Statistical Difference In Occurrence Research Articles

A Comparison of Postoperative Outcomes Between Immediate, Delayed Immediate, and Delayed Autologous Free Flap Breast Reconstruction: Analysis of 2010-2020 NSQIP Data.

While many factors influence decisions related to the timing between mastectomy and flap-based breast reconstruction, there is limited literature comparing postoperative complications between immediate (IBR), delayed immediate (DIBR), and delayed (DBR) reconstruction modalities. Using the National Surgical Quality Improvement Program (NSQIP), we sought to compare postoperative complication rates of each timing modality. The NSQIP 2010-2020 database was queried for patients who underwent free flap breast reconstruction. Cases were categorized to include mastectomy performed concurrently with a free flap reconstruction, removal of a tissue expander with free flap reconstruction, and free flap reconstruction alone which are defined as IBR, DIBR, and DBR, respectively. The frequency of postoperative outcomes including surgical site infection (SSI), wound dehiscence, intraoperative transfusion, deep venous thrombosis (DVT), and return to operating room (OR) was assessed. Overall complication rates, hospital length of stay (LOS), and operative time were analyzed. Multivariable regression analysis controlling for age, race, BMI, diabetes, hypertension, ASA class, and laterality was performed. A total of 7,907 cases that underwent IBR, DIBR (n = 976), and DBR reconstruction (n = 6,713) were identified. No statistical difference in occurrence of SSIs, wound dehiscence, or DVT was identified. DIBR (9%) and DBR (11.9%) were associated with less occurrences of reoperation than IBR (13.2%, p < 0.001). Univariate and multivariate regression analysis demonstrated that DIBR and DBR were associated with a lower odds of complications and shorter operation time versus IBR. No statistically significant differences between DIBR and DBR in surgical complications, LOS, and operative time were identified. Awareness of overall complication rates associated with each reconstructive timing modality can be used to help guide physicians when discussing reconstructive options. Our data suggests that DIBR and DBR are associated with less overall complications than IBR. Physicians should continue to consider patients' unique circumstances when deciding upon which timing modality is appropriate.

Retrospective comparison of side effects and outcomes of three-dimensional conformal vs. intensity-modulated radiation therapy in the palliative-intent treatment (4 Gy × 5 daily fractions) of canine intranasal tumors (2010-2017).

To compare the occurrence of radiation side effects and treatment outcomes in dogs with intranasal tumors treated with a total dose of 20 Gy delivered in 5 daily 4 Gy fractions using computer-based 3D conformal (3DCRT) or intensity-modulated (IMRT) radiation therapy plans. Retrospective case series. Medical records for dogs with intranasal tumors treated with 4 Gy × 5 fractions between 2010 and 2017 were reviewed. Radiation side effects, time to local progression (TTLP), progression-free survival (PFS) and survival time (OS) were evaluated. Thirty-six dogs (24 carcinomas, 10 sarcomas and 2 others) met the inclusion criteria. Sixteen were treated with 3DCRT and 20 with IMRT. Clinical signs improvement or resolution were reported in 84% of dogs. The median time to clinical signs improvement was 12 days (1-88 days) after the end of treatment. Eight dogs treated with 3DCRT (8/16, 50%) and 5 with IMRT (5/20, 25%) were documented acute radiation side effects. Almost all were classified as grade 1 skin, oral or ocular acute side effects. Only one dog in 3DCRT group was demonstrated grade 2 skin acute effects. The median TTLP for dogs treated with 3DCRT or IMRT was 238 days and 179 days, respectively (p = 0.967). The median PFS for 3DCRT or IMRT was 228 days and 175 days, respectively (p = 0.940). The median OS for 3DCRT or IMRT was 295 days and 312 days, respectively (p = 0.787). No significantly differences were observed in side effects, TTLP, PFS and OS between 3DCRT and IMRT groups. Palliative-intent conformal radiation therapy given in five daily 4 Gy fractions relieved clinical signs with minimal radiation side effects, with no statistical difference in occurrence between 3DCRT and IMRT dogs.

Power chains as an alternative to steel-wire ligatures in temporary maxillomandibular fixation: a pilot study

The aim of this study was to compare two techniques for temporary intraoperative maxillomandibular fixation (TIO-MMF) during orthognathic surgery: steel-wire ligatures versus power chains. Patients undergoing orthognathic surgery between October 2019 and March 2020 were included in a prospective cross-sectional study conducted in three participating hospitals. Data were collected using a standardized measurement form. A total of 44 patients were included, in whom TIO-MMF was applied 79 times. A statistically significant difference in intraoperative loss of stability of the segment relationship was found between steel-wire ligatures (11.4%) and power chains (0%). The mean application time of TIO-MMF differed significantly between steel-wire ligatures (99 seconds) and power chains (157 seconds) (P < 0.001). There was no statistical difference in occurrence of adverse events between the two techniques. This study found that the application of TIO-MMF with power chains is more stable compared to steel-wire ligatures. Steel-wire ligatures were significantly faster to apply, although the absolute difference (less than 1 minute) was small. Other possible advantages of the proposed technique are discussed. The results of this study suggest that power chains for the application of TIO-MMF in orthognathic surgery are a valuable alternative to steel-wire ligatures.

Tuberculosis at the time of Coronavirus disease (COVID-19) lockdown - Back to the days of yore!!!

Abstract Background: The coronavirus disease (COVID-19) pandemic and the lockdown imposed due to it have served as a major setback to tuberculosis (TB) control. We therefore conducted this study to assess the profile of TB patients presenting to our department immediately after COVID-19 lockdown, which was imposed in India from 24 March 2020 and continued for &gt;3 months, and to compare it with the pre-pandemic pattern. Methods: This was an observational study conducted at the pulmonary medicine department of our tertiary care institute. We evaluated the consecutive cases of TB referred to or diagnosed new by our department as soon as the lockdown was lifted and non-COVID services resumed. The data of 2020 and 2019 during September and October month were gathered and analysed retrospectively. Results: A total of 162 patients were hospitalised from September to October 2019, while 40 non-COVID patients were hospitalised during September to October 2020 in our unit. The mean duration of symptoms was 1 month in both the groups. The incidence of TB cases amongst the patients needing hospitalisation after lockdown was more in 2020 [57.5%; 23 diagnosed TB cases (12 males and 11 females) out of 40 non-COVID hospitalised cases] than in 2019 [13.5%; 22 diagnosed TB cases (13 males 9 females) out of 162 hospitalised cases], and this was statistically significant (chi-squared test: p &lt; 0.00001). There was a statistically significant increase in transfers to the TB hospital where patients requiring further long-term medical care were referred to; in 2020 (12.5%; 5 out of 23 diagnosed TB cases) as compared with those in 2019 (0 out of 22 diagnosed TB cases) (p = 0.049, Fischer’s exact test). There was a statistically significant increase in the duration of hospital stay in 2020 than that in 2019 (p = 0.0076, unpaired t-test). There was no statistical difference in occurrence of pulmonary versus extrapulmonary TB (EPTB) or in occurrence of complications of TB in the two years. Conclusion: The COVID-19 pandemic and its lockdown have skewed the profile and pattern of the clinical manifestations and the complications of TB with a more severe trend.

Short-Term Complications of Emergency and Elective Tracheostomy; A Comparative Study

&#x0D; &#x0D; &#x0D; Objective: To compare short-term complications in elective and emergency tracheostomy.Study Design: Comparative cross sectional. Place Duration of Study: The study was conducted in the Department of ENT, Head and Neck Surgery at Combined Military Hospital (CMH) Peshawar from 21th October 2018 to 20th October 2019. Materials and Methods: In this study 60 patients undergoing tracheostomy were included. Patients were divided into two groups, each with 30 participants. Patients in group A had elective whereas group B had emergency tracheostomy. Short term complications including hemorrhage, surgical emphysema, cardiac arrest and stomal infection were noted in both groups. Chi-square test was applied as test of significance to compare the two groups. Results: Emergency tracheostomy is associated with significantly increased risk of hemorrhage and surgical emphysema (p value being &lt;0.05. There was no statistical difference in occurrence of stomal infection and cardiac arrest between the two groups. Conclusion: Tracheostomy performed in emergency is fraught with complications. Our study validates the fact that emergency tracheostomy is associated with significantly increased risk of postoperative hemorrhage and surgical emphysema.&#x0D; &#x0D; &#x0D;

Impacts on outcomes and management of preoperative magnetic resonance cholangiopancreatography in patients scheduled for laparoscopic cholecystectomy: for whom it should be considered?

PurposeWe evaluated the impact of preoperative magnetic resonance cholangiopancreatography (MRCP) on patient outcomes, and found which patients should be considered for MRCP before cholecystectomy.MethodsWe performed retrospective analysis of 2,072 patients that underwent cholecystectomy for benign gallbladder disease from January 2014 to June 2017. Patients were grouped as CT only group (n = 737) and MRCP group (n = 1,335), including both CT and MRCP (n = 1,292) or MRCP only (n = 43). The main outcome measure was associated with complications after cholecystectomy, and the secondary outcomes were hospital stay, readmission, and events that could impact patient management due to addition of MRCP.ResultsThere were no statistical differences in occurrence of intraoperative or postoperative complications or readmission rate between the 2 groups. Hospital stay was about 0.6 days longer in the MRCP group. However, MRCP group was more susceptible to complications due to underlying patient demographics (older age, higher frequency of diabetes, and higher level of the inflammatory markers). MRCP diagnosed common bile duct (CBD) stones in 6.5% of patients (84/1,292) without CBD stones in CT, and bile duct anomalies were identified in 41 patients (3.2%). Elevated γ-GT was the only independent factor for additional detection of CBD stones (adjusted odds ratio [OR], 2.89; P = 0.029) and subsequent biliary procedures (adjusted OR, 3.34; P = 0.018) when additional MRCP was performed.ConclusionMRCP is valuable for identification of bile duct variation and CBD stones. Preoperative MRCP can be considered, particularly in patients with elevated γ-GT, for proper preoperative management and avoidance of complications.

The distribution and frequency of detection of woodland birds after selective logging of a small woodland remnant in an agricultural landscape in inland southern Australia

The majority of studies into the response of birds to logging in Australian forests has been done in forest-dominated landscapes or relatively large forest blocks, where the surrounding landscape can ameliorate impacts. This is the first study to examine the response of birds to logging of a small, relatively isolated woodland remnant in a landscape dominated by agriculture, with a focus on declining woodland birds. Approximately two thirds of a 120 ha cypress-eucalypt woodland remnant was selectively logged. Eighty bird species in total were recorded 2–3½ years after logging, including 18 recognised as declining woodland birds. Sixty-four species were recorded in the unlogged area and 72 in the logged area. Of the 31 species recorded sufficiently frequently for analysis, 19 showed no statistical difference in occurrence between logged and unlogged areas at the power of the study, nine were more prevalent in unlogged areas and three more prevalent in logged areas. Declining woodland birds comprised 22½% of overall species and 33% of those more prevalent in unlogged areas. Mapping of records enabled the response of a subset of species to be examined in greater detail. Four species illustrate the range of responses by declining woodland birds: Eastern Yellow Robin Eopsaltria australis was confined to unlogged areas, White-browed Babbler Pomatostomus superciliosus favoured unlogged areas, Varied Sittella Daphoenositta chrysoptera favoured proximity to unlogged areas and Red-capped Robin Petroica goodenovii was widely distributed in both logged and unlogged areas. The likelihood of recovery of local woodland bird populations is discussed in the context of limited landscape connectivity and the recent colonisation of the remnant by the hyper-aggressive Noisy Miner Manorina melanocephala. White-browed Babbler and Eastern Yellow Robin are considered to be at high risk of local extinction in the remnant.

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OBJECTIVES/SPECIFIC AIMS: The morbidity and mortality in adults with single ventricular hearts who have undergone Fontan palliation is poorly defined. These patients have a high burden of arrhythmia, heart failure, and re-operation. We hypothesized that age and type of Fontan predict occurrence of arrhythmia. METHODS/STUDY POPULATION: In total, 205 patients aged 18 years who had undergone a Fontan procedure were identified. Those with incomplete data were excluded. Demographic, anatomic, pharmacologic, imaging, hemodynamic, and electrophysiologic data were collected. The χ2 and Mann-Whitney U tests were used to test significance defined as p&lt;0.05. RESULTS/ANTICIPATED RESULTS: Of the 205 patients identified, 59 had been lost to follow-up. Of the 146 patients (77, 53% female) actively followed 18 (12%) had died at a median (IQR) age of 27 (21–34.3); in patients alive as of 10/2016 the median age was 26 years (22–34). Fontan types were lateral tunnel (LT) (n=79, 54.1%), extracardiac (EC) (n=32, 22%), right atrial to pulmonary artery (RV-PA) (n=28, 19%), and Fontan with Bjork modification (n=4, 2.7%). Systemic left ventricle (n=96, 66%) was more common than systemic right ventricle (n=43, 30%). Of the 146 patients, 101 (69%) had significant morbidity or mortality: 86 (59%) were diagnosed with arrhythmia, 18 (12%) died, and 11 (8%) underwent heart transplants. Frequent procedures included: Fontan revisions/cryoablation in 28 (19%), electrophysiology studies with ablation in 73 (50%), and pacemakers in 53 (36%). Of the arrhythmia diagnoses, 57 (64%) were atrial tachyarrhythmias. RV-PA Fontan procedures were associated with significantly more atrial arrhythmia than all other Fontan types (70% vs. 30%; p&lt;0.01). There was no statistical difference in occurrence of atrial arrhythmia in adults with LT Versus EC Fontans (p=0.3). While patients who had undergone RV-PA and Bjork Fontans were older with median age 34 years, there was no significant difference in age between LT and EC (median 24.0 and 24.5). DISCUSSION/SIGNIFICANCE OF IMPACT: Adult survivors of the Fontan procedure suffer from significant morbidity and mortality. The single most prevalent morbidity is atrial arrhythmia. We conclude that RV-PA Fontans, now obsolete, have the highest prevalence of arrhythmia and that there is no difference in arrhythmia burden between LT and EC Fontans. Given the high prevalence of morbidity and mortality in this population, it is imperative that they be followed by cardiologists with expertise in congenital heart disease.

Abstract 19014: Significant Major Complication Occurrence in Extracting Riata Compared to Sprint Fidelis Leads

Introduction: Medtronic Sprint Fidelis and St. Jude Medical Riata defibrillator leads have been subject to class I recall. Extraction of these leads is a complex clinical decision with a case by case analysis. We compared the difference in the occurrence of major complications to understand the morbidity and mortality risk extracting either of these leads. Methods: We retrospectively reviewed 86 consecutive cases (59 men, 27 women) of Sprint Fidelis (n = 72) or Riata (n = 14) lead extraction from 2007 to 2012 and compared the rate of major complications between the two. The only exclusion criteria were pocket infection or endocarditis as an indication for extraction. Major complications were defined as death, cardiac/vascular avulsion or tear, cardiac tamponade requiring pericardiocentesis and/or stroke. Minor complications were defined as pericardial effusion not requiring intervention, pneumothorax and/or hematoma at surgical site. Results: The main indications for extraction included lead fracture (n = 36, 42%) and elective removal at pulse generator change (n = 28, 33%). There was a significant difference in occurrence of major complications with extraction of Riata as compared to Sprint Fidelis leads (2/14 vs. 1/72, p = 0.016). All 3 major complications occurred in dual coil leads. Within the Riata family of leads, there was no statistical difference in occurrence of major complications (1500 series 2/7 vs. 7000 series 0/7, p = 0.127). There was also no difference in patients with component failure versus prophylactic extraction (1/36 vs. 2/50, p = 0.76). Conclusions: Major complication occurrences in extraction are higher with Riata as compared with Sprint Fidelis leads based on this large, single-center experience. There was no statistical difference between the 8-Fr 1500 and 7-Fr 7000 Riata series of leads. Further investigation is needed to help guide clinical decision-making for patients presenting with these recalled leads.

Safety of intralesional cidofovir in patients with recurrent respiratory papillomatosis: an international retrospective study on 635 RRP patients

Intralesional use of cidofovir (Vistide(®)) has been one of the mainstays of adjuvant therapy in patients with recurrent respiratory papillomatosis (RRP) since 1998. In 2011, a communication provided by the producer of cidofovir addressed very serious side effects concerning its off-label use. As this was a general warning, it was inconclusive whether this would account for its use in RRP. The aim of this study is to determine whether nephrotoxic, neutropenic, or oncogenic side effects have occurred after intralesional use of cidofovir in patients with RRP. Update of recent developments in RRP, a multicentre questionnaire and a multicentre retrospective chart review. Sixteen hospitals from eleven countries worldwide submitted records of 635 RRP patients, of whom 275 were treated with cidofovir. RRP patients received a median of three intralesional injections (interquartile range 2-6). There were no statistical differences in occurrence of neutropenia or renal dysfunction before and after cidofovir. There was no statistical difference in occurrence of upper airway and tracheal malignancies between the cidofovir and the non-cidofovir group. In this retrospective patient chart review, no clinical evidence was found for more long-term nephrotoxicity, neutropenia or laryngeal malignancies after the administration of intralesional cidofovir in RRP patients.

Single-port laparoscopic cholecystectomy: A comparative study in 106 initial cases

Introduction: Laparoscopic cholecystectomy has been the standard of care for gallbladder diseases since the late 1980s. Many surgeons have rapidly adopted single-port laparoscopic cholecystectomy for gallbladder pathologies. The aim of the present study was to analyze the clinical outcome in initial single-port laparoscopic cholecystectomy. Methods: Data from 106 consecutive single-port laparoscopic cholecystectomies between May 2008 and April 2009 were analyzed retrospectively. We divided the patients into two groups – an early group (group I, n=56) and a late group (group II, n=50) – to compare clinical outcomes. During each procedure, only one longitudinal transumbilical incision, 1.5 to 2.0 cm in length, was made to access the abdominal cavity. A multichannel port system was assembled with existing devices. Standard laparoscopic instruments were used to perform each cholecystectomy. Results: Patient demographics did not differ between the two groups. Of the eight cases that were converted to conventional laparoscopic surgery, seven were part of group I (P=0.063). Mean operation time for single-port laparoscopic cholecystectomy was significantly shorter in group II (58.2 versus 71.6 min, P=0.004). There were two operative complications in group I, which were successfully managed with laparoscopic surgery. There was no statistical difference in occurrence of operative complication and hospital stay between the two groups. Conclusion: Single-port laparoscopic cholecystectomy can be safely performed for various gallbladder lesions in selected cases, and the operation time improved with accumulation of cases.

Does Spatial Structure Persist Despite Resource and Population Changes? Effects of Experimental Manipulations on Coyotes

We tested the influence of a change in food resource distribution on space use and diet of coyotes (Canis latrans). We focused on 2 facets of space use: maintenance of home ranges by residents, and establishment of home ranges by immigrants after a coyote removal program. The study was conducted on 2 populations of coyotes in southern Texas. In both populations, a clumped, high-quality food source was added to randomly selected feeding stations to measure the influence of food distribution and abundance on home-range patterns, trespassing rates, and consumption of native prey. In established home ranges, coyotes visited and foraged at stations regularly and were found closer to stations during the treatment period. Although there was no overall treatment effect on home-range size (F = 1.66, d.f. = 5, P = 0.15), home ranges without supplemental food remained stable in size, whereas home ranges that had received supplemental food increased during the posttreatment period (t = 2.09, d.f. = 1, P = 0.04). Core areas showed a similar trend; there was no overall treatment effect (F = 1.51, d.f. = 2, P = 0.24); however, core areas of home ranges that received supplemental food were smaller than those of controls during the treatment period (t = 2.71, d.f. = 1, P < 0.01). There were no statistical differences in occurrence of any species, such as small mammals or white-tailed deer (Odocoileus virginianus), in scats of treatment versus control coyotes. Coyotes within the study site after removals were located closer to feeding stations during treatment than posttreatment (F = 8.83, d.f. = 1, P < 0.02, n = 897) periods, yet home-range size with supplemental food was larger than home-range size during the posttreatment period. Our findings suggest that a resource other than food influences coyote spatial patterns.

Effect of Age and Gender on Restenosis after Carotid Endarterectomy

Several studies have suggested that the benefits of CEA may be gender-dependent. The purpose of this study was to focus on age and gender outcomes after CEA. Three hundred seventy-two CEAs were performed in 344 patients (115 females, 229 males; mean age 72.9 years). Mean follow-up was 25.8 months. Data were collected retrospectively by chart review, and follow-up data were obtained by clinical examination and duplex ultrasound. Recurrent stenosis was defined as >50% and/or occlusion. Three hundred and seventy-two CEAs were performed in 120 female and 252 male carotid arteries: 97.3% of patients underwent patch angioplasty (bovine pericardium 71.5%, Dacron 21.8%, vein 3.8%, and polytetrafluoroethylene 0.3%) and 2.7% of patients underwent eversion endarterectomy. Perioperative mortality rate (30-day) was 0.8% (0% of females vs. 1.2% of males), and stroke rate was 0.5% (1.7% of females vs. 0% of males), with no significant gender difference (p = 0.554 and p = 0.103, respectively). Follow-up ultrasound revealed 21 (7%) restenoses (>50%) and/or occlusions, with a significantly higher rate of restenosis in females (14% vs. 3.9% in males, p = 0.008) and in patients <70 years of age at time of surgery (p = 0.003). There was no age difference between women and men with restenosis. Although there was no statistical difference in occurrence of restenosis between Dacron and bovine patch (p = 0.62), females who underwent patch angioplasty with Dacron were more likely to develop restenosis (p = 0.052). CEA is a low-risk procedure for significant carotid stenosis; however, females are more likely to develop restenosis after carotid surgery, especially with Dacron patches. Younger patients appear to be at a higher risk of restenosis after surgery.

Recurrence of the odontogenic keratocyst in relation to clinical and histological features: A 20-year follow-up study of 72 patients

Seventy-two patients with 75 primary odontogenic keratocysts have been followed from 6 months to 20 years after the primary treatment. Patients with the nevoid basal cell carcinoma syndrome were not included in the material. Fifty-four patients with 57 primary cysts have been followed for 5 years or more, and 18 patients all having a single primary cyst for less. If the number of primary cysts later recurring was related to the number of primary cysts observed for more than 5 years, a recurrence rate of 51 % was found. A diagnosis of recurrence was made in 37 cases within a period of 5 years postoperatively and in 10 cases from 5 to 12 years after the operation. Only two of these patients have been followed with regular intervals for the first 5 years postoperatively. The diagnosis of recurrence was in these two cases made 6 and 8 years after the primary treatment. A postoperative follow-up period of 10 years after the last operation is therefore advocated. The occurrence of microcysts and/or islands of odontogenic epithelium in the cyst membrane of 26 nonrecurring cysts, 25 recurring primary cysts and the last recurrence in 14 patients were compared. There were no statistical differences in occurrence of remnants of odontogenic epithelium in the cyst wall between the three groups.