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Saab M, Beldame J, Charpail C, Kaba A, Mainard D, Caubère A, Maynou C, Bredicianu R, Ghorbani A, Giunta JC, Coursier R, Thoreux P, Laboute E. Clinical and functional outcomes of 405 Achilles tendon ruptures after a minimum follow-up of 1 year. Orthop Traumatol Surg Res 2024:103886. [PMID: 38615885 DOI: 10.1016/j.otsr.2024.103886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 11/28/2023] [Accepted: 02/02/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE The results of surgical versus conservative treatment of acute Achilles tendon ruptures are still controversial. The objective of this study was to compare surgical and conservative treatment at a minimum follow-up of 1 year in terms of the complications, functional outcomes and clinical results. HYPOTHESES There is no difference in the complications, clinical results and functional outcomes between the two treatment groups. There is no difference in the occurrence of complications or the clinical results due to the immobilization or rehabilitation protocols. METHODS This was a retrospective comparative, multicenter, non-randomized study of acute Achilles tendon ruptures treated between 01/01/2018 and 31/12/2019 at 21 study sites in France. All patients who received surgical or conservative treatment were included. The demographics, sports participation, nature of treatment, immobilization parameters (type, duration, position) and rehabilitation protocol were collected. Rerupture, general and specific complications, clinical results (heel-rise test, single-leg hop, calf circumference, ankle dorsiflexion) and the functional outcomes (ATRS, VISA-A, EFAS, SF-12) were collected at the final review. RESULTS Four hundred five patients were reviewed at a mean follow-up of 24 (±7) months. Surgical treatment was done in 372 patients (92%) and conservative treatment in 33 patients (8%), with these two sets of patients having comparable preoperative characteristics. There was a similar number of reruptures in the conservative group (3 cases, 9%) as in the surgical group (15 cases, 4%) (p=0.176). There were more general complications in the conservative group (24%) than in the surgical group (11%) (p=0.04). There was a 9% rate of surgery-related complications (infection, nerve damage, anesthesia after-effects). The ATRS (p=0.017), EFAS Total (p=0.013), EFAS daily living (p=0.008), and SF-12 physical (p=0.01) were better in the surgical group. Strict then relative immobilization provided the best balance between functional recovery (EFAS total of 33, p<0.01) and tendon lengthening (0°, p=0.01) without increasing the occurrence of rerupture (2%, p=0.18). Early weightbearing accompanied by immobilization and rehabilitation within 30 days did not lead to more reruptures than if it was started beyond 30 days (p=0.082 and p=0.07). CONCLUSIONS This study found no differences in the number of reruptures between surgical treatment and conservative treatment of acute Achilles tendon ruptures. Surgical treatment led to better clinical results but had a variable effect on improving the functional scores. No matter which treatment is used, in the ideal case, 3 weeks of strict immobilization in equinus should be followed by progressive reduction over the next 3 weeks. Early weightbearing and mobilization within 30 days did not increase the risk of rerupture; it actually optimized the clinical and functional outcomes. LEVEL OF EVIDENCE III; retrospective comparative, non-randomized.
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Affiliation(s)
- Marc Saab
- Service d'orthopédie 1-traumatologie, CHU de Lille, 59000 Lille, France.
| | - Julien Beldame
- Institut de la cheville et du pied, clinique Blomet, 75015 Paris, France; Clinique Megival, 76550 Saint-Aubin-sur-Scie, France
| | - Christel Charpail
- SOS pied-cheville, clinique du sport, 33700 Merignac, France; Centre Achille, 34070 Montpellier, France
| | - Arnaud Kaba
- Centre hospitalier de Dunkerque, 130, avenue Louis-Herbeaux, 59240 Dunkerque, France
| | - Didier Mainard
- CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France
| | - Alexandre Caubère
- Hôpital d'instruction des armées Saint-Anne, 2, boulevard Saint-Anne, 83000 Toulon, France
| | - Carlos Maynou
- Service d'orthopédie 1-traumatologie, CHU de Lille, 59000 Lille, France
| | - Rares Bredicianu
- Centre hospitalier de Sarrebourg, 25, avenue General-de-Gaulle, 57400 Sarrebourg, France
| | - Ali Ghorbani
- Medipole Garonne, 45, rue de Gironis, 31036 Toulouse, France
| | | | - Raphaël Coursier
- Hôpital Saint-Vincent, boulevard de Belfort, 59000 Lille, France
| | - Patricia Thoreux
- Hôpital Hôtel-Dieu-APHP-université Sorbonne Paris Nord, 75004 Paris, France
| | - Eric Laboute
- CERS, groupe Ramsay Santé, 83, avenue du Maréchal-de-Lattre-de-Tassigny, 40130 Capbreton, France
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Chen B. Effect of damage control strategy combining pre-hospital emergency treatment with in-hospital treatment on pelvic fracture complicated by multiple injuries. Injury 2024; 55:111391. [PMID: 38377672 DOI: 10.1016/j.injury.2024.111391] [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: 05/29/2023] [Revised: 12/19/2023] [Accepted: 01/26/2024] [Indexed: 02/22/2024]
Abstract
OBJECTIVE To analyze the application value of damage control strategies combining pre-hospital emergency treatment with in-hospital treatment for multiple injuries in treating pelvic fracture complicated by multiple injuries. METHODS 120 patients with pelvic fracture complicated by multiple injuries admitted to our hospital from January 2020 to January 2023 were selected and divided into a damage control group (early temporary reduction after resuscitation, n = 60) and a control group (no reduction and resuscitation only, n = 60) by treatment methods. The control group was treated with conventional methods, while the damage control group was treated with the damage control strategy combining pre-hospital emergency treatment combined with in-hospital treatment in addition to conventional methods. The mortality rate, complication rate, fracture reduction quality, long-term efficacy, and patient satisfaction of the two groups were compared. RESULTS The mortality rate of the damage control group was lower than that of the control group, and the difference has statistical significance (P<0.05); the incidence of infection, DIC, and MODS of the damage control group were lower than that of the control group, with the difference being statistically significant (P<0.05); the incidence of ARDS in the two groups is not that different (P>0.05); the fracture reduction quality and long-term therapeutic effect of patients in the two groups were statistically different, with the damage control group outperforming the control group in both aspects; the difference between the two groups in terms of patient satisfaction was statistically significant (P<0.05), with the patient satisfaction of the damage control group being higher than that of the control group. CONCLUSION For patients with pelvic fracture, the application of the damage control strategy combining pre-hospital emergency treatment and in-hospital treatment is a boon to the standardization of the treatment process, the improvement of the treatment success rate and fracture reduction quality and the reduction of complications, and therefore is worth promoting in clinical practice. the early application of external fixation has helped with the definitive reduction at a time when the patuent was stable.
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Affiliation(s)
- Bijun Chen
- Department of Emergency surgery, Hangzhou Linan TCM Hospital, Hangzhou City, Zhejiang Province, 311300, China.
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de Sa R, Shah N, Rudge B, Ieong E. Safety of early weightbearing after ankle fracture fixation. Eur J Orthop Surg Traumatol 2024; 34:1003-1007. [PMID: 37843568 DOI: 10.1007/s00590-023-03758-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] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/02/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE Patients with surgically treated ankle fractures are traditionally kept non-weightbearing for at least six weeks post-operatively; however, recent literature suggests numerous benefits of early weightbearing (EWB) before six weeks without significantly impacting long-term outcomes. This study aims to review the safety of early vs late weightbearing following ankle fracture fixation by assessing the complication rate. METHODS This was a single-centre retrospective study. Between 2020 and 2023, all ankle fixations that commenced weightbearing at two weeks were added to the EWB group. An equal number of similar patients with six-week non-weightbearing were added to the late weightbearing (LWB) group. Baseline characteristics, risk factors, types of fractures and any complications in the six-month post-operative period were evaluated from these cohorts. RESULTS In total, 459 ankle fixations were identified of which 87 patients met the criteria for the EWB group, with a further 87 added to the LWB group. There was no significant difference in age between the two groups (51.7 ± 20.1 vs 51.0 ± 15.5, respectively; p = 0.81), but more female patients and diabetics in the EWB group. Fracture types were similar between both cohorts (p = 0.51). Complication rate in the EWB group was not significantly different to the LWB group (5 vs 9, p > 0.05). CONCLUSION No increase in complication rate was identified by commencing weightbearing early at two weeks after ankle fixation compared to six weeks. We therefore suggest EWB if appropriate, given its associated benefits including restoration of patient independence and improved quality of life. LEVEL OF EVIDENCE Therapeutic, Level IV.
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Affiliation(s)
- Russell de Sa
- Department of Trauma & Orthopaedics, West Hertfordshire Teaching Hospital NHS Trust, Hertfordshire, UK.
| | - Nikki Shah
- Department of Trauma & Orthopaedics, West Hertfordshire Teaching Hospital NHS Trust, Hertfordshire, UK
| | - Benjamin Rudge
- Department of Trauma & Orthopaedics, West Hertfordshire Teaching Hospital NHS Trust, Hertfordshire, UK
| | - Edmund Ieong
- Department of Trauma & Orthopaedics, West Hertfordshire Teaching Hospital NHS Trust, Hertfordshire, UK
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Haslhofer DJ, Stiftinger JM, Kraml N, Dannbauer F, Schmolmüller C, Gotterbarm T, Kwasny O, Klasan A. Complication rates after proximal femoral nailing: does level of training matter? J Orthop Traumatol 2023; 24:56. [PMID: 37923919 PMCID: PMC10624794 DOI: 10.1186/s10195-023-00737-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/20/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Surgical treatment of pertrochanteric fractures is one of the most performed surgeries in orthogeriatrics. Proximal femoral nailing, the most performed procedure, is often used as a training surgery for young residents. The objective of this study was to evaluate the relevance of the resident's training level to complication rates. MATERIAL AND METHODS This study was a retrospective cohort study. Surgeons were divided into four groups according to their training level. Complications included infection, cut-out, and revision surgery. The study was performed at a level 1 trauma center. All patients who were treated with proximal femoral nailing surgery with a radiological follow-up of at least 3 months were included. RESULTS Of the 955 patients extracted, a total of 564 patients met the inclusion criteria. Second-year residents had significantly higher cut-out rates (p = 0.012). Further analysis indicated a correlation between level of training and surgery duration (p < 0.001) as well as a correlation between surgery duration and infection rate (p < 0.001). The overall complication rate was 11.2%. Analyzing overall complications, no significant difference was found when comparing surgeon groups (p = 0.3). No statistically significant difference was found concerning infection (p = 0.6), cut-out (p = 0.7), and revision surgery (p = 0.3) either. CONCLUSION Complication rates after proximal femoral nailing are not higher in patients who are treated by residents. Therefore, proximal femoral nailing is an excellent procedure for general orthopedic training. However, we must keep in mind that accurate positioning of the femoral neck screw is essential to keep cut-out rates as low as possible. LEVEL OF EVIDENCE III
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Affiliation(s)
- D J Haslhofer
- Department for Trauma Surgery and Sport Traumatology, Med Campus III, Kepler University Hospital Linz, Krankenhausstrasse 9, 4020, Linz, Austria.
- Department for Orthopaedics and Traumatology, Med Campus III, Kepler University Hospital Linz, Krankenhausstrasse 9, 4020, Linz, Austria.
- Faculty of Medicine, Johannes Kepler University Linz, Altenbergerstrasse 69, 4040, Linz, Austria.
- , Weingartshofstraße 6/609, 4020, Linz, Austria.
| | - J M Stiftinger
- Department for Trauma Surgery and Sport Traumatology, Med Campus III, Kepler University Hospital Linz, Krankenhausstrasse 9, 4020, Linz, Austria
- Department for Orthopaedics and Traumatology, Med Campus III, Kepler University Hospital Linz, Krankenhausstrasse 9, 4020, Linz, Austria
- Faculty of Medicine, Johannes Kepler University Linz, Altenbergerstrasse 69, 4040, Linz, Austria
| | - N Kraml
- Faculty of Medicine, Johannes Kepler University Linz, Altenbergerstrasse 69, 4040, Linz, Austria
| | - F Dannbauer
- Department for Trauma Surgery and Sport Traumatology, Med Campus III, Kepler University Hospital Linz, Krankenhausstrasse 9, 4020, Linz, Austria
- Department for Orthopaedics and Traumatology, Med Campus III, Kepler University Hospital Linz, Krankenhausstrasse 9, 4020, Linz, Austria
- Faculty of Medicine, Johannes Kepler University Linz, Altenbergerstrasse 69, 4040, Linz, Austria
| | - C Schmolmüller
- Department for Trauma Surgery and Sport Traumatology, Med Campus III, Kepler University Hospital Linz, Krankenhausstrasse 9, 4020, Linz, Austria
- Department for Orthopaedics and Traumatology, Med Campus III, Kepler University Hospital Linz, Krankenhausstrasse 9, 4020, Linz, Austria
- Faculty of Medicine, Johannes Kepler University Linz, Altenbergerstrasse 69, 4040, Linz, Austria
| | - T Gotterbarm
- Department for Orthopaedics and Traumatology, Med Campus III, Kepler University Hospital Linz, Krankenhausstrasse 9, 4020, Linz, Austria
- Faculty of Medicine, Johannes Kepler University Linz, Altenbergerstrasse 69, 4040, Linz, Austria
| | - O Kwasny
- Department for Trauma Surgery and Sport Traumatology, Med Campus III, Kepler University Hospital Linz, Krankenhausstrasse 9, 4020, Linz, Austria
- Faculty of Medicine, Johannes Kepler University Linz, Altenbergerstrasse 69, 4040, Linz, Austria
| | - A Klasan
- Faculty of Medicine, Johannes Kepler University Linz, Altenbergerstrasse 69, 4040, Linz, Austria
- Department for Orthopedics and Traumatology, AUVA Graz, Göstinger Straße 24, 8020, Graz, Austria
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Pearson ZC, Harris AB, Agarwal AR, Kreulen RT, Martin J, Ahiarakwe U, Golladay GJ, Thakkar SC. Higher revision rates in patients with preoperative contralateral pes planovalgus deformity following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2023; 31:4920-4926. [PMID: 37596366 DOI: 10.1007/s00167-023-07520-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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/23/2023] [Indexed: 08/20/2023]
Abstract
PURPOSE The purpose of this study was to compare the incidence of revision in those with pes planovalgus deformity to those without using a large national database. Given the reciprocal changes in lower extremity alignment associated with planovalgus foot deformity, it has been suggested that patients with this deformity has worse outcomes following total knee arthroplasty (TKA). METHODS A retrospective cohort analysis of patients undergoing elective TKA was conducted using the PearlDiver database. Patients were stratified into three cohorts: those without pes planovalgus, patients with ipsilateral or bilateral pes planovalgus relative to the TKA, and patients with contralateral pes planovalgus. Patients with prior foot reconstructive surgery were excluded. The cohorts were each matched to those without pes planovalgus. Bivariate analysis was performed comparing 90-day medical complications and 2- and 4-year revisions following TKA. An adjusted number needed to be exposed for one additional person to be harmed (NNEH) was calculated using the adjusted odds ratio (OR) and unexposed event rate. RESULTS Following matched analysis, those with contralateral pes planovalgus had similar odds (OR 3.41; 95% CI 0.93-12.54; p = n.s.) for aseptic revision within 2 years but significantly higher odds (OR 3.35; 95% CI 1.08-10.41; p = 0.03) within 4 years when compared to those without a pes planovalgus deformity. Within 4 years, there was no significant difference in the incidence of aseptic revision (p = n.s.) in patients with ipsilateral/bilateral pes planovalgus. No patients in any cohort underwent septic revision within 4 years of TKA. CONCLUSION This study found that patients with contralateral pes planovalgus deformity had higher odds of aseptic revision within 4 years following primary TKA in a national database, suggesting that the change in gait kinematics associated with this deformity could possibly be associated with increased revision rates. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Zachary C Pearson
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA.
| | - Andrew B Harris
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA
| | - Amil R Agarwal
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA
| | - R Timothy Kreulen
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA
| | - Jalen Martin
- Department of Orthopaedic Surgery, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
| | - Uzoma Ahiarakwe
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA
| | - Gregory J Golladay
- Department of Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Savyasachi C Thakkar
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA
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Mann C, Berlth F, Grimminger PP. [Anastomotic techniques in minimally invasive esophageal and gastric surgery]. Chirurgie (Heidelb) 2023; 94:759-767. [PMID: 37358597 DOI: 10.1007/s00104-023-01902-0] [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] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 06/27/2023]
Abstract
In specialized centers minimally invasive surgery has become established as the standard of care for esophageal and gastric surgery. Offering equal oncological outcome, patients benefit with respect to lower postoperative pain and complication rates. The creation of the anastomosis during minimally invasive surgery remains a critical step and the complications are decisive for the immediate postoperative course. So far no clear consensus exists in the literature regarding the recommended techniques for placement of an anastomosis after resections in the upper gastrointestinal tract. This article summarizes and compares the various established anastomotic techniques used in minimally invasive esophageal and gastric surgery.
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Affiliation(s)
- Carolina Mann
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - Felix Berlth
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - Peter Philipp Grimminger
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
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Hinz S, Bömicke W, Bensel T. Cumulative 10-year performance of endodontically treated teeth with prosthetic restorations of base metal alloy double crowns with friction pins-a retrospective study. Clin Oral Investig 2023; 27:4411-4423. [PMID: 37212841 PMCID: PMC10415510 DOI: 10.1007/s00784-023-05060-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 05/02/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVES This 120-month follow-up study aimed to investigate the complication rate of abutment teeth after endodontic pretreatment with base metal alloy double crowns with friction pins. MATERIALS AND METHODS A total of 158 participants (n = 71, 44.9% women) aged 62.5 ± 12.7 years with 182 prostheses on 520 abutment teeth (n = 459, 88.3% vital) were retrospectively analyzed between 2006 and 2022. Of the endodontically treated abutment teeth, 6.9% (n = 36) were additionally treated with post and core reconstructions. Cumulative complication rates were calculated using the Kaplan-Meier estimator and log-rank test. In addition, Cox regression analysis was performed. RESULTS The cumulative complication rate at 120 months for the entire set of abutment teeth was 39.6% (confidence interval [CI]: 33.0-46.2). Endodontically treated abutment teeth (33.8%; CI: 19.6-48.0) were found to have a significantly higher cumulative fracture rate than vital teeth (19.9%; CI: 13.9-25.9, p < 0.001). Endodontically treated teeth restored with post and core reconstructions (30.4%; CI: 13.2-47.6) showed a nonsignificant lower cumulative fracture rate than that of teeth with root fillings only (41.6%; CI: 16.4-66.8, p = 0.463). CONCLUSIONS Higher 120-month cumulative fracture rates were observed in endodontically treated teeth. Comparable performance was observed in teeth with post and core reconstructions compared to teeth with root fillings only. CLINICAL RELEVANCE If endodontically treated teeth are used as abutments for double crowns, the risk of complications from these teeth should be considered when planning treatment and communicating with the patient.
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Affiliation(s)
- Sebastian Hinz
- Department of Prosthetic Dentistry, University School of Dental Medicine, Martin-Luther-University Halle-Wittenberg, Magdeburger Str. 16, 06112, Halle, Germany.
| | - Wolfgang Bömicke
- Department of Prosthetic Dentistry, University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Tobias Bensel
- Institute for Research in International Assistance, Akkon University for Human Sciences, Colditzstraße 34-36, 12099, Berlin, Germany
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Wang Y, Kahaer A, Maimaiti A, Guo H, Rexiti P. Complication, fusion, and revision rate in the lumbar cortical bone trajectory and pedicle screw fixation techniques: a systematic review and meta-analysis. J Orthop Surg Res 2023; 18:382. [PMID: 37226223 DOI: 10.1186/s13018-023-03820-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 05/02/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND To obtain the complication rate, fusion rate, and revision rate of the lumbar cortical bone trajectory technique and pedicle screw fixation technique in lumbar interbody fusion surgery by single-arm meta-analysis and lay a basis for orthopedic surgeons to select the fixation techniques and perioperative management. METHODS PubMed, Ovid Medline, Web of Science, CNKI, and Wanfang databases were searched comprehensively. Data extraction, content analysis, and quality assessment of the literature were performed by two independent reviewers according to the Cochrane Collaboration guidelines using R and STATA software for single-arm meta-analysis. RESULTS The total complication rate of the lumbar cortical bone trajectory technique was 6%, including a hardware complication rate of 2%, ASD (adjacent segment degeneration) rate of 1%, wound infection rate of 1%, dural damage rate of 1%, hematoma rate tending to 0%, fusion rate of 94%, and revision rate of 1%. Lumbar pedicle screw fixation techniques had a total complication rate of 9%, with a hardware complication rate of 2%, ASD rate of 3%, wound infection rate of 2%, dural damage rate of 1%, hematoma rate tending to 0%, fusion rate of 94%, and revision rate of 5%. This study was registered with PROSPERO, CRD42022354550. CONCLUSION Lumbar cortical bone trajectory was associated with a lower total complication rate, ASD rate, wound infection rate, and revision rate than pedicle screw fixation. The cortical bone trajectory technique reduces the incidence of intraoperative and postoperative complications and can be an alternative in lumbar interbody fusion surgery.
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Affiliation(s)
- Yixi Wang
- First Clinical Medical College, Xinjiang Medical University, Urumqi, China
| | - Alafate Kahaer
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Abulikemu Maimaiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Hailong Guo
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Paerhati Rexiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
- Key Laboratory of High Incidence Disease Research in Xingjiang (Xinjiang Medical University), China Ministry of Education, Urumqi, China.
- Xinjiang Clinical Research Center for Orthopedics, Xinjiang Medical University, Urumqi, China.
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Walter N, Szymski D, Kurtz SM, Alt V, Lowenberg DW, Lau EC, Rupp M. Femoral shaft fractures in eldery patients - An epidemiological risk analysis of incidence, mortality and complications. Injury 2023:S0020-1383(23)00490-4. [PMID: 37208254 DOI: 10.1016/j.injury.2023.05.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 05/02/2023] [Accepted: 05/13/2023] [Indexed: 05/21/2023]
Abstract
OBJECTIVES This work aimed at answering the following research questions: (1) What is the incidence of femoral shaft fractures in the geriatric population in the U.S.? (2) What is the rate of mortality, mechanical complications, nonunion and infection, and what are the associated risk factors? STUDY DESIGN AND SETTING In this cross-sectional study, femoral shaft fractures occurred between January 1, 2009, and December 31, 2019, were identified from Medicare records. Rates of mortality, nonunion, infection, and mechanical complications were calculated with the Kaplan-Meier method with Fine and Gray sub-distribution adaptation. Semiparametric Cox regression was applied with twenty-three covariates to determine risk factors. RESULTS Between 2009 through 2019 the incidence of femoral shaft fractures decreased by 12.07% to 40.8/100,000 inhabitants (p = 0.549). The 5-year mortality risk was 58.5%. Male sex, age over 75 years, chronic obstructive pulmonary disease, cerebrovascular disease, chronic kidney disease, congestive heart failure, diabetes mellitus, osteoporosis, tobacco dependence, and lower median household income were significant risk factors. The infection rate was 2.22% [95%CI: 1.90-2.58] and the union failure rate 2.52% [95%CI: 2.17-2.92] after 24 months. CONCLUSION An early assessment of individual patient risk factors may be beneficial in the care and treatment of patients with these fractures.
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Affiliation(s)
- Nike Walter
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Dominik Szymski
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Steven M Kurtz
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, USA
| | - Volker Alt
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - David W Lowenberg
- Department of Orthopaedic Surgery, Stanford School of Medicine, Stanford, USA
| | | | - Markus Rupp
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany.
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Tan DNH, Tan M, Liew H, Shen L, Ngiam KY, Chen DZ. A data-driven approach to evaluate factors affecting resident performance in cataract surgery. Int Ophthalmol 2023:10.1007/s10792-023-02730-1. [PMID: 37160586 DOI: 10.1007/s10792-023-02730-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 04/22/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE To evaluate the operative duration and clinical performance of ophthalmology residents performing standard phacoemulsification cataract surgeries using information available from electronic health records (EHR). METHODS This is a retrospective cohort study. De-identified surgical records of all standard phacoemulsifications performed in a tertiary institution between 1st January 2015 and 8th August 2018 were retrieved from the hospital EHR. The main outcome measures were improvement in operative duration with case experience, corrected distance visual acuity (CDVA) improvement, and intra-operative complication rates. RESULTS Twelve ophthalmology residents performed a total of 1427 standard phacoemulsifications. The median operative duration was 27 min (interquartile range, 22-34 min), which improved from 31 to 24 min (before the 101st case [Group 1] versus 101st case onwards [Group 2], p < 0.001). Gradient change analysis (non-linear regression) showed significant reduction until the 100th case (p = 0.043). Older patients (0.019), worse pre-operative CDVA (0.343), and surgery performed by Group 1 (1.115) were significantly associated with operative duration above 30 min. LogMAR CDVA improved from a mean of 0.57 ± 0.52 pre-operatively to 0.10 ± 0.18 post-operatively (p < 0.001). Posterior capsule rupture (PCR) rate decreased from 4.0% [Group 1] to 2.1% [Group 2] (p = 0.096), while overall complication rate decreased from 8.9% to 3.1% (p < 0.001). CONCLUSION The median operative duration reduced consistently with surgical experience for the first 100 cases. Older patients, poorer pre-operative VA, and surgical experience of less than 100 cases were significantly associated with an operative duration above 30 min. There was a statistically significant decrease in complication rate between Group 1 and 2.
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Affiliation(s)
- Darren Ngiap Hao Tan
- Department of Ophthalmology, National University Hospital, Level 7, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Marcus Tan
- Department of Ophthalmology, National University Hospital, Level 7, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Hariz Liew
- Department of Ophthalmology, National University Hospital, Level 7, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Liang Shen
- Biostatistics Unit, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Kee Yuan Ngiam
- Division of General Surgery (Endocrine and Thyroid Surgery), Department of Surgery, National University Hospital, Singapore, Singapore
| | - David Z Chen
- Department of Ophthalmology, National University Hospital, Level 7, 1E Kent Ridge Road, Singapore, 119228, Singapore.
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11
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Parikh RM, Ata A, Edwards MJ. A Contemporary Review of Surgical Approach and Outcomes in Pediatric Hypertrophic Pyloric Stenosis. J Surg Res 2023; 285:142-149. [PMID: 36669393 DOI: 10.1016/j.jss.2022.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/02/2022] [Accepted: 12/25/2022] [Indexed: 01/20/2023]
Abstract
INTRODUCTION In order to define optimal resources and outcome standards for infant pyloromyotomy, we sought to perform a contemporary analysis of surgical approach (laparoscopic versus open) and outcomes. METHODS The National Surgical Quality Improvement Project Pediatrics Participant Use File (NSQIP PUF) was queried from 2016 to 2020. Utilization of laparoscopy was trended over time. Complication rates and length of stay were compared by operative approach. RESULTS 9752 pyloromyotomies were included in the analysis. The utilization of laparoscopy steadily increased over the study time period (66% to 79%) and was associated with a shorter operative time. On multivariate regression, the utilization of laparoscopy was associated with a lower risk of overall complications, length of stay, and superficial surgical site infections. Overall complication rates were lower than previously reported (2.02%). The most common complication was superficial infection (1.2%). CONCLUSIONS In facilities reporting to pediatric National Quality Improvement Project, utilization of laparoscopy has steadily increased, and complication rates are lower than previously reported. Complication rates and length of stay were lower with the laparoscopic approach in this contemporary cohort. These results offer benchmarks for quality improvement initiatives. The laparoscopic approach should be standard in facilities performing this procedure.
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Affiliation(s)
| | - Ashar Ata
- Department of Surgery, Albany Medical Center, Albany, New York
| | - Mary J Edwards
- Department of Surgery, Albany Medical Center, Albany, New York.
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12
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Zou Q, Jiang J, Shi C, Wu B, Gui B, Zhou X. Single and double developing lines improve ultrasound-guided radial artery catheterization in obese patients: A randomized controlled trial. Anaesth Crit Care Pain Med 2023; 42:101166. [PMID: 36306989 DOI: 10.1016/j.accpm.2022.101166] [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: 08/25/2022] [Revised: 10/09/2022] [Accepted: 10/11/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Arterial catheterization is challenging in obese patients. The present study tested the hypothesis that ultrasound guidance with acoustic shadowing improves the success rate of radial artery catheterization in obese patients. METHODS 240 obese patients were enrolled and were randomly assigned to three groups: control group, single developing line group, or double developing lines group. Patients underwent radial artery catheterization guided by acoustic shadowing ultrasound with none, single or double developing lines. The primary outcome was the first-attempt success rate. The secondary outcomes included the procedure time and complication rate. RESULTS In the single or double developing lines group, the success rate of radial artery catheterization at the first attempt was higher than in the control group (control vs. single vs. double, 71% vs. 90% vs. 91%, P = 0.001). Besides, the single and double developing lines groups had a shorter procedure time to success at the first attempt and a lower overall complication (vasospasm and hematoma) rate than the control group (procedure time: control vs. single vs. double, 63 s vs. 54 s vs. 40 s, P < 0.001; overall complication rate: control vs. single vs. double, 29% vs. 10% vs. 9%, P = 0.001). There was no significant difference in the first-attempt success rate, the procedure time to success within the first attempt, or overall complications' rate between the single and double developing lines groups. CONCLUSION Single and double developing lines improve first-attempt success rate and reduced the overall complications' rate of ultrasound-guided radial artery catheterization in obese patients.
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Affiliation(s)
- Qi Zou
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jindi Jiang
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chonglong Shi
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Bianliang Wu
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Bo Gui
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xuelong Zhou
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Bassi S, Pinar U, Di Maria S, Gambachidze D, Manach Q, Chartier-Kastler E. Ambulatory peri-bulbar implantation, revision and replacement of Artificial Urinary Sphincter in neurogenic and non-neurogenic male patients: A preliminary feasibility study over a one-year experience. Prog Urol 2023:S1166-7087(23)00061-1. [PMID: 36925358 DOI: 10.1016/j.purol.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/16/2023] [Accepted: 02/19/2023] [Indexed: 03/17/2023]
Abstract
INTRODUCTION Our goal was to determine the rate of complications, early revision and removal after full ambulatory implantation of bulbar AUS in men; secondly, to describe satisfaction and short-term continence rate. MATERIAL AND METHODS Between April 2018 and April 2019, 28 consecutive patients underwent AUS implantation in a newly organised ambulatory setting. A prospective database of all included patients was established with comprehensive data collected on medical history, aetiology and severity of SUI, surgical procedures, postoperative complications and patient satisfaction. RESULTS Twenty-eight patients were included (30 consecutive procedures: 22 primary AUS placement, 6 complete revisions, 2 partial revisions), with a mean follow up of 223±220.5 days. Fourteen patients had prior radiotherapy. Readmission rate was 6.7% in the first 30 days after surgery. Both revision and removal rates were 6.7%. Complications were reported in 26.7% of procedures, mainly Clavien-Dindo I. Patient satisfaction of ambulatory surgery organisation and experience was high (87/5% satisfied or very satisfied). Full continence & social continence were achieved for, respectively, 55.6% and 88.9% of procedures. CONCLUSION Ambulatory placement of AUS is safe and can be performed successfully. Larger patient cohorts and randomised trials are crucial to improve knowledge on non-indications for full ambulatory AUS implantation in men. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- S Bassi
- Department of Urology, University of Verona, Piazzale Aristide Stefani, 1, 37126 Verona (VR), Italy; Department of Urology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - U Pinar
- Department of Urology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - S Di Maria
- Department of Anaesthesiology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - D Gambachidze
- Department of Urology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - Q Manach
- Department of Urology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - E Chartier-Kastler
- Department of Urology, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France.
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14
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Stephens SP, Decoons RM, Szerlip BW, Goubeaux CA, Schuette HB, Glazier MT, Braden AM, Hendrickson LA, Comisar BR. Outpatient total shoulder arthroplasty in the ambulatory surgery center: a comparison of early complications in patients with and without glenoid bone loss. JSES Int 2023; 7:270-6. [PMID: 36911779 DOI: 10.1016/j.jseint.2022.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background The purpose of this study is to compare the 90-day complications and readmission rates between patients undergoing total shoulder arthroplasty (TSA) in an ambulatory surgery center (ASC) with glenoid bone loss requiring an augmented glenoid component compared to patients without bone loss. Methods This is a retrospective cohort study of patients undergoing outpatient TSA at an ASC (2018-2021). Readmission, direct transfer, and complications were recorded. Major and minor complications were compared. Secondary outcomes included operative time, estimated blood loss, range of motion, and patient-reported outcome measures. Results There were 44 patients (45 shoulders) included in the study, 20 with augmented implants for glenoid bone loss and 25 nonaugmented with a concentric glenoid. There were no statistical differences in demographics. Two complications were seen in both the augmented and nonaugmented groups (10% vs. 8%). There were no readmissions or direct transfers. The augmented group had significantly increased preoperative glenoid retroversion (23° vs. 9°, P < .05), posterior humeral head subluxation (78% vs. 61%., P < .05), and longer operative time (124.4 min vs. 112.3 min., P < .05). Patient-specific instrumentation was used in 60% of augmented cases and 29% of nonaugmented cases. Conclusion There was no significant difference in complications, direct transfers, or readmissions between patients with and without glenoid bone loss being treated in an outpatient ASC. The augmented group had significantly worse preoperative deformities, longer operative times, and increased utilization of patient-specific instrumentation. Outpatient TSA in the setting of glenoid bone loss requiring augmentation was found to be safe and effective at a stand-alone ASC.
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15
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Sato H, Ota H, Munakata K, Matsuura Y, Fujii M, Wada N, Takiuchi D, Hama N, Takachi K, Yukawa M. Perioperative fluid management influences complication rates and length of hospital stay in the enhanced recovery after surgery (ERAS) protocol for patients with colorectal cancer. Surg Today 2023; 53:242-251. [PMID: 35933631 DOI: 10.1007/s00595-022-02568-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/18/2022] [Indexed: 01/28/2023]
Abstract
PURPOSE To evaluate the efficacy and safety of the enhanced recovery after surgery (ERAS) protocol and quantify the impact of each ERAS item on postoperative outcomes. METHODS We used a generalized linear model to compare 289 colorectal cancer patients treated with the ERAS protocol between June, 2015 and April, 2021, with 99 colorectal cancer patients treated with the conventional colorectal surgery pathway between April, 2014 and June, 2015. RESULTS The median length of hospital stay (LOHS) was significantly shorter in the ERAS group, at 9 days (range 3-104 days) vs. 14 days (range 4-44 days) (p < 0.001), but the complication rates (Clavien-Dindo grade 2 or more) were similar (16.6% vs. 22.2%; p = 0.227). However, in the ERAS group, the higher the compliance with ERAS items, the lower the complication rate and LOHS (both p < 0.001). Multiple regression analysis demonstrated that "Discontinuation of continuous intravenous infusion on POD1" and "Avoidance of fluid overload" were significantly associated with the LOHS (p < 0.001 and p = 0.008). CONCLUSION The ERAS protocol is safe and effective for elective colorectal cancer surgery, and compliance with the ERAS protocol contributes to shorter LOHS and fewer complications. Items related to perioperative fluid management had a crucial impact on these outcomes.
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Affiliation(s)
- Hiromichi Sato
- Department of Gastroenterological Surgery, Ikeda City Hospital, Ikeda, Japan
| | - Hirofumi Ota
- Department of Gastroenterological Surgery, Ikeda City Hospital, Ikeda, Japan.
| | - Koji Munakata
- Department of Gastroenterological Surgery, Ikeda City Hospital, Ikeda, Japan
| | - Yusuke Matsuura
- Department of Gastroenterological Surgery, Ikeda City Hospital, Ikeda, Japan
| | - Makoto Fujii
- Division of Health Sciences, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Noriko Wada
- Department of Gastroenterological Surgery, Ikeda City Hospital, Ikeda, Japan
| | - Daisuke Takiuchi
- Department of Gastroenterological Surgery, Ikeda City Hospital, Ikeda, Japan
| | - Naoki Hama
- Department of Gastroenterological Surgery, Ikeda City Hospital, Ikeda, Japan
| | - Kou Takachi
- Department of Gastroenterological Surgery, Ikeda City Hospital, Ikeda, Japan
| | - Masao Yukawa
- Department of General and Breast Surgery, Ikeda City Hospital, Ikeda, Japan
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16
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Gottardi E, Renaudin B, Ville Y. [Interruption of pregnancy between 12 and 16 weeks of gestation: Complications depending on term and method]. Gynecol Obstet Fertil Senol 2022; 50:519-526. [PMID: 35595063 DOI: 10.1016/j.gofs.2022.05.001] [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: 12/19/2021] [Revised: 05/03/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Analyze the complication rate of pregnancy termination between 12 and 16 weeks of gestation, depending on the method and the exact term. MATERIAL AND METHODS Retrospective study focuses on patients who were going through a pregnancy termination between January 2015 and December 2020 at the Necker Universitary hospital in Paris. Two methods were applied: surgical abortion or medical evacuation. We compared 4 groups of patients depending on methods and term (12-14 or 14-16 weeks of gestation). The main complications such as hemorrhage, infection, need for surgery were collected. RESULTS 414 patients were included. Blood loss and hemorrhage rate>500cc were higher for surgical abortion (3.5 vs 55% P<0.001), but the medical evacuation lead to an important rate of secondary aspiration for trophoblastic retention (14.7% vs 1.5% P<0.001). We didn't observe any difference regarding the complication rate for medical evacuation depending on the term. However, in case of surgical abortion the increase of term from 12-14 to 14-16 weeks of gestation leads to a tiny increment of the transfusion rate (0.6% vs 4.4% P=0.04), even if the hemorrhage rate >500cc didn't significantly differ (50,3 vs 57,9% P=0,2). CONCLUSION Surgical abortion between 12 and 16 weeks of gestation exposed the patients to an increased hemorrhagic risk, while the medical evacuation required more secondary aspiration for trophoblastic retention. The term of the abortion didn't affect the complication rate, beside a tiny increase in transfusion rate for surgical abortion.
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Affiliation(s)
- E Gottardi
- Service de Gynécologie Obstétrique de l'hôpital Necker, 149, rue de Sèvre, 75015 Paris, France.
| | - B Renaudin
- Service de Gynécologie Obstétrique de l'hôpital Necker, 149, rue de Sèvre, 75015 Paris, France
| | - Y Ville
- Service de Gynécologie Obstétrique de l'hôpital Necker, 149, rue de Sèvre, 75015 Paris, France
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Ibis MA, Gokce MI, Babayigit M, Yitgin Y, Karagoz MA, Boyuk A, Verep S, Turan S, Tefik T, Kiremit MC, Sonmez MG, Ergul R, Guven S, Sarica K. Could retrograde intrarenal surgery be a safe and effective alternative to mini-percutaneous nephrolithotomy ın the management of relatively large (20-30 mm) stones? A critical evaluation. Int Urol Nephrol 2022; 54:2141-2148. [PMID: 35763186 DOI: 10.1007/s11255-022-03255-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 05/11/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare the outcomes of mini-percutaneous nephrolithotomy (mPCNL) and retrograde intrarenal surgery (RIRS) in patients with renal stones sizing 2-3 cm. METHODS A total of 566 patients from 6 institutions who underwent mPCNL (n = 440) and RIRS (n = 126) procedures were enrolled in our study. The retrospective patient cohort was reviewed and compared. Binary logistic regression analysis was performed to determine factors predicting success in the RIRS group. RESULTS The stone-free rates were 91.1 and 77% for the mPCNL and RIRS groups, respectively (p < 0.001). The auxiliary procedure rates were 4.5 and 39.7% in the mPCNL and RIRS groups, respectively (p < 0.001). Mean values of hemoglobin decrease, fluoroscopy time, and hospitalization time were significantly higher in the mPCNL group (p < 0.001). While the Clavien grade 1-2 complication rates were 10.9 and 34.1% (p < 0.001) in two groups, these values were 2.7 and 1.6% (p = 0.539), respectively, for Clavien grade 3-4 complication rates. Although three patients in the mPCNL group received blood transfusions, none of the patients in the RIRS groups were transfused. The stone location and stone density parameters were found to be the independent predictive factors for RIRS success. CONCLUSIONS mPCNL provided a higher stone-free rate, less need for the auxiliary procedure, and lower complication rates compared to RIRS in patients with 2-3 cm stones. Blood loss, radiation exposure, and a hospital stay of mPCNL can be significantly reduced with the RIRS technique in selected patients.
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Affiliation(s)
- Muhammed Arif Ibis
- Department of Urology, University of Health Sciences, Ataturk Sanatoryum Training and Research Hospital, Ankara, 06380, Turkey.
| | - Mehmet Ilker Gokce
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Muammer Babayigit
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Yasin Yitgin
- Department of Urology, Istinye University School of Medicine, Istanbul, Turkey
| | - Mehmet Ali Karagoz
- Department of Urology, University of Health Sciences, Cemil Tascıoglu City Hospital Training and Research Hospital, Prof. Dr, Istanbul, Turkey
| | - Abubekir Boyuk
- Department of Urology, Private Istanbul Medivita Ethica Hospital, Istanbul, Turkey
| | - Samed Verep
- Department of Urology, University of Health Sciences, Van Training and Research Hospital, Van, Turkey
| | - Serdar Turan
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Tzevat Tefik
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Murat Can Kiremit
- Department of Urology, School of Medicine, Koc University, Istanbul, Turkey
| | | | - Rifat Ergul
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Selcuk Guven
- Department of Urology, NEÜ Meram Medicine Faculty, Konya, Turkey
| | - Kemal Sarica
- Department of Urology, Biruni University School of Medicine, Istanbul, Turkey
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Li M, Luo R, Zeng Y, Wu Y, Liu Y, Wu L, Shen B. Same-day discharge arthroplasty has a higher overall complications rate than fast-track arthroplasty: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2022; 142:1167-1176. [PMID: 34129118 DOI: 10.1007/s00402-021-03883-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/27/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Published studies have reported many inconsistent results regarding the comparison of same-day discharge total joint arthroplasty (TJA) and inpatient TJA. More notably, many recent studies comparing same-day discharge TJA with fast-track TJA presented higher rates of complications for same-day discharge TJA, which raises concerns about the safety of same-day discharge TJA. METHODS We systematically searched the MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases up to June 2020 for studies comparing mortality, readmission, and complications in same-day discharge and inpatient total hip or knee arthroplasty. Studies that used inpatient TJA as the control could be further divided into fast-track inpatient TJA (length of stay [LOS] ≤ 2 days) and traditional inpatient TJA (no restrictions on LOS). Relative risks were pooled to compare the outcomes of the same-day discharge group and the control group. RESULTS According to selection criteria and quality assessment, 14 studies including 222,766 cases were identified. There was no significant difference in the risk of mortality (RR = 1.42, CI [0.67, 3.01]) or readmission (RR = 0.93, CI [0.79, 1.10]) between same-day discharge TJA and inpatient TJA. Compared with fast-track TJA, the rate of overall complications in same-day discharge TJA was significantly higher (RR = 1.67, CI [1.45, 1.93]), while the rates of overall complications were similar between same-day discharge and traditional inpatient TJA (RR = 0.83, CI [0.67, 1.03]). CONCLUSION The overall safety of same-day discharge TJA is satisfactory; however, more complications were detected in same-day discharge TJA than that in fast-track TJA. Complications in same-day discharge TJA might be underestimated in some previous studies taking long-staying inpatient TJA as control. Being more cautious about complications is necessary in the care of same-day discharge TJA, and extensive prospective studies are needed to explore the optimized option that weighs both cost and complications.
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Affiliation(s)
- Mingyang Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, 610041, Chengdu, Sichuan, People's Republic of China
| | - Rong Luo
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, 610041, Chengdu, Sichuan, People's Republic of China
| | - Yi Zeng
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, 610041, Chengdu, Sichuan, People's Republic of China
| | - Yuangang Wu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, 610041, Chengdu, Sichuan, People's Republic of China
| | - Yuan Liu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, 610041, Chengdu, Sichuan, People's Republic of China
| | - Limin Wu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, 610041, Chengdu, Sichuan, People's Republic of China
| | - Bin Shen
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, 610041, Chengdu, Sichuan, People's Republic of China.
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Bulian DR, Sauerwald A, Thomaidis P, Seefeldt CS, Richards DC, Schulz SA, Weltermann NJ, Heiss MM, Eisenberger CF. Does a prior hysterectomy complicate transvaginal/transumbilical hybrid NOTES cholecystectomy?-a comparative analysis of prospectively collected data. Langenbecks Arch Surg 2021; 407:655-662. [PMID: 34964915 PMCID: PMC8933306 DOI: 10.1007/s00423-021-02401-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 12/06/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE Hysterectomy alters the anatomy of the posterior vaginal vault used as access for transvaginal/transumbilical hybrid NOTES cholecystectomy (NC), creating potential consequences for the feasibility and complication rate of the procedure. Therefore, the aim of our retrospective analysis of prospectively collected data was to analyze the postoperative course after NC in previously hysterectomized (PH) patients compared with patients who had not undergone hysterectomy (NH). METHODS A total of 126 NH patients and 50 PH patients aged over 42 who had an NC from 12/2008 to 04/2021 were compared regarding age, body mass index (BMI), ASA classification, number of percutaneous trocars, need for intraoperative urinary bladder catheterization, length of procedure, conversion rate, and intraoperative and postoperative complication rate according to the Clavien/Dindo classification, Comprehensive Complication Index (CCI), mortality, and hospital length of stay. RESULTS PH patients were older than NH patients (63.0 vs 51.5 years; P < 0.001) but did not differ significantly in ASA classification (P = 0.595) and BMI (26.8 vs 27.9 kg/m2; P = 0.480). They required more percutaneous trocars (P = 0.047) and longer procedure time (66.0 vs. 58.5 min; P = 0.039). Out of all 287 scheduled NC only one had to be "converted" to traditional laparoscopic cholecystectomy. Intraoperative and postoperative complication rates, Clavien/Dindo classification, CCI, need for intraoperative urinary bladder catheterization, and length of stay did not differ significantly. CONCLUSION Our results indicate an increased degree of difficulty of NC in PH patients, although there is no major impact on intraoperative and postoperative complication rates. Urinary bladder perforation is a specific access-related complication in PH patients.
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Affiliation(s)
- Dirk R Bulian
- Department of Abdominal, Tumor, Transplant and Vascular Surgery, Cologne-Merheim Medical Center, Witten/Herdecke University, Ostmerheimer Strasse 200, D-51109, Cologne, Germany.
| | - Axel Sauerwald
- Department for Obstetrics and Gynecology, Holweide Hospital, Neufelder Strasse 32, D-51067, Cologne, Germany
- Department of Gynecology and Obstetrics, St. Marien- Hospital, Hospitalstraße 44, D-52353, Dueren, Germany
| | - Panagiotis Thomaidis
- Department of Abdominal, Tumor, Transplant and Vascular Surgery, Cologne-Merheim Medical Center, Witten/Herdecke University, Ostmerheimer Strasse 200, D-51109, Cologne, Germany
| | - Claudia S Seefeldt
- Department of Abdominal, Tumor, Transplant and Vascular Surgery, Cologne-Merheim Medical Center, Witten/Herdecke University, Ostmerheimer Strasse 200, D-51109, Cologne, Germany
| | - Dana C Richards
- Department of Abdominal, Tumor, Transplant and Vascular Surgery, Cologne-Merheim Medical Center, Witten/Herdecke University, Ostmerheimer Strasse 200, D-51109, Cologne, Germany
| | - Sissy-A Schulz
- Department of Abdominal, Tumor, Transplant and Vascular Surgery, Cologne-Merheim Medical Center, Witten/Herdecke University, Ostmerheimer Strasse 200, D-51109, Cologne, Germany
| | - Niklas J Weltermann
- Department of Abdominal, Tumor, Transplant and Vascular Surgery, Cologne-Merheim Medical Center, Witten/Herdecke University, Ostmerheimer Strasse 200, D-51109, Cologne, Germany
| | - Markus M Heiss
- Department of Abdominal, Tumor, Transplant and Vascular Surgery, Cologne-Merheim Medical Center, Witten/Herdecke University, Ostmerheimer Strasse 200, D-51109, Cologne, Germany
| | - Claus F Eisenberger
- Department of Abdominal, Tumor, Transplant and Vascular Surgery, Cologne-Merheim Medical Center, Witten/Herdecke University, Ostmerheimer Strasse 200, D-51109, Cologne, Germany
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Merboth F, Hasanovic J, Stange D, Distler M, Kaden S, Weitz J, Welsch T. [Change of strategy to minimally invasive esophagectomy-Results at a certified center]. Chirurg 2021; 93:694-701. [PMID: 34932142 PMCID: PMC9246796 DOI: 10.1007/s00104-021-01550-2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2021] [Indexed: 02/07/2023]
Abstract
Hintergrund Es gibt Hinweise, dass die roboterassistierte minimal-invasive Ösophagektomie (RAMIE) die Morbidität im Vergleich zur konventionellen Operationstechnik verringern kann. Ziel der Arbeit Es erfolgte eine Vergleichsanalyse eines Single-Center-Strategiewechsels des Standards von offener Ösophagektomie zu RAMIE mit perioperativer, enteraler, selektiver Darmdekontamination (SDD). Material und Methoden Patienten- und Morbiditätsdaten nach elektiver RAMIE entsprechend dem neuen Standardmanagement zwischen Juli 2018 und September 2020 wurden retrospektiv mit einer historischen Kontrollkohorte nach offener Ösophagektomie zwischen Januar 2014 und Juni 2018 verglichen. Es erfolgte eine 1:1-Propensity-Score-Matching(PSM)-Analyse. Ergebnisse Insgesamt 75 Patienten konnten nach PSM in beiden Gruppen analysiert werden. Etwa zwei Drittel der Operationen erfolgte aufgrund eines Adenokarzinoms und ein Drittel bei Plattenepithelkarzinom. Im Median wurden 22 bzw. 21 Lymphknoten reseziert. Die intrathorakale Ösophagogastrostomie erfolgte in der RAMIE-Gruppe in 97 % mit einem Zirkularstapler mit ≥28 mm Durchmesser (offen: 25 mm in 90 % der Fälle). Die Operationszeit war länger (Median 490 vs. 339 min, p < 0,001), hingegen waren der Blutverlust (Median 300 vs. 500 ml, p < 0,001), die Anastomoseninsuffizienz- (8,0 % vs. 25,3 %, p = 0,004), Wundinfektions- (4,0 % vs. 17,3 %, p = 0,008) und pulmonale Komplikationsrate (29,3 % vs. 44,0 %, p = 0,045) sowie die mediane Krankenhausverweildauer (14 vs. 20 Tage, p < 0,001) und die 90-Tage-Mortalität signifikant geringer verglichen mit der offenen Kontrollkohorte (4,0 % vs. 13,3 %, p = 0,039). Diskussion Ein konsequenter Wechsel des perioperativen Managements u. a. mit RAMIE und SDD kann zu einer stabilen Reduktion der Morbidität ohne Einschränkungen der onkologischen Radikalität führen.
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Affiliation(s)
- Felix Merboth
- Klinik und Poliklinik für Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - Jasmin Hasanovic
- Klinik und Poliklinik für Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - Daniel Stange
- Klinik und Poliklinik für Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - Marius Distler
- Klinik und Poliklinik für Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - Sandra Kaden
- Klinik-Apotheke, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland
| | - Jürgen Weitz
- Klinik und Poliklinik für Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - Thilo Welsch
- Klinik und Poliklinik für Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus, Fetscherstr. 74, 01307, Dresden, Deutschland
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Michno V, Malter W, Paepke S, Thill M, Kelling K, Meiré A, Tofall S, Nolte E, Christ H, Eichler C. Impact of demographic and perioperative risk factors on complication rates in skin-sparing/nipple-sparing mastectomy with implant-based reconstruction using titanized polypropylene mesh (TiLOOP® Bra). Surg Oncol 2021; 40:101675. [PMID: 34871867 DOI: 10.1016/j.suronc.2021.101675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/11/2021] [Accepted: 11/14/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Skin/nipple-sparing mastectomies (SSM/NSSM) have been reported to have acceptable complication rates and good aesthetic outcomes with high patient satisfaction. However, in this relatively young and rapidly expanding field of reconstructive plastic surgery, differences in perioperative management are noted between breast centers. Prospective studies of complication rates using a titanized polypropylene mesh (TiLOOP® Bra) are currently lacking. METHODS A prospective subgroup analysis was performed based on the data set of the prospective, single-arm, multicenter observational study (PRO-BRA). Early complication rates after skin/nipple-sparing mastectomy with implant-based immediate or secondary reconstruction using a titanized polypropylene mesh (TiLOOP® Bra) subpectorally were investigated in relation to demographic factors, as well as intra-and postoperative management. The subgroup consists of 258 patients. Complications were categorised into necrosis, infection, postoperative bleeding or hematoma, seroma, wound healing delays and R1-situations. RESULTS Early complication rates of SSM/NSSM using titanium-based meshes are comparable to complication-rates using ADM's. Logistic regression shows significantly higher risk for wound healing delays, necrosis and seroma with increasing BMI, abladat- and implant-weight (OR 1,17 -1,66, p-value < 0,001). Smokers have significantly higher necrosis rates (20.7%) compared to non-smokers (5.5%) (p-value = 0.002). Discharge with drainage results in a trend toward higher rates of wound healing complications. CONCLUSION The use of TiLOOP® Bra meshes was shown to have acceptable complication rates. Complication rates depend on certain demographic and intraoperative risk factors and should be considered in indications and information of patients.
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Affiliation(s)
- Viktoria Michno
- Clinic for Gynecology and Obstetrics, Center of Breast Disease, University of Cologne, Cologne, Germany.
| | - Wolfram Malter
- Clinic for Gynecology and Obstetrics, Center of Breast Disease, University of Cologne, Cologne, Germany
| | - Stefan Paepke
- Department of Obstetrics and Gynecology, Technical University of Munich, Munich, Germany
| | - Marc Thill
- Department of Gynecology and Gynecologic Oncology, Agaplesion Markus Hospital, Frankfurt Am Main, Germany
| | - Katharina Kelling
- Department of Gynecology and Gynecologic Oncology, Agaplesion Markus Hospital, Frankfurt Am Main, Germany
| | - Anette Meiré
- Center of Breast Disease,St. Elisabeth Hospital, Cologne, Germany
| | | | | | - Hildegard Christ
- Clinic for Gynecology and Obstetrics, Center of Breast Disease, University of Cologne, Cologne, Germany
| | - Christian Eichler
- Breast Cancer Center, St.- Franziskus Hospital Münster, Germany and Clinic for Gynecology and Obstetrics, Center of Breast Disease, University of Cologne, Cologne, Germany
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Liu SY, Li C, Zhang PX. Enhanced recovery after surgery for hip fractures: a systematic review and meta-analysis. Perioper Med (Lond) 2021; 10:31. [PMID: 34511117 PMCID: PMC8436561 DOI: 10.1186/s13741-021-00201-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 06/22/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) programs have achieved promising results in many surgical specialties. However, uncertainty still remains regarding the effect of ERAS on hip fractures. The objective of this review was to investigate the clinical prognosis of ERAS programs in terms of (1) hospital-related endpoints (time to surgery [TTS], length of stay [LOS]), (2) readmission rate, (3) complications, and (4) mortality. METHODS Published literature was searched in the PubMed, EMBASE, and Cochrane Library databases. All of the included studies met the inclusion criteria. The primary outcomes were TTS and LOS. The secondary outcomes included the 30-day readmission rate, overall complication rate, specific complication rate (delirium and urinary tract infection), and 30-day and 1-year mortality. Language was restricted to English. The data analysis was carried out by Review Manager 5.3. RESULTS A total of 7 published studies (9869 patients) were finally included, and these were all cohort studies. The meta-analysis showed that the TTS, LOS, and overall complication rate were significantly reduced in the ERAS group compared with the control group (p < 0.01). Moreover, no significant change was found in the 30-day readmission rate or 30-day and 1-year mortality. CONCLUSIONS ERAS significantly decreases the TTS, LOS, and complication rate without increasing readmission rate and mortality, which adds to the evidence that the implementation of ERAS is beneficial to patients undergoing hip fracture repair surgeries.
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Affiliation(s)
- Song-Yang Liu
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, China
| | - Ci Li
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, China
| | - Pei-Xun Zhang
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, China.
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Pantea R, Meister P, Neuhaus JP, Nowak K, Paul A, Saner FH. [Surgery in patients with liver cirrhosis]. Chirurg 2021; 92:838-845. [PMID: 33459796 PMCID: PMC8384819 DOI: 10.1007/s00104-020-01319-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Hintergrund und Ziel der Arbeit Patienten mit einer Leberzirrhose, die eine operative Behandlung benötigen, weisen eine hohe Krankenhausmortalität auf. Die vorliegende Studie untersucht die postoperative Morbidität sowie Krankenhausmortalität nach stattgehabter Operation von Patienten mit einer Leberzirrhose. Material und Methode Retrospektiv wurden im Zeitraum von 01/2010 bis 12/2017 321 Patienten mit einer Leberzirrhose in unserer Klinik operativ behandelt. Erfasst wurden leberspezifische Scoringsysteme wie MELD(Model of End Stage Liver Disease)- und Child-Pugh-Score (CPS), die Krankenhausletalität und die postoperative Morbidität wurden mittels der Dindo-Clavien-Klassifikation erhoben. Ergebnisse Von den 321 Patienten (68 % männlich) wurden 21,2 % als Notfall versorgt. Die Letalität der Notfallpatienten war mit 60 % signifikant höher als die der elektiv operierten Patienten (12 %, p < 0,0001). Komplexe Eingriffe zeigen insgesamt eine Letalität von 41 %, kleinere Eingriffe immer noch 20,5 % (p = 0,0001). Die postoperativen Komplikationsrate und Mortalität zeigten sich nach CPS signifikant unterschiedlich bei 11,8 % bzw. 6,3 % in der CPS-A-Kategorie im Vergleich zu 84 % bzw. 73 % in der CPS-C-Kategorie (p = 0,001). Statistisch steigt die Krankenhausletalität um etwa 20 % mit jedem MELD-Anstieg um einen Punkt (OR 1,23, p = 0,0001). Am schwerwiegendsten ist das Vorliegen einer hepatischen Dekompensation. Diskussion Operative Eingriffe von Patienten mit Leberzirrhose sind mit einer hohen Komplikationsrate und Krankenhausletalität verbunden. CPS und MELD können bei der objektiven Risikoeinschätzung helfen, während auch die klinische Untersuchung auf Zeichen einer hepatischen Dekompensation von Bedeutung ist. Natrium, Kreatinin und andere Laborwerte können diese Einschätzung ergänzen.
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Affiliation(s)
- Roxana Pantea
- Klinik für Allgemein‑, Viszeral-, und Transplantationschirurgie, Universitätsklinikum Essen, Hufelandstr 55, 45147, Essen, Deutschland
| | - Phil Meister
- Klinik für Allgemein‑, Viszeral-, und Transplantationschirurgie, Universitätsklinikum Essen, Hufelandstr 55, 45147, Essen, Deutschland
| | - Jan P Neuhaus
- Klinik für Allgemein‑, Viszeral-, und Transplantationschirurgie, Universitätsklinikum Essen, Hufelandstr 55, 45147, Essen, Deutschland
| | - Knut Nowak
- Klinik für Allgemein‑, Viszeral-, und Transplantationschirurgie, Universitätsklinikum Essen, Hufelandstr 55, 45147, Essen, Deutschland
| | - Andreas Paul
- Klinik für Allgemein‑, Viszeral-, und Transplantationschirurgie, Universitätsklinikum Essen, Hufelandstr 55, 45147, Essen, Deutschland
| | - Fuat H Saner
- Klinik für Allgemein‑, Viszeral-, und Transplantationschirurgie, Universitätsklinikum Essen, Hufelandstr 55, 45147, Essen, Deutschland.
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Gekka M, Osanai T, Aoki T, Nakayama N, Kazumata K, Houkin K, Fujimura M. Efficacy of Carotid Artery Stenting Performed under General Anesthesia with Somatosensory Evoked Potential Monitoring. J Stroke Cerebrovasc Dis 2021; 30:106007. [PMID: 34407498 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/01/2021] [Accepted: 07/10/2021] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES During carotid artery stenting (CAS), hemodynamics may be affected by the carotid sinus reflex in some cases. Although general anesthesia has been reported to stabilize intraoperative hemodynamics, the patient's neurological condition must be assessed indirectly. Therefore, we investigated the changes in intraoperative hemodynamics and perioperative complications of CAS under general anesthesia and evaluated the efficacy of somatosensory evoked potential (SEP) monitoring in detecting a reduction in perfusion during CAS. MATERIALS AND METHODS From April 2011 to August 2016,57 consecutive patients who underwent CAS under general anesthesia were evaluated. The follow-up period ranged from 3 to 8 years. During CAS, anesthesiologists monitored and managed the hemodynamics. SEP monitoring was performed during the CAS procedure in all patients. RESULTS Intraoperative hypotension (systolic blood pressure ≤ 100 mmHg) was evident in 16 patients (28.1%), and 13 patients (22.8%) experienced intraoperative bradycardia; however, all of these cases were promptly managed under general anesthesia. None of the patients showed systolic blood pressure < 50 mmHg from baseline. Regarding perioperative complications, none of the patients exhibited myocardial infarction or postoperative hyperperfusion symptoms, and there was no mortality. Among 21 patients (36.8%) with a decrease in the intraoperative SEP, 3 (5.3%) exhibited transient ischemic symptoms and 1 (1.8%) had postoperative infarction. CONCLUSIONS CAS under general anesthesia is a safe and effective management option in terms of intraoperative hemodynamic stability. In addition, our findings indicate that SEP monitoring could be helpful in evaluating transient postoperative cerebral ischemia or cerebral infarction after CAS.
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Affiliation(s)
- Masayuki Gekka
- Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15 West 7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan.
| | - Toshiya Osanai
- Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15 West 7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan.
| | - Takeshi Aoki
- Department of Neurosurgery, Hokkaido Neurosurgical Memorial Hospital, Sapporo, Japan.
| | - Naoki Nakayama
- Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15 West 7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan
| | - Ken Kazumata
- Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15 West 7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan
| | - Kiyohiro Houkin
- Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15 West 7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan.
| | - Miki Fujimura
- Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15 West 7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan.
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van der Stuijt W, Quast AFBE, Baalman SWE, de Wilde KC, Brouwer TF, Wilde AAM, Knops RE. Complications related to elective generator replacement of the subcutaneous implantable defibrillator. Europace 2021; 23:395-399. [PMID: 33197266 PMCID: PMC7947576 DOI: 10.1093/europace/euaa263] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 08/07/2020] [Indexed: 11/27/2022] Open
Abstract
Aims To guarantee uninterrupted function of the subcutaneous implantable cardioverter-defibrillator (S-ICD), the pulse generator needs to be surgically replaced before the battery is depleted. The risks related to this replacement substantially impact long-term outcome for S-ICD recipients, as the majority will undergo one or several of these procedures in their lifetime. We aim to describe the procedural characteristics of the replacement procedure and to provide an insight in the complications associated with these replacements. Methods and results In this retrospective analysis, data from replacement procedures and follow-up visits were collected from all patients who underwent elective S-ICD generator replacement in our tertiary centre from June 2014 until November 2019. Original device position was assessed using the PRAETORIAN score. Complications were defined as those requiring surgical intervention, systemic antibiotic treatment, or device extraction. Seventy-two patients were included, with a median follow-up of 1.9 years (IQR 0.6–3.3 years) after replacement. Battery depletion occurred after 5.9 ± 0.7 years. The pulse generator was repositioned in patients with a PRAETORIAN score ≥90 to minimize the defibrillation threshold. Although there was an increase in impedance compared to the implant procedure, first shock conversion rate during defibrillation testing was 91.4% with a success rate of 100% after multiple attempts. Two patients developed a complication after, respectively, 9 and 21 months, resulting in a complication rate of 1.4% per year. Conclusion With a median follow-up of 1.9 years, this study shows a low complication rate after S-ICD replacement, with a first shock conversion rate of 91.4%.
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Affiliation(s)
- Willeke van der Stuijt
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, AMC, PO Box 22700, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Anne-Floor B E Quast
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, AMC, PO Box 22700, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Sarah W E Baalman
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, AMC, PO Box 22700, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Koen C de Wilde
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, AMC, PO Box 22700, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Tom F Brouwer
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, AMC, PO Box 22700, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Arthur A M Wilde
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, AMC, PO Box 22700, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Reinoud E Knops
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, AMC, PO Box 22700, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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Zeman P, Rafi M, Kautzner J. Evaluation of primary hip arthroscopy complications in mid-term follow-up: a multicentric prospective study. Int Orthop 2021; 45:2525-2529. [PMID: 34223924 DOI: 10.1007/s00264-021-05114-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/14/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Hip arthroscopy is a common procedure in hip preservation surgery. Its complication rate is relatively low. This prospective multicentric study evaluates complication rate in patients undergoing primary hip arthroscopy. MATERIALS AND METHODS The study cohort consisted of 908 patients mean age of 37 years (14-67 years). Patients were prospectively included in the study in the years 2009-2017. All complications were recorded and evaluated. The minimum follow-up was 36 months. Results were statistically evaluated and risk factors for complications were identified. RESULTS The overall complication rate was 7.3% (67/908 cases), the minor complication rate of 4.9% (45/908 cases) and the major complication rate 2.4% (22/908 cases). The most common severe complications were iatrogenic cartilage damage and instrument breakage, while the most common minor complications were perineal hypoaesthesia and heterotopic ossifications. The conversion rate to total hip replacement was 4.2% (39/908 patients). CONCLUSION Hip arthroscopy is a safe procedure with low complication rates. Surgeon training and experience greatly influence the complication rates.
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Affiliation(s)
- Petr Zeman
- Orthopaedics and Traumatology Department, University Hospital Pilsen, Pilsen, Czech Republic
| | - Moheb Rafi
- Orthopaedic Department, Kromeriz Hospital, Kromeriz, Czech Republic
| | - Jakub Kautzner
- Department of Childrens and Adults Orthopaedics and Traumatology 2Nd Medical Faculty, Charles University and Motol Hospital, V Uvalu 84, Prague, 15006, Czech Republic.
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Huth A, Viestenz A. [Micropulse cyclophotocoagulation lowers the intraocular pressure: half year results]. Ophthalmologe 2021; 119:19-24. [PMID: 33931788 DOI: 10.1007/s00347-021-01391-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/31/2021] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Cyclophotocoagulation (CPC) is a simple noninvasive and quickly available procedure for lowering intraocular pressure but due to its dreaded potential for complications it continues to play an outsider role in surgical treatment planning. The Micropulse-CPC promises to be a more tissue-friendly and less painful procedure and thus a lower rate of side effects. METHOD Retrospective evaluation of all patients who were treated with the Micropulse-CPC laser at the measurement times 1 day preoperatively, 2 days postoperatively, after 3 months and 6 months. RESULTS Between 2018 and 2019 a total of 63 eyes in 46 patients were treated. The mean intraocular pressure in the total collective was 20.6 mm Hg before surgery and decreased to 13.5 mm Hg 2 days after surgery, 16.2 mm Hg after 3 months and 14.6 mm Hg after 6 months (p < 0.002). An average of 3.2 hypotensive substances were used preoperatively, 2.4 substances 2 days postoperatively, 2.6 substances after 3 months and 2.8 after 6 months (p < 0.001). The visual acuity (VA) before surgery was 0.59 logMAR, 2 days postoperatively VA was 0.60, after 3 months 0.59 and after 6 months VA was 0.5 (statistically not significant). A complication (subconjunctival bleeding) occurred intraoperatively and the postoperative complication rate was 0%. CONCLUSION Treatment with a Micropulse-CPC laser offers a gentle way of reducing pressure in a timely manner. The use of the Micropulse-CPC is advocated as a first surgical option as well as for patients with good visual acuity.
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Affiliation(s)
- Andrea Huth
- Martin-Luther-Universitat Halle-Wittenberg, Halle (Saale), Deutschland.
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Zekaj E, Iess G, Servello D. Anterior cervical spine surgical complications: Safety comparison between teacher and student. Surg Neurol Int 2021; 12:43. [PMID: 33598359 PMCID: PMC7881496 DOI: 10.25259/sni_876_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 01/08/2021] [Indexed: 11/04/2022] Open
Abstract
Background Anterior cervical surgery has a widespread use. Despite its popularity, this surgery can lead to serious and life-threatening complications, and warrants the attention of skilled attending spinal surgeons with many years of experience. Methods We retrospectively evaluated postoperative complications occurring in 110 patients who underwent anterior cervical surgery (anterior cervical discectomy without fusion, anterior cervical discectomy and fusion, and anterior cervical disc arthroplasty) between 2013 and 2020. These operations were performed by an either an attending surgeon with 30 years' experience versus a novice neurosurgeon (NN) with <5 years of training with the former surgeon. Complications were variously identified utilizing admission/discharge notes, surgical reports, follow-up visits, and phone calls. Complications for the two groups were compared for total and specific complication rates (using the Pearson's Chi-square and Fisher's test). Results The total cumulative complication rate was 15.4% and was not significantly different between the two cohorts. The most frequent postoperative complication was dysphagia. Notably, there were no significant differences in total number of postoperative instances of dysphagia, dysphonia, unintended durotomy, hypoasthenia, and hypoesthesia; the only difference was the longer operative times for NNs. Conclusion Surgeons' years of experience proved not to be a critical factor in determining complication rates following anterior cervical surgery.
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Affiliation(s)
- Edvin Zekaj
- Department of Neurosurgery, IRCCS, Istituto Ortopedico Galeazzi, Milan, Italy
| | - Guglielmo Iess
- Department of Functional Neurosurgery, IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Domenico Servello
- Department of Neurosurgery, IRCCS, Istituto Ortopedico Galeazzi, Milan, Italy
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Seyfried S, Herrle F, Schröter M, Hardt J, Betzler A, Rahbari NN, Reißfelder C. [Initial experiences with the implementation of the enhanced recovery after surgery (ERAS®) protocol]. Chirurg 2021; 92:428-433. [PMID: 33471183 DOI: 10.1007/s00104-020-01341-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND To further improve treatment quality and patient orientation, a multiprofessional enhanced recovery after surgery (ERAS®) transformation program was initiated in our clinic in January 2020. The ERAS® treatment pathway for colorectal surgery was established in October 2020. OBJECTIVE The aim of the study was to show that the perioperative treatment quality can be increased by implementing a certified ERAS® program in the setting of a fast-track pathway that has been established since 2008. MATERIAL AND METHODS The first ERAS® patients from October/November 2020 (ERAS®) were compared with those of a representative consecutive control cohort (pre-ERAS®) who had undergone interventions from August to December 2019. Patient care and data collection of the ERAS® patients were ensured by an ERAS® nurse in daily visits. For the comparison cohorts, the electronic patient files were analyzed and historical colon pathway data from our clinic from 2008 were used. RESULTS AND CONCLUSION A total of 10 ERAS® and 50 pre-ERAS® patients were included. After the ERAS® transformation, an increase in overall compliance with ERAS® guideline recommendations from 45% (pre-ERAS®) to 75% (ERAS®) was achieved. The number of days to tolerance of solid food decreased from 2 days (pre-ERAS®) to 1 day (ERAS®). The general postoperative complication rate was comparable (22% pre-ERAS® vs. 20% ERAS®). Most noticeable was the reduction of the median hospital stay of 9 days in the historical cohort to 3 days after ERAS® implementation. We attribute the necessary high ERAS® pathway compliance of 75% to a successful combination of process standards and multiprofessional ERAS® teams.
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Affiliation(s)
- Steffen Seyfried
- Chirurgische Klinik, Universitätsmedizin Mannheim, Medizinische Fakultät, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - Florian Herrle
- Chirurgische Klinik, Universitätsmedizin Mannheim, Medizinische Fakultät, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - Michele Schröter
- Chirurgische Klinik, Universitätsmedizin Mannheim, Medizinische Fakultät, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - Julia Hardt
- Chirurgische Klinik, Universitätsmedizin Mannheim, Medizinische Fakultät, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - Alexander Betzler
- Chirurgische Klinik, Universitätsmedizin Mannheim, Medizinische Fakultät, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - Nuh N Rahbari
- Chirurgische Klinik, Universitätsmedizin Mannheim, Medizinische Fakultät, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - Christoph Reißfelder
- Chirurgische Klinik, Universitätsmedizin Mannheim, Medizinische Fakultät, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
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Schulz GB, Volz Y, Jokisch F, Casuscelli J, Eismann L, Pfitzinger P, Stief CG, Schlenker B. [Enhanced Recovery After Surgery (ERAS®) after radical cystectomy-current data]. Urologe A 2021; 60:162-168. [PMID: 33439288 DOI: 10.1007/s00120-020-01435-y] [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] [Accepted: 12/18/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Radical cystectomy is associated with considerable morbidity and mortality. Based on the solid evidence in colorectal surgery, fast-track/ERAS® (Enhanced Recovery After Surgery) protocols have been developed to improve the perioperative management of patients undergoing radical cystectomy. OBJECTIVES To review the literature and guidelines and evaluate the evidence regarding the different components of ERAS® protocols. MATERIALS AND METHODS Systemic literature search and evaluation of relevant guidelines. RESULTS The majority of ERAS® recommendations for radical cystectomy are based on extrapolations of abdominal surgery studies. Four randomized, controlled trials and one ERAS® guideline were published for radical cystectomy. ERAS® seems to shorten length of stay without increasing the complication rate. Key elements are no bowel preparation, no nasogastric tube, optimized fluid substitution, multimodal pain management, early mobilization, and oral diet. CONCLUSIONS Implementation of ERAS® requires multidisciplinary collaboration. Individualization of an ERAS® program, identification of the most important components and adaption to the specific needs of radical cystectomy patients are future goals.
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Affiliation(s)
- G B Schulz
- Urologische Klinik und Poliklinik, LMU Klinikum München, Marchioninistr. 15, 81377, München, Deutschland.
| | - Y Volz
- Urologische Klinik und Poliklinik, LMU Klinikum München, Marchioninistr. 15, 81377, München, Deutschland
| | - F Jokisch
- Urologische Klinik und Poliklinik, LMU Klinikum München, Marchioninistr. 15, 81377, München, Deutschland
| | - J Casuscelli
- Urologische Klinik und Poliklinik, LMU Klinikum München, Marchioninistr. 15, 81377, München, Deutschland
| | - L Eismann
- Urologische Klinik und Poliklinik, LMU Klinikum München, Marchioninistr. 15, 81377, München, Deutschland
| | - P Pfitzinger
- Urologische Klinik und Poliklinik, LMU Klinikum München, Marchioninistr. 15, 81377, München, Deutschland
| | - C G Stief
- Urologische Klinik und Poliklinik, LMU Klinikum München, Marchioninistr. 15, 81377, München, Deutschland
| | - B Schlenker
- Urologische Klinik und Poliklinik, LMU Klinikum München, Marchioninistr. 15, 81377, München, Deutschland
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Jacheć W, Polewczyk A, Segreti L, Bongiorni MG, Kutarski A. Risk Factors and Long-Term Survival of Octogenarians and Nonagenarians Undergoing Transvenous Lead Extraction Procedures. Gerontology 2020; 67:36-48. [PMID: 33242867 DOI: 10.1159/000511358] [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: 05/01/2020] [Accepted: 09/05/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Transvenous lead extraction (TLE) has become a frequently used tool for the management of complications related to pacemakers, implantable cardiac defibrillators and cardiac resynchronization therapy devices. However, it is still a matter of debate whether the lead extraction procedure is a safe treatment choice in the elderly. METHODS We collected the clinical information from 3,810 patients undergoing TLE in 2 high-volume centers (Poland and Italy) between 2006 and 2017. We tested risk factors, effectiveness, safety and long-term survival in 3 groups of patients: those aged 80-89.99 years, ≥90 years and 30-79.99 years. RESULTS Lower BMI, lower levels of hemoglobin and more comorbidities characterized the patients, whose ages ranged from 80 to 89.99 years. Those aged ≥90 years most often had single-chamber pacemakers. Octogenarians and nonagenarians were more often undergoing TLE due to infectious indications (57.19 and 74.29 vs. 45.35% in younger individuals). Lead age and the number of leads extracted were comparable in the 3 groups. In octogenarians, leads were more often removed using standard extraction techniques: simple traction and mechanical dilatators, whereas in nonagenarians TLE was more complex. The duration of the procedure was shorter in older patients, while clinical and procedural effectiveness was similar to that in younger individuals. The rate of major complications related to TLE did not differ between octogenarians and younger subjects (2.0 vs. 1.38%, p = ns), and the number of procedure-related risk factors was smaller in older people. Nonagenarians did not develop any major complication related to TLE. Long-term mortality after TLE was similar among octogenarians and nonagenarians (39.67 and 40.00%) but higher than in younger patients (24.41; p < 0.001 and 0.05). CONCLUSIONS Lead extraction procedures appear effective and safe in octogenarians and nonagenarians, comparable to younger individuals. Procedure-related risk in the elderly is not associated with most of the typical risk factors encountered in younger subjects, but only with the higher number of pacemaker, implantable cardiac defibrillator and cardiac resynchronization therapy device procedures before TLE. Long-term survival after TLE was found to be similar among octogenarians and nonagenarians being about 60% at over 3 years of follow-up. Age alone should not be considered a risk factor for the occurrence of major complications or procedure-related death, and therefore it should not prevent candidacy for TLE.
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Affiliation(s)
- Wojciech Jacheć
- 2nd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Anna Polewczyk
- Collegium Medicum of Jan Kochanowski University, Kielce, Poland, .,Department of Cardiac Surgery, Swietokrzyskie Cardiology Center, Kielce, Poland,
| | - Luca Segreti
- Department of Cardiology, University Hospital of Pisa, Pisa, Italy
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Agarwala S, Wagh YS, Vijayvargiya M. Is obesity a contraindication for simultaneous bilateral total knee arthroplasty? A prospective case-control study. SICOT J 2020; 6:42. [PMID: 33124979 PMCID: PMC7597594 DOI: 10.1051/sicotj/2020040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 10/10/2020] [Indexed: 11/20/2022] Open
Abstract
Aim: Total Knee Arthroplasty (TKA) for decades has been an effective treatment modality for chronic arthritis of the knee. However, there is scarcity of literature comparing the functional outcomes of simultaneous bilateral TKA in obese patients with non-obese Indian population. We conducted this study to evaluate the functional outcomes and complication rates of simultaneous bilateral TKA in obese patients matched control with non-obese patients. Materials and methods: We divided the patients into two study groups based on their body mass index (BMI). Patients with a BMI of less than 30 were classified as non-obese and those with a BMI of more than 30 were classified as obese. All the patients underwent simultaneous bilateral TKA by a single surgeon using the same implant and technique. Patients were followed up regularly and functional outcomes in terms of Oxford knee score were noted at 6 weeks, 3 months, and 1 year. Post-operative complications and time to recovery was also compared. Results: Mean follow-up in obese group was 18 months (12–25 months) and in non-obese group was 17 months (12–24 months). Both the groups were matched with control in terms of pre-operative parameters. Post-operative hemoglobin drop, ICU requirement, length of hospital stay, mean walking time, and mean time to climbing stairs were similar in both the groups. Oxford knee score was significantly better in non-obese group at 6 weeks, but was similar in both the groups at 3 months, 6 months, 1 year, and last follow-up. There was no statistically significant difference seen in the complication rate in both the groups. There was no implant loosening or radiolucency seen. Conclusion: We conclude in our study that simultaneous bilateral TKA gives comparable mid-term results in obese patients in comparison to the non-obese patients.
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Affiliation(s)
- Sanjay Agarwala
- Chief of Orthopaedics and Director Professional Services, P.D Hinduja Hospital and Medical Research Centre, Mumbai, India
| | - Yash Santosh Wagh
- Clinical Assistant, P.D Hinduja Hospital and Medical Research Centre, Mumbai, India
| | - Mayank Vijayvargiya
- Junior Consultant, Department of Orthopedics, P.D Hinduja Hospital and Medical Research Centre, Mumbai, India
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Reiser E, Pötsch N, Seebacher V, Reinthaller A, Wimazal F, Fleischmann E, Krainer M, Horvat R, Polterauer S, Grimm C. Impact of frailty on the management of patients with gynecological cancer aged 80 years and older. Arch Gynecol Obstet 2020; 303:557-563. [PMID: 33009994 PMCID: PMC7858206 DOI: 10.1007/s00404-020-05807-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 09/18/2020] [Indexed: 12/29/2022]
Abstract
Purpose To assess the impact of frailty on compliance of standard therapy, complication, rate and survival in patients with gynecological malignancy aged 80 years and older. Methods In total, 83 women with gynecological malignancy (vulva, endometrial, ovarian or cervical cancer) who underwent primary treatment between 2007 and 2017 were retrospectively analyzed. Frailty index was calculated and its association with compliance of standard treatment, peri- and postoperative mortality and morbidity, and survival was evaluated. Results Frailty was observed in 24.1% of cases. Both frail and non-frail patients were able to receive standard therapy in most cases − 75.0% and 85.7%, respectively (p = 0.27). Frail patients did not show an increased postoperative complication rate. Frail patients had shorter 3 years overall survival rates (28%) when compared to non-frail patients (55%) (p = 0.02). In multivariable analysis high frailty index (Hazard Ratio [HR] 12.15 [1.39–106.05], p = 0.02) and advanced tumor stage (HR 1.33 [1.00–1.76], p = 0.05) were associated with poor overall survival, but not age, histologic grading, performance status, and compliance of standard therapy. Conclusion Majority of patients was able to receive standard therapy, as suggested by the tumor board, irrespective of age and frailty. Nonetheless, frailty is a common finding in patients with gynecological malignancy aged 80 years and older. Frail patients show shorter progression-free, and overall survival within this cohort. Electronic supplementary material The online version of this article (10.1007/s00404-020-05807-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elisabeth Reiser
- Division of General Gynecology and Gynecologic Oncology Department of Obstetrics and Gynecology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Nina Pötsch
- Division of General Gynecology and Gynecologic Oncology Department of Obstetrics and Gynecology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Veronika Seebacher
- Division of General Gynecology and Gynecologic Oncology Department of Obstetrics and Gynecology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Alexander Reinthaller
- Division of General Gynecology and Gynecologic Oncology Department of Obstetrics and Gynecology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Karl Landsteiner Institute for General Gynecology and Experimental Gynecologic Oncology, Vienna, Austria
| | - Friedrich Wimazal
- Division of General Gynecology and Gynecologic Oncology Department of Obstetrics and Gynecology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Edith Fleischmann
- Clinic for General Anesthesiology, Intensive Care and Pain Management, Medical University of Vienna, Vienna, Austria
| | - Michael Krainer
- Clinical Division of Oncology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Reinhart Horvat
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Stephan Polterauer
- Division of General Gynecology and Gynecologic Oncology Department of Obstetrics and Gynecology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria. .,Karl Landsteiner Institute for General Gynecology and Experimental Gynecologic Oncology, Vienna, Austria.
| | - Christoph Grimm
- Division of General Gynecology and Gynecologic Oncology Department of Obstetrics and Gynecology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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Göbel S, Schwuchow‐Thonke S, Jansen T, Karbach S, Emrich T, Gori T, Knies F, Schulz E, Münzel T, Keller K, Wenzel P. Safety of transradial and transfemoral left ventricular compared with transfemoral right ventricular endomyocardial biopsy. ESC Heart Fail 2020; 7:4015-4023. [PMID: 32949187 PMCID: PMC7754772 DOI: 10.1002/ehf2.13006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/05/2020] [Accepted: 08/26/2020] [Indexed: 12/19/2022] Open
Abstract
AIMS With the present study, we sought to determine the safety of three different endomyocardial biopsy (EMB) access routes in 514 patients admitted for diagnostic workup of heart failure of unknown aetiology. METHODS AND RESULTS In this retrospective monocentric cohort study, we analysed 514 consecutive patients with heart failure without evidence of significant coronary artery disease or valvular disease undergoing EMB between November 2013 and December 2018, stratified in three access route groups: transradial arterial left ventricular (LV-)EMB (323 patients), transfemoral LV-EMB (138 patients), and transfemoral right ventricular (RV-)EMB (53 patients). Patients undergoing selective transradial LV-EMB were older compared with patients undergoing selective transfemoral LV-EMB or RV-EMB [transradial LV-EMB: 56.0 (45.0/64.0) vs. transfemoral LV-EMB: 53 (42.5/64.5), P = 0.455; transradial LV-EMB: 56 (45.0/64.0) vs. RV-EMB: 53 (42.5/64), P = 0.695] and presented more often in New York Heart Association-functional class III and IV. A total of eight major complications including permanent atrioventricular block requiring pacemaker implantation, pericardial tamponade necessitating pericardiocentesis, stroke and transient cerebral ischaemic attack as well as severe valvular damage, vascular access site complications, and ventricular fibrillation were documented with no significant differences between the groups (8/514, 1.5%). Minor complications such as transient chest pain, non-sustained electrocardiogram abnormalities, and transient atrioventricular block were rare and equally distributed between groups. CONCLUSIONS Transradial LV-EMB is a safe procedure for experienced radial operators and non-inferior compared with transfemoral LV-EMB and RV-EMB. An accurate peri-procedural and post-procedural monitoring and follow-up care should be recommended for all patients undergoing this procedure in order to identify potential complications.
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Affiliation(s)
- Sebastian Göbel
- Department of CardiologyUniversity Medical Center MainzLangenbeckstr. 1Mainz55131Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine‐MainMainzGermany
| | - Sören Schwuchow‐Thonke
- Department of CardiologyUniversity Medical Center MainzLangenbeckstr. 1Mainz55131Germany
| | - Thomas Jansen
- Department of CardiologyUniversity Medical Center MainzLangenbeckstr. 1Mainz55131Germany
| | - Susanne Karbach
- Department of CardiologyUniversity Medical Center MainzLangenbeckstr. 1Mainz55131Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine‐MainMainzGermany
- Center for Thrombosis and HemostasisMainzGermany
| | - Tilman Emrich
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine‐MainMainzGermany
- Center for Diagnostic and Interventional RadiologyUniversity Medical Center MainzMainzGermany
| | - Tommaso Gori
- Department of CardiologyUniversity Medical Center MainzLangenbeckstr. 1Mainz55131Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine‐MainMainzGermany
| | - Finja Knies
- Department of CardiologyUniversity Medical Center MainzLangenbeckstr. 1Mainz55131Germany
| | - Eberhard Schulz
- Department of CardiologyUniversity Medical Center MainzLangenbeckstr. 1Mainz55131Germany
| | - Thomas Münzel
- Department of CardiologyUniversity Medical Center MainzLangenbeckstr. 1Mainz55131Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine‐MainMainzGermany
| | - Karsten Keller
- Department of CardiologyUniversity Medical Center MainzLangenbeckstr. 1Mainz55131Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine‐MainMainzGermany
| | - Philip Wenzel
- Department of CardiologyUniversity Medical Center MainzLangenbeckstr. 1Mainz55131Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine‐MainMainzGermany
- Center for Thrombosis and HemostasisMainzGermany
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Altshuler M, Mueller K, MacConnell A, Wirth P, Sandhu F, Voyadzis JM. Does minimally invasive spine surgery reduce the rate of perioperative medical complications? A retrospective single-center experience of 1435 degenerative lumbar spine surgeries. Eur Spine J 2021; 30:122-7. [PMID: 32700125 DOI: 10.1007/s00586-020-06536-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 06/02/2020] [Accepted: 07/09/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE It is unclear if minimally invasive techniques reduce the rate of perioperative complications when compared to traditional open approaches to the lumbar spine. Our aim was to evaluate perioperative complications in patients that underwent MIS and conventional open techniques for degenerative lumbar pathology. METHODS A retrospective review of a prospectively collected database identified 1435 patients that underwent surgery for degenerative lumbar pathology from January 2013-2016. We evaluated the rates of deep vein thrombosis, pulmonary embolism, urinary tract infection, and pneumonia. Groups were analyzed based on decompression alone as compared with decompression and fusion for both MIS and traditional open techniques. RESULTS Patients that underwent traditional open lumbar decompression surgery were more likely to develop a DVT (P = .01) than those undergoing MIS decompression. There was no significant difference in rates of PE (P = .99), UTI (P = .24), or pneumonia (P = .56). Patients that underwent traditional open lumbar fusion surgery compared to MIS fusion were also more likely to have a PE (P = .03). There was no significant difference in rates of DVT (P = .22), UTI (P = .43), or pneumonia (P = .24). CONCLUSION Minimally invasive spinal surgery was found to reduce the rate of DVT for decompression surgeries and reduce the rate of PE for fusion surgeries.
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Sarwahi V, Galina J, Wendolowski S, Dimauro JP, Moguilevich M, Katyal C, Thornhill B, Lo Y, Amaral TD. A dual-team approach benefits standard-volume surgeons, but has minimal impact on outcomes for a high-volume surgeon in AIS patients. Spine Deform 2020; 8:447-453. [PMID: 32026443 DOI: 10.1007/s43390-020-00049-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/30/2019] [Indexed: 11/28/2022]
Abstract
STUDY DESIGN Retrospective chart review of prospectively collected data. OBJECTIVE This study seeks to evaluate the effect of number of surgeons, surgeon experience, and surgeon volume on AIS surgery. Recent literature suggests that utilizing two surgeons for spine deformity correction surgery can improve perioperative outcomes. However, the surgeon's experience and surgical volume are likely as important. METHODS AIS patients undergoing PSF from 2009 to 2019 were included. Patient demographics, X-ray and perioperative outcomes were collected and collated based on primary surgeon. Analysis was performed for single versus dual surgeons, surgeon experience (≤ 10 years in practice), and surgical volume (less/greater than 50 cases/year). Median (IQR) values, Wilcoxon Rank Sums test, Kruskal-Wallis test, and Fisher's exact test were utilized. RESULTS 519 AIS cases, performed by 4 surgeons were included. Two surgeons were highly experienced, 1 of whom was also high volume. Five cohorts were studied: a single senior high volume (S1) (n = 302), dual-junior surgeons (DJ) (n = 73), dual senior-junior (SJ) (n = 36), dual-senior (DS) (n = 21) and a single senior, standard-volume surgeon alone (S2) (n = 87). Radiographic parameters were similar between the groups (p > 0.05). Preoperative Cobb was significantly higher for DS compared to S1 (p = 0.034) Pre- and post-op kyphosis were similar (p > 0.05). Cobb correction was similar (p > 0.05). Levels fused, fixation points, anesthesia and surgical times were similar (p > 0.05). When the standard-volume surgeon operated with a second surgeon, radiographic parameters were similar (p > 0.05), but anesthesia time, surgical time, and hospital length of stay were significantly shorter (p < 0.05). Additionally, DJ had significantly shorter anesthesia and operative times (p < 0.001) and length of stay (p < 0.001) compared to S2. CONCLUSION Standard-volume surgeons have better outcomes with a dual surgeon approach. Junior surgeons benefit operating with an experienced surgeon. A high-volume surgeon, however, does not benefit from a dual surgeon approach. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Vishal Sarwahi
- Department of Pediatric Orthopaedics, Center for Advanced Pediatric Orthopaedics, Cohen Children's Medical Center, Northwell Health System, 7 Vermont Drive, New Hyde Park, NY, 11042, USA.
| | - Jesse Galina
- Department of Pediatric Orthopaedics, Center for Advanced Pediatric Orthopaedics, Cohen Children's Medical Center, Northwell Health System, 7 Vermont Drive, New Hyde Park, NY, 11042, USA
| | - Stephen Wendolowski
- Department of Pediatric Orthopaedics, Center for Advanced Pediatric Orthopaedics, Cohen Children's Medical Center, Northwell Health System, 7 Vermont Drive, New Hyde Park, NY, 11042, USA
| | - Jon-Paul Dimauro
- Department of Pediatric Orthopaedics, Center for Advanced Pediatric Orthopaedics, Cohen Children's Medical Center, Northwell Health System, 7 Vermont Drive, New Hyde Park, NY, 11042, USA
| | - Marina Moguilevich
- Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, NY, USA
| | - Chhavi Katyal
- Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, NY, USA
| | - Beverly Thornhill
- Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, NY, USA
| | - Yungtai Lo
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Terry D Amaral
- Department of Pediatric Orthopaedics, Center for Advanced Pediatric Orthopaedics, Cohen Children's Medical Center, Northwell Health System, 7 Vermont Drive, New Hyde Park, NY, 11042, USA
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Lorenz G, Schönthaler W, Huf W, Komjati M, Fialka C, Boesmueller S. Complication rate after operative treatment of three- and four-part fractures of the proximal humerus: locking plate osteosynthesis versus proximal humeral nail. Eur J Trauma Emerg Surg 2020; 47:2055-2064. [PMID: 32448941 DOI: 10.1007/s00068-020-01380-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 04/24/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE There is still disagreement regarding the optimal surgical treatment of three- and four-part fractures of the proximal humerus. The aim of this monocentric, retrospective study was to compare the complication rate of internal fixation with a locking plate versus proximal humeral nailing after a one-year follow-up. METHODS From 2005 to 2016, 292 patients suffered a fracture of the proximal humerus and were treated surgically at our level-I trauma center. According to the inclusion criteria, 50 patients were included in this study: 19 of these (11 three-part fractures and 8 four-part fractures) were treated with a proximal humeral nail (HN) and 31 (12 three-part fractures and 19 four-part fractures) with a locking plate (LP) osteosynthesis. Classification was performed according to the Hertel classification. At a 1-year follow-up, the complication rate of the two treatment methods was compared. RESULTS Twenty patients (40%) suffered at least one complication. Of these, six patients (12%) were treated with a HN and 14 (28%) with a LP (p = 0.39). The most frequent complication was screw perforation (22%), followed by non-union (16%). Humeral head necrosis (10%) occurred only in the LP cohort. One wound infection occurred in a patient treated with a HN. Four-part fractures were treated more frequently with a LP. However, the difference was non-significant in this sample (p = 0.186). CONCLUSIONS The results of our study provide some evidence that in terms of complication rate, both treatment options are comparable for internal fixation of three- and four-part fractures of the proximal humerus. The type of fracture seems to be decisive for the choice of implant.
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Affiliation(s)
- Greta Lorenz
- Department of Trauma Surgery, AUVA Trauma Center Vienna Meidling, Kundratstraße 37, 1120, Vienna, Austria.
| | - Wolfgang Schönthaler
- Department of Trauma Surgery, AUVA Trauma Center Vienna Meidling, Kundratstraße 37, 1120, Vienna, Austria
| | - Wolfgang Huf
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Micha Komjati
- Department of Trauma Surgery, AUVA Trauma Center Vienna Meidling, Kundratstraße 37, 1120, Vienna, Austria
| | - Christian Fialka
- Department of Trauma Surgery, AUVA Trauma Center Vienna Meidling, Kundratstraße 37, 1120, Vienna, Austria
| | - Sandra Boesmueller
- Department of Trauma Surgery, AUVA Trauma Center Vienna Meidling, Kundratstraße 37, 1120, Vienna, Austria
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Hoffmann CH, Kandziora F. [Minimally invasive transforaminal lumbar interbody fusion]. Oper Orthop Traumatol 2020; 32:180-91. [PMID: 32447419 DOI: 10.1007/s00064-020-00660-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 11/01/2019] [Accepted: 12/02/2019] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Instrumented fusion of lumbar motion segments using a minimally invasive technique. INDICATIONS Degenerative disc disease, segmental degeneration, degenerative spondylolisthesis, isthmic spondylolisthesis, pseudarthrosis, other spinal lumbar instabilities, disc prolapse, revision for failed back surgery syndrome, unilateral neuroforaminal stenosis, facet joint arthrosis. CONTRAINDICATIONS High-grade spondylolisthesis (Meyerding grades III/IV, spondyloptosis), bilateral nerve root compression, vertebral fractures, tumors, high-grade spinal instabilities, primary spinal deformities, multilevel pathologies. SURGICAL TECHNIQUE Ipsilateral minimally invasive approach using a self-retaining tubular retractor system, partial or complete facetectomy, insertion of pedicle screws, transforaminal lumbar interbody fusion (TLIF) cage insertion preserving nerve roots, fusion, contralateral insertion of pedicle screws using a minimally invasive or percutaneous technique. POSTOPERATIVE MANAGEMENT Mobilization with physiotherapy, followed by standing plain x‑ray examinations, clinical and radiological follow-up at 6-12 weeks and 1 year postoperatively. RESULTS Fusion rates >90%, comparable to open TLIF. Complication rates lower than open TLIF. Shorter radiation exposure during surgery, lower blood loss. Less surgical trauma leads to shorter hospitalization time and earlier return-to-work. Oswestry Disability index (ODI) scores and visual analog scale (VAS) scores significantly decreased.
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Saylor DK, Brownstone ND, Naik HB. Office-Based Surgical Intervention for Hidradenitis Suppurativa (HS): A Focused Review for Dermatologists. Dermatol Ther (Heidelb) 2020; 10:529-549. [PMID: 32435998 PMCID: PMC7367977 DOI: 10.1007/s13555-020-00391-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Indexed: 12/28/2022] Open
Abstract
Easily accessible office-based procedures that require minimal resources may facilitate timely surgical management of hidradenitis suppurativa (HS). This review focuses on excision and unroofing as two surgical HS treatments that can be tailored to the outpatient setting. Fifty-five articles were included in our review, representing 3914 patients. The majority were retrospective studies (58%, n = 32), and the studies reported data both across patients and by number of treated lesions. Recurrence rates for unroofing (14.5%) were found to be half that of excision (30%) across patients (p = 0.015) and slightly lower across lesions [20% recurrence vs 26% for excision (p = 0.023)]. Complication rates at the lesion level were also significantly associated with procedure, with rates after excision more than double those after roofing (26% vs. 12%, p < 0.001). The complication rate after combined medical and surgical therapy did not differ between procedures. Studies also suggest that continuing medical therapy in the perioperative period may be associated with improved recurrence rates, although delayed wound healing with biologic therapy has been reported. The existing data are limited by low-quality uncontrolled studies with small sample sizes, variable reporting of outcomes, and lack of uniform definitions for recurrence and remission. Further systematic prospective studies are needed to better compare complication and recurrence rates across these procedures in HS, especially in the context of concomitant medical therapy.
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Affiliation(s)
- Drew K Saylor
- Department of Dermatology, University of California, San Francisco, CA, USA.
| | | | - Haley B Naik
- Department of Dermatology, University of California, San Francisco, CA, USA
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Abstract
Background: The decision for using supine or prone position in percutaneous nephrolithotomy (PCNL) is still debatable. The aim of this study is to compare the efficacy and safety profile of the supine and prone position when performing PCNL. Methods: A systematic electronic search was performed using the database from MEDLINE, Cochrane library and Google Scholar from January 2009 to November 2019. The outcomes assessed were stone free rate, major complication rate, length of hospital stay and mean operation time. Results: A total of 11 articles were included in qualitative and quantitative analysis. The efficacy of PCNL in supine position as determined by stone free rate is significantly lower than in prone position (OR: 0.74; 95% CI: 0.66 - 0.83; p<0.00001), However, major complication rate is also lower in the supine group compared with the prone group (OR: 0.70; 95% CI: 0.51 - 0.96; p=0.03). There is no statistically significant difference in the length of hospital stay and mean operation time between both groups. Conclusion: Prone position leads to a higher stone free rate, but also a higher rate of major complication. Thus, the decision of using which position during PCNL should be based on the surgeon's experience and clinical aspects of the patients.
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Affiliation(s)
- Ponco Birowo
- Department Urology, Faculty of Medicine Universitas Indonesia / Cipto Mangunkusumo Hospital, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - William Tendi
- Department Urology, Faculty of Medicine Universitas Indonesia / Cipto Mangunkusumo Hospital, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - Indah S. Widyahening
- Department of Community Medicine, Faculty of Medicine Universitas Indonesia, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - Nur Rasyid
- Department Urology, Faculty of Medicine Universitas Indonesia / Cipto Mangunkusumo Hospital, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - Widi Atmoko
- Department Urology, Faculty of Medicine Universitas Indonesia / Cipto Mangunkusumo Hospital, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
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Birowo P, Tendi W, Widyahening IS, Rasyid N, Atmoko W. Supine versus prone position in percutaneous nephrolithotomy: a systematic review and meta-analysis. F1000Res 2020; 9:231. [PMID: 33014345 PMCID: PMC7509599.2 DOI: 10.12688/f1000research.22940.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2020] [Indexed: 03/30/2024] Open
Abstract
Background: The decision for using supine or prone position in percutaneous nephrolithotomy (PCNL) is still debatable. The aim of this study is to compare the efficacy and safety profile of the supine and prone position when performing PCNL. Methods: A systematic electronic search was performed using the database from MEDLINE, Cochrane library and Google Scholar from January 2009 to November 2019. The outcomes assessed were stone free rate, major complication rate, length of hospital stay and mean operation time. Results: A total of 11 articles were included in qualitative and quantitative analysis. The efficacy of PCNL in supine position as determined by stone free rate is significantly lower than in prone position (OR: 0.74; 95% CI: 0.66 - 0.83; p<0.00001), However, major complication rate is also lower in the supine group compared with the prone group (OR: 0.70; 95% CI: 0.51 - 0.96; p=0.03). There is no statistically significant difference in the length of hospital stay and mean operation time between both groups. Conclusion: Prone position leads to a higher stone free rate, but also a higher rate of major complication. Thus, the decision of using which position during PCNL should be based on the surgeon's experience and clinical aspects of the patients.
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Affiliation(s)
- Ponco Birowo
- Department Urology, Faculty of Medicine Universitas Indonesia / Cipto Mangunkusumo Hospital, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - William Tendi
- Department Urology, Faculty of Medicine Universitas Indonesia / Cipto Mangunkusumo Hospital, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - Indah S Widyahening
- Department of Community Medicine, Faculty of Medicine Universitas Indonesia, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - Nur Rasyid
- Department Urology, Faculty of Medicine Universitas Indonesia / Cipto Mangunkusumo Hospital, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - Widi Atmoko
- Department Urology, Faculty of Medicine Universitas Indonesia / Cipto Mangunkusumo Hospital, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
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Abstract
Background: The decision for using supine or prone position in percutaneous nephrolithotomy (PCNL) is still debatable. The aim of this study is to compare the efficacy and safety profile of the supine and prone position when performing PCNL. Methods: A systematic electronic search was performed using the database from MEDLINE, Cochrane library and Google Scholar from January 2009 to November 2019. The outcomes assessed were stone free rate, major complication rate, length of hospital stay and mean operation time. Results: A total of 11 articles were included in qualitative and quantitative analysis. The efficacy of PCNL in supine position as determined by stone free rate is significantly lower than in prone position (OR: 0.74; 95% CI: 0.66 - 0.83; p<0.00001), However, major complication rate is also lower in the supine group compared with the prone group (OR: 0.70; 95% CI: 0.51 - 0.96; p=0.03). There is no statistically significant difference in the length of hospital stay and mean operation time between both groups. Conclusion: Prone position leads to a higher stone free rate, but also a higher rate of major complication. Thus, the decision of using which position during PCNL should be based on the surgeon's experience and clinical aspects of the patients.
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Affiliation(s)
- Ponco Birowo
- Department Urology, Faculty of Medicine Universitas Indonesia / Cipto Mangunkusumo Hospital, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - William Tendi
- Department Urology, Faculty of Medicine Universitas Indonesia / Cipto Mangunkusumo Hospital, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - Indah S Widyahening
- Department of Community Medicine, Faculty of Medicine Universitas Indonesia, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - Nur Rasyid
- Department Urology, Faculty of Medicine Universitas Indonesia / Cipto Mangunkusumo Hospital, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
| | - Widi Atmoko
- Department Urology, Faculty of Medicine Universitas Indonesia / Cipto Mangunkusumo Hospital, Jakarta Pusat, DKI Jakarta, 10430, Indonesia
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Cai H, Liang X, Sun DY, Chen JY. Long-term clinical performance of flapless implant surgery compared to the conventional approach with flap elevation: A systematic review and meta-analysis. World J Clin Cases 2020; 8:1087-1103. [PMID: 32258079 PMCID: PMC7103964 DOI: 10.12998/wjcc.v8.i6.1087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/13/2019] [Accepted: 12/06/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The conventional implant approach involves flap elevation, which may result in increased soft tissue and bone loss and postoperative morbidity. The flapless surgical technique, aided by three-dimensional medical imaging equipment, is regarded as a possible alternative to the conventional approach to alleviate the above issues. Several studies have been performed regarding the role of flapless implant surgery. However, the results are inconsistent and there is no robust synthesis of long-term evidence to better inform surgeons regarding which type of surgical technique is more beneficial to the long-term prognosis of patients in need of implant insertion.
AIM To compare the long-term clinical performance after flapless implant surgery to that after the conventional approach with flap elevation.
METHODS PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and grey literature databases were searched from inception to 23 September 2019. Randomised controlled trials (RCTs) and cohort studies comparing the long-term clinical performance after flapless implant surgery to that after the conventional approach over a follow-up of three years or more were included. Meta-analyses were conducted to estimate the odds ratios (ORs) or mean differences (MDs) and their 95% confidence intervals (CIs) between the long-term implant survival rate, marginal bone loss, and complication rate of the flapless and conventional groups. Subgroup analyses were carried out to account for the possible effects of the guided or free-hand method during flapless surgery.
RESULTS Ten articles, including four RCTs and six cohort studies, satisfied the eligibility criteria and nine of them were included in the meta-analysis. There was no significant difference between the long-term implant survival rate [OR = 1.30, 95%CI (0.37, 4.54), P = 0.68], marginal bone loss [MD = 0.01, 95%CI (-0.42, 0.44), P = 0.97], and complication rate [OR = 1.44, 95%CI (0.77, 2.68), P = 0.25] after flapless implant surgery and the conventional approach. Moreover, subgroup analyses revealed that there was no statistically significant difference between the implant survival rate [guided: OR = 1.52, 95%CI (0.19, 12.35), P = 0.70]; free-hand: n = 1, could not be estimated), marginal bone loss [guided: MD = 0.22, 95%CI (-0.14, 0.59), P = 0.23; free-hand: MD = -0.27, 95%CI (-1.10, 0.57), P = 0.53], or complication rate [guided: OR = 1.16, 95%CI (0.52, 2.63), P = 0.71; free-hand: OR = 1.75, 95%CI (0.66, 4.63), P = 0.26] in the flapless and conventional groups either with use of the surgical guide or by the free-hand method.
CONCLUSION The flapless surgery and conventional approach had comparable clinical performance over three years or more. The guided or free-hand technique does not significantly affect the long-term outcomes of flapless surgery.
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Affiliation(s)
- He Cai
- Department of Prosthodontics, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan Province, China
- Botnar Research Centre, University of Oxford, Windmill Road, Oxford OX3 7LD, United Kingdom
| | - Xing Liang
- Department of Prosthodontics, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Dong-Yuan Sun
- Department of Prosthodontics, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jun-Yu Chen
- Department of Prosthodontics, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan Province, China
- Kennedy Institute of Rheumatology, University of Oxford, Roosevelt Drive, Oxford OX3 7FY, United Kingdom
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Lledó-García E, González J, Martínez-Holguín E, Herranz-Amo F, Hernández-Fernández C. Beyond the Limits: How to Avoid a Surgical Nightmare in the Third and Subsequent Renal Transplantation Procedures. Curr Urol Rep 2020; 21:13. [PMID: 32166418 DOI: 10.1007/s11934-020-0964-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE OF REVIEW Approximately, 25% of the patients with ESRD will enter the waiting list for kidney transplantation. Among these patients, almost 15% will require a retransplantation surgery. This review aims to summarize the most recent information on different controversial issues regarding retransplantation, to provide the reader with a clear and updated view on the topic. RECENT FINDINGS Despite current evidence is mainly based on retrospective, small, single-center experiences, it seems clear that retransplantation remains a surgical and immunological challenge, for which the perioperative management still remains crucial to avoid mishaps. Different surgical approaches have been tested, but the general consensus advocates for the heterotopic extraperitoneal in first instance. Although higher immunological risk and complication rates are reported invariably in the available series, the benefits in terms of overall survival are superior to those obtained under dialysis, thus still representing the most recommended option for this group of patients.
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Affiliation(s)
- Enrique Lledó-García
- Adult & Pediatric Kidney Transplant Program, Servicio de Urología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Gregorio Marañón, Universidad Complutense, C/Doctor Esquerdo, 46, 28007, Madrid, Spain.
| | - Javier González
- Adult & Pediatric Kidney Transplant Program, Servicio de Urología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Gregorio Marañón, Universidad Complutense, C/Doctor Esquerdo, 46, 28007, Madrid, Spain
| | - Elena Martínez-Holguín
- Adult & Pediatric Kidney Transplant Program, Servicio de Urología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Gregorio Marañón, Universidad Complutense, C/Doctor Esquerdo, 46, 28007, Madrid, Spain
| | - Felipe Herranz-Amo
- Adult & Pediatric Kidney Transplant Program, Servicio de Urología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Gregorio Marañón, Universidad Complutense, C/Doctor Esquerdo, 46, 28007, Madrid, Spain
| | - Carlos Hernández-Fernández
- Adult & Pediatric Kidney Transplant Program, Servicio de Urología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Gregorio Marañón, Universidad Complutense, C/Doctor Esquerdo, 46, 28007, Madrid, Spain
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Ratanaprasatporn L, Mandell JC. Clinical utility of a postprocedural CT scan in CT-guided musculoskeletal biopsies. Skeletal Radiol 2020; 49:257-262. [PMID: 31327022 DOI: 10.1007/s00256-019-03279-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 07/02/2019] [Accepted: 07/05/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study is first to determine the clinical utility of the postprocedure scan in detecting postinterventional complications after CT-guided musculoskeletal biopsies, and second to evaluate the contribution to the radiation dose of the postprocedural CT scan. MATERIALS AND METHODS Retrospective analysis of 500 consecutive CT-guided musculoskeletal biopsies over an 18-month period from 29 March 2017 to 28 September 2018, where spiral postprocedure scans were obtained in every case. To assess the clinical utility of postinterventional CT scans, it was determined whether immediate post-procedural complications were detected on the postprocedural scans only or were also seen on the procedural images. To evaluate the relative radiation exposure of postprocedural scans, a ratio was obtained of the dose-length product (DLP) of the postprocedural scan compared with the total DLP of each case. RESULTS A total of 397 bone biopsies and 103 soft-tissue biopsies were performed in 471 patients. The immediate postprocedural complication rate was 0.4% (2 out of 500) in all procedures. Both complications were minor (small hematomas) and detected only on postinterventional CT scans. The average total DLP for the procedures was 383.5 mGy*cm. The average DLP of the postprocedural scan was 64.0 mGy*cm. The average radiation dose contribution of the postprocedural CT scans toward the total DLP was 17.4%. CONCLUSION Immediate postprocedural complications in CT-guided musculoskeletal interventions are rare. When complications do occur, they are usually minor. To substantially reduce radiation dose, postinterventional CT scans should not be performed routinely.
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Affiliation(s)
- Lisa Ratanaprasatporn
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
| | - Jacob C Mandell
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
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Li J, Qin C, Lai D, Hu Y, Wang L. Safety and effectiveness of inguinal hernia repair in patients with liver cirrhosis: a retrospective study and literature review. Hernia. 2020;24:489-494. [PMID: 31773547 DOI: 10.1007/s10029-019-02087-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 11/03/2019] [Indexed: 01/15/2023]
Abstract
PURPOSE Inguinal hernia is a common feature of decompensated liver cirrhosis and a frequent cause of life-threatening complications. The traditional treatment of inguinal hernia in patients with liver cirrhosis includes non-operative management; however, emerging data suggest elective surgical repair as a preferable approach. Therefore, we aimed to assess the outcomes of inguinal hernia repair in patients with liver cirrhosis and describe their clinical characteristics. METHODS In this retrospective study, we included a total of 28 consecutive patients with liver cirrhosis who underwent inguinal hernia repair between March 2000 and May 2019 at the First People's Hospital of Xiaoshan, Hangzhou, China. We also reviewed the literature on inguinal hernia repair in patients with liver cirrhosis. RESULTS Emergency surgery for complicated hernia was performed in 17.9% of the study patients. Two patients developed major complications including wound hematoma in 1, who required reoperation, and gastrointestinal tract hemorrhage in the other patient, who required blood transfusion. Further, minor complications developed in 6 patients, including wound seroma in 1 and scrotal swelling in 5. Emergency hernia repair was found to be associated with a higher complication rate than elective surgery in patients with liver cirrhosis. CONCLUSION Elective surgery for inguinal hernia repair in patients with liver cirrhosis appears to be successful and might be associated with a lower complication rate than emergency surgery. Inguinal hernia repair is recommended for patients with liver cirrhosis to prevent the development of life-threatening complications.
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Moog P, Buchner L, Cerny MK, Schmauss D, Megerle K, Erne H. Analysis of recurrence and complications after percutaneous needle fasciotomy in Dupuytren's disease. Arch Orthop Trauma Surg 2019; 139:1471-1477. [PMID: 31367843 DOI: 10.1007/s00402-019-03247-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Indexed: 01/02/2023]
Abstract
INTRODUCTION The partial aponeurectomy for treatment of Dupuytren's contracture represents the gold standard for treatment of Dupuytren's contracture. In selected cases, the alternative is the percutaneous needle fasciotomy (PNF). MATERIALS AND METHODS Between 2008 and 2018, 80 rays in 64 patients were treated using PNF. 53 patients (68 rays) were reviewed with a mean follow-up of 31 months. RESULTS The recurrence rate was 18.9%. 49 patients with 62 rays had a totally free extension intra-operatively (92.4%). There were no complications. Only one patient reported a transient dysesthesia (1.8%) in the zone of operation. 86% of all patients would undergo the treatment again, if necessary. Patients were able to return to their job in an average of 5.5 days. CONCLUSIONS PNF is reliable and relatively simple to perform compared to partial aponeurectomy. Therefore, the PNF could be seen as a serious alternative for selected cases.
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Affiliation(s)
- P Moog
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany.
| | - L Buchner
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany
| | - M K Cerny
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany
| | - D Schmauss
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany.,Department for Plastic, Reconstructive and Aesthetic Surgery, Ospedale Regionale Di Lugano, Lugano, Switzerland
| | - K Megerle
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany
| | - H Erne
- Department for Plastic Surgery and Hand Surgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany
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Baogui L, Juwen C. Fusion rates for odontoid fractures after treatment by anterior odontoid screw versus posterior C1-C2 arthrodesis: a meta-analysis. Arch Orthop Trauma Surg 2019; 139:1329-1337. [PMID: 30877428 DOI: 10.1007/s00402-019-03164-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE For odontoid fractures, surgical treatment approaches including anterior odontoid screw fixation approach and the posterior C1-C2 arthrodesis approach are generally adopted in practice. However, the choice of different surgical procedures remains controversial. In addition to surgical technique, the fusion rate is an important factor contributing to the clinical efficacy. Therefore, this study was aimed to investigate the discrepancy in fusion rate between these two surgical approaches through synthesizing the currently available evidence on the topic. METHODS A computerized search of Ovid, Medline, Embase, and the Cochrane library up to December 2017 for literature on the complication rate during odontoid fracture treatment was conducted. Risk ratio (RR) with its 95% confidence interval (CI) was pooled to assess fusion rates after surgical treatments, including anterior odontoid screw fixation approach or posterior C1-2 arthrodesis procedure, for patients with odontoid fractures. RESULTS Thirteen studies were enrolled in the meta-analysis. Results show that no significant difference was found in the overall fusion rate (RR = 0.96, 95% CI 0.90-1.01). There was no significant heterogeneity among the studies (p value = 0.60). As to age- and economic-level subgroups, there was no statistical evidence to suggest an association of the patient age and economy development level with the choice of surgical approach. However, it is shown that better fusion rates of patients (≥ 60 years) in developed countries received a better fusion rates after posterior fixation compared with anterior group using the fixed-effect model (RR = 0.88, 95% CI 0.79-0.98). CONCLUSION Elderly patients (≥ 60 years) underwent posterior C1-2 arthrodesis fixation shows higher fusion rates in developed countries comparing with patients who underwent anterior odontoid screw fixation. Overall, there is no significant discrepancy between these two surgical approaches. However, the conclusion should be verified by further study enrolling larger sample size.
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Affiliation(s)
- Li Baogui
- Orthopedics Department, Tian Jin 4th Center Hospital, Tianjin, 300000, China
| | - Chen Juwen
- Orthopedics Department, Tian Jin 4th Center Hospital, Tianjin, 300000, China.
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Gembruch O, Lemonas E, Ahmadipour Y, Sure U, El Hindy N, Dodel R, Müller O. Treatment of Odontoid Type II Fractures in Octogenarians: Balancing Two Different Treatment Strategies. Neurospine 2019; 16:360-367. [PMID: 31154696 PMCID: PMC6603819 DOI: 10.14245/ns.1836250.125] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 12/31/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Demographic changes have led to a higher incidence of C-2 fractures, especially in elderly patients. For patients with type II fractures, treatment remains controversial, as discussed by Anderson and D'Alonzo, due to the rising morbidity and mortality rates for any treatment. The aim of this study was to compare conservative and surgical management in patients with type II C-2 fractures regarding outcomes, complications, and the mortality rate. METHODS A retrospective analysis was performed of the medical records, X-rays, and/or computed tomography scans of patients ≥80 years of age with type II fractures who were admitted to our Department of Neurosurgery between January 1990 and December 2017. The success of treatment was evaluated 3 months after surgery. RESULTS In total, 125 patients were included, of whom 98 were treated surgically and 27 were treated conservatively. Surgical treatment was successful in 90.8% of cases, while conservative treatment was successful in 70.0%. The in-hospital mortality was 14.29% and the 3-month mortality was 27.8% in the surgical group, compared to 3.7% and 20% in the conservatively treated group. The in-hospital complication rate was 22.4% in the surgically treated patients and 7.4% in the conservatively treated patients. CONCLUSION Surgical treatment of type II fractures seemed to be associated with higher success and complication rates than conservative treatment. Nevertheless, 3-month mortality was comparable in both groups. Therefore, we conclude that surgical treatment for type II fractures in elderly patients is superior to conservative management, although conservative treatment remains a valuable option in elderly patients with severe comorbidities.
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Affiliation(s)
- Oliver Gembruch
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Elias Lemonas
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Yahya Ahmadipour
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Nicolai El Hindy
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Department of Spine Surgery, Katholisches Klinikum Lünen/Werne GmbH, St. Christophorus-Krankenhaus, Werne, Germany
| | - Richard Dodel
- Department of Geriatric Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Geriatric Center Haus Berge, Contilia Group, Essen, Germany
| | - Oliver Müller
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Abstract
OBJECTIVE To evaluate surgical outcomes and feasibility of robotic myomectomy in large uterine myomas. MATERIALS AND METHODS This is a retrospective study for robotic myomectomies performed from October 2012 to August 2017 by a single surgeon in a tertiary care referral hospital. Demographics, diagnosis, perioperative variables, operative outcomes and complications were recorded. Large uterine myoma was defined as the estimated diameter of dominant myoma equal to or larger than 10 cm by sonography. RESULTS Seventy-four patients were included and 32 (43.2%) patients had large uterine myoma. Patients with myoma larger than 10 cm showed significantly heavier myoma weight (446.5 ± 206.2 mg vs. 288.1 ± 147.5, p < 0.001), similar blood loss (309.4 ± 190.3 mL vs. 200.9 ± 285.9 mL, p = 0.06), and longer operative time (263.4 ± 83.7 min vs. 219.1 ± 75.7 min, p = 0.02) compared with patients with myoma <10 cm. The largest myoma removed was 20 cm in diameter. Perioperative complications were rare. CONCLUSION Robotic myomectomy is feasible for managing large uterine myomas. It is a safe procedure with acceptable longer operative time.
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