Respiratory-related Complications Research Articles

Advanced Heart Failure Therapies in Neuromuscular Diseases

Abstract Purpose of Review The main objective of this review article is to discuss the prevalence, utilization, and outcomes associated with advanced heart failure therapies among patients with neuromuscular disorders. Recent Findings Neuromuscular disorders often have multisystem involvement with a high prevalence of cardiovascular pathology. With the improvement in management of respiratory related complications, heart failure is now the leading cause of mortality in this patient population. Advanced heart failure therapies with durable left ventricular assist devices and heart transplantation have proven to be feasible and safe treatment options in selected patients. Summary Management of neuromuscular disease involves multidisciplinary team involvement given the systemic nature of the disease. Early recognition and close monitoring of these patients will allow for timely initiation of advanced heart failure therapies that can lead to successful outcomes.

Mastering Sedation and Associated Respiratory Events through Simulation-Based Training: A Randomised Controlled Trial Involving Non-Anaesthesiology Residents.

Non-anaesthetists commonly administer procedural sedation worldwide, posing the risk of respiratory events that can lead to severe complications. This study aimed to evaluate whether simulation-based learning could lead to enhancements in the clinical proficiency of non-anaesthesiology residents in managing sedation and related respiratory complications. Following the evaluation of baseline clinical performance through a pre-test simulation, 34 residents were randomly allocated to either participate in an innovative simulation-based learning module (intervention group) or view a brief self-learning video (control group). After a one-month period, their clinical performance was assessed again in a post-test simulation involving respiratory arrest during procedural sedation. Two independent assessors rated each resident's performance using video recordings and a scoring tool with scores ranging from 0 to 19/19. The two assessments were averaged for each performance, and the pre- to post-test change was calculated for each resident. While baseline clinical performance was similar, mean (SD) increase in clinical performance was significantly greater in the intervention group than in the control group (+2.4 (1.6) points versus +0.8 (1.3) points, respectively; p = 0.002). Our simulation-based learning sedation module resulted in the enhanced management of sedation-related complications compared to baseline and minimal self-learning. Simulation-based medical education may offer an effective approach for equipping non-anaesthesiology residents with essential skills to mitigate risks associated with sedation. (ClinicalTrials.gov identifier: NCT02722226).

Urban Slums Morbidity Spectrum: A Cross Sectional Study on Korogocho Slum, Kenya

Community health outreach is part of community-based health care, an extension of facility-based primary care services used to reach the underserved. Slums population in sub-Sahara Africa has been growing by 9 million persons per year making slum occupancy to form more than 56% of urban settlements. A slum is characterized by inadequate access to safe water, inadequate access to sanitation and infrastructure, poor structural quality of housing, overcrowding, and insecure residential status. People in slums due to their environment are more vulnerable to communicable diseases, respiratory diseases, malnutrition and accidents. The main objective was to identify the 10 top most prevalent diseases in Korogocho slums. A cross-sectional study design was applied. Study period was between January 2021 and December 2021. Data was collected through a series of 12 Community health outreach sessions at Korogocho slums in Nairobi, Kenya. Secondary data was extracted and analyzed using SPSS version 25.A total of 3699 individuals were treated, there were more females (67.96%) than males (32.01%) and at least 1 person was identified as a transgender. Age group of 0 to 59 months (472 patients) had more males than females while 19 to 59 years old (1413 patients) females formed majority of Community health outreach attendants. Modal age group was 19 to 59 years among females and 0 to 59 months among males representing 45.28% of the total patients. An average of 308 patients was seen per session. Respiratory tract infections (44.8%), skin diseases (13.8%), abdominal diseases (13.2%), musculoskeletal disorder (7.86%), eye conditions (4.75%), genitourinary diseases (4.18%), ENT diseases (3.9%), hypertension (3.36%), dental problems (2.1%) and wounds and injuries (2.05%) respectively formed the 10 most prevalent diseases in Korogocho slums. Public health intervention of wearing of medical face mask to prevent allergens and airborne infections is highly recommended, prompt and timely treatment of respiratory diseases will help in reducing respiratory related complications. Cost effective and sustainable water treatment options should be availed to the locals to help in improving water quality so as to reduce infective abdominal-diseases.

Three-staged minimally invasive esophagectomy with end-to-end esophago-gastric anastomosis for thoracic esophageal cancers: An experience from a low middle-income country

BackgroundEsophageal cancer is on a steady rise and carries significant mortality and morbidity. Depending upon the clinical stage at presentation, either chemotherapy, radiotherapy with or without surgical resection is the treatments in practice. Traditionally, open esophagectomy was performed but over time, the importance of minimally invasive esophagectomy has been established. In this study, we aimed to report our data of totally minimally invasive esophagectomies performed for thoracic esophageal cancers in last four years. MethodologyA prospective cross-sectional study was conducted at the Department of Upper GI Surgery, Dow University of Health Sciences, Karachi. All diagnosed cases of esophageal carcinoma undergoing minimally invasive esophagectomy, from 2019 to 2022 were included in this study. Outcomes measured were operative time, intra operative complications, conversion rate to open, postoperative complications, number of lymph nodes harvested, margin clearance, in-hospital mortality and 90-days mortality. ResultsA total of 53 cases were included in the study, the most prevalent histological type was squamous cell carcinoma 42(79.2%) as compared to adenocarcinoma 8(15.1%). Most common tumor site was lower thoracic esophagus (30–38 cm) in 20 (56.6%) cases. Neo-adjuvant chemotherapy was given in all 53(100%) cases, whereas neo-adjuvant radiation therapy was offered to 49(92.5%) patients. There was a significant and favorable patient response to the neo-adjuvant treatment in 37(69.8%) cases, leading to a decrease in tumor size. Laparoscopic McKeown Esophagectomies were performed in 44 (83.0%) and 9(17.0%) were Robot-assisted Minimally Invasive esophagectomy (RAMIE). Intraoperative injuries (i.e., lung parenchymal injury and bleeding) were reported in only 2(3.8%) patients. Post-operative complications were recorded in 12(22.6%) patients. Margin clearance was observed in 53 (100%) of the patients. The 90-day mortality rate was 3(5.7%), one due to bleeding and other two mortalities were due to COVID related respiratory complications. ConclusionMinimally invasive esophagectomy was found to be safe and feasible technique with encouraging results in terms of decreased intraoperative and post operative complications as well as achieving the standard oncological surgery with acceptable lymph node yield and margin clearance and in hospital and 90 days mortality.

Harnessing the Antiviral and Anti-inflammatory Properties of Copper and Zinc Chlorophyllins: A Potential Therapeutic for COVID-19 Patients with Acute Respiratory Distress Syndrome

Chlorophyllins are highly soluble non-toxic derivatives of chlorophyll α, containing a centralised metal at their core, known to target and treat cancer and immune-based diseases. The antiviral and anti-inflammatory effects of sodium copper chlorophyllin (SCC) and sodium zinc chlorophyllin (SZC), though documented, are rarely considered in treatment of viral respiratory diseases. Moreover, the use of chlorophyllins to potentially treat acute respiratory distress syndrome (ARDS), triggered by infection with respiratory viruses such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has yet to be studied. The published literature suggests antiviral and anti-inflammatory effects against SARS-CoV-2 and other enveloped respiratory viruses. Treatment with chlorophyllins inhibits virus entry, as well as replication and budding of viral progeny from the host cell in cell lines infected with enveloped respiratory viruses. Furthermore, treatments with SCC in vivo show diminished viral loads in animals infected with respiratory viruses, suggesting clinical antiviral capacity in treating viruses that cause ARDS-like manifestations, notably coronavirus disease 2019 (COVID-19). Similarly, SZC reduces inflammatory responses, while SCC may block key pro-inflammatory markers in vitro and in vivo, producing an anti-inflammatory effect against interleukin-6 and tumour necrosis factor α, two of the main antagonists associated with poorer outcomes in viral respiratory diseases, particularly among COVID-19 patients. This indicates a possible application in treating cytokine storm and hyperinflammation. Both SCC and SZC could act as a novel therapeutic in the treatment and prevention of ARDS and related respiratory complications, especially relevant to severe COVID-19 cases.

Retrospective Survey and Analysis of Anaesthesia and Outcomes in Paediatric Cleft Lip or Palate Surgery in a Tertiary Care Center, Portugal.

Orofacial clefts are the most common craniofacial abnormalities, affecting approximately one in 700 newborns each year. The anaesthetic management of these patients is challenging, including difficulties in airway approach and respiratory complications that have direct implications in the final outcome. The present study aimed to characterize the anesthetic approach to paediatric patients undergoing cleft palate or lip surgical repair and review the perioperative anesthetic complications in a tertiary Portuguese hospital. Data were collected from a retrospective review of thepatient records which included anaesthesia perioperative notes of paediatric patients submitted to cleft surgery repair during a five-year period (2016 to 2021). Demographic, pre-anaesthetic characteristics, anaesthetic management and perioperative complications were recorded. A total of 102 patients were included, with a median age of 1.5 years. Congenital syndromes were present in 14 (13.7%) of the children included. Inhalational induction of anaesthesia with sevoflurane was the preferred approach in 86 cases (84.3%), with neuromuscular blockade being used in 59 cases (57.8%). Intubation was achieved at first attempt in 91 (89.2%) cases with four (3.9%) patients needing three or more attempts. Intraoperative respiratory-related complications were the most frequent, occurring in 22 (21.6%) cases. These include multiple attempts to intubation, desaturation due to bronchospasm or laryngospasm. The average length of stay was two days. Postoperative complications were recorded in 17 (16.7%) of patients. The predominance of airway and respiratory complications occurring in cleft is consistent with previous studies. Care must be taken in order to avoid such complications in the perioperative period by following protocols, having skilled personnel, appropriate monitoring equipment and airway devices available during cleft surgeries to minimise morbidity.

Airway management and related respiratory complications in ankylosing spine disorder patients with operative management of acute cervical fractures

Airway management and related respiratory complications in ankylosing spine disorder patients with operative management of acute cervical fractures

Indications, trends, and perioperative outcomes of minimally invasive and open liver surgery in non-obese and obese patients: An international multicentre propensity score matched retrospective cohort study of 9963 patients

BackgroundDespite the worldwide increase of both obesity and the use of minimally invasive liver surgery (MILS), evidence regarding the safety and eventual benefits of MILS in obese patients is scarce. The aim of this study was therefore to compare the outcomes of non-obese and obese patients (BMI 18.5–29.9 and BMI≥30, respectively) undergoing MILS and OLS, and to assess trends in MILS use among obese patients. MethodsIn this retrospective cohort study, patients operated at 20 hospitals in eight countries (2009–2019) were included and the characteristics and outcomes of non-obese and obese patients were compared. Thereafter, the outcomes of MILS and OLS were compared in both groups after propensity-score matching (PSM). Changes in the adoption of MILS during the study period were investigated. ResultsOverall, 9963 patients were included (MILS: n = 4687; OLS: n = 5276). Compared to non-obese patients (n = 7986), obese patients(n = 1977) were more often comorbid, less often received preoperative chemotherapy or had a history of previous hepatectomy, had longer operation durations and more intraoperative blood loss (IOBL), paralleling significantly higher rates of wound- and respiratory-related complications. After PSM, MILS, compared to OLS, was associated, among both non-obese and obese patients, with less IOBL (200 ml vs 320 ml, 200 ml vs 400 ml, respectively), lower rates of transfusions (6.6% vs 12.8%, 4.7% vs 14.7%), complications (26.1% vs 35%, 24.9% vs 34%), bile leaks(4% vs 7%, 1.8% vs 4.9%), liver failure (0.7% vs 2.3%, 0.2% vs 2.1%), and a shorter length of stay(5 vs 7 and 4 vs 7 days). A cautious implementation of MILS over time in obese patients (42.1%–53%, p < .001) was paralleled by stable severe morbidity (p = .433) and mortality (p = .423) rates, despite an accompanying gradual increase in surgical complexity. ConclusionsMILS is increasingly adopted and associated with perioperative benefits in both non-obese and obese patients.

The association between erector spinae plane block timing and reduced rib fracture related respiratory complications: A cohort study

Is erector spinae plane (ESP) catheter insertion within 24h of hospital admission for rib fractures associated with a lower incidence of respiratory complications compared to those having an ESP within 48h or after 48h of admission. Retrospective cohort study. Hospital. 199 patients admitted for rib fractures, who received an ESP catheter. Timing of ESP performance was assessed by dividing the study cohort into three subgroups: prompt block within 24h, early block within 48h and late block after 48h of admission. The primary outcome of interest was the development of respiratory complications. This included pneumonia, pulmonary embolism and respiratory failure. Secondary outcomes included intensive care unit (ICU) length of stay and hospital length of stay. A prompt ESP within 24h was performed in 14.5% (n=29) of patients, 47% (n=95) received an early block within 48h and 37% (n=75) of patients received a late block after 48h from admission. There was a significantly higher rate of respiratory complications (p=0.005) with late block. A late block was associated with a significantly longer ICU length of stay (7.82±5.2days) compared to patients who received an early block (5.84±2.8days; p=0.044). There was no significant association with hospital length of stay (p=0.06). There were no differences between the prompt (within 24h) and early (within 48h) block groups for any outcome. The performance of an ESP block after 48h of admission was associated with an increased incidence of respiratory complications and ICU length of stay. There appears to be no added benefit associated with the provision of a prompt ESP within 24h.

Incidence and factors associated with post-anesthesia care unit complications in resource-limited settings: An observational study.

Background and aimsPostoperative complications are frequent encounters in the patients admitted to postanesthesia care units (PACU). The main aim of this study was to assess the incidence of complications and associated factors among surgical patients admitted in limited‐resource settings of the PACU.MethodsThis is an observational study of 396 surgical patients admitted to PACU. This study was conducted from February 1 to March 30, 2021, in Ethiopia. Study participants' demographics, anesthesia, and surgery‐related parameters, PACU complications, and length of stay in PACU were documented. Multivariate and bivariate logistic regression analyses, the odds ratio (OR), and 95% confidence interval (CI) were calculated. p‐value < 0.05 was considered as statistically significant.ResultsThe incidence of complications among surgical patients admitted to PACU was 54.8%. Of these, respiratory‐related complications and postoperative nausea/vomiting were the most common types of PACU complications. Being a female (adjusted odds ratio [AOR] = 2.928; 95% CI: 1.899–4.512) was significantly associated with an increased risk of developing PACU complications. Duration of anesthesia >4 h (AOR = 5.406; 95% CI: 2.418–12.088) revealed an increased risk of association with PACU complications. The occurrences of intraoperative complications (AOR = 2.238; 95% CI: 0.991–5.056) during surgery were also associated with PACU complications. Patients who develop PACU complications were strongly associated with length of PACU stay for >4 h (AOR = 2.177; 95% CI: 0.741–6.401).ConclusionThe identified risk factors for complications in surgical patients admitted to PACU are female sex, longer duration of anesthesia, and intraoperative complications occurrences. Patients who developed complications had a long time of stay in PACU. Based on our findings, we recommend the PACU team needs to develop area‐specific institutional guidelines and protocols to improve the patients' quality of care and outcomes in PACU.

New Persistent Opioid Use After Surgery: A Risk Factor for Opioid Use Disorder?

New Persistent Opioid Use After Surgery: A Risk Factor for Opioid Use Disorder?

Conscious sedation versus general anesthesia for transcatheter aortic valve implantation in patients with severe chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is considered a major risk factor for postoperative complications after transcatheter aortic valve implantation (TAVI). To date, there is no clear consensus on the best anesthesia management for these patients. We aimed to investigate the effects of types of anesthesia on clinical outcomes in patients with severe COPD undergoing TAVI. This is a single-center, retrospective study comparing conscious sedation (CS) versus general anesthesia (GA) in 72 patients with severe COPD who underwent TAVI. The primary endpoints were 30-day all-cause mortality and postoperative pulmonary complications. The main outcome of interest of this study was that the frequency of pulmonary complications was statistically higher in the GA group (21.4% vs 3.3%, p = 0.038). These differences are most likely attributed to the GA because of prolonged mechanical ventilation, and longer ICU stay (2 (1.2-3) vs 2.5 (2-4) days, p = 0.029) associated with an increased risk of nosocomial infections. There were no significant differences in procedure complications and 30-day mortality between the two groups (GA; 19% vs CS; 13.3%, p = 0.521). One-year survival rates, compared by Kaplan-Meier analysis, were similar between groups (log-rank p = 0.733). In aortic stenosis patients with severe COPD undergoing TAVI, the use of GA compared with CS was associated with higher incidences of respiratory-related complications, and longer ICU length of stay. CS is a safe and viable option for these patients and should be considered the favored approach.

Respiratory concerns in children with medical complexity

Children with medical complexity (CMC) are a diverse group of children affected by a spectrum of chronic disorders and physiologic abnormalities. Due to their underlying disorders, they disproportionately experience respiratory comorbidities and complications. Respiratory-related complications that arise in this population often begin subtly and progress over time and can result in lung injury, respiratory insufficiency, and eventual chronic respiratory failure. CMC make up a substantial proportion of pediatric hospitalizations and healthcare expenditures, with respiratory-related illness being one of the leading causes of admission. It is, therefore, important for the practitioner caring for these children to have knowledge of the common respiratory concerns in this population as well as prevention and management strategies. This review will describe the most common respiratory concerns in CMC and will provide an overview of diagnosis and management.

Management of Internal Hernia in Neonates with Multiple Heart Diseases: A Case Report

Internal hernia is a rare clinical entity. In all cases, less than 1% found as the cause of intestinal obstruction. However, delayed treatment of internal hernia may lead to necrosis of the intestines. Neonates with congenital heart disease may be at increased risk of morbidity and mortality than another concurrent disease. A male infant was delivered with a Cesarean section due to a congenital disorder of umbilical hernia, ventricular septal defect, and aortic transposition. The infant was born full-term with a 2,515 g birth weight and 3, 5, 7 APGAR score, positive ventilation, and intubation proceeded. Prostaglandin E1 10 mcg/kg/minute, packed blood cell, and thrombocyte concentrate was administered preoperatively. The patient underwent laparotomy for intestinal resection on day-3; the necrotic intestine was found starting 70 cm from ligament of Treitz to midsection of the transverse colon. Postoperatively, the stoma was vital, and we noted its production. The infant died one day14 due to respiratory failure caused by hospital-acquired pneumonia. Infants with an internal hernia and multiple congenital heart diseases require prompt management to prevent intestinal necrosis and other respiratory-related complications.

Micronutrients Deficiency, Supplementation and Novel Coronavirus Infections-A Systematic Review and Meta-Analysis.

Background: Micronutrients play roles in strengthening and maintaining immune function, but their supplementation and/or deficiency effects on respiratory tract infections are inconclusive. This review aims to systematically assess the associations between micronutrient supplementation or deficiency, with novel coronavirus incidence and disease severity. Methods: Systematic literature searches conducted in five electronic databases identified 751 unique studies, of which 33 studies (five supplementation studies, one supplementation and deficiency study, and 27 deficiency studies) were eventually included in this review. Proportions of incidence and severity outcomes in each group, and adjusted summary statistics with their relevant 95% confidence intervaIs (CI) were extracted. Data from 19 studies were pooled in meta-analysis using the generic inverse variance method. Findings: A total of 360,346 patients across 16 countries, with a mean age between 32 and 87.7 years, were involved across 33 studies. All studies were on COVID-19 infections. In individuals without micronutrient deficiency, there was a significant reduction on odds of COVID-19 incidence (pooled OR: 0.37, 95% CI: 0.18, 0.78), and ICU admissions or severe/critical disease onset when combined as a severity outcome (pooled OR: 0.26, 95% CI: 0.08, 0.89). Insignificant protective effects were observed on other outcome measures, namely mortality, ICU admission, progression to respiratory-related complications, severe/critical disease onset or requiring respiratory support and hospitalization rate. Conclusion: The absence of micronutrient deficiency significantly reduced COVID-19 incidence and clinical deterioration in hospitalized patients. Usage of micronutrients as prophylaxis and complementary supplement in therapeutic management of COVID-19 patients may be a promising and cost-effective approach warranting in-depth investigation.

Long-Term Analysis of Respiratory-Related Complications Following Gastrostomy Placement with or without Fundoplication in Neurologically Impaired Children: A Retrospective Cohort Study.

Gastrostomy placement is crucial in neurologically impaired (NI) children to ensure an adequate food intake and a safe route for drugs administration and to reduce the risk of primary aspiration. NI patents are more prone to gastroesophageal reflux. The association with fundoplication is deemed to reduce reflux-related respiratory complications. However, long-term benefits of this approach are not clear. We therefore aimed to compare long-term reflux-related respiratory complications of gastrostomy only (GO) to gastrostomy with fundoplication (GF). We retrospectively reviewed 145 consecutive NI children managed from 2008 to 2018. As long-term outcomes, we analyzed number and length of hospital admissions (Reflux-Related-Hospitalization, RRH) and emergency department accesses (Reflux-Related-Accesses, RRA) due to respiratory problems. Results were analyzed with appropriate statistical method. Median age at referral and at gastrostomy placement were 2.2 and 3.4 years (SD 5.6), respectively. Median follow-up was four years (range 1–12). Anti-reflux procedures were performed in 26/145 patients (18%); tracheotomy in 23/145 (16%). RRH following surgery showed lower number of admissions/year (0.32 vs. 1 for GO vs. GF, p < 0.005) and days hospitalization/year (3 vs. 13, p = 0.08) in GO compared to GF; RRA was similar (0.60 vs. 0.65, p = 0.43). Gastrostomy placement alone appeared not to be inferior to gastrostomy plus fundoplication with respect to long-term respiratory-related outcomes for NI children in our center.

COVID-19 Associated Spontaneous Bowel Perforation

The purpose of this article is to report on the newly recognized life threating gastrointestinal complications of Corona virus infection (COVID-19) in the form of bowel ischemia and ischemic bowel perforation. In a retrospective observational study at Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, United Arab Emirates during the period between March and May 2020. All COVID-19 positive patients with free intra peritoneal air were included; total of five patients met our inclusion criteria during the study period, all patients were admitted to the intensive care unit for mechanical ventilation and management of severe COVID 19 related respiratory complications. COVID-19 status was based on a positive PCR nasopharyngeal swab supported by typical radiological findings on either chest X-ray (CXR) or CT Chest. Free air under the diaphragm was radiologically confirmed in all patients. Patients’ demographics and co-morbidities were reviewed. Four patients underwent an emergency surgical intervention confirming ischemic perforation of the right colon. The caecum was identified as the starting point of ischemia with variable distal extension into the ascending colon and the hepatic flexure. One patient unfortunately demised prior to surgery due to severe septic complications. These findings highlight the importance of paying attention to COVID 19 patients with sudden clinical deterioration and raise the extent of the gastrointestinal manifestation of COVID-19 infection beyond simple diarrhea and abdominal pain.

Antiviral use is associated with a decrease in the rate of influenza-related complications, health care resource utilization, and costs

Aims To determine the effect of antiviral agents on influenza-related complications, health care resource utilization (HRU), and costs over three influenza seasons (2014–2016). Methods This retrospective cohort study used claims data from the U.S. MarketScan Research Databases. Patients with a diagnosis code for influenza during the 2014–2016 seasons in an outpatient setting, with continuous enrollment from 1 year before to 91 d after diagnosis, were included. Patients who received an antiviral within 48 h of diagnosis were identified and propensity score–matched to a comparator cohort of untreated patients on baseline demographics, comorbid conditions, and HRU. Outcomes were assessed at days 30 and 90 after diagnosis and included respiratory-related complications (all respiratory-related and selected respiratory-related conditions [influenza, asthma, chronic obstructive pulmonary disease, or infection]), HRU, and costs. Results Treated and matched untreated cohorts each consisted of 362,818 patients. HRU was significantly lower in the treated cohort compared with the untreated cohort at 30 and 90 d after diagnosis, respectively (hospitalizations: 0.6% vs. 0.8% and 1.2% vs. 1.6%; emergency department [ED] visits: 4.1% vs. 4.9% and 7.9% vs. 9.2%; intensive care unit/critical care unit (ICU/CCU) admissions: 0.2% vs. 0.4% and 0.4% vs. 0.6%). Respiratory-related HRU was lower in the treated cohort at both 30 and 90 d after diagnosis (p < .0001 for both periods). Mean all-cause total costs (including prescription costs) were significantly reduced in the treated group (day 30: $633 vs. $778; day 90: $1778 vs. $2119), despite higher prescription costs in the treated group. Limitations The study was retrospective and subject to residual selection bias, despite propensity score matching. Additionally, despite its potential relevance to influenza severity, vaccination status was not available in our data. Conclusions Antiviral influenza treatment is associated with a significant reduction in complications, HRU, and costs at 30 and 90 d after diagnosis.

Cervical Spinal Fusion in Adult Patients With Rheumatoid Arthritis: A National Analysis of Complications and 90-day Readmissions.

Retrospective cohort study. The purpose of this study was to utilize the National Readmission Database to determine the national estimates of complication and 90-day readmission rates associated with cervical spinal fusion in adult patients with rheumatoid arthritis (RA). RA patients who undergo cervical spine surgery are known to be at high risk for readmissions, which are costly and may not be reimbursed by Medicare. The National Readmission Database was queried for adults (>18 years) diagnosed with RA undergoing cervical spine fusion. Patient, operative, and hospital factors were assessed in bivariate analyses. Independent risk factors for readmissions were identified using stepwise multivariate logistic regression. From 2013 to 2014, a total of 5597 RA patients (average age: 61.5 ± 11.2 years, 70.9% female) underwent cervical spine fusion. A total of 691 (12.3%) patients were readmitted within 90 days (). Index inpatient complications included dysphagia (readmitted: 7.9% vs. non-readmitted: 5.1%; P = 0.003), urinary tract infection (UTI) (8.8% vs. 3.7%; P < 0.001), respiratory-related complications (7.6% vs. 3.4%; P < 0.001), and implant-related complications (5.4% vs. 2.7%; P < 0.001). Multivariate logistic regression demonstrated the following as the strongest independent predictors for 90-day readmission: intraoperative bleeding (odds ratio [OR]: 3.6, P = 0.001), inpatient Deep Vein Thrombosis (DVT) (OR 4.1, P = 0.004), and patient discharge against medical advice (OR 33.5, P = 0.001). Readmission rates for RA patients undergoing cervical spine surgery are high and most often due to postoperative infection (septicemia, UTI, pneumonia, wound). Potential modifiable factors which may improve outcomes include minimizing intraoperative blood loses, postoperative DVT prophylaxis, and discharge disposition. 3.

Analysis of intravenous sedation for dental treatment in elderly patients with severe dementia-a retrospective cohort study of a Japanese population

Background/purposePatients with severe dementia require intravenous sedation during dental treatment. However, few reports have compared the outcomes of intravenous sedation management among sedatives. Intravenous sedation in the elderly with severe dementia undergoing dental treatment was evaluated retrospectively. Materials and methodsPatients’ characteristics and type of dementia were obtained from medical records. Midazolam (MID), dexmedetomidine (DEX), and propofol (PRO) were administered as sedatives. The systolic blood pressure (SBP), heart rate (HR), SpO2, bispectral index (BIS) values and complications were evaluated. ResultsNineteen patients with severe dementia who underwent 62 instances of sedation were included. There was no difference in patient background between sedatives. The sedation time and permission time to return home were significantly longer in DEX than in MID or PRO group. Half the usual dose in MID and lower limits of the routine dose was effective in DEX and PRO. HR was significantly lower in DEX group. There were 3 cases with airway obstruction requiring nasopharyngeal airway and 4 cases of apnea when MID was administered. Two cases of Cheyne-Stokes-like respiration when MID or DEX was administered. SpO2 <94% was found in 22 cases (35%) irrespective of the sedative. A patient with dementia with Lewy bodies had experienced hallucinations during the recovery period after sedation when MID or DEX was administered. The BIS value of ≤80 was noted during complications. ConclusionIntravenous sedation for dental treatment in the elderly with severe dementia, needs a dose titration. All sedatives had respiratory-related complications which mandate close monitoring.