166 research outputs found
Author response to: Comment on: Effect of centre volume on pathological outcomes and postoperative complications after surgery for colorectal cancer: results of a multicentre national study
No full textPredictive Factors for Drain Placement After Laparoscopic Cholecystectomy
No full textPurpose: Currently, surgical drainage during a laparoscopic cholecystectomy (LC) is still placed in selected patients. Evidence of the non-beneficial effect of the surgical drain comes from studies with a heterogeneous population. This preliminary study aims to identify any clinical, demographic, or intraoperative predictive factors for a surgical drain placement during LC as the first step to identify population for a prospective randomized study. Method: The study was conducted in a single referral center and academic hospital between 2014 and 2018. Patients who underwent unconverted LC were divided into two groups: Group A (drain) and Group B (no drain). We explored baseline, preoperative, intraoperative characteristics, and postoperative outcomes. Results: Between 409 patients who underwent LC: 90 (22%) patients were in Group A (drain). Age >64 years, male sex, cholecystitis, Charlson comorbidity index (CCI) ≥ 1, experienced surgeon, intraoperative technical difficulties, need for an additional trocar, operative time >60 min, and estimated blood loss >10 ml were predictive factors at univariate analysis. While at multivariate analysis, cholecystitis (odds ratio [OR]: 2.8, 95% CI:1.5–5.1; p < 0.001), CCI ≥ 1 (OR:1.9, 95% CI:1.0–3.5; p = 0.05), intraoperative technical difficulties (OR: 3.6, 95% CI:1.8–6.2; p < 0.001), need of an additional trocar (OR: 2.5, 95% CI: 1.4–4.4; p < 0.005), and estimated blood loss >10 ml (OR: 3.0, 95% CI:1.7–5.3; p < 0.0001) were predictive factors for a surgical drain placement during LC. Conclusions: This study identified predictive factors that currently drive the surgeons to a surgical drain placement after LC. Randomized prospective studies are needed to define the use of drain placement in these selected patients
P214 Effects of rectal stump proctitis on short-term postoperative complications after proctectomy and ileal pouch-anal anastomosis for Ulcerative Colitis
No full textP414 Timing of biologics discontinuation is not associated with postoperative complications (POCs), infective complications, bleeding, or intra-abdominal septic complications (IASCs) after primary ileocecal resection for Crohn’s Disease: a retrospective analysis of 237 patients in a tertiary centre
No full textHypothermic machine perfusion can safely prolong cold ischemia time in deceased donor kidney transplantation. A retrospective analysis on postoperative morbidity and graft function
No full textIn deceased donor kidney transplantation (KT), a prolonged cold ischemia time (CIT) is a negative prognostic factor for KT outcome, and the efficacy of hypothermic machine perfusion (HMP) in prolonging CIT without any additional hazard is highly debated. We conducted a retrospective study on a cohort of 154 single graft deceased donor KTs, in which a delayed HMP, after a preliminary period of static cold storage (SCS), was used to prolong CIT for logistic reasons. Primary outcomes were postoperative complications as well as 1 year graft survival and function. 73 cases (47.4%) were managed with HMP and planned KT, while 81 (52.6%) with SCS and urgent KT. The median CIT in HMP group and SCS group was 29 hour:57 minutes [27-31 hour:45 minutes] and 11 hour:25 minutes [9-14 hour:30 minutes], respectively (P <.001). The period of SCS in the HMP group was significantly shorter than in the SCS group (10 vs. 11 hour:25 minutes, P =.02) as well as the prevalence of expanded criteria donors was significantly higher (43.8% vs. 18.5%, P <.01). After propensity score matching for these two baseline characteristics, the HMP and SCS groups showed comparable outcomes in terms of delayed graft function, vascular, and urologic complications, infections, and episodes of graft rejection. At 1 year follow-up, serum creatinine levels were comparable between the groups. Therefore, the use of HMP to prolong the CIT and convert KT into a planned procedure seemed to have an adequate safety profile, with outcomes comparable to KT managed as an urgent procedure and a CIT nearly three time shorter
Endoscopic failure for foreign body ingestion and food bolus impaction in the upper gastrointestinal tract: An updated analysis in a European tertiary care hospital
No full textObjective Harmfulness of foreign body ingestion and food bolus impaction (FBIs) varies according to geographical area, population, habits, and diet. Therefore, studies may not draw generalizable conclusions. Furthermore, data regarding FBIs management in Europe are limited and outdated. This study aimed to analyze the endoscopic management and outcomes of FBIs in an Italian tertiary care hospital to identify risk factors for endoscopic failure. Methods We retrospectively reviewed patients who underwent upper gastrointestinal endoscopy for FBIs between 2007 and 2017. Baseline, clinical, FBIs, and endoscopic characteristics and outcomes were collected and reported using descriptive statistics and logistic regression analyses. Results Of the 381 endoscopies for FBIs, 288 (75.5%) were emergent endoscopy and 135 (35,4%) included underlying upper gastrointestinal conditions. The study population included 44 pediatric patients (11.5%), 54 prisoners (15.8%), and 283 adults (74.2%). The most common type and location of FBIs were food boluses (52.9%) and upper esophagus (36.5%), respectively. While eight patients (2.1%) developed major adverse events requiring hospital admission, the remainder (97.9%) were discharged after observation. No mortality occurred. Endoscopic success was achieved in 263 of 286 (91.9%) verified FBIs endoscopies. Endoscopic failure (8.04%) was associated with age, bone, disk battery, intentional ingestion, razor blade, prisoners, and stomach in the univariate analysis. Multivariate logistic regression revealed that intentional ingestion was associated with endoscopic failure (odds ratio: 7.31; 95% confidence interval = 2.06-25.99; P = 0.002). Conclusion Endoscopy for FBIs is safe and successful, with low hospital admission rate in children, prisoners, and adults. Intentional ingestion is a risk factor of endoscopic failure
P255 Association of penetrating disease and hypoalbuminemia with Crohn's disease anastomotic recurrence in the biological era: results of a long-term experience from a tertiary IBD center
No full textCholecystectomy in the elderly: clinical outcomes and risk factors
No full textAIM OF THE STUDY: Recent decades have seen a steady increase in the number of elderly patients undergoing cholecystectomy surgery. The objective of this study is to evaluate clinical outcomes in this cohort of patients and to identify any predictive factors correlative with adverse outcomes arising in the postoperative period. METHOD: A retrospective study was conducted regarding patients aged ≥65 years who underwent cholecystectomy surgery. The independent variables considered to be related to the patient were: age, gender, co-morbidities, and severity of cholelithiasis. The clinical variables were type of procedure, length of stay and hospitalization. The outcomes considered were mortality, re-intervention, transfer to intensive care and post-operative complications. RESULTS: 778 patients with an age between 65 and 74 and 508 patients with an age above 75 were reviewed. With the increase of age, patients who underwent cholecystectomy presented greater co-morbidity, more accesses in emergency, more cases of cholecystitis, which led to a higher number of interventions in open surgery. Considering postoperative outcomes: the need for intensive care, postoperative complications and mortality significantly increase in older patients. Negative predictive factors are the presence of co-morbidities, emergency access and cholecystectomy performed in open. CONCLUSIONS: Elderly patients undergoing cholecystectomy are an increased surgical risk group in particular because of the presence of co-morbidities and because of the frequent need to perform an emergency procedure often for complicated lithiasis pathology. This implies a special attention towards these patients, and towards those over 75 considering, when possible, alternative treatments such as percutaneous drainage. KEY WORDS: Cholecystectomy, Elderly, Outcomes, Risk factors
TRANSANAL EXCISION PRECEDING EARLY SALVAGE TOTAL MESORECTAL EXCISION FOR RECTAL CANCER: IMPACT ON DISEASE PROGNOSIS
No full textACADEMIC PRODUCTIVITY AFTER COLON AND RECTAL SURGERY FELLOWSHIP
No full textPurpose/Background: Early career publication productivity among academic surgeons after Colon and Rectal Surgery (CRS) Fellowship has not been studied. Hypothesis/Aim: We aimed to describe predictive factors of academic surgeons’ publication productivity using pre-CRS fellowship characteristics. Methods/Interventions: Candidates included those applying for CRS fellowship at Mayo Clinic between 2015 and 2018 and appointed in an academic position post-fellowship. Academic position was defined as Instructor, Assistant Professor, Associate Professor, or Professor. It was assessed through a cross-checking of information on public online sources (American College of Surgeons, American Society of Colon and Rectal Surgeons, university website, and social media). Academic position and publications were blindly assessed by three authors (G.C, S.A., S.B.) in July 2021, any incongruity was further resolved. The number of publications post-fellowship and authorship positions was retrieved from PubMed, with a median follow-up of 2.5 years [range: 1-4 years]. Academics top quartile (Q1) was defined according to a composite productivity outcome of publications/year ratio as first, last and any-position author. Data were compared between Q1 and the less productive quartiles (Q2-4). Pre-fellowship data were retrieved from the Electronic Residency Application Service (ERAS®) application. Results/Outcome(s): Among 130 defined academic surgeons, first author, last author, and any position publications were less than one publication/year ratio in 80%, 86%, and 47%, respectively. First author publications were one, two, or ≥three publications/year ratio in 16%, 4%, and 2% of the academics, while last author publications in 9%, 3%, and 3%. Overall, the number of publications as any author position was one in 21%, two in 13%, three to five in 11%, and >five publications/year ratio in 10% of the academics. Academics in the top quartile (Q1) more frequently attended a top-20 medical school, top-20 Surgery Residency Program, and completed a Research Fellowship. Prior to fellowship, Q1 academics had more publications as 1st author and had more presentations. Understandably, these individuals frequently received research awards and had earned advanced degrees (Master/PhD) (Table 1). Limitations: Its retrospective nature and follow-up duration limited our study. Conclusions/Discussion: Among early-career academics, half coauthored less than one article/year after CRS fellowship, and more than 80% authored less than one article/year as first or last author. Conversely, academics with the highest publication productivity during their early career demonstrated high pre-fellowship research and publication performances
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