scholarly journals Study of social disparities in pediatric laparoscopic appendectomy outcomes and cost

2021 ◽  
Vol 9 ◽  
pp. 205031212198962
Author(s):  
Sathyaprasad Burjonrappa
Keyword(s):  
Laparoscopic Appendectomy ◽  
Chart Review ◽  
Minority Groups ◽  
Minority Group ◽  
Retrospective Chart Review ◽  
Racial Groups ◽  
Social Disparities ◽  
Level Of Evidence ◽  
Uncomplicated Acute Appendicitis ◽  
American Ethnicity

Purpose: There is an increasing focus on racial and social disparities in health care. There have been several studies that have documented disparities in outcome between racial groups in the adult literature. Not much is known about disparities in outcomes after surgical procedures in children. The purpose of this study was to investigate the effect of race on complications (outcomes) and costs after laparoscopic appendectomy. Methods: This study is a single-center retrospective chart review of 248 pediatric patients who underwent appendectomies for uncomplicated acute appendicitis from 2015 to 2017. Patients were divided into minority (Africa American or Hispanic) and non-minority groups, and length of stay, preoperative and postoperative factors, and total costs were compared. Results: Of 185 eligible patients, 45.9% (n = 85) were of Hispanic or African American ethnicity and 54.1% (n = 100) were Caucasian. About 11.8% of minority patients had comorbidities and 12% of majority patients had comorbidities (p = 1). Readmission rate for minority group patients was 3.5% (n = 3) and 2% (n = 2) for majority patients (p = 0.7). The average cost of hospital stay for minority patients was $30,900 and for majority patients was $31,111 (p = 0.59). Conclusions: Standardization of care protocols has reduced social/racial disparities in surgical outcomes. In the most common pediatric surgery emergency procedure, laparoscopic appendectomy, there were no differences in outcomes or costs between minority (Hispanic/Africa American) and Caucasian ethnic groups. Level of evidence: Level III Type of study: Clinical Study

Evaluation of Cost-effectiveness and Clinical Value of Routine Histopathologic Examination of Septoplasty Specimens

2021 ◽  
pp. 019459982110129
Author(s):  
Randall S. Ruffner ◽  
Jessica W. Scordino
Keyword(s):  
Chart Review ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cost Savings ◽  
Retrospective Chart Review ◽  
Clinical Value ◽  
Level Of Evidence ◽  
Significant Pathology ◽  
National Model ◽  
Routine Histopathologic Examination

Objectives During septoplasty, normal cartilage and bone are often sent for pathologic examination despite benign appearance. We explored pathology results following septoplasty from April 2016 to April 2018, examining clinical value and relevance, implications, and cost analysis. Study Design Retrospective chart review. Setting Single-institution academic medical center. Methods A retrospective chart review was compiled by using Current Procedural Terminology code 30520 for septoplasty for indication of nasal obstruction, deviated septum, and nasal deformity. Results A total of 236 consecutive cases were identified spanning a 2-year period. Septoplasty specimens were sent for pathology evaluation in 76 (31%). The decision to send a specimen for histopathology was largely physician dependent. No cases yielded unexpected or significant pathology that changed management. The average total charges for septoplasty were $10,200 at our institution, with 2.2% of procedural charges accounting for pathology preparation and review, averaging $225. Nationally, this results in an estimated charged cost of $58.5 million. The Centers for Medicare and Medicaid Services (CMS) reimbursement for septoplasty pathology charges was $46 in 2018, accounting for 1.3% of hospital-based reimbursements and 2.2% of ambulatory center reimbursements. With CMS as a national model for reimbursement, $11.8 million is spent yearly for septoplasty histopathology. Given that CMS reimbursement is significantly lower than private insurers, national total reimbursement is likely considerably higher. Conclusion Routine pathology review of routine septoplasty specimens is unnecessary, unremarkable, and wasteful. Correlation of the patient’s presentation and intraoperative findings should justify the need for pathology evaluation. This value-based approach can offer significant direct and indirect cost savings. Level of evidence 4.

Occult Malignancy in Adult Tonsillectomy for Benign Indication

2020 ◽  
pp. 000348942095247
Author(s):  
Noah Syme ◽  
Stefan Brettfeld ◽  
Ashley Dorneden ◽  
Von Samedi ◽  
Therese Bocklage ◽  
...  
Keyword(s):  
Literature Review ◽  
Chart Review ◽  
Tertiary Care ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Pooled Analysis ◽  
Level Of Evidence ◽  
Occult Malignancy ◽  
Pathologic Analysis ◽  
Adult Tonsillectomy

Objective: National pathology guidelines recommend full pathologic analysis for all adult tonsillectomy specimens. We evaluated the available data on occult malignancy in adult tonsillectomy for benign indication, and created a screening system to reduce the risk of missed malignancies if routine histopathologic examination were to be discontinued. Study design: Retrospective chart review and systematic review of the literature. Setting: Tertiary care academic hospital and multi-hospital private healthcare system. Subjects and methods: A systematic literature review identified case series of adult tonsillectomy. Retrospective chart review at our institutions from 2000 to 2016 produced an additional case series. The pooled rate of occult malignancy was determined, and re-analyzed using criteria based on preoperative risk factors designed to identify patients requiring full pathologic analysis. The predicted effects of prospective application of the proposed criteria were calculated. Pooled occult malignancy prevalence was estimated. Results: Literature review and our own case series yielded 12,094 total cases. Occult malignancy prevalence in the combined data was 0.033%, representing four occult malignancies. Three out of the four would have been selected for full pathology preoperatively with use of the proposed criteria. Statistical analysis indicates that the predicted frequency of occult malignancy incidence in cases negative for the criteria is 0.01%, or 1/10,000. Conclusion: Application of the proposed criteria to adults undergoing tonsillectomy for benign indication identifies a subset of patients with an estimated incidence of occult malignancy similar to that reported for pediatric tonsillectomy, and potentially may permit safe elimination of pathologic analysis of their tonsil specimens. Level of Evidence: Pooled analysis of case series from the literature and a single institution, level 4.

scholarly journals Salami-Tactics: when is it time for a major cut after multiple minor amputations?

2021 ◽  
Author(s):  
Martin C. Berli ◽  
Zoran Rancic ◽  
Madlaina Schöni ◽  
Tobias Götschi ◽  
Pascal Schenk ◽  
...  
Keyword(s):  
Chart Review ◽  
Cox Regression ◽  
Retrospective Chart Review ◽  
Major Amputation ◽  
Level Of Evidence ◽  
Cox Regression Analysis ◽  
Patient Demographics ◽  
Minor Amputation ◽  
Retrospective Comparative Study

Abstract Introduction Repetitive minor amputations carry the concomitant risks of multiple surgical procedures, major amputations have physical and economical major drawbacks. The aim of this study was to evaluate whether there is a distinct number of minor amputations predicting a major amputation in the same leg and to determine risk factors for major amputation in multiple minor amputations. Materials and methods A retrospective chart review including 429 patients with 534 index minor amputations between 07/1984 and 06/2019 was conducted. Patient demographics and clinical data including number and level of re-amputations were extracted from medical records and statistically analyzed. Results 290 legs (54.3%) had one or multiple re-amputations after index minor amputation. 89 (16.7%) legs needed major amputation during follow up. Major amputation was performed at a mean of 32.5 (range 0 – 275.2) months after index minor amputation. No particular re-amputation demonstrated statistically significant elevated odds ratio (a.) to be a major amputation compared to the preceding amputation and (b.) to lead to a major amputation at any point during follow up. Stepwise multivariate Cox regression analysis revealed minor re-amputation within 90 days (HR 3.8, 95% CI 2.0-7.3, p <0.001) as the only risk factor for major amputation if at least one re-amputation had to be performed. Conclusions There is no distinct number of prior minor amputations in one leg that would justify a major amputation on its own. If a re-amputation has to be done, the timepoint needs to be considered as re-amputations within 90 days carry a fourfold risk for major amputation. Level of evidence Retrospective comparative study (Level III).

scholarly journals A retrospective chart review study of symptom onset, diagnosis, comorbidities, and treatment in patients with binge eating disorder in Canadian clinical practice

2020 ◽  
Author(s):  
Simerpal K. Gill ◽  
Allan S. Kaplan
Keyword(s):  
Eating Disorder ◽  
Binge Eating ◽  
Binge Eating Disorder ◽  
Symptom Onset ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Healthcare Setting ◽  
Well Being ◽  
Diagnosis And Treatment ◽  
Level Of Evidence

Abstract Purpose In the Canadian healthcare setting, there is limited understanding of the pathways to diagnosis and treatment for patients with binge eating disorder (BED). Methods This retrospective chart review examined the clinical characteristics, diagnostic pathways, and treatment history of adult patients diagnosed with BED. Results Overall, 202 charts from 57 healthcare providers (HCPs) were reviewed. Most patients were women (69%) and white (78%). Mean ± SD patient age was 37 ± 12.1 years. Comorbidities identified in > 20% of patients included obesity (50%), anxiety (49%), depression and/or major depressive disorder (46%), and dyslipidemia (26%). Discussions regarding a diagnosis of BED were typically initiated more often by HCPs than patients. Most patients (64%) received a diagnosis of BED ≥ 3 years after symptom onset. A numerically greater percentage of patients received (past or current) nonpharmacotherapy than pharmacotherapy (84% vs. 67%). The mean ± SD number of binge eating episodes/week numerically decreased from pretreatment to follow-up with lisdexamfetamine (5.4 ± 2.8 vs. 1.7 ± 1.2), off-label pharmacotherapy (4.7 ± 3.9 vs. 2.0 ± 1.13), and nonpharmacotherapy (6.3 ± 4.8 vs. 3.5 ±  6.0) Across pharmacotherapies and nonpharmacotherapies, most patients reported improvement in symptoms of BED (84–97%) and in overall well-being (80–96%). Conclusions These findings highlight the importance of timely diagnosis and treatment of BED. Although HCPs are initiating discussions about BED, earlier identification of BED symptoms is required. Furthermore, these data indicate that pharmacologic and nonpharmacologic treatment for BED is associated with decreased binge eating and improvements in overall well-being. Level of evidence IV, chart review.

Syndesmotic Screw Removal in a Clinic Setting Is Safe and Cost-effective

2019 ◽  
Vol 13 (2) ◽  
pp. 144-151 ◽  
Author(s):  
Michelle T. Sugi ◽  
Brandon Ortega ◽  
Lane Shepherd ◽  
Charalampos Zalavras
Keyword(s):  
Operating Room ◽  
Chart Review ◽  
Cost Savings ◽  
Retrospective Chart Review ◽  
Cost Effective ◽  
Level Of Evidence ◽  
Superficial Infection ◽  
Syndesmotic Screw ◽  
Level 1 ◽  
Level 1 Trauma Center

Background. There is no consensus in the literature regarding the necessity of syndesmotic screw removal, but the majority of surgeons prefer screw removal in the operating room. Purpose. The aim of this study is to analyze the safety and cost-effectiveness of syndesmotic screw removal in the clinic. Methods. A retrospective chart review was performed on all acute, traumatic ankle fractures that required syndesmotic stabilization over 5 years at a level 1 trauma center. Radiographs were evaluated for maintenance of syndesmotic reduction. Orthopaedic clinic visits and operating room costs were calculated. Results. Of 269 patients, syndesmotic screws were successfully removed in the clinic in 170 patients and retained in 99 patients. Two superficial infections (1.2%) developed following screw removal. The superficial infection rate was 3.3% (2 of 60) in patients who did not receive antibiotics compared with 0% (0 of 110) in patients who received antibiotics (P = .12). No patient lost syndesmotic reduction after screw removal. Cost savings of $13 829 per patient were achieved by syndesmotic screw removal in the clinic. Conclusion. Our study demonstrates that syndesmotic screw removal in the clinic is safe, does not result in tibiofibular diastasis, is cost-effective, and results in substantial financial savings. Level of Evidence: Level IV

Iatrogenic Symmastia: Causes and Suggested Repair Technique

2018 ◽  
Vol 39 (8) ◽  
pp. 863-872 ◽  
Author(s):  
Shana S Kalaria ◽  
Joshua Henderson ◽  
Clayton L Moliver
Keyword(s):  
Breast Augmentation ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Pectoralis Major ◽  
Pectoralis Muscle ◽  
Base Diameter ◽  
Common Risk Factor ◽  
Level Of Evidence ◽  
Repair Technique ◽  
Scarpa’S Fascia

Abstract Background Various theories exist to explain the etiology of iatrogenic symmastia. Subglandular over-dissection of the medial breast pocket over the sternum, disruption of midline sternal fascia, oversized implant base diameter, and over-dissection of the medial pectoralis muscle attachments to the sternum are popular explanations. Objectives The authors hypothesized that the most common risk factor for iatrogenic symmastia is subpectoral breast augmentation. Methods A retrospective chart review was conducted including all symmastia patients who underwent surgery from January 2008 to April 2018 by a single surgeon (C.L.M.). ASAPS members were also surveyed regarding the etiology and incidence of symmastia in their practice. Results Twenty-three patients with symmastia were included in the retrospective chart review. All had previous subpectoral breast augmentation. In the ASAPS survey, 91 plastic surgeons reported seeing an average of 2.2 consults for acquired symmastia over the preceding year; 1.9 of the 2.2 (84.9%) acquired symmastia consults previously underwent subpectoral breast augmentation. Most surgeons attributed these patients’ symmastia to over-dissection of the medial pectoralis muscle attachments to the sternum. Conclusions Symmastia is most often caused by pectoralis major sternal dehiscence during subpectoral breast augmentation. In the senior author’s experience, all patients with iatrogenic symmastia previously had a submuscular breast augmentation. The ASAPS survey supports multiple causes for symmastia with retromuscular breast augmentation occurring in the majority of patients. Repair of symmastia should include securing Scarpa’s fascia to the sternum, reattaching the pectoralis major to the sternum, avoiding another subpectoral implant, and using postoperative modalities to protect the repair. Level of Evidence: 4

Relationship of Postoperative Achilles Tendon Elongation With Plantarflexion Strength Following Surgical Repair

2019 ◽  
Vol 41 (2) ◽  
pp. 140-146 ◽  
Author(s):  
Önder Murat Hürmeydan ◽  
Mehmet Demirel ◽  
Natig Valiyev ◽  
Turker Sahinkaya ◽  
Önder İsmet Kılıçoğlu
Keyword(s):  
Achilles Tendon ◽  
Chart Review ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Isokinetic Dynamometer ◽  
Level Of Evidence ◽  
Tendon Elongation ◽  
The Mean ◽  
Relationship Of

Background: Little data exist regarding the adverse effects of Achilles tendon (AT) elongation after rupture repair on plantarflexion strength. This study aimed to investigate the effect of AT elongation measured using AT resting angle (ATRA) on the plantarflexion strength in patients with surgically treated acute AT rupture. Methods: A retrospective chart review was performed on 40 patients (15 female and 25 female) who underwent open operative repair due to an acute AT rupture. At the final follow-up, AT elongation was assessed using ATRA. Plantarflexion strength (peak torques and angle-specific torques) was measured using an isokinetic dynamometer. All variables were obtained from the operated and unoperated contralateral ankles of the patients. Results: The mean ATRA was greater in the operated ankles (mean, 57 degrees; range, 39-71 degrees) compared with the unoperated ones (mean, 52 degrees; range, 36-66 degrees; P = .009). Except the plantarflexion torque at 20 degrees of plantarflexion ( P = .246), all the other angle-specific torques were lower in the operated ankles ( P < .05). Peak flexion torque at 30 degrees/s was lower in the operated ankle ( P = .002). A negative correlation was found between operated/unoperated (O/N) ATRA and O/N plantarflexion torque ratios at 0 degrees ( r = −0.404; P = .01), 10 degrees ( r = −0.399; P= .011), and 20 degrees ( r = −0.387; P = .014). Conclusion: Postoperative AT elongation measured using ATRA may have a deleterious effect on the plantarflexion strength in patients with surgically treated acute AT rupture. Level of Evidence: Level IV, case series.

scholarly journals Anatomic Implants in Breast Reconstruction: A Comparison of Outcomes and Aesthetic Results Compared to Smooth Round Silicone Implants

2019 ◽  
Vol 39 (8) ◽  
pp. NP322-NP330 ◽  
Author(s):  
Nneamaka Agochukwu-Nwubah ◽  
Ashley Boustany ◽  
Margaret Wetzel ◽  
Jacob Maus ◽  
Brian Rinker
Keyword(s):  
Breast Reconstruction ◽  
Chart Review ◽  
Capsular Contracture ◽  
Retrospective Chart Review ◽  
Well Being ◽  
Silicone Implants ◽  
Body Type ◽  
Level Of Evidence ◽  
Aesthetic Results ◽  
Implant Reconstruction

Abstract Background Direct comparison studies of outcomes and aesthetic satisfaction of anatomic implants compared to other implants are scarce in the literature. Objectives The objective of this study was to compare outcomes and aesthetic satisfaction of patients who underwent breast reconstruction with anatomic implants vs other implants (smooth round silicone). Methods A retrospective chart review was performed of patients who underwent implant-based breast reconstruction over 3 years. Outcomes including complications, number of surgeries, need for revisions, and aesthetic satisfaction of patients were tracked and compared. Results A total of 156 patients met inclusion criteria for this study. A total of 123 underwent reconstruction with a round implant, and 33 underwent reconstruction with an anatomic implant. Of the 156 patients, 38 underwent a 1-stage direct-to-implant reconstruction and the remainder underwent a 2-stage implant reconstruction. The round and anatomic implant groups did not differ with regards to number of surgeries, revisions, utilization of contralateral symmetry procedures, implant-related reoperations, complications, implant loss, infection, capsular contracture, and seroma. The Breast Q survey had a response rate of 27%. On all parameters, the round and anatomic implant groups did not significantly differ. Conclusions There were no significant differences among round and shaped implants in regards to complications, revision surgeries, and overall outcomes. Furthermore, patients showed no differences regarding satisfaction and well-being when surveyed on the Breast Q survey. The decision of implant choice in breast reconstruction should be based on surgeon comfort and the patient’s needs/body type. Level of Evidence: 4

Does Use of Intraoperative Irrigation with Open or Laparoscopic Appendectomy Reduce Post-Operative Intra-abdominal Abscess?

2011 ◽  
Vol 77 (1) ◽  
pp. 78-80 ◽  
Author(s):  
Christopher B. Moore ◽  
R. Stephen Smith ◽  
Robert Herbertson ◽  
Christine Toevs
Keyword(s):  
Laparoscopic Appendectomy ◽  
Chart Review ◽  
Tertiary Care ◽  
Open Appendectomy ◽  
Care Facility ◽  
Retrospective Chart Review ◽  
Abscess Formation ◽  
Abdominal Abscess ◽  
Tertiary Care Facility

To date, no study shows a decrease in postoperative abscess with the use of irrigation during appendectomy. Postoperative abscess rate for laparoscopic and open appendectomy is 3.3 and 2.6 per cent. The purpose of this study is to determine if irrigation at appendectomy decreases the postoperative intra-abdominal abscess rate. Retrospective chart review of 176 consecutive appendectomies, open (39%) and laparoscopic (61%), at a university affiliated tertiary care facility from July 2007 to November 2008 for use of intraoperative irrigation was performed. Patients under age 18 were excluded. There were no differences between the irrigation groups in regards to age, sex, or weight. Perforation was observed in 28 per cent (50/176), of which 86 per cent (43/50) of patients received intraoperative irrigation. Eleven patients (9.6%) with irrigation developed postoperative abscess compared with two (3.3%) patients without irrigation ( P = 0.22). Our results do not show decrease in postoperative intra-abdominal abscess with use of intraoperative irrigation. Thirteen patients developed postoperative abscess: 11 with irrigation, two without irrigation. Ten of 13 patients who developed abscess were perforated; nine with irrigation and one without. These results suggest routine use of intraoperative irrigation for appendectomies does not prevent intra-abdominal abscess formation, adds extra costs, and may be avoided.

An Overview of Amish Mortalities at a Level I Trauma Center

2021 ◽  
pp. 000313482110472
Author(s):  
Madison E. Morgan ◽  
Catherine Ting Brown ◽  
Larissa Whitney ◽  
Kelly Bonneville ◽  
Lindsey L. Perea
Keyword(s):  
Trauma Center ◽  
Chart Review ◽  
Trauma Registry ◽  
Age Groups ◽  
Retrospective Chart Review ◽  
Trauma Patients ◽  
Injury Patterns ◽  
Level Of Evidence ◽  
Trauma Mortality ◽  
Level I

Background The Amish population is a unique subset of patients that may require a specialized approach due to their lifestyle differences compared to the general population. With this reasoning, Amish mortalities may differ from typical trauma mortality patterns. We sought to provide an overview of Amish mortalities and hypothesized that there would be differences in injury patterns between mortalities and survivors. Methods All Amish trauma patients who presented and were captured by the trauma registry at our Level I trauma center over 20 years (1/2000-2004/2020) were analyzed. A retrospective chart review was subsequently performed. Patients who died were of interest to this study. Demographic and clinical variables were analyzed for the mortalities. Mortalities were then compared to Amish patients who survived. Results There were 1827 Amish trauma patients during the study period and, of these, 32 (1.75%) were mortalities. The top 3 mechanisms of injury leading to mortality were falls (34.4%), pedestrian struck (21.9%), and farming accidents (15.6%). Pediatric (age ≤ 14y) (25%) and geriatric (age ≥ 65y) (28.1%) had the highest percentage of mortalities. Mortalities in the Amish population were significantly older (mean age: 39 years vs 27 years, P = .003) and had significantly higher ISS (mean ISS: 29 vs 10, P < .001) compared to Amish patients who survived. Discussion The majority of mortalities occurred in the pediatric and geriatric age groups and were falls. Further intervention and outreach in the Amish population should be done to highlight this particular cause of mortality. Level of Evidence Level III, epidemiological.

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