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Heesen P, Elyes M, Domanski J, Schelling G, Könneker S, Fuchs B. Exploring Risk Factors for Predicting 30-Day Postoperative Morbidity in Musculoskeletal Tumor Surgery. J Clin Med 2024; 13:2681. [PMID: 38731210 PMCID: PMC11084328 DOI: 10.3390/jcm13092681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024] Open
Abstract
Background: This study investigates the risk factors associated with postoperative complications in musculoskeletal tumor surgeries and evaluates the impact of benchmarking in enhancing surgical outcomes. Methods: Conducted at a tertiary referral center, this retrospective analysis included 196 patients who underwent surgeries for various musculoskeletal tumors, ranging from soft tissue to bone sarcomas. Patient and tumor characteristics, along with surgical interventions and outcomes, were comprehensively assessed using the Charlson Comorbidity Index and the Clavien-Dindo classification. Results: Key findings indicate that surgical reconstruction, ASA 3 status, bone tumor presence, and the need for multiple erythrocyte transfusions significantly increase postoperative morbidity. Notably, no significant correlation was found between the Charlson Comorbidity Index scores and the occurrence or severity of complications, challenging the utility of this index in predicting short-term surgical outcomes. Conclusions: This study highlights the importance of tailored surgical approaches and emphasizes rigorous preoperative assessments to mitigate risks and enhance patient care. Despite its insights, limitations include its retrospective nature and single-center scope, suggesting a need for broader, multicenter studies to generalize findings. Overall, our results underscore the necessity of integrating clinical assessments with benchmarking data to optimize outcomes in the complex field of musculoskeletal tumor surgery.
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Affiliation(s)
- Philip Heesen
- Department of Plastic & Reconstructive Surgery, University Hospital USZ, University of Zurich, 8000 Zurich, Switzerland
| | - Maria Elyes
- Department of Orthopedics & Trauma, Sarcoma Service, LUKS University Hospital, University of Lucerne, 6000 Lucerne, Switzerland
| | - Jan Domanski
- Department of Trauma Surgery and Orthopedics, Ortenau Klinikum, 77654 Offenburg, Germany
| | - Georg Schelling
- Department of Orthopedics & Trauma, Sarcoma Service, LUKS University Hospital, University of Lucerne, 6000 Lucerne, Switzerland
| | - Sören Könneker
- Department of Plastic & Reconstructive Surgery, University Hospital USZ, University of Zurich, 8000 Zurich, Switzerland
| | - Bruno Fuchs
- Department of Orthopedics & Trauma, Sarcoma Service, LUKS University Hospital, University of Lucerne, 6000 Lucerne, Switzerland
- Department of Orthopedics and Trauma, Sarcoma Service, Kantonsspital Winterthur, 8400 Winterthur, Switzerland
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Morii T, Sato K, Ogura K, Kawai A. Incidence and risk of infection in malignant soft tissue tumor resection: Data from the nationwide soft tissue tumor registry. J Orthop Sci 2023:S0949-2658(23)00211-7. [PMID: 37599134 DOI: 10.1016/j.jos.2023.08.002] [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: 05/17/2023] [Revised: 07/24/2023] [Accepted: 08/02/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Postoperative infection is a devastating complication in limb salvage surgery for malignant soft tissue tumors. The low absolute case numbers of these rare cancers represent a bottleneck for data collection and analysis. The administration of nationwide registry data is a practical option for the accumulation of cases. METHODS Data on malignant soft tissue tumor resection were extracted from the Bone and Soft Tissue Tumor Registry in Japan. The incidence of postoperative infection and its risk factors were analyzed. RESULTS A total of 14,460 cases were included. The incidence of infection was 2.6%. Significant risks for infection were male sex, lower extremity or trunk location, tumor diameter of over 10 cm, trans-compartmental invasion, high grade, autologous bone graft, myocutaneous flap, vascular reconstruction, reconstruction by prosthesis, postoperative radiotherapy, and delayed wound healing. CONCLUSIONS The incidence was lower than those in the previous studies, perhaps because of less frequent radiotherapy application. Some of the significant risk factors represented local invasiveness of the tumor, suggesting the importance of the preservation of soft tissue for infection prevention. The administration of nationwide registry data was informative for the analysis of infection in malignant soft tissue tumor resection.
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Affiliation(s)
- Takeshi Morii
- Department of Orthopaedic Surgery, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
| | - Kenji Sato
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Koichi Ogura
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Akira Kawai
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
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Kayton ML, Weiss AR, Xue W, Binitie O, Hayes Dixon A, Randall RL, Sorger JI, Hawkins DS, Spunt SL, Wang D, Million L, Terezakis S, Choy E, Okuno SH, Venkatramani R, Chen YL, Scharschmidt TJ. Neoadjuvant pazopanib in nonrhabdomyosarcoma soft tissue sarcomas (ARST1321): A report of major wound complications from the Children's Oncology Group and NRG Oncology. J Surg Oncol 2023; 127:871-881. [PMID: 36779385 PMCID: PMC10121189 DOI: 10.1002/jso.27205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 01/05/2023] [Accepted: 01/15/2023] [Indexed: 02/14/2023]
Abstract
BACKGROUND AND OBJECTIVES The impact upon wound healing of targeted molecular therapies, when incorporated into neoadjuvant therapy of soft tissue sarcoma, is largely unknown. Here, we describe wound complications following addition of pazopanib, a tyrosine kinase inhibitor (TKI), to neoadjuvant radiotherapy (RT) +/- chemotherapy for soft tissue sarcoma. METHODS Wound complications were evaluated on dose-finding and randomized arms of ARST1321, a phase II/III study incorporating neoadjuvant RT, +/- pazopanib, +/- ifosfamide/doxorubicin (ID) for sarcoma therapy. RESULTS Of 85 evaluable patients, 35 (41%) experienced postoperative wound complications. Most (57%) were grade III. Randomization to pazopanib + RT + ID carried a 50% wound complication rate (17/34, with 47% grade III), compared to 22% (5/23) with ID + RT alone. In nonchemotherapy study arms, pazopanib + RT resulted in a 59% wound complication rate versus 25% for those receiving RT alone. Grade III wound complications occurred among 26% (15/58) of all patients receiving pazopanib. Wound complications occurred a median of 35 days postoperatively. Some occurred following diagnostic biopsies and at remote surgical sites. CONCLUSION The addition of pazopanib to neoadjuvant chemotherapy and RT resulted in a higher wound complication rate following therapy of soft tissue sarcoma. The rate of grade III complications remained comparable to that reported in contemporary literature.
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Affiliation(s)
- Mark L Kayton
- Department of Surgery, K. Hovnanian Children's Hospital at Jersey Shore University Medical Center, Hackensack-Meridian Health Network, Neptune, New Jersey, USA
| | - Aaron R Weiss
- Department of Pediatrics, Maine Medical Center, Portland, Maine, USA
| | - Wei Xue
- Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | - Odion Binitie
- Department of Sarcoma, Moffitt Cancer Center, Tampa, Florida, USA
| | - Andrea Hayes Dixon
- Department of Surgery, Howard University, Washington, District of Columbia, USA
| | - R Lor Randall
- Department of Orthopaedic Surgery, University of California Davis, Sacramento, California, USA
| | - Joel I Sorger
- Department of Orthopedic Surgery, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Douglas S Hawkins
- Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, USA
| | - Sheri L Spunt
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Dian Wang
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois, USA
| | - Lynn Million
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Stephanie Terezakis
- Department of Radiation Oncology, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Edwin Choy
- Department of Medical Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Scott H Okuno
- Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rajkumar Venkatramani
- Department of Pediatrics, Texas Children's Cancer Center, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Yen-Lin Chen
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Thomas J Scharschmidt
- Department of Orthopaedics, James Cancer Hospital and Nationwide Children's Hospital, Columbus, Ohio, USA
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Virtual surgical planning and 3D printing in pediatric musculoskeletal oncological resections: a proof-of-concept description. Int J Comput Assist Radiol Surg 2023; 18:95-104. [PMID: 36152167 DOI: 10.1007/s11548-022-02745-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/01/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND OBJECTIVES Patient-specific models may have a role in planning and executing complex surgical procedures. However, creating patient-specific models with virtual surgical planning (VSP) has many steps, from initial imaging to finally realizing the three-dimensional printed model (3DPM). This manuscript evaluated the feasibility and potential benefits of multimodal imaging and geometric VSP and 3DPM in pediatric orthopedic tumor resection and reconstruction. MATERIALS AND METHODS Twelve children with Ewing's sarcoma, osteosarcoma, or chondrosarcoma were studied. Computed tomography (CT) and contrast-enhanced magnetic resonance imaging (MRI) were acquired as the standard-of-care. Bony and soft tissue components of the tumor and the adjacent bone were segmented to create a computer-generated 3D model of the region. VSP used the computer-generated 3D model. The Objet350 Stratasys™ polyjet printer printed the final physical model used for pre-surgical planning, intraoperative reference, and patient education. Clinical impact, the utility of the model, and its geometric accuracy were assessed. RESULTS Subjectively, using the patient-specific model assisted in preoperative planning and intra-operative execution of the surgical plan. The mean difference between the models and the surgical resection was -0.09 mm (range: -0.29-0.45 mm). Pearson's correlation coefficient (r) of the cross-sectional area was -0.9994, linear regression r2 = 0.9989, and the Bland Altman plot at 95% confidence interval showed all data within boundaries. CONCLUSION We studied the geometric accuracy, utility and clinical impact of VSP and 3DPM produced from multi-modal imaging studies and concluded 3DPM accurately represented the patients' tumor and proved very useful to the surgeon in both the preoperative surgical planning, patient and family education and operative phases. Future studies will be planned to evaluate surgery procedure duration and other outcomes.
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Goodenough CJ, Hartline CA, Wei S, Moffitt JK, Cepeda A, Nguyen PD, Greives MR. Incidence of Readmission Following Pediatric Hand Surgery: An Analysis of 6600 Patients. EPLASTY 2022; 22:e40. [PMID: 36160660 PMCID: PMC9490882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Quality in surgical outcomes is frequently assessed by the 30-day readmission rate. There are limited data available in the published literature regarding readmission rates following pediatric hand surgery. This study aims to identify factors associated with an increased risk of readmission following hand surgery in a pediatric population. METHODS The 2012-2017 National Surgical Quality Improvement Project - Pediatric (NSQIP-P) databases were queried for pediatric patients who underwent procedures with hand-specific current procedural terminology (CPT) codes. The primary outcome was readmission. RESULTS A total of 6600 pediatric patients were identified and included in the analysis. There were 45 patients who were readmitted in the study cohort, giving an overall readmission rate of 0.68%. The median time to readmission was 12 (IQR 5-20) days. On univariate analysis, factors associated with readmission included younger age, smaller size, prematurity, higher American Society of Anesthesiologists (ASA) class, inpatient admission at index operation, and longer anesthesia and operative times. Complex syndactyly repair was also associated with higher readmission rates. On multivariate analysis, ASA class 3 or 4 and inpatient surgery remained significant predictors of readmission. CONCLUSIONS Overall, pediatric hand surgery is associated with a very low risk of 30-day readmission. Higher ASA class and inpatient surgery increase patients' risk for readmission. In particular, complex syndactyly repair is associated with a higher risk of readmission than other hand procedures. This information is useful in surgical planning and preoperative counseling of parents.
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Affiliation(s)
- Christopher J Goodenough
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Louisville, Louisville, KY
| | - Cassie A Hartline
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Louisville, Louisville, KY
| | - Shuyan Wei
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Louisville, Louisville, KY
| | - Joseph K Moffitt
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Louisville, Louisville, KY
| | - Alfredo Cepeda
- University of Louisville School of Medicine, Louisville, KY
| | - Phuong D Nguyen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Louisville, Louisville, KY
| | - Matthew R Greives
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Louisville, Louisville, KY
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Niknam K, Sabharwal S, Swarup I. Issues With Big Data: Variability in Reported Demographics and Complications Associated With Posterior Spinal Fusion in Pediatric Patients. J Pediatr Orthop 2022; 42:e559-e564. [PMID: 35667050 DOI: 10.1097/bpo.0000000000002151] [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] [Indexed: 02/07/2023]
Abstract
BACKGROUND Clinical and administrative registries provide large volumes of data that can be used for clinical research. However, there are several limitations relating to the quality, consistency, and generalizability of big data. In this study, we aim to compare reported demographics and certain outcomes in patients undergoing posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS), neuromuscular scoliosis (NS), and Scheuermann kyphosis (SK) between 3 commonly utilized databases in pediatric orthopaedic research. METHODS We used International Classification of Diseases, Ninth Revision (ICD-9), International Classification of Diseases, 10th Revision (ICD-10), and Current Procedural Terminology (CPT) codes to identify patients in the National Surgical Quality Improvement Program (NSQIP), Healthcare Cost and Utilization Project (HCUP), and Pediatric Health Information System (PHIS) between the ages of 10 to 18 that underwent PSF for AIS, SK, and NS from 2012 to 2015. We compared various demographic factors, such as sex, race/ethnicity, age, and rates of postsurgical infection and 30-day readmissions. Data was analyzed with descriptive and univariate statistics. RESULTS We identified 9891 patients that underwent PSF in NSQIP, 10,771 patients in PHIS, and 4335 patients in HCUP over the study period. There were significant differences in patient demographics, readmission rates, and infection rates between all patients that underwent PSF across the databases (P<0.01), as well as specifically in patients with AIS (P<0.01). HCUP had the highest proportion of Hispanic patients that underwent PSF (13.5%), as well as patients who had AIS (13.3%) or NS (17.9%). The PHIS database had the highest proportion of patients undergoing PSF for SK. Among patients with NS, there were significant differences in race across the databases (P<0.01), but no significant differences in sex, ethnicity, or readmission (P>0.05). In addition, there were significant differences in race (P=0.04) and readmission (P=0.01) across databases for patients with SK, but no differences in sex or ethnicity (P>0.05). NSQIP reported the highest rate of 30-day readmissions for patients undergoing PSF (17.9%) compared with other databases (HCUP 4.1%, PHIS 12.1%). CONCLUSIONS There are significant differences in patient demographics, sample sizes, and rates of complications for pediatric patients undergoing PSF across 3 commonly utilized US administrative databases. Given the variability in reported outcomes and demographics, generalizability is difficult to extrapolate from these large data sources. In addition, certain databases should be selected to appropriately power studies focusing on particular patient populations or outcomes.
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Affiliation(s)
| | - Sanjeev Sabharwal
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA
| | - Ishaan Swarup
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA
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Lazarides AL, Flamant EM, Cullen MM, Ferlauto HR, Cochrane N, Gao J, Jung SH, Visgauss JD, Brigman BE, Eward WC. Investigating readmission rates for patients undergoing oncologic resection and endoprosthetic reconstruction for primary sarcomas and tumors involving bone. J Surg Oncol 2022; 126:356-364. [PMID: 35319106 DOI: 10.1002/jso.26864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 02/21/2022] [Accepted: 03/10/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Little is known about the drivers of readmission in patients undergoing Orthopaedic oncologic resection. The goal of this study was to identify factors independently associated with 90-day readmission for patients undergoing oncologic resection and subsequent prosthetic reconstruction for primary tumors involving bone. METHODS This was a retrospective comparative cohort study of patients treated from 2008 to 2019 who underwent endoprosthetic reconstruction for a primary bone tumor or soft tissue tumor involving bone, as well as those who underwent a revision endoprosthetic reconstruction if the primary endoprosthetic reconstruction was performed for an oncologic resection. The primary outcome measure was unplanned 90-day readmission. RESULTS A total of 149 patients were identified who underwent 191 surgeries were for a primary bone or soft tissue tumor. The 90-day readmission rate was 28.3%. Female gender, depression, higher tumor grade, vascular reconstruction, longer procedure duration, longer length of stay (LOS), multiple surgeries during an admission and disposition to a Skilled Nursing Facility were associated with readmission (p < 0.05). In a multivariate analysis, female sex, higher tumor grade and longer procedure duration were independently associated with risk of readmission (p < 0.05). CONCLUSIONS Readmission rates are high following endoprosthetic reconstruction for Orthopaedic oncologic resections. Further work is necessary to help minimize unplanned readmissions.
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Affiliation(s)
- Alexander L Lazarides
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Etienne M Flamant
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Mark M Cullen
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Harrison R Ferlauto
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Niall Cochrane
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Junheng Gao
- Department of Biostatistics & Bioinformatics, Duke University Medical Center, Durham, North Carolina, USA
| | - Sin-Ho Jung
- Department of Biostatistics & Bioinformatics, Duke University Medical Center, Durham, North Carolina, USA
| | - Julia D Visgauss
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Brian E Brigman
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - William C Eward
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
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Lazarides AL, Flamant EM, Cullen MC, Ferlauto HR, Goltz DE, Cochrane NH, Visgauss JD, Brigman BE, Eward WC. Why Do Patients Undergoing Extremity Prosthetic Reconstruction for Metastatic Disease Get Readmitted? J Arthroplasty 2022; 37:232-237. [PMID: 34740789 DOI: 10.1016/j.arth.2021.10.019] [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: 07/29/2021] [Revised: 09/11/2021] [Accepted: 10/27/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Orthopedic oncology patients are particularly susceptible to increased readmission rates and poor surgical outcomes, yet little is known about readmission rates. The goal of this study is to identify factors independently associated with 90-day readmission for patients undergoing oncologic resection and subsequent prosthetic reconstruction for metastatic disease of the hip and knee. METHODS This is a retrospective comparative cohort study of all patients treated from 2013 to 2019 at a single tertiary care referral institution who underwent endoprosthetic reconstruction by an orthopedic oncologist for metastatic disease of the extremities. The primary outcome measure was unplanned 90-day readmission. RESULTS We identified 112 patients undergoing 127 endoprosthetic reconstruction surgeries. Metastatic disease was most commonly from renal (26.8%), lung (23.6%), and breast (13.4%) cancer. The most common type of skeletal reconstruction performed was simple arthroplasty (54%). There were 43 readmissions overall (33.9%). When controlling for confounding factors, body mass index >40, insurance status, peripheral vascular disease, and longer hospital length of stay were independently associated with risk of readmission (P ≤ .05). CONCLUSION Readmission rates for endoprosthetic reconstructions for metastatic disease are high. Although predicting readmission remains challenging, risk stratification presents a viable option for helping minimize unplanned readmissions. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | - Etienne M Flamant
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Mark C Cullen
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Harrison R Ferlauto
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Daniel E Goltz
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Niall H Cochrane
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Julia D Visgauss
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Brian E Brigman
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - William C Eward
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
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Wells SJ, Austin M, Gottumukkala V, Kruse B, Mayon L, Kapoor R, Lewis V, Kelly D, Penny A, Braveman B, Shkedy E, Crowder R, Moody K, Swartz MC. Development of an Enhanced Recovery Program in Pediatric, Adolescent, and Young Adult Surgical Oncology Patients. CHILDREN 2021; 8:children8121154. [PMID: 34943351 PMCID: PMC8700533 DOI: 10.3390/children8121154] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/02/2021] [Accepted: 12/05/2021] [Indexed: 01/02/2023]
Abstract
Enhanced recovery after surgery (ERAS) protocols are standardized perioperative treatment plans aimed at improving recovery time in patients following surgery using a multidisciplinary team approach. These protocols have been shown to optimize pain control, improve mobility, and decrease postoperative ileus and other surgical complications, thereby leading to a reduction in length of stay and readmission rates. To date, no ERAS-based protocols have been developed specifically for pediatric patients undergoing oncologic surgery. Our objective is to describe the development of a novel protocol for pediatric, adolescent, and young adult surgical oncology patients. Our protocol includes the following components: preoperative counseling, optimization of nutrition status, minimization of opioids, meticulous titration of fluids, and early mobilization. We describe the planning and implementation challenges and the successes of our protocol. The effectiveness of our program in improving perioperative outcomes in this surgical population could lead to the adaptation of such protocols for similar populations at other centers and would lend support to the use of ERAS in the pediatric population overall.
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Affiliation(s)
- Stephanie J. Wells
- Department of Pediatrics Research, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Mary Austin
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.A.); (L.M.)
| | - Vijaya Gottumukkala
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (V.G.); (R.K.)
| | - Brittany Kruse
- Institute for Cancer Care Innovation, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Lauren Mayon
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (M.A.); (L.M.)
| | - Ravish Kapoor
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (V.G.); (R.K.)
| | - Valerae Lewis
- Department of Orthopaedic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (V.L.); (A.P.)
| | - Donna Kelly
- Department of Rehabilitation Services, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (D.K.); (B.B.)
| | - Alexander Penny
- Department of Orthopaedic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (V.L.); (A.P.)
| | - Brent Braveman
- Department of Rehabilitation Services, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (D.K.); (B.B.)
| | - Eliana Shkedy
- Department of Clinical Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (E.S.); (R.C.)
| | - Rebekah Crowder
- Department of Clinical Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (E.S.); (R.C.)
| | - Karen Moody
- Department of Patient Care, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Maria C. Swartz
- Department of Pediatrics Research, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
- Correspondence: ; Tel.: +1-713-745-3763
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Geißler K, Rippe W, Boeger D, Buentzel J, Hoffmann K, Kaftan H, Mueller A, Radtke G, Guntinas-Lichius O. 30-day readmission rate in pediatric otorhinolaryngology inpatients: a retrospective population-based cohort study. J Otolaryngol Head Neck Surg 2021; 50:55. [PMID: 34544499 PMCID: PMC8454104 DOI: 10.1186/s40463-021-00536-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 07/28/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Analysis of frequency and reasons for planned and unplanned 30-day readmission in hospitalized pediatric otorhinolaryngology patients using German Diagnosis Related Group (G-DRG) system data. METHODS A retrospective population-based cohort study in Thuringia, Germany, was performed for the year 2015 with 2440 cases under 18 years (55.6% male) out of a total number of 15.271 inpatient cases. The majority of pediatric patients were from 2 to 5 years old (54.5%). The most frequent diagnoses were hyperplasia of adenoids or/and tonsils (26.6%). 36 cases (1.5%) experienced readmission within 30-days. RESULTS 30-day readmission was planned in 9 cases (25% of all readmission) and was unplanned in 27 cases (75%). The median interval between index and readmission treatment was 8 days. Postoperative bleeding after adenoidectomy, tonsillotomy/tonsillectomy or tracheostomy (33.4%) and infectious complications after surgery like acute otitis media, abscess formation or fever (36.2%) were the most frequent reasons for 30-day readmission. Compared to adults treated in 2015 in Thuringia, the readmission rate was higher in adult patients (8.9%) than in this pediatric cohort. In contrast to children, readmissions in adults were mainly planned (65.1%) with a different spectrum of underlying diseases and reasons for readmission. CONCLUSION The 30-day readmission rate seemed to be lower for pediatric otolaryngology patients compared to adult patients. Unplanned readmissions dominated in pediatric patients, whereas planned readmissions dominated in adults.
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Affiliation(s)
- Katharina Geißler
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
| | - Wido Rippe
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Daniel Boeger
- Department of Otorhinolaryngology, SRH Zentralklinikum, Suhl, Germany
| | - Jens Buentzel
- Department of Otorhinolaryngology, Südharz-Krankenhaus gGmbH, Nordhausen, Germany
| | - Kerstin Hoffmann
- Department of Otorhinolaryngology, Sophien- Und Hufeland-Klinikum, Weimar, Germany
| | - Holger Kaftan
- Department of Otorhinolaryngology, HELIOS-Klinikum, Erfurt, Germany
| | - Andreas Mueller
- Department of Otorhinolaryngology, SRH Wald-Klinikum, Gera, Germany
| | - Gerald Radtke
- Department of Otorhinolaryngology, Ilm-Kreis-Kliniken, Arnstadt, Germany
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
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Evans DR, Lazarides AL, Cullen MM, Visgauss JD, Somarelli JA, Blazer DG, Brigman BE, Eward WC. Identifying Modifiable and Non-modifiable Risk Factors of Readmission and Short-Term Mortality in Osteosarcoma: A National Cancer Database Study. Ann Surg Oncol 2021; 28:7961-7972. [PMID: 34018083 DOI: 10.1245/s10434-021-10099-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/16/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND There are limited data to inform risk of readmission and short-term mortality in musculoskeletal oncology. The goal of this study was to identify factors independently associated with 30-day readmission and 90-day mortality following surgical resection of osteosarcoma. METHODS We retrospectively reviewed patients (n = 5293) following surgical resection of primary osteosarcoma in the National Cancer Database (2004-2015). Univariate and multivariate methods were used to correlate variables with readmission and short-term mortality. RESULTS Of 210 readmissions (3.97%), risk factors independently associated with unplanned 30-day readmission included comorbidity burden (odds ratio [OR] 2.4, p = 0.042), Medicare insurance (OR 1.9, p = 0.021), and axial skeleton location (OR 1.5, p = 0.029). A total of 91 patients died within 90 days of their surgery (1.84%). Risk factors independently associated with mortality included age (hazard ratio 1.1, p < 0.001), increasing comorbidity burden (OR 6.6, p = 0.001), higher grade (OR 1.7, p = 0.007), increasing tumor size (OR 2.2, p = 0.03), metastatic disease at presentation (OR 8.5, p < 0.001), and amputation (OR 2.0, p = 0.04). Chemotherapy was associated with a decreased risk of short-term mortality (p < 0.001). CONCLUSIONS Several trends were clear: insurance status, tumor location and comorbidity burden were independently associated with readmission rates, while age, amputation, grade, tumor size, metastatic disease, and comorbidity burden were independently associated with short-term mortality.
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Affiliation(s)
| | | | | | - Julia D Visgauss
- Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC, USA.,Duke Cancer Institute, Duke University Hospital, Durham, NC, USA
| | - Jason A Somarelli
- Duke Cancer Institute, Duke University Hospital, Durham, NC, USA.,Department of Medicine, Duke University Hospital, Durham, NC, USA
| | - Dan G Blazer
- Duke Cancer Institute, Duke University Hospital, Durham, NC, USA.,Department of Surgery, Duke University Hospital, Durham, NC, USA
| | - Brian E Brigman
- Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC, USA.,Duke Cancer Institute, Duke University Hospital, Durham, NC, USA
| | - William C Eward
- Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC, USA.,Duke Cancer Institute, Duke University Hospital, Durham, NC, USA
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