Philipp Vetter, Cédric Niggli, Jan Hambrecht, Philipp Niggli, Jindrich Vomela, Richard Chaloupka, Hans-Christoph Pape, Ladislav Mica
The Watson Trauma Pathway Explorer® is an outcome prediction tool invented by the University Hospital of Zurich in collaboration with IBM®, representing an artificial intelligence application to predict the most adverse outcome scenarios in polytrauma patients: Systemic Inflammatory Respiratory Syndrome (SIRS), sepsis within 21 days and death within 72 h. The hypothesis was how lactate values woud be associated with the incidence of sepsis. Data from 3653 patients in an internal database, with ongoing implementation, served for analysis. Patients were split in two groups according to sepsis presence, and lactate values were measured at formerly defined time points from admission until 21 days after admission for both groups. Differences between groups were analyzed; time points with lactate as independent predictor for sepsis were identified. The predictive quality of lactate at 2 and 12 h after admission was evaluated. Threshold values between groups at all timepoints were calculated. Lactate levels differed from less than 2 h after admission until the end of the observation period (21 d). Lactate represented an independent predictor for sepsis from 12 to 48 h and 14 d to 21 d after admission relative to ISS levels. AUROC was poor at 2 and 12 h after admission with a slight improvement at the 12 h mark. Lactate levels decreased over time at a range of 2 [mmol/L] for 6-8 h after admission. These insights may allow for time-dependent referencing of lactate levels and anticipation of subsequent sepsis, although further parameters must be considered for a higher predictability.
{"title":"The Role of Lactate for Sepsis in Polytrauma Patients, a Time related Analysis using the IBM Watson Trauma Pathway Explorer<sup>®</sup>.","authors":"Philipp Vetter, Cédric Niggli, Jan Hambrecht, Philipp Niggli, Jindrich Vomela, Richard Chaloupka, Hans-Christoph Pape, Ladislav Mica","doi":"10.26502/jsr.10020268","DOIUrl":"https://doi.org/10.26502/jsr.10020268","url":null,"abstract":"<p><p>The <i>Watson Trauma Pathway Explorer</i> <sup>®</sup> is an outcome prediction tool invented by the University Hospital of Zurich in collaboration with IBM<sup>®</sup>, representing an artificial intelligence application to predict the most adverse outcome scenarios in polytrauma patients: Systemic Inflammatory Respiratory Syndrome (SIRS), sepsis within 21 days and death within 72 h. The hypothesis was how lactate values woud be associated with the incidence of sepsis. Data from 3653 patients in an internal database, with ongoing implementation, served for analysis. Patients were split in two groups according to sepsis presence, and lactate values were measured at formerly defined time points from admission until 21 days after admission for both groups. Differences between groups were analyzed; time points with lactate as independent predictor for sepsis were identified. The predictive quality of lactate at 2 and 12 h after admission was evaluated. Threshold values between groups at all timepoints were calculated. Lactate levels differed from less than 2 h after admission until the end of the observation period (21 d). Lactate represented an independent predictor for sepsis from 12 to 48 h and 14 d to 21 d after admission relative to ISS levels. AUROC was poor at 2 and 12 h after admission with a slight improvement at the 12 h mark. Lactate levels decreased over time at a range of 2 [mmol/L] for 6-8 h after admission. These insights may allow for time-dependent referencing of lactate levels and anticipation of subsequent sepsis, although further parameters must be considered for a higher predictability.</p>","PeriodicalId":73961,"journal":{"name":"Journal of surgery and research","volume":"5 4","pages":"618-624"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9912541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10708929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Klaudia Gjinoska, O. Kostovski, A. Nikolovski, Daniela Bajdevska Dukoska, Agron Alimi, S. Antović
Mesenteric pseudocysts are rare intraabdominal lesions. A total of 29 similar case reports were retrieved via the Medline/PubMed search engine. They represent a subtype of mesenteric cysts displaying histological similarity to pancreatic pseudocysts which are usually surrounded by a thick fibrous wall without an inner epithelial lining. Mesenteric pseudocysts may present as any other expanding intraabdominal lesion. Accurate preoperative characterization of mesenteric cystic lesions remains challenging. Imaging diagnostics for most of the cases involve both ultrasound and computerized tomography. It is unclear whether routine MRI use would increase preoperative diagnostic accuracy and aid in preoperative planning. Total surgical excision of the pseudocyst has been the treatment of choice. Surgical removal has been achieved by means of open surgery, laparoscopy and the robotic system. It remains unclear to this date whether other treatment approaches are feasible. Other options such as debridement, marsupialization or partial excision have been considered inadequate due to concerns such as the possibility of malignant cell seeding, septic complications and risk of recurrence. We present the case of a posttraumatic mesenteric pseudocyst following blunt abdominal trauma in a 27 year old female, treated by surgical excision.
{"title":"Mesenteric Pseudocyst Following Blunt Abdominal Trauma: Report of a Case and Review of Literature","authors":"Klaudia Gjinoska, O. Kostovski, A. Nikolovski, Daniela Bajdevska Dukoska, Agron Alimi, S. Antović","doi":"10.26502/jsr.10020258","DOIUrl":"https://doi.org/10.26502/jsr.10020258","url":null,"abstract":"Mesenteric pseudocysts are rare intraabdominal lesions. A total of 29 similar case reports were retrieved via the Medline/PubMed search engine. They represent a subtype of mesenteric cysts displaying histological similarity to pancreatic pseudocysts which are usually surrounded by a thick fibrous wall without an inner epithelial lining. Mesenteric pseudocysts may present as any other expanding intraabdominal lesion. Accurate preoperative characterization of mesenteric cystic lesions remains challenging. Imaging diagnostics for most of the cases involve both ultrasound and computerized tomography. It is unclear whether routine MRI use would increase preoperative diagnostic accuracy and aid in preoperative planning. Total surgical excision of the pseudocyst has been the treatment of choice. Surgical removal has been achieved by means of open surgery, laparoscopy and the robotic system. It remains unclear to this date whether other treatment approaches are feasible. Other options such as debridement, marsupialization or partial excision have been considered inadequate due to concerns such as the possibility of malignant cell seeding, septic complications and risk of recurrence. We present the case of a posttraumatic mesenteric pseudocyst following blunt abdominal trauma in a 27 year old female, treated by surgical excision.","PeriodicalId":73961,"journal":{"name":"Journal of surgery and research","volume":"73 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87470506","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}
Ibrahim H Alawadh, Waleed M Alshehri, Nouf A Alshehri, Ahmed S Alsaleh, Ibrahim AlQuniabut, Sami A Alharethy
Closure Techniques and Suture Materials Upper Abstract Purpose Blepharoplasty is an operation performed for the correction of functional abnormalities and for esthetic appearance. Differences in various techniques include the wound closure technique and the suture materials used. In this review, we Few studies have been conducted on this subject; however, there are various suturing and non-suturing techniques available for upper blepharoplasty wound closure, and several materials are used for these suturing and non-suturing closure techniques. These techniques include suturing with different materials, such as an adhesive made of a polymer called cyanoacrylate and wound adhesive strips. The selection of the wound closure technique and material should be performed depending on the surgeon’s preference and experience.
{"title":"Closure Techniques and Suture Materials for Upper Blepharoplasty: An Extensive Narrative Literature Review","authors":"Ibrahim H Alawadh, Waleed M Alshehri, Nouf A Alshehri, Ahmed S Alsaleh, Ibrahim AlQuniabut, Sami A Alharethy","doi":"10.26502/jsr.10020213","DOIUrl":"https://doi.org/10.26502/jsr.10020213","url":null,"abstract":"Closure Techniques and Suture Materials Upper Abstract Purpose Blepharoplasty is an operation performed for the correction of functional abnormalities and for esthetic appearance. Differences in various techniques include the wound closure technique and the suture materials used. In this review, we Few studies have been conducted on this subject; however, there are various suturing and non-suturing techniques available for upper blepharoplasty wound closure, and several materials are used for these suturing and non-suturing closure techniques. These techniques include suturing with different materials, such as an adhesive made of a polymer called cyanoacrylate and wound adhesive strips. The selection of the wound closure technique and material should be performed depending on the surgeon’s preference and experience.","PeriodicalId":73961,"journal":{"name":"Journal of surgery and research","volume":"60 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77212922","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}
Tanja Birri, Hans-Christoph Pape, Cyrill Dennler, Hans-Peter Simmen, Jindrich Vomela, Richard Chaloupka, Ladislav Mica
Polytrauma is a major cause of death in young adults. The trial was to identify clusters of interlinked anatomical regions to improve strategical operational planning in the acute situation. A total of 2219 polytrauma patients with an ISS (Injury Severity Score) ≥ 16 and an age ≥ 16 years was included into this retrospective cohort study. Pearson's correlation was performed amongst the AIS (Abbreviated Injury Scale) groups. The predictive quality was tested by ROC (Receiver Operating Curve) and their area under the curve. Independency was tested by the binary logistic regression, AIS ≥3 was taken as a significant injury. The analysis was conducted using IBM SPSS® 24.0. The highest predictive value was reached in the combination of thorax, abdomen, pelvis and spine injuries (ROC: abdomen for thorax 0.647, thorax for abdomen 0.621, pelvis for thorax 0.608, pelvis for abdomen 0.651, spine for thorax 0.617). The binary logistic regression revealed the anatomical regions thorax, abdomen pelvis and spine as per-mutative independent predictors for each other when a particular injury exceeded the AIS ≥3. The documented clusters of injuries in truncal trauma are crucial to define priorities in the polytrauma management.
{"title":"Anatomical Injury Clusters in Polytrauma Patients.","authors":"Tanja Birri, Hans-Christoph Pape, Cyrill Dennler, Hans-Peter Simmen, Jindrich Vomela, Richard Chaloupka, Ladislav Mica","doi":"10.26502/jsr.10020270","DOIUrl":"https://doi.org/10.26502/jsr.10020270","url":null,"abstract":"<p><p>Polytrauma is a major cause of death in young adults. The trial was to identify clusters of interlinked anatomical regions to improve strategical operational planning in the acute situation. A total of 2219 polytrauma patients with an ISS (Injury Severity Score) ≥ 16 and an age ≥ 16 years was included into this retrospective cohort study. Pearson's correlation was performed amongst the AIS (Abbreviated Injury Scale) groups. The predictive quality was tested by ROC (Receiver Operating Curve) and their area under the curve. Independency was tested by the binary logistic regression, AIS ≥3 was taken as a significant injury. The analysis was conducted using IBM SPSS<sup>®</sup> 24.0. The highest predictive value was reached in the combination of thorax, abdomen, pelvis and spine injuries (ROC: abdomen for thorax 0.647, thorax for abdomen 0.621, pelvis for thorax 0.608, pelvis for abdomen 0.651, spine for thorax 0.617). The binary logistic regression revealed the anatomical regions thorax, abdomen pelvis and spine as per-mutative independent predictors for each other when a particular injury exceeded the AIS ≥3. The documented clusters of injuries in truncal trauma are crucial to define priorities in the polytrauma management.</p>","PeriodicalId":73961,"journal":{"name":"Journal of surgery and research","volume":"5 4","pages":"626-631"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9912614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10708930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Nishio, K. Kimura, A. Yamamoto, R. Amano, G. Ohira, Ken Kageyama, Kotaro Miura, Naoki Kametani, T. Ishizawa
Background: Postoperative liver failure is one of the most frequent causes of perioperative mortality in hepatectomy patients, even with preoperative portal vein embolization (PVE). However, recent research has found that administration of granulocyte colony-stimulating factor (G-CSF) improves liver function and increases the survival rate of patients with decompensated liver cirrhosis. This study aimed to determine the effects of G-CSF administration on liver hypertrophy after PVE in a rabbit model. Methods: Eight rabbits were divided into an embolization only (PVE) group (n = 4) and an embolization with G-CSF administration (G-CSF) group (n = 4). The degree of nonembolized liver volume hypertrophy (DLV) and the immunohistochemistry for Ki67, RAM11, and CD34 levels were compared between the two groups to quantify macrophage and cell proliferation and the presence of CD34-positive cells in the liver. Results: The median DLV in the PVE group was 14.7%, compared to 18.8% in the G-CSF group. This was a significant difference (p = 0.042). The expression of both Ki67 and RAM11 in the nonembolized parts of the livers of the G-CSF group was significantly greater than in the nonembolized livers of the PVE group (p = 0.0003). There was no significant difference in CD34 expression in the nonembolized livers of the rabbits in the two groups. Conclusions: In our rabbit model, the DLV and cell proliferation in the G-CSF group were significantly greater than in the PVE group. This suggests that G-CSF administration with PVE prompts the proliferation of liver
{"title":"Effects of Granulocyte Colony-Stimulating Factor Administration on Liver Hypertrophy After Portal Vein Embolization in a Rabbit Model","authors":"K. Nishio, K. Kimura, A. Yamamoto, R. Amano, G. Ohira, Ken Kageyama, Kotaro Miura, Naoki Kametani, T. Ishizawa","doi":"10.26502/jsr.10020249","DOIUrl":"https://doi.org/10.26502/jsr.10020249","url":null,"abstract":"Background: Postoperative liver failure is one of the most frequent causes of perioperative mortality in hepatectomy patients, even with preoperative portal vein embolization (PVE). However, recent research has found that administration of granulocyte colony-stimulating factor (G-CSF) improves liver function and increases the survival rate of patients with decompensated liver cirrhosis. This study aimed to determine the effects of G-CSF administration on liver hypertrophy after PVE in a rabbit model. Methods: Eight rabbits were divided into an embolization only (PVE) group (n = 4) and an embolization with G-CSF administration (G-CSF) group (n = 4). The degree of nonembolized liver volume hypertrophy (DLV) and the immunohistochemistry for Ki67, RAM11, and CD34 levels were compared between the two groups to quantify macrophage and cell proliferation and the presence of CD34-positive cells in the liver. Results: The median DLV in the PVE group was 14.7%, compared to 18.8% in the G-CSF group. This was a significant difference (p = 0.042). The expression of both Ki67 and RAM11 in the nonembolized parts of the livers of the G-CSF group was significantly greater than in the nonembolized livers of the PVE group (p = 0.0003). There was no significant difference in CD34 expression in the nonembolized livers of the rabbits in the two groups. Conclusions: In our rabbit model, the DLV and cell proliferation in the G-CSF group were significantly greater than in the PVE group. This suggests that G-CSF administration with PVE prompts the proliferation of liver","PeriodicalId":73961,"journal":{"name":"Journal of surgery and research","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86040906","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}
Background: The implementation of an organized screening strategy should include a cost-effectiveness analysis for the governments to take decisions that promote health and better allocate resources which does not happen most of the times. This study aimed to evaluate the most cost-effective strategy for CRC screening in a European Country. Methods: A cost-effectiveness (CE) probabilistic Markov model was developed to compare the costs and the quality-adjusted life expectancy of 50-year-old average-risk individuals submitted to five alternative screening strategies based on colonoscopy, computed tomography (CT) and FIT, as well as no screening. We calculated the costs from the perspective of a third payer (Portuguese National Health Service) and populated the model with data from published literature. Probability of being cost-effective was estimated for different thresholds of willingness-to-pay. Results: Colonoscopy 3/10 years is the most cost-effective strategy for colorectal screening in Portugal, with an estimated ICER of 802 €/ QALY when compared with colonoscopy every 10 years. The FIT and CT colonography based strategies are dominated by colonoscopy-based strategies. Biennial FIT, the strategy currently being used in Portugal, showed the smallest gains in life years gained (498.3 days) the smallest reduction in the incidence of CRC (-37%) and the smallest reduction in CRC mortality (-57%) between all the screening strategies. The findings were robust to probabilistic sensitivity analysis. Conclusions: Colonoscopy based strategies offer the best value for the money in Portugal. Biennial FIT, the screening strategy in Portugal should be replaced by a colonoscopy-based strategy. Screening European Country. A Comparison of Five Alternative Screening Strategies.
{"title":"Cost-effectiveness of Colorectal Screening in a European Country. A Comparison of Five Alternative Screening Strategies","authors":"Luís Lopes, M. Certo, Paula Veiga, J. Canena","doi":"10.26502/jsr.10020253","DOIUrl":"https://doi.org/10.26502/jsr.10020253","url":null,"abstract":"Background: The implementation of an organized screening strategy should include a cost-effectiveness analysis for the governments to take decisions that promote health and better allocate resources which does not happen most of the times. This study aimed to evaluate the most cost-effective strategy for CRC screening in a European Country. Methods: A cost-effectiveness (CE) probabilistic Markov model was developed to compare the costs and the quality-adjusted life expectancy of 50-year-old average-risk individuals submitted to five alternative screening strategies based on colonoscopy, computed tomography (CT) and FIT, as well as no screening. We calculated the costs from the perspective of a third payer (Portuguese National Health Service) and populated the model with data from published literature. Probability of being cost-effective was estimated for different thresholds of willingness-to-pay. Results: Colonoscopy 3/10 years is the most cost-effective strategy for colorectal screening in Portugal, with an estimated ICER of 802 €/ QALY when compared with colonoscopy every 10 years. The FIT and CT colonography based strategies are dominated by colonoscopy-based strategies. Biennial FIT, the strategy currently being used in Portugal, showed the smallest gains in life years gained (498.3 days) the smallest reduction in the incidence of CRC (-37%) and the smallest reduction in CRC mortality (-57%) between all the screening strategies. The findings were robust to probabilistic sensitivity analysis. Conclusions: Colonoscopy based strategies offer the best value for the money in Portugal. Biennial FIT, the screening strategy in Portugal should be replaced by a colonoscopy-based strategy. Screening European Country. A Comparison of Five Alternative Screening Strategies.","PeriodicalId":73961,"journal":{"name":"Journal of surgery and research","volume":"198 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79672620","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}
{"title":"Study to Compare Bilateral Lichtenstein Repair with Stoppa’s (Giant Prosthetic Reinforcement of The Visceral Sac) Repair in Cases of Bilateral Inguinal Hernia","authors":"J. Prakash, Rajiv Nandan Sahai","doi":"10.26502/jsr.10020264","DOIUrl":"https://doi.org/10.26502/jsr.10020264","url":null,"abstract":"","PeriodicalId":73961,"journal":{"name":"Journal of surgery and research","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76247942","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}
Juliette Strella, Q. Langouet, É. Marchand, J. Pucheux, A. Legras, Robert R. Martinez
Aberrant Left Subclavian Artery with Kommerell’s Diverticulum And Right Sided Aortic Arch: Hybrid Approach Abstract A 58 years-old woman presented a rare right-sided aortic arch with an aberrant left subclavian retro-esophageal artery, originates from Kommerell’s diverticulum. After left subclavian to carotid transposition, we implanted a thoracic endoprosthesis under ventricular fibrillation. Type IA symptomatic proximal endoleak was treated with a second endograft a week later. We shared here technical aspects and challenges of endovascular management, including precise preoperative imaging (CT angiography, lymphangio-MRI), the need of a hybrid operative room, conformable endoprosthesis and right ventricle overstimulation.
{"title":"Aberrant Left Subclavian Artery with Kommerell’s Diverticulum And Right Sided Aortic Arch: Hybrid Approach","authors":"Juliette Strella, Q. Langouet, É. Marchand, J. Pucheux, A. Legras, Robert R. Martinez","doi":"10.26502/jsr.10020229","DOIUrl":"https://doi.org/10.26502/jsr.10020229","url":null,"abstract":"Aberrant Left Subclavian Artery with Kommerell’s Diverticulum And Right Sided Aortic Arch: Hybrid Approach Abstract A 58 years-old woman presented a rare right-sided aortic arch with an aberrant left subclavian retro-esophageal artery, originates from Kommerell’s diverticulum. After left subclavian to carotid transposition, we implanted a thoracic endoprosthesis under ventricular fibrillation. Type IA symptomatic proximal endoleak was treated with a second endograft a week later. We shared here technical aspects and challenges of endovascular management, including precise preoperative imaging (CT angiography, lymphangio-MRI), the need of a hybrid operative room, conformable endoprosthesis and right ventricle overstimulation.","PeriodicalId":73961,"journal":{"name":"Journal of surgery and research","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85238182","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}
Gilles Houvenaeghel, Monique Cohen, Laura Sabiani, Aurore Van Troy, Olivia Quilichini, Axelle Charavil, Max Buttarelli, Sandrine Rua, Agnès Tallet, Alexandre de Nonneville, Marie Bannier
Immediate breast reconstruction (IBR) rates increase during last years and implant-based reconstruction was the most commonly performed procedure. We examined data collected over 25 months to assess complication rate, duration of surgery, patient's satisfaction and cost, according to pre-pectoral or sub-pectoral implant-IBR. All patients who received an implant-IBR, from January 2020 to January 2022, were included. Results were compared between pre-pectoral and sub-pectoral implant-IBR in univariate and multivariate analysis. We performed 316 implant-IBR, 218 sub-pectoral and 98 (31%) pre-pectoral. Pre-pectoral implant-IBR was significantly associated with the year (2021: OR=12.08 and 2022: OR=76.6), the surgeons and type of mastectomy (SSM vs NSM: OR=0.377). Complications and complications Grade 2-3 rates were 12.9% and 10.1% for sub-pectoral implant-IBR respectively, without significant difference with pre-pectoral implant-IBR: 17.3% and 13.2%. Complications Grade 2-3 were significantly associated with age <50-years (OR=2.27), ASA-2 status (OR=3.63) and cup-size >C (OR=3.08), without difference between pre and sub-pectoral implant-IBR. Durations of surgery were significantly associated with cup-size C and >C (OR=1.72 and 2.80), with sentinel lymph-node biopsy and axillary dissection (OR=3.66 and 9.59) and with sub-pectoral implant-IBR (OR=2.088). Median hospitalization stay was 1 day, without difference between pre and sub-pectoral implant-IBR. Cost of surgery was significantly associated with cup-size > C (OR=2.216) and pre-pectoral implant-IBR (OR=8.02). Bad-medium satisfaction and IBR-failure were significantly associated with local recurrence (OR=8.820), post-mastectomy radiotherapy (OR=1.904) and sub-pectoral implant-IBR (OR=2.098).
Conclusion: Complications were not different between pre and sub-pectoral implant-IBR. Pre-pectoral implant-IBR seems a reliable and faster technique with better patient satisfaction but with higher cost.
即时乳房重建(IBR)率在过去几年中增加，以植入物为基础的重建是最常见的手术。我们检查了超过25个月收集的数据，根据胸前或胸下植入物ibr评估并发症发生率、手术时间、患者满意度和成本。所有在2020年1月至2022年1月期间接受植入式ibr的患者均被纳入研究。结果在单因素和多因素分析中比较了胸前和胸下植入式ibr。我们进行了316例植入式ibr, 218例胸下ibr和98例(31%)胸前ibr。胸前植入物- ibr与年份(2021年:OR=12.08, 2022年:OR=76.6)、外科医生和乳房切除术类型(SSM vs NSM: OR=0.377)显著相关。胸下ibr组的并发症和并发症2-3级发生率分别为12.9%和10.1%，与胸前ibr组的17.3%和13.2%无显著差异。并发症2-3级与年龄C显著相关(OR=3.08)，胸前和胸下植入ibr无差异。手术时间与罩杯大小C和>C (OR=1.72和2.80)、前哨淋巴结活检和腋窝清扫(OR=3.66和9.59)以及胸下植入物- ibr (OR=2.088)显著相关。中位住院时间为1天，胸前和胸下植入ibr无差异。手术费用与罩杯尺寸> C (OR=2.216)和胸前植入物- ibr (OR=8.02)显著相关。不良介质满意度和ibr失败与局部复发(OR=8.820)、乳房切除术后放疗(OR=1.904)和胸下植入物- ibr (OR=2.098)显著相关。结论:胸前植入术与胸下植入术并发症无明显差异。胸前植入式ibr是一种可靠、快速的技术，患者满意度较高，但成本较高。
{"title":"Mastectomy and Immediate Breast Reconstruction with Pre-Pectoral or Sub-Pectoral Implant: Assessing Clinical Practice, Post-Surgical Outcomes, Patient's Satisfaction and Cost.","authors":"Gilles Houvenaeghel, Monique Cohen, Laura Sabiani, Aurore Van Troy, Olivia Quilichini, Axelle Charavil, Max Buttarelli, Sandrine Rua, Agnès Tallet, Alexandre de Nonneville, Marie Bannier","doi":"10.26502/jsr.10020250","DOIUrl":"https://doi.org/10.26502/jsr.10020250","url":null,"abstract":"<p><p>Immediate breast reconstruction (IBR) rates increase during last years and implant-based reconstruction was the most commonly performed procedure. We examined data collected over 25 months to assess complication rate, duration of surgery, patient's satisfaction and cost, according to pre-pectoral or sub-pectoral implant-IBR. All patients who received an implant-IBR, from January 2020 to January 2022, were included. Results were compared between pre-pectoral and sub-pectoral implant-IBR in univariate and multivariate analysis. We performed 316 implant-IBR, 218 sub-pectoral and 98 (31%) pre-pectoral. Pre-pectoral implant-IBR was significantly associated with the year (2021: OR=12.08 and 2022: OR=76.6), the surgeons and type of mastectomy (SSM vs NSM: OR=0.377). Complications and complications Grade 2-3 rates were 12.9% and 10.1% for sub-pectoral implant-IBR respectively, without significant difference with pre-pectoral implant-IBR: 17.3% and 13.2%. Complications Grade 2-3 were significantly associated with age <50-years (OR=2.27), ASA-2 status (OR=3.63) and cup-size >C (OR=3.08), without difference between pre and sub-pectoral implant-IBR. Durations of surgery were significantly associated with cup-size C and >C (OR=1.72 and 2.80), with sentinel lymph-node biopsy and axillary dissection (OR=3.66 and 9.59) and with sub-pectoral implant-IBR (OR=2.088). Median hospitalization stay was 1 day, without difference between pre and sub-pectoral implant-IBR. Cost of surgery was significantly associated with cup-size > C (OR=2.216) and pre-pectoral implant-IBR (OR=8.02). Bad-medium satisfaction and IBR-failure were significantly associated with local recurrence (OR=8.820), post-mastectomy radiotherapy (OR=1.904) and sub-pectoral implant-IBR (OR=2.098).</p><p><strong>Conclusion: </strong>Complications were not different between pre and sub-pectoral implant-IBR. Pre-pectoral implant-IBR seems a reliable and faster technique with better patient satisfaction but with higher cost.</p>","PeriodicalId":73961,"journal":{"name":"Journal of surgery and research","volume":"5 3","pages":"500-510"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9793874/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10466306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shannon M Smith, Jenna Stelmar, Grace Lee, Peter R Carroll, Maurice M Garcia
Introduction: It has been demonstrated that patient memory for medical information is often poor and inaccurate. The use of audio recordings for patient consultation has been described; however, to our knowledge this is the first reported use of audio recordings in consultation for gender-affirming surgery. Our aim was to determine whether, and specifically how, audio recording the consultation of patients presenting for genital gender-affirming surgery would be of benefit to patients.
Materials and methods: We began to offer all new patients the opportunity to have their consultations recorded. At the end of the consultation the recording was uploaded to a USB, which was given to the patient to keep. We then surveyed all patients who had received a copy of their recorded consultation to query the utility of having access to an audio recording of their consultation.
Results: 71/72 (98.6%) patients who were given the option to have their consultation recorded chose to do so. 50/71 (70%) of patients who had their consultation recorded responded to our survey. Patients reported that having access to a voice recording of their consultation was beneficial and was viewed overwhelmingly positively.
Conclusions: Routine audio recording of patient consultations is highly beneficial to patients, with little cost to providers, and should be considered as a valuable addition to the new patient consultation. This approach may have applications in broader clinical contexts where patients face numerous, complex, and nuanced management options. The study would benefit from continued application and a larger (multi-center, international) sample.
{"title":"Use of Voice Recordings in the Consultation of Patients Seeking Genital Gender-Affirming Surgery: An Opportunity for Broader Application Throughout Surgery?","authors":"Shannon M Smith, Jenna Stelmar, Grace Lee, Peter R Carroll, Maurice M Garcia","doi":"10.26502/jsr.10020269","DOIUrl":"https://doi.org/10.26502/jsr.10020269","url":null,"abstract":"<p><strong>Introduction: </strong>It has been demonstrated that patient memory for medical information is often poor and inaccurate. The use of audio recordings for patient consultation has been described; however, to our knowledge this is the first reported use of audio recordings in consultation for gender-affirming surgery. Our aim was to determine whether, and specifically how, audio recording the consultation of patients presenting for genital gender-affirming surgery would be of benefit to patients.</p><p><strong>Materials and methods: </strong>We began to offer all new patients the opportunity to have their consultations recorded. At the end of the consultation the recording was uploaded to a USB, which was given to the patient to keep. We then surveyed all patients who had received a copy of their recorded consultation to query the utility of having access to an audio recording of their consultation.</p><p><strong>Results: </strong>71/72 (98.6%) patients who were given the option to have their consultation recorded chose to do so. 50/71 (70%) of patients who had their consultation recorded responded to our survey. Patients reported that having access to a voice recording of their consultation was beneficial and was viewed overwhelmingly positively.</p><p><strong>Conclusions: </strong>Routine audio recording of patient consultations is highly beneficial to patients, with little cost to providers, and should be considered as a valuable addition to the new patient consultation. This approach may have applications in broader clinical contexts where patients face numerous, complex, and nuanced management options. The study would benefit from continued application and a larger (multi-center, international) sample.</p>","PeriodicalId":73961,"journal":{"name":"Journal of surgery and research","volume":"5 4","pages":"618-625"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9836232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10538884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号