Faculty Opinions recommendation of Ambulatory sinus and nasal surgery in the United States: demographics and perioperative outcomes.

The objectives of this study were to evaluate 1) the rate of immediate breast reconstruction; 2) the frequency of immediate tissue expander placement; and 3) to compare perioperative outcomes in patients who underwent breast reconstruction after mastectomy for breast cancer with immediate tissue expander placement (TE) with those with no reconstruction (NR). Using the Nationwide Inpatient Sample database, we examined the clinical data of patients with breast cancer who underwent mastectomy with or without immediate TE from 2006 to 2010 in the United States. A total of 344,253 patients with breast cancer underwent mastectomy in this period in the United States. Of these patients, 31 per cent had immediate breast reconstruction. We only included patients with mastectomy and no reconstruction (NR: 237,825 patients) and patients who underwent only TE placement with no other reconstruction combination (TE: 61,178 patients) to this study. Patients in the TE group had a lower overall postoperative complication rate (2.6 vs 5.5%; P < 0.01) and lower in-hospital mortality rate (0.01 vs 0.09%; P < 0.01) compared with the NR group. Fifty-three per cent of patients in the NR group were discharged the day of surgery compared with 36 per cent of patients in the TE group. Using multivariate regression analyses and adjusting patient characteristics and comorbidities, patients in the TE group had a significantly lower overall complication rate (adjusted odds ratio [AOR], 0.6) and lower in-hospital mortality (AOR, 0.2) compared with the NR group. The rate of immediate reconstruction is 31 per cent. TE alone is the most common type of immediate reconstruction (57%). There is a lower complication rate for the patients who underwent immediate TE versus the no-reconstruction cohort.

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Trends in utilization, perioperative outcomes, and costs among open, laparoscopic, and robotic nephroureterectomies: A 10-year population-based analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.7_suppl.337 ◽

2015 ◽

Vol 33 (7_suppl) ◽

pp. 337-337

Author(s):

Francisco Jose Gelpi-Hammerschdmidt ◽

Christopher B. Allard ◽

Benjamin I. Chung ◽

Steven L. Chang

Keyword(s):

United States ◽

Hospital Costs ◽

The United States ◽

Population Based ◽

Perioperative Outcomes ◽

Patient Specific ◽

Complication Rates ◽

Incidence Risk ◽

Nationally Representative ◽

Survey Weighting

337 Background: Nephroureterectomy (NU) is the standard treatment for upper tract urothelial carcinoma (UTUC). Minimally invasive (MI) laparoscopic or robotic-assisted approaches have been introduced in an effort to reduce morbidity. We performed a population-based study to evaluate contemporary utilization trends, morbidity, and costs associated with NUs in the United States. Methods: Using the Premier Hospital Database (Premier, Inc., Charlotte, NC), a nationally representative discharge database with data from over 600 non-federal hospitals in the United States, we captured patients who underwent a NU (ICD-9 55.51) with diagnoses of renal pelvis (189.1) or ureteral (189.2) neoplasms from 2004 to 2013. We fitted regression models, adjusting for clustering by hospitals and survey weighting to evaluate 90-day postoperative complications, length of stay (LOS), OR time, and direct hospital costs among open, laparoscopic, and robotic NU. Results: The weighted cohort included 17,245 open, 13,298 laparoscopic, and 3,745 robotic NUs. MI surgeries increased from 36% to 54% from 2004 to 2013, while the number of NUs decreased by nearly 20% during the same period (Figure 1). The overall 90-day mortality, major (Clavien 3-5), and minor (Clavien 1-2) complication rates were 1.89%, 9.4%, and 27.7%, respectively, with no statistically significant differences between the three approaches based on adjusted logistic regression analyses. The LOS was decreased for laparoscopic (Incidence Risk Ratio [IRR]: 0.87, 95% CI: 0.82-0.92, p<0.001) and robotic (IRR: 0.76, 95% CI: 0.7-0.83, p<0.001) NU compared to open NU. OR time was 10.35 (p<0.05) and 56.35 (p<0.001) minutes longer for laparoscopic and robotic NU. Adjusted 90-day median direct hospital costs were $1,354 and $3,533 higher for laparoscopic and robotic NU (p<0.001). Conclusions: During this contemporary 10-year study, the use of MI NUs increased to over half of procedures with a recent surge in robotic NUs, along with a concurrent reduction in total NUs performed in the United States. Comparable perioperative outcomes suggest that the morbidity profile may be driven primarily by patient-specific characteristics as opposed to surgical approach.

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