High Risk Of Early Complications Research Articles

Prognostic Significance of Heart Failure in Acute Pulmonary Embolism: A Comprehensive Assessment of 30-Day Outcomes.

Patients with heart failure (HF) are known to have an increased risk of pulmonary embolism (PE), but there is limited evidence regarding the prognostic implications of HF in patients with acute PE and the relationship between PE prognosis and left ventricular ejection fraction (LVEF). The primary objective of this study was the development of a composite outcome (mortality, major bleeding, and recurrence) within the first 30 days. The secondary objective was to identify the role of LVEF in predicting the development of early complications in patients with both HF and reduced LVEF. A prospective study was conducted at two tertiary hospitals between January 2012 and December 2022 to assess differences among patients diagnosed with acute PE based on the presence or absence of a history of HF. Cox regression models were employed to assess the impact of HF and reduced LVEF on the composite outcome at 30 days. Out of 1991 patients with acute symptomatic PE, 7.13% had a history of HF. Patients with HF were older and had more comorbidities. The HF group exhibited higher mortality (11.27% vs. 4.33%, p < 0.001) and a higher incidence of major bleeding (9.86% vs. 4.54%, p = 0.005). In the multivariate analysis, HF was an independent risk factor for the development of the composite outcome (HR 1.93; 95% CI 1.35-2.76). Reduced LVEF was independently associated with a higher risk of major bleeding (HR 3.44; 95% CI 1.34-8.81). In patients with acute pulmonary embolism, heart failure is independently associated with a higher risk of early complications. Additionally, heart failure with reduced LVEF is an independent risk factor for major bleeding.

Predicting early complications in patients with spinal gunshot wounds: A multicenter study

IntroductionThere is a wide variation in the clinical presentation of spinal gunshot wounds ranging from isolated minor stable fractures to extremely severe injuries with catastrophic neurological damage. Research questionwe aim to analyze the risk factors for early complications and impact of surgical treatment in patients with spinal gunshot wounds. Material and methodsThis is a multicentre retrospective case-control study to compare patients with spinal gunshot wounds who had early complications with those who did not. The following matching criteria were used: sex (1:1), injury level (1:1) and age (±5 years). Univariate and multivariate analyses were performed using logistic regression. ResultsResults: Among 387 patients, 36.9 % registered early complications, being persistent pain (n = 32; 15 %), sepsis/septic shock (n = 28; 13 %), pneumonia (n = 27; 13 %) and neurogenic bladder (n = 27; 12 %) the most frequently reported. After case-control matched analysis, we obtained 133 patients who suffered early complications (cases) and 133 patients who did not as control group, not differing significantly in sex (p = 1000), age (p = 0,535) and injury level (p = 1000), while the 35 % of complications group required surgical treatment versus 15 % of the non-complication group (p < 0.001). On multivariable analysis, significant predictors of complications were surgical treatment for spinal injury (OR = 3.50, 95 % CI = 1.68–7.30), dirty wound (3.32, 1.50–7.34), GCS ≤8 (3.56, 1.17–10.79), hemodynamic instability (2.29, 1.07–4.88), and multiple bullets (1.97, 1.05–3.67). Discussion and conclusionSpinal gunshot wounds are associated with a high risk of early complications, especially when spinal surgery is required, and among patients with dirty wound, low level of consciousness, hemodynamic instability, and multiple bullets.

Knee Arthrodesis: An Analysis of Surgical Risk Factors and Complications Using a National Database.

Knee arthrodesis is predominantly a salvage procedure. In present time, knee arthrodesis is mostly considered for cases of unreconstructable failed total knee arthroplasty after prosthetic joint infection or trauma. Knee arthrodesis has shown better functional outcomes than amputation for these patients but has a high complication rate. The purpose of this study was to characterize the acute surgical risk profile of patients undergoing a knee arthrodesis for any indication. The American College of Surgeons National Surgical Quality Improvement Program database was queried to determine 30-day outcomes after knee arthrodesis between 2005 and 2020. Demographics, clinical risk factors, and postoperative events were analyzed, along with reoperation and readmission rates. A total of 203 patients that underwent a knee arthrodesis were identified. Forty-eight percent of patients had at least 1 complication. The most common complication was acute surgical blood loss anemia requiring a blood transfusion (38.4%), followed by organ space surgical site infection (4.9%), superficial surgical site infection (2.5%), and deep vein thrombosis (2.5%). Smoking was associated with higher rates of reoperation and readmission (odds ratio 9, P < .01, and odds ratio 6, P < .05). Overall, knee arthrodesis is a salvage procedure that has a high rate of early postoperative complications and is most often performed in patients at higher risk. Early reoperation is strongly associated with a poor preoperative functional status. Smoking places patients at higher risk of early complications.

MP50-10 EVALUATION AND RISK FACTOR ANALYSIS OF COMPLICATIONS OF INGUINAL LYMPH NODE DISSECTION IN A LARGE MULTI-DISCIPLINARY COHORT

You have accessJournal of UrologyCME1 Apr 2023MP50-10 EVALUATION AND RISK FACTOR ANALYSIS OF COMPLICATIONS OF INGUINAL LYMPH NODE DISSECTION IN A LARGE MULTI-DISCIPLINARY COHORT Manon Vreeburg, Judith Quik, Hielke-Martijn De Vries, Winan Van Houdt, Yvonne Schrage, Henry Zijlmans, Henk Van Der Poel, and Oscar Brouwer Manon VreeburgManon Vreeburg More articles by this author , Judith QuikJudith Quik More articles by this author , Hielke-Martijn De VriesHielke-Martijn De Vries More articles by this author , Winan Van HoudtWinan Van Houdt More articles by this author , Yvonne SchrageYvonne Schrage More articles by this author , Henry ZijlmansHenry Zijlmans More articles by this author , Henk Van Der PoelHenk Van Der Poel More articles by this author , and Oscar BrouwerOscar Brouwer More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003298.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Inguinal lymph node dissection (ILND) is an essential part of treatment in patients with lymph node metastases from penile cancer (PeCa), vulvar cancer (VC) and malignant melanoma (MM). However, ILND is associated with high complication rates. To our knowledge, no studies have evaluated complications in such a large cohort, across specialties. Therefore, the aim of this study is to assess the incidence and nature of postoperative complications after ILND and to identify potential predictors associated with the occurrence of complications in PeCa, VC and MM patients. METHODS: In total, we retrospectively evaluated 324 patients (PeCa n=114, VC n=48 and MM n=162) who underwent 342 ILNDs in 381 groins between 2017 and 2021 in a single high-volume center. Template and operative technique was the same. The main difference between the 3 indications was their postoperative drainage management. In PeCa and MM a time-controlled drainage protocol is applied (removal 3 days after surgery) while in VC, the drain is removed when drain production is <50 ml (or after 30 days). Early (<30 days) and late (30-90-days) postoperative complications were collected. Uni- and multivariate logistic regression were used to identify risk factors for early and late complications per groin. RESULTS: In total, 837 complications were reported, of which 3.8% required surgical (open) revision and 21% required drainage. The most occurring complications were wound infection (33.3%) and lymphocele (31.8%). 335 groins (88.4%) developed ≥1 early complications of which lymphocele formation (43.4%) was the most common. Obesity (OR 2.81), higher drain production (OR 1.50) were significantly associated with a higher risk of early complications whilst volume-controlled drain removal (OR 0.95) with less complications. Between 30 to 90 days postoperatively, 188 groins (50.4%) developed ≥1 late complications, of which wound infection (45.9%) was the most frequently occurring. Obesity (OR 1.8), volume-controlled drain removal (OR 1.05) were significantly associated with a higher risk of late complications. CONCLUSIONS: Although ILND is associated with a high risk of complications, only 3.8% required surgical revision. While some of the identified risk factors cannot be easily influenced (e.g. obesity), postoperative drain management seems to be an important consideration. In this large cohort, volume-controlled drainage resulted in less (early) lymphocele formation, but was associated with more (late) wound infections. Source of Funding: No conflicts of interest to declare © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e688 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Manon Vreeburg More articles by this author Judith Quik More articles by this author Hielke-Martijn De Vries More articles by this author Winan Van Houdt More articles by this author Yvonne Schrage More articles by this author Henry Zijlmans More articles by this author Henk Van Der Poel More articles by this author Oscar Brouwer More articles by this author Expand All Advertisement PDF downloadLoading ...

Comparison of comfort and complications of Implantable Venous Access Port (IVAP) with ultrasound guided Internal Jugular Vein (IJV) and Axillary Vein/Subclavian Vein (AxV/SCV) puncture in breast cancer patients: a randomized controlled study

BackgroundAxillary vein/subclavian vein (AxV/SCV) and Internal jugular vein (IJV) are commonly used for implantable venous access port (IVAP) implantation in breast cancer patients for chemotherapy. Previous research focused on comparison of complications while patient comfort was ignored. This study aims to compare patient comfort, surgery duration and complications of IVAP implantation between IJV and AxV/SCV approaches.MethodsTwo hundred forty-eight breast cancer patients were enrolled in this randomized controlled study from August 2020 to June 2021. Patients scheduled to undergo IVAP implantation were randomly and equally assigned to receive central venous catheters with either AxV /SCV or IJV approaches. All patients received comfort assessment using a comfort scale table at day 1, day 2 and day 7 after implantation. Patient comfort, procedure time of operation as well as early complications were compared.ResultsPatient comfort was significantly better in the AxV/SCV group than that of IJV group in day 1 (P < 0.001), day 2 (P < 0.001) and day 7(P = 0.023). Procedure duration in AxV/SCV group was slightly but significantly shorter than IJV group (27.14 ± 3.29 mins vs 28.92 ± 2.54 mins, P < 0.001). More early complications occurred in AxV/SCV group than IJV group (11/124 vs 2/124, P = 0.019). No difference of complications of artery puncture, pneumothorax or subcutaneous hematoma between these two groups but significantly more catheter misplacement in AxV/SCV group than IJV group (6/124 vs 0/124, P = 0.029). Absolutely total risk of complications was rather low in both groups (8.87% in AxV/SCV group and 1.61% in IJV group).ConclusionsOur study indicates that patients with AxV/SCV puncture have higher comfort levels than IJV puncture. AxV/SCV puncture has shorter procedure duration but higher risk of early complications, especially catheter misplacement. Both these two approaches have rather low risk of complications. Consequently, our study provides an alternative choice for breast cancer patients to reach better comfort.

Complications and reoperations related to tension band wiring and plate osteosynthesis of olecranon fractures.

Olecranon fractures are common and usually treated operatively either by tension band wiring (TBW) or plate fixation (PF). The aim of this study was to assess early complications and reoperations and their predictive factors related to those operative methods. A retrospective analysis of all patients with an operatively treated olecranon fracture between 2007 and 2017 at Turku University hospital was performed. Reoperations, postoperative complications, and potential risk factors for these were recorded. A total of 434 patients (387 TBW and 47 PF) were identified. There was no statistically significant difference in the rate of early complications (49% vs. 62%, P = .262) or reoperations (38% vs. 53%, P = .079) between patients treated with TBW and PF. In the TBW group, the intramedullary placement of Kirschner (K)-wires predisposed patients to complications compared to transcortical placement of the K-wires according to multivariate analysis (odds ratio [OR] 1.94, P = .026). Younger age was associated with the frequency of reoperations, the odds decreasing 24% for every 10 years of age (P < .001). Further, patients with high-energy trauma mechanisms were reoperated more often compared to patients with low-energy trauma (OR 2.99, P = .002). Also, excellent postoperative reduction was associated with higher reoperation rate than good or fair reduction (OR 0.48, P = .033). There is a high risk of early complications and reoperations associated to both TBW and PF. Transcortical positioning of K-wires may reduce the rate of complications in TBW.

Bloodstream Infection Survey in High-Risk Oncology Patients (BISHOP): Preliminary Report

IntroductionBloodstream bacterial infections are a potentially life-threatening complication of cytotoxic chemotherapy, with approximately 10 to 25% of febrile neutropenic (FN) patients having a positive blood culture taken at the time of first fever during neutropenia (Liu et al ., 2011; Gustinett, Mikulska 2016). Empiric antibiotic therapy started promptly at onset of fever and neutropenia will reduce morbidity and mortality and is standard of care. The choice of empiric antibiotics depends on the prevailing bacterial pathogens in a given at-risk population. Accordingly, it is essential know the patterns of bacterial types and antibiotic susceptibilities in the population at risk, especially in the global context of rising bacterial resistance to common antibiotics. Currently, no such data exists from the United States; a national survey of bloodstream isolates from cancer patients was last published in 2003(Wisplinghoff et al ., 2003). The BISHOP study aims to generate a geographically broad data set describing bloodstream isolate epidemiology, antibiotic susceptibility and clinical outcomes of bacteremias in patients with hematologic malignancies (HM) or undergoing allogeneic or autologous HSCT in the United States.MethodsFifteen geographically diverse US cancer centers that perform at least 100 HSCTs yearly are participating, starting from December 2016. Patients are consecutively enrolled at each center if they have a documented bacterial bloodstream infection at the time of first fever and neutropenia within 14 days of receiving cytotoxic chemotherapy for treatment of HM or in preparation for HSCT. Bacterial isolates are shipped to the central lab (UNMC) and frozen; microtiter antibiotic susceptibility testing will be performed in the future. Clinical data collected electronically include patient demographics, clinical course over first 24 hours, empiric antibiotic treatments and outcomes at 30 days. Target collection is 720 bacterial isolates over 18 months.ResultsEleven of 15 participating centers enrolled 187 patients (chemo only 127, HSCT 60), with 213 bacterial bloodstream isolates in the first 8 months of study (Table 1). There were 49% gram negative isolates, with E.coli (22%), Klebsiella pneumoniae (7.5%) and Pseudomonas aeruginosa (7.5%) predominating. Among gram positives (46%) , Viridans group streptococci (21.6%), coagulase negative staphylococci (7.0%) and methicillin-resistant Staph aureus (MRSA) (5.2%), predominated. Anaerobes accounted for 5% of isolates. Table 2 shows types of bacteremias in the 187 patients, with about equal proportions of single gram negative and gram positive isolates. Full susceptibility data have not yet been collated. Ninety seven patients (chemo only 63, HSCT: 19 allo,15 auto) have clinical data available for the initial 24 hours after presentation: 39% were female, median age 59 years (23-73 y), median ANC 0 cells/ul (0-430). Underlying primary diagnoses were AML 59%, NHL 12%, MM 10%, ALL 6%, MDS 3% HL 2%, and other 7%. Antibiotic prophylaxis prior to onset of FN was given in 61%. Complicated presentations were mucositis 29%, pneumonia 13%, altered mental status 7% or hypotension/pressor requirement 9%. Empiric antibiotics included cefepime 58%, pip-tazobactam 19% ,meropenem 10%, ceftazidime 4%, aztreonam 4%, doripenem (1%) and Other 4 %. Vancomycin and tobramycin were included in the initial regimen in 41% and 3% respectively. Median MASCC score was 21 (6-26). Median Pitt bacteremia score was 1.0 (0-7). There were no deaths within the first 24 hours after presentation.ConclusionThe initial data from the BISHOP survey is described here, representing the largest multicenter profile of bloodstream infections among patients with HM or HSCT collected in the US. Gram negative and positive organisms are distributed equally, with E.coli and viridans group streptococci most commonly isolated. MASCC and Pitt score on presentation did not indicate that this patient cohort was at high risk for early complications (first 24h). Susceptibility data, when available, may inform empiric antibiotic choices. Notably, no patients died within the first 24 hours after presentation indicating that current empiric therapy strategies are generally successful in the early period of fever and neutropenia. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Assessment of interleukin 17 and transforming growth factor-beta 1 in hepatitis C patients with disease progression.

Hepatitis C virus (HCV) infection in Egypt is the most serious health problem. Identifying HCV-positive persons at high risk of early complications can help prioritize treatment decisions. Recently, attention has been directed to non-invasive, accurate alternatives using serum biochemical markers. The transforming growth factor β 1/interleukins pathway plays an important role in the process of cell injury and inflammation. Thus, TGF-β1 and IL-17 were assessed in serum of chronic HCV patients with correlation to hepatic inflammatory and fibrotic status. The quantitative serum levels of TGF-β1 and IL-17 were analyzed among chronic hepatitis C (CHC) patients (n=75) and normal control (NC) subjects (n=15). Disease severity in patients was assessed using the Child-Pugh scores and METAVIR. Serum levels of TGF-β1 and IL-17 were significantly increased in HCV patients compared to control group. Furthermore, the levels of TGF-β1 and Il-17 were positively correlated to serum transaminases and alpha-fetoprotein and they were negatively correlated with serum albumin and platelets. Additionally, the serum levels of TGF-β1 and Il-17 were associated with inflammation grades and stages of liver fibrosis. TGF-β1 and IL-17 may be hopeful serum biomarkers concerned in the progression of liver inflammation and fibrosis accompanying chronic HCV infection. Therefore, they could be used in the future as targets for anti-fibrotic therapy of chronic HCV to ameliorate the disease progress.

Machine Learning Algorithm Identifies Patients at High Risk for Early Complications After Intracranial Tumor Surgery: Registry-Based Cohort Study.

Reliable preoperative identification of patients at high risk for early postoperative complications occurring within 24 h (EPC) of intracranial tumor surgery can improve patient safety and postoperative management. Statistical analysis using machine learning algorithms may generate models that predict EPC better than conventional statistical methods. To train such a model and to assess its predictive ability. This cohort study included patients from an ongoing prospective patient registry at a single tertiary care center with an intracranial tumor that underwent elective neurosurgery between June 2015 and May 2017. EPC were categorized based on the Clavien-Dindo classification score. Conventional statistical methods and different machine learning algorithms were used to predict EPC using preoperatively available patient, clinical, and surgery-related variables. The performance of each model was derived from examining classification performance metrics on an out-of-sample test dataset. EPC occurred in 174 (26%) of 668 patients included in the analysis. Gradient boosting machine learning algorithms provided the model best predicting the probability of an EPC. The model scored an accuracy of 0.70 (confidence interval [CI] 0.59-0.79) with an area under the curve (AUC) of 0.73 and a sensitivity and specificity of 0.80 (CI 0.58-0.91) and 0.67 (CI 0.53-0.77) on the test set. The conventional statistical model showed inferior predictive power (test set: accuracy: 0.59 (CI 0.47-0.71); AUC: 0.64; sensitivity: 0.76 (CI 0.64-0.85); specificity: 0.53 (CI 0.41-0.64)). Using gradient boosting machine learning algorithms, it was possible to create a prediction model superior to conventional statistical methods. While conventional statistical methods favor patients' characteristics, we found the pathology and surgery-related (histology, anatomical localization, surgical access) variables to be better predictors of EPC.

Weekend effect on early allograft outcome after kidney transplantation- a multi-centre cohort study.

Weekend surgery may be associated with a higher risk of early complications, but the effect of the timing of kidney transplant surgery on early allograft outcome remains uncertain. The aim of this study is to evaluate whether the association between weekend transplant surgery and allograft failure was modified by prevalent vascular disease. Using data from the Australia and New Zealand Dialysis and Transplant registry, we examined the association between weekend status and 90-day and 1-year allograft failure in deceased donor transplant recipients between 1994-2012. Two-way interaction between vascular disease and weekend status was examined. Of 6622 recipients, 1868 (28.2%) received transplants during weekends. Compared with weekday transplants, weekend transplants were associated with an adjusted hazard ratio (HR) for 90-day and 1-year allograft failure of 0.99 (0.78-1.25; P = 0.917) and 0.93 (0.76-1.13, P = 0.468), respectively. There was a significant interaction between prevalent vascular disease and weekend status for 90-day allograft failure (Pinteraction = 0.008) but not at 1-year, such that patients with vascular disease were more likely to experience 90-day allograft failure if transplanted on weekend (versus weekdays), particularly failures secondary to vascular complications. Timing of transplantation does not impact on allograft outcome, although those with vascular disease may benefit from more intensive post-transplant follow-up for potential vascular complications.

CORR Insights®: Revisions of Modular Metal-on-metal THA Have a High Risk of Early Complications.

CORR Insights®: Revisions of Modular Metal-on-metal THA Have a High Risk of Early Complications.

Early and late puerperal complications associated with the mode of delivery in a cohort in Brazil.

The rates of cesarean section births significantly increased in Brazil and worldwide in recent years; and along with them, the interest in studying the complications related to this procedure. To assess the early and late maternal complications associated with the mode of delivery in up to six years after labor. This is a prospective cohort study that followed all births in the city of Pelotas, in Southern Brazil (4,244 mothers) in 2004, for a period of 6 years. Descriptive analyses and the association between the outcome and mode of delivery were performed. The control for potential confounding factors was performed using Poisson regression with robust error variance. About half (44.9%) of the women underwent cesarean section. Cesarean sections were associated with a 56% higher risk of early complications, 2.98 times higher risk of postpartum infection, 79% higher risk of urinary tract infection, 2.40 times higher risk of pain, 6.16 times higher risk of headaches, and 12 times higher risk of anesthetic complications compared to the vaginal delivery. Cesarean section was a protection factor against the presence of hemorrhoids. The mode of delivery was not associated with any of the late complications studied. Due to the risk of associated complications, cesarean sections should be performed with caution, when their benefits outweigh the risks.

A Longitudinal Population Analysis of Cumulative Risks of Circumcision

BackgroundCircumcision is widely accepted for newborns in the United States. However, circumcision carries a risk of complications, the rates of which are not well described in the contemporary era. MethodsWe performed a longitudinal population analysis of the California Office of Statewide Health Planning and Development database between 2005 and 2010. Using International Classification of Procedures, Ninth Revision, Clinical Modification and Current Procedural Terminology codes, we calculated early and late complication rates by Kaplan–Meier survival estimates. Late complications were defined as those that occurred between 30 d and 5 y after circumcision. Descriptive analysis of complications was obtained by analysis of variance, chi-square test, or log-rank test. On adjusted analysis, a Cox proportional hazard model was performed to determine the risk of early and late complications, adjusting for patient demographics. ResultsA total of 24,432 circumcised children under age 5 y were analyzed. Overall, cumulative complication rates over 5 y were 1.5% in neonates, 0.5% of which were early, and 2.9% in non-neonates, 2.2% of which were early. On adjusted analysis, non-neonates had a higher risk of early complications (OR 18.5). In both neonates and non-neonates, the majority of patients with late complications underwent circumcision revision. ConclusionsCircumcision has a complication rate higher than previously recognized. Most patients with late complications after circumcision received an operative circumcision revision. Clinicians should weigh the surgical risks against the reported medical benefits of circumcision when counseling parents about circumcision.

Primary Total Hip Arthroplasty for Charcot Arthropathy is Associated With High Complications but Improved Clinical Outcomes

BackgroundNeuropathic (Charcot) arthropathy of the hip is rare but can lead to joint destruction, bone loss, and dysfunction. While total hip arthroplasty (THA) may be considered a treatment option, only very limited data in the form of case reports are available on the results of THA. The goal of this study was to analyze the outcomes of primary THA for Charcot arthropathy with emphasis on implant survivorship, complications, and clinical outcomes. MethodsEleven patients undergoing 12 primary THAs for Charcot arthropathy from 2007 to 2014 were retrospectively reviewed. All patients had a severe underlying neuropathy and clear radiographic evidence of Charcot arthropathy. Mean age was 54 years with 4 patients being female. Mean follow-up was 5 years. ResultsSurvivorship free of any revision was 75% at both 2 and 5 years. Three THAs (3/12) were revised: 2 for recurrent instability and 1 for femoral component loosening. Survivorship free of any reoperation was 67% at both 2 and 5 years. One additional THA underwent open reduction and internal fixation of a Vancouver B1 periprosthetic fracture. The overall complication rate (including revisions and reoperations) was high at 58% with 3 recurrent dislocations, 2 periprosthetic fractures, 1 femoral component loosening, and 1 delayed wound healing. Harris Hip Scores improved from a mean of 43 preoperatively to 81 postoperatively (P < .001). ConclusionIn this study, the largest to date, we found that patients undergoing primary THA for Charcot arthropathy have a significant improvement in clinical outcomes but that there was a high risk of early complications and revisions, mostly related to recurrent instability. Specific precautions to avoid early complications, namely utilization of components that provide robust fixation and strategies that provide enhanced hip stability, should be considered. Level of EvidenceLevel IV.

Ten-Year Review of Perioperative Complications After Transurethral Resection of Bladder Tumors: Analysis of Monopolar and Plasmakinetic Bipolar Cases.

To evaluate the rate of perioperative complications after plasmakinetic bipolar and monopolar transurethral resection of bladder tumor (BTURB and MTURB). In addition, the study identifies patient and procedure characteristics associated with early complications. Retrospective review was conducted on patients undergoing transurethral resection of bladder tumor procedures at a single institution from 2003 to 2013 to assess the 30-day complication rates associated with BTURB and MTURB. Four hundred twenty-seven patients met inclusion criteria and underwent 586 procedures (379 BTURB and 207 MTURB). Baseline patient demographics, tumor stage, and tumor grade were similar in BTURB and MTURB cohorts. The overall complication rate was 34.3% for MTURB and 26.7% for BTURB. The most frequent complications were acute urinary retention (AUR) 11%, hematuria 8%, and urinary tract infection (UTI) 7%. There was no statistical difference in rates of AUR, hematuria, UTI, or readmission for continuous bladder irrigation or hemostasis procedures between BTURB and MTURB cohorts. There was a trend toward lower perforation rate during BTURB (2.6% vs 5.8%). In multivariate logistic regression analysis, MTURB, male gender, and large resections were predictive of overall complications. Male gender was associated with hematuria and AUR. Large bladder tumor resection size was also associated with increased risk of overall complications and AUR. BTURB was associated with a lower risk of overall complications, but there was no difference in the rate of hematuria in the two cohorts. Male gender and large tumor size are associated with higher risk of early complications.

Comparing Child-Pugh, MELD, and FIB-4 to Predict Clinical Outcomes in Hepatitis C Virus-Infected Persons: Results From ERCHIVES.

Identifying hepatitis C virus (HCV)-positive persons at high risk of early complications can help prioritize treatment decisions. We conducted this study to compare Child-Turcotte-Pugh (CP), MELD, and FIB-4 scores for predicting clinical outcomes and to identify those at low risk of complications. Within electronically retrieved cohort of HCV-infected veterans, we identified HCV-positive persons and excluded those with human immunodeficiency virus (HIV), hepatitis B surface antigen (HBsAg), prevalent hepatic decompensation (HD), hepatocellular carcinoma (HCC), and those treated for HCV. We calculated incidence rates for HD, HCC, and all-cause mortality at 1, 3, and 5 years after HCV diagnosis. Using receiver operating characteristic (ROC) curves, we determined the optimal cut-off values for each score for these outcomes. Among 21 116 persons evaluated, 89.7% were CP Class-A, 79.9% had MELD<9, and 43.4% had FIB-4<1.45. AUROC for HD at 1, 3, and 5 years was higher for FIB-4 (0.84-0.86) compared with MELD (0.70-0.76) (P < .001). AUROC for HCC at 1, 3, and 5 years was 0.81-0.82 for FIB-4 but 0.61-0.68 for CP and MELD scores. (P < .001) AUROC for all-cause mortality at 3 and 5 years was 0.65-0.68. The optimal cut-off scores to identify persons at low risk of complications were as follows: CP <5; MELD <8; FIB-4 <3 for HD and HCC, and <2 for all-cause mortality, below which <1.5% developed HD and HCC and ≤2.5% died at 3 years. FIB-4 score is a better predictor of HD and HCC in HCV-positive persons. A score of <3 is associated with a low risk of HD and HCC 1 and 3 years after HCV diagnosis.

Pulmonary embolism in old age: usefulness of risk stratification in clinical decision-making

Pulmonary embolism (PE) is a common disease with a not negligible short-term risk of death, in particular in the elderly. An adequate evaluation of the prognosis in patients with PE may guide decision-making in terms of the intensity of the initial treatment during the acute phase. Patients with shock or persistent hypotension are at high risk of early mortality and may benefit from immediate reperfusion. Several tools are available to define the short-term prognosis of hemodynamically stable patients. The pulmonary embolism severity index (PESI) score, and the simplified PESI score are particularly useful for identifying patients at low risk of early complications who might be safely treated at home. The identification of patients who are hemodynamically stable at diagnosis but are at a high risk of early complications is more challenging. Current guidelines recommend a multi-parametric prognostic algorithm based on the clinical status, biomarkers and imaging tests. However an aggressive treatment in hemodynamically stable patients is still controversial.

Revision of ceramic fracture with ceramic-on-polyethylene in total hip arthroplasty: Medium-term results

There is no consensus on the bearing of choice in revision for ceramic fracture after total hip arthroplasty (THA). The aim of this study was to evaluate the outcomes using ceramic‐on‐polyethylene (CoP) articulation in revision for ceramic breakage. Twelve patients who underwent revision hip surgery between 2002 and 2013 were followed-up. Appropriate surgical technique, including accurate synoviectomy, was used. The cup and the head were changed in four patients and only the liner and the head were replaced in the remaining eight patients. At the final follow-up there were no cases of re-revision due to tribological reasons, and only one case of polyethylene (PE) wear and osteolysis was scheduled for a new revision because of clear cup malposition. Complications were four cases of dislocation, one case of loosening and one case of infection. Revision of fractured ceramic is a challenging situation with a high risk of early complications. Using CoP liners with accurate synoviectomy and correction of misalignment can be considered a valuable bearing option at medium‐term follow-up.

How to predict short- and long-term mortality in patients with pulmonary embolism?

Pulmonary embolism (PE) is a common disease with a considerable short- and long-term risk of death. An adequate evaluation of the prognosis in patients with PE may guide decision making in terms of the intensity of the initial treatment during the acute phase, duration of treatment, and intensity of follow-up control visits in the long term. Patients with shock or persistent hypotension are at high risk of early mortality and may benefit from immediate reperfusion. Several tools are available to define the short-term prognosis of hemodynamically stable patients. The Pulmonary Embolism Severity Index (PESI) score, simplified PESI score, and N-terminal pro-B-type natriuretic peptide levels are particularly useful for identifying patients at low risk of early complications who might be safely treated at home. However, the identification of patients who are hemodynamically stable at diagnosis but are at a high risk of early complications is more challenging. The current guidelines recommended a multiparametric prognostic algorithm based on the clinical status and comorbidities. Unfortunately, only a few studies have evaluated the role of risk factors potentially affecting the long-term prognosis of these patients. The available studies suggest a potential role of the PESI score and troponin levels evaluated at the time of an index event. However, further studies are warranted to confirm these preliminary findings and to identify other long-term prognostic factors in this setting.

Systematic review of central pancreatectomy and meta-analysis of centralversusdistal pancreatectomy

Central pancreatectomy (CP) is a parenchyma-sparing surgical procedure that enables the removal of benign and/or low-grade malignant lesions from the neck and proximal body of the pancreas. The aim of this review was to evaluate the short- and long-term surgical results of CP from all published studies, and the results of comparative studies of CP versus distal pancreatectomy (DP). Eligible studies published between 1988 and 2010 were reviewed systematically. Comparisons between CP and DP were pooled and analysed by meta-analytical techniques using random- or fixed-effects models, as appropriate. Ninety-four studies, involving 963 patients undergoing CP, were identified. Postoperative morbidity and pancreatic fistula rates were 45·3 and 40·9 per cent respectively. Endocrine and exocrine pancreatic insufficiency was reported in 5·0 and 9·9 per cent of patients. The overall mortality rate was 0·8 per cent. Compared with DP, CP had a higher postoperative morbidity rate and a higher incidence of pancreatic fistula, but a lower risk of endocrine insufficiency (relative risk (RR) 0·22, 95 per cent confidence interval 0·14 to 0·35; P < 0·001). The risk of exocrine failure was also lower after CP, although this was not significant (RR 0·59, 0·32 to 1·07; P = 0·082). CP is a safe procedure with good long-term functional reserve. In situations where DP represents an alternative, CP is associated with a slightly higher risk of early complications.