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Aboueisha MA, Freeman M, Allotey JK, Evans L, Caposole MZ, Tatum D, Levy S, Baker JW, Galvani C. Battle of the buttress: 5-year propensity-matched analysis of staple-line reinforcement techniques from the MBSAQIP database. Surg Endosc 2022; 37:3090-3102. [PMID: 35927350 DOI: 10.1007/s00464-022-09452-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 07/05/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Vertical sleeve gastrectomy (VSG) has demonstrated to be safe; however, controversy remains on how to decrease major complications, particularly bleeding and leaks. There are variations in staple-line reinforcement techniques, including no reinforcement, oversewing, and buttressing. We sought to evaluate the effect of those methods on post-operative complications using the Metabolic and Bariatric Surgery Accreditation Quality Initiative Program (MBSAQIP) database. METHODS The MBSAQIP was queried for patients who underwent VSG during 2015-2019. A propensity-matched analysis was performed between different staple-line reinforcement (SLR) methods, specifically No reinforcement (NR), Oversewing (OS), and Buttressing (BR). The primary outcome of interest was complications within 30 days. RESULTS A total of 513,354 VSG cases were analyzed. The cohort was majority female (79.0%), with mean (SD) age of 44.2 ± 11.9 years and mean BMI of 45 ± 7.8 kg/m2. Frequency of SLR methods used was 54%BR, 25.6%NR, 10.8% BR + OS, and 9.8%OS. There were no differences in rate of leaks among SLR methods. Compared to NR, BR was associated with decreased rate of reoperations, overall bleeding, and major bleeding (p < 0.05) but prolonged operative time and length of stay (LOS) (p < 0.05). OS was associated with decreased overall bleeding (p < 0.05) but prolonged operative times and length of stay (p < 0.05) compared to NR. Compared to BR, OS was associated with increased operative times, LOS, and rates of post-operative ventilator use, pneumonia, and venous thrombosis (p < 0.05). Patients with bleeding were associated with lower rate of BR (56% vs 61%) and higher rate of NR (34% vs 28%) compared to patients with no bleeding. Bleeding was associated with a greater frequency of leaks (4.4% vs 0.3%), along with higher morbidity and mortality (p < 0.05). CONCLUSIONS Of the reinforcement methods evaluated, BR and OS were both associated with decreased bleeding despite longer operative times. No method was found to significantly reduce incidence of leaks; however, bleeding was associated with increased incidence of leaks, morbidity, and mortality. The liberal use of SLR techniques is recommended for further optimization of patient outcomes after VSG.
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Affiliation(s)
- Mohamed A Aboueisha
- Division of Minimally Invasive Surgery and Bariatric, Department of Surgery, Tulane University, 1430 Tulane Ave., Mailbox #8622, New Orleans, LA, 70112, USA
| | - Meredith Freeman
- Division of Minimally Invasive Surgery and Bariatric, Department of Surgery, Tulane University, 1430 Tulane Ave., Mailbox #8622, New Orleans, LA, 70112, USA
| | - Jonathan K Allotey
- Division of Minimally Invasive Surgery and Bariatric, Department of Surgery, Tulane University, 1430 Tulane Ave., Mailbox #8622, New Orleans, LA, 70112, USA
| | - Leah Evans
- Division of Minimally Invasive Surgery and Bariatric, Department of Surgery, Tulane University, 1430 Tulane Ave., Mailbox #8622, New Orleans, LA, 70112, USA
| | - Michael Z Caposole
- Division of Minimally Invasive Surgery and Bariatric, Department of Surgery, Tulane University, 1430 Tulane Ave., Mailbox #8622, New Orleans, LA, 70112, USA
| | - Danielle Tatum
- Department of Surgery, Tulane University, New Orleans, LA, 70112, USA
| | - Shauna Levy
- Division of Minimally Invasive Surgery and Bariatric, Department of Surgery, Tulane University, 1430 Tulane Ave., Mailbox #8622, New Orleans, LA, 70112, USA
| | - John W Baker
- Division of Minimally Invasive Surgery and Bariatric, Department of Surgery, Tulane University, 1430 Tulane Ave., Mailbox #8622, New Orleans, LA, 70112, USA
| | - Carlos Galvani
- Division of Minimally Invasive Surgery and Bariatric, Department of Surgery, Tulane University, 1430 Tulane Ave., Mailbox #8622, New Orleans, LA, 70112, USA.
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Aboueisha MA, Attia AS, McCoul ED, Carter J. Efficacy and safety of balloon dilation of eustachian tube in children: Systematic review and meta-analysis. Int J Pediatr Otorhinolaryngol 2022; 154:111048. [PMID: 35085875 DOI: 10.1016/j.ijporl.2022.111048] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 10/16/2021] [Revised: 12/11/2021] [Accepted: 01/16/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Eustachian tube dysfunction is a common condition that may lead to otitis media with effusion, hearing loss and developmental delays in children. We sought to determine the efficacy and safety of balloon dilation of the eustachian tube (BDET) in the pediatric population. DATA SOURCES Original studies of BDET in a pediatric population were identified in PubMed, Embase, Web of Science, Cochrane, Clinicaltrials.gov and CINAHL. METHODS Outcomes of efficacy included audiometric findings and adverse events were summarized for each study. RESULTS Seven articles were included involving 408 children with a mean age of 9.9 years old (95%CI 8.8, 11.1) and a mean follow up of 19.2 months (95%CI 15, 23). Type B tympanograms decreased after BDET from 64.2% (95%CI 53.3, 73.8) to 16.1% (95%CI 8.5, 28.4). Air-bone gap (ABG) decreased after BDET from a mean of 25.3 dB (95%CI 18.9, 31.6) to 10.2 dB (95%CI 8.9, 11.5). The pooled estimate of adverse events after BDET was 5.1% (95%CI 3.2, 8.1), the majority being self-limited epistaxis with no major adverse events reported. Three studies compared BDET to ventilation tube insertion; analysis of post-operative ABG showed a greater decrease in the BDET group (mean difference -6.4 dB; 95%CI -9.8, -3.1; p = 0.002). CONCLUSION Although there are no prospective randomized control trials, BDET ± tympanostomy tube placement may produce outcomes that are comparable to tympanostomy tube placement in the treatment of otitis media with effusion in the pediatric population. Most children undergoing the procedure are those with recalcitrant disease. The procedure is safe with the most common complication being epistaxis.
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Affiliation(s)
- Mohamed A Aboueisha
- Department of Otolaryngology-Head and Neck Surgery Faculty of Medicine, Suez Canal University, Egypt; Department of Surgery, Tulane School of Medicine, New Orleans, LA, USA
| | - Abdallah S Attia
- Department of Surgery, Tulane School of Medicine, New Orleans, LA, USA
| | - Edward D McCoul
- Department of Otorhinolaryngology, Ochsner Clinic, New Orleans, LA, USA; Ochsner Clinical School, University of Queensland, New Orleans, LA, USA
| | - John Carter
- Department of Otorhinolaryngology, Ochsner Clinic, New Orleans, LA, USA; Department of Otolaryngology-Head and Neck Surgery, Tulane University, New Orleans, LA, USA.
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Attia AS, Hussein M, Aboueisha MA, Omar M, Youssef MR, Mankowski N, Miller M, Munshi R, Swinford A, Kline A, Nguyen T, Toraih E, Duchesne J, Kandil E. Altered mental status is a predictor of poor outcomes in COVID-19 patients: A cohort study. PLoS One 2021; 16:e0258095. [PMID: 34610034 PMCID: PMC8491909 DOI: 10.1371/journal.pone.0258095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 09/19/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction Several studies have described typical clinical manifestations, including fever, cough, diarrhea, and fatigue with COVID-19 infection. However, there are limited data on the association between the presence of neurological manifestations on hospital admission, disease severity, and outcomes. We sought to investigate this correlation to help understand the disease burden. Methods We delivered a multi-center retrospective study of positive laboratory-confirmed COVID-19 patients. Clinical presentation, laboratory values, complications, and outcomes data were reported. Our findings of interest were Intensive Care Unit (ICU) admission, intubation, mechanical ventilation, and in-hospital mortality. Results A total of 502 patients with a mean age of 60.83 ± 15.5 years, of them 71 patients (14.14%) presented with altered mental status, these patients showed higher odds of ICU admission (OR = 2.06, 95%CI = 1.18 to 3.59, p = 0.01), mechanical ventilation (OR = 3.28, 95%CI = 1.86 to 5.78, p < 0.001), prolonged (>4 days) mechanical ventilation (OR = 4.35, 95%CI = 1.89 to 10, p = 0.001), acute kidney injury (OR = 2.18, 95%CI = 1.28 to 3.74, p = 0.004), and mortality (HR = 2.82, 95%CI = 1.49 to 5.29, p = 0.01). Conclusion This cohort study found that neurological presentations are associated with higher odds of adverse events. When examining patients with neurological manifestations, clinicians should suspect COVID-19 to avoid delayed diagnosis or misdiagnosis and lose the chance to treat and prevent further transmission.
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Affiliation(s)
- Abdallah S. Attia
- Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, United States of America
| | - Mohammad Hussein
- Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, United States of America
| | - Mohamed A. Aboueisha
- Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, United States of America
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Mahmoud Omar
- Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, United States of America
| | - Mohanad R. Youssef
- Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, United States of America
| | - Nicholas Mankowski
- Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, United States of America
| | - Michael Miller
- Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, United States of America
| | - Ruhul Munshi
- Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, United States of America
| | - Aubrey Swinford
- Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, United States of America
| | - Adam Kline
- Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, United States of America
| | - Therese Nguyen
- Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, United States of America
| | - Eman Toraih
- Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, United States of America
- Genetics Unit, Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Juan Duchesne
- Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, United States of America
| | - Emad Kandil
- Department of Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, United States of America
- * E-mail:
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