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Sadek J, Moloo H, Belanger P, Nadeau K, Aitken D, Foss K, Zwiep T, McIsaac D, Williams L, Raiche I, Musselman R, Mullen KA. Implementation of a systematic tobacco treatment protocol in a surgical outpatient setting: a feasibility study. Can J Surg 2021; 64:E51-E58. [PMID: 33533579 PMCID: PMC7955818 DOI: 10.1503/cjs.009919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Smoking cessation programs started as late as 4 weeks before surgery reduce perioperative morbidity and death, yet outpatient clinic interventions are rarely provided. Our aim was to evaluate the feasibility of implementing a tobacco treatment protocol designed for an outpatient surgical setting. Methods We completed a pre–post feasibility study of the implementation of a systematic, evidence-based tobacco treatment protocol in an outpatient colorectal surgery clinic. Outcomes included smoking prevalence, pre- and postimplementation smoker identification and intervention rates, recruitment, retention, smoking cessation and provider satisfaction. Results Preimplementation, 15.5% of 116 surveyed patients were smokers. Fewer than 10% of surveyed patients reported being asked about smoking, and none were offered any cessation intervention. Over a 16-month postimplementation period, 1198 patients were seen on 2103 visits. Of these, 950 (79.3%) patients were asked smoking status on first visit and 1030 (86.0%) were asked on at least 1 visit. Of 169 identified smokers, 99 (58.6%) were referred to follow-up support using an opt-out approach. At 1-, 3- and 6-month follow- up, intention-to-quit rates among 78 enrolled patients were 24.4%, 22.9% and 19.2%, respectively. Postimplementation staff surveys reported that the protocol was easy to use, that staff would use it again and that it had positive patient responses. Conclusion Implementation of our smoking cessation protocol in an outpatient surgical clinic was found to be feasible and used minimal clinic resources. This protocol could lead to increases in identification and documentation of smoking status, delivery of smoking cessation interventions and rates of smoking reduction and cessation.
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Affiliation(s)
- Joseph Sadek
- From the Department of General Surgery, University of Ottawa Faculty of Medicine, Ottawa, Ont. (Sadek, Moloo, Zwiep, Williams, Raiche, Musselman); the Ottawa Hospital Research Institute, Ottawa, Ont. (Moloo); the Department of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ont. (Belanger, Aitken, Mullen); the University of Ottawa Medical School, Ottawa, Ont. (Nadeau); the Ottawa Hospital, Ottawa, Ont. (Foss); and the Department of Anesthesia, University of Ottawa Faculty of Medicine, Ottawa, Ont. (McIsaac)
| | - Husein Moloo
- From the Department of General Surgery, University of Ottawa Faculty of Medicine, Ottawa, Ont. (Sadek, Moloo, Zwiep, Williams, Raiche, Musselman); the Ottawa Hospital Research Institute, Ottawa, Ont. (Moloo); the Department of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ont. (Belanger, Aitken, Mullen); the University of Ottawa Medical School, Ottawa, Ont. (Nadeau); the Ottawa Hospital, Ottawa, Ont. (Foss); and the Department of Anesthesia, University of Ottawa Faculty of Medicine, Ottawa, Ont. (McIsaac)
| | - Priscilla Belanger
- From the Department of General Surgery, University of Ottawa Faculty of Medicine, Ottawa, Ont. (Sadek, Moloo, Zwiep, Williams, Raiche, Musselman); the Ottawa Hospital Research Institute, Ottawa, Ont. (Moloo); the Department of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ont. (Belanger, Aitken, Mullen); the University of Ottawa Medical School, Ottawa, Ont. (Nadeau); the Ottawa Hospital, Ottawa, Ont. (Foss); and the Department of Anesthesia, University of Ottawa Faculty of Medicine, Ottawa, Ont. (McIsaac)
| | - Kara Nadeau
- From the Department of General Surgery, University of Ottawa Faculty of Medicine, Ottawa, Ont. (Sadek, Moloo, Zwiep, Williams, Raiche, Musselman); the Ottawa Hospital Research Institute, Ottawa, Ont. (Moloo); the Department of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ont. (Belanger, Aitken, Mullen); the University of Ottawa Medical School, Ottawa, Ont. (Nadeau); the Ottawa Hospital, Ottawa, Ont. (Foss); and the Department of Anesthesia, University of Ottawa Faculty of Medicine, Ottawa, Ont. (McIsaac)
| | - Debbie Aitken
- From the Department of General Surgery, University of Ottawa Faculty of Medicine, Ottawa, Ont. (Sadek, Moloo, Zwiep, Williams, Raiche, Musselman); the Ottawa Hospital Research Institute, Ottawa, Ont. (Moloo); the Department of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ont. (Belanger, Aitken, Mullen); the University of Ottawa Medical School, Ottawa, Ont. (Nadeau); the Ottawa Hospital, Ottawa, Ont. (Foss); and the Department of Anesthesia, University of Ottawa Faculty of Medicine, Ottawa, Ont. (McIsaac)
| | - Kris Foss
- From the Department of General Surgery, University of Ottawa Faculty of Medicine, Ottawa, Ont. (Sadek, Moloo, Zwiep, Williams, Raiche, Musselman); the Ottawa Hospital Research Institute, Ottawa, Ont. (Moloo); the Department of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ont. (Belanger, Aitken, Mullen); the University of Ottawa Medical School, Ottawa, Ont. (Nadeau); the Ottawa Hospital, Ottawa, Ont. (Foss); and the Department of Anesthesia, University of Ottawa Faculty of Medicine, Ottawa, Ont. (McIsaac)
| | - Terry Zwiep
- From the Department of General Surgery, University of Ottawa Faculty of Medicine, Ottawa, Ont. (Sadek, Moloo, Zwiep, Williams, Raiche, Musselman); the Ottawa Hospital Research Institute, Ottawa, Ont. (Moloo); the Department of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ont. (Belanger, Aitken, Mullen); the University of Ottawa Medical School, Ottawa, Ont. (Nadeau); the Ottawa Hospital, Ottawa, Ont. (Foss); and the Department of Anesthesia, University of Ottawa Faculty of Medicine, Ottawa, Ont. (McIsaac)
| | - Dan McIsaac
- From the Department of General Surgery, University of Ottawa Faculty of Medicine, Ottawa, Ont. (Sadek, Moloo, Zwiep, Williams, Raiche, Musselman); the Ottawa Hospital Research Institute, Ottawa, Ont. (Moloo); the Department of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ont. (Belanger, Aitken, Mullen); the University of Ottawa Medical School, Ottawa, Ont. (Nadeau); the Ottawa Hospital, Ottawa, Ont. (Foss); and the Department of Anesthesia, University of Ottawa Faculty of Medicine, Ottawa, Ont. (McIsaac)
| | - Lara Williams
- From the Department of General Surgery, University of Ottawa Faculty of Medicine, Ottawa, Ont. (Sadek, Moloo, Zwiep, Williams, Raiche, Musselman); the Ottawa Hospital Research Institute, Ottawa, Ont. (Moloo); the Department of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ont. (Belanger, Aitken, Mullen); the University of Ottawa Medical School, Ottawa, Ont. (Nadeau); the Ottawa Hospital, Ottawa, Ont. (Foss); and the Department of Anesthesia, University of Ottawa Faculty of Medicine, Ottawa, Ont. (McIsaac)
| | - Isabel Raiche
- From the Department of General Surgery, University of Ottawa Faculty of Medicine, Ottawa, Ont. (Sadek, Moloo, Zwiep, Williams, Raiche, Musselman); the Ottawa Hospital Research Institute, Ottawa, Ont. (Moloo); the Department of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ont. (Belanger, Aitken, Mullen); the University of Ottawa Medical School, Ottawa, Ont. (Nadeau); the Ottawa Hospital, Ottawa, Ont. (Foss); and the Department of Anesthesia, University of Ottawa Faculty of Medicine, Ottawa, Ont. (McIsaac)
| | - Reily Musselman
- From the Department of General Surgery, University of Ottawa Faculty of Medicine, Ottawa, Ont. (Sadek, Moloo, Zwiep, Williams, Raiche, Musselman); the Ottawa Hospital Research Institute, Ottawa, Ont. (Moloo); the Department of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ont. (Belanger, Aitken, Mullen); the University of Ottawa Medical School, Ottawa, Ont. (Nadeau); the Ottawa Hospital, Ottawa, Ont. (Foss); and the Department of Anesthesia, University of Ottawa Faculty of Medicine, Ottawa, Ont. (McIsaac)
| | - Kerri-Anne Mullen
- From the Department of General Surgery, University of Ottawa Faculty of Medicine, Ottawa, Ont. (Sadek, Moloo, Zwiep, Williams, Raiche, Musselman); the Ottawa Hospital Research Institute, Ottawa, Ont. (Moloo); the Department of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ont. (Belanger, Aitken, Mullen); the University of Ottawa Medical School, Ottawa, Ont. (Nadeau); the Ottawa Hospital, Ottawa, Ont. (Foss); and the Department of Anesthesia, University of Ottawa Faculty of Medicine, Ottawa, Ont. (McIsaac)
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Pippi R, Luigetti L, Scorsolini MG, Pietrantoni A, Cafolla A. Is telephone follow-up useful in preventing post-extraction bleeding in patients on antithrombotic treatment? J Clin Exp Dent 2021; 13:e140-e147. [PMID: 33574998 PMCID: PMC7864370 DOI: 10.4317/jced.57401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/10/2020] [Indexed: 11/27/2022] Open
Abstract
Background The aim of the study was to investigate the usefulness of telephone follow-up in preventing post-extraction bleeding and improving wound healing in patients on chronic antithrombotic treatment.
Material and Methods A prospective randomized clinical trial was carried out on 256 patients (test group = 128; control group = 128). The exact two-tailed Fisher test and the two-tailed non-parametric Mann-Whitney test were used for statistical analysis.
Results The incidence of post-extraction bleeding was 15.6% and there was no difference between test and control groups. However, the study group was significantly, though weakly, associated with the severity of bleeding. Patient satisfaction with post-operative follow-up differed significantly between patients who had and those who did not have post-extraction bleeding.
Conclusions Telephone follow-up after tooth extraction may play a role in the prevention of severe post-operative bleeding as well as in monitoring and managing the surgical wound. Key words:Post-operative instructions, patient satisfaction, wound healing.
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Affiliation(s)
- Roberto Pippi
- Associate Professor of Oral Surgery. Department of Odontostomatological and Maxillo Facial Sciences, Sapienza University of Rome
| | - Luca Luigetti
- Oral surgeon. Department of Odontostomatological and Maxillo Facial Sciences, Sapienza University of Rome
| | - Maria-Giulia Scorsolini
- Post-graduate student in Oral Surgery. Department of Odontostomatological and Maxillo Facial Sciences, Sapienza University of Rome
| | - Alessandra Pietrantoni
- Oral surgeon. Department of Odontostomatological and Maxillo Facial Sciences, Sapienza University of Rome
| | - Arturo Cafolla
- Aggregate Professor of Hematology. Sapienza University of Rome
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Senker W, Stefanits H, Gmeiner M, Trutschnig W, Radl C, Gruber A. The influence of smoking in minimally invasive spinal fusion surgery. Open Med (Wars) 2021; 16:198-206. [PMID: 33585696 PMCID: PMC7863003 DOI: 10.1515/med-2021-0223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 11/10/2020] [Accepted: 12/05/2020] [Indexed: 11/15/2022] Open
Abstract
Background The impact of smoking on spinal surgery has been studied extensively, but few investigations have focused on minimally invasive surgery (MIS) of the spine and the difference between complication rates in smokers and non-smokers. We evaluated whether a history of at least one pack-year preoperatively could be used to predict adverse peri- and postoperative outcomes in patients undergoing minimally invasive fusion procedures of the lumbar spine. In a prospective study, we assessed the clinical effectiveness of MIS in an unselected population of 187 patients. Methods We evaluated perioperative and postoperative complication rates in MIS fusion techniques of the lumbar spine in smoking and non-smoking patients. MIS fusion was performed using interbody fusion procedures and/or posterolateral fusion alone. Results Smokers were significantly younger than non-smokers. We did not encounter infection at the site of surgery or severe wound healing disorder in smokers. We registered no difference between the smoking and non-smoking groups with regard to peri- or postoperative complication rate, blood loss, or length of stay in hospital. We found a significant influence of smoking (p = 0.049) on the overall perioperative complication rate. Conclusion MIS fusion techniques seem to be a suitable tool for treating degenerative spinal disorders in smokers.
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Affiliation(s)
- Wolfgang Senker
- Department of Neurosurgery, Kepler University Hospital, Neuromed Campus, Linz, Austria
| | - Harald Stefanits
- Department of Neurosurgery, Kepler University Hospital, Neuromed Campus, Linz, Austria
| | - Matthias Gmeiner
- Department of Neurosurgery, Kepler University Hospital, Neuromed Campus, Linz, Austria
| | | | - Christian Radl
- Department of Neurosurgery, Kepler University Hospital, Neuromed Campus, Linz, Austria
| | - Andreas Gruber
- Department of Neurosurgery, Kepler University Hospital, Neuromed Campus, Linz, Austria
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Thapa B, Sutanto E, Bhandari R. Thickness of subcutaneous fat is a risk factor for incisional surgical site infection in acute appendicitis surgery: a prospective study. BMC Surg 2021; 21:6. [PMID: 33397364 PMCID: PMC7784256 DOI: 10.1186/s12893-020-01029-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 12/21/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Incisional surgical site infection (SSI) is a significant source of postoperative morbidity resulting in increased length of stay and cost. In this study, our aim was to evaluate the association between thickness of subcutaneous fat (TSF) and incisional SSI among patients undergoing open appendectomy in low-resource settings. METHODS 90 patients with acute uncomplicated appendicitis who underwent emergency open appendectomy from December 2017 to August 2018 were included in this prospective study. TSF was measured preoperatively using ultrasound. TSF and other possible predictors of incisional SSI, including body mass index and other clinical characteristics, were assessed by univariate and multivariable logistic regression analysis. Receiver operating characteristic (ROC) curve analysis evaluated the predictive value of TSF and the optimum cut-off value for TSF was determined using the Youden index. RESULTS The prevalence of incisional SSI was 13.3% (12/90). TSF was independently associated with incisional SSI (P < 0.001). Additionally, history of smoking (P = 0.048) was also associated with incisional SSI. A model of incisional SSI using a cut-off of 23.0 mm for TSF was moderately accurate (area under curve 0.83, confidence interval 0.70-0.97; sensitivity 83.3%; specificity 76.9%). CONCLUSIONS The study demonstrated that TSF, as evaluated by ultrasound, is a predictor in the development of incisional SSI in patients with acute appendicitis undergoing open appendectomy. These findings suggest that ultrasound is useful both for the evaluation of TSF and the prediction of incisional SSI risk factor in low-resource settings.
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Affiliation(s)
- Bikas Thapa
- Department of General and Gastrointestinal Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Tribhuvan University, Maharajgung, Kathmandu, Nepal
| | - Edward Sutanto
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Raju Bhandari
- Department of General and Gastrointestinal Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Tribhuvan University, Maharajgung, Kathmandu, Nepal.
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155
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Famiglietti A, Memoli JW, Khaitan PG. Are electronic cigarettes and vaping effective tools for smoking cessation? Limited evidence on surgical outcomes: a narrative review. J Thorac Dis 2021; 13:384-395. [PMID: 33569219 PMCID: PMC7867832 DOI: 10.21037/jtd-20-2529] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The rising popularity of e-cigarettes and vaping, particularly in youth populations, has prompted the scientific community to ocassionally recommend their use as alternative to smoking or as a modality for smoking cessation. Media also tends to portray them as stylish, smoking cessation tools. We first studied the current literature to better understand whether they are viable options for surgeons to use prior to surgery as part of their armamentarium and their efficacy in attaining smoking abstinence. Next, we performed a comprehensive review of the literature to study the impact of e-cigarette and vaping on lung pathophysiology, surgical outcomes, and postoperative complications. After a thorough search, we found limited evidence suggesting that e-cigarettes and vaping are effective smoking cessation tools, and indeed may increase the propensity of dual smoking, contrary to e-cigarette advertisements. Many potential biases and limitations exist due to self-reporting when investigating e-cigarettes and vaping. While there is controversial data in the literature about e-cigarettes and vaping not leading to lung cancer, there are chemicals in these products that compromise lung hemostasis, negatively affect the immune system, and have detrimental inflammatory effects on wound healing. Studies are warranted to elucidate objective data regarding short and long-term effects of these products on surgical outcomes, and given the current data, they should not be utilized as viable smoking cessation tools.
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Affiliation(s)
- Amber Famiglietti
- Department of Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, D.C., USA
| | - Jessica Wang Memoli
- Division of Interventional Pulmonology, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, D.C., USA
| | - Puja Gaur Khaitan
- Department of Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, D.C., USA
- Division of Thoracic and Esophageal Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, D.C., USA
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156
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Wu F, Laza-Cagigas R, Pagarkar A, Olaoke A, El Gammal M, Rampal T. The Feasibility of Prehabilitation as Part of the Breast Cancer Treatment Pathway. PM R 2020; 13:1237-1246. [PMID: 33369236 PMCID: PMC8596630 DOI: 10.1002/pmrj.12543] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 11/19/2020] [Accepted: 12/04/2020] [Indexed: 12/15/2022]
Abstract
Background There is compelling support for implementing prehabilitation to optimize perioperative risk factors and to improve postoperative outcomes. However, there is limited evidence studying the application of multimodal prehabilitation for patients with breast cancer. Objective To determine the feasibility of multimodal prehabilitation as part of the breast cancer treatment pathway. Design This was a prospective, cohort observational study. Breast cancer patients undergoing surgery were recruited. They were assigned to an intervention or control group according to patient preference. Setting UK prehabilitation center. Participants A total of 75 patients were referred during the study period. Forty eight patients (64%) did not participate; 20 of those opted to be in the control group. Twenty four patients engaged with prehabilitation and returned completed questionnaires. In total, 44 patients were included in the analysis. Interventions The program consisted of supervised exercise, nutritional advice, smoking cessation, and psychosocial support. Outcome Measures Feasibility was determined by the center's ability to deliver the program. This was measured by the number of patients who wanted to access the service, compared with those able to. Service uptake, patient satisfaction, and project costs were recorded. Patient‐reported outcomes (PROs) and the use of healthcare resources were also evaluated. Results A total of 61 patients (81%) wanted to participate; 24 (32%) were able to partake and return questionnaires. Reasons for nonparticipation included surgery within weeks, full‐time commitments, and transportation difficulties. A total of 25 (93%) prehabilitation patients recorded high satisfaction with the program. There was a significant reduction in anxiety among prehabilitation patients. There were no significant improvements in the other PROs. There were no changes to hospital length of stay, readmissions, and complications. Conclusions Multimodal prehabilitation is a feasible intervention. Logistical challenges need to be addressed to improve engagement. These results are limited and would require a larger sample to confirm the findings. Work on a thorough cost‐benefit analysis is also required.
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Affiliation(s)
- Fiona Wu
- Surgery Department, Medway Maritime Hospital, Gillingham, UK
| | | | - Aalia Pagarkar
- Surgery Department, Medway Maritime Hospital, Gillingham, UK
| | - Adeola Olaoke
- Surgery Department, Medway Maritime Hospital, Gillingham, UK
| | | | - Tarannum Rampal
- Prehabilitation Unit, Medway Maritime Hospital, Gillingham, UK
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Snow GE, Shaver TB, Teplitzky TB, Guardiani E. Predictors of Tracheostomy Decannulation in Adult Laryngotracheal Stenosis. Otolaryngol Head Neck Surg 2020; 164:1265-1271. [PMID: 33290164 DOI: 10.1177/0194599820978276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Predictors of tracheostomy decannulation in patients with laryngotracheal stenosis are not fully known, making prognosis difficult. The aim was to identify predictors of tracheostomy decannulation in adult patients with acquired stenosis of the larynx and/or trachea who were tracheostomy dependent. STUDY DESIGN Case series. SETTING Academic teaching hospital. METHODS A total of 103 consecutive adult patients with laryngotracheal stenosis who were tracheostomy dependent and seen by the otolaryngology clinic from January 1, 2013, to August 2, 2018, were included. Exclusion criteria included age <18 years, history of laryngeal cancer or head and neck radiation, or history of laryngeal fracture. The primary outcome was the presence of tracheostomy at last follow-up. The patients' etiology of stenosis, comorbid conditions, and characteristics of the stenosis were analyzed to determine if there was a statistically significant relationship with decannulation. RESULTS A total of 103 patients were included: 67% of patients were women and the average age was 53.5 years. Sixty-four patients (62%) were successfully decannulated. In multivariate analysis, patients who were successfully decannulated presented to the otolaryngology clinic earlier after tracheostomy was performed, were more likely to have been intubated due to trauma, and were less likely to have gastroesophageal reflux disease. In patients with subglottic or tracheal stenosis, those with granulation tissue without firm scar were more likely to be decannulated, and those who underwent rigid dilation were less likely to be decannulated. CONCLUSION Early evaluation by an otolaryngologist may increase the likelihood of tracheostomy decannulation in patients with laryngotracheal stenosis. Patient comorbidities may assist in predicting which patients will be successfully decannulated.
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Affiliation(s)
- Grace E Snow
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - Taylor B Teplitzky
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Elizabeth Guardiani
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Moroco AE, Saadi RA, Patel VA, Lehman EB, Gniady JP. 30-Day Postoperative Outcomes Following Transcervical Zenker's Diverticulectomy in the Elderly: Analysis of the NSQIP Database. Otolaryngol Head Neck Surg 2020; 165:129-136. [PMID: 33287659 DOI: 10.1177/0194599820970503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To compare the effect of patient factors, including age, on 30-day postoperative outcomes and complications for patients undergoing transcervical Zenker's diverticulectomy. STUDY DESIGN Retrospective cross-sectional analysis. SETTING American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Database. METHODS Patients who underwent open Zenker's diverticulectomy (Current Procedural Terminology code 43130) were queried via the NSQIP (2006-2018). Outcomes analyzed include patient demographics, medical comorbidities, admission type, operative characteristics, length of admission, postoperative complication, readmission, and reoperation. RESULTS A total of 614 patients were identified. Mean age at time of surgery was 71.1 years, with 13.4% older than 85 years. Outpatient procedures were performed in 29.8%. Postoperative complications occurred in 6.7%, with reoperation and readmission rates of 6.4% and 7.2%, respectively. A mortality rate of 0.3% was observed. Only smoking status (odds ratio, 2.94; P = .008) and history of congestive heart failure (odds ratio, 10.00; P = .014) were shown to have a significant effect on postoperative complications. CONCLUSION Smoking status confers a high risk for postoperative complication. Age was not an independent risk factor associated with adverse outcomes following open diverticulectomy, suggesting this procedure can be safely performed in patients with advanced age.
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Affiliation(s)
- Annie E Moroco
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Robert A Saadi
- Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA
| | - Vijay A Patel
- Department of Otolaryngology, University of Pittsburgh School of Medicine, UPMC Centers for Cranial Base Surgery & Sinonasal Disorders and Allergy, Pittsburgh, Pennsylvania, USA
| | - Erik B Lehman
- Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA
| | - John P Gniady
- Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA
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Zhuang T, Ku S, Shapiro LM, Hu SS, Cabell A, Kamal RN. A Cost-Effectiveness Analysis of Smoking-Cessation Interventions Prior to Posterolateral Lumbar Fusion. J Bone Joint Surg Am 2020; 102:2032-2042. [PMID: 33038088 PMCID: PMC8136338 DOI: 10.2106/jbjs.20.00393] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Smoking cessation represents an opportunity to reduce both short and long-term effects of smoking on complications after lumbar fusion and smoking-related morbidity and mortality. However, the cost-effectiveness of smoking-cessation interventions prior to lumbar fusion is not fully known. METHODS We created a decision-analytic Markov model to evaluate the cost-effectiveness of 5 smoking-cessation strategies (behavioral counseling, nicotine replacement therapy [NRT], bupropion or varenicline monotherapy, and a combined intervention) prior to single-level, instrumented lumbar posterolateral fusion (PLF) from the health payer perspective. Probabilities, costs, and utilities were obtained from published sources. We calculated the costs and quality-adjusted life years (QALYs) associated with each strategy over multiple time horizons and accounted for uncertainty with probabilistic sensitivity analyses (PSAs) consisting of 10,000 second-order Monte Carlo simulations. RESULTS Every smoking-cessation intervention was more effective and less costly than usual care at the lifetime horizon. In the short term, behavioral counseling, NRT, varenicline monotherapy, and the combined intervention were also cost-saving, while bupropion monotherapy was more effective but more costly than usual care. The mean lifetime cost savings for behavioral counseling, NRT, bupropion monotherapy, varenicline monotherapy, and the combined intervention were $3,291 (standard deviation [SD], $868), $2,571 (SD, $479), $2,851 (SD, $830), $6,767 (SD, $1,604), and $34,923 (SD, $4,248), respectively. The minimum efficacy threshold (relative risk for smoking cessation) for lifetime cost savings varied from 1.01 (behavioral counseling) to 1.15 (varenicline monotherapy). A PSA revealed that the combined smoking-cessation intervention was always more effective and less costly than usual care. CONCLUSIONS Even brief smoking-cessation interventions yield large short-term and long-term cost savings. Smoking-cessation interventions prior to PLF can both reduce costs and improve patient outcomes as health payers/systems shift toward value-based reimbursement (e.g., bundled payments) or population health models. LEVEL OF EVIDENCE Economic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Thompson Zhuang
- VOICES Health Policy Research Center (T.Z., S.K., L.M.S, and R.N.K.), Department of Orthopaedic Surgery (T.Z., S.K., L.M.S., S.S.H., A.C., and R.N.K.), Stanford University, Redwood City, California
| | - Seul Ku
- VOICES Health Policy Research Center (T.Z., S.K., L.M.S, and R.N.K.), Department of Orthopaedic Surgery (T.Z., S.K., L.M.S., S.S.H., A.C., and R.N.K.), Stanford University, Redwood City, California
| | - Lauren M. Shapiro
- VOICES Health Policy Research Center (T.Z., S.K., L.M.S, and R.N.K.), Department of Orthopaedic Surgery (T.Z., S.K., L.M.S., S.S.H., A.C., and R.N.K.), Stanford University, Redwood City, California
| | - Serena S. Hu
- VOICES Health Policy Research Center (T.Z., S.K., L.M.S, and R.N.K.), Department of Orthopaedic Surgery (T.Z., S.K., L.M.S., S.S.H., A.C., and R.N.K.), Stanford University, Redwood City, California
| | - Akaila Cabell
- VOICES Health Policy Research Center (T.Z., S.K., L.M.S, and R.N.K.), Department of Orthopaedic Surgery (T.Z., S.K., L.M.S., S.S.H., A.C., and R.N.K.), Stanford University, Redwood City, California
| | - Robin N. Kamal
- VOICES Health Policy Research Center (T.Z., S.K., L.M.S, and R.N.K.), Department of Orthopaedic Surgery (T.Z., S.K., L.M.S., S.S.H., A.C., and R.N.K.), Stanford University, Redwood City, California
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Tay JRH, Lu XJ, Lai WMC, Fu JH. Clinical and histological sequelae of surgical complications in horizontal guided bone regeneration: a systematic review and proposal for management. Int J Implant Dent 2020; 6:76. [PMID: 33241468 PMCID: PMC7688776 DOI: 10.1186/s40729-020-00274-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 10/27/2020] [Indexed: 12/11/2022] Open
Abstract
It is not uncommon to encounter post-surgical complications after horizontal guided bone regeneration (GBR). The primary aim of this review was to evaluate the incidence and types of complications that occur after horizontal GBR and propose management strategies to deal with these clinical situations. A secondary aim was to conduct a histomorphometric review of the wound healing process at sites that experienced post-surgical complications after GBR. A keyword search of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials for studies published in English from January 2015 to January 2020 was conducted for the primary aim and 23 studies were selected. A second search addressing the secondary aim was conducted, and five studies were included. Site-level analysis showed that the weighted mean incidence proportion of minor wound dehiscence and minor infections occurring at the augmented site was 9.9% [95% CI 6.4, 13.9, P < 0.01] and 1.5% [95% CI 0.4, 3.1, P = 0.21) respectively. Patient-level analysis showed minor and major complications occurring at a weighted mean incidence proportion of 16.1% [95% CI 11.9, 20.8, P = 0.01] and 1.6% [95% CI 0.0, 4.7, P < 0.01] respectively, while neurosensory alterations at the donor site was 7.0% [95% CI 1.3, 15.5, P < 0.01]. Subgroup analysis also revealed that the use of block grafts increased the incidence proportion of minor post-surgical complications, whereas a staged GBR procedure increased the incidence proportion of both minor and major post-surgical complications. Although exposure of the barrier membrane is often associated with less bone regeneration and graft resorption, the type of membrane used (resorbable or non-resorbable) had no statistically significant influence on any post-surgical complication. Histologically, a layer of fibrous connective tissue instead of bone is commonly observed at the interface between the native bone at the recipient site and the regenerated bone in cases with membrane exposure after GBR procedure. Minor wound dehiscence was the highest incidence proportion of post-surgical complications. Methods ranging from daily application of antiseptics, use of systemic antimicrobials, regular reviews, and total removal of the non-integrated biomaterials are commonly prescribed to manage these post-surgical complications in attempt to minimise the loss of tissue at the surgical site.
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Affiliation(s)
- John Rong Hao Tay
- Discipline of Periodontics, National University Centre for Oral Health Singapore, 9 Lower Kent Ridge Road, Singapore, 119085, Singapore.,Department of Restorative Dentistry, National Dental Centre Singapore, 5 Second Hospital Ave, Singapore, 168938, Singapore
| | - Xiaotong Jacinta Lu
- Discipline of Periodontics, National University Centre for Oral Health Singapore, 9 Lower Kent Ridge Road, Singapore, 119085, Singapore
| | - Wei Ming Clement Lai
- Statistics Unit, National University Centre for Oral Health Singapore, 9 Lower Kent Ridge Road, Singapore, 119085, Singapore
| | - Jia-Hui Fu
- Discipline of Periodontics, National University Centre for Oral Health Singapore, 9 Lower Kent Ridge Road, Singapore, 119085, Singapore.
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161
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Khozenko A, Lamperti M, Velly L, Simeone P, Tufegdzic B. Role of anaesthesia in neurosurgical enhanced recovery programmes. Best Pract Res Clin Anaesthesiol 2020; 35:241-253. [PMID: 34030808 DOI: 10.1016/j.bpa.2020.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 10/29/2020] [Accepted: 11/02/2020] [Indexed: 12/12/2022]
Abstract
The application of Enhanced Recovery After Surgery (ERAS) in neurosurgical practice is a relatively new concept. A limited number of studies involving ERAS protocols within neurosurgery, specifically for elective craniotomy, have been published, contrary to the ERAS spine surgery pathways that are now promoted by numerous national and international dedicated surgical societies and hospitals. In this review, we want to present the patient surgical journey from an anaesthesia perspective through the key components that can be included in the ERAS pathways for neurosurgical procedures, both craniotomies and major spine surgery.
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Affiliation(s)
- Andrey Khozenko
- Anaesthesiology Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, PO box 112412, Abu Dhabi, United Arab Emirates
| | - Massimo Lamperti
- Anaesthesiology Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, PO box 112412, Abu Dhabi, United Arab Emirates.
| | - Lionel Velly
- Aix Marseille Univ, AP-HM, Department of Anesthesiology and Critical Care Medicine, University Hospital Timone, 264 rue saint Pierre, 13005, CEDEX 5, Marseille, France.
| | - Pierre Simeone
- Aix Marseille Univ, AP-HM, Department of Anesthesiology and Critical Care Medicine, University Hospital Timone, 264 rue saint Pierre, 13005, CEDEX 5, Marseille, France.
| | - Boris Tufegdzic
- Anaesthesiology Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, PO box 112412, Abu Dhabi, United Arab Emirates.
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162
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Adapa AR, Linzey JR, Daou BJ, Mehta UV, Patel T, Ponnaluri-Wears S, Washer LL, Thompson BG, Park P, Pandey AS. Evaluating the role of methicillin-resistant Staphylococcus aureus (MRSA)-specific antibiotic prophylaxis for neurosurgical patients. Clin Neurol Neurosurg 2020; 200:106353. [PMID: 33168331 DOI: 10.1016/j.clineuro.2020.106353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Surgical site infection (SSI) in neurosurgical patients increases morbidity. Despite the rise of methicillin-resistant Staphylococcus aureus (MRSA) colonization, there is little consensus regarding antibiotic prophylaxis for SSI in MRSA-colonized neurosurgical patients. Our objective was to examine the incidence of SSI in MRSA-colonized neurosurgical patients and interrogate whether MRSA-specific antibiotic prophylaxis reduces SSIs. METHODS We performed a retrospective analysis of adult patients undergoing neurosurgical procedures between 2013 and 2018. The primary outcome was SSI in patients with MRSA colonization receiving MRSA-specific antibiotics. Secondary outcomes included predictors of SSI, including whether broad use of MRSA-specific antibiotics affects SSI rate. RESULTS Of 9739 procedures, 376 had SSI (3.9 %). Seven hundred forty-four procedures (7.6 %) were performed on patients screened preoperatively for MRSA, including 54 procedures on MRSA-colonized patients. MRSA-colonized patients were more likely than MRSA-non-colonized patients to receive MRSA-specific antibiotics (35.2 % vs. 17.8 %, p = 0.002) for prophylaxis. Nevertheless, MRSA-colonized patients had higher SSI rates compared to MRSA-non-colonized patients (22.2 % vs. 6.4 %, p = 0.00002). MRSA-colonization led to 3.49 greater odds (95 % CI 1.52-7.65, p = 0.002) of SSI relative to MRSA-non-colonization. MRSA-colonized patients receiving MRSA-specific antibiotics, compared to those receiving non-MRSA-specific antibiotics, had lower SSI rates, but this difference was not statistically significant (15.8 % vs. 25.7 %, p = 0.40). In the non-screened population, those receiving MRSA-specific antibiotics, compared to those receiving non-MRSA-specific antibiotics, had significantly higher SSI rates (6.9 % vs. 3.0 %, p = 0.00001). The use of MRSA-specific antibiotic prophylaxis in the non-screened population increased the odds of SSI (OR 1.90, 95 % CI 1.45-2.46, p = 0.0001). CONCLUSION MRSA-colonized neurosurgical patients had a higher SSI rate compared to MRSA-non-colonized patients. While MRSA-specific antibiotics may benefit those with MRSA colonization, the difference in SSI rate between MRSA-colonized patients receiving MRSA-specific antibiotics vs. non-specific antibiotics requires further investigation. The broader use of MRSA-specific antibiotics may paradoxically confer an increased risk of SSI in a non-screened neurosurgical population.
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Affiliation(s)
- Arjun Rohit Adapa
- University of Michigan Medical School, Ann Arbor, MI, USA; Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | | | - Badih Junior Daou
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Unnati Vikram Mehta
- Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, MA, USA
| | - Twisha Patel
- Department of Pharmacy Services, University of Michigan, Ann Arbor, MI, USA
| | | | - Laraine Lynn Washer
- Division of Infectious Disease, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Paul Park
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA; Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
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163
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Wang VL, Jalilvand AD, Gupta A, Chen J, Vadlamudi C, Perry KA. Tobacco use is not associated with increased risk of recurrent reflux 5 years after laparoscopic anti-reflux surgery. Surg Endosc 2020; 35:4771-4778. [PMID: 32914359 DOI: 10.1007/s00464-020-07956-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 08/27/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Tobacco use worsens gastrointestinal reflux disease (GERD). Smoking cessation improves GERD symptoms, but its impact on the efficacy of laparoscopic anti-reflux surgery (LARS) is unclear. In this retrospective cohort study, we hypothesized that non-smokers would demonstrate greater long-term improvements in disease-specific quality of life than active smokers. METHODS Data were maintained in an IRB-approved prospective database, and patients were stratified according to tobacco use. Postoperative follow-up occurred in clinic and long-term follow-up via telephone interview. Outcomes measured were gastroesophageal health-related quality of life (GERD-HRQL) and GERD symptom scale (GERSS) scores, proton pump inhibitor (PPI) cessation, and satisfaction with surgery. RESULTS Two hundred and thirty-five patients underwent primary LARS, and 31 (13%) were active smokers with 18 median pack-years [10-30]. Baseline PPI use (96% vs. 94%, p = 0.64), presence of a hiatal hernia (79% vs. 68%, p = 0.13), esophagitis (28% vs. 45%, p = 0.13), and DeMeester score (41.9 vs. 33.6, p = 0.47) were similar. Baseline GERD-HRQL and GERSS scores and their post-surgical decreases were also similar between groups. PPI cessation was achieved in 92% of non-smokers and 94% of smokers (p = 0.79), and GERD-HRQL scores decreased to 4 [1-7] and 5 [0-12], respectively (p = 0.53). After 59 [25-74] months, GERD-HRQL scores were 5 [2-11] and 2 [0-13] (p = 0.61) and PPI cessation was maintained in 69% and 79% of patients (p = 0.59). Satisfaction with surgery was similar between smokers and non-smokers (88% vs. 87%, p = 0.85). Female gender was significantly associated with increased improvements in GERD-HRQL (p < 0.01) and GERSS scores (p = 0.04) postoperatively but not at long-term follow-up. Patients without a hiatal hernia were less likely to achieve long-term PPI cessation compared to those with a hernia (OR 0.23, p < 0.01). CONCLUSIONS After 5 years, smokers demonstrate similar symptom resolution, PPI cessation rates, and satisfaction with surgery as non-smokers. Active smoking does not appear to negatively impact long-term symptomatic outcomes of LARS.
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Affiliation(s)
- Vivian L Wang
- Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, 410 W 10th Ave, 558 Doan Hall, Columbus, OH, USA
| | - Anahita D Jalilvand
- Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, 410 W 10th Ave, 558 Doan Hall, Columbus, OH, USA
| | - Anand Gupta
- Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, 410 W 10th Ave, 558 Doan Hall, Columbus, OH, USA
| | - Jennwood Chen
- Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, 410 W 10th Ave, 558 Doan Hall, Columbus, OH, USA
| | - Chaitanya Vadlamudi
- Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, 410 W 10th Ave, 558 Doan Hall, Columbus, OH, USA
| | - Kyle A Perry
- Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, 410 W 10th Ave, 558 Doan Hall, Columbus, OH, USA.
- Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, 410 W 10th Ave, N729 Doan Hall, Columbus, OH, 43210, USA.
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164
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Abstract
Surgical site infection (SSI) can be a significant complication of cardiac surgery, delaying recovery and acting as a barrier to enhanced recovery after cardiac surgery. Several risk factors predisposing patients to SSI including smoking, excessive alcohol intake, hyperglycemia, hypoalbuminemia, hypo- or hyperthermia, and Staphylococcus aureus colonization are discussed. Various measures can be taken to abolish these factors and minimize the risk of SSI. Glycemic control should be optimized preoperatively, and hyperglycemia should be avoided perioperatively with the use of intravenous insulin infusions. All patients should receive topical intranasal Staphylococcus aureus decolonization and intravenous cephalosporin if not penicillin allergic.
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Affiliation(s)
- Shruti Jayakumar
- Department of Cardiothoracic Surgery, St. George's Hospital, Blackshaw Road, London SW17 0QT, UK
| | - Ali Khoynezhad
- MemorialCare Heart and Vascular Institute, MemorialCare Long Beach Medical Center, 2801 Atlantic Avenue, Long Beach, CA 90806, USA
| | - Marjan Jahangiri
- Department of Cardiothoracic Surgery, St. George's Hospital, Blackshaw Road, London SW17 0QT, UK.
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165
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Smoking and obesity are associated with increased readmission after elective repair of small primary ventral hernias: A nationwide database study. Surgery 2020; 168:527-531. [DOI: 10.1016/j.surg.2020.04.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/26/2020] [Accepted: 04/07/2020] [Indexed: 11/19/2022]
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166
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Al Hafez ASS, Ingle N, alshayeb AA, Tashery HM, Alqarni AAM, Alshamrani SH. Effectiveness of mechanical debridement with and without adjunct antimicrobial photodynamic for treating peri-implant mucositis among prediabetic cigarette-smokers and non-smokers. Photodiagnosis Photodyn Ther 2020; 31:101912. [DOI: 10.1016/j.pdpdt.2020.101912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/28/2020] [Accepted: 07/02/2020] [Indexed: 12/15/2022]
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167
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Tizabi Y, Getachew B, Copeland RL, Aschner M. Nicotine and the nicotinic cholinergic system in COVID-19. FEBS J 2020; 287:3656-3663. [PMID: 32790936 PMCID: PMC7436654 DOI: 10.1111/febs.15521] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/29/2020] [Accepted: 08/08/2020] [Indexed: 12/16/2022]
Abstract
There is an urgent need to address the devastating pandemic, COVID‐19, caused by SARS‐CoV‐2. The efforts to understand the details of this disease in hope of providing effective treatments are commendable. It is clear now that the virus can cause far more damage in patients with comorbid conditions—particularly in those with respiratory, cardiovascular, or immune‐compromised system—than in patients without such comorbidities. Drug use can further exacerbate the condition. In this regard, the ill effects of smoking are amply documented, and no doubt can be a confounding factor in COVID‐19 progression. Although conflicting hypotheses on the potential role of nicotine in COVID‐19 pathology have recently been offered, we believe that nicotine itself, through its interaction with the nicotinic cholinergic system, as well as ACE2, may not only be of use in a variety of neuropsychiatric and neurodegenerative diseases, but may also be of potential use in COVID‐19. Thus, on one hand, while we strongly support smoking cessation as a means of harm reduction associated with COVID‐19, on the other hand, we support a potential therapeutic role for nicotine, nicotinic agonists, or positive allosteric modulators of nicotinic cholinergic receptors in COVID‐19, owing to their varied effects including mood regulation, anti‐inflammatory, and purported interference with SARS‐CoV‐2 entry and/or replication.
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Affiliation(s)
- Yousef Tizabi
- Department of Pharmacology, Howard University College of Medicine, Washington, DC, USA
| | - Bruk Getachew
- Department of Pharmacology, Howard University College of Medicine, Washington, DC, USA
| | - Robert L Copeland
- Department of Pharmacology, Howard University College of Medicine, Washington, DC, USA
| | - Michael Aschner
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY, USA
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168
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Stone R, Carey E, Fader AN, Fitzgerald J, Hammons L, Nensi A, Park AJ, Ricci S, Rosenfield R, Scheib S, Weston E. Enhanced Recovery and Surgical Optimization Protocol for Minimally Invasive Gynecologic Surgery: An AAGL White Paper. J Minim Invasive Gynecol 2020; 28:179-203. [PMID: 32827721 DOI: 10.1016/j.jmig.2020.08.006] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 02/07/2023]
Abstract
This is the first Enhanced Recovery After Surgery (ERAS) guideline dedicated to standardizing and optimizing perioperative care for women undergoing minimally invasive gynecologic surgery. The guideline was rigorously formulated by an American Association of Gynecologic Laparoscopists Task Force of US and Canadian gynecologic surgeons with special interest and experience in adapting ERAS practices for patients requiring minimally invasive gynecologic surgery. It builds on the 2016 ERAS Society recommendations for perioperative care in gynecologic/oncologic surgery by serving as a more comprehensive reference for minimally invasive endoscopic and vaginal surgery for both benign and malignant gynecologic conditions. For example, the section on preoperative optimization provides more specific recommendations derived from the ambulatory surgery and anesthesia literature for the management of anemia, hyperglycemia, and obstructive sleep apnea. Recommendations pertaining to multimodal analgesia account for the recent Food and Drug Administration warnings about respiratory depression from gabapentinoids. The guideline focuses on workflows important to high-value care in minimally invasive surgery, such as same-day discharge, and tackles controversial issues in minimally invasive surgery, such as thromboprophylaxis. In these ways, the guideline supports the American Association of Gynecologic Laparoscopists and our collective mission to elevate the quality and safety of healthcare for women through excellence in clinical practice.
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Affiliation(s)
- Rebecca Stone
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland (Drs. Stone, Fader, and Weston).
| | - Erin Carey
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina (Dr. Carey)
| | - Amanda N Fader
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland (Drs. Stone, Fader, and Weston)
| | - Jocelyn Fitzgerald
- Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr. Fitzgerald)
| | - Lee Hammons
- Allegheny Women's Health, Pittsburgh, Pennsylvania (Dr. Hammons)
| | - Alysha Nensi
- Department of Obstetrics and Gynecology, St. Michael's Hospital, Toronto, Ontario, Canada (Dr. Nensi)
| | - Amy J Park
- Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Ohio (Drs. Park and Ricci)
| | - Stephanie Ricci
- Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Ohio (Drs. Park and Ricci)
| | | | - Stacey Scheib
- Department of Obstetrics and Gynecology, Tulane University, New Orleans, Louisiana (Dr. Scheib)
| | - Erica Weston
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, Maryland (Drs. Stone, Fader, and Weston)
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169
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Cheng KY, Ball ST, Gonzales FB, Schenk S, Hughes-Austin JM. Metabolic Syndrome Is Associated With Higher Risk of Wound Complications After Total Hip Arthroplasty. Arthroplast Today 2020; 6:571-577. [PMID: 32802927 PMCID: PMC7419251 DOI: 10.1016/j.artd.2020.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/23/2020] [Accepted: 06/20/2020] [Indexed: 11/26/2022] Open
Abstract
Background Obesity is prevalent among patients undergoing total hip arthroplasty and has been associated with the risk of wound complications, particularly when an anterior approach is used. However, most studies have focused on obesity defined by the body mass index (BMI), without considering the metabolic effects of adiposity. Thus, in this study, we investigated the independent effects of the BMI and metabolic syndrome on wound complications after total hip arthroplasty. Methods Among 804 consecutive patients undergoing total hip arthroplasty between October 2013 and July 2016, we evaluated the associations between obesity (BMI ≥30 mg/kg2), metabolic syndrome (defined by the National Cholesterol Education Program Adult Treatment Panel III guidelines), and wound complication (defined as documented wound dehiscence, drainage, erythema, hematoma, infection, or seroma) over a 1-year follow-up period. We used Cox proportional hazards models adjusting for demographics, smoking status, and hospital length of stay. Results Patients’ mean age at time of surgery was 62.0 ± 11.9 years. Forty-seven percent were male, 27.9% were obese, and 11.6% met the definition for metabolic syndrome. Metabolic syndrome was associated with a 4-fold higher risk of wound complication (95% confidence interval: 1.4-11.1) after adjusting for all covariates including the BMI. In unadjusted analysis, obesity was associated with a higher risk of wound complication (hazard ratio: 2.8, 95% confidence interval: 1.3-6.2). However, obesity was not associated with the risk of wound complication after adjusting for the metabolic syndrome (P = .16). Conclusions Metabolic syndrome, but not obesity, defined by a BMI ≥30, was associated with wound complications, suggesting that metabolic effects of adiposity may represent a distinct risk factor in the development of wound complications from a higher BMI alone.
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Affiliation(s)
- Karen Y Cheng
- Department of Radiology, University of California, San Diego, San Diego, CA, USA
| | - Scott T Ball
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, USA
| | - Francis B Gonzales
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, USA
| | - Simon Schenk
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, USA
| | - Jan M Hughes-Austin
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, USA
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170
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Lenze NR, Ghodke A, Shah RN, Buckmire RA. Predictors of Increased Surgical Drain Output following Type I Thyroplasty for Glottic Insufficiency. Laryngoscope 2020; 131:1557-1560. [PMID: 32809241 DOI: 10.1002/lary.29015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/14/2020] [Accepted: 07/20/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To determine predictors of increased drain output following type I thyroplasty for glottic insufficiency. STUDY DESIGN Retrospective chart review. METHODS A retrospective review was conducted for patients who underwent type I thyroplasty for glottic insufficiency from 2014-2019. The primary outcome was 24-hour drain output. Increased drain output was defined as >50th percentile for the sample. Univariate logistic regression models and linear regression models were used. RESULTS There were 84 patients with a mean age of 58.9 (SD 16.9) years. Twenty-four-hour drain output ranged from 0 to 29 mL with a mean of 9.47 (SD 6.49) mL. Patients with a history of tobacco use (OR 3.33; 95% CI, 1.24-8.95; P = .017) and prior neck surgery (OR 3.52; 95% CI, 1.26 to 9.83; P = .016) were significantly more likely to have increased drain output following surgery; these patients had a mean increase in 24-hour drain output of 3.51 mL (95% CI, 0.52 to 6.51; P = .022) and 1.74 mL (95% CI, -1.41 to 4.89; P = .274), respectively. Type of implant (Gore-Tex vs. Silastic; P = .425) and operative technique (unilateral vs. bilateral; P = .506) were not significantly associated with drain output. CONCLUSION History of tobacco use and prior surgery of the neck predict increased drain output following type I thyroplasty surgery. These patients may derive the most benefit from surgical drain placement. More research is needed to confirm these findings and elucidate potential mechanisms. LEVEL OF EVIDENCE 4 Laryngoscope, 131:1557-1560, 2021.
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Affiliation(s)
- Nicholas R Lenze
- Department of Otolaryngology-Head and Neck Surgery, University of School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Ameer Ghodke
- Department of Otolaryngology-Head and Neck Surgery, University of School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Rupali N Shah
- University of North Carolina Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Robert A Buckmire
- University of North Carolina Chapel Hill, Chapel Hill, North Carolina, U.S.A
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171
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Janis JE, Jefferson RC, Kraft CT. Panniculectomy: Practical Pearls and Pitfalls. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3029. [PMID: 32983784 PMCID: PMC7489615 DOI: 10.1097/gox.0000000000003029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/08/2020] [Indexed: 02/03/2023]
Abstract
Panniculectomy is an increasingly common operation, given the current obesity epidemic and the increasing prevalence of bariatric surgery. At first glance, it could be considered a technically simple operation; however, this procedure can be fraught with complications, given the patient population and high demands placed on compromised abdominal tissue. Sufficient attention must be given to the nuances of patient optimization and surgical planning to maximize safe and ideal outcomes. We highlight our practical tips when performing standard or massive panniculectomy for preoperative optimization, intraoperative techniques, and postoperative management to reduce complication and maximize outcomes of this procedure from a surgeon's and a patient's perspective.
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Affiliation(s)
- Jeffrey E. Janis
- From the Ohio State University Wexner Medical Center, Department of Plastic Surgery, Columbus, Ohio
| | - Ryan C. Jefferson
- From the Ohio State University Wexner Medical Center, Department of Plastic Surgery, Columbus, Ohio
| | - Casey T. Kraft
- From the Ohio State University Wexner Medical Center, Department of Plastic Surgery, Columbus, Ohio
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172
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Ogura Y, Kobayashi Y, Shinozaki Y, Kitagawa T, Yonezawa Y, Takahashi Y, Yoshida K, Yasuda A, Ogawa J. Factors Influencing Patient Satisfaction After Decompression Surgery Without Fusion for Lumbar Spinal Stenosis. Global Spine J 2020; 10:627-632. [PMID: 32677560 PMCID: PMC7359692 DOI: 10.1177/2192568219868205] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES Decompression without fusion is a standard surgical treatment for lumbar spinal stenosis (LSS) with reasonable surgical outcomes. Nevertheless, some studies have reported low patient satisfaction (PS) following decompression surgery. The cause of the discrepancy between reasonable clinical outcomes and PS is unknown; moreover, the factors associated with PS are expected to be complex, and little is known about them. This study aimed to identify satisfaction rate and to clarify the factors related to PS following decompression surgery in LSS patients. METHODS We retrospectively reviewed 126 patients who underwent lumbar decompression with a minimum follow-up of 1 year. Patients were divided into 2 groups based on the PS question. The Japanese Orthopaedic Association (JOA) scores, and the Numeric Rating Scale (NRS) scores of low back pain (LBP), leg pain, and leg numbness were compared between the 2 groups preoperatively and at the latest visit. To identify the prognostic factors for dissatisfaction, multiple logistic regression analysis was performed. RESULTS Overall satisfaction rate was 75%. The JOA recovery rate, NRS improvement, and Short Form-8 (SF-8) were significantly higher in the satisfied group. Postoperative NRS scores of LBP, leg pain, and leg numbness were significantly lower in the satisfied group. Multivariate logistic regression analysis showed that smoking and scoliosis were significant risk factors for dissatisfaction. CONCLUSIONS Overall satisfaction rate was 75% in patients with LSS undergoing decompression surgery. This study found that smoking status and scoliosis were associated with patient dissatisfaction following decompression in LSS patients.
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Affiliation(s)
- Yoji Ogura
- Japanese Red Cross Shizuoka Hospital, Shizuoka, Shizuoka, Japan,Yoji Ogura, Department of Orthopaedic Surgery, Japanese Red Cross Shizuoka Hospital, 8-2 Ohtemachi, Aoi-ku, Shizuoka 420-0853, Japan.
| | | | | | | | | | | | - Kodai Yoshida
- Japanese Red Cross Shizuoka Hospital, Shizuoka, Shizuoka, Japan
| | - Akimasa Yasuda
- Japanese Red Cross Shizuoka Hospital, Shizuoka, Shizuoka, Japan
| | - Jun Ogawa
- Japanese Red Cross Shizuoka Hospital, Shizuoka, Shizuoka, Japan
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173
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Abstract
Wound healing is affected by several factors. Preexisting diagnoses may significantly alter, delay, or inhibit normal wound healing. This is most commonly seen with chronic disorders, such as diabetes and renal failure, but also occurs secondary to aging and substance abuse. Less commonly, genetic or inflammatory disorders are the cause of delayed wound healing. In some cases, it is not the illness, but the treatment that can inhibit wound healing. This is seen in patients getting chemotherapy, radiation, steroids, methotrexate, and a host of other medications. Understanding these processes may help treat or avoid wound healing problems.
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Affiliation(s)
- Robel T Beyene
- Department of Surgery, Vanderbilt University Medical Center, 1310 24th Avenue South, Nashville, TN 37212, USA
| | - Stephen Lentz Derryberry
- Department of Surgery, Vanderbilt University Medical Center, 1310 24th Avenue South, Nashville, TN 37212, USA
| | - Adrian Barbul
- Department of Surgery, Vanderbilt University Medical Center, 1310 24th Avenue South, Nashville, TN 37212, USA; Department of Surgery, Nashville Veterans Administration Hospital, 1310 24th Avenue South, Nashville, TN 37212, USA.
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174
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Nordestgaard AT, Rasmussen LS, Sillesen M, Steinmetz J, King DR, Saillant N, Kaafarani HM, Velmahos GC. Smoking and risk of surgical bleeding: nationwide analysis of 5,452,411 surgical cases. Transfusion 2020; 60:1689-1699. [PMID: 32441364 DOI: 10.1111/trf.15852] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 04/06/2020] [Accepted: 04/06/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Although smoking is associated with several postoperative complications, a possible association with surgical bleeding remains unclear. We examined if smoking is associated with a higher risk of surgical bleeding. STUDY DESIGN AND METHODS We included patients from the American College of Surgeons National Surgical Quality Improvement Program 2007-2016 from 680 hospitals across the United States. Patients with information on age, sex, surgical specialty, and smoking status were included. Surgical bleeding was defined as 1 or more red blood cell (RBC) units transfused intraoperatively to 72 hours postoperatively. The association between smoking and surgical bleeding was examined using logistic regressions adjusted for age, sex, body mass index, ethnicity, comorbidities, laboratory values, American Society of Anesthesiologists score, type of anesthesia, duration of surgery, work relative value unit (surrogate for operative complexity), surgical specialty, and procedure year. RESULTS A total of 5,452,411 cases were recorded, of whom 19% smoked and 6% received transfusion. Odds ratios for transfusion were 1.06 (95% confidence interval [CI], 1.05-1.07) for smokers versus nonsmokers and 1.06 (95% CI, 1.04-1.09) for current smokers versus never-smokers. Odds ratios for cumulative smoking were 0.97 (95% CI, 0.95-1.00) for greater than 0 to 20 versus 0 pack-years, 1.04 (95% CI, 1.01-1.07) for greater than 20 to 40, and 1.12 (95% CI, 1.09-1.15) for greater than 40 (p for trend < 0.001). Hazard ratios for reoperations due to any cause and to bleeding were 1.28 (95% CI, 1.27-1.31) and 0.99 (95% CI, 0.93-1.04). CONCLUSION Smoking was associated with a higher risk of RBC transfusion as a proxy for surgical bleeding across all surgical specialties combined.
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Affiliation(s)
- Ask T Nordestgaard
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Anaesthesia, Centre of Head and Orthopaedics 4231, Rigshospitalet & Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars S Rasmussen
- Department of Anaesthesia, Centre of Head and Orthopaedics 4231, Rigshospitalet & Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Martin Sillesen
- Department of Surgical Gastroenterology & Institute for Inflammation Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Steinmetz
- Department of Anaesthesia, Centre of Head and Orthopaedics 4231, Rigshospitalet & Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - David R King
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Noelle Saillant
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Haytham M Kaafarani
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - George C Velmahos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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175
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Hawkins AT, Wise PE, Chan T, Lee JT, Glyn T, Wood V, Eglinton T, Frizelle F, Khan A, Hall J, Ilyas MIM, Michailidou M, Nfonsam VN, Cowan ML, Williams J, Steele SR, Alavi K, Ellis CT, Collins D, Winter DC, Zaghiyan K, Gallo G, Carvello M, Spinelli A, Lightner AL. Diverticulitis: An Update From the Age Old Paradigm. Curr Probl Surg 2020; 57:100862. [PMID: 33077029 DOI: 10.1016/j.cpsurg.2020.100862] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/10/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Alexander T Hawkins
- Section of Colon & Rectal Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
| | - Paul E Wise
- Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Tiffany Chan
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Janet T Lee
- Department of Surgery, University of Minnesota, Saint Paul, MN
| | - Tamara Glyn
- University of Otago, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Verity Wood
- Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Timothy Eglinton
- Department of Surgery, University of Otago, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Frank Frizelle
- Department of Surgery, University of Otago, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Adil Khan
- Raleigh General Hospital, Beckley, WV
| | - Jason Hall
- Dempsey Center for Digestive Disorders, Department of Surgery, Boston Medical Center, Boston, MA
| | | | | | | | | | | | - Scott R Steele
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Oh
| | - Karim Alavi
- Division of Colorectal Surgery, University of Massachusetts Memorial Medical Center, Worcester, MA
| | - C Tyler Ellis
- Department of Surgery, University of Louisville, Louisville, KY
| | | | - Des C Winter
- St. Vincent's University Hospital, Dublin, Ireland
| | | | - Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Michele Carvello
- Colon and Rectal Surgery Unit, Humanitas Clinical and Research Center IRCCS, Department of Biomedical Sciences, Humanitas University, Milano, Italy
| | - Antonino Spinelli
- Colon and Rectal Surgery Unit, Humanitas Clinical and Research Center IRCCS, Department of Biomedical Sciences, Humanitas University, Milano, Italy
| | - Amy L Lightner
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
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176
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Wan YI, Patel A, Abbott TE, Achary C, MacDonald N, Duceppe E, Sessler DI, Szczeklik W, Ackland GL, Devereaux PJ, Pearse RM. Prospective observational study of postoperative infection and outcomes after noncardiac surgery: analysis of prospective data from the VISION cohort. Br J Anaesth 2020; 125:87-97. [DOI: 10.1016/j.bja.2020.03.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 02/24/2020] [Accepted: 03/05/2020] [Indexed: 11/28/2022] Open
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177
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Muire PJ, Mangum LH, Wenke JC. Time Course of Immune Response and Immunomodulation During Normal and Delayed Healing of Musculoskeletal Wounds. Front Immunol 2020; 11:1056. [PMID: 32582170 PMCID: PMC7287024 DOI: 10.3389/fimmu.2020.01056] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 05/01/2020] [Indexed: 12/20/2022] Open
Abstract
Single trauma injuries or isolated fractures are often manageable and generally heal without complications. In contrast, high-energy trauma results in multi/poly-trauma injury patterns presenting imbalanced pro- and anti- inflammatory responses often leading to immune dysfunction. These injuries often exhibit delayed healing, leading to fibrosis of injury sites and delayed healing of fractures depending on the intensity of the compounding traumas. Immune dysfunction is accompanied by a temporal shift in the innate and adaptive immune cells distribution, triggered by the overwhelming release of an arsenal of inflammatory mediators such as complements, cytokines and damage associated molecular patterns (DAMPs) from necrotic cells. Recent studies have implicated this dysregulated inflammation in the poor prognosis of polytraumatic injuries, however, interventions focusing on immunomodulating inflammatory cellular composition and activation, if administered incorrectly, can result in immune suppression and unintended outcomes. Immunomodulation therapy is promising but should be conducted with consideration for the spatial and temporal distribution of the immune cells during impaired healing. This review describes the current state of knowledge in the spatiotemporal distribution patterns of immune cells at various stages during musculoskeletal wound healing, with a focus on recent advances in the field of Osteoimmunology, a study of the interface between the immune and skeletal systems, in long bone fractures. The goals of this review are to (1) discuss wound and fracture healing processes of normal and delayed healing in skeletal muscles and long bones; (2) provide a balanced perspective on temporal distributions of immune cells and skeletal cells during healing; and (3) highlight recent therapeutic interventions used to improve fracture healing. This review is intended to promote an understanding of the importance of inflammation during normal and delayed wound and fracture healing. Knowledge gained will be instrumental in developing novel immunomodulatory approaches for impaired healing.
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Affiliation(s)
- Preeti J Muire
- Orthopaedic Trauma Research Department, US Army Institute of Surgical Research, Fort Sam Houston, TX, United States
| | - Lauren H Mangum
- Orthopaedic Trauma Research Department, US Army Institute of Surgical Research, Fort Sam Houston, TX, United States
| | - Joseph C Wenke
- Orthopaedic Trauma Research Department, US Army Institute of Surgical Research, Fort Sam Houston, TX, United States
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178
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Schwindt R, Elkhadragy N, Hudmon KS. Tobacco-Related Health Disparities in Gender-Diverse Populations: A Call to Action. Transgend Health 2020. [DOI: 10.1089/trgh.2019.0063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Rhonda Schwindt
- The George Washington University School of Nursing, Washington, District of Columbia, USA
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179
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Boskey ER, Jolly D, Tabaac AR, Ganor O. Behavioral Health Concerns and Eligibility Factors Among Adolescents and Young Adults Seeking Gender-Affirming Masculinizing Top Surgery. LGBT Health 2020; 7:182-189. [DOI: 10.1089/lgbt.2019.0213] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Elizabeth R. Boskey
- Center for Gender Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Divya Jolly
- Center for Gender Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Ariella R. Tabaac
- Center for Gender Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Oren Ganor
- Center for Gender Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
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180
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Camargo CP, Pfann RZ, Kubrusly MS, Silva MFR, Guimarães ET, Leite MS, Saldiva PHN, Gemperli R. Study of the Effect of Hyperbaric Oxygen Therapy on the Viability of Dorsal Cutaneous Flaps in Tobacco-Exposed Rats. Aesthetic Plast Surg 2020; 44:979-985. [PMID: 32193614 DOI: 10.1007/s00266-020-01677-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/01/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Smoking causes a threefold increase in the risk of surgical complications in flaps. Hyperbaric oxygen therapy (HBOT) increases the viability of chronic wounds. However, there are few studies concerning the effects of HBOT on surgical flaps in patients who smoke. This study aimed to analyze the effect of HBOT on the viability of cutaneous flaps in tobacco-exposed rats. METHODS Twenty Wistar rats were exposed to tobacco smoke for two months. Following this period, all animals underwent a dorsal cutaneous flap (3 × 10 cm) surgery and were divided into two groups: control (n = 10) and HBOT (n = 10). HBOT was performed in seven daily sessions (2 ATA, 90 min). After seven days, the animals were euthanized. The outcomes were total area, viable area, viable area/total area rate, analysis of dermal appendages and angiogenesis (hematoxylin-eosin), and gene expression analysis of iNOS and VEGF-a biomarkers. RESULTS The HBOT group showed an increase in viable area compared with the control group (84% versus 47%, p = 0.009, respectively). The HBOT group also showed an increase in appendage units (1.69 ± 0.54 versus 1.87 ± 0.58, p = 0.04) and angiogenesis density (1.29 ± 0.45 versus 1.82 ± 0.64, p < 0.001) compared to the control group. There was a difference between the control and HBOT groups in iNOS levels (0.926 ± 1.4 versus 0.04 ± 0.1 p = 0.002, respectively). However, this study did not show a difference between the groups concerning the gene expression of VEGF-a. CONCLUSION The use of hyperbaric oxygen therapy increased the viability of cutaneous flaps in tobacco-exposed rats and decreased iNOS mRNA levels; however, it did not change VEGF-a levels. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- C P Camargo
- Laboratório de Microcirurgia E Cirurgia Plástica, Faculdade de Medicina, Universidade de São Paulo, Avenida Dr. Arnaldo, 455/1363, São Paulo, SP, 01246903, Brazil.
| | - R Z Pfann
- School of Medicine, Faculdade de Medicina, Universidade de São Paulo, Avenida Dr. Arnaldo, 455, São Paulo, SP, 01246903, Brazil
| | - M S Kubrusly
- Laboratório de Transplante de Cirurgia Do Fígado, Faculdade de Medicina, Universidade de São Paulo, Avenida Dr. Arnaldo, 455/2302, São Paulo, SP, 01246903, Brazil
| | - M F R Silva
- Laboratório de Poluição Atmosférica Experimental, Faculdade de Medicina, Universidade de São Paulo, Avenida Dr. Arnaldo, 455/1120, São Paulo, SP, 01246903, Brazil
| | - E T Guimarães
- Laboratório de Poluição Atmosférica Experimental, Faculdade de Medicina, Universidade de São Paulo, Avenida Dr. Arnaldo, 455/1120, São Paulo, SP, 01246903, Brazil
| | - M S Leite
- Laboratório de Poluição Atmosférica Experimental, Faculdade de Medicina, Universidade de São Paulo, Avenida Dr. Arnaldo, 455/1120, São Paulo, SP, 01246903, Brazil
| | - P H N Saldiva
- Laboratório de Poluição Atmosférica Experimental, Faculdade de Medicina, Universidade de São Paulo, Avenida Dr. Arnaldo, 455/1120, São Paulo, SP, 01246903, Brazil
| | - R Gemperli
- Laboratório de Microcirurgia E Cirurgia Plástica, Faculdade de Medicina, Universidade de São Paulo, Avenida Dr. Arnaldo, 455/1363, São Paulo, SP, 01246903, Brazil
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181
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Krishna A, Mathieu W, Mull E, Tobias JD. Perioperative Implications of Vaping. J Med Cases 2020; 11:129-134. [PMID: 34434382 PMCID: PMC8383562 DOI: 10.14740/jmc3451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 03/12/2020] [Indexed: 12/17/2022] Open
Abstract
Over the past 10 - 15 years, there has been a significant increase in the use of electronic cigarettes. These devices are generally used to deliver nicotine through inhalation by aerosolization. While the long-term risk of lung cancer is yet to be known, the chemicals and impurities in the solutions may have other acute and chronic effects on the respiratory system including respiratory failure from adult respiratory distress syndrome. Recent concerns have been raised regarding the potential for significant acute and chronic health care risks of these devices including pneumonitis, airway reactivity and respiratory failure. Given that many of the acute effects are related to the respiratory system, anesthetic care may be required during diagnostic procedures including bronchoscopy to investigate the etiology of acute respiratory symptomatology. We present an adolescent who presented to the operating room for bronchoscopy and bronchoalveolar lavage to investigate the etiology of respiratory involvement following an episode of vaping. The healthcare and end-organ effects of nicotine, tobacco smoke and vaping are discussed, and potential anesthetic implications are presented.
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Affiliation(s)
- Amogha Krishna
- Heritage College of Osteopathic Medicine, Dublin, OH, USA
| | - Wana Mathieu
- The Ohio State University School of Medicine, Columbus, OH, USA
| | - Eric Mull
- Division of Pediatric Pulmonology and Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA
| | - Joseph D Tobias
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
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182
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Revision Carpal Tunnel Release: Risk Factors and Rate of Secondary Surgery. Plast Reconstr Surg 2020; 145:1204-1214. [DOI: 10.1097/prs.0000000000006742] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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183
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Rosiello G, Knipper S, Palumbo C, Pecoraro A, Luzzago S, Deuker M, Stolzenbach LF, Tian Z, Gallina A, Gandaglia G, Montorsi F, Shariat SF, Saad F, Briganti A, Karakiewicz PI. Rates of other-cause mortality after radical cystectomy are decreasing over time-A population-based analysis over two decades. J Surg Oncol 2020; 121:1329-1336. [PMID: 32246846 DOI: 10.1002/jso.25919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 03/19/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES To investigate other-cause mortality (OCM) rates over time according to several baseline characteristics in bladder cancer (BCa) patients treated with radical cystectomy (RC). METHODS Within the Surveillance, Epidemiology, and End Results database (1988-2011), we identified 7702 T1-2 N0 M0 urothelial BCa patients treated with RC. Temporal trends and multivariable Cox regression (MCR) analyses assessed 5-year OCM. Data were stratified according to the year of diagnosis (1988-1995 vs 1996-2000 vs 2001-2004 vs 2005-2008 vs 2009-2011), age group (<60 vs 60-75 vs >75 years), sex, race, marital status, and socioeconomic status. RESULTS Overall, OCM rates decreased from 13.9% in 1988-1995 to 8.6% in 2009-2011. The greatest decrease was recorded in elderly (>75) patients (32%-16%, slope: -0.55% per year; P = .01), followed by patients aged 60 to 75 (21%-5%, slope: -0.35% per year; P = .01), unmarried patients (16%-10%, slope: -0.26% per year; P < .001), male patients (14%-8.9%, slope: -0.23% per year), and African Americans (16%-11%, slope: -0.27% per year; P < .001). MCR models corroborated these results. CONCLUSIONS Most important decrease in OCM after RC over the last decades was recorded in the elderly, unmarried, and male patients. Nonetheless, these three patient groups still represent ideal targets for efforts aimed at minimizing the morbidity and mortality after RC, as their risk of OCM is higher than in others.
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Affiliation(s)
- Giuseppe Rosiello
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada.,Division of Experimental Oncology, Department of Urology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sophie Knipper
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada.,Department of Urology, Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Carlotta Palumbo
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada.,Urology Unit, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Angela Pecoraro
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada.,Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Stefano Luzzago
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada.,Department of Urology, European Institute of Oncology, Milan, Italy
| | - Marina Deuker
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada.,Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Lara F Stolzenbach
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada.,Department of Urology, Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Andrea Gallina
- Division of Experimental Oncology, Department of Urology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giorgio Gandaglia
- Division of Experimental Oncology, Department of Urology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology, Department of Urology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Department of Urology, Institute of Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Alberto Briganti
- Division of Experimental Oncology, Department of Urology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada
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184
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Gräsbeck H, Ekroos H, Halonen K, Vasankari T. Weak smoking cessation awareness in primary health care before surgery: a real-world, retrospective cohort study. Scand J Prim Health Care 2020; 38:42-46. [PMID: 32019399 PMCID: PMC7054971 DOI: 10.1080/02813432.2020.1717093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective: Tobacco smoking is a well-established risk factor for postoperative complications. Research on preoperative smoking cessation in primary health care is scarce.Design: This was a retrospective cohort study.Setting: The Stop Smoking before Surgery Project (SSSP) started in Porvoo, Finland, in May of 2016, involving both primary health care and specialized health care. The goals of the project were smoking awareness and preoperative smoking cessation.Subjects: Our study involved 1482 surgical patients operated at Porvoo Hospital between May and December of 2016.Main outcome measures: We studied the recording of smoking status in all patients, and ICD-10 diagnosis of nicotine dependency and the initiation of preoperative smoking cessation in current smokers. Variables were studied from electronic patient records, comparing primary health care referrals and surgical outpatient clinic records.Results: Smoking status was visible in 14.2% of primary health care referrals, and in 18.4% of outpatient clinic records. Corresponding rates for current smokers (n = 275) were 0.0 and 8.7% for ICD-10 diagnosis of nicotine dependence, and 2.2 and 15.3% for initiation of preoperative smoking cessation. The differences between primary health care referrals and outpatient clinic records were statistically significant for all three variables (p ≤ .001).Conclusion: In primary health care, very little attention was paid to preoperative smoking cessation. Rates were significantly better at the surgical outpatient clinic, but still low. We could not demonstrate any certain effect of the intervention. Our results call for future research on ways to improve smoking cessation rates.Key pointsTobacco smoking is a well-established risk factor for postoperative complications. Research on preoperative smoking cessation in primary health care is scarce.We found weak smoking awareness and weak smoking cessation intervention numbers among both primary and specialized health care doctors. Our results indicate an urgent need for an efficient preoperative smoking cessation model involving both primary and specialized health care.
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Affiliation(s)
- Helene Gräsbeck
- Department of Pulmonary Medicine, Porvoo Hospital, Porvoo, Finland;
- Doctoral Programme of Clinical Research, University of Helsinki, Helsinki, Finland;
- CONTACT Helene Gräsbeck Department of Pulmonary Medicine, Porvoo Hospital, Sairaalantie 1, 06150 Porvoo, Finland
| | - Heikki Ekroos
- Department of Pulmonary Medicine, Porvoo Hospital, Porvoo, Finland;
| | - Kimmo Halonen
- Department of Surgery, Porvoo Hospital, Porvoo, Finland;
| | - Tuula Vasankari
- Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland;
- Finnish Lung Health Association (FILHA), Helsinki, Finland
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185
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Shin JM, Park JH, Yang HW, Lee HM, Park IH. Cigarette smoke extract inhibits cell migration and contraction via the reactive oxygen species/adenosine monophosphate-activated protein kinase pathway in nasal fibroblasts. Int Forum Allergy Rhinol 2020; 10:356-363. [PMID: 31693801 DOI: 10.1002/alr.22479] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 09/15/2019] [Accepted: 10/16/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Fibroblast migration plays a significant role in wound healing after endoscopic sinonasal surgery. Cigarette smoke extract (CSE) is a potent inhibitor of fibroblast functions including cell proliferation and migration. The purpose of the study was to determine the influence of CSE on migration and collagen gel contraction in nasal fibroblasts and investigate its underlying mechanisms. METHODS Fibroblast migration was evaluated using wound healing assay and transwell migration assay. Contractile activity was assessed by collagen gel contraction assay. Reactive oxygen species (ROS) were quantified by 2',7'-dichlorofluorescein diacetate. Fibroblasts were treated with CSE and N-acetylcysteine (NAC), metformin, compound C, or transfected with small interfering RNA (siRNA) to suppress adenosine monophosphate-activated protein kinase (AMPK) expression. AMPK activation was determined by Western blot. RESULTS CSE and metformin were found to significantly reduce the migration and collagen gel contraction activity of nasal fibroblasts. Conversely, pretreatment with NAC and compound C significantly enhanced the migration and collagen gel contraction activity of fibroblasts. ROS production and AMPK phosphorylation were found to be significantly induced by CSE treatment, whereas the activity was inhibited on treatment with NAC, metformin, compound C, or AMPK siRNA. Silencing of AMPK expression was found to significantly reverse the suppressive effect of CSE in nasal fibroblasts. CONCLUSION CSE has an inhibitory effect on cell migration and collagen gel contraction activity via the ROS/AMPK signaling pathway in nasal fibroblasts.
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Affiliation(s)
- Jae-Min Shin
- Upper Airway Chronic inflammatory Diseases Laboratory, Korea University, College of Medicine, Seoul, Korea
- Medical Devices Clinical Trials Laboratory, Korea University, College of Medicine, Seoul, Korea
- IVD Support Center Korea University, Korea University, College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University, College of Medicine, Seoul, Korea
| | - Joo-Hoo Park
- Upper Airway Chronic inflammatory Diseases Laboratory, Korea University, College of Medicine, Seoul, Korea
- Medical Devices Clinical Trials Laboratory, Korea University, College of Medicine, Seoul, Korea
- IVD Support Center Korea University, Korea University, College of Medicine, Seoul, Korea
| | - Hyun-Woo Yang
- Upper Airway Chronic inflammatory Diseases Laboratory, Korea University, College of Medicine, Seoul, Korea
- IVD Support Center Korea University, Korea University, College of Medicine, Seoul, Korea
| | - Heung-Man Lee
- Upper Airway Chronic inflammatory Diseases Laboratory, Korea University, College of Medicine, Seoul, Korea
- IVD Support Center Korea University, Korea University, College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University, College of Medicine, Seoul, Korea
| | - Il-Ho Park
- Upper Airway Chronic inflammatory Diseases Laboratory, Korea University, College of Medicine, Seoul, Korea
- Medical Devices Clinical Trials Laboratory, Korea University, College of Medicine, Seoul, Korea
- IVD Support Center Korea University, Korea University, College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University, College of Medicine, Seoul, Korea
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186
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Combs P, Imamura T, Siddiqi U, Spiller RE, Williamson R, Mirzai S, Symalla T, LaBuhn C, Jeevanandam V. Effect of tobacco smoking on outcomes after left ventricular assist device implantation. Artif Organs 2020; 44:693-699. [DOI: 10.1111/aor.13660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/22/2020] [Accepted: 01/27/2020] [Indexed: 01/30/2023]
Affiliation(s)
- Pamela Combs
- Department of Surgery University of Chicago Medical Center Chicago IL USA
- Section of Cardiac Surgery The University of Chicago Biological Sciences Chicago IL USA
| | - Teruhiko Imamura
- Department of Medicine University of Chicago Medical Center Chicago IL USA
| | - Umar Siddiqi
- Department of Surgery University of Chicago Medical Center Chicago IL USA
| | - Robert E. Spiller
- Department of Surgery University of Chicago Medical Center Chicago IL USA
| | - Rebecca Williamson
- Department of Surgery University of Chicago Medical Center Chicago IL USA
| | - Saeid Mirzai
- Department of Surgery University of Chicago Medical Center Chicago IL USA
| | - Trevor Symalla
- Department of Surgery University of Chicago Medical Center Chicago IL USA
| | - Colleen LaBuhn
- Department of Surgery University of Chicago Medical Center Chicago IL USA
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187
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Wang CY, Dudzinski J, Nguyen D, Armbrecht E, Maher IA. Association of Smoking and Other Factors With the Outcome of Mohs Reconstruction Using Flaps or Grafts. JAMA FACIAL PLAST SU 2020; 21:407-413. [PMID: 31194217 DOI: 10.1001/jamafacial.2019.0243] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Importance Smoking, a common lifestyle trait, is considered by many surgeons to be a major risk factor for postoperative complications. However, in the literature on local reconstruction, the association between smoking and the rate of postoperative complications after cutaneous tissue transfer is not well characterized. Objective To study the outcomes of flaps and grafts used in Mohs micrographic surgery reconstruction with respect to smoking status and patient-specific and surgery-specific variables. Design, Setting, and Participants This retrospective case-control study was conducted at a single tertiary referral center among 1008 patients who underwent Mohs reconstruction repaired by flap or graft between July 1, 2012, and June 30, 2016, and were selected via consecutive sampling. Cases with incomplete records or those in which a single flap or graft was used to repair multiple defects were excluded. Data analysis was performed from September 2017 to January 2018. Main Outcomes and Measures Postoperative acute and long-term complications. Acute complications included postsurgical infection, dehiscence, hematoma, uncontrolled bleeding, and tissue necrosis that required medical counseling or intervention. Long-term complications included functional or cosmetic outcomes that prompted the patient to request or the surgeon to offer additional intervention. Results Of the 1008 patients included in the study (396 women and 612 men), the median (SD) age was 70 (12) years (range, 21-90 years). A total of 128 patients (12.7%) were current smokers, 385 (38.2%) were former smokers, and 495 (49.1%) were never smokers. On multivariate logistic regression, current smoking (odds ratio [OR], 9.58; 95% CI, 3.63-25.3), former smoking (OR, 3.64; 95% CI, 1.41-9.38), larger defect size (OR, 2.25; 95% CI, 1.58-3.20), and the use of free cartilage graft (OR, 8.19; 95% CI, 2.02-33.1) were associated with increased risks of acute complications. For long-term complications, central face location (OR, 25.4; 95% CI, 6.16-106.5), use of interpolation flap or flap-graft combination (OR, 3.49; 95% CI, 1.81-6.74), larger flap size (OR, 1.42; 95% CI, 1.09-1.87), and basal cell carcinomas or other basaloid tumors (OR, 3.43; 95% CI, 1.03-11.5) were associated with an increased risk, whereas increased age (OR, 0.66 per 10-year interval; 95% CI, 0.54-0.80) was associated with decreased risk. Conclusions and Relevance This study suggests that both current and former smokers are at increased risk for acute postsurgical complications but that smoking status is not associated with long-term complications. These findings may allow the surgeon to better quantify the magnitude of risk and provide helpful information for patient counseling. Level of Evidence 3.
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Affiliation(s)
- Chang Ye Wang
- Department of Dermatology, St Louis University, St Louis, Missouri
| | | | - Derek Nguyen
- St Louis University School of Medicine, St Louis, Missouri
| | - Eric Armbrecht
- Department of Dermatology, St Louis University, St Louis, Missouri
| | - Ian A Maher
- Department of Dermatology, University of Minnesota, Minneapolis
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188
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Crippen MM, Patel N, Filimonov A, Brady JS, Merchant AM, Baredes S, Park RCW. Association of Smoking Tobacco With Complications in Head and Neck Microvascular Reconstructive Surgery. JAMA FACIAL PLAST SU 2020; 21:20-26. [PMID: 30347003 DOI: 10.1001/jamafacial.2018.1176] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Smoking is a highly prevalent risk factor among patients with head and neck cancer. However, few studies have examined the association of this modifiable risk factor on postoperative outcomes following microvascular reconstruction of the head and neck. Objective To analyze the risk associated with smoking in patients undergoing free flap surgery of the head and neck. Design, Setting, and Participants In this retrospective, population, database study, the National Quality Improvement Program data sets from 2005 to 2014 were queried for all cases of head and neck surgery involving free flap reconstruction in the United States. The 2193 cases identified were stratified into smoking and nonsmoking cohorts and compared using χ2 and binary logistic regression analyses. Pack-years of smoking data were used to assess the degree of risk associated with a prolonged history of smoking. All analyses were conducted between January 2018 and June 2018. Main Outcomes and Measures Smoking and nonsmoking cohorts were compared for rates of demographic characteristics, comorbidities, and complications. Following correction for differences in patient demographics and comorbidities, smoking and nonsmoking cohorts were compared for rates of postoperative complications. Complication rates were further assessed within the smoking cohort by number of pack years smoked. Results Of the 2193 patients identified as having undergone free flap reconstruction of the head and neck, 624 (28.5%) had a history of recent smoking. After accounting for differences in demographic variables and patient comorbidities using regression analyses, smoking status was found to be independently associated with wound disruption (odds ratio, 1.74; 95% CI, 1.17-2.59; P = .006) and unplanned reoperation (odds ratio, 1.50; 95% CI, 1.15-1.95; P = .003). An analysis by pack-years of smoking showed that a longer smoking history was significantly associated with higher rates of numerous comorbidities but not with a corresponding increase in rates of complications. Conclusions and Relevance Smokers undergoing free flap reconstruction of the head and neck may be at significantly higher risk of postoperative wound disruption and subsequent reoperation. These risks were independent of pack-years of smoking history, suggesting that both risks were associated with perioperative smoke exposure, and preoperative smoking cessation may be of benefit. Level of Evidence NA.
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Affiliation(s)
- Meghan M Crippen
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark
| | - Nirali Patel
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark
| | - Andrey Filimonov
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark
| | - Jacob S Brady
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark
| | - Aziz M Merchant
- Department of Surgery, Rutgers New Jersey Medical School, Newark
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark
| | - Richard Chan Woo Park
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark
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189
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Cottom JM, Douthett SM, McConnell KK, Plemmons BS. The Effect of Tobacco Use on Incision Healing in Total Ankle Arthroplasty: A Review of 114 Patients. Foot Ankle Spec 2020; 13:27-31. [PMID: 30720341 DOI: 10.1177/1938640019826675] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to compare wound complication rates after total ankle replacement in 3 groups of patients based on tobacco status. The total cohort was divided into 3 groups based on tobacco history. Group 1 included patients who were actively tobacco users. Group 2 included patients with a history of tobacco user. Group 3 served as the control group and included patients who had never used tobacco. Available charts were reviewed for patients who underwent primary total ankle arthroplasty by 1 surgeon. Patient demographics, tobacco history, and postoperative wound complications were recorded. A total of 114 patients with tobacco history were available for follow-up and were included in this study, which ranged from March 2012 to July 2017. Group 1 included 11 active smokers. Group 2 included 38 former smokers, and group 3 had a total of 65 never smokers included. The average follow-up was 28 months for group 1 (range 10-55 months), 34.1 months for group 2 (range 12-60 months), and 32.8 months for group 3 (range 11-60 months). The wound complication rate was noted to be statistically significant when comparing active smokers to never smokers using Fisher's exact test (P = .0223). When comparing former smokers with never smokers, the difference in wound complication rate did not reach statistical significance (P = 0.7631). All patients underwent at least 1 concomitant procedure at the time of initial ankle replacement. Our findings show that total ankle replacement wound healing complication rates are significantly higher in active tobacco users. There was no significant difference in wound healing complications when comparing former tobacco users versus never tobacco users. Levels of Evidence: Level III: Retrospective comparative study.
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Affiliation(s)
- James M Cottom
- Florida Orthopedic Foot and Ankle Center, Sarasota, Florida (JMC, SMD, KKM).,Longview Orthopedic Clinic Association, Longview, Texas, USA (BSP)
| | - Steven M Douthett
- Florida Orthopedic Foot and Ankle Center, Sarasota, Florida (JMC, SMD, KKM).,Longview Orthopedic Clinic Association, Longview, Texas, USA (BSP)
| | - Kelly K McConnell
- Florida Orthopedic Foot and Ankle Center, Sarasota, Florida (JMC, SMD, KKM).,Longview Orthopedic Clinic Association, Longview, Texas, USA (BSP)
| | - Britton S Plemmons
- Florida Orthopedic Foot and Ankle Center, Sarasota, Florida (JMC, SMD, KKM).,Longview Orthopedic Clinic Association, Longview, Texas, USA (BSP)
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190
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Osmonov D, Christopher AN, Blecher GA, Falcone M, Soave A, Dahlem R, Czeloth K, Bannowsky A, Matanes E, Ward S, Martínez-Salamanca JI, Bettocchi C, Garaffa G, Reisman Y, Corona G. Clinical Recommendations From the European Society for Sexual Medicine Exploring Partner Expectations, Satisfaction in Male and Phalloplasty Cohorts, the Impact of Penile Length, Girth and Implant Type, Reservoir Placement, and the Influence of Comorbidities and Social Circumstances. J Sex Med 2020; 17:210-237. [PMID: 31812683 DOI: 10.1016/j.jsxm.2019.10.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/30/2019] [Accepted: 10/09/2019] [Indexed: 01/28/2023]
Abstract
INTRODUCTION To date, several aspects of inflatable penile prosthesis (IPP) surgical procedure have been poorly studied. AIM The aim of this study was to review the evidence associated with IPP implantation and provide clinical recommendations on behalf of the European Society for Sexual Medicine (ESSM). Overall, 130 peer-reviewed studies and systematic reviews, which were published from 2007-2018 in the English language, were included. METHODS MEDLINE and EMBASE were searched for randomized clinical trials, meta-analyses, and open-label prospective and retrospective studies. MAIN OUTCOME MEASURE The panel provided statements exploring patients and partner expectations, satisfaction in male and phalloplasty cohorts, the impact of penile length, girth and implant type, reservoir placement, the influence of comorbidities, and social circumstances. Levels of evidence were provided according to the Oxford 2011 criteria and graded as for the Oxford Centre for Evidence-Based Medicine recommendations. RESULTS In the preoperative setting, it is fundamental to identify and interact with difficult patients with the intention of enhancing the surgeon's ability to establish the surgeon-patient relationship, reduce physical and legal risk, as well as enhancing patient satisfaction. To address this need, the mnemonic Compulsive, Unrealistic, Revision, Surgeon Shopping, Entitled, Denial, and Psychiatric ("CURSED") has been suggested to identify patients who are at high risk of dissatisfaction. The current recommendations suggest improving glycemic control in patients with diabetes. Available evidence suggests evaluating transplant recipients with the criteria of Barry, consisting of stable graft function for >6 months, avoidance of intra-abdominal reservoir placement, and low-dose immunosuppression. HIV status does not represent a contraindication for surgery. Smoking, peripheral vascular disease, and hypertension may be associated with an increased risk of revision surgery. Patients with spinal cord injury may receive IPP. Patients aged ≥70 years, as well as obese patients, can be offered IPP. The IPP implantation can be performed in patients with stable Peyronie's disease. Ectopic high submuscular reservoir placement can be considered as an alternative method. CLINICAL IMPLICATIONS There is a relevant lack of high-level data and definite conclusions in certain areas remain difficult to draw. STRENGTH & LIMITATIONS All studies have been evaluated by a panel of experts providing recommendations for clinical practice. Because of lack of sufficient prospective data, some of the included studies are retrospective and this could be stated as a limitation. CONCLUSION This ESSM position statement provides recommendations on optimization of patient outcome by patient selection, and individualized peri- and intra-operative management. ESSM encourages centers to collaborate and to create prospective, multicenter registries in order to address this topic of increasing importance. Osmonov D, Christopher AN, Blecher GA, et al. Clinical Recommendations from the European Society for Sexual Medicine Exploring Partner Expectations, Satisfaction in Male and Phalloplasty Cohorts, the Impact of Penile Length, Girth and Implant Type, Reservoir Placement, and the Influence of Comorbidities and Social Circumstances. J Sex Med 2020;17:210-237.
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Affiliation(s)
- Daniar Osmonov
- Department of Urology and Pediatric Urology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
| | - Andrew Nim Christopher
- Department of Urology, University College London Hospitals & St Peters Andrology Centre, London, UK
| | - Gideon A Blecher
- Department of Urology, The Alfred Hospital, Melbourne, Australia; Monash Health, Melbourne, Australia
| | - Marco Falcone
- Department of Urology, University of Turin - Cittàdella Salute e della Scienza, Turin, Italy
| | - Armin Soave
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Roland Dahlem
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karen Czeloth
- Vitus Prostata Center Offenbach, Prof. Stehling Institut für bildgebende Diagnostik, Germany
| | | | - Emad Matanes
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Sam Ward
- Department of Urology, Clinique Saint Jean, Brussels; Medicis Medical Center, Woluwe, Belgium
| | - Juan Ignacio Martínez-Salamanca
- Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda Lyx Institute of Urology, Universidad Autónoma de Madrid, Spain
| | - Carlo Bettocchi
- Department of Urology, University of Bari, Bari, Apulia, Italy
| | - Giulio Garaffa
- The Institute of Urology, University College London Hospitals, London, UK
| | - Yacov Reisman
- Department of Urology, Amstelland Hospital, Amstelveen, The Netherlands
| | - Giovanni Corona
- Endocrinology Unit, Medical Department, AziendaUsl Bologna Maggiore-Bellaria Hospital, Bologna, Italy
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191
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Abstract
OBJECTIVES To recognize cancer prehabilitation as a pretreatment regimen to increase functional status for patients requiring cancer treatment. This article presents current evidence addressing the efficacy and benefits of prehabilitation regimens in different cancer survivor populations. DATA SOURCES Studies and case reports in the PubMed database. CONCLUSION Cancer prehabilitation may improve outcomes. Prehabilitation may include targeted or whole-body exercise, nutrition, education, psychologic counseling, and smoking cessation. Opportunities exist to further improve access to and delivery of multimodal prehabilitation, and nurses play a critical role in connecting patients to these services. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses who are knowledgeable of cancer treatment-related effects are poised to assess survivors for existing impairments, advocate for prehabilitation for existing and potential morbidities, and monitor functional status over time. As patient educators, they are key to informing cancer survivors about the role of prehabilitation.
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192
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Improving Shared Decision-making and Treatment Planning Through Predictive Modeling: Clinical Insights on Ventral Hernia Repair. Comput Inform Nurs 2020; 38:227-231. [PMID: 31929356 DOI: 10.1097/cin.0000000000000590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Abdominal wall hernia repair, including ventral hernia repair, is one of the most common general surgical procedures. Nationally, at least 350 000 ventral hernia repairs are performed annually, and of those, 150 000 cases were identified as incisional hernias. Outcomes are reported to be poor, resulting in additional surgical repair rates of 12.3% at 5 years and as high as 23% at 10 years. Healthcare costs associated with ventral hernia repair are estimated to exceed $3 billion each year. Additionally, ventral hernia repair is often complex and unpredictable when there is a current infection or a history of infection and significant comorbidities. Accordingly, a predictive model was developed using a retrospectively collected dataset to associate the pre- and intra-operative characteristics of patients to their outcomes, with the primary goal of identifying patients at risk of developing complications a priori in the future. The benefits and implications of such a predictive model, however, extend beyond this primary goal. This predictive model can serve as an important tool for clinicians who may use it to support their clinical intuition and clarify patient need for lifestyle modification prior to abdominal wall reconstruction. This predictive model can also support shared decision-making so that a personalized plan of care may be developed. The outcomes associated with use of the predictive model may include surgical repair but may suggest lifestyle modification coupled with less invasive interventions.
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193
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Napolitano M, Brody F, Lee KB, Rosenfeld E, Chen S, Murillo-Berlioz AE, Amdur R. 30-Day outcomes and predictors of complications after Puestow procedure. Am J Surg 2020; 220:372-375. [PMID: 31894016 DOI: 10.1016/j.amjsurg.2019.12.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/10/2019] [Accepted: 12/18/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND A lateral pancreaticojejunostomy, or a Puestow procedure, is used in chronic pancreatitis with ductal dilation and pain. The current literature on the Puestow is sparse. This study examines outcomes of Puestow procedures nationwide. METHODS Using ACS-NSQIP database, patients who underwent a Puestow procedure from 2010 to 2016 were identified. Univariate analysis and multivariable regression models were used to identify predictors of mortality and morbidities. Covariates included in the regression models were chosen based on clinical significance. RESULTS The cohort included 524 patients. The 30-day mortality rate was 1.2%(n = 6). At least one major complication occurred in 19.1% of patients including death (1.2%), major organ dysfunction (8.2%), pulmonary embolism (1.3%), and surgical site infections (13.0%). Diabetes, COPD, and transfusions were the strongest predictors of complications. CONCLUSIONS The Puestow procedure is an acceptable treatment modality with low rates of morbidity and mortality. Minimizing transfusions and optimizing pulmonary status may improve 30-day outcomes.
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Affiliation(s)
- Michael Napolitano
- Department of Surgery, Washington D.C. Veterans Affairs Medical Center, Washington D.C., USA; Department of Surgery, George Washington University Hospital, Washington D.C., USA
| | - Fred Brody
- Department of Surgery, Washington D.C. Veterans Affairs Medical Center, Washington D.C., USA.
| | - Kyongjune Benjamin Lee
- Department of Surgery, Washington D.C. Veterans Affairs Medical Center, Washington D.C., USA; Department of Surgery, George Washington University Hospital, Washington D.C., USA
| | - Ethan Rosenfeld
- Department of Surgery, Washington D.C. Veterans Affairs Medical Center, Washington D.C., USA; Department of Surgery, George Washington University Hospital, Washington D.C., USA
| | - Sheena Chen
- Department of Surgery, Washington D.C. Veterans Affairs Medical Center, Washington D.C., USA; Department of Surgery, George Washington University Hospital, Washington D.C., USA
| | - Alejandro Ernesto Murillo-Berlioz
- Department of Surgery, Washington D.C. Veterans Affairs Medical Center, Washington D.C., USA; Department of Surgery, George Washington University Hospital, Washington D.C., USA
| | - Richard Amdur
- Department of Surgery, George Washington University Hospital, Washington D.C., USA
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194
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Sharma K, Mull A, Friedman J, Pan D, Poppler L, Fox IK, Levin LS, Moore AM. Development and Validation of a Prognostic, Risk-Adjusted Scoring System for Operative Upper-Extremity Infections. J Hand Surg Am 2020; 45:9-19. [PMID: 31901333 DOI: 10.1016/j.jhsa.2019.10.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 08/07/2019] [Accepted: 10/11/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Acute infections of the distal upper extremity (UE) can require one and possibly multiple debridements. We aimed to develop and validate a prognostic scoring system based on patient, infection, and microbiology risk factors to help with operative planning and patient counseling. METHODS We studied all acute surgical UE infections distal to the elbow joint over a 5-year period. A split-sample design was created with 1:1 randomization into development and validation samples. The primary outcome was infection persistence, defined as the need for additional operative drainage according to usual indications. Multivariable logistic regression identified risk factors for persistent infections in the development sample, which was translated to a simple clinical scoring system derived from regression coefficients. The model was then tested separately against the validation sample. RESULTS A total of 602 patients were included; 31% of all infections exhibited persistence. Independent risk factors from the development sample included diabetes (3 points), smoking (2 points), leukocytosis at presentation (2 points), animal bite mechanism (3 points), osteomyelitis (4 points), tenosynovitis (7 points), pyarthrosis (3 points), necrotizing fasciitis (11 points), and methicillin-resistant Staphylococcus aureus (3 points). These were all confirmed in the validation sample. Infections were categorized into 3 groups based on risk for persistent infection: low (less than 8 points), medium (8-11 points), and high (12 points or more). In the validation sample, the probability of persistent infection for these 3 groups was 23%, 57%, and 79%, respectively. The c statistic for the model in the validation sample was 0.79. CONCLUSIONS Persistence of acute surgical distal UE infections is mediated by patient and microbiology factors, as well as infection mechanism and type. Surgeons can use this risk-adjusted prognostic scoring system to anticipate which infections may require additional therapeutic debridement and plan operative schedules and counsel patients accordingly. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Affiliation(s)
- Ketan Sharma
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St Louis, St. Louis, MO; Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Aaron Mull
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St Louis, St. Louis, MO
| | - James Friedman
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Deng Pan
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St Louis, St. Louis, MO
| | - Louis Poppler
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St Louis, St. Louis, MO
| | - Ida K Fox
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St Louis, St. Louis, MO
| | - L Scott Levin
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA; Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Amy M Moore
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St Louis, St. Louis, MO; Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, OH.
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Coovadia S, D'Alimonte L, Bristow B, Curle E, Gibson L, Di Prospero L. Catalyst for Change: Measuring the Effectiveness of Training of All Health Care Professionals to Provide Brief Intervention for Smoking Cessation to Cancer Patients. J Med Imaging Radiat Sci 2019; 51:7-11. [PMID: 31864933 DOI: 10.1016/j.jmir.2019.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/02/2019] [Accepted: 10/02/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Smoking cessation is recommended to prevent individuals from developing cancer, with additional benefits after a cancer diagnosis. Tobacco use during cancer treatments increases the risk of complications and may reduce the effectiveness of treatment; patients who quit smoking are less likely to experience recurrence. Health care professionals play a vital role in assessing and educating cancer patients on how to quit. We report on the effectiveness of peer-to-peer education of a brief smoking cessation intervention to patients. METHODS An interprofessional team was created to implement and integrate smoking cessation best practices into daily clinical care. Health care providers were provided with peer-to-peer training to provide brief interventions of smoking cessation to patients. After training, participants were invited to complete an electronic survey to assess the effectiveness of the peer-to-peer training sessions. The survey consisted of 3 domains: confidence, comfort, and knowledge. Participants were asked to rate a series of statement questions using a Likert scale as well as to self-assess knowledge. The survey also included open-ended questions to invite respondents to share further comments and feedback. RESULTS Approximately 90% of staff across the oncology program participated in a training session. This included nurses, radiation therapists, and patient and family support professionals. Sixty-one surveys were returned (30% response rate). Most respondents had >10 years of clinical experience (70%), 91% agreed it was important to support patients in their efforts to quit smoking, 88% agreed they have an impact on their patients' smoking cessation attempts, and 67% had opportunities in daily practice to support smoking cessation. Sixty-one percent would benefit from additional education. Fifty-three percent indicated they experienced challenges providing interventions and patients' responsiveness to the intervention. CONCLUSIONS Peer-to-peer training for smoking cessation can increase confidence, comfort, and knowledge. Challenges include comfort level of clinician, determining the best time to ask patients, and having the confidence in knowing their scope of practice.
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Affiliation(s)
- Sadiya Coovadia
- Department of Radiation Therapy, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Laura D'Alimonte
- Department of Radiation Therapy, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Nursing, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Bonnie Bristow
- Department of Radiation Therapy, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Elaine Curle
- Department of Patient and Family Support, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Leslie Gibson
- Practice-based Research and Innovation, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lisa Di Prospero
- Department of Nursing, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
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196
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Wang X, Zhang W. [Research progress of two-stage revision for periprosthetic joint infection after hip and knee arthroplasties]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:1566-1571. [PMID: 31823560 DOI: 10.7507/1002-1892.201901098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To summarize the research progress of two-stage revision for periprosthetic joint infection (PJI) after hip and knee arthroplasties. Methods The related literature on two-stage revision for PJI was summarized, and the new progress in the choice of spacers, systemic antibiotic therapy, and risk factors were analyzed. Results Two-stage revision is a common way to treat infection after hip and knee arthroplasties. The types of spacers used in the one-stage operation are diverse and each has its own advantages and disadvantages. Non-articular spacers are mainly used for the patients with poor soft tissue conditions around the joints and severe bone defects. But the joint mobility is not good after the placement of the spacer. Articular spacers can restore the affected joint movement after operation, which is beneficial to the joint mobility after two-stage operation. The use of antibiotics is an indispensable part of the treatment process, and the effectiveness of short-term antibiotic treatment is similar to long-term treatment. Identifying the relevant risk factors that influence the prognosis of the two-stage revision can help preoperative management and reduce the recurrence rate of infection. Conclusion There are still controversies about the choice of spacers and systemic antibiotic therapy during the two-stage revision and treatment of PJI. The factors affecting the prognosis of the two-stage revision need to be explored and the further high-quality research is needed.
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Affiliation(s)
- Xiangxuan Wang
- Department of Orthopedics, the First Affiliated Hospital of Fujian Medical University, Fuzhou Fujian, 350000, P.R.China
| | - Wenming Zhang
- Department of Orthopedics, the First Affiliated Hospital of Fujian Medical University, Fuzhou Fujian, 350000,
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197
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Ashraff S, Siddiqui MA, Santos D, Carline T. Prediction of stump healing in lower limb amputation: a narrative review. J Wound Care 2019; 28:S18-S25. [PMID: 31825767 DOI: 10.12968/jowc.2019.28.sup12.s18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Both types of diabetes, as well as different forms of acquired diabetes, are associated with diabetic peripheral neuropathy. Diabetic foot ulcers (DFU) is the condition most commonly related to somatic peripheral neuropathy, often leading to gangrene and limb amputation. Independent from large-vessel disease, sensory loss may result in DFU development and even amputation. The crucial part of any lower limb amputation is the stump healing process, which represents the central goal of postoperative management. Despite the importance attributed to this process, a standard set of guidelines regarding efficient healing methods is yet to be formulated. Health professionals are faced with the challenge of assessing the different risk factors and deciding which has a greater influence on the stump healing rate. There is currently an insufficient number of studies regarding factors effecting lower limb amputation. The main purpose of this review is to discuss the markers that can be helpful in the prediction of stump healing in patients who have undergone lower limb amputation.
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Affiliation(s)
| | - Muhammad A Siddiqui
- Research and Performance Support, Saskatchewan Health Authority, Regina, Canada
| | - Derek Santos
- School of Health Sciences, Queen Margaret University, Edinburgh, UK
| | - Thomas Carline
- School of Health Sciences, Queen Margaret University, Edinburgh, UK
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198
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Xiao R, Pham Y, Ward MC, Houston N, Reddy CA, Joshi NP, Greskovich JF, Woody NM, Chute DJ, Lamarre ED, Prendes BL, Lorenz RR, Scharpf J, Burkey BB, Geiger JL, Adelstein DJ, Koyfman SA. Impact of active smoking on outcomes in HPV+ oropharyngeal cancer. Head Neck 2019; 42:269-280. [DOI: 10.1002/hed.26001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 08/13/2019] [Accepted: 10/18/2019] [Indexed: 11/08/2022] Open
Affiliation(s)
- Roy Xiao
- Department of OtolaryngologyHarvard Medical School Boston Massachusetts
- Department of OtolaryngologyMassachusetts Eye and Ear Boston Massachusetts
| | - Yvonne Pham
- Department of Radiation OncologyResearch Medical Center, Therapeutic Radiologists, Inc. Kansas City Missouri
| | | | - Narcissa Houston
- Department of Radiation OncologyTaussig Cancer Institute, Cleveland Clinic Cleveland Ohio
| | - Chandana A. Reddy
- Department of Radiation OncologyTaussig Cancer Institute, Cleveland Clinic Cleveland Ohio
| | - Nikhil P. Joshi
- Department of Radiation OncologyTaussig Cancer Institute, Cleveland Clinic Cleveland Ohio
| | - John F. Greskovich
- Department of Radiation OncologyTaussig Cancer Institute, Cleveland Clinic Florida Weston Florida
| | - Neil M. Woody
- Department of Radiation OncologyTaussig Cancer Institute, Cleveland Clinic Cleveland Ohio
| | - Deborah J. Chute
- Department of Anatomic Pathology, Pathology & Laboratory MedicineCleveland Clinic Cleveland Ohio
| | - Eric D. Lamarre
- Department of OtolaryngologyHead and Neck Institute, Cleveland Clinic Cleveland Ohio
| | - Brandon L. Prendes
- Department of OtolaryngologyHead and Neck Institute, Cleveland Clinic Cleveland Ohio
| | - Robert R. Lorenz
- Department of OtolaryngologyHead and Neck Institute, Cleveland Clinic Cleveland Ohio
| | - Joseph Scharpf
- Department of OtolaryngologyHead and Neck Institute, Cleveland Clinic Cleveland Ohio
| | - Brian B. Burkey
- Department of OtolaryngologyHead and Neck Institute, Cleveland Clinic Cleveland Ohio
| | - Jessica L. Geiger
- Department of Hematology and Medical OncologyTaussig Cancer Institute, Cleveland Clinic Cleveland Ohio
| | - David J. Adelstein
- Department of Hematology and Medical OncologyTaussig Cancer Institute, Cleveland Clinic Cleveland Ohio
| | - Shlomo A. Koyfman
- Department of Radiation OncologyTaussig Cancer Institute, Cleveland Clinic Cleveland Ohio
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199
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Wong J, An D, Urman RD, Warner DO, Tønnesen H, Raveendran R, Abdullah HR, Pfeifer K, Maa J, Finegan B, Li E, Webb A, Edwards AF, Preston P, Bentov N, Richman DC, Chung F. Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement on Perioperative Smoking Cessation. Anesth Analg 2019; 131:955-968. [DOI: 10.1213/ane.0000000000004508] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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200
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McKissack HM, Viner GC, Jha AJ, Wilson JT, Anderson MC, McGwin G, Shah AB. Comparison of risk factors for postoperative complications across age groups in patients undergoing ORIF of the ankle. Injury 2019; 50:2116-2122. [PMID: 31547967 DOI: 10.1016/j.injury.2019.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/09/2019] [Accepted: 09/08/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Risk factors associated with various adverse outcomes for patients undergoing open reduction and internal fixation (ORIF) of the ankle, and how these risks differ between younger and older patient populations, has not been clearly established. Objective quantitative data may aid physicians in surgical decision making, individualizing postoperative management, and targeting interventions for reducing postoperative comorbidity. The purpose of this study is to compare the incidence of and risk factors for adverse postoperative outcomes following ORIF of ankle fractures across patient age groups. MATERIALS AND METHODS Charts of patients age 18 years and older who underwent open reduction and internal fixation (ORIF) for any closed, non-polytraumatic, non-pilon ankle fracture at a single institution between the years 2008 and 2018 were reviewed. Demographic information, comorbidities, and postoperative outcomes were collected. Relative risks for adverse outcomes were calculated and compared between patients younger than 50 and patients 50 years and older. RESULTS A total of 886 patients were included, 375 (42.3%) of which were over age 50. In both age groups, risk of infection was significantly increased among patients with hypertension, although risk among older patients (RR = 3.52, p = 0.004) was greater than that among younger patients (RR = 2.46, p = 0.017). In patients younger than 50, significant risk of wound dehiscence was associated with tobacco use (RR = 3.39, p = 0.022), substance use (RR = 3.07, p = 0.020), and CHF (RR = 12.77, p < 0.001). Risk of implant failure was significantly increased among younger patients with HIV (RR = 4.33, p = 0.026), CHF (RR = 10.54, p < 0.001), and CKD (RR = 10.54, p < 0.001), and among older patients with HTN (RR = 4.51, p = 0.006), CHF (RR = 5.83, p < 0.001), and tobacco use (RR = 3.82, P = 0.001). CONCLUSION Patients undergoing ORIF of the ankle should be well-informed of the potential risks of surgery as they pertain to specific comorbidities. Multidisciplinary approaches are warranted for appropriate management of patients with multiple comorbidities.
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Affiliation(s)
- Haley M McKissack
- Division of Orthopaedic Surgery, Department of Surgery, University of Alabama, Birmingham, School of Medicine, 1313 13th Street South, Suite 226, Birmingham, Alabama, 35205, USA.
| | - Gean C Viner
- Division of Orthopaedic Surgery, Department of Surgery, University of Alabama, Birmingham, School of Medicine, 1313 13th Street South, Suite 226, Birmingham, Alabama, 35205, USA.
| | - Aaradhana J Jha
- Division of Orthopaedic Surgery, Department of Surgery, University of Alabama, Birmingham, School of Medicine, 1313 13th Street South, Suite 226, Birmingham, Alabama, 35205, USA.
| | - John T Wilson
- Division of Orthopaedic Surgery, Department of Surgery, University of Alabama, Birmingham, School of Medicine, 1313 13th Street South, Suite 226, Birmingham, Alabama, 35205, USA.
| | - Matthew C Anderson
- Division of Orthopaedic Surgery, Department of Surgery, University of Alabama, Birmingham, School of Medicine, 1313 13th Street South, Suite 226, Birmingham, Alabama, 35205, USA.
| | - Gerald McGwin
- Division of Orthopaedic Surgery, Department of Surgery, University of Alabama, Birmingham, School of Medicine, 1313 13th Street South, Suite 226, Birmingham, Alabama, 35205, USA.
| | - Ashish B Shah
- Division of Orthopaedic Surgery, Department of Surgery, University of Alabama, Birmingham, School of Medicine, 1313 13th Street South, Suite 226, Birmingham, Alabama, 35205, USA.
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