Publications by authors named "Arianne T Train"

4 Publications

  • Page 1 of 1

The Early (2009-2017) Experience With Robot-assisted Cholecystectomy in New York State.

Ann Surg 2021 09;274(3):e245-e252

Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY.

Objective: The aim of this study was to examine real-life patterns of care and patient outcomes associated with robot-assisted cholecystectomy (RAC) in New York State (NYS).

Background: Although robotic assistance may offer some technological advantages, RACs are associated with higher procedural costs and longer operating times compared to traditional laparoscopic cholecystectomies (LCs). Evidence on long-term patient outcomes after RAC from large population-based datasets remains limited and inconsistent.

Methods: Using NYS inpatient and ambulatory surgery data from the Statewide Planning and Research Cooperative System (2009-2017), we conducted bivariate and multivariate analyses to examine patterns of utilization, complications, and secondary procedures following cholecystectomies.

Results: Among 299,306 minimally invasive cholecystectomies performed in NYS between 2009 and 2017, one thousand one hundred eighteen (0.4%) were robot-assisted. Compared to those undergoing LC, RAC patients were older, travelled further for surgery, and were more likely to have public insurance and preoperative comorbidities. RAC versus LC patients were more significantly likely to have conversions to open procedure (4.9% vs 2.8%), bile duct injuries (1.3% vs 0.4%), and major reconstructive interventions (0.6% vs 0.1%), longer median length of stay (3 vs 1 day), readmissions (7.3% vs 4.4%), and higher 12-month post-index surgery hospital charges (P < 0.01 for all estimates). Other postoperative complications decreased over time for LC but remained unchanged for RAC patients.

Conclusions: Patients receiving RAC in NYS experienced higher rates of complications compared to LC patients. Addressing patient-, surgeon-, and system-level factors associated with intra/postoperative complications and applying recently promulgated safe cholecystectomy strategies coupled with advanced imaging modalities like fluorescence cholangiography to RAC may improve patient outcomes.
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September 2021

Teaching surgery novices and trainees advanced laparoscopic suturing: a trial and tribulations.

Surg Endosc 2021 Oct 13;35(10):5816-5826. Epub 2020 Oct 13.

Department of Surgery, University at Buffalo, State University of New York Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA.

Introduction: The benefits of minimally invasive surgery are numerous; however, considerable variability exists in its application and there is a lack of standardized training for important advanced skills. Our goal was to determine whether participation in an advanced laparoscopic curriculum (ALC) results in improved laparoscopic suturing skills.

Methods And Procedures: Study design was a prospective, randomized controlled trial. Surgery novices and trainees underwent baseline FLS training and were pre-tested on bench models. Participants were stratified by pre-test score and randomized to undergo either further FLS training (control group) or ALC training (intervention group). All were post-tested on the same bench model. Tests for differences between post-test scores of cohorts were performed using least squared means. Multivariable regression identified predictors of post-test score, and Wilcoxon rank sum test assessed for differences in confidence improvement in laparoscopic suturing ability between groups.

Results: Between November 2018 and May 2019, 25 participants completed the study (16 females; 9 males). After adjustment for relevant variables, participants randomized to the ALC group had significantly higher post-test scores than those undergoing FLS training alone (mean score 90.50 versus 82.99, p = 0.001). The only demographic or other variables found to predict post-test score include level of training (p = 0.049) and reported years of video gaming (p = 0.034). There was no difference in confidence improvement between groups.

Conclusions: Training using the ALC as opposed to basic laparoscopic skills training only is associated with superior advanced laparoscopic suturing performance without affecting improvement in reported confidence levels. Performance on advanced laparoscopic suturing tasks may be predicted by lifetime cumulative video gaming history and year of training but does not appear to be associated with other factors previously studied in relation to basic laparoscopic skills, such as surgical career aspiration or musical ability.
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October 2021

Predictors and Outcomes of Laparoscopy in Pediatric Trauma Patients: A Retrospective Cohort Study.

J Laparoendosc Adv Surg Tech A 2019 Dec 5;29(12):1598-1604. Epub 2019 Nov 5.

Department of Surgery, University at Buffalo, State University of New York Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York.

Laparoscopy has been shown to offer a safe alternative to laparotomy in hemodynamically stable pediatric trauma patients. Our purpose was to identify factors predictive of this approach and examine surgical outcomes. This is a retrospective cohort study using the ACS Pediatric Trauma Quality Improvement Program to examine pediatric patients who underwent exploration for blunt or penetrating abdominal trauma in 2014 and 2015. Patients with contraindications to laparoscopy were excluded. Multivariable modeling identified predictors of a laparoscopic approach. Secondary analysis assessed differences in outcomes and resource utilization between laparoscopy and laparotomy groups. A total of 160 patients met inclusion criteria. Patients undergoing surgery in the northeastern (odds ratio [OR]: 2.25, 95% confidence interval [CI]: 1.26-4.03,  = .006) and western (OR: 2.03, 95% CI: 1.06-3.88,  = .032) U.S. regions had over two times greater odds of undergoing laparoscopy as those treated in the south. Patients injured by a firearm were significantly less likely to undergo laparoscopy than those suffering blunt injury (OR: 0.27, 95% CI: 0.13-0.55,  < .001). After adjustment, patients explored laparoscopically in comparison with those through laparotomy had decreased average length of stay (LOS) (mean difference [MD]: 2.55 days, 95% CI: 1.19-3.90,  < .001) and number of intensive care unit (ICU) days (MD: 1.13 days, 95% CI: 0.28-1.98,  = .01). Trauma laparoscopy may decrease LOS and ICU days in select pediatric patients requiring abdominal exploration; however, laparoscopy is not uniformly practiced in the United States. Targeted education and protocols for initial use of laparoscopy should be incorporated into hospitals treating this group to minimize morbidity and resource utilization.
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December 2019

Influence of hospital-level practice patterns on variation in the application of minimally invasive surgery in United States pediatric patients.

J Pediatr Surg 2017 Oct 2;52(10):1674-1680. Epub 2017 Feb 2.

Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, Buffalo, NY; Department of Surgery, University at Buffalo, State University of New York School of Medicine and Biomedical Sciences, Buffalo, NY.

Background: Although disparities in access to minimally invasive surgery are thought to exist in pediatric surgical patients in the United States, hospital-level practice patterns have not been evaluated as a possible contributing factor.

Methods: Retrospective cohort study using the Kids' Inpatient Database, 2012. Odds ratios of undergoing a minimally invasive compared to open operation were calculated for six typical pediatric surgical operations after adjustment for multiple patient demographic and hospital-level variables. Further adjustment to the regression model was made by incorporating hospital practice patterns, defined as operation-specific minimally invasive frequency and volume.

Results: Age was the most significant patient demographic factor affecting application of minimally invasive surgery for all procedures. For several procedures, adjusting for individual hospital practice patterns removed race- and income-based disparities seen in performance of minimally invasive operations. Disparities related to insurance status were not affected by the same adjustment.

Conclusion: Variation in the application of minimally invasive surgery in pediatric surgical patients is primarily influenced by patient age and the type of procedure performed. Perceived disparities in access related to some socioeconomic factors are decreased but not eliminated by accounting for individual hospital practice patterns, suggesting that complex underlying factors influence application of advanced surgical techniques.

Level Of Evidence: II.
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October 2017