Arthroscopic versus mini-open rotator cuff repair: a comparison of clinical outcomes and patient satisfaction

This study compares the results of arthroscopic and arthroscopically assisted mini-open rotator cuff repair in a series of 84 patients who underwent repair of small, medium, or large tears between March 1997 and September 2001 with at least 2 years of follow-up. There were 42 arthroscopic repairs and 42 mini-open repairs. Of the patients, 81 (96.4%) had good or excellent UCLA (University of California, Los Angeles) scores (40 arthroscopic repairs [95.2%] and 41 mini-open repairs [97.6%]); there were 2 fair results and 1 poor outcome. The ASES (American Shoulder and Elbow Surgeons) scores averaged 91.1 for the arthroscopic group and 90.2 for the mini-open group (P > .05). Six patients required further surgery (three from the arthroscopic group and three from the mini-open group). Of 84 patients, 83 (98.8%) reported being satisfied with the procedure. At greater than 2 years of follow-up, arthroscopic and mini-open rotator cuff repairs produced similar results for small, medium, and large rotator cuff tears with equivalent patient satisfaction rates.     

Open versus endoscopic component separation: a cost comparison

Background  

The components separation technique (CST) is performed through an open or endoscopic approach. It is unclear whether the costs associated with the endoscopic instruments outweigh any clinical benefit derived from their use and the avoidance of lipocutaneous flaps. This study aimed to compare the direct costs associated with each approach.     

Suprapubic versus transurethral bladder drainage following reconstructive pelvic surgery: a comparison of patient satisfaction and quality of life

Introduction and hypothesis

To assess the differences in patient-reported, catheter-specific satisfaction and quality of life with either suprapubic or transurethral postoperative bladder drainage following reconstructive pelvic surgery.

Methods

This was a prospective study of all eligible women who were scheduled to undergo reconstructive surgery requiring bladder drainage during the study period November 2013 to March 2015. Women who did not undergo the planned procedure(s) or did not require bladder drainage were excluded. The primary outcome was patient-reported quality of life using catheter-specific instruments including the Catheter-related Quality of Life (CIQOL) instrument, and a modified version of the Intermittent Self-Catheterization Questionnaire (ISC-Q), designed to evaluate aspects of catheter-related quality of life and satisfaction specific to the needs of the individual.

Results

A total of 178 women were analyzed, 108 in the transurethral catheter group and 70 in the suprapubic group. Women with suprapubic bladder drainage had higher quality of life and satisfaction scores than women with transurethral bladder drainage as measured by the ISC-Q (68.31?±?16.87 vs. 54.04?±?16.95, mean difference 14.27, 95 % CI 9.15?–?19.39). There was no difference in quality of life by the CIQOL. After regression analysis, women with suprapubic bladder drainage were more satisfied with their catheter-specific needs despite longer duration of catheter use, more concurrent continence surgery, and higher trait anxiety.

Conclusions

Differences in catheter-specific quality of life and patient satisfaction scores favoring suprapubic bladder drainage support its continued use in appropriately selected women for treatment of temporary postoperative urinary retention after reconstructive pelvic surgery.

     

Continuous versus interrupted suturing of traumatic lacerations: a time, cost, and complication rate comparison

BACKGROUND: The most frequently used techniques in the repair of traumatic lacerations are interrupted and continuous suturing. METHODS: We performed a prospective study of interrupted and continuous suturing techniques evaluating suturing rates, suture economy, and complication rates in the repair of 101 traumatic lacerations. RESULTS: Continuous closure was accomplished at a statistically faster rate (mean, 0.276 cm/min) than interrupted closure (mean, 0.175 cm/min; p = 0.004). Less suture material was used in the continuous closures (0.321 suture packets/cm) than in interrupted closures (0.508 suture packets/cm; p = 0.03). No statistically significant difference existed in the complication rate between the two closure methods (continuous, 1 of 44; interrupted, 1 of 57; p = 0.59). CONCLUSION: Although suturing technique should be selected primarily on the basis of wound characteristics and surgeon preference, continuous suturing warrants consideration for the closure of traumatic lacerations because of its time/material economy and the lack increased complication rates.     

Pneumatic versus laser ureteroscopic lithotripsy: a comparison of initial outcomes and cost

Purpose

To audit the cost of laser versus pneumatic semirigid ureteroscopic lithotripsy and to analyze their relative initial outcomes and cost.

Methods

Hundred and eighty-seven patients who underwent semirigid ureteroscopic lithotripsy were analyzed retrospectively in terms of age and sex of the patients; location and size of the stones; the type of probe and ancillary equipment such as guide wire, basket catheter, JJ stent requirements; irrigation amount; operation time; the cost of the anesthesia and further treatments such as a JJ stent removal operation and shock wave lithotripsy requirements and their costs. Two groups were formed based on this type of lithotripters, pneumatic and laser lithotripsy.

Results

Operation times (min.) in terms of the stone size, for stones <100 and >100 mm² were 20.75 ± 10.78 and 25.82 ± 14.23, respectively (p = 0.007). Operation times for the pneumatic and laser groups were 33.05 ± 11.36 and 15.25 ± 6.14, respectively (p < 0.05).The stone-free rates for pneumatic and laser groups were 89.6 % (n = 69) and 98.2 % (n = 108), respectively (p = 0.01). The mean cost of the operations for each of the study groups was 261.5 ± 66.13 and 311.7 ± 51.97 US$, respectively (p = 0.001). The mean cost in terms of the stone size, for stones <100 and >100 mm², was 272.86 ± 53.05 and 323.71 ± 66.88 US$, respectively (p = 0.01).

Conclusions

It seems that usage of laser lithotripsy (LL) in patients with ureteral stones is more effective than pneumatic lithotripsy (PL) in terms of operation time and SF rate. On the other hand, the mean cost of LL seems to be more expensive than PL. Urologists should think these parameters before the choice of these two treatment modalities. The higher the effectiveness, the greater the cost.     

Increased patient satisfaction from transrectal ultrasonography and biopsy under sedation.

OBJECTIVE: To determine the acceptability and patient satisfaction of transrectal biopsy undertaken with the patient under sedation. Patients and methods A retrospective questionnaire was sent to 100 patients who had undergone transrectal biopsy between January and August 1998. Levels of patient acceptability and satisfaction were assessed using visual analogue scales (VAS, with a maximum score of 10 being the least satisfactory or acceptable) and direct questions about the side-effects of the procedure. A subsequent prospective study was undertaken on 130 patients undergoing transrectal biopsy with sedation between January 1999 and January 2000. RESULTS: The mean score for patient discomfort with sedation was 1.5, compared with 3.5 with no sedation. The overall satisfaction score improved from 3.1 to 0.9 with sedation. Complication rates were comparable, although slightly higher overall in the prospective group. Conclusion Sedation can significantly reduce patient discomfort and make the transrectal biopsy a more satisfactory experience for the patient. This is particularly important in the proportion of men who need to be considered for repeat biopsies.     

Laparoscopic ultrasonography versus operative cholangiography during laparoscopic cholecystectomy: review of the literature and a comparison with open intraoperative ultrasonography

BACKGROUND: Laparoscopic ultrasonography (LUS) has been used increasingly over the last several years as a new imaging modality. To define the role of LUS during laparoscopic cholecystectomy, we evaluated LUS by prospectively comparing it with operative cholangiography (OC), by reviewing the literature on LUS, and by retrospectively comparing it with intraoperative ultrasonography performed during open cholecystectomy. STUDY DESIGN: LUS and OC were compared prospectively in 100 consecutive patients during laparoscopic cholecystectomy. The success rate of examination, the time required, the accuracy in diagnosing bile duct calculi, and the delineation of biliary anatomy were evaluated. RESULTS: The success rate of examination was 95% for LUS and 92% for OC. The main reason for unsatisfactory LUS was incomplete visualization of the distal common bile duct. The time required was 8.2 minutes for LUS and 15.9 minutes for OC (p<0.0001). Nine patients had bile duct calculi. LUS had one false-negative result and OC had two false-positives and one false-negative. The accuracies of LUS and OC were comparable except for a slightly better positive predictive value of LUS (100% versus 77.8%; p>0.1). In a literature review, 12 recent prospective studies comparing LUS and OC and three studies on open intraoperative ultrasonography were reviewed. Twelve studies of LUS with a total of 2,059 patients demonstrated results similar to the present study. The success rate was 88% to 100% for both tests. The time for LUS was approximately 7 minutes, about half of the time needed for OC. Overall, LUS was associated with fewer false-positive results than OC; the positive predictive value and specificity of LUS were better, while the sensitivity and negative predictive value of LUS and OC were comparable. OC detected ductal variations or anomalies more distinctly than LUS. Compared with open intraoperative ultrasonography, LUS had a slightly lower success rate and required a slightly longer time because it was technically more demanding, but the two procedures had a similar accuracy for diagnosing bile duct calculi. CONCLUSIONS: Because of their different advantages and disadvantages, LUS and OC can be used in a complementary manner. There is a learning curve for LUS because of its technical difficulty. Once learned, however, LUS can be used as the primary screening procedure for bile duct calculi because of its safety, speed, and cost-effectiveness. OC can be used selectively, particularly when ductal anatomic variations or anomalies or bile duct injuries are suspected.     

Quality of life and patient satisfaction in breast cancer patients after immediate breast reconstruction: a prospective study

The aim of immediate breast reconstruction is to improve well-being and quality of life for women undergoing mastectomy for breast cancer. This prospective study used the SF-36 Health Survey questionnaire to assess quality of life before and 12 months after mastectomy and immediate breast reconstruction together with patients' expectations of and satisfaction with the immediate breast reconstruction with implant. Scores for 76 participants were compared with those in 920 age-matched women from the general population. Preoperative scores for emotional well-being and physical role functioning were lower than in the reference population, while after 12 months the scores in all domains had improved and were comparable with those in the reference population. The most common reason for immediate reconstruction was the desire to avoid an external prosthesis. Most women were satisfied with immediate reconstruction, and the major determinant of aesthetic satisfaction was completion of the procedure. Although many factors may influence quality of life, 1 year after breast cancer surgery with immediate reconstruction scores are equivalent to those of the normal population.     

Prospective comparison of ambulatory with inpatient laparoscopic cholecystectomy: outcome, patient preference and satisfaction

This prospective study compares inpatient with ambulatory laparoscopic cholecystectomy with respect to outcome, patient preference and satisfaction. In total, 51 inpatients and 42 ambulatory cases were included. Mean operating and total anaesthesia times were significantly shorter for ambulatory patients (P = 0.010 and <0.001, respectively). Post-operative pain scores at 24 h were significantly lower for ambulatory patients (P = 0.005) but there was no difference after 48 h. Morbidity included three conversions (one ambulatory and two inpatients), one laparotomy for post-operative bleeding and one percutaneous drainage of a haematoma. There was no significant difference in return to home or work activity between the two groups. Measures of patient satisfaction relating to the admission procedure, amount of information received and hospital environment were significantly higher for ambulatory patients (P < 0.001, <0.001 and <0.001, respectively). The majority of patients (66%) expressed a preference for an ambulatory procedure. In addition to the demonstrated clinical benefits, ambulatory laparoscopic cholecystectomy is preferred by the majority of patients and is associated with significantly higher levels of overall satisfaction.     

Benign breast disease: The cost of the service and the cost to the patient

The patients attending a hospital breast clinic during 1 year have been reviewed to assess the impact and cost of benign conditions. Four of 5 patients referred do not have cancer.The cost to the patient lies predominantly in anxiety related to the possibility of cancer and, to a lesser extent, in cosmetic damage due to multiple biopsies.Benign breast disease is a common problem that creates severe anxiety in many women and a heavy burden on an overstretched National Health Service. A policy of reeducating general practitioners when it is safe not to refer may reduce this problem. Cyst aspiration or needle aspiration cytology may reduce the burden to both the patient and the health service, while desensitization of women's groups and women themselves to the needs for breast self-examination can also reduce this burden.

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Resumen Las pacientes que asistieron a la clínica de seno en el curso de un año fueron revisadas con el objeto de determinar el impacto y costo de las entidades mamarias benignas. Cuatro de cada cinco pacientes no posee cáncer.El costo para la paciente se refiere predominantemente a la ansiedad sobre la posibilidad de cáncer y en menor grado a la deformación estética resultante de las múltiples biopsias.La enfermedad mamaria benigna es un problema común que crea severa ansiedad en muchas mujeres y una pesada carga sobre un ya sobrecargado Servicio Nacional de Salud. Una política orientada a la reeducación de los médicos generales sobre cuándo no se debe referir a una paciente puede contribuir a reducir el problema. La aspiración de quistes o la citología por aspiración puede reducir la carga, tanto para la paciente como para el servicio de salud, al tiempo que logra la desensibilización de los grupos femeninos y de las mujeres mismas sobre la necesidad del autoexamen mamario, lo cual de por sí también puede contribuir a la reducción de tal carga.

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Résumé Les dossiers de toutes les patientes vues pendant un an dans un service hospitalier spécialisé dans la pathologie du sein ont été analysés pour déterminer l'incidence et le coût des maladies bénignes. Quatre patientes sur cinq n'ont pas de cancer.Du point de vue de la patiente, le préjudice subi est principalement en rapport avec la peur d' avoir un cancer, et, à un degré moindre, avec les séquelles esthétiques en rapport avec des biopsies multiples.Les maladies bénignes du sein sont fréquentes: elles inquiètent beaucoup la population féminine et surchargent le budget national de la Santé. Un programme de recyclage des médecins généralistes est souhaitable pour apprendre à ne pas courir le risque de laisser passer un cancer sans toujours avoir recours à un spécialiste. La cytoponction est un moyen intéressant pour réduire et l'anxiété de la patiente et le coût à la Santé. Une campagne de désensibilisation du problème du cancer du sein est également nécessaire.

     

Limited-dose Daclizumab versus Basiliximab: a comparison of cost and efficacy in preventing acute rejection

The purpose of this study was to compare the efficacy and cost of the limited-dose Daclizumab regimen to that of the standard-dose Basiliximab regimen. Two antibody induction regimens were compared in patients aged 18 years and older who received renal transplants from January 2002 to September 2003 and completed interleukin (IL)-2R antibody induction with standard-dose Basiliximab (20 mg x 2 doses) or limited-dose Daclizumab (1 mg/kg x 2 doses). The primary outcome measure was the incidence of acute rejection. Secondary outcomes included cost, changes in serum creatinine level, and delayed graft function. Of the 46 patients randomized, 42 patients completed the 6-month follow-up. Mean serum creatinine level at time of discharge was originally higher in the limited-dose Daclizumab group than the standard-dose Basiliximab group (1.89 vs 1.57, respectively). By 1, 3, and 6 months, mean serum creatinine values were similar between both groups, with a trend toward lower mean serum creatinine values in the limited-dose Daclizumab group. The incidence of acute rejection was also similar between the groups (6% vs 7%). The average cost difference between the 2 regimens was approximately $715. This study suggests that a limited-dose Daclizumab regimen may be an efficacious and less costly alternative to the standard-dose Basiliximab regimen for antibody induction therapy following renal transplantation.     

Direct cost of hysterectomy: comparison of robotic versus other routes

Journal of Robotic Surgery - The aim of this study was to investigate the direct cost of robotic hysterectomy in comparison with abdominal, vaginal, and laparoscopic routes past the initial...     

Long-term follow-up and patient satisfaction after reduction mammoplasty: Superomedial versus inferior pedicle

Background:Surgery for hypertrophied breasts represents a challenge for plastic surgeons. The search for a good post-surgical cosmetic breast has led to the development of many techniques. Objectives for reduction mammoplasty are to achieve elevated, symmetrical breasts, a round shape, good projection, small cicatrices that are not very perceptible, and a lasting result.Results:Long-term projection and contour of the breast were more satisfactory among patients who had superomedial pedicle with a statistically significant difference. No statistically significant difference was observed between patients underwent either superomedial or inferior pedicle reduction mammoplasty with regard to breast shape symmetry, nipple symmetry and sensation. The mean score for satisfaction was higher among patients who underwent superomedial pedicle rather than the inferior pedicle method.Conclusion:The superomedial pedicle shows better long-term cosmetic results.KEY WORDS: Bottoming out, inferior pedicle, patients’ satisfaction, reduction mammoplasty, superomedial pedicle     

Women's preferences for early discharge after conservative breast surgery: feasibility,patient profile and satisfaction

PURPOSE: Ours aims were to assess the feasibility of short stay after conservative breast surgery when giving the choice to women, to identify women characteristics associated to short (less than 48 hours) or conventional stay and to confront satisfaction and anxiety of the two groups. METHODS: Women were able to choice the length of stay immediately after surgery. Afterwards they completed a questionnaire measuring pain, anxiety and satisfaction. Clinical data concerning surgery were also collected. RESULTS: The hospital stay was short for 114 women (75.5%) and conventional for 37 women (24.5%). Length of stay was related to education level (P = 0,021), general health status (ASA score) (P = 0,003), breast pain (P = 0,001), the number of wound drains (P = 0,005), cancer (P = 0,001) and satisfaction about hospitalisation (P = 0,022). Post-surgical morbidity was similar between groups, except prolonged axillary drainage more frequent in conventional stay group. CONCLUSION: Women often chose a short stay after breast conservative surgery. This procedure is feasible routinely without heavy complication. Women preference for a short stay is real and could be improved by a better organisation, which ensure the continuity of care between hospital and home, with satisfaction assessment.     

Cost-effectiveness and high patient satisfaction in the elderly: sevoflurane versus propofol anaesthesia

BACKGROUND AND OBJECTIVE: The use of propofol compared with isoflurane is associated with improved patient comfort and decreased costs. However, as the cost saving, the quicker recovery time and patient comfort may not be evident if sevoflurane is substituted for isoflurane; these two anaesthetic agents were analysed in elderly patients. METHODS: In a prospective randomized study, 96 patients undergoing elective ophthalmic surgery received either total intravenous anaesthesia with propofol (Group P), propofol for induction and sevoflurane for maintenance (Group P/S) or sevoflurane for inhalation induction and maintenance (Group S). Analyses focussed on haemodynamics, the quality of recovery, and the costs for the anaesthetic and the entire procedure. RESULTS: Bradycardia or hypotension, mainly registered in Groups P and P/S, did not influence patients' recovery. In Group S, postoperative nausea and vomiting occurred frequently, and 50% of patients complained of discomfort during induction. In Group P/S, the costs for anaesthetics and total costs were lower than those in Groups P and S. CONCLUSIONS: Propofol- and sevoflurane-based maintenance of anaesthesia were similar with regard to patient comfort and recovery in the elderly. Cost analysis revealed that it was less expensive to use propofol for induction and sevoflurane for maintenance than to use either propofol or sevoflurane as sole agents for anaesthesia.     

Patient-perceived cosmesis and satisfaction after breast biopsy: comparison of stereotactic incisional,excisional, and wire-localized biopsy techniques

BACKGROUND: Several options exist for obtaining tissue for pathologic diagnosis of nonpalpable breast lesions. They are generally divided into traditional, open wire-localized biopsy through a 3- to 5-cm incision, stereotactic-guided excisional biopsy through a 1- to 2.5-cm incision, and stereotactic-guided incisional biopsy through a puncture wound a few millimeters long. Because all 3 techniques are reliable, cosmesis has been suggested to be a critical issue driving procedure choice. However, no study has surveyed breast biopsy patients themselves as to the importance of this issue. METHODS: We conducted telephone interviews with 59 women who underwent wire-localized biopsy (WL), stereotactic incisional biopsy with the Mammotome device (Mammo), or stereotactic excisional biopsy with the ABBI device (ABBI). All patients had benign diagnoses, were at least 2 years after procedure, and were matched to age and race. The questions were (1) How would you rate your scar? (2) Were you satisfied or dissatisfied with your biopsy experience? (3) Which is more important to you-complete removal of the abnormality or scar appearance? (4) Do you have any additional comments? RESULTS: Eighty percent of patients ranked complete removal of the abnormality more important than cosmesis. Ninety-five percent of the ABBI and Mammo patients rated their scar as excellent, whereas only 25% of WL did (P =.02). Ninety percent of WL patients, 80% of Mammo patients, and 75% of ABBI patients were satisfied with their experience (P = not significant). Many of the reasons for dissatisfaction were related to service quality rather than medical quality. CONCLUSIONS: Complete removal of the mammographic abnormality may be the priority for patients undergoing breast biopsy. There did not seem to be patient-perceived difference in cosmetic result between the Mammo and ABBI patients. Patient satisfaction is multifactorial, and attention must be paid to these issues generally ignored by physicians.     

An analysis of fine needle aspiration versus core needle biopsy in clinically palpable breast lesions: a report on the predictive values and a cost comparison

BackgroundAlthough fine-needle aspiration (FNA) is an established tool in the biopsy of breast masses, there has been a trend toward using core-needle biopsy (CNB). The aim of this study was to determine whether FNA has comparable predictive value with CNB and whether FNA is more cost effective.MethodsA retrospective review was conducted on 162 patients who underwent either FNA or CNB of palpable breast lesions and had histologic confirmation with surgical biopsy in calendar year 2005.ResultsThere were no false-positives or false-negatives in either group. The sensitivity, specificity, and positive predictive value for FNA were 89%, 98%, and 94%, respectively. CNB had sensitivity, specificity, and positive predictive value of 100%, 90%, and 93%, respectively. The cost to perform FNA was $166.34, compared with $477.92 for CNB.ConclusionsFNA and CNB had comparable predictive value, with FNA being more cost effective.