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Noe MC, Hagaman D, Sipp B, Qureshi F, Warren JR, Kaji E, Sherman A, Schwend RM. The effect of surgical time on perioperative complications in adolescent idiopathic scoliosis cases. A propensity score analysis. Spine Deform 2024:10.1007/s43390-024-00839-6. [PMID: 38492171 DOI: 10.1007/s43390-024-00839-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 02/06/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Posterior spinal instrumentation and fusion (PSIF) for adolescent idiopathic scoliosis (AIS) can be lengthy and complication-ridden. The aim of this study was to evaluate the effect of surgical time on perioperative complications in this procedure when controlling for confounding variables with propensity score analysis. METHODS This was an IRB-approved review of electronic health records from 2010 to 2019 at a single tertiary care children's hospital. Patients undergoing PSIF were grouped into "short" (< 6 h) or "long" (≥ 6 h) surgical time groups. Outcome measures were estimated blood loss (EBL), cell saver transfusions, packed red blood cell (pRBC) transfusions, length of stay (LOS), intraoperative monitoring (IOM) alerts, hematocrit, ICU transfer, neurologic loss, surgical site infection, and 90-day readmissions. We controlled for age, sex, BMI, curve severity, number of segments fused, and surgeon factors. RESULTS After propensity score matching there were 113 patients in each group. The short surgical time group had lower EBL (median 715, IQR 550-900 vs median 875, IQR 650-1100 cc; p < 0.001), received less cell saver blood (median 120, IQR 60-168 vs median 160, IQR 97-225 cc; p = 0.001), received less intraoperative pRBCs (median 0, IQR 0-0 vs median 0, IQR 0-320, p = 0.002), had shorter average LOS (4.8 ± 1.7 vs 5.4 ± 2.5 days; p = 0.039), and fewer IOM alerts (4.3% vs 18%, p = 0.003). CONCLUSIONS Patients with shorter surgical times had less blood loss, received less transfused blood, had a shorter LOS, and fewer IOM alerts compared to patients with longer surgical times. Surgical times < 6 h may have safety and efficacy advantages over longer times. LEVEL OF EVIDENCE III.
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Affiliation(s)
- McKenna C Noe
- Department of Orthopaedic Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Daniel Hagaman
- Department of Orthopaedic Surgery, University of Missouri Kansas City, Kansas City, MO, USA
| | - Brittany Sipp
- Department of Surgery, University of Missouri Kansas City, Kansas City, MO, USA
| | - Fahad Qureshi
- Department of Interventional Radiology, Loma Linda University, Loma Linda, CA, USA
| | - Jonathan R Warren
- Department of Orthopaedic Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA
- Department of Orthopaedic Surgery, University of Missouri Kansas City, Kansas City, MO, USA
| | - Ellie Kaji
- University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | - Ashley Sherman
- Department of Orthopaedic Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Richard M Schwend
- Department of Orthopaedic Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA.
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Hirakawa Y, Manaka T, Ito Y, Nakazawa K, Iio R, Kubota N, Nakamura H. Comparison of cost, surgical time, and clinical results between arthroscopic transosseous rotator cuff repair with lateral cortical augmentation and arthroscopic transosseous equivalent suture bridge: A propensity score-matched analysis. J Orthop Sci 2024; 29:529-536. [PMID: 36822948 DOI: 10.1016/j.jos.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/15/2023] [Accepted: 02/04/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND To reduce the healthcare burden, the clinical results of arthroscopic rotator cuff repair and the cost of the implants used have recently been focused upon. This study compared implant cost, surgical time, short-term clinical results, and cuff repair integrity 2 years postoperatively between arthroscopic transosseous rotator cuff repair using lateral cortical augmentation (TOA) and arthroscopic transosseous-equivalent suture bridge (TOE). METHODS This study included 220 patients with rotator cuff repairs performed by a single surgeon between December 2013 and December 2018. Overall, 70 TOA and 68 TOE cases met the inclusion criteria. The same surgeon performed the procedures at two different hospitals, and the techniques differed between the facilities. A total of 42 TOA patients were matched with 42 TOE patients. The patients were matched using a propensity score analysis by gender, age, and cuff tear size. The minimum follow-up period was 2 years. Implant cost and surgical time were compared between the two methods. The range of motion, clinical outcomes, and visual analog scale were evaluated. Magnetic resonance imaging was performed to examine cuff repair integrity 2 years postoperatively. RESULTS The follow-up rate was 81% (112/138 patients). Implant cost was significantly lower with TOA ($1,396 vs. $2,165; p < 0.001) than with TOE. The average surgical time in the TOA method was significantly shorter than that in the TOE method (82 vs. 109 min; p = 0.001). At a minimum 2-year follow-up, the mean active elevation, abduction, and clinical outcomes improved with both methods, although no improvements in external and internal rotations were observed with either method. There were no significant differences in the postoperative variables and retear rate (TOA, 12%; TOE, 19%; p = 0.548) between the two methods. CONCLUSIONS TOA and TOE achieved comparable clinical results; however, TOA was more cost-effective and had a shorter surgical time than TOE. LEVEL OF EVIDENCE Level Ⅲ, retrospective matched control study.
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Affiliation(s)
- Yoshihiro Hirakawa
- Ishikiriseiki Hospital, 18-28, Yayoi-town, Higashi-Osaka City 579-8026, Japan
| | - Tomoya Manaka
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka 545-8585, Japan.
| | - Yoichi Ito
- Osaka Shoulder Center, Ito Clinic, 1-10-12, Ueda, Matsubara-city, Osaka, 580-0016 Japan
| | - Katsumasa Nakazawa
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka 545-8585, Japan
| | - Ryosuke Iio
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka 545-8585, Japan
| | - Naoya Kubota
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka 545-8585, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka 545-8585, Japan
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Vandenberk J, Mievis J, Deferm J, Janssen D, Bollars P, Vandenneucker H. NAVIO RATKA shows similar rates of hemoglobin-drop, adverse events, readmission and early revision vs conventional TKA: a single centre retrospective cohort study. Knee Surg Sports Traumatol Arthrosc 2023; 31:4798-4808. [PMID: 37555860 DOI: 10.1007/s00167-023-07524-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/23/2023] [Indexed: 08/10/2023]
Abstract
PURPOSE Despite widespread adoption of NAVIO robotic-assisted total knee arthroplasty (NAVIO RATKA) in clinical practice, clinical outcome in terms of adverse events and complications remains unclear. The purpose of this study was to compare adverse events, length of stay, surgical time, hemoglobin drop, early readmission rate and revision rate between conventional TKA (CTKA) and NAVIO RATKA. METHODS This single-centre retrospective cohort analysis compared 230 NAVIO RATKA patients to 489 CTKA patients with a minimal follow-up of 12 months. Baseline demographic and comorbidity parameters were collected, as well as length of stay, revision rate and reason for revision, early readmission rate (< 6w) and reason for readmission, post-operative hemoglobin levels, adverse events, surgical time and operating room time. Data were compared using Mann-Whitney U test for continuous data without normal distribution and ordinal data, categorical variables were compared using the Chi-square or Fisher exact test. RESULTS There were no clinically relevant baseline demographic or comorbidity differences between groups. CTKA had shorter length of stay than NAVIO RATKA (5.0 days vs 5.4 days, p = 0.010) but trended towards a higher reoperation rate (4.1% vs 1.7%, p = .144, n.s). No differences were found in hemoglobin drop, readmission rate or overall incidence of adverse events, but CTKA showed more hematoma formation (1.6% vs 0%, p = .044) and higher incidence of periprosthetic joint infection (PJI) (1% vs 0%, p = n.s.), whilst NAVIO RATKA showed more periprosthetic fractures and persistent wound drainage (0.4% vs 2.2%, p = .038 and 0.6% vs 4.3%, p = .001, respectively). Surgical time remained significantly longer in NAVIO RATKA during all 230 cases (87 min vs 67.6 min) and showed a continuous downward trend. CONCLUSIONS This study further validates the usage of NAVIO RATKA as a safe method to perform TKA, with comparable short term outcomes to CTKA in terms of early revisions and adverse events. Surgeons should be mindful of the differing adverse event profile in NAVIO RATKA and adjust their patient selection accordingly to ensure optimal outcomes. In addition, surgeons using NAVIO RATKA should expect a linear learning curve and a surgical time exceeding that of CTKA. LEVEL OF EVIDENCE Level III (therapeutic retrospective cohort study).
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Affiliation(s)
- Jim Vandenberk
- Department of Biomedical Sciences (Development and Regeneration), KU Leuven-University of Leuven, Herestraat 49, Box 700, 3000, Louvain, Belgium.
- Department of Orthopaedic Surgery, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium.
| | - Jan Mievis
- Orthoteam Limburg, Dienst Orthopedische Heelkunde St. Trudo, Sint-Truiden, Belgium
| | - Jorien Deferm
- St. Elisabeth Krankenhaus Geilenkirchen, Geilenkirchen, Duitsland
| | - Daniël Janssen
- Orthoteam Limburg, Dienst Orthopedische Heelkunde St. Trudo, Sint-Truiden, Belgium
| | | | - Hilde Vandenneucker
- Department of Biomedical Sciences (Development and Regeneration), KU Leuven-University of Leuven, Herestraat 49, Box 700, 3000, Louvain, Belgium
- Department of Orthopaedic Surgery, University Hospitals Leuven, Herestraat 49, 3000, Louvain, Belgium
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de Menezes MP, de Faria LG, Franco GG, Ido CK, Kawamoto FYK, de Souza JAL, Gomide PRS, Filgueira FGF, Yamada DI, Minto BW. Intraoperative and early postoperative pain in cats that underwent ovariohysterectomy using a spay hook: a randomised, masked, experimental study. BMC Vet Res 2023; 19:154. [PMID: 37705013 PMCID: PMC10500812 DOI: 10.1186/s12917-023-03718-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 09/02/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND This study aimed to compare the feasibility and practicality of the ovariohysterectomy (OHE) technique in cats with or without a spay hook with respect to the incision size, surgical time, surgical variables, and intra- and postoperative pain. Twenty-nine female cats underwent OHE using a spay hook (spay hook group [SHG], n = 15) or without using a spay hook (control group [CG], n = 14) to achieve the ovaries and cervix. Physiological parameters were monitored during the intraoperative period, and postoperative pain was assessed using a multidimensional composite and visual analogue pain scales. RESULTS The SHG had a significantly shorter operative time than the CG. The variables in the intraoperative period showed no statistically significant difference between both groups, as well as the early postoperative pain. CONCLUSIONS Less invasive OHE using a spay hook could potentially be a viable and feasible technique when performed by an inexperienced surgeon with appropriate training, especially in sterilisation campaigns, reducing the time to perform the procedure and increasing the number of animals spayed per time.
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Affiliation(s)
- Mareliza Possa de Menezes
- Department of Clinic and Veterinary Surgery, School of Agricultural and Veterinarian Sciences, São Paulo State University (UNESP), Via de Acesso Prof. Paulo Donato Castellane w/n, Jaboticabal - São Paulo, CEP 14884-900, Brazil.
| | | | - Guilherme Galhardo Franco
- Center of Agrarian Sciences and Engineering, Federal University of Espírito Santo (UFES), Alegre - Espírito Santo, 29.500-000, Brazil
| | - Cléber Kazuo Ido
- Department of Clinic and Veterinary Surgery, School of Agricultural and Veterinarian Sciences, São Paulo State University (UNESP), Via de Acesso Prof. Paulo Donato Castellane w/n, Jaboticabal - São Paulo, CEP 14884-900, Brazil
| | | | | | - Paula Regina Silva Gomide
- Department of Clinic and Veterinary Surgery, School of Agricultural and Veterinarian Sciences, São Paulo State University (UNESP), Via de Acesso Prof. Paulo Donato Castellane w/n, Jaboticabal - São Paulo, CEP 14884-900, Brazil
| | - Fabrícia Geovânia Fernandes Filgueira
- Department of Clinic and Veterinary Surgery, School of Agricultural and Veterinarian Sciences, São Paulo State University (UNESP), Via de Acesso Prof. Paulo Donato Castellane w/n, Jaboticabal - São Paulo, CEP 14884-900, Brazil
| | - Diego Iwao Yamada
- University of Marília (UNIMAR), Marília, São Paulo, 17525-902, Brazil
| | - Bruno Watanabe Minto
- Department of Clinic and Veterinary Surgery, School of Agricultural and Veterinarian Sciences, São Paulo State University (UNESP), Via de Acesso Prof. Paulo Donato Castellane w/n, Jaboticabal - São Paulo, CEP 14884-900, Brazil
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Heydweiller AC, König TT, Yavuz ST, Schwind M, Oetzmann von Sochaczewski C, Rohleder S. [Influencing factors on operating times for metal bar removal after Nuss repair]. Chirurgie (Heidelb) 2023; 94:796-803. [PMID: 37353682 PMCID: PMC10447265 DOI: 10.1007/s00104-023-01914-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Metal bar removal after the Nuss repair procedure is prone to be cancelled in cases of operating time shortages due it being suitable to be postponed without harming patients. Consequently, planning operation times as exactly as possible could be one solution. OBJECTIVE Statistical modelling of operation times of metal bar removal after Nuss repair using the prespecified independent predictors of age, sex, intraoperative complications, and number of implanted metal bars. MATERIAL AND METHODS We included all patients whose operation notes included an operation time, which was modelled via linear regression and subject to internal validation via bootstrap. Exploratory analyses also consisted of the surgeon's experience, the number of stabilizers, the body mass index, and preceding re-do surgery for bar dislocation. RESULTS We included 265 patients (14% ♀) with a median age of 19 years (interquartile range 17-20 years), of whom 81% had 1 and 17% had 2 metal bars removed. The prespecified regression model was statistically significant (likelihood ratio 56; df = 5; P < 0.001) and had a bias corrected R2 of 0.148. Patient age influenced operation times by 2.1min per year of life (95% confidence interval 1.3-2.9min; P < 0.001) and 16min per explanted metal bar (95% confidence interval: 10-22min; P < 0.001). CONCLUSION The patient-specific factors of age and the number of explanted metal bars influenced the operation times and can be included into scheduling operation times.
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Affiliation(s)
- Andreas C Heydweiller
- Sektion Kinderchirurgie der Klinik und Poliklinik für Allgemein‑, Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Tatjana T König
- Klinik und Poliklinik für Kinderchirurgie, Universitätsmedizin Mainz, Mainz, Deutschland
| | - S Tolga Yavuz
- Klinik für Allgemeine Pädiatrie, Universitätsklinik Bonn, Bonn, Deutschland
| | - Martin Schwind
- Klinik und Poliklinik für Kinderchirurgie, Universitätsmedizin Mainz, Mainz, Deutschland
| | - Christina Oetzmann von Sochaczewski
- Sektion Kinderchirurgie der Klinik und Poliklinik für Allgemein‑, Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland.
- Sektion Kinderchirurgie, Klinik und Poliklinik für Allgemein‑, Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
| | - Stephan Rohleder
- Klinik und Poliklinik für Kinderchirurgie, Universitätsmedizin Mainz, Mainz, Deutschland
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Moog P, Jiang J, Buchner L, Suhova I, Schmauss D, Machens HG, Kükrek H. Aesthetic training concept during plastic surgery residency - Opportunity or risk? Heliyon 2023; 9:e17398. [PMID: 37416684 PMCID: PMC10320284 DOI: 10.1016/j.heliyon.2023.e17398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 07/08/2023] Open
Abstract
Background Aesthetic surgery training renders to be challenging to acquire sufficient hands-on experience during residency. To resolve this problem, the "Munich Model" was established in our clinic: Senior residents perform aesthetic surgeries, supervised by an experienced plastic surgeon while patients benefit from reduced surgery costs. With this model, we hypothesize no significant differences in the postoperative outcome between procedures performed by residents and plastic surgeons. Methods Between August 2012 and December 2017, 481 aesthetic surgeries were included in this retrospective single-center study, of which 283 were performed by residents and 198 by plastic surgeons. Procedures included mastopexy, abdominoplasty, extremity lift, breast reduction, breast augmentation, facial surgery, aesthetic liposuction and lipedema liposuction. Postoperative outcomes were compared regarding surgery time, time of drain removal, inpatient length of stay, duration of wound healing, perioperative blood loss and occurrence of major (surgical revision needed) and minor complications (no surgery needed). Results We found no significant differences in aesthetic surgical procedures between residents and board-certified plastic surgeons in the outcome measures of surgery duration, time of drain removal, inpatient length of stay, perioperative blood loss and complication rate, including major and minor complications. Only the inpatient stay was prolonged in aesthetic liposuctions performed by residents. Conclusion This study demonstrates comparatively that supervised aesthetic surgeries at a university hospital utilizing the "Munich Model" widely meet the specialist surgeons' standards.
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Affiliation(s)
- Philipp Moog
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - Jun Jiang
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - Lara Buchner
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - Inessa Suhova
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - Daniel Schmauss
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Hans-Günther Machens
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - Haydar Kükrek
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany
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Chen P, Yeh HW, Lu Y, Chen ACY, Chan YS, Lädermann A, Chiu JCH. Comparison of suture-bridge and independent double-row techniques for medium to massive posterosuperior cuff tears: a two-year retrospective study. BMC Musculoskelet Disord 2023; 24:154. [PMID: 36855071 PMCID: PMC9972682 DOI: 10.1186/s12891-023-06256-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/20/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Transosseous-equivalent suture-bridge (TOE-SB) and independent double-row (IDR) repair techniques were developed to treat rotator cuff tears. The study was designed to prove that both TOE-SB and IDR techniques provided comparable clinical results and retear rate for medium to massive posterosuperior rotator cuff tears, while the surgical time and number of suture anchor used were less in the IDR group. STUDY DESIGN Level of evidence: level III, Retrospective comparative study. METHODS Patients with medium to massive posterosuperior rotator cuff tears receiving arthroscopic TOE-SB and IDR between November 2016 to October 2019 were retrospectively enrolled. All patients were confirmed to have grade ≤ 2 fatty infiltration in the muscles of the torn tendons. Revision, concomitant subscapularis tear, acromiohumeral distance < 7 mm, glenohumeral osteoarthritis, partial repair, incomplete repair, partial thickness, or irreparable posterosuperior cuff tear were excluded. Surgical time, number of suture anchor used for the surgery, pre-operative, and post-operative clinical scores such as Constant-Murley score, subjective shoulder value (SSV), and visual analog scale (VAS) were compared. The retear rates between groups were evaluated by ultrasound. RESULTS Thirty-five IDR and thirty-five TOE-SB repairs were enrolled. The IDR technique required much fewer anchors than TOE-SB did to complete the cuff repair. The mean operation time in IDR and TOE-SB group were 86(18.23), and 114(18.7) (min), respectively (P < 0.01). The mean number of anchors used to complete the cuff repair was 2(0.17) in IDR and 3(0.61) in TOE-SB (P < 0.01). The Constant-Murley score improved from 34.9 ± 6.6 to 80.6 ± 9.4 in the IDR group, and 37.4 ± 6 to 81.9 ± 4.6 in the TOE-SB group (both P < 0.001). SSV improved from 24.6 ± 9.6 to 79.3 ± 10.6 in the IDR, and 27.9 ± 9 to 82.9 ± 6.9 in the TOE-SB group (both P < 0.001). VAS improved from 7.9 ± 0.6 to 1.5 ± 0.7 in the IDR, and 8 ± 0.5 to 1.3 ± 0.6 in the TOE-SB group (both P < 0.001) at final follow-up. No significant difference was found between the retear rates (14.3% in the IDR vs. 17.1% in the TOE-SB, respectively) in the 2-year follow-up. CONCLUSIONS Both IDR and TOE-SB group provided comparable clinical results and retear rates for medium to massive posterosuperior rotator cuff tears. The surgical time and number of anchors used were less in the IDR group than in the TOE-SB group.
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Affiliation(s)
- Poyu Chen
- grid.454211.70000 0004 1756 999XDepartment of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, No.5, Fusing St., Gueishan District, Taoyuan City, 333 Taiwan ,grid.145695.a0000 0004 1798 0922Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Han-Wei Yeh
- grid.454211.70000 0004 1756 999XLinkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi Lu
- grid.454211.70000 0004 1756 999XDepartment of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, No.5, Fusing St., Gueishan District, Taoyuan City, 333 Taiwan
| | - Alvin Chao-Yu Chen
- grid.454211.70000 0004 1756 999XDepartment of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, No.5, Fusing St., Gueishan District, Taoyuan City, 333 Taiwan ,grid.413801.f0000 0001 0711 0593Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan ,grid.413801.f0000 0001 0711 0593Comprehensive Sports Medicine Center (CSMC) Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi-Sheng Chan
- grid.413801.f0000 0001 0711 0593Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan ,grid.413801.f0000 0001 0711 0593Comprehensive Sports Medicine Center (CSMC) Chang Gung Memorial Hospital, Taoyuan, Taiwan ,grid.454209.e0000 0004 0639 2551Department of Orthopedic Surgery, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Alexandre Lädermann
- grid.413934.80000 0004 0512 0589Division of orthopedics and Trauma Surgery, Hôpital de la Tour, Meyrin, Switzerland ,grid.8591.50000 0001 2322 4988Faculty of Medicine, University of Geneva, Geneva, Switzerland ,grid.150338.c0000 0001 0721 9812Orthopedics and Trauma Service, University Hospitals of Geneva, Geneva, Switzerland
| | - Joe Chih-Hao Chiu
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, No.5, Fusing St., Gueishan District, Taoyuan City, 333, Taiwan. .,Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan. .,Comprehensive Sports Medicine Center (CSMC) Chang Gung Memorial Hospital, Taoyuan, Taiwan.
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Nishitsuka K, Nishi K, Yamashita H. Effectiveness of intraoperative optical coherence tomography on vitrectomy for proliferative diabetic retinopathy. Jpn J Ophthalmol 2022; 66:527-533. [PMID: 36318355 DOI: 10.1007/s10384-022-00944-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/21/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE We sought to verify the effect of intraoperative optical coherence tomography (iOCT) on vitrectomy for the treatment of proliferative diabetic retinopathy (PDR). STUDY DESIGN Retrospective study. METHODS We reviewed 178 eyes with PDR treated with 25-gauge vitrectomy by a single surgeon between April 2013 and December 2017. In total, 98 eyes of 77 patients with PDR (mean age, 52.5 ± 11.7 years) treated with vitrectomy using iOCT (iOCT group) and 80 eyes of 60 patients with PDR (mean age, 53.1 ± 10.9 years) treated without iOCT (non-iOCT group) were included in the study. To determine the effects of combining vitrectomy with iOCT, a comparison was made of patients treated with this combination and patients treated with vitrectomy without iOCT. The effects of these treatments were assessed on the basis of intraoperative complications, reoperation ratios, postoperative complications, operation times, and postoperative visual acuity. RESULTS The operation time was significantly reduced for the iOCT group (72.9 ± 23.9 min) when compared with the non-iOCT group (91.3 ± 31.2 min) (P = .001). The incidences of intraoperative complications, reoperation, and postoperative complications did not differ significantly between the 2 groups (P = .542, 0.258, and 0.860 respectively). Six months after surgery, the postoperative visual acuity did not differ significantly between the 2 groups (P = .508). Multiple linear regression analysis revealed that the operation time was significantly correlated with iOCT (beta [standard partial regression coefficient] = - 0.28, P < .001), the fibrovascular proliferative membrane (beta = 0.17, P = .009), cataract surgery (beta = 0.22, P = .016), preoperative retinal photocoagulation (beta = - 0.14, P = .021), intraoperative complications (beta = 0.16, P = .023), and posterior vitreous detachment (beta = - 0.14, P = .04). CONCLUSION Use of iOCT reduced the operation time without affecting the incidence rates of intraoperative and postoperative complications, reoperation ratios, or postoperative visual acuities in patients who underwent vitreous surgery for PDR.
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Affiliation(s)
- Koichi Nishitsuka
- Department of Ophthalmology and Visual Sciences, Yamagata University Faculty of Medicine, Yamagata, Japan.
| | - Katsuhiro Nishi
- Department of Ophthalmology and Visual Sciences, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Hidetoshi Yamashita
- Department of Ophthalmology and Visual Sciences, Yamagata University Faculty of Medicine, Yamagata, Japan
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Reyna-Sepúlveda F, Cantu-Alejo D, Martinez-Fernandez A, Rodriguez-Garcia J, Guevara-Charles A, Perez-Rodriguez E, Hernandez-Guedea M, Muñoz-Maldonado G. 5-Year management and outcomes of penetrating neck injury in a trauma center. Penetrating neck injury. Cir Esp 2022; 100:629-634. [PMID: 36109114 DOI: 10.1016/j.cireng.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 06/25/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND Penetrating neck injuries represent 5-10% of all traumatic injuries, these bring with them a high rate of morbidity and mortality due to vital structures that could be injured in this area. The aim of this study was to determine the epidemiological and clinical characteristics of penetrating neck injuries. METHODS This was a retrospective, unicentric and descriptive study that included all patients who underwent neck exploration surgery. RESULTS A total of 70 neck exploration cases were reviewed, 34 (49%) didn't had any injury. Thirty (43%) had at least one hard sign, 42 (60%) patients showed at least one soft sign. Statistical analysis showed only surgical time (252±199.5 vs. 155±76.4; p=0.020) and transfusions (1.87±3 vs. 0.4±0.856; p=0.013) were statistically significant. We report a mortality of 2 (3%) patients. CONCLUSIONS Our prevalence of neck surgical exploration without vascular injury was slightly higher (49% vs. 40%) than literature. We highlight the importance of not performing neck explorations in all patients who present a penetrating injury. We did not obtain differences between groups for hard signs and soft signs. We were not able to identify whether or not there would be an injury based on clinical characteristics. Imaging studies should be performed to avoid unnecessary neck explorations; however, depending on the clinical scenario some surgery cannot be avoided.
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Affiliation(s)
| | - Daniel Cantu-Alejo
- General Surgery Department, University Hospital, Universidad Autónoma de Nuevo León, Mexico
| | | | - Jaime Rodriguez-Garcia
- General Surgery Department, University Hospital, Universidad Autónoma de Nuevo León, Mexico; Emergency Department, University Hospital, Universidad Autónoma de Nuevo León, Mexico
| | - Asdrubal Guevara-Charles
- General Surgery Department, University Hospital, Universidad Autónoma de Nuevo León, Mexico; Emergency Department, University Hospital, Universidad Autónoma de Nuevo León, Mexico
| | | | - Marco Hernandez-Guedea
- General Surgery Department, University Hospital, Universidad Autónoma de Nuevo León, Mexico; Emergency Department, University Hospital, Universidad Autónoma de Nuevo León, Mexico
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Nicoll K, Lucocq J, Khalil T, Khalil M, Watson H, Patil P. Follow-up after emergency laparotomy suggests high one- and five-year mortality with risk stratified by ASA. Ann R Coll Surg Engl 2022; 104:202-209. [PMID: 34519559 PMCID: PMC9773906 DOI: 10.1308/rcsann.2021.0156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION We investigated all-cause mortality following emergency laparotomy at 1 and 5 years. We aimed to establish a basis from which to advise patients and relatives on long-term mortality. METHODS Local data from a historical audit of emergency laparotomies from 2010 to 2012 were combined with National Emergency Laparotomy Audit (NELA) data from 2017 to 2020. Covariates collected included deprivation status, preoperative blood work, baseline renal function, age, American Society of Anesthesiologists (ASA) grade, operative time, anaesthetic time and gender. Associations between covariates and survival were determined using multivariate logistic regression and Kaplan-Meier analysis. We used patients undergoing laparoscopic cholecystectomy between 2015 and 2020 as controls. RESULTS ASA grade was the best discriminator of long-term outcome following laparotomy (n=894) but was not a predictor of survival following cholecystectomy (n=1,834), with mortality being significantly greater in the laparotomy group. Following cholecystectomy, 95% confidence intervals for survival at 5 years were 98-99%. Following laparotomy these intervals were: ASA grade 1, 79-96%; ASA grade 2, 69-82%; ASA grade 3, 44-58%; ASA grade 4, 33-48%; and ASA grade 5, 4-51%. The majority of deaths occurred after 30 days. CONCLUSIONS Emergency laparotomy is associated with a significantly increased risk of death in the following 5 years. The risk is strongly correlated to ASA grade. Thirty-day mortality estimation is not a good basis on which to advise patients and carers on long-term outcomes. ASA grade can be used to predict long-term outcomes and to guide patient counsel.
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11
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de Quintana-Schmidt C, Salgado-Lopez L, Aibar-Duran JA, Alvarez Holzapfel MJ, Cortes CA, Alvarado JDP, Rodriguez RR, Teixidó JM. Neuronavigated Ultrasound in Neuro-Oncology: A True Real-Time Intraoperative Image. World Neurosurg 2021; 157:e316-e326. [PMID: 34655818 DOI: 10.1016/j.wneu.2021.10.082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Ultrasound is considered a real-time imaging method in neuro-oncology because of its highly rapid image acquisition time. However, to our knowledge, there are no studies that analyze the additional surgical time that it requires. METHODS A prospective study of 100 patients who underwent intra-axial brain tumor resection with navigated intraoperative ultrasound. The primary outcomes were lesion visibility grade on ultrasound and concordance with preoperative magnetic resonance imaging (MRI) scan, intraoperative ultrasound usage time, and percentage of tumor resection on ultrasound and comparison with postoperative MRI scan. RESULTS The breakdown of patients included the following: 53 high-grade gliomas, 26 metastases, 14 low-grade gliomas, and 7 others. Ninety-six percent of lesions were clearly visualized. The tumor border was clearly delimited in 71%. Concordance with preoperative MRI scan was 78% (P < 0.001). The mean time ± SD for sterile covering of the probe was 2.16 ± 0.5 minutes, and the mean image acquisition time was 2.49 ± 1.26 minutes. Insular tumor location, low-grade glioma, awake surgery, and recurrent tumor were statistically associated with an increased ultrasound usage time. Ultrasound had a sensitivity of 94.4% and a specificity of 100% for residual tumor detection. CONCLUSIONS Neuronavigated ultrasound can be considered a truly real-time intraoperative imaging method because it does not increase surgical time significantly and provides optimal visualization of intra-axial brain lesions and residual tumor.
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Affiliation(s)
| | - Laura Salgado-Lopez
- Department of Neurosurgery, Albany Medical Center, Albany, New York, USA; Universitat Autònoma de Barcelona (Doctorat), Barcelona, Spain
| | | | | | | | | | | | - Joan Molet Teixidó
- Department of Neurosurgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Rohe S, Brodt S, Windisch C, Matziolis G, Böhle S. [Patient safety during endoprosthetic training : Does the training of surgeons in primary hip arthroplasty at certified endoprosthesis centres lead to increased complications?]. Orthopade 2021; 51:52-60. [PMID: 33929552 PMCID: PMC8766393 DOI: 10.1007/s00132-021-04110-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/30/2021] [Indexed: 11/30/2022]
Abstract
Hintergrund Ziel der Studie war die Untersuchung, ob sich das perioperative Outcome und operationsspezifische Prozessgrößen bei Patienten mit Hüftgelenksersatz signifikant verschlechtern, wenn die Operation durch einen unerfahrenen Operateur, assistiert durch einen erfahrenen Operateur, im Kontext eines zertifizierten Endoprothesenzentrums durchgeführt wird. Material und Methoden Es wurden 1480 Patienten eingeschlossen, die zwischen 2013 und 2016 bei primärer Koxarthrose mit einer primären zementfreien Hüfttotalendoprothese (HTEP) versorgt wurden. Die relevanten Daten wurden retrospektiv aus dem Krankenhausinformationssystem, dem Entlassungsbrief und aus dem EndoCert-Bogen dokumentiert. Die Operateure wurden nach ihrer Qualifikation in erfahrene (Senior, > 50 HTEP pro Jahr) und unerfahrene Operateure (Junior, < 50 HTEP pro Jahr) unterteilt. Anschließend erfolgte der Vergleich der erhobenen Daten anhand dieser Unterteilung. Resultate Es zeigte sich bei unerfahrenen Operateuren eine signifikante Verlängerung der Operationsdauer um 20,7 min (Senior 62,6 ± 20,4 min; Junior 83,3 ± 19,5 min; p ≤ 0,001), der Krankenhausverweildauer um 0,25 Tage (Senior 8,8 ± 0,9 d; Junior 9,0 ± 0,9 d; p ≤ 0,001) und eine Erhöhung der Transfusionshäufigkeit von Erythrozytenkonzentraten (Senior 0,6 ± 1,1 Stk.; Junior 0,9 ± 1,4 Stk.; p ≤ 0,001). Dagegen zeigte sich kein Unterschied bei perioperativen Komplikationen (p = 0,682) und beim perioperativen Blutverlust (Senior 1,3 ± 0,5 l; Junior 1,3 ± 0,5 l; p = 0,097). Zwischen Operationsdauer und Blutverlust bestand allerdings eine positive Korrelation (Senior r = 0,183; Junior r = 0,214; jeweils p ≤ 0,01). Schlussfolgerung Die Ausbildung von unerfahrenen Operateuren an einem zertifizierten Endoprothesenzentrum führt bei Assistenz durch erfahrene Operateure nicht zur Reduktion der Patientensicherheit mit vermehrten Komplikationen. Aufgrund der Operationszeitverlängerung kommt es allerdings zu einer Mehrbelastung der Kliniken im Wettbewerb mit nichtausbildenden Kliniken, die nicht im DRG-System abgebildet ist.
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Affiliation(s)
- S Rohe
- Waldklinken Eisenberg, Campus für Orthopädie, Medizinische Fakultät, Friedrich-Schiller-Universität Jena, Klosterlausnitzer Str. 81, 07607, Eisenberg, Deutschland.
| | - S Brodt
- Waldklinken Eisenberg, Campus für Orthopädie, Medizinische Fakultät, Friedrich-Schiller-Universität Jena, Klosterlausnitzer Str. 81, 07607, Eisenberg, Deutschland
| | - C Windisch
- Abteilung für Orthopädie und Unfallchirurgie, Helios Klinikum Blankenhain, Wirthstr. 5, 99444, Blankenhain, Deutschland
| | - G Matziolis
- Waldklinken Eisenberg, Campus für Orthopädie, Medizinische Fakultät, Friedrich-Schiller-Universität Jena, Klosterlausnitzer Str. 81, 07607, Eisenberg, Deutschland
| | - S Böhle
- Waldklinken Eisenberg, Campus für Orthopädie, Medizinische Fakultät, Friedrich-Schiller-Universität Jena, Klosterlausnitzer Str. 81, 07607, Eisenberg, Deutschland
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Costa GG, Lo Presti M, Agrò G, Vasco C, Cialdella S, Casali M, Neri MP, Grassi A, Zaffagnini S. Difficult primary total knee arthroplasty requiring a varus-valgus constrained implant is at higher risk of periprosthetic infection. Knee Surg Sports Traumatol Arthrosc 2020; 28:3787-3795. [PMID: 31982919 DOI: 10.1007/s00167-020-05866-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 01/17/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The goal of this study was to compare the risk of periprosthetic infection of a consecutive cohort of primary varus-valgus constrained (VVC) total knee arthroplasties (TKAs), with a matched 1:1 cohort of primary posterior-stabilized (PS) TKAs. METHODS 74 primary VVC TKAs performed in 66 patients were identified and matched 1:1 with a cohort of 74 primary PS TKAs performed in 73 patients. At last follow up, patients were clinically evaluated using the Knee Society Score (KSS). Kaplan-Meier survival curves were generated to analyze survivorship using as endpoints revision for any reason, revision for periprosthetic infection and revision for mechanical failure after excluding periprosthetic infection. A multivariate logistic regression analysis was constructed to determine whether revision surgery for periprosthetic infection was influenced by patients' gender, age, surgical time and reasons for TKA (primary vs secondary osteoarthritis). RESULTS Demographic data were not significantly different between the two groups as regard patients' age, gender, body mass index, Charlson Comorbidity Index, reasons for replacement, and length of follow-up. Surgical time was greater in the VVC group (95.7 ± 22.5 min vs 88.6 ± 17.1 min, respectively, p = 0.032). Postoperative KSS, range of motion and radiographic data did not differ significantly between the two groups. Overall revision rate and revision rate for mechanical failure after 5 years of follow-up was not statistically different between the two groups. Considering only the revision rate due to periprosthetic infection, the risk was higher in patients with primary VVC implants (p = 0.013). The surgical time was the only factor that significantly affected the risk of revision for periprosthetic infection (OR 1.0636, CI 95% 1.0209-1.1081, p = 0.0032), whereas patients' gender, age and reason for TKA had no influence. CONCLUSIONS Patients and surgeons should be aware of the higher risk of periprosthetic knee infection using a VVC prosthesis. However, the present study supports the use of VVC implants in cases of difficult knee replacements, since comparable clinical outcomes and overall revision rate was found after at least 5 years of follow up. LEVEL OF EVIDENCE Retrospective cohort study, Level III.
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Affiliation(s)
- Giuseppe Gianluca Costa
- II Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy.
| | - Mirco Lo Presti
- II Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy
| | - Giuseppe Agrò
- II Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy
| | - Cosimo Vasco
- II Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy
| | - Sergio Cialdella
- II Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy
| | - Marco Casali
- II Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy
| | - Maria Pia Neri
- II Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy
| | - Alberto Grassi
- II Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy
| | - Stefano Zaffagnini
- II Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano n. 1/10, 40136, Bologna, Italy
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Abstract
BACKGROUND Compared with the current gold standard of knee endoprosthetics, the concept of kinematic alignment is more responsive to the individual anatomy of the patient as it enables the three-dimensional restoration of individual axes, joint lines and capsule tension. One point of criticism is the lack of intraoperative control over individual bone resections with conventional instrumentation. However, with the help of CT-based individual 3D-printed cutting blocks, a precise preoperative plan can be transferred to the operating room. The aim of this article is to explain the operative technique of patient-specific instrumentation (PSI)-protected kinematic alignment. METHODS The procedure is based on a preoperative 3D model of the bony anatomy of the patient, with the aid of which the planning of the operation, with the positioning and size of the implant, as well as the necessary bone resections, are carried out. With this information about anatomy and resection levels the individual cutting blocks are produced, aided by a 3D printer. Intraoperative control is achieved by measuring the resection by means of a gage and comparison with the digital 3D design. DISCUSSION With the aid of the 3D-printed PSI cutting blocks the preoperative plan of kinematic alignment can be implemented in a precise manner. It is a simple tool and does not require any great expense. Compared with the conventional instrumentation, the operating time is shortened. However, because of the purely CT-based design, no information about the state of the soft tissue is obtained.
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Barbas-Bernardos G, Herranz-Amo F, Caño-Velasco J, Gonzalo-Balbás Á, Subirá-Ríos D, Moralejo-Gárate M, Mayor-de Castro J, Escribano-Patiño G, Rodríguez-Fernández E, Aragón-Chamizo J, Hernández Fernández C. [Effect of surgical approach on radical nephrectomy outcomes: Comparative study between open and laparoscopic nephrectomy.]. ARCH ESP UROL 2020; 73:172-182. [PMID: 32240107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The aim of this study is to evaluate the influence of laparoscopy in patients with renal cancer treated with radical nephrectomy in terms of surgical time, hospital stay, postoperative complications and survival.MATERIAL AND METHODS: Retrospective study of 570 patients with renal cancer treated with radical nephrectomyin stage ≤pT3a. Differences between groups were analysed using ANOVA test for quantitative variables and Chi squared test for qualitative. In order to evaluate possible risk factors for longer hospital stay and surgical time, multivariate analysis was performed (lineal regression). For complications we performed binary logistic regression. Overall survival (OS), recurrence free survival (RFS) and cancer specific survival (CSS) were estimated using Kaplan Meier and compared using Log Rank test. Univariate and multivariate analysis was performed using Cox regression in order to identify independent risk factors for overall, cancer specific and recurrence mortality. RESULTS Two cohorts: 361 (63.3%) open radical nephrectomies (ORN) and 209 (36.7%) laparoscopic (LRN). Surgical time was longer in LRN (p=0.001) globally. After the period when the learning curve was over these differences were no longer significant. Hospital stay was shorter in LRN (p=0.0001). cT stage (p=0.005) and surgical access (p=0.001) acted as independent risk factors for longer surgical time. 33,5% (121 patients) of the ORN had some sort of postoperative complication vs. 11% (23 patients) in the LRN group (p=0.0001). These differences were observed in the Clavien-Dindo's grade II group. Independent risk factors for postoperative complications observed were: ASA≥III (OR=1.82, p=0.004) and stage pT3a (OR=2.29,p=0.0001). Laparoscopy acted as a protective factor for complications (OR=0,26, p=0.0001). Surgical access did not influence RFS (HR=0.87, p=0.50), CSS(HR=0.69, p=0.12). CONCLUSIONS Laparoscopic access to RN in patients with renal cancer in ≤pT3a stage increased surgical time only in the first years, reduced hospital stayand postoperative complications and did not influence RFS, OS or CSS.
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Affiliation(s)
| | - Felipe Herranz-Amo
- Servicio de Urología. Hospital General Universitario Gregorio Marañón. Madrid. España
| | - Jorge Caño-Velasco
- Servicio de Urología. Hospital General Universitario Gregorio Marañón. Madrid. España
| | | | - David Subirá-Ríos
- Servicio de Urología. Hospital General Universitario Gregorio Marañón. Madrid. España
| | | | | | | | | | - Juan Aragón-Chamizo
- Servicio de Urología. Hospital General Universitario Gregorio Marañón. Madrid. España
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Jawhar A, Stetzelberger V, Kollowa K, Obertacke U. Tourniquet application does not affect the periprosthetic bone cement penetration in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2019; 27:2071-81. [PMID: 30539303 DOI: 10.1007/s00167-018-5330-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 12/07/2018] [Indexed: 12/28/2022]
Abstract
PURPOSE Poor scientific evidence exists on the issue of tourniquet application during total knee arthroplasty (TKA). It has been suggested that tourniquet application might improve interdigitation of the cement into the periprosthetic bones due to relatively dry surgical field. The hypothesis of the present study was that tourniquet use did not affect the periprosthetic bone cement penetration. METHODS The single-centre, randomized, controlled trial included 86 patients undergoing primary TKA (Clinical-Trials.gov NCT02475603). All patients meeting the inclusion criteria were randomly assigned to the tourniquet (n = 43) or non-tourniquet (n = 43) group after obtaining a written informed consent. The cumulative bone cement penetration was radiologically measured in AP (seven zones) and lateral views (three zones) as defined by Knee Society Scoring System. Further parameters such as perioperative blood loss, soft tissue swelling, pain level/analgesic consumption, operative time, length of hospital stay (LOS) and complication rate were statistically compared between the groups. RESULTS The cumulative bone cement penetration averaged 28.5 ± 1.7 mm in tourniquet versus 26.6 ± 1.6 mm in non-tourniquet groups (n.s.). The mean intraoperative blood loss was 250 ml higher in the non-tourniquet group (p = 0.0001). Patient-reported pre- to 6th-day post-operative reduction of the pain level was significantly higher in the non-tourniquet group (p = 0.003). The Morphine Equivalent Dose was higher in the Tourniquet group at discharge day (p = 0.02). Parameters such as total blood loss, soft tissue swelling, surgical time, LOS, and complication rates revealed similar results between the groups. CONCLUSIONS Tourniquet application did not influence the bone cement penetration significantly. Even though the intraoperative blood loss was reduced, the total blood loss was not affected significantly by tourniquet use. There was a tendency of higher post-operative pain and opioid analgesic requirement in the tourniquet group. LEVEL OF EVIDENCE I.
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Sborgia G, Niro A, Sborgia L, Grassi MO, Gigliola S, Romano MR, Boscia F, Sborgia A, Alessio G. One-year outcomes of 27-gauge versus 25-gauge pars plana vitrectomy for uncomplicated rhegmatogenous retinal detachment repair. Int J Retina Vitreous 2019; 5:13. [PMID: 31171987 PMCID: PMC6547499 DOI: 10.1186/s40942-019-0164-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 04/20/2019] [Indexed: 11/26/2022] Open
Abstract
Background 27-gauge (27G) and 25-gauge (25G) transconjunctival sutureless vitrectomy (TSV) were considered equal about safety, effectiveness and vitrectomy time for the treatment of rhegmatogenous retinal detachment (RRD), although larger and long-term comparative studies are needed to confirm previous knowledge. Furthermore, a combined comparison of time duration of surgery and vitreous removal was never performed. Our purpose was to compare the safety and efficacy of 27G versus 25G TSV for the treatment of uncomplicated RRD over a 1-year follow-up. Methods A 12-months single-center prospective, randomized, interventional study of 92 consecutive patients was performed. 46 patients underwent 27G TSV (Group 1) and 46 underwent 25G TSV (Group 2). Primary outcomes were primary and final reattachment rate, and final functional success (visual acuity ≥ 20/200, 1 LogMar). Secondary outcomes were the surgical and vitrectomy time. Complications were recorded. Results All functional and morphologic data at baseline and at all follow-up time points up to 12 months after surgery were available for only 88 patients. Four patients in Group 1 dropped out of the study after surgery. There was no significant difference in baseline characteristics between the two groups. Primary and final reattachment rates were 90.5% and 100% in Group 1, and 95.6% and 100% in Group 2, respectively (p > .05, p > .05, respectively). Visual acuity improved from 1.5 ± 1.09 LogMar to 0.38 ± 0.55 LogMar in Group 1 (p < .001) and 1.2 ± 0.9 LogMar to 0.49 ± 0.53 LogMar in Group 2 (p < .001), without significant difference between the groups (p > .05). The surgical time was 73.2 ± 11.3 min with 27G TSV and 64.4 ± 9.5 min with 25G TSV (p = .0001). The vitrectomy time was 19.9 ± 3.8 min with 27G TSV and 20.8 ± 3.8 min with 25G TSV (p > .05). One single case of choroidal detachment occurred. Conclusions Reattachment rates, functional success and vitrectomy time were comparable between 27G and 25G TSV for RRD. Surgical time was significantly longer using 27G vitrectomy.
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Affiliation(s)
- Giancarlo Sborgia
- 1Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy
| | - Alfredo Niro
- Eye Clinic, Hospital "S. G. MOSCATI", ASL TA, Via per Martina Franca, 74010 Statte, Taranto, Italy
| | - Luigi Sborgia
- 1Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy
| | - Maria Oliva Grassi
- 1Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy
| | - Samuele Gigliola
- 1Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy
| | - Mario R Romano
- 3Department of Ophthalmology, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Francesco Boscia
- 4Department of Surgical, Microsurgical and Medical Sciences, Eye Clinic, University of Sassari, Sassari, Italy
| | - Alessandra Sborgia
- 1Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy.,Eye Clinic, Hospital "S. G. MOSCATI", ASL TA, Via per Martina Franca, 74010 Statte, Taranto, Italy
| | - Giovanni Alessio
- 1Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy
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Chen L, Li DH, Lu YH, Hao B, Cao YQ. Preoperative Embolization Versus Direct Surgery of Meningiomas: A Meta-Analysis. World Neurosurg 2019; 128:62-68. [PMID: 30954743 DOI: 10.1016/j.wneu.2019.02.223] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 02/22/2019] [Accepted: 02/23/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Preoperative embolization (POE) of meningioma has been established to facilitate surgical resection, which may reduce intraoperative blood loss and surgical time. However, no consensus has been achieved in meningioma treatment and no meta-analysis has been conducted. The purpose of this study was to perform a systematic review and meta-analysis and provide evidence of the efficacy of meningioma treatment with POE and direct surgery. METHODS This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. A systematic search was performed using PubMed and EMBASE. Meta-analysis was performed using the risk ratio of overall complication, mean difference (MD) of blood loss, and surgical time. The I2 statistic was used to assess the heterogeneity. RESULTS Eight studies (1 randomized controlled trial and 7 non-randomized controlled trials) were included, in which 510 patients met the inclusion criteria. We found that preoperative embolization for patients with meningioma did not increase the overall complication rate (risk ratio = 0.92, 95% confidence interval [CI] 0.61-1.38) and can significantly reduce intraoperative blood loss (MD = -65.10, 95% CI -124.76 to -20.82) and surgical time (MD = -38.48, 95% CI -64.03 to -12.93) compared with the control patients. No significant publication bias was observed. CONCLUSIONS This meta-analysis supports the hypothesis that POE of meningioma is a useful adjunct in meningioma treatment. This technique helps reduce blood loss and surgical time during meningioma resection.
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Affiliation(s)
- Lei Chen
- Department of Neurosurgery, Fudan University Shanghai Cancer Center, and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - De-Heng Li
- Department of Neurosurgery, Fudan University Shanghai Cancer Center, and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yun-He Lu
- Department of Neurosurgery, Fudan University Shanghai Cancer Center, and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Bin Hao
- Department of Neurosurgery, Fudan University Shanghai Cancer Center, and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yi-Qun Cao
- Department of Neurosurgery, Fudan University Shanghai Cancer Center, and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
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López CC, Ríos JFDL, González Y, Vásquez-Trespalacios EM, Serna D, Arango A, Cifuentes C, Vásquez R, Castañeda JD, Almanza LA, Jiménez LA. Barbed Suture versus Conventional Suture for Vaginal Cuff Closure in Total Laparoscopic Hysterectomy: Randomized Controlled Clinical Trial. J Minim Invasive Gynecol 2018; 26:1104-1109. [PMID: 30414998 DOI: 10.1016/j.jmig.2018.08.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 08/15/2018] [Accepted: 08/20/2018] [Indexed: 02/08/2023]
Abstract
STUDY OBJECTIVE To determine the surgical time, suture time, presence of postoperative dyspareunia, and complications that occur after closing the vaginal cuff with a barbed suture compared with conventional suture. DESIGN A randomized, controlled clinical trial (Canadian Task Force classification I). SETTING Private gynecologic clinic in Medellin, Colombia. PATIENTS One hundred fifty women who underwent total laparoscopic hysterectomy for benign pathology. INTERVENTIONS The patients underwent total laparoscopic hysterectomy with intracorporeal closure of the vaginal cuff and were randomized to 2 groups, 1 using a barbed suture (V-Loc 90; Medtronic/Covidien, New Haven, CT) and 1 using polyglactin 910 (coated Vicryl suture; Ethicon/Johnson & Johnson, New Brunswick, NJ). MEASUREMENTS AND MAIN RESULTS The total operative time, closing time of the vaginal vault, presence of complications in the cuff, and incidence of postoperative dyspareunia were recorded. The patients were evaluated at a postoperative office visit 2 weeks after the procedure and by telephone interview at 24 weeks. Seventy-five patients were included in the barbed suture group and 75 patients in the polyglactin 910 group. The average time to complete the suture of the vaginal cuff was 12.01 minutes (± 5.37 standard deviation) for the barbed suture group versus 13.49 minutes (± 6.48) in the polyglactin 910 group (95% confidence interval, -.44 to 3.4; p = .130). Blood loss was 31.56 ± 22.93 mL in the barbed suture group versus 30.82 ± 21.75 mL in the polyglactin 910 group (95% confidence interval, -7.95 to 6.47; p = .840). The frequency of postoperative events such as hematoma, cellulitis, cuff dehiscence, fever, emergency consultation, and hospitalization was not statistically significant between groups. No statistically significant difference was found regarding deep dyspareunia at 24 postoperative weeks. CONCLUSION No differences were found in surgical time or frequency of adverse events when comparing patients after vaginal cuff closure with barbed suture versus polyglactin 910.
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Affiliation(s)
- Claudia C López
- Clinica del Prado (Drs. López, De Los Ríos, Arango, Cifuentes, Vásquez, Castañeda, Almanza, and Jiménez), Medellín, Colombia, and the School of Medicine (Drs. González, Vásquez-Trespalacios, and Serna), CES University, Medellín, Colombia
| | - José F De Los Ríos
- Clinica del Prado (Drs. López, De Los Ríos, Arango, Cifuentes, Vásquez, Castañeda, Almanza, and Jiménez), Medellín, Colombia, and the School of Medicine (Drs. González, Vásquez-Trespalacios, and Serna), CES University, Medellín, Colombia
| | - Yenyffer González
- Clinica del Prado (Drs. López, De Los Ríos, Arango, Cifuentes, Vásquez, Castañeda, Almanza, and Jiménez), Medellín, Colombia, and the School of Medicine (Drs. González, Vásquez-Trespalacios, and Serna), CES University, Medellín, Colombia
| | - Elsa María Vásquez-Trespalacios
- Clinica del Prado (Drs. López, De Los Ríos, Arango, Cifuentes, Vásquez, Castañeda, Almanza, and Jiménez), Medellín, Colombia, and the School of Medicine (Drs. González, Vásquez-Trespalacios, and Serna), CES University, Medellín, Colombia..
| | - Daniel Serna
- Clinica del Prado (Drs. López, De Los Ríos, Arango, Cifuentes, Vásquez, Castañeda, Almanza, and Jiménez), Medellín, Colombia, and the School of Medicine (Drs. González, Vásquez-Trespalacios, and Serna), CES University, Medellín, Colombia
| | - Adriana Arango
- Clinica del Prado (Drs. López, De Los Ríos, Arango, Cifuentes, Vásquez, Castañeda, Almanza, and Jiménez), Medellín, Colombia, and the School of Medicine (Drs. González, Vásquez-Trespalacios, and Serna), CES University, Medellín, Colombia
| | - Carolina Cifuentes
- Clinica del Prado (Drs. López, De Los Ríos, Arango, Cifuentes, Vásquez, Castañeda, Almanza, and Jiménez), Medellín, Colombia, and the School of Medicine (Drs. González, Vásquez-Trespalacios, and Serna), CES University, Medellín, Colombia
| | - Ricardo Vásquez
- Clinica del Prado (Drs. López, De Los Ríos, Arango, Cifuentes, Vásquez, Castañeda, Almanza, and Jiménez), Medellín, Colombia, and the School of Medicine (Drs. González, Vásquez-Trespalacios, and Serna), CES University, Medellín, Colombia
| | - Juan D Castañeda
- Clinica del Prado (Drs. López, De Los Ríos, Arango, Cifuentes, Vásquez, Castañeda, Almanza, and Jiménez), Medellín, Colombia, and the School of Medicine (Drs. González, Vásquez-Trespalacios, and Serna), CES University, Medellín, Colombia
| | - Luis A Almanza
- Clinica del Prado (Drs. López, De Los Ríos, Arango, Cifuentes, Vásquez, Castañeda, Almanza, and Jiménez), Medellín, Colombia, and the School of Medicine (Drs. González, Vásquez-Trespalacios, and Serna), CES University, Medellín, Colombia
| | - Luis A Jiménez
- Clinica del Prado (Drs. López, De Los Ríos, Arango, Cifuentes, Vásquez, Castañeda, Almanza, and Jiménez), Medellín, Colombia, and the School of Medicine (Drs. González, Vásquez-Trespalacios, and Serna), CES University, Medellín, Colombia
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Mejdoub I, Bouassida M, Mseddi MA, Fourati M, Hadjslimen M, Rebai N. Laparoscopic approach for retrocaval ureter: How to decrease surgical time? Urol Case Rep 2018; 20:106-107. [PMID: 30116716 PMCID: PMC6083818 DOI: 10.1016/j.eucr.2018.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 07/25/2018] [Indexed: 12/02/2022] Open
Affiliation(s)
- Ibrahim Mejdoub
- Urology Department, Medical University of Sfax, Habib Bourguiba Hospital, Avenue Majida-Boulila, 3029, Sfax, Tunisia
| | - Mehdi Bouassida
- Urology Department, Medical University of Sfax, Habib Bourguiba Hospital, Avenue Majida-Boulila, 3029, Sfax, Tunisia
| | - Mohamed Amine Mseddi
- Urology Department, Medical University of Sfax, Habib Bourguiba Hospital, Avenue Majida-Boulila, 3029, Sfax, Tunisia
| | - Mohamed Fourati
- Urology Department, Medical University of Sfax, Habib Bourguiba Hospital, Avenue Majida-Boulila, 3029, Sfax, Tunisia
| | - Mourad Hadjslimen
- Urology Department, Medical University of Sfax, Habib Bourguiba Hospital, Avenue Majida-Boulila, 3029, Sfax, Tunisia
| | - Nouri Rebai
- Urology Department, Medical University of Sfax, Habib Bourguiba Hospital, Avenue Majida-Boulila, 3029, Sfax, Tunisia
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Windisch C, Brodt S, Röhner E, Matziolis G. [Complications and costs in primary knee replacement surgery in an endoprosthetics centre : Influence of state of training]. Orthopade 2017; 46:353-358. [PMID: 27826627 DOI: 10.1007/s00132-016-3351-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This work examines the hypothesis that in endoprosthesis implantation there are differences between experienced primary and senior caregivers (S-Op) and less experienced follow-up assistants (T-Op) with respect to process-relevant parameters. The main hypothesis is that compared to S‑Op, T‑Op cause significantly longer surgery times and thus additional operating theatre costs. As sub-hypotheses, differences in various perioperative (p-o) parameters between T‑Op and S‑Op were examined. MATERIALS AND METHODS The status of the operator (senior and/or senior main operator [S-Op]) and/or postoperative CRP, perioperative blood loss, the amount of transfused erythrocyte concentrates, patient age, gender, ASA risk classification (American Society of Anesthesiologists), duration of surgery and blood transfusion, duration of inpatient stay, as well as the rates of early revision surgery and complications were recorded. A comparison of patients who had been operated by an S‑Op and those who had been operated by a T‑Op was made for all parameters. RESULTS Significant differences were found with respect to the duration of surgery, the duration of the hospital stay, and CRP on the third p‑o day. The T‑Op required an average of 11 min more than the S‑Op. CRP was significantly higher in the T‑Op group only on the third p‑o day, by 18 mg/l. In contrast, in the T‑Op group, a blood loss of 181 ml was lower than in the S‑Op group. This corresponded to a reduction of 0.26 transfused erythrocyte concentrates. There were no significant differences in complication rates between S‑Op and T‑Op. DISCUSSION In the setting of a certified endoprosthetics centre, the comparison of T‑Op with S‑Op showed that the use of the former with at a non-increased complication rate led to a significant extension of the operating time. This leads to additional training costs in the amount of an estimated 3% of the current DRG remuneration. These additional costs are not represented adequately in the current remuneration system.
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Affiliation(s)
- C Windisch
- Klinik für Orthopädie, Campus Eisenberg, Friedrich-Schiller Universität Jena, Klosterlausnitzer Straße 81, 07607, Eisenberg, Deutschland.
| | - S Brodt
- Klinik für Orthopädie, Campus Eisenberg, Friedrich-Schiller Universität Jena, Klosterlausnitzer Straße 81, 07607, Eisenberg, Deutschland
| | - E Röhner
- Klinik für Orthopädie, Campus Eisenberg, Friedrich-Schiller Universität Jena, Klosterlausnitzer Straße 81, 07607, Eisenberg, Deutschland
| | - G Matziolis
- Klinik für Orthopädie, Campus Eisenberg, Friedrich-Schiller Universität Jena, Klosterlausnitzer Straße 81, 07607, Eisenberg, Deutschland
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Westberg J, Scott F, Creinin MD. Safety outcomes of female sterilization by salpingectomy and tubal occlusion. Contraception 2017; 95:505-508. [PMID: 28232128 DOI: 10.1016/j.contraception.2017.02.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 02/14/2017] [Accepted: 02/14/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Compare immediate and short-term complications and surgical times among women having laparoscopic salpingectomy or tubal occlusion for female sterilization. STUDY DESIGN We used billing data to identify women having laparoscopic sterilization at our training institution between July 1, 2011, and June 30, 2015. We performed a retrospective chart review to extract demographic information, surgical times and complications within 30 days, including unscheduled clinic or emergency room visits. We categorized complications as immediate (prior to discharge) and short-term (within 30 days after the procedure). Surgeries including additional procedures other than IUD removal were considered mixed operations. Mixed operations and unilateral sterilization procedures were only included in safety evaluations. RESULTS The 149 procedures included 81 salpingectomies (including 18 mixed operations and 2 unilateral salpingectomies) and 68 tubal occlusions (including 8 mixed operations). All procedures involved Obstetrics and Gynecology residents. Salpingectomy and occlusion procedures had similar immediate (2.5% vs. 2.9%, p=1.0) and short-term (4.9% vs. 14.7%, p=.051) complication rates. Surgical time averaged 6 min longer for salpingectomies than occlusion procedures (44 vs. 38 min, respectively, p=.018). Average surgical times were shorter with more experienced (3rd/4th year) residents than less experienced (1st/2nd year) residents for both salpingectomy (32±18 min vs. 46±13 min, respectively, p=.124) and occlusion procedures (32±13 min vs. 41±12 min, respectively, p=.026). CONCLUSION Salpingectomy for female sterilization takes slightly longer to complete than tubal occlusion procedures without evidence that it increases complications. IMPLICATIONS STATEMENT Laparoscopic salpingectomy is a safe alternative to tubal occlusion with only a small increase in surgical time. Because salpingectomy offers higher efficacy and more ovarian cancer protection than occlusion procedures, salpingectomy should be an option offered to women seeking laparoscopic sterilization.
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Affiliation(s)
- Julie Westberg
- University of California, Davis; Sacramento, CA, United States
| | - Fiona Scott
- University of California, Davis; Sacramento, CA, United States
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Harato K, Maeno S, Tanikawa H, Kaneda K, Morishige Y, Nomoto S, Niki Y. What are the important manoeuvres for beginners to minimize surgical time in primary total knee arthroplasty? Knee Surg Sports Traumatol Arthrosc 2016; 24:2704-9. [PMID: 25743043 DOI: 10.1007/s00167-015-3554-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 02/24/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE It was hypothesized that surgical time of beginners would be much longer than that of experts. Our purpose was to investigate and clarify the important manoeuvres for beginners to minimize surgical time in primary total knee arthroplasty (TKA) as a multicentre study. METHODS A total of 300 knees in 248 patients (averaged 74.6 years) were enrolled. All TKAs were done using the same instruments and the same measured resection technique at 14 facilities by 25 orthopaedic surgeons. Surgeons were divided into three surgeon groups (four experts, nine medium-volume surgeons and 12 beginners). The surgical technique was divided into five phases. Detailed surgical time and ratio of the time in each phase to overall surgical time were recorded and compared among the groups in each phase. A total of 62, 119, and 119 TKAs were done by beginners, medium-volume surgeons, and experts, respectively. RESULTS Significant differences in surgical time among the groups were seen in each phase. Concerning the ratio of the time, experts and medium-volume surgeons seemed cautious in fixation of the permanent component compared to other phases. Interestingly, even in ratio, beginners and medium-volume surgeons took more time in exposure of soft tissue compared to experts. (0.14 in beginners, 0.13 in medium-volume surgeons, 0.11 in experts, P < 0.05). CONCLUSION Beginners took more time in exposure and closure of soft tissue compared to experts. Improvement in basic technique is essential to minimize surgical time among beginners. First of all, surgical instructors should teach basic techniques in primary TKA for beginners. LEVEL OF EVIDENCE Therapeutic studies, Level IV.
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Salazar Méndez R, Cuesta García M, Llaneza Velasco ME, Rodríguez Villa S, Cubillas Martín M, Alonso Álvarez CM. Usefulness of surgical complexity classification index in cataract surgery process. ACTA ACUST UNITED AC 2016; 91:281-7. [PMID: 26897332 DOI: 10.1016/j.oftal.2016.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 12/18/2015] [Accepted: 01/04/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the usefulness of surgical complexity classification index (SCCI) to predict the degree of surgical difficulty in cataract surgery. MATERIAL AND METHODS This retrospective study includes data collected between January 2013 and December 2014 from patients who underwent cataract extraction by phacoemulsification at our hospital. A sample size of 159 patients was obtained by simple random sampling (P=.5, 10% accuracy, 95% confidence). The main variables were: recording and value of SCCI in electronic medical record (EMR), presence of exfoliation syndrome (XFS), criteria for inclusion in surgical waiting list (SWL), and functional results. SCCI was classified into 7 categories (range: 1-4) according to predictors of technical difficulty, which was indirectly estimated in terms of surgical time (ST). All statistical analyses were performed using SPSS v15.0 statistical software. RESULTS Prevalence of XFS was 18.2% (95%CI: 11.9-24.5). In terms of quality indicators in the cataract surgery process, 96.8% of patients met at least one of the criteria to be included in SWL, and 98.1% gained ≥2 Snellen lines. The SCCI was recorded in EMR of 98.1% patients, and it was grouped for study into 2 categories: High and low surgical complexity. Statistically significant differences in the distribution of ST were found depending on the assigned SCCI (P<.005) and the presence of XFS (P<.005). CONCLUSIONS The SCCI enables to estimate the degree of surgical complexity in terms of ST in cataract surgery, which is especially useful in those areas with high prevalence of XFS, because of the higher theoretical risk of surgical complications.
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Delo C, Leclercq P, Martins D, Pirson M. Costs of disposable material in the operating room do not show high correlation with surgical time: Implications for hospital payment. Health Policy 2015; 119:1126-32. [PMID: 25796316 DOI: 10.1016/j.healthpol.2015.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 01/12/2015] [Accepted: 02/16/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The objectives of this study are to analyze the variation of the surgical time and of disposable costs per surgical procedure and to analyze the association between disposable costs and the surgical time. METHODS The registration of data was done in an operating room of a 419 bed general hospital, over a period of three months (n = 1556 surgical procedures). Disposable material per procedure used was recorded through a barcode scanning method. RESULTS The average cost (standard deviation) of disposable material is €183.66 (€183.44). The mean surgical time (standard deviation) is 96 min (63). Results have shown that the homogeneity of operating time and DM costs was quite good per surgical procedure. The correlation between the surgical time and DM costs is not high (r = 0.65). CONCLUSIONS In a context of Diagnosis Related Group (DRG) based hospital payment, it is important that costs information systems are able to precisely calculate costs per case. Our results show that the correlation between surgical time and costs of disposable materials is not good. Therefore, empirical data or itemized lists should be used instead of surgical time as a cost driver for the allocation of costs of disposable materials to patients.
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Affiliation(s)
- Caroline Delo
- Centre de recherche en Economie de la Santé (Health Economics Research Center), Gestion des Institutions de Soins et Sciences Infirmières (Management of Institutions of care and nursing research), Ecole de Santé Publique (School of Public Health), Université Libre de Bruxelles, 808, Route de Lennik, CP 592, 1070 Brussels, Belgium
| | - Pol Leclercq
- Centre de recherche en Economie de la Santé (Health Economics Research Center), Gestion des Institutions de Soins et Sciences Infirmières (Management of Institutions of care and nursing research), Ecole de Santé Publique (School of Public Health), Université Libre de Bruxelles, 808, Route de Lennik, CP 592, 1070 Brussels, Belgium
| | - Dimitri Martins
- Centre de recherche en Economie de la Santé (Health Economics Research Center), Gestion des Institutions de Soins et Sciences Infirmières (Management of Institutions of care and nursing research), Ecole de Santé Publique (School of Public Health), Université Libre de Bruxelles, 808, Route de Lennik, CP 592, 1070 Brussels, Belgium
| | - Magali Pirson
- Centre de recherche en Economie de la Santé (Health Economics Research Center), Gestion des Institutions de Soins et Sciences Infirmières (Management of Institutions of care and nursing research), Ecole de Santé Publique (School of Public Health), Université Libre de Bruxelles, 808, Route de Lennik, CP 592, 1070 Brussels, Belgium.
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Erestam S, Erichsen A, Derwinger K, Kodeda K. A survey of surgeons' perception and awareness of intraoperative time utilization. Patient Saf Surg 2014; 8:30. [PMID: 25006350 PMCID: PMC4086263 DOI: 10.1186/1754-9493-8-30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 06/19/2014] [Indexed: 12/14/2022] Open
Abstract
Background Surgical teams’ awareness of the time needed to perform specific phases of a surgical procedure is likely to improve communication in the operating theatre and benefit patient safety. The aim of this study was to assess surgeons’ awareness of time utilization and the actual time needed to perform specific phases of an operation. Methods A survey was conducted to examine the method and design for a larger study. Interviews were conducted with 18 surgeons, and surgical time was measured during 21 colon cancer resections. Correlation analyses were performed to explore the factors that might affect operating time. Results The surgical phase with the greatest variation in time was dissection/resection (43–308 minutes). On a group level, no statistically significant differences were found between estimated and measured surgical procedural times for partial or full resections (160.4 versus 173.0 minutes, p = 0.539). However, interindividual variation was substantial. There was a positive significant correlation between long duration of dissection/resection and longer time to close the abdomen (r = 0.464, p = 0.039), as well as between long duration of a hand-sewn anastomosis and time needed to close the abdomen (r = 0.536, p = 0.018). Conclusions It can be difficult for a single surgeon to estimate the time required for a partial or full surgical procedure. A larger study might provide additional time estimates and identify variables that affect surgical time. The data could be of interest in the planning and scheduling of surgical resources, thus improving theatre team communication and patient safety.
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Affiliation(s)
- Sofia Erestam
- Institute of Health and Care Sciences, Sahlgrenska University Hospital, Campus Östra, Gothenburg, Sweden ; Department of Anaesthesia, Surgery, and Intensive Care, Sahlgrenska University Hospital, Campus Östra, Gothenburg, Sweden
| | - Annette Erichsen
- Institute of Health and Care Sciences, Sahlgrenska University Hospital, Campus Östra, Gothenburg, Sweden ; Department of Anaesthesia, Surgery, and Intensive Care, Sahlgrenska University Hospital, Campus Östra, Gothenburg, Sweden
| | - Kristoffer Derwinger
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Campus Östra, Gothenburg, Sweden ; Department of Colorectal Surgery, Sahlgrenska University Hospital, Campus Östra, Gothenburg, Sweden
| | - Karl Kodeda
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Campus Östra, Gothenburg, Sweden ; Department of Colorectal Surgery, Sahlgrenska University Hospital, Campus Östra, Gothenburg, Sweden
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