Patient-reported assessment of functional gait outcomes following superior gluteal artery perforator reconstruction

PMCID: PMC4174196BACKGROUND: Harvesting the superior gluteal artery perforator (SGAP) flap involves dissection of vessels through the gluteal muscle, potentially compromising gait and ambulation. We compared patient-reported gait and ambulation problems between SGAP flap and deep inferior epigastric perforator (DIEP) flap reconstructions. METHODS: Forty-three patients who underwent bilateral free flap breast reconstruction (17 SGAP, 26 DIEP) participated in the study. The Lower Extremity Functional Score (LEFS) was administered with a supplementary section evaluating gait, balance, fatigue, and pain. Patients evaluated how they felt 2 months postoperatively and at time of survey administration. Multivariate regressions were fit to assess association between type of reconstruction and self-reported lower extremity function controlling for potential confounding factors. RESULTS: Although there was no significant difference in overall LEFS between the cohorts on the date of survey, the SGAP patients reported greater difficulty performing the following activities after surgery (P < 0.05): work, usual hobbies, squatting, walking a mile, walking up stairs, sitting for an hour, running, turning, and hopping. The SGAP patients also reported easier fatigue (P < 0.01) both during the early postoperative period and on the date of survey. CONCLUSIONS: SGAP flap surgery causes no statistically significant differences in overall LEFS. However, SGAP patients did report donor-site morbidity with decreased ability to perform certain activities and increased fatigue and pain in the longer follow-up period. We feel that patients should be educated regarding gait issues and undergo physical therapy during the early postoperative period.JH Libraries Open Access Fun

Association measures of claims-based algorithms for common chronic conditions were assessed using regularly collected data in Japan

OBJECTIVE: Although claims data are widely used in medical research, their ability to identify persons' health-related conditions has not been fully justified. We assessed the validity of claims-based algorithms (CBAs) for identifying people with common chronic conditions in a large population using annual health screening results as the gold standard.STUDY DESIGN AND SETTING: Using a longitudinal claims database (n=523,267) combined with annual health screening results, we defined the people with hypertension, diabetes, and/or dyslipidemia by applying health screening results as their gold standard, and compared them against various CBAs.RESULTS: By using diagnostic and medication code-based CBAs, sensitivity and specificity were 74.5% (95% Confidence Interval [CI], 74.2-74.8%) and 98.2% (98.2-98.3%) for hypertension, 78.6% (77.3-79.8%) and 99.6% (99.5-99.6%) for diabetes, and 34.5% (34.2-34.7%) and 97.2% (97.2-97.3%) for dyslipidemia, respectively. Sensitivity did not decrease substantially for hypertension (65.2% [95% CI, 64.9-65.5%]) and diabetes (73.0% [71.7-74.2%]) when we used the same CBAs without limiting to primary care settings.CONCLUSION: We employed regularly collected data to obtain CBA association measures which are applicable to a wide range of populations. Our framework can be a basis of the validity assessment of CBAs for identifying persons' health-related conditions with regularly collected data

Episode-based cost reduction for endovascular aneurysm repair

ObjectiveEffective strategies to reduce costs associated with endovascular aneurysm repair (EVAR) remain elusive for many medical centers. In this study, targeted interventions to reduce inpatient EVAR costs were identified and implemented.MethodsFrom June 2015 to February 2016, we analyzed the EVAR practice at a high-volume academic medical center to identify, to rank, and ultimately to reduce procedure-related costs. In this analysis, per-patient direct costs to the hospital were compared before (September 2013-May 2015) and after (March 2016-January 2017) interventions were implemented. Improvement efforts concentrated on three categories that accounted for a majority of costs: implants, rooming costs, and computed tomography scans performed during the index hospitalization.ResultsCosts were compared between 141 EVAR procedures before implementation (PRE period) and 47 EVAR procedures after implementation (POST period). Based on data obtained through the Society for Vascular Surgery EVAR Cost Demonstration Project, it was determined that implantable device costs were higher than those at peer institutions. New purchasing strategies were implemented, resulting in a 30.8% decrease in per-case device costs between the PRE and POST periods. Care pathways were modified to reduce use of and costs for computed tomography scans obtained during the index hospitalization. Compared with baseline, per-case imaging costs decreased by 92.9% (P&nbsp;&lt; .001), including a 99.0% (P&nbsp;= .001) reduction in postprocessing costs. Care pathways were also implemented to reduce preprocedural rooming for patients traveling long distances the day before surgery, resulting in a 50% decrease in utilization rate (35.4% PRE to 17.0% POST; P&nbsp;= .021), without having a significant impact on median postprocedural length of stay (PRE, 2&nbsp;days [interquartile range, 1-11&nbsp;days]; POST, 2&nbsp;days [1-7&nbsp;days]; P&nbsp;= .185). Medication costs also decreased by 38.2% (P&nbsp;&lt; .001) as a hospital-wide effort.ConclusionsExcessive costs associated with EVAR threaten the sustainability of these procedures in health care organizations. Targeted cost reduction efforts can effectively reduce expenses without compromising quality or limiting patients' access

Patient-Reported Assessment of Functional Gait Outcomes following Superior Gluteal Artery Perforator Reconstruction

Background: Harvesting the superior gluteal artery perforator (SGAP) flap involves dissection of vessels through the gluteal muscle, potentially compromising gait and ambulation. We compared patient-reported gait and ambulation problems between SGAP flap and deep inferior epigastric perforator (DIEP) flap reconstructions. Methods: Forty-three patients who underwent bilateral free flap breast reconstruction (17 SGAP, 26 DIEP) participated in the study. The Lower Extremity Functional Score (LEFS) was administered with a supplementary section evaluating gait, balance, fatigue, and pain. Patients evaluated how they felt 2 months postoperatively and at time of survey administration. Multivariate regressions were fit to assess association between type of reconstruction and self-reported lower extremity function controlling for potential confounding factors. Results: Although there was no significant difference in overall LEFS between the cohorts on the date of survey, the SGAP patients reported greater difficulty performing the following activities after surgery (P < 0.05): work, usual hobbies, squatting, walking a mile, walking up stairs, sitting for an hour, running, turning, and hopping. The SGAP patients also reported easier fatigue (P < 0.01) both during the early postoperative period and on the date of survey. Conclusions: SGAP flap surgery causes no statistically significant differences in overall LEFS. However, SGAP patients did report donor-site morbidity with decreased ability to perform certain activities and increased fatigue and pain in the longer follow-up period. We feel that patients should be educated regarding gait issues and undergo physical therapy during the early postoperative period

Role of nutrition support in adult cardiac surgery: a consensus statement from an International Multidisciplinary Expert Group on Nutrition in Cardiac Surgery

Nutrition support is a necessary therapy for critically ill cardiac surgery patients. However, conclusive evidence for this population, consisting of well-conducted clinical trials is lacking. To clarify optimal strategies to improve outcomes, an international multidisciplinary group of 25 experts from different clinical specialties from Germany, Canada, Greece, USA and Russia discussed potential approaches to identify patients who may benefit from nutrition support, when best to initiate nutrition support, and the potential use of pharmaco-nutrition to modulate the inflammatory response to cardiopulmonary bypass. Despite conspicuous knowledge and evidence gaps, a rational nutritional support therapy is presented to benefit patients undergoing cardiac surgery

Hereditary multiple exostoses in the hands and fingers: early presentation and early surgical treatment in family members. Case reports

Hereditary multiple exostosis (HME) is a benign condition with multiple bony tumors with cartilage caps (osteochondromas), mainly presenting in the long and flat bones. Usually the presentation for HME is between 2 and 10 years of age and most are seen by 4 years of age (Khan et al. 2009). In this paper, we report a family with three members (father, son, and a daughter) who had very early presentations of HME in the fingers within the first 2 years of age. The son presented with bony nodules at 7 months of age, and he required surgery at 13 months of age for a severe functional deformity of his left ring finger. He also had an unusual histological presentation on his osteochondroma that consists of only subperiosteal cartilage without ossification