A novel over-the-scope deployment method for enteral stent placement

Background

Over the last two decades, self-expanding enteral stents have gained popularity and shown therapeutic potential for strictures, obstructions, fistulae, and perforations of the gastrointestinal (GI) tract. Currently available stent delivery systems make deployment in many locations in the GI tract difficult due to the inability to traverse curves or impossible due to the size requirements of the deployment systems.

Methods

A 67-year-old male presented to our hospital with severe gallstone pancreatitis, requiring a prolonged intensive care unit course. Two days after discharge to a rehabilitation facility he developed acute abdominal pain and pneumoperitoneum. Operative exploration failed to identify a perforation. Subsequently, a left-upper-quadrant abscess developed that was drained percutaneously, yielding coliform bacteria. The drain produced several hundred milliliters of stool a day. A barium enema demonstrated a perforation in the descending colon from an old colo-colic anastomosis site. We proposed a novel over-the-scope (OTS) stent deployment method. Utilizing a heat-activated polymer sheath, the stent was affixed to the endoscope. A modified speed-banding attachment was created to permit release of the polymer sheath once endoscopic and fluoroscopic confirmation of the correct position was obtained.

Results

Utilizing this method of OTS stent deployment, a fully covered 23 × 155 mm self-expanding metal stent (WallFlex, Boston Scientific, Natick, MA) was placed in the colon. Endoscopic and fluoroscopic evaluation following stent placement confirmed stent coverage of the perforation with no ongoing evidence of leak. The patient was discharged to his home state 2 weeks after stent placement in stable condition.

Conclusion

We have developed a novel method of OTS stent placement that permits deployment of a variety of enteral stents on any available endoscope. This method permits placement of fully covered stents in locations in the GI tract not reachable with currently available delivery systems.     

Risk factors for 30-day unplanned readmission following infrainguinal endovascular interventions

Objective

Unplanned hospital readmissions following surgical interventions are associated with adverse events and contribute to increasing health care costs. Despite numerous studies defining risk factors following lower extremity bypass surgery, evidence regarding readmission after endovascular interventions is limited. This study aimed to identify predictors of 30-day unplanned readmission following infrainguinal endovascular interventions.

Predictors of 30-day hospital readmission after coronary artery bypass

BACKGROUND: Risk factors for 30-day hospital readmission following coronary artery bypass grafting (CABG) have not been established. METHODS: We prospectively followed 485 consecutive patients who underwent isolated primary CABG at our institution in 1997. Patients were contacted by telephone at 30 days following operation to determine readmission status. RESULTS: The overall readmission rate was 16% (76 of 485). Female gender (25% versus 11%, p = 0.001) and diabetes (22% versus 12%, p = 0.005) were associated with significantly higher readmission rates. The relationship between female gender and readmission persisted after correcting for age and other comorbidities. Congestive heart failure trended towards a significant relationship with increased readmission rate (22% versus 14%, p = 0.09). There were no significant associations between 30-day readmission rate and age, hypertension, chronic obstructive pulmonary disease, history of myocardial infarction, peripheral vascular disease, creatinine level of > or = 1.4 mg/dL, or decreased left ventricular ejection fraction (< 40%). CONCLUSIONS: These data show that most of the classic risk factors for postoperative mortality are not necessarily associated with increased readmission. However, female gender and diabetes are associated with greater than twice the risk of 30-day readmission following CABG.     

30-day all-cause hospital readmission after cystectomy: no worse for rural Medicare residents

Objective

To evaluate rural/urban disparities in 30-day all-cause hospital admission after cystectomy.

Factors associated with readmission after laparoscopic gastric bypass surgery

BACKGROUND: Studies have demonstrated that laparoscopic Roux-en-Y gastric bypass (RYGB) is associated with the greatest readmission rate among bariatric surgeries. Some readmissions might be avoidable. We sought to evaluate the risk factors for readmission in a high-volume bariatric surgery program at a university hospital in the United States. METHODS: We performed a retrospective review of prospectively maintained data. Patients readmitted within 30 days of laparoscopic RYGB were randomly matched to control patients who had undergone RYGB in the same year but were not readmitted. The readmissions were categorized as technical complications (leak), wound infections, or malaise (nausea, dehydration, or benign abdominal pain). Patients with a wound infection treated in an outpatient setting were also evaluated and compared with the patients admitted with a wound infection. RESULTS: From July 2002 to July 2008, 450 patients underwent RYGB. Readmission occurred in 42 patients (9%). Of these 42 patients, 6 were admitted with wound infections (14%), 18 (43%) with malaise, and 18 (43%) with technical complications. The patients admitted with wound infections were similar to their controls, except that they were more likely to have publicly funded insurance (Medicare or Medicaid) and more likely to present for medical attention to the emergency department after clinic hours. The patients admitted with malaise reported a greater pain score at discharge and were also more likely to have public health insurance than controls. The patients with technical complications did not differ from the control patients in any examined variable. CONCLUSIONS: Patients with publicly funded insurance are at increased risk of readmission after RYGB. Outpatient mechanisms for managing wound infections and malaise might result in decreased readmissions.     

Predictors of 30-day hospital readmission after hip fracture: a systematic review

BackgroundEarly readmission to hospital after hip fracture is associated with increased mortality and significant costs to the healthcare system. There is growing interest in the use of 30-day readmission rates as a metric of hospital performance. Identifying patients at increased risk of readmission after hip fracture may enable pre-emptive action to mitigate this risk and the development of effective methods of risk-adjustment to allow readmission to be used as a reliable measure of hospital performance.MethodsWe conducted a systematic review of bibliographic databases and reference lists up to July 2016 to identify primary research papers assessing the effect of patient- and hospital-related risk factors for 30-day readmission to hospital after hip fracture.Results495 papers were found through electronic and reference search. 65 full papers were assessed for eligibility. 22 met inclusion criteria and were included in the final review.Medical causes of readmission were significantly more common than surgical causes, with pneumonia consistently being cited as the most common readmission diagnosis. Age, pre-existing pulmonary disease and neurological disorders were strong independent predictors of readmission. ASA grade and functional status were more robust predictors of readmission than the Charlson score or individual co-morbidities. Hospital-related risk factors including initial length of stay, hospital size and volume, time to surgery and type of anaesthesia did not have a consistent effect on readmission risk. Discharge location and the strength of hospital-discharge facility linkage were important determinants of risk.ConclusionsPatient-related risk factors such as age, co-morbidities and functional status are stronger predictors of 30-day readmission risk after hip fracture than hospital-related factors. Rates of 30-day readmission may not be a valid reflection of hospital performance unless a clear distinction can be made between modifiable and non-modifiable risk factors. We identify a number of deficiencies in the existing literature and highlight key areas for future research.     

Unplanned 30-day readmission in patients with diabetic foot wounds treated in a multidisciplinary setting

Objective

Readmission rates are known to be high for vascular surgery patients in general, but there are limited data describing the risk of surgical and nonsurgical readmission among patients with diabetic foot ulcers (DFUs). Our aim was to identify factors associated with unplanned readmission in DFU patients treated in a multidisciplinary setting.

30例老年食管癌晚期支架置入术的疗效观察

目的探讨食管支架置入术治疗老年晚期食管癌的临床疗效。方法对我院在2005年2月至2007年7月30例晚期食管癌支架置入术后生活质量及生存期进行回顾性分析。结果26例患者术后感到胸骨后不适及疼痛,在1-2周后均可缓解。术后16例能较正常地食。所有患者均可进食半流。本组有3例发生支架滑脱,经胃镜下调整后完全复位。术后30例均获得随访,其中6例分别手术后4-25个月死亡。死亡原因是肝转移3例,支气管食管瘘并发肺炎及败血症1例,脑血管意外1例及癌肿胃转移后恶液质全身衰竭1例。其余24例术后至今仍生存,生存最长者达23个月;支架仍然保持通畅。结论老年晚期食管癌行支架置入术能明显改善梗阻症状,减轻痛苦,延长生存期。     

30例老年食管癌晚期支架置入术的疗效观察

目的探讨食管支架置人术治疗老年晚期食管癌的临床疗效。方法对我院在2005年2月至2007年7月30例晚期食管癌支架置入术后生活质量及生存期进行回顾性分析。结果26例患者术后感到胸骨后不适及疼痛，在1-2周后均可缓解。术后16例能较正常地食。所有患者均可进食半流。本组有3例发生支架滑脱，经胃镜下调整后完全复位。术后30例均获得随访，其中6例分别手术后4—25个月死亡。死亡原因是肝转移3例，支气管食管瘘并发肺炎及败血症1例，脑血管意外1例及癌肿胃转移后恶液质全身衰竭1例。其余24例术后至今仍生存，生存最长者达23个月；支架仍然保持通畅。结论老年晚期食管癌行支架置入术能明显改善梗阻症状，减轻痛苦，延长生存期。     

Retrospective analysis of 30-day unplanned readmission after major abdominal surgery with reversal by sugammadex or neostigmine

Background

Sugammadex is associated with fewer postoperative complications, but its impact on 30-day unplanned readmission is unclear.

Factors associated with the long-term outcome of a self-expandable colon stent used for palliation of malignant colorectal obstruction

Background  

The placement of self-expanding metal stents (SEMS) is a safe and effective definitive procedure for the palliation of malignant colorectal obstruction. In this study, the clinical outcomes, including the technical and clinical success rates, and the risk factors associated with the long-term outcomes of palliative SEMS were evaluated.     

Indications,risk factors,and outcomes of 30-day readmission after infrarenal abdominal aneurysm repair

Objective

Reducing readmissions is an important target for improving patient care and enhancing health care quality and cost-effectiveness. The aim of this study was to assess rates, risk factors, and indications of 30-day readmission after open aortic repair (OAR) and endovascular aneurysm repair (EVAR) of infrarenal abdominal aortic aneurysms (AAAs).

Risk of 30-day readmission in patients aged 75 years and older following same-day discharge for primary total shoulder arthroplasty

BackgroundLittle is known about the safety and feasibility of same-day discharge following primary total shoulder arthroplasty (anatomic and reverse, SA) in geriatric patients, who may have more comorbidities and be at higher risk of surgical complications. The purpose of this study is to evaluate whether patients aged 75 years or older undergoing same-day discharge following primary SA are at an increased risk for certain complications, readmission, or mortality compared to their younger counterparts.MethodsThe 2007-2019 National Surgical Quality Improvement Program database was used to identify all primary SA patients who underwent same-day discharge. Patients were categorized into 2 cohorts, younger than 75 years and aged 75 years or older. Bivariate and multivariate analyses were performed to compare the 2 cohorts.ResultsOf 1637 SA patients who were discharged on the same day, 1246 (76.1%) patients were younger than 75 years, and 391 (23.9%) were aged 75 years or older. Bivariate analyses showed that patients aged 75 years or older were more likely to develop urinary tract infections (P = .003) and require hospital readmission (P = .002). After controlling for potential confounding variables on multivariate analysis, the cohort of patients aged 75 years or older had an increased risk of unplanned hospital readmission compared to patients younger than 75 years (odds ratio 3.99; P = .001).ConclusionPatients of age 75 years or older are at an increased risk for unplanned hospital readmission within 30 days of same-day discharge following primary SA. Surgeons and patients should be aware of this risk when evaluating SA candidates for same-day discharge.