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Longterm outcomes following dermal matrix used as a fascial bridge
Vol. 205, No. 3S, September 2007
Surgical Forum Abstracts
S69
mon, RR 1.85 (95% CI 1.07, 3.17). ICU patients treated in TC were more likely to have pneumonia and urinary tract infections with RR 1.46 (95% CI 1.10,1.95) and 2.13 (95% CI 1.05,4.35) respectively. Both intubation and placement of pulmonary artery catheters had the largest effect on overall complications. Pulmonary artery catheters were highly associated with arrhythmias, pulmonary embolisms, and cardiac arrests regardless of trauma center designation.
Longterm outcomes following dermal matrix used as a fascial bridge
CONCLUSIONS: Complications that should be addressed specifically in trauma centers are urinary tract infections and pneumonia. Treatment variables such as the use of pulmonary artery catheters and intubations are likely indicators of illness severity, but they may also lead to an increased risk of complications in trauma centers.
INTRODUCTION: Short-term outcomes after placement of biologic prosthetics are favorable, with low recurrence rates and enhanced resistance to infection. Durable outcomes after abdominal wall reconstruction with biologic materials have not been well described.
A blinded randomised controlled trial comparing porcine dermal collagen with polypropylene for primary inguinal hernia repair Dan M Ridgway, MBChB, MRCS,* Faisal Mahmood, MBBS, Lorraine Moore, MSc, RGN, Diane Bramley, RGN, Steven Stojkovic, MD, FRCS, Ahmed Al-Muhktar, FRCS, Peter Moore, MD, FRCS North Lincolnshire and Goole Hospitals NHS Trust, Scunthorpe, N Lincs, UK INTRODUCTION: Postoperative complications such as recurrence, infection, and pain affect patiet quality of life after inguinal hernia repair. The optimal repair material would be non-allergenic, strong, flexible, permanent, and incorporated into host tissues, and porcine dermal collagen fulfils these criteria. This trial compares postoperative complications and quality of life following inguinal hernia repair using modified porcine dermal collagen and polypropylene. METHODS: Patients were prospectively randomised and blinded to repair using porcine dermal collagen or polypropylene. Materials were scored for ease of handling, suturing, and insertion. A blinded assessor determined the presence of recurrence, postoperative complications, pain using a visual analogue scale, and quality of life using Euroqol© and SF-36© questionnaires up to 2 years following repair. Variables were compared by appropriate statistical tests using a 5% level of statistical significance. RESULTS: Porcine dermal collagen (n⫽110) and polypropylene (n⫽91) groups were demographically comparable. Operative duration (mean 37 mins), handling (2.5 vs 2.1), insertion (2.4 vs 2.4) and suturing scores (2.7 vs 2.2) were comparable. Recurrence, inflammation, infection and haematoma rates were comparable at all time intervals. Collagen repairs had improved pain scores at 2 years (mean 1.7 vs 2.3; p⫽0.009). Quality of life scores between groups were comparable at all time intervals. CONCLUSIONS: Inguinal hernia repair using modified porcine dermal collagen can be performed successfully, rapidly, and with a technical ease comparable to polypropylene. Quality of life is comparable with polypropylene repair, though collagen repair appears less painful postoperatively.
William L Newcomb, MD, William W Hope, MD, Thomas M Schmelzer, MD, H James Norton, PhD, Amy E Lincourt, PhD, Gamal Mostafa, MD, David A Iannitti, MD, B Todd Heniford, MD, FACS Carolinas Medical Center, Charlotte, NC
METHODS: Patients who received acellular human dermis (AHD) to bridge an abdominal fascial defect at a single institution were retrospectively reviewed; P⬍0.05 was considered statistically significant. RESULTS: Forty-nine patients were identified with a mean age of 50 (19-74) years, body mass index of 32 (17-73) kg/m2, ASA score 2.7 (2-4), graft size 217 (36-832) cm2, operating room time 257 (41-603) minutes and median LOS 8 (2-164) days. Thirty-nine percent had at least 1 prior ventral hernia repair. Wound classifications were clean (24%), clean-contaminated (33%), contaminated (29%), and dirty (14%). Mean follow-up was 7 (1-28) months. Recurrence rates compared to follow-up was: 0-3 months (0%), 3-6 months (22%), 6-9 months (50%), 9-12 months (70%), and ⬎⫽12 months (100%). All patients with greater than 10.5 months follow-up (11/ 11) recurred. Progressive eventration of the mesh was noted in all patients. Age (P⫽0.560), ASA score (P⫽0.870), BMI (P⫽0.854), graft size (P⫽0.510), and wound classification (P⫽0.410) did not affect recurrence. CONCLUSIONS: When used to bridge a fascial defect, AHD stretches over time leading to recurrent herniation. A synthetic prosthetic should be used in clean repairs. When AHD is used in contaminated cases, a formal, elective repair should be considered after clinical improvement.
Assessing the effects of hospital case volume on outcomes in colorectal cancer William W Hope, MD, Thomas Schmelzer, MD, William Newcomb, MD, Nicholas Lang, MD, Andrew Stewart, MA, Amy Lincourt, PhD, Ronald Sing, DO, Frederick Greene, MD, FACS, B Todd Heniford, MD, FACS Carolinas Medical Center, Charlotte, NC INTRODUCTION: Regionalization of healthcare remains controversial. The purpose of this study was to evaluate the effect of hospital volume on outcomes for colorectal cancer. METHODS: Consecutive cases of colon and rectal cancer with 5 years of follow-up reported to the American College of Surgeons National Cancer Database ending in 2001 were analyzed. Variables examined included age, race, sex, annual case volume, and annual case volume related to lymph node examination and stage. Analysis was performed using Cox Proportional Hazards Regression Model-
Surgical Forum Abstracts
S69
mon, RR 1.85 (95% CI 1.07, 3.17). ICU patients treated in TC were more likely to have pneumonia and urinary tract infections with RR 1.46 (95% CI 1.10,1.95) and 2.13 (95% CI 1.05,4.35) respectively. Both intubation and placement of pulmonary artery catheters had the largest effect on overall complications. Pulmonary artery catheters were highly associated with arrhythmias, pulmonary embolisms, and cardiac arrests regardless of trauma center designation.
Longterm outcomes following dermal matrix used as a fascial bridge
CONCLUSIONS: Complications that should be addressed specifically in trauma centers are urinary tract infections and pneumonia. Treatment variables such as the use of pulmonary artery catheters and intubations are likely indicators of illness severity, but they may also lead to an increased risk of complications in trauma centers.
INTRODUCTION: Short-term outcomes after placement of biologic prosthetics are favorable, with low recurrence rates and enhanced resistance to infection. Durable outcomes after abdominal wall reconstruction with biologic materials have not been well described.
A blinded randomised controlled trial comparing porcine dermal collagen with polypropylene for primary inguinal hernia repair Dan M Ridgway, MBChB, MRCS,* Faisal Mahmood, MBBS, Lorraine Moore, MSc, RGN, Diane Bramley, RGN, Steven Stojkovic, MD, FRCS, Ahmed Al-Muhktar, FRCS, Peter Moore, MD, FRCS North Lincolnshire and Goole Hospitals NHS Trust, Scunthorpe, N Lincs, UK INTRODUCTION: Postoperative complications such as recurrence, infection, and pain affect patiet quality of life after inguinal hernia repair. The optimal repair material would be non-allergenic, strong, flexible, permanent, and incorporated into host tissues, and porcine dermal collagen fulfils these criteria. This trial compares postoperative complications and quality of life following inguinal hernia repair using modified porcine dermal collagen and polypropylene. METHODS: Patients were prospectively randomised and blinded to repair using porcine dermal collagen or polypropylene. Materials were scored for ease of handling, suturing, and insertion. A blinded assessor determined the presence of recurrence, postoperative complications, pain using a visual analogue scale, and quality of life using Euroqol© and SF-36© questionnaires up to 2 years following repair. Variables were compared by appropriate statistical tests using a 5% level of statistical significance. RESULTS: Porcine dermal collagen (n⫽110) and polypropylene (n⫽91) groups were demographically comparable. Operative duration (mean 37 mins), handling (2.5 vs 2.1), insertion (2.4 vs 2.4) and suturing scores (2.7 vs 2.2) were comparable. Recurrence, inflammation, infection and haematoma rates were comparable at all time intervals. Collagen repairs had improved pain scores at 2 years (mean 1.7 vs 2.3; p⫽0.009). Quality of life scores between groups were comparable at all time intervals. CONCLUSIONS: Inguinal hernia repair using modified porcine dermal collagen can be performed successfully, rapidly, and with a technical ease comparable to polypropylene. Quality of life is comparable with polypropylene repair, though collagen repair appears less painful postoperatively.
William L Newcomb, MD, William W Hope, MD, Thomas M Schmelzer, MD, H James Norton, PhD, Amy E Lincourt, PhD, Gamal Mostafa, MD, David A Iannitti, MD, B Todd Heniford, MD, FACS Carolinas Medical Center, Charlotte, NC
METHODS: Patients who received acellular human dermis (AHD) to bridge an abdominal fascial defect at a single institution were retrospectively reviewed; P⬍0.05 was considered statistically significant. RESULTS: Forty-nine patients were identified with a mean age of 50 (19-74) years, body mass index of 32 (17-73) kg/m2, ASA score 2.7 (2-4), graft size 217 (36-832) cm2, operating room time 257 (41-603) minutes and median LOS 8 (2-164) days. Thirty-nine percent had at least 1 prior ventral hernia repair. Wound classifications were clean (24%), clean-contaminated (33%), contaminated (29%), and dirty (14%). Mean follow-up was 7 (1-28) months. Recurrence rates compared to follow-up was: 0-3 months (0%), 3-6 months (22%), 6-9 months (50%), 9-12 months (70%), and ⬎⫽12 months (100%). All patients with greater than 10.5 months follow-up (11/ 11) recurred. Progressive eventration of the mesh was noted in all patients. Age (P⫽0.560), ASA score (P⫽0.870), BMI (P⫽0.854), graft size (P⫽0.510), and wound classification (P⫽0.410) did not affect recurrence. CONCLUSIONS: When used to bridge a fascial defect, AHD stretches over time leading to recurrent herniation. A synthetic prosthetic should be used in clean repairs. When AHD is used in contaminated cases, a formal, elective repair should be considered after clinical improvement.
Assessing the effects of hospital case volume on outcomes in colorectal cancer William W Hope, MD, Thomas Schmelzer, MD, William Newcomb, MD, Nicholas Lang, MD, Andrew Stewart, MA, Amy Lincourt, PhD, Ronald Sing, DO, Frederick Greene, MD, FACS, B Todd Heniford, MD, FACS Carolinas Medical Center, Charlotte, NC INTRODUCTION: Regionalization of healthcare remains controversial. The purpose of this study was to evaluate the effect of hospital volume on outcomes for colorectal cancer. METHODS: Consecutive cases of colon and rectal cancer with 5 years of follow-up reported to the American College of Surgeons National Cancer Database ending in 2001 were analyzed. Variables examined included age, race, sex, annual case volume, and annual case volume related to lymph node examination and stage. Analysis was performed using Cox Proportional Hazards Regression Model-