WSM only). Endorsement of any of these behaviours was recoded into a composite variable focusing on factors indicating increased STI risk (yes/no). We used chi-squares and logistic regression (calculating predicted marginals to estimate adjusted prevalence ratios (aPRs)) to examine STI risk factors over time among the key subpopulations.ResultsFrom 2002 to 2011–2015, reported STI risk factors did not change or declined over time among key subpopulations in the USA. In adjusted analyses comparing 2002 to 2011–2015, we identified significant declines among WSM: Hispanics (aPR=0.84 (0.68–1.04), non-Hispanic blacks (aPR=0.69 (0.58–0.82), adolescents (aPR=0.71 (0.55–0.91) and 25–29 year olds (aPR=0.76 (0.58–0.98); among MSW: Hispanics (aPR=0.53 (0.40–0.70), non-Hispanic blacks (aPR=0.74 (0.59–0.94) and adolescents (aPR=0.63 (0.49–0.82); and among MSM (aPR=0.53 (0.34–0.84).ConclusionsWhile reported STIs have increased, STI risk factors among key subpopulations were stable or declined. Condom use related to these risk factors, sexual mixing patterns and STI testing should be examined.

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Changes Over Time in COVID-19 Severity and Mortality in Patients Undergoing Cancer Treatment in the United States: Initial Report From the ASCO Registry

JCO Oncology Practice ◽

10.1200/op.21.00394 ◽

2021 ◽

Author(s):

Kathryn F. Mileham ◽

Suanna S. Bruinooge ◽

Charu Aggarwal ◽

Alicia L. Patrick ◽

Christiana Davis ◽

...

Keyword(s):

Mortality Rate ◽

Cancer Treatment ◽

B Cell ◽

Solid Tumors ◽

Mortality Risk ◽

Older Patients ◽

The United States ◽

B Cell Malignancies ◽

Increased Risk ◽

Over Time

PURPOSE: People with cancer are at increased risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. ASCO's COVID-19 registry promotes systematic data collection across US oncology practices. METHODS: Participating practices enter data on patients with SARS-CoV-2 infection in cancer treatment. In this analysis, we focus on all patients with hematologic or regional or metastatic solid tumor malignancies. Primary outcomes are 30- and 90-day mortality rates and change over time. RESULTS: Thirty-eight practices provided data for 453 patients from April to October 2020. Sixty-two percent had regional or metastatic solid tumors. Median age was 64 years. Forty-three percent were current or previous cigarette users. Patients with B-cell malignancies age 61-70 years had twice mortality risk (hazard ratio = 2.1 [95% CI, 1.3 to 3.3]) and those age > 70 years had 4.5 times mortality risk (95% CI, 1.8 to 11.1) compared with patients age ≤ 60 years. Association between survival and age was not significant in patients with metastatic solid tumors ( P = .12). Tobacco users had 30-day mortality estimate of 21% compared with 11% for never users (log-rank P = .005). Patients diagnosed with SARS-CoV-2 before June 2020 had 30-day mortality rate of 20% (95% CI, 14% to 25%) compared with 13% (8% to 18%) for those diagnosed in or after June 2020 ( P = .08). The 90-day mortality rate for pre-June patients was 28% (21% to 34%) compared with 21% (13% to 28%; P = .20). CONCLUSION: Older patients with B-cell malignancies were at increased risk for death (unlike older patients with metastatic solid tumors), as were all patients with cancer who smoke tobacco. Diagnosis of SARS-CoV-2 later in 2020 was associated with more favorable 30- and 90-day mortality, likely related to more asymptomatic cases and improved clinical management.

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Comparison of quality of life between patients undergoing trans-oral endoscopic thyroid surgery and conventional open surgery

BMC Surgery ◽

10.1186/s12893-020-0685-3 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

Pornthep Kasemsiri ◽

Srongpaun Trakulkajornsak ◽

Piyapong Bamroong ◽

Kanokkarn Mahawerawat ◽

Patorn Piromchai ◽

...

Keyword(s):

Quality Of Life ◽

Thyroid Surgery ◽

Open Surgery ◽

Endoscopic Thyroid Surgery ◽

Conventional Open Surgery

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Excessive remifentanil during total intravenous anesthesia is associated with increased risk of pain after robotic thyroid surgery

PLoS ONE ◽

10.1371/journal.pone.0209078 ◽

2018 ◽

Vol 13 (12) ◽

pp. e0209078 ◽

Cited By ~ 1

Author(s):

Hyung-Chul Lee ◽

Ho-Geol Ryu ◽

Hyung-Jun Kim ◽

Yoonsang Park ◽

Soo Bin Yoon ◽

...

Keyword(s):

Thyroid Surgery ◽

Total Intravenous Anesthesia ◽

Intravenous Anesthesia ◽

Increased Risk ◽

Robotic Thyroid Surgery

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Modern technologies in thyroid surgery – an overview of the benefits

Polish Journal of Surgery ◽

10.5604/01.3001.0013.2091 ◽

2019 ◽

Vol 91 (Suplement 1) ◽

pp. 5-11

Author(s):

Marcin Barczyński ◽

Małgorzata Stopa-Barczyńska ◽

Aleksander Konturek

Keyword(s):

Thyroid Surgery ◽

Near Infrared ◽

Infrared Imaging ◽

Endoscopic Thyroidectomy ◽

Early Discharge ◽

Endoscopic Thyroid Surgery ◽

Quality Of Surgery ◽

Pubmed Database ◽

Modern Technologies

Utilization of modern technologies in thyroid surgery is increasing. The aim of this paper was to present the up-to-data use of modern technologies in thyroid surgery with special emphasis put on their potential influence on minimized risk of surgeryrelated morbidity and improved quality of surgery. Authors searched PubMed database using the following search terms: modern technologies AND/OR thyroid surgery AND/ OR transoral endoscopic thyroidectomy AND/OR neuromonitoring AND/OR parathyroid preservation AND/OR energybased hemostasis. Of 1678 publications identified 826 were found to be consistent with the aim of this review. The relevant papers addressed the following issues: neuromonitoring in minimization of risk of laryngeal nerves injury (62%), intraoperative iPTH monitoring in preselection of patients for early discharge or onset of substitution with calcium (21.5%), narrow-band and near infrared imaging for identification of parathyroids (5.7%), parathyroids angiography with indcyianine green for parathyroids vascularity assessment (5.5%), transoral endoscopic thyroid surgery via vestibular approach for improvement of cosmetic effects (4.1%), energy-based devices for surgical hemostasis (1.2%). Modern technologies are primarily designed to improve the safety and quality of thyroid surgery, and only then to optimize the cosmetic effects and reduce the time of surgery.

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2766. Identification and Description of Mumps Cases in a Non-Outbreak Setting and Evaluation of the Effectiveness of Mumps Containing Vaccines Over Time

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.2443 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S975-S975

Author(s):

Ousseny Zerbo ◽

Julia Glanternik ◽

Sharareh Modaressi ◽

Kristin Goddard ◽

Pat Ross ◽

...

Keyword(s):

Clinical Diagnosis ◽

Geographical Area ◽

Vaccine Dose ◽

The United States ◽

Healthcare Organization ◽

Calendar Time ◽

High Coverage ◽

Increased Risk ◽

Waning Immunity ◽

Over Time

Abstract Background Despite high coverage for 2 doses of MMR/MMRV vaccine, the United States and other countries have seen increases in outbreaks of mumps, mainly on college campuses and other close communities, which has been attributed to waning immunity to mumps. The objective of this study was to identify mumps cases within Kaiser Permanente Northern California, a large healthcare organization, and to assess waning of vaccine immunity against mumps in a non-outbreak setting. Methods Potential cases were identified by international classification of disease (ICD) 9 code 072, ICD 10 code B26 or by laboratory orders for mumps. We conducted medical chart reviews to confirm diagnoses, timing relative to vaccination and clinical characteristics. We selected cases and controls among KPNC born after 1988 who were members for ≥9 months before diagnosis or anchor date and who received their second dose at ages 4 to 6 years, matching cases with controls on geographical area. To assess for risk of mumps in relation to time since a second MMR/MMRV dose, we compared cases and controls using multivariable logistic regression adjusted for age, sex and calendar time of mumps diagnosis. Results Among 397 potential cases identified, chart review confirmed 178 (44.8%) as mumps. About half (87/178) were confirmed by both positive laboratory test and clinical diagnosis, with the remainder by clinical diagnosis alone. Median age at diagnosis for the 187 cases was 30 years (range 1 year–91 years). Most cases had parotitis (93%) and there were 7 cases of orchitis. The 34 cases with complete vaccination information were matched to 539,301 controls. The mean time since the second vaccine dose was shorter for cases compared with controls (6.5 years vs. 9.0 years, P = 0.008). After adjustment, there was no significantly increased risk of mumps associated with time since second MMR/MMRV dose (adjusted odds ratio = 1.08, 95% CI 0.57–2.05). Conclusion In the setting of a large healthcare organization, our results do not provide evidence of waning immunity following 2 doses of MMR/MMRV; however, identifying and confirming mumps cases were challenging and analyses were limited by small number of cases. Large future studies will be needed to confirm whether risk of mumps increases over time in non-outbreak settings. Disclosures All authors: No reported disclosures.

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Postoperative complications: an observational study of trends in the United States from 2012 to 2018

BMC Surgery ◽

10.1186/s12893-021-01392-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Emilie Even Dencker ◽

Alexander Bonde ◽

Anders Troelsen ◽

Kartik Mangudi Varadarajan ◽

Martin Sillesen

Keyword(s):

Postoperative Complications ◽

Healthcare Costs ◽

Predictor Variable ◽

The United States ◽

Incidence Rates ◽

Major Surgery ◽

Complication Rates ◽

Regression Analyses ◽

The Individual ◽

Over Time

Abstract Background Postoperative complications continue to constitute a major issue for both the healthcare system and the individual patient and are associated with inferior outcomes and higher healthcare costs. The objective of this study was to evaluate the trends of postoperative complication rates over a 7-year period. Methods The NSQIP datasets from 2012 to 2018 were used to assess 30-day complication incidence rates including mortality rate following surgical procedures within ten surgical subspecialties. Multivariable logistic regression was used to associate complication rates with dataset year, while adjusting for relevant confounders. Results A total of 5,880,829 patients undergoing major surgery were included. Particularly the incidence rates of four complications were found to be decreasing: superficial SSI (1.9 to 1.3%), deep SSI (0.6 to 0.4%), urinary tract infection (1.6 to 1.2%) and patient unplanned return to the operating room (3.1 to 2.7%). Incidence rate for organ/space SSI exhibited an increase (1.1 to 1.5%). When adjusted, regression analyses indicated decreased odds ratios (OR) through the study period years for particularly deep SSI OR 0.92 [0.92–0.93], superficial SSI OR 0.94 [0.94–0.94] and acute renal failure OR 0.96 [0.95–0.96] as the predictor variable (study year) increased (p < 0.01). However, OR’s for organ/space SSI 1.05 [1.05–1.06], myocardial infarction 1.01 [1.01–1.02] and sepsis 1.01 [1.01–1.02] increased slightly over time (all p < 0.01). Conclusions Incidence rates for the complications exhibited a stable trend over the study period, with minor in or decreases observed.

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Development of Care Curves Following the Stage 1 Palliation: A Comparison of Intensive Care Among 5 Centers

Journal of the American Heart Association ◽

10.1161/jaha.120.019396 ◽

2021 ◽

Author(s):

Francesca Sperotto ◽

Jesse A. Davidson ◽

Melissa N. Smith‐Parrish ◽

Justin J. Elhoff ◽

Anjuli Sinha ◽

...

Keyword(s):

Intensive Care ◽

Fluid Balance ◽

Fluid Intake ◽

The United States ◽

Complication Rates ◽

Mechanical Ventilator ◽

Opioid Administration ◽

Versus Center ◽

Stage 1 ◽

Over Time

Background Comparison of care among centers is currently limited to major end points, such as mortality, length of stay, or complication rates. Creating “care curves” and comparing individual elements of care over time may highlight modifiable differences in intensive care among centers. Methods and Results We performed an observational retrospective study at 5 centers in the United States to describe key elements of postoperative care following the stage 1 palliation. A consecutive sample of 502 infants undergoing stage 1 palliation between January 2009 and December 2018 were included. All electronic health record entries relating to mandatory mechanical ventilator rate, opioid administration, and fluid intake/outputs between postoperative days (POD) 0 to 28 were extracted from each institution's data warehouse. During the study period, 502 patients underwent stage 1 palliation among the 5 centers. Patients were weaned to a median mandatory mechanical ventilator rate of 10 breaths/minute by POD 4 at Center 5 but not until POD 7 to 8 at Centers 1 and 2. Opioid administration peaked on POD 2 with extreme variance (median 6.9 versus 1.6 mg/kg per day at Center 3 versus Center 2). Daily fluid balance trends were variable: on POD 3 Center 1 had a median fluid balance of −51 mL/kg per day, ranging between −34 to 19 mL/kg per day among remaining centers. Intercenter differences persist after adjusting for patient and surgical characteristics ( P <0.001 for each end point). Conclusions It is possible to detail and compare individual elements of care over time that represent modifiable differences among centers, which persist even after adjusting for patient factors. Care curves may be used to guide collaborative quality improvement initiatives.

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