Browsing by Author "Drake, Connor"

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    Comparison of Contemporary Surgical Outcomes Between Holmium Laser Enucleation of the Prostate and Robotic-Assisted Simple Prostatectomy
    (Springer Nature, 2023) Shelton, T. Max; Drake, Connor; Vasquez, Ruben; Rivera, Marcelino; Urology, School of Medicine
    Purpose of review: This study reviews contemporary literature on RASP and HoLEP to evaluate perioperative outcomes, common complications, cost analytics, and future directions of both procedures. Recent findings: RASP is indicated for prostates > 80 mL, while HoLEP is size-independent. No notable differences were found in operative time, PSA nadir (surrogate for enucleation volume), re-catheterization rates, or long-term durability. Prolonged incontinence and bladder neck contracture rates are low for both surgeries. Patients experience similar satisfaction outcomes and improvements in uroflowmetry and post-void residual volumes. HoLEP demonstrates shorter hospitalizations, lower transfusion rates, lower costs, and higher rates of same-day discharge. RASP offers a shorter learning curve and lower rates of early postoperative urinary incontinence. HoLEP is a size-independent surgery that offers advantages for patients seeking a minimally invasive procedure with the potential for catheter-free same-day discharge. Future directions with single-port simple prostatectomy may offer parity in same-day discharge, but further research is needed to determine broader feasibility.
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    Comparison of Patient-Reported Outcomes after Local Flap Coverage versus Amputation for Complex Lower Extremity Trauma
    (Thieme, 2024-10-24) Bhagat, Neel; Drake, Connor; Dawson, Steven; Loewenstein, Scott N.; Knox, Kevin R.; Adkinson, Joshua M.; Hassanein, Aladdin H.; Bamba, Ravinder; Surgery, School of Medicine
    Background: There is a paucity of patient-reported outcomes (PROs) data in lower extremity salvage. Limb salvage can often be achieved with the use of local muscle flaps or fasciocutaneous flaps. The purpose of this study was to compare PROs of patients who underwent lower extremity salvage using local fasciocutaneous flaps or muscle flaps to lower extremity amputation. Materials and Methods: The outcomes of 61 patients that underwent lower extremity local flap reconstruction ( n  = 33) or amputation ( n  = 28) between 2014 and 2020 were recorded. Chart reviews were performed to collect perioperative data. Patients were contacted via telephone for participation in the survey portion of our study. PROs were recorded utilizing both the Lower Extremity Functional Scale (LEFS) and the 36-Item Short-Form Health Survey (SF-36). Results: Surveys were completed by 61 patients (response rate 59.2%). The mean time of survey after flap reconstruction or amputation was 2.7 ± 1.4 years. Recent trauma (within 90 days) was the most common indication for local flap coverage ( n  = 23). LEFS score and SF-36 physical functioning scores were significantly lower in patients who underwent muscle flaps compared with fasciocutaneous flaps ( p  = 0.021 and p  = 0.022). Muscle flap patients had similar LEFS and SF-36 scores to amputation patients, while fasciocutaneous flap patients had significantly higher LEFS ( p  = 0.01), SF-36 physical functioning ( p  = 0.031), physical role functioning ( p  = 0.031), and emotional role functioning ( p  = 0.047) scores than amputation patients. Conclusion: Patients who underwent local fasciocutaneous flaps for limb salvage reported higher PRO scores than those undergoing amputation, while patients undergoing muscle flaps reported outcomes similar to those undergoing amputation. PROs for muscle flap patients were significantly lower than those of fasciocutaneous flap patients. These data suggest that while fasciocutaneous and muscle flaps are both useful limb salvage procedures, fasciocutaneous flaps may confer advantages that result in improved patient-perceived outcomes. Further study is needed to better characterize outcomes in limb salvage.
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    Patient-reported Outcomes after Local Flap Coverage Versus Amputation for Complex Lower Extremity Trauma
    (Wolters Kluwer, 2022) Bhagat, Neel; Drake, Connor; Dawson, Steven; Loewenstein, Scott; Knox, Kevin; Adkinson, Joshua M.; Bamba, Ravi; Surgery, School of Medicine
    PURPOSE: Lower extremity trauma can be devastating, and limb salvage is hypothesized to result in improved quality of life. However, there is a paucity of patient-reported outcomes (PRO) data in lower extremity salvage. Limb salvage can often be achieved with the use of local muscle (e.g. gastrocnemius, soleus) flaps or fasciocutaneous (e.g. reverse sural and propeller) flaps. Limited PRO data is available after local flap reconstruction. Further, PROs comparing these flap types to patients who underwent amputation are limited. The purpose of this study was to compare PROs of patients who received lower extremity salvage using fasciocutaneous flaps or muscle flaps to lower extremity amputation. PURPOSE: Lower extremity trauma can be devastating, and limb salvage is hypothesized to result in improved quality of life. However, there is a paucity of patient-reported outcomes (PRO) data in lower extremity salvage. Limb salvage can often be achieved with the use of local muscle (e.g. gastrocnemius, soleus) flaps or fasciocutaneous (e.g. reverse sural and propeller) flaps. Limited PRO data is available after local flap reconstruction. Further, PROs comparing these flap types to patients who underwent amputation are limited. The purpose of this study was to compare PROs of patients who received lower extremity salvage using fasciocutaneous flaps or muscle flaps to lower extremity amputation. RESULTS: Surveys were completed by 65 patients (response rate 60.7%). The mean time of survey after flap reconstruction was 3.2 years. Recent trauma (within 90 days) was the most common indication for local flap coverage (n=26). Flap complications included wound dehiscence (n=8) and infection (n=4). Other flap complications included partial flap necrosis (n=12), total flap necrosis (n=2), and secondary amputation (n=4). LEFS score and SF-36 physical functioning scores were significantly lower in patients who underwent muscle flaps compared to fasciocutaneous flaps (p=0.021 and p=0.022 respectively). Muscle flap patients had similar LEFS and SF-36 scores to amputation patients, while fasciocutaneous flap patients had significantly higher LEFS (p=0.017), SF-36 physical functioning (p=0.033), and health change (p=0.050) scores than amputation patients. CONCLUSION: PROs for muscle flap patients were significantly lower than those of fasciocutaneous flap patients. Patients who underwent fasciocutaneous flaps for limb salvage reported higher PRO scores than those undergoing amputation, while patients undergoing muscle flaps reported outcomes similar to those undergoing amputation. This data suggests that while fasciocutaneous and muscle flaps are both useful limb salvage procedures, fasciocutaneous flaps may confer advantages that result in improved patient perceived outcomes. Further study is needed to better characterize outcomes in limb salvage.