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Gerald J Marks - One of the best experts on this subject based on the ideXlab platform.
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Transanal endoscopic microsurgery for the treatment of rectal cancer: comparison of Wound Complication rates with and without neoadjuvant radiation therapy
Surgical Endoscopy, 2009Co-Authors: John H. Marks, Elsa B Valsdottir, Albert S Denittis, Shadi Yarandi, D A Newman, I Nweze, M Mohiuddin, Gerald J MarksAbstract:Background Neoadjuvant therapy for rectal cancer has led to improved tumor downstaging and higher complete pathologic response rates. At the same time, the introduction of transanal endoscopic microsurgery (TEM) technique has renewed interest in local excision of rectal cancer. There has been concern that radiation may make the more radical local excision with TEM unsuitable. Our study compared morbidity rates and Wound Complication rates for patients undergoing TEM and local excision with and without neoadjuvant radiation to determine whether this could be accomplished safely. Methods Data for all patients undergoing TEM are prospectively entered into a database. This database was queried for patients with rectal cancer undergoing TEM from November 1997 to June 2007. Of 64 patients identified, 2 were excluded because of previous radiation to the pelvis. Results The study enrolled 62 patients with a final pathologic diagnosis of rectal cancer: 43 treated using neoadjuvant therapy with radiation (XRT) and 19 patients treated with TEM alone. The patients in the XRT group were 67 years of age (range, 29–86 years) and included 13 women. The patients in the non-XRT group were 66 years of age (range, 40–89 years) and included 8 women. Neither group had any mortalities. The overall morbidity rate was 33% for the XRT group and 5.3% for the non-XRT group, and this difference was statistically significant ( p
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transanal endoscopic microsurgery for the treatment of rectal cancer comparison of Wound Complication rates with and without neoadjuvant radiation therapy
Surgical Endoscopy and Other Interventional Techniques, 2009Co-Authors: John Marks, Elsa B Valsdottir, Albert S Denittis, Shadi Yarandi, D A Newman, I Nweze, M Mohiuddin, Gerald J MarksAbstract:Background Neoadjuvant therapy for rectal cancer has led to improved tumor downstaging and higher complete pathologic response rates. At the same time, the introduction of transanal endoscopic microsurgery (TEM) technique has renewed interest in local excision of rectal cancer. There has been concern that radiation may make the more radical local excision with TEM unsuitable. Our study compared morbidity rates and Wound Complication rates for patients undergoing TEM and local excision with and without neoadjuvant radiation to determine whether this could be accomplished safely.
Mary T. Hawn - One of the best experts on this subject based on the ideXlab platform.
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Impact of Gastrointestinal Surgical Site Wound Complications on Long-term Healthcare Utilization
Journal of Gastrointestinal Surgery, 2020Co-Authors: Tanmaya D. Sambare, Laura A. Graham, Kamal M. F. Itani, Melanie S. Morris, Shawn Moshrefi, Mary T. HawnAbstract:Importance Wound Complication following gastrointestinal surgery substantially impacts the quality and costs of surgical care. The impact of Wound Complication on subsequent long-term healthcare utilization has not been fully studied. Objective We assessed the impact of surgical Wound Complication on inpatient and outpatient healthcare utilization in the 2 years after gastrointestinal (GI) surgery. Design An observational retrospective cohort study was conducted on Veterans Affairs health system patients who underwent an inpatient GI surgical procedure, were assessed by the Veterans Affairs Surgical Quality Improvement Program (VASQIP), and were discharged alive from Veterans Affairs (VA) hospitals between October 1, 2007 and September 30, 2014. Setting Population-based Participants A total of 64,351 patients underwent a GI surgical procedure in the VA system between 2007 and 2014. The cohort was 93.5% male, with a median age of 63.0 years (interquartile range (IQR) 57.0–70.0). A total of 7880 patients (12.2%) had at least one reported Wound Complication, 5460 of which had their postoperative Wound Complication classified by a VASQIP nurse. Exposure VASQIP-assessed or ICD-9-coded Wound Complication in the 30 days after surgery Main Outcome Measurements Inpatient visits, total inpatient days, outpatient visits, and emergency department visits, and operative interventions up to 2 years after discharge from index admission Results Patients with a postoperative Wound Complication had greater inpatient healthcare utilization compared with no-Wound Complication for up to 2 years after surgery: inpatient admissions (mean number 3.5 vs. 2.8; P
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Impact of Gastrointestinal Surgical Site Wound Complications on Long-term Healthcare Utilization.
Journal of Gastrointestinal Surgery, 2020Co-Authors: Tanmaya D. Sambare, Laura A. Graham, Kamal M. F. Itani, Melanie S. Morris, Shawn Moshrefi, Mary T. HawnAbstract:IMPORTANCE: Wound Complication following gastrointestinal surgery substantially impacts the quality and costs of surgical care. The impact of Wound Complication on subsequent long-term healthcare utilization has not been fully studied. OBJECTIVE: We assessed the impact of surgical Wound Complication on inpatient and outpatient healthcare utilization in the 2 years after gastrointestinal (GI) surgery. DESIGN: An observational retrospective cohort study was conducted on Veterans Affairs health system patients who underwent an inpatient GI surgical procedure, were assessed by the Veterans Affairs Surgical Quality Improvement Program (VASQIP), and were discharged alive from Veterans Affairs (VA) hospitals between October 1, 2007 and September 30, 2014. SETTING: Population-based PARTICIPANTS: A total of 64,351 patients underwent a GI surgical procedure in the VA system between 2007 and 2014. The cohort was 93.5% male, with a median age of 63.0 years (interquartile range (IQR) 57.0-70.0). A total of 7880 patients (12.2%) had at least one reported Wound Complication, 5460 of which had their postoperative Wound Complication classified by a VASQIP nurse. EXPOSURE: VASQIP-assessed or ICD-9-coded Wound Complication in the 30 days after surgery MAIN OUTCOME MEASUREMENTS: Inpatient visits, total inpatient days, outpatient visits, and emergency department visits, and operative interventions up to 2 years after discharge from index admission RESULTS: Patients with a postoperative Wound Complication had greater inpatient healthcare utilization compared with no-Wound Complication for up to 2 years after surgery: inpatient admissions (mean number 3.5 vs. 2.8; P < .001), inpatient bed days (mean 41.0 vs. 25.0; P < .001). Patients with a postoperative Wound Complication also had greater 2-year outpatient utilization than the no-Wound Complication cohort: outpatient visits (mean number 92.7 vs. 75.9; P < .001) and emergency department visits (mean 3.5 vs. 2.7; P < .001). The same relationship held for Wound-related parameters; inpatient admissions (2.2 vs. 0.4; P < .001); inpatient bed days (21.4 vs. 3.7; P < .001); and outpatient visits (56.2 vs. 9.7; P < .001). A greater proportion of patients in the Wound Complication cohort had an operative intervention for all time intervals examined (P < .001). CONCLUSIONS: Surgical Wound Complications impact healthcare utilization patterns for up to 2 years after the index procedure including hospital readmissions and operative interventions; efforts to reduce postoperative Wound Complications will have substantial effects on patient outcomes and healthcare expenditures well beyond the 30-day postoperative period.
P Nunag - One of the best experts on this subject based on the ideXlab platform.
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tranexamic acid with total knee arthoplasty reduced Wound Complication and transfusion rates
Orthopaedic Proceedings, 2018Co-Authors: H W Sargeant, P NunagAbstract:Tranexamic Acid (TA) has been shown to reduce transfusion rates in Total Knee Replacement (TKR) without Complication. In our unit it was added to our routine enhanced recovery protocol. No other changes were made to the protocol at this time and as such we sought to examine the effects of TA on Wound Complication and transfusion rate.All patients undergoing primary TKR over a 12 month period were identified. Notes and online records were reviewed to collate demographics, length of stay, use of TA, thromboprophylaxis, blood transfusion, Wound Complications and haemoglobin levels. All patients received a Columbus navigated TKR with a tourniquet. Only patients who received 14 days of Dalteparin for thromboprophylaxis were included.124 patients were included, 72 receiving TA and 52 not. Mean age was 70. Four patients required a blood transfusion all of whom did not receive TA (p = 0.029). Mean change in Hb was 22 without TA and 21 with (p = 0.859). Mean length of stay was 6.83 days without Tranexamic Acid and...
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tranexamic acid with total knee arthoplasty reduced Wound Complication and transfusion rates
Journal of Bone and Joint Surgery-british Volume, 2016Co-Authors: H W Sargeant, P NunagAbstract:Tranexamic Acid (TA) has been shown to reduce transfusion rates in Total Knee Replacement (TKR) without Complication. In our unit it was added to our routine enhanced recovery protocol. No other changes were made to the protocol at this time and as such we sought to examine the effects of TA on Wound Complication and transfusion rate. All patients undergoing primary TKR over a 12 month period were identified. Notes and online records were reviewed to collate demographics, length of stay, use of TA, thromboprophylaxis, blood transfusion, Wound Complications and haemoglobin levels. All patients received a Columbus navigated TKR with a tourniquet. Only patients who received 14 days of Dalteparin for thromboprophylaxis were included. 124 patients were included, 72 receiving TA and 52 not. Mean age was 70. Four patients required a blood transfusion all of whom did not receive TA (p = 0.029). Mean change in Hb was 22 without TA and 21 with (p = 0.859). Mean length of stay was 6.83 days without Tranexamic Acid and 5.15 with (p In our unit we have demonstrated a significantly lower transfusion rate, Wound Complication rate and length of stay, without any significant increase in thromboembolic disease with the use of TA in TKR.
Tanmaya D. Sambare - One of the best experts on this subject based on the ideXlab platform.
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Impact of Gastrointestinal Surgical Site Wound Complications on Long-term Healthcare Utilization
Journal of Gastrointestinal Surgery, 2020Co-Authors: Tanmaya D. Sambare, Laura A. Graham, Kamal M. F. Itani, Melanie S. Morris, Shawn Moshrefi, Mary T. HawnAbstract:Importance Wound Complication following gastrointestinal surgery substantially impacts the quality and costs of surgical care. The impact of Wound Complication on subsequent long-term healthcare utilization has not been fully studied. Objective We assessed the impact of surgical Wound Complication on inpatient and outpatient healthcare utilization in the 2 years after gastrointestinal (GI) surgery. Design An observational retrospective cohort study was conducted on Veterans Affairs health system patients who underwent an inpatient GI surgical procedure, were assessed by the Veterans Affairs Surgical Quality Improvement Program (VASQIP), and were discharged alive from Veterans Affairs (VA) hospitals between October 1, 2007 and September 30, 2014. Setting Population-based Participants A total of 64,351 patients underwent a GI surgical procedure in the VA system between 2007 and 2014. The cohort was 93.5% male, with a median age of 63.0 years (interquartile range (IQR) 57.0–70.0). A total of 7880 patients (12.2%) had at least one reported Wound Complication, 5460 of which had their postoperative Wound Complication classified by a VASQIP nurse. Exposure VASQIP-assessed or ICD-9-coded Wound Complication in the 30 days after surgery Main Outcome Measurements Inpatient visits, total inpatient days, outpatient visits, and emergency department visits, and operative interventions up to 2 years after discharge from index admission Results Patients with a postoperative Wound Complication had greater inpatient healthcare utilization compared with no-Wound Complication for up to 2 years after surgery: inpatient admissions (mean number 3.5 vs. 2.8; P
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Impact of Gastrointestinal Surgical Site Wound Complications on Long-term Healthcare Utilization.
Journal of Gastrointestinal Surgery, 2020Co-Authors: Tanmaya D. Sambare, Laura A. Graham, Kamal M. F. Itani, Melanie S. Morris, Shawn Moshrefi, Mary T. HawnAbstract:IMPORTANCE: Wound Complication following gastrointestinal surgery substantially impacts the quality and costs of surgical care. The impact of Wound Complication on subsequent long-term healthcare utilization has not been fully studied. OBJECTIVE: We assessed the impact of surgical Wound Complication on inpatient and outpatient healthcare utilization in the 2 years after gastrointestinal (GI) surgery. DESIGN: An observational retrospective cohort study was conducted on Veterans Affairs health system patients who underwent an inpatient GI surgical procedure, were assessed by the Veterans Affairs Surgical Quality Improvement Program (VASQIP), and were discharged alive from Veterans Affairs (VA) hospitals between October 1, 2007 and September 30, 2014. SETTING: Population-based PARTICIPANTS: A total of 64,351 patients underwent a GI surgical procedure in the VA system between 2007 and 2014. The cohort was 93.5% male, with a median age of 63.0 years (interquartile range (IQR) 57.0-70.0). A total of 7880 patients (12.2%) had at least one reported Wound Complication, 5460 of which had their postoperative Wound Complication classified by a VASQIP nurse. EXPOSURE: VASQIP-assessed or ICD-9-coded Wound Complication in the 30 days after surgery MAIN OUTCOME MEASUREMENTS: Inpatient visits, total inpatient days, outpatient visits, and emergency department visits, and operative interventions up to 2 years after discharge from index admission RESULTS: Patients with a postoperative Wound Complication had greater inpatient healthcare utilization compared with no-Wound Complication for up to 2 years after surgery: inpatient admissions (mean number 3.5 vs. 2.8; P < .001), inpatient bed days (mean 41.0 vs. 25.0; P < .001). Patients with a postoperative Wound Complication also had greater 2-year outpatient utilization than the no-Wound Complication cohort: outpatient visits (mean number 92.7 vs. 75.9; P < .001) and emergency department visits (mean 3.5 vs. 2.7; P < .001). The same relationship held for Wound-related parameters; inpatient admissions (2.2 vs. 0.4; P < .001); inpatient bed days (21.4 vs. 3.7; P < .001); and outpatient visits (56.2 vs. 9.7; P < .001). A greater proportion of patients in the Wound Complication cohort had an operative intervention for all time intervals examined (P < .001). CONCLUSIONS: Surgical Wound Complications impact healthcare utilization patterns for up to 2 years after the index procedure including hospital readmissions and operative interventions; efforts to reduce postoperative Wound Complications will have substantial effects on patient outcomes and healthcare expenditures well beyond the 30-day postoperative period.
H W Sargeant - One of the best experts on this subject based on the ideXlab platform.
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tranexamic acid with total knee arthoplasty reduced Wound Complication and transfusion rates
Orthopaedic Proceedings, 2018Co-Authors: H W Sargeant, P NunagAbstract:Tranexamic Acid (TA) has been shown to reduce transfusion rates in Total Knee Replacement (TKR) without Complication. In our unit it was added to our routine enhanced recovery protocol. No other changes were made to the protocol at this time and as such we sought to examine the effects of TA on Wound Complication and transfusion rate.All patients undergoing primary TKR over a 12 month period were identified. Notes and online records were reviewed to collate demographics, length of stay, use of TA, thromboprophylaxis, blood transfusion, Wound Complications and haemoglobin levels. All patients received a Columbus navigated TKR with a tourniquet. Only patients who received 14 days of Dalteparin for thromboprophylaxis were included.124 patients were included, 72 receiving TA and 52 not. Mean age was 70. Four patients required a blood transfusion all of whom did not receive TA (p = 0.029). Mean change in Hb was 22 without TA and 21 with (p = 0.859). Mean length of stay was 6.83 days without Tranexamic Acid and...
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tranexamic acid with total knee arthoplasty reduced Wound Complication and transfusion rates
Journal of Bone and Joint Surgery-british Volume, 2016Co-Authors: H W Sargeant, P NunagAbstract:Tranexamic Acid (TA) has been shown to reduce transfusion rates in Total Knee Replacement (TKR) without Complication. In our unit it was added to our routine enhanced recovery protocol. No other changes were made to the protocol at this time and as such we sought to examine the effects of TA on Wound Complication and transfusion rate. All patients undergoing primary TKR over a 12 month period were identified. Notes and online records were reviewed to collate demographics, length of stay, use of TA, thromboprophylaxis, blood transfusion, Wound Complications and haemoglobin levels. All patients received a Columbus navigated TKR with a tourniquet. Only patients who received 14 days of Dalteparin for thromboprophylaxis were included. 124 patients were included, 72 receiving TA and 52 not. Mean age was 70. Four patients required a blood transfusion all of whom did not receive TA (p = 0.029). Mean change in Hb was 22 without TA and 21 with (p = 0.859). Mean length of stay was 6.83 days without Tranexamic Acid and 5.15 with (p In our unit we have demonstrated a significantly lower transfusion rate, Wound Complication rate and length of stay, without any significant increase in thromboembolic disease with the use of TA in TKR.
