Significant Difference In Morbidity Research Articles

Associated factors of mortality and morbidity in emergency and elective abdominal surgery: a two-year prospective cohort study at lacor hospital, Uganda

BackgroundThe mortality rate associated with open abdominal surgery is a significant concern for patients and healthcare providers. This is particularly worrisome in Africa due to scarce workforce resources and poor early warning systems for detecting physiological deterioration in patients who develop complications.MethodsThis prospective cohort study aimed to follow patients who underwent emergency or elective abdominal surgery at Lacor Hospital in Uganda. The participants were patients who underwent abdominal surgery at the hospital between April 27th, 2019 and July 07th, 2021. Trained research staff collected data using standardized forms, which included demographic information (age, gender, telephone contact, and location), surgical indications, surgical procedures, preoperative health status, postoperative morbidity and mortality, and length of hospital stay.ResultsThe present study involved 124 patients, mostly male, with an average age of 35 years, who presented with abdominal pain and varying underlying comorbidities. Elective cases constituted 60.2% of the total. The common reasons for emergency and elective surgery were gastroduodenal perforation and cholelithiasis respectively. The complication rate was 17.7%, with surgical site infections being the most frequent. The mortality rate was 7.3%, and several factors such as preoperative hypotension, deranged renal function, postoperative use of vasopressors, and postoperative assisted ventilation were associated with it. Elective and emergency-operated patients showed no significant difference in survival (P-value = 0.41) or length of hospital stay (P-value = 0.17). However, there was a significant difference in morbidity (p < 0.001).ConclusionCholelithiasis and gastroduodenal perforation were key surgical indications, with factors like postoperative ventilation and adrenaline infusion linked to mortality. Emergency surgeries had higher complication rates, particularly surgical site infections, despite similar hospital stay and mortality rates compared to elective surgeries.

Morbidity and Mortality Following Total Hip and Knee Arthroplasty with Spinal versus General Anesthesia: A Retrospective Analysis

BackgroundDespite the longstanding debate surrounding anesthesia in total joint arthroplasty, an optimal anesthetic mode has yet to be clearly identified. Patients undergoing total joint arthroplasty may be offered spinal anesthesia (SA) or general anesthesia (GA). While the arthroplasty literature has reported differences in postoperative morbidity, the hip fracture literature does not demonstrate the superiority of SA or GA. The purpose of this study was to further investigate this relationship and determine if there is a significant difference in morbidity and mortality between patients undergoing SA compared with those undergoing GA during primary total hip and knee arthroplasty surgery. Study DesignCohort study; Level of evidence, 3. MethodsPatients undergoing primary total hip or total knee arthroplasty from February 2007 to February 2021 were retrospectively reviewed. From this population, four cohorts were created: THA/GA (n = 1,266), THA/SA (n = 1,084), TKA/GA (n =882), and THA/SA (n = 2,067). Readmission within 90 days, mortality within 365 days, and thromboembolic events in the postoperative 30 days were compared using logistic regression analysis. The multivariate model controlled for age, body mass index (BMI), and Charlson Comorbidity Index (CCI). ResultsThe odds of experiencing a deep venous thrombosis (DVT) within 30 days postoperatively were elevated in the analysis of both the THA/GA (OR [odds ratio] = 3.1; 95% CI [confidence interval]: 1.5 to 7.0; P = 0.004) and the TKA/GA (OR = 1.9; 95% CI: 1.2 to 3.0; P = 0.005) groups. Similarly, the risk of pulmonary embolism (PE) as higher in the THA/GA cohort (OR = 3.9; 95% CI: 1.2 to 17.3; P = 0.04). There were also higher odds of mortality within 365 days postoperatively in THA/GA patients (OR = 4.3; 95% CI: 1.7 to 13.0; P = 0.004). No other differences existed among TKA patients. ConclusionBased upon these data, both spinal and general anesthesia are reasonable options for primary total knee arthroplasty with similar risk profiles. However, general anesthesia may be associated with higher rates of DVT in total joint arthroplasty and PE in total hip arthroplasty. General anesthesia was also loosely associated with increased mortality within one year of total hip arthroplasty, but this result should be considered with caution.

Prophylactic occlusion balloons of both internal iliac arteries in caesarean hysterectomy for placenta accreta spectrum disorder reduces blood loss: A retrospective comparative study

BackgroundThe placenta accreta spectrum is a complex disorder characterized by abnormal invasion of the placenta into the uterine wall, posing a significant risk of life-threatening haemorrhage for patients. Its incidence is on the rise, largely attributed to the increasing rates of caesarean sections. Management of this spectrum involves a multidisciplinary approach, although standardized protocols are not yet established. While caesarean hysterectomy remains the standard Gold, several adjunctive treatments have emerged in recent years to mitigate bleeding risk and associated morbidity. Among these, prophylactic occlusion balloons placed in the internal iliac arteries have shown promise. The aim of our study is to demonstrate the effect of prophylactic occlusion balloons in both uterine iliac arteries in the management of placental accreta spectrum disorders. MethodsA retrospective monocentric cohort study was conducted in the Department "C" of Gynaecology and Obstetrics at the Maternity Center of Tunis. The study spanned three years, from January 2nd, 2020, to December 31st, 2022. The study population consisted of two groups: Control Group (CG) comprised patients who underwent caesarean hysterectomy without internal-iliac prophylactic occlusion balloons, and Occlusion balloons of both internal iliac arteries Group (OBIIAG) included patients who underwent caesarean hysterectomy with internal-iliac prophylactic occlusion balloons. ResultsA total of 38 patients were included in the study, all of whom exhibited similar epidemiological characteristics and comparable personal and obstetric histories. The most prevalent risk factor among the patients was a history of caesarean section (92%). On average, patients were diagnosed at 30 weeks of gestation, with third-trimester bleeding being the most common presentation (71% of cases). The median gestational age at delivery was between 36 and 37 weeks. We observed a significant difference in blood loss between the two groups (2888 ml in the control group and 1828 ml in the group with internal-iliac prophylactic occlusion balloons, p < 0.05). Implementation of this technique resulted in a reduced need for massive transfusions (p < 0.01) and shorter operating times (126 min for the control group and 92 min for the group with internal-iliac prophylactic occlusion balloons; p = 0.04). There were no significant differences in morbidity between the two groups. ConclusionThe intra-iliac prophylactic occlusion balloons can help reduce the risk of hemorrhage and the morbidities that come with the placenta accreta spectrum disorder.

Prospective with historical control, case-matched cohort study of the tertiary survey beneficial in critically severe trauma patients

Background The tertiary survey is an evaluation process conducted after the primary and secondary surveys. It aims to identify missed injuries. This research aims to study the benefits of tertiary surveys in severely traumatized patients. Methods This prospective with historical control, case-matched cohort was conducted on critically-ill trauma patients who were admitted to the surgical intensive care unit (SICU) of Thammasat University Hospital. The study compared the period before and after the implementation of the tertiary survey. Tertiary survey record form was used in all severely traumatized patients with Injury Severity Score (ISS) &gt; 15 within the first 24 hours and before discharge from SICU between August 2022 and February 2023. The comparison data were retrieved from electronic medical records of patients admitted to SICU with ISS &gt; 15 between April 2020 and July 2022. Results We identified 55 type II missed injuries in 39 of 100 cases prior to implementation and 1 type II missed injury after implementation. Type II missed injury decreased from 31% to 4%, and the missed injury detection rate was 56% after implementing the tertiary survey. However, there is no statistically significant difference in morbidity and mortality rates from missed injuries before and after implementation. Conclusions Using tertiary surveys can reduce missed injury rates and increase missed injury detection rates. This research highlights the importance of implementing tertiary surveys as a routine part of trauma evaluation to improve patient care. However, there is no effect on the outcomes, which may require more sample size. Clinical Trials Registry (reference number TCTR20230625001).

Perioperative complications of minor and major reinterventions for peripheral arterial disease.

Patients with peripheral arterial disease (PAD) frequently require reinterventions after lower-extremity revascularization (LER) to maintain perfusion. Current Society for Vascular Surgery guidelines define reinterventions as major or minor based on the magnitude of the procedure. While prior studies have compared primary LER procedures of different magnitudes, similar studies for reinterventions have not been performed. The objective of this study is to compare perioperative outcomes associated with major and minor reinterventions. Patients undergoing LER for PAD at a tertiary care center from 2013 to 2017 were included. A retrospective review of electronic medical records was performed, and reinterventions were categorized as major or minor based on the procedure magnitude. Minor reinterventions included endovascular procedures and open revision with patch angioplasty, while major reinterventions were characterized by open surgical or endovascular LER with catheter-directed thrombolysis (CDT). Perioperative outcomes following LER were captured and compared for major and minor reinterventions. An additional subgroup analysis was performed comparing outcomes associated with major reinterventions stratified into open major surgical reinterventions and CDT. This study included 713 patients over a mean follow-up of 2.5years. A total of 291 patients underwent 696 ipsilateral reinterventions (range = 1-12 reinterventions). Most reinterventions were minor (72.1%, N = 502) and 27.9% (N = 194) were major. Patients receiving reinterventions had an average age of 67.2 ± 11.5 and most were white (73.5%) males (60.1%) initially treated for claudication (58.2%) and CLTI (41.8%). There was significantly higher post-operative bleeding (9.8% vs 3.4%, p = .001), arterial thrombosis (3.1% vs 1.0%, p = .047), and acute renal failure (6.2% vs 2.4%, p = .014) after major reinterventions than minor. Additionally, major reinterventions had significantly higher return to the OR (17.0% vs 11.3%, p = .046) and longer hospital stays (7.5 vs 4.3days, p = <.0001). Overall, major reinterventions were associated with significantly increased perioperative morbidity (37.6% vs 19.7%, p ≤ .001) with no difference in perioperative mortality. In the subgroup analysis, open reinterventions resulted in significantly longer hospital stays (8.6days vs 5.5days, p ≤ .001) and more wound infections than CDT (11.0% vs 0%, p = .017). However, there was no other significant difference in morbidity or mortality following treatment with open surgical reinterventions or CDT. In this study, major reinterventions after LER were associated with greater perioperative morbidity than minor reinterventions, with no difference in mortality. Major reinterventions performed via open surgery and CDT had similar morbidity and mortality.

P393 The frequency of COVID-19 infection and the impact of vaccination on the disease morbidity in Polish pediatric patients with Inflammatory Bowel Disease

Abstract Background Little is known about morbidity of Covid-19 infection in pediatric patients with inflammatory bowel diseases (IBD). The aim of this study was to evaluate the frequency of SARS-CoV-2 infection in children with IBD. Methods A prospective, observational cohort study to evaluate morbidity of coronavirus disease 2019 (COVID-19) among pediatric patients with IBD. The questionnaire included information concerning numbers of vaccine doses, patients’ medication and disease activity. Disease flare was defined by worsening IBD symptoms and change in IBD medications. Results A total of 320 children with IBD, 169 with Crohn’s disease (CD)-52,8%, 150 with ulcerative colitis (UC) - 46,9%, 1 unclassified -0,3%, responded to the questionnaire concerning COVI-19 vaccination. Among the participants 114 (35,6%) patients have suffered from COVID19 (62 CD- 54,4%, 51 UC- 44,7%, 1 unclassified - 0,9%). In 79 cases (69,3%) COVID-19 course was mild, in 31 (27,2%) it was moderate, and 3 (2,6%) children had severe disease. There was no statistically significant difference in morbidity among patients with CD and UC. A total of 127 (39,7%) patients received at least 1 COVID-19 vaccine, and among them 22 (17,3%) children got COVID-19 infection after vaccination. 91 (47.2%) of unvaccinated patients got COVID 19 infection. Following SARS-CoV-2 disease, 22 (19.3%) patients reported exacerbation of IBD during or after COVID 19. In 82 (71.9%) patients COVID-19 infection had no effect on the course of their IBD. Among patients with exacerbation during/after SARS-CoV-2 disease, 3 (13.6%) were vaccinated and 19 (86.4%) of them were not vaccinated. Conclusion Based on the outcomes from our questionnaire concerning COVID-19 vaccination state on the large cohort of pediatric patients with IBD, we conclude that unvaccinated patients get sick more often than vaccinated ones, and there is no difference in the frequency of SARS-CoV-2 infection between children with CD and UC. Also, there is no statistically significant difference in the severity of COVID-19 infection between vaccinated and unvaccinated patients. Vaccination against COVID-19 has no effect on the exacerbation of IBD during/after infection.

Less Invasive Surfactant Administration (LISA) Versus INSURE Method in Preterm Infants: a Retrospective Study.

Respiratory distress syndrome (RDS) is a major cause of morbidity and mortality in preterm infants. Early nasal CPAP and selective administration of surfactant via the endotracheal tube are widely used in the treatment of RDS in preterm infants. The aim of this study was to compare the need for intubation and mechanical ventilation after surfactant delivery between LISA-treated and INSURE-treated premature infants with respiratory distress syndrome (RDS). Retrospective registry-based cohort study enrolled 36 newborns admitted to the neonatal intensive care unit of the "Santa Maria" Hospital of Terni between 2016 and 2023. As a primary outcome, we followed the need for intubation and mechanical ventilation within 72 hours of life, while the secondary outcomes were major neonatal morbidities and death before discharge. The LISA group and the INSURE group included 13 and 23 newborns respectively. Demographic features showed no significant differences between the two groups. The need for mechanical ventilation in the first 72 hours of life was similar in both groups (p >0.99). There were no significant differences in morbidities. LISA and INSURE are equally effective modalities for surfactant administration for the treatment of RDS in preterm infants.

Ivabradine in the Prevention, and Reduction in Size, of Perioperative Myocardial Injury in Patients Undergoing Orthopedic Surgery for Acute Fracture.

Perioperative myocardial injury is common after major noncardiac surgery and is associated with adverse outcomes. This study investigated the use of ivabradine in patients undergoing urgent surgery for fracture. This was a prospective, double-blind, placebo-controlled, randomized clinical trial. Participants were enrolled 1:1 into ivabradine or placebo arm, and study drug was commenced before operation and continued for 7 days or until discharge. High-sensitivity troponin I was measured daily using Abbott Alinity analyzer and assay, and heart rate data were obtained using continuous Holter monitoring. A total of 199 patients underwent acute orthopedic surgery, 98 in the ivabradine group and 101 in the placebo group. The mean age was 78.7 years (range, 77.5-79.9 years), with 68% women. The average heart rate was 5 to 11 beats per minute lower in the ivabradine group compared with the placebo group at all time points (P<0.001 for all). There was no statistically significant difference between the ivabradine and placebo groups in the number of patients who had perioperative myocardial injury: 28.6% versus 31.6% (P=0.71). In patients with perioperative myocardial injury, average peak troponin was 168.8 ng/L (±431.2 ng/L) in the ivabradine group and 2094.5 ng/L (±7201.9 ng/L) in the placebo group (P=0.16). There was no statistically significant difference between groups in 30-day mortality, blood pressure, stroke, or major adverse cardiovascular event. Starting ivabradine preoperatively in elderly patients requiring acute surgery for fracture did not result in a statistically significant difference in the incidence of perioperative myocardial injury. There was no statistically significant difference in morbidity, mortality, or adverse events between treatment groups. URL: https://www.anzctr.org.au/; Unique identifier: ACTRN12616001634460p.

Abstract 108: Artery Of Percheron Infarctions (AOP): A Tale of Two Outcomes

Introduction The AOP is a rare anatomic variant in which a solitary arterial trunk arises from the proximal segment of the posterior cerebral artery (PCA) and supplies the bilateral paramedian thalami and rostral midbrain. Occlusion may result in variable bilateral thalamic and midbrain infarcts. The clinical presentation is most commonly lethargy and somnolence thought to lack other localizing features. Often the diagnosis and treatment of stroke is delayed. Methods Here we present two cases of likely AOP infarcts which highlight the importance of considering this diagnosis on the differential of acute lethargy as timely treatment can lead to a significant difference in morbidity and mortality. Results Case 1: A 68‐year‐old male was initially admitted to an outside hospital with acute lethargy. He was transferred to our institution where he was found to be somnolent and required repeated stimulation to participate with interview. On further exam he was noted to have left ptosis, anisocoria, restricted left supra‐ and add‐ duction, and dysarthria. CT angiogram (CTA) showed no large vessel occlusion (LVO) or significant stenosis. Magnetic resonance imaging (MRI) demonstrated acute infarcts in the medial thalami and subthalamic nuclei bilaterally and uppermost portion of the midbrain. He was out of the window for IV thrombolytic. He was ultimately discharged to inpatient rehab with a persistent CN III palsy. Case 2: A 71‐year‐old female was evaluated emergently via telestroke for acute lethargy and was found to additionally have vertical diplopia, right facial palsy, and subsequent bilateral numbness of the face, arms, and legs. NIHSS 10 for LOC questions (1), facial palsy (2), motor drift (1 pt for each limb), sensory loss (1), aphasia (1), and dysarthria (1). She was treated with IV tenecteplase 179 minutes after the last known well and ultimately had complete symptom resolution. CTA was negative for LVO or significant stenosis. MRI brain demonstrated acute infarcts in the medial thalami bilaterally. Conclusion Here we present two cases of acute onset lethargy. MRI Brain revealed relatively symmetric restricted diffusion in the bilateral thalami of both patients suggesting the presence of an AOP variant. In contrast to the first case, signs of a posterior circulation infarct were quickly recognized in the second patient and IV thrombolytic administration resulted in return to baseline. In both cases there were subtle neurologic findings that suggested midbrain involvement – ptosis, restricted ductions, anisocoria. A high level of suspicion for bilateral thalamic infarct and potential AOP variant should be maintained in cases of acute lethargy. Careful neurologic exam often reveals other signs suggestive of posterior circulation infarct and timely therapeutics can significantly improve morbidity and mortality.

Impact of trans-anal versus laparoscopic total mesorectal excision on the surgical and pathologic outcomes of patients with rectal cancer: meta-analysis of randomized controlled trials.

Despite its profound impact on the oncologic outcomes of rectal cancer, the most optimal surgical approach to total mesorectal excision (TME) has not been identified yet. All previous meta-analyses on this subject have been based on observational studies. This meta-analysis was conducted to assess the surgical and oncologic outcomes of laparoscopic TME (LaTME) compared to trans-anal TME (TaTME), utilizing only randomized controlled trials. Systematic review and meta-analysis of randomized controlled trials. We searched electronic databases (MEDLINE, Cochrane CENTRAL, Clinicaltials.gov) from 2010 onwards, for all published clinical trials comparing TaTME to LaTME. Results are presented as risk ratios, with 95% CI, and pooled using the random effects model. A total of 1691 patients, from 6 eligible randomized controlled trials, were included for analysis. Analyzed data showed no significant difference in morbidity (RR: 0.85, p = 0.15), mortality (RR: 0.50, p = 0.44), conversion to open (RR: 0.40, p = 0.07), or anastomotic leakage (RR: 0.73, p = 0.10) between TaTME and LaTME. There was also no difference in the rate of positive distal resection margin (DRM) (RR: 0.55, p = 0.10) or positive circumferential resection margin (CRM) (RR: 0.67, p = 0.30). Patients undergoing TaTME were more likely to have a complete TME (RR: 1.06, p = 0.002) and shorter hospital stays (RR: - 0.97, p < 0.00001). Patients undergoing TaTME for rectal cancer were more likely to have a complete TME when compared to LaTME, though this did not translate into improved distal or circumferential resection margin. Additionally, TaTME and LaTME had similar surgical outcomes except for shorter length of stay with TaTME.

The perinatal period should be considered in neonatal acute respiratory distress syndrome: comparison of the Montreux definition vs. the second pediatric acute lung injury consensus conference definition.

The recently developed Montreux definition for neonatal acute respiratory distress syndrome (ARDS) partially differs from the Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2) definition. Here, we compare the Montreux and PALICC-2 definitions regarding morbidity, mortality, and prognosis of neonatal cases of ARDS in order to evaluate which definition is more appropriate for newborns. Neonates admitted to our neonatal intensive care unit between 1 January 2018 and 30 September 2019 who met the Montreux or PALICC-2 definition of neonatal ARDS were retrospectively analyzed (n = 472). One comparison was made between application of the Montreux and PALICC-2 definitions to neonates outside the perinatal period (> 7 d after birth). A second comparison was made between a diagnosis of neonatal ARDS within (≤ 7 d of birth) and outside (> 7 d after birth) the perinatal period using the Montreux definition. No significant differences in morbidity, mortality, severity, therapies, or prognosis were observed between neonates in the extra perinatal group according to the Montreux and PALICC-2 definitions. However, epidemiology, clinical course, and prognosis of neonatal ARDS within the perinatal period did differ from those outside the perinatal period according to the Montreux definition. Neonates with ARDS within the perinatal period have unique triggers, epidemiology, clinical course, and prognosis, yet a similar pathobiology pattern, to neonates at other ages. Therefore, it may be essential to consider the perinatal period when defining neonatal ARDS.

Antimicrobial Stewardship in Neonates with Necrotizing Enterocolitis: A Quality Improvement Initiative

BackgroundAntibiotic overutilization in the neonatal intensive care unit (NICU) has many adverse effects, and necrotizing enterocolitis (NEC) is one of the most common indications for antibiotics in premature infants. Evidence for a preferred antibiotic regimen for NEC is lacking. This project aims to reduce piperacillin-tazobactam use and overall antibiotic duration in neonates with NEC through the implementation of an antibiotic stewardship pathway based on the modified Bell stage classification system. MethodsA multidisciplinary team consisting of neonatology, pharmacy, infectious disease, and surgery developed an antibiotic protocol for the management of NEC based on Bell stage. Recommendations included 48 h of ampicillin/gentamicin (AG) for stage I, 5–10 days of AG for stage II, the addition of metronidazole for stage IIIA, and 7–14 days of piperacillin-tazobactam (PT) for stage IIIB. We evaluated overall antibiotic and PT exposure, progression to surgical NEC, NEC recurrence, antibiotic resistance, bacteremia/fungemia, and mortality 1 year pre- and post-protocol implementation. Results27 patients pre-intervention and 44 post-intervention were analyzed. Antibiotic exposure was reduced from a median 119.19 to 80.65 days of therapy (DOT) per 1000 patient days (p = 0.11). PT exposure decreased after protocol implementation (median 68.78 vs. 7.97 DOT per 1000 patient days, p = 0.002). There were no significant differences in morbidity or mortality outcomes. ConclusionsAntibiotic stewardship strategies can be implemented in the NICU without compromising outcomes in patients with NEC. Bell stage stratification appears to be an effective method for antibiotic selection. Further studies are needed in a larger population to optimize regimens and ensure safety. Type of StudyRetrospective comparative study. Level of EvidenceLevel III.

Pancreatic surgery in elderly patients: results of 329 consecutive patients during 10 years.

There is a progressive shift from a younger population to an older population throughout the world. With the population age shift, surgeons will be more encountered with older patient profiles. We aim to determine age-related risk factors of pancreatic cancer surgery and the effect of patient age on outcomes after pancreatic surgery. A retrospective review was conducted with data obtained from consecutive 329 patients whose pancreatic surgery was performed by a single senior surgeon between January 2011 and December 2020. Patients were divided into three groups based on age: patients younger than 65 years old, between 65 and 74 years old, and older than 74 years old. Demographics and postoperative outcomes of the patients were evaluated and compared between these age groups. The distribution of a total of 329 patients into the groups was 168 patients (51.06%) in Group 1 (age <65 years old), 93 patients (28.26%) in Group 2 (age ≥65 and <75 years old), and 68 patients (20.66%) in Group 3 (age ≥75 years old). The overall postoperative complications were statistically significantly higher in Group 3 than in Group 1 and Group 2 (p = 0.013). The comprehensive complication index of the patients in each group was 23.1 ± 6.8, 20.4 ± 8.1, and 20.5 + 6.9, respectively (p = 0.33). Fisher's exact test indicated a significant difference in morbidity in patients with ASA 3-4 (p = 0.023). In-hospital or 90-day mortality was observed in two patients (0.62%), one from Group 2 and one from Group 3. The 3-year survival rates for each group were 65.4%, 58.8%, and 56.8%, respectively (p = 0.038). Our data demonstrate that comorbidity, ASA score, and the possibility of achieving a curative resection do have significantly more impact than age alone.

Comparison of Coronary Artery Bypass Grafting Outcomes in patients with and without Prior Percutaneous Coronary Artery Intervention

Percutaneous coronary intervention (PCI) is a crucial treatment for patients with coronary artery disease (CAD), especially high-risk patients like advanced age, diabetes, chronic kidney disease, left main lesions, and multi vessel CAD. Objective: To compare coronary artery bypass grafting outcomes in patients with and without prior percutaneous coronary artery intervention. Methods: This retrospective 5-year cross-sectional study was conducted on 2579 patients operated for CABG in between August 1st, 2017, and December 31st, 2021 in a tertiary care hospital. All patients who underwent CABG were included in study, and comparison was done in patients with or without PCI. Data analysis were done by using SPSS version 23. p&lt;0.05 was set statistically significant. Results: The results of perfusion and cross clamp time in operative room, use of IABP and reopening rates in both groups showed no statistically significant difference. The incidence of post-operative atrial fibrillation in group A is 4% Vs 1.5% in group B with significant p value of 0.028. Prolong ventilation, perioperative stroke and reintubation rates comparison in both groups were with non-significant p values. In hospital mortality was 4.5% in group A and 3.7% in group B with p-value of 0.370 which is non-significant. Conclusions: Patients with prior percutaneous coronary intervention can undergo CABG surgery with similar mortality rates as those with no prior PCI. The only significant difference in morbidity is post-operative risk of atrial fibrillation which is more in prior PCI patients’ group.

Effects of dosage in new users of lamotrigine inducing epidermal necrolysis: Results of the German Registry of Severe Skin Reactions.

This study was undertaken to determine the impact of dosage in new users of lamotrigine (LTG) and the concomitant intake of valproic acid (VPA) on epidermal necrolysis (EN). A total of 102 EN cases with exposure to LTG were identified (1992-2018) in the German Registry of Severe Skin Reactions. All cases are validated by an independent expert committee. Six cases were excluded due to lack of exposure in the relevant time frame. Causality assessment was performed with ALDEN (Algorithm for Assessment of Drug Causality in EN) on definite/probable cases (≥12 years; n= 84). Evaluation of dosing regimen was restricted to cases with complete LTG dosing history (n= 74). Demography showed a mean age of 42.4 years, female predominance (69%), and low mortality (7.3%). Epilepsy was the indication for use in 87.5%. LTG was the very probable cause in 71.4% and probable cause in 28.6%. On average, one additional antiseizure medication was taken, most frequently VPA (43/84). Combined LTG/VPA treatment showed no statistically significant difference in morbidity or mortality. Mean time latency from initiation of LTG to reaction onset was 24.2 days, varying between 21 days with high initial dose and 29.2 days with low initial dose. Low initial LTG dose (n= 9) revealed higher mortality (22.2%) and higher severity (5/9) than high initial dose (n= 35, mortality=14.3%, 14/35 higher severity). No patient died when the starting dose was as recommended. The highest mortality (25%) was found in patients with no dose increase (n= 8), which correlated with higher age. Despite the recommended or low initial dose, 52.7% of patients developed EN, in contrast to 39.2% with a slow, recommended, or no dose escalation. Neither the initial dose, dose escalation, nor the combination with VPA seems to influence the general occurrence of EN. However, EN patients with the recommended starting dose and the recommended dose escalation had the best outcome in terms of clinical severity and mortality.

The impact of increased body mass index on the outcomes after valve replacement

Background: The association between obesity and the outcomes of surgery is controversial. This study aimed to assess the effect of body mass index (BMI) on early and late morbidity and mortality after valve replacement surgery.&#x0D; Methods: The study was conducted on 100 valve replacement patients from 2020 to 2022. The patients were divided according to BMI into two groups: patients with morbid obesity (BMI ≥ 35) (Group A: n = 50) and patients who had BMI&lt; 35 (Group B.; n = 50).&#x0D; Results: Hospital (9.43 ± 5.93 vs. 7.25 ± 4.05 days, P= 0.034), ICU length of stay (7.32 ± 5.67 vs. 4.52 ± 3.24 days, P= 0.003), and duration of mechanical ventilation (3.58 ± 2.54 vs. 2.342 ± 2.05 days, P= 0.008) were significantly higher in Group A. There was no significant difference in postoperative mortality between both groups (P= 0.678). There was no significant difference in morbidity and mortality after a 3-month follow-up. Hemoglobin was significantly lower in Group A (P =0.034), with no difference in postoperative laboratory investigations.&#x0D; Conclusions: Morbid obesity was not associated with increased mortality after valve replacement surgery; however, it could increase the duration of ventilation, ICU, and hospital stay.

Risks and benefits of pancreaticoduodenectomy in patients aged 80years and over.

The frequency of pancreaticoduodenectomy is increasing in oldest old patients owing to population aging. We aimed to clarify the clinical significance of pancreaticoduodenectomy in patients aged ≥ 80years with multiple underlying diseases. A total of 649 consecutive patients who underwent pancreaticoduodenectomy from April 2010 to March 2021 in our institute were divided into two groups according to their age: ≥ 80years (51) and ≤ 79years (598). We compared mortality and morbidity between the groups. The age-related prognosis was analyzed in 302 patients who underwent pancreaticoduodenectomy for pancreatic ductal adenocarcinoma treatment. There were no significant differences in morbidity (Clavien-Dindo classification grade III or higher; P = 0.1300), mortality (P = 0.0786), or postoperative hospital stay (P = 0.5763) between the groups. Patients aged ≥ 80years, who underwent pancreaticoduodenectomy for pancreatic ductal adenocarcinoma, had shorter overall survival than those aged ≤ 79years (median survival time, 16.7months vs. 32.7months; P = 0.0206). However, the overall survival of patients aged ≥ 80years who received perioperative chemotherapy was comparable to that of patients aged ≤ 79years (P = 0.9795). In the multivariate analysis, the absence of perioperative chemotherapy was identified as an independent prognostic factor, while age ≥ 80years was not. Perioperative chemotherapy was the sole independent prognostic factor in patients aged ≥ 80years who underwent pancreaticoduodenectomy for pancreatic ductal adenocarcinoma. Pancreaticoduodenectomy is safe for patients aged ≥ 80years. The survival benefits of pancreaticoduodenectomy for patients with pancreatic ductal adenocarcinoma aged ≥ 80years might be limited to those who can receive perioperative chemotherapy.

Conservative Management of Patent Ductus Arteriosus Is Feasible in the Peri-Viable Infants at 22-25 Gestational Weeks.

The purpose of this study was to determine the natural course of hemodynamically significant (HS) patent ductus arteriosus (PDA) with conservative management and whether the presence or prolonged duration of HS PDA affected mortality/morbidities in infants at 22-25 weeks estimated gestational age (EGA). We retrospectively reviewed the medical records of 77 infants born at 22-25 weeks EGA, stratified into 22-23 weeks (n = 21) and 24-25 weeks EGA (n = 56). HS PDA was present in 77%, 76%, and 77%, and open ductus at discharge was 12%, 13%, and 12% in the total and at 22-23 and 24-25 weeks EGA infants, respectively. For backup rescue treatment, 7% and 5% of the infants received oral ibuprofen and device closure, respectively. A mortality rate of 9% was found in the HS PDA (+) infants, significantly lower than the 28% in HS PDA (-) infants. There are no significant differences in morbidities. In multivariate analyses, the presence and/or prolonged duration of HS PDA was not associated with increased mortality or morbidity. Spontaneous closure of HS PDA was achieved through conservative management in the peri-viable infants at 22-25 weeks EGA.

Optimal Dose of Vitamin D For Covid-19 Treatment

Highlights: Vitamin D supplementations in different doses yield different outcomes. Multi-day vitamin D administration of 1000-6000 IU in patients with COVID-19 has more positive impacts than a single high dose of vitamin D. Patient morbidity, length of hospitalization, and patient mortality improved with multi-day vitamin D administration.   Abstract: This meta-analysis aimed to determine whether there is any optimal dose of vitamin D for morbidity, length of hospitalization, and mortality in patients with COVID-19. We conducted a comprehensive search in three online databases for eligible studies until February 28, 2022. Odds ratio (OR) and standardized mean difference (SMD) were applied as summary statistics of primary outcomes. The study quality of the literatures collected was assesed using the Cochrane risk of bias tool version 2 (RoB 2). Eight randomized clinical trials (RCT) were included in the study. In our analysis, we found that there was no significant difference in morbidity when vitamin D was administered to COVID-19 patients [OR=0.50 (95% CI=0.13-1.96); SMD=-0.14 (95% CI=-0.55-0.28)]. Duration of hospitalization [SMD=-0.12 (95% CI=-0.39-0.15)] and mortality [OR 0.47 (95% CI=0.19-1.17)] of COVID-19 patients in five studies also showed no significant difference compared to patients who do not take vitamin D. However, when we analyzed two other studies, we found that in patients who did not take vitamin D, mortality was lower [SMD=0.43 (95% CI=0.29, 0.58)]. Compared to a single high dose of vitamin D, the multi-day vitamin D administration of 1000-6000 IU in patients with COVID-19 resulted in improved patient morbidity, length of hospitalization, and patient mortality.

Short Term Outcomes of Open and Minimally Invasive Approaches to Segmental Colectomy for Benign Colovesical Fistula.

We speculated that a minimally invasive (MIS) colectomy for colovesical fistula is associated with less morbidity compared to an open colectomy. Multivariate analysis using logistic regression was used to investigate the outcomes of patients who underwent colectomy for benign colovesical fistula during 2012-2017 by surgical approach using the NSQIP database. We identified 748 patients underwent partial colectomy for benign colovesical fistula during 2012-2017. Surgeons used the MIS approach in 72.7% of operations, with a conversion rate of 13.1%. The MIS approach was associated with lower morbidity (27.4% vs. 43.1%, AOR: 0.46, P=0.02) compared to the open approach. The mean operation duration was longer in MIS operations compared to open (225 min vs. 201 min, P < 0.01). The robotic approach to colectomy showed no significant difference in morbidity (28.4% vs. 27.2%, P=0.77) but a decrease in conversion rate (8.1% vs. 13.8%, P < 0.01) and an increase in operation length (249 min vs. 222 min, mean difference: 27 min, P < 0.01) compared to a laparoscopic approach. There was no significant difference in the anastomotic leak rate between MIS and open approaches (3.7% vs. 5.4%, P=0.14) and between laparoscopic and robotic approaches (2.8% vs. 3.8%, P=0.99). We found a 72.7% utilization rate of MIS approach to colectomy for benign colovesical fistula in the NSQIP hospitals with a 13.6% conversion rate. Patients with MIS approach had significantly lower morbidity compared to open. A robotic approach to partial colectomy has the same morbidity risk with a decreased conversion rate compared to laparoscopic approach.