Open and laparoscopic surgeries are associated with comparable 90 day morbidities and mortalities following ERAS protocols- A retrospective Study. (Preprint)

2020 ◽  
Author(s):  
BHAVIN VASAVADA ◽  
Hardik Patel

UNSTRUCTURED All the gastrointestinal surgeries performed between April 2016 to march 2019 in our institution have been analysed for morbidity and mortality after ERAS protocols and data was collected prospectively. We performed 245 gastrointestinal and hepato-biliary surgeries between April 2016 to march 2019. Mean age of patients was 50.96 years. 135 were open surgeries and 110 were laparoscopic surgeries. Mean ASA score was 2.40, mean operative time was 111 minutes, mean CDC grade of surgery was 2.56. 40 were emergency surgeries and 205 were elective surgeries. Overall 90 days mortality rate was 8.5% and over all morbidity rate was around 9.79% . On univariate analysis morbidity was associated significantly with higher CDC grade of surgeries, higher ASA grade, more operative time, more blood products use, more hospitalstay, open surgeries,HPB surgeries and luminal surgeries(non hpb gastrointestinal surgeries) were associated with higher 90 days morbidity. On multivariate analysis no factors independently predicted morbidity. On univariate analysis 90 days mortality was predicted by grade of surgeries, higher ASA grade, more operative time, more blood products use, open surgeries and emergency surgeries. However on multivariate analysis only more blood products used was independently associated with mortality There is no difference between 90 day mortality and moribidity rates between open and laparoscopic surgeries.

2020 ◽  
Author(s):  
Bhavin B. Vasavada ◽  
Hardik Patel

ABSTRACTIntroductionThe aim of this study is to compare 90-day mortality and morbidity between open and laparoscopic surgeries performed in one centre since the introduction of ERAS protocols.Material and MethodsAll gastrointestinal surgeries performed between April 2016 and March 2019 at our institution after the introduction of ERAS protocols have been analysed for morbidity and mortality. The analysis was performed in a retrospective manner using data from our prospectively maintained database.ResultsWe performed 245 gastrointestinal and hepatobiliary surgeries between April 2016 and March 2019. The mean age of patients was 50.96 years. 135 were open surgeries and 110 were laparoscopic surgeries. The mean ASA score was 2.4, the mean operative time was 111 minutes and the mean CDC grade of surgery was 2.56. 40 were emergency surgeries and 205 were elective surgeries. Overall the 90-day mortality rate was 8.5% and the morbidity rate was around 9.79%. On univariate analysis morbidity was associated with a higher CDC grade of surgeries, a higher ASA grade, longer operating time, the use of more blood products, a longer hospital stay and open surgeries. HPB surgeries and luminal surgeries (non hpb gastrointestinal surgeries) were associated with 90 day post operative morbidity. On multivariate analysis no factors independently predicted morbidity. On univariate analysis 90-day mortality was predicted by the grade of surgeries, a higher ASA grade, longer operative time, the use of more blood products, open surgeries and emergency surgeries. However on multivariate analysis only the use of more blood products was independently associated with mortalityConclusionThe 90-day mortality and morbidity rates between open and laparoscopic surgeries after the introduction of ERAS protocol were similar.


2017 ◽  
Vol 45 (3) ◽  
pp. 1175-1180 ◽  
Author(s):  
Mir Sadat-Ali ◽  
Moaad Alfaraidy ◽  
Abdulaziz AlHawas ◽  
Ahmed Abdallah Al-Othman ◽  
Dakheel A Al-Dakheel ◽  
...  

Objective To determine the functional morbidity and mortality after fragility hip fracture and compare the mortality with three other common diseases. Methods Data were collected from patients admitted to King Fahd Hospital of the University, AlKhobar from January 2010 to December 2014. Demographic data included the preoperative American Society of Anesthesiologists (ASA) score as assessed by the anesthetist and the type of surgery. Personal and telephone interviews were performed, and data were entered into a database and analyzed. Results We identified 203 patients with fragility proximal femoral fractures, and the data of 189 patients (109 male, 80 female; average age, 66.90 ± 13.43 years) were available for analysis. The overall mortality rate was 26.98% (51 patients). The mortality rate was significantly higher among patients with an ASA score of 4 (36.36%) than 1 (20.45%). With respect to morbidity, only 48.23% of patients were able to return to their pre-fracture status; 32.35% of those who required assisted walking and 83.4% of those who required a wheelchair became bedridden. Conclusions Our data demonstrate that patients with fragility hip fractures have high morbidity and a mortality rate approaching 30%. Age and the ASA score significantly influence this high mortality rate.


2015 ◽  
Vol 81 (10) ◽  
pp. 1015-1020 ◽  
Author(s):  
Maryam N. Saidy ◽  
Sunal S. Patel ◽  
Mark W. Choi ◽  
Mohammed Al-Temimi ◽  
Deron J. Tessier

The aim of our study is to compare single incision laparoscopic cholecystectomy (SILC) performed using the “marionette” technique (m-SILC), to the standard four-port technique [four-port laparoscopic cholecystectomy (4PLC)]. Patient information was extracted from a prospectively maintained database (n = 188). Our primary endpoint was operative costs (determined by operating time and instruments used). Secondary endpoints were length of stay, operative time, blood loss, and postoperative complication rates. Univariate and adjusted multivariate analysis was used to compare the outcomes. There were a total of 188 patients for this study. Gender, body mass index, American Society of Anesthesiologists class, and resident participation were similar. Patients undergoing m-SILC were younger (43.8 vs 49.8 years old), less likely to have cholangiogram (32% vs 54%), and were more likely to undergo cholecystectomy for chronic cholecystitis (73.3% vs 52%). In univariate analysis, cholecystectomy performed by the “marionette method” as compared with the 4PLC was associated with shorter operative time (67 vs 59 minutes respectively) and shorter hospital stay (1.2 vs 2.08 days respectively). In multivariate analysis, SILC was associated with shorter hospital stay and comparable operative time, blood loss, and postoperative complications. Instrumentation cost was less in SILC (by $94). SILC done by an experienced surgeon with the “marionette” technique on a carefully selected population shows a statistically significant cost benefit while maintaining clinically comparable outcomes to the standard 4PLC.


2012 ◽  
Vol 03 (01) ◽  
pp. 28-35 ◽  
Author(s):  
Aliasgar V Moiyadi ◽  
Prakash M Shetty

ABSTRACT Background: Perioperative outcomes following surgery for brain tumors are an important indicator of the safety as well as efficacy of surgical intervention. Perioperative morbidity not only has implications on direct patient care, but also serves as an indicator of the quality of care provided, and enables objective documentation, for comparision in various clinical trials. We document our experience at a tertiary care referral, a dedicated neuro-oncology center in India. Materials and Methods: One hundred and ninety-six patients undergoing various surgeries for intra-axial brain tumors were analyzed. Routine microsurgical techniques and uniform antibiotic policy were used. Navigation/ intraoperative electrophysiological monitoring was not available. The endpoints assessed included immediate postoperative neurological status, neurological outcome at discharge, regional complications, systemic complications, overall morbidity, and mortality. Various risk factors assessed included clinico-epidemiological factors, tumor-related factors, and surgery-related factors. Univariate and multivariate analysis were performed. Results: Median age was 38 years. 72% had tumors larger than 4 cm. Neurological morbidity, and regional and systemic complications occurred in 16.8, 17.3, and 10.7%, respectively. Overall, major morbidity occurred in 18% and perioperative mortality rate was 3.6%. Although a few of the known risk factors were found to be significant on univariate analysis, none achieved significance on multivariate analysis. Conclusions: Our patients were younger and had larger tumors than are generally reported. Despite the unavailability of advanced intraoperative aids we could achieve acceptable levels of morbidity and mortality. Objective recording of perioperative events is crucial to document outcomes after surgery for brain tumors.


2010 ◽  
Vol 8 (3) ◽  
pp. 0-0
Author(s):  
Paulius Gradauskas ◽  
Stanislovas Maknavičius

Paulius Gradauskas, Stanislovas MaknavičiusVilniaus greitosios pagalbos universitetinės ligoninės Krūtinės chirurgijos skyrius, Šiltnamių g. 29, LT-04130 Vilnius El. paštas: [email protected] Įvadas/tikslas: Didelės kinetinės energijos traumas patyrusiems žmonėms neretai yra sužalojami ir krūtinės ląstos organai. Gydant šiuos ligonius dažnai pasitaiko su kvėpavimo sistema susijusių komplikacijų. Darbo tikslas – nustatyti veiksnius, darančius įtaką dauginę traumą patyrusių pacientų gydymo komplikacijų dažniui ir mirštamumui. Ligoniai ir metodai: Retrospektyviai analizuoti 257 ligonių ligos istorijų duomenys. Vertinant vieno ar kelių veiksnių įtaką komplikacijų atsiradimo ar mirties tikimybei, naudota logistinė regresija. Rezultatai: Veiksniais, galinčiais daryti įtaką komplikacijų vystymuisi ar mirštamumui, buvo įvardyti: pacientų amžius; lytis; suminis sužalojimo sunkumas; krūtinės sužalojimo sunkumas pagal AIS; chirurginės intervencijos atlikimo laikas; chirurginės intervencijos apimtis; lėtinės obstrukcinės plaučių ligos arba bronchinės astmos anamnezė, koronarinės širdies ligos anamnezė, cukrinis diabetas, šokas stacionarizavimo metu, hemotransfuzijos poreikis. Nepriklausomu komplikacijų vystimosi veiksniu buvo nustatytas suminis sužalojimo sunkumas (ISS balas). įtakojančių Mirštamumo, veiksnių nenustatyta. Išvados: Iš sužeistųjų, patyrusių krūtinės ir kitų anatominių sričių uždarą traumą, komplikacijų radosi 39,3 %, o mirštamumas siekė 12,5 %. Suminis sužalojimo sunkumas (ISS balas) buvo nepriklausomas komplikacijų vystymosi dažnio veiksnys. Reikšminiai žodžiai: krūtinės sužalojimas, dauginė trauma, ūminių sužalojimų sunkumas, mirštamumas. Assessment of management results of polytraumas, involving the thorax and other anatomical parts Paulius Gradauskas, Stanislovas MaknavičiusVilnius University Emergency Hospital Thoracic Surgery Unit, Šiltnamių str. 29, LT-04130 Vilnius, LithuaniaE-mail: [email protected] Background / oObjective: Thoracic trauma is still one of the leading causes of morbidity and mortality in different countries. The aim of the study was to analyse the results of the management of polytrauma patients suffering from thoracic injuries. Patients and methods: In this retrospective study, the medical charts of 257 patients were reviewed. The risk factors influencing morbidity and mortality were identified. Results: Gender, age, ISS score, AIS score of the thoracic injury, time and invasivness of the surgery, presence of COPD or bronchial asthma, presence of coronary heart disease, diabetes, need of hemotransfusion, and shock at the arrival were analysed as the risk factors. ISS score, need of hemotransfusion and presence of COPD or bronchial asthma were found to be the prognostic factors of morbidity in the univariate analysis. Only the ISS score was found to be an independent risk factor at the multivariate analysis. No risk factors for mortality were identified. Conclusions: The overall morbidity rate was 39.3 %, and the mortality was 12.5 %. The only risk factor independently influencing morbidity was found to be the ISS score. No independent risk factors for mortality were identified. Keywords: thoracic injury, multiple trauma, ISS, mortality.


2021 ◽  
Vol 8 (18) ◽  
pp. 1287-1292
Author(s):  
Binitha Tresa Thomas ◽  
Preeya Vasanthakumary ◽  
Ancy Joseph

BACKGROUND Breast cancer is now the most common cancer in Indian women, having recently surpassed cervical cancer in incidence. Triple negative breast cancer (TNBC), which accounts for 15 % of all the breast cancers is an aggressive type seen in younger women with early signs of metastasis, has a poor prognosis due to systemic recurrence and its refractoriness to conventional adjuvant therapy. The purpose of this study was to look into the various prognostic factors associated with 5 years disease-free survival (DFS) and overall survival (OS) in TNBC. METHODS This retrospective study included 67 patients with complete treatment and followup (median 57 months) presented and treated in the Department of Radiotherapy, Kottayam, between January 2011 and December 2012. The Kaplan-Meier approach was used to analyse survival. Using the log-rank test, univariate analysis of prognostic factors was completed. Using the Cox regression process, multivariate analysis was performed on IBM SPSS version 20. RESULTS The average age was 51.36 ± 11.393 (median, 51.36 years; range 30.0 – 80.0 years), with a median of 50 months, the five-year OS was 65.7 % and DFS was found to be 59.7 % with a median of 45 months, suggesting aggressive nature and poor TNBC survival. Univariate analysis of prognostic factor, clinical stage (cN) and positive nodes (pN) status, clinical tumour size, lympho-vascular invasion (LVI), grade, and nodal density were found to have a significant impact on DFS. Except tumour grade and LVI all were found to be associated with OS. Multivariate analysis, clinical tumour size and pathological nodal status had a significant impact on OS and DFS. CONCLUSIONS TNBC is an aggressive subtype of breast cancer in younger patients with a high risk of metastasis to visceral organs with inherent molecular subtypes and immunological heterogeneity. For treatment of TNBC, targeted estimated glomerular filtration rate (EGFR), fibroblast growth factor receptor 2 (FGFR2), vascular endothelial growth factor (VEGF), and mechanistic target of rapamycin (mTOR) receptor based initial treatment setting will improve the outcome dramatically and will fill the unmet clinical needs. KEYWORDS TNBC, Recurrence, OS, DFS, Nodal Density


2021 ◽  
pp. 1-10
Author(s):  
Ali S. Farooqi ◽  
Austin J. Borja ◽  
Donald K. E. Detchou ◽  
Gregory Glauser ◽  
Kaitlyn Shultz ◽  
...  

OBJECTIVE This study assesses how degree of overlap, either before or after the critical operative portion, affects lumbar fusion outcomes. METHODS The authors retrospectively studied 3799 consecutive patients undergoing single-level, posterior-only lumbar fusion over 6 years (2013–2019) at a university health system. Outcomes recorded within 30–90 and 0–90 postoperative days included emergency department (ED) visit, readmission, reoperation, overall morbidity, and mortality. Furthermore, morbidity and mortality were recorded for the duration of follow-up. The amount of overlap that occurred before or after the critical portion of surgery was calculated as a percentage of total beginning or end operative time. Subsequent to initial whole-population analysis, coarsened exact-matched cohorts of patients were created with the least and most amounts of either beginning or end overlap. Univariate analysis was performed on both beginning and end overlap exact-matched cohorts, with significance set at p < 0.05. RESULTS Equivalent outcomes were observed when comparing exact-matched patients. Among the whole population, the degree of beginning overlap was correlated with reduced ED visits within 30–90 and 0–90 days (p = 0.007, p = 0.009; respectively), and less 0–90 day morbidity (p = 0.037). Degree of end overlap was correlated with fewer 30–90 day ED visits (p = 0.015). When comparing only patients with overlap, degree of beginning overlap was correlated with fewer 0–90 day reoperations (p = 0.022), and no outcomes were correlated with degree of end overlap. CONCLUSIONS The degree of overlap before or after the critical step of surgery does not lead to worse outcomes after lumbar fusion.


2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Qinrui Hu ◽  
Yujing Bai ◽  
Xiaoli Chen ◽  
Lvzhen Huang ◽  
Yi Chen ◽  
...  

Objective. To determine the prevalence and risk factors for the recurrence of retinopathy of prematurity (ROP) in Zone II Stage 3+ after ranibizumab treatment.Methods. This was a retrospective, nonrandomized, noncontrolled study that excluded Zone I and aggressive posterior ROP (APROP) cases. Infants who developed Zone II Stage 3 ROP with plus disease and underwent initial intravitreal injection of ranibizumab (IVR) were recruited. Patients were divided into 2 groups based on the outcome after initial ranibizumab treatment: recurrence of ROP or favorable outcome. Data was collected and analyzed by SPSS 16.0.Results. Forty-two patients were included, and 80 eyes with Zone II Stage 3+ were subjected to IVR treatment. Eleven of 42 patients (26.2%, 18 eyes) had a recurrence of ROP after the initial treatment. On univariate analysis, preretinal hemorrhage before treatment was significantly different between the two groups (P=0.000). Multivariate analysis found that preretinal hemorrhage before treatment was the only factor associated with the recurrence of ROP in our study (P=0.004).Conclusions. The recurrence rate of ROP in Zone II Stage 3+ after initial ranibizumab treatment was notable and preretinal hemorrhage before treatment was associated with the recurrence of ROP in our study.


2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 3560-3560
Author(s):  
Toshiki Masuishi ◽  
Toshikazu Moriwaki ◽  
Shota Fukuoka ◽  
Atsuo Takashima ◽  
Yosuke Kumekawa ◽  
...  

3560 Background: Regorafenib (REG) and trifluridine/tipiracil (FTD/TPI) have been recognized as standard treatments for patients (pts) with refractory metastatic colorectal cancer (mCRC). Because these drugs have limits on efficacy benefit for some pts, we are necessary to select pts who may be better not to receive REG or FTD/TPI. However, no reports are available on how to predict pts with early mortality after initiation of these drugs. Methods: We retrospectively evaluated pts with mCRC who were registered in a multicenter observational study (the REGOTAS study). The main inclusion criteria were ECOG PS of 0–2, refractory or intolerant to fluoropyrimidines, oxaliplatin, irinotecan, and anti-VEGF and anti-EGFR therapy (if KRAS wild type), and no prior use of REG or FTD/TPI. Predictive factors for early mortality (≤ 12 weeks from initiation of REG or FTD/TPI) were evaluated by multivariate analysis for survival with all variables with P values of <0.05 from the univariate analysis, using the Cox proportional hazards model. In this analysis, the pts who lived at first 15 weeks were defined as censored case. Results: A total of 523 pts (REG, 212; FTD/TPI, 311) were eligible. Predictive factors for early mortality were without primary tumor resection [adjusted hazard ratio (aHR), 1.56; p = 0.02], the low level of albumin (aHR, 2.31; p < 0.0001), the high level of CRP (aHR, 2.31; p < 0.0001), and short time from diagnosis of mCRC (aHR, 1.77; p = 0.002) by multivariate analysis. The pts harboring all these poor factors were classified into the high (H) risk of early mortality group. Two groups of pts with H and non-H were identified, with 12-week mortality rate of 39 and 14%, with 14-week mortality rate of 70 and 18%, and with median survival time (MST) of 2.9 and 7.8 months, respectively (HR of H/non-H, 4.02; p value < 0.0001). In pts treated with REG, H and non-H groups had 12-week mortality rate of 38 and 16%, 14-week mortality rate of 79 and 18%, and MST of 2.8 and 7.8 months, respectively. In pts treated with FTD/TPI, H and non-H groups had 12-week mortality rate of 41 and 13%, 14-week mortality rate of 63 and 18%, and MST of 3.2 and 7.7 months, respectively. Conclusions: Our predictive model for early mortality after initiation of REG or FTD/TPI might be useful for selecting pts who should not receive either these drugs.


2010 ◽  
Vol 13 (5) ◽  
pp. 589-593 ◽  
Author(s):  
Charles A. Sansur ◽  
Davis L. Reames ◽  
Justin S. Smith ◽  
D. Kojo Hamilton ◽  
Sigurd H. Berven ◽  
...  

Object This is a retrospective review of 10,242 adults with degenerative spondylolisthesis (DS) and isthmic spondylolisthesis (IS) from the morbidity and mortality (M&M) index of the Scoliosis Research Society (SRS). This database was reviewed to assess complication incidence, and to identify factors that were associated with increased complication rates. Methods The SRS M&M database was queried to identify cases of DS and IS treated between 2004 and 2007. Complications were identified and analyzed based on age, surgical approach, spondylolisthesis type/grade, and history of previous surgery. Age was stratified into 2 categories: > 65 years and ≤ 65 years. Surgical approach was stratified into the following categories: decompression without fusion, anterior, anterior/posterior, posterior without instrumentation, posterior with instrumentation, and interbody fusion. Spondylolisthesis grades were divided into low-grade (Meyerding I and II) versus high-grade (Meyerding III, IV, and V) groups. Both univariate and multivariate analyses were performed. Results In the 10,242 cases of DS and IS reported, there were 945 complications (9.2%) in 813 patients (7.9%). The most common complications were dural tears, wound infections, implant complications, and neurological complications (range 0.7%–2.1%). The mortality rate was 0.1%. Diagnosis of DS had a significantly higher complication rate (8.5%) when compared with IS (6.6%; p = 0.002). High-grade spondylolisthesis correlated strongly with a higher complication rate (22.9% vs 8.3%, p < 0.0001). Age > 65 years was associated with a significantly higher complication rate (p = 0.02). History of previous surgery and surgical approach were not significantly associated with higher complication rates. On multivariate analysis, only the grade of spondylolisthesis (low vs high) was in the final best-fit model of factors associated with the occurrence of complications (p < 0.0001). Conclusions The rate of total complications for treatment of DS and IS in this series was 9.2%. The total percentage of patients with complications was 7.9%. On univariate analysis, the complication rate was significantly higher in patients with high-grade spondylolisthesis, a diagnosis of DS, and in older patients. Surgical approach and history of previous surgery were not significantly correlated with increased complication rates. On multivariate analysis, only the grade of spondylolisthesis was significantly associated with the occurrence of complications.


Sign in / Sign up

Export Citation Format

Share Document