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Background: Reoperation for positive margins after lumpectomy for breast cancer is common. Intraoperative analysis of frozen-section (FS) margins permits immediate re-excision, avoiding reoperation. The aim of this study was to compare reoperation rates between an institution using routine FS analysis of all margins and the National Surgical Quality Improvement Program (NSQIP) data.
Methods: We designed a retrospective cohort analysis comparing the NSQIP data from a FS single institution with the national NSQIP data from 2006 to 2010. Women undergoing lumpectomy for cancer were identified (N = 24,217), and reoperation rates were compared by the use of χ(2) analyses and multivariable logistic regression. During this time period, NSQIP did not differentiate between reoperations for complications or oncologic reasons. Reoperation rates for mastectomy patients (N = 21,734) and lumpectomy patients without cancer (N = 2,777) over the same time period were analyzed as controls, because reoperations after these procedures likely would be for reasons other than positive margins.
Results: The 30-day reoperation rate after lumpectomy for cancer was greater nationally than at the FS institution (13.2% vs 3.6%, P < .001). Multivariable analysis showed that patients in the national NSQIP data set were over four times as likely to undergo reoperation as those at the FS institution's (odds ratio 4.19). The reoperation rates were similar between the two, both for patients undergoing mastectomy (4.7% vs 4.5%, P = .84) and those undergoing lumpectomy for benign diagnosis (2.9% vs 5.9%, P = .39).
Conclusion: Intraoperative FS margin analysis decreases the number of reoperations for patients undergoing breast conservation for breast cancer. This technique has important implications for patient satisfaction and cost of care.
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http://dx.doi.org/10.1016/j.surg.2014.03.025 | DOI Listing |
Jt Dis Relat Surg
January 2025
Trakya Üniversitesi Tıp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalı, 22030 Edirne, Türkiye.
Objectives: This study aimed to evaluate the rates and risk factors associated with revision amputation following ischemic lower major limb amputations, focusing on cases related to peripheral arterial disease.
Patients And Methods: This retrospective study included 253 patients (174 males, 79 females; mean age: 73.1±12.
J Am Acad Orthop Surg Glob Res Rev
December 2024
From the Connecticut Orthopaedics, Fairfield, CT (Dr. Bernstein); the Epidemiology and Real-World Data Sciences, Johnson & Johnson MedTech, New Brunswick, NJ (Dr. Gupta and Ruppenkamp); the Global Health Economics and Market Access, Johnson & Johnson MedTech, Raynham, MA (Dr. Kabiri and Goldstein); and the Medical Affairs, Johnson & Johnson MedTech, Palm Beach Gardens, FL (Dr. Diaz).
Background: Computer-assisted fluoroscopic navigation and robotic technologies aim to optimize implant placement and alignment in primary total hip arthroplasty (THA) to improve patient outcomes. This study uses a retrospective hospital billing database covering 1,300 hospitals to compare the clinical and economic effect of these technologies.
Methods: The study compared patients undergoing THA with robotic versus computer-assisted fluoroscopic navigation technologies between January 1, 2016, and September 30, 2021, using the Premier Healthcare Database.
J Am Acad Orthop Surg Glob Res Rev
December 2024
From the Department of Orthopaedic Surgery, UT Health San Antonio, San Antonio, TX.
Introduction: Depression is among the most common mental illnesses, with an estimated 8.1% of adults in the United States living with the condition. Despite its prevalence, the effect of depression on surgical outcomes is not well studied.
View Article and Find Full Text PDFJ Pediatr Orthop B
December 2024
Department of Spine Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
Rett syndrome, a neurodevelopmental disorder primarily affecting females, presents unique challenges in managing associated scoliosis. This study aims to evaluate the efficacy and challenges of posterior spinal fusion (PSF) in Rett syndrome patients by analyzing postoperative complications. A retrospective cohort study was conducted using a large national database.
View Article and Find Full Text PDFJ Shoulder Elbow Surg
December 2024
Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA. Electronic address:
Purpose: Although open reduction and internal fixation (ORIF) is the gold standard treatment for displaced midshaft clavicle fractures, recent studies have advocated for nonoperative management, citing high rates of reoperation associated with operative intervention. However, no studies have compared nonoperative management to ORIF with dual-plate fixation, which may be associated with lower rates of reoperation compared to single-plate fixation. The purpose of this study was to compare the complications and patient-reported outcomes of dual mini-fragment plate fixation to nonoperative management for displaced midshaft clavicle fractures.
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