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Maskal SM, Thomas JD, Miller BT, Fafaj A, Zolin SJ, Montelione K, Ellis RC, Prabhu AS, Krpata DM, Beffa LRA, Costanzo A, Zheng X, Rosenblatt S, Rosen MJ, Petro CC. Corrigendum to: Open retromuscular keyhole compared with Sugarbaker mesh for parastomal hernia repair: Early results of a randomized clinical trial '175(3):813-821.'. Surgery 2024; 175:1626. [PMID: 38503603 DOI: 10.1016/j.surg.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Affiliation(s)
- Sara M Maskal
- Cleveland Clinic, Department of Surgery, Cleveland, OH
| | | | | | - Aldo Fafaj
- Cleveland Clinic, Department of Surgery, Cleveland, OH
| | | | | | - Ryan C Ellis
- Cleveland Clinic, Department of Surgery, Cleveland, OH
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McLaughlin CM, Montelione KC, Tu C, Candela X, Pauli E, Prabhu AS, Krpata DM, Petro CC, Rosenblatt S, Rosen MJ, Horne CM. Outcomes of posterior component separation with transversus abdominis release for repair of abdominally based breast reconstruction donor site hernias. Hernia 2024; 28:507-516. [PMID: 38286880 DOI: 10.1007/s10029-023-02942-5] [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: 08/31/2023] [Accepted: 12/08/2023] [Indexed: 01/31/2024]
Abstract
PURPOSE Abdominally based autologous breast reconstruction (ABABR) is common after mastectomy, but carries a risk of complex abdominal wall hernias. We report experience with posterior component separation (PCS) and transversus abdominis release (TAR) with permanent synthetic mesh repair of ABABR-related hernias. METHODS Patients at Cleveland Clinic Foundation and Penn State Health were identified retrospectively. Outcomes included postoperative complications, hernia recurrence, and patient-reported outcomes (PROs): Hernia Recurrence Inventory, HerQLes Summary Score, Patient-Reported Outcome Measurement Information System (PROMIS) Pain Intensity 3a Survey, and the Decision Regret Scale (DRS). RESULTS Forty patients underwent PCS/TAR repair of hernias resulting from pedicled (35%), free (5%), muscle-sparing TRAMs (15%), and DIEPs (28%) from August 2014 to March 2021. Following PCS, 30-day complications included superficial surgical site infection (13%), seroma (8%), and superficial wound breakdown (5%). Five patients (20%) developed clinical hernia recurrence. At a minimum of 1 year, 17 (63%) reported a bulge, 12 (44%) reported pain, median HerQLes Quality Of Life Scores improved from 33 to 63/100 (p value < 0.01), PROMIS 3a Pain Intensity Scores improved from 52 to 38 (p value < 0.05), and DRS scores were consistent with low regret (20/100). CONCLUSION ABABR-related hernias are complex and technically challenging due to missing abdominal wall components and denervation injury. After repair with PCS/TAR, patients had high rates of recurrence and bulge, but reported improved quality of life and pain and low regret. Surgeons should set realistic expectations regarding postoperative bulge and risk of hernia recurrence.
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Affiliation(s)
- C M McLaughlin
- Department of General Surgery, Division of Plastic Surgery, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA.
| | - K C Montelione
- Department of General Surgery, Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - C Tu
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - X Candela
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Hershey, PA, USA
| | - E Pauli
- Department of General Surgery, Division of Minimally Invasive Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - A S Prabhu
- Department of General Surgery, Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - D M Krpata
- Department of General Surgery, Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - C C Petro
- Department of General Surgery, Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - S Rosenblatt
- Department of General Surgery, Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - M J Rosen
- Department of General Surgery, Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - C M Horne
- Department of General Surgery, Division of Minimally Invasive Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
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Maskal SM, Thomas JD, Miller BT, Fafaj A, Zolin SJ, Montelione K, Ellis RC, Prabhu AS, Krpata DM, Beffa LRA, Costanzo A, Zheng X, Rosenblatt S, Rosen MJ, Petro CC. Open retromuscular keyhole compared with Sugarbaker mesh for parastomal hernia repair: Early results of a randomized clinical trial. Surgery 2024; 175:813-821. [PMID: 37770344 DOI: 10.1016/j.surg.2023.06.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/27/2023] [Revised: 05/14/2023] [Accepted: 06/18/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Open parastomal hernia repair can be performed using retromuscular synthetic mesh in a keyhole or Sugarbaker configuration. Relative morbidity and durability are unknown. Here, we present perioperative outcomes of a randomized controlled trial comparing these techniques, including 30-day patient-reported outcomes, reoperations, and wound complications in ≤90 days. METHODS This single-center randomized clinical trial compared open parastomal hernia repair with retromuscular medium-weight polypropylene mesh in the keyhole and Sugarbaker configuration for permanent stomas between April 2019 and April 2022. Adult patients with parastomal hernias requiring open repair with sufficient bowel length for either technique were included. Patient-reported outcomes were collected at 30 days; 90-day outcomes included initial hospital length of stay, readmission, wound morbidity, reoperation, and mesh- or stoma-related complications. RESULTS A total of 150 patients were randomized (75 keyhole and 75 Sugarbaker). There were no differences in length of stay, readmission, reoperation, recurrence, or wound complications. Twenty-four patients (16%) required procedural intervention for wound morbidity. Ten patients (6.7%) required abdominal reoperation in ≤90 days, 7 (4.7%) for wound morbidity, including 3 partial mesh excisions (1 keyhole compared with 2 Sugarbaker; P = 1). Four mesh-related stoma complications requiring reoperations occurred, including stoma necrosis (n = 1), bowel obstruction (n = 1), parastomal recurrence (n = 1), and mucocutaneous separation (n = 1), all in the Sugarbaker arm (P = .12). Patient-reported outcomes were similar between groups at 30 days. CONCLUSION Open parastomal hernia repair with retromuscular mesh in the keyhole and Sugarbaker configurations had similar perioperative outcomes. Patients will be followed to determine long-term relative durability, which is critical to understanding each approach's risk-benefit ratio.
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Affiliation(s)
- Sara M Maskal
- Cleveland Clinic, Department of Surgery, Cleveland, OH
| | | | | | - Aldo Fafaj
- Cleveland Clinic, Department of Surgery, Cleveland, OH
| | | | | | - Ryan C Ellis
- Cleveland Clinic, Department of Surgery, Cleveland, OH
| | - Ajita S Prabhu
- Cleveland Clinic, Department of Surgery, Cleveland, OH. https://twitter.com/aprabhumd1
| | - David M Krpata
- Cleveland Clinic, Department of Surgery, Cleveland, OH. https://twitter.com/DKrpataMD
| | - Lucas R A Beffa
- Cleveland Clinic, Department of Surgery, Cleveland, OH. https://twitter.com/BeffaLukeMD
| | | | | | | | - Michael J Rosen
- Cleveland Clinic, Department of Surgery, Cleveland, OH. https://twitter.com/MikeRosen
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Niemtzow RC, Hobbs RF, Litscher G, Hubacher J, Pulsifer JV, Rosenblatt S. Electroacupuncture Roundtable Discussion. Med Acupunct 2023; 35:281-289. [PMID: 38162548 PMCID: PMC10753941 DOI: 10.1089/acu.2023.29245.rtd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Affiliation(s)
| | - Richard F. Hobbs
- Longitudinal Curriculum in Medical Acupuncture, Maine-Dartmouth Family Medicine Residency, Waterville, ME, USA
| | - Gerhard Litscher
- International Society for Medical Laser Applications (ISLA transcontinental; president since 2012), German-Chinese Research Foundation (DCFG) for TCM (German vice president since 2014), Honorary President of the European Federation of Acupuncture and Moxibustion Societies (2023), Honorary Professor of China Beijing International Acupuncture Training Center, China Academy of Chinese Medical Sciences (2023), Graz, Austria
| | | | - Jeremy V. Pulsifer
- NYS Licensed Acupuncturist/NCCAOM Certified in Chinese Herbal Medicine, New York, NY, USA
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Ellis RC, Petro CC, Krpata DM, Beffa LRA, Miller BT, Montelione KC, Maskal SM, Tu C, Huang LC, Lau B, Fafaj A, Rosenblatt S, Rosen MJ, Prabhu AS. Transfascial Fixation vs No Fixation for Open Retromuscular Ventral Hernia Repairs: A Randomized Clinical Trial. JAMA Surg 2023; 158:789-795. [PMID: 37342018 PMCID: PMC10285673 DOI: 10.1001/jamasurg.2023.1786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/13/2023] [Accepted: 02/21/2023] [Indexed: 06/22/2023]
Abstract
IMPORTANCE Transfascial (TF) mesh fixation in open retromuscular ventral hernia repair (RVHR) has been advocated to reduce hernia recurrence. However, TF sutures may cause increased pain, and, to date, the purported advantages have never been objectively measured. OBJECTIVE To determine whether abandonment of TF mesh fixation would result in a noninferior hernia recurrence rate at 1 year compared with TF mesh fixation in open RVHR. DESIGN, SETTING, AND PARTICIPANTS In this prospective, registry-based, double-blinded, noninferiority, parallel-group, randomized clinical trial, a total of 325 patients with a ventral hernia defect width of 20 cm or less with fascial closure were enrolled at a single center from November 29, 2019, to September 24, 2021. Follow-up was completed December 18, 2022. INTERVENTIONS Eligible patients were randomized to mesh fixation with percutaneous TF sutures or no mesh fixation with sham incisions. MAIN OUTCOME AND MEASURES The primary outcome was to determine whether no TF suture fixation was noninferior to TF suture fixation for open RVHR with regard to recurrence at 1 year. A 10% noninferior margin was set. The secondary outcomes were postoperative pain and quality of life. RESULTS A total of 325 adults (185 women [56.9%]; median age, 59 [IQR, 50-67] years) with similar baseline characteristics were randomized; 269 patients (82.8%) were followed up at 1 year. Median hernia width was similar in the TF fixation and no fixation groups (15.0 [IQR, 12.0-17.0] cm for both). Hernia recurrence rates at 1 year were similar between the groups (TF fixation, 12 of 162 [7.4%]; no fixation, 15 of 163 [9.2%]; P = .70). Recurrence-adjusted risk difference was found to be -0.02 (95% CI, -0.07 to 0.04). There were no differences in immediate postoperative pain or quality of life. CONCLUSIONS AND RELEVANCE The absence of TF suture fixation was noninferior to TF suture fixation for open RVHR with synthetic mesh. Transfascial fixation for open RVRH can be safely abandoned in this population. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03938688.
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Affiliation(s)
- Ryan C. Ellis
- Department of Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Clayton C. Petro
- Department of Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, Ohio
| | - David M. Krpata
- Department of Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Lucas R. A. Beffa
- Department of Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Benjamin T. Miller
- Department of Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Katie C. Montelione
- Department of Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Sara M. Maskal
- Department of Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Chao Tu
- Department of Statistics, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Li-Ching Huang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Braden Lau
- Department of Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Aldo Fafaj
- Department of Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Steven Rosenblatt
- Department of Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Michael J. Rosen
- Department of Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ajita S. Prabhu
- Department of Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, Ohio
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Maskal S, Miller B, Ellis R, Phillips S, Prabhu A, Beffa L, Krpata D, Rosenblatt S, Rosen M, Petro C. Mediumweight polypropylene mesh fractures after open retromuscular ventral hernia repair: incidence and associated risk factors. Surg Endosc 2023:10.1007/s00464-023-10039-4. [PMID: 37038022 DOI: 10.1007/s00464-023-10039-4] [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: 11/17/2022] [Accepted: 03/12/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE Mediumweight (MW) and heavyweight (HW) polypropylene have demonstrated similar clinical and patient-reported outcomes in the setting of open retromuscular ventral hernia repair (VHR). While MW mesh has an anecdotal risk of central mesh fracture, that phenomenon is not well-characterized. We sought to assess the incidence of and risk factors for MW polypropylene mesh fractures after VHR. METHODS The ACHQC registry was queried for patients with CT-documented hernia recurrence after open retromuscular VHR with MW polypropylene mesh at our institution with 1-year follow-up between January 2014 and April 2022. Images were reviewed by five blinded surgeons at Cleveland Clinic to reach consensus that hernia recurrence mechanism was central mesh fracture. Patients without clinical recurrence or patient-reported bulge were used as a comparator group. RESULTS Eighty patients were identified with radiographically documented recurrence; 28 had recurrence from mesh fractures and these were compared to 644 patients without recurrence. Incidence of MW fracture was 4.2%. Bridging of anterior fascia was more common in the group with the central mesh fracture (33.3% vs 3.3%, p < 0.001); the incidence of fracture was 30% (9/30) in patients requiring a bridged closure. Mesh fracture was associated with larger hernias (median width: 20 cm [16-26] vs 15 cm [12-18], p < 0.001,), length (25 cm [23-30] vs 23 cm [19-26], p = 0.004). CONCLUSION MW polypropylene mechanical failures are surprisingly common, particularly in settings of bridged fascial closure and larger hernias. Use of HW polypropylene should be considered in this setting, and industry should be encouraged to create larger pieces of HW polypropylene mesh.
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Affiliation(s)
- Sara Maskal
- Department of General Surgery, Center for Abdominal Core Health, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
| | - Benjamin Miller
- Department of General Surgery, Center for Abdominal Core Health, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Ryan Ellis
- Department of General Surgery, Center for Abdominal Core Health, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | | | - Ajita Prabhu
- Department of General Surgery, Center for Abdominal Core Health, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Lucas Beffa
- Department of General Surgery, Center for Abdominal Core Health, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - David Krpata
- Department of General Surgery, Center for Abdominal Core Health, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Steven Rosenblatt
- Department of General Surgery, Center for Abdominal Core Health, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Michael Rosen
- Department of General Surgery, Center for Abdominal Core Health, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Clayton Petro
- Department of General Surgery, Center for Abdominal Core Health, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
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Zolin SJ, Krpata DM, Petro CC, Prabhu AS, Rosenblatt S, Rosen S, Thompson R, Fafaj A, Thomas JD, Huang LC, Rosen MJ. Long-term Clinical and Patient-Reported Outcomes After Transversus Abdominis Release With Permanent Synthetic Mesh: A Single Center Analysis of 1203 Patients. Ann Surg 2023; 277:e900-e906. [PMID: 35793810 DOI: 10.1097/sla.0000000000005443] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We aimed to report long-term clinical and patient-reported outcomes of transversus abdominis release (TAR) with permanent synthetic mesh performed in a high-volume abdominal wall reconstruction practice. SUMMARY BACKGROUND DATA Despite increasing utilization of TAR in abdominal wall reconstruction, long-term clinical and patient-reported outcomes remain uncertain. METHODS Prospectively collected registry data from the Cleveland Clinic Center for Abdominal Core Health were analyzed retrospectively. Patients undergoing elective, open VHR with TAR and permanent synthetic mesh implantation between August 2014 and March 2020 with 30-day clinical and ≥1 year clinical or patient-reported outcome follow-up were included. Outcomes included composite hernia recurrence, characterized by patient-reported bulges and recurrent hernias noted on physical exam or imaging, as well as hernia-specific quality of life and pain. RESULTS A total of 1203 patients were included. Median age was 60 years [interquartile range (IQR): 52-67], median body mass index was 32 kg/m 2 (IQR: 28-36), median hernia width was 15 cm (IQR: 12-19), and 57% of hernias were recurrent. Fascial reapproximation was achieved in 92%. At a median follow-up of 2 years (IQR: 1-4), the overall composite hernia recurrence rate was 26%, with sensitivity analysis yielding best-case and worst-case estimates of 5% and 28%, respectively. Patients experienced improved hernia-specific quality of life and pain regardless of recurrence outcome; however, those who did not recur experienced more substantial improvement. CONCLUSIONS TAR with permanent synthetic mesh remains a valuable, versatile technique; however, surgeon and patient expectations should be tempered regarding long-term durability. Despite a high rate of recurrence, patients experience measurable improvements in quality of life.
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Affiliation(s)
- Samuel J Zolin
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease & Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - David M Krpata
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease & Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Clayton C Petro
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease & Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Ajita S Prabhu
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease & Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Steven Rosenblatt
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease & Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Samantha Rosen
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease & Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Reid Thompson
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease & Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Aldo Fafaj
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease & Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Jonah D Thomas
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Li-Ching Huang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Michael J Rosen
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease & Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH
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Gentle CK, Thomas JD, Montelione KC, Tu C, Prabhu AS, Krpata DM, Beffa LR, Rosenblatt S, Rosen MJ, Lo Menzo E, Alaedeen D, Szomstein S, Massier CG, Petro CC. Opioid prescribing practices and patient-requested refill patterns following laparoscopic inguinal hernia repair. Hernia 2023; 27:85-92. [PMID: 36418792 PMCID: PMC9685134 DOI: 10.1007/s10029-022-02708-5] [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: 07/25/2022] [Accepted: 11/01/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Excessive post-operative opioid prescribing has led to efforts to match prescriptions with patient need after surgery. We investigated opioid prescribing practices, rate of patient-requested opioid refills, and associated factors after laparoscopic inguinal hernia repair (LIHR). METHODS LIHRs at a single institution from 3/2019 to 3/2021 were queried from the Abdominal Core Health Quality Collaborative for demographics, perioperative details, and patient-reported opioid usage. Opioid prescriptions at discharge and opioid refills were extracted from the medical record. Univariate and multivariable regression were used to identify factors associated with opioid refills within 30-days of surgery. RESULTS Four hundred and ninety LIHR patients were analyzed. The median number of opioid tablets prescribed was 12 [interquartile range (IQR) 10-15], and 4% requested a refill. On univariate analysis, patients who requested refills were younger [55 years (IQR 37-61) vs. 62 years (IQR 36.8-61), p = 0.012], more likely to have undergone transabdominal preperitoneal repair (75% vs. 26.4%, p < 0.001), have a scrotal component (30% vs. 11%, p = 0.022), and have permanent tacks used (80% vs. 49.4%, p = 0.014). There was a 12% increase in the odds of opioid refill for every 1 tablet of oxycodone prescribed at discharge (95% CI for OR 1.04-1.21, p = 0.003) after controlling for age and surgery type. Patient-reported opioid use was available for 289 (59%) patients. Post-operatively, 67% of patients used ≤ 4 opioid tablets, and 87% used no more than 10 opioid tablets. CONCLUSION Most patients use fewer opioid tablets than prescribed. Requests for opioid refills are rare following LIHR (4%) and associated with higher opioid prescribing.
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Affiliation(s)
- C. K. Gentle
- Department of General Surgery, Digestive Disease and Surgery Institute, Center for Abdominal Core Health, Cleveland Clinic, 9500 Euclid Avenue, A-100, Cleveland, OH 44195 USA
| | - J. D. Thomas
- Department of Surgery, Massachusetts General Hospital, Boston, MA USA
| | - K. C. Montelione
- Department of General Surgery, Digestive Disease and Surgery Institute, Center for Abdominal Core Health, Cleveland Clinic, 9500 Euclid Avenue, A-100, Cleveland, OH 44195 USA
| | - C. Tu
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH USA
| | - A. S. Prabhu
- Department of General Surgery, Digestive Disease and Surgery Institute, Center for Abdominal Core Health, Cleveland Clinic, 9500 Euclid Avenue, A-100, Cleveland, OH 44195 USA
| | - D. M. Krpata
- Department of General Surgery, Digestive Disease and Surgery Institute, Center for Abdominal Core Health, Cleveland Clinic, 9500 Euclid Avenue, A-100, Cleveland, OH 44195 USA
| | - L. R. Beffa
- Department of General Surgery, Digestive Disease and Surgery Institute, Center for Abdominal Core Health, Cleveland Clinic, 9500 Euclid Avenue, A-100, Cleveland, OH 44195 USA
| | - S. Rosenblatt
- Department of General Surgery, Digestive Disease and Surgery Institute, Center for Abdominal Core Health, Cleveland Clinic, 9500 Euclid Avenue, A-100, Cleveland, OH 44195 USA
| | - M. J. Rosen
- Department of General Surgery, Digestive Disease and Surgery Institute, Center for Abdominal Core Health, Cleveland Clinic, 9500 Euclid Avenue, A-100, Cleveland, OH 44195 USA
| | - E. Lo Menzo
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Florida, Weston, FL USA
| | - D. Alaedeen
- Department of General Surgery, Fairview Hospital, Cleveland, OH USA
| | - S. Szomstein
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Florida, Weston, FL USA
| | - C. G. Massier
- Department of General Surgery, Marymount Hospital, Garfield Heights, OH USA
| | - C. C. Petro
- Department of General Surgery, Digestive Disease and Surgery Institute, Center for Abdominal Core Health, Cleveland Clinic, 9500 Euclid Avenue, A-100, Cleveland, OH 44195 USA
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Greco CD, Petro CC, Thomas JD, Montelione K, Tu C, Fafaj A, Zolin S, Krpata D, Rosenblatt S, Rosen M, Beffa L, Prabhu A. Ileus rate after abdominal wall reconstruction: a retrospective analysis of two clinical trials. Hernia 2022; 26:1591-1598. [DOI: 10.1007/s10029-022-02687-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 09/14/2022] [Indexed: 11/25/2022]
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Fafaj A, Lo Menzo E, Alaedeen D, Petro CC, Rosenblatt S, Szomstein S, Massier C, Prabhu AS, Krpata DM, Cha W, Montelione K, Tastaldi L, Alkhatib H, Zolin SJ, Okida LF, Rosen MJ. Effect of Intraoperative Urinary Catheter Use on Postoperative Urinary Retention After Laparoscopic Inguinal Hernia Repair: A Randomized Clinical Trial. JAMA Surg 2022; 157:667-674. [PMID: 35704302 PMCID: PMC9201739 DOI: 10.1001/jamasurg.2022.2205] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Urinary catheters are commonly placed during laparoscopic inguinal hernia repair as a presumed protection against postoperative urinary retention (PUR), one of the most common complications following this operation. Data from randomized clinical trials evaluating the effect of catheters on PUR are lacking. Objective To investigate the effect of intraoperative catheters on PUR after laparoscopic inguinal hernia repair. Design, Setting, and Participants This 2-arm registry-based single-blinded randomized clinical trial was conducted at 6 academic and community hospitals in the US from March 2019 to March 2021 with a 30-day follow-up period following surgery. All patients who presented with inguinal hernias were assessed for eligibility, 534 in total. Inclusion criteria were adult patients undergoing laparoscopic, elective, unilateral, or bilateral inguinal hernia repair. Exclusion criteria were inability to tolerate general anesthesia and failure to understand and sign the written consent form. A total of 43 patients were excluded prior to intervention. Interventions Patients in the treatment arm had placement of a urinary catheter after induction of general anesthesia and removal at the end of procedure. Those in the control arm had no urinary catheter placement. Main Outcomes and Measures PUR rate. Results Of the 491 patients enrolled, 241 were randomized to catheter placement, and 250 were randomized to no catheter placement. The median (IQR) age was 61 (51-68) years, and 465 participants (94.7%) were male. Overall, 44 patients (9.1%) developed PUR. There was no difference in the rate of PUR between the catheter and no-catheter groups (23 patients [9.6%] vs 21 patients [8.5%], respectively; P = .79). There were no intraoperative bladder injuries. In the catheter group, there was 1 incident of postoperative urethral trauma in a patient who presented to the emergency department with PUR leading to a suprapubic catheter placement. Conclusions and Relevance Intraoperative urinary catheters did not reduce the risk of PUR after laparoscopic inguinal hernia repair. While their use did not appear to be associated with a high rate of iatrogenic complications, there may be a low rate of catastrophic complications. In patients who voided urine preoperatively, catheter placement did not appear to confer any advantage and thus their use may be reconsidered. Trial Registration ClinicalTrials.gov Identifier: NCT03835351.
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Affiliation(s)
- Aldo Fafaj
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Center for Abdominal Core Health, The Cleveland Clinic Foundation, Cleveland, Ohio
| | - Emanuele Lo Menzo
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Florida, Weston Hospital, Weston
| | - Diya Alaedeen
- Department of General Surgery, Fairview Hospital, Cleveland, Ohio
| | - Clayton C. Petro
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Center for Abdominal Core Health, The Cleveland Clinic Foundation, Cleveland, Ohio
| | - Steven Rosenblatt
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Center for Abdominal Core Health, The Cleveland Clinic Foundation, Cleveland, Ohio
| | - Samuel Szomstein
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Florida, Weston Hospital, Weston
| | - Christian Massier
- Department of General Surgery, Marymount Hospital, Garfield Heights, Ohio
| | - Ajita S. Prabhu
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Center for Abdominal Core Health, The Cleveland Clinic Foundation, Cleveland, Ohio
| | - David M. Krpata
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Center for Abdominal Core Health, The Cleveland Clinic Foundation, Cleveland, Ohio
| | - Walter Cha
- Department of General Surgery, Hillcrest Hospital, Mayfield Heights, Ohio
| | - Katherine Montelione
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Center for Abdominal Core Health, The Cleveland Clinic Foundation, Cleveland, Ohio
| | - Luciano Tastaldi
- Department of General Surgery, University of Texas Medical Branch, Galveston
| | - Hemasat Alkhatib
- Department of General Surgery, MetroHealth System, Cleveland, Ohio
| | - Samuel J. Zolin
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Center for Abdominal Core Health, The Cleveland Clinic Foundation, Cleveland, Ohio
| | - Luis Felipe Okida
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Florida, Weston Hospital, Weston
| | - Michael J. Rosen
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Center for Abdominal Core Health, The Cleveland Clinic Foundation, Cleveland, Ohio
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11
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Krpata DM, Petro CC, Prabhu AS, Tastaldi L, Zolin S, Fafaj A, Rosenblatt S, Poulose BK, Pierce RA, Warren JA, Carbonell AM, Goldblatt MI, Stewart TG, Olson MA, Rosen MJ. Effect of Hernia Mesh Weights on Postoperative Patient-Related and Clinical Outcomes After Open Ventral Hernia Repair: A Randomized Clinical Trial. JAMA Surg 2021; 156:1085-1092. [PMID: 34524395 DOI: 10.1001/jamasurg.2021.4309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Although multiple versions of polypropylene mesh devices are currently available on the market for hernia repair, few comparisons exist to guide surgeons as to which device may be preferable for certain indications. Mesh density is believed to impact patient outcomes, including rates of chronic pain and perception of mesh in the abdominal wall. Objective To examine whether medium-weight polypropylene is associated with less pain at 1 year compared with heavy-weight mesh. Design, Setting, and Participants This multicenter randomized clinical trial was performed from March 14, 2017, to April 17, 2019, with 1-year follow-up. Patients undergoing clean, open ventral hernia repairs with a width 20 cm or less were studied. Patients were blinded to the intervention. Interventions Patients were randomized to receive medium-weight or heavy-weight polypropylene mesh during open ventral hernia repair. Main Outcomes and Measures The primary outcome was pain measured with the National Institutes of Health (NIH) Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity Short Form 3a. Secondary outcomes included quality of life and pain measured at 30 days, quality of life measured at 1 year, 30-day postoperative morbidity, and 1-year hernia recurrence. Results A total of 350 patients participated in the study, with 173 randomized to receive heavy-weight polypropylene mesh (84 [48.6%] female; mean [SD] age, 59.2 [11.4] years) and 177 randomized to receive medium-weight polypropylene mesh (91 [51.4%] female; mean [SD] age, 59.3 [11.4] years). No significant differences were found in demographic characteristics (mean [SD] body mass index of 32.0 [5.4] in both groups [calculated as weight in kilograms divided by height in meters squared] and American Society of Anesthesiologists classes of 2-4 in both groups), comorbidities (122 [70.5%] vs 93 [52.5%] with hypertension, 44 [25.4%] vs 43 [24.3%] with diabetes, 17 [9.8%] vs 12 [6.8%] with chronic obstructive pulmonary disease), or operative characteristics (modified hernia grade of 2 in 130 [75.1] vs 140 [79.1] in the heavy-weight vs medium-weight mesh groups). Pain scores for patients in the heavy-weight vs medium-weight mesh groups at 30 days (46.3 vs 46.3, P = .89) and 1 year (30.7 vs 30.7, P = .59) were identical. No significant differences in quality of life (median [interquartile range] hernia-specific quality of life score at 1 year of 90.0 [67.9-96.7] vs 86.7 [65.0-93.3]; median [interquartile range] hernia-specific quality of life score at 30 days, 45.0 [24.6-73.8] vs 43.3 [28.3-65.0]) were found for the heavy-weight mesh vs medium-weight mesh groups. Composite 1-year recurrence rates for patients in the heavy-weight vs medium-weight polypropylene groups were similar (8% vs 7%, P = .79). Conclusions and Relevance Medium-weight polypropylene did not demonstrate any patient-perceived or clinical benefit over heavy-weight polypropylene after open retromuscular ventral hernia repair. Long-term follow-up of these comparable groups will elucidate any potential differences in durability that have yet to be identified. Trial Registration ClinicalTrials.gov Identifier: NCT03082391.
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Affiliation(s)
- David M Krpata
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, Ohio
| | - Clayton C Petro
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ajita S Prabhu
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, Ohio
| | - Luciano Tastaldi
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, Ohio
| | - Sam Zolin
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, Ohio
| | - Aldo Fafaj
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, Ohio
| | - Steven Rosenblatt
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, Ohio
| | | | - Richard A Pierce
- Department of Surgery, Vanderbilt University, Nashville, Tennessee
| | - Jeremy A Warren
- Department of Surgery, University of South Carolina School of Medicine, Greenville.,Department of Surgery, Prisma Health, Greenville, South Carolina
| | - Alfredo M Carbonell
- Department of Surgery, University of South Carolina School of Medicine, Greenville.,Department of Surgery, Prisma Health, Greenville, South Carolina
| | | | - Thomas G Stewart
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Molly A Olson
- Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Michael J Rosen
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, Ohio
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12
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Thomas JD, Fafaj A, Zolin SJ, Rosen MJ, Lipman JM, French JC, Prabhu AS, Krpata DM, Rosenblatt S, Horne CM, Khandelwal C, Petro CC. Registry-based Trainee Assessments: Leveraging a Quality Collaborative for Surgical Education. J Surg Res 2021; 268:136-144. [PMID: 34311295 DOI: 10.1016/j.jss.2021.06.017] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 06/08/2021] [Accepted: 06/11/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION We present our experience developing and embedding a registry-based module for resident feedback. METHODS At our institution, entering operative data into the institutional quality collaborative registry is standard practice. In February 2019, a surgical education module was embedded into the registry to capture procedure-specific resident operative assessments. Faculty engagement with the sugical education module was assessed during its first year in existence (February 2019-February 2020). RESULTS In total, 1074 of 1269 (85%) operative assessments were completed by 27 faculty via the surgical education registry module. Median faculty engagement rate with the module following resident-assisted procedures was 91% [IQR 76%-100%]. Residents received a median of 7 operative assessments [IQR 2-19] over the study period. CONCLUSION By embedding a surgical education module into an existing surgical quality collaborative registry, procedure-specific operative assessments can be routinely captured.
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Affiliation(s)
- Jonah D Thomas
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Aldo Fafaj
- Department of General Surgery, Cleveland Clinic, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Samuel J Zolin
- Department of General Surgery, Cleveland Clinic, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Michael J Rosen
- Department of General Surgery, Cleveland Clinic, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Jeremy M Lipman
- Department of General Surgery, Cleveland Clinic, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Judith C French
- Department of General Surgery, Cleveland Clinic, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ajita S Prabhu
- Department of General Surgery, Cleveland Clinic, Cleveland Clinic Foundation, Cleveland, Ohio
| | - David M Krpata
- Department of General Surgery, Cleveland Clinic, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Steven Rosenblatt
- Department of General Surgery, Cleveland Clinic, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Charlotte M Horne
- Department of General Surgery, Cleveland Clinic, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Cathleen Khandelwal
- Department of General Surgery, Cleveland Clinic, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Clayton C Petro
- Department of General Surgery, Cleveland Clinic, Cleveland Clinic Foundation, Cleveland, Ohio.
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Shin TH, Klingler M, Han A, Mocsiran JL, Vilchez V, Naples R, French J, Lipman JM, Rosenblatt S. Efficacy of Virtual Case-Based General Surgery Clerkship Curriculum During COVID-19 Distancing. Med Sci Educ 2021; 31:101-108. [PMID: 33200037 PMCID: PMC7654350 DOI: 10.1007/s40670-020-01126-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/13/2020] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The COVID-19 pandemic created a paradigm shift in medical education with a reliance upon alternative teaching methods to deliver meaningful surgery clerkship content. This study examines the efficacy of a novel, case-based virtual surgery clerkship curriculum to determine its impact on student experience during quarantine. STUDY DESIGN Sixteen third-year medical students enrolled in the General Surgery clerkship between April through June 2020 during COVID-19 distancing at a quaternary medical center (Cleveland Clinic, Cleveland, OH) participated in this study. Course surveys, including a 10-question curriculum-based multiple-choice assessment, were administered before and after the clerkship. Analyses include student self-perception of readiness to see a surgical consult independently, students' interest in pursuing a General Surgery residency, and improvement of surgical knowledge. RESULTS AND CONCLUSION On a 5-point Likert scale, students felt significantly more assured in their ability to independently assess a surgical consult by the end of the course. Five (31%) students reported an influence of the curriculum on their personal interest in a career in General Surgery. Mean scores on the curriculum-based knowledge assessment increased. These findings highlight that a virtual platform can be a reliable alternative adjunct that delivers surgical content and positively impacts student experience. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40670-020-01126-5.
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Affiliation(s)
- Thomas H. Shin
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH 44195 USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA
| | - Michael Klingler
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH 44195 USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA
| | - Amy Han
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH 44195 USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA
| | - Jennifer L. Mocsiran
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH 44195 USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA
| | - Valery Vilchez
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH 44195 USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA
| | - Robert Naples
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH 44195 USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA
| | - Judith French
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH 44195 USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA
| | - Jeremy M. Lipman
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH 44195 USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA
| | - Steven Rosenblatt
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH 44195 USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH USA
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14
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Fafaj A, Tastaldi L, Alkhatib H, Zolin SJ, Rosenblatt S, Huang LC, Phillips S, Krpata DM, Prabhu AS, Petro CC, Rosen MJ. Management of ventral hernia defect during enterocutaneous fistula takedown: practice patterns and short-term outcomes from the Abdominal Core Health Quality Collaborative. Hernia 2021; 25:1013-1020. [PMID: 33389276 DOI: 10.1007/s10029-020-02347-8] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 11/16/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND An enterocutaneous fistula (ECF) with an associated large hernia defect poses a significant challenge for the reconstructive surgeon. We aim to describe operative details and 30-day outcomes of elective hernia repair with an ECF when performed by surgeons participating in the Abdominal Core Health Quality Collaborative (ACHQC). STUDY DESIGN Patients undergoing concomitant hernia and ECF elective repair were identified within the ACHQC. Outcomes of interest were operative details and 30-day rates of surgical site infections (SSI), surgical site occurrences requiring procedural intervention (SSOPI), medical complications, and mortality. RESULTS 170 patients were identified (mean age 60 years, 52.4% females, mean BMI 32.3 kg/m2). 106 patients (62%) had small-bowel ECFs, mostly managed with resection without diversion. 30 patients (18%) had colonic ECFs, which were managed with resection without diversion (14%) or resection with diversion (6%). 100 (59%) had a prior mesh in place, which was removed in 90% of patients. Hernias measured 14 cm ± 7 in width, and 68 (40%) had a myofascial release performed (41 TARs). Mesh was placed in 115 cases (68%), 72% as a sublay, and more frequently of biologic (44%) or permanent synthetic (34%) material. 30-day SSI was 18% (37% superficial, 40% deep), and 30-day SSOPI was 21%. 19 patients (11%) were re-operated: 8 (8%) due to a wound complication and 4 (2%) due to a missed enterotomy. Two infected meshes were removed, one biologic and one synthetic. CONCLUSIONS Surgeons participating in the ACHQC predominantly resect ECFs and repair the associated hernias with sublay mesh with or without a myofascial release. Morbidity remains high, most closely related to wound complications, as such, concomitant definitive repairs should be entertained with caution.
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Affiliation(s)
- A Fafaj
- Department of General Surgery, Center for Abdominal Core Health, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA.
| | - L Tastaldi
- Department of General Surgery, Center for Abdominal Core Health, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA.,Department of General Surgery, University of Texas Medical Branch, 3100 University Boulevard, Galveston, TX, 77555, USA
| | - H Alkhatib
- Department of General Surgery, Center for Abdominal Core Health, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA
| | - S J Zolin
- Department of General Surgery, Center for Abdominal Core Health, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA
| | - S Rosenblatt
- Department of General Surgery, Center for Abdominal Core Health, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA
| | - L-C Huang
- Department of Biostatistics, Vanderbilt University Medical Center, 1211 Medical Center Dr., Nashville, TN, 37232, USA
| | - S Phillips
- Department of Biostatistics, Vanderbilt University Medical Center, 1211 Medical Center Dr., Nashville, TN, 37232, USA
| | - D M Krpata
- Department of General Surgery, Center for Abdominal Core Health, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA
| | - A S Prabhu
- Department of General Surgery, Center for Abdominal Core Health, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA
| | - C C Petro
- Department of General Surgery, Center for Abdominal Core Health, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA
| | - M J Rosen
- Department of General Surgery, Center for Abdominal Core Health, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA
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15
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Zolin SJ, Petro CC, Prabhu AS, Fafaj A, Thomas JD, Horne CM, Tastaldi L, Alkhatib H, Krpata DM, Rosenblatt S, Rosen MJ. Registry-Based Randomized Controlled Trials: A New Paradigm for Surgical Research. J Surg Res 2020; 255:428-435. [DOI: 10.1016/j.jss.2020.05.069] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/26/2020] [Accepted: 05/11/2020] [Indexed: 01/02/2023]
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16
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Fafaj A, Zolin SJ, Rossetti N, Thomas JD, Horne CM, Petro CC, Krpata DM, Prabhu AS, Rosenblatt S, Rosen MJ. Patient-reported opioid use after open abdominal wall reconstruction: How low can we go? Surgery 2020; 168:141-146. [DOI: 10.1016/j.surg.2020.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/11/2020] [Accepted: 04/06/2020] [Indexed: 01/15/2023]
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17
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Krpata DM, Tastaldi L, Petro CC, Fafaj A, Rosenblatt S, Prabhu AS. Discussion on: Surgical treatment for chronic postoperative inguinal pain-short term outcomes of a specialized center. Am J Surg 2020; 219:429. [PMID: 32037050 DOI: 10.1016/j.amjsurg.2019.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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18
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Colvin J, Rosen M, Prabhu A, Rosenblatt S, Petro C, Zolin S, Krpata D. Enhanced recovery after surgery pathway for patients undergoing abdominal wall reconstruction. Surgery 2019; 166:849-853. [DOI: 10.1016/j.surg.2019.05.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/27/2019] [Accepted: 05/19/2019] [Indexed: 12/14/2022]
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Fafaj A, Tastaldi L, Alkhatib H, Zolin S, Petro C, Prabhu AS, Rosenblatt S, Krpata DM, Rosen MJ. Development and Implementation of a General Surgery Departmental Quality Improvement Collaborative across a Large Institutional Health System. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.1021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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20
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Alkhatib H, Tastaldi L, Krpata DM, Petro CC, Fafaj A, Rosenblatt S, Rosen MJ, Prabhu AS. Outcomes of transversus abdominis release (TAR) with permanent synthetic retromuscular reinforcement for bridged repairs in massive ventral hernias: a retrospective review. Hernia 2019; 24:341-352. [DOI: 10.1007/s10029-019-02046-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 09/02/2019] [Indexed: 11/28/2022]
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21
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Tastaldi L, Krpata DM, Prabhu AS, Petro CC, Rosenblatt S, Haskins IN, Olson MA, Stewart TG, Rosen MJ, Greenberg JA. The effect of increasing body mass index on wound complications in open ventral hernia repair with mesh. Am J Surg 2019; 218:560-566. [DOI: 10.1016/j.amjsurg.2019.01.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/13/2019] [Accepted: 01/22/2019] [Indexed: 11/16/2022]
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22
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Tastaldi L, Barros PHF, Krpata DM, Prabhu AS, Rosenblatt S, Petro CC, Alkhatib H, Szutan LA, Silva RA, Olson MA, Stewart TG, Roll S, Rosen MJ, Poulose BK. Hernia recurrence inventory: inguinal hernia recurrence can be accurately assessed using patient-reported outcomes. Hernia 2019; 24:127-135. [DOI: 10.1007/s10029-019-02000-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 06/28/2019] [Indexed: 11/29/2022]
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23
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Tastaldi L, Petro CC, Krpata DM, Alkhatib H, Fafaj A, Tu C, Rosenblatt S, Prabhu AS, Poulose BK, Rosen MJ. History of surgical site infection increases the odds for a new infection after open incisional hernia repair. Surgery 2019; 166:88-93. [DOI: 10.1016/j.surg.2019.01.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/12/2019] [Accepted: 01/25/2019] [Indexed: 01/03/2023]
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Alkhatib H, Tastaldi L, Krpata DM, Petro CC, Huang LC, Phillips S, Fafaj A, Rosenblatt S, Rosen MJ, Prabhu AS. Impact of modifiable comorbidities on 30-day wound morbidity after open incisional hernia repair. Surgery 2019; 166:94-101. [DOI: 10.1016/j.surg.2019.03.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 03/01/2019] [Accepted: 03/11/2019] [Indexed: 01/15/2023]
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25
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Aliotta RE, Gatherwright J, Krpata D, Rosenblatt S, Rosen M, Gurunluoglu R. Complex abdominal wall reconstruction, harnessing the power of a specialized multidisciplinary team to improve pain and quality of life. Hernia 2019; 23:205-215. [PMID: 30798398 DOI: 10.1007/s10029-019-01916-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 10/16/2018] [Accepted: 02/19/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Patients who require highly complex abdominal wall hernia repair with composite soft tissue free flap coverage represent the most challenging population, and the most difficult to definitively treat. For many, this combined procedure represents their last chance to restore any sense of normalcy to their lives. To date, patient reported post-operative outcomes have been limited in the literature, in particular, quality of life has been an under-reported component of successful management. METHODS Patient-reported outcomes were analyzed using the 12-question HerQLes survey, a validated hernia-related quality of life survey to assess patient function after complex abdominal wall reconstruction. Using synthetic mesh for structural stability, and microsurgical flaps for soft tissue coverage, ten consecutive heterogeneous patients underwent repair of massive abdominal wall defects. Baseline preoperative HerQLes and numerical pain scores were then compared to those obtained postoperatively (at or greater than 6 months). RESULTS All patients experienced improvement in their quality of life and pain scores post operatively with average follow-up at 15.9 months, even in those who experienced complications. All microsurgical flaps survived. There were no hernia recurrences. CONCLUSION Despite the extraordinary preoperative morbidity of massive abdominal wall defects, with an experienced General Surgery and Plastic Surgery multidisciplinary team, these highly complex patients are able to achieve a significant improvement in their pain and quality of life following repair and reconstruction with complex mesh hernia repair and microsurgical free tissue transfer.
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Affiliation(s)
- R E Aliotta
- Department of Plastic and Reconstructive Surgery, Dermatology and Plastic Surgery Institute, Cleveland Clinic Foundation, A60 Crile building 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - J Gatherwright
- Division of Plastic Surgery, MetroHealth Medical Center, Cleveland, OH, USA
| | - D Krpata
- Department of Surgery, Comprehensive Hernia Center, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - S Rosenblatt
- Department of Surgery, Comprehensive Hernia Center, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - M Rosen
- Department of Surgery, Comprehensive Hernia Center, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - R Gurunluoglu
- Department of Plastic and Reconstructive Surgery, Dermatology and Plastic Surgery Institute, Cleveland Clinic Foundation, A60 Crile building 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
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Tastaldi L, Krpata DM, Prabhu AS, Petro CC, Ilie R, Haskins IN, Alkhatib H, Tu C, Rosenblatt S, Rosen MJ. Emergent groin hernia repair: A single center 10-year experience. Surgery 2019; 165:398-405. [DOI: 10.1016/j.surg.2018.08.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/27/2018] [Accepted: 08/01/2018] [Indexed: 11/26/2022]
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Alkhatib H, Tastaldi L, Krpata DM, Petro CC, Olson M, Rosenblatt S, Rosen MJ, Prabhu AS. Outcomes of transversus abdominis release in non-elective incisional hernia repair: a retrospective review of the Americas Hernia Society Quality Collaborative (AHSQC). Hernia 2019; 23:43-49. [PMID: 30627813 DOI: 10.1007/s10029-019-01878-z] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 01/01/2019] [Indexed: 01/27/2023]
Abstract
PURPOSE Elective repair of large incisional hernias using posterior component separation with transversus abdominis release (TAR) has acceptable wound morbidity and long-term recurrence rates. The outcomes of using this reconstructive technique in the non-elective setting remains unknown. We aim to report 30-day outcomes of TAR in non-elective settings. METHODS All patients undergoing open TAR in non-elective settings were identified within the Americas Hernia Society Quality Collaborative (AHSQC). A retrospective review was conducted and outcomes of interest were 30-day Surgical Site Infections (SSI), Surgical Site Occurrences (SSO), SSOs requiring procedural intervention (SSOPI), medical complications, and unplanned readmissions and reoperations. RESULTS Fifty-nine patients met inclusion criteria. Mean BMI was 36.6 ± 8.9 kg/m2 and mean hernia width was 14.4 ± 7.2 cm. Forty (67.8%) were recurrent hernias. Pain (88%) and bowel obstruction (79.7%) were the most frequent indications for surgery. Surgical field was classified as clean in 69.5% of cases, with an 88% use of permanent synthetic mesh and fascial closure achieved in 93.2% of cases. There were 15 (25.4%) total wound events, 8 (13.6%) were SSIs. There were 8 (13.6%) SSOPIs, 6 of which were wound opening, 1 wound debridement, and 1 percutaneous drainage. At least one wound or medical complication was reported for 37% of the patients. There were no mortalities. CONCLUSION Not surprisingly, TAR in the non-elective setting is associated with increased wound morbidity requiring procedural interventions and reoperations compared to what has previously been reported for elective cases. The long-term consequences of this wound morbidity with regard to hernia recurrence are as of yet unknown.
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Affiliation(s)
- H Alkhatib
- Comprehensive Hernia Center, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA.
| | - L Tastaldi
- Comprehensive Hernia Center, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA
| | - D M Krpata
- Comprehensive Hernia Center, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA
| | - C C Petro
- Comprehensive Hernia Center, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA
| | - M Olson
- Department of Biostatistics, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, 37232, USA
| | - S Rosenblatt
- Comprehensive Hernia Center, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA
| | - M J Rosen
- Comprehensive Hernia Center, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA
| | - A S Prabhu
- Comprehensive Hernia Center, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA
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Haskins IN, Ilie RN, Krpata DM, Perez AJ, Butler RS, Prabhu AS, Rosenblatt S, Rosen MJ. Association of Thoracic Epidural Pain Management with Urinary Retention after Complex Abdominal Wall Reconstruction. Am Surg 2018; 84:1808-1813. [PMID: 30747638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The association of thoracic epidural analgesia and urinary retention after complex abdominal wall reconstruction (CAWR) is unknown. The purpose of this study was to investigate the association between the presence of a thoracic epidural, timing of Foley catheter removal, and the rates of urinary retention and catheter-associated urinary tract infections (CAUTIs) in patients undergoing CAWR. All patients undergoing CAWR, who had an epidural catheter for postoperative pain management at our institution from September 2015 through April 2016, were prospectively followed. Patients were divided into two groups. Group 1 had their Foley catheters removed on postoperative day one, whereas Group 2 had their Foley catheters removed after epidural removal. The incidence of urinary retention and CAUTI were compared between the two groups. A total of 67 patients met inclusion criteria; 27 (40.3%) patients were in Group 1. Patients in Group 1 were significantly more likely to experience urinary retention requiring Foley catheter replacement (P = 0.02). There was no statistically significant difference in the rate of CAUTI between the two groups (P = 0.51). Patients undergoing CAWR with thoracic epidural pain management are at risk of experiencing postoperative urinary retention. Foley catheter removal after epidural removal does not place the patient at an increased risk for CAUTI and therefore should be strongly considered in this patient population.
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Haskins IN, Ilie RN, Krpata DM, Perez AJ, Butler RS, Prabhu AS, Rosenblatt S, Rosen MJ. Association of Thoracic Epidural Pain Management with Urinary Retention after Complex Abdominal Wall Reconstruction. Am Surg 2018. [DOI: 10.1177/000313481808401140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The association of thoracic epidural analgesia and urinary retention after complex abdominal wall reconstruction (CAWR) is unknown. The purpose of this study was to investigate the association between the presence of a thoracic epidural, timing of Foley catheter removal, and the rates of urinary retention and catheter-associated urinary tract infections (CAUTIs) in patients undergoing CAWR. All patients undergoing CAWR, who had an epidural catheter for postoperative pain management at our institution from September 2015 through April 2016, were prospectively followed. Patients were divided into two groups. Group 1 had their Foley catheters removed on postoperative day one, whereas Group 2 had their Foley catheters removed after epidural removal. The incidence of urinary retention and CAUTI were compared between the two groups. A total of 67 patients met inclusion criteria; 27 (40.3%) patients were in Group 1. Patients in Group 1 were significantly more likely to experience urinary retention requiring Foley catheter replacement ( P = 0.02). There was no statistically significant difference in the rate of CAUTI between the two groups ( P = 0.51). Patients undergoing CAWR with thoracic epidural pain management are at risk of experiencing postoperative urinary retention. Foley catheter removal after epidural removal does not place the patient at an increased risk for CAUTI and therefore should be strongly considered in this patient population.
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Affiliation(s)
- Ivy N. Haskins
- Department of General Surgery, Comprehensive Hernia Center, The Cleveland Clinic Foundation, Cleveland, Ohio and
| | - Ramona N. Ilie
- Department of General Surgery, Comprehensive Hernia Center, The Cleveland Clinic Foundation, Cleveland, Ohio and
| | - David M. Krpata
- Department of General Surgery, Comprehensive Hernia Center, The Cleveland Clinic Foundation, Cleveland, Ohio and
| | - Arielle J. Perez
- Department of General Surgery, Comprehensive Hernia Center, The Cleveland Clinic Foundation, Cleveland, Ohio and
| | - Robert S. Butler
- Department of Quantitative Health Sciences, Lerner Research Institute, The Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ajita S. Prabhu
- Department of General Surgery, Comprehensive Hernia Center, The Cleveland Clinic Foundation, Cleveland, Ohio and
| | - Steven Rosenblatt
- Department of General Surgery, Comprehensive Hernia Center, The Cleveland Clinic Foundation, Cleveland, Ohio and
| | - Michael J. Rosen
- Department of General Surgery, Comprehensive Hernia Center, The Cleveland Clinic Foundation, Cleveland, Ohio and
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Haskins IN, Krpata DM, Prabhu AS, Tastaldi L, Perez AJ, Tu C, Rosenblatt S, Poulose BK, Rosen MJ. Immunosuppression is not a risk factor for 30-day wound events or additional 30-day morbidity or mortality after open ventral hernia repair: An analysis of the Americas Hernia Society Quality Collaborative. Surgery 2018; 164:594-600. [PMID: 30029991 DOI: 10.1016/j.surg.2018.05.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/13/2018] [Accepted: 05/18/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Some form of immunosuppression is relatively common in patients undergoing ventral hernia repair. Nevertheless, the association of immunosuppression with 30-day wound events and additional outcomes of morbidity and mortality remains unknown. The purpose of our study was to investigate the association of immunosuppression with 30-day wound events and additional morbidity and mortality after ventral hernia repair by evaluating the database of the Americas Hernia Society Quality Collaborative. METHODS All patients undergoing open, elective, incisional ventral hernia surgery from July 2013 through April 2017 were identified within the database of the Americas Hernia Society Quality Collaborative. Patients on immunosuppression within the 3 months before operative intervention were compared with patients not on immunosuppression with respect to the incidence of 30-day wound events, using a 1:5 propensity matched analysis. RESULTS A total of 3,537 patients met inclusion criteria; 200 (5.7%) patients were on some form of immunosuppression at the time of ventral hernia repair. After propensity matching, 1,200 patients remained for analysis; 200 (16.7%) patients were in the immunosuppression group. There were no statistically significant differences between the 2 groups with respect to the incidence of 30-day surgical site infection, surgical site occurrence requiring procedural intervention, or additional 30-day morbidity or mortality outcomes. Patients in the immunosuppression group had a greater rate of surgical site occurrences, the majority of which were seromas (P = .03). CONCLUSION Immunosuppression is associated with an increased risk of 30-day surgical site occurrence but not surgical site infection, surgical site occurrence requiring procedural intervention, or additional 30-day morbidity or mortality. Additional studies are needed to determine the clinical importance of these surgical site occurrences with respect to long-term durability of the hernia repair.
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Affiliation(s)
- Ivy N Haskins
- Comprehensive Hernia Center, Department of General Surgery, The Cleveland Clinic Foundation, Cleveland, OH
| | - David M Krpata
- Comprehensive Hernia Center, Department of General Surgery, The Cleveland Clinic Foundation, Cleveland, OH
| | - Ajita S Prabhu
- Comprehensive Hernia Center, Department of General Surgery, The Cleveland Clinic Foundation, Cleveland, OH
| | - Luciano Tastaldi
- Comprehensive Hernia Center, Department of General Surgery, The Cleveland Clinic Foundation, Cleveland, OH
| | - Arielle J Perez
- Comprehensive Hernia Center, Department of General Surgery, The Cleveland Clinic Foundation, Cleveland, OH
| | - Chao Tu
- Department of Quantitative Health Sciences, Lerner Research Institute, The Cleveland Clinic Foundation, Cleveland, OH
| | - Steven Rosenblatt
- Comprehensive Hernia Center, Department of General Surgery, The Cleveland Clinic Foundation, Cleveland, OH
| | - Benjamin K Poulose
- The Vanderbilt Hernia Center, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Michael J Rosen
- Comprehensive Hernia Center, Department of Surgery, Cleveland Clinic, Cleveland, OH.
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Tastaldi L, Krpata DM, Prabhu AS, Petro CC, Haskins IN, Perez AJ, Alkhatib H, Colturato I, Tu C, Lichtin A, Rosen MJ, Rosenblatt S. Laparoscopic splenectomy for immune thrombocytopenia (ITP): long-term outcomes of a modern cohort. Surg Endosc 2018; 33:475-485. [DOI: 10.1007/s00464-018-6321-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 06/29/2018] [Indexed: 01/19/2023]
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Abstract
Ulcer perforation in the excluded stomach and duodenum is a rare complication after Roux-en-Y gastric bypass (RYGB). Pathogenesis of these ulcers are multifactorial. We report a case of perforated gastric remnant ulcer in a 54-year-old woman who had undergone a laparoscopic RYGB 5 years previously. The perforation was successfully repaired with an omental patch. We also present a review of the literature of similar cases.
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Affiliation(s)
- Lu Dai
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Mihir M Shah
- Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Steven Rosenblatt
- Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA
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Abstract
Parastomal hernias are a common complication after ostomy formation that can require surgical repair when they become symptomatic. Operative planning and a thorough understanding of the anatomy of the abdominal wall are important. Simple fascial repair is associated with an unacceptably high recurrence rate and should be used as a temporary measure only. Stoma relocation has a high recurrence rate. Prophylactic mesh can and should be used. At this time, the use of mesh is considered the standard of care in the repair of parastomal hernias.
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Affiliation(s)
- Jennifer Colvin
- General Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Steven Rosenblatt
- General Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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Haskins IN, Horne CM, Krpata DM, Prabhu AS, Tastaldi L, Perez AJ, Rosenblatt S, Poulose BK, Rosen MJ. A call for standardization of wound events reporting following ventral hernia repair. Hernia 2018; 22:729-736. [PMID: 29429064 DOI: 10.1007/s10029-018-1748-6] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [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: 09/22/2017] [Accepted: 01/25/2018] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Postoperative wound events following ventral hernia repair are an important outcome measure. While efforts have been made by hernia surgeons to identify and address risk factors for postoperative wound events following VHR, the definition of these events lacks standardization. Therefore, the purpose of our study was to detail the variability of wound event definitions in recent ventral hernia literature and to propose standardized definitions for postoperative wound events following VHR. METHODS The top 50 cited ventral hernia, peer-reviewed publications from 1995 through 2015 were identified using the search engine Google Scholar. The definition of wound event used and the incidence of postoperative wound events was recorded for each article. The number of articles that used a standardized definition for surgical site infection (SSI), surgical site occurrence (SSO), or surgical site occurrence requiring procedural intervention (SSOPI) was also identified. RESULTS Of the 50 papers evaluated, only nine (18%) used a standardized definition for SSI, SSO, or SSOPI. The papers that used standardized definitions had a smaller variability in the incidence of wound events when compared to one another and their reported rates were more consistent with recently published ventral hernia repair literature. CONCLUSION Postoperative wound events following VHR are intimately associated with patient quality of life and long-term hernia repair durability. Standardization of the definition of postoperative wound events to include SSI, SSO, and SSOPI following VHR will improve the ability of hernia surgeons to make evidence-based decisions regarding the management of ventral hernias.
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Affiliation(s)
- I N Haskins
- Department of General Surgery, Comprehensive Hernia Center, The Cleveland Clinic Foundation, Cleveland, OH, USA. .,Department of General Surgery, Cleveland Clinic Comprehensive Hernia Center, The Cleveland Clinic, 9500 Euclid Avenue, A100, Cleveland, OH, 44195, USA.
| | - C M Horne
- Department of General Surgery, Comprehensive Hernia Center, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - D M Krpata
- Department of General Surgery, Comprehensive Hernia Center, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - A S Prabhu
- Department of General Surgery, Comprehensive Hernia Center, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - L Tastaldi
- Department of General Surgery, Comprehensive Hernia Center, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Arielle J Perez
- Department of General Surgery, Comprehensive Hernia Center, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - S Rosenblatt
- Department of General Surgery, Comprehensive Hernia Center, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - B K Poulose
- Department of Surgery, The Vanderbilt Hernia Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - M J Rosen
- Department of General Surgery, Comprehensive Hernia Center, The Cleveland Clinic Foundation, Cleveland, OH, USA
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Perez AJ, Haskins IN, Prabhu AS, Krpata DM, Tu C, Rosenblatt S, Hashimoto K, Diago T, Eghtesad B, Rosen MLJ. Concurrent Umbilical Hernia Repair at the Time of Liver Transplantation: A Six-Year Experience from a Single Institution. Int J Organ Transplant Med 2018; 9. [PMID: 29531643 PMCID: PMC5839626] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Umbilical hernias are common in patients with end-stage liver disease undergoing liver transplantation. Management of those persisting at the time of liver transplantation is important to define. OBJECTIVE To evaluate the long-term results of patients undergoing simultaneous primary umbilical hernia repair (UHR) at the time of liver transplantation at a single institution. METHODS Retrospective chart review was performed on patients undergoing simultaneous UHR and liver transplantation from 2010 through 2016. 30-day morbidity and mortality outcomes and long-term hernia recurrence were investigated. RESULTS 59 patients had primary UHR at the time of liver transplantation. All hernias were reducible with no overlying skin breakdown or leakage of ascites. 30-day morbidity and mortality included 5 (8%) superficial surgical site infections, 1 (2%) deep surgical site infection, and 7 (12%) organ space infections. Unrelated to the UHR, 10 (17%) patients had an unplanned return to the operating room, 16 (27%) were readmitted within 30 days of their index operation, and 1 (2%) patient died. With a mean follow-up of 21.8 months, 7 (18%) patients experienced an umbilical hernia recurrence. CONCLUSION Despite the high perioperative morbidity associated with the transplant procedure, concurrent primary UHR resulted in an acceptable long-term recurrence rate with minimal associated morbidity.
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Affiliation(s)
- A. J. Perez
- Comprehensive Hernia Center, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - I. N. Haskins
- Comprehensive Hernia Center, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - A. S. Prabhu
- Comprehensive Hernia Center, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - D. M. Krpata
- Comprehensive Hernia Center, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - C. Tu
- Department of Quantitative Health Sciences, Lerner Research Institute, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - S. Rosenblatt
- Comprehensive Hernia Center, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - K. Hashimoto
- Transplantation Center, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - T. Diago
- Transplantation Center, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - B. Eghtesad
- Transplantation Center, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - M. l. J. Rosen
- Comprehensive Hernia Center, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, OH, USA,Correspondence: Michael Rosen, MD, Clinical Fellow, Comprehensive Hernia Center, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH 44195, USA Tel: +1-21-6445-0767, Fax: +1-21-6444-2153, E-mail:
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Rosenblatt S, Kirts K, Greenwood MT. The Birth of Acupuncture in America: The White Crane's Gift. Med Acupunct 2017. [DOI: 10.1089/acu.2017.29060.mtg] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Boules M, Strong AT, Corcelles R, Haskins IN, Ilie R, Wathen C, Froylich D, Sharma G, Rodriguez J, Rosenblatt S, El-Hayek K, Kroh M. Single-center ventral hernia repair with porcine dermis collagen implant. Surg Endosc 2017; 32:1820-1827. [PMID: 28932941 DOI: 10.1007/s00464-017-5866-5] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 08/23/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION This study aims to evaluate the outcomes and utilization of porcine acellular dermal collagen implant (PADCI) during VHR at a large tertiary referral center. METHODS Records of 5485 patients who underwent VIHR from June 1995 to August 2014 were retrospectively reviewed to identify patients >18 years of age who had VIHR with PADCI reinforcement. Use of multiple mesh reinforcement products, inguinal hernias, and hiatal hernias were exclusion criteria. The primary outcome was hernia recurrence, and secondary outcomes were early complications and surgical site occurrences (SSOs). Uni- and multivariate analyses assessed risk factors for recurrence after PADCI reinforced VIHR. RESULTS There were 361 patients identified (54.5% female, mean age of 56.7 ± 12.5 years, and mean body mass index (BMI) of 33.0 ± 9.9 kg/m2). Hypertension (49.5%), diabetes (24.3%), and coronary artery disease (14.4%) were the most common comorbidities, as was active smoking (20.7%). Most were classified as American Association of Anesthesiologists (ASA) Class 3 (61.7%). Hernias were distributed across all grades of the ventral hernia working group (VHWG) grading system: grade I 93 (25.7%), grade II 51 (14.1%), grade III 113 (31.3%), and grade IV 6 (1.6%). Most VIHR were performed from an open approach (96.1%), and were frequently combined with concomitant surgical procedures (47.9%). Early postoperative complications (first 30 days) were reported in 39.0%, with 71 being SSO. Of the 19.7% of patients with SSO, there were 31 who required procedural intervention. After a mean follow-up of 71.5 ± 20.5 months, hernia recurrence was documented in 34.9% of patients. Age and male gender were predictors of recurrence on multivariate analysis. CONCLUSION To the best of our knowledge, this is the largest retrospective single institutional study evaluating PADCI to date. Hernias repaired with PADCI were frequently in patients undergoing concomitant operations. Reinforcement with PADCI may be considered a temporary closure, with a relatively high recurrence rate, especially among patients who are older, male, and undergo multiple explorations in a short perioperative period.
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Affiliation(s)
- M Boules
- Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, A100, Cleveland, OH, 44195, USA
| | - A T Strong
- Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, A100, Cleveland, OH, 44195, USA
| | - R Corcelles
- Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, A100, Cleveland, OH, 44195, USA.,Fundació Clínic per la Recerca Biomèdica, Hospital Clínic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - I N Haskins
- Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, A100, Cleveland, OH, 44195, USA
| | - R Ilie
- Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, A100, Cleveland, OH, 44195, USA
| | - C Wathen
- Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, A100, Cleveland, OH, 44195, USA
| | - D Froylich
- Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, A100, Cleveland, OH, 44195, USA
| | - G Sharma
- Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, A100, Cleveland, OH, 44195, USA
| | - J Rodriguez
- Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, A100, Cleveland, OH, 44195, USA
| | - S Rosenblatt
- Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, A100, Cleveland, OH, 44195, USA
| | - K El-Hayek
- Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, A100, Cleveland, OH, 44195, USA
| | - M Kroh
- Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, A100, Cleveland, OH, 44195, USA. .,Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE.
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Haskins IN, Krpata DM, Rosen MJ, Perez AJ, Tastaldi L, Butler RS, Rosenblatt S, Prabhu AS. Online Surgeon Ratings and Outcomes in Hernia Surgery: An Americas Hernia Society Quality Collaborative Analysis. J Am Coll Surg 2017; 225:582-589. [PMID: 28838868 DOI: 10.1016/j.jamcollsurg.2017.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 08/02/2017] [Accepted: 08/03/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Online surgeon ratings are viewed as a measure of physician quality by some consumers. Nevertheless, the correlation between online surgeon ratings and surgeon quality metrics remains unknown. The purpose of this study was to investigate the association between online surgeon ratings and hernia-specific quality metrics. STUDY DESIGN The Americas Hernia Society Quality Collaborative (AHSQC) is recognized by the Centers for Medicaid and Medicare as a Quality Clinical Data Registry (QCDR) that reports risk-adjusted quality metrics for hernia surgeons. All surgeons who input at least 10 patients into the AHSQC and had both a HealthGrades.com and Vitals.com rating were included in the analysis. The association of surgeons' average, risk-adjusted QCDR quality score with their online ratings was investigated using a linear regression model. RESULTS A total of 70 surgeons met inclusion criteria. The median number of evaluations each surgeon received on HealthGrades.com was 7; the median number of evaluations each surgeon received on Vitals.com was 3. There was a statistically significant correlation between the ratings surgeons received on HealthGrades.com and those that they received on Vitals.com (p < 0.0001). However, there was no correlation between surgeon ratings on either HealthGrades.com or Vitals.com and surgeon QCDR quality scores (p = 0.37 and p = 0.18, respectively). CONCLUSIONS Online physician rating systems correlate with one another, but they do not accurately reflect physician quality. The development of specialty-specific, risk-adjusted quality measures and appropriate public dissemination of this information may help patients make more informed decisions about their health care.
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Affiliation(s)
- Ivy N Haskins
- Comprehensive Hernia Center, Department of General Surgery, The Cleveland Clinic Foundation, Cleveland, OH
| | - David M Krpata
- Comprehensive Hernia Center, Department of General Surgery, The Cleveland Clinic Foundation, Cleveland, OH
| | - Michael J Rosen
- Comprehensive Hernia Center, Department of General Surgery, The Cleveland Clinic Foundation, Cleveland, OH
| | - Arielle J Perez
- Comprehensive Hernia Center, Department of General Surgery, The Cleveland Clinic Foundation, Cleveland, OH
| | - Luciano Tastaldi
- Comprehensive Hernia Center, Department of General Surgery, The Cleveland Clinic Foundation, Cleveland, OH
| | - Robert S Butler
- Department of Quantitative Health Sciences, Lerner Research Institute, The Cleveland Clinic Foundation, Cleveland, OH
| | - Steven Rosenblatt
- Comprehensive Hernia Center, Department of General Surgery, The Cleveland Clinic Foundation, Cleveland, OH
| | - Ajita S Prabhu
- Comprehensive Hernia Center, Department of General Surgery, The Cleveland Clinic Foundation, Cleveland, OH.
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Tastaldi L, Haskins IN, Perez AJ, Prabhu AS, Rosenblatt S, Rosen MJ. Single center experience with the modified retromuscular Sugarbaker technique for parastomal hernia repair. Hernia 2017; 21:941-949. [DOI: 10.1007/s10029-017-1644-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 08/20/2017] [Indexed: 01/11/2023]
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40
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Haskins IN, Rosen MJ, Prabhu AS, Amdur RL, Rosenblatt S, Brody F, Krpata DM. Umbilical hernia repair in pregnant patients: review of the American College of Surgeons National Surgical Quality Improvement Program. Hernia 2017; 21:767-770. [PMID: 28735364 DOI: 10.1007/s10029-017-1633-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 07/01/2017] [Indexed: 11/26/2022]
Affiliation(s)
- I N Haskins
- Comprehensive Hernia Center, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA.
- Department of Surgery, The George Washington University, Washington, DC, USA.
| | - M J Rosen
- Comprehensive Hernia Center, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA
| | - A S Prabhu
- Comprehensive Hernia Center, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA
| | - R L Amdur
- Department of Surgery, The George Washington University, Washington, DC, USA
| | - S Rosenblatt
- Comprehensive Hernia Center, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA
- Department of Surgery, The George Washington University, Washington, DC, USA
| | - F Brody
- Department of Surgery, The George Washington University, Washington, DC, USA
| | - D M Krpata
- Comprehensive Hernia Center, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA.
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Haskins IN, Prabhu AS, Krpata DM, Perez AJ, Tastaldi L, Tu C, Rosenblatt S, Poulose BK, Rosen MJ. Is there an association between surgeon hat type and 30-day wound events following ventral hernia repair? Hernia 2017. [DOI: 10.1007/s10029-017-1626-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Moores N, Rosenblatt S, Prabhu A, Rosen M. Do Iodine-Impregnated Adhesive Surgical Drapes Reduce Surgical Site Infections during Open Ventral Hernia Repair? A Comparative Analysis. Am Surg 2017. [DOI: 10.1177/000313481708300627] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study evaluated the role of iodine-impregnated adhesive drapes to reduce surgical site infections and occurrences in open ventral hernia repairs. All patients undergoing open ventral hernia repair of clean wounds with a retromuscular repair using synthetic mesh by a single surgeon were prospectively evaluated from the American Hernia Society Quality Collaborative. Patients were divided into those that had an Ioban drape and those that did not. The primary endpoints of this study were postoperative surgical site occurrence and infections. One hundred and four patients met inclusion criteria and were analyzed. There were 56 patients that received a 3M™ Ioban™ drape and 48 patients did not. The two groups were similar based on baseline demographics, risk factors, and operative details. There were four (7%) surgical site occurrences in the Ioban group (one wound cellulitis, one superficial surgical site infection, one allergic reaction to the Ioban, and one sterile seroma). There was one (2%) surgical site occurrence in the non-Ioban group (one superficial wound dehiscence). For patients undergoing clean ventral hernia repair with synthetic mesh placed in the retrorectus plane, the use of an iodine-impregnated drape does not result in a reduction in surgical site occurrences or superficial surgical site infections.
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Affiliation(s)
- Neal Moores
- Cleveland Clinic Comprehensive Hernia Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Steven Rosenblatt
- Cleveland Clinic Comprehensive Hernia Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ajita Prabhu
- University Hospitals of Cleveland, Cleveland, Ohio
| | - Michael Rosen
- Cleveland Clinic Comprehensive Hernia Center, Cleveland Clinic Foundation, Cleveland, Ohio
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Prabhu AS, Krpata DM, Phillips S, Huang LC, Haskins IN, Rosenblatt S, Poulose BK, Rosen MJ. Preoperative Chlorhexidine Gluconate Use Can Increase Risk for Surgical Site Infections after Ventral Hernia Repair. J Am Coll Surg 2016; 224:334-340. [PMID: 28017808 DOI: 10.1016/j.jamcollsurg.2016.12.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 11/01/2016] [Revised: 12/07/2016] [Accepted: 12/08/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND There is varying evidence about the use of preoperative chlorhexidine gluconate to decrease surgical site infection for elective surgery. This intervention has never been studied in ventral hernia repair, the most common general surgery procedure in the US. We aimed to determine whether preoperative chlorhexidine gluconate decreases the risk of 30-day wound morbidity in patients undergoing ventral hernia repair. STUDY DESIGN All patients undergoing ventral hernia repair in the Americas Hernia Society Quality Collaborative were separated into 2 groups: 1 group received preoperative chlorhexidine scrub and the other did not. The 2 groups were evaluated for 30-day wound morbidity, including surgical site occurrence (SSO), surgical site infection (SSI), and SSO requiring procedural intervention. Statistical analysis was performed using multivariate regression analysis and propensity score modeling. Multiple factors were controlled for statistical analysis, including patient-related factors and operative factors. RESULTS In total, 3,924 patients were included for comparison. After multivariate logistic regression modeling, the preoperative chlorhexidine scrub group had a higher incidence of SSOs (odds ratio [OR] = 1.34; 95% CI 1.11 to 1.61) and SSIs (OR = 1.46; 95% CI 1.03 to 2.07). After propensity score modeling, the increased risk of SSO and SSI persisted (SSO: OR = 1.39; 95% CI 1.15 to 1.70; SSI: OR = 1.45; 95% CI 1.011 to 2.072, respectively). CONCLUSIONS Prehospital chlorhexidine gluconate scrub appears to increase the risk of 30-day wound morbidity in patients undergoing ventral hernia repair. These findings suggest that the generalized use of prehospital chlorhexidine might not be desirable for all surgical populations.
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Affiliation(s)
- Ajita S Prabhu
- Comprehensive Hernia Center, Digestive Disease and Surgical Institute, The Cleveland Clinic Foundation, Cleveland, OH.
| | - David M Krpata
- Comprehensive Hernia Center, Digestive Disease and Surgical Institute, The Cleveland Clinic Foundation, Cleveland, OH
| | - Sharon Phillips
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Li-Ching Huang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Ivy N Haskins
- Comprehensive Hernia Center, Digestive Disease and Surgical Institute, The Cleveland Clinic Foundation, Cleveland, OH
| | - Steven Rosenblatt
- Comprehensive Hernia Center, Digestive Disease and Surgical Institute, The Cleveland Clinic Foundation, Cleveland, OH
| | - Benjamin K Poulose
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Michael J Rosen
- Comprehensive Hernia Center, Digestive Disease and Surgical Institute, The Cleveland Clinic Foundation, Cleveland, OH
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Krpata DM, Haskins IN, Phillips S, Prabhu AS, Rosenblatt S, Poulose BK, Rosen MJ. Does Preoperative Bowel Preparation Reduce Surgical Site Infections During Elective Ventral Hernia Repair? J Am Coll Surg 2016; 224:204-211. [PMID: 27825916 DOI: 10.1016/j.jamcollsurg.2016.10.049] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 10/14/2016] [Accepted: 10/14/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND To date, little is known about the benefits of preoperative bowel preparation in patients undergoing elective ventral hernia repair (VHR). The purpose of this study was to determine the effect of preoperative bowel preparation on 30-day wound events in patients undergoing elective VHR using the Americas Hernia Society Quality Collaborative (AHSQC). STUDY DESIGN All patients undergoing elective VHR from January 2013 through January 2016 were identified within the AHSQC. Patients undergoing emergency VHR and those with a CDC wound class IV were excluded from our analysis. Patients were divided into 2 groups: Clean (CDC wound class I) and Contaminated (CDC wound classes II and III). The association of preoperative bowel preparation with 30-day wound events was investigated using logistic regression modeling. RESULTS A total of 3,709 patients met inclusion criteria; 3,101 (83.6%) had CDC wound class I, and 608 (16.4%) had CDC wound classes II or III. Within the Clean group, patients who underwent preoperative bowel preparation were significantly more likely to experience a surgical site infection (SSI), surgical site occurrence (SSO), and surgical site occurrence requiring procedural intervention (SSOPI). Within the Contaminated group, patients who underwent preoperative bowel preparation were significantly more likely to experience an SSOPI. CONCLUSIONS The use of preoperative bowel preparation in patients undergoing elective VHR does not reduce the risk of 30-day wound events.
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Affiliation(s)
- David M Krpata
- Comprehensive Hernia Center, Digestive Disease and Surgical Institute, The Cleveland Clinic Foundation, Cleveland, OH.
| | - Ivy N Haskins
- Comprehensive Hernia Center, Digestive Disease and Surgical Institute, The Cleveland Clinic Foundation, Cleveland, OH
| | - Sharon Phillips
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Ajita S Prabhu
- Comprehensive Hernia Center, Digestive Disease and Surgical Institute, The Cleveland Clinic Foundation, Cleveland, OH
| | - Steven Rosenblatt
- Comprehensive Hernia Center, Digestive Disease and Surgical Institute, The Cleveland Clinic Foundation, Cleveland, OH
| | - Benjamin K Poulose
- Division of General Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Michael J Rosen
- Comprehensive Hernia Center, Digestive Disease and Surgical Institute, The Cleveland Clinic Foundation, Cleveland, OH
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Sakr H, Cruise M, Chahal P, Cotta C, Cook J, Chalikonda S, Rosenblatt S, Hamadeh F, Al-Nourhji O, Sturgis CD. Anaplastic lymphoma kinase positive large B-cell lymphoma: Literature review and report of an endoscopic fine needle aspiration case with tigroid backgrounds mimicking seminoma. Diagn Cytopathol 2016; 45:148-155. [PMID: 27686567 DOI: 10.1002/dc.23616] [Citation(s) in RCA: 8] [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: 06/15/2016] [Revised: 08/04/2016] [Accepted: 09/12/2016] [Indexed: 01/02/2023]
Abstract
Anaplastic lymphoma kinase-positive large B-cell lymphoma (ALK+ LBCL) is a rare distinct type of non-Hodgkin's lymphoma that arises in association with alterations of the ALK gene. This distinct disease entity is typically associated with an aggressive clinical course and appears in light microscopic preparations as a monomorphic population of large, immunoblast-like cells. In this report, we describe a case of ALK+ LBCL diagnosed by transgastric endoscopic ultrasound-guided fine needle aspiration (EUS FNA) of splenic hilar lymph nodes. Modified Giemsa stained direct smears from the FNA sample demonstrated large lesional cells with foamy cytoplasm and macronucleoli admixed with small lymphocytes in tigroid backgrounds, mimicking the cytologic appearance of seminoma. Ancillary immunohistochemical studies subsequently confirmed the diagnosis of ALK+ LBCL with the lesional cells being immunoreactive for CD138, VS38c, MUM1, ALK1, and lambda light chain. The cohesiveness of the cells, the cellular morphology, and the tigroid backgrounds were all pitfalls for accurate diagnosis of this rare specific type of lymphoid malignancy by cytology. To our knowledge this is the first case report detailing the diagnosis of ALK+ LBCL by EUS FNA and the first report describing a glycogen-rich tigroid background in direct FNA smears. Establishing a refined diagnosis in cases of this rare form of LBCL is necessary, as therapies targeting ALK may be of value in clinical management. Diagn. Cytopathol. 2017;45:148-155. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Hany Sakr
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Michael Cruise
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Prabhleen Chahal
- Department of Gastroenterology, Cleveland Clinic, Cleveland, Ohio
| | - Claudiu Cotta
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
| | - James Cook
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
| | | | | | - Fatima Hamadeh
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Omar Al-Nourhji
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Charles D Sturgis
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
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Haskins IN, Krpata DM, O'Rourke CP, Rosenblatt S, Rosen MJ. The clinical significance of postoperative tachycardia following ventral hernia repair. Surgery 2016; 160:418-25. [PMID: 27083481 DOI: 10.1016/j.surg.2016.02.030] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 02/12/2016] [Accepted: 02/24/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Early identification of serious adverse events following ventral hernia repair (VHR) could result in improved patient outcomes. Establishment of clinical markers that correlate with serious adverse events following VHR would help facilitate a more timely diagnosis of such events. We investigated the clinical utility of postoperative tachycardia to predict serious adverse events in patients undergoing VHR. METHODS Consecutive patients undergoing VHR at the Cleveland Clinic Comprehensive Hernia Center from September 2013 through June 2015 were identified within the Americas Hernia Society Quality Collaborative database. Tachycardia was classified according to frequency and duration. Sustained tachycardia was defined as >8 consecutive hours of tachycardia on any postoperative day. Serious adverse events were defined as cardiac events, venous thromboembolism, infection, bleeding, and anastomotic leak or missed enterotomy. Association between tachycardia class and serious adverse events was investigated using the Pearson χ(2) test. RESULTS A total of 377 patients underwent VHR during the study period. A total of 119 (31.6%) patients experienced at least 1 episode of tachycardia. There were 26 (6.9%) patients with a serious adverse event. Tachycardia was present in 21 (80.7%) of these patients. Sustained tachycardia had a significant association with serious adverse events (P = .007). The presence of postoperative tachycardia was associated with the occurrence of a serious adverse event, having a positive likelihood ratio of 2.9 (95% confidence interval 2.2-3.7). CONCLUSION Postoperative tachycardia is common following VHR. Nevertheless, sustained tachycardia is associated with a significant risk for serious postoperative adverse events and mandates further investigation.
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Affiliation(s)
- Ivy N Haskins
- Cleveland Clinic Comprehensive Hernia Center, Department of General Surgery, The Cleveland Clinic, Cleveland, OH.
| | - David M Krpata
- Cleveland Clinic Comprehensive Hernia Center, Department of General Surgery, The Cleveland Clinic, Cleveland, OH
| | - Colin P O'Rourke
- Cleveland Clinic Department of Quantitative Health Sciences, Lerner Research Institute, The Cleveland Clinic, Cleveland, OH
| | - Steven Rosenblatt
- Cleveland Clinic Comprehensive Hernia Center, Department of General Surgery, The Cleveland Clinic, Cleveland, OH
| | - Michael J Rosen
- Cleveland Clinic Comprehensive Hernia Center, Department of General Surgery, The Cleveland Clinic, Cleveland, OH
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Nicolson GL, Rosenblatt S, de Mattos GF, Settineri R, Breeding PC, Ellithorpe RR, Ash ME. Clinical Uses of Membrane Lipid Replacement Supplements in Restoring Membrane Function and Reducing Fatigue in Chronic Diseases and Cancer. Discoveries (Craiova) 2016; 4:e54. [PMID: 32309576 PMCID: PMC6941554 DOI: 10.15190/d.2016.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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] [Indexed: 01/22/2023] Open
Abstract
Membrane Lipid Replacement is the use of functional oral supplements containing cell membrane glycerolphospholipids and antioxidants to safely replace damaged membrane lipids that accumulate during aging and in various chronic and acute diseases. Most if not all clinical conditions and aging are characterized by membrane phospholipid oxidative damage, resulting in loss of membrane and cellular function. Clinical trials have shown the benefits of Membrane Lipid Replacement supplements in replenishing damaged membrane lipids and restoring mitochondrial function, resulting in reductions in fatigue in aged subjects and patients with a variety of clinical diagnoses. Recent observations have indicated that Membrane Lipid Replacement can be a useful natural supplement strategy in a variety of conditions: chronic fatigue, such as found in many diseases and disorders; fatiguing illnesses (fibromyalgia and chronic fatigue syndrome); chronic infections (Lyme disease and mycoplasmal infections); cardiovascular diseases; obesity, metabolic syndrome and diabetes; neurodegenerative diseases (Alzheimer’s disease); neurobehavioral diseases (autism spectrum disorders); fertility diseases; chemical contamination (Gulf War illnesses); and cancers (breast, colorectal and other cancers). Membrane Lipid Replacement provides general membrane nutritional support during aging and illness to improve membrane function and overall health without risk of adverse effects.
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Affiliation(s)
- Garth L Nicolson
- Department of Molecular Pathology, Institute for Molecular Medicine, Huntington Beach, California, 92647 USA
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Nicolson GL, de Mattos GF, Settineri R, Costa C, Ellithorpe R, Rosenblatt S, La Valle J, Jimenez A, Ohta S. Clinical Effects of Hydrogen Administration: From Animal and Human Diseases to Exercise Medicine. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/ijcm.2016.71005] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Falk GA, Nooli NP, Morris-Stiff G, Plesec TP, Rosenblatt S. Sclerosing Angiomatoid Nodular Transformation (SANT) of the spleen: Case report and review of the literature. Int J Surg Case Rep 2012; 3:492-500. [PMID: 22858789 DOI: 10.1016/j.ijscr.2012.06.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Accepted: 06/30/2012] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Sclerosing Angiomatoid Nodular Transformation of the spleen (SANT) is a rare benign vascular lesion of the spleen with extensive sclerosis and unknown etiology. PRESENTATION OF CASE We report a new case of SANT of the spleen found in a 53-year-old female following detection of a splenic mass on a routine computed tomography (CT). The patient underwent an uncomplicated laparoscopic splenectomy and the specimen was sent for histopathologic examination. DISCUSSION A review of the 97 reported cases of SANT found in the literature was undertaken. There were 43 males and 54 females with a median age of 46 years (range: 11-82 years). SANT is classically considered to be a female predominant disease, however 44.3% of reported case were male and the gender predilection may soon be neutralized as more cases are reported. 65 of the 97 (67%) patients were in 30-60 year age group. The majority of lesions (n=50) were incidentally found on imaging, and for those patients presenting with symptoms, abdominal pain (n=18) was the predominant symptom. CONCLUSION The diagnosis of SANT should be considered in any patient presenting with a splenic lesion that contains an angiomatoid or inflammatory component. As the differential diagnosis for SANT includes malignant pathologies, and currently no reliable diagnostic radiological feature has been identified to differentiate between these conditions, SANT will continue to be diagnosed on the basis of surgical histopathology.
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Affiliation(s)
- Gavin A Falk
- Department of General Surgery, Cleveland Clinic Foundation, Digestive Disease Institute, 9500 Euclid Avenue, Cleveland, OH 44195, United States
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50
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Jiang H, Rosenblatt S, Keller R, Butts S, Raavi G. Sinonasal Myxoma in an Infant. Am J Clin Pathol 2012. [DOI: 10.1093/ajcp/138.suppl1.304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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