Incidence Of Major Complications Research Articles

Safety and Feasibility of 3D Intracardiac Echocardiography in Guiding Left AtrialAppendage Occlusion With WATCHMAN FLX.

Intracardiac echocardiography (ICE) is an alternative to transesophageal echocardiography to guide left atrial appendage occlusion (LAAO). However, 2-dimensional ICE has important limitations that hinder its adoption in routine practice. This prospective multicenter study (NCT04569734) investigated the feasibility and safety of ICE-guided LAAO with Watchman FLX using a novel 3-dimensional ICE catheter (VeriSight Pro, Philips). A total of 100 patients undergoing LAAO with the Watchman FLX device were recruited. All cases were performed under moderate sedation. A simplified 2 orthogonal view ICE imaging protocol was adopted to assess PASS (position, anchoring, sizing, and sealing) criteria. The feasibility endpoint was successful implantation of the FLX device and adequate seal (peri-device leak<5mm) at 45days. The safety endpoint was the incidence of major complications at 7 and 45days. Physician experience and imaging quality scores were collected (1=lowest, 5=highest). The mean age was 77.0±8.1years, and 39 (39%) were women. CHA2DS2-VASc score was 4.8±1.5 and HAS-BLED score was 3.2±1.1. Total procedural time was 54±25minutes. Mean contrast volume was 41±46ml, with no contrast used in 16 patients. The feasibility endpoint was achieved in 95 patients (95%); 4 patients were not implanted due to unsuitable anatomy, and 1 patient had a leak >5mm at 45days. There was 1 periprocedural stroke and 2 gastrointestinal bleeds requiring transfusion at 7days with no other major complications. Physicians' rating of overall ICE imaging quality was 4.6±0.6. The novel 3-dimensional ICE VeriSight Pro Probe can safely and effectively guide LAAO with Watchman FLX using a simplified imaging protocol.

Perioperative respiratory complications in intracapsular tonsillectomy and total tonsillectomy: Is there a difference?

The primary objective was to determine any difference in perioperative respiratory complications in children undergoing intracapsular tonsillectomy versus those undergoing total tonsillectomy for sleep-disordered breathing or obstructive sleep apnea. All children undergoing total tonsillectomy from November 2015 to December 2017 and intracapsular tonsillectomy from May 2016 to July 2020 for sleep-disordered breathing or obstructive sleep apnea were included in the study. 2408 patients underwent total tonsillectomy whereas 410 patients underwent intracapsular tonsillectomy. The incidence of major respiratory complications was 13.9% for intracapsular tonsillectomy and 8.9% for total tonsillectomy in an unmatched cohort and 13.8% for intracapsular tonsillectomy and 10.5% for total tonsillectomy in a matched cohort. Surgical technique was not significant for both major (OR:0.969, 95% CI:0.596-1.573, p=0.8979) and minor (OR 0.9, 95% CI:0.431-1.878, p=0.7785) respiratory complications in the unmatched cohort and also not significant for major (OR:0.996, 95% CI:0.353 2.809, p=0.9944) and minor (OR:1.5, 95% CI:0.66-3.612, p=0.31) respiratory complications in the matched cohort. Factors associated with an increased incidence of major perioperative respiratory complications in the unmatched cohort included race (Black or African American) (OR:1.768, 95% CI:1.298-2.409, p=0.0038), reactive airway disease (OR:1.814, 95% CI:1.39-2.367, p=<0.0001), and an upper respiratory infection (OR:1.631, 95% CI:1.095-2.431, p=0.0161) whereas reactive airway disease (OR:3.596,95% CI:1.217-10.621, p=<0.0206), an upper respiratory infection (OR:5.779, 95% CI:1.392-23.99, p=0.0157), and the presence of obstructive sleep apnea (OR:4.174, 95% CI:1.242-14.025, p=0.0208) were significant in the matched cohort. There was no difference in perioperative respiratory complications in children undergoing intracapsular tonsillectomy versus total tonsillectomy.

Data-Driven Estimated Glomerular Filtration Rate Strata Predict 90-Day Major Complications Following Total Knee Arthroplasty in Patients With Chronic Kidney Disease.

Lower estimated glomerular filtration rate (eGFR) in patients who have chronic kidney disease (CKD) is associated with increased risk of complications following total knee arthroplasty (TKA). However, there is a lack of literature that identifies eGFR levels those are associated with notable differences in risk of these complications. The purpose of this study was to create eGFR strata for CKD patients that are associated with varying risks of 90-day major complications following TKA. Nondialysis patients who have CKD and known eGFR levels one month before primary TKA were identified using a national database. Stratum-specific likelihood ratio (SSLR) analysis was used to construct data-driven eGFR strata associated with varying risks of 90-day major complications. The incidence rates were recorded for each stratum. Each stratum was propensity score matched to the highest eGFR stratum. The risk ratio with a corresponding 95% confidence interval for 90-day major complications was recorded for each stratum. A total of 24,895 patients with CKD who underwent TKA were included in this study. SSLR identified four data-driven eGFR strata: 15-31, 32-44, 45-54, and 55+. The unmatched 90-day major complication incidence increased sequentially as the eGFR strata decreased: 55+ (10.72%), 45-54 (13.87%), 32-44 (17.30%), and 15-31 (25.16%). When compared with the matched highest eGFR strata (55+), the risk of sustaining a 90-day major complication increased sequentially as the eGFR strata decreased (RR: 1.27, 1.56, 2.06, P < 0.001). The risk of death within 90 days was higher in the 15-31 stratum (RR: 3.08, P < 0.001) when compared with the matched 55+ stratum. Using SSLR analysis, four data-driven strata were identified with varying risks of 90-day major complications following TKA. These eGFR thresholds were created specifically for TKA and can therefore be appropriately used to risk-stratify CKD patients in the preoperative setting when discussing TKA.

Endomyocardial Biopsy: short- and long-term safety in myocarditis patients.

To assess the short-term and long-term outcomes of percutaneous endomyocardial biopsy (EMB) in patients with myocarditis and to identify the risk factors for EMB-related complications in this patient population. A retrospective analysis was conducted on 294 hospitalized patients with clinically suspected myocarditis at Tongji Hospital from October 2019 to October 2023, with a median follow-up duration of 18 months. Patients were divided into an EMB group (n = 151) and a non-EMB group (n = 143) based on whether they underwent EMB procedure. The incidence of endpoints was compared between the two groups, and the Kaplan-Meier survival curve was used to assess the survival rate without endpoints. Endpoints included major adverse cardiovascular events (MACE), ventricular enlargement, and decline in cardiac function. Multivariate logistic regression analysis was employed to evaluate the risk factors for EMB-related complications. The incidence of major short-term complications following EMB was 2.0% (3/151), while the incidence of minor complications was 9.3% (14/151). Multivariate risk regression analysis revealed that operative duration (OR: 1.101, 95% CI: 1.02-1.079, p < 0.05) and BNP levels (OR: 1.083, 95% CI: 0.931-1.26, p < 0.05) were associated with short-term complications following EMB. Compared to the non-EMB group, the EMB group had no significant increase in hospital stay (10 [8, 15] vs. 9 [7, 16], p = 0.27) and no significant decline in cardiac function. Long-term follow-up results showed that 8 patients (5.3%) in the EMB group experienced MACE, 14 patients (9.3%) had left ventricular enlargement, and 18 patients (11.9%) had a decline in left ventricular ejection fraction (LVEF) after discharge; in the non-EMB group, 12 patients (8.4%) experienced MACE, 30 patients (19.9%) had left ventricular enlargement, and 18 patients (11.9%) had a decline in LVEF after discharge. The Kaplan-Meier curve revealed a lower incidence of endpoint events in the EMB group (p < 0.05). In patients with myocarditis, EMB is associated with a risk of short-term complications, with higher levels of BNP and operative duration being independent risk factors for EMB-related complications. However, EMB does not adversely affect cardiac function or hospital stay during the inpatient period and may contribute to the improvement of long-term outcomes in patients with myocarditis.

Incidence of Thrombotic Complications in COVID-19 Patients and the Impact of Antithrombotic Therapy on ICU Mortality.

Aim We aimed to determine the incidence of thrombotic complications and outcomes of critically ill COVID-19 patients admitted to the intensive care unit (ICU) and evaluate the association between combined antithrombotic therapy and mortality in ICU patients admitted for COVID-19 pneumonia. Methods We retrospectively collected data of adult critically ill patients with COVID-19 admitted to the ICU in a major hospital in Dubai during the COVID-19 pandemic. The primary outcome was in-hospital mortality. Secondary outcomes included the incidence of major complications, such asthrombotic complications during the ICU stay. The study population was classified into two groups based on the type of prophylactic anticoagulant and antiplatelet therapy received. Results The study included 257 ICU patients admitted with COVID-19 pneumonia. The mean duration of their ICU stay was 24.95 days, ranging from one day to 327 days. The primary outcome was in-hospital mortality. In our study, 151 patients (58.7%) suffered in-hospital mortality. Secondary outcomes included the incidence of major complications during the ICU stay. A total of 202 patients (78.6%) presented with acute respiratory distress syndrome. Ninety-nine (38.5%) of the patients had progressed to acute kidney injury. Thirty-three patients (12.8%) had various thrombotic complications. Three of these (9%) had venous thrombosis, and 30 patients (91%) had arterial thrombosis. Ischemic stroke was the major thrombotic complication of COVID-19 (36.3% of overall thrombotic events, n = 12), followed by myocardial infarction (27.2%; n = 9) and pulmonary embolism (21.2%; n = 7). Out of 257 COVID-19 ICU patients, 73 patients (28.4%) received both anticoagulants and antiplatelet therapy, and 183 patients (70.8%) received only anticoagulant therapy. We compared the mortality of COVID-19 ICU patients who received anticoagulants alone to those with added antiplatelets. The application of combined antiplatelet and anticoagulants as thromboprophylaxis for COVID-19 ICU patients was not associated with a significant reduction in mortality (P = 0.868).Peak serum levels of D-dimer significantly correlatewith the length of ICU stay (rho= 0.137, P = 0.031). Peak D-dimer level during the ICU stay was statistically significantly higher in non-survivors (mean = 11.87) compared to survivors (mean = 8.59) (P < 0.001). D-dimer on ICU admission had a good prognostic value for ICU patients with COVID-19 infection (P = 0.018). Conclusion The incidence of thrombotic complications among COVID-19 pneumonia patients admitted to ICU is remarkably high, which reinforces the recommendation to apply thrombosis prophylaxis strictly to all ICU patients admitted with COVID-19. The application of combined antiplatelets with anticoagulants as thromboprophylaxis for COVID-19 ICU patients was not associated with a significant reduction in ICU mortality.D-dimer has a significant correlation with prognosis and length of ICU stay of COVID-19 patients.

Comparison of temporary mechanical circulatory support devices for patients with cardiogenic shock after acute myocardial infarction: A network meta-analysis of randomized controlled trials.

Despite the high mortality of cardiogenic shock after acute myocardial infarction (AMI-CS), the comparative efficacy and safety of mechanical circulatory support (MCS) in patients with AMI-CS is unknown. This study aimed to compare the efficacy and safety of various MCS with initial medical therapy for AMI-CS patients. We searched PubMed and EMBASE in July 2024. Randomized controlled trials (RCTs) comparing at least any of the following 2 were included: initial medical therapy, intra-aortic balloon pump (IABP), percutaneous ventricular assist device (pVAD), or extracorporeal membrane oxygenation (ECMO). We performed a network meta-analysis using a frequentist approach. The primary outcome was mid-term (6-12 months) mortality. The secondary outcomes were short-term (30-day or in-hospital) mortality, major bleeding, and vascular complications. We included a total of 1845 patients with AMI-CS from 14 RCTs. There was no significant difference in short-term mortality between the treatment groups. However, pVAD and ECMO were associated with higher risks of major bleeding and vascular complications compared to initial medical therapy. Compared to initial medical therapy, pVAD (hazard ratio [HR], 0.77; 95 % confidence interval [CI], 0.60-1.00; p = 0.054) and ECMO (HR, 0.51; 95 % CI, 0.26-1.01; p = 0.054) were associated with the marginal benefits in reducing mid-term mortality. In our study, there was no significant benefits of MCS devices in reducing short-term mortality, and pVAD and ECMO were associated with a higher incidence of major bleeding and vascular complications. Although not statistically significant, MCS showed a favorable trend in mid-term mortality.

Complications associated with equine transvaginal ultrasound-guided follicle aspiration: Practitioner survey and field results.

Transvaginal ultrasound-guided follicle aspiration (TVA) is being performed commonly in clinical equine practice. There is limited information in the literature about the type and incidence of complications related to TVA. We conducted a survey (Study 1), completed by 23 practicing veterinarians, soliciting information about the types and incidence of minor and major complications and of fatalities they had experienced associated with performance of TVA. In Study 2, data from a large clinical practice in which six veterinarians performed over 14,000 TVAs over a period of 7 years was reviewed to determine the type and incidence of complications seen (Study 2). Overall, major complications, i.e. complications resulting in severe mare illness or illness that took longer than a week to resolve, was seen in an estimated 1 in 1000 cases in Study 1 and 1 in 375 cases in Study 2. Fatalities were reported in an estimated 1 in 3000 cases in Study 1 and in 1 in 2000 cases in Study 2. In summary, performance of TVA in a variety of settings has a low rate of major or fatal complications. Survey responses noted areas to which attention might be brought that have potential to further reduce the incidence of complications.

Clinical characteristics and treatment outcomes of patients with insulinoma-a single center's experience of 76 cases over a 10-year period.

Insulinoma is a rare pancreatic neuroendocrine neoplasm caused by pancreatic beta cell tumor or beta cell proliferation resulting in excessive insulin secretion. Due to its rarity, surgical analysis and summary studies on patients with insulinoma are few and the sample size is limited. In this study, we retrospective the cumulative experiences including demographics, clinical characteristics, detailed surgical reports and postoperative outcome of 76 patients diagnosed with insulinoma from 2010 to 2020at the First Affiliated Hospital of Xi'an Jiaotong University. Our cohort consisted of 48 females and 28 males with an average diagnosis age of 52 years. Loss of consciousness (68 %), sweating (59 %), vertigo (56 %) are three most shown symptoms. The average time from symptom onset to diagnosis of insulinoma was 33.4 month. When CT combined with MRI was used, the diagnostic rate was as high as 96.87%. Of the 76 patients, 48.68% of preoperative tumors were in the head/neck, and the remaining 51.32% were in the body/tail. Most of the patients received surgery for enucleation (65.79%). The duration of surgery was 216±105min. The incidence of postoperative pancreatic fistula was 53.95%. Postoperative pancreatic hemorrhage occurred in 6 patients (7.89%), all of whom were pancreatic head/neck surgery patients. The incidence of pancreatic fistula, bleeding and major complications after the operation of pancreatic head/neck insulinoma was higher than that of pancreatic body/tail insulinoma. CT combined with MRI can localize insulinoma in most patients. As a parenchyma-sparing pancreatectomy, enucleation is the procedure of choice if possible. The incidence of postoperative hemorrhage should be more vigilant after the surgery of pancreatic head/neck insulinoma. The intraoperative suture of high-risk vessels prone to bleeding should be performed if necessary.

Surgical approach for lower postoperative anal stenosis.

After anorectal surgery, hemorrhoids frequently lead to chronic issues, particularly in patients with mixed hemorrhoids. Liu et al investigated the outcomes of staple removal at the 3- and 9-o'clock positions following modified stapled hemorrhoidopexy (SH) in patients with grade III or IV hemorrhoids. This study included patients who underwent standard or modified SH between January 1, 2015, and January 1, 2020. Key metrics assessed included hospital stay duration, blood loss, operation time, and the incidence of minor or major complications. The findings indicated that the modified SH technique is a safe option for advanced-grade hemorrhoids, resulting in a lower rate of postoperative anal stenosis compared to standard SH. Notably, this technique also showed reduced anal stenosis rates in patients with prior hemorrhoid treatments. While the modified SH demonstrates immediate benefits, further research is necessary to evaluate long-term effects. Despite its advantages, the study's limited sample size restricts the generalizability of the findings, underscoring the need for larger, long-term studies to validate these results. Clinically, the modified SH method appears to significantly reduce the incidence of postoperative anal stenosis, a common concern following typical surgeries. If confirmed by larger trials, this procedure may become the preferred surgical approach for hemorrhoids. In conclusion, the work of Liu et al signifies a meaningful advancement in hemorrhoid surgery, enhancing patient safety and outcomes.

Goal-directed fluid therapy on the postoperative complications of laparoscopic hepatobiliary or pancreatic surgery: An interventional comparative study.

Intraoperative fluid balance significantly affects patients' outcomes. Goal-directed fluid therapy (GDFT) has reduced the incidence of major postoperative complications by 20% for 30 days after open abdominal surgery. Little is known about GDFT during laparoscopic surgery. We investigated whether GDFT affects the postoperative outcomes in laparoscopic hepatobiliary or pancreatic surgery compared with conventional fluid management. This interventional comparative study with a historical control group was performed in the tertiary care center. Patients were allocated to one of two groups. The GDFT (n = 147) was recruited prospectively and the conventional group (n = 228) retrospectively. In the GDFT group, fluid management was guided by the stroke volume (SV) and cardiac index (CI), whereas it had been performed based on vital signs in the conventional group. Propensity score (PS) matching was performed to reduce selection bias (n = 147 in each group). Postoperative complications were evaluated as primary outcome measures. The amount of crystalloid used during surgery was less in the GDFT group than in the conventional group (5.1 ± 1.1 vs 6.3 ± 1.8 ml/kg/h, respectively; P <0.001), whereas the amount of colloid was comparable between the two groups. The overall proportion of patients who experienced any adverse events was 57.8% in the GDFT group and 70.1% in the conventional group (P = 0.038), of which the occurrence of pleural effusion was significantly lower in the GDFT group than in the conventional group (9.5% vs. 19.7%; P = 0.024). During the postoperative period, the proportion of patients admitted to the intensive care unit (ICU) was lower in the GDFT group than that in the conventional group after PS matching (4.1% vs 10.2%; P = 0.049). GDFT based on SV and CI resulted in a lower net fluid balance than conventional fluid therapy. The overall complication rate in laparoscopic hepatobiliary or pancreatic surgery decreased after GDFT, and the frequency of pleural effusion was the most affected.

Postoperative Analgesia and Length of Hospital Stay After Surgery for Malignant Pleural Mesothelioma: A Retrospective Observational Study

Background: Pleurectomy/decortication (P/D), a surgical procedure for malignant pleural mesothelioma (MPM), is a highly invasive surgery requiring prolonged hospitalization. Previous studies have reported that postoperative analgesia using regional anesthesia contributes to shorter hospital stays after surgery under general anesthesia by reducing acute postoperative pain. However, the association between postoperative analgesia and the length of hospital stay (LOHS) following P/D has not been evaluated. Objectives: To evaluate the association between postoperative analgesia and postoperative LOHS after P/D. Methods: This single-institution observational study enrolled consecutive adult patients undergoing P/D under general anesthesia, who postoperatively received either intertransverse process block (ITPB) or continuous intravenous (IV) fentanyl infusion as postoperative analgesia between March 2022 and February 2023. Results: Among all enrolled patients with ASA physical status II or III (n = 60), postoperative analgesia was administered using either continuous ITPB (n = 19) or continuous IV fentanyl infusion (n = 41). Multivariable logistic regression analysis revealed that postoperative analgesia with continuous ITPB (P = 0.007), a lower incidence of major complications after surgery (P = 0.034), and female sex (P = 0.033) were significantly associated with a shorter postoperative LOHS. In subgroup analysis, patients who received continuous ITPB had significantly lower postoperative LOHS, lower postoperative serum C-reactive protein levels on postoperative day (POD) 3, and reduced acute postoperative pain on POD3 compared to those who received continuous IV fentanyl infusion. Conclusions: Postoperative analgesia using continuous ITPB appears to be associated with a reduction in LOHS following P/D for MPM under general anesthesia.

Complications and blood loss after invasive treatments for small renal masses: A systematic review.

This systematic review and meta-analysis provides estimates of major complications and blood loss for open partial nephrectomy, conventional laparoscopic partial nephrectomy, and robot-assisted partial nephrectomy. Additionally, it outlines the incidence of major complications associated with percutaneous thermal ablation in patients with small renal masses. We searched MEDLINE, EMBASE, and CINAHL from inception to the end of July 2023. We supplemented the electronic search with a hand search of references in the included studies and suggestions from two content experts. We used random effect meta-analysis to obtain pooled estimates of major complications and blood loss. We used the QUIPS tool for risk of bias assessment and applied a prognosis approach to rate the quality of evidence using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) framework. We included 65 eligible studies that provided pooled estimates of major complications after open partial nephrectomy of 5.4% (95% confidence interval [CI] 2.9-9.9); after conventional laparoscopic partial nephrectomy of 4.7% (95% CI 2.6-8.3); after robot-assisted partial nephrectomy of 2.9% (95% CI 2.2-3.7); and after thermal ablation of 2.9% (95% CI 2.3-3.8). Pooled estimates demonstrating mean estimated blood loss of 262 ml (95% CI 200-324) for open partial nephrectomy; 224 ml (95% CI 193-254) for conventional laparoscopic partial nephrectomy; and 163 ml (95% CI 136-190) for robot-assisted partial nephrectomy. This review provides the best available estimates of major complications and mean blood loss after partial nephrectomy in patients with small renal masses.

Preoperative Nutritional Status Screened by MNA-SF Predicts Major Complications in Elderly Patients Undergoing Lumbar Fusion Surgery.

To investigate the role of Mini Nutritional Assessment-Short Form (MNA-SF) in predicting postoperative complications in older patients (≥75 years) undergoing lumbar fusion surgery. Patients who had undergone posterior lumbar fusion surgery between June 2019 and September 2021 were enrolled. Those with an MNA-SF score of 12 or higher were categorized as the Nourished group, while those with a score less than 12 were placed in the Malnutrition-Risk group. Preoperative, intraoperative, and postoperative variables between groups were compared. Patients were then re-classified based on the presence of major complications, univariate analysis and multivariate logistic regression was used to identify risk factors for major complications. A total of 240 patients were enrolled, with 182 in the Nourished group and 58 in the Malnutrition-Risk group. The Malnutrition-Risk group exhibited a higher incidence of major complications (46.6% vs 23.1%, p = 0.001) and comprehensive complications index (18.42 ± 18.00 vs 12.65 ± 15.87, p = 0.021), Oswestry Disability Index (27.52 ± 23.44 vs 20.45 ± 20.42, p = 0.029) and longer recovery times (12.53 days vs 10.15 days, p =0.033). Length of stay (LOS) were also increased in the Malnutrition-Risk group (19.22 ± 10.67 vs 16.04 ± 7.69, p = 0.014). Multiple regression analysis identified nutritional risk and malnutrition, as assessed by MNA-SF, as independent factors associated with postoperative major complications (OR 2.81, 95% CI 1.42-5.53, p = 0.003). Preoperative nutritional risk or malnutrition is an independent risk factor for major complications among older patients undergoing posterior lumbar fusion surgery. The MNS-SF emerges as a convenient and effective tool for promptly screening the nutritional status of older patients, prompting subsequent nutritional evaluation or intervention before surgery.

Incidence and timing of postoperative complications after total hip and knee arthroplasty.

Follow-up protocols after total hip or knee arthroplasty (THA or TKA, respectively) have little uniformity, which can lead to emergency department (ED) visits for postoperative complications. We sought to determine the incidence and timing of postoperative complications after THA or TKA. We conducted a population-based retrospective cohort study of all adults in Ontario who underwent primary THA or TKA between 2010 and 2019. We used data available through ICES. We identified medical and surgical complications, ED visits, and hospital readmissions using institutional databases and Ontario Health Insurance Plan claims. Outcomes included major medical complications within 30 days and surgical complications within 1 year after surgery. We included 158 503 and 103 728 patients who underwent TKA and THA, respectively. The incidence of medical complications within 30 days was 2.90% after TKA and 2.42% after THA. Visits to the ED (20.0% after TKA, 16.9% after THA) and readmission rates within 30 days (3.8% after TKA, 4.1% after THA) were similar for both groups. Visits to the ED occurred at a median of 10 days after surgery for both groups, with readmissions at a median of 12 and 13 days after TKA and THA, respectively. The incidence of major TKA complications was 1.6%, with a median time of 84 (interquartile range [IQR] 26-224) days. The incidence of major THA complications was 2.2%, with a median time of 29 (IQR 16-80) days. Our findings suggest follow-up contact 7-10 days after THA or TKA to minimize ED visits, with at least 1 subsequent in-person follow-up at 5-6 weeks after surgery. After that, surgeons may personalize additional follow-ups as needed.

Perioperative and Neurological Complications after Open Thoracic Aortic Surgery in a High-Volume Aortic Surgery Center

Objective: Thoracic aortic surgery is associated with an increased risk of mortality and complications. The present study aimed to evaluate the incidence of 30-day mortality and perioperative major complications after open thoracic aortic surgery in a high-volume aortic center. Materials and Methods: The present study was a retrospective analysis and included patients who underwent open thoracic aortic surgery with cardiopulmonary bypass (CPB) between December 2018 and November 2020. Demographics and perioperative data were analyzed. The incidence of 30-day mortality and risk factors of perioperative and neurological complications were determined. Results: One hundred ninety-five patients were included in the present study. Most were male, at 67.2%, with a mean age of 59.3±14.5 years. The incidence of 30-day mortality was 4.6%, with a 95% confidence interval (CI) 2.5 to 8.5. The major complication characterized by the Clavien-Dindo classification was 40.5%. The multivariable analysis identified aortic arch surgery (adjusted odds ratio (aOR) 2.86, 95% CI 1.11 to 7.33, p=0.029), maximum vasoactive-inotropic (VISmax) score greater than 10 (aOR 2.58, 95% CI 1.01 to 6.64, p=0.049), and VISmax score greater than 20 (aOR 5.54, 95% CI 1.67 to 18.34, p=0.005) as significant risk factors for postoperative major complications. In addition, aortic arch surgery, preoperative neurological complications (aOR 4.01, 95% CI 1.47 to 10.95, p=0.007), cerebral desaturation of greater than 20% reduction of regional cerebral oxygen saturation rScO₂ during CPB (aOR 4.60, 95% CI 1.49 to 14.15, p=0.008), and red blood cell transfusions of more than one blood volume (aOR 4.19, 95% CI 1.01 to 17.36, p=0.048) were identified as risk factors for postoperative stroke. Conclusion: The present study demonstrated a 30-day mortality rate of 4.6% after thoracic aortic surgery. Operations of the aortic arch and VISmax score of greater than 10 are associated with an increased risk of major postoperative complications. Reduction of rScO₂ during CPB is strongly associated with postoperative stroke.

Prostatic stents: a systematic review and analysis of functional outcomes and complication rate.

This review aims to identify and summarize the current literature on the use of prostatic stents or nitinol devices as minimally invasive techniques for the management of lower urinary tract symptoms (LUTS) resulting from benign prostatic hyperplasia (BPH). A comprehensive search of the literature was conducted until October 2023. Only original articles written in English were considered for inclusion. This review has been registered in PROSPERO (registration number CRD42023474884). Thirty-eight articles were included (2618 patients). Generally, the risk of bias was deemed as high or very high. The most frequently investigated stents were the UroLume, followed by the Memokath/Memotherm. The mean age was 72.01 ± 5.6 years, with a mean prostate volume of 48.27 ± 12.8 cc and a mean urethral length of 40.53 ± 9.16 mm. Surgeries were usually performed under local anesthesia. The rates of catheter-free status and complications were 85.2% and 30.83%, respectively. The primary complications included urinary tract infections (17.2%), followed by calcifications (12.6%), irritative symptoms (12.2%), and acute urinary retention (10.4%). During a follow-up period of 12 months, the failure rate intended as stent removal or repositioning was 14.8%. The International Prostate Symptom Score (IPSS) showed an overall improvement of 9.85 points. The mean improvement in maximum flow rate and post-void residual volume were 6.62 ml/sec and 147 ml, respectively. Prostatic stents remain an efficient choice for addressing obstructive symptoms from BPH, offering the advantage of being performed under local anaesthesia, relieving symptoms with good functional outcomes and a low incidence of major complications. Prospective studies are needed to corroborate these results.

Laparoscopic hepatectomy versus microwave ablation for multifocal 3-5cm hepatocellular carcinoma: a multi-centre, real-world study.

Researches comparing laparoscopic liver resection (LLR) with microwave ablation (MWA) for 3-5cm multifocal hepatocellular carcinoma (MFHCC) are rare. From 2008 to 2019, 666 intrahepatic tumours in 289 patients from 12 tertiary medical centres in China were included in this retrospective study. Propensity score matching (PSM) was performed to balance variables between the two treatment groups over time frames 2008-2019 and 2013-2019 to observe the potential impact of advancements in intervention techniques on overall survival (OS), disease-free progression (DFS) of patients. complications, hospitalization, and cost were compared. Among 289 patients, the median age was 59 years [interquartile range (IQR) 52-66]. 2008-2019, after PSM, the median OS was 97.4 months in the LLR group and 75.2 months (95% CI 47.8-102.6) in the MWA group during a follow-up period of 39.0 months. The 1-year, 3-year and 5-year OS rates in the two groups were 91.8%, 72.6%, 60.7% and 96.5%, 72.8%, 62.5% [hazard ratio (HR) 1.03, 95% CI 0.62-1.69, P =0.920]; The corresponding DFS rates were 75.9%, 57.2%, 46.9%, and 53.1%, 17.5%, 6.2% (HR 0.35, 95% CI 0.23-0.54, P <0.001). 2013-2019, the median OS time was not reached in either group during the 34.0 months of follow-up, the 1-year, 3-year and 5-year OS rates in the two groups were 90.2%, 67.6%, 56.7% and 96.5%, 76.7%, 69.7% (HR 1.54, 95% CI 0.79-3.01, P =0.210); The corresponding DFS rates were 69.6%, 53.9%, 43.3%, and 70.4%, 32.1%, 16.5% (HR 0.68, 95% CI 0.41-1.11, P =0.120). The incidence of major complications was similar in both groups (all P> 0.05). MWA had shorter intervention times, hospitalization, and lower costs. For resectable MFHCC patients, LLR is preferable due to its lower recurrence rate. For patients who do not qualify for LLR, advances in ablation technology have promoted MWA as a promising alternative.

Anticoagulation management during veno-venous ECMO support because of ARDS: Single-center experience

BackgroundPatients with severe acute respiratory distress syndrome (ARDS) show a high mortality rate of up to 60 %. In such cases, extracorporeal membrane oxygenation (ECMO) support is often required, which would necessitate anticoagulation therapy, predominantly with heparin. Some bleeding events occurred more frequently in patients during the COVID-19 pandemic who were on venovenous (V-V) ECMO, so it is necessary to investigate whether anticoagulation management should be adjusted. MethodsWe collected data on 90 patients with severe ARDS who underwent ECMO support at the University Hospital Magdeburg between 2014 and 2022. In order to estimate the role of anticoagulation therapy as a cause of bleeding, patients were divided into two groups based on their mean activated partial thromboplastin time (aPTT): one group with a mean aPTT of more than 58 s (45 patients) and another with a mean aPTT of less than 58 s (45 patients). Demographic data, data before, during ECMO support, and bleeding complications were retrospectively recorded. We compared laboratory parameters before ECMO, essential coagulation parameters on days 3, 7, 10 of ECMO support, before the bleeding event occurred, and analyzed hospital survival in both groups. ResultsThe incidence of major bleeding complications was significantly higher in the group of patients with higher aPTT (68.9 % vs 33.3 %, p < 0.001), the differences in the occurrence of hemothorax were especially significant (28.9 % vs 2.2 %, p < 0.001). We observed better hospital patients’ survival in the group with lower aPTT (40.0 % vs 68.9 %, p = 0.006). The results of the bivariate analysis indicate that the independent predictors of hospital mortality in adult patients receiving V-V ECMO support due to severe ARDS were COVID-19 (OR: 3.504; 95 % confidence interval [CI]: 1.415–8.681, p = 0.007) acute liver failure (OR: 8.0000; 95 % CI: 1.692–37.822; p = 0.009), high antithrombin level (%) (OR: 1.036; 95 % CI: 1.003–1.071, p = 0.035). A high mean aPTT level increased the risk of major bleeding (OR: 1.080; 95 % CI: 1.016–1.148, p = 0.014) without a significant increase in mortality. ConclusionProlonged aPTT during V-V ECMO support in patients with ARDS significantly impacts the risk of major bleeding, especially hemothorax, without significant increase in hospital mortality.

Complication comparison in intermediate-to-high risk venous thromboembolism patients, treated with high vs standard dose apixaban and rivaroxaban after low molecular weight heparin

Abstract Background In patients with intermediate-to-high risk venous thromboembolism (VTE), current guidelines recommend initial treatment with low molecular weight heparin (LMWH), followed by an oral anticoagulant. However, the studies supporting these guidelines have only focused on the use of Edoxaban and Dabigatran after 5 days of LMWH treatment. To date there are no studies supporting similarly implemented guidelines for Apixaban and Rivaroxaban. Purpose To investigate the incidence of bleeding complications and thrombosis in intermediate-to-high risk VTE patients, when treated with either lead-in high or standard dose Rivaroxaban or Apixaban, following initial LMWH treatment. Methods Through a real-life retrospective study of 844 intermediate-to-high risk VTE patients, 584 were initially treated with LMWH and subsequently Apixaban or Rivaroxaban and divided into two groups. The first group of 514 patients, received high dose Apixaban or Rivaroxaban (10mg x 2 for 7 days and 15mg x 2 for 21 days respectively) before being reduced to their standard doses. The remaining 70 patients, instead transitioned directly to the standard doses (5mg x 2 and 20mg x 1 respectively) from LMWH. All patients started treatment between 2018 and 2023, and all complications were recorded until one year following initiation of treatment. Treatment complications include recurrent VTE, separated into deep vein thrombosis and pulmonary embolism, and bleeding complications in the form of fatal, non-fatal, minor and a drop in haemoglobin. The recurrence of VTE and incidence of bleeding complications were evaluated as the primary efficacy outcome and safety outcome respectively. Results Overall, 4.7% of patients treated with initial high dose Apixaban or Rivaroxaban suffered major bleeding complications as opposed to 2.9% treated with the standard dose (p=&amp;lt;0.05). Out of all complications, 5 were fatal, all of which were part of the high dose group and included 3 cerebral and 2 gastrointestinal bleeds. However, minor bleeding complications were more frequent in the standard dose group, presenting in 26.1% of patients, while, paradoxically, the high dose group had similar complications in only 15.8% of patients (p=&amp;lt;0.05). Although treated with a higher dose, 6/478 (1,26%) incurred a recurrent thrombus within a year of treatment, while the standard dose group had no cases of recurrence, though this was not a statistically significant result. Conclusion Directly transitioning from LMWH to standard dose Apixaban/Rivaroxaban in intermediate-to-high risk VTE, leads to a statistically significant reduced incidence of major bleeding complications, without an increased risk of recurrent thrombosis.

Significant reduction of complications applying an optimized vascular access and post-interventional groin-site management during electrophysiology procedures

Abstract Background Catheter ablation of cardiac arrhythmias is an established treatment strategy. However, the optimal femoral vascular access strategy and post-interventional management in the electrophysiology (EP) setting is still under debate. Purpose To assess the impact of ultrasound-guided versus conventional femoral vascular puncture and of a modified post-interventional groin-site management strategy on complication rates. Method Patients undergoing EP procedures at the our university heart and vascular center are included in an institutional prospective registry. Conventional vascular access as well as post-interventional groin site pressure-bandage and bed rest of 6 hours (group I) was compared to a new strategy including ultrasound-guided vascular access, venous closure by a Z-suture and groin site pressure-bandage for only 2 hours plus additional 4 hours bed rest (group II). Incidences of minor and major groin site complications for both groups were compared. Hematoma, bleeding, arteriovenous fistula or pseudoaneurysm of the femoral artery without need for intervention (e.g. transfusion, thrombin injection, surgery) were classified as minor complications. Complications requiring intervention or retroperitoneal hematoma were defined as major complications. Results A total of 1535 procedures in 1381 patients (779 (51 %) procedures in 705 (51%) patients in group I and 756 (49%) procedures in 676 (49%) patients in group II) were analyzed. In group I and group II, respectively, 39%/44% procedures were index pulmonary vein isolations, 30%/29% repeat atrial fibrillation, 16 %/15% supraventricular tachycardia, 12%/11% PVC or VT ablations, and 4%/2% left atrial appendage occlusions. The total groin site complication rate was 9% (70/779 procedures) for group I, and 5% (38/756 procedures) for group II (OR 0.54 [95%-CI 0.35-0.82], p=0.003). Major groin site complications occurred in 2% (19/779 procedures) in group I and were reduced to 1% (10/756 procedures) in group II (OR 0.53 [95%-CI 0.22-1.22], p=0.156). Conclusion The overall groin site complication rate in EP-procedures was significantly reduced by implementing a novel institutional standard for vascular access management including ultrasound-guided puncture and a modified post-interventional groin site management.