Retrospective comparison of open vs minimally invasive cystotomy in 28 cats using a composite outcome score

Objectives The aim of this study was to compare the outcomes of cats undergoing open cystotomy with those undergoing minimally invasive surgery (MIS) for removal of cystic calculi by use of a composite outcome score. Methods Twenty-eight cats were retrospectively enrolled and divided into two groups: open cystotomy (n = 14) and MIS (n = 14). The primary outcome measure was a composite outcome score, including three variables: pain scores ⩾2 at either 6 or 12 h postoperatively; failure to remove all stones as determined by postoperative radiographs; and postoperative complications requiring a visit to the hospital separate from the planned suture removal appointment. Other data collected included signalment, history, other procedures performed during anesthesia, willingness to eat the day after surgery and the financial cost of the procedures. Results There was no significant difference in age, weight, sex or breed between the two groups. The risk of experiencing the composite outcome was 3/14 (21.4%) in the MIS group and 10/14 (71%) in the open procedure group ( P = 0.02). The cats in the open surgery group had 8.3 times greater odds of developing the composite outcome than cats in the MIS group (odds ratio 8.3, 95% confidence interval 1.3–74.4; P = 0.02). In the MIS group, 10/14 cats were eating the day after surgery vs 3/14 in the open procedure group ( P = 0.02). The procedural cost was higher in the MIS group, with a median cost of US$945 (interquartile range [IQR] US$872–1021) vs US$623 (IQR US$595–679) in the open group ( P <0.01). Conclusions and relevance In this study the composite outcome score provided evidence to support the use of MIS techniques in cats with cystic calculi. The composite outcome score should be considered in future veterinary studies as a promising method of assessing clinically relevant outcomes.

LASER IN PERIODONTOLOGY- A REVIEW

Lasers are used in implant and periodontal field practices. Laser has various periodontal applications including calculus removal, decontamination of root and implant surfaces and bio stimulation, incision and ablation, osseous surgery, excision of the soft tissue, and bacterial reduction. There is a strong evidence that laser is used for surgical and nonsurgical periodontal therapies including root bio modification, bacterial decline and decontamination of infected implant surface, and removal of the pocket epithelium.Waterlase® and Periowave™ systems are recent devices that have further revolutionized the laser technology for its favorable clinical applications; however, the procedural cost with the laser device constitutes an obstacle for its routine application. Keywords: laser, biomodulation, fluorencence, LANAP

Comparison of Cost and Efficacy of Trufill® vs Histoacryl® n-Butyl Cyanoacrylate for Translumbar Type 2 Endoleak Embolization

Purpose: The study aimed to compare the cost and efficacy of translumbar approach type 2 endoleak repairs using either Trufill® or Histoacryl® n-BCA liquid embolic. Method and Materials: This was a retrospective review of patients who had translumbar approach type 2 endoleak repairs using either Trufill® or Histoacryl®. Patients were included if they underwent a technically successful type 2 endoleak repair via a translumbar approach with Trufill® or Histoacryl® n-BCA. A multivariable analysis was performed with the primary clinical outcome of percent change in aneurysm diameter per month compared. Procedure cost was calculated based on typical materials used. Results: 20 Trufill® and 14 Histoacryl® patients were included. The mean procedure cost was higher for Trufill® ($5,757.30 vs. $1,586.09, p ≤ 0.001). There was no significant difference between Trufill® or Histoacryl® patients for age at first embolization, gender, total number of embolizations, number of feeding branches, aneurysm sac size prior to embolization, or residual endoleak at first follow-up. Trufill® patients had more coils used (12.0 vs. 4.3, p = 0.0007), less glue used (0.9 vs. 2.1 mL, p < 0.001), longer follow-up duration (33.5 vs. 13.2 months, p = 0.002), more follow-up CT angiograms (CTA) (3.7 vs. 1.9, p = 0.01), and larger excluded aneurysm sac size at most recent CTA (7.1 cm vs. 5.9 cm, p = 0.04). Percent change in sac diameter per month was not significantly different between Trufill® and Histoacryl® (0.21% vs. -0.25%/month, p = 0.06, respectively). There were no complications. Conclusion: Use of Histoacryl® over Trufill® n-BCA resulted in significantly less procedural cost while maintaining safety and efficacy.

Novel Indices of Coronary Physiology

Fractional flow reserve is the current invasive gold standard for assessing the ischemic potential of an angiographically intermediate coronary stenosis. Procedural cost and time, the need for coronary vessel instrumentation, and the need to administer adenosine to achieve maximal hyperemia remain integral components of invasive fractional flow reserve. The number of new alternatives to fractional flow reserve has proliferated over the last ten years using techniques ranging from alternative pressure wire metrics to anatomic simulation via angiography or intravascular imaging. This review article provides a critical description of the currently available or under-development alternatives to fractional flow reserve with a special focus on the available evidence, pros, and cons for each with a view towards their clinical application in the near future for the functional assessment of coronary artery disease.

AMBULATORY SURGERY TRENDS IN PEDIATRIC ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: WHERE’S IT HAPPENING AND HOW MUCH CAN WE SAVE?

Background: Benefits of ambulatory surgery include more efficient operations, lower cost, and patient preference. The national frequency of anterior cruciate ligament (ACL) reconstruction in children has increased three-fold compared other pediatric orthopaedic procedures, a trend that is likely attributable to an increased rate of ACL tears associated with year-round training and competition in young athletes. Hypothesis/Purpose: The goal of this study was to utilize the Pediatric Health Information System (PHIS) to analyze the national trends towards ambulatory surgery for ACL reconstruction procedures and quantify the cost savings associated with the trend. Methods: The PHIS database was queried using Common Procedural Terminology (CPT) and International Classification of Disease (ICD-9 and 10) codes for ACL reconstruction from 2009-2017. Patient information including gender, age at surgery, region (Northeast, South, Midwest, West) and hospital cost data for each procedure was collected. Cases were classified as ambulatory or non-ambulatory (inpatient or observation). Annual rates of ambulatory surgery were calculated for each procedure regionally for hospitals with cases included in each year of the query. The Consumer Price Index (CPI) was used to adjust procedural costs for inflation. Ambulatory and non-ambulatory costs were analyzed with the Wilcoxon Signed-Rank test. Trends in rates of ambulatory surgery were compared using joinpoint regression and annual percent change (APC). Results: A total of 21,582 cases of ACL Reconstruction were identified from 33 different children’s hospitals from 2009-2017. More than half (50.3%) of the patients were female, and the average age at surgery was 15.4 years (± 2.1 years). The overall rate of ambulatory pediatric ACL reconstructions across the United States increased by 14.7% (APC 1.6%, 95% C.I. 0.8-2.4, p<0.01) from 2009 to 2017. Overall, this trend was most significant in the West (APC 2.0%, 95% C.I. 1.2-2.7, p<0.01), however in more recent years (2012-2017), there has been a similar significant increase in ambulatory pediatric ACL reconstruction in the South (APC 3.0%, 95% C.I. 1.7-4.3, p<0.01). The mean difference in median procedural cost between ambulatory and non-ambulatory ACL reconstructions was $3,145 ($13,866 vs. $10,721, p<0.01). This corresponds to national annual savings of 4.1% associated with the shift towards ambulatory surgery. Conclusions: From 2009-2017, there was a national trend towards performing pediatric ACL reconstruction in the ambulatory setting, which was accompanied by an annual 4.1% procedural cost savings. The feasibility of ambulatory surgery for other common pediatric orthopaedic surgeries should be explored in order to reduce healthcare costs. [Figure: see text]

The cost of implanting a cemented versus cementless total knee arthroplasty

Aims The aim of this study was to compare the actual cost of a cemented and cementless total knee arthroplasty (TKA) procedure. Materials and Methods The cost of operative time, implants, cement, and cementing accessories were included in the overall cost of the TKA procedure. Operative time was determined from a previously published study comparing cemented and cementless implants of the same design. The cost of operative time, implants, cement, and cementing accessories was determined from market and institutional data. Results Mean operative time for cemented TKA was 11.6 minutes longer for cemented TKA than cementless TKA (93.7 minutes (sd 16.7) vs 82.1 minutes (sd 16.6); p = 0.001). Using a conservative published standard of $36 per minute for operating theatre time cost, the total time cost was $418 higher for cementing TKA. The cost of cement and accessories ranged from $170 to $625. Overall, the calculated cost of cemented TKA is $588 to $1043, depending on technique. The general increased charge for cementless TKA implants over cemented TKA implants was $366. Conclusion The overall procedural cost of implanting a cementless TKA is less than implanting a cemented TKA. Cost alone should not be a barrier to using cementless TKA. Cite this article: Bone Joint J 2019;101-B(7 Supple C):61–63

Rupture of Accura balloon during percutaneous transvenous mitral commissurotomy

Percutaneous transvenous mitral commissurotomy (PTMC) is one of the treatment modality in the management of rheumatic mitral stenosis. Reuse of sterilized PTMC balloon catheters has been widely practiced in developing countries to bring down procedural cost. PTMC by reused balloons are prone to deform and rupture during procedure. This can cause fatal complications like embolism of air or balloon material. Herein, we report a case of Accura balloon rupture during PTMC without any fatal complication. Thus, during balloon preparation particularly of reused balloon, it should be examined for any deformity or tear and air should be removed completely to prevent the fatal outcome.

Clinical legal education in Croatia – from providing legal assistance to the poor to practical education of students

<p>Although clinical legal education has a long tradition in common law countries, the countries of the continental European legal system, to which the Republic of Croatia (hereinafter Croatia) belongs, have recognized its importance in the last few years. The first established legal clinic in Croatia was the one of the Faculty of Law at the University of Rijeka. It has been implemented as part of the curriculum for the academic year 1996/1997 and offered to the fourth year students as an elective course entitled “Clinic for Civil Law”. Within the Rijeka Clinic, law students were able to acquire theoretical and practical knowledge, by resolving hypothetical cases, under the supervision and with the support of teachers, lawyers, judges, notaries public and state attorneys. In 2002, with the support of the Institute Open Society from Budapest, the Faculty of Law at the University of Osijek established a legal clinic in the form of practical training for students of the third and fourth year of legal studies. By participating in the clinic’s activity, students of Osijek Law Faculty helped provide legal aid to citizens of lower economic status. This included help in providing general legal information and legal advice, as well as help in covering procedural cost from the funds donated to the Clinic. The lack of financial means that were needed for daily expenditures meant that the Legal Clinic in Osijek was temporarily closed. Nowadays, faculty members of Osijek Law Faculty are trying to solve financial problems and to continue previous good practice in providing legal aid to the poor citizens.</p>