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Weaver MD, Sullivan JP, Landrigan CP, Barger LK. Systematic Review of the Impact of Physician Work Schedules on Patient Safety with Meta-Analyses of Mortality Risk. Jt Comm J Qual Patient Saf 2023; 49:634-647. [PMID: 37543449 DOI: 10.1016/j.jcjq.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 08/07/2023]
Abstract
Resident physician work hour limits continue to be controversial. Numerous trials have come to conflicting conclusions about the impact on patient safety of eliminating extended duration work shifts. We conducted meta-analyses to evaluate the impact of work hour policies and work schedules on patient safety. After identifying 8,362 potentially relevant studies and reviewing 688 full-text articles, 132 studies were retained and graded on quality of evidence. Of these, 68 studies provided enough information for consideration in meta-analyses. We found that patient safety improved following implementation of the Accreditation Council for Graduate Medical Education's 2003 and 2011 resident physicians work hour guidelines. Limiting all resident physicians to 80-hour work weeks and 28-hour shifts in 2003 was associated with an 11% reduction in mortality (p < 0.001). Limited shift durations and shorter work weeks were also associated with improved patient safety in clinical trials and observational studies not specifically tied to policy changes. Given the preponderance of evidence showing that patient and physician safety is negatively affected by long work hours, efforts to improve physician schedules should be prioritized. Policies that enable extended-duration shifts and long work weeks should be reexamined. Further research should expand beyond resident physicians to additional study populations, including attending physicians and other health care workers.
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Mohtashami S, Richardson K, Forest VI, Mlynarek A, Payne RJ, Tamilia M, Pusztaszeri MP, Hier MP, Sadeghi N, Mascarella MA. Thyroidectomy for Graves' Disease Predicts Postoperative Neck Hematoma and Hypocalcemia: A North American cohort study. Ann Otol Rhinol Laryngol 2021; 131:341-351. [PMID: 34060342 PMCID: PMC8899812 DOI: 10.1177/00034894211021288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective: Examine the association of Graves’ disease with the development of
postoperative neck hematoma. Design: A cohort of patients participating in the Thyroid Procedure-Targeted Database
of the National Surgical Quality Improvement Program from January 1, 2016 to
December 31, 2018. Setting: A North American surgical cohort study. Methods: 17 906 patients who underwent thyroidectomy were included. Propensity score
matching was performed to adjust for differences in baseline covariates.
Multivariate logistic regression was used to ascertain the association
between thyroidectomy for Graves’ disease and risk of postoperative adverse
events within 30 days of surgery. The primary outcome was postoperative
hematoma. Secondary outcomes were postoperative hypocalcemia and recurrent
laryngeal nerve injury. Results: One-to-three propensity score matching yielded 1207 patients with mean age
(SD) of 42.6 (14.9) years and 1017 (84.3%) female in the group with Graves’
disease and 3621 patients with mean age (SD) of 46.7 (15.0%) years and 2998
(82.8%) female in the group with indications other than Graves’ disease for
thyroidectomy. The cumulative 30-day incidence of postoperative hematoma was
3.1% (38/1207) in the Graves’ disease group and 1.9% (70/3621) in other
patients. The matched cohort showed that Graves’ disease was associated with
higher odds of postoperative hematoma (OR 1.65, 95% CI 1.10-2.46) and
hypocalcemia (OR 2.04, 95% CI 1.66-2.50) compared with other indications for
thyroid surgery. There was no difference in recurrent laryngeal nerve injury
among the 2 groups. Conclusions: Patients with Graves’ disease undergoing thyroidectomy are more likely to
suffer from postoperative hematoma and hypocalcemia compared to patients
undergoing surgery for other indications.
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Affiliation(s)
- Sadaf Mohtashami
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Keith Richardson
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | | | - Alex Mlynarek
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Richard J Payne
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Michael Tamilia
- Division of Endocrinology, Department of Medicine, McGill University, Montreal, QC, Canada
| | | | - Michael P Hier
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Nader Sadeghi
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada.,Research Institute of the McGill University Health Center, Montreal, QC, Canada
| | - Marco A Mascarella
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada.,Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada.,Department of Biomedical Sciences, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
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3
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Gabrysz-Forget F, Rubin S, Nepomnayshy D, Dolan R, Yarlagadda B. Development and Validation of a Novel Surgical Simulation for Parotidectomy and Facial Nerve Dissection. Otolaryngol Head Neck Surg 2020; 163:344-347. [PMID: 32204639 DOI: 10.1177/0194599820913587] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We present the development and validation of a low-cost novel model for training of parotid surgery. The model consists of a 3-dimensionally printed skeleton, silicone-based soft tissue, and facial nerve replicated with copper wire, circuited to indicate contact with instruments. The face validity of the simulator was evaluated with a 21-item 5-point Likert survey. Content validity was evaluated through a survey completed by the trainees after their first live parotidectomy following the simulation. Twelve residents and 6 faculty completed the simulated procedure of superficial parotidectomy after watching a video demonstration. Completion of 16 surgical steps evaluated by this model was graded for each participant. The mean ± SD total assessment score for faculty was 15.83 ± 0.41, as compared with 13.33 ± 2.06 for residents (P = .0081). The simulator as a training tool was well received by both faculty and residents (5 vs 4, P = .0206). Participants strongly agreed that junior residents would benefits from use of the model.
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Affiliation(s)
- Fanny Gabrysz-Forget
- Center for Professional Development and Simulation, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Samuel Rubin
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Boston University, Boston, Massachusetts, USA
| | - Dmitry Nepomnayshy
- Center for Professional Development and Simulation, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA.,Department of Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Robert Dolan
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Boston University, Boston, Massachusetts, USA.,Division of Otolaryngology-Head and Neck Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Bharat Yarlagadda
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Boston University, Boston, Massachusetts, USA.,Division of Otolaryngology-Head and Neck Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
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4
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Siu JM, McCarty JC, Gadkaree S, Caterson EJ, Randolph G, Witterick IJ, Eskander A, Bergmark RW. Association of Vessel-Sealant Devices vs Conventional Hemostasis With Postoperative Neck Hematoma After Thyroid Operations. JAMA Surg 2019; 154:e193146. [PMID: 31532475 DOI: 10.1001/jamasurg.2019.3146] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Importance Vessel-sealant devices (VSDs) have been popularized for use in thyroid operations; however, the association of their use with postoperative neck hematoma, a rare but potentially fatal complication, has not been well studied. Objective To examine the association of VSDs vs conventional hemostasis (CH) in thyroid operations with the development of neck hematoma. Design, Setting, and Participants This retrospective cohort study evaluated 10 903 patients in the Thyroid Procedure-Targeted Database of the National Surgical Quality Improvement Program from January 1, 2016, to December 31, 2017. One-to-one nearest-neighbor propensity score matching was conducted to adjust for differences in baseline covariates, including demographics, comorbidities, indications for thyroid procedure (goiter, Graves disease, malignant and benign thyroid nodule), and several other thyroid-specific characteristics, between the VSD and CH groups. Main Outcomes and Measures The primary outcome was postoperative hematoma requiring intervention with open evacuation, return to the operating room, tracheostomy, additional observation, or extended length of stay. Secondary outcomes include recurrent laryngeal nerve injury, operative duration, and hospital length of stay. Results One-to-one propensity score matching yielded 6522 patients (mean [SD] age, 52 [15] years; 8544 [78.4%] female) with 3261 in each exposure group such that distribution of observed baseline covariates was not different between groups of the same propensity score. Within the matched cohort, CH was associated with higher odds of neck hematoma compared with VSD (odds ratio, 2.33; 95% CI, 1.55-3.49; P < .001), with 34 (1.0%) hematomas in the VSD group and 78 (2.4%) in the CH group. On the basis of this analysis, the number needed to treat with a VSD to prevent 1 postoperative hematoma was 74. Secondary outcomes included longer length of hospital stay (incidence rate ratio, 1.29; 95% CI, 1.23-1.36; P < .001]) in the CH group compared with the VSD group but no difference in the odds of recurrent laryngeal nerve injury (odds ratio, 0.90; 95% CI, 0.73-1.11; P = .32) or operative duration (incidence rate ratio, 0.99; 95% CI, 0.96-1.01; P = .24). Conclusions and Relevance Use of VSDs during thyroid operations was associated with reduced odds of neck hematoma compared with CH techniques without increasing odds of nerve injury. The results suggest that postoperative neck hematoma rates after thyroid surgery may differ based on the hemostasis technique and that these differences should be considered when developing strategies for quality improvement of postoperative outcomes.
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Affiliation(s)
- Jennifer M Siu
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Justin C McCarty
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts.,Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Shekhar Gadkaree
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston.,Department of Otolaryngology-Head & Neck Surgery, Harvard Medical School, Boston, Massachusetts
| | - Edward J Caterson
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Gregory Randolph
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston.,Department of Otolaryngology-Head & Neck Surgery, Harvard Medical School, Boston, Massachusetts
| | - Ian J Witterick
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Antoine Eskander
- Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head & Neck Surgery, Surgical Oncology, University of Toronto, Sunnybrook Health Sciences Centre and Michael Garron Hospital, Toronto, Ontario, Canada
| | - Regan W Bergmark
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Otolaryngology-Head & Neck Surgery, Harvard Medical School, Boston, Massachusetts.,Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, Massachusetts
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5
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The Effect of Lymph Node Dissection in Metastatic Prostate Cancer Patients Treated with Radical Prostatectomy: A Contemporary Analysis of Survival and Early Postoperative Outcomes. Eur Urol Oncol 2019; 2:541-548. [DOI: 10.1016/j.euo.2018.10.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/19/2018] [Accepted: 10/31/2018] [Indexed: 01/05/2023]
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Hsieh TY, O'Brien DC, Sykes J, Squires LD. Perceived Preparedness of Facial Plastic Surgery Fellows Over Time: A Survey of AAFPRS Fellowship Directors. Ann Otol Rhinol Laryngol 2019; 128:915-920. [PMID: 31081344 DOI: 10.1177/0003489419849611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Assess the effects of American Council for Graduate Medical Education (ACGME) resident work hour restrictions on the preparedness of incoming facial plastic surgery fellows as assessed by American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) fellowship directors. METHODS Observational survey study evaluating the perception of ACGME resident duty hour change on resident surgical and clinical skills from fellowship directors of AAFPRS fellowship programs in the US. A cross-sectional survey was sent to 47 fellowship directors of AAFPRS fellowship programs. Perceived change in resident clinical and surgical skills were measured using a 5-point Likert scale (1 = significantly improved, 2 = improved, 3 = neither improved nor worsened, 4 = worsened, 5 = significantly worsened) to evaluate 15 benchmarks. RESULTS Responses received from 36 fellowship directors. The results indicate no statistically significant perceived trend of ACGME duty hour reform on fellows for AAFPRS fellowships among fellowship directors. However, cohort analysis demonstrated that fellowship directors with more than 10 years of service perceived a more negative impact in 2 clinical benchmarks (assessment/planning and basic exposure) over time. CONCLUSIONS The study results appear to show no significant perceived trend over time on the effect of duty hour reform on fellows for AAFPRS fellowships among fellowship directors. However, there are some apparent opinion differences between fellowship directors separated by years of service, with more negative perceptions noted in 2 clinical areas by those with more than 10 years of service. This study is in line with the more recent literature that suggests a trend toward a less negative perception of the duty hour change. This may suggest resident education is adapting to the ACGME duty hour regulations.
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Affiliation(s)
- Tsung-Yen Hsieh
- 1 Department of Otolaryngology Head and Neck Surgery, University of California Davis, Sacramento, CA, USA
| | | | - Jonathan Sykes
- 1 Department of Otolaryngology Head and Neck Surgery, University of California Davis, Sacramento, CA, USA
| | - Lane Darwin Squires
- 1 Department of Otolaryngology Head and Neck Surgery, University of California Davis, Sacramento, CA, USA
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7
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Mazzone E, Preisser F, Nazzani S, Tian Z, Zaffuto E, Gallina A, Tilki D, Montorsi F, Shariat SF, Saad F, Briganti A, Karakiewicz PI. The effect of age and comorbidities on early postoperative complications after radical cystectomy: A contemporary population-based analysis. J Geriatr Oncol 2019; 10:623-631. [PMID: 31010691 DOI: 10.1016/j.jgo.2019.04.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/14/2019] [Accepted: 04/14/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Analyzing the relationship between perioperative outcomes and age in urothelial carcinoma of the bladder (UCB) patients treated with radical cystectomy (RC) in a continuous fashion may provide detailed information on the increased risk of complications in older patients, even after accounting for different comorbidity profiles. Given the limited data available in the literature, we tested these relationships within a large scale, population-based database. MATERIALS AND METHODS Within the NIS database (2003-2015), we identified patients who underwent RC for UCB. Multivariable logistic regression (MLoR) and Poisson regression (MPR) models were used after adjustment for clustering and stratification for comorbidity profiles. RESULTS Overall, 20,144 patients underwent RC with a median age of 70 years (interquartile range: 62-77). In MLoR models, continuously coded age represented an independent predictor of overall (odds ratio [OR]: 1.008, 95%-confidence interval [CI]: 1.005-1.012), cardiac (OR: 1.042, 95%-CI: 1.035-1.049), vascular (OR: 1.024, 95%-CI: 1.014-1.034), respiratory (OR: 1.016, 95%-CI 1.009-1.022), miscellaneous medical (OR: 1.013, 95%-CI: 1.009-1.017), infectious (OR: 1.012, 95%-CI 1.004-1.019), transfusions (OR: 1.011, 95%-CI 1.007-1.015) and bowel obstruction (OR: 1.009, 95%-CI 1.004-1.013) complications, and in-hospital mortality (OR: 1.057, 95%-CI 1.039-1.075). Conversely, patients age did not predict intraoperative (p = 0.7), genitourinary (p = 0.9), operative wound (p = 0.2) and miscellaneous surgical complications (p = 0.1). In MPR models, patients age predicted longer LOS (relative risk [RR]: 1.002, 95%-CI 1.001-1.003). Finally, a decreasing effect of age was observed in patients low vs high comorbidity burden for cardiac, respiratory and overall complications. CONCLUSIONS Most of early postoperative RC complications are related to patients age, but its impact varies according to comorbidity profile. Further studies are needed to validate our findings that may be then considered for individual counselling and informed consent, as well as for health expenditure planning.
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Affiliation(s)
- Elio Mazzone
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Division of Experimental Oncology, Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
| | - Felix Preisser
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sebastiano Nazzani
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Academic Department of Urology, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Emanuele Zaffuto
- Division of Experimental Oncology, Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Gallina
- Division of Experimental Oncology, Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Derya Tilki
- Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Francesco Montorsi
- Division of Experimental Oncology, Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | | | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Alberto Briganti
- Division of Experimental Oncology, Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
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Nazzani S, Bandini M, Preisser F, Mazzone E, Marchioni M, Tian Z, Stubinski R, Clementi MC, Saad F, Shariat SF, Montanari E, Briganti A, Carmignani L, Karakiewicz PI. Postoperative paralytic ileus after major oncological procedures in the enhanced recovery after surgery era: A population based analysis. Surg Oncol 2019; 28:201-207. [PMID: 30851901 DOI: 10.1016/j.suronc.2019.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 12/03/2018] [Accepted: 01/27/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) protocols have been developed and implemented as of 2001 and may have significantly reduced several complication types including paralytic ileus. However, no formal analyses targeted paralytic ileus rates after contemporary major surgical oncology procedures. We examined temporal trends of paralytic ileus following ten major oncological surgical procedures. The effect of paralytic ileus on length of stay (LOS) and total hospital charges was examined. Univariable and multivariable linear and logistic regression analyses were used. METHODS Between 2003 and 2013, we retrospectively identified patients, who underwent prostatectomy, colectomy, cystectomy, mastectomy, gastrectomy, hysterectomy, nephrectomy, oophorectomy, lung resection or pancreatectomy within the Nationwide Inpatient Sample. A total of 3 431 602 patients were included in our analyses. Annual paralytic ileus rate differences after major oncological surgical procedures were evaluated using linear regression. Multivariable logistic regression analyses were used to test for paralytic ileus rates determinants, as well as on the effect of paralytic ileus rates on LOS and hospital charges. RESULTS Paralytic ileus rates ranged from 0.1% (mastectomy) to 23.2% (cystectomy) after ten examined major oncological surgical procedures. Overall annual paralytic ileus rates did not change [estimated annual percentage change (EAPC)+0.1%, p = 0.7]. Multivariable logistic regression derived predicted probabilities (PP) of paralytic ileus were highest for cystectomy (PP: 26.1%) and colectomy (PP: 17.15%) and were lowest for lung resection (PP: 2.22%) and mastectomy (PP: 0.16%). In analyses predicting LOS above the 75th percentile, paralytic ileus effect after mastectomy (OR: 14.66) and prostatectomy (OR: 13.21) ranked, as highest and second highest respectively. In analyses predicting hospital charges above the 75th percentile, paralytic ileus effect after mastectomy (OR: 2.21) and oophorectomy (OR: 1.99) ranked as highest and second highest respectively. CONCLUSIONS Despite implementation of ERAS protocols paralytic ileus rates have not decreased over time. Gastrointestinal procedures are among the highest contributors of paralytic ileus. Moreover, procedures with short LOS represent the strongest relative contributors to LOS increases and increases in hospitalization costs.
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Affiliation(s)
- Sebastiano Nazzani
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Centre de Recherche du Centre Hospitalier de L'Université de Montréal (CR-CHUM), Institut du Cancer de Montréal, Montréal, Québec, Canada; Academic Department of Urology, IRCCS Policlinico San Donato, University of Milan, Milan, Italy.
| | - Marco Bandini
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Centre de Recherche du Centre Hospitalier de L'Université de Montréal (CR-CHUM), Institut du Cancer de Montréal, Montréal, Québec, Canada; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy, Vita-Salute San Raffaele University, Milan, Italy
| | - Felix Preisser
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Centre de Recherche du Centre Hospitalier de L'Université de Montréal (CR-CHUM), Institut du Cancer de Montréal, Montréal, Québec, Canada; Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Elio Mazzone
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Centre de Recherche du Centre Hospitalier de L'Université de Montréal (CR-CHUM), Institut du Cancer de Montréal, Montréal, Québec, Canada; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy, Vita-Salute San Raffaele University, Milan, Italy
| | - Michele Marchioni
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Department of Urology, SS Annunziata Hospital, "G.D'Annunzio" University of Chieti, Chieti, Italy
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Robert Stubinski
- Academic Department of Urology, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Maria Chiara Clementi
- Academic Department of Urology, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Centre de Recherche du Centre Hospitalier de L'Université de Montréal (CR-CHUM), Institut du Cancer de Montréal, Montréal, Québec, Canada
| | | | - Emanuele Montanari
- Department of Urology, IRCCS Fondazione Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy, Vita-Salute San Raffaele University, Milan, Italy
| | - Luca Carmignani
- Academic Department of Urology, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Centre de Recherche du Centre Hospitalier de L'Université de Montréal (CR-CHUM), Institut du Cancer de Montréal, Montréal, Québec, Canada
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9
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Regional differences in total hospital charges between open and robotically assisted radical prostatectomy in the United States. World J Urol 2018; 37:1305-1313. [DOI: 10.1007/s00345-018-2525-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 10/08/2018] [Indexed: 12/23/2022] Open
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10
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Crippen MM, Barinsky GL, Reddy RK, Elias ML, Eloy JA, Baredes S, Park RCW. The Impact of Duty-Hour Restrictions on Complication Rates Following Major Head and Neck Procedures. Laryngoscope 2018; 128:2804-2810. [PMID: 30284257 DOI: 10.1002/lary.27338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To assess the impact of resident duty-hour restrictions (DHR) in otolaryngology via comparison of postoperative outcomes between otolaryngology teaching hospitals (Oto-TH) and nonteaching hospitals (NTH) before and after complete implementation. STUDY DESIGN Retrospective database review. METHODS The Nationwide Inpatient Sample was queried for all major head and neck cases between 2000 and 2002 (n = 34,064) and 2008 and 2010 (n = 33,094). Cases were stratified into Oto-TH (n = 28,771) and NTH (n = 38,387) and assessed for procedure type, patient comorbidities, and complications. A subpopulation matched by procedure type was generated for direct comparison of complication rates using χ2 and binary logistic regression analyses. RESULTS In the years following DHR, total case volume and average case complexity increased at Oto-TH only. Using a case-matched subpopulation, regression analysis found Oto-TH status to be protective for medical complications both before (odds ratio [OR]: 0.60, P < .001) and after (OR: 0.76, P = .001) DHR. In contrast, Oto-TH cases had lower risk for surgical complications in 2000 to 2002 (OR: 0.77, P < .001) but not 2008 to 2010 (OR: 1.07, P = .275). When comparing time periods, the years following DHR were associated with a significant decrease in medical complications and mortality across hospital cohorts. For surgical complications, rates significantly improved at NTH only (OR: 0.82, P = .002), with no difference at Oto-TH (OR: 0.95, P = .450). CONCLUSIONS In the years following DHR, rates of medical complications, surgical complications, and mortality have significantly improved at NTH. At Oto-TH, there has been a lack of similar improvement in surgical complications, even after accounting for increasing case volume and complexity in more recent years. While the cause is likely multifactorial, DHR in otolaryngology residency may play a role. LEVEL OF EVIDENCE 4 Laryngoscope, 128:2804-2810, 2018.
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Affiliation(s)
- Meghan M Crippen
- Department of Otolaryngology-Head and Neck Surgery , Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Gregory L Barinsky
- Department of Otolaryngology-Head and Neck Surgery , Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Renuka K Reddy
- Department of Otolaryngology-Head and Neck Surgery , Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Marcus L Elias
- Department of Otolaryngology-Head and Neck Surgery , Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery , Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Center for Skull Base and Pituitary Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Neurological Institute of New Jersey; Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery , Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Center for Skull Base and Pituitary Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Richard Chan Woo Park
- Department of Otolaryngology-Head and Neck Surgery , Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
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Nazzani S, Mazzone E, Preisser F, Bandini M, Tian Z, Marchioni M, Ratti D, Motta G, Zorn KC, Briganti A, Shariat SF, Montanari E, Carmignani L, Karakiewicz PI. Comparison of Perioperative Outcomes Between Open and Robotic Radical Cystectomy: A Population-Based Analysis. J Endourol 2018; 32:701-709. [PMID: 29845866 DOI: 10.1089/end.2018.0313] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Radical cystectomy represents the standard of care for muscle-invasive bladder cancer (MIBC). Due to its novelty the use of robotic radical cystectomy (RARC) is still under debate. We examined intraoperative and postoperative morbidity and mortality in addition to impact on length of stay (LOS) and total hospital charges (THCGs) of RARC compared with open radical cystectomy (ORC). MATERIALS AND METHODS Within National Inpatient Sample (2008-2013), we identified patients with nonmetastatic bladder cancer treated with either ORC or RARC. We relied on inverse probability of treatment weighting to reduce the effect of inherent differences between ORC vs RARC. Multivariable logistic regression (MLR) and multivariable Poisson regression (MPR) models were used. RESULTS Of all 10,027 patients, 12.6% underwent RARC. Between 2008 and 2013, RARC rates increased from 0.8% to 20.4% [estimated annual percentage change (EAPC): +26.5%, 95% confidence interval (CI): +11.1 to +48.3; p = 0.035] and RARC THCGs decreased from 45,981 to 31,749 United States dollars (EAPC: -6.8%, 95% CI: -9.6 to -3.9; p = 0.01). In MLR models RARC resulted in lower rates of overall complications [odds ratio (OR): 0.6; p < 0.001] and transfusions (OR: 0.44; p < 0.001). In MPR models, RARC was associated with shorter LOS (relative risk 0.91; p < 0.001). Finally, higher THCGs (OR: 1.09; p < 0.001) were recorded for RARC. Data are retrospective and no tumor characteristics were available. CONCLUSION RARC is related to lower rates of overall complications and transfusions rates. In consequence, RARC is a safe and feasible technique in select MIBC patients. Moreover, RARC is associated with shorter LOS, although higher THCGs.
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Affiliation(s)
- Sebastiano Nazzani
- 1 Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center , Montreal, Canada .,2 Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du cancer de Montréal , Montréal, Canada .,3 Academic Department of Urology, IRCCS Policlinico San Donato, University of Milan , Milan, Italy
| | - Elio Mazzone
- 1 Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center , Montreal, Canada .,2 Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du cancer de Montréal , Montréal, Canada .,4 Division of Oncology/Unit of Urology, Urological Research Institute , IRCCS Ospedale San Raffaele, Milan, Italy .,5 Vita-Salute San Raffaele University , Milan, Italy
| | - Felix Preisser
- 1 Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center , Montreal, Canada .,2 Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du cancer de Montréal , Montréal, Canada .,6 Martini Klinik, University Medical Center Hamburg-Eppendorf , Hamburg, Germany
| | - Marco Bandini
- 1 Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center , Montreal, Canada .,2 Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du cancer de Montréal , Montréal, Canada .,4 Division of Oncology/Unit of Urology, Urological Research Institute , IRCCS Ospedale San Raffaele, Milan, Italy
| | - Zhe Tian
- 1 Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center , Montreal, Canada
| | - Michele Marchioni
- 7 Department of Urology, SS Annunziata Hospital, "G.D'Annunzio" University of Chieti , Chieti, Italy
| | - Dario Ratti
- 3 Academic Department of Urology, IRCCS Policlinico San Donato, University of Milan , Milan, Italy
| | - Gloria Motta
- 3 Academic Department of Urology, IRCCS Policlinico San Donato, University of Milan , Milan, Italy
| | - Kevin C Zorn
- 2 Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du cancer de Montréal , Montréal, Canada
| | - Alberto Briganti
- 4 Division of Oncology/Unit of Urology, Urological Research Institute , IRCCS Ospedale San Raffaele, Milan, Italy .,5 Vita-Salute San Raffaele University , Milan, Italy
| | | | - Emanuele Montanari
- 9 Department of Urology, IRCCS Fondazione Ca' Granda-Ospedale Maggiore Policlinico, University of Milan , Milan, Italy
| | - Luca Carmignani
- 3 Academic Department of Urology, IRCCS Policlinico San Donato, University of Milan , Milan, Italy
| | - Pierre I Karakiewicz
- 1 Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center , Montreal, Canada .,2 Centre de recherche du Centre Hospitalier de l'Université de Montréal (CR-CHUM) and Institut du cancer de Montréal , Montréal, Canada
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In-hospital length of stay after major surgical oncological procedures. Eur J Surg Oncol 2018; 44:969-974. [DOI: 10.1016/j.ejso.2018.05.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 04/23/2018] [Accepted: 05/02/2018] [Indexed: 02/04/2023] Open
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