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Ghanaati H, Zarei D, Issaiy M, Ghavami N, Shakiba M, Zebardast J, Abbastabar H, Jalali AH, Firouznia K. Efficacy and Safety of Preoperative Embolization in Glomus Jugulare Tumors: A Systematic Review and Meta-analysis of Clinical Outcomes and Complications. Cardiovasc Intervent Radiol 2024:10.1007/s00270-024-03687-z. [PMID: 38528173 DOI: 10.1007/s00270-024-03687-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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/16/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE This study aims to provide a comprehensive review of the clinical benefits, complications, and safety profile associated with preoperative embolization in Glomus jugulare tumors (GJTs). MATERIALS AND METHODS A comprehensive search in PubMed, Embase, and Web of Science was conducted for English articles published up to March 2023, focusing on GJTs and preoperative embolization. Included studies involved patients over 18 with GJTs. We excluded studies that explored embolization methods other than the standard endovascular approach, as well as studies involving paragangliomas that did not provide specific data related to GJTs. Key variables such as hemorrhage volume and surgical time, as well as clinical outcomes, were analyzed. Data were analyzed using a random-effects model meta-analysis, assessing heterogeneity with the I2 statistic. RESULTS This review encompasses 19 studies with a total of 328 patients. The studies incorporated into our meta-analysis display considerable differences and inconsistencies in their data. The findings of the meta-analysis show a mean hemorrhage volume of 636 ml (95% confidence interval (CI) 473-799) following preoperative embolization, and a mean surgical duration of 487 min (95% CI 350-624). The study also notes potential complications: facial nerve deficits occurred in 20% of cases (95% CI 11-32%), and vagal nerve deficits in 22% (95% CI 13-31%). CONCLUSION This study suggests that preoperative embolization could decrease surgery duration and blood loss, but emphasizes the importance of evaluating risks like nerve damage. However, the generalizability of these findings is restricted due to the diversity of available data.
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Affiliation(s)
- Hossein Ghanaati
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Diana Zarei
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Mahbod Issaiy
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Nafiseh Ghavami
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Madjid Shakiba
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Jayran Zebardast
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Hedayat Abbastabar
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Jalali
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Kavous Firouznia
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran.
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Lucocq J, Thakur V, Geropoulos G, Stansfield D, Irvine L, Duxbury M, de Beaux AC, Tulloh B, Wallace B, Joyce B, Harrow L, Drummond G, Lamb PJ, Robertson AG. Intensive pre-operative information course (IPIC) and pre-operative weight loss results in long-term sustained weight loss following bariatric surgery: 11 years results from a tertiary referral centre. Surg Endosc 2024:10.1007/s00464-024-10791-1. [PMID: 38519610 DOI: 10.1007/s00464-024-10791-1] [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: 12/08/2023] [Accepted: 03/09/2024] [Indexed: 03/25/2024]
Abstract
INTRODUCTION Outcomes of long-term (5-10-year) weight loss have not been investigated thoroughly and the role of pre-operative weight loss on long-term weight loss, among other factors, are unknown. Our regional bariatric service introduced a 12 week intensive pre-operative information course (IPIC) to optimise pre-operative weight loss and provide education prior to bariatric surgery. The present study determines the effect of pre-operative weight loss and an intense pre-operative information course (IPIC), on long-term weight outcomes and sustained weight loss post-bariatric surgery. METHODS Data were collected prospectively from a bariatric center (2008-2022). Excess weight loss (EWL) ≥ 50% and ≥ 70% were considered outcome measures. Survival analysis and logistic regression identified variables associated with overall and sustained EWL ≥ 50% and ≥ 70%. RESULTS Three hundred thirty-nine patients (median age, 49 years; median follow-up, 7 years [0.5-11 years]; median EWL%, 49.6%.) were evaluated, including 158 gastric sleeve and 161 gastric bypass. During follow-up 273 patients (80.5%) and 196 patients (53.1%) achieved EWL ≥ 50% and ≥ 70%, respectively. In multivariate survival analyses, pre-operative weight loss through IPIC, both < 10.5% and > 10.5% EWL, were positively associated with EWL ≥ 50% (HR 2.23, p < 0.001) and EWL ≥ 70% (HR 3.24, p < 0.001), respectively. After a median of 6.5 years after achieving EWL50% or EWL70%, 56.8% (154/271) had sustained EWL50% and 50.6% (85/168) sustained EWL70%. Higher pre-operative weight loss through IPIC increased the likelihood of sustained EWL ≥ 50% (OR, 2.36; p = 0.013) and EWL ≥ 70% (OR, 2.03; p = 0.011) at the end of follow-up. CONCLUSIONS IPIC and higher pre-operative weight loss improve weight loss post-bariatric surgery and reduce the likelihood of weight regain during long-term follow-up.
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Affiliation(s)
- James Lucocq
- Department of Bariatric and Upper Gastrointestinal Surgery, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Vikram Thakur
- Department of Bariatric and Upper Gastrointestinal Surgery, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Georgios Geropoulos
- Department of Bariatric and Upper Gastrointestinal Surgery, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Daniel Stansfield
- Department of Bariatric and Upper Gastrointestinal Surgery, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Laura Irvine
- Department of Bariatric and Upper Gastrointestinal Surgery, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Mhairi Duxbury
- Department of Bariatric and Upper Gastrointestinal Surgery, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Andrew C de Beaux
- Department of Bariatric and Upper Gastrointestinal Surgery, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Bruce Tulloh
- Department of Bariatric and Upper Gastrointestinal Surgery, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Beverley Wallace
- Department of Bariatric and Upper Gastrointestinal Surgery, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Brian Joyce
- Department of Bariatric and Upper Gastrointestinal Surgery, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Lisa Harrow
- Department of Bariatric and Upper Gastrointestinal Surgery, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Gillian Drummond
- Department of Bariatric and Upper Gastrointestinal Surgery, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Peter J Lamb
- Department of Bariatric and Upper Gastrointestinal Surgery, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Andrew G Robertson
- Department of Bariatric and Upper Gastrointestinal Surgery, Royal Infirmary Edinburgh, Edinburgh, UK.
- Department of Clinical Surgery, NHS Lothian, University of Edinburgh, Edinburgh, UK.
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Sun Y, Guo N, Zhang M, Liu M, Gao Z, Sun T, Gao X, Xu L, Zhang H, Wei C, Liu P, Liu Y, Zhang X, Guo Y, Chen L, Zhou Z, Su Z, Hu Y, Shi X, Huang L, Wang Y. Association between preoperative frailty and myocardial injury after noncardiac surgery in geriatric patients: study protocol for a prospective, multicentre, real-world observational, cohort trial. BMC Geriatr 2024; 24:271. [PMID: 38504166 PMCID: PMC10953137 DOI: 10.1186/s12877-024-04847-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: 06/14/2023] [Accepted: 02/24/2024] [Indexed: 03/21/2024] Open
Abstract
INTRODUCTION Frailty has become a worldwide health burden that has a large influence on public health and clinical practice. The incidence of frailty is anticipated to increase as the ageing population increases. Myocardial injury after noncardiac surgery (MINS) is associated with short-term and long-term mortality. However, the incidence of MINS in frail geriatric patients is unknown. METHODS AND ANALYSIS This prospective, multicentre, real-world observational cohort study will be conducted at 18 designated centres in China from January 2023 to December 2024, with an anticipated sample size of 856 patients aged 65 years and older who are scheduled to undergo noncardiac surgery. The primary outcome will be the incidence of MINS. MINS is defined as a fourth-generation plasma cardiac troponin T (cTnT) concentration ≥ 0.03 ng/mL exhibited at least once within 30 days after surgery, with or without symptoms of myocardial ischaemia. All data will be collected via electronic data acquisition. DISCUSSION This study will explore the incidence of MINS in frail patients. The characteristics, predictive factors and 30-day outcomes of MINS in frail patients will be further investigated to lay the foundation for identifying clinical interventions. CLINICAL TRIAL REGISTRATION https://beta. CLINICALTRIALS gov/study/NCT05635877 , NCT05635877.
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Affiliation(s)
- Yongtao Sun
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, 250014, China
| | - Na Guo
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, 250014, China
| | - Min Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, 250014, China
| | - Mengjie Liu
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, 250014, China
| | - Zhongquan Gao
- Department of Anesthesiology, Shandong Public Health Clinical Center, Shandong University, Shandong, 250013, China
| | - Tao Sun
- Department of Clinical Laboratory Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, 250014, China
| | - Xiaojun Gao
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, 250014, China
| | - Lingling Xu
- Department of Nursing, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, 250014, China
| | - Haixia Zhang
- Department of Nursing, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, 250014, China
| | - Chuansong Wei
- Department of Nursing, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, 250014, China
| | - Peng Liu
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, 250014, China
- Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, 250117, China
| | - Yang Liu
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, 250014, China
| | - Xiaoning Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, 250014, China
| | - Yongle Guo
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, 250014, China
- Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, 250117, China
| | - Lina Chen
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, 250014, China
| | - Zheng Zhou
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, 250014, China
- Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, 250117, China
| | - Zhenqiang Su
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, 250014, China
- Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, 250117, China
| | - Yanmei Hu
- Department of Nursing, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, 250014, China
| | - Xin Shi
- Department of Nursing, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, 250014, China
| | - Linlin Huang
- Department of Nursing, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, 250014, China.
| | - Yuelan Wang
- Department of Anesthesiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University (Shandong Provincial Hospital), Jinan, 250021, China.
- Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, 250117, China.
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Leo CSY, Cheng LJ, Lam XR, He H. Global prevalence and factors associated with preoperative depression in women undergoing breast surgery: a meta-analysis and meta-regression. Breast Cancer Res Treat 2024:10.1007/s10549-023-07216-3. [PMID: 38492162 DOI: 10.1007/s10549-023-07216-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 12/05/2023] [Indexed: 03/18/2024]
Abstract
PURPOSE Depression is one of the main psychological responses experienced by patients with breast cancer perioperatively. Therefore, this review aimed to synthesize the prevalence rate of depression preoperatively among patients with breast cancer. METHODS Six databases were searched for published articles, which recruited female patients aged 18 years and above, diagnosed with breast cancer and planned for breast surgery. Grey literatures were searched from ProQuest Theses and Dissertations, Science.gov and CogPrints. Studies published in English from the inception of databases to January 2023 were considered. Two reviewers screened, extracted, and appraised the data independently. Joanna Briggs Institute data collection form was used for data collection. Hoy's Risk of Bias Tool was utilized to assess the individual study's quality. Review Manager 5.4 software was utilized for meta-analysis. Subgroup analyses were conducted to explore the reasons for any heterogeneity. Publication bias was evaluated by Egger's test and funnel plot. RESULTS Twenty studies involving 32,143 patients with breast cancer were included. Meta-analyses revealed an overall preoperative prevalence of 30% among all studies. Subgroup analyses showed that studies conducted in the Middle East and North Africa used purposive sampling, with patients undergoing mastectomy and lumpectomy and with moderate risk of bias reported higher prevalence of preoperative depression (54%, 44%, 40%, and 49%, respectively) as compared to other respective subgroups. CONCLUSION The high prevalence of preoperative depression among women with breast cancer indicated the need for health care professionals to provide more psychological support to them.
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Affiliation(s)
- Celest Su Yi Leo
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Bock MD11, 10 Medical Drive, Singapore, 117597, Singapore
- National University Health System, Singapore, Singapore
| | - Ling Jie Cheng
- National University Health System, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Xin Rong Lam
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Bock MD11, 10 Medical Drive, Singapore, 117597, Singapore
- National University Health System, Singapore, Singapore
| | - Honggu He
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Bock MD11, 10 Medical Drive, Singapore, 117597, Singapore.
- National University Health System, Singapore, Singapore.
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Routman DM, Jusue-Torres I, Brown PD, Trifiletti DM, Vora SA, Brown DA, Parney IF, Burns TC, Yan E. Pre-operative vs. post-operative stereotactic radiosurgery for operative metastatic brain tumors: study protocol for a phase III clinical trial. BMC Cancer 2024; 24:332. [PMID: 38475765 PMCID: PMC10929171 DOI: 10.1186/s12885-024-12060-9] [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: 06/02/2023] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Almost one third of cancer patients in the United States will develop brain metastases on an annual basis. Surgical resection is indicated in the setting of brain metastases for reasons, such as maximizing local control in select patients, decompression of mass effect, and/or tissue diagnosis. The current standard of care following resection of a brain metastasis has shifted from whole brain radiation therapy to post-operative stereotactic radiosurgery (SRS). However, there is a significant rate of local recurrence within one year of postoperative SRS. Emerging retrospective and prospective data suggest pre-operative SRS is a safe and potentially effective treatment paradigm for surgical brain metastases. This trial intends to determine, for patients with an indication for resection of a brain metastasis, whether there is an increase in the time to a composite endpoint of adverse outcomes; including the first occurrence of either: local recurrence, leptomeningeal disease, or symptomatic radiation brain necrosis - in patients who receive pre-operative SRS as compared to patients who receive post-operative SRS. METHODS This randomized phase III clinical trial compares pre-operative with post-operative SRS for brain metastases. A dynamic random allocation procedure will allocate an equal number of patients to each arm: pre-operative SRS followed by surgery or surgery followed by post-operative SRS. EXPECTED OUTCOMES If pre-operative SRS improves outcomes relative to post-operative SRS, this will establish pre-operative SRS as superior. If post-operative SRS proves superior to pre-operative SRS, it will remain a standard of care and halt the increasing utilization of pre-operative SRS. If there is no difference in pre- versus post-operative SRS, then pre-operative SRS may still be preferred, given patient convenience and the potential for a condensed timeline. DISCUSSION Emerging retrospective and prospective data have demonstrated some benefits of pre-op SRS vs. post-op SRS. This study will show whether there is an increase in the time to the composite endpoint. Additionally, the study will compare overall survival; patient-reported outcomes; morbidity; completion of planned therapies; time to systemic therapy; time to regional progression; time to CNS progression; time to subsequent treatment; rate of radiation necrosis; rate of local recurrence; and rate of leptomeningeal disease. TRIAL REGISTRATION NUMBER NCT03750227 (Registration date: 21/11/2018).
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Affiliation(s)
- David M Routman
- Department of Radiation Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | - Sujay A Vora
- Department of Radiation Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Desmond A Brown
- Neurosurgical Oncology Unit, National Institute of Health, Bethesda, MN, USA
| | - Ian F Parney
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Terry C Burns
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth Yan
- Department of Radiation Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Boden I, Reeve J, Jernås A, Denehy L, Fagevik Olsén M. Preoperative physiotherapy prevents postoperative pulmonary complications after major abdominal surgery: a meta-analysis of individual patient data. J Physiother 2024:S1836-9553(24)00013-4. [PMID: 38472053 DOI: 10.1016/j.jphys.2024.02.012] [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: 09/11/2023] [Revised: 02/06/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
QUESTIONS Among patients having elective abdominal surgery, how much does preoperative physiotherapy education with breathing exercise training reduce the incidence of postoperative pulmonary complications (PPCs), hospital length of stay and 12-month mortality? How stable are the treatment effects across different PPC definitions, including pneumonia? How much do the treatment effects on PPC, hospital length of stay and mortality vary within clinically relevant subgroups? DESIGN Individual participant-level meta-analysis (n = 800) from two randomised controlled trials analysed with multivariable regression. PARTICIPANTS Adults undergoing major elective abdominal surgery. INTERVENTIONS Experimental participants received a single preoperative session with a physiotherapist within 4 weeks of surgery and educated on PPC prevention with breathing exercises and early mobilisation. They were taught breathing exercises and instructed to start them immediately on waking from surgery. The control group received no preoperative or postoperative physiotherapy, or early ambulation alone. OUTCOME MEASURES PPC, hospital length of stay and 12-month mortality. RESULTS Participants who received preoperative physiotherapy had 47% lower odds of developing a PPC (adjusted OR 0.53, 95% CI 0.34 to 0.85). This effect was stable regardless of PPC definition. Effects were greatest in participants who smoked, were aged ≤ 45 years, had abnormal body weight, had multiple comorbidities, or were undergoing bariatric or upper gastrointestinal surgery. Participants having operations ≤ 3 hours in duration were least responsive to preoperative physiotherapy. Participants with multiple comorbidities were more likely to have a shorter hospital stay if provided with preoperative physiotherapy (adjusted MD -3.2 days, 95% CI -6.2 to -0.3). Effects on mortality were uncertain. CONCLUSION There is strong evidence to support preoperative physiotherapy in preventing PPCs after elective abdominal surgery.
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Affiliation(s)
- Ianthe Boden
- University of Tasmania, Launceston, Tasmania, Australia; Launceston General Hospital, Launceston, Australia.
| | - Julie Reeve
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand; Physiotherapy Department, North Shore Hospital, Auckland, New Zealand
| | - Anna Jernås
- Department of Physical Therapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Linda Denehy
- Physiotherapy Department, The University of Melbourne, Melbourne, Australia; Peter McCallum Cancer Centre, Melbourne, Australia
| | - Monika Fagevik Olsén
- Department of Physical Therapy, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
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Ren G, Zheng G, Du K, Dang Z, Dan H, Dou X, Duan L, Xie Z, Niu L, Tian Y, Zheng J, Feng F. Prognostic value of dynamic changes of pre- and post-operative tumor markers in colorectal cancer. Clin Transl Oncol 2024:10.1007/s12094-024-03429-0. [PMID: 38453817 DOI: 10.1007/s12094-024-03429-0] [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] [Received: 01/18/2024] [Accepted: 02/27/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Colorectal cancer (CRC) prognosis assessment is vital for personalized treatment plans. This study investigates the prognostic value of dynamic changes of tumor markers CEA, CA19-9, CA125, and AFP before and after surgery and constructs prediction models based on these indicators. METHODS A retrospective clinical study of 2599 CRC patients who underwent radical surgery was conducted. Patients were randomly divided into training (70%) and validation (30%) datasets. Univariate and multivariate Cox regression analyses identified independent prognostic factors, and nomograms were constructed. RESULTS A total of 2599 CRC patients were included in the study. Patients were divided into training (70%, n = 1819) and validation (30%, n = 780) sets. Univariate and multivariate Cox regression analyses identified age, total number of resected lymph nodes, T stage, N stage, the preoperative and postoperative changes in the levels of CEA, CA19-9, and CA125 as independent prognostic factors. When their postoperative levels are normal, patients with elevated preoperative levels have significantly worse overall survival. However, when the postoperative levels of CEA/CA19-9/CA125 are elevated, whether their preoperative levels are elevated or not has no significance for prognosis. Two nomogram models were developed, and Model I, which included CEA, CA19-9, and CA125 groups, demonstrated the best performance in both training and validation sets. CONCLUSION This study highlights the significant predictive value of dynamic changes in tumor markers CEA, CA19-9, and CA125 before and after CRC surgery. Incorporating these markers into a nomogram prediction model improves prognostic accuracy, enabling clinicians to better assess patients' conditions and develop personalized treatment plans.
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Affiliation(s)
- Guangming Ren
- Department of Gastrointestinal Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
- Department of General Surgery, Air Force 986(Th) Hospital, Fourth Military Medical University, Xi'an, China
| | - Gaozan Zheng
- Department of Gastrointestinal Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Kunli Du
- Department of Gastrointestinal Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Zhangfeng Dang
- Department of General Surgery, Air Force 986(Th) Hospital, Fourth Military Medical University, Xi'an, China
| | - Hanjun Dan
- Department of Gastrointestinal Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xinyu Dou
- Department of Gastrointestinal Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Lili Duan
- Department of Gastrointestinal Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Zhenyu Xie
- Department of Gastrointestinal Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Liaoran Niu
- Department of Gastrointestinal Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Ye Tian
- Department of Gastrointestinal Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jianyong Zheng
- Department of Gastrointestinal Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
| | - Fan Feng
- Department of Gastrointestinal Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
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Mendez-Pino L, Zorrilla-Vaca A, Hepner DL. Management of Preoperative Anemia. Anesthesiol Clin 2024; 42:65-73. [PMID: 38278593 DOI: 10.1016/j.anclin.2023.09.002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
Anemia is the most common modifiable risk factor for postoperative morbidity and mortality. Early identification and optimal management are key to restore iron stores and ensure its resolution before surgery. Several therapies have been proposed to treat anemia in the perioperative period, such as iron supplementation and erythropoiesis-stimulating agents, though it remains unclear which is the most optimal to improve clinical outcomes. This article summarizes the most updated evidence on perioperative management of anemia and denotes differences among the international guidelines to reflect the conflicting evidence in this field and the need for further research in specific areas.
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Affiliation(s)
- Laura Mendez-Pino
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115-6110, USA; Department of Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Hospital, 2799 W Grand Boulevard, Detroit, MI 48202, USA
| | - Andrés Zorrilla-Vaca
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115-6110, USA
| | - David L Hepner
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115-6110, USA.
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Antunez AG, Rowe KA, Bain PA, Doherty GM, Dossett LA. Behavioral Interventions on Surgeons' Preoperative Decision-Making: A Scoping Review and Critical Analysis. J Surg Res 2024; 295:547-558. [PMID: 38086255 PMCID: PMC10922393 DOI: 10.1016/j.jss.2023.11.037] [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: 06/20/2023] [Revised: 10/20/2023] [Accepted: 11/12/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Consensus is lacking regarding the optimal strategy to influence surgeons' behaviors to reduce low-value surgical care. Comprehensively describing the existing body of literature that seeks to intervene on surgeons' preoperative decision-making may aid in structuring future behavior change strategies. METHODS We performed a scoping review using four databases (Medical Literature Analysis and Retrieval System Online, Embase, Web of Science, and Cumulated Index to Nursing and Allied Health Literature) for articles that tested the effect of behavioral-based interventions on any aspect of surgeons' decision-making in the preoperative setting. Abstracted data were characterized by summative descriptions and analyzed using the Tailored Implementation for Chronic Disease framework, mapping aspects of deimplementation strategies in the studies onto the determinant(s) that they altered. Data abstraction and mapping tools were piloted and iteratively revised before two researchers independently assessing studies and categorizing determinants, and then meeting to discuss their decisions. RESULTS There were 1460 articles identified from the initial search, with 17 full text articles ultimately included in the scoping review. Eight studies relied on a multidisciplinary preoperative conference to accomplish their aims, while five were multifaceted in their approach to deimplementation, and four studies used only a clinical decision support tool to accomplish their aims. Mapping determinants addressed in these studies onto the Tailored Implementation for Chronic Disease framework demonstrated that most strategies attempted to close knowledge gaps, leverage communication between providers, and broadcast institutional prioritization of change. CONCLUSIONS There is a small but growing field of implementation and deimplementation strategies in preoperative surgical decision-making, and different approaches may be equally effective in varied clinical contexts. Deliberate measurement and comparison of outcomes, as well as selection of control groups, are areas for improvement in future work.
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Affiliation(s)
- Alexis G Antunez
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Katherine A Rowe
- Massachusetts General Hospital Department of Surgery, Boston, Massachusetts
| | - Paul A Bain
- Countway Library, Harvard Medical School, Boston, Massachusetts
| | - Gerard M Doherty
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Lesly A Dossett
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
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10
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Yuan JJ, Bangalore R, Darwish D, Moon TS, Wadhwa A. Preoperative Assessment of a Patient Undergoing Bariatric Surgery. Anesthesiol Clin 2024; 42:169-184. [PMID: 38278588 DOI: 10.1016/j.anclin.2023.07.005] [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: 01/28/2024]
Abstract
Over the past few decades, obesity rates in the United States have risen drastically, and with this, there has been a rising demand for bariatric surgery. As such, anesthesiologists need to be familiar with the challenges presented by patients seeking bariatric surgery. Obesity causes pathophysiologic changes which may affect decision-making during the management of these patients. Patients seeking bariatric surgery also have a long, prescribed preoperative course that offers anesthesiologists the opportunity to be involved earlier during the pre-surgical evaluation and optimization process.
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Affiliation(s)
- Jennifer J Yuan
- Department of Anesthesiology and Pain Management, University of Texas Southwestern, 5323 Harry Hines Boulevard, Dallas, TX 75390-9068, USA
| | - Raksha Bangalore
- Department of Anesthesiology and Pain Management, University of Texas Southwestern, 5323 Harry Hines Boulevard, Dallas, TX 75390-9068, USA
| | - Dana Darwish
- Department of Anesthesiology and Pain Management, University of Texas Southwestern, 5323 Harry Hines Boulevard, Dallas, TX 75390-9068, USA
| | - Tiffany S Moon
- Department of Anesthesiology and Pain Management, University of Texas Southwestern, 5323 Harry Hines Boulevard, Dallas, TX 75390-9068, USA.
| | - Anupama Wadhwa
- Department of Anesthesiology and Pain Management, University of Texas Southwestern, 5323 Harry Hines Boulevard, Dallas, TX 75390-9068, USA; Outcomes Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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11
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Nair KG, Kamath SD, Chowattukunnel N, Krishnamurthi SS. Preoperative Strategies for Locally Advanced Colon Cancer. Curr Treat Options Oncol 2024; 25:376-388. [PMID: 38349502 PMCID: PMC10894759 DOI: 10.1007/s11864-024-01184-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 02/27/2024]
Abstract
OPINION STATEMENT Neoadjuvant chemotherapy is safe for patients with locally advanced colon cancer (LACC). The FOxTROT trial demonstrated a reduction in residual and recurrent cancer at 2 years with neoadjuvant chemotherapy for patients with cT3-4 LACC. Preoperative chemotherapy should be avoided, if possible, for patients with dMMR LACC, as over 50% of dMMR cancers have no pathologic response. Early universal testing of MMR status is critical to selecting the appropriate neoadjuvant therapy. Concerns about CT staging of LACC have limited uptake of neoadjuvant chemotherapy, as approximately 25% of patients with cT3-T4 cancer on CT have low-risk stage II disease. Development of CT criteria for malignant nodes should reduce the risk of over-staging. A multidisciplinary approach is needed to identify patients for neoadjuvant therapy. Neoadjuvant immunotherapy is safe and results in dramatic pathologic responses in patients with dMMR LACC. Longer follow-up is needed to determine if the exceptionally high pathologic response rates observed will translate into long-term remission. Remarkably, neoadjuvant immunotherapy has been found to cause major pathologic responses in a subset of patients with pMMR LACC, indicating the potential to cure more patients with this common cancer. Patients with cT4 LACC, whether stage II or III, have a substantial risk of recurrence despite adjuvant fluoropyrimidine plus oxaliplatin chemotherapy. We recommend neoadjuvant systemic therapy for all patients with cT4b LACC (dMMR and pMMR). Features of T4b disease are routinely reported by radiology. We use three cycles of FOLFOX chemotherapy for patients with cT4b pMMR LACC, due to the high rate of compliance and improvement in residual and recurrent disease. Patients with cT4b dMMR LACC should receive neoadjuvant immunotherapy, if there are no contraindications. Clinical trials of neoadjuvant therapy for LACC are of great interest and should provide training for radiologists to identify eligible patients. Results are anticipated from multiple ongoing trials of neoadjuvant chemotherapy, immunotherapy, and targeted therapy for pMMR LACC and immunotherapy for dMMR LACC.
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Affiliation(s)
- Kanika G Nair
- Department of Hematology and Oncology, Cleveland Clinic Taussig Cancer Center, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Suneel D Kamath
- Department of Hematology and Oncology, Cleveland Clinic Taussig Cancer Center, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Nivan Chowattukunnel
- Department of Hematology and Oncology, Cleveland Clinic Taussig Cancer Center, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Smitha S Krishnamurthi
- Department of Hematology and Oncology, Cleveland Clinic Taussig Cancer Center, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
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12
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Diab T, El-Shaer W, Ibrahim S, El-Barky E, Elezz AA. Does preoperative silodosin administration facilitate ureteral dilatation during flexible ureterorenoscopy? A randomized clinical trial. Int Urol Nephrol 2024; 56:839-846. [PMID: 37902925 PMCID: PMC10853317 DOI: 10.1007/s11255-023-03824-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/26/2023] [Indexed: 11/01/2023]
Abstract
PURPOSE To assess whether preoperative administration of silodosin can facilitate the placement of ureteral access sheath (UAS) prior to flexible ureteroscopy (F-URS) and reduce the occurrence of ureteric injury in challenging cases. METHODS This prospective randomized clinical trial was carried out on 147 patients diagnosed with upper ureteric stone or stone kidney, non-stented. The patients were randomly divided into two equal groups. Group A (silodosin group) included patients in whom F-URS was done with daily preoperative intake of 8 mg silodosin for 1 week and group B (placebo/control group) included patients in whom F-URS was done with daily preoperative intake of placebo tablets. RESULTS In group A, a total of 23 (33.3%) experienced ureteral wall injury following UAS insertion, while in group B, this occurred in 40 patients (59.7%). There was a statistically significant difference in the grade of ureteral wall injury between the two groups (P < 0.001). In the multiple regression analysis, age, operative time and silodosin were found to be significant risk factors for ureteral wall injury (P = 0.007, 0.041 and < 0.001, respectively). CONCLUSIONS The administration of silodosin prior to retrograde intrarenal surgery (RIRS) effectively prevented significant ureteral wall damage and reduced initial postoperative discomfort.
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Affiliation(s)
- Tamer Diab
- Urology Department, Faculty of Medicine, Benha University, Benha, Qalyubiyya Governorate, Egypt.
| | - Waleed El-Shaer
- Urology Department, Faculty of Medicine, Benha University, Benha, Qalyubiyya Governorate, Egypt
| | - Saad Ibrahim
- Urology Department, Faculty of Medicine, Benha University, Benha, Qalyubiyya Governorate, Egypt
| | - Ehab El-Barky
- Urology Department, Faculty of Medicine, Benha University, Benha, Qalyubiyya Governorate, Egypt
| | - Ahmed Abou Elezz
- Urology Department, Faculty of Medicine, Benha University, Benha, Qalyubiyya Governorate, Egypt
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13
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Iddagoda MT. Introduction to the novel model of preoperative Multi - Domain Risk Stratification (pMDRS). J Perioper Pract 2024:17504589241228137. [PMID: 38418372 DOI: 10.1177/17504589241228137] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
Preoperative risk stratification is an important step in surgical procedures. The current scoring systems do not predict accurate overall surgical outcomes in complex comorbid patients. The novel model of preoperative multi-domain risk stratification is described in this article, which categorises patients in to three risk groups, aiming to modify the risk for optimal surgical outcomes.
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Sathya A, Goyal-Honavar A, Chacko AG, Jasper A, Chacko G, Devakumar D, Seelam JA, Sasidharan BK, Pavamani SP, Thomas HMT. Is radiomics a useful addition to magnetic resonance imaging in the preoperative classification of PitNETs? Acta Neurochir (Wien) 2024; 166:91. [PMID: 38376544 DOI: 10.1007/s00701-024-05977-4] [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: 10/26/2023] [Accepted: 01/18/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND The WHO 2021 introduced the term pituitary neuroendocrine tumours (PitNETs) for pituitary adenomas and incorporated transcription factors for subtyping, prompting the need for fresh diagnostic methods. Current biomarkers struggle to distinguish between high- and low-risk non-functioning PitNETs. We explored if radiomics can enhance preoperative decision-making. METHODS Pre-treatment magnetic resonance (MR) images of patients who underwent surgery between 2015 and 2019 with available WHO 2021 classification were used. The tumours were manually segmented on the T1w, T1-contrast enhanced, and T2w images using 3D Slicer. One hundred Pyradiomic features were extracted from each MR sequence. Models were built to classify (1) somatotroph and gonadotroph PitNETs and (2) high- and low-risk subtypes of non-functioning PitNETs. Feature were selected independently from the MR sequences and multi-sequence (combining data from more than one MR sequence) using Boruta and Pearson correlation. Support vector machine (SVM), logistic regression (LR), random forest (RF), and multi-layer perceptron (MLP) were the classifiers used. Data imbalance was addressed using the Synthetic Minority Oversampling TEchnique (SMOTE). Performance of the models were evaluated using area under the receiver operating curve (AUC), accuracy, sensitivity, and specificity. RESULTS A total of 222 PitNET patients (train, n = 149; test, n = 73) were enrolled in this retrospective study. Multi-sequence-based LR model discriminated best between somatotroph and gonadotroph PitNETs, with a test AUC of 0.84, accuracy of 0.74, specificity of 0.81, and sensitivity of 0.70. Multi-sequence-based MLP model perfomed best for the high- and low-risk non-functioning PitNETs, achieving a test AUC of 0.76, accuracy of 0.67, specificity of 0.72, and sensitivity of 0.66. CONCLUSIONS Utilizing pre-treatment MRI and radiomics holds promise for distinguishing high-risk from low-risk non-functioning PitNETs based on the latest WHO classification. This could assist neurosurgeons in making critical decisions regarding surgery or alternative management strategies for PitNETs after further clinical validation.
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Affiliation(s)
- Sathya A
- Quantitative Imaging Research and Artificial Intelligence Lab, Department of Radiation Oncology Unit II, Ida B Scudder Cancer Centre, Christian Medical College, Vellore, India
| | | | - Ari G Chacko
- Department of Neurosurgery, Christian Medical College, Vellore, India
| | - Anitha Jasper
- Department of Radiodiagnosis, Christian Medical College, Vellore, India
| | - Geeta Chacko
- Department of General Pathology, Christian Medical College, Vellore, India
| | - Devadhas Devakumar
- Department of Nuclear Medicine, Christian Medical College, Vellore, India
| | | | - Balu Krishna Sasidharan
- Quantitative Imaging Research and Artificial Intelligence Lab, Department of Radiation Oncology Unit II, Ida B Scudder Cancer Centre, Christian Medical College, Vellore, India
| | - Simon P Pavamani
- Quantitative Imaging Research and Artificial Intelligence Lab, Department of Radiation Oncology Unit II, Ida B Scudder Cancer Centre, Christian Medical College, Vellore, India
| | - Hannah Mary T Thomas
- Quantitative Imaging Research and Artificial Intelligence Lab, Department of Radiation Oncology Unit II, Ida B Scudder Cancer Centre, Christian Medical College, Vellore, India.
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15
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Benmassaoud A, Martel M, Carli F, Geraci O, Daskalopoulou SS, Sebastiani G, Bessissow A. Prehabilitation in patients awaiting liver transplantation. Transplant Rev (Orlando) 2024; 38:100835. [PMID: 38367398 DOI: 10.1016/j.trre.2024.100835] [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: 09/20/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Frailty, malnutrition and sarcopenia lead to a significant increase in morbidity and mortality before and after liver transplantation (LT). Prehabilitation attempts to optimize physical fitness of individuals before major surgeries. To date, little is known about its impact on patients awaiting LT. AIMS The aim of our scoping review was to describe whether prehabilitation in patients awaiting LT is feasible and safe, and whether it leads to a change in clinical parameters before or after transplantation. METHODS We performed a systematic review of the literature from 1946 to November 2023 to identify prospective studies and randomized controlled trials of adult LT candidates who participated in an exercise training program. RESULTS Out of 3262 citations initially identified, six studies were included. Studies were heterogeneous in design, patient selection, intervention, duration, and outcomes assessed. All studies were self-described as pilot or feasibility studies and had a sample size ranging from 13 to 33. Two studies were randomized controlled trials. Two study restricted to patients with cirrhosis who were eligible for liver transplantation or on the transplant list. Exercise programs lasted between 6 and 12 weeks. In terms of feasibility, proportion of eligible patients that were recruited was between 54 and 100%. Program completion ranged between 38 and 90%. Interventions appeared safe with 9 (9.2%) adverse events noted. In the intervention group, improvements were generally noted in peak oxygen consumption and workload, 6-min walking distance, and muscle strength. One study suggested a decrease in post-transplant hospital length of stay. CONCLUSIONS Overall, it appears that prehabilitation with exercise training is feasible, and safe in patients awaiting LT. Higher quality and larger studies are needed to confirm its impact on pre- and post-transplantation-related outcomes.
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Affiliation(s)
- Amine Benmassaoud
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Canada; Research Institute of the McGill University Health Centre, Montreal, Canada.
| | - Myriam Martel
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Franco Carli
- Department of Anesthesia, McGill University Health Centre
| | - Olivia Geraci
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Stella S Daskalopoulou
- Research Institute of the McGill University Health Centre, Montreal, Canada; Division of General Internal Medicine, McGill University Health Centre
| | - Giada Sebastiani
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Canada; Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Amal Bessissow
- Research Institute of the McGill University Health Centre, Montreal, Canada; Division of General Internal Medicine, McGill University Health Centre
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16
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Shen X, Yang F, Jiang T, Zheng Z, Chen Y, Tan C, Ke N, Qiu J, Liu X, Zhang H, Wang X. A nomogram to preoperatively predict the aggressiveness of non-functional pancreatic neuroendocrine tumors based on CT features. Eur J Radiol 2024; 171:111284. [PMID: 38232572 DOI: 10.1016/j.ejrad.2023.111284] [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: 09/05/2023] [Revised: 12/11/2023] [Accepted: 12/30/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVES To develop a nomogram to predict the aggressiveness of non-functional pancreatic neuroendocrine tumors (NF-pNETs) based on preoperative computed tomography (CT) features. METHODS This study included 176 patients undergoing radical resection for NF-pNETs. These patients were randomly divided into the training (n = 123) and validation sets (n = 53). A nomogram was developed based on preoperative predictors of aggressiveness of the NF-pNETs which were identified by univariable and multivariable logistic regression analysis. The aggressiveness of NF-pNETs was defined as a composite measure including G3 grading, N+, distant metastases, and/ or disease recurrence. RESULTS Altogether, the number of patients with highly aggressive NF-pNETs was 37 (30.08 %) and 15 (28.30 %) in the training and validation sets, respectively. Multivariable logistic regression analysis identified that tumor size, biliopancreatic duct dilatation, lymphadenopathy, and enhancement pattern were preoperative predictors of aggressiveness. Those variables were used to develop a nomogram with good concordance statistics of 0.89 and 0.86 for predicting aggressiveness in the training and validation sets, respectively. With a nomogram score of 59, patients with NF-pNETs were divided into low-aggressive and high-aggressive groups. The high-aggressive group had decreased overall survival (OS) and disease-free survival (DFS). Moreover, the nomogram showed good performance in predicting OS and DFS at 3, 5, and 10 years. CONCLUSION The nomogram integrating CT features helped preoperatively predict the aggressiveness of NF-pNETs and could potentially facilitate clinical decision-making.
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Affiliation(s)
- Xiaoding Shen
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Fan Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Taiyan Jiang
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Zhenjiang Zheng
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yonghua Chen
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Chunlu Tan
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Nengwen Ke
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Jiajun Qiu
- Department of West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xubao Liu
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Hao Zhang
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
| | - Xing Wang
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
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Sun J, Yang R, Wu H, Li L, Gu Y. Prognostic value of preoperative combined with postoperative systemic immune-inflammation index for disease-free survival after radical rectal cancer surgery: a retrospective cohort study. Transl Cancer Res 2024; 13:371-380. [PMID: 38410202 PMCID: PMC10894347 DOI: 10.21037/tcr-23-1289] [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: 07/21/2023] [Accepted: 11/17/2023] [Indexed: 02/28/2024]
Abstract
Background Colorectal cancer (CRC) ranks highly in malignant tumor incidence and mortality rates, severely affecting human health. The predictive value of the systemic immune-inflammation index (SII) in CRC prognosis is gaining attention, but there is limited research on the combined preoperative and postoperative SII. This study aims to explore the prognostic value of combined SII on disease-free survival (DFS) in patients undergoing radical surgery for rectal cancer. Methods We enrolled 292 patients with rectal cancer who underwent radical resection at the Affiliated Hospital of Xuzhou Medical University from May 2018 to September 2020, along with regular follow-ups to document the DFS. Patients' complete blood cell counts were assessed before surgery and between 21-56 days postoperatively. Calculating preoperative and postoperative SII, patients were categorized into four groups based on the optimal cutoff values: (I) low-low group (preoperative SII <449.325 and postoperative SII <568.13); (II) high-low group (preoperative SII ≥449.325 and postoperative SII <568.13); (III) low-high group (preoperative SII <449.325 and postoperative SII ≥568.13); and (IV) high-high group (preoperative SII ≥449.325 and postoperative SII ≥568.13). The receiver operating characteristic (ROC) curve analysis evaluated the prediction efficacy of preoperative, postoperative, and combined SII. Kaplan-Meier analysis generated DFS curves, and Cox regression analysis determined prognostic factors. Results With a median follow-up of 41 months, 65.4% (191/292) patients reached DFS. The clinical pathological features between the four groups are balanced and comparable (P>0.05). The area under the ROC curve for preoperative, postoperative, and combined SII was 0.668 [95% confidence interval (CI): 0.6-0.737], 0.696 (95%CI: 0.63-0.763), and 0.741 (95% CI: 0.681-0.802), respectively. After adjusting for confounding factors such as adjuvant therapy, differentiation, vascular invasion, neural invasion, tumor-node-metastasis (TNM) stage, carcinoembryonic antigen (CEA), and carbohydrate antigen 19-9 (CA19-9), significant differences were observed between the high-low group [hazard ratio (HR) =2.403; 95% CI: 1.255-4.602; P=0.008], low-high group (HR =5.058; 95% CI: 2.389-10.71; P<0.001), and high-high group (HR =6.214; 95% CI: 3.474-11.115; P<0.001) compared to the low-low group, with higher risks of adverse outcomes. Conclusions Combined SII has better predictive efficacy than monitoring preoperative or postoperative SII alone in rectal cancer patients undergoing radical surgery.
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Affiliation(s)
- Jiayi Sun
- Department of General Practice, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Ruiling Yang
- Department of General Practice, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Huimin Wu
- Department of General Practice, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Lei Li
- Department of General Practice, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yuming Gu
- Department of Interventional Radiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
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Abstract
Perioperative neurocognitive disorders are common and concerning complications in older adults undergoing surgery that can manifest as acute or chronic cognitive decline. It is hypothesized that cognitive prehabilitation can prepare the brain for the stress of surgery as for any other organ system. In this mini review we discuss the rationale for using cognitive prehabilitation, some of the interventions that have been assessed, and the effects of these interventions on postoperative cognition. PATIENT SUMMARY: Training the brain before surgery can potentially reduce the risk of cognitive decline after surgery in older adults. This mini review discusses some of the trials that examined how to train the brain before surgery and the results from these trials.
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Affiliation(s)
- Adam Fink
- Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Michelle Humeidan
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Itay Bentov
- Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA.
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Zhang Y, Lin Z, Chen Y, Hong L, Shen X. Factors related to pre-operative cough strength in cardiac surgical patients: a cross-sectional study. Heart Lung 2024; 63:128-135. [PMID: 37890310 DOI: 10.1016/j.hrtlng.2023.10.009] [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: 06/10/2023] [Revised: 10/12/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Pulmonary complications often arise from ineffective coughing, yet limited research exists on the determinants of cough strength in patients undergoing cardiac surgery. OBJECTIVES The aim is to explore preoperative cough strength in patients scheduled for cardiac surgery and identify factors associated with diminished cough strength. METHODS A cross-sectional study was conducted on 330 adult patients admitted for cardiac surgery at a tertiary Grade A hospital in Jiangsu Province, China between August 2022 and February 2023. Cough strength was assessed using cough peak flow, with values below 270 L/min classified as reduced cough strength. The study adhered to the STROBE guidelines. RESULTS The study comprised 228 males (69.1 %) and 102 females (30.9 %), aged 23 to 81 years. Types of cardiac surgery included coronary artery bypass surgery, heart valvuloplasty, or heart valve replacement among others. The mean preoperative cough peak flow was 250.38 ± 119.71 L/min, with 60.3 % of patients exhibiting reduced cough strength. A multiple linear regression analysis identified gender, age, exercise regimen, pulmonary arterial hypertension, left ventricular ejection fraction, inspiratory capacity, and proficiency in coughing techniques as primary factors affecting cough strength. CONCLUSIONS Our findings indicate an association between diminished cough strength and factors such as female gender, advanced age, absence of systematic exercise, presence of pulmonary arterial hypertension, lower left ventricular ejection fraction, reduced inspiratory capacity, and inadequate mastery of coughing techniques. Healthcare staff should prioritize regular assessment of cough strength and manage the pertinent factors to enhance preoperative coughing ability.
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Affiliation(s)
- Yan Zhang
- School of Nursing, Nanjing Medical University, the First Affiliated Hospital of Nanjing Medical University, China
| | - Zheng Lin
- Department of Intensive Care Medicine, Nanjing First Hospital, Nanjing Medical University, China.
| | - Yuhong Chen
- Ministry of Nursing, Nanjing First Hospital, Nanjing Medical University, China
| | - Liang Hong
- Department of Intensive Care Medicine, Nanjing First Hospital, Nanjing Medical University, China
| | - Xiao Shen
- Department of Intensive Care Medicine, Nanjing First Hospital, Nanjing Medical University, China
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Elkholy AR, Rezk EM, Shabaan N, Elkhouly RM, Shamhoot EA. The role of preoperative ultrasound in the management of peripheral nerve injuries. Clin Neurol Neurosurg 2024; 236:108083. [PMID: 38104445 DOI: 10.1016/j.clineuro.2023.108083] [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: 11/07/2023] [Revised: 12/09/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Peripheral nerve injury refers to any damage or trauma to the nerves located outside the central nervous system. Ultrasonography is a reliable, cheap, and minimally invasive method in clinical practice to give physicians useful information about nerve injury. OBJECTIVES to assess the power of ultrasound in determining the presence, localization, and extent of neural damage in patients with clinical evidence of peripheral nerve lesions before surgery. METHODS This cross-sectional study was conducted on 78 patients (56 females and 22 males, aged from 9 to 52 years) who had different pathologies including entrapment, tumoral, post-traumatic, and post-surgical nerve injuries at the Neurosurgery and Physical Medicine, Rheumatology, and Rehabilitation Departments, Tanta University Hospitals. All studied patients had preoperative evaluation; neurological examination, electrodiagnostic studies, and sonographic examinations with linear array transducers (frequencies ranging from 7.5 to 16 MHz). RESULTS The most common pathological condition was entrapment neuropathy (39 patients) (50%). Ultrasound complemented the electrodiagnostic studies by determining the site of entrapment manifested by increased mean maximum cross-sectional area of the nerve proximal to the site of entrapment and nerve hypoechogenicity. In post-traumatic and iatrogenic neuropathies (35 patients) (44.9%), the ultrasound finding revealed neuroma in continuity in nine cases (11.5%), complete neurotmesis with stump neuroma in eighteen patients (23.1%), and eight cases (10.3%) showed perineural adhesion. In all cases, the nerve was hypoechoic at the site of injury. The presence of hyperechoic fibrous tissue could indicate perineural adhesion and the necessity for neurolysis. This study also included three (3.8%) cases had schwannoma, and one case (1.3%) had neurofibroma. Ultrasound was used to confirm the diagnosis by determining the tumor's size and vascular supply. CONCLUSIONS Ultrasonography is a diagnostic and surgical planning tool that is becoming more and more useful for the management of peripheral nerve injuries. Its high resolution and real-time capability provide safe and cost-effective scans that aid in determining the extent of injuries. For patients with peripheral nerve injuries, ultrasound is advised to be added to the routine clinical and neurophysiological evaluation. It is also advised to use ultrasound as a first-line imaging modality for tumors thought to be of nerve origin.
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Affiliation(s)
- Ahmed R Elkholy
- Department of Neurosurgery, Faculty of Medicine, Tanta University, Egypt
| | - Essam M Rezk
- Department of Neurosurgery, Faculty of Medicine, Tanta University, Egypt.
| | - Nehal Shabaan
- Department of Neurosurgery, Faculty of Medicine, Tanta University, Egypt
| | - Radwa M Elkhouly
- Department of Rheumatology, Rehabilitation and Physical Medicine, Faculty of Medicine, Tanta University, Egypt
| | - Ebrahim A Shamhoot
- Department of Neurosurgery, Faculty of Medicine, Tanta University, Egypt
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Cury FL, Viani GA, Gouveia AG, Freire CVS, Grisi GDA, Moraes FY. Meta-analysis of 5-day preoperative radiotherapy for soft tissue sarcoma (5D-PREORTS). Radiother Oncol 2024; 190:109935. [PMID: 37884194 DOI: 10.1016/j.radonc.2023.109935] [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: 03/28/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND AND PURPOSE Although the role of conventionally fractionated radiotherapy (RT) in combination with surgery in the limb-sparing treatment of soft tissue sarcoma (STS) patients is well established, the effectiveness and safety of 5-day preoperative radiotherapy (RT) remain controversial. We performed a meta-analysis to evaluate the treatment outcomes of 5-day preoperative RT using ≥ 5 Gy per fraction with contemporary radiotherapy techniques. MATERIALS AND METHODS Medline, Embase, the Cochrane Library, and the proceedings of annual meetings through March 2022 were used to identify eligible studies. Following the PRISMA and MOOSE guidelines, a meta-regression analysis was performed to assess possible correlations between variables and outcomes. A p-value < 0.05 was considered significant. RESULTS Nine prospective studies with 786 patients (median follow-up 35 months, 20-60 months) treated with preoperative RT delivered a median total of 30 Gy (25-40 Gy) in 5 fractions. The local control (LC), R0 margins, overall survival (OS), and distant relapse (DR) rates were 92.3% (95% CI: 87---97%), 84.5% (95% CI: 78---90%), 78% (95% CI: 70---86%), and 36% (95% CI: 70---86%). The meta-regression analysis identified a significant relationship between biological equivalent dose (BED) and larger tumor size for LC and R0 margins (p < 0.05). The subgroup analysis reveals that patients receiving BED ≥ 90 (equivalent to 30 Gy in 5 fractions) had a higher LC control rate than BED < 90 (p < 0.0001). The complete pathologic response and amputation rates were 19% (95% CI: 13-26%) and 8.3% (95% CI: 0.5-15%). Amputation rates were higher in studies using the lowest and highest doses and were related to salvage surgery after recurrence and complications, respectively. The rate of wound complication and fibrosis grade 2 or worse was 30% (95% CI 23-38%) and 6.4% (95% CI 1.9-11%). CONCLUSION A 5-day course of preoperative RT results in high LC and favorable R0 margins, with acceptable complication rates in most studies. Better local control and R0 margins were associated with regimens using higher BED, i.e., doses equal to or higher than 30 Gy when using 5 fractions.
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Affiliation(s)
- Fabio L Cury
- Department of Oncology, Division of Radiation Oncology, McGill University Health Centre, McGill University, Montreal, Canada.
| | - Gustavo A Viani
- Ribeirao Preto Medical School, Department of Medical Imagings, Hematology and Oncology of University of São Paulo (FMRP-USP), Ribeirão Preto, Brazil.
| | - Andre G Gouveia
- Department of Oncology - Division of Radiation Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | | | | | - Fabio Y Moraes
- Department of Oncology, Division of Radiation Oncology, Kingston General Hospital, Queen's University, Kingston, Canada
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Ma J, Zhang Y, Ge Q, Wu K. The effect of auricular acupuncture on preoperative blood pressure across age groups: a prospective randomized controlled trial. Clin Exp Hypertens 2023; 45:2169452. [PMID: 36681906 DOI: 10.1080/10641963.2023.2169452] [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] [Indexed: 01/23/2023]
Abstract
PURPOSE To determine the effect of auricular acupuncture on preoperative blood pressure (BP) elevation in different age groups. MATERIALS AND METHODS Auricular acupuncture treats elevated BP among patients before surgery. This prospective, randomized clinical trial was performed at Li Huili Hospital of Ningbo Medical Center, China, from January to June 2021. We prospectively enrolled 120 patients with elevated BP aged 45 to 75 and observed them in the inpatient department. Patients were randomly assigned in a 1:1 ratio to undergo auricular acupuncture or sham control groups. In addition to usual care, the study group underwent auricular acupuncture bilaterally at HX6 7i-Ear apex, TF4-Shen men, TF1-Superior triangular fossa, and CO15-Heart. RESULTS A total of 120 patients completed the study, 60 in the study group and 60 in the control group. Of these, 76 (63.3%) were men, and the mean (standard deviation) was 64.55 (9.48) years. The differences in systolic BP comparisons after intervention were significant (7.88 mmHg; 95% confidence interval [CI], 2.94 to 12.81; P = .002). Diastolic BP also showed statistical significance (5.85 mmHg; 95% CI, 3.05 to 8.64; P < .01. Neither AA-related adverse events nor serious adverse events occurred. Stratified by age, the differences comparisons of systolic BP (-10.13 mmHg; 95% confidence interval [CI], -16.69 to -3.57; P < .01) and diastolic BP (-7.65 mmHg; 95% confidence interval [CI], -11.17 to -4.14; P < .01) were statistically significant for participants aged 60-75 years; The differences comparison of systolic BP (-2.37 mmHg; 95% confidence interval [CI], -8.04 to 3.31; P = .40) and diastolic BP (-1.46 mmHg; 95% confidence interval [CI], -5.68 to 2.76; P = .48) were not significant aged 45-59. CONCLUSION Auricular acupuncture can reduce BP before procedures. However, further research is needed on the antihypertensive effect on people aged 45-59. These findings provide clinicians with evidence of auricular acupuncture as a standard adjunctive therapy targeting this patient population.
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Affiliation(s)
- Jingjing Ma
- Department of Nursing, Ningbo Medical Center LiHuili Hospital, Ningbo, China
| | - Yiqing Zhang
- Department of Nursing, Ningbo Medical Center LiHuili Hospital, Ningbo, China
| | - Qingqing Ge
- Department of Nursing, Ningbo Medical Center LiHuili Hospital, Ningbo, China
| | - Keer Wu
- Department of Nursing, Ningbo Medical Center LiHuili Hospital, Ningbo, China
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Rung JM, Aliu O, Barrett TS, LeJeune K, Farah TG. Prevalence and Cost of Routine Preoperative Care for Low-Risk Cataract Surgery a Decade after Choosing Wisely. Ophthalmology 2023:S0161-6420(23)00871-0. [PMID: 38092081 DOI: 10.1016/j.ophtha.2023.12.001] [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: 06/22/2023] [Revised: 11/07/2023] [Accepted: 12/01/2023] [Indexed: 01/30/2024] Open
Abstract
PURPOSE Examine the frequency and cost of procedural clearance tests and examinations in preparation for low-risk cataract surgery among members of a commercial healthcare organization in the United States. Determine what characteristics most strongly predict receipt of preoperative care and the probability that preoperative care impacts postsurgical adverse events. DESIGN Retrospective healthcare claims analysis and medical records review from a large, blended-health organization headquartered in Western Pennsylvania. PARTICIPANTS Members aged ≥ 65 years who were continuously enrolled 6 months before and after undergoing cataract surgery from 2018 to 2021 and had approved surgery claims. METHODS Preoperative exams or tests occurring in the 30 days before surgery were identified via procedural and diagnosis codes on claims of eligible members (e.g., Current Procedural Terminology codes for blood panels and preprocedural International Classification of Diseases, 10th Revision, Clinical Modification codes). Prevalence and cost were directly estimated from claims; variables predictive of preoperative care receipt and adverse events were tested using mixed effects modeling. MAIN OUTCOME MEASURES Total costs, prevalence, and strength of association as indicated by odds ratios. RESULTS Up to 42% of members undergoing cataract surgery had a physician office visit for surgical clearance, and up to 23% of members had testing performed in isolation or along with clearance visits. The combined costs for the preoperative visits and tests were $4.3 million (approximately $107-$114 per impacted member). There was little difference in member characteristics between those receiving and not receiving preoperative testing or exams. Mixed effects models showed that the most impactful determinants of preoperative care were the surgical facility and member's care teams; for preoperative testing, facilities were a stronger predictor than care teams. Adverse events were rare and unassociated with receipt of preoperative testing, exams, or a combination of the two. CONCLUSIONS Rates of routine preoperative testing before cataract surgery appear similar to those prior to the implementation of the Choosing Wisely campaign, which was meant to reduce this use. Additionally, preoperative evaluations, many likely unnecessary, were common. Further attention to and reconsideration of current policies and practice for preoperative care may be warranted, especially at the facility level. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
| | - Oluseyi Aliu
- Allegheny Health Network, Pittsburgh, Pennsylvania
| | | | - Keith LeJeune
- Highmark Health, Pittsburgh, Pennsylvania; Allegheny Health Network, Pittsburgh, Pennsylvania
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Zhao H, Zhang J, Bao ZL, Kong J, Wei W, Gu JQ. A preoperative predictive model for stage IV endometriosis. J OBSTET GYNAECOL 2023; 43:2188072. [PMID: 36988228 DOI: 10.1080/01443615.2023.2188072] [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] [Indexed: 03/30/2023]
Abstract
This was a retrospective study that evaluated a total of 280 patients who underwent surgery for complete removal of endometriosis to develop and validate the predictive model for stage IV endometriosis. The differences between stage I-III and stage IV endometriosis were performed by logistic regression. A model for the prediction of stage IV endometriosis was constructed, which was subsequently validated. The independent variables were visual analogue scale (VAS)≥4 [3.855, 95% confidence interval (CI): 1.675-8.871, p = 0.002], painful nodularity on uterosacral ligaments (13.954, 95% CI: 1.658-117.423, p = 0.015), and bilateral endometriosis (5.933, 95% CI: 1.931-18.225, p = 0.002). The AUC of the model was 0.777, with a sensitivity of 71.9% and specificity of 76.3% for stage IV endometriosis. Therefore, a complete collection of patient information prior to surgery, asking about pain and VAS scores, careful completion of pelvic examinations, and application of imaging techniques are conducive to better diagnosis and prediction of advanced endometriosis.IMPACT STATEMENTWhat is already known on this subject? Endometriosis, a chronic disease causing pain and infertility, is characterised by endometrial-like tissue outside the uterine cavity, which is often treated via surgery at present. Considering the risks of surgery, it is necessary to identify patients with stage IV endometriosis through non-invasive predictive models for adequate preparation for surgery. However, there is no reliable non-invasive predictive model now, despite utilisation of patient medical history, symptoms especially pain-related ones, pelvic examinations, laboratory examinations, and images in the preoperative diagnosis of endometriosis in the clinic.What do the results of this study add? A model developed based on three simple, accessible and non-invasive indicators displays good performance in predicting stage IV endometriosis.What are the implications of these findings for clinical practice and/or further research? It is conducive to diagnosing and predicting advanced endometriosis before surgery, so as to reduce the difficulty and improve the safety of surgery.
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Affiliation(s)
- He Zhao
- Department of Obstetrics and Gynecology, Beijing Anzhen Hospital affiliated to Capital Medical University, Beijing, P.R. China
| | - Jun Zhang
- Department of Obstetrics and Gynecology, Beijing Anzhen Hospital affiliated to Capital Medical University, Beijing, P.R. China
| | - Zhao-Liang Bao
- Department of Obstetrics and Gynecology, Beijing Anzhen Hospital affiliated to Capital Medical University, Beijing, P.R. China
| | - Jia Kong
- Department of Obstetrics and Gynecology, Beijing Anzhen Hospital affiliated to Capital Medical University, Beijing, P.R. China
| | - Wei Wei
- Department of Obstetrics and Gynecology, Beijing Anzhen Hospital affiliated to Capital Medical University, Beijing, P.R. China
| | - Jia-Qi Gu
- Department of Obstetrics and Gynecology, Beijing Anzhen Hospital affiliated to Capital Medical University, Beijing, P.R. China
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25
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Kim J, Kim SW, Choi JK, Oh JK, Kim TH. Diagnostic trends of preoperative venous thromboembolism and its clinical implications in patients who underwent surgery for degenerative spinal diseases. Spine J 2023; 23:1838-1847. [PMID: 37704049 DOI: 10.1016/j.spinee.2023.08.023] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/05/2023] [Accepted: 08/30/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND CONTEXT Although the risk of postoperative venous thromboembolism (VTE) in patients who undergo surgery for degenerative spinal disease has received attention, patients experiencing prolonged pain and disability while awaiting or considering surgery have not received adequate attention regarding the risk of VTE. PURPOSE To investigate the epidemiology of preoperative VTE in patients undergoing surgery for degenerative spinal disease. DESIGN Retrospective cohort study using a nationwide database. PATIENT SAMPLE Patients who underwent surgery for degenerative spinal disease. OUTCOME MEASURES Preoperative occurrence of VTE. METHODS Data from 2014 to 2018 were obtained from the Korean National Health Insurance claims database. The occurrence of preoperative VTE within a 1-year period divided into 12 time intervals of 30 days each was investigated. The patients were categorized into two groups based on the presence of preoperative VTE. Multivariable logistic regression analysis was conducted to identify the factors associated with preoperative VTE. To validate the relationship between degenerative spinal disease and preoperative VTE, the diagnostic trends of preoperative VTE were analyzed in accordance with the identified risk factors. RESULTS The overall incidence of preoperative VTE was 50 per 10,000 individuals. Multivariable analysis revealed that VTE occurred more frequently in older patients with specific medical comorbidities, particularly in those with a lumbar spinal lesion accompanied by arthritis of the hip, knee, or shoulder. We also found that the incidence rates of preoperative VTE, as well as the gradient of their increase, began to rise approximately 2 to 3 months prior to the index surgery, peaking just before the index surgery. This diagnostic trend was consistently observed in all patients irrespective of the presence of other risk factors. CONCLUSIONS The incidence of preoperative VTE in patients with degenerative spinal disease exhibited a sharp increase immediately before surgery, with similar rates to those of postoperative VTE. Clinicians managing patients with degenerative spinal disease should be vigilant for preoperative as well as postoperative VTE.
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Affiliation(s)
- Jihye Kim
- Division of Infection, Department of Pediatrics, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, 150, Seongan-ro, Gangdong-gu, Seoul, 05355, Republic of Korea
| | - Seok Woo Kim
- Spine Center, Department of Orthopedics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-ro, 170, beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 14068, Republic of Korea
| | - Jin Kwan Choi
- Spine Center, Department of Orthopedics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-ro, 170, beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 14068, Republic of Korea
| | - Jae-Keun Oh
- Spine Center, Department of Orthopedics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-ro, 170, beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 14068, Republic of Korea
| | - Tae-Hwan Kim
- Spine Center, Department of Orthopedics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-ro, 170, beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 14068, Republic of Korea.
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Persaud E, Nissley C, Piasecki E, Quinn C. Transition of Care for Older Adults Undergoing General Surgery. Crit Care Nurs Clin North Am 2023; 35:453-467. [PMID: 37838418 DOI: 10.1016/j.cnc.2023.05.009] [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: 10/16/2023]
Abstract
The demand for surgical intervention and hospitalization is expected to increase with the growth of the older adult population. Despite advances in technology and minimally invasive surgical procedures, the needs of the older adult in the perioperative period are unique. Transitions of care from the decision to support surgery through surgical intervention, subsequent hospitalization, and postacute discharge must be supported to achieve optimal patient outcomes. The clinical nurse specialist is well suited to address care delivery and assure implementation of best practices across the continuum.
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Affiliation(s)
- Elissa Persaud
- Michigan Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5866, USA.
| | - Courtney Nissley
- Penn Medicine Lancaster General Hospital, 555 North Duke Street, Lancaster, PA 17602, USA
| | - Eric Piasecki
- Penn Medicine Lancaster General Hospital, 555 North Duke Street, Lancaster, PA 17602, USA
| | - Carrie Quinn
- Penn Medicine Lancaster General Hospital, 555 North Duke Street, Lancaster, PA 17602, USA
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Choi W, Liu CJ, Alam SR, Oh JH, Vaghjiani R, Humm J, Weber W, Adusumilli PS, Deasy JO, Lu W. Preoperative 18F-FDG PET/CT and CT radiomics for identifying aggressive histopathological subtypes in early stage lung adenocarcinoma. Comput Struct Biotechnol J 2023; 21:5601-5608. [PMID: 38034400 PMCID: PMC10681940 DOI: 10.1016/j.csbj.2023.11.008] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 12/02/2023] Open
Abstract
Lung adenocarcinoma (ADC) is the most common non-small cell lung cancer. Surgical resection is the primary treatment for early-stage lung ADC while lung-sparing surgery is an alternative for non-aggressive cases. Identifying histopathologic subtypes before surgery helps determine the optimal surgical approach. Predominantly solid or micropapillary (MIP) subtypes are aggressive and associated with a higher likelihood of recurrence and metastasis and lower survival rates. This study aims to non-invasively identify these aggressive subtypes using preoperative 18F-FDG PET/CT and diagnostic CT radiomics analysis. We retrospectively studied 119 patients with stage I lung ADC and tumors ≤ 2 cm, where 23 had aggressive subtypes (18 solid and 5 MIPs). Out of 214 radiomic features from the PET/CT and CT scans and 14 clinical parameters, 78 significant features (3 CT and 75 PET features) were identified through univariate analysis and hierarchical clustering with minimized feature collinearity. A combination of Support Vector Machine classifier and Least Absolute Shrinkage and Selection Operator built predictive models. Ten iterations of 10-fold cross-validation (10 ×10-fold CV) evaluated the model. A pair of texture feature (PET GLCM Correlation) and shape feature (CT Sphericity) emerged as the best predictor. The radiomics model significantly outperformed the conventional predictor SUVmax (accuracy: 83.5% vs. 74.7%, p = 9e-9) and identified aggressive subtypes by evaluating FDG uptake in the tumor and tumor shape. It also demonstrated a high negative predictive value of 95.6% compared to SUVmax (88.2%, p = 2e-10). The proposed radiomics approach could reduce unnecessary extensive surgeries for non-aggressive subtype patients, improving surgical decision-making for early-stage lung ADC patients.
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Affiliation(s)
- Wookjin Choi
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Chia-Ju Liu
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Sadegh Riyahi Alam
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Jung Hun Oh
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Raj Vaghjiani
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - John Humm
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Wolfgang Weber
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Prasad S. Adusumilli
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Joseph O. Deasy
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Wei Lu
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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Holmén A, Jebril W, Ida S, Agustsson T, Lampi M, Rouvelas I, Sunde B, Klevebro F. Effects of neoadjuvant therapy on health-related quality of life for patients with gastroesophageal cancer. Eur J Surg Oncol 2023; 49:107008. [PMID: 37673022 DOI: 10.1016/j.ejso.2023.107008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 02/09/2023] [Revised: 05/21/2023] [Accepted: 08/02/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Neoadjuvant therapy in combination with surgery increases survival in gastroesophageal cancer; however, little is known about its impact on health-related quality of life. This study compared the impact of neoadjuvant therapy with that of surgery alone on the health-related quality of life in patients treated for gastroesophageal cancer. METHODS A single-centre cohort study with prospectively collected data from patients undergoing curative intended treatment for gastroesophageal cancer between 2013 and 2020 was performed. Health-related quality of life was assessed prior to surgery and patients stratified according to neoadjuvant therapy or surgery alone. The primary endpoint was self-assessed health-related quality of life, evaluated using validated cancer-specific questionnaires. A pre-specified multivariable model adjusted for age, ASA score, and clinical T- and N-stage was used. RESULTS A total of 361 patients were included, of whom 239 (61%) were treated with neoadjuvant therapy. Patients treated with neoadjuvant therapy reported less difficulties with eating restrictions (-11.9, p = 0.005), pain (-10.9, p = 0.004), and insomnia (-12.6, p = 0.004) than patients treated with surgery alone. Patients with oesophageal cancer and neoadjuvant therapy reported less dysphagia (-16.6, p < 0.001), eating restrictions (-23.2, p < 0.001), and odynophagia (-18.0, p = 0.002) than those who underwent surgery alone. CONCLUSION Neoadjuvant therapy was associated with a significant reduction in symptoms affecting malnutrition and improved health-related quality of life in patients with gastroesophageal cancer. These results indicates that more patients might be available for neoadjuvant therapy, despite the baseline burden of gastroesophageal cancer.
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Affiliation(s)
- Anders Holmén
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Södersjukhuset AB, Stockholm, Sweden.
| | - William Jebril
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Satoshi Ida
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Thorhallur Agustsson
- Department of Surgery, Södersjukhuset AB, Stockholm, Sweden; Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Maria Lampi
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Department of Upper Abdominal Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Ioannis Rouvelas
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Department of Upper Abdominal Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Berit Sunde
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Department of Upper Abdominal Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Fredrik Klevebro
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Department of Upper Abdominal Cancer, Karolinska University Hospital, Stockholm, Sweden
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Dibabu AM, Ketema TG, Beyene MM, Belachew DZ, Abocherugn HG, Mohammed AS. Preoperative anxiety and associated factors among women admitted for elective obstetric and gynecologic surgery in public hospitals, Southern Ethiopia: a cross-sectional study. BMC Psychiatry 2023; 23:728. [PMID: 37807071 PMCID: PMC10561508 DOI: 10.1186/s12888-023-05005-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/05/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND Preoperative anxiety is a major mental health problem during the preoperative period. Admission of women to surgery is stressful, and a high level of anxiety was associated with increased perioperative morbidity and mortality, poor treatment satisfaction, and bad obstetric outcomes, including long-term cognitive impairment in children. Despite its negative consequences, little is known on this area, particularly in the study area. OBJECTIVE To assess preoperative anxiety and associated factors among women admitted for elective obstetrics and gynecologic surgeries in public hospitals in Southern Ethiopia, 2022. METHODS AND MATERIALS An institution-based cross-sectional study design was conducted among 389 women using structured interviewer-administered samples who were selected by systematic random sampling from May 20th to June 20th, 2022. The Amsterdam preoperative anxiety and information scale (APAIS) was used to assess the level of anxiety. Data were collected electronically using the Open Data Kit version 2022.2.3 and analyzed with the Statistical Package for Social Sciences version 26.0. Bivariate and multivariable logistic regression analyses were done. The strength of the association was declared by using an adjusted odds ratio (AOR) with a 95% confidence interval, and a statistical significance of P < 0.05. RESULTS The magnitude of preoperative anxiety was 57.1% (95% CI = 51.4-61.5), and 48.1% of women required an average amount of information. Being a gynecologic patient (AOR = 2.0, 95% CI = 1.21, 3.32), having previous anesthesia and surgery (AOR = 2.09, 95% CI = 1.10, 3.96), having fear of postoperative pain (AOR = 1.96, 95% CI = 1.08, 3.53), having concern for family (AOR = 2.56, 95% CI = 1.49, 4.37), having poor social support (AOR = 3.75, 95% CI = 1.99, 7.09), and moderate social supports (AOR = 3.27, 95% CI = 1.74, 6.17), and having a high information requirement about anesthesia and surgery (AOR = 4.68, 95%CI = 2.16, 10.13) were statistically associated with preoperative anxiety. CONCLUSION Preoperative anxiety was often high in the region. Associated factors were the type of surgery, previous anesthesia and surgery, fear of postoperative pain, fear for family, social support, and a high information need. So the national and regional health bureau should develop guidelines and implement strategies to reduce women preoperative anxiety as part of midwifery care. The women should be assessed regularly during the preoperative visits; and appropriate anxiety reduction and information regarding surgery, and anesthesia should be provided.
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Affiliation(s)
- Abera Mamo Dibabu
- Department of Midwifery, College of Medicine and Health Sciences, Mizan Tepi University, Mizan Teferi, Ethiopia.
| | - Teklemariam Gultie Ketema
- Department of Midwifery, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Maechel Maile Beyene
- Department of Midwifery, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Dereje Zeleke Belachew
- Department of Midwifery, College of Medicine and Health Sciences, Mizan Tepi University, Mizan Teferi, Ethiopia
| | | | - Abdu Seid Mohammed
- Department of Midwifery, College of Medicine and Health Sciences, Mizan Tepi University, Mizan Teferi, Ethiopia
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Kaneko T, Nakamura S, Hayakawa K, Tokimura F, Miyazaki T. Preoperative incidence and risk factors of deep vein thrombosis in Japanese patients undergoing total hip arthroplasty. Eur J Orthop Surg Traumatol 2023; 33:2859-2864. [PMID: 36871251 DOI: 10.1007/s00590-023-03508-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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 02/26/2023] [Indexed: 03/06/2023]
Abstract
PURPOSE Preoperative deep vein thrombosis (DVT) is a risk factor for postoperative venous thromboembolism (VTE), causing severe mortality. Early detection of preoperative DVT is essential to prevent postoperative VTE. However, little is known regarding preoperative DVT in patients undergoing major surgery. The present study aimed to determine the incidence and risk factors of preoperative DVT in patients admitted for total hip arthroplasty (THA). METHODS From August 2017 to September 2022, 243 patients admitted for THA at our institution were enrolled in this study. Patients medical records and preoperative laboratory data were retrospectively collected. According to the results of lower-limb ultrasonography, patients were divided into either the non-DVT (n = 136) or DVT (n = 43) group. The incidence of DVT and independent risk factors for preoperative DVT were investigated using univariate and multivariate logistic regression analyses. RESULTS The mean age was 74.0 ± 8.4 years. Preoperative DVT was diagnosed in 43 of the 243 (17.7%) patients. The risk of DVT was significantly high (p < 0.05) in patients with advanced age, increased D-dimer levels, and malnutrition status, as assessed by the Geriatric Nutritional Risk Index (GNRI). Multivariate analysis showed that advanced age, increased D-dimer level, and malnutrition status assessed by the GNRI were independent risk factors for preoperative DVT. CONCLUSION A high incidence of preoperative DVT was observed in patients undergoing THA. Advanced age, increased D-dimer levels, and malnutrition assessed by the GNRI increased the risk of preoperative DVT. Screening high-risk subgroups for preoperative DVT is necessary to prevent postoperative VTE.
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Affiliation(s)
- Taizo Kaneko
- Department of Orthopaedic Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Sakae-cho 35-2, Itabashi-ku, 173-0015, Tokyo, Japan.
| | - Shinya Nakamura
- Department of Orthopaedic Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Sakae-cho 35-2, Itabashi-ku, 173-0015, Tokyo, Japan
| | - Kentaro Hayakawa
- Department of Orthopaedic Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Sakae-cho 35-2, Itabashi-ku, 173-0015, Tokyo, Japan
| | - Fumiaki Tokimura
- Department of Orthopaedic Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Sakae-cho 35-2, Itabashi-ku, 173-0015, Tokyo, Japan
| | - Tsuyoshi Miyazaki
- Department of Orthopaedic Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Sakae-cho 35-2, Itabashi-ku, 173-0015, Tokyo, Japan
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Wang H, Oran A, Butler CG, Fox JA, Shernan SK, Muehlschlegel JD. Preoperative Tricuspid Regurgitation Is Associated With Long-Term Mortality and Is Graded More Severe Than Intraoperative Tricuspid Regurgitation. J Cardiothorac Vasc Anesth 2023; 37:1904-1911. [PMID: 37394388 DOI: 10.1053/j.jvca.2023.06.016] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/03/2023] [Accepted: 06/09/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVES To determine whether preoperative (preop) tricuspid regurgitation (TR) severity grade was associated with postoperative mortality, to examine the correlation between pre-op and intraoperative (intraop) TR grades, and to understand which TR grade had better prognostic predictability in cardiac surgery patients. DESIGN Retrospective. SETTING Single institution. PARTICIPANTS Patients. INTERVENTIONS Preop and intraop echocardiography TR grades of 4,232 patients who had undergone cardiac surgeries between 2004 and 2014 were examined. MEASUREMENTS AND MAIN RESULTS Kaplan-Meier curves and Cox proportional hazard models were used to determine the association between TR grades and the primary endpoint of all-cause mortality. The Wilcoxon signed-rank test and Spearman's rank correlation were analyzed to assess the similarity and correlation between preop and intraop-grade pairs. Multivariate logistic regression models of the area under the curve characteristics were compared for prognostic implications. Kaplan-Meier curves demonstrated a strong relationship between preop grades and survival. Multivariate models showed significantly increased mortality starting at mild preop TR (mild TR: hazard ratio [HR] 1.24; 95% CI 1.05-1.46, p = 0.013; moderate TR: HR 1.60; 95% CI 1.05-1.97, p < 0.001; severe TR: HR 2.50; 95% CI 1.74-3.58, p < 0.001). Preop TR grades were mostly higher than intraop grades. Spearman's correlation was 0.55 (p < 0.001). The area under the curves of preop and intraop TR-based models were almost identical (0.704 v 0.702 1-year mortality and 0.704 v 0.700 2-year mortality). CONCLUSIONS The authors found that echocardiographically-determined preop TR grade at the time of surgical planning was associated with long-term mortality, starting even at a mild grade. Preop grades were higher than intraop grades, with a moderate correlation. Preop and intraop grades exhibited similar prognostic implications.
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Affiliation(s)
- Huan Wang
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ali Oran
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Carolyn G Butler
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - John A Fox
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Stanton K Shernan
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jochen D Muehlschlegel
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
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Topal Hançer A. Prevalence and factors associated with surgery anxiety in hospitalized patients: a point-prevalence study. Ir J Med Sci 2023; 192:2095-2103. [PMID: 37548838 DOI: 10.1007/s11845-023-03475-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/24/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Preoperative anxiety is a challenging problem in the preoperative care of patients. Identifying risk factors helps nurses provide psychological support during the pre-operative visit so that stress can be reduced. AIMS This study aimed to determine the prevalence of surgical anxiety and related factors in hospitalized surgical patients. METHODS This research was designed as a point-prevalence study. The study was completed with 223 patients hospitalized in the surgical clinics of a tertiary hospital in Turkey. Surgical anxiety questionnaire (SAQ) and State-trait anxiety inventory (STAI) were used for the assessment of anxiety. RESULTS Preoperative anxiety prevalence was 69.5% according to the SAQ and 49.3% according to STAI. Women, participants with no primary school education, those who were unemployed and had low income, those with no previous surgery, those living in fear of surgery, the participants who underwent major surgery and general anesthesia, and those who did not have knowledge about the surgical procedure and anesthesia had higher anxiety according to the two scales. A highly significant and positive correlation was found between total STAI and total SAQ. CONCLUSION The importance of surgical anxiety for the health system, which affects two out of every three hospitalized patients, should not be underestimated. Therefore, national and global plans should be made to prevent and manage surgical anxiety.
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Affiliation(s)
- Ayşe Topal Hançer
- Nursing Department, Faculty of Health Sciences, Sivas Cumhuriyet University, Sivas, Turkey.
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Cheng H, Xu JH, Kang XH, Liu XM, Wang HF, Wang ZX, Pan HQ, Zhang QQ, Xu XL. Nomogram for predicting the preoperative lymph node metastasis in resectable pancreatic cancer. J Cancer Res Clin Oncol 2023; 149:12469-12477. [PMID: 37442865 PMCID: PMC10465378 DOI: 10.1007/s00432-023-05048-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Lymph node metastasis (LNM) is a critical prognostic factor in resectable pancreatic cancer (PC) patients, determining treatment strategies. This study aimed to develop a clinical model to adequately and accurately predict the risk of LNM in PC patients. METHODS 13,200 resectable PC patients were enrolled from the SEER (Surveillance, Epidemiology, and End Results) database, and randomly divided into a training group and an internal validation group at a ratio of 7:3. An independent group (n = 62) obtained from The First Affiliated Hospital of Xinxiang Medical University was enrolled as the external validation group. The univariate and multivariate logistic regression analyses were used to screen independent risk factors for LNM. The minimum Akaike's information criterion (AIC) was performed to select the optimal model parameters and construct a nomogram for assessing the risk of LNM. The performance of the nomogram was assessed by the receiver operating characteristics (ROC) curve, calibration plot, and decision curve analysis (DCA). In addition, an online web calculator was designed to assess the risk of LNM. RESULT A total of six risk predictors (including age at diagnosis, race, primary site, grade, histology, and T-stage) were identified and included in the nomogram. The areas under the curves (AUCs) [95% confidential interval (CI)] were 0.711 (95%CI: 0.700-0.722), 0.700 (95%CI: 0.683-0.717), and 0.845 (95%CI: 0.749-0.942) in the training, internal validation and external validation groups, respectively. The calibration curves showed satisfied consistency between nomogram-predicted LNM and actual observed LNM. The concordance indexes (C-indexes) in the training, internal, and external validation sets were 0.689, 0.686, and 0.752, respectively. The DCA curves of the nomogram demonstrated good clinical utility. CONCLUSION We constructed a nomogram model for predicting LNM in pancreatic cancer patients, which may help oncologists and surgeons to choose more individualized clinical treatment strategies and make better clinical decisions.
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Affiliation(s)
- Hao Cheng
- Department of Oncology, The First Affiliated Hospital of Xinxiang Medical University, 88 Jiankang Road, Xinxiang, 453100, Henan, China
| | - Jin-Hong Xu
- Department of Otolaryngology, AnYang District Hospital, Anyang, 455000, Henan, China
| | - Xiao-Hong Kang
- Department of Oncology, The First Affiliated Hospital of Xinxiang Medical University, 88 Jiankang Road, Xinxiang, 453100, Henan, China
| | - Xiao-Mei Liu
- Department of Oncology, The First Affiliated Hospital of Xinxiang Medical University, 88 Jiankang Road, Xinxiang, 453100, Henan, China
| | - Hai-Feng Wang
- Department of Oncology, The First Affiliated Hospital of Xinxiang Medical University, 88 Jiankang Road, Xinxiang, 453100, Henan, China
| | - Zhi-Xia Wang
- Department of Respiratory Medicine, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, 453100, Henan, China
| | - Hao-Qi Pan
- Department of Oncology, The First Affiliated Hospital of Xinxiang Medical University, 88 Jiankang Road, Xinxiang, 453100, Henan, China
| | - Qing-Qin Zhang
- Department of Oncology, The First Affiliated Hospital of Xinxiang Medical University, 88 Jiankang Road, Xinxiang, 453100, Henan, China.
| | - Xue-Lian Xu
- Department of Oncology, The First Affiliated Hospital of Xinxiang Medical University, 88 Jiankang Road, Xinxiang, 453100, Henan, China.
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Terrier J, Mach A, Fontana P, Bonhomme F, Casini A. Clinicians' adherence to guidelines for the preoperative management of direct oral anticoagulants in a tertiary hospital: a retrospective study. BMC Anesthesiol 2023; 23:314. [PMID: 37715136 PMCID: PMC10503177 DOI: 10.1186/s12871-023-02276-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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 09/10/2023] [Indexed: 09/17/2023] Open
Abstract
INTRODUCTION Despite clear, relatively easy-to-use guidance, many clinicians find the preoperative management of direct oral anticoagulants (DOACs) challenging. Inappropriate management can delay procedures and lead to haemorrhagic or thromboembolic complications. We aimed to describe preoperative management practices regarding DOACs in a tertiary hospital and clinicians' adherence to in-house recommendations. METHOD We included all patients being treated with DOACs who underwent elective surgery in 2019 and 2020 (n = 337). In-house recommendations for perioperative management were largely comparable to the 2022 American College of Chest Physicians guidelines. RESULTS Typical patients were older adults with multiple comorbidities and high thrombotic risk stratification scores, and 65.6% (n = 221) had not undergone recommended preoperative anticoagulation management protocols. Patients operated on using local anaesthesia (adjusted OR = 0.30, 95%CI 0.14-0.66; p < 0.01) were less likely to have been treated following institutional recommendations, but no association between their procedure's bleeding risk and adherence was found. Clinicians' failures to adhere to recommendations mostly involved late or non-indicated interruptions of anticoagulation treatment (n = 89, 26.4%) or inappropriate heparin bridging (n = 54, 16.0%). Forty-five (13.3%) procedures had to be postponed. Incorrect preoperative anticoagulation management was directly responsible for 12/45 postponements (26.7% of postponements). CONCLUSION This study highlights clinicians' low adherence rates to institutional recommendations for patients treated with DOACs scheduled for elective surgery in a tertiary hospital centre. To the best of our knowledge, this is the first clinical study addressing the issue of clinicians' adherence to guidelines for the preoperative management of DOACs. Going beyond the issue of whether clinicians are knowledgeable about guidelines or have them available, this study questions how generalisable guidelines are in a tertiary hospital managing many highly polymorbid patients. Further studies should identify the causes of poor adherence.
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Affiliation(s)
- Jean Terrier
- Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland.
- Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, 4 Rue Gabrielle Perret-Gentil, 1205, Geneva, Switzerland.
| | - Amélie Mach
- Division of Angiology and Hemostasis, Geneva University Hospitals, Geneva, Switzerland
| | - Pierre Fontana
- Division of Angiology and Hemostasis, Geneva University Hospitals, Geneva, Switzerland
| | - Fanny Bonhomme
- Division of Anesthesiology, Geneva University Hospitals, Geneva, Switzerland
| | - Alessandro Casini
- Division of Angiology and Hemostasis, Geneva University Hospitals, Geneva, Switzerland
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Sato H, Otsuka S, Abe H, Tsukada S. Comparison of outcomes of laparoscopic sacrocolpopexy with concomitant supracervical hysterectomy or uterine preservation. Int Urogynecol J 2023; 34:2217-2224. [PMID: 37052646 PMCID: PMC10506926 DOI: 10.1007/s00192-023-05534-0] [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: 01/12/2023] [Accepted: 02/26/2023] [Indexed: 04/14/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Sacrocolpopexy was traditionally performed for post-hysterectomy prolapse or during concurrent hysterectomy. Sacrocolpopexy outcome with uterine preservation is poorly investigated. This study compared outcomes of laparoscopic sacrocolpopexy with concurrent supracervical hysterectomy or uterine preservation. METHODS This retrospective study compared data of patients with pelvic organ prolapse who underwent laparoscopic sacrocolpopexy with uterine preservation with the data of controls who underwent laparoscopic sacrocolpopexy with supracervical hysterectomy. We analyzed composite failure in uterine preservation versus concurrent supracervical hysterectomy (primary objective) and evaluated factors associated with the primary outcome of composite failure after laparoscopic sacrocolpopexy with preservation or supracervical hysterectomy (secondary objective). Composite failure was defined as subjective bulge symptoms, reoperation, or anatomical prolapse. Cox models indicated time to composite failure as an endpoint. RESULTS Of 274 patients, 232 underwent laparoscopic sacrocolpopexy with supracervical hysterectomy and 42 underwent laparoscopic uterine preservation. After propensity score matching (ratio: 2, for the laparoscopic sacrocolpopexy with supracervical hysterectomy group), 56 patients (24.1%) were in the supracervical hysterectomy group and 28 (66.7%) in the uterine preservation group. All patients underwent 24 months of follow-up. The composite failure rates were 10.7% for supracervical hysterectomy and 3.6% for preservation (p=0.87). The mean estimated blood loss was 10 ml (preservation, 10.0 ml [5.0-10.0] versus supracervical hysterectomy, 10.0 ml [10.0-15.0]; p=0.007). In the Cox proportional hazards model, higher preoperative body mass index and the point Ba increased composite failure risk. CONCLUSIONS Although not statistically significant, composite failure in the two techniques is likely clinically meaningful.
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Affiliation(s)
- Hirotaka Sato
- Department of Urology, Hokusuikai Kinen Hospital, Ibaraki, Japan.
| | - Shota Otsuka
- Department of Urology, Hokusuikai Kinen Hospital, Ibaraki, Japan
| | - Hirokazu Abe
- Department of Urology, Kameda Medical Center, Chiba, Japan
| | - Sachiyuki Tsukada
- Department of Orthopedics, Hokusuikai Kinen Hospital, Ibaraki, Japan
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Schartz D, Furst T, Ellens N, Kohli GS, Rahmani R, Akkipeddi SMK, Schmidt T, Bhalla T, Mattingly T, Bender MT. Preoperative Embolization of Meningiomas Facilitates Reduced Surgical Complications and Improved Clinical Outcomes : A Meta-analysis of Matched Cohort Studies. Clin Neuroradiol 2023; 33:755-762. [PMID: 36854814 DOI: 10.1007/s00062-023-01272-4] [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: 11/07/2022] [Accepted: 01/24/2023] [Indexed: 03/02/2023]
Abstract
PURPOSE The utility of preoperative embolization (PE) of intracranial meningiomas is unclear and controversial. The aim of this study was to investigate the effect of PE on meningioma surgical resection by completing a meta-analysis of matched cohort studies. METHODS A systematic review and meta-analysis of matched cohort studies was completed to evaluate the effect of PE on meningioma resection and outcomes. Outcome measures included: intraoperative blood loss, major surgical complications, total surgical complications including minor ones, total major complications including major surgical and embolization complications, total overall complications, and postoperative functional independence defined as modified Rankin Score (mRS) of 0-2. Pooled odds ratios (OR) were determined via a fixed effects model. RESULTS A total of 6 matched cohort studies were identified with 219 embolized and 215 non-embolized meningiomas. There was no significant difference in intraoperative blood loss between the two groups (P = 0.87); however, the embolization group had a significantly lower odds ratio of major surgically related complications (OR: 0.37, 95% confidence interval, CI: 0.21-0.67, P = 0.0009, I2 = 0%), but no difference in minor surgical complications (P = 0.86). While there was a significantly lower odds ratio of total overall surgical and PE-related complications in PE cases (OR: 0.64, CI: 0.41-1.0, P = 0.05, I2 = 66%), there was no difference in total combined major complications between the groups (OR: 0.57, CI: 0.27-1.18, P = 0.13, I2 = 33%). Lastly, PE was associated with a higher odds ratio of functional independence on postoperative follow-up (OR: 2.3, CI: 1.06-5.02, P = 0.04, I2 = 0%). CONCLUSION For certain meningiomas, PE facilitates lower overall complications, lower major surgical complications, and improved functional independence. Further research is required to identify the particular subset of meningiomas that benefit from PE.
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Affiliation(s)
- Derrek Schartz
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA.
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA.
| | - Taylor Furst
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Nathaniel Ellens
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Gurkirat Singh Kohli
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Redi Rahmani
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Tyler Schmidt
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Tarun Bhalla
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Thomas Mattingly
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Matthew T Bender
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA
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Kirk JK, Gonzales CF. Preoperative considerations for patients with diabetes. Expert Rev Endocrinol Metab 2023; 18:503-512. [PMID: 37937905 DOI: 10.1080/17446651.2023.2272865] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/16/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION Patients undergoing surgery require a thorough assessment preoperatively. Hyperglycemia is associated with poor outcomes, and stability of glucose levels is an important factor in preoperative management. Diabetes presents a particular challenge since patients are often on multiple medications encompassing glycemic management and cardiovascular therapies. AREAS COVERED A PubMed search of published data and reviews on preoperative approaches in diabetes was conducted. Consensus opinion drives most of the guidelines and recommendations for management of diabetes in surgical patients. Pathophysiology is often complex with varying levels of glucose and surgical stress. Establishing well-controlled diabetes prior to surgical intervention should be standard practice in non-emergent procedures. We review the best practices for implementing preoperative assessment, with diabetes with a focus on diabetes medications. EXPERT OPINION The management of a patient preoperatively varies by region and country. Institutions differ in approaches to preoperative evaluation and the establishment of consistent approaches would provide a platform for monitoring patient outcomes. Multidisciplinary teams and pre-assessment clinics for preoperative evaluation can enhance patient care for those undergoing surgery.
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Affiliation(s)
- Julienne K Kirk
- Department of Family and Community Medicine, Medical Center Boulevard, Atrium Health Wake Forest Baptist, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
| | - Clifford F Gonzales
- Academic Nursing, Wake Forest University School of Medicine, Winston Salem, North Carolina
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Haddad BI, Hamdan M, Alshrouf MA, Alzubi A, Khirsheh A, Al-Oleimat A, Aldabaibeh M, Al-Qaryouti R, Abulubbad W, Al-Saber M, Jabaiti M, Karam AM. Preoperative hemoglobin levels and mortality outcomes after hip fracture patients. BMC Surg 2023; 23:266. [PMID: 37658363 PMCID: PMC10474652 DOI: 10.1186/s12893-023-02174-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 08/27/2023] [Indexed: 09/03/2023] Open
Abstract
PURPOSE Hip fracture surgery is associated with a risk of morbidity and mortality, with admission hemoglobin levels being a significant predictor of mortality risk. The aim of this study is to evaluate the relationship between the preoperative hemoglobin (Hb) levels and mortality in patients who underwent hip fracture surgeries, with the goal of enhancing prognosis prediction and reducing complications within this patient subset. In addition, to assess the characteristics of patients at a higher risk of postoperative mortality. METHODS This retrospective study was conducted at Jordan University Hospital, a single tertiary care and educational center. It included patients with hip fractures who underwent surgical repair at the Department of Orthopedic Surgery and were recruited between December 2019 and February 2022. We examined the relationships between preoperative hemoglobin status and variables such as age at admission, gender, fracture type, surgery type, comorbidities, duration of hospital stay, intensive care unit (ICU) admission, and survival outcomes. RESULTS We included 626 patients; the mean age was 76.27 ± 9.57 years. 3-month and 6-month mortality rates were 11.2% and 14.1%, respectively. The highest mortality was observed in patients aged over 80 years (n = 53/245, 21.6%), and in male patients (n = 53/300, 17.7%). The Hb level upon admission was lower in individuals who died within 6 months compared to those who survived (10.97 ± 2.02 vs. 11.99 ± 2.39, p < 0.001). In multivariate analysis, the independent factors that were statistically significant in the model included gender (OR = 1.867; 95% CI 1.122-3.107, p = 0.016), age (OR = 1.060; 95% CI 1.029-1.092; p < 0.001), hemoglobin level upon admission (OR = 0.827; 95% CI 0.721-0.949; p = 0.007), history of renal disease (OR = 1.958; 95% CI 1.014-3.784; p = 0.045), length of hospital stay (OR = 1.080; 95% CI 1.036-1.126; p < 0.001), and ICU admission (OR = 1.848; 95% CI 1.049-3.257; p = 0.034). CONCLUSION Our study illustrates that low hemoglobin levels, history of renal disease, along with male gender, advanced age, extended hospital stays, and ICU admission were significantly associated with 6-month mortality. Future investigations should consider assessing varying degrees of anemia based on hemoglobin concentrations to provide a more comprehensive understanding of anemia's impact on mortality. This study investigated the relationship between preoperative hemoglobin levels, patient characteristics, and mortality in patients who underwent hip fracture surgeries. The results showed that lower hemoglobin levels, history of renal disease, male gender, advanced age, extended hospital stays, and ICU admission were significant predictors for mortality.
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Affiliation(s)
- Bassem I Haddad
- Department of Special Surgery, Division of Orthopedics, School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Mohammad Hamdan
- Department of Special Surgery, Division of Orthopedics, School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Mohammad Ali Alshrouf
- Medical Internship, Jordan University Hospital, The University of Jordan, Amman, 11942, Jordan.
| | - Abdallah Alzubi
- The School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Ahmed Khirsheh
- The School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Ahmad Al-Oleimat
- The School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | | | | | - Waleed Abulubbad
- The School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Munther Al-Saber
- Department of Special Surgery, Division of Orthopedics, School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Mohammad Jabaiti
- Department of Special Surgery, Division of Orthopedics, School of Medicine, The University of Jordan, Amman, 11942, Jordan
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Kataria-Hale J, Gollins L, Bonagurio K, Blanco C, Hair AB. Nutrition for Infants with Congenital Heart Disease. Clin Perinatol 2023; 50:699-713. [PMID: 37536773 DOI: 10.1016/j.clp.2023.04.007] [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] [Indexed: 08/05/2023]
Abstract
Perioperative malnutrition in infants with congenital heart disease can lead to significant postnatal growth failure and poor short- and long-term outcomes. A standardized approach to nutrition is needed for the neonatal congenital heart disease population, taking into consideration the type of cardiac lesion, the preoperative and postoperative period, and prematurity. Early enteral feeding is beneficial and should be paired with parenteral nutrition to meet the fluid and nutrient needs of the infant.
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Affiliation(s)
- Jasmeet Kataria-Hale
- Department of Pediatrics, Division of Neonatology, Mission Hospital, 509 Biltmore Avenue, Asheville, NC 28801, USA
| | - Laura Gollins
- Department of Pediatrics, Division of Neonatology, Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin Street, MC: A5590, Houston, TX 77030, USA
| | - Krista Bonagurio
- University of Texas Health Science Center, San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - Cynthia Blanco
- University of Texas Health Science Center, San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - Amy B Hair
- Department of Pediatrics, Division of Neonatology, Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin Street, MC: A5590, Houston, TX 77030, USA.
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Yu L, Dai MG, Lu WF, Wang DD, Ye TW, Xu FQ, Liu SY, Liang L, Feng DJ. Preoperative prediction model for microvascular invasion in HBV-related intrahepatic cholangiocarcinoma. BMC Surg 2023; 23:239. [PMID: 37592274 PMCID: PMC10433593 DOI: 10.1186/s12893-023-02139-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 08/04/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND AND AIMS Preoperative prediction of microvascular invasion (MVI) using a noninvasive method remain unresolved, especially in HBV-related in intrahepatic cholangiocarcinoma (ICC). This study aimed to build and validate a preoperative prediction model for MVI in HBV-related ICC. METHODS Patients with HBV-associated ICC undergoing curative surgical resection were identified. Univariate and multivariate logistic regression analyses were performed to determine the independent risk factors of MVI in the training cohort. Then, a prediction model was built by enrolling the independent risk factors. The predictive performance was validated by receiver operator characteristic curve (ROC) and calibration in the validation cohort. RESULTS Consecutive 626 patients were identified and randomly divided into the training (418, 67%) and validation (208, 33%) cohorts. Multivariate analysis showed that TBIL, CA19-9, tumor size, tumor number, and preoperative image lymph node metastasis were independently associated with MVI. Then, a model was built by enrolling former fiver risk factors. In the validation cohort, the performance of this model showed good calibration. The area under the curve was 0.874 (95% CI: 0.765-0.894) and 0.729 (95%CI: 0.706-0.751) in the training and validation cohort, respectively. Decision curve analysis showed an obvious net benefit from the model. CONCLUSION Based on clinical data, an easy model was built for the preoperative prediction of MVI, which can assist clinicians in surgical decision-making and adjuvant therapy.
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Affiliation(s)
- Liang Yu
- Department of Radiology, Cancer Center, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Zhejiang, Hangzhou, China
| | - Mu-Gen Dai
- Department of Gastroenterology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
| | - Wen-Feng Lu
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Navy Medical University, Shanghai, China
| | - Dong-Dong Wang
- Department of Hepatobiliary & Pancreatic Surgery and Minimally Invasive Surgery , General Surgery, Cancer Center, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Zhejiang, Hangzhou, China
| | - Tai-Wei Ye
- Department of Hepatobiliary & Pancreatic Surgery and Minimally Invasive Surgery , General Surgery, Cancer Center, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Zhejiang, Hangzhou, China
| | - Fei-Qi Xu
- Department of Hepatobiliary & Pancreatic Surgery and Minimally Invasive Surgery , General Surgery, Cancer Center, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Zhejiang, Hangzhou, China
| | - Si-Yu Liu
- Department of Gastroenterology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
- Department of Laboratory Medicine, The Key Laboratory of Imaging Diagnosis and Minimally Invasive Interventional Research of Zhejiang Province, Zhejiang University Lishui Hospital, Lishui, Zhejiang, China
| | - Lei Liang
- Department of Hepatobiliary & Pancreatic Surgery and Minimally Invasive Surgery , General Surgery, Cancer Center, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Zhejiang, Hangzhou, China
| | - Du-Jin Feng
- Department of Clinical Laboratory, Laboratory Medicine Center, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Zhejiang, 310014, Hangzhou, China.
- Department of Laboratory Medicine Center, Zhejiang Center for Clinical Laboratories, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China.
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Gowd AK, Plate JF, Lichtig A, Gencer A, Yanmis O, D'Agostino R, Poehling GG. Favourable mid-term outcomes following unicompartmental knee arthroplasty with wider patient selection: A single-centre experience. J ISAKOS 2023; 8:255-260. [PMID: 37004741 DOI: 10.1016/j.jisako.2023.03.002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 02/17/2023] [Accepted: 03/11/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVE The purpose of this study was to determine surgical outcomes of robotic-assisted UKAs utilizing a wider set of indications than traditionally utilized. Additionally, we seek to determine alternate predictive factors as potential surgical indications and contraindications. METHODS A prospectively maintained institutional joint registry was queried at a single academic centre for all patients that underwent robotic-assisted UKA between January 2010-December 2016. Surgical indication included isolated medial or lateral compartment degenerative disease with a stable knee based on physical exam. In 2013, haemoglobin A1C levels over 7.5% were considered contraindications, which was lowered to 7.0% in 2015. Preoperative alignment, age, activity level and degree of pain were not contraindications for surgery. Preoperative demographics, Oxford scores, radiographic (joint space), comorbidities and operative data were collected and reviewed to determine factors related to conversion to TKA and survivorship of the primary implant. RESULTS In total, 1878 cases were performed; however, excluding multi-joint knees, there were a total of 1186 knees in 1014 patients with a minimum 4-year follow-up. The mean age was 63.4 ± 10.7 years and mean follow-up was 76.4 ± 17.4 months. Mean BMI was 32.3 ± 6.5 kg/m2. (52.9% females, 47.1% males). There were 901 patients undergoing medial UKA, 122 patients undergoing lateral UKA and 69 patients undergoing patellofemoral UKA. In total, 85 (7.2%) knees underwent conversion to TKA. Preoperative factors such as the degree of preoperative valgus deformity (p = 0.01), greater operative joint space (p = 0.04), previous surgery (p = 0.01), inlay implant (p = 0.04) and pain syndrome (p = 0.01) were associated with increased risk of revision surgery. Factors associated with decreased implant survivorship included patients with history of previous surgery (p < 0.01), history of pain syndrome (p < 0.01) and greater preoperative joint space (>2 mm) (p < 0.01). There was no association of BMI to conversion to TKA. CONCLUSION Robotic-assisted UKA with wider patient selection demonstrated favourable outcomes at 4 years with survivorship greater than 92%. The present series agree with emerging indications that do not exclude patients based on age, BMI, or degree of deformity. However, increased operative joint space, inlay design, history of surgery and coexistence of pain syndrome are factors that increase risk of conversion to TKA. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Anirudh K Gowd
- Department of Orthopaedic Surgery Wake Forest Medical Center Watlington Hall, 4th Floor 1 Medical Center Boulevard, Winston Salem, NC 27157, USA
| | - Johannes F Plate
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA
| | - Asher Lichtig
- Department of Orthopaedic Surgery Wake Forest Medical Center Watlington Hall, 4th Floor 1 Medical Center Boulevard, Winston Salem, NC 27157, USA.
| | - Ahmet Gencer
- Department of Orthopaedic Surgery Wake Forest Medical Center Watlington Hall, 4th Floor 1 Medical Center Boulevard, Winston Salem, NC 27157, USA
| | - Orhan Yanmis
- Department of Orthopaedic Surgery Wake Forest Medical Center Watlington Hall, 4th Floor 1 Medical Center Boulevard, Winston Salem, NC 27157, USA
| | - Ralph D'Agostino
- Department of Orthopaedic Surgery Wake Forest Medical Center Watlington Hall, 4th Floor 1 Medical Center Boulevard, Winston Salem, NC 27157, USA
| | - Gary G Poehling
- Department of Orthopaedic Surgery Wake Forest Medical Center Watlington Hall, 4th Floor 1 Medical Center Boulevard, Winston Salem, NC 27157, USA.
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Grantham JP, Hii A, Shenfine J. Combined and intraoperative risk modelling for oesophagectomy: A systematic review. World J Gastrointest Surg 2023; 15:1485-1500. [PMID: 37555117 PMCID: PMC10405120 DOI: 10.4240/wjgs.v15.i7.1485] [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: 11/26/2022] [Revised: 03/13/2023] [Accepted: 05/22/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Oesophageal cancer is the eighth most common malignancy worldwide and is associated with a poor prognosis. Oesophagectomy remains the best prospect for a cure if diagnosed in the early disease stages. However, the procedure is associated with significant morbidity and mortality and is undertaken only after careful consideration. Appropriate patient selection, counselling and resource allocation is essential. Numerous risk models have been devised to guide surgeons in making these decisions. AIM To evaluate which multivariate risk models, using intraoperative information with or without preoperative information, best predict perioperative oesophagectomy outcomes. METHODS A systematic review of the MEDLINE, EMBASE and Cochrane databases was undertaken from 2000-2020. The search terms used were [(Oesophagectomy) AND (Model OR Predict OR Risk OR score) AND (Mortality OR morbidity OR complications OR outcomes OR anastomotic leak OR length of stay)]. Articles were included if they assessed multivariate based tools incorporating preoperative and intraoperative variables to forecast patient outcomes after oesophagectomy. Articles were excluded if they only required preoperative or any post-operative data. Studies appraising univariate risk predictors such as preoperative sarcopenia, cardiopulmonary fitness and American Society of Anesthesiologists score were also excluded. The review was conducted following the preferred reporting items for systematic reviews and meta-analyses model. All captured risk models were appraised for clinical credibility, methodological quality, performance, validation and clinical effectiveness. RESULTS Twenty published studies were identified which examined eleven multivariate risk models. Eight of these combined preoperative and intraoperative data and the remaining three used only intraoperative values. Only two risk models were identified as promising in predicting mortality, namely the Portsmouth physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) and POSSUM scores. A further two studies, the intraoperative factors and Esophagectomy surgical Apgar score based nomograms, adequately forecasted major morbidity. The latter two models are yet to have external validation and none have been tested for clinical effectiveness. CONCLUSION Despite the presence of some promising models in forecasting perioperative oesophagectomy outcomes, there is more research required to externally validate these models and demonstrate clinical benefit with the adoption of these models guiding postoperative care and allocating resources.
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Affiliation(s)
- James Paul Grantham
- Department of General Surgery, Modbury Hospital, Modbury 5092, South Australia, Australia
| | - Amanda Hii
- Department of General Surgery, Modbury Hospital, Modbury 5092, South Australia, Australia
| | - Jonathan Shenfine
- Department of General Surgical Unit, Jersey General Hospital, Saint Helier JE1 3QS, Jersey, United Kingdom
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Hackenbroch C, Strobel JRB, Lorenz KJ, Beer M, Schüle S. Dose development in sinonasal imaging over the last decade - a retrospective patient study. Head Face Med 2023; 19:28. [PMID: 37430304 PMCID: PMC10332007 DOI: 10.1186/s13005-023-00378-x] [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: 04/07/2023] [Accepted: 07/01/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Computed tomography (CT) has become the primary imaging modality for visualization of the paranasal sinuses. In this retrospective, single center patient study the radiation dose development in the past 12 years in CT imaging of the paranasal sinuses was assessed. METHODS The computed tomography dose index (CTDIVol) and dose length product (DLP) of a total of 1246 patients (average age: 41 ± 18 years, 361 females, 885 males) were evaluated, who received imaging of the paranasal sinuses either for chronic sinusitis diagnostic, preoperatively or posttraumatically. Scans were performed on three different CT scanners (Somatom Definition AS, Somatom Definition AS+, Somatom Force, all from Siemens Healthineers) and on one CBCT (Morita) ranging from 2010 to 2022. Reconstruction techniques were filtered back projection and three generations of iterative reconstruction (IRIS, SAFIRE, ADMIRE, all from Siemens Healthineers). Group comparisons were performed using either parametrical (ANOVA) or non-parametrical tests (Kruskal-Wallis Test), where applicable. RESULTS Over the past 12 years, there was a 73%, 54%, and 66% CTDIVol reduction and a significant (p < 0.001) 72%, 33%, and 67% DLP reduction in assessing the paranasal sinuses for chronic sinusitis, preoperatively and posttraumatically, respectively. CONCLUSION Technological developments in CT imaging, both hardware and software based, have led to a significant reduction in dose exposure in recent years. Particularly in imaging of the paranasal sinuses, the reduction of radiation exposure is of great interest due to the often young patient age and radiation-sensitive organs in the area of radiation exposure.
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Affiliation(s)
- Carsten Hackenbroch
- Department of Diagnostic and Interventional Radiology and Neuroradiology, German Armed Forces Hospital Ulm, Ulm, Baden-Wurttemberg, Germany.
- Department of Radiology, University Hospital of Ulm, Ulm, Baden-Wurttemberg, Germany.
| | - Joachim Rudolf Balthasar Strobel
- Department of Diagnostic and Interventional Radiology and Neuroradiology, German Armed Forces Hospital Ulm, Ulm, Baden-Wurttemberg, Germany
| | - Kai Johannes Lorenz
- Department of Otorhinolaryngology and Head and Neck Surgery, German Armed Forces Central Hospital Koblenz, Koblenz, Rhineland-Palatinate, Germany
| | - Meinrad Beer
- Department of Radiology, University Hospital of Ulm, Ulm, Baden-Wurttemberg, Germany
| | - Simone Schüle
- Department of Diagnostic and Interventional Radiology and Neuroradiology, German Armed Forces Hospital Ulm, Ulm, Baden-Wurttemberg, Germany
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Moiyadi A, Jain K, Shetty P, kumar Singh V, Radhakrishnan K, Rane P, Velayutham P. Baseline neurocognitive dysfunction is ubiquitous in intrinsic brain tumors- results from a large Indian cohort of patients and analysis of factors associated with domain-specific dysfunction. World Neurosurg X 2023; 19:100210. [PMID: 37251242 PMCID: PMC10209697 DOI: 10.1016/j.wnsx.2023.100210] [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: 09/13/2022] [Revised: 04/22/2023] [Accepted: 05/02/2023] [Indexed: 05/31/2023] Open
Abstract
Background Neurocognitive function (NCF) before surgery is an important marker of baseline performance in patients with brain tumors. Increasingly, neurocognitive deficits (NCD) have been demonstrated in a high proportion of patients. Selection bias (patient, tumor, and surgical procedure related) may influence the prevalence and type of domains involved in patients with gliomas. Methods We evaluated baseline NCF in a consecutive cohort of intra-axial tumors in Indian patients (n = 142). A comprehensive battery evaluating five domains - attention & executive function (EF), memory, language, visuospatial function and visuomotor abilities was used. Deficits were categorized as severe and mild-moderate. Factors associated with severe NCD were evaluated. Results Severe NCD was present in 90% of the patients, 70% of them having affection of at least 2 domains. Attention-EF, memory and visuomotor speed were most affected. 132 underwent surgery (69 awake, 63 under general anesthesia - GA). The awake cohort had younger patients with lower grade gliomas and more left sided tumors. Multi-domain dysfunction was seen almost equally in awake/GA groups as well as left/right sided tumors. On multivariate analysis, older age, lower educational status and larger tumor volume adversely affected NCF in many of the domains. Only language dysfunction was location specific (temporal lobe tumors) though not laterality (left/right) specific. Conclusions NCD were seen in a large majority of cases before surgery, including those undergoing awake surgery. Language may be affected even in tumors in the non-dominant hemisphere. Attention-EF and memory are most affected and need to be factored in while assessing patient performance intraoperatively during awake surgery as well as tailoring rehabilitative measures subsequently.
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Affiliation(s)
- Aliasgar Moiyadi
- Neurosurgical Oncology Services, Dept of Surgical Oncology, Tata Memorial Centre, Mumbai, 400012, India
- Department of Health Sciences, Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400094, India
| | - Kanchi Jain
- Neurosurgical Oncology Services, Dept of Surgical Oncology, Tata Memorial Centre, Mumbai, 400012, India
- Department of Health Sciences, Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400094, India
| | - Prakash Shetty
- Neurosurgical Oncology Services, Dept of Surgical Oncology, Tata Memorial Centre, Mumbai, 400012, India
- Department of Health Sciences, Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400094, India
| | - Vikas kumar Singh
- Neurosurgical Oncology Services, Dept of Surgical Oncology, Tata Memorial Centre, Mumbai, 400012, India
- Department of Health Sciences, Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400094, India
| | - Keerthi Radhakrishnan
- Neurosurgical Oncology Services, Dept of Surgical Oncology, Tata Memorial Centre, Mumbai, 400012, India
- Department of Health Sciences, Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400094, India
| | - Pallavi Rane
- Clinical Research Secretariat, ACTREC, Tata Memorial Centre, Mumbai, 400012, India
| | - Parthiban Velayutham
- Neurosurgical Oncology Services, Dept of Surgical Oncology, Tata Memorial Centre, Mumbai, 400012, India
- Department of Health Sciences, Homi Bhabha National Institute, Training School Complex, Anushaktinagar, Mumbai, 400094, India
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Mapelli P, Bezzi C, Muffatti F, Ghezzo S, Baldassi F, Schiavo Lena M, Andreasi V, Canevari C, Magnani P, De Cobelli F, Gianolli L, Partelli S, Falconi M, Picchio M. Somatostatin receptor activity assessed by 68Ga-DOTATOC PET can preoperatively predict DAXX/ATRX loss of expression in well-differentiated pancreatic neuroendocrine tumors. Eur J Nucl Med Mol Imaging 2023; 50:2818-2829. [PMID: 37010579 DOI: 10.1007/s00259-023-06210-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/18/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE To evaluate the role of 68Ga-DOTATOC PET parameters in predicting DAXX/ATRX loss of expression in patients with Pancreatic neuroendocrine tumors (PanNET) candidate to surgery. METHODS This retrospective study included 72 consecutive patients with PanNET (January 2018-March 2022) who underwent to 68Ga-DOTATOC PET for preoperative staging. Image analysis: qualitative assessment and extraction of SUVmax, SUV mean, somatostatin receptor density (SRD), and total lesion somatostatin receptor density (TLSRD) from primary PanNET. Radiological diameter and biopsy information (grade, Ki67) were collected. Loss of expression (LoE) of DAXX/ATRX was assessed by immunohistochemistry on surgical specimen. Student t-test, univariate and multivariate logistic regression and ROC curves have been used to investigate the predictive value of PET parameters on DAXX/ATRX LoE. RESULTS Forty-two/72 patients had a G1, 28/72 a G2, and 2/72 a G3 PanNET. Seven/72 patients had DAXX LoE, 10/72 ATRX LoE, and 2/72 DAXX/ATRX LoE. SRD and TLSRD could predict DAXX LoE (p = 0.002, p = 0.018, respectively). By evaluating SRD in combination with radiological diameter, only SRD maintained statistical significance (multivariate logistic regression: p = 0.020, OR = 1.05), providing the best prediction (AUC-ROC = 79.01%; cut-off = 46.96; sensitivity = 77.78%; specificity = 88.89%). In the sub-analysis performed on 55 patients with biopsy availability, SRD demonstrated its role in providing useful and additional information (multivariate logistic regression: SRD p = 0.007; grade p = 0.040). CONCLUSION SRD has a predictive role on DAXX LoE in PanNETs, with higher probability of LoE at increasing SRD values. SRD provides complementary/additional information to grade assessed on biopsy material, and the combined use of these approaches might support patients' management by preoperatively identifying subjects with more aggressive diseases.
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Affiliation(s)
- Paola Mapelli
- Vita-Salute San Raffaele University, Milan, Italy
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carolina Bezzi
- Vita-Salute San Raffaele University, Milan, Italy
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Muffatti
- Pancreatic Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Samuele Ghezzo
- Vita-Salute San Raffaele University, Milan, Italy
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | | | - Valentina Andreasi
- Vita-Salute San Raffaele University, Milan, Italy
- Pancreatic Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carla Canevari
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Patrizia Magnani
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco De Cobelli
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luigi Gianolli
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Partelli
- Vita-Salute San Raffaele University, Milan, Italy
- Pancreatic Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Falconi
- Vita-Salute San Raffaele University, Milan, Italy
- Pancreatic Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Picchio
- Vita-Salute San Raffaele University, Milan, Italy.
- Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Boles S, Ashok SR. Pre-assessment and management of long COVID patients requiring elective surgery: challenges and guidance. Perioper Med (Lond) 2023; 12:20. [PMID: 37277879 DOI: 10.1186/s13741-023-00305-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 04/25/2023] [Indexed: 06/07/2023] Open
Abstract
Whilst most patients infected with COVID-19 make a full recovery, around 1 in 33 patients in the UK report ongoing symptoms post-infection, termed 'long COVID'. Studies have demonstrated that infection with early COVID-19 variants increases postoperative mortality and pulmonary complications for around 7 weeks after acute infection. Furthermore, this increased risk persists for those with ongoing symptoms beyond 7 weeks. Patients with long COVID may therefore also be at increased postoperative risk, and despite the significant prevalence of long COVID, there are minimal guidelines on how best to assess and manage these patients perioperatively. Long COVID shares several clinical and pathophysiological similarities with conditions such as myalgic encephalitis/chronic fatigue syndrome and postural tachycardia syndrome; however, there are no current guidelines for the preoperative management of these patients to help develop something similar for long COVID patients. Developing guidelines for long COVID patients is further complicated by its heterogenous presentation and pathology. These patients can have persistent abnormalities on pulmonary function tests and echocardiography 3 months after acute infection, correlating with a reduced functional capacity. Conversely, some long COVID patients can continue to experience symptoms of dyspnoea and fatigue despite normal pulmonary function tests and echocardiography, yet demonstrating significantly reduced aerobic capacity on cardiopulmonary exercise testing even a year after initial infection. How to comprehensively risk assess these patients is therefore challenging. Existing preoperative guidelines for elective patients with recent COVID-19 generally focus on the timing of surgery and recommendations for pre-assessment if surgery is required before this time interval has elapsed. How long to delay surgery in those with ongoing symptoms and how to manage them perioperatively are less clear. We suggest that multidisciplinary decision-making is required for these patients, using a systems-based approach to guide discussion with specialists and the need for further preoperative investigations. However, without a better understanding of the postoperative risks for long COVID patients, it is difficult to obtain a multidisciplinary consensus and obtain informed patient consent. Prospective studies of long COVID patients undergoing elective surgery are urgently required to help quantify their postoperative risk and develop comprehensive perioperative guidelines for this complex patient group.
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Affiliation(s)
- Sophie Boles
- Department of Anaesthesia and Intensive Care Medicine, Croydon University Hospital, Surrey, UK.
| | - Sundar Raj Ashok
- Department of Anaesthesia and Intensive Care Medicine, Croydon University Hospital, Surrey, UK
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Di Rocco F, de Laurentis C. Focus session on sodium fluorescein in pediatric oncological neurosurgery. Childs Nerv Syst 2023; 39:1449-1450. [PMID: 37160434 DOI: 10.1007/s00381-023-05957-6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/07/2023] [Indexed: 05/11/2023]
Abstract
Many tools and techniques have been developed to obtain maximal safe tumoral resection in neurosurgery. Fluorescent dyes, including sodium fluorescein, have become also part of this armamentarium to localize the lesion and its boundaries peroperatively. Considering its alleged safety profile and its ability to diffuse in areas of altered blood-brain barrier, a typical characteristic of a number of both benign and malignant pediatric tumors, sodium fluorescein may appear an ideal candidate as intraoperative adjunct in pediatric neurosurgery. Nevertheless, a definitive role of this dye in children has not been established yet, and the reports on the pediatric population remain scarce. For this reason, we propose focusing on the use of sodium fluorescein in pediatric oncological neurosurgery by collecting articles reporting the result of the application of the technique in the management of intracranial pediatric tumors.
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Affiliation(s)
- Federico Di Rocco
- Pediatric Neurosurgery, Université Claude Bernard, Lyon 1 and Hôpital femme Mère Enfant, 59 bd Pinel, Lyon, France.
| | - Camilla de Laurentis
- Pediatric Neurosurgery, Université Claude Bernard, Lyon 1 and Hôpital femme Mère Enfant, 59 bd Pinel, Lyon, France
- Università degli Studi di Milano Bicocca, Milano, Italy
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Oya R, Ogawa S, Oya K, Hirakawa Y, Maeda C, Amaya F. Prevalence of preoperative opioid usage and its impact on postoperative outcomes: a retrospective cohort study. J Anesth 2023:10.1007/s00540-023-03198-0. [PMID: 37160444 DOI: 10.1007/s00540-023-03198-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 04/25/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE Preoperative opioid treatment increases postoperative adverse events. This study was aimed to analyze preoperative opioid prevalence in countries with low opioid consumption. Additionally, the effect of low opioid usage on postoperative outcomes was also investigated. METHODS We conducted this single center retrospective cohort analysis in a Japanese university-affiliated hospital to investigate opioid usage and its impact on the duration of postoperative hospitalization and in-hospital mortality. Adult patients who underwent general anesthesia between 2015 and 2020 were included. We extracted the patients' characteristics, surgical information and postoperative outcomes. Subgroup analysis to address opioid dose effect was performed in high and low dose opioid subgroups. RESULTS Among 20,306 inpatients, 535 (2.63%) patients used opioids preoperatively. Tramadol was the most frequently used opioid. The median morphine equivalent (MME) dose was 15 mg/day. Median duration of hospitalization was 18 and 9 days in the opioid and non-opioid groups, and in-hospital mortality was 2.06% and 0.42%. Multivariable regression analysis demonstrated that preoperative opioid use was associated with a longer duration of hospitalization and in-hospital mortality. Subgroup analysis demonstrated longer durations of hospitalization in both high (> 30 mg/day MME) and low (≤ 30 mg/day MME) dose opioid groups, while higher in-hospital mortality was seen only in the high dose opioid group. CONCLUSIONS Preoperative opioid usage was one-tenth of the United States average. Despite its low prevalence and small dosage, preoperative opioid usage was associated with poor postoperative outcomes. Dedicated perioperative interventions to prevent opioid-associated adverse events should be developed even in countries with low opioid consumption.
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Affiliation(s)
- Rina Oya
- Department of Pain Management and Palliative Care Medicine, Kyoto Prefectural University of Medicine, Kajiicho 465, Kamigyo-ku, Kyoto, 602-0841, Japan
| | - Satoru Ogawa
- Department of Pain Management and Palliative Care Medicine, Kyoto Prefectural University of Medicine, Kajiicho 465, Kamigyo-ku, Kyoto, 602-0841, Japan
| | - Kiyofumi Oya
- Peace Home Care Clinic, 16-21 Oiwake-cho, Otsu, Shiga, 520-0064, Japan
| | - Yuka Hirakawa
- Department of Pain Management and Palliative Care Medicine, Kyoto Prefectural University of Medicine, Kajiicho 465, Kamigyo-ku, Kyoto, 602-0841, Japan
| | - Chika Maeda
- Department of Pain Management and Palliative Care Medicine, Kyoto Prefectural University of Medicine, Kajiicho 465, Kamigyo-ku, Kyoto, 602-0841, Japan
| | - Fumimasa Amaya
- Department of Pain Management and Palliative Care Medicine, Kyoto Prefectural University of Medicine, Kajiicho 465, Kamigyo-ku, Kyoto, 602-0841, Japan.
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Hu Y, Zhu L, Tian X, Duan F. Prevalence of preoperative deep vein thrombosis in long bone fractures of lower limbs: a systematic review and meta-analysis. J Orthop Traumatol 2023; 24:19. [PMID: 37156964 PMCID: PMC10167078 DOI: 10.1186/s10195-023-00699-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/02/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND There is a paucity of data regarding the prevalence of preoperative deep vein thrombosis (DVT) in patients with long bone (including femur, tibia and fibula) fractures of the lower limbs. We performed a meta-analysis to address the issue. METHODS Electronic databases, including PubMed, EMBASE, the Web of Science, the Cochrane Library, the VIP database, CNKI, and the Wanfang database, were systematic searched for original articles that reported the prevalence of preoperative DVT in long bone fractures of the lower limbs from January 2016 to September 2021. The prevalence of preoperative DVT was pooled using random-effects models, and subgroups were established according to study type, detection method, sample size and fracture site. RESULTS Twenty-three articles reporting on 18,119 patients were eligible. The overall pooled preoperative DVT prevalence was 24.1% (95% CI 19.3-28.8%). In different subgroups, the preoperative DVT prevalences were 18.2-27.3%, 15.2-28.6%, 23.1-24.9%, 18.2-26.0% and 23.2-23.4% for different study designs, sample sizes, age groups, detection methods and fracture sites, respectively. CONCLUSIONS Despite the heterogeneity among studies, this systematic review suggests that the prevalence of preoperative DVT, which may seriously affect the prognosis of patients, is high. Therefore, greater efforts should be devoted to the improvement of screening and prevention strategies for preoperative DVT in lower-extremity long bone fractures. LEVEL OF EVIDENCE Level III. Trial Registration The study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database with the registration number CRD42022324706.
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Affiliation(s)
- Yaowen Hu
- Beijing Jishuitan Hospital, The Fourth Clinical Medical College, Peking University Health Science Center, Beijing, China
| | - Liwen Zhu
- Beijing Jishuitan Hospital, The Fourth Clinical Medical College, Peking University Health Science Center, Beijing, China
| | - Xuan Tian
- Department of Vascular Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Fangfang Duan
- Clinical Epidemiology Research Center, Beijing Jishuitan Hospital, Beijing, China.
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Kassab K, Saltiel F. Current management of coronary artery disease prior to vascular surgery: A clinical dilemma. J Perioper Pract 2023; 33:148-152. [PMID: 36285610 PMCID: PMC10160823 DOI: 10.1177/17504589221123285] [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] [Indexed: 05/06/2023]
Abstract
Here we present a case of an elderly man who underwent cardiac stress testing as a preoperative evaluation prior to femoral-popliteal bypass surgery. He subsequently underwent a preoperative coronary angiogram after a high-risk stress test with the latter demonstrating obstructive three-vessel coronary artery disease. We discuss the clinical challenges that such a common clinical scenario presents particularly when it comes to preoperative coronary revascularisation prior to vascular surgery. We examine the case within the framework of the latest revascularisation guidelines and discuss the available evidence for preoperative revascularisation and its limitations.
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Affiliation(s)
- Kameel Kassab
- Division of Cardiology, Borgess Heart Institute, Kalamazoo, MI, USA
- Michigan State University, East Lansing, MI, USA
| | - Frank Saltiel
- Division of Cardiology, Borgess Heart Institute, Kalamazoo, MI, USA
- Michigan State University, East Lansing, MI, USA
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