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Outcomes Data Home Page
 

If you have spent much time searching on the Internet for information about one of these surgical problems, you probably have not seen many sites where there is specific information on "outcomes".  We at DeKalb Surgical feel this is helpful information for our patients and potential patients, so we have made this information available on our website for over the past 15 years.  We welcome your questions regarding our results.  We wish other surgeons would get on board and share such information with you as well; you won't find many practices with available data on the Internet for you to compare.  Collecting, evaluating, and presenting such data is time consuming, and for this reason, we must choose what and when to update and add to the information available here.  Some data may be less current than other, but we do our best to update the various components shown below, which spans the majority of the type of surgical procedures we do.

Overall Hospital Patient Satisfaction Scores (updated December 2012)

Breast Cancer (updated November 2012)
Colon Cancer  (updated November 2012)
Laparoscopic Cholecystectomy (Gallbladder)
Breast Biopsies
Customized Circular Cutting Device Lowers Re-Excision Rate for Breast Cancer  (updated June 2008)
Hernias- Recurrence Rates (updated August 2010)

Outcomes in Laparoscopic Cholecystectomy (gallbladder removal)

In 2002, the surgeons at DeKalb Surgical Associates performed 169 laparoscopic cholecystectomies.  Indications for surgery included: chronic cholecystitis and other chronic conditions in 59%, acute cholecystitis in 28%, and biliary pancreatitis in 13%.  The median length of stay was < 1 day.  For patients with acute cholecystitis the average length of stay was 3.8 days.  Although return to work was not analyzed, most patients return to their usual activities in 5-10 days after an elective procedure.

There were only 2 cases in which the conversion to an open cholecystectomy was necessary, and  in both cases this was for severe acute cholecystitis.  This represents a conversion percentage of only 1.2%, which compares extremely well with published reports, most of which are in the 5-10% range.  There were no cases of common bile duct injury.  Intra-operative cholangiography was performed in 30%, on a selective basis.  Four percent of patients had common bile duct stones, which were treated either with laparoscopic common bile duct exploration, or with post-operative ERCP.

Not all patients who are referred with gallstones undergo surgery.  Patients with atypical symptoms undergo further evaluation looking for other pathology, such as peptic ulcer disease, esophageal reflux, or irritable bowel syndrome.  In patients whose symptoms are correlated with other pathology, surgery is not recommended unless more typical symptoms develop.

You will find more information about laparoscopic cholecystectomy on our Gallstones and Gallbladder Page.
 

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 Breast Biopsy Data

 We reviewed all of the breast biopsies performed on our patients for the year 2002.  All in all, 445 biopsies were performed, including FNA’s, core biopsies, stereotactic biopsies, and excisional biopsies.  There were 82 patients diagnosed with breast cancer, including 11 (13%) with non-invasive disease.  One patient had bilateral cancer.  The diagnosis was made by needle biopsy in 73 (88%), usually at the first office visit, utilizing ultrasound for localization as needed, thereby allowing for a rapid diagnosis, and subsequent definitive surgical treatment with a single operative procedure.

 There were 69 stereotactic biopsies performed, for microcalcifications in 49, and for a nodular or asymmetric density in 20.  Cancer was identified in 16 (23%).  In 9 of these 16 patients (56%), the cancer was non-invasive.

 Of the 82 patients with breast cancer, 7 refused treatment or went elsewhere.  Of the remaining 75 patients, 66 (88%) underwent breast-conserving surgery.  Compared to published data, this is a remarkably high percentage.  In many reported series, particularly in the southeastern United States, conservative surgery rates are typically only about 50%.  Sentinel node biopsy was routinely used in all of these patients for clinically node negative disease.  Mastectomy was recommended in the other 9 patients because of either a large tumor size, more than one cancer in the breast, strong family history, or involved margins on attempted breast-conserving surgery.

 The average tumor size, including those with DCIS (non-invasive cancer), was 1.8 cm, with a median size of 1.3 cm.  Thirty-seven percent of patients had tumors less than or equal to 1 cm in size.

In summary, prompt and accurate evaluation of breast problems constitutes a major focus for DeKalb Surgical Associates.  We are committed to providing a timely and cost-effective diagnosis, with a high priority for breast conservation and sentinel node biopsy for patients diagnosed with cancer.

There is lots more information about breast diseases on our other pages, both Benign Disease, and Breast Cancer

 

Customized Surgical Device Lowers Re-excision Rate for Breast Cancer (updated June 2008)

Women with breast cancer can be overwhelmed with anxiety from the very moment they learn of their diagnosis.  Fortunately for most women at DeKalb Surgical, the diagnosis is made early, with a correspondingly good prognosis.  We then give extra effort to achieve a maximum cure with a minimum of surgery.

Particular emphasis must be given to obtaining clear margins around the lump of cancer.  This is essential in assuring a low risk of local recurrence in the breast.  If the margins are not clear, the patient must undergo either a re-excision, or a mastectomy.  For most surgeons, anywhere from 20% to over 50% of their patients must have a second procedure to obtain clear margins.  Mastectomy rates may run as high as 60%.

We have focused on this issue at DeKalb Surgical Associates over the past 6 years.  As a result, our re-excision rate for breast cancer patients undergoing breast conserving surgery is only 12%.  The primary method for achieving these superior results if the use of a customized circular surgical device (designed and patented by Dr. Kennedy) that standardizes the specimen removal, allowing for more precise assessment of the surgical margins.  As a corollary, our mastectomy rate is also remarkably low, at less than 10%, excluding patients who present with advanced disease.  Use of this instrument also meshes nicely with a new technique for radiation therapy, using a MammoSite balloon.  Our experience with this method of partial breast irradiation has been extremely favorable.  Here is a link to more information.

A nearby university center has actually reported their re-excision rate to be as high as 40!!  In fact, they are conducting a clinical trial to try to see if they can do better.  Patients would be randomized to having the surgery done the usual way (for which they KNOW the re-excision rate will be 40%) versus a new way.  This seems unnecessary in our opinion, since we already have a method for minimizing the need to return to the operating room a second time.

By minimizing the need for additional surgery, our patients complete their treatment more quickly.  This helps to reduce the anxiety that comes with the diagnosis, allowing them to resume their daily routine.

Here is a shortcut to our Breast Cancer Home Page.

 

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Hernia Repair- Recurrence Rate

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(updated August 2010)

DeKalb Surgical Associates routinely follows up patients who have previously undergone inguinal hernia repairs to monitor for recurrence.  Below are summaries of these questionnaire results, with the most recent summary listed first.  If you just want the final result, our cumulative recurrence risk for all hernia repairs is 1.5% based on all repairs done, and 2.7%, based on only those patients who responded to the questionnaire.

In November 2009, we once again sent out a questionnaire to our hernia patients from 2 years ago.  Of the entire group, there were 3 confirmed hernias out of 166 repairs (1.8%).  Of those who responded, the confirmed hernia recurrence rate is 2.6% (3/116).

Compared to the previous follow-ups conducted in November 2001, July 2003, and 2006, and 2007,response rate was good, at 65%.   If the results of the five surveys are combined, there are 14 confirmed recurrences out of a total of 929 repairs, for a rate of 1.4%, and a rate of 2.68% (14/523) for only those who responded.  Six of the 14 confirmed recurrences were done laparoscopically. 

If only the non-laparoscopic repairs are considered, the recurrence rate for the five combined surveys is 0.9% (8/870), and 1.65% (8/483) of only those who responded.  If only the laparoscopic repairs are considered, the corresponding recurrence rates for the three combined surveys are 10.2% (6/59) and 15% (6/40), respectively.  Although these rates seem high, the recurrence rate for the more recently done procedures appears to be lower.  Similar results have been published in surgical journals where patients are randomized to either "open" repair or laparoscopic repair, and in such studies, the recurrence rate with the laparoscopic technique has been higher. Nevertheless, there may be an advantage for the laparoscopic technique, with less pain, and more rapid return to usual activities.

Both techniques are utilized at DeKalb Surgical. You can discuss the options in more detail during your consultative visit. We aim to individualize your treatment to provide an optimal outcome based on your particular case. Older survey results are shown below.

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(updated July 2007)

DeKalb Surgical Associates routinely follows up patients who have previously undergone inguinal hernia repairs to monitor for recurrence.  Below are summaries of these questionnaire results, with the most recent summary listed first.  If you just want the final result, our cumulative recurrence risk for all hernia repairs is 1.1% based on all repairs done, and 2.5%, based on only those patients who responded to the questionnaire.

In July 2007, we once again sent out a questionnaire to our hernia patients from 2 years ago.  Of the entire group, there were 6 confirmed hernias out of 291 repairs (2.06%).  Of those who responded, the confirmed hernia recurrence rate is 4.11% (6/146).

Compared to the previous follow-ups conducted in November 2001, July 2003, and 2006, response rate was similar, at 53%.   If the results of the four surveys are combined, there are 11 confirmed recurrences out of a total of 763 repairs, for a rate of 1.44%, and a rate of 2.54% (11/433) for only those who responded.  Three of the eleven confirmed recurrences were done laparoscopically. 

If only the non-laparoscopic repairs are considered, the recurrence rate for the four combined surveys is 1.11% (8/722), and 2.10% (8/381) of only those who responded.  If only the laparoscopic repairs are considered, the corresponding recurrence rates for the three combined surveys are 7.32% (3/41) and 11.5% (3/26).

We have previously identified a higher recurrence rate among patients undergoing a laparoscopic repair, and the updated data also reflects that finding.  Both repair methods are offered to our patients, "traditional" or laparoscopic, although the majority of patients undergo an open repair.   Most often, this is done as an outpatient, under local anesthesia with sedation.  The laparoscopic repair is also done as an outpatient, but under general anesthesia.  In most cases, the repair is reinforced with mesh, which helps decrease the recurrence risk, as well as the amount of pain experience after surgery.  Time out of work is variable, depending on the type of work done, employer expectations, and your own individual response to the surgery.   For non-strenuous (desk-type) jobs, many patients will be back at work within three to seven days.  For very heavy labor (construction-type), the time off work may be up to four weeks or more.

2006 results

In early 2006, we once again sent out a questionnaire to our hernia patients from 2 years ago.  Of the entire group, there was 1 confirmed hernia out of 176 repairs (0.57%).  Of those who responded, the confirmed hernia recurrence rate is 1.01% (1/99).

Compared to the previous follow-ups conducted in November 2001, and fall of 2003, response rate was similar, though slightly lower.  The percentage of patients responding was 53%.  The response rate for the last two surveys was 59% and 63%, respectively.  This survey was conducted several months later for the entire group as an average, compared to previous surveys, and this is the probable explanation for the lower response rate.

If the results of the three surveys are combined, there are 5 confirmed recurrences out of a total of 494 repairs, for a rate of 1.01%, and a rate of 1.74% (5/187) for only those who responded.  Two of the five confirmed recurrences were done laparoscopically. 

If only the non-laparoscopic repairs are considered, the recurrence rate for the three combined surveys is 0.68% (3/443), and 1.23% (3/243) of only those who responded.  If only the laparoscopic repairs are considered, the corresponding recurrence rates for the three combined surveys are 6.9% (2/29) and 11.1% (2/18).

2003 results

Patients who had hernia repairs between 18 and 36 months ago were contacted by mail or telephone in the fall of 2003.  Followup rate was 59%. 

There were 159 patients with a total of 180 hernia repairs (21 with bilateral repairs) performed between October 1, 2000, and March 31, 2002.  There were 3 recurrences identified for a recurrence rate of 1.7%.  This recurrence rate compares very favorably with published recurrence rates.  If results are combined with our previous 2 year survey, the overall recurrence rate is 4/318, or 1.3%. 

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DeKalb Surgical Associates ©2012
2665 North Decatur Road
Suite 730
Decatur, Georgia 30033 (a suburb of Atlanta)

980 Building, Suite 430
980 Johnson Ferry Road, NE,
Atlanta, Georgia 30342

Phone: (404) 508-4320
Fax: (404) 508-4112 

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