Perioperative outcomes of aspirin use in radical prostatectomy.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 150-150
Author(s):  
Matthew D. Ingham ◽  
Ross E Krasnow ◽  
Matthew Mossanen ◽  
Ye Wang ◽  
Steven Lee Chang
Keyword(s):  
Radical Prostatectomy ◽  
Minimally Invasive ◽  
Major Complication ◽  
Perioperative Outcomes ◽  
Complication Rates ◽  
Hospital Outcomes ◽  
Group 2 ◽  
The Impact ◽  
To Receive ◽  
Group 1

150 Background: Increasing cardiovascular disease has led to increases in the patient population on anti-platelet therapy who require urologic surgery. We sought to study perioperative outcomes for those undergoing radical prostatectomy (RP) while taking or not taking perioperative aspirin (pASA). Methods: A retrospective review of patients undergoing RP was performed on the Premier Hospital Database from 2003 to 2015, with survey projection weighting resulting in a cohort of 157,674 patients. Two groups were formed – those continued on pASA (group 1, n = 4400) and those with no pASA (group 2, n = 153,274). In-hospital complication rates were studied: major bleeding, overall transfusion, day-of-surgery transfusion, prolonged ( > 4 days) length of stay (LOS), and prolonged ( > 285 minutes) operative time. We also assessed 90-day rates of: cardiovascular catastrophe, readmission, major complication, and DVT/PE. Unadjusted rates were calculated for all RP patients and further subdivided into open and minimally invasive RP. Adjusted odds ratios (OR) were then calculated between groups 1 and 2. Results: Group 1 was older (51.5% vs 41.8% ≥65 years, p = 0.002) and less healthy (13.8% vs 5.3% with a CCI score ≥2, p < 0.0001) vs those in group 2. Group 1 patients were more likely to receive an open RP (42.3% vs 28.1%, p < 0.0001). For in-hospital outcomes for all RPs, no significant differences were noted regardless of surgical approach. For 90-day outcomes, those in group 1 were more likely to suffer a MI (OR 5.88, CI [3.4-10.18], p < 0.001), major complication (OR2.95, CI [1.58-5.5], p < 0.001), or be readmitted (OR 1.63, CI [1.18-2.26], p < 0.05). The disparity in both MI and major complication rates appeared to be largely driven by those undergoing minimally invasive RPs, with an OR of 7.92 and 4.02 noted, respectively. Conclusions: This large, retrospective, database review of both academic and community hospitals provides an important assessment of the impact pASA has on RP outcomes. In-hospital outcomes were equivalent between groups but those on pASA saw increased rates of MI, major complication, and readmission. Despite this, this study lends support to the belief that pASA should likely not be considered an absolute contraindication to RP.

Perioperative outcomes of aspirin use in partial nephrectomy.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 698-698
Author(s):  
Matthew D. Ingham ◽  
Ross Erik Krasnow ◽  
Matthew Mossanen ◽  
Ye Wang ◽  
Adam B. Althaus ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Partial Nephrectomy ◽  
Surgical Approach ◽  
Major Complication ◽  
Perioperative Outcomes ◽  
Complication Rates ◽  
Hospital Outcomes ◽  
Group 2 ◽  
The Impact ◽  
Group 1

698 Background: Increasing cardiovascular disease has led to increases in the patient population on anti-platelet therapy who require urologic surgery. We sought to study perioperative outcomes for those undergoing partial nephrectomy (PN) while taking or not taking perioperative aspirin (pASA). Methods: A retrospective review of those undergoing PN was performed on the Premier Hospital Database from 2003 to 2015, with survey projection weighting resulting in a cohort of 10,807 patients. Two groups were formed – those continued on pASA (group 1, n = 774) and those with no pASA (group 2, n = 10,033). In-hospital complication rates were studied: major bleeding, overall transfusion, day-of-surgery transfusion, prolonged ( > 4 days) length of stay (LOS), and prolonged ( > 285 minutes) operative time. We also assessed 90-day rates of: cardiovascular catastrophe, readmission, major complication, and DVT/PE. Unadjusted rates were calculated for all PN patients and further subdivided into open and minimally invasive PN. Adjusted odds ratios (OR) were then calculated between groups 1 and 2. Results: Group 1 was older (58% vs 38% ≥65 years, p < 0.0001), largely male (73.1% vs 58.7%, p = 0.001), and less healthy (34.8% vs 18.4% with a CCI score ≥2, p = 0.003) than to group 2. For in-hospital outcomes, no significant differences were noted. Stratifying by surgical approach, those in group 1 undergoing minimally invasive PN were slightly less likely to require a day-of-surgery transfusion (OR 0.29, CI [0.05-0.99], p < 0.05). For 90-day outcomes, group 1 were far more likely to suffer a cardiovascular catastrophe (OR 7.56, CI [3.38-16.92], p < 0.001) regardless of surgical approach. Conversely, group 1 was slightly less likely to experience readmission (OR 0.48, CI [0.24-0.94], p < 0.05) and was likely driven by those undergoing minimally invasive PN. Conclusions: This large review of academic and community hospitals provides insight into the impact perioperative ASA has on PN outcomes. As noted, in-hospital outcomes were largely equivalent between groups while 90-day cardiovascular catastrophe rates were much higher in the ASA group. Despite this, this study lends support to the belief that pASA should not be considered an absolute contraindication to PN.

Perioperative Outcomes and Quality of Life after Repair of Recurrent Hiatal Hernia are Compromised Compared with Primary Repair

2019 ◽  
Vol 85 (5) ◽  
pp. 556-560 ◽  
Author(s):  
Andrew M. Brown ◽  
Ramzy Nagle ◽  
Michael J. Pucci ◽  
Karen Chojnacki ◽  
Ernest L. Rosato ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Recurrent Hernia ◽  
Perioperative Outcomes ◽  
Complication Rates ◽  
Conversion Rates ◽  
Quality Of Life Index ◽  
Group 2 ◽  
Gastrointestinal Quality Of Life ◽  
Group 1

Paraesophageal hernia repair (PEHR) is burdened by high recurrence rates that frequently lead to redo PEHR. Revisional surgery, because of higher complexity, higher risk of injury, and the intrinsic risk of recurrence, has increased likelihood of higher complication rates and decreased quality of life (QOL) postoperatively. We aimed to compare perioperative outcomes and QOL after revisional and primary PEHR. A retrospective review of all patients who underwent PEHR for a recurrent hernia between January 2011 and July 2016 was completed. These were matched with a contemporary cohort of patients who underwent primary PEHR by age, gender, and BMI. Perioperative measures were compared. The patients were invited to complete the Gastrointestinal Quality of Life Index (GIQLI) to assess response to surgical intervention. There were 24 patients (group 1) who underwent revisional PEHR, and they were matched to 48 patients (group 2) who had a primary hernia repair. Thirteen patients in group 1 responded to the survey (54%), whereas 21 patients’ responses were received from group 2 (44%). Conversion rates, LOS, and mean Gastrointestinal Quality of Life Index scores were significantly different between the two groups. Reoperative procedures for paraesophageal and hiatal hernias are burdened by higher conversion rates and length of stay, with similar overall complication rates. Patients who are undergoing repair of a recurrent hernia should be preoperatively counseled, and should have realistic expectations of their GI QOL after surgery.

scholarly journals Fixation of Ankle Fractures

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0008
Author(s):  
Andrew Molloy ◽  
Samantha Whitehouse ◽  
Lyndon Mason
Keyword(s):  
Complication Rate ◽  
Major Complication ◽  
Ankle Fractures ◽  
Complication Rates ◽  
Junior Staff ◽  
System Changes ◽  
Major Complication Rate ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Category: Trauma Introduction/Purpose: Ankle fractures are one of the most common fractures. Historically these have been frequently treated by non-specialists and junior staff. In 2011 we presented high malunion rates, which have been mirrored in other departments work. We present the results of system changes to improve the results of ankle fracture fixation Methods: Image intensifier films were reviewed on PACS and scored based on the criteria published by Pettrone et al. At least two blinded assessors assigned scores independently. Patients clinical data was collected from medical records. In 2011 we presented the results of fixation in 94 consecutive patients (Group 1) from 2009. Following this there was period of education in the department to allow change. 68 patients (Group 2) were then reviewed from a 7 month period in 2014 Multiple system changes were introduced in the department including; new treatment algorithms, dedicated foot and ankle trauma lists and clinics, and next day review of all intra-operative radiographs by independent attending. Prospective data was collected on 205 consecutive cases (Group 3) from 01/01/15 – 09/30/16 Results: Patients in group 1 had a malreduction rate of 33%. The major complication rate in this group was 8.5% (8 patients); with only one of these occurred in a correctly reduced fracture. These complications included 4 revision fixations, 2 deep infections and 1 amputation. Following the period of re-education, in Group 2, the mal-reduction rate deteriorated to 43.8%. In this group the major complication rate was 10.9%; including 6 revision fixations and 1 ankle fusion. In Group 3, following overall system changes, the malreduction rate was 2.4%. This result is statistically significant. The major complication rate fell to 0.98%; 1deep infection and 1 amputation (in a polytrauma patient with vascular injury). This result is again statistically significant. Conclusion: Our initial results show that very poor results are a consequence when sufficient attention is not given to what are frequently considered to be ‘simple’ fractures. In group 2 we demonstrated that soft educational changes (eg presentations, emails) are ineffective in improving results. We have demonstrated that hard (institutional system) changes in our department provided statistically significant improvements. These changes allowed the correct surgeon for the fracture in both determining the treatment plan and operating. With these changes, malreduction rates fell from 43.8% to 2.4% and major complication rates from 10.9% to 0.98%

scholarly journals Influence of Aging in Outcomes of Patients Undergoing Percutaneous Nephrolithotomy for Staghorn Stones : A retrospective comparative study

2021 ◽  
Author(s):  
Murat Sahan ◽  
Serkan Yarımoğlu ◽  
Metin Savun ◽  
Onur Erdemoglu ◽  
Tansu Degirmenci
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Major Complication ◽  
Renal Stones ◽  
The Elderly ◽  
Treatment Method ◽  
Transfusion Rate ◽  
Complication Rates ◽  
Number Of Patients ◽  
Group 2 ◽  
Group 1

Objective: To evaluate the effect of age on the success and complications of percutaneous nephrolithotomy (PCNL) in staghorn renal stones. Materials and Methods: The files of 182 patients who underwent single-access PCNL for staghorn renal stones between 2012 and 2017 were retrospectively analyzed. The patients were divided into two groups according to their age: those aged<65 years were defined as Group-1 and those aged≥65 years as Group-2. The demographic characteristics and perioperative and postoperative results were compared between the two groups. Results: Of the patients with staghorn renal stones,139 were in Group-1 and 43 were in Group-2. The mean age of the patients was 43.9±10.6 years for Group-1 and 67.8±2.1 years for Group-2(p=0.001). The amount of hemoglobin drop was statistically significantly higher in Group-1 (p=0.001). However, blood transfusion rate was higher in Group-2 than in Group-1 (18.6% and 7.2%, respectively). The stone-free rate was 54.7% in Group-1 and 67.4% in Group-2(p=0.139). According to the evaluation of the overall complication rates,34.5% of the patients in Group-1 and 46.5% of those in Group-2 developed complications(p=0.206). According to the Clavien scoring system, the rate of minor complications was found to be 22.3% in Group-1 and 41.9% in Group-2,and the difference was statistically significant (p=0.012). The major complication rates were determined as 4.7% and 12.2% for Group-1 and Group-2, respectively (p=0.155). The number of patients with Clavien grade-2 complications was statistically higher in the elderly patient group (p=0.019). Conclusions: PCNL can be used as an effective and safe treatment method in the treatment of complex stones in elderly patients.

scholarly journals Dramatic Impact of Centralization and a Multidisciplinary Bladder Cancer Program in Reducing Mortality: The CABEM Project

2021 ◽  
pp. 1547-1555
Author(s):  
Fernando Korkes ◽  
Frederico Timóteo ◽  
Suelen Martins ◽  
Matheus Nascimento ◽  
Camila Monteiro ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Care Program ◽  
Mortality Rates ◽  
Perioperative Outcomes ◽  
Cancer Program ◽  
Multidisciplinary Clinic ◽  
Group 2 ◽  
Muscle Invasive ◽  
The Impact ◽  
Group 1

PURPOSE Muscle-invasive bladder cancer (MIBC) is an aggressive disease with a complex treatment. In Brazil, as in most developing countries, data are scarce, but mortality seems exceedingly high. We have created a centralization program involving a multidisciplinary clinic in a region comprising seven municipalities. The aim of this study is to evaluate the impact of a multidisciplinary clinic and a centralization-of-care program (CABEM program) on MIBC treatment in Brazil. PATIENTS AND METHODS A total of 116 consecutive patients were evaluated. In group 1, 58 patients treated for MIBC before establishing a bladder cancer program from 2011 to 2017 were retrospectively evaluated. Group 2 represented 58 patients treated for MIBC after the implementation of the CABEM centralization program. Age, sex, staging, comorbidity indexes, mortality rates, type of treatment, and perioperative outcomes were compared. RESULTS Patients from group 2 versus 1 were older (68 v 64.2 years, P = .02) with a higher body mass index (25.5 v 22.6 kg/m2, P = .017) and had more comorbidities according to both age-adjusted Charlson Comorbidity Index (4.2 v 2.8, P = .0007) and Isbarn index (60.6 v 43.9, P = .0027). Radical cystectomy (RC) was the only treatment modality for patients in group 1, whereas in group 2, there were 31 (53%) RC; three (5%) partial cystectomies; seven (12%) trimodal therapies; 13 (22%) palliative chemotherapies; and three (5%) exclusive transurethral resections of the bladder tumor. No patient in group 1 received neoadjuvant chemotherapy, whereas it was offered to 69% of patients treated with RC. Ninety-day mortality rates were 34.5% versus 5% for groups 1 versus 2 ( P < .002). One-year mortality was also lower in group 2. CONCLUSION Our data support that a centralization program, a structured bladder clinic associated with protocols, a multidisciplinary team, and inclusion of chemotherapy and radiotherapy treatments can pleasingly improve outcomes for patients with MIBC.

scholarly journals Intravesical prostatic protrusion may affect early postoperative continence undergoing robot-assisted radical prostatectomy

BMC Urology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Katsuya Hikita ◽  
Masashi Honda ◽  
Shogo Teraoka ◽  
Ryoma Nishikawa ◽  
Yuske Kimura ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Symptom Score ◽  
Multivariate Analyses ◽  
Specific Antigen ◽  
Robot Assisted ◽  
Significant Difference ◽  
Group 2 ◽  
The Impact ◽  
Intravesical Prostatic Protrusion ◽  
Group 1

Abstract Background In this study, we investigated the effect of preoperative prostate morphology, especially intravesical prostatic protrusion (IPP), on continence after robot-assisted radical prostatectomy (RARP). Methods Retrospective analysis was applied to patients who underwent RARP between October 2010 and July 2014. The following parameters were assessed in all patients: age, body mass index (BMI), prostate-specific antigen, magnetic resonance imaging and pressure-flow studies findings. The impact of preoperative and intraoperative factors on postoperative urinary incontinence (UI) was assessed using multivariate logistic regression analysis. To evaluate the effects of IPP, the patients were divided into groups according to the IPP length: Group 1, < 5 mm and Group 2, ≥ 5 mm. The International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score, Quality of Life index and the number of pads used were assessed. Results A total of 119 patients were eligible for this study. Multivariate analyses showed that IPP (odds ratio (OR) 1.14, 95% confidence interval (CI) 1.02–1.28, p < 0.05) and nerve-sparing (NS) (OR 0.23, 95% CI 0.18–0.61, p < 0.01) were significant factors related to UI in the first month after RARP. Twelve months after RARP, multivariate analyses revealed that only NS is a factor related to postoperative UI (OR 0.23, 95% CI 0.18–0.61, p < 0.01). The comparison of Groups 1 and 2 indicated significant differences in age (p < 0.01), prostate volume (p < 0.01), total IPSS and voiding symptom score (p < 0.05), compliance (p < 0.01), and detrusor pressure at maximum flow (p < 0.01). Group 1 had a higher continence rate (38.0%) than Group 2 (20.8%) in the first month after RARP (p < 0.05), but the difference was no longer significant from the third month after RARP. The total IPSS and voiding symptom scores were significantly different between the two groups before RARP, however, the significant difference disappeared from the first month after RARP. Conclusions The data suggest that IPP affects early postoperative UI. Although NS was strongly involved in UI in the early and later stages after RARP, IPP had no effect on UI in the later stages.

Is It Safe to Offer Radical Cystectomy to Patients above 85 Years of Age? A Long-Term Follow-Up in a Single-Center Institution

2020 ◽  
Vol 104 (11-12) ◽  
pp. 975-981
Author(s):  
Alexander Tamalunas ◽  
Yannic Volz ◽  
Boris Alexander Schlenker ◽  
Alexander Buchner ◽  
Alexander Kretschmer ◽  
...  
Keyword(s):  
Radical Cystectomy ◽  
Oldest Old ◽  
Complication Rates ◽  
Age Group ◽  
Patient Cohort ◽  
Group 2 ◽  
The Impact ◽  
Group 1

<b><i>Purpose:</i></b> With a median age at diagnosis of 73 years, bladder cancer has the highest median age of all cancers. Age alone seems to be an independent risk factor for developing the disease with peak age advancing into the range of 85 years. As demographic changes will lead to an ever more aging population in western countries, incidence of advanced age malignancies will rise. We, therefore, analyzed a contemporary radical cystectomy (RC) series at a single high-volume center on patients undergoing RC for urothelial carcinoma of the bladder (UCB). We aim to evaluate the feasibility of RC in the oldest-old patient cohort by assessing perioperative complications and long-term outcome. <b><i>Materials and Methods:</i></b> We retrospectively analyzed data of 1,278 consecutive patients who underwent RC for UCB at our tertiary referral center between 2004 and 2019. A total of 408 patients were aged 75–97 years at the time of RC and were further divided into 2 groups: 75–84 years of age (group 1) and ≥85 years of age (group 2). Median follow-up was 23 months. Outcome was analyzed using the χ<sup>2</sup> test, Mann-Whitney U test, Kaplan-Meier method, and log-rank test. <b><i>Results:</i></b> Perioperative Clavien-Dindo grade ≥III complications were seen in 25.1% (92/366) of group 1 patients and 35.7% (15/42) of group 2 patients (<i>p</i> = 0.073). Thirty- and 90-day mortality was 3.3 and 8.7% in group 1 and 4.8 and 14.3% in group 2 (<i>p</i> = 0.617 and <i>p</i> = 0.242, respectively). Three-year overall survival was 54.6% in group 1 and 31.3% in group 2 (<i>p</i> = 0.03). Three-year cancer-specific survival was 64.8% in group 1 and 38.8% in group 2 (<i>p</i> = 0.037). Recurrence-free survival was 105 months in group 1 and 12 months in group 2 (<i>p</i> = 0.039). <b><i>Conclusion:</i></b>In light of increasing life expectancy in western nations, we sought to evaluate the impact of age in a large series of elderly patients undergoing RC for UCB. We found that RC offers acceptable perioperative complication rates in the oldest-old patient cohort (≥85 years). Therefore, RC for UCB can be offered as a viable treatment option even in the oldest patients.

scholarly journals Impact of obesity on functional and oncological outcomes in radical perineal prostatectomy

2015 ◽  
Vol 9 (11-12) ◽  
pp. 766 ◽  
Author(s):  
Bulent Altay ◽  
Bulent Erkurt ◽  
Vahit Guzelburc ◽  
Murat Can Kiremit ◽  
Mustafa Yucel Boz ◽  
...  
Keyword(s):  
Erectile Function ◽  
Morbidly Obese ◽  
Complication Rates ◽  
Oncological Outcomes ◽  
Patient Reported ◽  
Group 3 ◽  
Perineal Prostatectomy ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Introduction: We evaluated the impact of obesity on perioperative morbidity, functional, and oncological outcomes after radical perineal prostatectomy (RPP).Methods: A total of 298 consecutive patients underwent RPP at our institution. Patients were categorized into 3 groups based on their body mass index (BMI): Normal weight <25 kg/m2 (Group 1), overweight 25 to <30 kg/m2 (Group 2), and obese ≥30 kg/m2 (Group 3). We compared the groups with respect to perioperativedata, postoperative oncologic, and functional outcomes. Evaluation of urinary continence and erectile function was performed using a patient-reported questionnaire and the International Index of Erectile Function-5 questionnaire, respectively, administered preoperatively and at 3, 6, and 12 months. Limitations included shortfollow-up time, retrospective design and lack of a morbidly obese group.Results: No significant differences were found among the 3 groups with regard to operative time, estimated blood loss, length of hospital stay, catheter removal time, positive surgical margin, and complication rates. At 12 months, 94.7%, 95% and 95% of normal, overweight and obese patients, respectively, were continent (freeof pad use) (p = 0.81). At 12 months, 30.6%, 29.8% and 30.4% of patients had spontaneous erections and were able to penetrate and complete intercourse in Group 1, Group 2, and Group 3, respectively (p = 0.63).Conclusions: In this cohort of patients, no clinically relevant risks were associated with increasing BMI.

scholarly journals Minimally invasive adrenalectomy for large pheochromocytoma: not recommendable yet? Results from a single institution case series

2021 ◽  
Author(s):  
Simone Arolfo ◽  
Giuseppe Giraudo ◽  
Caterina Franco ◽  
Mirko Parasiliti Caprino ◽  
Elisabetta Seno ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Tumor Resection ◽  
Case Series ◽  
Perioperative Outcomes ◽  
Open Approach ◽  
Single Institution ◽  
Significant Difference ◽  
Group 2 ◽  
Minimally Invasive Adrenalectomy ◽  
Group 1

Abstract Background Minimally invasive adrenalectomy represents the treatment of choice of pheochromocytoma (PCC). For large or invasive PCCs, an open approach is currently recommended, in order to ensure complete tumor resection, prevent tumor rupture, avoid local recurrence, and limit perioperative hemodynamic instability. The aim of this study is to analyze perioperative outcomes of laparoscopic adrenalectomies (LAs) for large adrenal PCCs. Methods All consecutive LAs for PCC performed at a single institution between 1998 and 2020 were included. Two groups were defined: lesions larger (group 1) and smaller (group 2) than 5 cm. Short-term outcomes were compared in order to find any significant difference between the two groups. Outcomes One hundred fourteen patients underwent LA during the study period: 46 for lesions larger and 68 for lesions smaller than 5 cm. No significant differences were found in patients’ characteristics, median operative time, conversion rate, intraoperative hemodynamic and metabolic parameters, postoperative intensive care unit (ICU) admission rate, complications rate, and length of hospital stay. Long-term oncologic outcomes were similar, with a recurrence rate of 5.1% in group 1 vs 3.6% in group 2 (p = 1). Conclusion Minimally invasive adrenalectomy seems to be safe and effective even in large PCC. The recommendation to prefer an open approach for large PCCs should probably be reconsidered.

CD34 immunostain increases sensitivity of the diagnosis of fetal vascular malperfusion in placentas from ex-utero intrapartum treatment

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Jerzy Stanek
Keyword(s):  
Statistical Significance ◽  
Treatment Procedure ◽  
Fetal Survival ◽  
Ex Utero Intrapartum Treatment ◽  
Life Threatening ◽  
Group 2 ◽  
Cd34 Immunostain ◽  
The Impact ◽  
Diaphragmatic Hernias ◽  
Group 1

AbstractShort CommunicationsEXIT (ex-utero intrapartum treatment) procedure is a fetal survival-increasing modification of cesarean section. Previously we found an increase incidence of fetal vascular malperfusion (FVM) in placentas from EXIT procedures which indicates the underlying stasis of fetal blood flow in such cases. This retrospective analysis analyzes the impact of the recently introduced CD34 immunostain for the FVM diagnosis in placentas from EXIT procedures.Objectives and MethodsA total of 105 placentas from EXIT procedures (48 to airway, 43 to ECMO and 14 to resection) were studied. In 73 older cases, the placental histological diagnosis of segmental FVM was made on H&E stained placental sections only (segmental villous avascularity) (Group 1), while in 32 most recent cases, the CD34 component of a double E-cadherin/CD34 immunostain slides was also routinely used to detect the early FVM (endothelial fragmentation, villous hypovascularity) (Group 2). 23 clinical and 47 independent placental phenotypes were compared by χ2 or ANOVA, where appropriate.ResultsThere was no statistical significance between the groups in rates of segmental villous avascularity (29 vs. 34%), but performing CD34 immunostain resulted in adding and/or upgrading 12 more cases of segmental FVM in Group 2, thus increasing the sensitivity of placental examination for FVM by 37%. There were no other statistically significantly differences in clinical (except for congenital diaphragmatic hernias statistically significantly more common in Group 2, 34 vs 56%, p=0.03) and placental phenotypes, proving the otherwise comparability of the groups.ConclusionsThe use of CD34 immunostain increases the sensitivity of placental examination for FVM by 1/3, which may improve the neonatal management by revealing the increased likelihood of the potentially life-threatening neonatal complications.

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