scholarly journals Evaluation of the short-term cessation and early initiation of antithrombotic therapy in high-risk patients undergoing HoLEP procedure for large prostates (> 100 mL): A critical evaluation

2021 ◽  
Author(s):  
Zafer Tokatli ◽  
Muhammed Ibis
Keyword(s):  
High Risk ◽  
Critical Evaluation ◽  
Early Postoperative Period ◽  
Antithrombotic Treatment ◽  
Short Term ◽  
Symptomatic Benign Prostatic Hyperplasia ◽  
Clot Retention ◽  
Risk Patients ◽  
Laser Enucleation ◽  
Holmium Laser Enucleation

Background: To characterize the safety and efficacy of Holmium Laser Enucleation of Prostate (HoLEP) in patients with large prostates (>100ml) at high risk for thromboembolic events (TE) resuming antithrombotic treatment (AT) in the early postoperative period. Methods: Data for 378 men with large prostates treated with HoLEP for symptomatic benign prostatic hyperplasia between December 2016 and July 2020 were reviewed retrospectively. Of the patients, 134 had been receiving AT, (anticoagulant (AC), n=51; antiplatelet (AP), n=83). AT was resumed within 24 hours postoperatively. We determined pre-, peri-, and postoperative parameters, functional outcome, and adverse events for the 3-month period postoperatively in patients receiving AC and AP; and compared results with 203 patients without AT. Results: Patients receiving AC and AP were older (p=0.015) and had a higher median ASA score (p<0.001). Objective voiding parameters (Qmax, PVR) and urinary symptoms (IPSS, QoL) improved in the three groups (p<0.001). Median enucleation and morcellation efficiencies were 1.58 (IQR:0.87-3.13) and 5 (IQR:1-8.08), median catheterization and hospitalization time was 2 days (IQR:2-3) and 3 days (IQR:3-4), respectively. The perioperative results were similar in the three groups. Overall, one patient in the AP group required blood transfusion at 4 days postoperatively due to clot retention and significant hemoglobin decrease (p=0.216). There was no adverse TE in any patient within 3-month postoperatively. Conclusion: HoLEP is an effective and safe method in patients with a high risk of TE whose AT is discontinued for surgery, as it enables AT to be resumed as soon as possible.

636 SHORT-TERM OUTCOME FOR HIGH-RISK PATIENTS AFTER ESOPHAGECTOMY

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Victor Plat ◽  
Wessel Stam ◽  
Boukje Bootsma ◽  
Jennifer Straatman ◽  
Thomas Klausch ◽  
...  
Keyword(s):  
High Risk ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Charlson Comorbidity Index ◽  
Short Term ◽  
Term Outcome ◽  
High Risk Patients ◽  
Short Term Outcome ◽  
Risk Patients ◽  
Comorbidity Index

Abstract   Transthoracic esophagectomy (TTE) for esophageal cancer facilitates mediastinal dissection, however it has a significant impact on cardiopulmonary status. High-risk patients may therefore be better candidates for transhiatal esophagectomy (THE) in order to prevent serious complications. This study addressed short-term outcome following TTE and THE in patients that are considered to have a higher risk of surgery-related morbidity. Methods This population-based study included patients who underwent a curative esophagectomy between 2011 and 2018, registered in the Dutch Upper GI Cancer Audit. The Charlson comorbidity index was used to assign patients to a low-risk (score ≤ 1) and high-risk group (score ≥ 2). Propensity score matching was applied to produce comparable groups between high-risk patients receiving TTE and THE. Primary endpoint was mortality (in-hospital/30-day mortality), secondary endpoints included morbidity and oncological outcomes. Additionally, a matched subgroup analysis was performed, including only cervical reconstructions. Results Of 5438 patients, 945 and 431 high-risk patients underwent TTE and THE respectively. After propensity score matching, mortality (6.3% vs 3.3%, P = 0.050), overall morbidity, Clavien-Dindo ≥3 complications, pulmonary complications, cardiac complications and re-interventions were significantly more observed after TTE compared to THE. A significantly higher mortality after TTE with a cervical reconstruction was found compared to THE (7.0% vs 2.2%, P = 0.020). Conclusion Patients with a high Charlson comorbidity index predispose for a complicated postoperative course after esophagectomy, this was more outspoken after TTE compared to THE. In daily practice these outcomes should be balanced with the lower lymph node yield, but comparable positive node count and radicality after THE.

scholarly journals Preoperative predictors of enucleation time during en bloc no-touch holmium laser enucleation of the prostate

2020 ◽  
Author(s):  
Chun-Hsuan Lin ◽  
Ching-Chia Li ◽  
Wen-Jeng Wu ◽  
Sheng-Chen Wen
Keyword(s):  
Operation Time ◽  
Holmium Laser ◽  
En Bloc ◽  
Symptomatic Benign Prostatic Hyperplasia ◽  
Clinical Variables ◽  
Specimen Weight ◽  
History Of ◽  
Laser Enucleation ◽  
Holmium Laser Enucleation ◽  
Preoperative Predictors

Abstract Background To evaluate preoperative predictors of enucleation time during en bloc no-touch holmium laser enucleation of the prostate (HoLEP) Methods We enrolled 135 patients with symptomatic benign prostatic hyperplasia (BPH) treated with en bloc no-touch HoLEP from July 2017 to March 2019 by a single surgeon. Preoperative, perioperative, and postoperative clinical variables were examined. Stepwise linear regression was performed to determine clinical variables associated with enucleation times. Result The average (range) enucleation time was 46.1 (12–220) minutes, and the overall operation time was 71 (18–250) minutes. History of anticoagulation, history of urinary tract infection (UTI), and increasing specimen weight were each significantly associated with increasing enucleation time. No category IV complications were recorded, and all complications were evenly distributed among the groups according to the HoLEP specimen weight. Conclusion En bloc no-touch HoLEP was found to be an efficient and reproducible surgical method for treating BPH. Prostatic gland size was significantly associated with increased enucleation times. Similarly, history of UTI and anticoagulation were correlated with increased operative time.

567 Holmium laser enucleation of the prostate (HOLEP) versus open prostatectomy for prostates >70 GR: Short term follow-up

2004 ◽  
Vol 3 (2) ◽  
pp. 144
Author(s):  
R. Naspro ◽  
B. Mazzoccoli ◽  
N. Suardi ◽  
A. Salonia ◽  
F. Deho' ◽  
...  
Keyword(s):  
Holmium Laser ◽  
Open Prostatectomy ◽  
Short Term ◽  
Laser Enucleation ◽  
Holmium Laser Enucleation

scholarly journals Aortic Valve Sclerosis Adds to Prediction of Short-Term Mortality in Patients with Documented Coronary Atherosclerosis

2019 ◽  
Vol 8 (8) ◽  
pp. 1172
Author(s):  
Paolo Poggio ◽  
Laura Cavallotti ◽  
Veronika A. Myasoedova ◽  
Alice Bonomi ◽  
Paola Songia ◽  
...  
Keyword(s):  
High Risk ◽  
Aortic Valve ◽  
Artery Bypass ◽  
Myocardial Revascularization ◽  
Short Term ◽  
Aortic Valve Sclerosis ◽  
Short Term Mortality ◽  
Risk Patients ◽  
Integrated Discrimination Improvement

Aims: Aortic valve sclerosis (AVSc), a non-uniform thickening of leaflets with an unrestricted opening, is characterized by inflammation, lipoprotein deposition, and matrix degradation. In the general population, AVSc predicts long-term cardiovascular mortality (+50%) even after adjustment for vascular risk factors and clinical atherosclerosis. We have hypothesized that AVSc is a risk-multiplier able to predict even short-term mortality. To address this issue, we retrospectively analyzed 90-day mortality of all patients who underwent isolated coronary artery bypass grafting (CABG) at Centro Cardiologico Monzino over a ten-year period (2006–2016). Methods: We analyzed 2246 patients and 90-day all-cause mortality was 1.5% (31 deaths). We selected only patients deceased from cardiac causes (n = 29) and compared to alive patients (n = 2215). A cardiologist classified the aortic valve as no-AVSc (n = 1352) or AVSc (n = 892). Cox linear regression and integrated discrimination improvement (IDI) analyses were used to evaluate AVSc in predicting 90-day mortality. Results: AVSc 90-day survival (97.6%) was lower than in no-AVSc (99.4%; p < 0.0001) with a hazard ratio (HR) of 4.0 (95%CI: 1.78, 9.05; p < 0.0001). The HR for AVSc, adjusted for propensity score, was 2.7 (95%CI: 1.17, 6.23; p = 0.02) and IDI statistics confirmed that AVSc significantly adds (p < 0.001) to the identification of high-risk patients than EuroSCORE II alone. Conclusion: Our data supports the hypothesis that a risk stratification strategy based on AVSc, added to ESII, may allow better recognition of patients at high-risk of short-term mortality after isolated surgical myocardial revascularization. Results from this study warrant further confirmation.

Sign in / Sign up

Export Citation Format

Share Document