Vanishing congenital lung malformations: What is the incidence of true regression?

BACKGROUND: A congenital lung malformation (CLM) that is diagnosed on prenatal ultrasound exam may subsequently become undetectable on later scans, a “vanishing” CLM. OBJECTIVE: The purpose of our study is to characterize the prenatal natural history and postnatal outcomes of “vanishing” lesions treated at our institution. METHODS: We performed a retrospective chart review of 107 patients diagnosed prenatally with CLM at our institution. Comparisons were made using Kruskal-Wallis or t-test for continuous variables and Fisher’s exact test or Chi-Square test for categorical variables. Multivariable analysis using logistic regression was performed. RESULTS: Of the 104 patients, 59 (56.7%) had lesions that became sonographically undetectable on serial ultrasound scans. Patients with lesions that vanished prenatally tended to need less Neonatal Intensive Care Unit (NICU) admission at birth (persistent CLM: 54.8%vs vanished CLM: 28.8%), decreased need for supplemental O2 at birth (persistent CLM: 31.0%vs vanished CLM: 11.9%), and decreased delay in feeds (persistent CLM: 26.2%vs vanished CLM: 8.5%) compared to those with persistent CLM. After multivariate analysis controlling for maternal steroid administration and sex, admission to NICU maintained a slight statistical significance, with patients in the vanishing CLM group 2.5 times less likely to be admitted to the NICU. None of our patients whose lesions vanished prenatally required mechanical ventilation. Eighty-six patients underwent postnatal computed tomography (CT) chest. Only 2 patients had lesions that regressed on postnatal CT. CONCLUSION: Lesions that vanish on prenatal imaging may be associated with improved clinical outcomes. The rate of true regression at our institution was as low as 2.3%.

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Evaluation of the Risk of Clinical Deterioration among Inpatients with COVID-19

Advances in Virology ◽

10.1155/2021/6689669 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Víctor O. Costa ◽

Eveline M. Nicolini ◽

Bruna M. A. da Costa ◽

Fabrício M. Teixeira ◽

Júlia P. Ferreira ◽

...

Keyword(s):

Clinical Laboratory ◽

Lung Parenchyma ◽

Clinical Deterioration ◽

Categorical Variables ◽

Continuous Variables ◽

Chi Square ◽

Exact Test ◽

Laboratory Confirmation ◽

Chi Square Test ◽

Imaging Markers

This study aims to assess the risk of severe forms of COVID-19, based on clinical, laboratory, and imaging markers in patients initially admitted to the ward. This is a retrospective observational study, with data from electronic medical records of inpatients, with laboratory confirmation of COVID-19, between March and September 2020, in a hospital from Juiz de Fora-MG, Brazil. Participants (n = 74) were separated into two groups by clinical evolution: those who remained in the ward and those who progressed to the ICU. Mann–Whitney U test was taken for continuous variables and the chi-square test or Fisher’s exact test for categorical variables. Comparing the proposed groups, lower values of lymphocytes ( p = <0.001) and increases in serum creatinine ( p = 0.009), LDH ( p = 0.057), troponin ( p = 0.018), IL-6 ( p = 0.053), complement C4 ( p = 0.040), and CRP ( p = 0.053) showed significant differences or statistical tendency for clinical deterioration. The average age of the groups was 47.9 ± 16.5 and 66.5 ± 7.3 years ( p = 0.001). Hypertension ( p = 0.064), heart disease ( p = 0.048), and COPD ( p = 0.039) were more linked to ICU admission, as well as the presence of tachypnea on admission ( p = 0.051). Ground-glass involvement >25% of the lung parenchyma or pleural effusion on chest CT showed association with evolution to ICU ( p = 0.027), as well as bilateral opacifications ( p = 0.030) when compared to unilateral ones. Laboratory, clinical, and imaging markers may have significant relation with worse outcomes and the need for intensive treatment, being helpful as predictive factors.

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Neonatal and Maternal Outcomes in Spontaneously-Conceived Twin Pregnancies According to Mode of Delivery

Folia Medica ◽

10.3897/folmed.62.e49276 ◽

2020 ◽

Vol 62 (3) ◽

pp. 468-476

Author(s):

Samantha Mc Kenzie Stancu ◽

Manuela Cristina Russu

Keyword(s):

Neonatal Intensive Care ◽

Statistical Significance ◽

Mode Of Delivery ◽

Statistical Correlation ◽

P Value ◽

Maternal Outcomes ◽

Chi Square ◽

Chi Square Test ◽

Nicu Admission ◽

Twin Pregnancies

Introduction: Appropriate intrapartum conduct in a twin delivery remains a challenging aspect of obstetric practice. The objective of this study was to compare neonatal and maternal outcomes in twin pregnancies according to mode of delivery.  Materials and methods: This is a single centre retrospective cohort study of all consecutive spontaneously-conceived twin deliver-ies (≥ 24 weeks, estimated fetal weight ≥ 500 grams) over a nine-year period between 01/01/2007 - 31/12/2016 at a tertiary-level centre. Neonatal outcomes included survival, APGAR score, prematurity-associated pathology (PAP), admission to the neonatal intensive care unit (NICU) and length of stay (LOS). Maternal outcomes included postpartum complications and LOS. Statistical analysis comprised Chi-square test with subsequent p-value and odds-ratio with 95% confidence interval. Statistical significance was set at p<0.05. Results: A total of 173 consecutive women with spontaneously-conceived twin deliveries were enrolled in this study, 129 (74.6%) women delivered by caesarean section (CS). The success rate of vaginal delivery (VD) was 93.6% (44/47). A strong statistical correlation was identified between CS and NICU admission; 53.2% vs. 1.5% (p=0.0001). Neonatal LOS in the NICU was significantly longer in the CS group. Prematurity-associated pathology (PAP) was noted in 75 pairs of twins (75/173); 61 pairs were delivered by CS, bearing strong statistical significance (p<0.0001). Postpartum complications occurred in 14.7% of CS compared to 13.6% of VDs.  Conclusion: Neonates delivered by CS had a higher rate of PAP, NICU admission, lower birth weight and longer LOS. This study showed that VD is safe, especially when the first twin is in cephalic presentation

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P047: Emergency department practice patterns of UTI investigation among the delirious elderly: a retrospective chart review

CJEM ◽

10.1017/cem.2020.253 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S81-S81

Author(s):

R. Pinnell ◽

P. Joo

Keyword(s):

Emergency Department ◽

Elderly Patients ◽

Chart Review ◽

Retrospective Chart Review ◽

Patient Characteristics ◽

Urinary Symptoms ◽

Categorical Variables ◽

Continuous Variables ◽

Indwelling Catheter ◽

Exact Test

Introduction: Delirium is a common emergency department (ED) presentation in elderly patients. Urinary tract infection (UTI) investigation and treatment are often initiated in delirious patients in the absence of specific urinary symptoms, despite a paucity of evidence to support this practice. The purpose of this study is to describe the prevalence of UTI investigation, diagnosis and treatment in delirious elderly patients in the ED. Methods: We performed a retrospective chart review of elderly patients presenting to the ED at The Ottawa Hospital between January 15-July 30, 2018 with a chief complaint of confusion or similar. Exclusion criteria were pre-existing and current UTI diagnosis, Glasgow Coma Scale <13, current indwelling catheter or nephrostomy tube, transfers between hospitals, and leaving without being seen. The primary outcome was the proportion of patients for whom urine tests (urinalysis or culture) or antibiotic treatment were ordered. Secondary outcomes were associations between patient characteristics, rates of UTI investigation, and patient outcomes. Descriptive values were reported as proportions with exact binomial confidence intervals for categorical variables and means with standard deviations for continuous variables. Comparisons were conducted with Fischer's exact test for categorical variables and t-tests for continuous variables. Results: After analysis of 1039 encounters with 961 distinct patients, 499 encounters were included. Urine tests were conducted in 324 patients (64.9% [60.6-69.1]) and antibiotics were prescribed to 176 (35.2% [31.1-39.6]). Overall 57 patients (11.4% [8.8-14.5]) were diagnosed with UTI, of which only 12 (21.1% [11.4-33.9]) had any specific urinary symptom. For those patients who had no urinary symptoms or other obvious indication for antibiotics (n = 342), 199 (58.2% [52.8-63.5]) received urine tests and 62 (18.1% [14.2-22.6]) received antibiotics. Patients who received urine tests were older (82.4 ± 8.8 vs. 78.3 ± 8.4 years, p < 0.001) but did not differ in sex distribution from those than those who did not. Additionally, patients who received antibiotics were more likely to be admitted (OR = 2.6 [1.48-4.73]) and had higher mortality at 30 days (OR = 4.2 [1.35-12.91]) and 6 months (OR = 3.2 [1.33-7.84]) than those who did not. Conclusion: Delirious patient without urinary symptoms in the ED were frequently investigated and treated for UTI despite a lack of evidence regarding whether this practice is beneficial.

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Abstract TP236: Eval to Groin Puncture Times: Efficiencies and Deficiencies of Live Physician vs Telemedicine Triage

Stroke ◽

10.1161/str.51.suppl_1.tp236 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

David Rosenbaum-Halevi ◽

Sujan T Reddy ◽

Alyssa D Trevino ◽

Muhammad Bilal Tariq ◽

Mahan Shahrivari ◽

...

Keyword(s):

Primary Outcome ◽

Categorical Variables ◽

Continuous Variables ◽

Chi Square ◽

Specific Level ◽

Site Specific ◽

Exact Test ◽

Wilcoxon Rank Sum Test ◽

Significant Difference ◽

A Site

Introduction: Telemedicine (TM) is increasingly implemented in community hospitals acute ischemic stroke (AIS). The efficiency of TM to facilitate thrombectomy (IAT) is unknown. We addressed this question by studying our spoke hospitals which are staffed by both in-person (IP) consultation (Day: 8am-5pm) and TM (Night: 5pm-8am) to analyze differences between TM and IP and comparing to our university hub which has IP staffing day and night. Methods: We performed a retrospective analysis from 3/2016 to 3/2019 of all IAT cases directly admitted to 4 IAT capable centers (1 hub + 3 spokes) in our system. Demographic, clinical, and time metrics were analyzed. Primary outcome was door to groin (DTG) time. Continuous variables were analyzed with Wilcoxon rank sum test, and categorical variables with chi-square or Fischer’s exact test. Results: Table 1 summarizes the cohort. Eval to tPA (ETPA) time was faster at spokes vs hub (p < 0.0001), with no significant difference in DTG between spoke and hub (p= 0.444). At spokes, while DTPA times were no different between IP and TM at spokes, IP achieved faster DTG times (p<0.0001) (Fig.1A). DTG was equal during day vs. night at the hub. At the spokes, day (IP) DTG times were faster than night (TM) at some but not all spokes (Fig.1B). TPA administration did not delay DTG at either the hub or the spokes (Fig. 1C). At spokes, TM-TPA cases were associated with faster DTG than TM-noTPA (Fig. 1D). Conclusions: While no difference is noted between TM and IP in rapid TPA treatment, our data show delayed DTG at spokes during the TM day and night service. While DTG in TM was prolonged, differences in spoke metrics imply that availability of staff and resources play a significant role. Further analysis is needed to identify factors that prolong DTG at a site-specific level.

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Abstract TP69: Safety and Outcomes of IV Thrombolysis with Alteplase for Acute Ischemic Stroke Patients with Thrombocytopenia

Stroke ◽

10.1161/str.48.suppl_1.tp69 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Haris Kamal ◽

Nour Abdelhamid ◽

Liang Zhu ◽

Sean Savitz ◽

James Grotta ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Strong Evidence ◽

Demographic Data ◽

Categorical Variables ◽

Continuous Variables ◽

Chi Square ◽

Exact Test ◽

Chi Square Test ◽

Iv Tpa

Background: Intravenous tPA (IV tPA) has been the mainstay for reperfusion therapies for acute ischemic stroke (AIS) patients for 2 decades. Many contraindications from the initial NINDS trial were derived from experts’ consensus and not tested in the trial. Many AIS patients present with thrombocytopenia (< 100,000) and may be excluded from treatment in spite of lack of strong evidence. Some clinicians opt to treat these patients weighing the benefits and risks along with the lack of strong evidence behind this exclusion. We sought to evaluate the safety in AIS patients with low platelets receiving IV tPA as compared to those who do not. Methods: Restrospective chart review of all patients presenting with AIS between 1/2006 to 7/2016 at our center. We analyzed patients who had platelets <100,000 among this cohort and stratified them into those who were treated with IV tPA and those who received antiplatelet therapy only. Demographic data, medical history, medications, presence of sICH after treatment, presenting NIHSS were collected. Two sample Wilcoxon rank sum test was used to compare continuous variables between the two groups, and chi-square test or Fisher’s exact test used to compare categorical variables. Results: 21 patients were treated with IV tPA while 122 patients were treated with antiplatelets. Table 1 lists the demographic variables of the two groups with and without IV tPA. Patients included had moderate thrombocytopenia with very few <50,000. No significant differences were found in presenting NIHSS, race, gender, and history of atrial fibrillation between the two groups except platelets (p=0.0128), age (p=0.0462) and glucose (p=0.0279). Table 2 lists the outcome variables of mRS and symptomatic ICH. There was no petechial or sICH among 21 treated patients. Conclusion: While limited by small numbers and lack of randomization, our data suggest that IV tPA is safe in patients with moderately reduced platelet counts.

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Abstract TMP95: Structured Screening for Post-Stroke Cognitive Impairment in the Outpatient Stroke Clinic

Stroke ◽

10.1161/str.51.suppl_1.tmp95 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

M. Carter Denny ◽

Esther A Bonojo ◽

Evelyn Hinojosa ◽

Sean I Savitz ◽

Anjail Z Sharrief

Keyword(s):

Cognitive Impairment ◽

Neuropsychological Testing ◽

Univariate Analysis ◽

Multivariable Analysis ◽

Categorical Variables ◽

Continuous Variables ◽

Clinical Registry ◽

Exact Test ◽

Post Stroke

Introduction: Cognitive impairment (CI) affects 30% of stroke survivors and impacts ability to return to work, drive and perform ADLs. However, there is no standardized screening for post-stroke CI. We implemented CI screening in the STEP (Stroke Transitions, Education and Prevention) clinic. We sought to identify demographic and clinical factors associated with early post-stroke CI. Methods: Eligible pts had ischemic stroke, ICH or TIA, were seen in the STEP clinic from March 2017 to June 2018, and included in the prospective outpatient clinical registry. Screening for post-stroke CI was performed with a Brief Neurocognitive Screen (BNS), a validated 5-minute subset of the Montreal Cognitive Assessment. BNS 0-8 was defined as abnormal (CI present) and 9-12 was defined as normal. Continuous variables were analyzed with student t-tests or Wilcoxon rank-sum tests and categorical variables with Fisher’s exact test. Logistic regression was performed with the significant variables in the univariate analyses. Results: Of 256 patients, 116 completed a BNS at a median of 35 days after hospital discharge. Median NIHSS was 3 (IQR 0.5,6) and follow-up modified Rankin scale (mRS) was 1 (IQR 1,2). Median BNS was 10 (IQR 9,11). Abnormal BNS, was present in 17.2% of pts screened. Of the 20 pts with abnormal BNS, 17 had neuropsychological testing ordered. In the univariate analysis, age, education, admission NIHSS, poor mRS (<2) at follow-up, and atrial fibrillation were significantly associated with early post-stroke CI (Table 1). In the multivariable analysis, only age and follow-up mRS remained significant. Conclusion: Early post-stroke CI is common in stroke pts, even with low NIHSS, and associated with older age and worse mRS. The BNS is a post-stroke CI screening tool than can be performed in stroke clinics. Future studies are needed to assess the feasibility of implementing the BNS across multiple sites and outcomes associated with early identification of post-stroke CI.

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Rethink Your Transjugular Intrahepatic Portosystemic Shunt (TIPS): Pre-TIPS Infection Predicts Post-TIPS Infection and Post-TIPS Portosystemic Encephalopathy

EMJ Hepatology ◽

10.33590/emjhepatol/19-00204 ◽

2020 ◽

pp. 34-41

Author(s):

Jenna Koblinski ◽

Margaret C. Liu ◽

Roy U. Bisht ◽

Paul Kang ◽

Mark Wong ◽

...

Keyword(s):

Transjugular Intrahepatic Portosystemic Shunt ◽

Odds Ratio ◽

Portal Pressure ◽

Retrospective Chart Review ◽

Portosystemic Shunt ◽

Categorical Variables ◽

Continuous Variables ◽

Exact Test ◽

Portosystemic Encephalopathy ◽

Intrahepatic Portosystemic Shunt

Abstract Objective: Transjugular intrahepatic portosystemic shunt (TIPS) is used for decompression of elevated portal pressure; however, there are potential complications. The aim of this study was to compare the risk of complications of TIPS in those who had an episode of infection within 6 months prior to TIPS to those without an infection prior. Methods: A retrospective chart review was performed on patients who underwent TIPS at a single transplant centre over 8 years. They were divided into two groups: patients without infection during the 6 months prior to TIPS (n=349) and those with an infection prior (bacterial/fungal) (n=53). The Wilcoxon rank-sum test was used to compare continuous variables while chi-squared analysis and Fisher’s exact test was used for categorical variables. Multiple logistic regression was used to ascertain the association between pre-TIPS infection status and likelihood of post-TIPS infection. Results: In the group of patients who had an infection before TIPS, 26.4% (n=14) had an episode of infection after the procedure, while in the group without infection prior, 16.2% (n=55) had an infection after the procedure (p=0.047; odds ratio: 2.08). In the pre-TIPS infection group, 54.7% (n=29) had an episode of portosystemic encephalopathy post-TIPS versus 39.6% (n=134) in the group without infection before TIPS (p=0.046; odds ratio: 1.93). Conclusion: Pre-TIPS infection within 6 months of TIPS procedure is a risk factor for post-TIPS portosystemic encephalopathy and infection. Further studies are needed to determine the potential benefit of antibiotic prophylaxis in patients who had an infection in the 6 months preceding TIPS placement.

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The association between neutrophil-to-albumin ratio and mortality in patients with cardiogenic shock: a cohort study

10.21203/rs.2.16002/v1 ◽

2019 ◽

Author(s):

Yangpei Peng ◽

Yangjing Xue ◽

Jinsheng Wang ◽

Huaqiang Xiang ◽

Kangting Ji ◽

...

Keyword(s):

Cohort Study ◽

Cardiogenic Shock ◽

Primary Outcome ◽

Proportional Hazards ◽

Statistical Significance ◽

Cox Proportional Hazards ◽

Categorical Variables ◽

Continuous Variables ◽

Chi Square ◽

Albumin Ratio

Abstract Background Cardiogenic shock (CS) is a lethal complication. Given the poor outcome of CS, we performed a retrospective cohort study to identify whether the neutrophil-to-albumin ratio (NAR) was significantly associated with mortality from CS. Methods All patient data were extracted from the MIMIC III version 1.3. Comparisons between groups was made using the chi-square or Fisher’s exact tests for categorical variables and the variance analysis or the Kruskal-Wallis test was used for continuous variables. The primary outcome was 30-day mortality and the secondary ones were 90-day and 365-day mortality. We used Cox proportional hazards models to evaluate the association between the various categories of NAR and survival. To further identify the association, subgroup analyses were performed. Results A total of 475 patients with CS were enrolled. A significant positive correlation between NAR levels and 30-day, 90-day or 365-day mortality was observed. For the primary outcome of 30-day mortality, the HR (95% CI) values given NAR levels 23.54–27.86 and > 27.86 were 1.72 (1.17, 2.53) and 1.96 (1.34, 2.87) compared with the reference (NAR < 23.47) in tertile analysis. In multivariate analyses, the HR (95% CI) values were still of statistical significance[1.98 (1.25, 3.15) and 2.03 (1.26, 3.26)]. When quintiles were applied to grouping patients according to NAR level, similar associations were also observed. For the secondary outcomes, the upward trend remained statistically significant. Conclusions NAR level was associated with survival from CS. NAR appeared to be an independent and readily-available prognostic biomarker of mortality in patients with CS.

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Comparison of Uncomfortable Loudness Level in Stapedotomy with or without Stapedial Tendon Preservation

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v27i2.56357 ◽

2021 ◽

Vol 27 (2) ◽

pp. 117-123

Author(s):

Tamanna Nawshin ◽

Kanu Lal Saha ◽

Shah Sohel ◽

Sabyasachi Talukdar ◽

Sheikh Mohammad Tanjil Ul Alam

Keyword(s):

Statistical Significance ◽

Pure Tone Audiometry ◽

Neck Surgery ◽

Categorical Variables ◽

Continuous Variables ◽

Chi Square ◽

Group I ◽

Loudness Level ◽

Group Ii

Background: Otosclerosis is one of the commonest diseases of the ear mostly involves the otic capsule. Most often otosclerotic foci appear in stapes region leading to stapes fixation, predominantly affect the adolescence female. The most common presenting symptom of clinical otosclerosis is conductive deafness. The mainstay of treatment for otosclerosis is surgery. Surgical options include stapedectomy, stapedotomy with or without stapedial tendon preservation. The latter being is the procedure of choice. Aim: The aim of this study is to compare the outcome of uncomfortable loudness level in stapedotomy with or without stapedial tendon preservation. Methods: A prospective observational study was conducted in the Department of Otolaryngology-Head & Neck Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka for 18 months in patients with otosclerosis. Total 30 subjects were selected based on the inclusion and exclusion criteria. All patients were assessed pre-operatively by clinical examination, otoscopy and microscopic examination. Hearing was assessed by pure tone audiometry. Uncomfortable level and stapedial reflex threshold were tested in all cases. The selected cases were placed into two groups. Stapedial tendon resection in Group-I and stapedial tendon preservation in Group-II. Post-operative follow up was done at 3 months and 6 months. Hearing and uncomfortable loudness level were evaluated with PTA during follow up by calculating the average of 500Hz, 1000Hz, 2000Hz and 4000HZ. The data were calculated manually. The statistical significance was set to P< 0.05. Results of the study were expressed as mean, standard deviation (± SD), frequency and percentages. Means and standard deviations were reported for continuous variables. Frequencies and percentages were reported for categorical variables. Unpaired Student’s t test was done to compare the continuous variables and Chi Square test was done to compare the categorical variables. Results: In this study preoperative average ABG for group I and group II were 35 ± 4.57 dB and 34 ± 4.17 dB respectively. In group I, post operative average ABG after 3 months and 6 months were 14 ± 3.7 dB and 13±3.3 dB respectively. Post operative average ABG after 3 months was 13 ± 5.7 dB and was 12 ± 4.4 dB for group II. But the hearing improvement between two groups was not statistically significant. In case of preoperative mean UCL was 95 ± 1.8 dB and 96 ± 2.5 dB for group I and group II respectively. Postoperative mean UCL after 3 months was 96 ± 3.57 dB and after 6 months was 99 ± 6.28 dB in group I. For group II, postoperative mean UCL after 3 months and 6 months was 107±4.2 dB and 113 ± 3.2 dB respectively. Here mean UCL was on average 11 dB higher for group II in 3 months and additional 6 dB improvement noted after 6 months, but show minimal change in group I. This finding was statistically significant. Conclusion: Preservation of the stapedial tendon is the choice in the surgical treatment of otosclerosis which helps to improve functional outcomes as well as to provide the more physiologic protection of middle ear. Postoperative discomfort threshold levels were increased in patients who had their stapedial tendon restored. Bangladesh J Otorhinolaryngol 2021; 27(2): 117-123

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The Recipient Venule in Supermicrosurgical Lymphaticovenular Anastomosis: Flow Dynamic Classification and Correlation with Surgical Outcomes

Journal of Reconstructive Microsurgery ◽

10.1055/s-0038-1649518 ◽

2018 ◽

Vol 34 (08) ◽

pp. 581-589 ◽

Cited By ~ 10

Author(s):

Marzia Salgarello ◽

Akitatsu Hayashi ◽

Giuseppe Visconti

Keyword(s):

Surgical Outcomes ◽

Categorical Variables ◽

Continuous Variables ◽

Composite Outcome ◽

Compression Garment ◽

Flow Dynamic ◽

Chi Square ◽

Exact Test ◽

Preoperative Mapping ◽

Classification Quantitative

Background Venules have been usually neglected in the literature on lymphaticovenular anastomosis (LVA). The aim of this study was to analyze the flow dynamic of recipient venules in LVA and their impact on the surgical outcomes. Patients and Methods Data from 128 patients affected by extremity lymphedema, who underwent LVA, were collected in two institutions from August 2014 to May 2016. Recipient venules were classified according to their flow dynamic into backflow, slack, and outlet (BSO classification). Quantitative (lower extremity lymphedema/upper extremity lymphedema index) and qualitative outcomes (needing of compression garment and compression garment class) were evaluated. Chi-square test or Fisher's exact test was used for categorical variables and independent-samples t-test for continuous variables. The association between lymphatic collector degeneration status (normal, ectasis, contractile, sclerotic type [NECST]) and BSO classification with the outcomes was analyzed by the Mantel–Haenszel test. Results On a total of 128 patients, 37 suffered from upper and 91 from lower limb lymphedema. An average number of four LVA were performed for each patient (range: 2–8). A significant association was observed between NECST and BSO categories and the outcomes were evaluated. Patients with contractile and sclerotic collectors had 2.24 times the odd of having poor composite outcome compared with those with normal-to-ectasis collectors (p < 0.05). Patients with backflow venules had 3.32 times the odd of having poor composite outcome compared with those without outlet or slack pattern (p < 0.05). Conclusion The subtype of recipient venule flow dynamic has a significant impact on the surgical outcome of patients undergoing LVA for the treatment of lymphedema, regardless of the lymphatic collector degeneration status. Locating favorable venules in the preoperative mapping might enhance the surgical outcomes.

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