Surgical Management of Traumatic Diaphragmatic Hernia: a Single Institutional Experience of More Than Two Decades.

Abstract Background: We present here our experience with surgical management of traumatic diaphragmatic hernia, trying to find out the era impact of different periods on the outcome and risk factors of mortality. Methods: A series of 63 patients with traumatic diaphragmatic hernia were referred to us and operated on during March, 1990-August, 2017. The patient records were reviewed and statistically analyzed to demonstrate injury characteristics and to find out optimal treatment strategy, risk factors of death as well as the difference between two periods (1990-2005, 2005-2017) divided by introduction of computed tomography at our institution.Results: The overall mean age was 31.2±16.3 years old with a female to male ratio of 11/52. The mechanism was penetrating trauma in 19 cases (30.2%), and blunt trauma in 44 cases (69.9%). Two thirds of the patients in the latter period yet none in the former period underwent computed tomography. Ten patients (15.9%), of which 8 in the former and the other 2 in the latter period (p=.042), had late diagnoses. The most commonly used incision was a thoracotomy (n=43, 89.6%). There was no statistical difference in etiology or mortality between the two periods. Univariate analysis showed survivors were younger, and had lesser injury severity scores (ISS) and lower American Association for the Surgery of Trauma (AAST) grade than nonsurvivors. By multiple logistic regression analysis, increased age (odds ratio, 1.275; p=.013) and greater ISS (OR, 1.174; p=.028) were risk factors of death in all patients.Conclusions: High definition computed tomography has significantly improved the preoperative diagnosis rate. The transthoracic approach could be used in selected cases with traumatic diaphragmatic hernia with good outcomes. Patients with greater ISS and advanced age are at higher risk of death.

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Surgical management of traumatic diaphragmatic hernia: a single institutional experience of more than two decades

BMC Surgery ◽

10.1186/s12893-021-01141-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xicheng Deng ◽

Zuosheng Deng ◽

Erjia Huang

Keyword(s):

Risk Factors ◽

Computed Tomography ◽

Surgical Management ◽

Diaphragmatic Hernia ◽

Univariate Analysis ◽

Multivariate Logistic Regression Analysis ◽

Penetrating Trauma ◽

Traumatic Diaphragmatic Hernia ◽

Risk Of Death ◽

Severity Scores

Abstract Background We present here our experience with surgical management of traumatic diaphragmatic hernia, trying to find out the era impact of different periods on the outcome and risk factors of mortality. Methods A series of 63 patients with traumatic diaphragmatic hernia were referred to us and operated on during March, 1990-August, 2017. The patient records were reviewed and statistically analyzed to demonstrate injury characteristics and to find out optimal treatment strategy, risk factors of death as well as the difference between two periods (1990–2005, 2005–2017) divided by introduction of computed tomography at our institution. Results The overall mean age was 31.2 ± 16.3 years old with a female to male ratio of 11/52. The mechanism was penetrating trauma in 19 cases (30.2%), and blunt trauma in 44 cases (69.9%). Two thirds of the patients in the second group (2005–2017) yet none in the first group (1990–2005) underwent computed tomography. Ten patients (15.9%), of which 8 in the first and the other 2 in the second group (p = .042), had late diagnoses. The most commonly used incision was a thoracotomy (n = 43, 89.6%). There was no statistical difference in etiology or mortality between the two periods. Univariate analysis showed survivors were younger, and had lesser injury severity scores (ISS) and lower American Association for the Surgery of Trauma (AAST) grade than non-survivors. By multivariate logistic regression analysis, increased age (odds ratio, 1.275; p = .013) and greater ISS (OR, 1.174; p = .028) were risk factors of death in all patients. Conclusions High-definition computed tomography has significantly improved the preoperative diagnosis rate. The transthoracic approach could be used in selected cases with traumatic diaphragmatic hernia with good outcomes. Patients with greater ISS and advanced ages are at a higher risk of death.

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Is it possible to predict outcome in cardiac ECMO? Analysis of preoperative risk factors

Perfusion ◽

10.1177/0267659107083241 ◽

2007 ◽

Vol 22 (4) ◽

pp. 225-229 ◽

Cited By ~ 8

Author(s):

Kari Wagner ◽

Ivar Risnes ◽

Michael Abdelnoor ◽

Harald M. Karlsen ◽

Jan Ludvig Svennevig

Keyword(s):

Risk Factors ◽

Cardiac Failure ◽

Multiple Logistic Regression Analysis ◽

Univariate Analysis ◽

Early Mortality ◽

Cardiac Insufficiency ◽

Preoperative Risk ◽

Preoperative Risk Factors ◽

Va Ecmo ◽

Ecmo Treatment

Background. Serious heart failure may be treated with extracorporeal membrane oxygenation (ECMO) when other treatment fails. The aim of the present study was to analyse preoperative risk factors of early mortality in patients treated with veno-arterial (VA)-ECMO. Methods. We studied a total of 18 possible risk factors in 80 patients with severe cardiac insufficiency treated with VA-ECMO. All consecutive cases treated at our institution between Sept.1990 and May 2006 were included. Univariate analysis and multiple logistic regression analysis were performed on 16 risk factors. The endpoint was early mortality (any death within 30 days of ECMO treatment). Results. Thirty patients (37.5%) died within 30 days. Age, gender, cause of cardiac failure, pre-ECMO treatment (ventilator, NO, IABP) did not significantly influence early mortality. A higher SvO2 was associated with survival and remained significant in the multivariate analysis. Conclusion. Treatment with VA-ECMO in patients with severe cardiac failure may save lives. It is, however, difficult to predict outcome. In this study, only SvO2 values prior to ECMO were positively associated with survival. Perfusion (2007) 22, 225—229.

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Case control study of gastrointestinal complications after cardiopulmonary bypass heart surgery

Perfusion ◽

10.1177/0267659109346665 ◽

2009 ◽

Vol 24 (3) ◽

pp. 173-178 ◽

Cited By ~ 3

Author(s):

Guowei Zhang ◽

Naishi Wu ◽

Hongyu Liu ◽

Hang Lv ◽

Zhifa Yao ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Cardiopulmonary Bypass ◽

Heart Surgery ◽

Perfusion Pressure ◽

Multiple Logistic Regression Analysis ◽

Univariate Analysis ◽

Multiple Logistic Regression ◽

Gastrointestinal Complications ◽

Preoperative Serum

Background: Gastrointestinal complications (GIC) after cardiopulmonary bypass (CPB) surgery are rare, but, nevertheless, extremely dangerous.The identification of risks for GIC may be helpful in planning appropriate perioperative management strategies. The aim of the present study was to analyze perioperative factors of GIC in patients undergoing CPB surgery. Methods: We retrospectively analysed 206 patients who underwent GIC after cardiopulmonary bypass surgery from 2000 to 2007 and compared them with 206 matched control patients (matched for surgery, temperature, hemodilution and date). Univariate analysis and multiple logistic regression analysis were performed on 12 risk factors. Result: Sex and types of cardioplegia perfusate did not significantly influence the GIC after CPB surgery. Multiple logistic regression revealed that CPB time, preoperative serum creatinine (PSC) ≥ 179 mg/dL, emergency surgery, perfusion pressure ≤40mmHg, low cardiac output syndrome (LCOS), age ≥ 61, mechanical ventilation ≥96 h, New York Heart Association (NYHA) class III and IV were predictors of the occurrence of GIC after CPB surgery. Perfusion pressure and aprotinin administration were protective factors. Conclusion: Gastrointestinal complications after CPB surgery could be predictive in the presence of the above risk factors. This study suggests that GIC can be reduced by maintenance of higher perfusion pressure and shortening the time on CPB and ventilation.

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Risk factors for myocardial injury and death in patients with COVID-19: insights from a cohort study with chest computed tomography

Cardiovascular Research ◽

10.1093/cvr/cvaa193 ◽

2020 ◽

Vol 116 (14) ◽

pp. 2239-2246 ◽

Cited By ~ 3

Author(s):

Giuseppe Ferrante ◽

Fabio Fazzari ◽

Ottavia Cozzi ◽

Matteo Maurina ◽

Renato Bragato ◽

...

Keyword(s):

Risk Factors ◽

Computed Tomography ◽

Cohort Study ◽

Myocardial Injury ◽

Troponin I ◽

Cox Regression ◽

Chest Ct ◽

Chest Computed Tomography ◽

Risk Of Death ◽

Increased Risk

Abstract Aims Whether pulmonary artery (PA) dimension and coronary artery calcium (CAC) score, as assessed by chest computed tomography (CT), are associated with myocardial injury in patients with coronavirus disease 2019 (COVID-19) is not known. The aim of this study was to explore the risk factors for myocardial injury and death and to investigate whether myocardial injury has an independent association with all-cause mortality in patients with COVID-19. Methods and Results This is a single-centre cohort study including consecutive patients with laboratory-confirmed COVID-19 undergoing chest CT on admission. Myocardial injury was defined as high-sensitivity troponin I >20 ng/L on admission. A total of 332 patients with a median follow-up of 12 days were included. There were 68 (20.5%) deaths; 123 (37%) patients had myocardial injury. PA diameter was higher in patients with myocardial injury compared with patients without myocardial injury [29.0 (25th–75th percentile, 27–32) mm vs. 27.7 (25–30) mm, P < 0.001). PA diameter was independently associated with an increased risk of myocardial injury [adjusted odds ratio 1.10, 95% confidence interval (CI) 1.02–1.19, P = 0.01] and death [adjusted hazard ratio (HR) 1.09, 95% CI 1.02–1.17, P = 0.01]. Compared with patients without myocardial injury, patients with myocardial injury had a lower prevalence of a CAC score of zero (25% vs. 55%, P < 0.001); however, the CAC score did not emerge as a predictor of myocardial injury by multivariable logistic regression. Myocardial injury was independently associated with an increased risk of death by multivariable Cox regression (adjusted HR 2.25, 95% CI 1.27–3.96, P = 0.005). Older age, lower estimated glomerular filtration rate, and lower PaO2/FiO2 ratio on admission were other independent predictors for both myocardial injury and death. Conclusions An increased PA diameter, as assessed by chest CT, is an independent risk factor for myocardial injury and mortality in patients with COVID-19. Myocardial injury is independently associated with an approximately two-fold increased risk of death.

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Computed tomography angiography: improving diagnostic yield and cost effectiveness in the initial evaluation of spontaneous nonsubarachnoid intracerebral hemorrhage

Journal of Neurosurgery ◽

10.3171/2012.7.jns12281 ◽

2012 ◽

Vol 117 (4) ◽

pp. 761-766 ◽

Cited By ~ 15

Author(s):

Kimon Bekelis ◽

Atman Desai ◽

Wenyan Zhao ◽

Dan Gibson ◽

Daniel Gologorsky ◽

...

Keyword(s):

Risk Factors ◽

Computed Tomography ◽

Cost Effectiveness ◽

Intracerebral Hemorrhage ◽

Computed Tomography Angiography ◽

Diagnostic Yield ◽

Multiple Logistic Regression Analysis ◽

Patient Characteristics ◽

Vascular Pathology ◽

Significance Level

Object Computed tomography angiography (CTA) is increasingly used as a screening tool in the investigation of spontaneous intracerebral hemorrhage (ICH). However, CTA carries additional costs and risks, necessitating its judicious use. The authors hypothesized that subsets of patients with nontraumatic, nonsubarachnoid ICH are unlikely to benefit from CTA as part of the diagnostic workup and that particular patient risk factors may be used to increase the yield of CTA in the detection of vascular sources. Methods The authors performed a retrospective analysis of 1376 patients admitted to Dartmouth-Hitchcock Medical Center with ICH over an 8-year period. Patients with subarachnoid hemorrhage, hemorrhagic conversion of ischemic infarcts, trauma, and known prior malignancy were excluded from the analysis, resulting in 257 patients for final analysis. Records were reviewed for medical risk factors, hemorrhage location, and correlation of CTA findings with final diagnosis. Multiple logistic regression analysis was used to investigate the combined effects of baseline variables of interest. Model selection was conducted using the stepwise method with p = 0.10 as the significance level for variable entry and p = 0.05 the significance level for variable retention. Results Computed tomography angiography studies detected vascular pathology in 34 patients (13.2%). Patient characteristics that were associated with a significantly higher likelihood of identifying a structural vascular lesion as the source of hemorrhage included patient age younger than 65 years (OR = 16.36, p = 0.0039), female sex (OR = 14.9, p = 0.0126), nonsmokers (OR = 103.8, p = 0.0008), patients with intraventricular hemorrhage (OR = 9.42, p = 0.0379), and patients without hypertension (OR = 515.78, p < 0.0001). Patients who were older than 65 years of age, with a history of hypertension, and hemorrhage located in the cerebellum or basal ganglia were never found to have an identified structural source of hemorrhage on CTA. Conclusions Patient characteristics and risk factors are important considerations when ordering diagnostic tests in the workup of nonsubarachnoid, nontraumatic spontaneous ICH. Although CTA is an accurate diagnostic examination, it can usually be omitted in the workup of patients with the described characteristics. The use of this algorithm has the potential to increase the yield, and thus the safety and cost effectiveness, of this diagnostic tool.

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COVID-19 mortality in cancer patients: a report from a tertiary cancer centre in India

PeerJ ◽

10.7717/peerj.10599 ◽

2021 ◽

Vol 9 ◽

pp. e10599

Author(s):

Anurag Mehta ◽

Smreti Vasudevan ◽

Anuj Parkash ◽

Anurag Sharma ◽

Tanu Vashist ◽

...

Keyword(s):

Risk Factors ◽

Cancer Patients ◽

Univariate Analysis ◽

Significant Risk ◽

Case Fatality ◽

Nucleic Acid Amplification ◽

Risk Of Death ◽

Oropharyngeal Swab ◽

Probability Of Death ◽

Relationship Of

Background Cancer patients, especially those receiving cytotoxic therapy, are assumed to have a higher probability of death from COVID-19. We have conducted this study to identify the Case Fatality Rate (CFR) in cancer patients with COVID-19 and have explored the relationship of various clinical factors to mortality in our patient cohort. Methods All confirmed cancer cases presented to the hospital from June 8 to August 20, 2020, and developed symptoms/radiological features suspicious of COVID-19 were tested by Real-time polymerase chain reaction assay and/or cartridge-based nucleic acid amplification test from a combination of naso-oropharyngeal swab for SARS-CoV-2. Clinical data, treatment details, and outcomes were assessed from the medical records. Results Of the total 3,101 cancer patients admitted to the hospital, 1,088 patients were tested and 186 patients were positive for SARS-CoV-2. The CFR in the cohort was 27/186 (14.52%). Univariate analysis showed that the risk of death was significantly associated with the presence of any comorbidity (OR: 2.68; (95% CI [1.13–6.32]); P = 0.025), multiple comorbidities (OR: 3.01; (95% CI [1.02–9.07]); P = 0.047 for multiple vs. single), and the severity of COVID-19 presentation (OR: 27.48; (95% CI [5.34–141.49]); P < 0.001 for severe vs. not severe symptoms). Among all comorbidities, diabetes (OR: 3.31; (95% CI [1.35–8.09]); P = 0.009) and cardiovascular diseases (OR: 3.77; (95% CI [1.02–13.91]); P = 0.046) were significant risk factors for death. Anticancer treatments including chemotherapy, surgery, radiotherapy, targeted therapy, and immunotherapy administered within a month before the onset of COVID-19 symptoms had no significant effect on mortality. Conclusion To the best of our knowledge, this is the first study from India reporting the CFR, clinical associations, and risk factors for mortality in SARS-CoV-2 infected cancer patients. Our study shows that the frequency of COVID-19 in cancer patients is high. Recent anticancer therapies are not associated with mortality. Pre-existing comorbidities, especially diabetes, multiple comorbidities, and severe symptoms at presentation are significantly linked with COVID-19 related death in the cohort.

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Traumatic Diaphragmatic Hernia

IIUM Medical Journal Malaysia ◽

10.31436/imjm.v18i1.818 ◽

2019 ◽

Vol 18 (1) ◽

Author(s):

Nurashidah Musa ◽

Ruben Gregory Xavier

Keyword(s):

Respiratory Distress ◽

Diaphragmatic Hernia ◽

Left Lung ◽

Penetrating Trauma ◽

Exploratory Laparotomy ◽

Left Lobe ◽

Falciform Ligament ◽

Left Hemithorax ◽

Traumatic Diaphragmatic Hernia ◽

Abdominal Symptoms

Traumatic diaphragmatic hernia (TDH) is uncommon and it can be a result from both blunt and penetrating trauma. About to 1% to 7% of patients with blunt trauma sustained TDH. Left sided traumatic diaphragmatic hernia are much common compared to right side.TDH can present acutely or delayed with signs of respiratory distress of intestinal obstruction. The diagnosis was made with the aid of chest radiograph and computed topography (CT) abdomen. A coiled nasogastric tube within the hemithorax is a pathognomonic for TDH. We are presenting a case of high impact injury resulting in a TDH in a 19-year-old, malay male with unsure mechanism injury. He presented with generalised abdominal pain and in respiratory distress with a clinical evidence of abdominal tenderness and type 1 respiratory failure. Subsequently, he underwent exploratory laparotomy and repair of left diaphragmatic hernia. Intraoperatively, noted large linear tear of left hemidiaphragm posterolaterally extending medially until the insertion of falciform ligament. Stomach, left lobe of liver, spleen and splenic flexure of colon were herniated into the left hemithorax. The left diaphragmatic tear was repaired in 2 layers using prolene. A left subdiaphgramatic drain and a chest tube were inserted. Post operatively, the patient was nursed in ICU and recovered well. Repeated chest x -ray showed left lung was fully expanded. With aggressive chest physiotherapy and incentive spirometry, he recovered well and was discharged home. In trauma, there should be a high index of suspicion in patients with both respiratory and abdominal symptoms. Conclusion: Prompt recognition and early definitive management can improve patient outcomes.

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Risk factors for death among children aged 5–14 years hospitalised with pneumonia: a retrospective cohort study in Kenya

BMJ Global Health ◽

10.1136/bmjgh-2019-001715 ◽

2019 ◽

Vol 4 (5) ◽

pp. e001715 ◽

Cited By ~ 1

Author(s):

Liana Macpherson ◽

Morris Ogero ◽

Samuel Akech ◽

Jalemba Aluvaala ◽

David Gathara ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Clinical Characteristics ◽

Univariate Analysis ◽

Older Age ◽

Who Criteria ◽

Risk Of Death ◽

Increased Risk

IntroductionThere were almost 1 million deaths in children aged between 5 and 14 years in 2017, and pneumonia accounted for 11%. However, there are no validated guidelines for pneumonia management in older children and data to support their development are limited. We sought to understand risk factors for mortality among children aged 5–14 years hospitalised with pneumonia in district-level health facilities in Kenya.MethodsWe did a retrospective cohort study using data collected from an established clinical information network of 13 hospitals. We reviewed records for children aged 5–14 years admitted with pneumonia between 1 March 2014 and 28 February 2018. Individual clinical signs were examined for association with inpatient mortality using logistic regression. We used existing WHO criteria (intended for under 5s) to define levels of severity and examined their performance in identifying those at increased risk of death.Results1832 children were diagnosed with pneumonia and 145 (7.9%) died. Severe pallor was strongly associated with mortality (adjusted OR (aOR) 8.06, 95% CI 4.72 to 13.75) as were reduced consciousness, mild/moderate pallor, central cyanosis and older age (>9 years) (aOR >2). Comorbidities HIV and severe acute malnutrition were also associated with death (aOR 2.31, 95% CI 1.39 to 3.84 and aOR 1.89, 95% CI 1.12 to 3.21, respectively). The presence of clinical characteristics used by WHO to define severe pneumonia was associated with death in univariate analysis (OR 2.69). However, this combination of clinical characteristics was poor in discriminating those at risk of death (sensitivity: 0.56, specificity: 0.68, and area under the curve: 0.62).ConclusionChildren >5 years have high inpatient pneumonia mortality. These findings also suggest that the WHO criteria for classification of severity for children under 5 years do not appear to be a valid tool for risk assessment in this older age group, indicating the urgent need for evidence-based clinical guidelines for this neglected population.

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Analysis of pancreatic fistula risk in patients with laparoscopic pancreatoduodenectomy: what matters

Journal of International Medical Research ◽

10.1177/0300060520943422 ◽

2020 ◽

Vol 48 (7) ◽

pp. 030006052094342

Author(s):

Kate Nong ◽

Yue Zhang ◽

Shengyong Liu ◽

Yue Yang ◽

Donglin Sun ◽

...

Keyword(s):

Risk Factors ◽

Pancreatic Fistula ◽

Bilirubin Level ◽

Multiple Logistic Regression Analysis ◽

Univariate Analysis ◽

Amylase Level ◽

Drainage Fluid ◽

Soft Pancreas ◽

Laparoscopic Pancreatoduodenectomy ◽

Potential Risk Factors

Objective To analyse potential risk factors for postoperative pancreatic fistula (POPF). Methods A retrospective study on risk factors for POPF was conducted in patients undergoing laparoscopic pancreatoduodenectomy. Basic characteristics, and preoperative, intraoperative and postoperative patient data were collected and analysed. Results A total of 268 patients were enrolled in this study, including 54 patients with POPF following surgery (POPF incidence, 20.15%). Univariate analysis indicated that patient’s age, body mass index (BMI), preoperative bilirubin level, pancreas texture, and drainage fluid amylase level on day 1 following surgery were associated with POPF. Multiple logistic regression analysis indicated that preoperative bilirubin level ≥170 µmol/l, soft pancreas texture, BMI ≥25, and age ≥65 years were independent risk factors associated with POPF. Conclusions For patients with preoperative bilirubin level ≥170 µmol/l, soft pancreas texture, BMI ≥25 and age ≥65 years, clinically relevant measures should be taken as early as possible for the prophylaxis of POPF.

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O50 DIAPHRAGMATIC HERNIA AFTER IVOR-LEWIS OESOPHAGECTOMY: ANALYSIS OF RISK FACTORS AND SURGICAL REPAIR RESULTS

Diseases of the Esophagus ◽

10.1093/dote/doz092.50 ◽

2019 ◽

Vol 32 (Supplement_2) ◽

Author(s):

Puccetti Francesco ◽

Parise Paolo ◽

De Pascale Stefano ◽

Cossu Andrea ◽

Cerchione Raffaele ◽

...

Keyword(s):

Risk Factors ◽

Minimally Invasive ◽

Oesophageal Cancer ◽

Diaphragmatic Hernia ◽

Surgical Repair ◽

Univariate Analysis ◽

Multivariable Analysis ◽

Occurrence Rate ◽

Ivor Lewis

Abstract Backgrounds and aim oesophagectomy is the mainstay of curative treatment for oesophageal cancer and post-oesophagectomy diaphragmatic hernia (PODH) represents a potentially life-threatening complication with an underestimated occurrence rate and unclear related risk factors. Aim of this study was to identify possible risk factors of PODH and results of surgical treatment from experience of two tertiary referral centers. Methods all patients affected by a clinically resectable oesophageal cancer (any T, any N and M0) and submitted to Ivor-Lewis oesophagectomy, regardless of technique (open, hybrid or totally minimally invasive) between 1997 and 2017 at our Institutions were selected for this study. Demographic, clinical pre, intra, post-operative, and follow-up data were prospectively collected in an electronic database. A retrospective analysis was conducted in order to evaluate the incidence of PODH, associated risk factors and surgical repair results. Results 414 patients underwent Ivor-Lewis oesophagectomy for cancer in the study period and 22 (5.3%) developed PODH at a median follow-up time of 16 months (6 - 177). Surgical repair was mainly conducted by laparoscopic approach (77%) with a conversion rate of 24%. Postoperative morbidity was 22.7% and mortality 4.5%. Median postoperative hospital stay was 6 days (2 - 95). 3 recurrences (13.6%) occurred at a median follow-up time of 10.1 months. A wide univariate analysis identified statistically significant associations between PODH occurrence and the administration of preoperative chemoradiation, a complete pathological response (CPR) and a harvested lymph-nodes number (HLN) larger than 33 (p-value 0.016, 0.001 and 0.024 respectively). A significant association with a large HLN number was confirmed by the multivariable analysis (0.026) along with CPR which could however be considered as a longer survival-related bias. Conclusions The minimally invasive surgery and the neoadjuvant chemoradiation, in contrast to results of other authors, in our experience are not associated with PODH development, while a HLN number larger than 33 resulted to be an independent risk factor, probably mirroring the extent of surgical demolition in oesophagectomy. Surgical repair can be safely and effectively performed trough laparoscopy but recurrences can frequently occur.

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