P117 THE IMPACT OF ELDERLY ON SURGICAL OUTCOMES AFTER IVOR-LEWIS ESOPHAGECTOMY: REVIEW OF A SINGLE INSTITUTION EXPERIENCE

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
A Cossu ◽  
P Parise ◽  
F Puccetti ◽  
M Palucci ◽  
R Cerchione ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Elderly Patients ◽  
Morbidity Rate ◽  
High Morbidity ◽  
Consecutive Series ◽  
Ivor Lewis ◽  
High Morbidity Rate ◽  
Group A ◽  
Group B ◽  
The Impact

Abstract Background Esophagectomy is a surgical procedure burdened by a high morbidity rate. The effect of minimally invasive (MI) approach on elderly patients is still not clear. Aim of this study was to analyze the impact of MI approach on post-operative course according to the patient age. Methods A consecutive series of 692 patients underwent to elective oncological esophagectomy between 1997 and 2017. All data were entered into a prospective database. Patients submitted to 3-flield or trans-hiatal esophagectomy were excluded and only Ivor-Lewis open, hybrid or totally minimally invasive esophagectomy were evaluated. Patients were stratified according to age in 3 groups: Group A (≤ 50 years) 53 patients, Group B (> 51 and < 70 years) 269 and Group C (were ≥71 years) 126. Clinical and pathological factors influencing surgical outcome were evaluated. Complications were classified according to Clavien-Dindo (CD). Results As expected outcomes worsened with patients age (CD ≥ 3b: 7.5% group A, 13% group B and 21% group C. p=0.001), mortality (0% group A, 3% group B and 5.5% group C. p=0.035) and length of stay (10 days group A, 11 days group B and 13 days group C. p=0.001). A statistically significant higher incidence of anastomostic leaks was observed among patients submitted to totally MI esophagectomy in group C vs A and B that were respectively 12,5%, 0% and 7%. Major respiratory complications were not statistically different among these 3 three sub-group. Conclusions Old age has a significant impact on outcomes after esophagectomy. In this subset of patients a MI approach could also increase postoperative morbidity. Elderly patients should be carefully selected before to be submitted to MI esophagectomy.

PS01.227: THE IMPACT OF ELDERLY ON SURGICAL OUTCOMES AFTER IVOR-LEWIS ESOPHAGECTOMY: REVIEW OF A SINGLE INSTITUTION EXPERIENCE

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 114-114
Author(s):  
Andrea Cossu ◽  
Paolo Parise ◽  
Francesco Puccetti ◽  
Leonardo Garutti ◽  
Carlo Ferrari ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Elderly Patients ◽  
Conflicts Of Interest ◽  
High Morbidity ◽  
Consecutive Series ◽  
Ivor Lewis ◽  
High Morbidity Rate ◽  
Group A ◽  
Group B ◽  
The Impact

Abstract Background Esophagectomy is a surgical procedure burdened by a high morbidity rate. The effect of minimally invasive (MI) approach on elderly patients is still not clear. Aim of this study was to analyze the impact of MI approach on post-operative course according to the patient age. Methods A consecutive series of 692 patients underwent to elective oncological esophagectomy between 1997 and 2017. All data were entered into a prospective database. Patients submitted to 3-flield or trans-hiatal esophagectomy were excluded and only Ivor-Lewis open, hybrid or totally minimally invasive esophagectomy were evaluated. Patients were stratified according to age in 3 groups: Group A (≤ 50 years) 53 patients, Group B (> 51 and < 70 years) 269 and Group C (were ≥ 71 years) 126. Clinical and pathological factors influencing surgical outcome were evaluated. Complications were classified according to Clavien-Dindo (CD). Results As expected outcomes worsened with patients age (CD ≥ 3b: 7.5% group A, 13% group B and 21% group C. P = 0.001), mortality (0% group A, 3% group B and 5.5% group C. P = 0.035) and length of stay (10 days group A, 11 days group B and 13 days group C. P = 0.001). A statistically significant higher incidence of anastomotic leaks was observed among patients submitted to totally MI esophagectomy in group C vs A and B that were respectively 12,5%, 0% and 7%. Major respiratory complications were not statistically different among these 3 three sub-groups. Conclusion Old age has a significant impact on outcomes after esophagectomy. In this subset of patients a MI approach could also increase postoperative morbidity. Elderly patients should be carefully selected before to be submitted to MI esophagectomy. Disclosure All authors have declared no conflicts of interest.

scholarly journals The efficacy of primary closure following incision and drainage of lactational breast abscess over traditional open method

2021 ◽  
Vol 8 (12) ◽  
pp. 3501
Author(s):  
Ruksana Parvin ◽  
Ahmed Sharif ◽  
Mosammat Bilkis Parvin ◽  
Kazi Sohel Iqbal ◽  
Golshan Ara Kohinoor ◽  
...  
Keyword(s):  
Primary Closure ◽  
Morbidity Rate ◽  
High Morbidity ◽  
Breast Abscess ◽  
Incision And Drainage ◽  
Open Method ◽  
Medical College ◽  
High Morbidity Rate ◽  
Group A ◽  
Group B

Background: The incidence of breast abscess ranges from 0.4 to 11% of all lactating mothers. Although breast abscess is a serious common complication of mastitis with high morbidity rate, there is a lack of high-quality randomized trial to demonstrate the best treatments.Methods: The Study was conducted in the Department of Surgery of Universal medical college and hospital, Dhaka, Bangladesh and MH Samorita hospital and medical college. It was a randomized controlled trial to see the efficacy of primary closure following incision and drainage of lactational breast abscess over traditional open method. Total 120 population were randomly selected in group A (60 patients) and group B (60 patients) and data was collected with their signed ethical consent. The study was conducted from January 2014 to December 2019. Collected data were classified, edited, coded and entered into the computer for statistical analysis by using Statistical package for social sciences (SPSS) version 22.Results: In patients of group A, most breast abscesses healed successfully with a nicer circumareolar scar, earlier healing, lesser number of hospital visits and lower total cost as compared to patients in group B. There was early resumption of breastfeeding and better patient satisfaction seen in group A.Conclusions: Primary closure of lactational breast abscess following incision and drainage is an effective modality of treatment of lactational breast abscess and it should be the first line of treatment, especially for larger and multilocular breast abscesses while traditional incision and drainage should be reserved for abscesses with gangrenous skin changes, where primary closure is not justified.

scholarly journals The Impact of Unilateral or Bilateral Cataract Surgery on Visual Acuity and Life Quality of Elderly Patients

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Lei Zuo ◽  
Haidong Zou ◽  
Xinfeng Fei ◽  
Weiqi Xu ◽  
Jianhong Zhang
Keyword(s):  
Visual Acuity ◽  
Elderly Patients ◽  
Cataract Surgery ◽  
Life Quality ◽  
Weighted Average ◽  
Bilateral Cataract ◽  
Surgical Methods ◽  
Group A ◽  
Group B ◽  
The Impact

In the current study, the CLVQOL was used to assess VRQOL before unilateral or bilateral cataract surgery and at the end of the follow-up period in order to determine the greater beneficial mode of surgery for patients, if one of the two surgical methods is more beneficial over the other. The patients were classified as receiving unilateral (group A) and bilateral cataract surgery (group B). There were no significant differences between groups A and B before the operation in terms of life quality scores, binocular weighted average LogMAR BCVA, age, educational level, gender, systematic and ocular comorbidities, and the complications of the operation. It was shown that visual acuity improved more significantly with bilateral cataract surgery than with unilateral surgery in elderly patients with a high preoperative disease burden in Shanghai city. However, the improvement in life quality was not different in patients receiving either bilateral or unilateral cataract surgery.

The Use of Paravertebral Analgesia in the Management of Pain in the Elderly Patient With Rib Fractures

2020 ◽  
pp. 000313482093355
Author(s):  
Tarik Wasfie ◽  
Adam Howell ◽  
N Cwalina ◽  
Raquel Yapchai ◽  
Jennifer Hille ◽  
...  
Keyword(s):  
Elderly Patients ◽  
The Elderly ◽  
Rib Fractures ◽  
Morbidity Rate ◽  
Control Group ◽  
High Morbidity ◽  
Pain Scores ◽  
High Morbidity Rate ◽  
Significant Difference ◽  
The Mean

Background Elderly patients with rib fractures carry a high morbidity rate, particularly due to pulmonary complications as decreased respiratory efforts ensue secondary to pain. Risk of bleeds in the elderly on anticoagulant therapy is high. The effort to reduce narcotic use in patients is now a health care priority. We propose that the use of paravertebral analgesia (PVA) pumps is an alternative pain control method with less risk and easy placement. Methods Two hundred and seventy-nine patients were admitted with multiple fractured ribs to the Trauma Center of Community Hospital and treated with the application of continuous PVA via a pump (72 patients). Pain scores were recorded before and after the initiation of the pump. These patients were compared with a group of the remaining 207 patients who received intravenous narcotics only. Results The mean change from baseline in pain scores for all patients was 1.43 (SD = 2.75). The mean change in pain for the treatment group was 1.93 (SD = 2.60), and the change in pain for the control group was 1.24 (SD = 2.79). Change in pain differed between groups (1.3 vs 1.8; P = .01) although it was a small difference. After adjusting for age, gender, Injury Severity Score, Glasgow Coma Scale, number of fractures, and comorbid conditions, there was no significant difference in pain post-procedure (odds ratio = 0.75; P = 0.39) with an effect size of 30% and total sample size of 279. Conclusion The PVA pump using bupivacaine is an effective safe and alternative method for managing elderly patients with rib fractures eliminating the serious side effects associated with narcotics.

Citrobacter freundiicausing pharyngitis and secondary retropharyngeal abscess with intrathoracic extension to the diaphragm: minimally invasive management of a rare case

2010 ◽  
Vol 124 (5) ◽  
Author(s):  
A Trinidade ◽  
V Sekhawat ◽  
Z Andreou ◽  
J Meldrum ◽  
S Kamat ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Head And Neck ◽  
Clinical Course ◽  
Retropharyngeal Abscess ◽  
Morbidity Rate ◽  
Suction Catheter ◽  
High Morbidity ◽  
Pharyngeal Wall ◽  
Invasive Approach ◽  
High Morbidity Rate

AbstractIntroduction:Citrobacter freundiiis a rare but potentially aggressive cause of pharyngitis which may progress to retropharyngeal abscess with diaphragmatic extension.Objective:To raise awareness of: (1) citrobacter as a potential cause of head and neck infection, including retropharyngeal abscess; (2) a novel surgical approach to draining such an abscess; and (3) citrobacter's particular biological properties which may affect the clinical course.Method:Case report.Results:The abscess was drained via a minimally invasive posterior pharyngeal wall incision and placement of a suction catheter into the mediastinum through this incision. Residual intrathoracic collections were drained by the cardiothoracic team via percutaneous aspiration. The patient made a full recovery.Conclusion:Early recognition of citrobacter head and neck infections, an awareness of the peculiarities of the clinical course of such infections, and timely surgical intervention can prevent catastrophic outcomes. A minimally invasive approach to mediastinal collections can be considered as a viable alternative to open thoracotomy, which carries a high morbidity rate.

scholarly journals The influence of habitat factors on the prevalence of kidney and bladder cancer in bioclimatic zones of Primorsky krai

2017 ◽  
Vol 98 (3) ◽  
pp. 423-429
Author(s):  
P F Kiku ◽  
G N Alekseeva ◽  
V G Moreva ◽  
M V Volkov ◽  
S V Yudin
Keyword(s):  
Bladder Cancer ◽  
Morbidity Rate ◽  
Malignant Neoplasms ◽  
High Morbidity ◽  
Primorsky Krai ◽  
Urologic Oncology ◽  
Ecological Zones ◽  
High Morbidity Rate ◽  
Habitat Factors ◽  
The Impact

Aim. To evaluate the prevalence of kidney cancer and bladder cancer under the influence of environmental factors in different bioclimatic and ecological zones of Primorsky Krai. Methods. The initial data were the incidence of kidney and bladder cancer (form №12) according to administrative territories of Primorsky Krai during the period from 1994 to 2014. In assessing the risk of prevalence of malignant neoplasms of kidneys and bladder in bioclimatic zones (maritime climate of the coast, transitional climate from maritime to continental and continental climate), ranking of territories of the region by zones of ecological stress was used: critical, intense, satisfactory, and relatively benign. To calculate the impact of habitat factors on the urologic oncology, information entropy and correlation and regression analyses were used. Results. The groups of areas with low, medium and high incidence of malignant neoplasms of the bladder and kidneys were distinguished. High prevalence of oncourologic pathology was determined in the areas of critical and intense environmental situation, where the coal, mining and chemical industry, construction industry, machine-building plants are located, and in areas with intensive chemicalization of agriculture. It was revealed that bladder cancer prevalence has a tendency to rise from the continental bioclimatic zone to the coast in all ecological zones, mainly due to differences in the structure of coast and continental areas bioclimate. It was shown that high morbidity rate is associated with drinking water quality, overall pollution of the environment, and depends on the chemical composition of groundwater and sanitary condition of soils. Conclusion. Ranking of territories by the prevalence of oncourology gives the possibility to make further operational decisions on the development of the complex of top-priority preventive and health-improving activities for specific areas.

P54 INCIDENCE AND OUTCOME OF HIATAL HERNIA AFTER OESOPHAGECTOMY: COMPARISON OF TRADITIONAL OPEN AND MINIMALLY INVASIVE APPROACH

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Sanberg Ljungdalh Jonas ◽  
Markus Stilling Nicolaj ◽  
Patrick Ainsworth Alan ◽  
Hareskov Larsen Michael
Keyword(s):  
Minimally Invasive ◽  
Hiatal Hernia ◽  
Malignant Disease ◽  
University Hospital ◽  
Morbidity Rate ◽  
High Morbidity ◽  
Electronic Patient Records ◽  
Invasive Approach ◽  
High Morbidity Rate

Abstract Aim The primary aim of this retrospective study is to evaluate the incidence of symptomatic and asymptomatic hiatal hernia (HH) in patients who have undergone intended curative open or minimally invasive oesophagectomy (MIO) for cancer of the oesophagus in a high-volume surgical centre. The secondary aim is to describe the treatment and outcome after HH treatment. Background & Methods MIO for the treatment of oesophageal cancer has emerged as an alternative to traditional open oesophagectomy without compromising disease free or overall survival1. HH of abdominal viscera other than the gastric conduit is an infrequent but potentially life-threatening complication following oesophagectomy. HH may present with grievous complications, such as severe respiratory failure, intestinal ischemia with perforation, bowel obstruction, and strangulation leading to emergency surgery2,3. Surgical repair of these HHs is associated with a high morbidity rate and in the emergent setting even a high mortality4. In meta-analysis, the pooled incidence of symptomatic HH after MIO was 4.5 %, compared to a pooled incidence of 1.0 % after open oesophagectomy5. However, studies on the subject, often do not describe whether patients are asymptomatic or simply have not been examined for the existence of HH. The actual HH incidence may therefore be underestimated and may be more sufficiently reported when including patient material with comprehensive follow-up. This retrospective cohort study includes all patients (n≈455) who have undergone curative intended resection for malignant disease in the oesophagus at The Department of Surgery, Odense University Hospital, from 1th January 2012 – 31th December 2018. Patient demography, perioperative data including surgical approach and follow-up, including occurrence and treatment of hiatal hernia, mortality and recurrence of malignant disease will be extracted from complete electronic patient records. Follow-up ranges from 6-84 months. Primary outcome is occurrence of hiatal hernia after oesophagectomy determined by CT-scan or during surgery. Results As of abstract deadline for ESDE 2019, we have only just received permission for the study from The Danish Patient Safety Authority and can unfortunately not present our results yet. However, we expect that results are ready for presentation at ESDE 2019 and hope for your understanding.

scholarly journals Complicated Silicosis Associated with Mycobacterium tuberculosis Infection

2018 ◽  
Vol 69 (1) ◽  
pp. 27-31
Author(s):  
Patricia Petculescu ◽  
Andrei Năstase ◽  
Ana-Maria Mănescu ◽  
Marina Ruxandra Oțelea
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Latent Tuberculosis ◽  
Morbidity Rate ◽  
High Morbidity ◽  
Mycobacterium Tuberculosis Infection ◽  
High Morbidity Rate ◽  
Third Stage ◽  
Inducible Protein ◽  
The Impact

Abstract Romania is recognized as the European country with the highest tuberculosis rate in Europe. The association of tuberculosis with silicosis determines synergistic immunosuppression of the alveolar macrophages resulting in a higher grade of pulmonary parenchymal destruction and consequently respiratory failure. The case report approaches a patient with third stage of silicosis and associated active secondary pulmonary tuberculosis disease with positive smears. The impact of the Mycobacterium tuberculosis (MTB) infection’s activation is known to be severe, worsening the prognosis of silicosis and reducing the patient’s quality of life. Regarding the high morbidity rate of tuberculosis, an early diagnosis of tuberculosis in patients with silicosis is paramount, and sometimes cannot be achieved by usual bacteriological tests. Therefore, a better strategy is to be considered in silicotuberculosis, namely to prevent the progression of the latent tuberculosis foci by testing the positive predictive value of up-to-date tests such as IFN-γ inducible protein 10 biomarker, which may allow early detection and treatment.

scholarly journals Short-Term Outcomes in Elderly Patients with SARS-CoV-2 Infections Discharged from Community Hospitals

2021 ◽  
Vol 6 (4) ◽  
Keyword(s):  
Elderly Patients ◽  
Community Hospital ◽  
Care Home ◽  
Morbidity Rate ◽  
High Morbidity ◽  
Very Elderly ◽  
Short Term ◽  
Retrospective Case ◽  
High Morbidity Rate ◽  
Hospitalised Patients

Introduction: Clinical outcomes from very elderly hospitalised patients with SARS-COV-2 (Covid-19), are poor, with a reported in-patient mortality as high as 20%. Age, sex, comorbidities, ethnicity and deprivation have all been shown to correlate with worse outcomes in patients with Covid-19, however the outcomes of elderly hospitalised patients once discharged remains unknown. We looked at our cohort of very elderly patients treated within community hospital settings. Methods & Results: A retrospective case note analysis was undertaken within our 222 bedded community hospital structure during the first wave of the pandemic from April to August 2020. A total of 129 patients were treated during this period. The average age of the patients was 78.8 ± 2.7 years. In patient mortality was 11% (14 patients). 83% of patients were discharged from the hospitals. 27% were discharged to care home facilities. At 90 days, 83% of patients were still alive but a third of these patients were re-admitted into hospital with various different diagnoses. Conclusion: Elderly patients who survived Covid-19 infection and left hospital have a relatively high mortality rate in the short-term. Also connected with this is a high morbidity rate and therefore care must be directed within primary care to ensure that this group stay out of hospitals.

scholarly journals The benefits of protective defunctioning ileostomy in ileal perforation surgery

2019 ◽  
Vol 6 (7) ◽  
pp. 2565
Author(s):  
Abhilekh Tripathi ◽  
Anjali Sethi ◽  
Deepak Sethi
Keyword(s):  
Hospital Stay ◽  
Psychological Impact ◽  
High Morbidity ◽  
Ileal Perforation ◽  
Defunctioning Ileostomy ◽  
Primary Surgery ◽  
Protective Ileostomy ◽  
Group A ◽  
Group B ◽  
The Impact

Background: Perforation of bowel, particularly ileal perforation, is a significant emergency surgical problem in developing and underdeveloped nations and usually associated with high morbidity and mortality. The study is focussed on evaluating the impact of protective ileostomy in ileal perforation and to compare its outcome in term of post operative complication, hospital stay, psychological impact and mortality with primary surgery without ileostomy and observe its effect on prognosis of patient as a whole. Aim of the study we compared two modalities of treatment, primary surgery without ileostomy v/s primary surgery with protective defunctioning ileostomy with respect to post operative complications, duration of hospital stay, morbidity, mortality and psychological impact.  Methods: We studied 50 patients of ileal perforation (diagnosed per-operatively) admitted to tertiary level hospital and operated upon for laparotomy. Patients were divided in 2 groups: Group A = Protective defunctioning ileostomy along with primary surgery, and Group B = Primary surgery alone. Primary surgery includes primary closure of perforation or resection and end to end anastomosis.Results: The commonest cause of non-traumatic ileal perforation was typhoid (52%) followed by non specific, tuberculosis and diverticulitis. Different types of operative procedures were performed. In Group A, total no. of dreaded complications like faecal fistula was 1 while in Group B, 10 patients developed faecal fistula. Other complications like wound infection and wound dehiscence were 28% in Group A while 96% in Group B. Overall mortality rate was 24% with 12% mortality in group A and 36% in group B. Mean hospital stay in Group A patient was 12.640±5.75 days (1-23 days) and those of group B was 23.760±16.04 days (5 - 59 days).  Conclusions: Construction of protective defunctioning ileostomy in case of distal ileal perforation repair or anastomosis greatly reduces the dreaded complication and mortality in comparison to perforation repair or anastomosis without protective ileostomy. Although it is associated with ileostomy related complications, but they are only temporary and obviously no more than the price of life saved. 

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