1
|
Michael GM, Morrison SD, Nolan IT, Shoham M, Gomez DA, Akhavan A, Hubbs BS, Satterwhite T. Role of allogeneic placental tissues in penile inversion vaginoplasty. Transl Androl Urol 2024; 13:736-747. [PMID: 38855581 PMCID: PMC11157404 DOI: 10.21037/tau-23-420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 03/17/2024] [Indexed: 06/11/2024] Open
Abstract
Background The role of allogeneic placental tissue (APT) in genital gender-affirming surgery (GAS) is not well understood. Penile inversion vaginoplasty (PIV), the most common genital GAS, often results in tissue healing- or wound-related complications, including scarring and neovaginal stenosis. Surgical reoperation and revision vaginoplasty are common. The aim of this study was to evaluate the contribution of APT to postoperative outcomes in PIV. Methods The authors performed a retrospective analysis of consecutive adult patients undergoing primary PIV during a 6-year period (September 1, 2014 to September 1, 2020). Subjects receiving intraoperative application of an APT biomaterial were compared to those undergoing primary PIV without APT. Postoperative outcomes-including wound healing morbidity and reoperation-were compared between groups. Short- and long-term complications were classified using Clavien-Dindo. Results A total of 182 primary PIV cases were reviewed (115 conventional PIV; 67 PIV-APT). The postoperative follow-up time for the population averaged 12.7 months. All-cause and wound related complications were significantly lower amongst PIV-APT patients when compared to conventional PIV (P=0.002 and P=0.004, respectively). The rate of long-term complications was significantly lower in PIV-APT subjects: prolonged pain (P=0.001), prolonged swelling (P=0.047), and neovaginal stenosis (P<0.001). The PIV-APT group required significantly less reoperation for vaginal depth enhancement (P=0.007). Conclusions Though its use in urogenital reconstruction has been limited, this study indicates that the placement of APT during PIV significantly lowered the risk of complications associated with poor wound healing. This supports a novel use for placental tissues in reducing complications in genital GAS.
Collapse
Affiliation(s)
| | - Shane D. Morrison
- Division of Plastic Surgery, University of Washington, Seattle, WA, USA
| | - Ian T. Nolan
- Division of Plastic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Maia Shoham
- Stanford University School of Medicine, Stanford, CA, USA
| | | | - Arya Akhavan
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Brandon S. Hubbs
- Department of Clinical Research, MiMedx Group, Inc., Marietta, GA, USA
| | - Thomas Satterwhite
- Align Surgical Associates, Inc., San Francisco, CA, USA
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Stanford, CA, USA
| |
Collapse
|
2
|
Zhang Y, Lu H, Ji H, Li Y. Risk Factors for a High Comprehensive Complication Index after Splenectomy Plus Pericardial Devascularization for Portal Hypertension. THE TURKISH JOURNAL OF GASTROENTEROLOGY : THE OFFICIAL JOURNAL OF TURKISH SOCIETY OF GASTROENTEROLOGY 2023; 34:1041-1051. [PMID: 37603301 PMCID: PMC10645282 DOI: 10.5152/tjg.2023.22756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 12/26/2022] [Indexed: 08/22/2023]
Abstract
BACKGROUND/AIMS Mathematical integration of all complications from the Clavien-Dindo classification into one number called the comprehensive complication index provides a novel method to capture morbidity. This objective of this study was to compare the evaluations of complications between the novel comprehensive complication index and Clavien-Dindo classification for portal hypertension patients who underwent splenectomy plus pericardial devascularization. MATERIALS AND METHODS Patients treated with either splenectomy plus simplified pericardial devascularization or splenectomy plus traditional pericardial devascularization were included retrospectively. Correlation and logistic regression analyses of the postoperative hospital stay and total hospitalization expense were compared between the comprehensive complication index and Clavien-Dindo classification. The cumulative sum-comprehensive complication index was generated and compared between operation types. RESULTS The Child-Pugh classification at admission, spleen thickness, and intraoperative blood loss were risk factors for high comprehensive complication index. Comprehensive complication index showed a stronger relationship with the postoperative hospital stay and total hospitalization expense than the Clavien-Dindo classification. Logistic regression analysis of the postoperative hospital stay demonstrated that the R2 values for the comprehensive complication index and Clavien-Dindo classification were 0.15 and 0.14, respectively. The cumulative sum-comprehensive complication index graph showed a steady dynamic decrease in the cumulative sum score for the individual operation type, with splenectomy plus simplified pericardial devascularization revealing a more notable decrease than splenectomy plus traditional pericardial devascularization. CONCLUSIONS Comprehensive complication index is an excellent method to assess postoperative morbidity in portal hypertension patients. The cumulative sum-comprehensive complication index chart can better dynamically monitor and compare different operation types. Splenectomy plus simplified pericardial devascularization is better than splenectomy plus traditional pericardial devascularization at decreasing cumulative sum-comprehensive complication index.
Collapse
Affiliation(s)
- Yafei Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hongwei Lu
- Department of General Surgery, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Hong Ji
- Department of General Surgery, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yiming Li
- Department of General Surgery, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| |
Collapse
|
3
|
Kyaruzi VM, Chamshama DE, Khamisi RH, Akoko LO. Surgical Apgar Score can accurately predict the severity of post-operative complications following emergency laparotomy. BMC Surg 2023; 23:194. [PMID: 37415104 DOI: 10.1186/s12893-023-02088-2] [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: 01/23/2023] [Accepted: 06/21/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND The Surgical Apgar Score (SAS) describes a feasible and objective tool for predicting surgical outcomes. However, the accuracy of the score and its correlation with the complication severity has not been well established in many grounds of low resource settings. OBJECTIVE To determine the accuracy of Surgical Apgar Score in predicting the severity of post-operative complications among patients undergoing emergency laparotomy at Muhimbili National Hospital. METHODS A prospective cohort study was conducted for a period of 12 months; patients were followed for 30 days, the risk of complication was classified using the Surgical Apgar Score (SAS), severity of complication was estimated using the Clavien Dindo Classification (CDC) grading scheme and Comprehensive Complication Index (CCI). Spearman correlation and simple linear regression statistic models were applied to establish the relationship between Surgical Apgar Score (SAS) and Comprehensive Complication Index (CCI). The Accuracy of SAS was evaluated by determining its discriminatory capacity on Receiver Operating Characteristics (ROC) curve, data normality was tested by Shapiro-Wilk statistic 0.929 (p < 0.001).Analysis was done using International Business Machine Statistical Product and Service Solution (IBM SPSS) version 27. RESULTS Out of the 111 patients who underwent emergency laparotomy, 71 (64%) were Male and the median age (IQR) was 49 (36, 59).The mean SAS was 4.86 (± 1.29) and the median CCI (IQR) was 36.20 (26.2, 42.40). Patients in the high-risk SAS group (0-4) were more likely to experience severe and life-threatening complications, with a mean CCI of 53.3 (95% CI: 47.2-63.4), compared to the low-risk SAS group (7-10) with a mean CCI of 21.0 (95% CI: 5.3-36.2). A negative correlation was observed between SAS and CCI, with a Spearman r of -0.575 (p < 0.001) and a regression coefficient b of -11.5 (p < 0.001). The SAS demonstrated good accuracy in predicting post-operative complications, with an area under the curve of 0.712 (95% CI: 0.523-0.902, p < 0.001) on the ROC. CONCLUSION This study has demonstrated that SAS can accurately predict the occurrence of complications following emergency laparotomy at Muhimbili National Hospital.
Collapse
Affiliation(s)
- Victor Meza Kyaruzi
- Department of General Surgery, Muhimbili University of Health and Allied Science, Dar Es Salaam, Tanzania.
| | - Douglas E Chamshama
- Department of General Surgery, Muhimbili National Hospital, Dar Es Salaam, Tanzania
| | - Ramadhani H Khamisi
- Department of General Surgery, Muhimbili University of Health and Allied Science, Dar Es Salaam, Tanzania
| | - Larry O Akoko
- Department of General Surgery, Muhimbili University of Health and Allied Science, Dar Es Salaam, Tanzania
| |
Collapse
|
4
|
Haga Y, Yasunaga Y, Araki J, Nakao J, Mori H, Nakagawa M, Mukaigawa T. Perioperative Factors Aggravating Pharyngocutaneous Fistula After Total Laryngectomy: A Single-Center Retrospective Analysis Using the Clavien-Dindo Classification. Ann Plast Surg 2023; 91:84-89. [PMID: 37450865 DOI: 10.1097/sap.0000000000003627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKGROUND Pharyngocutaneous fistula formation represents a major postoperative complication following total laryngectomy. We aimed to investigate the risk factors for pharyngocutaneous fistula development after total laryngectomy and to identify factors that lead to severe cases of pharyngocutaneous fistula. METHODS Patients who underwent total laryngectomy between January 2013 and February 2021 were included in the study and were divided into 2 groups: Those with and without pharyngocutaneous fistula. The severity of pharyngocutaneous fistula was graded using the Clavien-Dindo classification. RESULTS Patients with pharyngocutaneous fistula experienced longer operative time, greater intraoperative blood loss, greater decrease in perioperative hemoglobin level, and longer postoperative hospitalization. Unlike in lower-severity cases, patients with grade IIIb pharyngocutaneous fistula underwent preoperative radiotherapy or chemoradiotherapy; preoperative treatment was thus a risk factor for higher severity of pharyngocutaneous fistula (odds ratio, 35; P = 0.004). CONCLUSION Salvage laryngectomy was found to be a predictor of severe pharyngocutaneous fistula development. Prolonged operative time, increased intraoperative blood loss, and decreased postoperative hemoglobin level were found to be predictors of postlaryngectomy pharyngocutaneous fistula formation.
Collapse
Affiliation(s)
| | - Yoshichika Yasunaga
- From the Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Nagaizumi
| | - Jun Araki
- From the Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Nagaizumi
| | - Junichi Nakao
- From the Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Nagaizumi
| | - Hiroaki Mori
- From the Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Nagaizumi
| | | | - Takashi Mukaigawa
- Division of Head and Neck Surgery, Shizuoka Cancer Center, Nagaizumi, Japan
| |
Collapse
|
5
|
Katna R, Naik G, Girkar F, Deshpande A, Chalke S, Bhosale B, Kalyani N. Clinical outcomes for microvascular reconstruction in oral cancers: experience from a single surgical centre. Ann R Coll Surg Engl 2023; 105:247-251. [PMID: 35175143 PMCID: PMC9974342 DOI: 10.1308/rcsann.2021.0295] [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] [Accepted: 10/09/2021] [Indexed: 12/09/2022] Open
Abstract
INTRODUCTION Reconstruction of a surgical defect is an important part of the management of oral cancers. Microvascular free flap construction provides better functional and cosmetic outcomes. METHODS Between 2014 and 2020, some 524 patients underwent microvascular reconstruction. Comorbidity variables were scored using the Charlson Comorbidity Index (CCI). Complications were recorded using Clavien-Dindo criteria. RESULTS Eighty-three (15.84%), 339 (64.69%) and 102 (19.47%) patients underwent free radial forearm flap, free anterolateral thigh flap and free fibula osteocutaneous flap (FFOCF), respectively. Clavien-Dindo complications of grade III and above were seen in 39 (7.44%) patients. Total flap loss was seen in 18 patients and of these, 16 were salvaged using alternative free flaps or pedicled flaps. On univariate analysis, overall and major complication rates were higher in FFOCF (p=0.171). Major complications significantly more common in patients with a CCI score >4 (p=0.001). Patients aged >65 years had higher rates of complications (p=0.03). CONCLUSION Microvascular free tissue transfer is a reliable, safe and gold standard modality in surgical reconstruction and can be replicated in non-institutional settings.
Collapse
Affiliation(s)
| | - G Naik
- Vedant Hospital, Thane, India
| | | | | | | | | | - N Kalyani
- Jaslok Hospital and Research Centre, Mumbai, India
| |
Collapse
|
6
|
DAMASKOS C, GARMPIS N, PSILOPATIS I, DIMITROULIS D. Natural Ending or Surgical Complication: Is It the Time to Reconsider the Clavien-Dindo Classification System? MAEDICA 2022; 17:939-947. [PMID: 36818261 PMCID: PMC9923058 DOI: 10.26574/maedica.2022.17.4.939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
To date, the Clavien-Dindo classification system represents the most popular assessment tool of postoperative events that ranks surgical complications by the extent of respective required therapeutic interventions. This uniform grading system allows for an objective evaluation of outcomes from a surgical procedure by accurately and standardly defining surgical complications. However, many scientists have meanwhile heavily criticized the Clavien-Dindo classification system as an overly generalized and conservative grading system that requires modification. Herein, we aim to explain the need for reconsideration of the Clavien-Dindo classification system, and discuss the features of an ideal system for the classification of complications that should evaluate not only surgical complications, but also the risk and patient's general performance status.
Collapse
Affiliation(s)
- Christos DAMASKOS
- Renal Transplantation Unit, Laiko General Hospital, Athens, Greece,N.S. Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos GARMPIS
- N.S. Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece,Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Iason PSILOPATIS
- Charité – Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt – Universität zu Berlin, Berlin, Germany
| | - Dimitrios DIMITROULIS
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
7
|
朱 易, 王 飞, 赵 怡, 朱 涛. [Research Updates: Standardized Reporting and Evaluation Instruments for Postoperative Complications]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2022; 53:342-348. [PMID: 35332740 PMCID: PMC10409346 DOI: 10.12182/20220360506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Indexed: 06/14/2023]
Abstract
Postoperative complications are important indicators for evaluating surgical outcomes, and mortality and the incidence of various specific complications are often used to measure the efficacy of surgical and perioperative management strategies. With the progress of medical technology, there has been a dramatic decline in mortality and the incidence of complications. As a result, reporting and evaluation in the traditional methods no longer meets the actual needs of the world. There has arisen an urgent need for an instrument of standardized reporting and evaluation. The instrument should be aligned with the actual circumstances and should represent the patient's overall burden of postoperative complications. We herein reviewed the latest research findings on Clavien-Dindo Classification (CDC) system and comprehensive complication index (CCI), two instruments of standardized reporting and evaluation of postoperative complications, and discussed the space for improvement and prospects of application of CDC and CCI.
Collapse
Affiliation(s)
- 易豪 朱
- 四川大学华西医院 麻醉科 (成都 610041)Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 飞 王
- 四川大学华西医院 麻醉科 (成都 610041)Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
- 电子科技大学 四川省医学科学院·四川省人民医院 麻醉科 (成都 610041)Department of Anesthesiology, Sichuan Academy of Medical Science and Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 610041, China
| | - 怡 赵
- 四川大学华西医院 麻醉科 (成都 610041)Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 涛 朱
- 四川大学华西医院 麻醉科 (成都 610041)Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China
| |
Collapse
|
8
|
Lan K, Zhou J, Sui X, Wang J, Yang F. Escalated grades of complications correlate with incremental costs of video-assisted thoracoscopic surgery major lung resection for lung cancer in China. Thorac Cancer 2021; 12:2981-2989. [PMID: 34581484 PMCID: PMC8590893 DOI: 10.1111/1759-7714.14161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Few studies have focused on factors associated with the incremental cost of video-assisted thoracoscopic surgery (VATS) in China. We aim to systematically classify the complications after VATS major lung resection and explore their correlation with hospital costs. METHODS Patients with pathologically stage I-III lung cancer who underwent VATS major lung resections from January 2007 to December 2018 were included. The Thoracic Mortality and Morbidity (TM&M) Classification system was used to evaluate postoperative complications. Grade I and II complications, defined as minor complications, require no therapy or pharmacologic intervention only. Grade III and IV complications, defined as major complications, require surgical intervention or life support. Grade V results in death. A generalized linear model was used to explore the correlation of incremental hospital costs and complications, as well as other clinicopathologic parameters between 2013 and 2016. RESULTS A total of 2881 patients were enrolled in the first part, and the minor and major complications rates were 24.3% (703 patients) and 8.3% (228 patients), respectively. Six hundred and eighty-two patients were enrolled in the second part. The complications grade II (odds ratio [OR] 1.12, 95% confidence interval [CI] 1.05-1.2, p = 0.0005), grade III (OR 1.55, 95% CI 1.26-1.9, p < 0.0001), grades IV and V (OR 1.09, 95% CI 1.04-1.13, p = 0.0002), diffusion capacity of carbon dioxide (OR 0.998, 95% CI 0.997-1.000, p = 0.004), and duration of chest drainage (OR 1.03, 95% CI 1.02-1.04, p < 0.001) and were independent risk factors for the increase in in-hospital costs of VATS major lung resections. CONCLUSIONS The severity of complications graded by the TM&M system was an independent risk factor for increased in-hospital costs.
Collapse
Affiliation(s)
- Ke Lan
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Jian Zhou
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Xizhao Sui
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Jun Wang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Fan Yang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| |
Collapse
|