Browsing by Subject "Microsurgery"
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Item Aspiration Pneumonia and Perioperative Antibiotic Use in Transoral Robotic and Laser Microsurgery(2015-01-26) Gajera, Prakash; Sumer, Baran D.INTRODUCTION: Aspiration pneumonia can follow transoral surgery for head and neck cancer due to abnormal swallowing function. While prophylactic post-operative antibiotics may decrease the incidence of this complication, excessive use can be costly, and lead to adverse reactions or antibiotic resistance. The objectives of this study are to 1) determine if the use post-op antibiotics prevent aspiration pneumonia. 2) Identify any complications related to the use of antibiotics. METHODS: A retrospective review of 155 patients who underwent transoral surgery for squamous cell carcinoma (SCCA) between May 2008 and June 2014 was conducted and demographic data was collected. The MD Anderson dysphagia inventory (MDADI) was used to assess swallowing function. RESULTS: Sixteen of 122 patients that received postoperative antibiotics (13.1%) developed pneumonia, compared to 4/32(12.5%) patients who did not receive antibiotics (p=0.925). Average antibiotic course was 39.2 days (median=23). Average time to infection was 290 days (median=217, range=11-979). Univariate analysis did not show a correlation between patients that developed pneumonia and antibiotic use (p=1.00), location (p=.1642), overall stage (p=.1599), comorbidity status (p=.5327), tobacco use (p=.6328), alcohol use (p=.351), and gastrostomy tube dependence (p=.254). Univariate analysis did show a correlation between pneumonia and tracheostomy placement (p=.0316), T stage (p=.0357), and days post-op of PEG placement (p=.0297). Multivariate analysis showed correlation with tracheostomy placement (p=.0236). No patients contracted C. difficile infection. No trend was observed in post-operative MDADI score. DISCUSSION: Routine use of post-operative prophylactic antibiotic does not correlate with a decreased rate of pneumonia or improved functional outcomes. Given that tracheostomies are performed mainly for pulmonary toilet, and a larger T stage results in larger resections, the significant correlation was expected. PEG placement in pneumonia patients was significantly later than patients with no pneumonia. This, and the fact that pneumonia generally developed outside of the 30-day perioperative period, supports the idea that aspiration pneumonia development reflects a chronic worsening swallowing dysfunction. Therefore, dysphagia immediately after surgery is probably not a significant risk factor for developing aspiration pneumonia and routine post-operative antibiotic use for pneumonia prevention is not indicated after transoral surgery.Item Co-Surgeons in Breast Reconstructive Microsurgery: What Do They Bring to the Table?(2019-03-18) Haddock, Nicholas T.; Kayfan, Samar; Pezeshk, Ronnie A.; Teotia, Sumeet S.; Kayfan, Samar; Teotia, Sumeet S.; Haddock, Nicholas T.; Rozen, ShaiINTRODUCTION: Current research within other surgical specialties suggests that a co-surgeon approach may reduce operative times and complications associated with complex bilateral procedures, possibly leading to improved patient and surgical outcomes. We sought to evaluate the role of the co-surgery team and its development in free flap breast reconstruction. METHODS: A retrospective review of free-flap breast reconstruction by two surgeons from 2011-2016 was conducted. We analyzed 128 patients who underwent bilateral-DIEP breast. Surgical groups were: single-surgeon reconstruction (SSR; 35 patients), Co-Surgery where both surgeons are present for entire reconstruction (CSR-I; 69 patients), and Co-Surgery reconstruction where co-surgeons appropriately assist in two concurrent or staggered cases (CSR-II; 24 patients). Efficiency data collected was OR time and patient length-of-stay (LOS). The rate of flap-failure, return to OR, infection, wound breakdown, seroma, hematoma and PE/DVT were compared. RESULTS: Single-surgeon reconstruction had significantly longer OR time (678 vs 485 minutes, p< 0.0001), LOS (5 vs 3.9 days, p<0.001), higher wound occurrences of the umbilical site that required surgical correction [11.4 percent (n=4) versus 1.5 percent,(n=1); p<0.043] compared to CSR-I. Similarly, SSR had significantly longer average OR time (678 vs 527 minutes p< 0.0001), average LOS (5 days vs 4 days, p=0.0005) when compared to CSR-II. There were no total increased patient related complications associated with co-surgery (CSR- I or II). CONCLUSION: The addition of a Co-surgeon, even with concurrent surgery, reduces operative time, average patient LOS, and post-operative complications. This work lends a strong credence that Co-surgery model is associated with increased operative efficiency.Item [UT News](1986-07-30) Rutherford, SusanItem [UT Southwestern Medical Center News](2009-11-05) Rian, Russell