scholarly journals P-OGC78 One year experience of a newly established super green ERAS pathway for performing oesophago-gastric cancer resections during the Covid-19 pandemic

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Dhruv Sahni ◽  
Khurram Khan ◽  
Lewis Gall ◽  
Paulina Kosk ◽  
Matthew Forshaw ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Cohort Study ◽  
Hospital Mortality ◽  
Retrospective Cohort ◽  
Surgical Oncology ◽  
Median Length ◽  
Clamshell Thoracotomy ◽  
One Year ◽  
The Uk ◽  
Transhiatal Oesophagectomy

Abstract Background Surgical oncology services in the UK have been impacted by the COVID-19 pandemic.  Various strategies have been employed in an attempt to continue cancer resectional surgery   during the pandemic.  This study examined our institution’s experience and outcomes with a newly established Super Green ERAS pathway for oesophago-gastric (OG) cancer resections during the pandemic. Methods A retrospective cohort study of consecutive patients who had a resection for OG cancer performed over a 12-month period beginning from the date of the first UK National Lockdown of 23 March 2020.  Barring two intervals each lasting 3 weeks, urgent elective cancer surgery continued on our mixed hot and cold site through the establishment of a Super Green ERAS pathway. Patients were confirmed COVID-19 negative within 72 hours pre-admission and retested  72-hourly post-op. 14 days self-isolation pre-admission was mandated.  Patients not complying had their surgery postponed. Transhiatal oesophagectomy was the preferred approach for oesophagectomy during the pandemic.  Results 45 resections (33 oesophagectomies, 10 gastrectomies and 2 trial of dissections) were performed.  37 (82.2%) patients were male with a median age of 64 (IQR 58-71) years.   3 patients were postponed due to non-adherence with self-isolation. No patients tested positive for COVID-19 post-operatively, hence, there was no COVID-19-related morbidity. Nine patients developed pneumonia. Seven patients had an anastomotic leak, all of whom were successfully rescued. One patient required a clamshell thoracotomy due to intra-operative mediastinal bleeding followed by a return to theatre for reconstruction 48hrs later.  Median length of stay was 12 (IQR 9-18) days. There was no in-hospital mortality. Conclusions OG cancer resections can be performed safely despite COVID-19, with favorable clinical outcomes when a Super Green ERAS pathway is strictly adhered to.   Implementation of such pathways will enable surgical oncology services, including OG cancer resections, to continue to ensure best possible outcomes for cancer patients despite any future waves of the COVID-19 pandemic.

Effectiveness of Palivizumab against Respiratory Syncytial Virus Hospitalization among Preterm Infants in a Setting with Year-round Circulation

2020 ◽  
Author(s):  
Kee Thai Yeo ◽  
Chee Fu Yung ◽  
Poh Choo Khoo ◽  
Seyed Ehsan Saffari ◽  
Jane Swee Peng Sng ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Preterm Infants ◽  
Retrospective Cohort ◽  
Median Length ◽  
Post Discharge ◽  
Tropical Regions ◽  
Very Preterm ◽  
Syncytial Virus ◽  
One Year

Abstract Background The year-round RSV circulation in tropical regions leads to different transmission patterns and burden of disease among infants born very preterm. Methods We conducted a retrospective cohort study to estimate the effectiveness of palivizumab in preventing RSV hospitalization among infants born <32 weeks gestation at 6 and 12 months after discharge in our tropical setting. Results A total of 109 (26.3%) infants received palivizumab at discharge, out of 415 who were eligible. All patients received at least 4 doses, with 105 infants (96.3%) completing 5 doses. Within one-year post-discharge, there were 35 RSV-associated admissions (3 palivizumab vs 32 non-palivizumab, 2.8% vs 10.5%, p=0.02). After adjusting for confounders, the effectiveness of palivizumab against RSV hospitalisation was estimated to be 90% (95%CI: 10% to 99%) up to 6-months post-discharge. The median length of time to RSV hospitalization was shorter in the non-palivizumab compared to the palivizumab group, 155 days (15, 358) vs 287 days (145, 359), p=0.1. Five infants (14.3%), all from the non-palivizumab group, required admission to the intensive care unit. Conclusions In our setting with year-round RSV circulation, palivizumab prophylaxis was effective in reducing RSV hospitalization among high-risk preterm infants <32 weeks gestation within the first 6 months post-discharge.

scholarly journals Retrospective cohort study of 925 OAGB procedures. The UK MGB/OAGB collaborative group

2019 ◽  
Vol 69 ◽  
pp. 13-18 ◽  
Author(s):  
A. Hussain ◽  
M. Van den Bossche ◽  
D.D. Kerrigan ◽  
A. Alhamdani ◽  
C. Parmar ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Collaborative Group ◽  
The Uk

scholarly journals Proton pump inhibitors versus histamine-2 receptor blockers for stress ulcer prophylaxis in patients with sepsis: a retrospective cohort study

2021 ◽  
Vol 49 (6) ◽  
pp. 030006052110251
Author(s):  
Minqiang Huang ◽  
Ming Han ◽  
Wei Han ◽  
Lei Kuang
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Proton Pump ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Stress Ulcer ◽  
Increased Risk ◽  
Ulcer Prophylaxis

Objective We aimed to compare the efficacy and risks of proton pump inhibitor (PPI) versus histamine-2 receptor blocker (H2B) use for stress ulcer prophylaxis (SUP) in critically ill patients with sepsis and risk factors for gastrointestinal bleeding (GIB). Methods In this retrospective cohort study, we used the Medical Information Mart for Intensive Care III Clinical Database to identify critically ill adult patients with sepsis who had at least one risk factor for GIB and received either an H2B or PPI for ≥48 hours. Propensity score matching (PSM) was conducted to balance baseline characteristics. The primary outcome was in-hospital mortality. Results After 1:1 PSM, 1056 patients were included in the H2B and PPI groups. The PPI group had higher in-hospital mortality (23.8% vs. 17.5%), GIB (8.9% vs. 1.6%), and pneumonia (49.6% vs. 41.6%) rates than the H2B group. After adjusting for risk factors of GIB and pneumonia, PPI use was associated with a 1.28-times increased risk of in-hospital mortality, 5.89-times increased risk of GIB, and 1.32-times increased risk of pneumonia. Conclusions Among critically ill adult patients with sepsis at risk for GIB, SUP with PPIs was associated with higher in-hospital mortality and higher risk of GIB and pneumonia than H2Bs.

scholarly journals Incidence and Outcomes of Acute Kidney Injury in Patients Admitted to Hospital With COVID-19: A Retrospective Cohort Study

2021 ◽  
Vol 8 ◽  
pp. 205435812110277
Author(s):  
Tyler Pitre ◽  
Angela (Hong Tian) Dong ◽  
Aaron Jones ◽  
Jessica Kapralik ◽  
Sonya Cui ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Cohort Study ◽  
Hospital Mortality ◽  
Disease Severity ◽  
Retrospective Cohort Study ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Kidney Injury ◽  
Icu Admission

Background: The incidence of acute kidney injury (AKI) in patients with COVID-19 and its association with mortality and disease severity is understudied in the Canadian population. Objective: To determine the incidence of AKI in a cohort of patients with COVID-19 admitted to medicine and intensive care unit (ICU) wards, its association with in-hospital mortality, and disease severity. Our aim was to stratify these outcomes by out-of-hospital AKI and in-hospital AKI. Design: Retrospective cohort study from a registry of patients with COVID-19. Setting: Three community and 3 academic hospitals. Patients: A total of 815 patients admitted to hospital with COVID-19 between March 4, 2020, and April 23, 2021. Measurements: Stage of AKI, ICU admission, mechanical ventilation, and in-hospital mortality. Methods: We classified AKI by comparing highest to lowest recorded serum creatinine in hospital and staged AKI based on the Kidney Disease: Improving Global Outcomes (KDIGO) system. We calculated the unadjusted and adjusted odds ratio for the stage of AKI and the outcomes of ICU admission, mechanical ventilation, and in-hospital mortality. Results: Of the 815 patients registered, 439 (53.9%) developed AKI, 253 (57.6%) presented with AKI, and 186 (42.4%) developed AKI in-hospital. The odds of ICU admission, mechanical ventilation, and death increased as the AKI stage worsened. Stage 3 AKI that occurred during hospitalization increased the odds of death (odds ratio [OR] = 7.87 [4.35, 14.23]). Stage 3 AKI that occurred prior to hospitalization carried an increased odds of death (OR = 5.28 [2.60, 10.73]). Limitations: Observational study with small sample size limits precision of estimates. Lack of nonhospitalized patients with COVID-19 and hospitalized patients without COVID-19 as controls limits causal inferences. Conclusions: Acute kidney injury, whether it occurs prior to or after hospitalization, is associated with a high risk of poor outcomes in patients with COVID-19. Routine assessment of kidney function in patients with COVID-19 may improve risk stratification. Trial registration: The study was not registered on a publicly accessible registry because it did not involve any health care intervention on human participants.

scholarly journals Survival analysis of elderly patients over 65 years old with stage II/III gastric cancer treated with adjuvant chemotherapy after laparoscopic D2 gastrectomy: a retrospective cohort study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yanrui Liang ◽  
Liying Zhao ◽  
Hao Chen ◽  
Tian Lin ◽  
Tao Chen ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Cohort Study ◽  
Adjuvant Chemotherapy ◽  
Elderly Patients ◽  
Retrospective Cohort ◽  
Stage Iii ◽  
Rank Test ◽  
Oral Capecitabine ◽  
D2 Gastrectomy ◽  
Log Rank Test

Abstract Background The benefits of adjuvant chemotherapy for elderly patients with gastric cancer (GC) remain unknown because elderly patients are underrepresented in most clinical trials. This study aimed to evaluate the effectiveness and complications of adjuvant chemotherapy in patients > 65 years of age after laparoscopic D2 gastrectomy. Methods This was a single-center retrospective cohort study of elderly patients (> 65 years) with stage II/III GC who underwent curative laparoscopic D2 gastrectomy with R0 resection between 2004 and 2018. The adjuvant chemotherapy regimens included monotherapy (oral capecitabine) and doublet chemotherapy (oral capecitabine plus intravenous oxaliplatin [XELOX] or intravenous oxaliplatin, leucovorin, and 5-fluorouracil [FOLFOX]). The data were retrieved from a prospectively registered database maintained at the Department of General Surgery in Nanfang Hospital, China. The patients were divided as surgery alone and surgery plus adjuvant chemotherapy (chemo group). The overall survival (OS), disease-free survival (DFS), chemotherapy duration, and toxicity were examined. Results There were 270 patients included: 169 and 101 in the surgery and chemo groups, respectively. There were 10 (10/101) and six (6/101) patients with grade 3+ non-hematological and hematological adverse events. The 1−/3−/5-year OS rates of the surgery group were 72.9%/51.8%/48.3%, compared with 90.1%/66.4%/48.6% for the chemo group (log-rank test: P = 0.018). For stage III patients, the 1−/3−/5-year OS rates of the surgery group were 83.7%/40.7%/28.7%, compared with 89.9%/61.2%/43.6% for the chemo group (log-rank test: P = 0.015). Adjuvant chemotherapy was significantly associated with higher OS (HR = 0.568, 95%CI: 0.357–0.903, P = 0.017) and DFS (HR = 0.511, 95%CI: 0.322–0.811, P = 0.004) in stage III patients. Conclusions This study suggested that adjuvant chemotherapy significantly improves OS and DFS compared with surgery alone in elderly patients with stage III GC after D2 laparoscopic gastrectomy, with a tolerable adverse event profile.

scholarly journals Diagnosis and management of polycystic ovary syndrome in the UK (2004–2014): a retrospective cohort study

BMJ Open ◽  
2016 ◽  
Vol 6 (7) ◽  
pp. e012461 ◽  
Author(s):  
Tao Ding ◽  
Gianluca Baio ◽  
Paul J Hardiman ◽  
Irene Petersen ◽  
Cormac Sammon
Keyword(s):  
Cohort Study ◽  
Polycystic Ovary Syndrome ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Polycystic Ovary ◽  
Ovary Syndrome ◽  
Diagnosis And Management ◽  
The Uk
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