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de Sa R, Hassan A, Soliman E, Al-Yaseen M, Kane P, Selmi H, Makki D. Traumatic rotator cuff injury: does delayed surgery worsen functional outcomes? Int Orthop 2024; 48:1271-1275. [PMID: 38403732 DOI: 10.1007/s00264-024-06127-2] [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] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/19/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE The optimal timing of surgery after traumatic rotator cuff tears (RCT) is unclear, with its impact on functional outcomes under debate. This study aimed to review functional outcomes after RCT repair in patients who underwent early vs delayed surgery at our unit. METHODS This was single-centre retrospective evaluation. Patients with an acute traumatic RCT that underwent repair between 2017 and 2019 and had local follow-up were included and placed into two groups: early surgery (within 6 months from injury) and delayed surgery (more than 6 months from injury). Patient demographics, RCT data and pre- and post-operative (after 12 months) Oxford Shoulder Score (OSS) were extracted from medical records. Data was analysed to compare OSS scores between groups, as well as the effect of cuff tear sizes on OSS scores. RESULTS Forty-nine patients were included in the analysis (15 early, 34 delayed). There were no significant differences in age, sex or cuff tear sizes between groups. No difference was identified in the mean post-operative OSS between early vs delayed groups (40.9 ± 6.34 vs 40.5 ± 7.65, p = 0.86). The mean improvement in OSS after surgery was also similar between groups (22.5 ± 7.81 vs 20.97 ± 7.19, p = 0.498). Having a large or massive RCT did not worsen OSS compared to small or medium RCT (p = 0.44), even when stratified by early or delayed surgery. CONCLUSION Delayed surgery for traumatic RCT greater than 6 months from injury did not negatively impact long-term functional outcomes at our unit. Patients should be reassured as applicable before surgery in the event of prolonged or unavoidable delays.
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Affiliation(s)
- Russell de Sa
- Department of Trauma & Orthopaedics, West Hertfordshire Teaching Hospitals NHS Trust, Hertfordshire, UK.
| | - Abdelmonem Hassan
- Department of Trauma & Orthopaedics, West Hertfordshire Teaching Hospitals NHS Trust, Hertfordshire, UK
| | - Emad Soliman
- Department of Trauma & Orthopaedics, West Hertfordshire Teaching Hospitals NHS Trust, Hertfordshire, UK
| | - Mustafa Al-Yaseen
- Department of Trauma & Orthopaedics, West Hertfordshire Teaching Hospitals NHS Trust, Hertfordshire, UK
| | - Prathamesh Kane
- Department of Trauma & Orthopaedics, West Hertfordshire Teaching Hospitals NHS Trust, Hertfordshire, UK
| | - Hussain Selmi
- Department of Trauma & Orthopaedics, West Hertfordshire Teaching Hospitals NHS Trust, Hertfordshire, UK
| | - Daoud Makki
- Department of Trauma & Orthopaedics, West Hertfordshire Teaching Hospitals NHS Trust, Hertfordshire, UK
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Itokawa R, Kowatari R, Imamura Y, Sasaki H, Kondo N, Daitoku K, Minakawa M. Delayed surgery for acute type A aortic dissection: a retrospective review of an alternative surgical strategy in the COVID-19 era. J Cardiothorac Surg 2024; 19:250. [PMID: 38643107 PMCID: PMC11031994 DOI: 10.1186/s13019-024-02682-2] [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: 11/01/2023] [Accepted: 03/24/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND During the coronavirus disease (COVID-19) pandemic, medical resources have often been limited to emergency surgeries. This study aimed to evaluate our experience with delayed surgery for acute type A aortic dissections (ATAADs). METHODS A retrospective study was conducted on 33 patients who underwent surgery for ATAADs between January 2020 and December 2021. The patients were divided into two groups: patients treated within 12 h of arrival (E group; N = 21) and those treated > 12 h after arrival (D group; N = 12) with strict antihypertensive therapy until surgery. RESULTS The plasma fibrinogen levels on arrival were lower in the D group than in the E group (174.3 ± 109.1 vs 293.4 ± 165.4, p = 0.038). The time to surgery from symptom onset was longer in the D group than in the E group (4 ± 1 h vs. 86 ± 108 h, p < 0.001). There was one case (3%) of mortality and seven cases (21%) of cerebral infarctions in the E group. There was no significant difference in the intraoperative data and quantity of blood transfused between the two groups. CONCLUSION Thus, delayed surgery for ATAAD with appropriate preoperative management may be an alternative surgical strategy in the COVID-19 era.
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Affiliation(s)
- Rin Itokawa
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8562, Japan
| | - Ryosuke Kowatari
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8562, Japan.
| | - Yuki Imamura
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8562, Japan
| | - Hanae Sasaki
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8562, Japan
| | - Norihiro Kondo
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8562, Japan
| | - Kazuyuki Daitoku
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8562, Japan
| | - Masahito Minakawa
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, 5 Zaifu-Cho, Hirosaki, Aomori, 036-8562, Japan
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Tsunemitsu A, Tsutsumi T, Inokuma S, Imanaka Y. Effects of hospitalist co-management for hip fractures. J Orthop Sci 2024; 29:278-285. [PMID: 36443140 DOI: 10.1016/j.jos.2022.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/29/2022] [Accepted: 11/01/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Early surgery is recommended for patients with hip fractures. Average time to surgery in Japan is 3.8 days. Such delay could be caused by the burden of preoperative assessment and management of geriatric comorbidities upon orthopedic surgeons. Hospitalist co-management has potential benefits in comprehensive perioperative care that could positively affect time to surgery in patients with hip fractures. We compare clinical outcomes of patients with hip fractures managed by orthopedic surgeon-led care (conventional group) vs. those of patients with hip fractures managed by hospitalist co-management. METHODS In this single-center retrospective cohort study, time to surgery was assessed with interrupted time series analyses. Whole length of hospital stay, length of hospital stay after surgery, complications during hospitalization, 30-day readmission, initiation of osteoporosis treatment and adherence to guidelines for deep vein thrombosis prophylaxis were also evaluated with Chi-square or Fisher's exact tests. RESULTS The conventional group comprised 332 patients and the co-management group 418 patients. Interrupted time series analyses revealed an immediate reduction of time to surgery by 1.2 days (95%CI, -1.9 to -0.4, P = 0.003) with the start of co-management. Whole length of hospital stay and length of hospital stay after surgery tended to be shorter, but without statistical significance. Intermediate to severe complications and 30-day readmission were not significantly different between the groups. In the co-management group, the rate of initiation of osteoporosis treatment (46.4% vs. 6.3%, P < 0.001) and adherence rate to guidelines for deep vein thrombosis prophylaxis (99.3% vs. 88%, P < 0.001) were significantly higher than those in the conventional group. CONCLUSIONS Hospitalist co-management for elderly patients with hip fractures led to significantly shorter time to surgery than conventional orthopedic surgeon-led care, and had advantages in other clinical indicators.
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Affiliation(s)
- Ayako Tsunemitsu
- Department of General Internal Medicine, Takatsuki General Hospital, 1-3-13 Kosobe-Cho, Takatsuki, Osaka 569-1192, Japan; Department of Healthcare Economics and Quality Management, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto 606-8501, Japan.
| | - Takahiko Tsutsumi
- Department of General Internal Medicine, Takatsuki General Hospital, 1-3-13 Kosobe-Cho, Takatsuki, Osaka 569-1192, Japan; Department of Healthcare Economics and Quality Management, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto 606-8501, Japan
| | - Sakiko Inokuma
- Department of General Internal Medicine, Takatsuki General Hospital, 1-3-13 Kosobe-Cho, Takatsuki, Osaka 569-1192, Japan
| | - Yuichi Imanaka
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto 606-8501, Japan
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Cheng X, Liu S, Yan J, Wang L, Lei X, Wu H, Zhu Y, Zhang Y. The Time-Effect Relationship between Time to Surgery and In-Hospital Postoperative Pneumonia in Older Patients with Hip Fracture. Gerontology 2023; 70:155-164. [PMID: 38008089 DOI: 10.1159/000535446] [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: 07/19/2022] [Accepted: 11/20/2023] [Indexed: 11/28/2023] Open
Abstract
INTRODUCTION Pneumonia is a common and devastating complication following hip fracture surgery in older patients. Time to surgery is a potentially modifiable factor associated with improved prognosis, and we aim to quantify the time-effect relationship between time to surgery and in-hospital postoperative pneumonia (IHPOP) and identify the effect of delayed surgery on the risk of IHPOP. METHODS We analyzed clinical data of older hip fracture patients (≥60 years) undergoing surgical treatments at a tertiary referral trauma center between 2015 and 2020. Restricted cubic spline (RCS) was used to fit the time-effect relationship between time to surgery and IHPOP. Based on the results of RCS, we divided patients into two groups of "early surgery" and "delayed surgery." A 1:1 propensity score matching (PSM) analysis and multivariate conditional logistic regression analysis were performed to minimize the selection bias and determine the association magnitude. Subgroup analysis was conducted to assess potential interaction effects between delayed surgery and common risk factors for IHPOP. RESULTS 3,118 eligible patients were included. The RCS curve showed an inverse S-shape trend and the relative risk of IHPOP decreased in the range of days 2-3 and increased on day 1 and day 3 or more post-injury, with the lowest point on day 3. PSM yielded 1,870 matched patients and delayed surgery (>3 days) was identified to be independently associated with IHPOP (relative ratio, 1.66; 95% confidence interval, 1.12-2.46; p value, 0.011). We observed positive interaction effects between delayed surgery and age of 80 years or more, female gender, COPD, heart disease, ASA score ≥3, anemia, and hypoproteinemia. CONCLUSION The relative risk of IHPOP decreased in the range of 2-3 days and increased on day 1 and day 3 or more post-injury. Delayed surgery (>3 days) was identified to be independently associated with a 1.66-fold increased risk of IHPOP.
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Affiliation(s)
- Xinqun Cheng
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, China
- Hebei Orthopedic Research Institute, Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
| | - Song Liu
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, China
- Hebei Orthopedic Research Institute, Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
| | - Jincheng Yan
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, China
- Hebei Orthopedic Research Institute, Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
| | - Lin Wang
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, China
- Hebei Orthopedic Research Institute, Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
| | - Xiang Lei
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, China
| | - Haifeng Wu
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yanbin Zhu
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, China
- Hebei Orthopedic Research Institute, Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
| | - Yingze Zhang
- Department of Orthopedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, China
- Hebei Orthopedic Research Institute, Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
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Kim JS, Chung MJ, Lee DY, Lee SH, Jeong SK, Yoo BE, Chung CS, Chung WK. Clinicopathological Outcomes in Patients With Locally Advanced Rectal Cancer Undergoing Preoperative Short- Versus Long-course Chemoradiotherapy With Delayed Surgery. In Vivo 2023; 37:2768-2775. [PMID: 37905618 PMCID: PMC10621450 DOI: 10.21873/invivo.13388] [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: 07/02/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND/AIM We aimed to compare the clinicopathological outcomes in patients with locally advanced rectal cancer after short- or long-course concurrent chemoradiotherapy (CCRT) followed by delayed surgery. PATIENTS AND METHODS The records of 94 patients with cT3-4N0-2M0 rectal cancer who received CCRT between 2010 and 2017 were reviewed. Short-course radiotherapy (RT) was delivered with a median total dose of 25 Gy in five fractions (n=27), and long-course RT was delivered with a median total dose of 50.4 Gy in 28 fractions (n=67). The following concurrent chemotherapy regimens were administered: 5-fluorouracil plus leucovorin in 58 and capecitabine in 24; in 12 cases agents were unknown. The median interval between CCRT and surgery was 8 weeks. Adjuvant chemotherapy was administered after surgery in 80 patients (5-fluorouracil plus leucovorin, n=54; capecitabine, n=9; other, n=14; and unknown, n=3). Propensity-score matching analysis was conducted. RESULTS The median follow-up duration was 4.3 years. There were no statistically significant differences between the short- and long-course RT groups in sphincter preservation (85.2% vs. 92.5%, p=0.478), pathological complete remission (18.5% vs. 14.9%, p=0.905), downstaging (44.4% vs. 26.9%, p=0.159), and negative circumferential resection margin (92.6% vs. 89.6%, p=0.947) rates. No differences were found in survival outcomes between the short- and long-course groups at 3 years (overall survival: 91.8% vs. 88.1%, p=0.790; disease-free survival, 75.2% vs. 72.5%, p=0.420; locoregional relapse-free survival, 90.5% vs. 98.4%, p=0.180; and distant metastasis-free survival, 79.6% vs. 73.5%, p=0.490). Similar results were observed after PSM. CONCLUSION Clinically, short-course CCRT may be a feasible alternative to long-course CCRT in patients with locally advanced rectal cancer.
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Affiliation(s)
- Jae Sik Kim
- Department of Radiation Oncology, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
- Department of Radiation Oncology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Mi Joo Chung
- Department of Radiation Oncology, Hanyang University Changwon Hanmaeum Hospital, Changwon, Republic of Korea
| | - Doo Yeul Lee
- Department of Radiation Oncology, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Suk Hwan Lee
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Seung-Kyu Jeong
- Department of Surgery, Yang Hospital, Seoul, Republic of Korea
| | - Byung Eun Yoo
- Department of Surgery, Yang Hospital, Namyangju, Republic of Korea
| | - Choon Sik Chung
- Department of Surgery, Hansol Hospital, Seoul, Republic of Korea
| | - Weon Kuu Chung
- Department of Radiation Oncology, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea;
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Ali F, Sandblom G, Fathalla B, Wallin G. Effect of the SARS-CoV-2 pandemic on planned and emergency hernia repair in Sweden: a register-based study. Hernia 2023; 27:1103-1108. [PMID: 37418049 PMCID: PMC10533583 DOI: 10.1007/s10029-023-02828-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 06/18/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE The COVID-19 has had a profound impact on the health care delivery in Sweden, including deprioritization of benign surgeries during the COVID-19 pandemic. The aim of this study was to assess the effect of COVID-19 pandemic on emergency and planned hernia repair in Sweden. METHODS Data on hernia repairs from January 2016 to December 2021 were retrieved from the Swedish Patient Register using procedural codes. Two groups were formed: COVID-19 group (January 2020-December 2021) and control group (January 2016-December 2019). Demographic data on mean age, gender, and type of hernia were collected. RESULTS This study showed a weak negative correlation between the number of elective hernia repairs performed each month during the pandemic and the number of emergency repairs carried out during the following 3 months for inguinal hernia repair (p = 0.114) and incisional hernia repair (p = 0.193), whereas there was no correlation for femoral or umbilical hernia repairs. CONCLUSION The COVID-19 pandemic had a great impact on planned hernia surgeries in Sweden, but our hypothesis that postponing planned repairs would increase the risk of emergency events was not supported.
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Affiliation(s)
- Fathalla Ali
- Faculty of Medicine and Health, Department of Surgery, Örebro University, 70185, Örebro, Sweden.
- Department of Surgery, Karlskoga Hospital, 69144, Karlskoga, Sweden.
| | - Gabriel Sandblom
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institute, Stockholm, Sweden
| | - Blend Fathalla
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institute, Stockholm, Sweden
- Emergency Department, Södersjukhuset, Stockholm, Sweden
| | - Göran Wallin
- Faculty of Medicine and Health, Department of Surgery, Örebro University, 70185, Örebro, Sweden
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Wang B, Gao R, Li Z, Guo Z, Ji Z, Li W, Sun K. Early versus delayed treatment of lateral condylar fracture of the humerus with > 2 mm displacement in children: a retrospective study. J Orthop Surg Res 2023; 18:139. [PMID: 36829228 PMCID: PMC9951476 DOI: 10.1186/s13018-023-03619-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 02/15/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND The purpose of this study was to investigate the clinical and functional outcomes of early versus delayed treatment of pediatric lateral condylar fractures of the humerus with a displacement greater than 2 mm. METHODS Sixty-seven children treated surgically at our hospital from March 2016 to September 2021 for lateral condylar fracture of the humerus with displacement > 2 mm were retrospectively analyzed. The children were divided into two groups where early surgery consisted of patients being operated on within 24-h post-injury (n = 36) and delayed surgery consisted of children operated after 24-h post-injury (n = 31). Clinical and functional results were compared between the two groups. RESULTS There were no significant differences between the two groups in terms of operation time, blood loss and incidences of perioperative complications. However, mean length of incision was significantly greater (P < 0.0001) in the delayed treatment group (5.68 ± 1.08 cm) compared to the early treatment group (3.89 ± 0.82 cm). No differences were found in functional outcomes, consisting of the Baumann angle of the affected limb, the carrying angle, Mayo Elbow Performance Score, and Flynn's criteria at final follow-up. CONCLUSIONS Delay in surgery for more than 24 h after injury does not influence the clinical and functional results for lateral condylar fracture of the humerus with displacement > 2 mm in children. However, delayed open reduction and pinning may increase the incision length possibly due to increased edema.
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Affiliation(s)
- Biao Wang
- grid.490612.8Department of Orthopaedics, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, Henan China
| | - Rongxuan Gao
- grid.411609.b0000 0004 1758 4735Department of Orthopaedics, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Zhenwei Li
- grid.490612.8Department of Orthopaedics, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, Henan China
| | - Zhanhao Guo
- grid.490612.8Department of Orthopaedics, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, Henan China
| | - Zejuan Ji
- grid.490612.8Department of Orthopaedics, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, Henan China
| | - Weili Li
- grid.490612.8Department of Orthopaedics, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, Henan China
| | - Keming Sun
- Department of Orthopaedics, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, Henan, China.
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Karthyarth MN, Mathew A, Ramachandra D, Goyal A, Yadav NK, Reddy KMR, Rakesh NR, Kaushal G, Dhar P. Early versus delayed surgery following neoadjuvant chemoradiation for esophageal cancer: a systematic review and meta-analysis. Esophagus 2023:10.1007/s10388-023-00989-y. [PMID: 36800076 DOI: 10.1007/s10388-023-00989-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/03/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Neoadjuvant chemoradiotherapy (nCRT) followed by surgery, is the mainstay of managing locally advanced esophageal cancer. However, the optimal timing of surgery after neoadjuvant therapy is not defined clearly. METHODS A systematic search of PubMed, Embase and Cochrane databases was conducted. 6-8 weeks were used as a cut-off to define early and delayed surgery groups. Overall Survival (OS) was the primary outcome, whereas pathological complete resolution (pCR), R0 resection, anastomotic leak, perioperative mortality, pulmonary complications, and major complication (> Clavien-Dindo grade 2) rates were secondary outcomes. Cohort studies and national registry bases studies were analysed separately. Survival data were pooled as Hazard Ratio (HR) and the rest as Odds Ratio (OR). According to heterogeneity, fixed-effect or random-effect models were used. RESULTS Twelve retrospective studies, one RCT, and six registry-based studies (13,600 participants) were included. Pooled analysis of cohort studies showed no difference in OS (HR 1.03, CI 0.91-1.16), pCR (OR 0.98, CI 0.80-1.20), R0 resection (OR 0.90, CI 0.55-I.45), mortality (OR 1.03, CI 0.59-1.77), pulmonary complications (OR 1.26, CI 0.97-1.64) or major complication rates (OR 1.29, CI 0.96-1.73). Delayed surgery led to increased leak (OR 1.48, CI 1.11-1.97). Analysis of registry studies showed that the delayed group had a better pCR rate (OR 1.12, CI 1.01-1.24), with no improvement in survival (HR 1.01, CI 0.92-1.10). Delayed surgery was associated with increased mortality (OR 1.35, CI 1.07-1.69) and major complication rate (OR 1.55, CI 1.20-2.01). Available RCT reported surgical outcomes only. CONCLUSION National registry-based studies' analysis shows that delay in surgery is riskier and leads to higher mortality and major complication rates. Further, well-designed RCTs are required.
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Affiliation(s)
- Mithun Nariampalli Karthyarth
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Anvin Mathew
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India.
| | - Deepti Ramachandra
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Anuj Goyal
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Neeraj Kumar Yadav
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | | | - Nirjhar Raj Rakesh
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Gourav Kaushal
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India
| | - Puneet Dhar
- Department of Surgical Gastroenterology, Amrita Institute of Medical Sciences, Faridabad, Haryana, 121002, India
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Ravery AS, Villatte G, Dartus J, Descamps S, Boisgard S, Erivan R. Reasons for Delays to Orthopaedic and Trauma Surgery: A Retrospective Five-Year Cohort. Orthop Traumatol Surg Res 2022;:103535. [PMID: 36574835 DOI: 10.1016/j.otsr.2022.103535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 07/30/2022] [Accepted: 08/25/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Early surgery seeks to decrease peri-operative complication rates and mean hospital stay lengths while also improving patient satisfaction. Few data exist on optimising care before orthopaedic and trauma surgery (OTS), notably regarding delays to surgery after admission. The objective of this study was to identify reasons for OTS delays at a university-hospital OTS centre in France. Surgery was defined as delayed if performed more than 48 h after admission. HYPOTHESIS Some reasons for OTS delays are amenable to modification by measures aimed at decreasing the adverse impact of long wait times. MATERIAL AND METHOD We conducted a retrospective single-centre observational study. Of 18 495 who underwent surgery at the OTS centre of the Clermont-Ferrand university hospital in 2015-2019, 1946 had a post-admission wait time longer than 48 h. After exclusion of repeat surgical procedures and dressing changes, 1175 patients remained for the analysis. The records of each patient were reviewed to identify the reason for the surgical delay. RESULTS A delay longer than 48 h was noted for 6.3% of OTS procedures. The most common reasons were limited resource availability (e.g., of operating theatres, nurses, or anaesthesia teams) (21.3%) and patient treatment by anticoagulants (20.9%). CONCLUSION Most delays were due to reasons independent from the patients operating-theatre logistics, delays in obtaining investigations) that could be targeted by those involved with operating-theatre management to diminish both surgical delays and hospital stay lengths. LEVEL OF EVIDENCE IV, retrospective observational cohort study.
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Bai G, Liang F, Zhao T, Deng F, Fu K, Chen X, Li Z, Zhang L, Jia W, Fu W, Liu G. Clinical characteristics, socioeconomic factors and COVID-19 were associated with delayed surgery in children with hypospadias: a retrospective study of 4439 cases in a single center. Eur J Med Res 2022; 27:125. [PMID: 35843999 PMCID: PMC9288920 DOI: 10.1186/s40001-022-00744-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/28/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Hypospadias is one of the most common congenital diseases of the genitourinary system in children. The European Association of Urology (EAU) Guidelines recommend that children undergoing hypospadias surgery should be between 6 and 18 months. In China, where many children have hypospadias, it remains unknown whether clinical characteristics, socioeconomic factors and COVID-19 were associated with delayed surgery in children with hypospadias. METHODS We retrospectively analyzed children with hypospadias who underwent primary surgery at the Department of Pediatric Urology in Guangzhou Women and Children's Medical Center between January 2010 and October 2021. Patients who had two-stage surgery or a second round of surgery due to complications were excluded to eliminate data duplication. The clinical characteristics and demographic information were collected. We defined delayed surgery as primary surgery performed after 18 months following the EAU Guidelines. RESULTS A total of 4439 children diagnosed with hypospadias were included in the study. The median age (29.1 ± 16.7 months) of surgery for hypospadias in our study was much higher than the recommended age reported in the EAU guidelines, and 76.6% of the children underwent surgery after the age of 18 months. Children without comorbidities including cryptorchidism (odds ratio [OR] = 1.562; 95% confidence interval [CI] 1.199-2.034; p = 0.001), prostatic cyst (OR = 2.613; 95% CI 1.579-4.324; p < 0.001), penile hypoplasia (OR = 1.778; 95% CI 1.225-2.580; p = 0.002), inguinal hernia (OR = 2.070; 95% CI 1.394-3.075; p < 0.001), and penoscrotal transposition (OR = 4.125; 95% CI 1.250-13.619; p = 0.020) were more likely to receive delayed surgery. Living in a low economic area (OR = 1.731; 95% CI 1.068-2.806; p = 0.026) or not close to a main medical center (OR = 1.580; 95% CI 1.370-1.824; p < 0.001) was highly associated with delayed surgery. The proportion of children undergoing delayed surgery and the median age of surgery during the COVID-19 pandemic were significantly higher than those before the COVID-19 pandemic (p = 0.004 and < 0.001, respectively). CONCLUSIONS Most children with hypospadias received delayed surgery (surgical age > 18 months). Comorbidities, living in a low economic area, too far from a main medical center and the COVID-19 pandemic were highly associated with delayed surgery. It is vital to improve the public awareness of hypospadias and strengthen the re-education of primary community doctors to reduce delayed surgery.
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Affiliation(s)
- Gaochen Bai
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 Jinsui Road, 510623, Guangzhou, China.,Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 Jinsui Road, 510623, Guangzhou, China
| | - Feng Liang
- Clinical Data Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 Jinsui Road, 510623, Guangzhou, China
| | - Tianxin Zhao
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 Jinsui Road, 510623, Guangzhou, China.,Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 Jinsui Road, 510623, Guangzhou, China
| | - Fuming Deng
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 Jinsui Road, 510623, Guangzhou, China.,Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 Jinsui Road, 510623, Guangzhou, China
| | - Kai Fu
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 Jinsui Road, 510623, Guangzhou, China.,Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 Jinsui Road, 510623, Guangzhou, China
| | - Xiong Chen
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 Jinsui Road, 510623, Guangzhou, China.,Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 Jinsui Road, 510623, Guangzhou, China
| | - Zhongmin Li
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 Jinsui Road, 510623, Guangzhou, China.,Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 Jinsui Road, 510623, Guangzhou, China
| | - Liyu Zhang
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 Jinsui Road, 510623, Guangzhou, China.,Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 Jinsui Road, 510623, Guangzhou, China
| | - Wei Jia
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 Jinsui Road, 510623, Guangzhou, China.,Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 Jinsui Road, 510623, Guangzhou, China
| | - Wen Fu
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 Jinsui Road, 510623, Guangzhou, China.,Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 Jinsui Road, 510623, Guangzhou, China
| | - Guochang Liu
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 Jinsui Road, 510623, Guangzhou, China. .,Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 Jinsui Road, 510623, Guangzhou, China.
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Dela SS, Paruk F, Conradie M, Jordaan JD, Kalla AA, Lukhele M, Cassim B. Access to care for low trauma hip fractures in South Africa. Arch Osteoporos 2022; 17:15. [PMID: 35024971 DOI: 10.1007/s11657-022-01057-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/28/2021] [Indexed: 02/03/2023]
Abstract
RATIONALE Early surgery is recommended for hip fractures. MAIN RESULT In this study only one-third of subjects with hip fractures were admitted within 24 h of the fracture, and surgery was delayed beyond 48 h in the majority. SIGNIFICANCE These findings highlight the need to improve access to care for hip fracture subjects. PURPOSE There is limited data on the timing of admission and surgery following a low trauma hip fracture (HF) in South Africa (SA). METHODS A prospective, observational study was conducted at public and private hospitals in three provinces, Gauteng (GP), KwaZulu-Natal (KZN) and the Western Cape (WC), in SA to determine time from fracture to admission and from admission to surgery in patients presenting with low trauma HF. Associations with delayed admission and surgery were explored using logistic regression. RESULTS The median age of the 1996 subjects was 73 years (IQR 63-81 years), the majority were women (1346, 67%) and 1347 (67%) were admitted to the public hospitals. In one-third of subjects (661, 33%), admission was delayed to beyond 24 h after the fracture. There was a significantly longer time to admission in public compared to private hospitals (21 h [IQR 10.0-48.5] versus 6 h [IQR 3.3-14.1], p < 0.001), in subjects < 65 years, the WC and when admission occurred on a weekday. Surgery was delayed beyond 48 h in the majority (1272, 69%) of subjects and was significantly longer in public compared to private hospitals (130 h [IQR 62.6-212.4] versus 45.4 h [IQR 24.0-75.5], p < 0.001), in KZN, and when admission occurred after hours. CONCLUSION The burden of HFs is higher at public hospitals in SA, where there is a significant delay in admission after a fracture and surgery after admission. This highlights the need for a review of HF care pathways, resources and policies.
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12
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Yu C, Zhao J, Lu J, Wei Y, Jiang L, Zhao T, Lin T, He D, Wen S, Wu S, Wei G. Demographic, clinical, and socioeconomic factors associated with delayed diagnosis and management of pediatric testicular torsion in West China: a retrospective study of 301 cases in a single tertiary children's hospital. BMC Pediatr 2021; 21:553. [PMID: 34872532 PMCID: PMC8647496 DOI: 10.1186/s12887-021-03001-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 11/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background To investigate the association between geographic, clinical, socioeconomic factors and delayed management of pediatric testicular torsion (TT) in West China. Methods A retrospective study was conducted on TT at Children’s Hospital of Chongqing Medical University in West China from November 2004 to December 2020. Univariate analysis and logistic regression analysis were conducted to determine the association between these factors and delayed management of TT. Results A total of 301 cases were included in this study. The misdiagnosis rate of TT in primary, secondary healthcare units and tertiary hospitals was 93.8, 71.1, and 8.9%, respectively. Approximately 26.9% of TT boys received timely surgical management (within 12 h from symptoms inset to surgery). Logistic regression analyses suggested the following factors were associated with delayed repair of TT: age less than 6 years (P = 0.001), with a history of symptoms progress (P = 0.001) or former treatment (P <0.001), absence of other diagnosis (P = 0.011) and those boys living far away from the main city zones (P <0.001). Conclusions Delayed surgical management for TT was more likely for boys with age less than 6 years, the absence of other diagnosis, with a history of former treatment or symptoms progress, and those living far away from the main city zone. To maximize the possibility of timely surgical management for TT, it is vital to strengthen the public awareness of TT and conduct continuously re-education and update physicians working at primary and secondary healthcare units.
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Affiliation(s)
- Chengjun Yu
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,China International Science and Technology Cooperation Basfe of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China
| | - Jie Zhao
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,China International Science and Technology Cooperation Basfe of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China
| | - Jiandong Lu
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,China International Science and Technology Cooperation Basfe of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China
| | - Yi Wei
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,China International Science and Technology Cooperation Basfe of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China
| | - Li Jiang
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tianxin Zhao
- Department of Pediatric Urology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Tao Lin
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,China International Science and Technology Cooperation Basfe of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Room 806, Kejiao Building (NO.6), No.136, Zhongshan 2nd Road, 400014, Yuzhong District, Chongqing City, China
| | - Dawei He
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,China International Science and Technology Cooperation Basfe of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Room 806, Kejiao Building (NO.6), No.136, Zhongshan 2nd Road, 400014, Yuzhong District, Chongqing City, China
| | - Sheng Wen
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,China International Science and Technology Cooperation Basfe of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China
| | - Shengde Wu
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China. .,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China. .,National Clinical Research Center for Child Health and Disorders, Chongqing, China. .,China International Science and Technology Cooperation Basfe of Child Development and Critical Disorders, Chongqing, China. .,Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China. .,Ministry of Education Key Laboratory of Child Development and Disorders, Room 806, Kejiao Building (NO.6), No.136, Zhongshan 2nd Road, 400014, Yuzhong District, Chongqing City, China.
| | - Guanghui Wei
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China.,Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,China International Science and Technology Cooperation Basfe of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics Chongqing, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Room 806, Kejiao Building (NO.6), No.136, Zhongshan 2nd Road, 400014, Yuzhong District, Chongqing City, China
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13
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Lieten S, Herrtwich A, Bravenboer B, Scheerlinck T, Van Laere S, Vanlauwe J. Analysis of the effects of a delay of surgery in patients with hip fractures: outcome and causes. Osteoporos Int 2021; 32:2235-2245. [PMID: 33990873 DOI: 10.1007/s00198-021-05990-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/03/2021] [Indexed: 10/21/2022]
Abstract
UNLABELLED This study analyzed characteristics of hip fracture patients who did not undergo surgery within 24 hours after hospitalization, as recommended by the Belgian quality standards. Reasons for delay were analyzed. Delay in surgery for hip fracture was related to the medical condition of the patients. INTRODUCTION To compare patients with optimal timing to patients with a delay in hip surgery, with respect to outcome (complications (postoperative) and mortality) and reasons for delay. METHODS A retrospective analysis of medical records compared patients operated on within 24h (Group A) to patients operated on more than 24h after admission (Group B). A follow-up period of 5 years after release or up to the time of data collection was used. Reasons for delay in relation with mortality were analyzed descriptively. Descriptive statistics were used for patient demographics and complications. Relationships causing a delayed surgery and mortality were analyzed using binary logistic regression. Additionally, a survival analysis was provided for overall mortality. RESULTS Respectively, 536 and 304 patients were included in Group A and B. The most prominent reason for delaying surgery was the patient not being medically fit (20.7%). Surgical delay was associated with more cardiovascular (p = 0.010), more pulmonary (p < 0.001), and less hematologic complications (p=0.037). Thirty-day mortality was higher with increasing age (p < 0.001), with hematologic (p < 0.001) or endocrine-metabolic complications (p = 0.001), and lower when no complications occurred (p = 0.004). Mortality at the end of data collection was higher for patients with delayed surgery (OR = 2.634, p < 0.001), an increased age (p = 0.006), male gender (p < 0.001), institutionalized patients (p = 0.009), pulmonary complication (p = 0.002), and having no endocrine-metabolic complications (p = 0.003). Survival analysis showed better survival for patients operated on within 24h (p < 0.001). CONCLUSIONS Delayed surgery for patients with hip fractures was associated with bad additional medical conditions. Survival was higher for patients operated on within 24h of admission.
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Affiliation(s)
- S Lieten
- Department of Orthopedics and Traumatology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium.
- Department of Geriatrics, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium.
| | - A Herrtwich
- Department of Orthopedics and Traumatology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - B Bravenboer
- Department of Geriatrics, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - T Scheerlinck
- Department of Orthopedics and Traumatology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - S Van Laere
- Interfaculty Center Data processing and Statistics, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090, Brussels, Belgium
| | - J Vanlauwe
- Department of Orthopedics and Traumatology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium
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Piketty J, Carbonnel M, Murtada R, Revaux A, Asmar J, Favre-Inhofer A, Ayoubi JM. Collateral damage of COVID-19 pandemic: The impact on a gynecologic surgery department. J Gynecol Obstet Hum Reprod 2021; 51:102255. [PMID: 34757223 DOI: 10.1016/j.jogoh.2021.102255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 10/03/2021] [Accepted: 10/13/2021] [Indexed: 11/22/2022]
Abstract
Objective This study focuses on changes in gynecologic surgical activity at Hospital Foch, Paris, France during the first French COVID lockdown in 2020. Additional goals include the evaluation the extent of the postponement suffered for each type of surgery and estimate the possible negative impact for patients. Study design Single-center, retrospective, chart-review cohort study in the gynecology department of Hospital Foch. Comparison of all patients scheduled, postponed and operated during the first COVID lockdown (March 14, to May 11, 2020) versus the same period in 2019. Postponed surgeries were classified into 4 scheduling interval categories according to the Society of Gynecology Oncology (SGO) recommendations: urgent (without delay), semi-urgent (1–4 weeks), non-urgent (>4–12 weeks) and elective (>3 months) and evaluated to determine whether COVID-19-related delays of surgeries fell within guidelines. The potential “loss of chance” or medical risk associated with postponed surgeries was estimated according to a composite criterion including death, aggravation of expected tumor stages/grades in cancers, increase in surgical complexity compared to that initially planned, need for preoperative transfusions, start of morphine consumption during preoperative treatment for opiate-naive patients, additional hospitalization or consultations in emergency room and delay in treatment when surgery was urgent. Results During the 2020 French COVID lockdown, 61 patients had a surgical procedure and 114 were postponed; in the comparator 2019 group, 232 patients underwent surgical procedures, indicating an overall decrease of 65% of activity. Analysis of differences between the two years revealed a reduction of 64% in emergency procedures, 90% of functional pathologies, and 13% of cancers. According to SGO guidelines, the only type of surgical procedures that had excessive delay was the semi-urgent group, where time to surgery was 6.7 weeks [range 5.4–10 weeks] instead of the recommended interval of 1–4 weeks. Among postponed surgeries there were 10 patients (8.7%) with a potential “loss of chance” according to the composite criteria, all included in the semi-urgent group. Conclusion The COVID 19 pandemic was responsible for a significant decrease of activity in the surgical department of Hospital Foch. Difficulty of rescheduling surgeries was responsible for an increased delay in semi-urgent operations. In almost 9% of postponed surgeries, there was a potential “loss of chance”, which likely represents only the tip of iceberg of collateral damages due to COVID 19 pandemic in this surgical unit. These data show the importance of continuing to treat pathologies requiring urgent or semi-urgent surgery during pandemics.
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He Y, Guo ZH, Wu YG, Li R, Xie X, Fu DH. Customized treatment protocols for patients with closed fracture in hospitals at varying coronavirus disease 2019 (COVID-19) risk. BMC Musculoskelet Disord 2021; 22:743. [PMID: 34461864 PMCID: PMC8405043 DOI: 10.1186/s12891-021-04614-w] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 08/05/2021] [Indexed: 01/19/2023] Open
Abstract
Background To determine an optimized treatment protocol during the COVID-19 epidemic for patients with closed fracture and delayed surgery. Methods The epidemic data of three hospitals, randomly selected from different administrative regions of Wuhan, were analyzed retrospectively from 23 January to 31 March 2020. Changes in the number of confirmed cases per day (cumulative and new) of each region were tracked as a reflection of changing epidemic risk levels. The risk level map was drawn. The epidemic status, treatment protocols, and treatment efficiencies for patients with closed fracture in the three hospitals were compared. Results Overall, 138 patients with closed fracture were admitted. Each hospital had established its own protocol, according to the initial perceived risk. Based on the risk level map, over the study period, the risk levels of the three regions changed independently and were not in sync. All patients recovered and were timely discharged. No staff member was detected with COVID-19. Conclusions The COVID-19 risk level of each area is dynamic. To optimize medical resources, avoid cross-infection, and improve efficiency, changes in epidemic risk should be monitored. For patients with closed fracture, treatment protocols should be adjusted according to changes in epidemic risk.
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Affiliation(s)
- Yu He
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), 1277 Jiefang Avenue, 430022, Wuhan, P.R. China
| | - Zhong-Hua Guo
- Department of Orthopedics, People's Hospital of Dongxihu District, Wuhan, P.R. China
| | - Yong-Guang Wu
- Department of Orthopedics, People's Hospital of Caidian District, Wuhan, P.R. China
| | - Rui Li
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), 1277 Jiefang Avenue, 430022, Wuhan, P.R. China
| | - Xie Xie
- Department of Traditional Chinese Medicine, Wuhan Third Hospital, Tongren Hospital of Wuhan University, 430060, Wuhan, P.R. China.
| | - De-Hao Fu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), 1277 Jiefang Avenue, 430022, Wuhan, P.R. China.
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Chan VWS, Tan WS, Leow JJ, Tan WP, Ong WLK, Chiu PKF, Gurung P, Pirola GM, Orecchia L, Liew MPC, Lee HY, Wang Y, Chen IHA, Castellani D, Wroclawski ML, Mayor N, Sathianathen NJ, Braga I, Liu Z, Moon D, Tikkinen K, Kamat A, Meng M, Ficarra V, Giannarini G, Teoh JYC. Delayed surgery for localised and metastatic renal cell carcinoma: a systematic review and meta-analysis for the COVID-19 pandemic. World J Urol 2021; 39:4295-4303. [PMID: 34031748 PMCID: PMC8143063 DOI: 10.1007/s00345-021-03734-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/13/2021] [Indexed: 12/04/2022] Open
Abstract
Purpose The COVID-19 pandemic has led to the cancellation or deferment of many elective cancer surgeries. We performed a systematic review on the oncological effects of delayed surgery for patients with localised or metastatic renal cell carcinoma (RCC) in the targeted therapy (TT) era. Method The protocol of this review is registered on PROSPERO(CRD42020190882). A comprehensive literature search was performed on Medline, Embase and Cochrane CENTRAL using MeSH terms and keywords for randomised controlled trials and observational studies on the topic. Risks of biases were assessed using the Cochrane RoB tool and the Newcastle–Ottawa Scale. For localised RCC, immediate surgery [including partial nephrectomy (PN) and radical nephrectomy (RN)] and delayed surgery [including active surveillance (AS) and delayed intervention (DI)] were compared. For metastatic RCC, upfront versus deferred cytoreductive nephrectomy (CN) were compared. Results Eleven studies were included for quantitative analysis. Delayed surgery was significantly associated with worse cancer-specific survival (HR 1.67, 95% CI 1.23–2.27, p < 0.01) in T1a RCC, but no significant difference was noted for overall survival. For localised ≥ T1b RCC, there were insufficient data for meta-analysis and the results from the individual reports were contradictory. For metastatic RCC, upfront TT followed by deferred CN was associated with better overall survival when compared to upfront CN followed by deferred TT (HR 0.61, 95% CI 0.43–0.86, p < 0.001). Conclusion Noting potential selection bias, there is insufficient evidence to support the notion that delayed surgery is safe in localised RCC. For metastatic RCC, upfront TT followed by deferred CN should be considered. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-021-03734-1.
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Affiliation(s)
- Vinson Wai-Shun Chan
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK.,Division of Surgery and Interventional Science, University College London, London, UK.,S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Wei Shen Tan
- Department of Urology, Royal Free Hospital, London, UK.,Division of Surgery and Interventional Science, University College London, London, UK
| | - Jeffrey J Leow
- Department of Urology, Tan Tock Seng Hospital, Singapore, Singapore.,Department of Urology, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Wei Phin Tan
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | | | - Peter Ka-Fung Chiu
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Pratik Gurung
- Department of Urology, University of Rochester Medical Center, New York, USA
| | | | - Luca Orecchia
- Urology Unit, Policlinico Tor Vergata Foundation, Rome, Italy
| | | | - Hsiang-Ying Lee
- Urology Department, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Yuding Wang
- Division of Urology, Department of Surgery, McMaster University, Hamilton, Canada
| | - I-Hsuan Alan Chen
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Daniele Castellani
- Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy
| | - Marcelo Langer Wroclawski
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil.,BP-A Beneficencia Portuguesa de Sao Paulo, Sao Paulo, Brazil
| | - Nikhil Mayor
- Department of Urology, Royal Surrey County Hospital, Guildford, UK
| | | | - Isaac Braga
- Department of Urology, Instituto Portugues de Oncologia, Porto, Portugal
| | - Zhenbang Liu
- Department of Urology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Dora Moon
- Department of Urology, East Lancashire Hospitals NHS Foundation Trust, Blackburn, UK
| | - Kari Tikkinen
- Departments of Urology and Public Health, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ashish Kamat
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Max Meng
- Department of Urology, University of California San Francisco, San Francisco, USA
| | - Vincenzo Ficarra
- Department of Human and Pediatric Pathology "Gaetano Barresi", Urologic Section, University of Messina, Messina, Italy
| | - Gianluca Giannarini
- Urology Unit, Santa Maria della Misericordia Academic Medical Centre, Udine, Italy
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
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Kim SH, Han SJ, Park YB, Kim DH, Lee HJ, Pujol N. A systematic review comparing the results of early vs delayed ligament surgeries in single anterior cruciate ligament and multiligament knee injuries. Knee Surg Relat Res 2021; 33:1. [PMID: 33413656 PMCID: PMC7792064 DOI: 10.1186/s43019-020-00086-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 11/27/2020] [Indexed: 12/30/2022] Open
Abstract
PURPOSE The purpose of this study was to compare clinical outcomes and incidence of concomitant injuries in patients undergoing early vs delayed surgical treatment of single anterior cruciate ligament (ACL) injury and multiligament knee injury (MLKI). METHODS A literature search using PubMed, Embase, the Cochrane Library, the Cumulative Index to Nursing and Allied Health, and Scopus from their inception to April 30, 2020 was conducted. Studies with levels I to IV evidence reporting the incidence of meniscus or cartilage injury according to early vs delayed surgery in single ACL injuries and MLKIs were included. In the meta-analysis, data based on the number of meniscus and cartilage injuries were extracted and pooled. Lysholm and Tegner scores were analyzed using two-sample Z-tests to calculate the non-weighted mean difference (NMD). A meta-regression analysis was also performed to determine the effect of single ACL injury and MLKI/study design. RESULTS Sixteen studies on single ACL injury and 14 studies on MLKI were included in this analysis. In the analysis, there were significant decreases in Lysholm score (NMD - 5.3 [95% confidence interval (CI) - 7.37 to - 3.23]) and Tegner score (NMD - 0.25 [95% CI - 0.45 to - 0.05]) and increases in risk of meniscus tear (odds ratio [OR] 1.73 [95% CI 1.1-2.73], p = 0.01) and cartilage injury (OR 2.48 [95% CI 1.46-4.2], p = 0.0007) in the delayed surgery group regardless of single ACL injury or MLKI. The result of the meta-regression analysis indicated that single ACL injury and MLKI/study design were not significant moderators of overall heterogeneity (p > 0.05). CONCLUSIONS Our study suggests that delayed ACL surgery significantly resulted in a higher risk of meniscus tear and cartilage injury and decreased Lysholm and Tegner scores compared to early ACL surgery. The Lysholm scores in the delayed MLKI surgery group were significantly decreased, but the risks of meniscus tear and cartilage injury in the delayed MLKI surgery group remained unclear. LEVEL OF EVIDENCE Level III, meta-analysis.
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Affiliation(s)
- Seong Hwan Kim
- Department of Orthopedic Surgery, Hyundae General Hospital, Chung-Ang University College of Medicine, Jinjeop-eup, Namyangju-si, Gyunggi-do, Republic of Korea
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea
| | - Sang-Jin Han
- Department of Orthopedic Surgery, Hyundae General Hospital, Chung-Ang University College of Medicine, Jinjeop-eup, Namyangju-si, Gyunggi-do, Republic of Korea
| | - Yong-Beom Park
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea
| | - Dong-Hyun Kim
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea
| | - Han-Jun Lee
- Department of Orthopedic Surgery, Hyundae General Hospital, Chung-Ang University College of Medicine, Jinjeop-eup, Namyangju-si, Gyunggi-do, Republic of Korea
| | - Nicolas Pujol
- Department of Orthopedic Surgery, Centre Hospitalier de Versailles, Le Chesnay, France.
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Chen CL, McLeod SD, Lietman TM, Shen H, Boscardin WJ, Chang HP, Whooley MA, Gelb AW, Lee SJ, Dudley RA. Preoperative Medical Testing and Falls in Medicare Beneficiaries Awaiting Cataract Surgery. Ophthalmology 2021; 128:208-15. [PMID: 32926912 DOI: 10.1016/j.ophtha.2020.09.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 09/05/2020] [Accepted: 09/08/2020] [Indexed: 11/21/2022] Open
Abstract
PURPOSE Delaying cataract surgery is associated with an increased risk of falls, but whether routine preoperative testing delays cataract surgery long enough to cause clinical harm is unknown. We sought to determine whether the use of routine preoperative testing leads to harm in the form of delayed surgery and falls in Medicare beneficiaries awaiting cataract surgery. DESIGN Retrospective, observational cohort study using 2006-2014 Medicare claims. PARTICIPANTS Medicare beneficiaries 66+ years of age with a Current Procedural Terminology claim for ocular biometry. METHODS We measured the mean and median number of days between biometry and cataract surgery, calculated the proportion of patients waiting ≥ 30 days or ≥ 90 days for surgery, and determined the odds of sustaining a fall within 90 days of biometry among patients of high-testing physicians (testing performed in ≥ 75% of their patients) compared with patients of low-testing physicians. We also estimated the number of days of delay attributable to high-testing physicians. MAIN OUTCOME MEASURES Incidence of falls occurring between biometry and surgery, odds of falling within 90 days of biometry, and estimated delay associated with physician testing behavior. RESULTS Of 248 345 beneficiaries, 16.4% were patients of high-testing physicians. More patients of high-testing physicians waited ≥ 30 days and ≥ 90 days to undergo surgery (31.4% and 8.2% vs. 25.0% and 5.5%, respectively; P < 0.0001 for both). Falls before surgery in patients of high-testing physicians increased by 43% within the 90 days after ocular biometry (1.0% vs. 0.7%; P < 0.0001). The adjusted odds ratio of falling within 90 days of biometry in patients of high-testing physicians versus low-testing physicians was 1.10 (95% confidence interval [CI], 1.03-1.19; P = 0.008). After adjusting for surgical wait time, the odds ratio decreased to 1.07 (95% CI, 1.00-1.15; P = 0.06). The delay associated with having a high-testing physician was approximately 8 days (estimate, 7.97 days; 95% CI, 6.40-9.55 days; P < 0.0001). Other factors associated with delayed surgery included patient race (non-White), Northeast region, ophthalmologist ≤ 40 years of age, and low surgical volume. CONCLUSIONS Overuse of routine preoperative medical testing by high-testing physicians is associated with delayed surgery and increased falls in cataract patients awaiting surgery.
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Meng Y, Leng K, Shan L, Guo M, Zhou J, Tian Q, Hai Y. A clinical pathway for pre-operative screening of COVID-19 and its influence on clinical outcome in patients with traumatic fractures. Int Orthop 2020; 44:1549-1555. [PMID: 32468202 PMCID: PMC7254976 DOI: 10.1007/s00264-020-04645-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/18/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE Coronavirus disease 2019 (COVID-19) has become a worldwide pandemic. The toughest issue traumatic orthopaedic surgeons are faced with is how to maintain a balance between adequate COVID-19 screening and timely surgery. In this study, we described our experience with pre-operative COVID-19 screening in patients with traumatic fractures. Furthermore, we analysed the clinical results of fracture patients undergoing confined or emergency surgery during the COVID-19 outbreak. METHODS This was a case series study. Patients with traumatic fractures who were admitted to our hospital for surgery were enrolled in this study during the COVID-19 outbreak from March to April 2020. All patients were enrolled and managed using the standardized clinical pathway we designed for preoperative COVID-19 screening. Clinical, laboratory and outcome data were analysed. RESULTS The average surgery waiting time from injury to surgery was 8.7 ± 3.4 days. The average waiting time from admission to surgery was 5.3 ± 2.8 days. These average waiting times were increased by 4.1 days and 2.0 days, respectively, compared with 2019 data. Cardiovascular complications, venous thromboembolism and pneumonia occurred in one, two and one patient, respectively. Three and two patients developed pre-operative and postoperative fevers, respectively. CONCLUSIONS We introduced a novel clinical pathway for pre-operatively screening of COVID-19 in traumatic orthopaedic patients. The delay in surgery caused by COVID-19 screening was minimized to a point at which reasonable and acceptable clinical outcomes were achieved. Doctors should pay more attention to perioperative complications, such as cardiovascular complications, venous thromboembolism, pneumonia and fever.
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Affiliation(s)
- Yutong Meng
- Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Kunpeng Leng
- Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Lei Shan
- Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Meng Guo
- Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Junlin Zhou
- Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
| | - Qingxian Tian
- Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
| | - Yong Hai
- Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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20
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Ding BTK, Decruz J, Kunnasegaran R. Time-sensitive ambulatory orthopaedic soft-tissue surgery paradigms during the COVID-19 pandemic. Int Orthop 2020; 44:1531-1538. [PMID: 32409911 PMCID: PMC7225011 DOI: 10.1007/s00264-020-04606-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/06/2020] [Indexed: 12/17/2022]
Abstract
Purpose Timing of surgery for orthopaedic injuries continues to evolve, as an improved understanding of biology, healing, and technological advances continues to challenge historical norms. With the growing COVID-19 pandemic stretching limited healthcare resources, postponing surgery becomes an inevitable and unenviable task for most orthopaedic surgeons, and a shift in outpatient paradigms is required to mitigate poor outcomes in patients. Methods A scoping review of five databases on surgical timing and orthopaedic soft-tissue injuries was performed. All randomized controlled trials, longitudinal cohort studies, retrospective case series, systematic reviews, meta-analyses, and expert opinions were included for review, with 65 studies meeting the inclusion criteria. Results Better outcomes appear to be associated with early surgery for subluxations (< 1 week), recurrent dislocations (> 2 episodes), ligamentous and tendinous injuries (< 2 weeks), and bony avulsion injuries (< 3 weeks). Spinal conditions with neurological compromise should be operated on within 24 hours and spinal instability within 72 hours to reduce the risk of complications and poor outcomes. Conclusion Most soft-tissue orthopaedic injuries can be managed with outpatient ambulatory surgery in a semi-elective setting. As the paradigm for outpatient surgery shifts due to technological advances and the COVID-19 pandemic, it is critical for surgeons to time their surgery appropriately to maintain the high standards of orthopaedic practice.
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Affiliation(s)
- Benjamin Tze Keong Ding
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, S308433, Singapore.
| | - Joshua Decruz
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, S308433, Singapore
| | - Remesh Kunnasegaran
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, S308433, Singapore
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21
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Caputo D, Angeletti S, Fiore M, Ciccozzi M, Coppola A, Cartillone M, La Vaccara V, Spagnolo G, Trodella L, Coppola R. Delayed surgery after radio-chemotherapy for rectal adenocarcinoma is protective for anastomotic dehiscence: a single-center observational retrospective cohort study. Updates Surg 2020; 72:469-75. [PMID: 32306273 DOI: 10.1007/s13304-020-00770-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 04/11/2020] [Indexed: 10/24/2022]
Abstract
Ideal time interval between end of neoadjuvant radio-chemotherapy (NRCT) and surgery for rectal cancer is debated. Effect that different time intervals have on postoperative complications with particular regard to anastomotic dehiscence (AD) was evaluated on 167 patients who underwent surgery after long-course NRCT. Three different time intervals were considered: (0-42; 43-56; > 57 days). A time interval > 57 days was significantly protective for AD (p = 0.04, Odds ratio = 0.35; 95% CI 0.1254-0.9585) without influence on early oncological outcomes. Optimal time interval after end of NRCT and surgery may help achieving the best pathological response with lowest postoperative morbidity.Trial registration number: Clinical Trial. Gov NCT04013347. https://clinicaltrials.gov/ct2/results?cond=&term=NCT04013347&cntry=&state=&city=&dist= ).
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22
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Hegde S, Bawa M, Kanojia RP, Mahajan JK, Menon P, Samujh R, Rao KLN. Pediatric Trauma: Management and Lessons Learned. J Indian Assoc Pediatr Surg 2020; 25:142-146. [PMID: 32581440 PMCID: PMC7302457 DOI: 10.4103/jiaps.jiaps_35_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/19/2019] [Accepted: 08/03/2019] [Indexed: 11/05/2022] Open
Abstract
Aim: The aim is to prospectively study 125 trauma patients admitted in the pediatric surgery ward in our institute. Materials and Methods: Pediatric patients admitted in the ward after initial resuscitation in the triage room were included. Isolated neurosurgical and orthopedic injuries were excluded. X-ray cervical spine, hip, and chest and a focused assessment with sonography in trauma ultrasound were done for all patients. Computed tomography of the abdomen or chest was done where relevant. Injury profile and surgical intervention when needed were analyzed. Results: Road traffic accidents and fall from height caused 73.6% of the injuries. School-going children were most commonly affected (60.8%). Distinctive injuries were noted such as abdominal wall hernias and delayed bladder perforation. All solid organ injury irrespective of grade treated conservatively. Forty percent of the children required surgical intervention. Five patients after laparotomy were found to have surgical conditions unrelated to trauma, whereas another 14 required delayed surgery. Five patients had injuries secondary to sexual abuse. All except two patients were discharged in a satisfactory condition and are doing well in the follow-up. Conclusion: In spite of extensive injuries and the need for multiple surgeries, children with trauma have a good prognosis. Close observation during admission and also in follow-up are essential, as many patients may require delayed surgery ≥1 week from injury.
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Affiliation(s)
- Shalini Hegde
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Monika Bawa
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ravi P Kanojia
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jai K Mahajan
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Prema Menon
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ram Samujh
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - K L N Rao
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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23
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Hoendervangers S, Sparreboom CL, Intven MPW, Lange JF, Verkooijen HM, Doornebosch PG, van Grevenstein WMU. The effect of neoadjuvant short-course radiotherapy and delayed surgery versus chemoradiation on postoperative outcomes in locally advanced rectal cancer patients - A propensity score matched nationwide audit-based study. Eur J Surg Oncol 2020; 46:1605-1612. [PMID: 32192792 DOI: 10.1016/j.ejso.2020.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 07/19/2019] [Revised: 01/27/2020] [Accepted: 03/03/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To investigate differences in postoperative outcomes between short-course radiotherapy and delayed surgery (SCRT-delay) and chemoradiation (CRT) in patients with locally advanced rectal cancer (LARC). BACKGROUND Previous trials suggest that SCRT-delay could serve as an adequate neoadjuvant treatment for LARC. Therefore, in frail LARC patients SCRT-delay is recommended as an alternative to CRT. However, data on postoperative outcomes after SCRT-delay in comparison to CRT is scarce. METHODS This was an observational study with data from the Dutch ColoRectal Audit (DCRA). LARC patients who underwent surgery (2014-2017) after an interval of ≥6 weeks were included. Missing values were replaced by multiple imputation. Propensity score matching (PSM), using age, Charlson Comorbidity Index, cT-stage and surgical procedure, was applied to create comparable groups. Differences in postoperative outcomes were analyzed using Chi-square test for categorical variables, independent sample t-test for continuous variables and Mann-Whitney U test for non-parametric data. RESULTS 2926 patients were included. In total, 288 patients received SCRT-delay and 2638 patients underwent CRT. Patients in the SCRT-delay group were older and had more comorbidities. Also, ICU-admissions and permanent colostomies were more common, as well as pulmonic, cardiologic, infectious and neurologic complications. After PSM, both groups comprised 246 patients with equivalent age, comorbidities and tumor stage. There were no differences in postoperative complications. CONCLUSION Postoperative complications were not increased in LARC patients undergoing SCRT-delay as neoadjuvant treatment. Regarding treatment-related complications, SCRT-delay is a safe alternative neoadjuvant treatment option for frail LARC patients.
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Affiliation(s)
- S Hoendervangers
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - C L Sparreboom
- Department of Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - M P W Intven
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J F Lange
- Department of Surgery, Erasmus MC, Rotterdam, the Netherlands; Department of Surgery, IJsselland Ziekenhuis, Capelle a/d Ijssel, the Netherlands
| | - H M Verkooijen
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - P G Doornebosch
- Department of Surgery, IJsselland Ziekenhuis, Capelle a/d Ijssel, the Netherlands
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Kobayashi T, Lefor AK, Hotta K, Morimoto T, Sonohata M, Mawatari M. Pain relief after more than 24 hours of preoperative skin traction in patients with intertrochanteric fractures: A retrospective comparative cohort study. Int J Orthop Trauma Nurs 2020; 37:100754. [PMID: 32081683 DOI: 10.1016/j.ijotn.2020.100754] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 04/08/2019] [Revised: 01/08/2020] [Accepted: 01/26/2020] [Indexed: 10/25/2022]
Abstract
AIM The primary aim of the study was to investigate pain relief after more than 24 h of preoperative skin traction (because of delay in surgery due to comorbidities and system issues) in patients with intertrochanteric fractures. METHOD We performed a retrospective comparative cohort study of 56 patients who underwent intramedullary nailing for the treatment of intertrochanteric fractures and who had waited for surgery for more than 48 h after admission due to comorbidities or system issues. Preoperative therapy was randomly selected with a ratio of one to two and patients classified as skin traction (n = 18) or no traction (n = 38). The Verbal Rating Scale (VRS) was used to assess pain at 12-60 h post-admission. RESULTS There was no significant difference in VRS at 12 h after admission (1.1 ± 1.0 vs. 0.8 ± 0.9, p = 0.73), but patients who received skin traction had a lower VRS pain score at 24-60 h after admission compared to those with no traction (24 h, 0.4 ± 0.8 vs. 1.1 ± 1.0, p < 0.05; 36 h, 0.2 ± 0.5 vs. 0.9 ± 0.9, p < 0.05; 48 h, 0.2 ± 0.4 vs. 0.8 ± 0.9, p < 0.05; 60 h, 0.2 ± 0.4 vs. 0.9 ± 0.9, p < 0.05). CONCLUSION Skin traction for patients with intertrochanteric fractures for more than 24 h preoperatively resulted in a lower VRS pain score. Therefore, more than 24 h of preoperative skin traction for patients with intertrochanteric fractures may give effective pain relief in situations where surgery is delayed.
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Affiliation(s)
- Takaomi Kobayashi
- Department of Orthopedic Surgery, Karatsu Red Cross Hospital, 1-5-1 Futago, Karatsu, Saga, 847-8588, Japan; Department of Orthopedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
| | - Alan Kawarai Lefor
- Department of Surgery, Jichi Medical University, Shimotsuke, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Kensuke Hotta
- Department of Orthopedic Surgery, Karatsu Red Cross Hospital, 1-5-1 Futago, Karatsu, Saga, 847-8588, Japan
| | - Tadatsugu Morimoto
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Motoki Sonohata
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Masaaki Mawatari
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
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25
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Kammar P, Chaturvedi A, Sivasanker M, de'Souza A, Engineer R, Ostwal V, Saklani A. Impact of delaying surgery after chemoradiation in rectal cancer: outcomes from a tertiary cancer centre in India. J Gastrointest Oncol 2020; 11:13-22. [PMID: 32175101 DOI: 10.21037/jgo.2019.12.04] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Delaying surgery after chemoradiation is one of the strategies for increasing tumor regression in rectal cancer. Tumour regression and PCR are known to have positive impact on survival. Methods It's a retrospective study of 161 patients undergoing surgery after neoadjuvant chemoradiation (NCRT) for locally advanced rectal cancer (LARC). Patients were divided into three categories based on the gap between NCRT and surgery, i.e., <8, 8-12 and >12 weeks. Tumor regression grades (TRG), sphincter preservation, post-operative morbidity-mortality and survival were evaluated. Results Sphincter preservation was significantly less in >12 weeks group compared to the other two groups (P=0.003). Intraoperative blood loss was significantly higher in >12 weeks group compared to 8-12 weeks group (P=0.001).There was no difference in major postoperative morbidity and hospital stay among the groups. There was no significant correlation between delay and TRG (P=0.644). At Median follow up of 49.5 months the projected 3-year overall survival (OS) and disease free survival (DFS) were not significantly different among the 3 groups (OS: 79.5% vs. 83.3% vs. 76.5%; P=0.849 and DFS 50.4% vs. 70.6% vs. 62%; P=0.270 respectively). Conclusions Delaying surgery by more than 12 weeks causes more blood loss but no change in morbidity or hospital stay. Increased time interval between radiation and surgery does not improve tumor regression and has no effect on survival.
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Affiliation(s)
- Praveen Kammar
- Colorectal Division, GI Services, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Aditi Chaturvedi
- Colorectal Division, GI Services, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Masillamany Sivasanker
- Colorectal Division, GI Services, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Ashwin de'Souza
- Colorectal Division, GI Services, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Reena Engineer
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Vikas Ostwal
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Avanish Saklani
- Colorectal Division, GI Services, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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26
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Masumbuko CK, Mutheke EG, Mbindyo B, Hawkes MT. Delayed surgery leads to reduced elbow range of motion in children with supracondylar humeral fractures managed at a referral hospital in sub-Saharan Africa. Afr Health Sci 2019; 19:2565-2570. [PMID: 32127829 PMCID: PMC7040283 DOI: 10.4314/ahs.v19i3.32] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Supracondylar humeral fractures (SHFs) in children are associated with morbidity due to elbow stiffness. Timely operative management and/or physiotherapy are thought to reduce this complication, but pose challenges in settings with limited resources for health. Methods This prospective cohort study included 45 pediatric patients with isolated SHF at a large tertiary hospital in Nairobi, Kenya. Patients were managed non-operatively or operatively with varying wait times to surgery, with or without physiotherapy. The measurement of elbow ROM was done up to 12 weeks after removal of Kirshner wires and/or backslab. Results Elbow ROM increased in the follow-up period, yet residual restricted mobility in the flexion-extension plane was common. Delayed surgical management ≥7 days was associated with reduced elbow ROM in the flexion-extension plane at 12 weeks median IQR 105° 92°–118° vs 120° 108°–124°, p=0.029. Physiotherapy was associated with reduced ROM at 12 weeks p=0.003, possibly due to the use of prolonged immobilization. Conclusion In this study of pediatric SHFs at a resource-limited hospital, elbow flexion was restricted at 12 weeks follow-up and was associated with major delays in operative management. Quality of orthopedic surgical care and physiotherapy services in low-resource settings deserves further attention.
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Affiliation(s)
| | | | | | - Michael T Hawkes
- Department of Pediatrics, University of Alberta, Edmonton, Canada
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Wu H, Fang C, Huang L, Fan C, Wang C, Yang L, Li Y, Zhou Z. Short-course radiotherapy with immediate or delayed surgery in rectal cancer: A meta-analysis. Int J Surg 2018; 56:195-202. [PMID: 29807169 DOI: 10.1016/j.ijsu.2018.05.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 02/27/2018] [Revised: 04/12/2018] [Accepted: 05/21/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND The safety and efficacy of preoperative short-course radiotherapy had been verified in rectal cancer. However, the timing of surgery after radiation had not been well defined. Thus, we performed this meta-analysis to compare the interval time of surgery after short-course radiotherapy in rectal cancer: immediate surgery (<4 weeks) vs delayed surgery (>4 weeks). METHODS We searched the PubMed, EMBASE, MEDLINE, and Cochrane Library database. The primary endpoints were survival rates and pathological outcomes, and the second endpoints included sphincter preservation rate, R0 resection rate and postoperative complications. RevMan 5.3 was used to calculate pooled risk ratio (RRs) and 95% confidence interval (CIs). RESULTS In total, 5 eligible studies including 1244 participants were identified. The delayed surgery group had a markedly higher pathological complete response rate [RR = 15.71, 95% CI (2.10, 117.30), P = 0.007] and downstaging rate [RR = 2.63, 95% CI (1.77, 3.90), P < 0.00001], a higher proportion of patients with adjuvant pathologic stage 0 + I disease [RR = 1.49, 95% CI (1.23, 1.81), P < 0.0001] and a lower incidence of postoperative complications [RR = 0.81, 95% CI (0.70, 0.95), P = 0.008] than did the immediate surgery group, but the survival rate, sphincter preservation rate and R0 resection rate were similar between the two groups. CONCLUSION Based on better pathologic outcomes and fewer postoperative complications, we recommended short-course radiotherapy with delayed surgery for more than 4 weeks.
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Affiliation(s)
- Haoyan Wu
- Department of Gastrointestinal Surgery, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China; Institute of Digestive Surgery, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China
| | - Chao Fang
- Department of Gastrointestinal Surgery, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China; Institute of Digestive Surgery, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China
| | - Libin Huang
- Department of Gastrointestinal Surgery, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China; Institute of Digestive Surgery, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China
| | - Chuanwen Fan
- Department of Gastrointestinal Surgery, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China; Institute of Digestive Surgery, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China
| | - Cun Wang
- Department of Gastrointestinal Surgery, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China
| | - Lie Yang
- Department of Gastrointestinal Surgery, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China
| | - Yuan Li
- Institute of Digestive Surgery, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China; Department of Pediatric Surgery, West China Hospital and State Key Laboratory of Biotherapy, Chengdu, China
| | - Zongguang Zhou
- Department of Gastrointestinal Surgery, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China; Institute of Digestive Surgery, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China.
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Lizaur-Utrilla A, Gonzalez-Navarro B, Vizcaya-Moreno MF, Miralles Muñoz FA, Gonzalez-Parreño S, Lopez-Prats FA. Reasons for delaying surgery following hip fractures and its impact on one year mortality. Int Orthop 2018; 43:441-448. [PMID: 29744645 DOI: 10.1007/s00264-018-3936-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 04/05/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE The purposes of this study were to identify the reasons for delayed surgery following hip fractures and analyze the impact of these reasons on 1-year mortality. METHODS A prospective cohort study of 1234 patients with mean age of 83.1 (range 65-92, SD 8.0) who underwent hip fracture surgery compared three subgroups: (1) surgery within two days from admission (609 patients); (2) delayed surgery for medical reasons (286); and (3) delayed surgery for organizational causes (339). Medical reason was defined as the need of medical optimization of the patient prior to surgery. Pre-operative assessment was performed by the American Society of Anesthesiologists (ASA) score, Charlson Comorbidity Index (CCI), Hodkinson mental status, Katz index for activities of daily living, and Short-Form (SF-12) questionnaire. Univariate analyses were used (chi-square and Fisher exact or Mantel-Haenszel tests for categorical data, and variance analysis, Student t test, or Mann-Whitney U test for continuous data). Logistic regression models were used for influence of variables on complications and one year mortality. RESULTS There were no significant differences in complications or one year mortality rates between patients with surgery within two days and those with delayed surgery for medical reasons. However, the patients with delayed surgery for organizational causes had significant higher rates of both complications and one year mortality compared to the other two groups (p = 0.001). CONCLUSIONS This study suggests that waiting time for hip fracture surgery more than two days was not associated with higher complication or mortality rate if waiting was to stabilize patients with active comorbidities at admission, compared to stable patients at admission with early surgery. Although early surgery within two days from admission is desirable for stable patients at admission, in patients with complex comorbidities, the surgery should be performed once they are optimized. However, the patients with delayed surgery for organizational reasons had a significant higher rate of post-operative complications and one year mortality compared to the other two groups.
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Affiliation(s)
- Alejandro Lizaur-Utrilla
- Orthopaedic Surgery, Elda University Hospital, Miguel Hernandez University, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain. .,Traumatology and Orthopaedia, Miguel Hernandez University, Elche, Alicante, Spain.
| | - Blanca Gonzalez-Navarro
- Orthopaedic Surgery, Elda University Hospital, Miguel Hernandez University, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain
| | - Maria F Vizcaya-Moreno
- Clinical Research Group, Faculty of Health Sciences, University of Alicante, Alicante, Spain
| | - Francisco A Miralles Muñoz
- Orthopaedic Surgery, Elda University Hospital, Miguel Hernandez University, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain
| | - Santiago Gonzalez-Parreño
- Orthopaedic Surgery, Elda University Hospital, Miguel Hernandez University, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain
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Alore EA, Ward JL, Todd SR, Wilson CT, Gordy SD, Hoffman MK, Suliburk JW. Population-level outcomes of early versus delayed appendectomy for acute appendicitis using the American College of Surgeons National Surgical Quality Improvement Program. J Surg Res. 2018;229:234-242. [PMID: 29936996 DOI: 10.1016/j.jss.2018.04.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/13/2018] [Accepted: 04/03/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND The optimal timing of appendectomy for acute appendicitis has been analyzed with mixed results. We hypothesized that delayed appendectomy would be associated with increased 30-d morbidity and mortality. MATERIALS AND METHODS The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients undergoing nonelective appendectomy from 2012 to 2015 with a postoperative diagnosis of appendicitis. Patients were grouped based on hospital day (HD) of operation. Primary outcomes included 30-d mortality and major complications. Logistic regression was performed to determine predictors of major morbidity and mortality. RESULTS From 2012 to 2015, 112,122 patients underwent appendectomy for acute appendicitis. Appendectomies performed on HD 3 had significantly worse outcomes as demonstrated by increased 30-d mortality (0.6%) and all major postoperative complications (8%) in comparison with operations taking place on HD 1 (0.1%; 3.4%) or HD 2 (0.1%, P < 0.001; 3.6%, P < 0.001). In subgroup analysis, open operations had significantly higher mortality and major postoperative complications, including organ/space surgical site infections (4.6% open versus 2.1% laparoscopic; P < 0.001). Patients with decreased baseline physical status by the American Society of Anesthesiologists Physical Status class had the worst outcomes (1.5% mortality; 14% major complications) when operation was delayed to HD 3. Logistic regression revealed higher American Society of Anesthesiologists Physical Status class and open operations as predictors of major complications; however, HD was not (P = 0.2). CONCLUSIONS Data from the American College of Surgeons National Surgical Quality Improvement Program demonstrate similar outcomes of appendectomy for acute appendicitis when the operation is performed on HD 1 or 2; however, outcomes are significantly worse for appendectomies delayed until HD 3. Increased complications in this group are likely not attributable to HD of operation, but rather decreased baseline health status and procedure type.
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Kaytan-Saglam E, Balik E, Saglam S, Akgün Z, Ibis K, Keskin M, Dagoglu N, Kapran Y, Gulluoglu M. Delayed versus immediate surgery following short-course neoadjuvant radiotherapy in resectable (T3N0/N+) rectal cancer. J Cancer Res Clin Oncol 2017; 143:1597-603. [PMID: 28374169 DOI: 10.1007/s00432-017-2406-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 03/24/2017] [Indexed: 02/01/2023]
Abstract
PURPOSE Preoperative short-course radiotherapy (SCRT) followed by surgery has shown advantage over surgery alone in patients with resectable rectal carcinoma (RC); however, the importance of the timing of surgery after SCRT has not been well defined. This study aimed to investigate the effect of this duration on treatment outcomes. METHODS Patients who underwent surgery after SCRT (25 Gy/500 cGy/daily/5fr, monday-friday) for resectable and infraperitoneal rectal adenocarcinoma (T3N0/(+)) were included into the study. Patients were divided into two groups in terms of the timing of surgery: delayed surgery (>4 weeks) or immediate surgery (<4 weeks). RESULTS A hundred and thirty-six patients were included in the study. Median time between RT and surgery was 4 ± 5.7 (1-58) weeks, where 68% (n = 93) patients underwent delayed surgery (≥4 weeks). The two groups did not differ in terms of surgical margin positivity, pathological tumor regression, N downstaging, or T downstaging (p > 0.05 for all). However, the number of positive lymph nodes was higher in the immediate surgery group [median 3 (0-18) vs. 1 (0-17), p = 0.009]. Median follow-up time was 36 ± 9 (6-93) months. Delayed surgery group had significantly longer mean overall survival (p = 0.038); however, the two groups did not differ in terms of local recurrence, mean time to local recurrence, or mean disease-free survival. CONCLUSIONS Our findings seem to support the benefit of a longer time interval between radiotherapy and surgery after short-course neoadjuvant radiotherapy in resectable rectal cancer in terms of overall survival. However, there is a need to better define patient characteristics that might benefit from delayed surgery.
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Weil YA, Mosheiff R, Firman S, Liebergall M, Khoury A. Outcome of delayed primary internal fixation of distal radius fractures: a comparative study. Injury 2014; 45:960-4. [PMID: 24731691 DOI: 10.1016/j.injury.2014.02.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 01/28/2014] [Accepted: 02/02/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION AND AIM Operative fixation of distal radius fractures using fixed-angle devices has become increasingly common. Although good to excellent results have been reported in acute fractures, little is currently known regarding the fixation of healing displaced distal radius fractures that were presented late. The aim of this study was to evaluate the results of internal fixation of distal radius fractures presented late (>21 days) as compared with an acute-care control group. METHODS Forty patients operated on for displaced distal radius fractures, presenting more than 21 days after injury (delayed treatment (DT) group), were compared with 75 age-matched controls with acute fracture repair (≤21 days). The same surgical approach was used in both groups, together with dorsal soft-tissue and brachioradialis release. No osteotomy was required. Direct and indirect reduction aids were used. A fixed-angle device (DVR; Biomet Inc., Warsaw, IN, USA) was used in both groups. Mean follow-up was 3.4 years. Quick DASH (Disabilities of the Arm, Shoulder and Hand) and Short Form 12 scores were used to evaluate outcome, as well as radiographic analysis for Arbeitsgemeinschaft für Osteosynthesefragen(AO)/Orthopaedic Trauma Association(OTA) classification, volar tilt, radial inclination and radial length. RESULTS Average age was 53 years in both groups and male to female (M/F) ratio was similar in the study groups. Mean time to surgery was 30 days in the DT group and 8 days in the control group. There were significantly more type C (91.5% vs. 67.5%) fractures in the control group. The average quick DASH score was 27.1 in the DT group as compared with 6.3 in the control group (p<0.03); however, when controlling for two outlier cases with complications (hardware irritation and a sensory neuropathy) there was no significant difference. Volar tilt, radial inclination and length were similar in both groups and were within normal anatomical values. CONCLUSIONS Delayed primary operative fixation of displaced unstable distal radial fractures is a viable option for cases that were presented late, with predictable, favourable results. Neither extensile approaches nor formal osteotomies are required.
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Affiliation(s)
- Yoram A Weil
- Department of Orthopaedics, Hadassah Hebrew University Medical Centre, Jerusalem, Israel.
| | - Rami Mosheiff
- Department of Orthopaedics, Hadassah Hebrew University Medical Centre, Jerusalem, Israel
| | - Shimon Firman
- Department of Orthopaedics, Hadassah Hebrew University Medical Centre, Jerusalem, Israel
| | - Meir Liebergall
- Department of Orthopaedics, Hadassah Hebrew University Medical Centre, Jerusalem, Israel
| | - Amal Khoury
- Department of Orthopaedics, Hadassah Hebrew University Medical Centre, Jerusalem, Israel
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Abstract
Background: Early surgery for appendicitis is thought to avoid complications associated with appendiceal rupture. Aims: This study was to evaluate the effect of timing of surgery on complications, length of stay (LOS) and cost in patients undergoing appendectomy. Materials and Methods: Retrospective review of 396 patients with appendectomies from January 1, 2005 to December 31, 2007 was performed. Demographic data, time of presentation, physical findings, diagnostic data, operating room times, LOS, cost and complications were collected. Patients were divided into 4 groups based on time from presentation to appendectomy. Results: Pathology confirmed appendicitis in 354 (89%) patients. Most patients (90%) had surgery within 18 h of presentation. Timing of surgery did not affect the incidence of purulent peritonitis (P = 0.883), abscess (P = 0.841) or perforation (P = 0.464). LOS was significantly shorter for patients with emergency department registration to operating room times less than 18 h (P < 0.0001). Costs were significantly higher for patients with times to operating room greater than 18 h (P < 0.001). Conclusion: Timing of surgery did not affect the incidence of complications or perforated appendicitis. However, delay in surgical consultation and surgery are associated with increased LOS and increased hospital costs. The optimal timing of appendectomy for uncomplicated acute appendicitis appears to be within 18 h of emergency department presentation.
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Affiliation(s)
- Frederick N Eko
- Department of Plastic and Reconstructive Surgery, Tulane University Hospital and Clinics, 1430 Tulane Avenue, New Orleans, Louisiana, USA
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Gupta A, Regmi S, Hazra NK, Panhani ML, Talwar OP. Clinically monitored delay-A valid option in cases with doubtful diagnosis of acute appendicitis. Indian J Surg 2010; 72:215-9. [PMID: 23133250 DOI: 10.1007/s12262-010-0049-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Accepted: 01/31/2010] [Indexed: 10/19/2022] Open
Abstract
AIM To evaluate the effect of delayed surgery after a period of observation in patients with doubtful diagnosis of acute appendicitis in the form of improvement in negative appendectomy rates and the incidence of complications. MATERIALS AND METHODS One hundred twelve patients operated with the diagnosis of acute appendicitis between May 2008 to June 2009 were included in this retrospective study. They were divided into two groups based on timing of surgery after admission. These two groups were studied in respect to age, sex, Alvarado score at presentation, ultrasound findings, operative findings, histopathology and postoperative complications. Proportions of negative appendectomies, and complicated appendicitis were analysed statistically. RESULTS Group wise age and sex distribution was comparable. The mean Alvarado score in the group 1 was 7.9 (range, 6-10) where as in those operated later than 12 hours (group 2), it was 4.5 (range, 3-8). Normal appendectomies were significantly (p < 0.05) less in group 2 (1 out of 40) as compared to group 1 (4 out of 72). The number of complicated appendicitis were higher in group 1 (14/72) as compared to group 2 (4/40) but not significantly (p > 0.06). The number of postoperative complications was also high in group 1 (11 vs 2 in group 2). CONCLUSION It is better to wait in cases with doubtful initial diagnosis of appendicitis on admission in order to decrease negative appendectomy rates. These patients need to be continuously monitored clinically to prevent complications.
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Abstract
Because cutaneous anthrax, caused by Bacillus anthracis, is rare in developed countries, sporadic cases of anthrax may easily be overlooked because the diagnosis is often difficult to make. Lower eyelid involvement of anthrax is rare in clinical practice. A 40-year-old woman with a history of contact with animals was evaluated and treated for a left lower eyelid lesion with a black eschar on it. A diagnosis of cutaneous anthrax had been made and intravenous penicillin had been given by the department of infectious diseases before plastic surgery consultation. Any kind of surgical intervention was delayed for three months. The lesion healed secondarily and the resulting scar did not result in ectropion of the lower eyelid. Delaying surgery is preferred because it is a safer approach when dealing with anthrax involving the lower eyelid, and secondary healing does not always result in deformity compromising function.
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Affiliation(s)
- Ugur Koçer
- Plastic and Reconstructive Surgery Clinic, Ankara Training and Research Hospital, Ankara, Turkey
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