RESUMO
Background: The aim of this study was to evaluate whether Accordion Severity Grading System can serve as a tool for classification, and severity assessment in reporting postoperative complications after breast reconstructive surgery. Methods: A retrospective analysis covered 88 breast reconstruction surgeries following mastectomy and prophylactic breast amputation with simultaneous reconstruction conducted from January 2015 to December 2017. All registered postoperative complications were evaluated using the Accordion Severity Grading System. The time horizon selected was 6 weeks after surgery. Results: Eighty-two adverse events which met the criteria for complications according to the Accordion classification were observed in 53.4% (n = 47) of the patients. The highest percentage of complications was observed in the group where reconstruction involved using autologous tissues (pedicled transverse rectus abdominis myocutaneous), which were associated with 77.4% risk of complications. In patients with combined methods (latissimus dorsi + prosthesis), complications occurred in half of the cases (51.4%). In patients who underwent reconstructive procedures with artificial materials (expander/prosthesis), complications occurred in 20% of cases. A high γ correlation coefficient of 0.7 (P < .001) was observed between the Accordion degree assigned to the patient and the length of hospital stay. A moderately strong correlation was found between the degree of Accordion system and rehospitalization rate (r = 0.54; P < .0001) and cost of hospital care (r = 0.65; P < .001). Discussion: Based upon the presented study, Accordion Severity Grading System is a workable, intuitive and universal scale for classifying and assessing the severity of postoperative complications and may be recommended for documenting complications in breast reconstructive procedures.
Historique: La présente étude visait à établir si le système de classement de la gravité Accordion peut servir d'outil de classification et d'évaluation de la gravité pour signaler les complications postopératoires après une chirurgie mammaire reconstructive. Méthodologie: Les chercheurs ont effectué l'analyse rétrospective de 88 chirurgies de reconstruction mammaire après une mastectomie et une amputation mammaire prophylactique accompagnée d'une reconstruction simultanée, effectuées entre janvier 2015 et décembre 2017. Ils ont évalué toutes les complications postopératoires consignées au moyen du système de classement de la gravité Accordion. L'horizon prévisionnel était de six semaines après l'opération. Résultats: Les chercheurs ont observé 82 événements indésirables qui respectaient les critères de complications chez 53,4 % (n = 47) des patients d'après le classement Accordion. Le plus fort pourcentage de complications était observé dans le groupe chez qui la reconstruction était effectuée avec des tissus autologues (le muscle grand droit abdominal pédiculé musculocutané), qui était associé à un risque de complications de 77,4 %. Lorsque les méthodes étaient combinées (grand dorsal + prothèse), des complications se produisaient dans la moitié des cas (51,4 %). Les patients chez qui l'intervention reconstructive était effectuée à l'aide de matériau artificiel (extenseurs et prothèse) présentaient des complications dans 20 % des cas. Les chercheurs ont observé un fort coefficient de corrélation γ de 0,7 (P < 0.001) entre le degré Accordion attribué au patient et la durée du séjour hospitalier. Ils ont constaté une corrélation modérément forte entre le degré du système Accordion, le taux de réhospitalisation (r = 0,54; P < 0.0001) et le coût des soins hospitaliers (r = 0,65; P < 0.001). Discussion: D'après la présente étude, le système de classement de la gravité Accordion est une échelle universelle applicable et intuitive pour classer et évaluer la gravité des complications postopératoires. Il peut être recommandé pour consigner les complications lors d'interventions de reconstruction mammaire.
RESUMO
BACKGROUND Screening colonoscopy is not obligatory in kidney pre-transplant work-up guidelines. According to recommendations, only transplant recipients over age 50 years should be screened. The aim of this study was to characterize endoscopic findings revealed as part of pre-transplant work-up. MATERIAL AND METHODS We retrospectively reviewed pre-transplant work-up charts of 434 adult patients who received a cadaveric donor kidney transplantation (KT) from 2012 to 2015. Endoscopic findings analysis with age subgroup (<50 and ³50) analysis were performed. RESULTS Out of 434 of patients that underwent KT, 29% have had a colonoscopy. In 75.6% of those, pathologies were found. Hemorrhoids were found in 33% and polyps in 30.7% of patients. Adenoma detection rate (ADR) was 18.1% (67.5% distal predominance). Advanced ADR was 10.2% (distal predominance). Diverticulosis was found in 28.3% of patients and ulcerative colitis was found in 2.4%. In age subgroup analysis, ADR was higher in patients ³50 years compared to those <50 years (21.6% vs. 4%; p=0.041). CONCLUSIONS Colonoscopy as part of pre-transplant work-up enables removal of precancerous lesions and management of benign findings. All candidates meeting criteria for the general population should be screened. Patients under age 50 years could also benefit from colonoscopy as part of the pre-transplant work-up. Therefore, we suggest that baseline colonoscopy should be included in pre-transplant work-up guidelines for all patients, regardless of age. However, further studies are needed to confirm this recommendation.