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Ridolfi D, Oyekan AA, Tang MY, Chen SR, Como CJ, Dalton J, Gannon EJ, Jackson KL, Bible JE, Kowalski C, de Groot SJ, Donaldson WF, Lee JY, Shaw JD. Modified Clavien-Dindo-Sink Classification System for operative complications in adult spine surgery. J Neurosurg Spine 2024:1-5. [PMID: 38306652 DOI: 10.3171/2023.11.spine23396] [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] [Received: 04/07/2023] [Accepted: 11/28/2023] [Indexed: 02/04/2024]
Abstract
OBJECTIVE Currently there is no standardized mechanism to describe or compare complications in adult spine surgery. Thus, the purpose of the present study was to modify and validate the Clavien-Dindo-Sink complication classification system for applications in spine surgery. METHODS The Clavien-Dindo-Sink complication classification system was evaluated and modified for spine surgery by four fellowship-trained spine surgeons using a consensus process. A distinct group of three fellowship-trained spine surgeons completed a randomized electronic survey grading 71 real-life clinical case scenarios. The survey was repeated 2 weeks after its initial completion. Fleiss' and Cohen's kappa (κ) statistics were used to evaluate interrater and intrarater reliabilities, respectively. RESULTS Overall, interobserver reliability during the first and second rounds of grading was excellent with a κ of 0.847 (95% CI 0.785-0.908) and 0.852 (95% CI 0.791-0.913), respectively. In the first round, interrater reliability ranged from good to excellent with a κ of 0.778 for grade I (95% CI 0.644-0.912), 0.698 for grade II (95% CI 0.564-0.832), 0.861 for grade III (95% CI 0.727-0.996), 0.845 for grade IV-A (95% CI 0.711-0.979), 0.962 for grade IV-B (95% CI 0.828-1.097), and 0.960 for grade V (95% CI 0.826-1.094). Intraobserver reliability testing for all three independent observers was excellent with a κ of 0.971 (95% CI 0.944-0.999) for rater 1, 0.963 (95% CI 0.926-1.001) for rater 2, and 0.926 (95% CI 0.869-0.982) for rater 3. CONCLUSIONS The Modified Clavien-Dindo-Sink Classification System demonstrates excellent interrater and intrarater reliability in adult spine surgery cases. This system provides a useful framework to better communicate the severity of spine-related complications.
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Affiliation(s)
- Dominic Ridolfi
- 1Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- 2Pittsburgh Orthopaedic Spine Research Group, University of Pittsburgh, Pennsylvania
| | - Anthony A Oyekan
- 1Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- 2Pittsburgh Orthopaedic Spine Research Group, University of Pittsburgh, Pennsylvania
| | - Melissa Yunting Tang
- 1Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- 2Pittsburgh Orthopaedic Spine Research Group, University of Pittsburgh, Pennsylvania
| | - Stephen R Chen
- 1Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- 2Pittsburgh Orthopaedic Spine Research Group, University of Pittsburgh, Pennsylvania
| | - Christopher J Como
- 1Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jonathan Dalton
- 1Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- 2Pittsburgh Orthopaedic Spine Research Group, University of Pittsburgh, Pennsylvania
| | - Emmett J Gannon
- 2Pittsburgh Orthopaedic Spine Research Group, University of Pittsburgh, Pennsylvania
- 3Department of Orthopaedic Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Keith L Jackson
- 4Department of Orthopaedic Surgery, Dwight David Eisenhower Army Medical Center, Fort Gordon, Georgia; and
| | - Jesse E Bible
- 5Department of Orthopaedic Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | - Christopher Kowalski
- 1Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- 2Pittsburgh Orthopaedic Spine Research Group, University of Pittsburgh, Pennsylvania
| | - S Joseph de Groot
- 1Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- 2Pittsburgh Orthopaedic Spine Research Group, University of Pittsburgh, Pennsylvania
| | - William F Donaldson
- 1Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- 2Pittsburgh Orthopaedic Spine Research Group, University of Pittsburgh, Pennsylvania
| | - Joon Y Lee
- 1Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- 2Pittsburgh Orthopaedic Spine Research Group, University of Pittsburgh, Pennsylvania
| | - Jeremy D Shaw
- 1Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- 2Pittsburgh Orthopaedic Spine Research Group, University of Pittsburgh, Pennsylvania
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El Naga AN, Gendelberg D, Tavolaro C, Zhou H, Bellabarba C, Bransford RJ. Thoracic costotransversectomy characteristics and 90-day complications vary based on underlying diagnosis. J Neurosurg Spine 2023; 39:831-838. [PMID: 37724834 DOI: 10.3171/2023.7.spine221220] [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: 01/05/2023] [Accepted: 07/07/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE Thoracic costotransversectomies are among the most invasive spinal procedures performed and are associated with unanticipated medical and surgical complications. Few studies have specifically assessed medical and surgical complications after a thoracic corpectomy via a costotransversectomy approach (TCT) or compared complications between different diagnoses. The purpose of this study was to describe the differences in operative characteristics and rates of 90-day surgical and medical complications in patients undergoing TCTs based on underlying diagnosis. METHODS A retrospective chart review of 123 consecutive patients who underwent TCTs at a single academic referral center over a 10-year period was conducted. Surgical indication, corpectomy levels, intraoperative dural tears, pleural injuries, neurological injuries, 90-day mortality, 90-day reoperations, and hospital-based medical complications were evaluated. RESULTS One hundred twenty-three patients underwent a TCT, including 35 for infection, 42 for malignancy, 23 for trauma, and 23 for deformity. Fifty-nine patients (48.0%) had at least one medical or 90-day operative complication, with 22 patients (17.9%) having two or more complications. Patients with a diagnosis of infection were more likely to undergo two-level corpectomies (80% vs 26.1%, p < 0.0005). Patients with a diagnosis of malignancy had significantly higher 90-day mortality (19.0% vs 4.9%, p = 0.022) and were more likely to undergo three-level corpectomies (9.5% vs 3.7%, p = 0.002) and upper thoracic (T1-4) corpectomies (37.9% vs 12.4%, p = 0.001), and sustain a pleural injury (14.3% vs 2.5%, p = 0.019). Ninety-day reoperation rates (p = 0.970), postoperative ventilator days (p = 0.224), intensive care unit stays (p = 0.350), hospital lengths of stay (p = 0.094), neurological injuries (p = 0.338), and dural tears (p = 0.794) did not significantly vary between the different groups. CONCLUSIONS Nearly half of the patients undergoing a TCT will experience an unanticipated short-term complication related to the procedure. Short-term complications may vary with the underlying patient diagnosis.
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Affiliation(s)
- Ashraf N El Naga
- 1Department of Orthopaedic Surgery, University of California, San Francisco, California; and
| | - David Gendelberg
- 1Department of Orthopaedic Surgery, University of California, San Francisco, California; and
| | - Celeste Tavolaro
- 2Department of Orthopaedics and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, Washington
| | - Haitao Zhou
- 2Department of Orthopaedics and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, Washington
| | - Carlo Bellabarba
- 2Department of Orthopaedics and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, Washington
| | - Richard J Bransford
- 2Department of Orthopaedics and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, Washington
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Whitham MD, Casali JG, Smith GK, Allihien AL, Wright BW, Barter SM, Urban AR, Dudley DJ, Fuller RR. Noise in cesarean deliveries: a comprehensive analysis of noise environments in the Labor and Delivery operating room and evaluation of a visual alarm noise abatement program. Am J Obstet Gynecol MFM 2023; 5:100887. [PMID: 36781121 DOI: 10.1016/j.ajogmf.2023.100887] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 01/26/2023] [Accepted: 01/31/2023] [Indexed: 02/13/2023]
Abstract
BACKGROUND Cesarean delivery is the most common major surgery worldwide. Noise in healthcare settings leads to impaired communication and concentration, and stress among healthcare providers. Limited information is available about noise at cesarean delivery. OBJECTIVE This study aimed to achieve a comprehensive analysis of noise that occurs during cesarean deliveries. Sound level meters are used to determine baseline noise levels and to describe the frequency of acute noise generated during a cesarean delivery that will cause a human startle response. Secondarily, we aimed to evaluate the effectiveness of a visual alarm system in mitigating excessive noise. STUDY DESIGN We completed a preintervention/postintervention observational study of noise levels during cesarean deliveries before and after introduction of a visual alarm system for noise mitigation between February 15, 2021 and August 26, 2021. There were 156 cases included from each study period. Sound pressure levels were analyzed by overall case median decibel levels and by time epoch for relevant phases of the operation. Rapid increases in noise events capable of causing a human startle response, "startle events," were detected by retrospective analysis, with quantification for baselines and analysis of frequency by case type. Median noise levels with interquartile ranges are presented. Data are compared between epochs and case characteristics with nonparametric 2-tailed testing. RESULTS The median acoustic pressure for all cesarean deliveries was 61.8 (58.8-65.9) (median [interquartile range]) dBA (A-weighted decibels). The median dBA for the full case time period was significantly higher in cases with neonatal intensive care unit team presence (62.1 [60.5-63.9]), admission to the neonatal intensive care unit (62.0 [60.4-63.9]), 5-minute Apgar score <7 (62.2 [61.1-64.3]), multiple gestations (62.6 [62.0-64.2]), and intraoperative tubal sterilization (62.8 [61.5-65.1]). The use of visual alarms was associated with a statistically significant reduction of median noise level by 0.7 dBA, from 61.8 (60.6-63.5) to 61.1 (59.8-63.7) dBA (P<.001). CONCLUSION The noise intensities recorded during cesarean deliveries were commonly at levels that affect communication and concentration, and above the safe levels recommended by the World Health Organization. Although noise was reduced by 0.7 dBA, the reduction was not clinically significant in reaching a discernible amount (a 3-dB change) or in reducing "startle events." Isolated use of visual alarms during cesarean deliveries is unlikely to be a satisfactory noise mitigation strategy.
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Affiliation(s)
- Megan D Whitham
- Department of Obstetrics and Gynecology, University of Virginia School of Medicine, Charlottesville, VA (Drs Whitham, Smith, Allihien, and Wright, Ms Urban, and Drs Dudley and Fuller).
| | - John G Casali
- Department of Industrial and Systems Engineering, Virginia Polytechnic Institute and State University, Blacksburg, VA (Drs Casali and Barter)
| | - Gabrielle K Smith
- Department of Obstetrics and Gynecology, University of Virginia School of Medicine, Charlottesville, VA (Drs Whitham, Smith, Allihien, and Wright, Ms Urban, and Drs Dudley and Fuller)
| | - Alexis L Allihien
- Department of Obstetrics and Gynecology, University of Virginia School of Medicine, Charlottesville, VA (Drs Whitham, Smith, Allihien, and Wright, Ms Urban, and Drs Dudley and Fuller)
| | - Brett W Wright
- Department of Obstetrics and Gynecology, University of Virginia School of Medicine, Charlottesville, VA (Drs Whitham, Smith, Allihien, and Wright, Ms Urban, and Drs Dudley and Fuller)
| | - Shannon M Barter
- Department of Industrial and Systems Engineering, Virginia Polytechnic Institute and State University, Blacksburg, VA (Drs Casali and Barter)
| | - Amanda R Urban
- Department of Obstetrics and Gynecology, University of Virginia School of Medicine, Charlottesville, VA (Drs Whitham, Smith, Allihien, and Wright, Ms Urban, and Drs Dudley and Fuller)
| | - Donald J Dudley
- Department of Obstetrics and Gynecology, University of Virginia School of Medicine, Charlottesville, VA (Drs Whitham, Smith, Allihien, and Wright, Ms Urban, and Drs Dudley and Fuller)
| | - Robert R Fuller
- Department of Obstetrics and Gynecology, University of Virginia School of Medicine, Charlottesville, VA (Drs Whitham, Smith, Allihien, and Wright, Ms Urban, and Drs Dudley and Fuller)
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Dhanis J, Keidan N, Blake D, Rundle S, Strijker D, van Ham M, Pijnenborg JMA, Smits A. Prehabilitation to Improve Outcomes of Patients with Gynaecological Cancer: A New Window of Opportunity? Cancers (Basel) 2022; 14:cancers14143448. [PMID: 35884512 PMCID: PMC9351657 DOI: 10.3390/cancers14143448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/30/2022] [Accepted: 07/11/2022] [Indexed: 12/02/2022] Open
Abstract
Simple Summary Surgery is an important mainstay in the treatment of gynaecological cancers but is associated with operative complications, especially for those with poor physical and mental health. Prehabilitation is a new and upcoming strategy to optimise patients’ functional capacity, nutritional status and psychosocial wellbeing in order to reduce complications and enhance recovery. In this review, we assessed the evidence on prehabilitation programmes for patients with gynaecological cancer. The limited evidence shows that prehabilitation may reduce length of hospital stay for ovarian cancer patients, and may result in significant weight loss in patients with endometrial and cervical cancer. Comparative prospective studies are required to determine the effectiveness of prehabilitation on reducing operative complications and improving quality of life, and to further specify the content of such a programme for patients with gynaecological cancer. Abstract The literature evaluating the effect of prehabilitation programmes on postoperative outcomes and quality of life of patients with gynaecological cancer undergoing surgery was reviewed. Databases including Pubmed, Medline, EMBASE (Ovid) and PsycINFO were systematically searched to identify studies evaluating the effect of prehabilitation programmes on patients with gynaecological cancer. Both unimodal and multimodal prehabilitation programmes were included encompassing physical exercise and nutritional and psychological support. Primary outcomes were surgical complications and quality of life. Secondary outcomes were anthropometric changes and adherence to the prehabilitation programme. Seven studies fulfilled the inclusion criteria, comprising 580 patients. Included studies were nonrandomised prospective studies (n = 4), retrospective studies (n = 2) and one case report. Unimodal programmes and multimodal programmes were included. In patients with ovarian cancer, multimodal prehabilitation resulted in significantly reduced hospital stay and time to chemotherapy. In patients with endometrial and cervical cancer, prehabilitation was associated with significant weight loss, but had no significant effects on surgical complications or mortality. No adverse events of the programmes were reported. Evidence on the effect of prehabilitation for patients with gynaecological cancer is limited. Future studies are needed to determine the effects on postoperative complications and quality of life.
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Affiliation(s)
- Joëlle Dhanis
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands; (M.v.H.); (J.M.A.P.); (A.S.)
- Faculty of Medical Sciences, Radboud University, 6526 GA Nijmegen, The Netherlands
- Correspondence: ; Tel.: +31-644404756
| | - Nathaniel Keidan
- Department of Gynaecological Oncology, Queen Elizabeth Hospital, Gateshead NE9 6SX, UK; (N.K.); (D.B.); (S.R.)
| | - Dominic Blake
- Department of Gynaecological Oncology, Queen Elizabeth Hospital, Gateshead NE9 6SX, UK; (N.K.); (D.B.); (S.R.)
| | - Stuart Rundle
- Department of Gynaecological Oncology, Queen Elizabeth Hospital, Gateshead NE9 6SX, UK; (N.K.); (D.B.); (S.R.)
| | - Dieuwke Strijker
- Department of Surgery, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands;
| | - Maaike van Ham
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands; (M.v.H.); (J.M.A.P.); (A.S.)
| | - Johanna M. A. Pijnenborg
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands; (M.v.H.); (J.M.A.P.); (A.S.)
| | - Anke Smits
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands; (M.v.H.); (J.M.A.P.); (A.S.)
- Department of Gynaecological Oncology, Queen Elizabeth Hospital, Gateshead NE9 6SX, UK; (N.K.); (D.B.); (S.R.)
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Lambat Emery S, Boulvain M, Petignat P, Dubuisson J. Operative Complications and Outcomes Comparing Small and Large Uterine Weight in Case of Laparoscopic Hysterectomy for a Benign Indication. Front Surg 2021; 8:755781. [PMID: 34676242 PMCID: PMC8525797 DOI: 10.3389/fsurg.2021.755781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/06/2021] [Indexed: 11/30/2022] Open
Abstract
Study Objective: This study was performed to evaluate the association between uterine weight and operative outcomes in women undergoing laparoscopic hysterectomy for a benign indication. Methods: This is a secondary analysis of a randomized trial with data collected prospectively and retrospectively. The data of 159 women undergoing laparoscopic hysterectomy for a benign indication were analyzed. Women were divided in two groups according to the postoperative uterine weight: small uterus group (<250 grams) and large uterus group (≥250 grams). Operative complications were compared between the two groups. Operative outcomes (need for uterine morcellation, operative duration, estimated blood loss), postoperative pain, and hospital length of stay were also analyzed. Main Results: Operative complications were not significantly different between the two groups (37% in the large uterus group versus 41% in the small uterus group). Operative outcomes showed a significantly increased use of uterine morcellation in the large uterus group (61% in the large uterus group versus 10% in the small uterus group). The operative duration was 150 min in the small uterus group and 176 min in the large uterus group, which corresponds to an increase of 17% in the large uterus group. The mean pain score on the day of surgery was identical in both groups (VAS pain score 5), but significantly in favor of the large uterus group on day 1 postoperatively (VAS pain score 4 in the small uterus group and 3 in the large uterus group). There was no statistical difference between groups in the mean hospital stay (62 ± 37 hours in the small uterus group versus 54 ± 21 hours in the large uterus group). In terms of surgical indication, the small uterus group comprised more patients with endometriosis/adenomyosis (36%) and the large uterus group more patients with leiomyoma (93%). Conclusion: The results from this study show that, even if a large uterine weight is associated with increased uterine morcellation requirement and operative duration, a laparoscopic approach is safe and does not increase operative complications nor pain and/or length of hospital stay in women undergoing hysterectomy for a benign indication.
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Affiliation(s)
- Shahzia Lambat Emery
- Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | | | - Patrick Petignat
- Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Jean Dubuisson
- Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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Alencar FHUD, Perini JA, Monteiro AV, Duarte MEL, Motta GDR, Guimarães JAM. Epidemiology of Dupuytren disease and Patients Undergoing Selective Fasciectomy. Rev Bras Ortop 2021; 56:478-484. [PMID: 34483392 PMCID: PMC8405273 DOI: 10.1055/s-0040-1721839] [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: 04/22/2020] [Accepted: 09/17/2020] [Indexed: 11/20/2022] Open
Abstract
Objective
To describe the epidemiological and clinical profile of patients with Dupuytren disease treated by selective fasciectomy and the factors associated with the severity of the disease.
Methods
Retrospective descriptive observational study involving 247 patients with Dupuytren disease, from 2013 to 2019. Multivariate logistic regression was performed for data analysis.
Results
Most patients were male (83.8%), self-declared white (65.2%), alcoholics (59.6%) and 49% were smokers, with a mean age of 66 ± 9 years old, with 77.2% presenting symptoms of the disease after the age of 51 years old. Approximately 51.9, 29.6 and 17.3%, respectively, had arterial hypertension, diabetes mellitus and dyslipidemia comorbidities. Bilateral involvement of the hands was observed in 73.3% of the patients. The rate of intra- and post-selective fasciectomy complications was of 0.6 and 24.3%, respectively, with 5.2% of the patients needing reintervention after 1 year of follow-up. After multivariate analysis, males were associated with bilateral involvement of the hands (odds ratio [OR] = 2.10; 95% confidence interval [CI]: 1.03–4.31) and with a greater number of affected rays (OR = 3.41; 95% CI: 1.66–7.03). Dyslipidemia was associated with reintervention (OR = 5.7; 95% CI = 1.03–31.4) and bilaterality with a higher number of complications (35.7 versus 19.7%).
Conclusion
A low rate of reintervention and operative complications was observed in patients with Dupuytren disease treated by selective fasciectomy. Male gender was associated with severe disease (bilaterality and more than two affected rays), and dyslipidemia with reintervention.
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Affiliation(s)
| | - Jamila Alessandra Perini
- Divisão de Pesquisa, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil.,Unidade de Farmácia, Centro Universitário Estadual da Zona Oeste, Rio de Janeiro, RJ, Brasil
| | - Anderson Vieira Monteiro
- Centro de Cirurgia da Mão, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
| | | | - Geraldo da Rocha Motta
- Divisão de Pesquisa, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
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Patoulias I, Gkalonaki I, Patoulias D. Inguinal hernia management in preterm infants: addressing current issues of interest. Folia Med Cracov 2020; 60:41-52. [PMID: 33821850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Ioannis Patoulias
- First Department of Pediatric Surgery, Aristotle University of Thessaloniki, General Hospital "G Gennimatas", Thessaloniki, Greece
| | - Ioanna Gkalonaki
- First Department of Pediatric Surgery, Aristotle University of Thessaloniki, General Hospital "G Gennimatas", Thessaloniki, Greece
| | - Dimitrios Patoulias
- First Department of Internal Medicine, General Hospital "Hippokration", Thessaloniki, Greece
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Abstract
BACKGROUND: The evidence regarding the prevalence of deep vein thrombosis (DVT) after foot and ankle surgery in elective patients that need to be 6 weeks non-weight bearing postoperatively is incomplete and has limitations. METHODS: The prevalence of DVT in 114 procedures involving the hindfoot and midfoot was determined using ultrasonographic surveillance at 2 and 6 weeks after surgery. RESULTS: The prevalence of DVT was observed to be 25.4%. The majority (68.9%) of DVTs were diagnosed at the ultrasonographic scan performed 2 weeks postoperatively. The remainder (31.1%) of DVTs were diagnosed at the 6-week postoperative ultrasonographic scan. At least 75% of the patients who had early and late DVT had no clinical symptoms or signs of DVT. The prevalence of DVT in clinically detectable patients was 6%. The average age of patients with early DVT was 62.2 years, significantly higher compared to those who had no DVT. The mean tourniquet time for patients with early DVT was 68.1 minutes, significantly higher compared to those without DVT. All DVTs detected were distal to the popliteal vein. CONCLUSIONS: The prevalence of clinically silent DVT was significantly higher than was previously thought. We believe this increased rate is directly attributable to the use of ultrasonographic surveillance postsurgery both at 2 and 6 weeks. The risk of DVT continued after the 2-week visit, and 30% of the DVTs were detected at the ultrasonographic scan at 6 weeks. LEVEL OF EVIDENCE: Level II, prospective cohort.
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Affiliation(s)
- Martin Sullivan
- 1 St. Vincent's Foot and Ankle Department, St Vincent's Clinic, Darlinghurst, Sydney, New South Wales, Australia
| | - Ilian Dominiq Eusebio
- 1 St. Vincent's Foot and Ankle Department, St Vincent's Clinic, Darlinghurst, Sydney, New South Wales, Australia
| | - Kristin Haigh
- 1 St. Vincent's Foot and Ankle Department, St Vincent's Clinic, Darlinghurst, Sydney, New South Wales, Australia
| | - Juan Paulo Panti
- 1 St. Vincent's Foot and Ankle Department, St Vincent's Clinic, Darlinghurst, Sydney, New South Wales, Australia
| | - Abdullah Omari
- 2 St Vincent's Vascular Laboratory, St. Vincent's Clinic, Darlinghurst, Sydney, New South Wales, Australia
| | - Jacqueline R Hang
- 1 St. Vincent's Foot and Ankle Department, St Vincent's Clinic, Darlinghurst, Sydney, New South Wales, Australia
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Liu Z, Hutt JA, Rajeshkumar B, Azuma Y, Duan KL, Donahue JK. Preclinical efficacy and safety of KCNH2-G628S gene therapy for postoperative atrial fibrillation. J Thorac Cardiovasc Surg 2017; 154:1644-1651.e8. [PMID: 28676183 DOI: 10.1016/j.jtcvs.2017.05.052] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 04/12/2017] [Accepted: 05/15/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Postoperative atrial fibrillation (POAF) is the most common complication occurring after cardiac surgery. Multiple studies have shown significantly increased risks of stroke, myocardial infarction, and death associated with POAF. Current prophylaxis strategies are inadequate to eliminate this problem. We examined the preclinical efficacy and safety of KCNH2-G628S gene transfer to prevent POAF. METHODS Domestic pigs received AdKCNH2-G628S by epicardial atrial gene painting and atrial pacemaker implantation for continuous-burst pacing to induce atrial fibrillation. In an initial dose-ranging evaluation, 3 pigs received 5 × 1010 to 5 × 1011 virus particles. In the formal study, 16 pigs were randomized to 3 groups: 5 × 1011 virus particles of AdKCNH2-G628S with 20% Pluronic P407 in saline, 20% Pluronic P407 in saline with no virus, and saline alone. Animals were followed with daily efficacy and safety evaluations through the period of peak adenovirus-mediated transgene expression. After 14 days, pacing was discontinued, and the animals were followed in sinus rhythm for an additional 14 days to assess any longer-term toxicity. RESULTS In the primary efficacy analysis, the G628S animals exhibited a significant increase in the average time in sinus rhythm compared with the Pluronic control group (59 ± 7% vs 14 ± 6%; P = .009). There was no significant difference between the Pluronic and saline controls (14 ± 6% vs 32 ± 12%; P = .16). Safety assessment showed improved left ventricular function in the G628S animals; otherwise there were no significant differences among the groups in any safety measure. CONCLUSIONS These data indicate that KCNH2-G628S gene therapy can successfully and safely reduce the risk of AF.
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Affiliation(s)
- Zhao Liu
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Julie A Hutt
- The Lovelace Respiratory Research Institute, Albuquerque, NM
| | - Barur Rajeshkumar
- Department of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Mass
| | - Yoshihiro Azuma
- Department of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Mass
| | - Kailai L Duan
- Department of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Mass
| | - J Kevin Donahue
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio; Department of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Mass.
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Abstract
The orbital branch of the infraorbital artery, a key vascular structure that is not universally noted in orbital textbooks and atlases, is clinically significant, since injury to it can result in perioperative hemorrhage. We conducted a cadaver dissection to document its presence, measure its location, and evaluate it histopathologically. It was present in 8 of 9 orbits and was a mean distance of 16.6 mm (range 10-23) from the inferior orbital rim. In half of the specimens, there were 2 separate structures seen. Histopathology confirmed these structures to be neurovascular bundles.
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Affiliation(s)
- Avni V Patel
- Department of Ophthalmology, Harvard Medical School , Boston, Massachusetts , USA
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11
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Menger R, Connor DE, Hefner M, Caldito G, Nanda A. Pseudomeningocele formation following chiari decompression: 19-year retrospective review of predisposing and prognostic factors. Surg Neurol Int 2015; 6:70. [PMID: 25984384 PMCID: PMC4427815 DOI: 10.4103/2152-7806.156632] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 01/11/2015] [Accepted: 03/10/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Pseudomeningocele is a known operative complication of Chiari decompression with significant morbidity. METHODS A retrospective analysis of 150 consecutive patients from November 1991 to June 2011 was conducted. Symptomatic pseudomeningocele was defined clinically; to meet definition it must have required operative intervention. Variables evaluated included sex, age, use of graft, and use of operative sealant. The Chi-square, Fisher test, and the two-sample t-test were used as appropriate to determine significance. Multiple logistic regression was used to determine independent risk factors for complication. RESULTS A total of 67.3% of patients were female, with average age being 39.7 years. A total of 67.3% of patients had a graft placed with the most common being fascia lata. Only nine patients (6%) presented with pseudomeningocele. Factors observed to be significantly associated with pseudomeningocele development were age and use of sealant. Age and sealant use were also independent risk factors for complication. Adjusted for the significant effect of age, odds for complication among patients with sealant usage were 6.67 times those for patients without sealant. Adjusted for the significance of sealant usage, there is a 6% increase in odds for complication for every year increase in patient's age. CONCLUSIONS A statistically significant relationship exists between age and sealant use and the risk of developing a postoperative pseudomeningocele. Emphasis and attention must be placed on meticulous closure technique. This information can aide in preoperative planning and patient selection.
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Affiliation(s)
- R Menger
- Department of Neurosurgery, Louisiana State University Health Sciences Center Shreveport, LA, USA
| | - D E Connor
- Department of Neurosurgery, Louisiana State University Health Sciences Center Shreveport, LA, USA
| | - M Hefner
- Department of Neurosurgery, Louisiana State University Health Sciences Center Shreveport, LA, USA
| | - G Caldito
- Department of Biometry, Louisiana State University Health Sciences Center Shreveport, LA, USA
| | - A Nanda
- Department of Neurosurgery, Louisiana State University Health Sciences Center Shreveport, LA, USA
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12
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Yuan J, Wang X, Yang LQ, Xing YQ, Yang YN. Assessment of visual outcomes of cataract surgery in Tujia nationality in Xianfeng County, China. Int J Ophthalmol 2015; 8:292-8. [PMID: 25938043 DOI: 10.3980/j.issn.2222-3959.2015.02.14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 07/18/2014] [Indexed: 09/26/2022] Open
Abstract
AIM To evaluate the visual outcome and factors influencing visual outcome of manual small incision cataract surgery (MSICS) in the rural area in the Xianfeng County. METHODS Eighty-two eyes of 82 patients who underwent cataract surgery performed by using MSICS technique were identified. Data collected included each patient's age, gender, the level of education. Uncorrected and corrected distance visual acuity (UDVA and CDVA) at presentation and at 1, 6, 8wk postoperatively, pre-existing eye disease, operative findings and complications, the risk factors were evaluated. RESULTS In 82 patients, the average age was 69.6±0.6y, illiterate were 52 (63.4%). Of 82 eyes, pseudophakia was present in 77 eyes (93.9%). At 1wk postoperatively, 47 eyes (57.3%) had the UDVA of ≥6/18, and 52 eyes (63.4%) had the CDVA of ≥6/18. At 6 to 8wk postoperatively, 50 eyes (61.0%) had UDVA of ≥6/18, and 57 eyes (69.5%) had the CDVA of ≥6/18. Postoperative visual status was significantly related to the co-morbidities, such as corneal pathology, glaucoma (P<0.001). Operative complications, such as posterior capsule opacity and cystoid macular edema were main operative cause for the poor visual outcome. CONCLUSION MSICS provides a good visual recovery in our study but the vision outcome did not fulfill the standards proposed by WHO, which highlights the need for an improvement in local socioeconomic understanding, population education and surgery quality.
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Affiliation(s)
- Jing Yuan
- Eye Center, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
| | - Xia Wang
- Department of Ophthalmology, Xianfeng County Renmin Hospital, Xianfeng 445600, Hubei Province, China
| | - Li-Qin Yang
- Department of Ophthalmology, Xianfeng County Renmin Hospital, Xianfeng 445600, Hubei Province, China
| | - Yi-Qiao Xing
- Eye Center, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
| | - Yan-Ning Yang
- Eye Center, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
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13
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Sajid MS, Craciunas L, Sains P, Singh KK, Baig MK. Use of antibacterial sutures for skin closure in controlling surgical site infections: a systematic review of published randomized, controlled trials. Gastroenterol Rep (Oxf) 2013; 1:42-50. [PMID: 24759666 PMCID: PMC3941439 DOI: 10.1093/gastro/got003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objective: The objective of this article is to systematically analyse the randomized, controlled trials that compare the use of antibacterial sutures (ABS) for skin closure in controlling surgical site infections. Methods: Randomized, controlled trials on surgical patients comparing the use of ABS for skin closure in controlling the surgical site infections were analysed systematically using RevMan® and combined outcomes were expressed as odds ratios (OR) and standardized mean differences (SMD). Results: Seven randomized, controlled trials evaluating 1631 patients were retrieved from electronic databases. There were 760 patients in the ABS group and 871 patients in the simple suture group. There was moderate heterogeneity among trials (Tau2 = 0.12; chi2 = 8.40, df = 6 [P < 0.01]; I2 = 29%). Therefore in the random-effects model, the use of ABS for skin closure in surgical patients was associated with a reduced risk of developing surgical site infections (OR, 0.16; 95% CI, 0.37, 0.99; z = 2.02; P < 0.04) and postoperative complications (OR, 0.56; 95% CI, 0.32, 0.98 z = 2.04; P = 0.04). The durations of operation and lengths of hospital stay were similar following the use of ABS and SS for skin closure in patients undergoing various surgical procedures. Conclusion: Use of ABS for skin closure in surgical patients is effective in reducing the risk of surgical site infection and postoperative complications. ABS is comparable with SS in terms of length of hospital stay and duration of operation.
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Affiliation(s)
- Muhammad S Sajid
- Department of General & Laparoscopic Colorectal Surgery, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK
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14
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Sakamoto K, Kojima Y, Takeda R, Terai K, Matsuda M. Solitary pelvic kidney encountered during laparoscopic colectomy. J Minim Access Surg 2011; 1:133-5. [PMID: 21188011 PMCID: PMC3001170 DOI: 10.4103/0972-9941.18998] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2005] [Accepted: 10/03/2005] [Indexed: 11/04/2022] Open
Abstract
We report a case of solitary pelvic kidney encountered during laparoscopic colectomy. A 55-year-old man was admitted to undergo laparoscopic colectomy for an early sigmoid colon cancer, which had been detected after a polypectomy. The kidneys were not clearly visualized in their normal position by ultrasonography. During the operation, anomalous vessels in the presacral space and a mass covered with fatty tissue were identified. We converted the operation to a mini-laparotomy, and on performing intraoperative ultrasonography a solitary pelvic kidney was detected. An anterior resection was performed without operative complications. Laparoscopic ultrasonography (LUS) and hand-assisted laparoscopic surgery (HALS) should be considered as feasible adjuvants, when difficult situations arise during laparoscopic colectomy. In case of uncertainty about anatomical orientation or identification, it is prudent to convert to open surgery thereby preventing intraoperative complications such as injury to anomalous vessels or the ureter.
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Affiliation(s)
- Kazuhiro Sakamoto
- Department of Coloproctological Surgery, Juntendo University, School of Medicine, Tokyo, Japan
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15
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Reddy DM, Townsend CM, Kuo YF, Freeman JL, Goodwin JS, Riall TS. Readmission after pancreatectomy for pancreatic cancer in Medicare patients. J Gastrointest Surg 2009; 13:1963-74; discussion 1974-5. [PMID: 19760307 PMCID: PMC2766461 DOI: 10.1007/s11605-009-1006-4] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2009] [Accepted: 08/25/2009] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The objective of this study was to use a population-based dataset to evaluate the number of readmissions and reasons for readmission in Medicare patients undergoing pancreatectomy for pancreatic cancer. METHODS We used Surveillance, Epidemiology, and End Results-Medicare linked data (1992-2003) to evaluate the initial hospitalization, readmission rates within 30 days (early), and between 30 days and 1 year (late) after initial discharge and reasons for readmission in patients 66 years and older undergoing pancreatectomy. RESULTS We identified 1,730 subjects who underwent pancreatectomy for pancreatic cancer. The in-hospital mortality was 7.5%. The overall Kaplan-Meier readmission rate was 16% at 30 days and 53% at 1 year, accounting for 15,409 additional hospital days. Early readmissions were clearly related to operative complications in 80% of cases and unrelated diagnoses in 20% of cases. Late readmissions were related to recurrence in 48%, operative complications in 25%, and unrelated diagnoses in 27% of cases. In a multivariate analysis, only distal pancreatic resection (P = 0.02) and initial postoperative length of stay > or =10 days (P = 0.03) predicted early readmission. When compared to patients not readmitted, patients readmitted early had worse median survival (11.8 vs.16.5 months, P = 0.04), but the 5-year survival was identical (18%). Late readmission was associated with worse median and 5-year survival (19.4 vs. 12.1 months, 12% vs. 21%, P < 0.0001). CONCLUSIONS Our study demonstrates overall 30-day and 1-year readmission rates of 16% and 53%. The majority of early readmissions were related to postoperative complications but not related to patient and tumor characteristics. Complications causing early readmission are a cause of early mortality and are potentially preventable. Conversely, late readmissions are related to disease progression and are a marker of early mortality and not the cause.
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Affiliation(s)
- Deepthi M. Reddy
- Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0542 USA
| | - Courtney M. Townsend
- Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0542 USA
| | - Yong-Fang Kuo
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX USA
| | - Jean L. Freeman
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX USA
| | - James S. Goodwin
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX USA
| | - Taylor S. Riall
- Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0542 USA
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Pillai RG, Patel AS, Kumar A. Vesicovaginal fistula: An unusual complication of laparoscopic assisted nephroureterectomy. J Minim Access Surg 2006; 2:79-80. [PMID: 21170240 PMCID: PMC2997278 DOI: 10.4103/0972-9941.26648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2006] [Accepted: 06/10/2006] [Indexed: 11/16/2022] Open
Abstract
We report a case of vesicovaginal fistula in 71-year-old lady who had previously undergone a lapascopic assisted nephroureterectomy for transitional cell carcinoma in her right ureter and kidney. The surgery was uncomplicated with no post-operative problems and was discharged on day on seven. She later presented five weeks following the initial operation with signs and symptoms suggestive of a vesicovaginal fistula, which was confirmed on cystogram and flexible cystosopy. She proceeded to have an abdominal (O'Connor's) repair of the fistula together with cystodiathermy for a few superficial bladder recurrences. The area of the fistula (within the bladder) was noted to be tumour free. She had an uneventful post-operative recovery and was discharged from hospital on day 11. At six month follow-up, there was another superficial recurrence in the bladder that was resected, with no sign of fistula.
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Affiliation(s)
- Rajiv G Pillai
- Departments of Urology, Addenbrookes' Hospital, Cambridge, UK
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