Surgery in practice and science最新文献

{"title":"Impact of nursing home admission on in-hospital mortality and morbidity and length of stay: A case-control analysis","authors":"Claudio Canal ,&nbsp;Anne-Sophie Mittlmeier ,&nbsp;Valentin Neuhaus ,&nbsp;Hans-Christoph Pape ,&nbsp;Mathias Schlögl","doi":"10.1016/j.sipas.2024.100243","DOIUrl":"https://doi.org/10.1016/j.sipas.2024.100243","url":null,"abstract":"<div><h3>Methods</h3><p>We examined a quality measurement database containing de-identified cases from across Switzerland. All patients with a complete dataset treated between 2015 and 2021 were included. A case-control matching method (same age, comorbidity, sex, diagnosis, admission type, and insurance coverage) was used to evaluate the impact of pre-admission residence. The outcomes measured included complications during hospitalization, in-hospital mortality, and length of stay. Statistical significance was set at a p-value of &lt;0.001 due to our large size of analyzed cases.</p></div><div><h3>Results</h3><p>We noted a higher prevalence of comorbidities and higher ASA scores among the 2130 (1.9 %) patients admitted from long-term care facilities (LTCFs). Complication rates in the LTCF group were higher than those in the home group (15 % vs. 6.9 %, <em>p</em> = &lt;0.001). Pneumonia was the most frequent complication in both groups. The in-hospital mortality rate was also significantly higher in the LTCF group than the home group (5.8 % vs. 1.1 %, <em>p</em> = &lt;0.001). However, matched-pair analysis showed no significant difference in complication rates and overall mortality between the two groups. Patients admitted from LTCFs even had a shorter hospital stay (7.5 ± 8.7 days vs. 8.9 ± 7.9 days, <em>p</em> = &lt;0.004).</p></div><div><h3>Conclusions</h3><p>Despite higher complication and mortality rates among LTCF patients, the matched-pair analysis showed no significant differences in these rates between the two groups. However, patients from LTCFs were discharged earlier, indicating the effectiveness of Switzerland's care system for older adults living in nursing homes.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"17 ","pages":"Article 100243"},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266626202400010X/pdfft?md5=dd3de3c847b126c1e6b6d000e3f9c42f&pid=1-s2.0-S266626202400010X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140344591","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}

{"title":"Preoperative pulmonary function is associated with left ventricular assist device outcomes","authors":"Austin Kluis,&nbsp;Aasim Afzal,&nbsp;Greg Milligan,&nbsp;J. Michael DiMaio,&nbsp;Nitin Kabra,&nbsp;David A. Rawitscher,&nbsp;Timothy J. George","doi":"10.1016/j.sipas.2024.100242","DOIUrl":"https://doi.org/10.1016/j.sipas.2024.100242","url":null,"abstract":"<div><h3>Introduction</h3><p>Although left ventricular assist device (LVAD) implantation is associated with improved survival in patients with end-stage heart failure, the impact of preoperative pulmonary function on short-term outcomes is unclear.</p></div><div><h3>Methods</h3><p>We conducted a retrospective review of all primary LVAD implants at a single institution. Common measures of preoperative pulmonary function were evaluated. Survival was estimated using the Kaplan-Meier method.</p></div><div><h3>Results</h3><p>From 2017–2022, 107 patients underwent primary LVAD implantation. Prior to implantation, 68 (63.6 %) were on room air, 28 (26.4 %) were on nasal cannula, 2 (1.9 %) were on noninvasive positive pressure ventilation, and 9 (8.5 %) were on the ventilator. The average preoperative fraction of inspired oxygen (FiO2) was 25.3 ± 8.2 % while the mean percentage predicted forced expiratory volume in 1 second (FEV1) was 71.4 ± 20.9 %. Overall, 1-year survival was 86.8 %, the median postoperative ventilator time was 20.4 [4.2-77.7] h, and 18 (16.8 %) patients required postoperative tracheostomy. When stratified by pulmonary function, lower FEV1 and increased preoperative FiO2 were associated with decreased 1-year survival</p></div><div><h3>Conclusions</h3><p>In conclusion, preoperative pulmonary function is associated with short-term LVAD survival, postoperative ventilatory time, and need for tracheostomy. Therefore, rigorous pulmonary function evaluation may help in appropriate preoperative risk stratification.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"17 ","pages":"Article 100242"},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262024000093/pdfft?md5=bcaae70819b2517254c29af31b8989af&pid=1-s2.0-S2666262024000093-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140328184","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}

{"title":"Retrospective registry-based nationwide analysis of the COVID-19 lockdown effect on the volume of general and visceral non-malignant surgical procedures","authors":"René Fahrner ,&nbsp;Eliane Dohner ,&nbsp;Fiona Joséphine Kierdorf ,&nbsp;Claudio Canal ,&nbsp;Valentin Neuhaus","doi":"10.1016/j.sipas.2024.100241","DOIUrl":"https://doi.org/10.1016/j.sipas.2024.100241","url":null,"abstract":"<div><h3>Introduction</h3><p>Coronavirus disease 2019 (COVID-19) is an acute virus infection, which was declared a pandemic by the World Health Organization. The Swiss government decreed a public lockdown to reduce and restrict further infections. The aim of this investigation was to analyze the impact of the first COVID-19 lockdown on the performance of general and visceral surgery procedures.</p></div><div><h3>Materials and Methods</h3><p>A retrospective study was performed on the basis of the surgical registry of the working group for quality assurance in surgery (“Arbeitsgemeinschaft für Qualitätssicherung in der Chirurgie” or AQC). All patients with specific surgical diagnoses (complicated gastric or duodenal ulcer, acute appendicitis, hernia, diverticular disease, gallstone disease, pilonidal sinus, cutaneous and perianal abscess) were analyzed during 2019 and the corresponding lockdown period of March 14 through April 26, 2020. Data regarding patients’ characteristics, diagnoses, and treatments were analyzed.</p></div><div><h3>Results</h3><p>In total, 3,330 patients were analyzed, with 2,203 patients treated in 2019 and 1,127 patients treated in 2020. There was a reduction in the number of all investigated diagnoses during the pandemic period, with statistically significant differences in acute appendicitis, hernia, diverticular disease, gallstone disease, pilonidal sinus (all <em>p</em> &lt; 0.001), and cutaneous abscess (<em>p</em> = 0.01). The proportion of complicated appendicitis (<em>p</em> = 0.02), complicated hernia (<em>p</em> &lt; 0.001), and complicated gallstone disease (choledocholithiasis <em>p</em> = 0.01; inflammation, <em>p</em> = 0.001) was significantly higher during the lockdown period. The surgical urgency rate in all patients was higher during the lockdown period compared to the control period (<em>p</em> &lt; 0.001).</p></div><div><h3>Conclusions</h3><p>The socioeconomic lockdown significantly impacted the number of general and visceral surgery procedures in Switzerland. The reasons for the reduction are multifactorial.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"17 ","pages":"Article 100241"},"PeriodicalIF":0.0,"publicationDate":"2024-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262024000081/pdfft?md5=75a3ce301b9c8f3a92a1b2cb93d00fc0&pid=1-s2.0-S2666262024000081-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140164035","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}

{"title":"Receptor discordance after nipple-sparing mastectomy","authors":"Rena Kojima ,&nbsp;Makoto Ishitobi ,&nbsp;Naomi Nagura ,&nbsp;Ayaka Shimo ,&nbsp;Hirohito Seki ,&nbsp;Akiko Ogiya ,&nbsp;Teruhisa Sakurai ,&nbsp;Yukiko Seto ,&nbsp;Shinsuke Sasada ,&nbsp;Chiya Oshiro ,&nbsp;Michiko Kato ,&nbsp;Takahiko Kawate ,&nbsp;Naoto Kondo ,&nbsp;Tadahiko Shien","doi":"10.1016/j.sipas.2024.100239","DOIUrl":"https://doi.org/10.1016/j.sipas.2024.100239","url":null,"abstract":"<div><h3>Background</h3><p>Recent studies have shown that receptor status of breast cancer change between primary tumor and recurrence, which may influence treatment strategy and prognosis, but there are few reports on receptor discordance between primary tumors and local recurrence (LR) after nipple-sparing mastectomy (NSM).</p></div><div><h3>Patients and methods</h3><p>We collected 74 patients who had LR after NSM for newly diagnosed stages 0 to 3 breast cancer between 2008 and 2016 at 14 institutions. We classified into 4 subtypes based on hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2). We evaluated clinicopathological factors that correlate with receptor discordance and assessed the impact of receptor discordance on survival.</p></div><div><h3>Results</h3><p>Discordance rates in estrogen receptor (ER), progesterone receptor (PgR) and HER2 were 9.5, 10.8 and 5.4 %, respectively. The most common change was from HR-/HER2+ to HR+/HER2+, and this pattern of receptor change occurred only in patients with nipple–areolar recurrence. Non-invasive tumors in LR, nipple–areolar recurrence (NAR), HR-/HER2+ primary tumor subtype, and the presence of chemotherapy for primary tumors were significantly associated with receptor discordance. With a median follow-up of 44.5 months (4–153 months), patients in the receptor-discordant group had no disease-free survival (DFS) event after LR resection (5-year DFS; 100 % in the receptor-discordant group vs 85.1 % in the receptor-concordant group; <em>p</em> = 0.2).</p></div><div><h3>Conclusion</h3><p>Our study demonstrates that the presence of chemotherapy for primary tumors, nipple-areolar recurrence, and its related factors (non-invasive tumor in LR, HR-/HER2+ primary tumor subtype) were associated with receptor discordance. However, further studies with longer follow-up periods and larger sample sizes are needed.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"17 ","pages":"Article 100239"},"PeriodicalIF":0.0,"publicationDate":"2024-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262024000068/pdfft?md5=b7091c311e0271e7e2fb777cf2be4321&pid=1-s2.0-S2666262024000068-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140063140","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}

{"title":"A meta-analysis of the American college of surgeons risk calculator's predictive accuracy among different surgical sub-specialties","authors":"Alyssa M. Goodwin,&nbsp;Steven S. Kurapaty,&nbsp;Jacqueline E. Inglis,&nbsp;Srikanth N. Divi,&nbsp;Alpesh A. Patel,&nbsp;Wellington K. Hsu","doi":"10.1016/j.sipas.2024.100238","DOIUrl":"https://doi.org/10.1016/j.sipas.2024.100238","url":null,"abstract":"<div><h3>Background</h3><p>The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) provides risk estimates of postoperative complications. While several studies have examined the accuracy of the ACS-Surgical Risk Calculator (SRC) within a single specialty, the respective conclusions are limited by sample size. We sought to conduct a meta-analysis to determine the accuracy of the ACS-SRC among various surgical specialties.</p></div><div><h3>Study design</h3><p>Clinical studies that utilized the ACS-SRC, predicted complication rates compared to actual rates, and analyzed at least one metric reported by ACS-SRC met the inclusion criteria. Data for each specialty were pooled using the DerSimonian and Laird random-effect models and analyzed with the binary random-effect model to produce risk difference (RD) and 95 % confidence intervals (CIs) using Open Meta[A<em>nalyst</em>].</p></div><div><h3>Results</h3><p>The initial search yielded 281 studies and, after applying inclusion and exclusion criteria, a total of 53 studies remained with a total sample of 30,134 patients spanning 10 surgical specialties. When considering any complication and death, the ACS-SRC significantly underpredicted complications for: Orthopaedic Surgery (RD –0.067, <em>p</em> = 0.008), Spine (RD -0.027, <em>p</em> &lt; 0.001), Urology (RD -0.03, <em>p</em> &lt; 0.001), Surgical Oncology (RD -0.045, <em>p</em> &lt; 0.001), and Gynecology (RD -0.098, <em>p</em> = 0.01).</p></div><div><h3>Conclusion</h3><p>The ACS-SRC proved useful in General, Acute Care, Colorectal, Otolaryngology, and Cardiothoracic Surgery, but significantly underpredicted complication rates in Spine, Orthopaedics, Urology, Surgical Oncology, and Gynecology. These data indicate the ACS-SRC is a reliable predictor in some specialties, but its use should be cautioned in the remaining specialties evaluated here.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"16 ","pages":"Article 100238"},"PeriodicalIF":0.0,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262024000056/pdfft?md5=d20a6752b84c885e3126caa50207a7e2&pid=1-s2.0-S2666262024000056-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139748894","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}

{"title":"Totally implantable venous access devices: A restrospective analysis of morbidity and risk factors in a hospital with multi-technique approaches","authors":"Diogo Melo-Pinto ,&nbsp;Tatiana Moreira-Marques ,&nbsp;Emanuel Guerreiro ,&nbsp;Marina Morais","doi":"10.1016/j.sipas.2024.100237","DOIUrl":"10.1016/j.sipas.2024.100237","url":null,"abstract":"<div><h3>Background</h3><p>Totally implantable venous central access devices (TIVADs) can be implanted by open surgery or by direct puncture in the subclavian (ScV), internal jugular (IJV) or cephalic (CephV) veins.</p></div><div><h3>Methods</h3><p>A retrospective study was conducted in 201 patients. Thirty-day follow-up data was analyzed to compare the outcomes of different techniques and evaluation of risk factors.</p></div><div><h3>Results</h3><p>Complications were reported in 3.8 % of the patients with no overall differences between different vascular accesses. Direct puncture was associated with more accidental arterial punction (<em>p</em> = 0.01). History of previous catheters was a risk factor for immediate complications (<em>p</em> = 0.01) and patients with history of thoracic disease had more early and late complications (<em>p</em> = 0.03 and <em>p</em> = 0.04, respectively). Late complications were more common in patients over 60 years old (<em>p</em> = 0.04) and with chronic pain (<em>p</em> = 0.03).</p></div><div><h3>Conclusion</h3><p>There was no difference in overall complication rates between the implantation techniques. Further prospective randomized controlled trials would clarify the most effective technique.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"16 ","pages":"Article 100237"},"PeriodicalIF":0.0,"publicationDate":"2024-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262024000044/pdfft?md5=4a2c892ebed4924920e701b37020f8a4&pid=1-s2.0-S2666262024000044-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139823048","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}

{"title":"Donor hepatitis C status is not associated with an increased risk of acute rejection in kidney transplantation","authors":"John C. Johnson ,&nbsp;Trine Engebretsen ,&nbsp;Muhammad Mujtaba ,&nbsp;Heather L Stevenson ,&nbsp;Rupak Kulkarni ,&nbsp;A. Scott Lea ,&nbsp;Akshata Moghe ,&nbsp;Syed Hussain ,&nbsp;Michael Kueht","doi":"10.1016/j.sipas.2024.100236","DOIUrl":"https://doi.org/10.1016/j.sipas.2024.100236","url":null,"abstract":"<div><h3>Introduction</h3><p>In renal transplantation, donor hepatitis C virus (HCV) status is crucial to consider when selecting a recipient given the high likelihood of transmission. We analyzed the effect of donor HCV status on post-renal transplant rejection and virologic infectious outcomes using electronic health record data from multiple US health care organizations.</p></div><div><h3>Methods</h3><p>Using real world data from electronic health records of renal transplant recipients, a propensity score-matched case-control study of one-year renal transplant outcomes was conducted on cohorts of HCV-negative recipients who received an organ from an HCV-positive donor (HCV D+/R-) versus from an HCV-negative donor (HCV D-/R-). Donor HCV positivity was defined as new recipient HCV positivity within 30 days post-transplant. Cohorts were matched by major risk factors for rejection including age, gender, race, etiologies of end-stage renal disease, dialysis dependence, donor type, induction immunosuppression, and virologic lab studies. The primary outcome was one-year incidence of rejection. Secondary outcomes included longitudinal measures of liver and kidney function, incidence of non-HCV viremia, and DAA treatment pathways and responses.</p></div><div><h3>Results</h3><p>Data from 900 renal transplant recipients were analyzed, 450 subjects per group (D+/R-, <span>D</span>-/R-). Mean age at transplant was 57.1 ± 11.9 years, 60 % were male, and 38 % were African American. Kaplan-Meier analysis showed a significantly increased incidence of one-year rejection for HCV <span>D</span>-/R- compared to HCV D+/R- (16.6% vs 22.8 %, <em>p</em> = 0.02). This difference did not persist on a sub-analysis excluding subjects with delayed graft function (DGF) (16.3% vs 19.2 %, <em>p</em> = 0.25). Although mean eGFR was initially higher in HCV D+/R-, there were no significant differences in liver or kidney allograft function at 12 months. There was no significant difference for composite viremia (CMV/EBV/BK; 37.66% vs 31.60 %, <em>p</em> = 0.07). The most common DAA regimen was glecaprevir/pibrentasvir (52.8 %). DAA treatment responses were excellent, with most subjects having a negative viral load by 90 days (mean: 1.7 ± 1.9 log units/mL).</p></div><div><h3>Conclusion</h3><p>Donor HCV positivity did not negatively impact one-year rejection outcomes post-renal transplantation. Importantly, this effect was not biased by age. Anti-HCV treatment was effective and liver and kidney function were excellent at one-year post-transplant. These data support the continued expansion of the donor pool by utilizing organs from HCV-positive donors in the era of anti-HCV direct-acting antiviral therapies.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"16 ","pages":"Article 100236"},"PeriodicalIF":0.0,"publicationDate":"2024-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262024000032/pdfft?md5=6c27ad30bf0f26896a955d37f73b7c63&pid=1-s2.0-S2666262024000032-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139718263","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}

{"title":"Variation in approach for midsize (4-6cm) ventral hernias across a statewide quality improvement collaborative","authors":"Anne P. Ehlers ,&nbsp;Alex K. Hallway ,&nbsp;Sean M. O'Neill ,&nbsp;Brian T. Fry ,&nbsp;Ryan A. Howard ,&nbsp;Jenny M. Shao ,&nbsp;Michael J. Englesbe ,&nbsp;Justin B Dimick ,&nbsp;Dana A Telem ,&nbsp;Grace J Kim","doi":"10.1016/j.sipas.2024.100235","DOIUrl":"10.1016/j.sipas.2024.100235","url":null,"abstract":"<div><h3>Introduction</h3><p>Repair of midsize (4–6 cm) ventral hernias is challenging given lack of guidelines. Within this context, we sought to characterize surgical approach among patients undergoing repair of midsize ventral hernias within the only population-level, clinically-nuanced hernia registry in the US.</p></div><div><h3>Methods</h3><p>Retrospective cohort study of patients undergoing ventral hernia repair in the Michigan Surgical Quality Collaborative Core Optimization Hernia Registry (MSQC<img>COHR). MSQC<img>COHR is the only US population-level registry that captures clinically-nuanced data pertaining to patient hernia characteristics. We included patients who underwent repair of a 4–6 cm hernia from January 1, 2020-June 30, 2022. We stratified repair type as open or minimally invasive and used a multivariable logistic regression model to identify factors associated with MIS approach. Secondary outcomes included complications rate.</p></div><div><h3>Results</h3><p>Among 771 patients, mean hernia width (SD) was 4.7 cm (0.8) and 339 (44 %) underwent MIS approach. Patients with MIS approach had lower BMI (33.5 vs 34.8, <em>p</em> = 0.02) and less often were ASA class III (47.5% vs 54.6 %, <em>p</em> = 0.02) or ASA class IV (2.4% vs 4.2 %, <em>p</em> = 0.02). MIS approach was associated with smaller mean hernia width (4.71 cm vs 4.84 cm, <em>p</em> = 0.02) and was used more often in the elective setting (94.4% vs 84.0 %, <em>p</em> &lt; 0.01). In the multivariable logistic regression model, higher BMI (aOR 0.97, 95 % CI 0.94–0.99) and urgent/emergent surgery (aOR 0.43, 95 % CI 0.24–0.79) were associated with lower odds of MIS. We found no significant association between MIS and risk of complications (aOR 0.62, 95 % CI 0.37–1.04). Among patients undergoing MIS, more than half (<em>n</em> = 236, 69.6 %) had a robotic approach but there were few patient factors associated with this.</p></div><div><h3>Conclusion</h3><p>Among patients with midsize hernias, few patient-level factors are associated with approach. This may indicate that surgeon preference factors largely into this decision.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"16 ","pages":"Article 100235"},"PeriodicalIF":0.0,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262024000020/pdfft?md5=61bbd733875b6999ed02afb740eb4712&pid=1-s2.0-S2666262024000020-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139635958","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}

{"title":"Delayed return of bowel function after general surgery in South Australia","authors":"Joshua G. Kovoor ,&nbsp;Stephen Bacchi ,&nbsp;Brandon Stretton ,&nbsp;Aashray K. Gupta ,&nbsp;Jonathan Henry W. Jacobsen ,&nbsp;Minh-Son To ,&nbsp;Rudy Goh ,&nbsp;Joseph N. Hewitt ,&nbsp;Christopher D. Ovenden ,&nbsp;Leigh Warren ,&nbsp;Matthew Marshall-Webb ,&nbsp;Karen L. Jones ,&nbsp;Benjamin A. Reddi ,&nbsp;Danny Liew ,&nbsp;Christopher Dobbins ,&nbsp;Robert T. Padbury ,&nbsp;Peter J. Hewett ,&nbsp;Thomas J. Hugh ,&nbsp;Markus I. Trochsler ,&nbsp;Guy J. Maddern","doi":"10.1016/j.sipas.2024.100234","DOIUrl":"https://doi.org/10.1016/j.sipas.2024.100234","url":null,"abstract":"<div><h3>Introduction</h3><p>Reference ranges for determining pathological versus normal postoperative return of bowel function are not well characterised for general surgery patients. This study aimed to characterise time to first postoperative passage of stool after general surgery; determine associations between clinical factors and delayed time to first postoperative stool; and evaluate the association between delay to first postoperative stool and prolonged length of hospital stay.</p></div><div><h3>Methods</h3><p>This study included consecutive admissions at two tertiary hospitals across a two-year period whom underwent a range of general surgery operations. Multivariable logistic regression analyses were conducted to determine associations between the explanatory variables and delayed first postoperative stool, and between delayed first postoperative stool and length of hospital stay. The previously specified explanatory variables were used, with the addition of the dichotomised ≥4-day delay to first postoperative stool. Prolonged length of hospital stay was considered ≥7 days.</p></div><div><h3>Results</h3><p>2,212 general surgery patients were included. Median time to first postoperative stool was 2.28 (IQR 1.06–3.96). Median length of stay was 7.19 (IQR 4.50–12.01). Several operative characteristics and medication exposures were associated with delayed first postoperative stool. There was a statistically significant association between delayed first postoperative stool (≥4 days) and prolonged length of stay (≥7 days) (OR 4.34, 95 %CI 3.27 to 5.77, <em>p</em> &lt; 0.001).</p></div><div><h3>Conclusions</h3><p>This study characterised expected reference ranges for time to return of bowel function across various general surgery operations and determined associations with clinical factors that may improve efficiency and identification of pathology within the postoperative course.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"16 ","pages":"Article 100234"},"PeriodicalIF":0.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262024000019/pdfft?md5=cdaebfe647c445c684835b5ed7869716&pid=1-s2.0-S2666262024000019-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139434624","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}

{"title":"A retrospective cohort study of the effect of sugammadex versus neostigmine on postoperative gastrointestinal motility in open colorectal surgical procedures","authors":"Taylor N. Harris ,&nbsp;Eric G. Johnson ,&nbsp;Aric Schadler ,&nbsp;Jitesh Patel ,&nbsp;Ekaterina Fain ,&nbsp;Laura M. Ebbitt","doi":"10.1016/j.sipas.2023.100233","DOIUrl":"https://doi.org/10.1016/j.sipas.2023.100233","url":null,"abstract":"<div><h3>Introduction</h3><p>Neuromuscular blockers (NMB) are used in surgical procedures to facilitate muscle relaxation and intubation. NMBs are then reversed at the end of the surgery with either an acetylcholinesterase inhibitor, such as neostigmine, or a modified cyclodextrin compound, such as sugammadex. Neostigmine and glycopyrrolate elicit counteracting cholinergic effects, potentially impairing postoperative gastrointestinal motility. This may have higher significance in colorectal surgery procedures given the baseline risk of delayed postoperative motility associated with some operations.</p></div><div><h3>Methods</h3><p>This is a retrospective, single-center, cohort review of open colorectal procedures that received either sugammadex alone, or neostigmine with glycopyrrolate. The primary outcome was time from end of colorectal procedure to time of first bowel movement. Secondary outcomes included incidence of postoperatively placed nasogastric tubes, nausea and vomiting, need for motility agents or TPN, hospital length of stay, 30-day hospital readmission or return to emergency department (ED).</p></div><div><h3>Results</h3><p>A total of 99 patients were included in the sugammadex group and 350 in the neostigmine + glycopyrrolate group. Time to first bowel movement was significantly faster in the sugammadex group (61.7 h) compared to the neostigmine group (71.9 h) (<em>p</em> = 0.03). Secondary outcomes were similar between the two groups, except for a higher incidence of postoperative nausea and vomiting in the sugammadex group (<em>p</em> = 0.04).</p></div><div><h3>Discussion</h3><p>These findings support that sugammadex may be utilized for open colorectal procedures to aid in earlier discharge which could lead to differences in length of stay. Using sugammadex did not result in patients requiring additional interventions or experiencing symptoms of post-operative ileus.</p></div><div><h3>Conclusion</h3><p>Compared to neostigmine and glycopyrrolate, patients receiving sugammadex for neuromuscular blockade reversal in open colorectal procedures experienced a shorter time to return of bowel function. The results from this study confirm the findings from previous retrospective studies that were conducted.</p></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"16 ","pages":"Article 100233"},"PeriodicalIF":0.0,"publicationDate":"2023-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666262023000797/pdfft?md5=a5a7b22dd1a4bea616ea77d980ee166d&pid=1-s2.0-S2666262023000797-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139099849","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}