The Impact of Resident Involvement on Postoperative Complications following Knee Arthroscopy

Objectives: Exposure to arthroscopic procedures is essential in orthopedic resident training. Previous studies have demonstrated that resident involvement is not associated with increased risk of short-term complication for various general surgical cases and orthopedic surgeries such as lumbar fusion, hand surgery, and foot and ankle surgery. However, the impact of resident involvement on postoperative complications and operative time following knee arthroscopy, the most common resident case logged orthopedic procedure, is unknown. The purpose of the current study was to investigate whether resident involvement in knee arthroscopic procedures impacts postoperative complication rates and operative time. Methods: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) registry was queried to identify patients who underwent common knee arthroscopy procedures between 2005 through 2012. Patients with a history of knee arthroplasty, treatment for septic arthritis or osteomyelitis of the knee, or concomitant open or mini-open procedures were excluded from the study. Cases without information on resident involvement were also excluded. A 1:1 propensity score match was utilized based on age, sex, body mass index (BMI), obesity, smoking history, and American Society of Anesthesiologist (ASA) classification to match cases with resident involvement to attending only cases. Fisher’s exact test, Pearson’s Chi-square tests, and student t-tests were utilized to compare patient demographics, comorbidities, and 30-day postoperative complications. Poisson regression analysis were used to compare operative time between the two groups, with statistically significance defined as P<0.05. Results: Overall, 15,536 patients that underwent knee arthroscopy were identified, of which 32.8% (n=5092) were excluded due to missing information on resident involvement, concomitant open or mini-open procedures, or treatment of septic arthritis or osteomyelitis of the knee. After propensity score matching, 2,954 cases (50% with resident involvement) were included in the study. Both groups were similar in age (P=0.987), sex (P=0.970), BMI (P=0.696), diabetes mellitus (P=0.613), chronic obstructive pulmonary disease (P=1.00), smoking history (P=1.00), and ASA classification (P=0.606) confirmed an appropriate match. The overall rate of 30-day complications was similar in the attending only (1.31%) group compared to the resident (1.11%) group (P=0.610; Table 1). There was no significant difference in postoperative surgical complications including superficial wound infection (P=1.00), deep wound infection (P=0.625), wound dehiscence (P=0.250), neurological deficit (P=1.00), or blood transfusion (P=0.375). Furthermore, there was no significant difference in postoperative medical complications including pulmonary embolism (P=0.500), deep vein thrombosis (P=0.616), urinary tract infection (P=1.00), or sepsis (P=1.00). Knee arthroscopy cases with resident involvement had significantly longer operative time (69.6 minutes vs 60.9 minutes, P<0.0001) when compared to cases performed without a resident. Conclusion: Resident involvement in knee arthroscopy procedures is not a significant risk for medical or surgical 30-day postoperative complications. Resident participation in knee arthroscopy cases did increase operative time. This information is valuable for resident education and patient reassurance. [Table: see text]

Download Full-text

Surgical Loupe at 4.0× Magnification in Pancreaticoduodenectomy—Does It Affect the Surgical Outcomes? A Propensity Score–Matched Study

Surgical Innovation ◽

10.1177/1553350618812322 ◽

2018 ◽

Vol 26 (2) ◽

pp. 201-208

Author(s):

Mohamed El Shobary ◽

Ayman El Nakeeb ◽

Ahmad Sultan ◽

Mahmoud Abd El Wahab Ali ◽

Mohamed El Dosoky ◽

...

Keyword(s):

Postoperative Complications ◽

Propensity Score ◽

Hospital Stay ◽

Pancreatic Fistula ◽

Surgical Outcomes ◽

Operative Time ◽

Postoperative Pancreatic Fistula ◽

Tube Removal ◽

Matched Study ◽

The Impact

Background. There is paucity of data about the impact of using magnification on rate of pancreatic leak after pancreaticoduodenectomy (PD). The aim of this study was to show the impact of using magnifying surgical loupes 4.0× EF (electro-focus) on technical performance and surgical outcomes of PD. Patients and Method. This is a propensity score–matched study. Thirty patients underwent PD using surgical loupes at 4.0× magnification (Group A), and 60 patients underwent PD using the conventional method (Group B). The primary outcome was postoperative pancreatic fistula. Secondary outcomes included operative time, intraoperative blood loss, postoperative complications, mortality, and hospital stay. Results. The total operative time was significantly longer in the loupe group ( P = .0001). The operative time for pancreatic reconstruction was significantly longer in the loupe group ( P = .0001). There were no significant differences between both groups regarding hospital stay, time to oral intake, total amount of drainage, and time of nasogastric tube removal. Univariate and multivariate analyses demonstrated 3 independent factors of development of postoperative pancreatic fistula: pancreatic duct <3 mm, body mass index >25, and soft pancreas. Conclusion. Surgical loupes 4.0× added no advantage in surgical outcomes of PD with regard to improvement of postoperative complications rate or mortality rate.

Download Full-text

Utility of Regional Anesthesia in Extremity Reconstruction

Journal of Reconstructive Microsurgery ◽

10.1055/s-0039-1694741 ◽

2019 ◽

Vol 36 (01) ◽

pp. 053-058

Author(s):

Joseph S. Weisberger ◽

Nicholas C. Oleck ◽

Haripriya S. Ayyala ◽

Margaret M. Dalena ◽

Edward S. Lee

Keyword(s):

Postoperative Complications ◽

Propensity Score ◽

General Anesthesia ◽

Propensity Score Matching ◽

Regional Anesthesia ◽

Operative Time ◽

General Anesthesia Group ◽

Anesthesia Group ◽

Significant Difference ◽

Extremity Reconstruction

Background Regional anesthesia (RA) may help to circumvent the well-documented risks associated with general anesthesia, increase patient comfort and satisfaction, and mitigate costs. This study aims to investigate the utility of RA in extremity reconstruction. Methods The American College of Surgeons National Surgical Quality Improvement Program database was queried for all cases of extremity reconstruction including muscle, myocutaneous, or fasciocutaneous flaps from 2005 to 2016. Two groups were created based on anesthesia technique, regional/epidural and general. Postoperative complications included reoperation, readmission, and wound complications. Propensity score matching was utilized to control for variation in sample size, significant comorbidities, and demographics in the analysis of complications. Results A total of 2,874 cases were identified with general anesthesia utilized in 2,820 cases and RA in the remaining 54. After propensity score matching, 53 cases were identified in each group. In both unmatched and matched cohorts, there was no statistically significant difference in the rates of reoperation, readmission, or wound complication rates. In the matched cohort, mean operative time in the RA cohort was significantly shorter, 157.64 (±112.36) minutes compared with 293.06 minutes (±201.35 minutes) in the general anesthesia group (p < 0.001). While no statistically significant difference was detected in mean length of stay (LOS) between the two groups, the RA group experienced a clinically significant shorter LOS of 5.77 days (±5.87 days) compared with 7.02 (±5.61) days in the general anesthesia group (p = 0.269). Conclusion RA may be a safe, reasonable alternative to general anesthesia in extremity reconstruction without increase in postoperative complications. Additionally, RA use is associated with a significant reduction in operative time, potentially leading to shorter and safer procedures without compromising outcomes.

Download Full-text

Impact of Low Skeletal Muscle Mass on Complications and Survival for Gastric Cancer: A Propensity Score Matching Analysis

10.21203/rs.3.rs-614857/v1 ◽

2021 ◽

Author(s):

Zhen Fang ◽

Peijuan Li ◽

Jin Liu ◽

Wei Chong ◽

Fengying Du ◽

...

Keyword(s):

Gastric Cancer ◽

Skeletal Muscle ◽

Postoperative Complications ◽

Propensity Score ◽

Propensity Score Matching ◽

Muscle Mass ◽

Laparoscopic Gastrectomy ◽

Skeletal Muscle Mass ◽

Significant Difference ◽

The Impact

Abstract Background: Increasing evidence has indicated that low skeletal muscle mass is linked with cancer prognosis, but existing have shown contrasting results. The purpose of the study is to determine the impact of preoperative low skeletal muscle mass (LSMM) on complications and survival of patients who undergo laparoscopic gastrectomy for gastric cancer (GC).Methods: Patients who undergo laparoscopic gastrectomy for GC were enrolled and third lumbar vertebra psoas muscles index (PMI) was assessed by computer tomography (CT). Using propensity score matching (1:1) to obtain 2 well-balanced cohorts for available variables influencing clinical outcomes, comparing the postoperative complications and 3-year overall survival (OS) between LSMM group and non-LSMM group.Results: A total of 386 patients, 226 were matched for analyses. Compared with the non-LSMM group, the LSMM group manifested significantly shorter 3-year OS (58.14% vs 71.95%, P=0.034). However, the incidence of postoperative complications was no difference between two groups after matching. After stratification based on the pT stage of the tumor, statistically significant difference in the 3-year OS rates of the advance GC cohort between the two groups were observed.Conclusions: LSMM predicts a poor prognosis for patients with advance GC and it is not associated with postoperative complications.

Download Full-text

The Impact of Resident Involvement on Postoperative Complications following Knee Arthroscopy

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2020.12.169 ◽

2021 ◽

Vol 37 (1) ◽

pp. e81-e82

Author(s):

Zain Khazi ◽

Trevor R. Gulbrandsen ◽

Alan G. Shamrock ◽

Qiang An ◽

Kyle R. Duchman ◽

...

Keyword(s):

Postoperative Complications ◽

Knee Arthroscopy ◽

Resident Involvement ◽

The Impact

Download Full-text

Neoadjuvant therapy versus upfront surgery for pancreatic adenocarcinoma: A propensity score matched analysis of short-term outcomes.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.361 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 361-361

Author(s):

Gyulnara G. Kasumova ◽

Susanna W.L. de Geus ◽

Omidreza Tabatabaie ◽

Ayotunde B. Fadayomi ◽

Rebecca A. Miksad ◽

...

Keyword(s):

Sensitivity Analysis ◽

Propensity Score ◽

Neoadjuvant Therapy ◽

Operative Time ◽

Locally Advanced ◽

Advanced Pancreatic Cancer ◽

Vascular Resection ◽

Pancreatic Tumors ◽

Significant Difference ◽

The Impact

361 Background: Neoadjuvant therapy is increasingly utilized and has demonstrated a survival advantage in borderline and locally advanced pancreatic cancer. However, many have feared that preoperative chemotherapy and radiation result in a more challenging operative field and consequently increased morbidity. Methods: ACS-NSQIP targeted pancreas database was queried for patients with adenocarcinoma who underwent PD in 2014. Propensity score matching was used to account for potential selection bias in pre-operative and intra-operative characteristics. Sensitivity analysis assessed the impact of neoadjuvant radiation. Results: 1,313 patients were identified, of whom 338 (25.7%) received neoadjuvant therapy. Patients who received neoadjuvant therapy vs upfront surgery were more likely to be: female (53.6% vs 47.2%; p=0.04), < 65 years of age (53.0% vs 39.2%; p < 0.0001), have BMI <25.0 (43.5% vs 36.6%; p = 0.03), and require vascular resection (37.6% vs 19.6%; p < 0.0001). Patients receiving neoadjuvant therapy were less likely to develop pancreatic fistulae (9.2% vs 14.0%; p = 0.02), more likely to require transfusion (27.8% vs 22.4%; p = 0.04), and had longer operative time (median: 405 vs 371 mins; p < 0.0001). After matching, there were no differences in baseline characteristics, approach, biliary stenting, and vascular resection. The only significant difference in outcomes between the two groups was longer operative time (median 405 vs 377, p = 0.006; Table). These results were robust on sensitivity analysis for use of radiation. Conclusions: Neoadjuvant therapy is safe and, despite prolonging operative time, does not affect 30-day outcomes. Concern for increased morbidity should no longer preclude treatment with neoadjuvant chemotherapy and/or radiation in borderline, locally advanced, and resectable pancreatic tumors. [Table: see text]

Download Full-text

Comparison of the operative time for open door laminoplasty using titanium plate spacers or hydroxyapatite block spacers: a retrospective study

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1539-5 ◽

2019 ◽

Vol 14 (1) ◽

Author(s):

Takahiro Inui ◽

Koichi Inokuchi ◽

Yoshinobu Watanabe ◽

Kentaro Matsui ◽

Yuhei Nakayama ◽

...

Keyword(s):

Postoperative Complications ◽

Propensity Score ◽

Propensity Score Matching ◽

Cumulative Incidence ◽

Operative Time ◽

Multivariate Regression Analysis ◽

Open Door ◽

Titanium Plate ◽

Significant Difference ◽

Cord Injury

Abstract Background Titanium plate (TP) and hydroxyapatite (HA) spacers are widely used during open-door laminoplasty, performed with the patient in a prone position. Reducing operative time is an important consideration, particularly to reduce the risk of postoperative complications in older patients. The purpose of this retrospective cohort study was to compare the operative time for open-door laminoplasty using TP or HA spacers. Methods Consecutive patients with a spinal cord injury, without bone injury, and ≥ 50 years of age were included. Multivariate regression analysis was used to compare the operative time between patients in the TP and HA group, adjusting for known factors that can influence surgical and postoperative outcomes. Propensity score matching was used to confirm the robustness of the primary outcome. The cumulative incidence of postoperative complications over 1-year after surgery was also compared. Results Of the 164 patients forming our study group, TP spacers were used in 62 and HA in 102. Operative time was significantly shorter for the TP (128 min) than HA (158 min) group (p < 0.001). Both multivariate and propensity score matching analyses confirmed a significant reduction in operative time for the TP, compared to HA, group (regression coefficient, − 30 min and − 38 min, p < 0.001 and p < 0.001, respectively). There was no significant difference in the cumulative incidence of postoperative complications. Conclusions The use of TP spacers reduced the operative time for cervical open-door laminoplasty by about 30 min, compared to the use of HA spacers, with no difference in the rate of postoperative complications.

Download Full-text

457 The Impact of PAP Therapy on Hematocrit in OSA and Polycythemia: A Pilot Study

SLEEP ◽

10.1093/sleep/zsab072.456 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A180-A181

Author(s):

Mustafa Jafri ◽

Gabrielle Rosa-Acosta ◽

Jose Flores Martinez ◽

Elizabeth Schofield ◽

Cy Wilkins ◽

...

Keyword(s):

Intervention Group ◽

Smoking History ◽

Event Analysis ◽

Control Groups ◽

Testosterone Therapy ◽

Obstructive Sleep ◽

Significant Difference ◽

Testosterone Administration ◽

And Control ◽

The Impact

Abstract Introduction Untreated polycythemia leads to complications including thrombosis. Obstructive sleep apnea (OSA) is commonly associated with secondary erythrocytosis, which testosterone therapy can perpetuate. Effects of positive airway pressure (PAP) on elevated hematocrit (HCT) is unknown. We hypothesize PAP adherence can reduce HCT in men with OSA and polycythemia. Methods Retrospective chart review of male outpatients with newly diagnosed OSA and HCT≥45% at or 3 months before polysomnography (PSG) was conducted. Intervention group consisted of patients initiating PAP for OSA. HCT within 6 months of PAP initiation and PSG were recorded for intervention and control groups, respectively. Primary endpoint was time-to-HCT reduction of HCT<50% plus 3% decrease. Cox proportional-hazards analysis was used to assess time-to-HCT response. Demographics, smoking history, testosterone administration, STOP-Bang score, AHI, and PAP compliance data were obtained. Patients excluded if PAP not indicated, or if PSG, PAP compliance, or repeat HCT were unavailable. Results 41 men with OSA had HCT≥45%, of which 16 had HCT≥50%. Median age was 60 years and median BMI was 32 kg/m2. 28 started PAP. 21 met definition for PAP compliance within 6 months. Median AHI of intervention and control groups were 23 and 19 events/hr, respectively. Mean baseline HCT of both groups were 49 and 50, respectively. No significant difference in age, BMI, smoking history, testosterone therapy, and baseline HCT between both groups noted. 39% of intervention group exhibited HCT response at 1 or more longitudinal assessments, versus 38% of control. Intervention group had higher mean STOP-Bang than control (mean 5.9 vs. 4.6, p=0.01) and trended towards higher mean baseline AHI (27.4 vs. 19.0, p= 0.06). Time-to-event analysis controlling for STOP-Bang and AHI demonstrated PAP was not associated with time-to-HCT response (HR = 1.3, 95% CI = 0.4–4.4). In moderate-severe OSA patients, 40% of intervention group had HCT response compared to 14% of control, though difference was not significant (HR = 2.5, 95% CI = 0.3–20.0). Conclusion Moderate-severe OSA patients trended towards reduction in HCT with PAP, although not statistically significant. Testosterone administration did not affect HCT response to PAP in this cohort. Larger studies are required to determine HCT response to PAP in these patients. Support (if any):

Download Full-text

A Standardized Approach to Cesarean Surgical Technique and Its Effect on Operative Time and Surgical Morbidity

American Journal of Perinatology ◽

10.1055/s-0038-1667370 ◽

2018 ◽

Vol 36 (03) ◽

pp. 277-284 ◽

Cited By ~ 3

Author(s):

M. Pallister ◽

J. Ballas ◽

J. Kohn ◽

C. S. Eppes ◽

M. Belfort ◽

...

Keyword(s):

Surgical Technique ◽

Operative Time ◽

Retrospective Chart Review ◽

Surgical Morbidity ◽

Entire Cohort ◽

Cesarean Deliveries ◽

Significant Difference ◽

Secondary Outcomes ◽

The Impact ◽

Academic Year

Objective To evaluate the impact of a standardized surgical technique for primary cesarean deliveries (CDs) on operative time and surgical morbidity. Materials and Methods Two-year retrospective chart review of primary CD performed around the implementation of a standardized CD surgical technique. The primary outcome was total operative time (TOT). Secondary outcomes included incision-to-delivery time (ITDT), surgical site infection, blood loss, and maternal and fetal injuries. Results When comparing pre- versus postimplementation surgical times, there was no significant difference in TOT (76.5 vs. 75.9 minutes, respectively; p = 0.42) or ITDT (9.8 vs. 8.8 minutes, respectively; p = 0.06) when the entire cohort was analyzed. Subgroup analysis of CD performed early versus late in an academic year among the pre- and postimplementation groups showed no significant difference in TOT (79.3 early vs. 73.8 minutes late; p = 0.10) or ITDT (10.8 early vs. 8.8 minutes late; p = 0.06) within the preimplementation group. In the postimplementation group, however, there was significant decrease in TOT (80.5 early vs. 71.3 minutes late; p = 0.02) and ITDT (10.6 early vs. 6.8 minutes late; p < 0.01). Secondary outcomes were similar for both groups. Conclusion A standardized surgical technique combined with surgical experience can decrease TOT and ITDT in primary CD without increasing maternal morbidity.

Download Full-text

Severe-COVID-19 and mortality among patients (pts) with prostate cancer (PCa) receiving androgen deprivation therapy (ADT).

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.6_suppl.39 ◽

2021 ◽

Vol 39 (6_suppl) ◽

pp. 39-39

Author(s):

Matthew D Tucker ◽

Andrew Lachlan Schmidt ◽

Chih-Yuan Hsu ◽

Yu Shyr ◽

Andrew J. Armstrong ◽

...

Keyword(s):

Prostate Cancer ◽

Mortality Rate ◽

Propensity Score ◽

Viral Entry ◽

Primary Diagnosis ◽

Significant Difference ◽

Secondary Endpoints ◽

Retrospective Nature ◽

Ecog Ps ◽

The Impact

39 Background: The presence of progressing cancer, male sex and advanced age have been shown to increase the severity of coronavirus disease 2019 (COVID-19). Given that the androgen regulated gene TMPRSS2 has been implicated in SARS-CoV-2 viral entry, we hypothesized that ADT may improve COVID-19 outcomes. This analysis evaluated clinical outcomes of pts with PCa with concurrent SARS-CoV-2 infection and investigated the impact of ADT on occurrence of severe-COVID-19 and mortality. Methods: Data was obtained via the COVID-19 and Cancer Consortium (CCC19), a multicenter registry including >120 cancer centers with de-identified data from pts with COVID-19 and cancer. Men with confirmed SARS-CoV-2 infection and a primary diagnosis of prostate cancer were included: data cutoff of July 31, 2020. The primary endpoint was the development of severe-COVID-19 (death, ICU admission, or mechanical ventilation) among pts on ADT vs. those not on ADT at time of COVID-19 infection. Secondary endpoints included 30-day mortality based on ADT use. Mortality and development of severe-COVID-19 were assessed in Pts grouped by therapy: 1st generation androgen receptor inhibitor (ARI-1), 2nd generation ARI (darolutamide, enzalutamide, apalutamide, ARI-2), abiraterone/prednisone, and chemotherapy. Propensity score matching was utilized. Logistic regression was utilized to adjust for age, ECOG PS, comorbidities, and race. Results: 589 pts were included; median follow-up was 42 days (IQR 25-90) and 62% (363/589) were hospitalized. Severe-COVID-19 developed in 28% of pts and the all-cause 30-day mortality rate was 19%. There was no significant difference in the development of severe-COVID-19 or 30-day mortality between Pts on ADT vs not on ADT, whether using descriptive statistics with the entire population or using the propensity score matched population (Table). Among the descriptive population, the numerical rates of severe-COVID-19 and mortality were lowest in Pts receiving ARI-2, but sample size was low. Conclusions: The overall 30-day mortality rate and percentage developing severe-COVID-19 were high. There was no statistical difference in the development of severe-COVID-19 or mortality based on receipt of ADT; however, this analysis is limited by the retrospective nature and small N after propensity-matching. [Table: see text]

Download Full-text

Effects of Preoperative Iodine Administration on Thyroidectomy for Hyperthyroidism: A Systematic Review and Meta-analysis

Otolaryngology ◽

10.1177/0194599819829052 ◽

2019 ◽

Vol 160 (6) ◽

pp. 993-1002 ◽

Cited By ~ 1

Author(s):

Chung-Hsin Tsai ◽

Po-Sheng Yang ◽

Jie-Jen Lee ◽

Tsang-Pai Liu ◽

Chi-Yu Kuo ◽

...

Keyword(s):

Postoperative Complications ◽

Blood Loss ◽

Operative Time ◽

Meta Analysis ◽

Thyroid Volume ◽

Vocal Cord Palsy ◽

Significant Heterogeneity ◽

Intraoperative Blood Loss ◽

Significant Difference ◽

And Control

Objective The current guidelines recommend that potassium iodide be given in the immediate preoperative period for patients with Graves’ disease who are undergoing thyroidectomy. Nonetheless, the evidence behind this recommendation is tenuous. The purpose of this study is to clarify the benefits of preoperative iodine administration from published comparative studies. Data Sources We searched PubMed, Embase, Cochrane, and CINAHL from 1980 to June 2018. Review Methods Studies were included that compared preoperative iodine administration and no premedication before thyroidectomy. For the meta-analysis, studies were pooled with the random-effects model. Results A total of 510 patients were divided into the iodine (n = 223) and control (n = 287) groups from 9 selected studies. Preoperative iodine administration was significantly associated with decreased thyroid vascularity and intraoperative blood loss. Significant heterogeneity was present among studies. We found no significant difference in thyroid volume or operative time. Furthermore, the meta-analysis showed no difference in the risk of postoperative complications, including vocal cord palsy, hypoparathyroidism/hypocalcemia, and hemorrhage or hematoma after thyroidectomy. Conclusion Preoperative iodine administration decreases thyroid vascularity and intraoperative blood loss. Nonetheless, it does not translate to more clinically meaningful differences in terms of operative time and postoperative complications.

Download Full-text