Do females have worse surgical outcomes after radical cystectomy? Impact of gender on 30-day complications in a national cohort.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 402-402
Author(s):  
Srinath Kotamarti ◽  
Michael Silver ◽  
Andrew Wood ◽  
Ervin Teper ◽  
David Silver ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Radical Cystectomy ◽  
Surgical Outcomes ◽  
Operative Time ◽  
Perioperative Outcomes ◽  
Categorical Variables ◽  
Improvement Program ◽  
Invasive Approach ◽  
Cancer Of The Bladder ◽  
National Cohort

402 Background:: Men have higher rates of bladder cancer and are more likely to undergo cystectomy than women, yet women seem to have worse oncologic outcomes. This is attributed to biologic factors including adverse histologic variants and social factors including delay in diagnosis. There is early evidence that women also have worse surgical outcomes. We further examined the role of gender in 30-day perioperative outcomes following radical cystectomies in a national cohort. Methods: We examined the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) from 2012 to 2016. The database was searched for CPT codes reflecting radical cystectomy and a diagnosis of “cancer of the bladder.” Frailty was estimated by the modified frailty index (functional status, diabetes, chronic obstructive pulmonary disorder, history of chronic heart failure, and hypertension requiring medication.) To compare demographic and perioperative characteristics between genders, Chi-Square analyses were performed for categorical variables, student’s t test to compare averages, and the Wilcoxon rank sum test for operative time and length of stay (LOS). Results: 4,681 radical cystectomies were identified including 842 (18.0%) females. Of the female cohort, average age was 68.6 (+/-11.2 years), 77.3% was Caucasian and 278 (33%) had a BMI of at least 30. There were no differences appreciated between genders with regards to age, average ASA score, frailty, or minimally-invasive approach (all p=NS). Compared to males, female gender was associated with longer operative time (350 vs. 336 min, p<0.009), length of stay (LOS) (8 vs 7, p<0.001) and lower rates of discharge to home (79.9% vs 87.0%, p<0.0001). Reoperation (4.8% vs. 6.0%), readmission (22.2% vs 20.6%), and death within 30 days (1.9% vs. 2.0%) were similar. Clavien 3 or greater was also similar among gender (Table). Conclusions: Female patients comprise a minority of radical cystectomies with slightly longer LOS and less home discharge than men, yet 30-day major complications, reoperation and mortality appear similar. [Table: see text]

scholarly journals The impact of resident involvement in minimally-invasive urologic oncology procedures

2014 ◽  
Vol 8 (9-10) ◽  
pp. 334 ◽  
Author(s):  
Nedim Ruhotina ◽  
Julien Dagenais ◽  
Giorgio Gandaglia ◽  
Akshay Sood ◽  
Firas Abdollah ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Minimally Invasive ◽  
Partial Nephrectomy ◽  
Operative Time ◽  
Readmission Rates ◽  
Improvement Program ◽  
Urologic Oncology ◽  
Invasive Approach ◽  
Resident Involvement ◽  
The Impact

Introduction: Robotic and laparoscopic surgical training is an integral part of resident education in urology, yet the effect of resident involvement on outcomes of minimally-invasive urologic procedures remains largely unknown. We assess the impact of resident participation on surgical outcomes using a large multi-institutional prospective database.Methods: Relying on the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Participant User Files (2005-2011), we abstracted the 3 most frequently performed minimally-invasive urologic oncology procedures. These included radical prostatectomy, radical nephrectomy and partial nephrectomy. Multivariable logistic regression models were constructed to assess the impact of trainee involvement (PGY 1-2: junior, PGY 3-4: senior, PGY ≥5: chief) versus attending-only on operative time, length-of-stay, 30-day complication, reoperation and readmission rates.Results: A total of 5459 minimally-invasive radical prostatectomies,1740 minimally-invasive radical nephrectomies and 786 minimally-invasive partial nephrectomies were performed during the study period, for which data on resident surgeon involvement was available. In multivariable analyses, resident involvement was not associated with increased odds of overall complications, reoperation, or readmission rates for minimally-invasive prostatectomy, radical and partial nephrectomy. However, operative time was prolonged when residents were involved irrespective of the type of procedure. Length-of-stay was decreased with senior resident involvement in minimally-invasive partial nephrectomies (odds ratio [OR] 0.49, p = 0.04) and prostatectomies (OR 0.68, p = 0.01). The major limitations of this study include its retrospective observational design, inability to adjust for the case complexity and surgeon/hospital characteristics, and the lack of information regarding the minimally-invasive approach utilized (whether robotic or laparoscopic).Conclusions: Resident involvement is associated with increased operative time in minimally-invasive urologic oncology procedures. However, it does not adversely affect the complication, reoperation or readmission rates, as well as length-of-stay.

scholarly journals Radical cystectomy in patients with disseminated disease: An assessment of perioperative outcomes using the National Surgical Quality Improvement Program database

2017 ◽  
Vol 11 (8) ◽  
pp. 244-8 ◽  
Author(s):  
Christopher Wallis ◽  
Suneil Khana ◽  
Mohammad Hajiha ◽  
Robert K. Nam ◽  
Raj Satkunasivam
Keyword(s):  
Quality Improvement ◽  
Length Of Stay ◽  
Radical Cystectomy ◽  
Pulmonary Complications ◽  
Quality Improvement Program ◽  
Perioperative Outcomes ◽  
Improvement Program ◽  
Surgical Quality ◽  
Prolonged Length ◽  
Disseminated Disease

Introduction: We sought to determine the effect of the presence of disseminated disease on perioperative outcomes following radical cystectomy for bladder cancer.Methods: We identified 4108 eligible patients who underwent radical cystectomy for bladder cancer using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. We matched patients with disseminated cancer at the time of surgery to those without disseminated cancer using propensity scores. The primary outcome of interest was major complications (death, reoperation, cardiac or neurological event). Secondary outcomes included pulmonary, infectious thromboembolic, and bleeding complications, in addition to prolonged length of stay. Generalized estimating equations were used to examine the association between disseminated cancer and the development of complications.Results: Following propensity score matching and adjusting for the type of urinary diversion, radical cystectomy in patients with disseminated disease was associated with a significant increase in major complications (8.6% vs. 4.0%; odds ratio [OR] 2.50; 95% confidence interval [CI] 1.02–6.11; p=0.045). The presence of disseminated disease was associated with an increase in pulmonary complications (5.8% vs. 1.2%; OR 5.17. 95% CI 1.00‒26.66. p=0.049), but not infectious complications, venous thromboembolism, bleeding requiring transfusion, and prolonged length of stay (p values 0.07–0.79).Conclusions: Patients with disseminated cancer undergoing cystectomy are more likely to experience major and pulmonary complications. The strength of these conclusions is limited by sample size, selection bias inherent in observational

Perioperative Outcomes of Combined Gynecologic Oncology and Urogynecologic Surgeries

2020 ◽  
pp. 1-5
Author(s):  
Abeer Eddib ◽  
Abeer Eddib ◽  
Ahmed Eddib ◽  
Kenneth Fan
Keyword(s):  
Urinary Incontinence ◽  
Pelvic Organ Prolapse ◽  
Operative Time ◽  
Gynecologic Oncology ◽  
Gynecologic Cancer ◽  
Pelvic Organ ◽  
Perioperative Outcomes ◽  
P Value ◽  
Gynecologic Malignancy ◽  
Improvement Program

Background: Many women diagnosed with a gynecologic malignancy may have coinciding urogynecologic complaints, such as pelvic organ prolapse (POP) and/or urinary incontinence, with approximately 35% reporting moderate to severe symptoms. Recent National Surgical Quality Improvement Program (NSQIP) database inquiries of gynecologic cancer cases found only 2.3-2.4% of women undergoing interventional surgery for gynecologic malignancy also had a procedure for pelvic organ prolapse urinary incontinence (POPUI), and those combination cases did not show significant increase in postoperative risks. The purpose of our study is to review our cases of gynecologic cancer that underwent concomitant urogynecologic procedures and compare their perioperative outcomes to gynecologic cancer cases without concomitant urogynecologic procedures. Methods: A retrospective cohort study conducted at a teaching hospital included 29 gynecologic oncology patients who underwent robot-assisted total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and lymphadenectomy. Controls underwent standard staging procedure and were compared to women with concomitant pelvic floor dysfunction that underwent additional laparoscopic uterosacral ligament suspension for apical suspension and a sling for stress urinary incontinence (SUI). The primary outcome was operative time, defined as documented total operative time and robot console time. Secondary outcomes include delta hemoglobin, hospital length of stay, readmission rate, total pain medication, urinary retention and discharge with foley. Results: The combined case group had longer total procedure time duration (301 minutes versus 210 minutes, p-value < 0.0001), with comparable mean console time (178 minutes versus 160 minutes; p = 0.1456). Blood loss estimated by mean percent difference of Hgb showed moderate conditional dependence on surgical case (22.2% cases versus 14.9% controls, p-value 0.04). Combined cases resulted in 76.9% of subjects discharged with a foley catheter compared to none in controls (p-value < 0.0001). Otherwise, there was no difference in the other perioperative outcomes between the two groups. Conclusion: With appropriate counseling and clinical judgement, combined urogynecologic and gynecologic oncologic surgeries can be performed to improve a patient’s quality of life (QOL) with minimal increase in perioperative morbidity.

scholarly journals Perioperative Outcomes Of Laparoscopic Hysterectomy: Comparison With Abdominal, Vaginal, And Robot-Assisted Surgical Approaches

2015 ◽  
Vol 8 (1) ◽  
pp. 52-60
Author(s):  
Slavcho T. Tomov ◽  
Grigor A. Gortchev ◽  
Latchesar S. Tantchev ◽  
Todor I. Dimitrov ◽  
Chavdar A. Tzvetkov ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Vaginal Hysterectomy ◽  
Operative Time ◽  
Laparoscopic Hysterectomy ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Perioperative Outcomes ◽  
Surgical Approaches ◽  
Significant Linear Correlation ◽  
The Mean

SummarySelection of an appropriate surgical method for hysterectomy in an individual patient is currently an issue that remains open and debatable. This study aimed to analyze perioperative outcomes in gynecologic patients who underwent laparoscopic hysterectomy at a single institution during a 6-year period and to compare the data for simple hysterectomy patients treated with different surgical approaches. The study included a retrospective analysis of demographics, pre- and post-operative characteristics of 1,023 patients, operated on using four types of simple hysterectomy approaches: 635 laparoscopic hysterectomies (62.1%), 289 total abdominal hysterectomies (28.3%), 45 total vaginal hysterectomies (4.4%) and 54 robotic-assisted hysterectomies (5.3%). For the laparoscopic hysterectomy group, the mean operative time was shorter as compared to the abdominal and vaginal hysterectomy groups (p<0.05), as well as a significantly shorter hospital length-of-stay when compared to the abdominal, robotic or vaginal hysterectomy groups (p<0.05). Regression analysis revealed significant linear correlation between operative time and body-mass index of laparoscopic hysterectomy patients (R2 =0.008; p=0.026). Complications emergence and hemotransfusion often prolonged the mean operative time significantly by 17.8 min (p=0.002) and 15.5 min, respectively (p<0.001). The rate of major complications was significantly higher in the laparoscopic vs. abdominal groups (p<0.05). Clinical outcomes in patients operated on with laparoscopic hysterectomy were better than in those operated with total abdominal and vaginal hysterectomy in terms of operative time and hospital length-of-stay. Prospective randomized multi-center studies would be desirable to further define the place of the modern minimally invasive hysterectomy approaches.

Surgical outcomes of hysterectomy for endometriosis: Benefits of a minimally invasive approach

2021 ◽  
pp. 228402652098571
Author(s):  
Olga Mutter ◽  
Sarah Ackroyd ◽  
George A Taylor ◽  
Juan Diaz
Keyword(s):  
Minimally Invasive ◽  
Surgical Approach ◽  
Surgical Outcomes ◽  
Abdominal Hysterectomy ◽  
Pelvic Surgery ◽  
Complication Rates ◽  
Minimally Invasive Approach ◽  
Improvement Program ◽  
Invasive Approach ◽  
Abdominal Approach

Introduction: We aimed to evaluate surgical outcomes of hysterectomy for endometriosis performed by general obstetricians and gynecologists (OB/GYNs) based on surgical approach. Methods: Using the 2016–2018 National Surgical Quality Improvement Program (NSQIP) database, we examined surgical outcomes including 30-day complication rates based on surgical approach in patients who underwent a hysterectomy for endometriosis by OB/GYNs. Results: From 2016 to 2018, 3641 hysterectomies were performed by OB/GYNs for endometriosis. 86.0% were performed via a minimally invasive (MIS) approach, with 2882 (79.2%) via a laparoscopic and 247 (6.8%) via a vaginal approach. Compared to MIS hysterectomies, those who underwent an abdominal hysterectomy included a higher proportion of African American and a lower proportion of non-Hispanic white patients, had heavier uteri, lower parity, and were more likely obese (all p < 0.05). There were no differences in age, American Society of Anesthesiologists class, comorbidities other than obesity, or a history of prior abdominal or pelvic surgery (all p > 0.05). Women undergoing hysterectomy for endometriosis experienced an overall 9.8% complication rate. Compared to abdominal approaches, MIS had a lower rate of overall complications (8.5% vs 17.8%) including wound (2.7% vs 7.2%) and major (4.4% vs 8.8%) complications (all p < 0.001). MIS had shorter operative time (129.2 ± 60.9 vs 143.8 ± 71.9), shorter length of stay (0.9 ± 1.6 vs 2.4 ± 1.8), and fewer readmissions (2.8% vs 5.5%) (all p < 0.001). Conclusion: While hysterectomy for endometriosis is a challenging procedure to perform, OB/GYNs are performing this procedure predominantly via a minimally invasive approach with fewer complications and more favorable surgical outcomes than an abdominal approach.

scholarly journals Uniportal versus multiportal video-assisted thoracoscopic anatomical resection for NSCLC: a meta-analysis

2020 ◽  
Author(s):  
Yueren Yan ◽  
Qingyuan Huang ◽  
Han Han ◽  
Yang Zhang ◽  
Haiquan Chen
Keyword(s):  
Blood Loss ◽  
Lymph Nodes ◽  
Subgroup Analysis ◽  
Operative Time ◽  
Pulmonary Resection ◽  
Meta Analysis ◽  
Perioperative Outcomes ◽  
Categorical Variables ◽  
Postoperative Stay ◽  
Video Assisted

Abstract Background Uniportal video-assisted thoracoscopic surgery (U-VATS) has recently emerged as an alternative procedure for non-small cell lung cancer (NSCLC); however, whether U-VATS has advantages over multiportal VATS (M-VATS) remains unknown. Methods We performed a systematic review of two databases (Pubmed and Web of Science) to search comparative studies of U-VATS and M-VATS anatomical pulmonary resection for NSCLC. Parameters of continuous variables (operative time, blood loss, number of resected lymph nodes, drainage duration, length of postoperative stay and pain in postoperative day 1(POD1)) or categorical variables (conversion rates) were retrieved to estimate the comparitiveoutcomes. A subgroup analysis stratified by study type (propensity-matched analysis& randomized-controlled trial versus non-propensity matched analysis) was performed. Result A total of 19 studies with 3809 patients were included in this meta-analysis. U-VATS was performed on 1747 patients, whereas the other 2062 patients underwent M-VATS. This meta-analysis showed that there was no significant difference in operative time (U-VATS: 146.48±55.07min versus M-VATS: 171.70±79.40min, P=0.81), blood loss (74.49±109.03mL versus 95.48±133.67mL, P=0.18), resected lymph nodes (17.28±9.46 versus 18.31±10.17, P=0.62), conversion rate (6.18% versus 4.34%, P=0.14), drainage duration (3.90±2.94 days versus 4.44±3.12 days, p=0.09), length of postoperative stay (6.16±4.40 days versus 6.45±4.80 days, P=0.22), and pain in POD1 (3.94±1.68 versus 3.59±2.76, p=0.07). Subgroup analysis showed the value of PSM&RCT group consistency with overall value. Conclusion This up-to-date meta-analysis shows that the perioperative outcomes of U-VATS and M-VATS anatomical pulmonary resection are equivalent. In addition, the differences in long-term outcomes of these two approaches are still unclear. Thoracic surgeons should pay more emphasize on providing high-quality and personalized surgical care for patients, to improve the survival ultimately.

Complication rates in patients with uncontrolled diabetes undergoing radical cystectomy: A population-based study.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 355-355
Author(s):  
Izak Faiena ◽  
Viktor Y. Dombrovskiy ◽  
Raymond C. Sultan ◽  
Yanina Barbalat ◽  
Amirali H. Salmasi ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Radical Cystectomy ◽  
Resource Utilization ◽  
Hospital Cost ◽  
Population Based ◽  
Categorical Variables ◽  
Complication Rates ◽  
Diagnosis Code ◽  
Hospital Resource ◽  
Uncontrolled Diabetes

355 Background: Radical cystectomy is known to be associated with a relatively high incidence of postoperative morbidity and mortality. We evaluated the complication rates of a population-based cohort of patients with uncontrolled diabetes who underwent radical cystectomy. Methods: The data for this analysis was captured from the NIS (Nationwide Inpatient Sample) 2002-2009. Among patients who underwent radical cystectomy (ICD-9 diagnosis code 188.x and 57.71), we selected those with uncontrolled diabetes, which is defined by the billing physician (ICD-9 diagnosis code 250.02) and compared to patients without diabetes. We also identified postoperative complications. Patient socio-demographic characteristics, principal and secondary diagnoses, principal and secondary procedures, comorbid diseases, disposition of patient at discharge, hospital length of stay, and hospital cost for our analysis. A chi-square test was employed for categorical variables and Student’s t-test for continuous variables. A multivariable logistic regression analysis was also employed with computing OR and 95% CI. P<0.05 was considered statistically significant. Results: There were significant differences in the postoperative outcomes between groups. In the univariable analysis, patients with uncontrolled diabetes were more likely to have complications (OR=3.21; 95%CI= 2.59-4.00) including infectious complications (OR=2.46; 95%CI= 1.98-3.06) and were more likely to die during the index hospitalization (OR=3.27; 95%CI= 1.41-7.61). Hospital resource utilization was also significantly greater in patients with uncontrolled diabetes. Mean length of stay in this group was 17.3 days compared to 11.4 days in non-diabetic group (P=0.0007); total hospital cost was, respectively, $47,960 and $32,422 (P=0.0009). Conclusions: This study demonstrates a significant association between uncontrolled diabetes and in-hospital post-cystectomy complications, mortality, and hospital resource utilization. This study highlights the recognition of uncontrolled diabetes as a potential modifiable risk factor for patients undergoing cystectomy.

Not all hip arthroplasties are created equal

2019 ◽  
Vol 101-B (6_Supple_B) ◽  
pp. 84-90 ◽  
Author(s):  
R. S. Charette ◽  
M. Sloan ◽  
G-C. Lee
Keyword(s):  
Operative Time ◽  
Categorical Variables ◽  
Complication Rates ◽  
Continuous Variables ◽  
Improvement Program ◽  
Major Morbidity ◽  
Fracture Care ◽  
Displaced Femoral Neck Fractures ◽  
Chi Squared ◽  
Student’S T

Aims Total hip arthroplasty (THA) is gaining popularity as a treatment for displaced femoral neck fractures (FNFs), especially in physiologically younger patients. While THA for osteoarthritis (OA) has demonstrated low complication rates and increased quality of life, results of THA for acute FNF are not as clear. Currently, a THA performed for FNF is included in an institutional arthroplasty bundle without adequate risk adjustment, potentially placing centres participating in fracture care at financial disadvantage. The purpose of this study is to report on perioperative complication rates after THA for FNF compared with elective THA performed for OA of the hip. Patients and Methods The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database between 2008 and 2016 was queried. Patients were identified using the THA Current Procedural Terminology (CPT) code and divided into groups by diagnosis: OA in one and FNF in another. Univariate statistics were performed. Continuous variables were compared between groups using Student’s t-test, and the chi-squared test was used to compare categorical variables. Multivariate and propensity-matched logistic regression analyses were performed to control for risk factors of interest. Results Analyses included 139 635 patients undergoing THA. OA was the indication in 135 013 cases and FNF in 4622 cases. After propensity matching, mortality within 30 days (1.8% vs 0.3%; p < 0.001) and major morbidity (24.2% vs 19%; p < 0.001) were significantly higher among FNF patients. Re-operation (3.7% vs 2.7%; p = 0.014) and re-admission (7.3% vs 5.5%; p = 0.002) were significantly higher among FNF patients. Hip fracture patients had significantly longer operative time and length of stay (LOS), and were significantly less likely to be discharged to their home. Multivariate analyses gave similar results. Conclusion This large database study showed a higher risk of postoperative complications including mortality, major morbidity, re-operation, re-admission, prolonged operative time, increased LOS, and decreased likelihood of discharge home in patients undergoing THA for FNF compared with OA. While THA is a good option for FNF patients, there are increased costs and financial risks to centres with a joint arthroplasty bundle programme participating in fracture care. Cite this article: Bone Joint J 2019;101-B(6 Supple B):84–90.

scholarly journals Effect of Myelopathy on Outcomes After Cervical Disc Replacement: A Study of a Local Patient Cohort and a Large National Cohort

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Sheeraz Qureshi ◽  
Andre Samuel ◽  
Steven Mcanany ◽  
Sravisht Iyer ◽  
Todd Albert ◽  
...  
Keyword(s):  
Neck Disability Index ◽  
Perioperative Outcomes ◽  
Cervical Disc ◽  
Improvement Program ◽  
Perioperative Morbidity ◽  
Cervical Disc Replacement ◽  
Arm Pain ◽  
Significant Difference ◽  
Patient Reported ◽  
National Cohort

Abstract INTRODUCTION Previous research has shown increased perioperative morbidity after anterior cervical discectomy and fusion (ACDF) for patients with myelopathy. However, the association of myelopathy with outcomes after CDR has not yet been shown. METHODS Consecutive patients undergoing CDR by a single surgeon were identified and patients undergoing CDR in the 2015 and 2016 National Surgical Quality Improvement Program (NSQIP) database were identified. Patients with a preoperative diagnosis of cervical myelopathy were identified in both cohort, and perioperative outcomes and short-term postoperative outcomes were compared between patients with and without myelopathy. Comparisons were also controlled based on the number of levels treated. RESULTS A total of 27 patients were identified in the institutional cohort, 12 patients (44.4%) with myelopathy. A total of 3023 patients were identified in the national cohort, 411 (13%) with myelopathy. In the institutional cohort, the nonmyelopathy group saw significant improvements in neck disability index (NDI), and visual analog scale (VAS) neck and arm pain at both 2 and 6 wk postoperatively. The myelopathy group only saw a significant improvement in NDI at 6 wk (−13.1± 4.1, P < .05) but not at 2 wk (P > .05). In the national cohort, myelopathy was associated with longer operative time and length of stay, even after controlling for the number of levels treated (P < .05). However, there was no significant difference in perioperative complications (P > .05). CONCLUSION Myelopathy is not associated with increased perioperative morbidity and complications after CDR. Significant improvement in patient reported outcomes is seen at 6 wk in myelopathy patients, although more rapid improvement is seen in patients without myelopathy.

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