Anthony Yang

Intracranial Meningioma Surgery: Value-Based Care Determinants in New York State, 1995–2015

OBJECTIVEnIntracranial meningiomas are the most commonly diagnosed brain tumor in the United States. With increasing incidence, efficient allocation of limited health care resources is a critical component of emerging value-based models of care. The purpose of this study was to evaluate the effect of patient and hospital variables on metrics of value-based care.nnnMETHODSnThe Statewide Planning and Research Cooperative System database was queried for records of patients undergoing intracranial meningioma surgery in New York State from 1995 to 2015. Multivariate logistic regression was used to investigate the effect of hospital volume and patient demographics on 30-day readmissions, 30-day mortality, prolonged length of stay (pLOS), and excess hospital charges.nnnRESULTSnAmong the 14,239 patients included, 10,252 (72%) cases were performed at high-volume centers (HVC) (>75th percentile). HVC were associated with lower rates of readmissions, mortality, and pLOS, but higher hospital charges. In the multivariate analysis, HVC had reduced odds of pLOS (odds ratio, 0.56; P < 0.0001) and 30-day mortality (odds ratio, 0.39; P < 0.0001). Patient variables associated with adverse outcomes in the multivariate model included advanced age, male gender, higher Charlson Comorbidity Index, lower socioeconomic status (low income, Medicaid, and Medicare insurance), black race, and Hispanic ethnicity. These populations were more likely to undergo treatment at lower-volume centers.nnnCONCLUSIONSnThis statewide population analysis of readmissions, mortality, length of stay, and hospital charges after intracranial meningioma surgery identified patient predictors of adverse outcomes. These determinants may be used by hospitals to develop improved systems of care in at-risk populations.

Percutaneous versus surgical tracheostomy: timing, outcomes, and charges: Percutaneous Versus Surgical Tracheostomy

The purpose of this study was to compare timing of procedure, patient characteristics, outcomes, and charges for patients who underwent percutaneous versus surgical tracheostomy.

Robotic-assisted vs. laparoscopic donor nephrectomy: a retrospective comparison of perioperative course and postoperative outcome after 1 year

Safety is of utmost importance in live donor nephrectomies. In this study, we describe our initial experience with robot-assisted laparoscopic donor nephrectomy (RDN) in comparison with the standard laparoscopic donor nephrectomy (LDN). We retrospectively reviewed 95 patients who either underwent RDN or LDN performed by a single surgeon from 2011 to 2016 at a tertiary institution. Donor perioperative course and postoperative outcome along with recipient outcomes were compared. Of the 95 cases, 73 were classified as LDN and 22 were classified as RDN. There were no significant differences between the two groups in age, sex, BMI, race, and ASA status. Operative times (pxa0<xa00.001) were longer in the RDN group, but eventually approached LDN times. Warm ischemia (pxa0=xa00.002) and extraction times (pxa0=xa00.05) were also longer in the RDN cohort. The donor length of hospital stay, complication rates, and postoperative change in eGFR from baseline were similar in both cohorts up to 1xa0year. Recipient outcomes, including delayed graft function, graft failure, and renal function up to 1xa0year, were also comparable. In this study, we compared the longest postoperative course so far in both donors and recipients between RDN and LDN. Up to 1xa0year, RDN does not negatively impact outcomes. Proficiency with RDN also quickly improved to match LDN, making it a suitable procedure for newer surgeons.

The socioeconomic determinants for transsphenoidal pituitary surgery: a review of New York State from 1995 to 2015: Outcome determinants in pituitary surgery

Prolonged length of stay (pLOS), disease‐related complications, and 30‐day readmissions are important quality metrics under the Affordable Care Act. The purpose of our study was to investigate the effect of patient‐level and hospital‐level factors on these outcomes for patients admitted for transsphenoidal pituitary surgery.

Incidence of Sphenoid Sinus Mucoceles after Endoscopic Transsphenoidal Approach with Sphenoid Obliteration

Objective: Sphenoid sinus mucocele is a rare complication of transsphenoidal surgery and can present clinically many years after the initial surgery. Although the formation of sphenoid sinus mucocele has been previously described in the literature as case reports, there is no information demonstrating the incidence of sphenoid sinus mucocele after sphenoid obliteration in a large series. This study aims to determine the incidence of sphenoid sinus mucocele formation and other postoperative complications following transsphenoidal surgery with fat obliteration. nMethods: A retrospective review was performed of patients who underwent sphenoid obliteration with fat after Transsphenoidal approach for pituitary adenoma by two surgeons at our institution from 2001 to 2003. Follow-up records up to 2015 were obtained for these patients. Data collected included demographics, operation performed, sphenoid sinus obliteration method, reconstruction method, follow-up period, postoperative complications, recurrence and residual disease. nResults: Of the 95 patients who underwent Transsphenoidal approach and sphenoid obliteration with fat, 27 patients developed postoperative complications. None had sphenoid sinus mucocele formation. Recurrence of disease occurred in 11.6% of patients. Residual disease was present in 7.4% of patients. Complications included sinusitis, hematoma, hyponatremia, acromegaly and postoperative need for the placement of a ventriculoperitoneal shunt. nConclusion: Sphenoid sinus mucocele formation is a rare complication following transsphenoidal surgery with fat obliteration with an estimated incidence of less than 1.1%. Further studies with more cases are needed to accurately establish the incidence.