Evaluating resident involvement and the ‘July effect’ in parotidectomy

Author(s):  
D A Benito ◽  
I Mamidi ◽  
L J Pasick ◽  
A D Sparks ◽  
C Badger ◽  
...  

Abstract Objective This study aimed to evaluate the effect of resident involvement and the ‘July effect’ on peri-operative complications after parotidectomy. Method The American College of Surgeons National Surgical Quality Improvement Program database was queried for parotidectomy procedures with resident involvement between 2005 and 2014. Results There were 11 733 cases were identified, of which 932 involved resident participation (7.9 per cent). Resident involvement resulted in a significantly lower reoperation rate (adjusted odds ratio, 0.18; 95 per cent confidence interval, 0.05–0.73; p = 0.02) and readmission rate (adjusted odds ratios 0.30; 95 per cent confidence interval, 0.11–0.80; p = 0.02). However, resident involvement was associated with a mean 24 minutes longer adjusted operative time and 23.5 per cent longer adjusted total hospital length of stay (respective p < 0.01). No significant difference in surgical or medical complication rates or mortality was found when comparing cases among academic quarters. Conclusion Resident participation is associated with significantly decreased reoperation and readmission rates as well as longer mean operative times and total length of stay. Resident transitions during July are not associated with increased risk of adverse peri-operative outcomes after parotidectomy.

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Lawrence Zeldin ◽  
Sean N Neifert ◽  
Robert J Rothrock ◽  
Ian T McNeill ◽  
Jonathan S Gal ◽  
...  

Abstract INTRODUCTION The ideal timing from admission of a thoracolumbar spinal trauma patient to the start of surgery at US trauma centers remains a hotly contested area of debate. The effect of surgical latency on patient outcomes in thoracolumbar trauma remains unclear. METHODS All 2013 to 2015 thoracolumbar spinal trauma cases from the American College of Surgeons Trauma Quality Improvement Program (TQIP) were analyzed. Patients with unsurvivable spine injury, polytraumas (serious injuries in more than one bodily region), and those discharged within 24 h were excluded. Patients were classified into 3 groups by surgery timing: less than 8 h (early, N = 1699), between 8 and 24 h (normal, N = 946), and over 24 h (delayed, N = 1601). Mortality, length of stay (LOS), and complication rates were compared between groups. Demographic variables and complication rates were compared. Multivariate logistic regression was utilized to determine the specific effect of surgery timing on outcomes. RESULTS Patients with earlier surgery presented with more severe spinal trauma (P < .0001). Patients in the normal surgical timing cohort were most likely to have altered mental status (4.97% vs 3.24%, P = .05), and less likely to suffer from UTI (4.97% vs 3.24%, P = .03). Patients in the delayed cohort were older (46.2 vs 43.7 yr, P = .0003), more likely to have a longer LOS (11.3 vs 10.6 d, P = .02), return to the ICU (2.94% vs 1.29%, P = .001), experience unplanned intubation (2.06% vs 1%, P = .01) and suffer from cardiac arrest (0.53% vs 1.19%, P = .04). Upon multivariate analysis, delayed surgery was an independent risk factor for prolonged LOS (OR: 1.21, 95% CI: 0.56-1.87, P = .0003). CONCLUSION Patients with earlier surgery possessed more severe spinal injury. When adjusting for demographics and severity, no significant difference is seen in mortality between the different surgery times; however, LOS is prolonged in patients with delayed surgery.


2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 688-688
Author(s):  
Christopher R. Deig ◽  
Blake Beneville ◽  
Amy Liu ◽  
Aasheesh Kanwar ◽  
Alison Grossblatt-Wait ◽  
...  

688 Background: Whether upfront resection or total neoadjuvant therapy is superior for the treatment of potentially resectable pancreatic adenocarcinoma (PDAC) remains controversial. The impact of neoadjuvant treatment on major perioperative complication rates for patients (pts) undergoing resection for PDAC is commonly debated. We hypothesized that rates would be comparable among patients receiving neoadjuvant chemoradiation (neo-CRT), neoadjuvant chemotherapy alone (neo-CHT), or upfront surgery. Methods: This is a retrospective study of 208 pts with PDAC who underwent resection within a multidisciplinary pancreatico-biliary program at an academic tertiary referral center between 2011-2018. Data were abstracted from the medical record, an institutional cancer registry and NSQIP databases. Outcomes were assessed using χ2, Fisher’s exact test and two-tailed Student’s t-tests. Results: 208 pts were identified: 33 locally advanced, borderline or upfront resectable pts underwent neo-CRT, 35 borderline or resectable pts underwent neoadjuvant-CHT, and 140 resectable pts did not undergo neoadjuvant therapy. There were no statistically significant differences in major perioperative complication rates between groups. Overall rates were 36.4%, 34.3%, and 26.4% for pts who underwent neo-CRT, neo-CHT alone, or upfront resection, respectively (p = 0.38). No significant difference were observed in complication rates (35.3% v. 26.4%; p = 0.19) or median hospital length of stay (10 days v. 10 days; p = 0.87) in pts who received any neoadjuvant therapy versus upfront resection. There were two perioperative deaths in the neo-CRT group (6.1%), zero in the neo-CHT group, and four in the upfront resection group (2.9%); p = 0.22. Conclusions: There were no significant differences in major perioperative complication rates, hospital length of stay, or post-operative mortality in pts who underwent neoadjuvant therapy (neo-CRT or neo-CHT alone) versus upfront surgery. Notably, neo-CRT had comparable perioperative complication rates to neo-CHT alone, which suggests neoadjuvant radiation therapy may not pose additional surgical risk.


2018 ◽  
Vol 9 (2) ◽  
pp. 133-137 ◽  
Author(s):  
Luke Brown ◽  
Tristan Weir ◽  
Scott Koenig ◽  
Mark Shasti ◽  
Imran Yousaf ◽  
...  

Study Design: Single-blinded prospective randomized control trial. Objectives: To compare the incidence of adverse events (AEs) and hospital length of stay between patients who received liposomal bupivacaine (LB) versus a single saline injection, following posterior lumbar decompression and fusion surgery for degenerative spondylosis. Methods: From 2015 to 2016, 59 patients undergoing posterior lumbar decompression and fusion surgery were prospectively enrolled and randomized to receive either 60 mL injection of 266 mg LB or 60 mL of 0.9% sterile saline, intraoperatively. Outcome measures included the incidence of postoperative AEs and hospital length of stay. Results: The most common AEs in the treatment group were nausea (39.3%), emesis (18.1%), and hypotension (18.1%). Nausea (23%), constipation (19.2%), and urinary retention (15.3%) were most common in the control group. Patients who received LB had an increased risk of developing nausea (relative risk [RR] = 1.7; 95% confidence interval [CI] = 0.75-3.8), emesis (RR = 2.3; 95% CI = 0.51-10.7), and headaches (RR = 2.36; 95% CI = 0.26-21.4). Patients receiving LB had a decreased risk of developing constipation (RR = 0.78; 95% CI = 0.25-2.43), urinary retention (RR = 0.78; 95% CI = 0.21-2.85), and pruritus (RR = 0.78; 95% = 0.21-2.8) postoperatively. Relative risk values mentioned above failed to reach statistical significance. No significant difference in the hospital length of stay between both groups was found (3.9 vs 3.9 days; P = .92). Conclusion: Single-dose injections of LB to the surgical site prior to wound closure did not significantly increase or decrease the incidence or risk of developing AEs postoperatively. Furthermore, no significant difference was found in the hospital length of stay between both groups.


2019 ◽  
Vol 08 (02) ◽  
pp. 139-142
Author(s):  
Jason Shrouder-Henry ◽  
Christine Novak ◽  
Timothy Jackson ◽  
Heather Baltzer

Background Bone reconstruction is frequently required for corrective osteotomy of the forearm long bones. Studies have evaluated long term outcomes but not the impact of these procedures on early postoperative complications and health care utilization. Questions/Purposes This study evaluated the early postoperative health care utilization following corrective osteotomy of the radius and/or ulna. Patients and Methods The American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) was the primary data source to perform a comparative statistical analysis of the bone autograft and nonautograft (allograft, graft substitute, or no graft) procedures. We performed a review of the NSQIP database (2005–2013) to evaluate patients who underwent a corrective osteotomy of the radius and/or ulna. Results There were 362 cases; autograft (n = 117) and nonautograft (n = 245). There were no significant differences with demographics or comorbidities. The majority of cases were outpatient surgeries and there were no significant differences in anesthesia time, operative time, or hospital length of stay. Overall, the average length of stay was 0.6 days, readmission rate was 2%, and the total complication rate was 1% and there was no statistically significant difference between reconstruction groups. Harvesting of autograft was not associated with the overall 30-day complications and specific markers of health care utilization. Conclusions Our results are derived from the heterogeneous hospital setting of NSQIP contributing centers. The health care utilization and 30-day complications are low following corrective osteotomy of forearm long bones and autograft harvest did not influence the health care utilization. Level of Evidence Therapeutic Level II.


2021 ◽  
Vol 74 (4) ◽  
pp. 856-863
Author(s):  
Glib I. Yemets ◽  
Oleksandra V. Telehuzova ◽  
Andrii V. Maksymenko ◽  
Georgiy B. Mankovsky ◽  
Yevhen Y. Marushko ◽  
...  

The aim: to reveal early results after transapical TAVI with a new self-manufactured XPand system, comparing them with SAVR and common transfemoral TAVI outcomes. Materials and methods: Eighty-four patients (mean age 79,5±10,2 years) with severe aortic stenosis were operated on from January 2016 to February 2019. Nine patients had undergone the TAVI (two with transfemoral access route and seven with transapical, using the XPand system). SAVR was performed in seventy five patients. For the latter, we estimate the in-hospital mortality, complication rates, intensive care unit and total hospital length of stay. Results: There was no intraoperative mortality. In the TAVI group, the frequency of intraoperative and postoperative complications was significantly lower (p<0.01). The SAVR group showed higher median intensive care unit length of stay (104 h, IQR 72 –112 versus 29 h, IQR 20–35,p<0.01), hemodynamic support duration (100,98 ± 78 minutes versus 11.13 ± 7.89 minutes, p<0.01) and paravalvular leakage causality (9,33% versus 0%). No significant difference in results depending on the TAVI access routes was obtained. Conclusions: We conclude that TAVI provides an alternative to the conventional approach in patients with severe aortic stenosis aged over 75 years. No significant difference in mortality rate between TAVI and SAVR groups was found. A novel transapical TAVI device is associated with good short-term results and lower complication rate.


2014 ◽  
Vol 121 (2) ◽  
pp. 262-276 ◽  
Author(s):  
Ranjith Babu ◽  
Steven Thomas ◽  
Matthew A. Hazzard ◽  
Allan H. Friedman ◽  
John H. Sampson ◽  
...  

Object On July 1, 2003, the Accreditation Council for Graduate Medical Education (ACGME) implemented duty-hour restrictions for resident physicians due to concerns for patient and resident safety. Though duty-hour restrictions have increased resident quality of life, studies have shown mixed results with respect to patient outcomes. In this study, the authors have evaluated the effect of duty-hour restrictions on morbidity, mortality, length of stay, and charges in patients who underwent brain tumor and cerebrovascular procedures. Methods The Nationwide Inpatient Sample was used to evaluate the effect of duty-hour restrictions on complications, mortality, length of stay, and charges by comparing the pre-reform (2000–2002) and post-reform (2005–2008) periods. Outcomes were compared between nonteaching and teaching hospitals using a difference-in-differences (DID) method. Results A total of 90,648 patients were included in the analysis. The overall complication rate was 11.7%, with the rates not significantly differing between the pre– and post–duty hour eras (p = 0.26). Examination of hospital teaching status revealed that complication rates decreased in nonteaching hospitals (12.1% vs 10.4%, p = 0.0004) and remained stable in teaching institutions (11.8% vs 11.9%, p = 0.73) in the post-reform era. Multivariate analysis demonstrated a significantly higher complication risk in teaching institutions (OR 1.33 [95% CI 1.11–1.59], p = 0.0022), with no significant change in nonteaching hospitals (OR 1.11 [95% CI 0.91–1.37], p = 0.31). A DID analysis to compare the magnitude in change between teaching and nonteaching institutions revealed that teaching hospitals had a significantly greater increase in complications during the post-reform era than nonteaching hospitals (p = 0.040). The overall mortality rate was 3.0%, with a significant decrease occurring in the post-reform era in both nonteaching (5.0% vs 3.2%, p < 0.0001) and teaching (3.2% vs 2.3%, p < 0.0001) hospitals. DID analysis to compare the changes in mortality between groups did not reveal a significant difference (p = 0.40). The mean length of stay for all patients was 8.7 days, with hospital stay decreasing from 9.2 days to 8.3 days in the post-reform era (p < 0.0001). The DID analysis revealed a greater length of stay decrease in nonteaching hospitals than teaching institutions, which approached significance (p = 0.055). Patient charges significantly increased in the post-reform era for all patients, increasing from $70,900 to $96,100 (p < 0.0001). The DID analysis did not reveal a significant difference between the changes in charges between teaching and nonteaching hospitals (p = 0.17). Conclusions The implementation of duty-hour restrictions correlated with an increased risk of postoperative complications for patients undergoing brain tumor and cerebrovascular neurosurgical procedures. Duty-hour reform may therefore be associated with worse patient outcomes, contrary to its intended purpose. Due to the critical condition of many neurosurgical patients, this patient population is most sensitive and likely to be negatively affected by proposed future increased restrictions.


2020 ◽  
pp. 112070002094970
Author(s):  
Mark Sikov ◽  
Matthew Sloan ◽  
Neil P Sheth

Background: Long operative times in total hip arthroplasty (THA) have been shown to be associated with increased risk of revision as well as perioperative morbidity. This study assesses the effect of extended operative times on complication rates following primary THA using the most recent national data. Methods: The National Surgical Quality Improvement Program (NSQIP) database (2008–2016) was queried for primary THA. Groups were defined by operative time 1 standard deviation (1 SD) above the mean. Univariate, propensity score-matched, and multivariate logistic regression analyses were performed to evaluate outcomes. Results: Data was available for 135,013 THA patients. Among these groups, mean operative time in the extended operative time group was 166 minutes (compared with 82 minutes). Patients undergoing longer operative times were 3.8 years younger, had a 1.5 kg/m2 higher body mass index and had a 0.5 day longer mean length of stay. Propensity matching identified 16,123 pairs for analysis in the 1 SD group. Longer operative time led to 173% increased risk of major medical morbidity, 140% increased likelihood of length of stay greater than 5 days, 59% increased risk of reoperation, 45% increased risk of readmission, and a 30% decreased likelihood of return to home postoperatively. There was no increased risk of death within 30 days. Conclusion: Long operative times were associated with increases in multiple postoperative complications, but not mortality. Surgeons should be advised to take steps to minimise operative time by adequate preoperative planning and optimal team communication.


2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S109-S109
Author(s):  
Phuong Khanh Nguyen ◽  
Thuong Tran ◽  
Kristy Jetsupphasuk ◽  
Nina Wang ◽  
Patricia Chun ◽  
...  

Abstract Background Drug-induced nephrotoxicity in the form of acute kidney injury (AKI) is a potential adverse effect of vancomycin, which is commonly prescribed empirically with an antipseudomonal agent. It is unclear if combinations with certain antipseudomonal agents (e.g., piperacillin-tazobactam) are associated with more AKI relative to others. Methods This retrospective cohort study conducted at two Veterans Affairs (VA) Medical Centers with differing preferred empiric vancomycin-antipseudomonal regimens aimed to assess the incidence of AKI in patients receiving vancomycin and piperacillin-tazobactam (VPT) at VA Greater Los Angeles Healthcare System (HCS) versus vancomycin and cefepime (VC) at VA Long Beach HCS. Patients who received VPT or VC for at least 48 hours in 2016–2018 were included. AKI definitions were derived from 2012 Kidney Disease Improving Global Outcomes guidelines. Secondary assessments included hospital length of stay, 90-day mortality, and incidence of Clostridioides difficile infection (CDI) within 90 days. Patients who developed AKI were further assessed for time-to-onset of AKI, development of chronic kidney disease (CKD) within 90 days, and hemodialysis (HD) dependence within 1 year. Statistical analysis was performed using Fisher’s exact and Mann-Whitney U tests where appropriate. Propensity score matching using logistic regression with nearest-neighbor matching was performed to control for potential confounding baseline characteristics. Results 21/120 patients receiving VPT developed AKI vs. 4/120 receiving VC (17.5% vs. 3.3%, p=0.0005). After propensity score matching, AKI incidence remained significantly higher for VPT patients (15.2% vs. 4.0%, p=0.01). Median length of stay was significantly longer for VPT patients (10 days vs. 8 days, p=0.03). There was no significant difference in time-to-onset of AKI, 90-day mortality, or CDI. No significant difference was found in the development of CKD within 90 days nor the requirement of HD within 1 year. Conclusion VPT combination therapy was associated with increased incidence of AKI compared to VC, though 90-day mortality and other outcomes were similar. Advising prescribers about potentially increased risk of AKI with VPT is a viable stewardship intervention. Disclosures All Authors: No reported disclosures


2021 ◽  
Vol 6 (1) ◽  
pp. e000701
Author(s):  
Leah E Larson ◽  
Melissa L Harry ◽  
Paul K Kosmatka ◽  
Kristin P Colling

BackgroundTrauma systems in rural areas often require longdistance transfers for definitive care. Delays in care, such as delayed femurfracture repair have been reported to be associated with poorer outcomes, butlittle is known about how transfer time affects time to repair or outcomesafter femur fractures.MethodsWe conducted a retrospective review of all trauma patients transferred to our level 1 rural trauma center between May 1, 2016-April 30, 2019. Patient demographics and outcomes were abstracted from chart and trauma registry review. All patients with femur fractures were identified. Transfer time was defined as the time from admission at the initial hospital to admission at the trauma center, and time to repair was defined as time from admission to the trauma center until operative start time. Our outcome variables were mortality, in-hospital complications, and hospital length of stay (LOS).ResultsOver the study period1,887 patients were transferred to our level 1 trauma center and 398 had afemur fracture. Compared to the entire transfer cohort, femur fracture patientswere older (71 versus 57 years), and more likely to be female (62% versus 43%).The majority (74%) of patients underwent fracture repair within 24hours. Delay in fracture fixation >24 hours wasassociated with increased length of stay (5 days versus 4 days; p<0.001),higher complication rates (23% versus 12%; p=0.01), and decreased dischargehome (19% vs. 32%, pp=0.02), but was not associated with mortality (6% versus5%; p=0.75). Transfer time and time at the initial hospital were not associatedwith mortality, complication rate, or time to femur fixation.DiscussionFixation delay greater than 24 hours associated with increased likelihood of in-hospital complications, longer length of stay, and decreased likelihood of dischargehome. Transfer time not related to patient outcomes or time to femur fixation.Level of evidenceLevel III; therapeutic/care management.


Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Matthew R Potter ◽  
Marco Mion ◽  
Eleni A Nikolopoulou ◽  
Neil Magee ◽  
Kelly Farrell ◽  
...  

Background: The neuropsychological and cognitive consequences of an ICU stay can cause a large burden on many patients. In this study, we assessed the outcomes of a group of patients attending a newly set up, multi-disciplinary outpatient clinic focused on assessing neuropsychological and cognitive outcomes following a significant (>72 hours) ICU stay, and compared patients whose ICU was post-OHCA (out of hospital cardiac arrest), and those non-OHCA. Methods: Between 2016 and 2019, 152 patients were assessed within the Care after REsuscitation (CARE) / ICU follow up clinic, 6 months following hospital discharge, using the SF-36, HADS, PTSS-14 and MoCA. The OHCA group were compared to other non-OHCA, ICU patients (>72 hour stay). Results: No significant differences (p<0.05) were found between the groups outcomes, however we found that 6 months post-discharge, the non-OHCA group experience significantly more pain, are older, and required a longer length of stay (p<0.05). However, we found compared to normative data of the SF-36, over half of the OHCA group (on 6 out of the 8 subscales) and the non-OHCA (on 7 out of the 8) were below population norms, especially Role-Physical (66.7% OHCA and 71.6% non-OHCA) and Energy/ fatigue (66.7% OHCA and 61.4% non-OHCA). Anxiety was observed in 33.3% of the OHCA group, and 35.2% of the non-OHCA group had an abnormal total HADS score. PTSD was seen in 12.7% of the OHCA group and 10.2% of the non-OHCA group. Cognitive impairment was observed in 61.9% of OHCA and 59.1% of non-OHCA patients. Age and hospital length of stay had no significant effect on outcomes on our OHCA population, however females had significantly worse health related quality of life (HRQoL) on 6 out of the 8 subscales (p<0.05). Conclusion: Despite the OHCA and non-OHCA groups having no significant difference between their outcomes, there is a great disease burden upon many individuals following ICU stay, with many experiencing poor HRQoL, mood disorders, PTSD and cognitive impairment. The factors contributing to poor outcome following both ICU related illness and cardiac arrest should be further studied. The creation and validation of new assessment tools is imperative to ensure we fully appreciate the extent of the morbidity in this group to improve care for all ICU patients.


Sign in / Sign up

Export Citation Format

Share Document