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Ebrahimian S, Chervu N, Hadaya J, Cho NY, Kronen E, Sakowitz S, Verma A, Bakhtiyar SS, Sanaiha Y, Benharash P. National outcomes of expedited discharge following esophagectomy for malignancy. PLoS One 2024; 19:e0297470. [PMID: 38394104 PMCID: PMC10889881 DOI: 10.1371/journal.pone.0297470] [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: 06/16/2023] [Accepted: 01/05/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Expedited discharge following esophagectomy is controversial due to concerns for higher readmissions and financial burden. The present study aimed to evaluate the association of expedited discharge with hospitalization costs and unplanned readmissions following esophagectomy for malignant lesions. METHODS Adults undergoing elective esophagectomy for cancer were identified in the 2014-2019 Nationwide Readmissions Database. Patients discharged by postoperative day 7 were considered Expedited and others as Routine. Patients who did not survive to discharge or had major perioperative complications were excluded. Multivariable regression models were constructed to assess association of expedited discharge with index hospitalization costs as well as 30- and 90-day non-elective readmissions. RESULTS Of 9,886 patients who met study criteria, 34.6% comprised the Expedited cohort. After adjustment, female sex (adjusted odds ratio [AOR] 0.71, p = 0.001) and increasing Elixhauser Comorbidity Index (AOR 0.88/point, p<0.001) were associated with lower odds of expedited discharge, while laparoscopic (AOR 1.63, p<0.001, Ref: open) and robotic (AOR 1.67, p = 0.003, Ref: open) approach were linked to greater likelihood. Patients at centers in the highest-tertile of minimally invasive esophagectomy volume had increased odds of expedited discharge (AOR 1.52, p = 0.025, Ref: lowest-tertile). On multivariable analysis, expedited discharge was independently associated with an $8,300 reduction in hospitalization costs. Notably, expedited discharge was associated with similar odds of 30-day (AOR 1.10, p = 0.40) and 90-day (AOR 0.90, p = 0.70) unplanned readmissions. CONCLUSION Expedited discharge after esophagectomy was associated with decreased costs and unaltered readmissions. Prospective studies are necessary to robustly evaluate whether expedited discharge is appropriate for select patients undergoing esophagectomy.
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Affiliation(s)
- Shayan Ebrahimian
- Cardiovascular Outcomes Research Laboratories, Division of Cardiothoracic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Nikhil Chervu
- Cardiovascular Outcomes Research Laboratories, Division of Cardiothoracic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Joseph Hadaya
- Cardiovascular Outcomes Research Laboratories, Division of Cardiothoracic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Nam Yong Cho
- Cardiovascular Outcomes Research Laboratories, Division of Cardiothoracic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Elsa Kronen
- Cardiovascular Outcomes Research Laboratories, Division of Cardiothoracic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Sara Sakowitz
- Cardiovascular Outcomes Research Laboratories, Division of Cardiothoracic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Arjun Verma
- Cardiovascular Outcomes Research Laboratories, Division of Cardiothoracic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Syed Shahyan Bakhtiyar
- Cardiovascular Outcomes Research Laboratories, Division of Cardiothoracic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Yas Sanaiha
- Cardiovascular Outcomes Research Laboratories, Division of Cardiothoracic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
- Department of Surgery, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories, Division of Cardiothoracic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
- Department of Surgery, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
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Giroletti L, Brembilla V, Graniero A, Albano G, Villari N, Roscitano C, Parrinello M, Grazioli V, Lanzarone E, Agnino A. Learning Curve Analysis of Robotic-Assisted Mitral Valve Repair with COVID-19 Exogenous Factor: A Single Center Experience. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1568. [PMID: 37763687 PMCID: PMC10536190 DOI: 10.3390/medicina59091568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/14/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023]
Abstract
Background and objective Renewed interest in robot-assisted cardiac procedures has been demonstrated by several studies. However, concerns have been raised about the need for a long and complex learning curve. In addition, the COVID-19 pandemic in 2020 might have affected the learning curve of these procedures. In this study, we investigated the impact of COVID-19 on the learning curve of robotic-assisted mitral valve surgery (RAMVS). The aim was to understand whether or not the benefits of RAMVS are compromised by its learning curve. Materials and Methods Between May 2019 and March 2023, 149 patients underwent RAMVS using the Da Vinci® X Surgical System at the Humanitas Gavazzeni Hospital, Bergamo, Italy. The selection of patients enrolled in the study was not influenced by case complexity. Regression models were used to formalize the learning curves, where preoperative data along with date of surgery and presence of COVID-19 were treated as the input covariates, while intraoperative and postoperative data were analyzed as output variables. Results The age of patients was 59.1 ± 13.3 years, and 70.5% were male. In total, 38.2% of the patients were operated on during the COVID-19 pandemic. The statistical analysis showed the positive impact of the learning curve on the trend of postoperative parameters, progressively reducing times and other key indicators. Focusing on the COVID-19 pandemic, statistical analysis did not recognize an impact on postoperative outcomes, although it became clear that variables not directly related to the intervention, especially ICU hours, were strongly influenced by hospital logistics during COVID-19. Conclusions Understanding the learning curve of robotic surgical procedures is essential to ensure their effectiveness and benefits. The learning curve involves not only surgeons but also other health care providers, and establishing a stable team in the early stage, as in our case, is important to shorten the duration. In fact, an exogenous factor such as the COVID-19 pandemic did not affect the robotic program despite the fact that the pandemic occurred early in the program.
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Affiliation(s)
- Laura Giroletti
- Division of Robotic and Minimally Invasive Cardiac Surgery, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy; (A.G.); (A.A.)
| | - Valentina Brembilla
- Department of Management, Information and Production Engineering, University of Bergamo, 24044 Dalmine (Bg), Italy; (V.B.); (E.L.)
| | - Ascanio Graniero
- Division of Robotic and Minimally Invasive Cardiac Surgery, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy; (A.G.); (A.A.)
| | - Giovanni Albano
- Division of Cardiac Anesthesia, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy; (G.A.); (N.V.); (C.R.); (M.P.)
| | - Nicola Villari
- Division of Cardiac Anesthesia, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy; (G.A.); (N.V.); (C.R.); (M.P.)
| | - Claudio Roscitano
- Division of Cardiac Anesthesia, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy; (G.A.); (N.V.); (C.R.); (M.P.)
| | - Matteo Parrinello
- Division of Cardiac Anesthesia, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy; (G.A.); (N.V.); (C.R.); (M.P.)
| | - Valentina Grazioli
- Cardiovascular Surgery Department, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy;
| | - Ettore Lanzarone
- Department of Management, Information and Production Engineering, University of Bergamo, 24044 Dalmine (Bg), Italy; (V.B.); (E.L.)
| | - Alfonso Agnino
- Division of Robotic and Minimally Invasive Cardiac Surgery, Humanitas Gavazzeni Hospital, 24125 Bergamo, Italy; (A.G.); (A.A.)
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Fatehi Hassanabad A, Nagase FNI, Basha AM, Hammal F, Menon D, Kent WDT, Ali IS, Nagendran J, Stafinski T. A Systematic Review and Meta-Analysis of Robot-Assisted Mitral Valve Repair. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:471-481. [PMID: 36529985 PMCID: PMC9846568 DOI: 10.1177/15569845221141488] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Robot-assisted surgery is a minimally invasive approach for repairing the mitral valve. This study aimed to assess its safety and clinical efficacy when compared with conventional sternotomy, partial sternotomy, and right minithoracotomy. METHODS A systematic review of peer-reviewed studies comparing robot-assisted mitral valve repair with conventional sternotomy, partial sternotomy, and right minithoracotomy was conducted following Cochrane Collaboration guidelines. Meta-analyses were performed where possible. RESULTS The search strategy yielded 15 primary studies, of which 12 compared robot-assisted with conventional sternotomy, 2 compared robot-assisted with partial sternotomy, and 6 compared robot-assisted with right minithoracotomy. The overall quality of evidence was low, and there was a lack of data on long-term outcomes. Individual studies and pooled data demonstrated that robotic procedures were comparable to conventional sternotomy and other minimally invasive approaches with respect to the rates of stroke, renal failure, reoperation for bleeding, and mortality. Robot-assisted mitral valve repair was superior to conventional sternotomy with reduced atrial fibrillation, intensive care unit and hospital stay, pain, time to return to normal activities, and physical functioning at 1 year. However, robot-assisted mitral valve repair had longer cardiopulmonary, aortic cross-clamp, and procedure times compared with all other surgical approaches. CONCLUSIONS Based on current evidence, robot-assisted mitral valve repair is comparable to other approaches for safety and early postoperative outcomes, despite being associated with longer operative times. Ideally, future studies will be randomized controlled trials that compare between robot-assisted surgery, conventional surgery, and other minimally surgery approaches focusing on hard clinical outcomes and patient-reported outcomes.
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Affiliation(s)
- Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department
of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine,
University of Calgary, AB, Canada,Ali Fatehi Hassanabad, MD, MSc, Section of
Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute,
Foothills Medical Center, 1403, 29th Street NW, Calgary, Alberta, T2N2T9,
Canada.
| | - Fernanda N. I. Nagase
- Health Technology & Policy Unit
(HTPU), School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Ameen M. Basha
- Section of Cardiac Surgery, Department
of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine,
University of Calgary, AB, Canada
| | - Fadi Hammal
- School of Public Health, University of
Alberta, Edmonton, AB, Canada
| | - Devidas Menon
- Health Technology & Policy Unit
(HTPU), School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - William D. T. Kent
- Section of Cardiac Surgery, Department
of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine,
University of Calgary, AB, Canada
| | - Imtiaz S. Ali
- Section of Cardiac Surgery, Department
of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine,
University of Calgary, AB, Canada
| | - Jeevan Nagendran
- Division of Cardiac Surgery, Department
of Surgery, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton,
AB, Canada
| | - Tania Stafinski
- Health Technology & Policy Unit
(HTPU), School of Public Health, University of Alberta, Edmonton, AB, Canada
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Follow-Up of Robotic Mitral Valve Repair: A Single Tertiary Institution Experience in China. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:1997371. [PMID: 35637846 PMCID: PMC9148248 DOI: 10.1155/2022/1997371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/06/2022] [Indexed: 11/17/2022]
Abstract
Surgical treatment of mitral valve diseases has become minimally invasive. This study analyzed the follow-up results of patients after mitral valve repairs (MVRep) using the da Vinci robot. The clinical data of patients who underwent minimally invasive MVRep using the da Vinci robot between January 2016 and June 2021 and completed follow-ups were prospectively collected. All operations were performed by the same surgeon and assistants. The data of a total of 120 patients were available for analysis, including 78 males (65%) and 42 females aged 49.9 ± 12.1 years (range, 19–73 years). Among them, there were 30 cases (25%) of mitral valve prolapse, 87 cases (72.5%) of mitral regurgitation, and 40 cases of combined tricuspid regurgitation. Edwards Physio II annuloplasty rings were implanted intraoperatively, followed by continuous sutures. The intraoperative cardiopulmonary bypass time was 152.32 ± 45.77 min, and the aortic occlusion time was 95.13 ± 5.64 min. After surgery, patients were followed up regularly with echocardiography with a follow-up period of 3–57 months postoperatively. One patient died in the early stage, and five patients required sternotomy due to postoperative bleeding. Follow-up transesophageal echocardiography showed that the end-systolic diameter, end-diastolic diameter, and ejection fraction of the left ventricular all improved after surgery. Among Chinese patients, MVRep using the da Vinci robot is a safe and effective surgical approach.
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Huang W, Hou B, Li Q, Zhang Y, Wang L. Comparative efficacy of five surgical methods in the treatment of mitral regurgitation: A systematic review and network meta-analysis. J Card Surg 2021; 37:186-196. [PMID: 34662452 DOI: 10.1111/jocs.16085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/19/2021] [Accepted: 10/08/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study has been compared the effectiveness of different surgical methods in the treatment of mitral regurgitation (MR) in adults by using the network meta-analysis method, so as to provide reference for clinical selection of the best surgical scheme. METHODS The PubMed, EMBASE, the Cochrane Library, CNKI, and Chongqing VIP Information databases were comprehensively searched until December 2020. We collected retrospective comparative studies on surgical procedures including 3D endoscopic mitral valve surgery (3D-MVS), robot-assisted mitral valve surgery (R-MVS); totally thoracoscopic mitral valve surgery (T-MVS), small incision mitral valve surgery (M-MVS), and traditional thoracotomy mitral valve surgery (C-MVS). Stata16.0 and Addis1.16.8 software was used for network meta-analysis using the Bayesian approach. RESULTS A total of 31 studies were included, 12,998 patients, involving five surgical methods. Network meta-analysis showed that: in terms of complications (odds ratio [OR]: 0.65, 95% CI: 0.13-3.00, probability rank = 0.37) and MR (OR: 0.03, 95% CI: 0.0-8315, probability rank = 0.64), the 3D-MVS group had the lowest event rate. In terms of blood transfusion rate (OR: 0.55, 95% CI: 0.16-1.84, probability rank = 0.45), T-MVS had the lowest event rate. In addition, with the exception of operation time and chest drainage, the R-MVS group has the best curative effect. CONCLUSION This minimally invasive surgery has their own advantages and disadvantages. Overall, 3D-MVS is most satisfactory, but more samples are needed.
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Affiliation(s)
- Weimin Huang
- Baotou Clinical Medical College of Inner Mongolia Medical University, Baotou, China
| | - Biao Hou
- Baotou Clinical Medical College of Inner Mongolia Medical University, Baotou, China
| | - Qin Li
- Baotou Clinical Medical College of Inner Mongolia Medical University, Baotou, China
| | - Yuhai Zhang
- Baotou Clinical Medical College of Inner Mongolia Medical University, Baotou, China
| | - Liang Wang
- Department of Cardiology, Baotou Central Hospital, Baotou, China
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Barac YD, Loungani RS, Sabulsky R, Carr K, Zwischenberger B, Glower DD. Sustained results of robotic mitral repair in a lower volume center with extensive minimally invasive mitral repair experience. J Robot Surg 2021; 16:199-206. [PMID: 33761097 DOI: 10.1007/s11701-021-01214-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/17/2021] [Indexed: 10/21/2022]
Abstract
The literature for robotic mitral repair is dominated by a small number of large volume institutions, and intermediate-term outcomes out to 5 years are rare. Whether and under what circumstances a lower volume institution could obtain durable outcomes is not known. A retrospective review was performed on all 133 patients undergoing robotically assisted mitral repair from 2011 to 2019 at a single institution. Mean volume of robotic mitral repair was 16 ± 7 cases per year, while mean institutional total volume of mitral repair was 116 ± 16 cases per year. Mean age was 58 ± 12 years, 77% were men, and mitral etiology was prolapse in 90%. Comorbidity was infrequent with atrial fibrillation in 20% and moderate tricuspid regurgitation in 14%. Central aortic cannulation was used in 97% with concurrent tricuspid operation in 5% and concurrent maze in 14%. Median clamp time, pump time, and length of stay were 146 min, 265 min, and 5 days, respectively, but none improved with experience. There were no deaths or stroke. At 5 years, the cumulative incidence of moderate mitral regurgitation was 18 ± 6% (prolapse patients 11 ± 5%), severe regurgitation 4 ± 3%, and mitral replacement 9 ± 5% (prolapse patients 5 ± 3%). 5-year survival was 96 ± 3%. At centers with significant mitral repair volume, a volume of 16 robotic mitral cases/year can yield good clinical outcomes durable out to 5 years. A case volume of 16 cases per year was not sufficient to improve pump time or length of stay over time.
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Affiliation(s)
- Yaron D Barac
- The Sackler Faculty of Medicine, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Rahul S Loungani
- Duke University Medical Center, Box 3851, Durham, NC, 27710, USA
| | - Richard Sabulsky
- Duke University Medical Center, Box 3851, Durham, NC, 27710, USA
| | - Keith Carr
- Duke University Medical Center, Box 3851, Durham, NC, 27710, USA
| | | | - Donald D Glower
- Duke University Medical Center, Box 3851, Durham, NC, 27710, USA.
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Seo YJ, Christian-Miller N, Aguayo E, Sanaiha Y, Benharash P, Yanagawa J. National Use and Short-term Outcomes of Video and Robot-Assisted Thoracoscopic Thymectomies. Ann Thorac Surg 2021; 113:230-236. [PMID: 33607051 DOI: 10.1016/j.athoracsur.2021.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 01/31/2021] [Accepted: 02/01/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Transsternal open thymectomy has long been the most widely used approach for thymectomy, but recent decades have seen the introduction of minimally invasive surgery (MIS), such as video-assisted thoracoscopic surgery (VATS) and robot-assisted thoracoscopic surgery (RATS) thymectomy. This retrospective cohort study provides a national comparison of trends, outcomes, and resource utilization of open, VATS, and RATS thymectomy. METHODS Admissions for thymectomies from 2008 to 2014 were identified in the National Inpatient Sample. Patients were identified as undergoing open, VATS, or RATS thymectomy. Propensity score-matched analyses were used to compare overall complication rates, length of stay (LOS), and cost of VATS and RATS thymectomies. RESULTS An estimated 23,087 patients underwent thymectomy during the study period: open in 16,025 (69%) and MIS in 7217 (31%). Of the MIS cohort, 4119 (18%) underwent VATS and 3097 (13%) underwent RATS. Performance of RATS and VATS thymectomy increased while that of open thymectomy declined. Baseline characteristics between VATS and RATS were similar, except more women underwent VATS thymectomy. No differences in LOS or overall complication rates were appreciable in this study. VATS was associated with the lowest cost of the 3 approaches. CONCLUSIONS Our findings demonstrate the increasing adoption of MIS and declining use of the open surgical approach for thymectomy. There are no differences in overall complication rates between RATS and VATS thymectomy, but RATS is associated with greater cost and lower cardiac complication rates.
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Affiliation(s)
- Young-Ji Seo
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | | | - Esteban Aguayo
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Yas Sanaiha
- Division of Cardiac Surgery, University of California, Los Angeles, Los Angeles, California
| | - Peyman Benharash
- Division of Cardiac Surgery, University of California, Los Angeles, Los Angeles, California
| | - Jane Yanagawa
- Division of Thoracic Surgery, University of California, Los Angeles, Los Angeles, California.
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