12 research outputs found
Association of operative approach with postoperative outcomes in neonates undergoing surgical repair of esophageal atresia and tracheoesophageal fistula
Introduction: Minimally invasive surgery (MIS) is gaining traction as a first-line approach to repair congenital anomalies. This study aims to evaluate outcomes for neonates undergoing open versus MIS repairs for esophageal atresia/tracheoesophageal fistula (EA/TEF).
Methods: Neonates undergoing EA/TEF repair from 2013-2020 were identified using the National Surgical Quality Improvement Program-Pediatric database. Proportions of operative approach (open vs. MIS) over time were analyzed. A propensity score-matched analysis using preoperative characteristics was performed and outcomes were compared including composite morbidity and reintervention rates (overall, major [thoracoscopy, thoracotomy], and minor [chest/feeding tube placement, endoscopy]) between operative approaches. Pearson’s chi-square or Fisher’s exact test were used as appropriate.
Results: We identified 1738 neonates who underwent EA/TEF repair. MIS utilization increased over time (p=0.019). Pre-match, neonates undergoing open repair were more likely premature, lower weight, and higher ASA class. Post-match, the groups were similar and included 183 neonates per group. MIS repair was associated with longer median operative time (206 vs. 180 minutes, p\u3c0.001), increased overall reintervention rates (MIS 9.8% vs. open 3.3%, p=0.011), and increased minor reintervention rates (MIS 7.7% vs. open 2.2%, p=0.016). There were no differences in composite morbidity (MIS 20.2% vs. open 26.8%, p=0.14) or major reinterventions (MIS 2.2% vs. open 1.1%, p=0.41).
Discussion: MIS is gaining traction as a first-line approach for neonates with EA/TEF but appears to be associated with a higher rate of reinterventions. Further studies evaluating MIS approaches for the repair of EA/TEF are needed to better define short and long-term outcomes to optimize patient selection
National trends in pectus excavatum repair: patient age, facility volume, and outcomes
Background: There is limited data on the adult repair of pectus excavatum (PE). Existing literature is largely limited to single institution experiences and suggests that adults undergoing modified Nuss repair may have worse outcomes than pediatric and adolescent patients. Using a representative national database, this analysis is the first to describe trends in demographics, outcomes, charges, and facility volume for adults undergoing modified Nuss procedure.
Methods: Because of a coding change associated with ICD-10, a retrospective cohort analysis using the National Inpatient Sample (NIS) for patients 12 or older undergoing modified Nuss repair between 2016-2018 was possible. Pearson\u27s χ2 and Student\u27s t-tests were utilized to compare patient, clinical, and hospital characteristics. Complications were sub-classified into major and minor categories. Facilities performing greater than the mean number of operations were categorized as high-volume.
Results: Of 360 patients, 79.2% were male. There was near gender parity for patients over 30 undergoing repair (55.2% male, 44.8% female). In all age cohorts, patients were predominantly Caucasian. Rates of any postoperative complication differed by age (12-17 years: 30.6%; 18-29 years: 45.2%; 30+ years: 62.1%; P\u3c0.01); older patients had higher rates of all but two subclasses of complication. Age over 30 was associated with higher charges (12-17 years: 57,001; 30+ years: $67,014; P\u3c0.01). High-volume centers operate on older patients, had shorter lengths of stay, and comparable charges to low-volume centers.
Conclusions: Women comprise nearly half of patients undergoing modified Nuss repair after 30 years of age. There are significant differences in complication rates and charges when comparing patients by age. Patients undergoing repair at high-volume facilities benefitted from shorter lengths of stay
sj-docx-1-gut-10.1177_26345161231151407 – Supplemental material for An Analysis of 30-Day Readmissions of Surgically Managed Hiatal Hernia in the United States, 2010 to 2018
Supplemental material, sj-docx-1-gut-10.1177_26345161231151407 for An Analysis of 30-Day Readmissions of Surgically Managed Hiatal Hernia in the United States, 2010 to 2018 by Gregory L. Whitehorn, Micaela L. Collins, Shale J. Mack, Brian M. Till, Christina J. Tofani, Karen A. Chojnacki and Olugbenga T. Okusanya in Foregut: The Journal of the American Foregut Society</p
sj-pptx-1-gut-10.1177_26345161221137089 – Supplemental material for The Epidemiology of Surgically Managed Hiatal Hernia: A Nine Year Review of National Trends
Supplemental material, sj-pptx-1-gut-10.1177_26345161221137089 for The Epidemiology of Surgically Managed Hiatal Hernia: A Nine Year Review of National Trends by Brian M. Till, Shale J. Mack, Gregory Whitehorn, Micaela Langille Collins, Chi-Fu Jeffrey Yang, Tyler Grenda, Nathaniel R. Evans and Olubenga Okusanya in Foregut: The Journal of the American Foregut Society</p
sj-docx-1-gut-10.1177_26345161221137089 – Supplemental material for The Epidemiology of Surgically Managed Hiatal Hernia: A Nine Year Review of National Trends
Supplemental material, sj-docx-1-gut-10.1177_26345161221137089 for The Epidemiology of Surgically Managed Hiatal Hernia: A Nine Year Review of National Trends by Brian M. Till, Shale J. Mack, Gregory Whitehorn, Micaela Langille Collins, Chi-Fu Jeffrey Yang, Tyler Grenda, Nathaniel R. Evans and Olubenga Okusanya in Foregut: The Journal of the American Foregut Society</p
Nitric Oxide-Releasing Insert for Disinfecting the Hub Region of Tunnel Dialysis Catheters
Is wedge a dirty word? Demographic and facility-level variables associated with high-quality wedge resectionCentral MessagePerspective
Objectives: Although sublobar resections have gained traction, wedge resections vary widely in quality. We seek to characterize the demographic and facility-level variables associated with high-quality wedge resections. Methods: The National Cancer Database was queried from 2010 to 2018. Patients with T1/T2 N0 M0 non–small cell lung cancer 2 cm or less who underwent wedge resection without neoadjuvant therapy were included. A wedge resection with no nodes sampled or with positive margins was categorized as a low-quality wedge. A wedge resection with 4 or more nodes sampled and negative margins was categorized as a high-quality wedge. Facility-specific variables were investigated via quartile analysis based on the overall volume and proportion of high-quality wedge or low-quality wedge resections performed. Results: A total of 21,742 patients met inclusion criteria, 6390 (29.4%) of whom received a high-quality wedge resection. Factors associated with high-quality wedge resection included treatment at an academic center (3005 [47.0%] vs low-quality wedge 6279 [40.9%]; P < .001). The 30- and 90-day survivals were similar, but patients who received a high-quality wedge resection had improved 5-year survival (4902 [76.7%] vs 10,548 [68.7%]; P < .001). Facilities in the top quartile by volume of high-quality wedge resections performed 69% (4409) of all high-quality wedge resections, and facilities in the top quartile for low-quality wedge resections performed 67.6% (10,378) of all low-quality wedge resections. A total of 113 facilities were in the top quartile by volume for both high-quality wedge and low-quality wedge resections. Conclusions: High-quality wedge resections are associated with improved 5-year survival when compared with low-quality wedge resections. By volume, high-quality wedge and low-quality wedge resections cluster to a minority of facilities, many of which overlap. There is discordance between best practice guidelines and current practice patterns that warrants additional study