Partial Meniscectomy for Degenerative Medial Meniscal Root Tears Shows Favorable Outcomes in Well-Aligned, Nonarthritic Knees

2019 ◽  
Vol 47 (3) ◽  
pp. 606-611 ◽  
Author(s):  
Bum-Sik Lee ◽  
Seong-Il Bin ◽  
Jong-Min Kim ◽  
Min-Ho Park ◽  
Sang-Min Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Significant Risk ◽  
Lysholm Score ◽  
Rank Test ◽  
Varus Alignment ◽  
Level Of Evidence ◽  
Term Survival ◽  
Arthroscopic Meniscectomy ◽  
End Stage

Background: Arthroscopic meniscectomy has been commonly performed for persistent pain caused by degenerative medial meniscal posterior root tears (MMPRTs). However, risk factors that affect long-term outcomes and joint survivorship after meniscectomy are unclear. Purpose: To identify the risk factors associated with end-stage osteoarthritis after arthroscopic meniscectomy for degenerative MMPRT for middle-aged or elderly patients and to determine the joint survivorship according to the identified risk factors. Study Design: Case-control study; Level of evidence, 3. Methods: Data from 288 patients (24 male and 264 female), followed for at least 5 years after arthroscopic meniscectomy for degenerative MMPRTs performed between 1999 and 2010, were examined retrospectively. The modified Lysholm score was used for clinical evaluation. Cox proportional hazards regression analysis was used to assess factors that affect joint survivorship when conversion to total knee arthroplasty (TKA) was taken as the endpoint; these factors were age, sex, body mass index (BMI), preoperative tibiofemoral alignment (varus [<2° valgus] vs well-aligned [2°-10° valgus]), preoperative Kellgren-Lawrence grade (0 or 1 vs 2 or 3), and the modified Outerbridge grade of the medial compartment. Kaplan-Meier survival analysis and the log-rank test were used to compare overall survivorship with respect to each significant risk factor. Results: Mean age at the time of surgery was 58.9 years (range, 43-78 years). Sixty (20.8%) patients underwent TKA at 7.0 ± 3.6 years (range, 1.1-14.4 years) postoperatively. The mean follow-up time for those who did not undergo TKA was 8.9 ± 2.9 years (range, 4.5-16.5 years). The overall modified Lysholm score improved from 64.4 to 81.3 ( P < .001), but progression of radiographic arthritis was noted in 156 (61.9%) patients ( P < .001) at 2 years postoperatively. Age (hazard ratio [HR] = 1.049), BMI (HR = 1.092), varus alignment (HR = 2.283), and Kellgren-Lawrence grade 2 or higher (HR = 2.960) were significant risk factors for end-stage arthritis requiring TKA. Well-aligned nonarthritic knees (n = 131, 45.5%) survived significantly longer before requiring TKA than did knees with varus alignment or radiographic arthritis ( P < .05). The 5- and 10-year survival rates in these low-risk groups were 97.7% (95% CI, 95.2%-100.2%) and 89.1% (95% CI, 82.4%-95.8%), respectively. Conclusion: Arthroscopic meniscectomy is an effective treatment for degenerative MMPRTs, with favorable long-term survival in well-aligned nonarthritic knees. However, meniscectomy should be undertaken cautiously in patients with varus alignment and preoperative radiographic osteoarthritis.

scholarly journals Long-term survival after Carpentier-Edwards Perimount aortic valve replacement in Western Denmark: a multi-centre observational study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Lytfi Krasniqi ◽  
Mads P. Kronby ◽  
Lars P. S. Riber
Keyword(s):  
Risk Factors ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Significant Risk ◽  
Valve Prosthesis ◽  
Term Survival ◽  
Long Term Survival ◽  
All Cause Mortality

Abstract Background This study describes the long-term survival, risk of reoperation and clinical outcomes of patients undergoing solitary surgical aortic valve replacement (SAVR) with a Carpentier-Edwards Perimount (CE-P) bioprosthetic in Western Denmark. The renewed interest in SAVR is based on the questioning regarding the long-term survival since new aortic replacement technique such as transcatheter aortic-valve replacement (TAVR) probably have shorter durability, why assessment of long-term survival could be a key issue for patients. Methods From November 1999 to November 2013 a cohort of a total of 1604 patients with a median age of 73 years (IQR: 69–78) undergoing solitary SAVR with CE-P in Western Denmark was obtained November 2018 from the Western Danish Heart Registry (WDHR). The primary endpoint was long-term survival from all-cause mortality. Secondary endpoints were survival free from major adverse cardiovascular and cerebral events (MACCE), risk of reoperation, cause of late death, patient-prothesis mismatch, risk of AMI, stroke, pacemaker or ICD implantation and postoperative atrial fibrillation (POAF). Time-to-event analysis was performed with Kaplan-Meier curve, cumulative incidence function was performed with Nelson-Aalen cumulative hazard estimates. Cox regression was applied to detect risk factors for death and reoperation. Results In-hospital mortality was 2.7% and 30-day mortality at 3.4%. The 5-, 10- and 15-year survival from all-cause mortality was 77, 52 and 24%, respectively. Survival without MACCE was 80% after 10 years. Significant risk factors of mortality were small valves, smoking and EuroSCORE II ≥4%. The risk of reoperation was < 5% after 7.5 years and significant risk factors were valve prosthesis-patient mismatch and EuroSCORE II ≥4%. Conclusions Patients undergoing aortic valve replacement with a Carpentier-Edwards Perimount valve shows a very satisfying long-term survival. Future research should aim to investigate biological valves long-term durability for comparison of different SAVR to different TAVR in long perspective.

scholarly journals Impact of Pediatric Chronic Dialysis on Long-Term Patient Outcome: Single Center Study

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Daniella Levy Erez ◽  
Irit Krause ◽  
Amit Dagan ◽  
Roxana Cleper ◽  
Yafa Falush ◽  
...  
Keyword(s):  
Survival Rate ◽  
Medical Center ◽  
Significant Risk ◽  
Chronic Dialysis ◽  
Term Survival ◽  
Successful Transplantation ◽  
Life Threatening ◽  
Stage Renal Disease ◽  
End Stage

Objective.Owing to a shortage of kidney donors in Israel, children with end-stage renal disease (ESRD) may stay on maintenance dialysis for a considerable time, placing them at a significant risk. The aim of this study was to understand the causes of mortality.Study Design. Clinical data were collected retrospectively from the files of children on chronic dialysis (>3 months) during the years 1995–2013 at a single pediatric medical center.Results.110 patients were enrolled in the study. Mean age was10.7±5.27 yrs. (range: 1 month–24 yrs). Forty-five children (42%) had dysplastic kidneys and 19 (17.5%) had focal segmental glomerulosclerosis. Twenty-five (22.7%) received peritoneal dialysis, 59 (53.6%) hemodialysis, and 6 (23.6%) both modalities sequentially. Median dialysis duration was 1.46 years (range: 0.25–17.54 years). Mean follow-up was13.5±5.84 yrs. Seventy-nine patients (71.8%) underwent successful transplantation, 10 (11.2%) had graft failure, and 8 (7.3%) continued dialysis without transplantation. Twelve patients (10.9%) died: 8 of dialysis-associated complications and 4 of their primary illness. The 5-year survival rate was 84%: 90%for patients older than 5 years and 61%for younger patients.Conclusions.Chronic dialysis is a suitable temporary option for children awaiting renal transplantation. Although overall long-term survival rate is high, very young children are at high risk for life-threatening dialysis-associated complications.

scholarly journals Risk Factors for Tooth Loss in Patients with ≥25 Remaining Teeth Undergoing Mid-Long-Term Maintenance: A Retrospective Study

2021 ◽  
Vol 18 (13) ◽  
pp. 7174
Author(s):  
Hiroo Kawahara ◽  
Miho Inoue ◽  
Kazuo Okura ◽  
Masamitsu Oshima ◽  
Yoshizo Matsuka
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Tooth Loss ◽  
Economic Status ◽  
Significant Risk ◽  
Related Factors ◽  
Term Survival ◽  
Worldwide Population

Tooth loss represents a diffused pathologic condition affecting the worldwide population. Risk factors have been identified in both general features (smoking, diabetes, economic status) and local tooth-related factors (caries, periodontitis). In this retrospective study, we examined the data of 366 patients with a large number of remaining teeth (≥25) undergoing maintenance therapy in order to identify specific risk factors for tooth loss. The number of remaining teeth, number of non-vital teeth, and number of occlusal units were investigated for their correlation with tooth loss. The mean follow-up of patients was 9.2 years (range 5 to 14). Statistically significant risk factors for tooth loss were identified as number of remaining teeth at baseline (p = 0.05), number of occlusal units (p = 0.03), and number of non-vital teeth in posterior regions (p < 0.001). Multiple logistic regression showed that the number of occlusal units and number of non-vital teeth in the posterior regions were significantly associated with a greater risk of tooth loss (odds ratio 1.88 and 3.17, respectively). These results confirm that not only the number of remaining teeth, but also their vital or non-vital status and the distribution between the anterior and posterior regions influence the long-term survival.

scholarly journals Long-Term Survival After Carpentier-Edwards Perimount Aortic Valve Replacement in Denmark: A Multi-Centre Observational Study

2020 ◽  
Author(s):  
Lytfi Krasniqi ◽  
Mads Philip Kronby ◽  
Lars Peter Schødt Riber
Keyword(s):  
Risk Factors ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Significant Risk ◽  
Valve Prosthesis ◽  
Term Survival ◽  
Long Term Survival ◽  
All Cause Mortality

Abstract Background: This study describes the long-term survival, risk of reoperation and clinical outcomes for patients undergoing solitary surgical aortic valve replacement (SAVR) with a Carpentier-Edwards Perimount (CE-P) bioprosthetic in Denmark. The renewed interest in SAVR is based on the questioning regarding the long-term survival since new aortic replacement technique such as transcatheter aortic-valve replacement (TAVR) probably have shorter durability, why assessment of long-term survival could be a key issue for patients.Methods: From November 1999 to November 2015 a cohort of a total of 1604 patients aged 20-91 undergoing solitary SAVR with CE-P in Western Denmark was obtained November 2018 from the Western Danish Heart Registry (WDHR). The primary endpoint was long-term survival from all-cause mortality. Secondary endpoints were survival free from major adverse cardiovascular and cerebral events (MACCE), risk of reoperation, cause of late death, patient-prothesis mismatch, risk of AMI, stroke, pacemaker or ICD implantation and postoperative atrial fibrillation (POAF). Time-to event analysis was performed with Kaplan-Meier curve, cumulative incidence function was performed with Nelson-Aalen cumulative hazard estimates. Cox regression was applied to detect risk factors for death and reoperation.Results: In-hospital mortality was 2.7% and 30-day mortality at 3.4%. The 5-, 10- and 15-year survival from all-cause mortality was 77%, 52% and 24%, respectively. Survival without MACCE was 80% after 10 years. Significant risk factors of mortality were small valves, smoking and EuroSCORE II ≥4%. The risk of reoperation was <5% after 7.5 years and significant risk factors were valve prosthesis-patient mismatch and EuroSCORE II ≥4%.Conclusions: Patients operated with for aortic valve replacement with a Carpentier-Edwards Perimount valve shows a very satisfying long-term survival. Future research should aim to investigate biological valves long-term durability for comparison of different SAVR to different TAVR in long perspective.

Immediate Postoperative Coagulopathy Predicts the Long-term Survival of Traumatic Brain Injury Patients: a Retrospective Cohort Study

2021 ◽  
Author(s):  
Wenxing Cui ◽  
Tian Li ◽  
Yingwu Shi ◽  
Chen Yang ◽  
Shunnan Ge ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rank Test ◽  
Proportional Hazard ◽  
Proportional Hazard Model ◽  
Term Survival ◽  
Long Term Survival ◽  
Cox Proportional Hazard ◽  
Log Rank Test

Abstract Objective: To assess the association between immediate postoperative coagulopathy and the long-term survival of traumatic brain injury (TBI) patients undergoing surgery, as well as to explore predisposing risk factors of immediate postoperative coagulopathy.Methods: This retrospective study included 352 TBI patients from January 1, 2015, to April 25, 2019. The log-rank test and a Cox proportional hazard model were conducted to assess the relationship between immediate postoperative coagulopathy and the long-term survival of TBI patients. Furthermore, a multivariate logistic regression model was performed to identify the underlying risk factors for postoperative coagulopathy.Results: Of the 352 patients analyzed, the median age was 50 (41,60) years, and 82 (23%) patients were female. By May 26, 2019, 117 (33.24%) patients had died, 195 (55.40%) had survived, and 40 (11.36%) had been lost to follow-up. The median follow-up time was 773 days. In the log-rank test, immediate postoperative coagulopathy was significantly associated with the survival of TBI patients (P = 0.002). A Cox proportional hazard model identified immediate postoperative coagulopathy (HR, 1.471; 95% CI, 1.011-2.141; P = 0.044) as an independent risk factor for survival following TBI. According to multivariate logistic regression analysis, abnormal ALT and RBC at admission, intraoperative infusion of crystalloid solution > 2900 mL, infusion of colloidal solution > 1100 mL and intraoperative bleeding > 950 mL were identified as independent risk factors for immediate postoperative coagulopathy.Conclusions: Those who suffered from immediate postoperative coagulopathy due to TBI were at higher risk of poor prognosis than those who did not.

Influence of fenestration on long-term Fontan survival

2021 ◽  
pp. 1-6
Author(s):  
Ondřej Materna ◽  
Vojtěch Illinger ◽  
Denisa Jičínská ◽  
Karel Koubský ◽  
Jan Kovanda ◽  
...  
Keyword(s):  
Risk Factors ◽  
Significant Risk ◽  
Composite Endpoint ◽  
Total Cavopulmonary Connection ◽  
Term Survival ◽  
Fenestration Closure ◽  
The Difference ◽  
Group 2 ◽  
Cavopulmonary Connection

Abstract Introduction: Fenestration in the total cavopulmonary connection system may improve the outcome of patients with significant risk factors for Fontan haemodynamics. Our study aims to analyse the difference in long-term survival between non-fenestrated and fenestrated patients. Methods: All consecutive patients (n = 351) who underwent total cavopulmonary connection between 1992 and 2016 were identified. Six early deaths were excluded resulting in a group of 345 patients. Median (interquartile range,) length of follow-up was 14.4 (7.1–19.7) years. Freedom from the composite endpoint of death, total cavopulmonary connection take-down or indication for a heart transplant was analysed. Results: Fenestration was absent in 237 patients (68.7%, Group 1), was created and closed later in 79 patients (22.9%, Group 2), and remained open in 29 patients (8.4%, Group 3). Mean survival probability until composite endpoint was 97.1 and 92.9% at 10 and 20 years, respectively. Patients with patent fenestration had worse survival (p < 0.001) as compared to both the non-fenestrated and fenestration closure groups. Despite a similar outcome, exercise capacity was lower in Group 2 than 1 (p = 0.013). In 58 patients with interventional fenestration closure, Nakata index was lower at the time of closure than pre-operatively, and both the pressure in the circuit and oxygen saturation in the aorta increased significantly (p < 0.001). Conclusions: Patients with persisting risk factors preventing fenestration closure are at higher risk of reaching the composite endpoint. Patients after fenestration closure have the worse functional outcome; their survival is, however, not different from the non-fenestrated group.

scholarly journals Improved Long-Term Survival with Edaravone Therapy in Patients with Amyotrophic Lateral Sclerosis: A Retrospective Single-Center Study in Japan

2021 ◽  
Vol 14 (8) ◽  
pp. 705
Author(s):  
Hideki Houzen ◽  
Takahiro Kano ◽  
Kazuhiro Horiuchi ◽  
Masahiro Wakita ◽  
Azusa Nagai ◽  
...  
Keyword(s):  
Amyotrophic Lateral Sclerosis ◽  
Rank Test ◽  
Positive Pressure ◽  
Control Group ◽  
Single Center ◽  
Term Survival ◽  
Long Term Survival ◽  
Kaplan Meier ◽  
Lateral Sclerosis

Reports on the long-term survival effect of edaravone, which was approved for the treatment of amyotrophic lateral sclerosis (ALS) in 2015 in Japan, are rare. Herein, we report our retrospective analysis of 45 consecutive patients with ALS who initially visited our hospital between 2013 and 2018. Of these, 22 patients were treated with edaravone for an average duration of 26.6 (range, 2–64) months, whereas the remaining patients were not treated with edaravone and comprised the control group. There were no differences in baseline demographics between the two groups. The primary endpoint was tracheostomy positive-pressure ventilation (TPPV) or death, and the follow-up period ended in December 2020. The survival rate was significantly better in the edaravone group than in the control group based on the Kaplan–Meier analysis, which revealed that the median survival durations were 49 (9–88) and 25 (8–41) months in the edaravone and control groups, respectively (p = 0.001, log-rank test). There were no serious edaravone-associated adverse effects during the study period. Overall, the findings of this single-center retrospective study suggest that edaravone might prolong survival in patients with ALS.

Age dependence of brachial cuff-based ambulatory PWV in end-stage kidney disease patients undergoing long-term peritoneal dialysis

2021 ◽  
pp. 089686082199692
Author(s):  
Vasilios Vaios ◽  
Panagiotis I Georgianos ◽  
Georgia Vareta ◽  
Dimitrios Divanis ◽  
Evangelia Dounousi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Heart Rate ◽  
Peritoneal Dialysis ◽  
Kidney Disease ◽  
Pulse Wave ◽  
Age Dependence ◽  
End Stage Kidney Disease ◽  
End Stage

Background: The newly introduced device Mobil-O-Graph (IEM, Stolberg, Germany) combines brachial cuff oscillometry and pulse wave analysis, enabling the determination of pulse wave velocity (PWV) via complex mathematic algorithms during 24-h ambulatory blood pressure monitoring (ABPM). However, the determinants of oscillometric PWV in the end-stage kidney disease (ESKD) population remain poorly understood. Methods: In this study, 81 ESKD patients undergoing long-term peritoneal dialysis underwent 24-h ABPM with the Mobil-O-Graph device. The association of 24-h oscillometric PWV with several demographic, clinical and haemodynamic parameters was explored using linear regression analysis. Results: In univariate analysis, among 21 risk factors, 24-h PWV exhibited a positive relationship with age, body mass index, overhydration assessed via bioimpedance spectroscopy, diabetic status, history of dyslipidaemia and coronary heart disease, and it had a negative relationship with female sex and 24-h heart rate. In stepwise multivariate analysis, age ( β: 0.883), 24-h systolic blood pressure (BP) ( β: 0.217) and 24-h heart rate ( β: −0.083) were the only three factors that remained as independent determinants of 24-h PWV (adjusted R 2 = 0.929). These associations were not modified when all 21 risk factors were analysed conjointly or when the model included only variables shown to be significant in univariate comparisons. Conclusion: The present study shows that age together with simultaneously assessed oscillometric BP and heart rate are the major determinants of Mobil-O-Graph-derived PWV, explaining >90% of the total variation of this marker. This age dependence of oscillometric PWV limits the validity of this marker to detect the premature vascular ageing, a unique characteristic of vascular remodelling in ESKD.

Post-Bariatric Abdominoplasty: Analysis of 406 Cases With Focus on Risk Factors and Complications

2020 ◽  
Vol 41 (1) ◽  
pp. 59-71 ◽  
Author(s):  
Torsten Schlosshauer ◽  
Marcus Kiehlmann ◽  
Diana Jung ◽  
Robert Sader ◽  
Ulrich M Rieger
Keyword(s):  
Risk Factors ◽  
Wound Healing ◽  
Surgical Technique ◽  
Significant Risk ◽  
Level Of Evidence ◽  
Increased Risk ◽  
Potential Risk Factors ◽  
Wound Healing Problems ◽  
Bariatric Patients

Abstract Background Post-bariatric patients present a surgical challenge within abdominoplasty because of residual obesity and major comorbidities. In this study, we analyzed complications following abdominoplasty in post-bariatric patients and evaluated potential risk factors associated with these complications. Objectives The authors sought to determine the complications and risk factors following abdominoplasty in post-bariatric patients. Methods A retrospective study of patients who underwent abdominoplasty was performed from January 2009 to December 2018 at our institution. Variables analyzed were sex, age, body mass index (BMI), smoking, surgical technique, operative time, resection weight, drain output, and complications. Results A total of 406 patients were included in this study (320 female and 86 male) with a mean age of 44.4 years and a BMI of 30.6 kg/m2. Abdominoplasty techniques consisted of traditional (64.3%), fleur-de-lis technique (27.3%), and panniculectomy without umbilical displacement (8.4%). Overall complications recorded were 41.9%, the majority of these being wound-healing problems (32%). Minor and major complications were found in 29.1% and 12.8% of patients, respectively. A BMI value of ≥30 kg/m2 was associated with an increased risk for wound-healing problems (P = 0.001). The frequency of total complications was significantly related to age (P = 0.007), BMI (P = 0.004), and resection weight (P = 0.001). Abdominoplasty technique tended to influence total complications. Conclusions This study demonstrates in a fairly large sample of post-bariatric patients (n = 406) that abdominoplasty alone can be performed safely, with an acceptable complication rate. Age, BMI, and resection weight are shown to be significant risk factors for total complications. The role of surgical technique needs to be evaluated further. Level of Evidence: 4

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