scholarly journals Open or Not Open the Retroperitoneum: A Pandora’s Box for High-grade Pancreatic Trauma?

2022 ◽  
Author(s):  
Kaiwei Li ◽  
Wensong Chen ◽  
Kai Wang ◽  
Chao Yang ◽  
Yunxuan Deng ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Clinical Outcomes ◽  
Management Strategy ◽  
Diffuse Peritonitis ◽  
Trauma Patients ◽  
High Grade ◽  
Pancreatic Trauma ◽  
Tertiary Referral Center

Abstract Background: The management strategy associated with the optimal clinical outcomes for patients with pancreatic trauma remains ambiguous. We sought to determine whether transitioning from initial laparotomy (LAP) to the nonoperative management strategy based on initial percutaneous drainage (PCD) without opening the retroperitoneum would improve clinical outcomes in patients with blunt high-grade pancreatic trauma.Methods: We conducted a retrospective cohort study of pancreatic trauma at a single tertiary referral center. Blunt high-grade pancreatic trauma patients with stable hemodynamics and no diffuse peritonitis were enrolled consecutively in the study. The primary outcome measure was the incidence of severe complications (Clavien-Dindo classification ≥ Ⅲb) for patients who underwent initial LAP vs PCD. To study effect modification by different initial strategies and to adjust for confounding, modified Poisson regression and sensitivity analysis based on propensity score matching and weighting were performed to estimate adjusted relative risks (aRR) and 95% confidence intervals (CIs).Results: Among 119 patients with blunt grade Ⅲ/Ⅳ pancreatic trauma (107 male [89.9%] and 12 female [10.1%]; mean age, 35.7 [SD, 12.7] years), 29 underwent initial PCD and 90 underwent initial LAP (January 2009 through October 2021). Compared with initial LAP, patients underwent initial PCD were significantly lower risk of severe complicates (9/29 [31.0%] vs 65/90 [72.2%]; aRR, 0.52 [95% CI, 0.30-0.90]). Consistent results are also observed in sensitivity analysis models. The relative risk of severe complications for the PCD group in propensity score matching model was 0.53 (95% CI, 0.28-0.99; P = 0.035), 0.37 (95% CI, 0.18-0.75; P = 0.006) in inverse probability of treatment weighting model, and 0.55 (95% CI, 0.31-0.99; P = 0.046) in overlap weighting model. In addition, the mean number of reinterventions per patient was 1.8 in the PCD group and 2.6 in the LAP group (P = 0.067). Conclusions: For blunt high-grade pancreatic trauma patients with stable hemodynamics and no diffuse peritonitis, initial PCD strategy without open the retroperitoneum has a significantly lower rate of severe complications and does not increase reinterventions compared with initial LAP. Further randomized controlled trials are warranted to validate these results.Trial Registration: ClinicalTrials.gov Identifier: NCT03681041(Sept. 21 2018).

scholarly journals Splenic Artery Embolization for Patients with High-Grade Splenic Trauma: Indications, Techniques, and Clinical Outcomes

2021 ◽  
Vol 38 (01) ◽  
pp. 105-112
Author(s):  
Majd Habash ◽  
Darrel Ceballos ◽  
Andrew J. Gunn
Keyword(s):  
Clinical Outcomes ◽  
Splenic Artery ◽  
Splenic Injury ◽  
Nonoperative Management ◽  
Operative Management ◽  
Splenic Trauma ◽  
Trauma Patients ◽  
High Grade ◽  
Artery Embolization ◽  
Splenic Artery Embolization

AbstractThe spleen is the most commonly injured organ in blunt abdominal trauma. Patients who are hemodynamically unstable due to splenic trauma undergo definitive operative management. Interventional radiology plays an important role in the multidisciplinary management of the hemodynamically stable trauma patient with splenic injury. Hemodynamically stable patients selected for nonoperative management have improved clinical outcomes when splenic artery embolization is utilized. The purpose of this article is to review the indications, technical aspects, and clinical outcomes of splenic artery embolization for patients with high-grade splenic injuries.

scholarly journals Health literacy and exercise interventions on clinical outcomes in Chinese patients with diabetes: a propensity score-matched comparison

2020 ◽  
Vol 8 (1) ◽  
pp. e001179
Author(s):  
Yan Wei ◽  
Yingyao Chen ◽  
Yingnan Zhao ◽  
Russell Rothman ◽  
Jian Ming ◽  
...  
Keyword(s):  
Health Literacy ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Clinical Outcomes ◽  
Exercise Intervention ◽  
Controlled Trial ◽  
Literacy Intervention ◽  
Chinese Patients ◽  
Exercise Interventions ◽  
Patients With Diabetes

IntroductionPatients with diabetes in China have low health literacy, which likely leads to poor clinical outcomes. This study aimed to assess the effectiveness of health literacy and exercise interventions on clinical measurements in Chinese adults with type 2 diabetes mellitus (T2DM).Research design and methodsA cluster randomized controlled trial was conducted from February 2015 through April 2017 in Shanghai, China. 799 patients with T2DM aged 18 years or older recruited from eight Community Healthcare Centers were randomized into one control arm and three intervention arms receiving 1-year health literacy intervention, exercise intervention or both as the comprehensive intervention. Propensity score matching was employed to minimize potential imbalance in randomization. The intervention-attributable effects on main clinical outcomes were estimated using a difference-in-difference regression approach.ResultsAfter propensity score matching, 634 patients were included in the analysis. The three intervention groups had decreased hemoglobin A1c (A1c) level after 12 months of intervention. The largest adjusted decrease was observed in the health literacy group (−0.95%, 95% CI: −1.30 to −0.59), followed by the exercise group (−0.81%, 95% CI: −1.17 to −0.45). However, A1c was observed to increase in the health literacy and the comprehensive groups from 12 to 24 months. No obvious changes were observed for other measurements including high-density and low-density lipoprotein cholesterols, and systolic and diastolic blood pressures.ConclusionsHealth literacy and exercise-focused interventions improve glycemic control in Chinese patients with diabetes after 12 months of intervention, and the health literacy intervention shows the greatest effect. Our results suggest that the interventions may have the potential to improve diabetes self-management and reduce diabetes burden in China.Trial registration numberISRCTN76130594.

scholarly journals Minimally invasive versus standard extracorporeal circulation system in minimally invasive aortic valve surgery: a propensity score-matched study

2019 ◽  
Author(s):  
Paolo Berretta ◽  
Mariano Cefarelli ◽  
Luca Montecchiani ◽  
Jacopo Alfonsi ◽  
Walter Vessella ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Propensity Score ◽  
Minimally Invasive ◽  
Propensity Score Matching ◽  
Clinical Outcomes ◽  
Extracorporeal Circulation ◽  
Fast Track ◽  
Blood Transfusions ◽  
Track Management ◽  
To Receive

Abstract OBJECTIVES The impact of minimally invasive extracorporeal circulation (MiECC) systems on the clinical outcomes of patients undergoing minimally invasive aortic valve replacement (MI-AVR) has still to be defined. This study compared in-hospital and 1 year outcomes of MI-AVR interventions using MiECC systems versus conventional extracorporeal circulation (c-ECC). METHODS Data from 288 consecutive patients undergoing primary isolated MI-AVR using MiECC (n = 102) or c-ECC (n = 186) were prospectively collected. Treatment selection bias was addressed by the use of propensity score matching (MiECC vs c-ECC). After propensity score matching, 2 groups of 93 patients each were created. RESULTS Compared with c-ECC, MiECC was associated with a higher rate of autologous priming (82.4% vs 0%; P < 0.001) and a greater nadir haemoglobin (9.3 vs 8.7 g/dl; P = 0.021) level and haematocrit (27.9% vs 26.4%; P = 0.023). Patients who had MiECC were more likely to receive ultra-fast-track management (60.8% vs 26.9%; P < 0.001) and less likely to receive blood transfusions (32.7% vs 44%; P = 0.04). The in-hospital mortality rate was 1.1% in the MiECC group and 0% in the c-ECC group (P = 0.5). Those in the MiECC group had reduced rates of bleeding requiring revision (0% vs 5.3%; P = 0.031) and postoperative atrial fibrillation (AF) (30.1% vs 44.1%; P = 0.034). The 1-year survival rate was 96.8% and 97.5% for MiECC and c-ECC patients, respectively (P = 0.4). CONCLUSIONS MiECC systems were a safe and effective tool in patients who had MI-AVR. Compared with c-ECC, MiECC promotes ultra-fast-track management and provides better clinical outcomes as regards bleeding, blood transfusions and postoperative AF. Thus, by reducing surgical injury and promoting faster recovery, MiECC may further validate MI-AVR interventions.

P5504Comparison of in-hospital clinical outcomes of acute myocardial infarction between nonagenarians and octogenarians: a propensity-score matched analysis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Seguchi ◽  
K Sakakura ◽  
K Yamamoto ◽  
Y Taniguchi ◽  
H Wada ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Propensity Score ◽  
Hospital Stay ◽  
Propensity Score Matching ◽  
Clinical Outcomes ◽  
Length Of Hospital Stay ◽  
Hospital Death ◽  
Very Elderly ◽  
Hospital Outcomes

Abstract Background Acute myocardial infarction (AMI) in the very elderly is associated with high morbidity and mortality. Because the majority of study population in clinical researches focusing on the very elderly with AMI were octogenarians, clinical evidences regarding AMI in nonagenarians are sparse. The aim of the present study was to compare in-hospital clinical outcomes of AMI between octogenarians and nonagenarians. Methods We included consecutive 415 very elderly (≥80 years) patients with AMI, and divided into the nonagenarian group (n=38) and the octogenarian group (n=377). Clinical characteristics and in-hospital outcomes were compared between the 2 groups. Furthermore, we used propensity-score matching to find the matched octogenarian group (n=38). Results Percutaneous coronary interventions (PCI) to the culprit of AMI were similarly performed between the nonagenarian (86.8%) and octogenarian (87.0%) groups The incidence of in-hospital death in the nonagenarian group (13.2%) was similar to that in the octogenarian group (14.6%) (P=0.811). The length of hospital stay was significantly shorter in the nonagenarian group (7.4±4.2 days) than that in the octogenarian group (15.4±19.4 days) (P<0.001). After using the propensity-score matching, the incidence of in-hospital death was less in the nonagenarian group (13.2%) than in the matched octogenarian group (21.1%) without reaching statistical significance (P=0.361). The length of hospitalization was significantly shorter in the nonagenarian group (7.4±4.2 days) than in the matched octogenarian group (17.8±37.0 days) (P=0.01). Clinical outcomes Nonagenarian group (n=38) Octogenarian group (n=377) P value In-hospital death, n (%) 5 (13.2) 55 (14.6) 0.811 Length of hospital stay (days) 7.4±4.2 15.4±19.4 <0.001 Length of CCU stay (days) 3.3±2.5 4.7±5.1 0.109 LVEF (%) 48.2±9.2 50.8±13.7 0.152 Peak CPK (U/L) 1424.8±1580.8 1640.1±2394.4 0.912 CCU indicates Coronary care unit; LVEF, Left ventricular ejection fraction; CPK, Creatine kinase. Flow-chart Conclusions The in-hospital mortality of nonagenarians with AMI was comparable to that of octogenarians with AMI. In-hospital outcomes in nonagenarians with AMI may be acceptable as long as acute medical management including PCI to the culprit of AMI is performed. Acknowledgement/Funding None

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