Postoperative poor oral intake after open distal pancreatectomy

AbstractThe laparoscopic approach is considered as standard practice in patients with body-tail pancreatic neoplasms. However, only a few randomized controlled trials (RCTs) and propensity score matching (PSM) studies have been performed. Thus, additional studies are needed to obtain more robust evidence. This is a single-centre propensity score-matched study including patients who underwent laparoscopic (LDP) and open distal pancreatectomy (ODP) with splenectomy for pancreatic neoplasms. Demographic, intra, postoperative and oncological data were collected. The primary endpoint was the length of hospital stay. The secondary endpoints included the assessment of the operative findings, postoperative outcomes, oncological outcomes (only in the subset of patients with pancreatic ductal adenocarcinoma-PDAC) and total costs. In total, 205 patients were analysed: 105 (51.2%) undergoing an open approach and 100 (48.8%) a laparoscopic approach. After PSM, two well-balanced groups of 75 patients were analysed and showed a shorter length of hospital stay (P = 0.001), a lower blood loss (P = 0.032), a reduced rate of postoperative morbidity (P < 0.001) and decreased total costs (P = 0.050) after LDP with respect to ODP. Regarding the subset of patients with PDAC, 22 patients were analysed: they showed a significant shorter length of hospital stay (P = 0.050) and a reduction in postoperative morbidity (P < 0.001) after LDP with respect to ODP. Oncological outcomes were similar. LDP showed lower hospital stay and postoperative morbidity rate than ODP both in the entire population and in patients affected by PDAC. Total costs were reduced only in the entire population. Oncological outcomes were comparable in PDAC patients.

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Minimally Invasive versus Open Distal Pancreatectomy: An Individual Patient Data Meta-Analysis of Two Randomized Controlled Trials

Pancreatology ◽

10.1016/j.pan.2020.07.365 ◽

2020 ◽

Vol 20 ◽

pp. S186

Author(s):

M. Korrel ◽

F. Vissers ◽

J. Van Hilst ◽

T. De Rooij ◽

M. Dijkgraaf ◽

...

Keyword(s):

Minimally Invasive ◽

Randomized Controlled Trials ◽

Distal Pancreatectomy ◽

Individual Patient Data ◽

Meta Analysis ◽

Patient Data ◽

Controlled Trials ◽

Randomized Controlled ◽

Open Distal Pancreatectomy

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Impact of coronavirus disease 2019 in a child who underwent ventricular septal defect device closure: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa478 ◽

2020 ◽

Author(s):

Saud A Bahaidarah ◽

Ahmed M Dohain ◽

Gaser Abdelmohsen ◽

Abeer A Alnajjar ◽

Jameel Al-Ata

Keyword(s):

Respiratory Failure ◽

Ventricular Septal Defect ◽

Septal Defect ◽

Systolic Dysfunction ◽

Oral Intake ◽

Serum Levels ◽

Multiple Risk Factors ◽

Late Closure ◽

Lung Condition ◽

Poor Oral Intake

Abstract Background Studies about the incidence and severity of coronavirus disease 2019 (COVID-19) in children are still significantly lower than those in adults. Moreover, data on the effect of COVID-19 in children with congenital heart disease (CHD) are limited. To the best of our knowledge, this study first reported mortality in a child with CHD who acquired COVID-19. Case summary A 16-month-old boy presented to the emergency department due to shortness of breath, fever, cough, and poor oral intake. He tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). He required mechanical ventilation for rapidly progressing respiratory failure. The patient had a large mid-muscular ventricular septal defect (VSD) that was closed percutaneously at the age of 13 months. Moreover, we followed his hospital sequelae from admission to death. Discussion This child had multiple risk factors, including malnutrition and persistent pulmonary hypertension (PH) after late closure of the VSD. The pre-existing PH could have been aggravated by the lung condition associated with COVID-19 and the respiratory failure triggered by SARS-CoV-2 infection. The patient presented with ventricular systolic dysfunction, elevated troponin serum levels and newly developed trifascicular block, which were indicative of myocardial injury. The elevated inflammatory markers and multi-organ dysfunction seem to corroborate multisystem inflammatory syndrome in children, which was described recently among paediatric patients with COVID-19.

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Shock Etiologies and Fluid Management in Liver Failure

Seminars in Respiratory and Critical Care Medicine ◽

10.1055/s-0038-1672139 ◽

2018 ◽

Vol 39 (05) ◽

pp. 538-545 ◽

Cited By ~ 4

Author(s):

Emmanuel Weiss ◽

Catherine Paugam-Burtz ◽

Samir Jaber

Keyword(s):

Liver Failure ◽

Systemic Vascular Resistance ◽

Vascular Resistance ◽

Fluid Management ◽

Hypovolemic Shock ◽

Oral Intake ◽

Chronic Liver ◽

Volume Responsiveness ◽

Beneficial Effects ◽

Poor Oral Intake

AbstractLiver failure can occur in patients with or without underlying chronic liver disease (mainly cirrhosis) and is, respectively, termed acute on chronic liver failure or acute liver failure (ALF). In both cases, it is associated with marked systemic inflammation and profound hemodynamic disturbances, that is, increased cardiac output, peripheral vasodilation, and decreased systemic vascular resistance, on top of several superimposed etiologies of shock. In patients with cirrhosis, sepsis is the main cause of intensive care unit admission but portal hypertension-related gastrointestinal hemorrhage is also common. Septic shock is also particularly frequent in patients with ALF and can complicate the initial hypovolemic shock related to poor oral intake, vomiting, and encephalopathy prior to admission. Given the susceptibility of the liver to hypoxia and also the potential deleterious effects of fluid on liver function, the assessment of hemodynamic status and volume responsiveness is especially important in these patients. However, one should keep in mind that the hyperdynamic state and low systemic vascular resistance in liver failure may bias the accuracy of some hemodynamic monitoring devices. Fluid therapy should use crystalloids, and balanced salt solutions may limit the risk of hyperchloremic acidosis and subsequent adverse kidney events. Nevertheless, the beneficial effects of albumin resuscitation have been demonstrated in patients with cirrhosis and may reflect more than mere volume expansion.

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Minimally Invasive Versus Open Distal Pancreatectomy (LEOPARD)

Annals of Surgery ◽

10.1097/sla.0000000000002979 ◽

2019 ◽

Vol 269 (1) ◽

pp. 2-9 ◽

Cited By ~ 107

Author(s):

Thijs de Rooij ◽

Jony van Hilst ◽

Hjalmar van Santvoort ◽

Djamila Boerma ◽

Peter van den Boezem ◽

...

Keyword(s):

Minimally Invasive ◽

Distal Pancreatectomy ◽

Open Distal Pancreatectomy

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Depressive Symptoms and Malnutrition are Associated with Other Geriatric Syndromes and Increase Risk for 30-Day Readmission in Hospitalized Older Adults: A Prospective Cohort Study

10.21203/rs.3.rs-1182649/v1 ◽

2022 ◽

Author(s):

Laura Tay ◽

Melvin Chua ◽

Yew Yoong Ding

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Depressive Symptoms ◽

Functional Decline ◽

Oral Intake ◽

Index Admission ◽

Geriatric Syndromes ◽

Poor Oral Intake ◽

Hospitalized Older Adults ◽

Minimal Adjustment

Abstract Background: Readmission in older adults is typically complex with multiple contributing factors. We aim to examine how two prevalent and potentially modifiable geriatric conditions – depressive symptoms and malnutrition – relate to other geriatric syndromes and 30-day readmission in hospitalized older adults. Methods: Consecutive admissions of patients >65 years to a general medical department were recruited over 15 months. Patients were screened for depression, malnutrition, delirium, cognitive impairment, and frailty at admission. Medical records were reviewed for intermediary events including poor oral intake and functional decline during hospitalization. Unplanned readmission within 30-days of discharge was tracked through the hospital’s electronic health records and follow-up telephone interviews. We use directed acyclic graphs (DAGs) to depict the relationship of depressive symptoms and malnutrition with geriatric syndromes that constitute covariates of interest and 30-day readmission outcome. Multiple logistic regression was performed for the independent associations of depressive symptoms and malnutrition with 30-day readmission, adjusting for variables based on DAG-identified minimal adjustment set. Results: We recruited 1619 consecutive admissions, with mean age 76.4 (7.9) years and 51.3% females. 30-day readmission occurred in 331 (22.0%) patients. Depressive symptoms (OR 1.55, 95% CI 1.15-2.07), malnutrition (OR 1.59, 95% CI 1.14-2.23), higher comorbidity burden, hospitalization in the one-year preceding index admission, frailty, delirium, as well as functional decline and poor oral intake during the index admission, were more commonly observed among patients who were readmitted within 30 days of discharge (P<0.05). Patients with active depressive symptoms were significantly more likely to be frail (OR=1.62, 95% CI 1.22-2.16), had poor oral intake (OR=1.35, 95% CI 1.02-1.79) and functional decline during admission (OR=1.58, 95% CI 1.11-2.23). Malnutrition at admission was significantly associated with frailty, delirium, cognitive impairment and poor oral intake during hospitalization (P<0.05). In minimal adjustment set identified by DAG, depressive symptoms (OR=1.38, 95% CI 1.02-1.86) remained significantly associated with 30-day readmission. The association of malnutrition with 30-day readmission was attenuated after adjusting for age, ethnicity and depressive symptoms in the minimal adjustment set (OR=1.40, 95% CI 0.99-1.98, P=0.06). Conclusion: The observed causal associations support screening and targeted interventions for depressive symptoms and malnutrition during admission and in the post-acute period.

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Open Distal Pancreatectomy with Splenectomy

Mental Conditioning to Perform Common Operations in General Surgery Training ◽

10.1007/978-3-319-91164-9_52 ◽

2020 ◽

pp. 265-268

Author(s):

Armando Rosales ◽

Omobolanle Oyefule ◽

Mayank Roy ◽

Conrad H. Simpfendorfer

Keyword(s):

Distal Pancreatectomy ◽

Open Distal Pancreatectomy

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Open Distal Pancreatectomy for Pancreatic Cancer

Textbook of Pancreatic Cancer ◽

10.1007/978-3-030-53786-9_62 ◽

2021 ◽

pp. 953-965

Author(s):

Stefan Stättner ◽

Florian Primavesi ◽

David Fuks ◽

Kjetil Søreide

Keyword(s):

Pancreatic Cancer ◽

Distal Pancreatectomy ◽

Open Distal Pancreatectomy

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Early versus On-Demand Nasoenteric Tube Feeding in Acute Pancreatitis

50 Studies Every Intensivist Should Know ◽

10.1093/med/9780190467654.003.0034 ◽

2018 ◽

pp. 204-208

Author(s):

Peter J. Fagenholz

Keyword(s):

Acute Pancreatitis ◽

Tube Feeding ◽

Oral Intake ◽

Adequate Nutrition ◽

On Demand ◽

Major Complications ◽

Nasojejunal Tube ◽

Poor Oral Intake ◽

Oral Diet

This study evaluated whether starting nasojejunal tube feeding within 24 hours of presentation would reduce the rate of death or major complications in patients with acute pancreatitis. This strategy was compared to allowing patients to take an “on demand” oral diet and only initiating nasojejunal tube feeding if there was poor oral intake by 96 hours after presentation. There was no difference between the two groups in any of the measured outcomes, though the study may have been underpowered. We conclude it is acceptable to allow an on-demand oral diet and reserve nasoenteric feeding for patients who have not achieved adequate nutrition by 96 hours after presentation. It is not necessary or beneficial to start nasojejunal tube feeds in the first 24 hours.

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