Surgical outcomes of gasless single port retroperitoneal radical nephrectomy for dialysis patients: A comparative analysis with nondialysis patients.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 376-376 ◽  
Author(s):  
Y. Okada ◽  
H. Masuda ◽  
K. Saito ◽  
Y. Iimura ◽  
M. Yokoyama ◽  
...  
Keyword(s):  
High Risk ◽  
Surgical Outcomes ◽  
Surgical Complications ◽  
Radical Nephrectomy ◽  
Single Port ◽  
Oral Feeding ◽  
Transfusion Rate ◽  
Dialysis Access ◽  
Dialysis Patients ◽  
The Mean

376 Background: Gasless single port retroperitoneal radical nephrectomy is minimally invasive, curative and cost effective operation which we have developed since 1998 (Eur Urol Suppl 2009; 8: 392), and covered by the Japanese universal insurance system from April, 2008. Patients necessitating dialysis are considered high risk operative candidates because of their multiple comorbidities. We compared surgical outcomes of dialysis patients with non-dialysis patients to evaluate this operation as treatment for high risk group. Methods: We reviewed 304 consecutive patients including 59 (19.4%) dialysis patients who underwent CO2 gasless single port retroperitoneal radical nephrectomy at our institute between 2000 and 2009. Complications within the first 30 days after the surgery were graded retrospectively according to the modified Clavien classification system. Patient demographics, operative outcomes, and complications were compared between dialysis and non-dialysis patients. Results: In all patients, the median patient age and body mass index were 60 years and 23.0 kg/m2. The median length of surgical incision, operative time (OT) and estimated blood loss (EBL) were 6.5 cm, 189 minutes and 214 mL, respectively. The transfusion rate was 3.3%. The intra and postoperative complication rate were 3.9% and 10.1%. Two grade 3a (ureteral obstruction, 1; diverticulitis, 1), three grade 3b (occlusion of peripheral hemodialysis shunt, 3) and two grade 4 (pulmonary embolism, 1; acute heart failure, 1) surgical complications occurred. In dialysis patients, the mean BMI was lower (20.4 vs. 23.3, p<0.0001), the mean OT was shorter (170 vs. 201 minutes, p<0.0001) and the mean EBL was lower (216 vs. 311mL, p<0.0001) than non-dialysis patients. There was no Clavien grade 3 or 4 surgical complications except dialysis access occlusion in dialysis patients. The average time to oral feeding and walking were equivalent, but possible discharge were longer in dialysis patients (4.3 vs. 3.4 days, p<0.0037). Conclusions: Our data supports the safety and feasibility of gasless single port retroperitoneal radical nephrectomy for dialysis patients. No significant financial relationships to disclose.

Effect of a Dialysis Access Coordinator on Preemptive Access Placement among Veterans: A Quality Improvement Initiative

2016 ◽  
Vol 45 (1) ◽  
pp. 14-21 ◽  
Author(s):  
Randall C. Gale ◽  
Doreen Kehoe ◽  
Yiming Z. Lit ◽  
Steven M. Asch ◽  
Manjula Kurella Tamura
Keyword(s):  
High Risk ◽  
Statistical Significance ◽  
P Value ◽  
Quality Improvement Initiative ◽  
Dialysis Access ◽  
Intervention Period ◽  
Historical Cohort ◽  
Significant Difference ◽  
The Mean ◽  
Access Surgery

Background and Objectives: Preemptive placement of permanent dialysis access is recommended in order to reduce the morbidity associated with central venous catheters. We assessed the effect of a dialysis access coordinator on preemptive access placement in veterans who are at high risk for end-stage renal disease (ESRD). Design, Setting, Participants, and Measurements: Pre-post evaluation of a dialysis access coordinator in the nephrology clinics of the Veterans Affairs Palo Alto. The access coordinator streamlined access referrals, prioritized surgical waiting lists and addressed patient barriers. We compared the frequency of preemptive access referral, surgery, and use for dialysis during the intervention period, July 1, 2013 to May 31, 2016, to a pre-intervention period, January 1, 2011 to December 31, 2013, among all patients with a predicted 1-year risk for ESRD ≥20%. Results: There were 156 patients in the historical cohort and 131 in the intervention cohort. The mean age was 69.9 ± 11.6 years and the mean estimated glomerular filtration rate was 14.5 ± 5.7 ml/min/1.73 m2. The intervention was associated with an 11.8% increase in access referral (p value = 0.03), and a 9.4% increase in completed access surgery (p value = 0.05). Increases in permanent access at the start of dialysis (15.2%), and functional permanent access at the start of dialysis (12.4%) did not reach statistical significance. Among patients who received access surgery, there was no significant difference in the prevalence of unused access. Conclusions: Implementation of an access coordinator was associated with a modest increase in preemptive access placement among patients who are at high risk for ESRD without increasing the prevalence of unused access.

scholarly journals Does Use of Oral Anticoagulants at the Time of Admission Affect Outcomes Following Hip Fracture

2018 ◽  
Vol 9 ◽  
pp. 215145931876415 ◽  
Author(s):  
Ariana Lott ◽  
Jack Haglin ◽  
Rebekah Belayneh ◽  
Sanjit R. Konda ◽  
Philipp Leucht ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Blood Loss ◽  
Surgical Outcomes ◽  
Academic Medical Center ◽  
Cost Of Care ◽  
Transfusion Rate ◽  
Time To Surgery ◽  
Discharge Disposition ◽  
Increased Risk ◽  
The Mean

Purpose: The purpose of this study was to compare hospital quality outcomes in patients over the age of 60 undergoing fixation of hip fracture based on their anticoagulation status. Materials and Methods: Patients aged 60 and older with isolated hip fracture injuries treated operatively at 1 academic medical center between October 2014 and September 2016 were analyzed. Patients on the following medications were included in the anticoagulation cohort: warfarin, clopidogrel, aspirin 325 mg, rivaroxaban, apixaban, dabigatran, and dipyridamole/aspirin. We compared outcome measures including time to surgery, length of stay (LOS), transfusion rate, blood loss, procedure time, complication rate, need for intensive care unit (ICU)/step-down unit (SDU) care, discharge disposition, and cost of admission. Outcomes were controlled for age, Charlson comorbidity index (CCI), and anesthesia type. Results: A total of 479 hip fracture patients met the inclusion criteria, with 367 (76.6%) patients in the nonanticoagulated cohort and 112 (23.4%) patients in the anticoagulated cohort. The mean LOS and time to surgery were longer in the anticoagulated cohort (8.3 vs 7.3 days, P = .033 and 1.9 vs 1.6 days, P = .010); however, after controlling for age, CCI, and anesthesia type, these differences were no longer significant. Surgical outcomes were equivalent with similar procedure times, blood loss, and need for transfusion. The mean number of complications developed and inpatient mortality rate in the 2 cohorts were similar; however, more patients in the anticoagulated cohort required ICU/SDU-level care (odds ratio = 2.364, P = .001, controlled for age, CCI, and anesthesia). There was increased utilization of post-acute care in the anticoagulated cohort, with only 10.7% of patients discharged home compared to 19.9% of the nonanticoagulated group ( P = .026). Lastly, there was no difference in cost of care. Conclusion: This study highlights that anticoagulation status alone does not independently put patients at increased risk with respect to LOS, surgical outcomes, and cost of hospitalization.

Liposuction used to treat deep vascular accesses for hemodialysis

2020 ◽  
pp. 112972982092791
Author(s):  
Marius C Florescu ◽  
Troy J Plumb ◽  
Scott Westphal ◽  
Ryan Mullane ◽  
Debra A Reilly
Keyword(s):  
Surgical Complication ◽  
Invasive Technique ◽  
Dialysis Access ◽  
Dialysis Patients ◽  
Hemodialysis Catheter ◽  
Arteriovenous Fistulas ◽  
Post Surgery ◽  
Manual Pressure ◽  
Arteriovenous Grafts ◽  
The Mean

Background: Oftentimes, obese dialysis patients develop a viable dialysis access but the access is too deep for cannulation and needs a superficialization procedure. Methods: We present our 14-patient cohort in whom we performed liposuction to superficialize viable but deep vascular accesses. Out of 14 patients, 12 had arteriovenous fistulas and 2 arteriovenous grafts. The primary end points were the ability to superficialize a completely unusable access and to remove the hemodialysis catheter (3patients), or to significantly extend the useful length of a deep access in which only a very short segment was used and to continue to use the access post-surgery without the need to place a dialysis catheter (11 patients). Results: The study goal was met in 13 out of 14 patients. In two of three patients, the catheters were removed and their access usable length was 14 and 13 cm, respectively. The accesses could be used immediately after liposuction in all patients in which this applied—11 patients. The usable access length increased from a mean of 5 to 12.7 cm. The access mean depth decreased from 10.8 mm pre-surgery to 7 mm post-surgery and 5.3 mm 4 weeks after surgery. The mean volume of fat removed was 43.8 cc. We had only one surgical complication: bleeding that was readily controlled with manual pressure. All patients were discharged to home the same day. Postoperative pain was mild. Conclusion: Liposuction is effective, safe, and seems to be the least invasive technique of superficialization.

ZIRK-Technique: Zero Ischemia Resection in the Kidney for High-Risk Renal Masses: Perioperative Outcome

2015 ◽  
Vol 95 (2) ◽  
pp. 216-222 ◽  
Author(s):  
Maximilian C. Kriegmair ◽  
Daniel Pfalzgraf ◽  
Axel Häcker ◽  
Maurice Stephan Michel
Keyword(s):  
High Risk ◽  
Operation Time ◽  
Surgical Margins ◽  
Renal Tumors ◽  
Transfusion Rate ◽  
Renal Masses ◽  
Estimated Blood Loss ◽  
Mri Scans ◽  
Zero Ischemia ◽  
The Mean

Objectives: This study evaluates the feasibility and safety of open-partial nephrectomies in the ZIRK-technique (Zero Ischemia Resection in the Kidney) for renal masses with high-risk anatomical features - objectified by the PADUA score. Methods: We identified 40 consecutive cases of partial nephrectomies performed without clamping of the renal artery in our department of urology. Retrospective analysis of the preoperative CT or MRI scans showed 27 cases with a PADUA score ≥8, of which 15 cases had a score ≥10. Cases were in particular assessed regarding operation time (ORT), estimated blood loss (EBL), surgical margins and postoperative complications using the Clavien classification. Results: The mean age of the study population was 67.6 years with an average BMI of 26.8 kg/m2. The mean ORT was 1:46 with an average EBL of 521 ml. Clavien grade II complications were observed seven times, while 3 patients had a grade IIIa complication. Despite complex and adverse location of the tumors, nephron-sparing surgery without ischemia could be performed with negative surgical margins for all cases. EBL, transfusion rate and complication were considerably more frequent in high-risk tumors. Conclusion: Highly complex renal tumors, PADUA ≥10, can be resected in ZIRK-technique with good operative outcome and a low complication rate.

scholarly journals Perioperative, oncological, and functional outcomes of the first robotic prostatectomy program in Quebec: Single fellowship-trained surgeon's experience of 250 cases

2013 ◽  
Vol 7 (9-10) ◽  
pp. 326 ◽  
Author(s):  
Naif Al-Hathal ◽  
Assaad El-Hakim
Keyword(s):  
High Risk ◽  
Functional Outcomes ◽  
Specific Antigen ◽  
Surgical Margin ◽  
Urinary Continence ◽  
Positive Surgical Margin ◽  
Transfusion Rate ◽  
Estimated Blood Loss ◽  
Surgeon Experience ◽  
The Mean

Background: Robotic-assisted radical prostatectomy (RARP) is being increasingly done in Canada. Despite this, the Canadian literature lacks publications on the oncologic and functional outcomes of RARP. The objective of this study is to report the longest single surgeon experience in the province of Quebec.Methods: We collected prospective data from 250 consecutive patients who underwent RARP by a single fellowship trained surgeon (AEH) from October 2006 to October 2012. Mean follow-up was 28 months (range: 1-72). The D’Amico risk stratification distribution was 34% in low-risk, 48% in intermediate-risk and 18% in high-risk groups.Results: The mean operation time (±SD) was 194 ± 60.6 minutes, and estimated blood loss 318 ± 179 mL. The transfusion rate was only 0.4%. All procedures were completed robotically. The mean hospital stay was 1.2 days, and 88% of patients were discharged on postoperative day 1. The mean catheterization time was 7 days (range: 6-13). There were 2% major (Clavien III-IV) and 7.2% minor (Clavien I-II) postoperative complications, and no mortalities. On final pathology, 76% of patients were organ-confined and 70% specimen-confined. Pathological Gleason sum ≥7 accounted for 86%. Return of urinary continence (0-pads) at 3, 6, 12, and 24 months was 73.3%, 83.5%, 92.3%, 96.5%, respectively. Potency rate (successful penetration with or without medication) at 6,12, and 24 months was 49.3%, 85%, and 95.3%, respectively. Operative time and positive surgical margin (PSM) in organ-confined disease (pT2) decreased significantly after 50 cases. Seventeen patients (6.8%) had no undetectable prostate-specific antigen (PSA) at first visit (PSA <0.1 ng/mL). Of the remaining 233 patients, biochemical recurrence (PSA >0.2 ng/mL) was 4.7% (11 patients), and another 3.4% (8 patients) received early salvage radiotherapy (rising PSA, but <0.2 ng/mL). No patients with undetectable PSA required salvage treatments within 6 months postoperatively.Conclusions: Our results compare favourably with high-volume RARP programs, despite mainly intermediate- to high-risk disease. Initial learning curve was estimated to be 50 cases. Fellowship training was instrumental in achieving adequate functional and oncological outcomes, while maintaining low complications rate.

1422 GASLESS LAPAROENDOSCOPIC SINGLE-PORT RETROPERITONEAL RADICAL NEPHRECTOMY IN DIALYSIS PATIENTS: PERIOPERATIVE OUTCOMES OF 82 CONSECUTIVE CASES

2012 ◽  
Vol 187 (4S) ◽  
Author(s):  
Kazunori Kihara ◽  
Hitoshi Masuda ◽  
Kazutaka Saito ◽  
Fumitaka Koga ◽  
Noboru Numao ◽  
...  
Keyword(s):  
Radical Nephrectomy ◽  
Single Port ◽  
Perioperative Outcomes ◽  
Dialysis Patients

scholarly journals Urgent-start peritoneal dialysis results in fewer procedures than hemodialysis

2019 ◽  
Vol 13 (2) ◽  
pp. 166-171
Author(s):  
Delin Wang ◽  
Nathan Calabro-Kailukaitis ◽  
Mahmoud Mowafy ◽  
Eric S Kerns ◽  
Khetisuda Suvarnasuddhi ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Retrospective Cohort ◽  
Venous Catheter ◽  
Dialysis Access ◽  
Dialysis Patients ◽  
Central Venous ◽  
The Usa ◽  
The Mean

Abstract Background Peritoneal dialysis (PD) is an underutilized modality for hospitalized patients with an urgent need to start renal replacement therapy in the USA. Most patients begin hemodialysis (HD) with a tunneled central venous catheter (CVC). Methods We examined the long-term burden of dialysis modality-related access procedures with urgent-start PD and urgent-start HD in a retrospective cohort of 73 adults. The number of access-related (mechanical and infection-related) procedures for each modality was compared in the first 30 days and cumulatively through the duration of follow-up. Results Fifty patients underwent CVC placement for HD and 23 patients underwent PD catheter placement for urgent-start dialysis. Patients were followed on average &gt;1 year. The PD group was significantly younger, with less diabetes, with a higher pre-dialysis serum creatinine and more likely to have a planned dialysis access. The mean number of access-related procedures per patient in the two groups was not different at 30 days; however, when compared over the duration of follow-up, the number of access-related procedures was significantly higher in the HD group compared with the PD group (4.6 ± 3.9 versus 0.61 ± 0.84, P &lt; 0.0001). This difference persisted when standardized to procedures per patient-month (0.37 ± 0.57 versus 0.081 ± 0.18, P = 0.019). Infection-related procedures were similar between groups. Findings were the same even after case-matching was performed for age and diabetes mellitus with 18 patients in each group. Conclusions Urgent-start PD results in fewer invasive access procedures compared with urgent-start HD long term, and should be considered for urgent-start dialysis.

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