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Adapa N, Adkins ZB, Hidden KA, Goyal KS. Risk Factors for Secondary Revision After Finger Amputations. Hand (N Y) 2023:15589447231174480. [PMID: 37269233 DOI: 10.1177/15589447231174480] [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] [Indexed: 06/05/2023]
Abstract
BACKGROUND Digit amputations are relatively simple and are often performed in the setting of trauma or infection. However, it is not uncommon for digit amputations to undergo secondary revision due to complications or patient dissatisfaction. Identifying factors associated with secondary revision may alter treatment strategy. We hypothesize that the secondary revision rate is affected by digit, initial level of amputation, and comorbidities. METHODS A retrospective chart review was conducted on patients undergoing digit amputations in operating rooms at our institution from 2011 to 2017. Secondary revision amputations were defined as a separate return to the operating room following initial surgical amputation, excluding emergency room amputations. Patient demographics, comorbidities, level of amputation, and complications were collected. RESULTS In all, 278 patients were included with a total of 386 digit amputations and mean follow-up of 2.6 months. Three hundred twenty-six primary digit amputations were performed in 236 patients (group A). Sixty digits were secondarily revised in 42 patients (group B). The secondary revision rate was 17.8% for patients and 15.5% for digits. Patients with heart disease and diabetes mellitus were associated with secondary revision, with wound complications being the leading indication overall (73.8%). Medicare covered 52.4% of patients in group B versus 30.1% in group A (P = .005). CONCLUSION Risk factors for secondary revision include Medicare insurance, comorbidities, previous digit amputations, and initial amputation of either the index finger or the distal phalanx. These data may serve as a prediction model to aid surgical decision-making by identifying patients at risk of secondary revision amputation.
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Affiliation(s)
- Nikhil Adapa
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Zachary B Adkins
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Krystin A Hidden
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kanu S Goyal
- Division of Hand and Upper Extremity Surgery, Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, USA
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Chan WK, Yong E, Hong Q, Zhang L, Lingam P, Tan GWL, Chandrasekar S, Lo ZJ. Systematic review and meta-analysis of the prevalence of abdominal aortic aneurysm in Asian populations. J Vasc Surg 2020; 73:1069-1074.e1. [PMID: 32987145 DOI: 10.1016/j.jvs.2020.08.140] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 08/17/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The prevalence of abdominal aortic aneurysms (AAAs) is well reported in Western countries and AAA screening programs are well-established. However, although individual studies have reported that the prevalence of AAAs is lower in Asian populations, high-quality data on the prevalence of AAA in Asians are relative lacking. The present study aimed to systematically synthesize the data available in the literature and report the prevalence of AAAs in Asians. METHODS An electronic search was performed using two major databases (PubMed and EMBASE) with no limitations imposed on the year of publication. The review conformed to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Studies that reported the prevalence of AAAs in Asians were selected, and the population characteristics, AAA definition, method of screening, target population, and total number of patients screened were recorded. RESULTS Our search yielded 157 unique articles. After a full-text review, 17 articles were included in the present study. All 17 studies of fair quality. The overall AAA prevalence was 1.30% (95% confidence interval [CI], 1.01%-1.59%) in Asian populations. The prevalence of AAAs was 2.56% (95% CI, 1.81%-3.31%) in Asian populations selected for cardiovascular risk factors and 0.61% (95% CI, 0.37%-0.85%) in Asian populations not selected for cardiovascular risk factors. CONCLUSIONS The prevalence of AAAs in the general Asian population is low. However, the prevalence in Asian populations selected for cardiovascular risk factors approaches the prevalence of AAAs in Western populations. As such, screening for AAAs in carefully selected Asian male populations with cardiovascular risk factors could potentially yield benefits. Opportunistic screening for AAAs during ultrasound examination of the abdomen or transthoracic echocardiography for other indications could also be considered. However, further studies are needed to evaluate the potential benefits of screening for AAAs in carefully selected Asian populations.
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Affiliation(s)
- Wai Kiu Chan
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore.
| | - Enming Yong
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Qiantai Hong
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Li Zhang
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Pravin Lingam
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Glenn Wei Leong Tan
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Sadhana Chandrasekar
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Zhiwen Joseph Lo
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
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Bierig SM, Arnold A, Einbinder LC, Armbrecht E, Burroughs T. Cardiovascular Ultrasound Combined With Non-invasive Screening for the Detection of Undiagnosed Cardiovascular Disease: A Literature Review. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2018. [DOI: 10.1177/8756479317737764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Non-invasive screenings have been widely utilized in the United States and worldwide to provide early identification of cardiovascular disease, allowing for earlier diagnosis and treatment. Screening sonography detects valve disease, cardiac dysfunction, and carotid disease in 5% to 20% of the population. This review discusses the current data regarding cardiovascular screening, the methodologies, and the resources required for performance of screenings. Cardiac and carotid sonography is highly accurate and discovers cardiovascular diseases that impact quality of life and risk of future events. Screenings are performed in a variety of settings and accuracy depends on the quality of personnel performing the non-invasive testing, the equipment utilized, and the personnel interpreting the studies. Despite the potential benefit for disease detection, population screening to detect cardiovascular disease is not widely supported by national organizations due to the theoretical cost of further testing and lack of cost versus benefit data. Additional studies are necessary to compare costs and benefits of non-invasive cardiovascular screening in the community setting.
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Affiliation(s)
| | | | | | - Eric Armbrecht
- Saint Louis University Center for Outcomes Research, Saint Louis, MO, USA
| | - Thomas Burroughs
- Saint Louis University Center for Outcomes Research, Saint Louis, MO, USA
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Han SA, Joh JH, Park HC. Risk Factors for Abdominal Aortic Aneurysm in the Korean Population. Ann Vasc Surg 2017; 41:135-140. [DOI: 10.1016/j.avsg.2016.08.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 08/04/2016] [Accepted: 08/13/2016] [Indexed: 01/31/2023]
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Vitalis A, Lip GYH, Kay M, Vohra RK, Shantsila A. Ethnic differences in the prevalence of peripheral arterial disease: a systematic review and meta-analysis. Expert Rev Cardiovasc Ther 2017; 15:327-338. [DOI: 10.1080/14779072.2017.1305890] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Antonios Vitalis
- Institute of Cardiovascular Sciences, University of Birmingham, City Hospital, Birmingham, UK
- Department of Vascular Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Gregory Y. H. Lip
- Institute of Cardiovascular Sciences, University of Birmingham, City Hospital, Birmingham, UK
| | - Mark Kay
- Department of Vascular Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Rajiv K. Vohra
- Department of Vascular Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Alena Shantsila
- Institute of Cardiovascular Sciences, University of Birmingham, City Hospital, Birmingham, UK
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Ahn S, Min SK, Min SI, Ha J, Jung IM, Kim SJ, Park HS, Lee T. Treatment Strategy for Persistent Sciatic Artery and Novel Classification Reflecting Anatomic Status. Eur J Vasc Endovasc Surg 2016; 52:360-9. [PMID: 27369291 DOI: 10.1016/j.ejvs.2016.05.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 05/06/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Persistent sciatic artery (PSA) is a relatively rare congenital variant of the lower limb vasculature and can have highly variable clinical presentations. The purpose of this study was to analyze the relationship between PSA anatomy and clinical presentation, and to suggest an optimal management strategy. METHODS Between 2001 and 2014, 24 PSAs in 19 patients were diagnosed by computed tomography and referred to the vascular surgery department. Patient demographics, types of PSA and femoral artery, aneurysmal changes, symptoms, and treatment methods were assessed. Additionally, all English literature from 1964 to 2014 was reviewed and compared using the PubMed database (224 PSAs in 171 patients). RESULTS PSA was diagnosed in 10 men (52.6%) and nine women (47.4%). PSAs were bilateral in five patients (26.3%) and symptomatic in 12 patients, while in seven patients PSA was found incidentally. According to the Pillet-Gauffre classification, Type 2a was the most common variant (n = 15/24, 62.5%), with unclassifiable types in two limbs. Compared with cases in the literature, the PSA occlusion rate in this study was higher (n = 10/24, 41.7% vs. n = 54/224, 27.5%), but aneurysm incidence was higher in the literature cases (n = 5/24, 20.8% vs. n = 112/224; 50.7%). In this study, 16 limbs (66.6%) were treated conservatively, and six limbs were treated by open surgery, including four bypasses, one amputation, and one thrombo-embolectomy. Endovascular coil embolization was performed in one limb, and a hybrid procedure with stent graft was performed in one limb with PSA aneurysm. Based on the present series and the literature review, a new classification system and treatment option is proposed according to the anatomic status and the presence of aneurysm. According to the new classification, class III was the most common in both the present study (18/24; 75%) and the literature review, and the presence of aneurysm was the most important determinant of surgical treatment. CONCLUSIONS The new classification system is simple and provides guidance for management. Limb anatomy of the femoral artery system and the presence of PSA aneurysm should be considered when selecting the optimal treatment. The risk of embolism from the presence of aneurysm is an important factor for treatment, and bypass surgery is mostly required in classes III and IV.
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Affiliation(s)
- S Ahn
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - S-K Min
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - S-I Min
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - J Ha
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - I M Jung
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - S J Kim
- Department of Surgery, Seonam University College of Medicine, Goyang-si, Gyeonggi-do, Republic of Korea
| | - H S Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - T Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Kim MH, Ahn S, Kim JY, Jun KW, Yun SS, Won YS. Current trends of major arterial diseases in Korea: based on data from the Health Insurance Review and Assessment Service. Ann Surg Treat Res 2016; 90:218-23. [PMID: 27073793 PMCID: PMC4826985 DOI: 10.4174/astr.2016.90.4.218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 11/01/2015] [Accepted: 11/30/2015] [Indexed: 01/19/2023] Open
Abstract
Purpose This study aims to figure out the changes of the prevalence and management of carotid arterial occlusive diseases (CAOD), abdominal aortic diseases (AAA), and arterial diseases of the lower extremities (LAOD) in Korea over the past 5 years. Methods Data were extracted from the Health Insurance Review and Assessment Service during the period from 2008 to 2012. Results The number of patients with CAOD increased by about 30% every year. From the year 2008, the number of open surgeries (OS) and endovascular treatments (ET) increased by more than 20% during each of the first 2 years and by 10% every year for 3 years thereafter for CAOD. ET was preferred to OS and occupied 77%–79% of the total number of procedures. The number of patients with AAA increased by 11%–17% every year. ET for AAA occupied 52% of the total number of procedures in 2008 and gradually increased to 70% in 2012. The number of patients who were diagnosed with LAOD fluctuated over the five years. The total number of procedures to treat LAOD increased each year by 20%–25%. ET for LAOD constantly increased by 18%–24% each year and occupied 80%–95% of the total number of procedures. Conclusion It is evident that the incidence of vascular diseases will be increasing as our society ages, not to mention its care costs. The need for long-range plans and guidelines are urgent.
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Affiliation(s)
- Mi-Hyeong Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sanghyun Ahn
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jang-Yong Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kang-Woong Jun
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang-Seop Yun
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong Sung Won
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
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