scholarly journals Risk of Bleeding after Colorectal Endoscopic Resection in Patients with Continued Warfarin Use Compared to Heparin Replacement: A Propensity Score Matching Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Katsuaki Inagaki ◽  
Ken Yamashita ◽  
Shiro Oka ◽  
Fumiaki Tanino ◽  
Noriko Yamamoto ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Endoscopic Resection ◽  
Warfarin Therapy ◽  
Colorectal Neoplasia ◽  
Perioperative Period ◽  
University Hospital ◽  
Risk Of Bleeding ◽  
Warfarin Group ◽  
Clinical Records

The Japan Gastroenterological Endoscopy Society (JGES) guidelines recommend continued warfarin treatment during gastroenterological endoscopic procedures with a high risk of bleeding as an alternative to heparin replacement in patients on warfarin therapy. However, there is insufficient evidence to support the use of warfarin in colorectal endoscopic resection (ER). The present study is aimed at verifying the risk of bleeding after ER for colorectal neoplasia (CRN) in patients with continued warfarin use. This was a single-center retrospective cohort study using clinical records. We assessed 126 consecutive patients with 159 CRNs who underwent ER (endoscopic mucosal resection, 146 cases; endoscopic submucosal dissection, 13 cases) at Hiroshima University Hospital between January 2014 and December 2019. Patients were divided into two groups: the heparin replacement group (79 patients with 79 CRNs) and the continued warfarin group (47 patients with 80 CRNs). One-to-one propensity score matching was performed to compare the bleeding rate after ER between the groups. The rate of bleeding after ER was significantly higher in the heparin replacement group than in the continued warfarin group for both before (10.1% vs. 1.3%, respectively; P = 0.0178 ) and after (11.9% vs. 0%, respectively; P = 0.0211 ) propensity score matching. None of the patients experienced thromboembolic events during the perioperative period. The risk of bleeding after colorectal ER was significantly lower in patients with continued warfarin use than in those with heparin replacement. Our data supports the recommendations of the latest JGES guidelines for patients receiving warfarin therapy.

scholarly journals Use of anticoagulants increases risk of bleeding after colorectal endoscopic submucosal dissection

2018 ◽  
Vol 06 (07) ◽  
pp. E857-E864 ◽  
Author(s):  
Ken Yamashita ◽  
Shiro Oka ◽  
Shinji Tanaka ◽  
Kazuki Boda ◽  
Daiki Hirano ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Perioperative Period ◽  
University Hospital ◽  
En Bloc ◽  
Risk Of Bleeding ◽  
Warfarin Group ◽  
Submucosal Dissection ◽  
Clinical Records

Abstract Background and study aims Japanese guidelines for gastroenterological endoscopy have recommended temporary withdrawal of anticoagulants (warfarin, direct oral anticoagulants [DOAC], or heparin) to prevent hemorrhagic complications during endoscopic submucosal dissection (ESD) for colorectal neoplasias (CRNs). However, serious thrombosis might occur during temporary withdrawal of anticoagulants. The current study aimed to evaluate outcomes with anticoagulants in patients undergoing ESD for CRNs. Patients and methods This study was a single-institution retrospective cohort study based on clinical records. We assessed 650 consecutive patients with 698 CRNs who underwent ESD at Hiroshima University Hospital between December 2010 and June 2016. The patients were divided into three groups: the warfarin group (19 patients with 19 CRNs), DOAC group (7 patients with 9 CRNs), and no-antithrombotics group (624 patients with 670 CRNs). We replaced warfarin with heparin 3 to 5 days before endoscopy. Although DOAC was suspended on the morning of endoscopy, we did not replace heparin. Results Bleeding after the procedure occurred in 26.3 % (5/19), 22.0 % (2/9), and 2.7 % (18/670) of patients in the warfarin, DOAC, and no-antithrombotics groups, respectively. In the warfarin group, four patients who bled after the procedure took not only warfarin but also other antiplatelets. En bloc resection rates were 94.7 % (18/19), 100 % (9/9), and 96.6 % (647/670) in the warfarin, DOAC, and no-antithrombotics groups, respectively. No patients experienced ischemic events in the perioperative period. Conclusions Among patients undergoing ESD for CRNs, risk of bleeding was higher among patients who took anticoagulants than among those who did not. In particular, careful attention to patients who took antiplatelets in addition to warfarin before ESD for CRNs is warranted.

scholarly journals The Effects of Anesthesiologist Experience on Postoperative Hoarseness After Double-Lumen Endotracheal Tube Intubation: A Single-Center Propensity Score-Matched Analysis

2020 ◽  
Author(s):  
Yuji Kamimura ◽  
Toshiyuki Nakanishi ◽  
Aiji Sato(Boku) ◽  
Satoshi Osaga ◽  
Eisuke Kako ◽  
...  
Keyword(s):  
Propensity Score ◽  
Endotracheal Tube ◽  
Propensity Score Matching ◽  
Lung Resection ◽  
Macintosh Laryngoscope ◽  
University Hospital ◽  
Double Lumen ◽  
Double Lumen Endotracheal Tube ◽  
Single Lumen ◽  
One To One

Abstract Background: Postoperative hoarseness after general anesthesia is associated with patient discomfort and dissatisfaction. A recent large retrospective study showed that single-lumen endotracheal tube intubation by a trainee did not alter the incidence of postoperative pharyngeal symptoms compared with that by a senior anesthesiologist. However, little is known about the relationship between anesthesiologist experience and hoarseness after double-lumen endotracheal tube intubation. We tested the hypothesis that double-lumen endotracheal tube intubation by a trainee increases the incidence of postoperative hoarseness compared with that by a senior anesthesiologist.Methods: This retrospective observational study included patients who underwent lung resection from April 2015 to March 2018 in a university hospital. Patients underwent double-lumen endotracheal tube intubation with a Macintosh laryngoscope. We divided the patients into two groups: one group comprising patients whose tracheas were intubated by a trainee anesthesiologist and the other comprising those whose tracheas were intubated by a senior anesthesiologist. The primary outcome was the incidence of postoperative hoarseness 24 h after surgery. We collected data on postoperative hoarseness using a checklist of postanesthetic adverse events. One-to-one propensity score matching was performed. P values of <0.05 were considered statistically significant.Results: There were 256 eligible patients; 153 patients underwent intubation by trainee anesthesiologists, and the remaining 103 patients underwent intubation by senior anesthesiologists. The one-to-one propensity score matching generated 96 pairs of patients for the groups. The incidence of postoperative hoarseness 24 h after the surgery was significantly higher in patients whose tracheas were intubated by a trainee anesthesiologist than in those whose tracheas were intubated by a senior anesthesiologist (9.4% vs. 2.1%, respectively; P = 0.03).Conclusions: Double-lumen endotracheal tube intubation by trainee anesthesiologists increased the incidence of postoperative hoarseness 24 h after the surgery compared with intubation by senior anesthesiologists.

scholarly journals Hybrid emergency rooms reduce the requirement of blood transfusion in patients with severe trauma

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Hiroaki Watanabe ◽  
Ryo Matsumoto ◽  
Shunsuke Kuramoto ◽  
Tomohiro Muronoi ◽  
Kazuyuki Oka ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Whole Blood ◽  
Injury Severity ◽  
Severe Trauma ◽  
Fresh Frozen Plasma ◽  
University Hospital ◽  
Clinical Effects ◽  
Study Results ◽  
Significant Difference

Abstract Background A hybrid emergency room (ER) is defined as an emergency unit with four functions—performing resuscitation, computed tomography (CT), surgery, and angiography. However, the safety and efficacy of performing CT in a hybrid ER are unclear in primary surveys. Therefore, this study aimed to evaluate the safety and clinical effects of hybrid ERs. Methods This retrospective observational study used data from the Shimane University Hospital Trauma Database from January 2016 to February 2019. Hospitalized patients with severe trauma and an injury severity score of ≥ 16 were divided into the non-hybrid ER group (n = 134) and the hybrid ER group (n = 145). The time from arrival to CT and interventions and the number of in-hospital survivors, preventable trauma deaths (PTD), and unexpected survivors (US) were assessed in both groups. Further, the amount of blood transfused was compared between the groups using propensity score matching. Results The time from arrival to CT and interventions was significantly reduced in the hybrid ER group compared to that in the non-hybrid ER group (25 vs. 6 min; p < 0.0001 and 101 vs. 41 min; p = 0.0007, respectively). There was no significant difference in the rate of in-hospital survivors (96.9% vs. 96.3%; p = 0.770), PTD (0% vs. 0%), and US (9.0 vs. 6.2%; p = 0.497) between the groups. The amount of blood transfused was significantly lower in the hybrid ER group than in the non-hybrid ER group (whole blood 14 vs. 8, p = 0.004; red blood cell 6 vs. 2, p = 0.012; fresh frozen plasma 9 vs. 6, p = 0.021). This difference was maintained after propensity score matching (whole blood 28 [10–54] vs. 6 [4–16.5], p = 0.015; RBC 8 [2.75–26.5] vs. 2 [0–8.5], p = 0.020, 18 [5.5–27] vs. 6 [3.5–7.5], p = 0.057). Conclusions The study results suggest that trauma treatment in a hybrid ER is as safe as conventional treatment performed in a non-hybrid ER. Further, hybrid ERs, which can reduce the time for trauma surveys and treatment, do not require patient transfer and can reduce the amount of blood transfused during resuscitation.

Influence of endoscopic resection on additional laparoscopic distal gastrectomy: a propensity score-matching analysis

Surgery Today ◽  
2020 ◽  
Vol 50 (10) ◽  
pp. 1290-1296
Author(s):  
Koji Shindo ◽  
Jaymel Castillo ◽  
Kenoki Ohuchida ◽  
Taiki Moriyama ◽  
Shuntaro Nagai ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Endoscopic Resection ◽  
Distal Gastrectomy ◽  
Laparoscopic Distal Gastrectomy ◽  
Propensity Score Matching Analysis

Non-valvular atrial fibrillation patients with low CHADS2 scores benefit from warfarin therapy according to propensity score matching subanalysis using the J-RHYTHM Registry

2015 ◽  
Vol 136 (2) ◽  
pp. 267-273 ◽  
Author(s):  
Akiko Chishaki ◽  
Naoko Kumagai ◽  
Naohiko Takahashi ◽  
Tetsunori Saikawa ◽  
Hiroshi Inoue ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Warfarin Therapy

scholarly journals The Effects of Glycopyrrolate as Premedication on Post-Operative Nausea and Vomiting: A Propensity Score Matching Analysis

2019 ◽  
Vol 13 (1) ◽  
pp. 93-99
Author(s):  
Seunghyuk Lee ◽  
Sang W. Yoon ◽  
Geun J. Choi ◽  
Yong-Hee Park ◽  
Hyun Kang ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Nausea And Vomiting ◽  
University Hospital ◽  
Gynecologic Surgery ◽  
Gynecological Surgery ◽  
Propensity Score Matching Analysis ◽  
Post Operative Nausea

Background: Glycopyrrolate is often used as a premedication for anesthesia as it has anti-sialogogue and vagolytic effect. Patients undergoing laparoscopic gynecologic surgery have high-risk of Post-Operative Nausea and Vomiting (PONV). Objectives: This retrospective study investigates the effect of glycopyrrolate as a premedication for PONV in patients receiving fentanyl-based Intravenous (IV) Patient-Controlled Analgesia (PCA) after laparoscopic gynecological surgery. Methods: We reviewed the medical records of adult patients who received fentanyl-based IV-PCA after laparoscopic gynecological surgery at Chung-Ang University Hospital between January 1, 2010, and June 30, 2016. We classified patients into two groups on the basis of glycopyrrolate premedication: non-premedicated group (Group N; n = 316) and glycopyrrolate premedicated group (Group P; n = 434). The Propensity Score Matching Method (PSM) was used to select 157 subjects in Group N and P, on the basis of their covariates which were matched with a counterpart in the other group. Results: Prior to PSM, the necessities for rescue anti-emetics were lower on Postoperative Day (POD) 0 (58[18.4%] vs. 45[10.4%], P = 0.002) and POD1 (60[19.0%] vs. 59[13.6%], P = 0.046), and Visual Analogue Scale (VAS) of pain on POD 1 (2.86 ± 1.49 vs. 3.13 ± 1.53, P = 0.017) was higher in group P. After PSM, the Numerical Rating Scale (NRS) score for nausea (0.38 ± 0.75 vs. 0.21 ± 0.62, P = 0.027) and rescue anti-emetics (27 [17.2%] vs. 15 [9.6%], P = 0.047) on POD 0 were both lower in the group P. Conclusion: In patients receiving fentanyl-based IV-PCA after laparoscopic gynecological surgery, the severity of nausea and necessity for rescue ant-emetic was lower in the glycopyrrolate premedication group.

scholarly journals Surgical Resection Is Still Better Than Endoscopic Resection for Patients With 2-5 cm Gastric Gastrointestinal Stromal Tumours: A Propensity Score Matching Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Hao Wu ◽  
Han Li ◽  
Qinfeng Xu ◽  
Liang Shang ◽  
Ronghua Zhang ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Mitotic Index ◽  
Surgical Resection ◽  
Endoscopic Resection ◽  
Operation Time ◽  
Progression Free Survival ◽  
Gastrointestinal Stromal Tumours ◽  
En Bloc ◽  
Gastric Gists

BackgroundThe management of 2-5 cm gastric gastrointestinal stromal tumours (GISTs) is still debated between surgeons and endoscopists. We aimed to investigate short-term and long-term outcomes between surgical resection (SR) and endoscopic resection (ER).MethodsThis study included 67 and 215 patients between 2010 and 2020 who underwent ER and SR, respectively. After propensity score matching, the clinical outcomes were compared. Individual patient information that requires special instructions is also summarized.ResultsAfter matching, the operation time (P=0.005) and postoperative hospital stay (P=0.005) were significantly longer in the SR group than in the ER group. However, there were no significant differences in blood loss (P=0.741), resection margin (P=1.000) or time to liquid diet (P=0.055). Statistical differences were also seen in en bloc resection (P&lt;0.001) and adverse events (P=0.027). The recurrence rate did not differ significantly between the two techniques, and the mitotic index and ulceration were identified as independent prognostic factors of progression-free survival.ConclusionsER might be comparable to SR for the treatment of 2-3 cm gastric GISTs. SR is still considered the standard treatment for 3-5 cm gastric GISTs, while the intraoperative and postoperative information of ER should be recorded in detail and closely evaluated. Surgical resection is recommended if the tumour has a high mitotic index or mucosal ulceration.

scholarly journals Clinical usefulness of the S-O clip during colorectal endoscopic submucosal dissection in difficult-to-access submucosal layer

2020 ◽  
Vol 08 (03) ◽  
pp. E437-E444 ◽  
Author(s):  
Yuki Okamoto ◽  
Shiro Oka ◽  
Shinji Tanaka ◽  
Katsuaki Inagaki ◽  
Hidenori Tanaka ◽  
...  
Keyword(s):  
Propensity Score ◽  
Endoscopic Submucosal Dissection ◽  
Propensity Score Matching ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
University Hospital ◽  
Submucosal Layer ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Colorectal Endoscopic Submucosal Dissection

Abstract Background and study aims In colorectal endoscopic submucosal dissection (ESD), the S-O clip improves the accessibility to the submucosal layer of the colon. However, its safety and usefulness in difficult colorectal ESDs are unclear. Thus, in this study, we aimed to assess the effectiveness of the S-O clip in colorectal ESD in the difficult-to-access submucosal layer. Patients and methods From January 2016 to December 2016, 189 consecutive cases of colorectal ESD were performed at Hiroshima University Hospital before the S-O clip was introduced. Between January 2017 and June 2018, among 271 consecutive colorectal ESD cases, 41 cases were performed colorectal ESD using the S-O clip. We compared outcomes between the two groups (41 cases with S-O clip [use group] and 189 cases without S-O clip [non-use group]) using propensity score matching. Results Prior to propensity score matching, 41 cases with the S-O clip (use group) and 189 cases without the S-O clip (non-use group) were extracted. The degree of submucosal fibrosis was more severe and the procedure time was longer in the use group than in the non-use group. In the use and non-use groups, en bloc resection (100 % vs. 94.7 %) and complete en bloc resection (100 % vs. 92.6 %) rates were satisfactory. After propensity score matching, 33 cases in each group were extracted. As a result, complete en bloc resection rate was significantly higher in the use group than in the non-use group (100 % vs. 84.9 %). Conclusion The S-O clip is effective and can be used safely in colorectal ESD in the difficult-to-access submucosal layer.

scholarly journals Effects of the anesthesiologist’s experience on postoperative hoarseness after double-lumen endotracheal tube intubation: a single-center propensity score-matched analysis

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Yuji Kamimura ◽  
Toshiyuki Nakanishi ◽  
Aiji Boku Sato ◽  
Satoshi Osaga ◽  
Eisuke Kako ◽  
...  
Keyword(s):  
Propensity Score ◽  
Endotracheal Tube ◽  
Propensity Score Matching ◽  
Lung Resection ◽  
Macintosh Laryngoscope ◽  
University Hospital ◽  
Years Of Experience ◽  
Double Lumen ◽  
Double Lumen Endotracheal Tube ◽  
One To One

Abstract Background Postoperative hoarseness after general anesthesia is associated with patient discomfort and dissatisfaction. A recent large retrospective study showed that single-lumen endotracheal tube intubation by a trainee did not alter the incidence of postoperative pharyngeal symptoms compared with intubation by a senior anesthesiologist. However, there is limited information about the relationship between the anesthesiologist’s experience and hoarseness after double-lumen endotracheal tube intubation. We tested the hypothesis that double-lumen endotracheal tube intubation performed by a trainee increases the incidence of postoperative hoarseness compared to intubation by a senior anesthesiologist. Methods This retrospective observational study included patients who underwent lung resection between April 2015 and March 2018 at a university hospital. Double-lumen endotracheal tube intubation was carried out with a Macintosh laryngoscope. We divided the patients into 2 groups - one group comprised of patients who were intubated by a trainee anesthesiologist with < 2 years of experience, and the other group comprised of those who underwent intubation by a senior anesthesiologist with ≥2 years of experience. The primary outcome was the incidence of postoperative hoarseness 24 h after surgery and we collected data on postoperative hoarseness using a checklist of postanesthetic adverse events. One-to-one propensity score matching was conducted and P values < 0.05 were considered statistically significant. Results There was a total of 256 eligible patients, of which 153 underwent intubation by trainee anesthesiologists, and the remaining 103 patients were intubated by a senior anesthesiologist. The one-to-one propensity score matching resulted in 96 pairs of patients for the groups. The incidence of postoperative hoarseness 24 h after surgery was significantly higher in patients who were intubated by a trainee anesthesiologist than in patients who were intubated by a senior anesthesiologist (9.4% vs. 2.1%, respectively; P = 0.03). Conclusions Double-lumen endotracheal tube intubation by trainee anesthesiologists with < 2 years of experience increased the incidence of postoperative hoarseness 24 h after surgery compared to intubation by senior anesthesiologists with ≥2 years of experience.

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