657 ROUTINE ESOPHAGRAMS FOLLOWING HIATUS HERNIA REPAIR MINIMISES REOPERATIVE MORBIDITY: A MULTICENTER COMPARATIVE COHORT STUDY

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
David Liu ◽  
Melissa Wee ◽  
James Grantham ◽  
Bee Ong ◽  
Stephanie Ng ◽  
...  
Keyword(s):  
Hernia Repair ◽  
Hiatus Hernia ◽  
Functional Outcomes ◽  
Gastric Resection ◽  
Postoperative Morbidity ◽  
Early Complications ◽  
Esophageal Obstruction ◽  
Comparative Cohort Study ◽  
One Year

Abstract   Hiatus hernia repairs are common. Early complications such as re-herniation, esophageal obstruction and perforation, although infrequent, incur significant morbidity. Here, we determine whether routine postoperative esophagrams following hiatus hernia repair may expedite the surgical management of these complications, reduce reoperative morbidity, and improve functional outcomes. Methods Analysis of a prospectively-maintained database of 1829 hiatus hernia repairs undertaken in 14 hospitals from 1 January 2000 to 30 September 2020. 1571 (85.9%) patients underwent a postoperative esophagram which was reviewed. An early (<14 days) reoperation was performed in 44 (2.4%) patients. Results Compared to those without an esophagram, patients who received one prior to reoperation (n = 37) had a shorter time to diagnosis (2.4 vs. 3.9 days, p = 0.041) and treatment (2.4 vs. 4.3 days, p = 0.037) of their complications. This was associated with decreased open surgery (10.8% vs. 42.9%, p = 0.034), gastric resection (0.0% vs. 28.6%, p = 0.022), postoperative morbidity (13.5% vs. 85.7%, p < 0.001), ICU admission (16.2% vs. 85.7%, p < 0.001), and length-of-stay (7.3 vs. 18.3 days, p = 0.009). Furthermore, patients who underwent early reoperations for asymptomatic re-herniation had less complications and superior functional outcomes at one-year follow-up than those who needed surgery for symptomatic recurrences later on. Conclusion Postoperative esophagrams decreases the morbidity associated with early and late reoperations following hiatus hernia repair, and should be considered for routine use.

scholarly journals Superior Capsular Reconstruction Patients Have High Rates of Return to Sports and Similar Functional Outcomes Compared to a Reverse Shoulder Arthroplasty Matched Cohort

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0027
Author(s):  
Brandon C. Cabarcas ◽  
Grant Hoerig Garcia ◽  
Joseph Liu ◽  
Gregory Louis Cvetanovich ◽  
Anirudh K. Gowd ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Return To Work ◽  
Functional Outcomes ◽  
Return To Sport ◽  
Postoperative Outcome ◽  
Rotator Cuff Tears ◽  
Return To Sports ◽  
Superior Capsular Reconstruction ◽  
One Year

Objectives: Superior capsular reconstruction (SCR) is a relatively new procedure to address irreparable rotator cuff tears and rotator cuff arthropathy. Biomechanical studies have produced favorable results on cadaveric models, but few studies have evaluated clinical outcomes, and none have addressed return to sport (RTS). The purpose of this study was to evaluate rates of RTS and functional outcomes after SCR compared to a reverse total shoulder arthroplasty (rTSA) matched cohort. Methods: A prospectively collected registry was queried retrospectively for consecutive patients who underwent SCR from 2015 to 2016. Inclusion criteria were ≥2 tendon irreparable rotator cuff tear by arthroscopic evaluation and minimum one-year follow up. All eligible SCR patients were matched by gender, age, handedness, and follow up time to patients that underwent rTSA with a similar preoperative diagnosis. All surgeries were performed by a single surgeon at one institution with consistent operative techniques. Patients were evaluated with the ASES questionnaire, VAS Pain Scale, as well as VR/SF-12 and VR6D. Patients were also administered a detailed outcomes survey regarding surgical history and return to sport and work activities. Results: Overall 75.0% of 32 eligible patients were available at follow up. Average age at surgery and follow up did not significantly differ between cohorts (p>0.500 both). Postoperative outcome scores for ASES, VAS, VR/SF-12, and VR6D did not differ (p>0.310 for all) between cohorts. Overall RTS rate was 77.8% for SCR and 87.5% for rTSA (p > 0.610). Average months to return to sports was significantly greater after SCR (7.3 ± 3.0) compared to rTSA (3.5 ± 2.2; p = 0.032). Patients in both cohorts participated in golf, weight-lifting, gym activity, basketball and cycling postoperatively. Direct RTS for these sports are displayed in Fig. 1. Return to work rate was 71.4% (10/14) SCR and 50.0% (4/8) rTSA (p = 0.326) at average 2.7 ± 2.8 and 1.9 ± 1.9 months, respectively (p = 0.591). Stratified by duty status, rates of return to work were sedentary (100% both SCR and rTSA), light (100% both SCR and rTSA), moderate (0% SCR and 66.67% rTSA), and heavy (0% both SCR and rTSA). Overall, 85.71% SCR patients and 90.0% rTSA patients were satisfied or very satisfied with their general postoperative outcome. Conclusion: At short-term follow-up, SCR patients had RTS rates comparable to rTSA patients with irreparable rotator cuff tears. However, time to RTS was more prolonged after SCR. Outcome scores did not significantly differ between the two cohorts, suggesting that SCR may achieve postoperative function and pain reduction similar to rTSA at one year. Return to work was also similar, although rates were not as high as return to sport. When stratified by duty status, return to more intense physical work demands was not consistent in either cohort. Despite this, over 85% of SCR and rTSA patients were satisfied postoperatively. The findings of this study demonstrate that SCR patients have high RTS levels, as well as similar functional outcomes and satisfaction compared to rTSA for irreparable rotator cuff tears. Clinicians can utilize this information for preoperative counseling, particularly with younger more athletic patients, considering SCR or rTSA for an irreparable rotator cuff tear.

Complex Ventral Hernia Repair with Acellular Dermal Matrices: Clinical and Quality of Life Outcomes

2017 ◽  
Vol 83 (2) ◽  
pp. 141-147 ◽  
Author(s):  
John Scott Roth ◽  
Amanda Zachem ◽  
Margareta Plymale ◽  
Daniel L. Davenport
Keyword(s):  
Quality Of Life ◽  
Hernia Repair ◽  
Ventral Hernia Repair ◽  
Short Form ◽  
Abdominal Wall Reconstruction ◽  
One Year ◽  
Dermal Matrices ◽  
Acellular Dermal

Acellular dermal matrices (ADMs) are used in conjunction with complex hernia repair, but their efficacy is often debated. This study assesses clinical and quality of life (QOL) outcomes in multiply comorbid patients undergoing complex ventral hernia repair using ADMs. After obtaining institutional review board approval, a prospective study was conducted evaluating patients undergoing complex ventral incisional hernia repair with abdominal wall reconstruction (AWR) using either human (Flex HD) or porcine ADM (Strattice). Patient accrual occurred over three years. Demographics, comorbid conditions, and operative details were recorded. Postoperative two-week, six-week, six-month, and one-year follow-up occurred. Primary outcomes measures include wound occurrence, QOL parameters using the Short Form-12 health survey, and hernia recurrence. Groups were compared using chi-squared, Fisher's exact, Mann-Whitney U, or t tests as appropriate. Significance was set at P < 0.05. Thirty-five patients underwent hernia repair using ADM: mean age = 58 years, mean body mass index = 34 kg/m2, >50 per cent Centers for Disease Control and Prevention Wound Class II and above, >50 per cent recurrent hernia repair, and 25 per cent current or previous mesh infection. Twenty patients (57%) experienced surgical site occurrences, 15 (43%) wound infections, and 5 (14%) recurrences with a median follow-up of one year. All Short Form-12 QOL indicators improved at 12 months compared with baseline (NS). Outcomes were similar between mesh types. In conclusion, abdominal wall reconstruction for complex hernias using biologic materials is safe but has significant morbidity. Wound complications occur in over half of all patients and are not impacted by ADM type. There is no decrement in QOL one year after hernia repair despite associated morbidity.

scholarly journals Basic self-disturbance in subjects at clinical high risk for psychosis: relationship with clinical and functional outcomes at one year follow-up

2021 ◽  
pp. 113942
Author(s):  
Tor Gunnar Værnes ◽  
Jan Ivar Røssberg ◽  
Ingrid Melle ◽  
Barnaby Nelson ◽  
Kristin Lie Romm ◽  
...  
Keyword(s):  
High Risk ◽  
Functional Outcomes ◽  
Clinical High Risk ◽  
One Year

scholarly journals Functional Outcomes of Perilunate Dislocation Injuries Treated With Deep Friction Massage: One Year Follow-Up

2019 ◽  
Vol 4 (12) ◽  
Author(s):  
Anna Pantouvaki̽ ◽  
George Velivasakis ◽  
Grigorios Kastanis
Keyword(s):  
Functional Outcomes ◽  
Chronic Pain Management ◽  
Severe Injuries ◽  
Good Tolerance ◽  
Perilunate Dislocation ◽  
Rehabilitation Programs ◽  
Therapeutic Value ◽  
Therapeutic Protocols ◽  
One Year

Perilunate injuries are the most complex severe injuries occurring in the wrist and there is a lack of suggested therapeutic protocols in literature, concerning rehabilitation programs. Although Deep friction massage is a widely known technique in the field of tendinopathies, ligamentous injuries and chronic pain management, its therapeutic value has not yet been documented in treatment of wrist lesions. The purpose of this study is to suggest that the technique should be considered as a good therapeutic method with good tolerance in patients and good functional outcomes and should be included in management of perilunate injuries.

scholarly journals MORTALITY AND FUNCTION AFTER SURGICALLY-TREATED HIP FRACTURE IN ADULTS YOUNGER THAN AGE 60

2017 ◽  
Vol 25 (4) ◽  
pp. 129-131 ◽  
Author(s):  
Babak Pourabbas ◽  
Mohammad Jafar Emami ◽  
Amir Reza Vosoughi ◽  
Hamideh Mahdaviazad ◽  
Zeinab Kargarshouroki
Keyword(s):  
Young Adults ◽  
Hip Fracture ◽  
Mortality Rate ◽  
Hip Fractures ◽  
Functional Outcomes ◽  
Pain Severity ◽  
Walking Aids ◽  
One Year ◽  
The One

ABSTRACT Objective: Hip fractures in young adults can cause poor functional capacity throughout life because of several complications. The purpose of this study was to prospectively evaluate 1-year mortality and functional outcomes for patients aged 60 years or younger with hip fracture . Methods: We prospectively obtained data for all consecutive patients aged 60 or younger with any type of hip fracture who were treated operatively between 2008 and 2014. After one year, patient outcomes were evaluated according to changes in pain severity, functional status (modified Barthel index), and mortality rate . Results: Of the total of 201 patients, 132 (65.7%) were men (mean age: 41.8 years) and 69 (34.3%) were women (mean age: 50.2 years) (p<0.001). Reduced pain severity was reported in 91.5% of the patients. The mean modified Barthel index was 22.3 in men and 18.6 in women (p<0.001). At the one-year follow-up, 39 cases (19.4%) were dependent on walking aids while only 17 patients (8.5%) used walking aids preoperatively (p<0.001). Seven patients (4 men and 3 women) died during the one-year follow-up period; 2 died in the hospital after surgery . Conclusion: Hip fractures in young adults have a low mortality rate, reduction in pain severity, and acceptable functional outcomes one year after surgery. Level of Evidence II, Prospective Comparative Study.

O168 VERY LONG-TERM (5-19 YEARS) FOLLOW-UP OF PARAESOPHAGEAL HERNIA REPAIR: PERMANENT MESH vs STANDARD CRUROPLASTY

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Pamela Milito ◽  
Simone Zanghì ◽  
Andrea Sironi ◽  
Emanuele Asti ◽  
Luigi Bonavina
Keyword(s):  
Hernia Repair ◽  
Hiatus Hernia ◽  
Paraesophageal Hernia ◽  
Synthetic Mesh ◽  
Hernia Recurrence ◽  
Paraesophageal Hernia Repair ◽  
Long Term Follow Up ◽  
Large Hiatus Hernia

Abstract Aim Aim of this comparative study was to analyze very long-term safety, symptomatic outcomes and rate of recurrence in a cohort of patients who underwent large hiatus hernia repair with or without synthetic mesh. Background & Methods The use of a permanent mesh to reinforce the hiatus could reduce the rate of radiological and symptomatic recurrences after laparoscopic paraesophageal hernia repair. However, strictures and even erosions into the esophageal lumen have been reported. Aim of this comparative study was to analyze very long-term safety, symptomatic outcomes and rate of recurrence in a cohort of patients who underwent large hiatus hernia repair with or without synthetic mesh. Observational cohort study using a prospectively maintained database. From November 2001 to September 2005, 39 consecutive patients underwent laparoscopic repair and fundoplication for large hiatus hernia (> 5 cm). Thirteen patients (Group M) received crural reinforcement with non-absorbable mesh, while 26 patients (Group S) underwent standard cruroplasty. Mesh-related complications, postoperative symptoms and hernia recurrence at very long-term follow-up through upper gastrointestinal endoscopy, GERD-HRQL and FOREGUT questionnaires. Results There were 23 women and 16 men, with a median age of 60 years (range 28-81). The hernia size was similar in both groups. Postoperative complications occurred in 2 patients (5.1%) and there was no mortality. The median long-term follow-up was 168 months (range 139-197 months, IQR: 23.5). At last follow-up visit, occasional (once a month) dysphagia occurred in 23% of Group M patients, but none required endoscopic dilatation. The hernia recurrence rate was 0. No short or long-term complications related to the use of the mesh were recorded. In group S, non of patients, complained of dysphagia, whereas 2 (7.7%) patients complained of occasional reflux symptoms and other 2 (7.7%) of dyspepsia. In 4 patients (15.4%), a small hiatus hernia recurrence or a partially slipped fundoplication was noted, but all patients were asymptomatic. GERD-HRQL scores significantly decrease in both groups (p<0.05). Conclusion Laparoscopic antireflux surgery with permanent prosthetic mesh is an effective and safe procedure in carefully selected patients with large hiatal hernia.

scholarly journals Comparison of complications after Ahmed versus Baerveldt implant in glaucoma patients: one year follow-up

2020 ◽  
Vol 13 (12) ◽  
pp. 1908-1914
Author(s):  
Sara Listyani Koentjoro ◽  
Iwan Soebijantoro ◽  
Vira Wardhana Istiantoro ◽  
Emma Rusmayani ◽  
Rini Sulastiwaty ◽  
...  
Keyword(s):  
Success Rate ◽  
Late Complications ◽  
Early Complications ◽  
Glaucoma Medication ◽  
Group 13 ◽  
The Mean ◽  
One Year ◽  
Baerveldt Implant ◽  
Glaucoma Implants

AIM: To compare surgical results of the Ahmed and Baerveldt implant procedures in glaucoma patients at 1y follow-up at Jakarta Eye Center (JEC) Eye Hospitals. METHODS: This cohort retrospective study was conducted on glaucoma patients aged ≥18y who had undergone Ahmed and Baerveldt implant surgery. Intraocular pressure (IOP), visual acuity, glaucoma medication, success rate, early and late postoperative complications, and the number of resurgeries were analyzed. RESULTS: A total of 351 eyes in the Ahmed group and 94 eyes in the Baerveldt group were included in this study. At 1y follow-up, the mean IOP was found to be significantly lower in the Baerveldt group (13±4.47 mm Hg) compared to the Ahmed group (15.02±5.73 mm Hg; P=0.025). Glaucoma medication was required in both the Ahmed and Baerveldt groups (58.92% vs 71.67%). Comparable success rate was found in both groups. The Ahmed group revealed a complete and qualified success of 86.82%, and failure of 13.17%. Similarly, the Baerveldt group showed complete and qualified success in 87.75% and failure in 12.25% cases. In the Ahmed group, 11.97% early complications, 26.06% late complications and 9.97% resurgeries were observed. In comparison, in the Baerveldt group, 23.40% early complications, 30.95% late complications and 11.70% resurgeries were observed. CONCLUSION: Both groups of glaucoma implants show significant IOP reduction, however, the Baerveldt implant group demonstrates greater IOP reduction with more failure rates and complications than the Ahmed implant group.

Abstract T P115: Racial/Ethnic Differences in Post-Stroke Rehabilitation Utilization and Functional Outcomes in the South Carolina Stroke Belt

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Charles Ellis ◽  
Andrea D Boan ◽  
Tanya N Turan ◽  
Shelly Ozark ◽  
David Bachman ◽  
...  
Keyword(s):  
South Carolina ◽  
Ethnic Differences ◽  
Functional Outcomes ◽  
Daily Living ◽  
Stroke Rehabilitation ◽  
Stroke Severity ◽  
Post Stroke ◽  
One Year ◽  
Racial Ethnic

Background: Significant racial and ethnic disparities in stroke incidence, severity, morbidity and mortality have been consistently reported, but there are limited reports on racial/ethnic differences in post-stroke rehabilitation utilization and long term functional outcomes. Objective: To examine racial and ethnic differences in post-stroke rehabilitation utilization and functional outcomes. Methods: We examined one year follow-up data collected as part of the STEP-South Carolina Project that was designed to measure clinical, treatment, and functional outcomes in post-stroke patients. We used univariate and multivariate regression analyses adjusted for stroke severity to examine racial-ethnic differences in rehabilitation utilization (occupational therapy, physical therapy, speech therapy) and functional outcomes using a 20 question measure of activities of daily living (ADL) & instrumental activities of daily living (IADL) performance, life participation and driving. Results: Data from 162 stroke survivors (106 White, 56 Black) were collected at one year follow-up. As shown in the table, no significant differences were found between Blacks and Whites for rehabilitation utilization. In multivariate comparisons controlling for NIHSS, Blacks were less likely to report independence in overall functional performance outcomes as well as specific measures of toileting, walking, transportation, laundry and shopping. In addition, fewer Blacks reported driving at one year post-discharge. Conclusions: Fewer Blacks exhibited ADL and IADL independence at one year post-stroke after controlling for stroke severity, despite the fact that there were no racial-ethnic differences in rehabilitation utilization. Future studies are needed to further understand the reason for this disparity in recovery

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