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Obi M, Obiri-Yeboah D, Han A, Prabhu A, French J, Lipman JM. Understanding General Surgery Recruitment and Attrition During the COVID-Era: A 1-Year Follow-Up Study. J Surg Res 2024; 300:1-7. [PMID: 38788481 DOI: 10.1016/j.jss.2024.04.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 04/08/2024] [Accepted: 04/21/2024] [Indexed: 05/26/2024]
Abstract
INTRODUCTION The COVID-19 pandemic resulted in modifications to resident selection. The success of these new recruitment strategies as well as the impact on trainee attrition and competency is unknown. We previously evaluated how selection of general surgery applicants changed early in the pandemic. Here we supplement that work by reporting further modifications to the recruitment process and the perceived impact on resident attrition and competency. METHODS An anonymous cross-sectional survey sent via the Association of Program Directors in Surgery listserv in June 2022 to programs directors (PDs) at Accreditation Council for Graduate Medical Education accredited general surgery programs. Surveys contained demographic questions, 5-point Likert scale questions evaluating factors related to recruitment and match process, and postgraduate year 1 performance. RESULTS 60 PDs responded to the survey. PDs continue to value the same post-COVID factors related to determining a resident's commitment to surgery but began to shift back to nonvirtual based strategies to recruit applicants in this new interview cycle. PD commentary frequently noted desire to return to in-person interviewing. 5.4% of postgraduate year 1s comprising this first class of residents who underwent virtual-only interviews and rotations did not reach Accreditation Council for Graduate Medical Education level 1 milestones, similar to prior years. The attrition rate amongst this class increased from 1.3% to 2.7%. CONCLUSIONS The attrition rate for postgraduate year 1 categorical general surgery residents has increased since the onset of the pandemic. The recruitment strategies adopted early in the pandemic have not maintained their initial perceived impact.
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Affiliation(s)
- Megan Obi
- Department of General Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Derrick Obiri-Yeboah
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Amy Han
- Department of General Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ajita Prabhu
- Department of General Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Judith French
- Department of General Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jeremy M Lipman
- Department of General Surgery, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
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Melland-Smith M, Chang J, Essani V, Maskal S, Ellis R, Beffa L, Petro C, Prabhu A, Krpata D, Miller B, Rosen M. Cost, Operative Delay, and X-Rays for Incorrect Surgical Counts. Am Surg 2024:31348241256064. [PMID: 38776896 DOI: 10.1177/00031348241256064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
At Cleveland clinic, an incorrect surgical count triggers Code Rust; a protocol that mandates an intraoperative patient X-ray, staff radiology read, and discussion with the surgeon before the incision is closed. Code Rust calls from November 2014 to December 2022 were retrospectively reviewed. Realtime workflow and operative details of Code Rust cases were analyzed.1277 Code Rusts were identified. Average time from ordering the X-ray to final radiology report was 50 minutes, totalling $2,362,450.00 spent on operating room time. Code Rust was called twice as frequently during urgent or emergent cases, compared to elective. There were more staff in Code Rust rooms compared to non-Code Rust rooms. A foreign body on X-ray was identified in 42/1277 (3.3%) cases. Code Rust is a resource intensive process that is more common in emergent cases that involve multiple staff. While retained foreign bodies are identified in a small percentage of cases, the current system should be revisited to reduce operating time and expense.
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Affiliation(s)
- Megan Melland-Smith
- Department of General Surgery, Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, OH, USA
- Department of General Surgery, North York General Hospital, University of Toronto, North York, ON, Canada
| | - Jenny Chang
- Department of General Surgery, Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Varisha Essani
- Department of General Surgery, Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Sara Maskal
- Department of General Surgery, Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Ryan Ellis
- Department of General Surgery, Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Lucas Beffa
- Department of General Surgery, Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Clayton Petro
- Department of General Surgery, Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Ajita Prabhu
- Department of General Surgery, Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - David Krpata
- Department of General Surgery, Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Benjamin Miller
- Department of General Surgery, Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Michael Rosen
- Department of General Surgery, Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, OH, USA
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Gross A, Brooks N, French J, Miller B, Prabhu A. Relaying quality: An incremental approach to quality improvement. Med Educ 2024; 58:598-599. [PMID: 38362772 DOI: 10.1111/medu.15354] [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] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/23/2024] [Indexed: 02/17/2024]
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Bahraini A, Hsu J, Cochran S, Campbell S, Overby DW, Phillips S, Prabhu A, Perez A. Evaluation of 30-day outcomes for open ventral hernia repair using self-gripping versus nonself-gripping mesh. Surg Endosc 2024:10.1007/s00464-024-10778-y. [PMID: 38609587 DOI: 10.1007/s00464-024-10778-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 03/04/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND The use of mesh is standard of care for large ventral hernias repaired on an elective basis. The most used type of mesh includes synthetic polypropylene mesh; however, there has been an increase in the usage of a new polyester self-gripping mesh, and there are limited data regarding its efficacy for ventral hernia. The purpose of the study is to determine whether there is a difference in surgical site occurrence (SSO), surgical site infection (SSI), surgical site occurrence requiring procedural intervention (SSOPI), and recurrence at 30 days after ventral hernia repair (VHR) using self-gripping (SGM) versus non-self-gripping mesh (NSGM). METHODS We performed a retrospective study from January 2014 to April 2022 using the Abdominal Core Health Quality Collaborative (ACHQC). We collected data on patients over 18 years of age who underwent elective open VHR using SGM or NSGM and whom had 30-day follow-up. Propensity matching was utilized to control for variables including hernia width, body mass index, age, ASA, and mesh location. Data were analyzed to identify differences in SSO, SSI, SSOPI, and recurrence at 30 days. RESULTS 9038 patients were identified. After propensity matching, 1766 patients were included in the study population. Patients with SGM had similar demographic and clinical characteristics compared to NSGM. The mean hernia width to mesh width ratio was 8 cm:18 cm with NSGM and 7 cm:15 cm with SGM (p = 0.63). There was no difference in 30-day rates of recurrence, SSI or SSO. The rate of SSOPI was also found to be 5.4% in the nonself-gripping group compared to 3.1% in the self-gripping mesh group (p < .005). There was no difference in patient-reported outcomes at 30 days. CONCLUSIONS In patients undergoing ventral hernia repair with mesh, self-gripping mesh is a safe type of mesh to use. Use of self-gripping mesh may be associated with lower rates of SSOPI when compared to nonself-gripping mesh.
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Affiliation(s)
- Anoosh Bahraini
- University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27514, USA
| | - Justin Hsu
- University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27514, USA
| | - Steven Cochran
- University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27514, USA
| | - Shannelle Campbell
- University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27514, USA
| | - David Wayne Overby
- University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27514, USA
| | | | | | - Arielle Perez
- University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27514, USA.
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Melland-Smith M, Zheng X, Messer N, Beffa L, Petro C, Prabhu A, Krpata D, Rosen M, Miller B. Epidural analgesia and post-operative ileus after incisional hernia repair with transversus abdominis release: Results of a 5-year quality improvement initiative. Am J Surg 2024; 230:30-34. [PMID: 38000938 DOI: 10.1016/j.amjsurg.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/06/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023]
Abstract
INTRODUCTION The optimal pain management strategy after open ventral hernia repair (VHR) with transversus abdominus release (TAR) is unknown. Opioids are known to have an inhibitory effect on the GI tract and cause postoperative ileus. Epidural analgesia is associated with lower postoperative ileus rates but may contribute to other postoperative complications. A propensity-matched retrospective review published by our group in 2018 found that epidural analgesia was associated with an increased length of stay and any postoperative complication after VHR. Epidural analgesia was therefore abandoned by our group following this publication. We aimed to determine if discontinuation of epidural analgesia affected ileus rates after open VHR. METHODS Patients who underwent open VHR with TAR from August 2014 to January 2022 at Cleveland Clinic Foundation with at least 30-day follow-up were retrospectively identified using the Abdominal Core Health Quality Collaborative registry. Patients with and without epidural analgesia were compared. The primary outcome was post-operative ileus. Additional outcomes included length of stay, deep venous thrombosis (DVT), pneumonia, wound complications and pain requiring intervention. RESULTS A total of 2570 patients were included: 420 had an epidural, 2150 did not. Preoperative patient and hernia characteristics were similar between both groups. Mean hernia width was 15.5 cm in the epidural group and 16.1 cm in the no epidural group. In the epidural group, ileus was seen in 9 of 420 (2.15%) of patients which was significantly less than in the no epidural group, 400 of 2150 (18.6%), p=>0.001. On multivariate analysis, epidurals were predictive of lower risk of ileus (OR 0.04, 95%CI 0.01-0.17, p = 0.001) and pain requiring intervention (OR 0.02, 95%CI 0.00-0.71, p = 0.02). Epidural analgesia was not associated with increased DVT rates, pneumonia, length of stay, SSI, or SSOPI. DISCUSSION Discontinuation of epidural analgesia was associated with a 9-fold increase in ileus rates after VHR with TAR. Epidurals may play an important role in limiting postoperative opioid use and therefore reducing risk of ileus. Other postoperative complications including pneumonia and venous thrombosis were not impacted by epidurals. Further prospective studies are needed to further define a ventral hernia patient population who will benefit from epidural analgesia.
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Affiliation(s)
- Megan Melland-Smith
- Cleveland Clinic Foundation, Center for Abdominal Core Health, Department of General Surgery, Cleveland, OH, USA.
| | | | - Nir Messer
- Cleveland Clinic Foundation, Center for Abdominal Core Health, Department of General Surgery, Cleveland, OH, USA
| | - Lucas Beffa
- Cleveland Clinic Foundation, Center for Abdominal Core Health, Department of General Surgery, Cleveland, OH, USA
| | - Clayton Petro
- Cleveland Clinic Foundation, Center for Abdominal Core Health, Department of General Surgery, Cleveland, OH, USA
| | - Ajita Prabhu
- Cleveland Clinic Foundation, Center for Abdominal Core Health, Department of General Surgery, Cleveland, OH, USA
| | - David Krpata
- Cleveland Clinic Foundation, Center for Abdominal Core Health, Department of General Surgery, Cleveland, OH, USA
| | - Michael Rosen
- Cleveland Clinic Foundation, Center for Abdominal Core Health, Department of General Surgery, Cleveland, OH, USA
| | - Benjamin Miller
- Cleveland Clinic Foundation, Center for Abdominal Core Health, Department of General Surgery, Cleveland, OH, USA
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Maskal S, Chang J, Ellis R, Messer N, Melland-Smith M, Tu C, Miller B, Petro C, Simon R, Prabhu A, Rosen M, Beffa L. Abdominal wall mass resections: single-center closure practices and outcomes following oncologic resections of abdominal wall fascia. Hernia 2024; 28:457-464. [PMID: 38062203 DOI: 10.1007/s10029-023-02928-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/05/2023] [Indexed: 04/06/2024]
Abstract
PURPOSE Radical resections for abdominal wall tumors are rare, thus yielding limited data on reconstruction of defects. We describe surgical management and long-term outcomes following radical tumor resection. METHODS This was a single-center retrospective review of patients between January 2010 and December 2022. Variables included operative characteristics, wound complications, hernia development, tumor recurrence, and reoperation. A multivariable analysis compared wound morbidity for suture and mesh repairs while adjusting for defect width, fascial closure, and CDC wound class. RESULTS 120 patients were identified. Mean follow-up was 3.9 ± 3.4 years. Seventy-five (62.5%) of the masses were primary; most commonly desmoid (n = 25) and endometrioma (n = 27). Forty-five masses were metastases. Mean tumor width was 6.2 ± 3.4 cm; mean defect width was 8.1 ± 4.1 cm. Sixty-one patients (50.8%) had mesh placed, with variation in technique. Postoperative CT scans were available for 88 (73.3%) patients. Forty SSOs (33.3%), 11 SSIs (9.2%), and 18 (15%) SSOPIs occurred within 30 days. On multivariable analysis, increased defect width was associated with SSOPI (OR 1.17, p = 0.041) and CDC wound class II-III was associated with SSI (OR 8.38 and 49.1, p < 0.05) and SSOPI (OR 5.77 and 17.4, p < 0.05); mesh was not associated with these outcomes. Seven patients (5.8%) underwent 30-day reoperations and 35 (20.8%) required additional operations after 30 days. Thirteen percent developed abdominal wall (n = 8) or intra-abdominal tumor recurrence (n = 8) requiring reoperation. Twenty-seven (22.5%) patients developed hernias with a mean fascial defect width of 9.8 ± 7.2 cm. CONCLUSION Abdominal wall mass resections are morbid, often contaminated cases with high postoperative complication rates. Risks and benefits of mesh implantation should be tailored on an individual basis.
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Affiliation(s)
- S Maskal
- Department of Surgery, Cleveland Clinic, 2049 E 100th St, A-100, Cleveland, OH, 44106, USA.
| | - J Chang
- Department of Surgery, Cleveland Clinic, 2049 E 100th St, A-100, Cleveland, OH, 44106, USA
| | - R Ellis
- Department of Surgery, Cleveland Clinic, 2049 E 100th St, A-100, Cleveland, OH, 44106, USA
| | - N Messer
- Department of Surgery, Cleveland Clinic, 2049 E 100th St, A-100, Cleveland, OH, 44106, USA
| | - M Melland-Smith
- Department of Surgery, Cleveland Clinic, 2049 E 100th St, A-100, Cleveland, OH, 44106, USA
| | - C Tu
- Department of Surgery, Cleveland Clinic, 2049 E 100th St, A-100, Cleveland, OH, 44106, USA
| | - B Miller
- Department of Surgery, Cleveland Clinic, 2049 E 100th St, A-100, Cleveland, OH, 44106, USA
| | - C Petro
- Department of Surgery, Cleveland Clinic, 2049 E 100th St, A-100, Cleveland, OH, 44106, USA
| | - R Simon
- Department of Surgery, Cleveland Clinic, 2049 E 100th St, A-100, Cleveland, OH, 44106, USA
| | - A Prabhu
- Department of Surgery, Cleveland Clinic, 2049 E 100th St, A-100, Cleveland, OH, 44106, USA
| | - M Rosen
- Department of Surgery, Cleveland Clinic, 2049 E 100th St, A-100, Cleveland, OH, 44106, USA
| | - L Beffa
- Department of Surgery, Cleveland Clinic, 2049 E 100th St, A-100, Cleveland, OH, 44106, USA
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Chang JH, Essani V, Maskal SM, Brooks NE, Lee EH, Prabhu A, Lum SS, Walsh RM. Paving a Path to Gender Parity: Recent Trends in Participation of Women in an Academic Surgery Society (Society for Surgery of the Alimentary Tract). J Gastrointest Surg 2023; 27:2705-2710. [PMID: 37907815 DOI: 10.1007/s11605-023-05865-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/07/2023] [Indexed: 11/02/2023]
Abstract
INTRODUCTION The proportion of women surgeons is increasing, although women in surgical leadership and research has not kept pace. The Society for Surgery of the Alimentary Tract (SSAT) pledged its commitment to diversity and inclusion in 2016. Our study sought to evaluate the temporal trend of gender representation in leadership, speakership, and research at SSAT. METHODS Publicly available SSAT meeting programs from 2010 to 2022 were reviewed to assess gender proportions within leadership positions (officers and committee chairs); invited speakerships, multidisciplinary symposia, and committee panel session moderators and speakers; and contributions to scientific sessions (moderator, first author and senior author). Verified individual professional profiles were analyzed to categorize gender as woman, man, or unavailable. Descriptive and trend analyses using linear regression and chi-squared testing were performed. RESULTS A total of 5506 individuals were reviewed; 1178 (21.4%) were identified as women and 4328 (78.6%) as men or did not have available data. The absolute proportion of total female participation increased by 1.05% per year (R2=0.82). There was a statistically significant difference in the total proportion of women participation before and after 2016 (18.5% vs. 27.1%, p<0.01). Increases in the proportion of women were demonstrated in leadership, invited speakerships, multidisciplinary symposia, committee panel sessions, research session moderators, and abstract first authors. The proportion of women senior authors remained stagnant. CONCLUSION Though this upward trajectory in SSAT women participation is encouraging, current trends predict that gender parity will not be reached until 2044.
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Affiliation(s)
- Jenny H Chang
- Department of General Surgery, Cleveland Clinic, Digestive Diseases and Surgery Institution, 9500 Euclid Ave A100, Cleveland, OH, 44195, USA.
| | - Varisha Essani
- Case Western Reserve University, School of Medicine, Cleveland, OH, USA
| | - Sara M Maskal
- Department of General Surgery, Cleveland Clinic, Digestive Diseases and Surgery Institution, 9500 Euclid Ave A100, Cleveland, OH, 44195, USA
| | - Nicole E Brooks
- Department of General Surgery, Cleveland Clinic, Digestive Diseases and Surgery Institution, 9500 Euclid Ave A100, Cleveland, OH, 44195, USA
| | - Edward H Lee
- Cleveland Clinic, Cole Eye Institute, Cleveland, OH, USA
| | - Ajita Prabhu
- Department of General Surgery, Cleveland Clinic, Digestive Diseases and Surgery Institution, 9500 Euclid Ave A100, Cleveland, OH, 44195, USA
| | - Sharon S Lum
- Department of Surgery, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - R Matthew Walsh
- Department of General Surgery, Cleveland Clinic, Digestive Diseases and Surgery Institution, 9500 Euclid Ave A100, Cleveland, OH, 44195, USA
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Ellis R, Maskal S, Prabhu A, Petro C, Beffa L, Rosen M, Miller B, Krpata D. Surgical approaches for core abdominal injuries: a review of the Abdominal Core Health Quality Collaborative database. Surg Endosc 2023; 37:8799-8803. [PMID: 37592045 DOI: 10.1007/s00464-023-10350-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/30/2023] [Indexed: 08/19/2023]
Abstract
INTRODUCTION Core abdominal injury (CAI) is a broad term that describes injuries resulting from repetitive loading of the pubis that leads to inflammation, rupture, or destabilization of the core muscles from the pubic bone. There is no clear recommendation on the surgical approach to CAI. We aimed to describe how hernia surgeons within the Abdominal Core Health Quality Collaborative (ACHQC) address this problem surgically and the short-term outcomes. METHODS We queried the ACHQC registry for patients undergoing surgery for isolated CAI and concomitant inguinal hernias (IH) and CAI. Operative approach and quality of life (using EuraHS survey scores) was abstracted. RESULTS A total of 29,451 patients underwent surgery for IHs, CAIs, or both within the registry. Twenty patients underwent surgery for isolated CAI (median age 29, 90% males). Eleven patients (55%) underwent surgery with mesh (four Lichtenstein, three TAPP, and four TEP). Nine patients (45%) underwent tissue-based repairs (four closure of floor, one Bassini, one McVay, one Shouldice, one femoral exploration, and one laparoscopic-to-open conversion). There were no postoperative complications or reoperations within 30 days. EuraHS scores showed improvement at 30 days from baseline (median 29 [6.75-41.75] from 42 [29.42-57.61]). Sixty patients had both IHs and CAIs (median age 31, 97% males). All patients received mesh. Thirty-one patients (52%) underwent open surgery (23 Lichtenstein, 1 plug, 7 TREPP) and 29 underwent minimally invasive repairs (23 TAPP, 6 TEP). There was one seroma at 30 days. EuraHS scores showed improvement at 30 days from baseline (median 16 [5.17-27.33] from 37.5 [26.44-46.58]). CONCLUSIONS Despite technical variability, CAIs with or without concomitant IH generally undergo operations commonly used for IH repairs. Within our series, there was inconsistency with approach and mesh placement. Future work should be focused on standardizing the approach to CAI and capturing long-term data within the ACHQC.
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Affiliation(s)
- Ryan Ellis
- Cleveland Clinic Center for Abdominal Core Health, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
| | - Sara Maskal
- Cleveland Clinic Center for Abdominal Core Health, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Ajita Prabhu
- Cleveland Clinic Center for Abdominal Core Health, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Clayton Petro
- Cleveland Clinic Center for Abdominal Core Health, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Lucas Beffa
- Cleveland Clinic Center for Abdominal Core Health, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Michael Rosen
- Cleveland Clinic Center for Abdominal Core Health, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Benjamin Miller
- Cleveland Clinic Center for Abdominal Core Health, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - David Krpata
- Cleveland Clinic Center for Abdominal Core Health, 9500 Euclid Ave, Cleveland, OH, 44195, USA
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Raman B, McCracken C, Cassar MP, Moss AJ, Finnigan L, Samat AHA, Ogbole G, Tunnicliffe EM, Alfaro-Almagro F, Menke R, Xie C, Gleeson F, Lukaschuk E, Lamlum H, McGlynn K, Popescu IA, Sanders ZB, Saunders LC, Piechnik SK, Ferreira VM, Nikolaidou C, Rahman NM, Ho LP, Harris VC, Shikotra A, Singapuri A, Pfeffer P, Manisty C, Kon OM, Beggs M, O'Regan DP, Fuld J, Weir-McCall JR, Parekh D, Steeds R, Poinasamy K, Cuthbertson DJ, Kemp GJ, Semple MG, Horsley A, Miller CA, O'Brien C, Shah AM, Chiribiri A, Leavy OC, Richardson M, Elneima O, McAuley HJC, Sereno M, Saunders RM, Houchen-Wolloff L, Greening NJ, Bolton CE, Brown JS, Choudhury G, Diar Bakerly N, Easom N, Echevarria C, Marks M, Hurst JR, Jones MG, Wootton DG, Chalder T, Davies MJ, De Soyza A, Geddes JR, Greenhalf W, Howard LS, Jacob J, Man WDC, Openshaw PJM, Porter JC, Rowland MJ, Scott JT, Singh SJ, Thomas DC, Toshner M, Lewis KE, Heaney LG, Harrison EM, Kerr S, Docherty AB, Lone NI, Quint J, Sheikh A, Zheng B, Jenkins RG, Cox E, Francis S, Halling-Brown M, Chalmers JD, Greenwood JP, Plein S, Hughes PJC, Thompson AAR, Rowland-Jones SL, Wild JM, Kelly M, Treibel TA, Bandula S, Aul R, Miller K, Jezzard P, Smith S, Nichols TE, McCann GP, Evans RA, Wain LV, Brightling CE, Neubauer S, Baillie JK, Shaw A, Hairsine B, Kurasz C, Henson H, Armstrong L, Shenton L, Dobson H, Dell A, Lucey A, Price A, Storrie A, Pennington C, Price C, Mallison G, Willis G, Nassa H, Haworth J, Hoare M, Hawkings N, Fairbairn S, Young S, Walker S, Jarrold I, Sanderson A, David C, Chong-James K, Zongo O, James WY, Martineau A, King B, Armour C, McAulay D, Major E, McGinness J, McGarvey L, Magee N, Stone R, Drain S, Craig T, Bolger A, Haggar A, Lloyd A, Subbe C, Menzies D, Southern D, McIvor E, Roberts K, Manley R, Whitehead V, Saxon W, Bularga A, Mills NL, El-Taweel H, Dawson J, Robinson L, Saralaya D, Regan K, Storton K, Brear L, Amoils S, Bermperi A, Elmer A, Ribeiro C, Cruz I, Taylor J, Worsley J, Dempsey K, Watson L, Jose S, Marciniak S, Parkes M, McQueen A, Oliver C, Williams J, Paradowski K, Broad L, Knibbs L, Haynes M, Sabit R, Milligan L, Sampson C, Hancock A, Evenden C, Lynch C, Hancock K, Roche L, Rees M, Stroud N, Thomas-Woods T, Heller S, Robertson E, Young B, Wassall H, Babores M, Holland M, Keenan N, Shashaa S, Price C, Beranova E, Ramos H, Weston H, Deery J, Austin L, Solly R, Turney S, Cosier T, Hazelton T, Ralser M, Wilson A, Pearce L, Pugmire S, Stoker W, McCormick W, Dewar A, Arbane G, Kaltsakas G, Kerslake H, Rossdale J, Bisnauthsing K, Aguilar Jimenez LA, Martinez LM, Ostermann M, Magtoto MM, Hart N, Marino P, Betts S, Solano TS, Arias AM, Prabhu A, Reed A, Wrey Brown C, Griffin D, Bevan E, Martin J, Owen J, Alvarez Corral M, Williams N, Payne S, Storrar W, Layton A, Lawson C, Mills C, Featherstone J, Stephenson L, Burdett T, Ellis Y, Richards A, Wright C, Sykes DL, Brindle K, Drury K, Holdsworth L, Crooks MG, Atkin P, Flockton R, Thackray-Nocera S, Mohamed A, Taylor A, Perkins E, Ross G, McGuinness H, Tench H, Phipps J, Loosley R, Wolf-Roberts R, Coetzee S, Omar Z, Ross A, Card B, Carr C, King C, Wood C, Copeland D, Calvelo E, Chilvers ER, Russell E, Gordon H, Nunag JL, Schronce J, March K, Samuel K, Burden L, Evison L, McLeavey L, Orriss-Dib L, Tarusan L, Mariveles M, Roy M, Mohamed N, Simpson N, Yasmin N, Cullinan P, Daly P, Haq S, Moriera S, Fayzan T, Munawar U, Nwanguma U, Lingford-Hughes A, Altmann D, Johnston D, Mitchell J, Valabhji J, Price L, Molyneaux PL, Thwaites RS, Walsh S, Frankel A, Lightstone L, Wilkins M, Willicombe M, McAdoo S, Touyz R, Guerdette AM, Warwick K, Hewitt M, Reddy R, White S, McMahon A, Hoare A, Knighton A, Ramos A, Te A, Jolley CJ, Speranza F, Assefa-Kebede H, Peralta I, Breeze J, Shevket K, Powell N, Adeyemi O, Dulawan P, Adrego R, Byrne S, Patale S, Hayday A, Malim M, Pariante C, Sharpe C, Whitney J, Bramham K, Ismail K, Wessely S, Nicholson T, Ashworth A, Humphries A, Tan AL, Whittam B, Coupland C, Favager C, Peckham D, Wade E, Saalmink G, Clarke J, Glossop J, Murira J, Rangeley J, Woods J, Hall L, Dalton M, Window N, Beirne P, Hardy T, Coakley G, Turtle L, Berridge A, Cross A, Key AL, Rowe A, Allt AM, Mears C, Malein F, Madzamba G, Hardwick HE, Earley J, Hawkes J, Pratt J, Wyles J, Tripp KA, Hainey K, Allerton L, Lavelle-Langham L, Melling L, Wajero LO, Poll L, Noonan MJ, French N, Lewis-Burke N, Williams-Howard SA, Cooper S, Kaprowska S, Dobson SL, Marsh S, Highett V, Shaw V, Beadsworth M, Defres S, Watson E, Tiongson GF, Papineni P, Gurram S, Diwanji SN, Quaid S, Briggs A, Hastie C, Rogers N, Stensel D, Bishop L, McIvor K, Rivera-Ortega P, Al-Sheklly B, Avram C, Faluyi D, Blaikely J, Piper Hanley K, Radhakrishnan K, Buch M, Hanley NA, Odell N, Osbourne R, Stockdale S, Felton T, Gorsuch T, Hussell T, Kausar Z, Kabir T, McAllister-Williams H, Paddick S, Burn D, Ayoub A, Greenhalgh A, Sayer A, Young A, Price D, Burns G, MacGowan G, Fisher H, Tedd H, Simpson J, Jiwa K, Witham M, Hogarth P, West S, Wright S, McMahon MJ, Neill P, Dougherty A, Morrow A, Anderson D, Grieve D, Bayes H, Fallon K, Mangion K, Gilmour L, Basu N, Sykes R, Berry C, McInnes IB, Donaldson A, Sage EK, Barrett F, Welsh B, Bell M, Quigley J, Leitch K, Macliver L, Patel M, Hamil R, Deans A, Furniss J, Clohisey S, Elliott A, Solstice AR, Deas C, Tee C, Connell D, Sutherland D, George J, Mohammed S, Bunker J, Holmes K, Dipper A, Morley A, Arnold D, Adamali H, Welch H, Morrison L, Stadon L, Maskell N, Barratt S, Dunn S, Waterson S, Jayaraman B, Light T, Selby N, Hosseini A, Shaw K, Almeida P, Needham R, Thomas AK, Matthews L, Gupta A, Nikolaidis A, Dupont C, Bonnington J, Chrystal M, Greenhaff PL, Linford S, Prosper S, Jang W, Alamoudi A, Bloss A, Megson C, Nicoll D, Fraser E, Pacpaco E, Conneh F, Ogg G, McShane H, Koychev I, Chen J, Pimm J, Ainsworth M, Pavlides M, Sharpe M, Havinden-Williams M, Petousi N, Talbot N, Carter P, Kurupati P, Dong T, Peng Y, Burns A, Kanellakis N, Korszun A, Connolly B, Busby J, Peto T, Patel B, Nolan CM, Cristiano D, Walsh JA, Liyanage K, Gummadi M, Dormand N, Polgar O, George P, Barker RE, Patel S, Price L, Gibbons M, Matila D, Jarvis H, Lim L, Olaosebikan O, Ahmad S, Brill S, Mandal S, Laing C, Michael A, Reddy A, Johnson C, Baxendale H, Parfrey H, Mackie J, Newman J, Pack J, Parmar J, Paques K, Garner L, Harvey A, Summersgill C, Holgate D, Hardy E, Oxton J, Pendlebury J, McMorrow L, Mairs N, Majeed N, Dark P, Ugwuoke R, Knight S, Whittaker S, Strong-Sheldrake S, Matimba-Mupaya W, Chowienczyk P, Pattenadk D, Hurditch E, Chan F, Carborn H, Foot H, Bagshaw J, Hockridge J, Sidebottom J, Lee JH, Birchall K, Turner K, Haslam L, Holt L, Milner L, Begum M, Marshall M, Steele N, Tinker N, Ravencroft P, Butcher R, Misra S, Walker S, Coburn Z, Fairman A, Ford A, Holbourn A, Howell A, Lawrie A, Lye A, Mbuyisa A, Zawia A, Holroyd-Hind B, Thamu B, Clark C, Jarman C, Norman C, Roddis C, Foote D, Lee E, Ilyas F, Stephens G, Newell H, Turton H, Macharia I, Wilson I, Cole J, McNeill J, Meiring J, Rodger J, Watson J, Chapman K, Harrington K, Chetham L, Hesselden L, Nwafor L, Dixon M, Plowright M, Wade P, Gregory R, Lenagh R, Stimpson R, Megson S, Newman T, Cheng Y, Goodwin C, Heeley C, Sissons D, Sowter D, Gregory H, Wynter I, Hutchinson J, Kirk J, Bennett K, Slack K, Allsop L, Holloway L, Flynn M, Gill M, Greatorex M, Holmes M, Buckley P, Shelton S, Turner S, Sewell TA, Whitworth V, Lovegrove W, Tomlinson J, Warburton L, Painter S, Vickers C, Redwood D, Tilley J, Palmer S, Wainwright T, Breen G, Hotopf M, Dunleavy A, Teixeira J, Ali M, Mencias M, Msimanga N, Siddique S, Samakomva T, Tavoukjian V, Forton D, Ahmed R, Cook A, Thaivalappil F, Connor L, Rees T, McNarry M, Williams N, McCormick J, McIntosh J, Vere J, Coulding M, Kilroy S, Turner V, Butt AT, Savill H, Fraile E, Ugoji J, Landers G, Lota H, Portukhay S, Nasseri M, Daniels A, Hormis A, Ingham J, Zeidan L, Osborne L, Chablani M, Banerjee A, David A, Pakzad A, Rangelov B, Williams B, Denneny E, Willoughby J, Xu M, Mehta P, Batterham R, Bell R, Aslani S, Lilaonitkul W, Checkley A, Bang D, Basire D, Lomas D, Wall E, Plant H, Roy K, Heightman M, Lipman M, Merida Morillas M, Ahwireng N, Chambers RC, Jastrub R, Logan S, Hillman T, Botkai A, Casey A, Neal A, Newton-Cox A, Cooper B, Atkin C, McGee C, Welch C, Wilson D, Sapey E, Qureshi H, Hazeldine J, Lord JM, Nyaboko J, Short J, Stockley J, Dasgin J, Draxlbauer K, Isaacs K, Mcgee K, Yip KP, Ratcliffe L, Bates M, Ventura M, Ahmad Haider N, Gautam N, Baggott R, Holden S, Madathil S, Walder S, Yasmin S, Hiwot T, Jackson T, Soulsby T, Kamwa V, Peterkin Z, Suleiman Z, Chaudhuri N, Wheeler H, Djukanovic R, Samuel R, Sass T, Wallis T, Marshall B, Childs C, Marouzet E, Harvey M, Fletcher S, Dickens C, Beckett P, Nanda U, Daynes E, Charalambou A, Yousuf AJ, Lea A, Prickett A, Gooptu B, Hargadon B, Bourne C, Christie C, Edwardson C, Lee D, Baldry E, Stringer E, Woodhead F, Mills G, Arnold H, Aung H, Qureshi IN, Finch J, Skeemer J, Hadley K, Khunti K, Carr L, Ingram L, Aljaroof M, Bakali M, Bakau M, Baldwin M, Bourne M, Pareek M, Soares M, Tobin M, Armstrong N, Brunskill N, Goodman N, Cairns P, Haldar P, McCourt P, Dowling R, Russell R, Diver S, Edwards S, Glover S, Parker S, Siddiqui S, Ward TJC, Mcnally T, Thornton T, Yates T, Ibrahim W, Monteiro W, Thickett D, Wilkinson D, Broome M, McArdle P, Upthegrove R, Wraith D, Langenberg C, Summers C, Bullmore E, Heeney JL, Schwaeble W, Sudlow CL, Adeloye D, Newby DE, Rudan I, Shankar-Hari M, Thorpe M, Pius R, Walmsley S, McGovern A, Ballard C, Allan L, Dennis J, Cavanagh J, Petrie J, O'Donnell K, Spears M, Sattar N, MacDonald S, Guthrie E, Henderson M, Guillen Guio B, Zhao B, Lawson C, Overton C, Taylor C, Tong C, Mukaetova-Ladinska E, Turner E, Pearl JE, Sargant J, Wormleighton J, Bingham M, Sharma M, Steiner M, Samani N, Novotny P, Free R, Allen RJ, Finney S, Terry S, Brugha T, Plekhanova T, McArdle A, Vinson B, Spencer LG, Reynolds W, Ashworth M, Deakin B, Chinoy H, Abel K, Harvie M, Stanel S, Rostron A, Coleman C, Baguley D, Hufton E, Khan F, Hall I, Stewart I, Fabbri L, Wright L, Kitterick P, Morriss R, Johnson S, Bates A, Antoniades C, Clark D, Bhui K, Channon KM, Motohashi K, Sigfrid L, Husain M, Webster M, Fu X, Li X, Kingham L, Klenerman P, Miiler K, Carson G, Simons G, Huneke N, Calder PC, Baldwin D, Bain S, Lasserson D, Daines L, Bright E, Stern M, Crisp P, Dharmagunawardena R, Reddington A, Wight A, Bailey L, Ashish A, Robinson E, Cooper J, Broadley A, Turnbull A, Brookes C, Sarginson C, Ionita D, Redfearn H, Elliott K, Barman L, Griffiths L, Guy Z, Gill R, Nathu R, Harris E, Moss P, Finnigan J, Saunders K, Saunders P, Kon S, Kon SS, O'Brien L, Shah K, Shah P, Richardson E, Brown V, Brown M, Brown J, Brown J, Brown A, Brown A, Brown M, Choudhury N, Jones S, Jones H, Jones L, Jones I, Jones G, Jones H, Jones D, Davies F, Davies E, Davies K, Davies G, Davies GA, Howard K, Porter J, Rowland J, Rowland A, Scott K, Singh S, Singh C, Thomas S, Thomas C, Lewis V, Lewis J, Lewis D, Harrison P, Francis C, Francis R, Hughes RA, Hughes J, Hughes AD, Thompson T, Kelly S, Smith D, Smith N, Smith A, Smith J, Smith L, Smith S, Evans T, Evans RI, Evans D, Evans R, Evans H, Evans J. Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study. Lancet Respir Med 2023; 11:1003-1019. [PMID: 37748493 PMCID: PMC7615263 DOI: 10.1016/s2213-2600(23)00262-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/16/2023] [Accepted: 06/30/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. METHODS In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. FINDINGS Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2-6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5-5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4-10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32-4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23-11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. INTERPRETATION After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification. FUNDING UK Research and Innovation and National Institute for Health Research.
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Nanayakkara KDL, Viswanath NG, Wilson M, Mahawar K, Baig S, Rosenberg J, Rosen M, Sheen AJ, Goodman E, Prabhu A, Madhok B. An international survey of 1014 hernia surgeons: outcome of GLACIER (global practice of inguinal hernia repair) study. Hernia 2023; 27:1235-1243. [PMID: 37310493 DOI: 10.1007/s10029-023-02818-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 06/04/2023] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The practice of inguinal hernia repair varies internationally. The global practice of inguinal hernia repair study (GLACIER) aimed to capture these variations in open, laparoscopic, and robotic inguinal hernia repair. METHODS A questionnaire-based survey was created on a web-based platform, and the link was shared on various social media platforms, personal e-mail network of authors, and e-mails to members of the endorsed organisations, which include British Hernia Society (BHS), The Upper Gastrointestinal Surgical Society (TUGSS), and Abdominal Core Health Quality Collaborative (ACHQC). RESULTS A total of 1014 surgeons from 81 countries completed the survey. Open and laparoscopic approaches were preferred by 43% and 47% of participants, respectively. Transabdominal pre-peritoneal repair (TAPP) was the favoured minimally invasive approach. Bilateral and recurrent hernia following previous open repair were the most common indications for a minimally invasive procedure. Ninety-eight percent of the surgeons preferred repair with a mesh, and synthetic monofilament lightweight mesh with large pores was the most common choice. Lichtenstein repair was the most favoured open mesh repair technique (90%), while Shouldice repair was the favoured non-mesh repair technique. The risk of chronic groin pain was quoted as 5% after open repair and 1% after minimally invasive repair. Only 10% of surgeons preferred to perform an open repair using local anaesthesia. CONCLUSION This survey identified similarities and variations in practice internationally and some discrepancies in inguinal hernia repair compared to best practice guidelines, such as low rates of repair using local anaesthesia and the use of lightweight mesh for minimally invasive repair. It also identifies several key areas for future research, such as incidence, risk factors, and management of chronic groin pain after hernia surgery and the clinical and cost-effectiveness of robotic hernia surgery.
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Affiliation(s)
- K D L Nanayakkara
- Royal Derby Hospital, University Hospital Derby and Burton NHS Trust, Derby, UK.
| | - N G Viswanath
- Royal Derby Hospital, University Hospital Derby and Burton NHS Trust, Derby, UK
| | - M Wilson
- Forth Valley NHS Trust, Larbert, UK
| | - K Mahawar
- South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - S Baig
- Belle Vue Hospital, Kolkata, India
| | - J Rosenberg
- Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - M Rosen
- Cleveland Clinic, Cleveland, USA
| | - A J Sheen
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | - A Prabhu
- Cleveland Clinic, Cleveland, USA
| | - B Madhok
- Royal Derby Hospital, University Hospital Derby and Burton NHS Trust, Derby, UK
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Malinger G, Prabhu A, Maroto González A, Brusilov M, Kidron D, Amster R, Birnbaum R, Krajden Haratz K. Fetal neurosonography as accurate tool for diagnosis of brain involvement in tuberous sclerosis. Ultrasound Obstet Gynecol 2023; 62:391-397. [PMID: 37021742 DOI: 10.1002/uog.26213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE To demonstrate the potential utility of dedicated neurosonography for the diagnosis of fetal brain involvement in tuberous sclerosis complex. METHODS This was a multicenter retrospective study of fetuses at high risk for tuberous sclerosis complex. Dedicated neurosonographic, fetal magnetic resonance imaging (MRI) and postnatal reports were reviewed. Data collected included reason for referral, gestational age at which cardiac rhabdomyoma was first suspected and final number of cardiac rhabdomyomas detected on dedicated imaging. We searched for tuberous sclerosis complex-related brain involvement, defined as the presence of one or more of the following findings: white-matter lesions; subependymal nodules; cortical/subcortical tubers; and subependymal giant-cell astrocytoma. RESULTS We included 20 patients at high risk of tuberous sclerosis complex, of whom 19 were referred for the presence of cardiac rhabdomyomas and one for a deletion in chromosome 16 involving the tuberous sclerosis complex gene locus. Cardiac rhabdomyomas were diagnosed at a mean gestational age of 27 + 2 weeks (range, 16 + 0 to 36 + 3 weeks) and the mean number of cardiac rhabdomyomas per patient was 4 (range, 1-10). Brain involvement was present in 15 fetuses, in 13 of which the disease was confirmed in one or more of the following ways: chromosomal microarray analysis (n = 1), exome sequencing (n = 7), autopsy (n = 4), clinical tuberous sclerosis complex in the newborn (n = 4) and a sibling diagnosed with clinical tuberous sclerosis complex (n = 1). In two cases, the disease could not be confirmed: one was lost to follow-up and autopsy, following termination of pregnancy, was not performed in the other. Among the five cases without brain findings, tuberous sclerosis complex was confirmed in three by exome sequencing (n = 2) and/or autopsy findings (n = 2). The two remaining cases had normal exome sequencing; one case had five cardiac rhabdomyomas, which was a highly suggestive finding, while in the final case, the autopsy was considered normal, representing the only false-positive case in our cohort. CONCLUSIONS Contrary to current literature, dedicated neurosonography appears to be effective in the diagnosis of brain involvement in fetuses at risk of tuberous sclerosis complex and should be used as the first-line approach. Although the number of cases in which MRI was performed was small, it seems that, in the presence of ultrasound findings, the added value of MRI is low. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- G Malinger
- Obstetrics and Gynecology Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Prabhu
- Apollo Center for Fetal Medicine, Indraprashta Apollo Hospitals, New Delhi, India
| | | | - M Brusilov
- Obstetrics and Gynecology Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - D Kidron
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pathology, Sapir Medical Center, Kfar Saba, Israel
| | - R Amster
- Obstetrics and Gynecology Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Birnbaum
- Obstetrics and Gynecology Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - K Krajden Haratz
- Obstetrics and Gynecology Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Melland-Smith M, Miller B, Petro C, Beffa L, Prabhu A, Krpata D, LaBelle M, Tamer R, Rosen M. Single-staged retromuscular abdominal wall reconstruction with mesh at the time of ostomy reversal: are we crossing the line? An ACHQC Analysis. Surg Endosc 2023; 37:7051-7059. [PMID: 37353652 DOI: 10.1007/s00464-023-10176-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 05/30/2023] [Indexed: 06/25/2023]
Abstract
INTRODUCTION The most appropriate method of reconstructing the abdominal wall at the site of a simultaneous stoma takedown is controversial. The contaminated field, concomitant GI procedure being performed and presence of a hernia all complicate decision-making. We sought to describe the surgical approaches, mesh type and outcomes of concomitant abdominal wall reconstruction during stoma takedown in a large hernia registry. METHODS AND PROCEDURES All patients who underwent stoma takedown with simultaneous hernia repair with retromuscular mesh placement from January 2014 to May 2022 were identified within the Abdominal Core Health Quality Collaborative (ACHQC). Patients were stratified by mesh type including permanent synthetic (PS), resorbable synthetic (RS) and biologic mesh. Association of mesh type with 30-day wound events and other complications and 1-year outcomes were evaluated. RESULTS There were 368 patients who met inclusion criteria. Eighty-nine patients had ileostomies, 276 colostomies and 3 had both. Two hundred and seventy-nine (75.8%) patients received PS mesh, 46 (12.5%) biologic, and 43 (11.7%) RS. Seventy percent (259/368) had a parastomal hernia, 75% (285/368) had a midline incisional hernia, and 48% (178/368) had both. All groups had similar preoperative comorbidities and the majority had a transversus abdominus release. All mesh groups had similar thirty-day SSI (13.2-14.3%), SSO (10.5-17.8%) and SSOPI (7.9-14.1%), p = 0.6. Three patients with PS mesh developed infected synthetic mesh and one PS mesh required excision. Four patients with PS developed an enterocutaneous fistula. Of these, only one patient was recorded as having both an enterocutaneous fistula and mesh infection. Thirty-day reoperation and readmission were similar across all mesh groups. Recurrence at 1-year was similar between mesh groups. Quality of life measured using HerQLes scores were higher at one year compared to baseline in all groups indicating improvement in hernia-specific quality of life. CONCLUSION Early complication rates associated with simultaneous stoma takedown and abdominal wall reconstruction are significant, regardless of mesh type utilized. Concomitant surgery should be weighed heavily and tailored to individual patients.
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Affiliation(s)
- Megan Melland-Smith
- Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Digestive Disease and Surgery Institute, 9500 Euclid Ave, Crile Building, 10th Floor, Cleveland, OH, USA.
| | - Benjamin Miller
- Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Digestive Disease and Surgery Institute, 9500 Euclid Ave, Crile Building, 10th Floor, Cleveland, OH, USA
| | - Clayton Petro
- Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Digestive Disease and Surgery Institute, 9500 Euclid Ave, Crile Building, 10th Floor, Cleveland, OH, USA
| | - Lucas Beffa
- Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Digestive Disease and Surgery Institute, 9500 Euclid Ave, Crile Building, 10th Floor, Cleveland, OH, USA
| | - Ajita Prabhu
- Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Digestive Disease and Surgery Institute, 9500 Euclid Ave, Crile Building, 10th Floor, Cleveland, OH, USA
| | - David Krpata
- Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Digestive Disease and Surgery Institute, 9500 Euclid Ave, Crile Building, 10th Floor, Cleveland, OH, USA
| | | | | | - Michael Rosen
- Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Digestive Disease and Surgery Institute, 9500 Euclid Ave, Crile Building, 10th Floor, Cleveland, OH, USA
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Maskal S, Miller B, Ellis R, Phillips S, Prabhu A, Beffa L, Krpata D, Rosenblatt S, Rosen M, Petro C. Mediumweight polypropylene mesh fractures after open retromuscular ventral hernia repair: incidence and associated risk factors. Surg Endosc 2023:10.1007/s00464-023-10039-4. [PMID: 37038022 DOI: 10.1007/s00464-023-10039-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/12/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE Mediumweight (MW) and heavyweight (HW) polypropylene have demonstrated similar clinical and patient-reported outcomes in the setting of open retromuscular ventral hernia repair (VHR). While MW mesh has an anecdotal risk of central mesh fracture, that phenomenon is not well-characterized. We sought to assess the incidence of and risk factors for MW polypropylene mesh fractures after VHR. METHODS The ACHQC registry was queried for patients with CT-documented hernia recurrence after open retromuscular VHR with MW polypropylene mesh at our institution with 1-year follow-up between January 2014 and April 2022. Images were reviewed by five blinded surgeons at Cleveland Clinic to reach consensus that hernia recurrence mechanism was central mesh fracture. Patients without clinical recurrence or patient-reported bulge were used as a comparator group. RESULTS Eighty patients were identified with radiographically documented recurrence; 28 had recurrence from mesh fractures and these were compared to 644 patients without recurrence. Incidence of MW fracture was 4.2%. Bridging of anterior fascia was more common in the group with the central mesh fracture (33.3% vs 3.3%, p < 0.001); the incidence of fracture was 30% (9/30) in patients requiring a bridged closure. Mesh fracture was associated with larger hernias (median width: 20 cm [16-26] vs 15 cm [12-18], p < 0.001,), length (25 cm [23-30] vs 23 cm [19-26], p = 0.004). CONCLUSION MW polypropylene mechanical failures are surprisingly common, particularly in settings of bridged fascial closure and larger hernias. Use of HW polypropylene should be considered in this setting, and industry should be encouraged to create larger pieces of HW polypropylene mesh.
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Affiliation(s)
- Sara Maskal
- Department of General Surgery, Center for Abdominal Core Health, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
| | - Benjamin Miller
- Department of General Surgery, Center for Abdominal Core Health, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Ryan Ellis
- Department of General Surgery, Center for Abdominal Core Health, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | | | - Ajita Prabhu
- Department of General Surgery, Center for Abdominal Core Health, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Lucas Beffa
- Department of General Surgery, Center for Abdominal Core Health, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - David Krpata
- Department of General Surgery, Center for Abdominal Core Health, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Steven Rosenblatt
- Department of General Surgery, Center for Abdominal Core Health, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Michael Rosen
- Department of General Surgery, Center for Abdominal Core Health, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Clayton Petro
- Department of General Surgery, Center for Abdominal Core Health, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
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Maskal S, Ellis R, Prabhu A, Miller B, Beffa L, Krpata D, Rosen M, Petro C. Injuries incurred from minimally invasive access for abdominal surgery. Surg Endosc 2023:10.1007/s00464-023-10031-y. [PMID: 36997650 DOI: 10.1007/s00464-023-10031-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/12/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND Injuries during initial port placement in minimally invasive abdominal surgery are rare but can cause major morbidity. We aimed to characterize the incidence, consequence, and risk factors for injury occurring on initial port placement. METHODS This is a retrospective review of a General Surgery quality collaborative database with supplementary input from the Morbidity and Mortality conference database at our institution between 6/25/2018 and 6/30/2022. Patient characteristics, operative details, and postoperative course were assessed. Cases with an injury on entry were compared to cases without an injury to identify risk factors for injury. RESULTS 8844 minimally invasive cases were present between the two databases. Thirty-four injuries (0.38%) occurred during initial port placement. Seventy-one percent of injuries were bowel injuries (full or partial thickness) and the majority (79%) of injuries were recognized during the index operation. Median surgeon experience for the cases with an injury was 9 years (IQR 4.25-14.5) compared to 12 years of experience for all surgeons contributing to the database (p = 0.004). Previous laparotomy was also significantly correlated with the rate of injury on entry (p = 0.012). There was no significant difference in the rate of injury based on method of entry (cut-down: 19 (55.9%), optical entry without Veress: 10 (29.4%), Veress followed by optical entry: 5 (14.7%), p = 0.11). BMI > 30 kg/m2 (injury: 16/34 vs no injury: 2538/8844, p = 0.847) was not associated with an injury. Fifty-six percent (19/34) of patients with an injury on initial port placement required laparotomy at some point in their hospital course. CONCLUSIONS Injuries are rare during initial port placement for minimally invasive abdominal surgery. In our database, history of a previous laparotomy was a significant risk factor for an injury and appears to be more consequential than commonly implicated factors such as technique, patient body habitus, or surgeon experience.
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Affiliation(s)
- Sara Maskal
- Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
| | - Ryan Ellis
- Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Ajita Prabhu
- Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Benjamin Miller
- Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Lucas Beffa
- Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - David Krpata
- Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Michael Rosen
- Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Clayton Petro
- Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA
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Thomas Z, Georgy J, Thumaty D, John A, Joel A, Wisely J, Jambunathan P, Kumar M P, Kovilapu H, Chacko R, Madhurima P, Prabhu A, Shreemal B, Kandagaddala M, Balakrishnan R, Singh A. 78P Dose-dense epirubicin and cisplatin (ddEP) in localised osteosarcoma. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.101115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Shah P, Olavarria O, Dhanani N, Ciomperlik H, Mohr C, Bernardi K, Neela N, Coelho R, Ali Z, Prabhu A, Liang MK. The Food and Drug Administration's (FDA's) 510(k) Process: A Systematic Review of 1000 Cases. Am J Med 2023; 136:172-178.e14. [PMID: 36170936 DOI: 10.1016/j.amjmed.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The vast majority of devices cleared by the Food and Drug Administration (FDA) are through the 510(k) process, which allows medical devices to be quickly introduced into the market. The FDA 510(k) process is designed to minimize the burden and expense of bringing new devices to market; however, as a result, the FDA may be limited in its ability to establish the safety of these devices. METHODS The FDA 510(k) online archives were searched for devices cleared from 2013 to 2014. One thousand devices were randomly selected. PubMed was searched for each device to identify publications about the devices. The primary outcome was the percentage of devices cleared through the 510(k) process with no published research. Secondary outcomes included: conflict of interest (COI) of authors and outcomes of published studies on the devices. RESULTS A total of 6152 devices were cleared through the 510(k) process in 2013-2014. Of the 1000 randomly selected devices, 17.8% had published research. There were 375 manuscripts, of which 47 (12.5%) were randomized controlled trials. One-fourth (25.1%) of studies had a clearly identifiable COI, while COI was unclear for half (49.9%). CONCLUSION AND RELEVANCE There is limited evidence examining the safety and effectiveness of devices cleared via the 510(k) process. Thousands of devices are cleared through the FDA's 510(k) process each year with limited or no evidence publicly available. This has led to the market being introduced to potentially costly, nonbeneficial, or harmful devices. Devices, like prescription drugs, should undergo a more rigorous clearance process.
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Affiliation(s)
- Puja Shah
- Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, Houston, Texas
| | - Oscar Olavarria
- Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, Houston, Texas; Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at UTHealth, Houston, Texas
| | - Naila Dhanani
- Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, Houston, Texas; Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at UTHealth, Houston, Texas
| | - Hailie Ciomperlik
- Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, Houston, Texas
| | - Cassandra Mohr
- Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, Houston, Texas
| | - Karla Bernardi
- Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, Houston, Texas; Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at UTHealth, Houston, Texas
| | - Niharika Neela
- Department of Surgery, Lyndon B. Johnson General Hospital, McGovern Medical School at UTHealth, Houston, Texas
| | - Rainna Coelho
- Department of Clinical Sciences, College of Medicine, University of Houston, Texas; Department of Surgery, Graduate Medical Education, HCA Healthcare Kingwood, Kingwood, Texas
| | - Zuhair Ali
- Department of Clinical Sciences, College of Medicine, University of Houston, Texas; Department of Surgery, Graduate Medical Education, HCA Healthcare Kingwood, Kingwood, Texas.
| | | | - Mike K Liang
- Department of Clinical Sciences, College of Medicine, University of Houston, Texas; Department of Surgery, Graduate Medical Education, HCA Healthcare Kingwood, Kingwood, Texas
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Dhanani NH, Lyons NB, Divino CM, Harris H, Holihan JL, Hope W, Itani K, Loor MM, Martindale R, Prabhu A, Reinke C, Roth JS, Towfigh S, Liang MK. Expert Consensus for Key Features of Operative Reports of Ventral Hernia. J Am Coll Surg 2023; 236:235-240. [PMID: 36102528 DOI: 10.1097/xcs.0000000000000410] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Operative reports are important documents; however, standards for critical elements of operative reports are general and often vague. Hernia surgery is one of the most common procedures performed by general surgeons, so the aim of this project was to develop a Delphi consensus on critical elements of a ventral hernia repair operative report. STUDY DESIGN The Delphi method was used to establish consensus on key features of operative reports for ventral hernia repair. An expert panel was selected and questionnaires were distributed. The first round of voting was open-ended to allow participants to recommend what details should be included. For the second round the questionnaire was distributed with the items that did not have unanimous responses along with free text comments from the first round. RESULTS Eighteen surgeons were approached, of which 11 completed both rounds. Twenty items were on the initial questionnaire, of which 11 had 100% agreement. Of the remaining 9 items, after the second questionnaire an additional 7 reached consensus. CONCLUSION Ventral hernia repairs are a common and challenging problem and often require reoperations. Surgeons frequently refer to previous operative notes to guide future procedures, which requires detailed and comprehensive operative reports. This Delphi consensus was able to identify key components needed for an operative report describing ventral hernia repair.
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Affiliation(s)
- Naila H Dhanani
- From the Department of Surgery, McGovern Medical School at UTHealth, Houston, TX (Dhanani, Holihan)
| | - Nicole B Lyons
- Dewitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL (Lyons)
| | - Celia M Divino
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York City, NY (Divino)
| | - Hobart Harris
- Department of Surgery, University of California San Francisco, San Francisco, CA (Harris)
| | - Julie L Holihan
- From the Department of Surgery, McGovern Medical School at UTHealth, Houston, TX (Dhanani, Holihan)
| | - William Hope
- Department of Surgery, Medical University of South Carolina, Charleston, SC (Hope)
| | - Kamal Itani
- Department of Surgery, VA Boston Health Care System and Boston University, Boston, MA (Itani)
| | - Michele M Loor
- Department of Surgery, Baylor College of Medicine, Houston, TX (Loor)
| | - Robert Martindale
- Department of Surgery, Oregon Health and Science University, Portland, OR (Martindale)
| | - Ajita Prabhu
- Department of Surgery, Cleveland Clinic, Cleveland, OH (Prabhu)
| | - Caroline Reinke
- Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC (Reinke)
| | - J Scott Roth
- Department of Surgery, University of Kentucky, Lexington, KY (Roth)
| | - Shirin Towfigh
- Beverly Hills Hernia Center, Beverly Hills, CA (Towfigh)
| | - Mike K Liang
- Department of Surgery, University of Houston, HCA Kingwood, Kingwood, TX (Liang)
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Greco CD, Petro CC, Thomas JD, Montelione K, Tu C, Fafaj A, Zolin S, Krpata D, Rosenblatt S, Rosen M, Beffa L, Prabhu A. Ileus rate after abdominal wall reconstruction: a retrospective analysis of two clinical trials. Hernia 2022; 26:1591-1598. [DOI: 10.1007/s10029-022-02687-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 09/14/2022] [Indexed: 11/25/2022]
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Evans RA, Leavy OC, Richardson M, Elneima O, McAuley HJC, Shikotra A, Singapuri A, Sereno M, Saunders RM, Harris VC, Houchen-Wolloff L, Aul R, Beirne P, Bolton CE, Brown JS, Choudhury G, Diar-Bakerly N, Easom N, Echevarria C, Fuld J, Hart N, Hurst J, Jones MG, Parekh D, Pfeffer P, Rahman NM, Rowland-Jones SL, Shah AM, Wootton DG, Chalder T, Davies MJ, De Soyza A, Geddes JR, Greenhalf W, Greening NJ, Heaney LG, Heller S, Howard LS, Jacob J, Jenkins RG, Lord JM, Man WDC, McCann GP, Neubauer S, Openshaw PJM, Porter JC, Rowland MJ, Scott JT, Semple MG, Singh SJ, Thomas DC, Toshner M, Lewis KE, Thwaites RS, Briggs A, Docherty AB, Kerr S, Lone NI, Quint J, Sheikh A, Thorpe M, Zheng B, Chalmers JD, Ho LP, Horsley A, Marks M, Poinasamy K, Raman B, Harrison EM, Wain LV, Brightling CE, Abel K, Adamali H, Adeloye D, Adeyemi O, Adrego R, Aguilar Jimenez LA, Ahmad S, Ahmad Haider N, Ahmed R, Ahwireng N, Ainsworth M, Al-Sheklly B, Alamoudi A, Ali M, Aljaroof M, All AM, Allan L, Allen RJ, Allerton L, Allsop L, Almeida P, Altmann D, Alvarez Corral M, Amoils S, Anderson D, Antoniades C, Arbane G, Arias A, Armour C, Armstrong L, Armstrong N, Arnold D, Arnold H, Ashish A, Ashworth A, Ashworth M, Aslani S, Assefa-Kebede H, Atkin C, Atkin P, Aung H, Austin L, Avram C, Ayoub A, Babores M, Baggott R, Bagshaw J, Baguley D, Bailey L, Baillie JK, Bain S, Bakali M, Bakau M, Baldry E, Baldwin D, Ballard C, Banerjee A, Bang B, Barker RE, Barman L, Barratt S, Barrett F, Basire D, Basu N, Bates M, Bates A, Batterham R, Baxendale H, Bayes H, Beadsworth M, Beckett P, Beggs M, Begum M, Bell D, Bell R, Bennett K, Beranova E, Bermperi A, Berridge A, Berry C, Betts S, Bevan E, Bhui K, Bingham M, Birchall K, Bishop L, Bisnauthsing K, Blaikely J, Bloss A, Bolger A, Bonnington J, Botkai A, Bourne C, Bourne M, Bramham K, Brear L, Breen G, Breeze J, Bright E, Brill S, Brindle K, Broad L, Broadley A, Brookes C, Broome M, Brown A, Brown A, Brown J, Brown J, Brown M, Brown M, Brown V, Brugha T, Brunskill N, Buch M, Buckley P, Bularga A, Bullmore E, Burden L, Burdett T, Burn D, Burns G, Burns A, Busby J, Butcher R, Butt A, Byrne S, Cairns P, Calder PC, Calvelo E, Carborn H, Card B, Carr C, Carr L, Carson G, Carter P, Casey A, Cassar M, Cavanagh J, Chablani M, Chambers RC, Chan F, Channon KM, Chapman K, Charalambou A, Chaudhuri N, Checkley A, Chen J, Cheng Y, Chetham L, Childs C, Chilvers ER, Chinoy H, Chiribiri A, Chong-James K, Choudhury N, Chowienczyk P, Christie C, Chrystal M, Clark D, Clark C, Clarke J, Clohisey S, Coakley G, Coburn Z, Coetzee S, Cole J, Coleman C, Conneh F, Connell D, Connolly B, Connor L, Cook A, Cooper B, Cooper J, Cooper S, Copeland D, Cosier T, Coulding M, Coupland C, Cox E, Craig T, Crisp P, Cristiano D, Crooks MG, Cross A, Cruz I, Cullinan P, Cuthbertson D, Daines L, Dalton M, Daly P, Daniels A, Dark P, Dasgin J, David A, David C, Davies E, Davies F, Davies G, Davies GA, Davies K, Dawson J, Daynes E, Deakin B, Deans A, Deas C, Deery J, Defres S, Dell A, Dempsey K, Denneny E, Dennis J, Dewar A, Dharmagunawardena R, Dickens C, Dipper A, Diver S, Diwanji SN, Dixon M, Djukanovic R, Dobson H, Dobson SL, Donaldson A, Dong T, Dormand N, Dougherty A, Dowling R, Drain S, Draxlbauer K, Drury K, Dulawan P, Dunleavy A, Dunn S, Earley J, Edwards S, Edwardson C, El-Taweel H, Elliott A, Elliott K, Ellis Y, Elmer A, Evans D, Evans H, Evans J, Evans R, Evans RI, Evans T, Evenden C, Evison L, Fabbri L, Fairbairn S, Fairman A, Fallon K, Faluyi D, Favager C, Fayzan T, Featherstone J, Felton T, Finch J, Finney S, Finnigan J, Finnigan L, Fisher H, Fletcher S, Flockton R, Flynn M, Foot H, Foote D, Ford A, Forton D, Fraile E, Francis C, Francis R, Francis S, Frankel A, Fraser E, Free R, French N, Fu X, Furniss J, Garner L, Gautam N, George J, George P, Gibbons M, Gill M, Gilmour L, Gleeson F, Glossop J, Glover S, Goodman N, Goodwin C, Gooptu B, Gordon H, Gorsuch T, Greatorex M, Greenhaff PL, Greenhalgh A, Greenwood J, Gregory H, Gregory R, Grieve D, Griffin D, Griffiths L, Guerdette AM, Guillen Guio B, Gummadi M, Gupta A, Gurram S, Guthrie E, Guy Z, H Henson H, Hadley K, Haggar A, Hainey K, Hairsine B, Haldar P, Hall I, Hall L, Halling-Brown M, Hamil R, Hancock A, Hancock K, Hanley NA, Haq S, Hardwick HE, Hardy E, Hardy T, Hargadon B, Harrington K, Harris E, Harrison P, Harvey A, Harvey M, Harvie M, Haslam L, Havinden-Williams M, Hawkes J, Hawkings N, Haworth J, Hayday A, Haynes M, Hazeldine J, Hazelton T, Heeley C, Heeney JL, Heightman M, Henderson M, Hesselden L, Hewitt M, Highett V, Hillman T, Hiwot T, Hoare A, Hoare M, Hockridge J, Hogarth P, Holbourn A, Holden S, Holdsworth L, Holgate D, Holland M, Holloway L, Holmes K, Holmes M, Holroyd-Hind B, Holt L, Hormis A, Hosseini A, Hotopf M, Howard K, Howell A, Hufton E, Hughes AD, Hughes J, Hughes R, Humphries A, Huneke N, Hurditch E, Husain M, Hussell T, Hutchinson J, Ibrahim W, Ilyas F, Ingham J, Ingram L, Ionita D, Isaacs K, Ismail K, Jackson T, James WY, Jarman C, Jarrold I, Jarvis H, Jastrub R, Jayaraman B, Jezzard P, Jiwa K, Johnson C, Johnson S, Johnston D, Jolley CJ, Jones D, Jones G, Jones H, Jones H, Jones I, Jones L, Jones S, Jose S, Kabir T, Kaltsakas G, Kamwa V, Kanellakis N, Kaprowska S, Kausar Z, Keenan N, Kelly S, Kemp G, Kerslake H, Key AL, Khan F, Khunti K, Kilroy S, King B, King C, Kingham L, Kirk J, Kitterick P, Klenerman P, Knibbs L, Knight S, Knighton A, Kon O, Kon S, Kon SS, Koprowska S, Korszun A, Koychev I, Kurasz C, Kurupati P, Laing C, Lamlum H, Landers G, Langenberg C, Lasserson D, Lavelle-Langham L, Lawrie A, Lawson C, Lawson C, Layton A, Lea A, Lee D, Lee JH, Lee E, Leitch K, Lenagh R, Lewis D, Lewis J, Lewis V, Lewis-Burke N, Li X, Light T, Lightstone L, Lilaonitkul W, Lim L, Linford S, Lingford-Hughes A, Lipman M, Liyanage K, Lloyd A, Logan S, Lomas D, Loosley R, Lota H, Lovegrove W, Lucey A, Lukaschuk E, Lye A, Lynch C, MacDonald S, MacGowan G, Macharia I, Mackie J, Macliver L, Madathil S, Madzamba G, Magee N, Magtoto MM, Mairs N, Majeed N, Major E, Malein F, Malim M, Mallison G, Mandal S, Mangion K, Manisty C, Manley R, March K, Marciniak S, Marino P, Mariveles M, Marouzet E, Marsh S, Marshall B, Marshall M, Martin J, Martineau A, Martinez LM, Maskell N, Matila D, Matimba-Mupaya W, Matthews L, Mbuyisa A, McAdoo S, Weir McCall J, McAllister-Williams H, McArdle A, McArdle P, McAulay D, McCormick J, McCormick W, McCourt P, McGarvey L, McGee C, Mcgee K, McGinness J, McGlynn K, McGovern A, McGuinness H, McInnes IB, McIntosh J, McIvor E, McIvor K, McLeavey L, McMahon A, McMahon MJ, McMorrow L, Mcnally T, McNarry M, McNeill J, McQueen A, McShane H, Mears C, Megson C, Megson S, Mehta P, Meiring J, Melling L, Mencias M, Menzies D, Merida Morillas M, Michael A, Milligan L, Miller C, Mills C, Mills NL, Milner L, Misra S, Mitchell J, Mohamed A, Mohamed N, Mohammed S, Molyneaux PL, Monteiro W, Moriera S, Morley A, Morrison L, Morriss R, Morrow A, Moss AJ, Moss P, Motohashi K, Msimanga N, Mukaetova-Ladinska E, Munawar U, Murira J, Nanda U, Nassa H, Nasseri M, Neal A, Needham R, Neill P, Newell H, Newman T, Newton-Cox A, Nicholson T, Nicoll D, Nolan CM, Noonan MJ, Norman C, Novotny P, Nunag J, Nwafor L, Nwanguma U, Nyaboko J, O'Donnell K, O'Brien C, O'Brien L, O'Regan D, Odell N, Ogg G, Olaosebikan O, Oliver C, Omar Z, Orriss-Dib L, Osborne L, Osbourne R, Ostermann M, Overton C, Owen J, Oxton J, Pack J, Pacpaco E, Paddick S, Painter S, Pakzad A, Palmer S, Papineni P, Paques K, Paradowski K, Pareek M, Parfrey H, Pariante C, Parker S, Parkes M, Parmar J, Patale S, Patel B, Patel M, Patel S, Pattenadk D, Pavlides M, Payne S, Pearce L, Pearl JE, Peckham D, Pendlebury J, Peng Y, Pennington C, Peralta I, Perkins E, Peterkin Z, Peto T, Petousi N, Petrie J, Phipps J, Pimm J, Piper Hanley K, Pius R, Plant H, Plein S, Plekhanova T, Plowright M, Polgar O, Poll L, Porter J, Portukhay S, Powell N, Prabhu A, Pratt J, Price A, Price C, Price C, Price D, Price L, Price L, Prickett A, Propescu J, Pugmire S, Quaid S, Quigley J, Qureshi H, Qureshi IN, Radhakrishnan K, Ralser M, Ramos A, Ramos H, Rangeley J, Rangelov B, Ratcliffe L, Ravencroft P, Reddington A, Reddy R, Redfearn H, Redwood D, Reed A, Rees M, Rees T, Regan K, Reynolds W, Ribeiro C, Richards A, Richardson E, Rivera-Ortega P, Roberts K, Robertson E, Robinson E, Robinson L, Roche L, Roddis C, Rodger J, Ross A, Ross G, Rossdale J, Rostron A, Rowe A, Rowland A, Rowland J, Roy K, Roy M, Rudan I, Russell R, Russell E, Saalmink G, Sabit R, Sage EK, Samakomva T, Samani N, Sampson C, Samuel K, Samuel R, Sanderson A, Sapey E, Saralaya D, Sargant J, Sarginson C, Sass T, Sattar N, Saunders K, Saunders P, Saunders LC, Savill H, Saxon W, Sayer A, Schronce J, Schwaeble W, Scott K, Selby N, Sewell TA, Shah K, Shah P, Shankar-Hari M, Sharma M, Sharpe C, Sharpe M, Shashaa S, Shaw A, Shaw K, Shaw V, Shelton S, Shenton L, Shevket K, Short J, Siddique S, Siddiqui S, Sidebottom J, Sigfrid L, Simons G, Simpson J, Simpson N, Singh C, Singh S, Sissons D, Skeemer J, Slack K, Smith A, Smith D, Smith S, Smith J, Smith L, Soares M, Solano TS, Solly R, Solstice AR, Soulsby T, Southern D, Sowter D, Spears M, Spencer LG, Speranza F, Stadon L, Stanel S, Steele N, Steiner M, Stensel D, Stephens G, Stephenson L, Stern M, Stewart I, Stimpson R, Stockdale S, Stockley J, Stoker W, Stone R, Storrar W, Storrie A, Storton K, Stringer E, Strong-Sheldrake S, Stroud N, Subbe C, Sudlow CL, Suleiman Z, Summers C, Summersgill C, Sutherland D, Sykes DL, Sykes R, Talbot N, Tan AL, Tarusan L, Tavoukjian V, Taylor A, Taylor C, Taylor J, Te A, Tedd H, Tee CJ, Teixeira J, Tench H, Terry S, Thackray-Nocera S, Thaivalappil F, Thamu B, Thickett D, Thomas C, Thomas S, Thomas AK, Thomas-Woods T, Thompson T, Thompson AAR, Thornton T, Tilley J, Tinker N, Tiongson GF, Tobin M, Tomlinson J, Tong C, Touyz R, Tripp KA, Tunnicliffe E, Turnbull A, Turner E, Turner S, Turner V, Turner K, Turney S, Turtle L, Turton H, Ugoji J, Ugwuoke R, Upthegrove R, Valabhji J, Ventura M, Vere J, Vickers C, Vinson B, Wade E, Wade P, Wainwright T, Wajero LO, Walder S, Walker S, Walker S, Wall E, Wallis T, Walmsley S, Walsh JA, Walsh S, Warburton L, Ward TJC, Warwick K, Wassall H, Waterson S, Watson E, Watson L, Watson J, Welch C, Welch H, Welsh B, Wessely S, West S, Weston H, Wheeler H, White S, Whitehead V, Whitney J, Whittaker S, Whittam B, Whitworth V, Wight A, Wild J, Wilkins M, Wilkinson D, Williams N, Williams N, Williams J, Williams-Howard SA, Willicombe M, Willis G, Willoughby J, Wilson A, Wilson D, Wilson I, Window N, Witham M, Wolf-Roberts R, Wood C, Woodhead F, Woods J, Wormleighton J, Worsley J, Wraith D, Wrey Brown C, Wright C, Wright L, Wright S, Wyles J, Wynter I, Xu M, Yasmin N, Yasmin S, Yates T, Yip KP, Young B, Young S, Young A, Yousuf AJ, Zawia A, Zeidan L, Zhao B, Zongo O. Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study. Lancet Respir Med 2022; 10:761-775. [PMID: 35472304 PMCID: PMC9034855 DOI: 10.1016/s2213-2600(22)00127-8] [Citation(s) in RCA: 144] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/23/2022] [Accepted: 03/31/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge. METHODS The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing. FINDINGS 2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters. INTERPRETATION The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials. FUNDING UK Research and Innovation and National Institute for Health Research.
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Chen B, Prats RG, Li G, Jansen Y, Prabhu A, Remco M, Lutz B, Hofmann S, Herzig S, Steffens S. Endothelial cannabinoid receptor CB1 deficiency decreases oxLDL uptake and attenuates vascular inflammation in atherosclerosis. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Said S, Thomas J, Montelione K, Fafaj A, Beffa L, Krpata D, Prabhu A, Rosen M, Petro C. Tanaka score predicts surgical intensive care admission following abdominal wall reconstruction. Hernia 2022; 26:873-880. [PMID: 35429304 DOI: 10.1007/s10029-022-02605-x] [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: 01/31/2022] [Accepted: 03/14/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE With the advancement of abdominal wall reconstruction, more complex hernia patients are undergoing repairs that may require a postoperative surgical intensive care unit (SICU) admission. The volume ratio (VR) of the hernia sac to the abdominal cavity is an easily applied method to quantify disease severity and the ensuing physiologic insult. This study aimed to predict postoperative SICU admission using VR and other preoperative variables. METHODS A single-center retrospective review was conducted for patients undergoing large abdominal hernias (width ≥ 18 cm) repaired from September 2014 to October 2019. Patient demographics, comorbidities, abdominal surgical history, and VR were analyzed through univariate and multivariable methods to identify predictors of SICU admission within the first two postoperative days. A predictive model was generated and validated. RESULTS Of 434 patients meeting inclusion criteria, 127(29%) required a SICU admission within the first two postoperative days. VR was significantly higher in SICU patients (Median 30.6% [IQR 14.4-59.0] vs. 10.6% [IQR 4.35-23.6], P < 0.001). Male sex, history of chronic obstructive pulmonary disease, prior component separation, recurrent incisional hernia, hernia grade 3, and VR showed higher odds of SICU admission. When validated on a testing dataset, these variables showed strong SICU admission predictions, with an area under the curve, sensitivity, and specificity of 0.82, 81.7% and 68.5%, respectively. CONCLUSIONS The volume ratio in combination with preoperatively available variables can reliably predict postoperative SICU admission following abdominal wall reconstruction. Anticipating such events preoperatively allows for bed space allocation as well as optimizing postoperative care.
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Affiliation(s)
- S Said
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA.
| | - J Thomas
- Department of General Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - K Montelione
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - A Fafaj
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - L Beffa
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - D Krpata
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - A Prabhu
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - M Rosen
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - C Petro
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA
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Crozier I, Haqqani H, Kotschet E, Shaw D, Prabhu A, Roubos J, Alison J, Melton I, Denman R, Lin T, Almeida A, Thompson A, Lande J, Liang S, O’donnell D. Three-year chronic follow-up from the pilot study of a substernal extravascular implantable cardioverter defibrillator. Europace 2022. [DOI: 10.1093/europace/euac053.467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Medtronic
Background
The investigational Extravascular Implantable Cardioverter-Defibrillator (EV ICD) uses a substernal lead and delivers defibrillation and pacing therapies, including antitachycardia pacing (ATP).
Objective
To characterize EV ICD system performance through 3 years.
Methods
The prospective, first-in-human EV ICD Pilot study was conducted at 4 sites in Australia and New Zealand. ICD-indicated patients were enrolled July-December of 2018. Defibrillation testing was conducted for all patients at implant, and chronically per physician discretion. Electrical testing was conducted at pre-hospital discharge, 2 weeks, 4-6 weeks and 3 months post-implant, and every 6 months thereafter. Posture effects on pacing and sensing were evaluated through 3 months.
Results
Of 26 patients enrolled, 21 underwent the EV ICD implant procedure. There were no intraprocedural complications. After successful implantation and testing, 17 of 21 patients entered chronic follow-up. 14 patients continue follow up, representing 523 patient-months. Eight elective chronic defibrillation tests converted 7 of 7 patients with ≤ 40 J (maximum energy). Five episodes of spontaneous ventricular tachycardia (VT) were detected in 1 patient and either self-terminated or successfully defibrillated with appropriate shock.
Over the total course of follow-up, 3 patients received an inappropriate shock due to; lead tip displacement with subsequent P-wave oversensing; Electromagnetic interference (EMI) in a ungrounded hot-tub; and EMI while doing plumbing work on unearthed electrical pipes, resulting in an annualized inappropriate shock rate of 6.9%.
Pacing capture thresholds remained stable across time (5.1 ± 2.0 V at implant and 5.5 ± 2.7 V at 3 years); similarly, R-wave amplitudes were stable across time (3.4 ±2.0 mV at implant and 4.2 ± 2.7 mV at 3 years). Pacing thresholds tended to be lowest with the patient lying on the right side and pacing threshold often increased relative to supine position for left-side, prone or bending postures. R-wave amplitude tended to be greater when bending forward.
There were 10 system or procedure-related adverse events in 8 patients through 3 years, including 3 elective system removals for: a single inappropriate shock (1), chronic defibrillation testing showing no safety margin in a patient with arrhythmogenic right ventricular dysplasia (1), intolerance to ATP (1 - high pacing threshold and frequent VT). Other than the lead tip displacement within the first 3 months, no additional clinically significant lead displacements have been observed through 3 years.
Conclusion
The EV ICD is a novel platform for delivering high-voltage therapy. There were no procedure and system related complications observed after the first year post-implant. Lead position and chronic system performance have generally remained stable through 3 years with a low rate of adverse events.
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Affiliation(s)
- I Crozier
- Christchurch Hospital, cardiology, Christchurch, New Zealand
| | - H Haqqani
- The Prince Charles Hospital, Department of Cardiology, Brisbane, Australia
| | - E Kotschet
- Monash Medical Center, Department of Cardiac Rhythm Services, Clayton, Australia
| | - D Shaw
- Christchurch Hospital, cardiology, Christchurch, New Zealand
| | - A Prabhu
- The Prince Charles Hospital, Department of Cardiology, Brisbane, Australia
| | - J Roubos
- Austin Health, Department of Cardiology, Heidelberg, Australia
| | - J Alison
- Monash Medical Center, Department of Cardiac Rhythm Services, Clayton, Australia
| | - I Melton
- Christchurch Hospital, cardiology, Christchurch, New Zealand
| | - R Denman
- The Prince Charles Hospital, Department of Cardiology, Brisbane, Australia
| | - T Lin
- Austin Health, Department of Cardiology, Heidelberg, Australia
| | - A Almeida
- Monash Medical Center, Department of Cardiac Rhythm Services, Clayton, Australia
| | - A Thompson
- Medtronic, Inc., Minneapolis, United States of America
| | - J Lande
- Medtronic, Inc., Minneapolis, United States of America
| | - S Liang
- Medtronic, Inc., Minneapolis, United States of America
| | - D O’donnell
- Austin Health, Department of Cardiology, Heidelberg, Australia
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Walweel K, Boon AC, See Hoe LE, Obonyo NG, Pedersen SE, Diab SD, Passmore MR, Hyslop K, Colombo SM, Bartnikowski NJ, Bouquet M, Wells MA, Black DM, Pimenta LP, Stevenson AK, Bisht K, Skeggs K, Marshall L, Prabhu A, James LN, Platts DG, Macdonald PS, McGiffin DC, Suen JY, Fraser JF. Brain stem death induces pro-inflammatory cytokine production and cardiac dysfunction in sheep model. Biomed J 2021; 45:776-787. [PMID: 34666219 PMCID: PMC9661508 DOI: 10.1016/j.bj.2021.10.007] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 08/12/2021] [Accepted: 10/07/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Organs procured following brain stem death (BSD) are the main source of organ grafts for transplantation. However, BSD is associated with inflammatory responses that may damage the organ and affect both the quantity and quality of organs available for transplant. Therefore, we aimed to investigate plasma and bronchoalveolar lavage (BAL) pro-inflammatory cytokine profiles and cardiovascular physiology in a clinically relevant 6-h ovine model of BSD. Methods Twelve healthy female sheep (37–42 Kg) were anaesthetized and mechanically ventilated prior to undergoing BSD induction and then monitored for 6 h. Plasma and BAL endothelin-1 and cytokines (IL-1β, 6, 8 and tumour necrosis factor alpha (TNF-α)) were assessed by ELISA. Differential white blood cell counts were performed. Cardiac function during BSD was also examined using echocardiography, and cardiac biomarkers (A-type natriuretic peptide and troponin I were measured in plasma. Results Plasma concentrations big ET-1, IL-6, IL-8, TNF-α and BAL IL-8 were significantly (p < 0.01) increased over baseline at 6 h post-BSD. Increased numbers of neutrophils were observed in the whole blood (3.1 × 109 cells/L [95% confidence interval (CI) 2.06–4.14] vs. 6 × 109 cells/L [95%CI 3.92–7.97]; p < 0.01) and BAL (4.5 × 109 cells/L [95%CI 0.41–9.41] vs. 26 [95%CI 12.29–39.80]; p = 0.03) after 6 h of BSD induction vs baseline. A significant increase in ANP production (20.28 pM [95%CI 16.18–24.37] vs. 78.68 pM [95%CI 53.16–104.21]; p < 0.0001) and cTnI release (0.039 ng/mL vs. 4.26 [95%CI 2.69–5.83] ng/mL; p < 0.0001), associated with a significant reduction in heart contractile function, were observed between baseline and 6 h. Conclusions BSD induced systemic pro-inflammatory responses, characterized by increased neutrophil infiltration and cytokine production in the circulation and BAL fluid, and associated with reduced heart contractile function in ovine model of BSD.
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Affiliation(s)
- K Walweel
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Road, Brisbane, Australia.
| | - A C Boon
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Road, Brisbane, Australia
| | - L E See Hoe
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Road, Brisbane, Australia
| | - N G Obonyo
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Road, Brisbane, Australia; Initiative to Develop African Research Leaders, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - S E Pedersen
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Road, Brisbane, Australia
| | - S D Diab
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Road, Brisbane, Australia
| | - M R Passmore
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Road, Brisbane, Australia
| | - K Hyslop
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Road, Brisbane, Australia
| | - S M Colombo
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Road, Brisbane, Australia; University of Milan, Italy
| | | | - M Bouquet
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Road, Brisbane, Australia
| | - M A Wells
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Road, Brisbane, Australia; School of Medical Science, Griffith University, Australia
| | - D M Black
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Road, Brisbane, Australia
| | - L P Pimenta
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Road, Brisbane, Australia
| | - A K Stevenson
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Road, Brisbane, Australia
| | - K Bisht
- Mater Research Institute, University of Queensland, Australia
| | - K Skeggs
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Road, Brisbane, Australia; Princess Alexandra Hospital, Woolloongabba, Brisbane, Australia
| | - L Marshall
- Princess Alexandra Hospital, Woolloongabba, Brisbane, Australia
| | - A Prabhu
- The Prince Charles Hospital, Rode Road, Brisbane, Australia
| | - L N James
- Princess Alexandra Hospital, Woolloongabba, Brisbane, Australia
| | - D G Platts
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Road, Brisbane, Australia
| | - P S Macdonald
- Cardiac Mechanics Research Laboratory, St. Vincent's Hospital and the Victor Chang Cardiac Research Institute, Victoria Street, Darlinghurst, Sydney, Australia
| | - D C McGiffin
- Cardiothoracic Surgery and Transplantation, The Alfred Hospital, Melbourne, Australia
| | - J Y Suen
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Road, Brisbane, Australia.
| | - J F Fraser
- Critical Care Research Group, Level 3, Clinical Sciences Building, The Prince Charles Hospital, Rode Road, Brisbane, Australia.
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Prabhu A. Prehabilitation: The Devil Is in the Details. J Am Coll Surg 2021; 232:223. [PMID: 33451451 DOI: 10.1016/j.jamcollsurg.2020.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 10/27/2020] [Indexed: 11/29/2022]
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Prabhu A, Brandl A, Wakama S, Sako S, Ishibashi H, Mizumoto A, Takao N, Ichinose M, Motoi S, Liu Y, Yonemura Y. Effect of oxaliplatin-based chemotherapy on chemosensitivity in patients with peritoneal metastasis from colorectal cancer treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: proof-of-concept study. BJS Open 2021; 5:6220267. [PMID: 33839755 PMCID: PMC8038512 DOI: 10.1093/bjsopen/zraa075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/13/2020] [Indexed: 12/15/2022] Open
Abstract
Background Chemosensitivity testing, including collagen gel droplet‐embedded culture drug sensitivity test, has proven to be a useful tool in therapeutic decision‐making. This retrospective analysis investigated chemosensitivity testing of peritoneal metastases collected during cytoreductive surgery (CRS), and its impact on survival in patients with colorectal cancer. Methods All patients with peritoneal metastasis from colorectal cancer who underwent CRS with or without hyperthermic intraperitoneal chemotherapy (HIPEC) between November 2008 and October 2014 were included. The growth inhibition rate was expressed as the ratio between the image density after treatment (T) and that before treatment (control, C). Tumours with a reduction in T/C ratio of less than 20 per cent were defined as resistant and those with a reduction of 20 per cent or more as sensitive. Groups were compared for overall (OS) and disease‐free (DFS) survival. Results Of 84 eligible patients, 81 received neoadjuvant chemotherapy (NACT), including 56 patients with an oxaliplatin‐based regimen. Mean(s.d.) follow‐up was 23·4(22·9) months. The median overall survival of all patients was 19·0 (i.q.r. 5·7–36·1) months, with a progression‐free survival time of 10·1 (4·5–17·0) months. Patients who received oxaliplatin‐based NACT had significantly altered chemosensitivity to oxaliplatin; only 20 of 51 such patients showed chemosensitivity to oxaliplatin compared with 16 of 24 who did not undergo oxaliplatin‐based NACT (P = 0·046). However, patients who showed chemoresistance to oxaliplatin had similar OS to those with chemosensitivity (18·8 versus 18·1 months; P = 0·835). The choice of HIPEC agents in patients who received oxaliplatin‐based NACT did not significantly influence survival (oxaliplatin versus mitomycin C: median OS 20·6 (10·9–24·8) versus 19·0 (10·5–34·6) months, P = 0·811; DFS 6·6 (2·8–25·7) versus 9·3 (4·1–13·9) months, P = 0·191). Conclusion Patients who had oxaliplatin‐based NACT showed a higher rate of chemoresistance to oxaliplatin at the time of CRS and HIPEC. The impact of chemosensitivity testing on OS remains unclear and needs further investigation.
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Affiliation(s)
- A Prabhu
- Department of Surgical Oncology Thangam Cancer Centre, Namakkal India
| | - A Brandl
- Digestive Unit Champalimaud Foundation, Lisbon, Portugal
| | - S Wakama
- Department of Surgery Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - S Sako
- Non-Profit Organization to Support Peritoneal Surface Malignancy Treatment Japanese/Asian School of Peritoneal Surface Oncology, Kyoto Japan.,Department of Regional Cancer Therapy Peritoneal Surface Malignancy Centre, Kishiwada, Tokushukai Hospital Kishiwada Japan
| | - H Ishibashi
- Department of Regional Cancer Therapy Peritoneal Surface Malignancy Centre, Kishiwada, Tokushukai Hospital Kishiwada Japan
| | - A Mizumoto
- Department of Regional Cancer Therapy Peritoneal Surface Malignancy Centre, Kusatsu General Hospital Shiga Japan
| | - N Takao
- Department of Regional Cancer Therapy Peritoneal Surface Malignancy Centre, Kusatsu General Hospital Shiga Japan
| | - M Ichinose
- Department of Regional Cancer Therapy Peritoneal Surface Malignancy Centre, Kusatsu General Hospital Shiga Japan
| | - S Motoi
- Department of Regional Cancer Therapy Peritoneal Surface Malignancy Centre, Kusatsu General Hospital Shiga Japan
| | - Y Liu
- Non-Profit Organization to Support Peritoneal Surface Malignancy Treatment Japanese/Asian School of Peritoneal Surface Oncology, Kyoto Japan
| | - Y Yonemura
- Non-Profit Organization to Support Peritoneal Surface Malignancy Treatment Japanese/Asian School of Peritoneal Surface Oncology, Kyoto Japan.,Department of Regional Cancer Therapy Peritoneal Surface Malignancy Centre, Kishiwada, Tokushukai Hospital Kishiwada Japan.,Department of Regional Cancer Therapy Peritoneal Surface Malignancy Centre, Kusatsu General Hospital Shiga Japan
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Challa A, Maddicks-Law J, Mulligan A, Prabhu A, Wong Y. High Pre-Donation Vasoactive Inotropic Score (VIS) May Be Associated with Increased Risk of Primary Graft Dysfunction in Cardiac Transplantation. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Fafaj A, Tastaldi L, Alkhatib H, Tish S, AlMarzooqi R, Olson MA, Stewart TG, Petro C, Krpata D, Rosen M, Prabhu A. Is there an advantage to laparoscopy over open repair of primary umbilical hernias in obese patients? An analysis of the Americas Hernia Society Quality Collaborative (AHSQC). Hernia 2020; 25:579-585. [PMID: 32447534 DOI: 10.1007/s10029-020-02218-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/11/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE The most common techniques used to repair umbilical hernias are open and laparoscopic. As the obesity epidemic in the United States is growing, it is essential to understand how this morbidity affects umbilical hernia repairs. This study compares laparoscopic versus open umbilical hernia repairs in obese patients. METHODS All patients with body mass index (BMI) ≥ 30 kg/m2 who underwent elective, open or laparoscopic repair of a primary umbilical hernia with mesh were identified from the Americas Hernia Society Quality Collaborative (AHSQC). A retrospective review of the prospectively collected data was conducted. Outcomes of interest included surgical site infections (SSI), surgical site occurrences requiring procedural intervention (SSOPI), hernia-related quality-of-life survey (HerQles), and long-term recurrence. A logistic regression model was used to generate propensity scores. RESULTS Of 1507 patients who met the inclusion criteria, 322 were laparoscopic, and 1185 were open cases. The laparoscopic group had higher mean BMI (37 ± 6 vs. 35 ± 5 kg/m2 , P < 0.001 ) and mean hernia width (3 cm ± 1 vs. 2 cm ± 2, P < 0.001). Using a propensity score model, we controlled for several clinically relevant covariates. Propensity score adjustment showed no differences in the 30-day HerQles score (OR 0.93, 95% CI 0.58-1.49), SSI (OR 1.57, 95% CI 0.52-4.77), SSOPI (OR 2.85, 95% CI 0.84-9.62) or hernia recurrence (hazard ratio 0.86, 95% CI 0.50-1.49). CONCLUSION In obese patients with primary umbilical hernias, there is likely no benefit to laparoscopy over open umbilical hernia repair with mesh with regard to wound morbidity. Although, the long-term recurrence also showed no difference between these two approaches, overall follow up was lacking.
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Affiliation(s)
- A Fafaj
- Center for Abdominal Core Health, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA.
| | - L Tastaldi
- Center for Abdominal Core Health, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA
| | - H Alkhatib
- Center for Abdominal Core Health, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA
| | - S Tish
- Center for Abdominal Core Health, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA
| | - R AlMarzooqi
- Center for Abdominal Core Health, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA
| | - M A Olson
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA
| | - T G Stewart
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - C Petro
- Center for Abdominal Core Health, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA
| | - D Krpata
- Center for Abdominal Core Health, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA
| | - M Rosen
- Center for Abdominal Core Health, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA
| | - A Prabhu
- Center for Abdominal Core Health, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA
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AlMarzooqi R, Tish S, Tastaldi L, Fafaj A, Olson M, Stewart T, Prabhu A, Krpata D, Petro C, Rosen M. Is concomitant cholecystectomy safe during abdominal wall reconstruction? An AHSQC analysis. Hernia 2020; 25:295-303. [PMID: 32417989 DOI: 10.1007/s10029-020-02208-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 05/04/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Unlike routine ventral hernia repair, abdominal wall reconstruction (AWR) can results in large pieces of mesh and extensive manipulation of the intra-abdominal contents, rendering subsequent laparoscopic cholecystectomy challenging. This study addresses the additional wound morbidity of concomitant cholecystectomy. METHODS The Americas Hernia Society Quality Collaborative (AHSQC) was retrospectively reviewed and logistic regression modeling was used to control for multiple covariates. Patients that underwent open AWR with cholecystectomy were compared to a similar group of patients undergoing uncomplicated, open, clean, AWR alone. RESULTS 130 patients undergoing concomitant cholecystectomy were compared to a control group of 6440 patients. The addition of a cholecystectomy did not cause a significant change in wound morbidity (SSI: p = 0.16; SSOPI: p = 0.65). CONCLUSIONS This study noted that a concomitant cholecystectomy does not increase the wound morbidity as compared to an uncomplicated, clean, AWR. This provides support for consideration of routine cholecystectomy in patients with cholelithiasis undergoing AWR.
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Affiliation(s)
- R AlMarzooqi
- Comprehensive Hernia Center, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA.
| | - S Tish
- Comprehensive Hernia Center, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - L Tastaldi
- Comprehensive Hernia Center, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - A Fafaj
- Comprehensive Hernia Center, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - M Olson
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - T Stewart
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - A Prabhu
- Comprehensive Hernia Center, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - D Krpata
- Comprehensive Hernia Center, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - C Petro
- Comprehensive Hernia Center, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - M Rosen
- Comprehensive Hernia Center, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
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Fafaj A, Petro CC, Tastaldi L, Alkhatib H, AlMarzooqi R, Olson MA, Stewart TG, Prabhu A, Krpata D, Rosen MJ. Intraperitonealversusretromuscular mesh placement for open incisional hernias: an analysis of the Americas Hernia Society Quality Collaborative. Br J Surg 2020; 107:1123-1129. [DOI: 10.1002/bjs.11560] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/23/2020] [Accepted: 01/27/2020] [Indexed: 01/20/2023]
Abstract
AbstractBackgroundIncisional hernia repair with mesh improves long-term outcomes, but the ideal mesh position remains unclear. This study compared intraperitoneal versus retromuscular or preperitoneal sublay (RPS) mesh positions for open incisional hernia repairs.MethodsAll patients who had elective open incisional hernia repairs were identified retrospectively in the Americas Hernia Society Quality Collaborative database. The primary outcome was the rate of 30-day surgical-site infection (SSI). Other outcomes of interest included 30-day surgical-site occurrences requiring procedural intervention (SSOPI), hernia-related quality-of-life survey (HerQLes) scores and long-term recurrence. A logistic model was used to generate propensity scores for mesh position using several clinically relevant co-variables. Regression models adjusting for propensity score and baseline characteristics were developed to assess the effect of mesh placement.ResultsA total of 4211 patients were included in the study population: 587 had intraperitoneal mesh and 3624 had RPS mesh. Analysis with propensity score adjustment provided no evidence for differences in SSOPI (odds ratio (OR) 0·79, 95 per cent c.i. 0·49 to 1·26) and SSI (OR 0·91, 0·50 to 1·67) rates or HerQLes scores at 30 days (OR 1·20, 0·79 to 1·82), or recurrence rates (hazard ratio 1·28, 0·90 to 1·82).ConclusionMesh position had no effect on short- or long-term outcomes, including SSOPI and SSI rates, HerQLes scores and long-term recurrence rates.
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Affiliation(s)
- A Fafaj
- Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - C C Petro
- Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - L Tastaldi
- Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - H Alkhatib
- Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - R AlMarzooqi
- Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - M A Olson
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, Tennessee, USA
| | - T G Stewart
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - A Prabhu
- Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - D Krpata
- Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - M J Rosen
- Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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AlMarzooqi R, Petro C, Tish S, Fafaj A, Alkhatib H, Tastaldi L, Tu C, Prabhu A, Krpata D, Rosen M. Patient perceptions on mesh use in hernia repair: A prospective, questionnaire-based study. Surgery 2020; 167:751-756. [PMID: 32061401 DOI: 10.1016/j.surg.2019.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 11/22/2019] [Accepted: 12/06/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND There has been increasing media coverage regarding the controversy of using mesh in various operations. At this time, there are no published studies evaluating the potential influence of this controversy on patients' perceptions. Therefore, our study aimed to assess patient perceptions of hernia repair surgery with mesh as well as factors that may influence patient opinions. METHODS A 16-item questionnaire evaluated each patient's perceptions of the use of mesh in their upcoming hernia repair. The primary outcomes of interest were their level of comfort regarding the possibility of hernia repair surgery with mesh, aversion to hernia surgery with mesh, and positive belief that mesh is a safe product in hernia repair surgery. RESULTS We included 100 patients presenting for a hernia repair and 100 patients presenting for other operations. Both groups identified the media as their most common influence (37% and 40%, respectively). Factors leading to a high level of comfort regarding the possibility of mesh repair included believing mesh was a safe product (P < .001) and hearing about the advantages of mesh (P = .012) from medical professionals (P = .001). Factors leading to a positive belief that mesh was a safe product included the male sex (P = .015), a high socioeconomic standing (P = .006), and their own personal experience (P = .013). Factors leading to aversion to mesh use included the female sex (P = .006) and hearing about meshes causing mesh-related (P = .028) and wound-related complications (P = .025) as well as chronic pain (.008). CONCLUSION Despite the high penetration of non-medical information in the population before presentation for medical care, most patients overall do not seem to be opposed to the concept of the use of mesh in a hernia repair, but there are certain factors associated with aversion to the use of mesh that physicians should acknowledge and should address this potential issue.
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Affiliation(s)
- Raha AlMarzooqi
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, OH.
| | - Clayton Petro
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, OH
| | - Shahed Tish
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, OH
| | - Aldo Fafaj
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, OH
| | - Hemasat Alkhatib
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, OH
| | - Luciano Tastaldi
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, OH
| | - Chao Tu
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic Foundation, OH
| | - Ajita Prabhu
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, OH
| | - David Krpata
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, OH
| | - Michael Rosen
- Cleveland Clinic Center for Abdominal Core Health, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, OH
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Ritter KA, Leifer D, Orabi D, Prabhu A, French J, Lipman JM. How We Do It: Creation of a Low-Cost Endoscopic Skills Model for Fundamentals of Endoscopic Surgery Training. J Surg Educ 2019; 76:1456-1459. [PMID: 31235442 DOI: 10.1016/j.jsurg.2019.06.005] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 06/03/2019] [Accepted: 06/06/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To design a low cost, high fidelity endoscopic skills model to help surgical trainees pass the Fundamentals of Endoscopic Surgery (FES) testing. DESIGN A homemade synthetic colon model was designed using liquid silicon and other commercially available products. The construction and design of the model is described here. The model was then successfully integrated into our simulation curriculum and endoscopic skills training modules. SETTING Cleveland Clinic Foundation, Cleveland, Ohio; large academic quaternary referral institution. PARTICIPANTS PGY 1-5 general surgery residents preparing for Fundamentals of Endoscopic Surgery testing. RESULTS A versatile, high fidelity model was designed for a total cost of approximately 25 dollars per unit. The model can be used with clinical endoscopic towers and easily integrated into an institution's simulation and endoscopic training curriculum. The flexibility of design allows trainees to practice all of the key motor skills necessary for FES examination success. CONCLUSIONS A homemade endoscopic colon model can be constructed at an affordable price point using commercially available materials. These models have significant versatility, low cost, and flexibility of design allowing for easy incorporation into a surgical residency simulation training program.
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Affiliation(s)
- Kaitlin A Ritter
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
| | - David Leifer
- Simulation and Advanced Skills Center, Cleveland Clinic, Cleveland, Ohio
| | - Danny Orabi
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ajita Prabhu
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
| | - Judith French
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jeremy M Lipman
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio; Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio.
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Prabhu A, Masghati S, Hernandez PW, Kim SJ, Klein NC. 2160 Effects of Visual Fidelity for Design of a Virtual Reality Based Pain Management System. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Colvin J, Rosen M, Prabhu A, Rosenblatt S, Petro C, Zolin S, Krpata D. Enhanced recovery after surgery pathway for patients undergoing abdominal wall reconstruction. Surgery 2019; 166:849-853. [DOI: 10.1016/j.surg.2019.05.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/27/2019] [Accepted: 05/19/2019] [Indexed: 12/14/2022]
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Quinn T, Kesarwani P, Kant S, Prabhu A, Chinnaiyan P. Characterization of GBM Immunophenotype in Murine Heterotopic and Orthotopic Models, Implications for Novel Treatment Modalities. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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AlMarzooqi R, Tish S, Huang LC, Prabhu A, Rosen M. Review of inguinal hernia repair techniques within the Americas Hernia Society Quality Collaborative. Hernia 2019; 23:429-438. [DOI: 10.1007/s10029-019-01968-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 04/28/2019] [Indexed: 11/28/2022]
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37
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Hansberry D, Kern R, Guez D, Prabhu A, Ayyaswami V, Adamo R. Abstract No. 482 Interventional radiology residency websites: a review of online content available for medical students. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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38
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Karanjkar Y, Prabhu A, Vishal K. Correlation of Handgrip Strength to Postoperative Outcomes in Rotator Cuff Repair: A Preliminary Report. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.01.2019.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | - A. Prabhu
- Assistant Professor, Department of Physiotherapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - K. Vishal
- Assistant Professor, Department of Physiotherapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Sladden T, Hopkins P, Linhardt R, Chambers D, Yerkovich S, Pohlner P, Prabhu A, William L, Zhang F, Yu Y, Han X, Ouyang Y. Hyaluronan in Ex Vivo Lung Perfusion: A Key Component in Lung Endothelium and Possible Therapeutic Intervention. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.02.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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40
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Bell D, Sharma V, Betts K, Prabhu A, Alphonso N, Pohlner P. Functional Outcomes Following Surgical Management of Pulmonary Atresia With Intact Ventricular Septum: A Queensland Experience. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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41
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Kesarwani P, Prabhu A, Kant S, Kumar P, Graham S, Buelow K, Wilson G, Chinnaiyan P. Tryptophan Metabolism Contributes to Radiation-Induced Immune Checkpoint Reactivation in Glioblastoma. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.06.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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42
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Lin A, Koitka K, Lau K, Scarlia G, Burstow D, Prabhu A, Thomson B, Tesar P, Bancroft J, Platts D. Longitudinal Evaluation of Inflow Cannula Orientation Following Ventricular-Assist Device Implantation Using Transoesophageal Echocardiography. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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43
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Dashwood A, Laher S, Menon N, Thomson B, Prabhu A, Tesar P, Ziegenfuss M, Smith I, Javorsky G, Platts D, McKenzie S, Chan W, Bancroft J, Maddicks-Law J, Wong Y. Validation of EUROMACS-RHF (European Registry for Patients with Mechanical Circulatory Support Right-Sided Heart Failure) Score in Predicting Early Right Heart Failure Following Left Ventricular Assist Device Insertion in an Australian Single-Centre Cohort. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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44
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Benjamin A, Lau K, Habibian M, Scalia G, Burstow D, Thomson B, Prabhu A, Tesar P, Bancroft J, Fraser J, Platts D. Assessment of Left Ventricular Apical Morphology Using Contrast-Enhanced Transthoracic Echocardiography Prior to Continuous-Flow Left Ventricular Assist Device Implantation. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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45
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Dashwood A, Laher S, Wang C, Prabhu A, Tesar P, Ziegenfuss M, Wong Y, Javorsky G, Smith I, Platts D, Chan W, McKenzie S, Bancroft J, Maddicks-Law J, Thomson B. Single-Centre Experience of Durable Bi-Ventricular Support with HeartWare Continuous Flow, Centrifugal Ventricular Assist Devices (HeartWare BiVADs). Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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46
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Lau K, Bancroft J, McKenzie S, Javorsky G, Chan W, Wong Y, Thomson B, Prabhu A, Fraser J, Platts D. Explant of Heartware Biventricular Assist Devices Following Myocardial Recovery After Peripartum Cardiomyopathy. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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47
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Dashwood A, Rusli S, Thomson B, Prabhu A, Platts D, Korczyk D, Hill J, Godbolt D, Small A, Wong Y. Rare Case of Advanced Non-Tropical, Isolated Right Ventricular Endomyocardial Fibrosis. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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48
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Kesarwani P, Kumar P, Kant S, Prabhu A, Wilson G, Graham S, Chinnaiyan P. GDC-0919 Modulates Tryptophan Metabolism in Glioblastoma and Enhances Radiation Response. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.2048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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49
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Moores N, Rosenblatt S, Prabhu A, Rosen M. Do Iodine-Impregnated Adhesive Surgical Drapes Reduce Surgical Site Infections during Open Ventral Hernia Repair? A Comparative Analysis. Am Surg 2017. [DOI: 10.1177/000313481708300627] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study evaluated the role of iodine-impregnated adhesive drapes to reduce surgical site infections and occurrences in open ventral hernia repairs. All patients undergoing open ventral hernia repair of clean wounds with a retromuscular repair using synthetic mesh by a single surgeon were prospectively evaluated from the American Hernia Society Quality Collaborative. Patients were divided into those that had an Ioban drape and those that did not. The primary endpoints of this study were postoperative surgical site occurrence and infections. One hundred and four patients met inclusion criteria and were analyzed. There were 56 patients that received a 3M™ Ioban™ drape and 48 patients did not. The two groups were similar based on baseline demographics, risk factors, and operative details. There were four (7%) surgical site occurrences in the Ioban group (one wound cellulitis, one superficial surgical site infection, one allergic reaction to the Ioban, and one sterile seroma). There was one (2%) surgical site occurrence in the non-Ioban group (one superficial wound dehiscence). For patients undergoing clean ventral hernia repair with synthetic mesh placed in the retrorectus plane, the use of an iodine-impregnated drape does not result in a reduction in surgical site occurrences or superficial surgical site infections.
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Affiliation(s)
- Neal Moores
- Cleveland Clinic Comprehensive Hernia Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Steven Rosenblatt
- Cleveland Clinic Comprehensive Hernia Center, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ajita Prabhu
- University Hospitals of Cleveland, Cleveland, Ohio
| | - Michael Rosen
- Cleveland Clinic Comprehensive Hernia Center, Cleveland Clinic Foundation, Cleveland, Ohio
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Lamba HK, Shi Y, Prabhu A. Gallstone ileus associated with impaction at Meckel’s diverticulum: Case report and literature review. World J Gastrointest Surg 2016; 8:755-760. [PMID: 27933137 PMCID: PMC5124704 DOI: 10.4240/wjgs.v8.i11.755] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 04/06/2016] [Accepted: 06/03/2016] [Indexed: 02/06/2023] Open
Abstract
Gallstone ileus due to erosion of one or more gallstones into the gastrointestinal tract is an uncommon cause of small bowel obstruction. The site of impaction is usually distal ileum, and less commonly the jejunum, colon, duodenum, or stomach. We report a rare case of gallstone ileus with impaction at the proximal small bowel and at a Meckel’s diverticulum (MD) in a 64-year-old woman managed with laparoscopic converted to open small bowel resections. Patient was discharged home in stable condition and remained asymptomatic at 6-mo follow up. We review the current literature on surgical approaches to MD and gallstone ileus. Diverticulectomy or segmental resection is preferred for complicated MD. For gallstone ileus, simple enterolithotomy or segmental resection are the most the most favored especially in older co-morbid patients due to lower mortality rates and the rarity of recurrent gallstone ileus. In addition, laparoscopy has been increasingly reported as a safe approach to manage gallstone ileus.
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