Postoperative outcomes and the association with overlap before or after the critical step of lumbar fusion

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.

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

10.2196/preprints.19313 ◽

2020 ◽

Author(s):

BHAVIN VASAVADA ◽

Hardik Patel

Keyword(s):

Multivariate Analysis ◽

Retrospective Study ◽

Mortality Rate ◽

Operative Time ◽

Univariate Analysis ◽

Morbidity And Mortality ◽

Morbidity Rate ◽

Blood Products ◽

Asa Score

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.

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Participants' Opinion about Conduct of Morbidity and Mortality Conferences in Surgical Practice in a Tertiary Hospital, Ethiopia

Ethiopian Journal of Health Sciences ◽

10.4314/ejhs.v30i3.6 ◽

2020 ◽

Vol 30 (3) ◽

Author(s):

Berhanetsehay Teklewold ◽

Tilahun Deresse ◽

Goytom Kinfe ◽

Henok Teshome

Keyword(s):

Patient Safety ◽

Multidisciplinary Team ◽

Addis Ababa ◽

Univariate Analysis ◽

Tertiary Hospital ◽

Morbidity And Mortality ◽

Cross Sectional ◽

Mortality And Morbidity ◽

Morbidity And Mortality Conferences

BACKGROUND: Morbidity and mortality conference has both educational and quality improvement purposes. However clear evidences for the effectiveness of the morbidity and mortality conferences in improving patient safety is lacking.METHODS: A facility based cross sectional study was conducted at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia, to assess participants’ opinion on benefits and functioning of morbidity and mortality conferences. Univariate analysis was used to determine the influence of professional type on participants’ opinion about the morbidity and mortality conferences.RESULT: A total of 98 participants completed the survey. The majority of the participants agreed that there was a structured system of case identification (67.3%), meeting format (72.4%), the conferences were conducted every month (79.6%), it is blame free (71.4%) and system of care was focus of discussion (70%). Most (88.8%) participants agreed that the conferences were important for improvement of patient safety and quality of care, whereas 67.3% of the participants believed that there is no written term of reference and prior dissemination of agendas. Only 40% agreed that there is multidisciplinary team involvement. Fifty one percent of them disagreed that there is a follow up on the implementation of the forwarded recommendations.CONCLUSION: Even though the majority of the participants were satisfied with the mortality and morbidity conferences, most disagreed on the presence of written term of reference, earlier dissemination of agendas, multidisciplinary team involvement and follow up on the implementation of the forwarded recommendations.

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Open and laparoscopic approaches are associated with comparable 90-day morbidity and mortality following ERAS protocol

10.1101/2020.04.08.20057521 ◽

2020 ◽

Author(s):

Bhavin B. Vasavada ◽

Hardik Patel

Keyword(s):

Multivariate Analysis ◽

Operative Time ◽

Univariate Analysis ◽

Operating Time ◽

Morbidity And Mortality ◽

Morbidity Rate ◽

Blood Products ◽

Mortality And Morbidity ◽

The Mean ◽

Eras Protocol

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.

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Patients with Single-Ventricle Physiology over the Age of 40 Years

Journal of Clinical Medicine ◽

10.3390/jcm9124085 ◽

2020 ◽

Vol 9 (12) ◽

pp. 4085

Author(s):

Claudia Pujol ◽

Sandra Schiele ◽

Susanne J. Maurer ◽

Julia Hock ◽

Celina Fritz ◽

...

Keyword(s):

Renal Disease ◽

Single Ventricle ◽

Independent Predictor ◽

Demographic Data ◽

Univariate Analysis ◽

Morbidity And Mortality ◽

Significant Morbidity ◽

Single Ventricle Physiology ◽

All Cause Mortality

Background: Single-ventricle physiology (SVP) is associated with significant morbidity and mortality at a young age. However, survival prospects have improved and risk factors for a negative outcome are well described in younger cohorts. Data regarding older adults is scarce. Methods: In this study, SVP patients under active follow-up at our center who were ≥40 years of age at any point between January 2005 and December 2018 were included. Demographic data, as well as medical/surgical history were retrieved from hospital records. The primary end-point was all-cause mortality. Results: Altogether, 49 patients (19 female (38.8%), mean age 49.2 ± 6.4 years) were included. Median follow-up time was 4.9 years (interquartile range (IQR): 1.8–8.5). Of these patients, 40 (81.6%) had undergone at least one cardiac surgery. The most common extracardiac comorbidities were thyroid dysfunction (n = 27, 55.1%) and renal disease (n = 15, 30.6%). During follow-up, 10 patients (20.4%) died. On univariate analysis, renal disease and liver cirrhosis were predictors of all-cause mortality. On multivariate analysis, only renal disease (hazard ratio (HR): 12.5, 95% confidence interval (CI): 1.5–106.3, p = 0.021) remained as an independent predictor. Conclusions: SVP patients ≥40 years of age are burdened with significant morbidity and mortality. Renal disease is an independent predictor of all-cause mortality.

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O49 COMPARING OUTCOMES BETWEEN MINIMALLY INVASIVE AND OPEN INGUINAL HERNIA REPAIR

British Journal of Surgery ◽

10.1093/bjs/znab396.048 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Michael Katzen ◽

Sullivan Ayuso ◽

Bola Aladegbami ◽

Raageswari Nayak ◽

Paul Colavita ◽

...

Keyword(s):

Inguinal Hernia ◽

Minimally Invasive ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Operative Time ◽

Univariate Analysis ◽

Wound Complications ◽

History Of ◽

Open Inguinal Hernia Repair

Abstract Aim Prospective evaluation comparing outcomes between laparoscopic (LIHR), robotic (RIHR), and open inguinal hernia repair (OIHR). Material and Methods Prospective institutional data comparison of patients undergoing inguinal hernia repair from 1999–2020 was performed. Patients with chronic pain or infection were excluded. Standard statistical methods were used and univariate analysis was performed between LIHR, RIHR, and OIHR groups. Results 3,300 repairs were performed: 1,970 LIHR (597-bilateral), 127 RIHR (25-bilateral), and 538 OIHR (43-bilateral). LIHR and RIHR patients were younger (55.4±14.8vs59.0±13.7vs 65.0±13.7years;p<0.01), with lower BMI (26.6±6.5vs28.9±20.3vs31.8±7.6kg/m2; p<0.01), fewer overall (2.7±1.9 vs 2.7±2.2vs3.7±2.5; p < 0.01) and cardiac (0.2% vs 0% vs 2.6%; p<0.01) comorbidities, and fewer patients had diabetes (5.2%vs4.6%vs10.9%; p<0.01). OIHR had the highest rate of recurrent hernias (21.2%vs11.2%vs30.9%; p<0.01). History of smoking was less in LIHR (13.9%vs30.9%vs19.5%%; p<0.01). Mesh was used in 99.5% of cases; synthetic was used in all minimally invasive cases and 98.4% of OIHR, with biologic mesh in 1.0% of OIHR due to bowel resection during the operation. Operative time was shortest in LIHR followed by open (86.5±39.6vs109.0±56.8vs92.6±55.2 min; p<0.01). Wound complications were more frequent in OIHR (0.8%vs0.7%vs3.8%; p<0.01). Admission was more common after open repair (2.2%vs2.7%vs5.7%; p<0.01) with a trend to less readmission following LIHR (1.0%vs2.0%vs2.3%; p=0.06). There were few recurrences overall (0.7%vs0.7%vs1.3%; p=0.40) with mean follow-up time 21.1±22.4 months. Conclusions LIHR, RIHR, and OIHR were performed with low overall morbidity and complications. Recurrent hernias and cardiac patients were most often repaired open, which more frequent admission and had higher wound morbidity. RIHR had longer OR times with no improvement overall outcomes.

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Minimally invasive versus open lumbar spinal fusion: a matched study investigating patient-reported and surgical outcomes

Journal of Neurosurgery Spine ◽

10.3171/2021.10.spine211128 ◽

2021 ◽

pp. 1-14

Author(s):

James Mooney ◽

Giorgos D. Michalopoulos ◽

Mohammed Ali Alvi ◽

Daniel Zeitouni ◽

Andrew K. Chan ◽

...

Keyword(s):

Minimally Invasive ◽

Spinal Fusion ◽

Operative Time ◽

Lumbar Fusion ◽

Leg Pain ◽

Lumbar Spinal Fusion ◽

Patient Reported ◽

Lumbar Spinal ◽

Incidental Durotomy

OBJECTIVE With the expanding indications for and increasing popularity of minimally invasive surgery (MIS) for lumbar spinal fusion, large-scale outcomes analysis to compare MIS approaches with open procedures is warranted. METHODS The authors queried the Quality Outcomes Database for patients who underwent elective lumbar fusion for degenerative spine disease. They performed optimal matching, at a 1:2 ratio between patients who underwent MIS and those who underwent open lumbar fusion, to create two highly homogeneous groups in terms of 33 baseline variables (including demographic characteristics, comorbidities, symptoms, patient-reported scores, indications, and operative details). The outcomes of interest were overall satisfaction, decrease in Oswestry Disability Index (ODI), and back and leg pain, as well as hospital length of stay (LOS), operative time, reoperations, and incidental durotomy rate. Satisfaction was defined as a score of 1 or 2 on the North American Spine Society scale. Minimal clinically important difference (MCID) in ODI was defined as ≥ 30% decrease from baseline. Outcomes were assessed at the 3- and 12-month follow-up evaluations. RESULTS After the groups were matched, the MIS and open groups consisted of 1483 and 2966 patients, respectively. Patients who underwent MIS fusion had higher odds of satisfaction at 3 months (OR 1.4, p = 0.004); no difference was demonstrated at 12 months (OR 1.04, p = 0.67). Lumbar stenosis, single-level fusion, higher American Society of Anesthesiologists Physical Status Classification System grade, and absence of spondylolisthesis were most prominently associated with higher odds of satisfaction with MIS compared with open surgery. Patients in the MIS group had slightly lower ODI scores at 3 months (mean difference 1.61, p = 0.006; MCID OR 1.14, p = 0.0495) and 12 months (mean difference 2.35, p < 0.001; MCID OR 1.29, p < 0.001). MIS was also associated with a greater decrease in leg and back pain at both follow-up time points. The two groups did not differ in operative time and incidental durotomy rate; however, LOS was shorter for the MIS group. Revision surgery at 12 months was less likely for patients who underwent MIS (4.1% vs 5.6%, p = 0.032). CONCLUSIONS In patients who underwent lumbar fusion for degenerative spinal disease, MIS was associated with higher odds of satisfaction at 3 months postoperatively. No difference was demonstrated at the 12-month follow-up. MIS maintained a small, yet consistent, superiority in decreasing ODI and back and leg pain, and MIS was associated with a lower reoperation rate.

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LAPAROSCOPIC TRANS-ABDOMINAL PRE-PERITONEAL (TAPP) REPAIR FOR TREATMENT INGUINAL HERNIA DISEASE

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2018.4.11 ◽

2018 ◽

Vol 8 (4) ◽

pp. 76-80

Author(s):

Thao Nguyen Minh ◽

Vu Pham Anh ◽

Tri Nguyen Huu ◽

Phu Nguyen Doan Van ◽

Phuc Nguyen Thanh ◽

...

Keyword(s):

Inguinal Hernia ◽

Operative Time ◽

Bilateral Hernia ◽

Repair Method ◽

Tapp Repair ◽

Post Operation ◽

Average Operative Time ◽

The Mean

Background: Inguinal hernia is one of the commonest surgical diseases and there are many different techniques applied. The laparoscopic trans-abdominal pre-peritoneal (TAPP) repair allows a better view of the inguinal anatomy, evaluation of opposite side and resolve combined peritoneal diseases as well. Patient and method: The study included 60 cases with inguinal hernia that have been treated by laparoscopic transabdominal pre-peritoneal (TAPP) repair. Method: Description, prospective follow-up. Result: The mean age was 58±18.2. 96.7% were males. The average operative time was 45.6±15.1 minutes for one side hernia, 73±25.2 minutes for bilateral hernia. 02 cases have been post-operation inguinal seroma complication (3.3%), 02 cases with hydrocele (3.3%), 01 case with abdominal seroma (1.7%). 04 cases (6.7%) opposite inguinal hernia were detected and 05 cases (8.3%) with combined diseases were resolved. Duration of post-operative stay was 3.9±1.1 days. Conclusion: TAPP is a safe and feasible procedure, allows evaluation of opposite side and resolve combined peritoneal diseases.

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Prevalence of Asymptomatic Cryptococcal Antigenemia and Association with Follow-up risk of Cryptococcal Meningitis and Mortality among HIV Infected Patients in North West India – A Prospective Cohort Study

Current HIV Research ◽

10.2174/1570162x18666200827113816 ◽

2020 ◽

Vol 18 ◽

Author(s):

Rajendra Bhati ◽

Pramendra Sirohi ◽

Bharat Sejoo ◽

Deepak Kumar ◽

Gopal K Bohra ◽

...

Keyword(s):

Cryptococcal Meningitis ◽

Morbidity And Mortality ◽

People Living With Hiv ◽

Cryptococcal Antigen ◽

North West ◽

Cryptococcal Disease ◽

Increased Risk ◽

Living With Hiv ◽

Inflammatory Syndrome

Objective: Cryptococcal meningitis is an important cause of morbidity and mortality in HIV infected individuals. In the era of universal antiretroviral therapy incidence of immune reconstitution inflammatory syndrome (IRIS) related cryptococcal meningitis has increased. Detection of serum cryptococcal antigen in asymptomatic PLHIV (People Living With HIV) and pre-emptive treatment with fluconazole can decrease the burden of cryptococcal disease. We conducted this study to find the prevalence of asymptomatic cryptococcal antigenemia in India and its correlation with mortality in PLHIV. Method and material: This was a prospective observational study. HIV infected ART naïve patients with age of ≥ 18 years who had CD4 counts ≤ 100 /µL were included and serum cryptococcal antigen test was done. These patients were followed for six months to look for the development of Cryptococcal meningitis and mortality. Results: A total of 116 patients were analysed. Asymptomatic cryptococcal antigenemia was detected in 5.17% patients and it correlated with increased risk of cryptococcal meningitis and mortality on follow-up in PLHIV. Conclusion: Serum cryptococcal positivity is correlated with increased risk of Cryptococcal meningitis and mortality in PLHIV. We recommend the screening of asymptomatic PLHIV with CD4 ≤ 100/µL for serum cryptococcal antigen, so that pre-emptive treatment can be initiated to reduce morbidity and mortality.

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CLINICO-PATHOLOGICAL AND RADIOLOGICAL PROGNOSTIC FACTORS IN CANCER CERVIX TREATED WITH CONCURRENT CHEMORADIATION

SRMS Journal of Medical Science ◽

10.21761/jms.v1i1.10940 ◽

2016 ◽

Vol 1 (1) ◽

Author(s):

Manraj S. Kang ◽

Kamal Sahni ◽

Piyush Kumar ◽

Rajneesh Madhok ◽

Ratna Saxena ◽

...

Keyword(s):

Prognostic Factors ◽

Mitotic Index ◽

Univariate Analysis ◽

Disease Free Survival ◽

Concurrent Chemoradiation ◽

P Value ◽

Publication Date ◽

Cancer Cervix ◽

Stage Ib

<bold>Introduction:</bold> Cervical cancer is most common cancer in the rural and second most common in urban areas of our country. It accounts for 16% of all cancers. There are various clinical, Paper Submission Datepathological and radiological factors which dictate the prognosis of these cancer cervix patients. The present study evaluates clinical, pathological and radiological prognostic factors in cancer cervix treated with concurrent chemoradiation. <bold>Material and Methods:</bold> A total of 32 patients seen between 2012 and 2014 patients planned concurrent chemoradiation were evaluated in terms of clinical (age, stage, Hb% and HPV Paper Publication Date infection), pathological (histopathology type and subtype, grade, mitotic index, lymph-July 2016 vascular invasion and necrosis) and radiological (parametrial extension, disease dimension, lymph node, hydronephrosis and vascularity of tumour) prognostic factors. After pre-DOI treatment evaluation patient was planned for 3 Dimentional-Conformal Radiotherapy (50Gy/25#/5 weeks) with concurrent chemotherapy (Cisplatin 35mg/m<sup>2</sup>) followed by 3 applications of Intracavitary radiotherapy (6Gy/fraction) with 6 months follow up. Response was accessed according to WHO response criteria and univariate analysis was done using chi-square test. <bold>Results:</bold> Clinical factors: Age – better disease free survival in older patients (p value=0.003), stage - Lower stage had better survival (for stage Ib-IIa vs stage IIb p value = 0.003 and for stage Ib vs. IIIb p value = 0.0005), Hb% - 57% patients with Hb <10g/dl had recurrence at end of 6 months (p value=0.00001), HPV – High recurrence with HPV presence. Pathological factors like high Mitotic Index had more residual disease (p=0.0009), grade - No statistical significance. Radiological factors- volume of disease - 35 % patients with volume of disease > 6 cm had disease at end of 6 months, hydronephrosis - 40 % patient with hydronephrosis had recurrence (p value = 0.0005) at end of 6 months follow up and vascularity of tumour showed statistically no difference. <bold>Conclusion:</bold> Hb <10%, HPV infection, Mitotic index (3-5/HPF), stage IIIB, pelvic nodes were concluded as the independent poor prognostic factors.

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Exclusive Bilateral Internal Thoracic Artery Grafts for Myocardial Revascularization Requiring Four Anastomoses or More: Outcomes from a Single Center Experience

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0036-1584688 ◽

2016 ◽

Vol 65 (04) ◽

pp. 265-271

Author(s):

Andrea Perrotti ◽

Enrica Dorigo ◽

Camille Durst ◽

Djamel Kaili ◽

Sidney Chocron ◽

...

Keyword(s):

Coronary Artery ◽

Internal Thoracic Artery ◽

Artery Bypass ◽

Univariate Analysis ◽

Bypass Graft ◽

Myocardial Revascularization ◽

Wound Complication ◽

Safe Procedure ◽

Off Pump

Introduction Multivessel coronary artery bypass graft (CABG) with bilateral internal thoracic arteries (BITA) has only been uncommon and technically demanding. We describe our experience with BITA only CABGs requiring ≥ 4 anastomoses. Material and Methods The department's database was queried for patients undergoing isolated CABG with ≥ 4 anastomoses. The surgical technique included systematically a right internal thoracic artery (ITA) of left ITA Y graft. The multivariate model included variables with a p < 0.3 at univariate analysis. Results Between January 2006 and December 2009, 251 consecutive patients (71 ± 10 years) (on-pump: 130, off-pump: 121) had CABG with ≥ 4 anastomoses, representing 21% of total isolated CABGs for the same period; all patients received a totally arterial BITA only revascularization. Follow-up was 4.9 ± 1.6 years. Overall and cardiac cumulative survivals were 78 and 92%, respectively, at 5 years. The occurrence of any major postoperative complication was associated with overall and cardiac mortality (odds ratio [OR]: 3.6, 95% confidence interval [CI]: 1.3–9.9 and OR: 5.4, 95% CI: 1.3–21.9, respectively). Major sternal wound complication requiring surgical revision was not associated with impaired glucose control (n = 9; diabetics: 6/82, 7.3%; nondiabetics: 3/169, 1.8%, p = 0.06). Preoperative kidney failure was associated with incomplete revascularization (OR: 6.2; 95% CI: 1.2–33.5), that was unfailingly due to ungraftable right coronary artery targets. Discussion BITA only revascularization was a valuable and safe procedure, with favorable results in terms of morbidity and mortality at a 5 years' follow-up.

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