Bladed and bladeless conical trocars do not differ in terms of caused fascial defect size in a Porcine Model.

INTRODUCTION: Trocar insertion during laparoscopy may lead to complications such as bleeding, bowel puncture and fascial defects with subsequent trocar site hernias. It is under discussion whether there is a difference in the extent of the trauma and thus in the size of the fascia defect between blunt and sharp trocars. But the level of evidence is low. Hence, we performed a Porcine Model. METHODS: A total of five euthanized female pigs were operated on. The average weight of the animals was 37.85 (Standard deviation SD 1.68) kg. All pigs were aged 90 ± 5 days. In alternating order five different conical 12-mm trocars (3 × bladeless, 2 × bladed) on each side 4 cm lateral of the mammary ridge were placed. One surgeon performed the insertions after conducting a pneumoperitoneum with 12 mmHg using a Verres' needle. The trocars were removed after 60 min. Subsequently, photo imaging took place. Using the GSA Image Analyser (v3.9.6) the respective abdominal wall defect size was measured. RESULTS: The mean fascial defect size was 58.3 (SD 20.2) mm2. Bladed and bladeless trocars did not significant differ in terms of caused fascial defect size [bladed, 56.6 (SD 20) mm2 vs. bladeless, 59.5 (SD 20.6) mm2, p = 0.7]. Without significance the insertion of bladeless trocars led to the largest (Kii Fios™ First entry, APPLIEDMEDICAL©, 69.3 mm2) and smallest defect size (VersaOne™ (COVIDIEN©, 54.1 mm2). CONCLUSION: Bladed and bladeless conical 12-mm trocars do not differ in terms of caused fascial defect size in the Porcine Model at hand. The occurrence of a trocar site hernia might be largely independent from trocar design.

[Reliability of DRG Routine Data to Analyse Treatment Outcome and Complications of Thyroid Surgery. A Critical Analysis of Data of Patient Records Compared to Administrative Data]. / Zuverlässigkeit von DRG-Routinedaten zur Analyse der Behandlungsergebnisse und Komplikationen im Rahmen der Schilddrüsenchirurgie. Ein kritischer Vergleich zwischen Krankenaktendaten und administrativen Routinedaten.

INTRODUCTION: Quality assurance of the thyroid surgery has been an important part of the work of the endocrine surgeon. For most analyses, data from register files or studies have been used. Administrative data taken from routine data are increasingly used in quality assurance for evaluation. The aim of the study is to determine the reliability of routine data to analyse the treatment outcome and complications of thyroid surgery. PATIENTS AND METHODS: In a cross-sectional study, we compared records of 121 patients with thyroid surgery for one year with the data of quality assurance of clinical routine. We determined sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of complications. RESULTS: Screening of administrative data identified 40 specific complications; 84 by patient records. Sensitivities for the detection of complications using administrative data ranged from 31.3 to 60.0%. Specificities ranged from 97.0 to 100%; PPV were 0.77 - 1.0 and NPV were 0.56 - 1.0. CONCLUSION: Quality assurance of clinical routine data of the thyroid surgery shows deficiencies in sensitivity accompanied by high specificity. It is necessary to increase the validity of administrative routine data to carry out a reliable clinic quality analysis or to prepare volume-outcome relationships in clinical health service research. The parameter of hypocalcaemia shows the most limitations due to quality assurance of clinical routine data.

[Morbidity and Mortality of Single Incision Cholecystectomy: Results of a 3-Year Register Analysis]. / Morbidität und Letalität der Single-Incision-Cholezystektomie: eine 3-Jahres-Registeranalyse.

INTRODUCTION: Two decades ago, single-incision surgery was established as a new concept in minimally invasive surgery. Single incision cholecystectomy is the most frequently performed procedure in clinical routine. Most of the results have been based on randomised trials. Large prospective multicentre observational datasets from clinical routine do not exist. This analysis of clinical health service research is based on the SILAP study (single-incision multiport/single port laparoscopic abdominal surgery study). PATIENTS AND METHODS: The data of the register were collected in 47 hospitals in the period of 2012 to 2014. Overall morbidity and mortality were the primary outcome. Multiple linear and logistic regression analyses were performed. Statistical significance was set at p < 0.05. RESULTS: Data from 975 patients in clinical routine with single incision cholecystectomy were collected. Intraoperative complications were recorded in 3.2% of cases. Bile duct injuries were registered in 0.1% of cases. Postoperative complications were detected in 3.7% of cases. The mortality rate was 0.2%.The median operating time dropped from 60.0 to 51.5 min (p < 0.001) during the study. The use of an extra trocar was necessary in 10.3% of cases. Conversion to open surgery was performed in 0.7% of cases. Body mass index (p = 0.024), male gender (p = 0.012) and operating time (p < 0.001) had a significant effect on intraoperative complications in multivariate analysis. Classification of ASA III (p = 0.001) and modification or conversion of single incision technique (p = 0.001) were significantly associated with postoperative complications. CONCLUSION: The register analysis of the prospective multicentre data shows that single incision cholecystectomy is feasible in clinical routine even outside the selective criteria of randomised studies. The only limitation is a BMI > 30 kg/m2 which has a significant influence on the intraoperative rate of complications in mild adverse events.

Hospital volume and mortality in liver resections for colorectal metastasis using population-based administrative data.

BACKGROUND: Approximately one-quarter of patients with colorectal carcinoma develop colorectal liver metastases (CRLM). Surgical treatment with curative intent by hepatic resection is the standard medical care. While some studies with small sample sizes have investigated the relationship between hospital procedure volume and in-hospital mortality for this diagnosis, no population-based study has been conducted. The present study was aimed at closing this gap. METHODS: Based on administrative population-based hospital discharge data (Diagnosis Related Group Statistic), patients diagnosed with CRLM and treated with hepatic resection from 2011 to 2015 were identified. The hospital operation-volume effect on risk-adjusted in-hospital mortality was examined by logistic regression models. RESULTS: During the study period, 5900 patients with CRLM were treated with hepatic resection, of whom 189 (3.2%) died before hospital discharge. Hospitals of different operation-volume quartiles did not differ in terms of mortality rates. Sensitivity analysis investigating the volume-mortality relationship separately for every resection procedure showed no clear result. Procedure frequencies vary among hospitals of different volume quartiles, with low-volume hospitals performing systematically more low-risk procedures (in terms of reduced mortality rate), than high-volume hospitals. CONCLUSION: Based on almost complete German hospital discharge data, the results did not confirm unconditional volume-outcome relationship for CRLM patients.