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Effects of Del Nido and Terminal Warm Blood Cardioplegia on Myocardial Protection and Rhythm in Isolated CABG Patients.
Karaarslan, K, Abud, B
The heart surgery forum. 2021;(5):E808-E813
Abstract
OBJECTIVE To investigate the effect of using del Nido cardioplegia+terminal hot-shot blood cardioplegia on myocardial protection and rhythm in isolated coronary bypass patients. MATERIAL AND METHODS A total of 122 patients were given cold (+4-8C') del Nido cardioplegia antegrade and evaluated. Del Nido+terminal warm blood cardioplegia (TWBCP) was applied to 63 patients out of 122 patients, while del Nido cardioplegia alone was applied to the other 59 patients. The preoperative and postoperative data of the patients were recorded and compared. RESULTS There was a significant statistical difference between the groups, in terms of volume with more cardioplegia in the del Nido+terminal warm blood cardioplegia group. Although there was no significant difference between cardiac arrest times in both groups, a statistically significant difference was found in the del Nido+terminal warm blood cardioplegia group in the starting to work time of the heart. No difference found between the groups regarding myocardial preservation. CONCLUSIONS We can add a return to spontaneous sinus rhythm to the advantages of terminal warm blood cardioplegia and del Nido cardioplegia in literature. We think it would be a good strategy to extend the safe ischemic time limit of del Nido to 120 minutes with a terminal warm blood cardioplegia. It seems that cardioplegia techniques that will be developed by adding the successful and superior results of crystalloid cardioplegia applications, such as single dose del Nido in various open heart surgery operations and the superior myocardial return effects of terminal warm blood cardioplegia, will be used routinely in the future.
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Clinical factors associated with severe hypophosphataemia after kidney transplant.
Ralston, MR, Stevenson, KS, Mark, PB, Geddes, CC
BMC nephrology. 2021;(1):407
Abstract
BACKGROUND The mechanism by which hypophosphataemia develops following kidney transplantation remains debated, and limited research is available regarding risk factors. This study aimed to assess the association between recipient and donor variables, and the severity of post-transplantation hypophosphataemia. METHODS We performed a single-centre retrospective observational study. We assessed the association between demographic, clinical and biochemical variables and the development of hypophosphataemia. We used linear regression analysis to assess association between these variables and phosphate nadir. RESULTS 87.6% of patients developed hypophosphataemia. Patients developing hypophosphataemia were younger, had a shorter time on renal replacement therapy, were less likely to have had a parathyroidectomy or to experience delayed graft function, were more likely to have received a living donor transplant, from a younger donor. They had higher pre-transplantation calcium levels, and lower alkaline phosphatase levels. Receipt of a living donor transplant, lower donor age, not having had a parathyroidectomy, receiving a transplant during the era of tacrolimus-based immunosuppression, not having delayed graft function, higher pre-transplantation calcium, and higher pre-transplantation phosphate were associated with lower phosphate nadir by multiple linear regression. CONCLUSIONS This analysis demonstrates an association between variables relating to better graft function and hypophosphataemia. The links with biochemical measures of mineral-bone disease remain less clear.
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Squeaking Is Common and Increases Over Time Among Patients With Long-term Follow-up After Ceramic-on-ceramic THA.
Taniguchi, K, Quacinella, M, Barlow, B
Clinical orthopaedics and related research. 2021;(4):736-744
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BACKGROUND Ceramic-on-ceramic (CoC) is a durable bearing with excellent wear characteristics, but squeaking remains a concern. The proportion of patients who report squeaking varies widely between studies performed at short- and mid-term follow-up. QUESTIONS/PURPOSES (1) What proportion of patients treated with CoC THA bearings report squeaking at a minimum of 10 years of follow-up? (2) Are patient, implant, or radiographic factors associated with squeaking? (3) Are THAs that squeak more likely to be revised than those that do not? (4) Are patient-reported functional outcome scores lower between THAs that squeak and THAs that do not squeak at long-term follow-up? METHODS Between January 1, 2003 and August 31, 2008 a total of 80 patients received THAs with third-generation alumina-on-alumina bearings at one center. Of the original 80 patients, 1% (1 of 80) had died, and 21% (17 of 80) were lost to follow-up before 10 years, leaving 62 patients for analysis at a median (range) of 14 years (11 to 16). Ceramic-on-ceramic THA represented 23% (80 of 343) of all primary THAs performed during the study period. Ceramic-on-ceramic THA was used preferentially in patients younger than 50 years of age. The mean (range) age of patients in the cohort was 44 ± 11 years (18 to 65). Sixty-eight percent (42 of 62) were men. Two separate manufacturers' implants were included. There were uncemented acetabular and femoral components included in this study. All CoC bearings were third-generation alumina-on-alumina. Squeaking was determined through a mailed questionnaire or telephone interview. The 10-question survey developed by the researchers queried patients whether audible "squeaking" could be heard from their hip replacement. Patients were asked to write in their description of the noise to distinguish squeaking from other noises not relevant to the current study. Implant information, component position, and patient demographics were obtained via chart review and postoperative radiographs reviewed by one of the investigators not involved with the index operative procedure. Using revision for any reason as an endpoint, a Kaplan-Meier analysis was performed to compare survivorship between THAs that squeaked versus those that did not. Patient-reported outcomes were surveyed using the Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS JR), which comprises six items regarding patient pain and function, raw summed scores range from 0 (perfect hip health) to 24 (total hip disability). RESULTS Squeaking was self-reported by 53% (33 of 62) of patients in this group. Squeaking was more common in patients who received the titanium-molybdenum-zirconium-iron stem than in patients with the titanium-aluminum-vanadium stem (63% [29 of 46] versus 31% [4 of 13]; odds ratio 3.8 [95% CI 1.02 to 14.4]; p = 0.046). We found no differences in the likelihood a patient would report squeaking based on component position, component size, patient age, sex, or BMI. Ten-year survivorship free from revision was not lower in patients who reported squeaking (91% [95% CI 74 to 97] versus 90% [95% CI 71 to 96]; p = 0.69). Patient-reported outcome scores (HOOS JR) were not lower in those who reported squeaking (3 ± 3 [95% CI 1.5 to 4.0] versus 3 ± 5 [95% CI 1.5 to 5.5]; p = 0.59). CONCLUSION At long-term follow-up, we found that CoC bearing squeaking in patients who underwent THA is more common than previously reported. Survivorship was lower than expected in this cohort, and most revisions in this series were for squeaking. Although implant-dependent, surgeons should counsel patients about the potential for squeaking in CoC THA, which may occur years after index procedure. LEVEL OF EVIDENCE Level III, therapeutic study.
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Denosumab-Induced Hypocalcemia and Hyperparathyroidism in de novo Kidney Transplant Recipients.
Cianciolo, G, Tondolo, F, Barbuto, S, Iacovella, F, Zavatta, G, Altieri, P, Grandinetti, V, Comai, G, Cozzolino, M, La Manna, G
American journal of nephrology. 2021;(8):611-619
Abstract
INTRODUCTION Denosumab represents a realistic treatment option to increase bone mineral density in kidney transplant recipients (KTRs). It is still unknown how and at what extent posttransplantation bone disease and graft function influence the effects of denosumab on mineral metabolism indexes. In this study, we analyze risk factors of hypocalcemia and parathyroid hormone (PTH) increase after denosumab administration in eighteen de novo KTRs and its management before and after this treatment. METHODS We conducted a monocentric, observational, prospective study on de novo KTRs. All KTRs enrolled received a single 60 mg subcutaneous dose of denosumab every 6 months. Before kidney transplantation, no patients were treated with calcio-mimetic. After kidney transplantation and before antiresorptive therapy, no patients were treated with calcio-mimetic drugs and/or vitamin D receptor agonists, while all patients received nutritional vitamin D supplementation (from 1,000 IU to 1,500 IU daily). RESULTS Hypocalcemia was related to the degree of lumbar osteoporosis (p = 0.047); the increase in the PTH level was correlated to baseline bone turnover markers (bone alkaline phosphatase, serum osteocalcin, and β-C-terminal telopeptide), the 25 OH status, and eGFR. The introduction of calcitriol, after the PTH increase, in addition to cholecalciferol was necessary to ensure an adequate control of serum calcium and PTH during a follow-up of 15 months. Following the treatment with denosumab, it was observed an improvement of areal bone mineral density both at lumbar and femoral sites with a mean percentual increase of 1.74% and 0.25%, respectively. CONCLUSIONS Denosumab is an effective treatment for bone disease in KTRs. In our study, the increase in PTH is not a transient event but prolonged throughout the follow-up period and requires continuous supplementation therapy with calcitriol.
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Protective and therapeutic experience of perioperative safety in extremely elderly patients with biliary diseases.
Zhang, Z, Zhao, Y, Lin, F, Liu, L, Zhang, C, Liu, Z, Zhu, M, Wan, B, Deng, H, Yang, H, et al
Medicine. 2021;(21):e26159
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To explore the protective and therapeutic measures of improving perioperative safety in extremely elderly patients with biliary diseases, so as to improve the therapeutic efficacy of surgery. A retrospective case–control study of 412 elderly patients with biliary diseases was carried out from July 2013 to July 2019. Seventy eight cases were divided into the high age (HA) group (≥80 years) and 334 into the middle–low age (MLA) group (60–79 years). In the HA compared with MLA group, 1. Preoperative coexisting diseases: the occurrence of coexisting coronary heart disease (CHD), hypertension, chronic bronchitis with emphysema, hypoproteinemia, and anemia were significantly increased; 2. Laboratory examinations: function of liver, kidneys, heart, lungs, and blood coagulation significantly declined; 3. Surgical procedures: open cholecystectomy with transcystic common bile duct (CBD) exploration significantly higher, while laparoscopic cholecystectomy significantly lower; 4. Operative effects: intraoperative blood loss, operation time, postoperative hospital stay, and length of hospitalization significantly increased or prolonged; 5. Postoperative complications: postoperative respiratory failure, pulmonary infection, anemia and electrolyte disorder significantly increased; 6. Therapeutic outcomes: no significant difference in the therapeutic effects. Although the surgical risk was significantly increased, there was no significant difference in the therapeutic efficacy in the HA compared with MLA group, suggesting that surgical treatment in extremely elderly patients with biliary diseases is safe and feasible. The key is to actively treat preoperative coexisting diseases, strictly adhere to surgical indications, reasonably select surgical procedures, precisely perform the operation, closely monitor and control intraoperative emergencies, timely prevent and treat postoperative complications, so as to improve the perioperative safety of extremely elderly patients with biliary diseases.
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Perioperative Risk Factors Predisposing to Atrial Fibrillation After CABG Surgery.
Omar, A, Ehab M Elshihy, , Mahmoud Singer, , David Zarif, , Omar Dawoud,
The heart surgery forum. 2021;(2):E402-E406
Abstract
OBJECTIVES To detect perioperative risk factors for atrial fibrillation (AF) after coronary artery bypass graft (CABG) and to assess the impact of AF on outcome and postoperative complications. METHODS We undertook a prospective observational study of 1000 consecutive patients who underwent isolated CABG in Cairo University hospitals and other centers from March 2019 to November 2020. Patients were subsequently divided into 2 groups depending on the occurrence of postoperative AF. Preoperative, intraoperative, and postoperative risk factors were recorded for all patients, as well as postoperative mortality, complications, and hospital and intensive care unit (ICU) lengths of stay. RESULTS Postoperative atrial fibrillation (POAF) occurred in 78 patients (7.8%), with significant risk factors of age (P = .001), low ejection fraction (P = .001), absence of preoperative beta-blocker use (P = .001), and presence of right coronary artery lesion (P = .003). The intraoperative significant risk factor was the absence of total coronary revascularization (P = .001). Postoperative significant risk factors were electrolyte imbalance (P = .001) and postoperative inotropes (P = .02). Patients with postoperative AF had increased risk of mortality (P = .001) and longer ICU (P = .001) and hospital (P = .001) stays. CONCLUSION The risk of POAF can be decreased by modifying perioperative adjustable risk factors, namely routinely using preoperative beta-blockers (unless contraindicated), achieving total coronary revascularization, avoiding postoperative electrolyte imbalance, and avoiding unnecessary use of inotropic support.
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The effects of preoperative alcohol, tobacco, and psychological stress on postoperative complications: a prospective observational study.
Myoga, Y, Manabe, H, Osaki, Y
BMC anesthesiology. 2021;(1):245
Abstract
BACKGROUND Postoperative complications occur frequently, despite progress in anesthetic pharmacology and surgical techniques. Although habits, such as alcohol and tobacco use, and mental health have been studied individually as modifying factors, few studies have examined the relationship between multiple lifestyle choices and postoperative complications in patients undergoing surgery. Hence, this study aimed to investigate the associations between unhealthy lifestyle choices and postoperative complications. METHODS We included 730 patients who underwent surgery in our department between March 2015 and April 2016. Participants completed preoperative questionnaires, including the Alcohol Use Disorders Identification Test, Fagerström Test for Nicotine Dependence, and tests for psychological stress (6-item Kessler Psychological Distress Scale; Hospital Anxiety and Depression Scale). Multivariable logistic analysis was used to analyze the association of preoperative drug dependence and psychological stress with postoperative complications. RESULTS Of the 721 cases analyzed, 461 (64%) were women. The median age of patients was 62 years (interquartile range: 48-71). At the time of surgical decision-making, 429 out of 710 respondents (60%) had a drinking habit, and 144 out of 693 respondents (21%) had a smoking habit during the preceding year. Seventy-nine patients had developed complications. Multivariable analysis revealed that old age (p = 0.020), psychological stress (p = 0.041), and longer anesthesia time (p < 0.001) were significantly associated with postoperative complications. Drinking or smoking variables were not associated with postoperative complications. CONCLUSIONS Preoperative psychological stress, as evaluated with the 6-item Kessler Psychological Distress Scale, is associated with the risk of postoperative complications.
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The Association Between Modifiable Lifestyle Factors and Postoperative Complications of Elective Surgery in Patients With Colorectal Cancer.
Loogman, L, de Nes, LCF, Heil, TC, Kok, DEG, Winkels, RM, Kampman, E, de Wilt, JHW, van Duijnhoven, FJB, , , ,
Diseases of the colon and rectum. 2021;(11):1342-1353
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BACKGROUND Research has demonstrated a possible relation between patients' preoperative lifestyle and postoperative complications. OBJECTIVE This study aimed to assess associations between modifiable preoperative lifestyle factors and postoperative complications in patients undergoing elective surgery for colorectal cancer. DESIGN This is a retrospective study of a prospectively maintained database. SETTING At diagnosis, data on smoking habits, alcohol consumption, BMI, and physical activity were collected by using questionnaires. Postoperative data were gathered from the nationwide database of the Dutch ColoRectal Audit. PATIENTS Patients (n = 1564) with newly diagnosed stage I to IV colorectal cancer from 11 Dutch hospitals were included in a prospective observational cohort study (COLON) between 2010 and 2018. MAIN OUTCOME MEASURES Multivariable logistic regression models were used to identify which preoperative lifestyle factors were associated with postoperative complications. RESULTS Postoperative complications occurred in 28.5%, resulting in a substantially prolonged hospital stay (12 vs 5 days, p < 0.001). Independently associated with higher postoperative complication rates were ASA class II (OR, 1.46; 95% CI, 1.05-2.04; p = 0.03) and III to IV (OR, 3.17; 95% CI, 1.96-5.12; p < 0.001), current smoking (OR, 1.62; 95% CI, 1.02-2.56; p = 0.04), and rectal tumors (OR, 1.81; 95%CI, 1.28-2.55; p = 0.001). Body mass index, alcohol consumption, and physical activity did not show an association with postoperative complications. However, in a subgroup analysis of 200 patients with ASA III to IV, preoperative high physical activity was associated with fewer postoperative complications (OR, 0.17; 95% CI, 0.03-0.87; p = 0.04). LIMITATIONS Compared with most studied colorectal cancer populations, this study describes a relatively healthy study population with 87.2% of the included patients classified as ASA I to II. CONCLUSIONS Modifiable lifestyle factors such as current smoking and physical activity are associated with postoperative complications after colorectal cancer surgery. Current smoking is associated with an increased risk of postoperative complications in the overall study population, whereas preoperative high physical activity is only associated with a reduced risk of postoperative complications in patients with ASA III to IV. See Video Abstract at http://links.lww.com/DCR/B632. LA ASOCIACIN ENTRE FACTORES MODIFICABLES DEL ESTILO DE VIDA Y COMPLICACIONES POSOPERATORIAS EN CIRUGA ELECTIVA EN PACIENTES CON CNCER COLORECTAL ANTECEDENTESEstudios han demostrado una posible relación entre el estilo de vida preoperatorio de los pacientes y las complicaciones posoperatorias.OBJETIVOEvaluar las asociaciones entre los factores de estilo de vida preoperatorios modificables y las complicaciones posoperatorias en pacientes llevados a cirugía electiva por cáncer colorrectal.DISEÑO:Estudio retrospectivo de una base de datos continua de forma prospectiva.ESCENARIOEn el momento del diagnóstico se recopilaron mediante cuestionarios datos sobre tabaquismo, consumo de alcohol, el IMC y la actividad física. Los datos posoperatorios se obtuvieron de la base de datos nacional de la Auditoría Colorectal Holandesa.PACIENTESSe incluyeron pacientes (n = 1564) de once hospitales holandeses con cáncer colorrectal en estadio I-IV recién diagnosticado incluidos en un estudio de cohorte observacional prospectivo (COLON) entre 2010 y 2018.PRINCIPALES VARIABLES ANALIZADASSe utilizaron modelos de regresión logística multivariable para identificar qué factores de estilo de vida preoperatorios y se asociaron con complicaciones posoperatorias.RESULTADOSLas complicaciones posoperatorias se presentaron en el 28,5%, lo que resultó en una estancia hospitalaria considerablemente mayor (12 contra 5 días, p <0,001). De manera independiente se asociaron con mayores tasas de complicaciones posoperatorias la clasificación ASA II (OR 1,46; 95% IC 1,05-2,04, p = 0,03) y III-IV (OR 3,17; 95% IC 1,96-5,12, p <0,001), tabaquismo presente (OR 1,62; IC 95% 1,02-2,56, p = 0,04) y tumores rectales (OR 1,81; IC 95% 1,28-2,55, p = 0,001). El IMC, el consumo de alcohol y la actividad física no mostraron asociación con complicaciones posoperatorias. Sin embargo, en un análisis de subgrupos de 200 pacientes ASA III-IV, la actividad física íntensa preoperatoria se asoció con menos complicaciones posoperatorias (OR 0,17; IC del 95%: 0,03-0,87, p = 0,04).LIMITACIONESEn comparación con las poblaciones de cáncer colorrectal más estudiadas, este estudio incluyó una población relativamente sana con el 87,2% de los pacientes incluidos clasificados como ASA I-II.CONCLUSIONESLos factores modificables del estilo de vida, como son el encontrarse fumando y la actividad física, se asocian con complicaciones posoperatorias después de la cirugía de cáncer colorrectal. El encontrarse fumando se asocia con un mayor riesgo de complicaciones posoperatorias en la población general del estudio, mientras que la actividad física íntensa preoperatoria se asocia con un menor riesgo de complicaciones posoperatorias únicamente en pacientes ASA III-IV. Consulte Video Resumen en http://links.lww.com/DCR/B632.
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Prospective multicentre study of a new bowel obstruction treatment in colorectal surgery: Reduced morbidity and mortality.
Fahim, M, Dijksman, LM, Derksen, WJM, Bloemen, JG, Biesma, DH, Smits, AB
European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2021;(9):2414-2420
Abstract
INTRODUCTION Bowel obstruction patients are at increased risk of emergency surgery and have poor nutritional and physical conditions. These patients could benefit from prehabilitation and prevention of emergency surgery. This study assessed the effect of a multimodal obstruction treatment for bowel obstruction patients in colorectal surgery on the risk of emergency surgery and postoperative morbidity and mortality. MATERIALS AND METHODS This multicenter observational cohort study included all consecutive bowel obstruction patients who received obstruction treatment (obstruction protocol) in the period 2019-2020 in two Dutch hospitals. Benign and malignant causes of bowel obstruction were included. Treatment consisted of 1. dietary adjustments, 2. postponing surgery for three weeks, 3. laxatives, and 4. prehabilitation. We compared emergency surgery and postoperative morbidity and mortality rates to known rates from the literature. RESULTS Eighty-nine patients were included: obstruction treatment was successful in 77 patients (87%) who underwent elective surgery and unsuccessful in 12 patients (13%) who underwent emergency surgery. Sixty-six (74%) had colorectal cancer, and 22 (25%) had benign disease. Thirty-day mortality of 0% in our study was significantly lower than the national average of 4% in colorectal cancer patients in the Netherlands (p = 0.049). Anastomotic leakage rate was 3%, severe complications (Clavien-Dindo ≥ III) 8%, and bowel perforation 0%. These rates did not differ significantly from rates reported in literature. CONCLUSION The obstruction treatment prevented emergency surgery in most patients with bowel obstruction and reduced postoperative morbidity and mortality. The obstruction treatment seems to be a safe and efficient alternative to emergency surgery.
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A comparison of postoperative outcomes after open and laparoscopic reduction of Petersen's Hernia: a multicenter observational cohort study.
Min, JS, Seo, KW, Jeong, SH, Kim, KH, Park, JH, Yoon, KY, Kim, TH, Jung, EJ, Ju, YT, Jeong, CY, et al
BMC surgery. 2021;(1):195
Abstract
BACKGROUND The aim of this multicenter cohort study was to compare the clinical courses between open and laparoscopic Petersen's hernia (PH) reduction. METHOD We retrospectively collected the clinical data of patients who underwent PH repair surgery after gastrectomy for gastric cancer from 2015-2018. Forty patients underwent PH reduction operations that were performed by six surgeons at four hospitals. Among the 40 patients, 15 underwent laparoscopic PH reduction (LPH), and 25 underwent open PH reduction (OPH), including 4 patients who underwent LPH but required conversion to OPH. RESULTS We compared the clinical factors between the LPH and OPH groups. In the clinical course, we found no differences in operation times or intraoperative bowel injury, morbidity, or mortality rates between the two groups (p > 0.05). However, the number of days on a soft fluid diet (OPH vs. LPH; 5.8 vs. 3.7 days, p = 0.03) and length of hospital stay (12.6 vs. 8.2 days, p = 0.04) were significantly less in the LPH group than the OPH group. Regarding postoperative complications, the OPH group had a case of pneumonia and sepsis with multi-organ failure, which resulted in mortality. In the LPH group, one patient experienced recurrence and required reoperation for PH. CONCLUSION Laparoscopic PH reduction was associated with a faster postoperative recovery period than open PH reduction, with a similar incidence of complications. The laparoscopic approach should be considered an appropriate strategy for PH reduction in selected cases.