scholarly journals A retrospective study of the short-term complication rate following 750 elective elbow arthroscopies

2014 ◽  
Vol 27 (01) ◽  
pp. 68-73 ◽  
Author(s):  
L. Li ◽  
K. L. Perry
Keyword(s):  
Retrospective Study ◽  
Complication Rate ◽  
Articular Surface ◽  
Perioperative Complications ◽  
Small Animal ◽  
Major Complication ◽  
Complication Rates ◽  
Repeat Surgery ◽  
Elbow Arthroscopy ◽  
Surface Examination

SummaryArthroscopy is the gold standard for articular surface examination and is commonly advocated for diagnosing and treating cases of canine elbow dysplasia. Arthroscopy is generally regarded as a low-risk procedure, however there is a paucity of information in the small animal veterinary literature regarding the associated complication rates. In a retrospective study spanning a ten year period, 750 elective elbow arthroscopies were evaluated. Complications necessitating repeat surgery were defined as major, and were documented in 4.8% of dogs. Minor perioperative complications occurred in 17.1% dogs. The failure of arthroscopic treatment necessitating unplanned conversion to arthrotomy was the most frequently encountered complication in this category, having been reported in five percent of dogs. Minor postoperative complications occurred in 10.7% dogs; these included a worsened postoperative lameness (5.5%), severe pain (2.8%), severe swelling (2%), infection (0.2%), and neurapraxia (0.2%). A total of 204 dogs returned for a postoperative re-examination and in seven percent, lameness was more severe than that noted preoperatively. The results of the study show that the major complication rate associated with elective elbow arthroscopy is low, but that the minor peri- and postoperative complication rate is concerning. These findings will assist veterinarians in their preoperative discussions with owners to ensure the achievement of informed consent.

Complications and Outcomes of Chimeric Free Flaps: A Systematic Review

2019 ◽  
Vol 161 (4) ◽  
pp. 568-575 ◽  
Author(s):  
Abhinav R. Ettyreddy ◽  
Collin L. Chen ◽  
Joseph Zenga ◽  
Laura E. Simon ◽  
Patrik Pipkorn
Keyword(s):  
Head And Neck ◽  
Complication Rate ◽  
Operative Time ◽  
Donor Site ◽  
Locally Advanced ◽  
Major Complication ◽  
Free Flaps ◽  
Controlled Vocabulary ◽  
Cochrane Central Register ◽  
Complication Rates

ObjectiveAblations of locally advanced or recurrent head and neck cancer commonly result in large composite orofacial defects. Chimeric flaps represent a unique surgical option for these defects, as they provide diverse tissue types from a single donor site. The purpose of the study was to consolidate the literature on chimeric flaps with regard to postoperative complication rates to help inform surgical decision making.Data SourcesThe librarian created search strategies with a combination of keywords and controlled vocabulary in Ovid Medline (1946), Embase (1947), Scopus (1823), Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Clinicaltrails.gov (1997).Review MethodsCandidate articles were independently reviewed by 2 authors familiar with the subject material, and inclusion/exclusion criteria were uniformly applied for article selection. Articles were considered eligible if they included patients who received a single chimeric flap for reconstruction of head and neck defects and if they provided data on complication rates.ResultsA total of 521 chimeric flaps were included in the study. The major complication rate was 22.6%, while the minor complication rate was 14.0%. There were 7 flap deaths noted in the series. Median operative time and harvest time were 15.0 and 2.5 hours, respectively.ConclusionChimeric flaps represent a viable option for reconstruction of complex head and neck defects and have complication rates similar to those of double free flaps and single free flaps with locoregional flap while only modestly increasing total operative time.

Failure to Rescue and Mortality Following Resection of Intracranial Neoplasms

Neurosurgery ◽  
2017 ◽  
Vol 83 (2) ◽  
pp. 263-269 ◽  
Author(s):  
Hani Malone ◽  
Michael Cloney ◽  
Jingyan Yang ◽  
Dawn L Hershman ◽  
Jason D Wright ◽  
...  
Keyword(s):  
Perioperative Complications ◽  
Major Complication ◽  
High Volume ◽  
Mortality Rates ◽  
Complication Rates ◽  
Surgical Volume ◽  
Failure To Rescue ◽  
Intracranial Neoplasms ◽  
Perioperative Complication ◽  
Overall Risk

Abstract BACKGROUND There is growing recognition that perioperative complication rates are similar between hospitals, but mortality rates are lower at high-volume centers. This may be due to differences in the ability to rescue patients from major complications. OBJECTIVE To examine the relationship between hospital caseload and failure to rescue from complications following resection of intracranial neoplasms. METHODS We identified adults in the Nationwide Inpatient Sample diagnosed with glioma, meningioma, brain metastasis, or acoustic neuroma, who underwent surgical resection between 1998 and 2010. We stratified hospitals by low, intermediate, and high surgical volume tertiles and calculated failure to rescue rates (mortality in patients after a major complication). RESULTS A total of 550 054 patients were analyzed. Overall risk-adjusted complication rates were comparable between low- and medium-volume centers, and slightly lower at high-volume centers (15.3% [15.2, 15.5] vs 15.7% [15.5, 15.9] vs 14.3% [14.1, 14.6]). Risk-adjusted mortality decreased with increasing hospital surgical volume (10.3% [10.2, 10.5] vs 9.0% [8.9, 9.1] vs 7.1% [7.0, 7.2]). The overall risk-adjusted failure to rescue rate also decreased with increasing surgical volume (26.9% [26.3, 27.4] vs 24.8% [24.3, 25.3] vs 20.9% [20.5, 21.5]). CONCLUSION While complication rates were similar between high-volume and low-volume hospitals following craniotomy for tumor, mortality rates were substantially lower at high-volume centers. This appears to be due to the ability of high-volume hospitals to rescue patients from major perioperative complications.

scholarly journals Fixation of Ankle Fractures

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0008
Author(s):  
Andrew Molloy ◽  
Samantha Whitehouse ◽  
Lyndon Mason
Keyword(s):  
Complication Rate ◽  
Major Complication ◽  
Ankle Fractures ◽  
Complication Rates ◽  
Junior Staff ◽  
System Changes ◽  
Major Complication Rate ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Category: Trauma Introduction/Purpose: Ankle fractures are one of the most common fractures. Historically these have been frequently treated by non-specialists and junior staff. In 2011 we presented high malunion rates, which have been mirrored in other departments work. We present the results of system changes to improve the results of ankle fracture fixation Methods: Image intensifier films were reviewed on PACS and scored based on the criteria published by Pettrone et al. At least two blinded assessors assigned scores independently. Patients clinical data was collected from medical records. In 2011 we presented the results of fixation in 94 consecutive patients (Group 1) from 2009. Following this there was period of education in the department to allow change. 68 patients (Group 2) were then reviewed from a 7 month period in 2014 Multiple system changes were introduced in the department including; new treatment algorithms, dedicated foot and ankle trauma lists and clinics, and next day review of all intra-operative radiographs by independent attending. Prospective data was collected on 205 consecutive cases (Group 3) from 01/01/15 – 09/30/16 Results: Patients in group 1 had a malreduction rate of 33%. The major complication rate in this group was 8.5% (8 patients); with only one of these occurred in a correctly reduced fracture. These complications included 4 revision fixations, 2 deep infections and 1 amputation. Following the period of re-education, in Group 2, the mal-reduction rate deteriorated to 43.8%. In this group the major complication rate was 10.9%; including 6 revision fixations and 1 ankle fusion. In Group 3, following overall system changes, the malreduction rate was 2.4%. This result is statistically significant. The major complication rate fell to 0.98%; 1deep infection and 1 amputation (in a polytrauma patient with vascular injury). This result is again statistically significant. Conclusion: Our initial results show that very poor results are a consequence when sufficient attention is not given to what are frequently considered to be ‘simple’ fractures. In group 2 we demonstrated that soft educational changes (eg presentations, emails) are ineffective in improving results. We have demonstrated that hard (institutional system) changes in our department provided statistically significant improvements. These changes allowed the correct surgeon for the fracture in both determining the treatment plan and operating. With these changes, malreduction rates fell from 43.8% to 2.4% and major complication rates from 10.9% to 0.98%

Contemporary analysis of the intraoperative and perioperative complications of neurosurgical procedures performed in the sitting position

2017 ◽  
Vol 127 (1) ◽  
pp. 182-188 ◽  
Author(s):  
Benjamin T. Himes ◽  
Grant W. Mallory ◽  
Arnoley S. Abcejo ◽  
Jeffrey Pasternak ◽  
John L. D. Atkinson ◽  
...  
Keyword(s):  
Complication Rate ◽  
Perceived Risk ◽  
Perioperative Complications ◽  
Subdural Hemorrhage ◽  
Neurosurgical Procedures ◽  
Complication Rates ◽  
Sitting Position ◽  
Tension Pneumocephalus ◽  
Suboccipital Craniotomy ◽  
Clinically Significant

OBJECTIVEHistorically, performing neurosurgery with the patient in the sitting position offered advantages such as improved visualization and gravity-assisted retraction. However, this position fell out of favor at many centers due to the perceived risk of venous air embolism (VAE) and other position-related complications. Some neurosurgical centers continue to perform sitting-position cases in select patients, often using modern monitoring techniques that may improve procedural safety. Therefore, this paper reports the risks associated with neurosurgical procedures performed in the sitting position in a modern series.METHODSThe authors reviewed the anesthesia records for instances of clinically significant VAE and other complications for all neurosurgical procedures performed in the sitting position between January 1, 2000, and October 8, 2013. In addition, a prospectively maintained morbidity and mortality log of these procedures was reviewed for instances of subdural or intracerebral hemorrhage, tension pneumocephalus, and quadriplegia. Both overall and specific complication rates were calculated in relation to the specific type of procedure.RESULTSIn a series of 1792 procedures, the overall complication rate related to the sitting position was 1.45%, which included clinically significant VAE, tension pneumocephalus, and subdural hemorrhage. The rate of any detected VAE was 4.7%, but the rate of VAE requiring clinical intervention was 1.06%. The risk of clinically significant VAE was highest in patients undergoing suboccipital craniotomy/craniectomy with a rate of 2.7% and an odds ratio (OR) of 2.8 relative to deep brain stimulator cases (95% confidence interval [CI] 1.2–70, p = 0.04). Sitting cervical spine cases had a comparatively lower complication rate of 0.7% and an OR of 0.28 as compared with all cranial procedures (95% CI 0.12–0.67, p < 0.01). Sitting cervical cases were further subdivided into extradural and intradural procedures. The rate of complications in intradural cases was significantly higher (OR 7.3, 95% CI 1.4–39, p = 0.02) than for extradural cases. The risk of VAE in intradural spine procedures did not differ significantly from sitting suboccipital craniotomy/craniectomy cases (OR 0.69, 95% CI 0.09–5.4, p = 0.7). Two cases (0.1%) had to be aborted intraoperatively due to complications. There were no instances of intraoperative deaths, although there was a single death within 30 days of surgery.CONCLUSIONSIn this large, modern series of cases performed in the sitting position, the complication rate was low. Suboccipital craniotomy/craniectomy was associated with the highest risk of complications. When appropriately used with modern anesthesia techniques, the sitting position provides a safe means of surgical access.

Morbidity and mortality after spinal deformity surgery in patients 75 years and older: complications and predictive factors

2011 ◽  
Vol 15 (6) ◽  
pp. 667-674 ◽  
Author(s):  
Frank L. Acosta ◽  
Jamal McClendon ◽  
Brian A. O'Shaughnessy ◽  
Heiko Koller ◽  
Chris J. Neal ◽  
...  
Keyword(s):  
Predictive Factors ◽  
Spinal Deformity ◽  
Complication Rate ◽  
Perioperative Complications ◽  
Major Complication ◽  
Major Complications ◽  
Spinal Deformity Surgery ◽  
Perioperative Complication ◽  
The Mean

Object As the population continues to age, relatively older geriatric patients will present more frequently with complex spinal deformities that may require surgical intervention. To the authors' knowledge, no study has analyzed factors predictive of complications after major spinal deformity surgery in the very elderly (75 years and older). The authors' objective was to determine the rate of minor and major complications and predictive factors in patients 75 years of age and older who underwent major spinal deformity surgery requiring a minimum 5-level arthrodesis procedure. Methods Twenty-one patients who were 75 years of age or older and underwent thoracic and/or lumbar fixation and arthrodesis across 5 or more levels for spinal deformity were analyzed retrospectively. The medical and surgical records were reviewed in detail. Age, diagnosis, comorbidities, operative data, hospital data, major and minor complications, and deaths were recorded. Factors predictive of perioperative complications were identified by logistic regression analysis. Results The mean patient age was 77 years old (range 75–83 years). There were 14 women and 7 men. The mean follow-up was 41.2 months (range 24–81 months). Fifteen patients (71%) had at least 1 comorbidity. A mean of 10.5 levels were fused (range 5–15 levels). Thirteen patients (62%) had at least 1 perioperative complication, and 8 (38%) had at least one major complication for a total of 17 complications. There were no perioperative deaths. Increasing age was predictive of any perioperative complication (p = 0.03). However, major complications were not predicted by age or comorbidities as a whole. In a subset analysis of comorbidities, only hypertension was predictive of a major complication (OR 10, 95% CI 1.3–78; p = 0.02). Long-term postoperative complications occurred in 11 patients (52%), and revision fusion surgery was necessary in 3 (14%). Conclusions Patients 75 years and older undergoing major spinal deformity surgery have an overall perioperative complication rate of 62%, with older age increasing the likelihood of a complication, and a long-term postoperative complication rate of 52%. Patients in this age group with a history of hypertension are 10 times more likely to incur a major perioperative complication. However, the mortality risk for these patients is not increased.

Complications of Diagnostic Arteriography Performed by a Vascular Surgeon in a Recent Series of 558 Patients

Vascular ◽  
2007 ◽  
Vol 15 (2) ◽  
pp. 92-97 ◽  
Author(s):  
Ali F. AbuRahma ◽  
Michael Elmore ◽  
John Deel ◽  
Bandy Mullins ◽  
John Hayes
Keyword(s):  
Operative Time ◽  
Perioperative Complications ◽  
Operating Time ◽  
Major Complication ◽  
Aortic Aneurysms ◽  
Complication Rates ◽  
Vascular Surgeon ◽  
Technical Success Rate ◽  
Abdominal Aortic ◽  
The Mean

This article analyzes the complication rates of diagnostic arteriographies performed by a single vascular surgeon and compares them to those previously published by interventional radiologists. Five hundred fifty-eight consecutive patients who underwent diagnostic arteriographies were analyzed. A modification of one study's criteria was used to compile perioperative complications. The technical success rate was 99%. These included 345 aortoiliofemoral arteriograms with runoff, 64 aortoiliofemoral arteriograms for abdominal aortic aneurysms, 83 aortoiliofemoral arteriograms with contralateral selective iliacs, 35 aortoiliofemoral arteriograms with carotids, and 27 aortoiliofemoral arteriograms with selective visceral/renal. Femoral artery puncture was used in 93%, and left brachial artery in 7%. The mean amount of contrast was 97 cc and the mean operative time was 25 minutes. The overall complication rate was 3.8% (1.3% major), which was comparable to what was published previously (1.9% and 2.9%) but superior to what we published previously as performed by our radiologists (7%, p <.001). A logistic regression could not find any variables that were significant for the prediction of a major complication. However, increased age, a longer operating time (≥ 30 minutes), and smoking were associated with an increase in overall complications. It was determined that diagnostic arteriography can be done safely by experienced vascular surgeons with low complication rates that compare favorably with what was published by interventional radiologists.

Intermediate-term Experience With the STAR Total Ankle in the United States

2018 ◽  
Vol 40 (3) ◽  
pp. 268-275 ◽  
Author(s):  
Evan M. Loewy ◽  
Thomas H. Sanders ◽  
Arthur K. Walling
Keyword(s):  
United States ◽  
Perioperative Complications ◽  
Case Series ◽  
Major Complication ◽  
The United States ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Patient Reported ◽  
The Mean

Background: Limited intermediate and no real long-term follow-up data have been published for total ankle arthroplasty (TAA) in the United States. This is a report of clinical follow-up data of a prospective, consecutive cohort of patients who underwent TAA by a single surgeon from 1999 to 2013 with the Scandinavian Total Ankle Replacement (STAR) prosthesis. Methods: Patients undergoing TAA at a single US institution were enrolled into a prospective study. These patients were followed at regular intervals with history, physical examination, and radiographs; American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale scores were obtained and recorded. Primary outcomes included implant survivability and functional outcomes scores. Secondary outcomes included perioperative complications such as periprosthetic or polyethylene fracture. Between 1999 and 2013, a total of 138 STAR TAAs were performed in 131 patients; 81 patients were female. The mean age at surgery was 61.5 ± 12.3 years (range, 30-88 years). The mean duration of follow-up for living patients who retained both initial components at final follow-up was 8.8±4.3 years (range 2-16.9 years). Results: The mean change in AOFAS Ankle-Hindfoot scores from preoperative to final follow-up was 36.0 ± 16.8 ( P < .0001). There were 21 (15.2%) implant failures that occurred at a mean 4.9 ± 4.5 years postoperation. Ten polyethylene components in 9 TAAs (6.5%) required replacement for fracture at an average 8.9 ± 3.3 years postoperatively. Fourteen patients died with their initial implants in place. Conclusion: This cohort of patients with true intermediate follow-up after TAA with the STAR prosthesis had acceptable implant survival, maintenance of improved patient-reported outcome scores, and low major complication rates. Level of Evidence: Level IV, case series.

Failure to Rescue As a Source of Variation in Hospital Mortality for Ovarian Cancer

2012 ◽  
Vol 30 (32) ◽  
pp. 3976-3982 ◽  
Author(s):  
Jason D. Wright ◽  
Thomas J. Herzog ◽  
Zainab Siddiq ◽  
Rebecca Arend ◽  
Alfred I. Neugut ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Complication Rate ◽  
Major Complication ◽  
High Volume ◽  
Complication Rates ◽  
Failure To Rescue ◽  
High Volume Hospital ◽  
Lower Complication ◽  
Major Complication Rate ◽  
Low Volume

Purpose Although the association between high surgical volume and improved outcomes from procedures is well described, the mechanisms that underlie this association are uncertain. There is growing recognition that high-volume hospitals may not necessarily have lower complication rates but rather may be better at rescuing patients with complications. We examined the role of complications, failure to rescue from complications, and mortality based on hospital volume for ovarian cancer. Patients and Methods The Nationwide Inpatient Sample was used to identify women who underwent surgery for ovarian cancer from 1988 to 2009. Hospitals were ranked on the basis of their procedure volume. We determined the risk-adjusted mortality, major complication rate, and “failure to rescue” rate (mortality in patients with a major complication) for each tertile. Univariate and multivariate associations were then compared. Results We identified 36,624 patients. The mortality rate for the cohort was 1.6%. The major complication rate was 20.4% at low-volume, 23.4% at intermediate-volume, and 24.6% at high-volume hospitals (P < .001). However, the rate of failure to rescue (death after a complication) was markedly higher at low-volume (8.0%) compared with high-volume hospitals (4.9%; P < .001). After accounting for patient and hospital characteristics, women treated at low-volume hospitals who experienced a complication were 48% more likely (odds ratio [OR], 1.48; 95% CI, 1.11 to 1.99) to die than patients with a complication at a high-volume hospital. Conclusion Mortality is lower for patients with ovarian cancer treated at high-volume hospitals. The reduction in mortality does not appear to be the result of lower complications rates but rather a result of the ability of high-volume hospitals to rescue patients with complications.

scholarly journals Intraoperative and perioperative complications in minimally invasive transforaminal lumbar interbody fusion: a review of 513 patients

2015 ◽  
Vol 22 (5) ◽  
pp. 487-495 ◽  
Author(s):  
Albert P. Wong ◽  
Zachary A. Smith ◽  
Alexander T. Nixon ◽  
Cort D. Lawton ◽  
Nader S. Dahdaleh ◽  
...  
Keyword(s):  
Complication Rate ◽  
Interbody Fusion ◽  
Perioperative Complications ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Complication Rates ◽  
Lumbar Interbody Fusion ◽  
Disc Disease ◽  
Lumbar Degenerative Disc Disease ◽  
Significant Difference ◽  
Perioperative Complication

OBJECT Transforaminal lumbar interbody fusion (TLIF) has become one of the preferred procedures for circumferential fusion in the lumbar spine. Over the last decade, advances in surgical techniques have enabled surgeons to perform the TLIF procedure through a minimally invasive approach (MI-TLIF). There are a few studies reported in the medical literature in which perioperative complication rates of MI-TLIF were evaluated; here, the authors present the largest cohort series to date. They analyzed intraoperative and perioperative complications in 513 consecutive MI-TLIF–treated patients with lumbar degenerative disc disease. METHODS The authors performed a retrospective review of prospectively collected data on 513 consecutive patients treated over a 10-year period for lumbar degenerative disc disease using MI-TLIF. All patients undergoing either a first-time or revision 1- or 2-level MI-TLIF procedure were included in the study. Demographic, intraoperative, and perioperative data were collected and analyzed using bivariate analyses (Student t-test, analysis of variance, odds ratio, chi-square test) and multivariate analyses (logistic regression). RESULTS A total of 513 patients underwent an MI-TLIF procedure, and the perioperative complication rate was 15.6%. The incidence of durotomy was 5.1%, and the medical and surgical infection rates were 1.4% and 0.2%, respectively. A statistically significant increase in the infection rate was seen in revision MI-TLIF cases, and the same was found for the perioperative complication rate in multilevel MI-TLIF cases. Instrumentation failure occurred in 2.3% of the cases. After analysis, no statistically significant difference was seen in the rates of durotomy during revision and multilevel surgeries. There was no significant difference between the complication rates when stratified according to presenting diagnosis. CONCLUSIONS To the authors' knowledge, this is the largest study of perioperative complications in MI-TLIF in the literature. A total of 513 patients underwent MI-TLIF (perioperative complication rate 15.6%). The most common complication was a durotomy (5.1%), and there was only 1 surgical wound infection (0.2%). There were significantly more perioperative infections in revision MI-TLIF cases and more perioperative complications in multilevel MI-TLIF cases. The results of this study suggest that MI-TLIF has a similar or better perioperative complication profile than those documented in the literature for open-TLIF treatment of degenerative lumbar spine disease.

Comparison of Internal Maxillary Artery Ligation Versus Embolization for Refractory Posterior Epistaxis

1998 ◽  
Vol 118 (5) ◽  
pp. 636-642 ◽  
Author(s):  
Michelle Marie Cullen ◽  
Thomas A. Tami
Keyword(s):  
Complication Rate ◽  
Medical Center ◽  
Major Complication ◽  
Maxillary Artery ◽  
Complication Rates ◽  
Failure Rates ◽  
Internal Maxillary Artery ◽  
Artery Ligation ◽  
Advantages And Disadvantages ◽  
The Cost

OBJECTIVE: This study examined the advantages and disadvantages of internal maxillary artery (IMA) ligation versus embolization for the treatment of refractory posterior epistaxis. METHODS: Thirty-nine patients underwent 42 procedures for treatment of posterior epistaxis at the University of Cincinnati Medical Center between 1986 and 1994. Complication rates, failure rates, demographics, and the costs of IMA ligation and embolization were compared. A review of 20 studies published between 1973 and 1995 was done to determine the complication and failure rates of IMA ligation and embolization. Finally, a mail survey was used to determine the availability and use of IMA ligation and embolization by urban and rural otolaryngologists in Ohio. RESULTS: Complication and failure rates of IMA ligation and embolization were similar at our institution. In the literature review, IMA ligation had a higher complication rate, but fewer failures. Although the major complication rates were not significantly different, those associated with embolization were often more serious than those associated with IMA ligation. At our institution, the cost of IMA embolization was significantly lower than the cost of IMA ligation. Only 11% of Ohio otolaryngologists in nonurban areas have embolization available to treat posterior epistaxis. CONCLUSION: IMA ligation is more effective than IMA embolization but may be associated with a higher minor complication rate. The major complications that occur with IMA embolization are often more serious. Although IMA embolization was less expensive at our institution, it is unavailable in most nonurban regions in Ohio. Training in the use of IMA ligation for refractory posterior epistaxis should continue in otolaryngology residency training programs despite the increasing availability of embolization at university training centers. (Otolaryngol Head Neck Surg 1998;118:636–42.)

Sign in / Sign up

Export Citation Format

Share Document