Grace S. Hwang

Unplanned readmission after appendectomy

BACKGROUND Unplanned readmission of patients who undergo appendectomy is a relatively frequent occurrence. Our aim was to report the most common reasons and the predictors of unplanned readmission after appendectomy. METHODS The National Surgical Quality Improvement Program database was used to examine the clinical data of patients undergoing emergent and/or urgent appendectomy during 2012 to 2013. Multivariate regression analysis was performed to identify the predictors of unplanned readmission. RESULTS We evaluated a total of 46,960 patients who underwent appendectomy. Of these, 18.5% had perforated appendicitis. Overall, 1,755 (3.7%) of patients had an unplanned readmission. The most common reasons for readmission were intra-abdominal infection (27.3%), nonspecific abdominal pain (7.9%), and paralytic ileus (4.6%). Factors such as perforated appendicitis (adjusted odds ratio [AOR], 1.38; P < .01), preoperative sepsis (AOR, 1.30; P < .01), and dirty surgical wound (AOR, 1.91; P < .01) were associated with unplanned readmission. CONCLUSIONS Overall, 3.7% of patients who underwent emergent appendectomy had an unplanned readmission. Intra-abdominal infections and nonspecific abdominal pain are the most common reasons for readmission. Unplanned readmissions are predominantly related to postoperative complications and severity of disease.

Surgical site infection impact of pelvic exenteration procedure

We sought to investigate morbidity and infectious complications following pelvic exenteration (PEx) and compare infectious complications of patients undergoing PEx and conventional rectal resections.

Outcomes of colon resection in patients with metastatic colon cancer

BACKGROUND Patients with advanced colorectal cancer have a high incidence of postoperative complications. We sought to identify outcomes of patients who underwent resection for colon cancer by cancer stage. METHODS The National Surgical Quality Improvement Program database was used to evaluate all patients who underwent colon resection with a diagnosis of colon cancer from 2012 to 2014. Multivariate logistic regression analysis was performed to investigate patient outcomes by cancer stage. RESULTS A total of 7,786 colon cancer patients who underwent colon resection were identified. Of these, 10.8% had metastasis at the time of operation. Patients with metastatic disease had significantly increased risks of perioperative morbidity (adjusted odds ratio [AOR]: 1.44, P = .01) and mortality (AOR: 3.72, P = .01). Patients with metastatic disease were significantly younger (AOR: .99, P < .01) had a higher American Society of Anesthesiologists score (AOR: 1.29, P < .2) and had a higher rate of emergent operation (AOR: 1.40, P < .01). CONCLUSIONS Overall, 10.8% of patients undergoing colectomy for colon cancer have metastatic disease. Postoperative morbidity and mortality are significantly higher than in patients with localized disease.

Robotic Abdominoperineal Resection

Minimally invasive approaches to colorectal disease and cancer have been largely accepted and new techniques are being explored on several fronts. Robotic and robotic-assisted laparoscopic colorectal dissection is one such area and has become more and more relevant in this field. This approach is especially important for cases requiring precise movements in a limited space, such as in pelvic dissections. The use of the robotic technique has led to improved outcomes and lower rates of conversion and, in some areas, reduced morbidity. In this chapter, we will review our operative techniques of robotic-assisted abdominoperineal resection (APR).

Repair of complex parastomal hernias

Abstract Development of parastomal hernias (PH) is very common after stoma formation and carries a risk of subsequent bowel incarceration, obstruction and strangulation. The management of PH remains a challenge for the colorectal surgeon, and there are currently no standardized guidelines for the treatment of PH. Even more difficult is the management of complex parastomal hernias (CPH). We conducted a review of the literature to identify recent developments in the treatment of CPH, including analysis of the use of synthetic and biologic mesh prostheses, method of mesh placement and surgical approach.