1
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Menendez Alvarado LR, Margulis Landayan A, Morell J, Wasielewski AS, Zhang Z, Levine R, Gauthier TP. Evaluating the Impact of Source-specific Order Sets for Sepsis on Empiric Antibiotic Selection in the Emergency Department. Open Forum Infect Dis 2024; 11:ofad677. [PMID: 38352157 PMCID: PMC10863544 DOI: 10.1093/ofid/ofad677] [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: 08/11/2023] [Accepted: 12/20/2023] [Indexed: 02/16/2024] Open
Abstract
This retrospective cohort study found that implementing source-specific antibiotic order sets for sepsis in the emergency department increased appropriate empiric antibiotic selection from 51% to 74% (P = .01).
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Affiliation(s)
| | | | - Jason Morell
- Pharmacy Department, Doctor’s Hospital, Miami, Florida, USA
| | | | - Zhenwei Zhang
- Center for Advanced Analytics, Baptist Health South Florida, Miami, Florida, USA
| | - Richard Levine
- Infectious Diseases Department, Doctor’s Hospital, Miami, Florida, USA
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2
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The incremental value of multislice CT in diagnosis of late bariatric surgery complications. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00856-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Bariatric surgery has become a widely accepted treatment option among the population for obesity management. Nevertheless, different complications may still be encountered during the late post-operative period. Our prospective cross-sectional study aimed to show the incremental value of multislice CT for diagnosis of such complications.
Results
Within the included twenty patients who underwent multislice CT of upper abdomen, gastric pouch dilatation causing recurrent weight gain was the commonest complication detected in 70% of the studied patients and was found mainly after sleeve gastrectomy in whom mean gastric pouch volume was 248.4 ml. Gastric stricture, gastric herniation through plication suture, hiatus hernia and incisional hernia were less commonly encountered complications.
Conclusion
Multislice CT is a useful non-invasive imaging modality for detection of late bariatric surgery complications.
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3
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Anastomotic leak test using indocyanine green during laparoscopic Roux-en-Y gastric bypass: A cohort study. Ann Med Surg (Lond) 2022; 84:104939. [DOI: 10.1016/j.amsu.2022.104939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/24/2022] [Accepted: 11/12/2022] [Indexed: 11/18/2022] Open
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4
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van Ede E, Scheerhoorn J, Bonomi A, Buise M, Bouwman R, Nienhuijs S. “Continuous remote monitoring in post bariatric surgery patients: development of an early warning protocol”. Surg Obes Relat Dis 2022; 18:1298-1303. [DOI: 10.1016/j.soard.2022.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/02/2022] [Accepted: 06/12/2022] [Indexed: 10/31/2022]
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5
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Retrospective assessment of the association between inhalation anesthesia and post-operative complications in morbidly obese patients undergoing bariatric surgery. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.1083644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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6
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Tavernier C, Flaris AN, Passot G, Glehen O, Kepenekian V, Cotte E. Assessing Criteria for a Safe Early Discharge After Laparoscopic Colorectal Surgery. JAMA Surg 2021; 157:52-58. [PMID: 34730770 DOI: 10.1001/jamasurg.2021.5551] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Early discharge after colorectal surgery has been advocated. However, there is little research evaluating clinical and/or laboratory criteria to determine who can be safely discharged early. Objective To evaluate the diagnostic performance of a C-reactive protein (CRP) level combined with 4 clinical criteria in ruling out an anastomotic leak and therefore allowing an early discharge on postoperative day 2 or 3. Design, Setting, and Participants This prospective, single-center cohort study was performed between February 2012 and July 2017. All consecutive adult patients undergoing laparoscopic colorectal surgery were included. All patients were followed up for 30 days postoperatively. Data analysis was performed in May 2021. Exposures Whether the 5 discharge criteria were fulfilled on postoperative day 3 (or day 2 for patients discharged on day 2). Fulfillment was defined as a CRP level less than 150 mg/dL on the day of discharge, a return of bowel function, tolerance of a diet, pain less than 5 of 10 on a visual analog scale, and being afebrile during the entire stay. Main Outcomes and Measures The primary outcome measurement was the diagnostic performance of the 5 discharge criteria in anticipating anastomotic leak development. The diagnostic performance of CRP level alone and 4 clinical criteria alone was also evaluated. Secondary measures were anastomotic leaks and mortality rates up to postoperative day 30. A discharge was successful if the patient left the hospital on postoperative day 2 or 3 without any complications or readmissions. Results A total of 287 patients were included (median [IQR] age, 58 [20] years; 141 men [49%] and 146 women [51%]). Mortality was 0%. There were 17 anastomotic leaks, of which 2 were on day 1 and were excluded. A total of 128 patients fulfilled all criteria, and 125 did not, including 34 for whom data were missing. Two leaks occurred in patients who had fulfilled all criteria vs 13 leaks in patients who did not (hazard ratio, 0.15 [95% CI, 0.03-0.69]; P = .01). Seventy-six of 128 patients (59.4%) were discharged successfully by postoperative day 3. The negative predictive value in ruling out an anastomotic leak was at least 96.9% for CRP alone (96.9% [95% CI, 93.3%-98.8%]), the 4 clinical criteria (98.4% [95% CI, 95.3%-99.7%]), and all 5 criteria combined (98.4% [95% CI, 94.5%-99.8%]). False-negative rates were 40% (95% CI, 16.3%-67.7%) for CRP level alone, 20% (95% CI, 4.3%-48.1%) for the other 4 criteria, and 13.3% (95% CI, 0%-40.5%) for all 5 criteria. Conclusions and Relevance These 5 criteria have a high negative predictive value and the lowest false-negative rate, indicating they have the potential to allow for safe early discharge after laparoscopic colorectal surgery.
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Affiliation(s)
- Clement Tavernier
- Department of Surgical Oncology, Lyon Sud University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Alexandros N Flaris
- Department of Surgical Oncology, Lyon Sud University Hospital, Hospices Civils de Lyon, Lyon, France.,Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Guillaume Passot
- Department of Surgical Oncology, Lyon Sud University Hospital, Hospices Civils de Lyon, Lyon, France.,EMR 37-38, Lyon 1 University, Lyon, France
| | - Olivier Glehen
- Department of Surgical Oncology, Lyon Sud University Hospital, Hospices Civils de Lyon, Lyon, France.,EMR 37-38, Lyon 1 University, Lyon, France
| | - Vahan Kepenekian
- Department of Surgical Oncology, Lyon Sud University Hospital, Hospices Civils de Lyon, Lyon, France.,EMR 37-38, Lyon 1 University, Lyon, France
| | - Eddy Cotte
- EMR 37-38, Lyon 1 University, Lyon, France.,Department of Digestive and Oncological Surgery, Lyon Sud University Hospital, Hospices Civils de Lyon, Lyon, France
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7
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Bozan MB, Kutluer N, Aksu A, Bozan AA, Kanat BH, Böyük A. IS BODY MASS INDEX AND OBESITY SURGERY MORTALITY SCORE IMPORTANT IN PERIOPERATIVE COMPLICATIONS OF LAPAROSCOPIC SLEEVE GASTRECTOMY BEFORE DISCHARGE? ACTA ACUST UNITED AC 2021; 34:e1602. [PMID: 34669891 PMCID: PMC8521821 DOI: 10.1590/0102-672020210002e1602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/13/2021] [Indexed: 12/23/2022]
Abstract
Background:
Morbid obesity surgery and related complications have increased with time.
Aim: To evaluate the relationship between perioperative complications before discharge and preoperative body mass index and obesity surgery mortality score in laparoscopic sleeve gastrectomy.
Method:
1617 patients who met the inclusion criteria were evaluated retrospectively. The patients were examined in terms of demographic data, presence of comorbidities, whether there were complications or not, type of complications and obesity surgery mortality score.
Results:
Complications were seen in 40 patients (2.5%) and mortality wasn’t seen in the early postoperative period before discharge. The mean age of patients with complications was 36.3±10.02 years (19-57) and without complications 34.12±9.54 (15-64) years. The preoperative mean BMI values of patients with and without complications were 45.05±3.93 (40-57) kg/m2 and 44.8±3.49 (35-67) kg/m2 respectively. According to BMI groups 40-45 kg/m2, 45-50 kg/m2 and 50 and over, there was not any statistical significance seen in three groups in terms of complication positivity and major-minor complication rates. There was not any statistical significance seen between the patients with and without major-minor complications and obesity surgery mortality score.
Conclusion:
There was not any relation between perioperative laparoscopic sleeve gastrectomy complication rates before discharge and BMI and obesity surgery mortality scores.
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Affiliation(s)
- Mehmet Buğra Bozan
- Department of Surgery, Kahramanmaras Sutcu Imam University, Professor (Assistant), Kahramanmaras, Turkey
| | - Nizamettin Kutluer
- Department of Surgery, Elazig Training and Research Hospital, Specialist of General Surgery, Elazig, Turkey
| | - Ali Aksu
- Department of Surgery, Elazig Training and Research Hospital, Specialist of General Surgery, Elazig, Turkey
| | - Ayşe Azak Bozan
- Department of Surgery, Malatya Turgut Özal University, Professor (Associate), Malatya, Turkey
| | - Burhan Hakan Kanat
- Department of Anesthesiology and Reanimation, Elazig Training and Research Hospital, Specialist of General Surgery, Elazig, Turkey
| | - Abdullah Böyük
- Department of Surgery, Elazig Training and Research Hospital, Professor, Elazig, Turkey
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8
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Hui BY, Khorgami Z, Puthoff JS, Kuwada TS, Lim RB, Chow GS. Postoperative sepsis after primary bariatric surgery: an analysis of MBSAQIP. Surg Obes Relat Dis 2020; 17:667-672. [PMID: 33509730 DOI: 10.1016/j.soard.2020.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 10/02/2020] [Accepted: 12/06/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Identifying patients at higher risk of postoperative sepsis (PS) may help to prevent this life-threatening complication. OBJECTIVES This study aimed to identify the rate and predictors of PS after primary bariatric surgery. SETTING An analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) 2015-2017. METHODS Patients undergoing elective sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) were included. Exclusion criteria were revisional, endoscopic, and uncommon, or investigational procedures. Patients were stratified by the presence or absence of organ/space surgical site infection (OS-SSI), and patients who developed sepsis were compared with patients who did not develop sepsis in each cohort. Logistic regression was used to identify independent predictors of PS. RESULTS In total, 438,752 patients were included (79.4% female, mean age 44.6±12 years). Of those, 661 patients (.2%) developed PS of which 245 (37.1%) developed septic shock. Out of 892 patients with organ/space surgical site infections (OS-SSI), 298 (45.1%) developed sepsis (P <.001). Patients who developed PS had higher mortality (8.8% versus .1%, P < .001), and this was highest in patients without OS-SSI (11.8% versus 5%, P = .002). The main infectious complications associated with PS in patients without OS-SSI were pneumonia and urinary tract infection. Independent predictors of PS in OS-SSI included RYGB versus SG (OR, 1.8), and age ≥50 years (OR, 1.4). Independent predictors of PS in patients without OS-SSI were conversion to other approaches (OR, 6), operation length >2 hours (OR, 5.7), preoperative dialysis (OR, 4.1), preoperative therapeutic anticoagulation (OR, 2.8), limited ambulation most or all of the time (OR, 2.4), preoperative venous stasis (OR, 2.4), previous nonbariatric foregut surgery (OR, 2), RYGB versus SG (OR, 2), hypertension on medication (OR, 1.5), body mass index ≥50 kg/m2(OR, 1.4), age ≥50 years (OR, 1.3), obstructive sleep apnea (OR, 1.3). CONCLUSION Development of OS-SSI after primary bariatric surgery is associated with sepsis and increased 30-day mortality. Patients without OS-SSI who develop PS have a significantly higher mortality rate compared with patients with OS-SSI who develop PS. Early identification and intervention in patients with PS, including those without OS-SSI, may improve survival in this high-risk group.
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Affiliation(s)
- Benedict Y Hui
- Atrium Health Weight Management, Section of Bariatric and Metabolic Surgery, Department of Surgery, Atrium Health, Charlotte, North Carolina
| | - Zhamak Khorgami
- Department of Surgery, School of Community Medicine, University of Oklahoma, Tulsa, Oklahoma; Harold Hamm Diabetes Center, University of Oklahoma, Oklahoma City, Oklahoma.
| | - Justin S Puthoff
- Department of Surgery, School of Community Medicine, University of Oklahoma, Tulsa, Oklahoma
| | - Timothy S Kuwada
- Atrium Health Weight Management, Section of Bariatric and Metabolic Surgery, Department of Surgery, Atrium Health, Charlotte, North Carolina
| | - Robert B Lim
- Department of Surgery, School of Community Medicine, University of Oklahoma, Tulsa, Oklahoma
| | - Geoffrey S Chow
- Department of Surgery, School of Community Medicine, University of Oklahoma, Tulsa, Oklahoma
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9
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Severac M, Chiali W, Severac F, Perus O, Orban JC, Iannelli A, Debs T, Gugenheim J, Raucoules-Aimé M. Alveolar recruitment manoeuvre results in improved pulmonary function in obese patients undergoing bariatric surgery: a randomised trial. Anaesth Crit Care Pain Med 2020; 40:100775. [PMID: 33137453 DOI: 10.1016/j.accpm.2020.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 08/14/2019] [Accepted: 09/25/2020] [Indexed: 12/16/2022]
Abstract
Perioperative ventilation is an important challenge of anaesthesia, especially in obese patients: body mass index is correlated with reduction of the pulmonary volume and they develop significantly more perioperative atelectasis and pulmonary complications. The alveolar recruitment manoeuvre is the most effective technique to reverse atelectasis. However, the clinical benefit on lung function in the perioperative period is not clear. The aim of the present study is to assess the perioperative clinical results of systematic alveolar recruitment manoeuvre associated with protective ventilation in patients undergoing laparoscopic bariatric surgery. It was a single-centre, randomised, double blind, superiority trial: control group with standard protective ventilation and recruitment group with protective ventilation and systematic recruitment manoeuvre. The primary outcome was a composite clinical criterion of pulmonary dysfunction including oxygen saturation, oxygen needs and dyspnoea in recovery room and at day 1. Secondary outcomes were recruitment manoeuvre tolerance, pulmonary and non-pulmonary complications, length of hospital stay and proportion of Intensive Care Unit admission. Two hundred and thirty patients were included: 115 in the recruitment manoeuvre group and 115 in the control group, 2 patients were excluded from the analysis in the control group. Patients in the recruitment manoeuvre group had significantly lower rate of pulmonary dysfunction in the recovery room (73% versus 84% (p = 0.043) and 77% versus 88% at postoperative day 1 (p = 0.043)). No significant differences were found for secondary outcomes. No patient was excluded from the recruitment manoeuvre group for intolerance to the manoeuvre. Recruitment manoeuvre is safe and effective in reducing early pulmonary dysfunction in obese patients undergoing bariatric surgery.
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Affiliation(s)
- Mathilde Severac
- Department of Anaesthesia, Nice University Hospital, University Côte d'Azur, Nice, France.
| | - Walid Chiali
- Department of Anaesthesia, Nice University Hospital, University Côte d'Azur, Nice, France
| | - François Severac
- Department of Biostatistics, Strasbourg University Hospital, Strasbourg, France
| | - Olivier Perus
- Department of Anaesthesia, Nice University Hospital, University Côte d'Azur, Nice, France
| | - Jean-Christophe Orban
- Department of Anaesthesia, Nice University Hospital, University Côte d'Azur, Nice, France
| | - Antonio Iannelli
- Department of Digestive Surgery and Liver Transplantation, Nice University Hospital, University Côte d'Azur, Nice, France; Inserm, U1065, Team 8 "Hepatic complications of obesity", University Côte d'Azur, Nice, France
| | - Tarek Debs
- Department of Digestive Surgery and Liver Transplantation, Nice University Hospital, University Côte d'Azur, Nice, France
| | - Jean Gugenheim
- Department of Digestive Surgery and Liver Transplantation, Nice University Hospital, University Côte d'Azur, Nice, France
| | - Marc Raucoules-Aimé
- Department of Anaesthesia, Nice University Hospital, University Côte d'Azur, Nice, France
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10
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The effects of pneumoperitoneum and patient position on the perfusion index and pleth variability index during laparoscopic bariatric surgery. MARMARA MEDICAL JOURNAL 2020. [DOI: 10.5472/marumj.711735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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11
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Lopez Luciano MJ, Then EO, Brana CJ, Ofosu A, Gaduputi V. Spontaneous Gastrojejunal Fistulization after Roux-en-Y Bypass Surgery: A Case Report and Review of Literature. Cureus 2019; 11:e5035. [PMID: 31501727 PMCID: PMC6721868 DOI: 10.7759/cureus.5035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Fistula development is an uncommon but well-recognized complication following Roux-en-Y gastric bypass (RYGB). The broad spectrum of clinical presentation represents a challenge at the time of diagnosis. We present the case of a patient who developed gastrojejunal fistulization after gastric bypass surgery.
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Affiliation(s)
| | - Eric O Then
- Internal Medicine, St. Barnabas Hospital Health System, Bronx, USA
| | | | - Andrew Ofosu
- Internal Medicine: Gastroenterology, The Brooklyn Hospital Center, Affiliate of the Mount Sinai Hospital, New York, USA
| | - Vinaya Gaduputi
- Internal Medicine, St. Barnabas Hospital Health System, Bronx, USA
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12
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Nguyen MTJP, Carpenter D, Tadros J, Mathur A, Sandoval PR, Woodle ES, Diwan T, Ratner LE. Bariatric surgery prior to living donor nephrectomy: a solution to expand the living donor kidney pool - a retrospective study. Transpl Int 2019; 32:702-709. [PMID: 30721545 DOI: 10.1111/tri.13408] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 01/31/2019] [Indexed: 01/05/2023]
Abstract
Most transplant centers decline morbidly obese people for living kidney donation. Their inclusion in the living donor pool after weight loss and reversal of comorbidities by bariatric surgery could reverse the downward living donation trend. We investigated whether bariatric surgery in the morbidly obese altered their candidacy for donation, complicated their subsequent donor nephrectomy, and impacted their early postoperative outcomes in a series of 22 donors who had bariatric surgery 0.7-22 years prior to laparoscopic living donor nephrectomy. Eighteen would have been excluded from donation prior to bariatric surgery based on a body mass index (BMI) > 40. Seventeen reached a BMI < 35 after bariatric surgery. One had hypertension that resolved after bariatric surgery. Prior bariatric surgery did not influence port placement and laterality of donor nephrectomy. None required open conversion or blood transfusion. In an exploratory comparison with 37 donors with a BMI 35-40, length of stay and warm ischemic time were shorter, blood loss and postoperative complications were similar, and operative time was longer. We therefore advocate the consideration of bariatric surgery in preparation for donation in morbidly obese people since it positively alters their candidacy without major impact on the subsequent living donor nephrectomy and early outcomes.
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Affiliation(s)
- Minh-Tri J P Nguyen
- Department of Surgery, Columbia University, New York, NY, USA.,Department of Surgery, Saint Louis University, Saint Louis, MO, USA
| | | | - Joseph Tadros
- Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Abhishek Mathur
- Department of Surgery, Columbia University, New York, NY, USA
| | | | - E Steve Woodle
- Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Tayyab Diwan
- Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Lloyd E Ratner
- Department of Surgery, Columbia University, New York, NY, USA
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13
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Miller JM, Binnicker MJ, Campbell S, Carroll KC, Chapin KC, Gilligan PH, Gonzalez MD, Jerris RC, Kehl SC, Patel R, Pritt BS, Richter SS, Robinson-Dunn B, Schwartzman JD, Snyder JW, Telford S, Theel ES, Thomson RB, Weinstein MP, Yao JD. A Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2018 Update by the Infectious Diseases Society of America and the American Society for Microbiology. Clin Infect Dis 2018; 67:e1-e94. [PMID: 29955859 PMCID: PMC7108105 DOI: 10.1093/cid/ciy381] [Citation(s) in RCA: 286] [Impact Index Per Article: 47.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 04/28/2018] [Indexed: 12/12/2022] Open
Abstract
The critical nature of the microbiology laboratory in infectious disease diagnosis calls for a close, positive working relationship between the physician/advanced practice provider and the microbiologists who provide enormous value to the healthcare team. This document, developed by experts in laboratory and adult and pediatric clinical medicine, provides information on which tests are valuable and in which contexts, and on tests that add little or no value for diagnostic decisions. This document presents a system-based approach rather than specimen-based approach, and includes bloodstream and cardiovascular system infections, central nervous system infections, ocular infections, soft tissue infections of the head and neck, upper and lower respiratory infections, infections of the gastrointestinal tract, intra-abdominal infections, bone and joint infections, urinary tract infections, genital infections, and other skin and soft tissue infections; or into etiologic agent groups, including arthropod-borne infections, viral syndromes, and blood and tissue parasite infections. Each section contains introductory concepts, a summary of key points, and detailed tables that list suspected agents; the most reliable tests to order; the samples (and volumes) to collect in order of preference; specimen transport devices, procedures, times, and temperatures; and detailed notes on specific issues regarding the test methods, such as when tests are likely to require a specialized laboratory or have prolonged turnaround times. In addition, the pediatric needs of specimen management are also emphasized. There is intentional redundancy among the tables and sections, as many agents and assay choices overlap. The document is intended to serve as a guidance for physicians in choosing tests that will aid them to quickly and accurately diagnose infectious diseases in their patients.
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Affiliation(s)
| | - Matthew J Binnicker
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | | | - Karen C Carroll
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | | | - Peter H Gilligan
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill
| | - Mark D Gonzalez
- Department of Pathology, Children’s Healthcare of Atlanta, Georgia
| | - Robert C Jerris
- Department of Pathology, Children’s Healthcare of Atlanta, Georgia
| | | | - Robin Patel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Bobbi S Pritt
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | | | - Barbara Robinson-Dunn
- Department of Pathology and Laboratory Medicine, Beaumont Health, Royal Oak, Michigan
| | | | - James W Snyder
- Department of Pathology and Laboratory Medicine, University of Louisville, Kentucky
| | - Sam Telford
- Department of Infectious Disease and Global Health, Tufts University, North Grafton, Massachusetts
| | - Elitza S Theel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Richard B Thomson
- Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, Illinois
| | - Melvin P Weinstein
- Departments of Medicine and Pathology & Laboratory Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Joseph D Yao
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
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14
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Alban EAD, García CA, Ospina LM, Munevar HE. Imaging after Bariatric Surgery: When Interpretation Is a Challenge, from Normal to Abnormal. Obes Surg 2018; 28:2923-2931. [DOI: 10.1007/s11695-018-3334-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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15
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Metabolic Surgery for the Treatment of Diabetes Mellitus Positioning of Leading Medical Associations in Mexico. Obes Surg 2018; 28:3474-3483. [DOI: 10.1007/s11695-018-3357-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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16
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Cosse C, Rebibo L, Brazier F, Hakim S, Delcenserie R, Regimbeau JM. Cost-effectiveness analysis of stent type in endoscopic treatment of gastric leak after laparoscopic sleeve gastrectomy. Br J Surg 2018; 105:570-577. [DOI: 10.1002/bjs.10732] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 09/12/2017] [Accepted: 09/20/2017] [Indexed: 01/30/2023]
Abstract
Abstract
Background
Gastric leak is the most feared surgical postoperative complication after sleeve gastrectomy. An endoscopic procedure is usually required to treat the leak. No data are available on the cost-effectiveness of different stent types in this procedure.
Methods
Between April 2005 and July 2016, patients with a confirmed gastric leak undergoing endoscopic treatment using a covered stent (CS) or double-pigtail stent (DPS) were included. The primary objective of the study was to assess overall costs of the stent types after primary sleeve gastrectomy. Secondary objectives were the cost-effectiveness of each stent type expressed as an incremental cost-effectiveness ratio (ICER); the incremental net benefit; the probability of efficiency, defined as the probability of being cost-effective at a threshold of €30 000, and identification of the key drivers of ICER derived from a multivariable analysis.
Results
One hundred and twelve patients were enrolled. The overall mean costs of gastric leak were €22 470; the mean(s.d.) cost was €24 916(12 212) in the CS arm and €20 024(3352) in the DPS arm (P = 0·018). DPS was more cost-effective than CS (ICER €4743 per endoscopic procedure avoided), with an incremental net benefit of €25 257 and a 27 per cent probability of efficiency. Key drivers of the ICER were the inpatient ward after diagnosis of gastric leak (surgery versus internal medicine), type of institution (private versus public) and duration of hospital stay per endoscopic procedure.
Conclusion
DPS for the treatment of gastric leak is more cost-effective than CS and should be proposed as the standard regimen whenever possible.
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Affiliation(s)
- C Cosse
- Department of Digestive Surgery, Amiens South Hospital, Jules Verne University of Picardie, Amiens, France
- Institut National de la Santé et de la Recherche Médicale U1088, Jules Verne University of Picardie, Amiens, France
| | - L Rebibo
- Department of Digestive Surgery, Amiens South Hospital, Jules Verne University of Picardie, Amiens, France
| | - F Brazier
- Department of Gastroenterology, Amiens South Hospital, Jules Verne University of Picardie, Amiens, France
| | - S Hakim
- Department of Gastroenterology, Amiens South Hospital, Jules Verne University of Picardie, Amiens, France
| | - R Delcenserie
- Department of Gastroenterology, Amiens South Hospital, Jules Verne University of Picardie, Amiens, France
| | - J M Regimbeau
- Department of Digestive Surgery, Amiens South Hospital, Jules Verne University of Picardie, Amiens, France
- EA4294, Jules Verne University of Picardie, Amiens, France
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Diagnostic Performance of C-Reactive Protein in Detecting Post-Operative Infectious Complications After Laparoscopic Sleeve Gastrectomy. Obes Surg 2017; 27:3124-3132. [DOI: 10.1007/s11695-017-2744-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Montravers P, Lortat-Jacob B, Snauwaert A, BenRehouma M, Guivarch E, Ribeiro-Parenti L. Quoi de neuf dans la prise en charge des péritonites postopératoires. MEDECINE INTENSIVE REANIMATION 2016. [DOI: 10.1007/s13546-016-1174-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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