1,721,002 research outputs found
Opioid PrEscRiptions and usage After Surgery (OPERAS): protocol for a prospective multicentre observational cohort study of opioid use after surgery
No full textIntroductionPostoperative pain is common and frequently addressed through opioid analgesia. This practice must balance the benefits of achieving adequate pain relief against the harms of adverse effects such as opioid-induced ventilatory impairment and opioid use disorder. This student and trainee-led collaborative study aims to investigate and compare the prescription versus consumption of opioids at 7 days postdischarge after common surgical procedures and their impact on patient-reported outcomes regarding postoperative pain.Methods and analysisThis is a prospective multicentre observational cohort study of surgical patients in Australia, Aotearoa New Zealand and select international sites, conducted by networks of students, trainees and consultants. Consecutive adult patients undergoing common elective and emergency general, orthopaedic, gynaecological and urological surgical procedures are eligible for inclusion, with follow-up 7 days after hospital discharge. The primary outcome will be the proportion of prescribed opioids consumed by patients at 7 days postdischarge. Secondary outcomes will include patient-reported quality of life and satisfaction scores, rate of non-opioid analgesic use, rate of continuing use of opioids at follow-up, rates of opioid prescription from other sources and hospital readmissions at 7 days postdischarge for opioid related side-effects or surgery-related pain. Descriptive and multivariate analyses will be conducted to investigate factors associated with opioid requirements and prescription-consumption discrepancies.Ethics and disseminationOPERAS has been approved in Australia by the Hunter New England Human Research Ethics Committee (Protocol 2021/ETH11508) and by the Southern Health and Disability Ethics Committee (2021 EXP 11199) in Aotearoa New Zealand. Results will be submitted for conference presentation and peer-reviewed publication. Centre-level data will be distributed to participating sites for internal audit
CROHN'S DISEASE COMPLICATED BY ILEOSIGMOID FISTULA: ASSESSMENT AND MANAGEMENT UPDATE
No full textAbstrac
Cholecystectomy 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 cholecys- tectomy 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 out- comes: 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 complicat- ed lithiasis pathology. This implies a special attention towards these patients, and towards those over 75 considering, when possible, alternative treatments such as percutaneous drainage
Recurrent diverticulitis after elective surgery
No full textPurpose: Elective sigmoid resection is proposed as a treatment for symptomatic diverticular disease for the possible improvement in quality of life achievable. Albeit encouraging results have been reported, recurrent diverticulitis is still a concern deeply affecting quality of life. The aim of this study is to determine the rate of recurrent diverticulitis after elective sigmoid resection and to look for possible perioperative risk factors. Methods: Patients who underwent elective resection for DD with at least a 3-year follow-up were included. Postoperative recurrence was defined as left-sided or lower abdominal pain, with CT scan-confirmed findings of diverticulitis. Results: Twenty of 232 (8.6%) patients developed CT-proven recurrent diverticulitis after elective surgery. All the 20 recurrent diverticulitis were uncomplicated and did not need surgery. Eighty-five percent of the recurrences occurred in patients with a preoperative diagnosis of uncomplicated DD, 70% in patients who had at least 4 episodes of diverticulitis, and 70% in patients with a history of diverticulitis extended to the descending colon. Univariate analysis showed that recurrence was associated with diverticulitis of the sigmoid and of the descending colon (p = 0.04), with a preoperative diagnosis of IBS (p = 0.04) and with a longer than 5 years diverticular disease (p = 0.03). Multivariate analysis was not able to determine risks factors for recurrence. Conclusion: Our study showed that patients with a preoperative diagnosis of IBS, diverticulitis involving the descending colon, and a long-lasting disease are more likely to have recurrent diverticulitis. However, these variables could not be assumed as risk factors
Incisional Hernia rates between Intracorporeal and Extracorporeal Anastomosis in Minimally Invasive Ileocolic Resection for Crohn's disease
No full textOne-third of patients with Crohn’s disease require multiple surgeries during their lifetime, an ileocolic resection most frequently. So, reducing the incisional hernia rate in patients with Crohn’s Disease is crucial. Minimally invasive ileocolic resection with an intracorporeal anastomosis allows using a Pfannenstiel incision as extraction-site, while extracorporeal anastomosis is usually performed with a midline vertical incision. To date, there is limited data regarding incisional hernia after minimally invasive surgery in Crohn’s Disease. To define incisional hernia rates after minimally invasive ileocolic resection for Crohn’s disease, comparing intracorporeal anastomosis with Pfannenstiel incision (ICA-P) versus extracorporeal anastomosis with midline vertical incision (ECA-M).
This retrospective cohort of minimally invasive ileocolic resections compares ICA-P versus ECA-M. Data are retrieved from a prospectively maintained database of consecutive minimally invasive ileocolic resections performed between 2014 and 2021 in a referral center for inflammatory bowel diseases specialized in minimally invasive surgery. Exclusion criteria were different extraction-site incision, conversion, and no anastomosis performed. The primary outcome was incisional hernia differentiated between extraction-site incisional hernia (Pfannenstiel or midline vertical incision) and port-site incisional hernia. The incisional hernia was confirmed by imaging with a median follow-up of 15 (4-28) months. Secondary outcomes included 30-day postoperative complications, hospital length of stay, and 30-day readmission.
Between 274 patients, 25 were excluded (14 different extraction-site incisions, 8 conversions, 3 no anastomosis). Of the 249 patients included in the analysis: 59 were in the ICA-P group, 190 in the ECA-M group. The surgical approach of the ileocolic resection was 166 (67%) laparoscopic and 83 (33%) robotic. Both groups were similar according to age, sex, BMI, diabetes mellitus, smoking, ASA score, previous surgery, Crohn’s disease preoperative medical treatments, malnutrition, serum laboratory test, preoperative antibiotics, drainage of intra-abdominal collection, nutritional support, associated intraoperative procedures and ventral hernia repair. Overall, 22 (8.8%) patients developed an imaging-proven incisional hernia: seven at the port-site and 15 at the extraction-site. All 15 extraction-site incisional hernias were midline vertical incisions [7.9%; p=0.025], and 8 patients (53%) required surgical repair with mesh placement. Time-to-event analysis showed a 20% rate of extraction-site incisional hernia in the ECA-M group after 48 months (p =0.037). Port-site incisional hernia rate was similar between the two groups, all were < 20mm, contained preperitoneal fat tissue, and none underwent surgical repair. The overall 30-day postoperative complication rate was 28.1% [ICA-P: 11 (18.6) vs. ECA-M: 59 (31.1); p=0.064], and severe complications (Clavien-Dindo classification ≥ 3) occurred in 16 (6.4%) patients. The length of stay was lower in the ICA-P group [ICA-P: 3.3±2.5 vs. ECA-M: 4.1±2.4 days; p=0.02] with similar 30-day readmission rates [ICA-P: 7 (11.9) vs. ECA-M: 18 (9.5); p=0.59].
Patients in the ICA-P group did not encounter any incisional hernias while having shorter hospital length of stay and similar 30-day postoperative complications or readmission compared to ECA-M. Time-to-event analysis showed a 20% rate of extraction-site incisional hernia in the ECA-M group after 48 months. Therefore, strong consideration should be given to performing intracorporeal anastomosis with Pfannenstiel incision during Ileocolic resection in patients with Crohn’s to reduce hernia risk
RISK FACTORS FOR MORTALITY AND SEVERE POSTOPERATIVE COMPLICATIONS AFTER URGENT SURGERY FOR COLORECTAL CANCER IN AN ITALIAN SERIES OF 16000 PATIENTS.
No full textBackground: Urgent surgery for colorectal cancer (CRC) is associated with increased mortality and postoperative complications (POCs). Guidelines are based on low-grade evidence and small series. We aimed to define risk factors for mortality and severe (Clavien-Dindo>=III) POCs in patients undergoing urgent surgery for CRC.
Methods: This is a retrospective, multicenter cohort study from 2018 to 2021 in 81 centers in Italy, including tertiary centers and community hospitals. We used data from the COVID-CRC Study Group database including palliative and curative surgery for colorectal cancer. Exclusion criteria were non-colorectal tumors and perioperative COVID-19 diagnosis. Risk factors were determined using logistic regression, multivariate models used p-value<=0.10 variables at univariate.
Results: Urgent surgery rate for CRC was 11.4% (1897/16649) during the 4 years of the study and was associated with a higher rate of 30-day mortality (8.0% vs 1.4%) and severe POCs (15.8% vs 9.7%) than elective surgery. At multivariate, 30-day mortality for urgent surgery was associated with older age, cardiovascular (OR=1.73, 95%CI 1.04-2.88, p=0.035), pulmonary (OR=1.90, 95%CI 1.14-3.17, p=0.014), and neurological (OR=2.13, 95%CI 1.24-3.65, p=0.006) comorbidities, inflammatory bowel disease (OR=5.20, 95%CI 1.00-26.88, p=0.049), intraoperative complications (OR=4.05, 95%CI 2.03-8.09, p<0.0001), T4 disease (OR=2.11, 95%CI 1.31-3.40, p=0.002), and metastatic disease (OR=2.11, 95%CI 1.31-3.40, p=0.002). While, 30-day severe POCs were associated with male sex, cardiovascular (OR=1.40, 95%CI 1.03-1.90, p=0.030), and neurological comorbidities (OR=1.94, 95%CI 1.33-2.84, p=0.001), intraoperative complications (OR=3.92, 95%CI 2.45-6.26, p<0.0001). Female sex (OR=0.75, 95%CI 0.57-0.98, p=0.036) and laparoscopic approach (OR=0.67, 95%CI 0.49-0.93, p=0.015) were associated with a reduced risk of 30-day severe postoperative complications.
Conclusions: We reported risk factors for 30-day mortality and severe postoperative complications for urgent CRC surgery using real-world data from a large cohort study in Italy
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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