Pub Date : 2024-04-15DOI: 10.1097/as9.0000000000000422
Pratik Raichurkar, Devesh Kaushal, Robert Beaumont Wilson
The 1904–1905 Russo-Japanese War was the first “modern” conflict, using rapid-firing artillery and machine guns, fought over imperial ambitions in Korea and Manchuria. During the war, Princess Vera Gedroits pioneered early laparotomy for penetrating abdominal wounds with unprecedented success. Her techniques were then adopted by the Russian Society of Military Doctors. However, Allied forces took 10 years to adopt operative management of penetrating abdominal wounds over conservative management. Gedroits was later appointed in Kyiv as the world’s first female Professor of Surgery. Kanehiro Takaki, a Japanese Naval surgeon, showed in 1884 a diet of barley, meat, milk, bread, and beans, rather than polished white rice, eliminated beriberi in the Japanese Navy. Despite this success, the Japanese Army failed to change the white rice rations until March 1905. During the 1904–1905 Russo-Japanese War, an estimated 250,000 Japanese soldiers developed beriberi, of whom 27,000 died. Japan’s 1905 defeat of Russia sowed the seeds of discontent with Tsar Nicholas’ rule, culminating in the 1917 Russian Revolution. Although the Russian Navy was destroyed, Japan ceded North Sakhalin Island to Russia in peace negotiations, and Russia seized Manchuria, South Sakhalin, and the Kuril Islands in 1945. We highlight the contributions of Gedroits and Takaki, 2 intellectual prodigies who respectively pioneered rapid triage and surgical management of trauma and a cure for beriberi. We aim to show how both these surgeons challenged entrenched dogma and the cultural and political zeitgeist, and risked their professional reputations and their lives in being ADOPTERs of innovation during a crisis.
{"title":"ADOPTERs of Innovation in a Crisis: The History of Vera Gedroits, Kanehiro Takaki and the Russo-Japanese War of 1904–1905","authors":"Pratik Raichurkar, Devesh Kaushal, Robert Beaumont Wilson","doi":"10.1097/as9.0000000000000422","DOIUrl":"https://doi.org/10.1097/as9.0000000000000422","url":null,"abstract":"The 1904–1905 Russo-Japanese War was the first “modern” conflict, using rapid-firing artillery and machine guns, fought over imperial ambitions in Korea and Manchuria. During the war, Princess Vera Gedroits pioneered early laparotomy for penetrating abdominal wounds with unprecedented success. Her techniques were then adopted by the Russian Society of Military Doctors. However, Allied forces took 10 years to adopt operative management of penetrating abdominal wounds over conservative management. Gedroits was later appointed in Kyiv as the world’s first female Professor of Surgery. Kanehiro Takaki, a Japanese Naval surgeon, showed in 1884 a diet of barley, meat, milk, bread, and beans, rather than polished white rice, eliminated beriberi in the Japanese Navy. Despite this success, the Japanese Army failed to change the white rice rations until March 1905. During the 1904–1905 Russo-Japanese War, an estimated 250,000 Japanese soldiers developed beriberi, of whom 27,000 died. Japan’s 1905 defeat of Russia sowed the seeds of discontent with Tsar Nicholas’ rule, culminating in the 1917 Russian Revolution. Although the Russian Navy was destroyed, Japan ceded North Sakhalin Island to Russia in peace negotiations, and Russia seized Manchuria, South Sakhalin, and the Kuril Islands in 1945. We highlight the contributions of Gedroits and Takaki, 2 intellectual prodigies who respectively pioneered rapid triage and surgical management of trauma and a cure for beriberi. We aim to show how both these surgeons challenged entrenched dogma and the cultural and political zeitgeist, and risked their professional reputations and their lives in being ADOPTERs of innovation during a crisis.","PeriodicalId":503165,"journal":{"name":"Annals of Surgery Open","volume":"7 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140699350","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 : 2024-04-11DOI: 10.1097/as9.0000000000000420
J. Théreaux, Mohammed Bennani, J. Khemis, Elisabeth Ohayon, I. Visnovec Buissez, Alexandre Lafourcade, L. Quiriconi, Caroline Philippe, J. Oppert
This study compared the effectiveness of 4 main revisional bariatric surgery (RBS) sequences after sleeve gastrectomy (SG) and adjustable gastric banding (AGB), on the reimbursement of antidiabetic treatments in France. Few large-scale prospective cohort studies have assessed the changes in antidiabetic treatments after RBS. This nationwide observational population-based cohort study analyzed data from the French National Health Insurance Database. All patients who underwent primary SG and AGB in France between January 2012 and December 2014 were included and followed up until December 31, 2020. The changes in categories and costs of reimbursed antidiabetic treatments across different RBS sequences were assessed (presented as follows: bariatric surgery (BS)-RBS). Among the 107,088 patients who underwent BS, 6396 underwent RBS, 2400 SG-GBP (SG converted to gastric bypass [GBP] during follow-up), 2277 AGB-SG, 1173 AGB-GBP, and 546 SG-SG. Pre-RBS insulin was used in 10 (2.9%), 4 (0.9%), 8 (2.4%), and 10 (2.6%) patients, respectively. Two years after RBS, the treatment discontinuation or decrease (the change of treatment to a lighter one category rates [eg, insulin to bi/tritherapy]) was 47%, 47%, 49%, and 34%, respectively. Four years after RBS, the median annual cost per patient compared with baseline was lower (P < 0.01) for all sequences, except SG-SG (P = 0.24). The most notable effect concerned AGB-GBP (median of more than 220 euros to 0). This study demonstrated the positive impact of RBS over a 4-year follow-up period on antidiabetic treatments reimbursement, through the reduction or discontinuation of treatments and a significant decrease in costs per patient.
{"title":"Cost-Effectiveness of Sleeve Gastrectomy and Gastric Bypass as Revisional Surgery on Antidiabetic Reimbursement: A Nationwide Cohort Study","authors":"J. Théreaux, Mohammed Bennani, J. Khemis, Elisabeth Ohayon, I. Visnovec Buissez, Alexandre Lafourcade, L. Quiriconi, Caroline Philippe, J. Oppert","doi":"10.1097/as9.0000000000000420","DOIUrl":"https://doi.org/10.1097/as9.0000000000000420","url":null,"abstract":"\u0000 \u0000 This study compared the effectiveness of 4 main revisional bariatric surgery (RBS) sequences after sleeve gastrectomy (SG) and adjustable gastric banding (AGB), on the reimbursement of antidiabetic treatments in France.\u0000 \u0000 \u0000 \u0000 Few large-scale prospective cohort studies have assessed the changes in antidiabetic treatments after RBS.\u0000 \u0000 \u0000 \u0000 This nationwide observational population-based cohort study analyzed data from the French National Health Insurance Database. All patients who underwent primary SG and AGB in France between January 2012 and December 2014 were included and followed up until December 31, 2020. The changes in categories and costs of reimbursed antidiabetic treatments across different RBS sequences were assessed (presented as follows: bariatric surgery (BS)-RBS).\u0000 \u0000 \u0000 \u0000 Among the 107,088 patients who underwent BS, 6396 underwent RBS, 2400 SG-GBP (SG converted to gastric bypass [GBP] during follow-up), 2277 AGB-SG, 1173 AGB-GBP, and 546 SG-SG. Pre-RBS insulin was used in 10 (2.9%), 4 (0.9%), 8 (2.4%), and 10 (2.6%) patients, respectively. Two years after RBS, the treatment discontinuation or decrease (the change of treatment to a lighter one category rates [eg, insulin to bi/tritherapy]) was 47%, 47%, 49%, and 34%, respectively. Four years after RBS, the median annual cost per patient compared with baseline was lower (P < 0.01) for all sequences, except SG-SG (P = 0.24). The most notable effect concerned AGB-GBP (median of more than 220 euros to 0).\u0000 \u0000 \u0000 \u0000 This study demonstrated the positive impact of RBS over a 4-year follow-up period on antidiabetic treatments reimbursement, through the reduction or discontinuation of treatments and a significant decrease in costs per patient.\u0000","PeriodicalId":503165,"journal":{"name":"Annals of Surgery Open","volume":"91 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140713788","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 : 2024-04-11DOI: 10.1097/as9.0000000000000421
M. Bicket, Kao-Ping Chua, Pooja Lagisetty, Yi Li, J. Waljee, Chad Brummett, Thuy D. Nguyen
{"title":"Prevalence of Surgery Among Individuals in the United States","authors":"M. Bicket, Kao-Ping Chua, Pooja Lagisetty, Yi Li, J. Waljee, Chad Brummett, Thuy D. Nguyen","doi":"10.1097/as9.0000000000000421","DOIUrl":"https://doi.org/10.1097/as9.0000000000000421","url":null,"abstract":"","PeriodicalId":503165,"journal":{"name":"Annals of Surgery Open","volume":"20 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140715740","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 : 2024-04-10DOI: 10.1097/as9.0000000000000414
Edward H. Livingston, Hila Zelicha, Erik P. Dutson, Zhaoping Li, Matthew L. Maciejewski, Yijun Chen
To assess the external validity of randomized controlled trials (RCTs) of bariatric surgical treatment on diabetes control. Multisite RCTs provide the strongest evidence supporting clinical treatments and have the greatest internal validity. However, characteristics of trial participants may not be representative of patients receiving treatment in the real world. There is a need to assess how the results of RCTs generalize to all contemporary patient populations undergoing treatments. All patients undergoing sleeve gastrectomy at University of California Los Angeles (UCLA) between January 8, 2018 and May 19, 2023 had their baseline characteristics, weight change, and diabetes control compared with those enrolled in the surgical treatment and medications potentially eradicate diabetes efficiently (STAMPEDE) and diabetes surgery study (DSS) RCTs of bariatric surgery’s effect on diabetes control. Weight loss and diabetes control were compared between UCLA patients who did and did not fit the entry criteria for these RCTs. Only 65 (17%) of 387 patients with diabetes fulfilled the eligibility criteria for STAMPEDE, and 29 (7.5%) fulfilled the criteria for DSS due to being older, having higher body mass index, and lower HbA1c. UCLA patients experienced slightly less weight loss than patients in the RCTs but had similar diabetes control. The 313 (81%) patients not eligible for study entry into either RCT had similar long-term diabetes control as those who were eligible for the RCTs. Even though only a very small proportion of patients undergoing bariatric surgery met the eligibility criteria for the 2 major RCTs, most patients in this contemporary cohort had similar outcomes. Diabetes outcomes from STAMPEDE and DSS generalize to most patients undergoing bariatric surgery for diabetes control.
{"title":"Generalizability of Randomized Clinical Trial Outcomes for Diabetes Control Resulting From Bariatric Surgery","authors":"Edward H. Livingston, Hila Zelicha, Erik P. Dutson, Zhaoping Li, Matthew L. Maciejewski, Yijun Chen","doi":"10.1097/as9.0000000000000414","DOIUrl":"https://doi.org/10.1097/as9.0000000000000414","url":null,"abstract":"\u0000 \u0000 To assess the external validity of randomized controlled trials (RCTs) of bariatric surgical treatment on diabetes control.\u0000 \u0000 \u0000 \u0000 Multisite RCTs provide the strongest evidence supporting clinical treatments and have the greatest internal validity. However, characteristics of trial participants may not be representative of patients receiving treatment in the real world. There is a need to assess how the results of RCTs generalize to all contemporary patient populations undergoing treatments.\u0000 \u0000 \u0000 \u0000 All patients undergoing sleeve gastrectomy at University of California Los Angeles (UCLA) between January 8, 2018 and May 19, 2023 had their baseline characteristics, weight change, and diabetes control compared with those enrolled in the surgical treatment and medications potentially eradicate diabetes efficiently (STAMPEDE) and diabetes surgery study (DSS) RCTs of bariatric surgery’s effect on diabetes control. Weight loss and diabetes control were compared between UCLA patients who did and did not fit the entry criteria for these RCTs.\u0000 \u0000 \u0000 \u0000 Only 65 (17%) of 387 patients with diabetes fulfilled the eligibility criteria for STAMPEDE, and 29 (7.5%) fulfilled the criteria for DSS due to being older, having higher body mass index, and lower HbA1c. UCLA patients experienced slightly less weight loss than patients in the RCTs but had similar diabetes control. The 313 (81%) patients not eligible for study entry into either RCT had similar long-term diabetes control as those who were eligible for the RCTs.\u0000 \u0000 \u0000 \u0000 Even though only a very small proportion of patients undergoing bariatric surgery met the eligibility criteria for the 2 major RCTs, most patients in this contemporary cohort had similar outcomes. Diabetes outcomes from STAMPEDE and DSS generalize to most patients undergoing bariatric surgery for diabetes control.\u0000","PeriodicalId":503165,"journal":{"name":"Annals of Surgery Open","volume":"25 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140716288","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 : 2024-04-09DOI: 10.1097/as9.0000000000000417
Michael H. McGillion, F. K. Borges, D. Conen, D. Sessler, Brenda L. Coleman, Maura Marcucci, Carley Ouellette, M. Bird, Carly Whitmore, Shaunattonie Henry, Sandra Ofori, S. Pettit, Deborah M. Bedini, Leslie P. Gauthier, Jennifer Lounsbury, Nancy M. Carter, V. Tandon, Ameen Patel, Teresa Cafaro, Marko R. Simunovic, John Harlock, D. Heels-Ansdell, Fadi Elias, T. Rapanos, Shawn Forbes, Elizabeth Peter, J. Watt-Watson, Kelly Metcalfe, Sandra L. Carroll, P. J. Devereaux
To determine timing and risk factors associated with readmission within 30 days of discharge following noncardiac surgery. Hospital readmission after noncardiac surgery is costly. Data on the drivers of readmission have largely been derived from single-center studies focused on a single surgical procedure with uncertainty regarding generalizability. We undertook an international (28 centers, 14 countries) prospective cohort study of a representative sample of adults ≥45 years of age who underwent noncardiac surgery. Risk factors for readmission were assessed using Cox regression (ClinicalTrials.gov, NCT00512109). Of 36,657 eligible participants, 2744 (7.5%; 95% confidence interval [CI], 7.2–7.8) were readmitted within 30 days of discharge. Rates of readmission were highest in the first 7 days after discharge and declined over the follow-up period. Multivariable analyses demonstrated that 9 baseline characteristics (eg, cancer treatment in past 6 months; adjusted hazard ratio [HR], 1.44; 95% CI, 1.30–1.59), 5 baseline laboratory and physical measures (eg, estimated glomerular filtration rate or on dialysis; HR, 1.47; 95% CI, 1.24–1.75), 7 surgery types (eg, general surgery; HR, 1.86; 95% CI, 1.61–2.16), 5 index hospitalization events (eg, stroke; HR, 2.21; 95% CI, 1.24–3.94), and 3 other factors (eg, discharge to nursing home; HR, 1.61; 95% CI, 1.33–1.95) were associated with readmission. Readmission following noncardiac surgery is common (1 in 13 patients). We identified perioperative risk factors associated with 30-day readmission that can help frontline clinicians identify which patients are at the highest risk of readmission and target them for preventive measures.
{"title":"Risk Factors for Hospital Readmission Following Noncardiac Surgery: International Cohort Study","authors":"Michael H. McGillion, F. K. Borges, D. Conen, D. Sessler, Brenda L. Coleman, Maura Marcucci, Carley Ouellette, M. Bird, Carly Whitmore, Shaunattonie Henry, Sandra Ofori, S. Pettit, Deborah M. Bedini, Leslie P. Gauthier, Jennifer Lounsbury, Nancy M. Carter, V. Tandon, Ameen Patel, Teresa Cafaro, Marko R. Simunovic, John Harlock, D. Heels-Ansdell, Fadi Elias, T. Rapanos, Shawn Forbes, Elizabeth Peter, J. Watt-Watson, Kelly Metcalfe, Sandra L. Carroll, P. J. Devereaux","doi":"10.1097/as9.0000000000000417","DOIUrl":"https://doi.org/10.1097/as9.0000000000000417","url":null,"abstract":"\u0000 \u0000 To determine timing and risk factors associated with readmission within 30 days of discharge following noncardiac surgery.\u0000 \u0000 \u0000 \u0000 Hospital readmission after noncardiac surgery is costly. Data on the drivers of readmission have largely been derived from single-center studies focused on a single surgical procedure with uncertainty regarding generalizability.\u0000 \u0000 \u0000 \u0000 We undertook an international (28 centers, 14 countries) prospective cohort study of a representative sample of adults ≥45 years of age who underwent noncardiac surgery. Risk factors for readmission were assessed using Cox regression (ClinicalTrials.gov, NCT00512109).\u0000 \u0000 \u0000 \u0000 Of 36,657 eligible participants, 2744 (7.5%; 95% confidence interval [CI], 7.2–7.8) were readmitted within 30 days of discharge. Rates of readmission were highest in the first 7 days after discharge and declined over the follow-up period. Multivariable analyses demonstrated that 9 baseline characteristics (eg, cancer treatment in past 6 months; adjusted hazard ratio [HR], 1.44; 95% CI, 1.30–1.59), 5 baseline laboratory and physical measures (eg, estimated glomerular filtration rate or on dialysis; HR, 1.47; 95% CI, 1.24–1.75), 7 surgery types (eg, general surgery; HR, 1.86; 95% CI, 1.61–2.16), 5 index hospitalization events (eg, stroke; HR, 2.21; 95% CI, 1.24–3.94), and 3 other factors (eg, discharge to nursing home; HR, 1.61; 95% CI, 1.33–1.95) were associated with readmission.\u0000 \u0000 \u0000 \u0000 Readmission following noncardiac surgery is common (1 in 13 patients). We identified perioperative risk factors associated with 30-day readmission that can help frontline clinicians identify which patients are at the highest risk of readmission and target them for preventive measures.\u0000","PeriodicalId":503165,"journal":{"name":"Annals of Surgery Open","volume":"72 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140722605","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 : 2024-04-05DOI: 10.1097/as9.0000000000000412
M. Alsabbagh, Michael A. Beazely, Leona Spasik
This study examined whether there is an association between opioid-related mortality and surgical procedures. A case-control study design using deceased controls compared individuals with and without opioid death and their exposure to common surgeries in the preceding 4 years. This population-based study used linked death and hospitalization databases in Canada (excluding Quebec) from January 01, 2008 to December 31, 2017. Cases of opioid death were identified and matched to 5 controls who died of other causes by age (±4 years), sex, province of death, and date of death (±1 year). Patients with HIV infection and alcohol-related deaths were excluded from the control group. Logistic regression was used to determine if there was an association between having surgery and death from an opioid-related cause by estimating the crude and adjusted odds ratios (ORs) with the corresponding 95% confidence interval (CI). Covariates included sociodemographic characteristics, comorbidities, and the number of days of hospitalization in the previous 4 years. We identified 11,865 cases and matched them with 59,345 controls. About 11.2% of cases and 12.5% of controls had surgery in the 4 years before their death, corresponding to a crude OR of 0.89 (95% CI: 0.83–0.94). After adjustment, opioid mortality was associated with surgical procedure with OR of 1.26 (95% CI: 1.17–1.36). After adjusting for comorbidities, patients with opioid mortality were more likely to undergo surgical intervention within 4 years before their death. Clinicians should enhance screening for opioid use and risk factors when considering postoperative opioid prescribing.
{"title":"Association Between Opioid-Related Mortality and History of Surgical Procedure: A Population-Based Case-Control Study","authors":"M. Alsabbagh, Michael A. Beazely, Leona Spasik","doi":"10.1097/as9.0000000000000412","DOIUrl":"https://doi.org/10.1097/as9.0000000000000412","url":null,"abstract":"\u0000 \u0000 This study examined whether there is an association between opioid-related mortality and surgical procedures.\u0000 \u0000 \u0000 \u0000 A case-control study design using deceased controls compared individuals with and without opioid death and their exposure to common surgeries in the preceding 4 years. This population-based study used linked death and hospitalization databases in Canada (excluding Quebec) from January 01, 2008 to December 31, 2017. Cases of opioid death were identified and matched to 5 controls who died of other causes by age (±4 years), sex, province of death, and date of death (±1 year). Patients with HIV infection and alcohol-related deaths were excluded from the control group. Logistic regression was used to determine if there was an association between having surgery and death from an opioid-related cause by estimating the crude and adjusted odds ratios (ORs) with the corresponding 95% confidence interval (CI). Covariates included sociodemographic characteristics, comorbidities, and the number of days of hospitalization in the previous 4 years.\u0000 \u0000 \u0000 \u0000 We identified 11,865 cases and matched them with 59,345 controls. About 11.2% of cases and 12.5% of controls had surgery in the 4 years before their death, corresponding to a crude OR of 0.89 (95% CI: 0.83–0.94). After adjustment, opioid mortality was associated with surgical procedure with OR of 1.26 (95% CI: 1.17–1.36).\u0000 \u0000 \u0000 \u0000 After adjusting for comorbidities, patients with opioid mortality were more likely to undergo surgical intervention within 4 years before their death. Clinicians should enhance screening for opioid use and risk factors when considering postoperative opioid prescribing.\u0000","PeriodicalId":503165,"journal":{"name":"Annals of Surgery Open","volume":"11 S1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140740467","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 : 2024-04-02DOI: 10.1097/as9.0000000000000416
J. Diers, Nikolas Baumann, P. Baum, Konstantin L. Uttinger, Johanna C. Wagner, P. Kranke, P. Meybohm, Christoph-Thomas Germer, Armin Wiegering
Postoperative pulmonary embolism (PE) is a rare but potentially life-threatening complication, which can be treated with extracorporeal membrane oxygenation (ECMO) therapy, a novel therapy option for acute cardiorespiratory failure. We postulate that hospitals with ECMO availability have more experienced staff, technical capabilities, and expertise in treating cardiorespiratory failure. A retrospective analysis of surgical procedures in Germany between 2012 and 2019 was performed using hospital billing data. High-risk surgical procedures for postoperative PE were analyzed according to the availability of and expertise in ECMO therapy and its effect on outcome, regardless of whether ECMO was used in patients with PE. Descriptive, univariate, and multivariate analyses were applied to identify possible associations and correct for confounding factors (complications, complication management, and mortality). A total of 13,976,606 surgical procedures were analyzed, of which 2,407,805 were defined as high-risk surgeries. The overall failure to rescue (FtR) rate was 24.4% and increased significantly with patient age, as well as type of surgery. The availability of and experience in ECMO therapy (defined as at least 20 ECMO applications per year; ECMO centers) are associated with a significantly reduced FtR in patients with PE after high-risk surgical procedures. In a multivariate analysis, the odds ratio (OR) for FtR after postoperative PE was significantly lower in ECMO centers (OR, 0.75 [0.70–0.81], P < 0.001). The availability of and expertise in ECMO therapy lead to a significantly reduced FtR rate of postoperative PE. This improved outcome is independent of the use of ECMO in these patients.
术后肺栓塞（PE）是一种罕见但可能危及生命的并发症，可通过体外膜肺氧合（ECMO）疗法治疗，这是一种治疗急性心肺功能衰竭的新型疗法。我们推测，可提供 ECMO 的医院在治疗心肺功能衰竭方面拥有更多经验丰富的员工、技术能力和专业知识。 我们利用医院账单数据对 2012 年至 2019 年期间德国的外科手术进行了回顾性分析。根据 ECMO 治疗的可用性和专业性及其对疗效的影响（无论 PE 患者是否使用 ECMO），对术后 PE 的高风险外科手术进行了分析。 应用描述性分析、单变量分析和多变量分析来确定可能存在的关联，并校正混杂因素（并发症、并发症处理和死亡率）。 共分析了 13,976,606 例手术，其中 2,407,805 例被定义为高风险手术。总体抢救失败率 (FtR) 为 24.4%，随着患者年龄和手术类型的增加而显著增加。ECMO 治疗的可用性和经验（定义为每年至少 20 次 ECMO 应用；ECMO 中心）与高风险手术后 PE 患者的 FtR 显著降低有关。在一项多变量分析中，ECMO 中心术后 PE 的 FtR 的比值比 (OR) 明显降低（OR, 0.75 [0.70-0.81], P < 0.001）。 ECMO 治疗的可用性和专业性使术后 PE 的 FtR 率显著降低。这一结果的改善与这些患者是否使用 ECMO 无关。
{"title":"Availability in ECMO Reduces the Failure to Rescue in Patients With Pulmonary Embolism After Major Surgery: A Nationwide Analysis of 2.4 Million Cases","authors":"J. Diers, Nikolas Baumann, P. Baum, Konstantin L. Uttinger, Johanna C. Wagner, P. Kranke, P. Meybohm, Christoph-Thomas Germer, Armin Wiegering","doi":"10.1097/as9.0000000000000416","DOIUrl":"https://doi.org/10.1097/as9.0000000000000416","url":null,"abstract":"\u0000 \u0000 Postoperative pulmonary embolism (PE) is a rare but potentially life-threatening complication, which can be treated with extracorporeal membrane oxygenation (ECMO) therapy, a novel therapy option for acute cardiorespiratory failure. We postulate that hospitals with ECMO availability have more experienced staff, technical capabilities, and expertise in treating cardiorespiratory failure.\u0000 \u0000 \u0000 \u0000 A retrospective analysis of surgical procedures in Germany between 2012 and 2019 was performed using hospital billing data. High-risk surgical procedures for postoperative PE were analyzed according to the availability of and expertise in ECMO therapy and its effect on outcome, regardless of whether ECMO was used in patients with PE.\u0000 \u0000 \u0000 \u0000 Descriptive, univariate, and multivariate analyses were applied to identify possible associations and correct for confounding factors (complications, complication management, and mortality).\u0000 \u0000 \u0000 \u0000 A total of 13,976,606 surgical procedures were analyzed, of which 2,407,805 were defined as high-risk surgeries. The overall failure to rescue (FtR) rate was 24.4% and increased significantly with patient age, as well as type of surgery. The availability of and experience in ECMO therapy (defined as at least 20 ECMO applications per year; ECMO centers) are associated with a significantly reduced FtR in patients with PE after high-risk surgical procedures. In a multivariate analysis, the odds ratio (OR) for FtR after postoperative PE was significantly lower in ECMO centers (OR, 0.75 [0.70–0.81], P < 0.001).\u0000 \u0000 \u0000 \u0000 The availability of and expertise in ECMO therapy lead to a significantly reduced FtR rate of postoperative PE. This improved outcome is independent of the use of ECMO in these patients.\u0000","PeriodicalId":503165,"journal":{"name":"Annals of Surgery Open","volume":"13 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140751704","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 : 2024-04-01DOI: 10.1097/as9.0000000000000418
Jeffrey R. Savarino, Emily Rubin, Peter T Masiakos, R. McLellan, Myron Rolle, P. Nanda, Christopher J. Stapleton, C. Sacks
We sought to identify people who survived firearm suicide attempts to describe the acute stressors, substance use, and mental health conditions related to the attempt. Most firearm deaths in the United States are the result of suicide. Because firearm suicide attempts have a case fatality rate of approximately 90%, little is known about the precipitating factors that lead to firearm suicide attempts. We conducted a retrospective case series of patients admitted to a large hospital system between 2000 and 2019 who survived intentional, self-inflicted gunshot wounds to the head. Through the electronic medical record, we collected information about acute stressors, substance use, and mental health diagnoses before or at the time of the suicide attempt. Thirty-four patients were included in the study cohort. Patients were predominantly White (74%) and male (88%), with a mean age of 44 (range, 14–82). Nineteen (56%) patients were acutely intoxicated with alcohol upon hospitalization and 17 (50%) patients had a positive urine drug screen. Acute stressors involving interpersonal relationships (53%), work/school (32%), and legal disputes (18%), among others, were documented in 82% of patients. Most patients (65%) had been diagnosed with depression before their index hospitalization. Most patients were discharged to an acute rehabilitation center (41%) or an inpatient psychiatric facility (41%). Acute stress and alcohol intoxication were common in this cohort of patients who attempted suicide using firearms. These data offer an ability to learn from the experience of survivors of firearm suicide attempts, a rare population.
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Pub Date : 2024-03-29DOI: 10.1097/as9.0000000000000411
Joseph Aryankalayil, Rex Atwood, Mark Johnson, Jamie Fitch, Aldo Ayvar, Eileen Natuzzi, Juan Elvin Muñoz, R. Jagilly, Scott Siota, T. Worlton
{"title":"Beyond the Expected: Evaluating Preoperative Predictors of a Difficult Cholecystectomy Aboard the USNS Comfort","authors":"Joseph Aryankalayil, Rex Atwood, Mark Johnson, Jamie Fitch, Aldo Ayvar, Eileen Natuzzi, Juan Elvin Muñoz, R. Jagilly, Scott Siota, T. Worlton","doi":"10.1097/as9.0000000000000411","DOIUrl":"https://doi.org/10.1097/as9.0000000000000411","url":null,"abstract":"","PeriodicalId":503165,"journal":{"name":"Annals of Surgery Open","volume":"75 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140366598","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 : 2024-03-29DOI: 10.1097/as9.0000000000000395
Joseph D. Bozzay, Eric A. Elster, Jennifer M. Gurney
{"title":"Sustaining Military Surgeons and the Joint Trauma System: Current Efforts, Unique Challenges, and Proposed Strategies in an Era of Global Uncertainty","authors":"Joseph D. Bozzay, Eric A. Elster, Jennifer M. Gurney","doi":"10.1097/as9.0000000000000395","DOIUrl":"https://doi.org/10.1097/as9.0000000000000395","url":null,"abstract":"","PeriodicalId":503165,"journal":{"name":"Annals of Surgery Open","volume":"76 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140366647","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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