Preoperative Hypertension Research Articles

Prolonged cardiovascular pharmacological support and fluid management after cardiac surgery.

To identify potentially modifiable risk factors related to prolonged cardiovascular pharmacological support after weaning from cardiopulmonary bypass (CPB). This is a secondary analysis of two prospective cohort study in a specialized cardiac surgery institution in adult patients undergoing cardiac surgery with the use of CPB between August 2016 and July 2017. Prolonged cardiovascular pharmacological support was defined by the need for at least one vasopressor or one inotropic agent 24 hours after separation from CPB. Risk factors were identified among baseline characteristics and peri-operative events through multivariable logistic regression. A total of 247 patients were included and 98 (39.7%) developed prolonged pharmacological support. In multivariable analysis, left ventricular ejection fraction ≤ 30% (OR 9.52, 95% confidence interval (CI) 1.14; 79.25), elevated systolic pulmonary artery pressure (sPAP) > 30 and ≤ 55 mmHg (moderate) (OR 2.52, CI 1.15; 5.52) and sPAP > 55 mmHg (severe) (OR 8.12, CI 2.54; 26.03), as well as cumulative fluid balance in the first 24 hours after surgery (OR 1.76, CI 1.32; 2.33) were independently associated with the development of prolonged pharmacological support. Prolonged cardiovascular pharmacological support is frequent after cardiac surgery on CPB. Severe LV systolic dysfunction, preoperative pulmonary hypertension and postoperative fluid overload are risk factors. Further studies are required to explore if those risk factors could be modified or not.

Supplemental oxygen is associated with increased complications and readmission following total shoulder arthroplasty

BackgroundChronic lung disease has a significant burden on surgical patients and in some instances can be so advanced that patients are dependent on home supplemental oxygen. Prior literature has shown that lower extremity total joint arthroplasty patients who are oxygen-dependent exhibit significantly increased rates of postoperative complications and readmission. However, there is a paucity of literature evaluating outcomes following total shoulder arthroplasty (TSA) in oxygen-dependent patients. The purpose of this study is to compare the rates of complications, readmission, revision, and mortality within 180 days of primary elective TSA in oxygen-dependent vs. oxygen-independent patients with comorbid chronic pulmonary disease. MethodsThe Nationwide Readmissions Database was queried from 2015 to 2019 to identify all patients that underwent primary elective TSA with comorbid chronic lung disease (n = 19,469). Patients were stratified into oxygen-dependent (n = 622) and oxygen-independent (n = 18,847) groups. Relevant demographic characteristics and postoperative complications were compared between the oxygen-dependent and oxygen-independent groups. One hundred eighty-day postoperative complication, readmission, revision, and mortality rates were also compared between the two groups. ResultsOxygen dependent patients were significantly more likely to have preoperative hypertension (81% vs. 74%; P < .001), congestive heart failure (20% vs. 7.2%; P < .001), chronic kidney disease (13% vs. 10%; P = .009), and increased Charlson-Deyo comorbidity index (2.4 vs. 2.0; P < .001). Oxygen-dependent patients exhibited higher rates of wound dehiscence (0.2% vs. 0.0%; P = .003), cardiovascular complications (0.6% vs. 0.2%; P = .014), acute renal failure (5.5% vs. 1.9%; P < .001), urinary tract infection (1.9% vs. 1.0%; P = .019), pneumonia (1.6% vs. 0.6%; P = .001), and acute respiratory distress syndrome (6.9% vs. 1.5%; P < .001). Oxygen-dependent patients exhibited higher rates of complications (16% vs. 7.1%; P < .001) and readmission (20% vs. 12%; P < .001) within 180 days of surgery, but no significant differences were observed in 180-day revision or mortality rates between groups. ConclusionOxygen-dependent TSA patients have higher 180-day complication and readmission rates while having similar revision and mortality rates as oxygen-independent patients. These findings should be considered by orthopedic surgeons when considering strategies for perioperative management of oxygen-dependent patients following TSA.

Identification of risk factors for postoperative delirium in patients following intraoral reconstruction with microvascular free flaps: a matched-pair analysis

Postoperative delirium (POD) following microvascular head and neck reconstruction negatively impacts patient outcomes, and only a few risk factors have been identified. The aim of this study was to identify additional risk factors for POD after intraoral reconstruction with microvascular free flaps. Data from 377 patients who underwent intraoral microvascular free flap reconstruction between 2011 and 2019 were analysed retrospectively. Preoperative, intraoperative, and postoperative variables were compared between 40 patients with POD and 40 patients without POD who were matched for previously identified risk factors (i.e., sex, age, American Society of Anesthesiologists class, preoperative arterial hypertension, tracheotomy, operation time, and blood transfusion). A multivariable regression analysis was then performed to identify risk factors associated with POD. POD occurred in 50 (13.3%) of the 377 cases studied; the median time of onset was postoperative day 2. Excessive preoperative alcohol consumption (odds ratio 9.22, 95% confidence interval 1.09–77.97; P = 0.041) and postoperative transplant revision (odds ratio 25.72, 95% confidence interval 1.26–525.43; P = 0.035) were identified as risk factors for POD. The identification of patients at high risk of POD based on these two risk factors may allow early adjustment of diagnostic and therapeutic modalities to improve outcomes and reduce healthcare costs.

Association between intraoperative pulmonary artery pressure and cardiovascular complications after off-pump coronary artery bypass surgery: a single-center observational study

BackgroundThe impact of intraoperative pulmonary hemodynamics on prognosis after off-pump coronary artery bypass (OPCAB) surgery remains unknown. In this study, we examined the association between intraoperative vital signs and the development of major adverse cardiovascular events (MACE) during hospitalization or within 30 days postoperatively.MethodsThis retrospective study analyzed data from a university hospital. The study cohort comprised consecutive patients who underwent isolated OPCAB surgery between November 2013 and July 2021. We calculated the mean and coefficient of variation of vital signs obtained from the intra-arterial catheter, pulmonary artery catheter, and pulse oximeter. The optimal cut-off was defined as the receiver operating characteristic curve (ROC) with the largest Youden index (Youden index = sensitivity + specificity – 1). Multivariate logistic regression analysis ROC curves were used to adjust all baseline characteristics that yielded P values of < 0.05.ResultsIn total, 508 patients who underwent OPCAB surgery were analyzed. The mean patient age was 70.0 ± 9.7 years, and 399 (79%) were male. There were no patients with confirmed or suspected preoperative pulmonary hypertension. Postoperative MACE occurred in 32 patients (heart failure in 16, ischemic stroke in 16). The mean pulmonary artery pressure (PAP) was significantly higher in patients with than without MACE (19.3 ± 3.0 vs. 16.7 ± 3.4 mmHg, respectively; absolute difference, 2.6 mmHg; 95% confidence interval, 1.5 to 3.8). The area under the ROC curve of PAP for the prediction of MACE was 0.726 (95% confidence interval, 0.645 to 0.808). The optimal mean PAP cut-off was 18.8 mmHg, with a specificity of 75.8% and sensitivity of 62.5% for predicting MACE. After multivariate adjustments, high PAP remained an independent risk factor for MACE.ConclusionsOur findings provide the first evidence that intraoperative borderline pulmonary hypertension may affect the prognosis of patients undergoing OPCAB surgery. Future large-scale prospective studies are needed to verify the present findings.

Hypertension and hypercholesterolemia are predictive factors associated with type 2 diabetes persistence after metabolic surgery: A prospective study

BackgroundMetabolic surgery is the most effective therapeutic strategy for the management of type 2 diabetes (T2DM). Several preoperative clinical factors have been associated with T2DM remission after metabolic surgery. However, other potential predictors remain unexplored. AimTo assess the role of basal (pre-surgery) clinical and biochemical parameters in T2DM remission after metabolic surgery. MethodsA prospective study including 98 patients with T2DM undergoing metabolic surgery was performed. Clinical, anthropometric, and biochemical data were collected at baseline and 1 year following metabolic surgery. ResultsPatients without T2DM remission 1 year after metabolic surgery presented a longer duration of diabetes and higher glycated hemoglobin (HbA1c) levels; a higher percentage of these subjects were using insulin therapy, antihypertensive drugs, and lipid-lowering therapies before metabolic surgery, compared to those patients with T2DM remission. A lower percentage of T2DM remission after metabolic surgery was observed among patients with hypertension/hypercholesterolemia before surgery, compared to those patients without hypertension/hypercholesterolemia (51.7 % vs 86.8 %, p < 0.001, and 38.5 % vs 75 %, p < 0.001, respectively), and among patients with longer duration of diabetes (≥5 years vs <5 years; 44.4 % vs 83 %, respectively; p < 0.001). In the logistic regression model, diabetes duration, basal HbA1c, and the presence of hypertension and hypercholesterolemia before surgery were inversely related to T2DM remission following metabolic surgery, after adjusting for sex, age, waist circumference, and type of surgery. ConclusionsIn a cohort of patients with obesity and T2DM, preoperative hypertension and hypercholesterolemia, together with a longer diabetes duration and higher HbA1c concentrations, were independent predictors of T2DM persistence after metabolic surgery.

PD24-02 IMPACT OF SYSTEMIC THERAPY (ST) ON DEFERRED CYTOREDUCTIVE NEPHRECTOMY (CN) PERIOPERATIVE OUTCOMES: A NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM (NSQIP) ANALYSIS

You have accessJournal of UrologyCME1 Apr 2023PD24-02 IMPACT OF SYSTEMIC THERAPY (ST) ON DEFERRED CYTOREDUCTIVE NEPHRECTOMY (CN) PERIOPERATIVE OUTCOMES: A NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM (NSQIP) ANALYSIS Shawn Dason, Tyler Sheetz, Shagnik Ray, Danielle Zimmerman, Ming Yin, Edmund Folefac, Amir Mortazavi, Michael Gong, Ahmad Shabsigh, Tasha Posid, and Eric Singer Shawn DasonShawn Dason More articles by this author , Tyler SheetzTyler Sheetz More articles by this author , Shagnik RayShagnik Ray More articles by this author , Danielle ZimmermanDanielle Zimmerman More articles by this author , Ming YinMing Yin More articles by this author , Edmund FolefacEdmund Folefac More articles by this author , Amir MortazaviAmir Mortazavi More articles by this author , Michael GongMichael Gong More articles by this author , Ahmad ShabsighAhmad Shabsigh More articles by this author , Tasha PosidTasha Posid More articles by this author , and Eric SingerEric Singer More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003302.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Management of metastatic renal cell carcinoma (mRCC) is highly individualized and often involves cytoreductive nephrectomy (CN) and systemic therapy (ST). The optimal sequencing of CN and ST is uncertain. A difference in perioperative outcomes based on sequence of CN and ST could influence decision-making. We conducted this NSQIP analysis to assess whether preoperative systemic therapy adversely impacted perioperative outcomes in patients receiving deferred CN. METHODS: This analysis was conducted using the American College of Surgeons NSQIP Participant Use Data File for years 2019 and 2020. These years were selected because data on receipt of preoperative therapy is only available since 2019. Inclusion criteria were i) CPT code consistent with nephrectomy, ii) urologist operating surgeon & iii) presence of disseminated cancer. All cases with ICD-10 diagnosis codes not consistent with mRCC were excluded. Groups were stratified by their receipt of preoperative systemic therapy within 90 days before CN and we assessed 46 preoperative and perioperative outcomes. RESULTS: The study cohort included 505 patients with 115 (23%) who received preoperative ST. No differences were noted in perioperative outcomes (Table 1). Patients receiving preoperative ST were more likely to be on steroids (23% vs. 7%, p<0.01) and develop urinary tract infections (4.3% vs. 0.5%, p<0.01). There were no significant differences noted in other related variables like surgical site infections, wound dehiscence, sepsis, septic shock, pneumonia, cardiovascular complications, preoperative hypertension, or preoperative diabetes (p>0.05). CONCLUSIONS: Because preoperative ST did not have an appreciable impact on deferred CN perioperative outcomes, decision making for ST and CN sequencing should not be influenced by perioperative outcomes. Those who undergo deferred CN are unlikely to experience delayed time to surgery or perioperative complications from their ST. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e721 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shawn Dason More articles by this author Tyler Sheetz More articles by this author Shagnik Ray More articles by this author Danielle Zimmerman More articles by this author Ming Yin More articles by this author Edmund Folefac More articles by this author Amir Mortazavi More articles by this author Michael Gong More articles by this author Ahmad Shabsigh More articles by this author Tasha Posid More articles by this author Eric Singer More articles by this author Expand All Advertisement PDF downloadLoading ...

Risk factors for incisional complications after lumbar internal fixation via posterior midline approach: A case-control study of 455 consecutive cases.

To analyse the clinical data of patients who developed incisional complications and those who did not develop incisional complications after lumbar internal fixation, and investigate the risk factors for incisional complications in patients after lumbar internal fixation with posterior midline incision. A standardised data collection form was used to collect the clinical data of patients who were admitted and underwent lumbar internal fixation in our hospital from July 2018 to July 2021. Patients who experienced any one of the incisional complications, such as incision exudates, swelling, blisters, bruising, superficial/deep incisional infections, poor healing and scarring, after surgery were included in the incisional complication group, and patients who did not develop the above-mentioned incisional complications were included in the control group. Univariate logistic regression analysis was first performed to identify potential risk factors, significant factors from univariate analysis were then included in multivariable logistic regression analysis to identify independent risk factors for incisional complications after lumbar spine surgery. Among 455 patients included in the study, postoperative incision complications occurred in 82 patients, with an incidence rate of 18.02%. Multivariate regression analysis identified seven independent risk factors for incisional complications: age, body mass index, preoperative albumin level, hypertension, diabetes mellitus, operation time and local anaesthetic infiltration at the incision site after surgery. Our findings documented that age, body mass index, preoperative albumin level, hypertension, diabetes mellitus, operation time, and postoperative local anaesthetic infiltration at the incision site were risk factors for incisional complications after lumbar internal fixation with posterior median incision. Awareness of these risk factors can enable surgeons to develop a more appropriate perioperative management plan for patients undergoing lumbar internal fixation, thus helping them recover faster.

Analysis of factors associated with postoperative acute kidney injury in patients with colorectal cancer and the development of a risk prediction model: a retrospective study.

To investigate the factors associated with acute kidney injury (AKI) in postoperative colorectal cancer (CRC) patients and develop a risk prediction model. The clinical data of 389 CRC patients were retrospectively analyzed. The patients were divided into AKI (n = 30) and non-AKI groups (n = 359) according to KDIGO diagnostic criteria. Demographic data, the presence of underlying diseases, perioperative conditions and related examination results were compared between the two groups. Binary logistic regression was used to analyze the independent risk factors for postoperative AKI, and a risk prediction model was established. And a verification group (94 patients) was used to verify the model. 30 patients (7.71%) with CRC had postoperative AKI. Binary logistic regression analysis showed that preoperative combined hypertension, preoperative anemia, inadequate intraoperative crystalloid infusion, low intraoperative minimum mean arterial pressure (MAP) and moderate to severe postoperative decline in hemoglobin (Hb) levels were independent risk factors. The risk prediction model developed was expressed as Logit P = -0.853 + 1.228 * preoperative combined hypertension + 1.275 *preoperative anemia -0.002 * intraoperative crystalloid infusion (ml) -0.091 * intraoperative minimum MAP (mmHg) + 1.482 * moderate to severe postoperative decline in Hb levels. In Hosmer-Lemeshow test, χ2 = 8.157, P = 0.718 showed that the fitting effect was good. The area under ROC curve was 0.776 (95% CI 0.682-0.871, P < 0.001), with a prediction threshold of 1.570, a sensitivity of 63.3% and a specificity of 88.9%. The sensitivity and specificity of the verification group were 65.8% and 86.1%. Preoperative combined hypertension, preoperative anemia, inadequate intraoperative crystalloid infusion, low intraoperative minimum MAP, and moderate to severe postoperative decline in Hb levels were independent risk factors for AKI development in CRC patients. The prediction model can effectively predict the occurrence of postoperative AKI in patients with CRC.

Impact of systemic therapy (ST) on deferred cytoreductive nephrectomy (CN) perioperative outcomes: A National Surgical Quality Improvement Program (NSQIP) analysis.

650 Background: Management of metastatic renal cell carcinoma (mRCC) is highly individualized and often involves cytoreductive nephrectomy (CN) and systemic therapy (ST). The optimal sequencing of CN and ST is uncertain. A difference in perioperative outcomes based on sequence of CN and ST could influence decision-making. We conducted this NSQIP analysis to assess whether preoperative systemic therapy adversely impacted perioperative outcomes in patients receiving deferred CN. Methods: This analysis was conducted using the American College of Surgeons NSQIP Participant Use Data File for years 2019 and 2020. These years were selected because data on receipt of preoperative therapy is only available since 2019. Inclusion criteria were i) CPT code consistent with nephrectomy, ii) urologist operating surgeon &amp; iii) presence of disseminated cancer. All cases with ICD-10 diagnosis codes not consistent with mRCC were excluded. Groups were stratified by their receipt of preoperative systemic therapy within 90 days before CN and we assessed 46 preoperative and perioperative outcomes. Results: The study cohort included 505 patients with 115 (23%) who received preoperative ST. No differences were noted in perioperative outcomes (Table). Patients receiving preoperative ST were more likely to be on steroids (23% vs. 7%, p&lt;0.01) and develop urinary tract infections (4.3% vs. 0.5%, p&lt;0.01). There were no significant differences noted in other related variables like surgical site infections, wound dehiscence, sepsis, septic shock, pneumonia, cardiovascular complications, preoperative hypertension, or preoperative diabetes (p&gt;0.05). Conclusions: Because preoperative ST did not have an appreciable impact on deferred CN perioperative outcomes, decision making for ST and CN sequencing should not be influenced by perioperative outcomes. Those who undergo deferred CN are unlikely to experience delayed time to surgery or perioperative complications from their ST. [Table: see text]

Nomogram for predicting non-proliferative vitreoretinopathy probability after vitrectomy in eyes with rhegmatogenous retinal detachment.

To identify the risk factors for postoperative proliferative vitreoretinopathy (PVR) in patients with primary rhegmatogenous retinal detachment (RRD) and develop a nomogram for predicting postoperative PVR-free probability. A total of 741 patients (741 eyes) diagnosed with primary RRD who underwent first surgery in the same hospital were retrospectively reviewed and randomly assigned with 521 to the training set and 220 to the validation set. Univariate and multivariate logistic regression analyses were performed in the training cohort to determine risk factors to construct a nomogram for predicting the 3-, 4-, 5-, and 6-month postoperative PVR-free probabilities. Nomogram performance was estimated by the concordance index (C-index), calibration plot, and the area receiver operating characteristic (ROC) curve. A nomogram was constructed based on the preoperative PVR, silicone oil tamponade time (SOTT), photocoagulation energy (PE), retinal tear size (RTS), and hypertension. In the training set, the C-index of the nomogram was 0.896, 0.936, 0.961, and 0.972 at 3, 4, 5, and 6mo, respectively. The C-index values in the validation set were 0.860, 0.936, 0.951, and 0.965 at 3, 4, 5, and 6mo, respectively. Decision-curve analysis indicated that only the 4-, 5-, and 6-month nomograms had significant net benefits over a large threshold probabilities interval. Preoperative PVR, SOTT, PE, RTS, and hypertension are significant risk factors for postoperative PVR formation in patients with primary RRD. The proposed nomogram can effectively predict the 4-, 5-, and 6-month PVR-free probabilities after surgery and assist in making clinical decisions during follow-up.

Preoperative pulmonary artery hypertension as a risk factor: the tip of the iceberg

Preoperative pulmonary artery hypertension as a risk factor: the tip of the iceberg

Patient outcomes after revision total shoulder arthroplasty in an inpatient vs. outpatient setting.

Total shoulder arthroplasty (TSA) is becoming an increasingly common surgical procedure for numerous shoulder conditions. The incidence of revision TSA is increasing because of the increase in primary TSA and the increased utilization of TSA in younger patients. Conducting revision TSA as an outpatient procedure would be beneficial in limiting expenditure and resource allocation but must show a similar complication profile compared to inpatient revision TSA in order to justify its clinical value. The purpose of this study is to compare the outcomes of outpatient revision TSA to inpatient revision TSA and outpatient primary TSA. The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was queried from 2010-2019 to identify all patients who underwent revision TSA (n=1456) in either an inpatient or outpatient setting, as well as patients who underwent primary TSA in an outpatient setting (n=2630). Relevant demographic characteristics were compared between the outpatient revision group and both the inpatient revision and outpatient primary groups. Postoperative complications, readmission, and reoperation rates were also compared between the groups. Patients undergoing inpatient revision TSA exhibited increased rates of preoperative hypertension (P=.013) and had increased prevalence of severe American Society of Anesthesiologists classification (P=.021) compared to patients undergoing outpatient revision TSA. Patients undergoing outpatient revision TSA were significantly more likely to experience complications (P<.001), have longer surgical times (P<.001), and undergo readmission (P=.006) and reoperation (P=.049) compared to patients undergoing outpatient primary TSA. There was no significant increase in rates of overall complication, readmission, or reoperation between patients undergoing revision TSA in an outpatient vs. an inpatient setting. Outpatient revision TSA has higher complication rates, readmission, and reoperation rates compared to outpatient primary TSA, similar to previous findings when comparing revision and primary TSA done as an inpatient. However, there was no increased risk of complications, readmission, or reoperation for outpatient revision TSA compared to inpatient revision TSA. Outpatient revision TSA should be considered by orthopedic surgeons in patients who are medically healthy to undergo the procedure as an outpatient surgery.

Determination of preoperative hypertension prevalence and awareness in patients before elective surgery

Determination of preoperative hypertension prevalence and awareness in patients before elective surgery

Risk factors for failed back surgery syndrome following open posterior lumbar surgery for degenerative lumbar disease

BackgroundWith the growing number of traditional posterior open surgery, the incidence of failed back surgery syndrome (FBSS) increases gradually. We aimed to investigate the incidence and risk factors for FBSS following open posterior lumbar surgery for degenerative lumbar disease (DLD).MethodA multivariable regression analysis was performed for 333 consecutive patients to identify potential risk factors for FBSS. Clinical outcomes were evaluated by the validated North American Spine Society (NASS) Questionnaire and numerical rating scale (NRS) for pain. Demographics, diagnostic characteristics, surgical data, radiographic parameters for each patient were analyzed.Result16.8% of the included patients were classified as FBSS. Univariate analysis showed that age, hypertension, symptom location, intermittent claudication, preoperative pain NRS-leg, HIZ, Modic changes (MCs), surgical strategy and postoperative rehabilitation were related to FBSS. Multivariable logistic regression analysis demonstrated that preoperative NRS-leg (OR:0.80, 95%CI:0.71–0.91, P = 0.001), hypertension (OR: 2.22, 95%CI: 1.10–4.51, P = 0.027), intermittent claudication with waking distance > 100 m (OR: 4.07, 95%CI: 1.75–9.47, P = 0.001) and waking distance ≤ 100 m (OR: 12.43, 95%CI: 5.54–27.92, P < 0.001), HIZ (OR: 8.26, 95%CI: 4.00–17.04, P < 0.001), MCs (OR: 3.41, 95%CI: 1.73–6.71, P < 0.001), postoperative rehabilitation (OR: 2.63, 95%CI: 1.13–6.12, P = 0.024) were risk factors for FBSS.ConclusionOpen posterior lumbar surgery is an effective treatment for DLD which provides pain reduction and lumbar curve improvement with a considerable satisfaction rate. Lower preoperative NRS-leg, hypertension, intermittent claudication, HIZ, MCs and postoperative rehabilitation are risk factors for FBSS, which can serve as a tool for clinicians to identify at-risk population and provide more effective management to mitigate the doctor-patient contradictions and further occupation of medical resources.

The Effect Of Head Massage Therapy On Blood Pressure In Hypertension Patients Pre Operations In The Home Outpatient Unit Eye Soreness Invitation Surabaya

Hypertension is one of the main causes of mortality and morbidity in Indonesia, found at various levels of health facilities so that preventive and curative efforts are needed, one of which is the application of head massage therapy. The purpose of this study was to determine the effect of head massage therapy on patients with preoperative hypertension at the Undaan Eye Hospital, Surabaya. The research design used is Pre-Experimental Design One Group Pre – Post Test Design. The population of this study were 35 respondents. The Instruments used are SPO head massage, sphygmomanometer, and observation sheet. The analysis used the Paired Sample T Test statistical test with a significance level of 0.05. The results showed that the value of p = 0.000 &lt;0.05 so that H0 was Rejected, meaning that there was an effect of Head Massage Therapy on the blood pressure of hypertensive patients. The results of blood pressure before treatment Were mostly grade 2 as many as 26 respondents (81%) while after treatment most Were grade 1 as many as 17 respondents (53%).With this research, it is hoped that head massage therapy can be applied to patients with hypertension in health services and it is hoped that further research can develop a better theory, duration of administration and design.

SHORT AND MID-TERM MEDICAL OUTCOMES OF SLEEVE GASTRECTOMY IN OBESITY IN SULAIMANI CITY. AN ANALYTICAL CROSS-SECTIONAL STUDY

Background &#x0D; The laparoscopic sleeve gastrectomy (LSG) is a frequently performed bariatric procedure. Studies indicate that LSG can facilitate successful and sustainable weight loss.&#x0D; Objectives &#x0D; To examine the short-term (weight reduction) and mid-term (weight maintenance, quality of life, and medical conditions) outcomes following sleeve gastrectomy in Sulaimani.&#x0D; Patients and Methods&#x0D; A cross-sectional study was conducted on 114 participants from both high-quality and Zhyan hospitals in Sulaimani. From Feb 3, 2020, to Jul 22, 2021, data was gathered by evaluating the patient data records of 114 patients. Data included patients’ demographics, preoperative BMI&amp; comorbidities, complications, and weight loss in the first week, second,4th, sixth months, and sixth months. Also, after the sixth month, complications were recorded and analyzed by SPSS software (IBM, version 25), including frequency and percentage, mean, and standard deviation, also obtained for parametric data. The associations between the variables were tested at a P value &lt;0.05.&#x0D; Results&#x0D; The study consists of 114 patients (71.9% female and 28.1% male), with an average age of 34.0 years (range 20- 51 years). The average preoperative BMI and weight were 41.2 kg/m2 and 110.80 kg, respectively. Six months after surgery, the average ± SD of BMI was 32.8 kg/m ± 2 4.5, and the average ± SD of weight was 87.8 kg ±14.4. The prevalence of early postoperative problems (leak, upper GI bleeding, and intraperitoneal hemorrhage) among 114 patients was 0.9% for each complication, while the proportion of early postoperative nausea was 66.7%, and vomiting was 39.5%. Preoperative sleep apnea was 34.2%; after six months of surgery, the percentage was 0%; 19.3% of patients had joint pain; after six months of surgery, the percentage was 0.9%. In addition, 14 out of 114 patients (12.3%) had preoperative Hypertension, and 2 out of 114 patients (1.75%) had diabetes; after six months, 50% of both groups discontinued medical treatment. The incidence of gallstone development six months after surgery was 13.2%. Six months following LSG, 68.4% of individuals had hair loss. &#x0D; Conclusion&#x0D; laparoscopic sleeve gastrectomy can considerably reduce BMI six months following surgery and may help improve or eliminate obesity-related comorbidities such as Hypertension and type 2 diabetes. A laparoscopic sleeve gastrectomy is an effective option for obese adults, resulting in significant weight loss with a low incidence of postoperative complications. LSG could be recommended as a valuable single intervention therapy for patients who typically fail to achieve and obtain real benefits from a structured weight loss program.

Predictors of 30-Day Readmission Following Cervical Laminoplasty in 3,085 Patients: An American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Database Study.

Background Cervical laminoplasty is a surgical alternative to laminectomy and fusion for treating multi-level cervical spondylotic myelopathy. There is limited evidence evaluating readmission incidence and risk factors following cervical laminoplasty. Here, we provide a retrospective review evaluating preoperative risk for 30-day readmission following cervical laminoplasty. Methodology The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify patients undergoing laminoplasty as defined by Current Procedural Terminology codes 63050 and 63051. Patients were then categorized based on whether 30-day readmission occurred, and preoperative risk factors were examined. Continuous and categorical variables were analyzed using Student's t-test or Fisher's exact test. Multivariate regression analysis was performed for each variable, with p-values of <0.05 considered significant. Results In total, 3,085 patients were identified as undergoing posterior cervical laminoplasty. Of these, 2,938 patients did not require readmission, and 147 patients were readmitted, representing a 4.77% 30-day readmission rate. For all patients, sepsis (odds ratio (OR) = 5.58, p = 0.03), dialysis (OR = 3.46, p = 0.01), American Society of Anesthesiologists class >2 (OR = 1.69, p = 0.011), and hypertension (OR = 1.51, p = 0.04) were predictive of readmission. A subgroup analysis was performed for all geriatric patients (aged >65). In total, 1,353 patients were identified, of whom 76 were readmitted, demonstrating a readmission rate of 5.62%. For the elderly patients, hypertension (OR = 1.98, confidence interval (CI) = 1.04-3.75, p = 0.04) and independent status (OR = 0.39, CI = 0.21-0.74, p = 0.004) were predictive of readmission. Conclusions Assessment of predictors for readmission is important for patient education and setting appropriate clinical expectations for surgeons and providers. Preoperative hypertension, dialysis, and sepsis were risk factors for 30-day readmission following cervical laminoplasty, with functional status being a unique risk factor for elderly patients.

CARDIAC SURGERY ASSOCIATED KIDNEY INJURY: PREDICTORS, BIOMARKERS AND PREVENTION ASSOCIATED COST REDUCTION

Objective To determine the incidence and main predictors of cardiac surgery associated acute kidney injury (CS-AKI), as well as to evaluate hospital and intensive care unit length of stay (LOS) in these patients. A secondary exploratory analysis was made to estimate the potential benefit of including damage biomarkers evaluation in our clinical practice. Design and Method A consecutive sample of adults who underwent elective cardiac surgery between January and March 2015 were included in an University Hospital single-centre retrospective cohort study. Results A total of 274 patients were admitted during the study period. CS-AKI occurred in 86. After adjustment, higher preoperative serum creatinine (mg/L, ORadj =1.10; CI95%: 1.01-1.19), lower preoperative hemoglobin (g/dL, ORadj =0.80; CI95%: 0.70-0.98), preoperative hypertension (ORadj=2.91; CI95%: 1.24-6.84), an increase in cardiopulmonary bypass (CPB) time (min, ORadj=1.01; CI95%:1.00-1.01) and perioperative use of sodium nitroprusside (ORadj=5.31; CI95%:1.51-18.72) remained significantly associated with CS-AKI. The expected cumulative surplus cost for the hospital, associated with CS-AKI (86 patients), was 120,695.84 EUR. Based on a median ARR of 16.6% we would expect a break-event point upon screening 78 patients, which would translate in our 276 patients’ cohort in an overall cost benefit of 7.145 EUR. Conclusions Preoperative hemoglobin, serum creatinine, systemic hypertension, CPB time and perioperative nitroprusside were settled as CS-AKI independent predictors. The use of damage biomarkers combined with early treatment strategy could be associated with a potential cost savings. To determine the incidence and main predictors of cardiac surgery associated acute kidney injury (CS-AKI), as well as to evaluate hospital and intensive care unit length of stay (LOS) in these patients. A secondary exploratory analysis was made to estimate the potential benefit of including damage biomarkers evaluation in our clinical practice. A consecutive sample of adults who underwent elective cardiac surgery between January and March 2015 were included in an University Hospital single-centre retrospective cohort study. A total of 274 patients were admitted during the study period. CS-AKI occurred in 86. After adjustment, higher preoperative serum creatinine (mg/L, ORadj =1.10; CI95%: 1.01-1.19), lower preoperative hemoglobin (g/dL, ORadj =0.80; CI95%: 0.70-0.98), preoperative hypertension (ORadj=2.91; CI95%: 1.24-6.84), an increase in cardiopulmonary bypass (CPB) time (min, ORadj=1.01; CI95%:1.00-1.01) and perioperative use of sodium nitroprusside (ORadj=5.31; CI95%:1.51-18.72) remained significantly associated with CS-AKI. The expected cumulative surplus cost for the hospital, associated with CS-AKI (86 patients), was 120,695.84 EUR. Based on a median ARR of 16.6% we would expect a break-event point upon screening 78 patients, which would translate in our 276 patients’ cohort in an overall cost benefit of 7.145 EUR. Preoperative hemoglobin, serum creatinine, systemic hypertension, CPB time and perioperative nitroprusside were settled as CS-AKI independent predictors. The use of damage biomarkers combined with early treatment strategy could be associated with a potential cost savings.

Airway Hemorrhage Complicating Pulmonary Thromboendarterectomy: Risk Factors and Outcomes

BackgroundAirway hemorrhage is a known complication of pulmonary thromboendarterectomy (PTE) in patients with chronic thromboembolic pulmonary hypertension. Predisposing factors for postoperative airway hemorrhage have not been well described. The aims of this study were to determine the incidence and outcomes of airway hemorrhage after PTE and to identify potential risk factors. MethodsThis was a retrospective chart review of subjects undergoing PTE between 2015 and 2019. Postoperative airway hemorrhage was defined as significant endobronchial bleeding requiring withholding anticoagulation, bronchial blocker placement, and/or extracorporeal membrane oxygenation (ECMO). ResultsOf 877 subjects who underwent PTE, 58 subjects (6.6%) developed postoperative airway hemorrhage. Subjects with hemorrhage were more likely to be women (60% vs 45%, P = .03), to be older (57.8 vs 54.0 years, P = .04), and to have a higher incidence of preoperative hemoptysis (19.0% vs 7.6%, P = .006) compared with control subjects (subjects without airway hemorrhage). Those with hemorrhage had significantly higher preoperative right atrial pressure (P = .002) and pulmonary vascular resistance (P < .001) and a higher incidence of residual pulmonary hypertension (P = .005). Airway hemorrhage management included ECMO with bronchial blocker (n = 2), bronchial blocker without ECMO (n = 26), or withholding anticoagulation alone until bleeding subsided (n = 30). Mortality was significantly higher in those with airway hemorrhage compared with control subjects (13.8% vs 1.2%, P < .001). ConclusionsThe incidence of postoperative airway hemorrhage is low but associated with significant mortality. Older age, female sex, preoperative hemoptysis, and worse preoperative pulmonary hypertension were associated with an increased risk of developing postoperative airway hemorrhage.

Subcapsular renal haematoma after ureteroscopic lithotripsy: a single-centre, retrospective study in China

ObjectivesTo investigate the incidence, predisposing factors, diagnosis and management of subcapsular renal haematoma (SRH) after ureteroscopic lithotripsy (URSL).DesignRetrospective observational study.SettingShandong Provincial Hospital, a 4500-bed tertiary hospital in China.ParticipantsThe data from...