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Dagnæs-Hansen J, Kristensen GH, Stroomberg HV, Rohrsted M, Sørensen SS, Røder A. Surgical Complications Following Renal Transplantation in a Large Institutional Cohort. Transplant Direct 2024; 10:e1626. [PMID: 38757053 PMCID: PMC11098183 DOI: 10.1097/txd.0000000000001626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/25/2024] [Accepted: 02/20/2024] [Indexed: 05/18/2024] Open
Abstract
Background Successful renal transplantation (RTx) relies on immunosuppression and an optimal surgical course with few surgical complications. Studies reporting the postoperative complications after RTx are heterogeneous and often lack systematic reporting of complications. This study aims to describe and identify postoperative short-term and long-term complications after RTx in a large institutional cohort and identify risk factors for a complicated surgical course. Methods The study is a retrospective single-center cohort of 571 recipients who underwent living or deceased donor open RTx between 2014 and 2021. Data were collected on background information and perioperative and postoperative data. Complications were defined as short-term (<30 d) or long-term (>30 d) after transplantation and graded according to the Clavien-Dindo classification. Multivariable logistic regression was performed to evaluate risk factors for serious short-term complications and multivariable time-dependent Cox regression to evaluate risk factors for long-term complications. Results A total of 351 patients received a graft from a deceased donor, and 144 of these grafts were on perfusion machine before transplantation. One or more short-term complications occurred in 345 (60%) patients. Previous RTx was associated with short-term Clavien-Dindo >2 complications in recipients (odds ratio = 2.08; 95% confidence interval [CI], 1.18-3.69; P = 0.01). Being underweight (body mass index <18.5) in combination with increasing age increased the odds of short-term Clavien-Dindo >2 and vascular complications. Increasing blood loss per 100 mL was associated with increased odds of short-term Clavien-Dindo >2 (odds ratio = 1.11; 95% CI, 1.01-1.21; P = 0.032). No associations were found for long-term complications after RTx. The 5-y cumulative incidence of graft loss was 12.6% (95% CI, 8.9-16.3). Conclusions Short-term complications are common after RTx, and risk factors for severe short-term complications include previous RTx, increasing age, and low body mass index. No risk factors were identified for severe long-term complications. Further studies should explore whether new surgical techniques can reduce surgical complications in RTx.
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Affiliation(s)
- Julia Dagnæs-Hansen
- Urologic Research Unit, Department of Urology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gitte H. Kristensen
- Urologic Research Unit, Department of Urology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Hein V. Stroomberg
- Urologic Research Unit, Department of Urology, Copenhagen University Hospital, Copenhagen, Denmark
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Malene Rohrsted
- Department of Urology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Søren S. Sørensen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Nephrology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Andreas Røder
- Urologic Research Unit, Department of Urology, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Urology, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Patlin BH, Mok H, Arra M, Haspel JA. Circadian rhythms in solid organ transplantation. J Heart Lung Transplant 2024; 43:849-857. [PMID: 38310995 PMCID: PMC11070314 DOI: 10.1016/j.healun.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/17/2024] [Accepted: 01/29/2024] [Indexed: 02/06/2024] Open
Abstract
Circadian rhythms are daily cycles in physiology that can affect medical interventions. This review considers how these rhythms may relate to solid organ transplantation. It begins by summarizing the mechanism for circadian rhythm generation known as the molecular clock, and basic research connecting the clock to biological activities germane to organ acceptance. Next follows a review of clinical evidence relating time of day to adverse transplantation outcomes. The concluding section discusses knowledge gaps and practical areas where applying circadian biology might improve transplantation success.
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Affiliation(s)
- Brielle H Patlin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Huram Mok
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Monaj Arra
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Jeffrey A Haspel
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri.
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Uhl M, Waeckel T, Seizilles De Mazancourt E, Taha F, Kaulanjan K, Goujon A, Beretta A, Papet J, Dupuis H, Panis A, Peyrottes A, Lemaire A, Larose C, Bettler L, Pues M, Joncour C, Stempfer G, Ghestem T, De Sousa P. Impact of Transplantation Timing on Renal Graft Survival Outcomes and Perioperative Complications. Transpl Int 2024; 37:12202. [PMID: 38420268 PMCID: PMC10899379 DOI: 10.3389/ti.2024.12202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024]
Abstract
Nighttime organ transplantation aims to decrease cold ischemia duration, yet conflicting data exists on its impact on graft function and perioperative complications. This multicenter TRANSPLANT'AFUF study including 2,854 patients, transplanted between 1 January 2011, and 31 December 2022, investigated nighttime kidney transplantation's impact (8:00 p.m.-8:00 a.m.) versus daytime (8:00 a.m.-8:00 p.m.) on surgical complications and graft survival. Overall, 2043 patients (71.6%) underwent daytime graft, while 811 (28.4%) underwent nighttime graft. No impact was observed of timing of graft surgery on graft survival with a median survival of 98 months and 132 months for daytime and nightime grafting, respectively (p = 0.1749). Moreover, no impact was observed on early surgical complications (Clavien I-II = 20.95% for DG and 20.10% for NG; Clavien III-IV-V = 15.42% for DG and 12.94% for NG; p = 0.0889) and late complications (>30 days) (Clavien I-II = 6.80% for DG and 5.67% for NG; Clavien III-IV-V = 12.78% for DG and 12.82% for NG; p = 0.2444). Noteworthy, we found a significant increase in Maastricht 3 donors' rates in nighttime transplantation (5.53% DG vs. 21.45% NG; p < 0.0001). In conclusion, nighttime kidney transplantation did not impact early/late surgical complications nor graft survival.
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Affiliation(s)
- M. Uhl
- Urology, Centre Hospitalo-Universitaire Amiens Picardie, Amiens, France
| | - T. Waeckel
- Urology, Centre Hospitalo-Universitaire Caen, Caen, France
| | | | - F. Taha
- Urology, Centre Hospitalo-Universitaire Reims, Reims, France
| | - K. Kaulanjan
- Urology, Centre Hospitalo-Universitaire Pointe A Pitre, Guadeloupe, Pointe à Pitre, France
| | - A. Goujon
- Urology, Centre Hospitalo-Universitaire Rennes, Rennes, France
| | - A. Beretta
- Urology, Centre Hospitalo-Universitaire Lyon, Lyon, France
| | - J. Papet
- Urology, Centre Hospitalo-Universitaire Rouen, Rouen, France
| | - H. Dupuis
- Urology, Centre Hospitalo-Universitaire Rouen, Rouen, France
| | - A. Panis
- Urology, Centre Hospitalo-Universitaire Créteil, Paris, France
| | - A. Peyrottes
- Urology, Hôpital Européen Georges Pompidou, Paris, France
| | - A. Lemaire
- Urology, Hôpital Saint Louis, Paris, France
| | - C. Larose
- Urology, Centre Hospitalo-Universitaire Nancy, Nancy, France
| | - L. Bettler
- Urology, Centre Hospitalo-Universitaire Dijon, Dijon, France
| | - M. Pues
- Urology, Centre Hospitalo-Universitaire Lille, Lille, France
| | - C. Joncour
- Urology, Centre Hospitalo-Universitaire Reims, Reims, France
| | - G. Stempfer
- Urology, Centre Hospitalo-Universitaire Pointe A Pitre, Guadeloupe, Pointe à Pitre, France
| | - T. Ghestem
- Urology, Centre Hospitalo-Universitaire Amiens Picardie, Amiens, France
| | - P. De Sousa
- Urology, Centre Hospitalo-Universitaire Amiens Picardie, Amiens, France
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Dong C, Li J, Tang Q, Wang Y, Zeng C, Du L, Sun Q. Denervation aggravates renal ischemia reperfusion injury via BMAL1-mediated Nrf2/ARE pathway. Arch Biochem Biophys 2023; 746:109736. [PMID: 37657745 DOI: 10.1016/j.abb.2023.109736] [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: 06/21/2023] [Revised: 08/04/2023] [Accepted: 08/27/2023] [Indexed: 09/03/2023]
Abstract
AIM To explore the change of clock gene rhythm under renal denervation (RDN) and its effect on renal function and oxidative stress during renal ischemia-reperfusion (IR) injury. METHOD C57/BL6 mice were randomly divided into 4 groups at daytime 7 A M (zeitgeber time [ZT] 0) or at nighttime 7 P M (ZT12) in respectively: Sham (S) group, RDN group, IR group and RDN + IR (DIR) group. Renal pathological and functional changes were assessed by H&E staining, and serum creatinine, urea nitrogen and neutrophil gelatinase-associated lipocalin levels. Renal oxidative stress was detected by SOD and MDA levels, and renal inflammation was measured by IL-6, IL-17 A F and TNF-ɑ levels. BMAL1, CLOCK, Nrf2 and HO-1 mRNA and protein expressions were tested by qPCR and Western Blot. RESULT Compared with S groups, the rhythm of BMAL1, CLOCK and Nrf2 genes in the kidney were disordered in RDN groups, while renal pathological and functional indexes did not change significantly. Compared with IR groups, renal pathological and functional indexes were significantly higher in the DIR groups, as well as oxidative stress and inflammation in renal tissues. The nocturnal IR injury in the RDN kidney was the worst while the BMAL1, Nrf2 and HO-1 expressions were the highest. In DIR groups, renal injury was aggravated after the Brusatol treatment, but there was no significant improvement after the t-BHQ treatment at night, which might be consistent with the changes of Nrf2 and HO-1 protein expressions. CONCLUSION RDN lead to the disruption of BMAL1-mediated Nrf2 rhythm accumulation in the kidney, which reduced the renal ability to resist oxidative stress and inflammation, due to the impaired effect of activating Nrf2/ARE pathway in renal IR injury at nighttime.
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Affiliation(s)
- Chong Dong
- Organ Transplantation Center, Tianjin First Central Hospital, Tianjin, China; Tianjin Key Laboratory for Organ Transplantation, Tianjin, China
| | - Jing Li
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee, 1193053, Regensburg, Germany
| | - Qiao Tang
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yifei Wang
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Cheng Zeng
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Li Du
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qian Sun
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China.
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Geldmaker LE, Baird BA, Hasse CH, Haehn DA, Anyane-Yeboah AN, Knutson JE, Wieczorek MA, Ball CT, Lyon TD, Thiel DD. Analysis of Transurethral Resection of Bladder Tumor Efficiency Utilizing Nonprocedural Operating Room Times. Urology 2023; 177:6-11. [PMID: 37160169 DOI: 10.1016/j.urology.2023.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVE To analyze the contribution of nonprocedural operating room (OR) times to transurethral resection of bladder tumor (TURBT) operative efficiency. METHODS Over a 24-month period, all nonprocedural OR times from TURBT surgeries performed at a single institution were prospectively collected. Nonprocedural times included: in-room to anesthesia release time, anesthesia release to cut time, and close to wheels out time. Procedural OR time was cut to close time. We also analyzed the impact of time of day on TURBT efficiency (morning vs afternoon). Comparisons between groups were made using the Wilcoxon rank sum test for continuous variables. RESULTS We identified 777 consecutive TURBT procedures from 2019 to 2020. The median total OR time was 63 minutes (interquartile range: 50-81 minutes). The nonprocedural time occupied a median of 49.4% of the total operating time (interquartile range: 38.9%-60.4%). Median anesthesia release to cut time was slower when 1 TURBT was performed a day compared to 2 or more (13 minutes vs 12 minutes, P = .04). Median close to wheels out time was faster when there was 1 TURBT in a day (7 minutes vs 8 minutes, P = .02). Median in-room to anesthesia release time was faster in the morning than it was in the afternoon (10 minutes vs 11 minutes, P = .02). CONCLUSION Nonprocedural times made up roughly half of the total TURBT operating time and should be considered in OR efficiency analyses. TURBT OR efficiency may be related to the number of TURBTs performed in a day as well as the time of day of TURBT start.
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Affiliation(s)
| | - Bryce A Baird
- Department of Urology, Mayo Clinic, Jacksonville, FL
| | | | | | | | - Jill E Knutson
- Department of Anesthesiology, Mayo Clinic, Jacksonville, FL
| | - Mikolaj A Wieczorek
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, FL
| | - Colleen T Ball
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, FL
| | - Timothy D Lyon
- Department of Urology, Mayo Clinic, Jacksonville, FL; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL
| | - David D Thiel
- Department of Urology, Mayo Clinic, Jacksonville, FL.
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Association of Surgical Start Time with Outcomes of Benign Hysterectomy. J Minim Invasive Gynecol 2023; 30:389-396. [PMID: 36708764 DOI: 10.1016/j.jmig.2023.01.008] [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: 10/19/2022] [Revised: 01/10/2023] [Accepted: 01/13/2023] [Indexed: 01/27/2023]
Abstract
STUDY OBJECTIVE To evaluate whether surgical start time is associated with clinical and financial outcomes of hysterectomies performed for benign indications. DESIGN Retrospective cohort study. SETTING University 5-hospital healthcare system. PATIENTS Women who underwent benign hysterectomy between 2014 and 2019. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We analyzed demographic, operative, and financial data to evaluate the relationships between surgical start time and perioperative outcomes including operating room time, estimated blood loss, length of stay, same-day discharge, and adverse perioperative events. Additionally, we evaluated the impact of surgical start time on total hysterectomy charges. Descriptive statistics and multivariate logistic and linear regressions were performed adjusting for confounders. Our study identified 2894 women who underwent benign hysterectomy, with 1910 hysterectomies starting prior to 12 pm (am group) and 984 hysterectomies starting after 12 pm (pm group). A pm start time was associated with higher estimated blood loss (Median 100, interquartile range 50, 200 in the am group vs Median 125, interquartile range 75, 250), increased length of stay, and decreased likelihood of same-day discharge. No significant differences were noted in the rates of adverse perioperative events between the 2 groups. Surprisingly, an afternoon start time was associated with decreased total hospital charges (median am $14 055.30 versus median pm $11 724.80). These cost differences persisted after multivariate linear regression, and when stratified by hysterectomy surgical approach, remained significant in the open and laparoscopic cohorts. CONCLUSION Afternoon hysterectomy start time is associated with increased blood loss and length of stay with decreased rates of same-day discharge; however, there was no associated increase in perioperative adverse events or mortality. Awareness regarding surgical start time and outcomes can guide surgical scheduling and optimize same-day discharge.
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Analysis of fixed and variable operating room (or) time point efficiency in partial nephrectomies: open versus robotic-assisted. J Robot Surg 2022; 17:853-858. [PMID: 36318380 PMCID: PMC9628460 DOI: 10.1007/s11701-022-01477-8] [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] [Received: 04/20/2022] [Accepted: 10/14/2022] [Indexed: 11/05/2022]
Abstract
To analyze operating room (OR) efficiency by evaluating fixed and variable OR times for open (OPN) and robotic-assisted partial nephrectomies (RAPN). We analyzed consecutive OPN and RAPN performed by one surgeon over a 24-month period. All patients were placed in the lateral decubitus position and secured with a beanbag regardless of approach. Fixed (non-procedural) OR times were prospectively collected and defined as: in-room to anesthesia-release time (IRAT), anesthesia release to cut time (ARCT), and close to wheels-out time (CTWO). Variable OR time was procedural cut to close time (CTCT). Comparisons of fixed and variable OR time points between OPN and RAPN were performed using the Wilcoxon rank-sum test. 146 RAPN and 31 OPN were evaluated from 2019–2020. Median IRAT was similar for RAPN versus OPN [20 min (IQR: 16–25) vs. 20 min (IQR: 16–26), P = 0.57]. Median ARCT was longer for RAPN than it was for OPN [40 min (IQR: 36–46) vs. 34 min (IQR: 30–39), P < 0.001]. Median CTWO was similar for OPN (12 min, IQR: 9–14) and RAPN (11 min, IQR: 7–15) (P = 0.89). Median CTCT was longer for RAPN (202 min, IQR: 170–236) compared to OPN (164 min, IQR: 154–184) (P < 0.001). In a single surgeon, partial nephrectomy series with the same patient positioning, utilization of robotic technology was associated with longer surgeon operating time as well as less efficient fixed OR times, specifically ARCT.
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Takahashi B, Kamohara K, Amamoto S, Kawaguchi A. Impact of after-hours surgery on outcomes of acute type A aortic dissection repair. Surg Today 2022; 52:1453-1462. [PMID: 35338427 DOI: 10.1007/s00595-022-02487-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/16/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE To establish whether emergency surgery performed outside working hours (after hours) contributed to adverse outcomes for patients with acute type A aortic dissection (ATAAD). METHODS We reviewed the operation records of ATAAD repair in our institution from 2004 to 2019 (n = 187). Emergency surgery was performed by one of a few teams of experienced surgeons, regardless of the time of day. Patients were divided into two groups based on the surgery start time: during working hours (n = 65) and after hours (n = 122). A propensity score-matched analysis was performed for 58 pairs of patients. RESULTS The overall in-hospital mortality was 6.9% for the working-hours group and 13.8% for the after-hours group. There were no significant differences between the groups in the relatively limited study population (n = 187). Surgeon experience and aortic interventions did not differ remarkably between the groups. After-hours repair was not associated with postoperative complications. There were no significant differences in the long-term survival or aortic event-free rates between the groups. CONCLUSIONS After-hours surgery did not affect the short- or long-term outcomes of ATAAD repair under our backup system, which supports the recommendation of immediate surgical repair. Efforts to minimize the discrepancies between working hours and after hours could help to improve the surgical outcomes of patients undergoing ATAAD repair.
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Affiliation(s)
- Baku Takahashi
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-0937, Japan.
| | - Keiji Kamohara
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-0937, Japan
| | - Sojiro Amamoto
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-0937, Japan
| | - Atsushi Kawaguchi
- Research and Education Center for Comprehensive Community Medicine, Faculty of Medicine, Saga University, Saga, Japan
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Bailey D, Lehman M, Tuohy K, Ko E, Hatten S, Rizk E. The Impact of Surgical Scheduling on Outcomes in Lumbar Laminectomy. Cureus 2021; 13:e20272. [PMID: 35018266 PMCID: PMC8741263 DOI: 10.7759/cureus.20272] [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] [Accepted: 12/08/2021] [Indexed: 11/25/2022] Open
Abstract
Objective The purpose of this study was to determine whether surgical scheduling affected patient outcomes following lumbar laminectomy. Physician fatigue caused by prolonged work hours has been shown to worsen outcomes. Previous research has also established a relationship between surgical scheduling and outcomes. Methods This was a retrospective chart review of single-level lumbar laminectomy patients at the Penn State Milton S. Hershey Medical Center between 1992 and 2019. Patients who underwent a one-level laminectomy between 1992 and 2019 were included in the study. Patients with procedures defined as complex (>1 level, tumor or abscess removal, discectomy, implant removal) were excluded. The surgical complication rate [cerebrospinal fluid (CSF) leak, 30-day redo, 30-day ED visit, weakness, sensation loss, infection, urinary retention] was compared across surgical start times, day of the week, proximity to a holiday, and procedure length. Results Procedures that started between 9:01-11:00 were more likely to have a complication than those between 7:01-9:00 (p=0.04). For every 60-min increase in surgery length, odds of having a complication increased by 2.01 times (p=0.0041). Surgeries that started between 11:01-13:00 had a significantly longer median surgery length than those between 7:01-9:00. Conclusion The time of the day when the procedure was started was predictive of worse outcomes following laminectomy. This may be attributed to several factors, including fatigue and staff turnover. Additionally, increased surgical length was predictive of more complications. It remains unclear whether increased surgical time results from correction of noticed errors or a fatigue-related decline in speed and performance. These findings on one-level laminectomy warrant further investigations since they have implications for reducing systemic failures that impact patient outcomes.
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Affiliation(s)
- David Bailey
- Neurological Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Morgan Lehman
- Neurological Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Kyle Tuohy
- Neurological Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Elizabeth Ko
- Neurological Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Steven Hatten
- Neurological Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Elias Rizk
- Neurological Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
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Day-Time Declamping Is Associated with Better Outcomes in Kidney Transplantation: The Circarein Study. J Clin Med 2021; 10:jcm10112322. [PMID: 34073444 PMCID: PMC8198093 DOI: 10.3390/jcm10112322] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/15/2021] [Accepted: 05/22/2021] [Indexed: 11/17/2022] Open
Abstract
Despite improvements in organ preservation techniques and efforts to minimize the duration of cold ischemia, ischemia–reperfusion (IR) injury remains associated with poor graft function and long-term survival in kidney transplantation. We recently demonstrated a clinically significant day-time variation in myocardial tolerance to IR, transcriptionally orchestrated by the circadian clock. Patient and graft post-transplant survival were studied in a cohort of 10,291 patients first transplanted between 2006 and 2017 to test whether kidney graft tolerance to IR depends on the time-of-the-day of clamping/declamping, and thus impacts graft and patient survival. Post-transplant 1- and 3-year survival decreased with increasing ischemia duration. Time-of-the-day of clamping did not influence outcomes. However, night-time (vs. day-time) declamping was associated with a significantly worse post-transplant survival. After adjustment for other predictors, night-time (vs. day-time) declamping remained associated with a worse 1-year (HR = 1.26 (1.08–1.47), p = 0.0028 by Cox multivariable analysis) and 3-year (HR = 1.14 (1.02–1.27), p = 0.021) outcome. Interestingly, the deleterious impact of prolonged ischemia time (>15 h) was partially compensated by day-time (vs. night-time) declamping. Compared to night-time declamping, day-time declamping was associated with a better prognosis of kidney transplantation despite a longer duration of cold ischemia.
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Tattan M, Puranam M, Comnick C, McBrearty C, Xie XJ, Caplan DJ, Avila-Ortiz G, Elangovan S. Surgery start time and early implant failure: A case-control study. Clin Oral Implants Res 2021; 32:871-880. [PMID: 33949022 DOI: 10.1111/clr.13763] [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: 12/16/2020] [Revised: 03/12/2021] [Accepted: 04/24/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the influence of surgery start time (SST) and other patient- and therapy-related variables on the risk for early implant failure (EIF) in an academic setting. MATERIAL AND METHODS Data were extracted from the electronic health records of 61 patients who had at least one EIF and 140 age- and gender-matched, randomly selected, non-EIF controls. Bivariate and multivariable analyses were performed to identify relevant associations between EIF and different variables, such as SST. RESULTS Incidence of EIF was not significantly associated with SST (HR: 1.9 for afternoon implant placement, 95% CI: 0.9-3.9; p = .105). Other factors that were associated with a significantly increased risk for EIF in a multivariable model were pre-placement ridge augmentation (HR: 7.5, 95% CI: 2.2-25.1; p = .001), intra-operative complications (HR: 5.9, 95% CI: 2.2-16.3; p < .001), simultaneous soft tissue grafting (HR: 5.03, 95% CI: 1.3-19.5; p = .020), simultaneous bone grafting (HR: 3.7, 95% CI: 1.6-8.8; p = .002), and placement with sedation (HR: 3.4, 95% CI: 1.5-7.5; p = .002). CONCLUSIONS While SST was not associated with the occurrence of EIF in our cohort, other variables, such as ridge augmentation prior to implant placement, simultaneous bone or soft tissue grafting, intra-operative complications, implant placement with sedation, and number of implants in the oral cavity, were associated with an increased risk for this adverse event.
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Affiliation(s)
- Mustafa Tattan
- Department of Periodontics, University of Iowa College of Dentistry, Iowa City, IA, USA
| | - Megha Puranam
- University of Iowa College of Dentistry, Iowa City, IA, USA
| | - Carissa Comnick
- Department of Biostatistics, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Charles McBrearty
- College Administration, University of Iowa College of Dentistry, Iowa City, IA, USA
| | - Xian Jin Xie
- Department of Biostatistics, University of Iowa College of Public Health, Iowa City, IA, USA.,College Administration, University of Iowa College of Dentistry, Iowa City, IA, USA.,Department of Preventive and Community Dentistry, University of Iowa College of Dentistry, Iowa City, IA, USA
| | - Daniel J Caplan
- Department of Preventive and Community Dentistry, University of Iowa College of Dentistry, Iowa City, IA, USA
| | - Gustavo Avila-Ortiz
- Department of Periodontics, University of Iowa College of Dentistry, Iowa City, IA, USA
| | - Satheesh Elangovan
- Department of Periodontics, University of Iowa College of Dentistry, Iowa City, IA, USA
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Qian K, Wu S, Lee W, Liu S, Li A, Cang J, Fang F. A model-based validation study of postoperative complications with considerations on operative timing. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:708. [PMID: 33987406 PMCID: PMC8106084 DOI: 10.21037/atm-21-669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Surgery is a highly technical procedure relying on high mental acuity and manual dexterity. The possibility that surgical outcomes and post-operative complications could be subject to influence by fatigue and/or circadian rhythms in surgeons has been investigated with inconsistent results. Methods We conducted a retrospective study to assess the significance of operative timing on classifying surgical complications using an interpretable machine learning approach. We trained various linear, generative as well as tree models on the surgical record data collected from a university-affiliated, tertiary teaching hospital in China by performing parameter tuning using grid search cross-validation for optimizing the F1 score. Results The results indicated that XGBoost was the best-performing model overall and its feature importance was shown to provide insight into possible timing-related associations with postoperative complications. We observed that the duration of surgery acted as the strongest indicator, and while surgery initiated at night (between 9 pm and 7 am) also ranked higher on the feature importance scale, it bore less significance than other factors such as the patient's age, gender, and type of surgery performed. Conclusions We showed that surgical records could be used to demonstrate that operative timing might affect the occurrence of postoperative complications, but only in a relatively mild way while potentially entangling with multiple factors.
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Affiliation(s)
- Kun Qian
- Department of Information and Intelligence Development, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Simeng Wu
- Department of Information and Intelligence Development, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Weishan Lee
- Department of Anesthesia, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shiwen Liu
- Department of Anesthesia, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ailun Li
- Department of Anesthesia, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jing Cang
- Department of Anesthesia, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Fang Fang
- Department of Anesthesia, Zhongshan Hospital, Fudan University, Shanghai, China
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Bery A, Marklin G, Itoh A, Kreisel D, Takahashi T, Meyers BF, Nava R, Kozower BD, Shepherd H, Patterson GA, Puri V. Specialized Donor Care Facility Model and Advances in Management of Thoracic Organ Donors. Ann Thorac Surg 2021; 113:1778-1786. [PMID: 33421385 DOI: 10.1016/j.athoracsur.2020.12.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 12/13/2020] [Accepted: 12/15/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Donor hearts and lungs are more susceptible to the inflammatory physiologic changes that occur after brain death. Prior investigations have shown that protocolized management of potential organ donors can rehabilitate donor organs that are initially deemed unacceptable. In this review we discuss advances in donor management models with particular attention to the specialized donor care facility model. In addition we review specific strategies to optimize donor thoracic organs and improve organ yield in thoracic transplantation. METHODS We performed a literature review by searching the PubMed database for medical subject heading terms associated with organ donor management models. We also communicated with our local organ procurement organization to gather published and unpublished information first-hand. RESULTS The specialized donor care facility model has been shown to improve the efficiency of organ donor management and procurement while reducing costs and minimizing travel and its associated risks. Lung protective ventilation, recruitment of atelectatic lung, and hormone therapy (eg, glucocorticoids and triiodothyronine/thyroxine) are associated with improved lung utilization rates. Stroke volume-based resuscitation is associated with improved heart utilization rates, whereas studies evaluating hormone therapy (eg, glucocorticoids and triiodothyronine/thyroxine) have shown variable results. CONCLUSIONS Lack of high-quality prospective evidence results in conflicting practices across organ procurement organizations, and best practices remain controversial. Future studies should focus on prospective, randomized investigations to evaluate donor management strategies. The specialized donor care facility model fosters a collaborative environment that encourages academic inquiry and is an ideal setting for these investigations.
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Affiliation(s)
- Amit Bery
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St Louis, Missouri.
| | | | - Akinobu Itoh
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Daniel Kreisel
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Tsuyoshi Takahashi
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Bryan F Meyers
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Ruben Nava
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Benjamin D Kozower
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Hailey Shepherd
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - G Alexander Patterson
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Varun Puri
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
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Arnaoutakis G, Bianco V, Estrera AL, Brinster DR, Ehrlich MP, Peterson MD, Bossone E, Myrmel T, Pacini D, Montgomery DG, Eagle KA, Bekeredijan R, Shalhub S, De Vincentiis C, Chad Hughes G, Chen EP, Eckstein HH, Nienaber CA, Sultan I. Time of day does not influence outcomes in acute type A aortic dissection: Results from the IRAD. J Card Surg 2020; 35:3467-3473. [PMID: 32939836 DOI: 10.1111/jocs.15017] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/15/2020] [Accepted: 08/05/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Type A acute aortic dissection (TAAAD) represents a surgical emergency requiring intervention regardless of time of day. Whether such a "evening effect" exists regarding outcomes for TAAAD has not been previously studied using a large registry data. METHODS Patients with TAAAD were identified from the International Registry of Acute Aortic Dissections (1996-2019). Outcomes were compared between patients undergoing operative repair during the daytime (D), defined as 8 am-5 pm, versus the evening (N), defined as 5 pm-8 am. RESULTS Four thousand one-hundrd and ninety-seven surgically treated patients with TAAAD were identified, with 1824 patients undergoing daytime surgery (43.5%) and 2373 patients undergoing evening surgery (56.5%). Daytime patients were more likely to have undergone prior cardiac surgery (13.2% vs. 9.5%; p < .001) and have had a prior aortic dissection (4.8% vs. 3.4%; p = .04). Evening patients were more likely to have been transferred from a referring hospital (70.8% vs. 75.0%; p = .003). Daytime patients were more likely to undergo aortic valve sparing root procedures (23.3% vs. 19.2%; p = .035); however, total arch replacement was performed with equal frequency (19.4% vs. 18.8%; p = .751). In-hospital mortality (D: 17.3% vs. N. 16.2%; p = .325) was similar between both groups. Subgroup analysis examining the effect of weekend presentation revealed no significant mortality difference. CONCLUSIONS A majority of TAAAD patients underwent surgical repair at night. There were higher rates of postoperative tamponade in evening patients; however, mortality was similar. The expertise of cardiac-dedicated operative and critical care teams regardless of time of day as well as training paradigms may explain similar mortality outcomes in this high risk population.
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Affiliation(s)
| | - Valentino Bianco
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anthony L Estrera
- International Registry of Acute Aortic Dissections (IRAD), Ann Arbor, Michigan, USA
| | - Derek R Brinster
- International Registry of Acute Aortic Dissections (IRAD), Ann Arbor, Michigan, USA
| | - Marek P Ehrlich
- International Registry of Acute Aortic Dissections (IRAD), Ann Arbor, Michigan, USA
| | - Mark D Peterson
- International Registry of Acute Aortic Dissections (IRAD), Ann Arbor, Michigan, USA
| | - Eduardo Bossone
- International Registry of Acute Aortic Dissections (IRAD), Ann Arbor, Michigan, USA
| | - Truls Myrmel
- International Registry of Acute Aortic Dissections (IRAD), Ann Arbor, Michigan, USA
| | - Davide Pacini
- International Registry of Acute Aortic Dissections (IRAD), Ann Arbor, Michigan, USA
| | - Daniel G Montgomery
- International Registry of Acute Aortic Dissections (IRAD), Ann Arbor, Michigan, USA
| | - Kim A Eagle
- International Registry of Acute Aortic Dissections (IRAD), Ann Arbor, Michigan, USA
| | - Raffi Bekeredijan
- International Registry of Acute Aortic Dissections (IRAD), Ann Arbor, Michigan, USA
| | - Sherene Shalhub
- International Registry of Acute Aortic Dissections (IRAD), Ann Arbor, Michigan, USA
| | - Carlo De Vincentiis
- International Registry of Acute Aortic Dissections (IRAD), Ann Arbor, Michigan, USA
| | - G Chad Hughes
- International Registry of Acute Aortic Dissections (IRAD), Ann Arbor, Michigan, USA
| | - Edward P Chen
- International Registry of Acute Aortic Dissections (IRAD), Ann Arbor, Michigan, USA
| | | | - Christoph A Nienaber
- International Registry of Acute Aortic Dissections (IRAD), Ann Arbor, Michigan, USA
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Alnajashi SS, Alayed SA, Al-Nasher SM, Aldebasi B, Khan MM. Will surgeries performed at night lead to worse outcomes? Findings from a trauma center in Riyadh. Medicine (Baltimore) 2020; 99:e20273. [PMID: 32769860 PMCID: PMC7593025 DOI: 10.1097/md.0000000000020273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
As surgeries are performed around the clock, the time of surgery might have an impact on outcomes. Our aim is to investigate the impact of daytime and nighttime shifts on surgeons and their performance. We believe that such studies are important to enhance the quality of surgeries and their outcomes and help understand the effects of time of the day on surgeons and the surgeries they perform.A retrospective cohort study was conducted using the database from the King Abdulaziz Medical City trauma center. We selected 330 cases of patients between 2015 and 2018, who underwent a trauma intervention surgery within 24 hours after admission. Patients were aged 15 years and above who underwent 1 or more of the following trauma interventions: neurosurgery, general surgery, plastic surgery, vascular surgery, orthopedics, ophthalmology, and/or otolaryngology. We divided the work hours into 3 shifts: 8 AM to 3:59 PM, 4 PM to 11:59 PM, and midnight to 7:59 AM.Participants' mean age was 31.4 (standard deviation ± 13) years. Most surgeries occurred on weekdays (68.4%). Complications were one and a half times more on weekends, with 5 complicated cases on weekends (1.55%) and 3 (0.9%) on weekdays. Half of all surgeries were performed in the morning (152 cases, 53.15%); 73 surgeries (25.5%) were performed in the evening and 61 (21.3%) were performed late at night. Surgeries performed during late-night shifts were marginally better. Complications occurred in 4 out of 152 morning surgeries (2.6%), 2 out of 73 evening surgeries (2.7%), and only 1 out of 61 late-night surgeries (1.6%). The earlier comparison scored a P-value of >.99, suggesting that patients in morning and evening surgeries were twice more likely to experience complications than late-night surgeries.This study may support previous research that there is little difference in outcomes between daytime and nighttime surgeries. The popular belief that rested physicians are better physicians requires further assessment and research.
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Affiliation(s)
| | | | | | - Bader Aldebasi
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Thongprayoon C, Hansrivijit P, Leeaphorn N, Acharya P, Torres-Ortiz A, Kaewput W, Kovvuru K, Kanduri SR, Bathini T, Cheungpasitporn W. Recent Advances and Clinical Outcomes of Kidney Transplantation. J Clin Med 2020; 9:jcm9041193. [PMID: 32331309 PMCID: PMC7230851 DOI: 10.3390/jcm9041193] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 02/07/2023] Open
Abstract
Recent advances in surgical, immunosuppressive and monitoring protocols have led to the significant improvement of overall one-year kidney allograft outcomes. Nonetheless, there has not been a significant change in long-term kidney allograft outcomes. In fact, chronic and acute antibody-mediated rejection (ABMR) and non-immunological complications following kidney transplantation, including multiple incidences of primary kidney disease, as well as complications such as cardiovascular diseases, infections, and malignancy are the major factors that have contributed to the failure of kidney allografts. The use of molecular techniques to enhance histological diagnostics and noninvasive surveillance are what the latest studies in the field of clinical kidney transplant seem to mainly focus upon. Increasingly innovative approaches are being used to discover immunosuppressive methods to overcome critical sensitization, prevent the development of anti-human leukocyte antigen (HLA) antibodies, treat chronic active ABMR, and reduce non-immunological complications following kidney transplantation, such as the recurrence of primary kidney disease and other complications, such as cardiovascular diseases, infections, and malignancy. In the present era of utilizing electronic health records (EHRs), it is strongly believed that big data and artificial intelligence will reshape the research done on kidney transplantation in the near future. In addition, the utilization of telemedicine is increasing, providing benefits such as reaching out to kidney transplant patients in remote areas and helping to make scarce healthcare resources more accessible for kidney transplantation. In this article, we discuss the recent research developments in kidney transplants that may affect long-term allografts, as well as the survival of the patient. The latest developments in living kidney donation are also explored.
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Affiliation(s)
- Charat Thongprayoon
- Division of Nephrology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA;
| | - Panupong Hansrivijit
- Department of Internal Medicine, University of Pittsburgh Medical Center Pinnacle, Harrisburg, PA 17105, USA;
| | - Napat Leeaphorn
- Department of Nephrology, Department of Medicine, Saint Luke’s Health System, Kansas City, MO 64111, USA;
| | - Prakrati Acharya
- Division of Nephrology, Department of Medicine, Texas Tech University Health Sciences Center, El Paso, TX 79905, USA;
| | - Aldo Torres-Ortiz
- Department of Medicine, Ochsner Medical Center, New Orleans, LA 70121, USA;
| | - Wisit Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand;
| | - Karthik Kovvuru
- Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA; (K.K.); (S.R.K.)
| | - Swetha R. Kanduri
- Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA; (K.K.); (S.R.K.)
| | - Tarun Bathini
- Department of Internal Medicine, University of Arizona, Tucson, AZ 85724, USA;
| | - Wisit Cheungpasitporn
- Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA; (K.K.); (S.R.K.)
- Correspondence: ; Tel.: +1-601-984-5670; Fax: +1-601-984-5765
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