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1.
Johannes Leitgeb Walter Mauritz Alexandra Brazinova Marek Majdan Ingrid Wilbacher 《Archives of orthopaedic and trauma surgery》2013,133(2):199-207
Objective
The aim of this study was to identify factors contributing to outcomes after severe traumatic brain injury (TBI) associated with epidural hematoma (EDH).Methods
Between 02/2002 and 4/2010 17 Austrian centers prospectively enrolled 863 patients with moderate and severe TBI into observational studies. Data on accident, treatment, and outcomes were collected. Data sets from patients who had severe TBI (=Glasgow Coma Scale score <9) and EDH were selected. Six-month outcomes were classified as “favorable” if Glasgow Outcome Scale (GOS) scores were 5 or 4, and were classified as “unfavorable” if GOS scores were 3 or less. The Rotterdam score was used to classify computed tomography (CT) findings; the scores published by Hukkelhoven et al. (J Neurotrauma 22:1025–1039, 2005) were used to estimate predicted rates of death and of unfavorable outcomes. Univariate (Fisher’s exact test, t test, Chi2-test) and multivariate (logistic regression) statistics were used to identify factors associated with hospital mortality and favorable outcome.Results
Of the 738 patients with severe TBI 159 (21.5 %) had EDH. Of these, 49 (30.8 %) died in the hospital, 21 (13.2 %) survived with unfavorable outcome, 82 (51.6 %) with favorable outcome; long-term outcome was unknown in 7 survivors (4.4 %). Mortality rates predicted by the Rotterdam score showed good correlation with observed mortality rates. According to the Hukkelhoven scores, observed/predicted ratios for mortality and unfavorable outcome were 0.94 and 0.97, respectively. Age, severity of TBI, and neurological status were the main factors influencing outcomes after severe TBI associated with EDH. We were unable to demonstrate significant effects of treatment factors. 相似文献2.
C. Dübendorfer A. T. Billeter B. Seifert M. Keel M. Turina 《European journal of trauma and emergency surgery》2013,39(1):25-34
Objective
Arterial lactate, base excess (BE), lactate clearance, and Sequential Organ Failure Assessment (SOFA) score have been shown to correlate with outcome in severely injured patients. The goal of the present study was to separately assess their predictive value in patients suffering from traumatic brain injury (TBI) as opposed to patients suffering from injuries not related to the brain.Materials and methods
A total of 724 adult trauma patients with an Injury Severity Score (ISS) ≥ 16 were grouped into patients without TBI (non-TBI), patients with isolated TBI (isolated TBI), and patients with a combination of TBI and non-TBI injuries (combined injuries). The predictive value of the above parameters was then analyzed using both uni- and multivariate analyses.Results
The mean age of the patients was 39 years (77 % males), with a mean ISS of 32 (range 16–75). Mortality ranged from 14 % (non-TBI) to 24 % (combined injuries). Admission and serial lactate/BE values were higher in non-survivors of all groups (all p < 0.01), but not in patients with isolated TBI. Admission SOFA scores were highest in non-survivors of all groups (p = 0.023); subsequently septic patients also showed elevated SOFA scores (p < 0.01), except those with isolated TBI. In this group, SOFA score was the only parameter which showed significant differences between survivors and non-survivors. Receiver operating characteristic (ROC) analysis revealed lactate to be the best overall predictor for increased mortality and further septic complications, irrespective of the leading injury.Conclusion
Lactate showed the best performance in predicting sepsis or death in all trauma patients except those with isolated TBI, and the differences were greatest in patients with substantial bleeding. Following isolated TBI, SOFA score was the only parameter which could differentiate survivors from non-survivors on admission, although the SOFA score, too, was not an independent predictor of death following multivariate analysis. 相似文献3.
4.
Ágnes Haris Kálmán Polner József Arányi Henrik Braunitzer Ilona Kaszás István Mucsi 《International urology and nephrology》2014,46(8):1595-1600
Background
Older age is independently associated with mortality in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV). We hypothesized that a reduced-dose immunosuppressive treatment would result in similar effectiveness and comparable treatment-related morbidity in elderly patients as the regular dose in younger patients. We also postulated that the higher baseline comorbidities may contribute to the higher mortality of the elderly subjects.Methods
Ninety-three consecutive patients with AAV between 1998 and 2012 were retrospectively analyzed. Forty-one individuals were defined as “elderly” (age >65 years) and 52 as “younger” (age <65 years). All cause and cardiovascular mortality, death due to vasculitis and infections, and effectiveness of “reduced-dose” immunosuppressive treatment in the elderly group were compared to the effects of “full-dose” treatment in younger individuals.Results
Mortality in the elderly group was higher (p = 0.007). Cardiovascular death was significantly increased (p = 0.002) in the elderly, but mortality due to vasculitis or infections was comparable. Treatment effectiveness was also similar in elderly and younger patients. At the end of the first follow-up year, 37 % of the elderly and 27 % of the younger patients died (p = 0.22). In univariate Cox regression analyses, being older than 65 year, having cardiovascular disease at baseline, need for dialysis at diagnosis, and lower serum albumin were associated with an increased hazard of mortality.Conclusions
Delivering reduced dose of immunosuppression for elderly patients was associated with satisfactory outcome and favorable treatment-related complication profile. The higher mortality in the elderly could be attributed mainly to baseline cardiovascular morbidity. 相似文献5.
Sung Hoon Kim Dae Ryong Kang Jae Gil Lee Do Young Kim Sang Hoon Ahn Kwang-Hyub Han Chae Yoon Chon Kyung Sik Kim 《World journal of surgery》2013,37(5):1028-1033
Background
Although mortality after liver resection has declined, posthepatectomy liver failure (PHLF) remains a major cause of operative mortality. To date there is not consensus on a definition for PHLF. However, there have been many efforts to define PHLF causing operative mortality. In the present study we sought to identify early predictors of death from irreversible PHLF.Materials and methods
We retrospectively analyzed the medical records of 359 patients with hepatocellular carcinoma who underwent liver resection between March 2000 and December 2010. Various biochemical parameters from postoperative days (POD) 1, 3, 5, and 7 were analyzed and compared with the “50–50” criterion.Results
Operative mortality was 4.7 %. Prothrombin time (PT) <65 % and bilirubin ≥38 μmol/L on POD 5 showed the only significant difference as compared with “50–50” criterion. The new combination of bilirubin level and the international normalized ratio showed higher sensitivity, area under the curve, as well as similar accuracy (sensitivity 78.6 vs. 28.6 %; p = 0.002; area under the curve 0.8402 vs. 0.6396; p = 0.00176; accuracy 88.6 vs. 93.4 %; p = 0.090). Multivariate analysis revealed the combination of PT <65 % and bilirubin ≥38 μmol/L on POD 5 to be the only independent predictive factor of mortality (odds ratio, 82.29; 95 % confidence interval 8.69–779.64; p < 0.001).Conclusions
In patients with chronic liver disease who will undergo liver resection the combination of PT <65 % and bilirubin ≥38 μmol/L on POD 5 may be a more sensitive predictor than the “50–50” criterion of mortality from PHLF. Although it needs to validated by prospective study, this measure may be applied to select patients receiving artificial liver supports or liver transplantation. 相似文献6.
Ji Min Choi Changhyun Lee Yoo Min Han Minjong Lee Young Hoon Choi Dong Kee Jang Jong Pil Im Sang Gyun Kim Joo Sung Kim Hyun Chae Jung 《Surgical endoscopy》2014,28(9):2649-2655
Background
Self-expandable metallic stents (SEMS) are now regarded as an effective and safe intervention for malignant colorectal obstruction (MCO). However, manipulation of the tumor might lead to the spillage of tumor cells and result in distant metastases. We aimed to compare the long-term oncologic outcomes of SEMS as a bridge to surgery with those of emergency surgery for MCO.Methods
Between June 2005 and December 2011, 60 patients who underwent elective curative resection after endoscopic SEMS insertion were included in the “SEMS group”. The SEMS group was matched to 180 patients who underwent emergency curative surgery for MCO during the same period [“Emergency surgery (ES) group”]. The clinicopathologic characteristics, recurrence-free survival (RFS), and overall survival (OS) were compared between the two groups.Results
There were no significant differences in demographics, tumor stage, location, and histology between the SEMS group and the ES group. The median follow-up times were 41.4 months (IQR, 22.2–60.0 months) for the SEMS group and 45.0 months (IQR, 20.9–68.1 months) for the ES group. The proportions of patients who received postoperative adjuvant chemotherapy were comparable (SEMS group vs. ES group, 68.3 % vs. 77.8 %; P = 0.210). The long-term prognosis did not significantly differ between two groups in either the 5-year RFS rate (79.6 % vs. 70.2 %; P = 0.218) or the 5-year OS rate (97.8 % vs. 94.3 %; P = 0.469).Conclusions
Long-term oncologic outcomes of SEMS insertion as a bridge to surgery were comparable to those of primary curative surgery. 相似文献7.
Background
Earthquakes are the leading cause of natural disaster-related mortality and morbidity. Soft tissue and musculoskeletal injuries are the predominant type of injury seen after these events and a major reason for admission to hospital. Open fractures are relatively common; however, they are resource-intense to manage. Appropriate management is important in minimising amputation rates and preserving function. This review describes the pattern of musculoskeletal and soft-tissue injuries seen after earthquakes and explores the manpower and resource implications involved in their management.Methods
A Medline search was performed, including terms “injury pattern” and “earthquake,” “epidemiology injuries” and “earthquakes,” “plastic surgery,” “reconstructive surgery,” “limb salvage” and “earthquake.” Papers published between December 1992 and December 2012 were included, with no initial language restriction.Results
Limb injuries are the commonest injuries seen accounting for 60 % of all injuries, with fractures in more than 50 % of those admitted to hospital, with between 8 and 13 % of these fractures open. After the first few days and once the immediate lifesaving phase is over, the management of these musculoskeletal and soft-tissue injuries are the commonest procedures required.Conclusions
Due to the predominance of soft-tissue and musculoskeletal injuries, plastic surgeons as specialists in soft-tissue reconstruction should be mobilised in the early stages of a disaster response as part of a multidisciplinary team with a focus on limb salvage. 相似文献8.
Pietro Addeo Elie Oussoultzoglou Pascal Fuchshuber Edoardo Rosso Cinzia Nobili Regis Souche Daniel Jaeck Philippe Bachellier 《World journal of surgery》2013,37(3):573-581
Background
Repeat repair of bile duct injuries (BDIs) after cholecystectomy is technically challenging, and its success remains uncertain. We retrospectively evaluated the short- and long-term outcomes of patients requiring reoperative surgery for BDI at a major referral center for hepatobiliary surgery.Methods
Between January 1991 and May 2011, we performed surgical BDI repairs in 46 patients. Among them, 22 patients had undergone a previous surgical repair elsewhere (group 1), and 24 patients had no previous repair (group 2). We compared the early and late outcomes in the two groups.Results
The patients in group 1 were younger (48.6 vs. 54.8 years, p = 0.0001) and were referred after a longer interval (>1 month) from BDI (72.7 vs. 41.7 %, p = 0.042). Intraoperative diagnosis of BDI (59.1 vs. 12.5 %, p = 0.001), ongoing cholangitis (45.4 vs. 12.5 %; p = 0.02), and delay of repair after referral to our institution (116 ± 34 days vs. 23 ± 9 days; p = 0.001) were significantly more frequent in group 1 than in group 2. No significant differences were found for postoperative mortality, morbidity, or length of stay between the groups. Patients with associated vascular injuries had a higher postoperative morbidity rate (p = 0.01) and associated hepatectomy rate (p = 0.045). After a mean follow-up of 96.6 ± 9.7 months (range 5–237.2 months, median 96 months), the rate of recurrent cholangitis (6.5 %) was comparable in the two groups.Conclusions
This study demonstrates that short- and long-term outcomes after surgical repair of BDI are comparable regardless of whether the patient requires reoperative surgery for a failed primary repair. Associated vascular injuries increase postoperative morbidity and the need for liver resection. 相似文献9.
Francesco Feroci Maddalena Baraghini Elisa Lenzi Alessia Garzi Andrea Vannucchi Stefano Cantafio Marco Scatizzi 《Surgical endoscopy》2013,27(4):1130-1137
Background
Patients with significant comorbidities often are denied laparoscopic colorectal resections, because they are thought to be too “high-risk.” This study was designed to examine the feasibility and safety of laparoscopic colorectal resections in high-risk colorectal cancer patients and to compare them with a similar cohort of patients undergoing open resections in the same time period.Methods
This was a single-center, prospective, cohort study conducted at a high-volume, nonuniversity, tertiary care hospital. From a database of 616 patients submitted to elective colorectal surgery for cancer within a fast-track protocol (January 2005 to November 2011), 188 patients who met at least one minor (age >80 years and body mass index (BMI) >30 m/kg2) and one major (cardiac, pulmonary, renal or liver disease, diabetes mellitus) criterion were classified as high-risk. Differences in baseline characteristics, intraoperative outcomes, and short-term (30-day) postoperative outcomes, as well as the pathology findings and the readmission and reoperation rates, were compared between the open and laparoscopic cohorts in both high- and low-risk groups and between high- and low-risk groups.Results
During the study period, 68 high-risk patients underwent laparoscopic resections and 120 had open surgeries. A shorter length of postoperative stay (6 vs. 9 days, p < 0.0001) and fewer postoperative nonsurgical complications (4 % vs. 19 %, p = 0.003) were observed among the laparoscopic group. Postoperative major (p = 0.774) and minor complications (p = 0.3) and reoperations (p = 0.196) were similar between the two groups, and a significantly lower rate of mortality (1.5 vs. 7.5 %, p = 0.038) was observed in the laparoscopic group than in the open group.Conclusions
Laparoscopic colorectal resection can be safely performed on “high-risk” surgical patients with better results than a similar group of high-risk patients undergoing open colon resections. 相似文献10.
J. Leitgeb W. Mauritz A. Brazinova M. Majdan I. Janciak I. Wilbacher M. Rusnak 《European journal of trauma and emergency surgery》2013,39(3):285-292
Objective
To analyse the association between the Glasgow Coma Scale (GCS) score at intensive care unit (ICU) discharge and the 1-year outcome of patients with severe traumatic brain injury (TBI).Design
Retrospective analysis of prospectively collected observational data.Patients
Between 01/2001 and 12/2005, 13 European centres enrolled 1,172 patients with severe TBI. Data on accident, treatment and outcomes were collected. According to the GCS score at ICU discharge, survivors were classified into four groups: GCS scores 3–6, 7–9, 10–12 and 13–15. Using the Glasgow Outcome Scale (GOS), 1-year outcomes were classified as “favourable” (scores 5, 4) or “unfavourable” (scores <4). Factors that may have contributed to outcomes were compared between groups and for favourable versus unfavourable outcomes within each group.Main results
Of the 538 patients analysed, 308 (57 %) had GCS scores 13–15, 101 (19 %) had scores 10–12, 46 (9 %) had scores 7–9 and 83 (15 %) had scores 3–6 at ICU discharge. Factors significantly associated with these GCS scores included age, severity of trauma, neurological status (GCS, pupils) at admission and patency of the basal cisterns on the first computed tomography (CT) scan. Favourable outcome was achieved in 74 % of all patients; the rates were significantly different between GCS groups (93, 83, 37 and 10 %, respectively). Within each of the GCS groups, significant differences regarding age and trauma severity were found between patients with favourable versus unfavourable outcomes; neurological status at admission and CT findings were not relevant.Conclusion
The GCS score at ICU discharge is a good predictor of 1-year outcome. Patients with a GCS score <10 at ICU discharge have a poor chance of favourable outcome. 相似文献11.
Francesco Di Fabio Morsal Samim Paolo Di Gioia Rosemary Godeseth Neil W. Pearce Mohammed Abu Hilal 《World journal of surgery》2014,38(12):3169-3174
Background
According to the Louisville Statement, laparoscopic major hepatectomy is a heterogeneous category that includes “traditional” trisectionectomies/hemi-hepatectomies and the technically challenging resection of segments 4a, 7, and 8. The aims of this study were to assess differences in clinical outcomes between laparoscopic “traditional” major hepatectomy and resection of “difficult-to-access” posterosuperior segments and to define whether the current classification is clinically valid or needs revision.Methods
We reviewed a prospectively collected single-center database of 390 patients undergoing pure laparoscopic liver resection. A total of 156 patients who had undergone laparoscopic major hepatectomy according to the Louisville Statement were divided into two subcategories: laparoscopic “traditional” major hepatectomy (LTMH), including hemi-hepatectomies and trisegmentectomies, and laparoscopic “posterosuperior” major hepatectomy (LPMH), including resection of posterosuperior segments 4a, 7, and 8. LTMH and LPMH subgroups were compared with respect to demographics, intraoperative variables, and postoperative outcomes.Results
LTMH was performed in 127 patients (81 %) and LPMH in 29 (19 %). Operation time was a median 330 min for LTMH and 210 min for LPMH (p < 0.0001). Blood loss was a median 500 ml for LTMH and 300 ml for LPMH (p = 0.005). Conversion rate was 9 % for LTMH and nil for LPMH (p = 0.219). In all, 28 patients (22 %) developed postoperative complications after LTMH and 5 (17 %) after LPMH (p = 0.801). Mortality rate was 1.6 % after LTMH and nil after LPMH. Hospital stay was a median 5 days after LTMH and 4 days after LPMH (p = 0.026).Conclusions
The creation of two subcategories of laparoscopic major hepatectomy seems appropriate to reflect differences in intraoperative and postoperative outcomes between LTMH and LPMH. 相似文献12.
John P. Burke PhD MRCSI J. Calvin Coffey PhD FRCSI Emily Boyle MD MRCSI Frank Keane MCh FRCSI Deborah A. McNamara MD FRCSI 《Annals of surgical oncology》2013,20(11):3414-3421
Background
Following a national audit of rectal cancer management in 2007, a national centralization program in the Republic of Ireland was initiated. In 2010, a prospective evaluation of rectal cancer treatment and early outcomes was conducted.Methods
A total of 29 colorectal surgeons in 14 centers prospectively collated data on all patients with rectal cancer who underwent curative surgery in 2010.Results
Data were available on 447 patients who underwent proctectomy with curative intent for rectal cancer in 2010; 23.7 % of patients underwent abdominoperineal excision. The median number of lymph nodes identified was 12. The 30-day mortality rate was 1.1 %. Compared with 2007, there was a reduction in positive circumferential margin rate (15.8 vs 4.5 %, P < 0.001), clinical anastomotic leak rate (10.8 vs 4.3 %, P = 0.002), and postoperative radiotherapy use (17.8 vs 4.0 %, P < 0.001). Also, 53.9 % received preoperative radiotherapy in 2010. Four centers gave statistically more patients (high-administration), and four centers gave fewer patients (low-administration) preoperative radiotherapy for T2/T3 tumors (P < 0.05). On multivariate analysis, being treated in a “high-administration center” increased the likelihood (likelihood ratio [LR], 2.9; 95 % CI 1.7–4.8; P < 0.001) while attending a “low-administration center” (LR, 0.3; 95 % CI 0.2–0.5; P < 0.001) reduced the likelihood of receiving preoperative radiotherapy for a T2/T3 rectal cancer.Conclusions
Patients undergoing rectal cancer surgery in hospitals following a national centralization initiative received high-quality surgery. Significant heterogeneity exists in radiotherapy administration, and evidence-based guidelines should be developed and implemented. 相似文献13.
S. Y. Chabok H. Yazdanshenas A. F. Naeeni A. Ziabakhsh S. S. Bidar A. Reihanian S. Bazargan-Hejazi 《European journal of trauma and emergency surgery》2014,40(1):51-55
Purpose
Obesity is a risk factor in treatment outcomes of critically ill patients. This study was conducted to determine the impact of obesity on the likelihood of recovery from traumatic brain injury (TBI) in intensive care unit (ICU) patients.Methods
We carried out a prospective study on 115 head injury patients who were admitted to the ICU of Poursina Hospital, Rasht, in the one-year period between July 2006 and June 2007. Obese patients (body mass index [BMI] ≥ 30 kg/m2) were compared with non-obese patients (BMI < 30 kg/m2). Demographic information, acute physiology and chronic health evaluation scores, Injury Severity Scores (ISS), Glasgow Coma Scale scores, and ICU mortality incidences were recorded.Results
Obese patients had significantly higher ICU mortality rates compared to non-obese patients (p = 0.02). Furthermore, we observed a trend towards a higher ICU mortality rate in obese patients with ISS > 25 (p = 0.04). Moreover, obesity was associated with prolonged mechanical ventilation, ICU length of stay (ILOS), and hospital length of stay (HLOS) (p < 0.001).Conclusions
Obesity was associated with increased ICU mortality and prolonged dependency on mechanical ventilation, ILOS, and HLOS in patients with TBI. However, further prospective studies with larger sample sizes are needed to substantiate these findings. 相似文献14.
Satoru Domoto Osamu Tagusari Yoshitsugu Nakamura Hideaki Takai Yoshimasa Seike Yujiro Ito Yuko Shibuya Fumiaki Shikata 《General thoracic and cardiovascular surgery》2014,62(2):95-102
Purposes
The aim of this retrospective study was to investigate the effect of chronic kidney disease (CKD) on outcomes after coronary artery bypass grafting (CABG), and to determine whether preoperative estimated glomerular filtration rate (eGFR) can be a predictor of long-term outcomes after CABG.Methods
486 Japanese patients who underwent isolated CABG between December 2000 and August 2010 were evaluated. Preoperative eGFR was estimated by the Japanese equation according to guidelines from the Japanese Society of Nephrology. We defined CKD as a preoperative eGFR of less than 60 ml/min/1.73 m2. 203 patients had CKD (CK group) and 283 patients did not (N group).Results
During a mean observation time of 53 months, the overall survival rate was significantly lower in the CK group than in the N group (p = 0.0044). Similarly, the CK group had significantly more unfavorable results with regard to freedom from cardiac death, major adverse cardiovascular and cerebrovascular events (MACCE), and hemodialysis. Using multivariate analyses, preoperative eGFR was an independent predictor of all-cause mortality (HR 0.983; p = 0.026), cardiac mortality (HR 0.963; p = 0.006), and incidence of MACCE (HR 0.983; p = 0.002).Conclusions
The CK group had significantly more unfavorable outcomes than the N group. Preoperative eGFR was an independent predictor of long-term outcomes after CABG in Japanese patients. 相似文献15.
James Edward Carroll Jillian K. Smith Jessica P. Simons Melissa M. Murphy Sing Chau Ng Shimul A. Shah Zheng Zhou Jennifer F. Tseng 《Journal of gastrointestinal surgery》2010,14(11):1701-1708
Introduction
Distinct outcome measures such as in-hospital and 30-day mortality have been used to evaluate pancreatectomy results. We posited that these measures could be compared using national data, providing more precision for evaluating published outcomes after pancreatectomy.Methods
Patients undergoing resection for pancreatic cancer were identified from the linked SEER-Medicare databases (1991–2002). Mortality was analyzed and trend tests were utilized to evaluate risk of death within ≤60 days of resection and from 60 days to 2 years post-resection. Univariate analysis assessed patient characteristics such as race, gender, marital status, socioeconomic status, hospital teaching status, and complications.Results
One thousand eight hundred forty-seven resected patients were identified: 7.7% (n?=?142) died within the first 30 days, 83.6% of whom died during the same hospitalization. Postoperative in-hospital mortality was 8.1% (n?=?150), 79% of which was within 30 days, greater than 90% of which was within 60 days. Risk of death decreased significantly over the first 60 days (P?<?0.0001). After 60 days, the risk did not decrease through 2 years (P?=?0.8533). Univariate analysis showed no difference between the two groups in terms of race, gender, marital status, and socioeconomic status, but patients dying within 60 days were more likely to have experienced a complication (41.1% vs. 17.0%, P?<?0.0001).Conclusions
In-hospital and 30-day mortality after resection for cancer are similar nationally; thus, comparing mortality utilizing these measures is acceptable. After a 60-day post-resection window of increased mortality, mortality risk then continues at a constant rate over 2 years, suggesting that mortality after pancreatectomy is not limited to early (“complication”) and late (“cancer”) phases. Determining ways to decrease perioperative mortality in the 60-day interval will be critical to improving overall survival. 相似文献16.
Gwendolyn M. van der Wilden D. Dante Yeh John O. Hwabejire Eric N. Klein Peter J. Fagenholz David R. King Marc A. de Moya Yuchiao Chang George C. Velmahos 《World journal of surgery》2014,38(2):335-340
Background
Pancreaticoduodenectomy for trauma (PDT) is a rare procedure, reserved for severe pancreaticoduodenal injuries. Using the National Trauma Data Bank (NTDB), our aim was to compare outcomes of PDT patients to similarly injured patients who did not undergo a PDT.Methods
Patients with pancreatic or duodenal injuries treated with PDT (ICD-9-CM 52.7) were identified in the NTDB 2008–2010 Research Data Sets. We excluded those who underwent delayed PDT (>4 days). The PDT group (n = 39) was compared to patients with severe combined pancreaticoduodenal injuries (grade 4 or 5) who did not undergo PDT (non-PDT group, n = 38). Patients who died in the emergency department or did not undergo a laparotomy were excluded. Our primary outcome was death. Secondary outcomes were intensive care unit length of stay (LOS), hospital LOS, and total ventilator days. A multivariate model was used to determine predictors of in-hospital mortality within each group and in the overall cohort.Results
The non-PDT group had a significantly lower systolic blood pressure and Glasgow Coma Scale values at baseline and more severe duodenal, pancreatic, and liver injuries. There were no significant differences in outcomes between the two groups. The Injury Severity Score was the only independent predictor of mortality among PDT patients [odds ratio (OR) 1.12, 95 % confidence interval (CI) 1.01–1.24] and in the entire cohort (OR 1.06, 95 % CI 1.01–1.12). The operative technique did not influence any of the outcomes.Conclusions
Compared to non-PDT, PDT did not result in improved outcomes despite a lower physiologic burden among PDT patients. More conservative procedures for high-grade injuries of the pancreaticoduodenal complex may be appropriate. 相似文献17.
Sean M. Ronnekleiv-Kelly David Y. Greenblatt Chee Paul Lin Kaitlyn J. Kelly Clifford S. Cho Emily R. Winslow Sharon M. Weber 《Journal of gastrointestinal surgery》2014,18(3):512-522
Background
In patients undergoing pancreatic resection (PR), identification of subgroups at increased risk for postoperative complications can allow focused interventions that may improve outcomes.Study Design
Patients undergoing PR from 2005–2010 were selected from the American College of Surgeons National Surgical Quality Improvement Program database and categorized as having any history of cardiac disease (angina, congestive heart failure (CHF), myocardial infarction (MI), cardiac stent, or bypass) or as having acute cardiac disease (symptoms of CHF or angina within 30 days or MI within 6 months). These variables were utilized to examine the relationship between cardiac disease and outcomes after PR.Results
The rate of serious complications and perioperative mortality in patients with any history of cardiac disease vs. those without was 34 vs. 24 % (p?<?0.001) and 4.5 vs. 2.0 % (p?<?0.001), respectively, and in patients with acute cardiac disease compared to patients without was 37 vs. 25 % (p?<?0.001) and 8.6 vs. 2.2 % (p?<?0.001), respectively. In multivariate analysis, the two cardiac disease variables remained associated with mortality.Conclusions
In patients undergoing PR, cardiac disease is a significant risk factor for adverse outcomes. These observations are critical for meaningful informed consent in patients considering pancreatectomy. 相似文献18.
M. Chand M. R. S. Siddiqui S. Rasheed G. Brown P. Tekkis A. Parvaiz T. Qureshi 《Surgical endoscopy》2014,28(12):3263-3272
Objectives
A meta-analysis of published literature comparing outcomes after laparoscopic resection (LR) with open resection (OR) for transverse colon tumours.Methods
Medline, PubMed, CINAHL, EMBASE and Cochrane were searched from inception to October 2013. The text words “minimally invasive”, “keyhole surgery” and “transverse colon” were used in combination with the medical subject headings “laparoscopy” and “colon cancer”. Outcome variables were chosen based upon whether the included articles reported results. A meta-analysis was performed to obtain a summative outcome.Results
Six comparatives involving 444 patients were analysed. Of them 245 patients were in the LR group and 199 in the OR group. There was a significant increase in operative time in the LR group compared with the OR group [random effects model: SMD = ?0.65, 95 % CI (?1.01, ?0.30), z = ?3.60, p < 0.001] but there was significant heterogeneity amongst trials (Q = 15.51, df = 5, p = 0.008, I 2 = 68). There was less blood loss in the LR group [fixed effects model: SMD = 0.70, 95 % CI (0.47, 0.93), z = 6.01, p < 0.001] and patients returned to oral diet earlier [random effects model: SMD = 0.78, 95 % CI (0.40, 1.16), z = 4.01, p < 0.001] and had a reduced time to functioning bowel [fixed effects model: SMD = 0.86, 95 % CI (0.60, 1.11), z = 6.63, p < 0.001]. No difference was seen for overall morbidity (p = 0.76) or mortality (p = 0.58).Conclusions
LR of transverse colon tumours is a safe and effective technique. Although there is an increase in operating time, operative and clinical outcomes of intraoperative blood loss and faster recovery are seen with laparoscopic procedures. 相似文献19.
Alessandro De Cesare Barbara Cangemi Enrico Fiori Marco Bononi Roberto Cangemi Luigi Basso 《Surgery today》2014,44(8):1424-1433
Purpose
To evaluate the early and long-term postoperative results of malabsorptive surgery in morbidly obese patients.Methods
Between 2000 and 2007, 102 morbidly obese patients were referred to the Department of Surgery “Pietro Valdoni”, “Sapienza” University of Rome, Policlinico “Umberto I°”, Rome, Italy for malabsorptive surgery. All patients underwent derivative biliodigestive surgery after they had been reviewed by a team of surgeons, physicians, dieticians, and psychologists.Results
There were no intra-operative complications, but two patients suffered postoperative pulmonary embolisms, which resolved with medical treatment. The mean postoperative hospital stay was 7 days, with no early or late mortality. Maximum weight loss was reached 12–24 months after surgery, while the mean percentage excess weight loss at 3–5 years ranged from 45 to 64 %. Specific postoperative complications in the first 2 years after surgery were abdominal abscess (n = 2), gastroduodenal reflux (n = 4), and incisional hernia (n = 6). Diabetes resolved in 98 % of the diabetic patients within a few weeks after surgery and blood pressure normalised in 86.4 % of those who had had hypertension preoperatively. Obstructive sleep apnoea and obesity hypoventilation syndrome also improved significantly in 92 % of the patients.Conclusions
Morbidly obese patients can undergo biliodigestive surgery safely with good long-term weight loss and quality of life expectancy. 相似文献20.
Matthew Z. Wilson Peter W. Dillon Christopher S. Hollenbeak David B. Stewart 《Surgical endoscopy》2014,28(12):3392-3400