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1.
Background
Anemia is the most common extraintestinal manifestation in patients with inflammatory bowel disease (IBD), and has been linked to severity of the disease. The aim of the study was to assess the impact of anemia on postoperative outcomes in patients with IBD.Methods
We retrospectively reviewed patients with IBD from the NSQIP database over an 8-year period. Patients were grouped based on the presence of anemia. The impact of anemia on postoperative morbidity, mortality and length of stay was assessed.Results
A total of 15,761 patients met our criteria. Half of the patients were anemic upon presentation. Anemic patients were more likely to have a history of steroid use, present with sepsis and require an emergency operation. In multivariate analysis, anemia was a significant predictor of overall morbidity, serious morbidity and increased length of stay.Conclusions
Anemic patients with IBD present more often with sepsis and require emergency surgery compared to their peers. In addition, anemia serves as an independent predictor of overall complications, serious morbidity and increased length of stay following abdominal operations. 相似文献2.
Background
The primary objective of this study was to determine rates of reoperation, ED visits, and hospital readmission after thyroid and parathyroid surgery at a tertiary hospital. A secondary objective was to determine if scores from the American College of Surgeons Surgical Risk Calculator (ACS SRC) predicted these events.Methods
We retrospectively reviewed the records of patients undergoing parathyroid and thyroid surgery between 2011 and 2014. Patients who underwent an unplanned reoperation, returned to the ED, or were readmitted to hospital were evaluated using the ACS SRC.Results
436 patients underwent thyroid and parathyroid operations. Rates of re-operations, ED visits and hospital readmissions after thyroid and parathyroid surgery were: 3.4%, 0.6% and 3.0% and 2.2%, 0% and 1.4%, respectively. 71% of patients who experienced post-operative complications scored below average on the ACS SRC, 17% scored above average and 12% scored average risk.Conclusions
The SRC did not predict re-operation, ED visits, or hospital readmission after thyroid or parathyroid operations. 相似文献3.
Amandeep Ghuman Naomi Kasteel Ahmer A. Karimuddin Carl J. Brown Manoj J. Raval P. Terry Phang 《American journal of surgery》2018,215(5):949-952
Background
High urinary infection (UTI) rate (12%) for our rectal surgery prompted practice change to early catheter removal (postoperative day 2) and prophylactic tamsulosin. Here we report urinary retention (UR) and UTI after this change.Methods
Retrospective cohort study in male patients 50+ years undergoing elective colorectal surgery from July 2015 to July 2017. Multivariate regression was used to determine risk factors for urinary retention.Results
157 patients, 57 without and 100 with tamsulosin had UR 11.46% and UTI 5.13%. Of all potential risk factors, ileus (OR 5.50, 95% CI: 1.86–16.24) was an independent risk factor for urinary retention.Conclusions
Urinary retention of 11% after colorectal resection is within literature range and associated with post-operative ileus. Tamsulosin did not affect UR in our small study sample. Early catheter removal was associated with decreased UTI rate. 相似文献4.
A. Lauro A.D. Pinna E. Tossani V. Stanghellini M. Manno G. Caio L. Golfieri C. Zanfi N. Cautero A. Bagni U. Volta M. Di Simone L. Pironi R.F. Cogliandro M. Serra A. Venturoli S. Grandi R. De Giorgio 《Transplantation proceedings》2018,50(1):226-233
Background
Clinical and psychosocial outcomes of a multimodal surgical approach for chronic intestinal pseudo-obstruction were analyzed in 24 patients who were followed over a 2- to 12-year period in a single center after surgery or intestinal/multivisceral transplant (CTx).Methods
The main reasons for surgery were sub-occlusion in surgery and parenteral nutrition–related irreversible complications with chronic intestinal failure in CTx.Results
At the end of follow-up (February 2015), 45.5% of CTx patients were alive: after transplantation, improvement in intestinal function was observed including a tendency toward recovery of oral diet (81.8%) with reduced parenteral nutrition support (36.4%) in the face of significant mortality rates and financial costs (mean, 202.000 euros), frequent hospitalization (mean, 8.8/re-admissions/patient), as well as limited effects on pain or physical wellness.Conclusions
Through psychological tests, transplant recipients perceived a significant improvement of mental health and emotional state, showing that emotional factors were more affected than were functional/cognitive impairment and social interaction. 相似文献5.
Mohamed Abdelgadir Adam Megan C. Turner Zhifei Sun Jina Kim Brian Ezekian John Migaly Christopher R. Mantyh 《American journal of surgery》2018,215(1):66-70
Background
Our study compares 30-day vs. 90-day mortality following colorectal cancer surgery (CRS), and examines hospital performance ranking based on this assessment.Methods
Mortality rates were compared between 30 vs. 90 days following CRS for patients with stage I-III colorectal cancers from the National Cancer Database (2004–2012). Risk-adjusted hierarchical regression models evaluated hospital performance based on mortality. Hospitals were ranked into top (10%), middle (80%), and lowest (10%) performance groups.Results
Among 185,464 patients, 90-day mortality was nearly double the 30-day mortality (4.4% vs. 2.5%). Following risk adjustment 176 hospitals changed performance ranking: 39% in the top 30-day mortality group changed ranking to the middle group; 37% of hospitals in the lowest 30-day group changed ranking to the middle 90-day group.Conclusions
Evaluation of hospital performance based on 30-day mortality is associated with misclassification for 15% of hospitals. Ninety-day mortality may be a better quality metric in oncologic CRS. 相似文献6.
Masashi Uehara Jun Takahashi Yohei Akazawa Shugo Kuraishi Shota Ikegami Toshimasa Futatsugi Hiroki Oba Hiroyuki Kato 《Journal of orthopaedic science》2018,23(2):294-298
Background
As the surgical treatment of scoliosis after a Fontan procedure is very challenging due to the risk of various perioperative complications, case reports are scarce. We herein describe three patients who were successfully treated for scoliosis following a Fontan procedure and discuss their clinical and radiological outcomes.Methods
We retrospectively reviewed three cases of scoliosis treated by posterior spinal fusion after a Fontan procedure.Results
Mean preoperative major curve Cobb angle was 83.7°, mean surgical time was 233.0 min, and mean blood loss was 1167 g. The mean correction rate of the major curve was 48.0%. Surgical outcome as evaluated by Scoliosis Research Society-22 patient questionnaires revealed acceptable results without any severe complications.Conclusions
Corrective surgery for scoliosis after a Fontan procedure becomes a stronger option if cardiac insufficiency is prevented during the perioperative period and a conservative plan is carried out with minimal invasiveness and operation time. 相似文献7.
Michael Derickson Cody Phillips Morgan Barron John Kuckelman Matthew Martin Mia DeBarros 《American journal of surgery》2018,215(5):887-890
Introduction
Bariatric surgery results in massive weight loss, leaving many patients with redundant skin that can cause significant physical and psychosocial limitations. We sought to identify variables associated with postoperative complications and adjuncts associated with the mitigation of postoperative complications.Methods
A retrospective review was performed of all post-bariatric surgery patients who underwent panniculectomy over a 10-year period.Results
Total 706 patients included. Overall complication rate was 56%: dehiscence (24%), surgical site infection (22%), seroma (18%), and post-operative bleeding (5%). Return to operating room rate was 12%. Significant factors were: BMI >26 (p?<?0.01), fleur-de-lis panniculectomy (p?<?0.01), concomitant hernia repair (p?<?0.01). Multivariate regression analysis demonstrated ASA class >2 (OR 1.97, p?<?0.05) and incision type (OR 1.64, p?<?0.05) to be independent predictors of morbidity.Conclusion
High morbidity for post-bariatric panniculectomy is primarily local wound complications. Potentially modifiable factors that increase the complication risk profile include higher BMI, higher ASA class, and the use of fleur-de-lis incision. 相似文献8.
Tom Schmidt-Braekling Andrew D. Pearle David J. Mayman Geoffrey H. Westrich Wenzel Waldstein Friedrich Boettner 《The Journal of arthroplasty》2017,32(3):965-967
Background
Although venous thromboembolism is one of the leading causes of morbidity after knee arthroplasty, little data exist on the risk of deep venous thrombosis (DVT) after unicompartmental knee arthroplasty (UKA).Methods
We prospectively enrolled 112 patients undergoing UKA to determine the incidence of DVT utilizing aspirin 325 mg twice a day (BID) for 4 weeks postoperatively as DVT prophylaxis. The data were compared with a recent randomized controlled trial of patients undergoing total knee arthroplasty utilizing aspirin and Lovenox in conjunction with pneumatic compression devices.Results
One patient (0.9%) had an asymptomatic DVT, and none developed clinical symptoms of either DVT or pulmonary embolus. The incidence of asymptomatic and symptomatic DVT was 0.9% and 0%, respectively.Conclusion
Our data suggest that 325 mg of aspirin BID for 4 weeks results in a very low risk of DVT for patients undergoing UKA. 相似文献9.
Zachary Kozick Ammar Hashmi James Dove Marie Hunsinger Tania Arora Jeffrey Wild Mohsen Shabahang Joseph Blansfield 《American journal of surgery》2018,215(4):686-692
Background
Oncotype DX (ODX) is a multi-gene tumor assay for breast cancer patients. Our objective is to assess whether eligible ODX patients received the test and whether recommendations were followed based on respective risk.Methods
We retrospectively analyzed testing in patients deemed eligible for ODX using the National Cancer Data Base.Results
A total of 158,235 patients met ODX eligibility criteria. Sixty-four percent of eligible patients did not receive the test. Non-testing rose with age. White patients were more likely to be tested (56%) versus black patients (46%, p < 0.0001). Testing was highest at academic facilities (40%). Privately insured patients were more likely to get the test compared to uninsured (45 versus 34%, p < 0.0001). Those in the highest income quartile were more likely to be tested (p < 0.001).Conclusions
ODX is under-utilized, with racial and socio-economic factors influencing testing. Further studies are necessary to identify ways to remove disparities and increase testing when appropriate. 相似文献10.
Paris D. Butler Olatomide Familusi Joseph M. Serletti Justin P. Fox 《American journal of surgery》2018,215(6):987-994
Background
This study evaluates the rates of immediate breast reconstruction (IBR) among racial and insurance status subgroups, in the setting of a changing plastic surgeon workforce.Methods
Using state level inpatient and ambulatory surgery data, we identified discharges for adult women who underwent mastectomy for breast cancer. This information was supplemented with plastic surgeon workforce data and aggregated to the health service area-level (HSA). Hierarchical linear models were used to risk standardized IBR rates for 8 race-payer subgroups.Results
The final cohort included 65,246 women treated across 67 HSAs. The plastic surgeon density per 100,000 population directly related to the IBR rate. While all subgroups saw a modest increase in IBR rates, Caucasian women with private insurance realized the largest absolute increase (46%) while African-American and Asian women with public insurance saw the smallest increase (6%).Conclusion
Significant disparities persist in the provision of IBR according to the form of insurance a patient possesses. Of heightened concern is the novel finding that even within privately insured patients, women of color have significantly lower IBR rates compared to Caucasian women. 相似文献11.
Joachim Gülke Barbara Leopold Daniel Grözinger Björn Drews Stephan Paschke Nikolaus J. Wachter 《Journal of hand therapy》2018,31(1):20-28
Study Design
Prospective cohort randomized controlled trial.Purpose of the Study
Is either a home exercise (HE) program or traditional physical therapy (PT) more effective in the postoperative management of metacarpal fractures?Methods
Sixty patients suffering from nonthumb metacarpal fractures who received mobilization-stable open reduction and internal fixation were included. All patients were prospectively randomized into either the PT group or the HE group. Follow-up examinations at 2, 6 and 12 weeks postoperatively.Results
After 2 weeks, the range of motion (ROM) in both groups was still severely reduced. Twelve weeks after surgery the ROM improved to 245° (PT) and 256° (HE). Grip strength after 6 weeks was 68% (PT) and 71% (HE) when compared to the non-injured hand, improving to 91% (PT) and 93% (HE) after 12 weeks.Conclusion
Study results show that both HE program and traditional PT are effective in the postoperative management of metacarpal fractures.Level of Evidence
II. 相似文献12.
Ilker Abdullah Sarikaya Ali Seker Ozan Ali Erdal Mehmet Ali Talmac Muharrem Inan 《Acta orthopaedica et traumatologica turcica》2018,52(5):352-356
Objective
Tibial derotation osteotomy can be used in the treatment of rotational deformities in case of ineffective conservative management. Our aim was to evaluate the results of the patients who underwent minimal invasive plate osteosynthesis for tibial derotation osteotomies.Methods
Total of 16 patients (17 procedures) were included in this study. Mean age was 11.5 (3–25) years. We clinically assessed the tibial torsion by measuring the thigh-foot angle (TFA). No immobilization was used postoperatively and range of motion exercises were begun immediately. The patient was allowed weight-bearing activity, as tolerated, when callus formation was seen on the radiographs, at approximately three to four weeks after surgery.Results
The mean follow-up time was 27.5 months. Mean preoperative and follow up TFA were 27° of internal rotation and 3.74° of external rotation, respectively. A mean of 22.3° improvement was achieved postoperatively. There was only one wound detachment, which was accepted as a complication and healed with local wound care.Conclusions
The recurrence risk and correction loss can be decreased with plate-screw fixation. Minimal invasive surgery would also decrease the risk of wound complications.Level of evidence
Level IV, Therapeutic study. 相似文献13.
Edin Mujagic Walter R. Marti Michael Coslovsky Jasmin Zeindler Sebastian Staubli Regula Marti Robert Mechera Savas D. Soysal Lorenz Gürke Walter P. Weber 《American journal of surgery》2018,215(4):651-657
Background
Routine preoperative blood work is not recommended but selected biochemical markers may predict the risk of surgical site infection (SSI). This study examines the association between preoperative biochemical markers and the risk of SSI.Methods
This observational cohort study, nested in a randomized controlled trial, was conducted at two tertiary referral centers in Switzerland.Results
122 (5.8%) of 2093 patients experienced SSI. Preoperative increasing levels of albumin (OR 0.93), CRP (OR 1.34), hemoglobin (OR 0.87) and eGFR (OR 0.90) were significantly associated with the odds of SSI. The same accounts for categorized parameters. The highest area under the curve from ROC curves was 0.62 for albumin. Positive predictive values ranged from 6.4% to 9.5% and negative predictive values from 94.8% to 95.7%. The association of CRP, mildly and moderately decreased eGFR and hemoglobin with the odds of SSI remained significant on multivariate analysis.Conclusions
Our results do not support generally delaying elective surgery based on preoperative blood results. However, it may be considered in situations with potentially severe sequelae of SSI. 相似文献14.
Katherine Hadlandsmyth Mark W. Vander Weg Kimberly D. McCoy Hilary J. Mosher Mary S. Vaughan-Sarrazin Brian C. Lund 《The Journal of arthroplasty》2018,33(1):119-123
Background
Patients undergoing total knee arthroplasty (TKA) may be at risk for prolonged postsurgical opioid use due to a high prevalence of persistent postsurgical pain (20%) and high rates of presurgical opioid use.Methods
The current study uses a Veterans Health Administration sample of 6653 Veterans who underwent TKA in the fiscal year 2014 that did not require surgical revision during the subsequent year.Results
Sixty percent of the sample had used an opioid in the year prior to surgery, including 20% who were on long-term opioid use at the time of surgery (defined as 90+ days of continuous use) and 40% with any other opioid use in the year prior to surgery. In patients on long-term opioids at the time of surgery, 69% received opioids for at least 6 months and 57% for at least 12 months after TKA. In patients not on long-term opioids at the time of TKA, only 4% received opioids for at least 6 months and 2% for at least 12 months after TKA. Differing risk factors for prolonged opioid use 12 months after TKA were identified in these 2 cohorts (ie, those who were and were not receiving long-term opioids at TKA).Conclusion
These findings suggest that the greatest risk for prolonged opioid use after TKA is preoperative opioid use. 相似文献15.
Francesco Santullo Alberto Biondi Ferdinando C.M. Cananzi Valeria Fico Flavio Tirelli Riccardo Ricci Gianluca Rizzo Claudio Coco Claudio Mattana Domenico D&#x;Ugo Roberto Persiani 《American journal of surgery》2018,215(1):71-77
Background
The aim of this study was to identify stage II colon cancer patients with a high risk of recurrence.Methods
All patients who underwent surgery for stage II colon cancer (CC) were retrospectively enrolled and sub-grouped according to TNM staging (IIa-b-c) and stage IIa in high (IIaHR) and low risk (IIaLR) according to pathologic features.The primary outcomes measured were the 5-year overall survival (OS) and disease-free survival (DFS).Results
A total of 214 patients were reviewed. Only a maximum tumor diameter<4 cm in the IIaLR group was associated with a higher recurrence rate than a large tumor size (5-year DFS 71.7%vs.87.6%, p = 0.028).The DFS in the large IIaLR CC group was better than that in the IIaHR and IIb-c groups (5-year DFS: 92.7%vs.79.3%, p = 0.023). In contrast, the recurrence rate in the small IIaLR CC group was similar to that in the IIaHR, IIb-c stage CC group.Conclusions
In stage IIa CC evaluation of the tumor size as a prognostic factor may help identify patients who could benefit from additional postoperative therapy. 相似文献16.
Angelena Crown Nicketti Handy Flavio G. Rocha Janie W. Grumley 《American journal of surgery》2018,215(5):910-915
INTRODUCTION
Oncoplastic breast conserving surgery (BCS) can enhance both cosmetic and oncologic breast cancer outcomes. This study evaluates the outcomes and complications associated with oncoplastic reduction mammaplasty performed by surgical breast oncologists.METHODS
A single institution retrospective chart review of patients undergoing oncoplastic reduction mammaplasty by a surgical breast oncologist for the treatment of breast cancer.RESULTS
Seventy-one patients were identified. The average patient age was 59.6 years (range 37–77 years). Average lesion span was 31.4?mm (range 3–166?mm). Six (8.5%) patients required additional surgery to obtain adequate margins. One (1.4%) patient developed recurrent disease during the follow-up interval. No major surgical complications were observed.CONCLUSION
Oncoplastic reduction mammaplasty is associated with low rates of re-excision and complications and can be safely and effectively performed by appropriately trained surgical breast oncologists. 相似文献17.
18.
Avinash Bhakta Owen Glotzer Ashar Ata Marcel Tafen Steven C. Stain Paul T. Singh 《American journal of surgery》2018,215(4):643-646
Background
Postoperative pain management is a major contributor to recovery and discharge in bariatric surgery. Local anesthetic agents are of particular interest: they're non-sedating and may reduce postoperative pain and hospital length of stay (LOS).Design
Researchers queried the Bariatric Surgery Service Database for patients undergoing laparoscopic weight loss surgery from January 2012–December 2014. Patients were divided between those who did and did not receive liposomal bupivacaine intra-operatively. Measures included demographics, narcotic use, LOS, antiemetic use, and pain scales.Results
The liposomal group consisted of 233 patients and the PCA group consisted of 243 patients. The liposomal group had significantly less narcotic use than the PCA group in terms of IV morphine equivalents. This did not translate into a reduction in LOS in the liposomal group.Conclusions
TAP block using liposomal bupivacaine provides effective analgesia comparable to PCA. 相似文献19.
Laquanda T. Knowlin Laura Purcell Bruce A. Cairns Anthony G. Charles 《American journal of surgery》2018,215(6):1011-1015
Introduction
We sought to examine the impact of preexisting and new onset renal disease on burn injury mortality.Methods
Retrospective analysis of patients admitted to a regional burn center from 2002-2012 was performed. Variables analyzed included demographics, burn mechanism, inhalation injury status, and % TBSA. Poisson regression was performed to estimate risk of in-hospital burn mortality.Results
There were a total of 7640 patients over the study period. The adjusted 60-day risk of in-hospital mortality in patients with preexisting renal disease (PRD was 3 times higher compared to patients with no preexisting renal disease (IRR?=?3.22, 95% CI?=?1.26–8.25). The adjusted 60-day risk of mortality is 2 times higher for patients with new onset renal disease compared to those without (IRR?=?2.11, 95% CI?=?1.55–2.87).Conclusion
Preexisting and new onset renal disease results in a significantly higher risk of mortality following burn injury compared to patients without renal disease. Prevention of new onset renal injury and careful management of patients with preexisting renal disease to prevent exacerbation should be pursued. 相似文献20.
Barrett A. Kielhorn Anthony J. Senagore Theodor Asgeirsson 《American journal of surgery》2018,215(3):373-376