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Perioperative risk model

Karam Nam, Yunseok Jeon, Won Ho Kim, Dhong Eun Jung, Seok Min Kwon, Pyoyoon Kang, Youn Joung Cho, Tae Kyong Kim
PURPOSE: Altered perioperative glycemic control may contribute to the development of renal dysfunction in cardiac surgery patients. Nevertheless, whether it is intraoperative hyperglycemia or increased glucose variability that affects postoperative outcomes is not yet clear. The aim of this study was to assess the association of intraoperative glucose concentration and variability with acute kidney injury (AKI) after cardiac surgery. METHODS: We retrospectively reviewed the electronic medical records of 3,598 patients who underwent cardiac surgery between November 1, 2006 to December 31, 2016...
March 15, 2019: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Minmin Chen, Yanhua Zhang, Yanping Du, Wei Hong, Wenjing Tang, Huilin Li, Songbai Zheng, Qun Cheng
In this study, we attempted to determine the epidemiology and clinical characteristics of hip fracture in the elderly. We find that elderly people with hip fracture have multiple comorbidities and suffer numerous complications. INTRODUCTION: We attempted to explore the epidemiology and clinical characteristics of hip fracture in the elderly. METHODS: One thousand five hundred thirty-nine patients aged over 65 years were included in the retrospective study. From the medical records, information was gathered about pre-fracture conditions, as well as fracture type, surgical details, laboratory indicators, postoperative complications, length of stay, outcomes, and costs of hospitalization...
March 12, 2019: Archives of Osteoporosis
Serena Sibilio, Alex Koziarz, Emilie P Belley-Côté, Graham R McClure, Sarah MacIsaac, Seleman J Reza, Kevin J Um, Alexandra Lengyel, Pablo Mendoza, Ali Alsagheir, Hatim Alraddadi, Saurabh Gupta, Adriaan W Schneider, Parth M Patel, John W Brown, Michael W A Chu, Mark D Peterson, Maral Ouzounian, Domenico Paparella, Ismail El-Hamamsy, Richard P Whitlock
OBJECTIVE: We conducted a meta-analysis to estimate the risk of adverse events, life expectancy, and event-free life expectancy after the Ross procedure in adults. METHODS: We searched databases for reports evaluating the Ross procedure in patients aged more than or equal to 16 years of age. A microsimulation model was used to evaluate age- and gender-specific life expectancy for patients undergoing the Ross procedure. RESULTS: Data were pooled from 63 articles totaling 19 155 patients from 20 countries...
March 13, 2019: Journal of Cardiac Surgery
Jin-Woo Park, Kyeong-Tae Lee, Byung-Joon Jeon, Jai-Kyong Pyon, Sa Ik Bang, Goo-Hyun Mun
BACKGROUND: Angiotensin receptor blocker (ARB), a commonly used antihypertensive drug, is reported to affect wound healing and flap survival in animal models. However, this has not been elucidated in a clinical series. This study aimed to investigate the impact that perioperative use of ARB has on outcomes after breast reconstruction. METHODS: Patients who underwent immediate breast reconstruction using a tissue expander or a deep inferior epigastric perforator (DIEP) flap were reviewed...
March 12, 2019: Annals of Surgical Oncology
Yoshimitsu Soga, Mitsuyoshi Takahara, Osamu Iida, Akio Kodama, Nobuyoshi Azuma
BACKGROUND: It is well known that the clinical outcome of patients with critical limb ischemia (CLI) is poor. However, the relationship between stress-related hormone levels and CLI outcome remains unclear. The aim of this study was to reveal the association of stress hormones with the risk of a perioperative major adverse cardiovascular event (pMACE) in CLI patients undergoing surgical and endovascular revascularization. METHODS: The study analyzed 467 CLI patients who had levels of stress-related hormones (epinephrine, norepinephrine, dopamine, and cortisol) measured before undergoing revascularization...
March 8, 2019: Journal of Vascular Surgery
Tanyong Pipanmekaporn, Nutchanart Bunchungmongkol, Yodying Punjasawadwong, Worawut Lapisatepun, Apichat Tantraworasin, Surasak Saokaew
BACKGROUND: Respiratory complications are some of the most common complications following thoracic surgery and can lead to higher perioperative morbidity and mortality. The purpose of this study was to develop a simple clinical score for prediction of respiratory complications after thoracic surgery, and determine the internal validity. METHODS: In this retrospective cohort study, all consecutive patients were aged 18 years and over and undergoing non-cardiac thoracic surgery at a tertiary-care university hospital...
March 11, 2019: Asian Cardiovascular & Thoracic Annals
Nikhil K Gupta, Randy Sulaver, Charles Welliver, Michael Kottwitz, Luke Frederick, Danuta Dynda, Tobias S Köhler
INTRODUCTION: Scrotoplasty has become a common practice during insertion of penile prosthesis, improving patient perception of penile length. Previous reports on scrotoplasty outcomes have only focused on the perceived benefits. The risk of wound complications after scrotoplasty is unknown. AIM: Identify wound complications and associated risk factors of scrotoplasty with insertion of penile prosthesis. METHODS: A retrospective review of a single-surgeon series (T...
March 6, 2019: Journal of Sexual Medicine
Jung-Min Shin, Su-Jin Hong, Kyung-Hwa Choi, Sung-Il Shin, Do Kyung Lee, Sung-Sahn Lee, Byung Hoon Lee
BACKGROUND: There have been many efforts to find modifiable risk factors for venous thromboembolism (VTE) in the perioperative period of total knee arthroplasty (TKA), while no study has investigated the relationship between the muscle mass and deep vein thrombosis (DVT) or pulmonary embolism frequency following TKA. This study aimed to evaluate the relationship between muscle volume and the prevalence of symptomatic and radiologically confirmed venous thromboembolism (VTE) after total knee arthroplasty (TKA)...
2019: PloS One
Mallory McKeon, Genevieve Medina, Kosuke Kawai, Michael Cunningham, Eelam Adil
OBJECTIVES/HYPOTHESIS: Endoscopic sinus surgery (ESS) is indicated in select pediatric patients with medically refractory sinus disease. Our objectives were to examine indications and rates of readmission following ambulatory pediatric ESS and identify specific subgroups that may benefit from inpatient admission. STUDY DESIGN: Retrospective database review. METHODS: The Pediatric Health Information Systems (PHIS) 2004-2016 database was retrospectively reviewed for patients age <18 years who underwent ambulatory ESS between January 2011 and December 2016 and were readmitted within 30 days postoperatively...
March 1, 2019: Laryngoscope
Mikita Fuchita, Sikandar H Khan, Anthony J Perkins, Sujuan Gao, Sophia Wang, Kenneth A Kesler, Babar A Khan
BACKGROUND: Postoperative delirium affects up to 50% of patients undergoing esophagectomy and is associated with negative outcomes. The perioperative risk factors for delirium in this population are not well understood. We conducted this study to assess perioperative risk factors for postoperative delirium among esophagectomy patients. METHODS: We performed a secondary data analysis of patients enrolled in a randomized controlled trial evaluating the efficacy of haloperidol prophylaxis postoperatively in reducing delirium among esophagectomy patients...
February 25, 2019: Annals of Thoracic Surgery
Sean P Ryan, Beau J Kildow, Timothy L Tan, Javad Parvizi, Michael P Bolognesi, Thorsten M Seyler
BACKGROUND: The prevention of surgical site infection guidelines issued by the Centers for Disease Control and Prevention (CDC) recently recommended that only a single dose of preoperative antibiotics be administered to patients undergoing clean-contaminated procedures based on data from a variety of surgical disciplines. For orthopaedic procedures, where postoperative infections can have significant consequences, the existing evidence for this recommendation is widely debated. QUESTIONS/PURPOSES: Is there a difference in postoperative infection risk when utilizing a single dose of preoperative antibiotics compared with multiple doses of perioperative antibiotics for orthopaedic procedures where implants are placed? METHODS: MEDLINE, EMBASE, Google Scholar, and Cochrane were systematically reviewed for randomized controlled trials (RCTs) of a single dose of preoperative antibiotics compared with pre- and postoperative prophylaxis from 1980 to 2017 for all orthopaedic procedures where implants were being placed...
January 3, 2019: Clinical Orthopaedics and related Research
Dimitrios Schizas, Nikoletta A Theochari, Christina A Theochari, Damianos G Kokkinidis, Vasileia Domi, Eustratia Mpaili, Anil Kumar Jonnalagadda, Alkistis Kapelouzou, Anargyros Bakopoulos, Theodore Liakakos
AIM: To present the experience of the upper Gastrointestinal Unit of the Surgical Department of National and Kapodistrian University of Athens in order to inform surgeons of the exact harms and benefits associated with their decisions concerning management of antiplatelet therapy. MATERIALS AND METHODS: This was a single-center study of patients who underwent surgery for esophageal cancer and had concomitant coronary artery disease from 1/1/2005 to 31/7/2017. Patients were divided into two cohorts based on when their antiplatelet therapy was stopped (<7 vs...
March 2019: In Vivo
Matthew D McElvany, Priscilla H Chan, Heather A Prentice, Elizabeth W Paxton, Mark T Dillon, Ronald A Navarro
BACKGROUND: Prior studies have identified diabetes and disease severity (defined using hemoglobin A1c [HbA1c]) as potential risk factors for complications after shoulder arthroplasty. Evaluations of diabetes status and risk of adverse outcomes beyond the 30-day window either are limited or have not accounted for disease severity. Further, measures of diabetes severity other than HbA1c have yet to be investigated in a shoulder arthroplasty population. QUESTIONS/PURPOSES: (1) Are diabetes status and glycemic control associated with adverse events, including deep infection, all-cause revision, and 90-day readmission after shoulder arthroplasty? (2) Is postoperative HbA1c associated with revision risk? (3) Is there a threshold of preoperative HbA1c that best identifies patients with diabetes who are at higher risk of 3-year deep infection, 1-year all-cause revision, or 90-day readmission? (4) Can the Adapted Diabetes Complications Severity index (aDCSI) be used as an alternative measure of diabetes severity in evaluating the risk of deep infection, all-cause revision, and 90-day readmission and identification of patients with diabetes at higher risk for these events? (5) Is there a difference between elective and traumatic shoulder arthroplasty patients? METHODS: We conducted a retrospective registry-based cohort study using Kaiser Permanente's Shoulder Arthroplasty Registry (2005-2015)...
February 6, 2019: Clinical Orthopaedics and related Research
Fred C Ko
PURPOSE: General surgical procedures are among the most commonly performed operations in the United States. Despite advances in surgical and anesthetic techniques and perioperative care, complications after general surgery in older adults remain a significant cause of increased morbidity, mortality, and health care costs. Frailty, a geriatric syndrome characterized by multisystem physiologic decline and increased vulnerability to stressors and adverse clinical outcomes, has emerged as a plausible predictor of adverse outcomes after surgery in older patients...
February 21, 2019: Clinical Therapeutics
Xavier Plano, Manuel Ramírez, Antonia Matamalas, Sleiman Haddad, Ana García de Frutos, J M Casamitjana, Ferran Pellisé
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: Analyze the rate and risk factors associated with Unplanned Surgeries (US) during the first 30 days in patients treated for cervical spondylotic myelopathy. BACKGROUND: US are often regarded as a potentially useful quality of care indicator. METHODS: We defined US as any, non-planned, surgical procedure as a complication after "index" surgery. Demographic data, comorbidities, ASA, smoking status, surgical details and postoperative complications were collected...
February 23, 2019: European Spine Journal
Rao Sun, Yue Liu, Bailing Hou, Yishan Lei, Jinhua Bo, Wei Zhang, Yu'E Sun, Ying Zhang, Zuoxia Zhang, Zhe Liu, Wenwen Huo, Yanting Mao, Zhengliang Ma, Xiaoping Gu
Preoperative stress could delay the recovery of postoperative pain and has been reported to be a risk factor for chronic postsurgical pain. As stress could facilitate the proinflammatory activation of microglia, we hypothesized that these cells may play a vital role in the development of preoperative stress-induced pain chronification after surgery. Our experiments were conducted in a rat model that consists of a single prolonged stress (SPS) procedure and plantar incision. A previous SPS exposure induced anxiety-like behaviors, prolonged incision-induced mechanical allodynia, and potentiated the activation of spinal microglia...
February 20, 2019: Brain, Behavior, and Immunity
Matthew J Klebanoff, Kathleen E Corey, Sumeyye Samur, Jin G Choi, Lee M Kaplan, Jagpreet Chhatwal, Chin Hur
Importance: Obesity is the most common risk factor for nonalcoholic steatohepatitis (NASH), the progressive form of nonalcoholic fatty liver disease that can lead to cirrhosis and hepatocellular carcinoma. Weight loss can be an effective treatment for obesity and may slow the progression of advanced liver disease. Objective: To assess the cost-effectiveness of bariatric surgery in patients with NASH and compensated cirrhosis. Design, Setting, and Participants: This economic evaluation study used a Markov-based state-transition model to simulate the benefits and risks of laparoscopic sleeve gastrectomy (SG), laparoscopic Roux-en-Y gastric bypass (GB), and intensive lifestyle intervention (ILI) compared with usual care in patients with NASH and compensated cirrhosis and varying baseline weight (overweight, mild obesity, moderate obesity, and severe obesity)...
February 1, 2019: JAMA network open
Kevin K Kumar, Mahendra T Bhati, Vinod K Ravikumar, Pejman Ghanouni, Sherman C Stein, Casey H Halpern
Meta-analytic techniques support neuroablation as a promising therapy for treatment-refractory obsessive-compulsive disorder (OCD). This technique appears to offer a more favorable complication rate and higher utility than deep brain stimulation. Moreover, these pooled findings suggest that bilateral radiofrequency (RF) capsulotomy has marginally greater efficacy than stereotactic radiosurgery or cingulotomy. MR-guided focused ultrasound (MRgFUS) capsulotomy is an emerging approach with a potentially more favorable profile than RF ablation and radiosurgery, with preliminary data suggesting safety and efficacy...
2019: Frontiers in Neuroscience
Shinichi Nakao, Tomohisa Yamamoto, Seishi Kimura, Takashi Mino, Tatsushige Iwamoto
Postoperative cognitive dysfunction (POCD) is a serious complication of anesthesia and surgery, and the major risk factor of POCD is aging. Although the exact pathophysiology of POCD remains unknown, two possible and reliable mechanisms have been proposed: neuroinflammation and neurodegeneration, i.e., amyloid β accumulation and/or tau protein phosphorylation, by surgery and/or general anesthetics. White matter lesions (WML) are produced by chronic cerebral hypoperfusion, frequently observed in elderly people, and closely related to cognitive decline...
February 20, 2019: Journal of Anesthesia
Besma Nejim, Devin Zarkowsky, Caitlin W Hicks, Satinderjit Locham, Hanaa Dakour Aridi, Mahmoud Malas
BACKGROUND: Endovascular aneurysm repair (EVAR) offered outstanding survival benefit but at the expense of cost, periodic radiographic monitoring, and higher reinterventions rates. Perioperative complications, although rare, can occur after EVAR, contributing to longer hospitalization, higher cost, and significant comorbidity and mortality. Therefore, the aim of this study was to identify the predictors of in-hospital events (IHEs) after elective EVAR. METHODS: The Vascular Quality Initiative database was explored from 2003 to 2017...
February 15, 2019: Journal of Vascular Surgery
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