Surgery Recipients Research Articles

Employment disruption following diagnosis of gynecologic malignancies

<h3>Objectives:</h3> Financial toxicity is a significant challenge for cancer survivors, which may be compounded a decrease in work hours or cessation of work altogether after diagnosis. We evaluated the frequency of employment change in the year following diagnosis of a gynecologic cancer, and assessed factors associated with a disruption in employment. <h3>Methods:</h3> A cohort of patients 18-63 years old who were diagnosed with cervical, ovarian, endometrial or vulvar cancer (January 2009-December 2017) were identified in the Truven MarketScan database, an insurance claims database of commercially insured patients in the United States. All patients who were working full or part-time at diagnosis were included, and all employment changes during the year following diagnosis were followed monthly. Clinical information, including receipt of surgery, chemotherapy and radiation, were identified using Common Procedural Terminology codes, and International Statistical Classification of Diseases codes. Cox proportional-hazards models incorporating measured covariates were used to evaluate the impact of covariates on change in employment status. Patients were censored when a change in employment was identified. <h3>Results:</h3> A total of 7,446 women diagnosed with a gynecologic cancer (12.6% cervical, 24.7% ovarian, 2.6% vulvar, and 60.1% endometrial cancer) were identified. All patients held a full-time or part-time job 12 months prior to diagnosis. While most patients continued working following diagnosis, 20.6% cervical, 20.8% ovarian, 15.7% vulvar, and 21.7% of endometrial cancer patients experienced a change in employment from full-or part-time to long-term disability, retirement, or cessation of work. Older age (58-63), presence of comorbidities, and metastatic disease were associated with an increased risk of change in employment (P<0.0001, P=0.0091, P=0.002 respectively). In a multivariable model controlling for age, region of residence, comorbidities, insurance plan type, presence of adverse events, presence of metastatic disease, and cancer type, recipients of surgery plus adjuvant therapy (chemotherapy, radiation or chemoradiation) were 20% more likely to experience an employment change than those who underwent surgery alone (HR 1.23 95% CI 1.082-1.409). <h3>Conclusions:</h3> A total of 16-22% women with a gynecologic malignancy and employer-subsidized health insurance experienced a change in employment status in the year following diagnosis. Adjuvant therapy, older age, presence of comorbidities and presence of metastatic disease.

Racial differences in the risk of second primary bladder cancer following radiation therapy among localized prostate cancer patients

ObjectivesTo investigate the race-specific second primary bladder cancer (SPBC) risk following prostatic irradiation. MethodsLouisiana residents who were diagnosed with localized prostate cancer (PCa) in 1996–2013 and received surgery or radiation were included. Patients were followed until SPBC diagnosis, death, or Dec. 2018. The exposure variable was type of treatment (radiation only vs. surgery only). The outcome was time from PCa diagnosis to SPBC diagnosis, stratified by race. Fine and Gray’s competing risk model was applied with death as a competing event and adjustment of sociodemographic and tumor characteristics. We used 5 years and 10 years as lag time in the analyses. ResultsA total of 26,277 PCa patients with a median follow-up of 10.7 years were analyzed, including 18,598 white and 7679 black patients. About 42.9 % of whites and 45.7 % of blacks received radiation. SPBC counted for 1.84 % in the radiation group and 0.90 % in the surgery group among white patients and for 0.91 % and 0.58 %, respectively, among black patients. The adjusted subdistribution hazard ratio of SPBC was 1.80 (95 % CI: 1.30–2.48) for radiation recipients compared to surgery recipients among white patients; 1.93 (95 % CI: 1.36–2.74) if restricted to external beam radiation therapy (EBRT). The SPBC risk was not significantly different between irradiated and surgically treated among blacks. ConclusionsThe SPBC risk is almost two-fold among white irradiated PCa patients compared to their counterparts treated surgically. Our findings highlight the need for enhanced surveillance for white PCa survivors receiving radiotherapy, especially those received EBRT.

First and second pregnancy outcomes in women with class III obesity: An observational cohort study

IntroductionClass III obesity (BMI ≥ 40 kg/m2) during pregnancy predisposes mother and offspring to a range of adverse pregnancy complications and outcomes. Risk profiles vary between pregnancies and are affected by interpregnancy weight gain. We evaluated the risk of adverse outcomes in women with BMI ≥ 40 kg/m2 in first and second pregnancies, and the impact of interpregnancy weight change on this risk. Materials and methodsData were extracted for all women with BMI ≥ 40 kg/m2 at first antenatal visit, who completed antenatal and delivery care for first and second pregnancies in NHS Lothian between 1/1/2009–31/12/2018. Multiple pregnancies and recipients of bariatric surgery were excluded. Results442 pregnancies among 221 women were included. In first pregnancy, median (interquartile range) weight was 117 kg (108.5–126.7), age 28 years (24–31) and BMI 42 kg/m2 (41.0−44.5), 14.4% had gestational diabetes (GDM), 11.3% had pregnancy-induced hypertension and 44.6% had a post-partum haemorrhage (PPH). 20.8% of babies were large for gestational age (LGA, ≥97% centile at birth). In second pregnancy, women were heavier with a median weight of 119.9 kg (109.0−130.0, p = 0.00) with 19.9% gaining over 10 kg. Women were more likely to develop GDM (21.6%, p = 0.02). Babies were heavier with 40% of babies LGA (p < 0.0001). Interpregnancy weight change had no significant impact on GDM, pregnancy induced hypertension, PPH, perinatal mortality or LGA. ConclusionsIn a population of women with BMI ≥ 40 kg/m2, pregnancy complications are common and risk is higher in second pregnancy. The interpregnancy period is a critical time to engage women in health improvement and weight loss strategies to maximise outcomes for mother and offspring.

Vascular surgery receipt and outcomes for people with serious mental illnesses: Retrospective cohort study using a large mental healthcare database in South London

ObjectiveVascular surgery can be common among people with serious mental illness (SMI) given the high prevalence of cardiovascular disease. However, post-operative outcomes following vascular surgery have received little investigation, particularly in a subpopulation of SMI. MethodsWe conducted a retrospective observational study using data from the South London and Maudsley NHS Foundation Trust (SLaM) via its Clinical Record Interactive Search (CRIS) platform and linkage with Hospital Episode Statistic (HES). Vascular surgery recipients were identified using OPCS version 4 codes. Length of stay (LOS) was modelled using Incidence Rate Ratios (IRRs), and 30-day emergency hospital readmissions using Odds Ratios (ORs) for people with SMI compared with the general population. ResultsVascular surgery was received by 152 patients with SMI diagnoses (schizophrenia, schizoaffective disorder, bipolar disorder) and 8821 catchment residents without any mental health conditions. People with active SMI symptoms more likely to be admitted to hospital via emergency route OR: 1.80 (95% CI: 1.06, 3.07) and more likely to stay longer in the hospital for vascular surgery IRR: 1.35 (1.01, 1.80) and more likely to be readmitted to hospital via emergency route within 30 days OR: 1.53 (1.02, 2.67). People with SMI who had major open vascular surgery and peripheral endovascular surgery more likely to have worse post-operative outcomes. ConclusionOur study highlights the risks faced by people with SMI following vascular surgery. These suggest tailored guidelines and policies are needed, based on the identification of pre-operative risk factors, allowing for focused post-vascular surgery care to minimise adverse outcomes.

Construct Validity and Item Response Theory Analysis of the PROMIS-29 v2.0 in Recipients of Lumbar Spine Surgery.

Observational cohort design involving measurement property assessment. The aim of this study was to assess construct validity through hypothesis testing and to examine reliability and discrimination of the PROMIS-29 v2.0 using item response theory (IRT) analyses. Patient-Reported Outcomes Measurement Information System (PROMIS) 29.0 version 2.0 includes 28 questions for the seven domains of Physical function, Anxiety, Depression, Fatigue, Sleep disturbance, Social role, and Pain interference, and one item related to pain intensity. To date, the tool has not been tested for construct validity for selected concepts, nor has it been evaluated using IRT in a population of spine surgery recipients. Using the Quality Outcomes Dataset lumbar registry, we evaluated the construct validity of the PROMIS-29 v2.0 against pain intensity measures for back and leg, the Oswestry Disability Index, the EQ5D 3L-visual analog scale (quality of life) and proxy measures of activities, mobility and self-care. IRT was used to test PROMIS-29 v2.0 assumptions and fit. The sample included 652 surgery recipients (mean age = 60.1, SD = 14.0) who had a high level of baseline disability. Hypothesis testing confirmed direction and magnitude of correlation between the PROMIS and legacy measures in 10 of the 12 hypotheses. IRT identified three misfit items, but otherwise adequate scale reliability and unidimensionality. The PROMIS-29 v2.0 measures several different constructs pertinent to a patient's health and recovery during spine surgery. We feel that the PROMIS-29 v2.0 tool is a useful and effective outcome measure for populations who receive spine surgery.Level of Evidence: 4.

The Science of Social Justice: A Conversation with David Ebershoff

David Ebershoff’s biographical novel The Danish Girl focuses on the life of Lili Elbe, one of the first recipients of gender-confirmation surgery. In this interview with Ebershoff, there is discussion about the intertwining roles of art and science both in the novel and in Lili’s life, and Ebershoff clarifies how he used Lili’s story to create a work of fiction about human agency.

Evaluation of Opioid Prescribing Patterns and Drivers of Variation Following Endoscopic Procedures for Benign Prostatic Hyperplasia Across an Integrated Academic Health System

To evaluate patient, provider, and facility factors associated with variation in opioid prescribing after endoscopic procedures for benign prostatic hyperplasia across a large academic health system to drive improvement efforts. Opioids prescribed at discharge for patients who underwent an endoscopic prostate procedure March 2018-November 2019 were analyzed. Multivariable logistic and linear regression were used to evaluate the relationship between patient, provider, and facility factors and the receipt of any opioid prescription and the quantity prescribed. We included 724 patients who had surgery with one of 26 urologists across five facilities. 222 (30.7%) received an opioid prescription, and the average morphine milligram equivalents (MMEs) prescribed was 97.9±33.5. We found wide variation in the proportion of patients who received an opioid prescription across surgeons (range 0%-88.9%) and facilities (range 19.9%-66.7%) and the average MMEs prescribed (range 25-188.5). Outpatient surgery (OR 2.32; 95% confidence interval [CI] 1.22-4.40, P = .010) and preoperative opioid use (OR 15.04; CI 9.65-23.45, P < .001) were associated with higher rates of opioid prescribing, while prescribing decreased with increasing patient age (OR 0.97; CI 0.95-0.99, P = 0.016). Multivariable linear regression analysis demonstrated an association between surgery at satellite facilities, having a surgeon in practice for at least 20 years, and higher surgeon volume with increased MMEs prescribed. Opioid prescribing following endoscopic prostate procedures varied widely. Targeted interventions tailored to younger patients, those taking opioids preoperatively, recipients of outpatient surgery and those undergoing surgery at satellite facilities may be particularly high yield given the association between these factors and increased postoperative prescribing.

The Evolution of Minimally Invasive Donor Hepatectomy: Robotic vs Laparoscopic and Open Right Lobe Procurement. A Multicenter Study on 1194 Donor Hepatectomies

Background: Laparoscopic and robotic Minimally invasive donor hepatectomies (MIDH) are increasingly performed, especially in Eastern countries. We conducted a retrospective, multicenter, propensity score-adjusted analysis on right lobe MIDH by comparing the robotic approach to the laparoscopic and open ones assessing feasibility, safety, and early outcomes. Methods: From January 2016 until December 2020, 1194 donors underwent right hepatectomy performed with a robotic (n=92), laparoscopic (n=306), and open approach (n=796) at six high volume centers. Propensity score matching (1:1:2) was performed to make donors comparable for sex, age, and body mass index (BMI), and recipients comparable for sex, age, BMI, liver disease, presence of HCC, MELD and graft-to-recipient-body weight ratio. Perioperative donor outcomes were analyzed, with complications classified according to Clavien-Dindo, and postoperative pain measured through a visual analog scale. Recipients' outcomes were also analyzed. Results: Ninety-two donors undergoing robotic surgery were matched and compared to 92 and 184 donors undergoing laparoscopic and open surgery. Conversions to open surgery occurred during 1 (1.1%) robotic and 2 (2.2%) laparoscopic procedures. Robotic procedures had a longer operative time than laparoscopic and open procedures (p < 0.001). The first graft warm ischemic time was also longer during robotic procedures. However, the robotic approach was associated with reduced donor blood losses (p<0.001). Postoperative mortality was nihil. No differences were observed in major complications (Clavien-Dindo ≥ IIIa). Donors undergoing robotic hepatectomy had less postoperative pain than those undergoing laparoscopic and open procedures (p<0.001). Fifty recipients of robotic-procured grafts were matched to 50 and 100 recipients of laparoscopic and open surgery procured grafts, respectively. There were no differences in terms of postoperative complicationns and 90 days mortality. After a mean follow-up of 18 months, recipients' survival was similar (p=0.455). Conclusions: In high volume centers, robotic right lobe procurement is a safe procedure for both donors and recipients. Despite an increased operative time, a robotic approach is associated with reduced intraoperative blood losses and postoperative pain, compared to the laparoscopic and open approaches. Recipients’ outcomes are independent of the surgical approach used for graft procurement.

Measurement Properties of the Oswestry Disability Index in Recipients of Lumbar Spine Surgery.

This is an observational study on the measurement properties of the Oswestry Disability Index (ODI) version 1.0. To (1) determine the construct validity of the tool, specifically structural validity; (2) analyze the criterion validity of the tool, specifically concurrent validity against proxy measures of pain, function, and quality of life and predictive validity of each item to proxy measures of disability; and (3) reliability of the tool, specifically internal consistency. We endeavored to investigate the measurement properties of the ODI on a spine surgery population to test the assumption that a more disabled population may influence the properties of the tool. Data were pulled from the Quality Outcomes Database (QOD) Spine Registry. A total of 57,199 participants who underwent primary or revision lumbar spine surgeries were included. Structural validity was assessed by exploratory and confirmatory factor analysis, concurrent validity, predictive validity by odds ratios, and internal consistency by Cronbach alpha. The Visual Analog Scale for back pain, two standard open questions, and the EuroQol 5 Dimension/Visual Analogue Scale were included as proxy measures of pain, function, and quality of life, respectively. Hospital readmission, return to operating room for treatment and revision surgery (all within 30 days) were included as proxy measures of disability to assess the predictive validity of each ODI item. The ODI demonstrated a two-factor structural solution, which explained 54.9% of the total variance. Fair internal consistency (0.74-0.77), and fair criterion validity (concurrent) and significant findings with predictive validity (P < 0.01) substantiated the use of each item of the ODI as well as the summary score and ODI thresholds. Our study lends value to a burgeoning repository of evidence that suggests the ODI is a useful tool for capturing outcomes in clinical practice. We recommend its continued use in clinical practice.Level of Evidence: 4.

When (fake) beauty turns ugly: Plastic surgery as a moral violation

Plastic surgery is a popular form of appearance modification. Nonetheless, attitudes toward the recipients of plastic surgery remain divided. These attitudes may be indicative of an underlying moralisation of plastic surgery in contemporary society. To test this hypothesis, we examined perceptions of plastic surgery in the context of Moral Foundations Theory – a formal framework in which morality is categorised into five innate foundations: Sanctity, Care, Fairness, Loyalty, and Authority. Across two complementary online surveys with samples of 385 undergraduate psychology students (75% female) and 1533 sexual minority men, respectively, we investigated participants’ valuation of each moral foundation and their moral condemnation of plastic surgery. Results indicated that scores on Sanctity predicted moral condemnation, such that participants who valued Sanctity more highly were more likely to perceive plastic surgery as morally fraught. Sanctity encompasses naturalness and purity elements of morality. As such, results were explored in the context of two broad theories: feminist theory, which posits that unnatural beauty is perceived as unfavourably as ugliness itself, and evolutionary theory, which suggests that unnatural stimuli are moralised because they elicit innate and powerful disgust reactions. Ultimately, we concluded that the underlying societal moralisation of plastic surgery is attributable to perceptions of plastic surgery as fundamentally unnatural. Implications for interventions targeted at eradicating plastic surgery condemnation are discussed.

Incidence and risk factors for new-onset atrial fibrillation following coronary artery bypass grafting: A systematic review and meta-analysis

ObjectivesTo estimate the incidence of new-onset post-operative atrial fibrillation after isolated coronary artery bypass surgery and summarise the evidence on risk factors that predispose people to developing the complication. Study design/methodsA systematic review was conducted to identify studies from the CINAHL, MEDLINE and Cochrane databases. A title and abstract review was conducted by one reviewer. Full text review and quality assessment processes were conducted by two reviewers. Incidence data was combined in meta-analysis using the ‘metaprop’ routine in Stata and risk factor data were synthesised in narrative and table format. ResultsTen studies, including 6173 participants, were included in the review. The estimated pooled incidence of post-operative atrial fibrillation was 25% (CI 0.19–0.30). In a secondary meta-analysis including studies that only included first time bypass surgery recipients the estimated pooled incidence was 26% (CI 0.14–0.41). Due to high levels of heterogeneity these results should be interpreted with caution. Risk factors with the strongest associations to post-operative atrial fibrillation were chronic obstructive pulmonary disease, decreased partial pressure of oxygen on air, congestive heart failure, right coronary artery disease, male gender, prolonged cross clamp time and port-operative inotropic exposure. ConclusionFurther prospective studies are needed to strengthen the current evidence base.

Curbing Obesity from One Generation to Another: the Effects of Bariatric Surgery on the In Utero Environment and Beyond.

Approximately 250,000 individuals seek bariatric surgery each year in the USA for the long-term resolution of obesity-related comorbidities. Greater than 80% of these individuals are women and approximately half are of child-bearing age. Although there are many positive metabolic benefits that are realized through surgical weight loss for both men and women, the various long-term hormonal, molecular, nutrient, and epigenetic changes following bariatric surgery have not been evaluated for the surgical recipient or in the context of pregnancy and the offspring. Pregnancy may be a vulnerable period of time for the bariatric surgery recipient, and thoughtful consideration of pregnancy management should be taken by health care providers and recipients alike. The purpose of this review is to explore potential etiologies of some of the gestation-specific outcomes for the mother and offspring.

Oral Health of Postbariatric Surgery Recipients

Introduction: A growing body of research has found implications for oral health postbariatric surgery. Purpose: To review the literature about the impact postbariatric surgery on oral health. Main ...

Timing of initiation of renal replacement therapy in acute kidney injury: an updated meta-analysis of randomized controlled trials

Purpose The results from randomized controlled trials (RCTs) concerning the timing of initiation of renal replacement therapy (RRT) for patients with acute kidney injury (AKI) are still inconsistent. Materials and methods We searched for RCTs, as well as relevant references, focusing on the timing of RRT for AKI patients in the Medline, Embase, Cochrane Library, Google Scholar and Chinese databases from their inception to December 2018. Results We included 18 RCTs from 1997 to 2018 involving 2856 patients. Pooled analyses of all RCTs showed no significant difference in mortality between early initiation and delayed initiation of RRT (RR 0.98, 95% CI: 0.89 to 1.08, p = .7) (I 2 = 2%), and similar results were found in critically ill and community-acquired AKI patients, as well as in a subgroup of patients with sepsis and in cardiac surgery recipients. There was also no difference in the incidence of dialysis independence (RR 0.75, 95% CI: 0.47 to 1.2, p = .2) (I 2 = 0). However, an early RRT strategy was associated with a significantly higher incidence of the need for RRT for AKI patients (RR 1.24, 95% CI: 1.13 to 1.36, p < .01) (I 2 = 34%). Conclusions As no life-threatening complications occurred, there was no evidence to show any benefit of an early RRT strategy for critically ill or community-acquired AKI patients; in contrast, a delayed strategy might avert the need for RRT.

Decision Support System Recipient In the House Surgery Department of Housing and Settlement Region Deli Serdang Using TOPSIS Method

The Inappropriate Home Assistance Program (PRTLH) or Home Renovation is assistance provided by the government to people who are Unable to reduce the economic burden. This assistance can be Obtained if the prospective beneficiary meets the specified criteria and conditions. This research is motivated by the house renovation assistance to the community is still subjective, less objective in the selection of the data and the weakness of the system used today. Therefore to help in the selection, a system for decision support was made in Determining the prospective recipient of house surgery assistance using the web-based TOPSIS method using a MySQL database, so that it can help smooth the evaluation process in the selection of subsequent home surgery recipients.

Aspirin for prevention of venous thromboembolism in recipients of major lower-limb orthopedic surgery: a systematic review of Level I evidence.

Major lower-limb orthopedic surgery recipients are at increased risk of venous thromboembolism (VTE). The optimal strategy for preventing VTE is a topic of ongoing debate. The use of aspirin has been implicated in reducing VTE events and is potentially advantageous compared to other agents in respect to cost, access, route of administration and reduced adverse effects such as bleeding. A systematic search for Level I evidence (systematic reviews and meta-analyses of randomised-controlled trials) was performed in April 2019 to evaluate the use of aspirin for primary and secondary VTE prophylaxis compared to alternative chemical and mechanical strategies. This search encompassed three electronic databases (Pubmed, Embase and the Cochrane Database of Systematic Reviews). All references of included studies were screened for additional studies. Data was compiled and compared to the recommendations and guidelines published by major institutions. Included studies were appraised with the aid of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. In total, 21 studies were included. Interventions and outcomes identified were heterogeneous across studies. Most statistical tests applied found no difference between aspirin and other interventions in regards to deep vein thrombosis, pulmonary embolism, bleeding and mortality outcomes. Aspirin may be a viable alternative to established thromboprophylactic regimes for primary prevention of VTE, however in the setting of secondary prevention it is generally less efficacious. Future studies should have clearly identified and comparable outcome measures, with direct comparisons and assessment of intervention combination, dosing and treatment duration.

Prevalence and Cost of Care Cascades After Low-Value Preoperative Electrocardiogram for Cataract Surgery in Fee-for-Service Medicare Beneficiaries

Low-value care is prevalent in the United States, yet little is known about the downstream health care use triggered by low-value services. Measurement of such care cascades is essential to understanding the full consequences of low-value care. To describe cascades (tests, treatments, visits, hospitalizations, and new diagnoses) after a common low-value service, preoperative electrocardiogram (EKG) for patients undergoing cataract surgery. Observational cohort study using fee-for-service Medicare claims data from beneficiaries aged 66 years or older without known heart disease who were continuously enrolled between April 1, 2013, and September 30, 2015, and underwent cataract surgery between July 1, 2014 and June 30, 2015. Data were analyzed from March 12, 2018, to April 9, 2019. Receipt of a preoperative EKG. The comparison group included patients who underwent cataract surgery but did not receive a preoperative EKG. Cascade event rates and associated spending in the 90 days after preoperative EKG, or in a matched timeframe for the comparison group. Secondary outcomes were patient, physician, and area-level characteristics associated with experiencing a potential cascade. Among 110 183 cataract surgery recipients, 12 408 (11.3%) received a preoperative EKG (65.6% of them were female); of those, 1978 (15.9%) had at least 1 potential cascade event. The comparison group included 97 775 participants (63.1% female). Those who received a preoperative EKG experienced between 5.11 (95% CI, 3.96-6.25) and 10.92 (95% CI, 9.76-12.08) additional events per 100 beneficiaries relative to the comparison group. This included between 2.18 (95% CI, 1.34-3.02) and 7.98 (95% CI, 7.12-8.84) tests, 0.33 (95% CI, 0.19-0.46) treatments, 1.40 (95% CI, 1.18-1.62) new patient cardiology visits, and 1.21 (95% CI, 0.62-1.79) new cardiac diagnoses. Spending for the additional services was up to $565 per Medicare beneficiary (95% CI, $342-$775), or an estimated $35 025 923 annually across all Medicare beneficiaries in addition to the $3 275 712 paid for the preoperative EKGs. Among preoperative EKG recipients, those who were older (adjusted odds ratio [aOR] for patients aged 75 to 84 years vs 66 to 74 years old, 1.42; 95% CI, 1.28-1.57), had more chronic conditions (aOR for each additional Elixhauser condition, 1.18; 95% CI, 1.14-1.22), lived in more cardiologist-dense areas (aOR, 1.05; 95% CI, 1.02-1.09), or had their preoperative EKG performed by a cardiac specialist rather than a primary care physician (aOR, 1.26; 95% CI, 1.10-1.43) were more likely to experience a potential cascade. Care cascades after preoperative EKG for cataract surgery are infrequent but costly. Policy and practice interventions to reduce low-value services and the cascades that follow could yield substantial savings.

WEIGHT PRODUCT DALAM IMPLEMENTASI SISTEM PENDUKUNG KEPUTUSAN BANTUAN BEDAH RUMAH

North Lampung is a district in Lampung province. The government issued an aid program, he program is that every region is given the opportunity to manage aid funds, one of which is in the form of home surgery , This good government program is thirsty supported by the level of data accuracy, efficiency of the time of the recipient's management. Therefore in order to get good results. Then in this study using the weight product method in the implementation of decision support systems for home surgery recipients.

Commemorating 50 years since the first heart transplantation in Bratislava - Czechoslovakia.

The first human-to-human heart transplantation in Czechoslovakia, and the 25th transplantation in the world, was performed in Bratislava, the second largest city in Czechoslovakia on July 9, 1968. The operation was carried out by a team led by Professors Karol Siska and Ladislav Kuzela at the second Surgical Clinic at the Comenius University of the Medical Faculty in Bratislava, Partizanska Street-only seven months after the first heart transplantation performed by Dr. Christiaan Barnard in Cape Town. Other members of the team in Bratislava included surgery recipients Siska, Kuzela, Pivkova, Holoman; surgery donors Schnorrer, Kuzela, Holoman; an extracorporeal circulation team of Treger, Carsky, Podolay; anesthesiologists Sobesky and Neumanova; operating room nurses Machkova, Homerova, Kralova, and operating room laboratory technician Malinova. The donor was P.V., a 46-year-old man, who suffered from a deadly brain trauma. The recipient was S.H., a 54-year-old woman with a failing heart, heavily affected diseased lungs, kidneys and liver. Her heart began to work, but lasted only for five hours. (Additional members of the team, Prof. Simkovic and Drs. Silvay and Sujansky were in the USA at the moment of transplantation, in Houston and New York, subsequently) (Tab. 1, Fig. 2, Ref. 62). Keywords: first heart transplantation in Bratislava, 2nd Surgical Clinic at the Comenius University.

SISTEM PENDUKUNG KEPUTUSAN SELEKSI PENERIMA BEDAH RUMAH MENGGUNAKAN METODE SIMPLE ADDITIVE WEIGHTING (SAW) (Studi Kasus : Dinas Sosial Dan Tenaga Kerja Kota Padang)

In making selection decisions, the selection of home surgery recipients in social services and labor is constrained by time because a lot of data is processed or selected by social service employees and is still done manually. Besides that there is often social jealousy and unfavorable prejudice from the community towards social services such as the prejudice of Collusion Nepotism Corruption (KKN) because the manual selection process and the results cannot be seen by the community. In the decision support system the selection of home surgery can obtain the results of an information and decision on a house that is worthy of being designated as the recipient of house surgery. In the process of making a decision system for the selection of home surgery in the city of Padang social service is done by using the web-based Simple Additive Weighting (SAW) method using the MySQL database, so that it can help smooth the evaluation process in the selection of subsequent home surgery recipients.