scholarly journals Predictive Factors for Postoperative Outcome in Children with Jejunoileal Atresia

2019 ◽  
Vol 05 (04) ◽  
pp. e131-e136
Author(s):  
Charlotta Jarkman ◽  
Martin Salö
Keyword(s):  
Birth Weight ◽  
Postoperative Complications ◽  
Enteral Feeding ◽  
Univariate Analysis ◽  
Length Of Hospital Stay ◽  
Postoperative Outcome ◽  
Central Line ◽  
Jejunoileal Atresia ◽  
Tertiary Center ◽  
Full Enteral Feeding

Abstract Background Jejunoileal atresia is a relatively rare congenital gastrointestinal requiring surgery and long postoperative care. The postoperative outcome is affected by many factors and this study focuses on finding predictors for time to full enteral feeding, length of hospital stay (LOH), and postoperative complications. Methods This was a retrospective study of all children operated for isolated jejunoileal atresia between 2001 and 2017 at a tertiary center of pediatric surgery. Independent variables regarding demographical-, operative-, and postoperative data were abstracted. Primary outcome was time to full enteral feeding, LOH, and postoperative complications in terms of reoperation or central line complication. Any significant variables from the univariate analysis were further analyzed with logistic regression and presented as odds ratio with 95% confidence interval. Results After exclusion because of concomitant gastroschisis (n = 1), and death before discharge (n = 2), 47 patients were further analyzed (49% boys, 53% premature). No significant differences could be seen in the univariate analysis between children with short and long time (median > 17 days) to full enteral nutrition. Patients with longer LOH (median >32 days) had significantly lower birth weight compared with those with shorter LOH; median 2,550 g versus 2,980 g (p = 0.04). Patients with a central line complication had significantly longer median time to full enteral feeding (median 27 vs. 12 days, p = 0.03), and significantly longer median LOH (median 43 vs. 21 days, p = 0.03), but these parameters were not significant in a multivariate analysis. No significant results were found regarding reoperation. Conclusion Low birth weight seems associated with an increased LOH in children operated on for jejunoileal atresia, and central line complications seem related to the duration with central line in this group. The small cohort may constitute a power problem in this study and further research regarding the included variables may reveal more potential predictors for the postoperative outcome.

scholarly journals Early full enteral feeding for preterm or low birth weight infants

2020 ◽  
Author(s):  
Verena Walsh ◽  
Jennifer Valeska Elli Brown ◽  
Bethany R Copperthwaite ◽  
Sam J Oddie ◽  
William McGuire
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Enteral Feeding ◽  
Low Birth Weight Infants ◽  
Full Enteral Feeding

Microsurgical Treatment of 86 Anterior Choroidal Artery Aneurysms: Analysis of Factors Influencing the Prognosis

2020 ◽  
Vol 81 (06) ◽  
pp. 501-507
Author(s):  
Chunli Lu ◽  
Yugong Feng ◽  
Huanting Li ◽  
Shifang Li ◽  
Lingwen Gu ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Univariate Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Artery Aneurysm ◽  
Postoperative Outcome ◽  
Anterior Choroidal Artery ◽  
Factors Influencing ◽  
Aneurysm Size ◽  
Anterior Choroidal ◽  
Choroidal Artery

Abstract Purpose To explore factors affecting the prognosis of choroidal anterior artery aneurysm (AChAA) and provide a reference for improving the postoperative outcome. Methods The clinical data of 86 patients with AChAA who underwent treatment by a single surgeon were collected and analyzed retrospectively. Univariate analysis and multivariate logistic regression analysis were conducted to examine 12 factors that possibly affected outcome. Results The five factors that affected the patient outcomes were times of subarachnoid hemorrhage (SAH), characteristics of SAH on computed tomography (CT), Hunt-Hess grade, aneurysm size, and presence or absence of postoperative complications. Characteristics of SAH on CT (odds ratio [OR]: 3.727; p = 0.000; 95% confidence interval [CI], 1.850–7.508), aneurysm size (OR: 6.335; p = 0.000; 95% CI, 2.564–15.647), and presence or absence of postoperative complications (OR: 4.141; p = 0.000; 95% CI, 1.995–8.599) were independent risk factors influencing the prognosis. In addition, the incidence of postoperative ischemia (caused by anterior choroidal artery syndrome) is related to the aneurysm emitting part and presence or absence of intraoperative rupture. Conclusions The analysis of characteristics of SAH on CT, aneurysm size, and presence or absence of postoperative complications can roughly determine the outcome of patients with AChAAs.

P175 TRANSLATION OF MINIMALLY INVASIVE ESOPHAGECTOMY FROM RANDOMIZED CONTROLLED TRIAL SETTING (TIME) TO NATIONAL PRACTICE (DUCA) IN NETHERLANDS

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
R Markar Sheraz ◽  
Ni Melody ◽  
Gisbertz Suzanne ◽  
Straatman Jennifer ◽  
van der Peet Donald ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Postoperative Complications ◽  
Minimally Invasive ◽  
Hospital Stay ◽  
Minimally Invasive Esophagectomy ◽  
Univariate Analysis ◽  
Length Of Hospital Stay ◽  
Time Trial ◽  
Reoperation Rate ◽  
Invasive Esophagectomy

Abstract Aims The TIME trial showed reduced pulmonary complications from minimally invasive esophagectomy (MIE) over an open approach, and led to widespread adoption of MIE in the Netherlands. The aim of this study was to compare clinical outcomes from minimally invasive esophagectomy in the DUCA (national dataset) and the TIME trial (RCT) for transthoracic esophagectomy1. Methods Original patient data from the TIME trial1 was extracted along-with data from the Dutch National Cancer Audit (DUCA) (2011-2017). Initially univariate analysis was used to compare patient and tumor demographics and clinical and pathological outcomes from patients receiving MIE in the TIME trial and in the DUCA-dataset. Secondly multivariate analysis, with adjustment patient and tumor factors, was performed for the effect of MIE vs. Open esophagectomy on clinical outcomes in both datasets. Thirdly the datasets were combined and multivariate analysis, was performed for the effect of patient inclusion in TIME trial or DUCA-dataset. Results 115 patients from TIME (59 MIE vs. 56 open) and 4605 patients from the DUCA-dataset (2652 MIE vs. 1953 open) were included. Univariate analysis showed, in TIME trial, MIE reduced postoperative complications and length of hospital stay. However in the DUCA-dataset, MIE increased postoperative complications, re-intervention rate and length of hospital stay, however pathological benefits included increased proportion of R0 margin and lymph nodes harvested. Multivariate analysis confirmed the TIME data showed MIE reduced postoperative complications (OR=0.38, 95%CI 0.16–0.90). In the DUCA-dataset, MIE was associated with increased postoperative complications (OR=1.37, 95%CI 1.20–1.55), re-intervention (OR=1.84, 95%CI 1.57–2.14), and length of hospital stay (Coeff=1.57, 95%CI 0.06–3.08). Pathological benefits to MIE in the DUCA-dataset included a reduction in proportion of R1 margin, and increased lymph node harvest. Multivariate analysis of the combined dataset, showed inclusion in the TIME trial was associated with a reduction in postoperative complications (OR=0.23, 95%CI 0.15–0.36) and reoperation rate (OR=0.34, 95%CI 0.17–0.66). Conclusions MIE when adopted nationally outside the TIME-trial, was associated with an increase in postoperative complications and reoperation rate, which may reflect surgeons on a national level going through their proficiency-gain curve in the technique and outside of expert MIE centers.

scholarly journals Two-port versus three-port video-assisted thoracoscopic surgery for primary spontaneous pneumothorax: feasibility, postoperative outcome and long-term recurrence rates

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Stephen Fung ◽  
Hany Ashmawy ◽  
Sami Safi ◽  
Anja Schauer ◽  
Alexander Rehders ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Hospital Stay ◽  
Chest Tube ◽  
Spontaneous Pneumothorax ◽  
Thoracoscopic Surgery ◽  
Length Of Hospital Stay ◽  
Operation Time ◽  
Postoperative Outcome ◽  
Primary Spontaneous Pneumothorax ◽  
Recurrence Rates

Abstract Background Two-port VATS (2-P-VATS) and three-port VATS (3-P-VATS) are well-established techniques for surgical therapy of primary spontaneous pneumothorax (PSP). However, comparisons of both techniques in terms of postoperative outcome and recurrence are limited. Methods From January 2010 to March 2020, we retrospectively reviewed data of 58 PSP patients who underwent VATS in our institution. For statistical analysis, categorical and continuous variables were compared by chi-square test or Fisher’s exact test and the Student´s t-test, respectively. Twenty-eight patients underwent 2-P-VATS and 30 were treated with 3-P-VATS. Operation time, length of hospital stay (LOS), total dose of analgesics per stay (opioids and non-opioids), duration of chest tube drainage, pleurectomy volume (PV), postoperative complications and recurrence rates were compared between both groups. Results Clinical and surgical characteristics including mean age, gender, Body-Mass-Index (BMI), pneumothorax size, smoking behaviour, history of contralateral pneumothorax, side of pneumothorax, pleurectomy volume and number of resected segments were similar in both groups. The mean operation time, LOS and total postoperative opioid and non-opioid dose was significantly higher in the 3-P-VATS group compared with the 2-P-VATS group. Despite not being statistically significant, duration of chest tube was longer in the 3-P-VATS group compared with the 2-P-VATS group. In terms of postoperative complications, the occurrence of hemothorax was significantly higher in the 3-P-VATS group (3-P-VATS vs. 2-P-VATS; p = 0.001). During a median follow-up period of 61.6 months, there was no significant statistical difference in recurrence rates in both groups (2/28 (16.7%) vs. 5/30 (7.1%); p = 0.274). Conclusion Our data demonstrate that 2-P-VATS is safer and effective. It is associated with reduced length of hospital stay and decreased postoperative pain resulting in less analgesic use.

Sequential Serum Aluminum and Urine Aluminum: Creatinine Ratio and Tissue Aluminum Loading in Infants With Fractures/Rickets

PEDIATRICS ◽  
1992 ◽  
Vol 89 (5) ◽  
pp. 877-881
Author(s):  
Winston W.K. Koo ◽  
Susan K. Krug-Wispe ◽  
Paul Succop ◽  
Robert Bendon ◽  
Lawrence A. Kaplan
Keyword(s):  
Birth Weight ◽  
Enteral Feeding ◽  
Very Low Birth Weight ◽  
Aluminum Toxicity ◽  
Creatinine Ratio ◽  
Low Birth Weight Infants ◽  
Mean Values ◽  
Antacid Therapy ◽  
Zone Of Provisional Calcification ◽  
Full Enteral Feeding

Aluminum toxicity is associated with the development of bone disorders, including fractures, osteopenia, and osteomalacia. Fifty-one infants with a mean (± SEM) birth weight of 1007 ± 34 g, gestational age of 28.5 ± 0.3 weeks, and serial radiographic documentation at 3, 6, 9, and 12 months for the presence (n = 16) or absence (n = 35) of fractures and/or rickets were studied at the same intervals to determine the serial changes in serum aluminum concentrations and urine aluminum-creatinine ratios. Autopsy bone samples were used to determine the presence of tissue aluminum. Serum aluminum concentrations from 46 infants were stable and similar between groups, with mean values between 15 and 22 µg/L. Urine aluminum-creatinine (micrograms per milligram) ratios from 14 infants were higher in infants with fractures and/or rickets (0.26 ± 0.06 vs 0.12 ± 0.04) at onset, and rate of decrease in aluminum-cratinine ratio was faster in infants without fractures and/or rickets. All but three infants were tolerating complete enteral feeding at all sampling points. One infant who received aluminum-containing antacid had marked increase in serum aluminum to 83 µg/L while urine aluminum-creatinine ratio increased from 0.09 to a peak of 8.53. Vertebrae from three infants at autopsy (full enteral feeding was tolerated for 37 and 41 days in two infants, respectively) showed aluminum deposition in the zone of provisional calcification and along the newly formed trabecula. It is concluded that in enterally fed very low birth weight infants, serum aluminum levels and urine aluminum-creatinine ratios were similar in infants with and without fractures and/or rickets, presumably in part from modulation of aluminum absorption. However, aluminum absorption can be increased as indicated by increased serum and urine aluminum concentrations from aluminum antacid therapy. Bone accumulation of aluminum is possible with currently used enteral and parenteral nutrients, but the critical level of tissue aluminum loading associated with development of fractures and/or rickets remains to be determined.

scholarly journals Early full enteral feeding for preterm or low birth weight infants

2020 ◽  
Author(s):  
Verena Walsh ◽  
Jennifer Valeska Elli Brown ◽  
Bethany R Copperthwaite ◽  
Sam J Oddie ◽  
William McGuire
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Enteral Feeding ◽  
Low Birth Weight Infants ◽  
Full Enteral Feeding

scholarly journals Efficacy of oral erythromycin to enhance feeding tolerance in preterm infants

2017 ◽  
Vol 57 (3) ◽  
pp. 154
Author(s):  
Made Sukmawati ◽  
Rinawati Rohsiswatmo ◽  
Rulina Suradi ◽  
Pramita Gayatri
Keyword(s):  
Placebo Group ◽  
Hospital Stay ◽  
Preterm Infants ◽  
Enteral Feeding ◽  
Controlled Trial ◽  
Length Of Hospital Stay ◽  
Feeding Intolerance ◽  
Body Weights ◽  
Full Enteral Feeding ◽  
Feeding Tolerance

Background Feeding intolerance is a common condition that affects preterm infants. Erythromycin is a prokinetic agent used to treat feeding intolerance, but its efficacy remains inconclusive.Objective To evaluate the effectiveness of oral erythromycin to enhance feeding tolerance in preterm infants.Methods This prospective, randomized controlled trial in preterm infants was conducted at Sanglah Hospital, Denpasar, Bali, from June 2015 to January 2016. Eligible infants were randomized to receive either 12.5 mg/kg/dose oral erythromycin or a placebo, every 8 hours. The primary outcome was the time to establish full enteral feeding. The secondary outcomes were body weight at full enteral feeding and length of hospital stay.Results Of 62 initial subjects, 3 infants dropped out of the study. Thirty infants were given erythromycin and 29 infants were given placebo. The baseline characteristics of the two groups were similar, with mean of gestational ages of 31.4 (SD 1.7) weeks in the erythromycin group and 32.4 (SD 2.2) weeks in the placebo group. The median times to reach full enteral feeding did not significantly differ between the two groups, with 10 (SD 5.3) days in the erythromycin group vs. 8 (SD 6.5) days in the placebo group (P=0.345). Also, median body weights at full enteral feeding and lengths of hospital stay were not significantly different between the two groups.Conclusion Erythromycin of 12.5 mg/kg/dose every 8 hours as prophylactic treatment does not significantly enhance feeding tolerance in preterm infants. Median body weights at full enteral feeding and length of hospital stay are not significantly different between the erythromycin and placebo groups.

Laryngeal Force Sensor for Suspension Microlaryngoscopy: A Prospective Controlled Trial

2021 ◽  
pp. 019459982098263
Author(s):  
Allen L. Feng ◽  
Elefteria Puka ◽  
Alex Ciaramella ◽  
Vishwanatha M. Rao ◽  
Tiffany V. Wang ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Controlled Trial ◽  
Univariate Analysis ◽  
Force Sensor ◽  
Maximum Force ◽  
Consecutive Series ◽  
Active Monitoring ◽  
Postoperative Visit ◽  
Tertiary Center ◽  
Force Data

Objectives The laryngeal force sensor (LFS) provides real-time force data for suspension microlaryngoscopy. This study investigates whether active use of the LFS can prevent the development of complications. Study Design Prospective controlled trial. Setting Academic tertiary center. Methods The LFS and custom software were developed to track intraoperative force metrics. A consecutive series of 100 patients had force data collected with operating surgeons blinded to intraoperative readings. The subsequent 100 patients had surgeons actively use the LFS monitoring system. Patients were prospectively enrolled, completing pre- and postoperative surveys to assess the development of tongue pain, paresthesia, paresis, dysgeusia, or dysphagia. Results On univariate analysis, the active monitoring group had lower total impulse ( P < .001) and fewer extralaryngeal complications ( P < .01). On multiple logistic regression, maximum force (odds ratio [OR], 1.08; 95% CI, 1.01-1.16; P = .02) was a significant predictive variable for the development of postoperative complications. Similarly, active LFS monitoring showed a 29.1% (95% CI, 15.7%-42.4%; P < .001) decrease in the likelihood of developing postoperative complications. These effects persisted at the first postoperative visit for maximum force ( P = .04) and active LFS monitoring ( P = .01). Maximum force (OR, 1.11; 95% CI, 1.04-1.18; P < .01) and active LFS monitoring (16.6%; 95% CI, 2.7%-30.5%; P = .02) were also predictive for the development of an abnormal 10-item Eating Assessment Tool score. These effects also persisted at the first postoperative visit for maximum force ( P = .01) and active LFS monitoring ( P = .01). Conclusion Maximum force is predictive of the development postoperative complications. Active monitoring with the LFS is able to mitigate these forces and prevent postoperative complications. Level of Evidence 2.

scholarly journals Hemoglobin Levels and Postoperative Outcome in Pediatric Surgical Patients

2021 ◽  
Vol 1 (3) ◽  
Author(s):  
Claudine Kumba
Keyword(s):  
Postoperative Complications ◽  
Secondary Analysis ◽  
Length Of Hospital Stay ◽  
Postoperative Outcome ◽  
Surgical Patients ◽  
Preoperative Anemia ◽  
Preoperative Hemoglobin ◽  
Implementation Program ◽  
Number Of Patients ◽  
Pediatric Study

Background: Postoperative outcome in children is multifactorial. Among the reported predictors of postoperative outcome, preoperative anemia has been related to adverse outcome in children. A secondary analysis was undertaken to determine the correlation between hemoglobin levels and postoperative outcome in children included in a cohort of an observational pediatric study published previously since this analysis has not been done. Objective: To determine the correlation between preoperative, intra-operative, postoperative hemoglobin levels and postoperative outcome in children in neurosurgery, abdominal and orthopedic surgery. Methods: Secondary analysis of a sub-cohort of 252 pediatric surgical patients with a median age of 62 months [12.50-144.00]. Results: Preoperative hemoglobin levels were negatively correlated to length of stay in the intensive care unit (LOSICU) (p=0.002), to length of hospital stay (LOS) (p<0.0001), to the number of patients with intra-operative and/or postoperative complications (p<0.0001) and to re-surgery (p<0001). Low preoperative hemoglobin levels below 6g/dL were correlated to higher postoperative LOSICU and LOS. Intra-operative hemoglobin levels were negatively correlated to LOS (p<0.0001) and to the number of patients with intra-operative and/or postoperative complications (p=0.004). Low intra-operative hemoglobin levels below 5g/dL were correlated to higher LOS. Postoperative hemoglobin levels were positively correlated to LMV (p=0.002). Conclusion: Hemoglobin levels are among other multifactorial predictors of postoperative outcome in pediatric surgical patients emphasizing the importance of a global patient blood management implementation program to improve outcome in surgical children.

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