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1.
Richard J. Hanly Salman K. Marvi Sarah L. Whitehouse Ross W. Crawford 《The Journal of arthroplasty》2017,32(9):2712-2716
Background
It is increasingly apparent that the effect of obesity in arthroplasty is joint-specific. This study evaluates the effects of morbid obesity on primary total knee arthroplasty by comparing short-term outcomes between a morbidly obese (body mass index ≥40 kg/m2) and a normal weight (body mass index 18.5-<25 kg/m2) cohort at our institution between January 2003 and December 2010.Methods
One hundred seventeen morbidly obese patients were compared with 94 normal weight patients. Operative time, length of stay, complications, 30-day readmission, and readmission length were compared.Results
Morbid obesity conveyed no significant increase in 30-day readmission. Operative time was increased at 100 minutes in the morbidly obese group, compared with 90.5 minutes (P = .026).Conclusion
Morbid obesity conveyed no increased risk of length of stay or readmission in this cohort. 相似文献2.
Chema Strik Martijn W.J. Stommel Jeroen C. Hol Harry van Goor Richard P.G. ten Broek 《American journal of surgery》2018,215(1):104-112
Background
Adhesiolysis during abdominal surgery can cause iatrogenic organ injury, increased operative time and a more complicated convalescence. We assessed the impact of adhesiolysis and adhesiolysis-related complications on quality of life and functional status following elective abdominal surgery.Methods
Prospective cohort study, comparing patients requiring and not requiring adhesiolysis during an elective laparotomy or laparoscopy using the SF-36 and DASI questionnaire scores.Results
518 patients were included. Pre- and postoperative quality of life did not significantly differ between both groups. Patients with adhesiolysis had a significantly lower pre- and postoperative functional status (p < 0.01). Higher age, concomitant pulmonary disease, postoperative complications, readmissions and chronic abdominal pain 6 months after surgery were all associated with a significant and independent decline in quality of life and functional status six months after surgery.Conclusion
Adhesiolysis in itself does not affect functional status and quality of life six months after surgery. Postoperative complications, readmissions and chronic abdominal pain are associated with a lower health status. 相似文献3.
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4.
Jad Khoraki Marilia G. Moraes Adriana P.F. Neto Luke M. Funk Jacob A. Greenberg Guilherme M. Campos 《American journal of surgery》2018,215(1):97-103
Background
Laparoscopic adjustable gastric banding (LAGB) is an option for the treatment of severe obesity. Few US studies have reported long-term outcomes. We aimed to present long-term outcomes with LAGB.Methods
Retrospective study of patients who underwent LAGB at an academic medical center in the US from 1/2005 to 2/2012. Outcomes included weight loss, complications, re-operations, and LAGB failure.Results
208 patients underwent LAGB. Mean BMI was 45.4 ± 6.4 kg/m2. Mean follow-up was 5.6 (0.5–10.7) years. Complete follow-up was available for 90% at one year (186/207), 80% at five years (136/171), and 71% at ten years (10/14). Percentage of excess weight loss at one, five, and ten years was 29.9, 30, and 16.9, respectively. Forty-eight patients (23.1%) required a reoperation. LAGB failure occurred in 118 (57%) and higher baseline BMI was the only independently associated factor (OR 1.1; 95%CI 1.0–1.1; p = 0.016).Conclusion
LAGB was associated with poor short and long-term weight loss outcomes and a high failure rate. With the increased safety profile and greater efficacy of other surgical techniques, LAGB utilization should be discouraged. 相似文献5.
H. Pinto R. Leal L. Rodrigues L. Santos C. Romãozinho F. Macário R. Alves C. Bastos A. Roseiro F. Costa M. Campos A. Mota A. Figueiredo 《Transplantation proceedings》2017,49(4):821-823
Background
The purpose of this study was to determine the incidence of early surgical complications of kidney transplantation in our institution and its association with donor and recipient factors, as well as patient and transplant outcome.Methods
A retrospective cohort study of all kidney transplants performed during 2015 was made. We evaluated the incidence of surgical complications and the outcome of patients and grafts at a 3-month follow-up interval.Results
During the study period, 141 kidney transplants occurred. Seventeen patients had surgical complications (6 urologic, 6 vascular, and 5 other complications). Five patients lost the graft during the follow-up. Older age was associated with other surgical complications (P = .023), and graft loss was associated with the existence of surgical complications, namely, vascular complications (P <.001). For both surgical complications in general and urologic complications, a statistically significant relationship was found with patient weight (P = .003 and P = .034, respectively). The correlation between body mass index (BMI) and surgical complications was not statistically significant.Conclusions
Our study reveals that older and heavier patients have a higher risk of surgical complications and that vascular complications are associated with graft loss. A statistically significant relationship was not found between BMI and surgical complications, which could indicate that BMI is not the ideal obesity marker. The incidence of surgical complications found in our study is similar to the literature. The selection of transplant recipients is a difficult task, and the possibility of additional surgical complications in older and overweight patients should be taken into account. 相似文献6.
Kyle R. Duchman Andrew J. Pugely Christopher T. Martin Yubo Gao Nicholas A. Bedard John J. Callaghan 《The Journal of arthroplasty》2017,32(4):1285-1291
Background
Increased operative time has been associated with increased complications after total joint arthroplasty (TJA). The purpose of the present study was to investigate the effect of operative time on short-term complications after TJA while also identifying patient and operative factors associated with prolonged operative times.Methods
The American College of Surgeons National Surgical Quality Improvement Program database was queried from 2011-2013 to identify all patients who underwent primary total hip or knee arthroplasty. Patients were stratified by operative time, and 30-day morbidity and mortality data compared using univariate and multivariable analyses.Results
We identified 99,444 patients who underwent primary TJA. The overall incidence of complications after TJA was 4.9%. Overall complications were increased in patients with operative times >120 minutes (5.9%) as compared to patients with operative times <60 minutes or 60-120 minutes (4.6% and 4.8%, respectively; P < .001). Wound complications, including surgical site infection, were also increased for procedures lasting >120 minutes. In a multivariable analysis, operative time exceeding 120 minutes remained an independent predictor of any complication and wound complication, with each 30-minute increase in operative time beyond 120 minutes further increasing risk. Patient age ≤65 years, male sex, black race, body mass index ≥30 kg/m2, and an American Society of Anesthesiologists classification of 3 or 4, predicted operative times >120 minutes.Conclusion
We found that operative time >120 minutes was associated with increased short-term morbidity and mortality after primary TJA. Younger age, male sex, black race, obesity, and increased comorbidity were risk factors for operative time exceeding 120 minutes. 相似文献7.
Bryan D. Haughom Bryce A. Basques Michael D. Hellman Nicholas M. Brown Craig J. Della Valle Brett R. Levine 《The Journal of arthroplasty》2018,33(6):1914-1918
Background
Epidemiological estimates indicate a rising incidence of periprosthetic hip fractures. While native hip fractures are known to be a highly morbid condition, a significant body of research has led to improved outcomes and decreased complications following these injuries. Comparatively, little research has evaluated the relative morbidity and mortality of periprosthetic hip fractures. The purpose of this study was to compare the morbidity and mortality of periprosthetic vs native hip fractures.Methods
Using the National Surgical Quality Improvement Program (NSQIP) database, 523 periprosthetic hip fractures were matched to native hip fractures using propensity scores. The 30-day rates of complications were compared using McNemar's test. A multivariate regression was then used to determine independent risk factors for mortality following periprosthetic fracture.Results
Mortality was similar between groups (periprosthetic: 2.7% vs native: 3.4%; P = .49). Periprosthetic fractures exhibited a greater rate of overall (63.1% vs 38.6%; P < .001) and minor complications (59.1% vs 34.4%; P < .001). There was an increased rate of return to the operating room (7.8% vs 3.1%; P < .001) and blood transfusion in the periprosthetic group (54.9% vs 30.2%; P = .001). Age greater than 85 (odds ratio 9.21) and dependent functional status (odds ratio 5.38) were both independent risk factors for mortality following periprosthetic fracture.Conclusions
While native hip fractures are known to be highly morbid, our findings suggest that periprosthetic hip fractures have a similar mortality with significantly higher short-term morbidity. Future research is warranted to better understand risk factors and prevention strategies for complications in this subset of patients. 相似文献8.
John L. Falcone 《American journal of surgery》2018,215(2):341-346
Background
There is a decreasing institutional percentage of surgical resident recipients of The Arnold P. Gold Humanism and Excellence in Teaching Award over time. The hypothesis was that this trend was a national phenomenon.Methods
This was a retrospective study from 2004 - 2015, utilizing data from the Arnold P. Gold Foundation. Multiple regression was performed using the estimated ratio of eligible surgical to non-surgical residents and the year as explanatory variables, utilizing an α = 0.05.Results
The percentage of surgical award winners was lower in the second study half compared to the first half (40.2% vs. 47.2%) (p = 0.02). Multiple regression showed that when controlling for the number of eligible residents, the number of resident awardees decreased over time (p = 0.01).Conclusion
There is a clear national trend that surgical residents are receiving the Arnold P. Gold Humanism and Excellence in Teaching Award less over time. 相似文献9.
Background
Obesity is a growing public health issue with the prevalence of morbid obesity, (Body Mass Index (BMI) ≥ 40 kg/m2) increasing. There is some evidence these patients have more peri- and post-operative complications and poorer outcomes when undergoing arthroplasty procedures. This audit aimed to determine and compare the outcomes of non-obese, obese and morbidly obese patients undergoing arthroplasty at our institution.Method
This was a retrospective audit of patients from our institution who had undergone total knee (TKA) or total hip arthroplasty (THA) in 2009. Data collected were: age, gender, BMI, length of stay (LOS), Oxford knee or hip score (OKS/OHS), satisfaction and complications up to two years post operation. Patients were divided into three groups: BMI < 30, BMI 30–40 and BMI > 40. Outcomes for each BMI group were compared.Results
1014 TKA and 906 THA operations were included. When compared to obese and non-obese patients, morbidly obese patients undergoing TKA had a mean LOS one day longer, a mean OKS four points lower and higher rates of postoperative problems, 37% vs. 21%. For THA patients there was no difference in LOS, OHS score was two points lower for each increasing BMI category and postoperative problems increase from 25% for non-obese to 31% for obese and 38% for morbidly obese patients.Conclusion
These results will be useful in informing obese patients of their potential outcomes following TKA or THA. These patients can then make a more informed choice before proceeding with arthroplasty. 相似文献10.
Xi Yu Hong Wang Xin Duan Ming Liu Zhou Xiang 《Acta orthopaedica et traumatologica turcica》2018,52(4):299-307
Objective
The aim of this meta-analysis was to explore the difference between and compare intramedullary fixation (IF) and extramedullary fixation (EF) for unstable intertrochanteric fractures.Methods
We searched Pubmed database and Cochrane library following by including and excluding articles based from inception to December, 2016. All randomized controlled trials (RCTs) comparing IF and EF for unstable intertrochanteric fractures were assessed and selected by two researchers independently. Data were analyzed using Review Manager 5.1 version.Results
17 RCTs were enrolled in our meta-analysis comparing IF and EF and showed evidence that IF had lower rate of implant failure RR = 0.2695%CI 0.13–0.51, P < 0.0001 and re-operation (RR = 0.60, 95%CI 0.37–0.98, P = 0.04), while there was no statistical differences of cut-out, postoperative infections and other complications. Moreover, PPM scores verified that IF had better postoperative hip mobility recovery (MD = 0.87, 95%CI 0.08–1.66, P = 0.03).Conclusion
IF has lower incidence of failure of implant and reoperation and shows better postoperative functional recovery when treating adult unstable intertrochanteric fracture while the most postoperative complications were not statistically different from EF.Level of evidence
Level I, therapeutic study. 相似文献11.
Dong-Yeong Lee Young-Jin Park Hyun-Jung Kim Hyeong-Sik Ahn Sun-Chul Hwang Dong-Hee Kim 《Acta orthopaedica et traumatologica turcica》2018,52(2):101-108
Introduction
The aim of this study is to evaluate whether early (<8 h) surgical decompression is better in improving neurologic outcomes than late (≥8 h) surgical decompression for traumatic spinal cord injury (tSCI).Methods
The various electronic databases were used to detect relevant articles published up until May 2016 that compared the outcomes of early versus late surgery for tSCI. Data searching, extraction, analysis, and quality assessment were performed according to Cochrane Collaboration guidelines. The results are presented as relative ratio (RR) for binary outcomes and mean difference (MD) for continuous outcomes with 95% confidence intervals (CIs).Results
Seven studies were finally included in this meta-analysis. There were significant differences between the 2 groups in neurologic improvement (MD = 0.54, 95% CI = ?18.52 to ?7.02, P < 0.0001) and length of hospital stay (MD = ?12.77, 95% CI = 0.34–0.74, P < 0.00001). However, no significant differences were found between the 2 groups in perioperative complications (OR = 0.95, 95% CI = 0.35–2.61, P = 0.92).Conclusions
Early surgical decompression within 8 h after tSCI was beneficial in terms of neurologic improvement compared with late surgery. Early surgical decompression (within 8 h) is recommended for patients with tSCI.Level of evidence
Level III, therapeutic study. 相似文献12.
Aaron L. Womer Justin T. Brady Kevin Kalisz Nilam D. Patel Raj M. Paspulati Harry L. Reynolds Timothy M. Pawlik Scott R. Steele 《American journal of surgery》2018,215(3):503-506
Background
Increasingly, patients with multiple co-morbidities undergo surgery for rectal cancer. We aimed to evaluate if decreased psoas muscle area and volume, as measures for sarcopenia, were associated with postoperative morbidity.Methods
Retrospective review of patients undergoing rectal cancer resection at a tertiary medical center (2007–2015). Variables included demographics, co-morbidities, preoperative psoas muscle area and volume, and postoperative complications.Results
Among 180 patients (58% male, mean age 62.7 years), 44% experienced complications (n = 79), of which 38% (n = 30) were major complications. Malnourished patients had smaller height-adjusted total psoas area than non-malnourished patients (6.4 vs. 9.5 cm2/m2, p = 0.004). Among patients with imaging obtained within 90 days of surgery, major morbidity was associated with smaller total psoas area (6.7 vs. 10.5 cm2/m2, p = 0.04) and total psoas volume (26.7 vs. 42.2 cm3/m2, p = 0.04) compared to those with minor complications.Conclusion
Preoperative cross-sectional imaging may help surgeons anticipate postoperative complications following rectal cancer surgery. 相似文献13.
Michal Radomski Mazen Zenati Stephanie Novak Vernissia Tam Jennifer Steve David L. Bartlett Amer H. Zureikat Herbert J. Zeh Melissa E. Hogg 《American journal of surgery》2018,215(4):636-642
Background
Complex surgeries such as a pancreatoduodenectomy (PD) traditionally have long hospital stays (LOS).Methods
Patients who underwent elective PD at our institution from 8/2011-6/2015 were retrospectively examined. Interquartile ranges were calculated from LOS. Patient were compared between the highest quartile and the remainder of the cohort.Results
492 patients had a median LOS of 9 days, with 106 (22%) admitted for >14 days. Characteristics associated with prolong hospitalization include age (p = 0.004) and preoperative albumin <3.5 (p = 0.007). Significant intra-operative measures associated with prolonged LOS were blood loss (EBL, p = 0.004) and increased operative time (p = 0.008). Any complication extended hospitalizations (p < 0.001). Patients in the top quartile were less likely to be discharged home (p < 0.0001) and more likely to be readmitted (p < 0.0001).Conclusion
Older patients with hypoalbuminemia are at higher risk of prolonged LOS following PD as well as high EBL, operative time, and surgical complications. Focused efforts to counsel and optimize patients pre-operatively and minimize intra-operative complications may shorten hospital stays. 相似文献14.
T. Bessede Y. Hammoudi D. Bedretdinova B. Parier H. Francois A. Durrbach G. Benoit 《Transplantation proceedings》2017,49(9):2018-2024
Background
Only surgically irrelevant risk factors including sex, African-American ancestry, or exceptional U-stitch anastomosis have been identified to associate with urinary complications after kidney transplantation. The objective was to identify modifiable and nonmodifiable risk factors associated with urinary complications after kidney transplantation.Methods
A single-center study of 3,129 kidney transplants performed over 40 years was conducted to identify independent risk factors using χ2 tests and logistic regression analysis.Results
We identified the quality of the transplant's ureter, cystographic abnormalities in the recipient, and repeat transplantations as independent risk factors for overall urinary complications occurring after kidney transplantation in multivariable analysis. Obesity was associated with an increased risk of urinary fistula, while the presence of a JJ stent was associated with a reduced risk of urinary fistula. The risk of urinary surgical complications for kidney transplantations was reduced when the kidney was recovered from a living related compared to a deceased donor.Conclusions
The risk factors identified in the present study will allow candidates for kidney transplantation to be more informed and will also allow for surgical modifications to limit the occurrence of urinary complications. 相似文献15.
Lauren Slakey Pointer Zaid Al-Qurayshi David Taylor Pointer Emad Kandil Douglas Philip Slakey 《American journal of surgery》2018,215(1):120-124
Purpose
This study evaluates the association of environmental, social and health risk factors in relation to outcomes of pancreatic surgery.Methods
Patients who underwent pancreatectomy with a 30 day postoperative follow up in Florida, New York and Washington states were identified using the State Inpatient Databases (SID) from 2010 to 2011. This data was merged with community health indicators complied from the County Health Ranking database. Fourteen community health indicators were used to determine higher risk communities. Communities were then divided into low and high risk communities based on a scoring system using accumulative community risk.Results
Among 3494 patients included recipients in high-risk communities were more likely African American (p < 0.001), younger (age 40–59; p = 0.001), and had Medicaid as primary insurance (p = 0.001). Management of patients in high-risk communities was associated with increased risk of postoperative complications (p < 0.001), ICU admissions (p < 0.001), increased length of stay (p < 0.001).Conclusion
Health indicators from patients' communities are predictors of increased risk of perioperative complications for individuals undergoing pancreas surgery. 相似文献16.
Chia-Chi Tsai Po-Sheng Yang Chien-Liang Liu Chih-Jen Wu Yi-Chiung Hsu Shih-Ping Cheng 《American journal of surgery》2018,215(1):179-185
Background
Topical antibiotics have been shown to reduce exit-site infection and peritonitis. The aim of this study was to compare infection rates between mupirocin and gentamicin.Methods
Multiple comprehensive databases were searched systematically to include relevant randomized controlled trials and observational studies. Pooled risk ratios (RRs) and 95% confidence intervals were calculated for the incidences of exit-site infection and peritonitis.Results
Seven studies (mupirocin group n = 458, gentamicin group n = 448) were analyzed for exit-site infection. The risk of gram-positive exit-site infection was similar between the groups. Gram-negative exit-site infection rate was higher in the mupirocin group (RR = 2.125, P = 0.037). Six studies were assessed the peritonitis risk. There was no difference in the gram-positive and -negative peritonitis rate.Conclusions
Topical use of gentamicin is associated with fewer exit-site infections caused by gram-negative organisms. Gentamicin has comparable efficacy to mupirocin for peritonitis and gram-positive exit-site infection. 相似文献17.
Brian C. Werner Matthew D. Higgins Hakan C. Pehlivan Joshua T. Carothers James A. Browne 《The Journal of arthroplasty》2017,32(2):402-406
Background
Recent studies have reported higher postoperative complication rates in obese and morbidly obese patients undergoing total hip arthroplasty (THA). Less data are available regarding super-obese (body mass index [BMI] >50 kg/m2) patients. This study aims to quantify the risk of complications after THA in super-obese patients on a national scale and to put these risks in context by comparing them to patients of other BMI classes as well as those undergoing revision THA.Methods
Utilizing a national insurance database, complication rates after THA in super-obese patients (n = 3244) were compared to nonobese, obese, and morbidly obese patients undergoing primary THA and all patients undergoing revision THA. A logistic regression analysis controlling for demographic and comorbidity variables was utilized to determine the independent effect of super obesity on complication rates after THA.Results
Super-obese patients had significantly higher rates of most complications than nonobese, obese, morbidly obese, and revision THA patients, including venous thromboembolism, infection, blood transfusion, medical complications, dislocation, readmission, and revision THA.Conclusion
Super-obese patients (BMI >50 kg/m2) have higher rates of postoperative complications after THA than nonobese, obese, morbidly obese, and revision THA patients. Super obesity is an independent risk factor for increased rates of most postoperative complications including the need for early revision THA. 相似文献18.
Akira Yoshiyama Takeshi Morii Michiro Susa Hideo Morioka Eisuke Kobayashi Naofumi Asano Tomoaki Mori Ukei Anazawa Itsuo Watanabe Katsuhito Takeuchi Yu Kushima Takayuki Aoyagi Shoichi Ichimura 《Journal of orthopaedic science》2017,22(5):924-930
Background
Surgical treatment for renal cell carcinoma metastases can be an effective modality for improving survival and patients' quality of life. However, it is often difficult to decide on the optimal surgical approach due to the lesion's high vascularity and uncertainty regarding postoperative performance status and survival.Patients and methods
Blood loss, postoperative performance status, overall survival, postoperative complication and related risk factors for surgical treatment were analysed in 61 renal cell carcinoma patients with bone metastases.Results
Pelvic location and impending/pathological fracture in the metastatic lesion were both significant risk factors for increased blood loss. An unresectable primary lesion and poor preoperative performance status were independent risk factors for poor postoperative performance status. A shorter duration from the discovery of primary lesion to bone metastasis, the number of metastases, and unresectable primary lesion were independent risk factors for shorter survival. Postoperative complications were identified in 15 cases (24.6%).Conclusion
The preoperative prediction of intraoperative blood loss, performance status and survival in renal cell carcinoma patients with bone metastases may be possible based on the risk factors identified in this study. 相似文献19.
Nicolas J. Mouawad Stefan W. Leichtle Christodoulos Kaoutzanis Kathleen Welch Suzanne Winter Richard Lampman Matt McCord Kimberly A. Hoskins Robert K. Cleary 《American journal of surgery》2018,215(4):570-576
Objective
To compare continuous infusion preperitoneal wound catheters (CPA) versus continuous epidural analgesia (CEA) after elective colorectal surgery.Methods
An open-label equivalence trial randomizing patients to CPA or CEA. Primary outcomes were postoperative pain as determined by numeric pain scores and supplemental narcotic analgesia requirements. Secondary outcomes included incidence of complications and patient health status measured with the SF-36 Health Survey (Acute Form).Results
98 patients were randomized [CPA (N = 50, 51.0%); CEA (N = 48, 49.0%)]. 90 patients were included [ CPA 46 (51.1%); CEA 44 (48.9%)]. Pain scores were significantly higher in the CPA group in the PACU (p = 0.04) and on the day of surgery (p < 0.01) as well as supplemental narcotic requirements on POD 0 (p = 0.02). No significant differences were noted in postoperative complications between groups, aggregate SF-36 scores and SF-36 subscale scores.Conclusions
Continuous epidural analgesia provided superior pain control following colorectal surgery in the PACU and on the day of surgery. The secondary endpoints of return of bowel function, length of stay, and adjusted SF-36 were not affected by choice of peri-operative pain control. 相似文献20.
Anne-Lise D. D&#x;Angelo Jonathan D. D&#x;Angelo David A. Rogers Carla M. Pugh 《American journal of surgery》2018,215(2):336-340