A Comparison of Outcomes Between Laparoscopic and Robotic Appendectomy Among ACS NSQIP Hospitals

Background/Objective: Robotic general surgery remains controversial with some employing the technology for common laparoscopic procedures such as appendectomies. Very few studies have compared robotic appendectomies to existing techniques, partly due to the relative scarcity of data. The purpose of this study was to compare outcomes for robotic appendectomies versus laparoscopic appendectomies. Methods: This retrospective cohort study evaluated procedural specific databases of ACS-NSQIP for appendectomy between 2016-2019 (inclusive). Demographic and surgical outcomes including composite 30 day complications, specific complications, and length of operation were analyzed using a univariant analysis. Results: There was no difference in the total number of comorbidities present or the severity of appendicitis (perforation/abscesses) between robotic and laparoscopic cases. Robotic appendectomy had a longer operation time (91 min vs 52 min, p < 0.001) but a shorter post-operative stay (0.66 days vs 1.27 days, p < 0.001). There was no difference in the frequency of 30-day mortality (p = 0.34), readmission (p = 0.20), or complications (p = 1) between robotically performed appendectomy and laparoscopic appendectomy (Table 1) Laparoscopic Robotic Complications N = 49,800 N = 50 P Value Odds ratio Any Complication 5302 (10.6%) 5 (10%) 1 1.06 Superficial surgical site infection 423 (0.8%) 0 >0.9 Organ Space SSI 1,355 (2.7%) 0 >0.9 Postoperative Intra-abdominal Abscess 1353 (2.7%) 0 >0.9 Sepsis 1,696 (3.4%) 1 (2%) >0.9 1.7 Table 1. Complications for Laparoscopic versus Robotic appendectomy. Conclusion and Potential Impact: Our results demonstrated laparoscopic and robotic appendectomy had a similar frequency and profile of complications. Robotic procedures took longer but resulted in shorter post-operative stays. Robotic appendectomies appear promising but at present, only make up a small fraction of cases (0.1%) and the widespread adoption of robotic appendectomies is difficult due to issues of cost, equipment, and training.

Download Full-text

Association Between Nursing Visits and Hospital-Related Disenrollment in the Home Hospice Population

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909117697933 ◽

2017 ◽

Vol 35 (2) ◽

pp. 316-323 ◽

Cited By ~ 3

Author(s):

Veerawat Phongtankuel ◽

Ronald D. Adelman ◽

Kelly Trevino ◽

Erika Abramson ◽

Phyllis Johnson ◽

...

Keyword(s):

Odds Ratio ◽

Retrospective Cohort ◽

Hospice Care ◽

Care Transitions ◽

Median Number ◽

P Value ◽

Medicare Data ◽

Hospice Patients ◽

Home Hospice Care ◽

Patients Experience

Background: Over 10% of hospice patients experience a transition out of hospice care during the last months of life. Hospice transitions from home to hospital (ie, hospital-related hospice disenrollment) result in fragmented care, which can be burdensome for patients and caregivers. Nurses play a major role in delivering home hospice care, yet little is known about the association between nursing visits and disenrollment. Objectives: The study’s purpose is to examine the association between the average number of nursing visits per week and hospital-related disenrollment in the home hospice population. We hypothesize that more nursing visits per week will be associated with reduced odds for disenrollment. Design: A retrospective cohort study using Medicare data. Participants: Medicare hospice beneficiaries who were ≥18 years old in 2012. Outcome measured: Hospitalization within 2 days of hospice disenrollment. Results: The sample included 115 103 home hospice patients, 6450 (5.6%) of whom experienced a hospital-related disenrollment. The median number of nursing visits per week was 2 (interquartile range 1.3-3.2), with a mean of 2.5 (standard deviation ±1.6). There was a decreased likelihood of a hospital-related disenrollment when comparing enrollments that had <3 nursing visits per week on average to 3 to <4 visits (odds ratio [OR] 0.39; P value <.001), 4 to <5 visits (OR 0.29; P value <.001), and 5+ visits (OR 0.21; P value <.001). Conclusions: More nursing visits per week was associated with a decreased likelihood of a hospital-related hospice disenrollment. Further research is needed to understand what components of nursing care influence care transitions in the home hospice setting.

Download Full-text

Hubungan Pengetahuan, Usia Dan Paritas Dengan Kejadian Komplikasi Kehamilan Pada Ibu Hamil Trimester Iii Di Rumah Sakit Ibu Dan Anak Aisyiyah Samarinda

KESMAS UWIGAMA: Jurnal Kesehatan Masyarakat ◽

10.24903/kujkm.v5i2.835 ◽

2020 ◽

Vol 5 (2) ◽

pp. 83

Author(s):

Siti Komariah ◽

Hary Nugroho

Keyword(s):

Odds Ratio ◽

P Value ◽

Cross Sectional ◽

Purposive Sampling

Latar Belakang:Komplikasi kehamilan adalah kegawat daruratan obstetrik yang dapat menyebabkan kematian pada ibu dan bayi. Penyebab komplikasi kehamilan diantaranya kurangnya pengetahuan ibu tentang deteksi dini kehamilannya, usia pasien < 20 tahun dan > 35 tahun serta anak lebih dari 3.Tujuan :Penelitian ini bertujuan untuk mengetahui hubungan pengetahuan, usia dan paritas dengan kejadian komplikasi kehamilan pada ibu hamil trimester III.Metode Penelitian:Jenis penelitian observasional analitik dengan pendekatan cross sectional. Teknik pengambilan sampel menggunakan purposive sampling, sehingga sampel adalah ibu hamil trimester III yang berkunjung di Rumah Sakit Ibu dan Anak Aisyiyah Samarinda berjumlah 84 orang. Analisis yang digunakan uji chi square.Hasil : Hasil penelitian menunjukkan terdapat responden yang memiliki pengetahuan kurang baik, terdapat usia berisiko antara < 20 tahun dan > 35 tahun, terdapat paritas berisiko > 3 orang anak dan komplikasi kehamilan berupa hipertensi, anemia, preeklempsia dan plasenta previa. Ada hubungan pengetahuan dengan kejadian komplikasi kehamilan (p value : 0,001 < α : 0,05 dan odds ratio : 6,800 > 1). Ada hubungan usia dengan kejadian komplikasi kehamilan (p value : 0,003 < α : 0,05 dan odds ratio : 5,837 > 1). Ada hubungan paritas dengan kejadian komplikasi kehamilan (p value : 0,002 < α : 0,05 dan odds ratio : 6,250 > 1).Kesimpulan: Terdapat pengetahuan kurang baik berjumlah 27 responden (32,1%), usia berisiko (< 20 tahun dan ≥ 35 tahun) berjumlah 25 responden (29,8%), paritas berisiko (1 atau ≥ 3 orang anak) berjumlah 21 responden (25%) dan ada komplikasi kehamilan berjumlah 18 responden (21,4%), Ada hubungan pengetahuan, usia dan paritas dengan kejadian komplikasi kehamilan pada ibu hamil trimester III di Rumah Sakit Ibu dan Anak Aisyiyah Samarinda.

Download Full-text

An Analysis of Dental Implants Survival and Success

Revista de Chimie ◽

10.37358/rc.18.9.6554 ◽

2018 ◽

Vol 69 (9) ◽

pp. 2465-2466

Author(s):

Iustin Olariu ◽

Roxana Radu ◽

Teodora Olariu ◽

Andrada Christine Serafim ◽

Ramona Amina Popovici ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Medical History ◽

Retrospective Cohort Study ◽

Odds Ratio ◽

Retrospective Cohort ◽

Demographic Data ◽

Kaplan Meier ◽

Number Of Patients ◽

Health Related

Osseointegration of a dental implant may encounter a variety of problems caused by various factors, as prior health-related problems, patients� habits and the technique of the implant inserting. Retrospective cohort study of 70 patients who received implants between January 2011- April 2016 in one dental unit, with Kaplan-Meier method to calculate the probability of implants�s survival at 60 months. The analysis included demographic data, age, gender, medical history, behavior risk factors, type and location of the implant. For this cohort the implants�survival for the first 6 months was 92.86% compared to the number of patients and 97.56% compared to the number of total implants performed, with a cumulative failure rate of 2.43% after 60 months. Failures were focused exclusively on posterior mandible implants, on the percentage of 6.17%, odds ratio (OR) for these failures being 16.76 (P = 0.05) compared with other localisations of implants, exclusively in men with median age of 42 years.

Download Full-text

Is there a relationship between gestational diabetes and postpartum depression?

Current Women s Health Reviews ◽

10.2174/1573404816999200918115133 ◽

2020 ◽

Vol 16 ◽

Author(s):

Salman Khazaei ◽

Erfan Ayubi ◽

Saeid Bashirian ◽

Ronak Hamzehei ◽

Ensiyeh Jenabi

Keyword(s):

Gestational Diabetes ◽

Postpartum Depression ◽

Odds Ratio ◽

Depression Scale ◽

Binary Logistic Regression ◽

Cross Sectional Study ◽

University Education ◽

P Value ◽

Cross Sectional ◽

The Relationship

Background: The relationship between gestational diabetes and postpartum depression (PPD) is poorly understood and seldom studied. Objective: In an effort to explore this issue, the present study investigated the relationship between gestational diabetes and PPD. Methods: The present cross-sectional study was performed with 342 women who were referred to four urban health centers of Hamadan city, west of Iran. We used convenience sampling as a method to recruit women in each health center. We used a researcher-made checklist for gathering data on socio-demographic characteristics and potential risk factors of PPD. The Persian validated version of the Edinburgh Postnatal Depression Scale (EPDS) was used to assess PPD. Univariate and multivariable binary logistic regression was applied to estimate the odds ratio (OR) (95% confidence interval [CI]). Results: Gestational diabetes was identified as the most important risk factor for PPD with OR (95% CI) of 2.19 (1.11, 4.31); P-value=0.02 after adjusting for other variables. Moreover, the adjusted odds ratio showed that PPD among lesseducated women (primary school) was 3.5 times higher compared to women with a university education (OR=3.54, 95% CI: 1.27, 9.84; P-value=0.01). Conclusion: Our findings suggested that PPD is more likely among women with gestational diabetes and those who were less educated. Interventional and educational activities for reducing the risk of PPD can be targeted for use with this population.

Download Full-text

Can a Difference in Gestational Age According to Biparietal Diameter and Abdominal Circumference Predict Intrapartum Placental Abruption?

Journal of Clinical Medicine ◽

10.3390/jcm10112413 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2413

Author(s):

Jee-Youn Hong ◽

Jin-Ha Kim ◽

Seo-yeon Kim ◽

Ji-Hee Sung ◽

Suk-Joo Choi ◽

...

Keyword(s):

Gestational Age ◽

Odds Ratio ◽

Retrospective Cohort ◽

Maternal Age ◽

Placental Abruption ◽

Independent Predictor ◽

Abdominal Circumference ◽

Biparietal Diameter ◽

Study Population ◽

Independent Risk Factors

This study aimed to investigate whether a difference in gestational age according to biparietal diameter (BPD) and abdominal circumference (AC) could be a clinically useful predictor of placental abruption during the intrapartum period. This retrospective cohort study was based on singletons who were delivered after 32 + 0 weeks between July 2015 and July 2020. We only included cases with at least two antepartum sonographies available within 4 weeks of delivery (n = 2790). We divided the study population into two groups according to the presence or absence of placental abruption and compared the clinical variables. The incidence of placental abruption was 2.0% (56/2790) and was associated with an older maternal age, a higher rate of preeclampsia, and being small for the gestational age. A difference of >2 weeks in gestational age according to BPD and AC occurred at a higher rate in the placental abruption group compared to the no abruption group (>2 weeks, 21.4% (12/56) vs. 7.5% (205/2734), p < 0.001; >3 weeks, 12.5% (7/56) vs. 2.0% (56/2734), p < 0.001). Logistic regression analysis revealed that the differences of >2 weeks and >3 weeks were both independent risk factors for placental abruption (odds ratio (OR) (95% confidence interval), 2.289 (1.140–4.600) and 3.918 (1.517–9.771), respectively) after adjusting for maternal age, preeclampsia, and small for gestational age births. We identified that a difference in gestational age of >2 weeks between BPD and AC could be an independent predictor of placental abruption.

Download Full-text

Incidence and Outcomes of Acute Kidney Injury in Patients Admitted to Hospital With COVID-19: A Retrospective Cohort Study

Canadian Journal of Kidney Health and Disease ◽

10.1177/20543581211027759 ◽

2021 ◽

Vol 8 ◽

pp. 205435812110277

Author(s):

Tyler Pitre ◽

Angela (Hong Tian) Dong ◽

Aaron Jones ◽

Jessica Kapralik ◽

Sonya Cui ◽

...

Keyword(s):

Mechanical Ventilation ◽

Acute Kidney Injury ◽

Cohort Study ◽

Hospital Mortality ◽

Disease Severity ◽

Retrospective Cohort Study ◽

Odds Ratio ◽

Retrospective Cohort ◽

Kidney Injury ◽

Icu Admission

Background: The incidence of acute kidney injury (AKI) in patients with COVID-19 and its association with mortality and disease severity is understudied in the Canadian population. Objective: To determine the incidence of AKI in a cohort of patients with COVID-19 admitted to medicine and intensive care unit (ICU) wards, its association with in-hospital mortality, and disease severity. Our aim was to stratify these outcomes by out-of-hospital AKI and in-hospital AKI. Design: Retrospective cohort study from a registry of patients with COVID-19. Setting: Three community and 3 academic hospitals. Patients: A total of 815 patients admitted to hospital with COVID-19 between March 4, 2020, and April 23, 2021. Measurements: Stage of AKI, ICU admission, mechanical ventilation, and in-hospital mortality. Methods: We classified AKI by comparing highest to lowest recorded serum creatinine in hospital and staged AKI based on the Kidney Disease: Improving Global Outcomes (KDIGO) system. We calculated the unadjusted and adjusted odds ratio for the stage of AKI and the outcomes of ICU admission, mechanical ventilation, and in-hospital mortality. Results: Of the 815 patients registered, 439 (53.9%) developed AKI, 253 (57.6%) presented with AKI, and 186 (42.4%) developed AKI in-hospital. The odds of ICU admission, mechanical ventilation, and death increased as the AKI stage worsened. Stage 3 AKI that occurred during hospitalization increased the odds of death (odds ratio [OR] = 7.87 [4.35, 14.23]). Stage 3 AKI that occurred prior to hospitalization carried an increased odds of death (OR = 5.28 [2.60, 10.73]). Limitations: Observational study with small sample size limits precision of estimates. Lack of nonhospitalized patients with COVID-19 and hospitalized patients without COVID-19 as controls limits causal inferences. Conclusions: Acute kidney injury, whether it occurs prior to or after hospitalization, is associated with a high risk of poor outcomes in patients with COVID-19. Routine assessment of kidney function in patients with COVID-19 may improve risk stratification. Trial registration: The study was not registered on a publicly accessible registry because it did not involve any health care intervention on human participants.

Download Full-text

Fetal CHD and perinatal outcomes

Cardiology in the Young ◽

10.1017/s1047951120000785 ◽

2020 ◽

Vol 30 (5) ◽

pp. 686-691

Author(s):

Christina J. Ge ◽

Amanda C. Mahle ◽

Irina Burd ◽

Eric B. Jelin ◽

Priya Sekar ◽

...

Keyword(s):

Cohort Study ◽

Preterm Delivery ◽

Odds Ratio ◽

Retrospective Cohort ◽

Mode Of Delivery ◽

Perinatal Outcomes ◽

Fold Increase ◽

Cesarean Sections ◽

Increased Risk ◽

Gestational Age At Delivery

AbstractObjective:To evaluate delivery management and outcomes in fetuses prenatally diagnosed with CHD.Study design:A retrospective cohort study was conducted on 6194 fetuses (born between 2013 and 2016), comparing prenatally diagnosed with CHD (170) to those with non-cardiac (234) and no anomalies (5790). Primary outcomes included the incidence of preterm delivery and mode of delivery.Results:Gestational age at delivery was significantly lower between the CHD and non-anomalous cohorts (38.6 and 39.1 weeks, respectively). Neonates with CHD had a significantly lower birth weights (p < 0.001). There was an approximately 1.5-fold increase in the rate of primary cesarean sections associated with prenatally diagnosed CHD with an odds ratio of 1.49 (95% CI 1.06–2.10).Conclusions:Our study provides additional evidence that the prenatal diagnosis of CHD is associated with a lower birth weight, preterm delivery, and with an increased risk of delivery by primary cesarean section.

Download Full-text

Does perianal disease influence the efficacy of combination therapy in Crohn’s disease?

Digestive Diseases ◽

10.1159/000513067 ◽

2020 ◽

Author(s):

Rui de Sousa Magalhães ◽

Sofia Xavier ◽

Tiago Cúrdia Gonçalves ◽

Francisca Dias de Castro ◽

Bruno Rosa ◽

...

Keyword(s):

Combination Therapy ◽

Clinical Remission ◽

Odds Ratio ◽

Perianal Disease ◽

Outcome Variable ◽

P Value ◽

Disease Relapse ◽

Endoscopic Remission ◽

Remission Rates ◽

One Year

Background: Perianal disease is associated with a disabling course of CD. We aim to study the impact of perianal disease on CD remission rates, after a one-year course of infliximab in combination therapy with azathioprine. Methods: Cohort, retrospective, single centre study, including consecutive CD patients on combination therapy, followed for one year since induction. The outcome variable was split into clinical and endoscopic remission. The correlation towards the outcome variable was assessed with univariate and multivariate analysis, and a survival assessment, using SPSS software. Results: We assessed 74 CD patients, of whom 41 (55.4%) were female, with a mean age of 36 years-old. Thirty-nine percent of the patients presented perianal disease at diagnosis (n=29). We documented 70.3% clinical and 47.2% endoscopic remissions. Several variables had statistical significance towards the outcomes (endoscopic and clinical remission) in the univariate analysis. After adjusting for confoundment, patients with perianal disease presented an odds ratio of 0.20 for achieving endoscopic remission (odds ratio 0.201 CI [0.054-0.75] p-value 0.017) and an odds ratio of 0.203 for achieving clinical remission (OR 0.203 CI [0.048-0.862] p-value 0.031). Sixty-six patients (89.2%) presented an initial response to treatment, from whom, 20 (30.3%) exhibited at least one disease relapse (clinical and/or endoscopic). Patients with perianal disease presented higher probability of disease relapse, displaying statistically significant difference on Kaplan-Meyer curves (Breslow p-value 0.043). Conclusion: In the first year of combination therapy, perianal disease is associated with an 80% decrease in endoscopic and clinical remission rates and higher ratio of disease relapse.

Download Full-text

Association between smoking and non-alcoholic fatty liver disease: A systematic review and meta-analysis

SAGE Open Medicine ◽

10.1177/2050312117745223 ◽

2018 ◽

Vol 6 ◽

pp. 205031211774522 ◽

Cited By ~ 15

Author(s):

Arash Akhavan Rezayat ◽

Malihe Dadgar Moghadam ◽

Mohammad Ghasemi Nour ◽

Matin Shirazinia ◽

Hamidreza Ghodsi ◽

...

Keyword(s):

Systematic Review ◽

Liver Disease ◽

Fatty Liver ◽

Odds Ratio ◽

Fatty Liver Disease ◽

Meta Analysis ◽

P Value ◽

Exclusion Criteria ◽

Alcoholic Fatty Liver ◽

Alcoholic Fatty Liver Disease

Background/aims: Non-alcoholic fatty liver disease is one of the most common chronic liver diseases. Some risk factors are known to influence the development of non-alcoholic fatty liver disease, but the effect of tobacco smoking on the progression of non-alcoholic fatty liver disease is controversial. The main goal of this systematic review and meta-analysis is to investigate the association between smoking and non-alcoholic fatty liver disease. Method: Electronic databases (PubMed, Scopus, and ISI Web of Science) were searched to find published articles on non-alcoholic fatty liver disease and smoking until December 2016. All relevant studies were screened by inclusion and exclusion criteria and compatible studies were chosen. The Newcastle–Ottawa Scale was used to assess the methodological quality of eligible articles. Subsequently, information was gathered based on the following: author, publication year, keywords, country, inclusion and exclusion criteria, main results, study design, conclusion, and confounder variables (age, body mass index, gender, ethnicity, and diabetes). Finally, analyses were performed using Comprehensive Meta-Analysis Software. Results: Data were extracted from 20 observational studies (9 cross-sectional, 6 case-control, 4 cohort studies, and 1 retrospective cohort study). A significant association was observed between smoking and non-alcoholic fatty liver disease with a pooled odds ratio of 1.110 (95% confidence interval, 1.028–1.199), p-value = 0.008. The statistical heterogeneity was medium with an I2 of 40.012%, p-heterogeneity = 0.074. Also there was a significant relation between non-alcoholic fatty liver disease and passive smoking with a pooled odds ratio of 1.380 (95% confidence interval, 1.199–1.588; p-value = 0.001; I2 = 59.41; p-heterogeneity = 0.117). Conclusion: Our meta-analysis demonstrated that smoking is significantly associated with non-alcoholic fatty liver disease. Further prospective studies exploring the underlying mechanisms of this association should be pursued. Also passive smoking increases the risk of non-alcoholic fatty liver disease about 1.38-fold. The effects of smoking cigarettes on active smokers (current smoker, former smoker, and total smoker) are less than passive smokers. Further studies are needed to compare the of effects of passive and active smoking on non-alcoholic fatty liver disease.

Download Full-text