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Akita S, Kumamaru H, Motomura H, Mitsukawa N, Morimoto N, Sakuraba M. The volume-outcome relationship in free-flap reconstruction: A nationwide study based on the Clinical Database. J Plast Reconstr Aesthet Surg 2023; 85:500-507. [PMID: 37603985 DOI: 10.1016/j.bjps.2023.07.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/18/2023] [Accepted: 07/22/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND The association between successful reconstructive surgery with a free flap and hospital volume has not been well established. This study was designed to retrospectively analyze the outcome of free-flap surgery registered in a nationwide surgical registration system in Japan to clarify the relationship between free-flap survival and facilities' average annual number of free-flap surgeries. METHODS We analyzed data from 19,482 free flaps performed during 2017-2020 at 407 facilities throughout Japan. After adjusting for sex, age, and disease classification that differ between the groups, we examined the differences in the flap survival rates among the different facilities in terms of the average number of free-flap surgeries performed annually. RESULTS The total overall necrosis rate was 2.8%. Of all procedures, 14.9%, 12.9%, 33.4%, and 38.8% were performed at facilities with an average number of free-flap procedures <10, 10-19, 20-49, and ≥ 50 per year, respectively, and the respective rates of total necrosis were 6.0%, 3.8%, 2.1%, and 1.7%, respectively. The odds ratios and 95% confidence intervals of flap necrosis for facilities with ≥ 50 cases per year relative to those <10 were 2.70 (1.98-3.68) for nonbreast reconstruction cases and 5.72 (2.77-11.8) for breast reconstruction cases. CONCLUSION This analysis of a nationwide plastic surgery database showed that free-flap surgeries in institutions with a low average annual number of free-flap surgeries had a higher risk of total necrosis. Measures should be taken to either aggregate cases into high-volume centers or improve management at low-volume centers.
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Affiliation(s)
- Shinsuke Akita
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Hisashi Motomura
- Department of Plastic and Reconstructive Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Nobuyuki Mitsukawa
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Naoki Morimoto
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Minoru Sakuraba
- Department of Plastic and Reconstructive Surgery, Iwate Medical University, Morioka, Japan
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Todd AR, Genereux O, Schrag C, Hatchell A, Matthews J. Improved Operative Efficiency and Surgical Times in Autologous Breast Reconstruction: A 15-year Single-center Retrospective Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5231. [PMID: 38152707 PMCID: PMC10752470 DOI: 10.1097/gox.0000000000005231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/07/2023] [Indexed: 12/29/2023]
Abstract
Background Autologous breast reconstruction using a free deep inferior epigastric perforator (DIEP) flap is a complex procedure that requires a dedicated approach to achieve operative efficiency. We analyzed data for DIEP flaps at a single center over 15 years to identify factors contributing to operative efficiency. Methods A single-center, retrospective cohort analysis was performed of consecutive patients undergoing autologous breast reconstruction using DIEP free flaps between January 1, 2005, and December 31, 2019. Data were abstracted a priori from electronic medical records. Analysis was conducted by a medical statistician. Results Analysis of 416 unilateral and 320 bilateral cases (1056 flaps) demonstrated reduction in operative times from 2005 to 2019 (11.7-8.2 hours for bilateral and 8.4-6.2 hours for unilateral, P < 0.000). On regression analysis, factors significantly correlating with reduced operative times include the use of venous couplers (P < 0.000), and the internal mammary versus the thoracodorsal recipient vessels (P < 0.000). Individual surgeon experience correlated with reduced OR times. Post-operative length of stay decreased significantly, without an increase in 30-day readmission or emergency presentations. Flap failure occurred in two cases. Flap take-back rate was 2% (n = 23) with no change between 2005 and 2019. Conclusions Operative times for breast reconstruction have decreased significantly at this center over 15 years. The introduction of venous couplers, use of the internal mammary system, and year of surgery significantly correlated with decreased operative times. Surgeon experience and a shift in surgical workflow for DIEP flap reconstruction likely contributed to the latter finding.
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Affiliation(s)
- Anna R. Todd
- From the Section of Plastic and Reconstructive Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Olivia Genereux
- From the Section of Plastic and Reconstructive Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Christiaan Schrag
- From the Section of Plastic and Reconstructive Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Alexandra Hatchell
- From the Section of Plastic and Reconstructive Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer Matthews
- From the Section of Plastic and Reconstructive Surgery, University of Calgary, Calgary, Alberta, Canada
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Clinicians' perceptions around discectomy surgery for lumbar disc herniation: a survey of orthopaedic and neuro-surgeons in Australia and New Zealand. Arch Orthop Trauma Surg 2023; 143:189-201. [PMID: 34216261 DOI: 10.1007/s00402-021-04019-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 06/24/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Understanding practice-based differences in treatment of lumbar disc herniations (LDHs) is vital for reducing unwarranted variation in the delivery of spine surgical health care. Identifying factors that influence surgeons' decision-making will offer useful insights for developing the most cost-effective and safest surgical strategy as well as developing surgeon education materials for common lumbar pathologies. This study was to capture any variation in techniques used by surgeons in Australia and New Zealand (ANZ) region, and perceived complications of different surgical procedures for primary and recurrent LDH (rLDH). MATERIALS AND METHODS Web-based survey study was emailed to orthopaedic and neurosurgeons who routinely performed spinal surgery in ANZ from Decmber 20, 2018 to February 20, 2020. The response data were analyzed to assess for differences based on geography, practice setting, speciality, practice experience, practice length, and operative volume. RESULTS Invitations were sent to 150 surgeons; 96 (64%) responded. Most surgeons reported microdiscectomy as their surgical technique of choice for primary LDH (73%) and the first rLDH (72%). For the second rLDH, the preferred choice for most surgeons was fusion surgery (82%). A surgeon's practice setting (academic/private/hybrid) was a statistically significant factor in what surgical procedure was chosen for the first rLDH (P = 0.014). When stratifying based on surgeon experience, there were statisfically significant differences based on the annual volume of spine surgeries performed (perceived reherniation rates following primary discectomy, P = 0.013; perceived reherniation rates following revision surgeries, P = 0.017; perceived intraoperative complications rates following revision surgeries, P = 0.016) and based on the annual volume of lumbar discectomies performed (perceived reherniation rates following revision surgeries, P = 0.022; perceived intraoperative complications rates following revision surgeries, P = 0.036; perceived durotomy rates following primary discectomy, P = 0.023). CONCLUSIONS Surgeons' annual practice volume and practice setting have significant influences in the selection of surgical procedures and the perception of surgical complications when treating LDHs.
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Jones A, Kaelberer Z, Clancy T, Fairweather M, Wang J, Molina G. Association between race, hospital volume of major liver surgery, and access to metastasectomy for colorectal liver metastasis. Am J Surg 2022; 224:522-529. [DOI: 10.1016/j.amjsurg.2022.01.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/21/2022] [Accepted: 01/30/2022] [Indexed: 12/12/2022]
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Case Volume-Dependent Changes in Operative Morbidity following Free Flap Breast Reconstruction: A 15-Year Single-Center Analysis. Plast Reconstr Surg 2021; 148:365e-374e. [PMID: 34432682 DOI: 10.1097/prs.0000000000008209] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Operative morbidity is a common yet modifiable feature of complex surgical procedures. With increasing case volume, improvement in morbidity has been reported through designated procedural processes and greater repetition. Defined as a volume-outcome association, improvement in breast reconstruction morbidity with increasing free flap volume requires further characterization. METHODS A retrospective analysis was conducted among consecutive free flap patients using a two-microsurgeon model between January of 2002 and December of 2017. Patient demographics and operative characteristics were obtained from medical records. Complications including unplanned surgical intervention (take-back) and flap loss were obtained from prospectively kept databases. Individual surgeon operative volume was estimated by considering overall practice volume and correcting for the number of surgeons at any given time. RESULTS During the study period, 3949 patients met inclusion criteria. A total of 6607 breasts underwent reconstruction with 6675 free flaps. Mean patient age was 50 ± 9.4 years and mean body mass index was 28.8 ± 5.0 kg/m2. Bilateral reconstruction was performed on 2633 patients (66.5 percent), with 4626 breasts (70.5 percent) reconstructed in the immediate setting. Overall, breast and donor-site complications were reported in 507 breasts (7.7 percent) and 607 cases (15.4 percent), respectively. Take-back was required in 375 cases (9.5 percent), with complete flap loss occurring in 57 cases (0.9 percent). Based on annual flaps per surgeon, the incidence of complications decreased with increasing volume (slope = -0.12; p = 0.056). CONCLUSION Through procedural efficiency and execution of defined clinical processes using a two-microsurgeon model, increases in microsurgical breast reconstruction case volume result in decreased morbidity. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Morgan AL, Sasor SE. Digit Replantation Outcomes at High-Volume Hospitals. J Am Coll Surg 2021; 232:909-911. [PMID: 34030852 DOI: 10.1016/j.jamcollsurg.2021.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 03/29/2021] [Indexed: 11/28/2022]
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Hsu CC, Malay S, Chen JS, Loh CYY, Lin YT, Chung KC. National Population Study of the Effect of Structure and Process on Outcomes of Digit Replantation. J Am Coll Surg 2021; 232:900-909.e1. [PMID: 33831540 PMCID: PMC10167636 DOI: 10.1016/j.jamcollsurg.2021.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/08/2021] [Accepted: 03/08/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND Surgeon experience, hospital volume, and teaching hospital status may play a role in the success of digit replantation. This study aims to analyze factors that influence digit replantation success rates. STUDY DESIGN We examined patients with traumatic digit amputations, between 2000 and 2015, from the National Health Insurance Research Database (NHIRD) of Taiwan, which comprises data of more than 99% of its population. We measured the number of traumatic digit amputations and success rate of replantation. Chi-square and ANOVA tests were used for descriptive statistics. Regression models were built to analyze the association among patient, surgeon, and hospital characteristics, and replant success. RESULTS We identified 13,416 digit replantation patients using the eligibility criteria. The overall replantation failure rate was significantly higher in medium- and high-volume hospitals (low-volume: 11%, medium-volume: 17%, and high-volume: 15%, p < 0.001). Teaching hospitals had significantly higher replantation failure rates [(15.5% vs 7.6%), odds ratio (OR) 2.0; confidence interval (CI) 1.1-3.7]. Lower surgeon case volume resulted in a significantly higher failure rate in the thumb replantation (OR 0.89; CI 0.85-0.94). CONCLUSIONS Teaching hospitals had greater odds of replantation failure, owing to being high volume centers and attempting more replantations. However, the effect of residents performing the replantation during their training should be considered. Teaching units are mandatory for resident training; however, a balance should be established to provide training, but with sufficient supervision to achieve optimal replant success. A national protocol to triage digit amputation cases to high volume centers with experienced microsurgeons will help improve the replantation success rate.
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Affiliation(s)
- Chung-Chen Hsu
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, the College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Sunitha Malay
- Section of Plastic Surgery Department of Surgery University of Michigan Medical School, Ann Arbor, MI
| | - Jung-Sheng Chen
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Charles Yuen Yung Loh
- Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Hills Road, Cambridge, United Kingdom, CB2 0QQ, UK
| | - Yu-Te Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, the College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kevin C Chung
- Section of Plastic Surgery Department of Surgery University of Michigan Medical School, Ann Arbor, MI; Charles BG de Nancrede Professor of Surgery, Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI.
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Kelz RR, Sellers MM, Niknam BA, Sharpe JE, Rosenbaum PR, Hill AS, Zhou H, Hochman LL, Bilimoria KY, Itani K, Romano PS, Silber JH. A National Comparison of Operative Outcomes of New and Experienced Surgeons. Ann Surg 2021; 273:280-288. [PMID: 31188212 PMCID: PMC6898745 DOI: 10.1097/sla.0000000000003388] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To determine whether outcomes achieved by new surgeons are attributable to inexperience or to differences in the context in which care is delivered and patient complexity. BACKGROUND Although prior studies suggest that new surgeon outcomes are worse than those of experienced surgeons, factors that underlie these phenomena are poorly understood. METHODS A nationwide observational tapered matching study of outcomes of Medicare patients treated by new and experienced surgeons in 1221 US hospitals (2009-2013). The primary outcome studied is 30-day mortality. Secondary outcomes were examined. RESULTS In total, 694,165 patients treated by 8503 experienced surgeons were matched to 68,036 patients treated by 2119 new surgeons working in the same hospitals. New surgeons' patients were older (25.8% aged ≥85 vs 16.3%,P<0.0001) with more emergency admissions (53.9% vs 25.8%,P<0.0001) than experienced surgeons' patients. Patients of new surgeons had a significantly higher baseline 30-day mortality rate compared with patients of experienced surgeons (6.2% vs 4.5%,P<0.0001;OR 1.42 (1.33, 1.52)). The difference remained significant after matching the types of operations performed (6.2% vs 5.1%, P<0.0001; OR 1.24 (1.16, 1.32)) and after further matching on a combination of operation type and emergency admission status (6.2% vs 5.6%, P=0.0007; OR 1.12 (1.05, 1.19)). After matching on operation type, emergency admission status, and patient complexity, the difference between new and experienced surgeons' patients' 30-day mortality became indistinguishable (6.2% vs 5.9%,P=0.2391;OR 1.06 (0.97, 1.16)). CONCLUSIONS Among Medicare beneficiaries, the majority of the differences in outcomes between new and experienced surgeons are related to the context in which care is delivered and patient complexity rather than new surgeon inexperience.
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Affiliation(s)
- Rachel R. Kelz
- Department of Surgery, Center for Surgery and Health Economics, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA
| | - Morgan M. Sellers
- Department of Surgery, Center for Surgery and Health Economics, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Bijan A. Niknam
- Center for Outcomes Research, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - James E. Sharpe
- Center for Outcomes Research, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Paul R. Rosenbaum
- The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA
- Department of Statistics, The Wharton School, The University of Pennsylvania, Philadelphia, PA
| | - Alexander S. Hill
- Center for Outcomes Research, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Hong Zhou
- Center for Outcomes Research, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Lauren L. Hochman
- Center for Outcomes Research, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Karl Y. Bilimoria
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Northwestern Medicine, Chicago IL
| | - Kamal Itani
- VA Boston Health Care System, Boston, MA
- Department of Surgery, Boston University School of Medicine, Boston, MA
| | - Patrick S. Romano
- Division of General Medicine and Center for Healthcare Policy and Research, University of California Davis School of Medicine, Sacramento, CA
| | - Jeffrey H. Silber
- The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA
- Center for Outcomes Research, Children’s Hospital of Philadelphia, Philadelphia, PA
- The Departments of Pediatrics, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Department of Health Care Management, The Wharton School, The University of Pennsylvania, Philadelphia, PA
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Jolly D, Wu CA, Boskey ER, Taghinia AH, Diamond DA, Ganor O. Is Clitoral Release Another Term for Metoidioplasty? A Systematic Review and Meta-Analysis of Metoidioplasty Surgical Technique and Outcomes. Sex Med 2021; 9:100294. [PMID: 33429241 PMCID: PMC7930881 DOI: 10.1016/j.esxm.2020.100294] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/18/2020] [Accepted: 11/21/2020] [Indexed: 12/21/2022] Open
Abstract
Introduction There has been an exponential increase in referrals for transmasculine patients seeking genital affirmation surgery. Despite transgender men’s equal interest in metoidioplasty and phalloplasty, research has primarily focused on phalloplasty. Aim To summarize and investigate the relationship between surgical technique, complications, and patient-satisfaction. Methods We performed a systematic review and meta-analysis of surgical techniques and physician- and patient-reported outcomes of gender-affirming clitoral release and metoidioplasty (PROSPERO# 158722) with literature from PubMed, Google Scholar, and ScienceDirect. Data were extracted using PRISMA guidelines. All searches, extractions, and grading were independently completed by 2 authors. Main Outcome Measures Main measures were surgical technique, patient satisfaction, voiding, urethral stricture, and urethral fistula. Results and Conclusion A total of 7 non-overlapping articles on metoidioplasty were identified, with a total of 403 patients. We identified 4 metoidioplasty techniques: Hage, Belgrade, labial ring flap, and extensive metoidioplasty. All techniques included urethral lengthening. The reported neophallus length ranged from 2 cm to 12 cm, with the smallest neophallus occurring with the labial ring flap technique and extensive metoidioplasty the largest. Across techniques, voiding while standing was reported in most patients, with the lowest rate reported with the labial ring flap (67%). Complications were impacted by surgical technique, with the lowest rates of fistula and stricture occurring with the Belgrade technique. Fistula rates ranged from 5% to 37%, while stricture ranged from 2% to 35% of patients. The Belgrade technique reported significantly lower rates of fistula and stricture (P = .000). The patient-reported outcomes were described for the Belgrade technique and extensive metoidioplasty. Both techniques showed high aesthetic and sexual satisfaction. Transgender individuals can achieve an aesthetically and sexually satisfactory neophallus using a variety of metoidioplasty techniques; however, urethral outcomes vary significantly by technique. The Belgrade technique reported the best outcomes, although data remains limited. Patient priorities should be used to determine surgical technique. Jolly D, Wu CA, Boskey ER, et al. Is Clitoral Release Another Term for Metoidioplasty? A Systematic Review and Meta-Analysis of Metoidioplasty Surgical Technique and Outcomes. Sex Med 2021;9:100294
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Affiliation(s)
- Divya Jolly
- Center for Gender Surgery, Boston Children's Hospital, Boston, MA; Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA.
| | | | - Elizabeth R Boskey
- Center for Gender Surgery, Boston Children's Hospital, Boston, MA; Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA; Department of Surgery, Harvard Medical School, Boston, MA
| | - Amir H Taghinia
- Center for Gender Surgery, Boston Children's Hospital, Boston, MA; Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA; Department of Surgery, Harvard Medical School, Boston, MA
| | - David A Diamond
- Center for Gender Surgery, Boston Children's Hospital, Boston, MA; Department of Urology, Boston Children's Hospital, Boston, MA
| | - Oren Ganor
- Center for Gender Surgery, Boston Children's Hospital, Boston, MA; Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA; Department of Surgery, Harvard Medical School, Boston, MA
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Al-Qurayshi Z, Sullivan CB, Pagedar N, Randolph G, Kandil E. Prevalence of major structures injury in thyroid and neck surgeries: a national perspective. Gland Surg 2020; 9:1924-1932. [PMID: 33447543 DOI: 10.21037/gs-20-369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background The objectives of the study is to examine the prevalence and burden of major structures injury (pharynx, esophagus, trachea, larynx, lymphatic, vessels & nerves) in patients who underwent thyroid, parathyroid, and neck dissection surgeries in the United States. Methods The study is a retrospective cross-sectional analysis utilizing the Nationwide Readmissions Database, 2010-2015. The study population included adults (≥18 years) patients who underwent thyroid, parathyroid, and neck dissection surgeries. Results A total of 54,443 patients were included. Major structures injury was reported in 221 (0.48%) patients. The injured structures were vascular (0.22%), lymphatic (0.18%), pharynx/esophagus (0.06%), neural (0.03%), and trachea/larynx (0.002%). The risk of injury increased annually during the study period (OR: 1.29, 95% CI: 1.16, 1.44, P<0.001). The risk of injury was highest in patients who underwent thyroidectomy with neck dissection (1.01%) or neck dissection alone (1.81%) (P<0.001 each). The risk was also highest for patients with a head and neck cancer diagnosis (OR: 1.80, 95% CI: 1.24, 2.61, P=0.002). Patients with those injuries had a higher prevalence of blood transfusion (2.82% vs. 0.17%), postoperative fistula (3.10% vs. 0.03%), readmission (28.90% vs. 3.59%), and postoperative mortality (0.87% vs. 0.06%) (P<0.05 each). Management of patients with those injuries was associated with a longer hospital stay by 4.86±0.48 days (P<0.001), and a higher cost by $16,151.00±173.36 (P<0.001). Conclusions Injuries of major structures in thyroid and neck surgeries are more prevalent in cancer patients. There has been a recent increase in the risk of such injuries in the United States. Those injuries are associated with significant clinical and economic burden.
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Affiliation(s)
- Zaid Al-Qurayshi
- Department of Otolaryngology - Head & Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Christopher Blake Sullivan
- Department of Otolaryngology - Head & Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Nitin Pagedar
- Department of Otolaryngology - Head & Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Gregory Randolph
- Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA, USA.,Division of Thyroid and Parathyroid Endocrine Surgery, Massachusetts Eye and Ear Infirmary, Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
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Becker BB. Diplopia following lower blepharoplasty. J AAPOS 2020; 24:363.e1-363.e4. [PMID: 33246110 DOI: 10.1016/j.jaapos.2020.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/19/2020] [Accepted: 07/28/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE To investigate the likelihood of surgeons performing lower blepharoplasties having cases of diplopia persisting for more than 1 week after surgery. METHODS An anonymous survey (13 questions) on the frequency and characteristics of persistent diplopia (lasting >1 week) after lower blepharoplasty was sent to members of the American Society of Ophthalmic Plastic and Reconstructive Surgery. RESULTS Of 703 members, 371 (52.8%) responded to the survey. Of these, 86 (23.2%) had at least 1 case of persistent diplopia following lower blepharoplasty. Complete data were available for 84 of the 86 physicians. The inferior oblique muscle was involved in 51 cases (61%), the inferior rectus muscle in 7 cases (8%), both the inferior oblique and inferior rectus muscles in 4 cases (5%), and the muscle involved was not identified in 22 patients (26%). The diplopia was paretic in 49 patients (58%) and restrictive in 35 (42%). The diplopia persisted in primary position in 7 patients (8%), in gaze positions other than primary position in 16 patients (19%), and resolved completely in 61 patients (73%). CONCLUSIONS There is a significant chance of surgeons performing lower blepharoplasties having at least 1 case of diplopia lasting over a week postoperatively. Our survey results indicate that this complication may be more common than is suggested by the medical literature.
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Affiliation(s)
- Bruce Bryan Becker
- Stein Eye Institute, Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
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Hsu CC, Malay S, Chung TT, Loh CYY, Lin YT, Chung KC. The impact of hospital, surgeon, and patient characteristics on digit replantation decision: A national population study. Injury 2020; 51:2532-2540. [PMID: 32829894 DOI: 10.1016/j.injury.2020.08.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/10/2020] [Accepted: 08/16/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Traumatic finger amputations cause a substantial burden to health care system. The purpose of this study is to investigate the epidemiology of traumatic finger amputations, the incidence of replantation attempts and to examine the patient, surgeon, and hospital characteristics that were associated with replantation attempts. METHODS We examined 49,469 patients with traumatic digit amputations from the National Health Insurance Research Database (NHIRD) of Taiwan. We used Chi-square, ANOVA tests, and regression analysis to determine the important factors in decision to replant. RESULTS The replantation rate increased significantly with increased hospital volume (low-volume: 4.7%, medium-volume: 19.1 % and high-volume: 35.9 %). Regional hospitals were more likely to attempt replantation (odds ratio = 1.35). Low-volume hospitals had a replantation failure rate of 11.1 %, medium-volume 19.7 % and high-volume hospitals had 13.8 %. CONCLUSION With the national health insurance coverage, hospital volume is a substantial factor to encourage microsurgical-trained staff to perform digit replantation when indicated. The findings from this study will support government initiatives to foster and reward regionalization centers with high to medium case volume of replants to manage this critical function restoring procedure.
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Affiliation(s)
- Chung-Chen Hsu
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taiwan; College of Medicine, Chang Gung University, Taiwan
| | - Sunitha Malay
- Clinical Research Coordinator, Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Ting-Ting Chung
- Data Analyst, Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Charles Yuen Yung Loh
- Center for Vascularized Composite Allotransplantation, Chang Gung Memorial Hospital, Taoyuan, Taiwan, St Andrew's Centre for Plastic and Reconstructive Surgery, Broomfield Hospital, Court Road, Chelmsford, Essex, CM1 7ET, United Kingdom
| | - Yu-Te Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taiwan; College of Medicine, Chang Gung University, Taiwan
| | - Kevin C Chung
- Charles B. G. de Nancrede Professor of Surgery, Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, United States.
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Wu S, Cui X, Zhang S, Tian W, Liu J, Wu Y, Wu M, Han Y. Economic burden of readmission due to postoperative cerebrospinal fluid leak in Chinese patients. J Comp Eff Res 2020; 9:1105-1115. [PMID: 33112181 DOI: 10.2217/cer-2020-0067] [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] [Indexed: 01/24/2023] Open
Abstract
Aim: This real-world data study investigated the economic burden and associated factors of readmissions for cerebrospinal fluid leakage (CSFL) post-cranial, transsphenoidal, or spinal index surgeries. Methods: Costs of CSFL readmissions and index hospitalizations during 2014-2018 were collected. Readmission cost was measured as absolute cost and as percentage of index hospitalization cost. Factors associated with readmission cost were explored using generalized linear models. Results: Readmission cost averaged US$2407-6106, 35-94% of index hospitalization cost. Pharmacy costs were the leading contributor. Generalized linear models showed transsphenoidal index surgery and surgical treatment for CSFL were associated with higher readmission costs. Conclusion: CSFL readmissions are a significant economic burden in China. Factors associated with higher readmission cost should be monitored.
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Affiliation(s)
| | - Xin Cui
- Shanghai Information Center for Health, Shanghai, PR China
| | - Shaoyu Zhang
- Shanghai Information Center for Health, Shanghai, PR China
| | - Wenqi Tian
- Shanghai Information Center for Health, Shanghai, PR China
| | - Jiazhen Liu
- Shanghai Information Center for Health, Shanghai, PR China
| | - Yiqing Wu
- Johnson & Johnson Medical Shanghai, Shanghai, PR China
| | - Man Wu
- Johnson & Johnson Medical Shanghai, Shanghai, PR China
| | - Yi Han
- Health Economics Research Institute, Sun Yat-Sen University, Guangzhou, Guangdong Province, PR China
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14
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Adult Cranioplasty and Perioperative Patient Safety: Does Plastic Surgery Facility Volume Matter? J Craniofac Surg 2020; 32:120-124. [PMID: 33055559 DOI: 10.1097/scs.0000000000007177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
ABSTRACT Cranioplasty lies at the intersection of neurosurgery and plastic surgery, though little is known about the impact of plastic surgery involvement. The authors hypothesized that adult cranioplasty patients at higher volume plastic surgery facilities would have improved inpatient outcomes. Adult cranioplasty encounters were extracted from the National Inpatient Sample from 2012 to 2014 based on International Classification of Diseases, Ninth Revision (ICD-9) codes. Regression models included the following variables: age, gender, race/ethnicity, Elixhauser Comorbidity Index, payer, hospital size, region, and urban/teaching status. Outcomes included odds of receiving a flap, perioperative patient safety indicators, and mortality. The weighted sample included 49,305 encounters with diagnoses of neoplasm (31.2%), trauma (56.4%), infection (5.2%), a combination of these diagnoses (3.9%), or other diagnoses (3.2%). There were 1375 inpatient mortalities, of which 10 (0.7%) underwent a flap procedure. On multivariable regression, higher volume plastic surgery facilities and all diagnoses except uncertain neoplasm were associated with an increased likelihood of a flap procedure during the admission for cranioplasty, using benign neoplasm as a reference (P < 0.001). Plastic surgery facility volume was not significantly associated with likelihood of a patient safety indicator event. The highest volume plastic surgery quartile was associated with lower likelihood of inpatient mortality (P = 0.008). These findings support plastic surgery involvement in adult cranioplasty and suggest that these patients are best served at high volume plastic surgery facilities.
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15
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Unplanned 30-day readmission rates after plastic and reconstructive surgery procedures: a systematic review and meta-analysis. EUROPEAN JOURNAL OF PLASTIC SURGERY 2020. [DOI: 10.1007/s00238-020-01731-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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16
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Brennan M, Wong S, Faringer PD, Lim JH. Head and Neck Tumor Resection and Free Flap Reconstruction in Low-Volume Center. EAR, NOSE & THROAT JOURNAL 2020; 100:647-650. [PMID: 32364445 DOI: 10.1177/0145561320923835] [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] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To determine the surgical outcomes of free tissue transfer surgery following head and neck tumor extirpation in a low-volume medical center. METHODS Retrospective chart review of patients who underwent free tissue transfer surgery for head and neck cancer at Moanalua Medical Center from 2015 to 2018. MAIN OUTCOME OF MEASURE Free flap failure rate and free flap-related complications. RESULTS From 2015 to 2018, there were 27 free tissue transfer surgery (mean 6.75 flap surgery/year). There were 2 events of partial flap necrosis, and no cases of total flap loss. One patient required leech therapy for venous congestion. One patient required additional free flap surgery. Two patients developed orocutaneous fistula that resolved with local wound care. One patient developed malocclusion following mandible reconstruction using fibular free flap. Overall free flap success rate was 96%. CONCLUSION This study supports the ability of small-volume centers to produce positive outcomes with few complications in head and neck cancer free flap reconstructive surgery. While the data are limited to a single surgical team in one care center, it provides additional support for the idea that there are factors beyond the surgical volume that determine outcome.
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Affiliation(s)
- Malia Brennan
- John A Burns School of Medicine, University of Hawaii, Honolulu, HI, USA.,Hawaii Permanente Medical Group, Honolulu, HI, USA
| | - Shelley Wong
- John A Burns School of Medicine, University of Hawaii, Honolulu, HI, USA.,Hawaii Permanente Medical Group, Honolulu, HI, USA
| | - Paul D Faringer
- John A Burns School of Medicine, University of Hawaii, Honolulu, HI, USA.,Hawaii Permanente Medical Group, Honolulu, HI, USA.,Department of Plastics and Reconstructive Surgery, Kaiser-Moanalua Medical Center, Honolulu, HI, USA
| | - Jae H Lim
- John A Burns School of Medicine, University of Hawaii, Honolulu, HI, USA.,Hawaii Permanente Medical Group, Honolulu, HI, USA.,Department of Otolaryngology-Head and Neck Surgery, Kaiser-Moanalua Medical Center, Honolulu, HI, USA
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17
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Reid CM, Parmeshwar N, Brandel MG, Crisera CA, Herrera FA, Suliman AS. Detailed analysis of the impact of surgeon and hospital volume in microsurgical breast reconstruction. Microsurgery 2020; 40:670-678. [PMID: 32304337 DOI: 10.1002/micr.30591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/13/2020] [Accepted: 04/02/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Prior investigations of microsurgical breast reconstruction have not distinguished the effects of surgeon versus hospital volume and failed to address the effect of patient clustering. Our data-driven analysis aims to determine the impacts of surgeon and hospital volume on outcomes of microsurgical breast reconstruction. METHODS Nationwide Inpatient Sample (NIS) data from 2008 to 2011 was analyzed for patients who underwent microsurgical breast reconstruction. Volume-outcome relationships were analyzed with restricted cubic spline analysis. A multivariable mixed-effects logistic regression was used to account for patient clustering effect. RESULTS A total of 5,404 NIS patients met inclusion criteria. High-volume (HV) surgeons had a 59% decrease in the risk of inpatient complications, which became non-significant after clustering correction. For HV hospitals, there was a 47% decrease in the risk of inpatient complications (odds ratio = 0.53; 95% confidence intervals 0.30, 0.91; p = 0.021) that was statistically significant with the clustering adjustment. Neither the volume-cost relationship for surgeons nor hospitals remained statistically significant after accounting for clustering. CONCLUSIONS Hospital volume plays a significant impact on outcomes in microsurgical breast reconstruction, while surgeon volume has comparatively not shown to be similarly impactful. The complexity of care related to microsurgical breast reconstruction warrants equally complex and engineered health systems.
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Affiliation(s)
- Chris M Reid
- Division of Plastic Surgery, Department of Surgery, University of California, San Diego, California, USA.,Section of Plastic & Reconstructive Surgery, VA San Diego Healthcare System, San Diego, California, USA
| | - Nisha Parmeshwar
- Division of Plastic Surgery, Department of Surgery, University of California, San Francisco, California, USA
| | - Michael G Brandel
- Division of Plastic Surgery, Department of Surgery, University of California, San Diego, California, USA
| | - Christopher A Crisera
- Division of Plastic Surgery, Department of Surgery, University of California, Los Angeles, California, USA
| | - Fernando A Herrera
- Division of Plastic Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ahmed S Suliman
- Division of Plastic Surgery, Department of Surgery, University of California, San Diego, California, USA.,Section of Plastic & Reconstructive Surgery, VA San Diego Healthcare System, San Diego, California, USA
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18
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Abstract
Annually, an estimated 234 million major surgical operations occur worldwide, with concomitant seven million complications and one million deaths. It is now well established that technical competence is necessary, but not sufficient for modern surgical practice and outcomes. Breakdown in non-technical skills has been attributed as a key root cause for near misses and patient harm in the operating room. This article discusses the multi-faceted skills-set that is necessary for the modern surgeon to succeed and for optimal patient outcomes. This includes technical skills, non-technical skills, with a focus on key CanMEDS framework domains, including leadership, communication, evidence-based surgery and mentorship.
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Affiliation(s)
- Ankur Khajuria
- Department of Surgery and Cancer, Imperial College London, UK.,Kellogg College, University of Oxford, UK
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19
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Heilbronn C, Cragun D, Wong BJ. Complications in Rhinoplasty: A Literature Review and Comparison with a Survey of Consent Forms. Facial Plast Surg Aesthet Med 2020; 22:50-56. [DOI: 10.1089/fpsam.2019.29007.won] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Cameron Heilbronn
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine Medical Center, Orange, California
| | - Dalan Cragun
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine Medical Center, Orange, California
| | - Brian J.F. Wong
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine Medical Center, Orange, California
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20
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The Outcomes Movement: Reflection from the Former Outcomes Editor with a View of the Future. Plast Reconstr Surg 2020; 145:590-592. [DOI: 10.1097/prs.0000000000006429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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21
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Computer-Assisted Design and Manufacturing Assists Less Experienced Surgeons in Achieving Equivalent Outcomes in Cranial Vault Reconstruction. J Craniofac Surg 2019; 30:2034-2038. [PMID: 31306375 DOI: 10.1097/scs.0000000000005748] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE The purpose of this study was to assess whether long-term outcomes were equivalent between computer-assisted design and manufacturing (CAD/CAM) -assisted cranial vault reconstruction performed by an inexperienced surgeon, with fewer years of surgical experience, and traditional reconstruction performed by senior surgeons with many decades of experience. METHODS An Institutional Review Board-approved retrospective cohort study was performed for all patients with nonsyndromic craniosynostosis between the ages of 1 month to 18 years who received primary, open calvarial vault reconstruction at the Johns Hopkins Hospital between 1990 and 2017. The primary outcome variable was the Whitaker category (I-IV) for level of required revision at the 2-year follow-up visit. Secondary outcomes included estimated blood loss, length of stay, operative time, and postoperative complications. CAD/CAM-assisted surgery was considered noninferior if the proportion of cases requiring any revision (Whitaker II, III, or IV) was no more than 10% greater than the proportion in the traditional surgery group with multivariate logistic regression analysis. t tests and fisher exact tests were used for secondary outcomes. RESULTS A total of 335 patients were included, with 35 CAD/CAM-assisted reconstructions. CAD/CAM-assisted reconstruction was noninferior to traditional after accounting for patient demographics, type of surgery, and experience level of the plastic surgeon. The traditional group required revision more frequently at 29.0% compared to CAD/CAM at 14.3%. Secondary outcomes were not significantly different between groups, but CAD/CAM had significantly longer average operative times (5.7 hours for CAD/CAM, 4.3 hours for traditional, P < 0.01). CONCLUSION CAD/CAM technology may lower the learning curve and assist less experienced plastic surgeons in achieving equivalent long-term outcomes in craniofacial reconstruction.
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22
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Virtual Surgical Planning for Mandibular Reconstruction With the Fibula Free Flap. Ann Plast Surg 2019; 84:117-122. [DOI: 10.1097/sap.0000000000002006] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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The Impact of Surgical Volume on Outcomes and Cost in Cleft Repair: A Kids' Inpatient Database Analysis. Ann Plast Surg 2019; 80:S174-S177. [PMID: 29672335 DOI: 10.1097/sap.0000000000001388] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Centralization of specialist services, including cleft service delivery, is occurring worldwide with the aim of improving the outcomes. This study examines the relationship between hospital surgical volume in cleft palate repair and outcomes. METHODS A retrospective analysis of the Kids' Inpatient Database was undertaken. Children 3 years or younger undergoing cleft palate repair in 2012 were identified. Hospital volume was categorized by cases per year as low volume (LV; 0-14), intermediate volume (IV; 15-46), or high volume (HV; 47-99); differences in complications, hospital costs, and length of stay (LOS) were determined by hospital volume. RESULTS Data for 2389 children were retrieved: 24.9% (n = 595) were LV, 50.1% (n = 1196) were IV, and 25.0% (n = 596) were HV. High-volume centers were more frequently located in the West (71.9%) compared with LV (19.9%) or IV (24.5%) centers (P < 0.001 for hospital region). Median household income was more commonly highest quartile in HV centers compared with IV or LV centers (32.3% vs 21.7% vs 18.1%, P < 0.001). There was no difference in complications between different volume centers (P = 0.74). Compared with HV centers, there was a significant decrease in mean costs for LV centers ($9682 vs $,378, P < 0.001) but no significant difference in cost for IV centers ($9260 vs $9682, P = 0.103). Both IV and LV centers had a significantly greater LOS when compared with HV centers (1.97 vs 2.10 vs 1.74, P < 0.001). CONCLUSIONS Despite improvement in LOS in HV centers, we did not find a reduction in cost in HV centers. Further research is needed with analysis of outpatient, long-term outcomes to ensure widespread cost-efficiency.
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24
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Effect of hospital and surgeon volume on postoperative outcomes after distal gastrectomy for gastric cancer based on data from 145,523 Japanese patients collected from a nationwide web-based data entry system. Gastric Cancer 2019; 22:190-201. [PMID: 30302654 DOI: 10.1007/s10120-018-0883-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 09/29/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite interest in surgeon and hospital volume effects on distal gastrectomy, clinical significance has not been confirmed in a large-scale population. We studied to clarify the effects of surgeon and hospital volume on postoperative mortality after distal gastrectomy for gastric cancer among Japanese patients in a nationwide web-based data entry system. METHODS We extracted data on distal gastrectomy for gastric cancer from the National Clinical Database between 2011 and 2015. The primary outcome was operative mortality. Hospital volume was divided into 3 tertiles: low (1-22 cases per year), medium (23-51) and high (52-404). Surgeon volume was divided into the 5 groups: 0-3, 4-10, 11-20, 21-50, 51 + cases per year. We calculated the 95% confidence interval (CI) for the mortality rate based on odds ratios (ORs) estimated from a hierarchical logistic regression model. RESULTS We analyzed 145,523 patients at 2182 institutions. Operative mortality was 1.9% in low-, 1.0% in medium- and 0.5% in high-volume hospitals. The operative mortality rate decreased definitively with surgeon volume, 1.6% in the 0-3 group and 0.3% in the 51 + group. After risk adjustment for surgeon and hospital volume and patient characteristics, hospital volume was significantly associated with operative morality (medium: OR 0.64, 95% CI 0.56-0.73, P < 0.001; high: OR 0.42, 95% CI 0.35-0.51, P < 0.001). CONCLUSIONS We demonstrate that hospital volume can have a crucial impact on postoperative mortality after distal gastrectomy compared with surgeon volume in a nationwide population study. These findings suggest that centralization may improve outcomes after distal gastrectomy.
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25
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Wagner ER, Chung KC. Commentary on "Our Surgical Experience: Open Versus Endoscopic Carpal Tunnel Surgery". J Hand Surg Am 2018; 43:862-863. [PMID: 30172278 DOI: 10.1016/j.jhsa.2018.03.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 03/21/2018] [Indexed: 02/02/2023]
Affiliation(s)
- Eric R Wagner
- Division of Upper Extremity Surgery, Department of Orthopedic Surgery, Emory University, Atlanta, GA
| | - Kevin C Chung
- Section of Plastic Surgery, University of Michigan Medical School, Ann Arbor, MI
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