scholarly journals 838 Pulmonary Embolectomy: Techniques and Outcomes from The Literature

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
L Y A Kwan ◽  
J Lee ◽  
A Cheung ◽  
J Chan
Keyword(s):  
Mortality Rate ◽  
Postoperative Bleeding ◽  
Intervention Group ◽  
Surgical Removal ◽  
Complication Rates ◽  
Pulmonary Embolectomy ◽  
Recovery Times ◽  
Surgical Embolectomy ◽  
Acute Pe ◽  
Over Time

Abstract Aim Pulmonary embolectomy involves the surgical removal of a thrombus from the pulmonary tree, with the most popular approaches being surgical embolectomy (SE), percutaneous pulmonary embolectomy (PPE) and minimally invasive thoracotomy (MIT). The latter two new techniques are gradually increasing in popularity in the treatment of acute pulmonary embolism (PE) due to reduced recovery times. This study aims to evaluate and compare the clinical outcomes of the three aforementioned techniques in the treatment of acute PE. Method A literature review was performed with PUBMED to identify studies reporting these interventions. 79 papers were included, involving a total of 2445 patients. Patients’ baseline characteristics and perioperative status, inpatient mortality rates and complication rates of each intervention group were individually assessed and compared. Results Among all three interventions, SE studies demonstrated the highest in-patient mortality rate (20.8%). Patients receiving SE are also more likely to have pulmonary (2.8%) and other postoperative bleeding (7.4%). PPE patients are more likely to develop gastrointestinal bleeding and surgical site complications (4%). Scatter graph of the SE studies showed a declining trend of mortality rate over time (R²=0.50). Conclusions All three methods are effective in treating acute PE, while SE showed a trend of decreasing mortality over time. Further research on PPE and MIT is needed to define its place in the treatment of acute PE.

scholarly journals Finnish flow diverter study: 8 years of experience in the treatment of acutely ruptured intracranial aneurysms

2021 ◽  
pp. neurintsurg-2021-017641
Author(s):  
Kemal Alpay ◽  
Tero Hinkka ◽  
Antti E Lindgren ◽  
Juha-Matti Isokangas ◽  
Rahul Raj ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Intracranial Aneurysms ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Flow Diverter ◽  
Supporting Evidence ◽  
Complication Rates ◽  
Related Complication ◽  
Anterior Circulation ◽  
Clinical And Radiological Results ◽  
Ruptured Intracranial Aneurysms

BackgroundFlow diversion of acutely ruptured intracranial aneurysms (IAs) is controversial due to high treatment-related complication rates and a lack of supporting evidence. We present clinical and radiological results of the largest series to date.MethodsThis is a nationwide retrospective study of acutely ruptured IAs treated with flow diverters (FDs). The primary outcome was the modified Rankin Scale (mRS) score at the last available follow-up time. Secondary outcomes were treatment-related complications and the aneurysm occlusion rate.Results110 patients (64 females; mean age 55.7 years; range 12–82 years) with acutely ruptured IAs were treated with FDs between 2012 and 2020 in five centers. 70 acutely ruptured IAs (64%) were located in anterior circulation, and 47 acutely ruptured IAs (43%) were blister-like. A favorable functional outcome (mRS 0–2) was seen in 73% of patients (74/102). Treatment-related complications were seen in 45% of patients (n=49). Rebleeding was observed in 3 patients (3%). The data from radiological follow-ups were available for 80% of patients (n=88), and complete occlusion was seen in 90% of aneurysms (79/88). The data from clinical follow-ups were available for 93% of patients (n=102). The overall mortality rate was 18% (18/102).ConclusionsFD treatment yields high occlusion for acutely ruptured IAs but is associated with a high risk of complications. Considering the high mortality rate of aneurysmal subarachnoid hemorrhage, the prevention of rebleeding is crucial. Thus, FD treatment may be justified as a last resort option.

Prospective review of a single center's general pediatric neurosurgical intraoperative and postoperative complication rates

2014 ◽  
Vol 13 (1) ◽  
pp. 107-113 ◽  
Author(s):  
Erik J. van Lindert ◽  
Hans Delye ◽  
Jody Leonardo
Keyword(s):  
Mortality Rate ◽  
Adverse Events ◽  
Postoperative Complication ◽  
Complication Rate ◽  
Surgical Procedure ◽  
Neurosurgical Procedures ◽  
Complication Rates ◽  
Tumor Surgery ◽  
Infection Rates ◽  
Targeted Interventions

Object The authors conducted a study to compare the complication rate (CR) of pediatric neurosurgical procedures in a general neurosurgery department to the CRs that are reported in the literature and to establish a baseline of CR for further targeted improvement of quality neurosurgical care. Methods The authors analyzed the prospectively collected data from a complication registration of 1000 consecutive pediatric neurosurgical procedures in 581 patients from the beginning of the registration in January 2004 through August 2008. A pediatric neurosurgeon was involved in 50.5% of the procedures. All adverse events (AEs) from induction of anesthesia until 30 days postoperatively were recorded. Results Overall, 229 complications were counted in 202 procedures. The overall CR was 20.2%, with a 2.7% intraoperative CR and a 17.5% postoperative CR. Tumor surgery was associated with the highest CR (32.7%), followed by CSF disorders (21.8%). The mortality rate was 0.3%. An unplanned return to the operating room in relation to an AE happened in 10.5% of all procedures and in 52% of procedures associated with AEs, the majority of which were related to CSF disorders. Conclusions The CR in pediatric neurosurgical procedures was significant, and more than half of the patients with an AE required a repeat surgical procedure. Analysis of CRs should be a prerequisite for the prevention of complications and for the development of targeted interventions to reduce the CR (for example, infection rates).

scholarly journals Are patients willing to remove, and capable of removing, their own nonabsorbable sutures?

CJEM ◽  
2012 ◽  
Vol 14 (04) ◽  
pp. 221-227 ◽  
Author(s):  
Peter Macdonald ◽  
Nadia Primiani ◽  
Adam Lund
Keyword(s):  
Wound Care ◽  
Intervention Group ◽  
Comfort Level ◽  
Patient Comfort ◽  
Control Group ◽  
Complication Rates ◽  
Eligibility Criteria ◽  
Telephone Contact ◽  
Physician Visits

ABSTRACTObjectives:Providing patients with instructions and equipment regarding self-removal of nonabsorbable sutures could represent a new efficiency in emergency department (ED) practice. The primary outcome was to compare the proportion of patients successfully removing their own sutures when provided with suture removal instructions and equipment versus the standard advice and follow-up care. Secondary outcomes included complication rates, number of physician visits, and patient comfort level.Methods:This prospective, controlled, single-blinded, pseudorandomized trial enrolled consecutive ED patients who met the eligibility criteria (age > 19 years, simple lacerations, nonabsorbable sutures, immunocompetent). The study group was provided with wound care instructions, a suture removal kit, and instructions regarding suture self-removal. The control group received wound care instructions alone. Outcomes were assessed by telephone contact at least 14 days after suturing using a standardized questionnaire.Results:Overall, 183 patients were enrolled (93 in the intervention group; 90 in the control group). Significantly more patients performed suture self-removal in the intervention group (91.5%; 95% CI 85.4–97.5) compared to the control group (62.8%; 95% CI 52.1–73.6) (p< 0.001). Patients visited their physician less often in the intervention group (9.8%; 95% CI 3.3–16.2) compared to the control group (34.6%; 95% CI 24.1–45.2%) (p< 0.001). Complication rates were similar in both groups.Conclusion:Most patients are willing to remove, and capable of removing, their own sutures. Providing appropriate suture removal instructions and equipment to patients with simple lacerations in the ED appears to be both safe and acceptable.

Perioperative Antibiotic Use in Sleep Surgery: Clinical Relevance

2021 ◽  
pp. 019459982110487
Author(s):  
Mohamed Abdelwahab ◽  
Sandro Marques ◽  
Isolde Previdelli ◽  
Robson Capasso
Keyword(s):  
Surgical Site Infection ◽  
Hospital Readmission ◽  
Antibiotic Prescription ◽  
Postoperative Bleeding ◽  
Upper Airway ◽  
National Database ◽  
Complication Rates ◽  
Site Infection ◽  
Tertiary Referral Center ◽  
Obstructive Sleep

Objective Upper airway surgery is a common therapeutic approach recommended for patients with obstructive sleep apnea (OSA) to decrease disease burden. We aimed to evaluate the effect of perioperative antibiotic prescription on complication rates. Study Design Retrospective cohort (national database). Setting Tertiary referral center. Methods This is a retrospective study of a large national health care insurance database (Truven MarketScan) from 2007 to 2015. Subjects diagnosed with OSA who had uvulopalatopharyngoplasty (UPPP) were included and stratified in single versus multilevel surgery. Other variables included smoking, age, sex, antibiotic prescription, and comorbidities based on the Elixhauser index. Evaluated outcomes were postoperative bleeding, intubation, pneumonia, superficial surgical site infection, tracheostomy, and hospital readmission. A multivariate regression model was created to assess each complication. Results A total of 5,798,528 subjects received a diagnosis of OSA, of which 39,916 were >18 years old and underwent UPPP, either alone or with additional procedures. The mean age was 43 years, and 73.4% were male. Antibiotic prescription was associated with less bleeding in UPPP alone, UPPP with nasal surgery, and UPPP with nasal and tongue surgery ( P < .001, P < .001, and P = .006, respectively). It was also associated with a lower prevalence of surgical site infection, pneumonia, tracheostomy, intubation, and hospital readmission ( P < .001). On a multivariate model, antibiotic prescription was significantly associated with a decreased rate of complications. Conclusions Although former studies recommended against the use of antibiotics after tonsillectomy, our results suggest that antibiotic prescription after UPPP for OSA was associated with less bleeding, surgical site infection, pneumonia, intubation, tracheostomy, and hospital readmission 30 days postoperatively.

scholarly journals Temporal trends in tolvaptan use after revision of national heart failure guidelines in Japan

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yusuke Yamazaki ◽  
Yasuyuki Shiraishi ◽  
Shun Kohsaka ◽  
Yuji Nagatomo ◽  
Keiichi Fukuda ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Practice ◽  
Mortality Rate ◽  
Risk Score ◽  
Temporal Trends ◽  
National Guidelines ◽  
Hospital Outcomes ◽  
Trends Over Time ◽  
Multicenter Registry ◽  
Over Time

AbstractWithin no definite diuretic protocol for acute heart failure (AHF) patients and its variation in regional clinical guidelines, the latest national guidelines in Japan commends use of tolvaptan in diuretic-resistant patients. This study aimed to examine trends in tolvaptan usage and associated outcomes of AHF patients requiring hospitalization. Between April, 2018 and October, 2019, 1343 consecutive AHF patients (median 78 [69–85] year-old) were enrolled in a prospective, multicenter registry in Japan. Trends over time in tolvaptan usage, along with the severity of heart failure status based on the Get With The Guideline-Heart Failure [GWTG-HF] risk score, and in-hospital outcomes were investigated. During the study period, tolvaptan usage has increased from 13.0 to 28.7% over time (p for trend = 0.07), and 49.4% started tolvaptan within 3 days after admission. The GWTG-HF risk score in the tolvaptan group has significantly decreased over time, while that in the non-tolvaptan group has unchanged. There were no differences in the in-hospital mortality rate between the patients with and without tolvaptan (6.7% vs. 5.8%). After revision of the Japanese clinical practice guidelines for AHF in March 2018, tolvaptan usage for AHF patients has steadily increased. However, in-hospital outcomes including mortality do not seem to be affected.

Surgical treatment of multiple brain metastases

1993 ◽  
Vol 79 (2) ◽  
pp. 210-216 ◽  
Author(s):  
Rajesh K. Bindal ◽  
Raymond Sawaya ◽  
Milam E. Leavens ◽  
J. Jack Lee
Keyword(s):  
Brain Metastases ◽  
Survival Time ◽  
Prognostic Indicators ◽  
Survival Duration ◽  
Surgical Removal ◽  
Complication Rates ◽  
Multiple Brain Metastases ◽  
Significant Difference ◽  
Group A ◽  
Group B

✓ The authors conducted a retrospective review of the charts of 56 patients who underwent resection for multiple brain metastases. Of these, 30 had one or more lesions left unresected (Group A) and 26 underwent resection of all lesions (Group B). Twenty-six other patients with a single metastasis who underwent resection (Group C) were selected to match Group B by type of primary tumor, time from first diagnosis of cancer to diagnosis of brain metastases, and presence or absence of systemic cancer at the time of surgery. Statistical analysis indicated that Groups A and B were also homogeneous for these prognostic indicators. Median survival duration was 6 months for Group A, 14 months for Group B, and 14 months for Group C. There was a statistically significant difference in survival time between Groups A and B (p = 0.003) and Groups A and C (p = 0.012) but not between Groups B and C (p > 0.5). Brain metastasis recurred in 31% of patients in Group B and in 35% of those in Group C; this difference was not significant (p > 0.5). Symptoms improved after surgery in 65% of patients in Group A, 83% in Group B, and 84% in Group C. Symptoms worsened in 13% of patients in Group A, 6% in Group B, and 0% in Group C. Groups A, B, and C had complication rates per craniotomy of 8%, 9%, and 8%, and 30-day mortality rates of 3%, 4%, and 0%, respectively. Guidelines for management of patients with multiple brain metastases are discussed. The authors conclude that surgical removal of all lesions in selected patients with multiple brain metastases results in significantly increased survival time and gives a prognosis similar to that of patients undergoing surgery for a single metastasis.

scholarly journals Risk of Complications in Children With Adrenal Insufficiency and Covid-19

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A721-A721
Author(s):  
Manish Gope Raisingani
Keyword(s):  
Relative Risk ◽  
Mortality Rate ◽  
Adrenal Insufficiency ◽  
Endotracheal Intubation ◽  
Health Care Organizations ◽  
The Body ◽  
P Value ◽  
Complication Rates ◽  
Intubation Rate ◽  
Risk Of Mortality

Abstract Background: Adrenal insufficiency may put a person at higher risk with infections due to a lack of normal stress response by the body. Limited data has been available in pediatric adrenal insufficiency with Covid-19 Methods: We used TriNetX, with a large COVID-19 database, collecting real-time electronic medical records data. We compared children (0-18 years) who were diagnosed with Covid-19 with and without Adrenal insufficiency. This database collected information from 54 health care organizations Results: Mortality rate in children with Covid-19 and Adrenal insufficiency was 2.246% (19/846). Mortality rate in children with Covid-19 without adrenal insufficiency was 0.097 % (244/252211). Relative risk of mortality for children with Covid-19 and Adrenal insufficiency was 23.2 with a p value of &lt; 0.0001. Endotracheal intubation rate in children with Covid-19 and Adrenal insufficiency was 1.418% (12/846). Endotracheal intubation rate in children with Covid-19 without Adrenal insufficiency was 0.065% (165/252211). Relative risk of endotracheal intubation for children with Covid-19 and Adrenal insufficiency was 21.68 with a p value of &lt; 0.0001. Sepsis rate in children with Covid-19 and Adrenal insufficiency was 6.974% (59/846). Sepsis rate in children with Covid-19 without Adrenal insufficiency was 0.274% (691/252211). Relative risk of sepsis for children with Covid-19 and Adrenal insufficiency was 25.45 with a p value of &lt; 0.00001. Conclusion: Mortality rate, endotracheal and sepsis showed increased association in children with Adrenal insufficiency and Covid-19 versus children with Covid-19 and no Adrenal insufficiency. Further studies with larger sample size are needed to study complication rates of Covid-19 and Adrenal insufficiency.

Abstract 17132: Atrial Fibrillation Ablation in Heart Failure: Temporal Trends and Outcomes in Hospitalized Patients

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Manyoo Agarwal ◽  
Brijesh Patel ◽  
Lohit Garg ◽  
Mahek Shah ◽  
Rami Khouzam ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Temporal Trends ◽  
Complication Rates ◽  
Af Ablation ◽  
Southern Us ◽  
Comorbidity Burden

Introduction: Recent studies have shown catheter ablation for atrial fibrillation (AF) in patients with heart failure (HF) to have better outcomes over medical therapy. While AF ablation is predominantly an outpatient procedure, some patients may require longer hospitalization. Limited literature exists describing the trends of hospitalizations for HF patients undergoing AF ablation. Methods: Using ICD-9 (diagnosis and procedure codes) in nationwide inpatient sample database 2003 to 2014, we identified all HF adults who were admitted with a principal diagnosis code of AF (427.31) (n= 4,670,400) (AF-HF). Among these, we identified those with a principal procedure code of catheter ablation (37.34) and studied the temporal trends of clinical characteristics and outcomes (in-hospital mortality and complications) for this cohort (Table). Results: The overall number of AF-HF patients undergoing AF ablation was 62,653; with an increase from 1,928 in 2003 to 6,860 in 2014 (p trend<0.001). As shown in Table, over this 12-year period; mean age and proportion of females decreased, while there was an increase in blacks, clinical comorbidity burden, admissions to teaching hospitals and southern US region (all p trend<0.001). The overall procedure related complications (vascular, cardiac, respiratory, neurologic) increased, the in-hospital mortality rate decreased from 1.7% to 0.5% (all p trend<0.001). Conclusions: During 2003-2014, the annual incidence of AF ablation related hospitalizations in HF patients increased significantly. Despite increase in clinical comorbidities burden and procedural complication rates, the mortality rate declined.

Abstract 330: Thirty-day Incidence of Cardiac Tamponade and Mortality Following Catheter or Surgical Ablation of Atrial Fibrillation

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
John F Scoggins ◽  
Christie Teigland ◽  
Laura B Meisnere
Keyword(s):  
Atrial Fibrillation ◽  
Mortality Rate ◽  
Cardiac Tamponade ◽  
Large Population ◽  
Safety Information ◽  
Surgical Patient ◽  
Administrative Claims ◽  
Complication Rates ◽  
Age Group ◽  
Af Ablation

Background: The risks of cardiac tamponade and mortality during the first 30 days following catheter or surgical atrial fibrillation (AF) ablation are not well known. Previous large population studies have been limited to in-hospital complication rates and might significantly underestimate the risks of these procedures. Methods: This population based retrospective cohort study was conducted using a large national representative administrative claims database, the Medical Outcomes Research for Effectiveness and Economics Registry (MORE2 Registry®). Thirty-day incidence rates of cardiac tamponade and mortality were calculated and compared by type of procedure (i.e. catheter or surgical), patient gender and age. We analyzed 38,974 AF ablation procedures (catheter: 30,758, 78.9%; surgical: 8,216, 21.1%; age 80 or older: 6,077, 15.6%; 65 to 79: 19,572, 50.2%; 50 to 64: 10,243, 26.3%; 18 to 49: 3,082, 7.9%) performed on 35,754 patients (men: 21,879, 61.2%; women: 13,875, 38.8%) from 2007 to 2012. Results: Thirty-day incidence of cardiac tamponade was 1.74% and differed significantly by type of procedure (catheter: 1.51% vs. surgical: 2.62%, p<0.001) and gender (men: 1.60% vs. women: 1.96%, p=0.010), but not by age group (18-49: 1.49%; 50-64: 1.77%; 65-79: 1.91%; 80 or older: 1.28%, p=0.425). The thirty-day mortality rate was 1.15% and differed significantly by type of procedure (catheter: 0.70% vs. surgical: 2.76%, p<0.001), but not by gender (men: 1.06% vs. women: 1.29%, p=0.058). The mortality rate did not differ significantly from the youngest age group to the next oldest (18 to 49: 0.33% vs. 50 to 64: 0.21%, p=0.315), but increased significantly for the oldest age groups (65 to 79: 1.28%; 80 or older: 2.75%, p<0.001). Conclusion: The 30-day risks of both cardiac tamponade and mortality following catheter AF ablation are greater than the in-hospital rates reported in a previous study. Surgical AF ablation has significantly higher 30-day rates of both cardiac tamponade and mortality, compared to catheter AF ablation. The risk of cardiac tamponade is greater for women than men, but does not vary significantly by age group. Conversely, the risk of mortality is greater for patients age 65 and older, but is not significantly different for women compared to men. These findings provide new comparative safety information that can help inform optimal treatment practices and could serve as the basis of a physician or facility quality measure designed to evaluate relative performance and provide benchmarks to support both consumer choice and quality improvement efforts.

An Evaluation of A Practice-Based Minor Oral Surgery Service

2018 ◽  
Vol 7 (3) ◽  
pp. 30-36
Author(s):  
Thomas Anthony Dyer ◽  
Jessica Ga Lai Lau ◽  
Thomas Anthony Dyer ◽  
Jessica Ga Lai
Keyword(s):  
Oral Surgery ◽  
Waiting Times ◽  
Service Evaluation ◽  
Surgical Removal ◽  
Complication Rates ◽  
Third Molars ◽  
Information Giving ◽  
Mean Waiting Time ◽  
Minor Oral Surgery ◽  
Better Than

Aim To report the findings of a service evaluation of an NHS practice-based minor oral surgery service. Method A service evaluation including a retrospective analysis of activity and outcome data and assessment of patient and practitioner satisfaction. Results 623 appointments were arranged, with a mean waiting time of 43 days. Treatment provided included: surgical removal of third molars and non-third molars, surgical endodontics and other surgical and oral medicine cases (29.7%, 44.1%, 3.0% and 23.4% of cases respectively). Antibiotics were prescribed at 16.1 % of treatment appointments and 1.9% required appointments for post-operative complications. All participants reported overall satisfaction with their care and strongly agreed/agreed with positive attitudinal statements about the oral surgeon's communication/information giving, technical competence and understanding and acceptance; 77.5% were seen on time and none were seen more than 15 minutes late; 87.5% felt the standard of the service was better than expected than at a hospital and none felt it was worse. Over 80 of practitioners agreed that waiting times were better than expected at a hospital, urgent problems were seen quickly and the referral process was easy and understandable. All practitioners strongly agreed/agreed they that they were happy with the service provided. Conclusions A range of minor oral surgery procedures can be provided with low complication rates, acceptable waiting times and accessibility, and high patient and referring practitioner satisfaction from a practice-based specialist oral surgery service.

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