P061 ANALYSIS OF THE IMPACT DERIVED FROM MORBIDITY IN THE INCISIONAL HERNIA SURGERY

Abstract Aim To analyse the repercussion derived from the morbidity that appeared after the repair of incisional hernias. Material and Methods Descriptive, retrospective and longitudinal study based on a prospective database of all incisional hernia operated patients of a university-level hospital in the period between 2013 and 2019. Anthropometric parameters, classification of the hernia according to the European Hernia Society guides and characteristics of the intervention performed were registered. Complications observed until the end of the follow-up and the final evolution are analysed. Results The sample is composed by 244 patients with a mean follow-up of 11 months. In 50% of the surgeries anterior separation of components was performed. In 240 patients, the mesh was placed in the following positions: 68.5% onlay, 13.5% retromuscular, 13% preperitoneal, 3.6% intraperitoneal and 1.3% inlay. During the first postoperative month, 63 patients (25.8%) presented some type of complication: seroma (47.6%), surgical wound infection (20.6%) and dehiscence (17.5%). 31 complications (49.2%) were classified as Clavien-Dindo III or greater severity. In 60% of patients with seroma the mesh was placed onlay. Of the 30 patients with seroma, 9 recurred over a mean of 16 months of follow-up (30%). Conclusions In our sample, the main cause of postoperative seroma is onlay placement of the mesh, and this complication may cause recurrence. We consider that it’s important to register our results to obtain a correct analysis and to prevent morbidity in the future.

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Impact of thyroglobulin and thyroglobulin antibody assay performance on the differential classification of DTC patients

Journal of the Endocrine Society ◽

10.1210/jendso/bvab166 ◽

2021 ◽

Author(s):

Lise Schoonen ◽

Marjolein Neele ◽

Hans van Toor ◽

Caroline M J van Kinschot ◽

Charlotte van Noord ◽

...

Keyword(s):

Poor Correlation ◽

Antibody Assay ◽

Thyroglobulin Antibody ◽

Assay Performance ◽

Upper Limits ◽

Antibody Assays ◽

The Impact ◽

Storage Temperatures

Abstract Context Measurements of thyroglobulin (Tg) and Tg antibodies are crucial in the follow-up of treated differentiated thyroid cancer (DTC) patients. Inter-assay differences may significantly impact follow-up. Objective The aim of this multicenter study was to explore the impact of Tg and Tg antibody assay performance on the differential classification of DTC patients, as described in national and international guidelines. Design Four commonly used Tg and Tg antibody assays were technically compared to reflect possible effects on patients with DTC follow-up. Storage stability at different storage temperatures was also investigated for LIAISON® and Kryptor assays, as this is an underexposed topic in current literature. Results B.R.A.H.M.S. assays yield approximately 50% lower Tg values over the whole range compared to the DiaSorin and Roche assays investigated. These differences between assays may result in potential misclassification in up to 7% of patients if fixed cut-offs (e.g. 1 ng/mL) are applied. Poor correlation was also observed between the Tg antibody assays, when the method-specific upper limits of normal are used as cut-offs. Storage of Tg and Tg antibodies was possible for three to four weeks at -20 °C and -80 °C. Calibration of the assays, however, was found to be crucial for stable results over time. Conclusions Technical aspects of Tg and Tg antibody assays, including inter-assay differences, calibration and standardization, and cut-off values, may have a significant clinical impact on the follow-up of DTC patients.

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1022 Socioeconomic Deprivation and Colorectal Cancer Survival

British Journal of Surgery ◽

10.1093/bjs/znab135.052 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

F Ali ◽

M Jha

Keyword(s):

Cancer Survival ◽

Cox Regression ◽

Socioeconomic Deprivation ◽

Tumour Site ◽

Kaplan Meier ◽

Similar Survival ◽

The Impact ◽

Index Of Multiple Deprivation ◽

Prospective Database

Abstract Background Factors related to CRC survival include age, tumour site and stage. Other factors that may play a role on survival include race and socioeconomic status(SES).We aim to investigate the impact of SES on CRC survival. Method All patients diagnosed with CRC between January 2006-January 2019 were included. Demographics were collected from a prospective database. SES was defined using the Index of Multiple Deprivation(IMD).Cox-regression was used to investigate the effect of factors on survival and Kaplan-Meier to estimate survival. Results A total of 5,073 patients diagnosed with CRC with a median follow up of 65 months were include. Overall survival was 72.2% (76.0%0-78.4%), 59.6%(58.2%-61.0%) and 50.3% (48.8%-51.8%) at 1 year, 3 years and 5 years, respectively. Colon cancer was associated with worse survival(p = 0.00256,HR = 1.163). On multivariate analysis, socioeconomic deprivation was associated with poorer survival (HR = 1.02,p=0.00302).Male and female sex were associated with similar survival outcomes(HR = 0.9831 and 0.9341,respectively; p = 0.986 and 0.946 respectively). Conclusions SES impact on CRC survival seems to be inconsistent across the literature potentially due to lack of uniformity of indices used to assess SES and the heterogeneity of access to healthcare. This could ultimately impact comparability across different studies investigating the impact SES on CRC survival.

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COVID-19 pandemic: impact of lockdown and hospital classification on neurological patients

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20203097 ◽

2020 ◽

Vol 7 (8) ◽

pp. 2985

Author(s):

Amandeep Singh ◽

Nitisha Goyal ◽

Dinesh Chouksey ◽

Kapil Telang ◽

Rahul Jain ◽

...

Keyword(s):

Human Life ◽

Symptom Control ◽

P Value ◽

Study Group ◽

Drug Side Effects ◽

Monitoring Drug ◽

Neurological Patients ◽

The Impact

Background: COVID-19 pandemic has impacted human life by the steps taken to mitigate it. The restriction of movement and earmarking hospitals exclusively for catering to the COVID-19 patients might have affected the health of non-COVID-19 patients adversely. This study was aimed to assess the impact of lockdown and hospital classification in neurological patients.Methods: This study was conducted in the Department of Neurology in a 1000 bedded teaching hospital which has been earmarked as COVID dedicated hospital (the red hospital). The patients who attended the outpatient department and discharged from the Neurology department, prior to the lockdown, were contacted telephonically and asked to report their difficulties, if any, in the procurement of prescribed medication, medical consultation, monitoring drug side effects, and symptom control, etc. Patients were grouped into those who needed close surveillance and routine follow up.Results: Out of 1201 patients 646 could be reached. The average age of our population (n=646, female 56.4%) was 39.63±15.52 years. In the study group, the prescription breach was found in 343 patients (53.10%), management breach was in 449 (69.50%), confidence breach was in 398 (61.61%) and adverse effect on drug availability was found in 330 (53.10%) patients. In the close surveillance group (n=420), the patient's health was deemed to be at risk in 328 (78.10%) patients as compared to 161 patients (71.24%) in routine follow up group with a significant p value of 0.05.Conclusions: Our results suggest that lockdown and classification of hospitals to cater exclusively to COVID-19 patients has significantly ill-affected the health of the non-COVID subjects.

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Estimation of Elastic Follow-Up in Structures

Key Engineering Materials ◽

10.4028/www.scientific.net/kem.462-463.361 ◽

2011 ◽

Vol 462-463 ◽

pp. 361-365 ◽

Cited By ~ 4

Author(s):

Saeid Hadidi-Moud ◽

David John Smith

Keyword(s):

Residual Stresses ◽

Closed Form ◽

Analytical Solutions ◽

Unified Framework ◽

Integrity Assessment ◽

The Impact ◽

Model Structures

Using simplified benchmark models, representative of the behavior of real structures, a unified framework for quantification of elastic follow-up (EFU) in structures has been provided. Closed form analytical solutions for evaluation of elastic follow-up are presented for model structures. The impact of elastic follow-up on the relaxation i.e. the redistribution of residual stresses has been explored and hence its significance in the integrity assessment of structures in general and in classification of residual stresses in particular has been highlighted.

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Patient-reported outcomes after incisional hernia repair

Hernia ◽

10.1007/s10029-021-02477-7 ◽

2021 ◽

Author(s):

N. van Veenendaal ◽

M. M. Poelman ◽

B. van den Heuvel ◽

B. J. Dwars ◽

W. H. Schreurs ◽

...

Keyword(s):

Incisional Hernia ◽

Hernia Repair ◽

Abdominal Wall ◽

Patient Reported Outcomes ◽

Incisional Hernia Repair ◽

Hernia Surgery ◽

Incisional Hernias ◽

Patient Reported ◽

Postoperative Symptoms

Abstract Purpose Patient-reported outcomes (PROs) are pivotal to evaluate the efficacy of surgical management. Debate persists on the optimal surgical technique to repair incisional hernias. Assessment of PROs can guide the selection of the best management of patients with incisional hernias. The objective of this cohort study was to present the PROs after incisional hernia repair at long term follow-up. Methods Patients with a history of incisional hernia repair were seen at the out-patient clinic to collect PROs. Patients were asked about the preoperative indication for repair and postoperative symptoms, such as pain, feelings of discomfort, and bulging of the abdominal wall. Additionally, degree of satisfaction was asked and Carolina Comfort Scales were completed. Results Two hundred and ten patients after incisional hernia repair were included with a median follow-up of 3.2 years. The main indication for incisional hernia repair was the presence of a bulge (60%). Other main reasons for repair were pain (19%) or discomfort (5%). One hundred and thirty-two patients (63%) reported that the overall status of their abdominal wall had improved after the operation. Postoperative symptoms were reported by 133 patients (63%), such as feelings of discomfort, pain and bulging. Twenty percent of patients reported that the overall status of their abdominal wall was the same, and 17% reported a worse status, compared to before the operation. Ten percent of the patients would not opt for operation in hindsight. Conclusion This study showed that a majority of the patients after incisional hernia repair still report pain or symptoms such as feelings of discomfort, pain, and bulging of the abdominal wall 3 years after surgery. Embedding patients’ expectations and PROs in the preoperative counseling discussion is needed to improve decision-making in incisional hernia surgery.

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P088 SURGEON AS A RISK FACTOR OF REDUCED EURAHS QOL SCORE AFTER HERNIA REPAIR

British Journal of Surgery ◽

10.1093/bjs/znab395.082 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Jakub Woleský ◽

Barbora Jíšová ◽

Barbora East

Keyword(s):

Incisional Hernia ◽

Hernia Repair ◽

Internal Audit ◽

Major Complication ◽

Incisional Hernia Repair ◽

Hernia Surgery ◽

Post Surgery ◽

Before And After

Abstract Aim Our aim was to analyze patient’s reported EuraHS QoL (quality of life) scores before and after hernia surgery. And find whether the result is surgeon dependent or not, because hernia repair often serves as a training surgery for young surgeons or is performed by surgeons with no hernia interest. However, even a simple groin hernia repair can lead to life-long pain or reduced QoL and the risk of complications following incisional hernia repair is much higher. Material and Methods We have utilized the EuraHS database and its QoL questionnaire and prospectively entered all patients undergoing any hernia repair at our department since Jan. 2019. Results 519 patients have been included. Many patients in the incisional hernia cohort have reported no or very little symptoms before the operation. Only 251 have completed their 1 month follow-up with the QoL questionnaire. 63 patients have been contacted and questioned 1 year post-surgery to this date. In 6 cases the QoL scores are lower than pre-repair. 45 patients had a record of major complication or reoccurrence requiring surgery so far. Unfortunately 31 of those did not fill up the QoL questionnaire. 37 were operated on by resident with a supervision of a surgeon without a hernia interest. Conclusions Results of hernia repair are surgeon dependent and an internal audit of current practices is needed at many general surgery departments.

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425 The Impact Of COVID-19 On Hernia Surgery in The Lothian Region Of Scotland

British Journal of Surgery ◽

10.1093/bjs/znab259.587 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

A Ewing ◽

K Hodge ◽

R McFadyen ◽

C Grossart ◽

B East ◽

...

Keyword(s):

Incisional Hernia ◽

Hernia Repair ◽

Emergency Surgery ◽

Elective Surgery ◽

Incisional Hernia Repair ◽

Emergency Operation ◽

Hernia Surgery ◽

Time Period ◽

Surgical Audit ◽

The Impact

Abstract Aim The COVID-19 pandemic resulted in a lockdown in South East Scotland on the 23 March 2020. This had an impact on the volume of benign elective surgery able to be undertaken. The degree to which this reduced hernia surgery was unknown. The aim of this study was to review the hernia surgery workload in the Lothian region of Scotland and assess the impact of COVID-19 on hernia surgery. Method The Lothian Surgical Audit database was used to identify all elective and emergency hernia operations over a six-month period from 23 March 2020, and for the same time period in 2019. Data was collected on age, gender, location of the hernia, type of hernia repair and whether elective or emergency operation. Results The number of hernia repairs reduced dramatically between 2019 and 2020 (570 versus 149). The majority of this can be explained by a reduction in elective operating (488 versus 87). There was, however, also a reduction in the numbers of hernias repaired as an emergency over the same study periods (82 to 62). Lockdown in 2020 had the biggest effect on elective incisional hernia repair (74 versus 2). Conclusions The COVID-19 pandemic has reduced both the number of elective and emergency hernia operations in 2020 compared to 2019. While the reduction in elective surgery has not resulted in an associated increase in emergency surgery over the study period, it is possible that if continuing reduced availability to elective hernia surgery continues in Lothian, the emergency hernia workload may increase.

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Genetic diversity of human immunodeficiency viruses and antiretroviral therapy

Terapevticheskii arkhiv ◽

10.17116/terarkh20168811103-111 ◽

2016 ◽

Vol 88 (11) ◽

pp. 103-111 ◽

Cited By ~ 2

Author(s):

M R Bobkova

Keyword(s):

Genetic Diversity ◽

Antiretroviral Therapy ◽

Therapeutic Effects ◽

Resistance Mutations ◽

Origin And Evolution ◽

Treatment Regimens ◽

Human Immunodeficiency Viruses ◽

The Impact

The lecture is devoted to the analysis of the state-of-the-art of the impact of genetic diversity of human immunodeficiency (HIV) viruses on the pattern of infection and the efficiency of antiretroviral therapy (ART). It provides brief information on the origin and evolution of HIV and on the current classification of their genetic variants. The molecular epidemiological situation of HIV infection in Russia and nearby states and the major molecular HIV variants that are dominant in these countries, as well as their origin and prevalence trends are characterized. How the diversity of HIV can affect the efficiency of diagnosis, the transmission of the virus, and the pattern of HIV pathogenesis are briefly reviewed. The comparative data available in the world’s scientific literature on these topics are given. More detailed attention is given to the possible causes of varying therapeutic effects against different HIV subtypes, as well as to the specific features of the formation and phenotyping manifestation of ART drug resistance mutations. There is evidence for the necessity of forming a unified follow-up system for treated HIV-infected patients during ART scaling, including in an effort to evaluate the impact of the specific features of the HIV genome on the efficiency of treatment regimens used in Russia.

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Evaluation and Follow-Up of Carotid-Cavernous Fistulas by Transcranial Doppler Sonography: Illustrative Case

Neurosurgery ◽

10.1227/00006123-198905000-00015 ◽

1989 ◽

Vol 24 (5) ◽

pp. 749-753 ◽

Cited By ~ 9

Author(s):

Camilo R. Gomez ◽

Sandra M. Gomez ◽

Kong-Woo Peter Yoon ◽

Gary E. Kraus

Keyword(s):

Transcranial Doppler ◽

Doppler Sonography ◽

Transcranial Doppler Sonography ◽

Flow Characteristics ◽

Illustrative Case ◽

Computed Tomographic ◽

Carotid Cavernous Fistulas ◽

The Impact

ABSTRACT The availability of transcranial Doppler sonography has resulted in an easy, noninvasive, reproducible, and highly reliable method for evaluating the flow characteristics of carotid-cavernous sinus fistulas. It also allows the follow-up of the effect of different interventional measures, specifically, embolization with detachable balloons. An illustrative case is reported, in which the findings of serial transcranial Doppler sonograms are correlated with findings on computed tomographic scans and angiograms. The impact of our findings on future approaches to the hemodynamic classification of these acquired vascular shunts is discussed.

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P1002Echocardiographic assessment of optimal device position after percutaneous left atrial appendage occlusion - introduction of a novel classification and its impact on outcome

European Heart Journal ◽

10.1093/eurheartj/ehz747.0595 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

V O Vij ◽

B Al-Kassou ◽

D Nelles ◽

M Stuhr ◽

R Schueler ◽

...

Keyword(s):

Left Atrial ◽

Left Atrial Appendage ◽

Transoesophageal Echocardiography ◽

Atrial Appendage ◽

The Novel ◽

Left Atrial Appendage Occlusion ◽

Implantation Depth ◽

The Impact

Abstract Background Left atrial appendage occlusion (LAAo) is an established therapy in patients with atrial fibrillation. However, criteria regarding optimal device position are not well defined making comparability of procedural results virtually impossible. We therefore sought to a) introduce a classification describing optimal vs. suboptimal device-position by assessing predefined parameters in transoesophageal echocardiography (TEE) and to b) analyze the impact of device-position on outcome in patients treated with different LAAo devices. Methods and results We retrospectively analyzed 120 patients who were treated by LAAo and had undergone follow-up TEEs after 3 or 6 months. Patients were at mean age: 76±8 years; female 40% and presented an increased CHADS-VASC- (4.6±1.4) and HAS-BLED-score (3.7±1). TEE-guidance was performed in all cases. In 62.5% (75/120) pacifier occluders (PO) (ACP/Amulet, Lambre, Ultraseal) were used, whereas 37.5% (45/120) were treated with non-pacifier occluders (NPO) (Watchman, Wavecrest, Occlutech). To assess device position, TEE images in a commissural view (60–90°) were analyzed and characterised by 1) implantation depth in the left atrial appendage, 2) peridevice flow (PF) and 3) the angle between occluder disc and pulmonal ridge (LUPV). For the purpose of this study, optimal device position was defined as a) ostial (LUPV length <10mm) or slightly subostial position (LUPV length ≤15mm, angle ≥100°) with b) the absence of major PF (>3mm). Overall, occluders were implanted at a depth of 12±7.8 mm with ostial positioning being achieved in 47.5% (57/120). Major PF was seen in 7.5% (9/120). NPOs were implanted deeper than POs (depth: 15.6±7.1 vs. 9.8±7.4 mm, p<0.01; ostial position: 31.1% vs. 57.3%, p<0.01) and were associated with a higher incidence of major PF (15.6% vs. 2.7%, p=0.01). Also, the depth/angle ratio was higher (i.e. “worse”) in NPOs (18.3±9 vs. 14.6±8, p<0.04). As a result, optimal device position was achieved in 48.3% (58/120) of all patients, with lower rates in NPOs than in POs (26.7% vs. 61.3%, p<0.01). Procedural aspects revealed slight differences in occluder size (optimal: 23.7±3.2 vs. suboptimal: 24.5±3.7 mm, p=0.3), need for repositioning (10.3% vs. 17.7%, p=0.25) and procedural duration (48±36 vs. 52±34 min, p=0.3). Of interest, device related thrombi (DRT) occurred less frequently in optimally implanted devices (3.4% vs. 12.9%, p=0.06). Hereby, implantation depth and depth/angle ratio were found to be predictors for DRT in ROC-analysis, respectively (AUC: 0.7, 95% Confidence interval [CI]: 0.56–0.84, p=0.05 and AUC: 0.72, 95% CI: 0.58–0.86, p=0.03). Optimal vs. suboptimal position Conclusion Echocardiographic classification of device-position is warranted to provide comparability and appears to be feasible. Based on the novel classification provided, optimal device-position is achieved in 50% and is found more often with the use of POs. DRT appeared to occur more often in suboptimal device-position.

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