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Sojib MFMI, Wang YS. Comparative analysis of surgical outcomes in children with type 3 and type 4 lateral physeal condylar humerus fractures in China: Closed Reduction-PerCutaneous Pinning (CRPP) vs. Open Reduction-Internal Fixation (ORIF). J Orthop 2024; 54:22-31. [PMID: 38524360 PMCID: PMC10957379 DOI: 10.1016/j.jor.2024.02.031] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 02/19/2024] [Indexed: 03/26/2024] Open
Abstract
Background Lateral physeal condylar humerus fractures in pediatric patients aged 1-13 rank as the second most common elbow injury, occurring with a frequency ranging from 5% to 16.8%. There exists an ongoing debate regarding the surgical management of these fractures. This study aims to evaluate the efficacy of Open Reduction and Internal Fixation (ORIF) and Closed Reduction and Percutaneous Pinning (CRPP) as suitable surgical treatments for displaced unstable fractures of the lateral condyle physeal humerus in children. The comparison encompasses the results of ORIF and CRPP, alongside clinical and radiographic outcomes and complication rates. Method A retrospective review was conducted at the Department of Orthopedic Surgery in the research hospital. A cohort of 27 patients treated between 2016 and 2023 were analyzed, 19 patients meeting inclusion criteria. The fracture pattern and degree of displacement were assessed, with specialized radiologists, doctors, and surgeons in agreement. Among the patients, 11 underwent CRPP 7 type 3and 4 type 2, while 16 received ORIF 12 type 4 and 4 type 5. Data collection included fracture type, surgical method, operation time, pre and post-operative displacement, casting period, bone union condition, follow-up records, range of motion, complications, delayed union, lateral spurring, and pin removal records. Results For CRPP, the mean time for pin removal was 5.42 weeks, with excellent bone union and an average operation time of 34.57 min. Criteria of Hardacre showed 28.57% of cases as good and 71.42% as excellent. Similarly, ORIF demonstrated a mean operation time of 42.5 min, with the fracture healing within 5.33 weeks and the pin being removed after 15 days on average. Criteria of Hardacre indicated 25% of cases as good and 75% as excellent. Both groups showed satisfactory outcomes, with no complications such as osteomyelitis, nonunion, malunion, delayed union, myositis ossificans, physeal growth arrest, tardy ulnar nerve palsy, cubitus valgus, or varus, and no cases requiring re-surgery. Conclusion Both CRPP and ORIF are effective surgical methods for treating lateral physeal condylar humeral fractures (types 3 and 4 according to the Song classification) in children, demonstrating satisfactory outcomes. Notably, regardless of displacement (2 mm and >2 mm), both methods yield similar results, albeit with CRPP offering the advantage of avoiding incisions. Overall, both procedures are safe, with favorable bone healing outcomes.
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Affiliation(s)
| | - Yan Song Wang
- Department of Orthopedics, the First Affiliated Hospital of Jinzhou Medical University,Liaoning province,Jinzhou city, China
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Chowdary AR, Wukich DK, Sambandam S. Complications of periprosthetic fracture revision vs aseptic revision of total knee arthroplasty. J Orthop 2024; 53:20-26. [PMID: 38450064 PMCID: PMC10912218 DOI: 10.1016/j.jor.2024.02.033] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 02/19/2024] [Indexed: 03/08/2024] Open
Abstract
Background Periprosthetic fractures after total knee arthroplasty (TKA) are a challenging problem due to complex fracture patterns, poor bone quality, and a high-risk patient population. Treatment of both periprosthetic fractures and aseptic complications can include revision TKA. In this study, we compared systemic and orthopaedic complications following periprosthetic fracture associated revision TKA to aseptic revision TKA. Methods This is a retrospective cohort study using data from the years 2010-2020 from a national administrative claims database. Billing codes were used to identify revision TKAs with a diagnosis of periprosthetic fracture or aseptic complications (loosening, dislocation, arthrofibrosis, osteolysis, or prosthetic wear) within one year prior to revision. Pertinent systemic complications and rates of repeat revision TKA, periprosthetic infection, and repeat fractures were compared between the two groups. Results We identified 9891 periprosthetic fracture associated revision TKAs and 47,071 aseptic revision TKAs. Our study found higher rate of systemic complications including AKI, DVT, wound disruption, hematoma, and surgical site infections in periprosthetic fracture associated revision TKA compared to aseptic revision TKA. Furthermore, we found higher rates of repeat revision TKA, periprosthetic infections, and repeat periprosthetic fractures in fracture associated revision TKA group compared to aseptic revision group. Conclusions Our work highlights the significant short- and long-term complications associated with periprosthetic fracture associated revision TKA. Future working comparing functional outcomes and optimal surgical techniques are needed.
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Affiliation(s)
| | - Dane K. Wukich
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Senthil Sambandam
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX, USA
- Department of Orthopaedic Surgery, Dallas VA Medical Center, Dallas, TX, USA
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3
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Pahwa B, Kazim SF, Vellek J, Alvarez-Crespo DJ, Shah S, Tarawneh O, Dicpinigaitis AJ, Grandhi R, Couldwell WT, Schmidt MH, Bowers CA. Frailty as a predictor of poor outcomes in patients with chronic subdural hematoma (cSDH): A systematic review of literature. World Neurosurg X 2024; 23:100372. [PMID: 38638610 PMCID: PMC11024655 DOI: 10.1016/j.wnsx.2024.100372] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 03/22/2024] [Accepted: 03/22/2024] [Indexed: 04/20/2024] Open
Abstract
Objective In recent years, frailty has been reported to be an important predictive factor associated with worse outcomes in neurosurgical patients. The purpose of the present systematic review was to analyze the impact of frailty on outcomes of chronic subdural hematoma (cSDH) patients. Methods We performed a systematic review of literature using the PubMed, Cochrane library, Wiley online library, and Web of Science databases following PRISMA guidelines of studies evaluating the effect of frailty on outcomes of cSDH published until January 31, 2023. Results A comprehensive literature search of databases yielded a total of 471 studies. Six studies with 4085 patients were included in our final qualitative systematic review. We found that frailty was associated with inferior outcomes (including mortality, complications, recurrence, and discharge disposition) in cSDH patients. Despite varying frailty scales/indices used across studies, negative outcomes occurred more frequently in patients that were frail than those who were not. Conclusions While the small number of available studies, and heterogenous methodology and reporting parameters precluded us from conducting a pooled analysis, the results of the present systematic review identify frailty as a robust predictor of worse outcomes in cSDH patients. Future studies with a larger sample size and consistent frailty scales/indices are warranted to strengthen the available evidence. The results of this work suggest a strong case for using frailty as a pre-operative risk stratification measure in cSDH patients.
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Affiliation(s)
- Bhavya Pahwa
- Medical Student, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Syed Faraz Kazim
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA
| | - John Vellek
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | | | - Smit Shah
- Department of Neurology, PRISMA Health/University of South Carolina School of Medicine, Columbia, SC, USA
| | - Omar Tarawneh
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | | | - Ramesh Grandhi
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - William T. Couldwell
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Meic H. Schmidt
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA
| | - Christian A. Bowers
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA
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Sultan M, Zewdie A, Priyadarshani D, Hassen E, Tilahun M, Geremew T, Beane A, Haniffa R, Berenholtz SM, Checkley W, Hansoti B, Laytin AD. Implementing an ICU registry in Ethiopia-Implications for critical care quality improvement. J Crit Care 2024; 81:154525. [PMID: 38237203 PMCID: PMC10996997 DOI: 10.1016/j.jcrc.2024.154525] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE Intensive care units (ICUs) in low- and middle-income countries have high mortality rates, and clinical data are needed to guide quality improvement (QI) efforts. This study utilizes data from a validated ICU registry specially developed for resource-limited settings to identify evidence-based QI priorities for ICUs in Ethiopia. MATERIALS AND METHODS A retrospective cohort analysis of data from two tertiary referral hospital ICUs in Addis Ababa, Ethiopia from July 2021-June 2022 was conducted to describe casemix, complications and outcomes and identify features associated with ICU mortality. RESULTS Among 496 patients, ICU mortality was 35.3%. The most common reasons for ICU admission were respiratory failure (24.0%), major head injury (17.5%) and sepsis/septic shock (13.3%). Complications occurred in 41.0% of patients. ICU mortality was higher among patients with respiratory failure (46.2%), sepsis (66.7%) and vasopressor requirements (70.5%), those admitted from the hospital ward (64.7%), and those experiencing major complications in the ICU (62.3%). CONCLUSIONS In this study, ICU mortality was high, and complications were common and associated with increased mortality. ICU registries are invaluable tools to understand local casemix and clinical outcomes, especially in resource-limited settings. These findings provide a foundation for QI efforts and a baseline to evaluate their impact.
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Affiliation(s)
- Menbeu Sultan
- St. Paul's Hospital Millennium Medical Center, Addis Ababa, Ethiopia
| | - Ayalew Zewdie
- St. Paul's Hospital Millennium Medical Center, Addis Ababa, Ethiopia; Addis Ababa Burn, Emergency and Trauma Hospital, Addis Ababa, Ethiopia
| | | | - Ephrem Hassen
- St. Paul's Hospital Millennium Medical Center, Addis Ababa, Ethiopia
| | - Melkamu Tilahun
- St. Paul's Hospital Millennium Medical Center, Addis Ababa, Ethiopia
| | - Tigist Geremew
- Addis Ababa Burn, Emergency and Trauma Hospital, Addis Ababa, Ethiopia
| | - Abi Beane
- Centre for Inflammation Research, University of Edinburgh, Scotland, UK.
| | - Rashan Haniffa
- Centre for Inflammation Research, University of Edinburgh, Scotland, UK.
| | - Sean M Berenholtz
- Johns Hopkins University School of Medicine, Department of Anesthesia and Critical Care Medicine, Baltimore, MD, USA.
| | - William Checkley
- Johns Hopkins University School of Medicine, Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Baltimore, MD, USA.
| | - Bhakti Hansoti
- Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, MD, USA.
| | - Adam D Laytin
- Johns Hopkins University School of Medicine, Department of Anesthesia and Critical Care Medicine, Baltimore, MD, USA; Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, MD, USA.
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Budin JS, Waters TL, Collins LK, Cole MW, Winter JE, Delvadia BP, Iloanya MC, Sherman WF. Incontinence Is an Independent Risk Factor for Total Hip and Knee Arthroplasty. Arthroplast Today 2024; 27:101355. [PMID: 38516503 PMCID: PMC10951425 DOI: 10.1016/j.artd.2024.101355] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/18/2023] [Accepted: 02/14/2024] [Indexed: 03/23/2024] Open
Abstract
Background Urinary incontinence has been linked to worse postoperative pain, decreased physical function, and reduced quality of life in patients following total joint arthroplasty. The purpose of this study was to analyze whether incontinence is associated with increased postoperative medical and joint complications following primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). Methods A retrospective cohort study was conducted using a national insurance database. Thirty-two thousand eight hundred eleven patients with incontinence who underwent primary THA were identified and matched 1:4 with 129,073 patients without incontinence. Ninety-one thousand nine hundred thirty-five patients with incontinence who underwent primary TKA were matched 1:4 with 367,285 patients without incontinence. Medical and joint complication rates at 90 days and 2 years, respectively, were then compared for patient cohorts using multivariable logistic regressions. Results Patients who underwent primary THA with incontinence had statistically higher rates of dislocation, periprosthetic fracture, aseptic revisions, and overall joint complications compared to controls. Patients who underwent primary TKA with incontinence had higher rates of mechanical failure, aseptic revision, and all-cause revision compared to controls. Conclusions This study demonstrated an association between patients with incontinence and higher rates of dislocation, periprosthetic fractures, aseptic revisions, and overall joint complications following primary THA compared to controls. Patients with incontinence experience higher rates of mechanical failure, aseptic revision, and all-cause revision following TKA compared to controls. As such, perioperative management of urinary incontinence may help mitigate the risk of postoperative complications.
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Affiliation(s)
- Jacob S. Budin
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Timothy L. Waters
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Lacee K. Collins
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Matthew W. Cole
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Julianna E. Winter
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Bela P. Delvadia
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Michael C. Iloanya
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA
| | - William F. Sherman
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA
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Hedström K, Falk-Delgado A, Sackey H. Complications after breast augmentation with dermal fillers containing copolyamide: A systematic review. JPRAS Open 2024; 40:19-31. [PMID: 38389650 PMCID: PMC10879692 DOI: 10.1016/j.jpra.2024.01.009] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/17/2024] [Indexed: 02/24/2024] Open
Abstract
Background Dermal fillers containing copolyamide are used for breast augmentation and are marketed under different labels, such as Aquafilling, Los Deline, Aqualift, and Activegel. In recent years, the number of publications reporting complications after use of these fillers has increased. Methods Through a computerized search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review of published studies on complications, treatment options, and radiological findings related to breast augmentation with dermal fillers containing copolyamide was performed. Publications between January 1, 2007, and January 23, 2023, were included. Retrieved studies were screened for inclusion and quality assessment. The Joanna Briggs checklist for case reports and the Strengthening the Reporting of Observational Studies in Epidemiology checklist for cross-sectional studies were used. Results Sixteen studies met the inclusion criteria: 14 case reports and 2 retrospective cohort studies, including 196 women and 333 complications. Long-term complications (≥30 days after surgery) were described in 15 studies. The most commonly reported complications were nodules in the breast (130 patients), pain (92 patients), inflammation and/or infection (43 patients), breast deformities (35 patients), and migration of the filler to the pectoralis muscle, abdominal wall, thoracic wall, pubic area, back, or upper extremity (27 patients). The median time between injection of the dermal filler and any complication was 18 months, and the majority of patients with complications required surgical intervention. Conclusion Given the reports of severe complications months to years after injection of dermal fillers containing copolyamide and the lack of studies evaluating long-term safety, our interpretation is that dermal fillers containing copolyamide should not be used for breast augmentation.
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Affiliation(s)
- Karin Hedström
- Department of Surgery, South General Hospital, Stockholm, Sweden
| | - Alberto Falk-Delgado
- Department of Plastic and Craniofacial Surgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Helena Sackey
- Department of Breast-, Endocrine Tumors and Sarcoma, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Yamakawa Y, Masada Y, Ugawa R, Komatsubara T, Numoto K, Mastumoto T. A case of emphysematous cystitis caused by mechanical stimulation of pelvic fracture nonunion. Trauma Case Rep 2024; 51:100987. [PMID: 38515437 PMCID: PMC10950685 DOI: 10.1016/j.tcr.2024.100987] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 03/23/2024] Open
Abstract
Emphysematous cystitis is a rare condition that develops due to tissue hyperglycemia and urinary tract infection by gas-producing bacteria. We report a case of emphysematous cystitis caused by mechanical stimulation of a pelvic fracture nonunion. An 80-year-old man was injured in a motorcycle accident and diagnosed with pelvic fracture. Seven days later, he had high fever and computed tomography (CT) revealed gas in the hematoma around the pelvic fracture and the abscess. Therefore, infection following the pelvic fracture was diagnosed. Despite multiple operations and antibiotics treatment, malformation and nonunion of the pelvis occurred. One month after starting weight bearing, emphysema of the bladder wall adjacent to the pubic fracture were found and spread throughout the bladder wall. With stopping of weight bearing, antibiotics treatment and a urinary catheter, emphysema disappeared after 2 months. It was considered that the pubic fracture fragment irritated the bladder wall due to weight bearing and emphysematous cystitis consequently developed.
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Affiliation(s)
- Yasuaki Yamakawa
- Department of Orthopedic Surgery, Kochi Health Sciences Center, Kochi, Japan
| | - Yasutaka Masada
- Department of Orthopedic Surgery, Kochi Health Sciences Center, Kochi, Japan
| | - Ryo Ugawa
- Department of Orthopedic Surgery, Kochi Health Sciences Center, Kochi, Japan
| | - Tadashi Komatsubara
- Department of Orthopedic Surgery, Kochi Health Sciences Center, Kochi, Japan
| | - Kunihiko Numoto
- Department of Orthopedic Surgery, Kochi Health Sciences Center, Kochi, Japan
| | - Toshiyuki Mastumoto
- Department of Orthopedic Surgery, Kochi Health Sciences Center, Kochi, Japan
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Chung MS, Patel N, Abdelmalek G, Coban D, Changoor S, Elali F, Sinha K, Hwang K, Emami A. The 5-factor modified frailty index (mFI-5) predicts adverse outcomes after elective anterior cervical discectomy and fusion (ACDF). N Am Spine Soc J 2024; 18:100318. [PMID: 38618000 PMCID: PMC11015525 DOI: 10.1016/j.xnsj.2024.100318] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 04/16/2024]
Abstract
Background Anterior cervical discectomy and fusion (ACDF) is a reliable procedure commonly performed in older patients with degenerative diseases of the cervical spine. Over 130,000 procedures are performed every year with an annual increase of 5%, and overall morbidity rates can reach as high as 19.3%, indicating a need for surgeons to gauge their patients' risk for adverse outcomes. Frailty is an age-associated decline in functioning of multiple organ systems and has been shown to predict adverse outcomes following various spine procedures. There have been several proposed frailty indices of various factors including the 11-factor modified frailty index (mFI-11), which has been shown to be an effective tool for predicting complications in patients undergoing ACDF. However, there is a paucity of literature assessing the utility of the 5-factor modified frailty index (mFI-5) as a risk stratification tool for patients undergoing ACDF. The purpose of this study was to analyze the predictive capability of the mFI-5 score for 30-day postoperative adverse events following elective ACDF. Methods A retrospective review was performed using the National Surgical Quality Improvement Program (NSQIP) database from 2010 through 2019. Patients older than 50 years of age who underwent elective ACDF were identified using Current Procedural Terminology ([CPT] codes 22554, 22551, 22552, and 63075). Exclusion criteria removed patients under the age of 51, as well as those with fractures, sepsis, disseminated cancer, a prior operation in the last 30 days, ascites, wound infection, or an emergency surgery. Patients were grouped using mFI scores of 1, 2, and 3+. Univariate analysis, using chi-squared and one-way analysis of variance (ANOVA) tests, was conducted to compare demographics, comorbidities, and postoperative complications across the varying cohorts based on mFI-5 scores. Multivariate logistic regression, including patient demographics and preoperative comorbidities as covariates, was performed to evaluate if mFI-5 scores were independent predictors of 30-day postoperative adverse events. Covariates including race, BMI, sex, ASA, and comorbidities were included in regression models. Results The 45,991 patients were identified and allocated in cohorts based on mFI-5 score. Rates for superficial surgical site infection (SSI), organ/deep space SSI, pneumonia, progressive renal insufficiency, acute renal failure (ARF), urinary tract infection (UTI), stroke/cardiovascular accident (CVA), cardiac arrest requiring cardiopulmonary resuscitation (CPR), myocardial infarction, bleeding requiring transfusions, deep vein thrombosis/thrombophlebitis, sepsis, septic shock, readmissions, reoperation, and mortality incrementally increased with mFI-5 scores from 0 to 3+. Multivariate regression analysis revealed that mFI-5 scores 1 to 3+ increased the odds, in a stepwise manner, of total complications, cardiac arrest requiring CPR, pneumonia and mortality. MFI-5 scores of 2 and 3+ were independent predictors of readmission (2: OR=1.5, p<.001; 3+: OR=2.0, p<.001) and myocardial infarction (2: OR=3.4, p=.001; 3+: OR=6.9, p<.001). A score of 3+ increased the odds of ARF (OR=9.7, p=.022), septic shock (OR=3.6, p=.036), UTI (OR=2.1, p=.007), bleeding requiring transfusions (OR=2.1, p=.016), and reoperations (OR=1.7, p=.004). Conclusion mFI-5 score is a quick and viable option for surgeons to use as an assessment tool to stratify high risk patients undergoing elective ACDF, as increasing mFI-5 scores showed significantly higher rates of all adverse outcomes accounted for in this study, except for deep incisional SSI, wound disruption, and PE. Additionally, moderate to severe mFI-5 scores of 2 or 3+ were independent predictors for 30-day postoperative ARF, UTI, MI, bleeding requiring transfusions, septic shock, reoperation, and readmissions following elective ACDF surgery in adults over 50 years old.
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Affiliation(s)
- Matthew S. Chung
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York (SUNY) Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, United States
| | - Neil Patel
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ 07503, United States
| | - George Abdelmalek
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ 07503, United States
| | - Daniel Coban
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ 07503, United States
| | - Stuart Changoor
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ 07503, United States
| | - Faisal Elali
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York (SUNY) Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, United States
| | - Kumar Sinha
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ 07503, United States
| | - Ki Hwang
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ 07503, United States
| | - Arash Emami
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, 703 Main Street, Paterson, NJ 07503, United States
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Thompson DT, Breyfogle EG, Tran CG, Suraju MO, Mishra A, Lanewalla HA, Goffredo P, Hassan I. NSQIP 5-factor modified frailty index and complications after ileal anal pouch anastomosis for ulcerative colitis. Surg Open Sci 2024; 19:95-100. [PMID: 38601734 PMCID: PMC11004715 DOI: 10.1016/j.sopen.2024.03.011] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 03/04/2024] [Accepted: 03/25/2024] [Indexed: 04/12/2024] Open
Abstract
Background Frailty has been associated with worse postoperative outcomes. The 5-factor modified frailty index (mFI-5) is an objective measure although its validity in measuring frailty in patients undergoing ileal pouch-anal anastomosis (IPAA) for chronic ulcerative colitis (CUC) has not been reported. Methods This study used the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) targeted proctectomy database. The mFI-5 was calculated by five preoperative diagnoses: insulin-dependent or noninsulin-dependent diabetes, congestive heart failure, hypertension, chronic obstructive pulmonary disease, and dependent or partially dependent functional status. The impact of mFI-5 on minor and major postoperative morbidity in CUC patients undergoing IPAA was analyzed. Results The cohort included 1454 patients (median age 38 years, median body mass index [BMI] 26 kg/m2) of which 87 % had a mFI-5 = 0, 11 % had a mFI-5 = 1, and 2.5 % a mFI-5 ≥ 2. In multivariable logistic regression, mFI-5 ≥ 2 was significantly associated with minor complications (OR = 2.29, 95 % CI [1.00-5.22], p = 0.049), but not with major complications (p = 0.860). Conclusion IPAA for CUC is associated with high postoperative morbidity, however, the mFI-5 alone has limited utility in determining which patients are at a higher risk of complications due to frailty. These observations suggest there is a need for more relevant instruments to measure frailty in this patient cohort.
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Affiliation(s)
- Dakota T. Thompson
- Department of Surgery, University of Iowa Hospitals & Clinics, 200 Hawkins Drive, Iowa City, IA 52241, United States of America
| | - Ethan G. Breyfogle
- Department of Surgery, University of Iowa Hospitals & Clinics, 200 Hawkins Drive, Iowa City, IA 52241, United States of America
| | - Catherine G. Tran
- Department of Surgery, University of Iowa Hospitals & Clinics, 200 Hawkins Drive, Iowa City, IA 52241, United States of America
| | - Mohammed O. Suraju
- Department of Surgery, University of Iowa Hospitals & Clinics, 200 Hawkins Drive, Iowa City, IA 52241, United States of America
| | - Aditi Mishra
- Department of Surgery, University of Iowa Hospitals & Clinics, 200 Hawkins Drive, Iowa City, IA 52241, United States of America
| | | | - Paolo Goffredo
- Division of Colon & Rectal Surgery, University of Minnesota, Minneapolis, MN, United States of America
| | - Imran Hassan
- Department of Surgery, University of Iowa Hospitals & Clinics, 200 Hawkins Drive, Iowa City, IA 52241, United States of America
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10
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Walawender L, Santhanam N, Davies B, Fei YF, McLeod D, Becknell B. Müllerian anomalies in girls with congenital solitary kidney. Pediatr Nephrol 2024; 39:1783-1789. [PMID: 38197956 PMCID: PMC11026257 DOI: 10.1007/s00467-023-06266-5] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND The prevalence of Müllerian anomalies (MA) among patients with congenital solitary functioning kidney (SFK) is not well defined. A delay in diagnosis of obstructive MA can increase the risk of poor clinical outcomes. This study describes the prevalence of MA in patients with congenital SFK. METHODS A retrospective review was performed of patients within the Nationwide Children's Hospital system with ICD9 or ICD10 diagnostic codes for congenital SFK defined as either unilateral renal agenesis (URA) or multicystic dysplastic kidney (MCDK) and confirmed by chart review. Patients with complex urogenital pathology were excluded. Renal anomaly, MA, reason for and type of pelvic evaluation, and age of diagnosis of anomalies were evaluated. RESULTS Congenital SFK occurred in 431 girls due to URA (209) or MCDK (222). Pelvic evaluation, most commonly by ultrasound for evaluation of abdominal pain or dysmenorrhea, occurred in 115 patients leading to MA diagnosis in 60 instances. Among 221 patients ages 10 years and older, 104 underwent pelvic evaluation and 52 were diagnosed with an MA of which 20 were obstructive. Isolated uterine or combined uterine and vaginal anomalies were the most common MA. MA were five-fold more common in patients with URA compared to MCDK. In 75% of patients, the SFK was diagnosed prior to the MA. CONCLUSIONS The prevalence of MA in patients with congenital SFK was 24% among those age 10 years or older, and 38% were obstructive. This justifies routine screening pelvic ultrasound in girls with congenital SFK to improve early diagnosis.
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Affiliation(s)
- Laura Walawender
- Kidney and Urinary Tract Center, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- Division of Nephrology and Hypertension, Nationwide Children's Hospital, Columbus, OH, USA
| | - Natasha Santhanam
- Kidney and Urinary Tract Center, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Benjamin Davies
- Kidney and Urinary Tract Center, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Y Frances Fei
- Section of Pediatric and Adolescent Gynecology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
| | - Daryl McLeod
- Kidney and Urinary Tract Center, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
- Department of Urology, Nationwide Children's Hospital, Columbus, OH, USA.
| | - Brian Becknell
- Kidney and Urinary Tract Center, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
- Division of Nephrology and Hypertension, Nationwide Children's Hospital, Columbus, OH, USA.
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11
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Bardón-Cancho EJ, Marco-Sánchez JM, Benéitez-Pastor D, Payán-Pernía S, Llobet AR, Berrueco R, García-Morin M, Beléndez C, Senent L, Acosta MJO, Pleguezuelos IP, Velasco P, Collado A, Moreno-Servet M, Argilés B, de Soto IP, Del Mar Bermúdez M, Salido Fiérrez EJ, Blanco-Álvarez A, Navarro PG, Cela E. Spanish registry of hemoglobinopathies and rare anemias (REHem-AR): demographics, complications, and management of patients with β-thalassemia. Ann Hematol 2024; 103:1525-1539. [PMID: 38519604 PMCID: PMC11009731 DOI: 10.1007/s00277-024-05694-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 03/01/2024] [Indexed: 03/25/2024]
Abstract
INTRODUCTION The increase in the number of patients with hemoglobinopathies in Europe in recent decades highlights the need for more detailed epidemiological information in Spain. To fulfil this need, the Spanish Society of Pediatric Hematology and Oncology (SEHOP) sponsored the creation of a national registry of hemoglobinopathies known as REHem-AR (Spanish Registry of Hemoglobinopathies and Rare Anemias). Data from the transfusion-dependent (TDT) and non-transfusion-dependent (NTDT) β-thalassemia cohorts are described and analyzed. METHODS We performed an observational, multicenter, and ambispective study, which included patients of any age with TDT and NTDT, registered up to December 31, 2021. RESULTS Among the 1741 patients included, 168 cases of thalassemia were identified (103 TDT and 65 NTDT-patients). Survival at 18 years was 93% for TDT and 100% for NTDT. Regarding management, 80 patients with TDT (77.7%) and 23 patients with NTDT (35.4%) started chelation treatment during follow-up, with deferasirox being the most widely used. A total of 76 patients within the TDT cohort presented at least 1 complication (73.8%), the most frequent being hemosiderosis and osteopenia-osteoporosis. Comparison of both cohorts revealed significant differences in the diagnosis of hepatic hemosiderosis (p = 0.00024), although these were not observed in the case of cardiac iron overload (p = 0.27). DISCUSSION Our registry enabled us to describe the management of β thalassemia in Spain and to analyze the morbidity and mortality of the cohorts of patients with TDT and NTDT. Complications related to iron overload in TDT and NTDT account for most of the morbidity and mortality of the disease, which is associated with a considerable social, psychological, and economic impact, although cardiac, osteopathy and endocrinological complications requiring more attention. The convenience and simplicity of online registries make it possible to homogenize variables and periodically update data, thus providing valuable information on these diseases.
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Affiliation(s)
- Eduardo J Bardón-Cancho
- Data Manager de Grupo de trabajo de Eritropatología de la Sociedad Española de Hematología y Oncología Pediátricas (SEHOP), Hospital General Universitario Gregorio Marañón, Calle O'Donnell, 48, Madrid, España
- Sección de Hematología y Oncología Pediátricas. Servicio de Pediatría. Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón. CSUR Eritropatología. ERN-EuroBloodNet. CIBERER, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - José Manuel Marco-Sánchez
- Data Manager de Grupo de trabajo de Eritropatología de la Sociedad Española de Hematología y Oncología Pediátricas (SEHOP), Hospital General Universitario Gregorio Marañón, Calle O'Donnell, 48, Madrid, España
- Sección de Hematología y Oncología Pediátricas. Servicio de Pediatría. Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón. CSUR Eritropatología. ERN-EuroBloodNet. CIBERER, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - David Benéitez-Pastor
- Grupo de Investigación Translacional en Anemias Minoritarias, Unidad de Eritropatología. Servicio de Hematología Clínica. Hospital Universitario Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR) y Vall d'Hebron Institut d'Oncologia (VHIO), ERN-EuroBloodNet. CIBERER, Universitat Autònoma de Barcelona. Grupo de Eritropatología SEHH, Grupo Clínico Vinculado GCV21/ER/1, Barcelona, España
| | - Salvador Payán-Pernía
- Servicio de Hematología. Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)-Consejo Superior de Investigaciones Científicas (CSIC), Universidad de Sevilla, Sevilla, España
| | - Anna Ruiz Llobet
- Servicio de Hematología Pediátrica. Hospital Sant Joan de Déu Barcelona, Institut de Recerca Pediàtrica Hospital San Joan de Déu de Barcelona (IRP-HSJD), Universitat de Barcelona, Esplugues de Llobregat, Barcelona, España
| | - Rubén Berrueco
- Servicio de Hematología Pediátrica. Hospital Sant Joan de Déu Barcelona, Institut de Recerca Pediàtrica Hospital San Joan de Déu de Barcelona (IRP-HSJD), Universitat de Barcelona, Esplugues de Llobregat, Barcelona, España
| | - Marina García-Morin
- Sección de Hematología y Oncología Pediátricas. Servicio de Pediatría. Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón. CSUR Eritropatología. ERN-EuroBloodNet. CIBERER, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España.
| | - Cristina Beléndez
- Sección de Hematología y Oncología Pediátricas. Servicio de Pediatría. Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón. CSUR Eritropatología. ERN-EuroBloodNet. CIBERER, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - Leonor Senent
- Servicio de Hematología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | | | | | - Pablo Velasco
- Servicio de Hematología Infantil, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Anna Collado
- Servicio de Hematología Infantil, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Marta Moreno-Servet
- Servicio de Hematología. Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón. CSUR Eritropatología. ERN-EuroBloodNet, Universidad Complutense de Madrid, Madrid, España
| | - Bienvenida Argilés
- Servicio de Hematología Infantil, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Inmaculada Pérez de Soto
- Servicio de Hematología. Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)-Consejo Superior de Investigaciones Científicas (CSIC), Universidad de Sevilla, Sevilla, España
| | | | | | - Adoración Blanco-Álvarez
- Unitat de Genètica Molecular Hematològica. Servei d'Hematologia, Hospital Universitari Vall d'Hebron, Murcia, España
| | - Pablo González Navarro
- Bioestadístico. Unidad de Investigación Materno Infantil. Fundación Familia Alonso (UDIMIFFA). Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio, Madrid, España
| | - Elena Cela
- Sección de Hematología y Oncología Pediátricas. Servicio de Pediatría. Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón. CSUR Eritropatología. ERN-EuroBloodNet. CIBERER, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
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Ye G, Xu X, Xue Z, Li Z, Liu X. Reducing the risk of tooth injury in anterior maxillary interdental osteotomy for cleft lip and palate patients using a surgical navigation technique. Int J Oral Maxillofac Surg 2024; 53:368-375. [PMID: 37805371 DOI: 10.1016/j.ijom.2023.09.009] [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] [Received: 07/30/2022] [Revised: 09/07/2023] [Accepted: 09/25/2023] [Indexed: 10/09/2023]
Abstract
The aim of this study was to investigate the clinical feasibility of preventing tooth injury from anterior maxillary interdental osteotomy by using a surgical navigation technique. A retrospective review was conducted on cleft lip and palate patients treated with anterior maxillary osteotomy followed by distraction osteogenesis between August 2019 and May 2022. Patients operated on through image guidance were enrolled in the navigation group, while those who were operated on freehand were enrolled in the freehand group. Tooth injuries were identified on postoperative images. Linear and angular deviations of the osteotomy line were measured. Twelve patients were enrolled in the study, seven in the navigation group and five in the freehand group. Altogether, 24 osteotomy lines and 53 adjacent teeth were evaluated. The dental injury rate was 3% in the navigation group and 27% in the freehand group (P = 0.016). The average linear deviations (mean ± standard deviation) were 0.67 ± 0.30 mm and 2.05 ± 1.33 mm, respectively (P < 0.001), while the average angular deviations were 1.67 ± 0.68° and 11.41 ± 7.46°, respectively (P < 0.001). The results suggest that navigation was able to reduce the tooth injury risk compared with freehand interdental osteotomies in crowded dental arches.
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Affiliation(s)
- G Ye
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - X Xu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Z Xue
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Z Li
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - X Liu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.
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13
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Kuhar HN, Nesemeier R, Kim LR. Prevention and Management of Complications in Nasal Reconstruction. Facial Plast Surg Clin North Am 2024; 32:303-313. [PMID: 38575288 DOI: 10.1016/j.fsc.2024.01.009] [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: 04/06/2024]
Abstract
Nasal reconstruction is a challenging practice with the potential for complications. Surgeons can prevent complications through preoperative optimization of patient factors, refinement of intraoperative surgical techniques, and postoperative surgical and nonsurgical wound care. Preoperatively, optimization of modifiable and recognition of nonmodifiable risk factors is paramount. Intraoperatively, meticulous flap design and surgical technique promote healing. In the postoperative setting, attentive wound care, adjuvant therapies, and close follow-up for consideration of additional procedures enhance outcomes. By anticipating potential complications across perioperative settings, surgeons can prevent common complications in nasal reconstruction and more effectively manage those complications that arise.
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Affiliation(s)
- Hannah N Kuhar
- Department of Otolaryngology-Head and Neck Surgery, Ohio State University Wexner Medical Center, Ohio State Eye and Ear Institute, 915 Olentangy River Road, Suite 4000, Columbus, OH 43212, USA
| | - Ryan Nesemeier
- Department of Otolaryngology-Head and Neck Surgery, Ohio State University Wexner Medical Center, Ohio State Eye and Ear Institute, 915 Olentangy River Road, Suite 4000, Columbus, OH 43212, USA
| | - Leslie R Kim
- Department of Otolaryngology-Head and Neck Surgery, Ohio State University Wexner Medical Center, Ohio State Eye and Ear Institute, 915 Olentangy River Road, Suite 4000, Columbus, OH 43212, USA.
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14
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Myers JB, Kurtzman JT. Bladder-Related Quality of Life After Spinal Cord Injury: Findings from the Neurogenic Bladder Research Group Spinal Cord Injury Registry. Urol Clin North Am 2024; 51:163-176. [PMID: 38609189 DOI: 10.1016/j.ucl.2024.02.004] [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: 04/14/2024]
Abstract
The Neurogenic Bladder Research Group (NBRG) was formed with the mission to optimize quality of life (QoL), surgical outcomes, and clinical care of patients with neurogenic lower urinary tract dysfunction. One of the original priorities of the organization was to support creation of the NBRG Spinal Cord Injury (SCI) Registry. The aim of this Registry was to establish a prospective database, in order to study bladder-related QoL after SCI. The study enrolled close to 1500 participants from across North America over an 18 month time-period (January 2016-July 2017).
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Affiliation(s)
- Jeremy B Myers
- Division of Urology, Department of Surgery, University of Utah, 50 N Medical Drive, Salt Lake City, UT, 84103, USA.
| | - Jane T Kurtzman
- Division of Urology, Department of Surgery, University of Utah, 50 N Medical Drive, Salt Lake City, UT, 84103, USA
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15
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Michelson KA, Bucher BT, Neuman MI. Cost and Late Hospital Care of Publicly Insured Children After Appendectomy. J Surg Res 2024; 297:41-46. [PMID: 38430861 PMCID: PMC11023751 DOI: 10.1016/j.jss.2024.02.003] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 01/03/2024] [Accepted: 02/05/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Immediate complications of appendicitis are common, but the prevalence of long-term complications is uncertain. METHODS We studied all publicly-insured children in the US with uncomplicated or complicated appendicitis in 2018-2019 using administrative claims. The main outcome was late hospital care defined as hospitalization or abdominal procedure within 180 d of an appendicitis discharge, excluding interval appendectomies. Time to late hospital care was evaluated using Cox regression. We evaluated health-care expenditures arising from appendicitis episodes. RESULTS Among 95,942 children with appendicitis, 5727 (6.0%) had late hospital care, with 5062 requiring rehospitalization and 2012 (2.1%) surgery. The median time to late hospital care was 10 d (interquartile range 4-33). Age under 5 y (compared with >14 y, hazard ratio [HR] 1.88, 95% confidence interval [CI] 1.70-2.08), complex chronic conditions (HR 2.35, 95% CI 2.13-2.59), and complicated appendicitis (HR 2.81, 95% CI 2.67, 2.96) were each associated with time to late hospital care. Expenditures over 180 d were a median $6553 and $19,589 respectively in those requiring no late hospital care versus those requiring it (P < 0.001). CONCLUSIONS Late hospital care is uncommon in pediatric appendicitis but is costly. Prevention efforts should be targeted to the youngest, most complex children, and those with complicated appendicitis at presentation.
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Affiliation(s)
- Kenneth A Michelson
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts.
| | - Brian T Bucher
- Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Mark I Neuman
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
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16
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Clement E, Lin W, Shojaei D, Au-Yeung P, Motamedi A, Phang PT. Modified 2-stage IPAA has similar postoperative complication rates and functional outcomes compared to 3-stage IPAA. Am J Surg 2024; 231:96-99. [PMID: 38423807 DOI: 10.1016/j.amjsurg.2024.02.032] [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] [Received: 11/13/2023] [Revised: 01/22/2024] [Accepted: 02/19/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Reconstructive ileal-pouch anal anastomosis (IPAA) for ulcerative colitis (UC) is often created in 3-stages: colectomy + ileostomy, proctectomy + pouch creation with diverting loop ileostomy, then subsequent ileostomy closure. Modified 2-stage IPAA is without pouch diversion, thus avoiding a third operation. This study compares perioperative complications, quality of life (QOL) and functional outcomes of 3- versus modified 2-stage IPAA. METHODS Charts were reviewed for adult UC patients undergoing IPAA between 2010 and 2020. QOL and function were assessed with EQ-5D-3L Quality of Life and Pouch Functional Score questionnaires. RESULTS 152 patients were identified. 43 modified 2-stage and 109 3-stage IPAA were similar for anastomotic leak (9.3% vs. 1.8%, p = 0.06), SSI (34.9% vs. 29.7%, p = 0.51) and ileus (32.6% vs. 33%, p = 0.96). Modified 2-stage had less bowel obstruction than 3-stage IPAA (7.0% vs. 30.1%, p = 0.006). 92 patients returned questionnaires with similar QOL and pouch function. CONCLUSIONS Perioperative complications, QOL and function are similar for 3-stage IPAA and modified 2-stage IPAA. Modified 2-stage IPAA in select patients is safe and has less postoperative bowel obstruction than 3-stage IPAA.
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Affiliation(s)
- E Clement
- University of British Columbia, Canada.
| | - W Lin
- University of British Columbia, Canada
| | - D Shojaei
- University of British Columbia, Canada
| | | | | | - P T Phang
- University of British Columbia, Canada
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Sadeghpour A, Mahdipour S, Ghanjpour Sales J, Aslani H, Moharrami MR, Alizadeh H. Non-cannulated versus cannulated cancellous screws for the internal fixation of femoral neck fractures in osteoporotic patients: A single-blind randomized clinical trial. J Orthop 2024; 51:32-38. [PMID: 38299065 PMCID: PMC10825919 DOI: 10.1016/j.jor.2023.11.074] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/26/2023] [Accepted: 11/28/2023] [Indexed: 02/02/2024] Open
Abstract
Background The incidence of femoral neck fractures in osteoporotic patients is rising worldwide and is associated with significant increases in healthcare and social costs, as well as dependency. Improving minimally invasive treatment strategies, including internal fixation with screws, can result in favorable clinical outcomes and lesser incidence of complications, while preserving the hip. This study compared the outcomes of using non-cannulated cancellous screws (NCS) and cannulated cancellous screws (CS) in the internal fixation of undisplaced intracapsular femoral neck fractures (UIFNF) of osteoporotic patients of Iranian descent. Methods This randomized clinical trial was conducted on the patients referring to an institutional tertiary hospital in northwestern Iran between March 2020 and June 2021. The patients' preoperative, perioperative, and postoperative characteristics were evaluated for at least two years. Primary endpoints were defined as the incidence of hip-related complications, while secondary endpoints were assessed based on the patients' hip function using Harris Hip Score (HHS). Results Fifty-seven patients with osteoporosis and UIFNF were included in the final analysis, with 27 patients in the NCS group and 30 patients in the CS group. The surgical duration, the amount of intraoperative blood loss, and the frequency of C-arm were considerably lower in the CS group (p < 0.05). The incidence of implant failure was higher in the NCS group (p = 0.04). Screw migration occurred more frequently in the CS group (p = 0.03). The HHS values were significantly higher for the NCS group than those of the CS group at both the 1-year and 2-years of follow-up assessments (1 year, p = 0.007; 2 years, p = 0.001). Conclusion Fixation using CS was accompanied by enhanced perioperative outcomes and lower implant failure rates compared to the NCS group. However, patients in the NCS group posed a reduced risk of complications, including screw migration, and experienced a long-term improvement in HHS scores.
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Affiliation(s)
- Alireza Sadeghpour
- Department of Orthopedic Surgery, Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shahab Mahdipour
- Department of Orthopedic Surgery, Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Jafar Ghanjpour Sales
- Department of Orthopedic Surgery, Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Aslani
- Department of Orthopedic Surgery, Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Reza Moharrami
- Department of Orthopedic Surgery, Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hadi Alizadeh
- Department of Orthopedic Surgery, Shohada Educational Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Zhu W, Wu L, Xie W, Zhang G, Gu Y, Hou Y, He Y. Comparison of morbidity and mortality after radical cystectomy between individuals older and younger than 80 years: a systematic review and meta-analysis. Int Urol Nephrol 2024; 56:1525-1535. [PMID: 38095810 DOI: 10.1007/s11255-023-03897-3] [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] [Received: 09/22/2023] [Accepted: 11/23/2023] [Indexed: 04/09/2024]
Abstract
OBJECTIVE To compare outcomes related to survival and post-operative complications in individuals older and younger than 80 years with bladder cancer undergoing radical cystectomy (RC). METHODS We conducted a systematic search using three large databases: PubMed, EMBASE, and Scopus. We included observational studies comparing outcomes between individuals older than 80 years and younger patients undergoing RC. The outcomes of interest included overall survival, disease-specific survival, progression-free survival, and risk of post-operative complications. We applied a random effects model for the analysis and reported pooled effect sizes as odds ratios (ORs) or hazards ratios (HRs) along with 95% confidence intervals. RESULTS We analyzed 21 studies. Our results show that individuals older than 80 years had higher risks of mortality at 30 days (OR 2.82; 95% CI 1.97, 4.04), 90 days (OR 3.34; 95% CI 2.61, 4.27), 12 months (HR 3.03; 95% CI 2.64, 3.49), and 24 months (HR 3.54; 95% CI 2.27, 5.50) of the post-operative follow-up than younger individuals. In addition, individuals older than 80 years also had poor 5-year survivals (HR 2.17; 95% CI 1.64, 2.88), an increased risk of 5-year cancer-specific mortality (HR 1.58; 95% CI 1.24, 2.03), poor 5-year recurrence free survivals (HR 1.49; 95% CI 1.07, 2.08), and high complications risks (OR 1.20; 95% CI 1.02, 1.42) when compared to younger patients. CONCLUSION Individuals older than 80 years undergoing RC are likely to have poor survival-related outcomes and increased complications risks. Pre-planned comprehensive geriatric assessments (CGAs) may be needed to offer better peri- and post-operative care to improve the outcomes in this patient population.
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Affiliation(s)
- Wei Zhu
- Department of Urology, The First Hospital of Jiaxing andThe Affiliated Hospital of Jiaxing University, 1882 Zhonghuan South Road, Jiaxing City, 314000, Zhejiang Province, China
| | - Lingfeng Wu
- Department of Urology, The First Hospital of Jiaxing andThe Affiliated Hospital of Jiaxing University, 1882 Zhonghuan South Road, Jiaxing City, 314000, Zhejiang Province, China
| | - Wenhua Xie
- Department of Urology, The First Hospital of Jiaxing andThe Affiliated Hospital of Jiaxing University, 1882 Zhonghuan South Road, Jiaxing City, 314000, Zhejiang Province, China
| | - Gaoyue Zhang
- Department of Urology, The First Hospital of Jiaxing andThe Affiliated Hospital of Jiaxing University, 1882 Zhonghuan South Road, Jiaxing City, 314000, Zhejiang Province, China
| | - Yanqin Gu
- Department of Urology, The First Hospital of Jiaxing andThe Affiliated Hospital of Jiaxing University, 1882 Zhonghuan South Road, Jiaxing City, 314000, Zhejiang Province, China
| | - Yansong Hou
- Department of Urology, The First Hospital of Jiaxing andThe Affiliated Hospital of Jiaxing University, 1882 Zhonghuan South Road, Jiaxing City, 314000, Zhejiang Province, China
| | - Yi He
- Department of Urology, The First Hospital of Jiaxing andThe Affiliated Hospital of Jiaxing University, 1882 Zhonghuan South Road, Jiaxing City, 314000, Zhejiang Province, China.
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He Q, Huang Q, Hou B, Hao Z. Prediction of percutaneous nephrolithotomy outcomes and flexible ureteroscopy outcomes using nephrolithometry scoring systems. Int Urol Nephrol 2024; 56:1585-1593. [PMID: 38103147 DOI: 10.1007/s11255-023-03847-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 10/05/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Kidney stones account for a high proportion of urological emergencies. The main objective of this paper is to evaluate the predictive ability of five scoring systems for overall stone-free status and postoperative complications after percutaneous nephrolithotomy and retrograde ureteroscopy. MATERIALS AND METHODS This study retrospectively analysed 312 cases of kidney stone patients between January 2021 and May 2022 at our centre. Multivariate logistic regression as well as ROC curves were applied to determine the ability to evaluate each scale to predict stone-free rates and postoperative complications. RESULTS 179 patients have undergone PCNL. After multivariate logistic regression, the S.T.O.N.E score and history of ipsilateral renal surgery were predictive of stone-free status, and the predictive power of the S.T.O.N.E score was higher than that of history of ipsilateral renal surgery. Grade 1 complications were considered to be related to Guy's score and grade 2 complications were considered to be related to history of diabetes mellitus. 133 patients have undergone f-URS. After multivariate logistic regression analysis, the modified S-ReSC score, RUSS score, and R.I.R.S score were predictive of stone-free status, with the R.I.R.S score being the strongest predictor. Evidence of grade 2 complications was considered to be related to abnormal renal function. CONCLUSION For PCNL, the S.T.O.N.E score had the best efficacy in predicting stone-free status, and the Guy's score had the best efficacy in predicting postoperative complications; for f-URS, the R.I.R.S score had the best efficacy in predicting stone-free status, and no scoring system predicted postoperative complications.
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Affiliation(s)
- Qiushi He
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Urology, Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Qingfeng Huang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Urology, Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Bingbing Hou
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Urology, Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Zongyao Hao
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
- Institute of Urology, Anhui Medical University, Hefei, China.
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China.
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20
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Chen C, Zhang J, Cao R, Hua K, Zha Y, Gong M, Jiang X. Clinical outcomes of olecranon sled fixation in patients with Mayo type II olecranon fractures. Heliyon 2024; 10:e29184. [PMID: 38628716 PMCID: PMC11019171 DOI: 10.1016/j.heliyon.2024.e29184] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/19/2024] Open
Abstract
Background Tension band wiring and plate fixation are common internal fixation methods used for olecranon fractures, but complications and reoperations are common. The purpose of this study is to investigate the clinical outcomes of displaced olecranon fractures treated with olecranon sled internal fixation. Methods The data of 39 patients with olecranon fractures treated with olecranon sled in the Department of Traumatology of Beijing Jishuitan Hospital between May 2018 and April 2020 were retrospectively analyzed. There were 17 males and 22 females; the mean age was 44.0 ± 15.8 (range, 18-68 years). Preoperative olecranon fractures were classified according to the Mayo classification: 24 cases were type IIA and 15 cases were type IIB. Elbow range of motion (extension and flexion) and forearm rotation (protonation and supination) were observed at the last follow-up. The Mayo elbow performance score (MEPS), Disabilities of the arm, shoulder and hand (DASH) and visual analogue scale (VAS) scores were used to evaluate elbow function and pain, and complications were also recorded. Results Thirty-nine patients were followed up for 33.6 ± 8.3 months (range, 25-51 months) after the operation. At the last follow-up, the mean flexion-extension arc was 137° ± 15° (range, 60°-160°), and the mean pronation-supination arc was 178° ± 4° (range, 160°-180°). The mean MEPS was 94.9 ± 9.9 (range, 50.0-100.0). The mean DASH score was 5.4 ± 4.3 (range, 0-18.3). The mean VAS score was 0.4 ± 0.8 (range, 0-3). Seven patients developed olecranon skin irritation, and 3 of them had the internal fixation device removed. Two patients developed heterotopic ossification, of whom 1 patient suffered elbow stiffness. Conclusion Olecranon sled internal fixation has good clinical outcomes in the treatment of Mayo type II olecranon fractures with a low rate of reoperations.
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Affiliation(s)
- Chen Chen
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- Peking University Fourth School of Clinical Medicine, Beijing, China
- National Center of Orthopaedics, Beijing, China
| | - Jianyu Zhang
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- Peking University Fourth School of Clinical Medicine, Beijing, China
- National Center of Orthopaedics, Beijing, China
| | - Renwei Cao
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- Peking University Fourth School of Clinical Medicine, Beijing, China
- National Center of Orthopaedics, Beijing, China
| | - Kehan Hua
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- Peking University Fourth School of Clinical Medicine, Beijing, China
- National Center of Orthopaedics, Beijing, China
| | - Yejun Zha
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- Peking University Fourth School of Clinical Medicine, Beijing, China
- National Center of Orthopaedics, Beijing, China
| | - Maoqi Gong
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- Peking University Fourth School of Clinical Medicine, Beijing, China
- National Center of Orthopaedics, Beijing, China
| | - Xieyuan Jiang
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- Peking University Fourth School of Clinical Medicine, Beijing, China
- National Center of Orthopaedics, Beijing, China
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21
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Zhou Y, Chen ZQ. Research on the prognostic value of adjusting intraperitoneal three-dimensional quality evaluation mode in laparoscopic cholecystectomy patients. World J Gastrointest Surg 2024; 16:1078-1086. [DOI: 10.4240/wjgs.v16.i4.1078] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/30/2024] [Accepted: 03/15/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND Benign gallbladder diseases have become a high-prevalence condition not only in China but also worldwide. The main types of benign gallbladder diseases include gallbladder polyps, acute and chronic cholecystitis, and gallstones, with gallstones being the most common, accounting for over 70% of cases. Although the mortality rate of benign gallbladder diseases is low, they carry obvious potential risks. Studies have shown that an increased incidence of benign gallbladder diseases can increase the risk of cardiovascular diseases and gallbladder cancer, resulting in a substantial disease burden on patients and their families.
AIM To assess the medical utility of the Configuration-Procedure-Consequence (CPC) three-dimensional quality evaluation model in modulating the prognosis of laparoscopic cholecystectomy patients.
METHODS A total of 98 patients who underwent laparoscopic cholecystectomy in our hospital from February 2020 to January 2022 were selected as the subjects. According to the random number table method, they were divided into a study group and a control group, with 49 patients in each group. The control group received routine perioperative care, while the study group had the addition of the CPC three-dimensional quality evaluation. The postoperative recovery-related indicators (time to first flatus, time to oral intake, time to ambulation, hospital stay), stress indicators (cortisol and adrenaline levels), distinctions in anxiety and depression status, and the incidence of perioperative complications were compared.
RESULTS The time to first flatus, time to oral intake, time to ambulation, and hospital stay of the study group patients were obviously lower than those of the control group patients, with statistical significance (P < 0.05). On the 1st day after admission, there were no obvious distinctions in cortisol and adrenaline levels in blood samples, as well as in the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) scores between the study group and the control group (P > 0.05). However, on the 3rd day after surgery, the cortisol and adrenaline levels, as well as SAS and SDS scores of the study group patients, were obviously lower than those of the control group patients (P < 0.05). The study group had 2 cases of incisional infection and 1 case of pulmonary infection, with a total incidence of complications of 6.12% (3/49), which was obviously lower than the 20.41% (10/49) in the control group (P < 0.05).
CONCLUSION Implementing the CPC three-dimensional quality evaluation model for patients undergoing laparoscopic cholecystectomy can help accelerate their perioperative recovery process, alleviate perioperative stress symptoms, mitigate anxiety, depression, and other adverse emotions, and to some extent, reduce the incidence of perioperative complications.
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Affiliation(s)
- Yuan Zhou
- Operating Room, Lianyungang Hospital of Traditional Chinese Medicine, Lianyungang 222000, Jiangsu Province, China
| | - Zhan-Qing Chen
- Operating Room, The Second People's Hospital of Lianyungang Affiliated to Kangda College of Nanjing Medical University, Lianyungang 222000, Jiangsu Province, China
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22
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Chau E, Mew A, Bera K, Jiang S, Ramaiya N, Gilkeson R. Emergency department imaging utilization post-transcatheter aortic valve replacement: single institution 7-year experience. Emerg Radiol 2024:10.1007/s10140-024-02228-y. [PMID: 38649665 DOI: 10.1007/s10140-024-02228-y] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 04/04/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE This study aims to highlight presentations, acute findings and imaging phenotypes of patients presenting to the emergency department (ED) within 30 days of a transcatheter aortic valve replacement (TAVR). METHODS A retrospective review of patients diagnosed with aortic valve disease who underwent a TAVR between Jan 2015 and Nov 2021 at a large academic medical center was completed. From an initial 1271 patients, 146 were included based on their presentation to the ED within 30 days post-TAVR procedure. Patient data, including ED presentation details and imaging results, were recorded and de-identified. RESULTS Of the 146 post-TAVR patients, there were 168 ED visits within 30 days. The median time to ED after TAVR was 12 days. Respiratory symptoms were the most common complaint (27%). Neurological (23%) and cardiovascular symptoms (18%) followed. Cross-sectional imaging was conducted 250 times across visits, with an average of 1.7 scans per patient. CTs were most frequently used, followed by ultrasounds, especially echocardiograms and duplex extremity vasculature ultrasounds. 30.1% of patients had acute findings from imaging. Specific findings included heart failure (5.5%), access site complications (5.5%), pneumonia (5.5%), intracranial pathologies (3.4% for strokes and 0.7% for hematoma), and pleural effusion (3.4%). Echocardiograms and CTA chest were most associated with significant acute findings. CONCLUSION Our study highlights the vital role of early and accurate imaging in post-TAVR patients within 30 days post-procedure. As transcatheter approaches rise in popularity, emergency radiologists become instrumental in diagnosing common post-procedural presentations. Continued research is essential to devise post-discharge strategies to curtail readmissions and related costs. Proper imaging ensures prompt, effective care, enhancing overall patient outcomes.
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Affiliation(s)
- Eva Chau
- University of Pittsburgh School of Medicine, Pittsburgh, OH, USA
| | - Andy Mew
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Kaustav Bera
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
| | - Sirui Jiang
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Nikhil Ramaiya
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Robert Gilkeson
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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23
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Rooijakkers MJP, Versteeg GAA, Hemelrijk KI, Aarts HM, Overduin DC, van Ginkel DJ, Vlaar PJ, van Wely MH, van Nunen LX, van Geuns RJ, van Garsse LAFM, Geuzebroek GSC, Verkroost MWA, Rodwell L, Heijmen RH, Tonino PAL, Ten Berg JM, Delewi R, van Royen N. Upper extremity versus lower extremity for secondary access during transcatheter aortic valve implantation: rationale and design of the randomised TAVI XS trial. Neth Heart J 2024:10.1007/s12471-024-01869-5. [PMID: 38653922 DOI: 10.1007/s12471-024-01869-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND During transcatheter aortic valve implantation (TAVI), secondary access is required for angiographic guidance and temporary pacing. The most commonly used secondary access sites are the femoral artery (angiographic guidance) and the femoral vein (temporary pacing). An upper extremity approach using the radial artery and an upper arm vein instead of the lower extremity approach using the femoral artery and femoral vein may reduce clinically relevant secondary access site-related bleeding complications, but robust evidence is lacking. TRIAL DESIGN The TAVI XS trial is a multicentre, randomised, open-label clinical trial with blinded evaluation of endpoints. A total of 238 patients undergoing transfemoral TAVI will be included. The primary endpoint is the incidence of clinically relevant bleeding (i.e. Bleeding Academic Research Consortium (BARC) type 2, 3 or 5 bleeding) of the randomised secondary access site (either diagnostic or pacemaker access, or both) within 30 days after TAVI. Secondary endpoints include time to mobilisation after TAVI, duration of hospitalisation, any BARC type 2, 3 or 5 bleeding, and early safety at 30 days according to Valve Academic Research Consortium‑3 criteria. CONCLUSION The TAVI XS trial is the first randomised trial comparing an upper extremity approach to a lower extremity approach with regard to clinically relevant secondary access site-related bleeding complications. The results of this trial will provide important insights into the safety and efficacy of an upper extremity approach in patients undergoing transfemoral TAVI.
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Affiliation(s)
- Maxim J P Rooijakkers
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Geert A A Versteeg
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Kimberley I Hemelrijk
- Department of Cardiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Hugo M Aarts
- Department of Cardiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Daniël C Overduin
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Dirk-Jan van Ginkel
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Pieter J Vlaar
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Marleen H van Wely
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Lokien X van Nunen
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Robert Jan van Geuns
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Leen A F M van Garsse
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Guillaume S C Geuzebroek
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Michel W A Verkroost
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Laura Rodwell
- Department of Health Sciences, Section Biostatistics, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Robin H Heijmen
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Pim A L Tonino
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Jurrien M Ten Berg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Ronak Delewi
- Department of Cardiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands.
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Albalkhi I, Shafqat A, Bin-Alamer O, Mallela AN, Gersey ZC, Fernandes Cabral D, Sabbagh AJ, Hadjipanayis CG, González-Martínez JA, Friedlander RM, Abou-Al-Shaar H. Complications and visual outcomes following surgical resection of pediatric optic pathway/hypothalamic gliomas: a systematic review and meta-analysis. Childs Nerv Syst 2024:10.1007/s00381-024-06407-7. [PMID: 38649470 DOI: 10.1007/s00381-024-06407-7] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 04/12/2024] [Indexed: 04/25/2024]
Abstract
Pediatric optic pathway/hypothalamic gliomas (OPHG) pose challenges in treatment due to their location and proximity to vital structures. Surgical resection plays a key role in the management of OPHG especially when the tumor exhibits mass effect and causes symptoms. However, data regarding outcomes and complications of surgical resection for OPHG remains heterogenous. The authors performed a systematic review on pediatric OPHG in four databases: PubMed, EMBASE, Cochrane Library, and Google Scholar. We included studies that reported on the visual outcomes and complications of OPHG resection. A meta-analysis was performed and reported per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A total of 26 retrospective studies were included. Seven hundred ninety-seven pediatric patients with OPHG undergoing surgical resection were examined. A diagnosis of NF1 was confirmed in 9.7%. Gross total resection was achieved in 36.7%. Intraorbital optic pathway gliomas showed a significantly higher gross total resection rate compared to those located in the chiasmatic/hypothalamic region (75.8% vs. 9.6%). Postoperatively, visual acuity improved in 24.6%, remained unchanged in 68.2%, and worsened in 18.2%. Complications included hydrocephalus (35.4%), anterior pituitary dysfunction (19.6%), and transient diabetes insipidus (29%). Tumor progression post-resection occurred in 12.8%, through a mean follow-up of 53.5 months. Surgical resection remains an essential strategy for treating symptomatic and large pediatric OPHG and can result in favorable vision outcomes in most patients. Careful patient selection is critical. Patients should be monitored for hydrocephalus development postoperatively and followed up to assess for tumor progression and adjuvant treatment necessity.
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Affiliation(s)
- Ibrahem Albalkhi
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Department of Neuroradiology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Areez Shafqat
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Othman Bin-Alamer
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Arka N Mallela
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Zachary C Gersey
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - David Fernandes Cabral
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Abdulrahman J Sabbagh
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | | | - Robert M Friedlander
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Hussam Abou-Al-Shaar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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25
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Lisitano L, Wulff L, Schmidt J, Sieland C, Mahlke L, Röttinger T, Cifuentes J, Mayr E, Rau K. Unravelling variations: an examination of entry point selection in proximal femoral cephalomedullary nailing. J Orthop Traumatol 2024; 25:23. [PMID: 38653863 DOI: 10.1186/s10195-024-00760-8] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 03/24/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The exact positioning of the cephalomedullary (CM) nail entry point for managing femoral fractures remains debatable, with significant implications for fracture reduction and postoperative complications. This study aimed to explore the variability in the selection of the entry point among trauma surgeons, hypothesizing potential differences and their association with surgeon experience. METHODS In this prospective multicenter study, 16 participants, ranging from residents to senior specialists, partook in a simulation wherein they determined the optimal entry point for the implantation of a proximal femoral nail antirotation (PFN-A; DePuy Synthes) in various femora. The inter- and intra-observer variability was calculated, along with comprehensive descriptive statistical analysis, to assess the variability in entry point selection and the impact of surgeon experience. RESULTS In this study, the mean distance from the selected entry points to the calculated mean entry point was 3.98 mm, with a smaller distance observed among surgeons with more than 500 implantations (ANOVA, p = 0.050). Intra-surgeon variability for identical femora averaged at 5.14 mm, showing no significant differences across various levels of surgical experience or training. Notably, 13.6% of selected entry points would not allow a proper intramedullary positioning of the implant, thereby rendering anatomical repositioning unfeasible. Among these impossible entry points, a significant skew towards anterior placement was observed (70.6% of the impossible entry points), with a smaller fraction being overly lateral (27.5%) or medial (13.7%). On a patient level, the impossibility rate varied widely from 0 to 35% among the different femora examined, with a significantly higher rate seen in younger patients (mean age 55.02 versus 60.32; t-test for independent samples, p = 0.04). CONCLUSIONS Significant variations exist in surgeons' selection of entry points for proximal femoral nailing, underscoring the task's complexity. Experience does not prevent the choice of unfeasible entry points, emphasizing the inadequacy of a universal approach and pointing towards the necessity for a patient-specific strategy for improved outcomes. TRIAL REGISTRATION NUMBER DRKS00032465.
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Affiliation(s)
- Leonard Lisitano
- Department for Trauma, Orthopedics, Hand and Plastic Surgery, University Hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany.
| | - Laura Wulff
- Department for Trauma, Orthopedics, Hand and Plastic Surgery, University Hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Jürgen Schmidt
- Medical Care Center of Surgery and Orthopedics at Vincentinum, Augsburg, Germany
| | | | - Lutz Mahlke
- Department for Orthopedics, Trauma and Sports Traumatology, St. Vincenz-Krankenhaus, Paderborn, Germany
| | - Timon Röttinger
- Department for Trauma, Orthopedics, Hand and Plastic Surgery, University Hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Jairo Cifuentes
- Department for Trauma, Orthopedics, Hand and Plastic Surgery, University Hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Edgar Mayr
- Department for Trauma, Orthopedics, Hand and Plastic Surgery, University Hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Kim Rau
- Department for Trauma, Orthopedics, Hand and Plastic Surgery, University Hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
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Koltenyuk V, Merckling M, Li M, Chanmin Z, Butler JB. Frailty is a predictor of immediate postoperative complications following surgical management of knee dislocations. Eur J Orthop Surg Traumatol 2024:10.1007/s00590-024-03941-7. [PMID: 38643261 DOI: 10.1007/s00590-024-03941-7] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 03/26/2024] [Indexed: 04/22/2024]
Abstract
PURPOSE To assess the utility of frailty in predicting outcomes following surgical intervention for KDs. METHODS The NIS database was queried for non-congenital knee dislocations from 2015 to 2019 that underwent ligament repair or surgical reduction. Patients were assigned frailty scores using the mFI-11, and outcomes were compared. Multivariate regression and ROC curve analysis were used to assess the independent association of obesity, frailty, VI, and age with adverse outcomes. RESULTS A total of 3797 patients who underwent surgical management were included. Frailty was associated with extended LOS (OR 1.353, 95% CI 1.212-1.510, p < 0.001), adverse discharge (OR 1.716, 95% CI 1.515-1.946, p < 0.001), and complications (OR 1.449, 95% CI 1.352-1.553, p < 0.001). Severely frailty was associated with extended LOS (OR 1.838, 95% CI 1.611-2.097, p < 0.001), adverse discharge (OR 2.756, 95% CI 2.394-3.171, p < 0.001), and complications (OR 1.603, 95% CI 1.453-1.768, p < 0.001). Additionally, VI was a risk factor for extended LOS (OR 7.647 (6.442-9.076) p < 0.001), complications (OR 2.065 (1.810-2.341) p < 0.001), and adverse discharge (OR 1.825 (1.606-2.075), p < 0.001). Obesity was a risk factor for extended LOS (OR 1.599 (1.470-1.739), p < 0.001) and complications (OR 1.235 (1.108-1.377), p < 0.001). AUC analysis showed that frailty was the most accurate predictor of all outcomes when compared to VI, obesity, and age. CONCLUSIONS Frailty is superior to age and obesity, and comparable to VI, at predicting adverse outcomes following surgical management of KDs. These findings suggest that frailty assessment might play a role in risk stratification and preoperative planning for KD patients that require surgical intervention.
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Affiliation(s)
- Victor Koltenyuk
- School of Medicine, Westchester Medical Center, New York Medical College, 40 Sunshine Cottage Rd, Valhalla, NY, 10595, USA.
| | - Matthew Merckling
- School of Medicine, Westchester Medical Center, New York Medical College, 40 Sunshine Cottage Rd, Valhalla, NY, 10595, USA
| | - Michael Li
- School of Medicine, Westchester Medical Center, New York Medical College, 40 Sunshine Cottage Rd, Valhalla, NY, 10595, USA
| | - Zachary Chanmin
- College of Osteopathic Medicine, New York Institute of Technology, Glen Head, NY, USA
| | - Jay B Butler
- Orthopedic and Fracture Specialists, Portland, OR, USA
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27
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Gordon AM, Ng MK, Magruder ML, Schwartz JM, Jason Wong CH, Mont MA. The Association of Dental Caries or Dental Implant Placement Within One Year of Primary Total Hip Arthroplasty on Medical and Implant Complications. J Arthroplasty 2024:S0883-5403(24)00370-X. [PMID: 38649065 DOI: 10.1016/j.arth.2024.04.047] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/13/2024] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
INTRODUCTION Total hip arthroplasty (THA) adverse events among patients who have dental diagnoses remain unclear. We sought to determine if dental caries or dental implant placements increased: 1) 90-day medical complications; 2) 90-day readmissions; and 3) 2-year implant-related complications, including periprosthetic joint infections (PJIs) after THA. METHODS A nationwide database for primary THAs from 2010 to 2021 was queried to compare three patient cohorts. Patients who had a history of dental implants or caries within 12 months prior to THA (n = 1,179) or 12 months after THA (n = 1,218) were case-matched to patients who did not have dental history (n = 6,090) by age and comorbidities. Outcomes included 90-day complications, 90-day readmissions, and 2-year implant-related complications. Logistic regression models computed the odds ratios (OR) of complications and readmissions. P values less than 0.006 were significant. RESULTS Patients who had dental caries or implant placement 12 months before or after THA experienced 1.6-fold greater odds of 90-day medical complications compared to case-matched patients. Readmissions within 90 days increased for patients who had a dental history before (11.7 versus 8.3%; OR: 1.49, P < 0.0001) and after (14.2 versus 8.3%; OR: 1.84, P < 0.0001) THA compared to case-matched patients. A dental caries diagnosis or dental implant placement within 12 months following THA increased 2-year implant complications compared to case-matched patients (15.2 versus 9.3%; OR: 1.69, P < 0.0001), including PJIs (5.3 versus 2.8%; OR: 1.98, P < 0.0001), dislocations (4.4 versus 2.7%; OR: 1.63, P = 0.002), and THA revisions (3.9 versus 2.5%; OR: 1.61, P = 0.005). CONCLUSION Dental diagnoses within 12 months of THA are associated with increased medical complications. Dental diagnoses occurring 12 months after THA are associated with greater implant-related complications, including PJIs. Delaying invasive dental procedures for 12 months after THA may be advisable.
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Affiliation(s)
- Adam M Gordon
- Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, New York; Questrom School of Business, Boston University, Boston, MA
| | - Mitchell K Ng
- Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, New York
| | - Matthew L Magruder
- Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, New York
| | - Jake M Schwartz
- Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, New York
| | - Che Hang Jason Wong
- Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, New York
| | - Michael A Mont
- Rubin Institute of Orthopaedic Surgery, Department of Orthopaedic Surgery, Baltimore, Maryland.
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Zaman M, Li JH, Dhir M. Malpractice Claims Following Major Liver and Pancreatic Surgeries: What Can we Learn? J Surg Res 2024; 298:291-299. [PMID: 38640614 DOI: 10.1016/j.jss.2024.03.026] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/08/2024] [Accepted: 03/21/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION General surgery is a highly litigious specialty. Lawsuits can be a source of emotional distress and burnout for surgeons. Major hepatic and pancreatic surgeries are technically challenging general surgical oncology procedures associated with an increased risk of complications and mortality. It is unclear whether these operations are associated with an increased risk of lawsuits. The objective of the present study was to summarize the medical malpractice claims surrounding pancreatic and hepatic surgeries from publicly available court records. METHODS The Westlaw legal database was searched and analyzed for relevant malpractice claims from the last two decades. RESULTS Of 165 search results, 30 (18.2%) cases were eligible for inclusion. Appellant cases comprised 53.3% of them. Half involved a patient death. Including co-defendants, a majority (n = 21, 70%) named surgeons as defendants, whereas several claims (n = 13, 43%) also named non-surgeons. The most common cause of alleged malpractice was a delay in diagnosis (n = 12, 40%). In eight of these, surgery could not be performed. The second most common were claims alleging the follow-up surgery was due to negligence (n = 6). Collectively, 20 claims were found in favor of the defendant. Seven verdicts (23.3%) returned in favor of the plaintiff, two of which resulted in monetary awards (totaling $1,608,325 and $424,933.85). Three cases went to trial or delayed motion for summary judgment. There were no settlements. CONCLUSIONS A defendant verdict was reached in two-thirds of malpractice cases involving major hepatic or pancreatic surgery. A delay in diagnosis was the most cited claim in hepatopancreaticobiliary lawsuits, and defendants may often practice in nonsurgical specialties. While rulings favoring plaintiffs are less frequent, the payouts may be substantial.
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Affiliation(s)
- Muizz Zaman
- Norton College of Medicine, SUNY Upstate Medical University, Syracuse, New York; Department of Surgery, SUNY Upstate Medical University, Syracuse, New York.
| | - Jian Harvard Li
- Norton College of Medicine, SUNY Upstate Medical University, Syracuse, New York
| | - Mashaal Dhir
- Department of Surgery, SUNY Upstate Medical University, Syracuse, New York.
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Köle E, Doğan O, Arslan G, Köle MÇ, Aslan E, Çalışkan E. Labiaplasty Outcomes and Complications in Turkish Women: A Multicentric Study. Int Urogynecol J 2024:10.1007/s00192-024-05777-5. [PMID: 38635038 DOI: 10.1007/s00192-024-05777-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/20/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION AND HYPOTHESIS We aimed to evaluate the outcomes, complication rates, and complication types of different labiaplasty techniques. METHODS In this cross-sectional retrospective study, a total of 2,594 patients who underwent surgery owing to hypertrophy or asymmetry of the labium minus were retrospectively analyzed. Data were collected by individual interviews with 43 experts from different centers. The patients were between 18 and 50 years of age. During the interview information about the presence and nature of complications, and about concomitant or revision surgeries, were gathered. The surgeons who performed these surgeries were also questioned about their training and surgical experience. RESULTS The most frequently observed complication was complete dehiscence, accounting for 29% of all complications. Complete dehiscence was most commonly seen after wedge resection (16 cases). The second most common complication was labium majus hematoma, accounting for 12.5% of all cases. Among the labiaplasty techniques, wedge resection had the highest complication rate at 3% (26 cases out of 753 patients). This was followed by composite labiaplasty at 1.2% (5 cases out of 395 patients), Z-plasty at 0.8% (1 case out of 123 patients), and trimming labiaplasty at 0.5% (7 cases out of 1,323 patients). CONCLUSION Considering the heterogeneity and low quality of the existing studies on this subject, this study provides valuable information for surgeons practicing in this field. However, further research is clearly warranted as female genital aesthetic procedures are being performed with a steadily increasing trend.
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Affiliation(s)
- Emre Köle
- Department of Obstetrics and Gynecology, Alanya Alaaddin Keykubat University School of Medicine, Kestel, Karapınar Caddesi, 07450, Antalya, Turkey.
| | - Ozan Doğan
- Department of Obstetrics and Gynecology, Private Practice, Harbiye, Lal Apartmanı, Mim Kemal Öke Cd. No:23, 34367, Istanbul, Turkey
| | - Gaye Arslan
- Department of Obstetrics and Gynecology, Okan University School of Medicine, İçmeler Mah, Aydınlı Yolu Cd. No:2, 34947, Istanbul, Turkey
| | - Merve Çakır Köle
- Department of Obstetrics and Gynecology, Alanya Alaaddin Keykubat University School of Medicine, Kestel, Karapınar Caddesi, 07450, Antalya, Turkey
| | - Erdoğan Aslan
- Department of Obstetrics and Gynecology, Alanya Alaaddin Keykubat University School of Medicine, Kestel, Karapınar Caddesi, 07450, Antalya, Turkey
| | - Eray Çalışkan
- Department of Obstetrics and Gynecology, Okan University School of Medicine, İçmeler Mah, Aydınlı Yolu Cd. No:2, 34947, Istanbul, Turkey
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Liang W, Li R, Chen G, Ma H, Han A, Hu Q, Xie N, Wei J, Shen H, Wang X, Xiang H. Long-term exposure to ambient particulate matter is associated with prognosis in people living with HIV/AIDS: Evidence from a longitudinal study. Sci Total Environ 2024; 928:172453. [PMID: 38641108 DOI: 10.1016/j.scitotenv.2024.172453] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/24/2024] [Accepted: 04/11/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Evidence on the association between particulate matter (PM) exposure and prognosis in people living with HIV/AIDS (PWHA) is scarce. We aim to investigate the associations of long-term exposure to PM with AIDS-related deaths and complications. METHODS We collected follow-up information on 7444 PWHAs from 2000 to 2021 from the HIV/AIDS Comprehensive Response Information Management System of the Wuhan Center for Disease Control and Prevention. The AIDS-related deaths and complications were assessed by physicians every 3 to 6 months, and the monthly average PM concentrations for each PWHA were extracted from the China High Air Pollutants dataset. We employed time-varying Cox regression models to evaluate the associations of the average cumulative PM exposure concentrations with AIDS-related deaths and complications, as well as the mediating effects of AIDS-related complications in PM-induced AIDS-related deaths. RESULTS For each 1 μg/m3 increase in PM1, PM2.5, and PM10, the adjusted hazard ratios (HRs) for AIDS-related deaths were 1.021 (1.009, 1.033), 1.012 (1.005, 1.020), and 1.010 (1.005, 1.015), respectively; and the HRs for AIDS-related complications were 1.049 (1.034, 1.064), 1.029 (1.020, 1.038), and 1.031 (1.024, 1.037), respectively. AIDS-related complications mediated 18.38 % and 18.68 % of the association of exposure to PM1 and PM2.5 with AIDS-related deaths, respectively. The association of PM exposure with AIDS-related deaths was more significant in older PWHA. Meanwhile, the association between PM exposure and AIDS-related complications was stronger in PWHA with a BMI ≥ 24 kg/m2. CONCLUSION Long-term exposure to PM is positively associated with AIDS-related deaths and complications, and AIDS-related complications have mediating effects in PM-induced AIDS-related deaths. Our evidence emphasizes that enhanced protection against PM exposure for PWHAs is an additional mitigation strategy to reduce AIDS-related deaths and complications.
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Affiliation(s)
- Wei Liang
- Department of Global Health, School of Public Health, Wuhan University, 115# Donghu Road, Wuhan 430071, China
| | - Ruihan Li
- Department of Global Health, School of Public Health, Wuhan University, 115# Donghu Road, Wuhan 430071, China
| | - Gongbo Chen
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Hongfei Ma
- Wuhan Center for Disease Control and Prevention, 288# Machang Road, Wuhan 430024, China
| | - Aojing Han
- Department of Global Health, School of Public Health, Wuhan University, 115# Donghu Road, Wuhan 430071, China
| | - Qilin Hu
- Department of Global Health, School of Public Health, Wuhan University, 115# Donghu Road, Wuhan 430071, China
| | - Nianhua Xie
- Wuhan Center for Disease Control and Prevention, 288# Machang Road, Wuhan 430024, China
| | - Jing Wei
- Department of Atmospheric and Oceanic Science, Earth System Science Interdisciplinary Center, University of Maryland, College Park, MD 20742, United States
| | - Huanfeng Shen
- School of Resource and Environmental Science, Wuhan University, 115# Donghu Road, Wuhan 430071, China
| | - Xia Wang
- Wuhan Center for Disease Control and Prevention, 288# Machang Road, Wuhan 430024, China.
| | - Hao Xiang
- Department of Global Health, School of Public Health, Wuhan University, 115# Donghu Road, Wuhan 430071, China; Global Health Institute, School of Public Health, Wuhan University, 115# Donghu Road, Wuhan 430071, China.
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Hinojosa-González DE, Saffati G, Kronstedt S, La T, Chiu C, Wahlstedt E, Jones JA, Kadmon D, Badal J, Taylor JM, Slawin JR. Comparison of peritoneal interposition flaps and sealants for prevention of lymphocele after robotic radical prostatectomy and pelvic lymph node dissection: a systematic review, meta-analysis, Bayesian network meta-analysis, and meta-regression. J Robot Surg 2024; 18:177. [PMID: 38630430 DOI: 10.1007/s11701-024-01918-6] [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] [Received: 01/31/2024] [Accepted: 03/19/2024] [Indexed: 04/19/2024]
Abstract
Lymphocele is one of the most common complications after radical prostatectomy. Multiple authors have proposed the use of vessel sealants or peritoneal interposition techniques as preventive interventions. This study aimed to aggregate and analyze the available literature on different interventions which seek to prevent lymphocele through a Bayesian Network. A systematic review was performed to identify prospective studies evaluating strategies for lymphocele prevention after robot assisted laparoscopic prostatectomy + pelvic lymph node dissection. Data was inputted into Review Manager 5.4 for pairwise meta-analysis. Data was then used to build a network in R Studio. These networks were used to model 200,000 Markov Chains via MonteCarlo sampling. The results are expressed as odds ratios (OR) with 95% credible intervals (CrI). Meta-regression was used to determine coefficient of change and adjust for pelvic lymph node dissection extent. Ten studies providing data from 2211 patients were included. 1097 patients received an intervention and 1114 patients served as controls. Interposition with fenestration had the lowest risk of developing a lymphocele (OR 0.14 [0.04, 0.50], p = 0.003). All interventions, except sealants or patches, had significant decreased odds of lymphocele rates. Meta-analysis of all the included studies showed a decreased risk of developing a lymphocele (OR 0.42 [0.33, 0.53], p < 0.00001) for the intervention group. Perivesical fixation and interposition with fenestration appear to be effective interventions for reducing the overall incidence of lymphocele.
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Affiliation(s)
- David E Hinojosa-González
- Scott Department of Urology, Baylor College of Medicine, 7200 Cambridge St., Floor 10, Suite C, Houston, TX, 77030, USA.
| | - Gal Saffati
- Scott Department of Urology, Baylor College of Medicine, 7200 Cambridge St., Floor 10, Suite C, Houston, TX, 77030, USA
| | - Shane Kronstedt
- Scott Department of Urology, Baylor College of Medicine, 7200 Cambridge St., Floor 10, Suite C, Houston, TX, 77030, USA
| | - Troy La
- Scott Department of Urology, Baylor College of Medicine, 7200 Cambridge St., Floor 10, Suite C, Houston, TX, 77030, USA
| | | | - Eric Wahlstedt
- University of Kentucky College of Medicine, Lexington, KY, USA
| | - Jeffrey A Jones
- Scott Department of Urology, Baylor College of Medicine, 7200 Cambridge St., Floor 10, Suite C, Houston, TX, 77030, USA
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Dov Kadmon
- Scott Department of Urology, Baylor College of Medicine, 7200 Cambridge St., Floor 10, Suite C, Houston, TX, 77030, USA
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Justin Badal
- Scott Department of Urology, Baylor College of Medicine, 7200 Cambridge St., Floor 10, Suite C, Houston, TX, 77030, USA
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Jennifer M Taylor
- Scott Department of Urology, Baylor College of Medicine, 7200 Cambridge St., Floor 10, Suite C, Houston, TX, 77030, USA
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Jeremy R Slawin
- Scott Department of Urology, Baylor College of Medicine, 7200 Cambridge St., Floor 10, Suite C, Houston, TX, 77030, USA
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
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López JP, Orjuela MP, Díaz-Baez D, González LV. Comparison of the TMJ arthroscopy discopexy techniques: A systematic review and meta-analysis. J Craniomaxillofac Surg 2024:S1010-5182(24)00142-2. [PMID: 38631972 DOI: 10.1016/j.jcms.2024.04.004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 03/12/2024] [Accepted: 04/03/2024] [Indexed: 04/19/2024] Open
Abstract
This article aims to analyze which of the main arthroscopic discopexy techniques has the best results and if there are differences between the techniques for both pain and maxillary intercuspid opening. A systematic review and meta-analysis was performed according to the PRISMA statement. An electronic search was performed with no publication date restriction in PubMed, Ovid and Embase. The PICO criteria: (P) Patients: With temporomandibular internal disorders with discopexy indication. (I) Intervention: Temporomandibular joint arthroscopic discopexy. (C) Comparison: Arthroscopic discopexy among different techniques classified as non-rigid, semi-rigid and rigid. (O) Outcomes: Impact in clinical conditions such as pain and maximum mouth opening. The inclusion criteria were Patients with temporomandibular internal disorders with discopexy indication performed with different techniques classified as non-rigid, semi-rigid and rigid. The outcomes evaluated were pain and maximum mouth opening. Case series, cohort studies, quasi-experimental studies, and randomized clinical trials with at least 3 months of follow-up were included. The exclusion criteria considered were patients with related concomitant surgeries, patients with associated neoplastic disease or connective tissue disease. A total of 1515 joints where 1400 discopexies were performed including 849 females and 204 males. The most common diagnostic was Wilkes stage III in 257 joints. For pain and oral opening, the semi-rigid technique shows the best results median (MD) 4.84 (CI 2.52-7.16; p = 0.001, I2:100%), MD -2.78 (CI -4.34, -1.21; p = 0.001, I2:99%), respectively. The rigid technique has the greatest probability for complications MD 0.14 CI 95% (0.00, -0.28). Although the semi-rigid technique showed better results, there is no statistically significant difference. However, due to the heterogeneity of the studies, the results should be interpreted with caution.
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Affiliation(s)
- Juan Pablo López
- Oral and Maxillofacial Surgeon, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá DC, Colombia; Universidad El Bosque, Unidad de Investigación en Epidemiología Clínica Oral UNIECLO, Bogotá DC, Colombia.
| | - María Paula Orjuela
- Oral and Maxillofacial Surgery Surgeon, Universidad El Bosque, Bogotá DC, Colombia
| | - David Díaz-Baez
- Unit of Basic Oral Investigation (UIBO), Facultad de Odontología, Universidad El Bosque, Bogotá DC, Colombia
| | - Luis Vicente González
- Oral and Maxillofacial Surgeon, Hospital Universitario La Samaritana, Bogotá DC, Colombia; Department of Oral Research, School of Dentistry, Institución Universitaria de Colegios de Colombia UNICOC, Colombia
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Gallucci P, Marincola G, Pennestrì F, Procopio PF, Prioli F, Salvi G, Ciccoritti L, Greco F, Velotti N, Schiavone V, Franzese A, Mansi F, Uccelli M, Cesana G, Musella M, Olmi S, Raffaelli M. One-Anastomosis Gastric Bypass (OABG) vs. Single Anastomosis Duodeno-Ileal Bypass (SADI) as revisional procedure following Sleeve Gastrectomy: results of a multicenter study. Langenbecks Arch Surg 2024; 409:128. [PMID: 38627302 PMCID: PMC11021266 DOI: 10.1007/s00423-024-03306-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 04/03/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE Sleeve Gastrectomy (SG) is the most performed bariatric surgery, but a considerable number of patients may require revisional procedures for suboptimal clinical response/recurrence of weight (SCR/RoW). Conversion options include One-Anastomosis Gastric Bypass (OAGB) and Single Anastomosis Duodeno-Ileal Bypass (SADI). The study aims to compare SADI vs. OAGB as revisional procedures in terms of early and mid-term complications, operative time, postoperative hospital stay and clinical outcomes. METHODS All patients who underwent OAGB or SADI as revisional procedures following SG for SCR/RoW at three high-volume bariatric centers between January 2014 and April 2021 were included. Propensity score matching (PSM) analysis was performed. Demographic, operative, and postoperative outcomes of the two groups were compared. RESULTS One hundred and sixty-eight patients were identified. After PSM, the two groups included 42 OAGB and 42 SADI patients. Early (≤ 30 days) postoperative complications rate did not differ significantly between OAGB and SADI groups (3 bleedings vs. 0, p = 0.241). Mid-term (within 2 years) complications rate was significantly higher in the OAGB group (21.4% vs. 2.4%, p = 0.007), mainly anastomotic complications and reflux disease (12% of OAGBs). Seven OAGB patients required conversion to another procedure (Roux-en-Y Gastric Bypass-RYGB) vs. none among the SADI patients (p = 0.006). CONCLUSIONS SADI and OAGB are both effective as revisional procedures for SCR/RoW after SG. OAGB is associated with a significantly higher rate of mid-term complications and a not negligible rate of conversion (RYGB). Larger studies are necessary to draw definitive conclusions.
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Affiliation(s)
- Pierpaolo Gallucci
- Centro Dipartimentale Di Chirurgia Endocrina E Dell'Obesità, U.O.C. Chirurgia Endocrina E Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giuseppe Marincola
- Centro Dipartimentale Di Chirurgia Endocrina E Dell'Obesità, U.O.C. Chirurgia Endocrina E Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesco Pennestrì
- Centro Dipartimentale Di Chirurgia Endocrina E Dell'Obesità, U.O.C. Chirurgia Endocrina E Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
- Centro Di Ricerca In Chirurgia Delle Ghiandole Endocrine E Dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Priscilla Francesca Procopio
- Centro Dipartimentale Di Chirurgia Endocrina E Dell'Obesità, U.O.C. Chirurgia Endocrina E Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centro Di Ricerca In Chirurgia Delle Ghiandole Endocrine E Dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesca Prioli
- Centro Dipartimentale Di Chirurgia Endocrina E Dell'Obesità, U.O.C. Chirurgia Endocrina E Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giulia Salvi
- Centro Dipartimentale Di Chirurgia Endocrina E Dell'Obesità, U.O.C. Chirurgia Endocrina E Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centro Di Ricerca In Chirurgia Delle Ghiandole Endocrine E Dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luigi Ciccoritti
- Centro Dipartimentale Di Chirurgia Endocrina E Dell'Obesità, U.O.C. Chirurgia Endocrina E Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesco Greco
- Centro Dipartimentale Di Chirurgia Endocrina E Dell'Obesità, U.O.C. Chirurgia Endocrina E Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Nunzio Velotti
- Dipartimento Di Scienze Biomediche Avanzate, Ospedale Universitario Federico II, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | - Vincenzo Schiavone
- Dipartimento Di Scienze Biomediche Avanzate, Ospedale Universitario Federico II, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | - Antonio Franzese
- Dipartimento Di Scienze Biomediche Avanzate, Ospedale Universitario Federico II, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | - Federica Mansi
- Dipartimento Di Scienze Biomediche Avanzate, Ospedale Universitario Federico II, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | - Matteo Uccelli
- Dipartimento Di Chirurgia Generale Ed Oncologica, Centro Di Chirurgia Laparoscopica E Bariatrica, Policlinico San Marco, Gruppo San Donato, Zingonia, BG, Italy
| | - Giovanni Cesana
- Dipartimento Di Chirurgia Generale Ed Oncologica, Centro Di Chirurgia Laparoscopica E Bariatrica, Policlinico San Marco, Gruppo San Donato, Zingonia, BG, Italy
| | - Mario Musella
- Dipartimento Di Scienze Biomediche Avanzate, Ospedale Universitario Federico II, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | - Stefano Olmi
- Dipartimento Di Chirurgia Generale Ed Oncologica, Centro Di Chirurgia Laparoscopica E Bariatrica, Policlinico San Marco, Gruppo San Donato, Zingonia, BG, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Marco Raffaelli
- Centro Dipartimentale Di Chirurgia Endocrina E Dell'Obesità, U.O.C. Chirurgia Endocrina E Metabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centro Di Ricerca In Chirurgia Delle Ghiandole Endocrine E Dell'Obesità, Università Cattolica del Sacro Cuore, Rome, Italy
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Kumar KD, Choudhry HS, Shah VP, Desai AD, Sibala DR, Patel AM, Patel P, Eloy JA. Smoking impacts outcomes in transcervical Zenker's diverticulectomy. Am J Otolaryngol 2024; 45:104288. [PMID: 38640811 DOI: 10.1016/j.amjoto.2024.104288] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/07/2024] [Indexed: 04/21/2024]
Abstract
PURPOSE There is sparse literature discussing the impact of smoking on postoperative outcomes following surgical treatment of Zenker's diverticulum. In this study, we seek to characterize differences in the management and outcomes of open Zenker's diverticulectomy based on patient smoking status. METHODS AND MATERIALS This paper is a retrospective cohort review. The 2005-2018 American College of Surgeons National Surgical Quality Improvement (ACS-NSQIP) database was queried for patients undergoing open Zenker's diverticulectomy. Chi-square and multivariable logistic regression were performed to determine statistical associations between postoperative outcomes and smoking status. RESULTS Of the 715 identified patients, 70 (9.8 %) were smokers and 645 (91.2 %) were non-smokers. Smokers were younger than non-smokers (mean 63.9 vs. 71.7 years, p < 0.001) and more likely to have a prolonged operative time (20.0 % vs. 11.6 %, p = 0.044). On multivariable regression analysis controlling for demographics and comorbidities, smokers had greater odds than non-smokers for developing overall postoperative complications (OR: 2.776, p = 0.013), surgical infections (OR: 3.194, p = 0.039), medical complications (OR: 3.563, p = 0.011), and medical infections (OR: 1.247, p = 0.016). Smokers also had greater odds for requiring ventilation/intubation (OR: 8.508, p = 0.025) and having a prolonged postoperative stay (OR: 2.425, p = 0.030). CONCLUSION In a cohort of patients undergoing transcervical Zenker's diverticulectomy, smokers are at increased risk for overall complications, medical complications, medical infections, surgical infections, prolonged postoperative stay, and ventilation/intubation.
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Affiliation(s)
- Keshav D Kumar
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Hannaan S Choudhry
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Vraj P Shah
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Amar D Desai
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Dhiraj R Sibala
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Aman M Patel
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Prayag Patel
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA; Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ, USA; Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA; Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA; Department of Otolaryngology and Facial Plastic Surgery, Saint Barnabas Medical Center - RWJBarnabas Health, Livingston, NJ, USA.
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Shaikh N, Kais A, Dewey J, Jaffal H. Effect of perioperative ketorolac on postoperative bleeding after pediatric tonsillectomy. Int J Pediatr Otorhinolaryngol 2024; 180:111953. [PMID: 38653108 DOI: 10.1016/j.ijporl.2024.111953] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 03/28/2024] [Accepted: 04/11/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Ketorolac is a frequently used anesthetic pain agent which is traditionally avoided during tonsillectomy due to concern for postoperative hemorrhage. Our goal was to assess the degree of risk associated with the use of Ketorolac following pediatric tonsillectomy. METHODS The TriNetX electronic health records research database was queried in January 2024 for patients undergoing tonsillectomy with or without adenoidectomy under the age of 18 years and without a diagnosed bleeding disorder. Patients were separated into two cohorts either having received or not having received ketorolac the same day as surgery. Propensity score matching was performed for age at the time of surgery, sex, race, ethnicity, and preoperative diagnoses. The outcomes assessed were postoperative hemorrhage requiring operative control within the first day (primary hemorrhage) and within the first month after surgery (secondary hemorrhage). RESULTS 17,434 patients were identified who had undergone pediatric tonsillectomy with or without adenoidectomy and had received ketorolac the same day as surgery. 290,373 patients were identified who had undergone pediatric tonsillectomy with or without adenoidectomy and had not received ketorolac the same day as surgery. 1:1 propensity score matching resulted in 17,434 patients within each cohort. Receipt of ketorolac the same day as surgery resulted in an increased risk of primary hemorrhage OR 2.158 (95 % CI 1.354, 3.437) and secondary hemorrhage OR 1.374 (95 % CI 1.057, 1.787) requiring operative control. CONCLUSION Ketorolac use during pediatric tonsillectomy with or without adenoidectomy was associated with an increased risk of postoperative primary and secondary bleeding requiring surgery.
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Affiliation(s)
- Noah Shaikh
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, USA
| | - Amani Kais
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, USA
| | - John Dewey
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, USA
| | - Hussein Jaffal
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, USA.
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Krnic N, Sesa V, Mrzljak A, Berkovic MC. Are treatment options used for adult-onset type 2 diabetes mellitus (equally) available and effective for children and adolescents? World J Diabetes 2024; 15:623-628. [DOI: 10.4239/wjd.v15.i4.623] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/29/2024] [Accepted: 03/06/2024] [Indexed: 04/11/2024] Open
Abstract
Youth-onset type 2 diabetes mellitus (T2DM), influenced by an increase in obesity, is a rising problem worldwide. Pathophysiological mechanisms of this early-onset T2DM include both peripheral and hepatic insulin resistance, along with increased hepatic fasting glucose production accompanied by inadequate first and second-phase insulin secretion. Moreover, the incretin effect is reduced. The initial presentation of type 2 diabetes can be dramatic and symptoms may overlap with those of type 1 diabetes mellitus. Therefore, immediate therapy should address hyperglycemia and associated metabolic derangements irrespective of ultimate diabetes type, while further therapy adjustments are prone to patients’ phenotype. New agents with proven glycemic and beyond glycemia benefits, such as Glucagon-like polypeptide 1 receptor agonists and Sodium-glucose cotransporter-2 inhibitors, used in the adult population of T2DM patients, might become increasingly important in the treatment armamentarium. Moreover, metabolic surgery is an option for markedly obese (body mass index > 35 kg/m2) children and adolescents suffering from T2DM who have uncontrolled glycemia and/or serious comorbidities when lifestyle and pharmacologic interventions fail. In this mini-review, we will discuss the potential of treatment options considering new data available from randomized control trials, including individuals with adult-onset type diabetes mellitus.
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Affiliation(s)
- Nevena Krnic
- Clinics for Pediatrics, University Hospital Center Zagreb, Zagreb 10000, Croatia
| | - Vibor Sesa
- Department of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb 10000, Croatia
| | - Anna Mrzljak
- Department of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb 10000, Croatia
- University of Zagreb School of Medicine, Zagreb 10000, Croatia
| | - Maja Cigrovski Berkovic
- Department for Sport and Exercise Medicine, University of Zagreb Faculty of Kinesiology, Zagreb 10000, Croatia
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Ditonno F, Bertolo R, Veccia A, Costantino S, Montanaro F, Artoni F, Baielli A, Boldini M, Brusa D, De Marco V, Migliorini F, Porcaro AB, Rizzetto R, Cerruto MA, Autorino R, Antonelli A. Assessing the perioperative outcomes of abdominal drain omission after robot-assisted partial nephrectomy. Sci Rep 2024; 14:8658. [PMID: 38622320 PMCID: PMC11018825 DOI: 10.1038/s41598-024-59404-w] [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] [Received: 12/19/2023] [Accepted: 04/10/2024] [Indexed: 04/17/2024] Open
Abstract
The study aimed to evaluate the impact of abdominal drain placement (vs. omission) on perioperative outcomes of robot-assisted partial nephrectomy (RAPN), focusing on complications, time to canalization, deambulation, and pain management. A prospectively-maintained institutional database was queried to get data of patients who underwent RAPN for renal masses between January 2018 and May 2023 at our Institution. Baseline, surgical, and postoperative data were collected. Retrieved patients were stratified based upon placement of abdominal drain (Y/N). Descriptive analyses comparing the two groups were conducted as appropriate.77 After adjusting for potential confounders, a logistic regression analysis was conducted to evaluate significant predictors of any grade and "major" complications. 342 patients were included: 192 patients in the "drain group" versus 150 patients in the "no-drain" group. Renal masses were larger (p < 0.001) and at higher complexity (RENAL score, p = 0.01), in the drain group. Procedures in the drain group had statistically significantly longer operative time, ischemia time, and higher blood loss (all p-values < 0.001). The urinary collecting system was more likely involved compared to the no-drain group (p = 0.01). At multivariate analysis, abdominal drainage was not a significant predictor of any grade (OR 0.79, 95%CI 0.33-1.87) and major postoperative complications (OR 3.62, 95%CI 0.53-9.68). Patients in the drain group experienced a statistically significantly higher hemoglobin drop (p < 0.01). Moreover, they exhibited statistically significant higher paracetamol consumption (p < 0.001) and need for additional opioids (p = 0.02). In summary, the study results suggest the safety of omitting drain placement and remark on the need for personalized decision-making, which considers patient and procedural factors.
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Affiliation(s)
- Francesco Ditonno
- Department of Urology, Borgo Trento Hospital, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, AUOI Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | - Riccardo Bertolo
- Department of Urology, Borgo Trento Hospital, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, AUOI Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy.
| | - Alessandro Veccia
- Department of Urology, Borgo Trento Hospital, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, AUOI Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Sonia Costantino
- Department of Urology, Borgo Trento Hospital, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, AUOI Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Francesca Montanaro
- Department of Urology, Borgo Trento Hospital, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, AUOI Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Francesco Artoni
- Department of Urology, Borgo Trento Hospital, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, AUOI Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Alberto Baielli
- Department of Urology, Borgo Trento Hospital, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, AUOI Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Michele Boldini
- Department of Urology, Borgo Trento Hospital, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, AUOI Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Davide Brusa
- Department of Urology, Borgo Trento Hospital, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, AUOI Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Vincenzo De Marco
- Department of Urology, Borgo Trento Hospital, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, AUOI Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Filippo Migliorini
- Department of Urology, Borgo Trento Hospital, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, AUOI Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Antonio Benito Porcaro
- Department of Urology, Borgo Trento Hospital, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, AUOI Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Riccardo Rizzetto
- Department of Urology, Borgo Trento Hospital, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, AUOI Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Maria Angela Cerruto
- Department of Urology, Borgo Trento Hospital, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, AUOI Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Riccardo Autorino
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | - Alessandro Antonelli
- Department of Urology, Borgo Trento Hospital, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, AUOI Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
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Han Z, Ma X, Ma G. Improving cell reinfusion to enhance the efficacy of chimeric antigen receptor T-cell therapy and alleviate complications. Heliyon 2024; 10:e28098. [PMID: 38560185 PMCID: PMC10981037 DOI: 10.1016/j.heliyon.2024.e28098] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 02/24/2024] [Accepted: 03/12/2024] [Indexed: 04/04/2024] Open
Abstract
Adoptive cell therapy (ACT) is a rapidly expanding area within the realm of transfusion medicine, focusing on the delivery of lymphocytes to trigger responses against tumors, viruses, or inflammation. This area has quickly evolved from its initial promise in immuno-oncology during preclinical trials to commercial approval of chimeric antigen receptor (CAR) T-cell therapies for leukemia and lymphoma (Jun and et al., 2018) [1]. CAR T-cell therapy has demonstrated success in treating hematological malignancies, particularly relapsed/refractory B-cell acute lymphoblastic leukemia and non-Hodgkin's lymphoma (Qi and et al., 2022) [2]. However, its success in treating solid tumors faces challenges due to the short-lived presence of CAR-T cells in the body and diminished T cell functionality (Majzner and Mackall, 2019) [3]. CAR T-cell therapy functions by activating immune effector cells, yet significant side effects and short response durations remain considerable obstacles to its advancement. A prior study demonstrated that the therapeutic regimen can induce systemic inflammatory reactions, such as cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), tumor lysis syndrome (TLS), off-target effects, and other severe complications. This study aims to explore current research frontiers in this area.
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Affiliation(s)
- Zhihao Han
- Department of Nursing, Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, China
| | - Xiaoqin Ma
- Department of Nursing, Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, China
| | - Guiyue Ma
- Department of Nursing, Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, China
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Shichman I, Rajahraman V, Anil U, Lin CC, Rozell JC, Schwarzkopf R. Total hip arthroplasty outcomes in Ehlers-Danlos patients: data from the Statewide Planning and Research Cooperative System. Hip Int 2024:11207000241234030. [PMID: 38619151 DOI: 10.1177/11207000241234030] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
INTRODUCTION Ehlers-Danlos syndromes (EDS) are genetic connective tissue disorders affecting multiple organ systems that frequently result in connective tissue hyperlaxity and early osteoarthritis. Short- and long-term outcomes after primary total hip arthroplasty (THA) in this patient population remain poorly characterised. The primary purpose of this study is to compare postoperative outcomes and survivorship after primary THA in patients with and without EDS. METHODS The New York Statewide Planning and Research Cooperative System (SPARCS) database was queried for all patients undergoing primary elective THA between September 2009 and December 2020. Patients with EDS were identified using ICD9 and ICD10 diagnosis codes. Given the relatively low incidence of EDS in this patient population, the cohort was propensity-matched 1:10 to patients without diagnosis of EDS based on demographics characteristics and medical comorbidities as measured by the Elixhauser Comorbidity Index. RESULTS A total of 66 THA patients with and 660 without EDS were included in each group after 1:10 propensity-matching. There were no significant differences in baseline characteristics or THA indications. Early postoperative outcomes such as length of hospital stay and discharge disposition were similar. Emergency Room visits and inpatient readmission rates at 3 months postoperatively did not significantly differ between groups. Patients with EDS had a higher overall revision rate compared to those without (15.0% vs. 3.2%, p < 0.001). Revision free survival after primary THA in patients with EDS was significantly lower than those without EDS at 9-year follow-up. Cox proportional hazard regression demonstrated EDS patients had 7-times higher risk of revision (hazard ratio [HR] 7.43; 95% CI, 3.46-16.00; p < 0.001). Lastly, revision due to instability insignificantly trended higher in the EDS cohort (HR 2.29; 95% CI, 0.95-5.49; p = 0.063). CONCLUSIONS EDS patients undergoing primary THA have increased rate of all cause revision and demonstrate decreased revision free survival compared to non-EDS THA patients.
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Affiliation(s)
- Ittai Shichman
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Vinaya Rajahraman
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Utkarsh Anil
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Charles C Lin
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Joshua C Rozell
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Ran Schwarzkopf
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
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Foppiani JA, Weidman A, Hernandez Alvarez A, Valentine L, Bustos VP, Galinaud C, Hrdina R, Hrdina R, Musil Z, Lee BT, Lin SJ. A Meta-Analysis of the Mortality and the Prevalence of Burn Complications in Western Populations. J Burn Care Res 2024:irae064. [PMID: 38619135 DOI: 10.1093/jbcr/irae064] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Indexed: 04/16/2024]
Abstract
Management of burn injuries is complex, with highly variable outcomes occurring among different populations. This meta-analysis aims to assess the outcomes of burn therapy in North American (NA) and European adults, specifically, mortality and complications, to guide further therapeutic advances. A systematic review of PubMed, Web of Science, and Cochrane was performed. Random-effect meta-analysis of proportions was conducted to assess the overall prevalence of the defined outcomes. Fifty-four studies were included, pooling 60,269 adult patients. A total of 53,896 patients were in North America (NA, 89.4%), and 6,373 were in Europe (10.6%). Both populations experienced similar outcomes. The overall pooled prevalence of mortality was 13% (95% CI 8-19%) for moderate burns and 20% (95% CI 12-29%) for severe burns in the NA region, and 22% (95% CI 16-28%) for severe burns in Europe. Infectious complications were the most common across both regions. European studies showed an infection rate for moderate and severe burn patients at 8% and 76%, respectively, while NA studies had rates of 35% and 54%. Acute kidney injury (39% vs. 37%) and shock (29% vs. 35%), were the next most common complications in European and NA studies, respectively. The length of stay was 27.52 days for severe burn patients in Europe and 31.02 days for severe burn patients in NA. Burn outcomes are similar between Western populations. While outcomes are reasonably good overall, infectious complications remain high. These findings encourage the development of further therapeutic strategies disclosing respective costs to enable cost/efficiency evaluations in burn management.
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Affiliation(s)
- Jose A Foppiani
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Allan Weidman
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Angelica Hernandez Alvarez
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Lauren Valentine
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Valeria P Bustos
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Cécilia Galinaud
- Charles University, Faculty of Science, Department of Organic Chemistry, Praha, Czech Republic
| | - Radim Hrdina
- University of Pardubice, Faculty of Chemical Technology, Pardubice, Czech Republic
| | - Radim Hrdina
- Charles University, Faculty of Science, Department of Organic Chemistry, Praha, Czech Republic
| | - Zdenek Musil
- Charles University, Faculty of Medicine, Institute of Biology and Medical Genetics, Praha, Czech Republic
| | - Bernard T Lee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Samuel J Lin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Kufaishi H, Mizrak HI, Brock B, Hansen TW, Rossing P, Hansen CS. Gastrointestinal symptom burden in diabetic autonomic and peripheral neuropathy - A Danes cohort study. J Diabetes Complications 2024; 38:108745. [PMID: 38615421 DOI: 10.1016/j.jdiacomp.2024.108745] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE We investigated associations between gastrointestinal symptoms - evaluated as a combined weighted symptom score (CWSS) - Diabetic autonomic neuropathy (DAN), and distal symmetrical polyneuropathy (DSPN) in type 1 and type 2 diabetes. RESEARCH DESIGN AND METHODS Cross-sectional study in a tertiary outpatient clinic. CWSS was calculated based on questionnaires: gastroparesis composite symptom index (GCSI) and gastrointestinal symptom rating score (GSRS). DAN and DSPN were addressed using the composite autonomic symptom score 31 (COMPASS-31) questionnaire, cardiac autonomic reflex tests (CARTs), electrochemical skin conductance (ESC), vibration perception threshold (VPT), Michigan Neuropathy Screening Instrument (MNSI), pain- and thermal sensation. Analyses were adjusted for age, sex, diabetes duration, smoking, LDL-cholesterol, HbA1C and systolic blood pressure. Type 1 and type 2 diabetes were evaluated separately. RESULTS We included 566 with type 1 diabetes and 377 with type 2 diabetes. Mean ± SD age was 58 ± 15 years and 565 (59.9 %) were women. A high CWSS was present in 143 (25 %) with type 1 and 142 (38 %) with type 2 diabetes. The odds of DAN by COMPASS-31 (p < 0.001) were higher in the high score group. For type 1 diabetes, odds of cardiac autonomic neuropathy were higher in the high CWSS group. The odds of DSPN by VPT and MNSI in type 1 diabetes, and by ESC, VPT and pain sensation in type 2 diabetes were higher in the high CWSS group. CONCLUSIONS A high symptom score was associated with neuropathy by COMPASS-31 and vibration perception. Gastrointestinal symptom burden associated inconsistently with other neuropathy tests between diabetes types.
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Affiliation(s)
| | | | - Birgitte Brock
- Steno Diabetes Center Copenhagen, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Peter Rossing
- Steno Diabetes Center Copenhagen, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Gordon AM, Ng MK, Elali F, Piuzzi NS, Mont MA. A Nationwide Analysis of the Impact of Socioeconomic Status on Complications and Healthcare Utilizations After Total Knee Arthroplasty Using the Area Deprivation Index: Consideration of the Disadvantaged Patient. J Arthroplasty 2024:S0883-5403(24)00341-3. [PMID: 38615971 DOI: 10.1016/j.arth.2024.04.028] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 04/16/2024] Open
Abstract
INTRODUCTION Socioeconomic status (SES) has been demonstrated to be an important prognostic risk factor among patients undergoing total joint arthroplasty. We evaluated patients living near neighborhoods with higher socioeconomic risk undergoing total knee arthroplasty (TKA) and if they were associated with differences in: 1) medical complications; 2) emergency department (ED) utilizations; 3) readmissions; and 4) costs of care. METHODS A query of a national database from 2010 to 2020 was performed for primary TKAs. The Area Deprivation Index (ADI) is a weighted index comprised of 17 census-based markers of material deprivation and poverty. Higher numbers indicate a greater disadvantage. Patients undergoing TKA in zip codes associated with high ADI (90%+) were 1:1 propensity-matched to a comparison group by age, sex, and Elixhauser Comorbidity Index (ECI). This yielded 225,038 total patients, evenly matched between cohorts. Outcomes studied included complications, ED utilizations, readmission rates, and 90-day costs. Logistic regression models computed the odds ratios (OR) of ADI on the dependent variables. P-values less than 0.003 were significant. RESULTS High ADI led to higher rates and odds of any medical complications (11.7 versus 11.0%; OR: 1.05, P = 0.0006), respiratory failures (0.4 versus 0.3%; OR: 1.28, P = 0.001), and acute kidney injuries (1.7 versus 1.5%; OR: 1.15, P < 0.0001). Despite lower readmission rates (2.9 versus 3.5%), high ADI patients had greater 90-day ED visits (4.2 versus 4.0%; OR: 1.07, P = 0.0008). The 90-day expenditures ($15,066 versus $12,459; P < 0.0001) were higher in patients who have a high ADI. CONCLUSION Socioeconomically disadvantaged patients have increased complications and ED utilizations. Neighborhood disadvantage may inform healthcare policy and improve post-discharge care. The SES metrics, including ADI (which captures community effects), should be used to adequately risk-adjust or risk-stratify patients so that access to care for deprived regions and patients is not lost.
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Affiliation(s)
- Adam M Gordon
- Questrom School of Business, Boston University, Boston, MA; Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, New York
| | - Mitchell K Ng
- Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, New York
| | - Faisal Elali
- SUNY Downstate Health Sciences University, College of Medicine, Brooklyn, New York
| | - Nicolas S Piuzzi
- Cleveland Clinic, Department of Orthopaedic Surgery, Cleveland, Ohio
| | - Michael A Mont
- Rubin Institute of Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland(.).
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Xu Y, He Y, Wang H, Wu X, Liu Z, Du G, Wu X, Wu R, Wang Y, Liu W. Widening of narrow urethral plates with lateral skin in TIP hypospadias repair: single center series. BMC Surg 2024; 24:104. [PMID: 38609936 PMCID: PMC11010430 DOI: 10.1186/s12893-024-02400-8] [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] [Received: 02/25/2024] [Accepted: 04/01/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND To compare the outcomes of hypospadias repair using tubularized incised plate (TIP) urethroplasty and modified TIP with lateral skin to widen the urethral plate (WTIP). MATERIALS AND METHODS Data were obtained from pre-pubertal boys who underwent primary hypospadias repair between May 2018 and July 2023. The cases were divided into two groups; one group underwent TIP with urethral plate ≥ 6 mm width and the other group with urethral plate width < 6 mm underwent WTIP. WTIP urethroplasty was performed by widening incisions on the outer margins of the urethral plate to incorporate penile and glandular skin lateral to the urethral plate to facilitate tubularization. Complication rates and urinary functions were compared. RESULTS A total of 157 patients were enrolled in this study. Eighty-eight cases with narrow urethral plate were subjected to WTIP urethroplasty, and the rest were subjected to TIP urethroplasty. The preoperative glans width in WTIP group was less than that in TIP group (P < 0.001), and 44.3% had midshaft meatus in WTIP group compared to 17.4% in TIP group (P < 0.001). However, the incidences of postoperative complications (17.6% vs. 21.6%, P = 0.550) were not statistically different between the TIP and WTIP groups. In addition, both groups did not differ significantly in postoperative uroflowmetry assessment. CONCLUSIONS The described technique helps to create an adequately caliber aesthetic neomeatus and facilitates tubularization, especially in hypospadias with a narrow urethral plate. Our data suggest that augmentation of a narrow urethral plate with WTIP has a similar surgical outcome to that of the TIP procedure in patients with a wide urethral plate.
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Affiliation(s)
- Yingrui Xu
- Department of Pediatric Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Yan He
- Department of Pediatric Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Hongwei Wang
- Department of Pediatric Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Xuemin Wu
- Department of Pediatric Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Zhaoquan Liu
- Department of Pediatric Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Guoqiang Du
- Department of Pediatric Surgery, Shandong Provincial Hospital Afiliated to Shandong First Medical University, Jinan, China
| | - Xiangyu Wu
- Department of Pediatric Surgery, Shandong Provincial Hospital Afiliated to Shandong First Medical University, Jinan, China
| | - Rongde Wu
- Department of Pediatric Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Yanze Wang
- Department of Pediatric Surgery, Shandong Provincial Hospital Afiliated to Shandong First Medical University, Jinan, China.
| | - Wei Liu
- Department of Pediatric Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China.
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Zhou N, Ripley-Gonzalez JW, Zhang W, Xie K, You B, Shen Y, Cao Z, Qiu L, Li C, Fu S, Zhang C, Dun Y, Gao Y, Liu S. Preoperative Exercise Training Decreases Complications of Minimally Invasive Lung Cancer Surgery- A Randomized Controlled Trial. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00296-4. [PMID: 38614212 DOI: 10.1016/j.jtcvs.2024.04.009] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 03/13/2024] [Accepted: 04/06/2024] [Indexed: 04/15/2024]
Abstract
OBJECTIVE Limited evidence exists regarding the efficacy of preoperative exercise (PE) in reducing short-term complications after minimally invasive surgery in patients with non-small cell lung cancer (NSCLC). This study aims to investigate the impact of PE on short-term complications following minimally invasive lung resection. METHODS In this prospective, open-label, randomized (1:1) controlled trial at Xiangya Hospital, China (Sep 2020-Feb 2022), patients were randomly assigned to a PE group with 16-day alternate supervised exercise or a control. The primary outcome assessed was short-term postoperative complications, with a follow-up period of 30 days post-surgery. RESULTS A total of 124 patients were recruited (PE group n=62; control n=62). Finally, 101 patients (PE group; n=51 and control; n=50) with a median age of 56 years (interquartile range, 50-62 years) completed the study. Compared with the control, the PE group showed fewer postoperative complications (PE:3/51 vs. Control 10/50; OR [95% CI], 0.17 [0.04 to 0.86], P=0.03) and shorter hospital stays (mean difference [95% CI], -2 [-3 to -1], P=0.01). PE significantly improved depression, stress, functional capacity, and quality of life (all P<0.05) before surgery. Furthermore, PE demonstrated a significantly lower minimum blood pressure during surgery, lower increases body temperature on day 2 after surgery, neutrophil-to-lymphocyte ratio, and neutrophil count after surgery (all P<0.05). Exploratory research on lung tissue RNA sequencing (5 in each group) showed downregulation of the tumor necrosis factor signaling pathway in the PE group compared with control. CONCLUSIONS Preoperative exercise training decreased short-term postoperative complications in patients with NSCLC.
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Affiliation(s)
- Nanjiang Zhou
- Division of Cardiac Rehabilitation, Department of Physical Medicine & Rehabilitation, Xiangya Hospital of Central South University, Changsha, 410008, Hunan, China
| | - Jeffrey W Ripley-Gonzalez
- Division of Cardiac Rehabilitation, Department of Physical Medicine & Rehabilitation, Xiangya Hospital of Central South University, Changsha, 410008, Hunan, China
| | - Wenliang Zhang
- Division of Cardiac Rehabilitation, Department of Physical Medicine & Rehabilitation, Xiangya Hospital of Central South University, Changsha, 410008, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, 410008, Hunan, China
| | - Kangling Xie
- Division of Cardiac Rehabilitation, Department of Physical Medicine & Rehabilitation, Xiangya Hospital of Central South University, Changsha, 410008, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, 410008, Hunan, China
| | - Baiyang You
- Division of Cardiac Rehabilitation, Department of Physical Medicine & Rehabilitation, Xiangya Hospital of Central South University, Changsha, 410008, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, 410008, Hunan, China
| | - Yanan Shen
- Division of Cardiac Rehabilitation, Department of Physical Medicine & Rehabilitation, Xiangya Hospital of Central South University, Changsha, 410008, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, 410008, Hunan, China
| | - Zeng Cao
- Division of Cardiac Rehabilitation, Department of Physical Medicine & Rehabilitation, Xiangya Hospital of Central South University, Changsha, 410008, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, 410008, Hunan, China
| | - Ling Qiu
- Division of Cardiac Rehabilitation, Department of Physical Medicine & Rehabilitation, Xiangya Hospital of Central South University, Changsha, 410008, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, 410008, Hunan, China
| | - Cui Li
- Division of Cardiac Rehabilitation, Department of Physical Medicine & Rehabilitation, Xiangya Hospital of Central South University, Changsha, 410008, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, 410008, Hunan, China
| | - Siqian Fu
- Division of Cardiac Rehabilitation, Department of Physical Medicine & Rehabilitation, Xiangya Hospital of Central South University, Changsha, 410008, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, 410008, Hunan, China
| | - Chunfang Zhang
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, 410008, Hunan, China; Department of Thoracic Surgery, Xiangya Hospital of Central South University, Changsha, 410008, Hunan, China
| | - Yaoshan Dun
- Division of Cardiac Rehabilitation, Department of Physical Medicine & Rehabilitation, Xiangya Hospital of Central South University, Changsha, 410008, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, 410008, Hunan, China; Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, 200 1(st) st SW, 55905, MN, USA.
| | - Yang Gao
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, 410008, Hunan, China; Department of Thoracic Surgery, Xiangya Hospital of Central South University, Changsha, 410008, Hunan, China; Hunan Engineering Research Center for Pulmonary Nodules Precise Diagnosis & Treatment, Changsha, 410008, Hunan, China.
| | - Suixin Liu
- Division of Cardiac Rehabilitation, Department of Physical Medicine & Rehabilitation, Xiangya Hospital of Central South University, Changsha, 410008, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, 410008, Hunan, China.
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Yang J, Liu X, Song Y. One case of acute myocardial infarction combined with cardiac rupture. Asian J Surg 2024:S1015-9584(24)00609-2. [PMID: 38609823 DOI: 10.1016/j.asjsur.2024.03.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/15/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Affiliation(s)
- Jian Yang
- Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Xudong Liu
- Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Yanyan Song
- Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan, 750004, China.
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Bohr J, Küntscher M, Heß J. [New S2k guideline "Surgical techniques for gender incongruence"]. Urologie 2024:10.1007/s00120-024-02329-z. [PMID: 38592445 DOI: 10.1007/s00120-024-02329-z] [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] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Various techniques for the surgical treatment of gender incongruence (GI) have been available for years. The spectrum is broad and covers various specialties. In recent years, there has been an increase in the number of clinics offering body-modifying procedures. This has led to a considerable variation in methods in some cases. Although the topic has recently found its way more and more into teaching and the relevant specialist literature, there are still no evidence-based recommendations on the various techniques. AIM A compendium of established surgical techniques was to be compiled, containing recommendations on indication, performance and aftercare as well as complication management and subjecting them to a consensus-based evaluation. MATERIALS AND METHODS In accordance with "Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften" (AWMF) regulations, the guideline was developed at level S2k, i.e., it is consensus based. The guideline group was founded in February 2019 in a formal constituent meeting. A total of 14 medical societies and 2 interest groups were recruited for the guideline work. In the end, two consensus meetings were held, which was due to the large number of recommendations and background texts to be adopted. RESULTS The guideline focuses on the choice and applicability of surgical techniques as well as the wishes of those seeking treatment and protection of fertility. There is a wide variety of methods and treatment goals for each individual. Taking into account medical standards, recommendations, and contraindications, an optimal result that minimizes individual suffering can be achieved together with the person seeking treatment. CONCLUSION The content of the guideline represents a unique compendium of surgical methods, recommendations for the selection of procedures, and common indications in the field of body-modifying surgery for gender incongruence.
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Affiliation(s)
- Julia Bohr
- Zentrum für Transgenderchirurgie, Klinik für Urologie, Kinderurologie und urologische Onkologie, KEM|Evang. Kliniken Essen-Mitte, Henricistr. 92, 45136, Essen, Deutschland.
| | | | - Jochen Heß
- Klinik für Urologie, Kinderurologie und Uroonkologie, Universitätsklinikum Essen, Essen, Deutschland
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Baudry A, Schirmann A, Guillot-Tantay C, Lebret T, Vidart A, Neuville P, Madec FX. 50 years of inflatable penile implants: Where do we stand in France? Fr J Urol 2024; 34:102635. [PMID: 38599322 DOI: 10.1016/j.fjurol.2024.102635] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/08/2024] [Accepted: 04/02/2024] [Indexed: 04/12/2024]
Abstract
INTRODUCTION With 50 years' experience, inflatable penile implants are the preferred option for erectile dysfunction refractory to pharmacological and mechanical treatment. Technical and surgical improvements have optimized patient success and satisfaction. However, multi-factorial dissatisfaction persists. OBJECTIVE The aim of this study is to provide an overview of available technological improvements and innovations, as well as the perioperative management and complications of inflatable penile implant surgery. METHOD A literature review was carried out over the last twenty years to answer 4 questions: what are the different inflatable penile implants available in 2023, for which indications, results and complications. RESULTS Four companies propose inflatable penile implants in France. The main improvements have been in the various components of the prosthesis with better cylinder extension, more ergonomic reservoirs, and more manageable pumps, leading to a better durability. Indications have been extended to patients suffering from Peyronie's disease and in emergency cases of priapism. In response to demand from the transgender population, specific phalloplasty implants have been developed. New options are being developed for difficult cases of retracted penis. Results show a high satisfaction rate. Currently the main challenge is the management of infection with the development of rescue protocols using antibiotics to preserve implants - or replace them in a single operation. CONCLUSION After 50years' experience, improvements in penile implants led to effective, satisfactory and safe treatment and can be proposed in new indications. Further development is sill necessary to offer solutions in difficult cases.
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Boyapati RM, Hoggard TM, Yarboro SR, Hadeed MM. Dysphagia is associated with increased mortality risk after hip fracture surgery. Eur J Orthop Surg Traumatol 2024:10.1007/s00590-024-03918-6. [PMID: 38587621 DOI: 10.1007/s00590-024-03918-6] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 03/14/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE This study aims to explore the prevalence of dysphagia, as well as mortality associated with dysphagia in the elderly population receiving surgical treatment for a hip fracture. METHODS A retrospective cohort study was completed at an academic level 1 tertiary care center. Patients older than or equal to 65 admitted with a hip fracture diagnosis from January 2015 to December 2020 (n = 617) were included. The main outcome was the prevalence of dysphagia and association with mortality. Secondary analysis included timing of dysphagia and contributions to mortality. RESULTS Fifty-six percent of patients had dysphagia, and the mortality rates were higher in patients with dysphagia (8.9%) versus those without dysphagia (2.6%), chi-square p = 0.001, and odds ratio 3.69 (CI 1.6-8.5). Mortality rates in patients with acute dysphagia were also higher (12.4%) than those with chronic dysphagia (5%) and chi-squared p = 0.02. Mortality rates in patients with a perioperative dysphagic event (13.9%) were higher than those with non-perioperative dysphagia (4%) and chi-squared p = 0.001. Mortality rates in patients who had acute perioperative dysphagia (21.2%) were higher than those with chronic dysphagia that presented perioperatively (6.8%) and chi-squared p = 0.006. CONCLUSIONS This study demonstrates high rates of dysphagia in the elderly hip fracture population and a significant association between dysphagia and mortality. Timing and chronicity of dysphagia were relevant, as patients with acute perioperative dysphagia had the highest mortality rate. Unlike other identified risk factors, dysphagia may be at least partially modifiable. More research is needed to determine whether formal evaluation and treatment of dysphagia lowers mortality risk.
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Affiliation(s)
- Rohan M Boyapati
- Department of Orthopaedic Surgery, University of Virginia, 2280 Ivy Rd, Charlottesville, VA, USA
| | - Timothy M Hoggard
- Department of Orthopaedic Surgery, University of Virginia, 2280 Ivy Rd, Charlottesville, VA, USA
| | - Seth R Yarboro
- Department of Orthopaedic Surgery, University of Virginia, 2280 Ivy Rd, Charlottesville, VA, USA
| | - Michael M Hadeed
- Department of Orthopaedic Surgery, University of Virginia, 2280 Ivy Rd, Charlottesville, VA, USA.
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Prakash G, Peters CE, Badalato G, Hampson LA, Raman JD, Bagrodia A. Complications and Surgeon Health: Resources for individuals and institutions. Urol Oncol 2024:S1078-1439(24)00317-X. [PMID: 38594152 DOI: 10.1016/j.urolonc.2024.02.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 02/06/2024] [Indexed: 04/11/2024]
Abstract
The emotional impact of surgical complications on urologists is a significant yet historically under-addressed issue. Traditionally, surgeons have been expected to cope with complications and their psychological effects in silence, perpetuating a culture of perfectionism and 'silent suffering.' This has left many unprepared to handle the emotional toll of adverse events during their training and early careers. Recognizing the gap in structured education on this matter, there is a growing movement to openly address and educate on the emotional consequences of surgical complications. This article underscores the importance of such educational initiatives in the mid-career phase, proposing strategies to promote surgeon health, and psychological safety. It advocates for utilizing Morbidity and Mortality conferences as platforms for peer support, learning from 'near miss' events, and encourages at least annual department-wide discussions to raise awareness and normalize the emotional challenges faced by surgeons. Furthermore, it highlights the role of formal peer support programs, acceptance and commitment therapy, and resilience training as vital tools for promoting surgeon well-being. Resources from various organizations, including the American Urological Association and the American Medical Association, are now available to facilitate these critical conversations. By integrating these resources and encouraging a culture of openness and support, the article suggests that the surgical community can better manage the inevitable emotional ramifications of complications, thereby fostering resilience and reducing burnout among surgeons.
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Affiliation(s)
- Gagan Prakash
- Tata Memorial Hospital, Department of Urology, Mumbai, India
| | - Chloe E Peters
- University of Washington, Department of Urology, Seattle WA
| | - Gina Badalato
- Columbia University, Department of Urology, New York, NY
| | - Lindsay A Hampson
- University of California, San Francisco, Department of Urology, California
| | - Jay D Raman
- Penn State Health, Department of Urology, Hershey PA
| | - Aditya Bagrodia
- University of California, San Diego, Department of Urology, La Jolla, CA; University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX.
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Davies MG, Hart JP. Extra-corporal Membrane Oxygenation (ECMO) in Massive Pulmonary Embolism. Ann Vasc Surg 2024:S0890-5096(24)00182-1. [PMID: 38588954 DOI: 10.1016/j.avsg.2024.02.015] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/09/2024] [Accepted: 02/10/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Massive pulmonary embolism (MPE) carries significant 30-day mortality, and a change in societal guidelines has promoted the increasing use of extracorporeal membrane oxygenation (ECMO) in the immediate management of MPE-associated cardiovascular shock. This narrative review examines the current status of ECMO in MPE. METHODS A literature review was performed from 1982 to 2022 search for the terms Pulmonary embolism and ECMO and refined by examining those publications that covered MPE RESULTS: In the patient with MPE, veno-arterial-ECMO is now recommended as a bridge to interventional therapy. It can reliably decrease right ventricular overload, improve RV function, and allow hemodynamic stability and restoration of tissue oxygenation. The use of ECMO in MPE has been associated with lower mortality in registry reviews, but there has been no significant difference in outcomes between patients treated with and without ECMO in meta-analyses. Applying ECMO is also associated with substantial multisystem morbidity due to systemic inflammatory response, bleeding with coagulopathy, hemorrhagic stroke, renal dysfunction, and acute limb ischemia, which must be factored into the outcomes. CONCLUSIONS The application of ECMO in MPE should be combined with an aggressive interventional pulmonary interventional program and should strictly adhere to the current selection criteria.
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Affiliation(s)
- Mark G Davies
- Center for Quality, Effectiveness, and Outcomes in Cardiovascular Diseases, Houston, Texas; Department of Vascular and Endovascular Surgery, Ascension Health, Waco, Texas.
| | - Joseph P Hart
- Division of Vascular Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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