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Perioperative risk model

Jörn A Karhausen, Wenjing Qi, Alan M Smeltz, Yi-Ju Li, Svati H Shah, William E Kraus, Joseph P Mathew, Mihai V Podgoreanu, Miklos D Kertai
INTRODUCTION:  Thrombocytopenia after cardiac surgery independently predicts stroke, acute kidney injury and death. To understand the underlying risks and mechanisms, we analysed genetic variations associated with thrombocytopenia in patients undergoing coronary artery bypass grafting (CABG) surgery. MATERIALS AND METHODS:  Study subjects underwent isolated on-pump CABG surgery at Duke University Medical Center. Post-operative thrombocytopenia was defined as platelet count < 100 × 109 /L...
August 13, 2018: Thrombosis and Haemostasis
Michiel H F Poorthuis, Eelco C Brand, Alison Halliday, Richard Bulbulia, Michiel L Bots, Gert J de Borst
OBJECTIVE: To examine the association between operator or hospital volume and procedural outcomes of carotid revascularization. BACKGROUND: Operator and hospital volume have been proposed as determinants of outcome after carotid endarterectomy (CEA) or carotid artery stenting (CAS). The magnitude and clinical relevance of this relationship are debated. METHODS: We systematically searched PubMed and EMBASE until August 21, 2017. The primary outcome was procedural (30 days, in-hospital, or perioperative) death or stroke...
August 10, 2018: Annals of Surgery
Jowita Biernawska, Joanna Solek-Pastuszka, Arkadiusz Kazimierczak, Krzysztof Safranow, Mariusz Kaczmarczyk, Malgorzata Zegan-Baranska, Maciej Zukowski, Katarzyna Kotfis
Purpose: We aimed at assessing the predisposition of A-kinase anchoring protein 10 (AKAP10) polymorphism toward acquired repolarization disorders in high-risk vascular surgery patients. Patients and methods: One hundred adult patients (age =44-85 years), scheduled for an elective high-risk "open" vascular surgery procedure, were recruited. The electrocardiogram Holter monitor was used to assess repolarization stability from the beginning of the operation up to 24 hours afterward...
2018: Therapeutics and Clinical Risk Management
Nayeon Choi, Song I Park, Hyeseung Kim, Insuk Sohn, Han-Sin Jeong
OBJECTIVES: Unplanned reoperation causes physical and psychological stress in patients and it costs more in terms of medical, economic and social resource. The purpose of the study was to evaluate the incidence, risk factors and clinical significance of unplanned reoperation (any unscheduled surgery within 30 days from the initial surgery) in patients who had undergone head and neck cancer (HNC) surgery. MATERIALS AND METHODS: A total of 574 consecutive patients who had received surgery for HNC with or without flap reconstruction from 2010 to 2015 were analyzed...
August 2018: Oral Oncology
Takeshi Oichi, Yasushi Oshima, Hiroki Matsui, Kiyohide Fushimi, Sakae Tanaka, Hideo Yasunaga
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To compare morbidity and mortality between nonagenarians and other older adult patients who underwent elective spine surgery. SUMMARY OF BACKGROUND DATA: There is a lack of information of the perioperative risks of nonagenarians undergoing spine surgery. METHODS: Data of patients aged ≥65 years who underwent elective spine surgery from July 2010 to March 2013 were extracted from the Diagnosis Procedure Combination database, a nationwide administrative inpatient database in Japan...
August 7, 2018: Spine
Jaiben George, Jared M Newman, Mhamad Faour, William Messner, Alison K Klika, Wael K Barsoum, Carlos A Higuera
Although total hip arthroplasty and total knee arthroplasty commonly overlap, there are concerns about the safety and quality of this scenario. The objectives of this study were to (1) compare the operative time and the incidence of 90-day complications between overlapping and nonoverlapping total joint arthroplasties; and (2) evaluate the effect of the duration of overlap on operative time and the incidence of 90-day complications. A total of 9192 patients who underwent primary total hip arthroplasty or total knee arthroplasty at a large academic hospital from 2005 to 2014 were identified...
August 9, 2018: Orthopedics
Heui Seung Lee, Jeong Hoon Kim, Young-Hoon Kim, Seungjoo Lee
OBJECTIVE: Though outcome of brain abscess has been improved due to stereotactic drainage and appropriate antibiotic treatment, late unprovoked seizure often occurs after the abscess is resolved. The purpose of this study is to reveal the factors related to the late unprovoked seizure and effect of steroid on the prevention of seizure. PATIENTS AND METHODS: From January 2002 to August 2016, 119 patients with supratentorial brain abscesses were retrospectively analyzed...
August 1, 2018: Clinical Neurology and Neurosurgery
Julia E Noel, Maxwell P Kligerman, Uchechukwu C Megwalu
Objective To determine if a preoperative dose of intravenous corticosteroids reduces the risk of postoperative recurrent laryngeal nerve palsy and improves subjective voice outcomes among patients undergoing thyroidectomy. Data Sources PubMed, Cochrane database, and EMBASE. Review Methods Randomized controlled trials comparing corticosteroids with placebo on voice outcomes in thyroid surgery were extracted with standardized search criteria. Systematic review and meta-analysis were performed. With random effects models, trial data were pooled to determine the overall rate of recurrent laryngeal nerve palsy as well as secondary outcomes of adverse events, including wound infection and hyperglycemia...
August 7, 2018: Otolaryngology—Head and Neck Surgery
Nigel M Bagnall, Edward T Pring, George Malietzis, Thanos Athanasiou, Omar D Faiz, Robin H Kennedy, John T Jenkins
PURPOSE: This study aims to determine whether traditional risk models can accurately predict morbidity and mortality in patients undergoing major surgery by colorectal surgeons within an enhanced recovery program. METHODS: One thousand three hundred eighty patients undergoing surgery performed by colorectal surgeons in a single UK hospital (2008-2013) were included. Six risk models were evaluated: (1) Physiology and Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM), (2) Portsmouth POSSUM (P-POSSUM), (3) ColoRectal (CR-POSSUM), (4) Elderly POSSUM (E-POSSUM), (5) the Association of Great Britain and Ireland (ACPGBI) score, and (6) modified Estimation of Physiologic Ability and Surgical Stress Score (E-PASS)...
August 4, 2018: International Journal of Colorectal Disease
Brandon Peterson, Mehrdad Ghahramani, Matthew Emerich, Andrew J Foy
Preoperative stress testing in asymptomatic patients is considered rarely appropriate in patients with: (1) moderate to good functional capacity (≥4 metabolic equivalent (METs)), (2) no clinical risk factors, or who are (3) asymptomatic after revascularization, normal stress test, or normal coronary angiography within 1 year. Preoperative stress testing is also not recommended in patients at low risk (<1%) for adverse cardiac events. We investigated the frequency of rarely appropriate and low-risk preoperative stress testing across medical specialties at our institution in asymptomatic patients when applying appropriate use criteria and two different perioperative risk models...
June 2, 2018: American Journal of Cardiology
Samir Kendale, Prathamesh Kulkarni, Andrew D Rosenberg, Jing Wang
WHAT WE ALREADY KNOW ABOUT THIS TOPIC: WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Hypotension is a risk factor for adverse perioperative outcomes. Machine learning methods allow large amounts of data for development of robust predictive analytics. The authors hypothesized that machine learning methods can provide prediction for the risk of postinduction hypotension METHODS:: Data was extracted from the electronic health record of a single quaternary care center from November 2015 to May 2016 for patients over age 12 that underwent general anesthesia, without procedure exclusions...
August 1, 2018: Anesthesiology
Kalathil K Sureshkumar, Bhavna Chopra
OBJECTIVES: Immunosuppressive therapy in kidney transplant recipients with hepatitis B virus infection may increase the risk of disease progression. Here, we compared outcomes of depleting (antithymocyte globulin/alemtuzumab) versus nondepleting (basiliximab/daclizumab) antibody induction in kidney transplant recipients at different serologic phases of hepatitis B virus infection. MATERIALS AND METHODS: We used the Organ Procurement and Transplantation Network/United Network for Organ Sharing database to identify adult kidney transplant recipients at different serologic phases of hepatitis B virus infection (transplants received from 2001-2011 after patients received perioperative induction with discharge on calcineurin inhibitors/mycophenolate mofetil with/without steroids)...
July 31, 2018: Experimental and Clinical Transplantation
Emilie Katrine Kongebro, Lars N Jorgensen, Volkert D Siersma, Christian Sahlholt Meyhoff
BACKGROUND: Perioperative hyperoxia has been linked to increased long-term mortality. Vasoconstrictive and cellular side effects to hyperoxia have been suggested to increase the risk of coronary and cerebral ischemia. The aim of this post-hoc analysis of a large randomized trial was to compare the effects of 80% vs 30% perioperative oxygen on the long-term risk of stroke or transient cerebral ischemia (TCI) in patients undergoing abdominal surgery. METHODS: A total of 1386 patients were randomized to 80% or 30% perioperative oxygen during acute or elective open abdominal surgery...
July 31, 2018: Acta Anaesthesiologica Scandinavica
Matthew D Free, David H Owen, Paul A Agius, Edward M Pascoe, Paul Harvie
BACKGROUND: The aim of this study was to investigate whether the direct anterior approach (DAA) to total hip arthroplasty (THA) resulted in a shorter length of stay (LOS) in surgeons new to the approach when compared to their previously used approach. Perioperative complications were also assessed. METHODS: We examined 93 DAA THA performed by 3 hip arthroplasty surgeons at a single institution comparing these to their previous 166 operations performed using the lateral or posterior approach...
July 4, 2018: Journal of Arthroplasty
Nicholas J Goel, Prateek Agarwal, Arka N Mallela, Kalil G Abdullah, Zarina S Ali, Ali K Ozturk, Neil R Malhotra, James M Schuster, H Isaac Chen
BACKGROUND AND CONTEXT: The impact of underlying liver disease on surgical outcomes has been recognized in a wide variety of surgical disciplines. However, less empiric data is available about the importance of liver disease in spinal surgery. PURPOSE: To measure the independent impact of underlying liver disease on 30-day outcomes following surgery for the degenerative cervical spine. STUDY DESIGN: Retrospective comparative study PATIENT SAMPLE: A cohort of 21,207 patients undergoing elective surgery for degenerative disease of the cervical spine from the American College of Surgeons National Quality Improvement Program (ACS-NSQIP)...
July 24, 2018: Spine Journal: Official Journal of the North American Spine Society
Mike Fruscione, Russell C Kirks, Allyson Cochran, Keith Murphy, Erin H Baker, John B Martinie, David A Iannitti, Dionisios Vrochides
BACKGROUND: The American College of Surgeons National Surgical Quality Improvement Program® (NSQIP) Surgical Risk. Calculator (SRC) estimates postoperative outcomes. The aim of this study was to develop and validate a specific predictive outcomes model for cholecystectomy procedures. METHODS: Patients who underwent cholecystectomy between 2008 and 2016 and were deemed too high risk for acute care general surgery (GS) and had surgery performed by the Division of Hepatopancreatobiliary Surgery (HPB) were identified...
July 24, 2018: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
Steven Roth, Heather E Moss
Perioperative visual loss (POVL) is a rare, serious complication of non-ophthalmic surgeries. Ischemic optic neuropathy (ION), and retinal arterial occlusion (RAO) are the main causes (1, 2). Less frequent are cortical blindness (3), acute glaucoma (4), and choroidal and vitreous hemorrhage (5). ION is the most common cause for which the neurologist or neuro-ophthalmologist is consulted as it is associated either with a normal ophthalmic exam (posterior ION, PION), or less often, with optic nerve (ON) head swelling (anterior ION, AION)...
2018: Frontiers in Neurology
Brenton N Armstrong, Audrey Renson, Lee C Zhao, Marc A Bjurlin
INTRODUCTION AND OBJECTIVE: To identify predictors of thirty-day perioperative complications after urethroplasty and create a model to predict patients at increased risk. METHODS: We selected all patients recorded in the National Surgery Quality Improvement Program (NSQIP) from 2005 to 2015 who underwent urethroplasty, determined by Current Procedural Terminology (CPT) codes. The primary outcome of interest was a composite 30-day complication rate. To develop predictive models of urethroplasty complications we used random forest and logistic regression with tenfold cross-validation employing demographic, comorbidity, laboratory, and wound characteristics as candidate predictors...
July 23, 2018: World Journal of Urology
Raymond Sroka, Emmanuel M Gabriel, Danna Al-Hadidi, Steven J Nurkin, Richard D Urman, Timothy D Quinn
The objective of this retrospective analysis was to describe the development and implementation of an anesthesiologist-led multidisciplinary committee to evaluate high-risk surgical patients in order to improve surgical appropriateness. The study was conducted in an anesthesia preoperative evaluation clinic at an academic comprehensive cancer center. One hundred sixty-seven high-risk surgical patients with cancer-related diagnoses were evaluated and discussed at a High-Risk Committee (HRC) meeting to determine surgical appropriateness and optimize perioperative care...
July 23, 2018: Journal of Healthcare Risk Management: the Journal of the American Society for Healthcare Risk Management
X Duan, M Coburn, R Rossaint, R D Sanders, J V Waesberghe, A Kowark
BACKGROUND: The influence of dexmedetomidine on postoperative delirium (POD) in adult surgical patients remains controversial. We aimed to analyse whether dexmedetomidine use could decrease POD incidence in this population and its relation to timing of dexmedetomidine administration and patient age. METHODS: We used random-effects modelled meta-analysis, trial sequential analysis, and followed Cochrane methodology with Grading of Recommendations Assessment, Development, and Evaluation (GRADE)...
August 2018: British Journal of Anaesthesia
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