Robotic Surgery Is More Expensive with Similar Outcomes in Sleeve Gastrectomy: Analysis of the NIS Database.

The aim of this study was to compare postoperative outcomes after robotic-assisted and laparoscopic bariatric sleeve gastrectomy (SG). Sleeve gastrectomy is traditionally performed using laparoscopic techniques. Robotic-assisted surgery enables surgeons to perform minimally invasive SG, but with unknown benefits. Using a national database, we compared postoperative outcomes after laparoscopic SG and robotic-assisted SG. National data from individuals undergoing elective SG in the National Inpatient Sample database between 2011 and 2013 were analyzed. Propensity score matching was used to match robotic and laparoscopic groups by demographics, comorbidities, and hospital characteristics. The matching cohorts were compared. A total of 26,195 patients who underwent elective SG for morbid obesity were included. Of these, 25,391 (96.9%) were completed via laparoscopy, whereas 804 (3.1%) were performed with robotic assistance. There were no significant differences in demographics and subsequent postoperative complications. The inhospital mortality was similar. Length of hospital stay was statistically different, with a mean of 1.88 in laparoscopic versus 2.08 days in robotic (P < 0.001). Higher total hospital charges were noted in the robotic-assisted SG group (median US$38,569 vs US$54,658, P < 0.001). These differences were evident even after adjusting for confounding factors: wound infection, atelectasis, bowel obstruction, pneumonia, and bowel obstruction (P < 0.001).

Is the SMAS Flap Facelift Safe? A Comparison of Complications Between the Sub-SMAS Approach Versus the Subcutaneous Approach With or Without SMAS Plication in Aesthetic Rhytidectomy at an Academic Institution.

BACKGROUND: For treating the aging face, a facelift is the surgical standard. A variety of techniques have been described. The purpose of the current study is to evaluate the safety of the sub-SMAS facelift compared to the subcutaneous facelift with or without SMAS plication. METHODS: A retrospective chart review was conducted on all patients who underwent facelift surgery between 2003 and 2011. Patients included in the study were seeking elective improvement of facial appearance. All charts were reviewed to identify the presence of hematoma, seroma, deep venous thrombosis, skin loss, unfavorable scar, wound infection, or motor and sensory deficit following the operation. The primary outcome was overall complication rate. RESULTS: A total of 229 facelifts were included; 143 patients underwent a subcutaneous facelift with or without SMAS plication and 86 underwent a sub-SMAS facelift. For the subcutaneous facelifts, 88% of the patients were female with a mean age of 62 years. For the sub-SMAS dissections, 88% of the patients were female with a mean age of 59 years. The overall complication rate was 29.4% (n = 42) for patients who underwent a subcutaneous facelift compared to 24.4% (n = 21) for patients with a sub-SMAS facelift (p = 0.4123). Analysis of each individual complication failed to yield any statistically significant difference between the two groups. CONCLUSIONS: In the present study, sub-SMAS facelift complication rates were not statistically different compared to those of subcutaneous facelift with or without SMAS plication. These data suggest that sub-SMAS dissection can be performed with similar safety compared to the traditional subcutaneous facelift, with the potential additional advantage of the SMAS flap elevation. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Minimally invasive treatment of a painful osteolytic lumbar lesion secondary to epithelioid hemangioendothelioma.

Study Design Case report. Objective Multifocal epithelioid hemangioendothelioma (EHE) of the spine is a rare disorder. We describe a novel, multimodal treatment of a painful osteolytic lumbar lesion secondary to EHE. The minimally invasive treatment results in an excellent patient outcome with decreased morbidity compared to traditional techniques. Methods A previously healthy young adult presented with a painful osteolytic lesion at the L2 vertebrae. Imaging revealed multifocal spinal lesions consistent with a history of EHE. Core needle biopsy confirmed the diagnosis. Preoperative cryoablation of L2 was followed by a staged surgery, which included a partial L2 corpectomy, tumor resection, bone grafting, and vertebral reconstruction using a minimally invasive technique. This treatment was followed by prolonged therapy with interferon and bisphosphonate. Results At 3.5 years' follow-up, the patient has maintained his vertebral body height, has not required a fusion, and has had no recurrence of disease. Conclusion Multimodal treatment consisting of tumor cryoablation, partial corpectomy, allograft reconstruction of the vertebrae, and adjuvant interferon and bisphosphonate can result in good outcomes for well-contained EHE tumors of the spine.

Facelift complications related to median and peak blood pressure evaluation.

BACKGROUND: Hematoma remains the most challenging complication of facelifting and has been associated with male sex, hypertension, aspirin use, smoking, and high body mass index. Patients who underwent a facelift were studied to determine rates of hematoma and other complications and to identify predictive and protective factors, including meticulous analysis of perioperative blood pressure. METHODS: Charts of patients who underwent a facelift from 2003 to 2011 at our institution were retrospectively reviewed. Demographic, clinical, and procedural data were collected. All postoperative complications were recorded. Data from continuous blood pressure monitoring in the operating and recovery rooms were obtained from a perioperative database and stratified by median and peak values. Logistic regression was used for data analysis. RESULTS: Of the 229 patients included, the majority were female (88.2 %), mean age at presentation was 62 years, and 35.8 % had hypertension. Postoperative complications occurred in 60 patients (26.2 %). The most common complication was unfavorable scar (7.4 %), followed by hematoma (6.5 %). Male sex (P = 0.02), history of hypertension (P = 0.04), preoperative systolic blood pressure (SBP) greater than 160 mmHg (P = 0.04), and operating room peak SBP greater than 165 mmHg (P = 0.04) were predictive factors for hematoma. Recovery room peak SBP greater than 150 mmHg (P = 0.09) was also associated with hematoma. On multivariate analysis, only male sex and preoperative SBP greater than 160 mmHg remained independent risk factors for hematoma. CONCLUSIONS: This study is unique in that it compares the rate of hematoma to continuous blood pressure data in the operating and recovery rooms stratified by median and peak values. Meticulous control of perioperative SBP is recommended for a safe facelift. History of hypertension, increased SBP at admission, and increased perioperative peak SBP are predictors for postoperative hematoma. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .