LO24: What patients need early surgical intervention for acute ureteric colic?

Introduction: Ureteral colic is a common painful disorder. Early surgical intervention is an attractive management option but existing evidence does not clarify which patients benefit. Based on lack of evidence, current national specialty guidelines provide conflicting recommendations regarding who is a candidate for early intervention. We compared treatment failure rates in patients receiving early intervention to those in patients offered spontaneous passage to identify subgroups that benefit from early intervention. Methods: We used administrative data and structured chart review to study consecutive patients attending one of nine hospitals in two provinces with an index emergency department (ED) visit and a confirmed 2.0-9.9 mm ureteral stone. We described patient, stone and treatment variables, and used multivariable regression to identify factors associated with treatment failure, defined as the need for rescue intervention or hospitalization within 60 days. Our secondary outcome was ED revisit rate. Results: Overall, 1168 (37.9%) of 3081 eligible patients underwent early intervention. Patients with small stones <5mm experienced more treatment failures (31.5% v. 9.9%) and more ED revisits (38.5% v. 19.7%) with early intervention than with spontaneous passage. Patients with large stones ≥7.0mm experienced fewer treatment failures (34.7% v. 58.6%) and similar ED revisit rates with early intervention. Patients with intermediate-sized 5.0-6.9mm stones had fewer treatment failures with intervention (37.4% v. 55.5%), but only if stones were in the proximal or middle ureter. Conclusion: This study clarifies stone characteristics that identify patients likely to benefit from early intervention. We recommend low-risk patients with uncomplicated stones <5mm generally undergo initial trial of spontaneous passage, while high-risk patients with proximal or middle stones >5mm, or any stone >7mm, be offered early intervention.

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MP10: Does early intervention improve outcomes for patients with acute ureteral colic?

CJEM ◽

10.1017/cem.2019.145 ◽

2019 ◽

Vol 21 (S1) ◽

pp. S45

Author(s):

G. Innes ◽

A. McRae ◽

E. Grafstein ◽

J. Andruchow ◽

M. Law ◽

...

Keyword(s):

Early Intervention ◽

Treatment Failure ◽

Proportional Hazards ◽

Day Treatment ◽

Cox Proportional Hazards ◽

Ureteral Stones ◽

Management Approach ◽

Event Analysis ◽

Spontaneous Passage ◽

Ureteral Colic

Introduction: The optimal initial management approach for ureteral colic is unclear. Guidelines recommend spontaneous passage for most patients, but early stone intervention may rapidly terminate acute episodes. We compared 60-day treatment failure rates in matched patients undergoing early intervention versus spontaneous passage. Methods: We used administrative data and structured chart review to study all emergency department (ED) patients at nine Canadian hospitals who had an index ureteral colic visit and a computed tomography (CT) confirmed 2.0-9.9 mm stone during 2014. Using Cox Proportional Hazards models, we assessed 60-day treatment failure, defined as hospitalization or rescue intervention, in patients undergoing early intervention compared to propensity-score matched controls undergoing trial of spontaneous passage. Results: From 3,081 eligible patients, mean age 51 years and 70% male, we matched 577 patients in each group (total 1154). Control and intervention cohorts were balanced on all parameters and propensity scores, which reflect the conditional probability a patient would undergo early intervention, were similarly distributed. In the time to event analysis, 21.8% in both groups experienced the composite primary outcome of treatment failure (difference = 0%; 95% CI, -4.8 to 4.8%). Early intervention patients required more ED revisits (36.1% v. 25.5%; difference 10.6%; 95% CI 5.3 to 15.9%) and more 60-day hospitalizations (20.1% v. 12.8%). The strongest predictors of adverse outcome were stone size, proximal or middle stone location, and ED length of stay. Conclusion: If applied broadly to patients with 2.0-9.9mm ureteral stones, an early interventional approach was associated with similar rates of treatment failure, but more hospitalizations and emergency revisits. Research clarifying subgroups most likely to benefit will facilitate better targeting of early intervention, potentially reducing patient morbidity and improving system utilization.

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Which Patients Should Have Early Surgical Intervention for Acute Ureteral Colic?

The Journal of Urology ◽

10.1097/ju.0000000000001318 ◽

2021 ◽

Vol 205 (1) ◽

pp. 152-158

Author(s):

Grant D. Innes ◽

Frank X. Scheuermeyer ◽

Andrew D. McRae ◽

Michael R. Law ◽

Joel M. H. Teichman ◽

...

Keyword(s):

Surgical Intervention ◽

Ureteral Colic ◽

Early Surgical Intervention

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Re: Which Patients Should Have Early Surgical Intervention for Acute Ureteric Colic

The Journal of Urology ◽

10.1097/ju.0000000000001480 ◽

2020 ◽

Author(s):

Grant Innes ◽

Joel Teichman ◽

Andrew McRae ◽

Frank Scheuermeyer

Keyword(s):

Surgical Intervention ◽

Ureteric Colic ◽

Early Surgical Intervention

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Re: Which Patients Should Have Early Surgical Intervention for Acute Ureteric Colic

The Journal of Urology ◽

10.1097/ju.0000000000001479 ◽

2020 ◽

Author(s):

Johnathan A. Khusid ◽

Benjamin Seiden ◽

William M. Atallah ◽

Mantu Gupta

Keyword(s):

Surgical Intervention ◽

Ureteric Colic ◽

Early Surgical Intervention

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Which Patients Should Have Early Surgical Intervention for Acute Ureteral Colic?”. Letter

The Journal of Urology ◽

10.1097/ju.0000000000001680 ◽

2021 ◽

Author(s):

Ismail Selvi ◽

Numan Baydilli

Keyword(s):

Surgical Intervention ◽

Ureteral Colic ◽

Early Surgical Intervention

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Early Surgical Intervention in Non-specific Pleural Empyema

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-2007-1014081 ◽

1985 ◽

Vol 6 (01) ◽

pp. 41-43 ◽

Cited By ~ 5

Author(s):

P. Frimodt-Møller ◽

H. Vejlsted

Keyword(s):

Surgical Intervention ◽

Pleural Empyema ◽

Early Surgical Intervention

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Glue Embolization of Gastroesophageal Varices during Transjugular Intrahepatic Portosystemic Shunt (TIPS) Improves Survival Compared to Coil-only Embolization—A Single-Center Retrospective Study

CardioVascular and Interventional Radiology ◽

10.1007/s00270-021-02852-y ◽

2021 ◽

Author(s):

Karsten Wolter ◽

Michael Praktiknjo ◽

Julia Boie ◽

Georges Decker ◽

Jennifer Nadal ◽

...

Keyword(s):

Overall Survival ◽

Retrospective Study ◽

Treatment Failure ◽

Transjugular Intrahepatic Portosystemic Shunt ◽

Portosystemic Shunt ◽

Refractory Ascites ◽

Secondary Outcome ◽

Gastroesophageal Varices ◽

Intrahepatic Portosystemic Shunt ◽

Glue Embolization

Abstract Purpose To compare the safety and effectiveness of coil versus glue embolization of gastroesophageal varices during transjugular intrahepatic portosystemic shunt (TIPS) creation. Materials and Methods In this monocentric retrospective study 104 (males: 67 (64%)) patients receiving TIPS with concomitant embolization of GEV and a minimum follow-up of one year (2008—2017) were included. Primary outcome parameter was overall survival (6 week; 1 year). Six-week overall survival was assessed as a surrogate for treatment failure as proposed by the international Baveno working group. Secondary outcome parameters were development of acute-on-chronic liver failure (ACLF), variceal rebleeding and hepatic encephalopathy (HE). Survival analysis was performed using Kaplan–Meier with log-rank test and adjusted Cox regression analysis. Results Indications for TIPS were refractory ascites (n = 33) or variceal bleeding (n = 71). Embolization was performed using glue with or without coils (n = 40) (Group G) or coil-only (n = 64) (Group NG). Overall survival was significantly better in group G (p = 0.022; HR = -3.333). Six-week survival was significantly lower in group NG (p = 0.014; HR = 6.945). Rates of development of ACLF were significantly higher in group NG after 6 months (NG = 14; G = 6; p = 0.039; HR = 3.243). Rebleeding rates (NG = 6; G = 3; p = 0.74) and development of HE (NG = 22; G = 15; p = 0.75) did not differ significantly between groups. Conclusion Usage of glue in embolization of GEV may improve overall survival, reduce treatment failure and may be preferable over coil embolization alone.

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Early surgical intervention for active thoracic spinal tuberculosis patients with paraparesis and paraplegia

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04078-y ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Weiwei Li ◽

Zheng Liu ◽

Xiao Xiao ◽

Zhenchao Xu ◽

Zhicheng Sun ◽

...

Keyword(s):

Blood Loss ◽

Surgical Intervention ◽

Spinal Tuberculosis ◽

Thoracic Spinal ◽

Cobb’S Angle ◽

Perioperative Complication ◽

The Mean ◽

Early Surgical Intervention ◽

Thoracic Spinal Tuberculosis

Abstract Background To explore the therapeutic effect of early surgical intervention for active thoracic spinal tuberculosis (TB) patients with paraparesis and paraplegia. Methods Data on 118 active thoracic spinal TB patients with paraparesis and paraplegia who had undergone surgery at an early stage (within three weeks of paraparesis and paraplegia) from January 2008 to December 2014 were retrospectively analyzed. The operation duration, blood loss, perioperative complication rate, VAS score, ASIA grade and NASCIS score of neurological status rating, Erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP), kyphotic Cobb’s angle, and duration of bone graft fusion were analyzed to evaluate the therapeutic effects of surgery. Results The mean operating time was 194.2 minutes, and the mean blood loss was 871.2 ml. The perioperative complication rate was 5.9 %. The mean preoperative VAS score was 5.3, which significantly decreased to 3.2 after the operation and continued decreasing to 1.1 at follow up (P<0.05). All cases achieved an increase of at least one ASIA grade after operation. The rate of full neurological recovery for paraplegia (ASIA grade A and B) was 18.0 % and was significantly lower than the rate (100 %) for paraparesis (ASIA grade C and D) (P<0.05). On the NASCIS scale, the difference in the neurological improvement rate between paraplegia (22.2 % ± 14.1 % in sensation and 52.2 % ± 25.8 % in movement) and paraparesis (26.7 % ± 7.5 % in sensation and 59.4 % ± 7.3 % in movement) was remarkable (P<0.05). Mean preoperative ESR and CRP were 73.1 mm /h and 82.4 mg/L, respectively, which showed a significant increase after operation (P>0.05), then gradually decreased to 11.5 ± 1.8 mm/h and 2.6 ± 0.82 mg/L, respectively, at final follow up (P<0.05). The mean preoperative kyphotic Cobb’s angle was 21.9º, which significantly decreased to 6.5º after operation (P<0.05) while kyphotic correction was not lost during follow up (P>0.05). The mean duration of bone graft fusion was 8.6 ± 1.3 months. Conclusions Early surgical intervention may be beneficial for active thoracic spinal TB patients with paraparesis and paraplegia, with surgical intervention being more beneficial for recovery from paraparesis than paraplegia.

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Early Surgical Intervention for Infective Endocarditis

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230201000403 ◽

2002 ◽

Vol 10 (4) ◽

pp. 298-301 ◽

Cited By ~ 1

Author(s):

Hong Sheng Zhu ◽

Pei Yan Yao ◽

Jia Hao Zheng ◽

A Thomas Pezzella

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Heart Disease ◽

Infective Endocarditis ◽

Complex Disease ◽

Surgical Intervention ◽

Elective Surgery ◽

Postoperative Bleeding ◽

Arterial Embolization ◽

Early Surgical Intervention

Infective endocarditis remains a serious and complex disease with significant morbidity and mortality. Sixty cases of infective endocarditis were retrospectively reviewed, consisting of 41 males and 19 females aged 7 to 50 years (mean, 30 years). Congenital heart disease was diagnosed in 19 of the patients and rheumatic heart disease in 41. Congestive heart failure occurred in 36 and systemic embolism in 8 cases. Blood cultures were positive in only 21.7% of the cases, while vegetations were detected by 2-dimensional echocardiography in 70%. Elective surgery was performed in 57 patients and emergent operation for systemic arterial embolization and/or intractable congestive heart failure in 3 patients. Two patients required reoperation for postoperative bleeding. All but 2 patients had been followed up for 6 to 160 months with no evidence of reinfection. Three patients with mechanical valve implantation later died of intracranial bleeding due to over-anticoagulation. The remaining 55 resumed normal activity. The encouraging outcomes were the result of an aggressive diagnostic approach and early surgical intervention.

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