Adrenalectomy for malignant disease: Utilization and outcomes by surgeon specialty and surgical approach.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 489-489
Author(s):  
Izak Faiena ◽  
Alexandra Tabakin ◽  
Jeffrey Leow ◽  
Neal Patel ◽  
Parth K Modi ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Complication Rate ◽  
Malignant Disease ◽  
National Level ◽  
Major Complication ◽  
Geographic Region ◽  
Adrenal Tumors ◽  
Open Approach ◽  
Adrenal Cancer ◽  
Significant Difference

489 Background: Adrenal cancers have traditionally been treated using an open surgical approach. With advances in minimally invasive surgery (MIS), adrenal tumors have become more amenable to MIS resection. We report a study on the utilization and outcomes of surgery for adrenal cancers on a national level. Methods: Data on patients who underwent open, laparoscopic, or robotic adrenalectomy for adrenal cancer (ICD-9 code 194.0) from 2003-2013 were extracted from the nationally representative Premier Hospital Database. Surgeon specialty, patient demographics, hospital characteristics, intraoperative and perioperative data, and complications were compared. Data were analyzed using univariate and multivariate logistic regression analyses. Results: 4,781 adrenalectomies were performed for malignant disease. Surgery was more commonly performed in patients >50 years of age (83%), men (64%), and white race (80%). There was no significant difference in rate of adrenalectomy with regards to comorbidities, insurance status, teaching vs. non-teaching hospital, hospital bed size, or geographic region. Adrenalectomy for malignant disease was more commonly performed by non-urologists (66 vs. 34%; p=0.011). Among non-urologists, open surgery was most common followed by laparoscopic and robotic approaches (56.3% vs. 37.4% vs. 6.4%, respectively) as compared to urologists (48.8% vs. 38.4% vs. 12.9%, respectively). There was no difference in complication rate or operative time between surgeon types. On multivariate regression analysis, the best predictor of major complication was a Charlson Comorbidity Index (CCI) >2 (OR 6.1, 95% CI 2.9-12.5; p<0.0001). Surgical approach and surgeon specialty were not predictors of complications. Conclusions: Adrenalectomy for malignant disease was more commonly performed by non-urologists via an open approach. Patient CCI >2 was associated with a higher rate of post-op complications, while surgical approach did not influence complication rate. These findings indicate that MIS can be performed safely for adrenal cancers. Prospective study of MIS for adrenal cancer is needed to evaluate its oncologic efficacy.

scholarly journals Surgical Treatment of Olfactory Neuroblastoma: Major Complication Rates, Progression Free and Overall Survival

2017 ◽  
Vol 79 (02) ◽  
pp. 151-155 ◽  
Author(s):  
Aileen Wertz ◽  
Todd Hollon ◽  
Lawrence Marentette ◽  
Stephen Sullivan ◽  
Jonathan McHugh ◽  
...  
Keyword(s):  
Overall Survival ◽  
Major Complication ◽  
Olfactory Neuroblastoma ◽  
Csf Leak ◽  
Complication Rates ◽  
Care Hospital ◽  
Open Approach ◽  
Major Complications ◽  
Grading Systems ◽  
Significant Difference

Objective We aimed to compare major complication rates in patients undergoing open versus endoscopic resection of olfactory neuroblastoma (ONB) and to determine the prognostic utility of the Kadish staging and Hyams grading systems with respect to progression-free survival (PFS) and overall survival (OS). Methods It is a retrospective review of experience in treating ONB at a single tertiary care hospital from 1987 through 2015. Major complications were defined as cerebrospinal fluid (CSF) leak, meningitis, osteomyelitis, tracheostomy, and severe neurologic injury. Results Forty-one patients were included. An open approach was used in 34 (83%), endoscopic in 6 (15%), and combined in 1 (2%) case. Rates of major complications by surgical approach were 17% after endoscopic versus 31% after open (p = 0.65). There was no significant difference in PFS or OS based on Kadish B versus C (PFS, p = 0.28; OS, p = 0.11) or Hyams grade 1 and 2 versus Hyams grade 3 and 4 (PFS, p = 0.53; OS, p = 0.38). Conclusions There was no significant difference in major complications between open and endoscopic approaches for the treatment of ONB. Patient stratification using the Kadish staging and Hyams grading systems did not show significant differences in PFS or OS. Further research is needed to determine if a different staging system would better predict patient outcomes.

Comparative Outcomes by Surgical Approach in Patients with Malignant Sinonasal Disease

2021 ◽  
Author(s):  
Nicholas R. Lenze ◽  
Carolyn Quinsey ◽  
Deanna Sasaki-Adams ◽  
Matthew G. Ewend ◽  
Brian D. Thorp ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Surgical Approach ◽  
Complication Rate ◽  
Perioperative Complications ◽  
Intraoperative Complications ◽  
Care Center ◽  
Tertiary Care ◽  
Undifferentiated Carcinoma ◽  
Open Approach ◽  
Sinonasal Disease

Abstract Objective There is a paucity of data on comparative outcomes for open versus endoscopic surgery for patients with malignant sinonasal pathology. Most of the available studies are limited by a sample size <100 patients. Design This is a retrospective cohort study. Setting The findings of this study come from a single-institution tertiary care center from 2008 to 2019. Participants In total, 199 patients who underwent surgery for malignant sinonasal disease participated in this study. Main Outcome Measures The main outcome measures were perioperative complications and reoperation. Results Patients in our sample had a mean age of 59.7 years (SD, 20.4). In total, 62% were male and 72% were white. An endoscopic-only approach was used in 41% of patients and an open or combined approach in 59% of patients. Squamous cell carcinoma was the most common pathology (43.0%), followed by sarcoma (9.5%), skin cancer (6.5%), sinonasal undifferentiated carcinoma (6.5%), and adenocarcinoma (5.5%). The all-cause complication rate was 14.6%. Patients with an open resection had a higher rate of intraoperative complications (5.9 vs. 0%; p = 0.043), postoperative complications (19.5 vs. 3.7%; p = 0.001), and all-cause complications (21.0 vs. 3.7%; p < 0.001). The likelihood of early reoperation (<6 months) or late reoperation (>6 months) did not significantly differ by surgical approach (p = 1.000 and 0.741, respectively). Conclusion The endoscopic approach for resection of malignant sinonasal disease is viable for select patients and may be associated with a favorable complication rate compared with the open approach.

Comparison of Intra- and Postoperative Complications between Bilateral Simultaneous and Staged Tibial Plateau Levelling Osteotomy with Arthroscopy in 176 Cases

2020 ◽  
Author(s):  
Raz Peress ◽  
Sebastian Mejia ◽  
Marcos Unis ◽  
Giovanni Sotgiu ◽  
Simone Dore ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Complication Rate ◽  
Tibial Plateau ◽  
Cruciate Ligament ◽  
Statistical Error ◽  
Major Complication ◽  
Tibial Tuberosity ◽  
Cranial Cruciate Ligament ◽  
Significant Difference ◽  
Client Factors

Abstract Objective The aim of this study was to compare the resulting short-term complications after simultaneous (SIM) or staged (ST) tibial plateau levelling osteotomy (TPLO) in patients that presented with bilaterally torn cranial cruciate ligaments. Study Design This was a retrospective study. Materials and Methods Medical records of dogs diagnosed with bilateral cranial cruciate ligament disease that underwent bilateral SIM or ST TPLO surgery with arthroscopy (2005–2015) were reviewed to evaluate the intra- and postoperative complications. Data were analysed and major and minor complications were compared between the two groups. Results A total of 176 client-owned dogs (352 stifles) that had TPLO performed bilaterally with SIM or ST procedures were included for analysis. The overall complication rate was 47.5% for the SIM group and 19.5% for the ST group. The incidence of major complications was 10.1 and 3.8% in the SIM and ST groups respectively. Minor complications were 38.4 and 15.6% in the SIM and ST groups respectively. Tibial tuberosity fractures requiring revision were noted in 2% of the SIM group and none of the ST group. Clinical Significance Although no significant difference was noted in major complication rate or tibial tuberosity fractures in our cohort of patients, a Type II statistical error was found. The complication rate in the SIM group is numerically greater by a factor of 2–3× or more for nearly all categories. Surgeons should consider the risks and benefits of SIM versus ST procedures as well as relevant individual patient and client factors before electing either alternative.

Pancreaticoduodenectomy in a Community General Surgery Residency Program

2006 ◽  
Vol 72 (8) ◽  
pp. 750-753 ◽  
Author(s):  
Chadwick P. Smith ◽  
Michael L. Cheatham ◽  
Matthew W. Lube ◽  
Karen Safcsak
Keyword(s):  
General Surgery ◽  
Residency Program ◽  
Complication Rate ◽  
Malignant Disease ◽  
Major Complication ◽  
Morbidity And Mortality ◽  
General Surgery Residency ◽  
Major Complication Rate ◽  
Surgery Residency Program ◽  
Overall Mortality

The morbidity and mortality of pancreaticoduodenectomy (PD) has been well documented. A retrospective review was performed to determine the morbidity and mortality of PD performed within the general surgery residency program of a tertiary community hospital. Patients undergoing PD for benign or malignant disease over a 6-year period were analyzed to determine overall mortality, major complication rate, and length of stay (LOS). Of 50 consecutive patients undergoing PD, overall mortality was 6 per cent, with a major complication rate of 52 per cent. Mean operative time was 333 ± 68 minutes with an estimated blood loss of 459 ± 301 mL. Mean hospital LOS was 21 ± 13 days. Eighty-four per cent of patients with malignant disease had negative margins of resection. General surgery residents within a community residency program, with attending faculty supervision, can perform PD with mortality, morbidity, and LOS comparable with that reported in the university setting.

Complications After Distal Biceps Tendon Repair: A Systematic Review

2020 ◽  
Vol 48 (12) ◽  
pp. 3103-3111 ◽  
Author(s):  
Melanie Amarasooriya ◽  
Gregory Ian Bain ◽  
Tom Roper ◽  
Kimberley Bryant ◽  
Karim Iqbal ◽  
...  
Keyword(s):  
Nerve Injury ◽  
Surgical Approach ◽  
Complication Rate ◽  
Single Incision ◽  
Biceps Tendon ◽  
Major Complication ◽  
Fixation Technique ◽  
Distal Biceps ◽  
Major Complication Rate ◽  
Anterior Incision

Background: Distal biceps tendon injuries typically occur in the dominant arm of men in their fourth decade of life. Surgical repair restores flexion and supination strength, resulting in good functional outcome. The complication profile of each surgical approach and fixation technique has not been widely studied in the literature. Purpose: To report the rate of complications after repair of complete distal biceps ruptures, to classify them according to surgical approach and fixation technique, and to analyze risk factors and outcomes of the individual complications. Study Design: Systematic review. Methods: Studies published in English on primary repair of the distal biceps between January 1998 and January 2019 were identified. Data on complications were extracted and classified as major and minor for analysis. A quantitative synthesis of data was done to compare the complication rates between (1) limited anterior incision, extensile anterior incision, and double incision and (2) 4 fixation methods. Results: Seventy-two articles including 3091 primary distal biceps repairs were identified. The overall complication rate was 25% (n = 774). The major complication rate was 4.6% (n = 144) and included a 1.6% (n = 51) rate of posterior interosseous nerve injury; 0.3% (n = 10), median nerve injury; 1.4% (n = 43), rerupture; and a 0.1% (n = 4), synostosis. Brachial artery injury, ulnar nerve injury, compartment syndrome, proximal radius fracture, and chronic regional pain syndrome occurred at a rate of <0.1% each. The majority of nerve injuries resolved with an expectant approach. The minor complication rate was 20.4% (n = 630). The most common complication was lateral cutaneous nerve injury (9.2%, n = 283). An extensile single incision was associated with a higher rate of superficial radial nerve injury when compared to limited single incision(6% vs 2.1%, P = .002). Limited anterior single incision technique had a higher rate of lateral antebrachial cutaneous nerve injury compared to extensile single incision. (9.7% vs 5.2%, P = .03). Synostosis occurred only with double incision. Fixation technique had no significant effect on rerupture rate and posterior interosseous nerve injury rate. Conclusion: This is the largest analysis of complications after distal biceps repair, indicating a major complication rate of 4.6%. This study provides valuable data with regard to the choice of technique, surgical approach, and rate of complications, which is essential for surgical planning and patient consent. Registration: CRD42017074066 (PROSPERO).

scholarly journals Endoloops in Laparoscopic Appendicectomy: a Cost Effectiveness Analysis

2021 ◽  
Author(s):  
Emily Hale ◽  
Joel Bowen ◽  
Jonathon Sheen ◽  
Kirk Bowling
Keyword(s):  
Cost Effectiveness ◽  
Complication Rate ◽  
Laparoscopic Appendicectomy ◽  
P Value ◽  
Open Approach ◽  
Post Discharge ◽  
Potential Cost ◽  
Exact Test ◽  
Significant Difference ◽  
The Uk

Introduction Over 50,000 appendicectomies are performed in the UK annually with significant associated costs to the healthcare system.The aim of this study was to investigate whether a significant difference in complication rate exists where different numbers of endoloop ligatures have been applied to the appendiceal base during laparoscopic appendicectomy, and to analyse for potential cost saving. Methods We performed a retrospective analysis of appendicectomies at our centre in one year, providing a sample of 254 patients. Cases were analysed against exclusion criteria, operative method, and histological findings. Each was followed up for complications in the 30 days post discharge and graded using the Clavien-Dindo system. Our null hypothesis of no difference in complication rate was tested using Fisher’s exact test. Results Of 254 patients, 59 were excluded due to open approach, non-endoloop method, or lack of available record, leaving a population of 195. The result of the two-tailed P value equalled 1.000, indicating no statistically significant difference in complication rate whether one or two endoloops were used. Regarding cost effectiveness, an endoloop costs £13.59. If the 62 cases in which 2 endoloops were used to secure the base had utilised a single endoloop, this would amount to a saving of £842.58. Conclusion Our study set out to assess whether the complication rate differs in cases where one or two endoloops have been applied. Retrospective statistical analysis found no significant difference between groups. Based on these findings, we recommend use of one endoloop to secure the base in laparoscopic appendicectomy.

scholarly journals Laparoscopic Intervention to Pancreatic Pseudocyst Confers Short-Term Benefits: A Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Yulin Guo ◽  
Shun Hu ◽  
Shuo Wang ◽  
Ang Li ◽  
Feng Cao ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Pancreatic Pseudocyst ◽  
Surgical Intervention ◽  
Operating Time ◽  
Surgical Techniques ◽  
Laparoscopic Approach ◽  
Cochrane Library ◽  
Open Approach ◽  
Qualitative Synthesis ◽  
Significant Difference

Background. Surgical interventions for pancreatic pseudocyst (PP) are traditionally managed by an open surgical approach. With the development of minimally invasive surgical techniques, a laparoscopic surgical approach for PPs has been conducted increasingly with comparable outcomes. The present study was conducted to compare the efficacy and safety of surgical intervention for PPs between the laparoscopic approach and the open approach. Methods. Databases including Cochrane Library, PubMed, and EMBASE were searched to identify studies that compared the safety and efficacy of surgical intervention for PPs between the laparoscopic approach and the open approach (until Aug 1st 2020). Results. A total of 6 studies were eligible in qualitative synthesis. The laparoscopic approach was associated with less intraoperative blood loss (MD = −69.97; 95% CI: −95.14 to −44.70, P < 0.00001 ; P = 0.86 for heterogeneity) and shorter operating time (MD = −33.12; 95% CI: −62.24 to −4.00, P = 0.03 ; P < 0.00001 for heterogeneity). There was no significant difference found between the two approaches regarding the success rate and the recurrence rate. The postoperative complications and mortality rates were comparable between the two approaches. Conclusions. The laparoscopic approach for the surgical intervention of PPs is safe and efficacious with shorter-term benefits.

5970Morbidity and mortality in patients precluded for transvenous pacemaker implantation: experience with the Micra transcatheter pacemaker

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Garg ◽  
J N Koneru ◽  
D Fagan ◽  
K Stromberg ◽  
M F El-Chami ◽  
...  
Keyword(s):  
Complication Rate ◽  
Safety Profile ◽  
Pacemaker Implantation ◽  
Major Complication ◽  
Venous Access ◽  
Cox Models ◽  
Device Infection ◽  
Significant Difference ◽  
All Cause Mortality ◽  
Major Complication Rate

Abstract Background The Micra transcatheter pacemaker has proven to be a safe and effective alternative to transvenous pacemakers (TVPs). However, the safety profile after Micra implantation in patients deemed poor candidates for TVPs is poorly understood. Purpose To evaluate the safety and all-cause mortality outcomes in Micra recipients stratified by whether or not they were precluded for therapy with TVP. Methods Micra patients from the Micra Transcatheter Pacing (IDE) Study, Continued Access (CA) study, and Post-Approval Registry (PAR) were divided into groups based upon whether or not the implanting physician considered the patient to be precluded from receiving a transvenous pacing system. All-cause mortality was compared between the Micra patient groups and patients receiving a single-chamber transvenous pacing system (SC-TVP) since 2010 from the Medtronic product surveillance registry using univariate and multivariate Cox models. Results Among 2,819 patients who underwent a Micra implant attempt, the overall major complication rate through 24 months was 3.5%. In these patients, 548 were deemed precluded from TVP implantation. Prior device infection or bacteremia (38.9%), venous access issues (36.1%) and thrombosis (10.2%) were amongst the most common causes of preclusion for TVP implantation. These patients were younger (71.7 vs. 76.7 years), more frequently on hemodialysis (26.3% vs. 2.5%), and more often had a prior CIED implanted (38.4% vs. 4.4%) than non-precluded patients. Over an average follow-up of 13.5±11.1 months, all-cause mortality was significantly higher in precluded Micra patients compared with SC-TVP patients (HR: 2.16, 95% CI: 1.54–3.2, P<0.001) (Figure 1). However, there was no significant difference in all-cause mortality when comparing non-precluded Micra patients and SC-TVP patients (HR: 1.12, 95% CI: 0.86–1.44, P=0.401). Acute all-cause death (within 1 month) among Micra patients was 2.74% and 1.32% in the precluded and non-precluded TVP groups, respectively. The procedure-related death rate was 0.55% for the TVP precluded group and 0.13% for the not precluded group (P=0.092). The major complication rate through 24-months was similar between the two Micra groups (4.0% vs 3.4%, P=0.630). All-cause mortality for Micra and SC-TVP Conclusion The overall safety profile of Micra remains is in line with previously reported data. All-cause mortality risk (both acute and long term) appears to be higher in patients who were precluded from receiving TVP. Acknowledgement/Funding Supported by Medtronic

scholarly journals Retroperitoneal endoscopic adrenalectomy vs. Conventional adrenalectomy in treatment of benign adrenal lesions: Comparative analysis

2007 ◽  
Vol 54 (2) ◽  
pp. 45-48 ◽  
Author(s):  
G. Todorov ◽  
Tc. Lukanova
Keyword(s):  
Minimally Invasive ◽  
Hospital Stay ◽  
Complication Rate ◽  
Operative Time ◽  
Standard Of Care ◽  
Postoperative Hospital Stay ◽  
Adrenal Tumors ◽  
Endoscopic Adrenalectomy ◽  
Significant Difference ◽  
Median Operative Time

Minimally invasive adrenalectomy is considered to be the standard of care for the surgical treatment of the adrenal gland? s pathology. Since the initial report of laparoscopic adrenalectomy in 1992 and of retroperitoneal endoscopic adrenalectomy in 1994, it has evolved into a feasible and safe minimally invasive procedure for benign adrenal tumors. Clinical characteristics and outcomes of 63 retroperitoneal endoscopic adrenalectomies (REAs) and 45 conventional adrenalectomies (CAs) from 1996 to 2004 were evaluated. 61 patients underwent 63 REAs. Tumor size varied from 2 to 8 cm. Median age was 48.6 years. Median operative time was 135 min (45-240), median intraoperative blood loss - 85 ml (30- 550). The complication rate was 17.77%. Median postoperative hospital stay was 5 days (2-10). 44 patients underwent 45 conventional adenalectomies. Median age was 44.5 years (16-71). Intraoperative complication rate was 17.77%, postoperative - 22.22 %, Median operative time was 120 min (75 -240). Median postoperative hospital stay was 10 days (6-21). No statistically significant difference was established between median operative times of REA- and CA-groups (p=0.91). Conventional adrenalectomy was associated with a significantly increased complication rate (p= 0.009). Hospitalization was also longer after the open technique (d). Introduced in 1994 and displaying all advantages of minimal access surgery REA has become the standard of care for benign adrenal tumors. .

Complications of Mandibulotomy: Midline Versus Paramidline

2003 ◽  
Vol 128 (1) ◽  
pp. 137-141 ◽  
Author(s):  
Tsung-Sung Dai ◽  
Sheng-Po Hao ◽  
Kai-Ping Chang ◽  
Whei-Lin Pan ◽  
Hwey-Chin Yeh ◽  
...  
Keyword(s):  
Oral Cavity ◽  
Study Design ◽  
Surgical Approach ◽  
Complication Rate ◽  
Preoperative Evaluation ◽  
Lateral Incisor ◽  
Related Complication ◽  
Major Complications ◽  
Significant Difference

OBJECTIVE: Mandibulotomy is an important surgical approach to oral cavity and oropharynx. The objective of this study was to evaluate the related complications of 2 common mandibulotomies: midline (osteotomy between 2 central incisors) and paramidline (osteotomy between lateral incisor and canine). STUDY DESIGN: Ninety-six patients who had cancer in the oral cavity or oropharynx had preoperative evaluation of the mandible with panoramic films. Among them, 42 patients underwent mandibulotomies: midline for 19 patients and paramidline for 23. RESULTS: Twenty (47.6%) of 42 patients had mandibulotomy-related complications, including 9 (21.4%) minor complications and 11 (26.2%) major complications. There were 6 (31.6%) major and 4 (21.1%) minor complications in the midline mandibulotomy and both 5 (21.7%) major and minor complications in the paramidline mandibulotomy. CONCLUSION: There was no significant difference in the mandibulotomy-related complication rate between midline and paramidline mandibulotomies. Paramidline mandibulotomy, which preserves the geniohyoid and genioglossus muscles, should be a better function-preserving operation than midline mandibulotomy.

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