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1.
Barrett A. Kielhorn Anthony J. Senagore Theodor Asgeirsson 《American journal of surgery》2018,215(3):373-376
Background
Perioperative insulin resistance is associated with significant hyperglycemia-related morbidity in patients undergoing major surgery. We sought to assess the effect of preoperative loading with a low-dose maltodextrin/citrulline solution compared to a commercially available sports drink on glycemic levels in an established colorectal enhanced recovery program.Methods
Retrospective analysis was undertaken of elective non-diabetic colectomies and enterectomies from January 2016–March 2017. Cohorts included simple (SIM) and complex carbohydrate (COM) groups. Statistical analysis was performed with linear and logarithmic regression.Results
83 patients were included (42 SIM, 41 COM). SIM group was older (61.7 vs 52.7 p = 0.012) Glycemic variability was less in the COM group (7.6% vs 21.4% P = 0.034). The frequency of hyperglycemia, postoperative complications, and length of stay trended higher in the SIM group.Conclusions
This retrospective analysis identifies significant improvement in the perioperative glycemic variability with preoperative low dose complex carbohydrate loading compared to simple carbohydrate loading in colorectal surgery patients. 相似文献2.
A. Faulkner M.J. Reidy P.S.E. Davies W. Wang N. Buddhadev L. Johnston B. Clift 《The surgeon》2018,16(4):227-231
Introduction
10-year study examining differences in total knee arthroplasty (TKA) functional outcomes and survivorship in patients operated on by consultant and trainee orthopaedic surgeons.Method
Data was prospectively collected from all elective TKAs performed at our three linked institutions. Patient demographics, surgeon grade, and length of hospital stay were recorded. Outcomes pre-operatively and at 1, 3, 5, 7 and 10 years included mortality, need for revision surgery and function as documented by the patients’ Knee Society Score.Results
686 patients were included in the study. 450 (65.5%) patients were operated by consultant surgeons and 236 (34.4%) by trainees. On multivariate analysis no significant differences were observed between groups in length of hospital stay (p = 0.695), implant survival (p = 0.422), and function (p = 0.507) at 10 years. On Cox regression analysis no significant difference was observed in mortality (p = 0.209) at 10 years. 4 patients over this time period were lost to formal follow up.Conclusion
No significant difference was observed in the TKA outcomes between consultants and trainees 10 years post-operatively. 相似文献3.
N.R. Bhatt G. Sheridan M. Connolly S. Kelly A. Gillis K.C. Conlon S. Lane E. Shanahan P.F. Ridgway 《The surgeon》2017,15(3):139-146
Introduction
Pulmonary complications are a significant cause of morbidity, mortality and increased hospital stay following complex abdominal surgery. We investigated whether postoperative early aerobic activity with a pedal exerciser reduced respiratory morbidity and length of stay and improved pulmonary function.Methods
A prospective case-control study on 30 cases and 30 case matched controls aged 18 years or more who underwent major surgery was conducted. Controls were case-mix matched prospectively from a similar general surgical service not utilising postoperative exercising. Thirty consecutive cases were started on a twice-daily aerobic exercise program with pedal exerciser post-operatively day 2 or from when sitting independently. Primary outcome measures were respiratory tract infection (RTI), deep vein thrombosis (DVT) or pulmonary embolus (PE). Secondary outcome measure was subjective breathlessness and Length of Stay (LOS) postoperatively.Results
The rate of RTI was only 16.6% in the exercise group and 43.3% in the control group (P = 0.024). None of the cases or controls suffered from a DVT or PE. Median postoperative length of stay in the control group was 11 ± 7.5 days whereas in the cases it was 8.5 ± 5.00 days (P = 0.049). The Borg subjective breathlessness score in the cases group showed a decline in the subjective breathlessness on postoperative day 4 (P = 0.002).Conclusions
Early aerobic activity with a pedal exerciser halves the rate of postoperative RTI and postoperative hospital stay after complex abdominal surgery. Subjective breathlessness was also reduced with the use of pedal exerciser, signifying potential to improve exercise endurance in the postoperative patient. 相似文献4.
Michael E. Sellan Brent A. Lanting Emil H. Schemitsch Steven J. MacDonald Edward M. Vasarhelyi James L. Howard 《The Journal of arthroplasty》2018,33(3):878-881
Background
Periprosthetic femur fractures around total hip (THA) and total knee (TKA) arthroplasties are difficult complications to manage. With native hip fractures, delay to fixation has been correlated with an increase in postoperative mortality. The effect of time to definitive fixation of periprosthetic femur fractures around THA and TKA is not well established. The aim of our study is to evaluate the effect of time to definitive fixation on postoperative length of stay and mortality for patients with periprosthetic femur fractures around THA and TKA.Methods
A review of 2537 arthroplasty patient charts yielded 235 patients who were diagnosed with a periprosthetic femur fracture at our institution from 2005 to 2014. Time to surgical management, length of stay, demographics, referral status, fracture classification, and fixation modality along with mortality was recorded for all patients.Results
One hundred eighty patients met study inclusion (111 THAs, 69 TKAs). Average age was 79.2 years and 72.2% were female. The average time from admission to definitive fixation was 96.5 hours with 31.1% of patients having surgery within 48 hours after presenting to hospital. Postoperative length of stay and mortality were not affected by time to definitive fixation greater than 48 hours for either of the periprosthetic TKA or THA patient cohorts. Postoperative mortality within 1 year was 5.5% for all patients (6.3% THA, 4.3% TKA).Conclusion
The timing of fixation of periprosthetic femur fractures does not appear to affect postoperative length of stay or mortality within 1 year. 相似文献5.
Andres X. Samayoa Thai Vu Tanya Olszewski Michael Bova Qi Yan Orlando Kirton 《American journal of surgery》2018,215(6):1000-1003
Introduction
Managing trauma in the elderly is challenging and requires a multidisciplinary team approach. The aim of this study is to characterize and compare outcomes in patients 90 years and older in the last two decades.Methods
Retrospective review of trauma patients 90 years and older admitted from 1996 to 2015. The patients were divided into two groups: Early Decade (ED) and Late Decade (LD).Results
A total of 1697 patients were recorded, 551 (ED) and 1146 (LD). The mean age was 92.92?±?8(90–108)[ED] and 92.9?±?2.7(90–105)[LD] years. The most common mechanism and type of injury was falls and extremity trauma. Hospital length of stay (LOS) was shorter in the LD. There was no significant difference in in-hospital mortality or ICU LOS.Conclusion
Trauma admission has increased in the last decade. However, in-hospital mortality remains low. It is important for multidisciplinary teams to allocate resources to treat this elderly population. 相似文献6.
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7.
Background
The optimal timing for performing appendectomy in adults remains controversial.Method
A one-year retrospective review of adult patients with acute appendicitis who underwent appendectomy. The cohort was divided by time-to-intervention into two groups: patients who underwent appendectomy within 8 h (group 1), and those who had surgery after 8 h (group 2). Outcome measures including perioperative morbidity and mortality, post-operative length of stay, and the 30-day readmission rate were compared between the two groups.Results
A total of 116 patients who underwent appendectomy met the inclusion criteria: 75 patients (65%) in group 1, and 41 (35%) in group 2. There were no differences between group 1 & 2 in perioperative complications (6.7% vs. 9.8%, P = 0.483), postoperative length of stay (median [IQR]; 19.5 [11.5–40.5] vs. 20.0 [11.25–58.5] hours, P = 0.632), or 30-day readmission rate (2.7% vs. 4.9%, P = 0.543). There were no deaths in either group.Conclusion
Delayed appendectomy performed more than 8 h was not associated with increased perioperative complications, postoperative length of stay, 30-day readmission rate, or mortality. 相似文献8.
D.P. Joyce D. Murphy A.J. Lowery C. Curran K. Barry C. Malone R. McLaughlin M.J. Kerin 《The surgeon》2017,15(5):272-277
Introduction
Triple-negative breast cancers (TNBC) are associated with a poor prognosis owing to an aggressive phenotype. We aimed to carry out a prospective study comparing management strategies and response to therapy in TNBC and non-TNBC patients.Methods
Data were obtained from a prospectively maintained database of patients treated for breast cancer.Results
A total of 142 TNBC and 142 age-, stage- and NPI-matched non-TNBC patients were treated. The difference in overall survival between the 2 groups was statistically significant (77% of TNBC patients alive at a mean follow-up of 32 months, versus 92% of non-TNBC patients at a mean follow-up of 38 months, P = 0.0 Log rank test). This survival difference was found to be independent of NPI (P = 0.0 Log rank test). Locoregional recurrence rates were similar between TNBC patients who were treated with wide local excision versus mastectomy (P = 0.449 Log rank test). A significant difference in survival was noted between TNBC patients who responded differentially to neoadjuvant chemotherapy (P = 0.035 Log rank test).Conclusion
Patients with TNBC have adverse outcomes despite aggressive treatment. The development of effective targeted therapies is essential for this breast cancer subtype. 相似文献9.
Brian C. Wengerter Kevin Y. Pei David Asuzu Kimberly A. Davis 《American journal of surgery》2018,215(1):37-41
Background
The overall utility of the Rothman Index (RI), a global measure of inpatient acuity, for surgical patients is unclear. We evaluate whether RI variability can predict rapid response team (RRT) activation in surgical patients.Methods
Surgical patients who underwent RRT activation from 2013 to 2015 were matched to four control cases. RI variability was gauged by maximum minus minimum RI (MMRI) and RI standard deviation (RISD) within a 24-h period before RRT. The primary outcome measured was RRT activation, and our secondary outcome was in-hospital mortality.Results
Two hundred seventeen (217) patients underwent RRT. RISD (odds ratio, OR, 1.31, 95% confidence interval, CI, 1.23–1.38, P < 0.001; area under receiver operating characteristic, AUROC, curve 0.74, 95% CI 0.70–0.77) and MMRI (OR 1.10, 95% CI 1.08–1.12, P < 0.001; AUROC 0.76, 95% CI 0.72–0.79) predicted increased likelihood of RRT.Conclusions
RISD is predictive of RRT. 相似文献10.
Roshan Givergis Swapna Munnangi Katayoun Fayaz M Fomani Anthony Boutin Luis Carlos Zapat LD George Angus 《中华创伤杂志(英文版)》2018,21(5):261-266
Purpose
To evaluate massive transfusion protocol practices by trauma type at a level I trauma center.Methods
A retrospective analysis was performed on a sample of 76 trauma patients with MTP activation between March 2010 and January 2015 at a regional trauma center. Patient demographics, transfusion practices, and clinical outcomes were compared by type of trauma sustained.Results
Penetrating trauma patients who required MTP activation were significantly younger, had lower injury severity score (ISS), higher probability of survival (POS), decreased mortality, and higher Glasgow Coma scale (GCS) compared to blunt trauma patients. Overall, the mortality rate was 38.16%. The most common injury sustained among blunt trauma patients was head injury (36.21%), whereas the majority of the penetrating trauma patients sustained abdominal injuries (55.56%). Although the admission coagulation parameters and timing of coagulopathy were not significantly different between the two groups of patients, a significantly higher proportion of penetrating trauma patients received high plasma content therapy relative to blunt trauma patients (p < 0.01).Conclusion
Despite the use of the same MTP for all injured patients requiring massive transfusion, significant differences existed between blunt trauma patients and penetrating trauma patients. These differences in transfusion characteristics and outcomes following MTP activation underscore the complexity of implementing MTPs and warrant vigilant transfusion practices to improve outcomes in trauma patients. 相似文献11.
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12.
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13.
Zhamak Khorgami William J. Fleischer Yuen-Jing A. Chen Nasir Mushtaq Michael S. Charles C. Anthony Howard 《American journal of surgery》2018,215(4):727-734
Background
The Oklahoma Trauma Registry (OTR) collects data from all state-licensed acute care hospitals. This study investigates trends and outcomes of trauma in Oklahoma using OTR.Methods
107,549 patients (2005–2014) with major severity and one of the following criteria were included: length of hospital stay ≥48?h, dead on arrival or death in the hospital, hospital transfer, ICU admission, or surgery on the head, chest, abdomen, or vascular system. Patient characteristics, mechanisms of injury, and outcomes of trauma were analyzed.Results
Hospital admissions due to falls increased with an annual percent change of 4.0% (95%CI: 3.1%–4.9%) while hospital admissions due to motor vehicle crashes decreased. The number of overall deaths per year remained stable except for the fall-related deaths, which increased proportionate to the increase in the incidence of fall. Fall-related mortality was 4.2% and intracranial bleeding was present in 60% in these patients.Conclusion
Falls are significantly increasing as a mechanism of trauma admissions and trauma-related deaths in Oklahoma. Analysis of state-based trauma registries can identify trends in etiologies of injuries and may indicate a reference point to prioritize preventive plans. 相似文献14.
Momotaro Kawai Atsushi Tanji Takayuki Nishijima Koichi Tateyama Yuhei Yoda Ai Iizuka Yusaku Kamata Tadahisa Urabe 《Journal of orthopaedic science》2018,23(6):987-991
Background
It remains unclear whether early surgical intervention can reduce mortality after surgery in hip fracture patients. The aim of this study was to investigate the association between time from injury to surgery and mortality rate within 90 days after hip fracture surgery.Methods
We retrospectively identified 1827 patients who underwent hip fracture surgery in a tertiary care center in Japan between April 2007 and March 2017. After applying exclusion criteria (patients with spontaneous fracture, multiple fractures, revision surgery, total hip arthroplasty, or a refusal to participate), 1734 patients were included. We extracted data concerning patients’ age, race, sex, operative procedure, American Society of Anesthesiologists (ASA) score, days from injury to surgery (injury-surgery days), and days from admission to surgery (admission-surgery days), which could affect 90-day mortality after surgery. Variables associated with 90-day mortality were determined using multivariate logistic regression analysis.Results
The 90-day postoperative mortality rate was 3.5% (60 of 1734). Multivariable analysis showed that injury-surgery days were not associated with 90-day mortality (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.80 to 1.05; P = 0.19), and that older age (OR, 1.06; 95% CI, 1.02 to 1.10; P = 0.005), male sex (OR, 3.62; 95% CI, 1.86 to 7.03; P < 0.001) and high ASA score (OR, 2.10; 95% CI, 1.06 to 4.18; P = 0.034) significantly increased 90-day mortality. In addition, admission-surgery days were not associated with 90-day mortality (OR, 0.95; 95% CI, 0.83 to 1.09; P = 0.45).Conclusion
Our results demonstrated that time from injury to surgery was not associated with mortality within 90 days after surgery after adjusting for age, sex, operative procedure, and ASA score. 相似文献15.
Duraid Younan Russell Griffin Ahmed Zaky Jean-Francois Pittet Bernard Camins 《American journal of surgery》2018,215(4):678-681
Background
The Centers for Disease Control and Prevention (CDC) replaced its definition for ventilator-associated pneumonia (VAP) in 2013. The aim of the current study is to compare the outcome of burn patients with ventilator associated events (VAEs).Methods
Burn patients with at least two days of ventilator support were identified from the registry between 2013 and 2016. Kruskal-Wallis and Fisher's exact tests were utilized for continuous and categorical variables, respectively. A logistic regression was used for the association between VAE and in-hospital mortality.Results
243 patients were admitted to our burn center, of whom 208 had no VAE, 8 had a VAC, and 27 had an IVAC or PVAP. There was no difference in hospital length of stay, ICU length of stay and ventilator support days between those with no VAE and a VAC. Those with IVAC-plus had significantly worse outcomes compared to patients with no VAEs.Conclusions
Burn patients with IVAC-plus had significantly longer hospital and ICU lengths of stay, days on ventilator compared with patients with no VAEs. 相似文献16.
Introduction
Rib fractures after blunt trauma contribute substantially to morbidity and mortality in the elderly.Methods
Retrospective review of 255 patients ≥65 years old at a level 2 trauma center over 6 years, who sustained blunt trauma resulting in rib fractures. Outcomes measured include mortality, hospital length of stay(LOS), intensive care unit(ICU) admission, ICU LOS, need for MV, and MV days.Results
There were 24 deaths (9.4%), of which 7 were early (<24?h). 130 patients (51%) were admitted to ICU, and 49 (19.2%) required MV. Mean ICU and MV days were 5.9 and 6.3, respectively. ICU admission was predicted by a base deficit <-2.0, ISS>15, bilateral rib fractures, pneumothorax or hemothorax on chest x-ray (All p?<?0.001), as well as hypotension, GCS<15, and 1st rib fractures (All p?<?0.05). Mortality was predicted by a base deficit?<?-5.0, GCS score of 3(Both p?<?0.001), as well as hypotension, ISS≥25, RTS <7.0, bilateral pneumothoraces, 1st rib fractures, and >5 rib fractures (All p?<?0.05).Conclusion
Rib fractures in elderly blunt trauma patients are associated with significant mortality and morbidity, but outcomes can be predicted to improve care. 相似文献17.
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18.
G. Niewińsk J. Raszeja-Wyszomirska R. Główczyńska W. Figiel K. Zając O. Kornasiewicz K. Zieniewicz M. Grąt 《Transplantation proceedings》2018,50(7):2014-2017
Background
Prolonged initial intensive care unit (ICU) stay after liver transplantation (LT) is associated with prolonged total hospitalization, increased hospital mortality, and impaired patient and graft survival. Recent data suggested that model for end-stage liver disease (MELD) score at the time of LT and the length of surgery were the two independent risk factors for an ICU stay longer than 3 days after LT. We further identified factors influencing prolonged ICU stay in single-center liver graft recipients.Patients and methods
One hundred fifty consecutive LT recipients (M/F 94/56, median age 55 (range, 39–60), 36% with viral hepatitis, were prospectively enrolled into the study. Associations between clinical factors and prolonged ICU stay were evaluated using logistic regression models. Receiver operating characteristic curves were analyzed to determine the appropriate cutoffs for continuous variables. Threshold for significance was P ≤ .05.Results
Highly prolonged (≥8 days) and moderately prolonged (≥6 days) postoperative ICU stay was noted in 19 (12.7%) and 59 (39.3%) patients, respectively. Serum bilirubin (P = .001) and creatinine concentrations (P = .011), international normalized ratio (P = .004), and sodium-MELD (P < .001) were all significantly associated with postoperative intensive care unit stay over or equal to 75th percentile (6 days). Sodium-MELD was significantly associated with postoperative care unit stay greater or equal to the 90th percentile (8 days; P = .018).Conclusions
Sodium-MELD might be a novel risk factor of prolonged ICU stay in this single-center experience. 相似文献19.
20.
Adrian W. Ong Nick R. Jaisingh Susan Butler Adam Sigal Forrest B. Fernandez 《American journal of surgery》2018,215(3):419-422