Laryngeal Force Sensor for Suspension Microlaryngoscopy: A Prospective Controlled Trial

2021 ◽  
pp. 019459982098263
Author(s):  
Allen L. Feng ◽  
Elefteria Puka ◽  
Alex Ciaramella ◽  
Vishwanatha M. Rao ◽  
Tiffany V. Wang ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Controlled Trial ◽  
Univariate Analysis ◽  
Force Sensor ◽  
Maximum Force ◽  
Consecutive Series ◽  
Active Monitoring ◽  
Postoperative Visit ◽  
Tertiary Center ◽  
Force Data

Objectives The laryngeal force sensor (LFS) provides real-time force data for suspension microlaryngoscopy. This study investigates whether active use of the LFS can prevent the development of complications. Study Design Prospective controlled trial. Setting Academic tertiary center. Methods The LFS and custom software were developed to track intraoperative force metrics. A consecutive series of 100 patients had force data collected with operating surgeons blinded to intraoperative readings. The subsequent 100 patients had surgeons actively use the LFS monitoring system. Patients were prospectively enrolled, completing pre- and postoperative surveys to assess the development of tongue pain, paresthesia, paresis, dysgeusia, or dysphagia. Results On univariate analysis, the active monitoring group had lower total impulse ( P < .001) and fewer extralaryngeal complications ( P < .01). On multiple logistic regression, maximum force (odds ratio [OR], 1.08; 95% CI, 1.01-1.16; P = .02) was a significant predictive variable for the development of postoperative complications. Similarly, active LFS monitoring showed a 29.1% (95% CI, 15.7%-42.4%; P < .001) decrease in the likelihood of developing postoperative complications. These effects persisted at the first postoperative visit for maximum force ( P = .04) and active LFS monitoring ( P = .01). Maximum force (OR, 1.11; 95% CI, 1.04-1.18; P < .01) and active LFS monitoring (16.6%; 95% CI, 2.7%-30.5%; P = .02) were also predictive for the development of an abnormal 10-item Eating Assessment Tool score. These effects also persisted at the first postoperative visit for maximum force ( P = .01) and active LFS monitoring ( P = .01). Conclusion Maximum force is predictive of the development postoperative complications. Active monitoring with the LFS is able to mitigate these forces and prevent postoperative complications. Level of Evidence 2.

scholarly journals Predictive Factors for Postoperative Outcome in Children with Jejunoileal Atresia

2019 ◽  
Vol 05 (04) ◽  
pp. e131-e136
Author(s):  
Charlotta Jarkman ◽  
Martin Salö
Keyword(s):  
Birth Weight ◽  
Postoperative Complications ◽  
Enteral Feeding ◽  
Univariate Analysis ◽  
Length Of Hospital Stay ◽  
Postoperative Outcome ◽  
Central Line ◽  
Jejunoileal Atresia ◽  
Tertiary Center ◽  
Full Enteral Feeding

Abstract Background Jejunoileal atresia is a relatively rare congenital gastrointestinal requiring surgery and long postoperative care. The postoperative outcome is affected by many factors and this study focuses on finding predictors for time to full enteral feeding, length of hospital stay (LOH), and postoperative complications. Methods This was a retrospective study of all children operated for isolated jejunoileal atresia between 2001 and 2017 at a tertiary center of pediatric surgery. Independent variables regarding demographical-, operative-, and postoperative data were abstracted. Primary outcome was time to full enteral feeding, LOH, and postoperative complications in terms of reoperation or central line complication. Any significant variables from the univariate analysis were further analyzed with logistic regression and presented as odds ratio with 95% confidence interval. Results After exclusion because of concomitant gastroschisis (n = 1), and death before discharge (n = 2), 47 patients were further analyzed (49% boys, 53% premature). No significant differences could be seen in the univariate analysis between children with short and long time (median > 17 days) to full enteral nutrition. Patients with longer LOH (median >32 days) had significantly lower birth weight compared with those with shorter LOH; median 2,550 g versus 2,980 g (p = 0.04). Patients with a central line complication had significantly longer median time to full enteral feeding (median 27 vs. 12 days, p = 0.03), and significantly longer median LOH (median 43 vs. 21 days, p = 0.03), but these parameters were not significant in a multivariate analysis. No significant results were found regarding reoperation. Conclusion Low birth weight seems associated with an increased LOH in children operated on for jejunoileal atresia, and central line complications seem related to the duration with central line in this group. The small cohort may constitute a power problem in this study and further research regarding the included variables may reveal more potential predictors for the postoperative outcome.

Randomized Controlled Trial of Intensity-Modulated Radiotherapy for Early Breast Cancer: 5-Year Results Confirm Superior Overall Cosmesis

2013 ◽  
Vol 31 (36) ◽  
pp. 4488-4495 ◽  
Author(s):  
Mukesh B. Mukesh ◽  
Gillian C. Barnett ◽  
Jennifer S. Wilkinson ◽  
Anne M. Moody ◽  
Charles Wilson ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Breast Tissue ◽  
Controlled Trial ◽  
Univariate Analysis ◽  
Intensity Modulated Radiotherapy ◽  
Tumor Bed ◽  
Intensity Modulated ◽  
Randomized Controlled ◽  
Dose Homogeneity ◽  
Breast Imrt

Purpose There are few randomized controlled trial data to confirm that improved homogeneity with simple intensity-modulated radiotherapy (IMRT) decreases late breast tissue toxicity. The Cambridge Breast IMRT trial investigated this hypothesis, and the 5-year results are reported. Patients and Methods Standard tangential plans of 1,145 trial patients were analyzed; 815 patients had inhomogeneous plans (≥ 2 cm3 receiving 107% of prescribed dose: 40 Gy in 15 fractions over 3 weeks) and were randomly assigned to standard radiotherapy (RT) or replanned with simple IMRT; 330 patients with satisfactory dose homogeneity were treated with standard RT and underwent the same follow-up as the randomly assigned patients. Breast tissue toxicities were assessed at 5 years using validated methods: photographic assessment (overall cosmesis and breast shrinkage compared with baseline pre-RT photographs) and clinical assessment (telangiectasia, induration, edema, and pigmentation). Comparisons between different groups were analyzed using polychotomous logistic regression. Results On univariate analysis, compared with standard RT, fewer patients in the simple IMRT group developed suboptimal overall cosmesis (odds ratio [OR], 0.68; 95% CI, 0.48 to 0.96; P = .027) and skin telangiectasia (OR, 0.58; 95% CI, 0.36 to 0.92; P = .021). No evidence of difference was seen for breast shrinkage, breast edema, tumor bed induration, or pigmentation. The benefit of IMRT was maintained on multivariate analysis for both overall cosmesis (P = .038) and skin telangiectasia (P = .031). Conclusion Improved dose homogeneity with simple IMRT translates into superior overall cosmesis and reduces the risk of skin telangiectasia. These results are practice changing and should encourage centers still using two-dimensional RT to implement simple breast IMRT.

scholarly journals Applied Force during Piston Prosthesis Placement in a 3D-Printed Model: Freehand vs Robot-Assisted Techniques

2018 ◽  
Vol 160 (2) ◽  
pp. 320-325 ◽  
Author(s):  
Christopher R. Razavi ◽  
Paul R. Wilkening ◽  
Rui Yin ◽  
Nicolas Lamaison ◽  
Russell H. Taylor ◽  
...  
Keyword(s):  
Middle Ear ◽  
Force Sensor ◽  
Neck Surgery ◽  
Maximum Force ◽  
Maximum Magnitude ◽  
Robot Assisted ◽  
Freehand Technique ◽  
Stapes Prosthesis ◽  
3D Printed ◽  
The Mean

Objectives To describe a 3D-printed middle ear model that quantifies the force applied to the modeled incus. To compare the forces applied during placement and crimping of a stapes prosthesis between the Robotic ENT Microsurgery System ( REMS) and the freehand technique in this model. Study Design Prospective feasibility study. Setting Robotics laboratory. Subjects and Methods A middle ear model was designed and 3D printed to facilitate placement and crimping of a piston prosthesis. The modeled incus was mounted to a 6–degree of freedom force sensor to measure forces/torques applied on the incus. Six participants—1 fellowship-trained neurotologist, 2 neurotology fellows, and 3 otolaryngology–head and neck surgery residents—placed and crimped a piston prosthesis in this model, 3 times freehand and 3 times REMS assisted. Maximum force applied to the incus was then calculated for prosthesis placement and crimping from force/torque sensor readings for each trial. Robotic and freehand outcomes were compared with a linear regression model. Results Mean maximum magnitude of force during prosthesis placement was 126.4 ± 73.6 mN and 105.0 ± 69.4 mN for the freehand and robotic techniques, respectively ( P = .404). For prosthesis crimping, the mean maximum magnitude of force was 469.3 ± 225.2 mN for the freehand technique and 272.7 ± 97.4 mN for the robotic technique ( P = .049). Conclusions Preliminary data demonstrate that REMS-assisted stapes prosthesis placement and crimping are feasible with a significant reduction in maximum force applied to the incus during crimping with the REMS in comparison with freehand.

scholarly journals LYMPHOCYTE COUNT AND PLATELET VOLUME PREDICTS POSTOPERATIVE COMPLICATIONS IN ESOPHAGECTOMY FOR CANCER: A COHORT STUDY

2019 ◽  
Vol 56 (4) ◽  
pp. 377-385 ◽  
Author(s):  
Francisco TUSTUMI ◽  
Flávio Roberto TAKEDA ◽  
Antonio Adolfo Guerra Soares BRANDÃO ◽  
Rubens Antonio Aissar SALLUM ◽  
Ulysses RIBEIRO JUNIOR ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Blood Count ◽  
Univariate Analysis ◽  
Neoadjuvant Chemoradiotherapy ◽  
Postoperative Mortality ◽  
Platelet Volume ◽  
Curative Intent ◽  
Trimodal Therapy ◽  
Esophagectomy For Cancer ◽  
Cellular Components

ABSTRACT BACKGROUND: Biomarkers from routine complete blood count are known predictive factors of long-term outcomes in cancer patients. The value of these biomarkers in the setting of trimodal therapy for esophageal cancer in predicting early postoperative outcomes is not studied. OBJECTIVE: The present study evaluated the value of cellular blood components changes during neoadjuvant chemoradiotherapy followed by curative intent esophagectomy for cancer in predicting postoperative mortality and morbidity. METHODS: A cohort of 149 consecutive patients that underwent chemoradiotherapy using platinum- and taxane-based regimens followed by esophagectomy was analyzed. Cellular components of blood collected before neoadjuvant therapy (period A) and before surgery (period B) were assessed for postoperative mortality and complications. Univariate and multivariate Cox regression models were applied to evaluate the independent prognostic significance of blood count variables. RESULTS: Postoperative morbidity was present in 46% of the patients. On multiple regression analysis platelet volume (B) (OR: 1.53; 95% CI: 1.2-2.33) was an independent predictor of general complications. Severe postoperative surgical complications were present in 17% of the patients. On multiple regression analysis, lymphocyte decrease between B-A periods (OR: 0.992; 95% CI: 0.990-0.997) was related to higher risk for severe complications. Cervical anastomotic leakage was present in 25.6% of the patients. On univariate analysis eosinophil count in A and B periods was related to cervical anastomotic leakage. For this outcome, multivariate joint model could not identify independent risk variables of cellular components of blood. The 30-day mortality rate was 7.4%. On univariate analysis, platelet count in period B was associated to higher risk for mortality. The multivariate joint model could not accurately predict mortality due to the few number of patients in the mortality group. CONCLUSION: This is the first study to assess the relationship between peripheral blood count variables changes during neoadjuvant chemoradiotherapy using a platinum- and taxane-based regimen followed by curative intent esophagectomy for cancer in predicting postoperative complications. The platelet volume prior to surgery is related to postoperative complications and the lymphocyte count change prior to surgery predicts severe postoperative complications in the setting of trimodal therapy for esophageal cancer.

scholarly journals Preoperative ICG Test to Predict Posthepatectomy Liver Failure and Postoperative Outcomes in Hilar Cholangiocarcinoma

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Min Li ◽  
Jie Wang ◽  
Jieqiong Song ◽  
Feng Shen ◽  
Lujun Song ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Liver Function ◽  
Liver Failure ◽  
Clinical Significance ◽  
Hilar Cholangiocarcinoma ◽  
Retention Rate ◽  
Univariate Analysis ◽  
Postoperative Outcomes ◽  
Posthepatectomy Liver Failure ◽  
Icg R15

Preoperative evaluation of hepatic functional reserve in patients with hilar cholangiocarcinoma (hCCA) has vital clinical significance for prevention of posthepatectomy liver failure (PHLF) and mortality. The aim of the present study was to evaluate the clinical significance of the indocyanine green retention rate at 15 minutes (ICG R15) and related factors of postoperative outcomes in patients with hCCA. 147 patients who scheduled for hCCA resection underwent a preoperative ICG test between May 2015 and May 2020 and were prospectively analyzed. Single-factor analysis was used to evaluate the risk factors for PHLF and postoperative outcomes in hCCA. After univariate analysis, significant differences in ICG R15 were found between the PHLF group and the liver function recovered well (LFRW) group ( P ≤ 0.05 ). In terms of postoperative complications, ICG R15 was also a risk factor for moderate-to-severe postoperative complications. Preoperative ICG R15 was significantly associated with PHLF and moderate-to-severe postoperative complications. ICG R15 may become an ideal clinical indicator for the evaluation of liver function reserve before hCCA and can better predict the postoperative complications.

Comorbidities and indications for total hip arthroplasty at a tertiary care center in Saudi Arabia

2021 ◽  
Vol 12 (3) ◽  
pp. 59-63
Author(s):  
Bandar M Hetaimish ◽  
Eyad A Alakkas ◽  
Khalid F Alharbi ◽  
Abdulrahman M Alradadi ◽  
Habib Y Aletani ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Postoperative Complications ◽  
Total Hip Arthroplasty ◽  
Chronic Diseases ◽  
Hip Arthroplasty ◽  
Common Indication ◽  
Total Hip ◽  
Tertiary Center ◽  
Duration Of Surgery ◽  
Post Traumatic

Objectives: Total hip arthroplasty (THA) is one of the most effective orthopedic interventions for the treatment of patients with advanced‑ stage hip disease. However, reports regarding indications for primary THA in Saudi Arabia are limited. We aimed to evaluate primary indications for THA and identify associated chronic diseases and postoperative complications in THA patients at a tertiary hospital in Saudi Arabia. These are important to provide knowledge on types of hip diseases and variables that may affect the outcome of this intervention in the Saudi population. Methods: This is a retrospective cohort study of THA cases performed between 2010 and 2019 at a tertiary center in Saudi Arabia. Retrieved data include patients’ ages at the time of surgery, chronic diseases, presurgical diagnosis, site and duration of surgery, and postoperative complications. Results: We identified 83 patients who had undergone primary THA; in regard to comorbidities, 32.5% and 30.1% had hypertension and diabetes mellitus, respectively. The most common indication for THA was degenerative hip osteoarthritis (50.6%), followed by post-traumatic arthritis (22.9%) and hip avascular necrosis (20.5%). Conclusion: Despite the high rate of trauma and accidents in Saudi Arabia, degenerative osteoarthritis remains the most common indication for primary THA. Post-traumatic osteoarthritis is identified as the second major indication for THA.

Microsurgical Treatment of 86 Anterior Choroidal Artery Aneurysms: Analysis of Factors Influencing the Prognosis

2020 ◽  
Vol 81 (06) ◽  
pp. 501-507
Author(s):  
Chunli Lu ◽  
Yugong Feng ◽  
Huanting Li ◽  
Shifang Li ◽  
Lingwen Gu ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Univariate Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Artery Aneurysm ◽  
Postoperative Outcome ◽  
Anterior Choroidal Artery ◽  
Factors Influencing ◽  
Aneurysm Size ◽  
Anterior Choroidal ◽  
Choroidal Artery

Abstract Purpose To explore factors affecting the prognosis of choroidal anterior artery aneurysm (AChAA) and provide a reference for improving the postoperative outcome. Methods The clinical data of 86 patients with AChAA who underwent treatment by a single surgeon were collected and analyzed retrospectively. Univariate analysis and multivariate logistic regression analysis were conducted to examine 12 factors that possibly affected outcome. Results The five factors that affected the patient outcomes were times of subarachnoid hemorrhage (SAH), characteristics of SAH on computed tomography (CT), Hunt-Hess grade, aneurysm size, and presence or absence of postoperative complications. Characteristics of SAH on CT (odds ratio [OR]: 3.727; p = 0.000; 95% confidence interval [CI], 1.850–7.508), aneurysm size (OR: 6.335; p = 0.000; 95% CI, 2.564–15.647), and presence or absence of postoperative complications (OR: 4.141; p = 0.000; 95% CI, 1.995–8.599) were independent risk factors influencing the prognosis. In addition, the incidence of postoperative ischemia (caused by anterior choroidal artery syndrome) is related to the aneurysm emitting part and presence or absence of intraoperative rupture. Conclusions The analysis of characteristics of SAH on CT, aneurysm size, and presence or absence of postoperative complications can roughly determine the outcome of patients with AChAAs.

scholarly journals PACMAN trial protocol, Perioperative Administration of Corticotherapy on Morbidity and mortality After Non-cardiac major surgery: a randomised, multicentre, double-blind, superiority study

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e021262 ◽  
Author(s):  
Karim Asehnoune ◽  
Emmanuel Futier ◽  
Fanny Feuillet ◽  
Antoine Roquilly
Keyword(s):  
Cardiac Surgery ◽  
Postoperative Complications ◽  
Controlled Trial ◽  
Morbidity And Mortality ◽  
Major Surgery ◽  
Care Hospital ◽  
Trial Protocol ◽  
Double Blind ◽  
Term Survival ◽  
Randomised Controlled

IntroductionPostoperative complications are major healthcare problems and are associated with a reduced short-term and long-term survival after surgery. An excessive postoperative inflammatory response participates to the development of postoperative infection and mortality. The aim of the Perioperative Administration of Corticotherapy on Morbidity and mortality After Non-cardiac surgery (PACMAN) study is to assess the effectiveness of perioperative administration of corticosteroid to reduce postoperative morbidity and mortality in patients undergoing major non-cardiac surgery.Methods and analysisThe PACMAN is a multicentre, randomised, controlled, double-blind, superiority, two-arm trial of 1222 high-risk patients aged 50 years or older undergoing major non-cardiac surgery at 32 acute care hospital in France. Patients are randomly assigned to dexamethasone (0.2 mg/kg at the end of the surgical procedure and at day +1, n=611) or to placebo (n=611). The primary outcome is a composite of predefined 14-day major pulmonary complications and mortality. Secondary outcomes are surgical complications, infections, organ failures, critical care-free days, length of hospital stay and all-cause mortality at 28 days.Ethics and disseminationThe PACMAN trial protocol has been approved by the ethics committee of Sud Mediterranée V, and will be carried out according to the Good Clinical Practice guidelines and the principles of the Declaration of Helsinki. The PACMAN trial is a randomised controlled trial powered to investigate whether perioperative administration of corticosteroids in patients undergoing non-cardiac major surgery reduces postoperative complications. The results of this study will be disseminated through presentation at scientific conferences and publication in peer-reviewed journals.Trial registration numberNCT03218553; Pre-results.

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