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Shin J, Ihn MH, Kim KS, Kim SH, Lee J, Yun S, Cho SW. Risk factors for prolonged hospitalization and delayed treatment completion after laparoscopic appendectomy in patients with uncomplicated acute appendicitis. Ann Coloproctol 2023; 39:50-58. [PMID: 34788980 PMCID: PMC10009073 DOI: 10.3393/ac.2021.00773.0110] [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: 08/26/2021] [Accepted: 10/12/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE We sought to identify the risk factors for prolonged hospitalization and delayed treatment completion after laparoscopic appendectomy in patients with uncomplicated acute appendicitis. METHODS The study retrospectively analyzed 497 patients who underwent laparoscopic appendectomies for uncomplicated appendicitis between January 2018 and December 2020. The patients were divided into an early discharge group (≤2 days) and a late discharge group (>2 days) based on the length of hospital stay (LOS). The patients were also divided into uneventful and complicated groups according to the need for additional treatment after standard follow-up. RESULTS Thirty-seven patients (7.4%) were included in the late discharge group. The mean LOS of the late discharge groups was 3.9 days. There were significant differences according to age, preoperative C-reactive protein (CRP), and operative time between the 2 groups. Only operative time was significantly associated with prolonged LOS in multivariate analysis. Thirty-five patients (7.0%) were included in the complicated group. The mean duration of treatment in the uneventful and complicated groups was 7.4 and 25.3 days, respectively. Significant differences existed between the uneventful and complicated groups in preoperative body temperature, preoperative CRP levels, maximal appendix diameter, and the presence of appendicoliths. In multivariate analysis, preoperative CRP levels and maximal appendix diameter were independent predictors of delayed treatment completion. CONCLUSION Shorter operative time is desirable to ensure minimal hospital stay in patients with uncomplicated appendicitis. Further efforts are needed to ensure that patients with uncomplicated appendicitis do not experience delayed treatment completion after laparoscopic appendectomies.
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Affiliation(s)
- Jiyoung Shin
- Department of Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Myong Hoon Ihn
- Department of Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Kyung Sik Kim
- Department of Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Sang Hyun Kim
- Department of Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jihyoun Lee
- Department of Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Sangchul Yun
- Department of Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Sung Woo Cho
- Department of Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
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2
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Liao J, Zhou J, Wang J, Xie G, Wei H. Prophylactic abdominal drainage following appendectomy for complicated appendicitis: A meta-analysis. Front Surg 2023; 9:1086877. [PMID: 36743896 PMCID: PMC9889918 DOI: 10.3389/fsurg.2022.1086877] [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: 11/01/2022] [Accepted: 12/28/2022] [Indexed: 01/19/2023] Open
Abstract
Background To date, the value of prophylactic abdominal drainage (AD) following appendectomy in patients with complicated appendicitis (CA), including adults and children, has yet to be determined. This paper presents a meta-analysis of the effects of prophylactic AD on postoperative complications in patients with CA, with the goal of exploring the safety and effectiveness of prophylactic AD. Methods PubMed, Science Direct, Web of Science, Cochrane Library, and Embase databases were searched for relevant articles published before August 1, 2022. The primary outcomes were the complication rates [overall incidence of postoperative complications, incidence of intra-abdominal abscess (IAA), wound infection (WI), and postoperative ileus (PI), and the secondary outcome was the perioperative outcome]. The meta-analysis was performed with STATA V. 16.0A. Results A total of 2,627 articles were retrieved and 15 high-quality articles were eventually included after screening, resulting in a total of 5,123 patients, of whom 1,796 received AD and 3,327 did not. The results of this meta-analysis showed that compared with patients in the non-drainage group, patients in the drainage group had longer postoperative length of hospitalization (LOH) (SMD = 0.68, 95% CI: 0.01-1.35, P = 0.046), higher overall incidence of postoperative complications (OR = 0.50, 95% CI: 0.19-0.81, P = 0.01), higher incidence of WI (OR = 0.30, 95% CI: 0.08-0.51, P = 0.01) and PI (OR = 1.05, 95% CI: 0.57-1.54, P = 0.01), the differences were statistically significant. However, there was no significant difference in the incidence of IAA (OR = 0.10, 95% CI: -0.10 to 0.31, P = 0.31) between the two groups. The results of subgroup meta-analysis showed that in the adult subgroup, the overall incidence of postoperative complications in the drainage group was higher than that in the non-drainage group (OR = 0.67, 95% CI: 0.37-0.96, P = 0.01). However, there were no significant differences in IAA (OR = 0.18, 95% CI: -0.28 to 0.64, P = 0.45) and WI (OR = 0.13, 95% CI: (-0.40 to 0.66, P = 0.63) and PI (OR = 2.71, 95% CI: -0.29 to 5.71, P = 0.08). In the children subgroup, there were no significant differences in the incidence of IAA (OR = 0.51, 95% CI: -0.06 to 1.09, P = 0.08) between the two groups. The overall incidence of postoperative complications (OR = 0.46, 95% CI: 0.02-0.90, P = 0.04), incidences of WI (OR = 0.43, 95% CI: 0.14-0.71, P = 0.01) and PI (OR = 0.75, 95% CI: 0.10-1.39, P = 0.02) were significantly higher than those in the non-drainage group. Conclusion This meta-analysis concluded that prophylactic AD did not benefit from appendectomy, but increased the incidence of related complications, especially in children with CA. Thus, there is insufficient evidence to support the routine use of prophylactic AD following appendectomy.
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Toritani K, Kimura H, Fukuoka H, Watanabe J, Ishibe A, Kunisaki R, Endo I. Preoperative risk factors of incisional surgical site infection in severe or intractable ulcerative colitis. Surg Today 2021; 52:475-484. [PMID: 34387734 DOI: 10.1007/s00595-021-02354-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/22/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The present study explored preoperative risk factors (predictors) of incisional surgical site infection (I-SSI) in severe or intractable ulcerative colitis (UC). METHODS This was a retrospective study of 230 consecutive patients who underwent primary surgery for UC. Patients whose surgical indications were UC with cancer or dysplasia were excluded. SSI was defined as an infection according to the Centers for Disease Control and Prevention Guidelines. Preoperative variables were examined by univariate, receiver operating characteristic curve, and multivariate analyses. RESULTS We analyzed 208 patients in this study. In a multivariate logistic analysis, C-reactive protein (CRP) ≥ 1.7 mg/dl [odds ratio (OR) 5.35; 95% confidence interval (CI) 1.50-19.06; p = 0.01), albumin ≤ 2.4 g/dl (OR 5.77; 95% CI 1.41-23.57; p = 0.02), and preoperative blood transfusion (OR 3.21; 95% CI 1.04-9.96; p = 0.04) were predictors of I-SSI. Patients with all predictors had a more than 50% incidence of I-SSI, a higher incidence of all severe complications (13.6% vs. 3.2%; p = 0.02), and a longer postoperative hospital stay (19.5 vs. 17.0 days, p = 0.04) than the other patients. CONCLUSIONS CRP ≥ 1.7 mg/dl, albumin ≤ 2.4 g/dl, and transfusion are predictors of I-SSI in severe or intractable UC. Clinician should carefully evaluate the surgical options before these predictors appear.
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Affiliation(s)
- Kenichiro Toritani
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.,Inflammatory Bowel Disease Center, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Hideaki Kimura
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
| | - Hironori Fukuoka
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Jun Watanabe
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Atsushi Ishibe
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Reiko Kunisaki
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Predictive Value of Neutrophil Count for Postoperative Complications in Children after Surgery of Perforated Appendicitis. REV ROMANA MED LAB 2021. [DOI: 10.2478/rrlm-2021-0008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Abstract
Introduction: Perforated appendicitis (PA) in children is associated with a considerable risk for postoperative complications (POCs) such as wound infection and intra-abdominal abscess.
The aim of this study was to determine the diagnostic accuracy of hematological parameters in the early POC detection in children after PA surgery.
Materials and Methods: The study enrolled 71 patients with PA divided into two groups: 14 patients with POC (POC+ group) and 57 patients without POC (POC− group). Clinical and hematological parameters were followed preoperatively, prior to the surgery (PRO) and postoperatively on day 2 (POD2) and day 4 (POD4).
Results: The POC+ group had longer duration of higher axillar temperature as well as extended intensive and inpatient care. This group also had a significantly lower absolute neutrophil count ratio between POD2 and POD4. According to the receiver operating characteristic curve analysis, relative neutrophil count on POD4 higher than 71.8% and the ratio of absolute neutrophil count between POD2 and POD4 lower than 44.5% were found to be useful for predicting POC.
Conclusion: Absolute neutrophil count ratio between POD2 and POD4 and relative neutrophil count at POD4 could be efficient in identifying children at higher risk of developing POC after PA surgery.
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Nozaki S, Tsutsumi Y, Takasaki Y, Yoshikawa H, Shinya T, Souta R, Nakamoto N, Marukawa K, Usami T, Sunami J, Takashima M, Tanaka K, Nishizawa R, Yanase S, Negoro K, Negishi A, Okumura H, Otsuka Y, Honda Y, Otsuru H, Arika T, Nakashima T, Nagasaka H, Watanabe Y, Kajiya M, Senpuku H, Iwabuchi H. Predictors of early postoperative pneumonia after oncologic surgery with the patients receiving professional oral health care: A prospective, multicentre, cohort study. J Perioper Pract 2020; 31:289-295. [PMID: 32648836 DOI: 10.1177/1750458920939775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study was a prospective, multicentre, cohort study on 685 patients who had undergone oncologic surgery. The patients were divided into two groups according to the presence or absence of postoperative pneumonia. The two groups were compared with respect to their background, index operation, food eaten, oral condition, contents of oral care and dental treatment, laboratory data, and bacterial flora. All postoperative pneumonias occurred in six cases within four days postoperatively. The multivariable logistic regression analysis showed that preoperative serum C-reactive protein was the strongest predictor of postoperative pneumonia. In addition, decreased postoperative Candida albicans colonies was an effective predictor of postoperative pneumonia. For patients with predictors of postoperative pneumonia, perioperative strategies for its prevention should be considered in addition to professional oral health care. This study was approved by the National Hospital Organization's Central Ethics Review Board and was also approved by the directors of the participating institutions.
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Affiliation(s)
- Shinichi Nozaki
- Department of Dentistry and Oral Surgery, 38081National Hospital Organization Kanazawa Medical Center, Kanazawa, Japan
| | - Yasuhiko Tsutsumi
- Department of Dentistry and Oral Surgery, National Hospital Organization Higashi-Ohmi General Medical Center, Higashi-Ohmi, Japan
| | - Yoshito Takasaki
- Oral and Maxillo-Facial Surgery, 73515National Hospital Organization Takasaki General Medical Center, Takasaki, Japan
| | - Hiromasa Yoshikawa
- Department of Dentistry, Oral and Maxillofacial Surgery, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Toshiaki Shinya
- Department of Dentistry and Oral Surgery, National Hospital Organization Miyakonojo Medical Center, Miyakonojo, Japan
| | - Ruriko Souta
- Department of Dentistry and Oral Surgery, National Hospital Organization Tochigi Medical Center, Utsunomiya, Japan
| | - Norimichi Nakamoto
- Department of Dentistry and Oral Surgery, National Hospital Organization Yonago Medical Center, Yonago, Japan
| | - Kohei Marukawa
- Department of Dentistry and Oral Surgery, 38081National Hospital Organization Kanazawa Medical Center, Kanazawa, Japan
| | - Takeshi Usami
- Department of Dentistry and Oral Surgery, 13864National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Jiro Sunami
- Department of Dentistry, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Maho Takashima
- Department of Dentistry, National Hospital Organization Tokyo Hospital, Kiyose, Japan
| | - Kohji Tanaka
- Department of Dentistry and Oral Surgery, National Hospital Organization Kure Medical Canter/Chugoku Cancer Center, Kure, Japan
| | | | - Shigeaki Yanase
- Department of Dentistry and Oral Surgery, National Hospital Organization Mie Chuo Medical Center, Tsu, Japan
| | - Kenji Negoro
- Department of Dentistry and Oral Surgery, National Hospital Organization Minami Wakayama Medical Center, Tanabe, Japan
| | - Akihide Negishi
- Department of Oral and Maxillofacial Surgery, National Hospital Organization Yokohama Medical Center, Yokohama, Japan
| | - Hidenori Okumura
- Department of Dentistry and Oral Surgery, National Hospital Organization Higashinagoya National Hospital, Nagoya, Japan
| | - Yoshiaki Otsuka
- Department of Dentistry, National Hospital Organization Chiba-East Hospital, Chiba, Japan
| | - Yasutoshi Honda
- Department of Dentistry, National Hospital Organization Fukuyama Medical Center, Fukuyama, Japan
| | - Hiroshi Otsuru
- Department of Oral Surgery, National Hospital Organization Tokyo Medical Center, Meguro, Japan
| | - Takumi Arika
- Department of Oral and Maxilla-Facial Surgery, 13707National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Takeshi Nakashima
- Department of Dentistry and Oral Surgery, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Hiroshi Nagasaka
- Department of Dentistry and Oral Surgery, 175736Sendai Aoba Clinic, Sendai, Japan
| | - Yuuko Watanabe
- Department of Dentistry, National Hospital Organization Utsunomiya Hospital, Utsunomiya, Japan
| | - Mikihito Kajiya
- Department of Dentistry, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima, Japan
| | - Hidenobu Senpuku
- Department of Bacteriology I, 13511National Institute of Infectious Diseases, Shinjuku, Japan
| | - Hiroshi Iwabuchi
- Department of Dentomaxillofacial Diagnosis and Treatment, Division of Oral and Maxillofacial Surgery, Graduate School of Kanagawa Dental University, Yokosuka, Japan
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6
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Liu X, Xue Z, Yu J, Li Z, Ma Z, Kang W, Ye X, Jiang L. Risk Factors for Postoperative Infectious Complications in Elderly Patients with Gastric Cancer. Cancer Manag Res 2020; 12:4391-4398. [PMID: 32606934 PMCID: PMC7293399 DOI: 10.2147/cmar.s253649] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/16/2020] [Indexed: 12/24/2022] Open
Abstract
Background Elderly patients with gastric cancer (GC) are at increased risk of infectious complications following gastrectomy. A limited set of risk factors has been identified to predict complications in these patients. To improve the safety of gastrectomy in this population, we investigated the incidence of infectious complications and associated clinicopathologic, nutritional and surgical risk factors in a cohort of elderly patients with GC. Methods Elderly GC patients (≥70 years) who underwent gastrectomy between January 2013 and December 2017 in Peking Union Medical College Hospital were included in the study. Clinicopathologic data were collected retrospectively. Severity of complications was classified using the Clavien–Dindo system. Infectious complications were assessed based on clinical diagnosis of health care-associated infection as defined by the US Centers for Disease Control and Prevention. Multivariate logistic regression analyses were performed to determine the risk factors for infectious complications. Results Three hundred thirty-one consecutive patients were included, with a median age of 74 years (range 70–88). The rate of surgical morbidity was 37.5% and the mortality rate was 1.2%. The incidence of infectious complications was 19.6%, with the most common infectious complication being pulmonary infection (11.5%). Preoperative weight loss ≥5% (odds ratio [OR] = 2.21; 95% CI, 1.15–4.28; p = 0.018), Charlson comorbidity index score ≥3 (OR = 2.83; 95% CI, 1.30–6.16; p = 0.009) and preoperative hsCRP level ≥10 mg/L (OR = 2.48; 95% CI, 1.14–5.38; p = 0.022) were independently associated with infectious complications. Conclusion Preoperative weight loss, elevated hsCRP level and comorbidity burden can be used to predict postoperative infectious complications in elderly GC patients. It is recommended to pay more attention to the treatment of elderly GC patients with these risk factors.
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Affiliation(s)
- Xiao Liu
- Department of Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Zhigang Xue
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.,Graduate School, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Jianchun Yu
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Zijian Li
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.,Graduate School, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Zhiqiang Ma
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Weiming Kang
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Xin Ye
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Lin Jiang
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.,Graduate School, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
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Donlon NE, Mohan H, Free R, Elbaghir B, Soric I, Fleming C, Balasubramanian I, Ivanovski I, Schmidt K, Mealy K. Predictive value of CRP/albumin ratio in major abdominal surgery. Ir J Med Sci 2020; 189:1465-1470. [DOI: 10.1007/s11845-020-02238-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 04/16/2020] [Indexed: 01/06/2023]
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8
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Artificial Intelligence Methods for Surgical Site Infection: Impacts on Detection, Monitoring, and Decision Making. Surg Infect (Larchmt) 2019; 20:546-554. [DOI: 10.1089/sur.2019.150] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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9
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Diagnostic value of procalcitonin, C-reactive protein and lactate dehydrogenase in paediatric malignant solid tumour concurrent with infection and tumour progression. Sci Rep 2019; 9:5903. [PMID: 30976022 PMCID: PMC6459850 DOI: 10.1038/s41598-019-42264-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 03/26/2019] [Indexed: 01/06/2023] Open
Abstract
Infection is a fatal complication in cancer patients that sometimes is not distinguished from tumour progression. We compared the diagnostic value of procalcitonin (PCT), C-reactive protein (CRP) and lactate dehydrogenase (LDH) in paediatric malignant solid tumour concurrent with infection and tumour progression. The 152 children enrolled were divided into infection and control groups. Each group was divided further into stable and progression groups. An intergroup comparison was made in terms of serum PCT, CRP and LDH in all children. PCT, CRP and LDH levels were significantly higher in the infection than in the control groups (P < 0.05). Among the controls, PCT, CRP and LDH levels were significantly higher in the progression than in the stable groups (P < 0.05). In diagnosing infection, the sensitivity and specificity of PCT and CRP at the cutoff values of 0.296 ng/mL and 28.13 mg/L were relatively better than those at 0.5 ng/mL and 10 mg/L, respectively. LDH had the highest correlation with tumour progression, whereas PCT had the lowest (LDH, r = 0.684; CRP, r = 0.570; PCT, r = 0.322). Thus, PCT has the highest value in diagnosing infection and is less susceptible to tumour progression than CRP. LDH has obvious advantages in judging tumour progression.
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10
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Maximizing Interpretability and Cost-Effectiveness of Surgical Site Infection (SSI) Predictive Models Using Feature-Specific Regularized Logistic Regression on Preoperative Temporal Data. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2019; 2019:2059851. [PMID: 30915154 PMCID: PMC6399553 DOI: 10.1155/2019/2059851] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 01/17/2019] [Indexed: 12/14/2022]
Abstract
This study describes a novel approach to solve the surgical site infection (SSI) classification problem. Feature engineering has traditionally been one of the most important steps in solving complex classification problems, especially in cases with temporal data. The described novel approach is based on abstraction of temporal data recorded in three temporal windows. Maximum likelihood L1-norm (lasso) regularization was used in penalized logistic regression to predict the onset of surgical site infection occurrence based on available patient blood testing results up to the day of surgery. Prior knowledge of predictors (blood tests) was integrated in the modelling by introduction of penalty factors depending on blood test prices and an early stopping parameter limiting the maximum number of selected features used in predictive modelling. Finally, solutions resulting in higher interpretability and cost-effectiveness were demonstrated. Using repeated holdout cross-validation, the baseline C-reactive protein (CRP) classifier achieved a mean AUC of 0.801, whereas our best full lasso model achieved a mean AUC of 0.956. Best model testing results were achieved for full lasso model with maximum number of features limited at 20 features with an AUC of 0.967. Presented models showed the potential to not only support domain experts in their decision making but could also prove invaluable for improvement in prediction of SSI occurrence, which may even help setting new guidelines in the field of preoperative SSI prevention and surveillance.
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11
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Sun F, Ge X, Liu Z, Du S, Ai S, Guan W. Postoperative C-reactive protein/albumin ratio as a novel predictor for short-term complications following gastrectomy of gastric cancer. World J Surg Oncol 2017; 15:191. [PMID: 29065877 PMCID: PMC5655858 DOI: 10.1186/s12957-017-1258-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 10/15/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Postoperative complications following gastric cancer resection remain a clinical problem. Early detection of postoperative complications is needed before critical illness develops. The purpose of this study was to evaluate the prognostic value of C-reactive protein/albumin ratio in patients with gastric cancer. METHODS A total of 322 patients undergoing curative (R0) gastrectomy between 2015 and 2017 were retrospectively analyzed. Univariate and multivariate analyses were performed to identify clinical factors predicting postoperative complications. The cutoff values and diagnostic accuracy of C-reactive protein/albumin ratio and C-reactive protein were determined by receiver-operating characteristic curves. RESULTS Among all of the patients, 85 (26.4%) developed postoperative complications. The optimal cutoff of C-reactive protein/albumin ratio was set at 3.04 based on the ROC analysis. Multivariate analysis identified C-reactive protein/albumin ratio was an independent risk factors for complications after gastrectomy (OR 3.037; 95% CI 1.248-7.392; P = 0.014). Additionally, C-reactive protein/albumin ratio showed a higher diagnostic accuracy than C-reactive protein on postoperative day 3 (AUC: 0.685 vs 0.660; sensitivity: 0.624 vs 0.471; specificity: 0.722 vs 0.835). CONCLUSIONS Elevated C-reactive protein/albumin ratio was an independent predictor for postoperative complications following gastrectomy of gastric cancer, and the diagnostic accuracy was higher than C-reactive protein alone. Overall, postoperative C-reactive protein/albumin ratio may help to identify patients with high probability of postoperative complications.
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Affiliation(s)
- Feng Sun
- Department of General Surgery, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210008 China
| | - Xiaolong Ge
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310016 China
| | - Zhijian Liu
- Department of General Surgery, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210008 China
| | - Shangce Du
- Department of General Surgery, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210008 China
| | - Shichao Ai
- Department of General Surgery, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210008 China
| | - Wenxian Guan
- Department of General Surgery, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210008 China
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12
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Mujagic E, Marti WR, Coslovsky M, Zeindler J, Staubli S, Marti R, Mechera R, Soysal SD, Gürke L, Weber WP. The role of preoperative blood parameters to predict the risk of surgical site infection. Am J Surg 2017; 215:651-657. [PMID: 28982517 DOI: 10.1016/j.amjsurg.2017.08.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 08/17/2017] [Accepted: 08/21/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Routine preoperative blood work is not recommended but selected biochemical markers may predict the risk of surgical site infection (SSI). This study examines the association between preoperative biochemical markers and the risk of SSI. METHODS This observational cohort study, nested in a randomized controlled trial, was conducted at two tertiary referral centers in Switzerland. RESULTS 122 (5.8%) of 2093 patients experienced SSI. Preoperative increasing levels of albumin (OR 0.93), CRP (OR 1.34), hemoglobin (OR 0.87) and eGFR (OR 0.90) were significantly associated with the odds of SSI. The same accounts for categorized parameters. The highest area under the curve from ROC curves was 0.62 for albumin. Positive predictive values ranged from 6.4% to 9.5% and negative predictive values from 94.8% to 95.7%. The association of CRP, mildly and moderately decreased eGFR and hemoglobin with the odds of SSI remained significant on multivariate analysis. CONCLUSIONS Our results do not support generally delaying elective surgery based on preoperative blood results. However, it may be considered in situations with potentially severe sequelae of SSI.
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Affiliation(s)
- Edin Mujagic
- Department of Surgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Walter R Marti
- Department of Surgery, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland.
| | - Michael Coslovsky
- University of Basel, University Hospital, Department of Clinical Research, Clinical Trial Unit, Spitalstrasse 12, 4031, Basel, Switzerland.
| | - Jasmin Zeindler
- Department of Surgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Sebastian Staubli
- Department of Surgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Regula Marti
- Department of Surgery, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland.
| | - Robert Mechera
- Department of Surgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Savas D Soysal
- Department of Surgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Lorenz Gürke
- Department of Surgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Walter P Weber
- Department of Surgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
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13
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Affiliation(s)
- Rebecca M Rentea
- Deparment of Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA
| | - Shawn D St Peter
- Pediatric Surgical Fellowship and Scholars Programs, Department of Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA.
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14
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Abstract
Appendicitis is a common cause of abdominal pain in children. The diagnosis and treatment of the disease have undergone major changes in the past two decades, primarily as a result of the application of an evidence-based approach. Data from several randomized controlled trials, large database studies, and meta-analyses have fundamentally affected patient care. The best diagnostic approach is a standardized clinical pathway with a scoring system and selective imaging. Non-operative management of simple appendicitis is a reasonable option in selected cases, with the caveat that data in children remain limited. A minimally invasive (laparoscopic) appendectomy is the current standard in US and European children's hospitals. This article reviews the current 'state of the art' in the evaluation and management of pediatric appendicitis.
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Affiliation(s)
- Rebecca M Rentea
- Department of Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas, MO, 64108, USA.
| | - Shawn D St Peter
- Department of Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas, MO, 64108, USA
| | - Charles L Snyder
- Department of Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas, MO, 64108, USA
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15
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Kim EY, Yim HW, Park CH, Song KY. C-reactive protein can be an early predictor of postoperative complications after gastrectomy for gastric cancer. Surg Endosc 2016; 31:445-454. [PMID: 27734201 DOI: 10.1007/s00464-016-5272-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 09/27/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND The clinical outcomes for postoperative complications (PCs) after gastrectomy depend on early diagnosis and intensive treatment. The aim of this study was to investigate the role of C-reactive protein (CRP) as an early predictor of PCs after gastrectomy for gastric cancer. METHODS A total of 334 consecutive patients who underwent gastrectomy for gastric cancer in 2014 were enrolled in this study. Blood samples were obtained preoperatively, and at postoperative days 1 and 4 for the measurement of inflammatory markers (white blood cell, neutrophil, and platelet counts, and CRP). Patients were classified into groups of major and minor/no PCs, which were defined as patients with PCs of more than grade III and those with grade I/II or without PCs, respectively, according to the Clavien-Dindo classification. RESULTS Twenty-five patients developed major PCs. The CRP on postoperative day 4 provided superior diagnostic accuracy in predicting major PCs compared to the other systematic inflammatory markers. Multivariate analysis identified a CRP level of 16.8 mg/dl or greater on postoperative day 4 as a significant predictive factor for major PCs. CONCLUSIONS Among the various systemic inflammatory markers, CRP on postoperative day 4 is the most reliable predictor of PCs after gastrectomy for gastric cancer.
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Affiliation(s)
- Eun Young Kim
- Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Korea
| | - Hyun Woo Yim
- Clinical Research Coordinating Center of Catholic Medical Center, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Cho Hyun Park
- Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Korea
| | - Kyo Young Song
- Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Korea.
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16
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Giesen LJ, van den Boom AL, van Rossem CC, den Hoed P, Wijnhoven BP. Retrospective Multicenter Study on Risk Factors for Surgical Site Infections after Appendectomy for Acute Appendicitis. Dig Surg 2016; 34:103-107. [PMID: 27631081 PMCID: PMC5296882 DOI: 10.1159/000447647] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 06/13/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Surgical site infections (SSI) are seen in up to 5% of patients after appendectomy for acute appendicitis. SSI are associated with prolonged hospital stay and increased costs. The aim of this multicenter study was to identify factors associated with SSI after appendectomy for acute appendicitis. METHODS Patients who underwent appendectomy for acute appendicitis between June 2014 and January 2015 in 6 teaching hospitals in the southwest of the Netherlands were included. Patient, diagnostic, intra-operative and disease-related factors were collected from the patients' charts. Primary outcome was surgical site infection. Multivariable logistic regression was performed to identify independent risk factors for SSI. RESULTS Some 637 patients were included. Forty-two patients developed a SSI. In univariable analysis body temperature >38°C, CRP>65 and complex appendicitis were associated with SSI. After multivariable logistic regression with stepwise backwards elimination, complex appendicitis was significantly associated with SSI (OR 4.09; 95% CI 2.04-8.20). Appendiceal stump closure with a stapler device was inversely correlated with SSI (OR 0.40; 95% CI 0.24-0.97) Conclusions: Complex appendicitis is a risk factor for SSI and warrants close monitoring postoperatively. The use of a stapler device for appendiceal stump closure is associated with a reduced risk of SSI.
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Affiliation(s)
- Louis J.X. Giesen
- Department of Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | | | - P.T. den Hoed
- Department of Surgery, Ikazia Hospital, Rotterdam, The Netherlands
| | - Bas P.L. Wijnhoven
- Department of Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
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17
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Hu Q, Wang G, Ren J, Ren H, Li G, Wu X, Gu G, Li R, Guo K, Deng Y, Li Y, Hong Z, Wu L, Li J. Preoperative prognostic nutritional index predicts postoperative surgical site infections in gastrointestinal fistula patients undergoing bowel resections. Medicine (Baltimore) 2016; 95:e4084. [PMID: 27399098 PMCID: PMC5058827 DOI: 10.1097/md.0000000000004084] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Recent studies have implied a prognostic value of the prognostic nutritional index (PNI) in postoperative septic complications of elective colorectal surgeries. However, the evaluation of PNI in contaminated surgeries for gastrointestinal (GI) fistula patients is lack of investigation. The purpose of this study was to explore the predictive value of PNI in surgical site infections (SSIs) for GI fistula patients undergoing bowel resections.A retrospective review of 290 GI patients who underwent intestinal resections between November 2012 and October 2015 was performed. Univariate and multivariate analyses were conducted to identify risk factors for SSIs, and receiver operating characteristic cure was used to quantify the effectiveness of PNI.SSIs were diagnosed in 99 (34.1%) patients, with incisional infection identified in 54 patients (18.6%), deep incisional infection in 13 (4.5%), and organ/space infection in 32 (11.0%). receiver operating characteristic curve analysis defined a PNI cut-off level of 45 corresponding to postoperative SSIs (area under the curve [AUC] = 0.72, 76% sensitivity, 55% specificity). Furthermore, a multivariate analysis indicated that the PNI < 45 [odd ratio (OR): 2.24, 95% confidence interval (CI): 1.09-4.61, P = 0.029] and leukocytosis (OR: 3.70, 95% CI: 1.02-13.42, P = 0.046) were independently associated with postoperative SSIs.Preoperative PNI is a simple and useful marker to predict SSIs in GI fistula patients after enterectomies. Measurement of PNI is therefore recommended in the routine assessment of patients with GI fistula receiving surgical treatment.
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Affiliation(s)
- Qiongyuan Hu
- Department of Surgery, Jinling Hospital, Medical School of Southeast University, Nanjing, China
| | - Gefei Wang
- Department of Surgery, Jinling Hospital, Medical School of Southeast University, Nanjing, China
- Medical School of Nanjing University, Nanjing, China
| | - Jianan Ren
- Department of Surgery, Jinling Hospital, Medical School of Southeast University, Nanjing, China
- Medical School of Nanjing University, Nanjing, China
- Correspondence: Jianan Ren, Department of Surgery, Jinling Hospital, 305 East Zhongshan Road, Nanjing 210002, China (e-mail: )
| | - Huajian Ren
- Department of Surgery, Jinling Hospital, Medical School of Southeast University, Nanjing, China
| | - Guanwei Li
- Department of Surgery, Jinling Hospital, Medical School of Southeast University, Nanjing, China
- Medical School of Nanjing University, Nanjing, China
| | - Xiuwen Wu
- Department of Surgery, Jinling Hospital, Medical School of Southeast University, Nanjing, China
| | - Guosheng Gu
- Department of Surgery, Jinling Hospital, Medical School of Southeast University, Nanjing, China
| | - Ranran Li
- Department of Surgery, Jinling Hospital, Medical School of Southeast University, Nanjing, China
| | - Kun Guo
- Department of Surgery, Jinling Hospital, Medical School of Southeast University, Nanjing, China
- Medical School of Nanjing University, Nanjing, China
| | - Youming Deng
- Department of Surgery, Jinling Hospital, Medical School of Southeast University, Nanjing, China
- Medical School of Nanjing University, Nanjing, China
| | - Yuan Li
- Department of Surgery, Jinling Hospital, Medical School of Southeast University, Nanjing, China
- Medical School of Nanjing University, Nanjing, China
| | - Zhiwu Hong
- Department of Surgery, Jinling Hospital, Medical School of Southeast University, Nanjing, China
| | - Lei Wu
- Department of Surgery, Jinling Hospital, Medical School of Southeast University, Nanjing, China
| | - Jieshou Li
- Department of Surgery, Jinling Hospital, Medical School of Southeast University, Nanjing, China
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18
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Obayashi J, Ohyama K, Manabe S, Tanaka K, Nagae H, Shima H, Furuta S, Wakisaka M, Kawase H, Kitagawa H. Are there reliable indicators predicting post-operative complications in acute appendicitis? Pediatr Surg Int 2015; 31:1189-93. [PMID: 26310685 DOI: 10.1007/s00383-015-3786-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE To clarify the predictors of post-operative complications of pediatric acute appendicitis. METHODS The medical records of 485 patients with acute appendicitis operated on between January 2006 and November 2014 were retrospectively reviewed. Age, sex, preoperative WBC, CRP, and appendix maximum short diameter on diagnostic imaging (AMSD) were compared retrospectively with the complications group (Group C) vs the non-complication group (Group NC) by Student's T test, Fisher exact test and Multivariate analysis. Regression analysis with p less than 0.01 was considered significant. We analyzed the most recent 314 laparoscopic appendectomy patients similarly. RESULTS Complications were found in 29 of the 485 appendectomies (6.0%). Comparing Group C to Group NC, preoperative WBC (×10(3)/μl) 16.4 ± 5.6 vs 14.1 ± 4.1 (p < 0.01), CRP (mg/dl) 8.3 ± 7.1 vs 3.3 ± 4.6 (p < 0.01), AMSD (mm) was 12.1 ± 3.7 vs 9.9 ± 2.8 (p < 0.01). The CRP was significantly different by Multivariate analysis, but the WBC and AMSD wasn't. The results following laparoscopic appendicectomy data were identical. CONCLUSION Preoperative WBC, CPR and AMSD all indicated an increased risk of complications. If WBC (/μl) >16,500, CRP >3.1 mg/dl and AMSD >11.4 mm, complications increased sixfold.
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Affiliation(s)
- Juma Obayashi
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan
| | - Kei Ohyama
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan
| | - Shutaro Manabe
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan
| | - Kunihide Tanaka
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan
| | - Hideki Nagae
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan
| | - Hideki Shima
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan
| | - Shigeyuki Furuta
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan
| | - Munechika Wakisaka
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan
| | - Hirokazu Kawase
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan
| | - Hiroaki Kitagawa
- Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan.
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