1
|
Goldaracena N, Vargas PA, McCormack L. Pre-operative assessment of living liver donors' liver anatomy and volumes. Updates Surg 2024:10.1007/s13304-024-01806-6. [PMID: 38526699 DOI: 10.1007/s13304-024-01806-6] [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] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/24/2024] [Indexed: 03/27/2024]
Abstract
Decades of experience supports LDLT as a favorable strategy to reduce waitlist mortality. The multiple regenerative pathways of hepatocytes and other hepatic cells justify the rationale behind it. Nonetheless, living liver donation is still underused and its broader implementation is challenging, mostly due to variability in practices leading to concerns related to donor safety. A non-systematic literature search was conducted for peer-reviewed original articles related to pre-operative evaluation of living liver donor candidates. Eligible studies were synthesized upon consensus for discussion in this up-to-date review. Review of the literature demonstrate that the importance of preoperative assessment of vascular, biliary and liver volume to ensure donor safety and adequate surgical planning for graft procurement is widely recognized. Moreover, data indicates that anatomic variants in vascular and biliary systems in healthy donors are common, present in up to 50% of the population. Therefore, comprehensive mapping and visualizations of each component is needed. Different imaging modalities are reported across practices and are discussed in detail. Lastly, assessment of liver volume must take into account several technical and donor factors that increase the chances of errors in volume estimation, which occurs in up to 10% of the cases. Experience suggests that maximizing donor safety and lessening their risks is a result of integrated experience between hepatobiliary and transplant surgery, along with multidisciplinary efforts in performing a comprehensive pre-operative donor assessment. Although technical advances have increased the accuracy of volume estimation, over- or under-estimation remains a challenge that needs further attention.
Collapse
Affiliation(s)
- Nicolas Goldaracena
- Department of Surgery, Division of Transplantation, University of Virginia Health System, 1215 Lee Street, PO Box 800709, Charlottesville, VA, 22908-0709, USA.
| | - Paola A Vargas
- Department of Surgery, Division of Transplantation, University of Virginia Health System, 1215 Lee Street, PO Box 800709, Charlottesville, VA, 22908-0709, USA
| | - Lucas McCormack
- Transplant Unit, Hospital Aleman de Buenos Aires, Buenos Aires, Argentina
| |
Collapse
|
2
|
Wada H, Suzuki H, Sakairi Y, Tanaka K, Sata Y, Toyoda T, Inage T, Matsui Y, Yoshino I. Can modified frailty index predict postoperative complication after lung cancer surgery? Gen Thorac Cardiovasc Surg 2024; 72:176-182. [PMID: 37474741 DOI: 10.1007/s11748-023-01962-3] [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: 06/08/2023] [Accepted: 07/09/2023] [Indexed: 07/22/2023]
Abstract
PURPOSE The impact of the modified frailty index (mFI) on postoperative complications after lung cancer surgery was investigated. METHODS Patients who underwent lung cancer surgery in 2017 were included. 30-day postoperative mortality and morbidity were evaluated according to their Clavien-Dindo classification. mFI values are presented as the sum of values of 11 included items. Logistic regression was used to assess the effect of mFI on postoperative severe complication incidence. RESULTS Among 190 patients considered, severe postoperative complications (Grade 3 or more) were observed in 30 (16%). No patients died within 30 days of surgery. The incidence of severe complications was 3.6% in patients with mFI of 0, 16.2% in patients with mFI of 1, 23.4% in patients with mFI of 2, and 31.6% in patients with mFI of 3 or more, and was correlated with the grade of mFI. Univariate and multivariate analyses showed that the high mFI was significantly predictive of postoperative complications. Frail patients of mFI ≥ 2 were at 3.0-fold greater risk of severe complications than non-frail patients of mFI 0 or 1. CONCLUSION mFI was associated with morbidity after lung cancer surgery. Preoperative frailty assessment and appropriate intervention to frail patients would be required to improve postoperative outcomes.
Collapse
Affiliation(s)
- Hironobu Wada
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
- Department of Thoracic Surgery, International University of Health and Welfare School of Medicine, 4-3, Kozunomori, Narita, 286-8686, Japan
| | - Hidemi Suzuki
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Yuichi Sakairi
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Kazuhisa Tanaka
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Yuki Sata
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Takahide Toyoda
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Terunaga Inage
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Yukiko Matsui
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
- Department of Thoracic Surgery, International University of Health and Welfare School of Medicine, 4-3, Kozunomori, Narita, 286-8686, Japan
| |
Collapse
|
3
|
Gong M, Liu L, Ren H, He P, Ran X, Xu Y, Zou Y, Wu J, Li Z, Tan W, Zhang Z, Li K. Value of the virtual monoenergetic image from dual-layer dual-energy computed tomography enterography in the preoperative assessment of the internal penetrating complication of Crohn's disease. Abdom Radiol (NY) 2024; 49:814-822. [PMID: 38150141 DOI: 10.1007/s00261-023-04148-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/13/2023] [Accepted: 12/04/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND To determine the utility of virtual-monoenergetic imaging (VMI) at low energy levels from contrast-enhanced dual-layer dual-energy (DLDE) computed tomography enterography (CTE) in the preoperative assessment of internal penetrating lesions of Crohn's disease (CD). MATERIALS AND METHODS Thirty-eight patients with penetrating lesions of CD by surgery undergoing contrast-enhanced DLDE CTE were retrospectively included. Polyenergetic imaging (PEI) and VMIs at low energy levels [40-70 kiloelectron volts (keV)] with 10 keV intervals were reconstructed. The objective parameters of image quality [noise, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR)] and the subjective parameter of image quality [diagnostic performance of lesions (DPL), overall image quality(OIQ)] of PEI and all VMIs at the low energy level were compared to determine the VMI on the optimal energy level. The lesion detection capability between PEI and the optimal VMI was compared. RESULTS VMI40 was determined to be the optimal VMI among all VMIs at the low energy level for owning the best image quality. No significant difference was found in the detecting capability in penetrating lesions between VMI40 and PEI (p = 1.0), whereas a significant difference was found in the detecting capability in the bowel origin of the penetrating lesions (p = 0.004), the involved organ or structure by the fistula (p = 0.016) and the orifice of the fistula connected to the involved organ or structure ( p = 0.031) between them. CONCLUSIONS Compared to conventional PEI, VMI40 improves the detection capability in anatomical details of penetrating lesions of CD, helping colorectal surgeons rationalizing preoperative plans of internal penetrating lesions of CD.
Collapse
Affiliation(s)
- Meilin Gong
- Department of Radiology, Chongqing General Hospital, 118 Xingguang Street, Yubei District, Chongqing, 400000, ChongQing Province, China
| | - Lili Liu
- Department of Radiology, Chongqing General Hospital, 118 Xingguang Street, Yubei District, Chongqing, 400000, ChongQing Province, China
| | - Huanhuan Ren
- Department of Radiology, Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China
| | - Peipei He
- Department of Radiology, Chongqing General Hospital, 118 Xingguang Street, Yubei District, Chongqing, 400000, ChongQing Province, China
| | - Xiong Ran
- Department of Radiology, Chongqing General Hospital, 118 Xingguang Street, Yubei District, Chongqing, 400000, ChongQing Province, China
| | - Yu Xu
- Department of Radiology, Chongqing General Hospital, 118 Xingguang Street, Yubei District, Chongqing, 400000, ChongQing Province, China
| | - Ya Zou
- Department of Radiology, Chongqing General Hospital, 118 Xingguang Street, Yubei District, Chongqing, 400000, ChongQing Province, China
| | - Jingsong Wu
- Department of General Surgery, Chongqing General Hospital, Chongqing, China
| | - Zan Li
- Department of Pathology, Chongqing General Hospital, Chongqing, China
| | - Wei Tan
- Department of Gastroenterology, Chongqing General Hospital, Chongqing, China
| | - Zhengying Zhang
- Department of Health Management Center, Chongqing General Hospital, 5 Xingguang Road, Xingguang Street, Yubei District, Chongqing, 400000, ChongQing Province, China.
| | - Kang Li
- Department of Radiology, Chongqing General Hospital, 118 Xingguang Street, Yubei District, Chongqing, 400000, ChongQing Province, China.
| |
Collapse
|
4
|
Popovich SM, Vetter TR. Preoperative Management of the Adult Oncology Patient. Anesthesiol Clin 2024; 42:145-158. [PMID: 38278586 DOI: 10.1016/j.anclin.2023.07.004] [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] [Indexed: 01/28/2024]
Abstract
Anesthesiologists are experiencing first-hand the aging population, given older patients more frequently presenting for surgery, often with geriatric syndromes influencing their anesthetic management. The overall incidence and health burden of cancer morbidity and mortality are also rapidly increasing worldwide. This growth in the cancer population, along with the associated risk factors and comorbidities often accompanying a cancer diagnosis, underscores the need for anesthesiologists to become well versed in the preoperative evaluation and management of the adult patient with cancer. This article will focus on the unique challenges and opportunities for the anesthesiologist caring for the adult oncology patient presenting for surgery.
Collapse
Affiliation(s)
- Shannon M Popovich
- Department of Anesthesiology and Perioperative Medicine, Division of Anesthesiology, Critical Care Medicine and Pain Medicine, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Thomas R Vetter
- Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Health Discovery Building, Room 6.812, 1701 Trinity Street, Austin, TX 78712-1875, USA.
| |
Collapse
|
5
|
Macias AA, Goldfarb J. Preoperative Evaluation of Patients Undergoing Eye Surgery. Anesthesiol Clin 2024; 42:159-168. [PMID: 38278587 DOI: 10.1016/j.anclin.2023.08.006] [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] [Indexed: 01/28/2024]
Abstract
Ophthalmic surgery encompasses a wide range of procedures addressing various ocular conditions. Although generally considered low risk, a thorough preoperative evaluation is still crucial in optimizing patient outcomes and ensuring safe surgical interventions. This review provides a comprehensive overview of the preoperative assessment and management of patients presenting for ophthalmic surgery, specifically focusing on cataract surgery. We discuss the role of routine preoperative testing, the assessment of intraocular factors, and the evaluation of systemic comorbidities and medications. The review emphasizes the importance of individualized decision-making based on patient-specific factors and collaborative efforts between ophthalmologists and the health-care team.
Collapse
Affiliation(s)
- Alvaro Andres Macias
- Department of Anesthesiology, UCSD, University of California San Diego, 9300 Campus Point Drive, #7770, San Diego, CA 92037, USA.
| | - Jeremy Goldfarb
- Department of Anesthesia, Hospital Medicine, Massachusetts Eye and Ear, Harvard Medical School
| |
Collapse
|
6
|
Abrard S, Streichenberger A, Riou J, Hersant J, Rineau E, Jacquet-Lagrèze M, Fouquet O, Henni S, Rimmelé T. Preoperative endothelial dysfunction for the prediction of acute kidney injury after cardiac surgery using cardiopulmonary bypass: a pilot study based on a second analysis of the MONS study. Perioper Med (Lond) 2024; 13:12. [PMID: 38424616 PMCID: PMC10903056 DOI: 10.1186/s13741-024-00364-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 02/13/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Up to 42% of patients develop acute kidney injury (AKI) after cardiac surgery. The aim of this study was to describe the relationship between preoperative microcirculatory function and postoperative AKI after cardiac surgery using cardiopulmonary bypass (CPB). METHODS The prospective observational cohort MONS enrolled 60 patients scheduled for valvular (n = 30, 50%) or coronary (n = 30, 50%) surgery using CPB. Preoperative microcirculation was assessed during preoperative consultation from January 2019 to April 2019 at the University Hospital of Angers, France, using endothelium-dependent and endothelium-independent reactivity tests on the forearm (iontophoresis of acetylcholine (ACh) and sodium nitroprusside (SNP), respectively). Skin blood flow was measured by laser speckle contrast imaging. The primary endpoint was the occurrence of AKI according to the KDIGO classification during the hospital stay. RESULTS Forty-three (71.7%) patients developed AKI during the in-hospital follow-up, and 15 (25%) were classified as KDIGO stage 1, 20 (33%) KDIGO stage 2, and 8 (13%) KDIGO stage 3. Regarding preoperative microcirculation, a higher peak amplitude of vasodilation in response to iontophoresis of ACh was found in patients with postoperative occurrence of AKI (35 [20-49] vs 23 [9-44] LSPU, p = 0.04). Iontophoresis of SNP was not significantly different according to AKI occurrence (34 [22-49] vs 36 [20-50] LSPU, p = 0.95). In a multivariable model, the preoperative peak amplitude at iontophoresis of ACh was independently associated with postoperative AKI (OR 1.045 [1.001-1.092], p = 0.045). CONCLUSIONS The preoperative peak amplitude of endothelium-dependent vasodilation is independently associated with the postoperative occurrence of AKI. TRIAL REGISTRATION Clinical-Trials.gov, NCT03631797. Registered 15 August 2018, https://clinicaltrials.gov/ct2/show/NCT03631797.
Collapse
Affiliation(s)
- Stanislas Abrard
- Department of Anesthesiology and Critical Care Medicine, Hospices Civils de Lyon, Edouard Herriot Hospital, 5 Pl d'Arsonval, Lyon, 69437, France.
- MitoVasc Institut, UMR INSERM 1083 ‑ CNRS 6015, University of Angers, 3 Rue Roger Amsler, Angers, 49100, France.
- Faculté de Médecine Lyon-Est, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, Cedex 08, Lyon, 69373, France.
| | - Antoine Streichenberger
- Department of Anesthesiology and Critical Care Medicine, Hospices Civils de Lyon, Edouard Herriot Hospital, 5 Pl d'Arsonval, Lyon, 69437, France
| | - Jérémie Riou
- Department of Methodology and Biostatistics Delegation to Clinical Research and Innovation, Angers University Hospital, 4 Rue Larrey, 49933, Angers, France
- Micro Et Nanomedecines Translationnelles, MINT, UMR INSERM 1066 - CNRS 6021, University of Angers, 3 Rue Roger Amsler, Angers, 49100, France
| | - Jeanne Hersant
- MitoVasc Institut, UMR INSERM 1083 ‑ CNRS 6015, University of Angers, 3 Rue Roger Amsler, Angers, 49100, France
- Department of Vascular Medicine, University Hospital of Angers, 4 Rue Larrey, 49933, Angers, France
| | - Emmanuel Rineau
- MitoVasc Institut, UMR INSERM 1083 ‑ CNRS 6015, University of Angers, 3 Rue Roger Amsler, Angers, 49100, France
- Department of Anesthesiology and Intensive Care, University Hospital of Angers, 4 Rue Larrey, 49933, Angers, France
| | - Matthias Jacquet-Lagrèze
- Faculté de Médecine Lyon-Est, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, Cedex 08, Lyon, 69373, France
- CarMeN Laboratory, UMR INSERM 1060, Université Claude Bernard Lyon 1, 59 Bd Pinel, Bron, 69500, France
- Department of Anesthesiology and Intensive Care Medicine, Hospices Civils de Lyon, University Hospital Louis Pradel, 59 Bd Pinel, Bron, 69500, France
| | - Olivier Fouquet
- MitoVasc Institut, UMR INSERM 1083 ‑ CNRS 6015, University of Angers, 3 Rue Roger Amsler, Angers, 49100, France
- Department of Cardiac Surgery, University Hospital of Angers, 4 Rue Larrey, 49933, Angers, France
| | - Samir Henni
- MitoVasc Institut, UMR INSERM 1083 ‑ CNRS 6015, University of Angers, 3 Rue Roger Amsler, Angers, 49100, France
- Department of Vascular Medicine, University Hospital of Angers, 4 Rue Larrey, 49933, Angers, France
| | - Thomas Rimmelé
- Department of Anesthesiology and Critical Care Medicine, Hospices Civils de Lyon, Edouard Herriot Hospital, 5 Pl d'Arsonval, Lyon, 69437, France
- Faculté de Médecine Lyon-Est, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, Cedex 08, Lyon, 69373, France
- Pathophysiology of Injury-Induced Immunosuppression, EA7426, Hospices Civils de Lyon - BioMérieux - University Claude Bernard Lyon 1, 5 Pl d'Arsonval, Lyon, 69437, France
| |
Collapse
|
7
|
Fadlallah A, Khattar G, Habre C, Khanafer D. Impact of removing soft contact lenses 1 day versus 1 month before surgery on the outcomes of microkeratome laser in situ keratomileusis. Int Ophthalmol 2024; 44:79. [PMID: 38351423 DOI: 10.1007/s10792-024-03012-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 10/29/2023] [Indexed: 02/16/2024]
Abstract
PURPOSE To compare the outcomes, safety, efficacy, and predictability of microkeratome laser in situ keratomileusis (LASIK) 24 h and one month or more after removing soft contact lenses. SETTING ULTRALASIK Eye Center, Dubai, United Arab Emirates. METHODS The patients were divided based on the time of discontinuation of the soft contact lenses before LASIK (Group 1 at 24 h and Group 2 at one month or longer), and the two groups were well matched. Schirmer's testing, tear break-up time, corrected distance visual acuity, uncorrected distance visual acuity, manifest refraction spherical equivalent, and infection rate were evaluated preoperatively and at one week, one month, and six months after treatment. RESULTS Group 1 (G1) comprised 1025 eyes, and group 2 (G2) had 1052 eyes. The groups were comparable preoperatively. The overall-mentioned outcomes were comparable between groups with uncorrected distance visual acuity of - 0.084 ± 0.12 logMAR in G1 and - 0.078 ± 0.17 logMAR in the G2 at 6 months (P = 0.322). Tear break-up time as well as Schirmer's testing results was also comparable with no evidence of increased risk of dry eyes or non-inflammatory complications in any of the groups on follow-up visits at 1 week (P = 0.421), 1 month (P = 0.101), and 6 months (P = 0.399) postoperatively. Finally, no infectious complications were recorded in either of the groups. CONCLUSION With the absence of corneal warpage, no statistical or clinical difference in microkeratome LASIK outcomes and safety was spotted between the groups despite the difference in SCL discontinuation time before the procedure.
Collapse
Affiliation(s)
- Ali Fadlallah
- UltraLasik Eye Center, Dubai Health Care City, Building 27, Block A, Floor 6, Dubai, UAE.
- Eye and Ear Hospital International, Naqqache, Lebanon.
- Holy Spirit University of Kaslik, Jounieh, Lebanon.
| | - Georges Khattar
- Holy Spirit University of Kaslik, Jounieh, Lebanon
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Charbel Habre
- Eye and Ear Hospital International, Naqqache, Lebanon
- Holy Spirit University of Kaslik, Jounieh, Lebanon
| | - Dana Khanafer
- UltraLasik Eye Center, Dubai Health Care City, Building 27, Block A, Floor 6, Dubai, UAE
| |
Collapse
|
8
|
Raffone A, Raimondo D, Neola D, Travaglino A, Raspollini A, Giorgi M, Santoro A, De Meis L, Zannoni GF, Seracchioli R, Casadio P, Guida M. Diagnostic Accuracy of Ultrasound in the Diagnosis of Uterine Leiomyomas and Sarcomas. J Minim Invasive Gynecol 2024; 31:28-36.e1. [PMID: 37778636 DOI: 10.1016/j.jmig.2023.09.013] [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: 06/25/2023] [Revised: 08/08/2023] [Accepted: 09/26/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Differential diagnosis between uterine leiomyomas and sarcomas is challenging. Ultrasound shows an uncertain role in the clinical practice given that pooled estimates about its diagnostic accuracy are lacking. OBJECTIVES To assess the accuracy of ultrasound in the differential diagnosis between uterine leiomyomas and sarcomas. DATA SOURCES A systematic review was performed searching 5 electronic databases (MEDLINE, Web of Sciences, Google Scholar, Scopus, and ClinicalTrial.gov) from their inception to June 2023. METHODS OF STUDY SELECTION All peer-reviewed observational or randomized clinical trials that reported an unbiased postoperative histologic diagnosis of uterine leiomyoma or uterine sarcoma that also comprised a preoperative ultrasonographic evaluation of the uterine mass. TABULATION, INTEGRATION, AND RESULTS Sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratio, and area under the curve on summary receiver operating characteristic were calculated for each included study and as pooled estimate, with 95% confidence interval (CI); 972 women (694 with uterine leiomyomas and 278 with uterine sarcomas) were included. Ultrasound showed pooled sensitivity of 0.76 (95% CI, 0.70-0.81), specificity of 0.89 (95% CI, 0.87-0.92), positive and negative likelihood ratios of 6.65 (95% CI, 4.45-9.93) and 0.26 (95% CI, 0.07-1.0) respectively, diagnostic odds ratio of 23.06 (95% CI, 4.56-116.53), and area under the curve of 0.8925. CONCLUSIONS Ultrasound seems to have only a moderate diagnostic accuracy in the differential diagnosis between uterine leiomyomas and sarcomas, with a lower sensitivity than specificity.
Collapse
Affiliation(s)
- Antonio Raffone
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy (Drs. Raffone, Raspollini, and Seracchioli); Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy (Drs. Raffone, Neola, and Guida)
| | - Diego Raimondo
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (Drs. Raimondo, Raspollini, De Meis, Seracchioli, and Casadio).
| | - Daniele Neola
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy (Drs. Raffone, Neola, and Guida)
| | - Antonio Travaglino
- Unit of Pathology, Department of Medicine and Technological Innovation, University of Insubria, Varese, Italy (Dr. Travaglino)
| | - Arianna Raspollini
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy (Drs. Raffone, Raspollini, and Seracchioli); Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (Drs. Raimondo, Raspollini, De Meis, Seracchioli, and Casadio)
| | - Matteo Giorgi
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy (Dr. Giorgi)
| | - Angela Santoro
- Gynecopathology and Breast Pathology Unit, Department of Woman's Health Science, Agostino Gemelli University Polyclinic, Rome, Italy (Drs. Santoro and Zannoni)
| | - Lucia De Meis
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (Drs. Raimondo, Raspollini, De Meis, Seracchioli, and Casadio)
| | - Gian Franco Zannoni
- Gynecopathology and Breast Pathology Unit, Department of Woman's Health Science, Agostino Gemelli University Polyclinic, Rome, Italy (Drs. Santoro and Zannoni)
| | - Renato Seracchioli
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy (Drs. Raffone, Raspollini, and Seracchioli); Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (Drs. Raimondo, Raspollini, De Meis, Seracchioli, and Casadio)
| | - Paolo Casadio
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (Drs. Raimondo, Raspollini, De Meis, Seracchioli, and Casadio)
| | - Maurizio Guida
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy (Drs. Raffone, Neola, and Guida)
| |
Collapse
|
9
|
Dubuisson N, de Maere d'Aertrijcke O, Marta M, Gnanapavan S, Turner B, Baker D, Schmierer K, Giovannoni G, Verma V, Docquier MA. Anaesthetic management of people with multiple sclerosis. Mult Scler Relat Disord 2023; 80:105045. [PMID: 37866022 DOI: 10.1016/j.msard.2023.105045] [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: 02/09/2023] [Revised: 08/27/2023] [Accepted: 09/29/2023] [Indexed: 10/24/2023]
Abstract
There is a lack of published guidelines on the management of patients with multiple sclerosis (MS) undergoing procedures that require anaesthesia and respective advice is largely based on retrospective studies or case reports. The aim of this paper is to provide recommendations for anaesthetists and neurologists for the management of patients with MS requiring anaesthesia. This review covers issues related to the anaesthetic management of patients with MS, with a focus on preoperative assessment, choice of anaesthetic techniques and agents, side-effects of drugs used during anaesthesia and their potential impact on the disease evolution, drug interactions that may occur, and the need to use monitoring devices. A systematic PubMed research was performed to retrieve relevant articles.
Collapse
Affiliation(s)
- N Dubuisson
- Faculty of Medicine and Dentistry, Blizard Institute (Neuroscience), Queen Mary University London, 4 Newark Street, London E1 2AT, UK; Neuromuscular Reference Center, Department of Neurology, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, Brussels 1200, Belgium.
| | - O de Maere d'Aertrijcke
- Department of Anesthesia and Perioperative Medicine, Cliniques Universitaires Saint-Luc, St Luc Hospital, Avenue Hippocrate 10, Brussels 1200, Belgium
| | - M Marta
- Faculty of Medicine and Dentistry, Blizard Institute (Neuroscience), Queen Mary University London, 4 Newark Street, London E1 2AT, UK; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - S Gnanapavan
- Faculty of Medicine and Dentistry, Blizard Institute (Neuroscience), Queen Mary University London, 4 Newark Street, London E1 2AT, UK; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - B Turner
- Faculty of Medicine and Dentistry, Blizard Institute (Neuroscience), Queen Mary University London, 4 Newark Street, London E1 2AT, UK; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - D Baker
- Faculty of Medicine and Dentistry, Blizard Institute (Neuroscience), Queen Mary University London, 4 Newark Street, London E1 2AT, UK
| | - K Schmierer
- Faculty of Medicine and Dentistry, Blizard Institute (Neuroscience), Queen Mary University London, 4 Newark Street, London E1 2AT, UK; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - G Giovannoni
- Faculty of Medicine and Dentistry, Blizard Institute (Neuroscience), Queen Mary University London, 4 Newark Street, London E1 2AT, UK; Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - V Verma
- Department of Anesthesia, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - M-A Docquier
- Department of Anesthesia and Perioperative Medicine, Cliniques Universitaires Saint-Luc, St Luc Hospital, Avenue Hippocrate 10, Brussels 1200, Belgium
| |
Collapse
|
10
|
Hetherington A, Verhoeff K, Mocanu V, Birch DW, Karmali S, Switzer NJ. MBSAQIP risk calculator use in bariatric surgery is associated with a reduction in serious complications: a retrospective analysis of 210,710 patients. Surg Obes Relat Dis 2023; 19:1228-1234. [PMID: 37442754 DOI: 10.1016/j.soard.2023.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/30/2023] [Accepted: 05/27/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND The Metabolic and Bariatric Accreditation and Quality Improvement Program (MBSAQIP) Bariatric Surgical Risk/Benefit Calculator was developed to provide patient-specific information to assist surgical decision-making. To date, no study has characterized which patients are being evaluated with this tool. OBJECTIVE We sought to characterize the use and impact of the MBSAQIP calculator. SETTING MBSAQIP collects data from 955 centers in North America. METHODS The 2021 MBSAQIP database was evaluated for the use of the calculator on preoperative counseling for patients undergoing bariatric surgery. Patient characteristics, operative techniques, and outcomes were compared with bivariate analysis. Multivariable modeling evaluated factors including use of the calculator independently associated with serious complications and mortality. RESULTS Our study included 210,710 patients, 35,158 (16.7%) of whom were evaluated using the calculator. Patients with whom the calculator was used preoperatively were older (43.8 ± 11.6 yr versus 43.6 ± 11.7 yr; P < .001) and were more likely to have insulin-dependent diabetes, hypertension, gastroesophageal reflux disease, renal insufficiency, and sleep apnea. More patients underwent Roux-en-Y gastric bypass in the calculator cohort compared with the cohort that did not use the calculator (29.6% versus 28.6%; P < .003). The rate of serious complication was significantly less in the calculator cohort (3.1% versus 3.4%; P < .030). Multivariable modeling evaluating serious complications showed that use of the calculator was independently associated with reduced risk of serious complications (odds ratio .87, CI .82-.93, P < .001) but was not associated with mortality. CONCLUSION The use of the risk calculator may help to reduce the incidence of complications by opening a dialogue between healthcare professionals and patients, setting realistic expectations, and identifying modifiable risk factors.
Collapse
Affiliation(s)
| | - Kevin Verhoeff
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
| | - Valentin Mocanu
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Daniel W Birch
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Shahzeer Karmali
- Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Noah J Switzer
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
11
|
Chen A, An E, Yan E, He D, Saripella A, Butris N, Tsang J, Englesakis M, Wong J, Alibhai S, Chung F. Incidence of preoperative instrumental activities of daily living (IADL) dependence and adverse outcomes in older surgical patients: A systematic review and meta-analysis. J Clin Anesth 2023; 89:111151. [PMID: 37210810 DOI: 10.1016/j.jclinane.2023.111151] [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: 02/09/2023] [Revised: 04/26/2023] [Accepted: 05/15/2023] [Indexed: 05/23/2023]
Abstract
STUDY OBJECTIVE Instrumental activities of daily living (IADLs) are essential to patient function and quality of life after surgery. In older surgical patients, the incidence of preoperative IADL dependence has not been well characterized in the literature. This systematic review and meta-analysis aimed to determine the pooled incidence of preoperative IADL dependence and the associated adverse outcomes in the older surgical population. DESIGN Systematic review and meta-analysis. SETTING MEDLINE, MEDLINE Epub Ahead of Print and In-Process, In-Data-Review & Other Non-Indexed Citations, Embase/Embase Classic, Cochrane CENTRAL, and Cochrane Database of Systematic Reviews, ClinicalTrials.Gov, the WHO ICTRP (International Clinical Trials Registry Platform) were searched for relevant articles from 1969 to April 2022. PATIENTS Patients aged ≥60 years old undergoing surgery with preoperative IADL assessed by the Lawton IADL Scale. INTERVENTIONS Preoperative assessment. MEASUREMENT The primary outcome was the pooled incidence of preoperative IADL dependency. Additional outcomes included post-operative mortality, postoperative delirium [POD], functional status improvement, and discharge disposition. MAIN RESULTS Twenty-one studies (n = 5690) were included. In non-cardiac surgeries, the pooled incidence of preoperative IADL dependence was 37% (95% CI: 26.0%, 48.0%) among 2909 patients. Within cardiac surgeries, the pooled incidence of preoperative IADL dependence was 53% (95% CI: 24.0%, 82.0%) among 1074 patients. Preoperative IADL dependence was associated with an increased risk of postoperative delirium than those without IADL dependence (44.9% vs 24.4, OR 2.26; 95% CI: 1.42, 3.59; I2: 0%; P = 0.0005). CONCLUSIONS There is a high incidence of IADL dependence in older surgical patients undergoing non-cardiac and cardiac surgery. Preoperative IADL dependence was associated with a two-fold risk of postoperative delirium. Further work is needed to determine the feasibility of using the IADL scale preoperatively as a predictive tool for postoperative adverse outcomes.
Collapse
Affiliation(s)
- Alisia Chen
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Ekaterina An
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Ellene Yan
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - David He
- Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Aparna Saripella
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Nina Butris
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Jinny Tsang
- Department of Immunology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Marina Englesakis
- Library & Information Services, University Health Network, Toronto, ON, Canada
| | - Jean Wong
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Shabbir Alibhai
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Medicine, University Health Network and University of Toronto, Toronto, Canada
| | - Frances Chung
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
12
|
Wade S, Marshall E. A pharmacist-led penicillin allergy de-labelling project within a preoperative assessment clinic: the low-hanging fruit is within reach. J Hosp Infect 2023; 139:1-5. [PMID: 37343770 DOI: 10.1016/j.jhin.2023.06.012] [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: 06/08/2022] [Revised: 05/24/2023] [Accepted: 06/05/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Having a false penicillin-allergy label is linked to longer hospital stays and to an increased risk of Clostridioides difficile and meticillin-resistant Staphylococcus aureus infection. AIM To assess a penicillin-allergy de-labelling tool designed for use by the non-allergist. METHODS Patients attending the surgical preoperative assessment clinic (POAC) at a large UK teaching hospital, who reported a penicillin allergy, were directly de-labelled by nursing or pharmacy staff, where appropriate. A penicillin-allergy de-labelling tool designed for use by the non-allergist was adapted and applied; nursing staff were provided with supporting information and education to enable removal of spurious labels. Antimicrobial pharmacists (AMPs) provided follow-up, cross-checked prophylactic antibiotics administered, interrogated clinical notes, and telephoned patients following their surgery, for details of any adverse reactions suffered. FINDINGS A total of 163 patients reporting a penicillin allergy were identified for intervention. Twenty-nine (17.8%) patients reported a penicillin-allergy history appropriate for direct de-labelling, of whom eight (27.6%) declined to consent. The remaining 21 patients (12.8%) were directly de-labelled, with 12 (7.4%) patients consenting during their POAC appointment; the remaining nine (5.5%) patients were consented and de-labelled after their surgery by an AMP. CONCLUSION The POAC was identified as an appropriate location and time-point in the patient pathway to enable the direct removal of spurious penicillin-allergy labels prior to surgery. Results suggest that this could be undertaken by nursing staff, although support from AMPs enabled a greater number of patients to be de-labelled.
Collapse
Affiliation(s)
- S Wade
- University Hospitals Bristol & Weston NHS Foundation Trust, Marlborough Street, Bristol, UK.
| | - E Marshall
- University Hospitals Bristol & Weston NHS Foundation Trust, Marlborough Street, Bristol, UK
| |
Collapse
|
13
|
Urbonas T, Lakha AS, King E, Pepes S, Ceresa C, Udupa V, Soonawalla Z, Silva MA, Gordon-Weeks A, Reddy S. The safety of telemedicine clinics as an alternative to in-person preoperative assessment for elective laparoscopic cholecystectomy in patients with benign gallbladder disease: a retrospective cohort study. Patient Saf Surg 2023; 17:23. [PMID: 37644474 PMCID: PMC10466851 DOI: 10.1186/s13037-023-00368-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 07/06/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND The telemedicine clinic for follow up after minor surgical procedures in general surgery is now ubiquitously considered a standard of care. However, this method of consultation is not the mainstay for preoperative assessment and counselling of patients for common surgical procedures such as laparoscopic cholecystectomy. The aim of this study was to evaluate the safety of assessing and counselling patients in the telemedicine clinic without a physical encounter for laparoscopic cholecystectomy. METHODS We conducted a retrospective analysis of patients who were booked for laparoscopic cholecystectomy for benign gallbladder disease via general surgery telemedicine clinics from March 2020 to November 2021. The primary outcome was the cancellation rate on the day of surgery. The secondary outcomes were complication and readmission rates, with Clavein-Dindo grade III or greater deemed clinically significant. We performed a subgroup analysis on the cases cancelled on the day of surgery in an attempt to identify key reasons for cancellation following virtual clinic assessment. RESULTS We identified 206 cases booked for laparoscopic cholecystectomy from telemedicine clinics. 7% of patients had a cancellation on the day of surgery. Only one such cancellation was deemed avoidable as it may have been prevented by a face-to-face assessment. Severe postoperative adverse events (equal to or greater than Clavien-Dindo grade III) were observed in 1% of patients, and required re-intervention. 30-day readmission rate was 11%. CONCLUSIONS Our series showed that it is safe and feasible to assess and counsel patients for laparoscopic cholecystectomy remotely with a minimal cancellation rate on the day of operation. Further work is needed to understand the effect of remote consultations on patient satisfaction, its environmental impact, and possible benefits to healthcare economics to support its routine use in general surgery.
Collapse
Affiliation(s)
- Tomas Urbonas
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Adil Siraj Lakha
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Emily King
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Sophia Pepes
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Carlo Ceresa
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Venkatesha Udupa
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Zahir Soonawalla
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Michael A Silva
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Alex Gordon-Weeks
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Srikanth Reddy
- Department of hepatobiliary surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| |
Collapse
|
14
|
Khalid A, Saleem MA, Ihsan-Ul-Haq, Khan Y, Rashid S, Dar FS. Anatomical variations in living donors for liver transplantation-prevalence and relationship. Langenbecks Arch Surg 2023; 408:323. [PMID: 37597008 DOI: 10.1007/s00423-023-03066-1] [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: 05/18/2023] [Accepted: 08/14/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE Living donor liver transplantation (LDLT) is a widely accepted option to address the lack of a deceased liver program for transplantation. Understanding vascular and biliary anatomy and their variants is crucial for successful and safe graft harvesting. Anatomic variations are common, particularly in the right hepatic lobe. To provide evidence for screening potential liver transplant donors, the presence of vascular and biliary anatomic variations in Pakistan's preoperative assessment of transplantation donor candidates was explored. METHODS This retrospective cross-sectional study evaluated the hepatic artery, portal vein, hepatic vein, and biliary variations in living liver donors. The study included 400 living liver donors; data were collected from March 2019 to March 2023. We used a CT scan and MRCP to assess the anatomical variations. RESULTS The study examined 400 liver donors aged 18 to 53 years. Conventional arterial anatomy was the most common (65.8%), followed by replaced right hepatic artery (16%) and replaced left hepatic artery (10.8%). Conventional type 1 biliary anatomy was seen in 65.8% of cases. The dominant right hepatic vein was found in 13.3% of donors. There was a significant association between the prevalence of variant portal venous anatomy with variant biliary anatomy. CONCLUSION Variations of the hepatic arterial, portal venous, and biliary systems are frequent and should be carefully evaluated while selecting a suitable living donor. A strong relationship between variant portal venous and biliary anatomy was found. These findings can aid in selecting suitable candidates and improving surgical planning for liver transplantation.
Collapse
Affiliation(s)
- Abdullah Khalid
- Hepatopancreatic Biliary Surgery and Liver Transplant Unit, Pakistan Kidney & Liver Institute & Research Center (PKLI&RC), DHA Phase VI, Lahore, Pakistan.
| | - M Asad Saleem
- Hepatopancreatic Biliary Surgery and Liver Transplant Unit, Pakistan Kidney & Liver Institute & Research Center (PKLI&RC), DHA Phase VI, Lahore, Pakistan
| | - Ihsan-Ul-Haq
- Hepatopancreatic Biliary Surgery and Liver Transplant Unit, Pakistan Kidney & Liver Institute & Research Center (PKLI&RC), DHA Phase VI, Lahore, Pakistan
| | - Yasir Khan
- Hepatopancreatic Biliary Surgery and Liver Transplant Unit, Pakistan Kidney & Liver Institute & Research Center (PKLI&RC), DHA Phase VI, Lahore, Pakistan
| | - Sohail Rashid
- Hepatopancreatic Biliary Surgery and Liver Transplant Unit, Pakistan Kidney & Liver Institute & Research Center (PKLI&RC), DHA Phase VI, Lahore, Pakistan
| | - Faisal Saud Dar
- Hepatopancreatic Biliary Surgery and Liver Transplant Unit, Pakistan Kidney & Liver Institute & Research Center (PKLI&RC), DHA Phase VI, Lahore, Pakistan
| |
Collapse
|
15
|
Lu Z, Ding A, Yu Q, Wang H, Ma L. Effect of the preoperative assessment of the anteroposterior diameters of the spinal canal and dural area on the efficacy of oblique lumbar interbody fusion in patients with lumbar spinal stenosis. J Orthop Surg Res 2023; 18:440. [PMID: 37337281 DOI: 10.1186/s13018-023-03913-3] [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: 03/04/2023] [Accepted: 06/06/2023] [Indexed: 06/21/2023] Open
Abstract
OBJECTIVE The purpose of this study was to quantify the degree of lumbar spinal stenosis by assessing the anterior and posterior vertebral canal diameter and dural area, determine the sensitivity of the anterior and posterior spinal canal diameter, dural area and dural occupying rate in predicting the postoperative efficacy of oblique lumbar interbody fusion (OLIF) for patients with single-stage lumbar spinal stenosis, and identify the corresponding indicators suggesting that OLIF surgery should not be performed. METHODS In a retrospective analysis of patients who had previously undergone OLIF surgery in our hospital, we included a total of 104 patients with lumbar spinal stenosis who had previously undergone single-stage surgery in our hospital. Three independent observers were employed to measure the anterior and posterior diameter of the spinal canal (AD, mm), dural area (CSA, mm2), the spinal canal area (SCA, mm2), and the ratio of the dural area to the spinal canal area (DM, %) at the disc level with the most severe stenosis on MRI. According to the values of AD and CSA in preoperative MRI, patients were divided into three groups: A, B, and C (Group A: AD > 12 and 100 < CSA ≤ 130, group B: Except A and C, group C: AD ≤ 10 and CSA ≤ 75). Preoperative and postoperative clinical outcome scores (Japanese Orthopaedic Association [JOA] score, VAS score, modified Macnab standard) of 104 patients were statistically. RESULTS There were significant differences in the preoperative and postoperative clinical correlation scores among the mild, moderate and severe lumbar spinal stenosis groups. The improvement rate of the post treatment JOA score, the difference between the preoperative and postoperative VAS score, and the modified Macnab standard were compared pairwise. There was no statistical significance in the improvement rate of the post treatment JOA score, the difference between the preoperative and postoperative VAS score, and the modified Macnab standard between Group A and Group B (P = 0.125, P = 0.620, P = 0.803). There were statistically significant differences between Group A and Group C and between Group B and Group C in the improvement rate of the JOA score, the difference in the pre- and postoperative VAS score, and the modified Macnab standard. The anterior and posterior vertebral canal diameter and dural area are sensitive predictors of the postoperative efficacy of OLIF surgery for single-stage lumbar spinal stenosis. Moreover, when the anterior and posterior vertebral canal diameter was less than 6.545 mm and the dural area was less than 34.43 mm2, the postoperative effect of OLIF surgery was poor. CONCLUSIONS All the patients with mild, moderate, and severe lumbar spinal stenosis achieved curative effects after OLIF surgery. Patients with mild and moderate lumbar spinal stenosis had better curative effects, and there was no significant difference between them, while patients with severe lumbar spinal stenosis had poor curative effects. Both the anteroposterior diameter of the spinal canal and the dural area of the spinal canal were sensitive in predicting the curative effect of OLIF surgery for single-stage lumbar spinal stenosis. When the anterior and posterior vertebral canal diameter was less than 6.545 mm and the dural area was less than 34.43 mm2, the postoperative effect of OLIF surgery was poor.
Collapse
Affiliation(s)
- Zhe Lu
- Hebei Medical University, Shijiazhuang, China
| | - Aoran Ding
- Hebei Medical University, Shijiazhuang, China
| | - Qingsong Yu
- Hebei Medical University, Shijiazhuang, China
| | | | - Lei Ma
- Hebei Medical University, Shijiazhuang, China.
| |
Collapse
|
16
|
Scarfield P, Ryan J, Sallam M, Saratzis A, Pichel AC, Dhesi JK, Partridge JSL. Preoperative assessment and optimisation prior to planned aortic aneurysm repair: a UK survey examining current practice and attitudes of vascular surgeons and vascular anaesthetists. Perioper Med (Lond) 2023; 12:24. [PMID: 37312201 DOI: 10.1186/s13741-023-00304-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/25/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND The majority of those diagnosed with aortic aneurysm in the UK are older, multi-morbid patients. Decision-making as to who may benefit from intervention (open or endovascular aneurysm repair) is highly variable across the NHS (as is the mode of intervention), in part because there are no detailed guidelines or consensus on preoperative assessment. Thus, there is likely to be significant variation in the pre-operative assessment and optimisation of these patients. METHODS A survey was designed to understand current practice and attitudes of vascular surgeons and vascular anaesthetists in the UK regarding preoperative assessment and optimisation of patients undergoing elective aortic aneurysm repair. The survey was reviewed and validated by an expert panel, then distributed electronically to all vascular surgical and vascular anaesthetic leads in the UK. RESULTS Overall, the response rate was 68%. The responses were varied between surgeons and anaesthetists, with differences reported in the preoperative assessment and optimisation of patients, the approach to shared decision-making, and the perioperative pathway. CONCLUSIONS Despite initiatives such as Getting It Right First Time (GIRFT) and National Institute for Health and Care Excellence (NICE) guidelines, variation still exists between centres with some differences in opinion observed between surgeons and anaesthetists. These differences may be leading to duplication of work in the perioperative pathway, inconsistencies in how risk is assessed and communicated with consequent variation in patient care. Addressing these issues requires awareness and implementation of existing guidelines, transdisciplinary working, efficient data-driven pathways, and structured aortic aneurysm multi-disciplinary team to promote meaningful shared decision-making.
Collapse
Affiliation(s)
| | - Jack Ryan
- Guy's and St. Thomas' NHS Foundation Trust, London, SE1 4YB, UK.
| | - Morad Sallam
- Guy's and St. Thomas' NHS Foundation Trust, London, SE1 4YB, UK
| | | | | | - Jugdeep K Dhesi
- Guy's and St. Thomas' NHS Foundation Trust, London, SE1 4YB, UK
| | | |
Collapse
|
17
|
Deeb AL, Garrity M, Cooper L, Frain LN, Jaklitsch MT, DuMontier C. Implementing 4-meter gait speed as a routine vital sign in a thoracic surgery clinic. J Geriatr Oncol 2023; 14:101481. [PMID: 37060720 PMCID: PMC10445274 DOI: 10.1016/j.jgo.2023.101481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 02/06/2023] [Accepted: 03/13/2023] [Indexed: 04/17/2023]
Affiliation(s)
- Ashley L Deeb
- Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, 15 Francis St, Boston, MA, USA.
| | - Matthew Garrity
- University of New England College of Osteopathic Medicine, 11 Hills Beach Rd, Biddeford, ME, USA
| | - Lisa Cooper
- Division of Aging, Brigham and Women's Hospital, 75 Francis St, Boston, MA, USA; Department of Geriatric Medicine, Rabin Medical Center, Campus Beilinson, 39 Jabotinski St, Petah Tikva, Israel
| | - Laura N Frain
- Division of Aging, Brigham and Women's Hospital, 75 Francis St, Boston, MA, USA
| | - Michael T Jaklitsch
- Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, 15 Francis St, Boston, MA, USA
| | - Clark DuMontier
- Division of Aging, Brigham and Women's Hospital, 75 Francis St, Boston, MA, USA; New England GRECC (Geriatrics Research, Education and Clinical Center), VA Boston Healthcare System, 150 S Huntington Ave, Boston, MA, USA
| |
Collapse
|
18
|
Ochoa O, Chrysopoulo MT. Preoperative Assessment of the Breast Reconstruction Patient. Clin Plast Surg 2023; 50:201-210. [PMID: 36813398 DOI: 10.1016/j.cps.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Through a multidisciplinary approach, as well as, a nuanced appreciation of patient goals and setting appropriate expectations, breast reconstruction can significantly improve the quality of life following mastectomy. A thorough review of the patient medical and surgical history in addition to oncologic treatments will facilitate discussion and recommendations for an individualized shared decision-making reconstructive process. Alloplastic reconstruction, although a highly popular modality, has important limitations. On the contrary, autologous reconstruction is more flexible but requires more thorough consideration.
Collapse
Affiliation(s)
- Oscar Ochoa
- PRMA Plastic Surgery, 9635 Huebner Road, San Antonio, TX 78240, USA.
| | | |
Collapse
|
19
|
Jatana S, Verhoeff K, Mocanu V, Jogiat U, Birch DW, Karmali S, Switzer NJ. Does ASA classification effectively risk stratify patients undergoing bariatric surgery: a MBSAQIP retrospective cohort of 138,612 of patients. Surg Endosc 2023:10.1007/s00464-023-10017-w. [PMID: 36961601 DOI: 10.1007/s00464-023-10017-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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 03/12/2023] [Indexed: 03/25/2023]
Abstract
INTRODUCTION It is important to appropriately risk stratify bariatric surgery patients, as these patients often have obesity-related comorbidities which can increase postoperative complication risk but also benefit the most from bariatric surgery. We aimed to evaluate the utility of risk stratification using ASA class for bariatric surgery patients and assessed predictive factors of postoperative complications. METHODS The 2020 MBSAQIP database was analyzed, and an ASA-deemed high-risk cohort (class IV) and normal-risk (ASA class II and III) cohort were compared. Univariate analysis was performed to characterize differences between cohorts and to compare complication rates. Multivariate logistic regression analysis was performed to determine factors associated with increased odds of postoperative complications. RESULTS We evaluated 138 612 patients with 5380 (3.9%) considered high-risk and 133 232 (96.1%) normal-risk. High-risk patients were more likely to be older (46.2 ± 12.0vs.43.4 ± 11.9, p < 0.001), male (30.9%vs.18.4%, p < 0.001), have higher BMI (51.4 ± 10.2vs.44.9 ± 7.4, p < 0.001), and have more comorbidities. High-risk patients were more likely to have increased 30-day serious complications (4.5%vs.2.8%, p < 0.001) and death (0.2%vs.0.1%, p = 0.001) but not anastomotic leak (0.2%vs.0.2%, p = 0.983). Multivariate models showed ASA class IV patients were at higher odds for any serious complication by 30 days (aOR 1.36, 95%CI 1.18-1.56, p < 0.001) but not for death (aOR 1.04, 95%CI 0.49-2.21, p = 0.921). The factor independently associated with the highest odds of complication in both models was functional status preoperatively (partially dependent aOR 2.06, 95%CI 1.56-2.72, p < 0.001; fully dependent aOR 3.19, 95%CI 1.10-9.28, p = 0.033 for any serious complication; partially dependent aOR 5.08, 95%CI 2.16-12.00, p < 0.001 for death). CONCLUSIONS While elevated ASA class correlates with increased serious complications, pre-operative functional status appears to have a much greater contribution to odds of serious complications and mortality. These findings question the utility of using ASA to risk stratify patients peri-operatively and provides evidence for using a simpler and more practical functional status approach.
Collapse
Affiliation(s)
- Sukhdeep Jatana
- Department of Surgery, University of Alberta, Dvorkin Lounge Mailroom2G2 Walter C. Mackenzie Health Sciences Centre, 8440 - 112 ST NW, Edmonton, AB, T6G 2B7, Canada
| | - Kevin Verhoeff
- Department of Surgery, University of Alberta, Dvorkin Lounge Mailroom2G2 Walter C. Mackenzie Health Sciences Centre, 8440 - 112 ST NW, Edmonton, AB, T6G 2B7, Canada.
| | - Valentin Mocanu
- Department of Surgery, University of Alberta, Dvorkin Lounge Mailroom2G2 Walter C. Mackenzie Health Sciences Centre, 8440 - 112 ST NW, Edmonton, AB, T6G 2B7, Canada
| | - Uzair Jogiat
- Department of Surgery, University of Alberta, Dvorkin Lounge Mailroom2G2 Walter C. Mackenzie Health Sciences Centre, 8440 - 112 ST NW, Edmonton, AB, T6G 2B7, Canada
| | - Daniel W Birch
- Department of Surgery, University of Alberta, Dvorkin Lounge Mailroom2G2 Walter C. Mackenzie Health Sciences Centre, 8440 - 112 ST NW, Edmonton, AB, T6G 2B7, Canada
- Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Shahzeer Karmali
- Department of Surgery, University of Alberta, Dvorkin Lounge Mailroom2G2 Walter C. Mackenzie Health Sciences Centre, 8440 - 112 ST NW, Edmonton, AB, T6G 2B7, Canada
- Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Noah J Switzer
- Department of Surgery, University of Alberta, Dvorkin Lounge Mailroom2G2 Walter C. Mackenzie Health Sciences Centre, 8440 - 112 ST NW, Edmonton, AB, T6G 2B7, Canada
| |
Collapse
|
20
|
Kamdar BB, Zee H, Preiss D, Navedo DD, Minehart RD. Perceptions and goals of preoperative planning conversations between anesthesiology residents and attending physicians. J Clin Anesth 2023; 87:111086. [PMID: 36871486 DOI: 10.1016/j.jclinane.2023.111086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 02/09/2023] [Accepted: 02/19/2023] [Indexed: 03/06/2023]
Abstract
STUDY OBJECTIVE To systematically evaluate anesthesiology resident and attending perceptions of preoperative planning conversations (POPCs) and to generate understanding for improving the educational and clinical value of this practice. DESIGN cross-sectional study. SETTING two large Northeastern US academic residency training programs. PARTICIPANTS clinically practicing anesthesiology residents and attendings. INTERVENTIONS An electronic survey was administered to 303 anesthesia attendings and 168 anesthesia residents across two academic institutions between June and July 2014. MEASUREMENTS Survey questions addressing phone call frequency and duration, clinical value, educational value and intended purpose of POPC were administered to both groups. Chi-squared tests were used to evaluate differences in responses between groups, with p < 0.05 as statistically significant. MAIN RESULTS Responses were collected from 93 attending physicians (31%) and 80 trainee physicians (48%) for an overall response rate of 37%. 99% of residents reported paging their attendings to engage in the POPC the evening prior to all operations and 95% of trainees reported almost always receiving a call back from the attending. Trainees overwhelmingly reported attendings would believe they were unprofessional or negligent if they did not initiate a POPC (73% vs 14%, chi-square = 60.9, p < 0.001). Attendings were much more likely to view the POPC as a very important tool to discuss perioperative events (60% vs 16%, chi-square = 37.3, p < 0.001) and necessary for the majority or every case (59% vs. 31%, chi-square = 13.5, p < 0.001). The majority of attendings and trainees did not find the POPC to be a very important educational tool in terms of assessing trainee knowledge base (14% vs. 6%, chi-square = 2.76, p = 0.097), discussing teaching opportunities (26% vs. 9%, chi-square = 8.5, p = 0.004), or establishing rapport (24% vs. 7% trainees, chi-square = 8.3, p = 0.004). CONCLUSIONS Significant discrepancies exist between how anesthesia attendings and residents perceive the purpose of the POPC, with trainees less likely to view the POPC as having clinical value and neither group perceiving the conversation as a very useful educational tool. The results highlight the need to reexamine the value of the daily POPC as a deliberate educational practice to meet expectations of both trainees and attendings.
Collapse
Affiliation(s)
- Brinda B Kamdar
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Howard Zee
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - David Preiss
- Harvard Medical School, Boston, MA, USA; Department of Anesthesia, Brigham & Women's Hospital, Boston, MA, USA
| | - Deborah D Navedo
- STRATUS Center for Medical Simulation, Brigham & Women's Hospital, Boston, MA, USA
| | - Rebecca D Minehart
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Center for Medical Simulation, Charlestown, MA, USA
| |
Collapse
|
21
|
Evans J, Chan J, Saraqini DH, Mallick R. Is there a role for referral of high-risk patients seen in preoperative medical consultation for postoperative inpatient follow-up? J Perioper Pract 2023; 33:76-81. [PMID: 34396824 DOI: 10.1177/17504589211031076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The potential benefit of referring select high-risk surgical patients who are seen during a preoperative medical consultation for postoperative inpatient medical follow-up is uncertain. Over a seven-year period, our internal medicine perioperative clinic referred 5% of 4642 preoperative consults for postoperative follow-up. A retrospective chart review found that although reasons for referral were heterogeneous, those assessed by the medical consult team postoperatively were more comorbid, had more adverse medical complications and had longer hospital admissions compared to those not referred. Physicians were best able to predict adverse cardiac and diabetes-related complications. Half of the patients who were referred for postoperative assessment were lost to follow-up, and there was a trend towards increased hospital readmissions in this group. Further research is required to identify the subset of patients who might benefit from postoperative inpatient medical assessment.
Collapse
Affiliation(s)
- Jessica Evans
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - James Chan
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | | | - Ranjeeta Mallick
- The Ottawa Methods Center, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| |
Collapse
|
22
|
Suzuki J, Shiono S, Suzuki K, Watanabe H, Takamori S, Sasage T, Sato K, Matsui Y, Uchida T, Watarai F. The preoperative assessment of thoracic wall adhesions using four-dimensional computed tomography. Gen Thorac Cardiovasc Surg 2023:10.1007/s11748-023-01912-z. [PMID: 36739555 DOI: 10.1007/s11748-023-01912-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 01/21/2023] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Pleural adhesions are challenging during lung cancer surgery and may be associated with a long surgery time and excessive blood loss due to pleural adhesiolysis. We used preoperative four-dimensional computed tomography to quantitatively assess parietal pleural adhesions and determine its diagnostic accuracy. METHODS A total of 216 patients with lung cancer underwent four-dimensional computed tomography during the study period. Pleural adhesions were subsequently confirmed by surgery in 85 of these patients, whereas 126 patients had no adhesions. The movements of the tumor or target vessels (α) was tracked. Receiver-operating characteristic curve analysis was used to identify the relationship between adhesions and (α). RESULTS The movement of (α) was smaller in patients with adhesions than in those without adhesions. The greater the adhesion, the shorter the movement distance (p < 0.001). Receiver-operating characteristic curve analysis demonstrated an area under the curve for the moving (α) point at 0.71 (95% confidence interval: 0.62-0.80) in the upper lung field and at 0.75 (95% confidence interval: 0.64-0.85) in the lower field. To identify adhesions, a cut off of 11.3 mm (sensitivity = 43.6%, specificity = 93.2%) in the upper lung field and a cut off of 41.2 mm (sensitivity = 71.4%, specificity = 66.0%) in the lower lung field were established. CONCLUSIONS Four-dimensional computed tomography is a novel and helpful modality for predicting the presence of parietal pleural adhesions. To obtain robust evidence, further accumulation of cases and re-examination of the analysis methods are needed.
Collapse
Affiliation(s)
- Jun Suzuki
- Faculty of Medicine, Department of Surgery II, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan.
| | - Satoshi Shiono
- Faculty of Medicine, Department of Surgery II, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Katsuyuki Suzuki
- Faculty of Medicine, Department of Surgery II, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Hikaru Watanabe
- Faculty of Medicine, Department of Surgery II, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Satoshi Takamori
- Faculty of Medicine, Department of Surgery II, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Takayuki Sasage
- Faculty of Medicine, Department of Surgery II, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Kaito Sato
- Faculty of Medicine, Department of Surgery II, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Yusuke Matsui
- Faculty of Medicine, Department of Surgery II, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Testsuro Uchida
- Faculty of Medicine, Department of Surgery II, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Fumika Watarai
- Faculty of Medicine, Department of Radiology, Division of Diagnostic Radiology, Yamagata University, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| |
Collapse
|
23
|
Louyot C, Portran P, Schweizer R, Glerant JC, Thivolet S, Brassart O, Mewton N, Jacquet-Lagreze M, Fellahi JL. Elaboration of a French version of the Duke Activity Status Index questionnaire and performance to predict functional capacity. Anaesth Crit Care Pain Med 2023; 42:101199. [PMID: 36706990 DOI: 10.1016/j.accpm.2023.101199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND Guidelines recommend detecting poor functional capacity (VO2max < 14 ml.kg-1.min-1) to assess preoperative cardiac risk. This screening is performed via a cardiopulmonary exercise test (CPET), the self-reported inability to climb two flights of stairs, or the use of the Duke Activity Status Index (DASI) questionnaire, which has shown a significant correlation with VO2max and postoperative outcomes. The objectives of the present study were: 1) to create a French version of the DASI questionnaire (FDASI); 2) to assess its diagnostic performance in predicting functional capacity. METHODS Consecutive adult patients undergoing CPET for medical or preoperative evaluation were prospectively included between May 2020 and March 2021. All patients were asked to complete FDASI as a self-questionnaire and report their inability to climb two flights of stairs. RESULTS 122 patients were included. Test-retest reliability was 0.88 and 23 (19%) patients experienced a VO2max < 14 ml.kg-1.min-1. There was a significant positive relationship between FDASI and VO2max: r2 = 0.32; p < 0.001. ROCAUC was 0.81 [95%CI: 0.73-0.89]. The best FDASI score threshold was 36 points, leading to sensitivity and specificity values of 87% [74-100] and 68% [56-79], respectively. Besides, sensitivity and specificity were 35% [17-56] and 92% [86-97] for the self-reported inability to climb two flights of stairs. CONCLUSION A FDASI score of 36 represents a reliable threshold the clinicians could routinely use to identify patients with a VO2max < 14 ml.kg-1.min-1. FDASI could advantageously replace the self-reported inability to climb two flights of stairs.
Collapse
Affiliation(s)
- Claire Louyot
- Service d'Anesthésie-Réanimation, Hôpital Louis Pradel, Hospices Civils de Lyon, 28 Avenue du Doyen Lépine, 69677 Bron Cedex, France.
| | - Philippe Portran
- Service d'Anesthésie-Réanimation, Hôpital Louis Pradel, Hospices Civils de Lyon, 28 Avenue du Doyen Lépine, 69677 Bron Cedex, France.
| | - Rémi Schweizer
- Service d'Anesthésie-Réanimation, Hôpital Louis Pradel, Hospices Civils de Lyon, 28 Avenue du Doyen Lépine, 69677 Bron Cedex, France
| | - Jean-Charles Glerant
- Service d'Explorations Fonctionnelles Respiratoires, Hôpital Louis Pradel, Hospices Civils de Lyon, 28 Avenue du Doyen Lépine, 69677 Bron Cedex, France
| | - Sophie Thivolet
- Service d'Explorations Fonctionnelles Cardiovasculaires, Hôpital Louis Pradel, Hospices Civils de Lyon, 28 Avenue du Doyen Lépine, 69677 Bron Cedex, France
| | - Océane Brassart
- Direction de la Recherche Clinique et de l'Innovation, Hôpital Louis Pradel, Hospices Civils de Lyon, 28 Avenue du Doyen Lépine, 69677 Bron Cedex, France
| | - Nathan Mewton
- Laboratoire CarMeN, Inserm UMR 1060, Université Claude Bernard Lyon 1, France
| | - Matthias Jacquet-Lagreze
- Service d'Anesthésie-Réanimation, Hôpital Louis Pradel, Hospices Civils de Lyon, 28 Avenue du Doyen Lépine, 69677 Bron Cedex, France; Laboratoire CarMeN, Inserm UMR 1060, Université Claude Bernard Lyon 1, France
| | - Jean-Luc Fellahi
- Service d'Anesthésie-Réanimation, Hôpital Louis Pradel, Hospices Civils de Lyon, 28 Avenue du Doyen Lépine, 69677 Bron Cedex, France; Laboratoire CarMeN, Inserm UMR 1060, Université Claude Bernard Lyon 1, France
| |
Collapse
|
24
|
Hanna V, Popovic MM, El-Defrawy S, Schlenker MB, Alaei R, Kertes PJ. Preoperative evaluations for ophthalmic surgery: A systematic review of 48,869 eyes. Surv Ophthalmol 2022; 68:526-538. [PMID: 36572226 DOI: 10.1016/j.survophthal.2022.12.004] [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: 12/07/2021] [Revised: 12/17/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022]
Abstract
Eliminating low-yield testing can reduce the burden on modern health care systems. Our purpose is to determine whether routine preoperative assessment impacts the incidence of perioperative complications in ophthalmic surgery. We conducted a comprehensive search of Ovid MEDLINE, EMBASE, and Cochrane Library databases to identify studies investigating the incidence of perioperative complications following any preoperative assessment for patients undergoing ophthalmic surgery (PROSPERO ID#164008). Four randomized controlled trials (RCTs) and 5 observational studies were selected for inclusion. Risk of bias assessment revealed a lack of masking and insufficient statistical power in RCTs, and confounding in observational studies. Routine preoperative testing-including laboratory tests, electrocardiogram, and imaging studiesdid not decrease the incidence of adverse events or risk of perioperative ocular and systemic complications in most studies. Two cohort studies (1 retrospective, 1 prospective) suggestd that patients with certain preexisting health conditions were at increased risk for adverse events perioperatively. Another retrospective study found a lower risk of complications in high-risk patients who underwent evaluation. While patients with comorbidities may be at increased risk of adverse events, the role of preoperative assessment is not well delineated in this population. Further study is required to determine the comparative safety, effectiveness, and implementation of alternative assessment tools.
Collapse
Affiliation(s)
- Verina Hanna
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Marko M Popovic
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Sherif El-Defrawy
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology, Kensington Eye Institute, Toronto, Ontario, Canada
| | - Matthew B Schlenker
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology, Kensington Eye Institute, Toronto, Ontario, Canada
| | - Ravin Alaei
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Peter J Kertes
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Ontario, Canada; John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
| |
Collapse
|
25
|
Goeddel LA, Grant MC. Preoperative Evaluation and Cardiac Risk Assessment in Vascular Surgery. Anesthesiol Clin 2022; 40:575-585. [PMID: 36328616 DOI: 10.1016/j.anclin.2022.08.005] [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] [Indexed: 06/16/2023]
Abstract
We summarize epidemiologic trends, outcomes, and preoperative guidelines for vascular surgery patients from 2010 to 2022. Vascular surgery continues to evolve in technology and engineering to treat a surgical population that suffers from a high prevalence of comorbidities. Preoperative optimization seeks to characterize the burden of disease and to achieve medical control in the timeline available before surgery. Risk assessment, evaluation, optimization, and prediction of major adverse cardiac events is an evolving science where the Vascular Surgery Quality Initiative has made an impact. Ongoing investigation may demonstrate value for preoperative echocardiography, functional capacity, frailty, and mobility assessments.
Collapse
Affiliation(s)
- Lee A Goeddel
- Department of Anesthesiology & Critical Care Medicine, Johns Hopkins School of Medicine, Zayed 6208J, 1800 Orleans, Baltimore, MD 21287, USA.
| | - Michael C Grant
- Department of Anesthesiology & Critical Care Medicine, Johns Hopkins School of Medicine, Zayed 6208J, 1800 Orleans, Baltimore, MD 21287, USA
| |
Collapse
|
26
|
de la Matta M, Alonso-González M, Moreno-Conde J, Salas-Fernández S, López-Romero JL. Development and patient acceptance of Preanestes@s, a web-based application and electronic questionnaire for preoperative assessment. A prospective cohort study. Rev Esp Anestesiol Reanim (Engl Ed) 2022; 69:383-392. [PMID: 35871145 DOI: 10.1016/j.redare.2022.01.002] [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: 10/03/2021] [Accepted: 01/19/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVES We describe the development of Preanestes@s, a web-based application for preoperative assessment, which incorporates PreQuest, a smart computer-based self-assessment questionnaire for the automated management of information. Preanestes@s potentially enables remote non-telephonic preoperative assessment. The main objective of this work was the identification of factors that independently predict adequate completion of PreQuest. As a secondary objective, we assessed patient experience using the application. MATERIAL AND METHODS To assess the influence of patient conditions on PreQuest completion, our sample included 880 adult patients scheduled to undergo surgery at our institution between February 2020 and February 2021. We evaluated patient satisfaction and acceptability with the use of the application and PreQuest. RESULTS A total of 573 participants (65.1%) successfully completed the PreQuest. Age below 65 years and higher educational attainment were identified as independent predictors for PreQuest completion (p = 0.04 and p = 0.001, respectively). Most (89.4%) participants agreed that Preanestes@s was intuitive and easy to use, with over 85% showing high levels of acceptance of PreQuest prototype's communication improvement and ease of use. The final version of Preanestes@s and PreQuest was evaluated by 218 participants, many of whom (>74%) affirmed its ease of use. CONCLUSIONS The use of Preanestes@s for preoperative assessment is supported by high levels of satisfaction with the prototype and by an eQuest completion rate greater than 65% in a non-selective population. In our sample, younger age and higher education attainment predicted higher rates PreQuest completion. Trial registration number NCT04259268.
Collapse
Affiliation(s)
- M de la Matta
- Servicio de Anestesiología y Reanimación, Hospital General, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
| | - M Alonso-González
- Fundación Pública Andaluza para la Gestión de la Investigación en Salud de Sevilla (FISEVI), Sevilla, Spain
| | - J Moreno-Conde
- Grupo de Innovación Tecnológica, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - S Salas-Fernández
- Grupo de Innovación Tecnológica, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - J L López-Romero
- Servicio de Anestesiología y Reanimación, Hospital General, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| |
Collapse
|
27
|
Knaus ME, Onwuka AJ, Afrazi A, Breech L, Corkum KS, Dillon PA, Ehrlich PF, Fallat ME, Fraser JD, Gadepalli SK, Grabowski JE, Hertweck SP, Kabre R, Lal DR, Landman MP, Lawrence AE, Leys CM, Mak GZ, Markel TA, Merchan N, Overman RE, Rademacher BL, Raiji MT, Rymeski B, Sato TT, Scannel M, Schikler AG, Sujka JA, Wright T, Aldrink JH, Hewitt GD, Minneci PC, Deans KJ. Multi-Institutional Review of the Preoperative Diagnostic Accuracy for Pediatric Ovarian Mature Cystic Teratomas. J Pediatr Adolesc Gynecol 2022; 35:478-485. [PMID: 35124214 DOI: 10.1016/j.jpag.2022.01.009] [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: 10/18/2021] [Revised: 01/01/2022] [Accepted: 01/23/2022] [Indexed: 11/16/2022]
Abstract
STUDY OBJECTIVE To assess the preoperative imaging impression and surgeon diagnostic accuracy for pediatric ovarian mature cystic teratomas (MCTs) DESIGN: Retrospective review SETTING: Eleven pediatric hospitals PARTICIPANTS: Patients ages 2 to 21 who underwent surgical management of an ovarian neoplasm or adnexal torsion with an associated ovarian lesion INTERVENTION: None MAIN OUTCOME MEASURES: Preoperative imaging impression, surgeon diagnosis, tumor markers, and pathology RESULTS: Our cohort included 946 females. Final pathology identified 422 (45%) MCTs, 405 (43%) other benign pathologies, and 119 (12%) malignancies. Preoperative imaging impression for MCTs had a 70% sensitivity, 92% specificity, 88% positive predictive value (PPV), and 79% negative predictive value (NPV). For the preoperative surgeon diagnosis, sensitivity was 59%, specificity 96%, PPV 92%, and NPV 74%. Some measures of diagnostic accuracy were affected by the presence of torsion, size of the lesion on imaging, imaging modality, and surgeon specialty. Of the 352 masses preoperatively thought to be MCTs, 14 were malignancies (4%). Eleven patients with inaccurately diagnosed malignancies had tumor markers evaluated and 82% had at least 1 elevated tumor marker, compared with 49% of those with MCTs. CONCLUSIONS Diagnostic accuracy for the preoperative imaging impression and surgeon diagnosis is lower than expected for pediatric ovarian MCTs. For all ovarian neoplasms, preoperative risk assessment including a panel of tumor markers and a multidisciplinary review is recommended. This process could minimize the risk of misdiagnosis and improve operative planning to maximize the use of ovarian-sparing surgery for benign lesions and allow for appropriate resection and staging for lesions suspected to be malignant.
Collapse
Affiliation(s)
- Maria E Knaus
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Amanda J Onwuka
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Amin Afrazi
- American Family Children's Hospital, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Lesley Breech
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Kristine S Corkum
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Patrick A Dillon
- St. Louis Children's Hospital, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Peter F Ehrlich
- C.S. Mott Children's Hospital, University of Michigan Medical School, Ann Arbor, Michigan
| | - Mary E Fallat
- Norton Children's Hospital, University of Louisville School of Medicine, Louisville, Kentucky
| | - Jason D Fraser
- Children's Mercy Kansas City, University of Missouri Kansas City School of Medicine, Kansas City, Missouri
| | - Samir K Gadepalli
- C.S. Mott Children's Hospital, University of Michigan Medical School, Ann Arbor, Michigan
| | - Julia E Grabowski
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - S Paige Hertweck
- Norton Children's Hospital, University of Louisville School of Medicine, Louisville, Kentucky
| | - Rashmi Kabre
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Dave R Lal
- Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Matthew P Landman
- Riley Hospital for Children, Indiana University Health, Indianapolis, Indiana
| | - Amy E Lawrence
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Charles M Leys
- American Family Children's Hospital, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Grace Z Mak
- Comer Children's Hospital, The University of Chicago Medicine, Chicago, Illinois
| | - Troy A Markel
- Riley Hospital for Children, Indiana University Health, Indianapolis, Indiana
| | - Naila Merchan
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - R Elliott Overman
- C.S. Mott Children's Hospital, University of Michigan Medical School, Ann Arbor, Michigan
| | - Brooks L Rademacher
- American Family Children's Hospital, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Manish T Raiji
- Comer Children's Hospital, The University of Chicago Medicine, Chicago, Illinois
| | - Beth Rymeski
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Thomas T Sato
- Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Madeline Scannel
- St. Louis Children's Hospital, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Allegra G Schikler
- Norton Children's Hospital, University of Louisville School of Medicine, Louisville, Kentucky
| | - Joseph A Sujka
- Children's Mercy Kansas City, University of Missouri Kansas City School of Medicine, Kansas City, Missouri
| | - Tiffany Wright
- Norton Children's Hospital, University of Louisville School of Medicine, Louisville, Kentucky
| | - Jennifer H Aldrink
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Geri D Hewitt
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Peter C Minneci
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio.
| | - Katherine J Deans
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | | |
Collapse
|
28
|
Clark C, Bennett E, Foo I. Adherence to published guidelines for perioperative care of the elderly: a survey of Scottish anaesthetic departments. Perioper Med (Lond) 2022; 11:26. [PMID: 35787738 PMCID: PMC9253247 DOI: 10.1186/s13741-022-00258-z] [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: 11/15/2021] [Accepted: 03/26/2022] [Indexed: 11/12/2022] Open
Abstract
Background In 2010, a national enquiry into elderly patient outcomes after surgery identified that only 36% received ‘good’ care. Guidance was subsequently published by the Association of Anaesthetists of Great Britain and Ireland regarding perioperative care of the elderly and those with dementia; this study aims to assess current adherence to these guidelines in anaesthetic departments across Scotland. Methods A web-based survey was sent to all Scottish departments. The questions assessed department patient demographic, access to specialist pre-assessment services, availability of multidisciplinary input, perioperative care of patients with cognitive impairment and departmental training on geriatric perioperative care. Results Responses were collected from November-December 2020 with a 92.6% response rate. A total of 64% of departments stated that > 50% of their workload involved patients over 75. One department had a lead clinician for geriatric anaesthesia, whilst 20% could access a geriatric specialist when coordinating perioperative care. Specialist geriatric pre-assessment services operate in 20% of centres. A total of 60% of respondents used a clinical frailty score when pre-assessing patients over 75, with 48% specifically screening for cognitive impairment. The vast majority of centres, 76%, did not routinely provide information regarding post-operative delirium and 24% ‘never or very rarely’ invite caregivers to accompany patients with dementia into the department. Education sessions regarding perioperative elderly care had occurred in 56% of departments. Conclusions Elderly patients represent a significant proportion of anaesthetic workload in Scotland. Despite this, adherence to recommended practice is low. The vast majority of centres lack access to specialist multidisciplinary input or specialist pre-assessment services which are essential to providing good care. Reported screening for frailty and cognitive impairment is variable, with opportunities for improvement in communication and education (patient and clinician) surrounding these conditions. Supplementary Information The online version contains supplementary material available at 10.1186/s13741-022-00258-z.
Collapse
Affiliation(s)
- Clair Clark
- Anaesthetics Department, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, UK.
| | - Ella Bennett
- Anaesthetics Department, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, UK
| | - Irwin Foo
- Anaesthetics Department, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, UK
| |
Collapse
|
29
|
Servais L, Boschetti G, Meunier C, Gay C, Cotte E, François Y, Rozieres A, Fontaine J, Cuminal L, Chauvenet M, Charlois AL, Isaac S, Traverse-Glehen A, Roblin X, Flourié B, Valette PJ, Nancey S. Intestinal Conventional Ultrasonography, Contrast-Enhanced Ultrasonography and Magnetic Resonance Enterography in Assessment of Crohn's Disease Activity: A Comparison with Surgical Histopathology Analysis. Dig Dis Sci 2022; 67:2492-2502. [PMID: 34052948 DOI: 10.1007/s10620-021-07074-3] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/24/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS Contrast-enhanced ultrasonography (CEUS) is a potential interesting method for assessing accurately Crohn's disease (CD) activity. We compared the value of intestinal ultrasonography (US) coupled with contrast agent injection with that of magnetic resonance enterography (MRE) in the assessment of small bowel CD activity using surgical histopathology analysis as reference. METHODS Seventeen clinically active CD patients (14 women, mean age 33 years) requiring an ileal or ileocolonic resection were prospectively enrolled. All performed a MRE and a US coupled with contrast agent injection (CEUS) less than 8 weeks prior to surgery. Various imaging qualitative and quantitative parameters were recorded and their respective performance to detect disease activity, disease extension and presence of complications was compared to surgical histopathological analysis. RESULTS The median wall thickness measured by US differed significantly between patients with non-severely active CD (n = 5) and those with severely active CD (n = 12) [7.0 mm, IQR (6.5-9.5) vs 10.0 mm, IQR (8.0-12.0), respectively; p = 0.03]. A non-significant trend was found with MRE with a median wall thickness in severe active CD of 10.0 mm, IQR (8.0-13.7) compared with 8.0 mm, IQR (7.5-10.5) in non-severely active CD (p = 0.07). The area under the ROC curve (AUROC) of the wall thickness assessed by US and MRE to identify patients with or without severely active CD on surgical specimens were 0.85, 95% CI (0.64-1.04), p = 0.03 and 0.80, 95% CI (0.56-1.01), p = 0.07, respectively. Among the parameters derived from the time-intensity curve during CEUS, time to peak and rise time were the two most accurate markers [AUROC = 0.88, 95% CI (0.70-1.04), p = 0.02 and 0.86, 95% CI (0.68-1.04), p = 0.03] to detect patients with severely active CD assessed on surgical specimens. CONCLUSION The accuracy of intestinal CEUS is close to that of conventional US to detect disease activity. A thickened bowel and shortened time to peak and rise time were the most accurate to identify CD patients with severe histological disease activity.
Collapse
Affiliation(s)
- L Servais
- Department of Gastroenterology, Lyon-Sud Hospital, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite, France
| | - G Boschetti
- Department of Gastroenterology, Lyon-Sud Hospital, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite, France.,INSERM U1111, International Center for Research in Infectiology, Lyon, France
| | - C Meunier
- Department of Gastroenterology, Lyon-Sud Hospital, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite, France.,INSERM U1111, International Center for Research in Infectiology, Lyon, France
| | - C Gay
- Department of Gastroenterology, Lyon-Sud Hospital, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite, France
| | - E Cotte
- Department of Digestive Surgery, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Y François
- Department of Digestive Surgery, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre-Bénite, France
| | - A Rozieres
- INSERM U1111, International Center for Research in Infectiology, Lyon, France
| | - J Fontaine
- Department of Pathology, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre-Bénite, France
| | - L Cuminal
- Department of Radiology, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre-Bénite, France
| | - M Chauvenet
- Department of Gastroenterology, Lyon-Sud Hospital, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite, France
| | - A L Charlois
- Department of Gastroenterology, Lyon-Sud Hospital, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite, France
| | - S Isaac
- Department of Pathology, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre-Bénite, France
| | - A Traverse-Glehen
- Department of Pathology, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre-Bénite, France
| | - X Roblin
- Department of Gastroenterology, CHU Saint-Etienne, Saint-Etienne, France
| | - B Flourié
- Department of Gastroenterology, Lyon-Sud Hospital, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite, France.,INSERM U1111, International Center for Research in Infectiology, Lyon, France
| | - P J Valette
- Department of Radiology, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre-Bénite, France
| | - S Nancey
- Department of Gastroenterology, Lyon-Sud Hospital, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite, France. .,INSERM U1111, International Center for Research in Infectiology, Lyon, France.
| |
Collapse
|
30
|
Guo Y, Li H, Xie D, You L, Yan L, Li Y, Zhang S. Hemorrhage in pheochromocytoma surgery: evaluation of preoperative risk factors. Endocrine 2022; 76:426-433. [PMID: 35426588 PMCID: PMC9068676 DOI: 10.1007/s12020-021-02964-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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/11/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Pheochromocytoma surgery carries a higher risk of hemorrhage. Our objective was to identify preoperative risk factors for hemorrhage during pheochromocytoma surgery. METHODS Patients who underwent surgery and with postoperative pathological confirmation were enrolled. A total of 251 patients from our center were included in the investigation, and 120 patients from the First Affiliated Hospital, Sun Yat-sen University were included as an external validation dataset. Family and medical history, demographics, hemodynamics, biochemical parameters, image data, anesthesia and operation records, postoperative outcomes were collected. Postoperative complications were graded by the Clavien-Dindo classification. Correlation between intraoperative hemorrhage volume and postoperative outcomes was assessed. The features associated with intraoperative hemorrhage were identified by linear regression. All features that were statistically significant in the multiple linear regression were then used to construct models and nomograms for predicting intraoperative hemorrhage. The constructed models were evaluated by Akaike Information Criterion. Finally, internal and external validations were carried out by tenfold cross-validation. RESULTS Intraoperative hemorrhage volume was positively correlated with the postoperative hospitalization time (R = 0.454, P < 0.001) and the Clavien-Dindo grades (R = 0.664, P < 0.001). Features associated with intraoperative hemorrhage were male gender (β = 0.533, OR = 1.722, P = 0.002), tumor diameter (β = 0.027, OR = 1.027, P < 0.001), preoperative CCB use (β = 0.318, OR = 1.308, P = 0.123) and open surgery (β = 1.175, OR = 3.234, P < 0.001). Validations showed reliable results (internal (R = 0.612, RMSE = 1.355, MAE = 1.111); external (R = 0.585, RMSE = 1.398, MAE = 0.964)). CONCLUSION More intraoperative hemorrhage is correlated with longer postoperative hospitalization time and more severe postoperative complications. Male gender, larger tumor, preoperative CCB use and open surgery are preoperative risk factors for hemorrhage in PCC surgery.
Collapse
Affiliation(s)
- Ying Guo
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hai Li
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Dingxiang Xie
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lili You
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Li Yan
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yanbing Li
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Shaoling Zhang
- Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
| |
Collapse
|
31
|
Fiamanya S, Ma S, Yates DRA. The association between preoperative Mini-Cog© score and postoperative delirium (POD): a retrospective cohort study. Perioper Med (Lond) 2022; 11:16. [PMID: 35443735 PMCID: PMC9022325 DOI: 10.1186/s13741-022-00249-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 01/14/2022] [Indexed: 11/21/2022] Open
Abstract
Background The onset of delirium after major surgery is associated with worse in-hospital outcomes for major surgical patients. Best practice recommends assessing surgical patients for delirium risk factors and this includes screening for cognitive impairment. The Mini-Cog© is a short instrument which has been shown to predict postoperative delirium (POD) and other complications in elderly patients undergoing major elective surgery. The primary aim of this study was to ascertain whether a positive preoperative Mini-Cog© is associated with postoperative delirium in elective colorectal surgery patients at high-risk of mortality due to age or comorbidity. Secondary outcomes were 90-day mortality and length of stay. Methods This is a retrospective analysis of data gathered prospectively between October 2015 and December 2017. Baseline data were collected at a preoperative screening clinic, and postoperative data during daily ward rounds by the Perioperative Medicine team at The York Hospital. Results Three hundred nineteen patients were included in the final analysis, of which 52 (16%) were found to be cognitively impaired on the Mini-Cog©. Older patients (median difference 10 years, p < 0.001) and patients with cognitive impairment (OR 3.04, 95%CI 1.15 to 8.03, p = 0.019) were more likely to develop postoperative delirium in univariate analysis; however, cognitive impairment (OR 0.492, 95%CI 0.177 to 1.368, p = 0.174) loses its significance when controlled for by confounding factors in a logistic regression model. Cognitive impairment (OR 4.65, 95%CI 1.36 to 15.9, p = 0.02), frailty (OR 7.28, 95%CI 1.92 to 27.58, p = 0.009), American Society of Anesthesiologists (ASA) grade (OR 5.95, 95%CI 1.54 to 22.94, p = 0.006) and age (median difference 10 years, p = 0.002) were significantly associated with 90-day mortality in univariate analysis. Sex was the only factor significantly associated with length of stay in the multiple regression model, with males having a 3-day longer average length of stay than females (OR = 2.94, 95%CI 0.10–5.78). Conclusions Mini-Cog© is not independently associated with post-operative delirium in high-risk elective colorectal surgery patients in this cohort. Mini-Cog© shows promise as a possible predictor of 90-day mortality. Larger studies exploring preoperative cognitive status and postoperative confusion and mortality could improve risk-stratification for surgery and allocation of resources to those patients at higher risk.
Collapse
Affiliation(s)
- S Fiamanya
- Cross Lane Hospital, Tees, Esk and Wear Valley NHS Foundation Trust, Cross Lane, Scarborough, YO12 6DN, UK.
| | - S Ma
- York Hospital, York Teaching Hospitals NHS Foundation Trust, Wiggington Road, York, YO31 8HE, UK
| | - D R A Yates
- York Hospital, York Teaching Hospitals NHS Foundation Trust, Wiggington Road, York, YO31 8HE, UK.,Academic Alliance of Perioperative Medicine, Hull York Medical School, Heslington, UK
| |
Collapse
|
32
|
Folsom M, Gigantelli J, Timperley B, Johnson K, Bagenda D, Pang H, Ellis S. Periocular Manifestation of Obstructive Sleep Apnea as a Novel Perioperative Screening Tool. Obes Surg 2022; 32:1103-1109. [PMID: 35091903 PMCID: PMC8933341 DOI: 10.1007/s11695-021-05851-7] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/30/2021] [Accepted: 12/13/2021] [Indexed: 11/28/2022]
Abstract
Purpose Obstructive sleep apnea (OSA) presents perioperative challenges with increased risk for complications. Floppy eyelid syndrome (FES) is associated with OSA yet has not been addressed perioperatively. The current standard for perioperative OSA screening includes assessing patient risk factors or the STOP-BANG tool, which requires an active participant. We aimed to confirm a connection between FES and OSA in presurgical patients and develop a screening method appropriate for patients with perioperative OSA risk. Materials and Methods 162 presurgical pre-anesthesia clinic patients were enrolled. Screening questions determined eligibility. Those who were pregnant or aged < 19 were excluded. Control group included those with a STOP-BANG score < 3. Experimental group included those with BMI > 35 and OSA diagnosis. Examiners photographed participants’ eyes with vertical and horizontal retraction while two blinded ophthalmologists used a grading scale to review grade of eyelid laxity. Results Differences in habitus, ASA score, and hypertension as a comorbidity were significant. Sensitivity of FES screening was 52% (CI 37–66%) and specificity was 56% (CI 46–66%) for reviewer 1. For reviewer 2, sensitivity was 48% (CI 28–69%) and specificity was 72% (CI 60–81%). Negative predictive value was 86% (CI 81–90) for reviewer 1 and 88% (CI 83–92%) for reviewer 2. Inter-rater agreement was moderate. Conclusion While specificity and sensitivity were lower than anticipated, negative predictive value was high. Given this strong negative predictive value, our findings indicate using eyelid retraction to screen for FES has perioperative clinical utility. These findings encourage further research addressing the connection of lid laxity/FES to OSA. Key Points • Aimed to investigate if a FES screening tool could identify perioperative OSA risk. • Negative predictive value for FES with OSA was 86%. • Observing periocular lid laxity has clinical utility; is feasible in any patient. Graphical abstract ![]()
Collapse
Affiliation(s)
- Megan Folsom
- Department of Anesthesiology, University of Nebraska Medical Center, 42nd and Emile, Omaha, NE, 68198, USA. .,Department of Anesthesiology, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 1034, Kansas City, KS, 66160, USA.
| | - James Gigantelli
- Department of Ophthalmology, Marshall University, 1 John Marshall Drive, Huntington, WV, 25755, USA
| | - Brent Timperley
- Department of Ophthalmology, University of Nebraska Medical Center, 42nd and Emile, Omaha, NE, 68198, USA
| | - Kurtis Johnson
- Department of Anesthesiology, University of Nebraska Medical Center, 42nd and Emile, Omaha, NE, 68198, USA
| | - Danstan Bagenda
- Department of Anesthesiology, University of Nebraska Medical Center, 42nd and Emile, Omaha, NE, 68198, USA
| | - Huiling Pang
- Department of Anesthesiology, University of Nebraska Medical Center, 42nd and Emile, Omaha, NE, 68198, USA
| | - Sheila Ellis
- Department of Anesthesiology, University of Nebraska Medical Center, 42nd and Emile, Omaha, NE, 68198, USA
| |
Collapse
|
33
|
Troisi A. Emergence of bariatric psychiatry as a new subspecialty. World J Psychiatry 2022; 12:108-116. [PMID: 35111582 PMCID: PMC8783166 DOI: 10.5498/wjp.v12.i1.108] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 07/19/2021] [Accepted: 11/29/2021] [Indexed: 02/06/2023] Open
Abstract
Bariatric surgery is the branch of surgery aimed at helping a person with obesity lose weight. The implementation of surgical treatment of obesity is growing at an impressive rate. As expected, the expanding implementation of bariatric procedures has progressively revealed critical issues that were not evident when the number of obese patients treated with surgery was relatively small. One critical issue is the importance of mental health assessment and care of bariatric patients. The aim of this review is to provide readers with an up-to-date summary of the goals, methods, and clinical strategies of bariatric psychiatry. The aims can be grouped into three distinct categories. First, to ascertain that there are no psychiatric contraindications to safe bariatric surgery. Second, to diagnose and treat pre-surgery mental conditions that could predict poor weight loss. Third, to diagnose and treat post-surgery mental conditions associated with poor quality of life. Although bariatric psychiatry has gained the status of a new subspecialty within the field of mental health and psychopathology, many clinical questions remain unsolved. We need more long-term data on outcome measures such as quality of life, adherence to behavioral guidelines, risk of suicide, and post-surgery prevalence of psychological disturbances and mental disorders.
Collapse
Affiliation(s)
- Alfonso Troisi
- Department of Systems Medicine, University of Rome Tor Vergata, Rome 00133, Italy
| |
Collapse
|
34
|
Hajri R, Ponti A, Meuwly JY, Eminian S, Ledoux JB, Tenisch E, Alamo-Maestre L, Dromain C, Violi NV. Abbreviated MRI for Preoperative Assessment of Breast Cancer: is Maximal Intensity Projection (MIP) of the First Post Contrast Acquisition Subtracted (Fast) Sequence Sufficient for Disease Evaluation? J Cancer Sci Clin Ther 2022; 6:452-459. [PMID: 36938135 PMCID: PMC10022524 DOI: 10.26502/jcsct.5079184] [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] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objectives The aim of this study was to assess the diagnostic performance of abbreviated MRI (AMRI) using the maximal intensity projection (MIP) reconstruction of the first post-contrast acquisition subtracted (FAST) compared with MIP+FAST and full-protocol MRI (fpMRI) for the preoperative assessment of breast cancer (BC) in a biopsy-proven cancer population. Methods In this monocentric retrospective study, two readers consensually assessed two AMRI protocols consisting of MIP reconstruction of the FAST (MIP) and MIP+FAST. 228 patients were included with a breast MRI performed between 2013 and 2014, 207 of them (90.8%) had biopsy-proven cancer with 256 lesions. Data of MIP and MIP+FAST were compared to full-protocol MRI (fpMRI) reading and to the reference standard including 6-month follow-up imaging and pathology as the reference. Results MIP, MIP+FAST and fpMRI demonstrated a per-lesion sensitivity for BC detection of 87.5% (224/256, 95%CI: 82.9-91.3%) and 97.7% (250/256, 95-99.1%) and 98.4% (252/256, 96.1-99.6%), respectively with a statistical difference between MIP compared to MIP+FAST and fpMRI when considering confidence intervals. Per-lesion specificity was not different [MIP: 47.6% (10/21, 25.7-70.2%), MIP+FAST: 52.4% (11/21,29.8-74.3%, fpMRI: 66.7% (14/21, 43-85.4%)]. Conclusion AMRI using only MIP is not accurate for the pre-operative assessment of BC due to lower sensitivity when compared to MIP+FAST and fpMRI. AMRI using the MIP+FAST acquisition in the preoperative setting seems promising as it could be used as the same protocol for both screening and staging in case of positive cases, without need for a recall fpMRI. This needs confirmation with cohort including higher rate of negative cases in order to evaluate the specificity.
Collapse
Affiliation(s)
- Rami Hajri
- Department of Radiology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Alexandre Ponti
- Department of Radiology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Jean-Yves Meuwly
- Department of Radiology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Sylvain Eminian
- Department of Radiology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Jean-Baptiste Ledoux
- Department of Radiology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
- Centre for Biomedical Imaging (CIBM), Lausanne, Switzerland
| | - Estelle Tenisch
- Department of Radiology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Leonor Alamo-Maestre
- Department of Radiology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Clarisse Dromain
- Department of Radiology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Naïk Vietti Violi
- Department of Radiology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| |
Collapse
|
35
|
Akbulut S, Sahin TT. Recommendations for the ethical guidelines for publication of scientific studies: The responsibilities of editors, reviewers and the authors. Ann Med Surg (Lond) 2021; 72:103047. [PMID: 34815861 PMCID: PMC8591468 DOI: 10.1016/j.amsu.2021.103047] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 11/07/2021] [Accepted: 11/09/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE We aimed to evaluate the role of anesthesiologist in the management of hydatid disease from the perspective of the editors, reviewers and the authors. METHODS We searched the PubMed/Medline database using the following keywords: (hydatid* OR echinococc*) AND (disease OR cyst) AND (anesthesiology). We have evaluated the authors, their institutions and department, and the aim of the studies. We also evaluated the studies published by anesthesiologists in terms of content. RESULTS The literature search showed 6344 articles published between February 2010 to 2021. Sixty-three had at least one anesthesiologist in the author list. Anesthesiologists were leading authors in 35 studies; and in 19 of them, all the authors were anesthesiologist. Sixteen (84.2%) of these articles defined the outcomes of surgical therapy and there was no information regarding anesthesia technique. CONCLUSION The results of our study emphasize an important controversy regarding jurisdiction of different departments in terms of scientific research ethics. We believe that different disciplines can work together to evaluate a scientific problem and can publish a study in collaboration. But collaboration is very important and violating the subject of another field without collaboration is a deontological problem.
Collapse
Affiliation(s)
- Sami Akbulut
- Corresponding author. Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Elazig Yolu 10. Km, Malatya, 44280, Turkey.
| | | |
Collapse
|
36
|
Drami I, Lord AC, Sarmah P, Baker RP, Daniels IR, Boyle K, Griffiths B, Mohan HM, Jenkins JT. Preoperative assessment and optimisation for pelvic exenteration in locally advanced and recurrent rectal cancer: A review. Eur J Surg Oncol 2021; 48:2250-2257. [PMID: 34922810 DOI: 10.1016/j.ejso.2021.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 11/01/2021] [Accepted: 11/03/2021] [Indexed: 01/06/2023] Open
Abstract
The pre-operative phase in planning a pelvic exenteration or extended resections is critical to optimising patient outcomes. This review summarises the key components of preoperative assessment and planning in patients with locally advanced rectal cancer (LARC) and locally recurrent rectal cancer (LLRC) being considered for potential curative resection. The preoperative period can be considered in 5 key phases: 1) Multidisciplinary meeting (MDT) review and recommendation for neoadjuvant therapy and surgery, 2) Anaesthetic preoperative assessment of fitness for surgery and quantification of risk, 3) Shared decision making with the patient and the process of informed consent, 4) Prehabilitation and physiological optimisation 5) Technical aspects of surgical planning. This review will focus on patients who have been recommended for surgery by the MDT and have completed neoadjuvant therapy. Other important considerations beyond the scope of this review are the various neoadjuvant strategies employed which in this patient group include Total Neo-adjuvant Therapy and reirradiation. Critical to improving perioperative outcomes is the dual aim of achieving a negative resection margin in a patient fit enough for extended surgery. Advanced, realistic communication is required pre-operatively and should be maintained throughout recovery. Optimising patient's physiological and psychological reserve with a preoperative prehabilitation programme is important, with physiotherapy, psychological and nutritional input. From a surgical perspective, image based technical preoperative planning is important to identify risk points and ensure correct surgical strategy. Careful attention to the entire patient journey through these 5 preoperative phases can optimise outcomes with the accumulation of marginal gains at multiple timepoints.
Collapse
Affiliation(s)
- I Drami
- Dukes' Club, Association of Coloproctology of Great Britain and Ireland, Royal College of Surgeons of England, London, UK.
| | - A C Lord
- Dukes' Club, Association of Coloproctology of Great Britain and Ireland, Royal College of Surgeons of England, London, UK
| | - P Sarmah
- Dukes' Club, Association of Coloproctology of Great Britain and Ireland, Royal College of Surgeons of England, London, UK
| | - R P Baker
- Advanced Malignancy Subcommittee, Association of Coloproctology of Great Britain and Ireland, Royal College of Surgeons of England, London, UK
| | - I R Daniels
- Advanced Malignancy Subcommittee, Association of Coloproctology of Great Britain and Ireland, Royal College of Surgeons of England, London, UK
| | - K Boyle
- Advanced Malignancy Subcommittee, Association of Coloproctology of Great Britain and Ireland, Royal College of Surgeons of England, London, UK
| | - B Griffiths
- Advanced Malignancy Subcommittee, Association of Coloproctology of Great Britain and Ireland, Royal College of Surgeons of England, London, UK
| | - H M Mohan
- Dukes' Club, Association of Coloproctology of Great Britain and Ireland, Royal College of Surgeons of England, London, UK
| | - J T Jenkins
- Advanced Malignancy Subcommittee, Association of Coloproctology of Great Britain and Ireland, Royal College of Surgeons of England, London, UK
| |
Collapse
|
37
|
Kapoor P, Chen L, Saripella A, Waseem R, Nagappa M, Wong J, Riazi S, Gold D, Tang-Wai DF, Suen C, Englesakis M, Norman R, Sinha SK, Chung F. Prevalence of preoperative cognitive impairment in older surgical patients.: A systematic review and meta-analysis. J Clin Anesth 2022; 76:110574. [PMID: 34749047 DOI: 10.1016/j.jclinane.2021.110574] [Citation(s) in RCA: 4] [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: 09/15/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 12/23/2022]
Abstract
STUDY OBJECTIVE Older surgical patients with cognitive impairment are at an increased risk for adverse perioperative outcomes, however the prevalence of preoperative cognitive impairment is not well-established within this population. The purpose of this review is to determine the pooled prevalence of preoperative cognitive impairment in older surgical patients. DESIGN Systematic review and meta-analysis. SETTING MEDLINE (Ovid), PubMed (non-MEDLINE records only), Embase, Cochrane Central, Cochrane Database of Systematic Reviews, PsycINFO, and EMCare Nursing for relevant articles from 1946 to April 2021. PATIENTS Patients aged ≥60 years old undergoing surgery, and preoperative cognitive impairment assessed by validated cognitive assessment tools. INTERVENTIONS Preoperative assessment. MEASUREMENTS Primary outcomes were the pooled prevalence of preoperative cognitive impairment in older patients undergoing either elective (cardiac or non-cardiac) or emergency surgery. MAIN RESULTS Forty-eight studies (n = 42,498) were included. In elective non-cardiac surgeries, the pooled prevalence of unrecognized cognitive impairment was 37.0% (95% confidence interval [CI]: 30.0%, 45.0%) among 27,845 patients and diagnosed cognitive impairment was 18.0% (95% CI: 9.0%, 33.0%) among 11,676 patients. Within the elective non-cardiac surgery category, elective orthopedic surgery was analyzed. In this subcategory, the pooled prevalence of unrecognized cognitive impairment was 37.0% (95% CI: 26.0%, 49.0%) among 1117 patients, and diagnosed cognitive impairment was 17.0% (95% CI: 3.0%, 60.0%) among 6871 patients. In cardiac surgeries, the unrecognized cognitive impairment prevalence across 588 patients was 26.0% (95% CI: 15.0%, 42.0%). In emergency surgeries, the unrecognized cognitive impairment prevalence was 50.0% (95% CI: 35.0%, 65.0%) among 2389 patients. CONCLUSIONS A substantial number of surgical patients had unrecognized cognitive impairment. In elective non-cardiac and emergency surgeries, the pooled prevalence of unrecognized cognitive impairment was 37.0% and 50.0%. Preoperative cognitive screening warrants more attention for risk assessment and stratification.
Collapse
|
38
|
Zhang K, Rashid-Kolvear M, Waseem R, Englesakis M, Chung F. Virtual preoperative assessment in surgical patients: A systematic review and meta-analysis. J Clin Anesth 2021; 75:110540. [PMID: 34649158 DOI: 10.1016/j.jclinane.2021.110540] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/26/2021] [Accepted: 10/02/2021] [Indexed: 12/19/2022]
Abstract
STUDY OBJECTIVE Preoperative assessment is a standard evaluation, traditionally done in-person in a preanesthesia clinic, for patients who will be undergoing a procedure involving anesthesia. Given the increased adoption of virtual care during the coronavirus disease 2019 (COVID-19) pandemic, the purpose of this systematic review and meta-analysis is to review the effectiveness of virtual preoperative assessment for the evaluation of surgical patients. DESIGN Systematic review and meta-analysis. SETTING MEDLINE (Ovid), MEDLINE InProcess/ePubs, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov were searched from the initial coverage of the respective database to May 2021. A manual citation search of Google Scholar and PubMed was conducted to identify missed articles. Continued literature surveillance was done through July 2021. PATIENTS Patients aged 18 years and older undergoing virtual preoperative anesthesia assessment. INTERVENTIONS Virtual preoperative assessment. MEASUREMENTS Surgery cancellation rates, patient experience, resources saved, staff experience, success in using the data collected to diagnose and manage patients. MAIN RESULTS Fifteen studies (n = 31,496 patients) were included in this review. The average age of patients was 58 ± 15 years, and 47% were male. Virtual preoperative assessment resulted in similar surgery cancellation rates compared to in-person evaluation, with a pooled cancellation rate of 2% (95% confidence interval [CI]: 1-3%). Most studies reported a positive patient experience, with a pooled estimate of 90% (95% CI, 81-95%). There was a high success rate in using the information collected with virtual care, in the range of 92-100%, to diagnose and manage patients resulting in time and cost savings in the range of 24-137 min and $60-67 per patient. CONCLUSIONS This systematic review and meta-analysis demonstrates the utility of virtual care for preoperative assessment of surgical patients. Virtual preanesthesia evaluation had similar surgery cancellation rates, high patient satisfaction, and reduced costs compared to in-person evaluation.
Collapse
Affiliation(s)
- Kevin Zhang
- Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; Department of Anesthesia and Pain Management, University Health Network, University of Toronto, Toronto, ON M5T 2S8, Canada
| | - Matin Rashid-Kolvear
- Department of Anesthesia and Pain Management, University Health Network, University of Toronto, Toronto, ON M5T 2S8, Canada; School of Medicine, University College Dublin, Dublin, Leinster D04 C7X2, Ireland
| | - Rida Waseem
- Department of Anesthesia and Pain Management, University Health Network, University of Toronto, Toronto, ON M5T 2S8, Canada
| | - Marina Englesakis
- Library and Information Services, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Frances Chung
- Department of Anesthesia and Pain Management, University Health Network, University of Toronto, Toronto, ON M5T 2S8, Canada.
| |
Collapse
|
39
|
Vermeijden HD, Cerniglia B, Mintz DN, Rademakers MV, Kerkhoffs GMMJ, van der List JP, DiFelice GS. Distal remnant length can be measured reliably and predicts primary repair of proximal anterior cruciate ligament tears. Knee Surg Sports Traumatol Arthrosc 2021; 29:2967-2975. [PMID: 33057796 DOI: 10.1007/s00167-020-06312-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 07/15/2020] [Accepted: 09/28/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the reliability and predictive value of quantifying anterior cruciate ligament (ACL) tear location on magnetic resonance imaging (MRI) and assess the predictive value of tear location on the eligibility for arthroscopic primary repair of proximal ACL tears. METHODS In this case-control study, all adult patients undergoing acute ACL surgery between 2008 and 2020 were retrospectively reviewed. All patients were treated with the treatment algorithm of undergoing primary repair when proximal tears with sufficient tissue quality were present intraoperatively, and otherwise underwent single-bundle ACL reconstruction. Sagittal MRI images were reviewed to measure proximal and distal remnant lengths along the anterior aspect of the torn ligament, and tear location was calculated as distal remnant divided by total remnant length. Interobserver and intraobserver reliability for remnant measurements were calculated. Then, receiver operating curve analysis (ROC) was performed to calculate the optimal cut-off for the possibility of primary repair with the different measurements. RESULTS Two hundred and forty-eight patients were included, of which 151 underwent repair (61%). Inter- and intraobserver reliability ranged between 0.92 and 0.96 [95% confidence interval (CI) 0.55-0.98] and 0.91-0.97 (95% CI 0.78-0.98, respectively). All patients with a tear location of ≥ 80% on MRI could undergo repair, whereas all patients with tear location of < 60% required reconstruction. The positive predictive value of a proximal quarter tear (≥ 75%) on primary repair was 94%. Older age was correlated with more proximal tear location (p < 0.001), but there was no correlation between tear location and gender, BMI, or timing of surgery (all n.s). CONCLUSION This study showed that tear location could reliably be quantified on MRI by assessing distal and proximal remnant lengths. Tear location in the proximal quarter of the ACL was found to have a positive predictive value for repairability of 94%. These findings may assist orthopaedic surgeons in evaluating which patients are eligible for primary ACL repair preoperatively. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Harmen D Vermeijden
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.,Department of Orthopaedic Surgery, Spaarne Gasthuis Hospital, Hoofddorp, The Netherlands.,Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Science, Amsterdam, The Netherlands
| | - Brett Cerniglia
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Douglas N Mintz
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Maarten V Rademakers
- Department of Orthopaedic Surgery, Spaarne Gasthuis Hospital, Hoofddorp, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Science, Amsterdam, The Netherlands.,Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Amsterdam Collaboration On Health and Safety in Sports (ACHSS), University of Amsterdam and Vrije Universiteit Amsterdam IOC Research Center, Amsterdam, The Netherlands
| | - Jelle P van der List
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.,Department of Orthopaedic Surgery, Spaarne Gasthuis Hospital, Hoofddorp, The Netherlands.,Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Science, Amsterdam, The Netherlands
| | - Gregory S DiFelice
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
| |
Collapse
|
40
|
Espersen C, Borgwardt L, Larsen PN, Andersen TB, Stenholt L, Petersen LJ. Comparison of nuclear imaging techniques and volumetric imaging for the prediction of postoperative mortality and liver failure in patients undergoing localized liver-directed treatments: a systematic review. EJNMMI Res 2021; 11:80. [PMID: 34420109 PMCID: PMC8380203 DOI: 10.1186/s13550-021-00816-4] [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: 05/23/2021] [Accepted: 07/19/2021] [Indexed: 12/03/2022] Open
Abstract
Background/aims Although volumetric imaging by computed tomography (CT) is the gold standard for preoperative assessment of the future liver remnant, nuclear imaging studies have shown promising data. This systematic review summarized the results from trials investigating volumetric and nuclear medicine imaging for the prediction of postoperative mortality and liver failure (LF). Methods MEDLINE and Web of Science were searched for papers investigating nuclear imaging methods for the prediction of postoperative clinical outcomes in patients undergoing local, liver-directed treatments. Only papers investigating both preoperative nuclear imaging and CT or magnetic resonance imaging (MR) for the prediction of postoperative mortality and/or LF were included. Results Twenty-five trials were qualified for this review. All trials but two used technetium-based tracers for the nuclear imaging examination. Four papers used MR imaging and the remaining used CT for the volumetric evaluation. Overall, the studies were heterogeneous both in terms of methodology and imaging technique. Of the thirteen studies reporting on postoperative mortality, most were descriptive without detailed diagnostic data. A few with detailed data found that nuclear imaging had better predictive value than volumetric imaging. Nineteen studies investigated the prediction of postoperative LF of which seven papers investigated the predictive value of both modalities in multivariable regression analysis. Two papers found that only nuclear imaging parameters were predictive of LF, one paper found that the CT parameter was predictive, and four papers found that combined nuclear and CT/MR imaging parameters were predictive of LF. Conclusion Both methodologies were useful in the preoperative assessment of patients scheduled for liver interventions, especially in combination, but nuclear imaging demonstrated better predictive value for postoperative mortality and LF in a few trials. The overall technical and methodological heterogeneity of the included studies complicates the ability to directly compare the clinical utility of the two imaging techniques.
Collapse
Affiliation(s)
- Caroline Espersen
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Lise Borgwardt
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Peter Nørgaard Larsen
- Department of Gastrointestinal Surgery, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Trine Borup Andersen
- Department of Nuclear Medicine, Aalborg University Hospital, Hobrovej 18-22, 9100, Aalborg, Denmark
| | - Louise Stenholt
- The Medical Library, Aalborg University Hospital, Sdr. Skovvej 15, 9000, Aalborg, Denmark
| | - Lars J Petersen
- Department of Nuclear Medicine, Aalborg University Hospital, Hobrovej 18-22, 9100, Aalborg, Denmark.,Department of Clinical Medicine, University of Aalborg, Sdr. Skovvej 15, 9000, Aalborg, Denmark
| |
Collapse
|
41
|
Jeram M, Mohamed F, Coomarasamy C, MacCormick AD. Are There Ethnic Differences in Micronutrient Deficiencies in Preoperative Bariatric Patients? A Systematic Review and Meta-analysis. Obes Surg 2021. [PMID: 34383257 DOI: 10.1007/s11695-021-05625-1] [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] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/17/2021] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
Abstract
The purpose of this systematic review was to determine if in patients presenting for bariatric surgery, patients of different ethnicities, have different micronutrient deficiencies preoperatively. Databases searched were PubMed, Embase, MEDLINE and Cochrane Library. A meta-analysis of prevalence of vitamin D insufficiency (<20ng/ml) was carried out using a random effects model. Twenty-eight articles were included assessing preoperative micronutrient status across different ethnic groups. The most common micronutrient assessed was vitamin D, and the most assessed ethnicity was Caucasian. African Americans had the greatest prevalence of vitamin D insufficiency when compared to other ethnicities with a pooled prevalence and 95% confidence interval of 0.80 [0.74; 0.85]. There was a significant difference in vitamin D insufficiency when compared across ethnicities (p <0.01).
Collapse
|
42
|
Affiliation(s)
- Pierre-Emmanuel Falcoz
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France.,Université de Strasbourg, Faculté de médecine et pharmacie, Strasbourg, France.,Hôpitaux Universitaire de Strasbourg, Service de chirurgie thoracique-Nouvel Hôpital Civil, Strasbourg, France.,Department of Thoracic Surgery, University Hospital, Strasbourg, France
| | - Anne Olland
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France.,Université de Strasbourg, Faculté de médecine et pharmacie, Strasbourg, France.,Hôpitaux Universitaire de Strasbourg, Service de chirurgie thoracique-Nouvel Hôpital Civil, Strasbourg, France.,Department of Thoracic Surgery, University Hospital, Strasbourg, France
| | - Anne Charloux
- Hôpitaux Universitaire de Strasbourg, Service de physiologie et explorations fonctionnelles-Nouvel Hôpital Civil, Strasbourg, France.,EA 3072, Federation of Translational Medicine, Strasbourg University, Strasbourg, France.,Physiology and Functional Explorations Dept, University Hospital, Strasbourg, France
| |
Collapse
|
43
|
Oliveira ACC, Schwingel PA, Santos LAD, Correia LCL. The inductor role of cardiac consultation in the pre-anesthetic evaluation of asymptomatic patients submitted to non-cardiac minor and intermediate-risk surgery: a cross-sectional study. Braz J Anesthesiol 2021:S0104-0014(21)00226-8. [PMID: 34097944 DOI: 10.1016/j.bjane.2020.10.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/24/2020] [Revised: 09/27/2020] [Accepted: 10/18/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Asymptomatic patients with moderate functional capacity do not require Coronary Artery Disease (CAD) workup in the preoperative period of non-cardiac surgeries, especially when scheduled for minor and intermediate-risk surgeries. The workup is inappropriate because it promotes over diagnosing and pointless treatments. Moreover, those patients usually undergo cardiology assessment, in addition to pre-anesthetic evaluation. OBJECTIVE Investigate the role of cardiology consultation as mediator in inappropriate assessment of CAD for preoperative of non-cardiac surgeries. METHOD Retrospective study performed in a private anesthesia service using medical charts of asymptomatic patients with a history of controlled systemic disease and moderate functional capacity, submitted to pre-anesthetic consultation for minor and intermediate risk surgeries. Cardiology consultations were identified by the presence of a consultation report by a cardiologist. CAD workup was defined as undergoing cardiac stress tests. RESULTS We included 390 medical charts of patients with mean age of 48.6 ± 15.4 years, 67% women and 69% intermediate risk surgeries. CAD workup was infrequent and performed in 3.9% of patients. Besides, pre-anesthetic evaluation, 93 (24%) patients had a cardiology consultation. Among those patients, 15.1% were submitted to CAD workup, compared to 0.34% of patients without cardiology assessment (p < 0.001; RR = 4.4; 95% CI: 3.5-5.6). CONCLUSIONS Inappropriate testing for CAD investigation is infrequent for asymptomatic individuals submitted to minor and intermediate risk surgeries. However, cardiology consultation increases substantially the likelihood of a patient undergoing CAD workup, suggesting that, unlike the anesthesiologist, the cardiologist is a major mediator of this kind of management.
Collapse
|
44
|
Dirks RC, Athanasiadis DI, Hilgendorf WA, Ziegler KM, Waldrop C, Embry M, Selzer DJ. High-risk bariatric candidates: does red-flagging predict the post-operative course? Surg Endosc 2021; 36:2591-2599. [PMID: 33987766 DOI: 10.1007/s00464-021-08549-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 05/04/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Standards for preoperative bariatric patient selection include a thorough psychological evaluation. Using patients "red-flagged" during preoperative evaluations, this study aims to identify trends in long-term follow-up and complications to further optimize bariatric patient selection. METHODS A multidisciplinary team held a case review conference (CRC) to discuss red-flagged patients. A retrospective chart review compared CRC patients to control patients who underwent bariatric surgery in the same interval. Patients under 18 years old, undergoing revisional bariatric surgery, or getting band placement were excluded. High-risk characteristics causing CRC inclusion, preoperative demographics, percent follow-up and other postoperative outcomes were collected up to 5 years postoperatively. If univariate analysis revealed a significant difference between cohorts, multivariable analysis was performed. RESULTS Two hundred and fifty three patients were red-flagged from 2012 to 2013, of which 79 underwent surgery. After excluding 21 revisions, 3 non-adult patients, and 6 band patients, 55 red-flagged patients were analyzed in addition to 273 control patients. Patient age, sex, initial BMI, ASA, and co-morbidities were similar between groups, though flagged patients underwent RYGB more frequently than control patients. Notably, percent excess BMI loss and percent follow-up (6 months-5 years) were similar. In multivariable analysis, minor complications were more common in flagged patients; and marginal ulcers, endoscopy, and dilation for stenosis were more common in flagged versus control patients who underwent RYGB. Perforation, reoperation, revision, incisional hernia, and internal hernia were statistically similar in both groups, though reoperation was significantly more common in patients with multiple reasons to be flagged compared to controls. CONCLUSION Bariatric patients deemed high risk for various psychosocial issues have similar follow-up, BMI loss, and major complications compared to controls. High-risk RYGB patients have greater minor complications, warranting additional counseling of high-risk patients.
Collapse
Affiliation(s)
- Rebecca C Dirks
- Department of Surgery, University School of Medicine, Indiana, USA.
| | | | | | - Kathryn M Ziegler
- Department of Surgery, Oakland University William Beaumont School of Medicine, Rochester, USA
| | - Caitlyn Waldrop
- Department of Surgery, University School of Medicine, Indiana, USA
| | - Marisa Embry
- Department of Surgery, University School of Medicine, Indiana, USA
| | - Don J Selzer
- Department of Surgery, University School of Medicine, Indiana, USA
| |
Collapse
|
45
|
Jia X, Li J, Zhu S, Tian Q, Xu W, Niu X, Sun J, Tong W, Cao L, Li X, Guo J. Individualized protocol for radiation and contrast medium dose reduction in one-stop assessment for kidney transplantation patients. Eur J Radiol 2021; 140:109757. [PMID: 33989967 DOI: 10.1016/j.ejrad.2021.109757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/10/2021] [Revised: 04/23/2021] [Accepted: 05/03/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To compare image quality, radiation, and contrast medium (CM) doses between individualized and conventional scan protocols in combined coronary CT angiography (CCTA) and iliac artery CTA for kidney transplantation patients. METHODS 148 patients needing assessment for coronary and iliac arteries before kidney transplantation were prospectively enrolled and randomly divided into the conventional and individualized groups. All patients underwent one-stop combined scans on a 256-row CT scanner with automatic tube current modulation, 50 % pre-ASIR-V to control radiation dose. CCTA was performed first using one heartbeat axial scan mode with bolus tracking technique and iliac CTA was performed 3 s after CCTA using a spiral scan. The conventional group (n = 72) used the standard protocol: 100 kVp, 60 mL of 350 mgI/mL CM at 4.5 mL/s flow rate. The individualized group (n = 76) used a body-mass-index (BMI)-dependent protocol: kVp: 80 (BMI < 24) and 100 (BMI ≥ 24) and CM: 19 mgI/kg (BMI < 18); 21 mgI/kg (18 ≤ BMI < 24); and 22 mgI/kg (BMI ≥ 24). Image quality radiation and CM doses of the two groups were compared. RESULTS There was no significant difference in patient demographic data. Compared with the conventional group, the individualized group reduced contrast flow rate (in mL/s) by 14.4 % (3.85 ± 0.72 vs. 4.5), contrast dose (in mL) by 35.8 % (38.53 ± 7.18 vs. 60) and radiation dose (in mSv) by 34.3 % (4.30 ± 1.73 vs. 6.54 ± 1.45). The individualized group had significantly higher subjective image quality score (P < 0.05), lower noise (17.30 ± 4.97 HU vs. 19.13 ± 4.73 HU, P = 0.02) and higher signal-to-noise ratio (22.09 ± 7.41 vs. 19.55 ± 6.18, P = 0.03) for the three main vessels in CCTA compared with the conventional group. There were no differences in both subjective scores and objective measurements in iliac artery CTA between the two groups. CONCLUSION The individualized scanning protocol in the one-stop assessment of coronary and iliac arteries before kidney transplantation significantly reduces both radiation and CM doses while maintaining image quality in iliac artery CTA and providing better coronary artery images in CCTA.
Collapse
Affiliation(s)
- Xiaoqian Jia
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jianying Li
- GE Healthcare, Computed Tomography Research Center, Beijing, 100176, China
| | - Shumeng Zhu
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qian Tian
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Wenting Xu
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xinyi Niu
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jingtao Sun
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Wei Tong
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Le Cao
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xinyu Li
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jianxin Guo
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
| |
Collapse
|
46
|
Nayar SK, Li D, Ijaiya B, Lloyd D, Bharathan R. Waterlow score for risk assessment in surgical patients: a systematic review. Ann R Coll Surg Engl 2021; 103:312-317. [PMID: 33851894 DOI: 10.1308/rcsann.2020.7136] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION The Waterlow score (WS) is used routinely in clinical practice to assess risk of pressure sore development. Recent studies have also suggested its use in preoperative risk stratification. The primary aim of this systematic review was to evaluate the current evidence on the WS in predicting morbidity and mortality in surgical patients. METHODS A systematic review was carried out in accordance with PRISMA and SWiM guidelines. A search strategy was conducted on the MEDLINE and EMBASE databases. Quality was assessed using the Newcastle-Ottawa scale. FINDINGS Overall, 72 papers were identified, of which 7 met inclusion criteria for full text review, and 4 were included for analysis. All studies were cohort in nature and published between 2013 and 2016, encompassing a total of 505 surgical patients. The studies included general, vascular, transplant and orthopaedic surgery. A high WS was demonstrated to have statistically significant association with increased morbidity and mortality as well as need for intensive care unit admission and length of stay. Furthermore, this was a more accurate predictor compared with the P-POSSUM and ASA scoring systems used currently in routine practice. CONCLUSIONS The WS is a promising tool for risk stratification of surgical patients. It is already collected routinely by nursing staff throughout hospitals in the UK and would therefore be easy to implement. However, further large prospective studies are required in order to validate these findings prior to its establishment for this role in everyday surgical practice.
Collapse
Affiliation(s)
- S K Nayar
- Whittington Health NHS Trust, London, UK
| | - D Li
- University Hospitals of Leicester NHS Trust, UK
| | - B Ijaiya
- University Hospitals of Leicester NHS Trust, UK
| | - D Lloyd
- University Hospitals of Leicester NHS Trust, UK
| | - R Bharathan
- University Hospitals of Leicester NHS Trust, UK
| |
Collapse
|
47
|
Zientara A, Schwegler I, Dzemali O, Bruijnen H, Bernheim A, Dick F, Attigah N. Evaluation of metabolic equivalents of task (METs) in the preoperative assessment in aortic repair. BMC Surg 2021; 21:130. [PMID: 33714271 PMCID: PMC7955627 DOI: 10.1186/s12893-021-01143-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 03/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reliable prediction of the preoperative risk is of crucial importance for patients undergoing aortic repair. In this retrospective cohort study, we evaluated the metabolic equivalent of task (MET) in the preoperative risk assessment with clinical outcome in a cohort of consecutive patients. METHODS Retrospective analysis of prospectively collected data in a single center unit of 296 patients undergoing open or endovascular aortic repair from 2009 to 2016. The patients were divided into four anatomic main groups (infrarenal (endo: n = 94; open: n = 88), juxta- and para-renal (open n = 84), thoraco-abdominal (open n = 13) and thoracic (endo: n = 11; open: n = 6). Out of these, 276 patients had a preoperative statement of their functional capacity in metabolic units and were evaluated concerning their postoperative outcome including survival, in-hospital mortality, postoperative complications, myocardial infarction and stroke, and the need of later cardiovascular interventions. RESULTS The median follow-up of the cohort was 10.8 months. Patients with < 4MET had a higher incidence of diabetes mellitus (p = 0.0002), peripheral arterial disease (p < 0.0001), history of smoking (p = 0.003), obesity (p = 0.03) and chronic obstructive pulmonary disease (p = 0.05). Overall in-hospital mortality was 4.4% (13 patients). There was no significant difference in the survival between patients with a functional capacity of more than 4 MET (220 patients, mean survival: 74.5 months) and patients with less than 4 MET (56 patients, mean survival: 65.4 months) (p = 0.64). The mean survival of the infrarenal cohort (n = 169) was 74.3 months with no significant differences between both MET groups (> 4 MET: 131 patients, mean survival 75.5 months; < 4 MET: 38 patients, mean survival 63.6 months. p = 0.35). The subgroup after open surgical technique with less than 4 MET had the lowest mean survival of 38.8 months. In 46 patients with > 4MET (20.9%) perioperative complications occurred compared to the group with < 4MET with 18 patients (32.1%) (p = 0.075). There were no significant differences in both groups in the late cardiovascular interventions (p = 0.91) and major events including stroke and myocardial infarction (p = 0.4) monitored during the follow up period. The risk to miss a potential need for cardiac optimization in patients > 4MET was 7%. CONCLUSION The functional preoperative evaluation by MET in patients undergoing aortic surgery is a useful surrogate marker of perioperative performance but cannot be seen as a substitute for preoperative cardiopulmonary testing in selected individuals. Trial registration clinicaltrials.gov, registration number NCT03617601 (retrospectively registered).
Collapse
Affiliation(s)
- Alicja Zientara
- Department of Cardiac Surgery, Royal Brompton and Harefield Hospital, Sydney Street, London, SW3 6NP, UK
| | - Igor Schwegler
- Department of Vascular Surgery, Triemli Hospital, Birmensdorferstrasse 496, 8063, Zürich, Switzerland
| | - Omer Dzemali
- Department of Cardiac Surgery, Triemli Hospital, Birmensdorferstrasse 496, 8063, Zürich, Switzerland
| | - Hans Bruijnen
- Department of Vascular and Thoracic Surgery, Augsburg Hospital, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Alain Bernheim
- Department of Cardiology, Triemli Hospital, Birmensdorferstrasse 496, 8063, Zürich, Switzerland
| | - Florian Dick
- Department of Vascular Surgery, Cantonal Hospital, Rohrschacher Strasse 95, 9007, St. Gallen, Switzerland
| | - Nicolas Attigah
- Department of Vascular Surgery, Triemli Hospital, Birmensdorferstrasse 496, 8063, Zürich, Switzerland.
| |
Collapse
|
48
|
Aguilar-Frasco JL, Rodríguez-Quintero JH, Moctezuma-Velázquez P, Morales-Maza J, Moctezuma-Velázquez C, Pastor-Sifuentes F, Medina-Franco H. Frailty index as a predictive preoperative tool in the elder population undergoing major abdominal surgery: a prospective analysis of clinical utility. Langenbecks Arch Surg 2021; 406:1189-1198. [PMID: 33656576 DOI: 10.1007/s00423-021-02128-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 02/08/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE The geriatric population has increased considerably in the last decades. Such increases come along with new challenges for surgical practitioners, who now face a risen number of frail patients in need of major operations. The value of frailty indexes in this setting has been discussed recently. This study assessed the modified Rockwood frailty index (mRFI) as a predictive tool for postoperative complications in older adults subjected to major abdominal operations and correlated it with other scores widely utilized for this purpose. METHODS We performed a prospective study utilizing the mRFI including all patients older than 65 years subjected to major abdominal surgery between May 2017 and May 2019 in a third-level academic center. A comparison between frail (mRFI >0.25) and non-frail patients (mRFI <0.25) was performed. We performed logistic regression to identify predictors of postoperative complications and 30-day mortality. We analyzed the correlation between mRFI and ACS-NSQIP, P-POSSUM, PMP, and Charlson score risk calculators. RESULTS One hundred forty patients were included in our study, of whom 49 (35%) were identified as frail. Frail patients demonstrated significantly prolonged hospital stay (p<.0001), ICU admission rates (p=0.004), hospital readmissions (p=0.007), and higher mortality rates (p=0.02). Our univariate analysis associated frailty (mRFI>0.25), ASA >III, increased age, and BMI with postoperative complications. In our multivariate analysis, frailty remained an independent predictor for postoperative complications (OR 6.38, 95% CI [2.45-16.58], p<0.001). Frailty was also associated with length of stay (LOS) regardless of the type of surgery (OR 3.35, 95% CI [0.37-6.33], p= 0.03). mRFI>0.25 demonstrated a sensitivity (Se) of 70% and specificity (Sp) 67% with area under the curve (AUC) 0.75 for perioperative complications, Se 69% and Sp 70% with AUC 0.74 for ICU admissions, and Se 83% and Sp 68% with AUC 0.83 for mortality. CONCLUSION Frail patients demonstrated significantly prolonged hospital stay, ICU admission rates, hospital readmissions, and higher mortality rates. mRFI is an independent predictor for perioperative complications with a Se of 70% and Sp 67% and AUC 0.75.
Collapse
Affiliation(s)
- Jorge Luis Aguilar-Frasco
- Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Vasco de Quiroga, 15, Ciudad de México, México
| | - Jorge Humberto Rodríguez-Quintero
- Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Vasco de Quiroga, 15, Ciudad de México, México. .,Montefiore Medical Center/Albert Einstein College of Medicine, 3400 Bainbridge Avenue, Bronx, NY, 10467, USA.
| | - Paulina Moctezuma-Velázquez
- Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Vasco de Quiroga, 15, Ciudad de México, México
| | - Jesús Morales-Maza
- Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Vasco de Quiroga, 15, Ciudad de México, México
| | - Carlos Moctezuma-Velázquez
- Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Vasco de Quiroga, 15, Ciudad de México, México
| | - Francisco Pastor-Sifuentes
- Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Vasco de Quiroga, 15, Ciudad de México, México
| | - Heriberto Medina-Franco
- Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Vasco de Quiroga, 15, Ciudad de México, México
| |
Collapse
|
49
|
Lightsey HM, Crawford AM, Xiong GX, Schoenfeld AJ, Simpson AK. Surgical plans generated from telemedicine visits are rarely changed after in-person evaluation in spine patients. Spine J 2021; 21:359-365. [PMID: 33227550 DOI: 10.1016/j.spinee.2020.11.009] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/06/2020] [Accepted: 11/14/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The role of telemedicine within the realm of spine surgery is evolving, catalyzed by the recent pandemic. Specifically, the capability of this technology to provide high-quality, cost-effective care without an in-person interaction and physical examination remains poorly defined. PURPOSE To characterize the impact of telemedicine on spine surgical planning by assessing whether surgical plans established in virtual visits changed following in-person evaluation. STUDY DESIGN Retrospective cohort study. PATIENT SAMPLE We evaluated the records of patients who were indicated for surgery with documented specific surgical plans during a virtual encounter (March-July 2020) and underwent subsequent in-person evaluation prior to surgery. OUTCOME MEASURES We determined whether surgical plans changed between the virtual encounter and the in-person interaction. Secondarily, we reviewed use of the virtual physical examination across surgeons. METHODS We reviewed virtual and in-person clinical encounters from a single academic spine division, evaluating those patients who were seen exclusively via telemedicine encounters and indicated for surgery with documented specific surgical plans. These plans were compared to the surgical plan after these same patients underwent in-person evaluation. Demographic data, patient primary complaint, and the type and extent of physical examination performed by the surgeon were recorded. RESULTS Of the 33 patients included, the surgical plan did not change among 31 individuals (94%) following in-person interaction. For the two patients where surgical plans were modified, multilevel fusions were increased by one level. There was notable inter- and intra-surgeon variability with regard to the use of virtual physical exams. CONCLUSIONS Our findings suggest that telemedicine evaluations are efficient means of preoperative assessment of spine patients and delineation of surgical plans. These results may support innovations that can optimize access to care for patients.
Collapse
Affiliation(s)
- Harry M Lightsey
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115 USA
| | - Alexander M Crawford
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115 USA
| | - Grace X Xiong
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115 USA
| | - Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115 USA
| | - Andrew K Simpson
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115 USA.
| |
Collapse
|
50
|
Perry TE, George SA, Lee B, Wahr J, Randle D, Sigurðsson G. A guide for pre-procedural imaging for transcatheter aortic valve replacement patients. Perioper Med (Lond) 2020; 9:36. [PMID: 33292498 PMCID: PMC7690031 DOI: 10.1186/s13741-020-00165-1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 10/30/2020] [Indexed: 12/17/2022] Open
Abstract
Safe and accurate pre-procedural assessment of cardiovascular anatomy, physiology, and pathophysiology prior to TAVR procedures can mean the difference between success and catastrophic failure. It is imperative that clinical care team members share a basic understanding of the preprocedural imaging technologies available for optimizing the care of TAVR patients. Herein, we review current imaging technology for assessing the anatomy, physiology, and pathophysiology of the aortic valvular complex, ventricular function, and peripheral vasculature, including echocardiography, cardiac catheterization, cardiac computed tomography, and cardiac magnetic resonance prior to a TAVR procedure. The authorship includes cardiac-trained anesthesiologists, anesthesiologists with expertise in pre-procedural cardiac assessment and optimization, and interventional cardiologists with expertise in cardiovascular imaging prior to TAVRs. Improving the understanding of all team members will undoubtedly translate into safer, more coordinated patient care.
Collapse
Affiliation(s)
- Tjörvi E. Perry
- Department of Anesthesia, Division of Cardiothoracic Anesthesia, University of Minnesota, 420 Delaware St SE, MMC 294, Minneapolis, MN 55455 USA
| | - Stephen A. George
- Department of Cardiology, Regions Hospital Heart Center, 640 Jackson Street, Saint Paul, MN 55101 USA
| | - Belinda Lee
- Department of Anesthesia, Division of Cardiothoracic Anesthesia, University of Minnesota, 420 Delaware St SE, MMC 294, Minneapolis, MN 55455 USA
| | - Joyce Wahr
- Department of Anesthesia, Preoperative Assessment Center, University of Minnesota, 420 Delaware St SE, MMC 294, Minneapolis, MN 55455 USA
| | - Darrell Randle
- Department of Anesthesia, Preoperative Assessment Center, University of Minnesota, 420 Delaware St SE, MMC 294, Minneapolis, MN 55455 USA
| | - Garðar Sigurðsson
- Department of Cardiology, University of Minnesota, 420 Delaware St. SE, MMC 207, Minneapolis, MN 55455 USA
| |
Collapse
|