Rate Of Immediate Complications Research Articles

Lésions coronaires calcifiées et résistantes en ambulatoire, mythe ou réalité ?

Progress in coronary angioplasty has enabled outpatients treatment with rates of immediate complications below 1%. This shows a clear improvement in patient's comfort and it represents an important medical and economic gain.Considering the demographic evolution of the population, there is an increasing number of calcified coronary lesions which represent, according to the series, up to a quarter of angioplasties.However, their care is more delicate with a greater risk of complications and procedural failure. In fact, with the difficulties of crossing and with the vascular intrusions related to pre-dilation or sub-dilation stent deployment, the complication risk increases by almost 10% in these cases of angioplasties. Similarly, the death rate at 30 days goes from 4.7% in angioplasty in general up to 24.4% in calcified lesions.Several devices for atherectomy and plaque preparation have been developed in order to better overcome the lesions and better prepare the stent installation at the cost of a risk of complications between 2 and 10%. The three most frequent complications are dissection (1.8 to 7%), slow/no-flow (0.1 to 3%) and coronary perforation (0.2 to 4%).Nevertheless, despite this procedural increased risk, ambulatory angioplasty of calcified complex lesions can become a reality subject to 4-6 hours monitoring in a specialized unit with dedicated protocols.

Comparison of Outcomes of V-Y Atasoy vs Pentagonal Advancement Flap in the Management of Fingertip Injuries Allen Type II and III in a Tertiary Hospital

Background: Fingertip injuries are the most common traumatic conditions of the hand, affecting productivity and livelihood due to a decrease in manual labor capabilities. The V-Y Atasoy advancement flap is typically effective in managing dorsal or transverse fingertip Allen type II and III injuries but may result in complications like dog ears, flap necrosis, paresthesia, and hook nail deformities. Objective: This paper aimed to describe the assessment, operative technique, and outcomes in patients with fingertip injury Allen type II and type III treated with the V-Y Atasoy advancement flap versus the pentagonal flap. We also aimed to compare the outcomes and complications associated with each technique. Methodology: A randomized controlled trial was done among patients with fingertip injury Allen type II and III who were admitted to a tertiary hospital. Results: There were no significant differences in the rates of immediate complications (flap necrosis, infection, dog ear deformity) or short-term outcomes (two-point discrimination, Semmes-Weinstein monofilament test) between the two groups. Most patients had excellent satisfaction and were able to return to work. Conclusion: Patients of the two groups had good to excellent outcomes and had minimal complications, with no significant differences between the groups. The pentagonal flap can be an alternative to the V-Y Atasoy flap in managing fingertip injuries, especially those with a larger surface area of injury.

Resident physician training in bedside pleural procedures: A one-year experience at a teaching hospital

Background and objectiveThis study aims to quantify bedside pleural procedures performed at a quaternary teaching hospital describing technical and epidemiological aspects. Materials and methodsThe authors retrospectively reviewed consecutive patients who underwent invasive thoracic bedside procedures between March 2022 and February 2023. Results463 chest tube insertions and 200 thoracenteses were performed during the study period. Most procedures were conducted by 1st-year Thoracic Surgery residents, with Ultrasound Guidance (USG). There was a notable preference for small-bore pigtail catheters, with a low rate of immediate complications. ConclusionBedside thoracic procedures are commonly performed in current medical practice and are significant in surgical resident training. The utilization of pigtail catheters and point-of-care ultrasonography by surgical residents in pleural procedures is increasingly prevalent and demonstrates high safety.

Outcomes of mechanical thrombectomy in acute stroke patients with atrial fibrillation detected after stroke versus known atrial fibrillation

We aim to compare the outcomes in patients with atrial fibrillation detected after stroke (AFDAS) and their counterparts with known AF (KAF) presenting with large vessel occlusion (LVO) treated with mechanical thrombectomy (MT). This observational, prospective study included consecutive patients with acute LVO ischemic stroke of the anterior circulation with AFDAS, KAF and without AF. The primary study outcome was functional independence at 90 days after stroke. The secondary study outcomes were variation of the NIHSS score at 24 h, rate of successful reperfusion, death at 90 days and rate of immediate complications post-procedure. Overall, our cohort included 518 patients with acute ischemic stroke and LVO treated with MT, with 289 (56.8%) without a diagnosis of AF; 107 (21%) with AFDAS; 122 (22.2%) with KAF. There was no significant difference in terms of functional independence at 90 days after stroke between the three groups. Regarding the secondary study outcome, the rate of symptomatic intracranial haemorrhage (sICH) and/or parenchymal hematoma (PH) were significantly higher in the group of patients without AF (respectively, P = 0.030 and < 0.010). Logistic regression analysis showed that the subtypes of AF were not statistically significantly associated with functional independence at 90 days after stroke and with the likelihood of any ICH. Our results suggest that the subtypes of AF are not associated with clinical and safety outcomes of MT in patients with acute stroke and LVO. Further studies are needed to confirm our findings.

Impact of Bedside Balloon Atrial Septostomy in Neonates with Transposition of the Great Arteries in a Neonatal Intensive Care Unit in Romania.

(1) Background: Transposition of the great arteries (TGA) is the most common congenital heart disease, accounting for 5-7% of all cardiac anomalies, with a prevalence of 0.2-0.3 per 1000 live births. (2) Aim: Our main objectives were to evaluate the clinical safety of balloon atrial septostomy in neonates and the possible complications. Furthermore, we tried to establish whether the procedure should be performed in all TGA patients with small atrial septal defects, regardless of oxygen saturation, within a center where corrective surgery cannot be performed on an emergency basis due to the lack of a permanent cardiac surgery team for arterial switch surgery. (2) Methods: We conducted an observational, retrospective, single tertiary-care center study between January 2008 and April 2022, which included 92 neonates with TGA transferred to our institution for specialized treatment. (3) Results: The median age at the time of the Rashkind procedure was four days. The rate of immediate complications after balloon atrial septostomy (BAS) was high (34.3%), but most were transient (metabolic acidosis and arterial hypotension-21.8%). Twenty patients with TGA managed in our hospital underwent definitive and corrective surgical intervention (arterial switch operation) at a median age of 13 days. Most patients (82.6%) were term neonates, but 16 were born preterm. (4) Conclusions: Urgent balloon atrial septostomy is often the only solution to restore adequate systemic perfusion. Bedside balloon atrial septostomy is a safe, effective, and initial palliative intervention in neonates with TGA, which can be performed in the neonatal unit.

Comparison of Drip‐and‐Ship Versus Mothership Delivery Models of Mechanical Thrombectomy Delivery

Background It remains uncertain whether the drip‐and‐ship (DS) strategy (transport to the nearest primary stroke centers) or the mothership (MS) model (direct transportation to the comprehensive stroke center) is the organizational stroke model associated with the best functional outcome in acute stroke patients with large vessel occlusion. In this study, we compared the periprocedural complications and outcomes at 90 days of acute stroke patients with large vessel occlusion of the anterior circulation directly admitted to our comprehensive stroke center compared to those referred from primary stroke centers treated with mechanical thrombectomy. Methods This is a single‐center prospective observational study where patients with DS and MS were compared regarding the disability at 90 days, as assessed by applying the modified Rankin scale, the rate of successful reperfusion, and the rate of immediate complications postprocedure. Results Of 579 patients, 216 (37.30%) were MS, and 363 (62.7%) were DS. There was no difference regarding the modified Rankin scale at 3 months between the MS (36.4%) and DS (39.3%) groups of patients treated with mechanical thrombectomy ( P =0.362). There was no significant difference regarding the National Institutes of Health Stroke Scale at 24 hours, mortality at 90 days, and rate of successful recanalization postprocedure between the 2 groups. DS was associated with an increased risk of hemorrhagic transformation and symptomatic intracranial hemorrhage (odds ratio, 5.414 [95% CI, 1.572–18.644]; P =0.007). Conclusion Our single‐center study showed no difference in terms of functional independence between the DS and MS organizational paradigm. DS was associated with an increased risk of hemorrhagic transformation and symptomatic intracranial hemorrhage.

Experience with zotarolimus eluting stent in left main percutaneous coronary intervention at a very long-term follow-up

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Drug eluting stents (DES) has improved the results of percutaneous coronary intervention (PCI) in terms of safety and effectiveness in left main coronary artery (LMCA) disease. Zotarolimus is a second-generation drug with excellent clinical outcomes but nowadays their results are unclear in this subgroup of high-risk coronary lesions. Purpose The main objective of this study was to evaluate the efficacy and safety of zotarolimus eluting stent (ZES) in LMCA disease at 14-year follow-up. Methods We prospectively included 432 consecutive patients (69 ± 12 years, 75.5% male) with LMCA disease treated with PCI and ZES between June 2006 and June 2020. We evaluated the presence of major adverse cardiovascular events (MACE) defined as cardiac death, nonfatal myocardial infarction, target lesion revascularization (TLR) and stent thrombosis, after 14-year clinical follow-up (median 61 months). Results 52.8% of patients had stable coronary disease and 47.2% acute coronary syndrome (38.2% Non-STEMI and 9% STEMI). 40.7% were diabetic patients and 40.8% presented moderate-severe left ventricular systolic dysfunction. 5.8% were protected LMCA and 81.7% bifurcated lesions. An intra-aortic balloon pump was needed in 4.9% of the cases. Mean logistic EuroSCORE was 6.7% and Syntax score was ≥ 23 in 73.1% of patients. The most frequently bifurcation technique employed in LMCA was "provisional stenting" in 67.1% of cases with an angiographic success of 99.3%. Complication rate in the procedure was 4.6% with one intraoperative death. During follow-up, MACE rate at 14 years was 17.4% (12.5% cardiac death, 3.5% nonfatal myocardial infarction, 4.2% TLR and thrombosis rate 0.5%). We observed significant differences in the occurrence of MACE in diabetic patients (p=0.002), chronic kidney insufficiency (p&amp;lt;0.001), severe left ventricular systolic dysfunction (p&amp;lt;0.001) and patients in which we didn´t perform final kissing balloon (p=0.03). 21.07% of patients had an angiographic follow-up. Conclusions PCI treatment with ZES in LMCA disease is safe and effective with a low rate of immediate complications and a low rate of mayor cardiac events at very long-term follow-up. Patients with diabetes mellitus or chronic kidney insifficiency, severe left ventrcular systolic dysfinction or those in wich didn´t performe a final kissing balloon have worse prognosis.

Clinical outcomes of left main percutaneous coronary intervention in elderly patients at a long-term follow-up

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The progressive aging of the population leads to higher prevalence of ischemic heart disease with an increased left main coronary artery (LMCA) disease. Elderly patients (&amp;gt;75 years) represent an unfavorable subgroup because of their fragility, the frequent presence of multiple comorbidities associated and their especially high rate of surgical risk. Purpose The main objective of this study was to evaluate the efficacy and safety of percutaneous coronary interventions (PCI) in LMCA disease at 14 years follow-up in the elderly. Methods We prospectively included 217 consecutive patients (80.3 ± 2.4 years, 68.7% male) with LMCA disease treated with PCI between June 2006 and June 2020. We evaluated the occurrence of major adverse cardiovascular events (MACE) defined as cardiac death, non-fatal myocardial infarction, target lesion revascularization (TLR) and stent thrombosis after 14 years clinical follow-up (median 56 months). Results 48.4% of patients had stable coronary disease and 51.6% acute coronary syndrome (42.4% Non-STEMI and 9.2% STEMI). 43.3% were diabetic patients and 45.9% presented moderate-severe left ventricular systolic dysfunction. Mean logistic EuroSCORE was 10.4% and 47.5% of lesions with Syntax score ≥ 32. LMCA bifurcation was affected in 78.8% of cases and the most frequently bifurcation technique employed was "provisional stenting" in 64.1% of cases. Second-generation drug eluting stent was used in 97.6% of cases. The intraprocedural complication rate was 4.5% with one death. During follow-up, MACE rate at 14 years was 19.9% (14.7% cardiac death, 3.2% non-fatal myocardial infarction, 4.1% TLR and thrombosis rate 0.5%). There were significant differences in the occurrence of MACE in patients with moderate-severe ventricular systolic dysfunction (p=0.01 OR 3.92; IC 95% de 1.26-8.57). Conclusions Left main PCI in elderly patients with high surgical risk provide very favourable results with a low rate of immediate complications in the procedure and a low rate of cardiac adverse events at a very long-term follow-up. However, patients with ventricular dysfunction have poor prognosis.

To Wrap or Not? Utility of Anti-reflux Procedure in Infants Needing Gastrostomy Tubes.

PurposeGastrostomy tube (GT) insertion is commonly performed in children with failure to thrive. Pediatric patients' frequently have gastroesophageal reflux (GER) and discerning pathological GER can be challenging. Moreover, there is some evidence that GT insertion may lead to worsening GER and to avoid a subsequent anti-reflux procedure (ARP), though controversial some surgeons advocate considering an ARP concomitantly. The purpose of this report is to assess outcomes in infants who underwent a GT vs. GT with ARP.MethodsRetrospective review of all infants who had a GT placed at a single institution from 2009–2014. The patients were then divided into two cohorts based on the index operation i.e., GT vs GT with ARP and outcomes compared.Results226 operations (104 GT, 122 GT with ARP) were performed. The cohorts were similar in gender, gestational age, race, weight, median age, LOS, and proportion of neurologically impaired patients. Preoperative GER was significantly higher in the GT with ARP cohort (91 vs. 18%). No difference in the rate of immediate complications was noted between the two groups. Postoperative increase in anti-reflux medications was significantly higher in the GT cohort (p = 0.01). Post-op GER needing a secondary procedure (ARP or GJ tube) was noted in 21/104 (20%) patients. Those needing an additional procedure vs. those with GT alone were similar in the proportion of patients with pre-op GER, neurologic impairment, type of feeds, and age.ConclusionIdentifying patients who would benefit from a concomitant ARP remains challenging. A fifth of GT patients needed a subsequent procedure despite most high-risk patients having already undergone an ARP. Since the overall rate of complications remained similar, initial GT approach can be considered reasonable.

COMPLICATIONS AND LATE FOLLOW-UP OF SCOPINARO'S SURGERY WITH GASTRIC PRESERVATION: 1570 PATIENTS OPERATED IN 20 YEARS.

ABSTRACT - BACKGROUND:Scopinaro-type biliopancreatic diversion (BPD-S) and its variations are the surgeries that offer the best immediate results in weight loss and regain in the late follow-up. It has a high rate of immediate complications and demands control with frequent laboratory tests.AIMS: The aim of this study was to analyze the late postoperative complications of 1570 patients operated by biliopancreatic diversion with gastric preservation laparoscopic video with up to 20 years of postoperative follow-up.METHODS: In a follow-up period of up to 20 years, the clinical and surgical complications of 1570 patients with grade II or III obesity were evaluated who were operated on from 2001 to 2014 with the same team of surgeons. Clavien Dindo 11 classification was used for analysis and comparison. Laboratory tests and body mass index (BMI) were used in the analysis of late metabolic outcomes.RESULTS: On the one hand, complications in 204 patients were recorded (13%), and 143 patients (9.1%) were reoperated. On the other hand, 61 patients (29.9%), who had postoperative complications were clinically treated with good evolution in 9.2 years (95%CI 8.2-10.3), with a median of 9.5 years (95%CI 6.1-12.9). Gastroileal anastomosis ulcers occurred in 44 patients (2.8%). Patients with malnutrition, severe anemia, or chronic diarrhea were operated on with common loop elongation (n=64 - 4%), conversion to gastric diversion (n=29 - 5%), or reversal of surgery (n=10 - 0.6%). One death was registered throughout casuistry (0.06%).CONCLUSIONS: Metabolic result of DBP-S was considered excellent in most patients, even referring to changes in the frequency of bowel movements, loose stools, and unpleasant odor. Complications are usually serious and most of the patients require surgical treatment. Therefore, the biliopancreatic diversion of Scopinaro should be reserved for exceptional cases, as there are safer surgical alternatives with less serious side effects.

Treatment of esophageal cancer: surgical outcomes of 335 cases operated in a single center.

the surgical approach persists as the main treatment for esophageal cancer. This study compares the patients of the same institution over time at three different times. this is a retrospective, observational, descriptive study comparing the surgical outcomes obtained by the Division of Surgical Oncology of Erasto Gaertner Hospital. The sample was divided into Period 1 (1987-1997), Period 2 (1998-2003) and Period 3 (2007-2015). Survival rates and disease-free survival were estimated by the Kaplan-Maier method. Survival predictors were identified with Cox regression. ANOVA test was used for comparison between groups. Data were analyzed with SPSS 25.0 and STATA 16, and p<0.05 was considered statistically significant. a total of 335 patients underwent esophagectomy or esophagogastrectomy. When the clinical characteristics of the 3 groups were compared, there was no statistically significant difference. Neoadjuvance was significantly higher in Period 3 (55.4% of patients). We found a histological change in the diagnosis over time, with a significant increase in adenocarcinoma. Morbidity and mortality rates were higher in Period 3. The main complications were pulmonary and anastomotic fistulas. Overall survival in 5 years increased over time, reaching 59.7% in Period 3. better neoadjuvant treatment contributed to increase the global survival of patients, despite greater rate of immediate complications to surgery.

Outcomes of EUS-guided transluminal gallbladder drainage in patients without cholecystitis.

Background and Objectives:Cholecystectomy is the gold standard for most gallbladder-related disease. However, many patients with gallbladder disease are poor surgical candidates. Current nonsurgical gallbladder drainage (GBD) methods include percutaneous cholecystostomy and endoscopic ultrasound-guided transluminal GBD (EUS-GBD). Outcomes for EUS-GBD for the treatment of noncholecystitis (NC) gallbladder disease have not been defined.Materials and Methods:Cases were identified using procedural data from a quaternary academic hospital for endoscopic procedures from 2015 to 2020. Patients who underwent EUS-GBD for acute cholecystitis, biliary colic, gallstone pancreatitis, and secondary prevention of gallstone disease were included.Results:Fifty-five cases of EUS-GBD were identified over the 5-year study period. Forty-one cases were performed for acute cholecystitis, and 15 were performed for other NC indications. Indications for NC drainage included primary treatment of symptomatic biliary colic and secondary prevention of gallstone pancreatitis and choledocholithiasis. There was no statistically significant difference in complications, mortality, or reintervention requirements. There was a 13.3% rate of immediate complications in the NC group, which were all medically managed.Conclusions:EUS-GBD appears to be a safe and effective way to manage gallstone disease in nonsurgical candidates with NC gallbladder-related disease. Overall complications and readmissions were infrequent. Complication rates were similar to those published in patients who underwent EUS-GBD for acute cholecystitis.

Patent foramen ovale closure in children without cardiopathy: Child-PFO study

Closure of patent foramen ovale is well-managed in adults, but is performed less frequently in children. To analyse all patent foramen ovale closures performed in the past 20 years in French paediatric centres. Retrospective study of patent foramen ovale closures in children without cardiopathy in nine centres between 2000 and 2019. Forty-one procedures were carried out in children (median age: 14.9 years). Thirty-one patent foramen ovales were closed after a transient ischaemic attack or stroke, six for a left-to-right shunt and four for other reasons. Transthoracic echocardiography was used for 72.2% of the diagnoses and transoesophageal echocardiography for 27.8%. A substantial degree of shunting was found in 42.9% of patients and an atrial septal aneurysm in 56.2%. General anaesthesia with transoesophageal echocardiography guidance was performed in 68.3% of the procedures; local anaesthesia and transthoracic echocardiography or intracardiac echocardiography was performed in 31.7%. The success rate was 100%. The median fluoroscopy time was 4.14minutes: 3.55minutes with transoesophageal echocardiography; and 4.38minutes with transthoracic echocardiography (P=0.67). There was only one periprocedural complication (2.4%). Postoperatively, 80,5% of patients were treated with aspirin and 12,2% with an anticoagulant. The rate of complete occlusion was 56.8% immediately after the procedure, 68.6% at 1 year and 92.3% at the last follow-up. There were no delayed complications or cases of recurrent stroke during follow-up (median follow-up: 568 days). Closure of patent foramen ovale in children appears to be safe and effective, as we noted a low rate of immediate complications, no delayed complications and no stroke recurrence in this indication.

The Boston Medical Center Coronavirus Disease 2019 (COVID-19) Procedure Team: Optimizing the surgeon’s role in pandemic care at a safety-net hospital

BackgroundThe coronavirus disease 2019 pandemic has claimed many lives and strained the US health care system. At Boston Medical Center, a regional safety-net hospital, the Department of Surgery created a dedicated coronavirus disease 2019 Procedure Team to ease the burden on other providers coping with the surge of infected patients. As restrictions on social distancing are lifted, health systems are bracing for additional surges in coronavirus disease 2019 cases. Our objective is to quantify the volume and types of procedures performed, review outcomes, and highlight lessons for other institutions that may need to establish similar teams. MethodsProcedures were tracked prospectively along with patient demographics, immediate complications, and time from donning to doffing of the personal protective equipment. Retrospective chart review was conducted to obtain patient outcomes and delayed adverse events. We hypothesized that a dedicated surgeon-led team would perform invasive bedside procedures expeditiously and with few complications. ResultsFrom March 30, 2020 to April 30, 2020, there were 1,196 coronavirus disease 2019 admissions. The Procedure Team performed 272 procedures on 125 patients, including placement of 135 arterial catheters, 107 central venous catheters, 25 hemodialysis catheters, and 4 thoracostomy tubes. Specific to central venous access, the average procedural time was 47 minutes, and the rate of immediate complications was 1.5%, including 1 arterial cannulation and 1 pneumothorax. ConclusionProcedural complication rate was less than rates reported in the literature. The team saved approximately 192 hours of work that could be redirected to other patient care needs. In times of crisis, redeployment of surgeons (who arguably have the most procedural experience) into procedural teams is a practical approach to optimize outcomes and preserve resources.

Su1300 OUTCOMES OF ENDOSCOPIC ULTRASOUND-GUIDED TRANSLUMINAL GALLBLADDER DRAINAGE IN PATIENTS WITHOUT CHOLECYSTITIS

Cholecystectomy is the gold standard for most gallbladder related disease. However, many patients with gallbladder disease are poor surgical candidates. Current non-surgical gallbladder drainage (GBD) methods include percutaneous GBD, endoscopic transpapillary GBD with endoscopic retrograde cholangiopancreatography (ERCP), and endoscopic ultrasound-guided transluminal GBD (EUS-GBD). The success rates and adverse events for these methods have been documented. The outcomes for EUS-GBD for acute cholecystitis have been studied, with adverse event rates up to 38.6%, including stent migration, occlusion, infection, and bleeding. Outcomes in patients who are not surgical candidates and undergo EUS-GBD for prevention of biliary complications have not been defined. The objective of this study was to characterize outcomes in this patient population in a retrospective review. Cases were identified using billing data from Massachusetts General Hospital for endoscopic procedures from 2015-2019. Any case that billed for use of a stent for purposes other than EUS-GBD were excluded. Inclusion criteria were patients who underwent EUS-GBD for biliary colic, gallstone pancreatitis, and treatment of gallstones. The indication for GBD and etiology were identified from chart review, with use of the Tokyo criteria to define infectious etiologies. Forty-eight cases of EUS-GBD were identified over the 4-year study period. Twenty were performed for indications aside from acute cholecystitis. These included symptomatic biliary colic, prevention of gallstone pancreatitis, and treatment of gallstones in patients with choledocholithiasis. There was a 100% success rate, with an average admission of 10.9 days. There was a 20% rate of immediate complications, including fever (n=2), persistent abdominal pain (n=1), and bacteremia (n=1); these were all medically managed. Over a one year follow-up period, two patients were re-admitted with gallstone disease; one with symptomatic gallstones and one with pancreatitis. There was a 5% rate of late complications due to bleeding requiring ERCP and re-stenting. There was a stent removal rate of 40% at an average of 47 days post-procedure; these were all planned stent replacements. 25% of patients died within 1 year, with one dying in the same admission, none of which resulted from stent or biliary disease complications. EUS-GBD appears to be a safe and effective way to manage gallstone disease in non-surgical candidates. Overall immediate and delayed complications were low. Recurrent admissions for gallstone related disease were infrequent. Complication rates were similar to those published in patients who underwent EUS-GBD for acute cholecystitis. In conclusion, we suggest that EUS-GBD can be an option for patients who are poor surgical candidates to prevent recurrent gallstone related morbidity.

Percutaneous Tracheostomy under Real-time Ultrasound Guidance in Coagulopathic Patients: A Single-center Experience.

ABSTRACTObjectiveTo examine the safety and complications associated with percutaneous tracheostomy (PT) in critically ill coagulopathic patients under real-time ultrasound guidance.Materials and methodsCoagulopathy was defined as international normalized ratio (INR) ≥1.5 or thrombocytopenia (platelet count ≤50,000/mm3). Neck anatomy was assessed for all patients before the procedure and was characterized as excellent, good, satisfactory, and unsatisfactory based on the number of vessels in the path of needle. Percutaneous tracheostomy was performed under real-time ultrasound (USG) guidance, with certain modifications to the technique, and patients in both groups were assessed for immediate complications including bleeding.ResultsSix hundred and fifty-two patients underwent USG-guided PT. Three hundred and forty-five (52.9%) were coagulopathic before the procedure. Ninety-nine patients (15.2%) had an excellent neck anatomy on USG scan, and 112 patients (62 in coagulopathy group vs 50 in noncoagulopathy group, p value 0.386) had an unsatisfactory neck anatomy for tracheostomy. A total of 42 events of immediate complications were noted in 37 patients (5.7%). No difference was seen in the rate of immediate complications in both groups (5.8% in coagulopathy group vs 5.5% in noncoagulopathy group, p value 0.886). The incidence of minor bleeding in coagulopathic patients was 14 patients (4.1%) and 7 (2.3%) in those without coagulopathy, and this difference was not statistically different (p value—0.199). In the subgroup analysis of patients with significant coagulopathy and unsatisfactory anatomy, no difference was observed in the incidence of immediate complications.ConclusionThis study shows the efficacy and safety of real-time ultrasound-guided PT, even in patients with coagulopathy.How to cite this articleKumar P, Govil D, Patel SJ, Jagadeesh KN, Gupta S, Srinivasan S, et al. Percutaneous Tracheostomy under Real-time Ultrasound Guidance in Coagulopathic Patients: A Single-center Experience. Indian J Crit Care Med 2020;24(2):122–127.

Do Ventriculoperitoneal Shunts Increase Complications After Laparoscopic Gastrostomy in Children?

BackgroundIn patients requiring gastrostomies, ventriculoperitoneal (VP) shunts are a frequently encountered comorbidity. The objective of this study is to evaluate the postoperative management of children with VP shunts that undergo laparoscopic gastrostomy placement and determine their incidence of complications. Materials and methodsChildren 18 y old or younger who underwent laparoscopic gastrostomy placement at a freestanding academic children's hospital between January 2014 and October 2016 were reviewed. Data collected included demographics, management, and outcomes. Patients were compared based on their presence of a VP shunt before laparoscopic gastrostomy. Statistical analysis was performed using chi square, Fisher's exact, and Wilcoxon rank-sum tests. ResultsWe reviewed the medical records of 270 children that underwent laparoscopic gastrostomy placement by 15 pediatric surgeons. Of these, 9% (25) had a previously placed VP shunt. In comparing patients with a VP shunt with those without a VP shunt, there was no significant difference in median age (4 versus 3 y, P = 0.92), gender (48% versus 51% males, P = 0.80), body mass index (15 versus 16, P = 0.69), preoperative diet (48% versus 47% nasogastric tube dependent, P = 0.60), or procedure time (43 versus 42 min, P = 0.37). The postoperative management of these children was similar: day of initiation of postoperative feeds (84% versus 73% on postoperative day #1, P = 0.70), method of initiation of feeds (60% versus 55% continuous, P = 0.25), and type of initial feeds (83% versus 71% Pedialyte, P = 0.24). Similarly, there was no difference in hospital length of stay, return to the emergency department, or postoperative complications within 90 d (P > 0.05). ConclusionsChildren with ventriculoperitoneal shunts do not have a higher rate of immediate complications after laparoscopic gastrostomy placement and may be managed similar to other children in the postoperative period.

Anterior pericardial access to facilitate electrophysiology study and catheter ablation of ventricular arrhythmias: A single tertiary center experience.

Epicardial ablation is becoming an important part of management in patients with ventricular tachycardia (VT). Posterior epicardial access via the Sosa or needle-in-needle (NIN) approach for epicardial VT ablation is considered to be the method of choice for most electrophysiologists. Anterior epicardial access as an alternative technique has recently been proposed, but there are limited data about its safety, efficacy, and the rate of immediate complications. In this study, we report our experience with anterior epicardial access between 2009 and 2016. Between 2009 and June 2016, 100 consecutive patients underwent epicardial VT ablation using an anterior approach. The success rate, epicardial bleeding, and other complications related to the epicardial access in these patients were compared to the previously reported rate of complications in patients whom epicardial access was performed using the NIN or Sosa techniques. Anterior epicardial access was obtained successfully in 100% of patients in the first attempt. The success rate of the anterior approach was comparable with the reported success rate of the NIN technique (100%vs. 100%, P value not significant) but better than the Sosa technique (100%vs. 94%, P=0.012). None of the patients in the anterior approach series suffered from significant pericardial bleeding (defined as greater than 80mL of blood loss), RV puncture/damage, or need for an emergent cardiac surgery. An anterior epicardial approach is feasible and appears to have an acceptable safety profile in comparison with other epicardial approaches.

Cervical preparation prior to second-trimester surgical abortion and risk of subsequent preterm birth

Dilatation and evacuation, or D&E, is the safest method of second-trimester surgical abortion. It has a lower rate of immediate complications than the alternative of medical induction, causes less pain...

Can we consider immediate complications after thyroidectomy as a quality metric of operation?

Permanent recurrent laryngeal nerve palsy and hypoparathyroidism are 2 major complications after thyroid operation. Assuming that the rate of immediate complications can predict the permanent complication rate, some authors consider these complications as a valid metric for assessing the performance of individual surgeons. This study aimed to determine the correlation between rates of immediate and permanent complications after thyroidectomy at the surgeon level. We conducted a prospective, cross-sectional study in 5 academic hospitals between April 2008 and December 2009. The correlation between the rates of immediate and permanent complications for each of the 22 participating surgeons was calculated using the Pearson correlation test (r). The study period included 3,605 patients. There was a fairly good correlation between rates of immediate and permanent recurrent laryngeal nerve palsy (r=0.70, P=.004), but no correlation was found for immediate and permanent hypoparathyroidism (r=0.18, P=.427). The immediate hypoparathyroidism rate does not reflect the permanent hypoparathyroidism rate. Consequently, immediate hypoparathyroidism should not be used to assess the quality of thyroidectomy or to monitor the performance of surgeons.