Ochsner Journal最新文献

{"title":"Tubulocystic Renal Cell Carcinoma: An Underrecognized Clinicopathologic Entity.","authors":"Sudeep Khera,&nbsp;Poonam Elhence,&nbsp;Taruna Yadav,&nbsp;Himanshu Pandey","doi":"10.31486/toj.21.0065","DOIUrl":"https://doi.org/10.31486/toj.21.0065","url":null,"abstract":"<p><p><b>Background:</b> Tubulocystic renal cell carcinoma is a lesser-known neoplastic entity compared to other common histologic variants of renal cell carcinoma. The World Health Organization identified tubulocystic renal cell carcinoma as a newly recognized renal tumor in 2016. We report a case of tubulocystic renal cell carcinoma in a young adult. <b>Case Report:</b> A 21-year-old male presented with the chief complaint of a lump on the right side of his abdomen since childhood. Magnetic resonance imaging revealed an enlarged right kidney with multiple large multiloculated cysts with hemorrhagic contents and enhancing peripheral nodular solid components with enhancing septa in some of the cysts, suggesting the possibility of multifocal intracystic papillary renal cell carcinoma. Imaging showed a Bosniak type IV cystic lesion in the right kidney. Right radical nephrectomy was performed. Grossly, the kidney was almost replaced by variable-sized cystic lesions with thick septations filled with serous fluid to gelatinous material. The tubules and cysts were lined by a single layer of flat, hobnail, and cuboidal cells with high-grade nuclear features. No ovarian-type stroma was identified. In places, a papillary component was also identified. Tubulocystic renal cell carcinoma was diagnosed based on microscopy and immunohistochemistry results. <b>Conclusion:</b> Tubulocystic renal cell carcinoma is a rare entity that was previously called Bellini duct carcinoma and low-grade collecting duct carcinoma. Because of the limited number of cases reported, tubulocystic renal cell carcinoma needs to be followed to determine the biologic behavior and metastatic potential of these tumors so that management guidelines for such cases can be developed.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"22 2","pages":"182-187"},"PeriodicalIF":1.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9196962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40399666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Antepartum Factors for Predicting the Risk of Emergency Cesarean Delivery in Pregnancies Complicated With Placenta Previa.","authors":"Süleyman Cemil Oğlak,&nbsp;Fatma Ölmez,&nbsp;Şeyhmus Tunç","doi":"10.31486/toj.21.0138","DOIUrl":"https://doi.org/10.31486/toj.21.0138","url":null,"abstract":"<p><p><b>Background:</b> The optimal delivery timing for patients with placenta previa remains controversial in the literature. To reduce spontaneous vaginal bleeding rates, which occur increasingly with advancing gestational weeks, elective cesarean delivery is advocated between 36^0/7 and 37^6/7 weeks of gestation, but this clinical approach does not take into consideration numerous patient variables. Few papers identify the risk factors for emergency cesarean delivery in patients with placenta previa. An enhanced understanding of these variables could help with determining patients at high risk for emergency cesarean delivery and individualizing delivery date scheduling. This study sought to identify predictor variables associated with emergency cesarean delivery in pregnant patients with placenta previa in a tertiary referral hospital. We also investigated differences in maternal and perinatal outcomes between patients with placenta previa who underwent emergency vs planned cesarean delivery. <b>Methods:</b> This retrospective cohort study included 208 singleton pregnancy patients who had a confirmed diagnosis of placenta previa at the time of delivery and who underwent cesarean delivery in our hospital beyond 24 weeks of gestation. To define risk factors of the outcome variable (emergency vs planned cesarean delivery), univariate and multiple logistic regression analysis and adjusted odds ratios with their confidence intervals were calculated. <b>Results:</b> Ninety-seven patients (46.6%) required emergency cesarean delivery, and 111 patients (53.4%) underwent planned cesarean delivery. Antepartum bleeding episode (37.1% and 20.7%, <i>P</i>=0.013) and first antepartum bleeding episode ≤28 weeks of gestation (36.1% and 14.4%, <i>P</i><0.001) were significantly higher in the emergency group than the planned group. Antepartum bleeding episode (odds ratio [OR]=1.968, 95% CI 1.001-4.200, <i>P</i>=0.042), first antepartum bleeding episode ≤28 weeks of gestation (OR=2.750, 95% CI 1.315-5.748, <i>P</i>=0.007), and preoperative hemoglobin level (OR=0.713, 95% CI 0.595-0.854, <i>P</i><0.001) were the independent predictors significantly associated with emergency cesarean delivery. <b>Conclusion:</b> Three factors-antepartum bleeding episode during pregnancy, first antepartum bleeding episode ≤28 weeks of gestation, and lower preoperative hemoglobin level-might be useful in predicting emergency cesarean delivery in pregnancies complicated with placenta previa.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"22 2","pages":"146-153"},"PeriodicalIF":1.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9196971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40399669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unusual Cause of Respiratory Distress in a Term Neonate.","authors":"Aymen Mirza,&nbsp;Maribel Martinez,&nbsp;Sasikumar Kilaikode","doi":"10.31486/toj.21.0101","DOIUrl":"https://doi.org/10.31486/toj.21.0101","url":null,"abstract":"<p><p><b>Background:</b> Respiratory distress is a clinical finding often seen in neonates. Common causes of respiratory distress in this population include respiratory distress syndrome, transient tachypnea of the newborn, infection, aspiration, and cardiac etiologies. We present the case of a neonate who presented with respiratory distress with no identifiable cause on initial workup. The patient was eventually found to have a variant of a genetic mutation that predisposed the infant to this presentation. <b>Case Report:</b> A term male infant born via spontaneous vaginal delivery was admitted to the pediatric service at 3 weeks of age because of tachypnea. Chest x-ray showed perihilar infiltrates. Septic screen, thyroid function test, sweat test, echocardiogram, intracranial ultrasound, and modified barium swallow were normal. Computed tomography scan of the chest showed ground glass opacities in the upper and lower lobes. Airway evaluation showed no evidence of obstruction or anatomic abnormalities. Bronchoscopy showed no masses or tracheomalacia. Bronchoalveolar lavage was negative for infection. The infant was treated with intravenous antibiotics, steroids, and furosemide but continued to be tachypneic and required supplemental oxygen. Genetic studies were obtained to assess for surfactant deficiencies, and the patient was transferred to another center for a higher level of care. Genetic evaluation was positive for NKX2.1 variance mutation C.190C. The patient's symptoms improved, and he was weaned to room air by 3 months of age. <b>Conclusion:</b> When evaluating a child with unexplained pulmonary disease, clinicians should have a high index of suspicion for interstitial lung disease including surfactant protein mutations.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"22 2","pages":"196-198"},"PeriodicalIF":1.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9196966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40401473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multiple Biventricular Thrombi Associated With Methamphetamine-Associated Cardiomyopathy.","authors":"Syeda H Zaidi,&nbsp;Umair A Khan,&nbsp;Shazib Sagheer,&nbsp;Abubaker Sheikh,&nbsp;Mark E Garcia","doi":"10.31486/toj.21.0097","DOIUrl":"https://doi.org/10.31486/toj.21.0097","url":null,"abstract":"<p><p><b>Background:</b> As methamphetamine use has increased around the world, cardiovascular mortality has also increased. Methamphetamine-associated cardiomyopathy (MACM) is one of the serious cardiovascular complications of methamphetamine use. Limited evidence has been published regarding the increased risk of thrombogenicity in the setting of methamphetamine use. We propose that increased thrombogenicity presents a risk factor for intracardiac thrombi. <b>Case Report:</b> A 48-year-old female with a history of MACM was admitted to the hospital with acute decompensated heart failure. Transthoracic echocardiogram revealed multiple biventricular masses requiring further workup, but the patient left against medical advice on warfarin. The patient presented again 2.5 months later with decompensated heart failure. During the second admission, cardiac magnetic resonance imaging (CMR) characterized the masses in the left ventricle as thrombi, and computed tomography of the chest with contrast showed pulmonary embolism. Although the right ventricle mass was not seen on CMR, we believe the mass was a thrombus that either had migrated into the lungs or had resolved with warfarin use. <b>Conclusion:</b> MACM and biventricular thrombi are associated, but the association is rare and not well studied. Although the exact mechanism of this association is unknown, the increased circulating catecholamines are believed to be a contributing factor for increased thrombogenicity in the setting of active methamphetamine use. We suggest keeping a low threshold for surveillance echocardiography to screen for intracardiac thrombi in MACM patients with active methamphetamine use when they present with even mild symptoms of decompensated heart failure.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"22 2","pages":"192-195"},"PeriodicalIF":1.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9196964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40401472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Medicaid Expansion on Visit Composition in a Louisiana Health Care System.","authors":"Diana Hamer,&nbsp;Deekshith Mandala,&nbsp;Glenn Jones,&nbsp;Gerald M Knapp,&nbsp;Tonya Jagneaux","doi":"10.31486/toj.21.0106","DOIUrl":"https://doi.org/10.31486/toj.21.0106","url":null,"abstract":"<p><p><b>Background:</b> In 2016, Louisiana expanded Medicaid to low-income adults under the Patient Protection and Affordable Care Act. By 2020, the uninsured rate of adults in Louisiana had dropped from 22.7% to 8.9%; however, few reports describe the effect Medicaid expansion has had on access and utilization of health care services in Louisiana. <b>Methods:</b> For this study, we collected all-payer emergency department and clinic visits from one health care system in Louisiana from 2015 to 2019. We used a time series analysis to compare trends before and after Medicaid expansion in health insurance coverage and emergency department visit type. <b>Results:</b> The changes in payer mix in the urgent care and primary care clinics and emergency departments after Medicaid expansion was driven by the uptake of Medicaid coverage in the previously uninsured. Medicaid expansion had a limited impact on the number of urgent care and emergent and nonemergent emergency department visits, but an increase in primary care visits was observed. <b>Conclusion:</b> Medicaid expansion reduced uncompensated care in our patient population and expanded the access to primary care clinics. Ongoing research is needed to understand the effect of nonfinancial barriers to care on access to and utilization of services in Louisiana.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"22 2","pages":"154-162"},"PeriodicalIF":1.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9196955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40401475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uncommon Cause of Internal Mammary Artery Pseudoaneurysm.","authors":"Rohan M Prasad,&nbsp;Jason Z Liu,&nbsp;Christopher Garces,&nbsp;Ayushma Duwadi,&nbsp;James Choi,&nbsp;Farah Anwar,&nbsp;Adesuwa Olomu","doi":"10.31486/toj.21.0090","DOIUrl":"https://doi.org/10.31486/toj.21.0090","url":null,"abstract":"<p><p><b>Background:</b> Internal mammary artery pseudoaneurysms most commonly develop from thoracic penetrating trauma or procedures. However, other important etiologies should not be overlooked. <b>Case Report:</b> A 27-year-old female presented with antiphospholipid antibody syndrome, thrombotic microangiopathy, end-stage renal disease on hemodialysis, and epilepsy. On admission, the patient had pulseless electrical activity and hypertensive emergency. After the patient was successfully resuscitated, she developed status epilepticus. Laboratory workup on admission revealed a subtherapeutic international normalized ratio, elevated C-reactive protein and sedimentation rate, and acute anemia. Imaging showed a right-sided subdural hematoma with a midline shift and likely internal mammary artery pseudoaneurysm. Angiography demonstrated aneurysmal dilation, segmental narrowing, and a string of beads appearance. Because of our patient's demographics, string of beads appearance on diagnostic angiography, history of renal disease, and negative hepatitis serology, fibromuscular dysplasia was considered the etiology of the internal mammary artery pseudoaneurysm. The family opted for 2 burr holes and a subdural drain but declined further diagnostic and therapeutic interventions because of anoxic brain injury and poor prognosis. <b>Conclusion:</b> In this patient, the etiology of the internal mammary artery pseudoaneurysm was attributed to fibromuscular dysplasia. Although this patient's family chose comfort measures, treatment methods are available for internal mammary artery pseudoaneurysms.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"22 3","pages":"244-248"},"PeriodicalIF":1.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9477130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40390449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact on an Urgent Care Clinic of a New Freestanding Emergency Department in a Resource-Scarce Area.","authors":"Diana Hamer,&nbsp;Glenn N Jones,&nbsp;Michael R Loewe,&nbsp;Mandi W Musso","doi":"10.31486/toj.21.0146","DOIUrl":"https://doi.org/10.31486/toj.21.0146","url":null,"abstract":"<p><p><b>Background:</b> Convenience clinics-such as urgent care centers (UCCs), retail clinics, and freestanding emergency departments (FSEDs)-where patients can receive treatment for a variety of medical conditions have increased in number and popularity. We quantify the impact an FSED had on UCC visits in an underserved area in North Baton Rouge, Louisiana. <b>Methods:</b> All FSED and UCC visits were abstracted from 2015 to 2020. Visits were classified using <i>International Classification of Diseases, Tenth Revision</i> codes. We used a time series analysis to evaluate the association of nonemergent and emergent visits to the UCC after the opening of the FSED. Visits were also aggregated at the census block group (neighborhood) level. Demographic characteristics and the neighborhood Area Deprivation Index were used to compare UCC utilization before and after the FSED opened and to describe the visits to the UCC and the FSED. <b>Results:</b> We found a difference in the demographic composition of patients presenting to the UCC after the FSED opened. Emergent visits decreased at the UCC, but nonemergent visits did not change after the FSED opened. The majority of visits to the FSED were nonemergent, and the proportion of nonemergent visits to the FSED increased during the hours that the UCC was closed. The majority of visits to the FSED came from neighborhoods with a high Area Deprivation Index. <b>Conclusion:</b> The opening of an FSED resulted in a reduction of emergent visits to the UCC without impacting the number of nonemergent visits. The opening of an FSED in a poor, healthcare-resource-scarce area resulted in significantly more patients from deprived neighborhoods being treated at the FSED and UCC.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"22 3","pages":"211-217"},"PeriodicalIF":1.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9477131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40391987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of a Patient-Centered Dietary Educational Intervention.","authors":"Tiffany Wesley Ardoin,&nbsp;Diana Hamer,&nbsp;Nia Mason,&nbsp;Addy Reine,&nbsp;Lindsay Barleycorn,&nbsp;Diane Francis,&nbsp;Angela Johnson","doi":"10.31486/toj.21.0075","DOIUrl":"https://doi.org/10.31486/toj.21.0075","url":null,"abstract":"<p><p><b>Background:</b> A healthy diet is an important component of preventive medicine. With the changing landscape of medicine, physicians are encountering more challenges in educating patients about a healthy diet, so finding innovative ways to educate patients is imperative. This study investigated the effectiveness of an innovative educational intervention based on the United States Department of Agriculture-recommended MyPlate diet. <b>Methods:</b> Based on the assessed need for dietary education, patients were exposed to an educational video and received a handout on the MyPlate diet. The educational video was created to be culturally relevant with patient-informed edits. The handout was taken from www.ChooseMyPlate.gov. The patients who received the intervention were compared to those who were not exposed to the intervention. Data were collected in a primary care clinic for an underserved population in fall 2018 and analyzed in spring 2019 through patient-completed surveys and physician reporting on patient interactions. Data were analyzed using descriptive statistics, <i>t</i> tests, chi-squared models, and repeated measures analysis of variance. <b>Results:</b> Among 320 patients, 169 patients were exposed to the educational intervention. Intervention patients had better knowledge of the MyPlate diet (<i>P</i>=0.009), felt it would be easier to change their diet (<i>P</i>=0.03), and were more motivated to have conversations about diet with their physician (<i>P</i>=0.04) compared to those who were not exposed. Patients also enjoyed the video overall. <b>Conclusion:</b> This study shows that using multiple modalities including a patient-centered video and handouts to educate patients about diet is enjoyable to patients and effective in teaching, motivating change, and encouraging communication between patients and physicians.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"22 2","pages":"113-128"},"PeriodicalIF":1.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9196970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40399663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lower Extremity Salvage in a Diabetic Patient With Cutaneous Mucormycosis and COVID-19 After Open Patella Fracture.","authors":"Danny A S Hammoudi,&nbsp;Malika M Morar,&nbsp;Anna Garbuzov,&nbsp;Daniel Urias,&nbsp;Kristopher M Katira","doi":"10.31486/toj.21.0099","DOIUrl":"https://doi.org/10.31486/toj.21.0099","url":null,"abstract":"<p><p><b>Background:</b> Cutaneous mucormycosis, while less common than sinonasal or pulmonary infections, can cause widespread tissue necrosis after seemingly innocuous encounters. The most common location of cutaneous mucormycosis is the extremities, and extensive infection has been reported after trauma or orthopedic procedures. <b>Case Report:</b> A 60-year-old female with poorly controlled type 2 diabetes mellitus sustained an open patella fracture after a fall. She underwent washout and internal fixation with cannulated screws and cable tension band wiring. The patient's recovery was complicated by asymptomatic coronavirus disease 2019 (COVID-19) infection and repeated wound dehiscence, with growth of <i>Mucor</i> species initially presumed to be a contaminant. Despite serial washout and debridement, repeat dehiscence and patella exposure were noted. Free tissue transfer to the genicular vessels was selected for coverage of the extensor tendon, patella, and fracture line. In repeat skin cultures, <i>Mucor indicus</i> and <i>Staphylococcus epidermidis</i> grew from the wound. Topical voriconazole and a 6-week course of intravenous isavuconazole and oral doxycycline were started when the <i>Mucor</i> cultures were identified. <b>Conclusion:</b> This case highlights an approach to an indolent mucormycosis infection in the skin over a patella fracture in a patient with poorly controlled diabetes mellitus, including the sequence of surgical care, debridement, and selection of antimicrobials. Major amputation and orthopedic revision were avoided. This patient also underwent successful free tissue transfer after testing positive for COVID-19.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"22 2","pages":"163-168"},"PeriodicalIF":1.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9196960/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40399668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital-Based Same-Day Compared to Overnight-Stay Mastectomy: An American College of Surgeons National Surgical Quality Improvement Program Analysis.","authors":"Udai S Sibia,&nbsp;John R Klune,&nbsp;Justin J Turcotte,&nbsp;Luther H Holton,&nbsp;Adam I Riker","doi":"10.31486/toj.21.0103","DOIUrl":"https://doi.org/10.31486/toj.21.0103","url":null,"abstract":"<p><p><b>Background:</b> Enhanced Recovery after Surgery for mastectomy has resulted in increased use of outpatient same-day mastectomy (SDM). Whether SDM leads to increased readmissions or reoperations is not well documented. This study examines national data to compare outcomes of SDM to an overnight stay. <b>Methods:</b> We analyzed the American College of Surgeons National Surgical Quality Improvement Program Participant Use Data File from 2016 to 2018 for all mastectomy cases. Cases with a length of stay (LOS) >1 day were excluded. Cases were then categorized into 2 LOS cohorts: SDM vs 1-day LOS. <b>Results:</b> A total of 22,642 cases (80.8% 1-day LOS vs 19.2% SDM) were identified for the final analysis. Patients in the 1-day LOS group were more likely to be older (57.9 vs 54.0 years, <i>P</i><0.01), be female (98.0% vs 79.8%, <i>P</i><0.01), and have greater comorbidity (38.1% vs 30.7% American Society of Anesthesiologists classification 3 or 4, <i>P</i><0.01) compared to the SDM group. Multivariate analysis demonstrated no difference in risk for 30-day wound complications between the SDM and 1-day LOS groups. The risks for 30-day medical complications (1.60 odds ratio [OR], 95% CI 1.06-2.42, <i>P</i>=0.02), reoperations (1.46 OR, 95% CI 1.17-1.81, <i>P</i><0.01), and readmissions (1.60 OR, 95% CI 1.25-2.05, <i>P</i><0.01) were higher in the 1-day LOS group. Even after excluding patients undergoing reoperation on the day of surgery, the risk for reoperations (2.3% vs 3.3%, <i>P</i><0.01) remained higher in the 1-day LOS group. Characteristics associated with 1-day LOS were hypertension, steroid use, diabetes, dyspnea, dependent functional status, bilateral procedures, and breast reconstruction. <b>Conclusion:</b> We demonstrate that SDM is a safe procedure, with no increase in risk for 30-day postoperative complications. Appropriate patients should be offered SDM.</p>","PeriodicalId":47600,"journal":{"name":"Ochsner Journal","volume":"22 2","pages":"139-145"},"PeriodicalIF":1.2,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9196968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40401474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}