Assessing Bleeding Risk in Bariatric Surgeries: A Retrospective Analysis Study

2020 ◽  
Vol 38 (6) ◽  
pp. 449-457
Author(s):  
Sergio Susmallian ◽  
Revital Danoch ◽  
Benjamin Raskin ◽  
Asnat Raziel ◽  
Royi Barnea ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Lung Disease ◽  
Chronic Lung Disease ◽  
Demographic Data ◽  
Bleeding Risk ◽  
Patient Characteristics ◽  
Private Institutions ◽  
Perioperative Bleeding ◽  
Determining Factors ◽  
Stapler Line

<b><i>Objective:</i></b> To determine the factors that influence bleeding during the course of bariatric surgeries. <b><i>Background:</i></b> Bariatric surgery is safe with a low percentage of complications compared with other abdominal surgeries. Bleeding is one of the most common complications in surgery for obesity that has the risk of being catastrophic. <b><i>Methods:</i></b> The study includes 8,544 cases that underwent bariatric surgery from January 2013 to March 2016 retrospectively, in 4 private institutions. Multiple demographic data were collected: patient characteristics, diseases, medications, surgery type, operative technique, devices, surgeon’s skill, and volume.<b><i> Results:</i></b> Bleeding was the most frequent complication that occurred in 122 (1.3%) patients. The Gastric bypass had the highest rate of bleeding (3.05%) of which, 20% were intraoperative bleeding and 80% postoperatively (intra-abdominal in 75%, and intra-luminal in 5%). Simultaneous surgeries, revisional surgeries, stratification of body mass index, stapler line reinforcement, and hospital volume did not affect bleeding occurrence. The determining factors for bleeding were hypertension, chronic lung disease, age &#x3e;45 years, arrhythmia, and surgeon’s skills. <b><i>Conclusion:</i></b> Bleeding after bariatric surgery has a low occurrence. The factors that influence the occurrence of perioperative bleeding in bariatric surgery are: hypertension, chronic lung disease, age &#x3e;45 years, arrhythmia, and surgeon’s skills.

Abstract 299: Association of Chronic Lung Disease with Treatments and Outcomes of Acute Coronary Syndromes: Results from the NCDR®

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Jonathan R Enriquez ◽  
James A de Lemos ◽  
Ramin Farzaneh-Far ◽  
Anand Rohatgi ◽  
S. A Peng ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Lung Disease ◽  
Major Bleeding ◽  
Chronic Lung Disease ◽  
Beta Blockers ◽  
Bleeding Risk ◽  
Bleeding Complications ◽  
Processes Of Care ◽  
Increased Risk ◽  
The Impact

Background: Previous reports are conflicting regarding outcomes, treatments, and processes of care after acute myocardial infarction (MI) for patients with chronic lung disease (CLD). Methods: Using the NCDR ACTION Registry ® -GWTG ™ (AR-G), demographics, clinical characteristics, treatments, processes of care, and in-hospital adverse events after NSTEMI and STEMI were compared between patients with (n= 22,624; 14.2%) and without (n= 136,266; 85.8%) CLD. CLD was defined by a history of COPD, chronic bronchitis, or emphysema. Multivariable adjustment using published AR-G in-hospital mortality and major bleeding risk adjustment models was performed to quantify the impact of CLD on treatments and outcomes. Results: CLD was present in 10.1% of STEMI patients and 17.0% of NSTEMI patients. In both STEMI and NSTEMI, CLD patients were older, more likely to be female, and had more comorbidities including diabetes, renal disease, prior MI and heart failure, compared to those without CLD. Although on admission CLD patients were more likely to be on cardiovascular medications, by discharge slightly fewer CLD patients received composite core measures (aspirin, beta-blockers, ACE-inhibitors, and statins) (table). In NSTEMI, CLD was also associated with less use of invasive procedures and with increased risk of both death and major bleeding. In STEMI, major bleeding but not mortality was increased. Conclusions: CLD is a common comorbidity and is independently associated with an increased risk for major bleeding after MI. In NSTEMI, CLD is also associated with receiving fewer evidence-based medications, less timely angiography and revascularization, and increased in-hospital mortality. Close attention should be given to this high-risk subgroup for the prevention and management of bleeding complications after MI, and further investigation is needed to determine the reasons for treatment and outcome disparities in NSTEMI.

scholarly journals PICU Chronic Lung Disease Mortality and Morbidity (PLUM)

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Gayathri Subramanian ◽  
Claire Nissenbaum ◽  
Mia Kahvo ◽  
Catherine Fullwood
Keyword(s):  
Lung Disease ◽  
Chronic Lung Disease ◽  
Demographic Data ◽  
Oxygen Requirement ◽  
Retrospective Case ◽  
Icu Admission ◽  
Icu Stay ◽  
Transfusion Requirements ◽  
Length Of Icu Stay

Background: Children with Bronchopulmonary dysplasia (BPD) have increased incidence of respiratory illness, often necessitating Pediatric ICU admission. Little is known about the outcome of these admissions. Aim: This study aimed to determine clinical and demographic data of this cohort and determine factors affecting mortality and length of ICU stay. Oxygen requirement following a year after ICU admission was determined. Methods: Retrospective case-note review was performed. Patients with congenital cardiac abnormalities or chronic respiratory conditions like cystic fibrosis were excluded. Data were presented as descriptive statistics. Predictors of death and LOS were determined using Fisher’s exact test and univariate regression analyses. Results: Small numbers of deaths prohibited strong conclusions. Inotrope use (p<0.001), blood transfusion (p<0.001), use of inhaled nitric oxide (p=0.003) and a diagnosis of sepsis (p=0.004) were related to mortality. Age at admission, gestational age at birth, weight, oxygen requirement prior to admission or length of stay did not increase the odds of mortality. Inotrope usage (p=0.027), transfusion requirements (p=0.044) and a sepsis diagnosis (p=0.005) were significantly associated with length of ICU stay >7 days. More than half the patients, who were followed up, had an oxygen requirement at 6-month and 12-month follow up. Conclusion: Patients admitted with chronic lung disease to PICU with pulmonary hypertension and sepsis has long ICU stay and more odds of dying. More than half of the children who survive to 6-month and 12-month follow up have ongoing oxygen requirement. Studies in larger populations of children with BPD will help in more accurate prognostication following PICU admission.

Determination and Treatment of Disorders of Primary Haemostasis

1999 ◽  
Vol 19 (04) ◽  
pp. 168-175 ◽  
Author(s):  
M. Weippert-Kretschmer ◽  
V. Kretschmer
Keyword(s):  
Platelet Function ◽  
Bleeding Risk ◽  
Bleeding Complications ◽  
Bleeding Tendency ◽  
Platelet Counts ◽  
Platelet Function Disorders ◽  
Perioperative Bleeding ◽  
Before And After ◽  
Low Sensitivity

SummaryPerioperative bleeding complications due to disorders of primary haemostasis are often underestimated. Routine determination of primary haemostasis is still problematic. The in vivo bleeding time (BT) shows low sensitivity and high variability. In this contribution the results and experiences with the IVBT having been obtained in various studies and during 10 years of routine use are reported. Patients and Methods: Blood donors before and after ASA ingestion, patients with thrombocytopenia as well as congenital and acquired platelet function disorders. Monitoring of desmopressin efficacy. IVBT with Thrombostat 4000 (tests with CaCl2 = TST-CaCl2 and ADP = TST-ADP) and PFA-100 (test cartridges with epinephrine = PFA-EPI and ADP = PFA-ADP). Results and Conclusions: IVBT becomes abnormal with platelet counts <100,000/μl. With platelet counts <50,000/μl the results are mostly outside the methodical range. IVBT proved clearly superior to BT in von Willebrand syndrome (vWS). All 16 patients with vWS were detected by PFA-EPI, whereas with BT 7 of 10 patients with moderate and 1 of 6 patients with mild forms of vWS were spotted. The majority of acquired and congenital platelet function disorders with relevant bleeding tendency were detectable by IVBT. Sometimes diagnostic problems arose in case of storage pool defect. Four to 12 h after ingestion of a single dose of 100 mg ASA the TST-CaCl2 became abnormal in all cases, the PFA-EPI only in 80%. However, the ASA sensitivity of TST-CaCl2 proved even too high when looking for perioperative bleeding complications in an urological study. Therefore, the lower ASS sensitivity of the PFA-100 seems to be rather advantageous for the estimation of a real bleeding risk. The good efficacy of desmopressin in the majority of cases with mild thrombocytopenia, congenital and acquired platelet function disorders and even ASS-induced platelet dysfunction could be proven by means of the IVBT. Thus IVBT may help to increase the reliability of the therapy. However, the IVBT with the PFA-100 is not yet fully developed. Nevertheless, routine use can be recommended when special methodical guidelines are followed.

High-Frequency Oscillation and Chronic Lung Disease in Very Low Birth Weight Infants

PEDIATRICS ◽  
2001 ◽  
Vol 108 (1) ◽  
pp. 212-214
Author(s):  
J. P. Shenai; ◽  
P. Rimensberger; ◽  
U. Thome ◽  
F. Pohlandt; ◽  
P. Rimensberger
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Lung Disease ◽  
Chronic Lung Disease ◽  
High Frequency ◽  
Very Low Birth Weight ◽  
High Frequency Oscillation ◽  
Frequency Oscillation ◽  
Low Birth Weight Infants
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