scholarly journals Comparison of surgical indications and short- and long-term complications in 56 cats undergoing perineal, transpelvic or prepubic urethrostomy

2020 ◽  
pp. 1098612X2095903
Author(s):  
Maheeka Seneviratne ◽  
Polina Stamenova ◽  
Karla Lee

Objectives The aim of this study was to compare indications, complications and mortality rates for perineal urethrostomy (PU), transpelvic urethrostomy (TPU) and prepubic urethrostomy (PPU). Methods A retrospective review of, and follow-up owner questionnaire for, cats undergoing urethrostomy between 2008 and 2018, at a single referral hospital, were performed. Results Fifty-six cats underwent urethrostomy (PU, n = 37; TPU, n = 8; PPU, n = 11). The presenting problem was significantly associated with urethrostomy technique ( P <0.001). For PU cats, feline idiopathic cystitis (FIC; n = 21 [56.7%]) was the most common problem, whereas for PPU cats, trauma (n = 9 [81.8%]) was most common ( P <0.001). Urethrostomy technique was associated with imaging diagnosis ( P <0.001) of the urethral lesion. Most PU cats had no diagnostic imaging lesion (n = 15 [40.5%]) or obstructive calculi or clots (n = 10 [27.0%]), and all PPU cats had urethral rupture. Ten (90.9%) PPU cats had a pelvic lesion, while 21 (56.7%) PU cats had a penile lesion. TPU cats had a range of presenting problems and imaging diagnoses. Short- and long-term complications were reported in 33/55 (60.0%) and 11/30 (36.7%) cats, respectively. The number of cats with long-term complications was greater among PPU cats ( P = 0.02). Short-term dermatitis ( P = 0.019) and long-term incontinence ( P = 0.01) were associated with PPU. Short-term mortality was 5.6% and long-term mortality was 13.3%; both were independent of urethrostomy technique. Quality of life post-urethrostomy, across all techniques, was graded as good by 93% of owners. Conclusions and relevance In this study, PU was the most common feline urethrostomy technique indicated for FIC. Short-term urethrostomy complications are common, irrespective of urethrostomy technique. Long-term complications are less frequent but more common with PPU.

2018 ◽  
Author(s):  
TOH LEONG TAN ◽  
Ying Jing Tang ◽  
Ling Jing Ching ◽  
Noraidatulakma Abdullah ◽  
Hui-min Neoh

Objective: In year 2016, quick Sepsis-Related Organ Failure Assessment (qSOFA) was introduced as a better sepsis screening tool compared to systemic inflammatory response syndrome (SIRS). The purpose of this systematic review and meta-analysis is to evaluate the ability of the qSOFA in predicting short- and long-term mortality among patients outside the intensive care unit setting. Method: Studies reporting on the qSOFA and mortality from MEDLINE (published between 1946 and 15th December 2017) and SCOPUS (published before 15th December 2017). Hand-checking of the references of relevant articles was carried out. Studies were included if they involved inclusion of patients presenting to the ED; usage of Sepsis-3 definition with suspected infection; usage of qSOFA score for mortality prognostication; and written in English. Study details, patient demographics, qSOFA scores, short-term (<30 days) and long-term (≥30 days) mortality were extracted. Two reviewers conducted all reviews and data extraction independently. Results and Discussion: A total of 39 studies met the selection criteria for full text review and only 36 studies were inclided. Data on qSOFA scores and mortality rate were extracted from 36 studies from 15 countries. The pooled odds ratio was 5.5 and 4.7 for short-term and long-term mortality respectively. The overall pooled sensitivity and specificity for the qSOFA was 48% and 85% for short-term mortality and 32% and 92% for long-term mortality, respectively. Studies reporting on short-term mortality were heterogeneous (Tau=24%, I2=94%, P<0.001), while long-term mortality studies were homogenous (Tau=0%, I2<0.001, P=0.52). The factors contributing to heterogeneity may be wide age group, various clinical settings, variation in the timing of qSOFA scoring, and broad range of clinical diagnosis and criteria. There was no publication bias for short-term mortality analysis. Conclusion: qSOFA score showed a poor sensitivity but moderate specificity for both short and long-term mortality prediction in patients with suspected infection. qSOFA score may be a cost-effective tool for sepsis prognostication outside of the ICU setting.


2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Cacho ◽  
T Gonzalez Ferrero ◽  
A Torrelles Fortuny ◽  
M Perez Dominguez ◽  
C Abbou Johk ◽  
...  

Abstract Introduction Women have been less represented in every NSTEMI clinical trial. Moreover, it has been observed that this group of patients have usually received less revascularization and evidence based treatment, therefore presenting with a greater long and short-term mortality. Purpose The purpose of our study is to analyze the presence of differences in baseline characteristics, management and outcome of women with NSTEMI during the last decade. Methods and results Retrospective study including 861 women admitted for NSTEMI between 2003 and 2015 in our center. We divided 2 groups according to hospitalization period (2003–2008 and 2009–2015) with a medium follow up of 4.5±2.9 years. Baseline characteristics and treatment at discharge are described on table 1. We noticed a greater use of statins and ACEI/ARB on the second period as well as a greater percentage of patients receiving early revascularization. It is remarkable on women a non-significant reduction of heart failure hospitalization at follow up (6.8% vs 4.5%; p=0.091), neither differences on 30-day mortality (1.3% vs 0,4%) or 1-year mortality (7.1% vs 5.8%). However, long-term mortality for the second group is reduced (HR 0.69; CI 95% 0.52–0.89), even after performing a multivariate analysis (HR 0.64; CI 95% 0.48–0.85). Characteristic Population (n=861) 2003–2008 (n=395) 2009–2015 (n=466) p-value Age (years) 73±12 73±12 72±12 0.316 Hypertension 629 (73.1%) 285 (72.2%) 344 (73.8%) 0.318 Hypercholesterolemia 414 (48.1%) 190 (48.1%) 224 (48.1%) 0.523 Killip class 0.292   I 664 (77.1%) 299 (75.7%) 365 (78.3%)   II 143 (16.6%) 74 (18.7%) 69 (14.8%)   III 47 (5.5%) 20 (5.1%) 27 (5.8%)   IV 4 (0.5%) 2 (0.5%) 2 (0.4) GRACE score 129±32 130±37 128±33 0.897 Early PCI 249 (29.3%) 76 (19.2%) 173 (38.0%) <0.005 Treatment at discharge   AAS 698 (81.1%) 313 (79.2%) 385 (82.6%) 0.120   Clopidogrel 465 (54.0%) 221 (55.9%) 244 (52.4%) 0.162   ACEI/ARB 466 (54.1%) 191 (48.4%) 275 (59.0%) 0.001   Beta-blocker 509 (59.1%) 238 (60.3%) 271 (58.2%) 0.290   Statins 643 (74.7%) 275 (69.6%) 368 (79.0%) 0.001 Conclusions In recent years, early interventionist management and greater use of evidence-based therapies have been observed in women with NSTEMI. This has been associated with a lesser long-term mortality, although short-term events have remained the same.


EP Europace ◽  
2019 ◽  
Vol 21 (8) ◽  
pp. 1254-1260 ◽  
Author(s):  
Charlotte Gibbs ◽  
Jacob Thalamus ◽  
Doris Tove Kristoffersen ◽  
Martin Veel Svendsen ◽  
Øystein L Holla ◽  
...  

Abstract Aims A prolonged corrected QT interval (QTc) ≥500 ms is associated with high all-cause mortality in hospitalized patients. We aimed to explore any difference in short- and long-term mortality in patients with QTc ≥500 ms compared with patients with QTc <500 ms after adjustment for comorbidity and main diagnosis. Methods and results Patients with QTc ≥500 ms who were hospitalized at Telemark Hospital Trust, Norway between January 2007 and April 2014 were identified. Thirty-day and 3-year all-cause mortality in 980 patients with QTc ≥500 ms were compared with 980 patients with QTc <500 ms, matched for age and sex and adjusting for Charlson comorbidity index (CCI), previous admissions, and main diagnoses. QTc ≥500 ms was associated with increased 30-day all-cause mortality [hazard ratio (HR) 1.90, 95% confidence interval (CI) 1.38–2.62; P < 0.001]. There was no significant difference in mortality between patients with QTc ≥500 ms and patients with QTc <500 ms who died between 30 days and 3 years; 32% vs. 29%, P = 0.20. Graded CCI was associated with increased 3-year all-cause mortality (CCI 1–2: HR 1.62, 95% CI 1.34–1.96; P < 0.001; CCI 3–4: HR 2.50, 95% CI 1.95–3.21; P < 0.001; CCI ≥5: HR 3.76, 95% CI 2.85–4.96; P < 0.001) but was not associated with 30-day all-cause mortality. Conclusion QTc ≥500 ms is a powerful predictor of short-term mortality overruling comorbidities. QTc ≥500 ms also predicted long-term mortality, but this effect was mainly caused by the increased short-term mortality. For long-term mortality, comorbidity was more important.


2020 ◽  
Author(s):  
Michaela Plath ◽  
Matthias Sand Sand ◽  
Peter K. Plinkert ◽  
Ingo Baumann ◽  
Karim Zaoui

Abstract Backround:Parotidectomy may be burdened by numerous complications that may worsen subjects' quality of life (QoL). So far, the literature still lacks of long-term data (> 10 years) answering to the question what impacted the patients the most on QOL after parotidectomy compared to well-published short-term data.Methods:A prospective long-term follow-up study was carried out. Participants were divided into three groups concerning the follow-up: short-term (ST; 6 postoperative weeks), long-term (LT; 13 years postoperative) and short- and long-term (SLT) on same patient collective. QOL was assessed by the Parotidectomy Outcome Inventory (POI-8). Demographic and clinical data were collected from all patients. Operative reports were used to classify all parotidectomies as great nerve auricular (GAN) “preserving” or GAN “sacrificing” surgical preparations.Results:74 LT, 57 ST and 33 SLT patients were enrolled in this study. Hypoesthesia posed the major short- and long-term problem whereas facial palsy posed the minor problem. Pain (p < 0.01) and hypoesthesia (p < 0.001) significantly improved from six weeks to 13 years after parotidectomy as well as the overall POI-8 score (p = 0.04). The disease-specific impairment rate decreased from short (≈ 70%) to long-term (≈ 30%) follow-up. Sacrifice of the auricular nerve was associated with hypoesthesia in the ST-cohort (p = 0.028).Conclusion:To our knowledge, this study represents the longest follow-up of patients undergoing parotidectomy. Hypoesthesia significantly improved but still remains on long-follow-up without impacting QOL. As part of the preoperative informed consent, prolonged or permanent hypoesthesia should be explicitly emphasized.Trial registration:This study was prospectively approved and registered by the local Ethics Committee (Project Trial No: S-300/2007 and S-443/2018).


2021 ◽  
Vol 8 ◽  
Author(s):  
Yue-Yan Yu ◽  
Bo-Wen Zhao ◽  
Lan Ma ◽  
Xiao-Ce Dai

Objectives: Out-of-hour admission (on weekends, holidays, and weekday nights) has been associated with higher mortality in patients with acute myocardial infarction (AMI). We conducted a meta-analysis to verify the association between out-of-hour admission and mortality (both short- and long-term) in AMI patients.Design: This Systematic review and meta-analysis of cohort studies.Data Sources: PubMed and EMBASE were searched from inception to 27 May 2021.Eligibility Criteria for Selected Studies: Studies of any design examined the potential association between out-of-hour admission and mortality in AMI.Data Extraction and Synthesis: In total, 2 investigators extracted the data and evaluated the risk of bias. Analysis was conducted using a random-effects model. The results are shown as odds ratios [ORs] with 95% confidence intervals (CIs). I2 value was used to estimate heterogeneity. Grading of Recommendations Assessment, Development, and Evaluation was used to assess the certainty of the evidence.Results: The final analysis included 45 articles and 15,346,544 patients. Short-term mortality (defined as either in-hospital or 30-day mortality) was reported in 42 articles (15,340,220 patients). Out-of-hour admission was associated with higher short-term mortality (OR 1.04; 95%CI 1.02–1.05; I2 = 69.2%) but there was a significant statistical indication for publication bias (modified Macaskill's test P &lt; 0.001). One-year mortality was reported in 10 articles (1,386,837 patients). Out-of-hour admission was also associated with significantly increased long-term mortality (OR 1.03; 95%CI 1.01–1.04; I2 = 66.6%), with no statistical indication of publication bias (p = 0.207). In the exploratory subgroup analysis, the intervention effect for short-term mortality was pronounced among patients in different regions (p = 0.04 for interaction) and socio-economic levels (p = 0.007 for interaction) and long-term mortality was pronounced among patients with different type of AMI (p = 0.0008 for interaction) or on different types of out-to-hour admission (p = 0.006 for interaction).Conclusion: Out-of-hour admission may be associated with an increased risk of both short- and long-term mortality in AMI patients.Trial Registration: PROSPERO (CRD42020182364).


2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Goto ◽  
T Watanabe ◽  
Y Kobayashi ◽  
T Toshima ◽  
M Wanezaki ◽  
...  

Abstract Background Advances in therapies have successfully decreased short-term mortality in patients with acute myocardial infarction (AMI). Although aging population is recently increasing in developed countries, there are few reports about the association between prevalence of percutaneous coronary intervention (PCI) and long-term prognosis in elderly patients with AMI in Japan. Purpose The aim of this study was to clarify the prevalence of PCI and the impact of PCI on short and long-term prognosis of elderly patients with AMI. Methods and results We investigated the prevalence of PCI and short-term mortality in 4,109 patients with AMI who were registered in Yamagata AMI Registry from 2010 to 2017. Long-term mortality was investigated using data from death certification in July 2019. We divided patients with AMI into three age groups (group 1, &lt;65 years old; group 2, 65–79 years old; and group 3, ≥80 years old). Short-term mortality within 30 days was 6.5%, 12.1%, and 28.6%, respectively. Also, prevalence of PCI was 88.0%, 84.7%, and 62.7%, respectively. Multivariate analysis revealed that age, PCI, and severity of Killip classification were significantly associated with short-term mortality after adjustment for confound factors in group 3. Since the prevalence of PCI in group 3 was the lowest among three groups, the cause of PCI not being executed was investigated in 1,429 patients aged ≥80 years old. Elderly patients who didn't undergo PCI was older, more women, and had higher prevalence of chronic kidney disease, previous stroke, and severe Killip classification. Multivariate analysis revealed that age and Killip III/IV were significantly associated with non-executed PCI after adjustment for confound factors. Next, we investigated impact of PCI on long-term mortality in elderly patients who escaped acute death. Multivariate Cox hazard analysis revealed that PCI was associated with lower mortality after adjustment for confound factors (adjusted hazard ratio 2.47, 95% CI: 1.47–4.06; p=0.0008). Conclusion Lower prevalence of PCI and higher short-term mortality were observed in elderly patients with AMI aged ≥80 years old. PCI ameliorated long-term mortality as well as short-term mortality in elderly patients with AMI. Funding Acknowledgement Type of funding source: None


2021 ◽  
pp. 1098612X2110385
Author(s):  
Caroline Dumartinet ◽  
Fabrice Bernard ◽  
Antoine Bernardé

Objectives This article aimed to report on the short- and long-term outcomes after transpelvic urethrostomy (TPU) as a first-line surgery to treat obstructive lower urinary tract disease (OLUTD) in male cats. Methods A retrospective review and follow-up owner telephone questionnaire for cats with OLUTD undergoing TPU as a first-line surgery between 2013 and 2019, at a single referral hospital, were performed. A minimum follow-up period of 1 year was required to be included in the study. Short- and long-term complications were defined as those that occurred, respectively, within or after the first 4 weeks postoperatively. Results Thirty-eight male cats were included. The short-term complication rate was 18%. Idiopathic lower urinary tract disease (ILUTD) and stomal stenosis (SS) were the two most frequent short-term complications. Long-term complications were reported in 34% of the cats and included ILUTD, urinary tract infection and SS. The mortality rate was 5%. Eighty-two percent of the owners were satisfied with the postoperative outcome. The most common reason for owner dissatisfaction was the occurrence of SS, especially because these complications required multiple surgical revisions to be definitively managed. The long-term quality of life was considered to be good to very good by 89% of the owners. Ninety-one percent of the cats were free of clinical urinary signs at the time of the questionnaire completion. Conclusions and relevance TPU can be an acceptable first-line surgical technique to treat cats with OLUTD. Most cats experienced a good to very good quality of life after TPU. Most complications were transient or manageable medically. Most of the major complications were SS, which can be technically challenging to address and may require multiple revision surgeries.


2020 ◽  
Author(s):  
Michaela Plath ◽  
Matthias Sand ◽  
Peter K. Plinkert ◽  
Ingo Baumann ◽  
Karim Zaoui

Abstract Background: Parotidectomy may be burdened by numerous complications that may worsen subjects' quality of life (QoL). So far, the literature still lacks of long-term data (>10 years) answering to the question what impacted the patients the most on QOL after parotidectomy compared to well-published short-term data.Methods: A prospective long-term follow-up study was carried out. Participants were divided into three groups concerning the follow-up: short-term (ST; 6 postoperative weeks), long-term (LT; 13 years postoperative) and short- and long-term (SLT) on same patient collective. QOL was assessed by the Parotidectomy Outcome Inventory (POI-8). Demographic and clinical data were collected from all patients. Operative reports were used to classify all parotidectomies as great auricular nerve (GAN) “preserving” or GAN “sacrificing” surgical preparations.Results: 74 LT, 57 ST and 33 SLT patients were enrolled in this study. Hypoesthesia posed the major short- and long-term problem whereas facial palsy posed the minor problem. Pain (p < 0.01) and hypoesthesia (p < 0.001) significantly improved from six weeks to 13 years after parotidectomy as well as the overall POI-8 score (p = 0.04). The disease-specific impairment rate decreased from short (» 70%) to long-term (» 30%) follow-up. Sacrifice of the auricular nerve was associated with hypoesthesia in the ST-cohort (p = 0.028).Conclusion: To our knowledge, this study represents the longest follow-up of patients undergoing parotidectomy. Hypoesthesia significantly improved but still remains on long-follow-up without impacting QOL. As part of the preoperative informed consent, prolonged or permanent hypoesthesia should be explicitly emphasized.Trial registration: This study was prospectively approved and registered by the local Ethics Committee (Project Trial No: S-300/2007 and S-443/2018).


Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Michael C Kontos ◽  
Thomas T Noel ◽  
Charlotte S Roberts ◽  
F Philip Anderson ◽  
James L Tatum ◽  
...  

Background: Several randomized clinical trials have demonstrated that patients (pts) with ST Elevation myocardial infarction (STEMI) have a higher short-term mortality than those with non-STEMI, but that long-term mortality is similar. More recent studies suggest that pts who are troponin positive (TnI+), but not meeting the older CKMB criteria for MI may also be at increased risk. However, there is little data examining outcomes differentiating these 3 MI populations using the current ACC/ESC definition for MI selected from a heterogeneous cohort of pts admitted from the emergency department. Methods: Consecutive pts admitted for exclusion of myocardial ischemia underwent serial sampling of CK, CKMB, and TnI. MI was defined using ACC/ESC criteria. Pts were separated into 3 groups: STEMI (n=363; 22%), non-STEMI pts who met the prior CKMB criteria for MI (n=743; 46%), and non-STEMI pts who had MI based on TnI (+) alone (n=512; 32%) without meeting CKMB MI criteria. Demographic and clinical variables were compared among the three cohorts of patients, and 30 day and 1 year mortality were assessed. Results : Over a 6 year period, 1,618 pts were diagnosed with MI. Co-morbidities and outcomes are shown below in the table . Variables associated with worse outcomes were significantly more common in both groups of non-STEMI pts, particularly in the TnI (+) only pts. Thirty day mortality was similar and not significantly different among the 3 cohorts. However, at 1 year, mortality was a significant 68% higher in the 2 non-STEMI groups, despite having significantly lower peak CK (median 123 U/L for TnI (+) pts and 414 U/L for CKMB MI pts vs 1400 U/L for STEMI pts) and CKMB values (median 4 ng/ml for TnI (+) pts and 29 ng/ml for CKMB MI pts vs 140 ng/ml for STEMI pts) compared to STEMI pts. Conclusions : All MI pts had similar 30 day mortality; however, at 1 yr pts with non-STEMI had a substantially increased mortality compared to STEMI pts.


2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H Alraddadi ◽  
A Alsagheir ◽  
S Gao ◽  
K An ◽  
H Hronyecz ◽  
...  

Abstract Background Managing endocarditis in intravenous drug use (IVDU) patients is challenging: unless patients successfully quit IVDU, the risk of re-infection is high. Clinicians often raise concerns with ethical and resource allocation principles when considering valve replacement surgery in this patient population. To help inform practice, we sought to determine the long-term outcomes of IVDU patients with endocarditis who underwent valve surgery in our center. Method After research ethics board approval, infective endocarditis cases managed surgically at our General Hospital between 2009 and 2018 were identified through the Cardiac Care Network. We reviewed patients' charts and included those with a history of IVDU in this study. We abstracted data on baseline characteristics, peri-operative course, short- and long-term outcomes. We report results using descriptive statistics. Results We identified 124 IVDU patients with surgically managed endocarditis. Mean age was 37 years (SD 11), 61% were females and 8% had redo surgery. During admission, 45% (n=56) of the patients had an embolic event: 63% pulmonary, 30% cerebral, 18% peripheral and 11% mesenteric. Causative organisms included Methicillin-Sensitive Staphylococcus Aureus (51%, n=63), Methicillin-Resistant Staphylococcus Aureus (15%, n=19), Streptococcus Viridans (2%, n=2), and others (31%, n=38). Emergency cardiac surgery was performed for 42% of patients (n=52). Most patients (84%) had single valve intervention: 53% tricuspid, 18% aortic and 13% mitral. Double valve interventions occurred in 15% (n=18). Overall, bioprosthetic replacement was most commonly chosen (79%, n=98). In-hospital mortality was 7% (n=8). Median length of stay in hospital was 13 days (IQR 8,21) and ICU 2 days (IQR 1,6). Mortality at longest available follow-up was 24% (n=30), with a median follow-up of 129 days (IQR 15,416). Valve reintervention rate was 11% (n=13) and readmission rate was 14% (n=17) at a median of 275 days (IQR 54,502). Conclusion Despite their critical condition, IVDU patients with endocarditis have good intra-hospital outcomes. Challenges occur after hospital discharge with loss of follow-up and high short-term mortality. IVDU relapse likely accounts for some of these issues. In-hospital and community comprehensive addiction management may improve these patients' outcomes beyond the surgical procedure. Annual rate 2009–2018 Funding Acknowledgement Type of funding source: None


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