The impact of the Covid-19 pandemic on care of women with ectopic pregnancy in a tertiary London hospital

Background: In response to the COVID-19 pandemic, a central London tertiary referral hospital’s nurse-led Early Pregnancy & Acute Gynaecology Unit (EPAGU) suspended its walk-in service in favour of a telephone triage system with scheduled appointments. Objective: To assess if the pandemic and this adaptation to clinical services had an impact on the presentation, management and complication rate of ectopic pregnancies. Materials and Methods: A retrospective review was performed of ectopic pregnancies diagnosed in the EPAGU between 5th of March 2020 – 15th of July 2020 (pandemic) and 5th of March 2019 – 15th of July 2019 (pre-pandemic). Main outcome measures: Ultrasound findings, patient demographics, serum hCG concentrations, operative findings and complications. Results: There was a 36% reduction in attendances to the unit during the pandemic. Allowing for this, there was no significant difference in the diagnosis rate between the two periods. There was no significant difference in the gestation at diagnosis, serum hCG concentration or volume of mass at presentation. There was also no significant difference in rate of surgical intervention or complications including rupture of fallopian tube, haemoperitoneum or need for blood transfusion. Conclusion: This study suggests this is a safe means of caring for women with ectopic pregnancies which does not limit management options nor lead to higher complication rates. What is new: Other EPAGUs may choose to adopt a telephone triage system with reassurance of its safety.

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Abstract WP14: Higher Aspiration Force Improves Technical Outcomes in ADAPT Thrombectomy for Ischemic Stroke

Stroke ◽

10.1161/str.51.suppl_1.wp14 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Reda M Chalhoub ◽

Ali M Alawieh ◽

Clayton Korson ◽

Mohammad Anadani ◽

Jonathan Lena ◽

...

Keyword(s):

Ischemic Stroke ◽

Lower Number ◽

Stent Retriever ◽

Complication Rates ◽

Procedure Time ◽

Aspiration Thrombectomy ◽

Patient Demographics ◽

Significant Difference ◽

Catheter Size ◽

The Impact

Introduction: Aspiration thrombectomy using the direct aspiration at first pass technique (ADAPT) has been shown to be non-inferior to stent-retriever thrombectomy in ischemic stroke trials. Favorable outcomes after ADAPT are dependent on successful recanalization and lower number of aspiration attempts. We investigated the impact of aspiration force on technical and clinical outcomes of ADAPT by modulating two underlying determinants, the aspiration catheter size and the reperfusion pump power. Methods: We performed a retrospective analysis of patients undergoing ADAPT thrombectomy between 01/2018 and 02/2019. Patient treated using ADAPT were included irrespective of age, onset to groin or whether thrombolytic therapy was administered. Patient demographics and outcomes were reviewed from patient charts and thrombectomy procedure notes. Patients were dichotomized based on the reperfusion pump used (MAX, 28.5 inHb power vs ENGINE, 29.2 inHg power) and further split into the different reperfusion catheters used. Results: This study included 194 patients who underwent ADAPT thrombectomy during the study period with mean age of 69, and of which 48% were females. Comparing patients treated with two different reperfusion pumps, ENGINE (N=73) and MAX (N=118), similar rates of favorable outcomes measured by 90-day modified Rankin score (mRS) were observed. However, patients in the ENGINE groups had significantly shorter procedure time (20 vs 27 min, p<0.05), lower number of aspiration attempts (1.9 vs 2.2 p<0.05), and low rates of rescue stent retriever therapy (14% vs 33%, p<0.05). The use of ENGINE was an independent predictor of shorter procedure time (p<0.05) and lower rates of symptomatic hemorrhage (p<0.1) compared to MAX pump. There was no significant difference in procedure time and rates of functional outcomes among patients undergoing ADAPT using different sizes of large bore catheters ACE 60, ACE68 and Jet 7. Conclusion: Success of ADAPT thrombectomy is dependent on successful aspiration of the occluding clot, and is dependent on the aspiration force. Higher aspiration forces can be achieved by increasing the power of reperfusion pump leading to better technical outcomes without increased complication rates.

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Absence of Association between Preoperative Estimated Glomerular Filtration Rates and Postoperative Outcomes following Elective Gastrointestinal Surgeries: A Prospective Cohort Study

Anesthesiology Research and Practice ◽

10.1155/2018/5710641 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7

Author(s):

Sivesh K. Kamarajah ◽

Behrad Barmayehvar ◽

Mustafa Sowida ◽

Amirul Adlan ◽

Christina Reihill ◽

...

Keyword(s):

Risk Stratification ◽

Glomerular Filtration ◽

Elective Surgery ◽

Gastrointestinal Surgery ◽

Major Complication ◽

Postoperative Outcomes ◽

Queen Elizabeth Hospital ◽

Complication Rates ◽

Significant Difference ◽

The Impact

Background. Preoperative risk stratification and optimising care of patients undergoing elective surgery are important to reduce the risk of postoperative outcomes. Renal dysfunction is becoming increasingly prevalent, but its impact on patients undergoing elective gastrointestinal surgery is unknown although much evidence is available for cardiac surgery. This study aimed to investigate the impact of preoperative estimated glomerular filtration rate (eGFR) and postoperative outcomes in patients undergoing elective gastrointestinal surgeries. Methods. This prospective study included consecutive adult patients undergoing elective gastrointestinal surgeries attending preassessment screening (PAS) clinics at the Queen Elizabeth Hospital Birmingham (QEHB) between July and August 2016. Primary outcome measure was 30-day overall complication rates and secondary outcomes were grade of complications, 30-day readmission rates, and postoperative care setting. Results. This study included 370 patients, of which 11% (41/370) had eGFR of <60 ml/min/1.73 m2. Patients with eGFR < 60 ml/min/1.73 m2 were more likely to have ASA grade 3/4 (p<0.001) and >2 comorbidities (p<0.001). Overall complication rates were 15% (54/370), with no significant difference in overall (p=0.644) and major complication rates (p=0.831) between both groups. In adjusted models, only surgery grade was predictive of overall complications. Preoperative eGFR did not impact on overall complications (HR: 0.89, 95% CI: 0.45–1.54; p=0.2). Conclusions. Preoperative eGFR does not appear to impact on postoperative complications in patients undergoing elective gastrointestinal surgeries, even when stratified by surgery grade. These findings will help preassessment clinics in risk stratification and optimisation of perioperative care of patients.

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Baerveldt shunt surgery versus combined Baerveldt shunt and phacoemulsification: a prospective comparative study

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2017-310698 ◽

2017 ◽

Vol 102 (9) ◽

pp. 1248-1253 ◽

Cited By ~ 1

Author(s):

Mohamad El Wardani ◽

Ciara Bergin ◽

Kenza Bradly ◽

Eamon Sharkawi

Keyword(s):

Complication Rates ◽

Failure Rates ◽

Shunt Surgery ◽

Patient Demographics ◽

Aqueous Shunt ◽

Included Patient ◽

Significant Difference ◽

Negative Effect ◽

Prospective Comparative Study ◽

Baerveldt Tube

AimTo examine the efficacy and safety of Baerveldt tube (BT) implantation compared with combined phacoemulsification and Baerveldt tube (PBT) implantation in patients with refractory glaucoma.MethodsSeventy-six eyes of 76 patients were enrolled, 38 pseudophakic eyes underwent BT implantation alone and 38 phakic eyes underwent the BT implantation combined with phacoemulsification. Groups were matched for preoperative intraocular pressure (IOP) and number of glaucoma medications. Preoperative and postoperative measures recorded included patient demographics, visual acuity (VA), IOP, number of antiglaucoma medications and all complications. Patients were followed up for a minimum of 36 months. Failure was defined as: inadequate IOP control (IOP≤5 mm Hg/>21 mm Hg/<20% reduction from baseline, reoperation for glaucoma, loss of light perception vision, or removal of the implant).ResultsThere was a significant difference in failure rates between groups at 36 months (PBT 37% vs BT 15%, P=0.02). There was no significant difference for PBT versus BT in preoperative baseline ocular characteristics. At 36 months: median IOP=14 mm Hg vs 12 mm Hg, P=0.04; mean number of antiglaucomatous medications=1.7 vs 1.3, P=0.61; median VA=0.8 vs 0.7, P=0.44. Postoperative complication rates were similar in both groups (n=5 vs 5; 13% vs 13%).ConclusionsFailure rates were significantly greater in the PBT group at 3 years. Median IOP was also significantly higher in the PBT group. These results suggest that combining phacoemulsification with aqueous shunt surgery may have a negative effect on long-term shunt bleb survival.

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The Impact of Medical Comorbidities on Patient Satisfaction in Chronic Rhinosinusitis

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894211015736 ◽

2021 ◽

pp. 000348942110157

Author(s):

Amarbir S. Gill ◽

Joshua Hwang ◽

Angela M. Beliveau ◽

Jeremiah A. Alt ◽

Edward Bradley Strong ◽

...

Keyword(s):

Patient Satisfaction ◽

Hearing Impairment ◽

Chronic Rhinosinusitis ◽

Medical Comorbidities ◽

Patient Demographics ◽

Significant Difference ◽

Comorbidity Index ◽

The Mean ◽

Therapy Compliance ◽

The Impact

Background: Patient satisfaction has a significant bearing on medical therapy compliance and patient outcomes. The purpose of this study was to (1) describe patient satisfaction, as characterized by the Patient Satisfaction Questionnaire-18 (PSQ-18), in the care of patients with chronic rhinosinusitis (CRS) and (2) analyze the impact of comorbidities on satisfaction using the functional comorbidity index (FCI). Methods: Patient demographics, disease severity measures, and PSQ-18 scores for patients with CRS presenting to a tertiary rhinology clinic between November 2019 and April 2020 were collected and analyzed. FCI was calculated retrospectively using the electronic medical record; individual comorbidities were tabulated. Spearman’s correlations followed by multivariate regression was used to assess the relationship between medical comorbidities and PSQ-18. Results: Sixty-nine patients met criteria for analysis. There were no significant differences in age, gender, and Sinonasal Outcomes Test-22 scores between CRS patients with (CRSwNP) and without (CRSsNP) nasal polyps. There was no significant difference in the mean FCI for patients with CRSwNP versus CRSsNP (5.1 and 4.3, respectively) ( P = .843). Similarly, there was no significant difference in the mean sum PSQ-18 score (78/100 in both) between these cohorts ( P = .148). The mean sum PSQ-18 score was not significantly associated with anxiety ( P = .728), depression ( P = .624), or FCI ( P = .282), but was significantly associated with hearing impairment ( P < .001). Conclusion: Patient satisfaction in the care of CRS is generally high with a diagnosis of comorbid hearing impairment demonstrating a negative association with satisfaction in this cohort.

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Emergency Medical Services vs. Police: Impact of Pre-Hospital Transportation Method on Outcomes of Trauma Patients with Firearm Injuries

10.21203/rs.3.rs-103342/v1 ◽

2020 ◽

Author(s):

Christina Wohler ◽

Rachel Denneny ◽

Allegra Bermudez ◽

Robert Wilson ◽

Douglas Gouchoe ◽

...

Keyword(s):

Emergency Medical Services ◽

The United States ◽

Hospital Length Of Stay ◽

Medical Services ◽

Hospital Treatment ◽

Firearm Injuries ◽

Patient Demographics ◽

Emergency Medical ◽

Significant Difference ◽

The Impact

Abstract Background Firearms are a significant cause of morbidity and mortality in the United States. Few studies exist to investigate the impact of pre-hospital transportation methods on trauma patient outcomes. Methods Patients with firearm injuries were identified using an institutional trauma registry (2008 to 2017). Data on patient demographics, hospital transportation, treatments, and outcomes was collected and analyzed. Patient characteristics between Emergency Medical Services (EMS) vs. police transport groups were compared using Kruskal-Wallis, chi-square, or Fisher’s exact tests as appropriate. Results Of 224 patients identified, 147 (66%) were transported by EMS and 77 (34%) were transported by police. There was no significant difference in patient demographics between groups. Most patients were male (94.2%) and African American (69.2%), with a mean age of 27.1 years. 84.4% of patients suffered from an externally-inflicted gunshot wound, while 9.4% of patients had inflicted the wound themselves. Handguns were the weapon most commonly used. There was no significant difference in in-hospital treatments or mortality between patients transported by EMS vs. police. 44.1% of patients underwent surgery, and 34.8% required specialist consultation. The mean hospital length of stay for all patients was 1 day, and 27.7% of all patients expired during admission. Conclusions There is no difference in hospital treatment or mortality between firearm victims transported by EMS vs. police.

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Impact of SARS-Cov-2 on ectopic pregnancies management in the United Kingdom: a multicentre paired observational study

10.22541/au.160642275.57561401/v1 ◽

2020 ◽

Author(s):

Sophie Platts ◽

Jeewantha Ranawakagedon ◽

Reeba Oliver ◽

Sayantana Das ◽

Phalguni Kotabagi ◽

...

Keyword(s):

Ectopic Pregnancy ◽

Surgical Management ◽

Expectant Management ◽

Complication Rates ◽

University Hospitals ◽

Length Of Treatment ◽

Hospital Visits ◽

Ectopic Pregnancies ◽

The Impact ◽

Pregnancy Registry

Objective: to describe the impact of COVID-19 on the management of patients with ectopic pregnancy. Design: a multicentre study comparing outcomes from a prospective cohort during the pandemic [Covid-ectopic pregnancy registry (CEPR)] compared to an historical pre-pandemic cohort [non-Covid ectopic pregnancy registry (NCEPR)]. Setting: five London university hospitals. Population and Methods: consecutive patients diagnosed clinically and/or radiologically with ectopic pregnancy (March/2020-Aug/2020) were entered into the CEPR and an exploratory matched analysis was performed comparing results to NCEPR patients (January/2019-June/2019). Main outcome measures: patient demographics, management (expectant, medical and surgical), length of treatment, number of hospital visits (non-surgical management), length of stay (surgical management) and 30-day complications. Results: 341 patients met inclusion: 162 CEPR and 179 NCEPR. A significantly higher percentage of women underwent non-surgical management versus surgical management in the CEPR versus NCEPR (58.6% [95/162] vs 72.6% [130/179]; p= 0.0084]. Amongst patients managed with expectant management the CEPR had a significantly lower mean number of hospital visits compared to NCEPR [3.6 [SD 1.4] vs 13.7 [SD 13.4], p= 0.0053]. Amongst patients managed with medical management, the CEPR had a significantly lower mean number of hospital visits [NCEPR 6.4 [SD 2.3] vs 8.8 [SD 3.9], p= 0.0014]. There was no observed difference in complication rates between cohorts. Conclusion: women were found to undergo significantly higher rates of non-surgical management during COVID-19 first wave vs NCEPR cohort. Women managed non-surgically in CPER cohort were also managed with fewer hospital attendances. This did not lead to an increase in observed complications rates.

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Perioperative complication rates following neoadjuvant therapy in pancreatic adenocarcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.688 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 688-688

Author(s):

Christopher R. Deig ◽

Blake Beneville ◽

Amy Liu ◽

Aasheesh Kanwar ◽

Alison Grossblatt-Wait ◽

...

Keyword(s):

Length Of Stay ◽

Neoadjuvant Therapy ◽

Pancreatic Adenocarcinoma ◽

Locally Advanced ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Complication Rates ◽

Significant Difference ◽

Perioperative Complication ◽

The Impact

688 Background: Whether upfront resection or total neoadjuvant therapy is superior for the treatment of potentially resectable pancreatic adenocarcinoma (PDAC) remains controversial. The impact of neoadjuvant treatment on major perioperative complication rates for patients (pts) undergoing resection for PDAC is commonly debated. We hypothesized that rates would be comparable among patients receiving neoadjuvant chemoradiation (neo-CRT), neoadjuvant chemotherapy alone (neo-CHT), or upfront surgery. Methods: This is a retrospective study of 208 pts with PDAC who underwent resection within a multidisciplinary pancreatico-biliary program at an academic tertiary referral center between 2011-2018. Data were abstracted from the medical record, an institutional cancer registry and NSQIP databases. Outcomes were assessed using χ2, Fisher’s exact test and two-tailed Student’s t-tests. Results: 208 pts were identified: 33 locally advanced, borderline or upfront resectable pts underwent neo-CRT, 35 borderline or resectable pts underwent neoadjuvant-CHT, and 140 resectable pts did not undergo neoadjuvant therapy. There were no statistically significant differences in major perioperative complication rates between groups. Overall rates were 36.4%, 34.3%, and 26.4% for pts who underwent neo-CRT, neo-CHT alone, or upfront resection, respectively (p = 0.38). No significant difference were observed in complication rates (35.3% v. 26.4%; p = 0.19) or median hospital length of stay (10 days v. 10 days; p = 0.87) in pts who received any neoadjuvant therapy versus upfront resection. There were two perioperative deaths in the neo-CRT group (6.1%), zero in the neo-CHT group, and four in the upfront resection group (2.9%); p = 0.22. Conclusions: There were no significant differences in major perioperative complication rates, hospital length of stay, or post-operative mortality in pts who underwent neoadjuvant therapy (neo-CRT or neo-CHT alone) versus upfront surgery. Notably, neo-CRT had comparable perioperative complication rates to neo-CHT alone, which suggests neoadjuvant radiation therapy may not pose additional surgical risk.

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Supratentorial and Infratentorial Approaches to Pineal Surgery: A Database Analysis

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1675231 ◽

2018 ◽

Vol 80 (04) ◽

pp. 364-370

Author(s):

David M. Rosenberg ◽

Brett W. Geever ◽

Akash S. Patel ◽

Anisse N. Chaker ◽

Abhiraj D. Bhimani ◽

...

Keyword(s):

Pineal Gland ◽

Clinical Decision Making ◽

Tumor Resection ◽

Postoperative Outcomes ◽

Complication Rates ◽

Database Analysis ◽

Improvement Program ◽

Multicenter Studies ◽

Patient Demographics ◽

Significant Difference

Objectives Neoplasms involving the pineal gland are rare. When they do occur, tumor resection is anatomically challenging and is traditionally addressed by either a supratentorial or an infratentorial approach. To date, no large, multicenter studies have been performed that systematically analyze outcomes comparing these two approaches. This study aimed to evaluate outcomes for patients undergoing pineal neoplasm resection, comparing supratentorial and infratentorial approaches. Design Retrospective database review. Setting Multi-institutional database. Participants From 2005 to 2016, 60 patients were identified, with 13 undergoing a supratentorial approach and 47 undergoing an infratentorial approach. Main Outcome Measures Patient demographics, comorbidities, and 30-day postoperative outcomes were investigated using the American College of Surgeons National Surgical Quality Improvement Program database. Demographics, readmission, reoperation, and complication rates were analyzed and compared with previous studies. Results Patient demographics were similar between these two groups. The overall complication rates for the supratentorial and infratentorial approaches were 30.8 and 17%, respectively, and the difference was not statistically significant. The most common medical complications encountered were respiratory and hematological. Conclusion As the first multi-institutional database analysis of approaches to the pineal gland, this study provides an analysis of patient demographics, comorbidities, and postoperative complications. After controlling for preoperative risk factors and demographic characteristics, no statistically significant differences in postoperative outcomes were found between infratentorial and supratentorial approaches. The mean readmission, reoperation, and complication rates were found to be 2.1, 8.3, and 20%, respectively. The lack of significant difference between approaches suggests that clinical decision-making should depend upon anatomical considerations and physician preference, although the complications illustrated here may provide some preoperative guidance.

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Cochlear Implantation in Chronic Otitis Media with and without Cholesteatoma: Surgical Considerations and Auditory Outcomes

ORL ◽

10.1159/000513890 ◽

2021 ◽

pp. 1-6

Author(s):

Nagihan Gülhan Yaşar ◽

Recep Karamert ◽

Hakan Tutar ◽

Mehmet Birol Uğur ◽

Burak Hazır ◽

...

Keyword(s):

Otitis Media ◽

Hearing Aids ◽

Surgical Techniques ◽

Chronic Otitis Media ◽

Pure Tone Audiometry ◽

Complication Rates ◽

Speech Discrimination ◽

Mastoid Obliteration ◽

Significant Difference ◽

The Impact

Introduction: Cochlear implant (CI) surgery is a safe and standardized procedure in the presence of normal temporal bone anatomy. However, in the surgery of patients with chronic otitis media (COM), the surgeon may encounter several problems. The aim of this study was to evaluate the impact of COM with and without cholesteatoma on surgical and auditory outcomes of CIs. Methods: The study group consisted of 39 patients with COM who received CIs. Age- and gender-matched 38 standard CI patients served as controls. The surgical techniques and complications, pure tone audiometry (PTA) scores, speech discrimination scores (SDS), and the International Outcome Inventory for Hearing Aids (IOI-HA) questionnaire results of the groups were compared. Results: The presence of COM was associated with a higher rate of complication than controls. Staging the surgeries, presence or absence of cholesteatoma, and type of surgical technique were not associated with surgical outcomes and complications (p > 0.05). There was no significant difference between the groups in terms of postoperative PTA scores, SDS, and IOI-HA scores (p > 0.05). Conclusion: Postoperative complications like device failure and skin breakdown are increased in cases of COM compared to standard CI surgeries. However, that increase is not associated with staging the surgeries, presence or absence of cholesteatoma, and type of ear surgery performed. It is advocated to close the external ear canal and eustachian tube without mastoid obliteration in the presence of a radical mastoidectomy cavity, which will decrease the postoperative complication rates and allow for radiological follow-up with computed tomography for the possibility of cholesteatoma recurrence. The auditory benefits of CI in patients with and without COM are comparable.

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Role of minimally invasive glaucoma surgery in the management of chronic open-angle glaucoma

Scientific Reports ◽

10.1038/s41598-021-00808-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ojasvi Sharma ◽

Didar Abdulla ◽

Anthony King ◽

Monali Chakrabarti ◽

Tarun Sharma

Keyword(s):

Success Rate ◽

Primary Open Angle Glaucoma ◽

Open Angle Glaucoma ◽

Case Series ◽

Glaucoma Surgery ◽

Complication Rates ◽

Open Angle ◽

Patient Demographics ◽

Significant Difference ◽

Advanced Glaucoma

AbstractTo compare the safety and efficacy of phacoemulsification combined with ab-interno trabeculectomy (Trabectome) and phacoemulsification combined with I-Stent inject in patients with medically uncontrolled primary open-angle glaucoma (POAG). A retrospective comparative case series. 70 eyes of 66 patients completed 2 years follow up after these treatments performed in 2017–2018. 35 eyes of 33 patients underwent combined Phaco-Trabectome (PT); and 35 eyes of 33 patients underwent combined Phaco-I-Stent inject (Pi). Patient demographics and preoperative characteristics are comparable. A 20% drop in IOP was achieved in 27 eyes (77.14%) in PT group and 28 eyes (80%) in Pi group (p = 0.77). Success rate (target IOP achieved and maintained for 2 years) in advance glaucoma was 25% in PT group and 30.7% in Pi group (p = 0.90). In mild to moderate glaucoma, success rate was 85.71% in PT group and 90% in Pi group (p = 0.67). There was no significant difference between two groups with regards to mean reduction in glaucoma medications and complication rates. Trabectome and I-Stent combined with phacoemulsification are equally efficacious and safe for treating patients with medically uncontrolled mild and moderate primary open-angle glaucoma (POAG). However, they are not an effective treatment for patients with advanced glaucoma.

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