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Suthakaran R, Cao K, Arafat Y, Yeung J, Chan S, Master M, Faragher IG, Baird PN, Yeung JMC. Body composition assessment by artificial intelligence can be a predictive tool for short-term postoperative complications in Hartmann's reversals. BMC Surg 2024; 24:111. [PMID: 38622633 PMCID: PMC11017666 DOI: 10.1186/s12893-024-02408-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 04/09/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Hartmann's reversal, a complex elective surgery, reverses and closes the colostomy in individuals who previously underwent a Hartmann's procedure due to colonic pathology like cancer or diverticulitis. It demands careful planning and patient optimisation to help reduce postoperative complications. Preoperative evaluation of body composition has been useful in identifying patients at high risk of short-term postoperative outcomes following colorectal cancer surgery. We sought to explore the use of our in-house derived Artificial Intelligence (AI) algorithm to measure body composition within patients undergoing Hartmann's reversal procedure in the prediction of short-term postoperative complications. METHODS A retrospective study of all patients who underwent Hartmann's reversal within a single tertiary referral centre (Western) in Melbourne, Australia and who had a preoperative Computerised Tomography (CT) scan performed. Body composition was measured using our previously validated AI algorithm for body segmentation developed by the Department of Surgery, Western Precinct, University of Melbourne. Sarcopenia in our study was defined as a skeletal muscle index (SMI), calculated as Skeletal Muscle Area (SMA) /height2 < 38.5 cm2/m2 in women and < 52.4 cm2/m2 in men. RESULTS Between 2010 and 2020, 47 patients (mean age 63.1 ± 12.3 years; male, n = 28 (59.6%) underwent body composition analysis. Twenty-one patients (44.7%) were sarcopenic, and 12 (25.5%) had evidence of sarcopenic obesity. The most common postoperative complication was surgical site infection (SSI) (n = 8, 17%). Sarcopenia (n = 7, 87.5%, p = 0.02) and sarcopenic obesity (n = 5, 62.5%, p = 0.02) were significantly associated with SSIs. The risks of developing an SSI were 8.7 times greater when sarcopenia was present. CONCLUSION Sarcopenia and sarcopenic obesity were related to postoperative complications following Hartmann's reversal. Body composition measured by a validated AI algorithm may be a beneficial tool for predicting short-term surgical outcomes for these patients.
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Affiliation(s)
- Reshi Suthakaran
- Department of Colorectal Surgery, Western Health, Footscray, Melbourne, VIC, 3011, Australia.
- Department of Surgery, Western Precinct, University of Melbourne, Level 3, WCHRE, Sunshine Hospital, St Albans, Melbourne, VIC, 3021, Australia.
| | - Ke Cao
- Department of Surgery, Western Precinct, University of Melbourne, Level 3, WCHRE, Sunshine Hospital, St Albans, Melbourne, VIC, 3021, Australia
| | - Yasser Arafat
- Department of Colorectal Surgery, Western Health, Footscray, Melbourne, VIC, 3011, Australia
- Department of Surgery, Western Precinct, University of Melbourne, Level 3, WCHRE, Sunshine Hospital, St Albans, Melbourne, VIC, 3021, Australia
| | - Josephine Yeung
- Department of Surgery, Western Precinct, University of Melbourne, Level 3, WCHRE, Sunshine Hospital, St Albans, Melbourne, VIC, 3021, Australia
| | - Steven Chan
- Department of Surgery, Western Precinct, University of Melbourne, Level 3, WCHRE, Sunshine Hospital, St Albans, Melbourne, VIC, 3021, Australia
| | - Mobin Master
- Department of Radiology, Western Health, Melbourne, Australia
| | - Ian G Faragher
- Department of Colorectal Surgery, Western Health, Footscray, Melbourne, VIC, 3011, Australia
| | - Paul N Baird
- Department of Surgery, Western Precinct, University of Melbourne, Level 3, WCHRE, Sunshine Hospital, St Albans, Melbourne, VIC, 3021, Australia
| | - Justin M C Yeung
- Department of Colorectal Surgery, Western Health, Footscray, Melbourne, VIC, 3011, Australia.
- Department of Surgery, Western Precinct, University of Melbourne, Level 3, WCHRE, Sunshine Hospital, St Albans, Melbourne, VIC, 3021, Australia.
- Western Health Chronic Disease Alliance, Western Health, Footscray Hospital, Melbourne, VIC, 3011, Australia.
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Yanada BA, Galiabovitch E, Manning T, Dias BH, Suthakaran R, Yao H. "A button in my Benjamin" - Self-inflicted insertion of button batteries into the male urethra: Management and complications. Urol Case Rep 2024; 53:102653. [PMID: 38292563 PMCID: PMC10825319 DOI: 10.1016/j.eucr.2024.102653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 01/04/2024] [Indexed: 02/01/2024] Open
Abstract
We present a case of self-insertion of multiple button batteries into the urethra. Button batteries are corrosive and tissue liquefaction and necrosis can occur within 2 hours. Emergent removal, intravenous antibiotics, suprapubic and indwelling catheter insertion and close monitoring are required to prevent further tissue injury. In our case, the batteries were removed with stent grasper forceps. There was extensive caustic circumferential injury to the urethral mucosa on cystoscopic examination. This was complicated by periurethral necrosis and abscess, requiring urgent incision and debridement. No reconstruction was performed due to the very high risk of graft failure.
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Affiliation(s)
| | | | - Todd Manning
- Department of Urology, Western Health, Footscray, Victoria, Australia
| | - Brendan Hermenigildo Dias
- Department of Urology, Western Health, Footscray, Victoria, Australia
- Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia
| | - Reshi Suthakaran
- Department of Urology, Western Health, Footscray, Victoria, Australia
| | - Henry Yao
- Department of Urology, Western Health, Footscray, Victoria, Australia
- Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia
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Suthakaran R, Faragher IG, Yeung JMC. Reversal of Hartmann's procedure: timelines, preoperative investigations and early outcomes. A single Australian institution's ten-year experience. ANZ J Surg 2023; 93:214-218. [PMID: 36128604 DOI: 10.1111/ans.18045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/23/2022] [Accepted: 08/29/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Real-world data on outcomes following Hartmann's reversal is necessary to help optimize the patient experience. We have explored the timing between the index operation and its reversal; what investigations were carried out prior to this, and the associated short-term outcomes. METHODS A retrospective study of all patients who underwent Hartmann's reversal from 2010 to 2020 within a tertiary referral centre in Melbourne, Australia. One hundred from a total of 406 (25%) who underwent an emergency Hartmann's procedure had a subsequent reversal. Complete patient data was available for 83 of these patients. RESULTS The average patient age was 60 years, and the median time for reversal was 14.0 (IQR 10-23) months. Seventy-nine of 83 (95%) reversals had a preoperative endoscopic evaluation of both their rectal stump and a complete colonoscopy. Stoma stenosis (n = 2), patient refusal (n = 1) and emergency reversal (n = 1) were cited reasons for not undergoing preoperative endoscopic evaluation. A third (n = 28, 34%) had a computed tomography prior to reversal; the majority was due to their underlying cancer surveillance (n = 21, 75%). Reversal was associated with a morbidity rate of 47% (n = 39). Surgical site infections (SSIs) (n = 21, 25%) were the most common type of complications encountered, with the majority being superficial (n = 15, 71%). SSIs were associated with steroid use (5/21 versus 4/62, p = 0.03) and greater hospital length of stay (6 versus 10 days, p = 0.03). CONCLUSION Only a quarter of emergency Hartmann's procedures within our institution were reversed. A significant proportion developed postoperative complications. Surgical site infection was the most common morbidity.
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Affiliation(s)
- Reshi Suthakaran
- Department of Colorectal Surgery, Western Health, Melbourne, Victoria, Australia
| | - Ian G Faragher
- Department of Colorectal Surgery, Western Health, Melbourne, Victoria, Australia
| | - Justin M C Yeung
- Department of Colorectal Surgery, Western Health, Melbourne, Victoria, Australia.,Department of Surgery, Western Precinct, University of Melbourne, Melbourne, Victoria, Australia.,Western Health Chronic Disease Alliance, Western Health, Melbourne, Victoria, Australia
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Kaldas P, Suthakaran R, Weinberg L, Lee D, Al‐Habbal Y. Evaluating the effect of online surgical education on intraoperative cholangiogram interpretation: a pilot study. ANZ J Surg 2022; 92:2560-2564. [DOI: 10.1111/ans.18027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 08/09/2022] [Accepted: 08/23/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Peter Kaldas
- Department of Surgery Austin Health Melbourne Australia
| | | | - Laurence Weinberg
- Department of Surgery Austin Health Melbourne Australia
- Department of Anaesthesia Austin Health Melbourne Australia
- Department of Critical Care The University of Melbourne, Austin Health Melbourne Australia
| | - Dong‐Kyu Lee
- Department of Anesthesiology and Pain Medicine Dongguk University Ilsan Hospital Goyang Republic of Korea
| | - Yahya Al‐Habbal
- Department of Surgery Austin Health Melbourne Australia
- Department of Surgery Western Health Melbourne Australia
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