Perioperative Outcomes of Anatomic Endoscopic Enucleation of the Prostate, Robotic and Open Simple Prostatectomy From a Multi-Institutional Database

Objective: To compare the perioperative morbidity of robotic-assisted simple prostatectomy (RASP), anatomical endoscopic enucleation of the prostate (AEEP) and open simple prostatectomy (OSP) for the treatment of benign prostatic obstruction (BPO). Methods: The national surgical quality improvement program database was queried for AEEP, RASP, and OSPprocedures. Clavien-Dindo-graded complications, length of hospital stay (LOS), and operative time were compared among the procedures. To control for the potentially confounding variables, we first conducted a multivariate backward conditional logistic regression, and then resorted to propensity score matching. Results: We identified 2867 AEEP, 234 RASP, and 1492 OSP procedures. After matching, the risk of pulmonary, renal, infectious, and thromboembolic adverse events was lower after AEEP but not RASP in comparison with OSP (P < 0.05). In comparison with RASP, AEEP had lower cardiac and thromboembolic events (P < 0.05). When compared with OSP, AEEP had reduced odds of Clavien-Dindo grade I (OR = 0.12; 95% CI 0.10 to 0.16) and II (OR = 0.38; 95% CI 0.24 to 9.58) complications. Also, AEEP had lower odds for grade I and II as well as grade IV complications (OR = 0.30; 95% CI 0.19 to 0.48, and OR = 0.05; 95% CI 0.01 to 0.24, respectively) compared with RASP. Conclusion: AEEP and RASP were associated with fewer perioperative adverse events, a shorter LOS and a reduced risk of transfusion compared with OSP. AEEP was associated with overall lower complication rates than RASP and OSP.

Download Full-text

Simple prostatectomy using the open and robotic approaches for lower urinary tract symptoms: A retrospective, case-control series

Canadian Urological Association Journal ◽

10.5489/cuaj.7351 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Dor Golomb ◽

Fernanda Gabrigna Berto ◽

Jennifer Bjazevic ◽

Jose A. Gomez ◽

Joseph L.K. Chin ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Length Of Hospital Stay ◽

Functional Results ◽

Perioperative Outcomes ◽

Minimal Risk ◽

Complication Rates ◽

Control Series ◽

Estimated Blood Loss ◽

Simple Prostatectomy

Introduction: We aimed to assess the outcome of our series of simple prostatectomy using the open simple prostatectomy (OSP) and robotic-assisted simple prostatectomy (RASP) approaches, at our institution. Methods: A retrospective chart review of men who underwent OSP and RASP at Western University, in London, ON. Preoperative, intraoperative, and postoperative data were collected and analyzed. Results: From 2012–2020, 29 men underwent a simple prostatectomy at our institution. Eight patients underwent an OSP and 21 patients underwent a RASP. The median age was 69 years. Preoperative median prostate volume was 153 cm3 (range 80–432 cm3). The surgical indications were failed medical treatment, urinary retention, hydronephrosis, cystolithiasis, and recurrent hematuria. The median operative time was 137.5 minutes in OSP and 185 minutes in the robotic approach (p=0.04). Median estimated blood loss was 2300 ml (range 600–4000 ml) and 100 ml (range 50–400 ml) in the open and robotic procedures, respectively (p=0.4). The mean length of hospital stay was shorter in the RASP group, one day vs. three days (z=4.152, p<0.005). Perioperative complication rates were significantly lower in the group undergoing RASP, with no complications recorded in this group (p=0.004). Both groups demonstrated excellent functional results, with most patients reporting complete urinary continence (p=0.8). Conclusions: We report very good perioperative outcomes, with a minimal risk profile and excellent functional results, leading to marked improvement in patients' symptoms at followup after both the OSP and RASP approaches. RASP was associated with a shorter length of hospital stay, decreased blood loss, and a lower complication rate.

Download Full-text

Thyroidectomy in a Surgical Volunteerism Mission: Analysis of 464 Consecutive Cases

Journal of Thyroid Research ◽

10.1155/2019/1026757 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Rifat Latifi ◽

Mahir Gachabayov ◽

Shekhar Gogna ◽

Renato Rivera

Keyword(s):

Thyroid Surgery ◽

Length Of Hospital Stay ◽

Complication Rates ◽

Risk Calculator ◽

Improvement Program ◽

Female Ratio ◽

Surgical Risk ◽

Surgical Mission ◽

Safety Endpoint ◽

Male To Female

Although surgical volunteer missions (SVMs) have become a popular approach for reducing the burden of surgical disease worldwide, the outcomes of specific procedures in the context of a mission are underreported. The aim of this study was to evaluate outcomes and efficiency of thyroid surgery within a surgical mission. This was a retrospective analysis of medical records of all patients who underwent thyroid surgery within a SVM from 2006 to 2019. Postoperative complication rate was the safety endpoint, whereas length of hospital stay (LOS) was the efficiency endpoint. Serious complications were defined as Clavien–Dindo class 3–5 complications. Expected safety and efficiency outcomes were calculated using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) surgical risk calculator and compared to their observed counterparts. A total of 464 thyroidectomies were performed during the study period. Mean age of the patients was 40.3 ± 10.8 years, and male-to-female ratio was 72 : 392. Expected overall (p=0.127) and serious complication rates (p=0.738) were not significantly different from their observed counterparts. Expected LOS was found to be significantly shorter as compared to its observed counterpart (0.6 ± 0.2 vs. 2.5 ± 1.0 days; p<0.001). This study found thyroid surgery performed within a surgical mission to be safe. NSQIP surgical risk calculator underestimates the LOS following thyroidectomy in surgical missions.

Download Full-text

Reduction of Costs for Pelvic Exenteration Performed by High Volume Surgeons: Analysis of the Maryland Health Service Cost Review Commission Database

The American Surgeon ◽

10.1177/000313481608200123 ◽

2016 ◽

Vol 82 (1) ◽

pp. 46-52 ◽

Cited By ~ 4

Author(s):

Azah A. Althumairi ◽

Joseph K. Canner ◽

Michael A. Gorin ◽

Sandy H. Fang ◽

Susan L. Gearhart ◽

...

Keyword(s):

Pelvic Exenteration ◽

Quality Care ◽

Length Of Hospital Stay ◽

High Volume ◽

Complication Rates ◽

Health Service Cost ◽

Total Cost ◽

Icu Stay ◽

Lower Complication ◽

The Impact

High volume hospitals (HVHs) and high volume surgeons (HVSs) have better outcomes after complex procedures, but the association between surgeon and hospital volumes and patient outcomes is not completely understood. Our aim was to evaluate the impact of surgeon and hospital volumes, and their interaction, on postoperative outcomes and costs in patients undergoing pelvic exenteration (PE) in the state of Maryland. A review of the Maryland Health Services Cost Review Commission database between 2000 and 2011 was performed. Patients were compared for demographics and clinical variables. The differences in length of hospital stay, length of intensive care unit (ICU) stay, operating room (OR) cost, and total cost were compared for surgeon volume and hospital volume controlling for all other factors. Surgery performed by HVS at HVH had the shortest ICU stay and lowest OR cost. When PE was performed by a low volume surgeon at an HVH, the OR cost and total cost were the highest and increased by $2,683 ( P < 0.0001) and $16,076 ( P < 0.0001), respectively. OR costs reduced when surgery was performed by an HVS at an HVH ($-1632, P = 0.008). PE performed by HVS at HVH is significantly associated with lower OR costs and ICU stay. We feel this is indicative of lower complication rates and higher quality care.

Download Full-text

Association between Obesity, Surgical Route, and Perioperative Outcomes in Patients with Uterine Cancer

Minimally Invasive Surgery ◽

10.1155/2018/5130856 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 4

Author(s):

Entidhar Al Sawah ◽

Jason L. Salemi ◽

Mitchel Hoffman ◽

Anthony N. Imudia ◽

Emad Mikhail

Keyword(s):

Vaginal Hysterectomy ◽

Uterine Cancer ◽

Temporal Trends ◽

Laparoscopic Hysterectomy ◽

Total Abdominal Hysterectomy ◽

Perioperative Outcomes ◽

Morbidly Obese ◽

Improvement Program ◽

Perioperative Morbidity ◽

Laparoscopic Assisted Vaginal Hysterectomy

Objective. To study temporal trends of hysterectomy routes performed for uterine cancer and their associations with body mass index (BMI) and perioperative morbidity. Methods. A retrospective review of the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) 2005-2013 databases was conducted. All patients who were 18 years old and older with a diagnosis of uterine cancer and underwent hysterectomy were identified using ICD-9-CM and CPT codes. Surgical route was classified into four groups: total abdominal hysterectomy (TAH), total vaginal hysterectomy (TVH), laparoscopic assisted vaginal hysterectomy (LAVH), and total laparoscopic hysterectomy (TLH) including both conventional and robotically assisted. Patients were then stratified according to BMI. Results. 7199 records were included in the study. TLH was the most commonly performed route of hysterectomy regardless of BMI, with proportions of 50.9%, 48.9%, 50.4%, and 51.2% in ideal, overweight, obese, and morbidly obese patients, respectively. The median operative time for TAH was 2.2 hours compared to 2.7 hours for TLH (p < 0.01). The median length of stay for TAH was 3 days compared to 1 day for TLH (p < 0.01). The percentage of patients with an adverse outcome (composite indicator including transfusion, deep venous thrombosis, and infection) was 17.1 versus 3.7 for TAH and TLH, respectively (p < 0.01). Conclusion. During the last decade, TLH has been increasingly performed in women with uterine cancer. The increased adoption of TLH was seen in all BMI subgroups.

Download Full-text

Comparative Analysis of Laparoscopic and Open Approaches in Emergency Abdominal Surgery

The American Surgeon ◽

10.1177/000313481708301015 ◽

2017 ◽

Vol 83 (10) ◽

pp. 1089-1094

Author(s):

Anaar Siletz ◽

Jonathan Grotts ◽

Catherine Lewis ◽

Areti Tillou ◽

Henry Magill Cryer ◽

...

Keyword(s):

Open Surgery ◽

Univariate Analysis ◽

Length Of Hospital Stay ◽

Complication Rates ◽

Nursing Facilities ◽

Improvement Program ◽

Surgical Quality ◽

Skilled Nursing ◽

Academic Center ◽

Indications For Operation

The objective of this study was to evaluate usage and outcomes of emergency laparoscopic versus open surgery at a single tertiary academic center. Over a three-year period 165 patients were identified retrospectively using National Surgical Quality Improvement Program results. Appendectomies and cholecystectomies were excluded. Open and laparoscopic approaches were compared regarding preoperative and operative characteristics, the development of postoperative complications, 30-day mortality, and length of hospital stay. Indications for operation were similar between groups. Patients who underwent open surgery had more severe comorbidities and higher ASA class. Laparoscopy was associated with reduced complication rates, operative time, length of stay, and discharges to skilled nursing facilities on univariate analysis. In a multivariate model, surgical approach was not associated with the development of complications. Older age, dependent status, and dyspnea were predictors of conversion from attempted laparoscopic to open approaches.

Download Full-text

Gender-Based Analysis of Perioperative Outcomes Associated with Lower Extremity Bypass

The American Surgeon ◽

10.1177/000313481107700717 ◽

2011 ◽

Vol 77 (7) ◽

pp. 844-849 ◽

Cited By ~ 12

Author(s):

Ashish K. Jain ◽

Gabriela Velazquez-Ramirez ◽

Philip P. Goodney ◽

Matthew S. Edwards ◽

Matthew A. Corriere

Keyword(s):

Lower Extremity ◽

Female Gender ◽

Perioperative Outcomes ◽

Chronic Obstructive ◽

Complication Rates ◽

Improvement Program ◽

Chi Square ◽

Increased Risk ◽

Gender Based ◽

Surgical Site Complications

We analyzed gender-based differences in preoperative factors, procedural characteristics, and 30-day outcomes after lower extremity bypass (LEB). LEB procedures were identified from the American College of Surgeons National Surgical Quality Improvement Program Participant User File. Groupwise comparisons of preoperative and procedural variables were made using chi square, t tests, and nonparametric methods; gender influences on mortality, systemic, and surgical site complications were evaluated using logistic regression. Women (4,107 of 11,011 [37.3%]) were older and had greater prevalence of hypertension, diabetes, chronic obstructive pulmonary disease, rest pain, dialysis, previous stroke, open/infected wound, and dependent functional status ( P < 0.01 for all comparisons). Women more commonly underwent emergent and extra-anatomic procedures but had lower rates of venous conduit or tibial level outflow use. Univariable associations between female gender and risk of 30-day mortality, systemic, and surgical site complications were identified; only the association with surgical site complications remained significant in multivariable modeling (OR, 1.8; 95% CI, 1.6 to 2.1; P < 0.0001). Gender-based differences in demographic, comorbidity, and procedural factors may contribute to disparities in perioperative outcomes associated with LEB. Female gender may be associated with increased risk for surgical site complications, but 30-day mortality and systemic complication rates in women may reflect effects of confounding factors rather than gender-specific influence.

Download Full-text

802 PERIOPERATIVE AND SHORT-TERM OUTCOMES FOR PRIMARY ANTIREFLUX SURGERY: FUNDOPLICATION VS. RNY RECONSTRUCTION

Diseases of the Esophagus ◽

10.1093/dote/doab052.802 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Deepika Razia ◽

Sumeet K Mittal

Keyword(s):

Postoperative Complications ◽

Hospital Stay ◽

Antireflux Surgery ◽

Operative Time ◽

Length Of Hospital Stay ◽

Perioperative Outcomes ◽

Short Term ◽

Perioperative Morbidity ◽

Conversion To Open Surgery ◽

Time Length

Abstract Laparoscopic fundoplication is the gold standard for treatment of gastroesophageal reflux disease (GERD); however, RNY reconstruction may be an alternative option in patients with complex pathophysiology and other risk factors. This study aimed to compare perioperative and short-term outcomes between primary fundoplication and RNY reconstruction. Methods After IRB approval, a prospectively maintained esophageal surgery database was retrospectively reviewed to identify patients who underwent primary fundoplication or RNY reconstruction from September 2016 to July 2020. We retrieved perioperative outcomes (operative time, length of hospital stay, intraoperative and postoperative complications) along with GERD-Health-Related Quality of Life (HRQL) scores at annual follow-up. Results During the study period, 226 patients underwent surgery (fundoplication: 210; RNY: 16). The most common indication for RNY was severe esophageal dysmotility or morbid obesity. There was only one conversion to open surgery due to adhesions (fundoplication group). The operative time, length of hospital stay, and ICU stay were significantly lower in the fundoplication group. Rates of intraoperative (fundoplication: 3% vs RNY: 0) and postoperative complications (Clavien-Dindo ≥II) (fundoplication: 3% vs RNY: 6%) were not significantly different between groups. Both groups had a significant and similar improvement of GERD-HRQL scores 1 year after surgery (Table 1). Conclusion Primary antireflux surgery is associated with low perioperative morbidity and excellent short-term outcomes. RNY reconstruction and fundoplication have similar outcomes. More liberal use of RNY reconstruction as the primary antireflux surgery in patients at high risk of failure with fundoplication should be explored.

Download Full-text

Early Adverse Events Following Pediatric Mandibular Advancement: Analysis of the ACS NSQIP-Pediatric Database

The Cleft Palate-Craniofacial Journal ◽

10.1177/10556656211037852 ◽

2021 ◽

pp. 105566562110378

Author(s):

Kevin J. Carlson ◽

Suhas R. Bharadwaj ◽

William M. Dougherty ◽

Eric J. Dobratz

Keyword(s):

Adverse Event ◽

Adverse Events ◽

Statistical Significance ◽

Mandibular Advancement ◽

Complication Rates ◽

Improvement Program ◽

Diagnosis Codes ◽

American College Of Surgeons ◽

Postoperative Diagnosis ◽

Time Of Operation

Objective This study aims to assess early adverse events and patient factors associated with complications following mandible distraction osteogenesis (MDO). Materials and Methods The American College of Surgeons National Surgical Quality Improvement Program-Pediatric (NSQIP-Pediatric) database, years 2012 to 2019, was queried for patients undergoing mandible advancement via relevant Current Procedural Terminology and postoperative diagnosis codes. Thirty-day adverse events and co-morbidities are assessed. Results A total of 208 patients were identified with 17.3% (n = 36) experiencing an adverse event, reoperation (n = 14), and readmission (n = 11) being most common. Patients < 365 days old at the time of operation were more likely to experience an adverse event (26.1% vs 10.8%; P = .005). However, among patients less than 1 year of age, differences in the complication rates between patients ≤ 28 days and >28 days (30.2% vs 22.2%; P = .47) and those weighing ≤ 4 kg and >4 kg (31.7% vs 11.5%; P = .063) did not reach statistical significance. Conclusions Adverse events following mandible advancement are relatively common, though often minor. In our analysis of the NSQIP-Pediatric database, neonatal age ( ≤ 28 days) or weight ≤ 4 kg did not result in a statistically significant increase in complications among patients less than 1 year of age. Providers should consider early intervention in patients who may benefit from MDO.

Download Full-text

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

Neurosurgery ◽

10.1093/neuros/nyz310_616 ◽

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.

Download Full-text

Propensity-matched analysis of general versus spinal anaesthesia for patients undergoing ankle fracture surgery

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00451 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0045 ◽

Cited By ~ 1

Author(s):

David Sing ◽

Molly Vora ◽

Paul Tornetta

Keyword(s):

Length Of Stay ◽

Adverse Events ◽

General Anaesthesia ◽

Spinal Anaesthesia ◽

Ankle Fracture ◽

Operating Time ◽

Knee Surgery ◽

Complication Rates ◽

Improvement Program ◽

Hip And Knee Surgery

Category: Ankle Introduction/Purpose: The choice of anaesthesia is a modifiable risk factor in optimizing post-operative outcomes in hip and knee surgery, with decreased rates of transfusion, thromboembolic events, and infection with the use of spinal anaesthesia versus general anaesthesia. Regional anaesthesia has been evaluated with respect to its effect on early pain in patients undergoing ORIF of the ankle, but there is no data regarding complication rates. The purpose of this study was to compare operating time, length of stay, and rates of post-operative adverse events within 30-days in patients undergoing open reduction and internal fixation (ORIF) of the ankle using spinal vs. general anaesthesia. Methods: Adult patients who underwent ORIF of a closed ankle fracture from 2012 to 2016 were identified from the American College of Surgeons National Surgical Quality Improvement Program database. Patients who were operated on after admission from the ED are not included in the database. Operative time (skin to skin), length of stay, thirty-day adverse events, and unplanned readmissions were compared between patients who received general anaesthesia and those who received spinal anaesthesia. Propensity-adjustment with respect to known risk factors for complications and adjunctive regional block was used to match patients using a 1:4 ratio of spinal to general anaesthesia. Adverse events tracked included wound dehiscence, surgical site infection (superficial and deep), sepsis, venous thrombolic events, cardiac events, prolonged intubation, need for unplanned intubation, return to operating room, pneumonia, urinary tract infection, renal insufficiency, and re-admission within 30 days. Comparisons were performed using a propensity based multivariate analysis. Results: Of the 10,795 patients meeting inclusion criteria, 9,862 (91.4%) were treated with only general anaesthesia and 933 (8.6%) were treated with only spinal anaesthesia. Using propensity-scored matching, 822 patients in the spinal cohort were matched to 3,288 patients in the general cohort with similar baseline demographics (61.5% female, mean age 56.4). Procedure performed was similar in both cohorts (47% lateral malleolus ORIF, 34% bimalleolar ORIF, 10% trimalleolar ORIF, 8% medial malleolus ORIF, 1% posterior malleolus ORIF). Spinal anaesthesia was associated with increased length of stay (+0.5 days, 95% confidence interval (CI) 0.20-0.75, p<0.001) and increased mortality (0.6% vs 0.2%, OR: 4.02, 95% CI 1.15-14.1, p=0.03). Rates of overall complications (4.0% vs 4.2%) and readmissions (0.8% vs 0.7%) were similar and available in Table 1. Conclusion: General anaesthesia is predominantly used for fixation of ankle fractures. While spinal anaesthesia is associated with lower complication rates in hip and knee surgery, we found no advantage in patients undergoing ORIF of the ankle.

Download Full-text