1
|
Layrisse Landaeta V, Dincheva GR, Hong JS, Kim A, Verzani Z, Yuan V, Zhang C, Chao SY. Acute Appendicitis in the Epicenter of the COVID-19 Pandemic: A New York City Single-Center Experience. Am Surg 2024; 90:780-787. [PMID: 37915247 DOI: 10.1177/00031348231204909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
BACKGROUND Appendectomy is the gold standard for simple appendicitis. During the coronavirus-19 pandemic, it was estimated that appendectomies in the United States decreased by 24%. We aimed to describe trends in acute appendicitis management at a center located in one of the largest epicenters of the pandemic. METHODS This is a retrospective cohort study in a single institution located in Queens, New York, of patients who presented with acute appendicitis. A pre-COVID time period, March-June 2019, was compared to peak-COVID, March-June 2020, and late-COVID, March-June 2021. RESULTS Of the 382 patients admitted with appendicitis during the time periods, 164 were admitted pre-COVID. Appendicitis presentations decreased by 44% during peak-COVID and 23% in late-COVID. Patients were younger during peak-COVID compared to pre-COVID (39 vs 34 years old, P = .036). Incidence of complicated appendicitis in pre-, peak-, and late-COVID was equivalent (41% vs 46% vs 45%) and operative management was similar (85% vs 76% vs 79%). Non-operative patients had shorter lengths of stay (pre- vs peak-COVID: 4.6 vs 2.9 days, P = .006). Readmission rates were similar between the cohorts across time periods. CONCLUSIONS During peak-COVID, there was a significant decrease in presentation of acute appendicitis but clinical presentation and outcomes remained similar between the cohorts. Patients who were managed non-operatively may be discharged earlier without increased rates of readmissions.
Collapse
Affiliation(s)
| | | | - Julie S Hong
- Department of Surgery, New York-Presbyterian/Queens, Queens, NY, USA
| | - Angelina Kim
- Department of Surgery, New York-Presbyterian/Queens, Queens, NY, USA
| | - Zoe Verzani
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Victoria Yuan
- Department of Surgery, New York-Presbyterian/Queens, Queens, NY, USA
| | - Charles Zhang
- Department of Surgery, New York-Presbyterian/Queens, Queens, NY, USA
| | - Steven Y Chao
- Department of Surgery, New York-Presbyterian/Queens, Queens, NY, USA
- Department of Surgery, Weill Cornell Medicine, New York, NY, USA
| |
Collapse
|
2
|
Hamilton BCS, Dincheva GR, Matthay MA, Hays S, Singer JP, Brzezinski M, Kukreja J. Improved survival after lung transplantation for adults requiring preoperative invasive mechanical ventilation: A national cohort study. J Thorac Cardiovasc Surg 2020; 160:1385-1395.e6. [PMID: 32252988 DOI: 10.1016/j.jtcvs.2020.02.080] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 02/03/2020] [Accepted: 02/19/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Early survival after lung transplantation has improved in the last decade. Mechanically ventilated recipients are known to be at greater risk for early post-transplant mortality. We hypothesized that post-transplant survival in mechanically ventilated recipients has improved over time. METHODS Using a national registry, we compared hazard of death at 30 days, 4 and 14 months, 3 and 5 years, and overall for adults on mechanical ventilation who underwent lung or heart-lung transplantation from May 4, 2011, to April 4, 2018 (modern group) with those undergoing transplantation from May 4, 2005, to May 3, 2011 (early group). We quantified the impact of mechanical ventilation on survival using population-attributable fractions. We also compared mechanically ventilated recipients with nonmechanically ventilated recipients. RESULTS Mechanically ventilated recipients from the modern group had lower hazard of death than recipients in the early group at all time-points, lowest at 30-days post-transplant (hazard ratio, 0.04; 95% confidence interval, 0.02-0.08). In the modern period, mechanically ventilated recipients had greater hazard of death than nonmechanically ventilated recipients at 30 days' post-transplant (9.53; 4.57-19.86). For mechanically ventilated recipients, the population attributable fraction was lower in the modern group compared to the earlier group (0.6% vs 5.7%). CONCLUSIONS While mechanically ventilated recipients remain at high risk, survival in this patient population has improved over time. This may reflect improvements in perioperative recipient management.
Collapse
Affiliation(s)
- Barbara C S Hamilton
- Department of Surgery, University of California San Francisco, San Francisco, Calif.
| | - Gabriela R Dincheva
- Department of Surgery, University of California San Francisco, San Francisco, Calif
| | - Michael A Matthay
- Department of Medicine, Anesthesia and the Cardiovascular Research Institute, University of California San Francisco, San Francisco, Calif
| | - Steven Hays
- Department of Medicine, Pulmonary and Critical Care, University of California San Francisco, San Francisco, Calif
| | - Jonathan P Singer
- Department of Medicine, Pulmonary and Critical Care, University of California San Francisco, San Francisco, Calif
| | - Marek Brzezinski
- Department of Anesthesia, University of California San Francisco, San Francisco, Calif
| | - Jasleen Kukreja
- Department of Surgery, University of California San Francisco, San Francisco, Calif
| |
Collapse
|
3
|
Hamilton BCS, Dincheva GR, Zhuo H, Golden JA, Brzezinski M, Singer JP, Matthay MA, Kukreja J. Elevated donor plasminogen activator inhibitor-1 levels and the risk of primary graft dysfunction. Clin Transplant 2018; 32:e13210. [PMID: 29377268 DOI: 10.1111/ctr.13210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2018] [Indexed: 01/11/2023]
Abstract
Primary graft dysfunction (PGD) following lung transplantation is associated with elevated recipient plasma levels of plasminogen activator inhibitor-1 (PAI-1) and the receptor for advanced glycation end products (RAGE). However, the significance of these biomarkers in the donor plasma is uncertain. We hypothesized that elevated donor plasma levels of PAI-1 and RAGE would be associated with recipient PGD. We carried out a prospective unmatched case-control study of double-lung transplant recipients between May 2014 and September 2015. We compared donor plasma levels of PAI-1 and RAGE using rank-sum tests and t tests, in 12 recipients who developed PGD grade 2 or 3 within 72 hours postoperatively with 13 recipients who did not. Recipients who developed PGD had higher donor plasma levels of PAI-1 than recipients who did not (median 2.7 ng/mL vs 1.4; P = .03). Recipients with PGD also had numerically higher donor plasma levels of RAGE than recipients without PGD, although this difference did not achieve statistical significance (median 1061 pg/mL vs 679; P = .12). Systemic inflammatory responses in the donor, as reflected by elevated plasma levels of PAI-1, may contribute to the risk of developing PGD. Rapid biomarker assessment of easily available plasma samples may assist in donor lung selection and risk stratification.
Collapse
Affiliation(s)
| | | | - Hanjing Zhuo
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Jeffrey A Golden
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Marek Brzezinski
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Jonathan P Singer
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Michael A Matthay
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Jasleen Kukreja
- Department of Surgery, University of California, San Francisco, CA, USA
| |
Collapse
|
4
|
Tranbaugh RF, Dimitrova KR, Lucido DJ, Geller CM, Dincheva GR, Hoffman DM. Improving the results of coronary artery bypass surgery: the role of multiple arterial grafting. J Am Coll Surg 2014. [DOI: 10.1016/j.jamcollsurg.2014.07.553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
5
|
Dimitrova KR, Dincheva GR, Hoffman DM, DeCastro H, Geller CM, Tranbaugh RF. Results of endoscopic radial artery harvesting in 1577 patients. Innovations (Phila) 2014; 8:398-402. [PMID: 24356428 DOI: 10.1097/imi.0000000000000027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We reviewed 1577 consecutive patients undergoing coronary artery bypass grafting (CABG) using endoscopic harvesting of the radial artery (RA) to define our current results. METHODS Since 2000, we have performed endoscopic RA harvest on 1577 consecutive patients; 1476 patients had isolated CABG, and 101 patients had CABG and other procedures. The mean ± SD age was 59.4 ± 9.0 years; 80.2% were men and 40% had diabetes mellitus. All data were prospectively collected. All-cause mortality was determined using the Social Security Death Index. RESULTS There were nine in-hospital or 30-day deaths, for an operative mortality of 0.57%: mortality was 0.34% in isolated CABG and 3.85% in CABG/combined procedures. The overall estimated Kaplan-Meier survival at 1, 5, and 10 years was 99%, 95%, and 88%. In 37 patients, the RAs were not harvested or were not used for grafting because of a positive Allen test, extensive calcification or dissection, intramural hematoma, and scarring from previous arterial lines or catheterization. During postoperative follow-up, five patients (0.32%) were treated for incisional infection, and there were no ischemic hand complications. Three patients had a perioperative myocardial infarction in the RA graft distribution, and 15 patients had a coronary artery reintervention in the RA graft distribution. Two other patients had a percutaneous coronary intervention of their RAs. The overall RA patency at 10 years was 82%. CONCLUSIONS Endoscopic harvest of the RA is an excellent minimally invasive conduit harvesting technique with minimal morbidity.
Collapse
Affiliation(s)
- Kamellia R Dimitrova
- From the Division of Cardiothoracic Surgery, Beth Israel Medical Center, New York, NY USA
| | | | | | | | | | | |
Collapse
|
6
|
Tranbaugh RF, Dimitrova KR, Lucido DJ, Hoffman DM, Dincheva GR, Geller CM, Balaram SK, Ko W, Swistel DG. The second best arterial graft: A propensity analysis of the radial artery versus the free right internal thoracic artery to bypass the circumflex coronary artery. J Thorac Cardiovasc Surg 2014; 147:133-40. [DOI: 10.1016/j.jtcvs.2013.08.040] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 07/30/2013] [Accepted: 08/20/2013] [Indexed: 11/26/2022]
|
7
|
Dimitrova KR, Hoffman DM, Geller CM, Ko W, Lucido DJ, Dincheva GR, Tranbaugh RF. Radial artery grafting in women improves 15-year survival. J Thorac Cardiovasc Surg 2013; 146:1467-73. [DOI: 10.1016/j.jtcvs.2012.10.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 09/14/2012] [Accepted: 10/02/2012] [Indexed: 11/15/2022]
|
8
|
Dimitrova KR, Dincheva GR, Hoffman DM, DeCastro H, Geller CM, Tranbaugh RF. Results of Endoscopic Radial Artery Harvesting in 1577 Patients. Innovations 2013. [DOI: 10.1177/155698451300800603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Gabriela R. Dincheva
- Division of Cardiothoracic Surgery, Beth Israel Medical Center, New York, NY USA
| | - Darryl M. Hoffman
- Division of Cardiothoracic Surgery, Beth Israel Medical Center, New York, NY USA
| | - Helbert DeCastro
- Division of Cardiothoracic Surgery, Beth Israel Medical Center, New York, NY USA
| | - Charles M. Geller
- Division of Cardiothoracic Surgery, Beth Israel Medical Center, New York, NY USA
| | - Robert F. Tranbaugh
- Division of Cardiothoracic Surgery, Beth Israel Medical Center, New York, NY USA
| |
Collapse
|