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Xu G, Lovell DY, Guan X. Robot-Assisted Vaginal Natural Orifice Transluminal Endoscopic Surgery (RvNOTES) With Total Hysterectomy for Management of Stage IV Endometriosis With/Without Complete Cul-de-Sac Obliteration: 23-Case Pilot Feasibility Study. J Minim Invasive Gynecol 2024; 31:496-503. [PMID: 38493829 DOI: 10.1016/j.jmig.2024.03.006] [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: 09/18/2023] [Revised: 03/05/2024] [Accepted: 03/11/2024] [Indexed: 03/19/2024]
Abstract
STUDY OBJECTIVE To show feasibility and short-term outcomes of robot-assisted vaginal NOTES (RvNOTES) for the treatment of stage IV endometriosis during total hysterectomy with/without complete cul-de-sac obliteration. DESIGN Retrospective case series. SETTING Single academic tertiary care hospital in Houston, Texas, USA. PATIENTS Twenty-three adult women with stage IV endometriosis. INTERVENTIONS RvNOTES with total hysterectomy for excision of severe endometriosis. MEASUREMENTS AND MAIN RESULTS Patients were assessed for various metrics including total operative time, robot dock time, robot console time, hysterectomy time, estimated blood loss, perioperative pain using the Visual Analogue Scale (VAS), and complications. The mean total operative time was 224.3 minutes. The study also found that patients with complete cul-de-sac obliteration had significantly longer operative times and higher estimated blood loss compared to those with partial or no obliteration. Postoperative VAS pain scores showed a significant reduction over a 6-week period. Complications included one case of complete ureteral transection, pelvic hematoma with infection, vaginal abscess, urinary tract infection, and pneumonia. CONCLUSION Our findings suggest that RvNOTES may be a feasible surgical approach in expert hands for treating stage IV endometriosis, even in cases with complete obliteration of the cul-de-sac.
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Affiliation(s)
- Gufeng Xu
- Division of Minimally Invasive Gynecologic surgery, Baylor College of Medicine (Drs. Xu, Lovell, and Guan), Houston, Texas; Department of Ambulatory Surgery, Women's Hospital, Zhejiang University School of Medicine (Dr. Xu), Hangzhou, China
| | - Daniel Y Lovell
- Division of Minimally Invasive Gynecologic surgery, Baylor College of Medicine (Drs. Xu, Lovell, and Guan), Houston, Texas
| | - Xiaoming Guan
- Division of Minimally Invasive Gynecologic surgery, Baylor College of Medicine (Drs. Xu, Lovell, and Guan), Houston, Texas.
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Nowak R, Przywitowski S, Golusiński P, Olejnik A, Zawiślak E. Complications of Surgically Assisted Rapid Maxillary/Palatal Expansion (SARME/SARPE)-A Retrospective Analysis of 185 Cases Treated at a Single Center. J Clin Med 2024; 13:2053. [PMID: 38610817 PMCID: PMC11012378 DOI: 10.3390/jcm13072053] [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: 02/27/2024] [Revised: 03/19/2024] [Accepted: 03/30/2024] [Indexed: 04/14/2024] Open
Abstract
Objectives: The study aims to assess and classify complications in patients treated for maxillary transverse deficiency using surgically assisted rapid maxillary/palatal expansion (SARME/SARPE) under general anesthesia. The classification of the complications aimed to assess the difficulty of their treatment as well as estimate its real cost. Methods: The retrospective study covered 185 patients who underwent surgery for a skeletal deformity in the form of maxillary constriction or in which maxillary constriction was one of its components treated by a team of maxillofacial surgeons at one center (97 females and 88 males, aged 15 to 47 years, mean age 26.1 years). Complications were divided into two groups: early complications (up to 3 weeks after surgery) and late complications (>3 weeks after surgery). In relation to the occurrence of complications, we analyzed the demographic characteristics of the group, type of skeletal deformity (class I, II, III), presence of open bite and asymmetry, surgical technique, type and size of appliance used for maxillary expansion, as well as the duration of surgery. Results: In the study group, complications were found in 18 patients (9.73%). Early complications were found in nine patients, while late complications were also found in nine patients. Early complications include no possibility of distraction, palatal mucosa necrosis, perforation of the maxillary alveolar process caused by the distractor and asymmetric distraction. Late complications include maxillary incisor root resorption, no bone formation in the distraction gap, and maxillary incisor necrosis. None of the patients required prolonged hospitalization and only one required reoperation. Conclusions: Complications were found in 18 patients (9.73%). All challenges were classified as minor difficulties since they did not suppress the final outcome of the treatment of skeletal malocclusion. However, the complications that did occur required additional corrective measures. Surgically assisted rapid maxillary expansion, when performed properly and in correlation with the correct orthodontic treatment protocol, is an effective and predictable technique for treating maxillary constriction.
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Affiliation(s)
- Rafał Nowak
- Department of Otolaryngology and Maxillofacial Surgery, Institute of Medical Science, University of Zielona Góra, 65-046 Zielona Góra, Poland
| | - Szymon Przywitowski
- Face Surgery and Aesthetic Center, Pl. Powstańców Śląskich 1, 53-329 Wrocław, Poland
| | - Paweł Golusiński
- Department of Otolaryngology and Maxillofacial Surgery, Institute of Medical Science, University of Zielona Góra, 65-046 Zielona Góra, Poland
| | - Anna Olejnik
- Face Surgery and Aesthetic Center, Pl. Powstańców Śląskich 1, 53-329 Wrocław, Poland
| | - Ewa Zawiślak
- Face Surgery and Aesthetic Center, Pl. Powstańców Śląskich 1, 53-329 Wrocław, Poland
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Madadi-Sanjani O, Ure BM. Benchmarks for Pediatric Surgical Registries: Recommendations for the Assessment and Grading of Complications. Eur J Pediatr Surg 2024; 34:182-188. [PMID: 37871645 DOI: 10.1055/a-2196-1755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Procedure-related registries in general surgical practice offer a platform for prospective trials, the pooling of data, and detailed outcome analysis. Recommendations by the Idea, Development, Exploration, Assessment, and Long-term follow-up (IDEAL) collaboration and Outcome4Medicine have further improved the uniform reporting of complications and adverse events.In the pediatric surgical network, disease-specific registries for rare and inherited congenital anomalies are gaining importance, fostering international collaborations on studies of low-incidence diseases. However, to date, reporting of complications in the pediatric surgical registries has been inconsistent. Therefore, the European Reference Network for Rare Inherited and Congenital Anomalies (ERNICA) recently endorsed the validation of the first severity grading system for children. The planned reform of the European Paediatric Surgical Audit (EPSA) registry, which includes the implementation of the Clavien-Madadi classification, represents a further effort to establish uniform outcome reporting.This article provides an overview of experiences with surgical registries and complication reporting, along with the potential application of this knowledge to future pediatric surgical practice.
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Affiliation(s)
| | - Benno M Ure
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
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Oseni AO, Chun JY, Morgan R, Ratnam L. Dealing with complications in interventional radiology. CVIR Endovasc 2024; 7:32. [PMID: 38512496 PMCID: PMC10957835 DOI: 10.1186/s42155-024-00442-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/28/2024] [Indexed: 03/23/2024] Open
Abstract
It is widely accepted that most misadventures, which lead to harm have not occurred because of a single individual but rather due to a failure of process that results in healthcare workers making mistakes. This failure of process and the pervasiveness of adverse events is just as prevalent in Interventional Radiology (IR) as it is in other specialities. The true prevalence and prevailing aetiology of complications in IR are not exactly known as there is a paucity of investigative literature into this area; especially when compared with other more established disciplines such as Surgery. Some IR procedures have a higher risk profile than others. However, published data suggests that many adverse events in IR are preventable (55-84%) and frequently involve a device related complication such as improper usage or malfunction. This article aims to discuss factors that contribute to complications in IR along with tools and strategies for dealing with them to achieve optimal patient outcomes.
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Affiliation(s)
- A O Oseni
- ST6 Interventional Radiology Fellow at St George's Hospital NHS Trust, London, UK.
| | - J-Y Chun
- Consultant Diagnostic and Interventional Radiologist at St Georges Hospital NHS Trust, London, UK
| | - R Morgan
- Consultant Diagnostic and Interventional Radiologist at St Georges Hospital NHS Trust, London, UK
| | - L Ratnam
- ST6 Interventional Radiology Fellow at St George's Hospital NHS Trust, London, UK
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5
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Madadi-Sanjani O, Kuebler JF, Brendel J, Costanzo S, Granström AL, Aydin E, Loukogeorgakis S, Lacher M, Wiesner S, Domenghino A, Clavien PA, Mutanen A, Eaton S, Ure BM. Validation of the Clavien-Madadi Classification for Unexpected Events in Pediatric Surgery: A Collaborative ERNICA Project. J Pediatr Surg 2024:S0022-3468(24)00174-X. [PMID: 38582705 DOI: 10.1016/j.jpedsurg.2024.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/28/2024] [Accepted: 03/10/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND The Clavien-Madadi classification is a novel instrument for the assessment and grading of unexpected events in pediatric surgery, based on the Clavien-Dindo classification. The system has been adjusted to better fit the pediatric population in a prospective single-center study. There is a need now to validate the Clavien-Madadi classification within an international expert network. METHODS A pediatric surgical working group created 19 case scenarios with unexpected events in a multi-staged process. Those were circulated within the European Reference Network of Inherited and Congenital Anomalies (ERNICA) and surgeons were instructed to rate the scenarios according to the Clavien-Madadi vs. Clavien-Dindo classification. RESULTS 59 surgeons from 12 European countries completed the questionnaire. Based on ratings of the case scenarios, the Clavien-Madadi classification showed significantly superior agreement rates of the respondents (85.9% vs 76.2%; p < 0.05) and was less frequently considered inaccurate for rating the pediatric population compared to Clavien-Dindo (2.1% vs 11.1%; p = 0.05). Fleiss' kappa analysis showed slightly higher strength of agreement using the Clavien-Madadi classification (0.74 vs 0.69). Additionally, intraclass correlation coefficient was slightly higher for the Clavien-Madadi compared to the Clavien-Dindo classification (ICCjust 0.93 vs 0.89; ICCunjust 0.93 vs 0.89). More pediatric surgeons preferred the Clavien-Madadi classification for the case scenarios (43.0% vs 11.8%; p = 0.002) and advantages of the Clavien-Madadi were confirmed by 81.4% of the surgeons. CONCLUSION The Clavien-Madadi classification is an accurate and reliable instrument for the grading of unexpected events in pediatric surgery. We therefore recommend its application in clinical and academic pediatric surgical practice. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Omid Madadi-Sanjani
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany; Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; European Reference Network for Rare Inherited and Congenital Anomalies (ERNICA), European Union, Netherlands.
| | - Joachim F Kuebler
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany; European Reference Network for Rare Inherited and Congenital Anomalies (ERNICA), European Union, Netherlands
| | - Julia Brendel
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany; European Reference Network for Rare Inherited and Congenital Anomalies (ERNICA), European Union, Netherlands
| | - Sara Costanzo
- Pediatric Surgery Department, Vittore Buzzi Children's Hospital, Milano, Italy
| | - Anna L Granström
- European Reference Network for Rare Inherited and Congenital Anomalies (ERNICA), European Union, Netherlands; Division of Pediatric Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Emrah Aydin
- Department of Pediatric Surgery, Faculty of Medicine, Tekirdağ Namık Kemal University, Tekirdağ, Turkey
| | - Stavros Loukogeorgakis
- Stem Cells and Regenerative Medicine Section, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Martin Lacher
- Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
| | - Soeren Wiesner
- Institute of Biostatistics, Hannover Medical School, Hannover, Germany
| | - Anja Domenghino
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Pierre-Alain Clavien
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Annika Mutanen
- European Reference Network for Rare Inherited and Congenital Anomalies (ERNICA), European Union, Netherlands; Department of Pediatric Surgery, New Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Simon Eaton
- European Reference Network for Rare Inherited and Congenital Anomalies (ERNICA), European Union, Netherlands; Stem Cells and Regenerative Medicine Section, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Benno M Ure
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany; European Reference Network for Rare Inherited and Congenital Anomalies (ERNICA), European Union, Netherlands
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Horcajadas Almansa Á, Ley Urzaiz L, Garcia Leal R, González Llanos F, Lara Almunia M, Martinez Laez R, Torres Campa JM, Zaspe Cenoz I, Lafuente Baraza J. A new standardized nomenclature in neurosurgery: Criteria and quantitative and qualitative evaluation indicators of medical procedures. NEUROCIRUGIA (ENGLISH EDITION) 2024; 35:95-112. [PMID: 38295899 DOI: 10.1016/j.neucie.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 10/01/2023] [Indexed: 02/06/2024]
Abstract
PURPOSE Update the list of medical acts in the specialty of Neurosurgery, eliminating obsolete acts and adding the new surgical techniques developed in recent years, so that they are faithfully adapted to the usual medical practice of our specialty, as well as establishing the general principles and defining the grading criteria, quantitative indicators and assessment scales. METHODS The elaboration of the new nomenclator was divided into 3 phases: 1) identification and selection of medical acts, 2) establishment of the degree of difficulty of each of them based on the experience and the time necessary for their completion, as well as the percentage and severity of the possible complications and 3) consensus with the members of the SENEC through their individualized submission, making the necessary adjustments and subsequent approval in the general assembly of SENEC. RESULTS The new nomenclator has 255 medical acts grouped into 4 groups: consultations and visits, therapeutic acts, diagnostic procedures and surgical interventions. 42 procedures included in the OMC nomenclator have been eliminated due to being obsolete, not related to the specialty or being too vague. New techniques have been included and medical acts have been more precisely defined. CONCLUSIONS This nomenclator provides up-to-date terminology and will serve to offer the portfolio of services, measure and know the relative value of our activity and the approximate costs of the procedures, and additionally, to carry out longitudinal comparative studies. It should be a tool to improve patient care and minimise geographic variability in all healthcare settings.
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Affiliation(s)
| | | | | | | | - Mónica Lara Almunia
- Fundación Jiménez Diaz, Hospital Rey Juan Carlos, Hospital Ruber Internacional, Madrid, Spain
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Speculand B. Current thinking about medicolegal aspects of temporomandibular joint surgery. Br J Oral Maxillofac Surg 2024; 62:217-221. [PMID: 38307764 DOI: 10.1016/j.bjoms.2023.12.009] [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: 10/02/2023] [Revised: 12/06/2023] [Accepted: 12/12/2023] [Indexed: 02/04/2024]
Abstract
This paper considers the current situation regarding medicolegal risks in temporomandibular joint surgery from three perspectives: the law, the patient, and the surgeon. The law relating to successful claims of clinical negligence requires that a cause-and-effect relationship is demonstrated by the claimant. Complications are considered in the light of recent research on their stratification in other fields of surgery. Surgeons become repeat offenders rarely. They display certain common characteristics which are discussed in this paper.
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Ierardi AM, Ascenti V, Lanza C, Carriero S, Amato G, Pellegrino G, Giurazza F, Torcia P, Carrafiello G. Is it a complication or a consequence - a new perspective on adverse outcomes in Interventional Radiology. CVIR Endovasc 2024; 7:6. [PMID: 38180623 PMCID: PMC10769947 DOI: 10.1186/s42155-023-00417-3] [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: 09/29/2023] [Accepted: 12/07/2023] [Indexed: 01/06/2024] Open
Abstract
The aim of the article is to introduce a new term in post-procedural events related to the procedure itself. All the Societies and Councils report these events as complications and they are divided in mild, moderate and severe or immediate and delayed.On the other hand the term error is known as the application of a wrong plan, or strategy to achieve a goal.For the first time, we are trying to introduce the term "consequence"; assuming that the procedure is the only available and the best fit to clinical indication, a consequence should be seen as an expected and unavoidable occurrence of an "adverse event" despite correct technical execution.
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Affiliation(s)
- Anna Maria Ierardi
- Radiology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy.
| | - Velio Ascenti
- Postgraduate School of Radiology, University of Milan, Milan, Italy
| | - Carolina Lanza
- Postgraduate School of Radiology, University of Milan, Milan, Italy
| | - Serena Carriero
- Postgraduate School of Radiology, University of Milan, Milan, Italy
| | - Gaetano Amato
- Postgraduate School of Radiology, University of Milan, Milan, Italy
| | | | - Francesco Giurazza
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Pierluca Torcia
- Radiology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Gianpaolo Carrafiello
- Radiology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
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Han ES, Hong SK, Hong K, Hong SY, Lee JM, Choi Y, Yi NJ, Lee KW, Suh KS. Pure laparoscopic donor right hepatectomy in patients over 50 years old: Why age should not be a barrier. Clin Transplant 2023; 37:e15117. [PMID: 37658832 DOI: 10.1111/ctr.15117] [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: 05/24/2023] [Revised: 07/30/2023] [Accepted: 08/20/2023] [Indexed: 09/05/2023]
Abstract
INTRODUCTION Given the global aging population, the average age of liver donors is increasing. This study aimed to evaluate the surgical outcomes of grafts from pure laparoscopic donor right hepatectomy (PLDRH) in liver donors aged > 50 years. METHODS The medical records of liver donors were retrospectively reviewed. The donors underwent conventional donor right hepatectomy (CDRH) from January 2011 to May 2019 or PLDRH from March 2016 to May 2019. We divided the donors into three groups: PLDRH donors aged ≥50 (n = 26; Group 1) and aged < 50 (n = 257; Group 2), and CDRH donors aged ≥50 years (n = 66; Group 3). RESULTS Operation time (p < .01) and hospital stay (p < .01) were significantly lower in Group 1 than in Group 3. Other postoperative outcomes of donors including graft anatomical variation, graft weight, graft-to-recipient weight ratio, and hepatic steatosis were similar among the three groups. Although no postoperative complications occurred in Groups 1 and 3, they were detected in 17 cases (6.6%) in Group 2. No postoperative complications were detected among the recipients. CONCLUSIONS PLDRH was feasible and safe in donors aged over 50 years, with outcomes similar to those for donors aged <50 years. PLDRH should not be avoided solely based on the donor's age ≥50 years.
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Affiliation(s)
- Eui Soo Han
- Department of Surgery, The Catholic University of Korea, Uijeongbu ST. Mary's Hospital, Uijeongbu-si, South Korea
| | - Suk Kyun Hong
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Kwangpyo Hong
- Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu-si, South Korea
| | - Su Young Hong
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Jeong-Moo Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - YoungRok Choi
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Nam-Joon Yi
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Kwang-Woong Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyung-Suk Suh
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
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Collins E, Liv P, Strandell A, Ehrström S, Pålsson M, Darelius A, Magarakis L, Idahl A. Physicians' assessment of complications after gynecological surgery in Sweden: The GYNCOM survey. Acta Obstet Gynecol Scand 2023; 102:1479-1487. [PMID: 37614120 PMCID: PMC10577629 DOI: 10.1111/aogs.14661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 07/14/2023] [Accepted: 07/20/2023] [Indexed: 08/25/2023]
Abstract
INTRODUCTION Complications after gynecological surgery in Sweden are registered in the well-established Swedish National Quality Register of Gynecological Surgery, GynOp. The aim of this study was to analyze interrater reliability in assessing complications according to the methods in GynOp, and to explore physicians' perceptions of registering complications. MATERIAL AND METHODS A digital survey was sent to gynecologists and residents in gynecology in Sweden. Participating clinics were recruited through the Swedish network for national clinical studies in Obstetrics and Gynecology, SNAKS. Twenty fictional cases, intended to represent normal postoperative course, failure to cure, and varying degrees of complications, were developed by the research group. The clinical scenarios included abdominal and laparoscopic surgery of the uterus and adnexa, vaginal hysterectomies, as well as hysteroscopy. The respondents graded each case on the presence of a complication (yes/no). Type of complication, severity, and what action the complication required according to Clavien-Dindo was registered if a complication was acknowledged, according to the method in GynOp. Interrater reliability and the opinions of the respondents were presented descriptively. More than 80% of respondents making the same assessment was considered as agreement. RESULTS The response rate was 41%, with 104 responding physicians from 16 gynecological clinics. Type and severity of complication was considered relevant to register by 88% and 89% of respondents, respectively. Agreement on whether the case described a complication was >80% in 85% (17/20) of cases and agreement using the Clavien-Dindo classification was >90% in 80% (16/20) of cases. There was high agreement in assessments of classically severe complications, such as pulmonary embolism and ureteral damage, in both presence of complication and severity, as well as Clavien-Dindo (>90% for all methods). Cases with agreement <80% on whether the case described a complication were bordering between normal postoperative course and minor complication. CONCLUSIONS This study provides validation for the methods used to register complications after gynecological surgery according to the GynOp register, including the use of Clavien-Dindo in gynecology. However, the results indicate a need to define what should be considered symptoms inherent to each type of surgery.
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Affiliation(s)
- Elin Collins
- Department of Clinical Sciences, Obstetrics and GynecologyUmeå UniversityUmeåSweden
| | - Per Liv
- Epidemiology and Global Health Unit, Department of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
| | - Annika Strandell
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Sophia Ehrström
- Division of Obstetrics and Gynecology, Department of Clinical SciencesKarolinska InstitutetStockholmSweden
| | - Mathias Pålsson
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Anna Darelius
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Leonidas Magarakis
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Annika Idahl
- Department of Clinical Sciences, Obstetrics and GynecologyUmeå UniversityUmeåSweden
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Saner FACM, Ruggeri G, Siegenthaler F, Wampfler J, Imboden S, Mueller MD. Change of Fagotti score is associated with outcome after neoadjuvant chemotherapy for ovarian cancer. Int J Gynecol Cancer 2023; 33:1595-1601. [PMID: 37567597 PMCID: PMC10579493 DOI: 10.1136/ijgc-2023-004540] [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: 04/19/2023] [Accepted: 06/26/2023] [Indexed: 08/13/2023] Open
Abstract
OBJECTIVE To investigate whether a change in the Fagotti score (ΔFagotti) following neoadjuvant chemotherapy is predictive of resection to no residual disease (R0) and survival in women diagnosed with ovarian cancer. METHODS Women treated with neoadjuvant chemotherapy for newly diagnosed ovarian cancer between January 2012 and June 2021 at the Bern University Hospital were included in this retrospective cohort study. Fagotti scores before and after neoadjuvant chemotherapy treatment were assessed for a potential association with resection status at interval debulking surgery defined as no residual disease (R0), macroscopic residual disease with a diameter of 0.1-1 cm (R1) or >1 cm (R2), and survival. RESULTS During the study period, 130 patients received neoadjuvant chemotherapy, mainly in response to advanced ovarian cancer International Federation of Gynecology and Obstetrics (FIGO) stages IIIC (68.5%) or IV (20.8%). 91 patients (70%) experienced a relapse and 81 (62%) died due to their disease. Median overall survival was 40 months (95% CI 30.6 to 49.4). Fagotti scores dropped from a mean of 7.8 (95% CI 7.14 to 8.42) at diagnosis to 3.9 (95% CI 3.34 to 4.46, p<0.001) after neoadjuvant therapy. This decrease was associated with resection status during interval debulking surgery (mean ΔFagotti -4.9 in R0, -2.2 in R1, -0.6 in R2, p<0.001). Women whose Fagotti score declined more than 2 points after neoadjuvant chemotherapy (n=51/88, 58%) survived significantly longer (median overall survival of 42 vs 32 months, p=0.048). CONCLUSION Fagotti scores and ΔFagotti scores are associated with complete cytoreduction at interval debulking surgery and longer overall survival in women treated with neoadjuvant chemotherapy for ovarian cancer. These markers are valuable for individualized patient treatment planning and should always be performed after neoadjuvant therapy.
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Affiliation(s)
| | - Giovanni Ruggeri
- Department of Gynaecology, Inselspital University Hospital Bern, Bern, Switzerland
- University of Bern, Bern, Switzerland
| | - Franziska Siegenthaler
- Department of Gynaecology, Inselspital University Hospital Bern, Bern, Switzerland
- University of Bern, Bern, Switzerland
| | - Julian Wampfler
- University of Bern, Bern, Switzerland
- Department of Medical Oncology, Inselspital University Hospital Bern, Bern, Switzerland
| | - Sara Imboden
- Department of Gynaecology, Inselspital University Hospital Bern, Bern, Switzerland
- University of Bern, Bern, Switzerland
| | - Michael D Mueller
- Department of Gynaecology, Inselspital University Hospital Bern, Bern, Switzerland
- University of Bern, Bern, Switzerland
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Rhu J, Kwon J, Lim M, Oh N, An S, Han SW, Jo SJ, Park S, Choi GS, Kim JM, Joh JW. Graft-recipient-weight ratio and lowered immunosuppression is important for the success of adult liver retransplantation. Sci Rep 2023; 13:12778. [PMID: 37550392 PMCID: PMC10406835 DOI: 10.1038/s41598-023-39007-7] [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: 02/14/2023] [Accepted: 07/18/2023] [Indexed: 08/09/2023] Open
Abstract
This study analyzed the risk of liver retransplantation and factors related to better outcome. Adult liver transplantations performed during 1996-2021 were included. Comparison between first transplantation and retransplantation were performed. Among retransplantation cases, comparison between whole liver and partial liver graft was performed. Multivariable Cox analyses for analyzing risk factors for primary graft and overall patient survival were performed for the entire cohort as well as the subgroup of patients with retransplantation. A total 2237 transplantations from 2135 adults were included and 103 cases were retransplantation. A total of 44 cases (42.7%) were related to acute graft dysfunction while 59 cases (57.3%) were related to subacute or chronic graft dysfunction. Retransplantation was related poor primary graft (HR 3.439, CI 2.230-5.304, P < 0.001) and overall patient survival. (HR 2.905, CI 2.089-4.040, P < 0.001) Among retransplantations, mean serum FK506 trough level ≥ 9 ng/mL was related to poor primary graft (HR 3.692, CI 1.288-10.587, P = 0.015) and overall patient survival. (HR 2.935, CI 1.195-7.211, P = 0.019) Graft-recipient-weight ratio under 1.0% was related to poor overall patient survival in retransplantations. (HR 3.668, CI 1.150-11.698, P = 0.028). Retransplantation can be complicated with poor graft and patient survival compared to first transplantation, especially when the graft size is relatively small. Lowering the FK506 trough level during the first month can be beneficial for outcome.
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Affiliation(s)
- Jinsoo Rhu
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-Dong, Gangnam-Gu, Seoul, 135-710, Korea
| | - Jieun Kwon
- Department of Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Manuel Lim
- Department of Surgery, Myungji Hospital, Hanyang University Medical Center, Goyang, Korea
| | - Namkee Oh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-Dong, Gangnam-Gu, Seoul, 135-710, Korea
| | - Sunghyo An
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-Dong, Gangnam-Gu, Seoul, 135-710, Korea
| | - Seung Wook Han
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-Dong, Gangnam-Gu, Seoul, 135-710, Korea
| | - Sung Jun Jo
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-Dong, Gangnam-Gu, Seoul, 135-710, Korea
| | - Sunghae Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-Dong, Gangnam-Gu, Seoul, 135-710, Korea
| | - Gyu-Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-Dong, Gangnam-Gu, Seoul, 135-710, Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-Dong, Gangnam-Gu, Seoul, 135-710, Korea.
| | - Jae-Won Joh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-Dong, Gangnam-Gu, Seoul, 135-710, Korea
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Rhu J, Choi GS, Kim JM, Kwon CHD, Joh JW. Risk Factors Associated With Surgical Morbidities of Laparoscopic Living Liver Donors. Ann Surg 2023; 278:96-102. [PMID: 36994737 DOI: 10.1097/sla.0000000000005851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
OBJECTIVE This study analyzed the incidence and risk factors for surgical morbidities of laparoscopic living donors. BACKGROUND Although laparoscopic living donor programs have been established safely in leading centers, donor morbidities have not been discussed sufficiently. METHODS Laparoscopic living donors operated on from May 2013 to June 2022 were reviewed. Donor complications were reviewed, and factors related to bile leakage and biliary stricture were analyzed using the multivariable logistic regression method. RESULTS A total of 636 donors underwent laparoscopic living donor hepatectomy. The open conversion rate was 1.6%, and the 30-day complication rate was 16.8% (n=107). Grade IIIa and IIIb complications occurred in 4.4% (n=28) and 1.9% (n=12) of patients, respectively. The most common complication was bleeding (n=38, 6.0%). Fourteen donors (2.2%) required reoperation. Portal vein stricture, bile leakage, and biliary stricture occurred in 0.6% (n=4), 3.3% (n=21), and 1.6% (n=10) of cases, respectively. The readmission rate and reoperation rate were 5.2% (n=33) and 2.2% (n=14), respectively. Risk factors related to bile leakage were 2 hepatic arteries in the liver graft (OR=13.836, CI=4.092-46.789, P <0.001), division-free margin<5 mm from the main duct (OR=2.624, CI=1.030-6.686, P =0.043), and estimated blood loss during operation (OR=1.002, CI=1.001-1.003, P =0.008), while the Pringle maneuver (OR=0.300, CI=0.110-0.817, P =0.018) was protective against leakage. Regarding biliary stricture, bile leakage was the only significant factor (OR=11.902, CI=2.773-51.083, P =0.001). CONCLUSIONS Laparoscopic living donor surgery showed excellent safety for the majority of donors, and critical complications were resolved with proper management. To minimize bile leakage, cautious surgical manipulation is needed for donors with complex hilar anatomy.
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Affiliation(s)
- Jinsoo Rhu
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyu-Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Choon Hyuck David Kwon
- Department of General Surgery, Digestive Disease & Surgery Institute, Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Jae-Won Joh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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14
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Zhao W, Hu C, Xu T. In vivo bioprinting: Broadening the therapeutic horizon for tissue injuries. Bioact Mater 2023; 25:201-222. [PMID: 36817820 PMCID: PMC9932583 DOI: 10.1016/j.bioactmat.2023.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/06/2023] [Accepted: 01/25/2023] [Indexed: 02/09/2023] Open
Abstract
Tissue injury is a collective term for various disorders associated with organs and tissues induced by extrinsic or intrinsic factors, which significantly concerns human health. In vivo bioprinting, an emerging tissue engineering approach, allows for the direct deposition of bioink into the defect sites inside the patient's body, effectively addressing the challenges associated with the fabrication and implantation of irregularly shaped scaffolds and enabling the rapid on-site management of tissue injuries. This strategy complements operative therapy as well as pharmacotherapy, and broadens the therapeutic horizon for tissue injuries. The implementation of in vivo bioprinting requires targeted investigations in printing modalities, bioinks, and devices to accommodate the unique intracorporal microenvironment, as well as effective integrations with intraoperative procedures to facilitate its clinical application. In this review, we summarize the developments of in vivo bioprinting from three perspectives: modalities and bioinks, devices, and clinical integrations, and further discuss the current challenges and potential improvements in the future.
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Affiliation(s)
- Wenxiang Zhao
- State Key Laboratory of Tribology, Department of Mechanical Engineering, Tsinghua University, Beijing, 100084, China
- Beijing Key Laboratory of Precision/Ultra-Precision Manufacturing Equipments and Control, Tsinghua University, Beijing, 100084, China
| | - Chuxiong Hu
- State Key Laboratory of Tribology, Department of Mechanical Engineering, Tsinghua University, Beijing, 100084, China
- Beijing Key Laboratory of Precision/Ultra-Precision Manufacturing Equipments and Control, Tsinghua University, Beijing, 100084, China
| | - Tao Xu
- Center for Bio-intelligent Manufacturing and Living Matter Bioprinting, Research Institute of Tsinghua University in Shenzhen, Tsinghua University, Shenzhen, 518057, China
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15
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Metzemaekers J, Bouwman L, de Vos M, van Nieuwenhuizen K, Twijnstra ARH, Smeets M, Jansen FW, Blikkendaal M. Clavien-Dindo, comprehensive complication index and classification of intraoperative adverse events: a uniform and holistic approach in adverse event registration for (deep) endometriosis surgery. Hum Reprod Open 2023; 2023:hoad019. [PMID: 37250430 PMCID: PMC10224795 DOI: 10.1093/hropen/hoad019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 05/03/2023] [Indexed: 05/31/2023] Open
Abstract
STUDY QUESTION What is the additional value of the comprehensive complication index (CCI) and ClassIntra system (classification for intraoperative adverse events (ioAEs)) in adverse event (AE) reporting in (deep) endometriosis (DE) surgery compared to only using the Clavien-Dindo (CD) system? SUMMARY ANSWER The CCI and ClassIntra are useful additional tools alongside the CD system for a complete and uniform overview of the total AE burden in patients with extensive surgery (such as DE), and with this uniform data registration, it is possible to provide greater insight into the quality of care. WHAT IS KNOWN ALREADY Uniform comparison of AEs reported in the literature is hampered by scattered registration. In endometriosis surgery, the usage of the CD complication system and the CCI is internationally recommended; however, the CCI is not routinely adapted in endometriosis care and research. Furthermore, a recommendation for ioAEs registration in endometriosis surgery is lacking, although this is vital information in surgical quality assessments. STUDY DESIGN SIZE DURATION A prospective mono-center study was conducted with 870 surgical DE cases from a non-university DE expertise center between February 2019 and December 2021. PARTICIPANTS/MATERIALS SETTING METHODS Endometriosis cases were collected with the EQUSUM system, a publicly available web-based application for registration of surgical procedures for endometriosis. Postoperative adverse events (poAEs) were classified with the CD complication system and CCI. Differences in reporting and classifying AEs between the CCI and the CD were assessed. ioAEs were assessed with the ClassIntra. The primary outcome measure was to assess the additional value toward the CD classification with the introduction of the CCI and ClassIntra. In addition, we report a benchmark for the CCI in DE surgery. MAIN RESULTS AND THE ROLE OF CHANCE A total of 870 DE procedures were registered, of which 145 procedures with one or more poAEs, resulting in a poAE rate of 16.7% (145/870), of which in 36 cases (4.1%), the poAE was classified as severe (≥Grade 3b). The median CCI (interquartile range) of patients with poAEs was 20.9 (20.9-31.7) and 33.7 (33.7-39.7) in the group of patients with severe poAEs. In 20 patients (13.8%), the CCI was higher than the CD because of multiple poAEs. There were 11 ioAEs reported (11/870, 1.3%) in all procedures, mostly minor and directly repaired serosa injuries. LIMITATIONS REASONS FOR CAUTION This study was conducted at a single center; thus, trends in AE rates and type of AEs could differ from other centers. Furthermore, no conclusion could be drawn on ioAEs in relation to the postoperative course because the power of this database is not robust enough for that purpose. WIDER IMPLICATIONS OF THE FINDINGS From our data, we would advise to use the Clavien-Dindo classification system together with the CCI and ClassIntra for a complete overview of AE registration. The CCI appeared to provide a more complete overview of the total burden of poAEs compared to only reporting the most severe poAEs (as with CD). If the use of the CD, CCI, and ClassIntra is widely adapted, uniform data comparison will be possible at (inter)national level, providing better insight into the quality of care. Our data could be used as a first benchmark for other DE centers to optimize information provision in the shared decision-making process. STUDY FUNDING/COMPETING INTERESTS No funding was received for this study. The authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Jeroen Metzemaekers
- Department of Gynecology/Endometriosis, Leiden University Medical Center, Leiden, The Netherlands
| | - Lotte Bouwman
- Department of Gynecology/Endometriosis, Leiden University Medical Center, Leiden, The Netherlands
| | - Marit de Vos
- Department of Gynecology/Endometriosis, Leiden University Medical Center, Leiden, The Netherlands
| | - Kim van Nieuwenhuizen
- Department of Gynecology/Endometriosis, Leiden University Medical Center, Leiden, The Netherlands
| | - Andries R H Twijnstra
- Department of Gynecology/Endometriosis, Leiden University Medical Center, Leiden, The Netherlands
| | - Maddy Smeets
- Department of Gynecology/Endometriosis, Leiden University Medical Center, Leiden, The Netherlands
| | - Frank Willem Jansen
- Department of Gynecology/Endometriosis, Leiden University Medical Center, Leiden, The Netherlands
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Mathijs Blikkendaal
- Correspondence address. Department of Gynecology/Endometriosis, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. E-mail:
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16
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Mothes AR, Kather A, Cepraga I, Esber A, Kwetkat A, Runnebaum IB. Robotic-assisted Gynecological Surgery in Older Patients - a Comparative Cohort Study of Perioperative Outcomes. Geburtshilfe Frauenheilkd 2023; 83:437-445. [PMID: 37153652 PMCID: PMC10155232 DOI: 10.1055/a-1902-4577] [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: 07/15/2022] [Accepted: 11/28/2022] [Indexed: 05/10/2023] Open
Abstract
Study design Because of current demographic developments, a hypothesis was proposed whereby older female patients aged > 65 years can be safely operated using minimally invasive, robotic-assisted surgery, despite having more preoperative comorbidities. A comparative cohort study was designed to compare the age group ≥ 65 years (older age group, OAG) with the age group < 65 years (younger age group, YAG) after robotic-assisted gynecological surgery (RAS) in two German centers. Patients and methods Consecutive RAS procedures performed between 2016 and 2021 at the Women's University Hospital of Jena and the Robotic Center Eisenach to treat benign or oncological indications were included in the study. The age groups were compared according to their preoperative comorbidities (ASA, Charlson comorbidity index [CCI], cumulative illness rating scale - geriatric version [CIRS-G]) and perioperative parameters such as Clavien-Dindo (CD) classification of surgical complications. Analysis was performed using Welch's t -test, chi 2 test, and Fisher's exact test. Results A total of 242 datasets were identified, of which 63 (73 ± 5 years) were OAG and 179 were YAG (48 ± 10 years). Patient characteristics and the percentage of benign or oncological indications did not differ between the two age groups. Comorbidity scores and the percentage of obese patients were higher in the OAG group: CCI (2.7 ± 2.0 vs. 1.5 ± 1.3; p < 0.001), CIRS-G (9.7 ± 3.9 vs. 5.4 ± 2.9; p < 0.001), ASA class II/III (91.8% vs. 74.1%; p = 0.004), obesity (54.1% vs. 38.2%; p = 0.030). There was no difference between age groups, even grouped for benign or oncological indications, with regard to perioperative parameters such as duration of surgery (p = 0.088; p = 0.368), length of hospital stay (p = 0.786; p = 0.814), decrease in Hb levels (p = 0.811; p = 0.058), conversion rate (p = 1.000; p = 1.000) and CD complications (p = 0.433; p = 0.745). Conclusion Although preoperative comorbidity was higher in the group of older female patients, no differences were found between age groups with regard to perioperative outcomes following robotic-assisted gynecological surgery. Patient age is not a contraindication for robotic gynecological surgery.
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Affiliation(s)
- Anke R. Mothes
- Klinik für Frauenheilkunde und Robotisches Zentrum, St. Georg Klinikum Eisenach, Akademisches Lehrkrankenhaus des Universitätsklinikums Jena, Eisenach, Germany
| | - Angela Kather
- Klinik und Poliklinik für Frauenheilkunde und Fortpflanzungsmedizin, Universitätsklinikum Jena, Jena, Germany
| | - Irina Cepraga
- Klinik für Frauenheilkunde und Robotisches Zentrum, St. Georg Klinikum Eisenach, Akademisches Lehrkrankenhaus des Universitätsklinikums Jena, Eisenach, Germany
- Klinik und Poliklinik für Frauenheilkunde und Fortpflanzungsmedizin, Universitätsklinikum Jena, Jena, Germany
| | - Anke Esber
- Klinik für Frauenheilkunde und Robotisches Zentrum, St. Georg Klinikum Eisenach, Akademisches Lehrkrankenhaus des Universitätsklinikums Jena, Eisenach, Germany
- Klinik und Poliklinik für Frauenheilkunde und Fortpflanzungsmedizin, Universitätsklinikum Jena, Jena, Germany
| | - Anja Kwetkat
- Klinik für Geriatrie und Palliativmedizin, Klinikum Osnabrück GmbH, Osnabrück, Germany
| | - Ingo B. Runnebaum
- Klinik und Poliklinik für Frauenheilkunde und Fortpflanzungsmedizin, Universitätsklinikum Jena, Jena, Germany
- Correspondence Prof. Dr. Ingo B. Runnebaum, MBA Klinik und Poliklinik für Frauenheilkunde und Fortpflanzungsmedizin,
Universitätsklinikum JenaAm Klinikum 107747
JenaGermany
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Madadi-Sanjani O, Brendel J, Kuebler JF, Ure BM. Definition, Documentation, and Classification of Complications in Pediatric Surgical Literature-A Plea for Standardization. Eur J Pediatr Surg 2023; 33:105-113. [PMID: 36720251 DOI: 10.1055/s-0043-1760835] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Severity grading systems for complications in surgical patients have been used since 1992. An increasing assessment of these instruments in pediatric surgery is also noticed, without their validation in children. To analyze the current practice, we performed a literature review with focus on the assessment and grading of complications. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Studies reporting on postoperative complications as a primary or secondary endpoint using a severity grading system were included. Definition for simple adverse events, classification systems used, and the time horizon of postoperative documentation were analyzed. A total of 566 articles were screened, of which 36 met the inclusion criteria. About 86.1% of the papers were retrospective and 13.9% prospective analyses. None of the studies were prospective-randomized trials. Twenty (55.6%) studies did not include a definition of adverse events, whereas the remaining 16 (44.4%) showed variations in their definitions. All studies applied the Clavien-Dindo classification, whereas five (13.9%) additionally used the Comprehensive Complication Index. One study compared alternative grading instruments with the Clavien-Dindo classification, without demonstrating the superiority of any classification in pediatric surgery. Twenty-two studies (61.1%) did not report the time horizon of perioperative complication documentation, while 8 studies (22.2%) used 30 days and 6 studies (16.7%) used 3 months of postoperative documentation. Definition and classification of postoperative complications are inconsistent in the pediatric surgical literature. Establishment of a standardized protocol is mandatory to accurately compare outcome data.
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Affiliation(s)
| | - Julia Brendel
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Joachim F Kuebler
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Benno M Ure
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
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18
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Le HD, Wolinska JM, Baertschiger RM, Himidan SA. Complication Is Inevitable, but Suffering is Optional-Psychological Aspects of Dealing with Complications in Surgery. Eur J Pediatr Surg 2023; 33:181-190. [PMID: 36948212 DOI: 10.1055/s-0043-1767830] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
Surgical complications remain common in health care and constitute a significant challenge for hospitals, surgeons, and patients. While they cause significant physical, financial, and psychological harm to patients and their families, they also heavily burden the involved physicians. This phenomenon, known as the "second victim," results in negative short and long-term physical, cognitive, and psychological consequences on the surgeon. In this review, we explored the intricate connections between the surgeons' emotional response to adverse events concerning the patient outcome, perceived peer reaction, and existing social and institutional support systems. Using a selective literature review coupled with personal experiences, we propose a model of this complex interaction and suggest specific interventions to ameliorate the severity of response within this framework. The institution of the proposed interventions may improve the psychological well-being of surgeons facing complications and promote a cultural shift to better support physicians when they occur.
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Affiliation(s)
- Hau D Le
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Justyna M Wolinska
- Division of Pediatric Surgery, Department of Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - Reto M Baertschiger
- Division of General and Thoracic Surgery, Department of Surgery, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sharifa A Himidan
- Division of General and Thoracic Surgery, Department of Surgery, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Surgery, Humber River Hospital, Toronto, Ontario, Canada
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19
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Im C, Park YS, Min SH, Kang SH, Lee S, Lee E, Yoo M, Hwang D, Ahn SH, Suh YS, Park DJ, Kim HH. Postoperative major bleeding risk in patients using oral antiplatelets and/or anticoagulants after laparoscopic gastric cancer surgery. Ann Surg Treat Res 2023; 104:80-89. [PMID: 36816732 PMCID: PMC9929431 DOI: 10.4174/astr.2023.104.2.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/16/2022] [Accepted: 12/05/2022] [Indexed: 02/09/2023] Open
Abstract
Purpose The use of antiplatelet and/or anticoagulant therapies has become common. In rare cases, these therapies may increase the risk of dangerous postoperative bleeding. We investigated the association of antiplatelets and/or anticoagulants with postoperative major bleeding risk in laparoscopic gastric cancer surgery. Methods We retrospectively enrolled 3,663 gastric cancer patients (antiplatelet/anticoagulant group, 518; control group, 3,145) who had undergone laparoscopic surgery between January 2012 and December 2017. To minimize selection bias, 508 patients in each group were matched using propensity score matching (PSM) method. The primary outcome was postoperative major bleeding. Secondary outcomes were intraoperative, postoperative transfusion and early complications. Results After PSM, postoperative major bleeding occurred in 10 (2.0%) and 3 cases (0.6%) in the antiplatelets/anticoagulants and control groups, respectively (P = 0.090). Intraoperative and postoperative transfusions were not significantly different between 2 groups (2.4% vs. 1.4%, P = 0.355 and 5.5% vs. 4.3%, P = 0.469). Early complications developed in 58 (11.4%) and 43 patients (8.5%) in the antiplatelets/anticoagulants and control groups, respectively (P = 0.142). The mean amounts of intraoperative and postoperative transfusions were not significantly different between the groups (366.67 ± 238.68 mL vs. 371.43 ± 138.01 mL, P = 0.962; 728.57 ± 642.25 mL vs. 508.09 ± 468.95 mL, P = 0.185). In multivariable analysis, male (P = 0.008) and advanced stage (III, IV) (P = 0.024) were independent significant risk factors for postoperative major bleeding. Conclusion Preoperative antiplatelets and/or anticoagulants administration did not significantly increase the risk of postoperative major bleeding after laparoscopic gastric cancer surgery.
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Affiliation(s)
- Chami Im
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Suk Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sa-Hong Min
- Department of Surgery, Asan Medical Center, Seoul, Korea
| | - So Hyun Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sangjun Lee
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Eunju Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Mira Yoo
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Duyeong Hwang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang-Hoon Ahn
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yun Suhk Suh
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University Hospital, Seoul, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyung-Ho Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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20
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Katsura M, Fukuma S, Chida K, Saegusa Y, Kanda S, Kawasaki K, Tsuzuki Y, Ie M. Which factors influence the decision to perform Hartmann's reversal in various causative disease situations? A retrospective cohort study between 2006 and 2021. Colorectal Dis 2023; 25:305-314. [PMID: 36222174 DOI: 10.1111/codi.16364] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 07/18/2022] [Accepted: 09/29/2022] [Indexed: 02/08/2023]
Abstract
AIM Our aim was to investigate the predictive factors for Hartmann's reversal and to describe the differences in the rates and timings of Hartmann's reversal for various causative diseases. METHOD In this multicentre retrospective cohort study patients who underwent Hartmann's procedure (HP) between 2006 and 2018 were enrolled. To describe the demographic patterns of Hartmann's reversal through to 2021, we analysed the cumulative incidence rate of Hartmann's reversal over time based on the Kaplan-Meier failure estimate. Multivariable Cox proportional hazard analysis was performed with cluster-adjusted robust standard errors to calculate hazard ratios (HRs) for the assessment of variables associated with colostomy reversal. RESULTS Of 250 patients who underwent the index HP and survived to discharge, 112 (45%) underwent subsequent Hartmann's reversal (36% for malignant and 51% for benign disease). The causative diseases with the highest probability of colostomy reversal were trauma (85%) and diverticular disease (73%). Conversely, colostomy reversal was performed in only 16% for colonic volvulus and 17% for bowel ischaemia. Home discharge after index HP (HR 5.22, 95% CI 3.31-8.23) and a higher body mass index (HR 1.03, 95% CI 1.01-1.04) were associated with a higher probability of Hartmann's reversal, whereas older age, malignant disease and a history of cardiovascular and psychoneurological diseases were independently associated with a lower probability of colostomy reversal. CONCLUSION The probability and timing of Hartmann's reversal varied considerably with the surgical indications for colostomy creation. Our results could help surgeons counsel patients and their families regarding stoma closure surgery to set realistic expectations.
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Affiliation(s)
- Morihiro Katsura
- Department of Surgery, Okinawa Chubu Hospital, Uruma, Japan.,Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shingo Fukuma
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kohei Chida
- Department of Surgery, Okinawa Chubu Hospital, Uruma, Japan
| | | | - Shuhei Kanda
- Department of Surgery, Okinawa Miyako Hospital, Miyakojima, Japan
| | - Kyohei Kawasaki
- Department of Surgery, Okinawa Yaeyama Hospital, Ishigaki, Japan
| | - Yukihiro Tsuzuki
- Department of Surgery, Okinawa Nanbu Medical Center & Children's Medical Center, Haebaru, Japan
| | - Masafumi Ie
- Department of Surgery, Okinawa Chubu Hospital, Uruma, Japan
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21
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Samuel LT, Karnuta JM, Banerjee A, Briskin I, Cantrell WA, George JW, Higuera-Rueda CA, Kamath AF, Khlopas A, Klika A, Krebs VE, Mesko NW, Mont MA, Murray TG, Piuzzi NS, Shah P, Stearns K, Sultan AA, Molloy RM. Robotic Arm-Assisted versus Manual Total Knee Arthroplasty: A Propensity Score-Matched Analysis. J Knee Surg 2023; 36:105-114. [PMID: 34187067 DOI: 10.1055/s-0041-1731323] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purpose of this study was to compare (1) operative time, (2) in-hospital pain scores, (3) opioid medication use, (4) length of stay (LOS), (5) discharge disposition at 90-day postoperative, (6) range of motion (ROM), (7) number of physical therapy (PT) visits, (8) emergency department (ED) visits, (9) readmissions, (10) reoperations, (11) complications, and (12) 1-year patient-reported outcome measures (PROMs) in propensity matched patient cohorts who underwent robotic arm-assisted (RA) versus manual total knee arthroplasty (TKA). Using a prospectively collected institutional database, patients who underwent RA- and manual TKA were the nearest neighbor propensity score matched 3:1 (255 manual TKA:85 RA-TKA), accounting for various preoperative characteristics. Data were compared using analysis of variance (ANOVA), Kruskal-Wallis, Pearson's Chi-squared, and Fisher's exact tests, when appropriate. Postoperative pain scores, opioid use, ED visits, readmissions, and 1-year PROMs were similar between the cohorts. Manual TKA patients achieved higher maximum flexion ROM (120.3 ± 9.9 versus 117.8 ± 10.2, p = 0.043) with no statistical differences in other ROM parameters. Manual TKA had shorter operative time (105 vs.113 minutes, p < 0.001), and fewer PT visits (median [interquartile range] = 10.0 [8.0-13.0] vs. 11.5 [9.5-15.5] visits, p = 0.014). RA-TKA had shorter LOS (0.48 ± 0.59 vs.1.2 ± 0.59 days, p < 0.001) and higher proportion of home discharges (p < 0.001). RA-TKA and manual TKA had similar postoperative complications and 1-year PROMs. Although RA-TKA patients had longer operative times, they had shorter LOS and higher propensity for home discharge. In an era of value-based care models and the steady shift to outpatient TKA, these trends need to be explored further. Long-term and randomized controlled studies may help determine potential added value of RA-TKA versus manual TKA. This study reflects level of evidence III.
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Affiliation(s)
- Linsen T Samuel
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Jaret M Karnuta
- School of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Aditya Banerjee
- School of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Isaac Briskin
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | | | - Joseph W George
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | | | - Atul F Kamath
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Anton Khlopas
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Alison Klika
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Viktor E Krebs
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Nathan W Mesko
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Michael A Mont
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Trevor G Murray
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Paras Shah
- School of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Kim Stearns
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Assem A Sultan
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Robert M Molloy
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
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22
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Vasilenko II, Evsyukov AV, Ryabykh SO, Amelina EV, Kubetsky YE, Garipov II, Rzaev JA. Treatment of patients with degenerative deformities of the lumbar spine using MIS technologies: analysis of 5-year results. HIRURGIÂ POZVONOČNIKA (SPINE SURGERY) 2022. [DOI: 10.14531/ss2022.4.52-59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objective. To analyze the results of the use of minimally invasive technologies in the treatment of patients with degenerative deformity of the lumbar spine.Material and Methods. Design: Single-center, non-randomized continuous retrospective cohort study. The level of evidence is 3b (UK Oxford, version 2009). A total of 57 patients (10 men and 47 women) were operated for degenerative scoliosis of the lumbar spine using minimally invasive techniques. The quality of life indicators using ODI, SF-36, VAS, as well as linear and angulometric parameters of the spine were studied.Results. The age of patients ranged from 37 to 81 years (62/62 [55; 67], hereinafter the data format is mean/median [1; 3rd quartile]). In the postoperative period, patients operated on with MIS techniques showed a statistically significant decrease in pain by 4.3/4.0 [3; 6] points in the lumbar spine, and by 4.3/4.0 [3; 6] points in the legs. Quality of life indicators according to ODI improved by 24/23 [19; 29], and the level of functional adaptation according to the SF-36 questionnaire – by 18/18 [14; 21] in terms of physical parameters and by 18/20 [16; 23] in terms of mental parameters. The deformity angle in the frontal plane according to Cobb decreased by 12.9°/13.0° [10°; 17°], lumbar lordosis changed by 3.3°/2.0° [-1°; 7°], segmental angle L4–S1 – by 1.0°/0.0° [-5°; 7°], and SVA changed by -7.5/-2.0 [-29; 15] mm. As a result of minimally invasive surgical intervention, a good clinical result was obtained in correcting the scoliotic deformity angle from 17.5°/16.0° [11°; 22°] to 4.6°/4.0° [1°; 7°].Conclusion. The study showed the effectiveness of minimally invasive surgical treatment of degenerative scoliosis of the lumbar spine with short-segment fixation, which allowed obtaining satisfactory clinical results in 93 % of cases with a minimum number of complications (7 %).
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Affiliation(s)
- I. I. Vasilenko
- Federal Neurosurgical Center;
Research Institute of Clinical and Experimental Lymphology
132/1 Nemirovicha-Danchenko str., Novosibirsk, 630087, Russia;
6 Arbuzova str., Novosibirsk, 630117, Russia
| | - A. V. Evsyukov
- National Ilizarov Medical Research Center for Traumatology and Ortopedics
6 M. Ulyanovoj str., Kurgan, 640014, Russia
| | - S. O. Ryabykh
- National Medical Research Center for Traumatology and Orthopedics n.a. N.N. Priorov
10 Priorova str., Moscow, 127299, Russia
| | - E. V. Amelina
- Novosibirsk State University
1 Pirogova str., Novosibirsk, 630090, Russia
| | - Yu. E. Kubetsky
- Federal Center of Neurosurgery
132/1 Nemirovicha-Danchenko str., Novosibirsk, 630087, Russia
| | - I. I. Garipov
- National Ilizarov Medical Research Center for Traumatology and Ortopedics
6 M. Ulyanovoj str., Kurgan, 640014, Russia
| | - J. A. Rzaev
- Federal Neurosurgical Center;
Novosibirsk State University
132/1 Nemirovicha-Danchenko str., Novosibirsk, 630087, Russia;
2 Pirogova str., Novosibirsk, 630090, Russia
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23
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Mehrabi A, Abbasi Dezfouli S, Schlösser F, Ramouz A, Khajeh E, Ali-Hasan-Al-Saegh S, Loos M, Strobel O, Müller-Stich B, Berchtold C, Mieth M, Klauss M, Chang DH, Wielpütz MO, Büchler MW, Hackert T. Validation of the ISGLS classification of bile leakage after pancreatic surgery: A rare but severe complication. Eur J Surg Oncol 2022; 48:2440-2447. [PMID: 35842371 DOI: 10.1016/j.ejso.2022.06.030] [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: 05/01/2022] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Hepaticoenterostomy is an important step of reconstruction during hepatopancreatobiliary (HPB) surgery with a subsequent bile leakage rate of up to 5%. The International Study Group of Liver Surgery (ISGLS) proposed a severity grading system for defining bile leakage after HPB surgery, which has not been validated after pancreatic surgery in a large patient cohort. The present study aimed to validate the ISGLS definition for bile leakage in pancreatic surgery and to investigate the postoperative outcomes of bile leakage after pancreatic resections. MATERIALS AND METHODS Data from the prospectively maintained database for pancreas surgery were extracted for any type of pancreatectomy with hepaticoenterostomy between 2006 and 2019. The severity of bile leakage was graded according to the ISGLS definition. The influence of our standardized hepaticoenterostomy technique and of the complexity of the surgical procedure on the rate of clinically relevant bile leakages (B and C) were assessed in three different timeframes. RESULTS Bile leakage was detected in 152 of 5,300 patients (2.9%). Clinically relevant bile leakages included seventy patients with grade B and eighty-two patients with grade C bile leakages (46.1% and 53.9%, respectively). During the study period, the overall rate of bile leakage showed to be stable (from 3.5% to 2.4%). Patients with grade C bile leakage had a higher rate of postoperative wound infection (P < 0.001) and longer ICU stays and hospital stays compared to patients with grade B bile leakage (P = 0.03 and P < 0.001 respectively). These parameters were significantly higher in patients with late grade C bile leakage but were similar between patients with grade B bile leakage and early grade C bile leakage (<5th day POD). In the whole patients' cohort, the 90-day mortality rate was 3.2% (174/5,300), with a rate of 25% in patients with bile leakage (38/152). CONCLUSION The ISGLS classification is a valid method for classifying postoperative bile leak after pancreas surgery. Standardization of our hepaticoenterostomy technique resulted in a stable rate of bile leakage. Although rare, bile leakage following pancreas surgery is a severe complication that has a major impact on patient outcomes and contributes significantly to morbidity and mortality, even in the absence of POPF.
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Affiliation(s)
- Arianeb Mehrabi
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, 69120, Germany; Liver Cancer Center Heidelberg (LCCH), Heidelberg University Hospital, 69120, Heidelberg, Germany; European Pancreas Center, Heidelberg University Hospital, 69120, Heidelberg, Germany.
| | - Sepehr Abbasi Dezfouli
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, 69120, Germany
| | - Fabian Schlösser
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, 69120, Germany
| | - Ali Ramouz
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, 69120, Germany
| | - Elias Khajeh
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, 69120, Germany
| | - Sadeq Ali-Hasan-Al-Saegh
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, 69120, Germany
| | - Martin Loos
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, 69120, Germany; European Pancreas Center, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Oliver Strobel
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, 69120, Germany; European Pancreas Center, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Beat Müller-Stich
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, 69120, Germany; Liver Cancer Center Heidelberg (LCCH), Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Christoph Berchtold
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, 69120, Germany
| | - Markus Mieth
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, 69120, Germany; Liver Cancer Center Heidelberg (LCCH), Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Miriam Klauss
- Liver Cancer Center Heidelberg (LCCH), Heidelberg University Hospital, 69120, Heidelberg, Germany; Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - De-Hua Chang
- Liver Cancer Center Heidelberg (LCCH), Heidelberg University Hospital, 69120, Heidelberg, Germany; Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Mark O Wielpütz
- Liver Cancer Center Heidelberg (LCCH), Heidelberg University Hospital, 69120, Heidelberg, Germany; Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Markus W Büchler
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, 69120, Germany; Liver Cancer Center Heidelberg (LCCH), Heidelberg University Hospital, 69120, Heidelberg, Germany; European Pancreas Center, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Thilo Hackert
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, 69120, Germany; Liver Cancer Center Heidelberg (LCCH), Heidelberg University Hospital, 69120, Heidelberg, Germany; European Pancreas Center, Heidelberg University Hospital, 69120, Heidelberg, Germany
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24
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Li S, van Boekel RLM, van den Heuvel SAS, Coenen MJH, Vissers KCP. Pain predict genetics: protocol for a prospective observational study of clinical and genetic factors to predict the development of postoperative pain. BMJ Open 2022; 12:e066134. [PMID: 36446453 PMCID: PMC9710368 DOI: 10.1136/bmjopen-2022-066134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Postoperative pain remains a challenging medical condition impacting the quality of life of every patient. Although several predictive factors for postoperative pain have been identified, an adequate prediction of postoperative pain in patients at risk has not been achieved yet.The primary objective of this study is to identify specific genetic risk factors for the development of acute and chronic postoperative pain to construct a prediction model facilitating a more personalised postoperative pain management for each individual. The secondary objectives are to build a databank enabling researchers to identify other risk factors for postoperative pain, for instance, demographic and clinical outcome indicators; provide insight into (genetic) factors that predict pharmacological pain relief; investigate the relationship between acute and chronic postoperative pain. METHODS AND ANALYSIS In this prospective, observational study, patients who undergo elective surgery will be recruited to a sample size of approximately 10 000 patients. Postoperative acute and chronic pain outcomes will be collected through questionnaires at different time points after surgery in the follow-up of 6 months. Potential genetic, demographic and clinical risk factors for prediction model construction will be collected through blood, questionnaires and electronic health records, respectively.Genetic factors associated with acute and/or chronic postoperative pain will be identified using a genome-wide association analysis. Clinical risk factors as stated in the secondary objectives will be assessed by multivariable regression. A clinical easy-to-use prediction model will be created for postoperative pain to allow clinical use for the stratification of patients. ETHICS AND DISSEMINATION The Institutional Review Board of the Radboud university medical centre approved the study (authorisation number: 2012/117). The results of this study will be made available through peer-reviewed scientific journals and presentations at relevant conferences, which will finally contribute to personalised postoperative pain management. TRIAL REGISTRATION NUMBER NCT02383342.
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Affiliation(s)
- Song Li
- Department of Human Genetics, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Regina L M van Boekel
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Sandra A S van den Heuvel
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Marieke J H Coenen
- Department of Human Genetics, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Kris C P Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud university medical center, Nijmegen, The Netherlands
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25
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Türkeri L, Karşıyakalı N, Aslan G, Akgül M, Baltacı S, Bolat D, Şahin H, Karabay E, İzol V, Tinay I. Immediate post-operative intravesical instillation of a single dose chemotherapy is not superior to continuous saline irrigation. Actas Urol Esp 2022; 46:464-472. [PMID: 36089504 DOI: 10.1016/j.acuroe.2021.11.007] [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: 10/24/2021] [Accepted: 11/25/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION AND OBJECTIVES To evaluate whether there is any difference between immediate postoperative instillation of intravesical chemotherapy (IPOIC) and continuous saline bladder irrigation (CSBI) in terms of bladder cancer (BC) recurrence in patients with primary low- or intermediate-risk non-muscle-invasive BC (NMIBC). MATERIALS AND METHODS Medical records of 1482 patients who underwent transurethral resection of bladder tumor between March 1994 and August 2020 were reviewed retrospectively. Patients were divided into two groups according to IPOIC and/or CSBI administration status [Group-1 = CSBI alone; Group-2 = CSBI following IPOIC]. Low- and intermediate-risk NMIBC patients were also divided into subgroups according to IPOIC and/or CSBI administration status. RESULTS A total of 594 patients with primary NMIBC were included. Of the patients, 86 (14.5%) were female and 508 (85.5%) were male with a median age of 69 (60-78) years. The frequency of patients in Group-1 and Group-2 were 361 (60.8%) and 233 (39.2%), respectively. Recurrent disease was observed in 213 (35.9%) patients. There was no difference between the groups when they were compared for recurrent disease frequency, median time to first recurrence and frequency of recurrence within first 12 months (P = .064, P = .671, and P = .145, respectively). Disease recurrence rates in low-risk NMIBC patients was lower when they were treated with "CSBI following IPOIC" when compared to "CSBI alone" (P = .042). However, no difference was observed in low-risk NMIBC subgroups when they were compared for pathological features of recurrent tumors such as number, size, grade, stage, and presence of carcinoma in situ (P > .05, for each). CONCLUSIONS "CSBI following IPOIC" combination was not superior to "CSBI alone" for preventing adverse pathological outcomes in recurrent low- and intermediate-risk NMIBC.
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Affiliation(s)
- L Türkeri
- Department of Urology, Acibadem M.A. Aydinlar University, Altunizade Hospital, Istanbul, Turkey
| | - N Karşıyakalı
- Department of Urology, Acibadem M.A. Aydinlar University, Altunizade Hospital, Istanbul, Turkey.
| | - G Aslan
- Department of Urology, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - M Akgül
- Department of Urology, Namik Kemal University, Faculty of Medicine, Tekirdag, Turkey
| | - S Baltacı
- Department of Urology, Ankara University, Faculty of Medicine, Ankara, Turkey
| | - D Bolat
- Department of Urology, University of Health Sciences, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - H Şahin
- Department of Urology, Mugla Sitki Kocman University, Faculty of Medicine, Mugla, Turkey
| | - E Karabay
- Department of Urology, University of Health Sciences, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - V İzol
- Department of Urology, Cukurova University, Faculty of Medicine, Adana, Turkey
| | - I Tinay
- Department of Urology, Marmara University, Faculty of Medicine, Istanbul, Turkey
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26
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Dias IR, Ghefter MC, Andrade Filho PHDE, Morais LLS, Marchetti Filho MA, Himuro HS, Feichas RLP. The impact of the COVID-19 pandemic on the decrease in the use of intensive care units in the postoperative period of anatomic lung resections. A retrospective analysis. Rev Col Bras Cir 2022; 49:e20223140. [PMID: 35792804 PMCID: PMC10578854 DOI: 10.1590/0100-6991e-20223140-en] [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: 07/30/2021] [Accepted: 04/09/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE COVID-19 pandemic required optimization of hospital institutional flow, especially regarding the use of intensive care unit (ICU) beds. The aim of this study was to assess whether the individualization of the indication for postoperative recovery from pulmonary surgery in ICU beds was associated with more perioperative complications. METHOD retrospective analysis of medical records of patients undergoing anatomic lung resections for cancer in a tertiary hospital. The sample was divided into: Group-I, composed of surgeries performed between March/2019 and February/2020, pre-pandemic, and Group-II, composed of surgeries performed between March/2020 and February/2021, pandemic period in Brazil. We analyzed demographic data, surgical risks, surgeries performed, postoperative complications, length of stay in the ICU and hospital stay. Preventive measures of COVID-19 were adopted in group-II. RESULTS 43 patients were included, 20 in group-I and 23 in group-II. The groups did not show statistical differences regarding baseline demographic variables. In group-I, 80% of the patients underwent a postoperative period in the ICU, compared to 21% in group-II. There was a significant difference when comparing the average length of stay in an ICU bed (46 hours in group-I versus 14 hours in group-II - p<0.001). There was no statistical difference regarding postoperative complications (p=0.44). CONCLUSIONS the individualization of the need for ICU use in the immediate postoperative period resulted in an improvement in the institutional care flow during the COVID-19 pandemic, in a safe way, without an increase in surgical morbidity and mortality, favoring the maintenance of essential cancer treatment.
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Affiliation(s)
- Ismael Rodrigo Dias
- - Hospital do Servidor Público Estadual de São Paulo- HSPE/IAMSPE, Departamento de Cirurgia Torácica - São Paulo - SP - Brasil
| | - Mario Claudio Ghefter
- - Hospital do Servidor Público Estadual de São Paulo- HSPE/IAMSPE, Departamento de Cirurgia Torácica - São Paulo - SP - Brasil
| | - Pedro Hilton DE Andrade Filho
- - Hospital do Servidor Público Estadual de São Paulo- HSPE/IAMSPE, Departamento de Anestesiologia - São Paulo - SP - Brasil
| | - Lilianne Louise Silva Morais
- - Hospital do Servidor Público Estadual de São Paulo- HSPE/IAMSPE, Departamento de Cirurgia Torácica - São Paulo - SP - Brasil
| | - Marco Aurelio Marchetti Filho
- - Hospital do Servidor Público Estadual de São Paulo- HSPE/IAMSPE, Departamento de Cirurgia Torácica - São Paulo - SP - Brasil
| | - Hebert Santos Himuro
- - Hospital do Servidor Público Estadual de São Paulo- HSPE/IAMSPE, Departamento de Cirurgia Torácica - São Paulo - SP - Brasil
| | - Rafael Lacerda Pereira Feichas
- - Hospital do Servidor Público Estadual de São Paulo- HSPE/IAMSPE, Departamento de Cirurgia Torácica - São Paulo - SP - Brasil
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27
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Rhu J, Choi GS, Kim JM, Kwon CHD, Joh JW. Complete transition from open surgery to laparoscopy: 8-year experience with more than 500 laparoscopic living donor hepatectomies. Liver Transpl 2022; 28:1158-1172. [PMID: 35138684 DOI: 10.1002/lt.26429] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/14/2022] [Accepted: 01/20/2022] [Indexed: 01/13/2023]
Abstract
This study was designed to review laparoscopic living donor liver transplantations (LDLTs) at a single center that achieved complete transition from open surgery to laparoscopy. LDLTs performed from January 2013 to July 2021 were reviewed. Comparisons between open and laparoscopic surgeries were performed according to periods divided into initial, transition, and complete transition periods. A total of 775 LDLTs, 506 laparoscopic and 269 open cases, were performed. Complete transition was achieved in 2020. Bile duct variations were significantly abundant in the open group both in the initial period (30.2% vs. 8.1%; p < 0.001) and transition period (48.1% vs. 24.3%; p < 0.001). Portal vein variation was more abundant in the open group only in the initial period (13.0% vs. 4.1%; p = 0.03). Although the donor reoperation rate (0.0% vs. 4.1%; p = 0.02) and Grade III or higher complication rate (5.6% vs. 13.5%; p = 0.03) were significantly higher in the laparoscopy group in the initial period, there were no differences during the transition period as well as in overall cases. Median number of opioids required by the donor (three times [interquartile range, IQR, 1-6] vs. 1 time [IQR, 0-3]; p < 0.001) was lower, and the median hospital stay (10 days [IQR, 8-12] vs. 8 days [IQR, 7-9]; p < 0.001) was shorter in the laparoscopy group. Overall recipient bile leakage rate (23.8% vs. 12.8%; p < 0.001) and overall Grade III or higher complication rate (44.6% vs. 37.2%; p = 0.009) were significantly lower in the laparoscopy group. Complete transition to laparoscopic living donor hepatectomy was possible after accumulating a significant amount of experience. Because donor morbidity can be higher in the initial period, donor selection for favorable anatomy is required for both the donor and recipient.
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Affiliation(s)
- Jinsoo Rhu
- Department of SurgerySamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Gyu-Seong Choi
- Department of SurgerySamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Jong Man Kim
- Department of SurgerySamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Choon Hyuck David Kwon
- Department of General SurgeryDigestive Disease & Surgery InstituteLerner College of MedicineCleveland ClinicClevelandOhioUSA
| | - Jae-Won Joh
- Department of SurgerySamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
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28
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La dosis única de instilación intravesical postoperatoria inmediata de quimioterapia no es superior al lavado continuo con suero. Actas Urol Esp 2022. [DOI: 10.1016/j.acuro.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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29
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Manekk RS, Gharde P, Gattani R, Lamture Y. Surgical Complications and Its Grading: A Literature Review. Cureus 2022; 14:e24963. [PMID: 35706751 PMCID: PMC9187255 DOI: 10.7759/cureus.24963] [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] [Accepted: 05/12/2022] [Indexed: 12/04/2022] Open
Abstract
The demand for improvement in healthcare delivery has been increasing. Thus, a standardized method allows quality assessment of data and its comparison between various institutions over time. Many attempts have been made to classify surgical complications before 1990; however, none of those attempts gained popularity and acceptance. Clavien and his colleagues started the wave by explaining negative outcomes on the basis of complications, failure to cure, and sequelae. Complications were primarily defined as “any deviation from the normal postoperative course”. Since then, many such classification systems and grading systems have been introduced and studied for analyzing the post-operative complications. The purpose of this study was to review the revolution in the classification systems for surgical complications, its validation, and to analyze the results of various qualitative indicators for post-operative complications obtained by using these classification systems. A global set of keywords were built such as “grading of surgical complications”, “abdominal surgery”, “classification of surgical complications”, and the “Clavien Dindo Classification”. A literature review was done using PubMed, Medline, and Google Scholar. A list of reference articles concerning the literature on classification systems for surgical complications was manually analyzed from the year 1992 and the data was summarized.
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Morii T, Asano N, Nakayama R, Kikuta K, Susa M, Horiuchi K, Watanabe I, Anazawa U, Suzuki Y, Nishimoto K, Takeuchi K, Morioka H. Complications of surgery for giant cell tumor of bone in the extremities: Incidence, risk factors, management modality, and impact on functional and oncological outcomes. J Orthop Sci 2022; 27:681-688. [PMID: 33685766 DOI: 10.1016/j.jos.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 01/21/2021] [Accepted: 02/01/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Due to the wide variations in location, size, local invasiveness, and treatment options, the complications associated with surgery for giant cell tumor of bone have been sporadically reported. For quality assessment, fundamental data based on large-scale surveys of complications under a universal evaluation system is needed. The Dindo-Clavien classification is an evaluation system for complications based on severity and required intervention type and is suitable for the evaluation of surgery in a heterogeneous cohort. METHODS A multi-institutional retrospective survey of 141 patients who underwent surgery for giant cell tumor of bone in the extremity was performed. The incidence and risk factors of complications, type of intervention for complication control, and impact of complications on functional and oncological outcomes were analyzed using the Dindo-Clavien classification. RESULTS Forty-six cases (32.6%) had one or more complications. Of them, 18 (12.8%), 11 (7.8%), and 17 (12.1%) cases were classified as Dindo-Clavien classification grade I, II, and III complications, respectively. There were no cases with grade IV or V complications. Progression in Campanacci grading (p = 0.04), resection (over curettage, p < 0.0001), reconstruction with prosthesis (p = 0.0007), and prolonged operative duration (p = 0.0002) were significant risk factors for complications. Complications had a significant impact on function (p < 0.0001). Differences in the impact of complication types and tumor location on function were confirmed. Complications had no impact on local recurrence and metastasis development. CONCLUSION The Dindo-Clavien classification could provide fundamental information, under a uniform definition and classification system, on postoperative complications in patients with giant cell tumor of bone in terms of incidence, type of intervention for complication control, risk factors, and impact on functional outcome. The data are useful not only for preoperative evaluation for the risk of complications under specific conditions but also for quality assessment of surgery for giant cell tumor of bone.
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Affiliation(s)
- Takeshi Morii
- Department of Orthopaedic Surgery, Faculty of Medicine, Kyorin University, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611 Japan.
| | - Naofumi Asano
- Department of Orthopaedic Surgery, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Robert Nakayama
- Department of Orthopaedic Surgery, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kazutaka Kikuta
- Department of Orthopaedic Surgery, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya, Tochigi, 320-0834, Japan
| | - Michiro Susa
- Department of Orthopaedic Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-0042, Japan
| | - Keisuke Horiuchi
- Department of Orthopaedic Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-0042, Japan
| | - Itsuo Watanabe
- Department of Orthopaedic Surgery, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa, Chiba, 272-8513, Japan
| | - Ukei Anazawa
- Department of Orthopaedic Surgery, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa, Chiba, 272-8513, Japan
| | - Yoshihisa Suzuki
- Department of Orthopaedic Surgery, Tachikawa Hospital, 4-2-22 Nishiki-cho, Tachikawa, Tokyo, 190-8531, Japan
| | - Kazumasa Nishimoto
- Department of Orthopaedic Surgery, Kawasaki Municipal Ida Hospital, 2-27-1 Ida, Nakahara-ku, Kawasaki, Kanagawa, 211-0035, Japan
| | - Katsuhito Takeuchi
- Department of Orthopaedic Surgery, Saiseikai Yokohamashi Nanbu Hospital, 3-2-10, Konandai Konan-ku, Yokohama, Kanagawa, 234-0054, Japan
| | - Hideo Morioka
- Department of Orthopaedic Surgery, National Hospital Organization, Tokyo Medical Center., 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan
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Klimov V, Evsyukov A, Amelina E, Ryabykh S, Simonovich A. Predictors of Complications and Unfavorable Outcomes of Minimally Invasive Surgery Treatment in Elderly Patients With Degenerative Lumbar Spine Pathologies (Case Series). Front Surg 2022; 9:869345. [PMID: 35558384 PMCID: PMC9086490 DOI: 10.3389/fsurg.2022.869345] [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: 02/04/2022] [Accepted: 03/18/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction The use of minimally invasive surgery (MIS) results in fewer adverse and more improved outcomes. However, the literature data describing the factors increasing the number of complications, reoperation frequency and unscheduled re-hospitalizations in older patients after MIS are contradictory. In this study, a large number of patients was investigated for the complications of minimally invasive surgical treatment of degenerative disease of the lumbar spine in older patients. The objective of the study was to determine the predictors of unfavorable outcomes in such patients. Materials and Methods 1,013 patients underwent MIS (decompression alone, TLIF, LLIF, ALIF) in 2013-2017. All operations were performed with the participation of the authors (neurosurgeons). The patient's average age was 66. The following data were collected: BMI; CCI; presence of postoperative complications according to the Dindo-Clavien classification; unplanned readmission at 90 days; hospital length of stay (LOS); surgical complexity (low, intermediate, and high); surgical time; and risk factors. The cumulative reoperation rate was determined at 5-years follow-up. Results A total of 256 patients suffered a complication (25.2%), 226 classified as mild (grade I, II, IIIA), and 30 - as severe (IIIB, IVA). Such factors as the surgical complexity, BMI > 30, surgical time, number of operated levels were associated with a significant risk of developing a complication. For patients with and without complications, LOS was 9.3 and 6.3 days, respectively (p < 0.0001), the unplanned readmission rate was 1.3%. 104 patients underwent 133 revision operations. The 5-year cumulative reoperation rate was 15.2%, and the reoperation index was 12.1%. The CCI had no statistically significant effect on the complication incidence after MIS. A higher risk of complications was found in patients who underwent intermediate-complexity surgery (MIS TLIF) compared with uncompounded (decompression alone) and more complex (MIS LLIF, MIS ALIF) surgical procedures (p < 0.001 and p = 0.001, respectively). Conclusion A register of postoperative complications is an important tool for health quality assessment and choosing the best surgical option that helps to establish measures to reduce such complications. Using MIS for the treatment of elderly patients reduces the number of severe complications.
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Affiliation(s)
- Vladimir Klimov
- European Medical Center, Moscow, Russia
- Department of Neurosurgery, Peoples' Friendship University of Russia (RUDN University), Moscow, Russia
| | - Aleksey Evsyukov
- Division of Spinal Pathology and Rare Diseases, Ilizarov National Medical Research Centre for Traumatology and Orthopedics, Kurgan, Russia
| | - Evgeniya Amelina
- Stream Data Analytics and Machine Learning Laboratory, Novosibirsk State University, Novosibirsk, Russia
- *Correspondence: Evgeniya Amelina
| | - Sergey Ryabykh
- Priorov National Medical Research Center of Traumatology and Orthopedics, Moscow, Russia
| | - Alexander Simonovich
- Research Organization Department, Y.L. Tsivyan Novosibirsk Research Institute of Traumatology and Orthopedics, Novosibirsk, Russia
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Shepherd ARH, Bunjo Z, Sutherland P, Fuller A. Robotic-assisted radical cystectomy with intracorporeal urinary diversion: Initial South Australian experience. JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/20514158221084828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aim: The aim of this study was to describe the initial experience with robotic-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) performed by two robotic surgeons at a single, Australian centre. Methods: Retrospective analysis was conducted on 30 consecutive patients who underwent RARC with ICUD with curative intent for muscle-invasive and high-risk non-muscle-invasive bladder cancer between 2017 and 2021. Variables analysed included patient baseline characteristics, operative and peri-operative outcomes, as well as short-term pathological outcomes. Results: A total 30 patients were included; 87% were male and the median age was 71 years. Half of patients had muscle-invasive bladder cancer and 93% had ileal conduit formation (with the remaining two patients undergoing neobladder formation). The median operating time was 247 minutes. The median estimated blood loss was 450 mL and 20% of patients received a blood transfusion. A high-grade complication (Clavien III–V) was encountered in 13% of patients post-operatively. At 90 days, 30 overall complications (Clavien I–V) occurred across 67% of the patients. Conclusion: This series provides further support for the safe introduction of RARC with ICUD in Australia. Further studies with extended duration of follow-up, including oncological outcomes, are required to support widespread adoption of RARC. Level of evidence: Level 4 (case series)
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Affiliation(s)
- Andrew RH Shepherd
- Department of Urology, Royal Adelaide Hospital, Australia
- Adelaide Medical School, The University of Adelaide, Australia
| | - Zachary Bunjo
- Department of Urology, Royal Adelaide Hospital, Australia
- Adelaide Medical School, The University of Adelaide, Australia
| | | | - Andrew Fuller
- Department of Urology, Royal Adelaide Hospital, Australia
- South Terrace Urology, Australia
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Karşıyakalı N, Özgen MB, Özveren B, Durak H, Sağlıcan Y, Türkeri L. The Comparison of Conventional and Retzius-Sparing Robot-Assisted Radical Prostatectomy for Clinical, Pathological, and Oncological Outcomes. JOURNAL OF UROLOGICAL SURGERY 2022. [DOI: 10.4274/jus.galenos.2021.2021.0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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DIAS ISMAELRODRIGO, GHEFTER MARIOCLAUDIO, ANDRADE FILHO PEDROHILTONDE, MORAIS LILIANNELOUISESILVA, MARCHETTI FILHO MARCOAURELIO, HIMURO HEBERTSANTOS, FEICHAS RAFAELLACERDAPEREIRA. O impacto da Pandemia de COVID-19 na diminuição do uso de Unidade de Terapia Intensiva em pós-operatório de ressecções pulmonares anatômicas. Uma análise retrospectiva. Rev Col Bras Cir 2022. [DOI: 10.1590/0100-6991e-20223140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Introdução: a pandemia de COVID-19 exigiu otimização dos fluxos institucionais hospitalares, especialmente quanto ao uso de leitos de unidade de terapia intensiva (UTI). O objetivo deste estudo foi avaliar se a individualização da indicação de recuperação pós-operatória de cirurgias pulmonares em leitos de UTI associou-se a mais complicações perioperatórias. Método: análise retrospectiva de prontuários dos pacientes submetidos a ressecções pulmonares anatômicas por câncer em hospital terciário. A amostra foi dividida em dois grupos: Grupo-I, composto pelas cirurgias realizadas entre março/2019 e fevereiro/2020, pré-pandemia, e Grupo-II, composto pelas cirurgias realizadas entre março/2020 e fevereiro/2021, período de pandemia no Brasil. Analisamos dados demográficos, riscos cirúrgicos, cirurgias realizadas, complicações pós-operatórias, tempo de UTI e de internação hospitalar. Foram adotadas medidas preventivas de COVID-19 no grupo-II. Resultados: foram incluídos 43 pacientes, 20 no grupo-I e 23 no grupo-II. Os grupos não apresentaram diferenças estatísticas quanto às variáveis demográficas basais. No grupo-I 80% dos pacientes fizeram pós-operatório em UTI, comparados a 21% do grupo-II. Houve diferença significativa na comparação de tempo médio de permanência em leito de UTI (46 horas no grupo-I versus 14 horas no grupo-II - p<0,001). Não houve diferença estatística quanto a complicações pós-operatórias entre grupos (p=0,44). Conclusões: a individualização da necessidade do uso de UTI no pós-operatório imediato de cirurgias pulmonares resultou em melhora no fluxo assistencial institucional durante a pandemia de COVID-19, de maneira segura, sem aumento na morbimortalidade cirúrgica, favorecendo a manutenção do tratamento oncológico essencial.
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OUP accepted manuscript. Br J Surg 2022; 109:308-310. [DOI: 10.1093/bjs/znab447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/26/2021] [Accepted: 12/07/2021] [Indexed: 11/14/2022]
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Machado MAC, Lobo-Filho MM, Mattos BH, Ardengh AO, Makdissi FF. ROBOTIC LIVER RESECTION. REPORT OF THE FIRST 50 CASES. ARQUIVOS DE GASTROENTEROLOGIA 2021; 58:514-519. [PMID: 34909859 DOI: 10.1590/s0004-2803.202100000-92] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 06/07/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Robotic surgery has gained growing acceptance in recent years, expanding to liver resection. OBJECTIVE The aim of this paper is to report the experience with our first fifty robotic liver resections. METHODS This was a single-cohort, retrospective study. From May 2018 to December 2020, 50 consecutive patients underwent robotic liver resection in a single center. All patients with indication for minimally invasive liver resection underwent robotic hepatectomy. The indication for the use of minimally invasive technique followed practical guidelines based on the second international laparoscopic liver consensus conference. RESULTS The proportion of robotic liver resection was 58.8% of all liver resections. Thirty women and 20 men with median age of 61 years underwent robotic liver resection. Forty-two patients were operated on for malignant diseases. Major liver resection was performed in 16 (32%) patients. Intrahepatic Glissonian approach was used in 28 patients for anatomical resection. In sixteen patients, the robotic liver resection was a redo hepatectomy. In 10 patients, previous liver resection was an open resection and in six it was minimally invasive resection. Simultaneous colon resection was done in three patients. One patient was converted to open resection. Two patients received blood transfusion. Four (8%) patients presented postoperative complications. No 90-day mortality was observed. CONCLUSION The use of the robot for liver surgery allowed to perform increasingly difficult procedures with similar outcomes of less difficult liver resections.
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Garcia-Ochoa C, Feldman LS, Nguan C, Monroy-Caudros M, Arnold JB, Barnieh L, Boudville N, Cuerden MS, Dipchand C, Gill JS, Karpinski M, Klarenbach S, Knoll G, Lok CE, Miller M, Prasad GVR, Sontrop JM, Storsley L, Garg AX. Impact of Perioperative Complications on Living Kidney Donor Health-Related Quality of Life and Mental Health: Results From a Prospective Cohort Study. Can J Kidney Health Dis 2021; 8:20543581211037429. [PMID: 34394947 PMCID: PMC8361543 DOI: 10.1177/20543581211037429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/05/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Although living kidney donation is safe, some donors experience perioperative complications. Objective: This study explored how perioperative complications affected donor-reported health-related quality of life, depression, and anxiety. Design: This research was a conducted as a prospective cohort study. Setting: Twelve transplant centers across Canada. Patients: A total of 912 living kidney donors were included in this study. Measurements: Short Form 36 health survey, Beck Depression Inventory and Beck Anxiety Inventory. Methods: Living kidney donors were prospectively enrolled predonation between 2009 to 2014. Donor perioperative complications were graded using the Clavien-Dindo classification system. Mental and physical health-related quality of life was assessed with the 3 measurements; measurements were taken predonation and at 3- and 12-months postdonation. Results: Seventy-four donors (8%) experienced a perioperative complication; most were minor (n = 67 [91%]), and all minor complications resolved before hospital discharge. The presence (versus absence) of a perioperative complication was associated with lower mental health-related quality of life and higher depression symptoms 3-month postdonation; neither of these differences persisted at 12-month. Perioperative complications were not associated with any changes in physical health-related quality of life or anxiety 3-month postdonation. Limitations: Minor complications may have been missed and information on complications postdischarge were not collected. No minimal clinically significant change has been defined for kidney donors across the 3 measurements. Conclusions: These findings highlight a potential opportunity to better support the psychosocial needs of donors who experience perioperative complications in the months following donation. Trial registration: NCT00319579 and NCT00936078.
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Affiliation(s)
| | - Liane S Feldman
- Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Chris Nguan
- The University of British Columbia, Vancouver, Canada
| | | | | | | | - Neil Boudville
- Medical School, Department of Renal Medicine, Sir Charles Gairdner Hospital, The University of Western Australia, Perth, Australia
| | | | | | - John S Gill
- The University of British Columbia, Vancouver, Canada
| | | | | | - Greg Knoll
- Division of Nephrology, Department of Medicine, University of Ottawa, ON, Canada
| | | | - Matthew Miller
- Division of Nephrology and Transplantation, St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, ON, Canada
| | | | - Jessica M Sontrop
- Department of Epidemiology & Biostatistics, Western University, London, ON, Canada
| | | | - Amit X Garg
- Department of Epidemiology & Biostatistics, Western University, London, ON, Canada.,Department of Medicine, Western University, London, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
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The Unsolved Issue of Reporting of Late Complications in Urology. Eur Urol 2021; 80:527-528. [PMID: 34362581 DOI: 10.1016/j.eururo.2021.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 07/13/2021] [Indexed: 01/16/2023]
Abstract
Lack of uniformity in the reporting of late complications hampers the quality of data available on surgical outcomes. Adoption of standardized criteria and a taxonomy for reporting of late complications is urgently needed.
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Aguilera-Bohórquez B, Pacheco J, Castillo L, Calvache D, Cantor E. Complications of Hip Endoscopy in the Treatment of Subgluteal Space Pathologies. Arthroscopy 2021; 37:2152-2161. [PMID: 33621650 DOI: 10.1016/j.arthro.2021.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 01/29/2021] [Accepted: 02/04/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess complications of hip endoscopy in patients with subgluteal space pathologies. METHODS This was a retrospective study of patients diagnosed with sciatic nerve entrapment (SNE), ischiofemoral impingement (IFI), and rupture of the proximal origin of the hamstring muscles (RHM) who underwent a hip endoscopy from January 2012 to December 2018, after a minimum of 3 months of conservative management without satisfactory results. Complications were documented and graded using the adapted system of Clavien-Dindo. Revision surgeries were classified as treatment failures. Function was evaluated by the Western Ontario McMaster Universities Osteoarthritis Index before and 12 months after the surgical procedure. RESULTS A total of 97 hips with subgluteal space pathologies were treated with hip endoscopy. This total consisted of 77 hips with SNE, 5 with IFI, 12 with SNE + IFI, and 3 hips with RHM. Minor (Clavien-Dindo I-II) and major (Clavien-Dindo III-V) complications occurred in 7.22% (7) (95% confidence interval 3.54%-14.15%) and 12.37% (12) (95% confidence interval 7.22%-20.39%). Grade II, III, and IV complications were reported in 7.22% (7), 7.22%, and 5.15% (5) hips, respectively. Temporary nerve injury of the sciatic nerve, hematoma, and permanent nerve injury of the posterior femoral cutaneous nerve were the most common grade II, grade III, and grade IV complications, respectively. The revision rate was 6.19% (6) and entrapment of the sciatic nerve was the main cause of reoperation. No statistically significant differences were found between cases with and without complications in the Western Ontario McMaster Universities Osteoarthritis Index scores evaluated before and after surgery (P > .05). CONCLUSIONS A high rate of complications associated with hip endoscopy were observed in patients with SNE, IFI, and RHM. Sciatic nerve and posterior femoral cutaneous nerve injury were the most frequent events. LEVEL OF EVIDENCE IV, case series type.
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Affiliation(s)
| | - Julio Pacheco
- Hip Preservation Unit, Institute of Osteoarticular Diseases, Centro Médico Imbanaco, Cali, Colombia; Pontificia Universidad Javeriana, Cali, Colombia
| | - Lizardo Castillo
- Hip Preservation Unit, Institute of Osteoarticular Diseases, Centro Médico Imbanaco, Cali, Colombia; Pontificia Universidad Javeriana, Cali, Colombia
| | - Daniela Calvache
- Hip Preservation Unit, Institute of Osteoarticular Diseases, Centro Médico Imbanaco, Cali, Colombia
| | - Erika Cantor
- Institute of Statistics, Universidad de Valparaiso, Valparaiso, Chile
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Rosato L, Lavorini E, Balzi D, Mondini G, Panier Suffat L. Morbidity and mortality analysis in general surgery operations. Is there any room for improvement? Minerva Surg 2021; 77:229-236. [PMID: 34160169 DOI: 10.23736/s2724-5691.21.08737-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this work is to examine the performance of surgeries, by evaluating the results. The evaluation of the results, with particular attention to complications, is the corner stone to identify the causes leading to correction of any predisposing factors and reducing risks, to improve quality of care. METHODS We performed a retrospective analysis of 952 consecutive patients who had elective or emergency surgery from November 1, 2018 to October 31, 2019. We classified surgical intervention according to their complexity. The Clavien Dindo classification was used to categorize the complications. We performed a stepwise multivariate logistic-regression analysis, with the presence of post-operative complications as dependent variable and age, gender, BMI, ASA, type of surgery procedures, complexity of surgery, operative time as covariates. RESULTS A total of 952 surgical procedures were included in this study. Abdominal procedures were the most frequent type of surgery performed (52.1%). Post-operative complications occurred in 120 surgical procedures (12.6%), these are related to the increase of the ASA score and the longer average operative time, with an increase of developing complication of 5% for each additional 10 minutes of surgery. CONCLUSIONS many factors influence postoperative morbidity and mortality. Particular attention was due to complication's evaluation, about all in abdominal surgery and high complexity procedures. We argue that key factors which influence the favourable surgical outcome are: compliance with standardized safety procedures, volume of activity of the structure, presence of interdisciplinary care groups, and ability of health professionals in recognizing and promptly treating complications.
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Affiliation(s)
- Lodovico Rosato
- General Surgical Unit, Oncology and Surgery Departments ASL TO4 Piedmont Region, Ivrea Hospital, School of Medicine, University of Turin, Ivrea, Turin, Italy
| | - Eugenia Lavorini
- General Surgical Unit, Oncology and Surgery Departments ASL TO4 Piedmont Region, Ivrea Hospital, School of Medicine, University of Turin, Ivrea, Turin, Italy
| | - Daniela Balzi
- Epidemiology Unit, AUSL Tuscany Center, Florence, Italy
| | - Guido Mondini
- General Surgical Unit, Oncology and Surgery Departments ASL TO4 Piedmont Region, Ivrea Hospital, Ivrea, Turin, Italy -
| | - Luca Panier Suffat
- General Surgical Unit, Oncology and Surgery Departments ASL TO4 Piedmont Region, Ivrea Hospital, Ivrea, Turin, Italy
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Adverse Events due to Lack of Precision in Total Hip Arthroplasty: The Potential of Provocation-Based CT for Diagnosis of Implant Loosening. ScientificWorldJournal 2021; 2021:8836687. [PMID: 34121950 PMCID: PMC8192178 DOI: 10.1155/2021/8836687] [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] [Received: 09/01/2020] [Revised: 03/22/2021] [Accepted: 05/25/2021] [Indexed: 11/18/2022] Open
Abstract
Adverse events in total hip replacement (THR) may have several origins, one being lack of precision in diagnosis and/or during surgery. This study describes the pattern and frequency of avoidable injuries in THR and the potential value of a new tool for early diagnosis of implant loosening. This retrospective study was based on all (n = 1 456) settled claims regarding THR in the Swedish National Patient Insurance database from 2010 to 2017. The claims and medical records were analyzed for root causes, with special focus on adverse events where lack of precision could be the cause. In a second stage, we assessed in 10 patients (20 implants) the diagnostic precision of a new software tool based on provocation-CT. These were all patients where the implant loosening diagnosis was deemed as inconclusive after a first plain X-ray. The findings from the provocation-CT and plain X-ray were compared to the surgical findings at revision. While 3 of 20 implants were correctly diagnosed with plain X-ray, for dynamic CT, this number was 14 of 20 implants. The retrospective study showed that the most common types of injuries were infections (34%), nerve injury (29%), mechanical problems (14.5%), dislocation (6%), and miscellaneous complications (16.5%). Of the patients with mechanical complications, one-third had aseptic implant loosening. Statement of clinical significance: we estimated that almost 200 patients in our registry study had mechanical complications after THR, mainly implant loosening. A third of these could potentially have been diagnosed and treated if CT examination with a dedicated image analysis tool to assess implant loosening after THR had been available.
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Prashar A, Butt S, Castiglione DG, Shaida N. Informed consent in interventional radiology - are we doing enough? Br J Radiol 2021; 94:20201368. [PMID: 33882250 DOI: 10.1259/bjr.20201368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES Obtaining informed consent is a mandatory part of modern clinical practice. The aim of this study was to identify how often complications relating to Interventional Radiology (IR) procedures were discussed with the patient prior to the procedure. METHODS A retrospective analysis of 100 patients who experienced a complication related to an IR procedure was performed. The patient's procedure consent form was examined to identify whether the complication they experienced had been discussed as a possible risk. Other parts of the consent form relating to need for blood transfusion and the need for further procedures were also examined. RESULTS 39% of patients who experienced a complication did not have the complication documented as a potential risk on the consent form. 14% of patients required a blood transfusion but were not consented for this. 42% of patients required a further procedure or operation but were not warned of this. CONCLUSION The model of gaining informed consent on the day of procedure is no longer valid. Better education and the use of clinics, patient information sheets and other resources is essential. ADVANCES IN KNOWLEDGE The paper highlights the inadequacies of the current model in gaining consent for IR procedures. A more comprehensive consent process making use of all available resources is essential.
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Affiliation(s)
- Akash Prashar
- Department of Interventional Radiology, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - Saqib Butt
- Department of Interventional Radiology, Guy's & St. Thomas Hospitals NHS Foundation Trust, London, UK
| | | | - Nadeem Shaida
- Department of Interventional Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Han ES, Suh KS, Lee KW, Yi NJ, Hong SK, Lee JM, Hong KP, Tan MY. Advances in the surgical outcomes of 300 cases of pure laparoscopic living donor right hemihepatectomy divided into three periods of 100 cases: a single-centre case series. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:553. [PMID: 33987251 DOI: 10.21037/atm-20-6886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Minimally invasive surgery has been widely used for hepatobiliary operations. This study aimed to determine the safety and feasibility of pure laparoscopic living donor right hepatectomy. Methods From November 2015 to April 2019, 300 cases of adult pure laparoscopic living donor right hepatectomy performed at Seoul National University Hospital were divided into three subgroups of periods 1-3 of 100 cases each: 1-100, 101-200, and 201-300, respectively. We retrospectively reviewed and analysed the safety and feasibility outcomes. Results The operative time (period 1: 318.9±62.2 min, period 2: 256.7±71.4 min, period 3: 227.7±57.4 min) and blood loss (period 1: 419.7±196.5 mL, period 2: 198.9±197.2 mL, period 3: 166.0±130.0 mL) gradually decreased (P<0.01). Similarly, the length of hospital stay decreased (period 1: 8.1±2.0 days, period 2: 7.3±3.1 days, period 3: 6.9±2.4 days, P<0.01). There was no requirement for intraoperative transfusions or care in the intensive care unit. The overall complication rate was 20/300 (6.7%), of which 8/300 (2.7%) were Clavien-Dindo grade III and above. Complications were not different among the three periods. In terms of anatomical variations, the incidences of multiple portal veins, multiple hepatic arteries, and multiple bile ducts were 32/300 (10.7%), 11/300 (3.7%), and 161/300 (53.7%), respectively. No differences were found among the three periods. Conclusions Owing to the technical improvements over time, pure laparoscopic living donor hepatectomy is currently feasible and safe even for donors with anatomical variations.
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Affiliation(s)
- Eui Soo Han
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung-Suk Suh
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kwang-Woong Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Nam-Joon Yi
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Suk Kyun Hong
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong-Moo Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kwang Pyo Hong
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Ming Yuan Tan
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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Lack of Association between Postoperative Pancreatitis and Other Postoperative Complications Following Pancreaticoduodenectomy. J Clin Med 2021; 10:jcm10061179. [PMID: 33799863 PMCID: PMC8001526 DOI: 10.3390/jcm10061179] [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: 02/04/2021] [Revised: 03/02/2021] [Accepted: 03/09/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Prediction of post-pancreaticoduodenectomy (PD) morbidity is difficult, especially in the early postoperative period when CT (Computed Tomography) scans are not available. Elevated serum amylase and lipase in postoperative day 0 or 1 may be used to define postoperative acute pancreatitis (POAP), but the existing literature does not agree on whether POAP is significantly associated with postoperative pancreatic fistula (POPF). Methods: We analyzed the data obtained from a previously published randomized controlled trial. POAP was defined as elevations in serum amylase above 110 U/L on postoperative day 0 or 1. Clinically relevant POAP (CR-POAP) was defined as elevations in C-reactive protein level (CRP) on postoperative day 2 in those with POAP. Postoperative complications including severe complications (Clavien–Dindo ≥ IIIa), POPF, and clinically relevant POPF (CR-POPF) were analyzed. Results: In 246 patients, POAP did not show significant associations with total postoperative complications (odds ratio (OR) 0.697; 95% CI, 0.360–1.313; p = 0.271), severe complications (OR 0.647; 95% CI, 0.258–1.747; p = 0.367), and CR-POPF (OR 0.998; 95% CI, 0.310–3.886; p = 0.998) in multivariable analysis. Conclusions: In patients undergoing PD, POAP was not significantly associated with postoperative complications including POPF. Caution should be taken when using POAP as a predictor of POPF.
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Abstract
BACKGROUND Limb lengthening by distraction osteogenesis is now achievable via motorized intramedullary devices, mitigating many complications of lengthening by external fixation. In young patients, antegrade intramedullary nailing of the femur risks avascular necrosis of the femoral head. A method of extramedullary placement of a motorized expandable intramedullary nail has been employed by the senior author to safely achieve femoral lengthening without the use of an external fixator in young patients. METHODS Eleven skeletally immature patients with lower limb length discrepancy were reviewed who underwent extramedullary placement of a magnetic, expandable intramedullary nail for lengthening of the femur. Surgical details, lengthening parameters, and complications were reviewed and classified according to the modified Clavien-Dindo Classification. RESULTS Average lengthening was 32.3 mm (range: 27 to 40 mm) comprising an average 14.8% of femoral segment length. The average lengthening duration was 6.3 weeks, and average full weight-bearing began at 12.6 weeks. All but 1 patient underwent early removal of the device at an average of 4.5 months, and 5 had immediate plating of the femur. Complications rates were comparable to other methods of femoral lengthening, including varus or procurvatum through the regenerate, and unplanned reoperation in 3 of 11 cases. Preoperative considerations included careful planning of implant length due to short femoral segments and protection of the knee joint from contracture or iatrogenic instability. CONCLUSIONS Extramedullary placement of a magnetic expandable intramedullary lengthening nail can achieve lengthening of the femur without the use of external fixation. Considerations with this technique include careful planning of implant length relative to trochanteric-physeal distance, protection against knee subluxation during lengthening, and mitigating deformity of the regenerate. Off-label, extramedullary use of these devices can be considered to decrease the burdens of external fixation in young children. The technique begs the advent of future all-internal technology specifically designed for safe limb lengthening in this age group. LEVEL OF EVIDENCE Level IV-retrospective case series.
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Higgins MCSS, Herpy JP. Medical Error, Adverse Events, and Complications in Interventional Radiology: Liability or Opportunity? Radiology 2020; 298:275-283. [PMID: 33320064 DOI: 10.1148/radiol.2020202341] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mikhail C S S Higgins
- From the Department of Radiology, Boston Medical Center, 820 Harrison Ave, FGH Building 4th Floor, Boston, MA 02118 (M.C.S.S.H.); and Department of Radiology, Boston University School of Medicine, Boston, Mass (J.P.H.)
| | - James P Herpy
- From the Department of Radiology, Boston Medical Center, 820 Harrison Ave, FGH Building 4th Floor, Boston, MA 02118 (M.C.S.S.H.); and Department of Radiology, Boston University School of Medicine, Boston, Mass (J.P.H.)
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Brodie A, Kijvikai K, Decaestecker K, Vasdev N. Review of the evidence for robotic-assisted robotic cystectomy and intra-corporeal urinary diversion in bladder cancer. Transl Androl Urol 2020; 9:2946-2955. [PMID: 33457267 PMCID: PMC7807361 DOI: 10.21037/tau.2019.12.19] [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] [Indexed: 01/18/2023] Open
Abstract
Radical cystectomy, pelvic lymph node dissection and urinary diversion is the gold-standard treatment for muscle-invasive bladder cancer. The surgery is both complex and highly morbid. Robotic cystectomy is now in its 16th year with established techniques and sufficient research maturity to enable comparison with its open counterpart. The present review focuses on the current evidence for robotic cystectomy and assesses various metrics including oncological, perioperative, functional, surgeon-specific and cost outcomes. The review also encapsulates the current evidence for intra-corporeal urinary diversion and its current status in the cystectomy arena.
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Affiliation(s)
- Andrew Brodie
- Hertfordshire and Bedfordshire Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, UK
| | - Kittinut Kijvikai
- Division of Urology, Department of Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Nikhil Vasdev
- Hertfordshire and Bedfordshire Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, UK.,School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, UK
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Faddan AA, Shalaby MM, Gadelmoula M, Alshamsi Y, Osmonov DK, Mohammed N, Kurkar A, Abdel Latif AM, Fornara P, Jünemann KP. Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a multi-institutional comparative study. AFRICAN JOURNAL OF UROLOGY 2020. [DOI: 10.1186/s12301-020-00083-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The standard surgical treatment of localized prostate cancer (PCa) has been rapidly changed along the last two decades from open to laparoscopic and finally robot-assisted techniques. Herein, we compare the three procedures for radical prostatectomy (RP), namely radical retropubic (RRP), laparoscopic (LRP), and robot-assisted laparoscopic (RALRP) regarding the perioperative clinical outcome and complication rate in four academic institutions.
Methods
A total of 394 patients underwent RP between January 2016 and December 2018 in four academic institutions; their records were reviewed. We recorded the patient age, BMI, PSA level, Gleason score and TNM stage, type of surgery, the pathological data from the surgical specimen, the perioperative complications, unplanned reoperating, and readmission rates within 3 months postoperatively. Statistical significance was set at (P < 0.05). All reported P values are two-sided.
Results
A total of 123 patients underwent RALRP, 220 patients underwent RRP, and 51 underwent LRP. There was no statistically significant difference between the three groups regarding age, BMI, prostatic volume, and preoperative PSA. However, there were statistically significant differences between them regarding the operating time (P < .0001), catheterization period (P < .001), hospital stay (P < .0001), and overall complications rate (P = .023).
Conclusions
The minimally invasive procedures (RALRP and LRP) are followed by a significantly lower complication rate. However, the patients’ factors and surgical experience likely impact perioperative outcomes and complications.
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Comprehensive Complication Index or Clavien-Dindo Classification: Which is Better for Evaluating the Severity of Postoperative Complications Following Pancreatectomy? World J Surg 2020; 45:849-856. [PMID: 33191470 DOI: 10.1007/s00268-020-05859-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Complications are important indicators of immediate postoperative outcomes. The Clavien-Dindo classification (CDC) is a widely used index for the classification of surgical complications. More recently, the comprehensive complication index (CCI) has also been introduced for classifying postoperative complications. The aim of this study was to compare the relationship of CCI and CDC with clinical or economic parameters. METHODS The study prospectively enrolled patients from April 2015 to October 2016. Two hundred and twenty-two patients underwent pancreatectomy during the enrolled period. Complications were ranked according to CDC and CCI indices. After analyzing the correlation between CCI and CDC, the correlations of length of stay (LOS) and cost with CCI and CDC were compared. Finally, differences between the correlation coefficients of CDC and CCI parameters were calculated. RESULTS Complications occurred in 211 patients (95.0%). The correlation between CDC and CCI was r = 0.938. (p < 0.001) Compared to the CDC, CCI showed significantly stronger correlations with LOS and cost of complications (LOS: CCI vs. CDC, r = 0.725 vs. r = 0.630, p < 0.001; cost: CCI vs. CDC, r = 0.774 vs. r = 0.723, p < 0.001). CONCLUSION CCI is a more accurate classification index, compared to CDC, for evaluating the risk of postoperative complications.
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Nabavizadeh R, Noorali AA, Makhani SS, Hong G, Holzman S, Patil DH, Kim FY, Tso PL, Turgeon NA, Ogan K, Master VA. Transplant Radical Nephrectomy and Transplant Radical Nephroureterectomy for Renal Cancer: Postoperative and Survival Outcomes. Ann Transplant 2020; 25:e925865. [PMID: 33093437 PMCID: PMC7590527 DOI: 10.12659/aot.925865] [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] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The treatment of complex tumors in non-functioning renal transplants requiring surgical extirpation is challenging. Here, we report the largest series of patients who underwent transplant radical nephrectomy for renal cell carcinoma (RCC) and transplant radical nephroureterectomy for urothelial cell carcinoma (UCC) in their transplanted kidneys. MATERIAL AND METHODS From 2004 to 2018, 10 patients underwent transplant radical nephrectomy (7 patients) and nephroureterectomy (3 patients). Retrospective analyses, in terms of complications, oncological recurrence, and survival, of peri-operative and long-term outcomes, were performed. RESULTS Out of the 10 patients, 7 had RCC and 3 had UCC. No intraoperative mortality occurred. Three patients presented with Clavien-Dindo grade IIIa or greater within 30 days of surgery. Two patients died within 60 days of surgery, both due to vascular events: one due to myocardial infarction and one due to stroke. Two other patients died: one after 2.9 years, due to myocardial infarction, and the other after 6 years, due to unknown reasons. At the 7-year follow-up, there was a 60% overall survival rate. For all patients, average survival post-nephrectomy was approximately 4.5 years, including the 6 living patients and 4 deceased patients. Importantly, there was no observed cancer recurrence. CONCLUSIONS This study reports outcomes of the largest series of transplant radical nephrectomy and nephroureterectomy for malignancies of renal allografts. In the optimized setting, extirpative surgeries appear safe, with favorable long-term oncological and survival outcomes.
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Affiliation(s)
- Reza Nabavizadeh
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - Gordon Hong
- College of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Sarah Holzman
- Department of Urology, University of California Irvine and Children's Hospital, Orange, CA, USA
| | - Dattatraya H Patil
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Frances Y Kim
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Paul L Tso
- Department of Transplant Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Nicole A Turgeon
- Department of Transplant Surgery, University of Texas Dell Medical School, Austin, TX, USA
| | - Kenneth Ogan
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA.,Winship Cancer Institute, Emory University, Atlanta, GA, USA
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