Role of Breast-Conserving Surgery on the National Health System Economy From and to SARS-COVID-19 Era

Buonomo, Oreste Claudio; Vinci, Danilo; Carolis, Gerardo De; Pellicciaro, Marco; Petracca, Francesco; Sadri, Amir; Buonomo, Chiara; Dauri, Mario; Vanni, Gianluca

doi:10.3389/fsurg.2021.705174

Cited by 5 publications

(7 citation statements)

References 17 publications

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“…The patients included in the ordinary surgical procedure group were those who did not satisfy the day surgery criteria (30%). During their study, no major complications were reported, and there were no statistically significant differences in patient characteristics between the two groups (p>0.05) (7). The cost of ordinary surgery to the National Health System (NHS) was 48,135 €, whereas that of day surgery was 53,118 €.…”

Section: Resultsmentioning

confidence: 96%

“…The study's benchmark was the comparison between the costs incurred by a DS-BCS treatment and those incurred by an ORD-BCS treatment. Based on the assumption that the DS regimen also guarantees a high degree of safety and quality of treatment, it not only reduces the costs and the shortening of waiting time for the patient, but also increases the efficiency and productivity of the healthcare system, i.e., the number of patients undergoing treatment (7,18). Demonstrating this, Buonomo et al managed to maximize the utility of the hospital health service during the pandemic with awake breast surgery and, at the same time, minimize the risk of COVID-19.…”

Section: Discussionmentioning

confidence: 99%

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Awake Breast Surgery: A Systematic Review

VANNI,

COSTANZO,

PELLICCIARO

et al. 2023

In Vivo

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Background/Aim: Awake surgery has become a valid alternative to general anesthesia in many surgery fields. This technique played a very important role during the COVID-19 period. The growing use of this technique has many advantages. We performed a systematic review to study the potentialities of awake breast surgery. Materials and Methods: We searched Pubmed, Embase, and Cochrane library database and retrieved a total of 109 records. Fortynine of them were excluded as unsuitable. Finally, we selected a total of 12 records concerning different types of studies for topic appropriateness. Three reviewers reviewed independently each record. Results: Five articles analyzing the sustainability of awake surgery during the COVID-19 period were selected. In addition, one article analyzing the impact on the immune system and six articles and eight case reports analyzing anesthetic techniques were also selected. The studies analyzing awake breast surgery during the COVID-19 period showed advantages in terms of sustainability and length of hospitalization. The study analyzing the immune response after awake breast surgery showed lesser lymphocyte response than the general anesthesia group. The studies analyzing anesthetic techniques in awake breast surgery showed that the nerve blocks allow good level of safety and postoperative pain control. Conclusion: The awake breast surgery and fast track implementation shortened hospital stays and reduced costs, without influencing the surgical results. Furthermore, awake breast surgery reduced surgical stress compared to general anesthesia. Among the various anesthetic techniques, nerve blocks are the most advantageous in terms of safety and efficacy compared to epidural anesthesia.Historically, surgery mainly required support with general anesthesia. The practice of surgical interventions on awake patients under local anesthesia, with or without mild sedation, has gained popularity in recent years. Awake surgery is currently proposed for surgical procedures in which the patient was previously expected to be intubated. Surgery with local anesthesia on an awake patient is a valid alternative for different types of surgery such as hand surgery, neurosurgery, spinal surgery, and cardiac surgery. In all these, awake surgery appears to be advantageous in terms of costs, associated symptoms, and recovery after surgery, without increasing the surgical burden on the patient or on the result of the operation (1-4).In neurosurgery, awake strategy can be used in intraoperative brain mapping. In these cases, many techniques such as local 1412

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Section: Resultsmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Awake Breast Surgery: A Systematic Review

VANNI,

COSTANZO,

PELLICCIARO

et al. 2023

In Vivo

Self Cite

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“…According to the higher risk of breast cancer diagnosis underestimation, we believe that a pathological examination of the whole lesion should also be performed in elderly patients. Furthermore, healthcare compliance of elderly patients may be low, and lack of surveillance in underdiagnosed invasive cancer or progressing DCIS may lead to the need for more invasive treatments and higher national healthcare costs due to the delay in surgical treatments (28)(29)(30)(31).…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatments for Ductal Carcinoma In Situ (DCIS) in Elderly Patients

et al. 2023

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Background/Aim: Despite an aging population, there is no consensus regarding ductal carcinoma in situ (DCIS) treatment for elderly women. Breast surgery can be well tolerated even in elderly patients. The aim of this study is to evaluate the surgical management of DCIS in elderly patients. Patients and Methods: We retrospectively analyzed patients with DCIS from 2016 to 2022 at our Breast Unit and divided our population according to age. Results: Out of 231 patients with DCIS, 45 (19.5%) were elderly. The Charlson comorbidity index and American Society of Anesthesiology (ASA) score was significantly higher in the elderly (p<0.001 for both). Among the elderly, 10 (22.2%) patients received upstaging diagnoses, versus 18 (9.7%) in the control (p=0.048). Twelve (26.7%) of the elderly patients underwent sentinel lymph node biopsy, versus 93 (50%) in the control group (p=0.005). No difference was reported between groups in terms of breast conserving surgeries performed. A higher incidence of surgeries performed using local anesthesia was reported in the elderly group (p=0.041). Thirty-day surgical complications, according to Clavien-Dindo, did not show significant differences. Conclusion: Despite higher comorbidity and ASA score, breast surgery is safe and feasible in elderly patients. Due to the higher risk of upstaging to invasive ductal carcinoma, surgery should be performed but sentinel lymph node biopsy should be omitted, owing to the low risk of lymph node metastasis and lower use of adjuvant treatments.

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“…LVCs were more likely to use MP in selected high‐risk donors compared to HVCs where a more routine use was observed. Such differences were also seen in other surgical fields 26 and could be given by the fact that in some countries (i.e., Italy and Germany) LVCs must face the up‐front cost and financial constraints of the diagnosis‐related‐group (DRG) reimbursement, leading to limited MP use. In the French PERPHO study, the total costs for LT with end‐ischemic HOPE were similar to those preserved with static cold storage, given the reduced length of stay and the lower postoperative complications in the HOPE group 27 .…”

Section: Discussionmentioning

confidence: 99%

The impact of center volume on the utilization and outcomes of machine perfusion technology in liver transplantation: An international survey

Angelico,

Sensi,

Quaranta

et al. 2023

Artificial Organs

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IntroductionMachine perfusion (MP) was developed to expand the donor pool and improve liver transplantation (LT) outcomes. Despite optimal results in clinical trials, the real‐world MP benefit in centers with low‐/mid‐volume activity (LVCs) is still being determined.MethodsOnline survey on MP for LT, distributed to worldwide LT‐centers representatives. Variables of interest included logistics, technicalities, and outcomes. Responders were grouped into high‐volume centers (HVCs) (>60 LTs/year) and LVCs and results compared.ResultsSixty‐seven centers were included, 36 HVCs and 31 LVCs. Significant differences in MP regarded: (I) existence of an established program (80.6% vs. 41.9%; p = 0.02), (II) presence of a dedicated perfusionist (58.3% vs. 22.6%; p = 0.006), (III) duration (>4 h: 47.2% vs. 16.1%; p = 0.01), (IV) routine use (20%–40% vs. 5%–20%; p = 0.002), (V) graft utilization (>50%: 75% vs. 51.6%; p = 0.009), (VI) 90‐day patient‐survival (90%–100% vs. 50%–90%; p = 0.001) and (VII) subjectively perceived benefit (always vs. only in selected ECD; p = 0.009). Concordance was found for indications, type, viability tests, graft‐salvage, 90‐day graft‐loss, and major‐complications.ConclusionsThis study captured a picture of MP in real‐world LT‐practice. Significant disparities have surfaced between LVCs and HVCs regarding logistics, utilization, and results. To close this gap, efforts should be made to more efficiently deliver dedicated support, training and mentoring to LVC teams adopting MP technology.

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Role of Breast-Conserving Surgery on the National Health System Economy From and to SARS-COVID-19 Era

Cited by 5 publications

References 17 publications

Awake Breast Surgery: A Systematic Review

Awake Breast Surgery: A Systematic Review

Surgical Treatments for Ductal Carcinoma In Situ (DCIS) in Elderly Patients

The impact of center volume on the utilization and outcomes of machine perfusion technology in liver transplantation: An international survey

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