Surgical Complications Requiring Intervention in Open versus Minimally Invasive Radical Prostatectomy

2021 ◽  
pp. 1-5
Author(s):  
Lorine Haeuser ◽  
Stephen W. Reese ◽  
Marco Paciotti ◽  
Joachim Noldus ◽  
Ethan Y. Brovman ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Minimally Invasive ◽  
Surgical Approach ◽  
Large Bowel ◽  
Bowel Injury ◽  
Improvement Program ◽  
Significant Difference ◽  
American College Of Surgeons ◽  
Vascular Structures ◽  
Open Versus

<b><i>Introduction:</i></b> Injuries to surrounding structures during radical prostatectomy (RP) are rare but serious complications. However, it remains unknown if injuries to intestines, rectum, or vascular structures occur at different rates depending on the surgical approach. <b><i>Methods:</i></b> We compared the frequency of these outcomes in open RP (ORP) and minimally invasive RP (MIS-RP) using the national American College of Surgeons National Surgical Quality Improvement Program database (2012–2017). Along with important metrics of clinical and surgical outcomes, patients were identified as undergoing surgical repair of small or large bowel, vascular structures, or hernias based on Current Procedural Terminology codes. <b><i>Results:</i></b> In our propensity matched analysis, a total of 13,044 patients were captured. Bowel injury occurred more frequently in ORP than in MIS-RP (0.89 vs. 0.26%, <i>p</i> &#x3c; 0.01). By intestinal segment, rectal and large bowel injuries were more common in ORP than MIS-RP (0.41 vs. 0.11% and 0.31 vs. 0.05%, both <i>p</i> &#x3c; 0.01). However, there was no statistically significant difference between the groups for small bowel injury (0.17 vs. 0.11%, <i>p</i> = 0.39). Vascular injury was more common in MIS-RP (0.18 vs. 0.08%, <i>p</i> = 0.08). Hernias requiring repair were only identified in the MIS-RP group (0.12%). <b><i>Conclusion:</i></b> When considering surgical approach, rectal and large bowel injuries were more common in ORP, while vascular injuries and hernia repair were more common in MIS-RP. Our findings can be used in counseling patients and identifying risk factors and strategies to reduce these complications.

Evaluation of Minimally Invasive Surgical Therapies for Ulcerative Colitis

2020 ◽  
Vol 86 (7) ◽  
pp. 782-786 ◽  
Author(s):  
Salini Hota ◽  
Salvatore Parascandola ◽  
Richard Amdur ◽  
Vincent Obias
Keyword(s):  
Ulcerative Colitis ◽  
Minimally Invasive ◽  
Postoperative Outcomes ◽  
Open Group ◽  
Open Approach ◽  
Cardiac Events ◽  
Improvement Program ◽  
Robotic Assisted ◽  
Confounding Variables ◽  
Significant Difference

Introduction Ulcerative colitis (UC) is a chronic inflammatory intestinal disorder that can be managed surgically with a proctocolectomy. Minimally invasive techniques such as laparoscopic or robotic-assisted surgery are available based on the surgeon’s preference and familiarity. To date, there is a paucity of literature evaluating the safety of these techniques in comparison to the open approach in patients with UC. Methods We surveyed the National Surgical Quality Improvement Program (NSQIP) database to select patients with the diagnosis of UC who underwent either robotic, laparoscopic, or open proctocolectomy between 2012 and 2017. A total of 2129 patients were included in the study. The 30-day postoperative outcomes were compared using multivariable logistic regression models after adjusting for confounding variables. The confounding variables were defined as any preoperative variable that was associated with the type of procedure. Results The 30-day postoperative outcomes reported in the NSQIP database were reviewed for each of the treatment groups (open, laparoscopic, and robotic). The anastomotic leak rate was significantly higher in the open group ( P = .022). The robotic and laparoscopic groups had significantly fewer occurrences of postoperative ileus ( P = .0006) and wound infections ( P < .0001). There were significantly more strokes, cardiac events, and pulmonary events in the open surgical group. Operative time was significantly shorter in the open group ( P < .0001). Reintervention rates were not significantly different among the groups. Conclusions Minimally invasive proctocolectomy has significantly fewer postoperative complications compared with open proctocolectomy for UC. There is no significant difference in the postoperative outcomes between robotic-assisted and laparoscopic proctocolectomy.

Does hepatectomy approach influence transfusion? An analysis of the National Surgical Quality Improvement Program database.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 447-447
Author(s):  
Jack P Silva ◽  
Nicholas G Berger ◽  
Susan Tsai ◽  
Kathleen K. Christians ◽  
Callisia Clarke ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Minimally Invasive ◽  
Surgical Approach ◽  
Quality Improvement Program ◽  
Red Blood Cell Transfusion ◽  
Perioperative Outcomes ◽  
Start Time ◽  
Improvement Program ◽  
Surgical Quality ◽  
Open Hepatectomy

447 Background: Transfusion is one of the causes of morbidity in hepatectomy, and is a predictor of mortality and cancer recurrence. This study sought to analyze the role of surgical approach in the incidence of transfusion in a large national dataset. Methods: The National Surgical Quality Improvement Program database identified patients undergoing hepatectomy between January 1, 2014 and December 31, 2014. Demographic information, surgical approach, perioperative characteristics, and short-term postoperative outcomes were compared for patients with and without perioperative red blood cell transfusion. Transfusions occurring from surgical start time to 72 hours postoperatively were included in the dataset. Results: A total of 3,064 patients were included in this study. Patients with right lobectomy and trisegmentectomy were more likely to receive transfusion compared to left and partial lobectomies (p < 0.001). Rate of transfusion was highest in unplanned minimally invasive conversion to open hepatectomy compared to open hepatectomy and minimally invasive surgery (25.2% vs. 21.2% vs. 6.7% respectively, p < 0.001). Patients requiring transfusion were more likely to suffer from other morbidity (47.1% vs. 19.6%, p < 0.001), had a longer median length of stay (7 vs. 5 days, p < 0.001), higher readmission rates (14.2% vs. 9.4%, p = 0.001), and higher 30-day mortality (4.9% vs. 0.8%, p < 0.001) compared to patients not receiving blood transfusions. Conclusions: Transfusion is the most common morbidity-defining complication associated with hepatectomy. Perioperative outcomes are significantly improved if no transfusion was needed. Further work should focus on avoiding unplanned conversion and minimizing blood loss.

scholarly journals Reporting Methodology of Neurosurgical Studies Utilizing the American College of Surgeons-National Surgical Quality Improvement Program Database: A Systematic Review and Critical Appraisal

Neurosurgery ◽  
2019 ◽  
Vol 86 (1) ◽  
pp. 46-60 ◽  
Author(s):  
Yagiz Yolcu ◽  
Waseem Wahood ◽  
Mohammed Ali Alvi ◽  
Panagiotis Kerezoudis ◽  
Elizabeth B Habermann ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Critical Appraisal ◽  
Quality Improvement Program ◽  
Improvement Program ◽  
Surgical Quality ◽  
Acs Nsqip ◽  
Significant Difference ◽  
American College Of Surgeons ◽  
Potential Sources ◽  
Strobe Statement

AbstractBACKGROUNDUse of large databases such as the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) has become increasingly common in neurosurgical research.OBJECTIVETo perform a critical appraisal and evaluation of the methodological reporting for studies in neurosurgical literature that utilize the ACS-NSQIP database.METHODSWe queried Ovid MEDLINE, EMBASE, and PubMed databases for all neurosurgical studies utilizing the ACS-NSQIP. We assessed each study according to number of criteria fulfilled with respect to Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement, REporting of studies Conducted using Observational Routinely-collected Health Data (RECORD) Statement, and Journal of American Medical Association–Surgical Section (JAMA-Surgery) Checklist. A separate analysis was conducted among papers published in core and noncore journals in neurosurgery according to Bradford's law.RESULTSA total of 117 studies were included. Median (interquartile range [IQR]) scores for number of fulfilled criteria for STROBE Statement, RECORD Statement, and JAMA-Surgery Checklist were 20 (IQR:19-21), 9 (IQR:8-9), and 6 (IQR:5-6), respectively. For STROBE Statement, RECORD Statement, and JAMA-Surgery Checklist, item 9 (potential sources of bias), item 13 (supplemental information), and item 9 (missing data/sensitivity analysis) had the highest number of studies with no fulfillment among all studies (56, 68, 50%), respectively. When comparing core journals vs noncore journals, no significant difference was found (STROBE, P = .94; RECORD, P = .24; JAMA-Surgery checklist, P = .60).CONCLUSIONWhile we observed an overall satisfactory reporting of methodology, most studies lacked mention of potential sources of bias, data cleaning methods, supplemental information, and external validity. Given the pervasive role of national databases and registries for research and health care policy, the surgical community needs to ensure the credibility and quality of such studies that ultimately aim to improve the value of surgical care delivery to patients.

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