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Wang Y, Du X, Gong Y, Jiang Y, Zheng Y. Influencing factors of cancer-related fatigue in acute leukemia patients: A cross-sectional study. Heliyon 2023; 9:e22813. [PMID: 38144341 PMCID: PMC10746407 DOI: 10.1016/j.heliyon.2023.e22813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 12/26/2023] Open
Abstract
Purpose To investigate influencing factors of cancer-related fatigue (CRF) in adult patients with acute leukemia (AL). Methods A total of 288 adult patients diagnosed with acute leukemia in West China Hospital were included in this study. A cross-sectional survey, including the Clinical Information Questionnaire, the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Pittsburgh Sleep Quality Index (PSQI), and Hospital Anxiety and Depression Scale (HAD), was provided to the patients. Hierarchical multiple linear regression analyses were conducted to evaluate the associations of the variable factors and the AL patients' CRF. Results The CRF score of AL patients was 33.25 ± 10.35. Gender, age, albumin level, depression, anxiety status of the patients and treatment cycles were identified as influencing factors of CRF in AL patients (P < 0.05). The CRF level of acute leukemia patients in the complete remission group was lower than that of patients who were not achieving complete remission. Depression, anxiety, age, employment, albumin, and sleep disturbance were independent influencing factors for CRF in patients who were not achieving complete remission. Conclusions Acute leukemia patients who are female, older, hypoalbuminemia,or in the induction therapy have a higher risk of developing a high degree of CRF. Clinical staff should pay more attention to the CRF of patients who were not achieving complete remission. Early screening and aggressive intervention could be adopted in caring for these patients.
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Affiliation(s)
- Yingli Wang
- Department of Hematology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, China
| | - Xinwen Du
- Department of Hematology, West China Hospital, Sichuan University, China
| | - Yuping Gong
- Department of Hematology, West China Hospital, Sichuan University, China
| | - Yan Jiang
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, China
| | - Yuhuan Zheng
- Department of Hematology, West China Hospital, Sichuan University, China
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Park JH, Lee J, Kim DH, Min JS, Kim TH, Jung EJ, Park T, Jang JY, Woo JW, lee HS, Park M, Jeong SH. Concurrent laparoscopic highly selective vagotomy with closure of duodenal ulcer perforations show good clinical results as primary repair alone. J Int Med Res 2023; 51:3000605231206319. [PMID: 37890147 PMCID: PMC10612450 DOI: 10.1177/03000605231206319] [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: 10/19/2022] [Accepted: 08/08/2023] [Indexed: 10/29/2023] Open
Abstract
OBJECTIVE To compare clinical and operative results between laparoscopic primary repair (LPR) alone and LPR with highly selective vagotomy (LPR-HSV) in patients with duodenal ulcer perforation. METHODS Clinical data from patients who underwent either LPR or LPR-HSV by resecting both sides of the neurovascular bundle using an ultrasonic or bipolar electrosurgical device for duodenal ulcer perforations, between 2010 and 2020, were retrospectively collected. Between-group differences in continuous and categorical variables were statistically analysed. RESULTS Data from 184 patients (mean age, 49.6 years), who underwent either LPR (n = 132) or LPR-HSV (n = 52) were included. The mean operation time was significantly longer in the LPR-HSV group (116.5 ± 39.8 min) than in the LPR group (91.2 ± 33.3 min). Hospital stay was significantly shorter in the LPR-HSV group (8.6 ± 2.6 days) versus the LPR group (11.3 ± 7.1 days). The mean postoperative day of starting soft fluid diet was also significantly shorter in the LPR-HSV group (4.5 ± 1.4 days) than in the LPR group (5.6 ± 4 days). No between-group difference in morbidity rate was observed. The learning curve of the HSV procedure showed a stable procedure time after 10 operations. CONCLUSIONS LPR with HSV may be a safe and feasible procedure for selective cases who are at high risk for ulcer recurrence.
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Affiliation(s)
- Ji-Ho Park
- Department of Surgery, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Jin‑Kwon Lee
- Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Dong-Hwan Kim
- Department of Surgery, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Jae-Seok Min
- Department of Surgery, Dongnam Institute of Radiological and Medical Sciences, Cancer Centre, Busan, Republic of Korea
| | - Tae-Han Kim
- Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Eun-Jung Jung
- Department of Surgery, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
- Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Taejin Park
- Department of Surgery, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
- Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Jae Yool Jang
- Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Jung-Woo Woo
- Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Han Shin lee
- Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Miyeong Park
- Department of Anaesthesiology, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Sang-Ho Jeong
- Department of Surgery, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
- Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
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Treuheit J, Krautz C, Weber GF, Grützmann R, Brunner M. Risk Factors for Postoperative Morbidity, Suture Insufficiency, Re-Surgery and Mortality in Patients with Gastroduodenal Perforation. J Clin Med 2023; 12:6300. [PMID: 37834943 PMCID: PMC10573308 DOI: 10.3390/jcm12196300] [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: 09/04/2023] [Revised: 09/27/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
(1) Background: The aim of the present study was to identify risk factors associated with postoperative morbidity, suture/anastomotic insufficiency, re-surgery, and mortality in patients undergoing surgery for gastroduodenal perforation. (2) Methods: A retrospective analysis of 273 adult patients who received surgical treatment for gastroduodenal perforation from January 2006 to June 2021 at the University Hospital Erlangen was performed. The patient demographics and preoperative, intraoperative, and postoperative parameters were collected and compared among the different outcome groups (in-hospital morbidity, suture/anastomotic insufficiency, re-surgery, and 90-day mortality). (3) Results: In-hospital morbidity, suture/anastomotic insufficiency, need for re-surgery, and 90-day mortality occurred in 71%, 10%, 26%, and 25% of patients, respectively. The independent risk factors for morbidity were a significantly reduced general condition, a lower preoperative hemoglobin level, and a higher preoperative creatinine level. The independent risk factors for suture/anastomotic insufficiency could be identified as an intake of preoperative steroids and a perforation localization in the proximal stomach or duodenum. The four parameters were independent risk factors for the need for re-surgery: a significantly reduced general condition, a perforation localization in the proximal stomach, a higher preoperative creatinine level, and a higher preoperative CRP level. An age over 66 years and a higher preoperative CRP level were independent risk factors for 90-day mortality. (4) Conclusions: Our study could identify relevant risk factors for the postoperative outcome of patients undergoing surgical treatment for gastroduodenal perforation. Patients exhibiting the identified risk factors should receive heightened attention in the postoperative period and may potentially benefit from personalized and tailored therapy.
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Affiliation(s)
| | | | | | | | - Maximilian Brunner
- Department of General and Visceral Surgery, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Krankenhausstraße 12, 91054 Erlangen, Germany; (J.T.); (C.K.); (G.F.W.); (R.G.)
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4
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Xie D, Lu PL, Xu W, You JY, Bi XG, Xian Y. Correlation of serum albumin level on postoperative day 2 with hospital length of stay in patients undergoing emergency surgery for perforated peptic ulcer. World J Gastrointest Surg 2023; 15:1434-1441. [PMID: 37555103 PMCID: PMC10405103 DOI: 10.4240/wjgs.v15.i7.1434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/18/2023] [Accepted: 06/02/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Perforated peptic ulcer (PPU) is a common emergency surgical condition and a significant cause of morbidity and mortality worldwide. While advances in surgical techniques have improved outcomes for patients with PPU, many factors still affect postoperative hospital stay and overall prognosis. One potential factor is the serum albumin (SA) level, a widely utilized marker of nutritional status that has been associated with length of stay and complications in various surgical procedures. AIM To clarify the correlation of SA level on postoperative day 2 with hospital length of stay (HLOS) in patients undergoing emergency surgery for perforated peptic ulcer (PPU). METHODS We retrospectively collected and analyzed clinical baseline data, including blood routine and SA levels, of patients who underwent emergency PPU surgery and postoperative treatment at the Lingnan Hospital, the Third Affiliated Hospital of Sun Yat-sen University between December 2012 and September 2021. Patients were grouped according to HLOS with 7 d as the cut-off value, and relevant indicators were analyzed using SPSS 26.0. RESULTS Of the 37 patients undergoing emergency surgery for PPU referred to our department, 33 had gastric and 4 had duodenal ulcer perforation. The median HLOS was 10 d. There were 8 patients in the ≤ 7-d group (median HLOS: 7 d) and 29 patients in the > 7-d group (median HLOS: 10 d). The ≤ 7-d group had markedly higher SA on postoperative day 2 than the > 7-d group (37.7 g/L vs 32.6g/L; P < 0.05). The SA level on postoperative day 2 was a protective factor for patients with HLOS > 7 d (Odds ratio = 0.629, P = 0.015). The cut-off of SA on postoperative day 2 was 30.6g/L, with an area under the curve of 0.86 and a negative predictive value of 100% for the prediction of HLOS ≤ 7 d. CONCLUSION The SA level on postoperative day 2 was associated with the HLOS in patients undergoing emergency surgery for PPU. The pre- and post-operative albumin levels should be monitored, and infusion of human SA should be considered in a timely manner.
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Affiliation(s)
- Dan Xie
- Department of General Intensive Care Unit, Lingnan Hospital, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510530, Guangdong Province, China
| | - Ping-Lan Lu
- Department of Surgical Intensive Care Unit, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China
| | - Wen Xu
- Department of General Intensive Care Unit, Lingnan Hospital, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510530, Guangdong Province, China
| | - Jing-Ya You
- Department of General Intensive Care Unit, Lingnan Hospital, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510530, Guangdong Province, China
| | - Xiao-Gang Bi
- Department of General Intensive Care Unit, Lingnan Hospital, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510530, Guangdong Province, China
| | - Ying Xian
- Department of General Intensive Care Unit, Lingnan Hospital, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510530, Guangdong Province, China
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5
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Mazepa MM, Pereira MA, Arabi AYM, Dias AR, Ribeiro U, Zilberstein B, D’Albuquerque LAC, Ramos MFKP. Gastroduodenal Perforation in Cancer Patients: Association with Chemotherapy and Prognosis. Med Sci (Basel) 2023; 11:medsci11020026. [PMID: 37092495 PMCID: PMC10123675 DOI: 10.3390/medsci11020026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 03/30/2023] Open
Abstract
Background: Gastroduodenal perforation stands out as one of the complications in cancer patients. Despite its high mortality, its characteristics are still poorly described. This study aimed to evaluate the characteristics and outcomes of cancer patients who had gastroduodenal perforation, and the influence of chemotherapy (CMT) in these cases. Method: A retrospective analysis of patients who underwent emergency surgery with an intraoperative finding of gastroduodenal perforation. Patients who performed CMT within 60 days before perforation were considered as the CMT group. Results: Among 45 patients included, 16 (35.5%) were classified as the CMT group and the remaining 29 (64.5%) patients as the non-CMT group. There was no difference between the groups regarding sex, age, BMI, comorbidity, and laboratory exams. ECOG 2-3 was significantly more frequent in the CMT group (68.8% vs. 34.5% p = 0.027). Major postoperative complications were similar between both groups (75% vs. 58.6%, p = 0.272). The sepsis of abdominal focus was the main postoperative complication. The 30-day mortality was 55.6%, with no difference between non-CMT and CMT groups (62.5% vs. 51.7%, respectively; p = 0.486). A multivariate analysis of risk factors showed that only an age of ≥65 years was related to 30-day mortality. Conclusions: Patients with gastroduodenal perforation and oncologic treatment present high mortality, regardless of receiving recent CMT.
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Pelloni M, Afonso-Luís N, Marchena-Gomez J, Piñero-González L, Ortíz-López D, Acosta-Mérida MA, Rahy-Martín A. Comparative study of postoperative complications after open and laparoscopic surgery of the perforated peptic ulcer: Advantages of the laparoscopic approach. Asian J Surg 2021; 45:1007-1013. [PMID: 34593282 DOI: 10.1016/j.asjsur.2021.08.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/10/2021] [Accepted: 08/11/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Despite the acceptance of the laparoscopic approach for the treatment of perforated peptic ulcers, its definitive implantation is still a matter of discussion. We performed a comparative study between the open and laparoscopic approach focused on postoperative surgical complications. METHODS Retrospective observational study in which patients operated on for perforated peptic ulcus in our center between 2001 and 2017 were analyzed. Only those in whom suture and/or omentoplasty had been performed were selected, either for open or laparoscopic approach. Demographic, clinical, and intraoperative variables, complications, mortality and length of stay were collected. Both groups, open and laparoscopic surgery patients, were compared. RESULTS The final study sample was 250 patients, 190 (76%) men and 60 (24%) women, mean age 54 years (SD ± 16.7). In 129 cases (52%), the surgical approach was open, and in 121 (48%) it was laparoscopic. Grades III-V complications of the Clavien-Dindo Classification occurred in 23 cases (9%). Operative mortality was 1.2% (3 patients). Laparoscopically operated patients had significantly fewer complications (p = 0.001) and shorter hospital stay (p < 0.001). In multivariate analysis, laparoscopic approach (p = 0.025; OR:0.45-95%CI: 0.22-0.91), age (p = 0.003; OR:1.03-95%CI: 1.01-1.06), and Boey score (p = 0.024 - OR:1.71 - CI95%: 1.07-2.72), were independent prognostic factors for postoperative surgical complications. CONCLUSION Laparoscopic surgery should be considered the first-choice approach for patients with perforated peptic ulcer. It is significantly associated with fewer postoperative complications and a shorter hospital stay than the open approach.
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Affiliation(s)
- Maria Pelloni
- Department of General and Digestive Surgery, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Natalia Afonso-Luís
- Department of General and Digestive Surgery, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Joaquin Marchena-Gomez
- Department of General and Digestive Surgery, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
| | - Luís Piñero-González
- Department of General and Digestive Surgery, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - David Ortíz-López
- Department of General and Digestive Surgery, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Maria Asunción Acosta-Mérida
- Department of General and Digestive Surgery, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Aida Rahy-Martín
- Department of General and Digestive Surgery, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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7
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Ho ST, Chen TJ, Yeh TC, Kao S, Lin TC, Wang JO. Anesthesia services in Taiwan: A nationwide population-based study. J Chin Med Assoc 2021; 84:713-717. [PMID: 34029215 DOI: 10.1097/jcma.0000000000000553] [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: 11/26/2022] Open
Abstract
BACKGROUND This study was conducted to provide an overview of anesthesia services in Taiwan from 2001 to 2010. METHODS A retrospective population-based analysis was performed using data from Taiwan's National Health Insurance Research Database for the period 2001 to 2010. The results were stratified by patient sex, patient age, anesthesia type, and hospital setting. Categorical data are presented as totals and percentages. Linear regression was performed to analyze the anesthesia trends. RESULTS The annual use of anesthesia increased continually from 964,440 instances in 2001 to 1,073,160 in 2010, totaling 10,076,600 cases with a total cost of 25.4 billion USD. The overwhelming majority (83.9%) of anesthesia cases was for anesthesia in an inpatient setting; general anesthesia accounted for 73.8% of anesthesia cases, and female patients outnumbered male patients (52.4% vs 47.6%). The average number of anesthesia cases was 44.2 per thousand of the population annually, but this percentage was much higher in elderly people (100.9 cases per thousand people annually). The annual number of anesthesia cases per thousand of the population increased from 104.4 in 2001 to 113.0 in 2010 in the oldest group (>80 years). By contrast, a considerable decline in use of anesthesia was discovered over the study period among those aged younger than 18 years. CONCLUSION The use of anesthesia services in Taiwan has increased over the years. The relationships of age with anesthesia volume and cost were found to follow an inverse U-shaped pattern. Elderly people used anesthesia services more frequently. The planning of geriatric anesthesia services deserves attention, especially in continually aging societies such as Taiwan.
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Affiliation(s)
- Shung-Tai Ho
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC
- Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Te-Chun Yeh
- Development and Planning Center, Taipei City Hospital, Taipei, Taiwan, ROC
| | - Senyeong Kao
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Tso-Chou Lin
- Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Ju-O Wang
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
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8
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Jayaraman SS, Kulkarni SS, Eaton B, Sides J, Gergen AK, Harmon L, Weinberger JM, Bruns BR, Neal MD, Turcotte J, Feather C, Klune JR. Does routine postoperative contrast radiography improve outcomes for patients with perforated peptic ulcer? A multicenter retrospective cohort study. Surgery 2021; 170:1554-1560. [PMID: 34175115 DOI: 10.1016/j.surg.2021.05.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 05/05/2021] [Accepted: 05/15/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Perforated peptic ulcer is a morbid emergency general surgery condition. Best practices for postoperative care remain undefined. Surgical dogma preaches practices such as peritoneal drain placement, prolonged nil per os, and routine postoperative enteral contrast imaging despite a lack of evidence. We aimed to evaluate the role of postoperative enteral contrast imaging in postoperative perforated peptic ulcer care. Our primary objective was to assess effects of routine postoperative enteral contrast imaging on early detection of clinically significant leaks. METHODS We conducted a multicenter retrospective cohort study of patients who underwent repair of perforated peptic ulcer between July 2016 and June 2018. We compared outcomes between those who underwent routine postoperative enteral contrast imaging and those who did not. RESULTS Our analysis included 95 patients who underwent primary/omental patch repair. The mean age was 60 years, and 54% were male. Thirteen (14%) had a leak. Eighty percent of patients had a drain placed. Nine patients had leaks diagnosed based on bilious drain output without routine postoperative enteral contrast imaging. Use of routine postoperative enteral contrast imaging varied significantly between institutions (30%-87%). Two late leaks after initial normal postoperative enteral contrast imaging were confirmed by imaging after a clinical change triggered the second study. Two patients had contained leaks identified by routine postoperative enteral contrast imaging but remained clinically well. Duration of hospital stay was longer in those who received routine postoperative enteral contrast imaging (12 vs 6 days, median; P = .000). CONCLUSION Routine postoperative enteral contrast imaging after perforated peptic ulcer repair likely does not improve the detection of clinically significant leaks and is associated with increased duration of hospital stay.
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Affiliation(s)
| | | | - Barbara Eaton
- Department of Surgery, University of Maryland Medical Center, Baltimore, MD
| | - Jake Sides
- Department of Surgery, Christiana Care Health System, Wilmington, DE
| | - Anna K Gergen
- Department of Surgery, University of Colorado Hospital, Aurora, CO
| | - Laura Harmon
- Department of Surgery, University of Colorado Hospital, Aurora, CO. https://twitter.com/lauraharmonmd
| | | | - Brandon R Bruns
- Department of Surgery, University of Maryland Medical Center, Baltimore, MD. https://twitter.com/BrandonRBruns1
| | - Matthew D Neal
- Department of Surgery, University of Pittsburgh Medical Center, PA. https://twitter.com/macky_neal
| | - Justin Turcotte
- Department of Surgery, Anne Arundel Medical Center, Annapolis, MD
| | - Cristina Feather
- Department of Surgery, Anne Arundel Medical Center, Annapolis, MD
| | - John R Klune
- Department of Surgery, Anne Arundel Medical Center, Annapolis, MD.
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9
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Boyd-Carson H, Doleman B, Cromwell D, Lockwood S, Williams JP, Tierney GM, Lund JN, Anderson ID. Delay in Source Control in Perforated Peptic Ulcer Leads to 6% Increased Risk of Death Per Hour: A Nationwide Cohort Study. World J Surg 2020; 44:869-875. [PMID: 31664496 DOI: 10.1007/s00268-019-05254-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Delay to theatre for patients with intra-abdominal sepsis is cited as a particular risk factor for death. Our aim was to evaluate the potential relationship between hourly delay from admission to surgery and post-operative mortality in patients with perforated peptic ulcer (PPU). METHODS All patients entered in the National Emergency Laparotomy Audit who had an emergency laparotomy for PPU within 24 h of admission from December 2013 to November 2017 were included. Time to theatre from admission was modelled as a continuous variable in hours. Outcome was 90-day mortality. Logistic regression adjusting for confounding factors was performed. RESULTS 3809 patients were included, and 90-day mortality rate was 10.61%. Median time to theatre was 7.5 h (IQR 5-11.6 h). The odds of death increased with time to operation once adjustment for confounding variables was performed (per hour after admission adjusted OR 1.04 95% CI 1.02-1.07). In patients who were physiologically shocked (N = 334), there was an increase of 6% in risk-adjusted odds of mortality for every hour Em Lap was delayed after admission (OR 1.06 95% CI 1.01-1.11). CONCLUSION Hourly delay to theatre in patients with PPU is independently associated with risk of death by 90 days. Therefore, we suggest that surgical source control should occur as soon as possible after admission regardless of time of day.
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Affiliation(s)
- H Boyd-Carson
- Division of General Surgery, Royal Derby Hospital, Derby Hospitals NHS Trust, Derby, UK. .,National Emergency Laparotomy Audit Project Team, Royal College of Anaesthetists, London, UK. .,Division of Medical Sciences and Graduate Entry Medicine, Department of Surgery, University of Nottingham, Nottingham, UK.
| | - B Doleman
- Division of General Surgery, Royal Derby Hospital, Derby Hospitals NHS Trust, Derby, UK.,Division of Medical Sciences and Graduate Entry Medicine, Department of Surgery, University of Nottingham, Nottingham, UK
| | - D Cromwell
- National Emergency Laparotomy Audit Project Team, Royal College of Anaesthetists, London, UK.,Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.,Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - S Lockwood
- National Emergency Laparotomy Audit Project Team, Royal College of Anaesthetists, London, UK
| | - J P Williams
- Division of General Surgery, Royal Derby Hospital, Derby Hospitals NHS Trust, Derby, UK.,Division of Medical Sciences and Graduate Entry Medicine, Department of Surgery, University of Nottingham, Nottingham, UK
| | - G M Tierney
- Division of General Surgery, Royal Derby Hospital, Derby Hospitals NHS Trust, Derby, UK.,National Emergency Laparotomy Audit Project Team, Royal College of Anaesthetists, London, UK.,Division of Medical Sciences and Graduate Entry Medicine, Department of Surgery, University of Nottingham, Nottingham, UK
| | - J N Lund
- Division of General Surgery, Royal Derby Hospital, Derby Hospitals NHS Trust, Derby, UK.,Division of Medical Sciences and Graduate Entry Medicine, Department of Surgery, University of Nottingham, Nottingham, UK
| | - I D Anderson
- National Emergency Laparotomy Audit Project Team, Royal College of Anaesthetists, London, UK.,University of Manchester Academic Health Sciences Centre, Manchester, UK
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10
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Dadfar A, Edna TH. Epidemiology of perforating peptic ulcer: A population-based retrospective study over 40 years. World J Gastroenterol 2020; 26:5302-5313. [PMID: 32994689 PMCID: PMC7504248 DOI: 10.3748/wjg.v26.i35.5302] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/23/2020] [Accepted: 08/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The incidence of peptic ulcer disease has decreased during the last few decades, but the incidence of reported peptic ulcer complications has not decreased. Perforating peptic ulcer (PPU) is a severe form of the disease.
AIM To assess trends in the incidence, presentation, and outcome of PPU over a period of 40 years.
METHODS This was a single-centre, retrospective, cohort study of all patients admitted to Levanger Hospital, Norway, with PPU from 1978 to 2017. The patients were identified in the Patient Administrative System of the hospital using International Classification of Diseases (ICD), revision 8, ICD-9, and ICD-10 codes for perforated gastric and duodenal ulcers. We reviewed the medical records of the patients to retrieve data. Vital statistics were available for all patients. The incidence of PPU was analysed using Poisson regression with perforated ulcer as the dependent variable, and sex, age, and calendar year from 1978 to 2017 as covariates. Relative survival analysis was performed to compare long-term survival over the four decades.
RESULTS Two hundred and nine patients were evaluated, including 113 (54%) men. Forty-six (22%) patients were older than 80 years. Median age increased from the first to the last decade (from 63 to 72 years). The incidence rate increased with increasing age, but we measured a decline in recent decades for both sexes. A significant increase in the use of acetylsalicylic acid, from 5% (2/38) to 18% (8/45), was observed during the study period. Comorbidity increased significantly over the 40 years of the study, with 22% (10/45) of the patients having an American Society of Anaesthesiologists (ASA) score 4-5 in the last decade, compared to 5% (2/38) in the first decade. Thirty-nine percent (81/209) of the patients had one or more postoperative complications. Both 100-day mortality and long-term survival were associated with ASA score, without significant variations between the decades.
CONCLUSION Declining incidence rates occurred in recent years, but the patients were older and had more comorbidity. The ASA score was associated with both short-term mortality and long-term survival.
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Affiliation(s)
- Aydin Dadfar
- Department of Surgery, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger 7600, Norway
| | - Tom-Harald Edna
- Department of Surgery, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger 7600, Norway
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim 7491, Norway
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11
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Manco G, Caramaschi S, Rolando G, Malagoli M, Zanelli G, Reggiani Bonetti L, Rossi A. Primary laparoscopic approach to repair perforated peptic ulcer. A retrospective cohort study. MINERVA CHIR 2020; 75:436-441. [PMID: 32456394 DOI: 10.23736/s0026-4733.20.08287-5] [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 Perforated peptic ulcer is a serious complication of peptic ulcer disease and carries high risk for morbidity and mortality. Although the incidence of peptic ulcer disease has decreased in recent decades, the percentage of patients with perforated peptic ulcer requiring emergency surgery remains constant. The use of laparoscopic management as a first choice for the treatment of the perforation is growing but is not routine in many centers. METHODS Clinical and surgical data on 42 patients underwent surgical treatment for perforated peptic ulcer from January 2012 to December 2016 were collected. Laparoscopic repair of the perforation with a three-port technique was made in all cases. The Boey scoring system was used to predict the prognosis. RESULTS All patients underwent suture-closure of the ulcer, and omental patch through laparoscopy without conversion to open surgery. Duodenal leakages occurred in 3 patients (7.1%), then treated with a conservative approach and resolved on the 10th postoperative day. Two patients (4.7%) had deep space infections in the first week after surgery, therefore subdiaphragmatic and pelvic abscess were drained by ultrasound guidance. Four patients (9.5%) died up to 30-day post-surgery due to progression of multisystem organ failure in absence of leakages or infections. All these patients were American Society of Anesthesiologists Classification >III and Boey Score 3. CONCLUSIONS Our data show that a primary laparoscopic approach in patients with peptic ulcer perforation is associated with postoperative advantages and acceptable rates of morbidity and mortality, essentially related to high Boey Score. Therefore, we suggest that the surgical repair of PPU could be always started laparoscopically.
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Affiliation(s)
- Gianrocco Manco
- Department of Surgery, University of Modena and Reggio Emilia, University Hospital of Modena, Modena, Italy
| | - Stefania Caramaschi
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, University Hospital of Modena, Modena, Italy -
| | - Giovanni Rolando
- Department of Surgery, University of Modena and Reggio Emilia, University Hospital of Modena, Modena, Italy
| | - Marzio Malagoli
- Department of Surgery, University of Modena and Reggio Emilia, University Hospital of Modena, Modena, Italy
| | - Giuliana Zanelli
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, University Hospital of Modena, Modena, Italy
| | - Luca Reggiani Bonetti
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, University Hospital of Modena, Modena, Italy
| | - Aldo Rossi
- Department of Surgery, University of Modena and Reggio Emilia, University Hospital of Modena, Modena, Italy
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12
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Hallam S, Bickley M, Phelan L, Dilworth M, Bowley DM. Does declared surgeon specialist interest influence the outcome of emergency laparotomy? Ann R Coll Surg Engl 2020; 102:437-441. [PMID: 32374217 DOI: 10.1308/rcsann.2020.0098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION In the UK, general surgeons must demonstrate competency in emergency general surgery before obtaining a certificate of completion of training. Subsequently, many consultants develop focused elective specialist interests which may not mirror the breadth of procedures encountered during emergency practice. Recent National Emergency Laparotomy Audit analysis found that declared surgeon special interest impacted emergency laparotomy outcomes, which has implications for emergency general surgery service configuration. We sought to establish whether local declared surgeon special interest impacts emergency laparotomy outcomes. METHODS Adult patients having emergency laparotomy were identified from our prospective National Emergency Laparotomy Audit database from May 2016 to May 2019 and categorised as colorectal or oesophagogastric according to operative procedure. Outcomes included 30-day mortality, return to theatre and length of stay. Binomial logistic regression was used to identify any association between declared consultant specialist interest and outcomes. RESULTS Of 600 laparotomies, 358 (58.6%) were classifiable as specialist procedures: 287 (80%) colorectal and 71 (20%) oesophagogastric. Discordance between declared specialty and operation undertaken occurred in 25% of procedures. For colorectal emergency laparotomy, there was an increased risk of 30-day mortality when performed by a non-colorectal consultant (unadjusted odds ratio 2.34; 95% confidence interval 1.10-5.00; p = 0.003); however, when adjusted for confounders within multivariate analysis declared surgeon specialty had no impact on mortality, return to theatre or length of stay. CONCLUSION Surgeon-declared specialty does not impact emergency laparotomy outcomes in this cohort of undifferentiated emergency laparotomies. This may reflect the on-call structure at Birmingham Heartlands Hospital, where a colorectal and oesophagogastric consultant are paired on call and provide cross-cover when needed.
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Affiliation(s)
- S Hallam
- Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - M Bickley
- Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - L Phelan
- Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - M Dilworth
- Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - D M Bowley
- Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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13
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Katz M, Silverstein N, Coll P, Sullivan G, Mortensen EM, Sachs A, Gross JB, Girard E, Liang J, Ristau BT, Stevenson C, Smith PP, Shames BD, Millea R, Ali I, Poulos CM, Ramaraj AB, Otukoya AO, Nolan J, Wahla Z, Hardy C, Al-Naggar I, Bliss LA, McFadden DW. Surgical care of the geriatric patient. Curr Probl Surg 2019; 56:260-329. [DOI: 10.1067/j.cpsurg.2019.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 03/13/2019] [Indexed: 12/15/2022]
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14
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Huston JM, Kreiner L, Ho VP, Sanders JM, Duane TM. Role of Empiric Anti-Fungal Therapy in the Treatment of Perforated Peptic Ulcer Disease: Review of the Evidence and Future Directions. Surg Infect (Larchmt) 2019; 20:593-600. [PMID: 31188069 DOI: 10.1089/sur.2019.062] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Peptic ulcer disease (PUD) affects four million people worldwide. Perforated peptic ulcer (PPU) occurs in less than 15% of cases but is associated with significant morbidity and mortality rates. Administration of antibiotics is standard treatment for gastrointestinal perforations, including PPU. Although fungal growth is common in peritoneal fluid cultures from patients with PPU, current data suggest empiric anti-fungal therapy fails to improve outcomes. To examine the role of anti-fungal agents in the treatment of PPU, the Surgical Infection Society hosted an Update Symposium at its 37th Annual Meeting. Here, we provide a synopsis of the symposium's findings and a brief review of prospective and retrospective reports on the subject. Methods: A search of Pubmed/MEDLINE, EMBASE, and the Cochrane Library was performed between January 1, 2000, and November 1, 2018, comparing outcomes of PPU following empiric anti-fungal treatment versus no anti-fungal therapy. We used the search terms "perforated peptic ulcer," "gastroduodenal ulcer," "anti-fungal," and "perforated" or "perforation." Results: There are no randomized clinical trials comparing outcomes specifically for patients with PPU treated with or without empiric anti-fungal therapy. We identified one randomized multi-center trial evaluating outcomes for patients with intra-abdominal perforations, including PPU, that were treated with or without empiric anti-fungal therapy. We identified one single-center prospective series and three additional retrospective studies comparing outcomes for patients with PPU treated with or without empiric anti-fungal therapy. Conclusion: The current evidence reviewed here does not demonstrate efficacy of anti-fungal agents in improving outcomes in patients with PPU. As such, we caution against the routine use of empiric anti-fungal agents in these patients. Further studies should help identify specific subpopulations of patients who might derive benefit from anti-fungal therapy and help define appropriate treatment regimens and durations that minimize the risk of resistance, adverse events, and cost.
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Affiliation(s)
- Jared M Huston
- Departments of Surgery and Science Education, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Laura Kreiner
- Department of Surgery, Case Western Reserve University School of Medicine, The MetroHealth System, Cleveland, Ohio
| | - Vanessa P Ho
- Department of Surgery, Case Western Reserve University School of Medicine, The MetroHealth System, Cleveland, Ohio
| | - James M Sanders
- Department of Pharmacy, John Peter Smith Health Network, Fort Worth, Texas
| | - Therese M Duane
- Department of Surgery, John Peter Smith Health Network, Fort Worth, Texas
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15
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Boyd-Carson H, Doleman B, Herrod PJJ, Anderson ID, Williams JP, Lund JN, Tierney GM, Murray D, Hare S, Lockwood S, Oliver CM, Spurling LJ, Poulton T, Johnston C, Cromwell D, Kuryba A, Martin P, Lourtie J, Goodwin J, Mooesinghe R, Eugene N, Catrin-Cook S, Anderson I. Association between surgeon special interest and mortality after emergency laparotomy. Br J Surg 2019; 106:940-948. [DOI: 10.1002/bjs.11146] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/07/2019] [Accepted: 01/31/2019] [Indexed: 11/07/2022]
Abstract
Abstract
Background
Approximately 30 000 emergency laparotomies are performed each year in England and Wales. Patients with pathology of the gastrointestinal tract requiring emergency laparotomy are managed by general surgeons with an elective special interest focused on either the upper or lower gastrointestinal tract. This study investigated the impact of special interest on mortality after emergency laparotomy.
Methods
Adult patients having emergency laparotomy with either colorectal or gastroduodenal pathology were identified from the National Emergency Laparotomy Audit database and grouped according to operative procedure. Outcomes included all-cause 30-day mortality, length of hospital stay and return to theatre. Logistic and Poisson regression were used to analyse the association between consultant special interest and the three outcomes.
Results
A total of 33 819 patients (28 546 colorectal, 5273 upper gastrointestinal (UGI)) were included. Patients who had colorectal procedures performed by a consultant without a special interest in colorectal surgery had an increased adjusted 30-day mortality risk (odds ratio (OR) 1·23, 95 per cent c.i. 1·13 to 1·33). Return to theatre also increased in this group (OR 1·13, 1·05 to 1·20). UGI procedures performed by non-UGI special interest surgeons carried an increased adjusted risk of 30-day mortality (OR 1·24, 1·02 to 1·53). The risk of return to theatre was not increased (OR 0·89, 0·70 to 1·12).
Conclusion
Emergency laparotomy performed by a surgeon whose special interest is not in the area of the pathology carries an increased risk of death at 30 days. This finding potentially has significant implications for emergency service configuration, training and workforce provision, and should stimulate discussion among all stakeholders.
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Affiliation(s)
- H Boyd-Carson
- Division of General Surgery, Royal Derby Hospital, Derby Hospitals NHS Trust, Derby, UK
- National Emergency Laparotomy Audit Project Team, Royal College of Anaesthetists, London, UK
- Department of Surgery, Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK
| | - B Doleman
- Division of General Surgery, Royal Derby Hospital, Derby Hospitals NHS Trust, Derby, UK
- Department of Surgery, Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK
| | - P J J Herrod
- Division of General Surgery, Royal Derby Hospital, Derby Hospitals NHS Trust, Derby, UK
- Department of Surgery, Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK
| | - I D Anderson
- National Emergency Laparotomy Audit Project Team, Royal College of Anaesthetists, London, UK
| | - J P Williams
- Department of Surgery, Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK
| | - J N Lund
- Division of General Surgery, Royal Derby Hospital, Derby Hospitals NHS Trust, Derby, UK
- Department of Surgery, Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK
| | - G M Tierney
- Division of General Surgery, Royal Derby Hospital, Derby Hospitals NHS Trust, Derby, UK
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16
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Byrne BE, Bassett M, Rogers CA, Anderson ID, Beckingham I, Blazeby JM. Short-term outcomes after emergency surgery for complicated peptic ulcer disease from the UK National Emergency Laparotomy Audit: a cohort study. BMJ Open 2018; 8:e023721. [PMID: 30127054 PMCID: PMC6104767 DOI: 10.1136/bmjopen-2018-023721] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES This study used national audit data to describe current management and outcomes of patients undergoing surgery for complications of peptic ulcer disease (PUD), including perforation and bleeding. It was also planned to explore factors associated with fatal outcome after surgery for perforated ulcers. These analyses were designed to provide a thorough understanding of current practice and identify potentially modifiable factors associated with outcome as targets for future quality improvement. DESIGN National cohort study using National Emergency Laparotomy Audit (NELA) data. SETTING English and Welsh hospitals within the National Health Service. PARTICIPANTS Adult patients admitted as an emergency with perforated or bleeding PUD between December 2013 and November 2015. INTERVENTIONS Laparotomy for bleeding or perforated peptic ulcer. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was 60-day in-hospital mortality. Secondary outcomes included length of postoperative stay, readmission and reoperation rate. RESULTS 2444 and 382 procedures were performed for perforated and bleeding ulcers, respectively. In-hospital 60-day mortality rates were 287/2444 (11.7%, 95% CI 10.5% to 13.1%) for perforations, and 68/382 (17.8%, 95% CI 14.1% to 22.0%) for bleeding. Median (IQR) 2-year institutional volume was 12 (7-17) and 2 (1-3) for perforation and bleeding, respectively. In the exploratory analysis, age, American Society of Anesthesiology score and preoperative systolic blood pressure were associated with mortality, with no association with time from admission to operation, surgeon grade or operative approach. CONCLUSIONS Patients undergoing surgery for complicated PUD face a high 60-day mortality risk. Exploratory analyses suggested fatal outcome was primarily associated with patient rather than provider care factors. Therefore, it may be challenging to reduce mortality rates further. NELA data provide important benchmarking for patient consent and has highlighted low institutional volume and high mortality rates after surgery for bleeding peptic ulcers as a target for future research and improvement.
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Affiliation(s)
- Benjamin E Byrne
- Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Michael Bassett
- National Emergency Laparotomy Audit, The Royal College of Anaesthetists, London, UK
- Department of Anaesthesia, Manchester University NHS Foundation Trust, Manchester, UK
| | - Chris A Rogers
- Clinical Trials and Evaluation Unit, Bristol Medical School, University of Bristol, Bristol, UK
| | - Iain D Anderson
- National Emergency Laparotomy Audit, The Royal College of Anaesthetists, London, UK
- Department of Surgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - Ian Beckingham
- Department of Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Association of Upper Gastrointestinal Surgeons, Royal College of Surgeons of England, London, UK
| | - Jane M Blazeby
- Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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17
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Hernandez MC, Thorn MJ, Kong VY, Aho JM, Jenkins DH, Bruce JL, Laing GL, Zielinski MD, Clarke DL. Validation of the AAST EGS grading system for perforated peptic ulcer disease. Surgery 2018; 164:738-745. [PMID: 30082138 DOI: 10.1016/j.surg.2018.05.061] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 05/07/2018] [Accepted: 05/10/2018] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Perforated peptic ulcer disease (PPUD) including both duodenl and gastric ulcers is a severe disease and outcomes are influenced by comorbidities and physiology. We validated the AAST EGS grading system at two diverse centers (Mayo Clinic, USA and Pietermaritzburg, South Africa). METHODS Dual-center review of historic data (2010-2016) of adults with PPUD was performed. Preoperative, procedural, and postoperative data were abstracted. ASA, Boey, PULP and AAST EGS grades were generated. Comparative, multivariable, and pairwise analyses were performed. RESULTS There were 306 patients, 42% female with a mean (±SD) age of 56 ±20 years. Overall, the patints were categorized into the following AAST EGS grades: I (30, 10%), II (38, 12%), III (104, 34%), IV (76, 2e%), V (58, 18.9%). Initial management included: midline laparotomy (51%, n=157), laparoscopy (18%, n=58), laparoscopy converted to laparotomy (1%, n=3), and endoscopy (30%, n=88). Duration of stay increased with AAST EGS grade. In United States cohort, factors predictive for 30-day mortality included AAST EGS grade and patient comorbidity status. The AAST EGS grade was comparable to other scoring systems (Boey, PULP, and ASA). CONCLUSIONS Differences exist between centers for management of PPUD and their outcomes; however, the AAST EGS grade can be utilized to stratify thedisease severity of the patient and this demonstrates initial construct validity in a United States but not in a South African population.
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Affiliation(s)
- Matthew C Hernandez
- Division of Trauma Critical Care and General Surgery, Department of Surgery, Rochester, MN 55905.
| | - Michael J Thorn
- Division of Trauma Critical Care and General Surgery, Department of Surgery, Rochester, MN 55905.
| | - Victor Y Kong
- Department of Surgery, Pietermaritzburg Metropolitan Complex, University of Kwa-Zulu Natal, South Africa.
| | - Johnathon M Aho
- Division of Trauma Critical Care and General Surgery, Department of Surgery, Rochester, MN 55905.
| | - Donald H Jenkins
- Division Trauma and Emergency Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - John L Bruce
- Department of Surgery, Pietermaritzburg Metropolitan Complex, University of Kwa-Zulu Natal, South Africa.
| | - Grant L Laing
- Department of Surgery, Pietermaritzburg Metropolitan Complex, University of Kwa-Zulu Natal, South Africa.
| | - Martin D Zielinski
- Division of Trauma Critical Care and General Surgery, Department of Surgery, Rochester, MN 55905.
| | - Damian L Clarke
- Department of Surgery, Pietermaritzburg Metropolitan Complex, University of Kwa-Zulu Natal, South Africa.
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