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Jones JM, Hu YD, Eid MA, Sensenig CJ, Mehta KS, Goldwag JL, Barnes JA, Kang R, Barry MJ, Spangler EL, Nelson PR, Mureebe L, Tang G, Tzeng E, Alabi O, Halpern VJ, Stone DH, Brooke BS, Moore K, Henke P, Scali S, O'Connell J, Goodney PP. Short-Term Concerns Primarily Determine Patient Preference for Abdominal Aortic Aneurysm Repair. J Surg Res 2021; 269:119-128. [PMID: 34551368 DOI: 10.1016/j.jss.2021.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/26/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Abdominal aortic aneurysm (AAA) repair may be performed through open or endovascular approaches, but the factors influencing a patient's repair-type preference are not well characterized. Here we performed a qualitative analysis to better understand factors influencing patient preference within the Preference for Open Versus Endovascular Repair of AAA Trial. METHODS Open-ended responses regarding primary (n = 21) and secondary (n = 47) factors influencing patient preference underwent qualitative analysis using the constant comparative method with iterative reviews. Codes were used to generate themes and themes grouped into categories, with each step conducted via consensus agreement between three researchers. Relative prevalence of themes were compared to ascertain trends in patient preference. RESULTS Patient responses regarding both primary and secondary factors fell into four categories: Short-term concerns, long-term concerns, advice & experience, and other. Patients most frequently described short-term concerns (23) as their primary influence, with themes including post-op complications, hospitalization & recovery, and intraoperative concerns. Long-term concerns were more prevalent (20) as secondary factors, which included themes such as survival, and chronic management. The average age of patients voicing only long-term concerns as a primary factor was 11 years younger than those listing only short-term concerns. CONCLUSION Short-term concerns relating to the procedure and recovery are more often the primary factor influencing patient preference, while long term concerns play a more secondary role. Long-term concerns are more often a primary factor in younger patients. Vascular surgeons should consider this information in shared decision making to reach an optimal outcome.
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Affiliation(s)
- J M Jones
- The Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
| | - Y D Hu
- The Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
| | - M A Eid
- Department of Surgery and VA Outcomes Group, White River Junction VA Medical Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Department of Surgery and VA Outcomes Group, White River Junction VA Medical Center, White River Junction, Vermont
| | | | - K S Mehta
- Department of Surgery and VA Outcomes Group, White River Junction VA Medical Center, White River Junction, Vermont
| | - J L Goldwag
- Department of Surgery and VA Outcomes Group, White River Junction VA Medical Center, White River Junction, Vermont
| | - J A Barnes
- Department of Surgery and VA Outcomes Group, White River Junction VA Medical Center, White River Junction, Vermont
| | - R Kang
- Department of Surgery and VA Outcomes Group, White River Junction VA Medical Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - M J Barry
- Massachusetts General Hospital Center for Shared Decision Making, Boston, Massachusetts
| | | | - P R Nelson
- Muskogee VAMC, Muskogee, Okla; Tampa VAMC, Tampa Bay, Florida
| | | | - G Tang
- Seattle VAMC, Seattle, Washington
| | - E Tzeng
- Pittsburgh VAMC, Pittsburgh, Pennsylvania
| | - O Alabi
- Atlanta VAMC, Atlanta, Georgia
| | | | - D H Stone
- Department of Surgery and VA Outcomes Group, White River Junction VA Medical Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | | | - K Moore
- The Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
| | - P Henke
- Ann Arbor VAMC, Ann Arbor, Michigan
| | - S Scali
- Gainesville VAMC, Gainesville, Florida
| | | | - P P Goodney
- Department of Surgery and VA Outcomes Group, White River Junction VA Medical Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Department of Surgery and VA Outcomes Group, White River Junction VA Medical Center, White River Junction, Vermont.
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Bostock IC, Zarkowsky DS, Hicks CW, Stone DH, Eslami MH, Malas MB, Goodney PP. Outcomes of Endovascular Aortic Aneurysm Repair in Kidney Transplant Recipients: Results From a National Quality Initiative. Am J Transplant 2016; 16:2395-400. [PMID: 26813253 PMCID: PMC5292261 DOI: 10.1111/ajt.13733] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 11/29/2015] [Revised: 12/28/2015] [Accepted: 01/20/2016] [Indexed: 01/25/2023]
Abstract
Contrast-induced nephropathy after endovascular aortic aneurysm repair (EVAR) in kidney transplant recipients (KTRs) can have devastating consequences. The Vascular Quality Initiative (VQI) database was queried to select all KTRs who underwent EVAR between January 2003 and December 2014. Our primary outcome was renal dysfunction, defined as acute kidney injury (AKI; elevation of serum creatinine >0.5 mg/dL from baseline) or new postoperative hemodialysis requirement. Within the EVAR VQI dataset, 40 patients were KTRs (40 of 17 213, or 0.2%). Renal dysfunction occurred in five of 40 patients in the KTR group in comparison to 779 of 17 173 patients in the nontransplanted group (12.5% versus 4.5%, p < 0.01). Emergent EVAR was required in 2 (5%) patients, one of whom required dialysis after surgery and subsequently died. One-year survival after EVAR was similar in the two groups (92.9% versus 93.1%, p = 0.73). KTRs who developed renal dysfunction had significantly lower preoperative estimated glomerular filtration rates (eGFRs) (29.5 versus 54.7, p = 0.007) and a significantly higher iodine:eGFR ratio (0.78 versus 0.39, p = 0.02) despite receiving a similar volume of contrast (70.0 versus 68.8, p = 0.97). Renal dysfunction is 3 times more frequent in KTRs treated with EVAR, though overall survival did not differ between the groups. Decreased preoperative eGFR and a higher iodine:eGFR ratio are associated with postoperative renal dysfunction.
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Affiliation(s)
- I. C. Bostock
- Division of Vascular and Endovascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - D. S. Zarkowsky
- Division of Vascular and Endovascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - C. W. Hicks
- Department of Surgery, The Johns Hopkins Institutes, Baltimore, MD
| | - D. H. Stone
- Division of Vascular and Endovascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - M. H. Eslami
- Division of Vascular and Endovascular Surgery, Boston University School of Medicine, Boston, MA
| | - M. B. Malas
- Department of Surgery, The Johns Hopkins Institutes, Baltimore, MD
| | - P. P. Goodney
- Division of Vascular and Endovascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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McGreevy JM, Goodney PP, Birkmeyer CM, Finlayson SRG, Laycock WS, Birkmeyer JD. A prospective study comparing the complication rates between laparoscopic and open ventral hernia repairs. Surg Endosc 2003; 17:1778-80. [PMID: 12958679 DOI: 10.1007/s00464-002-8851-5] [Citation(s) in RCA: 136] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2002] [Accepted: 03/31/2003] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although ventral hernia repair is increasingly performed laparoscopically, complication rates with this procedure are not well characterized. For this reason, we performed a prospective study comparing early outcomes after laparoscopic and open ventral hernia repairs. METHODS We identified all the patients undergoing ventral (including incisional) hernia repair at a single tertiary care center between September 1, 1999 and July 1, 2001 (overall n = 257). To increase the homogeneity of the sample, we excluded umbilical hernia repairs, parastomal hernia repairs, nonelective procedures, procedures not involving mesh, and repairs performed concurrently with another surgical procedure. Postoperative complications (in-hospital or within 30-days) were assessed prospectively according to standardized definitions by trained nurse clinicians. RESULTS Of the 136 ventral hernia repairs that met the study criteria, 65 (48%) were laparoscopic repairs (including 3 conversions to open surgery) and 71 (52%) were open repairs. The patients in the laparoscopic group were more likely to have undergone a prior (failed) ventral hernia repair (40% vs 27%; p = 0.14), but other patient characteristics were similar between the two groups. Overall, fewer complications were experienced by patients undergoing laparoscopic repair (8% vs 21%; p = 0.03). The higher complication rate in the open ventral hernia repair group came from wound infections (8%) and postoperative ileus (4%), neither of which was observed in the patients who underwent laparoscopic repair. The laparoscopic group had longer operating room times (2.2 vs 1.7 h; p = 0.001), and there was a nonsignificant trend toward shorter hospital stays with laparoscopic repair (1.1 vs 1.5 days; p = 0.10). CONCLUSIONS The patients undergoing laparoscopic repair had fewer postoperative complications than those receiving open repair. Wound infections and postoperative ileus accounted for the higher complication rates in the open ventral hernia repair group. Otherwise, these groups were very similar. Long-term studies assessing hernia recurrence rates will be required to help determine the optimal approach to ventral hernia repair.
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Affiliation(s)
- J M McGreevy
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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