scholarly journals Vancouver B periprosthetic fractures involving the Exeter cemented stem

2021 ◽  
Vol 103-B (2) ◽  
pp. 309-320
Author(s):  
Matilda F. R. Powell-Bowns ◽  
Erlend Oag ◽  
Nathan Ng ◽  
Hemant Pandit ◽  
Matthew Moran ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Hospital Stay ◽  
Bone Cement ◽  
Revision Arthroplasty ◽  
Femoral Stem ◽  
Length Of Hospital Stay ◽  
Primary Outcome Measure ◽  
Cement Interface ◽  
Kaplan Meier ◽  
Increased Risk

Aims The aim of this study was to determine whether fixation, as opposed to revision arthroplasty, can be safely used to treat reducible Vancouver B type fractures in association with a cemented collarless polished tapered femoral stem (the Exeter). Methods This retrospective cohort study assessed 152 operatively managed consecutive unilateral Vancouver B fractures involving Exeter stems; 130 were managed with open reduction and internal fixation (ORIF) and 22 with revision arthroplasty. Mean follow-up was 6.5 years (SD 2.6; 3.2 to 12.1). The primary outcome measure was revision of at least one component. Kaplan–Meier survival analysis was performed. Regression analysis was used to identify risk factors for revision following ORIF. Secondary outcomes included any reoperation, complications, blood transfusion, length of hospital stay, and mortality. Results Fractures (B1 n = 74 (49%); B2 n = 50 (33%); and B3 n = 28 (18%)) occurred at median of 4.2 years (interquartile range (IQR) 1.2 to 9.2) after primary total hip arthroplasty (THA) (n = 138) or hemiarthroplasty (n = 14). Rates of revision and reoperation were significantly higher following revision arthroplasty compared to ORIF for B2 (p = 0.001) and B3 fractures (p = 0.050). Five-year survival was significantly better following ORIF: 92% (95% confidence interval (CI) 86.4% to 97.4%) versus 63% (95% CI 41.7% to 83.3%), p < 0.001. ORIF was associated with reduced blood transfusion requirement and reoperations, but there were no differences in medical complications, hospital stay, or mortality between surgical groups. No independent predictors of revision following ORIF were identified: where the bone-cement interface was intact, fixation of B2 or B3 fractures was not associated with an increased risk of revision. Conclusion When the bone-cement interface was intact and the fracture was anatomically reducible, all Vancouver B fractures around Exeter stems could be managed with fixation as opposed to revision arthroplasty. Fixation was associated with reduced need for blood transfusion and lower risk of revision surgery compared with revision arthroplasty. Cite this article: Bone Joint J 2021;103-B(2):309–320.

scholarly journals SARS-CoV-2 infection in acute pancreatitis increases disease severity and 30-day mortality: COVID PAN collaborative study

Gut ◽  
2021 ◽  
pp. gutjnl-2020-323364
Author(s):  
Sanjay Pandanaboyana ◽  
John Moir ◽  
John S Leeds ◽  
Kofi Oppong ◽  
Aditya Kanwar ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Hospital Stay ◽  
Organ Failure ◽  
Collaborative Study ◽  
Length Of Hospital Stay ◽  
Secondary Outcome ◽  
Icu Admission ◽  
Local Complications ◽  
Persistent Organ Failure ◽  
Increased Risk

ObjectiveThere is emerging evidence that the pancreas may be a target organ of SARS-CoV-2 infection. This aim of this study was to investigate the outcome of patients with acute pancreatitis (AP) and coexistent SARS-CoV-2 infection.DesignA prospective international multicentre cohort study including consecutive patients admitted with AP during the current pandemic was undertaken. Primary outcome measure was severity of AP. Secondary outcome measures were aetiology of AP, intensive care unit (ICU) admission, length of hospital stay, local complications, acute respiratory distress syndrome (ARDS), persistent organ failure and 30-day mortality. Multilevel logistic regression was used to compare the two groups.Results1777 patients with AP were included during the study period from 1 March to 23 July 2020. 149 patients (8.3%) had concomitant SARS-CoV-2 infection. Overall, SARS-CoV-2-positive patients were older male patients and more likely to develop severe AP and ARDS (p<0.001). Unadjusted analysis showed that SARS-CoV-2-positive patients with AP were more likely to require ICU admission (OR 5.21, p<0.001), local complications (OR 2.91, p<0.001), persistent organ failure (OR 7.32, p<0.001), prolonged hospital stay (OR 1.89, p<0.001) and a higher 30-day mortality (OR 6.56, p<0.001). Adjusted analysis showed length of stay (OR 1.32, p<0.001), persistent organ failure (OR 2.77, p<0.003) and 30-day mortality (OR 2.41, p<0.04) were significantly higher in SARS-CoV-2 co-infection.ConclusionPatients with AP and coexistent SARS-CoV-2 infection are at increased risk of severe AP, worse clinical outcomes, prolonged length of hospital stay and high 30-day mortality.

Influence of revision arthroplasty on bone/cement interface shear strength

1987 ◽  
Vol 20 (8) ◽  
pp. 824
Author(s):  
J.E. Bechtold ◽  
Y. Dohmae ◽  
R.E. Sherman ◽  
R.B. Gustilo
Keyword(s):  
Shear Strength ◽  
Bone Cement ◽  
Revision Arthroplasty ◽  
Interface Shear Strength ◽  
Interface Shear ◽  
Cement Interface

The Effect of Omentoplasty on the Rate of Anastomotic Leakage after Intestinal Resection: A Randomized Controlled Trial

2017 ◽  
Vol 83 (2) ◽  
pp. 157-160 ◽  
Author(s):  
Shirzad Nasiri ◽  
Babak Mirminachi ◽  
Reyhaneh Taherimehr ◽  
Roya Shadbakhsh ◽  
Mohsen Hojat
Keyword(s):  
Hospital Stay ◽  
Anastomotic Leakage ◽  
Controlled Trial ◽  
Randomized Study ◽  
Intestinal Resection ◽  
Length Of Hospital Stay ◽  
Fistula Formation ◽  
Intestinal Surgery ◽  
Increased Risk ◽  
Significant Difference

Anastomotic leakage is a major postoperative complication after intestinal surgery leading to increased risk of morbidity and mortality. Omentoplasty has been evaluated to prevent anastomotic leakage in several studies. However, there is no consensus regarding whether or not omentoplasty should be used to decrease the rate of anastomotic leakage after intestinal resection. A prospective, randomized study was conducted to evaluate the influence of omentoplasty on anastomotic leakage after intestinal resection. A total of 124 patients who underwent intestinal resection were enrolled in this prospective study. Patients were randomly assigned to receive either the omentoplasty or nonomentoplasty. In the omentoplasty group, the omentum was wrapped around the anastomotic region. Age, gender, site and type of anastomosis, duration of hospital stay, and performance of omentoplasty were recorded. This study was registered in Iranian Registry of clinical trial (number: IRCT201412316925N3). The rate of anastomotic leakage was significantly lower in the omentoplasty group (P = 0.04). Patients in the omentoplasty group developed a significantly lower rate of postoperative infection and peritonitis (P < 0.05). There was no significant difference of abscess and fistula formation between the two groups (P > 0.05). The length of hospital stay was longer in the nonomentoplasty group, compared with that for omentoplasty patients (P < 0.05). No death occurred in the omentoplasty subjects, while six nonomentoplasty patients died (P < 0.05). Our data demonstrated that omentoplasty is useful to lower the rate of postoperative complications in patients underwent intestinal surgery.

Surgical Site Infection in a Tertiary Neonatal Surgery Centre

2018 ◽  
Vol 29 (03) ◽  
pp. 260-265 ◽  
Author(s):  
Adiam Woldemicael ◽  
Sarah Bradley ◽  
Caroline Pardy ◽  
Justin Richards ◽  
Paolo Trerotoli ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Model ◽  
Surgical Site Infection ◽  
Hospital Stay ◽  
Logistic Regression Model ◽  
Length Of Hospital Stay ◽  
Neonatal Surgery ◽  
Site Infection ◽  
Increased Risk

Introduction Surgical site infection (SSI) is a key performance indicator to assess the quality of surgical care. Incidence and risk factors for SSI in neonatal surgery are lacking in the literature. Aim To define the incidence of SSI and possible risk factors in a tertiary neonatal surgery centre. Materials and Methods This is a prospective cohort study of all the neonates who underwent abdominal and thoracic surgery between March 2012 and October 2016. The variables analyzed were gender, gestational age, birth weight, age at surgery, preoperative stay in neonatal intensive care unit, type of surgery, length of stay, and microorganisms isolated from the wounds. Statistical analysis was done with chi-square, Student's t- or Mann–Whitney U-tests. A logistic regression model was used to evaluate determinants of risk for SSI; variables were analyzed both with univariate and multivariate models. For the length of hospital stay, a logistic regression model was performed with independent variables. Results A total of 244 neonates underwent 319 surgical procedures. The overall incidence of SSIs was 43/319 (13.5%). The only statistical differences between neonates with and without SSI were preoperative stay (<4 days vs. ≥4 days, p < 0.01) and length of hospital stay (<30 days vs. ≥30 days, p < 0.01). A pre-operative stay longer than 4 days was associated with almost three times increased risk of SSI (odds ratio [OR] 2.96, 95% confidence interval [CI] 1.05–8.34, p = 0.0407). Gastrointestinal procedures were associated with more than ten times the risk of SSI compared with other procedures (OR 10.17, 95% CI 3.82–27.10, p < 0.0001). Gastroschisis closure and necrotizing enterocolitis (NEC) laparotomies had the highest incidence SSI (54% and 62%, respectively). The risk of longer length of hospital stay after SSI was more than three times higher (OR = 3.36, 95%CI 1.63–6.94, p = 0.001). Conclusion This is the first article benchmarking the incidence of SSI in neonatal surgery in the United Kingdom. A preoperative stay ≥4 days and gastrointestinal procedures were independent risk factors for SSI. More research is needed to develop strategies to reduce SSI in selected neonatal procedures.

scholarly journals A comparative study of the fracture union between long and short proximal femoral intramedullary nails antirotation in the treatment of intertrochanteric femur fractures in the elderly: a multicentric analysis

2019 ◽  
Vol 5 (2) ◽  
pp. 288
Author(s):  
B. Hari Krishnan ◽  
S. K. Rai ◽  
Rohit Vikas ◽  
Manoj Kashid ◽  
Pramod Mahender
Keyword(s):  
Postoperative Complications ◽  
Blood Transfusion ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Operation Time ◽  
The Elderly ◽  
Intertrochanteric Fractures ◽  
Intraoperative Blood Loss ◽  
Fracture Union ◽  
Femur Fractures

<p class="abstract"><strong>Background:</strong> The objective of the study was to compare the fracture union of long vs. short proximal femoral intramedullary nail antirotation (PFNA) in the treatment of intertrochanteric fractures in elderly patients who was more than 60 years old.</p><p class="abstract"><strong>Methods:</strong> A retrospective analysis of 170 cases of intertrochanteric fractures of the femur (AO type A1 and A2) in the elderly was conducted. There were 64 males (37.6%) and 106 females (62.3%) with the age of 60–90 (mean age 75) years. The general demographic data of patients, operation time, intraoperative blood loss, length of hospital stay, blood transfusion rate, anterior thigh pain, postoperative complications like periprosthetic fractures, infections were recorded.<strong></strong></p><p class="abstract"><strong>Results:</strong> The short nail group also had a significantly shorter operation time (41.5±15.3 minutes vs. 62.5±25.3 minutes, p=0.002) and lower rate of postoperative transfusion (31.3% vs. 58.7%, p=0.041). However the length of hospital stay showed no significant differences. After surgery in short group there were 03 cases of periprosthetic fracture with a total incidence of 03%, however there were none in long nail group. At the end of the follow-up, all patients achieved bony union. The average fracture union time of the long nail group was (8.5±3.2) months, and the short nail group was (7.8±4.7) months, revealing no significant differences (p=0.09).</p><p class="abstract"><strong>Conclusions:</strong> Both the proximal femoral intramedullary long and short nail fixation has a good result in the form of fracture union in treating intertrochanteric femur fractures in the elderly. They showed no significant difference in terms of fracture union, hospital stay, and postoperative complications. The incidence of periprosthetic fractures and anterior thigh pain was slightly high in short nail group. In short intramedullary nailing group there was obvious decrease in the intraoperative blood loss, operation time and postoperative blood transfusion.</p>

scholarly journals Vasoactive Agents for the Management of Acute Variceal Bleeding: A Systematic Review and Meta-analysis

2021 ◽  
Vol 30 (1) ◽  
pp. 110-121
Author(s):  
Jorge Huaringa-Marcelo ◽  
Mariella R Huaman ◽  
Ana Brañez-Condorena ◽  
Pamela Villacorta-Landeo ◽  
Diego F Pinto-Ruiz ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Adverse Events ◽  
Hospital Stay ◽  
Variceal Bleeding ◽  
Meta Analysis ◽  
Bleeding Control ◽  
Vasoactive Agents ◽  
Acute Variceal Bleeding ◽  
Increased Risk ◽  
Grade Methodology

Background and Aims: Vasoactive agents with endoscopic therapy are used to treat acute variceal bleeding (AVB). There are two main groups of vasoactive agents: terlipressin and vasopressin (T-V), and octreotide and somatostatin (O-S). However, the benefit/harm balance is unclear. Our aim was to assess the efficacy and safety of T-V versus O-S for the management of AVB. Methods: We performed a systematic search for randomized controlled trials (RCTs) in PubMed, Scopus, and CENTRAL. Our main outcomes were mortality and adverse events. Secondary outcomes were bleeding control, rebleeding, blood transfusion, hospital stay. We evaluated the certainty of evidence using GRADE methodology. Results: We included 21 RCTs. The risk of mortality (RR: 1.01; 95%CI: 0.83-1.22), bleeding control (RR: 0.96; 95%CI: 0.91-1.02; I 2 =53%), early rebleeding (RR: 0.91; 95%CI: 0.66-1.24: I 2 =0%), late rebleeding (RR: 0.94; 95 CI: 0.56-1.60; I 2 =0%), blood transfusion (MD: 0.04; 95%CI: -0.31-0.39; I 2 =68%) and hospital stay (MD: -1.06; 95%CI: -2.80-0.69; I 2 =0%) were similar between T-V and O-S groups. Only 15 studies reported adverse events, which were significantly higher in the T-V compared to the O-S group (RR 2.39; 95%CI: 1.58-3.63; I 2 =57%). The certainty of evidence was moderate for the main outcomes, and low or very low for others. Conclusions: In cirrhotic patients with AVB, those treated with T-V had similar mortality risk compared to O-S. However, the use of T-V showed an increased risk of adverse events compared to O-S.

scholarly journals Factors affecting outcome of decompressive hemicraniectomy in malignant middle cerebral artery infarction

2021 ◽  
Vol 18 (3) ◽  
pp. 35-38
Author(s):  
Sagar Koirala ◽  
Shreeram Bhandari ◽  
Subash Lohani
Keyword(s):  
Hospital Stay ◽  
Primary Outcome ◽  
Length Of Hospital Stay ◽  
Primary Outcome Measure ◽  
Early Surgery ◽  
Brain Swelling ◽  
Middle Cerebral Artery Infarction ◽  
Factors Affecting ◽  
Decompressive Hemicraniectomy ◽  
Outcome Of Surgery

Introduction: Decompressive Hemicraniectomy (DHC) is a standard surgical management of malignant MCA (MMCA) infarction. This study was conducted to review the outcome of surgery and to find out factors associated with favorable outcomes at a tertiary level neurosurgery referral centre. Methods and Materials: This is a retrospective study conducted over a period of three years from 2017 to 2019. Patient charts were reviewed for variable like age, sex, timing of surgery, GCS at presentation, length of ventilation, length of ICU admission and length of hospital stay. Primary outcome measure was GOSE: favorable (<=4) and unfavorable (>=5). SPSS version 23 was used for analysis. Results:  A total of 28 patients underwent DHC out of which 21 patients were available for analysis. Mean age of patients was 58.62 years. Mean GCS on arrival was 11.86. Mean interval duration between event and surgery was 51.88 hours. Mean duration of ventilation was 4.43 days. Mean length of ICU stay was 5.95 days. Mean hospital stay was 22.33 days. Mean GOSE was 2. Mean age was significantly lower in patients with favorable GOSE. Early surgery had better mean GOSE which was not significant statistically. Conclusion: Patients with age less than 50 years have favorable GOSE despite MMCA infarction if decompressive hemicraniectomy is performed to accommodate brain swelling. Early surgery at presentation rather than waiting for deterioration might improve the outcome.

scholarly journals Length of Hospital Stay for Hip Fracture and 30-Day Mortality in People With Alzheimer’s Disease: A Cohort Study in Finland

2020 ◽  
Vol 75 (11) ◽  
pp. 2184-2192
Author(s):  
Piia Lavikainen ◽  
Marjaana Koponen ◽  
Heidi Taipale ◽  
Antti Tanskanen ◽  
Jari Tiihonen ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Hospital Stay ◽  
Older Persons ◽  
Length Of Hospital Stay ◽  
Inpatient Rehabilitation ◽  
Risk Of Death ◽  
Increased Risk ◽  
Hospital Stays ◽  
Worse Prognosis

Abstract Background Persons with Alzheimer’s disease (AD) are at higher risk of hip fractures (HFs) than general older population and have worse prognosis after HF. Hospital stays after HF have shortened along time. We investigated the association between length of hospital stay after HF and mortality after discharge among persons with AD. Method The MEDALZ cohort includes all Finnish community dwellers who received clinically verified AD diagnosis in 2005–2011 (N = 70 718). Patients who experienced first HF after AD diagnosis in 2005‒2015 (n = 6999) were selected. Length of hospital stay for HF was measured as a sum of the consecutive days spent in hospital after HF until discharge. Outcome was defined as death within 30 days after hospital discharge. Results Mean of overall length of hospital stay after a HF decreased from 52.6 (SD 62.9) days in 2005 to 19.6 (SD 23.1) days in 2015. Shortest treatment decile (1‒4 days) had the highest risk of death within 30 days after discharge (adjusted hazard ratio [aHR] 2.76; 95% confidence interval [CI] 1.66–4.60) in addition to second (5‒6 days; aHR 2.52; 95% CI 1.50–4.23) and third (7‒10 days; aHR 2.22; 95% CI 1.34–3.69) deciles when compared to the sixth decile of length of stays (21‒26 days). Conclusions Among persons with AD, shorter length of hospital stay after HF was associated with an increased risk of death after discharge. After acute HF treatment, inpatient rehabilitation or proper care and services in home need to be organized to older persons with AD.

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