201
|
Stillman MD, Kuo EJ, Liou R, Almuqate A, Virk R, Lee JA, Kuo JH, McManus CM. Molecular Testing for Bethesda III Thyroid Nodules: Trends in Implementation, Cytopathology Call Rates, Surgery Rates, and Malignancy Yield at a Single Institution. Thyroid 2024; 34:460-466. [PMID: 38468547 DOI: 10.1089/thy.2023.0664] [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] [Indexed: 03/13/2024]
Abstract
Background: Molecular testing (MT) has become standard practice to more accurately rule out malignancy in indeterminate Bethesda III (BIII) thyroid lesions. We sought to assess the adoption of this technology and its impact on cytology reporting, malignancy yield, and rates of surgery across community and academic sites affiliated with a tertiary medical center. Methods: We performed a retrospective cross-sectional study including all fine-needle aspirations (FNAs) analyzed at our institution from 2017 to 2021. We analyzed trends in MT utilization by platform and by community or academic site. We compared BIII call rates, MT utilization rates, rates of subsequent surgery, and malignancy yield on final pathology before and after MT became readily available using chi-square analysis and linear regression. Results: A total of 8960 FNAs were analyzed at our institution from 2017 to 2021. There was broad adoption of MT across both community and academic sites. There was a significant increase in both the BIII rate and the utilization of MT between the pre- and post-MT periods (p < 0.001 and p < 0.001). There was no significant change in the the malignancy yield on final pathology (57.1% vs. 50.0%, p = 0.347), while the positive predictive value of MT decreased from 85% to 50% (p = 0.008 [confidence interval 9.5-52.5% decrease]). Conclusions: The use of MT increased across the institution over the study period, with the largest increase seen after a dedicated pass for MT was routinely collected. This increased availability of MT may have led to an unintended increase in the rates of BIII lesions, MT utilization, and surgery for benign nodules. Physicians who use MT should be aware of potential consequences of its adoption to appropriately counsel patients.
Collapse
Affiliation(s)
- Mason D Stillman
- Division of GI/Endocrine Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Eric J Kuo
- Division of GI/Endocrine Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Rachel Liou
- Division of GI/Endocrine Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Abdullah Almuqate
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Renu Virk
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - James A Lee
- Division of GI/Endocrine Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Jennifer H Kuo
- Division of GI/Endocrine Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Catherine M McManus
- Division of GI/Endocrine Surgery, Columbia University Irving Medical Center, New York, New York, USA
| |
Collapse
|
202
|
Acar A, Lu D, Wu Y, Oguz I, Kavoussi N, Wu JY. Towards navigation in endoscopic kidney surgery based on preoperative imaging. Healthc Technol Lett 2024; 11:67-75. [PMID: 38638503 PMCID: PMC11022214 DOI: 10.1049/htl2.12059] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 11/21/2023] [Indexed: 04/20/2024] Open
Abstract
Endoscopic renal surgeries have high re-operation rates, particularly for lower volume surgeons. Due to the limited field and depth of view of current endoscopes, mentally mapping preoperative computed tomography (CT) images of patient anatomy to the surgical field is challenging. The inability to completely navigate the intrarenal collecting system leads to missed kidney stones and tumors, subsequently raising recurrence rates. A guidance system is proposed to estimate the endoscope positions within the CT to reduce re-operation rates. A Structure from Motion algorithm is used to reconstruct the kidney collecting system from the endoscope videos. In addition, the kidney collecting system is segmented from CT scans using 3D U-Net to create a 3D model. The two collecting system representations can then be registered to provide information on the relative endoscope position. Correct reconstruction and localization of intrarenal anatomy and endoscope position is demonstrated. Furthermore, a 3D map is created supported by the RGB endoscope images to reduce the burden of mental mapping during surgery. The proposed reconstruction pipeline has been validated for guidance. It can reduce the mental burden for surgeons and is a step towards the long-term goal of reducing re-operation rates in kidney stone surgery.
Collapse
Affiliation(s)
- Ayberk Acar
- Department of Computer ScienceVanderbilt UniversityNashvilleTennesseeUSA
- Present address:
Department of Computer ScienceVanderbilt UniversityNashvilleTennesseeUSA
| | - Daiwei Lu
- Department of Computer ScienceVanderbilt UniversityNashvilleTennesseeUSA
| | - Yifan Wu
- Department of Computer ScienceVanderbilt UniversityNashvilleTennesseeUSA
| | - Ipek Oguz
- Department of Computer ScienceVanderbilt UniversityNashvilleTennesseeUSA
| | - Nicholas Kavoussi
- Department of UrologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Jie Ying Wu
- Department of Computer ScienceVanderbilt UniversityNashvilleTennesseeUSA
| |
Collapse
|
203
|
Lee Y, Anvari S, Padoan A, McKechnie T, Park L, Doumouras AG, Eskicioglu C, Hong D. Financial toxicity among patients undergoing resectional surgery for inflammatory bowel disease in the United States. Colorectal Dis 2024; 26:692-701. [PMID: 38353528 DOI: 10.1111/codi.16903] [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: 03/02/2023] [Revised: 07/11/2023] [Accepted: 01/21/2024] [Indexed: 05/02/2024]
Abstract
AIM Financial toxicity describes the financial burden and distress that patients experience due to medical treatment. Financial toxicity has yet to be characterized among patients with inflammatory bowel disease (IBD) undergoing surgical management of their disease. This study investigated the risk of financial toxicity associated with undergoing surgery for IBD. METHODS This study used a retrospective analysis using the National Inpatient Sample from 2015 to 2019. Adult patients who underwent IBD-related surgery were identified using the International Classification of Diseases (10th Revision) diagnostic and procedure codes and stratified into privately insured and uninsured groups. The primary outcome was risk of financial toxicity, defined as hospital admission charges that constituted 40% or more of patient's post-subsistence income. Secondary outcomes included total hospital admission cost and predictors of financial toxicity. RESULTS The analytical cohort consisted of 6412 privately insured and 3694 uninsured patients. Overall median hospital charges were $21 628 (interquartile range $14 758-$35 386). Risk of financial toxicity was 86.5% among uninsured patients and 0% among insured patients. Predictors of financial toxicity included emergency admission, being in the lowest residential income quartile and having ulcerative colitis (compared to Crohn's disease). Additional predictors were being of Black race or male sex. CONCLUSION Financial toxicity is a serious consequence of IBD-related surgery among uninsured patients. Given the pervasive nature of this consequence, future steps to support uninsured patients receiving surgery, in particular emergency surgery, related to their IBD are needed to protect this group from financial risk.
Collapse
Affiliation(s)
- Yung Lee
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Sama Anvari
- Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Adelia Padoan
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Tyler McKechnie
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lily Park
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Aristithes G Doumouras
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Cagla Eskicioglu
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Dennis Hong
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
204
|
Milne B, Gilbey T, De Somer F, Kunst G. Adverse renal effects associated with cardiopulmonary bypass. Perfusion 2024; 39:452-468. [PMID: 36794518 PMCID: PMC10943608 DOI: 10.1177/02676591231157055] [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] [Indexed: 02/17/2023]
Abstract
Cardiac surgery on cardiopulmonary bypass (CPB) is associated with postoperative renal dysfunction, one of the most common complications of this surgical cohort. Acute kidney injury (AKI) is associated with increased short-term morbidity and mortality and has been the focus of much research. There is increasing recognition of the role of AKI as the key pathophysiological state leading to the disease entities acute and chronic kidney disease (AKD and CKD). In this narrative review, we will consider the epidemiology of renal dysfunction after cardiac surgery on CPB and the clinical manifestations across the spectrum of disease. We will discuss the transition between different states of injury and dysfunction, and, importantly, the relevance to clinicians. The specific facets of kidney injury on extracorporeal circulation will be described and the current evidence evaluated for the use of perfusion-based techniques to reduce the incidence and mitigate the complications of renal dysfunction after cardiac surgery.
Collapse
Affiliation(s)
- Benjamin Milne
- Department of Anaesthesia & Pain Medicine, King’s College Hospital NHS Foundation Trust, London, UK
| | - Tom Gilbey
- Department of Anaesthesia & Pain Medicine, King’s College Hospital NHS Foundation Trust, London, UK
- Nuffield Department of Anaesthesia, John Radcliffe Hospital, Oxford, UK
| | - Filip De Somer
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
| | - Gudrun Kunst
- Department of Anaesthesia & Pain Medicine, King’s College Hospital NHS Foundation Trust, London, UK
- School of Cardiovascular and Metabolic Medicine and Sciences, King’s College London British Heart Foundation Centre of Excellence, London, UK
| |
Collapse
|
205
|
Cevik J, Read D, Putland M, Fazio T, Gumm K, Varma A, Santos R, Ramakrishnan A. The impact of electric scooters in Melbourne: data from a major trauma service. ANZ J Surg 2024; 94:572-579. [PMID: 38087881 DOI: 10.1111/ans.18814] [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: 10/19/2023] [Revised: 11/14/2023] [Accepted: 11/22/2023] [Indexed: 04/17/2024]
Abstract
BACKGROUND The proliferation of electric scooters globally has been associated with an increase in related injuries and consequent economic burden. This study aims to assess the injury patterns and the economic impact associated with electric scooter use in Melbourne, Australia. METHODS A retrospective cohort study was conducted using hospital and registry data from January 2022 to January 2023. Data collected included demographic details, alcohol and helmet use, injury type and severity, operative treatment provided, and direct medical costs. The economic impact (in AUD) of the patient's emergency presentation and hospital admission was calculated. RESULTS During the study period, 256 electric scooter related injuries were recorded, comprising 247 riders and nine pedestrians. The majority of patients were males (69%) with a median age of 29.5 (15-78). Alcohol use was reported by 34% and helmet use by 33%. Injuries most commonly affected the upper limb (53%) and head (50%), with abrasions (75%) and fractures (48%) being the most common type of injury sustained. The total hospital cost was $1 911 062, and the median cost was $1321.66 per patient (IQR: $479.37-$5096.65). CONCLUSION Electric scooter usage, as observed through patient presentations to the Royal Melbourne Hospital, is associated with a considerable number of injuries, primarily among young males, and an ensuing substantial economic burden. The findings underscore the urgent need for improved safety measures to minimize electric scooter-related injuries and their clinical and economic repercussions.
Collapse
Affiliation(s)
- Jevan Cevik
- Department of Plastic Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - David Read
- Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Mark Putland
- Emergency Department, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Timothy Fazio
- Health Intelligence Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kellie Gumm
- Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Amrita Varma
- Department of Plastic Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Roselyn Santos
- Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Anand Ramakrishnan
- Department of Plastic Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
206
|
Qian W, Bruinsma J, Mac Curtain B, Ibraheem M, Temperley HC, Ng ZQ. Surgical prevalence and outcomes in ischemic colitis: A systematic review and meta-analysis. World J Surg 2024; 48:943-953. [PMID: 38441288 DOI: 10.1002/wjs.12123] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/09/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND/AIM This study reviews the literature to examine the proportion of patients requiring surgical management in ischemic colitis (IC) and identify surgical outcomes. METHOD A systematic review of PubMed, EMBASE, and Cochrane Central Register of Controlled Trials was conducted in accordance with the latest Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. English language studies and adult patients were included. Studies with fewer than 10 patients, and IC post aortic or cardiac surgery was excluded. We present our systematic review and meta-analysis with pooled proportions of right sided IC distribution and prevalence of surgical treatment. RESULTS 23 studies with a total of 12,844 patients were included in the systematic review, with 19 studies and 12,420 patients included in the meta-analysis. Four studies were excluded from the meta-analysis due to only including specific cohorts of patients-two with cocaine induced colitis, one with phlebosclerotic colitis, and one with IC associated with acute myocardial infarction. The pooled proportion of right sided IC distribution was 15% (CI 14%-17%, p < 0.001), whilst the pooled proportion of surgical management of IC was 15% (CI 13%-16% p < 0.001). CONCLUSION Prevalence of surgical management of IC is rare. Right sided IC is associated with higher mortality and higher rates of surgical management. Reporting of surgical outcomes is scant.
Collapse
Affiliation(s)
- Wanyang Qian
- Department of Surgery, St John of God Subiaco Hospital, Subiaco, Western Australia, Australia
| | - Joshua Bruinsma
- Department of Surgery, St John of God Subiaco Hospital, Subiaco, Western Australia, Australia
| | - Benjamin Mac Curtain
- Department of Surgery, St John of God Subiaco Hospital, Subiaco, Western Australia, Australia
| | - Mark Ibraheem
- Department of Surgery, St John of God Subiaco Hospital, Subiaco, Western Australia, Australia
| | - Hugo C Temperley
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Zi Qin Ng
- Department of General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
| |
Collapse
|
207
|
Kamalumpundi V, Meyers E, Torfah M, de Gusmão Correia ML. A patient with a rare co-occurrence of papillary and follicular thyroid carcinomas. Clin Case Rep 2024; 12:e8707. [PMID: 38585590 PMCID: PMC10996043 DOI: 10.1002/ccr3.8707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/07/2024] [Accepted: 02/10/2024] [Indexed: 04/09/2024] Open
Abstract
The occurrence of papillary and follicular thyroid carcinoma as a collision tumor is rare. We report on a case of a collision tumor consisting of papillary and follicular thyroid carcinoma treated successfully with surgery and radioiodine ablation.
Collapse
Affiliation(s)
| | - Erin Meyers
- Division of Endocrinology and Metabolism, Department of Internal MedicineUniversity of Iowa Hospitals and ClinicsIowa CityIowaUSA
| | - Maisoon Torfah
- Division of Endocrinology and Metabolism, Department of Internal MedicineUniversity of Iowa Hospitals and ClinicsIowa CityIowaUSA
| | - Marcelo Lima de Gusmão Correia
- Roy J. and Lucille A. Carver College of MedicineUniversity of IowaIowa CityIowaUSA
- Division of Endocrinology and Metabolism, Department of Internal MedicineUniversity of Iowa Hospitals and ClinicsIowa CityIowaUSA
| |
Collapse
|
208
|
Vosoughi F, Mafhoumi A, Gouravani M, LaPrade RF, Sherafat Vaziri A, Movahedinia M, Keyhani S. Hypermobile lateral meniscus: A systematic review of current treatment options. Knee Surg Sports Traumatol Arthrosc 2024; 32:843-863. [PMID: 38431797 DOI: 10.1002/ksa.12102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/08/2024] [Accepted: 02/11/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE The reliable data on the incidence of hypermobile lateral meniscus (HLM) and its clinical manifestations, diagnostic methods and therapeutic approaches are limited. This systematic study aimed to review available treatment options for HLM and the outcomes of each approach. METHODS A systematic search was performed in four electronic databases (PubMed, EMBASE, Scopus, Web of Science) to identify studies in which arthroscopically confirmed cases of HLM were treated surgically or nonsurgically, and the required data comprising study characteristics, patient data, treatment approaches and outcome measures were extracted from eligible studies. RESULTS Twenty studies with a total of 212 patients (138 males and 74 females) and 219 knees were included. The most frequently reported symptoms were locking sensations, knee pain, giving way and snapping. Treatments used by the studies were: radiofrequency energy in two studies; arthroscopic partial meniscectomy in one study; open surgery in two studies; and arthroscopic meniscal repair in 17 studies. Eleven studies used an all-inside repair method and an inside-out meniscal repair was reported in eight studies. Three studies reported the usage of posterior arthroscopy for therapeutic or diagnostic approaches. Evaluation of symptom resolution was the main outcome measurement for which almost all of the studies stated relief of symptoms after intervention. CONCLUSION Despite the lack of definite consensus about the most appropriate intervention for HLM, therapeutic preference was directed towards arthroscopic all-inside and inside-out repair techniques. Although the surgeon's decision remains the key factor in choosing the most suitable treatment option for each individual, posterior arthroscopic meniscal repair may be considered as a better option for HLM treatment according to the findings of this review. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Fardis Vosoughi
- Department of Orthopedic and Trauma Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Asma Mafhoumi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Center for Orthopedic Trans-Disciplinary Applied Research, Tehran, Iran
| | - Mahdi Gouravani
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | - Sohrab Keyhani
- Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
209
|
Moon J, Khan S, Tao S, Kim G. Analysis of Reapplicants to Ophthalmology Residency: Factors Associated with Successful Matching. Semin Ophthalmol 2024; 39:229-234. [PMID: 37938027 DOI: 10.1080/08820538.2023.2278540] [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: 07/20/2023] [Accepted: 10/30/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Ophthalmology residency programs are highly competitive and each year there are many unmatched reapplicants who must make time-sensitive decisions on how to prepare for their reapplication. Our analysis of reapplication factors will be the first evidence-based guide to reapplying ophthalmology. OBJECTIVE To determine the components of a reapplicants application that contribute and that do not contribute to ophthalmology residency match success. METHODS Eighty-eight total reapplicants to Dell Medical School's Department of Ophthalmology residency program for the year of 2022 and 2023 were analyzed in a retrospective review in 2023 based on their San Francisco match applications. We assessed match success in the context of demographics, academic performance, cognitive measures, letters of recommendation, personal statements, and extracurricular activities. RESULTS Of 84 reapplicants who completed the San Francisco Match, 41 matched successfully (48.8%). Factors that significantly affected match success include quantity of LORs written by ophthalmologists (P = .0143), choice of interim year activity (p = .0019), and Step 2 Clinical Knowledge score (P = .0017). Our findings demonstrate that noncontributory factors to reapplicant match rate include number of publications during research years, demographics, clinical grades, Alpha Omega Alpha (AOA) membership, LOR qualities, and Step 1 score. CONCLUSIONS Ophthalmology residency reapplicants should focus their efforts on finding a research year or established pre-ophthalmology residency program for their interim year and bolstering their letters of recommendations within the field. The quality of in-specialty relationships and letters of recommendation are more impactful than the number of publications during a research gap year. Step 2 CK score is a significant factor but would have already been determined by the time of reapplication. Metrics such as Step 1 scores, AOA status, number of volunteering experiences, and LOR and personal statement qualities had no effect on a reapplicant's chance of matching.
Collapse
Affiliation(s)
- Jared Moon
- Mitchel and Shannon Wong Eye Institute, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - Saima Khan
- Mitchel and Shannon Wong Eye Institute, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - Sara Tao
- Mitchel and Shannon Wong Eye Institute, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - Gene Kim
- Mitchel and Shannon Wong Eye Institute, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| |
Collapse
|
210
|
Brovman EY, Motejunas MW, Bonneval LA, Whang EE, Kaye AD, Urman RD. Relationship Between Newly Established Perioperative DNR Status and Perioperative Outcomes in the Elderly Population: A NSQIP Database Analysis. J Palliat Care 2024; 39:97-104. [PMID: 32718256 DOI: 10.1177/0825859720944746] [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] [Indexed: 02/28/2024]
Abstract
Background: Health care practitioners have developed complex algorithms to numerically calculate surgical risk. We examined the association between the initiation of a new do-not-resuscitate (DNR) status during hospitalization and postoperative outcomes, including mortality. We hypothesized that new DNR status would be associated with similar complication rates, even though mortality rates may be higher. Methods: A retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Geriatric Surgery Research File. Two cohorts were defined by the presence of a new DNR status during the hospitalization that was not present on hospital admission. Multivariable logistic regression was used to control for differences between the DNR and non-DNR cohorts. The primary outcome was 30-day mortality. Secondary outcomes included rates of postoperative complications, including returning to the operating room, reintubation, failure to wean from ventilation, surgical site infections, dehiscence, pneumonia, acute kidney injury, renal failure, stroke, cardiac arrest, acute myocardial infarction, transfusion requirements, sepsis, urinary tract infections, venous thromboembolisms, total number of complications for each patient, and hospital length of stay. Results: In our geriatric population with a newly established DNR status, the mortality rate was 39.29%, significantly greater than the non-DNR population after multivariable regression. Secondary outcomes also occurred at an increased rate in the DNR cohort including surgical site infections (8.29% vs 4.04%), pneumonia (18% vs 2.26%), renal insufficiency (2.43% vs 0.35%), acute renal failure (5% vs 0.19%), stroke (3% vs 0.36%), acute myocardial infarction (6.29% vs 0.95%), and cardiac arrest (5.86% vs 0.51%). Conclusions: The initiation of a new DNR status during hospitalization is associated with a significantly higher burden of both morbidity and mortality. This contrasts with prior studies that did not show an increased rate of adverse outcomes and suggests that a new DNR status in postoperative patients may reflect a consequence of adverse postoperative events. The informed consent process in older patients at risk for adverse outcomes after surgery should include discussions regarding goals of care and acceptable risk.
Collapse
Affiliation(s)
- Ethan Y Brovman
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA, USA
| | - Mark W Motejunas
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Lauren A Bonneval
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Edward E Whang
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| |
Collapse
|
211
|
Zuhdi K, Khan A, El-Kolalli S, Anwer A, Wilkins C. Spotlight on El-Zahrawi, Father of Modern Surgery: Reflections on His Impact on Contemporary Medicine and the Need for Greater Medical Education on Pivotal Figures in Medicine. Teach Learn Med 2024; 36:230-234. [PMID: 36636879 DOI: 10.1080/10401334.2023.2166941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 12/14/2022] [Accepted: 12/23/2022] [Indexed: 06/17/2023]
Abstract
Issue: For students in the preclinical years of medical school, it is easy to overlook the narrative component of medicine and become occupied with learning the vast sea of information about the human body. There are limited, if any, options to learn about historical figures in medicine and how they can inform our future in clinical medicine. Evidence: There is an apparent lack of education offered on pivotal figures in medicine across many institutions. The few instances that medical history has been incorporated into the curriculum are further discussed. Implications: In order to incorporate cultural competency in our delivery of care, it is important to consider the diversity of the population we will be serving and how we can prepare to help patients feel heard in their unique issues. In this paper, we propose learning about the true history of certain medical practices, rather than the "colonial" version often utilized in textbooks and lectures, as a means of diversifying students' perspectives of the origins of these practices as well as giving credit where it is due. The time period during which many of these medical practices were cultivated is referred to as the Islamic Golden Age, but scholars who made contributions belonged to many different faiths and cultural backgrounds. El-Zahrawi was a Muslim physician whose principal work, Kitab-at-Tasrif, contains topics on medicine, surgery, midwifery, pharmacology, therapeutics, diet, psychotherapy, and medical chemistry. He pioneered numerous techniques in surgery and invented surgical devices that are still used to this day.
Collapse
Affiliation(s)
- Kareem Zuhdi
- USF Health Morsani College of Medicine, Tampa, Florida, USA
| | - Ayesha Khan
- USF Health Morsani College of Medicine, Tampa, Florida, USA
| | | | - Ayesha Anwer
- USF Health Morsani College of Medicine, Tampa, Florida, USA
| | | |
Collapse
|
212
|
Federica F, Elisa Z, Maria Grazia P, Calogero V, Patrizia DI, Maria Caterina P, Marica DP, Piergiorgio G, DeCorti F. Surgical treatment of invasive fungal infection in pediatric oncology. Eur J Haematol 2024. [PMID: 38558136 DOI: 10.1111/ejh.14205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 03/04/2024] [Accepted: 03/12/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Invasive fungal disease (IFD) is typically aggressive and related with high mortality in children with a hematological malignancy. The association of medical and surgical treatment may ameliorate the outcome. The aim of this study was to analyze the surgical treatment of fungal infections in pediatric oncological populations. METHODS Retrospective study (2000-2022) of a single-center experience. We reviewed the medical record of all patients with hematologic malignancies and IFD, analyzing the outcome. RESULTS From the 70 pediatric cases of hematologic malignancies with the diagnosis IFD over 22 years, we included in the present study 44 cases who required surgical approaches for either diagnosis or treatment. Twenty-one patients were males and the mean age was 11 (range 1-23) years. The main indications for surgery were lack of improvement following medical treatment and/or progression of fungal infection (80%) and diagnosis confirmation (20%). Only five patients needed an emergency operation for rapid worsening of symptoms. The most common site of infection was the lung (80%) and the most frequently identified pathogen was Aspergillus (75%). The most common surgical procedures were lobectomy (performed in 17 patients) and atypical lung resection (10). Complications of surgery were mostly treated by medical approach. The mean time of resumption of oncological treatment was 40 (range 0-150) days. CONCLUSIONS Surgery is an important step in the multimodal treatment of invasive fungal infection with excellent resolution rate. Overall mortality depends on the underlying malignancy.
Collapse
Affiliation(s)
- Fati Federica
- Pediatric Surgery, Department of Woman and Child's Health, University Hospital of Padua, Padua, Italy
| | - Zambaiti Elisa
- Pediatric Surgery, Department of Woman and Child's Health, University Hospital of Padua, Padua, Italy
- Department of Pediatric Surgery, Pediatric Hospital Regina Margherita, Turin, Italy
| | - Petris Maria Grazia
- Pediatric Hematology, Oncology and Stem Cell Transplant Center, Department of Women's and Child's Health, University of Padua, Padua, Italy
| | - Virgone Calogero
- Pediatric Surgery, Department of Woman and Child's Health, University Hospital of Padua, Padua, Italy
| | - Dall' Igna Patrizia
- Division of Pediatric Surgery, Department of Emergencies and Organ Transplantation, Bari University, Bari, Italy
| | - Putti Maria Caterina
- Pediatric Hematology, Oncology and Stem Cell Transplant Center, Department of Women's and Child's Health, University of Padua, Padua, Italy
| | - De Pieri Marica
- Division of Pediatric Infectious Diseases, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Gamba Piergiorgio
- Pediatric Surgery, Department of Woman and Child's Health, University Hospital of Padua, Padua, Italy
| | - Federica DeCorti
- Pediatric Surgery, Department of Woman and Child's Health, University Hospital of Padua, Padua, Italy
| |
Collapse
|
213
|
Khan F, Somawardana I, Mitchell M, Adewumi MT, Berger B, Marmie B, Lopez L, Clark D. Ameloblastic Carcinoma of the Maxilla With Uncommon Sinus Manifestations. Ear Nose Throat J 2024:1455613241245207. [PMID: 38561954 DOI: 10.1177/01455613241245207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Ameloblastic carcinoma (AC) represents a distinct challenge in the realm of odontogenic malignancies due to its rarity and aggressive nature. We present a unique case of AC in a 70-year-old male, retired dry cleaner, with symptoms initially suggestive of chronic allergic rhinitis and recurrent acute sinusitis with asymmetric facial edema and paresthesia. Detailed evaluation revealed a prominent mass in the right maxillary sinus with extensive cortical destruction. Pathological assessment post-right maxillectomy identified a high-grade AC with malignant spindle cell transformation. The patient underwent subsequent interventions, including neck dissection and radiation therapy. Twelve months post-presentation, the patient was recovering appropriately without evidence of recurrence of malignancy. This case highlights the diagnostic challenges posed by AC as well as its unique presentations emphasizing the importance of a comprehensive approach and multidisciplinary management. It also raises considerations about potential chemical exposure implications in AC development.
Collapse
Affiliation(s)
- Faizaan Khan
- Texas A&M School of Engineering Medicine, Houston, TX, USA
| | | | | | | | - Blaine Berger
- Department of Pathology, Baylor Scott & White Medical Center, Temple, TX, USA
| | - Blake Marmie
- Department of Radiology, Baylor Scott & White Medical Center, Temple, TX, USA
| | - Lisa Lopez
- Department of Pathology, Baylor Scott & White Medical Center, Temple, TX, USA
| | - David Clark
- Department of Otolaryngology, Baylor Scott & White Medical Center, Temple, TX, USA
| |
Collapse
|
214
|
Bedel A, Blache G, Jauffret C, Houvenaeghel G, Buttarelli M, Sabiani L, Mokarram Dorri N, El Hajj H, Lambaudie E. A computer synoptic operative report versus a report dictated by a surgeon in advanced ovarian cancer. Int J Gynecol Cancer 2024; 34:581-585. [PMID: 38336374 DOI: 10.1136/ijgc-2023-004947] [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] [Indexed: 02/12/2024] Open
Abstract
OBJECTIVE To evaluate the role of a computer synoptic operative report in enhancing the quality and completeness of surgical reporting for advanced ovarian cancer surgeries. METHODS The study was conducted at a tertiary cancer center between January 2016 and September 2021, and the computer synoptic operative report was implemented in May 2019. The study compared two cohorts: the first consisted of the 'before computer synoptic operative report (P1)' period, during which the operative reports were dictated freely by the surgeons, and the second consisted of the 'after computer synoptic operative report (P2)' period, during which all surgeons used the computer synoptic operative report. RESULTS The study analyzed 227 operative reports, with 104 during period 1 (P1) and 123 during period 2 (P2). In the P1 group, more than half of the patients (54 out of 104, 52%) underwent interval surgery after completing six cycles of chemotherapy; In contrast, in the P2 group, all interval debulking surgeries were performed after fewer than six chemotherapy cycles (p<0.001). Although interval debulking surgery after fewer than six chemotherapy cycles was more frequent in P2, the rate of primary debulking surgery was similar between the groups. The median intra-operative peritoneal carcinomatosis index was higher in P2 (2 in P1 vs 4 in P2, p<0.001), and mean blood loss was higher in P1 (308 mL vs 151 mL, p<0.001). The rate of complete cytoreduction was similar between P1 and P2 (97% vs 87%, respectively, p=0.6). The median length of hospital stay was 12 days in the P1 group and 16 days in the P2 group (p=0.5). Compliance with all eight significant items was higher in the P2 group, with all items present in 66% of the operative reports in the P2 group compared with none of the reports in the P1 group. Compliance for the following items was: International Federation of Obstetrics and Gynecology stage (24% vs 100%), histology (76% vs 97%), CA125 (63% vs 89%), type of surgery (38% vs 100%), peritoneal carcinomatosis index (21% vs 100%), complete cytoreduction score 36% vs 99%), Aletti score (0% vs 89%), and blood loss (32% vs 98%) for P1 and P2; respectively. CONCLUSION The use of the computer synoptic operative report improved the completeness and quality of the surgical information documented in advanced ovarian cancer surgeries.
Collapse
Affiliation(s)
- Alice Bedel
- Department of Surgery, Paoli-Calmettes Institute, Marseille, Provence-Alpes-Côte d'Azu, France
| | - Guillaume Blache
- Department of Surgery, Paoli-Calmettes Institute, Marseille, Provence-Alpes-Côte d'Azu, France
| | - Camille Jauffret
- Department of Surgery, Paoli-Calmettes Institute, Marseille, Provence-Alpes-Côte d'Azu, France
| | - Gilles Houvenaeghel
- Department of Surgery, Paoli-Calmettes Institute, Marseille, Provence-Alpes-Côte d'Azu, France
| | - Max Buttarelli
- Department of Surgery, Paoli-Calmettes Institute, Marseille, Provence-Alpes-Côte d'Azu, France
| | - Laura Sabiani
- Department of Surgery, Paoli-Calmettes Institute, Marseille, Provence-Alpes-Côte d'Azu, France
| | - Navid Mokarram Dorri
- Department of Surgery, Paoli-Calmettes Institute, Marseille, Provence-Alpes-Côte d'Azu, France
| | - Houssein El Hajj
- Department of Surgery, Paoli-Calmettes Institute, Marseille, Provence-Alpes-Côte d'Azu, France
| | - Eric Lambaudie
- Department of Surgery, Paoli-Calmettes Institute, Marseille, Provence-Alpes-Côte d'Azu, France
| |
Collapse
|
215
|
Li ZW, Shu XP, Liu F, Liu XR, Tong Y, Lv Q, Liu XY, Zhang W, Peng D. Remission of Nonalcoholic Fatty Liver Disease After Radical Surgery in Patients with Colorectal Cancer: A Single-Center Retrospective Study. Metab Syndr Relat Disord 2024; 22:207-213. [PMID: 38232369 DOI: 10.1089/met.2023.0232] [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] [Indexed: 01/19/2024] Open
Abstract
Purpose: The purpose of this study was to investigate the relationship between remission of nonalcoholic fatty liver disease (NAFLD) and radical surgery for colorectal cancer (CRC) patients. Methods: From January 2014 to December 2021, data of patients with concurrent CRC and NAFLD who underwent radical surgery in a single-center hospital were retrospectively collected. NAFLD was defined as a mean computed tomography (CT) liver attenuation value of <40 Hounsfield units (HUs). Comparison of preoperative and 1-year postoperative CT images was performed to evaluate the change of NAFLD. Multivariate logistic regression analysis was performed to identify independent predictive factors for NAFLD remission. The Kaplan-Meier method was used to estimate overall survival (OS) and disease-free survival (DFS) between the remission group and no remission group. Results: In this study, a total of 55 eligible patients were included. The remission group had 33 (60.0%) patients and the no remission group had 22 (40.0%) patients. The mean preoperative weight was 66.1 ± 9.9 kg. The mean preoperative body mass index (BMI) was 25.4 ± 2.5 kg/m2. We found that the average weight was significantly decreased (P < 0.01), average BMI was significantly decreased (P < 0.01), and HU score was significantly increased (P < 0.01). By comparing baseline characteristics between the remission group and no remission group, we found that the remission group exhibited larger tumor sizes (P = 0.036) than the no remission group. In the multivariate logistic regression analysis, we found that weight change was a predictor for NAFLD (odds ratio = 0.764, 95% confidence interval = 0.618-0.944, P = 0.013). We did not find any statistically significant differences in OS (P = 0.182) or DFS (P = 0.248) between the remission group and no remission group. Conclusions: The NAFLD remission rate reached 60.0% for CRC patients 1 year after radical surgery. In addition, we found that weight change was a predictor of NAFLD remission.
Collapse
Affiliation(s)
- Zi-Wei Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xin-Peng Shu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fei Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xu-Rui Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yue Tong
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Quan Lv
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao-Yu Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dong Peng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
216
|
Mardani P, Koulaian S, Fouladi D, Rajaie Ramsheh FS, Amirian A, Shahriarirad S, Malekhosseini SA, Shahriarirad R. Demographic, clinical, and surgical features of patients undergoing thyroidectomy due to thyroid lesions in Southern Iran: A cross-sectional study. Health Sci Rep 2024; 7:e2012. [PMID: 38567186 PMCID: PMC10985224 DOI: 10.1002/hsr2.2012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 03/04/2024] [Accepted: 03/10/2024] [Indexed: 04/04/2024] Open
Abstract
Background and Aims The incidence of thyroid cancer has witnessed a significant global increase and stands as one of the most prevalent cancers in Iran. This surge is primarily attributed to the escalating incidence of papillary thyroid cancer (PTC), with overdiagnosis emerging as an equally noteworthy factor. Consequently, this study aims to ascertain the incidence of thyroid cancer, along with its clinical presentation, demographic characteristics, and surgical features in patients undergoing thyroid surgery. Methods This cross-sectional study involved the evaluation of patient files from referral centers in Shiraz spanning the years 2015-2020. Demographic and clinical information pertaining to thyroid cancer was extracted and subsequently analyzed using SPSS software. Results A total of 533 documented cases of thyroid cancer undergoing surgery revealed an annual rate of 89 cases in our location. The average age of the patients was 43.9 ± 13.4 years (ranging from 13 to 92), with females constituting 429 (83.5%) of the cases, and 278 (54.1%) being malignant. Conventional PTC emerged as the most prevalent pathology, accounting for 239 (45.0%) of the cases. Patients with thyromegaly exhibited significantly higher incidences of nonmalignant tumors (p = 0.01), while those with malignant tumors were notably younger than those with nonmalignant tumors (p = 0.001). Conclusion Our study revealed a progressive rise in the number of patients undergoing thyroidectomy over the years, with PTC constituting the majority of cases. Malignant cases were more frequently observed in younger patients, and in smaller lesion sizes, highlighting the importance of early screening and optimizing detection methods, especially in high-risk populations.
Collapse
Affiliation(s)
- Parviz Mardani
- Thoracic and Vascular Surgery Research CenterShiraz University of Medical ScienceShirazIran
- Shiraz Transplant Research CenterShiraz University of Medical SciencesShirazIran
| | - Sepehr Koulaian
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Damoun Fouladi
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | | | - Armin Amirian
- Thoracic and Vascular Surgery Research CenterShiraz University of Medical ScienceShirazIran
| | | | | | - Reza Shahriarirad
- Thoracic and Vascular Surgery Research CenterShiraz University of Medical ScienceShirazIran
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| |
Collapse
|
217
|
Gomez J, Theodosopoulos E, MacRae H, Brar MS, de Buck van Overstraeten A, O'Connor B, Huang H, Kennedy E. Is extended venous thromboprophylaxis required in patients undergoing ileal pouch procedure for ulcerative colitis? Colorectal Dis 2024; 26:726-733. [PMID: 38374529 DOI: 10.1111/codi.16912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 01/15/2024] [Accepted: 01/21/2024] [Indexed: 02/21/2024]
Abstract
AIM Venous thromboembolic events (VTEs) are relatively common adverse surgical complications. Extended VTE prophylaxis for 4 weeks is recommended after colorectal cancer surgery, but its use in inflammatory bowel disease surgery lacks high-quality evidence. This retrospective study aimed to assess and characterize VTEs within the first 30 days after ileal pouch-anal anastomosis (IPAA) procedures and subtotal colectomies (STCs) for ulcerative colitis (UC). METHODS All patients who underwent IPAA for UC between 1 January 2017 and 31 December 2021 were included. VTE rates after IPAA, in-hospital or at-home occurrences, utilization of in-hospital thromboprophylaxis, and prescribed anticoagulant treatment were evaluated. Retrospectively, the same variables were analysed if patients of the cohort underwent STC before the IPAA construction. RESULTS In all, 204 patients underwent IPAA (61.8% men, 73% laparoscopic), with an average hospital stay of 6.8 days. Among them, 116 patients underwent STC prior to IPAA. Thirteen patients (6.3%) experienced VTEs after IPAA, with 76.9% (10/13) of cases occurring during hospitalization and under adequate thromboprophylaxis. The VTE rate after STC was 10.3% (12/116), with 58.2% (7/12) occurring in hospital and under appropriate thromboprophylaxis. No reoperations or mortality were attributed to thrombotic events. The type and duration of anticoagulant treatment varied considerably. CONCLUSION The VTE rate after IPAA for UC was 6.3%, with the majority of events occurring in hospital and under adequate thromboprophylaxis. These findings suggest that routine use of extended VTE prophylaxis in our cohort may not be supported. Further research is needed to clarify the optimal VTE prophylaxis strategy for inflammatory bowel disease surgery.
Collapse
Affiliation(s)
- Javier Gomez
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Evangelia Theodosopoulos
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Helen MacRae
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Mantaj S Brar
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Anthony de Buck van Overstraeten
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Brenda O'Connor
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Harden Huang
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Erin Kennedy
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada
| |
Collapse
|
218
|
Bilger J, Pletscher M, Müller T. Separating the wheat from the chaff: How to measure hospital quality in routine data? Health Serv Res 2024; 59:e14282. [PMID: 38258324 PMCID: PMC10915488 DOI: 10.1111/1475-6773.14282] [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] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVE To measure hospital quality based on routine data available in many health care systems including the United States, Germany, the United Kingdom, Scandinavia, and Switzerland. DATA SOURCES AND STUDY SETTING We use the Swiss Medical Statistics of Hospitals, an administrative hospital dataset of all inpatient stays in acute care hospitals in Switzerland for the years 2017-2019. STUDY DESIGN We study hospital quality based on quality indicators used by leading agencies in five countries (the United States, the United Kingdom, Germany, Austria, and Switzerland) for two high-volume elective procedures: inguinal hernia repair and hip replacement surgery. We assess how least absolute shrinkage and selection operator (LASSO), a supervised machine learning technique for variable selection, and Mundlak corrections that account for unobserved heterogeneity between hospitals can be used to improve risk adjustment and correct for imbalances in patient risks across hospitals. DATA COLLECTION/EXTRACTION METHODS The Swiss Federal Statistical Office collects annual data on all acute care inpatient stays including basic socio-demographic patient attributes and case-level diagnosis and procedure codes. PRINCIPAL FINDINGS We find that LASSO-selected and Mundlak-corrected hospital random effects logit models outperform common practice logistic regression models used for risk adjustment. Besides the more favorable statistical properties, they have superior in- and out-of-sample explanatory power. Moreover, we find that Mundlak-corrected logits and the more complex LASSO-selected models identify the same hospitals as high or low-quality offering public health authorities a valuable alternative to standard logistic regression models. Our analysis shows that hospitals vary considerably in the quality they provide to patients. CONCLUSION We find that routine hospital data can be used to measure clinically relevant quality indicators that help patients make informed hospital choices.
Collapse
Affiliation(s)
- Jana Bilger
- Department of Health, Institute of Health Economics & PolicyBern University of Applied SciencesBernSwitzerland
| | - Mark Pletscher
- Department of Health, Institute of Health Economics & PolicyBern University of Applied SciencesBernSwitzerland
| | - Tobias Müller
- Department of Health, Institute of Health Economics & PolicyBern University of Applied SciencesBernSwitzerland
| |
Collapse
|
219
|
Navare S, Rozental O, Girardi N. PRO: Implementation Science Has Value in Anesthesiology and Cardiothoracic Surgery. J Cardiothorac Vasc Anesth 2024; 38:1049-1051. [PMID: 38057168 DOI: 10.1053/j.jvca.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 11/01/2023] [Indexed: 12/08/2023]
Abstract
Implementation science is a nascent field that aims to study the factors that influence the effectiveness of a given clinical intervention, such as the characteristics of the individuals involved, the internal and external settings, the process of implementation, and other factors. Overall, implementation science aims to increase the extent to which an intervention is practiced, and the quality of its delivery to a patient. Although still in its infancy, the applications of implementation science in anesthesiology and cardiothoracic surgery abound. Whether used to adopt novel innovations, avoid the use of obsolete practices, or redeploy existing interventions to improve quality, implementation science holds promise in optimizing how we bring the latest in clinical science to produce tangible benefits to patients and create sustainable change.
Collapse
Affiliation(s)
- Sagar Navare
- Department of Anesthesiology, Weill Cornell Medical College, New York, NY.
| | - Olga Rozental
- Department of Anesthesiology, Weill Cornell Medical College, New York, NY
| | - Natalia Girardi
- Department of Anesthesiology, Weill Cornell Medical College, New York, NY
| |
Collapse
|
220
|
Jedidi L, Mabrouk A, Ghali H, Ben Dhaou A, Ben Lahouel S, Daldoul S, Said Latiri H, Ben Moussa M. Right-sided acute diverticulitis in a North African country: Presentation and management in one surgical center. World J Surg 2024. [PMID: 38557977 DOI: 10.1002/wjs.12172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/24/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE Right-sided diverticulitis is a rare entity in North Africa. Therefore, it is usually misdiagnosed, and the management of cecal diverticulitis is aggressive in most cases, whereas nowadays, most studies recommend a conservative approach with promising results. This study aims to describe the presentation, management, and outcomes of right-sided diverticulitis (RSD) and to present the experience of one surgical center in Tunisia. METHODS This is a retrospective study including all patients presented with RSD, in the Department of Surgery "A" of the Charles Nicolle Hospital between 2007 and 2021. RESULTS Forty patients were included in our study. The mean age was 42 years with a standard deviation of 14. The sex ratio was 1.1. Only 2 patients had chronic constipation. All patients presented right-sided abdominal pain, and only 3 patients had diarrhea. Twenty one patients were diagnosed during surgery. Fourteen patients were treated successfully by conservative management. An operative procedure was performed in 26 cases: 21 had a diverticulectomy (80%), two had an ileal resection (8%), and three had a right colectomy (11.5%). No postoperative events occurred with a short hospital stay (5 ± 3 days). Follow-up showed no recurrences. CONCLUSION Right-sided diverticulitis has a lower incidence and complication rate compared to left-sided diverticulitis. Conservative treatment has demonstrated favorable outcomes in managing RSD, although the available evidence remains limited.
Collapse
Affiliation(s)
- Laila Jedidi
- Department of General Surgery, Jendouba Hospital, Jendouba, Tunisia
| | - Aymen Mabrouk
- Department of Surgery A, Charles Nicolle Hospital, Tunis, Tunisia
| | - Hela Ghali
- Department of Prevention and Security of Care, Sahloul University Hospital, Sousse, Tunisia
| | - Anis Ben Dhaou
- Department of Surgery A, Charles Nicolle Hospital, Tunis, Tunisia
| | | | - Sami Daldoul
- Department of Surgery A, Charles Nicolle Hospital, Tunis, Tunisia
| | - Houyem Said Latiri
- Department of Prevention and Security of Care, Sahloul University Hospital, Sousse, Tunisia
| | | |
Collapse
|
221
|
Yadav TN, Pandit N, Deo KB, Awale L, Neupane D, Adhikary S. Continuous versus interrupted anastomotic technique for the hepaticojejunostomy: a prospective cohort study. Ann Med Surg (Lond) 2024; 86:1950-1955. [PMID: 38576960 PMCID: PMC10990411 DOI: 10.1097/ms9.0000000000001902] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/25/2024] [Indexed: 04/06/2024] Open
Abstract
Background Interrupted sutures is the gold standard technique of hepaticojejunostomy (HJ) for bilioenteric anastomosis. This study compares the safety and early complications of continuous and interrupted suture HJ. Methods A prospective study involving all elective HJ between September 2019 and June 2021 was conducted. Patients with type IV or V biliary strictures, duct diameter less than 8 mm and/or associated vascular injury, and bilateral HJ were excluded. The study patients were divided into two random groups; interrupted and continuous anastomotic technique. Patient demographics, preoperative parameters including pathology (benign vs. malignant), HJ leak, suture time, and postoperative morbidity were recorded. Results Total 34 patients were enroled. Eighteen (52.9%) were into interrupted and 16 (47.1%) patients into the continuous group. Both the groups were comparable with regards to demographics, haemoglobin, serum albumin, preoperative cholangitis and biliary stenting. Total three (8.8%) patients in the entire study developed bile leak; interrupted-2 and continuous-1, which was not significant statistically (P=1.0). Similarly, total number of sutures used and the mean operating time to complete anastomosis in the continuous group was significantly lesser than the interrupted group (2.3±0.5 versus 9.6±1.6, P<0.001) and (16.2±3.1 versus 38.6±9.2 min, P<0.001), respectively. There were three (18.8%) re-exploration in the continuous anastomotic technique. Among them, only one re-operation was due to HJ anastomosis failure without mortality, remaining had re-exploration for bleeding (non-HJ). Conclusions Both the techniques is safe with comparable morbidity. Further, continuous has an added advantage of decreased anastomotic time and cost.
Collapse
Affiliation(s)
- Tek Narayan Yadav
- Department of Surgical, Gastroenterology B. P. Koirala Institute of Health Sciences, Dharan
| | - Narendra Pandit
- Department of Surgical, Gastroenterology Birat Medical College Teaching Hospital (BMCTH), Budhiganga, Morang, Nepal
| | - Kunal Bikram Deo
- Department of Surgical, Gastroenterology B. P. Koirala Institute of Health Sciences, Dharan
| | - Lalijan Awale
- Department of Surgical, Gastroenterology B. P. Koirala Institute of Health Sciences, Dharan
| | - Durga Neupane
- Department of Surgical, Gastroenterology B. P. Koirala Institute of Health Sciences, Dharan
| | - Shailesh Adhikary
- Department of Surgical, Gastroenterology B. P. Koirala Institute of Health Sciences, Dharan
| |
Collapse
|
222
|
Schneider MM, Badhiwala JH, Alvi MA, Tetreault LA, Kalsi P, Idler RK, Wilson JR, Fehlings MG. Prevalence of Neck Pain in Patients with Degenerative Cervical Myelopathy and Short-Term Response After Operative Treatment: A Cohort Study of 664 Patients From 26 Global Sites. Global Spine J 2024; 14:830-838. [PMID: 36073893 DOI: 10.1177/21925682221124098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Ambispective cohort study. OBJECTIVES 1) To define the prevalence of neck pain in patients with degenerative cervical myelopathy (DCM). 2) To identify associated factors of preoperative neck pain in patients with DCM. 3) To assess the neck pain response to surgical intervention. METHODS 757 patients with DCM were enrolled at 26 global sites from 2005 to 2011. A total of 664 patients had complete neck pain scores preoperatively (Neck Disability Index, NDI). The prevalence and severity of neck pain preoperatively and at the 6-months follow-up was summarized. Functional assessments of individuals with and without pain were compared. Associations of preoperative neck pain and related factors were evaluated. RESULTS Preoperatively, 79.2% of patients reported neck pain while 20.8% had no neck pain. Of individuals with neck pain, 20.2% rated their pain as very mild, 27.9% as moderate, 19.6% as fairly severe, 9.6% as very severe and 1.9% as the worst imaginable. Functional status (mJOA), number of stenotic levels, age, and duration of symptoms did not significantly differ in patients with and without pain. Factors associated with the presence of neck pain were female gender, BMI ≥27 kg/m2, rheumatologic and gastrointestinal comorbidities, and age <57 years. Neck pain improved significantly from the preoperative examination to the 6-months postoperative follow-up (P < .0001). CONCLUSION Here, we demonstrate a high prevalence of neck pain in patients with DCM as well as a link between gender, body weight, comorbidity and age. We highlight a significant reduction in neck pain 6 months after surgery.
Collapse
Affiliation(s)
- Michel M Schneider
- Division of Neurosurgery and Spine Program, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada
| | - Jetan H Badhiwala
- Division of Neurosurgery and Spine Program, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Mohammed Ali Alvi
- Division of Neurosurgery and Spine Program, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada
| | - Lindsay A Tetreault
- Division of Neurosurgery and Spine Program, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada
- School of Medicine, University College Cork, Cork, Ireland
| | - Pratipal Kalsi
- Division of Neurosurgery and Spine Program, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada
| | - Randy K Idler
- Hackensack Meridian Health JFK University Medical Center, Edison, NJ, USA
| | | | - Michael G Fehlings
- Division of Neurosurgery and Spine Program, Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
223
|
Bertelsen Á, Iribar‐Zabala A, Otegi‐Alvaro E, Benito R, López‐Linares K, Macía I. Proof-of-concept of a robotic-driven photogrammetric scanner for intra-operative knee cartilage repair. Healthc Technol Lett 2024; 11:59-66. [PMID: 38638487 PMCID: PMC11022211 DOI: 10.1049/htl2.12054] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/17/2023] [Indexed: 04/20/2024] Open
Abstract
This work presents a proof-of-concept of a robotic-driven intra-operative scanner designed for knee cartilage lesion repair, part of a system for direct in vivo bioprinting. The proposed system is based on a photogrammetric pipeline, which reconstructs the cartilage and lesion surfaces from sets of photographs acquired by a robotic-handled endoscope, and produces 3D grafts for further printing path planning. A validation on a synthetic phantom is presented, showing that, despite the cartilage smooth and featureless surface, the current prototype can accurately reconstruct osteochondral lesions and their surroundings with mean error values of 0.199 ± 0.096 mm but with noticeable concentration on areas with poor lighting or low photographic coverage. The system can also accurately generate grafts for bioprinting, although with a slight tendency to underestimate the actual lesion sizes, producing grafts with coverage errors of -12.2 ± 3.7, -7.9 ± 4.9, and -15.2 ± 3.4% for the medio-lateral, antero-posterior, and craneo-caudal directions, respectively. Improvements in lighting and acquisition for enhancing reconstruction accuracy are planned as future work, as well as integration into a complete bioprinting pipeline and validation with ex vivo phantoms.
Collapse
Affiliation(s)
- Álvaro Bertelsen
- Digital Health and Biomedical Applications Area, Vicomtech FoundationBasque Research and Technology Alliance (BRTA)Donostia‐San SebastiánSpain
- eHealth GroupBioengineering areaBiogipuzkoa Health Research InstituteDonostia‐San SebastiánSpain
| | - Amaia Iribar‐Zabala
- Digital Health and Biomedical Applications Area, Vicomtech FoundationBasque Research and Technology Alliance (BRTA)Donostia‐San SebastiánSpain
| | - Ekiñe Otegi‐Alvaro
- Digital Health and Biomedical Applications Area, Vicomtech FoundationBasque Research and Technology Alliance (BRTA)Donostia‐San SebastiánSpain
| | - Rafael Benito
- Digital Health and Biomedical Applications Area, Vicomtech FoundationBasque Research and Technology Alliance (BRTA)Donostia‐San SebastiánSpain
| | - Karen López‐Linares
- Digital Health and Biomedical Applications Area, Vicomtech FoundationBasque Research and Technology Alliance (BRTA)Donostia‐San SebastiánSpain
- eHealth GroupBioengineering areaBiogipuzkoa Health Research InstituteDonostia‐San SebastiánSpain
| | - Iván Macía
- Digital Health and Biomedical Applications Area, Vicomtech FoundationBasque Research and Technology Alliance (BRTA)Donostia‐San SebastiánSpain
- eHealth GroupBioengineering areaBiogipuzkoa Health Research InstituteDonostia‐San SebastiánSpain
| |
Collapse
|
224
|
Tong G, Xu J, Pfister M, Atoum J, Prasad K, Miller A, Topf M, Wu JY. Development of an augmented reality guidance system for head and neck cancer resection. Healthc Technol Lett 2024; 11:93-100. [PMID: 38638497 PMCID: PMC11022213 DOI: 10.1049/htl2.12062] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 11/22/2023] [Indexed: 04/20/2024] Open
Abstract
The use of head-mounted augmented reality (AR) for surgeries has grown rapidly in recent years. AR aids in intraoperative surgical navigation through overlaying three-dimensional (3D) holographic reconstructions of medical data. However, performing AR surgeries on complex areas such as the head and neck region poses challenges in terms of accuracy and speed. This study explores the feasibility of an AR guidance system for resections of positive tumour margins in a cadaveric specimen. The authors present an intraoperative solution that enables surgeons to upload and visualize holographic reconstructions of resected cadaver tissues. The solution involves using a 3D scanner to capture detailed scans of the resected tissue, which are subsequently uploaded into our software. The software converts the scans of resected tissues into specimen holograms that are viewable through a head-mounted AR display. By re-aligning these holograms with cadavers with gestures or voice commands, surgeons can navigate the head and neck tumour site. This workflow can run concurrently with frozen section analysis. On average, the authors achieve an uploading time of 2.98 min, visualization time of 1.05 min, and re-alignment time of 4.39 min, compared to the 20 to 30 min typical for frozen section analysis. The authors achieve a mean re-alignment error of 3.1 mm. The authors' software provides a foundation for new research and product development for using AR to navigate complex 3D anatomy in surgery.
Collapse
Affiliation(s)
- Guansen Tong
- Computer Science DepartmentVanderbilt UniversityNashvilleTennesseeUSA
| | - Jiayi Xu
- Computer Science DepartmentVanderbilt UniversityNashvilleTennesseeUSA
| | - Michael Pfister
- Computer Science DepartmentVanderbilt UniversityNashvilleTennesseeUSA
| | - Jumanh Atoum
- Computer Science DepartmentVanderbilt UniversityNashvilleTennesseeUSA
| | - Kavita Prasad
- Vanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Alexis Miller
- Vanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Michael Topf
- Vanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Jie Ying Wu
- Computer Science DepartmentVanderbilt UniversityNashvilleTennesseeUSA
| |
Collapse
|
225
|
Alkan Bayburt F, Meyanci Koksal G, Bulut A, Sengul I. Intraoperative Patient Warming Instead of Gas on the Management of Postoperative Pain in Laparoscopic Colectomy and Cholecystectomy: A Randomized Controlled Trial. Cureus 2024; 16:e57989. [PMID: 38601811 PMCID: PMC11006424 DOI: 10.7759/cureus.57989] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2024] [Indexed: 04/12/2024] Open
Abstract
INTRODUCTION Blurred lines remain in details of the association between patient warming with postoperative pain and a proper analgesic requirement. Therefore, the present study proposes to observe the effects of intraoperative patient warming and carbon dioxide insufflation duration in laparoscopic colectomy (LCol) and laparoscopic cholecystectomy (LChol) procedures on postoperative pain, analgesic requirements, and hemodynamics. METHODS The present study involved 80 cases aged 18-80 years with the American Society of Anesthesiologists I-III classification, possessing two initial groups primarily, one for LCol and one for LChol. Subsequently, each was divided into two through randomization for intraoperative warming. Postoperatively, pain perception, per se, was evaluated using the visual analog scale (VAS) score at the 30 minutes, 1st, 6th, 12th, and 24th hours, along with the impact of pain on hemodynamic parameters and side effects such as nausea/vomiting and the dosage of analgesics used. RESULTS Groups actively heated with warm air-blowing devices detected significantly higher intraoperative core and skin temperature measurements, and postoperative early pain perception was significantly lower in the warmed ones. Furthermore, a significant decrease in the VAS scores and the analgesic at the 12th and 24th hours compared to the first six hours was recognized between them. CONCLUSION Consequently, herewith, we postulate that so-called patient warming positively affects the VAS scores.
Collapse
Affiliation(s)
- Fatma Alkan Bayburt
- Anesthesiology and Reanimation, Giresun Education and Research Hospital, Giresun, TUR
| | - Guniz Meyanci Koksal
- Anesthesiology and Reanimation, Istanbul University Faculty of Medicine, Istanbul, TUR
| | - Azime Bulut
- Anesthesiology and Reanimation, Giresun University Faculty of Medicine, Giresun, TUR
| | - Ilker Sengul
- Endocrine and General Surgery, Giresun University Faculty of Medicine, Giresun, TUR
| |
Collapse
|
226
|
Tepedino MS, Voegels RL, Pezato R, Thamboo A, Kosug EM, Ferrão ACM, Neves RDF, Castilla VMB, Gregório LC. Olfaction and Quality of Life in Patients with Eosinophilic CRS Undergoing Endoscopic Sinus Surgery. Int Arch Otorhinolaryngol 2024; 28:e234-e239. [PMID: 38618594 PMCID: PMC11008929 DOI: 10.1055/s-0043-1772494] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/18/2023] [Indexed: 04/16/2024] Open
Abstract
Introduction Chronic rhinosinusitis (CRS) is a common inflammatory disease. This high prevalence leads to high direct and indirect public health costs, which include medical visits, laboratory tests and imaging, pharmacotherapy, hospitalizations, and surgical treatment. Furthermore, CRS has a substantial impact on patient quality of life, affecting productivity and being a common cause of absence from work CRS-associated olfactory dysfunction is highly prevalent, the actual effectiveness of surgical intervention remains inconsistent. Although there are studies evaluating the postoperative course of patients with eosinophilic Chronic rhinosinusitis (eCRS) treated with high-volume budesonide irrigation, there is little objective information regarding the impact of this intervention on olfactory status and quality of life. Objective To conduct a pre- and postoperative analysis of olfaction and quality of life in patients with eCRS treated with surgical intervention followed by high-volume budesonide nasal irrigation. Methods Prospective, descriptive, uncontrolled study of patients with eCRS. All patients underwent pre- and postoperative nasal endoscopy, SNOT-22 questionnaire, and the University of Pennsylvania Smell Identification Text (UPSIT), always by the same previously trained examiner. The SNOT-22 questionnaire and the UPSIT were readministered to all patients at 3 months, 6 months, and 1 year postoperatively, and scores compared with those obtained preoperatively. Results Twenty patients were included in the study, 13 males and 7 females, between the ages of 23 and 65; 8 patients had comorbid asthma. Quantitative evaluation using the UPSIT test showed a significant improvement in olfaction 3 months after surgery, which remained 6 months and 1 year after surgery (p = 0.0063). There was no significant association between eosinophil concentrations in polypoid tissue and postoperative SNOT-22 and UPSIT results. Patients with tissue eosinophils >50 had a lower preoperative UPSIT score. As early as 3 months postoperatively, a significant improvement in quality of life was already noticeable, as represented by a decrease in SNOT-22 values, which persisted through the 1-year postoperative follow-up evaluation (p = 0.0005). Quantitative evaluation using the UPSIT test showed a significant improvement in olfaction 3 months after surgery, which remained 6 months and 1 year after surgery (p = 0.0063). Conclusion Surgery effectively controlled eCRS in patients who adhered to high-volume budesonide nasal irrigation postoperatively. There were significant improvements in quality of life and olfaction, which persisted at least up to one year postoperatively.
Collapse
Affiliation(s)
- Miguel Soares Tepedino
- Department of Otolaryngology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- Department of Otolaryngology, Policlinica de Botafogo, Rio de Janeiro, RJ, Brazil
- Department of Otorhinolaryngology and Head and Neck Surgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Rogério Pezato
- Department of Otolaryngology and Head & Neck Surgery, ENT Research Laboratory, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Andrew Thamboo
- Division of Rhinology, University of British Columbia, Vancouver, Canada
| | - Eduardo Macoto Kosug
- Department of Otorhinolaryngology and Head and Neck Surgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | | | | | - Luis Carlos Gregório
- Department of Otorhinolaryngology and Head and Neck Surgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| |
Collapse
|
227
|
Hernandez Dominguez O, Lincango EP, Spivak R, Almonacid-Cardenas F, Prien C, Uchino T, Spivak A, Hull TL, Steele SR, Holubar SD. Colosplenic fistula diagnosis and management: a case series and review of literature. Int J Surg 2024; 110:2381-2388. [PMID: 38668664 PMCID: PMC11020030 DOI: 10.1097/js9.0000000000001128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 01/09/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND A colosplenic fistula (CsF) is an extremely rare complication. Its diagnosis and management remain poorly understood, owing to its infrequent incidence. Our objective was to systematically review the etiology, clinical features, diagnosis, management, and prognosis to help clinicians gain a better understanding of this unusual complication and provide aid if it is to be encountered. METHODS A systematic review of studies reporting CsF diagnosis in Ovid MEDLINE, Ovid EMBASE, Scopus, Web of Science, and Wiley Cochrane Library from 1946 to June 2022. Additionally, a retrospective review of four cases at our institution were included. Cases were evaluated for patient characteristics (age, sex, and comorbidities), CsF characteristics including causes, symptoms at presentation, diagnosis approach, management approach, pathology findings, intraoperative complications, postoperative complications, 30-day mortality, and prognosis were collected. RESULTS Thirty patients with CsFs were analyzed, including four cases at our institution and 26 single-case reports. Most of the patients were male (70%), with a median age of 56 years. The most common etiologies were colonic lymphoma (30%) and colorectal carcinoma (17%). Computed tomography (CT) was commonly used for diagnosis (90%). Approximately 87% of patients underwent a surgical intervention, most commonly segmental resection (81%) of the affected colon and splenectomy (77%). Nineteen patients were initially managed surgically, and 12 patients were initially managed nonoperatively. However, 11 of the nonoperative patients ultimately required surgery due to unresolved symptoms. The rate of postoperative complications was (17%). Symptoms resolved with surgical intervention in 25 (83%) patients. Only one patient (3%) had had postoperative mortality. CONCLUSIONS Our review of 30 cases worldwide is the largest in literature. CsFs are predominantly complications of neoplastic processes. CsF may be successfully and safely treated with splenectomy and resection of the affected colon, with a low rate of postoperative complications.
Collapse
Affiliation(s)
| | - Eddy P. Lincango
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute
| | - Rebecca Spivak
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute
| | | | - Christopher Prien
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute
| | - Tairin Uchino
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute
| | - Anna Spivak
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute
| | - Tracy L. Hull
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute
| | - Scott R. Steele
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute
| | - Stefan D. Holubar
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute
| |
Collapse
|
228
|
Liet S, Logeay M, Besnier E, Selim J, Wood G, Tuech JJ, Coget J, Compère V, Occhiali E, Popoff B, Clavier T. Effect of opioid-free anesthesia on post-operative period in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: a propensity score matched study. Acta Chir Belg 2024; 124:81-90. [PMID: 36970976 DOI: 10.1080/00015458.2023.2190289] [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: 06/24/2022] [Accepted: 03/04/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Postoperative pain after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is important. It appears essential to reduce postoperative pain and morphine consumption. METHODS Retrospective study in a university hospital comparing patient benefiting from CRS-HIPEC under opioid-free anesthesia (OFA; dexmedetomidine) to those anesthetized with opioid anesthesia (OA; remifentanil) using a propensity score matching method. The main objective was the impact of OFA on postoperative morphine consumption in the first 24 h after surgery. RESULTS 102 patients were included, matching on the propensity score allowed selecting 34 unique pairs analyzed. Morphine consumption was lower in the OFA group than in the OA group (3.0 [0.00-11.0] mg/24 h vs. 13.0 [2.5-25.0] mg/24 h; p = 0.02). In multivariable analysis, OFA was associated with a reduction of 7.2 [0.5-13.9] mg of postoperative morphine (p = 0.04). The rate of renal failure with a KDIGO-score > 1 was lower in the OFA group than in the OA group (12% vs. 38%; p = 0.01). There was no difference between groups concerning length of surgery/anesthesia, norepinephrine infusion, volume of fluid therapy, post-operative complications, rehospitalization or ICU readmission within 90 days, mortality, and postoperative rehabilitation. CONCLUSION Our results suggest that OFA for CRS-HIPEC patients appears safe and is associated with less postoperative morphine use and acute kidney injury.
Collapse
Affiliation(s)
- Sylvain Liet
- Department of Anesthesiology, Critical Care and Perioperative Medicine, Rouen University Hospital, Rouen, France
| | - Mathilde Logeay
- Department of Anesthesiology, Critical Care and Perioperative Medicine, Rouen University Hospital, Rouen, France
| | - Emmanuel Besnier
- Department of Anesthesiology, Critical Care and Perioperative Medicine, Rouen University Hospital, Rouen, France
- Normandie Univ, UNIROUEN, INSERM U1096, FHU REMOD-VHF, Rouen, France
| | - Jean Selim
- Department of Anesthesiology, Critical Care and Perioperative Medicine, Rouen University Hospital, Rouen, France
- Normandie Univ, UNIROUEN, INSERM U1096, FHU REMOD-VHF, Rouen, France
| | - Gregory Wood
- Department of Anesthesiology, Critical Care and Perioperative Medicine, Rouen University Hospital, Rouen, France
| | - Jean-Jacques Tuech
- Department of Digestive Surgery, Rouen University Hospital, Rouen, France
| | - Julien Coget
- Department of Digestive Surgery, Rouen University Hospital, Rouen, France
| | - Vincent Compère
- Department of Anesthesiology, Critical Care and Perioperative Medicine, Rouen University Hospital, Rouen, France
| | - Emilie Occhiali
- Department of Anesthesiology, Critical Care and Perioperative Medicine, Rouen University Hospital, Rouen, France
| | - Benjamin Popoff
- Department of Anesthesiology, Critical Care and Perioperative Medicine, Rouen University Hospital, Rouen, France
| | - Thomas Clavier
- Department of Anesthesiology, Critical Care and Perioperative Medicine, Rouen University Hospital, Rouen, France
- Normandie Univ, UNIROUEN, INSERM U1096, FHU REMOD-VHF, Rouen, France
| |
Collapse
|
229
|
Mu A, Ni Z, Ma C. Nasal Irrigation Improves the Nasal Related Quality of Life in Patients Undergoing Transsphenoidal Resection of Pituitary Adenoma. Biol Res Nurs 2024; 26:293-302. [PMID: 38079151 DOI: 10.1177/10998004231221548] [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] [Indexed: 03/16/2024]
Abstract
Background: After transsphenoidal pituitary adenoma resection patients have reduced olfactory function and quality of life. This study aimed to evaluate the effects of nasal irrigation on the nasal related quality of life in patients undergoing transsphenoidal pituitary adenoma resection. Methods: Patients undergoing transsphenoidal resection of pituitary adenomas in a tertiary hospital in China were included. The patients were randomly divided into a control group and nasal irrigation group according to the random sequence generated by the SPSS22.0 software. The 22-item sino-nasal outcome test (SNOT-22) was used to evaluate nasal related quality of life; lower SNOT-22 scores indicate a higher quality of life. The Toyota and Takagi (T&T) olfactometer test was used to evaluate the olfactory function of patients. Results: A total of 82 patients were finally included. The SNOT-22 scores of both groups after surgery were significantly higher than those before surgery (p < .05). The total SNOT-22 score of nasal irrigation group at one month (23.45 ± 3.72 vs. 27.48 ± 4.07) and three months (15.83 ± 2.86 vs. 21.82 ± 3.36) after surgery was lower than that in the control group (p < .05). There was no significant difference in olfactory function between the two groups at one month and three months after surgery (p > .05). The nasal mucosal score in the nasal irrigation group was significantly improved compared with the control group at one month and three months after surgery (p < .05). Conclusion: Nasal irrigation is associated with improved quality of life in patients undergoing transsphenoidal pituitary adenoma resection compared with the control group.
Collapse
Affiliation(s)
- Aiping Mu
- Department of Neurosurgery, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhuojun Ni
- Department of Neurosurgery, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chen Ma
- Department of Neurosurgery, First Affiliated Hospital of Soochow University, Suzhou, China
| |
Collapse
|
230
|
Liu Y, Nicotera DJ, Islam AA, Dunsky K, Lieu JEC. Prognostic Factors for Retropharyngeal Abscess in Children Receiving Surgery or Antibiotic Therapy. Laryngoscope 2024; 134:1955-1960. [PMID: 37740903 DOI: 10.1002/lary.31064] [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: 07/03/2023] [Revised: 08/14/2023] [Accepted: 09/11/2023] [Indexed: 09/25/2023]
Abstract
OBJECTIVE Effective management of retropharyngeal abscess (RPA) may predicate upon identification of key patient characteristics. We analyzed characteristics and outcomes of pediatric patients with RPA to identify prognostic factors associated with successful surgical intervention. METHODS A financial database was searched for pediatric otolaryngology patients with RPA from 2010 to 2021. Medical charts were reviewed for demographics, presenting history, physical examination, laboratory testing, imaging, surgical findings, and hospital course. Bivariate analyses were performed to identify potentially significant predictors of positive drainage. These variables were included in multivariate analysis of surgical outcomes. RESULTS Of 245 total patients, 159 patients (65%) received surgery and 86 patients (35%) received antibiotics only. Patients with restricted cervical motion, neck swelling, and computed tomography (CT) cross-sectional area (CSA) >2 cm2 were more likely to receive surgery. Rim enhancement on CT imaging was associated with positive surgical drainage (odds ratio [OR] 2.58, 95% confidence interval [CI] 1.16-5.74). However, no variables from clinical symptoms or physical exam were associated with positive drainage. Variables that approached significance were included in multivariate analysis, which revealed only rim enhancement predicted positive drainage (OR 2.57, 95% CI 1.13-5.83). The mean length of stay (LOS) was 2.6 versus 3.5 days (p < 0.001) for medical vs surgical treatment groups, respectively. CONCLUSION Our study revealed a high success rate of medical management. Although patient characteristics and clinical features were not significant predictors of surgical outcomes, CT findings such as rim enhancement were strongly associated with positive surgical drainage. LEVEL OF EVIDENCE 2 Laryngoscope, 134:1955-1960, 2024.
Collapse
Affiliation(s)
- Yupeng Liu
- Department of Pediatric Otolaryngology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, U.S.A
| | - Dante J Nicotera
- Department of Pediatric Otolaryngology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, U.S.A
| | - Aseeyah A Islam
- Department of Pediatric Otolaryngology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, U.S.A
| | - Kate Dunsky
- Department of Pediatric Otolaryngology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, U.S.A
| | - Judith E C Lieu
- Department of Pediatric Otolaryngology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, U.S.A
| |
Collapse
|
231
|
Farlow JL, Abouyared M, Rettig EM, Kejner A, Edwards HA, Patel R. Portrait of a Surgeon: Artificial Intelligence Reflections. OTO Open 2024; 8:e139. [PMID: 38633142 PMCID: PMC11022959 DOI: 10.1002/oto2.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/17/2024] [Accepted: 03/20/2024] [Indexed: 04/19/2024] Open
Abstract
Text-to-image artificial intelligence (AI) programs are popular public-facing tools that generate novel images based on user prompts. Given that they are trained from Internet data, they may reflect societal biases, as has been shown for text-to-text large language model programs. We sought to investigate whether 3 common text-to-image AI systems recapitulated stereotypes held about surgeons and other health care professionals. All platforms queried were able to reproduce common aspects of the profession including attire, equipment, and background settings, but there were differences between programs most notably regarding visible race and gender diversity. Thus, historical stereotypes of surgeons may be reinforced by the public's use of text-to-image AI systems, particularly those without procedures to regulate generated output. As AI systems become more ubiquitous, understanding the implications of their use in health care and for health care-adjacent purposes is critical to advocate for and preserve the core values and goals of our profession.
Collapse
Affiliation(s)
- Janice L. Farlow
- Department of Otolaryngology–Head and Neck SurgeryIndiana University School of MedicineIndianapolisIndianaUSA
| | - Marianne Abouyared
- Department of Otolaryngology–Head and Neck SurgeryUniversity of California DavisSacramentoCaliforniaUSA
| | - Eleni M. Rettig
- Department of Otolaryngology–Head and Neck SurgeryHarvard Medical SchoolBostonMassachusettsUSA
| | - Alexandra Kejner
- Department of Otolaryngology–Head and Neck SurgeryMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Heather A. Edwards
- Department of Otolaryngology–Head and Neck SurgeryBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
| | - Rusha Patel
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Oklahoma College of MedicineOklahoma CityOklahomaUSA
| |
Collapse
|
232
|
Ray Velez D. Program Factors Associated With Improved American Board of Surgery Examination Pass Rates. Am Surg 2024:31348241241655. [PMID: 38557331 DOI: 10.1177/00031348241241655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
INTRODUCTION The American Board of Surgery awards board certification after successful completion of both the Qualifying Exam and Certifying Exam. Although multiple studies have evaluated board performance at the resident level, fewer studies have evaluated board performance at the program level. METHODS Program pass rates, available through the American Board of Surgery, for 2019-2021 were compared to program information through the American Medical Association Fellowship and Residency Electronic Interactive Database Access (FREIDA). RESULTS A significant positive correlation of Certifying Exam performance to residency length, resident class size, and number of total physician faculty within the program was seen. Greater average hours of didactics per week had a significant positive correlation to improved Qualifying Exam performance but not Certifying Exam. Programs with higher percentages of residents graduating from a United States MD program, compared to international or DO schools, were associated with improved performances. It also appears that more established programs performed better than younger programs <20 years old. Programs in the West and Midwest performed significantly better on the Qualifying Exam than programs in the South and Northeast. CONCLUSION Board certification serves as the capstone for surgeons after completing general surgery residency. Multiple program factors demonstrate a significant correlation to board performance.
Collapse
|
233
|
Pinelli D, Guerci C, Cammarata F, Cirelli R, Scatigno A, Colledan M. Huge mesenchymal hamartoma in a young adult: a case report. J Surg Case Rep 2024; 2024:rjae184. [PMID: 38572276 PMCID: PMC10984728 DOI: 10.1093/jscr/rjae184] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 03/07/2024] [Indexed: 04/05/2024] Open
Abstract
Mesenchymal hamartoma of the liver (MHL) is rare. Less than 50 adult cases have been described. Due to their potential degeneration or recurrence, a complete surgical resection must be performed. We describe a case of a 26-year-old with a palpable solid lesion, which displaced abdominal organs. Percutaneous needle biopsies suggested the diagnosis of MHL. A right hemi-hepatectomy without segment 1 was performed; the post-operative course was uneventful. The mesenchymal component of the tumour was reactive to desmin and smooth muscle actin. Low proliferation index was confirmed (MIB1). Genetic counselling: the sequencing analysis of DICER1 and CDKN1C gene was negative, DNA methylation analysis on the chromosome 11p15 region was normal. After 42 months, there was no recurrence. In conclusion, clinicians should consider MHL in the differential diagnosis. The dimension and the need of radicality impose major liver resections or liver transplantations, which should be performed in referral centres.
Collapse
Affiliation(s)
- Domenico Pinelli
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII Hospital, Bergamo 24127, Italy
| | - Claudio Guerci
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII Hospital, Bergamo 24127, Italy
- University of Milan, Via Festa del Perdono 7, Milano 20122, Italy
| | - Francesco Cammarata
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII Hospital, Bergamo 24127, Italy
- University of Milan, Via Festa del Perdono 7, Milano 20122, Italy
| | - Riccardo Cirelli
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII Hospital, Bergamo 24127, Italy
| | - Agnese Scatigno
- Department of Pediatrics, ASST Papa Giovanni XXIII Hospital, Bergamo 24127, Italy
| | - Michele Colledan
- Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII Hospital, Bergamo 24127, Italy
- School of Medicine and Surgery, Unversity of Milano-Bicocca, Milan 20126, Italy
| |
Collapse
|
234
|
Atyah MM, Xu L, Yang Z. Novel definition of textbook outcome in biliary system cancers and its influence on patients' survival and quality of life. Cancer Med 2024; 13:e7186. [PMID: 38597789 PMCID: PMC11005687 DOI: 10.1002/cam4.7186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/15/2024] [Accepted: 03/29/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND The definition of textbook outcome in biliary system cancers is a developing concept in need of expansion and investigation of its association with survival and quality of life. METHODS In this original research, we developed a novel "all or none" textbook outcome definition which addresses the rapid recovery of post-surgical indexes, in addition to short-term mortality, hospital re-admission, prolonged stay, surgical margin and postoperative complications. Based on the fulfillment of relevant criteria, patients were divided into textbook outcome and non-textbook outcome groups and their characteristics and survival data were analyzed. A customized "quality of life" questionnaire was developed to address short-term recovery and post-discharge life quality of patients. Association with quality of life improvement was then investigated. RESULTS A total of 129 patients were included. Textbook outcome was achieved in 25.58% of patients (37.04% of gallbladder cancer patients and 17.8% of cholangiocarcinoma patients). Compared to non-textbook outcome group, patients with textbook outcome had lower rate of pre-operative biliary drainage (p = 0.026), higher rate of normal preoperative liver function (p < 0.001) and tumor markers (p = 0.001), reduced perioperative bleeding (p = 0.006) and blood transfusion (p = 0.005), and higher rate of N0 stage cases (p = 0.008). Textbook outcome was also associated with enhanced survival, significantly in older patients (<65 years) (1-year survival rate: 100% vs. 78.57% (p = 0.108), 2-year survival rate: 87.5% vs. 44% (p = 0.046)). Finally, textbook outcome was significantly associated with enhanced basic daily performance (p < 0.001), social life performance (p = 0.033), and personal evaluation (p < 0.001), and thus improved quality of life (p < 0.001). CONCLUSIONS The novel definition of textbook outcome was able to address the specific nature of recovery after resection of biliary system cancers. Expanding the scope of textbook outcome and addressing the influence on survival and quality of life provides a comprehensive concept able to reflect physical, psychological and functioning enhancements in patients recovery.
Collapse
Affiliation(s)
- Manar Mikhail Atyah
- Department of Hepatobiliary and Pancreatic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Li Xu
- Department of Hepatobiliary and Pancreatic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Zhiying Yang
- Department of Hepatobiliary and Pancreatic Surgery, China-Japan Friendship Hospital, Beijing, China
| |
Collapse
|
235
|
Al Saffar H, Thomson A, Tan JS, Wang Q, Birch E, Koschel S, Medhurst E, Jobson D, Ong S, Moon DA, Murphy D, Lawrentschuk N. Patient-centred pathology reporting improves patient experience and understanding of disease in prostate cancer care. BJUI Compass 2024; 5:497-505. [PMID: 38633832 PMCID: PMC11019249 DOI: 10.1002/bco2.322] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/16/2023] [Accepted: 12/23/2023] [Indexed: 04/19/2024] Open
Abstract
Introduction and Objectives Patient-centred (PC) and holistic care improves patient satisfaction and health outcomes. We sought to investigate the benefit of utilising a PC pathology report in patients undergoing radical prostatectomy (RP) for prostate cancer (PCa). Our study aimed to evaluate and compare patient understanding of their PCa diagnosis after RP, upon receiving either a standard histopathology report or a personalised and PC report (PCR). Moreover, we evaluated knowledge retention at 4 weeks after the initial consultation. Methods We invited patients undergoing RP at three metropolitan Urology clinics to participate in our randomised controlled study. Patients were randomised to receive either a PCR or standard pathology report. Patient satisfaction questionnaires (Perceived Efficacy in Patient-Physician Interactions [PEPPI], Consultation and Relational Empathy [CARE] and Communication Assessment Tool [CAT]) and a knowledge test were conducted within 72 h of the initial appointment and again at 4 weeks. Accurate recollection of Gleason grade group (GGG) and extracapsular extension (ECE) were classified as 'correct'. Baseline demographic data included age, education, marital and employment status, pre-op prostate specific antigen (PSA) and clinical stage. Baseline data were tested for differences between groups using the Student's t test, chi-squared test or Fisher's exact test depending on whether data were continuous, categorical or sparse. Comparison of correctly answered 'knowledge' questions was analysed using chi-squared test. A significance level of p ≤ 0.05 was used. Results Data from 62 patients were analysed (30 standard vs. 32 PCR). No significant differences in baseline demographics were found between groups. Both groups reported high levels of satisfaction with their healthcare experiences in all domains of patient-physician rapport, empathy and communication. There were no significant differences between groups in PEPPI (p = 0.68), CAT (p = 0.39) and CARE (p = 0.66) scores, at baseline and 4 weeks. Ninety-three per cent of patients who received the PCR understood the report while 90% felt the report added to their understanding of their PCa. Regarding patient knowledge, the PCR group had significantly more correct answers on GGG and ECE as compared with the standard report group at baseline and 4 weeks (p < 0.001 and 0.001, respectively). Conclusions Our findings demonstrate that PC pathology reports improve patient knowledge and understanding of their PCa that is retained for at least 4 weeks after initial receipt of results.
Collapse
Affiliation(s)
- Haidar Al Saffar
- Department of Genitourinary Cancer SurgeryPeter MacCallum Cancer CentreMelbourneVictoriaAustralia
| | - Alice Thomson
- Department of Genitourinary Cancer SurgeryPeter MacCallum Cancer CentreMelbourneVictoriaAustralia
| | - Jo‐Lynn S. Tan
- Department of Genitourinary Cancer SurgeryPeter MacCallum Cancer CentreMelbourneVictoriaAustralia
- St Vincent's Hospital, MelbourneFitzroyVictoriaAustralia
| | - Qiwei Wang
- St Vincent's Hospital, MelbourneFitzroyVictoriaAustralia
- Melbourne Medical School, St Vincent's Hospital, MelbourneUniversity of MelbourneFitzroyVictoriaAustralia
| | - Emma Birch
- Department of Genitourinary Cancer SurgeryPeter MacCallum Cancer CentreMelbourneVictoriaAustralia
| | - Samantha Koschel
- Department of Genitourinary Cancer SurgeryPeter MacCallum Cancer CentreMelbourneVictoriaAustralia
| | - Elizabeth Medhurst
- Department of Genitourinary Cancer SurgeryPeter MacCallum Cancer CentreMelbourneVictoriaAustralia
| | - Dale Jobson
- St Vincent's Hospital, MelbourneFitzroyVictoriaAustralia
- School of Public Health and Preventative MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Sean Ong
- Department of Genitourinary Cancer SurgeryPeter MacCallum Cancer CentreMelbourneVictoriaAustralia
- EJ Whitten Prostate Cancer Research CentreEpworth HospitalRichmondVictoriaAustralia
| | - Daniel A. Moon
- Department of Genitourinary Cancer SurgeryPeter MacCallum Cancer CentreMelbourneVictoriaAustralia
- Department of Surgery (Urology)Epworth Hospital RichmondRichmondVictoriaAustralia
| | - Declan Murphy
- Department of Genitourinary Cancer SurgeryPeter MacCallum Cancer CentreMelbourneVictoriaAustralia
- Department of Surgery (Urology)Epworth Hospital RichmondRichmondVictoriaAustralia
| | - Nathan Lawrentschuk
- Department of Genitourinary Cancer SurgeryPeter MacCallum Cancer CentreMelbourneVictoriaAustralia
- EJ Whitten Prostate Cancer Research CentreEpworth HospitalRichmondVictoriaAustralia
- Department of Surgery (Urology)Epworth Hospital RichmondRichmondVictoriaAustralia
- Department of Surgery (Urology)Royal Melbourne HospitalMelbourneVictoriaAustralia
| |
Collapse
|
236
|
Magarinos J, Egelko A, Criner GJ, Abbas A, Enofe N, Thomas J, Carney K, Friedberg J, Bakhos C. Lung volume reduction surgery is safe and leads to functional improvement in patients who fail or cannot undergo bronchoscopic lung volume reduction. JTCVS Open 2024; 18:369-375. [PMID: 38690414 PMCID: PMC11056479 DOI: 10.1016/j.xjon.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 05/02/2024]
Abstract
Background Bronchoscopic lung volume reduction (BLVR) has supplanted surgery in the treatment of patients with advanced emphysema, but not all patients qualify for it. Our study aimed to investigate the outcomes of lung volume reduction surgery (LVRS) among patients who either failed BLVR or were not candidates for it. Methods We conducted a retrospective analysis of patients who underwent LVRS for upper lobe-predominant emphysema at a single tertiary center between March 2018 and December 2022. The main outcomes measures were preoperative and postoperative respiratory parameters, perioperative morbidity, and mortality. Results A total of 67 LVRS recipients were evaluated, including 10 who had failed prior valve placement. The median patient age was 69 years, and 35 (52%) were male. All procedures were performed thoracoscopically, with 36 patients (53.7%) undergoing bilateral LVRS. The median hospital length of stay was 7 days (interquartile range, 6-11 days). Prolonged air leak (>7 days) occurred in 20 patients. There was one 90-day mortality from a nosocomial pneumonia (non-COVID-related) and no further deaths at 12 months. There were mean improvements of 10.07% in forced expiratory volume in 1 second and 4.74% in diffusing capacity of the lung for carbon monoxide, along with a mean decrease 49.2% in residual volume (P < .001 for all). The modified Medical Research Council dyspnea scale was improved by 1.84 points (P < .001). Conclusions LVRS can be performed safely in patients who are not candidates for BLVR and those who fail BLVR and leads to significant functional improvement. Long-term follow-up is necessary to ensure the sustainability of LVRS benefits in this patient population.
Collapse
Affiliation(s)
- Jessica Magarinos
- Department of General Surgery, Temple University Hospital, Philadelphia, Pa
| | - Aron Egelko
- Department of General Surgery, Temple University Hospital, Philadelphia, Pa
| | - Gerard J. Criner
- Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, Pa
| | - Abbas Abbas
- Lifespan Health System, Department of Thoracic Oncology, Brown University, Providence, RI
| | - Nosayaba Enofe
- Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, Pa
| | - JiJi Thomas
- Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, Pa
| | - Kevin Carney
- Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, Pa
| | - Joseph Friedberg
- Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, Pa
| | - Charles Bakhos
- Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, Pa
| |
Collapse
|
237
|
Gouin F, Michot A, Jafari M, Honoré C, Mattei JC, Rochwerger A, Ropars M, Tzanis D, Anract P, Carrere S, Gangloff D, Ducoulombier A, Lebbe C, Guiramand J, Waast D, Marchal F, Sirveaux F, Causeret S, Gimbergues P, Fiorenza F, Paquette B, Soibinet P, Guilloit JM, Le Nail LR, Dujardin F, Brinkert D, Chemin-Airiau C, Morelle M, Meeus P, Karanian M, Le Loarer F, Vaz G, Blay JY. Improved Metastatic-Free Survival after Systematic Re-Excision Following Complete Macroscopic Unplanned Excision of Limb or Trunk Soft Tissue Sarcoma. Cancers (Basel) 2024; 16:1365. [PMID: 38611043 PMCID: PMC11010862 DOI: 10.3390/cancers16071365] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 03/22/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Whether re-excision (RE) of a soft tissue sarcoma (STS) of limb or trunk should be systematized as adjuvant care and if it would improve metastatic free survival (MFS) are still debated. The impact of resection margins after unplanned macroscopically complete excision (UE) performed out of a NETSARC reference center or after second resection was further investigated. METHODS This large nationwide series used data from patients having experienced UE outside of a reference center from 2010 to 2019, collected in a French nationwide exhaustive prospective cohort NETSARC. Patient characteristics and survival distributions in patients reexcised (RE) or not (No-RE) are reported. Multivariate Cox proportional hazard model was conducted to adjust for classical prognosis factors. Subgroup analysis were performed to identify which patients may benefit from RE. RESULTS Out of 2371 patients with UE for STS performed outside NETSARC reference centers, 1692 patients were not reviewed by multidisciplinary board before treatment decision and had a second operation documented. Among them, 913 patients experienced re-excision, and 779 were not re-excised. Characteristics were significantly different regarding patient age, tumor site, size, depth, grade and histotype in patients re-excised (RE) or not (No-RE). In univariate analysis, final R0 margins are associated with a better MFS, patients with R1 margins documented at first surgery had a better MFS as compared to patients with first R0 resection. The study identified RE as an independent favorable factor for MFS (HR 0.7, 95% CI 0.53-0.93; p = 0.013). All subgroups except older patients (>70 years) and patients with large tumors (>10 cm) had superior MFS with RE. CONCLUSIONS RE might be considered in patients with STS of limb or trunk, with UE with macroscopic complete resection performed out of a reference center, and also in originally defined R0 margin resections, to improve LRFS and MFS. Systematic RE should not be advocated for patients older than 70 years, or with tumors greater than 10 cm.
Collapse
Affiliation(s)
- Francois Gouin
- Surgery Department, Centre Léon Bérard, 69008 Lyon, France (G.V.)
| | - Audrey Michot
- Surgery Department, Institut Bergonié, 33076 Bordeaux, France
| | - Mehrdad Jafari
- General and Digestive Oncologic Surgery, Centre Oscar Lambret, 59000 Lille, France
| | - Charles Honoré
- Surgery Department, Gustave Roussy Cancer Campus, 94805 Villejuif, France
| | - Jean Camille Mattei
- Orthopedic and Traumatologic Surgery Department, Hôpital Nord, Hopital de la Conception, APHM, 13005 Marseille, France
| | - Alexandre Rochwerger
- Orthopedic and Traumatologic Surgery Department, Hôpital Nord, Hopital de la Conception, APHM, 13005 Marseille, France
| | - Mickael Ropars
- Orthopedic Surgery Department, CHU de Rennes, 35033 Rennes, France;
| | - Dimitri Tzanis
- Surgery Department, Institut Curie, PSL University, 75248 Paris, France;
| | - Philippe Anract
- Orthopedic Surgery Department, Hôpital Cochin, AP-HP, Université de Paris, Faculté de Santé, Unités de Formation et de Recherche de Médecine, 75015 Paris, France
| | - Sébastien Carrere
- Surgery Department, Institut de Recherche en Cancérologie, 34298 Montpellier, France
| | | | - Agnès Ducoulombier
- Senology Surgery Department, Onco-Gynécologique et Reconstructrice, Centre Antoine Lacassagne, 06100 Nice, France
| | - Céleste Lebbe
- Reconstructive et Esthetic Plastic Surgery, Hôpital Saint Louis, 75010 Paris, France
| | - Jérôme Guiramand
- Surgery Department, Institut Paoli Calmette, 13009 Marseille, France
| | - Denis Waast
- Orthopedic and Traumatologic Surgery Clinic, CHU Nantes, 44093 Nantes, France
| | - Frédéric Marchal
- Surgery Department, Institut de Cancérologie de Lorraine, Université de Lorraine, CNRS, CRAN, UMR 7039, 54000 Nancy, France
| | | | - Sylvain Causeret
- Surgery Department, Centre George-François Leclerc, 21079 Dijon, France;
| | - Pierre Gimbergues
- Surgery Department, Centre Jean Perrin, 63011 Clermont Ferrand, France
| | - Fabrice Fiorenza
- Orthopedic and Traumatology Surgery Department, CHU Limoges, 87000 Limoges, France
| | - Brice Paquette
- Department of Digestive Surgery, Jean Minjoz University Hospital, 25000 Besançon, France;
| | - Pauline Soibinet
- Medical Oncology Department, Institut Godinot, 51100 Reims, France
| | - Jean-Marc Guilloit
- Visceral et Digestive Surgery Department, Centre François Baclesse, 14076 Caen, France
| | - Louis R. Le Nail
- Onco-Orthopedic Surgery Department, Hôpital Trousseau, CHRU de Tours, 37000 Tours, France
| | - Franck Dujardin
- Medical Oncology and Surgical Oncology Department, Centre Henri Becquerel, 76038 Rouen, France
| | - David Brinkert
- Orthopedic Surgery Department, CHU de Strasbourg, 67200 Strasbourg, France;
| | - Claire Chemin-Airiau
- Clinical Research and Innovation Department, Centre Léon Bérard, 69008 Lyon, France
| | - Magali Morelle
- Clinical Research and Innovation Department, Centre Léon Bérard, 69008 Lyon, France
| | - Pierre Meeus
- Surgery Department, Centre Léon Bérard, 69008 Lyon, France (G.V.)
| | - Marie Karanian
- Department of Biopathology, Centre Léon Bérard, 69008 Lyon, France
| | - François Le Loarer
- Anatomo-Pathology Surgery Department, Institut Bergonié, 33076 Bordeaux, France
| | - Gualter Vaz
- Surgery Department, Centre Léon Bérard, 69008 Lyon, France (G.V.)
| | - Jean-Yves Blay
- Department of Medical Oncology, University Claude Bernard Lyon I, 69008 Lyon, France
- Department of Medicine, Léon Bérard Center, Unicancer, 69008 Lyon, France
| |
Collapse
|
238
|
Luțenco V, Rebegea L, Beznea A, Tocu G, Moraru M, Mihailov OM, Ciuntu BM, Luțenco V, Stanculea FC, Mihailov R. Innovative Surgical Approaches That Improve Individual Outcomes in Advanced Breast Cancer. Int J Womens Health 2024; 16:555-560. [PMID: 38577150 PMCID: PMC10992669 DOI: 10.2147/ijwh.s447837] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/25/2024] [Indexed: 04/06/2024] Open
Abstract
Breast cancer is the most common cause of cancer death in women and the second cause in the general population. The incidence has increased over time. Women in developing countries often present at an advanced stage where initial surgery is not feasible. Short disease-free intervals, the number of metastatic organs and liver metastasis were consistently associated with poor overall survival. Surgery is an integral part of the therapeutic plan for locally advanced breast cancer. The integration of surgical care into the management of patients with advanced cancer has changed substantially with the use of neoadjuvant chemotherapy. Also, more recently, neoadjuvant endocrine therapy and targeted therapies offer new opportunities to downsize the tumor burden and transform the role of surgery for this population from palliation to largely curative intent. Innovative surgical approach to the primary tumor in metastatic disease may provide survival benefits and local control in some patients. Similar to systemic therapy, surgical therapy for secondary dissemination should be considered in certain cases for improved individual outcomes. Advances in reconstructive techniques have improved the quality of life of these patients.
Collapse
Affiliation(s)
- Valerii Luțenco
- Surgery I Clinic, Emergency Hospital “Sf. Ap. Andrei”, Galați, Romania
| | - Laura Rebegea
- Oncology and Radiotherapy Clinic, Emergency Hospital “Sf. Ap. Andrei”, Galați, Romania
- “Dunărea de Jos” University of Galati, Faculty of Medicine and Pharmacy, Galați, Romania
| | - Adrian Beznea
- Surgery I Clinic, Emergency Hospital “Sf. Ap. Andrei”, Galați, Romania
- “Dunărea de Jos” University of Galati, Faculty of Medicine and Pharmacy, Galați, Romania
| | - George Tocu
- “Dunărea de Jos” University of Galati, Faculty of Medicine and Pharmacy, Galați, Romania
| | - Monica Moraru
- “Dunărea de Jos” University of Galati, Faculty of Medicine and Pharmacy, Galați, Romania
| | - Oana Mariana Mihailov
- “Dunărea de Jos” University of Galati, Faculty of Medicine and Pharmacy, Galați, Romania
| | | | - Verginia Luțenco
- Clinical Children Emergency Hospital “Sf. Ioan”, Galați, Romania
| | | | - Raul Mihailov
- Surgery I Clinic, Emergency Hospital “Sf. Ap. Andrei”, Galați, Romania
- “Dunărea de Jos” University of Galati, Faculty of Medicine and Pharmacy, Galați, Romania
| |
Collapse
|
239
|
Olson S, Welton L, Jahansouz C. Perioperative Considerations for the Surgical Treatment of Crohn's Disease with Discussion on Surgical Antibiotics Practices and Impact on the Gut Microbiome. Antibiotics (Basel) 2024; 13:317. [PMID: 38666993 PMCID: PMC11047551 DOI: 10.3390/antibiotics13040317] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/22/2024] [Accepted: 03/28/2024] [Indexed: 04/29/2024] Open
Abstract
Crohn's disease, a chronic inflammatory process of the gastrointestinal tract defined by flares and periods of remission, is increasing in incidence. Despite advances in multimodal medical therapy, disease progression often necessitates multiple operations with high morbidity. The inability to treat Crohn's disease successfully is likely in part because the etiopathogenesis is not completely understood; however, recent research suggests the gut microbiome plays a critical role. How traditional perioperative management, including bowel preparation and preoperative antibiotics, further changes the microbiome and affects outcomes is not well described, especially in Crohn's patients, who are unique given their immunosuppression and baseline dysbiosis. This paper aims to outline current knowledge regarding perioperative management of Crohn's disease, the evolving role of gut dysbiosis, and how the microbiome can guide perioperative considerations with special attention to perioperative antibiotics as well as treatment of Mycobacterium avium subspecies paratuberculosis. In conclusion, dysbiosis is common in Crohn's patients and may be exacerbated by malnutrition, steroids, narcotic use, diarrhea, and perioperative antibiotics. Dysbiosis is also a major risk factor for anastomotic leak, and special consideration should be given to limiting factors that further perturb the gut microbiota in the perioperative period.
Collapse
Affiliation(s)
- Shelbi Olson
- Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA; (S.O.); (L.W.)
| | - Lindsay Welton
- Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA; (S.O.); (L.W.)
| | - Cyrus Jahansouz
- Division of Colon and Rectal Surgery, University of Minnesota, Minneapolis, MN 55455, USA
| |
Collapse
|
240
|
Leterrier J, Iung B, de Tymoski C, Deconinck L, Para M, Duval X, Provenchere S, Mesnier J, Delhomme C, Haviari S, Urena M, Suc G. Sex differences and outcomes in surgical infective endocarditis. Eur J Cardiothorac Surg 2024; 65:ezae114. [PMID: 38521543 DOI: 10.1093/ejcts/ezae114] [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: 12/26/2023] [Revised: 03/06/2024] [Accepted: 03/21/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Cardiac surgery for infective endocarditis (IE) is associated with significant hospital mortality, and female sex may be associated with worse outcomes. However, the impact of sex on the presenting characteristics, management, and outcomes of patients operated on for acute infective endocarditis (IE) has not been adequately studied. OBJECTIVES The goal of our study was to analyse differences in management and outcome of IE between women and men who undergo surgery. METHODS Clinical data of 717 patients undergoing cardiac surgery for IE between December 2005 and December 2019 were prospectively collected. Sex-related postoperative outcomes including in-hospital mortality were recorded. Univariable and multivariable analyses were performed to identify potential sex-related determinant of in-hospital mortality. RESULTS In all, 532 male patients (74.2%) and 185 female patients (25.8%) underwent surgery for IE. At baseline, women had more frequent mitral regurgitation with 63 patients (34.1%) than men with 135 patients (25.4%) (P = 0.002). Female sex was associated with higher in-hospital mortality (23.2% versus 17.3%, P = 0.049). However, multivariable analysis revealed age (P < 0.01), antibiotics < 7 days before surgery (P = 0.01) and staphylococcal IE (P < 0.01) but not female sex (P = 0.99) as independent determinants of hospital mortality. CONCLUSIONS In this study of patients operated-on for IE, female sex was associated with more severe manifestations of IE and significantly higher in-hospital mortality. However, after multivariable analysis, initial presentation, but not sex, seemed to determine clinical outcomes.
Collapse
Affiliation(s)
| | - Bernard Iung
- Cardiology Bichat, AP-HP, Paris, France
- UMRS1148, INSERM, 75018, Paris, France
- Université Paris Cité, Paris, France
| | - Christian de Tymoski
- Université Paris Cité, Paris, France
- Cardiac Surgery, Bichat Hospital, AP-HP, Paris, France
- Inserm CIC 1425, Bichat-Claude Bernard University Hospital, AP-HP, Paris, France
| | - Laurene Deconinck
- Université Paris Cité, Paris, France
- Infectious Diseases Department, Bichat Hospital, APHP, Paris, France
| | - Marylou Para
- UMRS1148, INSERM, 75018, Paris, France
- Université Paris Cité, Paris, France
- Cardiac Surgery, Bichat Hospital, AP-HP, Paris, France
| | - Xavier Duval
- Université Paris Cité, Paris, France
- Inserm CIC 1425, Bichat-Claude Bernard University Hospital, AP-HP, Paris, France
- Inserm, UMR-1137, IAME, Paris, France
| | - Sophie Provenchere
- Inserm CIC 1425, Bichat-Claude Bernard University Hospital, AP-HP, Paris, France
- Anesthesia and Critical Care Department, DMU Parabol, Bichat Claude Bernard University Hospital, APHP, Paris, France
| | - Jules Mesnier
- Cardiology Bichat, AP-HP, Paris, France
- UMRS1148, INSERM, 75018, Paris, France
- Université Paris Cité, Paris, France
| | | | - Skerdi Haviari
- Université Paris Cité, Paris, France
- Epidemiology Biostatistics & Clinical Research Department, Bichat, APHP, Paris, France
- UPC-Inserm UMR1137 IAME, Paris, France
| | - Marina Urena
- Cardiology Bichat, AP-HP, Paris, France
- UMRS1148, INSERM, 75018, Paris, France
- Université Paris Cité, Paris, France
| | - Gaspard Suc
- Cardiology Bichat, AP-HP, Paris, France
- UMRS1148, INSERM, 75018, Paris, France
- Université Paris Cité, Paris, France
| |
Collapse
|
241
|
Nye AK, Thieman Mankin KM. Small animal patient preoperative preparation: a review of common antiseptics, comparison studies, and resistance. Front Vet Sci 2024; 11:1374826. [PMID: 38605919 PMCID: PMC11007076 DOI: 10.3389/fvets.2024.1374826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/19/2024] [Indexed: 04/13/2024] Open
Abstract
This review aims to describe commonly used antiseptics in veterinary medicine including their mechanism of action, spectrum of activity, potential adverse effects, and application techniques. Additionally, it provides a review of the veterinary literature comparing antiseptics, a discussion of effectiveness and efficacy studies, and the potential for increased resistance to biocides and antimicrobials. This review concludes that appropriate selection and use is necessary to prevent the occurrence of surgical site infections, adverse effects, and potential for increasing resistance to antimicrobials. Continued research is needed to fill gaps in the current knowledge such as optimal preparation procedures for various surgical sites, standardization of efficacy and effectiveness testing, and the clinical impact of decreased susceptibility to chlorhexidine and other antiseptics.
Collapse
Affiliation(s)
| | - Kelley M. Thieman Mankin
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, United States
| |
Collapse
|
242
|
Mančinskienė D, Mikėnaitė M, Barakat M, Kačerauskienė J, Railaitė DR, Maleckienė L, Bartusevičius A, Bartusevičienė E. Quality of Life after Treatment for Pelvic Organ Prolapse in Real-World Study: Recommendations, Vaginal Pessary, and Surgery. Medicina (Kaunas) 2024; 60:547. [PMID: 38674193 PMCID: PMC11052354 DOI: 10.3390/medicina60040547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/17/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: Pelvic organ prolapse (POP) is a common condition in women, with its prevalence increasing with age, and can significantly impact the quality of life (QOL) of many individuals. The objective of this study was to assess the overall improvement, quality of life, and continuation of primary treatment for POP over a 24-month period in a real-world setting. Materials and Methods: This is a prospective, observational, follow-up study of women with symptomatic POP who, as a primary treatment, opted for recommendations (lifestyle changes and pelvic floor muscle training), pessary therapy, or surgery. The primary outcome measure was a subjective improvement at the 24-month follow-up, measured with the Patient Global Impression of Improvement (PGI-I) scale. Secondary outcome measures were the continuation rate of the primary treatment method, reason for discontinuation, and the quality of life evaluated with the P-QoL questionnaire. Results: We included 137 women, with 45 women (32.8%) in the recommendations group, 39 (28.5%) in the pessary group, and 53 women (38.7%) in the surgery group. After 24 months, surgery, in comparison with pessary treatment and recommendations, resulted in significantly more women reporting a subjective improvement: 89.6%, 66.7%, and 22.9% (p < 0.001), respectively. Overall, 52% of women from the recommendations group and 36.4% from the pessary group switched to another treatment or discontinued the primary treatment within 24 months. However, women who continued the primary treatment, pessary use, and surgery showed similar subjective improvements (90.5% and 89.6%, respectively) and quality-of-life improvement. Conclusions: The chance of significant improvement was higher following surgery. However, after 24 months, both vaginal pessaries and surgery showed an important quality-of life improvement and can be proposed as primary treatment methods for pelvic organ prolapse.
Collapse
Affiliation(s)
- Dominyka Mančinskienė
- Department of Obstetrics and Gynaecology, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania; (J.K.); (D.R.R.); (L.M.); (A.B.); (E.B.)
| | - Miglė Mikėnaitė
- Faculty of Medicine, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania; (M.M.); (M.B.)
| | - Mark Barakat
- Faculty of Medicine, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania; (M.M.); (M.B.)
| | - Justina Kačerauskienė
- Department of Obstetrics and Gynaecology, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania; (J.K.); (D.R.R.); (L.M.); (A.B.); (E.B.)
| | - Dalia Regina Railaitė
- Department of Obstetrics and Gynaecology, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania; (J.K.); (D.R.R.); (L.M.); (A.B.); (E.B.)
| | - Laima Maleckienė
- Department of Obstetrics and Gynaecology, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania; (J.K.); (D.R.R.); (L.M.); (A.B.); (E.B.)
| | - Arnoldas Bartusevičius
- Department of Obstetrics and Gynaecology, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania; (J.K.); (D.R.R.); (L.M.); (A.B.); (E.B.)
| | - Eglė Bartusevičienė
- Department of Obstetrics and Gynaecology, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania; (J.K.); (D.R.R.); (L.M.); (A.B.); (E.B.)
| |
Collapse
|
243
|
Tian Y, Lin J, Yang X, Zeng D, Hu Y, Chen J, Wu Z, Deng X. A rare morphology of the cardiac fibroma in a child: a case report. Front Cardiovasc Med 2024; 11:1357747. [PMID: 38606376 PMCID: PMC11008678 DOI: 10.3389/fcvm.2024.1357747] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/08/2024] [Indexed: 04/13/2024] Open
Abstract
Here we report a rare morphology of a cardiac fibroma in a child. A 2-year and 8-month-old toddler came for "chronic constipation" and was found to have a heart murmur on cardiac auscultation. Further transthoracic echocardiography suggested "a strong echogenic mass in the left ventricular wall, with some part of "a string of beads" in shape extending into left ventricle outflow tract", which was atypical for either a tumor, thrombus or vegetation. The child underwent resection of the mass and mitral valvuloplasty. Pathological examination confirmed the mass as a cardiac fibroma.
Collapse
Affiliation(s)
- Yunfei Tian
- Heart Center, The Affiliated Children’s Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Jiayi Lin
- Heart Center, The Affiliated Children’s Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Xiaohui Yang
- Heart Center, The Affiliated Children’s Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Debin Zeng
- Heart Center, The Affiliated Children’s Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Yuan Hu
- Department of Echocardiography and Ultrasound, The Affiliated Children's Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Jingnan Chen
- Heart Center, The Affiliated Children’s Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Zhongshi Wu
- Heart Center, The Affiliated Children’s Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Xicheng Deng
- Heart Center, The Affiliated Children’s Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| |
Collapse
|
244
|
Kazbekov A, Bekarisov O, Tazhin K. Surgical Treatment of Chest Deformity in a Patient with Poland Syndrome. Clinical Case Report. Int Med Case Rep J 2024; 17:247-252. [PMID: 38562434 PMCID: PMC10982578 DOI: 10.2147/imcrj.s441944] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/07/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Poland syndrome is a rare congenital syndrome that is characterized by partial or complete unilateral absence of the pectoralis major muscle, congenital malformation of the hand and deformation of the chest. Often the patients has abnormalities of the nipple-areolar complex. Here, we present a case of surgical treatment of local chest deformity with patient with Poland syndrome. Case Presentation We observed a patient, an 18-year-old man. The parents noticed the deformation of the chest from birth. The patient did not receive any treatment until adulthood. The patient contacted our clinical research center to correct chest deformity. After clinical and diagnostic procedures, the patient underwent surgical operation: open thoracoplasty with installation of a wire-frame construction. The early postoperative period was uneventful. Early postoperative outcome was assessed 6 months after surgery. Conclusion Our experience shows that thoracoplasty using a wire-frame construction is a good method for correcting local chest deformities in patients with Poland syndrome.
Collapse
Affiliation(s)
- Ablaikhan Kazbekov
- National Scientific Center for Traumatology and Orthopedics Named After Academician N.D. Batpenov, Ministry of Health of the Republic of Kazakhstan, Astana, Kazakhstan
- Astana Medical University, Astana, Kazakhstan
| | - Olzhas Bekarisov
- National Scientific Center for Traumatology and Orthopedics Named After Academician N.D. Batpenov, Ministry of Health of the Republic of Kazakhstan, Astana, Kazakhstan
| | - Kairat Tazhin
- National Scientific Center for Traumatology and Orthopedics Named After Academician N.D. Batpenov, Ministry of Health of the Republic of Kazakhstan, Astana, Kazakhstan
| |
Collapse
|
245
|
Alfredson H, Roberts D, Spang C, Waldén M. Ultrasound- and Doppler-Guided WALANT Arthroscopic Surgery for Patellar Tendinopathy with Partial Rupture in Elite Athletes-A 2-Year Follow-Up of a Prospective Case Series. Medicina (Kaunas) 2024; 60:541. [PMID: 38674187 PMCID: PMC11051799 DOI: 10.3390/medicina60040541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 03/06/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: Patellar tendinopathy is difficult to treat, and when combined with partial rupture, there are additional challenges. The aim of this study was to evaluate the subjective outcome and return-to-sport status after ultrasound (US)- and colour doppler (CD)-guided wide awake local anaesthetic no tourniquet (WALANT) arthroscopic shaving in elite athletes. Material and Methods: Thirty Swedish and international elite athletes (27 males) with a long duration (>1 year) of persistent painful patellar tendinopathy in 35 patellar tendons, not responding to non-surgical treatment, were included. All patients were treated with the same protocol of arthroscopic shaving, including bone removal and debridement of partial rupture, followed by at least 3 months of structured rehabilitation. The VISA-P score and a study-specific questionnaire evaluating physical activity level and subjective satisfaction with the treatment were used for evaluation. Results: At the 2-year follow-up (mean 23, range 8-38 months), 25/30 patients (29/35 tendons) were satisfied with the treatment result and had returned to their pre-injury sport. The mean VISA-P score increased from 37 (range 7-69) before surgery to 80 (range 44-100) after surgery (p < 0.05). There was one drop-out (one tendon). There were no complications. Conclusions: US- and CD-guided WALANT arthroscopic shaving for persistent painful patellar tendinopathy, including bone removal and debridement of partial rupture, followed by structured rehabilitation showed good clinical results in the majority of the elite-level athletes.
Collapse
Affiliation(s)
- Håkan Alfredson
- Sports Medicine Unit, Department of Community Medicine and Rehabilitation, Umeå University, 90187 Umeå, Sweden
- Alfredson Tendon Clinic, Capio Ortho Center Skåne, 21532 Malmö, Sweden
| | - David Roberts
- Capio Ortho Center Skåne, 21532 Malmö, Sweden; (D.R.); (M.W.)
| | - Christoph Spang
- Anatomy Section, Department of Integrative Medical Biology, Umeå University, 90187 Umeå, Sweden;
- Institute for Sports Science, Würzburg University, 97082 Würzburg, Germany
- Private Orthopaedic Spine Center, 97080 Würzburg, Germany
| | - Markus Waldén
- Capio Ortho Center Skåne, 21532 Malmö, Sweden; (D.R.); (M.W.)
- Department of Health, Medicine and Caring Sciences, Linköping University, 58183 Linköping, Sweden
| |
Collapse
|
246
|
Mukherjee A, Shammas N, Xu L, Cannavale KL, Gilfillan AD, Szamreta EA, Monberg M, Hodeib M, Chao CR. Impact of the Coronavirus Disease 2019 pandemic on neoadjuvant chemotherapy use in patients diagnosed with epithelial type ovarian cancer. Front Oncol 2024; 14:1290719. [PMID: 38601762 PMCID: PMC11005450 DOI: 10.3389/fonc.2024.1290719] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 03/13/2024] [Indexed: 04/12/2024] Open
Abstract
Introduction The Coronavirus Disease 2019 (COVID-19) pandemic posed critical challenges in providing care to ovarian cancer (OC) patients, including delays in OC diagnosis and treatment initiation. To accommodate for delays in OC surgery, the Society of Gynecologic Oncology (SGO) recommended preferential use of neoadjuvant chemotherapy during the pandemic. The purpose of this study was to assess the association of the COVID-19 pandemic with neoadjuvant chemotherapy use in patients diagnosed with OC. Methods This retrospective cohort study included patients diagnosed with stage II-IV ovarian cancer of epithelial subtype between 01/01/2017-06/30/2021 at Kaiser Permanente Southern California (KPSC), a large integrated healthcare system in the United States. Ovarian cancer patients diagnosed between 2017-2020 were identified from KPSC's Surveillance, Epidemiology, and End Results (SEER)-affiliated cancer registry. Patients diagnosed in 2021 were identified from the electronic medical records (EMR) using ICD-10 diagnosis codes, followed by medical chart review to validate diagnosis and extract information on histology and stage at diagnosis. March 4, 2020 was used as the cut-off to define pre-pandemic and pandemic periods. Patients diagnosed with COVID-19 between OC diagnosis and treatment completion were excluded. Data on neoadjuvant chemotherapy use were extracted from the cancer registry and EMR, supplemented by chart review. Modified Poisson regression was used to evaluate the association of the pandemic with neoadjuvant chemotherapy use. Results Of 566 OC patients, 160 (28.3%) were diagnosed in the pandemic period. Patients diagnosed in the pandemic period were slightly younger (mean age 62.7 vs 64.9 years, p=0.07) and had a higher burden of Charlson comorbidities (p=0.05) than patients diagnosed in pre-pandemic period. No differences in time to treatment initiation were observed by pandemic periods. Neoadjuvant chemotherapy use was documented in 58.7% patients during the pandemic period compared to 47.3% in pre-pandemic period (p=0.01). After adjusting for covariates, patients diagnosed in the pandemic period were 29% more likely to receive neoadjuvant chemotherapy than patients diagnosed in pre-pandemic period [RR(95%CI): 1.29(1.12-1.49)]. Discussions Ovarian cancer patients diagnosed in the COVID-19 pandemic were more likely to receive neoadjuvant chemotherapy than patients diagnosed before the pandemic. Future research on patient outcomes and trends in the post-pandemic period are warranted.
Collapse
Affiliation(s)
- Amrita Mukherjee
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Natalie Shammas
- Obstetrics and Gynecology, Adventist Health White Memorial Medical Center, Los Angeles, CA, United States
| | - Lanfang Xu
- Data Reporting and Analytics, MedHealth Statistical Consulting Inc., Solon, OH, United States
| | - Kimberly L. Cannavale
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Alec D. Gilfillan
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Elizabeth A. Szamreta
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Rahway, NJ, United States
| | - Matthew Monberg
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Rahway, NJ, United States
| | - Melissa Hodeib
- Gynecology Oncology, Kaiser Permanente Southern California, Riverside, CA, United States
| | - Chun R. Chao
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| |
Collapse
|
247
|
Wahlstedt ER, Wahlstedt JC, Rosenberg JS, deVries CR. Lifecycle of surgical devices: Global, environmental, and regulatory considerations. World J Surg 2024. [PMID: 38530108 DOI: 10.1002/wjs.12140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/05/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Technological advancements, improved surgical access, and heightened demand for surgery have fueled unprecedented device and supply turnover impelling wealthy hospitals to upgrade continually and sell, donate, recycle, or dispose of used, expired, antiquated, or surplus goods. This paper reviews the issues related to device and supply lifecycles and discusses the opportunities and challenges they present for sustainable surgical growth in low- and middle-income (LMICs) countries. OBSERVATIONS This review found, in LMICs countries, regulatory disparities persist that limit effective harmonization secondary to highly variable national policies and a lack of prioritized enforcement. Heterogeneity in the regulatory landscape, specifically in the classification, nomenclature, and identification of medical devices, encumbers effective regulation and distribution. Once devices are sold, donated, or reused in LMICs countries, complexities arise in regulatory compliance, maintenance, and appropriate use of these technologies. At the end of the lifecycle, waste management poses significant obstacles with limited resources hindering the implementation of best practices. CONCLUSION There are major disparities in access to quality surgical equipment and supplies around the world. Improved communication between relevant stakeholders and harmonization of manufacture and disposal regulations will be needed to ensure adequate and appropriate responses to these challenges. TRIAL REGISTRATION NUMBER Not applicable.
Collapse
Affiliation(s)
- Eric R Wahlstedt
- University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | | | - Jenna S Rosenberg
- Center for Global Surgery, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, Utah, USA
| | - Catherine R deVries
- Center for Global Surgery, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, Utah, USA
| |
Collapse
|
248
|
Netz A, Hof L, Rumpf F, Blum LV, Neef V, Kerner A, Zacharowski K, Meybohm P, Choorapoikayil S. Adjusting Current Hemoglobin Thresholds: A Way to Improve Outcome in Women Undergoing Major Surgery. J Womens Health (Larchmt) 2024. [PMID: 38530069 DOI: 10.1089/jwh.2023.0665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
Background/Objective: In the perioperative setting, a suboptimal total hemoglobin (Hb) mass puts women and men at an unreasonable disadvantage. Anemia is an independent risk factor for transfusion, postoperative complications, and mortality. The Hb cut-off value for women was set at <12.0 g/dL by the World Health Organization (WHO) and has been rigorously debated for decades. The aim of this study was to elucidate the risk for postoperative complications in female patients with Hb levels < 12.0, 12.0-12.9, and ≥13.0 g/dL. Material and Methods: Single-center retrospective analysis of female patients undergoing major surgery. Results: In total, 6,516 patients ≥18 years of age had major surgery between 2018 and 2019 and 2,446 female patients were included in analysis. Mean age was 67.4 ± 16.6, 66.4 ± 15.6, and 64.5 ± 15.5 years in female patients with preoperative Hb levels <12.0, 12.0-12.9 and ≥13.0 g/dL, respectively. The transfusion rate of red blood cells (RBCs) was significantly higher in female patients with Hb <12.0 g/dL (53%) and with Hb 12.0-12.9 g/dL (31%) compared to female patients ≥13.0 g/dL (22%). Rates of pneumonia, acute kidney injury, and sepsis were significantly higher in patients with Hb <12.0 and 12.0-12.9 g/dL compared to patients with Hb ≥13.0 g/dL. Total length of hospital stay was significantly longer in female patients with Hb <12.0 g/dL than patients with Hb 12.0-12.9 g/dL and Hb ≥13.0 g/dL (10 days vs. 8 days). Conclusion: Taken together, our data show that Hb values below 12.9 g/dL are associated with increased probability of RBC transfusions and increased risk of postoperative complications. In addition, our results indicate that postoperative outcomes for women might be optimized by increasing cut-off values for anemia. The call to revise the anemia threshold for women by the WHO can no longer be disregarded.
Collapse
Affiliation(s)
- Alina Netz
- Goethe University Frankfurt, University Hospital Frankfurt, Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Frankfurt, Germany
| | - Lotta Hof
- Goethe University Frankfurt, University Hospital Frankfurt, Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Frankfurt, Germany
| | - Florian Rumpf
- University Hospital Würzburg, Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Würzburg, Germany
| | - Lea Valeska Blum
- Goethe University Frankfurt, University Hospital Frankfurt, Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Frankfurt, Germany
| | - Vanessa Neef
- Goethe University Frankfurt, University Hospital Frankfurt, Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Frankfurt, Germany
| | - Anja Kerner
- Goethe University Frankfurt, University Hospital, Institute of Medical Informatics (IMI), Frankfurt am Main, Germany
- University Hospital, Department of Information and Communication Technology (DICT), Data Integration Center (DIC), Frankfurt am Main, Germany
| | - Kai Zacharowski
- Goethe University Frankfurt, University Hospital Frankfurt, Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Frankfurt, Germany
| | - Patrick Meybohm
- University Hospital Würzburg, Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Würzburg, Germany
| | - Suma Choorapoikayil
- Goethe University Frankfurt, University Hospital Frankfurt, Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Frankfurt, Germany
| |
Collapse
|
249
|
Zhang C, Zhang XW, Liu SM, Huang KH, Chen ZM. Surgical treatment of multiple magnet ingestion by children: A single-center experience from China. Qatar Med J 2024; 2024:4. [PMID: 38654816 PMCID: PMC11037096 DOI: 10.5339/qmj.2024.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/27/2023] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND The incidence of magnet ingestion in children has escalated concurrent with the rise in popularity of magnetic playthings, bearing the capacity to induce substantial morbidity. AIM The objective of this study was to encapsulate our accumulated expertise in handling pediatric cases featuring multiple magnetic foreign bodies within the gastrointestinal tract sometimes necessitating surgical intervention, as well as to formulate a clinical management algorithm. METHODS This was a retrospective review of patients with multiple magnetic foreign bodies in the digestive tract, admitted to Shenzhen Children's Hospital, between January 2018 and December 2022. RESULTS A total of 100 cases were included in this study, including 66 males and 34 females. The main clinical manifestation ns were abdominal pain and vomiting. All patients had abdominal x-ray, all of which indicated foreign bodies in the digestive tract. 33 patients had to undergo a surgical intervention. Among these cases, the gastrointestinal complications occurred in 31 patients, including gastric rupture (n = 9), intestinal obstruction (n = 11) and intestinal perforation (n = 30). Postoperative intestinal obstruction occurred in 6 children. There was no statistical significant difference in age and gender between the Surgical group and Non-surgical group, but the Surgical group had a higher number of magnets ([7.5(2-44) vs 4(2-20)], p = 0.009), a longer interval between time of misingestion to clinical visit ([48(7.2-480) vs 5(2-336)]hours, p < 0.001), and a longer length of hospital stay ([10(6-19) vs 2(1-8)]days, p < 0.001). CONCLUSIONS Multiple magnet ingestion in children can lead to serious complications and carry severe risks. Timely diagnosis and effective treatment are crucial for managing such patients.
Collapse
Affiliation(s)
- Chen Zhang
- Department of General Surgery, Shenzhen Children's Hospital, China Medical University, Shenzhen 518038, China
| | - Xiao-Wen Zhang
- Department of General Surgery, Shenzhen Children's Hospital, China Medical University, Shenzhen 518038, China
| | - Shao-Mei Liu
- Department of General Surgery, Shenzhen Children's Hospital, China Medical University, Shenzhen 518038, China
| | - Ke-Hua Huang
- Department of General Surgery, Shenzhen Children's Hospital, China Medical University, Shenzhen 518038, China
| | - Zi-Min Chen
- Department of General Surgery, Shenzhen Children's Hospital, China Medical University, Shenzhen 518038, China
| |
Collapse
|
250
|
Rabin EE, Kirkendoll S, Tatebe LC. On the Operating Table: A Student's Experience in Surgery. Am Surg 2024:31348241241740. [PMID: 38529585 DOI: 10.1177/00031348241241740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
The role of medical students in patient care is complex. Students suggest plans but are not responsible for enacting them. We are anticipated to make mistakes but expected to perform tasks with excellence. Regardless of the field, physicians are tasked with the responsibility and burden of making decisions. Students are at the interface between the patient and the surgical team; their interactions with the patient can be life-changing and potentially lifesaving. Choosing to not operate on patients, deemed inoperable, can be morally challenging. As students, we may not have the power to make decisions but can be present and learn from our patients.
Collapse
Affiliation(s)
- Erik E Rabin
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Leah C Tatebe
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|