Risk Factors For Surgical Treatment Research Articles

Risk factors and prognostic indicators for surgical outcome of dogs with esophageal foreign body obstructions.

OBJECTIVE To determine risk factors for surgical intervention, complications, and outcome in dogs with an esophageal foreign body (EFB). DESIGN Retrospective observational study. ANIMALS 224 incidents of EFB in 223 dogs evaluated at a veterinary teaching hospital from 1995 through 2014. PROCEDURES Hospital records were reviewed to collect data regarding signalment, history, clinical signs, EFB type and location, procedures, complications, and outcomes. Breed distributions were compared between dogs with EFB and the entire canine patient population during the study period. Variables were tested for associations with each other and with outcomes. RESULTS Terrier breeds were most common (71/233 [30.5%]). Duration of EFB entrapment, body weight, anorexia, lethargy, rectal temperature, and esophageal perforation were associated with the need for surgical intervention. Older age, longer duration of EFB entrapment, and perforation were associated with a poorer prognosis. Endoscopic retrieval or advancement into the stomach was successful for 183 of 219 (83.6%) EFBs, and 16 of 143 (11.2%) entrapments resulted in postprocedural esophageal stricture. Overall median duration of hospitalization was brief (1 day), and the need for surgical intervention was associated with a longer duration. Overall mortality rate was 5.4% (12/223); 90 of 102 (88.2%) dogs with a median follow-up period of 27 months after EFB treatment had an excellent outcome. CONCLUSIONS AND CLINICAL RELEVANCE Study findings suggested that endoscopic EFB retrieval remains the initial treatment option of choice for affected dogs, provided that esophageal perforation does not necessitate surgical intervention. Although esophageal stricture formation was the most common complication, the overall rate of this outcome was low.

Successful non-operative management of blunt abdominal trauma in highly selective cases: A safe and effective choice.

The non-operative management (NOM) of abdominal injuries has gained wide acceptance over the last few decades. The present study evaluated the efficacy of NOM in blunt abdominal trauma (BAT) at a regional Hellenic hospital. We analyzed the results of a pre-decided treatment protocol, which was applied to all patients hospitalized for BAT, from 2008 to 2015. The protocol proposed NOM in hemodynamically stable patients with no signs of peritonitis. The demographic characteristics, type of injury, injured organ(s), type of management (operative vs. non-operative), Injury Severity Score (ISS), morbidity, mortality rates, and health costs were evaluated. One hundred and forty-six patients hospitalized for BAT at our department were included. Among them, 49 were operated and 97 were subjected to NOM. Although ISS was significantly higher in the surgical group, the severity of injuries in liver, spleen, and kidneys was not different between the two groups. Surprisingly, no case subjected to NOM required a conversion to operative management, which may probably be because of the strict inclusion criteria for NOM. Patients with hemodynamic stability and normal physical examination may be non-operatively treated, independent of the grade of injury, in highly selective cases. ISS score is an independent risk factor for surgical treatment.

Experience of Tubo-Ovarian Abscess: A Retrospective Clinical Analysis of 318 Patients in a Single Tertiary Center in Middle Turkey.

The objective was to identify the clinical and laboratory parameters, ultrasonographic (USG) morphology, and to predict surgical treatment for patients with tubo-ovarian abscess (TOA). Data for a total of 318 patients with a diagnosis of TOA between January 2005 and December 2016 were analyzed retrospectively at a referral center in Turkey. Patients requiring surgical treatment were compared with those who did not with respect to demographic characteristics and clinical, USG, and laboratory findings. Ninety-three (29.25%) patients whose medical treatment failed underwent surgical intervention and a minimally invasive drainage procedure. Menopausal status, diabetes mellitus, long-term intrauterine device use, fever at admission, bilateral and multi-cystic TOA, and TOA size are risk factors for surgical treatment. An abscess size of 6.5 cm was a significant indicator for surgical intervention (odds ratio = 16.632; 95% confidence interval 8.745-31.632; p < 0.05). The area under the curve (AUC = 0.868) in the receiver operating characteristic (ROC) curve analysis was found to be statistically significant for TOA size, with a threshold value of 6.5 cm. The recommended cutoff value for erythrocyte sedimentation rate (ESR) was 61.0 mm/h, and the cutoff point of the C-reactive protein (CRP) level in the ROC analysis was found to be 24.5 mg/dL. There were no complications in the USG-guided drainage surgical treatment group. The TOA size, complex multi-cystic mass image, CRP, and ESR are useful indicators as to whether surgical treatment is required for the management of TOA. The USG-guided drainage was less invasive with fewer complications and should be the preferred surgical treatment.

Bronchoscopic assessments and clinical outcomes in pediatric patients with tracheomalacia and bronchomalacia.

Tracheomalacia and bronchomalacia (TM/BM) are one of the serious causes of airway obstruction in infants and children. This study reviewed our bronchoscopic assessments and clinical outcomes in pediatric patients with TM/BM, and investigated risk factors of surgical intervention for TM/BM. Fifty-seven consecutive patients who were diagnosed as TM/BM by bronchoscopy between 2009 and 2013 were reviewed retrospectively. They were divided into two groups according to the presence (group E, n = 26) or absence (group N, n = 31) of acute life-threatening events and extubation failure (ALTE/EF). The severity of TM/BM was evaluated by Oblateness Index which was obtained from bronchoscopic images. Oblateness Index was significantly higher in Group E than in Group N. Patients in Group E underwent surgical intervention for TM/BM more frequently, and had significantly longer intubation period and hospital stay. Clinical symptoms of ALTE/EF, Oblateness Index ≥ 0.70, and multiple malacic lesions were significant risk factors indicating surgical events in patients with TM/BM. Patients with TM/BM who had ALTE/EF had more severe malacic lesions indicating surgical intervention, and worse clinical outcomes. Oblateness Index is a simple and semi-quantitative index for bronchoscopic assessment of TM/BM, and can be one of the prognostic tools to predict clinical severity of pediatric TM/BM.

Clinical Features and Factors Associated With Surgical Treatment in Patients With Complicated Colonic Diverticulitis.

PurposeColonic diverticulitis is uncommon in Korea, but the incidence is rapidly increasing nowadays. The clinical features and the factors associated with complications of diverticulitis are important for properly treating the disease.MethodsA retrospective review of the medical records of 225 patients that were prospectively collected between October 2007 and September 2016 was conducted.ResultsDiverticulitis was detected mainly in men and women aged 30 to 50 years. Diverticulitis more frequently affected the right colon (n = 194, 86.2%), but age was higher in case of left colonic involvement (42 years vs. 57 years, P < 0.001). Percentages of comorbidities (65.6% vs. 23.8%, P < 0.001), complications (65.6% vs. 6.2%, P < 0.001), and surgical treatment (50.0% vs. 4.1%, P < 0.001) were significantly higher in patients with left colonic diverticulitis. In the multivariate analysis, a risk factor for complicated diverticulitis was left colonic involvement (P < 0.001; relative risk [RR], 47.108; 95% confidence interval [CI], 12.651–175.413). In complicated diverticulitis, age over 50 was the only significant risk factor for surgical treatment (P = 0.024; RR, 19.350; 95% CI, 1.474–254.023).ConclusionIn patients over 50 years of age with left colonic diverticulitis, a preventive colectomy should be reconsidered as one of the options for treatment.

Preoperative evaluation of renal cell carcinoma patients with bone metastases on risks for blood loss, performance status and lethal event.

Surgical treatment for renal cell carcinoma metastases can be an effective modality for improving survival and patients' quality of life. However, it is often difficult to decide on the optimal surgical approach due to the lesion's high vascularity and uncertainty regarding postoperative performance status and survival. Blood loss, postoperative performance status, overall survival, postoperative complication and related risk factors for surgical treatment were analysed in 61 renal cell carcinoma patients with bone metastases. Pelvic location and impending/pathological fracture in the metastatic lesion were both significant risk factors for increased blood loss. An unresectable primary lesion and poor preoperative performance status were independent risk factors for poor postoperative performance status. A shorter duration from the discovery of primary lesion to bone metastasis, the number of metastases, and unresectable primary lesion were independent risk factors for shorter survival. Postoperative complications were identified in 15 cases (24.6%). The preoperative prediction of intraoperative blood loss, performance status and survival in renal cell carcinoma patients with bone metastases may be possible based on the risk factors identified in this study.

The Risk of Curve Progression and Surgery in African Americans With Adolescent Idiopathic Scoliosis

Study DesignRetrospective clinical cohort study. ObjectiveTo determine if certain risk factors (age, curve magnitude, skeletal maturity, gender, and curve pattern) traditionally associated with curve progression and surgical intervention in the general population apply equally to African Americans. Summary of Background DataCurrently, information is limited on the role that a patient's race plays in the risk of curve progression of adolescent idiopathic scoliosis (AIS), and existing studies have conflicting results. MethodsRetrospective search of records identified patients who were African American, had been diagnosed with AIS, had a major curve Cobb angle of 10 degrees or more, and had at least two clinical visits with spinal radiographs at least 90 days apart to determine the risk factors for surgical treatment, and 2 years apart to determine the risk factors for curve progression. Patients with a medical condition likely to cause scoliosis were excluded. ResultsOf 738 African American patients with AIS, 223 were assessed for surgical risk factors, and 72 were assessed for curve progression risk factors. Fifty-six (29.17%) had progression of the major coronal curve, and 38 (17.04%) underwent surgery. Age at presentation and curve magnitude at presentation were significant risk factors for surgical intervention. Curve magnitude at presentation was a significant risk factor for curve progression. No significant relationships were found for gender or curve type as they relate to surgical intervention or curve progression. ConclusionAge and curve magnitude at presentation were significantly associated with surgery, as is true in other scoliosis populations. Curve magnitude at presentation was associated with curve progression. In contrast to studies in other populations, however, no significant association was observed between curve progression and age at presentation, curve type, or gender, or between surgery and curve type or gender. Level of EvidenceLevel III, prognostic cohort study.

Incidence of Bowel Surgery and Associated Risk Factors in Pediatric-Onset Crohn's Disease.

Data describing the incidence and the risk factors for surgical interventions in pediatric Crohn's disease (CD) is inconsistent. Our aim was to describe the rates of intestinal surgery and to identify associated risk factors in a large cohort of children with CD. Medical charts of 482 children with CD from the Schneider Pediatric Inflammatory Bowel Disease cohort who were diagnosed between 1981 and 2013 were carefully reviewed retrospectively. Of 482 patients, 143 (29.7%) underwent intestinal surgery with a median follow-up time of 8.6 years (range, 1-30.5). Kaplan-Meier survival estimates of the cumulative probability of CD-related intestinal surgery were 14.2% at 5 years and 24.5% at 10 years from diagnosis. Of these, 14% needed more than one operation. Multivariate Cox models showed that isolated ileal disease (hazard ratio [HR] 2.39, P = 0.008), complicated behavior (penetrating or stricturing) (HR 2.44, P < 0.001) and higher severity indices, at diagnosis, including Harvey-Bradshaw (HR 1.06, P = 0.009) and short Pediatric Crohn's Disease Activity Index (HR 1.02, P = 0.001) were associated with increased risk for intestinal surgery. Age, gender, family history of CD, early introduction of immunomodulators, treatment with anti-tumor necrosis factor α, or diagnosis before the year 2000 did not affect the risk of bowel surgery. Ileal location, complicated behavior, and higher disease activity indices at diagnosis are independent risk factors for bowel surgery, whereas anti-tumor necrosis factor α treatment and diagnosis during the "biological era" are not associated with diminished long-term surgical risk.

Factors Associated With Failure of Nonoperative Treatment in Lateral Epicondylitis

Background: Lateral epicondylitis is a common cause of elbow pain that is treated with a variety of nonoperative measures and often improves with time. Minimal research is available on patients in whom these nonoperative treatments fail. Purpose: To identify baseline patient and disease factors associated with the failure of nonoperative treatment of lateral epicondylitis, defined as surgery after a period of nonoperative treatment. Study Design: Case control study; Level of evidence, 3. Methods: A total of 580 patients treated for lateral epicondylitis at a tertiary center between 2007 and 2012 were analyzed. Disease-specific and patient demographic characteristics were compared between patient groups (nonoperative vs surgical treatment). A multivariable logistic regression model was created based on preliminary univariate testing to determine which characteristics were associated with failure of nonoperative treatment. Results: Of the 580 patients, 92 (16%) underwent surgical treatment at a mean of 6 months (range, 0-31 months) from their initial visit. Univariate analysis demonstrated a potential association (P < .10) between operative management and the following factors at initial diagnosis: increased age, body mass index, duration of symptoms, presence of radial tunnel syndrome, prior injection, physical therapy, splinting, smoking, workers’ compensation, a labor occupation, use of narcotics, use of antidepressant medications, and previous orthopaedic surgery. In the final multivariable model, a workers’ compensation claim (odds ratio [OR], 8.1), prior injection (OR, 5.6), the presence of radial tunnel syndrome (OR, 3.1), previous orthopaedic surgery (OR, 3.2), and duration of symptoms >12 months (OR, 2.5) remained significant independent predictors of surgical treatment. Conclusion: This study identifies risk factors for surgical treatment for lateral epicondylitis. While these findings do not provide information regarding causal factors associated with surgery, these patient and disease-specific considerations may be helpful when counseling patients regarding treatment options and the likelihood of the success of continued nonoperative treatment.

Prognostic factors of breast cancer liver metastasis surgery.

The current survival of patients with breast cancer liver metastases (BCLM) after systemic oncological treatment is between 22 to 27 months [1, 2]. The proper indication for surgical treatment of BCLM is still a matter of discussion [3, 4]. We evaluated the risk factors of surgical treatment of BCLM in 21 women with an average age of 50.9 ±8.9 years. The interval between the breast and the liver surgery was 4.0 ±2.8 years. Local recurrence was observed in 6 (28.6%) patients. The primary tumour was a ductal carcinoma in 12 (57.1%) cases, a lobular carcinoma in 6 (28.6%) cases and another type in 3 (14.3%) cases. The primary tumour was oestrogen receptor positive in 14 (66.7%) cases, and progesterone receptor positive in 10 (47.6%) cases. Both receptor types were positive in 15 (71.4%) and both were negative in 2 (9.5%) patients. Fourteen patients had a solitary BCLM, and 7 patients had more metastases. The average sum of BCLM diameters was 5.2 ±3.8 cm. Extra-hepatic metastases were present in 6 (28.6%) patients. We performed 11 (52.4%) liver resections and 10 (47.6%) radiofrequency ablations (RFA). In 3 patients, a lymphadenectomy of the hepato-duodenal ligament, because of the presence of positive lymph nodes, was performed. We studied the effects of patients’ age, time interval between the breast cancer and BCLM surgery, the type of surgical procedure, histopathological findings of the primary tumour, the number and overall diameter of BCLM, the presence of resectable extra-hepatic metastases, and local tumour recurrence after primary breast cancer surgery on patients’ overall (OS) and progression-free survival (PFS). The 1-, 3- and 5-year OS for patients treated with resection or RFA was 89.6, 85.7 and 14.3%; and 79.6, 45.5 and 11.4%, respectively (NS). Younger patients (< 50) were at greater risk in terms of both OS (HR = 4.163, 95% CI: 1.146–15.118, and p < 0.02) and PFS (HR = 4.303, 95% CI: 1.056–17.531, and p < 0.01). An interval ≥ 4 years between the primary procedure and BCLM surgery had a protective effect in terms of OS (HR = 4.738, 95% CI: 1.287–17.441, and p < 0.01) and PFS (HR = 5.088, 95% CI: 1.496–17.303, and p < 0.005). Negative status of ER and PR in the primary tumour was a negative factor for PFS (HR = 21.475, 95% CI: 1.907–241.843, and p < 0.0003). The presence of extra-hepatic surgically resectable metastases had a negative impact on OS (HR = 5.078, 95% CI: 1.437–17.949, and p < 0.005). If the overall diameter of the BCLM was ≥ 3.5 cm, then PFS was significantly worse (HR = 9.999, 95% CI: 1.257–79.513, and p < 0.009). The other studied factors did not have any impact on OS or PFS (Table I). Table I Patients characteristic and prognostic factors The surgical treatment of BCLM remains the method of choice in a selected group of patients. The short time interval between the breast and BCLM surgery, presence of extra-hepatic metastases, an overall large BCLM diameter, especially in younger patients, and negative status for both hormone receptors represent significant risk factors, and in such cases the decision to proceed with surgical treatment of BCLM should be weighed on an individual basis by a multi-disciplinary team.

Successful Conservative Management of Ruptured Ovarian Cysts with Hemoperitoneum in Healthy Women

Study ObjectiveTo determine the success rate of the “intended conservative management strategy” of ruptured ovarian cysts with hemoperitoneum and the risk factors for surgical interventions in healthy women of reproductive age.MethodsPatients who visited the emergency department with abdominal pain and were diagnosed with a ruptured ovarian cyst with hemoperitoneum between August 2008 and June 2013 were included in this retrospective study. The diagnosis of the ruptured ovarian cysts and hemoperitoneum was based on the clinical symptoms, physical examination and ultrasound and CT imaging. The rate of surgical interventions and the risk factors for surgical intervention were determined.ResultsA total of 78 women were diagnosed with a ruptured ovarian cyst with hemoperitoneum. Most patients (80.8%, 63/78) were managed conservatively, and 19.2% of the patients (15/78) required a surgical intervention. In the multiple logistic regression analysis, the diastolic blood pressure (dBP) (odds ratio [OR] of 0.921 with 95% confidence interval [CI] of 0.855–0.993) and the depth of the total pelvic fluid collection in CT (DTFC_CT) (OR 1.599 with 95% CI 1.092–2.343) were the significant determining factors of surgical intervention after adjustment. The rate of surgical intervention was 6.5% vs. 15.8% vs. 77.8% in the patients with neither dBP≤70 mmHg nor DTFC_CT≥5.6 cm, those with only one of those features, and those with both, respectively.ConclusionMost cases of ruptured ovarian cysts with hemoperitoneum can be managed conservatively. A low diastolic blood pressure and a large amount of hemoperitoneum suggest the need for surgical intervention.

Shared and Nonshared Familial Susceptibility to Surgically Treated Inguinal Hernia, Femoral Hernia, Incisional Hernia, Epigastric Hernia, and Umbilical Hernia

The familial risk of abdominal wall hernia (AWH) is largely unknown. In addition, it is unknown whether inguinal hernia (IH), femoral hernia (FH), incisional hernia (INH), epigastric hernia (EH), and umbilical hernia (UH) share familial susceptibility. The aim of this nationwide study was to determine the familial risks of concordant AWH (same disease in proband and exposed relative) and discordant AWH (different disease in proband and exposed relative). Data from the Swedish Multigeneration Register on individuals aged 0 to 78 years were linked to the Swedish hospital discharge register and the Swedish outpatient register for the period from 1964 to 2010. Standardized incidence ratios (SIRs) and 95% CIs for surgically treated IH (n = 209,814 cases), FH (n = 4,576), INH (n = 19,494), EH (n = 8,257), and UH (n = 22,761) were calculated for siblings of individuals with hernia compared with the siblings of unaffected individuals. The procedure was repeated for spouses. All concordant and most discordant familial sibling risks were increased. Familial concordant SIRs for siblings were IH = 1.97 (95% CI, 1.94-1.99), FH = 3.40 (95% CI, 2.44-4.62), INH = 2.24 (95% CI, 2.04-2.46), EH = 5.57 (95% CI, 4.64-6.64), and UH = 3.61 (95% CI, 3.33-3.91). Concordant familial risks were higher than discordant risks. For example, when the proband sibling had IH, the discordant SIRs were FH = 1.74 (95% CI, 1.61-1.88), INH = 1.22 (95% CI, 1.16-1.28), EH = 1.30 (95% CI, 1.20-1.40), and UH = 1.35 (95% CI, 1.29-1.41). Concordant SIRs for spouses were lower: IH = 1.23 (95% CI, 1.20-1.26), FH = 0.97 (95% CI, 0.64-1.36), INH = 1.56 (95% CI, 1.41-1.71), EH = 1.70 (95% CI, 1.09-2.45), and UH = 1.31 (95% CI, 1.09-1.56). Family history of surgically treated AWH is an important risk factor for surgical treatment of AWH. The 5 forms of AWH studied share familial susceptibility, but site-specific familial factors might exist. Several spouse risks were increased, suggesting the possibility of a nongenetic contribution to familial risks.

Retrospective analysis of clinical and pathologic risk factors in liver resection for hepatic colorectal metastases

To analyze the clinical and pathologic risk factors of surgical treatment for liver metastases from colorectal cancer. The data on 98 patients who underwent liver resection for hepatic colorectal metastases were collected and analyzed retrospectively. Overall 1-, 3-, and 5-year survival rates after hepatectomy for metastases were 94.6%, 45.0%, and 22.3%, respectively. Gender, pathologic primary tumor stage, histologic differentiation, size of metastatic tumor, and type of metastases were not statistically significant prognostic factors (P > 0.05). The 5-year survival rate was significantly lower in patients with lymph node metastases from the primary site than that in patients without lymph node metastases (14.1% vs. 39.5%, P = 0.013); survival rate in patients with vascular invasion from the primary tumor was also significantly lower than in those without invasion (10.2% vs. 49.0%, P = 0.032). The survival rate in patients who had unilobar metastases was higher than that in patients who had bilobar metastases (25.3% vs. 0%, P = 0.012). The 5-year survival rates in solitary metastasis, two to three metastases, and with the transfer number ≥4 were 29.1%, 14.4%, and 0%, respectively (P = 0.019). Multivariate analysis revealed resection margin, distribution of metastases, and the number of metastases as the independent risk factors associated with the overall survival rates (P = 0.044, 0.037, and 0.005, respectively). Surgical resection may be the only treatment modality for the cure of colorectal liver metastases. Negative resection margin, metastases confined to unilobar type, and number of metastases ≤3 are associated with better prognosis.

Management of Refractory Chylothorax After Pediatric Cardiovascular Surgery

We investigated the optimal treatment for refractory chylothorax after pediatric cardiovascular surgery. We retrospectively reviewed the cases of 15 consecutive patients who developed chylothorax after congenital heart surgery performed between December 2004 and November 2010. Among the 15 patients (12 male and 3 female; median age 13.9 months) who developed postoperative chylothorax, 10 recovered with conservative therapy, such as a low-fat diet, medium chain triglyceride-enriched diet, or total parenteral nutrition. Of the remaining 5 patients who underwent surgical treatment followed by conventional therapy, 4 showed improvement, and 1 died from cardiac failure. Surgical treatment was performed at a median of 19 days after diagnosis of chylothorax. Average drainage output of thoracocentesis for the first 5 days before thoracic duct ligation was 33.1 ml/kg/day. Duration of chylous fluid drainage was significantly longer in surgical patients than in patients who recovered with conservative therapy (p < 0.01). Surgical patients tended to be younger with lower body weight. Significant risk factors for surgical intervention were age <4 months, body weight <4 kg, and duration of drainage >10 days. In cases of refractory postoperative chylothorax, surgical therapy such as thoracic duct ligation should be considered when discharge from the drainage tube is >30 ml/kg/day or chylothorax is not improved within 10 days.

Abdominal and perineal approaches in the surgical treatment of rectal prolapse

Introduction: Rectal prolapse is a disease, which is an important cause of social and functional problems and has a continuing debate about the ideal surgical treatment of itself. In this study, we aimed to investigate the abdominal and perineal approaches with early and late postoperative result in the patients undergoing surgery for rectal prolapse. Materials and methods: Between 2006-2011, the records of 21 patients undergoing surgery with the diagnosis of rectal prolapse were reviewed, retrospectively. The demographic and physical examination findings, surgical proce-dures, early and late postoperative complications, recurrence and mortality rates were recorded. Results: The median age was 43 years and female/male ratio was 1.63/1. The most common presenting complaint was gas control failure and often wetting with mucus. Stage 1 and stage 3 rectal prolapses was detected in 19% and 81% of the patients, respectively. The most common surgical procedure was Notaras (54%). Early postoperative complications were seen in 14.3% of the patients. There were no postoperative recurrence, mortality and complica-tion requiring re-exploration. Advanced age and shorter duration of hospital stay were determined and often per-formed under regional anesthesia in the patients undergoing perineal approach. No statistical differences were ob-served in terms of early postoperative complications and recurrence. Conclusion: Results of abdominal and perineal approaches were similar, when they were applied with taking into account the risk factors for surgical treatment, findings of the patients and the surgeon's experience.

Is simultaneous splenectomy an additive risk factor in surgical treatment for active endocarditis?

Splenic abscess formation is a serious complication in the setting of active endocarditis, and splenectomy is recommended. However, the optimal timing for splenectomy is yet undetermined. The purpose of this study was to evaluate the role of a one-stage splenectomy and valve surgery for active endocarditis. Among 202 consecutive endocarditis patients, 18 had splenic lesions on preoperative abdominal screening, who underwent cardiac surgery and splenectomy as a one-stage procedure (group A) and were compared to patients with unremarkable abdominal screening (group B, n = 184) undergoing sole cardiac surgery. No difference was observed regarding preoperative characteristics (age, gender, New York Heart Association [NYHA] grade, diabetes, coronary artery disease, redo surgery, adiposity, smoking), intubation time, and prolonged ventilation. There were 23 early postoperative deaths in group B (12.5%) vs. none in group A. At 180days, survival was significantly higher for patients in group A (94.4%) vs. group B (67.9%, p = 0.016), although this difference did not reach statistical significance (log-rank test, p = 0.073). Multivariate Cox proportional hazards regression revealed age above 50years (hazard ratio [HR] 3.327, 95% confidence interval [CI] 1.279-8.650) and NYHA class above III (NYHA III or IV: HR 3.117, 95% CI 1.119-8.683, p = 0.030; NYHA IV: HR 3.678, 95% CI 1.984-6.817, p < 0.001) as independent risk factors for mortality at 180days. A trend towards a protective factor was observed for simultaneous splenectomy (HR = 0.171, 95% CI 0.023-1.255). Simultaneous valve surgery and splenectomy is an approach for active endocarditis complicated by splenic lesions with a low 180-day mortality. Despite the expected risk elevation by septic lesions and the additive trauma of a laparotomy, patients with simultaneous splenectomy had a favourable outcome regarding early mortality and mortality at 6months.

Perineal Approaches to the Treatment of Rectal Prolapse

Rectal prolapse is a disabling and socially isolating surgical disease that frequently strikes elderly individuals with multiple risk factors for surgical intervention. Numerous operations have been designed to correct prolapse. In choosing an approach, the surgeon must balance the medical condition of his patient against the likelihood of an effective and durable repair. Operations for rectal prolapse are divided into abdominal and perineal approaches, with the former being traditionally perceived as more morbid but more enduring, and the latter as less invasive but more prone to recurrence. These perceptions are based on observational studies and there continues to be a lack of randomized data comparing the 2 approaches in terms of morbidity, efficacy, and functional outcome. Furthermore, as new surgical tools and techniques—such as bioprosthetic materials and minimally invasive surgery—are employed, the optimal surgery for rectal prolapse remains a matter for debate.

Surgical repair of congenital mitral valve malformations in infancy and childhood: A single-center 36-year experience

We sought to evaluate the results of surgical repair and determine predictors for the late outcome of congenital mitral valve dysplasia. Preoperative, operative and postoperative data were obtained from an institutional database; follow-up data came from regular clinical evaluation at our institution or elsewhere. Patients were divided into isolated and complex cases according to the complexity of associated lesions. Between 1972 and 2008, 93 patients (43 male and 50 female patients) underwent mitral repair (median, 4.5 years; range, 0.16-19.8 years). Predominant mitral regurgitation was present in 52%. Associated cardiac anomalies were present in 72%. Sixty-one patients were in the complex group. All patients underwent successful mitral repair. Surgical repair was tailored to the patient's valve anatomy. Early death was 7.5%. The postoperative course was uneventful in 86% of patients. At a mean follow-up of 10.3 years (median, 8.4 years; completeness, 94%), late mortality is 8% (7 patients). Twelve patients underwent mitral reintervention (11 replacements and 1 repair). Among the 80 survivors, 82.5% were in New York Heart Association class I or II, and 61.2% had some degree of persistent mitral regurgitation or stenosis, despite stable hemodynamics. Stenosis is a statistically significant risk factor for surgical intervention at less than 1 year of age and is related to higher overall mortality and incidence of late cardiac failure and mitral dysfunction; parachute mitral valve is related to higher mortality and morbidity. Mitral valve repair shows acceptable early mortality and reoperation rates. Mitral malformations in the complex group are related to a significantly higher risk of reoperation on the mitral valve. Parachute mitral valve is associated with a higher rate of early mortality.

Chronic Intestinal Insufficiency as an Independent Risk Factor in Surgical Treatment of Degenerative Diseases of the Spine and Large Joints

Objective. To study the chronic intestinal insufficiency in patients with degenerative spine and large joint diseases as a possible independent risk factor in a perioperative period. Material and Methods. The study included 200 case histories selected by double-blind sampling out of 823 histories of patients with degenerative diseases of the spine and hip who received non-steroid anti-inflammatory drugs. All patients underwent highly traumatic surgical procedures, and clinical analysis of gastrointestinal tract, fiberoptic gastroduodenoscopy, fibercolonoscopy, phonoenterography, chronography, and dysbiosis test were performed to all of them. Results. The developed scale of chronic intestinal insufficiency signs represents a significant prognostic criterion for treatment selection in patients with degenerative spine and large joint diseases. It suggests that 74 % of patients have chronic intestinal insufficiency as a baseline clinically significant pathological condition. Conclusion. Chronic intestinal insufficiency is an essential risk factor in patients with degenerative diseases of the spine and large joints in perioperative period.

Incidence and risk factors for surgical intervention after uterine artery embolization

To determine the incidence and risk factors for surgical intervention after uterine artery embolization for symptomatic uterine fibroids. Electronic medical records of all patients who underwent uterine artery embolization for symptomatic uterine leiomyomata were reviewed. Logistic regression was used to identify independent risk factors for any surgical intervention and for hysterectomy alone after uterine artery embolization. Uterine artery embolization was performed in 454 patients during the study period, with a median follow-up time (range) of 14 (0-128) months. Overall, 99 patients (22%) underwent any surgical intervention after uterine artery embolization in the operating room. Risk factors for any surgical intervention included younger age (P < .003), bleeding as an indication for uterine artery embolization (P < .01), presence of significant collateral ovarian vessel contribution to the uterus (P < .01), or use of 355-500 mum particles (P < .008). Patients undergoing uterine artery embolization have a 22% risk for requiring additional surgical intervention, but overall uterine artery embolization is an effective minimally invasive option.