Which Sagittal Assessment System Can Effectively Predict the Risk of Mechanical Complications in the Treatment of Elderly Patients With Adult Degenerative Scoliosis? Roussouly Classification or Global Alignment and Proportion (GAP) Score

Abstract Background: In order to achieve the proper sagittal alignment, previous studies have developed different assessment systems for degenerative spinal deformity which could help us in making treatment strategies. The purpose of our study is to evaluate whether Roussouly classification or GAP score is more appropriate in the prediction of mechanical complications in the treatment of ADS.Methods: The ADS patients who received long segmental fusion in the treatment during the period from December 2016 to December 2018 were evaluated in this study. The basic information of the patients and all radiologic measurements, which were included in GAP score and Roussouly classification, were collected for analysis. Patients were divided into two groups according to occurrence or absence of mechanical complications for comparison. The correlation between evaluation systems and mechanical complications could be analyzed in logistic regression model via stepwise backward elimination based on the Wald statistics. ROC curve was used to determine the predictability of the evaluation systems in the occurrence of mechanical complications and calculate their cut-off value. A two-tailed P value < 0.05 was statistically significant for all statistical tests.Results: A total of 80 cases were included in this study. The results of logistic regression showed: GAP score (P = 0.008) and GAP categories (P = 0.007) were positively correlated with Mechanical complications; Roussouly score was negatively correlated with mechanical complications (P=0.034); GAP score was positively correlated with PJK (P = 0.021); Roussouly score was negatively correlated with implant-related complications (P = 0.018); GAP categories were correlated with implant loosening (P = 0.023). Results of ROC showed that GAP score was mostly effective in predicting PJK (AUC = 0.863) and PJF (AUC = 0.724); GAP categories (AUC = 0.561) was more effective than GAP score (AUC = 0.555) in predicting implant-related complications.Conclusions: Roussouly-type matching could not accurately predict the risk of mechanical complications. In contrast, GAP score was mostly effective in predicting PJK and PJF. The GAP score was better than Roussouly classification in predicting mechanical complications.

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Which Sagittal Evaluation System Can Effectively Predict Mechanical Complications in the Treatment of Elderly Patients With Adult Degenerative Scoliosis? Roussouly Classification or Global Alignment and Proportion (GAP) Score

10.21203/rs.3.rs-599099/v1 ◽

2021 ◽

Author(s):

Xiangyao Sun ◽

Wenzhi Sun ◽

Siyuan Sun ◽

Hailiang Hu ◽

Sitao Zhang ◽

...

Keyword(s):

Logistic Regression ◽

Evaluation System ◽

Statistical Tests ◽

Treatment Strategies ◽

P Value ◽

Global Alignment ◽

Evaluation Systems ◽

Mechanical Complications ◽

Adult Degenerative Scoliosis ◽

Roussouly Classification

Abstract Background: To achieve the proper sagittal alignment, previous studies have developed different assessment systems for degenerative spinal deformity which could help us in making treatment strategies. The purpose of our study is to evaluate whether Roussouly classification or GAP score is more appropriate in the prediction of mechanical complications after surgical treatment of ADS.Methods: The ADS patients who received long segmental fusion in the treatment during the period from December 2016 to December 2018 were evaluated in this study. The basic information of the patients and all radiologic measurements, which were included in GAP score and Roussouly classification, were collected for analysis. Patients were divided into two groups according to occurrence or absence of mechanical complications for comparison. The correlation between evaluation systems and mechanical complications could be analyzed in logistic regression model via stepwise backward elimination based on the Wald statistics. ROC curve was used to determine the predictability of the evaluation systems in the occurrence of mechanical complications and calculate their cut-off value. A two-tailed P value < 0.05 was statistically significant for all statistical tests.Results: A total of 80 cases were included in this study. The results of logistic regression showed: GAP score (P = 0.008) and GAP categories (P = 0.007) were positively correlated with mechanical complications; Roussouly score was negatively correlated with mechanical complications (P=0.034); GAP score was positively correlated with PJK (P = 0.021); Roussouly score was negatively correlated with implant-related complications (P = 0.018); GAP categories were correlated with implant loosening (P = 0.023). Results of ROC showed that GAP score was most effective in predicting PJK (AUC = 0.863) and PJF (AUC = 0.724); GAP categories (AUC = 0.561) was more effective than GAP score (AUC = 0.555) in predicting implant-related complications.Conclusions: Roussouly-type matching could not accurately predict the risk of mechanical complications. In contrast, GAP score was most effective in predicting PJK and PJF. The GAP score was better than Roussouly classification in predicting mechanical complications.

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Which sagittal evaluation system can effectively predict mechanical complications in the treatment of elderly patients with adult degenerative scoliosis? Roussouly classification or Global Alignment and Proportion (GAP) Score

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02786-8 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Xiangyao Sun ◽

Wenzhi Sun ◽

Siyuan Sun ◽

Hailiang Hu ◽

Sitao Zhang ◽

...

Keyword(s):

Evaluation System ◽

Treatment Strategies ◽

Area Under The Curve ◽

Global Alignment ◽

Mechanical Complication ◽

Degenerative Scoliosis ◽

Evaluation Systems ◽

Mechanical Complications ◽

Adult Degenerative Scoliosis ◽

Roussouly Classification

Abstract Background To achieve the proper sagittal alignment, previous studies have developed different assessment systems for adult degenerative scoliosis (ADS) which could help the spine surgeon in making treatment strategies. The purpose of our study is to evaluate whether Roussouly classification or global alignment and proportion (GAP) score is more appropriate in the prediction of mechanical complications after surgical treatment of ADS. Methods ADS patients who received long segmental fusion in the treatment during the period from December 2016 to December 2018 were evaluated in this study. Basic information and radiologic measurements were collected for analysis. Patients were divided into two groups according to occurrence or absence of mechanical complications for comparison. Mechanical complications included proximal junctional kyphosis (PJK), proximal junctional failure (PJF). GAP categories divided GAP score into proportioned spinopelvic position, moderately disproportioned position, and severely disproportioned position according to the cut-off values. The correlation between evaluation systems and mechanical complications was analyzed through a logistic regression model via stepwise backward elimination based on the Wald statistics. Receiver operator characteristic (ROC) curve was used to determine the predictability of the evaluation systems in the occurrence of mechanical complications and calculate their cut-off value. Area under the curve (AUC) was used to evaluate the validity of the thresholds. Results A total of 80 patients were included in this study. There were 41 patients in mechanical complication group and 39 patients in no mechanical complication group. GAP score (P = 0.008) and GAP categories (P = 0.007) were positively correlated with mechanical complications; Roussouly score was negatively correlated with mechanical complications (P = 0.034); GAP score was positively correlated with PJK (P = 0.021); Roussouly score was negatively correlated with implant-related complications (P = 0.018); GAP categories were correlated with implant loosening (P = 0.023). Results of ROC showed that GAP score was more effective in predicting PJK (AUC = 0.863) and PJF (AUC = 0.724) than Roussouly score; GAP categories (AUC = 0.561) was more effective than GAP score (AUC = 0.555) in predicting implant-related complications. Conclusions Roussouly classification could only be a rough estimate of optimal spinopelvic alignment. Quantitative parameters in GAP score made it more effective in predicting mechanical complications, PJK and PJF than Roussouly classification.

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Partial Intraoperative Global Alignment and Proportion Scores Do Not Reliably Predict Postoperative Mechanical Failure in Adult Spinal Deformity Surgery

Global Spine Journal ◽

10.1177/2192568220935438 ◽

2020 ◽

pp. 219256822093543

Author(s):

Alex S. Ha ◽

Daniel Y. Hong ◽

Josephine R. Coury ◽

Meghan Cerpa ◽

Griffin Baum ◽

...

Keyword(s):

Logistic Regression ◽

Sagittal Plane ◽

Adult Spinal Deformity ◽

Mechanical Failure ◽

Global Alignment ◽

Mechanical Complications ◽

Plane Analysis ◽

Spinal Deformity Surgery ◽

Distribution Index

Study Design: Retrospective radiographic review. Objectives: The Global Alignment and Proportion (GAP) score allows sagittal plane analysis for deformity patients and may be predictive of mechanical complications. This study aims to assess the effectiveness of predicting mechanical failure based on partial intraoperative GAP (iGAP) scores. Methods: A retrospective radiographic review was performed on 48 deformity patients between July 2015 to January 2017 with a 2-year follow-up. Using the same methodology as the original GAP study, the partial iGAP score was calculated with the sum of the scores for age, relative lumbar lordosis (RLL), and lordosis distribution index (LDI). Therefore, the iGAP score (0-7) was grouped into proportional (0-2), mildly disproportionate (3-5), and severely disproportionate (6-7). Logistic regression was performed to assess the ability of the partial iGAP score to predict postoperative mechanical failure. Results: The mean iGAP for patients with a mechanical failure was 3.54, whereas the iGAP for those without a mechanical failure was 3.46 ( P = .90). The overall mechanical failure rate was 27.1%. The mechanical failures included 8 proximal junctional kyphosis, 7 rod fractures, and 1 rod slippage from the distal end of the construct. Logistic regression analysis revealed that the partial iGAP score was not able to predict postoperative mechanical failure (χ2 = 1.4; P = .49). Conclusion: The iGAP scores for RLL or LDI did not show any significant correlation to postoperative mechanical failure. Ultimately, the proposed partial iGAP score did not predict postoperative mechanical failure and thus, cannot be used as an intraoperative alignment assessment to avoid postoperative mechanical complications.

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Sikap Ayah dan Jumlah Anak serta Praktik Air Susu Ibu Eksklusif

Kesmas National Public Health Journal ◽

10.21109/kesmas.v8i5.389 ◽

2013 ◽

Vol 8 (5) ◽

pp. 229

Author(s):

Suci Destriatania ◽

Judhiastuty Februhartanty ◽

Fatmah Fatmah

Keyword(s):

Logistic Regression ◽

Exclusive Breastfeeding ◽

Positive Attitude ◽

Statistical Tests ◽

Dominant Factor ◽

P Value ◽

Chi Square ◽

Cross Sectional ◽

Feeding Method ◽

Breastfeeding Practice

Partisipasi ayah pada pola pemberian makan bayi harus dipersiapkan dengan baik sehingga mendukung ibu untuk menyusui. Penelitian ini bertujuan untuk mengetahui hubungan antara pengetahuan dan sikap ayah terhadap praktik pemberian ASI eksklusif. Sampel dalam penelitian ini adalah 536 pasangan suami istri yang mempunyai bayi usia 0-6 bulan. Data dikumpulkan dengan menggunakan kuesioner terstruktur. Desain yang digunakan adalah potong lintang dan analisis data menggunakan kai kuadrat dan regresi logistik. Rata-rata pemberian ASI eksklusif pada saat wawancara adalah 29,1%. Sekitar 83,6% dan 59,1% ayah mempunyai pengetahuan rendah tentang manajemen laktasi prenatal dan postnatal, tetapi 89,6% dan 61,9% ayah menunjukkan sikap positif terhadap praktik menyusui ketika masa kehamilan dan menyusui. Dukungan ayah terhadap praktik menyusui justru rendah pada saat persalinan (37,3%). Sikap ayah selama masa menyusui (nilai p < 0,05; OR = 1,623; 95%CI = 1,086 _ 2,425) merupakan faktor yang paling dominan memengaruhi praktik pemberian ASI eksklusif setelah dikontrol faktor lainnya dalam analisis regresi logistik. Pengetahuan yang baik dan sikap yang positif diketahui sebagai faktor penting dalam keberhasilan praktik pemberian ASI eksklusif. Hal ini menunjukkan kebutuhan keterlibatan ayah dalam berbagai program promosi praktik menyusui.Fathers participation in the decision making of infant feeding method have to be well prepared so that they can support mothers to breastfeed. The objective of the paper is to analyze the relationship between knowledge and attitude of the fathers on exclusive breastfeeding practice. Couples whose baby aged 0-6 months were recruited in this study. Structured questionnaire was used to collect the data. The study design was cross sectional in which chi square and logistic regression analyses were used for the statistical tests. The prevalence of exclusive breastfeeding at time of interviewwas 29.1%. Around 83.6% and 59.1% of fathers had low level of knowledge on prenatal and postnatal lactation management but 89.6% and 61.9% had positive attitude toward breastfeeding. Only 37.3% fathers showed positive attitude about breastfeeding during labor. Attitude of fathers during nursing period was a dominant factor associated with exclusive breastfeeding (p value < 0.05; OR = 1.623; 95% CI = 1.086 _ 2.425) after controlling for other factors in the logistic regression analysis. Good knowledge and positive attitude were known as important factors for successful exclusive breastfeeding practice. This indicates a need of breastfeeding education for fathers.

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HUBUNGAN ASUPAN PROTEIN, OMEGA 3, OMEGA 6 DAN ZINK TERHADAP TUMBUH KEMBANG BALITA

JURNAL MEDIA KESEHATAN ◽

10.33088/jmk.v7i2.239 ◽

2018 ◽

Vol 7 (2) ◽

pp. 150-156

Author(s):

Indria Pijaryani

Keyword(s):

Logistic Regression ◽

Nutritional Status ◽

Growth And Development ◽

Statistical Tests ◽

Normal Growth ◽

P Value ◽

Multiple Logistic Regression ◽

Omega 3 ◽

Cross Sectional ◽

Omega 6

The growth and development is an evolutionary process that includes the stages of change through a physical , cognitive , and emotional that can be identified . From the initial survey conducted by the researchers found two toddler nutrition toddler skinny and one fat nutritional status with the percentage ( 50 % ) are not age-appropriate development . This study used a cross sectional. Seen from the growth and nutritional status of pre- screening questionnaire development (KPSP). The sample amounted to 96 toddlers . Proportional sampling technique using random sampling . Data was collected through primary and secondary data . Data processed Chi-square test and multiple logistic regression . The results of both studies of protein intake with corresponding growth as much as 94.3 % , statistical tests showed no correlation with p value of 0.00 . Intake of omega- 3 well with normal growth and development as much as 96.2 % , statistical tests showed no p value of 0.008 . Intake of omega- 6 well with normal growth and development as much as 95 % , statistical tests showed no correlation with p value of 0.042. Zinc intake well with the corresponding growth as much as 95.7 % , statistical tests showed no correlation with p value 0.019 . Results of multiple logistic regression known intake of omega 3 are factors that influence the growth and development of the value ekponen is 9.209 , so the omega- 3 chance 9.2 times affect the growth and development of infants.

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HUBUNGAN DUKUNGAN KELUARGA TERHADAP TINGKAT KEMANDIRIAN ANAK RETARDASI MENTAL

Jurnal Keperawatan ◽

10.32583/keperawatan.v11i2.427 ◽

2019 ◽

Vol 11 (2) ◽

pp. 87-92

Author(s):

Dwi Indah Iswanti ◽

Fery Agusman Motuho Mendrofa ◽

Diyanto Diyanto

Keyword(s):

Family Support ◽

Quantitative Method ◽

Statistical Tests ◽

Sampling Technique ◽

Mentally Retarded ◽

P Value ◽

Cross Sectional ◽

Need Support ◽

The Family ◽

Mentally Retarded Children

Kemandirian bukanlah keterampilan yang muncul secara tiba-tiba tetapi perlu diajarkan dan dilatih pada anak agar tidak menghambat tugas- tugas perkembangan anak selanjutnya. Terutama pada anak yang mengalami retardasi mental akan sangat membutuhkan dukungan dari keluarga. Tujuan penelitian untuk mengetahui hubungan dukungan keluarga dengan tingkat kemandirian anak retardasi mental di SLB Negeri Semarang. Penelitian ini menggunakan metode kuantitatif dengan pendekatan cross sectional. Populasi dalam penelitian ini adalah seluruh orang tua siswa kelas IV-VI di SLB Negeri Semarang yang berjumlah 64 siswa. Teknik sampling yang digunakan adalah total sampling. Dukungan keluarga pada anak retardasi mental sebagian besar adalah mendukung yaitu sebanyak 53,1%, kemandirian anak retardasi mental sebagian besar adalah kurang mandiri yaitu sebanyak 53,1%. Hasil uji statistik menemukan ada hubungan antara dukungan keluarga dengan kemandirian anak retardasi mental di SLB Negeri Semarang, dengan p value sebesar 0,000. Kata kunci : dukungan keluarga, kemandirian anak retardasi mental THE CORRELATION BETWEEN FAMILY SUPPORT AND THE LEVEL OF INDEPENDENCE OF MENTALLY RETARDED CHILDREN ABSTRACT Independence is not a skill that emerges suddenly but needs to be taught and trained in children so as not to inhibit the tasks of further child development. Especially for children who are mentally retarded, they will need support from the family. Research objectives to find out the correlation between family support and the level of independence of mentally retarded children in extraordinary school State of Semarang. This study uses a quantitative method with a cross sectional approach. The population in this study were all parents of students in class IV-VI in Semarang State SLB, amounting to 64 students. The sampling technique used is total sampling. Family support for mentally retarded children was mostly supportive, as much as 53.1%, the independence of most mentally retarded children was less independent, which was as much as 53.1%. The results of statistical tests found that there was a correlation between family support and the independence of mentally retarded children in Semarang State SLB, with a p value of 0,000. Keywords: family support, independence of mentally retarded children

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Analisis Faktor Determinan Pelaksanaan Inisiasi Menyusu Dini Oleh Bidan Di Rumah Sakit Umum Anutapura Palu

Jurnal Bidan Cerdas (JBC) ◽

10.33860/jbc.v1i1.87 ◽

2018 ◽

Vol 1 (1) ◽

pp. 34

Author(s):

Ni Nyoman Novita ◽

Gusman Arsyad

Keyword(s):

Emergency Room ◽

Peer Support ◽

Statistical Tests ◽

Bivariate Analysis ◽

P Value ◽

Chi Square ◽

Cross Sectional ◽

Implementation Processes ◽

Chi Square Test ◽

The Government

Implementation of IMD in hospitals has decreased from the previous year and has not reached the target set by the government. Some IMD implementation processes have not been carried out according to applicable standards. So that babies do not get an IMD in accordance with existing SOPs. The purpose of this study was to determine the determinant factors associated with the implementation of the IMD by midwives in the Midwifery and Maternity Room Emergency Room (IGD) at the Anutapura General Hospital in Palu. This research method is analytical with cross sectional approach. The population of this study was that all midwives in the obstetrics emergency room and maternity room at Anutapura Palu Hospital were 37 respondents. The sample in this study is total sampling. The analysis used was univariate, and bivariate analysis using the chi square test with a confidence level of 95% (α = 0.05). The results of statistical tests on variable knowledge of midwives with the implementation of IMD p value: 0.018 (p value <0.05). APN training with the implementation of IMD p value: 0.697 (p value> 0.05). length of work with the implementation of IMD p value: 0.029 (p value <0.05). and peer support with the implementation of IMD p value: 0.007 (p value <0.05). Conclusions there is a relationship between knowledge, length of work, peer support with the implementation of the IMD, and training factors that have nothing to do with IMD implementation. The strongest factor in the relationship is peer support. It is recommended that the Anutarapura Palu Hospital be able to motivate midwives so that they can further enhance their role in the implementation and provide support to their colleagues so that the implementation of the IMD can be carried out in accordance with applicable standards.Keywords: Knowledge, APN Training, Duration of work, Implementation of IMD

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Epidemiology of pediatric hydrocephalus in Haiti: analysis of a surgical case series

Journal of Neurosurgery Pediatrics ◽

10.3171/2018.12.peds18568 ◽

2019 ◽

Vol 23 (5) ◽

pp. 568-576

Author(s):

Michael Ragheb ◽

Ashish H. Shah ◽

Sarah Jernigan ◽

Tulay Koru-Sengul ◽

John Ragheb

Keyword(s):

Public Health ◽

Logistic Regression ◽

Head Circumference ◽

Rainy Season ◽

Statistical Tests ◽

Multivariate Logistic Regression Analysis ◽

Case Series ◽

Multivariate Logistic Regression ◽

Surgical Case ◽

Operative Notes

OBJECTIVEHydrocephalus is recognized as a common disabling pediatric disease afflicting infants and children disproportionately in the developing world, where access to neurosurgical care is limited and risk of perinatal infection is high. This surgical case series describes the Project Medishare Hydrocephalus Specialty Surgery (PMHSS) program experience treating hydrocephalus in Haiti between 2008 and 2015.METHODSThe authors conducted a retrospective review of all cases involving children treated for hydrocephalus within the PMHSS program in Port-au-Prince, Haiti, from 2008 through 2015. All relevant epidemiological information of children treated were prospectively collected including relevant demographics, birth history, hydrocephalus etiology, head circumference, and operative notes. All appropriate associations and statistical tests were performed using univariate and multivariate logistic regression analyses.RESULTSAmong the 401 children treated within PMHSS, postinfectious hydrocephalus (PIH) accounted for 39.4% (n = 158) of cases based on clinical, radiographic, and endoscopic findings. The majority of children with hydrocephalus in Haiti were male (54.8%, n = 197), born in the rainy season (59.7%, n = 233), and born in a coastal/inland location (43.3%, n = 61). The most common surgical intervention was endoscopic third ventriculostomy with choroid plexus cauterization (ETV/CPC) (45.7%, n = 175). Multivariate logistic regression analysis yielded coastal birth location (OR 3.76, 95% CI 1.16–12.18) as a statistically significant predictor of PIH. Increasing head circumference (adjusted OR 1.06, 95% CI 0.99–1.13) demonstrated a slight trend toward significance with the incidence of PIH.CONCLUSIONSThis information will provide the foundation for future clinical and public health studies to better understand hydrocephalus in Haiti. The 39.4% prevalence of PIH falls within observed rates in Africa as does the apparently higher prevalence for those born during the rainy season. Although PIH was the most frequent etiology seen in almost all birth locations, the potential relationship with geography noted in this series will be the focus of further research in an effort to understand the link between climate and PIH in Haiti. The ultimate goal will be to develop an appropriate public health strategy to reduce the burden of PIH on the children of Haiti.

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HUBUNGAN ANTARA PENDIDIKAN DAN PEKERJAAN IBU HAMIL DENGAN PEMERIKSAAN KEHAMILAN DI PUSKESMAS MARIANA KECAMATAN BANYUASIN I KABUPATEN BANYUASIN TAHUN 2011

Jurnal Kebidanan : Jurnal Medical Science Ilmu Kesehatan Akademi Kebidanan Budi Mulia Palembang ◽

10.35325/kebidanan.v2i1.20 ◽

2019 ◽

Vol 2 (1) ◽

Author(s):

Leny Leny

Keyword(s):

Prenatal Care ◽

Pregnant Women ◽

Maternal Education ◽

Statistical Tests ◽

Univariate Analysis ◽

World Health ◽

P Value ◽

Chi Square ◽

Cross Sectional ◽

Health Organization

ABSTRACT Prenatal care is health care by health personnel to care the pregnant according to standards. Worlrd Health Organization (WHO) estimates more than 500.000 women die during pregnancy or childbirth. Maternal mortality in Indonesia is 307 per 100,000 live births. The quantity of pregnant women’s visit in Kabupaten Banyuasin in 2009 of 89.1%. The purpose of this study to determine the relationship between education and occupation with prenatal care at Puskesmas Mariana Kecamatan Banyuasin I Kabupaten Banyuasin in 2011. This study uses analytic approach survey by Cross Sectional methods, the population are 1.946 pregnant women and the samples as many as 332 people. The results of univariate analysis study of pregnant women who are higher education as much as 45.2%, and low maternal education as much as 54.8%. In pregnant women who work of 43.4%, and pregnant women who do not work for 56.6%. From the results of bivariate analysis and Chi-Square statistical tests found a significant association between education of pregnant women with prenatal care with P Value = 0.000, and there was a significant association between occupation of pregnant women with prenatal care with P Value = 0.000. Can be concluded that there is a relationship between education and occupation of pregnant women with prenatal care. Expected to health workers to provide counseling on the importance of prenatal care in pregnant women and expected future studies may explore again the factors associated with prenatal care with the different variables. ABSTRAK Pemeriksaan kehamilan adalah pelayanan kesehatan oleh tenaga kesehatan untuk memeriksakan ibu hamil sesuai standar. World Health Organization (WHO) memperkirakan lebih dari 500.000 ibu pertahunnya meninggal saat hamil atau bersalin. AKI di Indonesia 307 per 100.000 kelahiran hidup. Jumlah kunjungan ibu hamil di Kabupaten Banyuasin tahun 2009 sebesar 89,1%. Tujuan penelitian ini untuk mengetahui hubungan antara pendidikan dan pekerjaan dengan pemeriksaan kehamilan di Puskesmas Mariana Kecamatan Banyuasin I Kabupaten Banyuasin tahun 2011. Penelitian ini menggunakan metode survey analitik dengan pendekatan Cross Sectional, populasi ibu hamil dengan jumlah 1.946 orang dan jumlah sampel sebanyak 332 orang. Hasil penelitian Analisa Univariat adalah ibu hamil yang pendidikan tinggi sebanyak 45,2%, dan pendidikan rendah ibu hamil sebanyak 54,8%. Pada variabel pekerjaan ibu hamil yang bekerja sebesar 43,4%, dan ibu hamil yang tidak bekerja sebesar 56,6%. Dari hasil analisa bivariat dan uji statistik Chi-Square didapatkan hubungan yang bermakna antara pendidikan ibu hamil dengan pemeriksaan kehamilan dengan P Value = 0,000, dan ada hubungan yang bermakna antara pekerjaan ibu hamil dengan pemeriksaan kehamilan dengan P Value = 0,000. Dapat disimpulkan bahwa ada hubungan antara pendidikan dan pekerjaan ibu hamil dengan pemeriksaan kehamilan. Diharapkan kepada petugas kesehatan agar dapat memberikan penyuluhan tentang pentingnya pemeriksaan pada ibu hamil dan diharapkan penelitian yang akan datang dapat menggali lagi faktor-faktor yang berhubungan dengan pemeriksaan kehamilan dengan variabel yang berbeda.

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The impact of SPY angiography on intraoperative decision making and outcomes for post-mastectomy reconstruction

Journal of Cancer Science and Therapeutics ◽

10.36879/jcst.19.000109 ◽

2019 ◽

pp. 1-5

Keyword(s):

Decision Making ◽

Logistic Regression ◽

Skin Necrosis ◽

Regression Models ◽

Multivariable Analysis ◽

P Value ◽

Flap Necrosis ◽

Single Institution ◽

Logistic Regression Models ◽

The Impact

Objective: While the use of intraoperative laser angiography (SPY) is increasing in mastectomy patients, its impact in the operating room to change the type of reconstruction performed has not been well described. The purpose of this study is to investigate whether SPY angiography influences post-mastectomy reconstruction decisions and outcomes. Methods and materials: A retrospective analysis of mastectomy patients with reconstruction at a single institution was performed from 2015-2017.All patients underwent intraoperative SPY after mastectomy but prior to reconstruction. SPY results were defined as ‘good’, ‘questionable’, ‘bad’, or ‘had skin excised’. Complications within 60 days of surgery were compared between those whose SPY results did not change the type of reconstruction done versus those who did. Preoperative and intraoperative variables were entered into multivariable logistic regression models if significant at the univariate level. A p-value <0.05 was considered significant. Results: 267 mastectomies were identified, 42 underwent a change in the type of planned reconstruction due to intraoperative SPY results. Of the 42 breasts that underwent a change in reconstruction, 6 had a ‘good’ SPY result, 10 ‘questionable’, 25 ‘bad’, and 2 ‘had areas excised’ (p<0.01). After multivariable analysis, predictors of skin necrosis included patients with ‘questionable’ SPY results (p<0.01, OR: 8.1, 95%CI: 2.06 – 32.2) and smokers (p<0.01, OR:5.7, 95%CI: 1.5 – 21.2). Predictors of any complication included a change in reconstruction (p<0.05, OR:4.5, 95%CI: 1.4-14.9) and ‘questionable’ SPY result (p<0.01, OR: 4.4, 95%CI: 1.6-14.9). Conclusion: SPY angiography results strongly influence intraoperative surgical decisions regarding the type of reconstruction performed. Patients most at risk for flap necrosis and complication post-mastectomy are those with questionable SPY results.

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