Dataset Information

Variation in complications and mortality following ALPPS at early-adopting centers.

ABSTRACT:

Background

Various, often conflicting, estimates for post-operative morbidity and mortality following ALPPS have been reported in the literature, suggesting that considerable center-level variation exists. Some of this variation may be related to center volume and experience.

Methods

Using data from seventeen centers who were early adopters of the ALPPS technique, we estimated the variation, by center, in standardized 90-day mortality and comprehensive complication index (CCI) for patients treated between 2012 and 2018.

Results

We estimated that center-specific 90-day mortality following treatment with ALPPS varied from 4.2% (95% CI: 0.8, 9.9) to 29.1% (95% CI: 13.9, 50.9), and that center-specific CCI following treatment with ALPPS varied from 17.0 (95% CI: 7.5, 26.5) to 49.8 (95% CI: 38.1, 61.8). Declines in estimated 90-day mortality and CCI were observed over time, and almost all individual centers followed this trend. Patients treated at centers with a higher number of ALPPS cases performed over the prior year had a lower risk of post-operative mortality.

Conclusion

Despite considerable center-level variation in ALPPS outcomes, perioperative outcomes following ALPPS have improved over time and treatment at higher volume centers results in a lower risk of 90-day mortality. Morbidity and mortality remain concerningly high at some centers.

SUBMITTER: Wanis KN

PROVIDER: S-EPMC7680722 | biostudies-literature | 2021 Jan

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Variation in complications and mortality following ALPPS at early-adopting centers.

Wanis Kerollos N KN Linecker Michael M Madenci Arin L AL Müller Philip C PC Nüssler Natascha N Brusadin Roberto R Robles-Campos Ricardo R Hahn Oszkar O Serenari Matteo M Jovine Elio E Lehwald Nadja N Knoefel Wolfram T WT Reese Tim T Oldhafer Karl K de Santibañes Martin M Ardiles Victoria V Lurje Georg G Capelli Rafaela R Enne Marcelo M Ratti Francesca F Aldrighetti Luca L Zhurbin Alexey S AS Voskanyan Sergey S Machado Marcel M Kitano Yuki Y Adam René R Chardarov Nikita N Skipenko Oleg O Ferri Valentina V Vicente Emilio E Tomiyama Koji K Hernandez-Alejandro Roberto R

HPB : the official journal of the International Hepato Pancreato Biliary Association 20200523 1

<h4>Background</h4>Various, often conflicting, estimates for post-operative morbidity and mortality following ALPPS have been reported in the literature, suggesting that considerable center-level variation exists. Some of this variation may be related to center volume and experience.<h4>Methods</h4>Using data from seventeen centers who were early adopters of the ALPPS technique, we estimated the variation, by center, in standardized 90-day mortality and comprehensive complication index (CCI) for ...[more]

PMID: 32456975

Similar Datasets

Project description:BackgroundSurgeons who lack experience with total ankle arthroplasty (TAA) may remain hesitant to introduce this procedure owing to previously published results of high complication rates during initial cases. The purpose of the present study was to report the development of a TAA program through intermediate outcomes and complications for an initial consecutive series of TAA patients of a single community-based foot and ankle fellowship-trained orthopedic surgeon with little TAA experience using a co-surgeon with similar training and TAA exposure.MethodsThe initial 20 patients following third-generation TAA with a single surgeon were reviewed. Clinical outcomes were measured and radiographs were evaluated to determine postoperative implant and ankle position. Complications were also measured including intraoperative, early (<3 months), and intermediate postoperative complications.ResultsWith a minimum follow-up of 2 years and average follow-up of 51 months (range 24-70 months), the mean American Orthopaedic Ankle & Foot Society Ankle-Hindfoot score was 87.7 (59-100) and VAS was 1.0 (0-5.5). All patients were improved following TAA. Radiographic evaluation demonstrated no evidence of component malalignment or ankle joint incongruity. There were no intraoperative complications nor any wound complications. Three patients returned to the operating room for placement of medial malleolar screw placement, and 1 had asymptomatic tibial component subsidence.ConclusionsOrthopedic surgeons with a proper background and updated training may be able to perform TAA with good outcomes. A TAA program was developed to define minimum training criteria to perform this procedure in our community. Our complication rate is consistent with those reported in the literature for experienced TAA centers, which contrasts previous literature suggesting increased complication rates and worse outcomes when surgeons perform initial TAAs. Utilization of an orthopedic co-surgeon was felt to be instrumental in the success of the program.Level of evidenceLevel IV, retrospective case series.

Dataset Information

Variation in complications and mortality following ALPPS at early-adopting centers.

Background

Methods

Results

Conclusion

Publications

Variation in complications and mortality following ALPPS at early-adopting centers.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets