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Ostojic A, Mahmud N, Reddy KR. Surgical risk stratification in patients with cirrhosis. Hepatol Int 2024:10.1007/s12072-024-10644-y. [PMID: 38472607 DOI: 10.1007/s12072-024-10644-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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 01/15/2024] [Indexed: 03/14/2024]
Abstract
Individuals with cirrhosis experience higher morbidity and mortality rates than the general population, irrespective of the type or scope of surgery. This increased risk is attributed to adverse effects of liver disease, encompassing coagulation dysfunction, altered metabolism of anesthesia and sedatives, immunologic dysfunction, hemorrhage related to varices, malnutrition and frailty, impaired wound healing, as well as diminished portal blood flow, overall hepatic circulation, and hepatic oxygen supply during surgical procedures. Therefore, a frequent clinical dilemma is whether surgical interventions should be pursued in patients with cirrhosis. Several risk scores are widely used to aid in the decision-making process, each with specific advantages and limitations. This review aims to discuss the preoperative risk factors in patients with cirrhosis, describe and compare surgical risk assessment models used in everyday practice, provide insights into the surgical risk according to the type of surgery and present recommendations for optimizing those with cirrhosis for surgical procedures. As the primary focus is on currently available risk models, the review describes the predictive value of each model, highlighting its specific advantages and limitations. Furthermore, for models that do not account for the type of surgical procedure to be performed, the review suggests incorporating both patient-related and surgery-related risks into the decision-making process. Finally, we provide an algorithm for the preoperative assessment of patients with cirrhosis before elective surgery as well as guidance perioperative management.
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Affiliation(s)
- Ana Ostojic
- Division of Gastroenterology, Department of Internal Medicine, University Hospital Center Zagreb, Kispaticeva 12, Zagreb, 10000, Croatia
| | - Nadim Mahmud
- Division of Gastroenterology and Hepatology, University of Pennsylvania, 2 Dulles, 3400 Spruce Street, HUP, Philadelphia, PA, 19104, USA
| | - K Rajender Reddy
- Division of Gastroenterology and Hepatology, University of Pennsylvania, 2 Dulles, 3400 Spruce Street, HUP, Philadelphia, PA, 19104, USA.
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Tjeertes EKM, Simoncelli TFW, van den Enden AJM, Mattace-Raso FUS, Stolker RJ, Hoeks SE. Perioperative outcome, long-term mortality and time trends in elderly patients undergoing low-, intermediate- or major non-cardiac surgery. Aging Clin Exp Res 2024; 36:64. [PMID: 38462583 PMCID: PMC10925572 DOI: 10.1007/s40520-024-02717-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/31/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Decision-making whether older patients benefit from surgery can be a difficult task. This report investigates characteristics and outcomes of a large cohort of inpatients, aged 80 years and over, undergoing non-cardiac surgery. METHODS This observational study was performed at a tertiary university medical centre in the Netherlands. Patients of 80 years or older undergoing elective or urgent surgery from January 2004 to June 2017 were included. Outcomes were length of stay, discharge destination, 30-day and long-term mortality. Patients were divided into low-, intermediate and high-risk surgery subgroups. Univariable and multivariable logistic regression were used to evaluate the association of risk factors and outcomes. Secondary outcomes were time trends, assessed with Mantel-Haenszel chi-square test. RESULTS Data of 8251 patients, undergoing 19,027 surgical interventions were collected from the patients' medical record. 7032 primary procedures were suitable for analyses. Median LOS was 3 days in the low-risk group, compared to six in the intermediate- and ten in the high-risk group. Median LOS of the total cohort decreased from 5.8 days (IQR 1.9-14.5) in 2004-2007 to 4.6 days (IQR 1.9-9.0) in 2016-2017. Three quarters of patients were discharged to their home. Postoperative 30-day mortality in the low-risk group was 2.3%. In the overall population 30-day mortality was high and constant during the study period (6.7%, ranging from 4.2 to 8.4%). CONCLUSION Patients should not be withheld surgery solely based on their age. However, even for low-risk surgery, the mortality rate of more than 2% is substantial. Deciding whether older patients benefit from surgery should be based on the understanding of individual risks, patients' wishes and a patient-centred plan.
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Affiliation(s)
- E K M Tjeertes
- Department of Anesthesiology, Erasmus MC University Medical Center, PO BOX 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Anesthesiology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - T F W Simoncelli
- Department of Anesthesiology, Erasmus MC University Medical Center, PO BOX 2040, 3000 CA, Rotterdam, The Netherlands
| | - A J M van den Enden
- Department of Anesthesiology, Erasmus MC University Medical Center, PO BOX 2040, 3000 CA, Rotterdam, The Netherlands
| | - F U S Mattace-Raso
- Division of Geriatric Medicine, Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - R J Stolker
- Department of Anesthesiology, Erasmus MC University Medical Center, PO BOX 2040, 3000 CA, Rotterdam, The Netherlands
| | - S E Hoeks
- Department of Anesthesiology, Erasmus MC University Medical Center, PO BOX 2040, 3000 CA, Rotterdam, The Netherlands.
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Rajesh K, Levine D, Murana G, Castagnini S, Bianco E, Childress P, Zhao Y, Kurlansky P, Pacini D, Takayama H. Is surgical risk of aortic arch aneurysm repair underestimated? A novel perspective based on 30-day versus 1-year mortality. Eur J Cardiothorac Surg 2024; 65:ezae041. [PMID: 38318956 DOI: 10.1093/ejcts/ezae041] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/11/2024] [Accepted: 02/01/2024] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVES The decision to undergo aortic aneurysm repair balances the risk of operation with the risk of aortic complications. The surgical risk is typically represented by perioperative mortality, while the aneurysmal risk relates to the 1-year risk of aortic events. We investigate the difference in 30-day and 1-year mortality after total arch replacement for aortic aneurysm. METHODS This was an international two-centre study of 456 patients who underwent total aortic arch replacement for aneurysm between 2006 and 2020. Our primary end-point of interest was 1-year mortality. Our secondary analysis determined which variables were associated with 1-year mortality. RESULTS The median age of patients was 65.4 years (interquartile range 55.1-71.1) and 118 (25.9%) were female. Concomitantly, 91 (20.0%) patients had either an aortic root replacement or aortic valve procedure. There was a drop in 1-year (81%, 95% confidence interval (CI) 78-85%) survival probability compared to 30-day (92%, 95% CI 90-95%) survival probability. Risk hazards regression showed the greatest risk of mortality in the first 4 months after discharge. Stroke [hazard ratio (HR) 2.54, 95% CI (1.16-5.58)], renal failure [HR 3.59 (1.78-7.25)], respiratory failure [HR 3.65 (1.79-7.42)] and reoperation for bleeding [HR 2.97 (1.36-6.46)] were associated with 1-year mortality in patients who survived 30 days. CONCLUSIONS There is an increase in mortality up to 1 year after aortic arch replacement. This increase is prominent in the first 4 months and is associated with postoperative complications, implying the influence of surgical insult. Mortality beyond the short term may be considered in assessing surgical risk in patients who are undergoing total arch replacement.
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Affiliation(s)
- Kavya Rajesh
- Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Dov Levine
- Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Giacomo Murana
- Division of Cardiac Surgery, Cardiac Surgery Department, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Sabrina Castagnini
- Division of Cardiac Surgery, Cardiac Surgery Department, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Edoardo Bianco
- Division of Cardiac Surgery, Cardiac Surgery Department, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Patra Childress
- Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Yanling Zhao
- Center for Innovation and Outcomes Research, Columbia University, New York, NY, USA
| | - Paul Kurlansky
- Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
- Center for Innovation and Outcomes Research, Columbia University, New York, NY, USA
| | - Davide Pacini
- Division of Cardiac Surgery, Cardiac Surgery Department, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Hiroo Takayama
- Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
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Wang ZG, Yang FL, Liu CY, Wang F, Xiong Y, Zhang Q, Chen MN, Lai H. Predicting intraoperative hemorrhage during curettage treatment of cesarean scar pregnancy using free-breathing GRASP DCE-MRI. BMC Pregnancy Childbirth 2024; 24:22. [PMID: 38172701 PMCID: PMC10763255 DOI: 10.1186/s12884-023-06188-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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 12/11/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE To explore the feasibility of the golden-angle radial sparse parallel (GRASP) dynamic magnetic resonance imaging (MRI) technique in predicting the intraoperative bleeding risk of scar pregnancy. METHODS A total of 49 patients with cesarean scar pregnancy (CSP) who underwent curettage and GRASP-MRI imaging were retrospectively selected between January 2021 and July 2022. The pharmacokinetic parameters, including Wash-in, Wash-out, time to peck (TTP), initial area under the curve (iAUC), the transfer rate constant (Ktrans), constant flow rate (Kep), and volume of extracellular space (Ve), were calculated. The amount of intraoperative bleeding was recorded by a gynecologist who performed surgery, after which patients were divided into non-hemorrhage (blood loss ≤ 200 mL) and hemorrhage (blood loss > 200 mL) groups. The measured pharmacokinetic parameters were statistically compared using the t-test or Mann-Whitney U test with a significant level set to be p < 0.05. The receiver operating characteristic (ROC) curve was constructed, and the area under the curve (AUC) was calculated to evaluate each parameter's capability in intraoperative hemorrhage subgroup classification. RESULTS Twenty patients had intraoperative hemorrhage (blood loss > 200 mL) during curettage. The hemorrhage group had larger Wash-in, iAUC, Ktrans, Ve, and shorter TTP than the non-hemorrhage group (all P > 0.05). Wash-in had the highest AUC value (0.90), while Ktrans had the lowest value (0.67). Wash-out and Kep were not significantly different between the two groups. CONCLUSION GRASP DCE-MRI has the potential to forecast intraoperative hemorrhage during curettage treatment of CSP, with Wash-in exhibiting the highest predictive performance. This data holds promise for advancing personalized treatment. However, further study is required to compare its effectiveness with other risk factors identified through anatomical MRI and ultrasound.
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Affiliation(s)
- Zhi-Gang Wang
- Department of Radiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No.1617 of Riyue Avenue, Qingyang District, Chengdu, 610091, China
| | - Feng-Leng Yang
- Department of Radiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No.1617 of Riyue Avenue, Qingyang District, Chengdu, 610091, China
| | - Chun-Ying Liu
- Department of Radiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No.1617 of Riyue Avenue, Qingyang District, Chengdu, 610091, China
| | - Fang Wang
- Department of Radiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No.1617 of Riyue Avenue, Qingyang District, Chengdu, 610091, China
| | - Ying Xiong
- Department of Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Qiang Zhang
- Department of Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Mei-Ning Chen
- Department of MR Scientific Marketing, Siemens Healthineers, Shanghai, China
| | - Hua Lai
- Department of Radiology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No.1617 of Riyue Avenue, Qingyang District, Chengdu, 610091, China.
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Wang CJ, Chao YJ, Liu YS, Liao FT, Chang SS, Liao TK, Lu WH, Su PJ, Shan YS. Prediction of surgical outcomes in severe encapsulating peritoneal sclerosis using a computed tomography scoring system. J Formos Med Assoc 2024; 123:98-105. [PMID: 37365098 DOI: 10.1016/j.jfma.2023.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 04/27/2023] [Accepted: 06/14/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND/PURPOSE Encapsulating peritoneal sclerosis (EPS) is a rare and potential lethal complication of peritoneal dialysis characterized by bowel obstruction. Surgical enterolysis is the only curative therapy. Currently, there are no tools for predicting postsurgical prognosis. This study aimed to identify a computed tomography (CT) scoring system that could predict mortality after surgery in patients with severe EPS. METHODS This retrospective study enrolled patients with severe EPS who underwent surgical enterolysis in a tertiary referral medical center. The association of CT score with surgical outcomes including mortality, blood loss, and bowel perforation was analyzed. RESULTS Thirty-four patients who underwent 37 procedures were recruited and divided into a survivor and non-survivor group. The survivor group had higher body mass indices (BMIs, 18.1 vs. 16.7 kg/m2, p = 0.035) and lower CT scores (11 vs. 17, p < 0.001) than the non-survivor group. The receiver operating characteristic curve revealed that a CT score of ≥15 could be considered a cutoff point to predict surgical mortality, with an area under the curve of 0.93, sensitivity of 88.9%, and specificity of 82.1%. Compared with the group with CT scores of <15, the group with CT scores of ≥15 had a lower BMI (19.7 vs. 16.2 kg/m2, p = 0.004), higher mortality (4.2% vs. 61.5%, p < 0.001), greater blood loss (50 vs. 400 mL, p = 0.007), and higher incidence of bowel perforation (12.5% vs. 61.5%, p = 0.006). CONCLUSION The CT scoring system could be useful in predicting surgical risk in patients with severe EPS receiving enterolysis.
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Affiliation(s)
- Chih-Jung Wang
- Division of Trauma, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan; Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ying Jui Chao
- Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yi-Sheng Liu
- Department of Radiology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Fan-Ting Liao
- Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Shen-Shin Chang
- Division of Transplantation, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Ting-Kai Liao
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Wei-Hsun Lu
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Ping-Jui Su
- Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yan-Shen Shan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan.
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Mao HM, Huang SG, Yang Y, Cai TN, Guo WL. Using machine learning models to predict the surgical risk of children with pancreaticobiliary maljunction and biliary dilatation. Surg Today 2023; 53:1352-1362. [PMID: 37160428 DOI: 10.1007/s00595-023-02696-8] [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: 11/18/2022] [Accepted: 03/27/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE To develop machine learning (ML) models to predict the surgical risk of children with pancreaticobiliary maljunction (PBM) and biliary dilatation. METHODS The subjects of this study were 157 pediatric patients who underwent surgery for PBM with biliary dilatation between January, 2015 and August, 2022. Using preoperative data, four ML models were developed, including logistic regression (LR), random forest (RF), support vector machine classifier (SVC), and extreme gradient boosting (XGBoost). The performance of each model was assessed via the area under the receiver operator characteristic curve (AUC). Model interpretations were generated by Shapley Additive Explanations. A nomogram was used to validate the best-performing model. RESULTS Sixty-eight patients (43.3%) were classified as the high-risk surgery group. The XGBoost model (AUC = 0.822) outperformed the LR (AUC = 0.798), RF (AUC = 0.802) and SVC (AUC = 0.804) models. In all four models, enhancement of the choledochal cystic wall and an abnormal position of the right hepatic artery were the two most important features. Moreover, the diameter of the choledochal cyst, bile duct variation, and serum amylase were selected as key predictive factors by all four models. CONCLUSIONS Using preoperative data, the ML models, especially XGBoost, have the potential to predict the surgical risk of children with PBM and biliary dilatation. The nomogram may provide surgeons early warning to avoid intraoperative iatrogenic injury.
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Affiliation(s)
- Hui-Min Mao
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Shun-Gen Huang
- Pediatric Surgery, Children's Hospital of Soochow University, Suzhou, 215025, China
| | - Yang Yang
- Department of Radiology, Children's Hospital of Soochow University, Suzhou, 215025, China
| | - Tian-Na Cai
- Department of Radiology, Children's Hospital of Soochow University, Suzhou, 215025, China
| | - Wan-Liang Guo
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.
- Department of Radiology, Children's Hospital of Soochow University, Suzhou, 215025, China.
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Yuan C, Yang D, Xu L, Liu J, Li H, Yu X, Zou S, Wang K, Hu Z. Nomogram predicting surgical risk of laparoscopic left-sided hepatectomy for hepatolithiasis. Langenbecks Arch Surg 2023; 408:357. [PMID: 37704787 DOI: 10.1007/s00423-023-03099-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/07/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE To explore the surgical risk factors of laparoscopic left-sided hepatectomy for hepatolithiasis and establish and validate a nomogram to estimate the corresponding surgical risks. METHODS Patients with hepatolithiasis who underwent laparoscopic left-sided hepatectomy were retrospectively enrolled. Demographic data, clinicopathological parameters, and surgical factors were collected. Three hundred fifty-three patients were enrolled and randomly divided into training set (n=267) and validation set (n=86) by 3:1. Conversion to laparotomy was used as a surrogate index to evaluate the surgical risk. Univariate analysis was used to screen potential surgical risk factors, and multivariate analysis using logistic regression model was used to screen independent surgical risk factors. Nomogram predicting the surgical risks was established based on the independent risk factors. Discrimination, calibration, decision curve, and clinical impact analyses were used to evaluate the performance of the nomogram on the statistical and clinical aspects both in the training and validation sets. RESULTS Five independent surgical risk factors were identified in the training set, including recurrent abdominal pain, bile duct stricture, ASA classification ≥2, extent of liver resection, and biliary tract T tube drainage. No collinearity was found among these five factors, and a nomogram was established. Performance analyses of the nomogram showed good discrimination (AUC=0.850 and 0.817) and calibration (Hosmer-Lemeshow test, p=0.530 and 0.930) capabilities both in the training and validation sets. Decision curve and clinical impact analyses also showed that the prediction performance was clinically valuable. CONCLUSIONS A nomogram was established and validated to be effective in evaluating and predicting the surgical risk of patients undergoing laparoscopic left-sided hepatectomies for hepatolithiasis.
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Affiliation(s)
- Chen Yuan
- Hepato-Biliary-Pancreatic Surgery Division, Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
- Jiangxi Provincial Clinical Research Center for General Surgery Disease, Nanchang, China
- Jiangxi Provincial Engineering Research Center for Hepatobiliary Disease, Nanchang, China
| | - Dongxiao Yang
- Hepato-Biliary-Pancreatic Surgery Division, Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
- Jiangxi Provincial Clinical Research Center for General Surgery Disease, Nanchang, China
- Jiangxi Provincial Engineering Research Center for Hepatobiliary Disease, Nanchang, China
| | - Linlong Xu
- Hepato-Biliary-Pancreatic Surgery Division, Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
- Jiangxi Provincial Clinical Research Center for General Surgery Disease, Nanchang, China
- Jiangxi Provincial Engineering Research Center for Hepatobiliary Disease, Nanchang, China
| | - Jia Liu
- Hepato-Biliary-Pancreatic Surgery Division, Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
- Jiangxi Provincial Clinical Research Center for General Surgery Disease, Nanchang, China
- Jiangxi Provincial Engineering Research Center for Hepatobiliary Disease, Nanchang, China
| | - Huaiyang Li
- Hepato-Biliary-Pancreatic Surgery Division, Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
- Jiangxi Provincial Clinical Research Center for General Surgery Disease, Nanchang, China
- Jiangxi Provincial Engineering Research Center for Hepatobiliary Disease, Nanchang, China
| | - Xin Yu
- Hepato-Biliary-Pancreatic Surgery Division, Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
- Jiangxi Provincial Clinical Research Center for General Surgery Disease, Nanchang, China
- Jiangxi Provincial Engineering Research Center for Hepatobiliary Disease, Nanchang, China
| | - Shubing Zou
- Hepato-Biliary-Pancreatic Surgery Division, Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
- Jiangxi Provincial Clinical Research Center for General Surgery Disease, Nanchang, China
- Jiangxi Provincial Engineering Research Center for Hepatobiliary Disease, Nanchang, China
| | - Kai Wang
- Hepato-Biliary-Pancreatic Surgery Division, Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China.
- Jiangxi Provincial Clinical Research Center for General Surgery Disease, Nanchang, China.
- Jiangxi Provincial Engineering Research Center for Hepatobiliary Disease, Nanchang, China.
| | - Zhigang Hu
- Hepato-Biliary-Pancreatic Surgery Division, Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China.
- Jiangxi Provincial Clinical Research Center for General Surgery Disease, Nanchang, China.
- Jiangxi Provincial Engineering Research Center for Hepatobiliary Disease, Nanchang, China.
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Liu R, Liu S, Yi L, Wang D, Zhou X, Zhiming W, Ren K, Ke J, Zhu W, Lu Y. Development and validation of multiparametric models based on computed tomography enterography to determine endoscopic activity and surgical risk in patients with Crohn's disease: A multi-center study. Heliyon 2023; 9:e19942. [PMID: 37810028 PMCID: PMC10559359 DOI: 10.1016/j.heliyon.2023.e19942] [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: 12/13/2022] [Revised: 08/24/2023] [Accepted: 09/06/2023] [Indexed: 10/10/2023] Open
Abstract
Objective To develop novel multiparametric models based on computed tomography enterography (CTE) scores to identify endoscopic activity and surgical risk in patients with Crohn's disease (CD). Methods We analyzed 171 patients from 3 hospitals. Correlations between CTE outcomes and endoscopic scores were assessed using Spearman's rank correlation analysis. Predictive models for moderate to severe CD were developed, and receiver operating characteristic (ROC) curves were constructed to determine the area under the ROC curve (AUC). A combined nomogram based on CTE scores and clinical variables was also developed for predicting moderate to severe CD and surgery. Results CTE scores were significantly correlated with endoscopy scores at the segment level. The global CTE score was an independent predictor of severe (HR = 1.231, 95% CI: 1.048-1.446, p = 0.012) and moderate-to-severe Simplified Endoscopic Scores for Crohn's Disease (SES-CD) (HR = 1.202, 95% CI: 1.090-1.325, p < 0.001). The nomogram integrating CTE and clinical data predicted moderate to severe SES-CD and severe SES-CD scores in the validation cohort with AUCs of 0.837 and 0.807, respectively. The CTE score (HR = 1.18; 95% CI: 1.103-1.262; p = 0.001) and SES-CD score (HR = 3.125, 95% CI: 1.542-6.33; p = 0.001) were independent prognostic factors for surgery-free survival. A prognostic nomogram incorporating CTE scores, SES-CD and C-reactive protein (CRP) accurately predicted the risk of surgery in patients with CD. Conclusion The newly developed CTE score and multiparametric models displayed high accuracy in predicting moderate to severe CD and surgical risk for CD patients.
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Affiliation(s)
- Ruiqing Liu
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, Shandong, China
| | - Shunli Liu
- Department of Radiology, The Affiliated Hospital of Qingdao University Qingdao, 16 Jiangsu Road, Qingdao, Shandong, China
| | - Li Yi
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu Province, China
| | - Dongsheng Wang
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, Shandong, China
| | - Xiaoming Zhou
- Department of Radiology, The Affiliated Hospital of Qingdao University Qingdao, 16 Jiangsu Road, Qingdao, Shandong, China
| | - Wang Zhiming
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu Province, China
| | - Keyu Ren
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jia Ke
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510655, Guangdong, China
| | - Weiming Zhu
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu Province, China
| | - Yun Lu
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, Shandong, China
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Xu SY, Jackson J, Goldblatt MI. Assessing surgical risk calculators on hernia repair candidates with cirrhosis. Hernia 2023:10.1007/s10029-023-02817-9. [PMID: 37291373 DOI: 10.1007/s10029-023-02817-9] [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: 04/02/2023] [Accepted: 05/28/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE Several risk calculators have been developed and deployed to help surgeons estimate the mortality risk that comes with performing hernia repair surgery on patient with severe liver disease. This study seeks to evaluate the accuracy of these risk calculators on patients with cirrhosis and identify the most suitable population of patient to use these calculators on. METHODS The American College of Surgeons National Surgery Quality Improvement Program (NSQIP) 2013-2021 datasets were queried for patients who underwent hernia repair surgery. Mayo Clinic's "Post-operative Mortality Risk in Patients with Cirrhosis" risk calculator, Model for End-Stage Liver Disease (MELD) calculator, NSQIP's Surgical Risk Calculator, and a surgical 5-item modified frailty index were assessed to determine whether they accurately predict mortality following abdominal hernia repair. RESULTS In total, 1368 patients met inclusion criteria. Receiver operating characteristic (ROC) curve analysis of the 4 mortality risk calculators resulted in the following: NSQIP Surgical Risk Calculator = 0.803 (p < 0.001); "Post-operative Mortality Risk in Patients with Cirrhosis" with an etiology of "Alcoholic or Cholestatic" yielded an AUC = 0.722 (p < 0.001); MELD score yielded an AUC = 0.709 (p < 0.001); and the modified 5-item frailty index yielded an AUC = 0.583 (p = 0.04). CONCLUSION The NSQIP Surgical Risk Calculator more accurately predicts 30-day mortality in patients with ascites undergoing hernia repair. However, if the patient is missing one of the 21 input variables required by this calculator, Mayo Clinic's 30-day mortality calculator should be consulted before the more widely used MELD score.
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Affiliation(s)
- S Y Xu
- Division of Minimally Invasive and Gastrointestinal Surgery, Department of Surgery, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Wauwatosa, WI, 53226, USA
| | - J Jackson
- Saint Joseph Hospital, Denver, CO, USA
| | - M I Goldblatt
- Division of Minimally Invasive and Gastrointestinal Surgery, Department of Surgery, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Wauwatosa, WI, 53226, USA.
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10
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Kalo E, George J, Read S, Majumdar A, Ahlenstiel G. Evolution of risk prediction models for post-operative mortality in patients with cirrhosis. Hepatol Int 2023; 17:542-545. [PMID: 36971983 DOI: 10.1007/s12072-023-10494-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 01/24/2023] [Indexed: 05/29/2023]
Abstract
The perception of high surgical risk among patients with cirrhosis has resulted in a long-standing reluctance to operate. Risk stratification tools, first implemented over 60 years ago, have attempted to assess mortality risk among cirrhotic patients and ensure the best possible outcomes for this difficult to treat cohort. Existing postoperative risk prediction tools including the Child-Turcotte-Pugh (CTP) and Model for End-stage Liver Disease (MELD) provide some prediction of risk in counselling patients and their families but tend to overestimate surgical risk. More personalised prediction algorithms such as the Mayo Risk Score and VOCAL-Penn score that incorporate surgery-specific risks have demonstrated a significant improvement in prognostication and can ultimately aid multidisciplinary team determination of potential risks. The development of future risk scores will need to incorporate, first and foremost, predictive efficacy, but perhaps just as important is the feasibility and usability by front-line healthcare professionals to ensure timely and efficient prediction of risk for cirrhotic patients.
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Affiliation(s)
- Eric Kalo
- Blacktown Clinical School, School of Medicine, Western Sydney University, Blacktown, NSW, 2148, Australia
| | - Jacob George
- Storr Liver Centre, The Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Westmead, NSW, 2145, Australia
| | - Scott Read
- Blacktown Clinical School, School of Medicine, Western Sydney University, Blacktown, NSW, 2148, Australia
- Blacktown Hospital, Western Sydney Local Health District, Blacktown, NSW, 2148, Australia
- Storr Liver Centre, The Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Westmead, NSW, 2145, Australia
| | - Avik Majumdar
- Victorian Liver Transplant Unit, Austin Health, Heidelberg, VIC, 3181, Australia
- The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Golo Ahlenstiel
- Blacktown Clinical School, School of Medicine, Western Sydney University, Blacktown, NSW, 2148, Australia.
- Blacktown Hospital, Western Sydney Local Health District, Blacktown, NSW, 2148, Australia.
- Storr Liver Centre, The Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Westmead, NSW, 2145, Australia.
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11
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Fugazzola P, Cobianchi L, Di Martino M, Tomasoni M, Dal Mas F, Abu-Zidan FM, Agnoletti V, Ceresoli M, Coccolini F, Di Saverio S, Dominioni T, Farè CN, Frassini S, Gambini G, Leppäniemi A, Maestri M, Martín-Pérez E, Moore EE, Musella V, Peitzman AB, de la Hoz Rodríguez Á, Sargenti B, Sartelli M, Viganò J, Anderloni A, Biffl W, Catena F, Ansaloni L. Prediction of morbidity and mortality after early cholecystectomy for acute calculous cholecystitis: results of the S.P.Ri.M.A.C.C. study. World J Emerg Surg 2023; 18:20. [PMID: 36934276 PMCID: PMC10024826 DOI: 10.1186/s13017-023-00488-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/04/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND Less invasive alternatives than early cholecystectomy (EC) for acute calculous cholecystitis (ACC) treatment have been spreading in recent years. We still lack a reliable tool to select high-risk patients who could benefit from these alternatives. Our study aimed to prospectively validate the Chole-risk score in predicting postoperative complications in patients undergoing EC for ACC compared with other preoperative risk prediction models. METHOD The S.P.Ri.M.A.C.C. study is a World Society of Emergency Surgery prospective multicenter observational study. From 1st September 2021 to 1st September 2022, 1253 consecutive patients admitted in 79 centers were included. The inclusion criteria were a diagnosis of ACC and to be a candidate for EC. A Cochran-Armitage test of the trend was run to determine whether a linear correlation existed between the Chole-risk score and a complicated postoperative course. To assess the accuracy of the analyzed prediction models-POSSUM Physiological Score (PS), modified Frailty Index, Charlson Comorbidity Index, American Society of Anesthesiologist score (ASA), APACHE II score, and ACC severity grade-receiver operating characteristic (ROC) curves were generated. The area under the ROC curve (AUC) was used to compare the diagnostic abilities. RESULTS A 30-day major morbidity of 6.6% and 30-day mortality of 1.1% were found. Chole-risk was validated, but POSSUM PS was the best risk prediction model for a complicated course after EC for ACC (in-hospital mortality: AUC 0.94, p < 0.001; 30-day mortality: AUC 0.94, p < 0.001; in-hospital major morbidity: AUC 0.73, p < 0.001; 30-day major morbidity: AUC 0.70, p < 0.001). POSSUM PS with a cutoff of 25 (defined in our study as a 'Chole-POSSUM' score) was then validated in a separate cohort of patients. It showed a 100% sensitivity and a 100% negative predictive value for mortality and a 96-97% negative predictive value for major complications. CONCLUSIONS The Chole-risk score was externally validated, but the CHOLE-POSSUM stands as a more accurate prediction model. CHOLE-POSSUM is a reliable tool to stratify patients with ACC into a low-risk group that may represent a safe EC candidate, and a high-risk group, where new minimally invasive endoscopic techniques may find the most useful field of action. TRIAL REGISTRATION ClinicalTrial.gov NCT04995380.
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Affiliation(s)
- Paola Fugazzola
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Lorenzo Cobianchi
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100, Pavia, PV, Italy.
| | - Marcello Di Martino
- Hepato-Biliary and Liver Transplantation Department, AORN Cardarelli, Napoli, Italy
| | - Matteo Tomasoni
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesca Dal Mas
- Department of Management, Ca' Foscari University of Venice, Venice, Italy
| | - Fikri M Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | | | - Marco Ceresoli
- General and Emergency Surgery, School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
| | - Federico Coccolini
- Department of Emergency and Trauma Surgery, Pisa University Hospital, University of Pisa, Pisa, Italy
| | - Salomone Di Saverio
- Department of Surgery, Madonna Del Soccorso Hospital, San Benedetto del Tronto, Italy
| | - Tommaso Dominioni
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Camilla Nikita Farè
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Simone Frassini
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giulia Gambini
- Unit of Clinical Epidemiology and Biometry, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Ari Leppäniemi
- Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Marcello Maestri
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Elena Martín-Pérez
- Department of General and Digestive Surgery, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Ernest E Moore
- Denver Health System - Denver Health Medical Center, Denver, USA
| | - Valeria Musella
- Unit of Clinical Epidemiology and Biometry, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrew B Peitzman
- Department of Surgery, University of Pittsburgh School of Medicine, UPMC-Presbyterian, Pittsburgh, USA
| | - Ángela de la Hoz Rodríguez
- Department of General and Digestive Surgery, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Benedetta Sargenti
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Massimo Sartelli
- Department of Surgery, Macerata Hospital, 62100, Macerata, Italy
| | - Jacopo Viganò
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Anderloni
- Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Walter Biffl
- Division of Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Fausto Catena
- General and Emergency Surgery, Bufalini Hospital, Cesena, Italy
| | - Luca Ansaloni
- Division of General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100, Pavia, PV, Italy
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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.
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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
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13
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Tan W, Aboulhosn J. Catheter-based Interventions to Reduce or Modify Surgical Risk in High-Risk Adult Congenital Heart Disease Patients. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2023; 26:89-97. [PMID: 36842803 DOI: 10.1053/j.pcsu.2022.12.005] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/11/2022] [Accepted: 12/16/2022] [Indexed: 12/25/2022]
Abstract
The field of adult congenital heart disease has changed greatly over the past sixty years. As patients are now surviving longer into adulthood due to various improvements in surgical technique and medical technology, the demographic of patients with congenital heart disease (CHD) has changed, such that there are now more adults with CHD than there are children with CHD. This older and more medically complex population needs more interventions to treat residual defects or sequelae of their initial surgeries, and many of these patients are now deemed high risk for surgery. When the surgical risk becomes too great, either due to patient complexity, surgical complexity, or both, then transcatheter procedures may have a role in either mitigating or avoiding the risk altogether.
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Affiliation(s)
- Weiyi Tan
- Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Adult Congenital Heart Disease, Dallas, Texas.
| | - Jamil Aboulhosn
- Division of Cardiology, Department of Medicine, University of California Los Angeles, Adult Congenital Heart Disease, Los Angeles, California
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14
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Demal TJ, Weimann J, Ojeda FM, Bhadra OD, Linder M, Ludwig S, Grundmann D, Voigtländer L, Waldschmidt L, Schirmer J, Schofer N, Blankenberg S, Reichenspurner H, Conradi L, Seiffert M, Schaefer A. Temporal changes of patient characteristics over 12 years in a single-center transcatheter aortic valve implantation cohort. Clin Res Cardiol 2023. [PMID: 36792752 DOI: 10.1007/s00392-023-02166-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Beneficial results of transcatheter aortic valve implantation (TAVI) compared to surgical aortic valve replacement (SAVR) in patients at all risk strata have led to substantial changes in guideline recommendations for valvular heart disease. AIM To examine influence of these guideline changes on a real-world TAVI cohort, we evaluated how risk profiles and outcomes of TAVI patients developed in our single-center patient cohort over a period of 12 years. METHODS Baseline, procedural and 30-day outcome parameters of TAVI patients were retrospectively compared between three time periods (period 1: 2008-2012, period 2: 2013-2017, period 3: 2018-2020). RESULTS Between 03/2008 and 12/2020, a total of 3678 patients underwent TAVI at our center. The median age was 81.1 years (25th, 75th percentile: 76.7, 84.9) with no significant change over time. The EuroSCORE II showed a continuous and significant decline from 5.3% (3.3, 8.6) in period 1 to 2.8% (1.7, 5.0) in period 3 (p < 0.001). Furthermore, rates of permanent pacemaker implantation, acute kidney injury, and paravalvular leakage ≥ moderate continuously declined over time. Accordingly, the 30-day mortality fell from 9.3% in period 1 to 4.3% in period 3 (p < 0.001). CONCLUSION Despite substantial guideline alterations, median patient age remained largely unchanged in our TAVI cohort over the past 12 years. Therefore, increased age still appears to be the main reason to choose TAVI over SAVR. However, risk profiles declined substantially. Significant improvements in early outcomes suggest favorable influence of less invasive access routes, improved device platforms and growing user experience.
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15
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Herranz Cabarcos A, Pifarré Benítez R, Martínez Palmer A. Impact of intraoperative floppy IRIS syndrome in cataract surgery by phacoemulsification: Analysis of 622 cases. Arch Soc Esp Oftalmol (Engl Ed) 2023; 98:78-82. [PMID: 36368628 DOI: 10.1016/j.oftale.2022.08.008] [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] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/13/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Small pupil syndromes, including IFIS, increase the risk of complications during cataract surgery if proper surgical planning is not performed. Tamsulosin is associated with a very significant increase in the risk of IFIS, due to the prolonged inactivation of alpha-1 adrenergic receptors in the smooth muscle fiber of the iris. MATERIAL AND METHODS Single-center prospective observational study, carried out at the Hospital de l'Esperança - Parc de Salut Mar. RESULTS 622 eyes of 502 patients were included, of which 337 (62%) were women. The mean age of the sample is 74.8 years. 61 cases of IFIS (11%) were observed, of which 13 received treatment with Tamsulosin and 1 with Doxazosin. 23 cases of IFIS were observed in female patients. The female:male ratio was approximately 1:3. 19 cases (3%) of severe IFIS were observed, of which 6 received treatment with alpha-antagonists, with no statistically significant correlation. The mean surgical time was 13.80 min (Standard Deviation - SD: 4.01 min) in patients without IFIS and 16.93 min (SD: 4.32 min) in patients with IFIS. The relationship between the duration of the surgical procedure in minutes and the presence of IFIS was statistically significant, applying a 'two-tailed' or bilateral t-Student test with a p value of 0.01. CONCLUSION Regardless of the degree of severity, the diagnosis of IFIS lengthens the surgical time in cataract surgery. This represents yet another piece of evidence that supports the use of less selective alpha-1 adrenergic antagonist treatments than Tamsulosin or the performance of cataract surgery before starting these treatments.
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Affiliation(s)
- A Herranz Cabarcos
- Departamento de Oftalmología, Consorci Sanitari Moisès Broogi, Sant Joan Despí, Barcelona, Spain.
| | - R Pifarré Benítez
- Departamento de Oftalmología, Hospital de l'Esperança, Barcelona, Spain
| | - A Martínez Palmer
- Departamento de Oftalmología, Hospital de l'Esperança, Barcelona, Spain
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16
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Silvestri F, Nguyen JF, Hüe O, Mense C. Lingual foramina of the anterior mandible in edentulous patients: CBCT analysis and surgical risk assessment. Ann Anat 2022; 244:151982. [PMID: 35882296 DOI: 10.1016/j.aanat.2022.151982] [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: 03/01/2022] [Revised: 04/28/2022] [Accepted: 06/28/2022] [Indexed: 10/16/2022]
Abstract
OBJECTIVE The mandible has various unnamed accessory foramina, and surgery is often performed in the symphyseal area. The aim of this study was to analyze the anatomical characteristics of mandibular lingual foramina with the objective of preventing clinical complications during implant surgery on an edentulous mandible. STUDY DESIGN A total of 100 cone beam computed tomography scans of completely edentulous patients were included in this study. For each canal, nine measurements were recorded in millimeters: seven length or height measurements and two diameter measurements. The placement of a standard implant was simulated and whether the implant passed through the canal was noted. The results were analyzed by t-test and chi-squared at a significance level of 0.05. Pearson correlation analysis was used to assess the relationship between variables. RESULTS We identified 309 foramina: 236 medial lingual foramina and 73 lateral lingual foramina. We found no significant relationship between the number of foramina and the age of the individuals, or between diameter and the age or gender of the individuals. The mandibular canal was injured in 32.7 % of implant placement simulations. CONCLUSION The risk of injury to neurovascular bundles is increased in edentulous patients due to vertical bone resorption.
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Affiliation(s)
- Frédéric Silvestri
- UMR 7268 ADES, CNRS, EFS, Aix-Marseille University, Faculté des sciences médicales et paramédicales, 27 Boulevard Jean Moulin, 13005, Marseille, France; Department of Prosthesis and Implantology, Ecole de médecine dentaire, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005, Marseille, France.
| | - Jean-François Nguyen
- PSL Research University, Chimie ParisTech CNRS, Institut de Recherche de Chimie Paris, Paris, France; Odontologie Université de Paris, Paris, France, Chimie ParisTech CNRS, Institut de Recherche de Chimie Paris, Paris, France.
| | - Olivier Hüe
- Emeritus, Department of Prosthesis and Implantology, Ecole de Médecine dentaire, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005, Marseille, France.
| | - Chloë Mense
- UMR 7268 ADES, CNRS, EFS, Aix-Marseille University, Faculté des sciences médicales et paramédicales, 27 Boulevard Jean Moulin, 13005, Marseille, France; Department of Prosthesis and Implantology, Ecole de médecine dentaire, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005, Marseille, France.
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Koizumi E, Goto O, Takizawa K, Mitsunaga Y, Hoteya S, Hatta W, Masamune A, Osawa S, Takeuchi H, Suzuki S, Omori J, Ikeda G, Habu T, Ishikawa Y, Kirita K, Noda H, Higuchi K, Onda T, Akimoto T, Akimoto N, Kaise M, Iwakiri K. Bilateral Risk Assessments of Surgery and Nonsurgery Contribute to Providing Optimal Management in Early Gastric Cancers after Noncurative Endoscopic Submucosal Dissection: A Multicenter Retrospective Study of 485 Patients. Digestion 2022; 103:296-307. [PMID: 35512657 DOI: 10.1159/000523972] [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: 01/17/2022] [Accepted: 03/06/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Surgery is recommended in early gastric cancer (EGC) after noncurative endoscopic submucosal dissection (ESD), although observation can be an alternative. We aimed to develop a tailor-made treatment strategy for noncurative EGCs by comparing the lymph node metastasis risk (LNMR) and the surgical risk. METHODS We retrospectively identified 485 patients with differentiated-type, noncurative EGCs removed by ESD and classified them into two groups: a surgery-preferable group and an observation-preferable group, according to the clinical courses. Subsequently, LNMR and surgery-related death risk were assessed using a published scoring system and a risk calculator for gastrectomy, respectively. Finally, we investigated the optimal cutoff value of the risk difference (LNMR minus surgery-related death risk) to efficiently allocate these cases into either of two groups, surgery-preferable or observation-preferable. RESULTS In 485 patients (surgery in 322, observation in 163), 57 and 428 patients were classified into the surgery-preferable group and the observation-preferable group, respectively. The optimal cutoff value of the risk difference (LNMR minus surgery-related death risk) to allocate the cases to the two preferable groups was 7.85 with the highest area under the curve (0.689). When cases with >7.85 LNMR over the surgery-related death risk were allocated into the surgery-preferable group and vice versa, the discriminability was 73.2%, which was sufficiently higher than that in the clinical decision (44.5%). CONCLUSION Personalized comparison of LNMR and surgery-related death risk is helpful to provide a favorable treatment option for each patient with EGCs after noncurative ESD.
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Affiliation(s)
- Eriko Koizumi
- Department of Gastroenterology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Osamu Goto
- Department of Gastroenterology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Kohei Takizawa
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yutaka Mitsunaga
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Shu Hoteya
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Waku Hatta
- Department of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Atsushi Masamune
- Department of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Osawa
- Department of Photodynamic and Endoscopic Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Hiroya Takeuchi
- Department of Photodynamic and Endoscopic Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Sho Suzuki
- Department of Gastroenterology and Hepatology, Nihon University School of Medicine, Tokyo, Japan
| | - Jun Omori
- Department of Gastroenterology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Go Ikeda
- Department of Gastroenterology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Tsugumi Habu
- Department of Gastroenterology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Yumiko Ishikawa
- Department of Gastroenterology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Kumiko Kirita
- Department of Gastroenterology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Hiroto Noda
- Department of Gastroenterology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Kazutoshi Higuchi
- Department of Gastroenterology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Takeshi Onda
- Department of Gastroenterology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Teppei Akimoto
- Department of Gastroenterology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Naohiko Akimoto
- Department of Gastroenterology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Mitsuru Kaise
- Department of Gastroenterology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Katsuhiko Iwakiri
- Department of Gastroenterology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
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Casanova D, Papalois V. SEVE project (Surgical Expertise Validity Evaluation) risk adjusted quality by standard data. Cir Esp 2022; 100:62-66. [PMID: 35148863 DOI: 10.1016/j.cireng.2022.01.005] [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] [Received: 03/17/2021] [Accepted: 03/21/2021] [Indexed: 06/14/2023]
Abstract
The SEVE project (Surgical Expertise Validity Evaluation) is a collaborative effort of the AEC (Spanish Association of Surgeons) and the Section of Surgery of the European Union of Medical Specialists (UEMS) that aims to develop a model and an on line application that can be used to evaluate surgical complications. The aim is to identify the optimal results that can be obtained in each intervention, in order to present them as a reference for our usual practice (benchmarking).
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Lan L, Chen F, Luo J, Li M, Hao X, Hu Y, Yin J, Zhu T, Zhou X. Prediction of intensive care unit admission (>24h) after surgery in elective noncardiac surgical patients using machine learning algorithms. Digit Health 2022; 8:20552076221110543. [PMID: 35910815 PMCID: PMC9326842 DOI: 10.1177/20552076221110543] [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: 11/01/2021] [Revised: 05/28/2022] [Accepted: 06/13/2022] [Indexed: 02/05/2023] Open
Abstract
Background To develop a highly discriminative machine learning model for the prediction of intensive care unit admission (>24h) using the easily available preoperative information from electronic health records. An accurate prediction model for ICU admission after surgery is of great importance for surgical risk assessment and appropriate utilization of ICU resources. Method Data were collected retrospectively from a large hospital, comprising 135,442 adult patients who underwent surgery except for cardiac surgery between 1 January 2014, and 31 July 2018 in China. Multiple existing predictive machine learning algorithms were explored to construct the prediction model, including logistic regression, random forest, adaptive boosting, and gradient boosting machine. Four secondary analyses were conducted to improve the interpretability of the results. Results A total of 2702 (2.0%) patients were admitted to the intensive care unit postoperatively. The gradient boosting machine model attained the highest area under the receiver operating characteristic curve of 0.90. The machine learning models predicted intensive care unit admission better than the American Society of Anesthesiologists Physical Status (area under the receiver operating characteristic curve: 0.68). The gradient boosting machine recognized several features as highly significant predictors for postoperatively intensive care unit admission. By applying subgroup analysis and secondary analysis, we found that patients with operations on the digestive, respiratory, and vascular systems had higher probabilities for intensive care unit admission. Conclusion Compared with conventional American Society of Anesthesiologists Physical Status and logistic regression model, the gradient boosting machine could improve the performance in the prediction of intensive care unit admission. Machine learning models could be used to improve the discrimination and identify the need for intensive care unit admission after surgery in elective noncardiac surgical patients, which could help manage the surgical risk.
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Affiliation(s)
- Lan Lan
- West China Biomedical Big Data Center, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China.,IT Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Fangwei Chen
- West China Biomedical Big Data Center, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China.,Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China.,Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Jiawei Luo
- West China Biomedical Big Data Center, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China.,Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Mengjiao Li
- West China Biomedical Big Data Center, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China.,Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Xuechao Hao
- Department of Anesthesiology, West China Hospital/ West China School of Medicine, Sichuan University, Chengdu, China
| | - Yao Hu
- West China Biomedical Big Data Center, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China.,Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Jin Yin
- West China Biomedical Big Data Center, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China.,Med-X Center for Informatics, Sichuan University, Chengdu, China.,School of Computer Science and Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - Tao Zhu
- Department of Anesthesiology, West China Hospital/ West China School of Medicine, Sichuan University, Chengdu, China
| | - Xiaobo Zhou
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, USA
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Dyas AR, Bronsert MR, Meguid RA, Colborn KL, Lambert-Kerzner A, Hammermeister KE, Rozeboom PD, Velopulos CG, Henderson WG. Using the Surgical Risk Preoperative Assessment System to Define the "High Risk" Surgical Patient. J Surg Res 2021; 270:394-404. [PMID: 34749120 DOI: 10.1016/j.jss.2021.08.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/22/2021] [Accepted: 08/28/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Defining a "high risk" surgical population remains challenging. Using the Surgical Risk Preoperative Assessment System (SURPAS), we sought to define "high risk" groups for adverse postoperative outcomes. MATERIALS AND METHODS We retrospectively analyzed the 2009-2018 American College of Surgeons National Surgical Quality Improvement Program database. SURPAS calculated probabilities of 12 postoperative adverse events. The Hosmer Lemeshow graphs of deciles of risk and maximum Youden index were compared to define "high risk." RESULTS Hosmer-Lemeshow plots suggested the "high risk" patient could be defined by the 10th decile of risk. Maximum Youden index found lower cutoff points for defining "high risk" patients and included more patients with events. This resulted in more patients classified as "high risk" and higher number needed to treat to prevent one complication. Some specialties (thoracic, vascular, general) had more "high risk" patients, while others (otolaryngology, plastic) had lower proportions. CONCLUSIONS SURPAS can define the "high risk" surgical population that may benefit from risk-mitigating interventions.
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21
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Gómez Hernández MT, Novoa Valentín N, Fuentes Gago M, Aranda Alcaide JL, Varela Simó G, Jiménez López MF. Mortality predictors in complicated patients after anatomical lung resection. Arch Bronconeumol 2021; 57:625-629. [PMID: 35702903 DOI: 10.1016/j.arbr.2021.07.003] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/03/2020] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Failure to rescue (FTR), defined as the mortality rate among patients suffering from postoperative complications, is considered an indicator of the quality of surgical care. The aim of this study was to investigate the risk factors associated with FTR after anatomical lung resections. METHOD Patients undergoing anatomical lung resection at our center between 1994 and 2018 were included in the study. Postoperative complications were classified as minor (grade I and II) and major (grade IIIA to V), according to the standardized classification of postoperative morbidity. Patients who died after a major complication were considered FTR. A stepwise logistic regression model was created to identify FTR predictors. Independent variables included in the multivariate analysis were age, body mass index, cardiac, renal, and cerebrovascular comorbidity, ppoFEV1%, VATS approach, extended resection, pneumonectomy, and reintervention. A non-parametric ROC curve was constructed to estimate the predictive capacity of the model. RESULTS A total of 2.569 patients were included, of which 223 (8.9%) had major complications and 49 (22%) could not be rescued. Variables associated with FTR were: age (OR: 1.07), history of cerebrovascular accident (OR: 3.53), pneumonectomy (OR: 6.67), and reintervention (OR: 12.26). The area under the ROC curve was 0.82 (95% CI: 0.77-0.88). CONCLUSIONS Overall, 22% of patients with major complications following anatomical lung resection in this series did not survive until discharge. Pneumonectomy and reintervention are the most significant risk factors for FTR.
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Affiliation(s)
- M Teresa Gómez Hernández
- Departamento de Cirugía Torácica, Hospital Universitario de Salamanca, Salamanca, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.
| | - Nuria Novoa Valentín
- Departamento de Cirugía Torácica, Hospital Universitario de Salamanca, Salamanca, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Marta Fuentes Gago
- Departamento de Cirugía Torácica, Hospital Universitario de Salamanca, Salamanca, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - José Luis Aranda Alcaide
- Departamento de Cirugía Torácica, Hospital Universitario de Salamanca, Salamanca, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | | | - Marcelo F Jiménez López
- Departamento de Cirugía Torácica, Hospital Universitario de Salamanca, Salamanca, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
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Yang Y, Zhang Y, Yang Y, Chen X, Mou Y, Liu L, Sun Y, Tang N, Song X. Risk factors analysis and intervention of lung dysfunction in children with obstructive sleep apnea: A retrospective case series study. Int J Pediatr Otorhinolaryngol 2021; 146:110772. [PMID: 34022655 DOI: 10.1016/j.ijporl.2021.110772] [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: 01/12/2021] [Revised: 03/31/2021] [Accepted: 05/12/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To establish an optimized airway management process to improve preoperative lung dysfunction in obstructive sleep apnea (OSA). METHODS The study included 483 children (319 males and 164 females; 6y to14y years) with OSA who underwent an adenotonsillectomy from November 2017 to December 2018. Children with OSA and who had abnormal airway function were identified by lung function test, and the risk factors for abnormal lung function were assessed. Next, the children received individualized atomization intervention based on the severity of their abnormal lung function, and the improvement in lung function was evaluated. RESULTS Lung function tests revealed that 45 patients had obstructive ventilation dysfunction, and histories of chronic cough or asthma were identified as risk factors for perioperative abnormal lung function. The FEV1% pre exceeded 80% after 2 days of atomization intervention in 27 of 28 mild cases, 4 of 13 moderate cases, but in none of the 4 moderate-severe cases. After 4 days of atomization intervention, the FEV1%pre of the remaining 14 patients in the three groups all increased up to 80%. Other indicators of lung function (e.g., FEV1/FVC% pre, MEF50% pre, MEF25% pre, and MMEF% pre) were also greatly improved following the improvement of FEV1% pre. No perioperative airway complications occurred. CONCLUSIONS Prior to performing surgery on children with OSA and who have risk factors associated with abnormal lung function, it is potentially beneficial to establish an optimized airway management process to improve lung function before adenotonsillectomy.
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Affiliation(s)
- Yujuan Yang
- Department of Otolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Yu Zhang
- Department of Otolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Yanyan Yang
- Department of Otolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Xiumei Chen
- Department of Otolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Yakui Mou
- Department of Otolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Liping Liu
- Department of Allergy, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Yuemei Sun
- Department of Allergy, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Ningbo Tang
- Department of Allergy, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Xicheng Song
- Department of Otolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China.
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Huang Z, Liu H, Huang W, Wang H, Liu J, Wu Z. Giant retroperitoneal paraganglioma: Challenges of misdiagnosis and high surgical risks, a case report. Int J Surg Case Rep 2021; 84:106081. [PMID: 34119947 PMCID: PMC8209176 DOI: 10.1016/j.ijscr.2021.106081] [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: 04/15/2021] [Revised: 05/28/2021] [Accepted: 06/03/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction and importance In surgery, misdiagnosis is not uncommon, usually a result of erroneous image interpretations and pathology diagnosis especially involving a tumor or cancer. Misdiagnosis may cause increased morbidity, mortality and surgical risks. Case presentation A 49-year-old man presented for the second time with a right upper abdominal mass of 7 months. Previous CT scan of abdomen and exploratory surgery made the diagnosis of liver cancer. Two other tertiary hospitals drew the similar conclusions. At a cancer hospital the needle biopsy was suspicious for gastrointestinal stromal tumor, Imatinib was recommended but not started due to high cost. During this re-admission, the diagnosis of liver cancer or GIST was challenged. A high risk surgery was done with successive removal of a giant tumor. A final diagnosis of paraganlioma was made and the patient is now tumor free for 6 years. Clinical discussion There are 4 lessons from this case. First, a paraganlioma may be misdiagnosed. Second, the misdiagnosis may be misled by CT scan and pathology. Third, a misdiagnosis can cause increased morbidity, mortality and surgical risks. Forth, massive intraoperative hemorrhage is a high risk of surgery. Conclusion Careful clinical evaluation combined with pathology diagnosis may reduce the misdiagnosis of some tumor/cancer. Surgical resection may be the only way to reach a diagnosis in patient with paraganlioma. Massive intraoperative hemorrhage is a high risk of surgery in such patients. Paraganglioma may be misdiagnosed as other tumor or cancer. Computed tomography of abdomen is not diagnostic for paraganglioma. Misdiagnosis can cause increased morbidity, mortality and surgical risks. Careful clinical evaluation combined with pathological diagnosis can prevent or reduce misdiagnosis of abdominal solid mass. Massive intraoperative hemorrhage is a high risk of surgery for large garaganglioma.
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Affiliation(s)
- Zhengbin Huang
- Department of General Surgery, Hanchuan People's Hospital, 1 Renmin Avenue, Hanchuan, Hubei 431600, China
| | - Hanzhong Liu
- Department of Pathology, Xiaogan Central Hospital, 6 Guangchang Road, Xiaogan, Hubei 432100, China
| | - Wenwei Huang
- Department of General Surgery, Hanchuan People's Hospital, 1 Renmin Avenue, Hanchuan, Hubei 431600, China
| | - Hui Wang
- Department of General Surgery, Hanchuan People's Hospital, 1 Renmin Avenue, Hanchuan, Hubei 431600, China
| | - Jun Liu
- Department of General Surgery, Hanchuan People's Hospital, 1 Renmin Avenue, Hanchuan, Hubei 431600, China
| | - Zhengqi Wu
- Department of Medicine, Winchester Medical Center, 1840 Amherst Street, Winchester, VA 22601, USA.
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Casanova D, Papalois V. SEVE project (Surgical Expertise Validity Evaluation) risk adjusted quality by standard data. Cir Esp 2021; 100:S0009-739X(21)00129-9. [PMID: 33902893 DOI: 10.1016/j.ciresp.2021.03.016] [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: 03/17/2021] [Accepted: 03/21/2021] [Indexed: 11/17/2022]
Abstract
The SEVE project (Surgical Expertise Validity Evaluation) is a collaborative effort of the AEC (Spanish Association of Surgeons) and the Section of Surgery of the European Union of Medical Specialists (UEMS) that aims to develop a model and an on line application that can be used to evaluate surgical complications. The aim is to identify the optimal results that can be obtained in each intervention, in order to present them as a reference for our usual practice (benchmarking).
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Gómez de Antonio D, Crowley Carrasco S, Romero Román A, Royuela A, Sánchez Calle Á, Obiols Fornell C, Call Caja S, Embún R, Royo Í, Recuero JL, Cabañero A, Moreno N, Bolufer S, Congregado M, Jimenez MF, Aguinagalde B, Amor-Alonso S, Arrarás MJ, Blanco Orozco AI, Boada M, Cal I, Cilleruelo Ramos Á, Fernández-Martín E, García-Barajas S, García-Jiménez MD, García-Prim JM, Garcia-Salcedo JA, Gelbenzu-Zazpe JJ, Giraldo-Ospina CF, Gómez Hernández MT, Hernández J, Illana Wolf JD, Jáuregui Abularach A, Jiménez U, López Sanz I, Martínez-Hernández NJ, Martínez-Téllez E, Milla Collado L, Mongil Poce R, Moradiellos-Díez FJ, Moreno-Basalobre R, Moreno Merino SB, Quero-Valenzuela F, Ramírez-Gil ME, Ramos-Izquierdo R, Rivo E, Rodríguez-Fuster A, Rojo-Marcos R, Sanchez-Lorente D, Moreno LS, Simón C, Trujillo-Reyes JC, López García C, Fibla Alfara JJ, Sesma Romero J, Hernando Trancho F. Surgical Risk Following Anatomic Lung Resection in Thoracic Surgery: A Prediction Model Derived from a Spanish Multicenter Database. Arch Bronconeumol 2021; 58:398-405. [PMID: 33752924 DOI: 10.1016/j.arbres.2021.01.037] [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: 12/08/2020] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 11/02/2022]
Abstract
INTRODUCTION The aim of this study was to develop a surgical risk prediction model in patients undergoing anatomic lung resections from the registry of the Spanish Video-Assisted Thoracic Surgery Group (GEVATS). METHODS Data were collected from 3,533 patients undergoing anatomic lung resection for any diagnosis between December 20, 2016 and March 20, 2018. We defined a combined outcome variable: death or Clavien Dindo grade IV complication at 90 days after surgery. Univariate and multivariate analyses were performed by logistic regression. Internal validation of the model was performed using resampling techniques. RESULTS The incidence of the outcome variable was 4.29% (95% CI 3.6-4.9). The variables remaining in the final logistic model were: age, sex, previous lung cancer resection, dyspnea (mMRC), right pneumonectomy, and ppo DLCO. The performance parameters of the model adjusted by resampling were: C-statistic 0.712 (95% CI 0.648-0.750), Brier score 0.042 and bootstrap shrinkage 0.854. CONCLUSIONS The risk prediction model obtained from the GEVATS database is a simple, valid, and reliable model that is a useful tool for establishing the risk of a patient undergoing anatomic lung resection.
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Affiliation(s)
- David Gómez de Antonio
- Servicio de Cirugía Torácica, Hospital Universitario Puerta de Hierro Majadahonda. Madrid, España.
| | - Silvana Crowley Carrasco
- Servicio de Cirugía Torácica, Hospital Universitario Puerta de Hierro Majadahonda. Madrid, España
| | - Alejandra Romero Román
- Servicio de Cirugía Torácica, Hospital Universitario Puerta de Hierro Majadahonda. Madrid, España
| | - Ana Royuela
- Unidad de Bioestadística, Instituto de Investigación Biomédica Puerta de Hierro (IDIPHISA); CIBERESP. Madrid, España
| | - Álvaro Sánchez Calle
- Servicio de Cirugía Torácica, Hospital Universitario Puerta de Hierro Majadahonda. Madrid, España
| | - Carme Obiols Fornell
- Servicio de Cirugía Torácica, Hospital Universitari Mútua Terrassa, Universidad de Barcelona, Terrassa, Barcelona, España
| | - Sergi Call Caja
- Servicio de Cirugía Torácica, Hospital Universitari Mútua Terrassa, Universidad de Barcelona, Terrassa, Barcelona, España
| | - Raúl Embún
- Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet y Hospital Clínico Universitario Lozano Blesa, IIS Aragón, Zaragoza, España
| | - Íñigo Royo
- Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet y Hospital Clínico Universitario Lozano Blesa, IIS Aragón, Zaragoza, España
| | - José Luis Recuero
- Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet y Hospital Clínico Universitario Lozano Blesa, IIS Aragón, Zaragoza, España
| | - Alberto Cabañero
- Servicio de Cirugía Torácica, Hospital Universitario Ramón y Cajal. Madrid, España
| | - Nicolás Moreno
- Servicio de Cirugía Torácica, Hospital Universitario Ramón y Cajal. Madrid, España
| | - Sergio Bolufer
- Servicio de Cirugía Torácica, Hospital General Universitario de Alicante, Alicante, España
| | - Miguel Congregado
- Servicio de Cirugía Torácica, Hospital Universitario Virgen Macarena, Sevilla, España
| | - Marcelo F Jimenez
- Servicio de Cirugía Torácica, Hospital Universitario de Salamanca, Universidad de Salamanca, IBSAL, Salamanca, España
| | - Borja Aguinagalde
- Servicio de Cirugía Torácica, Hospital Universitario de Donostia, San Sebastián-Donostia, España
| | - Sergio Amor-Alonso
- Servicio de Cirugía Torácica, Hospital Universitario Quironsalud Madrid, Madrid, España
| | - Miguel Jesús Arrarás
- Servicio de Cirugía Torácica, Fundación Instituto Valenciano de Oncología, Valencia, España
| | | | - Marc Boada
- Servicio de Cirugía Torácica, Hospital Clinic de Barcelona, Instituto Respiratorio, Universidad de Barcelona, Barcelona, España
| | - Isabel Cal
- Servicio de Cirugía Torácica, Hospital Universitario La Princesa, Madrid, España
| | | | | | | | | | - Jose María García-Prim
- Servicio de Cirugía Torácica, Hospital Universitario Santiago de Compostela , Santiago de Compostela, España
| | | | | | | | - María Teresa Gómez Hernández
- Servicio de Cirugía Torácica, Hospital Universitario de Salamanca, Universidad de Salamanca, IBSAL, Salamanca, España
| | - Jorge Hernández
- Servicio de Cirugía Torácica, Hospital Universitario Sagrat Cor, Barcelona, España
| | | | | | - Unai Jiménez
- Servicio de Cirugía Torácica, Hospital Universitario Cruces, Bilbao, España
| | - Iker López Sanz
- Servicio de Cirugía Torácica, Hospital Universitario de Donostia, San Sebastián-Donostia, España
| | | | - Elisabeth Martínez-Téllez
- Servicio de Cirugía Torácica, Hospital Santa Creu y Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España
| | | | - Roberto Mongil Poce
- Servicio de Cirugía Torácica, Hospital Regional Universitario, Málaga, España
| | | | | | | | | | | | - Ricard Ramos-Izquierdo
- Servicio de Cirugía Torácica, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, España
| | - Eduardo Rivo
- Servicio de Cirugía Torácica, Hospital Universitario Santiago de Compostela , Santiago de Compostela, España
| | - Alberto Rodríguez-Fuster
- Servicio de Cirugía Torácica, Hospital del Mar, IMIM (Instituto de Investigación Médica Hospital del Mar), Barcelona, España
| | - Rafael Rojo-Marcos
- Servicio de Cirugía Torácica, Hospital Universitario Cruces, Bilbao, España
| | - David Sanchez-Lorente
- Servicio de Cirugía Torácica, Hospital Clinic de Barcelona, Instituto Respiratorio, Universidad de Barcelona, Barcelona, España
| | - Laura Sánchez Moreno
- Servicio de Cirugía Torácica, Hospital Universitario Marqués de Valdecilla, Santader, España
| | - Carlos Simón
- Servicio de Cirugía Torácica, Hospital Universitario Gregorio Marañón, Madrid, España
| | - Juan Carlos Trujillo-Reyes
- Servicio de Cirugía Torácica, Hospital Santa Creu y Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España
| | | | | | - Julio Sesma Romero
- Servicio de Cirugía Torácica, Hospital General Universitario de Alicante, Alicante, España
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Brunelli A, Decaluwe H, Gossot D, Guerrera F, Szanto Z, Falcoz PE. Perioperative outcomes of segmentectomies versus lobectomies in high-risk patients: an ESTS database analysis. Eur J Cardiothorac Surg 2020; 59:ezaa308. [PMID: 32929479 DOI: 10.1093/ejcts/ezaa308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 07/11/2020] [Accepted: 07/18/2020] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVES We queried the European Society of Thoracic Surgeons (ESTS) database with the aim to assess cardiopulmonary morbidity and 30-day mortality of segmentectomies and lobectomies in patients with a Eurolung-predicted mortality above the upper interquartile and classified as high risk. METHODS A total of 61 492 patients registered in the ESTS database (2007-2018) and submitted to lobectomy (55 353) or segmentectomy (6139) were divided into high risk or low risk according to a Eurolung-predicted mortality cut-off of 2.5% (corresponding in our population to the upper interquartile). Predicted versus observed mortalities were compared within each type of operation by using binomial test of proportion. Observed morbidity and mortality rates were compared between the 2 procedures using the χ2 test. RESULTS A total of 14 007 lobectomies and 1251 segmentectomies were classified as high risk. In the high-risk group, the cardiopulmonary morbidity and 30-day mortality rates observed in segmentectomies were lower than in lobectomies (morbidity: 12% vs 17%, P < 0.0001; mortality: 2.4% vs 3.7%, P = 0.018). In segmentectomy patients, the observed mortality rate was lower than the Eurolung-predicted one (2.4% vs 3.8%, P = 0.009), while in the lobectomy patients, there was no difference between observed and predicted mortality (3.7% vs 3.8%, P = 0.9). In the low-risk group, the cardiopulmonary morbidity and 30-day mortality rates observed in segmentectomies were lower than in lobectomies (morbidity: 4.5% vs 7.8%, P < 0.0001; mortality: 0.6% vs 1.0%, P = 0.01). In segmentectomy patients, the observed mortality rate was lower than the Eurolung-predicted one (0.6% vs 1.0%, P = 0.0003), while in the lobectomy patients, there was no difference between observed and predicted mortality (1.0% vs 1.1%, P = 0.06). CONCLUSIONS Segmentectomy was found associated with a 0.65 relative risk of mortality rate compared to lobectomy in patients deemed at higher surgical risk.
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Affiliation(s)
| | - Herbert Decaluwe
- Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
| | - Dominique Gossot
- Department of Thoracic Surgery, Institut du Thorax Curie-Montsouris - IMM, Paris, France
| | | | - Zalan Szanto
- Department of Thoracic Surgery, University of Pecs, Pecs, Hungary
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Matano F, Mizunari T, Murai Y, Tamaki T, Tateyama K, Suzuki M, Morita A. White Matter Lesions as Brain Frailty and Age are Risk Factors for Surgical Clipping of Unruptured Intracranial Aneurysms in the Elderly. J Stroke Cerebrovasc Dis 2020; 29:105121. [PMID: 32912506 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/28/2020] [Accepted: 06/29/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION We aimed to identify the risk factors for surgical treatment of unruptured intracranial aneurysms (UIAs) in individuals aged >60 years, particularly focusing on white matter lesions (WMLs). MATERIAL AND METHODS We investigated a total of 214 patients with UIAs. The patient group comprised 53 males and 151 females with an average age of 68.2 years. UIA size ranged from 2.7 to 26 (mean: 7.3) mm. The primary endpoint of the study was patient prognosis evaluated at the time of discharge using the modified Rankin Scale. We examined the risk factors for poor outcome and WMLs using magnetic resonance imaging. RESULTS Poor outcome was observed in 23 (10.7%) patients. Significant correlations were observed between poor outcome and UIA size (P < 0.0001), UIAs located posteriorly (P = 0.0204), UIA thrombosis (P = 0.0002), and presence of WMLs (P < 0.0001) in univariate regression analysis. However, no significant correlations were noted between poor outcome and age (P = 0.1438). Multivariate logistic regression analyses showed significant correlations between poor outcome and UIA size (P < 0.0001), presence of WMLs (P = 0.001). Severe WMLs based on the Fazekas classification was correlated to age (P < 0.0001) and atherosclerosis (P = 0.0001). Severe WMLs were associated with ischemia (P < 0.001) and epilepsy (P = 0.0502) as well as length of hospitalization (P < 0.0001). CONCLUSION Severe WMLs are risk factors for surgical treatment of UIAs in the elderly. Surgical indications must be considered and caution should be taken when managing patients with severe WMLs.
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Palamuthusingam D, Kunarajah K, Pascoe EM, Johnson DW, Hawley CM, Fahim M. Postoperative outcomes of kidney transplant recipients undergoing non-transplant-related elective surgery: a systematic review and meta-analysis. BMC Nephrol 2020; 21:365. [PMID: 32843007 PMCID: PMC7448361 DOI: 10.1186/s12882-020-01978-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 07/22/2020] [Indexed: 12/22/2022] Open
Abstract
Background Reliable estimates of the absolute and relative risks of postoperative complications in kidney transplant recipients undergoing elective surgery are needed to inform clinical practice. This systematic review and meta-analysis aimed to estimate the odds of both fatal and non-fatal postoperative outcomes in kidney transplant recipients following elective surgery compared to non-transplanted patients. Methods Systematic searches were performed through Embase and MEDLINE databases to identify relevant studies from inception to January 2020. Risk of bias was assessed by the Newcastle Ottawa Scale and quality of evidence was summarised in accordance with GRADE methodology (grading of recommendations, assessment, development and evaluation). Random effects meta-analysis was performed to derive summary risk estimates of outcomes. Meta-regression and sensitivity analyses were performed to explore heterogeneity. Results Fourteen studies involving 14,427 kidney transplant patients were eligible for inclusion. Kidney transplant recipients had increased odds of postoperative mortality; cardiac surgery (OR 2.2, 95%CI 1.9–2.5), general surgery (OR 2.2, 95% CI 1.3–4.0) compared to non-transplanted patients. The magnitude of the mortality odds was increased in the presence of diabetes mellitus. Acute kidney injury was the most frequently reported non-fatal complication whereby kidney transplant recipients had increased odds compared to their non-transplanted counterparts. The odds for acute kidney injury was highest following orthopaedic surgery (OR 15.3, 95% CI 3.9–59.4). However, there was no difference in the odds of stroke and pneumonia. Conclusion Kidney transplant recipients are at increased odds for postoperative mortality and acute kidney injury following elective surgery. This review also highlights the urgent need for further studies to better inform perioperative risk assessment to assist in planning perioperative care.
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Affiliation(s)
- Dharmenaan Palamuthusingam
- Metro South Integrated Nephrology and Transplant Services, Logan Hospital, Armstrong Road & Loganlea Road, Meadowbrook, Queensland, 4131, Australia. .,Faculty of Medicine, University of Queensland, St Lucia, Queensland, 4072, Australia. .,School of Medicine, Griffith University, Mount Gravatt, Queensland, Australia.
| | - Kuhan Kunarajah
- Department of Medicine, Sunshine Coast University Hospital, Doherty St, Birtinya, Queensland, 4575, Australia
| | - Elaine M Pascoe
- Centre for Health Services Research, University of Queensland, St Lucia, Queensland, 4072, Australia
| | - David W Johnson
- Faculty of Medicine, University of Queensland, St Lucia, Queensland, 4072, Australia.,Metro South Integrated Nephrology and Transplant Services, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Queensland, 4074, Australia.,Translational Research Institute, Brisbane, Australia
| | - Camel M Hawley
- Faculty of Medicine, University of Queensland, St Lucia, Queensland, 4072, Australia.,Metro South Integrated Nephrology and Transplant Services, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Queensland, 4074, Australia
| | - Magid Fahim
- Faculty of Medicine, University of Queensland, St Lucia, Queensland, 4072, Australia.,Metro South Integrated Nephrology and Transplant Services, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Queensland, 4074, Australia
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Day AT, Sher DJ, Lee RC, Truelson JM, Myers LL, Sumer BD, Stankova L, Tillman BN, Hughes RS, Khan SA, Gordin EA. Head and neck oncology during the COVID-19 pandemic: Reconsidering traditional treatment paradigms in light of new surgical and other multilevel risks. Oral Oncol 2020; 105:104684. [PMID: 32330858 PMCID: PMC7136871 DOI: 10.1016/j.oraloncology.2020.104684] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/03/2020] [Accepted: 04/04/2020] [Indexed: 02/08/2023]
Abstract
The COVID-19 pandemic demands reassessment of head and neck oncology treatment paradigms. Head and neck cancer (HNC) patients are generally at high-risk for COVID-19 infection and severe adverse outcomes. Further, there are new, multilevel COVID-19-specific risks to patients, surgeons, health care workers (HCWs), institutions and society. Urgent guidance in the delivery of safe, quality head and neck oncologic care is needed. Novel barriers to safe HNC surgery include: (1) imperfect presurgical screening for COVID-19; (2) prolonged SARS-CoV-2 aerosolization; (3) occurrence of multiple, potentially lengthy, aerosol generating procedures (AGPs) within a single surgery; (4) potential incompatibility of enhanced personal protective equipment (PPE) with routine operative equipment; (5) existential or anticipated PPE shortages. Additionally, novel, COVID-19-specific multilevel risks to HNC patients, HCWs and institutions, and society include: use of immunosuppressive therapy, nosocomial COVID-19 transmission, institutional COVID-19 outbreaks, and, at some locations, societal resource deficiencies requiring health care rationing. Traditional head and neck oncology doctrines require reassessment given the extraordinary COVID-19-specific risks of surgery. Emergent, comprehensive management of these novel, multilevel surgical risks are needed. Until these risks are managed, we temporarily favor nonsurgical therapy over surgery for most mucosal squamous cell carcinomas, wherein surgery and nonsurgical therapy are both first-line options. Where surgery is traditionally preferred, we recommend multidisciplinary evaluation of multilevel surgical-risks, discussion of possible alternative nonsurgical therapies and shared-decision-making with the patient. Where surgery remains indicated, we recommend judicious preoperative planning and development of COVID-19-specific perioperative protocols to maximize the safety and quality of surgical and oncologic care.
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Affiliation(s)
- Andrew T Day
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States.
| | - David J Sher
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Rebecca C Lee
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - John M Truelson
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Larry L Myers
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Baran D Sumer
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Lenka Stankova
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Brittny N Tillman
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Randall S Hughes
- Department of Internal Medicine, Division of Hematology and Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Saad A Khan
- Department of Internal Medicine, Division of Hematology and Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Eli A Gordin
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
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Gómez Hernández MAT, Novoa Valentín N, Fuentes Gago M, Aranda Alcaide JL, Varela Simó G, Jiménez López MF. Mortality Predictors In Complicated Patients After Anatomical Lung Resection. Arch Bronconeumol 2020; 57:S0300-2896(20)30132-0. [PMID: 32493640 DOI: 10.1016/j.arbres.2020.04.015] [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: 02/07/2020] [Revised: 04/03/2020] [Accepted: 04/03/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Failure to rescue (FTR), defined as the mortality rate among patients suffering from postoperative complications, is considered an indicator of the quality of surgical care. The aim of this study was to investigate the risk factors associated with FTR after anatomical lung resections. METHOD Patients undergoing anatomical lung resection at our center between 1994 and 2018 were included in the study. Postoperative complications were classified as minor (grade I and II) and major (grade IIIA to V), according to the standardized classification of postoperative morbidity. Patients who died after a major complication were considered FTR. A stepwise logistic regression model was created to identify FTR predictors. Independent variables included in the multivariate analysis were age, body mass index, cardiac, renal, and cerebrovascular comorbidity, ppoFEV1%, VATS approach, extended resection, pneumonectomy, and reintervention. A non-parametric ROC curve was constructed to estimate the predictive capacity of the model. RESULTS A total of 2,569 patients were included, of which 223 (8.9%) had major complications and 49 (22%) could not be rescued. Variables associated with FTR were: age (OR: 1.07), history of cerebrovascular accident (OR: 3.53), pneumonectomy (OR: 6.67), and reintervention (OR: 12.26). The area under the ROC curve was 0.82 (95% CI: 0.77-0.88). CONCLUSIONS Overall, 22% of patients with major complications following anatomical lung resection in this series did not survive until discharge. Pneumonectomy and reintervention are the most significant risk factors for FTR.
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Affiliation(s)
| | - Nuria Novoa Valentín
- Departamento de Cirugía Torácica. Hospital Universitario de Salamanca, Salamanca, España
| | - Marta Fuentes Gago
- Departamento de Cirugía Torácica. Hospital Universitario de Salamanca, Salamanca, España
| | | | - Gonzalo Varela Simó
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
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Turrentine FE, Schenk WG, McMurry TL, Tache-Leon CA, Jones RS. Surgical errors and the relationships of disease, risks, and adverse events. Am J Surg 2020; 220:1572-1578. [PMID: 32456774 DOI: 10.1016/j.amjsurg.2020.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/18/2020] [Accepted: 05/05/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Relationships between surgical errors and adverse events have not been fully explored and were examined in this study. MATERIALS AND METHODS This retrospective cohort study reviewed records of deceased surgical patients over 12 months. Bivariate associations between predictors and errors were examined. RESULTS 84 deaths occurred following 5,209 operations. Errors in care (63%) compared to those without had significantly more adverse events, (98% vs 80% respectively, p = 0.004). Significant association occurred between error and emergency status, p = 0.016); length of stay >10 days, p = 0.011; adverse events, p = 0.005). Regression results indicated number of adverse events (OR = 1.27, 95% CI (1.08-1.49), p = 0.003) and length of stay (OR = 1.05, 95% CI (1.01-1.09), p = 0.008) were associated with surgical errors. CONCLUSIONS Examining postoperative adverse events in error cases identified opportunities for improvement. Reducing medical errors requires measuring medical errors.
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Affiliation(s)
| | | | - Timothy L McMurry
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA.
| | | | - R Scott Jones
- Department of Surgery, University of Virginia, Charlottesville, VA, USA.
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Huang Z, Yan J, Jin T, Huang X, Zeng G, Adashek ML, Wang X, Li J, Zhou D, Wu Z. The challenges of urgent radical sigmoid colorectal cancer resection in a COVID-19 patient: A case report. Int J Surg Case Rep 2020; 71:147-150. [PMID: 32395420 PMCID: PMC7212967 DOI: 10.1016/j.ijscr.2020.04.088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic presents a unique global health challenge further complicating surgical management of COVID-19 positive patients due to a lack of published literature. CASE Within we discuss a 48-year-old Chinese man, presenting with acute gastrointestinal obstruction due to sigmoid colonic mass. The patient was screened and tested positive for COVID 19 due to his employment in Wuhan, China at the COVID-19 pandemic epicenter. The patient was subsequently taken for open sigmoid colonic resection, however the case presented multiple challenges due to the patient's COVID-19 positive status. DISCUSSION The challenges of surgical management of COVID-19 positive patients exist are four-fold. First the unknown efficacy of pre-surgical risk stratification in COVID-19 positive patients, second the risk of aerosolized COVID-19 transmission during intubation for surgery, third the risk of fecal COVID-19 transmission to surgical staff during large bowel resection, and fourth the post-operative challenges of caring for COVID-19 positive patients. CONCLUSION Further research is needed into these topics, as well as the medical management of COVID-19 surgical patients.
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Affiliation(s)
- Zhengbin Huang
- Department of General Surgery, Hanchuan People's Hospital, 1 Renmin Avenue, Hanchuan, Hubei 431600, China
| | - Jijun Yan
- Department of General Surgery, Hanchuan People's Hospital, 1 Renmin Avenue, Hanchuan, Hubei 431600, China
| | - Tian Jin
- Department of Pathology, Hanchuan People's Hospital, 1 Renmin Avenue, Hanchuan, Hubei 431600, China
| | - Xiufang Huang
- Department of General Surgery, Hanchuan People's Hospital, 1 Renmin Avenue, Hanchuan, Hubei 431600, China
| | - Guoxiang Zeng
- Department of General Surgery, Hanchuan People's Hospital, 1 Renmin Avenue, Hanchuan, Hubei 431600, China
| | - Michael L Adashek
- Department of Internal Medicine, Sinai Hospital, 2401 W. Belvedere Ave, Baltimore, MD 21215, USA
| | - Xinhai Wang
- Department of Pathology, Hanchuan People's Hospital, 1 Renmin Avenue, Hanchuan, Hubei 431600, China
| | - Jieping Li
- Department of Radiology, Hanchuan People's Hospital, 1 Renmin Avenue, Hanchuan, Hubei 431600, China
| | - Dan Zhou
- Department of Molecular Biology Laboratory, Hanchuan People's Hospital, 1 Renmin Avenue, Hanchuan, Hubei 431600, China
| | - Zhengqi Wu
- Department of Medicine, Winchester Medical Center, 1840 Amherst Street, Winchester, VA 22601, USA.
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Maassel NL, Fleming MM, Luo J, Zhang Y, Pei KY. Model for End-Stage Liver Disease Sodium as a Predictor of Surgical Risk in Cirrhotic Patients With Ascites. J Surg Res 2020; 250:45-52. [PMID: 32018142 DOI: 10.1016/j.jss.2019.12.037] [Citation(s) in RCA: 4] [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: 09/30/2019] [Revised: 12/11/2019] [Accepted: 12/30/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The Model for End-Stage Liver Disease Sodium (MELD-Na) incorporates hyponatremia into the MELD score and has been shown to correlate with surgical outcomes. The pathophysiology of hyponatremia parallels that of ascites, which purports greater surgical risk. This study investigates whether MELD-Na accurately predicts morbidity and mortality in patients with ascites undergoing general surgery procedures. MATERIALS AND METHODS We used the National Surgical Quality Improvement Program database (2005-2014) to examine the adjusted risk of morbidity and mortality of cirrhotic patients with and without ascites undergoing inguinal or ventral hernia repair, cholecystectomy, and lysis of adhesions for bowel obstruction. Patients were stratified by the MELD-Na score and ascites. Outcomes were compared between patients with and without ascites for each stratum using low MELD-Na and no ascites group as a reference. RESULTS A total of 30,391 patients were analyzed. Within each MELD-Na stratum, patients with ascites had an increased risk of complications compared with the reference group (low MELD-Na and no ascites): low MELD-Na with ascites odds ratio (OR) 4.33 (95% confidence interval [CI] 1.96-9.59), moderate MELD-Na no ascites OR 1.70 (95% CI 1.52-1.9), moderate MELD-Na with ascites OR 3.69 (95% CI 2.49-5.46), high MELD-Na no ascites OR 3.51 (95% CI 3.07-4.01), and high MELD-Na ascites OR 7.18 (95% CI 5.33-9.67). Similarly, mortality risk was increased in patients with ascites compared with the reference: moderate MELD-Na no ascites OR 3.55 (95% CI 2.22-5.67), moderate MELD-Na ascites OR 13.80 (95% CI 5.65-33.71), high MELD-Na no ascites OR 8.34 (95% CI 5.15-13.51), and high MELD-Na ascites OR 43.97 (95% CI 23.76-81.39). CONCLUSIONS MELD-Na underestimates morbidity and mortality risk for general surgery patients with ascites.
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Affiliation(s)
- Nathan L Maassel
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut.
| | - Matthew M Fleming
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Jiajun Luo
- Section of Surgical Outcomes and Epidemiology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Yawei Zhang
- Section of Surgical Outcomes and Epidemiology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut; Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Kevin Y Pei
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut; Department of Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, Texas
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Czajka S, Marczenko K, Włodarczyk M, Szczepańska AJ, Olakowski M, Mrowiec S, Krzych ŁJ. Fluid Therapy in Patients Undergoing Abdominal Surgery: A Bumpy Road Towards Individualized Management. Adv Exp Med Biol 2020; 1324:63-72. [PMID: 33230636 DOI: 10.1007/5584_2020_597] [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] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Prudent intraoperative fluid replacement therapy, inotropes, and vasoactive drugs should be guided by adequate hemodynamic monitoring. The study aimed to evaluate the single-centre practice on intraoperative fluid therapy in abdominal surgery (AS). The evaluation, based on a review of medical files, included 235 patients (103 men), aged 60 ± 15 years who underwent AS between September and November 2017. Fluid therapy was analyzed in terms of quality and quantity. There were 124 high-risk patients according to the American Society of Anaesthesiologists Classification (ASA Class 3+) and 89 high-risk procedures performed. The median duration of procedures was 175 (IQR 106-284) min. Eleven patients died post-operatively. The median fluids volume was 10.4 mL/kg/h of anaesthesia, including 9.1 mL/kg/h of crystalloids and 2.7 mL/kg/h of synthetic colloids. Patients undergoing longer than the median procedures received significantly fewer fluids than those who underwent shorter procedures. The volume of fluids in the longer procedures depended on the procedural risk classification and was significantly greater in high-risk patients undergoing high-risk surgery. Patients who died received significantly more fluids than survivors. In all patients, a non-invasive blood pressure monitoring was used and only six patients had therapy guided by metabolic equilibrium. The fluid therapy used was liberal but complied with the recommendations regarding the type of fluid and risk-adjusted dosing. Hemodynamic monitoring was suboptimal and requires modifications. In conclusion, the optimization of intraoperative fluid therapy requires a balanced and standardized approach consistent with treatment procedures.
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Affiliation(s)
- Szymon Czajka
- Department of Anesthesiology and Intensive Care, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.
| | - Konstanty Marczenko
- Department of Gastrointestinal Surgery, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Martyna Włodarczyk
- Students' Scientific Society, Department of Anesthesiology and Intensive Care, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Anna J Szczepańska
- Department of Anesthesiology and Intensive Care, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Marek Olakowski
- Department of Gastrointestinal Surgery, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Sławomir Mrowiec
- Department of Gastrointestinal Surgery, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Łukasz J Krzych
- Department of Anesthesiology and Intensive Care, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
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Baker S, Waldrop MG, Swords J, Wang T, Heslin M, Contreras C, Reddy S. Timed Stair-Climbing as a Surrogate Marker for Sarcopenia Measurements in Predicting Surgical Outcomes. J Gastrointest Surg 2019; 23:2459-2465. [PMID: 30511131 DOI: 10.1007/s11605-018-4042-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 08/22/2018] [Accepted: 10/29/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Estimating sarcopenia by measuring psoas muscle density (PMD) has been advocated as a method to accurately predict post-operative morbidity. The aim of the present study was to determine whether the Timed Stair Climb (TSC) could be used to replace PMD measurements in predicting morbidity. METHODS Patients were prospectively enrolled from March 2014-2015 and were eligible if they were undergoing an abdominal operation. PMD was measured using pre-operative CT scans obtained within 90 days of surgery. Ninety-day complications were assessed using the Accordion Severity Grading System. Multivariable analysis was performed to identify risk factors associated with operative morbidity. RESULTS Of the patients, 298 were enrolled and completed TSC prior to undergoing an operation. Using the According Grading System, a grade 2 or higher complication occurred in 72 (24. 2%) patients with 8 (2.7%) deaths. There was an indirect relationship between PMD and TSC (P < 0.0001) and a direct relationship between TSC and complications (P = 0.04). On multivariable analysis decreasing PMD (P = 0.018) and increasing TSC (P = 0.026) were predictive of post-operative morbidity. Receiver operating characteristic curves demonstrated that the TSC was superior to both the ACS NSQIP Risk Calculator and PMD in predicting outcomes (TSC vs. PMD, P = 0.012; PMD vs. ACS NSQIP, P = 0.013; TSC vs. ACS NSQIP, P < 0.0001). CONCLUSION TSC, PMD, and the ACS NSQIP calculator are all useful tools; however, the TSC is superior in predicting post-operative morbidity.
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Affiliation(s)
- Samantha Baker
- Division of Surgical Oncology, University of Alabama at Birmingham, BDB 607 1808 7th Avenue South, Birmingham, AL, 352433-3411, USA
| | - Mary Glen Waldrop
- Division of Surgical Oncology, University of Alabama at Birmingham, BDB 607 1808 7th Avenue South, Birmingham, AL, 352433-3411, USA
| | - Joshua Swords
- Division of Surgical Oncology, University of Alabama at Birmingham, BDB 607 1808 7th Avenue South, Birmingham, AL, 352433-3411, USA
| | - Thomas Wang
- Division of Surgical Oncology, University of Alabama at Birmingham, BDB 607 1808 7th Avenue South, Birmingham, AL, 352433-3411, USA
| | - Martin Heslin
- Division of Surgical Oncology, University of Alabama at Birmingham, BDB 607 1808 7th Avenue South, Birmingham, AL, 352433-3411, USA
| | - Carlo Contreras
- Division of Surgical Oncology, University of Alabama at Birmingham, BDB 607 1808 7th Avenue South, Birmingham, AL, 352433-3411, USA
| | - Sushanth Reddy
- Division of Surgical Oncology, University of Alabama at Birmingham, BDB 607 1808 7th Avenue South, Birmingham, AL, 352433-3411, USA.
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Reverter E, Cirera I, Albillos A, Debernardi-Venon W, Abraldes JG, Llop E, Flores A, Martínez-Palli G, Blasi A, Martínez J, Turon F, García-Valdecasas JC, Berzigotti A, de Lacy AM, Fuster J, Hernández-Gea V, Bosch J, García-Pagán JC. The prognostic role of hepatic venous pressure gradient in cirrhotic patients undergoing elective extrahepatic surgery. J Hepatol 2019; 71:942-950. [PMID: 31330170 DOI: 10.1016/j.jhep.2019.07.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [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: 04/09/2019] [Revised: 07/04/2019] [Accepted: 07/06/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Surgery in cirrhosis is associated with a high morbidity and mortality. Retrospectively reported prognostic factors include emergency procedures, liver function (MELD/Child-Pugh scores) and portal hypertension (assessed by indirect markers). This study assessed the prognostic role of hepatic venous pressure gradient (HVPG) and other variables in elective extrahepatic surgery in patients with cirrhosis. METHODS A total of 140 patients with cirrhosis (Child-Pugh A/B/C: 59/37/4%), who were due to have elective extrahepatic surgery (121 abdominal; 9 cardiovascular/thoracic; 10 orthopedic and others), were prospectively included in 4 centers (2002-2011). Hepatic and systemic hemodynamics (HVPG, indocyanine green clearance, pulmonary artery catheterization) were assessed prior to surgery, and clinical and laboratory data were collected. Patients were followed-up for 1 year and mortality, transplantation, morbidity and post-surgical decompensation were studied. RESULTS Ninety-day and 1-year mortality rates were 8% and 17%, respectively. Variables independently associated with 1-year mortality were ASA class (American Society of Anesthesiologists), high-risk surgery (defined as open abdominal and cardiovascular/thoracic) and HVPG. These variables closely predicted 90-, 180- and 365-day mortality (C-statistic >0.8). HVPG values >16 mmHg were independently associated with mortality and values ≥20 mmHg identified a subgroup at very high risk of death (44%). Twenty-four patients presented persistent or de novo decompensation at 3 months. Low body mass index, Child-Pugh class and high-risk surgery were associated with death or decompensation. No patient with HVPG <10 mmHg or indocyanine green clearance >0.63 developed decompensation. CONCLUSIONS ASA class, HVPG and high-risk surgery were prognostic factors of 1-year mortality in cirrhotic patients undergoing elective extrahepatic surgery. HVPG values >16 mmHg, especially ≥20 mmHg, were associated with a high risk of post-surgical mortality. LAY SUMMARY The hepatic venous pressure gradient is associated with outcomes in patients with cirrhosis undergoing elective extrahepatic surgery. It enables a better stratification of risk in these patients and provides the foundations for potential interventions to improve post-surgical outcomes.
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Affiliation(s)
- Enric Reverter
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain; Centro de Investigaciones Biomédicas en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | - Isabel Cirera
- Gastroenterology and Hepatology, Hospital del Mar, Barcelona, Spain
| | - Agustín Albillos
- Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain; Centro de Investigaciones Biomédicas en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | | | - Juan G Abraldes
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain; Centro de Investigaciones Biomédicas en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | - Elba Llop
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain; Centro de Investigaciones Biomédicas en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | - Alexandra Flores
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain; Centro de Investigaciones Biomédicas en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | | | - Annabel Blasi
- Anesthesiology Department, Hospital Clínic, IDIBAPS, University of Barcelona, Spain
| | - Javier Martínez
- Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain; Centro de Investigaciones Biomédicas en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | - Fanny Turon
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain; Centro de Investigaciones Biomédicas en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | | | - Annalisa Berzigotti
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain; Centro de Investigaciones Biomédicas en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | - Antoni M de Lacy
- Gastrointestinal Surgery Department, Hospital Clínic, IDIBAPS, University of Barcelona, Spain
| | - Josep Fuster
- Hepatobiliary and Pancreatic Surgery Department, Hospital Clínic. IDIBAPS, University of Barcelona, Spain
| | - Virginia Hernández-Gea
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain; Centro de Investigaciones Biomédicas en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | - Jaume Bosch
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain; Centro de Investigaciones Biomédicas en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | - Joan Carles García-Pagán
- Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain; Centro de Investigaciones Biomédicas en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain.
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Abstract
Evidence in transcatheter aortic valve replacement (TAVR) has accumulated rapidly over the last few years and its application to clinical decision making are becoming more important. In this review, we discuss the advances in TAVR for patient selection, expanding indications, complications, and emerging technologies.
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Eichberg DG, Di L, Shah AH, Luther E, Richardson AM, Sarkiss CA, Ivan ME, Komotar RJ. Brain Tumor Surgery is Safe in Octogenarians and Nonagenarians: A Single-Surgeon 741 Patient Series. World Neurosurg 2019; 132:e185-92. [PMID: 31505286 DOI: 10.1016/j.wneu.2019.08.219] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 08/26/2019] [Accepted: 08/28/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Elderly patients with surgically accessible brain tumors are often not offered clinically indicated brain tumor surgery (BTS) because of to assumptions of greater risk for perioperative morbidity and mortality. Because brain tumor incidence is highest in the geriatric population, and because the global population is aging, accurate understanding of BTS risk in elderly patients is critical. We aimed to compare safety of BTS in elderly patients with younger counterparts to better understand the risk-benefit profile of BTS for elderly patients. METHODS Retrospective cohort study of young (20-29 years), senior (60-79 years), and elderly (80+ years) patients who underwent BTS with a single neurosurgeon. Differences between pre- and postoperative modified Rankin score (ΔmRS), length of hospitalization (LOH), complication rate, and 30-day readmission rates (30DRR) were recorded. RESULTS A total of 741 patients (83 elderly, 570 senior, and 88 young) were identified. No significant difference in preoperative mRS between different age groups, χ2 = 0.269, P = 0.874. Elderly complication rate was 6.0%, not significantly different from young (4.5%, P = 0.667) or senior (7.2%, P = 0.696) complication rate. Elderly LOH was 1.93 ± SD 0.176 days; not significantly different from young (3.01 ± 0.384 days, P = 0.081) or senior (2.47 ± 0.144 days, P = 0.881). Statistical equivalence testing showed with 95% confidence that there was equivalence in ΔmRS among age groups. CONCLUSIONS Elderly patients did not have significantly different ΔmRS, LOH, 30DRR, or complication rates after BTS compared with younger counterparts. Therefore, in healthy patients, advanced age alone should not prevent patients from being offered BTS.
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Castillo MCMD, Valladares-García J, Abad JJHB, Halabe-Cherem J. Valoración preoperatoria en cirugía no cardiaca: un abordaje por pasos. GAC MED MEX 2019; 155:298-306. [PMID: 31219462 DOI: 10.24875/gmm.18004492] [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: 11/17/2022] Open
Abstract
Preoperative assessment in non-cardiac surgery is essential to reducing the rate of in-hospital complications. Its purpose is to identify patients with higher levels of risk. Preoperative assessment should not be restricted to cardiovascular aspects, but it should focus on all organs and systems and include medication reconciliation. The purpose of this article is to approach the performance of a preoperative assessment in non-cardiac surgery from the perspective of the internist, with the purpose to help prevent adverse events and improve the overall outcome.
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Affiliation(s)
| | - Jorge Valladares-García
- Centro Médico ABC, Departamento de Medicina Interna, División de Estudios de Posgrado. Ciudad de México, México
| | | | - José Halabe-Cherem
- Universidad Nacional Autónoma de México, Facultad de Medicina, División de Estudios de Posgrado. Ciudad de México, México
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Antonello M, Squizzato F, Bassini S, Porcellato L, Grego F, Piazza M. Open repair versus endovascular treatment of complex aortoiliac lesions in low risk patients. J Vasc Surg 2019; 70:1155-1165.e1. [PMID: 30850298 DOI: 10.1016/j.jvs.2018.12.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 12/10/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The aim of the present study was to compare open surgical repair (OSR) versus endovascular repair (ER) using self-expanding covered stents for complex TransAtlantic Inter-Society Consensus II (TASC) class C or D aortoiliac lesions in low-risk patients, with a specific subanalysis for younger patients. METHODS A single-center retrospective review of TASC C/D lesions treated from January 2008 to December 2017 was conducted. Patients with associated aortic aneurysm or lesions involving the entire infrarenal aorta were excluded. Thirty-day outcomes, long-term patency, limb salvage, and freedom from related reinterventions were compared between OSR and ER. "Low surgical risk" was defined as a Society for Vascular Surgery comorbidity score of ≤0.7 and age <75 years. Patients were considered "young" if aged ≤60 years. The follow-up results were analyzed using Kaplan-Meier curves. Major clinical and anatomic characteristics were evaluated for their association with patency using Cox proportional hazards. RESULTS Overall, 114 patients (OSR, n = 56; ER, n = 58) were treated, of whom, 70 patients (63%) had bilateral iliac disease involvement, for a total of 182 limbs revascularized (OSR, n = 96; ER, n = 86). Iliac lesions were classified by limb as TASC C (n = 71; 39%) or D (n = 111; 61%). Their mean age was 61.4 ± 8.4 years, and the mean Society for Vascular Surgery comorbidity score was 0.51 ± 0.39, without statistically significant differences between the OSR and ER groups (0.48 ± 0.29 vs 0.56 ± 0.47; P = .357). At 30 days, the ER group had had a shorter length of hospitalization (8.5 ± 6.2 vs 2.6 ± 0.8 days; P < .001) and intensive care unit stay (0.1 ± 0.6 vs 0.9 ± 0.5 day; P < .001) than the OSR group. The cumulative medical (OSR, 7%; ER, 5%; P = .714) and surgical (OSR, 10%; ER, 8%; P = .759) complication rates were similar. At 5 years, the primary patency rate was similar between the two groups (OSR, 87.3%; ER, 81.4%; P = .317). This result was confirmed in the subgroup of "young" patients (OSR, 84.7; ER, 75.0; P = .272). The limb salvage (OSR, 98.9%; ER, 98.4%; P = .920) and freedom from related reintervention (OSR, 74.4%; ER, 73.0%; P = .703) rates were similar. This trend was also confirmed in the "young" patients for both limb salvage (OSR, 98.5%; ER, 97.6%; P = .896) and freedom from related reintervention (OSR, 76.9%; ER, 63.6%; P = .223). Multivariate analysis indicated that the only independent negative predictor of patency was female gender in the ER group (hazard ratio, 2.89; 95% confidence interval, 1.45-26.60; P = .024). CONCLUSIONS In the case of severe aortoiliac obstructive lesions in low-risk and young patients, ER using a covered stent can be considered as valid as OSR. In addition, it allows for shorter hospitalization and maintains a similar patency rate in the long term. However, for female patients, OSR remains the reference standard of treatment.
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Affiliation(s)
- Michele Antonello
- Division of Vascular and Endovascular Surgery, Padua University School of Medicine, Padua, Italy
| | - Francesco Squizzato
- Division of Vascular and Endovascular Surgery, Padua University School of Medicine, Padua, Italy.
| | - Silvia Bassini
- Division of Vascular and Endovascular Surgery, Padua University School of Medicine, Padua, Italy
| | - Luca Porcellato
- Division of Vascular and Endovascular Surgery, Padua University School of Medicine, Padua, Italy
| | - Franco Grego
- Division of Vascular and Endovascular Surgery, Padua University School of Medicine, Padua, Italy
| | - Michele Piazza
- Division of Vascular and Endovascular Surgery, Padua University School of Medicine, Padua, Italy
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Abstract
Cardiac risk stratification before surgery informs consent, may advise optimization interventions, and guides intraoperative and postoperative management and monitoring. Published guidelines provide an outline for risk stratification but are only updated every 5 to 10 years; hence, cardiology expert opinion is often needed. Preoperative cardiovascular evaluation starts with an excellent history and physical examination. Accurate assessment of exercise tolerance is paramount in defining risk and determining the need for further testing. Risk/benefit ratio needs to be assessed and reviewed with all stakeholders, which pertains to deciding on cardiac intervention before surgery and bleeding versus thrombosis risk when managing medications.
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Affiliation(s)
- Vahé S Tateosian
- Department of Anesthesiology, Stony Brook Medicine, 101 Nicolls Road, Stony Brook, NY 11794-8480, USA.
| | - Deborah C Richman
- Department of Anesthesiology, Stony Brook Medicine, 101 Nicolls Road, Stony Brook, NY 11794-8480, USA
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Fraccaro C, Testa L, Schiavo A, Brambilla N, Napodano M, Azzolina D, Bedogni F, Tarantini G. Transcatheter aortic valve implantation in patients younger than 75 years: Guidelines-based patients selection and clinical outcome. Int J Cardiol 2018; 272:273-8. [PMID: 30104032 DOI: 10.1016/j.ijcard.2018.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/11/2018] [Accepted: 08/08/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Patients treated by transcatheter aortic valve implantation (TAVI) in all major recent trials are still mostly octogenarians. Aim of this study is to analyze the risk profile and outcome of TAVI patients <75 years. METHODS AND RESULTS We retrospectively analyzed 172 patients <75 years with symptomatic severe native AS or degeneration of surgical aortic bioprosthesis treated with TAVI. The level of surgical risk was reassessed according to multiparametric ACC classification (prohibitive in 68 patients, high in 34, intermediate in 70). Mean age was 69.02 ± 6.18 years, mean STS score 5.56 ± 5.21. The majority of them presented one or more clinical or anatomical characteristics favoring TAVI according to ECS guidelines, despite the young age. Vascular access was transfemoral in 76%. According to the VARC-2 definitions, device success was high (90%) in all groups. The early safety was 89%, clinical recovery was slower in prohibitive risk patients. Bleeding events were more frequent in prohibitive and high surgical risk classes. Clinical efficacy at 1 year was overall 83%, and significantly better in intermediate risk patients (p = 0.004). The functional status remained stable over time as well as prostheses performance. CONCLUSION About 40% of patients <75 years were treated by TAVI due to the presence of a prohibitive risk, mainly related to technical impediments. The remaining was referred to TAVI due to an estimated high or intermediate surgical risk driven by STS score, frailty and/or major organ system compromise. Early and mid-term clinical and hemodynamic outcomes were good, in particular in intermediate risk patients.
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Smeesters T, Pierrakos C, Sanoussi A, Demanet H, Wauthy P. [Demographic evolution of patients with a surgical aortic valvular replacement in the era of percutaneous replacement]. ACTA ACUST UNITED AC 2018; 39:134-141. [PMID: 29869470 DOI: 10.30637/2018.17-081] [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: 11/20/2022]
Abstract
INTRODUCTION Percutaneous aortic valve replacement has been performed in daily practice for less than 10 years. This technique was until recently reserved for patients with very high surgical risk. There is little data in the literature documenting the impact of this percutaneous technique on the patient population continuing to benefit from a surgical replacement of the aortic valve. We studied the characteristics of these patients immediately before and after the introduction of the percutaneous technique in the CHU Brugmann. MATERIALS AND METHODS Two separate cohorts of patients were retrospectively studied: one before the percutaneous era between 2005 and 2010 and the other after introduction of the percutaneous technique in our daily practice between 2010 and 2015. Demographic, intraoperative, mortality and postoperative morbidity indices were compared. RESULTS The number of surgical replacements of the aortic valve was 194 before and 132 after introduction of the percutaneous technique. The demographic, operative characteristics and postoperative morbidity and mortality of the patients remained the same between the two cohorts. Only the incidence of pulmonary arterial hypertension (12.1 vs 25 %, p = 0.015) and recent myocardial infarction (0 vs 3 %, p = 0.003) were higher in the second cohort. CONCLUSION Replacement of the aortic valve percutaneously did not significantly change the demographic characteristics and postoperative morbidity and mortality of patients candidate for surgical replacement of the aortic valve. Nevertheless, after its introduction, the number of surgical replacements dropped considerably in our center.
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Affiliation(s)
- T Smeesters
- Service de Chirurgie cardiaque, CHU Brugmann, ULB
| | - C Pierrakos
- Service de Soins intensifs, CHU Brugmann, ULB
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Oue T, Yoneda A, Usui N, Sasaki T, Zenitani M, Tanaka N, Uehara S, Ibuka S, Takama Y, Okuyama H. Image-based surgical risk factors for Wilms tumor. Pediatr Surg Int 2018; 34:29-34. [PMID: 29119252 DOI: 10.1007/s00383-017-4210-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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] [Accepted: 11/01/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE The standard treatment for Wilms tumor (WT) is primary resection. However, in cases with unresectable tumor or tumor spillage, which are considered to have high surgical risks, more intensive chemotherapy and radiotherapy are required. In the present study, we retrospectively analyzed preoperative image parameters to identify factors associated with surgical risks. METHODS Twenty-nine patients with WT were enrolled in this study. Data on various preoperative image parameters, such as tumor size, tumor volume, displacement of great vessels, and contralateral extension of the tumor were collected, and their relationship with surgical factors, including operative time, hemorrhage, tumor spillage, and unresectability were analyzed. RESULTS Patients with unresectable tumor or with tumor spillage (surgical high-risk group) more frequently demonstrated displacement of great vessels and contralateral tumor extension. Operative time and blood loss were also significantly related to tumor size, area, volume, displacement of great vessels and contralateral extension. CONCLUSION Besides tumor size, displacement of great vessels and contralateral extension were significantly associated with surgical risks. These factors are easily determined using CT images and are, therefore, useful to decide whether preoperative chemotherapy should be started instead of primary tumor resection for large localized WTs.
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Affiliation(s)
- Takaharu Oue
- Department of Pediatric Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 63-8501, Japan.
| | - Akihiro Yoneda
- Department of Pediatric Surgery, Osaka City General Hospital, Miyakojima Hon-Dori, Miyakojima-ku, Osaka-shi, Osaka, 2-15-16, Japan
| | - Noriaki Usui
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka, 594-1101, Japan
| | - Takashi Sasaki
- Department of Pediatric Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 63-8501, Japan
| | - Masahiro Zenitani
- Department of Pediatric Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 63-8501, Japan
| | - Natsumi Tanaka
- Department of Pediatric Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 63-8501, Japan
| | - Shuichiro Uehara
- Department of Pediatric Surgery, Osaka City General Hospital, Miyakojima Hon-Dori, Miyakojima-ku, Osaka-shi, Osaka, 2-15-16, Japan
| | - Soji Ibuka
- Department of Pediatric Surgery, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka, 594-1101, Japan
| | - Yuichi Takama
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hiroomi Okuyama
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
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García-García ML, Martín-Lorenzo JG, Lirón-Ruiz R, Torralba-Martínez JA, García-López JA, Aguayo-Albasini JL. Failure of the Obesity Surgery Mortality Risk Score (OS-MRS) to Predict Postoperative Complications After Bariatric Surgery. A Single-Center Series and Systematic Review. Obes Surg 2017; 27:1423-9. [PMID: 27975153 DOI: 10.1007/s11695-016-2506-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND The obesity surgery mortality risk score (OS-MRS) was developed to determine the risk of postoperative mortality in patients undergoing bariatric surgery. The aim of the present study is to assess the utility of this score for preventing the risk of postoperative complications from bariatric surgery. METHODS Prospective study of 321 patients undergoing bariatric surgery to whom the OS-MRS was applied. Postoperative complications were classified according to the Clavien-Dindo system. The relation between the OS-MRS and the appearance of complications and mortality was analyzed. A Medline/Embase search was conducted using bariatric surgery, mortality, and complications as key words. Studies using the OS-MRS to predict morbidity and mortality were included. RESULTS Of the 321 patients, 303 (94.3%) underwent gastric bypass and the remaining 18 (5.6%) a sleeve gastrectomy. The OS-MRS classified 178 patients as class A (55.5%), 129 as class B (40.2%), and 14 as class C (4.4%). According to the Clavien-Dindo system, 10.4% of the complications were ≥III. There was one death (class B). No significant association was found between the OS-MRS and the rate of complications. CONCLUSIONS In our study, the OS-MRS is not correlated with the appearance of early complications or mortality. Future studies must focus on systems for predicting the appearance and severity of postoperative complications classified according to the Clavien-Dindo system, and not only on mortality.
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Lopez LF, Reaven PD, Harman SM. Review: The relationship of hemoglobin A1c to postoperative surgical risk with an emphasis on joint replacement surgery. J Diabetes Complications 2017; 31:1710-1718. [PMID: 29029935 DOI: 10.1016/j.jdiacomp.2017.08.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 08/06/2017] [Accepted: 08/31/2017] [Indexed: 12/12/2022]
Abstract
Patients with diabetes mellitus are known to have a high risk of postoperative complications, including infections, impaired wound healing, cardiovascular events, venous thromboembolism, and mortality. Because hyperglycemia has been thought to mediate this risk, there is a clinical propensity for improving glycemic control, as assessed by hemoglobin A1c (HbA1c) level, prior to proceeding with elective surgery, particularly joint replacement surgery. However, it is not established whether chronic poor glycemic control, indicated by elevated HbA1c levels, predicts increased risk of postoperative complications. The benefit of improving glycemic control must be weighed against risks of delaying necessary elective surgery, such as joint replacement surgery, which risks may include negative impact on long-term glycemic control. Thus, we review the current evidence to determine the relationship between HbA1c and postoperative surgical risk, especially on joint replacement surgery.
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Affiliation(s)
- Lizette F Lopez
- Endocrinology Division, Phoenix VA Health Care System, 650 E. Indian School Road, Phoenix, AZ 85012, USA.
| | - Peter D Reaven
- Endocrinology Division, Phoenix VA Health Care System, 650 E. Indian School Road, Phoenix, AZ 85012, USA; University of Arizona College of Medicine-Phoenix, 550 E. Van Buren St., Phoenix, AZ 85004, USA.
| | - Sherman M Harman
- Endocrinology Division, Phoenix VA Health Care System, 650 E. Indian School Road, Phoenix, AZ 85012, USA; University of Arizona College of Medicine-Phoenix, 550 E. Van Buren St., Phoenix, AZ 85004, USA.
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Prieto R, Pascual JM, Rosdolsky M, Barrios L. Preoperative Assessment of Craniopharyngioma Adherence: Magnetic Resonance Imaging Findings Correlated with the Severity of Tumor Attachment to the Hypothalamus. World Neurosurg 2017; 110:e404-e426. [PMID: 29138072 DOI: 10.1016/j.wneu.2017.11.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 08/21/2017] [Revised: 11/01/2017] [Accepted: 11/03/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND OBJECTIVE Craniopharyngioma (CP) adherence represents a heterogeneous pathologic feature that critically influences the potentially safe and radical resection. The aim of this study was to define the magnetic resonance imaging (MRI) predictors of CP adherence severity. METHODS This study retrospectively investigated a cohort of 200 surgically treated CPs with their corresponding preoperative conventional MRI scans. MRI findings related to the distortions of anatomic structures along the sella turcica-third ventricle axis caused by CPs, in addition to the tumor's shape and calcifications, were analyzed and correlated with the definitive type of CP adherence observed during the surgical procedures. RESULTS CP adherence is defined by 3 components, as follows: 1) the specific structures attached to the tumor, 2) the adhesion's extent, and 3) its strength. Combination of these 3 components determines 5 hierarchical levels of adherence severity with gradually increasing surgical risk of hypothalamic injury. Multivariate analysis identified 4 radiologic variables that allowed a correct overall prediction of the levels of CP adherence severity in 81.5% of cases: 1) the position of the hypothalamus in relation to the tumor-the most discriminant factor; 2) the type of pituitary stalk distortion; 3) the tumor shape; and 4) the presence of calcifications. A binary logistic regression model including the first 3 radiologic variables correctly identified the CPs showing the highest level of adherence severity (severe/critical) in almost 90% of cases. CONCLUSIONS A position of the hypothalamus around the middle portion of the tumor, an amputated or infiltrated appearance of the pituitary stalk, and the elliptical shape of the tumor are reliable predictors of strong and extensive CP adhesions to the hypothalamus.
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Affiliation(s)
- Ruth Prieto
- Department of Neurosurgery, Puerta de Hierro University Hospital, Madrid, Spain.
| | - José M Pascual
- Department of Neurosurgery, La Princesa University Hospital, Madrid, Spain
| | - Maria Rosdolsky
- Independent Medical Translator, Jenkintown, Pennsylvania, USA
| | - Laura Barrios
- Statistics Department, Computing Center, C.S.I.C., Madrid, Spain
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Zhou Y, Wang Y, Wu Y, Zhu J. Transcatheter versus surgical aortic valve replacement in low to intermediate risk patients: A meta-analysis of randomized and observational studies. Int J Cardiol 2016; 228:723-728. [PMID: 27886617 DOI: 10.1016/j.ijcard.2016.11.262] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 06/21/2016] [Revised: 11/05/2016] [Accepted: 11/10/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) has become the treatment of choice for patients with aortic stenosis and the preferred alternative for high surgical risk patients. However, TAVR's suitability for patients at low to intermediate risk still remains controversial. METHODS PubMed, MEDLINE and Clinical trials were systematically searched for randomized control trials and observational cohort studies which reported the clinical outcomes of TAVR versus surgical aortic valve replacement (SAVR) in patients at low to intermediate surgical risk. Clinical endpoints including death, acute kidney injury, myocardial infarction, and major adverse cardiac and cerebrovascular events (MACCE) were assessed. RESULTS From 2000 to 2016, 7 clinical studies comprising 6214 patients were identified. In each time point (in-hospital or 30days, 1year), TAVR was associated with similar incidence of death from any cause, cardiovascular death and MACCE. TAVR reduced short-term incidence of myocardial infarction and cerebrovascular events. However, TAVR was associated with a higher rate of major vascular complications and permanent pacemaker implantation. CONCLUSIONS Comparing with SAVR in patients at low to intermediate surgical risk, TAVR has similar rates of mortality and MACCE, lower incidence of acute kidney injury and new-onset atrial fibrillation, but an increase in major vascular complications and permanent pacemaker implantation.
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Affiliation(s)
- Yijiang Zhou
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou 310003, PR China
| | - Yanwei Wang
- Department of Cardiology, Ningbo Medical Treatment Center Lihuili Hospital, Ningbo 315000, PR China
| | - Yutao Wu
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou 310003, PR China
| | - Jianhua Zhu
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou 310003, PR China.
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49
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Ansaloni L, Pisano M, Coccolini F, Peitzmann AB, Fingerhut A, Catena F, Agresta F, Allegri A, Bailey I, Balogh ZJ, Bendinelli C, Biffl W, Bonavina L, Borzellino G, Brunetti F, Burlew CC, Camapanelli G, Campanile FC, Ceresoli M, Chiara O, Civil I, Coimbra R, De Moya M, Di Saverio S, Fraga GP, Gupta S, Kashuk J, Kelly MD, Koka V, Jeekel H, Latifi R, Leppaniemi A, Maier RV, Marzi I, Moore F, Piazzalunga D, Sakakushev B, Sartelli M, Scalea T, Stahel PF, Taviloglu K, Tugnoli G, Uraneus S, Velmahos GC, Wani I, Weber DG, Viale P, Sugrue M, Ivatury R, Kluger Y, Gurusamy KS, Moore EE. 2016 WSES guidelines on acute calculous cholecystitis. World J Emerg Surg 2016; 11:25. [PMID: 27307785 PMCID: PMC4908702 DOI: 10.1186/s13017-016-0082-5] [Citation(s) in RCA: 179] [Impact Index Per Article: 22.4] [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: 04/04/2016] [Accepted: 06/02/2016] [Indexed: 12/12/2022] Open
Abstract
Acute calculus cholecystitis is a very common disease with several area of uncertainty. The World Society of Emergency Surgery developed extensive guidelines in order to cover grey areas. The diagnostic criteria, the antimicrobial therapy, the evaluation of associated common bile duct stones, the identification of “high risk” patients, the surgical timing, the type of surgery, and the alternatives to surgery are discussed. Moreover the algorithm is proposed: as soon as diagnosis is made and after the evaluation of choledocholitiasis risk, laparoscopic cholecystectomy should be offered to all patients exception of those with high risk of morbidity or mortality. These Guidelines must be considered as an adjunctive tool for decision but they are not substitute of the clinical judgement for the individual patient.
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Affiliation(s)
- L Ansaloni
- General Surgery I, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy
| | - M Pisano
- General Surgery I, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy
| | - F Coccolini
- General Surgery I, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy
| | - A B Peitzmann
- Department of Surgery, UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - A Fingerhut
- Department of Surgical Research, Medical Univeristy of Graz, Graz, Austria
| | - F Catena
- Department of Emergency and Trauma Surgery of the University Hospital of Parma, Parma, Italy
| | - F Agresta
- Department of General Surgery, Adria Civil Hospital, Adria (RO), Italy
| | - A Allegri
- General Surgery I, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy
| | - I Bailey
- University Hospital Southampton, Southampton, UK
| | - Z J Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW Australia
| | - C Bendinelli
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW Australia
| | - W Biffl
- Acute Care Surgery, Queen's Medical Center, School of Medicine of the University of Hawaii, Honolulu, HI USA
| | - L Bonavina
- Department of Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Milan, Italy
| | | | - F Brunetti
- Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital AP-HP, Université Paris Est-UPEC, Créteil, France
| | - C C Burlew
- Surgical Intensive Care Unit, Department of Surgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, USA
| | - G Camapanelli
- General Surgery - Day Surgery Istituto Clinico Sant'Ambrogio, Insubria University, Milan, Italy
| | - F C Campanile
- Ospedale San Giovanni Decollato - Andosilla, Civita Castellana, Italy
| | - M Ceresoli
- General Surgery I, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy
| | - O Chiara
- Emergency Department, Trauma Center, Niguarda Hospital, Milan, Italy
| | - I Civil
- Department of Surgery, Auckland City Hospital, Auckland, New Zealand
| | - R Coimbra
- Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, University of California San Diego Health Sciences, San Diego, CA USA
| | - M De Moya
- Harvard University, Cambridge, MA USA
| | - S Di Saverio
- General, Emergency and Trauma Surgery, Maggiore Hospital Trauma Center, Bologna, Italy
| | - G P Fraga
- Division of Trauma Surgery, University of Campinas, Campinas, SP Brazil
| | - S Gupta
- Department of Surgery, Government Medical College, Chandigarh, India
| | - J Kashuk
- Tel Aviv University Sackler School of Medicine, Assia Medical Group, Tel Aviv, Israel
| | - M D Kelly
- Acute Surgical Unit, Canberra Hospital, Canberra, ACT Australia
| | - V Koka
- Surgical Department, Mozyr City Hospital, Mozyr, Belarus
| | - H Jeekel
- Erasmus MC Rotterdam, Rotterdam, Holland Netherlands
| | - R Latifi
- University of Arizona, Tucson, AZ USA
| | | | - R V Maier
- Department of Surgery, Harborview Medical Center, Seattle, WA USA
| | - I Marzi
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital, Goethe-University Frankfurt, Frankfurt, Germany
| | - F Moore
- Department of Surgery, University of Florida, Gainesville, FL USA
| | - D Piazzalunga
- General Surgery I, Papa Giovanni XXIII Hospital, Piazza OMS 1, 24127 Bergamo, Italy
| | - B Sakakushev
- First General Surgery Clinic, University Hospital St. George/Medical University, Plovdiv, Bulgaria
| | - M Sartelli
- Department of Surgery, Macerata Hospital, Macerata, Italy
| | - T Scalea
- Shock Trauma Center, Critical Care Services, University of Maryland School of Medicine, Baltimore, MD USA
| | - P F Stahel
- Denver Health Medical Center, Denver, CO USA
| | - K Taviloglu
- Taviloglu Proctology Center, Istanbul, Turkey
| | - G Tugnoli
- General, Emergency and Trauma Surgery, Maggiore Hospital Trauma Center, Bologna, Italy
| | - S Uraneus
- Department of Surgery, Medical University of Graz, Graz, Austria
| | - G C Velmahos
- Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA USA
| | - I Wani
- DHS, Srinagar, Kashmir India
| | - D G Weber
- Trauma and General Surgery & The University of Western Australia, Royal Perth Hospital, Perth, Australia
| | - P Viale
- Infectious Disease Unit, Teaching Hospital, S. Orsola-Malpighi Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - M Sugrue
- Letterkenny University Hospital & Donegal Clinical Research Academy, Donegal, Ireland
| | - R Ivatury
- Virginia Commonwealth University, Richmond, VA USA
| | - Y Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - K S Gurusamy
- Royal Free Campus, University College London, London, UK
| | - E E Moore
- Taviloglu Proctology Center, Istanbul, Turkey
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50
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Prestes I, Riva J, Bouchacourt JP, Kohn E, López A, Hurtado FJ. Microcirculatory changes during cardiac surgery with cardiopulmonary bypass. ACTA ACUST UNITED AC 2016; 63:513-8. [PMID: 27095670 DOI: 10.1016/j.redar.2016.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 03/04/2016] [Accepted: 03/12/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To evaluate microcirculation in intermediate and high mortality risk patients undergoing cardiac surgery (CS) with cardiopulmonary bypass (CPB). PATIENTS AND METHODS The study included 22 patients with a Euroscore >3. Using the Videomicroscopy Side Stream Dark Field system, and evaluation was made of, capillary density, proportion of perfused capillaries, density of perfused capillaries, microcirculatory flow index (MFI), and heterogeneity flow index. Three to five video sequences were recorded: after induction of anaesthesia (T1), at the beginning of the CPB (T2), before finalising CPB (T3), at the end of the surgery, and before the patient was transferred to Intensive Care Unit (T4). Mean arterial pressure decreased, while the blood lactate increased significantly, when comparing the initial and final values (P<.05). MFI increased significantly in T3 and T4 (P<.05) with regards to the initial values. When the patients with and without postoperative complications were compared, significant differences were found in, Euroscore, left ventricular ejection fraction, and MFI in T3. CONCLUSIONS in patients with intermediate/high preoperative risk, CS and CBP can involve an increase in MFI and blood lactate at the end of the study. These alterations suggest the possibility of a functional microcirculatory shunt at tissue perfusion level, secondary to the surgical injury and the CPB. Further investigation is needed to have a better understanding of the mechanisms involved.
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