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Local surgical complication rates in patients receiving surgery without immediate post-operative radiation therapy for lower extremity bone metastases.

ABSTRACT: Purpose:Pathological metastatic fractures in lower-extremity weight bearing bones often require surgical reconstruction. Post-operative radiation is routinely recommended following surgical reconstruction. This study evaluated the clinical outcomes of patients that undergo surgical fixation of an established or an impending pathologic lower extremity fracture without post-operative radiation. Materials and methods:A retrospective chart review of patients at Sunnybrook Health Sciences Center between 2007 and 2019 was performed. Descriptive statistical analyses were performed. Results:A total of 161 surgical reconstruction procedures were identified. Among these cases, 86/161 (53.4%) received post-operative radiation, 75/161 (47%) did not receive post-operative radiation within 12 weeks of their index surgery. Of the 75 patients not receiving post-operative radiation, 40 patients had prior radiation to the surgical site and 35 patients were radiation naïve. 5 patients (6.7%) required a second operation to the index surgical site, with 4 patients (5.3%) requiring a second fixation surgery to stabilize hardware at a median of 6.0 months post-surgery. Post-surgical radiation to the surgical site (at >12 weeks) was administered to 12 patients (16.0%) at a median of 9.1 months post-surgery. Conclusions:The surgical revision rate was low despite absence of immediate post-operative radiation therapy and was similar to prior reports in patients receiving post-operative radiation.

SUBMITTER: Pidduck W

PROVIDER: S-EPMC7262003 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Local surgical complication rates in patients receiving surgery without immediate post-operative radiation therapy for lower extremity bone metastases.

Pidduck William W Drost Leah L Yee Albert A Chow Edward E Tuazon Ravi R Henry Patrick P

Journal of bone oncology 20200423

<h4>Purpose</h4>Pathological metastatic fractures in lower-extremity weight bearing bones often require surgical reconstruction. Post-operative radiation is routinely recommended following surgical reconstruction. This study evaluated the clinical outcomes of patients that undergo surgical fixation of an established or an impending pathologic lower extremity fracture without post-operative radiation.<h4>Materials and methods</h4>A retrospective chart review of patients at Sunnybrook Health Scien ...[more]

PMID: 32489810

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Project description:BACKGROUND:Wound complication rates after lower extremity vascular operative procedures stand as high as 40% and represent a major cause of morbidity, mortality, and cost. In view of increasing recognition of adipose tissue involvement in homeostasis and the response to injury, we hypothesized that adipose phenotype is linked to operative wound outcomes. METHODS:Clinical history, peripheral blood, and subcutaneous and perivascular adipose tissue were prospectively collected at the time of operation in patients undergoing lower extremity revascularization and lower extremity amputations. Nine biologic mediators (adiponectin; interleukin [IL]-1?, IL-6, and IL-8; leptin; monocyte chemoattractant protein-1; plasminogen activator inhibitor-1; resistin; and tumor necrosis factor) were assayed in the adipose tissues and plasma. The 30-day wound complications were captured in real time. Logarithmic transformation of mediator levels was performed based on positively skewed, non-Gaussian distribution, and data were compared using the Student t test. Bonferroni correction was used for multiple comparisons. RESULTS:Sixty-six patients undergoing lower extremity revascularization or lower extremity amputations for severe peripheral arterial disease were enrolled. The 30-day follow-up was 92.4%. In total, 19 (29%) patients developed wound complications. Patients who developed wound complications had elevated perivascular adiponectin levels (mean ± standard error, 2,372.45 ± 648.64 ng/mL vs 832.53 ± 180.54 ng/mL, P = .004). Perivascular IL-1? levels were lower among patients with wound dehiscence (0.41 ± 0.004 pg/mL vs 0.73 ± 0.09 pg/mL, P = .001). CONCLUSION:Local adipose tissue mediator levels at the time of operation demonstrate a previously undescribed compartment-specific relationship to wound outcomes in patients undergoing lower extremity vascular operative procedures. These associations provide fertile directives for defining the mechanisms underlying the pathogenesis of wound complications and their prevention.

Project description:ObjectivesTo compare 90-day postoperative complication rates between Veterans receiving cataract surgery in VA vs Community Care (CC) during the first year of implementation of the Veterans Choice Act.Data sourcesFiscal Year (FY) 2015 VA and CC outpatient data from VA's Corporate Data Warehouse (CDW) 10/01/14-9/30/15). FY14 data were used to obtain baseline clinical information prior to surgery.Study designRetrospective one-year study using secondary data to compare 90-day complication rates following cataract surgery (measured using National Quality Forum (NQF) criteria) in VA vs CC. NQF defines major complications from a specified list of Current Procedural Terminology (CPT) codes. We ran a series of logistic regression models to predict 90-day complication rates, adjusting for Veterans' sociodemographic characteristics, comorbidities, preoperative ocular conditions, eye risk group, and type of cataract surgery (classified as routine vs complex).Data collectionWe linked VA and CC users through patient identifiers obtained from the CDW files. Our sample included all enrolled Veterans who received outpatient cataract surgery either in the VA or through CC during FY15. Cataract surgeries were identified through CPT codes 66 984 (routine) and 66 982 (complex).Principal findingsOf the 83,879 cataract surgeries performed in FY15, 31 percent occurred through CC. Undergoing complex surgery and having a high-risk eye (based on preoperative ocular conditions) were the strongest clinical predictors of 90-day postoperative complications. Overall, we found low complication rates, ranging from 1.1 percent in low-risk eyes to 3.6 percent in high-risk eyes. After adjustment for important confounders (eg, race, rurality, and preoperative ocular conditions), there were no statistically significant differences in 90-day complication rates between Veterans receiving cataract surgery in VA vs CC.ConclusionsAs more Veterans seek care through CC, future studies should continue to monitor quality of care across the two care settings to help inform VA's "make vs buy decisions."

Project description:BackgroundWide variations exist in price and quality for health-care services, but the link between price and quality remains uncertain.ObjectiveThis paper used claims data from a large commercially insured population to assess the association between both procedure- and provider-level prices and complication rates for three common outpatient surgical services.DesignThis is a retrospective cohort study.SettingThe study used medical claims data from commercial health plans between 2009 and 2013 for three outpatient surgical services-joint arthroscopy, cataract surgery, and colonoscopy.Main measuresFor each procedure, price was assessed as the sum of patient, employer, and insurer spending. Complications were identified using existing algorithms specific to each service. Multivariate regressions were used to risk-adjust prices and complication rates. Provider-level price and complication rates were compared by calculating standardized differences that compared provider risk-adjusted price and complication rates with other providers within the same geographic market. The association between provider-level risk-adjusted price and complication rates was estimated using a linear regression.Key resultsAcross the three services, there was an inverse association between both procedure- and provider-level prices and complication rates. For joint arthroscopy, cataract surgery, and colonoscopy, a one standard deviation increase in procedure-level price was associated with 1.06 (95% CI 1.05-1.08), 1.14 (95% CI 1.11-1.16), and 1.07 (95% CI 1.06-1.07) odds increases in the rate of procedural complications, respectively. A one standard deviation increase in risk-adjusted provider price was associated with 0.09 (95% CI 0.07 to 0.11), 0.02 (95% CI 0.003 to 0.05), and 0.32 (95% CI 0.29 to 0.34) standard deviation increases in the rate of provider risk-adjusted complication rates, respectively.LimitationsResults may be due to unobserved factors. Only three surgical services were examined, and the results may not generalize to other services and procedures. Quality measurements did not include patient satisfaction or experience measures.ConclusionsFor three common outpatient surgical services, procedure- and provider-level prices are associated with modest increased rates of complication rates.

Project description:IntroductionPatients with chronic kidney disease (CKD) have a high prevalence of peripheral artery disease. How best to manage lower extremity peripheral artery disease remains unclear in this patient population. We therefore sought to compare the outcomes after endovascular versus surgical lower extremity revascularization among patients with CKD.MethodsWe used data from Optum's de-identifed Clinformatics® Data Mart Database, a nationwide database of commercially insured persons in the United States to study patients with CKD who underwent lower extremity endovascular or surgical revascularization. We used inverse probability of treatment weighting to balance covariates. We employed proportional hazard regression to study the primary outcome of major adverse limb events (MALE), defined as a repeat revascularization or amputation. We also studied each of these events separately and death from any cause.ResultsIn our cohort, 60,057 patients underwent endovascular revascularization and 9,338 patients underwent surgical revascularization. Endovascular revascularization compared with surgical revascularization was associated with a higher adjusted hazard of MALE (hazard ratio (HR) 1.52; 95% confidence interval (CI) 1.46-1.59). Endovascular revascularization was also associated with a higher adjusted hazard of repeat revascularization (HR 1.65; 95% CI 1.57-1.72) but a lower adjusted risk of amputation (HR 0.71; CI 0.73-0.89). Patients undergoing endovascular revascularization also had a lower adjusted hazard for death from any cause (0.85; CI 0.82-0.88).ConclusionsIn this analysis of patients with CKD undergoing lower extremity revascularization, an endovascular approach was associated with a higher rate of repeated revascularization but a lower risk of subsequent amputation and death compared with surgical revascularization. Multiple factors must be considered when counseling patients with CKD, who have a high burden of comorbid conditions. Clinical trials should include more patients with kidney disease, who are often otherwise excluded from participation, to better understand the most effective treatment strategies for this vulnerable patient population.

Dataset Information

Local surgical complication rates in patients receiving surgery without immediate post-operative radiation therapy for lower extremity bone metastases.

Publications

Local surgical complication rates in patients receiving surgery without immediate post-operative radiation therapy for lower extremity bone metastases.

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