Rxivist logo

Rxivist combines biology preprints from bioRxiv and medRxiv with data from Twitter to help you find the papers being discussed in your field. Currently indexing 146,228 papers from 618,561 authors.

Most downloaded biology preprints, all time

in category surgery

95 results found. For more information, click each entry to expand.

61: Prognostic significance of compound physiology variables in oesophageal cancer
more details view paper

Posted 19 Apr 2020

Prognostic significance of compound physiology variables in oesophageal cancer
291 downloads medRxiv surgery

Arfon G Powell, Catherine Eley, Alexandra coxon, Carven Chin, Damian M. Bailey, Wyn G Lewis

Aims: Objective identification of patient risk profile in Oesophageal Cancer (OC) surgery is critical. This study aimed to evaluate to what extent cardiorespiratory fitness and select metabolic factors predict clinical outcome. Methods: Consecutive 186 patients were recruited (median age 69 yr. 160 male, 138 neoadjuvant therapy). All underwent pre-operative cardiopulmonary exercise testing to determine peak oxygen uptake (V O2Peak), anaerobic threshold (AT), and ventilatory equivalent for carbon dioxide (V E/V CO2). Cephalic venous blood was assayed for serum C-reactive protein (CRP), albumin, and full blood count. Primary outcome measures were Morbidity Severity Score (MSS), and Overall Survival (OS). Results: MSS (Clavien-Dindo >2) developed in 33 (17.7%) and was related to elevated CRP (AUC 0.69, p=0.001) and lower V O2Peak (AUC 0.33, p=0.003). Dichotomisation of CRP (above 10mg/L) and V O2Peak (below 18.6mL/kg/min) yielded adjusted Odds Ratios (OR) for MSS CD>2, of 4.01 (p=0.002) and 3.74 (p=0.002) respectively. OC recurrence occurred in 36 (19.4%) and 69 (37.1%) patients died. On multivariable analysis; pTNM stage (Hazard Ratio (HR) 2.20, p=0.001), poor differentiation (HR 2.20, p=0.010), resection margin positivity (HR 2.33, p=0.021), and MSS (HR 4.56, p<0.001) were associated with OS. Conclusions: CRP and V O2Peak are collective independent risk factors that can account for over half of OC survival variance.

62: A prospective observational cohort study considering the feasibility and tolerability of high intensity interval training as a novel treatment therapy for patients with intermittent claudication.
more details view paper

Posted 06 Apr 2020

A prospective observational cohort study considering the feasibility and tolerability of high intensity interval training as a novel treatment therapy for patients with intermittent claudication.
290 downloads medRxiv surgery

Sean Pymer, Said Ibeggazene, Joanne Palmer, George E. Smith, Amy E. Harwood, Sean Carroll, Lee Ingle, Ian C. Chetter

BackgroundUptake and completion rates for supervised exercise programmes (SEP) for patients with intermittent claudication (IC) are low. Current exercise prescription is a one size fits all approach, based on claudication pain thresholds, potentially limiting individual benefits. High-intensity interval training (HIIT) has the potential to overcome these barriers as it is a more time-efficient, objectively prescribed exercise programme. This study aimed to assess a novel HIIT programme for patients with IC in terms of safety, feasibility, tolerability and indicators of efficacy. Design/MethodsPatients referred to a usual-care SEP were invited to undertake an alternative HIIT programme. All recruited patients performed a baseline cardiopulmonary exercise test (CPET), to inform their exercise prescription. HIIT involved ten, one-minute high-intensity intervals on a stationary cycle ergometer interspersed with one-minute recovery intervals, performed three times per week for six-weeks. Outcomes included safety, feasibility, tolerability, walking distance and quality of life (QoL). Results144 patients with IC were referred, 95 met initial eligibility criteria (66%) and 30 (32%) were recruited for HIIT, of which 15 (50%) completed. Of the recruited patients, 90% were on optimal medical therapy and 40% had concomitant cardiac, cerebrovascular and/or respiratory disease. One serious adverse event was recorded and patients who completed the programme attended 100% of the sessions. Improvements in walking distances and quality of life were observed. Following recruitment of the first 20 patients, the inclusion criteria was refined on the basis of CPET, leading to improved completion rates. ConclusionThe study provides preliminary findings indicating that patients with IC can complete a short-term HIIT programme. HIIT also appears safe, well-tolerated and although not formally powered, walking distances and QoL appear to improve following HIIT. Further research to evaluate the role of HIIT in patients with IC seems warranted.

63: Non surgical procedure related postoperative complications independently predicts perioperative mortality, in gastrointestinal and Hpb surgeries.- A retrospective analysis of prospectively maintained data.
more details view paper

Posted 22 Apr 2020

Non surgical procedure related postoperative complications independently predicts perioperative mortality, in gastrointestinal and Hpb surgeries.- A retrospective analysis of prospectively maintained data.
288 downloads medRxiv surgery

BHAVIN VASAVADA, Hardik Patel

Aim: The Aim of the study was to evaluate relationship between non surgical procedure related complication and 30 days mortality. Material and Methods: All gastrointestinal and hepatobiliary procedures performed in last 3 years have been evaluated retrospectively. Non surgical procedure related postoperative complications were defined as perioperative complications non related to surgical procedures or techniques and related to patients physiological health or comorbidities (e.g acute kidney injury, ARDS, acute respiratory failure, pre existing sepsis , etc.), Surgical related complications were defined as perioperative complications related to surgical procedures or techniques (e.g. bleeding, leaks, sepsis due to leaks etc.). Factors affecting 30 days mortality and morbidity were analysed using univariate and multivariate analysis. Chi square test was used for categorical values, Mann Whitney U test was used for numerical values. Multivariate logistic regression analysis was used for multivariate analysis. Statistical analysis was used suing SPSS version 21. Results: Total 325 major hepatobiliary and pancreatic surgery was done in our institute in last 2 years. 30 days overall mortality rate was 6.4%. In univariate analysis mortality was significantly associated with nonsurgical procedure related complications. (p < 0.0001). Surgical complications were not associated with mortality. On univariate analysis other factors associated with mortality were emergency surgeries, high CDC grade of surgery, higher ASA grades, increase operative duration, increased blood product requirements. However on multivariate analysis only nonsurgical procedure related postoperative complications independently predicted mortality. (p=0.001). Conclusions: Non surgical procedure related post operative complications (Physiological) is strongly associated with 30 days mortality, suggesting improved perioperative care can help to reduce post operative mortality.

64: FREQUENCY OF INFECTION AFTER CEREBROSPINAL FLUID SHUNTING PROCEDURES
more details view paper

Posted 06 Apr 2020

FREQUENCY OF INFECTION AFTER CEREBROSPINAL FLUID SHUNTING PROCEDURES
287 downloads medRxiv surgery

Kashif Ramooz, Eesha Yaqoob, Nadeem Akhtar, Fraz Mehmood, Saad Javed

Hydrocephalus is routinely treated by surgical procedures. Cerebrospinal fluid shunt placement is a critical therapeutic intervention for hydrocephalus.CSF shunting has multiple complications among which infection is very common. The major cause of morbidity and mortality in patients with CSF shunts is theinfection of the central nervous system (CNS).It can lead to prolonged hospital stay, increase the number of operative procedures 03 times more than then none infected cases and has twice the fatality rate. Study of such type of complication will help the patients to improve their health and also improve our sterilization techniques and reduce burden of hospital and patients expenditures. The objective of the study was to determine the frequency of infection after cerebrospinal fluid shunting procedures.Case series study was used as study design.Study was conducted from 10-2010 to 10-06-2011.One hundred and forty four patients with both genders of all age groups undergoing cerebrospinal fluid shunting, meeting inclusion and exclusion criteria, were selected for the present study after informed consent of patient or guardian and approval by the hospital ethical committee. Follow up was ensured by taking the telephonic contact and address of patient.Total no of patients were 144 among which, 89 were males and 55 were females. Age distribution was from 01 month to 75 years with the mean age of 15.280 and standard deviation was {+/-} 20.450. Post-operative infection was present in 20(13.9%) patients. Authors approvalAll the authors have seen the manuscript and approved it. Declaration of interestNone Conflict/Competing of InterestNone. Disclosure of FundingNone. Ethical ApprovalAttached

65: Comparison of surgical quality and long-term outcome between hybrid trans-anal total meso-rectal excision and laparoscopic total meso-rectal excision: a systematic review and meta-analysis
more details view paper

Posted 05 May 2020

Comparison of surgical quality and long-term outcome between hybrid trans-anal total meso-rectal excision and laparoscopic total meso-rectal excision: a systematic review and meta-analysis
286 downloads medRxiv surgery

Yingchi Yang, Huihui Wang, Kaixin Zhao, Xiangyu Chu, Kai Pang, Yun Yang, Jun Li, Hongwei Yao, Lan Jin, Zhongtao Zhang

BACKGROUND Laparoscopy-assisted trans-anal TME (ta-TME), or hybrid ta-TME, inherited the advantages of both trans-anal surgery and trans-abdominal surgery, and is gaining increasing acceptance from colorectal surgeons worldwide. This research aims to make a comprehensive comparison between hybrid ta-TME surgery and traditional laparoscopic TME (la-TME) surgery regarding surgical quality and long-term survival. METHODS Cochrane Library, EMbase, Web of Science and PubMed were searched for studies comparing hybrid ta-TME with traditional la-TME. Indicators for surgical quality and long-term prognosis were extracted and pooled. Heterogeneity was assessed with I2 index and was significant when p<0.1 and I2>50%. Publication bias was estimated by Egger test, where p<0.1 was considered statistically significant. RESULTS 13 studies with 992 patients were included in meta-analysis, of which 467 were in hybrid ta-TME cohorts, and 525 were in traditional la-TME cohorts. Compared with traditional la-TME, hybrid ta-TME has lower rate of positive circumferential margin (RR=0.454, 95%CI 0.240~0.862, p=0.016) and lower conversion rate (RR=0.336, 95%CI 0.134~0.844, p=0.020). On rate of positive distal resection margin, completeness/near-completeness of meso-rectum, overall complications, anal leakage, ileus, urinary dysfunction, 2-year DFS and 2-year OS, there were no significant difference between the two techniques. CONCLUSIONS Hybrid ta-TME is significantly superior to traditional la-TME in ensuring CRM safety and lowering intra-operative conversion rate, and is meanwhile not inferior on other major outcome indicators concerning surgical quality and long-term survival. To further understand this new surgical technique, we need high-quality RCTs, as well as previous researchers updates with results of prolonged follow-up.

66: Prognostic significance of compound combined peri-operative biomarkers in gastric cancer
more details view paper

Posted 24 Apr 2020

Prognostic significance of compound combined peri-operative biomarkers in gastric cancer
281 downloads medRxiv surgery

Arfon G Powell, Alexandra Harriet Coxon, David BT Robinson, Osian James, Adam Christian, Stuart Ashley Roberts, Wyn G Lewis

Objective: Survival after gastric cancer surgery is largely attributed to tumor biology, neoadjuvant chemotherapy (NAC), and surgical approach, yet other prognostic factors have been reported, including pre-operative systemic inflammatory response (SIR), and Morbidity Severity Score (MSS). The hypothesis tested was that a SIR, MMS, and pathological composite score, would be associated with disease-free (DFS) and overall survival (OS). Methods: Consecutive 358 patients undergoing potentially curative gastrectomy for adenocarcinoma were studied. Complications were defined as a MSS of Clavien-Dindo classification (CDSC) >1. Serum SIR measurements were performed on the day before surgery, and a composite score (CIMpN) (0-3) was developed based on CRP, morbidity, and pN-stage. Primary outcome measures were DFS and OS. Results: Post-operative complications occurred in 138 (38.5%) patients, (8 (2.2%) deaths), and was associated with higher CRP (28.3% vs. 15.5%, p=0.003), vascular invasion (55.8% vs. 36.8%, p<0.001), and R1 status (26.1% vs. 9.5%, p=0.001). Five-year DFS and OS were 32.9% and 33.3% for patients with post-operative complications compared with 62.5% and 64.0% in controls (p<0.001). Five-year DFS and OS were 31.4% and 37.3% in patients with raised CRPs compared with 58.5% and 59.5% in controls (p=0.005, p=0.001, respectively). Five-year DFS for CIMpN scores of 0, 1, 2, and 3 were 85.9%, 50.0%, 26.2%, and 15.4% (p<0.001) respectively. On multivariable analysis CIMpN score was independently associated with DFS [HR 3.00, 95% Confidence Interval (CI) 1.90-4.73, p<0.001] and OS [1.93 (1.43-2.59), p<0.001]. Conclusion: A novel composite score, CIMpN, based on SIR, MSS and pN-stage, offers important prognostic signals.

67: An effect of the COVID-19 pandemic: significantly more complicated appendicitis due to delayed presentation of patients!
more details view paper

Posted 25 Jan 2021

An effect of the COVID-19 pandemic: significantly more complicated appendicitis due to delayed presentation of patients!
280 downloads medRxiv surgery

Marie Burgard, Floryn Cherbanyk, Konstantinos Nassiopoulos, Sonaz Malekzadeh, Francois Pugin, Bernhard Egger

AIMS OF THE STUDY: The novel coronavirus pandemic has affected emergency department consultations for surgical pathologies. The aim of our study was to compare the number of acute appendicitis cases and the proportion of complicated appendicitis before and during the COVID 19 pandemic. METHODS: We retrospectively analyzed all data collected from a multicenter database of patients presenting to the emergency department for acute appendicitis during the COVID-19 pandemic from March 12 to June 6, 2020, and compared these data with those from the same periods in 2017, 2018, and 2019. The number of acute appendicitis cases, proportion of complicated appendicitis, and pre and postoperative patient characteristics were evaluated. RESULTS: A total of 306 patients were included in this evaluation. Sixtyfive patients presented during the 2020 COVID-19 pandemic lockdown (group A), and 241 patients in previous years (group B: 2017 to 2019). The number of consultations for acute appendicitis decreased by almost 20 percent during the pandemic compared with previous periods, with a significant increase in complicated appendicitis (52% in group A versus 20% in group B, p < 0,001.). Comparing the two groups, significant differences were also noted in the duration of symptoms ( symptoms > 48h in 61% and 26% , p < 0,001), the intervention time ( 77 vs 61 minutes, p = 0,002), length of hospital stay ( hospitalization of > 2 days in 63% and 32%, p < 0.001) and duration of antibiotic treatment ( antibiotics > 3 days in 36% and 24% p = 0.001). CONCLUSIONS: The COVID 19 pandemic resulted in a decreased number of consultations for acute appendicitis, with a higher proportion of complicated appendicitis, most likely due to patient delay in consulting the emergency department at symptom onset. Patients and general practitioners should be aware of this problem to avoid a time delay from initial symptoms to consultation.

68: Achieving engagement with a Deliberate Practice programme using portable laparoscopy simulators - 'Incentivised Laparoscopy Practice'.
more details view paper

Posted 20 Nov 2020

Achieving engagement with a Deliberate Practice programme using portable laparoscopy simulators - 'Incentivised Laparoscopy Practice'.
265 downloads medRxiv surgery

Kenneth G Walker, Jennifer Cleland, Paul M Brennan, Vivienne I Blackhall, Laura G Nicol, Adarsh Shah, Satheesh Yalamarthi, Mark Vella

BackgroundThe transfer validity of portable laparoscopy simulation is well established. However, attempts to integrate take-home simulation into surgical training have met with inconsistent engagement, as reported in our 2014-15 study of an Incentivised Laparoscopy Practice (ILP) programme. Our subsequent multi-centre study examined barriers and facilitators, informing revisions of the programme for 2018-20. We now report engagement with the revised versions. MethodsIn ILP v2.1 and 2.2, two consecutive year-groups of new CSTs (n= 48 and 46) were loaned portable simulators. The 6-month programme included induction, technical support, and intermittent feedback. Six tasks were prescribed, with video instruction and charting of metric scores. Video uploads were required and scored by faculty. A pass resulted in an eCertificate, expected at Annual Review. ILP was set within a wider reform, "Improving Surgical Training". ResultsILP v2.1 and 2.2 saw pass rates of 94% and 76% (45/48 and 35/46 trainees respectively), compared with only 26% (7/27) in v1, despite the v2.1 and v2.2 groups having less electronic gaming experience. In the ILP v2.2 group, 73% reported their engagement was adversely affected by COVID19 redeployments. ConclusionsSimply providing kit, no matter how good, is not enough. To achieve trainee engagement with take- home simulators, as in ILP v2, a whole programme is required, with motivated learning, individual and group practice, intermittent feedback, and clear goals and assessments. ILP is a complex intervention, best understood as a "reform within a reform, within a context." This may explain why trainee engagement fell away during early pandemic conditions. WHAT IS ALREADY KNOWN ON THIS SUBJECTO_LIAttaining automation of motor skills is essential to free up operating surgeons attention for higher cognitive functions. C_LIO_LILaparoscopic operating skills can transfer from simulation to the operating room, and deliberate practice is the most important variable in the development of expertise. C_LIO_LISimply providing take-home portable simulators to surgical trainees, even with online training programmes, is insufficient to facilitate consistent deliberate practice by more than a minority of trainees. C_LI WHAT THIS STUDY ADDSO_LIA package of evidence-based reforms transformed participation of Core Surgical trainees in a 6-month programme of practice using take-home portable simulators, resulting in near- 100% engagement. C_LIO_LISuch reforms are complex, including motivators for learning, individual and group practice, intermittent feedback, clear goals and assessments, and adoption into a wider curriculum reform called "Improving Surgical Training". C_LIO_LIThe improved engagement with this form of remote simulation-based training did not continue in the face of a national "lockdown" for the COVID19 pandemic, where there was widespread redeployment of trainees. C_LI

69: PREOPERATIVE SERUM ALBUMIN LEVEL AS A PREDICTOR OF MORTALITY AND MORBIDITY AFTER VALVE REPLACEMENT SURGERY
more details view paper

Posted 15 Oct 2020

PREOPERATIVE SERUM ALBUMIN LEVEL AS A PREDICTOR OF MORTALITY AND MORBIDITY AFTER VALVE REPLACEMENT SURGERY
263 downloads medRxiv surgery

Md. Noor-E-Elahi Mozumder, Md. Mostafizur Rahman, Md. Rezwanul Hoque, Muhammad Nasif Imtiaz, Abu Jafar Md. Tareq Morshed, Md. Zanzibul Tareq, Md. Nahedul Morshed

BackgroundSerum albumin has a close correlation with degree of malnutrition which is associated with poor outcome and quality of life after cardiac surgery. Hypoalbuminemia is associated with increased wound infection, prolonged hospital stay and death after major surgery. Hence, preoperative serum albumin level can be utilized to upgrade risk models which will further benefit the cardiac surgical patients without extra financial burden. Objective of this study was to evaluate the role of serum albumin as a predictor of morbidity and mortality after valve replacement surgery. MethodsThis comparative cross-sectional study was carried out at the department of cardiac surgery in BSMMU. The study population was 50, with two groups having 25 patients each. Grouping of patients were done with respect to a preset cut off value for serum albumin. The period of study was from August, 2018 to February, 2020 and purposive sampling method was applied for this study. Data was collected by using a standardized semi-structured questionnaire and face to face interview. ResultsBy demographic characteristics, mean age was significantly higher in group B (49.96{+/-}8.69 years) than in group A (41.60{+/-}11.16 years) (p=0.005). Mean BMI was lower in group B (20.88{+/-}3.71 kg/m2) than in group A (22.26{+/-}1.67 kg/m2), which was found statistically significant (p=0.006). In terms of postoperative outcome, total chest drain collection was significantly higher in group B (968.80{+/-}183.49 ml) than in group A (816.00{+/-}113.40 ml), (p=0.001). Duration of ICU stay were significantly longer in group B (4.60{+/-}0.76 days) than in group A (3.92{+/-}0.86 days) (p=0.005). Similarly, duration of hospital stay was significantly longer in group B (9.88{+/-}1.56 days) than in group A (8.64{+/-}0.81 days) (p=0.001). Overall morbidity was significantly higher in group B (48%) than in group A (20%) (p<0.05). Mortality rate was higher in group B (12%) than in group A (4%), but that was not found statistically significant (p>0.05). Pearson co-efficient correlation test showed strong inverse relationship of serum albumin with total chest drain, ICU stay and hospital stay following valve replacement surgery (r= -0.473, r= -0.448 & r= -0.487 respectively), which was most significant than age and BMI (p[&le;]0.001). Multivariate logistic regression analysis was done to assess the predictive value of serum albumin level, age and BMI, where preoperative serum albumin level was found to be the most valuable predictor of postoperative morbidity after valve replacement surgery (B= -2.251, OR 0.105, 95% CI 0.011-0.986, p<0.05). ConclusionThis study demonstrated that preoperative low serum albumin level is associated with increased morbidity and mortality after valve replacement surgery. Hence, preoperative serum albumin level can be used as a reliable predictor of postoperative outcome following valve replacement surgery.

70: Surgical activity in England and Wales during the COVID-19 pandemic: a nationwide observational cohort study
more details view paper

Posted 01 Mar 2021

Surgical activity in England and Wales during the COVID-19 pandemic: a nationwide observational cohort study
249 downloads medRxiv surgery

T. D. Dobbs, J A G Gibson, A J Fowler, T E Abbott, T. Shahid, F Torabi, R Griffiths, R A Lyons, R M Pearse, I S Whitaker

ObjectivesTo report the volume of surgical activity and the number of cancelled surgical procedures during the COVID-19 pandemic. Design and settingAnalysis of electronic health record data from the National Health Service (NHS) in England and Wales. MethodsWe used hospital episode statistics for all adult patients undergoing surgery between 1st January 2020 and 31st December 2020. We identified surgical procedures using a previously published list of procedure codes. Procedures were stratified by urgency of surgery as defined by NHS England. We calculated the deficit of surgical activity by comparing the expected number of procedures from the years 2016-2019 with the actual number of procedures in 2020. We estimated the cumulative number of cancelled procedures by 31st December 2021 according patterns of activity in 2020. ResultsThe total number of surgical procedures carried out in England and Wales in 2020 was 3,102,674 compared to the predicted number of 4,671,338. This represents a 33.6% reduction in the national volume of surgical activity. There were 763,730 emergency surgical procedures (13.4% reduction), compared to 2,338,944 elective surgical procedures (38.6% reduction). The cumulative number of cancelled or postponed procedures was 1,568,664. We estimate that this will increase to 2,358,420 by 31st December 2021. ConclusionsThe volume of surgical activity in England and Wales was reduced by 33.6% in 2020, resulting in over 1,568,664 cancelled operations. This deficit will continue to grow in 2021. Summary boxesO_ST_ABSWhat is already known on this topicC_ST_ABSO_LIThe COVID-19 pandemic necessitated a rapid change in the provision of care, including the suspension of a large proportion of surgical activity C_LIO_LISurgical activity has yet to return to normal and has been further impacted by subsequent waves of the pandemic C_LIO_LIThis will lead to a large backlog of cases C_LI What this study addsO_LI3,102,674 surgical procedures were performed in England and Wales during 2020, a 33.6% reduction on the expected yearly surgical activity C_LIO_LIOver 1.5 million procedures were not performed, with this deficit likely to continue to grow to 2.3 million by the end of 2021 C_LIO_LIThis deficit is the equivalent of more than 6 months of pre-pandemic surgical activity, requiring a monumental financial and logistic challenge to manage C_LI

71: A hemodynamic model to predict regional cerebral blood flow and blood flow reserve in patients with carotid stenosis
more details view paper

Posted 22 Jul 2020

A hemodynamic model to predict regional cerebral blood flow and blood flow reserve in patients with carotid stenosis
247 downloads medRxiv surgery

joseph p archie

Joseph P Archie Jr, PhD, MD Abstract Purpose. Patients with 50% or greater diameter stenosis are at risk for ischemic stroke due to embolization and/or reduced cerebral blood flow. The hemodynamics of progressive carotid stenosis on cerebral blood flow and blood flow reserve has not been adequately measured or predicted. This information is needed for stroke risk stratification in patients with carotid stenosis. The aim of this hemodynamic model study is to predict the contribution of carotid and collateral blood flows to regional cerebral blood flow and cerebral blood flow reserve in patients with moderate to severe carotid stenosis. Methods. A one-dimensional three-parameter fluid mechanics model for the carotid, collateral and brain vascular systems is used to predict regional cerebral blood flow and blood flow reserve as a function of percent diameter carotid stenosis. The model is based on the principal of conservation of energy as employed by Bernoulli to describe fluid flow on a streamline. When applied to the human cerebrovascular system there are three vascular resistance components; carotid, collateral and brain. Carotid artery vascular resistance is assumed to be a function of fractional percent carotid artery area stenosis. This is not a complex modern computational fluid mechanics study. The model blood flow algebraic equations have simple solutions, one of which gives patient specific collateral resistance values. The solutions are given as patient specific cerebral blood flows and flow reserve as a function of percent diameter stenosis. Established normal clinical values of regional cerebral blood flow, cerebral blood flow auto-regulation and the lower threshold of cerebral perfusion pressure for cerebral auto-regulation are used. Carotid vascular resistance is assumed to be proportional to percent area carotid stenosis. Theoretical solutions use mean systemic arterial pressure of 100mmHg and key clinical values of patient collateral vascular resistance. Clinical solutions use patient measured systemic arterial pressures and carotid stump pressures. The solutions are given as patient specific cerebral blood flow and reserve cerebral blood flow curves over the range of diameter carotid stenosis. Results. Normal regional cerebral blood flow of 50ml/min/100g is predicted to be maintained up to 65% diameter carotid stenosis as reserve blood flow is reduced. With further progression of carotid stenosis to occlusion approximately half of patients are predicted to develop some reduction in cerebral blood flow. However, only about 20% of patients have a decrease in cerebral blood flow below the 30ml/min/100g threshold for cerebral ischemic symptoms. Approximately 10% of patients are predicted to develop regional cerebral blood flow less than the 18ml/min/100g threshold for irreversible ischemic injury. The model predicts critical carotid artery stenosis to be between 65% and 71% diameter depending on mean systemic arterial pressure. With higher degrees of stenosis carotid artery blood flow cannot maintain normal cerebral flow without the contribution of collateral flow. The predicted magnitude of carotid energy dissipation between 60% and 90% stenosis is consistent with observed cervical bruit intensity. Predicted patient specific cerebral blood flow reserve is adequate to prevent significant cerebral ischemia in the majority of patients. Conclusions. Patient specific collateral vascular resistance blood flow curves predict regional cerebral blood flow and blood flow reserve as a function of the degree of diameter carotid artery stenosis. The carotid component of cerebral blood flow is predicted to maintain normal cerebral blood flow up to a critical carotid diameter stenosis of 65% to 71%. Collateral blood flow is necessary to maintain normal cerebral flow at higher degrees of carotid stenosis. The clinical model predicts that many patients do not have sufficient collateral flow to prevent a decrease in cerebral flow should carotid stenosis progress to high grade or occlusion. However, only about 10% of patients are predicted to develop irreversible regional cerebral ischemic injury. Estimated carotid stenosis energy dissipation magnitudes agree with observed cervical bruit intensity. Correlation of predicted cerebral reserve blood flow curves with clinically measured cerebrovascular reactivity/reserve has the potential to predict the probability of future cerebral ischemia in asymptomatic patients with 60% to 80% stenosis.

72: Timing and Dose of Pharmacological Thromboprophylaxis in Adult Trauma Patients: Perceptions, Barriers, and Experience of Saudi Arabia Practicing Physicians
more details view paper

Posted 29 Jan 2021

Timing and Dose of Pharmacological Thromboprophylaxis in Adult Trauma Patients: Perceptions, Barriers, and Experience of Saudi Arabia Practicing Physicians
244 downloads medRxiv surgery

Marwa R Amer, Mohammed Bawazeer, Khalid Maghrabi, Rashid Amin, Edward De Vol, Mohammed Hijazi

Background: Pharmacological venous thromboembolism prophylaxis (PVTE-Px) in trauma care is challenging and frequently delayed until post injury bleeding risk is perceived to be sufficiently low; yet data for optimal initiation time is lacking. This study assessed practice pattern of PVTE-Px initiation time and dose in traumatic brain injury (TBI), spinal cord injury (SCI), and non-operative (NOR) solid organ injuries. Methods: Multicenter, cross sectional, observational, survey-based study involving intensivists, trauma surgeons, general surgeons, spine orthopedics, and neurosurgeons practicing in trauma centers. The data of demographics, PVTE-Px timing and dose, and five clinical case scenarios were obtained. Analyses were stratified by early initiators vs. late initiators and logistic regression models were used to identify factors associated with early initiation of PVTE-Px. Results: Of 102 physicians (29 % response rate), most respondents were intensivists (63.7%) and surgeons (who are general and trauma surgeons) (22.5%); majority were consultants (58%), practicing at level 1 trauma centers (40.6%) or academic teaching hospitals (45.1%). A third of respondents (34.2%) indicated that decision to initiate PVTE-Px in TBI and SCI was made by a consensus between surgical, critical care, and neurosurgical services. For patients with NOR solid organ injuries, 34.2% of respondents indicated trauma surgeons initiated the decision on PVTE-Px timing. About 53.7% of the respondents considered their PVTE-Px practice as appropriate, half used combined mechanical and PVTE-Px (57.1%), 52% preferred enoxaparin (40 mg once daily), and only 6.5% used anti-Xa level to guide enoxaparin prophylactic dose. Responses to clinical cases varied. For TBI and TBI with intracranial pressure monitor , 40.3% and 45.6% of the respondents were early initiators with stable repeated head computed tomography [CT], respectively. For SCI, most respondents were early initiators without repeated CT spine (36.8%). With regards to NOR solid organ injuries [gunshot wound to the liver and grade IV splenic injuries], 49.1% and 36.4% of respondents were early initiators without a repeat CT abdomen. Conclusions: Variations were observed in PVTE-Px initiation time influenced by trauma type. Our findings suggested enoxaparin is preferred in a standard prophylactic dose. More robust data from randomized trials are needed and the use of clinicians judgment is recommended.

73: Post-operative day 3 Procalcitonin predicts post-operative infectious complications in pancreatic surgery A systemic review and updated meta-analysis.
more details view paper

Posted 23 Sep 2020

Post-operative day 3 Procalcitonin predicts post-operative infectious complications in pancreatic surgery A systemic review and updated meta-analysis.
238 downloads medRxiv surgery

BHAVIN VASAVADA, hardik patel

Aim of study: Aim of this meta-analysis is to evaluate post-operative procalcitonin as a marker to predict post- operative infectious complications after pancreatic surgeries. Material and Methods: Systemic literature search was performed using MEDLINE, EMBASE and to identify studies evaluating the diagnostic accuracy of Procalcitonin (PCT) as a predictor for detecting infectious complications on postoperative days (POD) 3 and 5 following pancreatic surgery. A meta-analysis was performed using random effect model and pooled predictive parameters for POD 3 and 5 were derived. Geometric means were calculated for PCT cut offs. Results: 6 studies included day 3 PCT analysis, 2 studies included both day 3 and day 5 analysis. Total data of 471 patients were derived. 161 patients developed infectious complications. Pooled sensitivity, specificity, pooled area under curve, diagnostic odds ratio (DOR), positive and negative like hood ratio of day 3 PCT were 74%,79%,0.8453, 11.03,3.17 and 0.31 respectively. Pooled sensitivity, specificity, diagnostic odds ratio (DOR), positive and negative like hood ratio of day 5 PCT were 83%,70%,12.91,2.91 and 0.25 respectively. Geometric means for PCT cut off for day 3 and 5 were 0.80 and 0.43. Conclusion: Postoperative procalcitonin particularly day 3 procalcitonin levels predict post-operative infectious complications following pancreatic surgeries.

74: Brain growth and neurodevelopment after surgical treatment of infant postinfectious hydrocephalus in sub-Saharan Africa
more details view paper

Posted 13 Nov 2020

Brain growth and neurodevelopment after surgical treatment of infant postinfectious hydrocephalus in sub-Saharan Africa
237 downloads medRxiv surgery

Steven J. Schiff, Abhaya V. Kulkarni, Edith Mbabazi Kabachelor, John Mugamba, Peter Ssenyonga, Ruth Donnelly, Jody Levenbach, Vishal Monga, Mallory Peterson, Venkateswararao Cherukuri, Benjamin C Warf

ImportancePost-infectious hydrocephalus in infants is a major public health burden in sub-Saharan Africa. ObjectiveTo determine long-term brain growth and cognitive outcome after surgical treatment of infant post-infectious hydrocephalus in Uganda. DesignProspective follow-up of a previously randomized cohort. SettingSingle center in Mbale, Uganda. ParticipantsInfants (<180 days old) with post-infectious hydrocephalus. InterventionsEndoscopic or shunt surgery. Main outcomesBayley Scales of Infant Development (BSID-3) and brain volume on computed tomography (raw and normalized for age and sex) at 2 years after treatment. ResultsEighty-nine infants were assessed for 2-year outcome. There were no significant differences between the two surgical treatment arms, so they were analyzed together. Raw brain volumes increased between baseline and 24 months (median change=361 cc, IQR=293 to 443, p<0.001), but almost all of this increase was seen in the first year (median change=381 cc, IQR=310 to 442, p<0.001), with very little change between 12 and 24 months (median change=-5 cc, IQR=-52 to 42, p=0.66). The fraction of those with a normal brain volume increased from 15% at baseline to 50% at 1 year, but then declined to 18% at 2 years. Substantial normalized brain volume loss was seen in 21% between baseline and year 2 and in 77% between years 1 and 2. The extent of brain growth in the first year was not associated with extent of brain volume changes in the second year. There were significant positive correlations between 2-year brain volume and all BSID-3 scores and BSID-3 changes from baseline. Conclusions and RelevanceIn sub-Saharan Africa, even after successful surgical treatment of infant post-infectious hydrocephalus, post-treatment brain growth stagnates in the second year. While the reasons for this are unclear, this emphasizes the importance of primary infection prevention strategies along with optimizing the childs environment to maximize brain growth potential. Trial RegistrationClinicalTrials.gov number, NCT01936272 KEY POINTSO_ST_ABSQuestionC_ST_ABSWhat is the brain growth and cognitive trajectory of infants treated for post-infectious hydrocephalus in Uganda? FindingsIn this prospective follow-up of a cohort of 89 infants, early normalization of brain volume after treatment was followed by brain growth stagnation in the second year, with many falling back into the sub-normal range. Poor brain growth was associated with poor cognitive outcome. MeaningSuccessful surgical treatment of hydrocephalus is not sufficient to allow for adequate brain growth and cognitive development. Interventions aimed at primary infection prevention and reducing comorbidities are needed to improve brain growth potential.

75: Impact of gastric resection and enteric anastomotic configuration on delayed gastric emptying after pancreaticoduodenectomy: a network meta-analysis of randomized trials
more details view paper

Posted 25 Jan 2021

Impact of gastric resection and enteric anastomotic configuration on delayed gastric emptying after pancreaticoduodenectomy: a network meta-analysis of randomized trials
236 downloads medRxiv surgery

Chris Varghese, Sameer Bhat, Tim Hsu-Han Wang, Gregory O'Grady, Sanjay Pandanaboyana

Introduction Delayed gastric emptying (DGE) is frequent after pancreaticoduodenectomy (PD). Several randomised controlled trials (RCTs) have explored operative strategies to minimise DGE, however, the optimal combination of gastric resection approach, anastomotic route, and configuration, role of Braun enteroenterostomy remains unclear. Methods MEDLINE, Embase, and CENTRAL databases were systematically searched for RCTs comparing gastric resection (Classic Whipple, pylorus-resecting, and pylorus-preserving), anastomotic route (antecolic vs retrocolic) and configuration (Billroth II vs Roux-en-Y), and enteroenterostomy (Braun vs no Braun). A random-effects, Bayesian network meta-analysis with non-informative priors was conducted to determine the optimal combination of approaches to PD for minimising DGE. Results Twenty-four RCTs, including 2526 patients and 14 approaches were included. There was some heterogeneity, although inconsistency was low. The overall incidence of DGE was 25.6% (n = 647). Pylorus-resecting, antecolic, Billroth II with Braun enteroenterostomy was associated with the lowest rates of DGE and ranked the best in 35% of comparisons. Classic Whipple, retrocolic, Billroth II with Braun ranked the worst for DGE in 32% of comparisons. Pairwise meta-analysis of retrocolic vs antecolic route of gastro-jejunostomy found increased risk of DGE with the retrocolic route (OR 2.1, 95% CrI; 0.92 - 4.7). Pairwise meta-analysis of Braun enteroenterostomy found a trend towards lower DGE rates with Braun compared to no Braun (OR 1.9, 95% CrI; 0.92 - 3.9). Having a Braun enteroenterostomy ranked the best in 96% of comparisons. Conclusion Based on existing RCT evidence, a pylorus-resecting, antecolic, Billroth II with Braun enteroenterostomy may be associated with the lowest rates of DGE.

76: Determinants of Cerebrovascular Reserve in Patients with Significant Carotid Stenosis
more details view paper

Posted 16 Nov 2020

Determinants of Cerebrovascular Reserve in Patients with Significant Carotid Stenosis
233 downloads medRxiv surgery

Joseph P Archie

IntroductionIn patients with 70% to 99% diameter carotid artery stenosis cerebral blood flow reserve may be protective of future ischemic cerebral events. Reserve cerebral blood flow is created by brain auto-regulation. Both cerebral blood flow reserve and cerebrovascular reactivity can be measured non-invasively. However, the factors and variables that determine the availability and magnitude and of reserve blood flow remain poorly understood. The availability of reserve cerebral blood flow is a predictor of stroke risk. The aim of this study is to employ a hemodynamic model to predict the variables and functional relationships that determine cerebral blood flow reserve in patients with significant carotid stenosis. MethodsA basic one-dimensional, three-unit (carotid, collateral and brain) energy conservation fluid mechanics blood flow model is employed. It has two distinct but adjacent blood flow components with normal cerebral blood flow at the interface. In the brain auto-regulated blood flow component cerebral blood flow is maintained normal by reserve flow. In the brain pressure dependent blood flow component cerebral blood flow is below normal because cerebral perfusion pressure is below the lower threshold value for auto-regulation. Patient specific values of collateral vascular resistance are determined from a model solution using clinically measured systemic and carotid arterial stump pressures. Collateral vascular resistance curves illustrate the model solutions for reserve and actual cerebral blood flow as a function of percent diameter carotid artery stenosis and mean systemic arterial pressure. The threshold cerebral perfusion pressure value for auto-regulation is assumed to be 50 mmHg. Normal auto-regulated regional cerebral blood flow is assumed to be 50 ml/min/100g. Cerebral blood flow and reserve blood flow solutions are given for systemic arterial pressures of 80, 90, 100, 110 and 120 mmHg and for three patient specific collateral vascular resistance values, Rw = 1.0 (mean patient value), Rw = 0.5 (lower 1 SD) and Rd = 3.0 (upper 1 SD). ResultsReserve cerebral blood flow is only available when a patients cerebral perfusion pressure is in the normal auto-regulatory range. Both actual and reserve cerebral blood flows are primarily from the carotid circulation when carotid stenosis is less than 60% diameter. Between 60% and 75% stenosis the remaining carotid blood flow reserve is utilized and at higher degrees of stenosis all reserve flow is from the collateral circulation. The primary independent variables that determine actual and reserve cerebral blood flow are mean systemic arterial pressure, degree of carotid stenosis and patient specific collateral vascular resistance. Approximate 16% of patients have collateral vascular resistance greater than 5.0 and are predicted to be at high risk of cerebral ischemia or infarction with progression to severe carotid stenosis or occlusion. The approximate 50% of patients with a collateral vascular resistance less than 1.0 are predicted to have adequate cerebral blood flow with progression to carotid occlusion, and most maintain some reserve. Clinically measured values of cerebral blood flow reserve or cerebrovascular reactivity are predicted to be unreliable without consideration of systemic arterial pressure and degree of carotid stenosis. Reserve cerebral blood flow values measured in patients with only moderate 60% to 70% carotid stenosis are in general too high and variable to be of clinical value, but are most reliable when measured near 80% diameter stenosis and considered as percent of the maximum reserve blood flow. Patient specific measured reserve blood flow values can be inserted into the model to calculate the collateral vascular resistance. ConclusionsPredicting cerebral blood flow reserve in patients with significant carotid stenosis is complex and multifactorial. A simple cerebrovascular model predicts that patient specific collateral vascular resistance is an excellent predictor of reserve cerebral blood flow in patients with significant carotid stenosis. Cerebral blood flow reserve measurements are of limited value without accounting for systemic pressure and actual percent carotid stenosis. Asymptomatic patients with severe carotid artery stenosis and a collateral vascular resistance greater than 1.0 are at increased risk of cerebral ischemia and may benefit from carotid endarterectomy.

77: Pre operative fitness score accurately predicts uneventful post operative course in gastrointestinal and hepatobiliary surgery.
more details view paper

Posted 17 Apr 2020

Pre operative fitness score accurately predicts uneventful post operative course in gastrointestinal and hepatobiliary surgery.
229 downloads medRxiv surgery

BHAVIN VASAVADA, hardik patel

Background: Aim of our study was to analyze if we can acuratly predict uneventful post operative course pre operatively in gastrointestinal and HPB surgery patients so that we can better explain risk benefit ratio to the patients and prognostify the results. Material and Methods: We retrospectively evaluated patients who have undergone gastrointestinal and hepatobiliary surgery at our institute in last 3 years and analyzed 90 days mortality and morbidity rates among these patients. We described any 90 day morbidity and mortality as an event. We performed univariate and multivariate analyses for factors predicting an event. Then based on pre operative factors that predicted an event we formulated a score and then evaluated sensitivity, specificity, positive predictive and negative predictive value of that score and also evaluated ROC curve. We also performed kaplan-meier analysis for 90 days event free survival. Statistical analysis was done using SPSS version 23. Results: Total 264 patient operated for gastrointestinal and HPB surgeries between april 2016 to may 2019 were evaluated .Total 45 (17%) events occurred. On univariate analysis CDC grade, ASA score,Operative time,Blood products used, emmergency surgeries and open surgeries predicted an event.We developed score based on pre operative factors like ASA score, CDC grade of surgery,open surgery and emmergency surgeries included in the score. Each variable was given 1 point.We proposed score grater than 2 was associated with 90 day event. This score had sensitivity of 77.78%, specificity of 81.65%. low positive predictive value of 46.67% but very high negative predictive value of 94.68%. AUROC showed AUROC of 0.797 (p < 0.0001, 95 % confidence interval 0.721-0.874). Pre operative fitness score, Open Surgery and operative time independently predicted an event on multivarious analysis. (p =0.003 and 0.026 respectively.) Conclusions: Pre operative fitness score accurately predicts uneventful post operative course in gastrointestinal and hepatobiliary surgery.

78: Post operative acute kidney injury in abdominal Surgeries. A retrospective analysis of single center in western India.
more details view paper

Posted 06 Jan 2021

Post operative acute kidney injury in abdominal Surgeries. A retrospective analysis of single center in western India.
228 downloads medRxiv surgery

BHAVIN VASAVADA, Hardik Patel

AIMThe aim of our study was to evaluate the incidence and causative factors for acute kidney injury in abdominal surgeries. Material and MethodsAll the abdominal surgeries performed between April 2018 to December 2020, in our institution have been analyzed for acute kidney injury. Acute kidney injury defined according to acute kidney injury network classification. Categorical variables were evaluated by chi-square t-test or fishers t-test wherever appropriate and continuous variables by Mann Whitney U test for nonparametric data and student t-test for parametric test after skewness and kurtosis analysis. Statistical analysis was done using SPSS version 23. P< 0.05 was considered statistically significant. ResultsWe performed 402 gastrointestinal and hepatobiliary surgery from April 2018 to December 2020. After exclusion 372 patients were included in the study population. 20 patients (5.37%) were defined as having acute kidney injury according to acute kidney injury network classifications. On univariate analysis acute kidney injury was associated with open surgery (p= 0.003), Intraoperative hypotension (p<0.001), Colorectal surgeries (p<0.0001), Emergency surgery (p=0.028), CDC grade of surgery (p<0.001), increased used to blood products (p=0.001), higher ASA grade (p<0.0001), increased operative time(p<0.0001). On multivariate logistic regression analysis higher ASA grade (p<0.0001) and increased operative time (0.049) independently predicted acute kidney injury. Acute kidney injury was also significantly associated with 90 days mortality. (p= <0.0001). ConclusionPost-operative acute kidney injury was associated with significant mortality in abdominal surgery. Higher ASA grades and increased operative time predicted acute kidney injury.

79: Post-operative serum procalcitonin vs C reactive Protein as a marker of post-operative infectious complications in pancreatic surgery. A systemic review and metaanalysis.
more details view paper

Posted 09 Oct 2020

Post-operative serum procalcitonin vs C reactive Protein as a marker of post-operative infectious complications in pancreatic surgery. A systemic review and metaanalysis.
223 downloads medRxiv surgery

Bhavin Vasavada, Hardik Patel

Aim of StudyAim of this meta-analysis was to compare diagnostic accuracy of C reactive Protein and Procalcitonin between postoperative day 3 to 5 in predicting infectious complications post pancreatic surgery. MethodsSystemic literature search was performed using MEDLINE, EMBASE and SCOPUS to identify studies evaluating the diagnostic accuracy of Procalcitonin (PCT) and C-Reactive Protein (CRP) as a predictor for detecting infectious complications between postoperative days (POD) 3 to 5 following pancreatic surgery. A meta-analysis was performed using random effect model and pooled predictive parameters. Geometric means were calculated for PCT cut offs. The work has been reported in line with PRISMA guidelines. ResultsAfter applying inclusion and exclusion criteria 15 studies consisting of 2212 patients were included in the final analysis according to PRISMA guidelines. Pooled sensitivity, specificity, Area under curve and diagnostic odds ratio (DOR)for day 3 C-reactive protein was respectively 62%,67% 0.772 and 6.54. Pooled sensitivity, specificity, Area under curve and diagnostic odds ratio (DOR)for day 3 procalcitonin was respectively 74%,79%,0.8453 and 11.03. Sensitivity, specificity, Area under curve, and Diagnostic odds ratio for day 4 C-reactive protein was respectively 60%,68%, 0.8022 and 11.90. Pooled Sensitivity, specificity and Diagnostic odds ratio of post-operative day 5 procalcitonin level in predicting infectious complications were respectively 83%,70% and 12.9. Pooled Sensitivity, specificity, AUROC and diagnostic odds ratio were respectively 50%,70%, 0.777 and 10.19. ConclusionPost-operative procalcitonin is better marker to predict post-operative infectious complications after pancreatic surgeries and post-operative day 3 procalcitonin has highest diagnostic accuracy.

80: Impact of the COVID-19 pandemic on surgical procedures in Brazil: a descriptive study
more details view paper

Posted 20 Mar 2021

Impact of the COVID-19 pandemic on surgical procedures in Brazil: a descriptive study
214 downloads medRxiv surgery

Barbara Okabaiasse Luizeti, Victor Augusto Santos Perli, Gabriel da Costa, Igor Eckert, Aluisio Marino Roma, Karina Miura da Costa

Background: The COVID-19 pandemic has deeply affected medical practice, and changes in healthcare activities were needed to minimize the overload and avoid healthcare systems collapse. The aim of this study was to evaluate the impact of the pandemic on surgical procedures in Brazil. Materials and Methods: We conducted a descriptive study of the number of hospitalizations for surgical procedures in Brazil from 2016 to 2020. Data were collected from the Brazilian Department of Informatics of the Unified Health System (DATASUS). Analyzes were performed according to the type of procedure, geographical region, subgroups of surgical procedures, and the number of surgeries from 2020 were compared with the average from 2016 to 2019. Results: There were 4,009,116 hospitalizations for surgical procedures in the Brazilian Public Health System in 2020. When comparing it to the average of hospitalizations from 2016-2019, there was a decrease of 14.88% [95%IC (14.82-14.93)]. Decrease rates were 34.82% [95%IC (34.73-34.90)] for elective procedures and 1.11% [95%IC (1.07-1.13)] for urgent procedures. Decrease rates were similar in all the five regions of the country (average 14.17%). Surgical procedure subgroups with the highest decrease rates were endocrine gland surgery (48.03%), breast surgery (40.68%), oral and maxillofacial surgery (37.03%), surgery of the upper airways, face, head and neck (36.06%), and minor surgeries and surgeries of skin, subcutaneous tissue and mucosa (33.16%). Conclusion: The overload of healthcare facilities has demanded a reduction of non-urgent activities to prevent a collapse of healthcare systems, resulting in a decrease in elective surgeries. Recommendations about the performance of surgical procedures were made, and continuous refinements of these recommendations are encouraged.

Previous page 1 2 3 4 5 Next page

PanLingua

News