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Mongelli F, Garofalo F, Giacopelli P, Munini M, Volontè F, Marengo M. Assessment of gastric pouch blood supply with indocyanine green fluorescence in conversional and revisional bariatric surgery: a prospective comparative study. Sci Rep 2023; 13:9152. [PMID: 37280278 PMCID: PMC10244382 DOI: 10.1038/s41598-023-36442-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/03/2023] [Indexed: 06/08/2023] Open
Abstract
Our study aimed to evaluate the usefulness of indocyanine green (ICG) angiography during conversional or revisional bariatric surgery. We prospectively enrolled all patients scheduled for reoperative bariatric surgery with gastric pouch resizing and ICG assessment and we compared them with a retrospective series of similar patients who did not receive ICG. The primary outcome was the rate of intraoperative change in the surgical strategy due to the ICG test. We included 32 prospective patients receiving intraoperatively an ICG perfusion test and 48 propensity score-matched controls. The mean age was 50.7 ± 9.7 years, 67 (83.7%) patients were female, and the mean BMI was 36.8 ± 5.3 kg/m2. The patient characteristics were similar in both groups. The ICG angiography was successfully conducted in all patients, and no change of the surgical strategy was necessary. Postoperative complications were similar in both groups (6.2% vs. 8.3%, p = 0.846), as well as operative time (125 ± 43 vs. 133 ± 47 min, p = 0.454) and length of hospital stay (2.8 ± 1.0 vs. 3.3 ± 2.2 days, p = 0.213). Our study suggested that ICG fluorescence angiography might not have been useful for assessing the blood supply of the gastric pouch in patients who underwent reoperative bariatric surgery. Therefore, it remains uncertain whether the application of this technique is indicated.
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Affiliation(s)
- Francesco Mongelli
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Via Gallino 12, 6500, Bellinzona, Switzerland.
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, 6500, Lugano, Switzerland.
| | - Fabio Garofalo
- Department of Surgery, Lugano Regional Hospital, EOC, 6900, Lugano, Switzerland
| | - Pietro Giacopelli
- Department of Surgery, Mendrisio Regional Hospital, EOC, 6850, Mendrisio, Switzerland
| | - Martino Munini
- Department of Surgery, Lugano Regional Hospital, EOC, 6900, Lugano, Switzerland
| | | | - Michele Marengo
- Department of Surgery, Locarno Regional Hospital, EOC, 6600, Locarno, Switzerland
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Malik AT, Xie JJ, Drain JP, Yu E, Khan SN, Kim J. The Association of "U.S. News & World Report" Hospital Rankings and Outcomes Following Anterior Cervical Fusions: Do Rankings Even Matter? Spine (Phila Pa 1976) 2021; 46:401-407. [PMID: 33394982 DOI: 10.1097/brs.0000000000003913] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective observational study. OBJECTIVE The aim of this study was to evaluate whether there are any differences in outcomes and costs for elective one- to three-level anterior cervical fusions (ACFs) performed at US News and World Report (USNWR) ranked and unranked hospitals. SUMMARY OF BACKGROUND DATA Although the USNWR rankings are advertised by media and are routinely used by patients as a guide in seeking care, evidence regarding whether these rankings are reflective of actual clinical outcome remains limited. METHODS The 2010-2014 USNWR hospital rankings were used to identify ranked hospitals in "Neurosurgery" and "Orthopedics." The 2010-2014 100% Medicare Standard Analytical Files (SAF100) were used to identify patients undergoing elective ACFs at ranked and unranked hospitals. Multivariable logistic regression and generalized linear regression analyses were used to assess for differences in 90-day outcomes and costs between ranked and unranked hospitals. RESULTS A total of 110,520 patients undergoing elective one- to three-level ACFs were included in the study, of which 10,289 (9.3%) underwent surgery in one of the 100 ranked hospitals. Following multivariate analysis, there were no significant differences between ranked versus unranked hospitals with regards to wound complications (1.2% vs. 1.1%; P = 0.907), cardiac complications (12.9% vs. 11.9%; P = 0.055), pulmonary complications (3.7% vs. 6.7%; P = 0.654), urinary tract infections (7.3% vs. 5.8%; P = 0.120), sepsis (9.3% vs. 7.9%; P = 0.847), deep venous thrombosis (1.9% vs. 1.3%; P = 0.077), revision surgery (0.3% vs. 0.3%; P = 0.617), and all-cause readmissions (4.7% vs. 4.4%; P = 0.266). Ranked hospitals, as compared to unranked hospitals, had a slightly lower odds of experiencing renal complications (7.0% vs. 4.9%; P = 0.047), but had significantly higher risk-adjusted 90-day charges (+$17,053; P < 0.001) and costs (+ $1695; P < 0.001). CONCLUSION Despite the higher charges and costs of care at ranked hospitals, these facilities appear to have similar outcomes as compared to unranked hospitals following elective ACFs.Level of Evidence: 3.
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Affiliation(s)
- Azeem Tariq Malik
- Department of Orthopedics, The Ohio State University Wexner Medical Center, Columbus, OH
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Abstract
BACKGROUND Despite the growing frequency of revision total knee arthroplasty (rTKA), there is limited information regarding patient-reported outcome measures (PROMs) after that procedure. Therefore, the purpose of this study was to determine (1) PROM improvements in pain, function, quality of life (QOL), and global health and (2) predictors of PROMs for patients undergoing aseptic rTKA as determined using a multilevel model with patients nested within surgeons. METHODS A prospective cohort of 246 patients who underwent aseptic rTKA from January 2016 to December 2017 and had baseline and 1-year postoperative PROMs were analyzed. The most common surgical indications were aseptic loosening (n = 109), instability (n = 73), and implant failure (n = 64). The PROMs included in this study were the Knee injury and Osteoarthritis Outcome Score (KOOS)-Pain, -Physical Function Short Form (PS), and -Quality of Life (QOL) as well as the Veterans Rand-12 (VR-12) Physical Component Summary (PCS) and Mental Component Summary (MCS). Multivariable linear regression models with patients nested within surgeons were constructed for predicting change in PROMs from baseline to 1 year. RESULTS The mean 1-year postoperative improvements in the KOOS-Pain and PS PROMs were 30.3 and 19.15 points, respectively, for the overall rTKA series. Improvement in the KOOS-Pain was associated with older age, baseline arthrofibrosis, lower baseline pain, and non-Medicare/Medicaid insurance and worsening of the scores was associated with multiple prior surgical procedures and instability. Improvement in the KOOS-PS was associated with baseline arthrofibrosis and female sex and worsening was associated with limited baseline function, an instability diagnosis, multiple prior surgical procedures, and increased hospital length of stay (LOS). Overall, the mean KOOS-QOL improved by 29.7 points. Although the mean VR-12 PCS improved, 54.9% of the patients saw no clinical improvement. Additionally, only 31.3% of the patients reported improvements in the VR-12 MCS. A multilevel mixed-effects model with patients/operations nested within surgeons demonstrated that the differences in the surgeons' results were minimal and explained only ∼1.86%, ∼1.12%, and ∼1.65% of the KOOS-Pain, KOOS-PS, and KOOS-QOL variance that was not explained by other predictors, respectively. CONCLUSIONS Overall, patients undergoing aseptic rTKA had improvements in pain, function, and QOL PROMs at 1 year. Although overall QOL improved, other global-health PROMs remained unchanged. The associations highlighted in this study can help guide the preoperative clinical decision-making process by setting expectations before aseptic rTKA. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
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Keeling WB, Beckerman Z, Wei J, Binongo J, Leshnower BG, Chen EP. Benchmarking Outcomes: Reoperation for Aortic Valve Patient-Prosthesis Mismatch. Ann Thorac Surg 2020; 111:1472-1477. [PMID: 32980325 DOI: 10.1016/j.athoracsur.2020.07.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 07/13/2020] [Accepted: 07/20/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Surgical reoperations for symptomatic aortic valve patient-prosthesis mismatch (PPM) are complex. The purpose of this research was to investigate the clinical and echocardiographic outcomes of patients who underwent reoperation for correction of symptomatic PPM after prior aortic valve replacement. METHODS An institutional review identified 60 patients from 2004 to 2018 who underwent reoperative aortic valve replacement for PPM without structural valve degeneration. Univariate analyses were conducted to evaluate risk factors for perioperative mortality. RESULTS Median patient age was 62.8 (interquartile range, 48.3-68.7) years, and mean body mass index was 29.2 ± 6.6 kg/m2. Thirty-nine (66%) patients underwent a first-time reoperation, and 18 (30.5%) underwent a second-time reoperation. The median interval between initial operation to reoperation for the treatment of PPM was 89 months. Thirty-four (56.7%) patients underwent aortic root replacement, while the remainder (43.3%) underwent aortic valve replacement. Additional procedures included replacement of the ascending aorta with or without aortic arch in 26 (43.3%) patients and coronary artery bypass grafting in 7 (12%) patients. Operative mortality and the rates of stroke and renal failure were 5.0%, 3.3%, and 5.0%, respectively. Echocardiographic follow-up was available in 64.9% of patients at a mean follow-up of 36.5 months. Preoperative mean pressure gradients were 32.1 ± 16.0 mm Hg and mean aortic valve area was 0.8 ± 0.3 cm2, and both improved to 6.6 ± 4.2 mm Hg and 2.3 ± 0.7 cm2 (P < .001). CONCLUSIONS Reoperative surgery for PPM is complex but may be performed with good outcomes and low mortality in experienced centers. These data provide excellent clinical and hemodynamic benchmarks for the treatment of PPM in the current era of valve-in-valve transcatheter aortic valve replacement.
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Affiliation(s)
- William B Keeling
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
| | - Ziv Beckerman
- Departments of Pediatrics and Surgery and Perioperative Care, Dell Children's Medical Center of Central Texas, Austin, Texas
| | - Jane Wei
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jose Binongo
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Bradley G Leshnower
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Edward P Chen
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
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Jones L, Danks E, Clarke J, Alidu L, Costello B, Jolly K, Byrne A, Fassam-Wright M, Latthe P, Taylor J. Exploring the views of female genital mutilation survivors, their male partners and healthcare professionals on the timing of deinfibulation surgery and NHS FGM care provision (the FGM Sister Study): protocol for a qualitative study. BMJ Open 2019; 9:e034140. [PMID: 31628134 PMCID: PMC6803147 DOI: 10.1136/bmjopen-2019-034140] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Female genital mutilation (FGM) is a significant global health concern and is likely to become an increasingly important healthcare challenge in destination countries such as the UK owing to rising levels of migration from FGM-affected countries. Currently, there is no consensus on the optimal timing of deinfibulation (opening) surgery for women who have experienced type 3 FGM and care provision remains suboptimal in the UK. This qualitative study aims to explore the views of survivors, male partners and healthcare professionals (HCPs) on the timing of deinfibulation and delivery of NHS FGM services. METHODS AND ANALYSIS A qualitative study, informed by the Sound of Silence conceptual framework, will be undertaken via two work packages (WPs). WP1 will explore views on timing preferences for deinfibulation and NHS FGM services through interviews and discussion groups with FGM survivors (n~50), male partners (n~10) and HCPs (n~50). WP2 will use established techniques via two workshops (community (n~20-25 participants) and national stakeholder (n~30-35 participants)) to synthesise qualitative research findings and inform best practice and policy recommendations around the timing of deinfibulation and NHS FGM care provision. Supported by trained interpreters, data collection will be audio recorded and transcribed. Data will be analysed using the framework method to facilitate a systematic mapping and exploration of qualitative data from multiple sources. ETHICS AND DISSEMINATION The study has received ethical approval from the North West Greater Manchester East Research Ethics Committee (18/NW/0498). The outputs for this study will be recommendations for best practice and policy around FGM care provision that reflects the views and preferences of key stakeholders. The findings will be disseminated via conference presentations, peer-reviewed publications, patient groups, third sector organisations and social media. TRIAL REGISTRATION NUMBER ISRCTN 14710507.
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Affiliation(s)
- Laura Jones
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Emma Danks
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Joanne Clarke
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Lailah Alidu
- Warwick Medical School, University of Warwick, Warwick, UK
| | - Benjamin Costello
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Alison Byrne
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Pallavi Latthe
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Julie Taylor
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
- School of Nursing, University of Birmingham, Birmingham, UK
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Gray CF, Prieto HA, Deen JT, Parvataneni HK. Bundled Payment "Creep": Institutional Redesign for Primary Arthroplasty Positively Affects Revision Arthroplasty. J Arthroplasty 2019; 34:206-210. [PMID: 30448324 DOI: 10.1016/j.arth.2018.10.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 08/03/2018] [Revised: 10/02/2018] [Accepted: 10/22/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Revision total joint arthroplasty (TJA) is associated with increased readmissions, complications, and expense compared to primary TJA. Bundled payment methods have been used to improve value of care in primary TJA, but little is known of their impact in revision TJA patients. The purpose of this study is to evaluate the impact of a care redesign for a bundled payment model for primary TJA on quality metrics for revision patients, despite absence of a targeted intervention for revisions. METHODS We compared quality metrics for all revision TJA patients including readmission rate, use of post-acute care facility after discharge, length of stay, and cost, between the year leading up to the redesign and the 2 years following its implementation. Changes in the primary TJA group over the same time period were also assessed for comparison. RESULTS Despite a volume increase of 37% over the study period, readmissions declined from 8.9% to 5.8%. Use of post-acute care facilities decreased from 42% to 24%. Length of stay went from 4.84 to 3.92 days. Cost of the hospital episode declined by 5%. CONCLUSION Our health system experienced a halo effect from our bundled payment-influenced care redesign, with revision TJA patients experiencing notable improvements in several quality metrics, though not as pronounced as in the primary TJA population. These changes benefitted the patients, the health system, and the payers. We attribute these positive changes to an altered institutional mindset, resulting from an invested and aligned care team, with active physician oversight over the care episode.
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MESH Headings
- Aged
- Arthroplasty, Replacement, Hip/economics
- Arthroplasty, Replacement, Hip/standards
- Arthroplasty, Replacement, Hip/statistics & numerical data
- Arthroplasty, Replacement, Knee/economics
- Arthroplasty, Replacement, Knee/standards
- Arthroplasty, Replacement, Knee/statistics & numerical data
- Critical Pathways/economics
- Critical Pathways/standards
- Critical Pathways/statistics & numerical data
- Episode of Care
- Health Expenditures
- Hospitals
- Humans
- Middle Aged
- Patient Care Bundles/economics
- Patient Care Bundles/standards
- Patient Care Bundles/statistics & numerical data
- Patient Discharge
- Reoperation/economics
- Reoperation/standards
- Reoperation/statistics & numerical data
- Retrospective Studies
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Affiliation(s)
- Chancellor F Gray
- Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, FL
| | - Hernan A Prieto
- Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, FL
| | - Justin T Deen
- Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, FL
| | - Hari K Parvataneni
- Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, FL
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Abstract
Unicompartmental knee arthroplasty (UKA) is one of the effective surgical methods for the treatment of unicompartmental knee arthritis. When UKA fails, a revised surgery to total knee arthroplasty (TKA) is often necessary. The purpose of this study was to compare the clinical outcomes of revision of failed UKAs to TKAs with primary TKAs. The hypothesis was that the TKAs revised from UKAs had inferior clinical outcomes compared with primary TKAs.This meta-analysis was conducted in accordance with the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. Newcastle-Ottawa Scale (NOS) proposed by the Cochrane Collaboration was used for evaluating the methodological quality of the studies. PubMed, Medline, Embase, Web of Science, and the Cochrane Library were searched to identify studies that compared the revision of UKA to TKA with primary TKA. Primary outcomes included Range of motion (ROM); Knee society score (KSS); (re-)revision rate and complications. Secondary outcomes were blood loss and length of hospital stay.A total of 8 eligible retrospective comparative studies were identified from a keyword search. Results revealed that the primary TKAs group has a better ROM (MD = -7.29, 95% CI:-14.03-0.56, P < .05), higher Knee Society Knee scores (MD = -0.54, 95% CI:-1.12-0.04, P < .05), higher Knee Society function score (MD = -0.65,95% CI:-1.25-0.06, P < .05), lower (re-)revision rate (MD = 4.15, 95% CI:2.37-7.25, P < .05) than rUKAs. There was no significant difference in postoperative complications, blood loss and length of stay between the 2 groups.Our meta-analysis revealed that compared with primary TKAs, TKAs revised from UKAs had inferior clinical outcomes.
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Affiliation(s)
- Wei Zuo
- Peking University China-Japan Friendship School of Clinical Medicine, 2 Yinghuadong Road
| | - Jinhui Ma
- Center for Osteonecrosis and Joint Preserving & Reconstruction, Department of Orthopaedic Surgery, China-Japan Friendship Hospital, 2 Yinghuadong Road China
| | - Wanshou Guo
- Center for Osteonecrosis and Joint Preserving & Reconstruction, Department of Orthopaedic Surgery, China-Japan Friendship Hospital, 2 Yinghuadong Road China
| | - Qidong Zhang
- Center for Osteonecrosis and Joint Preserving & Reconstruction, Department of Orthopaedic Surgery, China-Japan Friendship Hospital, 2 Yinghuadong Road China
| | - Weiguo Wang
- Center for Osteonecrosis and Joint Preserving & Reconstruction, Department of Orthopaedic Surgery, China-Japan Friendship Hospital, 2 Yinghuadong Road China
| | - Zhaohui Liu
- Center for Osteonecrosis and Joint Preserving & Reconstruction, Department of Orthopaedic Surgery, China-Japan Friendship Hospital, 2 Yinghuadong Road China
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Mullen MG, Hawkins RB, Johnston LE, Shah PM, Turrentine FE, Hedrick TL, Friel CM. Open Surgical Incisions After Colorectal Surgery Improve Quality Metrics, But Do Patients Benefit? Dis Colon Rectum 2018; 61:622-628. [PMID: 29578920 PMCID: PMC5889337 DOI: 10.1097/dcr.0000000000001049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Surgical site infection is a frequent cause of morbidity after colorectal resection and is a quality measure for hospitals and surgeons. In an effort to reduce the risk of postoperative infections, many wounds are left open at the time of surgery for secondary or delayed primary wound closure. OBJECTIVE The purpose of this study was to evaluate the impact of delayed wound closure on the rate of surgical infections and resource use. DESIGN This retrospective propensity-matched study compared colorectal surgery patients with wounds left open with a cohort of patients with primary skin closure. SETTINGS The American College of Surgeons National Quality Improvement Program Participant Use file for 2014 was queried. PATIENTS A total of 50,212 patients who underwent elective or emergent colectomy, proctectomy, and stoma creation were included. MAIN OUTCOME MEASURES Rates of postoperative infections and discharge to medical facilities were measured. RESULTS Surgical wounds were left open in 2.9% of colorectal cases (n = 1466). Patients with skin left open were broadly higher risk, as evidenced by a significantly higher median estimated probability of 30-day mortality (3.40% vs 0.45%; p < 0.0001). After propensity matching (n = 1382 per group), there were no significant differences between baseline characteristics. Within the matched cohort, there were no differences in the rates of 30-day mortality, deep or organ space infection, or sepsis (all p > 0.05). Resource use was higher for patients with incisions left open, including longer length of stay (11 vs 10 d; p = 0.006) and higher rates of discharge to a facility (34% vs 27%; p < 0.001). LIMITATIONS This study was limited by its retrospective design and a large data set with a bias toward academic institutions. CONCLUSIONS In a well-matched colorectal cohort, secondary or delayed wound closure eliminates superficial surgical infections, but there was no decrease in deep or organ space infections. In addition, attention should be given to the possibility for increased resource use associated with open surgical incisions. See Video Abstract at http://links.lww.com/DCR/A560.
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Affiliation(s)
- Matthew G Mullen
- Section of Colorectal Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
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Qin X, Wang H, Sun Y. [Strategies for prevention and treatment of postoperative complications of gastric cancer]. Zhonghua Wei Chang Wai Ke Za Zhi 2017; 20:125-128. [PMID: 28226342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Postoperative complications after gastric cancer surgery has their own specificity and complexity, and the strategies for prevention and treatment should be of equal emphasis on both theory and technology. Based on the knowledge and familiarity with different postoperative complications, to efficiently prevent them, it is not only necessary to strengthen the training of acknowledged operative strategy, smooth and precise surgical techniques, but also to address the importance of overall preoperative assessment for patients, to treat the basic diseases, and to improve and correct their general conditions. Combining with the concept and basic protocol of enhanced recovery after surgery (ERAS), it is preferred to work out an individualized perioperative preventing strategy for patients who have high risk factors of specific postoperative complications. After the operation, to guarantee intensive and individual managements for patients, to catch early abnormal signs, then to make early and precise diagnosis, and to do timely response and accurate treatments, including timely and proper re-operations, can improve the efficacy of complications and promote the recovery of patients as soon as possible.
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Affiliation(s)
- Xinyu Qin
- Department of General Surgery, Zhongshan Hospital of Fudan University, General Surgery Research Institute of Fudan University, Shanghai 200032, China.
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Indrebø KL, Natvig GK, Andersen JR. A Cross-sectional Study to Determine Whether Adjustment to an Ostomy Can Predict Health-related and/or Overall Quality of Life. Ostomy Wound Manage 2016; 62:50-59. [PMID: 27768580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Ostomy-specific adjustment may or may not predict health-related quality of life (HRQoL) and/or overall quality of life (QoL). A cross-sectional study was conducted among patients recruited from the customer registers of 8 surgical suppliers and pharmacies across Norway between November 2010 and March 2011 to determine which of the 34 items of the Ostomy Adjustment Scale (OAS) are the strongest predictors for HRQoL and overall QoL and to determine the HRQoL and overall QoL of individuals with an ostomy compared to a control group representing the general population. Persons who were >18 years old; had a permanent colostomy, ileostomy, or urostomy for >3 months; and could read and write Norwegian were invited to participate. The participants received information about the study in a letter from the researcher and returned their demographic information (addressing gender, age, marital status, education, diagnosis, time since surgery, and ostomy type) and study questionnaires using prepaid envelopes. The 158 participants (mean age 64 years [range 29-91], 89 [56%] men and 69 [44%] women) completed and returned by mail a sociodemographic questionnaire, the 34-item OAS (questions scored on a scale of 1 to 6, totally disagree to totally agree, score range 34 to 204), the Short Form-36 (SF-36, including 2 main components [physical and mental issues] divided into 8 subscales, scored from 0 to 100), and the 16-item Quality of Life Scale (QOLS) instrument (each response scored 1 to 7, from very dissatisfied to very satisfied; total score ranging from 16 to 112). Statistical analysis, including ordinary least square regression analyses, assessed whether the OAS independently predicted the sum scores of the SF-36 (physical component summary [PCS] and mental component summary [MCS]) and the QOLS score after adjusting for age, gender, marital status, education, diagnosis, time since surgery, and ostomy type. The OAS significantly predicted the SF-36 (PCS and MCS) and QOLS scores (P <0.001). Five (5) OAS items ("living a fulfilling life," "being free to travel where I want despite my ostomy," "realizing that this ostomy will be there forever," "worries about being left alone," and "embarrassing accidents in sexual activities") strongly predicted the composite score of the SF-36 (PCS and MCS) and QOLS measurements. The SF-36 scores in physical role functioning, general health, vitality, and MCS were lower in ostomy patients than controls (P < 0.05), whereas no difference was found for QOLS. Overall, ostomy-specific adjustment may be an important predictor of HRQoL and overall QoL, with the OAS factors described above having greater influence. More research such as prospective cohort studies are needed regarding patient adjustment to an ostomy.
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Affiliation(s)
| | - Gerd Karin Natvig
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - John Roger Andersen
- Department of Surgery, Førde Central Hospital; and Health Studies, Sogn and Fjordane University College, Førde, Norway
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Kandala NB, Connock M, Pulikottil-Jacob R, Sutcliffe P, Crowther MJ, Grove A, Mistry H, Clarke A. Setting benchmark revision rates for total hip replacement: analysis of registry evidence. BMJ 2015; 350:h756. [PMID: 25752749 DOI: 10.1136/bmj.h756] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To compare 10 year revision rates for frequently used types of primary total hip replacement to inform setting of a new benchmark rate in England and Wales that will be of international relevance. DESIGN Retrospective cohort study. SETTING National Joint Registry. PARTICIPANTS 239 000 patient records. MAIN OUTCOME MEASURES Revision rates for five frequently used types of total hip replacement that differed according to bearing surface and fixation mode, encompassing 62% of all primary total hip replacements in the National Joint Registry for England and Wales. Revision rates were compared using Kaplan-Meier and competing risks analyses, and five and 10 year rates were estimated using well fitting parametric models. RESULTS Estimated revision rates at 10 years were 4% or below for four of the five types of total hip replacement investigated. Rates differed little according to Kaplan-Meier or competing risks analysis, but differences between prosthesis types were more substantial. Cemented prostheses with ceramic-on-polyethylene bearing surfaces had the lowest revision rates (1.88-2.11% at 10 years depending on the method used), and cementless prostheses with ceramic-on-ceramic bearing surfaces had the highest revision rates (3.93-4.33%). Men were more likely to receive revision of total hip replacement than were women, and this difference was statistically significant for four of the five prosthesis types. CONCLUSIONS Ten year revision rate estimates were all less than 5%, and in some instances considerably less. The results suggest that the current revision rate benchmark should be at least halved from 10% to less than 5% at 10 years. This has implications for benchmarks internationally.
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Affiliation(s)
- Ngianga-Bakwin Kandala
- Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Martin Connock
- Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Ruth Pulikottil-Jacob
- Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Paul Sutcliffe
- Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Michael J Crowther
- Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Amy Grove
- Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Hema Mistry
- Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Aileen Clarke
- Warwick Evidence, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
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12
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Saito A, Novick RJ, Kiaii B, McKenzie FN, Quantz M, Pflugfelder P, Fisher G, Chu MW. Early and late outcomes after cardiac retransplantation. Can J Surg 2013; 56:21-6. [PMID: 23187039 PMCID: PMC3569470 DOI: 10.1503/cjs.012511] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2011] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Cardiac retransplantation remains the most viable option for patients with allograft heart failure; however, careful patient selection is paramount considering limited allograft resources. We analyzed clinical outcomes following retransplantation in an academic, tertiary care institution. METHODS Between 1981 and 2011, 593 heart transplantations, including 22 retransplantations were performed at our institution. We analyzed the preoperative demographic characteristics, cause of allograft loss, short- and long-term surgical outcomes and cause of death among patients who had cardiac retransplantations. RESULTS Twenty-two patients underwent retransplantation: 10 for graft vascular disease, 7 for acute rejection and 5 for primary graft failure. Mean age at retransplantation was 43 (standard deviation [SD] 15) years; 6 patients were women. Thirteen patients were critically ill preoperatively, requiring inotropes and/or mechanical support. The median interval between primary and retransplantation was 2.2 (range 0-16) years. Thirty-day mortality was 31.8%, and conditional (> 30 d) 1-, 5- and 10-year survival after retransplantation were 93%, 79% and 59%, respectively. A diagnosis of allograft vasculopathy (p = 0.008) and an interval between primary and retransplantation greater than 1 year (p = 0.016) had a significantly favourable impact on 30-day mortality. The median and mean survival after retransplantation were 3.3 and 5 (SD 6, range 0-18) years, respectively; graft vascular disease and multiorgan failure were the most common causes of death. CONCLUSION Long-term outcomes for primary and retransplantation are similar if patients survive the 30-day postoperative period. Retransplantation within 1 year of the primary transplantation resulted in a high perioperative mortality and thus may be a contraindication to retransplantation.
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Affiliation(s)
- Aya Saito
- Division of Cardiac Surgery, Department of Surgery, University of Western Ontario, London Health Sciences Centre, Lawson Health Research Institute, London, Ont
- Department of Cardiothoracic Surgery, University ofTokyo, Tokyo, Japan
| | - Richard J. Novick
- Division of Cardiac Surgery, Department of Surgery, University of Western Ontario, London Health Sciences Centre, Lawson Health Research Institute, London, Ont
| | - Bob Kiaii
- Division of Cardiac Surgery, Department of Surgery, University of Western Ontario, London Health Sciences Centre, Lawson Health Research Institute, London, Ont
| | - F. Neil McKenzie
- Division of Cardiac Surgery, Department of Surgery, University of Western Ontario, London Health Sciences Centre, Lawson Health Research Institute, London, Ont
| | - Mackenzie Quantz
- Division of Cardiac Surgery, Department of Surgery, University of Western Ontario, London Health Sciences Centre, Lawson Health Research Institute, London, Ont
| | - Peter Pflugfelder
- Division of Cardiology, Department of Medicine, University of Western Ontario and London Health Sciences Centre, London, Ont
| | - Grant Fisher
- Multi-Organ Transplant Program, London Health Sciences Centre, London, Ont
| | - Michael W.A. Chu
- Division of Cardiac Surgery, Department of Surgery, University of Western Ontario, London Health Sciences Centre, Lawson Health Research Institute, London, Ont
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13
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van der Wijk J, Smid WM, Seelen MA, van de Kar NC, Offerman JJG, van Son WJ. Renal transplantation in patients with atypical haemolytic uraemic syndrome: a tailor made approach is necessary. Neth J Med 2011; 69:279-280. [PMID: 21868812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A 33-year-old woman with a history of chronic transplant dysfunction because of repeated bouts of haemolytic uraemic syndrome (HUS) was considered for a second transplant. Extensive genetic investigation of the complement system was executed to rule out known mutations prone to development of HUS. This case illustrates the importance of genetic screening in patients with recurrent HUS.
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Affiliation(s)
- J van der Wijk
- Department of Nephrology, Academic Medical Centre, Groningen, the Netherlands.
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14
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Wang Q, Leng B, Song D, Chen G. Fusiform aneurysms of the vertebrobasilar arterial trunk: choice of endovascular methods and therapeutic efficacy. Acta Neurochir (Wien) 2010; 152:1467-76. [PMID: 20496084 DOI: 10.1007/s00701-010-0691-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Accepted: 05/10/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Fusiform aneurysms (FUANs) of vertebrobasilar arterial (VBA) trunk are difficult to treat by using current surgical and endovascular techniques. The objective of this study is to compare the efficacy of FUANs of VBA trunk which was treated with various therapeutic modalities including unilateral or bilateral vertebral artery occlusion, trapping of the aneurysm with coils, stent-assistant coiling, or sole stenting. METHODS Between 2000 and 2008, 17 patients with FUANs (ranged in size from 8 to 45 mm) of VBA trunk in our hospital underwent endovascular treatment in our hospital. Eleven patients were evaluated by test occlusion with nondetachable silicone balloon or hyperglide balloon, and seven patients in this series passed testing with temporary balloon occlusion, among which four patients showed positive result, and three patients were conducted bilateral VA test occlusion. Finally, nine patients underwent a trapping of the aneurysm by coils, four patients were treated with stent-supported coil embolization, and four patients with nonhemorrhagic FUAN of VBA were treated only by stenting. RESULTS The average imaging follow-up was 28 months, with a range from 6 to 48 months. Fourteen (82%) had excellent or good outcome, three (17.6%) had a poor outcome, and one (5.8%) died. CONCLUSIONS Management of FUANs of VBA trunk often poses difficult therapeutic problems. In some cases, multiple treatment sessions may be not only safe but also necessary for the effective treatment of these aneurysms to achieve a complete or an acceptable result.
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Affiliation(s)
- Qihong Wang
- Department of Neurosurgery, Huashan Hospital, Fudan University, No.12, Wulumuqi Mid Road, Shanghai 200040, People's Republic of China
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15
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Acholonu E, McBean E, Court I, Bellorin O, Szomstein S, Rosenthal RJ. Safety and short-term outcomes of laparoscopic sleeve gastrectomy as a revisional approach for failed laparoscopic adjustable gastric banding in the treatment of morbid obesity. Obes Surg 2010; 19:1612-6. [PMID: 19711138 DOI: 10.1007/s11695-009-9941-4] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Accepted: 08/07/2009] [Indexed: 12/15/2022]
Abstract
Laparoscopic sleeve gastrectomy (LSG) has been used as a first step of a two-stage approach in bariatric surgery for high-risk patients. Recently, LSG is being utilized as a primary and final procedure for morbid obesity with acceptable short-term results. The aim of this study is to investigate the effectiveness of LSG as a revisional procedure for patients with unsatisfactory outcomes after laparoscopic adjustable gastric band (LAGB). A retrospective review of a prospectively maintained database was performed. Data were reviewed for all patients undergoing revision from LAGB to LSG during the period May 2005 and May 2009. Data collected included demographics, indication for revision, operative time, length of stay, postoperative complications, and degree of weight reduction. Fifteen patients (three males and 12 females) had revisional surgery converting a LAGB to a LSG. The indication in four patients (26.66%) was weight regains and in five patients (33.33%) was poor weight loss; four patients (26.66%) had a band slippage and symptoms of gastroesophageal reflux, and one patient (6.66%) had poor weight loss, band slippage, and reflux. In one patient (6.66%), the indication was slippage and duodenal fistula. One-step revision procedure was done in 13 patients (86.66%), while two-step procedure was done in two patients (13.33%). Mean preoperative weight and BMI were 233.02 (181.4-300) lb and 38.66 (29.7-49.3) kg/m2, respectively. Mean weight loss at 2, 6, 12, 18, and 24 months postoperatively was 20.7, 48.3, 57.2, 60.1, and 13.5 lb, respectively. Mean % excess BMI loss was 28.9%, 64.2%, 65.3%, 65.7%, and 22.25% at 2, 6, 12, 18, and 24 months, respectively. There was one major complication (staple line leak) and one postoperative acute gastric outlet obstruction. We had no mortality. Thirteen patients were followed up postoperatively. The number decreased as follow-up time progressed. LSG could provide short-term weight loss after previously failed LABG, but prone to more complications compared to an initial LSG without a prior bariatric procedure.
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Affiliation(s)
- Emeka Acholonu
- The Bariatric & Metabolic Institute, Section of Minimally Invasive Surgery, Department of General & Vascular Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA
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16
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Sharma V, Ranawat AS, Rasquinha VJ, Weiskopf J, Howard H, Ranawat CS. Revision total hip arthroplasty for ceramic head fracture: a long-term follow-up. J Arthroplasty 2010; 25:342-7. [PMID: 20347713 DOI: 10.1016/j.arth.2009.01.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2008] [Accepted: 01/13/2009] [Indexed: 02/01/2023] Open
Abstract
The results of revision total hip arthroplasty (THA) for ceramic head fracture have generally been disappointing, largely due to third body wear after incomplete synovectomy. We have followed 8 patients who sustained ceramic head fractures and were subsequently revised to a metal-on-polyethylene articulation. There were no revisions for osteolysis or aseptic loosening at a mean follow-up of 10.5 years. The yearly wear rates of each of 5 of these THAs after revision were compared with 6 matched metal-on-polyethylene THAs; there were no significant differences in wear rates. Greater than 10-year survivorship with a metal-on-polyethylene bearing couple is possible after revision THA for a ceramic head fracture if a complete and thorough synovectomy can be performed. Our technique of synovectomy will be described.
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Affiliation(s)
- Vineet Sharma
- Ranawat Orthopaedic Center, Lenox Hill Hospital, New York, New York 10021, USA
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17
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Nakayama DK, Thompson WM, Wynne JL, Dalton ML, Bozeman AT, Innes BJ. The effect of ACGME duty hour restrictions on operative continuity of care. Am Surg 2009; 75:1234-1237. [PMID: 19999918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Resident work restrictions limit participation in operations that address problems created by a prior operation, because complications occur at any time. We compared resident and attending surgeon staffing of operative complications. We reviewed all complications that required a second operation reported at our Morbidity and Mortality Conference over 1 year, noting surgeons present, their postgraduate year level, and call shift. Comparisons were done using chi2. Of 142 cases, 39 involved a second operation. The same attending surgeon was present for both in 79 per cent of cases, whereas the same resident was present in only 44 per cent (P = 0.002). Postgraduate year 4 to 5 were less likely to be present for second operations than attendings (48% vs 87%, P = 0.011). Resident shift (day, night float, and weekend) was known in 32 cases. When the first operation occurred during day hours, attendings and residents were equally likely to be present at the second (55% and 45%, P = 0.16). When original operations took place during night float or weekend shifts, residents were less likely to be present (33%) than attendings (83%) at second operations (P = 0.036). Duty hour restrictions interfere with operative continuity of care. Reoperations should be exempted from duty hour restrictions.
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Affiliation(s)
- Don K Nakayama
- Department of Surgery, Mercer University School of Medicine, Medical Center of Central Georgia, Macon, Georgia 31201, USA.
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18
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Bosma E, Roukema JA, Verhofstad MHJ. [Stump appendicitis after previous appendicectomy]. Ned Tijdschr Geneeskd 2008; 152:1113-1116. [PMID: 18552067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Two patients, a 25-year-old male and a 57-year-old female, were treated for stump appendicitis. Both patients had undergone appendicectomy 6 months previously and again presented with pain in the right lower abdominal region. On physical examination, the first patient had tenderness as well as rebound tenderness over the entire abdomen, indicative of a general peritonitis. The second patient had tenderness and rebound tenderness in the right iliac fossa alone. Both patients underwent a laparotomy. In the first patient a perforated appendiceal stump was found and removed. In the second patient an acutely inflamed appendiceal stump was found and removed. Appendicitis of a residual appendiceal stump following incomplete appendicectomy is a rare cause of abdominal pain. A lack of familiarity with this condition frequently causes a delay in diagnosis, which increases the chance of perforation and intra-abdominal sepsis. Therefore, all clinicians need to be aware of the possibility of stump appendicitis and to take appropriate measures to prevent serious complications should they suspect this.
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Affiliation(s)
- E Bosma
- St. Elisabeth Ziekenhuis, afd. Heelkunde, Postbus 90.151, 5000 LC Tilburg.
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19
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Hart AM, Tollan CJ, Dabernig J, Acland R, Taggart I. Tertiary resurfacing after one of the first free flaps in Europe, a reflection on 30 years of microsurgical progress. J Plast Reconstr Aesthet Surg 2007; 60:1263-7. [PMID: 17720645 DOI: 10.1016/j.bjps.2007.01.082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2006] [Accepted: 01/22/2007] [Indexed: 11/25/2022]
Abstract
Free flaps have been used for over 30 years. During this period, improved anatomical understanding has increased donor options and available pedicle lengths, permitting safer, single-stage reconstructions with simpler anastomoses. Refinements, such as perforator flaps in particular, have greatly improved donor morbidity, recipient site cosmesis, and the ability to replace 'like with like' while retaining options for innervation. This case highlights the evolution from one of Europe's first free tissue transfers, effectively a perforator flap, through the advent of free muscle flaps to the current generation of contourable perforator flaps. Free flap transfer has become increasingly sophisticated, safer, and more predictable, yet the potential quality of reconstructive outcome has changed little.
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Affiliation(s)
- A M Hart
- Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, 84 Castle Street, Glasgow G4 0SF, UK.
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20
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van Ruler O, Mahler CW, Boer KR, Reuland EA, Gooszen HG, Opmeer BC, de Graaf PW, Lamme B, Gerhards MF, Steller EP, van Till JWO, de Borgie CJAM, Gouma DJ, Reitsma JB, Boermeester MA. Comparison of on-demand vs planned relaparotomy strategy in patients with severe peritonitis: a randomized trial. JAMA 2007; 298:865-72. [PMID: 17712070 DOI: 10.1001/jama.298.8.865] [Citation(s) in RCA: 254] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
CONTEXT In patients with severe secondary peritonitis, there are 2 surgical treatment strategies following an initial emergency laparotomy: planned relaparotomy and relaparotomy only when the patient's condition demands it ("on-demand"). The on-demand strategy may reduce mortality, morbidity, health care utilization, and costs. However, randomized trials have not been performed. OBJECTIVE To compare patient outcome, health care utilization, and costs of on-demand and planned relaparotomy. DESIGN, SETTING, AND PATIENTS Randomized, nonblinded clinical trial at 2 academic and 5 regional teaching hospitals in the Netherlands from November 2001 through February 2005. Patients had severe secondary peritonitis and an Acute Physiology and Chronic Health Evaluation (APACHE-II) score of 11 or greater. INTERVENTION Random allocation to on-demand or planned relaparotomy strategy. MAIN OUTCOME MEASURES The primary end point was death and/or peritonitis-related morbidity within a 12-month follow-up period. Secondary end points included health care utilization and costs. RESULTS A total of 232 patients (116 on-demand and 116 planned) were randomized. One patient in the on-demand group was excluded due to an operative diagnosis of pancreatitis and 3 in each group withdrew or were lost to follow-up. There was no significant difference in primary end point (57% on-demand [n = 64] vs 65% planned [n = 73]; P = .25) or in mortality alone (29% on-demand [n = 32] vs 36% planned [n = 41]; P = .22) or morbidity alone (40% on-demand [n = 32] vs 44% planned [n = 32]; P = .58). A total of 42% of the on-demand patients had a relaparotomy vs 94% of the planned relaparotomy group. A total of 31% of first relaparotomies were negative in the on-demand group vs 66% in the planned group (P <.001). Patients in the on-demand group had shorter median intensive care unit stays (7 vs 11 days; P = .001) and shorter median hospital stays (27 vs 35 days; P = .008). Direct medical costs per patient were reduced by 23% using the on-demand strategy. CONCLUSION Patients in the on-demand relaparotomy group did not have a significantly lower rate of death or major peritonitis-related morbidity compared with the planned relaparotomy group but did have a substantial reduction in relaparotomies, health care utilization, and medical costs. TRIAL REGISTRATION http://isrctn.org Identifier: ISRCTN51729393.
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Affiliation(s)
- Oddeke van Ruler
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
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22
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Carvi Y Nievas MN, Höllerhage HG. Early combined cranioplasty and programmable shunt in patients with skull bone defects and CSF-circulation disorders. Neurol Res 2006; 28:139-44. [PMID: 16551430 DOI: 10.1179/016164106x98008] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE This study assesses the clinical outcome after early combined cranioplasty (own frozen bone) and shunt implantation (Codman-Medos programmable VP shunt) in patients with skull bone defects and cerebrospinal fluid (CSF) circulation disorders. METHOD Medical records were reviewed retrospectively for the last 100 patients with CSF disorders after trauma or subarachnoid hemorrhage (SAH), who previously underwent decompressive craniotomy owing to therapy-resistant brain swelling. Patients treated with early (5 to 7 weeks after injury) combined cranioplasty and shunt implantation were analysed and a follow-up for the survivors was obtained. RESULTS In 60 patients with a daily CSF external drainage over 150 ml and dilated ventricles in CT scan, a programmable VP shunt was implanted simultaneously with the cranioplasty within 5.1 weeks after decompression. The neurological condition 6 months later was good (independent patients) in 39 cases (65%); 12 patients (20%) survived with a severe disability; three patients (5%) remained in a persistent vegetative state and only six patients (10%) died. There were few complications: bone or shunt infection (three cases), post-operative intracranial bleeding (one case), transitory neurological impairment after bone reimplantation (two cases), bone resorption (two cases) and shunt dysfunction (three cases). CONCLUSION The early reimplantation of the patient's own skull bone combined to the employment of a programmable shunt system allowed us a dynamic adjustment of the intracranial pressure (ICP) changes. The combined treatment reduced the number of required surgical procedures, complications and unsatisfactory patient outcomes.
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Haniff J, de Vries E, Claassen ATPM, Looman CWN, van Berlo C, Coebergh JWW. Non-compliance with the re-excision guidelines for cutaneous melanoma in The Netherlands does not influence survival. Eur J Surg Oncol 2006; 32:85-9. [PMID: 16289645 DOI: 10.1016/j.ejso.2005.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2004] [Revised: 08/31/2005] [Accepted: 09/20/2005] [Indexed: 10/25/2022] Open
Abstract
AIM To evaluate causes and consequences of not adhering to the clinical practice guideline for cutaneous malignant melanoma. METHODS We conducted a retrospective cohort study of the clinical records of 454 subjects whose pathological reports were obtained from a population-based cancer registry to assess determinants and effects of non-compliance of physicians with the excision policy and the related clinical practice guideline for patients with primary localized cutaneous malignant melanoma (CMM). A comparative analysis was performed of patients who did and did not undergo re-excision (compliance versus non-compliance with the guideline). Subjects diagnosed in 1988, 1993 and 1997, just 1 year after publication of the (adapted) guideline, were followed until death due to any cause or until July 1st 2003. RESULTS Old age was the most important determinant of non-compliance. After adjusting for age at diagnosis, gender, subsite and Breslow thickness there was no significant difference in overall survival between the compliance group and the non-compliance group. CONCLUSIONS Non-compliance to the guideline is more common in older patients and in patients with melanoma in the head and neck region. After adjusting for confounders, a significant effect of complying with the guidelines on overall survival could not be observed.
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Affiliation(s)
- J Haniff
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
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24
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Toms A, Greidanus N, Garbuz D, Masri BA, Duncan CP. Optimally invasive exposure in revision total hip arthroplasty: a guide to selection and technique. Instr Course Lect 2006; 55:245-55. [PMID: 16958460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Revision total hip arthroplasty requires a careful surgical plan. Selection of the appropriate exposure is an essential step for success. Exposure is important not only for the complete and safe visualization and extraction of components and cement, but also for the achievement of a stable construct at the end of the procedure. In addition, controlled exposure minimizes intraoperative complications and bone and soft-tissue damage, essential considerations for eradication of infection. Three questions need to be addressed at the preoperative stage: (1) Is this a straightforward revision that can be handled with a standard approach? (2) Is this a more complex revision requiring an extensile exposure? (3) Is this an unusual revision requiring special techniques to allow adequate access that cannot be obtained using standard extensile techniques? Each group of exposures presents three further possibilities, each of which has specific indications, advantages, and disadvantages. In conjunction with the preoperative analysis, this knowledge should enable the revision surgeon to select the most appropriate approach, resulting in optimal exposure for each individual revision scenario.
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Affiliation(s)
- Andrew Toms
- Department of Orthopedics, University of British Columbia, Vancouver, British Colombia, Canada
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Abstract
CONTEXT Transsphenoidal surgery is currently the primary therapeutic option for Cushing's disease. Despite considerable initial success, 10-30% of patients fail to achieve lasting remission. EVIDENCE ACQUISITION We evaluated a strategy of immediate reoperation in surgical failures judged by plasma cortisol levels that did not fall to 2 microg/dl or less within 72 h of surgery. Of 215 patients with presumed ACTH microadenomas, treated between 1993 and 2004, 12 met inclusion criteria and had prompt (within 15 d) reoperation for residual or missed ACTH microadenoma. These 12 patients represent 28% of those who did not have evidence of postoperative adrenal insufficiency. EVIDENCE SYNTHESIS Based on an outcome measure of sustained subnormal or normal plasma cortisol levels, eight of 12 patients (67%) achieved remission from the two operations. Adjunctive therapies (radiotherapy, gamma knife radiosurgery, and adrenalectomy) led to remission in another three patients. It is recognized that this outcome required either total hypophysectomy (one patient) or postoperative hypopituitarism (all patients in remission). CONCLUSION Magnetic resonance imaging was not usually helpful in determining therapeutic strategies; however, inferior petrosal sinus sampling was critical in providing confidence that the disease was of pituitary origin. A treatment algorithm is recommended, based on this study.
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Affiliation(s)
- Marco Locatelli
- Department of Neuroscience, Ospedale maggiore Policlinico, IRCCS, Milan, Italy
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Affiliation(s)
- Kelly G Vince
- University of Southern California, Los Angeles, CA 90033, USA
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27
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Yoon ST, Qureshi AA, Heller JG, Nordt JC. Kyphoplasty for salvage of a failed vertebroplasty in osteoporotic vertebral compression fractures: case report and surgical technique. ACTA ACUST UNITED AC 2005; 18 Suppl:S129-34. [PMID: 15699799 DOI: 10.1097/00024720-200502001-00020] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Osteoporotic vertebral compression fractures are a significant source of morbidity. Recently described techniques of vertebroplasty and kyphoplasty have provided consistent successful outcomes in the short term. However, techniques to address the failure of vertebroplasty have not been addressed. We present two cases of failed vertebroplasty that were revised with a kyphoplasty technique. Both patients had near complete resolution of preoperative symptoms and had a significant vertebral height restoration more than 10 months after revision with kyphoplasty. In conclusion, kyphoplasty technique can be utilized to salvage failed vertebroplasty.
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Affiliation(s)
- S Tim Yoon
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
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Coats DK. Retinopathy of prematurity: involution, factors predisposing to retinal detachment, and expected utility of preemptive surgical reintervention. Trans Am Ophthalmol Soc 2005; 103:281-312. [PMID: 17057808 PMCID: PMC1447579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
PURPOSE To characterize involution of retinopathy of prematurity (ROP) following treatment at threshold, to identify findings during involution that portend development of retinal detachment, and to assess the potential utility of preemptive vitrectomy for eyes with high-risk features. METHODS The probability of ROP involution and of retinal detachment evolution over time was analyzed in 262 treated eyes of 138 infants in a retrospective observational non-case controlled series. Expected utility of preemptive reintervention in eyes with high-risk features was evaluated using decision analysis. Modifications were devised to enhance classification of advanced ROP. RESULTS ROP fully involuted in approximately 80% of eyes within 28 days of treatment. Vitreous organization meeting the study's clinically important definition was associated with a 31-fold (5.37 to 183.63; P < .0001) and a 13-fold (2.97 to 58.59; P < .0001) increase in the odds for retinal detachment for right and left eyes, respectively. Vitreous hemorrhage defined as clinically important was associated with a 38-fold (2.69 to 551.19; P = .007) and a 15-fold (1.65 to 144.12; P = .02) increase in the odds for retinal detachment for right and left eyes, respectively. As modeled, an expected utility of 0.85 was calculated for preemptive vitrectomy compared with 0.79 for deferred vitrectomy for eyes with clinically important vitreous organization. CONCLUSIONS Acute-phase ROP involuted quickly in most eyes. Vitreous organization and vitreous hemorrhage were predictive of eyes that developed a retinal detachment. Decision analysis suggests that preemptive vitrectomy for eyes with vitreous organization meeting specific criteria is not likely to be worse than deferred vitrectomy, and it could be advantageous in some scenarios.
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Eltchaninoff H, Tron C, Cribier A. Effectiveness of percutaneous mechanical mitral commissurotomy using the metallic commissurotome in patients with restenosis after balloon or previous surgical commissurotomy. Am J Cardiol 2003; 91:425-8. [PMID: 12586256 DOI: 10.1016/s0002-9149(02)03237-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Balloon mitral valvuloplasty has been reported to give equal or less positive results after previous commissurotomy than after a first procedure. Percutaneous mechanical mitral commissurotomy (PMMC) is a new technique that has not yet been evaluated in this subset of patients. Of 1,175 PMMC procedures (1,175 patients), 173 patients (14.7%) had previous commissurotomy; patients were older (40 vs 35 years of age, p <0.0001) and more often in atrial fibrillation (34% vs 21%, p = 0.0016) than were patients who had not undergone previous commissurotomy. The baseline transmitral gradient was lower (17 +/- 8 vs 19 +/- 8 mm Hg, p <0.002) and the echocardiographic Wilkins score was higher (8.7 +/- 1.9 vs 7.6 +/- 1.8, p <0.0001) for patients who underwent previous commissurotomy. Baseline mitral valve area was comparable between the 2 groups (0.96 +/- 0.21 vs 0.93 +/- 0.24 cm(2)). Immediate results were satisfactory, although slightly less favorable after previous commissurotomy, with a final mitral valve area of 2.01 +/- 0.30 versus 2.12 +/- 0.36 cm(2) (p <0.0001), and a residual transvalvular gradient of 5.0 +/- 3.6 versus 4.2 +/- 4.1 mm Hg (p = 0.003). The rates of procedural success (93%) and severe complications (4.7%) were comparable between the 2 groups. Thus, PMMC is an effective and safe technique for the treatment of mitral restenosis after previous commissurotomy.
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Affiliation(s)
- Hélène Eltchaninoff
- Department of Cardiology, Charles Nicolle Hospital, University of Rouen, Rouen, France.
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Azoulay D, Linhares MM, Huguet E, Delvart V, Castaing D, Adam R, Ichai P, Saliba F, Lemoine A, Samuel D, Bismuth H. Decision for retransplantation of the liver: an experience- and cost-based analysis. Ann Surg 2002; 236:713-21; discussion 721. [PMID: 12454509 PMCID: PMC1422637 DOI: 10.1097/01.sla.0000036264.66247.65] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To determine the patient factors affecting patient outcome of first liver retransplantation at a single center to help in the decision process for retransplantation. SUMMARY BACKGROUND DATA Given the critical organ shortage, one of the most controversial questions is whether hepatic retransplantation, the only chance of survival for patients with a failing first organ, should be offered liberally despite its greater cost, worse survival, and the inevitable denial of access to primary transplantation to other patients due to the depletion of an already-limited organ supply. The authors' experience of 139 consecutive retransplantations was reviewed to evaluate the results of retransplantation and to identify the factors that could improve the results. METHODS From 1986 to 2000, 1,038 patients underwent only one liver transplant and 139 patients underwent a first retransplant at the authors' center (first retransplantation rate = 12%). Multivariate analysis was performed to identify variables, excluding intraoperative and donor variables, associated with graft and patient long-term survival following first retransplantation. Lengths of hospital and intensive care unit stay and hospital charges incurred during the transplantation admissions were compared for retransplanted patients and primary-transplant patients. RESULTS One-year, 5-year, and 10-year graft and patient survival rates following retransplantation were 54.0%, 42.5%, 36.8% and 61.2%, 53.7%, and 50.1%, respectively. These percentages were significantly less than those following a single hepatic transplantation at the authors' center during the same period (82.3%, 72.1%, and 66.9%, respectively). On multivariate analysis, three patient variables were significantly associated with a poorer patient outcome: urgency of retransplantation (excluding primary nonfunction), age, and creatinine. Primary nonfunction as an indication for retransplantation, total bilirubin, and factor II level were associated with a better prognosis. The final model was highly predictive of survival: according to the combination of the factors affecting outcome, 5-year patient survival rates varied from 15% to 83%. Retransplant patients had significantly longer hospital and intensive care unit stays and accumulated significantly higher total hospital charges than those receiving only one transplant. CONCLUSIONS These data confirm the utility of retransplantation in the elective situation. In the emergency setting, retransplantation should be used with discretion, and it should be avoided in subgroups of patients with little chance of success.
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Affiliation(s)
- Daniel Azoulay
- Hepatobiliary Center, Hôspital Paul Brousse, Assitance Publique-Hôpitaux de Paris and Université Paris Sud, Villejuif, France.
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Affiliation(s)
- Björn Strömqvist
- Department of Orthopedics, Lund University Hospital, SE-221 85 Lund, Sweden.
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Affiliation(s)
- A Toni
- 1s Orthopaedic Department, Laboratory for Medical Technology, Istituti Ortopedici Rizzoli, Bologna, Italy
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Affiliation(s)
- R P Pitto
- Department of Orthopaedic Surgery, University of Erlangen-Nuremberg Waldkrankenhaus, Rathsbergerstr. 57, D-91054 Erlangen, Germany.
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MESH Headings
- Aged
- Arthroplasty, Replacement, Hip/economics
- Arthroplasty, Replacement, Hip/instrumentation
- Arthroplasty, Replacement, Hip/standards
- Arthroplasty, Replacement, Hip/statistics & numerical data
- Arthroplasty, Replacement, Hip/trends
- Data Collection/methods
- Evidence-Based Medicine
- Female
- Hip Prosthesis/adverse effects
- Hip Prosthesis/standards
- Hip Prosthesis/statistics & numerical data
- Hospitals, Special
- Humans
- Italy
- Length of Stay/statistics & numerical data
- Male
- Orthopedics
- Patient Selection
- Prosthesis Design
- Prosthesis Failure
- Registries
- Reoperation/standards
- Reoperation/statistics & numerical data
- Reoperation/trends
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Affiliation(s)
- S Stea
- Laboratory for Medical Technology, Istituti Ortopedici Rizzoli, Bologna, Italy
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Abstract
BACKGROUND The assessment of fracture healing is both a clinically relevant and frequently used outcome measure following lower extremity trauma. However, it remains uncertain whether there is a consensus in the assessment of fracture healing among orthopaedic surgeons. Variability in the assessment of healing may have important implications in surgeons' decisions to intervene when they perceive fracture healing is slow to progress. OBJECTIVE To identify surgeons' approaches in the assessment of tibial fracture healing and the definitions of a delayed union, nonunion, and malunion among orthopaedic surgeons. STUDY DESIGN Cross-sectional survey of 577 orthopaedic surgeons. METHODS Focus groups, key informants, and sampling to redundancy strategies were used to develop a survey to examine surgeons' opinions in the assessment of tibial shaft fractures. Surgeons were asked how often the following variables were used in the assessment of fracture healing: (a) callus size; (b) cortical continuity; (c) progressive loss of fracture line; (d) pain with weight bearing; and (e) pain to palpation at the fracture site. Further, surgeons were asked to provide a time point beyond which a delayed union becomes a nonunion. Finally, surgeons specified their limits of acceptable fracture alignment (translation, shortening, rotation, varus/valgus, and procurvatum/recurvatum). The survey was pilot tested for clarity and content validity. This survey was mailed to 577 orthopaedic surgeons who were members of the Orthopaedic Trauma Association, American Academy of Orthopaedic Surgeons, and European-AO International-affiliated trauma centers. RESULTS Responses were obtained from 444 surgeons (response rate 77%). For each variable, the proportion of surgeons who always used the criterion ranged from 39.7% to 45.4%, and those who occasionally or never used the criterion ranged from 20.7% to 26.9%. Surgeons' definitions of delayed union ranged from 1 to 8 months, whereas definitions of nonunion ranged from 2 to 12 months. There was also variability in definitions of fracture malunion. Acceptable degrees of fracture shortening and translation ranged from less than 5 mm to greater than 15 mm. Surgeons' definitions of acceptable angular malunions (rotational, varus/valgus, and procurvatum/recurvatum) ranged from less than 5 degrees to 20 degrees. CONCLUSIONS There is a lack of consensus in the assessment of fracture healing in tibial shaft fractures among orthopaedic surgeons. Varying definitions of nonunion and malunion may influence the decision to intervene in an effort to promote fracture healing and/or realign the fracture.
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Affiliation(s)
- Mohit Bhandari
- Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
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Hierner R, Cedidi C, Betz AM, Berger AC. [Standardized management of subtotal and total amputation injuries at the lower leg level - the "Integrated Treatment Concept"]. HANDCHIR MIKROCHIR P 2002; 34:277-91. [PMID: 12494379 DOI: 10.1055/s-2002-36315] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- R Hierner
- Plastische, Reconstructieve en Esthetische Chirurgie, Handchirurgie en Brandwondencentrum, Universitaire Ziekenhuis Gasthuisberg, Katholieke Universiteit Leuven, Leuven/Belgien.
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37
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Affiliation(s)
- B A Hoey
- Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, USA.
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Abstract
Every year, the transplant waiting list gets longer, while donor numbers essentially remain the same. This makes the responsibility of being good stewards of this precious and limited resource greater than ever. Transplant teams, who are both committed to their patients and aware of this important responsibility, are left to make the difficult and ethical decisions regarding retransplantation. Retransplantation of organs in pediatric patients presents a different set of issues to consider, and the results are promising. This case study presents a boy who received a kidney transplant for focal segmental glomerulosclerosis at age 5. At age 11, because of the recurrence of focal segmental glomerulosclerosis and severe cardiomyopathy, he required a rare combined kidney-heart transplant. At age 17, he developed chronic renal failure and posttransplant coronary artery disease, most likely related to a period of noncompliance, and required yet another combined kidney-heart transplant. He is currently alive and well 2 years after transplantation.
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Affiliation(s)
- Lisa Griffin
- Loma Linda University Medical Center, Loma Linda, Calif., USA
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Unal M, Demirsoy E, Arbatli H, Tansal S, Yağan N, Tükenmez F, Sener D, Sönmez B. [Coronary bypass reoperations: evaluation of 104 cases]. Anadolu Kardiyol Derg 2002; 2:98-105; AXV. [PMID: 12134549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
BACKGROUND Repetitive procedures usually take place in the natural course of coronary heart disease. The aim of this study was to evaluate the risk factors, which affect coronary bypass reoperations, and to compare them with the postoperative results of the coronary first operations and the reoperations. METHODS Between January 1995 and January 2000, coronary reoperations were performed in 104 cases (Coronary reoperations group) by the same surgical team. Ninety-nine of them were the first, 3 were the second and 2 were the third reoperations in this group. At the same period of time, 3609 patients underwent coronary bypass procedure as the first operation (Coronary 1. operation group). Eighty-seven patients were male (83.65%), 17 were female (16.35%) and the mean age was 60.82 +/- 9.49 in reoperation group; while among 2916 patients 2223 were male (80.8%), 693 were female (19.2%) and the mean age was 60.37 +/- 9.58 in the first operation group. RESULTS Incidence of prolonged ventilation (p = 0.0001), renal dysfunction requiring dialysis (p = 0.01), need for intraaortic balloon pump (p = 0.0001) and prolonged intensive care unit (p = 0.01) and hospital stay (p = 0.01) were significantly higher in reoperation group. The mortality rate was 9.62% in the reoperation group while it was 2.2% in the first operation group (p = 0.0001). CONCLUSIONS The high morbidity and mortality of coronary bypass reoperations can be reduced to acceptable levels accordingly with early therapy prior to ventricular dysfunction and clinical deterioration that will improve the outcome in these patients.
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Affiliation(s)
- Mehmet Unal
- Kadir Has Universitesi Florence Nightingale Hastanesi Kalp ve Damar Cerrahisi, Istanbul.
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Guity MR, Roques B, Mansat P, Bellumore Y, Mansat M. [Painful or unstable shoulder after coracoid transfer: result of surgical treatment]. Rev Chir Orthop Reparatrice Appar Mot 2002; 88:349-58. [PMID: 12124534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
INTRODUCTION The purpose of this study was to investigate the results of revision surgery for complications related to previous coracoïd transfer for recurrent anterior instability of the shoulder. MATERIALS AND METHODS Seventeen patients with previous surgery for anterior shoulder instability underwent a new surgical procedure, because of recurrent instability in 10, and painful shoulder with limitation of motion in 7. A soft tissue procedure (Bankart and/or capsuloplasty) was performed in the 10 unstable shoulders, and a joint debridement with removal of the coracoid transfer in the 7 painful shoulders. The subscapularis was found to be normal in only 2 cases, fibrotic in 11, thin in 3, and teared in 1. The interval between the initial procedure and the revision surgery was eleven years on average. RESULTS At an average of 21 months follow-up, the patients were evaluated according to the Duplay scoring system. A radiographic analysis was also performed for all the patients, and a CT-examination for fourteen. The results were good or excellent for 11 patients (70% in the soft tissue procedure group, and 57% in the debridement group with removal of the coracoid transfer), fair for 4, and poor for 2. Clinical evaluation of the subscapularis showed a lag of muscle function in 10 patients. Strength in internal rotation was 3.3 kg lesser in the operated shoulder compared to the opposite side. CT-examination showed that 4 patients presented a significantly fatty degeneration of the subscapularis. Finally on radiographic examination, osteoarthritis was present in 9 patients.The most important preoperative factor that affected the final results was the number of previous surgical procedures. DISCUSSION Recurrent instability, problems related to the bone graft or ostheosynthesis material, osteoarthritis, and neurological damage can complicate a coracoid transfer procedure. Our study shows that this procedure can also induce irreversible damage to the subscapularis muscle. CONCLUSION Revision surgery for complications related to coracoid transfer for anterior shoulder instability is a challenging procedure. Only 2/3 of patients achieved excellent or satisfactory results. Patients with recurrent instability had better results than those with painful impingement and or osteoarthritis. The high rate of late osteoarthritis and irreversible damage of the subscapularis muscle remain sources of concern.
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Affiliation(s)
- M R Guity
- Service d'Orthopédie-Traumatologie, CHU Purpan, place du Docteur-Baylac, 31059 Toulouse Cedex
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Abstract
PURPOSE The purpose of this review was to define and describe 2 years of adverse outcome variances for elective primary or revision of major total joint replacement in terms of baseline benchmark data. DESIGN Descriptive variance. METHODS Retrospective review of patients with greater than 4 days in acute care after total joint replacement, patients with unexpected comorbidities that required medical subspecialist management, patients who were transferred to a higher level of care, and patients who did not survive postoperatively. FINDINGS This review indicates that patients treated on a higher volume dedicated orthopaedic unit experience fewer adverse outcomes and shorter length of stay than patients treated on a general surgical unit. CONCLUSIONS Patients who are treated on a dedicated orthopaedic unit experience significantly fewer adverse outcomes or outcome variations. Costs can be effectively managed, and optimal clinical patient outcomes can be achieved with few complications. Treatment strategies can be used as a template for enhanced care processes for this population.
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Affiliation(s)
- Terry L Graul
- Southwest Center for Neurological Surgeons, Mesa, Arizona, USA
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Abstract
The aim of this review article was to look at the evidence supporting the surgical treatment of secondary bacterial peritonitis. Because the absolute necessity of adequate source control is not disputable and there is no question that peritoneal toilet (in whichever form) is mandatory, the main bulk of this manuscript is dedicated to the controversial issues of planned relaparotomy and laparostomy. We found little good evidence to support or refute the use of these modalities, but in the absence of evidence, one has to use experience and common sense. Ours suggest that planned relaparotomies combined with laparostomy represent, for the time being, the heaviest weaponry in the surgeon's mechanical armamentarium for the treatment of severe intra-abdominal infection. Even without level II evidence, we are convinced that these therapeutic modalities are life-saving in a well-selected group of patients. One has, however, to know when to stop and how not to harm.
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Affiliation(s)
- Moshe Schein
- Cornell University College of medicine, New York, NY, USA.
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Pahlman L. Is follow-up of colorectal cancer cost-effective? Przegl Lek 2001; 57 Suppl 5:75. [PMID: 11202302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- L Pahlman
- Universitet Akademiska Sjukhuset, Uppsala, Sweden
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Abstract
STUDY DESIGN Retrospective study of patients after extension of previous scoliosis fusions to the pelvis. OBJECTIVE To determine whether modern instrumentation and surgical techniques provide for increased fusion rates with fewer complications. SUMMARY OF BACKGROUND DATA Traditionally, long fusions to the pelvis in adults with idiopathic scoliosis have resulted in high complication rates, including pseudarthrosis. METHODS The hospital and clinic charts of 41 patients (40 female, 1 male) were reviewed 41 months (range: 24-116) after surgery for extension to the pelvis of previous scoliosis fusions. Thirty-nine of 41 had a combined anteroposterior fusion extension; two had posterior extension only. In 37 of 41 patients, Cotrel-Dubousset (CD) instrumentation was used; in two, Isola (Acromed Corp., Cleveland, OH), in one, TSRH; (Sofamor-Danek, Memphis, TN), and in one, Synergy (Cross Medical Products, Columbus, OH). Parameters analyzed were fusion rate, sagittal and coronal balance, lumbar lordosis, length of fusion extension, and distal fixation method. RESULTS Complications were seen in 30 of 41 patients. The pseudarthrosis rate was 37% (15/41) and was significantly related to the method of distal posterior fixation. With sacral fixation only, the rate was 53% (8/15), with iliac fixation only 42% (3/7), and with both iliac and sacral fixation 21% (4/19; P < 0.05). This was not correlated with fusion rate, and the length of fusion extension did not affect the pseudarthrosis rate or sagittal balance. CONCLUSION When fixed to the ilium and sacrum, modern instrumentation appears capable of maintaining sagittal balance with lower rates of pseudarthrosis when previous scoliosis fusions are extended to the pelvis. The complication rate remains significant.
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Affiliation(s)
- N C Islam
- Twin Cities Spine Center, Minneapolis, Minnesota, USA
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van Roosmalen J, Derksen J. [Female circumcision: histories of 3 patients]. Ned Tijdschr Geneeskd 2000; 144:95-6. [PMID: 10674110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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Kelly PJ, Rappaport ZH, Bhagwati SN, Ushio Y, Vapalahti M, de Tribolet N. Reoperation for recurrent malignant gliomas: what are your indications? Surg Neurol 1997; 47:39-42. [PMID: 8986164 DOI: 10.1016/s0090-3019(96)00273-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- P J Kelly
- Department of Neurosurgery, New York University Medical Center, New York, USA
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McMasters R. Retransplantation of scarce organs: the ethical lessons. JAMA 1994; 271:1157; author reply 1157-8. [PMID: 8179717 DOI: 10.1001/jama.271.15.1157a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Zinberg JM. Retransplantation of scarce organs: the ethical lessons. JAMA 1994; 271:1157; author reply 1157-8. [PMID: 8151866 DOI: 10.1001/jama.271.15.1157b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Abstract
Because of a shortage of transplantable livers and hearts, the transplant community has had to decide--by who gets an organ--who lives or dies. Despite this shortage, whether one has previously received a transplant is not used as a criterion to distribute organs. The existing allocation system distributes 10% to 20% of available hearts and livers to retransplant patients. This article examines three differences between primary transplantation and retransplantation that may affect the priority that retransplant candidates should receive in vying for organs: (1) the special obligations that transplant teams have not to abandon patients on whom they have already performed a transplant, (2) the fairness of allowing individuals to get multiple transplants while some die awaiting their first, and (3) the difference in efficacy between primary transplantation and retransplantation. Only this last difference holds up to critical analysis. Our moral duty to direct scarce, lifesaving resources to those likely to benefit from them, suggests that, all other things equal, primary transplant candidates should receive priority because their mortality after transplantation is lower. Consistency also demands that previous transplant history be taken into account, as we already allocate organs according to ABO blood group matching, a factor that affects transplant outcome approximately the same amount as a previous transplantation. We therefore conclude that the system should be revised so that primary transplant candidates have a better chance of receiving organs than retransplant candidates.
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Affiliation(s)
- P A Ubel
- Department of Medicine, University of Pittsburgh, PA 15261
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50
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Flowers RS. Optimal procedure in secondary blepharoplasty. Clin Plast Surg 1993; 20:225-37. [PMID: 8387414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Secondary repair is a common necessity after blepharoplasty. The need stems from faulty methodology in primary aesthetic periorbital repair. Rethinking initial procedures with careful attention to diagnosis, planning, and execution in the light of contemporary knowledge should eliminate the need for most secondary repair. The procedures that have been traditional over the last 50 years are obsolete today, as we have come to a better understanding of blepharoplasty. It is appropriate that conceptualization and technique change to eliminate the massive and growing volume of secondary deformity. Redirecting the focus in secondary repair, both in the upper and lower orbital regions, gives reoperation a greater chance of success, while avoiding ill conceived solutions that accentuate deformity.
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Affiliation(s)
- R S Flowers
- John A. Burns School of Medicine (University of Hawaii), Honolulu
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