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Marland H, McDonnell JM, Hughes L, Morrison C, Wilson KV, Cunniffe G, Morris S, Darwish S, Butler JS. Comparative surgical outcomes of navigated vs non-navigated posterior spinal fusions in ankylosing spondylitis patients. Surgeon 2024:S1479-666X(24)00029-5. [PMID: 38584041 DOI: 10.1016/j.surge.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 02/19/2024] [Accepted: 03/21/2024] [Indexed: 04/09/2024]
Abstract
INTRODUCTION Ankylosing Spondylitis (AS) patients with acute spinal fractures represent a challenge for practicing spine surgeons due to difficult operative anatomy and susceptibility to complications. RESEARCH QUESTION Does intraoperative CT-navigation improve outcomes in patients with ankylosing spondylitis undergoing surgery? METHODS A retrospective review was carried out at our centre from 05/2016-06/2021 to identify AS patients presenting with a traumatic spinal fracture, managed surgically with posterior spinal fusion (PSF). Cohorts were categorised and compared for outcomes based on those who underwent PSF with intraoperative CT-navigation versus those surgically managed with traditional intraoperative fluoroscopy. RESULTS 37 AS patients were identified. 29/37 (78.4%) underwent PSF. Intraoperative navigation was used in 14 (48.3%) cases. Mean age of the entire cohort was 67.6 years. No difference existed between the navigated and non-navigated groups for mean levels fused (5.35 vs 5.07; p = 0.31), length of operation (217.9mins vs 175.3mins; p = 0.07), overall length-of-stay (12 days vs 21.9 days; p = 0.16), patients requiring HDU (3/14 vs 5/15; p = 0.09) or ICU (5/14 vs 9/15; p = 0.10), postoperative neurological improvement (1/14 vs 1/15; p = 0.48) or deterioration (1/14 vs 0/15; p = 0.15), intraoperative complications (2/14 vs 3/15; p = 0.34), postoperative complications 4/14 vs 4/15; p = 0.46), revision surgeries (3/14 vs 1/15; p = 0.16) and 30-day mortality (0/14 vs 0/15). CONCLUSION This is the first study that compares surgical outcomes of navigated vs non-navigated PSFs for AS patients with an acute spinal fracture. Although limited by its retrospective design and sample size, this study highlights the non-inferiority of intraoperative navigation as a surgical aid in a challenging cohort.
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Affiliation(s)
- Harry Marland
- School of Medicine, University of Galway, Galway, Ireland.
| | - Jake M McDonnell
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland; Trinity Centre of Biomedical Engineering, Trinity College Dublin, Dublin, Ireland
| | - Lauren Hughes
- Department of Anaesthesia, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Cronan Morrison
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Kielan V Wilson
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland
| | - Gráinne Cunniffe
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Seamus Morris
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Stacey Darwish
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland; Department of Orthopaedics, St. Vincent's University Hospital, Dublin, Ireland
| | - Joseph S Butler
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland
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Ullrich S, Denning NL, Holder M, Wittenberg R, Krebs K, Schwan A, Verderber A, Garrison AP, Rymeski B, Rosen N, Frischer JS. Does Length of Extended Resection Beyond Transition Zone Change Clinical Outcome for Hirschsprung Pull-Through? J Pediatr Surg 2024; 59:86-90. [PMID: 37865574 DOI: 10.1016/j.jpedsurg.2023.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 09/07/2023] [Indexed: 10/23/2023]
Abstract
INTRODUCTION A proximal resection margin greater than 5 cm from the intra-operative histologically determined transition zone has been deemed necessary to minimize the risk of transition zone pull-through. This extended resection may require the sacrifice of vascular supply and even further bowel resection. The impact of extended proximal resection margin on post-operative complications and functional outcomes is unclear. METHODS A retrospective chart review of patients who underwent primary pull-through for Hirschsprung disease at a single institution between January 2008 and December 2022 was performed. An adequate proximal margin was defined by a circumferential normally ganglionated ring and absence of hypertrophic nerves. The extended margin was defined as the total length of proximal colon with normal ganglion cells and without hypertrophic nerves. Fecal incontinence severity was assessed with the Pediatric Fecal Incontinence Severity Score (PFISS). RESULTS Eighty seven patients met criteria for inclusion. Median age at primary pull-through was 17 days (IQR 10-92 days), 55% (n = 48) of patients had an extended proximal margin (EPM) ≤ 5 cm, and 45% (n = 39) had an EPM > 5 cm. An EPM ≤5 cm was not associated with increased rates of Hirschsprung associated enterocolitis (≤5 cm 43%, >5 cm 39%, P = 0.701), diversion post pull-through (≤5 cm 10%, >5 cm 5%, P = 0.367) or reoperation for transition zone pull-through (≤5 cm 3%, >5 cm 0%, P = 0.112). EPM ≤5 cm had more frequent involuntary daytime bowel movements (P = 0.041) and more frequent voluntary bowel movements (P = 0.035). There were no differences in other measures of fecal incontinence severity. CONCLUSIONS Shorter proximal extended margins beyond the adequate ganglionated margin do not significantly impact post-operative complication rates and have an unclear effect on fecal incontinence. TYPE OF STUDY Case Control. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Sarah Ullrich
- Cincinnati Children's Hospital Colorectal Center, Cincinnati, OH, USA.
| | | | - Monica Holder
- Cincinnati Children's Hospital Colorectal Center, Cincinnati, OH, USA
| | - Randi Wittenberg
- Cincinnati Children's Hospital Colorectal Center, Cincinnati, OH, USA
| | - Kevin Krebs
- Cincinnati Children's Hospital Colorectal Center, Cincinnati, OH, USA
| | - Ava Schwan
- Cincinnati Children's Hospital Colorectal Center, Cincinnati, OH, USA
| | - Abigail Verderber
- Cincinnati Children's Hospital Colorectal Center, Cincinnati, OH, USA
| | - Aaron P Garrison
- Cincinnati Children's Hospital Colorectal Center, Cincinnati, OH, USA
| | - Beth Rymeski
- Cincinnati Children's Hospital Colorectal Center, Cincinnati, OH, USA
| | - Nelson Rosen
- Cincinnati Children's Hospital Colorectal Center, Cincinnati, OH, USA
| | - Jason S Frischer
- Cincinnati Children's Hospital Colorectal Center, Cincinnati, OH, USA
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Alvarez IA, Ordoyne L, Borne G, Fabian I, Adilbay D, Kandula RA, Asarkar A, Nathan CA, Pang J. Chronic heart failure in patients undergoing major head and neck surgery: A hospital-based study. Am J Otolaryngol 2024; 45:104043. [PMID: 37734364 DOI: 10.1016/j.amjoto.2023.104043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/06/2023] [Accepted: 09/10/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE To investigate the effects of chronic heart failure on various post-operative outcomes in head and neck cancer patients undergoing major cancer surgery. STUDY DESIGN For this retrospective cohort study of patients undergoing major head and neck cancer surgery, a sample of 10,002 patients between 2017 and 2019 were identified through the Nationwide Inpatient Sample. SETTING Patients were selected as undergoing major head and neck cancer surgery, defined as laryngectomy, pharyngectomy, glossectomy, neck dissection, mandibulectomy, and maxillectomy, then separated based on pre-surgical diagnosis of chronic heart failure. METHODS The effects of pre-operative chronic heart failure on post-surgical outcomes in these patients were investigated by univariable and multivariable logistic regression using ICD-10 codes and SPSS. RESULTS A diagnosis of chronic heart failure was observed in 265 patients (2.6 %). Patients with chronic heart failure had more preexisting comorbidities when compared to patients without chronic heart failure (mean ± SD; 4 ± 1 vs. 2 ± 1). Multivariable logistic regression showed that chronic heart failure patients had significantly greater odds of dying during hospitalization (OR 2.86, 95 % CI 1.38-5.91) and experiencing non-routine discharge from admission (OR 1.89, 95 % CI 1.41-2.54) after undergoing major head and neck cancer surgery. CONCLUSION Chronic heart failure is associated with greater length of stay and hospital charges among head and neck cancer patients undergoing major head and neck cancer surgeries. Chronic heart failure patients have significantly greater rates of unfavorable post-operative outcomes, including death during hospitalization and non-routine discharge from admission.
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Affiliation(s)
- Ivan A Alvarez
- LSU Health Shreveport, Dept. of Otolaryngology-HNS, United States of America
| | - Liam Ordoyne
- LSU Health Shreveport, Dept. of Otolaryngology-HNS, United States of America
| | - Grant Borne
- LSU Health Shreveport, Dept. of Otolaryngology-HNS, United States of America
| | - Isabella Fabian
- LSU Health Shreveport, Dept. of Otolaryngology-HNS, United States of America
| | - Dauren Adilbay
- LSU Health Shreveport, Dept. of Otolaryngology-HNS, United States of America
| | - Rema A Kandula
- LSU Health Shreveport, Dept. of Otolaryngology-HNS, United States of America
| | - Ameya Asarkar
- LSU Health Shreveport, Dept. of Otolaryngology-HNS, United States of America; Feist Weiller Cancer Center, United States of America
| | - Cherie-Ann Nathan
- LSU Health Shreveport, Dept. of Otolaryngology-HNS, United States of America; Feist Weiller Cancer Center, United States of America
| | - John Pang
- LSU Health Shreveport, Dept. of Otolaryngology-HNS, United States of America; Feist Weiller Cancer Center, United States of America.
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De La Tejera G, Corona K, Efejuku T, Keys P, Joglar A, Villarreal E, Gotewal S, Wermine K, Huang L, Golovko G, El Ayadi A, Palackic A, Wolf SE, Song J. Early wound excision within three days decreases risks of wound infection and death in burned patients. Burns 2023; 49:1816-1822. [PMID: 37369613 PMCID: PMC10721718 DOI: 10.1016/j.burns.2023.06.003] [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: 07/07/2022] [Revised: 03/08/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023]
Abstract
INTRODUCTION In lieu of limited studies on the timing of burn wound eschar excision for burns, a more comprehensive analysis is indicated to determine the effects of early wound excision following burns. This study aims to address the outcomes of early wound excision in burn patients. METHODS Data collection were from TriNetX research database. Three groups of burn patients were stratified by the number of days in which they received burn wound excision within 14 days of injury. Five outcomes were observed: death, wound infection, sepsis, myocardial contractile dysfunction, and blood transfusion. Risk and incidence of various health outcomes were compared between the groups after propensity-matching age, sex, ethnicity, race and burn size using a z-test with p < 0.05 considered significant. RESULTS We identified 6158 burn patients with wound excision within 14 days of injury, the majority of whom (60.1%) received burn wound excision between 0 and 3 days after burn. 72.5% of patients had burns covering less than 20% of total body surface area. After propensity matching, we found a significantly lower risk of mortality in those who received burn wound excision within the first three days (3.84%) as compared to 8-14 days after burn (6.09%) (p < 0.05). Moreover, we found a decreased risk of wound infection in patients with burn wound excision within 0-3 days (37.84%) compared to those 4-7 days (42.48%) (p < 0.05). No statistical difference was detected in propensity-matched groups for myocardial contractile dysfunction, blood transfusion, or sepsis. In addition, the risk of hypertrophic scaring significantly decreased when wound excision was performed within 0-3 days (22% within 0-3 days, 28% within 4-7 days, p < 0.05). CONCLUSION Burn wound excision within 3 days of injury is beneficial when comparing to later treatment between 4 and 14 days, which results in a significantly lowered risk of mortality and infection in burn patient.
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Affiliation(s)
| | - Kassandra Corona
- School of Medicine, University of Texas Medical Branch, Galveston, United States
| | - Tsola Efejuku
- School of Medicine, University of Texas Medical Branch, Galveston, United States
| | - Phillip Keys
- School of Medicine, University of Texas Medical Branch, Galveston, United States
| | - Alejandro Joglar
- School of Medicine, University of Texas Medical Branch, Galveston, United States
| | - Elvia Villarreal
- School of Medicine, University of Texas Medical Branch, Galveston, United States
| | - Sunny Gotewal
- School of Medicine, University of Texas Medical Branch, Galveston, United States
| | - Kendall Wermine
- School of Medicine, University of Texas Medical Branch, Galveston, United States
| | - Lyndon Huang
- School of Medicine, University of Texas Medical Branch, Galveston, United States
| | - George Golovko
- Department of Pharmacology, University of Texas Medical Branch, Galveston, United States
| | - Amina El Ayadi
- Department of Surgery, University of Texas Medical Branch, Galveston, United States
| | - Alen Palackic
- Department of Surgery, University of Texas Medical Branch, Galveston, United States
| | - Steven E Wolf
- Department of Surgery, University of Texas Medical Branch, Galveston, United States
| | - Juquan Song
- Department of Surgery, University of Texas Medical Branch, Galveston, United States.
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Sleiman AG, Vallette N, Milto AJ, Revelt N, Scaife SL, Thuppal SV. The effect of autoimmune skin disorders on post-operative outcomes following arthroplasty. Surgeon 2023; 21:e292-e300. [PMID: 37028955 DOI: 10.1016/j.surge.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/17/2023] [Accepted: 03/20/2023] [Indexed: 04/09/2023]
Abstract
INTRODUCTION The impact of autoimmune skin disorders on post-operative outcomes after TJA is conflicting and studies are limited by small sample sizes. The purpose of this study is to analyze a range of common autoimmune skin disorders and identify whether an increased risk of post-operative complication exists after total joint arthroplasty. METHODS Data was collected from NIS database for patients diagnosed with autoimmune skin disorder (psoriasis, lupus, scleroderma, atopic dermatitis) and who underwent total hip arthroplasty (THA), total knee arthroplasty (TKA), or other TJA (shoulder elbow, wrist, ankle) between 2016 and 2019. Demographic, social, and comorbidity data was collected. Multivariate regression analyses were performed to assess the independent influence of autoimmune skin disorder on each post-operative outcome including implant infection, transfusion, revision, length of stay, cost, and mortality. RESULTS Among 55,755 patients with autoimmune skin disease who underwent TJA, psoriasis was associated with increased risk of periprosthetic joint infection following THA (odds ratio 2.44 [1.89-3.15]) and increased risk of transfusion following TKA (odds ratio 1.33 [1.076-1.64]). Similar analyses were performed for systemic lupus erythematosus, atopic dermatitis, and scleroderma, however no statistically significant associations were observed in any of the six collected post-operative outcomes. CONCLUSION This study suggests psoriasis is an independent risk factor for poorer post-operative outcomes following total joint arthroplasty, however similar risk was not observed for other autoimmune skin disorders such as lupus, atopic dermatitis, or scleroderma.
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Affiliation(s)
- Anthony G Sleiman
- Division of Orthopedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL P.O. Box 19679, Springfield, IL, 62794, USA; Center for Clinical Research, Southern Illinois University School of Medicine, 201 E. Madison St., Springfield, IL, 62702, USA
| | - Noah Vallette
- Division of Orthopedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL P.O. Box 19679, Springfield, IL, 62794, USA
| | - Anthony J Milto
- Division of Orthopedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL P.O. Box 19679, Springfield, IL, 62794, USA
| | - Nicolas Revelt
- Division of Orthopedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL P.O. Box 19679, Springfield, IL, 62794, USA
| | - Steven L Scaife
- Center for Clinical Research, Southern Illinois University School of Medicine, 201 E. Madison St., Springfield, IL, 62702, USA
| | - Sowmyanarayanan V Thuppal
- Division of Orthopedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL P.O. Box 19679, Springfield, IL, 62794, USA; Center for Clinical Research, Southern Illinois University School of Medicine, 201 E. Madison St., Springfield, IL, 62702, USA.
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Portale G, Spolverato YC, Tonello AS, Bartolotta P, Frigo G, Simonetto M, Gregori D, Fiscon V. Which video technology brings the higher cognitive burden and motion sickness in laparoscopic colorectal surgery: 3D, 2D-4 K or 3D-4 K? a propensity score study. Int J Colorectal Dis 2023; 38:190. [PMID: 37428283 DOI: 10.1007/s00384-023-04491-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/05/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Technological development has offered laparoscopic colorectal surgeons new video systems to improve depth perception and perform difficult task in limited space. The aim of this study was to assess the cognitive burden and motion sickness for surgeons during 3D, 2D-4 K or 3D-4 K laparoscopic colorectal procedures and to report post-operative data with the different video systems employed. METHODS Patients were assigned to either 3D, 2D-4 K or 3D-4 K video and two questionnaires (Simulator Sickness Questionnaire-SSQ- and NASA Task Load Index -TLX) were used during elective laparoscopic colorectal resections (October 2020-August 2022) from two operating surgeons. Short-term results of the operations performed with the three different video systems were also analyzed. RESULTS A total of 113 consecutive patients were included: 41 (36%) in the 3D Group (A), 46 (41%) in the 3D-4 K Group and 26 (23%) in the 2D-4 K Group (C). Weighted and adjusted regression models showed no significant difference in cognitive load amongst the surgeons in the three groups of video systems when using the NASA-TLX. An increased risk for slight/moderate general discomfort and eyestrain in the 3D-4 K group compared with 2D-4 K group (OR = 3.5; p = 0.0057 and OR = 2.8; p = 0.0096, respectively) was observed. Further, slight/moderate difficulty focusing was lower in both 3D and 3D-4 K groups compared with 2D-4 K group (OR = 0.4; p = 0.0124 and OR = 0.5; p = 0.0341, respectively), and higher in the 3D-4 K group compared with 3D group (OR = 2.6; p = 0.0124). Patient population characteristics, operative time, post-operative staging, complication rate and length of stay were similar in the three groups of patients. CONCLUSIONS 3D and 3D-4 K systems, when compared with 2D-4 K video technology, have a higher risk for slight/moderate general discomfort and eyestrain, but show lower difficulty focusing. Short post-operative outcomes do not differ, whichever imaging system is used.
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Affiliation(s)
- Giuseppe Portale
- Department of General Surgery, Azienda Euganea ULSS 6, Via Casa di Ricovero, 40; 35013, Cittadella, Padua, Italy.
| | - Ylenia Camilla Spolverato
- Department of General Surgery, Azienda Euganea ULSS 6, Via Casa di Ricovero, 40; 35013, Cittadella, Padua, Italy
| | | | - Patrizia Bartolotta
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35121, Padua, Italy
| | - Gianfranco Frigo
- Department of Cardiology, Azienda Euganea ULSS 6, Cittadella, Italy
| | - Marco Simonetto
- Department of Neurology, Azienda Euganea ULSS 6, Cittadella, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35121, Padua, Italy
| | - Valentino Fiscon
- Department of General Surgery, Azienda Euganea ULSS 6, Via Casa di Ricovero, 40; 35013, Cittadella, Padua, Italy
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Cai S, Lou H, Zhang L. Prognostic factors for post-operative outcomes in chronic rhinosinusitis with nasal polyps: a systematic review. Expert Rev Clin Immunol 2023; 19:867-881. [PMID: 37225659 DOI: 10.1080/1744666x.2023.2218089] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 04/30/2023] [Accepted: 05/22/2023] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Chronic rhinosinusitis with nasal polyps (CRSwNP) has a high recurrence rate after surgery despite the availability of medical treatments. Multiple clinical and biological factors have been associated with poor post-operative outcomes in patients with CRSwNP. However, these factors and their prognostic values have not yet been extensively summarized. AREAS COVERED This systematic review included 49 cohort studies exploring the prognostic factors for post-operative outcomes in CRSwNP. A total of 7802 subjects and 174 factors were included. All investigated factors were classified into three categories according to their predictive value and evidence quality, of which 26 factors were considered plausible for post-operative outcome prediction. Previous nasal surgery, ethmoid-to-maxillary (E/M) ratio, fractional exhaled nitric oxide, tissue eosinophil count or percentage, tissue neutrophil count, tissue IL-5, tissue eosinophil cationic protein, and CLC or IgE in nasal secretion provided more reliable information for prognosis in at least two studies. EXPERT OPINION Exploring predictors through noninvasive or minimally invasive methods for specimen collection is recommended for future work. Models combining multiple factors must be established, as no single factor is effective for the whole population.
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Affiliation(s)
- Shiru Cai
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
- Beijing Laboratory of Allergic Diseases and Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Hongfei Lou
- Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Luo Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
- Beijing Laboratory of Allergic Diseases and Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
- Research Unit of Diagnosis and Treatment of Chronic Nasal Diseases, Chinese Academy of Medical Sciences, Beijing, China
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China
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Mao D, Flynn DE, Yerkovich S, Tran K, Gurunathan U, Chandrasegaram MD. Effect of obesity on post-operative outcomes following colorectal cancer surgery. World J Gastrointest Oncol 2022; 14:1324-1336. [PMID: 36051092 PMCID: PMC9305574 DOI: 10.4251/wjgo.v14.i7.1324] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 11/22/2021] [Revised: 01/10/2022] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) resection is currently being undertaken in an increasing number of obese patients. Existing studies have yet to reach a consensus as to whether obesity affects post-operative outcomes following CRC surgery.
AIM To evaluate the post-operative outcomes of obese patients following CRC resection, as well as to determine the post-operative outcomes of obese patients in the subgroup undergoing laparoscopic surgery.
METHODS Six-hundred and fifteen CRC patients who underwent surgery at the Prince Charles Hospital between January 2010 and December 2020 were categorized into two groups based on body mass index (BMI): Obese [BMI ≥ 30, n = 182 (29.6%)] and non-obese [BMI < 30, n = 433 (70.4%)]. Demographics, comorbidities, surgical features, and post-operative outcomes were compared between both groups. Post-operative outcomes were also compared between both groups in the subgroup of patients undergoing laparoscopic surgery [n = 472: BMI ≥ 30, n = 136 (28.8%); BMI < 30, n = 336 (71.2%)].
RESULTS Obese patients had a higher burden of cardiac (73.1% vs 56.8%; P < 0.001) and respiratory comorbidities (37.4% vs 26.8%; P = 0.01). Obese patients were also more likely to undergo conversion to an open procedure (12.8% vs 5.1%; P = 0.002), but did not experience more post-operative complications (51.6% vs 44.1%; P = 0.06) or high-grade complications (19.2% vs 14.1%; P = 0.11). In the laparoscopic subgroup, however, obesity was associated with a higher prevalence of post-operative complications (47.8% vs 39.3%; P = 0.05) but not high-grade complications (17.6% vs 11.0%; P = 0.07).
CONCLUSION Surgical resection of CRC in obese individuals is safe. A higher prevalence of post-operative complications in obese patients appears to only be in the context of laparoscopic surgery.
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Affiliation(s)
- Derek Mao
- Faculty of Medicine and Health, The University of Sydney, Sydney 2050, New South Wales, Australia
| | - David E Flynn
- Department of General Surgery, The Prince Charles Hospital, Brisbane 4032, Queensland, Australia
| | - Stephanie Yerkovich
- Faculty of Medicine, The University of Queensland, Brisbane 4006, Queensland, Australia
| | - Kayla Tran
- Department of Pathology, The Prince Charles Hospital, Brisbane 4032, Queensland, Australia
| | - Usha Gurunathan
- Faculty of Medicine, The University of Queensland, Brisbane 4006, Queensland, Australia
- Department of Anaesthesia, The Prince Charles Hospital, Brisbane 4032, Queensland, Australia
| | - Manju D Chandrasegaram
- Department of General Surgery, The Prince Charles Hospital, Brisbane 4032, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane 4006, Queensland, Australia
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Duong SQ, Zaniletti I, Lopez L, Sutherland SM, Shin AY, Collins RT 2nd. Post-operative Morbidity and Mortality After Fontan Procedure in Patients with Heterotaxy and Other Situs Anomalies. Pediatr Cardiol 2022; 43:952-9. [PMID: 35064275 DOI: 10.1007/s00246-021-02804-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 12/09/2021] [Indexed: 10/19/2022]
Abstract
Heterotaxy is a complex, multisystem disorder associated with single ventricle heart disease and decreased survival. Ciliary dysfunction is common in heterotaxy and other situs abnormalities (H/SA) and may increase post-operative complications. We hypothesized that patients with H/SA have increased respiratory and renal morbidities and increased in-hospital mortality after Fontan procedure. We queried the Pediatric Health Information System database for hospitalizations with ICD-9/10 codes for Fontan procedure in patients aged 1 through 11 years from 2004 to 2019. H/SA was identified by codes for dextrocardia, situs inversus, asplenia/polysplenia, or atrial isomerism and compared to non-H/SA controls. Outcomes were in-hospital mortality or heart transplantation, ECMO, hemodialysis, length of stay (LOS), and mechanical ventilation or vasoactive medication use ≥ 4 days. We adjusted estimates with multivariable logistic regression. Of 7897 patients at 50 centers, 1366 (17%) met criteria for H/SA. H/SA had worse outcomes for all study measures: death/transplantation (1.9 vs 1.1%, OR 1.74 (95% CI 1.01-3.03); p = 0.047), ECMO (3.7 vs 2.3%, OR 1.74 (1.28-2.35); p < 0.001), hemodialysis (2.1 vs 1.2%, OR 1.66 (1.06-2.59); p = 0.026), prolonged mechanical ventilation (13.2% vs 7.6%, OR 1.85 (1.53-2.25); p < 0.001) and vasoactive medication use (29.4 vs 19.7%, OR 1.65 (1.43-1.90), and longer LOS (11 (8-17) vs 9 (7-14) days; p < 0.001). H/SA is associated with increased cardiovascular, renal, and respiratory morbidity, as well as in-hospital mortality after Fontan procedure. Attention to renal and respiratory needs may improve outcomes in this difficult population. The relationship between ciliary dysfunction and lung and renal morbidity should be explored further.
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Tay JQ. Re: Assessing patient frailty in plastic surgery: A systematic review. J Plast Reconstr Aesthet Surg 2022; 75:2387-2440. [PMID: 35618564 PMCID: PMC9069987 DOI: 10.1016/j.bjps.2022.04.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 04/12/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Jing Qin Tay
- Plastic, Burns and Reconstructive Surgery Department, Salisbury District Hospital, Thames Valley/Wessex Deanery, UK.
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11
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Goins EC, Weber JM, Truong T, Moss HA, Previs RA, Davidson BA, Havrilesky LJ. Malnutrition as a risk factor for post-operative morbidity in gynecologic cancer: Analysis using a national surgical outcomes database. Gynecol Oncol 2022; 165:309-316. [PMID: 35241292 DOI: 10.1016/j.ygyno.2022.01.030] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/18/2022] [Accepted: 01/26/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To assess, using a national surgical outcomes database, the association of various malnutrition definitions with post-operative morbidity in three gynecologic malignancies. METHODS Patients undergoing resection of ovarian, uterine, or cervical cancer between 2005 and 2019 were identified using the National Surgical Quality Improvement Program (NSQIP) database. Patients were classified based on specific, pre-defined malnutrition criteria: severe malnutrition (Body Mass Index (BMI) <18.5 + 10% weight loss), European Society for Clinical Nutrition and Metabolism ((ESPEN1); BMI 18.5-22 + 10% weight loss), ESPEN2 (BMI < 18.5), American Cancer Society ((ACS); normal/overweight BMI + 10% weight loss), mild malnutrition (BMI 18.5-22), or albumin (<3.5 g/dL). Outcomes included 30-day major complications, readmission, reoperation. Modified Poisson regression estimated associations between definitions and outcomes. RESULTS Of 76,290 total patients undergoing surgery, those meeting malnutrition definitions were: severe-98 (0.1%), ESPEN1-148 (0.2%), ESPEN2-877 (1.1%), ACS-1028 (1.3%), mild-2853 (3.7%), and albumin (11.1%). Complication rates were: unplanned readmission-5.5%, reoperation-1.7%, major complications-13.5%. For ovarian cancer, ESPEN2 malnutrition was associated with higher readmissions (risk ratio 1.69; 95% confidence interval 1.29-2.20), reoperations (2.53; 1.70-3.77), and complications (1.36; 1.20-1.54). For uterine cancer, ACS malnutrition was associated with readmissions (2.74; 2.09-3.59), reoperations (3.61; 2.29-5.71) and complications (3.92; 3.40-4.53). For cervical cancer, albumin<3.5 g/dL was associated with readmissions (1.48; 1.01-2.19), reoperations (2.25; 1.17-4.34), and complications (2.59; 2.11-3.17). Albumin<3.5 was associated with adverse outcomes in ovarian and uterine cancer. CONCLUSIONS Preoperative risk assessments might be tailored using cancer-specific malnutrition criteria. Major complications, readmissions, and reoperations are all associated with the ESPEN2 definition for ovarian cancer, the ACS definition for uterine cancer, and with albumin<3.5 for all cancers.
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Affiliation(s)
- Emily C Goins
- School of Medicine, Duke University, Durham, North Carolina, United States of America
| | - Jeremy M Weber
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Tracy Truong
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Haley A Moss
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Health System, Durham, North Carolina, United States of America
| | - Rebecca A Previs
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Health System, Durham, North Carolina, United States of America
| | - Brittany A Davidson
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Health System, Durham, North Carolina, United States of America
| | - Laura J Havrilesky
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Health System, Durham, North Carolina, United States of America
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12
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Bouaziz M, Schlesinger M, Kang JJ, Kim G. Incidence of postoperative week 1 management changes after resident-performed phacoemulsification cataract surgery. BMC Ophthalmol 2022; 22:15. [PMID: 34998368 PMCID: PMC8742418 DOI: 10.1186/s12886-021-02238-1] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 12/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The goal of this study was to investigate the incidence of departures from routine care at the postoperative week 1 (POW1) visit following uneventful resident-performed cataract surgery in asymptomatic patients who had a normal postoperative day 1 (POD1) examination. METHODS A retrospective chart review of phacoemulsification surgeries performed by the senior resident class at Montefiore Medical Center between June 20, 2018 and April 1, 2019 was performed. The most recent preoperative visit note, operative report, POD1 visit note, and POW1 visit note were evaluated and variables were recorded. Exclusion criteria consisted of any complications that would have necessitated close follow-up and a POW1 visit, whether discovered preoperatively, intraoperatively, at the POD1 visit, or leading up to the POW1 visit. The primary outcome measure was the incidence of unanticipated management changes at the POW1 visit following resident-performed cataract surgery. RESULTS The charts of 292 surgical cases of 234 patients that underwent phacoemulsification with intraocular lens implantation were reviewed. 226 cases (77%) had an uncomplicated pseudophakic fellow-eye history, with a routine surgery, and POD1 examination. 19 of these patients had symptomatic presentations at the POW1 timepoint, and an additional 30 had no POW1 visit at all. In total, 177 cases were included in the study, and only 4 of these cases (2.3%) had an unexpected management change at the POW1 visit. CONCLUSIONS Asymptomatic patients who underwent uncomplicated cataract surgeries performed by resident surgeons followed by a routine POD1 visit had a low incidence of unexpected management changes at the POW1 visit. These results suggest that regularly scheduled POW1 visits could potentially be omitted for patients deemed to be at low risk for complications, and instead performed on an as-needed basis.
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Affiliation(s)
- Michael Bouaziz
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Max Schlesinger
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Joann J Kang
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Gene Kim
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
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13
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Chopinet S, Bobot M, Reydellet L, Bollon E, Gérolami R, Decoster C, Blasco V, Moal V, Grégoire E, Hardwigsen J. Peri-operative risk factors of chronic kidney disease after liver transplantation. J Nephrol 2021; 35:607-617. [PMID: 34426948 DOI: 10.1007/s40620-021-01127-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 06/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) is a frequent long-term complication after liver transplantation (LT) and is associated with poor long-term survival. The aim of our study was to identify the risk factors of developing post-transplant CKD at 1 year, during the pre-operative, peri-operative, and post-LT phases. METHODS All consecutive patients who underwent primary LT between July 2013 and February 2018 were analyzed. To assess the impact of peri- and post-operative factors on renal function at 1 year we performed a propensity score matching on gender, age of the recipient, Model for End-Stage Liver Disease (MELD) score, etiology of the hepatic disease, and estimated Glomerular Filtration Rate (eGFR) at baseline. RESULTS Among the 245 patients who underwent LT, 215 had available data at one year (Y1), and 46% of them had CKD. Eighty-three patients in the CKD group and 83 in the normal renal function group were then matched. The median follow-up was 35 months (27-77). Patients with CKD at Y1 had a decreased 5-year survival compared to patients with normal renal function at one year: figures were 62% and 90%, respectively, p = 0.001. The independent predictors of CKD at Y1 were major complications (OR = 2.2, 95% CI [1.2-4.2]), p = 0.015, intensive care unit (ICU) stay > 5 days (OR = 2.2, 95% CI [1.3-5.1]), p = 0.046, ICU serum lactate level at 24 h ≥ 2.5 mmol/L (OR = 3.8 95% CI [1.1-8]), p = 0.034, need for post-LT renal replacement therapy (OR = 6.4 95% CI [1.4-25]), and MELD score ≥ 20 (OR = 2.1 95% CI [1.1-3.9]), p = 0.019. CONCLUSIONS The peri-operative period has a major impact on CKD incidence. Early recognition of patients at high risk of CKD may be critical for implementation of nephroprotective measures.
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Affiliation(s)
- Sophie Chopinet
- Department of Digestive Surgery and Liver Transplantation, Hôpital la Timone, 264 Rue Saint-Pierre, 13385, Marseille Cedex 05, France. .,European Center for Medical Imaging Research CERIMED/LIIE, Université Aix-Marseille, Marseille, France. .,Aix-Marseille Université, 27 Boulevard Jean Moulin, 13385, Marseille, France.
| | - Mickaël Bobot
- Department of Nephrology, Hôpital de la Conception, Marseille, France.,C2VN, INSERM 1263 INRAE 1260 Aix-Marseille Université, Marseille, France.,Aix-Marseille Université, 27 Boulevard Jean Moulin, 13385, Marseille, France
| | - Laurent Reydellet
- Department of Anesthesiology, Hôpital la Timone, Marseille, France.,Aix-Marseille Université, 27 Boulevard Jean Moulin, 13385, Marseille, France
| | - Emilie Bollon
- Department of Digestive Surgery and Liver Transplantation, Hôpital la Timone, 264 Rue Saint-Pierre, 13385, Marseille Cedex 05, France.,Aix-Marseille Université, 27 Boulevard Jean Moulin, 13385, Marseille, France
| | - René Gérolami
- Department of Hepatology Gastroenterology, Hôpital la Timone, Marseille, France.,Aix-Marseille Université, 27 Boulevard Jean Moulin, 13385, Marseille, France
| | - Claire Decoster
- Department of Hepatology Gastroenterology, Hôpital la Timone, Marseille, France.,Aix-Marseille Université, 27 Boulevard Jean Moulin, 13385, Marseille, France
| | - Valéry Blasco
- Department of Anesthesiology, Hôpital la Timone, Marseille, France.,Aix-Marseille Université, 27 Boulevard Jean Moulin, 13385, Marseille, France
| | - Valérie Moal
- Department of Nephrology, Hôpital de la Conception, Marseille, France.,Aix-Marseille Université, 27 Boulevard Jean Moulin, 13385, Marseille, France
| | - Emilie Grégoire
- Department of Digestive Surgery and Liver Transplantation, Hôpital la Timone, 264 Rue Saint-Pierre, 13385, Marseille Cedex 05, France.,European Center for Medical Imaging Research CERIMED/LIIE, Université Aix-Marseille, Marseille, France.,Aix-Marseille Université, 27 Boulevard Jean Moulin, 13385, Marseille, France
| | - Jean Hardwigsen
- Department of Digestive Surgery and Liver Transplantation, Hôpital la Timone, 264 Rue Saint-Pierre, 13385, Marseille Cedex 05, France.,Aix-Marseille Université, 27 Boulevard Jean Moulin, 13385, Marseille, France
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14
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Ghani M, Kuruppu S, Pritchard M, Harris M, Weerakkody R, Stewart R, Perera G. Vascular surgery receipt and outcomes for people with serious mental illnesses: Retrospective cohort study using a large mental healthcare database in South London. J Psychosom Res 2021; 147:110511. [PMID: 34051514 DOI: 10.1016/j.jpsychores.2021.110511] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Vascular surgery can be common among people with serious mental illness (SMI) given the high prevalence of cardiovascular disease. However, post-operative outcomes following vascular surgery have received little investigation, particularly in a subpopulation of SMI. METHODS We conducted a retrospective observational study using data from the South London and Maudsley NHS Foundation Trust (SLaM) via its Clinical Record Interactive Search (CRIS) platform and linkage with Hospital Episode Statistic (HES). Vascular surgery recipients were identified using OPCS version 4 codes. Length of stay (LOS) was modelled using Incidence Rate Ratios (IRRs), and 30-day emergency hospital readmissions using Odds Ratios (ORs) for people with SMI compared with the general population. RESULTS Vascular surgery was received by 152 patients with SMI diagnoses (schizophrenia, schizoaffective disorder, bipolar disorder) and 8821 catchment residents without any mental health conditions. People with active SMI symptoms more likely to be admitted to hospital via emergency route OR: 1.80 (95% CI: 1.06, 3.07) and more likely to stay longer in the hospital for vascular surgery IRR: 1.35 (1.01, 1.80) and more likely to be readmitted to hospital via emergency route within 30 days OR: 1.53 (1.02, 2.67). People with SMI who had major open vascular surgery and peripheral endovascular surgery more likely to have worse post-operative outcomes. CONCLUSION Our study highlights the risks faced by people with SMI following vascular surgery. These suggest tailored guidelines and policies are needed, based on the identification of pre-operative risk factors, allowing for focused post-vascular surgery care to minimise adverse outcomes.
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Affiliation(s)
- Marvey Ghani
- King's College London (Institute of Psychiatry, Psychology and Neuroscience), London, United Kingdom
| | - Sajini Kuruppu
- King's College London (Institute of Psychiatry, Psychology and Neuroscience), London, United Kingdom
| | - Megan Pritchard
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Matthew Harris
- King's College Hospital, Denmark Hill, London, United Kingdom
| | - Ruwan Weerakkody
- King's College London (Institute of Psychiatry, Psychology and Neuroscience), London, United Kingdom
| | - Robert Stewart
- King's College London (Institute of Psychiatry, Psychology and Neuroscience), London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Gayan Perera
- King's College London (Institute of Psychiatry, Psychology and Neuroscience), London, United Kingdom.
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15
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Tanaka S, Ozeki N, Mizuno Y, Nakajima H, Hattori K, Inoue T, Nagaya M, Fukui T, Nakamura S, Goto M, Sugiyama T, Nishida Y, Chen-Yoshikawa TF. Preoperative paraspinous muscle sarcopenia and physical performance as prognostic indicators in non-small-cell lung cancer. J Cachexia Sarcopenia Muscle 2021; 12:646-656. [PMID: 33665984 PMCID: PMC8200441 DOI: 10.1002/jcsm.12691] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 01/12/2021] [Accepted: 02/01/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Despite the associations of both preoperative sarcopenia and physical performance with post-operative mortality in non-small-cell lung cancer (NSCLC), there have been no comprehensive studies of the impact of physical status on prognosis. This study was performed to investigate the prognostic significance of preoperative sarcopenia and physical performance in NSCLC. METHODS This retrospective cohort study was performed in NSCLS patients undergoing curative lung resection at a university hospital between January 2014 and December 2017. The patients were divided into four groups according to the skeletal muscle index [sarcopenia (lowest sex-specific tertile) and non-sarcopenia] and 6 min walking distance (6MWD) [short distance (<400 m) and long distance (≥400 m)]. Sarcopenia was assessed by preoperative cross-sectional areas of right and left paraspinous muscles at the level of the 12th thoracic vertebra from computed tomography images, and physical performance was determined by preoperative 6MWD. The primary and secondary endpoints were post-operative overall survival (OS) and disease-free survival (DFS). RESULTS The 587 patients [mean age: 68.5 ± 8.8 years, 399 men (68%)] included in the study were divided into the non-sarcopenia/long-distance group (58%), sarcopenia/long-distance group (26%), non-sarcopenia/short-distance group (9%), and sarcopenia/short-distance group (7%). A total of 109 (18.6%) deaths and 209 (35.6%) combined endpoints were observed over a mean follow-up of 3.1 ± 1.3 years. After adjusting for other covariates, the sarcopenia/short-distance group showed significant associations with shorter OS (hazard ratio, 3.38; 95% confidence interval, 1.79-6.37; P < 0.001) and DFS (hazard ratio, 2.11; 95% confidence, 1.27-3.51; P = 0.004) compared with the non-sarcopenia/long-distance group on multivariate analyses. Although not significant, adding skeletal muscle index and 6MWD to the pre-existing risk model increased the area under the curve on time-dependent receiver operating characteristic curve analysis for OS and DFS, except within 2 years of surgery. CONCLUSIONS The presence of both preoperative paraspinous muscle sarcopenia and short distance in 6MWD had an adverse effect on post-operative prognosis in patients with NSCLC, suggesting that preoperative assessment of thoracic sarcopenia and physical performance may be useful for risk stratification of surgical candidates with potential for targeted interventions.
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Affiliation(s)
- Shinya Tanaka
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Naoki Ozeki
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yota Mizuno
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Hiroki Nakajima
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Keiko Hattori
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Takayuki Inoue
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Motoki Nagaya
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Takayuki Fukui
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shota Nakamura
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaki Goto
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoshi Sugiyama
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshihiro Nishida
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan.,Department of Orthopaedic Surgery, Nagoya University Graduate School and School of Medicine, Nagoya, Japan
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16
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McQuade C, Kavanagh DO, O'Brien C, Hunter K, Nally D, Hickie C, Ward E, Torreggiani WC. CT-determined sarcopenia as a predictor of post-operative outcomes in patients undergoing an emergency laparotomy. Clin Imaging 2021; 79:273-7. [PMID: 34171595 DOI: 10.1016/j.clinimag.2021.05.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/27/2021] [Accepted: 05/17/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE Emergency laparotomy has a high reported thirty-day mortality, ranging from 11 to 15%. Current peri-operative risk assessment tools may poorly estimate the risk of perioperative mortality. We sought to determine if CT-determined sarcopenia may be a useful predictor of post-operative outcomes in patients undergoing an emergency laparotomy. METHODS A retrospective review of a prospectively maintained database of consecutive adult patients who underwent an emergency laparotomy at our institution was performed. Post-operative mortality (90-day mortality), admission to HDU or ICU and APACHE-II scores were recorded for these patients. Sarcopenia was calculated by determining psoas area and density at the level of the third lumbar vertebra. The lowest quartile was determined to be sarcopenic. Univariate statistical analysis investigated associations between sarcopenia and these outcome measures. RESULTS Eighty patients were included in the study following application of exclusion criteria. Thirty-eight were male. The 90-day mortality rate was 11%. Compared to their non-sarcopenic counterparts, sarcopenic patients were significantly more likely to have died by 90 days post-operatively (χ2 = 9.51, p = 0.002) and to require admission to either the HDU or ICU in the post-operative period (χ2 = 10.62, p = 0.001). CONCLUSIONS CT determined sarcopenia is significantly associated with 90-day mortality and post-operative admission to HDU or ICU in patients undergoing an emergency laparotomy. The future development of a validated scoring tool incorporating sarcopenia could help to better select out those patients who will require higher levels of post-operative care as well as identifying those for whom surgery may not confer a survival benefit and be deemed futile.
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17
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Shankar V, Raj A, Singhal S, Sahni R, Goyal N, Venuthurimilli A, Olson MT, Chatterji C. Doppler-derived renal resistive index helps predict acute kidney injury in patients undergoing living-related liver transplantation. Clin Transplant 2021; 35:e14263. [PMID: 33608962 DOI: 10.1111/ctr.14263] [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: 10/30/2020] [Revised: 01/24/2021] [Accepted: 02/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is commonly associated with increased postoperative morbidity in liver transplant (LT) recipients. The aim of this study was to identify the role of renal resistive index (RRI) in predicting AKI and to study the factors associated with AKI in LT recipients. PATIENTS AND METHODS We performed a single-center, prospective study, including adult living donor LT recipients at our center between January 2018 and September 2019 with no preoperative renal dysfunction. RRI was calculated on ultrasound doppler once preoperatively, and once daily in the postoperative period through postoperative day (POD) six. Patients were grouped into AKI and non-AKI groups for comparison. RESULTS Fifty patients were included in the study (mean age, 44 years; 20% females). AKI developed in 25 patients (50%). Both groups were similar in baseline characteristics. RRI of ≥ 0.69 on POD 2 predicted AKI (sensitivity 88%; specificity 92%). RRI on the day before AKI diagnosis (0.71 vs. 0.65) and on the day of diagnosis (0.72 vs. 0.65) were significantly increased relative to preoperative baseline. CONCLUSIONS Doppler-derived RRI is a rapid, non-invasive, and bedside procedure capable of predicting the occurrence of postoperative AKI in LT recipients.
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Affiliation(s)
- Vijay Shankar
- Department of Anesthesiology and Critical Care, Indraprastha Apollo Hospital, New Delhi, India
| | - Anupam Raj
- Department of Anesthesiology and Critical Care, Indraprastha Apollo Hospital, New Delhi, India
| | - Saurabh Singhal
- Liver Transplant and Hepatopancreaticobiliary Unit, Indraprastha Apollo Hospital, New Delhi, India
| | - Reeti Sahni
- Department of Radiology, Indraprastha Apollo Hospital, New Delhi, India
| | - Neerav Goyal
- Liver Transplant and Hepatopancreaticobiliary Unit, Indraprastha Apollo Hospital, New Delhi, India
| | - Arun Venuthurimilli
- Liver Transplant and Hepatopancreaticobiliary Unit, Indraprastha Apollo Hospital, New Delhi, India
| | - Michael T Olson
- Department of Surgery, University of Arizona College of Medicine -Phoenix Campus, Phoenix, AZ, USA
| | - Chitra Chatterji
- Department of Anesthesiology and Critical Care, Indraprastha Apollo Hospital, New Delhi, India
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18
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Bonner RJ, Wallace T, Jones AD, Julian Scott D, Richards SH. The Content of Pre-habilitative Interventions for Patients Undergoing Repair of Abdominal Aortic Aneurysms and Their Effect on Post-Operative Outcomes: A Systematic Review. Eur J Vasc Endovasc Surg 2021; 61:756-765. [PMID: 33678532 DOI: 10.1016/j.ejvs.2021.01.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 01/05/2021] [Accepted: 01/21/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Patients requiring abdominal aortic aneurysm (AAA) repair are at risk of post-operative complications due to poor pre-operative state. Pre-habilitation describes the enhancement of functional capacity and tolerance to an upcoming physiological stressor, intended to reduce those complications. The ability to provide such an intervention (physical, pharmacological, nutritional, or psychosocial) between diagnosis and surgery is a growing interest, but its role in AAA repair is unclear. This paper aimed to systematically review existing literature to better describe the effect of pre-habilitative interventions on post-operative outcomes of patients undergoing AAA repair. DATA SOURCES EMBASE and Medline were searched from inception to October 2020. Retrieved papers, systematic reviews, and trial registries were citation tracked. REVIEW METHODS Randomised controlled trials (RCTs) comparing post-operative outcomes for adult patients undergoing a period of pre-habilitation prior to AAA repair (open or endovascular) were eligible for inclusion. Two authors screened titles for inclusion, assessed risk of bias, and extracted data. Primary outcomes were post-operative 30 day mortality, composite endpoint of 30 day post-operative complications, hospital length of stay (LOS), and health related quality of life (HRQL) outcomes. The content of interventions was extracted and a narrative analysis of results undertaken. RESULTS Seven RCTs with 901 patients were included (three exercise based, two pharmacological based, and two nutritional based). Risk of bias was mostly unclear or high and the clinical heterogeneity between the trials precluded data pooling for meta-analyses. The quality of intervention descriptions was highly variable. One exercise based RCT reported significantly reduced hospital LOS and another improved HRQL outcomes. Neither pharmacological nor nutritional based RCTs reported significant differences in primary outcomes. CONCLUSION There is limited evidence to draw clinically robust conclusions about the effect of pre-habilitation on post-operative outcomes following AAA repair. Well designed RCTs, adhering to reporting standards for intervention content and trial methods, are urgently needed to establish the clinical and cost effectiveness of pre-habilitation interventions.
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Affiliation(s)
- Rory J Bonner
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
| | - Tom Wallace
- Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Alexander D Jones
- Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - D Julian Scott
- Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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19
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Hijmans JM, Dekker R, Geertzen JHB. Pre-operative rehabilitation in lower-limb amputation patients and its effect on post-operative outcomes. Med Hypotheses 2020; 143:110134. [PMID: 33017911 DOI: 10.1016/j.mehy.2020.110134] [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: 04/15/2020] [Revised: 06/22/2020] [Accepted: 07/22/2020] [Indexed: 10/23/2022]
Abstract
Major lower-limb amputation (LLA) is a life-changing event associated with poor post-operative physical and psychological functioning and decreased quality of life. The general physical condition of most LLA patients prior to surgery is already significantly deteriorated due to chronic peripheral vascular disease often in combination with diabetes. Pre-operative rehabilitation (also called 'pre-rehabilitation') is an increasingly common strategy used in multiple patient populations to improve patients' physical and mental condition prior to surgery, thus aiming at improving the post-operative patient outcomes. Given the positive effects of post-surgical outcomes in many patient populations, we hypothesize that pre-operative rehabilitation will improve post-operative outcomes after LLA. To test this hypothesis, a literature search of PubMed, EMBASE, EBSCOhost, Web of Science and ScienceDirect was performed to identify studies that investigated the impact of a pre-operative rehabilitation therapy on post-operative outcomes such as length of hospital stay, mobility, physical functioning, and health related quality of life. No time restrictions were applied to the search. Only articles published in English were included in the selection. Two studies satisfied the eligibility criteria for inclusion in the review, one qualitative and one quantitative study. The quantitative study reported a beneficial effect of pre-rehabilitation, resulting in post-operative mobility (at least indoor ambulation) in 63% of the included LLA patients. There is a need for prospective clinical studies examining the effect of pre-rehabilitation on post-operative outcomes to be able to confirm or reject our hypothesis. Although the hypothesis seems plausible, evidence is lacking to support our hypothesis that pre-operative rehabilitation will improve post-operative outcomes in patients with LLA. The qualitative study indicated that integrating pre-rehabilitation in the care for LLA patients seems to be limited to a selected group of dysvascular patients, but at this stage cannot be advised based on current evidence even in this subgroup. Further research is needed to clarify whether such an intervention prior to amputation would be a useful and effective tool for optimizing post-operative outcomes in LLA patients.
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Affiliation(s)
- Juha M Hijmans
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, PO Box 30.001, 9700RB Groningen, the Netherlands.
| | - Rienk Dekker
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, PO Box 30.001, 9700RB Groningen, the Netherlands
| | - Jan H B Geertzen
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, PO Box 30.001, 9700RB Groningen, the Netherlands
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Anderson SR, Wimalawansa SM, Markov NP, Fox JP. Cannabis Abuse or Dependence and Post-operative Outcomes After Appendectomy and Cholecystectomy. J Surg Res 2020; 255:233-239. [PMID: 32570125 DOI: 10.1016/j.jss.2020.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/23/2020] [Accepted: 05/03/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Though cannabis is gaining broader acceptance among society and a noted increase in legalization, little is known regarding its impact on post-operative outcomes. We conducted this study to quantify the relationship between cannabis abuse or dependence (CbAD) on post-operative outcomes after cholecystectomy and appendectomy. METHODS Using the 2013-2015 Nationwide Readmissions Database, we identified discharges associated with cholecystectomy or appendectomy from January 2013-August 2015. Patients were grouped by CbAD history. The primary outcomes were length of stay, serious adverse events, home discharge, and 30-day readmission. Propensity-score matching was used to account for differences between groups and all statistics accounted for the matched sample. RESULTS The final sample included 3288 patients with a CbAD history matched 1:1 to patients without a CbAD history (total sample = 6576). After matching, acceptable balance was achieved in clinical characteristics between groups. In the cholecystectomy cohort (n = 1707 pairs), CbAD patients had longer hospitalizations (3.5 versus 3.2 d, P 0.003) and similar rates of serious adverse events (6.1 versus 4.8, P 0.092), home discharge (96.1 vs 96.2, P 0.855), and readmission (8.3 versus 6.9, P 0.137). In the appendectomy cohort (n = 1581 pairs), CbAD patients had longer hospital stays (2.7 versus 2.5 d, P 0.024); more frequent serious adverse events (5.0 versus 3.5, P 0.041); and similar home discharge (96.8 vs 97.3, P 0.404) and readmission (5.4 versus 5.1, P 0.639) rates. CONCLUSIONS Patients with a history of CbAD in the cholecystectomy and appendectomy cohorts had slightly longer hospital stays, and patients with a history of CbAD in the appendectomy group displayed a slight increase in adverse events, but otherwise similar clinical outcomes without clinically significant increases in complications compared to patients without this history.
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Affiliation(s)
- Spencer R Anderson
- Department of Plastic Surgery, Wright State University, Boonshoft School of Medicine, Dayton, Ohio.
| | - Sunishka M Wimalawansa
- Department of Plastic Surgery, Wright State University, Boonshoft School of Medicine, Dayton, Ohio
| | - Nickolay P Markov
- Surgical Operations Squadron, 88(th) Medical Group, Wright Patterson Medical Center, Wright Patterson AFB, Ohio
| | - Justin P Fox
- Department of Plastic Surgery, Wright State University, Boonshoft School of Medicine, Dayton, Ohio; Surgical Operations Squadron, 88(th) Medical Group, Wright Patterson Medical Center, Wright Patterson AFB, Ohio
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21
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Donovan K, Denham M, Kuchta K, Carbray J, Ujiki M, Linn J, Denham W, Haggerty S. Laparoscopic totally extraperitoneal and transabdominal preperitoneal approaches are equally effective for spigelian hernia repair. Surg Endosc 2020; 35:1827-1833. [PMID: 32333157 DOI: 10.1007/s00464-020-07582-9] [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] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 04/18/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Spigelian hernias (SH) are rare intraparietal abdominal wall hernias occurring just medial to the semilunar line. Several small series have reported on laparoscopic SH repair and both totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) approaches have been described. However, there are limited outcome data including both of these techniques. We present the largest series to date of laparoscopic SH repair comparing both popular approaches. METHODS Consecutive patients (n = 77) undergoing laparoscopic SH repair from 2009 to 2019 were identified from a prospectively managed quality database. All procedures were performed at a single institution. Patients were divided based on laparoscopic approach used, TEP group (n = 37) and TAPP group (n = 40). Comparison of patient demographics, surgical characteristics, and post-operative complications between TAPP and TEP groups was made using the Wilcoxon rank-sum and Fisher's exact tests. RESULTS Individuals undergoing TAPP had higher mean BMI (29.3 ± 5.4 vs. 26.3 ± 5.6 kg/m2; p = 0.019) and were more likely to have had prior abdominal surgery (65% vs 24.3%, (p < 0.001). Mean procedure length was 77 ± 45 min for TAPP repairs and 48 ± 21 for TEP repairs (p = 0.001). TAPP repairs had a significantly longer median LOS than TEP (25 vs. 7 h; p < 0.001). Days of narcotic use were significantly shorter after TEP repair than for TAPP (0 vs. 3; p = 0.007) and return to ADL was significantly shorter after TEP repair than for TAPP (5 vs. 7 days; p = 0.016. There were no significant differences in readmission, reoperations, SSI, or recurrence between the two groups. CONCLUSION Our large series revealed that both preperitoneal laparoscopic approaches, TEP, and TAPP, for SH repair are equally safe, effective, and can be performed on an outpatient basis. Therefore, we suggest that the approach used for repair should be based on surgeon experience, preference, and individual patient factors.
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Affiliation(s)
- Kara Donovan
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA
| | - Merritt Denham
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA
| | - Kristine Kuchta
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA
| | - JoAnn Carbray
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA
| | - Michael Ujiki
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA
| | - John Linn
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA
| | - Woody Denham
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA
| | - Stephen Haggerty
- NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL, 60201, USA.
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Yeung JC, Ali SO, McKeon MG, Grenier S, Kawai K, Rahbar R, Watters KF. Carbon dioxide laser versus cold-steel supraglottoplasty: A comparison of post-operative outcomes. Int J Pediatr Otorhinolaryngol 2020; 130:109843. [PMID: 31884047 DOI: 10.1016/j.ijporl.2019.109843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/17/2019] [Accepted: 12/17/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Supraglottoplasty is the mainstay of surgical treatment for laryngomalacia, and is commonly performed via two methods: cold steel or carbon dioxide (CO2) laser. The degree of post-operative monitoring following supraglottoplasty varies, both within and between institutions. The aim of this study was to compare the post-operative monitoring and interventions required by patients undergoing cold-steel versus CO2 laser supraglottoplasty. DESIGN Retrospective cohort of pediatric patients (age < 18 years) undergoing supraglottoplasty at a tertiary care pediatric hospital. The primary exposure was the surgical instrument(s) used during supraglottoplasty. The primary outcome was prolonged intensive care unit (ICU)-stay (defined as >24 h). RESULTS 155 cases were eligible for inclusion. Fifty-eight (37.4%) patients had a comorbid condition. Common indications for surgery included feeding difficulty (56.1%), severe respiratory distress (33.5%), and obstructive sleep apnea (25.2%). CO2 laser was employed in 49 cases and cold-steel in 106 cases. Prolonged ICU-stay (>24 h) was observed in 14 CO2 laser cases (28.6%) and 11 cold-steel cases (10.4%) (adjusted OR 3.42; 95% CI 1.43, 8.33). CO2 laser cases were more likely to require post-operative intubation, non-invasive positive pressure ventilation, and nebulized racemic epinephrine. Concomitant neurological condition was associated with an increased risk of prolonged ICU-stay, while extent of surgery and age were not. CONCLUSIONS CO2 laser supraglottoplasty is associated with an increased risk of prolonged ICU-stay and need for ICU-level airway intervention, compared to the cold-steel technique. While this association should not be misconstrued as a causal relationship, the current study demonstrates that specific surgical factors may influence the patient monitoring requirements following supraglottoplasty, particularly the choice of instrument and the extent of surgery.
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Affiliation(s)
- Jeffrey C Yeung
- Department of Otolaryngology - Head & Neck Surgery, McGill University, Canada; Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, USA.
| | - Syed O Ali
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, USA
| | - Mallory G McKeon
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, USA
| | - Samantha Grenier
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, USA
| | - Kosuke Kawai
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, USA
| | - Reza Rahbar
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, USA; Department of Otology and Laryngology, Harvard Medical School, USA
| | - Karen F Watters
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, USA; Department of Otology and Laryngology, Harvard Medical School, USA
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Patel R, Zagadailov P, Merchant AM. Laparoscopic colectomy for diverticulitis in patients with pre-operative respiratory comorbidity: analysis of post-operative outcomes in the United States from 2005 to 2017. Surg Endosc 2020; 34:1665-77. [PMID: 31286256 DOI: 10.1007/s00464-019-06943-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 06/26/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Current studies suggest that laparoscopic colorectal surgery is an advantageous alternative to open surgery due to improved post-operative outcomes in high-risk patient groups. Limited data is currently available on the benefits of minimally invasive colectomy for diverticulitis in patients with significant pre-operative respiratory comorbidities. STUDY DESIGN The NSQIP 2005-2017 datasets were used to identify patients that underwent partial colectomies due to diverticulitis. Partial colectomy cases were identified using CPT codes and then filtered to include only ICD 9 and 10 codes for diverticulitis. Pre-operative respiratory comorbidities included dyspnea, chronic obstructive pulmonary disease (COPD), and smoking status. Propensity matching was performed based on patient demographic and pre-operative risk factor data to create comparable groups for each respiratory comorbidity subset. Outcomes of interest were 30-day post-operative mortality and morbidity, incidence of return to operating room (ROR), and hospital length of stay (LoS). Laparoscopy and open surgery groups were compared using Chi square tests for categorical variables and t tests for continuous variables. A p value less than 0.05 was considered statistically significant. RESULTS Among 70,420 cases with diverticulitis, 15,237 cases were identified as smokers, 3934 had dyspnea, and 3219 had COPD. Patients that had open procedures had significantly greater odds of mortality (OR 2.624 for smokers; OR 2.698 for dyspnea; OR 2.663 for COPD), morbidity (OR 2.590 for smokers; OR 2.344 for dyspnea; OR 2.883 for COPD), wound complication (OR 1.989 for smokers; OR 1.461 for dyspnea; OR 1.956 for COPD), and ROR (OR 1.184 for smokers; OR 1.634 for dyspnea; OR 1.975 for COPD). Laparoscopic procedures resulted in significantly lower average LoS (5.34 vs. 9.46 days for smokers; 6.84 vs. 11.06 days for dyspnea; 7.41 vs. 12.62 days for COPD; all p < .0001). CONCLUSION Laparoscopic colectomy for diverticulitis diagnosis for a matched cohort of patients with pre-operative respiratory comorbidities such as smoking status, dyspnea, and COPD resulted in significantly improved post-operative outcomes, lower odds of mortality and morbidity, and shorter LoS.
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Rege RM, Runner RP, Staley CA, Vu CCL, Arora SS, Schenker ML. Frailty predicts mortality and complications in chronologically young patients with traumatic orthopaedic injuries. Injury 2018; 49:2234-2238. [PMID: 30274754 DOI: 10.1016/j.injury.2018.08.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 08/19/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND As morbidity and mortality from traumatic orthopaedic injuries continues to rise, increased research is being conducted on how to best predict complications in at risk patients. Recently, frailty indices have been validated in a variety of surgical subspecialties as predictors of morbidity and mortality. However, the vast majority of research has been conducted on geriatric patient populations, with little evidence on patients who are chronologically young. The purpose of this study was to evaluate the role of a modified frailty index (mFI) in predicting mortality and complications after pelvis, acetabulum, and lower extremity trauma in patients of all ages. METHODS The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was queried from 2005 to 2014 for all patients who underwent surgery for pelvis, acetabulum, and lower extremity trauma. The sample size was divided into geriatric (age ≥ 60) and young (age < 60) cohorts. The mFI score was calculated for each patient. Bivariate analysis was performed using logistic regression and a chi-square test to determine the relationship between mFI and both primary and secondary outcomes while adjusting for age. Univariate analysis and multivariate analyses were performed. All analyses were done using SAS 9.4 (Cary, NC) and a p < 0.05 was considered significant. RESULTS 56,241 patients were identified to have undergone surgery for pelvis, acetabulum, or lower extremity trauma. 28% of patients were identified under the age of 60. In the young cohort, mFI was a strong predictor of thirty-day mortality (OR 11.02, 95% CI 6.26-19.39, p < 0.001). With regards to Clavien-Dindo grade IV complications, MFI is also a strong predictor in the young cohort (OR 28.82, 95% CI 16.05-51.77, p < 0.001). CONCLUSION AND RELEVANCE The mFI score was a significant predictor of morbidity and mortality in chronologically young orthopaedic trauma patients. The use of the mFI score can provide an individualized risk assessment to interdisciplinary teams for perioperative counseling and to improve outcomes.
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Affiliation(s)
- Rahul M Rege
- Emory University, School of Medicine, 1648 Pierce Dr. NE, Atlanta, GA 30307, United States
| | - Robert P Runner
- Emory University, Department of Orthopaedics, 59 Executive Park South, Atlanta, GA 30329, United States
| | - Christopher A Staley
- Emory University, Department of Orthopaedics, 59 Executive Park South, Atlanta, GA 30329, United States
| | - CatPhuong Cathy L Vu
- Emory University, School of Medicine, 1648 Pierce Dr. NE, Atlanta, GA 30307, United States
| | - Sona S Arora
- Grady Memorial Hospital, 80 Jesse Hill Jr Dr. SE, Atlanta, GA 30303, United States; Emory University, Department of Anesthesiology, 1364 Clifton Rd. NE, Atlanta, GA 30322, United States
| | - Mara L Schenker
- Emory University, Department of Orthopaedics, 59 Executive Park South, Atlanta, GA 30329, United States; Grady Memorial Hospital, 80 Jesse Hill Jr Dr. SE, Atlanta, GA 30303, United States.
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25
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Abstract
OBJECTIVE To describe the current definitions, aetiology, assessment tools and clinical implications of frailty in modern surgical practice. BACKGROUND Frailty is a critical issue in modern surgical practice due to its association with adverse health events and poor post-operative outcomes. The global population is rapidly ageing resulting in more older patients presenting for surgery. With this, the number of frail patients presenting for surgery is also increasing. Despite the identification of frailty as a significant predictor of poor health outcomes, there is currently no consensus on how to define, measure and diagnose this important syndrome. METHODS Relevant references were identified through keyword searches of the Cochran, MEDLINE and EMbase databases. RESULTS Despite the lack of a gold standard operational definition, frailty can be conceptualised as a state of increased vulnerability resulting from a decline in physiological reserve and function across multiple organ systems, such that the ability to withstand stressors is impaired. Multiple studies have shown a strong association between frailty and adverse peri-operative outcomes. Frailty may be assessed using multiple tools; however, the ideal tool for use in a clinical setting has yet to be identified. Despite the association between frailty and adverse outcomes, few interventions have been shown to improve outcomes in these patients. CONCLUSION Frailty encompasses a group of individuals at high risk of adverse post-operative outcomes. Further work exploring ways to optimally assess and target interventions towards these patients should be the focus of ongoing research.
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Affiliation(s)
- Simon J G Richards
- University of Otago, Christchurch, New Zealand.
- Department of Surgery, Christchurch Hospital, Riccarton Ave, Christchurch, New Zealand.
| | - Frank A Frizelle
- University of Otago, Christchurch, New Zealand
- Department of Surgery, Christchurch Hospital, Riccarton Ave, Christchurch, New Zealand
| | | | - Tim W Eglinton
- University of Otago, Christchurch, New Zealand
- Department of Surgery, Christchurch Hospital, Riccarton Ave, Christchurch, New Zealand
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26
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Abstract
OBJECTIVE To describe the current definitions, aetiology, assessment tools and clinical implications of frailty in modern surgical practice. BACKGROUND Frailty is a critical issue in modern surgical practice due to its association with adverse health events and poor post-operative outcomes. The global population is rapidly ageing resulting in more older patients presenting for surgery. With this, the number of frail patients presenting for surgery is also increasing. Despite the identification of frailty as a significant predictor of poor health outcomes, there is currently no consensus on how to define, measure and diagnose this important syndrome. METHODS Relevant references were identified through keyword searches of the Cochran, MEDLINE and EMbase databases. RESULTS Despite the lack of a gold standard operational definition, frailty can be conceptualised as a state of increased vulnerability resulting from a decline in physiological reserve and function across multiple organ systems, such that the ability to withstand stressors is impaired. Multiple studies have shown a strong association between frailty and adverse peri-operative outcomes. Frailty may be assessed using multiple tools; however, the ideal tool for use in a clinical setting has yet to be identified. Despite the association between frailty and adverse outcomes, few interventions have been shown to improve outcomes in these patients. CONCLUSION Frailty encompasses a group of individuals at high risk of adverse post-operative outcomes. Further work exploring ways to optimally assess and target interventions towards these patients should be the focus of ongoing research.
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Affiliation(s)
- Simon J G Richards
- University of Otago, Christchurch, New Zealand. .,Department of Surgery, Christchurch Hospital, Riccarton Ave, Christchurch, New Zealand.
| | - Frank A Frizelle
- University of Otago, Christchurch, New Zealand.,Department of Surgery, Christchurch Hospital, Riccarton Ave, Christchurch, New Zealand
| | | | - Tim W Eglinton
- University of Otago, Christchurch, New Zealand.,Department of Surgery, Christchurch Hospital, Riccarton Ave, Christchurch, New Zealand
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Ahmed A, Deng W, Tew W, Bender D, Mannel RS, Littell RD, DeNittis AS, Edelson M, Morgan M, Carlson J, Darus CJ, Fleury AC, Modesitt S, Olawaiye A, Evans A, Fleming GF. Pre-operative assessment and post-operative outcomes of elderly women with gynecologic cancers, primary analysis of NRG CC-002: An NRG oncology group/gynecologic oncology group study. Gynecol Oncol 2018; 150:300-305. [PMID: 29807694 DOI: 10.1016/j.ygyno.2018.05.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 03/06/2018] [Revised: 05/11/2018] [Accepted: 05/14/2018] [Indexed: 11/13/2022]
Abstract
INTRODUCTION CC-002 is a prospective cooperative group study conducted by NRG Oncology to evaluate whether a pre-operative GA-GYN score derived from a predictive model utilizing components of an abbreviated geriatric assessment (GA) is associated with major post-operative complications in elderly women with suspected ovarian, fallopian tube, primary peritoneal or advanced stage papillary serous uterine (GYN) carcinoma undergoing primary open cytoreductive surgery. METHODS Patients 70 years or older with suspected advanced gynecologic cancers undergoing evaluation for surgery were eligible. A GA-GYN score was derived from a model utilizing the GA as a pre-operative tool. Patients were followed for six weeks post-operatively or until start of chemotherapy. Post-operative events were recorded either directly as binary occurrence (yes or no) using CTCAE version 4.0. RESULTS There were 189 eligible patients, 117 patients with primary surgical intervention and 37 patients undergoing interval cytoreduction surgery. The association between higher GA-GYN score and major postoperative complications in patients undergoing primary surgery was not significant (p = 0.1341). In a subgroup analysis of patients with advanced staged malignant disease who underwent primary cytoreductive surgery, there was a trend towards an association with the GA-GYN score and post-operative complications. CONCLUSION The pre-operative GA-GYN score derived from a predictive model utilizing components of an abbreviated geriatric assessment was not predictive of major post-operative complications in elderly patients undergoing primary open cytoreductive surgery. However, there was an association between GA-GYN score and post-operative complications in a subgroup of patients with advanced staged malignant disease.
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Affiliation(s)
- Amina Ahmed
- Department of OB/GYN, Division of Gyn Oncology, Rush University Medical Center, Chicago, IL 60612, United States.
| | - Wei Deng
- NRG Oncology, Clinical Trial Development Division, Biostatistics & Bioinformatics, Roswell Park Cancer Institute, Buffalo, NY 4263, United States.
| | - William Tew
- Department of Internal Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, United States.
| | - David Bender
- Gyn/Onc Division, University of Iowa, Iowa City, IA 52242, United States.
| | - Robert S Mannel
- Department of OB/GYN, University of Oklahoma, Oklahoma City, OK 73190, United States.
| | - Ramey D Littell
- Kaiser Permanente Northern California Gynecologic Cancer Program, San Francisco, CA 94115, United States.
| | - Albert S DeNittis
- Department of Radiation Oncology, Main Line Hospital, Wynnewood, PA 19096, United States.
| | - Mitchell Edelson
- Hanjani Institute for Gynecologic Oncology, Abington Hospital, Jefferson Health, Abington, PA 19001, United States.
| | - Mark Morgan
- Department of OB/GYN, University of Pennsylvania Hospital System, Philadelphia, PA 19104, United States.
| | - Jay Carlson
- Cancer Research for the Ozarks, Springfield, MO 65804, United States.
| | - Christopher J Darus
- Division of Gynecologic Oncology, Maine Medical Center, Scarborough, ME 04074, United States.
| | - Aimee C Fleury
- Department of Gynecologic Oncology, Women's Cancer Center of Nevada, Las Vegas, NV 89169, United States.
| | - Susan Modesitt
- Department of OB/GYN, University of Virginia, Charlottesville, VA 22908, United States.
| | - Alexander Olawaiye
- Department of Obstetrics & Gynecology, University of Pittsburgh Cancer Institute, Pittsburgh, PA 15213, United States.
| | - Anthony Evans
- Marshfield Clinic, OB-GYN Dept, Marshfield, WI 54449, United States.
| | - Gini F Fleming
- Section of Medical Oncology, University of Chicago, Chicago, IL 60637, United States.
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Steffens D, Young J, Beckenkamp PR, Ratcliffe J, Rubie F, Ansari N, Pillinger N, Solomon M. Feasibility and acceptability of PrE-operative Physical Activity to improve patient outcomes After major cancer surgery: study protocol for a pilot randomised controlled trial (PEPA Trial). Trials 2018; 19:112. [PMID: 29452599 PMCID: PMC5816517 DOI: 10.1186/s13063-018-2481-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 01/18/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND There is a need for evidence of the effectiveness of pre-operative exercise for patients undergoing major cancer surgery; however, recruitment to such trials can be challenging. The PrE-operative Physical Activity (PEPA) Trial will establish the feasibility and acceptability of a pre-operative exercise programme aimed to improve patient outcomes after cytoreductive surgery and pelvic exenteration. The secondary aim is to obtain pilot data on the likely difference in key outcomes (post-operative complications, length of hospital stay, post-operative functional capacity and quality of life) to inform the sample size calculation for the substantive randomised clinical trial. METHODS/DESIGN Twenty patients undergoing cytoreductive surgery and pelvic exenteration at the Royal Prince Alfred Hospital, Sydney will be recruited and randomly allocated (1:1 ratio) to either 2 to 6 weeks' pre-operative exercise programme (intervention group) or usual care (control group). Those randomised to the intervention group will receive up to six individualised, 1-h physiotherapy sessions (including aerobic and endurance exercises, respiratory muscle exercises, stretching and flexibility exercises), home exercises (instruction and recommendations on how to progress the exercises at home) and encouragement to be more active by using an activity tracker to measure the number of steps walked daily. Patients allocated to the control group will not receive any specific advice about exercise training. Feasibility will be assessed with consent rates to the study, and for the intervention group, retention and adherence rates to the exercise programme. Acceptability of the exercise programme will be assessed with a semi-structured questionnaire. The following measures of the effectiveness of the intervention will be collected at baseline (2 to 6 weeks pre-operative), a week before surgery, during hospital stay and pre hospital discharge: post-operative complication rates (Clavien-Dindo), post-operative functional capacity (Six-minute Walk Test) and quality of life (SF-36v2®) and length of hospital stay. Functional status will be additionally measured using Cardiopulmonary Exercise Testing (CPET), at baseline and within a week before surgery. DISCUSSION The PEPA Trial will provide important information about the feasibility and acceptability of a pre-operative exercise programme for patients undergoing major cancer surgery. Data from the PEPA Trial will be used to inform the design, methodology and to calculate sample size required for a larger, definitive trial. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ID: ACTRN12617001129370 . Registered on 1 August 2017.
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Affiliation(s)
- Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Building 89, Level 9, Missenden Road, Camperdown, Sydney, NSW, 2050, Australia. .,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
| | - Jane Young
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Building 89, Level 9, Missenden Road, Camperdown, Sydney, NSW, 2050, Australia.,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Paula R Beckenkamp
- Faculty of Health Sciences, Discipline of Physiotherapy, The University of Sydney, Sydney, NSW, Australia
| | - James Ratcliffe
- Department of Physiotherapy, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Freya Rubie
- Department of Physiotherapy, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Nabila Ansari
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Building 89, Level 9, Missenden Road, Camperdown, Sydney, NSW, 2050, Australia
| | - Neil Pillinger
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Michael Solomon
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Building 89, Level 9, Missenden Road, Camperdown, Sydney, NSW, 2050, Australia.,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, NSW, Australia
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29
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Vu CCL, Runner RP, Reisman WM, Schenker ML. The frail fail: Increased mortality and post-operative complications in orthopaedic trauma patients. Injury 2017; 48:2443-2450. [PMID: 28888718 DOI: 10.1016/j.injury.2017.08.026] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/05/2017] [Accepted: 08/13/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The burgeoning elderly population calls for a robust tool to identify patients with increased risk of mortality and morbidity. This paper investigates the utility of the MFI as a predictor of morbidity and mortality in orthopaedic trauma patients. DESIGN Retrospective review of the NSQIP database to identify patients age 60 and above who underwent surgery for pelvis and lower extremity fractures between 2005 and 2014. MAIN OUTCOMES AND MEASURES For each patient, an MFI score was calculated using NSQIP variables. The relationship between the MFI score and 30-day mortality and morbidity was determined using chi-square analysis. MFI was compared to age, American Society of Anesthesiologists physical status classification, and wound classifications in multiple logistic regression. RESULTS Study sample consisted of 36,424 patients with 27.8% male with an average age of 79.5 years (SD 9.3). MFI ranged from 0 to 0.82 with mean MFI of 0.12 (SD 0.09). Mortality increased from 2.7% to 13.2% and readmission increased from 5.5% to 18.8% with increasing MFI score. The rate of any complication increased from 30.1% to 38.6%. Length of hospital stay increased from 5.3days (±5.5days) to 9.1days (±7.2days) between MFI score 0 and 0.45+. There was a stronger association between 30-day mortality and MFI (aOR for MFI 0.45+: 2.6, 95% CI: 1.7-3.9) compared to age (aOR for age: 1.1, 95% CI: 1.1-1.1) and ASA (aOR 2.5, 95% CI: 2.3-2.7). CONCLUSIONS AND RELEVANCE MFI was a significant predictor of morbidity and mortality in orthopaedic trauma patients. The use of MFI can provide an individualized risk assessment tool that can be used by an interdisciplinary team for perioperative counseling and to improve outcomes.
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Affiliation(s)
| | - Robert P Runner
- Emory University Department of Orthopaedics, Atlanta, GA, United States
| | - William M Reisman
- Emory University Department of Orthopaedics, Atlanta, GA, United States; Grady Memorial Hospital, Atlanta, GA, United States
| | - Mara L Schenker
- Emory University Department of Orthopaedics, Atlanta, GA, United States; Grady Memorial Hospital, Atlanta, GA, United States.
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30
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Khan A, Riaz M, Kelly ME, Khan W, Waldron R, Barry K, Khan IZ. Prospective validation of neutrophil-to-lymphocyte ratio as a diagnostic and management adjunct in acute appendicitis. Ir J Med Sci 2017; 187:379-384. [PMID: 28744697 DOI: 10.1007/s11845-017-1667-z] [Citation(s) in RCA: 5] [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: 06/06/2017] [Accepted: 07/19/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND No optimal biomarker exists that accurately diagnoses appendicitis or predicts severity, estimates post-operative complications or total length of hospital stay (LOS). AIM To prospectively validate the utility of neutrophil-to-lymphocyte (NLR) ratio in predicting the severity of appendicitis, LOS, and 30-day complication rates. METHODS Patients who were admitted with a provisional diagnosis of acute appendicitis over a period of 18 months (Oct 2014-April 2016) were included. Patient demographics and blood results were prospectively collected. Details of imaging, operative intervention, severity of appendicitis, length of stay, and 30-days post admission complications were recorded. Recommended cut-off values of NLR and C-reactive protein for severity of appendicitis were determined using receiver operating characteristic analysis (ROC). These cut-off values were compared with C-reactive protein levels. Mann-Whitney test was performed to assess the correlations between LOS and 30-day complications to NLR. RESULTS Four hundred fifty-three patients were included in the study; 55.2% (n = 245) were female with mean patient age of 23 years. Two-thirds (n = 281, 62.03%) underwent operative management. Histologically, appendicitis was confirmed in 214 (76%) patients. A NLR of >6.36 or CRP of >28 were statistically associated with complicated acute appendicitis, with a median of one extra hospital day (p < 0.0001). Mean NLR was statistically higher in patients with post-operative complications (14.42 vs. 7.29 for simple appendicitis group, p < 0.001). CONCLUSION This confirms previous reports that NLR is a simple, readily available adjunct in predicting severity of appendicitis. Additionally, it can aid delineating severe appendicitis that should proceed to surgery without substantial delay.
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Affiliation(s)
- A Khan
- Department of Surgery, Mayo University Hospital, Castlebar, Mayo, Ireland
| | - M Riaz
- Department of Surgery, Mayo University Hospital, Castlebar, Mayo, Ireland
| | - Michael E Kelly
- Department of Surgery, Mayo University Hospital, Castlebar, Mayo, Ireland. .,Discipline of Surgery, National University of Ireland Galway, Mayo University Hospital, Saolta University Hospital Group, Galway, Ireland.
| | - W Khan
- Department of Surgery, Mayo University Hospital, Castlebar, Mayo, Ireland
| | - R Waldron
- Department of Surgery, Mayo University Hospital, Castlebar, Mayo, Ireland
| | - K Barry
- Department of Surgery, Mayo University Hospital, Castlebar, Mayo, Ireland.,Discipline of Surgery, National University of Ireland Galway, Mayo University Hospital, Saolta University Hospital Group, Galway, Ireland
| | - I Z Khan
- Department of Surgery, Mayo University Hospital, Castlebar, Mayo, Ireland
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31
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Tang Qian Ying C, Lai Wei Hong S, Lee BH, Thevendran G. Return to physical activity after gastrocnemius recession. World J Orthop 2016; 7:746-751. [PMID: 27900272 PMCID: PMC5112344 DOI: 10.5312/wjo.v7.i11.746] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 08/10/2016] [Accepted: 09/08/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To prospectively investigate the time taken and patients’ ability to resume preoperative level of physical activity after gastrocnemius recession.
METHODS Endoscopic gastrocnemius recession (EGR) was performed on 48 feet in 46 consecutive sportspersons, with a minimum follow-up of 24 mo. The Halasi Ankle Activity Score was used to quantify the level of physical activity. Time taken to return to work and physical activity was recorded. Functional outcomes were evaluated using the short form 36 (SF-36), American Orthopedic Foot and Ankle Society (AOFAS) Hindfoot score and modified Olerud and Molander (O and M) scores respectively. Patient’s satisfaction and pain experienced were assessed using a modified Likert scale and visual analogue scales. P-value < 0.05 was considered statistically significant.
RESULTS Ninety-one percent (n = 42) of all patients returned to their preoperative level of physical activity after EGR. The mean time for return to physical activity was 7.5 (2-24) mo. Ninety-eight percent (n = 45) of all patients were able to return to their preoperative employment status, with a mean time of 3.6 (1-12) mo. Ninety-six percent (n = 23) of all patients with an activity score > 2 were able to resume their preoperative level of physical activity in mean time of 8.8 mo, as compared to 86% (n = 19) of patients whose activity score was ≤ 2, with mean time of 6.1 mo. Significant improvements were noted in SF-36, AOFAS hindfoot and modified O and M scores. Ninety percent of all patients rated good or very good outcomes on the Likert scale.
CONCLUSION The majority of patients were able to return to their pre-operative level of sporting activity after EGR.
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Portigliotti L, Fuks D, Slivca O, Bourdeaux C, Nomi T, Bennamoun M, Gentilli S, Gayet B. A comparison of laparoscopic resection of posterior segments with formal laparoscopic right hepatectomy for colorectal liver metastases: a single-institution study. Surg Endosc 2016; 31:2560-2565. [PMID: 27752815 DOI: 10.1007/s00464-016-5261-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 09/19/2016] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The benefit of by laparoscopic resection for lesions located in postero-superior segments is unclear. The present series aimed at comparing intraoperative and post-operative results in patients undergoing either laparoscopic RPS or laparoscopic RH for colorectal liver metastases located in the right postero-superior segments. METHODS From 2000 to 2015, patients who underwent laparoscopic resection of segment 6 and/or 7 (RPS group) were compared with those with right hepatectomy (RH group) in terms of tumour characteristics, surgical treatment, and short-term outcomes. RESULTS Among the 177 selected patients, 78 (44.1 %) had laparoscopic RPS and 99 (55.9 %) a laparoscopic RH. Among RPS patients, 26 (33.3 %) underwent anatomical resection of either segment 7, 8 or both. Three (3 %) patients undergoing RH died in the post-operative course and none in the RPS group. Sixty-three (35.5 %) patients experienced post-operative complications, including major complications in 24 (13.5 %) patients. Liver failure (17.1 vs. 0 %, p = 000.1), biliary leakage (6.0 vs. 1.2 %, p = 00.1), intra-abdominal collection (19.1 vs. 2.5 %, p = 000.1), and pulmonary complication (16.1 vs. 1.2 %, p = 000.1) were significantly increased in the RH group. CONCLUSION The present series suggests that patients who underwent laparoscopic resection of CRLM located in the postero-superior segments developed significantly less complications than patients undergoing formal RH.
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Affiliation(s)
- Luca Portigliotti
- Department of Digestive Disease, Institut Mutualiste Montsouris, Jourdan, 75014, Paris, France. .,Department of Surgery, Università del Piemonte Orientale, Novara, Italy.
| | - David Fuks
- Department of Digestive Disease, Institut Mutualiste Montsouris, Jourdan, 75014, Paris, France.,Université Paris Descartes, 15 rue de l'Ecole de Médecine, Paris, France
| | - Oleg Slivca
- Department of Digestive Disease, Institut Mutualiste Montsouris, Jourdan, 75014, Paris, France
| | - Christophe Bourdeaux
- Department of Digestive Disease, Institut Mutualiste Montsouris, Jourdan, 75014, Paris, France
| | - Takeo Nomi
- Department of Digestive Disease, Institut Mutualiste Montsouris, Jourdan, 75014, Paris, France
| | - Mostefa Bennamoun
- Department of Surgical Oncology, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Sergio Gentilli
- Department of Surgery, Università del Piemonte Orientale, Novara, Italy
| | - Brice Gayet
- Department of Digestive Disease, Institut Mutualiste Montsouris, Jourdan, 75014, Paris, France.,Université Paris Descartes, 15 rue de l'Ecole de Médecine, Paris, France
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Nelson EA, Dowsey MM, Knowles SR, Castle DJ, Salzberg MR, Monshat K, Dunin AJ, Choong PF. Systematic review of the efficacy of pre-surgical mind-body based therapies on post-operative outcome measures. Complement Ther Med 2013; 21:697-711. [PMID: 24280480 DOI: 10.1016/j.ctim.2013.08.020] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 08/28/2013] [Accepted: 08/30/2013] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES A large body of research has demonstrated that patient factors are strong predictors of recovery from surgery. Mind-body therapies are increasingly targeted at pre-operative psychological factors. The objective of this paper was to evaluate the efficacy of pre-operative mind-body based interventions on post-operative outcome measures amongst elective surgical patients. METHODS A systematic review of the published literature was conducted using the electronic databases MEDLINE, CINAHL and PsychINFO. Randomised controlled trials (RCTs) with a prospective before-after surgery design were included. RESULTS Twenty studies involving 1297 patients were included. Mind-body therapies were categorised into relaxation, guided imagery and hypnotic interventions. The majority of studies did not adequately account for the risk of bias thus undermining the quality of the evidence. Relaxation was assessed in eight studies, with partial support for improvements in psychological well-being measures, and a lack of evidence for beneficial effects for analgesic intake and length of hospital stay. Guided imagery was examined in eight studies, with strong evidence for improvements in psychological well-being measures and moderate support for the efficacy of reducing analgesic intake. Hypnosis was investigated in four studies, with partial support for improvements in psychological well-being measures. Evidence for the effect of mind-body therapies on physiological indices was limited, with minimal effects on vital signs, and inconsistent changes in endocrine measures reported. CONCLUSIONS This review demonstrated that the quality of evidence for the efficacy of mind-body therapies for improving post-surgical outcomes is limited. Recommendations have been made for future RCTs.
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