scholarly journals Endonasal endoscopic pituitary surgery in the elderly

2018 ◽  
Vol 128 (2) ◽  
pp. 429-436 ◽  
Author(s):  
Peter J. Wilson ◽  
Sacit B. Omay ◽  
Ashutosh Kacker ◽  
Vijay K. Anand ◽  
Theodore H. Schwartz
Keyword(s):  
Elderly Patients ◽  
Complication Rate ◽  
Pituitary Adenomas ◽  
Statistical Tests ◽  
The Elderly ◽  
Medical Complications ◽  
Tumor Diameter ◽  
Complication Rates ◽  
Pseudoaneurysm Formation ◽  
Significant Difference

OBJECTIVEPituitary adenomas are benign, slow-growing tumors that cause symptoms either through mass effect or hormone overproduction. The decision to operate on a healthy young person is relatively straightforward. In the elderly population, however, the risks of complications may increase, rendering the decision more complex. Few studies have documented the risks of surgery using the endonasal endoscopic approach in a large number of elderly patients. The purpose of this study was to audit a single center's data regarding outcomes of purely endoscopic endonasal transsphenoidal resection of pituitary adenomas in elderly patients and to compare them to the current literature.METHODSA retrospective review of a prospectively acquired database of all endonasal endoscopic surgeries done by the senior authors was queried for patients aged 60–69 years and for those aged 70 years or older. Demographic and radiographic preoperative data were reviewed. Outcomes with respect to extent of resection and complications were examined and compared with appropriate statistical tests.RESULTSA total of 135 patents were identified (81 aged 60–69 years and 54 aged 70 years or older [70+]). The average tumor diameter was slightly larger for the patients in the 70+ age group (mean [SD] 25.7 ± 9.2 mm) than for patients aged 60–69 years (23.1 ± 9.8 mm, p = 0.056). There was no significant difference in intraoperative blood loss (p > 0.99), length of stay (p = 0.22), or duration of follow-up (p = 0.21) between the 2 groups. There was a 7.4% complication rate in patients aged 60–69 years (3 nasal and 3 medical complications) and an 18.5% complication rate in patients older than 70 years (4 cranial, 3 nasal, 1 visual, and 2 medical complications; p = 0.05 overall and 0.013 for cranial complications). Cranial complications in the 70+ age category included 2 postoperative hematomas, 1 pseudoaneurysm formation, and 1 case of symptomatic subdural hygromas.CONCLUSIONSEndonasal endoscopic surgery in elderly patients is safe, but there is a graded increase in complication rates with increasing age. The decision to operate on an asymptomatic or mildly symptomatic patient in these age groups should take this increasing complication rate into account. The use of a lumbar drain or lumbar punctures should be weighed against the risk of subdural hematoma in patients with preexisting atrophy.

scholarly journals Surgical outcomes of elderly patients with cervical spondylotic myelopathy: a meta-analysis of studies reporting on 2868 patients

2016 ◽  
Vol 40 (6) ◽  
pp. E13 ◽  
Author(s):  
Karthik Madhavan ◽  
Lee Onn Chieng ◽  
Hanyao Foong ◽  
Michael Y. Wang
Keyword(s):  
Elderly Patients ◽  
Cervical Spondylotic Myelopathy ◽  
Elderly Population ◽  
Meta Analysis ◽  
The Elderly ◽  
The United States ◽  
Elderly Group ◽  
Complication Rates ◽  
Significant Difference ◽  
Meta Analyses

OBJECTIVE Cervical spondylotic myelopathy usually presents in the 5th decade of life or later but can also present earlier in patients with congenital spinal stenosis. As life expectancy continues to increase in the United States, the preconceived reluctance toward operating on the elderly population based on older publications must be rethought. It is a known fact that outcomes in the elderly cannot be as robust as those in the younger population. There are no publications with detailed meta-analyses to determine an acceptable level of outcome in this population. In this review, the authors compare elderly patients older than 75 years to a nonelderly population, and they discuss some of the relevant strategies to minimize complications. METHODS In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the authors performed a PubMed database search to identify English-language literature published between 1995 and 2015. Combinations of the following phrases that describe the age group (“elderly,” “non-elderly,” “old,” “age”) and the disease of interest as well as management (“surgical outcome,” “surgery,” “cervical spondylotic myelopathy,” “cervical degenerative myelopathy”) were constructed when searching for relevant articles. Two reviewers independently assessed the outcomes, and any disagreement was discussed with the first author until it was resolved. A random-effects model was applied to assess pooled data due to high heterogeneity between studies. The mean difference (MD) and odds ratio were calculated for continuous and dichromatic parameters, respectively. RESULTS Eighteen studies comprising elderly (n = 1169) and nonelderly (n = 1699) patients who received surgical treatment for cervical spondylotic myelopathy were included in this meta-analysis. Of these studies, 5 were prospective and 13 were retrospective. Intraoperatively, both groups required a similar amount of operation time (p = 0.35). The elderly group had lower Japanese Orthopaedic Association (JOA) scores (MD −1.36, 95% CI −1.62 to −1.09; p < 0.00001) to begin with compared with the nonelderly group. The nonelderly group also had a higher postoperative JOA score (MD −1.11, 95% CI −1.44 to −0.79; p < 0.00001), therefore demonstrating a higher recovery rate from surgeries (MD −11.98, 95% CI −16.16 to −7.79; p < 0.00001). The length of stay (MD 4.14, 95% CI 3.54–4.73; p < 0.00001) was slightly longer in the elderly group. In terms of radiological outcomes, the elderly group had a smaller postoperative Cobb angle but a greater increase in spinal canal diameter compared with the nonelderly group. The complication rates were not significant. CONCLUSIONS Cervical myelopathy is a disease of the elderly, and age is an independent factor for recovery from surgery. Postoperative and long-term outcomes have been remarkable in terms of improvement in mobility and independence requiring reduced nursing care. There is definitely a higher potential risk while operating on the elderly population, but no significant difference in the incidence of postoperative complications was noted. Withholding surgery from the elderly population can lead to increased morbidity due to rapid progression of symptoms in addition to deconditioning from lack of mobility and independence. Reduction in operative time under anesthesia, lower blood loss, and perioperative fluid management have been shown to minimize the complication rate. The authors request that neurosurgeons weigh the potential benefit against the risks for every patient before withholding surgery from elderly patients.

Endoscopic endonasal transsphenoidal surgery in elderly patients with pituitary adenomas

2015 ◽  
Vol 123 (1) ◽  
pp. 31-38 ◽  
Author(s):  
Jackson A. Gondim ◽  
João Paulo Almeida ◽  
Lucas Alverne F. de Albuquerque ◽  
Erika Gomes ◽  
Michele Schops ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Elderly Patients ◽  
Transsphenoidal Surgery ◽  
Clinical Status ◽  
The Elderly ◽  
Elderly Group ◽  
Complication Rates ◽  
Endoscopic Transsphenoidal Surgery ◽  
Younger Patients ◽  
Significant Difference

OBJECT With the increase in the average life expectancy, medical care of elderly patients with symptomatic pituitary adenoma (PA) will continue to grow. Little information exists in the literature about the surgical treatment of these patients. The aim of this study was to present the results of a single pituitary center in the surgical treatment of PAs in patients > 70 years of age. METHODS In this retrospective study, 55 consecutive elderly patients (age ≥ 70 years) with nonfunctioning PAs underwent endoscopic transsphenoidal surgery at the General Hospital of Fortaleza, Brazil, between May 2000 and December 2012. The clinical and radiological results in this group were compared with 2 groups of younger patients: < 60 years (n = 289) and 60–69 years old (n = 30). RESULTS Fifty-five patients ≥ 70 years of age (average age 72.5 years, range 70–84 years) underwent endoscopic surgery for treatment of PAs. The mean follow-up period was 50 months (range 12–144 months). The most common symptoms were visual impairment in 38 (69%) patients, headache in 16 (29%) patients, and complete ophthalmoplegia in 6 (10.9%). Elderly patients presented a higher incidence of ophthalmoplegia (p = 0.032) and a lower frequency of pituitary apoplexy before surgery (p < 0.05). Tumors with cavernous sinus invasion were treated surgically less frequently than in younger patients. Although patients with an American Society of Anesthesiologists score of 3 were more common in the elderly group (p < 0.05), no significant difference regarding surgical time, extent of resection, and hospitalization were observed. Elderly patients presented with more complications than patients < 60 years (32.7% vs 10%, p < 0.05). Complications observed in the elderly group included 5 CSF leaks (9%), 2 permanent diabetes insipidus cases (3.6%), 4 postoperative refractory hypertension cases (7.2%), 1 myocardial ischemia (1.8%), and 1 death (1.8%). Postoperative new anterior pituitary deficit was more common in the younger group (< 60 years old: 17.7%) than in the elderly (≥ 70 years old: 12.7%); however, there was no statistical difference. CONCLUSIONS Endoscopic transsphenoidal surgery for elderly patients with PAs may be associated with higher complication rates, especially secondary to early transitory complications, when compared with surgery performed in younger patients. Although the worst preoperative clinical status might be observed in this group, age alone is not associated with a worst final prognosis after endoscopic removal of nonfunctioning PAs.

scholarly journals Admission and Acute Complication Rate for Outpatient Lumbar Microdiscectomy

2010 ◽  
Vol 37 (1) ◽  
pp. 49-53 ◽  
Author(s):  
Aria Fallah ◽  
Eric M. Massicotte ◽  
Michael G. Fehlings ◽  
Stephen J. Lewis ◽  
Yoga Raja Rampersaud ◽  
...  
Keyword(s):  
Complication Rate ◽  
Admission Rate ◽  
Complication Rates ◽  
Chi Square ◽  
Lumbar Microdiscectomy ◽  
Acute Complication ◽  
Admission Data ◽  
Improved Outcomes ◽  
Significant Difference ◽  
Revision Operations

Objective:Specialization is generally independently associated with improved outcomes for most types of surgery. This is the first study comparing the immediate success of outpatient lumbar microdiscectomy with respect to acute complication and conversion to inpatient rate. Long term pain relief is not examined in this study.Methods:Two separate prospective databases (one belonging to a neurosurgeon and brain tumor specialist, not specializing in spine (NS) and one belonging to four spine surgeons (SS)) were retrospectively reviewed. All acute complications as well as admission data of patients scheduled for outpatient lumbar microdiscectomy were extracted.Results:In total, 269 patients were in the NS group and 137 patients were in the SS group. The NS group averaged 24 cases per year while the SS group averaged 50 cases per year. Chi-square tests revealed no difference in acute complication rate [NS(6.7%), SS(7.3%)] (p>0.5) and admission rate [NS(4.1%), SS(5.8%)] (p=0.4) while the SS group had a significantly higher proportion of patients undergoing repeat microdiscectomy [NS(4.1%), SS(37.2%)] (p<0.0001). Excluding revision operations, there was no statistically significant difference in acute complication [NS(5.4%), SS(1.2%)] (p=0.09) and conversion to inpatient [NS(4.3%), SS(4.6%)] (p>0.5) rate. The combined acute complication and conversion to inpatient rate was 6.9% and 4.7% respectively.Conclusion:Based on this limited study, outpatient lumbar microdiscectomy can be apparently performed safely with similar immediate complication rates by both non-spine specialized neurosurgeons and spine surgeons, even though the trend favored the latter group for both outcome measures.

scholarly journals Liver and Pancreatic Resection in the Elderly

HPB Surgery ◽  
1997 ◽  
Vol 10 (4) ◽  
pp. 259-261 ◽  
Author(s):  
O. J. Garden
Keyword(s):  
Survival Rate ◽  
Liver Resection ◽  
Mortality Rate ◽  
Elderly Patients ◽  
Complication Rate ◽  
Pancreatic Resection ◽  
The Elderly ◽  
Term Survival ◽  
Pancreatic Resections

Background: Liver resection, or pancreaticoduodenectomy, has traditionally been thought to have a high morbidity and. mortality rate among the elderly. Recent improvements in surgical and anesthetic techniques, an increasing number of elderly patients, and an increasing need to justify use of limited health care resources prompted an assessment of recent surgical outcomes.Methods: Five hundred seventy-seven liver resections (July 1985–July 1994) performed for metastatic colorectal cancer and 488 pancreatic resections (October 1983–July 1994) performed for pancreatic malignancies were identified in departmental data bases. Outcomes of patients younger than age 70 years were compared with those of patients age 70 years or older.Results: Liver resection for 128 patients age 70 years or older resulted in a 4% perioperative. mortality rate and a 42% complication rate. Median hospital stay was 13 days, and 8% of the patients required admission to the intensive care unit (ICU). Median survival was 40 months, and the 5-year survival rate was 35%. No difference were found between results for the elderly and those for younger patients who had undergone liver resection, except for a minimally shorter hospital stay fortheyoungerpatients (median, 12 days vs. 13 days p=0.003). Pancreatic resection for 138 elderly patients resulted in a mortality rate of 6% and a complication rate of 45%. Median stay was 20 days, and 19% of the patients required ICU admission, results identical to those for the younger cohort. Long-term survival was poorer for the elderly patients, with a 5-year survival rate of 21% compared with 29% for the younger cohort (p=0.03).Conclusions: Major liver or pancreatic resections can be performed for the elderly with acceptable morbidity and mortality rates and possible long-term survival. Chronologic age alone is not a contraindication to liver or pancreatic resection for malignancy.

Two Types of Anesthesia and Hemodynamic Changes in Patients Over 60 Years of Age Who Need Artificial Femoral Head Replacement: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Weiqi Ke ◽  
Yuting WANG ◽  
Xukeng GUO ◽  
Ronghua HUANG ◽  
Xiangdong ZHANG ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Femoral Head ◽  
Elderly Patients ◽  
The Elderly ◽  
Hemodynamic Changes ◽  
Medical College ◽  
Replacement Surgery ◽  
Elder Patients ◽  
Significant Difference ◽  
And Gender

Abstract Background:Artificial femoral head replacement is one of the most effective methods for treatment of severe diseases of femoral joint in the elderly. The ideal anesthetic effect is one of the key elements for the success of the operation because it brings fast recovery. However, the multiple comorbidities of the elder patients make them too weak to tolerate the hemodynamic changes after anesthesia. In this case, the most suitable anesthesia method for patients undergoing femoral head replacement surgery is of great significance.Objective:To compare the post-anesthetic hemodynamic changes between combined lumbar plexus and sciatic nerve block(CLPSB) and combined spinal and epidural anesthesia(CSEA) in elderly patients undergoing unilateral artificial femoral head replacement.Methods:We reviewed records of the patients who aged over 60 years old (age 62-103 years) and received unilateral artificial femoral head replacement between January 2015 and December 2020 in the first affiliated hospital of Shantou University Medical College. After adjustment according to the inclusion criteria, 477 patients were included and divided into CLPSB group (n=90) and CSEA group (n=387). The primary outcome was comparison of the hemodynamic changes after anesthesia, including the systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and heart rate (HR). The second outcome was the comparison of the vasopressor used during the surgery.Results:We established three models to compare the two anesthesia methods on hemodynamic changes. Crude model included all variates for analysis, while model I adjusted age and gender. Model II adjusted other comorbidities in addition to model I. All three models exhibit that changes of MAP (∆MAP) after CSEA were higher than that after CLPSB(β= 6.88, 95% CI: 4.33 - 9.42, P < 0.0001), with significant difference, which indicated that CSEA causes higher fluctuation of MAP. Concurrently, the use of vasopressors increased by 137% (OR=2.37, 95%CI: 1.24-4.53, P=0.0091) in the CSEA group, which is statistically significant. However, the changes of HR (∆HR) between the CLPSB and CSEA was not significant(β= 0.50, 95% CI: 1.62 - 2.62, P = 0.6427). Conclusions:Both CLPSB and CSEA are ideal anesthesia methods for patients receiving femoral head eplacement, though CLPSB is more suitable for elderly patients with advanced hemodynamic stability.

Radical Cystectomy in Elderly Patients

1993 ◽  
Vol 60 (1) ◽  
pp. 19-22
Author(s):  
P. Bassi ◽  
M. Gholam Alipour ◽  
G.L. Drago Ferrante ◽  
N. Piazza ◽  
N. Panza ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Length Of Hospital Stay ◽  
Wound Dehiscence ◽  
The Elderly ◽  
Elderly Group ◽  
Medical Complications ◽  
Control Group ◽  
Pelvic Hematoma

Radical cystectomy is the most common treatment for deeply invasive bladder cancer; due to reported operative risks, concerns have been expressed regarding the suitability of this operation in elderly patients. We reviewed the morbility and mortality rates in 50 patients aged 70 years and over (elderly group), undergoing radical cystectomy and urinary diversion, to verify if this procedure could be considered as initial treatment in older-age patients. The findings were compared with those observed in 50 patients aged 40 to 69 years (control group). In the elderly group there was no operative mortality; however 2 patients (4%) died post-operatively due to pulmonary embolism and multi-organ-failure syndrome respectively. Four patients (8%) were re-operated due to intestinal obstruction (2 pts), pelvic hematoma (1 pt) and wound dehiscence (1 pt). Wound separation was the more frequent complication (15%); 6% of patients experienced extended intestinal atonia. The length of hospital stay was 17.1 days. In the control group, surgical complications were comparable to those observed in the elderly group: furthermore medical complications were more frequent. In conclusion, these data suggest that radical cystectomy and urinary diversion can be safely performed in the elderly. Radical surgery is an effective treatment modality for elderly individuals who are in reasonably good general health. A higher incidence of medical complications must be expected in elderly patients.

scholarly journals Feasibility and Safety of Left Bundle Branch Pacing for Advance Aged Patients: A Multicenter Comparative Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Zhongyuan Ren ◽  
Binni Cai ◽  
Songyun Wang ◽  
Peng Jia ◽  
Yang Chen ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Effective Means ◽  
The Elderly ◽  
Elderly Group ◽  
Complication Rates ◽  
Related Complication ◽  
Aged Patients ◽  
Fluoroscopic Time ◽  
Symptomatic Bradycardia

Background: Left bundle branch pacing (LBBP) has been shown to be a safe and effective means to achieve physiological pacing. However, elderly patients have increased risks from invasive procedures and the risk of LBBP in elderly patients is not known. We aimed to investigate the safety and efficacy of LBBP in elderly patients &gt;80 years of age.Methods: From December 2017 to June 2019, 346 consecutive patients with symptomatic bradycardia, 184 patients under 80 years of age and 162 over 80 years, were included and underwent LBBP. The safety and prognosis of LBBP were comparatively evaluated by measured pacing parameters, periprocedural complications, and follow-up clinical events.Results: Compared with the younger, the elderly group had worse baseline cardiac and renal function. LBBP was achieved successfully in both groups with comparable fluoroscopic time and paced QRS duration (110.0 [102.0, 118.0] ms for the young vs. 110.0 [100.0, 120.0] ms for the elderly, P = 0.874). Through a follow-up of 20.0 ± 6.1 months, pacing parameters were stable while higher threshold and impedance were observed in the elderly group. In the evaluation of safety, overall procedure-related complication rates were comparable (4.4 vs. 3.8%, young vs. elderly). For prognosis, similar rates of major adverse cardiocerebrovascular events (7.1 vs. 11.9%, young vs. elderly) were observed.Conclusions: Compared to younger patients, LBBP could achieve physiological pacing in patients over 80 with comparable midterm safety and prognosis. Long-term safety and benefits of LBBP, however, necessitate further evaluation.

scholarly journals Comparison of perioperative complications following posterior column osteotomy versus posterior-based 3-column osteotomy for correction of rigid cervicothoracic deformity: a single-surgeon series of 95 consecutive cases

2020 ◽  
Vol 33 (3) ◽  
pp. 297-306
Author(s):  
Darryl Lau ◽  
Vedat Deviren ◽  
Rushikesh S. Joshi ◽  
Christopher P. Ames
Keyword(s):  
Risk Factor ◽  
Complication Rate ◽  
Surgical Complications ◽  
Deformity Correction ◽  
Neurological Deficits ◽  
Wedge Osteotomy ◽  
Medical Complication ◽  
Complication Rates ◽  
Cervical Deformity ◽  
Significant Difference

OBJECTIVEThe correction of severe cervicothoracic sagittal deformities can be very challenging and can be associated with significant morbidity. Often, soft-tissue releases and osteotomies are warranted to achieve the desired correction. There is a paucity of studies that examine the difference in morbidity and complication profiles for Smith-Petersen osteotomy (SPO) versus 3-column osteotomy (3CO) for cervical deformity correction.METHODSA retrospective comparison of complication profiles between posterior-based SPO (Ames grade 2 SPO) and 3CO (Ames grade 5 opening wedge osteotomy and Ames grade 6 closing wedge osteotomy) was performed by examining a single-surgeon experience from 2011 to 2018. Patients of interest were individuals who had a cervical sagittal vertical axis (cSVA) > 4 cm and/or cervical kyphosis > 20° and who underwent corrective surgery for cervical deformity. Multivariate analysis was utilized.RESULTSA total of 95 patients were included: 49 who underwent 3CO and 46 who underwent SPO. Twelve of the SPO patients underwent an anterior release procedure. The patients’ mean age was 63.2 years, and 60.0% of the patients were female. All preoperative radiographic parameters showed significant correction postoperatively: cSVA (6.2 cm vs 4.5 cm [preoperative vs postoperative values], p < 0.001), cervical lordosis (6.8° [kyphosis] vs −7.5°, p < 0.001), and T1 slope (40.9° and 35.2°, p = 0.026). The overall complication rate was 37.9%, and postoperative neurological deficits were seen in 16.8% of patients. The surgical and medical complication rates were 17.9% and 23.2%, respectively. Overall, complication rates were higher in patients who underwent 3CO compared to those who underwent SPO, but this was not statistically significant (total complication rate 42.9% vs 32.6%, p = 0.304; surgical complication rate 18.4% vs 10.9%, p = 0.303; and new neurological deficit rate 20.4% vs 13.0%, p = 0.338). Medical complication rates were similar between the two groups (22.4% [3CO] vs 23.9% [SPO], p = 0.866). Independent risk factors for surgical complications included male sex (OR 10.88, p = 0.014), cSVA > 8 cm (OR 10.36, p = 0.037), and kyphosis > 20° (OR 9.48, p = 0.005). Combined anterior-posterior surgery was independently associated with higher odds of medical complications (OR 10.30, p = 0.011), and preoperative kyphosis > 20° was an independent risk factor for neurological deficits (OR 2.08, p = 0.011).CONCLUSIONSThere was no significant difference in complication rates between 3CO and SPO for cervicothoracic deformity correction, but absolute surgical and neurological complication rates for 3CO were higher. A preoperative cSVA > 8 cm was a risk factor for surgical complications, and kyphosis > 20° was a risk factor for both surgical and neurological complications. Additional studies are warranted on this topic.

Anatomic Site-Specific Complication Rates for Central Venous Catheter Insertions

2018 ◽  
Vol 35 (9) ◽  
pp. 869-874 ◽  
Author(s):  
Jacob Bell ◽  
Munish Goyal ◽  
Sallie Long ◽  
Anagha Kumar ◽  
Joseph Friedrich ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Complication Rate ◽  
Venous Catheter ◽  
Complication Rates ◽  
Central Venous ◽  
Site Specific ◽  
Mechanical Complications ◽  
Significant Difference ◽  
Insertion Techniques ◽  
Delayed Complications

Background: Central venous catheter (CVC) complication rates reflecting the application of modern insertion techniques to a clinically heterogeneous patient populations are needed to better understand procedural risk attributable to the 3 common anatomic insertion sites: internal jugular, subclavian, and femoral veins. We sought to define site-specific mechanical and duration-associated CVC complication rates across all hospital inpatients. Methods: A retrospective chart review was conducted over 9 months at Georgetown University Hospital and Washington Hospital Center. Peripherally inserted central catheters and tunneled or fluoroscopically placed CVC’s were excluded. Mechanical complications (retained guidewire, arterial injury, and pneumothorax) and duration-associated complications (deep vein thrombosis or pulmonary embolism, and central line-associated bloodstream infections) were identified. Results: In all, 1179 CVC insertions in 801 adult patients were analyzed. Approximately 32% of patients had multiple lines placed. Of 1179 CVCs, 73 total complications were recorded, giving a total rate of one or more complications occurring per CVC of 5.9%. There was no statistically significant difference between site-specific complications. A total of 19 mechanical complications were documented, with a 1.5% complication rate of one or more mechanical complications occurring. A total of 54 delayed complications were documented, with a 4.4% complication rate of 1 or more delayed complications occurring. There were no statistically significant differences between anatomic sites for either total mechanical or total delayed complications. Conclusions: These results suggest that site-specific CVC complication rates may be less common than previously reported. These data further inform on the safety of modern CVC insertion techniques across all patient populations and clinical settings.

scholarly journals Effect of Travel Time and Distance on Outcomes in Total Ankle Arthroplasty

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0015
Author(s):  
Kristin C. Caolo ◽  
Scott J. Ellis ◽  
Jonathan T. Deland ◽  
Constantine A. Demetracopoulos
Keyword(s):  
Travel Time ◽  
Complication Rate ◽  
High Volume ◽  
Total Ankle Arthroplasty ◽  
Complication Rates ◽  
Linear Regression Models ◽  
Ankle Arthroplasty ◽  
Significant Difference ◽  
Drive Time

Category: Ankle; Ankle Arthritis Introduction/Purpose: Surgeons who perform a higher volume of total ankle arthroplasty (TAA) are known to have decreased complication rates; evidence shows that low volume centers performing TAA have decreased survivorship when compared with high volume centers. Understanding differences in outcomes for patients traveling different distances for their TAA is important for future patients deciding where to travel for their surgery. No study has previously examined differences in outcomes of patients traveling different distances to a high volume center for their TAA. This study compares preoperative and postoperative PROMIS scores for patients undergoing total ankle arthroplasty who traveled less than and more than 50 miles for their TAA. We hypothesized that there would be no difference in outcome scores based on distance traveled or estimated drive time. Methods: This study is a single center retrospective review of 162 patients undergoing primary total ankle arthroplasty between January 2016 and December 2018. We collected the primary address as listed in the patient’s medical record and used the directions feature on Google Maps to estimate driving mileage and estimated driving time from the patient’s address to the hospital. To analyze the distance patients traveled, patients were divided into two groups: <50 miles traveled (n=91) and >50 miles traveled (n=71). To analyze the estimated drive time, patients were divided into two groups: <90 minutes (n=77), >90 minutes (n=85). We collected preoperative and most recent postoperative PROMIS scores for all patients. Differences in most recent post-operative PROMIS scores between distance groups and travel time groups were assessed using multivariable linear regression models, adjusting for the pre-operative score and follow-up time. Results: We found no significant difference in post-operative PROMIS scores between the two groups when analyzed for distance traveled or for estimated travel time after adjustment for pre-operative PROMIS score and follow-up time (Table 1). The average follow-up for all 162 patients was 1.49 years. Power analysis showed that with a sample size of 110 (55 in each group), we had 81% power to detect an effect size of 4. Patients saw an increase in their Physical Function scores and a decrease in their Pain Interference and Pain Intensity scores with postoperative scores better than population means (Table 1). Overall complication rate for the <50 miles group was 17.6%, 7.7% required surgery. The >50 miles group had an overall complication rate of 24.0%, 9.9% required surgery. Conclusion: Patients traveling further distances to a high volume orthopedic specialty hospital for their total ankle arthroplasty do not have different clinical outcomes than patients traveling shorter distances. This is particularly important for patients deciding where to have their total ankle arthroplasty surgery. Patients who travel further have the opportunity to be treated at a local academic center; however our results show that outcomes do not change when traveling further for total ankle arthroplasty. [Table: see text]

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