共查询到10条相似文献,搜索用时 140 毫秒
1.
Leah D. Canvasser Alyssa A. Mazurek David C. CronMichael N. Terjimanian MS Eric T. ChangChris S. Lee Mitchell B. AlameddineJake Claflin Elyse D. DavisTucker M. Schumacher Stewart C. WangMichael J. Englesbe MD 《The Journal of surgical research》2014
Background
Objective measures for preoperative risk assessment are needed to inform surgical risk stratification. Previous studies using preoperative imaging have shown that the psoas muscle is a significant predictor of postoperative outcomes. Because psoas measurements are not always available, additional trunk muscles should be identified as alternative measures of risk assessment. Our research assessed the relationship between paraspinous muscle area, psoas muscle area, and surgical outcomes.Methods
Using the Michigan Surgical Quality Collaborative database, we retrospectively identified 1309 surgical patients who had preoperative abdominal computerized tomography scans within 90 d of operation. Analytic morphomic techniques were used to measure the cross-sectional area of the paraspinous muscle at the T12 vertebral level. The primary outcome was 1-y mortality. Analyses were stratified by sex, and logistic regression was used to assess the relationship between muscle area and postoperative outcome.Results
The measurements of paraspinous muscle area at T12 were normally distributed. There was a strong correlation between paraspinous muscle area at T12 and total psoas area at L4 (r = 0.72, P <0.001). Paraspinous area was significantly associated with 1-y mortality in both females (odds ratio = 0.70 per standard deviation increase in paraspinous area, 95% confidence interval 0.50–0.99, P = 0.046) and males (odds ratio = 0.64, 95% confidence interval 0.47–0.88, P = 0.006).Conclusions
Paraspinous muscle area correlates with psoas muscle area, and larger paraspinous muscle area is associated with lower mortality rates after surgery. This suggests that the paraspinous muscle may be an alternative to the psoas muscle in the context of objective measures of risk stratification. 相似文献2.
Ashley L. Miller Lillian C. Min Kathleen M. Diehl David C. Cron Chiao-Li Chan Kyle H. Sheetz Michael N. Terjimanian June A. Sullivan William C. Palazzolo Stewart C. Wang Karen E. Hall Michael J. Englesbe 《The Journal of surgical research》2014
Background
Older patients account for nearly half of the United States surgical volume, and age alone is insufficient to predict surgical fitness. Various metrics exist for risk stratification, but little work has been done to describe the association between measures. We aimed to determine whether analytic morphomics, a novel objective risk assessment tool, correlates with functional measures currently recommended in the preoperative evaluation of older patients.Materials and methods
We retrospectively identified 184 elective general surgery patients aged >70 y with both a preoperative computed tomography scan and Vulnerable Elderly Surgical Pathways and outcomes Assessment within 90 d of surgery. We used analytic morphomics to calculate trunk muscle size (or total psoas area [TPA]) and univariate logistic regression to assess the relationship between TPA and domains of geriatric function mobility, basic and instrumental activities of daily living (ADLs), and cognitive ability.Results
Greater TPA was inversely correlated with impaired mobility (odds ratio [OR] = 0.46, 95% confidence interval [CI] 0.25–0.85, P = 0.013). Greater TPA was associated with decreased odds of deficit in any basic ADLs (OR = 0.36 per standard deviation unit increase in TPA, 95% CI 0.15–0.87, P <0.03) and any instrumental ADLs (OR = 0.53, 95% CI 0.34–0.81; P <0.005). Finally, patients with larger TPA were less likely to have cognitive difficulty assessed by Mini-Cog scale (OR = 0.55, 95% CI 0.35–0.86, P <0.01). Controlling for age did not change results.Conclusions
Older surgical candidates with greater trunk muscle size, or greater TPA, are less likely to have physical impairment, cognitive difficulty, or decreased ability to perform daily self-care. Further research linking these assessments to clinical outcomes is needed. 相似文献3.
I. Milaniak E. Wilczek-Rużyczka P. Przybyłowski K. Wierzbicki J. Siwińska J. Sadowski 《Transplantation proceedings》2014
Background
Heart transplantation (HTx) has a significant impact on all areas of the operation, adjustment, and quality of life (QOL) in patients after heart transplantation. In the process of healing and coping with the new situation, it is important to have personal resources.Aim
The main objectives of this study were to assess subjective QOL of patients after HTx and to determine the relationship between personal resources and QOL in this group of patients.Material and Methods
The study included 121 patients who received a heart transplant. A standardized instrument used to measure the quality of life was the World Health Organization (WHO) QOL Brief Questionnaire. The personal resources and deficits were determined using the following research techniques: Antonovsky's Sense of Coherence (SOC), coping strategies for stress (Brief-COPE), Generalized Self Efficacy Scale (GSES), and Life Orientation Test (LOT-R). The data were analyzed statistically.Results
The patients gained an average level of QOL (13.75). The results indicate a positive relationship between the QOL in all its domains and personal resources: a sense of coherence (r = 0.65; P < .05), optimism (r = 0.55; P < .05), self-efficacy (r = 0.58; P < .05), and strategies for coping (active coping [r = 0.41; P < .05], planning [r = 0.42; P < .05; P < .05], and positive revaluing [r = 0.40; P < .05]). The regression model explained 56% of the predictors of QOL in patients after HTx.Applications
It is necessary to strengthen personal resources in this group of patients as well as to detect early and treat symptoms of depression and to cope with stress. 相似文献4.
Alicia Ponton-Carss John B. Kortbeek Irene W.Y. Ma 《American journal of surgery》2016,212(5):1011-1019
Background
Surgical competence encompasses both technical and nontechnical skills. This study seeks to evaluate the validity evidence for a comprehensive surgical skills examination and to examine the relationship between technical and nontechnical skills.Methods
Six examination stations assessing both technical and nontechnical skills, conducted yearly for surgical trainees (n = 120) between 2010 and 2014 are included.Results
The assessment tools demonstrated acceptable internal consistency. Interstation reliability for technical skills was low (alpha = .39). Interstation reliability for the nontechnical skills was lower (alpha range −.05 to .31). Nontechnical skills domains were strongly correlated, ranging from r = .65, P < .001 to .86, P < .001. The associations between nontechnical and technical skills were inconsistent, ranging from poor (r = −.06; P = .54) to moderate (r = .45; P < .001).Conclusions
Multiple samplings of integrated technical and nontechnical skills are necessary to assess overall surgical competency. 相似文献5.
M. Yanishi H. Kinoshita H. Tsukaguchi Y. Kimura Y. Koito E. Jino M. Watanabe M. Sugi T. Matsuda 《Transplantation proceedings》2018,50(1):150-154
Purpose
Computed tomography (CT) is considered the gold standard method for the diagnosis and characterization of sarcopenia. The aim of the present study was to determine the correlation between the volume of psoas muscle measured using CT and the measurement of muscle mass with dual energy X-ray absorptiometry (DXA) and bioimpedance analysis (BIA) in kidney transplant recipients.Methods
Fifty-eight recipients (42 males and 16 females) were enrolled. Diagnostic criteria for sarcopenia were according to those of the Asia Working Group for Sarcopenia. The volume of psoas muscle was extracted using image recognition software from three-dimensional CT images.Results
The volume of psoas muscle was 227.2 ± 61.3 mL in Group 1 (sarcopenia), 283.9 ± 75.3 mL in Group 2 (presarcopenia), and 363.7 ± 138.0 mL in Group 3 (without sarcopenia). Muscle mass measured using DXA was 15.80 ± 3.19 kg in Group 1, 16.36 ± 2.49 kg in Group 2, and 21.21 ± 4.14 kg in Group 3. Additionally, muscle mass assessed using BIA was 17.22 ± 4.11 kg in Group 1, 17.86 ± 3.30 kg in Group 2, and 21.48 ± 5.39 kg in Group 3. There were significant differences in the mean volume of psoas muscle between the 3 groups. There was a significant positive correlation between the volume of psoas muscle and the muscle mass assessed using DXA (r = 0.797; P < .001) and BIA (r = 0.761; P < .001). Furthermore, there was a significant positive correlation between DXA and BIA (r = 0.900; P < .001).Conclusions
It was suggested that estimating muscle mass using DXA and BIA is a preferred method for diagnosis of sarcopenia in kidney transplant recipients. 相似文献6.
Sarah C. Oltmann Mohammad H. RajaeiRebecca S. Sippel MD Herbert ChenDavid F. Schneider MD MS 《The Journal of surgical research》2014
Background
Primary hyperparathyroidism (PHPT) is a disease process traditionally thought to present during middle age, but can occur at any age. The purpose of this study was to compare PHPT patient characteristics based on patient age at the time of surgical referral.Methods
A retrospective review of a prospectively managed database of adult patients undergoing parathyroid surgery for PHPT was conducted. Patients with a negative family history, no previous parathyroid surgery, and ≥6-mo follow-up were included. Patients were grouped by age for comparison.Results
From 2001–2012, 1372 patients met inclusion criteria. Age groups were as follows: ≤50 y, 51–60 y, 61–70 y, and >70 y. Female predominance increased with age (P > 0.01). Baseline serum parathyroid hormone levels were higher at the extremes of age (P < 0.001). Young patients had the highest serum calcium (P < 0.01), urinary calcium (P < 0.001), and T-score (P < 0.001) measures, and greater incidence of vitamin D deficiency (P = 0.03). The use of local anesthesia increased with age, whereas use of outpatient parathyroidectomy decreased with age (both P < 0.01). Rates of disease persistence (2.3%–2.9%, P = 0.95) and recurrence (2.1%–3.3%, P = 0.75) were low, and did not differ.Conclusions
Patients at the extremes of age are referred with more elevated laboratory indices whereas those in the traditional age range have milder biochemical indices. This may result from differential surgical referral. Individuals with laboratory evidence of abnormal calcium and parathyroid hormone regulation should be evaluated for parathyroidectomy regardless of age because all ages can be successfully treated. 相似文献7.
Jon S. Thompson Rebecca A. Weseman Fedja A. Rochling Wendy J. Grant Jean F. Botha Alan N. Langnas David F. Mercer 《American journal of surgery》2014
Background
Obese patients developing short bowel syndrome (SBS) maintain a higher body mass index (BMI) and have increased risk of hepatobiliary complications. Our aim was to determine the effect of pre-resection gastric bypass (GBP) on SBS outcome.Methods
We reviewed 136 adults with SBS: 69 patients with initial BMI < 35 were controls; 43 patients with BMI > 35 were the obese group; and 24 patients had undergone GBP before SBS.Results
BMI at 1, 2, and 5 years was similar in control and GBP groups, whereas obese patients had a persistently increased BMI. Eight (33%) of the GBP patients had a pre-resection BMI > 35, but post-SBS BMI was similar to those <35. Obese patients were more likely to wean off PN (47% vs 20% control and 12% GBP, P < .05). Radiographic fatty liver tended to be higher in the GBP group (54% vs 19% control and 35% obese). End-stage liver disease occurred more frequently in obese and GBP patients (30% and 33% vs 13%, P < .05).Conclusions
Pre-resection GBP prevents the nutritional benefits of obesity but does not eliminate the increased risk of hepatobiliary disease in obese SBS patients. This occurs independent of pre-SBS BMI suggesting the importance of GBP itself or history of obesity rather than weight loss. 相似文献8.
Chao-Ying Chen Corey W. McGee Tonya L. Rich Cecília N. Prudente Bernadette T. Gillick 《Journal of hand therapy》2018,31(3):348-356
Study Design
A cross-sectional clinical measurement study.Introduction
Measuring intrinsic hand muscle strength helps evaluate hand function or therapeutic outcomes. However, there are no established normative values in adolescents and young adults between 13 and 20 years of age.Purpose of the Study
To measure hand intrinsic muscle strength and identify associated factors that may influence such in adolescents and young adults through use of the Rotterdam intrinsic hand myometer.Methods
A total of 131 participants (male: 63; female: 68) between 13 and 20 years of age completed the strength measurements of abductor pollicis brevis, first dorsal interosseus (FDI), deep head of FDI and lumbrical of second digit, flexor pollicis brevis (FPB), and abductor digiti minimi. Two trials of the measurements of each muscle were averaged for analyses. Self-reported demographic data were used to examine the influences of age, sex, and body mass index (BMI) on intrinsic hand muscle strength.Results
Normative values of intrinsic hand muscle strength were presented by age groups (13, 14, 15-16, 17-18, 19-20 year olds) for each sex category (male, female). A main effect of sex, but not age, on all the muscles on both the dominant (FPB: P = .02, others: P < .001) and non-dominant (FDI: P = .005, FPB: P = .01, others: P < .001) sides was found. A significant effect of BMI was found on dominant (P = .009) and non-dominant abductor pollicis brevis (P = .002). In addition, FDI (P = .005) and FPB (P = .002) were stronger on the dominant side than the non-dominant side.Discussion
Intrinsic hand muscle strength may be influenced by different factors including sex, BMI, and hand dominance. A larger sample is needed to rigorously investigate the influence of age on intrinsic strength in male and female adolescents and young adults.Conclusion
The results provide reference values and suggest factors to be considered when evaluating hand function and therapeutic outcomes in both clinical and research settings. Further study is recommended.Level of Evidence
VI. 相似文献9.
Cheguevara Afaneh Jonathan Abelson Barrie S. Rich Gregory Dakin Rasa Zarnegar Philip S. Barie Thomas J. Fahey III Alfons Pomp 《The Journal of surgical research》2014
Background
Obesity has historically been a positive predictor of surgical morbidity, especially in the morbidly obese. The purpose of our study was to compare outcomes of obese patients undergoing laparoscopic cholecystectomy (LC).Methods
We reviewed 1382 consecutive patients retrospectively who underwent LC for various pathologies from January 2008 to August 2011. Patients were stratified based on the World Health Organization definitions of obesity: nonobese (body mass index [BMI] < 30 kg/m2), obesity class I (BMI 30–34.9 kg/m2), obesity class II (BMI 35–39.9 kg/m2), and obesity class III (BMI ≥ 40 kg/m2). The primary end points were conversion rates and surgical morbidity. The secondary end point was length of stay.Results
There were significantly more females in the obesity II and III groups (P = 0.0002). American Society of Anesthesiologists scores were significantly higher in the obesity I, II, and III groups compared with the nonobese (P < 0.05; P < 0.01; and P < 0.0001, respectively). Independent predictors of conversion on multivariate analysis (MVA) included age (P = 0.01), acute cholecystitis (P = 0.03), operative time (P < 0.0001), blood loss (P < 0.0001), and fellowship-trained surgeons (P < 0.0001). Independent predictors of intraoperative complications on MVA included age (P = 0.009), white patients (P = 0.009), previous surgery (P = 0.001), operative time (P < 0.0001), and blood loss (P = 0.01). Independent predictors of postoperative complications on MVA included American Society of Anesthesiologists score (P < 0.0001), acute cholecystitis (P < 0.0001), and a postoperative complication (P < 0.0001). BMI was not a predictor of conversions or surgical morbidity. Length of stay was not significantly different between the four groups.Conclusions
This study demonstrates that overall conversion rates and surgical morbidity are relatively low following LC, even in obese and morbidly obese patients. 相似文献10.
Abhishek MathurKenneth Luberice B.S. Harold PaulCo Franka B.S. Alexander Rosemurgy 《American journal of surgery》2015,209(6):969-973