The worldwide focus on work hour regulations and patient safety has led to the re-examination of the merits of night-time surgery, including kidney transplantation. The risks of operating during nontraditional work hours with potentially fatigued surgeons and staff must be weighed against the negative effects of prolonged cold ischemic time with resultant graft compromise. The aim of this study was to evaluate the impact of performing renal transplantation procedures during evening versus day time hours. The main outcome measures assessed between the day and night cohorts included comparisons of the postoperative complication rates and survival outcomes for both the renal allograft and the patient. A retrospective review of 633 deceased donor renal transplants performed at a single institution was analyzed. Three statistically significant results were noted, namely, a decrease in vascular complications in the nighttime cohort, an increase in urologic complications on subgroup analysis in the 3 AM to 6 AM cohort, and the 12 AM to 3 AM subgroup had the greatest odds of any complication. There was no statistical difference in either patient or graft survival over a twelve month period following transplantation. We conclude that although the complication rate varied among cohorts this was clinically insignificant and there was no overall clinically relevant impact on patient or graft survival.
Introduction In 2008 Coloplast Corporation modified their Titan inflatable penile prosthesis (IPP) with a new One-Touch Release (OTR) pump, in an attempt to facilitate device deflation. There is currently little published data concerning this new pump. Aim The aim of this pilot study was to assess initial patient and physician experience with the Titan OTR pump. Methods Retrospective chart review was used to assess the functionality and surgeon experience with 100 consecutive patients implanted with a Titan OTR pump, compared with 100 prior consecutive patients implanted with a Titan Genesis pump. Main Outcome Measures The ease of implantation of the OTR pump, the number of required postoperative inflate/deflate teaching visits, and OTR pump functionality were assessed and compared with that of the prior Genesis pump. Results The mean length of follow-up in the Genesis group (N = 100) was 20.8 months, and mean length of follow-up in the OTR group (N = 100) was 8.4 months. There was one device infection in each group. The average number of postoperative teaching sessions needed to teach the patient how to operate the device was 1.87 in the Genesis group, and 1.19 in the OTR group (P < 0.001). The range of teaching visits was 1–5 in the Genesis group, and 1–3 in the OTR group (P < 0.001). No pump malfunctions were seen in either group. Subjectively, the OTR pump was just as easy to implant as the Genesis pump. In addition, the OTR pump was subjectively easier for the surgeon and the patient to deflate, and just as easy to inflate, compared with the Genesis pump. Conclusions This pilot study revealed that the OTR pump functioned as specified by the manufacturer. With short-term follow-up, no pump malfunctions were detected. The OTR pump was associated with a statistically significant reduction in the number of postoperative teaching sessions required for the patient to properly operate the device. It was subjectively just as easy to implant and inflate, and easier to deflate, compared with the Genesis pump.
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