Combining multiple medical procedures increases complication rates and risks
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SUPPORTED
the evidence backs this
refutedsupported
the weight of evidence
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Peer-reviewed medical literature indicates that combining procedures increases complication rates, such as in cataract surgery where combined intraocular procedures are identified as an independent predictor of complications.
Background Lumbar spinal stenosis (LSS) is a serious degenerative condition of the spine that can cause significant functional disability. Therapies for these patients generally begin with conservative management, since more invasive interventions such as open surgery and spinal implants are associated with higher complication rates. Early in the treatment algorithm for LSS patients, multiple conventional medical management (CMM) therapies are often combined as an initial low-risk treatment strategy. This composite first-line treatment plan may include conservative care together with early interventional treatment options such as epidural steroid injections, radiofrequency ablation and the mild® Procedure. Methods This prospective randomized controlled trial evaluates patients aged 50 to 80 years treated with mild plus CMM, compared to those treated with CMM alone, as the active control. Walking tolerance test outcomes and incidence of subsequent disallowed procedures provided objective real-world outcome data. The incidence of device or procedure-related adverse events was analyzed. Follow-up includes 6-month, 1-year and 2-year assessments, with 1-year being primary. Patients in the mild+CMM group are followed at 3, 4, and 5 years. This is a report of interim 6-month outcomes. Results Of 155 patients enrolled at 19 US interventional pain management centers, 78 were allocated to CMM-Alone, and 77 to mild+CMM. At 6-months, the validated walking tolerance test demonstrated statistical superiority of mild+CMM versus CMM-Alone (p<0.001). The incidence of patients receiving a subsequent disallowed procedure, and thereby considered treatment failures in their study group, was statistically significantly higher in CMM-Alone versus mild+CMM (p<0.001). There were no device or procedure-related adverse events in either group. Conclusion At 6-months, the mild Procedure combined with CMM provided statistically superior objective real-world outcomes versus CMM-Alone. There were no device or procedure-related adverse events reported in either study group. With its excellent safety profile and superior efficacy, mild is uniquely positioned as early first-line therapy.
PURPOSE
Evaluate sociodemographic and clinical factors with postoperative complications after cataract surgery at academic medical centers in the United States.
SETTING
Sixteen U.S. academic medical centers contributing to the Sight Outcomes Research Collaborative (SOURCE) big data repository.
DESIGN
Retrospective, multicenter cohort study.
METHODS
Adults undergoing cataract surgery between 2010-2023 identified from the SOURCE database. Sociodemographic and clinical predictors including race, ethnicity, primary language, prior intraocular surgery were assessed. Postoperative complications within 6 months were identified using CPT/ICD codes. Multivariable Cox regression estimated hazard ratios with 95% confidence intervals.
RESULTS
78,565 eyes were analyzed (mean age 70.8 ± 8.9 years, 59% female, 12.6% Black). At 6 months, 1.49% of eyes developed a complication and 0.10 developed a severe adverse complication. Independent predictors of any complication included male sex (HR 1.14; p<0.01), Black race (HR 1.66; p<0.01), complex surgery (HR 1.23; p<0.01), combined intraocular procedures (HR 1.33; p <0.01), prior intraocular surgery (HR 1.18; p<0.01), and poorer preoperative vision (HR 1.10; p <0.01). Severe adverse complications were more likely among males (HR 1.54; p=0.02) and those with poorer vision (HR 1.62; p<0.01), but less likely with increasing age (HR 0.95; p<0.01), urban residence (HR 0.33; p<0.01), and having one or more children in the household (HR 0.32; p=0.03).
CONCLUSIONS
Sociodemographic and clinical factors that increase risk of postoperative outcomes after cataract surgery include Black race, male sex, and poor preoperative vision. Older age, urban residence, and children in the household are protective. Incorporating social determinants of health into perioperative risk stratification may improve surgical equity and outcomes.
<h4>Background</h4>Increasing obesity rates, GLP-1 receptor agonist adoption, and demand for body contouring procedures have created a population requiring both functional hernia repair and aesthetic abdominoplasty.<h4>Objectives</h4>To evaluate the safety and feasibility of concurrent abdominoplasty and hernia repair using a standardized approach.<h4>Methods</h4>We conducted a retrospective case series on patients undergoing simultaneous abdominoplasty and ventral hernia repair at a single academic center (2018-2024). Primary outcomes included 30-day surgical site occurrences (SSOs), hernia recurrence, and reoperation rates. Secondary outcomes included operative efficiency metrics and patient-reported satisfaction. Statistical analysis used chi-square and 2-sided t-tests; <i>P</i> < .05 was significant.<h4>Results</h4>This cohort included 20 patients. Mean age was 58.2 years, 75% were female, and there was substantial comorbidity burden (mean BMI 30.8 kg/m<sup>2</sup>; majority overweight or obese; 60% had prior hernia repair). Midline ventral/incisional, umbilical, inguinal, and complex/recurrent hernias were represented. Mesh reinforcement was utilized in 50% of cases. At a mean follow-up of 27.3 months, SSO occurrences were observed in 3 patients (15%): 2 seromas (10%) and one case (5%) of chronic drainage that resolved with bedside care. No hematomas, mesh infections, or hernia recurrences were identified. Mean total operative time was 306 minutes; reconstructive and aesthetic components averaged 115 and 167 minutes, respectively.<h4>Conclusions</h4>In this limited cohort of carefully selected patients, concurrent abdominoplasty with ventral hernia repair demonstrated an acceptable safety profile, with complication rates comparable to historical abdominoplasty alone benchmarks and no recurrences at intermediate follow-up. Larger prospective studies are warranted to refine patient selection and standardize best practices.<h4>Level of evidence 4 therapeutic</h4>For image description, please refer to the figure legend and surrounding text.
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