EP.WE.409Stoma forming surgery – has lockdown changed our operative practice during COVID 19

Abstract Aims This study aimed to establish whether the initial lockdown resulted in a shift towards emergency surgery, changes in stoma formation and in rate of surgery with curative intent. Methods A retrospective data collection was performed. Patients were identified using a local database of all patients with stomas. Data was collected from 16/03/20 to 16/09/20. A comparison data set was taken (16/03/19 to 16/09/19). Data was collected on whether the case was performed as an emergency; the type of stoma formed and whether the operation was performed with curative intent. Results Seventeen patients were identified in the 2020 cohort (age: 51-84, mean age: 67.6, M:F 10:7). Fourteen cases (82.4%) were performed as emergencies, three electively (17.6%). Six (35.3%) had end colostomies, three (17.6%) had loop colostomies, one (5.9%) had a caecostomy, four (23.5%) had an end ileostomy and three (17.6%) had a loop ileostomy. Ten operations were for patients with cancer, three (30%) were performed with curative intent. 38 patients were identified in the 2019 cohort (age: 28-85, mean age: 63.0, M:F 17:21). 23 (60.5%) were emergencies, fifteen (39.5%) were performed electively. Nine (23.7%) had end colostomies, eight (21.1%) had loop colostomies, three (7.9%) had caecostomies, ten (26.3%) had end ileostomies and nine (23.7%) had loop ileostomies. There were nineteen operations for cancer, eight (42.1%) were with curative intent. Conclusions Cessation of elective activity caused a shift towards emergency operating, with an associated shift towards surgery with non-curative intent. The distribution of stomas formed has not changed.

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New Persistent Opioid Use Among Patients With Cancer After Curative-Intent Surgery

Journal of Clinical Oncology ◽

10.1200/jco.2017.74.1363 ◽

2017 ◽

Vol 35 (36) ◽

pp. 4042-4049 ◽

Cited By ~ 156

Author(s):

Jay Soong-Jin Lee ◽

Hsou Mei Hu ◽

Anthony L. Edelman ◽

Chad M. Brummett ◽

Michael J. Englesbe ◽

...

Keyword(s):

Risk Factors ◽

Adjuvant Chemotherapy ◽

Prescription Opioid ◽

Patient Counseling ◽

Opioid Use ◽

Curative Intent ◽

Data Set ◽

Opioid Dose ◽

Adjusted Risk ◽

Patients With Cancer

Purpose The current epidemic of prescription opioid misuse has increased scrutiny of postoperative opioid prescribing. Some 6% to 8% of opioid-naïve patients undergoing noncancer procedures develop new persistent opioid use; however, it is unknown if a similar risk applies to patients with cancer. We sought to define the risk of new persistent opioid use after curative-intent surgery, identify risk factors, and describe changes in daily opioid dose over time after surgery. Methods Using a national data set of insurance claims, we identified patients with cancer undergoing curative-intent surgery from 2010 to 2014. We included melanoma, breast, colorectal, lung, esophageal, and hepato-pancreato-biliary/gastric cancer. Primary outcomes were new persistent opioid use (opioid-naïve patients who continued filling opioid prescriptions 90 to 180 days after surgery) and daily opioid dose (evaluated monthly during the year after surgery). Logistic regression was used to identify risk factors for new persistent opioid use. Results A total of 68,463 eligible patients underwent curative-intent surgery and filled opioid prescriptions. Among opioid-naïve patients, the risk of new persistent opioid use was 10.4% (95% CI, 10.1% to 10.7%). One year after surgery, these patients continued filling prescriptions with daily doses similar to chronic opioid users ( P = .05), equivalent to six tablets per day of 5-mg hydrocodone. Those receiving adjuvant chemotherapy had modestly higher doses ( P = .002), but patients with no chemotherapy still had doses equivalent to five tablets per day of 5-mg hydrocodone. Across different procedures, the covariate-adjusted risk of new persistent opioid use in patients receiving adjuvant chemotherapy was 15% to 21%, compared with 7% to 11% for those with no chemotherapy. Conclusion New persistent opioid use is a common iatrogenic complication in patients with cancer undergoing curative-intent surgery. This problem requires changes to prescribing guidelines and patient counseling during the surveillance and survivorship phases of care.

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Adverse outcomes for missed cases of CDI; results from retrospective data collection on patients with samples received during the European, multi-centre, prospective bi-annual point prevalence study of Clostridium difficile infection in hospitalized patients with diarrhoea (EUCLID2)

10.26226/morressier.56d5ba27d462b80296c95f6e ◽

2016 ◽

Author(s):

Kerrie Davies

Keyword(s):

Clostridium Difficile ◽

Data Collection ◽

Clostridium Difficile Infection ◽

Hospitalized Patients ◽

Adverse Outcomes ◽

Point Prevalence ◽

Prevalence Study ◽

Retrospective Data ◽

Point Prevalence Study ◽

Retrospective Data Collection

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Adverse reactions of targeted therapy in cancer patients: a retrospective study of hospital medical data in China

BMC Cancer ◽

10.1186/s12885-021-07946-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ruofei Du ◽

Xin Wang ◽

Lixia Ma ◽

Leon M. Larcher ◽

Han Tang ◽

...

Keyword(s):

Targeted Therapy ◽

Cancer Patients ◽

Adverse Reactions ◽

Cox Regression ◽

Target Therapy ◽

Skin Damage ◽

Data Set ◽

Patients With Cancer ◽

Number Of Patients ◽

Significant Difference

Abstract Background The adverse reactions (ADRs) of targeted therapy were closely associated with treatment response, clinical outcome, quality of life (QoL) of patients with cancer. However, few studies presented the correlation between ADRs of targeted therapy and treatment effects among cancer patients. This study was to explore the characteristics of ADRs with targeted therapy and the prognosis of cancer patients based on the clinical data. Methods A retrospective secondary data analysis was conducted within an ADR data set including 2703 patients with targeted therapy from three Henan medical centers of China between January 2018 and December 2019. The significance was evaluated with chi-square test between groups with or without ADRs. Univariate and multivariate logistic regression with backward stepwise method were applied to assess the difference of pathological characteristics in patients with cancer. Using the univariate Cox regression method, the actuarial probability of overall survival was performed to compare the clinical outcomes between these two groups. Results A total of 485 patients were enrolled in this study. Of all patients, 61.0% (n = 296) occurred ADRs including skin damage, fatigue, mucosal damage, hypertension and gastrointestinal discomfort as the top 5 complications during the target therapy. And 62.1% of ADRs were mild to moderate, more than half of the ADRs occurred within one month, 68.6% ADRs lasted more than one month. Older patients (P = 0.022) and patients with lower education level (P = 0.036), more than 2 comorbidities (P = 0.021), longer medication time (P = 0.022), drug combination (P = 0.033) and intravenous administration (P = 0.019) were more likely to have ADRs. Those with ADRs were more likely to stop taking (P = 0.000), change (P = 0.000), adjust (P = 0.000), or not take the medicine on time (P = 0.000). The number of patients with recurrence (P = 0.000) and metastasis (P = 0.006) were statistically significant difference between ADRs and non-ADRs group. And the patients were significantly poor prognosis in ADRs groups compared with non-ADRs group. Conclusion The high incidence of ADRs would affect the treatment and prognosis of patients with cancer. We should pay more attention to these ADRs and develop effective management strategies.

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Increased Risk of Severe COVID-19 in Hospitalized Patients With SARS-CoV-2 Variant of Concern Alpha Infection in France: A Multicentre Matched Cohort Study With Retrospective Data Collection

SSRN Electronic Journal ◽

10.2139/ssrn.3866550 ◽

2021 ◽

Author(s):

Guillaume Martin-Blondel ◽

Fraçois-Xavier Lescure ◽

Lambert Assoumou ◽

Charlotte Charpentier ◽

Jean-Marc Chapplain ◽

...

Keyword(s):

Cohort Study ◽

Data Collection ◽

Hospitalized Patients ◽

Retrospective Data ◽

Matched Cohort ◽

Matched Cohort Study ◽

Increased Risk ◽

Retrospective Data Collection

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Tonsillectomy Bleed Rates across the CHEER Practice Research Network

Otolaryngology ◽

10.1177/0194599816630523 ◽

2016 ◽

Vol 155 (1) ◽

pp. 28-32 ◽

Cited By ~ 12

Author(s):

Walter T. Lee ◽

David L. Witsell ◽

Kourosh Parham ◽

Jennifer J. Shin ◽

Nikita Chapurin ◽

...

Keyword(s):

Data Collection ◽

Postoperative Bleeding ◽

Age Groups ◽

Postoperative Hemorrhage ◽

Research Network ◽

Practice Research ◽

Retrospective Data ◽

Significant Difference ◽

Retrospective Data Collection ◽

A Site

Objectives (1) Compare postoperative bleeding in the CHEER network (Creating Healthcare Excellence through Education and Research) among age groups, diagnoses, and practice types. (2) Report the incidence of bleeding by individual CHEER practice site based on practice guidelines. Study Design Retrospective data collection database review of the CHEER network based on ICD-9 and CPT codes related to tonsillectomy patients. Setting Multisite practice–based network. Subjects and Methods A total of 8347 subjects underwent tonsillectomy as determined by procedure code within the retrospective data collection database, and 107 had postoperative hemorrhage. These subjects had demographic information and related diagnoses based on the CPT and ICD-9 codes collected. Postoperative ICD-9 and CPT codes were used to identify patients who also had postoperative bleed. Variables included age (<12 vs ≥12 years), diagnoses (infectious vs noninfectious), and practice type (community vs academic). Statistical analysis included multivariate logistic regression variables predictive of postoperative bleeding, with P < .05 considered significant. Results Thirteen sites contributed data to the study (7 academic, 6 community). There was postoperative bleeding for an overall bleed rate of 1.3%. Patients ≥12 years old had a significantly increased bleed rate when compared with the younger group (odds ratio, 5.98; 95% confidence interval: 3.79-9.44; P < .0001). There was no significant difference in bleed rates when practices or diagnoses were compared. Conclusion A site descriptor database built to expedite clinical research can be used for practice assessment and quality improvement. These data were also useful to identify patient risk factors for posttonsillectomy bleed.

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Ileostomy or colostomy for temporary decompression of colorectal anastomosis: systematic review and meta-analysis

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502008000300014 ◽

2008 ◽

Vol 23 (3) ◽

pp. 294-303 ◽

Cited By ~ 24

Author(s):

Katia Ferreira Güenaga ◽

Suzana Angélica Silva Lustosa ◽

Sarhan Sydney Saad ◽

Humberto Saconato ◽

Delcio Matos

Keyword(s):

Large Scale ◽

Loop Ileostomy ◽

Skin Irritation ◽

Colorectal Anastomosis ◽

Length Of Hospital Stay ◽

Transverse Colostomy ◽

Time Interval ◽

Stoma Formation ◽

Statistical Heterogeneity ◽

Stoma Prolapse

PURPOSE: The controversy regarding whether loop ileostomy or loop transverse colostomy is a better method for temporary decompression of colorectal anastomosis motivated this review. METHODS: Five randomized trials were included, with 334 patients: 168 in the loop ileostomy group and 166 in the loop transverse colostomy group. The outcomes analyzed were: 1. Mortality; 2. Wound infection; 3. Time of stoma formation; 4. Time of stoma closure; 5. Time interval between stoma formation and closure; 6. Stoma prolapse; 7. Stoma retraction; 8. Parastomal hernia; 9. Parastomal fistula; 10. Stenosis; 11. Necrosis; 12. Skin irritation; 13. Ileus; 14. Bowel leakage; 15. Reoperation; 16. Patient adaptation; 17. Length of hospital stay; 18. Colorectal anastomotic dehiscence; 19. Incisional hernia; 20. Postoperative bowel obstruction. RESULTS: Stoma prolapse was statistically significant (p = 0.00001), but with statistical heterogeneity; the sensitive analysis was applied, excluding the trials that included emergency surgery, and this showed: p = 0.02, with I² = 0% for the heterogeneity test. CONCLUSIONS: The outcomes reported were not statistically or clinically significant except for stoma prolapse. Better evidence for making the choice between loop ileostomy or loop colostomy requires large-scale randomized controlled trials.

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