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1.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 54(11): 837-842, 2019 Nov 07.
Artigo em Chinês | MEDLINE | ID: mdl-31795545

RESUMO

Objective: To investigate the potential risk factors for the death of patients underwent gastric pull-up reconstruction following total pharyngoesophagectomy during perioperative periods. Methods: A total of 71 patients, including 64 males and 7 females, aged from 35 to 72 years old, with hypopharyngeal or cervical esophageal carcinoma, who underwent gastric pull-up reconstruction after pharyngoesophagectomy between October 2008 and October 2017, were reviewed retrospectively. Seventeen factors which may have potential influence on the mortality of patients during perioperative periods were evaluated by single factor Logistic regression analysis, and then those factors with obvious difference in statistics were further analyzed by multi-factor Logistic regression. Results: The rate of perioperative mortality was 9.9% (7/71). Single factor Logistic regression analysis indicated that the age of patients, abnormal electrocardiogram, TNM stages, alanine aminotransferase and D-Dimer changes, postoperative bleeding were risk factors for the death of patients(P values were 0.023, 0.004, 0.026, 0.021, 0.015 and 0.002, respectively). Multi-factor Logistic regression showed that postoperative bleeding and D-Dimer changes were 2 independent risk factors for perioperative death(P=0.021 and 0.047, respectively). Conclusions: Many potential factors may affect the perioperative mortality of patients underwent gastric pull-up reconstruction following total pharyngoesophagectomy. Postoperative bleeding and significantly elevated D-Dimer level were independent risk factors for the death of patients, indicating poor prognosis.


Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia/mortalidade , Esôfago/cirurgia , Faringectomia/mortalidade , Faringe/cirurgia , Estômago/cirurgia , Adulto , Idoso , Anastomose Cirúrgica/mortalidade , Neoplasias Esofágicas/sangue , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/sangue , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/mortalidade , Procedimentos Cirúrgicos Reconstrutivos/mortalidade , Estudos Retrospectivos , Fatores de Risco
2.
Am Surg ; 85(10): 1184-1188, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657321

RESUMO

Guidelines suggest targeting a preoperative international normalized ratio (INR) < 1.5. We examined and compared the predictive value of INR relative to the Model for End-Stage Liver Disease (MELD). We reviewed the American College of Surgeons NSQIP from 2005 to 2016 for adult patients undergoing open or laparoscopic cholecystectomy. Patients with a preoperative INR were stratified into groups: ≤1, >1 to ≤1.5, >1.5 to ≤2, and >2. Thirty day postoperative mortality was the primary outcome. Multivariable logistic regressions controlled for baseline differences. Of 58,177 cholecystectomy patients, 15.2 per cent had INR ≤ 1, 80.4 per cent had INR > 1 to ≤1.5, 3.7 per cent had INR > 1.5 to ≤2, and 0.7 per cent had INR > 2. Patients with INR > 2 were older and more likely to have diabetes and hypertension (P < 0.001). Multivariable regression demonstrated a stepwise increase in mortality for INR > 1 to ≤1.5 (odds ratio (OR) = 1.50 [1.10-2.05]), INR > 1.5 to ≤2 (OR = 2.96 [1.97-4.45]), and INR > 2 (OR = 3.21 [1.64-6.31]) relative to INR ≤ 1. C-statistic for INR (0.910) and MELD (0.906) models indicated a similar value in predicting mortality. INR groups also faced an incremental, increased risk of bleeding. Although unable to track preoperative correction of INR, this analysis identifies that INR remains an excellent predictor of postoperative mortality and bleeding after both open and laparoscopic cholecystectomies and is comparable to MELD.


Assuntos
Colecistectomia/mortalidade , Doença Hepática Terminal/sangue , Doença Hepática Terminal/mortalidade , Coeficiente Internacional Normatizado/mortalidade , Adulto , Fatores Etários , Análise de Variância , Colecistectomia Laparoscópica/mortalidade , Diabetes Mellitus/tratamento farmacológico , Doença Hepática Terminal/diagnóstico , Doença Hepática Terminal/cirurgia , Feminino , Humanos , Hipertensão/tratamento farmacológico , Coeficiente Internacional Normatizado/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/mortalidade , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco
3.
Urology ; 134: 62-65, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31536740

RESUMO

OBJECTIVE: To evaluate feasibility of percutaneous nephrolithotomy (PCNL) for complex nephrolithiasis in patients 80 years of age and older compared to younger individuals. METHODS: From an institutional IRB-approved database, 1,647 patients were identified who underwent PCNL from 1999 to 2019. Patients were stratified by age: group 1 (20-59), group 2 (60-79), and group 3 (>80). Statistics were performed using chi-square and ANOVA to compare outcomes. RESULTS: Of the 1,647 patients, median age was 46, 66, and 83, respectively (P <0.0001). Three patients within group 3 were 90 or older. Females made up 54%, 46%, 56% of patients (P = 0.02). Average stone size with SD was 2.6 ± 2.2, 2.5 ± 2.3, 2.2± 1.9 cm for each group (P = 0.06). Mean preoperative hemoglobin (Hgb) was significantly lower in the 80+ group (13.8, 13.4, 13.1 g/dL, P <.0001). Change in Hgb was not significantly different. There were more Clavien II-IV complications (10.4, 14.4, 28.8%; P = 0.02) and transfusions (2.3, 4.7, 10.2%; P <0.001) in the elderly. The most common complications in the 80+ group were bleeding related (10.1%). No difference in readmission rates or ICU admissions was noted. CONCLUSION: PCNL is feasible in the extremely elderly; however with a higher rate of complications and longer hospitalizations. No long-term sequelae or deaths in the 80 and older cohort were seen. This study allows us to appropriately counsel older patients on a realistic postoperative course and supports use of PCNL as the best means of long-term survival.


Assuntos
Cálculos Renais , Nefrolitotomia Percutânea , Hemorragia Pós-Operatória , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Transfusão de Sangue/estatística & dados numéricos , Estudos de Viabilidade , Feminino , Hemoglobinas/análise , Humanos , Cálculos Renais/sangue , Cálculos Renais/epidemiologia , Cálculos Renais/cirurgia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/efeitos adversos , Nefrolitotomia Percutânea/métodos , Hemorragia Pós-Operatória/sangue , Hemorragia Pós-Operatória/mortalidade , Hemorragia Pós-Operatória/terapia , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Estados Unidos/epidemiologia
4.
Heart Surg Forum ; 22(4): E294-E297, 2019 07 25.
Artigo em Inglês | MEDLINE | ID: mdl-31398095

RESUMO

BACKGROUND: The aim of this study is to evaluate the negative effect of malnutrition in patients with coronary artery disease who are undergoing coronary artery bypass graft surgery. METHODS: In this study, we analyzed 149 patients, who underwent coronary artery bypass surgery. Nutritional status of the patients was classified using controlling nutritional status score (CONUT) and prognostic nutritional index (PNI). Statistical correlation between malnutrition and complication following operation was evaluated with the chi-square test. Statistical alpha significant level was accepted P < 0.05. RESULTS: There were various complications in 38 patients. Renal failure was the predominant problem in 18 of them. There was statistical significance between malnutrition and complication (P < .001). There were more complications in the controlling nutritional status score and prognostic nutritional index groups. Renal complication (P < .001), hemorrhage (P < .05), and mortality (P < .05) were high in the severe controlling nutritional status score and prognostic nutritional index groups. CONCLUSION: There are manifest correlations between the severe controlling nutritional status score and prognostic nutritional index groups and morbidity and mortality after coronary artery bypass graft surgery. We found that renal complications, hemorrhage, and mortality rate.


Assuntos
Ponte de Artéria Coronária/efeitos adversos , Desnutrição/complicações , Avaliação Nutricional , Estado Nutricional , Complicações Pós-Operatórias/etiologia , Adulto , Idoso , Distribuição de Qui-Quadrado , Ponte de Artéria Coronária/mortalidade , Feminino , Humanos , Masculino , Desnutrição/mortalidade , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/mortalidade , Insuficiência Renal/etiologia , Insuficiência Renal/mortalidade , Adulto Jovem
5.
J Vasc Surg ; 69(6): 1801-1806, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31159983

RESUMO

OBJECTIVE: Patch angioplasty has been shown to decrease rates of restenosis after carotid endarterectomy (CEA). In 2003, the Vascular Study Group of New England (VSGNE) implemented its first quality initiative aimed at increasing the rates of patch closure after CEA. This study reports the effects of that initiative on the rate of patch closure in the VSGNE and also postoperative and 1-year CEA outcomes. METHODS: Patients undergoing CEA (N = 14,636) within the VSGNE between 2003 and 2014 were studied. Rates of in-hospital postoperative events (death, ipsilateral stroke or transient ischemic attack [TIA], and return to the operating room for bleeding) and events during 1 year of follow-up (stroke or TIA and restenosis >70% or occlusion) were compared by repair type-patch closure, primary closure, or eversion. One-year follow-up events were also compared over time and by annualized surgeon volume. RESULTS: During the 12 years studied, patch use increased from 71% to 91% (P < .001). There was no difference in postoperative death or ipsilateral stroke or TIA between the repair types. However, there was a statistically lower rate of return to the operating room for bleeding (P < .001), 1-year stroke or TIA (P < .003), and 1-year restenosis or occlusion (P < .001) with patch closure. Overall, the rates of 1-year stroke or TIA and restenosis decreased over time in the VSGNE. The initiative affected patch closure rates and outcomes of high-volume surgeons (>47 CEAs/y) the most. High-volume surgeons increased patch use from 50% to 90% and decreased their restenosis rates from 9.0% to 1.2% and 1-year stroke or TIA from 4.9% to 1.9% (P < .001). CONCLUSIONS: The VSGNE carotid patch quality initiative successfully increased the rates of CEA patch closure. During the same time, there has been a decrease in postoperative bleeding requiring reoperation and 1-year ipsilateral neurologic events and restenosis or occlusion.


Assuntos
Angioplastia/instrumentação , Estenose das Carótidas/cirurgia , Endarterectomia das Carótidas , Idoso , Angioplastia/efeitos adversos , Angioplastia/mortalidade , Estenose das Carótidas/complicações , Estenose das Carótidas/mortalidade , Bases de Dados Factuais , Endarterectomia das Carótidas/efeitos adversos , Endarterectomia das Carótidas/mortalidade , Feminino , Humanos , Ataque Isquêmico Transitório/etiologia , Ataque Isquêmico Transitório/mortalidade , Masculino , New England , Hemorragia Pós-Operatória/mortalidade , Hemorragia Pós-Operatória/cirurgia , Recidiva , Reoperação , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/mortalidade , Fatores de Tempo , Resultado do Tratamento
7.
J Cardiothorac Surg ; 14(1): 64, 2019 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-30940172

RESUMO

BACKGROUND: Bleeding is a significant complication in cardiac surgery and is associated with substantial morbidity and mortality. This study evaluated the impact of bleeding on length of stay (LOS) and critical care utilization in a nationwide sample of cardiac surgery patients treated at English hospitals. METHODS: Retrospective, observational cohort study using linked English Hospital Episode Statistics (HES) and Clinical Practice Research Datalink (CPRD) records for a nationwide sample of patients aged ≥18 years who underwent coronary artery bypass graft (CABG), valve repair/replacement, or aortic operations from January 2010 through February 2016. The primary independent variables were in-hospital bleeding complications and reoperation for bleeding before discharge. Generalized linear models were used to quantify the adjusted mean incremental difference [MID] in post-procedure LOS and critical care days associated with bleeding complications, independent of measured baseline characteristics. RESULTS: The study included 7774 cardiac surgery patients (3963 CABG; 2363 valve replacement/repair; 160 aortic procedures; 1288 multiple procedures, primarily CABG+valve). Mean LOS was 10.7d, including a mean of 4.2d in critical care. Incidences of in-hospital bleeding complications and reoperation for bleeding were 6.7 and 0.3%, respectively. Patients with bleeding had longer LOS (MID: 3.1d; p < 0.0001) and spent more days in critical care (MID: 2.4d; p < 0.0001). Reoperation for bleeding was associated with larger increases in LOS (MID = 4.0d; p = 0.002) and days in critical care (MID = 3.2d; p = 0.001). CONCLUSIONS: Among English cardiac surgery patients, in-hospital bleeding complications were associated with substantial increases in healthcare utilization. Increased use of evidence-based strategies to prevent and manage bleeding may reduce the clinical and economic burden associated with bleeding complications in cardiac surgery.


Assuntos
Perda Sanguínea Cirúrgica/estatística & dados numéricos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Cuidados Críticos/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Hemorragia Pós-Operatória/epidemiologia , Adolescente , Adulto , Idoso , Procedimentos Cirúrgicos Cardíacos/mortalidade , Bases de Dados Factuais , Inglaterra/epidemiologia , Feminino , Hemorragia/epidemiologia , Hemorragia/etiologia , Hemorragia/cirurgia , Mortalidade Hospitalar , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/mortalidade , Hemorragia Pós-Operatória/cirurgia , Reoperação , Estudos Retrospectivos , Adulto Jovem
8.
Scand J Surg ; 108(2): 130-136, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30196769

RESUMO

BACKGROUND AND OBJECTIVES: The International Study Group of Liver Surgery established the first internationally standardized definitions and grading for posthepatectomy hemorrhage, posthepatectomy liver failure, and bile leakage. We aimed to correlate these definitions and grades of complications with objective parameters of the postoperative course, namely, mortality and length of stay, to assess the usefulness in clinical routine. METHODS: A total of 415 patients underwent hepatic surgery between 2004 and 2014. Uni- and multivariate analyses were made for correlations of posthepatectomy hemorrhage, posthepatectomy liver failure, and bile leakage with perioperative parameters and mortality. RESULTS: Of the total, 25 (6.1%) patients developed a posthepatectomy hemorrhage Grade A, 3 (0.7%) patients a posthepatectomy hemorrhage Grade B, and 1 (0.2%) patient a posthepatectomy hemorrhage Grade C; 23 (5.5%) patients had a posthepatectomy liver failure Grade A, 24 (5.8%) patients a posthepatectomy liver failure Grade B, and 7 patients (1.6%) a posthepatectomy liver failure Grade C. Bile leakage Grade A occurred in 10 (2.4%) patients, bile leakage Grade B in 24 (5.8%) patients, and bile leakage Grade C in 7 (1.6%) patients. Mortality was significantly increased in patients with posthepatectomy hemorrhage Grades B and C and in patients with posthepatectomy liver failure Grades A, B, and C. Three (42.9%) patients with bile leakage Grade C died. CONCLUSION: Our data indicate that the new definitions correlate well with mortality and duration of hospital stay.


Assuntos
Bile , Hepatectomia/efeitos adversos , Falência Hepática/diagnóstico , Neoplasias Hepáticas/cirurgia , Hemorragia Pós-Operatória/diagnóstico , Adulto , Idoso , Índice de Massa Corporal , Feminino , Humanos , Tempo de Internação , Falência Hepática/etiologia , Falência Hepática/mortalidade , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/mortalidade , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida
9.
J Cardiothorac Vasc Anesth ; 33(2): 307-317, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30269889

RESUMO

OBJECTIVES: Rotational thromboelastometry (ROTEM)-guided transfusion algorithms in cardiac surgery have been proven to be successful in reducing blood loss in randomized controlled trials. Using an institutional hemostasis registry of patients in cardiac surgery (HEROES-CS), the authors hypothesized that the use of ROTEM-guided transfusion algorithms would save blood products and overall costs in cardiac surgery in every day practice. DESIGN: Observational, prospective open cohort database. SETTING: Single-center academic hospital. PARTICIPANTS: Cardiac surgery patients. INTERVENTIONS: Implementation of ROTEM-guided bleeding management. MEASUREMENTS AND MAIN RESULTS: A classical-guided algorithm and a ROTEM-guided algorithm were used for patient blood management in 2 cohorts. Primary outcome was the use and amount of blood products and hemostatic medication. Secondary outcomes were amount of rethoracotomies, length of stay, and 30-day mortality. Finally, costs and savings were calculated. The classical-guided cohort comprised 204 patients, and ROTEM-guided cohort comprised 151 patients. Baseline characteristics showed excellent similarities after propensity score matching of 202 patients. Blood loss was lower after ROTEM guidance (p < 0.001). Absolute risk reduction was 17% for red blood cells (p = 0.024), 12% for fresh frozen plasma (p = 0.019), and 4% for thrombocyte concentrates (p = 0.582). More tranexamic acid was given, but not more fibrinogen concentrate, while desmopressin was given less often. Hospital length of stay was reduced by an overall median of 2 and a mean of 4 days (p < 0.001). Mortality and rethoracotomy rates were not affected. Potential savings were about €4,800 ($5,630) per patient. CONCLUSIONS: Implementation of a ROTEM-guided transfusion algorithm in cardiac surgery patients reduced the use of blood products and hemostatic medication, hereby saving costs. Reductions in mortality and rethoracotomy rates could not be found.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Transfusão de Sangue/métodos , Procedimentos Cirúrgicos Cardíacos , Hemostasia/fisiologia , Hemorragia Pós-Operatória/prevenção & controle , Sistema de Registros , Tromboelastografia/métodos , Idoso , Algoritmos , Perda Sanguínea Cirúrgica/mortalidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Hemorragia Pós-Operatória/sangue , Hemorragia Pós-Operatória/mortalidade , Pontuação de Propensão , Estudos Prospectivos , Taxa de Sobrevida/tendências
10.
J Cardiothorac Vasc Anesth ; 33(2): 321-327, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30057251

RESUMO

OBJECTIVES: To investigate whether administering fibrinogen concentrate or cryoprecipitate is associated with increased postoperative thromboembolic events and improved mortality in patients undergoing thoracic aortic surgery. DESIGN: Multicenter retrospective cohort study using propensity-score analyses and multivariate logistic regression analysis to control for confounders. SETTING: Four hospitals (1 national cardiovascular center and 3 university hospitals). PARTICIPANTS: Patients undergoing thoracic aortic surgery with cardiopulmonary bypass between January 2010 and October 2012 (n = 1,047). INTERVENTIONS: Outcomes in patients treated with fibrinogen concentrate or cryoprecipitate (fibrinogen group) were compared with those who did not receive these products (no fibrinogen group) based on propensity-score matching. Multivariate logistic regression analysis then was performed to confirm the results. MEASUREMENTS AND MAIN RESULTS: Among 1,047 patients enrolled in this study, 247 patients received fibrinogen concentrate or cryoprecipitate. The median amount of administered fibrinogen was 3 g (interquartile range 2-4 g). Eighty-seven patients were excluded from the propensity-score matching because of missing data. Propensity-score-matched analysis showed no significant difference in the incidence of thromboembolic events or 30-day mortality rate between the groups. Multivariate analysis revealed that the fibrinogen group showed no significant difference in thromboembolic events (odds ratio 1.22; 95% confidence interval 0.76-1.95; p = 0.408) or mortality rate (odds ratio 0.44; 95% confidence interval 0.18-1.12; p = 0.081) compared with those in the no fibrinogen group. CONCLUSIONS: Administering fibrinogen concentrate or cryoprecipitate was associated with neither thromboembolic events nor 30-day mortality in patients undergoing thoracic aortic surgery. Administering fibrinogen concentrate or cryoprecipitate is safe and does not appear to increase thromboembolic events and mortality in thoracic aortic surgery patients.


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Fibrinogênio/administração & dosagem , Hemorragia Pós-Operatória/prevenção & controle , Tromboembolia/epidemiologia , Idoso , Aneurisma da Aorta Torácica/sangue , Fatores de Coagulação Sanguínea/administração & dosagem , Bases de Dados Factuais , Feminino , Hemostáticos/administração & dosagem , Humanos , Incidência , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/sangue , Hemorragia Pós-Operatória/mortalidade , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Tromboembolia/sangue , Tromboembolia/etiologia
11.
Osteoporos Int ; 30(3): 583-591, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30498889

RESUMO

Hip fracture surgery is associated with high risk of bleeding and mortality. The patients often have cardiovascular comorbidity, which requires antithrombotic treatment. This study found that preoperative use of oral anticoagulants was not associated with transfusion or mortality following hip fracture surgery, whereas increased risk may exist for antiplatelet drugs. INTRODUCTION: Hip fracture surgery is associated with high bleeding risk and mortality; however, data on operative outcomes of hip fracture patients admitted while on antithrombotic therapy is sparse. We examined if preoperative antithrombotic treatment was associated with increased use of blood transfusion and 30-day mortality following hip fracture surgery. METHODS: Using data from the Danish Multidisciplinary Hip Fracture Registry, we identified 74,791 hip fracture surgery patients aged ≥ 65 years during 2005-2016. Exposure was treatment with non-vitamin K antagonist oral anticoagulant (NOAC), vitamin K antagonists (VKA), or antiplatelet drugs at admission for hip fracture. Outcome was blood transfusion within 7 days postsurgery and death within 30 days. RESULTS: A 45.3% of patients received blood transfusion and 10.6% died. Current NOAC use was associated with slightly increased risk of transfusion (adjusted relative risk (aRR) 1.07, 95% confidence interval (CI) 1.01-1.14), but similar mortality risk (adjusted hazard ratio (aHR) 0.88, 95% CI 0.75-1.03) compared with non-users. The pattern remained when restricting to patients with short surgical delay (< 24 h). VKA users did not have increased risk of transfusion or mortality. The risks of transfusion (aRR 1.15 95% CI 1.12-1.18) and 30-day mortality (aHR 1.18 95% CI 1.14-1.23) were increased among antiplatelet users compared with non-users. CONCLUSIONS: In an observational setting, neither preoperative NOAC nor VKA treatments were associated with increased risk of 30-day postoperative mortality among hip fracture patients. NOAC was associated with slightly increased risk of transfusion. Preoperative use of antiplatelet drugs was associated with increased risk of transfusion and mortality.


Assuntos
Anticoagulantes/efeitos adversos , Transfusão de Eritrócitos/estatística & dados numéricos , Fraturas do Quadril/cirurgia , Fraturas por Osteoporose/cirurgia , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/administração & dosagem , Estudos de Coortes , Dinamarca/epidemiologia , Feminino , Fraturas do Quadril/mortalidade , Humanos , Masculino , Fraturas por Osteoporose/mortalidade , Hemorragia Pós-Operatória/induzido quimicamente , Hemorragia Pós-Operatória/mortalidade , Hemorragia Pós-Operatória/terapia , Cuidados Pré-Operatórios/métodos , Cuidados Pré-Operatórios/estatística & dados numéricos , Período Pré-Operatório , Sistema de Registros , Medição de Risco/métodos
12.
World J Gastroenterol ; 24(39): 4499-4509, 2018 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-30356927

RESUMO

AIM: To analyse the postoperative survival of patients with portal hypertension and determine the factors that influence survival and construct nomograms. METHODS: We retrospectively followed 1045 patients who underwent splenectomy plus pericardial devascularisation (SPD) between January 2002 and December 2017. Two SPD types are used in our department: splenectomy plus simplified pericardial devascularisation (SSPD) and splenectomy plus traditional pericardial devascularisation (STPD). The Kaplan-Meier method and Cox regression analysis were used to evaluate the prognostic effects of multiple parameters on overall survival (OS), disease-specific survival (DSS) and bleeding-free survival (BFS). Significant prognostic factors were combined to build nomograms to predict the survival rate of individual patients. RESULTS: Five hundred and fifty-seven (53.30%) patients were successfully followed with 192 in the SSPD group and 365 in the STPD group; 93 (16.70%) patients died, of whom 42 (7.54%) died due to bleeding. Postoperative bleeding was observed in 84 (15.10%) patients. The 5- and 10-year OS, DSS and BFS rates in the group of patients who underwent SSPD were not significantly different from those in patients who underwent STPD. Independent prognostic factors for OS were age, operative time, alanine transaminase level and albumin-bilirubin score. Independent prognostic factors for BFS were male sex, age, intraoperative blood loss and time to first flatus. Independent prognostic factors for DSS were the Comprehensive Complication Index and age. These characteristics were used to establish nomograms, which showed good accuracy in predicting 1-, 3- and 5-year OS and BFS. CONCLUSION: SSPD achieves or surpasses the long-term survival effect of traditional pericardial devascularisation and is worthy of clinical promotion and application. Nomograms are effective at predicting prognosis.


Assuntos
Hipertensão Portal/mortalidade , Hipertensão Portal/cirurgia , Nomogramas , Hemorragia Pós-Operatória/mortalidade , Esplenectomia/efeitos adversos , Adulto , Fatores Etários , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pericárdio/cirurgia , Hemorragia Pós-Operatória/etiologia , Período Pós-Operatório , Estudos Retrospectivos , Fatores Sexuais , Esplenectomia/métodos , Análise de Sobrevida , Taxa de Sobrevida , Resultado do Tratamento
13.
Stroke ; 49(11): 2783-2785, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30355186

RESUMO

Background and Purpose- This study aimed to explore safety of tirofiban in endovascular treatment of acute ischemic stroke. Methods- Two hundred eighteen ischemic stroke patients receiving endovascular thrombectomy were prospectively recruited, with 94 treated with intra-arterial tirofiban and 124 were not. The 2 groups were compared in terms of symptomatic intracranial hemorrhage (ICH) and fatal ICH rate by the χ2 test and logistic regression. Results- Patients treated with tirofiban compared with those without tirofiban had significantly higher rate of symptomatic ICH (14.6% versus 5.7%; P=0.027) and fatal ICH (8.8% versus 1.6%; P=0.014). Tirofiban-treated patients had increased odds of symptomatic ICH by 2.9-fold (95% CI, 1.1-7.5), and odds of fatal ICH increased by 5.9-fold (95% CI, 1.2-28.4). Conclusions- Tirofiban treatment increases risk of major ICH after endovascular thrombectomy for acute ischemic stroke in this nonrandomized study.


Assuntos
Procedimentos Endovasculares/métodos , Fibrinolíticos/uso terapêutico , Hemorragias Intracranianas/epidemiologia , Hemorragia Pós-Operatória/epidemiologia , Acidente Vascular Cerebral/terapia , Trombectomia/métodos , Tirofibana/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Injeções Intra-Arteriais , Hemorragias Intracranianas/mortalidade , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/mortalidade , Estudos Prospectivos
14.
J Forensic Leg Med ; 60: 25-29, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30223232

RESUMO

BACKGROUND: Pregnancy-associated deaths are a widely recognized phenomenon, that warrants in-depth investigation. Of the 319 suspicious deaths of adult women (>20 years) autopsied during 2011-2012, in the Cairo and Giza governorates, 37 (11.7%) women were pregnant at the time of the autopsy. This paper analyzes the corresponding demographic data, autopsy findings, and toxicological screening. THE RESULTS: Reveal that the number of deaths of pregnant women were higher in 2012 than in 2011. In addition, the number of cases from Giza exceeded those from Cairo (62.2% and 37.8%, respectively). Most cases involved married women (62.2%) in the third trimester of pregnancy (67.5%). Most deaths were predominantly un-intentional (51.4%) attributed to peri-partum complications. Homicidal deaths contributed to 43% of cases, and the husband was the suspect perpetrator in 37.5% of cases. Only two cases were associated with substance abuse. CONCLUSION: the paper concludes that this analysis may inform future strategies to protect pregnant women from the hazards of violence and labor that threaten their lives.


Assuntos
Causas de Morte , Gestantes , Aborto Criminoso/mortalidade , Adulto , Asfixia/mortalidade , Queimaduras/mortalidade , Cesárea/mortalidade , Egito/epidemiologia , Feminino , Homicídio/estatística & dados numéricos , Humanos , Hemorragia Pós-Operatória/mortalidade , Gravidez , Embolia Pulmonar/mortalidade , Transtornos Relacionados ao Uso de Substâncias/mortalidade , Adulto Jovem
15.
Sci Rep ; 8(1): 13406, 2018 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-30194336

RESUMO

Postoperative complication III-V is closely related with hepatectomy-related mortality for hepatocellular carcinoma (HCC) patients. The aim of the study was to investigate the relationship between CONUTS and postoperative complication III-V. 1334 HCC patients who underwent hepatectomy were divided into two groups: high CONUTS group (early postoperative CONUTS ≥ 8, n = 659) and low CONUTS group (early postoperative CONUTS < 8, n = 675). The characteristics and clinical outcomes were compared and analyzed. Risk factors for postoperative complication III-V were evaluated by univariate and multivariate analysis. early postoperative CONUTS showed a good prediction ability for postoperative complication III-V (AUROC = 0.653, P < 0.001), with the cut-off value of 8. The high CONUTS group had higher incidence of postoperative pulmonary complications (12.0% vs 7.9%, P = 0.011), bile leakage (2.6% vs 0.9%, P = 0.018), intra-abdominal hemorrhage (4.9% vs 1.6%, P = 0.001), postoperative liver failure Grade C (3.6% vs 1.0%, P = 0.002), complication III-V (15.6% vs 6.2%, P < 0.001), length of ICU stay > 48 hours (9.4% vs 4.1%, P < 0.001) and mortality in 90 days (2.6% vs 0.4%, P = 0.001), longer period of postoperative hospitalization (10 (8-13) vs 9 (7-11) days, P < 0.001). Multivariable analysis revealed that early postoperative CONUTS ≥ 8 (OR = 2.054, 95%CI = 1.371-3.078, P < 0.001) was independently associated with postoperative complication III-V. Early postoperative CONUTS ≥ 8 was identified as a novel risk factor for postoperative complication III-V, and should be further evaluated as a predictive marker for who are to undergo liver resection.


Assuntos
Carcinoma Hepatocelular , Hepatectomia/efeitos adversos , Neoplasias Hepáticas , Pneumopatias , Estado Nutricional , Hemorragia Pós-Operatória , Adulto , Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/cirurgia , Feminino , Humanos , Unidades de Terapia Intensiva , Falência Hepática/mortalidade , Falência Hepática/patologia , Falência Hepática/cirurgia , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Pneumopatias/etiologia , Pneumopatias/mortalidade , Pneumopatias/patologia , Masculino , Pessoa de Meia-Idade , Mortalidade , Hemorragia Pós-Operatória/mortalidade , Hemorragia Pós-Operatória/patologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
16.
Am J Cardiol ; 122(8): 1287-1296, 2018 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-30115422

RESUMO

Most studies reporting bleedings in patients with ST-segment elevation myocardial infarction (STEMI) are reports from clinical trials, which may be unrepresentative of incidences in real-life. In this study, we investigated 1-year bleeding and mortality incidences in an unselected STEMI population, and compared participants with nonparticipants of a randomized all-comer clinical trial (The Third DANish Study of Optimal Acute Treatment of Patients with STEMI (DANAMI-3)). Hospital charts were read and bleedings classified according to thrombolysis in myocardial infarction (TIMI) and Bleeding Academic Research Consortium (BARC) criteria in 2,490 consecutive STEMI patients who underwent primary percutaneous coronary intervention in a single, large, and tertiary heart center. Thrombolysis in myocardial infarction minor and/or major bleeding (TMMB) occurred in 4.4% day 0 to 30 and 2.1% day 31 to 365. DANAMI-3 nonparticipants (n = 887) had significantly higher 30-day bleeding rates than DANAMI-3-participants (n = 1,603) (7.2% vs 2.9%, p <0.0001), but not thereafter (p = 0.8). DANAMI-3 nonparticipation was significantly associated with 30-day TMMB (hazard ratio, 1.8, 95% confidence interval, 1.2 to 2.8, p = 0.007), but this did not persist after adjusting for resuscitated cardiac arrest, Killip-class>2 and anemia. Patients with cardiac arrest, Killip-class>2, and anemia accounted for 70.0% of 30-day TMMBs, and the majority of these patients were DANAMI-3 nonparticipants. TMMB day 0 to 30 was associated with increased 30-day mortality (hazard ratio 3.1, 95% confidence interval 1.9 to 5.2, p <0.0001) but not thereafter (p = 0.9). In conclusion, we found that clinical trial (DANAMI-3) nonparticipants had significantly more TMMBs within 30 days than participants. Patients with resuscitated cardiac arrest, anemia, and Killip-class>2 were accountable for a high rate of TMMBs. Bleeding incidences from clinical trials cannot be translated to an unselected STEMI population.


Assuntos
Intervenção Coronária Percutânea , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/mortalidade , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Idoso , Angiografia Coronária , Dinamarca/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
17.
Surg Obes Relat Dis ; 14(10): 1454-1461, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30098885

RESUMO

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) has become a dominant bariatric procedure. In the past, significant leak rates prompted the search for staple line reinforcement (SLR) techniques. Previous analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database for all LSG suggested a detrimental influence of SLR on leak rates and overall morbidity. OBJECTIVE: To investigate the relationship between various SLR techniques and bougie size with 30-day outcomes. SETTING: Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program-accredited bariatric surgery hospitals. METHODS: Using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program 2015 to 2016 Participant Use File data, primary LSG cases were divided into study groups based on surgical techniques. All variables were reported in the Participant Use File except leak rate and overall morbidity, which had to be derived. Multiple bivariate analyses were used to analyze the 30-day outcomes. RESULTS: A total of 198,339 primary LSG operations were included and grouped into No SLR (23.0%), SLR (54.2%), oversewn staple line (9.5%), and a combination of SLR + oversewn staple line (13.3%). There were no statistical differences between study groups in mortality, overall morbidity, or leak rate. Bleeding and reoperation rates were statistically higher in the No SLR group. Bougie size was not associated with change in leak rates. CONCLUSION: Primary LSG is a safe procedure with low morbidity and mortality rates. SLR is associated with decreased rates of bleeding and reoperations but does not affect leak rates. The selection of SLR technique should be left to the surgeon's discretion with an understanding of the associated risks, benefits, and costs.


Assuntos
Cirurgia Bariátrica/métodos , Gastrectomia/métodos , Laparoscopia/métodos , Grampeamento Cirúrgico/métodos , Adulto , Fístula Anastomótica/prevenção & controle , Cirurgia Bariátrica/mortalidade , Cirurgia Bariátrica/estatística & dados numéricos , Feminino , Gastrectomia/mortalidade , Gastrectomia/estatística & dados numéricos , Humanos , Laparoscopia/mortalidade , Laparoscopia/estatística & dados numéricos , Masculino , Obesidade Mórbida/mortalidade , Obesidade Mórbida/cirurgia , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/mortalidade , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Grampeamento Cirúrgico/mortalidade , Grampeamento Cirúrgico/estatística & dados numéricos , Resultado do Tratamento , Estados Unidos/epidemiologia
18.
Ann Thorac Surg ; 106(4): 1113-1120, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29966596

RESUMO

BACKGROUND: This study evaluated outcomes in younger patients, specifically aged 50 years and younger, after mechanical aortic valve replacement (mAVR) and bioprosthetic AVR (bAVR). METHODS: From 1994 to 2016, 643 patients underwent AVR (411 mAVR and 232 bAVR) at age 50 or younger. Concomitant coronary artery bypass grafting and mitral valve procedures were also included. Propensity score-matching methods resulted in 170 evenly matched patient pairs. Primary end points were operative mortality and long-term survival. Secondary end points were stroke, major bleeding, and redo AVR. Median observation time was 8.1 years (range, 0 to 23.6 years). RESULTS: Overall, mean age was 41.9 years, and 29.3% were women, with an increasing trend toward use of bAVR. Mean age in the matched patients was 43.3 years for both cohorts (p = 0.68). Operative mortality, stroke, atrial fibrillation, reoperation for bleeding, and readmission rates within 30 days were all similar between the two groups. bAVR patients were at higher risk for redo AVR (13% vs 1.6%, p < 0.001), and mAVR patients were at higher risk for major bleeding events (8.5% vs 2.2%, p = 0.006). However, when adjusted, there were no differences in midterm and long-term survival between unmatched and matched cohorts. CONCLUSIONS: The increased risk of reoperation for bAVR and major bleeding incidents for mAVR was not reflected in midterm and long-term survival differences between the two groups. Our results suggest that bAVR may be an acceptable prosthesis choice for some patients aged 50 years and younger, although the results should be taken with caution.


Assuntos
Estenose da Valva Aórtica/cirurgia , Bioprótese , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas , Mortalidade Hospitalar , Hemorragia Pós-Operatória/cirurgia , Adulto , Fatores Etários , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/mortalidade , Estudos de Coortes , Bases de Dados Factuais , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/mortalidade , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Hemorragia Pós-Operatória/diagnóstico , Hemorragia Pós-Operatória/mortalidade , Prognóstico , Pontuação de Propensão , Modelos de Riscos Proporcionais , Desenho de Prótese , Reoperação/métodos , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida
19.
J Thorac Cardiovasc Surg ; 156(1): 66-74.e2, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29706372

RESUMO

BACKGROUND: Reducing blood product utilization after cardiac surgery has become a focus of perioperative care as studies have suggested improved outcomes. The relative impact of preoperative anemia versus packed red blood cells (PRBC) transfusion on outcomes remains poorly understood, however. In this study, we investigated the relative association between preoperative hematocrit (Hct) level and PRBC transfusion on postoperative outcomes after coronary artery bypass grafting (CABG) surgery. METHODS: Patient records for primary, isolated CABG operations performed between January 2007 and December 2017 at 19 cardiac surgery centers were evaluated. Hierarchical logistic regression modeling was used to estimate the relationship between baseline preoperative Hct level as well as PRBC transfusion and the likelihoods of postoperative mortality and morbidity, adjusted for baseline patient risk. Variable and model performance characteristics were compared to determine the relative strength of association between Hct level and PRBC transfusion and primary outcomes. RESULTS: A total of 33,411 patients (median patient age, 65 years; interquartile range [IQR], 57-72 years; 26% females) were evaluated. The median preoperative Hct value was 39% (IQR, 36%-42%), and the mean Society of Thoracic Surgeons (STS) predicted risk of mortality was 1.8 ± 3.1%. Complications included PRBC transfusion in 31% of patients, renal failure in 2.8%, stroke in 1.3%, and operative mortality in 2.0%. A strong association was observed between preoperative Hct value and the likelihood of PRBC transfusion (P < .001). After risk adjustment, PRBC transfusion, but not Hct value, demonstrated stronger associations with postoperative mortality (odds ratio [OR], 4.3; P < .0001), renal failure (OR 6.3; P < .0001), and stroke (OR, 2.4; P < .0001). A 1-point increase in preoperative Hct was associated with decreased probabilities of mortality (OR, 0.97; P = .0001) and renal failure (OR, 0.94; P < .0001). The models with PRBC had superior predictive power, with a larger area under the curve, compared with Hct for all outcomes (all P < .01). Preoperative anemia was associated with up to a 4-fold increase in the probability of PRBC transfusion, a 3-fold increase in renal failure, and almost double the mortality. CONCLUSIONS: PRBC transfusion appears to be more closely associated with risk-adjusted morbidity and mortality compared with preoperative Hct level alone, supporting efforts to reduce unnecessary PRBC transfusions. Preoperative anemia independently increases the risk of postoperative morbidity and mortality. These data suggest that preoperative Hct should be included in the STS risk calculators. Finally, efforts to optimize preoperative hematocrit should be investigated as a potentially modifiable risk factor for mortality and morbidity.


Assuntos
Anemia/sangue , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Transfusão de Eritrócitos/efeitos adversos , Hemoglobinas/metabolismo , Hemorragia Pós-Operatória/terapia , Idoso , Anemia/diagnóstico , Anemia/mortalidade , Biomarcadores/sangue , Procedimentos Cirúrgicos Cardíacos/mortalidade , Transfusão de Eritrócitos/mortalidade , Feminino , Hematócrito , Humanos , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/diagnóstico , Hemorragia Pós-Operatória/mortalidade , Sistema de Registros , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
20.
Ann Thorac Surg ; 106(3): 799-806, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29753821

RESUMO

BACKGROUND: Perioperative bleeding is a common complication in pediatric patients undergoing cardiac operation. Although thromboelastography (TEG) has been used in patients undergoing adult cardiac operation, limited data are available in pediatric patients. We hypothesize that TEG variables may be associated with surrogate end points for postoperative bleeding in pediatric patients undergoing complex cardiac operation. METHODS: In a retrospective study, TEG was obtained after protamine administration and on admission to the intensive care unit (ICU) in pediatric patients (≤18 years) undergoing cardiac operation that required cardiopulmonary bypass. A composite end point of extended blood product transfusion or surgical re-exploration for bleeding was used as a surrogate for perioperative bleeding. TEG variables were compared between patients who did or did not reach the composite end point. RESULTS: The study included 511 pediatric patients undergoing complex cardiac operation. The composite end point was reached in 52% of patients with maximum amplitude (MA) less than 45 mm compared with 31% with MA of 45 mm or more (p < 0.001). With the use of multivariable regression analysis, MA less than 45 mm was independently associated with the composite end point (p < 0.001). Patients with MA less than 45 mm who received platelet transfusion in the operating room (OR) were less likely to reach the composite end point within the subsequent 24 hours (8%) compared with patients who did not receive intraoperative platelet transfusion (24%) (p = 0.02). CONCLUSIONS: Intraoperative TEG MA less than 45 mm is associated with a surrogate end point for intraoperative bleeding in pediatric patients undergoing complex cardiac operation. In patients with MA less than 45 mm, prophylactic platelet transfusion in the OR may be associated with reduction in bleeding end points in the ICU.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Mortalidade Hospitalar , Hemorragia Pós-Operatória/terapia , Protaminas/uso terapêutico , Tromboelastografia/métodos , Transfusão de Sangue/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Ponte Cardiopulmonar/efeitos adversos , Ponte Cardiopulmonar/métodos , Pré-Escolar , Estudos de Coortes , Feminino , Seguimentos , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/cirurgia , Hospitais Pediátricos , Humanos , Lactente , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Transfusão de Plaquetas/métodos , Hemorragia Pós-Operatória/diagnóstico , Hemorragia Pós-Operatória/mortalidade , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Medição de Risco , Taxa de Sobrevida , Resultado do Tratamento
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