Chester J. Donnally

Durable oncologic outcomes after radiofrequency ablation: experience from treating 243 small renal masses over 7.5 years.

Long‐term oncologic outcomes for renal thermal ablation are limited. The authors of this report present their experience with radiofrequency ablation (RFA) therapy for 243 small renal masses (SRMs) over the past 7.5 years.

Importance of cosmesis to patients undergoing renal surgery: a comparison of laparoendoscopic single-site (LESS), laparoscopic and open surgery

Study Type – Therapy (case series)

Complications during the initial experience with laparoendoscopic single-site pyeloplasty

Study Type – Therapy (case series)

Minimally Invasive Nephrectomy: The Influence of Laparoendoscopic Single-site Surgery on Patient Selection, Outcomes, and Morbidity

OBJECTIVES To define clinical scenarios in urology for which laparoendoscopic single-site surgery (LESS) is indicated and likely to be successful. We report a series of LESS nephrectomies and compare patient characteristics with traditional laparoscopic nephrectomies performed during the same time period. METHODS We retrospectively reviewed all laparoscopic nephrectomies (conventional or LESS) performed by a single surgeon at our institution since our initial LESS cases in August 2007. Patients were not randomized; instead the surgeon used clinical judgment to decide with the patient which procedure should be performed. Factors that may have influenced this decision were retrospectively analyzed. RESULTS Of all minimally invasive nephrectomies, 47% were performed using LESS technique (30/64). One conversion from LESS to standard laparoscopy occurred. Patients undergoing LESS had a smaller median age (47 vs 63.5 years, P = .004), body mass index (24.4 vs 28.4, P = .001), tumor size in nephrectomies performed for suspected malignancy (4 cm vs 6 cm, P = .043), and hospital length of stay (42.7 vs 46.1 hours, P = .006). LESS patients were also more likely to be undergoing a nephrectomy for a benign indication (50% vs 15%, P = .006). The complication rate for LESS and conventional laparoscopy was 13% (4/30) and 15% (5/34), respectively, with similar distributions across Clavien grades. CONCLUSIONS With appropriate patient selection, almost 50% of minimally invasive nephrectomies can be performed using LESS with similar complication rates and outcomes compared with traditional laparoscopy. Younger, thinner patients with nononcological indications or smaller tumors are prime candidates for LESS nephrectomy.

Novel stone-magnetizing microparticles: in vitro toxicity and biologic functionality analysis.

BACKGROUND AND PURPOSE We have developed novel iron-based microparticles (Fe-MP) that bind to calcium oxalate stone fragments, rendering them paramagnetic. Previously, we demonstrated enhanced efficiency of stone extraction in an inanimate model using magnetic instrumentation. Before in vivo stone extraction studies, we sought to further characterize Fe-MP with regard to cellular toxicity and to assess the influence of biologic fluids on binding performance. MATERIALS AND METHODS TOXICITY Monolayers of murine fibroblasts, human urothelium, and human transitional-cell carcinoma cells were exposed to 1 mg/mL of Fe-MP or saline via an agarose overlay. Cellular viability was assessed using neutral red staining and densitometry. Biologic functionality: Human calcium oxalate stone fragments were incubated with a solution of 1 mg/mL of Fe-MP containing varying concentrations of urine (10%-50%) or blood (0.5%-2%) for 10 minutes. Fragments were then extracted using an 8F magnetic tool. Assays of 10 stone fragments categorized as small (3-3.9 mg) or large (6-6.9 mg) were run in quadruplicate at each concentration. RESULTS No toxicity was seen in any of the three cell lines after 48 hours of particle exposure, except in urothelial cells at the lowest cell concentration. Stone extraction success was 100% for all stones, regardless of concentration of urine or blood, and extractions were completed in less than 10 minutes. CONCLUSIONS Preliminary toxicity testing revealed minimal to no cellular toxicity that was attributable to Fe-MP. The microparticles function well in the presence of clinically relevant concentrations of urine and blood that may be present during endoscopic stone surgery. Further toxicity and stone extraction testing in animal models is necessary.

Intermediate term outcomes associated with the surveillance of ureteropelvic junction obstruction in adults.

PURPOSE We determined the outcome of minimally symptomatic adult ureteropelvic junction obstruction in a group of patients treated conservatively with an active surveillance regimen. MATERIALS AND METHODS A total of 27 patients with asymptomatic or minimally symptomatic ureteropelvic junction obstruction were treated conservatively. All patients were evaluated with diuretic renograms. Ureteropelvic junction obstruction was defined by an obstructive pattern of the clearance curve and/or T1/2 greater than 20 minutes. Followup consisted of an office visit and renogram every 6 to 12 months. Cases of greater than 10% loss of relative renal function of the affected kidney, development of pyelonephritis and/or more than 1 episode of acute pain were considered active surveillance failures, and treatment was recommended. RESULTS Of the 27 patients 6 were lost to followup, leaving 21 (median age 47 years) with sufficient followup for analysis. In the 4 patients (19%) who initially presented with mild pain that led to the diagnosis of ureteropelvic junction obstruction, the pain completely resolved. Ipsilateral relative renal function decreased significantly in 2 patients (9.5%, mean reduction 14%). Pain worsened in 3 patients (14.3%) and de novo pain occurred in 1 (4.7%). Surgical intervention for ureteropelvic junction obstruction was required in 6 patients (29%) at an average of 34 months. In total 15 patients (71%) remained on surveillance with a mean followup of 48 months. CONCLUSIONS Active surveillance seems to be a reasonable initial option for asymptomatic or mildly symptomatic adult patients with ureteropelvic junction obstruction because only approximately 30% have progression to surgical intervention within 4 years of diagnosis. This strategy offers the advantage of individualizing therapy according to symptoms and renographic findings.

How social media, training, and demographics influence online reviews across three leading review websites for spine surgeons

BACKGROUND CONTEXT The future of health care is consumer driven with a focus on outcome metrics and patient feedback. Physician review websites have grown in popularity and are guiding patients to certain health-care providers, for better or worse. No prior study has specifically evaluated Internet reviews of spine surgeons, determined if social media (SM) correlates with patient reviews, or evaluated Google as a physician review website. PURPOSE This study aimed to evaluate patient satisfaction scores for spine surgeons in Florida using leading physician ratings websites. STUDY DESIGN A retrospective study was carried out. SAMPLE POPULATION The sample comprised spine surgeons with a review on Healthgrades.com (HG), Vitals.com (V), or Google.com (G) online rating websites as of August 17, 2017. OUTCOME MEASURES Number of ratings, number of comments, overall rating, patient-reported wait times, physician website presence, and physician SM presence were the outcome measures. METHODS Using the directory of registered North American Spine Society physicians, we identified all spine surgeons practicing in Florida (137 orthopedic trained; 78 neurosurgery trained). Surgeon demographics and ratings data were collected from three physician rating websites (HG, V, G) from July 19, 2017 to August 17, 2017. Using only the first 10 search results from Google.com we then identified if the surgeon had accounts on Facebook (FB), Twitter (TW), or Instagram (IG). RESULTS Nearly every surgeon in this cohort had either an institutional or personal website (98.1%), and 38.6% had at least one SM outlet of our three reviewed. Both personal and institutional website presence significantly correlated with higher G scores. Spine surgeons with a searchable account on FB, TW, or IG made up 35.4%, 10.2%, and 0.5% of the cohort, respectively. Surgeons with an SM presence had a significantly higher number of ratings and comments on HG, V, and G, but not overall scores. In multivariable analysis, only V showed a significant inverse correlation between overall score and age, private institution, and orthopedic surgery training. Wait times >30 minutes were significantly associated with worse overall scores across all three review sites. Overall ratings between HG, V, and G all had significantly positive correlations on Pearson correlation analysis. CONCLUSION Social media presence correlates with patient communication in the form of number of ratings and comments, yet does not impact overall scores, suggesting social media may influence patient feedback. Longer wait times are indicative of lower scores across all three platforms. Overall ratings from all three websites correlate significantly with each other, indicating agreement between physician ratings across different platforms. Understanding the factors that optimize a patients overall experience with a physician is an important and emerging outcome measure for the future of patient-centered health care.

An epidural steroid injection in the 6 months preceding a lumbar decompression without fusion predisposes patients to postoperative infections

Background To determine if the timing of a lumbar epidural steroid injection (LESI) effects rates of post-operative infection in patients receiving a non-fusion lumbar decompression (LDC) due to degenerative disc disease (DDD). Lumbar pain due to DDD can frequently be temporized or definitively treated with epidural injections. While there is ample literature regarding the infection risks associated with corticosteroid injections prior to hip/knee replacements, there are few studies relating to the spine. Methods A nationwide insurance database was queried to identify those who underwent LDC for DDD without instrumentation [2005-2014]. Lumbar fusion procedures were excluded. From this group those with a history of a LESI were identified and matched to a control group without a history of LESI. Four separate cohorts were examined: (I) LDC and no LESI within 6 months (control); (II) LDC performed within 0-1 month after LESI; (III) LDC between 1 and 3 months after LESI; (IV) LDC performed between 3 and 6 months after LESI. Results There was an increased odds of a 90-day postoperative infection if the LESI was within the 1-3 months (OR =4.69; P<0.001) and 3-6 months (OR =5.33; P<0.001) interval prior to the LDC. Conclusions While LESI is helpful for possibly delaying or avoid lumbar surgery, it may predispose patients to higher infection rates following lumbar decompressions without fusion. Surgeons and pain management specialist should counsel patients on these risks and.

Comparison of implant survivability in primary 1- to 2-level lumbar fusion amongst opioid abusers and non-opioid abusers

Background Primary lumbar fusion (LF) is a treatment option for degenerative disc disease. The literature is limited regarding postoperative complications in opioid abusers undergoing LF. The purpose of this study was to compare 2-year short term implant-related complications, infection rates, 90-day readmission rates, in-hospital length of stay, and cost of care amongst opioid abusers (OAS) and non-opioid abusers (NAS) undergoing primary 1- to 2-level primary lumbar fusion (1-2LF). Methods A retrospective review was performed using the Medicare Standard Analytical Files from an administrative database. Patients undergoing LF were queried using the International Classification of Disease, ninth revision (ICD-9) procedure codes 81.04-81.08. Patients who underwent 1-2LF were filtered using ICD-9 procedure code 81.62. Inclusion criteria for the study group consisted of patients undergoing primary 1-2LF with a diagnosis of opioid abuse and dependency 90-day prior to the procedure. NAS undergoing 1-2LF served as controls. Patients in the study group were matched to controls according to age, gender, and Charlson-Comorbidity Index (CCI). Two mutually exclusive cohorts were formed and outcome measures analyzed and compared were implant complications, infection rates, 90-day readmission rates, LOS, and cost of care. Results After the matching process 13,342 patients were identified with equal cohort distribution. OAS had higher odds implant related complications (OR: 2.78, P<0.001) such as prosthetic joint dislocation (OR: 3.83, P<0.001), requiring revision (OR: 2.89, P<0.001), pseudarthrosis (OR: 2.50, P<0.001), and spine related infections (OR: 1.58, P<0.001) compared to NAS. OAS had higher 90-day readmission rates, (OR: 1.29, P<0.001), higher hospital costs (

Hypothyroidism increases 90-day postoperative complications in patients undergoing primary single level anterior cervical disectomy and fusion: a matched control analysis

143,057.38 vs.