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https://www.readbyqxmd.com/read/29775973/safety-model-for-the-introduction-of-robotic-surgery-in-gynecology
#1
Mariano Tamura Vieira Gomes, Beatriz Taliberti da Costa Porto, Jose Pedro Parise Filho, Ana Luiz Vasconcelos, Bruna Fernanda Bottura, Renato Moretti Marques
OBJECTIVE:  To analyze the perioperative results and safety of performing gynecological surgeries using robot-assisted laparoscopy during implementation of the technique in a community hospital over a 6-year period. METHODS:  This was a retrospective observational study in which the medical records of 274 patients who underwent robotic surgery from September 2008 to December 2014 were analyzed. We evaluated age, body mass index (BMI), diagnosis, procedures performed, American Society of Anesthesiologists (ASA) classification, the presence of a proctor (experienced surgeon with at least 20 robotic cases), operative time, transfusion rate, perioperative complications, conversion rate, length of stay, referral to the intensive care unit (ICU), and mortality...
May 18, 2018: Revista Brasileira de Ginecologia e Obstetrícia
https://www.readbyqxmd.com/read/29775554/outcomes-and-predictors-of-early-infection-after-heart-transplantation
#2
Kendall C Shultes, Jerrica E Shuster, Scott Micek, Justin M Vader, Keki Balsara, Akinobu Itoh, Bethany R Tellor
BACKGROUND: Limited data exist on the incidence and outcome of early infection after orthotopic heart transplantation (OHT). The purpose of this study was to describe characteristics and outcomes of OHT recipients with an early infection and to identify predictors of such infections. METHODS: This retrospective, single-center study included patients greater than 18 years of age who underwent OHT from February 2009 to May 2014 and had an infection within 30 days of transplantation...
May 18, 2018: Surgical Infections
https://www.readbyqxmd.com/read/29774601/the-impact-of-mitral-stenosis-on-outcomes-of-aortic-valve-stenosis-patient-undergoing-surgical-aortic-valve-replacement-or-transcatheter-aortic-valve-replacement
#3
Yasser Al-Khadra, Fahed Darmoch, Motaz Baibars, Amir Kaki, Zaher Fanari, M Chadi Alraies
BACKGROUND: The concomitant presence of mitral stenosis (MS) in the setting of symptomatic aortic stenosis represent a clinical challenge. Little is known regarding the outcome of mitral stenosis (MS) patients undergoing transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR). Therefore, we sought to study the outcome of MS patients undergoing aortic valve replacement (AVR). METHOD: Using weighted data from the National Inpatient Sample (NIS) database between 2011 and 2014, we identified patients who were diagnosed with MS...
May 17, 2018: Journal of Interventional Cardiology
https://www.readbyqxmd.com/read/29774564/mortality-in-sepsis-comparison-of-outcomes-between-patients-with-demand-ischemia-acute-myocardial-infarction-and-neither-demand-ischemia-nor-acute-myocardial-infarction
#4
Mahek Shah, Soumya Patnaik, Obiora Maludum, Brijesh Patel, Byomesh Tripathi, Manyoo Agarwal, Lohit Garg, Sahil Agrawal, Ulrich P Jorde, Matthew W Martinez
INTRODUCTION: Elevation in cardiac troponins is common among septic patients. We sought to explore outcomes among those admitted with demand ischemia(DI), acute myocardial infarction(AMI) and neither DI nor AMI in sepsis. METHODS: We analyzed data from the 2011-2014 National Inpatient Sample among patients admitted for sepsis. We compared outcomes among sepsis patients with i)DI versus AMI and ii)DI versus neither DI nor AMI using separate propensity matched cohorts...
May 18, 2018: Clinical Cardiology
https://www.readbyqxmd.com/read/29774399/endothelial-dysfunction-following-coronary-artery-bypass-grafting-influence-of-patient-and-procedural-factors
#5
J Hadem, R Rossnick, B Hesse, M Herr, M Hansen, A Bergmann, G Kensah, C Maess, H Baraki, P Kümpers, A Lukasz, I Kutschka
BACKGROUND: Angiopoietin-2 (Angpt2) mediates endothelial dysfunction (ED) following coronary artery bypass grafting (CABG). Its triggers are, however, poorly understood. METHODS: We examined the time course of ED beyond the early phase of postoperative recovery in 75 patients following CABG with a special focus on different cardiopulmonary bypass (CPB) modes as potential triggers of Angpt2 release. RESULTS: Nine patients (12.0%) underwent off-pump coronary artery bypass (OPCAB), 31 patients (41...
May 17, 2018: Herz
https://www.readbyqxmd.com/read/29774394/longitudinal-health-care-cost-in-hypoplastic-left-heart-syndrome-palliation
#6
Jesse E Hansen, Nicolas L Madsen, Laurie Bishop, David L S Morales, Jeffrey B Anderson
Management of hypoplastic left heart syndrome (HLHS) is resource intensive. Heath care systems are pressured to provide value to patients by improving outcomes while decreasing costs. A single-center retrospective cohort of infants with HLHS who underwent Norwood procedure or hybrid Norwood from 2004 to 2014 and survived to first outpatient follow up were studied. The primary outcome was total cost through 12 months with a sub-analysis of patients with 60 months of data. Costs were calculated using internal cost accounting system and reported by cost center...
May 17, 2018: Pediatric Cardiology
https://www.readbyqxmd.com/read/29774388/withholding-or-withdrawing-of-life-sustaining-therapy-in-older-adults-%C3%A2-80-years-admitted-to-the-intensive-care-unit
#7
Bertrand Guidet, Hans Flaatten, Ariane Boumendil, Alessandro Morandi, Finn H Andersen, Antonio Artigas, Guido Bertolini, Maurizio Cecconi, Steffen Christensen, Loredana Faraldi, Jesper Fjølner, Christian Jung, Brian Marsh, Rui Moreno, Sandra Oeyen, Christina Agwald Öhman, Bernardo Bollen Pinto, Ivo W Soliman, Wojciech Szczeklik, Andreas Valentin, Ximena Watson, Tilemachos Zafeiridis, Dylan W De Lange
PURPOSE: To document and analyse the decision to withhold or withdraw life-sustaining treatment (LST) in a population of very old patients admitted to the ICU. METHODS: This prospective study included intensive care patients aged ≥ 80 years in 309 ICUs from 21 European countries with 30-day mortality follow-up. RESULTS: LST limitation was identified in 1356/5021 (27.2%) of patients: 15% had a withholding decision and 12.2% a withdrawal decision (including those with a previous withholding decision)...
May 17, 2018: Intensive Care Medicine
https://www.readbyqxmd.com/read/29773957/perioperative-predictors-of-delirium-and-incidence-factors-in-adult-patients-post-cardiac-surgery
#8
Stavros Theologou, Konstantinos Giakoumidakis, Christos Charitos
Background: Delirium is a quite common complication in adult patients post-cardiac surgery. The purpose of our study was to identify perioperative characteristics and also focus on incidence factors that could predict delirium in the cardiac surgery intensive care unit (CICU) postoperatively. Methods: We conducted a prospective study of 179 consecutive patients, who underwent open-heart surgical operation and were admitted to the CICU of a general tertiary hospital in Athens, Greece...
2018: Pragmatic and Observational Research
https://www.readbyqxmd.com/read/29773712/acute-kidney-injury-and-risk-of-heart-failure-and-atherosclerotic-events
#9
Alan S Go, Chi-Yuan Hsu, Jingrong Yang, Thida C Tan, Sijie Zheng, Juan D Ordonez, Kathleen D Liu
BACKGROUND AND OBJECTIVES: AKI in the hospital is common and is associated with excess mortality. We examined whether AKI is also independently associated with a higher risk of different cardiovascular events in the first year after discharge. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted a retrospective analysis of a cohort between 2006 and 2013 with follow-up through 2014, within Kaiser Permanente Northern California. We identified all adults admitted to 21 hospitals who had one or more in-hospital serum creatinine test result and survived to discharge...
May 17, 2018: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/29773640/health-care-utilization-and-burden-of-diabetic-ketoacidosis-in-the-u-s-over-the-past-decade-a-nationwide-analysis
#10
Dimpi Desai, Dhruv Mehta, Priyanka Mathias, Gopal Menon, Ulrich K Schubart
OBJECTIVE: Diabetes is one of the most common chronic diseases and a leading cause of morbidity and mortality in the U.S. Although our ability to treat diabetes and its associated complications has significantly improved, presentation with uncontrolled diabetes leading to ketoacidosis remains a significant problem. RESEARCH DESIGN AND METHODS: We aimed to determine the incidence and costs of hospital admissions associated with diabetic ketoacidosis (DKA). We reviewed the National Inpatient Sample Database for all hospitalizations in which DKA (ICD-9 codes 250...
May 17, 2018: Diabetes Care
https://www.readbyqxmd.com/read/29772365/location-of-thalamic-hemorrhage-impacts-prognosis
#11
Brandon L Neisewander, Kimberly Hu, Zach Tan, Jack Zakrzewski, Pouyan Kheirkhah, Prateek Kumar, Miloni Shah, Douglas Cotanche, Kalpesh Shah, Darian R Esfahani, Ankit I Mehta
OBJECT: Approximately 12% of intracerebral hemorrhages (ICH) occur in the thalamus. Understanding the anatomical regions involved with thalamic hemorrhages is potentially useful, offering the physician a more accurate prognosis for patient outcomes. This study was performed to determine if thalamic hemorrhage location observed on a computed tomography scan (CT) is predictive of neurologic outcomes. METHODS: A sample of 168 thalamic hemorrhage patients admitted to a tertiary care center was analyzed...
May 14, 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29772312/early-and-late-outcomes-of-endovascular-aortic-aneurysm-repair-versus-open-surgical-repair-of-an-abdominal-aortic-aneurysm-a-single-center-study
#12
Kyunghak Choi, Youngjin Han, Gi-Young Ko, Yong-Pil Cho, Tae-Won Kwon
OBJECTIVE: To compare the treatment outcomes and cost of endovascular aortic aneurysm repair (EVAR) and open surgical repair (OSR) in patients with an abdominal aortic aneurysm (AAA) at a single center. METHODS: Patients treated for an AAA at a single center between January 2007 and December 2012 were retrospectively identified and classified based on the treatment that they received (EVAR or OSR). Patient demographics, and in hospital costs were recorded. Long-term survival was calculated using the Kaplan-Meier method...
May 14, 2018: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/29771899/excess-cost-and-inpatient-stay-of-treating-deep-spinal-surgical-site-infections
#13
James Barnacle, Dianne Wilson, Christopher Little, Christopher Hoffman, Nigel Raymond
AIM: To determine the excess cost and hospitalisation associated with surgical site infections (SSI) following spinal operations in a New Zealand setting. METHODS: We identified inpatients treated for deep SSI following primary or revision spinal surgery at a regional tertiary spinal centre between 2009 and 2016. Excess cost and excess length of stay (LOS) were calculated via a clinical costing system using procedure-matched controls. RESULTS: Twenty-eight patients were identified...
May 18, 2018: New Zealand Medical Journal
https://www.readbyqxmd.com/read/29771828/results-following-adoption-of-a-modified-melbourne-technique-of-total-scaphocephaly-correction
#14
Julia D Sharma, Justine L O'Hara, Alessandro Borghi, Naiara Florez-Rodriguez, William Breakey, Juling Ong, Nu Owase Jeelani, David J Dunaway, Greg James
The Melbourne technique was described in 2008 as a novel method for complete correction of scaphocephaly. Since 2015, it has become our operation of choice for children with sagittal synostosis who are too old at presentation for minimally invasive techniques. Our modifications were 2-position (initially supine then prone) technique and undertaking a formal fronto-orbital remodeling to correct forehead contour. Retrospective chart review was used to record demographics, blood transfusion frequency and volumes, operating time, length of stay, clinical outcome, and complications...
May 15, 2018: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/29771797/measuring-in-hospital-recovery-after-colorectal-surgery-within-a-well-established-enhanced-recovery-pathway-a-comparison-between-hospital-length-of-stay-and-time-to-readiness-for-discharge
#15
Saba Balvardi, Nicolò Pecorelli, Tanya Castelino, Petru Niculiseanu, A Sender Liberman, Patrick Charlebois, Barry Stein, Franco Carli, Nancy E Mayo, Liane S Feldman, Julio F Fiore
BACKGROUND: Hospital length of stay is often used as a measure of in-hospital recovery but may be confounded by organizational factors. Time to readiness for discharge may provide a superior index of recovery. OBJECTIVE: The purpose of this study was to contribute evidence for the construct validity of time to readiness for discharge and length of stay as measures of in-hospital recovery after colorectal surgery in the context of a well-established enhanced recovery pathway...
May 15, 2018: Diseases of the Colon and Rectum
https://www.readbyqxmd.com/read/29771723/comparing-short-term-and-oncologic-outcomes-of-minimally-invasive-versus-open-pancreaticoduodenectomy-across-low-and-high-volume-centers
#16
Robert J Torphy, Chloe Friedman, Alison Halpern, Brandon C Chapman, Steven S Ahrendt, Martin M McCarter, Barish H Edil, Richard D Schulick, Ana Gleisner
OBJECTIVE: To compare short-term and oncologic outcomes of patients with cancer who underwent open pancreaticoduodenectomy (OPD) versus minimally invasive pancreaticoduodenectomy (MIPD) using the National Cancer Database. SUMMARY BACKGROUND DATA: MIPD, including laparoscopic and robotic approaches, has continued to gain acceptance despite prior reports of increased short-term mortality when compared with OPD. METHODS: Patients with pancreatic cancer diagnosed from 2010 to 2015 undergoing curative intent resection were selected from the National Cancer Database...
May 16, 2018: Annals of Surgery
https://www.readbyqxmd.com/read/29771394/the-effect-of-intraoperative-hypothermia-on-shoulder-arthroplasty
#17
Toufic R Jildeh, Kelechi R Okoroha, Nathan E Marshall, Chad Amato, Hunter Trafton, Stephanie J Muh, Patricia Kolowich
Limited evidence is available regarding the correlation between intraoperative hypothermia and perioperative complications in shoulder arthroplasty. The purpose of this study was to determine the incidence of intraoperative hypothermia in patients treated with shoulder arthroplasty and its effect on perioperative complications. A retrospective chart review was performed on 657 consecutive patients who underwent shoulder arthroplasty at a single institution between August 2013 and June 2016. Demographic data, surgery-specific data, postoperative complications, length of stay, and 30-day read-mission were recorded...
May 16, 2018: Orthopedics
https://www.readbyqxmd.com/read/29771210/variables-affecting-hospital-length-of-stay-a-scoping-review
#18
Sandra C Buttigieg, Lorraine Abela, Adriana Pace
Purpose Tertiary hospitals have registered an incremental rise in expenditure mostly because of the increasing demands by ageing populations. Reducing the length of stay (LOS) of patients within tertiary hospitals is one of the strategies, which has been used in the last decades to ensure health care systems' sustainability. Furthermore, LOS is one of the key performance indicators, which is widely used to assess hospital efficiency. Hence, it is crucial that policy makers use evidence-based practices in health care to aim for optimal LOS...
May 21, 2018: Journal of Health Organization and Management
https://www.readbyqxmd.com/read/29770883/laparoscopic-liver-resection-for-large-hcc-short-and-long-term-outcomes-in-relation-to-tumor-size
#19
Giovanni Battista Levi Sandri, Gabriele Spoletini, Giovanni Vennarecci, Elisa Francone, Mohammed Abu Hilal, Giuseppe Maria Ettorre
OBJECTIVE: In this study, we aim to assess the impact of tumor size on clinical and oncological outcomes in patients undergoing laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC). BACKGROUND: LLR has been shown to be feasible, safe, and oncologically efficient. However, it has been slow to develop in patients with HCC who often suffer from chronic liver disease which represents an additional challenge for the surgeon. The experience with large HCCs is even more limited...
May 16, 2018: Surgical Endoscopy
https://www.readbyqxmd.com/read/29770881/robot-assisted-laparoscopic-resection-of-clinical-t4b-tumours-of-distal-sigmoid-and-rectum-initial-results
#20
Rogier M P H Crolla, Janneke J C Tersteeg, George P van der Schelling, Jan H Wijsman, Jennifer M J Schreinemakers
BACKGROUND: Radical resection by multivisceral resection of colorectal T4 tumours is important to reduce local recurrence and improve survival. Oncological safety of laparoscopic resection of T4 tumours is controversial. However, robot-assisted resections might have advantages, such as 3D view and greater range of motion of instruments. The aim of this study is to evaluate the initial results of robot-assisted resection of T4 rectal and distal sigmoid tumours. METHODS: This is a cohort study of a prospectively kept database of all robot-assisted rectal and sigmoid resections between 2012 and 2017...
May 16, 2018: Surgical Endoscopy
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