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Minimally invasive drainage of subcutaneous abscesses reduces hospital cost and length of stay
S110
Abstracts
J Am Coll Surg
after adjustment for age, sex, comorbidity and household income (adjusted hazard ratio 0.18, CI (0.16 to 0.19), p ⬍0.001).
was queried for direct and indirect costs. We compared LOS and cost data between the TP and MI treatment groups.
Table. Comparison of Recurrence Rates Across Various Hospital Volume Quartiles vs. Shouldice
RESULTS: I&D was performed on 329 children. Patients were 57.8% female and 72% Caucasian with a mean age of 43 months (range ⬍1 to 218). 190 abscesses (59.6%) were located in the groin/ buttock/perineum. MRSA was identified in 74% of culture specimens. 202 patients (61.4%) underwent TP, and 127 (38.6%) underwent MI drainage. MI drainage ranged from 0% (0/110) in JanuaryJune 2010 to 34.6% (44/127) in the July-December 2010 transition period and reached 90.2% (83/92) in 2011 (p ⬍ .001). Median LOS decreased from 2 days (interquartile range 1-2) in the TP only period to 1 day (interquartile range 1-2) in the predominantly MI period (p ⬍ .001). MI drainage was associated with a $431 reduction in median direct costs and a $402 reduction in median indirect costs (p ⬍ .001). (Fig).
Cox regression – age, sex, comorbidity and income quintile adjusted Hospital volume Hazard quartile ratio 95% CI p Value
Lowest vol. (referent) Mid-low volume Mid-high volume Highest volume Shouldice
–
–
–
1.070 0.856 0.794 0.177
(1.010 – 1.133) (0.803 – 0.911) (0.744 – 0.847) (0.162 – 0.193)
0.0216 ⬍0.001 ⬍0.001 ⬍0.001
CONCLUSIONS: Persons who had elective primary inguinal hernia repair at the Shouldice Hospital had a substantially lower risk of recurrence than those who had surgery at general hospitals, including high volume general hospitals.
CONCLUSIONS: Most soft tissue infections requiring I&D were due to MRSA and most frequently occurred in the diaper area of girls ⬍3 years. Changing to a MI technique has significantly decreased hospital costs and LOS in our patient population.
Minimally invasive drainage of subcutaneous abscesses reduces hospital cost and length of stay Tiffany N Wright, MD, Leah Gilligan, Oksana Zhurbich, John M Draus, Jr, MD Kentucky Children’s Hospital, University of Kentucky, Lexington, KY
Laparoscopy: Improvement in inguinal hernia repair Aaron Saul Rickles, MD, James C Iannuzzi, MD, Andrew-Paul Deeb, BA, Fergal J Fleming, MB, BCh, FRCS, John RT Monson, MD, FRCS, FACS University of Rochester, Rochester, NY
INTRODUCTION: We compared outcomes between patients managed with minimally invasive (MI) versus traditional packing (TP) techniques for drainage of subcutaneous abscesses. METHODS: After IRB approval, medical records of children requiring drainage of subcutaneous abscesses between January 2010 and June 2011 were reviewed. Data were collected on patient demographics, abscess location, surgical procedure, microbiology cultures, and hospital length of stay (LOS). The hospital accounting system
INTRODUCTION: Despite growing popularity for laparoscopy in inguinal hernia repairs (IHR), debate still exists over whether a laparoscopic approach is better than traditional open repair. This study aims to identify the relative safety between laparoscopic and open IHR with a sub-analysis of local and general anesthesia. METHODS: The ACS NSQIP (2005-2010) was queried for IHR using CPT and ICD-9 codes. Cases were identified as either open or laparoscopic, and for the use of general or local anesthesia. Chisquare and logistic regression were used to evaluate the risk of major and minor complications. Covariates with a p⬍0.1 were included in multivariate models. RESULTS: A total of 72,848 IHR were identified, 57,077(78%) open and 15,771(22%) laparoscopic. After adjusting for preoperative comorbidities on multivariate analysis, a laparoscopic approach had significantly lower risk of both minor (OR⫽0.73; 95%CI 0.582,0.915) and major complications (OR⫽0.83; 95%CI 0.697,0.998). Complications most associated with an open approach included an incisional infection (p⫽0.003), post-operative pneumonia (p⫽0.012), and return to the operating room (p⫽0.002). On sub-analysis of the open group, the use of local anesthesia also significantly reduced the risk of both minor (OR⫽0.60; 95%CI 0.465,0.777) and major complications (OR⫽0.79; 95%CI 0.663,0.950). When comparing laparoscopic to an open procedure with local anesthesia there was no statistically significant difference in outcomes (p⫽0.503). CONCLUSIONS: This study shows that laparoscopic inguinal herniorraphy offers superior safety to an open repair with general anes-
Abstracts
J Am Coll Surg
after adjustment for age, sex, comorbidity and household income (adjusted hazard ratio 0.18, CI (0.16 to 0.19), p ⬍0.001).
was queried for direct and indirect costs. We compared LOS and cost data between the TP and MI treatment groups.
Table. Comparison of Recurrence Rates Across Various Hospital Volume Quartiles vs. Shouldice
RESULTS: I&D was performed on 329 children. Patients were 57.8% female and 72% Caucasian with a mean age of 43 months (range ⬍1 to 218). 190 abscesses (59.6%) were located in the groin/ buttock/perineum. MRSA was identified in 74% of culture specimens. 202 patients (61.4%) underwent TP, and 127 (38.6%) underwent MI drainage. MI drainage ranged from 0% (0/110) in JanuaryJune 2010 to 34.6% (44/127) in the July-December 2010 transition period and reached 90.2% (83/92) in 2011 (p ⬍ .001). Median LOS decreased from 2 days (interquartile range 1-2) in the TP only period to 1 day (interquartile range 1-2) in the predominantly MI period (p ⬍ .001). MI drainage was associated with a $431 reduction in median direct costs and a $402 reduction in median indirect costs (p ⬍ .001). (Fig).
Cox regression – age, sex, comorbidity and income quintile adjusted Hospital volume Hazard quartile ratio 95% CI p Value
Lowest vol. (referent) Mid-low volume Mid-high volume Highest volume Shouldice
–
–
–
1.070 0.856 0.794 0.177
(1.010 – 1.133) (0.803 – 0.911) (0.744 – 0.847) (0.162 – 0.193)
0.0216 ⬍0.001 ⬍0.001 ⬍0.001
CONCLUSIONS: Persons who had elective primary inguinal hernia repair at the Shouldice Hospital had a substantially lower risk of recurrence than those who had surgery at general hospitals, including high volume general hospitals.
CONCLUSIONS: Most soft tissue infections requiring I&D were due to MRSA and most frequently occurred in the diaper area of girls ⬍3 years. Changing to a MI technique has significantly decreased hospital costs and LOS in our patient population.
Minimally invasive drainage of subcutaneous abscesses reduces hospital cost and length of stay Tiffany N Wright, MD, Leah Gilligan, Oksana Zhurbich, John M Draus, Jr, MD Kentucky Children’s Hospital, University of Kentucky, Lexington, KY
Laparoscopy: Improvement in inguinal hernia repair Aaron Saul Rickles, MD, James C Iannuzzi, MD, Andrew-Paul Deeb, BA, Fergal J Fleming, MB, BCh, FRCS, John RT Monson, MD, FRCS, FACS University of Rochester, Rochester, NY
INTRODUCTION: We compared outcomes between patients managed with minimally invasive (MI) versus traditional packing (TP) techniques for drainage of subcutaneous abscesses. METHODS: After IRB approval, medical records of children requiring drainage of subcutaneous abscesses between January 2010 and June 2011 were reviewed. Data were collected on patient demographics, abscess location, surgical procedure, microbiology cultures, and hospital length of stay (LOS). The hospital accounting system
INTRODUCTION: Despite growing popularity for laparoscopy in inguinal hernia repairs (IHR), debate still exists over whether a laparoscopic approach is better than traditional open repair. This study aims to identify the relative safety between laparoscopic and open IHR with a sub-analysis of local and general anesthesia. METHODS: The ACS NSQIP (2005-2010) was queried for IHR using CPT and ICD-9 codes. Cases were identified as either open or laparoscopic, and for the use of general or local anesthesia. Chisquare and logistic regression were used to evaluate the risk of major and minor complications. Covariates with a p⬍0.1 were included in multivariate models. RESULTS: A total of 72,848 IHR were identified, 57,077(78%) open and 15,771(22%) laparoscopic. After adjusting for preoperative comorbidities on multivariate analysis, a laparoscopic approach had significantly lower risk of both minor (OR⫽0.73; 95%CI 0.582,0.915) and major complications (OR⫽0.83; 95%CI 0.697,0.998). Complications most associated with an open approach included an incisional infection (p⫽0.003), post-operative pneumonia (p⫽0.012), and return to the operating room (p⫽0.002). On sub-analysis of the open group, the use of local anesthesia also significantly reduced the risk of both minor (OR⫽0.60; 95%CI 0.465,0.777) and major complications (OR⫽0.79; 95%CI 0.663,0.950). When comparing laparoscopic to an open procedure with local anesthesia there was no statistically significant difference in outcomes (p⫽0.503). CONCLUSIONS: This study shows that laparoscopic inguinal herniorraphy offers superior safety to an open repair with general anes-