Phonological outcome of laryngeal framework surgery by different anesthesia protocols: a single-surgeon experience

OBJECTIVEPosterior-based thoracolumbar 3-column osteotomy (3CO) is a formidable surgical procedure. Surgeon experience and case volume are known factors that influence surgical complication rates, but these factors have not been studied well in cases of adult spinal deformity (ASD). This study examines how surgeon experience affects perioperative complications and operative measures following thoracolumbar 3CO in ASD.METHODSA retrospective study was performed of a consecutive cohort of thoracolumbar ASD patients who underwent 3CO performed by the senior authors from 2006 to 2018. Multivariate analysis was used to assess whether experience (years of experience and/or number of procedures) is associated with perioperative complications, operative duration, and blood loss.RESULTSA total of 362 patients underwent 66 vertebral column resections (VCRs) and 296 pedicle subtraction osteotomies (PSOs). The overall complication rate was 29.4%, and the surgical complication rate was 8.0%. The rate of postoperative neurological deficits was 6.2%. There was a trend toward lower overall complication rates with greater operative years of experience (from 44.4% to 28.0%) (p = 0.115). Years of operative experience was associated with a significantly lower rate of neurological deficits (p = 0.027); the incidence dropped from 22.2% to 4.0%. The mean operative time was 310.7 minutes overall. Both increased years of experience and higher case numbers were significantly associated with shorter operative times (p < 0.001 and p = 0.001, respectively). Only operative years of experience was independently associated with operative times (p < 0.001): 358.3 minutes from 2006 to 2008 to 275.5 minutes in 2018 (82.8 minutes shorter). Over time, there was less deviation and more consistency in operative times, despite the implementation of various interventions to promote fusion and prevent construct failure: utilization of multiple-rod constructs (standard, satellite, and nested rods), bone morphogenetic protein, vertebroplasty, and ligament augmentation. Of note, the use of tranexamic acid did not significantly lower blood loss.CONCLUSIONSSurgeon years of experience, rather than number of 3COs performed, was a significant factor in mitigating neurological complications and improving quality measures following thoracolumbar 3CO for ASD. The 3- to 5-year experience mark was when the senior surgeon overcame a learning curve and was able to minimize neurological complication rates. There was a continuous decrease in operative time as the surgeon’s experience increased; this was in concurrence with the implementation of additional preventative surgical interventions. Ongoing practice changes should be implemented and can be done safely, but it is imperative to self-assess the risks and benefits of those practice changes.

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Time to event analysis for post-hypospadias repair complications: a single-surgeon experience

World Journal of Urology ◽

10.1007/s00345-021-03689-3 ◽

2021 ◽

Author(s):

Jin K. Kim ◽

Mitchell Shiff ◽

Michael E. Chua ◽

Fadi Zu’bi ◽

Jessica M. Ming ◽

...

Keyword(s):

Event Analysis ◽

Hypospadias Repair ◽

Time To Event ◽

Surgeon Experience

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674 Machine Learning and Automation in Burn Care: A Systematic Review

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.320 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S193-S193

Author(s):

Samantha Huang ◽

Justin Dang ◽

Clifford C Sheckter ◽

Haig A Yenikomshian ◽

Justin Gillenwater

Keyword(s):

Machine Learning ◽

Systematic Review ◽

Total Body Surface Area ◽

Burn Wound ◽

Burn Care ◽

Surgeon Experience ◽

Automated Software ◽

Burn Depth ◽

Automated Methods ◽

Equal Weighting

Abstract Introduction Current methods of burn evaluation and treatment are subjective and dependent on surgeon experience, with high rates of inter-rater variability leading to inaccurate diagnoses and treatment. Machine learning (ML) and automated methods are being used to develop more objective and accurate methods for burn diagnosis and triage. Defined as a subfield of artificial intelligence that applies algorithms capable of knowledge acquisition, machine learning draws patterns from data, which it can then apply to clinically relevant tasks. This technology has the potential to improve burn management by quantitating diagnoses, improving diagnostic accuracy, and increasing access to burn care. The aim of this systematic review is to summarize the literature regarding machine learning and automated methods for burn wound evaluation and treatment. Methods A systematic review of articles available on PubMed and MEDLINE (OVID) was performed. Keywords used in the search process included burns, machine learning, deep learning, burn classification technology, and mobile applications. Reviews, case reports, and opinion papers were excluded. Data were extracted on study design, study objectives, study models, devices used to capture data, machine learning, or automated software used, expertise level and number of evaluators, and ML accuracy of burn wound evaluation. Results The search identified 592 unique titles. After screening, 35 relevant articles were identified for systematic review. Nine studies used machine learning and automated software to estimate percent total body surface area (%TBSA) burned, 4 calculated fluid requirements, 18 estimated burn depth, 5 estimated need for surgery, 6 predicted mortality, and 2 evaluated scarring in burn patients. Devices used to estimate %TBSA burned showed an accuracy comparable to or better than traditional methods. Burn depth estimation sensitivities resulted in unweighted means >81%, which increased to >83% with equal weighting applied. Mortality prediction sensitivity had an unweighted mean of 96.75%, which increased to 99.35% with equal weighting. Conclusions Machine learning and automated technology are promising tools that provide objective and accurate measures of evaluating burn wounds. Existing methods address the key steps in burn care management; however, existing data reporting on their robustness remain in the early stages. Further resources should be dedicated to leveraging this technology to improve outcomes in burn care.

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Is It the Surgeon, the Patient, or the Device? A Comprehensive Clinical and Radiological Evaluation of Factors Influencing Patient Satisfaction in 648 Total Knee Arthroplasties

Journal of Clinical Medicine ◽

10.3390/jcm10122599 ◽

2021 ◽

Vol 10 (12) ◽

pp. 2599

Author(s):

Lorenzo Rissolio ◽

Luigi Sabatini ◽

Salvatore Risitano ◽

Alessandro Bistolfi ◽

Umberto Galluzzo ◽

...

Keyword(s):

Patient Satisfaction ◽

Female Gender ◽

Womac Score ◽

Clinical Results ◽

Positive Outcome ◽

High Expectations ◽

Surgeon Experience ◽

Total Knee ◽

Determinants Of Satisfaction ◽

Final Alignment

Total knee arthroplasty (TKA) is a successful and safe surgical procedure for treating osteoarthritic knees, but despite the overall good results, some patients remain dissatisfied. The aim of this study is to evaluate the influence of patient-related and surgery-related variables in a consecutive group of patients that underwent TKA. Individuals (n = 648) who had TKA performed between 01 January 2013 and 31 December 2017 were enrolled in the study. Postoperative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS) and Forgotten Joint score (FJS-12) were collected at a mean follow-up of 4.79 years. Patient satisfaction was assessed with a questionnaire. Determinants of satisfaction (age, sex, smoking, presence of diabetes or cardiovascular disease, pain in other joints, preoperative arthritic stage) and components of satisfaction (slope variation, mechanical axis variation, outlier final alignment, surgeon experience) were examined to identify which variables correlated with positive outcome. Correlations with septic and mechanicals failures were also evaluated. Thirteen percent of patients were unsatisfied, despite good results in KOOS, WOMAC and FJS-12 tests. Female gender, low Kellgren–Lawrence grade and the presence of back pain and pain in other joints were factors associated with poor clinical results. Poorer clinical results were also reported in younger patients. Infection rate was correlated with active smoking and mechanical failure with an outlier final alignment. Comorbidities, smoking habits and high expectations have a big influence on TKA results and on final satisfaction after surgery.

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Prediction of a positive surgical margin and biochemical recurrence after robot-assisted radical prostatectomy

Scientific Reports ◽

10.1038/s41598-021-93860-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ching-Wei Yang ◽

Hsiao-Hsien Wang ◽

Mohamed Fayez Hassouna ◽

Manish Chand ◽

William J. S. Huang ◽

...

Keyword(s):

Radical Prostatectomy ◽

Biochemical Recurrence ◽

Multivariable Analysis ◽

Specific Antigen ◽

Surgical Margin ◽

Asian Population ◽

Nerve Sparing ◽

Positive Surgical Margin ◽

Robot Assisted ◽

Surgeon Experience

AbstractThe positive surgical margin (PSM) and biochemical recurrence (BCR) are two main factors associated with poor oncotherapeutic outcomes after prostatectomy. This is an Asian population study based on a single-surgeon experience to deeply investigate the predictors for PSM and BCR. We retrospectively included 419 robot-assisted radical prostatectomy cases. The number of PSM cases was 126 (30.1%), stratified as 22 (12.2%) in stage T2 and 103 (43.6%) in stage T3. Preoperative prostate-specific antigen (PSA) > 10 ng/mL (p = 0.047; odds ratio [OR] 1.712), intraoperative blood loss > 200 mL (p = 0.006; OR 4.01), and postoperative pT3 stage (p < 0.001; OR 6.901) were three independent predictors for PSM while PSA > 10 ng/mL (p < 0.015; hazard ratio [HR] 1.8), pT3 stage (p = 0.012; HR 2.264), International Society of Urological Pathology (ISUP) grade > 3 (p = 0.02; HR 1.964), and PSM (p = 0.027; HR 1.725) were four significant predictors for BCR in multivariable analysis. PSMs occurred mostly in the posterolateral regions (73.8%) which were associated with nerve-sparing procedures (p = 0.012) while apical PSMs were correlated intraoperative bleeding (p < 0.001). A high ratio of pT3 stage after RARP in our Asian population-based might surpass the influence of PSM on BCR. PSM was less significant than PSA and ISUP grade for predicting PSA recurrence in pT3 disease. Among PSM cases, unifocal and multifocal positive margins had a similar ratio of the BCR rate (p = 0.172) but ISUP grade > 3 (p = 0.002; HR 2.689) was a significant BCR predictor. These results indicate that PSA and pathological status are key factors influencing PSM and BCR.

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662 Single Surgeon Experience Using a Polyactide-based Copolymer Dressing to Over and Secure Split Thickness Skin Grafts in Burn Patients.

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.308 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S186-S187

Author(s):

Eduardo Navarro ◽

Tera Thigpin ◽

Joshua S Carson

Keyword(s):

Skin Graft ◽

Outer Layer ◽

Healing Process ◽

Graft Loss ◽

Total Body Surface Area ◽

Surgeon Experience ◽

Pain Outcomes ◽

Total Body ◽

Operative Notes

Abstract Introduction In both partial thickness burns and skin graft donor sites, coverage with Polylactide-based copolymer dressing (PLBC dressing) has been shown to result in expedited healing and improved pain outcomes when compared to more traditional techniques. These advantages are generally attributed to the way in which PLBC remains as an intact coating over the wound bed throughout the healing process, protecting wounds from the contamination and microtraumas associated with changes more conventional dressings. At our institution, we began selectively utilizing PLBC as a means of securing and protecting fresh skin graft, in hopes that we would find similar benefits in this application. Methods Clinical Protocol-- The PLBC dressing was used at the attending surgeon’s discretion. In these cases, meshed STSG was placed over prepared wound beds. Staples were not utilized. PLBC dressing was then placed over the entirety of the graft surface, securing graft in place by adhering to wound bed through intercises. (Staples were not used.) The graft and PLBC complex was further dressed with a layer of non-adherent cellulose based liner with petroleum based lubricant, and an outer layer of cotton gauze placed as a wrap or bolster. Post operatively, the outer layer (“wrap”) of gauze was replaced as needed for saturation. The PLBC and adherent “inner” liner were left in place until falling off naturally over the course of outpatient follow-up. Retrospective Review-- With IRB approval, patients treated PLBC over STSG between April 2018 to March 2019 were identified via surgeon’s log and pulled for review. Documentation gathered from operative notes, progress notes (inpatient and outpatient) and clinical photography was used to identify demographics, mechanism of injury, depth, total body surface area percentage (TBSA%), size of area treated with PLBC dressing, graft loss, need for re-grafting, signs of wound infection, antibiotic treatment, and length of stay. Results Twenty-two patients had STSG secured and dressed with PLBC. Median patient age was 36.5 years. Median TBSA was 5.1%, and median treated area 375 cm2. Follow up ranged from 21 to 232 days post-operatively, with two patients lost to follow up. All patients seen in outpatient follow up were noted to have “complete graft take” or “minimal” graft. None of the areas treated with PLBC dressing required re-grafting. There were no unplanned readmissions, and no wound infections were diagnosed or treated. Practitioners in in-patient setting and in follow up clinic reported satisfaction with the PLBC dressing. Conclusions The PLBC dressing was a feasible solution for securing and dressings STSGs. Future work is needed to determine whether its use is associated with an improvement in patient outcomes.

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