1
|
Keele T, Hashemzadeh M, Movahed MR. Lower myocardial infarction and all-cause mortality with laparoscopic cholecystectomy compared with open cholecystectomy. Future Cardiol 2023; 19:759-765. [PMID: 38112267 DOI: 10.2217/fca-2023-0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/02/2023] [Indexed: 12/21/2023] Open
Abstract
Aim: We compared inpatient outcome data of open (OC) versus laparoscopic cholecystectomy (LC). Patients & methods: We used the National Inpatient Samples database from 2010-2014. Results: LC was done in 340,999 and OC in 68,529 OC patients. In 2010, ST-elevation myocardial infarction (STEMI) prevalence was 0.2 versus 0% (OR: 3.1, CI: 1.7-5.5; p < 0.001), non-STEMI 1 versus 0.4% (OR: 2.5 CI: 2.0-3.0; p < 0001), mortality 3.4 versus 0.4% (OR: 9.2, CI: 7.9-10.6; p < 0001). After multivariate adjustment, OC remained independently associated with STEMI, non-STEMI and all-cause inpatient mortality (mortality multivariate OR: 6.4, CI: 5.5-7.4; p < 0001, STEMI OR: 2.2. CI: 1.2-3.9; p = 0.007, non-STEMI OR: 1.5, CI: 1.3-1.9; p < 0001). Conclusion: OC is independently associated with STEMI, non-STEMI and all-cause inpatient mortality compared with LC.
Collapse
Affiliation(s)
- Taft Keele
- University of Arizona, College of Medicine, Phoenix 85004, AZ, USA
| | | | - Mohammad Reza Movahed
- University of Arizona, College of Medicine, Phoenix 85004, AZ, USA
- University of Arizona Sarver Heart Center, College of Medicine, Tucson 85724, AZ, USA
| |
Collapse
|
2
|
Prachand VN, Milner R, Angelos P, Posner MC, Fung JJ, Agrawal N, Jeevanandam V, Matthews JB. Medically Necessary, Time-Sensitive Procedures: Scoring System to Ethically and Efficiently Manage Resource Scarcity and Provider Risk During the COVID-19 Pandemic. J Am Coll Surg 2020; 231:281-288. [PMID: 32278725 PMCID: PMC7195575 DOI: 10.1016/j.jamcollsurg.2020.04.011] [Citation(s) in RCA: 227] [Impact Index Per Article: 56.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/07/2020] [Accepted: 04/07/2020] [Indexed: 01/08/2023]
Abstract
Hospitals have severely curtailed the performance of nonurgent surgical procedures in anticipation of the need to redeploy healthcare resources to meet the projected massive medical needs of patients with coronavirus disease 2019 (COVID-19). Surgical treatment of non-COVID-19 related disease during this period, however, still remains necessary. The decision to proceed with medically necessary, time-sensitive (MeNTS) procedures in the setting of the COVID-19 pandemic requires incorporation of factors (resource limitations, COVID-19 transmission risk to providers and patients) heretofore not overtly considered by surgeons in the already complicated processes of clinical judgment and shared decision-making. We describe a scoring system that systematically integrates these factors to facilitate decision-making and triage for MeNTS procedures, and appropriately weighs individual patient risks with the ethical necessity of optimizing public health concerns. This approach is applicable across a broad range of hospital settings (academic and community, urban and rural) in the midst of the pandemic and may be able to inform case triage as operating room capacity resumes once the acute phase of the pandemic subsides.
Collapse
Affiliation(s)
- Vivek N Prachand
- Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL.
| | - Ross Milner
- Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL
| | - Peter Angelos
- Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL
| | - Mitchell C Posner
- Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL
| | - John J Fung
- Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL
| | - Nishant Agrawal
- Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL
| | - Valluvan Jeevanandam
- Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL
| | - Jeffrey B Matthews
- Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL
| |
Collapse
|
3
|
Slidell MB, Kandel JJ, Prachand V, Baroody FM, Gundeti MS, Reid RR, Angelos P, Matthews JB, Mak GZ. Pediatric Modification of the Medically Necessary, Time-Sensitive Scoring System for Operating Room Procedure Prioritization During the COVID-19 Pandemic. J Am Coll Surg 2020; 231:205-215. [PMID: 32473197 PMCID: PMC7251404 DOI: 10.1016/j.jamcollsurg.2020.05.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/14/2020] [Accepted: 05/14/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND The COVID-19 pandemic forced surgeons to reconsider concepts of "elective" operations. Perceptions about the time sensitivity and medical necessity of a procedure have taken on greater significance during the pandemic. The evolving ethical and clinical environment requires reappraisal of perioperative factors, such as personal protective equipment conservation; limiting the risk of exposure to COVID-19 for patients, families, and healthcare workers; preservation of hospital beds and ICU resources; and minimizing COVID-19-related perioperative risk to patients. STUDY DESIGN A scaffold for the complex decision-making required for prioritization of medically necessary, time-sensitive (MeNTS) operations was developed for adult patients by colleagues at the University of Chicago. Although adult MeNTS scoring can be applied across adult surgical specialties, some variables were irrelevant in a pediatric population. Pediatric manifestations of chronic diseases and congenital anomalies were not accounted for. To account for the unique challenges children face, we modified the adult MeNTS system for use across pediatric subspecialties. RESULTS This pediatric MeNTS scoring system was applied to 101 cases both performed and deferred between March 23 and April 19, 2020 at the University of Chicago Comer Children's Hospital. The pediatric MeNTS scores provide a safe, equitable, transparent, and ethical strategy to prioritize children's surgical procedures. CONCLUSIONS This process is adaptable to individual institutions and we project it will be useful during the acute phase of the pandemic (maximal limitations), as well as the anticipated recovery phase.
Collapse
Affiliation(s)
- Mark B Slidell
- Sections of Pediatric Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL; Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL.
| | - Jessica J Kandel
- Sections of Pediatric Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL; Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL
| | - Vivek Prachand
- Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL
| | - Fuad M Baroody
- Otolaryngology, University of Chicago Medicine and Biological Sciences, Chicago, IL; Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL
| | - Mohan S Gundeti
- Urology, University of Chicago Medicine and Biological Sciences, Chicago, IL; Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL
| | - Russell R Reid
- Plastic Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL; Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL
| | - Peter Angelos
- Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL
| | - Jeffrey B Matthews
- Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL
| | - Grace Z Mak
- Sections of Pediatric Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL; Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL
| |
Collapse
|
4
|
Rao PB, Mangaraj M, Mahajan P, Tripathy S, Singh N, Mani T, Nayak S. The Carrico index is the parameter that guides the requirement of oxygen in the postoperative period in patients undergoing head and neck surgery under general anaesthesia: a cross-sectional study. Rom J Anaesth Intensive Care 2018; 25:49-54. [PMID: 29756063 PMCID: PMC5931183 DOI: 10.21454/rjaic.7518.251.crc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 03/29/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND & AIMS Altered lung function and consequent decrease in oxygenation has been linked to the duration of anaesthesia. This necessitates oxygen monitoring and supplementation in the perioperative period. But, evidence is lacking regarding the parameter that guides best the oxygen supplementation in the postoperative period and the parameter that correlates best with the duration of anaesthesia. METHODS Adult patients scheduled for head & neck surgery under general anaesthesia were recruited. Two radial arterial blood samples one at pre-induction and the other at one hour after extubation were obtained. Primary outcome measures were partial pressure of oxygen (PaO2), saturation (SpO2), arterial oxygen content (CaO2) and Carrico index (PaO2/FiO2) and their relation with duration of anaesthesia. RESULTS Data from 112 patients showed a hypoxaemia incidence of 11.6%. We observed a drop in the mean CaO2 and haemoglobin concentration but a rise in the mean PaO2 at recovery. The mean PaO2/FiO2 deteriorated by 225.65 ± 72.46 (95% CI 367.66, 83.64, p = 0.000) at recovery and there was a significant correlation (r = 0.2, p = 0.03) between duration of anaesthesia and decrease in PaO2/FiO2 at recovery with a regression coefficient of 0.27 (95% CI 0.02, 0.50). CONCLUSIONS The Carrico index was proven to be the best parameter which needs to be monitored perioperatively to detect the alteration in the gaseous exchange in patients undergoing general anaesthesia for head and neck surgery. There is a positive correlation between the decrease in the Carrico index and the duration of anaesthesia especially when it is prolonged beyond 150 minutes.
Collapse
Affiliation(s)
- Parnandi Bhaskar Rao
- Department of Anaesthesiology and Critical Care, AIIMS, Patrapada, Bhubaneswar-751019, Odisha, India
| | - Manaswini Mangaraj
- Department of Biochemistry, AIIMS, Patrapada, Bhubaneswar-751019, Odisha, India
| | - Preetam Mahajan
- Department of Community & Family medicine, AIIMS, Patrapada, Bhubaneswar-751019, Odisha, India
| | - Swagata Tripathy
- Department of Anaesthesiology and Critical Care, AIIMS, Patrapada, Bhubaneswar-751019, Odisha, India
| | - Neha Singh
- Department of Anaesthesiology and Critical Care, AIIMS, Patrapada, Bhubaneswar-751019, Odisha, India
| | - Thenmozhi Mani
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sukdev Nayak
- Department of Anaesthesiology and Critical Care, AIIMS, Patrapada, Bhubaneswar-751019, Odisha, India
| |
Collapse
|