Incidence and Risk Factors Associated with Readmission After Surgical Treatment for Adrenocortical Carcinoma

Introduction: Patients who undergo surgical treatment for ruptured intracranial aneurysms may have a different risk profile for a spectrum of cognitive impairment based upon characteristics at presentation of their subarachnoid hemorrhage. Methods: The Intraoperative Hypothermia for Aneurysm Surgery Trial (IHAST) is a multi-center, prospective, randomized clinical trial investigation of whether induced hypothermia during surgical treatment for subarachnoid hemorrhage resulted in improved outcomes. Cognitive status was defined by raw Mini-Mental Status Examination (MMSE) cutoff scores. A normal cognition was defined as a MMSE score of 28 or greater. Mildly impaired patients were defined as a score of 24-27, and severely impaired patients were defined as those with a score of less than 24. Age was analyzed by five-year age groups, with the exception of patients 30 or younger and patients 75 and older. Ordinal logistic regression was utilized to determine the final predictors. Results: Of the 1,000 patients who were followed for cognitive testing, 61 died and 21 were medically untestable. Five patients refused testing and tests were not administered to 30 patients. A total of 883 patients completed the MMSE at 3 months post-surgery. Based on the raw MMSE scores, the median score for the severely impaired patients was 20 (IQR: 16-22), 26 (IQR: 25-27) for mildly impaired patients, and 29 (IQR: 29-30) for cognitively normal patients. Gender, and race were found to be statistically significant (p<.05) predictors after controlling for age and education. Baseline Rankin Score and the occurrence of a leakage or rupture during surgery were also predictive of cognitive status. The World Federation of Neurosurgical Societies Score, the Fisher’s SAH Score, and aneurysm size and location were not found to be statistically significant. Conclusion: Patients with surgical treatment for subarachnoid hemorrhage share several demographic risk factors associated with cognitive changes in the general public, but have additional neurological risk factors associated with SAH and aneurysm procedures.

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Optimal Treatment and Management of Proximal Fifth Metatarsal Fractures

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00061 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0006

Author(s):

Reinout Heijboer ◽

Sofie Breuking ◽

Noortje Hagemeijer ◽

Daniel Guss ◽

Christopher DiGiovanni

Keyword(s):

Risk Factors ◽

Surgical Treatment ◽

Propensity Score ◽

Conservative Treatment ◽

Propensity Score Matching ◽

Avulsion Fracture ◽

Diaphyseal Fracture ◽

Factors Associated ◽

Metatarsal Fractures ◽

Diaphyseal Fractures

Category: Midfoot/Forefoot Introduction/Purpose: Proximal fifth metatarsal fractures (PFMF) are among the most common fractures of the foot, and may be subdivided into tuberosity avulsion fracture, Jones fracture, and proximal diaphyseal fracture. However, for Jones fractures and proximal diaphyseal fractures optimal treatment is still debated in literature. The Torg criteria are used in deciding to treat surgically or conservative, whereby Torg type I and II indicates conservative treatment, and type III indicates surgical treatment. Yet failure rates of both management options vary and derive from small study groups. The aim of this study was to compare failure rates after surgical- and conservative treatment of Jones fractures and proximal diaphyseal fractures, to evaluate the incidence of treatment failure, and to assess factors associated with healing difficulties of PFMF. Methods: A total of 1,133 adult patients that were diagnosed and treated for PFMF between 2005 and 2015 in a tertiary care foot and ankle referral center were included. Retrospective chart review recorded patient demographics, suspected risk factors for impaired healing of PFMF (rheumatoid arthritis, diabetes mellitus, osteoporosis, nutritional and hormonal disorders, foot deformities, (neuropathic) arthropathy of the foot and/or ankle and peripheral neuropathy of the lower extremity), and treatment indication. Multivariable logistic regression analysis was used to determine factors associated with healing difficulties. Propensity score matching was used to minimize selection bias between treatments in Jones fractures and proximal diaphyseal fractures. Results: In total, 489(43.2%) patients were diagnosed with a tuberosity avulsion fracture, 391(34.5%) patients with a Jones fracture and 253(22.3%) patients with a proximal diaphyseal fracture. In the tuberosity fracture group, a nonunion was found in 5.3%(25/473) of the patients treated conservatively and in 0%(0/16) treated operatively. For the Jones fractures and proximal diaphyseal fractures the non-union rate for conservative treatment was 10%(35/337) and 5.9%(14/238), and for surgical treatment 11%(6/54) and 0%(0/15), respectively. No independent risk factors for complicating the healing process of PFMF were identified. With propensity score matching, 37 patients treated operatively were matched to 37 patients undergoing conservative treatment. The risk for a nonunion was lower in the operative group compared to the conservative treatment group (relative risk 0.8, P=0.006). Conclusion: In this propensity-matched cohort, surgical treatment for Jones fractures and proximal diaphyseal fractures were associated with better fracture healing compared to conservative treatment. In addition, no factors were found to be associated with healing difficulties of proximal fifth metatarsal fractures.

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The association between personal history and the outcomes of transobturator sling surgery

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.65.6.864 ◽

2019 ◽

Vol 65 (6) ◽

pp. 864-869

Author(s):

Paula da Silva Feitosa ◽

Nicolle Henriques Barreto Colaço ◽

Cristiane Regina Barros ◽

Thomaz Rafael Gollop ◽

Ana Carolina Marchesini

Keyword(s):

Risk Factors ◽

Surgical Treatment ◽

Negative Impact ◽

Demographic Data ◽

Menopausal Status ◽

Total Sample ◽

The Body ◽

Transobturator Sling ◽

Factors Associated ◽

Sling Surgery

SUMMARY OBJECTIVE: This study aims to verify the association between risk factors for the onset of SUI and transobturator suburethral sling surgical treatment outcomes. PATIENTS AND METHODS: A retrospective study was conducted with 57 patients operated by the Pelvic Floor Surgery Service. Demographic data were compiled from the sample, the body mass index (BMI) was calculated, and the patients were divided according to the response to the surgical treatment. RESULTS: A total of 77.2% of the sample was cured or improved after surgical treatment. Out of the total sample, 75.4% of the women were postmenopausal, and 73.7% denied current or past smoking. The median age was 61 years, the median number of births was 4.0, the median BMI was 28.6 kg/m2, and 50.9% of the sample was classified as pre-obese. BMI, menopausal status, age, smoking, and sexual activity were not factors associated with the surgical outcome. However, parity equal to or greater than 5 was associated with worse postoperative results (p = 0.004). CONCLUSIONS: among risk factors associated with the emergence of SUI, only parity greater than 4 showed a negative impact on transobturator sling surgery outcomes.

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Risk factors associated with re-operation following surgical treatment of lisfranc injuries

Foot and Ankle Surgery ◽

10.1016/j.fas.2017.07.518 ◽

2017 ◽

Vol 23 ◽

pp. 141

Author(s):

M. Buda ◽

B. Chien ◽

S. Kink ◽

D. Guss ◽

A.H. Johnson ◽

...

Keyword(s):

Risk Factors ◽

Surgical Treatment ◽

Factors Associated ◽

Lisfranc Injuries

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Risk factors associated with recurrent referral to the emergency room following surgical treatment of Bartholin’s gland abscess

Journal of Obstetrics and Gynaecology ◽

10.1080/01443615.2019.1606790 ◽

2019 ◽

Vol 40 (1) ◽

pp. 111-115

Author(s):

Reut Rotem ◽

David Yahoy ◽

Chagit Diamant ◽

Noa Greenberg ◽

Misgav Rottenstreich ◽

...

Keyword(s):

Risk Factors ◽

Surgical Treatment ◽

Emergency Room ◽

Factors Associated ◽

Bartholin’S Gland

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Risk Factors Associated With the Development of Acquired Airway Disease After Congenital Heart Surgery: A Retrospective Cohort Study

Seminars in Cardiothoracic and Vascular Anesthesia ◽

10.1177/1089253218772848 ◽

2018 ◽

Vol 22 (3) ◽

pp. 294-299 ◽

Cited By ~ 3

Author(s):

Andrew J. Matisoff ◽

Pranathi Ari ◽

David Zurakowski ◽

Alexandra G. Espinel ◽

Nina Deutsch ◽

...

Keyword(s):

Risk Factors ◽

Cardiopulmonary Bypass ◽

Surgical Treatment ◽

Congenital Heart ◽

Heart Surgery ◽

Airway Disease ◽

Congenital Heart Surgery ◽

Significant Independent Predictor ◽

Factors Associated ◽

Postoperative Setting

Objective. In this single-center, retrospective review, we sought to determine the risk factors associated with the development of severe acquired airway disease (AAD; vocal cord paralysis [VCP] or subglottic stenosis [SGS]) in pediatric patients who had undergone surgery for congenital heart disease (CHD) with cardiopulmonary bypass. All patients who required surgical treatment for CHD using cardiopulmonary bypass at our institution between 2010 and 2015 were reviewed. We defined severe AAD as either clinically significant VCP, SGS, or both, requiring consultation with the otolaryngology (ENT) service for evaluation. The disease was classified as severe because it led to difficulty with intubation or failure to wean mechanical ventilation. This airway disease was not present or was clinically insignificant prior to congenital heart surgery. Results. Over a 5-year period (August 2010 to December 2015), 1395 patients were evaluated. Of these, 25 (1.8%) had significant AAD. Age was the only statistically significant independent predictor of AAD ( P < .001). Those with AAD were younger—3 versus 8 months—and had longer intubation time: 5 (2-18) versus 2 days (1-5). Of those who developed AAD, most (22/25) required some form of additional surgical procedure for its evaluation or management. Only 3 of the 25 patients with severe AAD required tracheostomy. Conclusions. Children who undergo congenital heart surgery with cardiopulmonary bypass are at risk for developing AAD, most often because of SGS or VCP. AAD can lead to failed extubation in the postoperative setting as well as difficult intubation during subsequent anesthetics. Although it often requires surgical treatment, it responds well to therapy and rarely requires tracheostomy.

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