Kayla K. Umemoto, Shahini Ananth, Anthony Ma, Anvay Ullal, P. Ramdass, P. Lo, D. Vyas
INTRODUCTION Laparoscopic cholecystectomy (LC) for gangrenous gallbladders (GGBs) can be challenging and represent a significant number of LC cases, necessitating more efficacious surgical techniques. Currently, the standard treatment for GGBs is blunt dissection which can have high iatrogenic complication rates. To our knowledge, this is the first large retrospective study conducted on the novel application of hydrodissection (HD) in LCs for GGBs. METHODS In this retrospective study of 386 LCs, data were collected for patient demographics, medical comorbidities, operating time (OT), anesthesia time (AT), length of stay (LOS), estimated blood loss, conversion to open procedures, 30-day readmissions, and mortality. Patients were categorized into four groups: (1) Vyas employing HD for GGBs (VHG), (2) non-Vyas group of five surgeons not employing HD for GGBs (NVG), (3) Vyas treating non-GGBs, and (4) non-Vyas group of five surgeons treating non-GGBs. Control groups were age-matched and sex-matched. Statistical analysis used descriptive statistics, Mann-Whitney U testing, and chi-squared testing (α = 0.05). RESULTS This study demonstrated significantly decreased (P < 0.05) OT (P = 0.001), AT (P < 0.001), LOS (P = 0.015), and conversion to open procedures (P = 0.047) between the VHG and NVG groups, with HD reducing OT by 35.5% compared to blunt dissection. This study did not demonstrate significantly decreased (P > 0.05) estimated blood loss (P = 0.185) and 30-day readmissions (P = 0.531) between the VHG and NVG groups, but they were trending toward significant. There were no mortalities in this study. CONCLUSIONS HD is associated with improved surgical outcomes of LCs for GGBs demonstrated by reduced OT, AT, LOS, and conversion to open procedures. Further multi-institutional studies are needed to validate HD implementation and further dissemination.
{"title":"Novel Application of Hydrodissection in Laparoscopic Cholecystectomy for Gangrenous Gallbladders.","authors":"Kayla K. Umemoto, Shahini Ananth, Anthony Ma, Anvay Ullal, P. Ramdass, P. Lo, D. Vyas","doi":"10.2139/ssrn.4065017","DOIUrl":"https://doi.org/10.2139/ssrn.4065017","url":null,"abstract":"INTRODUCTION\u0000Laparoscopic cholecystectomy (LC) for gangrenous gallbladders (GGBs) can be challenging and represent a significant number of LC cases, necessitating more efficacious surgical techniques. Currently, the standard treatment for GGBs is blunt dissection which can have high iatrogenic complication rates. To our knowledge, this is the first large retrospective study conducted on the novel application of hydrodissection (HD) in LCs for GGBs.\u0000\u0000\u0000METHODS\u0000In this retrospective study of 386 LCs, data were collected for patient demographics, medical comorbidities, operating time (OT), anesthesia time (AT), length of stay (LOS), estimated blood loss, conversion to open procedures, 30-day readmissions, and mortality. Patients were categorized into four groups: (1) Vyas employing HD for GGBs (VHG), (2) non-Vyas group of five surgeons not employing HD for GGBs (NVG), (3) Vyas treating non-GGBs, and (4) non-Vyas group of five surgeons treating non-GGBs. Control groups were age-matched and sex-matched. Statistical analysis used descriptive statistics, Mann-Whitney U testing, and chi-squared testing (α = 0.05).\u0000\u0000\u0000RESULTS\u0000This study demonstrated significantly decreased (P < 0.05) OT (P = 0.001), AT (P < 0.001), LOS (P = 0.015), and conversion to open procedures (P = 0.047) between the VHG and NVG groups, with HD reducing OT by 35.5% compared to blunt dissection. This study did not demonstrate significantly decreased (P > 0.05) estimated blood loss (P = 0.185) and 30-day readmissions (P = 0.531) between the VHG and NVG groups, but they were trending toward significant. There were no mortalities in this study.\u0000\u0000\u0000CONCLUSIONS\u0000HD is associated with improved surgical outcomes of LCs for GGBs demonstrated by reduced OT, AT, LOS, and conversion to open procedures. Further multi-institutional studies are needed to validate HD implementation and further dissemination.","PeriodicalId":191568,"journal":{"name":"The Journal of surgical research","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117225006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-01DOI: 10.1016/j.jss.2022.02.052
Tracy S. Wang
{"title":"A is for American. Asian. Ally.","authors":"Tracy S. Wang","doi":"10.1016/j.jss.2022.02.052","DOIUrl":"https://doi.org/10.1016/j.jss.2022.02.052","url":null,"abstract":"","PeriodicalId":191568,"journal":{"name":"The Journal of surgical research","volume":"3 2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"118319253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-18DOI: 10.1101/2021.10.14.21265033
Irene Y. Zhang, Danielle Norwitz, A. Drewnowski, Nidhi Agrawal, D. Flum, J. Liao
Introduction: The Mediterranean diet is being studied as an alternative to surgery for common gastrointestinal conditions. However, dietary change can be challenging. "Nudges" - behavioral science strategies seeking to influence cognitive processes to promote good behaviors - may help. We conducted a pilot study evaluating the acceptability of the MediDiet, a behaviorally designed dietary intervention incorporating nudges and recommendations based on the Mediterranean Diet. Methods: We conducted a three-phase pilot study involving parallel randomized surveys of U.S. adults. After completing a validated questionnaire assessing dietary consistency with a Mediterranean diet, participants were randomized to feedback containing no nudge versus nudge: peer comparison; peer comparison + positive affect induction; or default. Participants then rated their positive and negative emotions, motivation for dietary change, and interest in recipes. Responses were analyzed using baseline covariate-adjusted regression. Results: Among 1,709 participants, 56% were men, 73% were White, and the mean age was 38. In response to dietary feedback, participants reported low negative emotions, high positive emotions, moderate motivation for dietary change and high interest in recipes. Nudges did not affect the extent of negative (p=0.104) or positive (p=0.34) emotions, motivation (p=0.139), or interest (p=0.86). In exploratory analyses, those with moderate and high consistency with the Mediterranean diet, with or without nudges, reported lower negative affect, greater positive affect, greater motivation, and greater interest in recipes, than the minimally consistent, no nudge group. Conclusion: Delivering dietary feedback based on the Mediterranean diet using behavioral nudges was acceptable among U.S. adults, rousing positive reactions without triggering negative ones. As early evidence, this pilot study provides the basis for testing nudge-based dietary guidance among individuals with symptomatic gallstones, diverticulitis, and other gastrointestinal diseases.
{"title":"Applying Behavioral Nudges in a Dietary Comparator for Surgical Trials: Developing the MediDiet","authors":"Irene Y. Zhang, Danielle Norwitz, A. Drewnowski, Nidhi Agrawal, D. Flum, J. Liao","doi":"10.1101/2021.10.14.21265033","DOIUrl":"https://doi.org/10.1101/2021.10.14.21265033","url":null,"abstract":"Introduction: The Mediterranean diet is being studied as an alternative to surgery for common gastrointestinal conditions. However, dietary change can be challenging. \"Nudges\" - behavioral science strategies seeking to influence cognitive processes to promote good behaviors - may help. We conducted a pilot study evaluating the acceptability of the MediDiet, a behaviorally designed dietary intervention incorporating nudges and recommendations based on the Mediterranean Diet. Methods: We conducted a three-phase pilot study involving parallel randomized surveys of U.S. adults. After completing a validated questionnaire assessing dietary consistency with a Mediterranean diet, participants were randomized to feedback containing no nudge versus nudge: peer comparison; peer comparison + positive affect induction; or default. Participants then rated their positive and negative emotions, motivation for dietary change, and interest in recipes. Responses were analyzed using baseline covariate-adjusted regression. Results: Among 1,709 participants, 56% were men, 73% were White, and the mean age was 38. In response to dietary feedback, participants reported low negative emotions, high positive emotions, moderate motivation for dietary change and high interest in recipes. Nudges did not affect the extent of negative (p=0.104) or positive (p=0.34) emotions, motivation (p=0.139), or interest (p=0.86). In exploratory analyses, those with moderate and high consistency with the Mediterranean diet, with or without nudges, reported lower negative affect, greater positive affect, greater motivation, and greater interest in recipes, than the minimally consistent, no nudge group. Conclusion: Delivering dietary feedback based on the Mediterranean diet using behavioral nudges was acceptable among U.S. adults, rousing positive reactions without triggering negative ones. As early evidence, this pilot study provides the basis for testing nudge-based dietary guidance among individuals with symptomatic gallstones, diverticulitis, and other gastrointestinal diseases.","PeriodicalId":191568,"journal":{"name":"The Journal of surgical research","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133889609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-01DOI: 10.1016/j.jvs.2021.07.082
C. DeCarlo, J. Mohebali, A. Dua, M. Conrad, A. Mohapatra
{"title":"Preoperative Anemia is Associated With Postoperative Renal Failure After Elective Open Aortic Repair.","authors":"C. DeCarlo, J. Mohebali, A. Dua, M. Conrad, A. Mohapatra","doi":"10.1016/j.jvs.2021.07.082","DOIUrl":"https://doi.org/10.1016/j.jvs.2021.07.082","url":null,"abstract":"","PeriodicalId":191568,"journal":{"name":"The Journal of surgical research","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124897274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-01DOI: 10.1200/jco.2020.39.28_suppl.316
S. Hopkins, R. Vidri, M. Hill, Namrata Vijayvergia, J. Farma
INTRODUCTION Multidisciplinary tumor boards (TBs) are crucial for decision-making and management of patients diagnosed with complex malignancies. The social distancing conditions imposed by coronavirus disease 2019 presented an opportunity to compare virtual versus in-person TBs. METHODS A retrospective analysis of attendance data from an National Cancer Institute-designated cancer center's gastrointestinal (GI) TB participant data from September 2019 to October 2020. In addition, an online survey assessing the virtual TB experience was sent to participants of all TBs. Interrupted time series analyses were performed to evaluate preintervention and postintervention GI TB attendance only. RESULTS The overall mean attendance for GI TB was 30 participants; turnout was higher for virtual format compared to in-person (32 versus 23 attendees, P < 0.001). This increase was seen across all participant categories: attending physicians (15 versus 11 attendees, P < 0.001), trainees (11 versus 8, P < 0.001), and support staff (6 versus 3, P < 0.001). There was no significant difference in the mean number of cases discussed between TB formats. The majority of the 141 survey respondents (across all TB) were attending physicians with >20-year experience. Most supported a permanent virtual or hybrid TB format, 72.5% found this format to be more time efficient and with similar productivity, and 85.8% found it easier to attend. The majority (89.9%) felt confident that the decision-making process was not affected by virtual interactions. CONCLUSIONS A virtual platform for multispecialty TBs allows for greater attendance without sacrificing the decision-making process. This survey supports continuing with a virtual or hybrid format, which may increase attendance and facilitate access to multidisciplinary discussions leading to improved patient care.
{"title":"A Virtual Tumor Board Platform: A Way to Enhance Decision-Making for Complex Malignancies.","authors":"S. Hopkins, R. Vidri, M. Hill, Namrata Vijayvergia, J. Farma","doi":"10.1200/jco.2020.39.28_suppl.316","DOIUrl":"https://doi.org/10.1200/jco.2020.39.28_suppl.316","url":null,"abstract":"INTRODUCTION\u0000Multidisciplinary tumor boards (TBs) are crucial for decision-making and management of patients diagnosed with complex malignancies. The social distancing conditions imposed by coronavirus disease 2019 presented an opportunity to compare virtual versus in-person TBs.\u0000\u0000\u0000METHODS\u0000A retrospective analysis of attendance data from an National Cancer Institute-designated cancer center's gastrointestinal (GI) TB participant data from September 2019 to October 2020. In addition, an online survey assessing the virtual TB experience was sent to participants of all TBs. Interrupted time series analyses were performed to evaluate preintervention and postintervention GI TB attendance only.\u0000\u0000\u0000RESULTS\u0000The overall mean attendance for GI TB was 30 participants; turnout was higher for virtual format compared to in-person (32 versus 23 attendees, P < 0.001). This increase was seen across all participant categories: attending physicians (15 versus 11 attendees, P < 0.001), trainees (11 versus 8, P < 0.001), and support staff (6 versus 3, P < 0.001). There was no significant difference in the mean number of cases discussed between TB formats. The majority of the 141 survey respondents (across all TB) were attending physicians with >20-year experience. Most supported a permanent virtual or hybrid TB format, 72.5% found this format to be more time efficient and with similar productivity, and 85.8% found it easier to attend. The majority (89.9%) felt confident that the decision-making process was not affected by virtual interactions.\u0000\u0000\u0000CONCLUSIONS\u0000A virtual platform for multispecialty TBs allows for greater attendance without sacrificing the decision-making process. This survey supports continuing with a virtual or hybrid format, which may increase attendance and facilitate access to multidisciplinary discussions leading to improved patient care.","PeriodicalId":191568,"journal":{"name":"The Journal of surgical research","volume":"192 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129239377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-08-01DOI: 10.1016/j.jss.2021.05.032
K. Deveney
{"title":"Global Surgery Education: Whose Needs Should We Serve?","authors":"K. Deveney","doi":"10.1016/j.jss.2021.05.032","DOIUrl":"https://doi.org/10.1016/j.jss.2021.05.032","url":null,"abstract":"","PeriodicalId":191568,"journal":{"name":"The Journal of surgical research","volume":"267 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130732885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-22DOI: 10.1101/2021.06.14.21258932
M. S. Bajwa, M. Sohail, Hannatu K. Ali, U. Nazir, M. Bashir
Objectives: To explore candidate parameters for their ability to predict survival and length of hospital stay (LOS) in thermal burns patients, to prepare multivariate predictive models for these two outcomes, and to compare performance of native models to other models. Methods: A retrospective cohort study was undertaken based on record review. Data was extracted from files of patients admitted to a tertiary-care burn centre in Lahore, Pakistan from January 1, 2020 to October 31, 2020. Univariate preselection was used to prepare multivariate logistic regression models for each outcome of interest (survival and LOS). Multivariate models were tested and compared to other models. Results: Increasing TBSA of burn was positively associated with reduced survival and prolonged length of stay. Advancing age and full-thickness burns independently predicted decreased survival. Burn etiology showed prognostic value: petrol-flame burns predicted decreased survival and prolonged LOS; scald was associated with improved survival-odds and shorter LOS. The Survival-model consisted of (1) Baux score, (2) TBSA>40% and (3) serum albumin <3.5g/dl (AUC=0.968, Nagelkerke R^2=0.797). The LOS-model consisted of (1) TBSA^2 and (2) serum albumin concentration (AUC= 0.832, Nagelkerke R^2 =0.408). In tests of discrimination and calibration, native models prepared for survival and LOS outcomes outperformed other models applicable to our dataset. Conclusion: Data from a South Asian burn center has been used to explore factors influencing prognosis for their utility in predictive models for survival and the duration of hospital stay. The significant prognostic roles of TBSA, age, inhalational injury, burn-depth, etiology of burn, anatomic site of burn, hypoalbuminemia and other biochemical parameters were observed. These tools hold significance in guiding healthcare policy and in communications with patients and their families.
{"title":"Predicting thermal injury patient outcomes in a Tertiary-Care Burn Centre, Pakistan","authors":"M. S. Bajwa, M. Sohail, Hannatu K. Ali, U. Nazir, M. Bashir","doi":"10.1101/2021.06.14.21258932","DOIUrl":"https://doi.org/10.1101/2021.06.14.21258932","url":null,"abstract":"Objectives: To explore candidate parameters for their ability to predict survival and length of hospital stay (LOS) in thermal burns patients, to prepare multivariate predictive models for these two outcomes, and to compare performance of native models to other models. Methods: A retrospective cohort study was undertaken based on record review. Data was extracted from files of patients admitted to a tertiary-care burn centre in Lahore, Pakistan from January 1, 2020 to October 31, 2020. Univariate preselection was used to prepare multivariate logistic regression models for each outcome of interest (survival and LOS). Multivariate models were tested and compared to other models. Results: Increasing TBSA of burn was positively associated with reduced survival and prolonged length of stay. Advancing age and full-thickness burns independently predicted decreased survival. Burn etiology showed prognostic value: petrol-flame burns predicted decreased survival and prolonged LOS; scald was associated with improved survival-odds and shorter LOS. The Survival-model consisted of (1) Baux score, (2) TBSA>40% and (3) serum albumin <3.5g/dl (AUC=0.968, Nagelkerke R^2=0.797). The LOS-model consisted of (1) TBSA^2 and (2) serum albumin concentration (AUC= 0.832, Nagelkerke R^2 =0.408). In tests of discrimination and calibration, native models prepared for survival and LOS outcomes outperformed other models applicable to our dataset. Conclusion: Data from a South Asian burn center has been used to explore factors influencing prognosis for their utility in predictive models for survival and the duration of hospital stay. The significant prognostic roles of TBSA, age, inhalational injury, burn-depth, etiology of burn, anatomic site of burn, hypoalbuminemia and other biochemical parameters were observed. These tools hold significance in guiding healthcare policy and in communications with patients and their families.","PeriodicalId":191568,"journal":{"name":"The Journal of surgical research","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129427084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
INTRODUCTION To assess the prophylactic effect of simultaneous placement of mesh and the incidence of parastomal hernia (PSH) after abdominoperineal resection of rectal cancer. METHODS This study included real-world data of 56 surgically resected patients with colorectal cancer who were consecutively assigned to two groups: control (no mesh, n = 32) and experimental (received mesh, n = 24). An artificial patch was placed under the tunica vaginalis of rectus abdominis for patients in the experimental group, whereas those in the control group received routine sigmoidostomy. The median follow-up time was >20 mo. The difference in hazards function was analyzed by cox regression analysis. The Kaplan-Meir analysis was used to determine the survival curves. A P value of <0.05 was considered as significant. RESULTS The postoperative incidence rate of PSH was lower in the experimental (41.7%) group than in the control group (71.9%; P = 0.045). The PSH postoperative time in the experimental group was significantly delayed compared to the control group (48 mo versus 10 mo; P < 0.001). The risk of progression from H1 to H2 was less in the experimental group compared to the control group (49.28% versus 60.86%; P = 0.14). CONCLUSIONS Prophylactic mesh placement significantly prolonged postoperative time for the recurrence of PSH. The incidence of recurrence of H2 (severe PSH) requiring secondary surgical repair was also reduced.
{"title":"Prophylactic Effect of Simultaneous Placement of Mesh on Incidence of Parastomal Hernia After Miles' Surgical Resection of Colorectal Cancer: A Prospective Study.","authors":"Xu Gao, Ruo-fan Li, Li-xin Sun, Zuo-Jun Liu, Guangliang Tian, Huidong Qi, Xiao-Bin Li","doi":"10.21203/RS.3.RS-243315/V1","DOIUrl":"https://doi.org/10.21203/RS.3.RS-243315/V1","url":null,"abstract":"INTRODUCTION\u0000To assess the prophylactic effect of simultaneous placement of mesh and the incidence of parastomal hernia (PSH) after abdominoperineal resection of rectal cancer.\u0000\u0000\u0000METHODS\u0000This study included real-world data of 56 surgically resected patients with colorectal cancer who were consecutively assigned to two groups: control (no mesh, n = 32) and experimental (received mesh, n = 24). An artificial patch was placed under the tunica vaginalis of rectus abdominis for patients in the experimental group, whereas those in the control group received routine sigmoidostomy. The median follow-up time was >20 mo. The difference in hazards function was analyzed by cox regression analysis. The Kaplan-Meir analysis was used to determine the survival curves. A P value of <0.05 was considered as significant.\u0000\u0000\u0000RESULTS\u0000The postoperative incidence rate of PSH was lower in the experimental (41.7%) group than in the control group (71.9%; P = 0.045). The PSH postoperative time in the experimental group was significantly delayed compared to the control group (48 mo versus 10 mo; P < 0.001). The risk of progression from H1 to H2 was less in the experimental group compared to the control group (49.28% versus 60.86%; P = 0.14).\u0000\u0000\u0000CONCLUSIONS\u0000Prophylactic mesh placement significantly prolonged postoperative time for the recurrence of PSH. The incidence of recurrence of H2 (severe PSH) requiring secondary surgical repair was also reduced.","PeriodicalId":191568,"journal":{"name":"The Journal of surgical research","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134059057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-21DOI: 10.21203/rs.3.rs-150967/v1
Y. Qi, Wenjing Ma, Ying-Ya Cao, Qun Chen, Qiancheng Xu, Shi Xiao, Weihua Lu, zhen wang
INTRODUCTION Gastrointestinal failure results in death in critically ill patients. This study aimed to explore the effect of dexmedetomidine (DEX) on intestinal barrier function and its mechanism in critically ill patients undergoing gastrointestinal surgery. METHODS Patients undergoing gastrointestinal surgery were randomized into the DEX group (n = 21) or midazolam (MID) group (n = 21). Sufentanil was used for analgesia in both groups. In the DEX group, DEX was loaded (1 μg/kg) before sedation and infused (0.7 μg/kg/h) during sedation. In the MID group, MID was loaded (0.05 mg/kg) before sedation and infused (0.1 mg/kg/h) during sedation. The mean arterial pressure , heart rate , borborygmus resumption time , first defecation time, length of intensive care unit stay, and length of hospital stay were observed. The diamine oxidase (DAO), D-lactate , TNF-α, IL-6, and α7nAChR levels in plasma or hemocytes were detected before the start of sedation (0 h) and after sedation (24 h). RESULTS No significant differences in age, sex, body mass index, Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores were noted (P > 0.05). The mean arterial pressure between 0 h and 24 h showed no significant difference between the groups (P > 0.05), but the heart rate was significantly lower in the DEX group (P = 0.042). The borborygmus resumption time was significantly earlier in the DEX group (P = 0.034). The lengths of intensive care unit stay (P = 0.016) and hospital stay (P = 0.031) were significantly shorter in the DEX group. The TNF-α level in the DEX group was lower at 24 h than 0 h. The D-lactate level was significantly lower in the DEX group than the MID group at 24 h (P = 0.016). The expression of α7nAChR in the DEX group was significantly higher at 24 h than 0 h (P < 0.05). CONCLUSIONS DEX maintained intestinal barrier integrity in patients undergoing gastrointestinal surgery through the cholinergic anti-inflammatory pathway.
胃肠衰竭可导致危重病人死亡。本研究旨在探讨右美托咪定(DEX)对胃肠手术危重患者肠道屏障功能的影响及其机制。方法将胃肠手术患者随机分为右美托咪唑仑组(n = 21)和咪达唑仑组(n = 21)。两组均采用舒芬太尼镇痛。右美托咪唑组在镇静前注射右美托咪唑(1 μg/kg)，镇静时注射右美托咪唑(0.7 μg/kg/h)。MID组在镇静前灌注0.05 mg/kg的MID，镇静时灌注0.1 mg/kg/h的MID。观察两组患者平均动脉压、心率、排便恢复时间、首次排便时间、重症监护室住院时间和住院时间。检测两组患者在镇静开始前(0 h)和镇静结束后(24 h)血浆及血细胞中二胺氧化酶(DAO)、d -乳酸、TNF-α、IL-6、α7nAChR水平。结果两组患者年龄、性别、体重指数、急性生理与慢性健康评估II和序期器官衰竭评分差异无统计学意义(P > 0.05)。0 h ~ 24 h平均动脉压组间差异无统计学意义(P > 0.05)，但DEX组心率显著降低(P = 0.042)。DEX组鼻咽癌恢复时间明显早于DEX组(P = 0.034)。DEX组重症监护病房住院时间(P = 0.016)和住院时间(P = 0.031)均显著缩短。DEX组24 h TNF-α水平低于0 h, 24 h d -乳酸水平显著低于MID组(P = 0.016)。DEX组α7nAChR表达量在24 h显著高于0 h (P < 0.05)。结论sdex通过胆碱能抗炎途径维持胃肠手术患者肠道屏障的完整性。
{"title":"Effect of Dexmedetomidine on Intestinal Barrier in Patients Undergoing Gastrointestinal Surgery-A Single-Center Randomized Clinical Trial.","authors":"Y. Qi, Wenjing Ma, Ying-Ya Cao, Qun Chen, Qiancheng Xu, Shi Xiao, Weihua Lu, zhen wang","doi":"10.21203/rs.3.rs-150967/v1","DOIUrl":"https://doi.org/10.21203/rs.3.rs-150967/v1","url":null,"abstract":"INTRODUCTION\u0000Gastrointestinal failure results in death in critically ill patients. This study aimed to explore the effect of dexmedetomidine (DEX) on intestinal barrier function and its mechanism in critically ill patients undergoing gastrointestinal surgery.\u0000\u0000\u0000METHODS\u0000Patients undergoing gastrointestinal surgery were randomized into the DEX group (n = 21) or midazolam (MID) group (n = 21). Sufentanil was used for analgesia in both groups. In the DEX group, DEX was loaded (1 μg/kg) before sedation and infused (0.7 μg/kg/h) during sedation. In the MID group, MID was loaded (0.05 mg/kg) before sedation and infused (0.1 mg/kg/h) during sedation. The mean arterial pressure , heart rate , borborygmus resumption time , first defecation time, length of intensive care unit stay, and length of hospital stay were observed. The diamine oxidase (DAO), D-lactate , TNF-α, IL-6, and α7nAChR levels in plasma or hemocytes were detected before the start of sedation (0 h) and after sedation (24 h).\u0000\u0000\u0000RESULTS\u0000No significant differences in age, sex, body mass index, Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores were noted (P > 0.05). The mean arterial pressure between 0 h and 24 h showed no significant difference between the groups (P > 0.05), but the heart rate was significantly lower in the DEX group (P = 0.042). The borborygmus resumption time was significantly earlier in the DEX group (P = 0.034). The lengths of intensive care unit stay (P = 0.016) and hospital stay (P = 0.031) were significantly shorter in the DEX group. The TNF-α level in the DEX group was lower at 24 h than 0 h. The D-lactate level was significantly lower in the DEX group than the MID group at 24 h (P = 0.016). The expression of α7nAChR in the DEX group was significantly higher at 24 h than 0 h (P < 0.05).\u0000\u0000\u0000CONCLUSIONS\u0000DEX maintained intestinal barrier integrity in patients undergoing gastrointestinal surgery through the cholinergic anti-inflammatory pathway.","PeriodicalId":191568,"journal":{"name":"The Journal of surgical research","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127121215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-13DOI: 10.21203/rs.3.rs-89771/v1
Zehao Wu, Huili Li, Kaihua Liao, Yun Wang
BACKGROUND Delirium is a common complication in intensive care unit (ICU) patients, and it can significantly increase the length of hospital stay and cost. Dexamethasone is widely used in various inflammatory diseases and must be used with caution in critically ill patients. Previous studies have shown that the effect of corticosteroid use on the development of delirium in critically ill patients is still controversial, and there is inconclusive conclusion about the effect of dexamethasone on delirium in such patients. Therefore, this study aimed to confirm the effect of dexamethasone use and the dose on the incidence of delirium and patient prognosis in critically ill patients through a large cohort study. METHODS A retrospective cohort study was conducted using data extracted from the Medical Information Mart for Intensive Care III database, which is a large and freely available database of all 46,476 patients who visited Beth Israel Deaconess Medical Center in Boston, Massachusetts, USA and were admitted to the ICU between 2001 and 2012. The primary outcome was the development of delirium, using multivariate logistic regression analysis to reveal the relationship between dexamethasone and delirium. Secondary endpoints were in-hospital mortality, ICU mortality, total length of stay, and length of ICU stay, and the relationship between dexamethasone and prognosis was assessed with Cox proportional hazards models. Propensity score matching with 1:1 grouping was used to eliminate the effect of confounders on both cohorts. The locally weighted scatter plot smoothing technique was used to investigate the dose correlation between dexamethasone and outcomes, subgroup analysis was used to account for heterogeneity, and different correction models and propensity matching analysis were used to eliminate potential confounders. RESULTS Finally, 38,509 patients were included, and 2204 (5.7%) used dexamethasone. No significant statistical difference was observed in basic demographic information after propensity score matching between the two study groups. A significantly higher incidence of delirium (5.0% versus 3.4%, P < 0.001), increased in-hospital mortality (14.9% versus 10.3%, P < 0.001), ICU mortality (9.0% versus 7.5%, P = 0.008), and longer length of stay and ICU stay were observed in patients taking dexamethasone compared with those not taking dexamethasone. Multivariate logistic and Cox regression analyses confirmed that dexamethasone was significantly associated with delirium (adjusted odds ratio = 1.48, 95% confidence interval [CI] = 1.09-2.00, P = 0.012), in-hospital mortality (adjusted hazard ratio = 1.19, 95% CI = 1.02-1.40, P = 0.032), and ICU mortality (adjusted hazard ratio = 1.62, 95% CI = 1.22-2.15, P = 0.001). Compared with critically ill patients using high-dose dexamethasone, the risk of delirium was lower in the dose less than the 10 mg group, and patients using 10-14 mg may be associated with a lower risk of in-hospital death and
背景:谵妄是重症监护病房(ICU)患者的常见并发症，可显著增加住院时间和费用。地塞米松广泛用于各种炎症性疾病，危重患者必须谨慎使用。既往研究表明，皮质类固醇对危重患者谵妄发展的影响仍存在争议，地塞米松对危重患者谵妄的影响尚无定论。因此，本研究旨在通过大队列研究，证实地塞米松的使用及剂量对危重患者谵妄发生率及患者预后的影响。方法采用回顾性队列研究，数据取自美国马萨诸塞州波士顿Beth Israel Deaconess医疗中心2001 - 2012年ICU收治的46,476例重症监护医学信息市场III数据库，该数据库是一个大型免费数据库。主要结局为谵妄的发生，采用多因素logistic回归分析揭示地塞米松与谵妄的关系。次要终点为住院死亡率、ICU死亡率、总住院时间和ICU住院时间，采用Cox比例风险模型评估地塞米松与预后的关系。采用倾向评分匹配1:1分组来消除混杂因素对两个队列的影响。采用局部加权散点图平滑技术研究地塞米松剂量与预后之间的相关性，采用亚组分析解释异质性，采用不同的校正模型和倾向匹配分析消除潜在的混杂因素。结果最终纳入38509例患者，2204例(5.7%)使用地塞米松。倾向评分匹配后，两组基本人口学信息无统计学差异。与未服用地塞米松的患者相比，服用地塞米松的患者谵妄发生率(5.0%比3.4%，P < 0.001)、住院死亡率(14.9%比10.3%，P < 0.001)、ICU死亡率(9.0%比7.5%，P = 0.008)、住院时间和ICU住院时间均显著增加。多因素logistic和Cox回归分析证实，地塞米松与谵妄(校正优势比= 1.48,95%可信区间[CI] = 1.09-2.00, P = 0.012)、住院死亡率(校正风险比= 1.19,95% CI = 1.02-1.40, P = 0.032)和ICU死亡率(校正风险比= 1.62,95% CI = 1.22-2.15, P = 0.001)显著相关。与使用高剂量地塞米松的危重患者相比，剂量小于10 mg组谵妄风险较低，使用10-14 mg的患者院内死亡风险较低，ICU死亡率、住院时间和ICU住院时间最短。结论:地塞米松加重危重患者谵妄的发生，增加院内死亡、ICU死亡风险和住院时间，低剂量地塞米松比大剂量地塞米松谵妄发生风险低，总住院时间短。
{"title":"Association between Dexamethasone and Delirium in Critically Ill Patients: A Retrospective Cohort Study of a Large Clinical Database.","authors":"Zehao Wu, Huili Li, Kaihua Liao, Yun Wang","doi":"10.21203/rs.3.rs-89771/v1","DOIUrl":"https://doi.org/10.21203/rs.3.rs-89771/v1","url":null,"abstract":"BACKGROUND\u0000Delirium is a common complication in intensive care unit (ICU) patients, and it can significantly increase the length of hospital stay and cost. Dexamethasone is widely used in various inflammatory diseases and must be used with caution in critically ill patients. Previous studies have shown that the effect of corticosteroid use on the development of delirium in critically ill patients is still controversial, and there is inconclusive conclusion about the effect of dexamethasone on delirium in such patients. Therefore, this study aimed to confirm the effect of dexamethasone use and the dose on the incidence of delirium and patient prognosis in critically ill patients through a large cohort study.\u0000\u0000\u0000METHODS\u0000A retrospective cohort study was conducted using data extracted from the Medical Information Mart for Intensive Care III database, which is a large and freely available database of all 46,476 patients who visited Beth Israel Deaconess Medical Center in Boston, Massachusetts, USA and were admitted to the ICU between 2001 and 2012. The primary outcome was the development of delirium, using multivariate logistic regression analysis to reveal the relationship between dexamethasone and delirium. Secondary endpoints were in-hospital mortality, ICU mortality, total length of stay, and length of ICU stay, and the relationship between dexamethasone and prognosis was assessed with Cox proportional hazards models. Propensity score matching with 1:1 grouping was used to eliminate the effect of confounders on both cohorts. The locally weighted scatter plot smoothing technique was used to investigate the dose correlation between dexamethasone and outcomes, subgroup analysis was used to account for heterogeneity, and different correction models and propensity matching analysis were used to eliminate potential confounders.\u0000\u0000\u0000RESULTS\u0000Finally, 38,509 patients were included, and 2204 (5.7%) used dexamethasone. No significant statistical difference was observed in basic demographic information after propensity score matching between the two study groups. A significantly higher incidence of delirium (5.0% versus 3.4%, P < 0.001), increased in-hospital mortality (14.9% versus 10.3%, P < 0.001), ICU mortality (9.0% versus 7.5%, P = 0.008), and longer length of stay and ICU stay were observed in patients taking dexamethasone compared with those not taking dexamethasone. Multivariate logistic and Cox regression analyses confirmed that dexamethasone was significantly associated with delirium (adjusted odds ratio = 1.48, 95% confidence interval [CI] = 1.09-2.00, P = 0.012), in-hospital mortality (adjusted hazard ratio = 1.19, 95% CI = 1.02-1.40, P = 0.032), and ICU mortality (adjusted hazard ratio = 1.62, 95% CI = 1.22-2.15, P = 0.001). Compared with critically ill patients using high-dose dexamethasone, the risk of delirium was lower in the dose less than the 10 mg group, and patients using 10-14 mg may be associated with a lower risk of in-hospital death and","PeriodicalId":191568,"journal":{"name":"The Journal of surgical research","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114976802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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