Factor in Quality of Life When Deciding Radiotherapy vs Surgery in Patients With Oropharyngeal Cancer

MedicalResearch.com Interview with:

Dr. David Sher MD MPH Radiation Oncology, Harold C. Simmons Comprehensive Cancer Center UTSouthwestern Medical Center Associate Senior Editor International Journal of Radiation Oncology

Dr. Sher

Dr. David Sher MD MPH
Radiation Oncology,
Harold C. Simmons Comprehensive Cancer Center
UTSouthwestern Medical Center
Associate Senior Editor International Journal of Radiation Oncology

MedicalResearch.com: What is the background for this study?

Response: The prevalence of oropharyngeal cancer is rising rapidly, and the two primary therapeutic approaches – upfront radiation therapy or surgery resection – have both been improving in terms of acute and late toxicity profiles. There is significant debate as to which therapy is better, and comparative data are necessary to help physicians and patients decide which paradigm is preferred for a given clinical scenario. Although there is a lot of anecdotal experience in comparing the two treatments, there really is a lack of published data on the question, and this is where our study fits in. 

MedicalResearch.com: What is the background for this study? Were there significant quality-of-life differences between the two treatment modalities?

Response: The main findings were comparable outcomes in long-term survival, toxicity and even cost between primary radiation therapy and primary surgery. This equivalence highlights the importance of patient-centered decision-making and engaging patient preferences in their optimal treatment approach. There was clearly an increase in stomach tube use in patients receiving primary chemoradiotherapy, which may be an important consideration in some patients, depending on the expected functional outcome of initial surgery. This difference became non-significant after a short period of time, but it was real and may influence decision-making.

MedicalResearch.com: What should readers take away from your report?

Response: Readers should take away that there are no particularly large differences between these treatments. Survival, toxicity and cost are all comparable in the long-run. It was quite clear, though, that primary surgery was associated with a lower risk of gastrostomy tube use. Although the difference in tube use was negligible within a few months, the use of any feeding tube may be a deciding factor for some patients. We showed here this difference was due to concurrent chemotherapy during radiotherapy. This result echoes our clinical experience, but we were able to show this finding quite clearly. On the other hand, we also found that the increased dependence with radiation therapy was clearly short-lived, so patients should absolutely not consider this difference as a long-term problem preferentially associated with radiotherapy.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: It is critical for future research to consider the functional and quality-of-life outcomes in future comparisons of these different treatment approaches. Claims-based analyses such as this can uniquely show the “big picture” with respect to complications that require a medical treatment. However, more granular and subtle patient-reported outcomes are not included in this study, and they will be essential to help patients and physicians in the decision-making process.   

The study was funded by the Radiation Oncology Institute.

Citation:

Sher DJ, Agiro A, Zhou S, Day AT, DeVries A. Commercial Claims–Based Comparison of Survival and Toxic Effects of Definitive Radiotherapy vs Primary Surgery in Patients With Oropharyngeal Squamous Cell Carcinoma. JAMA Otolaryngol Head Neck Surg. Published online September 20, 2018. doi:10.1001/jamaoto.2018.1929

Sep 21, 2018 @ 3:05 pm 

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

Why Do Surgical Mesh Products Fail?

MedicalResearch.com Interview with:

Polypropylene (PP) mesh is currently used in both hernia and pelvic organ prolapses - Wikipedia Image

Polypropylene (PP) mesh is currently used in both hernia and pelvic organ prolapses – Wikipedia Image

Professor David Taylor
Trinity Centre for Bioengineering
Trinity College Dublin
The University of Dublin, Ireland

MedicalResearch.com: What is the background for this study?

Response: The study was motivated by the emerging clinical problem of the failure of surgical mesh products used for transvaginal operations. Increasing numbers of women are experiencing the failure of mesh used to treated vaginal prolapse, urinary incontinence and other pelvic organ conditions.

I carried out a survey of all existing research, including medical case reports, meta studies of clinical outcomes and biomechanics research on the material, which is a knitted plastic mesh. A phenomenon known as “mesh erosion” causes damage to surrounding tissues and organs and can leave the person in severe and lasting pain.  Continue reading

Access to Treatment for Head/Neck Cancer Patients Improved with Medicaid Expansion

MedicalResearch.com Interview with:

Richard B. Cannon, MD Division of Otolaryngology–Head and Neck Surgery School of Medicine University of Utah, Salt Lake City 

Dr. Cannon

Richard B. Cannon, MD
Division of Otolaryngology–Head and Neck Surgery
School of Medicine
University of Utah, Salt Lake City 

MedicalResearch.com: What is the background for this study? What are the main findings?

 Response: The Patient Protection and Affordable Care Act (ACA) is a nationwide effort to reduce the number of uninsured individuals in the United States and increase access to health care. This legislation is commonly debated and objective data is needed to evaluate its impact.  As a head and neck cancer surgeon, I sought to evaluate how the ACA had specifically influenced my patients.  Main findings below:    

MedicalResearch.com: What should readers take away from your report?

Response: This population-based study found an increase in the percentage of patients enrolled in Medicaid and private insurance and a large decrease in the rates of uninsured patients after implementation of the Patient Protection and Affordable Care Act (ACA).  This change was only seen in states that adopted the Medicaid expansion in 2014. The decrease in the rate of uninsured patients was significant, 6.2% before versus 3.0% after. Patients who were uninsured prior to the Patient Protection and Affordable Care Act had poorer survival outcomes.

Continue reading

Patients Most Often Receive Breast Cancer Diagnosis By Phone

MedicalResearch.com Interview with:

Dr. Emily Albright, MD Surgical Oncology Missouri University Health Care

Dr. Albright

Dr. Emily Albright, MD
Surgical Oncology
Missouri University Health Care

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Traditional medicine had a paternalistic approach but more recent changes have transitioned into shared decision making and a patient centered approach. However, current research has not addressed the mode of communicating bad news to patients.

This study was designed to look at trends in modes of communication of a breast cancer diagnosis. This study identified a trend for patients to receive a diagnosis of breast cancer over the telephone in more recent years. Also noted was that of those receiving the diagnosis in person 40% were alone.

Continue reading

High Burden of Trauma and Avoidable Surgical Deaths in US Prisons

MedicalResearch.com Interview with:

Tanya L. Zakrison, MHSc MD FRCSC FACS MPH Associate Professor of Surgery University of Miami Miller School of Medicine

Dr. Zakrison

Tanya L. Zakrison, MHSc MD FRCSC FACS MPH
Associate Professor of Surgery
University of Miami Miller School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Over 2 million people in the United States are incarcerated, the highest rate in the entire world.  To date no national statistics on surgical outcomes have been reported in this vulnerable patient population.  We examined 301 medical examiner’s reports from prisoner deaths in Miami-Dade County.  Excluding those with confounding medical conditions such as cirrhosis and cancer, we still found that one in five deaths were being attributed to trauma and reversible surgical diseases.   

Continue reading

Invasive Procedures For Chronic Pain Have Not Been Proven to Work

MedicalResearch.com Interview with:

Wayne B. Jonas, MD Clinical Professor of Family Medicine Uniformed Services University and at Georgetown University School of Medicine

Dr. Jonas

Wayne B. Jonas, MD
Clinical Professor of Family Medicine
Uniformed Services University and at
Georgetown University School of Medicine

MedicalResearch.com: What is the background for this study?

Response: The search for non-drug approaches to chronic pain is a major recommendation in many recent guidelines for both pain management and reduction in the use of opioids. Surgical and invasive procedures are non-drug approaches often used for pain conditions like back pain and arthritis, so good evidence is needed to determine the safety and efficacy of these procedures. Properly done randomized, placebo controlled trials are the best way (the gold standard) to get that evidence, so we did a thorough evaluation of such research, using standard systematic review and meta-analysis methods.

Continue reading

Active Shooter Incidents Involving Semi-automatic Rifles More Deadly

MedicalResearch.com Interview with:

Adil Haider, MD, MPH, FACS Kessler Director for the Center for Surgery and Public Health Brigham and Women’s Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health Deputy Editor of JAMA Surgery

Dr. Haider

Adil Haider, MD, MPH, FACS
Kessler Director for the Center for Surgery and Public Health
Brigham and Women’s Hospital, Harvard Medical School, and
Harvard T.H. Chan School of Public Health
Deputy Editor of JAMA Surgery

MedicalResearch.com: What is the background for this study?

Response: Firearm-related mortality is a public health issue. However, in the US, due in part to lack of funding, there is not enough research to inform the debate about firearms.

The question our group sought to answer was to understand if the presence of a semi-automatic weapon increased the number of victims killed or hurt during an active shooter incident. We chose to focus on these incidents given the availability of an FBI database detailing these active shooter incidents based on a strict definition and the similarities between such incidents that make a comparison valid.

Continue reading

Surgeons Likely Overprescribing Opioids After Rhinoplasty

MedicalResearch.com Interview with:

David A. Shaye, M.D., FACS Instructor in Otolaryngology Harvard Medical School 

Dr. Shaye

David A. Shaye, M.D., FACS
Instructor in Otolaryngology
Harvard Medical School 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Cosmetic and functional rhinoplasty (nasal surgery) is the most common procedure we perform and traditionally post operative pain medication includes opioids.

In light of the recent opioid epidemic, we wished to investigate if patients pain was being treated over-treated by surgeons.

Of 173 Rhinoplasties that we performed, the majority of patients received post operative opioid tablets (an average of 28 tablets).  However 11% of patients did not fill these prescriptions at all, and only 2 of the 178 patients required refills.

We believe patients experienced less pain than surgeons anticipated.

Continue reading

Robotic Surgery More Expensive But May Not Have Better Outcomes Than Traditional Surgery

MedicalResearch.com Interview with:
A robotically assisted surgical system: WikipediaChris Childers, M.D.

Division of General Surgery
David Geffen School of Medicine at UCLA
10833 Le Conte Ave., CHS 72-247
Los Angeles, CA 90095

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The robotic surgical approach has gained significant traction in the U.S. market despite mixed opinions regarding its clinical benefit. A few recent randomized trials have suggested there may be no clinical benefit of the robotic approach for some surgical procedures over the more traditional open or laparoscopic (“minimally-invasive”) approaches.

Previous studies have also suggested the robotic approach is very expensive, but until our study, there was no benchmark for the true costs (to the hospital) of using the robotic platform.

Our study analyzed financial statements from the main supplier of robotic technology. We found that the use of robotic surgery has increased exponentially over the past decade from approximately 136 thousand procedures in 2008 to 877 thousand procedures in 2017. The majority of these procedures were performed in the United States. While most people think of the robotic approach in urologic and perhaps gynecologic surgery, the fastest growing segment has been general surgery, for procedures such as colorectal resections, hernia repairs and gallbladder removals. In total, over 3 billion dollars was spent by hospitals to acquire and use robotic platforms in 2017 with 2.3 billion dollars in the United States. This equates to nearly $3,600 per procedure performed.

Continue reading

Magnetic Control Reduces Number of Incisions Required for Robotic or Laparoscopic Surgery

MedicalResearch.com Interview with:
Jeffrey Cadeddu, M.D. 

Professor
Ralph C. Smith, M.D., Distinguished Chair in Minimally Invasive Urologic Surgery
UT Southwestern Medical Center 

MedicalResearch.com: What is the background for your work? What are the main potential indication? How does magnetic surgery decrease the need for multiple incisions thus decrease pain and bleeding? 

Response: ​The device is manufactured and sold by a new company, Levita Magnetics.  I share a desire with it to reduce the morbidity of surgery by reducing the incisions and invasiveness.

My lab had worked on similar technology during the 2000s.  The main potential indication is to assist with single port surgery or to enable reduced-port laparoscopic or robotic surgery.  The devices allows tissue retraction without making an incision for dedicated instrument. By avoiding an incision for a trocar, risk of pain from that incision and injury to unseen vessel under the skin is obviously reduced.

Continue reading

Using a Pulmonary Valve To Replace Diseased Aortic Valve Improves QoL and Survival in Young and Middle-age Adults

MedicalResearch.com Interview with:

Amine Mazine, MD, MSc Associate Editor, BMC Surgery PGY-4 Cardiac Surgery PhD Candidate, Institute of Biomaterials and Biomedical Engineering McEwen Center for Regenerative Medicine Surgeon-Scientist Training Program  University of Toronto

Dr. Mazine

Amine Mazine, MD, MSc
Associate Editor, BMC Surgery
PGY-4 Cardiac Surgery
PhD Candidate, Institute of Biomaterials and Biomedical Engineering
McEwen Center for Regenerative Medicine
Surgeon-Scientist Training Program
University of Toronto

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: We performed this study to compare two methods of replacing a diseased aortic valve in young and middle-aged adults: using an artificial mechanical valve (mechanical aortic valve replacement) versus using the patient’s own pulmonary valve (Ross procedure).

The study was a meta-analysis of existing literature that included more than 3,500 adult patients. It found that those who underwent the Ross procedure were 46 per cent less likely to experience death from any cause than patients who underwent mechanical aortic valve replacement. Patients in the Ross group were also less likely to suffer from a stroke or major bleeding, and had better quality of life. Patients who underwent the Ross procedure were more likely to need late reoperation, but this did not negatively impact their survival. Continue reading

Percutaneous Repair or Medical Treatment for Secondary Mitral Regurgitation?

MedicalResearch.com Interview with:
Jean François Obadia Adult Cardiovascular Surgery and Transplantation Louis Pradel HospitalJean François Obadia MD PhD
Adult Cardiovascular Surgery and Transplantation
Louis Pradel Hospital

MedicalResearch.com: What is the background for this study?

-By definition a secondary MR concerns a normal valve or sub normal valve inside a dilated heart with poor LV function in a population of Heart failure patients. It is perfectly established today that secondary MR is a predictor of poor clinical outcomes of thissevere population.

-Therefore,it has been proposed to treat those regurgitation either by surgery (mainly the downsizing anuloplasty) or by percutaneous technique like the mitraclipwhich has been used more and more frequently recently.

-However, a beneficial effect on hardclinical outcomes has never been provedandwe still don’t know if those regurgitations need to be corrected or not, We still don’t Know if the regurgitation is the cause, the consequence or just a marker of poor prognosis.

-In this context according to the guidelines, there is a low level of evidence to support those treatments, and Europe and US Guidelines call for prospective randomized studies in this severe population.​

And this excatly what we have done with MITRA-FR

Continue reading

Diabetes: Microvascular Complications Markedly Decreased After Bariatric Surgery

MedicalResearch.com Interview with:

David Arterburn, MD, MPH Kaiser Permanente Washington Health Research Institute Seattle, WA 

Dr. Arterburn

David Arterburn, MD, MPH
Kaiser Permanente Washington Health Research Institute
Seattle, WA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: More than 9 percent of adult Americans—about 30 million people—are estimated to have type 2 diabetes, according to the American Diabetes Association. The disease tends to worsen over time, with blood sugar levels rising along with the risks of developing large blood vessel (macrovascular) complications like heart attack and stroke, as well as small blood vessel (microvascular) complications affecting the nerves of the feet and hands (neuropathy), kidneys (nephropathy), and eyes (retinopathy).

Among more than 4000 patients who underwent bariatric surgery, the 5-year incidence of microvascular disease — including neuropathy, nephropathy, and retinopathy — was nearly 60% lower than that of 11,000 matched nonsurgical control patients receiving usual diabetes care.  Continue reading

Why Do Patients Seek Cosmetic Procedures?

MedicalResearch.com Interview with:
Murad Alam, MD Vice-Chair and Professor of Dermatology Chief of Cutaneous and Aesthetic Surgery Northwestern University Feinberg School of MedicineMurad Alam, MD
Vice-Chair and Professor of Dermatology
Chief of Cutaneous and Aesthetic Surgery
Northwestern University
Feinberg School of Medicine

MedicalResearch.com: What is the background for this study?

Response: For the purposes of our study, non-invasive procedures included laser and light treatments (for brown spots, blood vessels, wrinkle reduction, scar treatment, hair removal), chemical peels, and non-surgical skin tightening and fat reduction (with radiofrequency energy, cold treatment, or ultrasound).  These noninvasive treatments do not even break the skin, and are applied on top of the skin

Then we have minimally invasive procedures, which include those that just barely break the skin, but are like getting a shot, and don’t require cutting and sewing the skin as in traditional surgery.   These minimally invasive procedures include filler and neuromodulator injections to fill out the sagging aging face while reducing lines and wrinkles, as well as liposuction through tiny openings to suck out excess fat.

In the old days, cosmetic treatments meant getting traditional plastic surgery, like a face lift or tummy tuck.  These required general anesthesia, cutting and sewing the skin, significant risk of scarring, and days to weeks of recovery time.  More recently, dermatologists have pioneered noninvasive and minimally invasive procedures, such as those I just described, which provide many of the same benefits as traditional plastic surgery without the risk, scars, and downtime.   Now these minimally invasive and noninvasive treatments have become more popular than traditional cosmetic surgery.  Continue reading

Why Do So Few Women Enter or Complete Surgical Residency?

MedicalResearch.com Interview with:

Erika L. Rangel, MD,MS Instructor, Harvard Medical School Trauma, Burn and Surgical Critical Care Department of Surgery, Center for Surgery and Public Health  Brigham and Women’s Hospital  Harvard T. H. Chan School of Public Health Boston, Massachusetts

Dr. Rangel

Erika L. Rangel, MD,MS
Instructor, Harvard Medical School
Trauma, Burn and Surgical Critical Care
Department of Surgery, Center for Surgery and Public Health
Brigham and Women’s Hospital
Harvard T. H. Chan School of Public Health
Boston, Massachusetts

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Although women make up half of medical student graduates in 2018, they only comprise a third of applicants to general surgery. Studies suggest that lifestyle concerns and perceptions of conflict between career and family obligations dissuade students from the field.

After entering surgical residencies, women residents have higher rates of attrition (25% vs 15%) and cite uncontrollable lifestyle as a predominant factor in leaving the field. Surgeons face reproductive challenges including stigma against pregnancy during training, higher rates of infertility, need for assisted reproduction, and increased rates of pregnancy complications. However, until recently, studies capturing the viewpoints of women who begin families during training have been limited. Single-institution experiences have described mixed experiences surrounding maternity leave duration, call responsibilities, attitudes of coworkers and faculty, and the presence of postpartum support.

Earlier this year, our group presented findings of the first national study of perspectives of surgical residents who had undergone pregnancy during training. A 2017 survey was distributed to women surgical residents and surgeons through the Association of Program Directors in Surgery, the Association of Women Surgeons and through social media via twitter and Facebook. Responses were solicited from those who had at least one pregnancy during their surgical training.

39% of respondents had seriously considered leaving surgical residency, and 30% reported they would discourage a female medical student from a surgical career, specifically because of the difficulties of balancing pregnancy and motherhood with training (JAMA Surg 2018; July 1; 153(7):644-652).

These findings suggested the challenges surrounding pregnancy and childrearing during training may have a significant impact on the decision to pursue or maintain a career in surgery. The current study provides an in-depth analysis of cultural and structural factors within residency programs that influence professional dissatisfaction.

We found that women who faced stigma related to their pregnancies, who had no formal maternity leave at their programs, and who altered subspecialty training plans due to perceived challenges balancing motherhood with the originally chosen subspecialty were most likely to be unhappy with their career or residency. Continue reading

Statins May Reduce Need For Surgery in Chronic Subdural Hematoma

MedicalResearch.com Interview with:
Jianning Zhang MD, Ph.D Chairman, II, VII Chinese Medical Association of Neurosurgery President, Tianjin Medical University General Hospital, China  Jianning Zhang MD, Ph.D
Chairman, II, VII Chinese Medical Association of Neurosurgery
President, Tianjin Medical University General Hospital,
China  

MedicalResearch.com: What is the background for this study?

Response: The elderly population is growing dramatically world widely, especially in China. The incidence of chronic subdural hematoma has been rising over the past years. Although the surgery is not a difficult process, the risk of death and recurrence persist, and the affliction and economic expenditure of the patients are relatively higher in the elderly. For these reasons, it is urgent to develop novel pharmacological therapies with sufficient safety and efficacy. 

It has been known that the high expression of VEGF and inflammatory factors in chronic subdural hematoma can lead to abundant angiogenesis of immature vessels on the wall of hematoma. In our previous study, patients with chronic subdural hematoma have impaired ability to promote vascular maturation. For example, the number of endothelial progenitor cells in circulating blood is about 67% of the healthy individuals with similar age. 

Atorvastatin can mobilize endothelial progenitor cells to reduce inflammation. It increases the number of circulating endothelial cells that are inversely correlated with the volume of hematoma. We have demonstrated that atorvastatin can promote endothelial cell formation and reduce the leakage of endothelial cell barrier in vitro. Results from in vivo experiments in animal models of subdural hematoma suggest that atorvastatin can promote the maturation of blood vessels and reduce inflammation on the margin of hematoma, and thus improve the neurological outcome. Continue reading

Bariatric Surgical Approach To Increase Bile Acids May Reduce Cocaine Reward

MedicalResearch.com Interview with:

Aurelio Galli, Ph.D. Professor of Molecular Physiology & Biophysics and Psychiatry & Behavioral Science Associate Director for Research Strategy Vanderbilt Brain Institute

Dr. Galli

Aurelio Galli, Ph.D.
Professor of Molecular Physiology & Biophysics and Psychiatry & Behavioral Science
Associate Director for Research Strategy
Vanderbilt Brain Institute

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The study builds on evidence that bile acids influence the brain’s reward system. Bile acids are normally released from the gall bladder into the upper part of the small intestine, where they emulsify fats for absorption, before being recycled further down the small intestine. In bile diversion surgery, an experimental treatment for weight loss, bile is released at the end of the small intestine, increasing the amount of bile acids that enter the general circulation.

Mice treated with this surgery have less appetite for high-fat foods, which suggests that bile acids affect brain reward pathways.

We demonstrated that mice receiving the surgery also showed less preference for the cocaine-associated chamber, indicating that cocaine was probably less rewarding. Continue reading

Multimodal Imaging Can Personalize and Predict Therapeutic Needs

MedicalResearch.com Interview with:

Yasser Iturria-Medina, PhD Primary Investigator, Ludmer Centre for Neuroinformatics & Mental Health Assistant Professor, Department of Neurology and Neurosurgery Faculty of Medicine McGill University

Dr. turria-Medina

Yasser Iturria-Medina, PhD
Primary Investigator, Ludmer Centre for Neuroinformatics & Mental Health
Assistant Professor, Department of Neurology and Neurosurgery
Faculty of Medicine
McGill University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There are millions of patients following therapeutic interventions that will not benefit them. In this study, we aimed to illustrate that it is possible to identify the most beneficial intervention for each patient, in correspondence with the principles of the personalized medicine (PM). Our results show that using multimodal imaging and computational models it is possible to predict individualized therapeutic needs. The predictions are in correspondence with the individual molecular properties, which validate our findings and the used computational techniques.

The results highly also the imprecision of the traditional clinical evaluations and categories for understanding the individual therapeutic needs, evidencing the positive impact that would have to use multimodal data and data-driven techniques in the clinic, in addition to the medical doctor’s criterion/evaluations.   Continue reading

Small Renal Cancers: For Select Older Patients, Percutaneous Ablation May Be As Effective and Safer

MedicalResearch.com Interview with:

Adam Talenfeld, M.D Assistant Professor of Radiology Weill Cornell Medical College Assistant Attending Radiologist New York-Presbyterian Hospital. 

Dr. Talenfeld

Adam Talenfeld, M.D
Assistant Professor of Radiology
Weill Cornell Medical College
Assistant Attending Radiologist
New York-Presbyterian Hospital.

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We know that renal function decreases as we age, and we know that decreased renal function is independently associated with increased mortality. This is why medical society guidelines recommend partial nephrectomy, which preserves kidney tissue and function, over radical nephrectomy for the treatment of the smallest kidney cancers, stage T1a tumors, which are under 4 cm diameter. Paradoxically, though, we know older patients are more likely than younger patients to receive radical nephrectomy for these smallest tumors, probably because it’s a simpler surgery than partial nephrectomy.

Percutaneous ablation, focal tissue destruction using heat or cold emanating from the tip of a needle, is a newer, image-guided, minimally-invasive, tissue-sparing treatment for solid organ tumors. We wanted to test how well percutaneous ablation would compare to partial nephrectomy and radical nephrectomy for these smallest kidney cancers.

We found that percutaneous ablation was associated with similar 5-year overall and cancer-specific survival compared to radical nephrectomy. At the same time, ablation was associated with significantly lower rates of new-onset chronic renal insufficiency and one-fifth as many serious non-urological complications than radical nephrectomy within 30 days of treatment. These were complications, such as deep venous thrombosis or pneumonia, that resulted in emergency department visits or new hospital admissions. The outcomes of percutaneous ablation compared with partial nephrectomy were somewhat less clear, though ablation was again associated with fewer perioperative complications. Continue reading

Surgery For Spondylolisthesis (Spinal Stress Fractures) Reduced Chances of Opioid Dependence

MedicalResearch.com Interview with:

Beatrice Ugiliweneza, PhD, MSPH Assistant Professor Kentucky Spinal Cord Injury Research Center Department of Neurosurgery, School of Medicine Department of Health Management and Systems Science School of Public Health and Information Sciences University of Louisville

Dr. Ugiliweneza

Beatrice Ugiliweneza, PhD, MSPH
Assistant Professor
Kentucky Spinal Cord Injury Research Center
Department of Neurosurgery, School of Medicine
Department of Health Management and Systems Science
School of Public Health and Information Sciences
University of Louisville

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This study stems from the observed opioid crisis in the United States in recent years. Opioids are used in the management of pain. In the spine population, back pain is one of the main conditions for which opioids are consumed.

A frequent cause of that pain is degenerative spondylolisthesis. We aimed to evaluate the effect of surgery, which has been shown to improve outcomes, on opioid dependence. We found that surgery is associated with reduced odds of opioid dependence.

MedicalResearch.com: What should readers take away from your report? 

Response: One interesting finding that we observed is that patients are twice less likely to become opioid dependent than they are to become dependent after surgery. However, an important note to keep in mind is that about 10% of patients will be opioid dependent after surgery (about 6% prior non-dependent and 4% prior dependent).  

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: Surgery has been proven to improve clinical outcomes and quality of life for patients with degenerative spondylolisthesis. Future research should explore why some patients remain or become opioid dependent after surgery.

It would also be interesting to look at the effect of other treatments for degenerative spondylolisthesis (such as epidural steroid injections for example) on opioid dependence.

MedicalResearch.com: Is there anything else you would like to add?

Response: Spine surgeons should have systems that help them recognize patients who are likely to become opioid dependent after surgery. Our paper discusses factors to watch for such as younger age, prior dependence, etc… This would help provide targeted attention and hopefully combat the ramping opioid crisis.

The authors have no disclosures. 

Citation:

Journal of Neurosurgery: Spine
Posted online on June 19, 2018.
Factors predicting opioid dependence in patients undergoing surgery for degenerative spondylolisthesis: analysis from the MarketScan databases
Mayur Sharma, MD, MCh, Beatrice Ugiliweneza, PhD, MSPH1, Zaid Aljuboori, MD1, Miriam A.Nuño, PhD2, Doniel Drazin, MD3, and  Maxwell Boakye, MD, MPH, MBA1

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

Are Abortions Safer in Ambulatory Surgery Centers Than Medical Offices?

MedicalResearch.com Interview with:

Sarah CM Roberts, DrPH Associate Professor ObGyn&RS Zuckerberg San Francisco General UCSF

Dr. Roberts

Sarah CM Roberts, DrPH
Associate Professor
ObGyn&RS
Zuckerberg San Francisco General
UCSF

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Thirteen states have laws that require abortions to be provided in Ambulatory Surgery Centers (ASCs); many of these laws apply only in the second trimester.  We examined outcomes from more than 50,000 abortions provided in two facility types:  Ambulatory Surgery Centers and office-based settings.

We found that there was no significant difference in abortion-related complications across facility type; in both settings, about 3.3% had any complication and about 0.3% had a major complication.  There also was no significant difference in complications across facility types for second trimester and later abortions.

Continue reading

2/3 Canadians Do Not Receive Timely Surgery for Hip Fractures

MedicalResearch.com Interview with:

Daniel Pincus MD Department of Surgery Institute for Clinical Evaluative Sciences University of Toronto

Dr. Pincus

Daniel Pincus MD
Department of Surgery
Institute for Clinical Evaluative Sciences
University of Toronto

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We chose to look at hip fractures because is the most common reason for urgent surgery complications have be tied to wait times (and in particular wait times greater than 24 hours).

Continue reading

More Complications When Pacemaker Required After TAVR

MedicalResearch.com Interview with:

Harindra C. Wijeysundera MD PhD FRCPC FCCS FAHA Director of Research, Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre Senior Scientist, Sunnybrook Research Institute (SRI) Associate Professor, Dept. of Medicine & Institute of Health Policy, Management and Evaluation, University of Toronto Adjunct Senior Scientist, Institute for Clinical Evaluative Sciences (ICES)

Dr. Wijeysundera

Harindra C. Wijeysundera MD PhD FRCPC FCCS FAHA
Director of Research, Division of Cardiology,
Schulich Heart Centre, Sunnybrook Health Sciences Centre
Senior Scientist, Sunnybrook Research Institute (SRI)
Associate Professor, Dept. of Medicine & Institute of Health Policy, Management and Evaluation, University of Toronto
Adjunct Senior Scientist, Institute for Clinical Evaluative Sciences (ICES)
Toronto, ON, Canada

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: One of the most common complications post TAVR is the need for a permanent pacemaker.  It is unclear if the need for a pacemaker is associated with long term adverse outcomes.

Using a population level registry of all TAVR procedures in ontario, canada, we found that pacemakers were required in ~15% of cases.  Requiring a pacemaker was associated with worse long term outcomes, including death, readmission to hospital and emergency room visits.  Continue reading

For Your Surgeon, Do You Want Younger Hands or More Experience?

MedicalResearch.com Interview with:
“Untitled” by Marcin Wichary is licensed under CC BY 2.0
Yusuke Tsugawa, MD, MPH, PhD
Assistant professor
Division of General Internal Medicine and Health Services Research
David Geffen School of Medicine at UCL
Los Angeles, CA 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We studied whether patients’ mortality rate differ based on age and sex of surgeons who performed surgical procedures. Using a nationally representative data of Medicare beneficiaries aged 65-99 years who underwent one of 20 major non-elective surgeries, we found that patients treated by older surgeons have lower mortality than those cared for by younger surgeons, whereas there was no difference in patient mortality between male and female surgeons. When we studied age and sex together, we found that female surgeons at their 50s had the lowest patient mortality across all groups.

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Racial Disparities in Post-Procedure ED Visits and Hospitalizations

MedicalResearch.com Interview with:

Dr-Hillary-J-Mull

Hillary J. Mull, PhD, MPP
Center for Healthcare Organization and Implementation Research
Veterans Affairs (VA) Boston Healthcare System
Department of Surgery, Boston University School of Medicine
Boston, Massachusetts

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Little is known about outpatient procedures that can be considered invasive but are not conducted in a surgical operating room. These procedures are largely neglected by quality or patient safety surveillance programs, yet they are increasingly performed as technology improves and the U.S. population gets older.

We assessed the rate of invasive procedures across five specialties, urology, podiatry, cardiology, interventional radiology and gastroenterology in the Veterans Health Administration between fiscal years 2012 and 2015. Our analysis included examining the rates of post procedure emergency department visits and hospitalizations within 14 days and the key patient, procedure or facility characteristics associated with these outcomes. We found varying rates of post procedure ED visits and hospitalizations across the specialties with podiatry accounting for a high volume of invasive outpatient care but the lowest rate of postoperative utilization (1.8%); in contrast, few of the procedures were in interventional radiology, but the postoperative utilization rate was the highest at 4.7%. In a series of logistic regression models predicting post procedure healthcare utilization for each specialty, we observed significantly higher odds of post procedural outcomes for African American patients compared to white patients.

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