scholarly journals Is Nighttime Really Not the Right Time for a Laparoscopic Cholecystectomy?

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Anna C. M. Geraedts ◽  
Meindert N. Sosef ◽  
Jan Willem M. Greve ◽  
Mechteld C. de Jong
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Postoperative Morbidity ◽  
Time Of Day ◽  
Outcome Data ◽  
Emergency Procedure ◽  
Out Of Hours ◽  
Increased Risk ◽  
The Right ◽  
The Impact ◽  
Univariate Analyses

Purpose. The impact of an out-of-hours laparoscopic cholecystectomy on outcome is controversial. We sought to determine the association between an out-of-hours procedure and postoperative complications within 90 days. Methods. Between 2014 and 2016, 1553 laparoscopic cholecystectomies were performed. Therapeutic, operative, and outcome data were prospectively collected and analyzed. We defined out of hours as during weekends, national holidays, and daily between 5PM and 8AM. Results. Most patients operated on were female (n=988; 63.6%) and the majority of procedures were electives (n=1341; 86.3%). Although all procedures were performed with a laparoscopic intent, 42 (2.7%) were converted to open procedure. In total, 145 (9.3%) procedures were out of hours, all nonelective, and in most cases for acute cholecystitis (n=111; 7.1%). Overall, there were 212 complications in 191 patients (12.3%), most (n=153; 9.9%) classified as minor. The conversion rate in the out-of-hours group was significantly higher (9.7% vs 2.0%; p<0.001). While univariate analyses revealed out-of-hours procedure (OR=1.83; p=0.008) to be associated with an increased risk of complications, when controlling for confounding factors by multivariate analysis, this association was not found. However, operation by surgical staff (OR=1.71) and conversion to laparotomy (OR=3.74) were found to be independently associated with an increased risk of complications (both p<0.05), while an emergency procedure tended to be associated with postoperative morbidity (OR=1.82; p=0.069). Conclusion. An out-of-hours laparoscopic cholecystectomy was not found to be an independent risk factor for developing postoperative morbidity and time of day should therefore only be a relative contraindication.

scholarly journals The Management of Myelomeningocele Study: Short-Term Neonatal Outcomes

2020 ◽  
Vol 47 (12) ◽  
pp. 865-872 ◽  
Author(s):  
Natalie E. Rintoul ◽  
Roberta L. Keller ◽  
William F. Walsh ◽  
Pamela K. Burrows ◽  
Elizabeth A. Thom ◽  
...  
Keyword(s):  
New England ◽  
Gestational Age ◽  
Periventricular Leukomalacia ◽  
Ductus Arteriosus ◽  
Outcome Data ◽  
Neonatal Outcomes ◽  
Increased Risk ◽  
Significant Difference ◽  
The Impact ◽  
Prenatal Surgery

<b><i>Introduction:</i></b> The Management of Myelomeningocele Study was a multicenter randomized trial to compare prenatal and standard postnatal repair of myelomeningocele (MMC). Neonatal outcome data for 158 of the 183 randomized women were published in <i>The New England Journal of Medicine</i> in 2011. <b><i>Objective:</i></b> Neonatal outcomes for the complete trial cohort (<i>N</i> = 183) are presented outlining the similarities with the original report and describing the impact of gestational age as a mediator. <b><i>Methods:</i></b> Gestational age, neonatal characteristics at delivery, and outcomes including common complications of prematurity were assessed. <b><i>Results:</i></b> Analysis of the complete cohort confirmed the initial findings that prenatal surgery was associated with an increased risk for earlier gestational age at birth. Delivery occurred before 30 weeks of gestation in 11% of neonates that had fetal MMC repair. Adverse pulmonary sequelae were rare in the prenatal surgery group despite an increased rate of oligohydramnios. There was no significant difference in other complications of prematurity including patent ductus arteriosus, sepsis, necrotizing enterocolitis, periventricular leukomalacia, and intraventricular hemorrhage. <b><i>Conclusion:</i></b> The benefits of prenatal surgery outweigh the complications of prematurity.

scholarly journals Porta Hepatis Injury during Laparoscopic Cholecystectomy

2020 ◽  
Vol 14 (1) ◽  
pp. 234-241
Author(s):  
Reem Shammout ◽  
Raiean Al Habbal ◽  
Fadi Rayya
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Treatment Strategy ◽  
Surgical Complication ◽  
Operative Procedure ◽  
Porta Hepatis ◽  
Mortality And Morbidity ◽  
Hepatic Lobe ◽  
The Right ◽  
Vasculobiliary Injury ◽  
The Impact

Iatrogenic porta hepatis injury is a rare but devastating surgical complication of laparoscopic cholecystectomy. There are no systematic studies examining the best treatment strategy in patients with this injury. We present a case of a 23-year-old woman with a large abscess in the right hepatic lobe due to an extreme vasculobiliary injury after laparoscopic cholecystectomy. Although rare, the impact of vasculobiliary injuries after cholecystectomy highlights the need for constant alertness and prompt management in order to minimize mortality and morbidity usually associated with the routine operative procedure.

scholarly journals Recurrent delirium over 12 months predicts dementia: results of the Delirium and Cognitive Impact in Dementia (DECIDE) study

2020 ◽  
Author(s):  
Sarah J Richardson ◽  
Daniel H J Davis ◽  
Blossom C M Stephan ◽  
Louise Robinson ◽  
Carol Brayne ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Cognitive Decline ◽  
Hospital Admissions ◽  
Outcome Data ◽  
Illness Severity ◽  
Cognitive Outcomes ◽  
Dementia Diagnosis ◽  
Increased Risk ◽  
The Impact ◽  
Over Time

Abstract Background Delirium is common, distressing and associated with poor outcomes. Previous studies investigating the impact of delirium on cognitive outcomes have been limited by incomplete ascertainment of baseline cognition or lack of prospective delirium assessments. This study quantified the association between delirium and cognitive function over time by prospectively ascertaining delirium in a cohort aged ≥ 65 years in whom baseline cognition had previously been established. Methods For 12 months, we assessed participants from the Cognitive Function and Ageing Study II-Newcastle for delirium daily during hospital admissions. At 1-year, we assessed cognitive decline and dementia in those with and without delirium. We evaluated the effect of delirium (including its duration and number of episodes) on cognitive function over time, independently of baseline cognition and illness severity. Results Eighty two of 205 participants recruited developed delirium in hospital (40%). One-year outcome data were available for 173 participants: 18 had a new dementia diagnosis, 38 had died. Delirium was associated with cognitive decline (−1.8 Mini-Mental State Examination points [95% CI –3.5 to –0.2]) and an increased risk of new dementia diagnosis at follow up (OR 8.8 [95% CI 1.9–41.4]). More than one episode and more days with delirium (&gt;5 days) were associated with worse cognitive outcomes. Conclusions Delirium increases risk of future cognitive decline and dementia, independent of illness severity and baseline cognition, with more episodes associated with worse cognitive outcomes. Given that delirium has been shown to be preventable in some cases, we propose that delirium is a potentially modifiable risk factor for dementia.

447 Night Time Is Not the Right Time: Increased Risk of Complications After Laparoscopic Cholecystectomy At Night

2013 ◽  
Vol 144 (5) ◽  
pp. S-1049
Author(s):  
Uma R. Phatak ◽  
Curtis J. Wray ◽  
Debbie Lew ◽  
Richard Escamilla ◽  
Winston M. Chan ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Night Time ◽  
Increased Risk ◽  
The Right

scholarly journals Predictors of Spontaneous Rupture of Hepatocellular Carcinoma and Clinical Outcomes Following Hepatectomy

2021 ◽  
Author(s):  
Yiran Chen ◽  
Jing Zhao ◽  
Deliang Guo ◽  
Chang Xu ◽  
Qian Zhu
Keyword(s):  
Hepatocellular Carcinoma ◽  
Tumor Size ◽  
Curative Resection ◽  
Postoperative Morbidity ◽  
Clinicopathological Parameters ◽  
Hospital Death ◽  
Term Survival ◽  
Increased Risk ◽  
Significant Difference ◽  
The Impact

Abstract Objective: To explore the independent predictive factors of spontaneous tumor rupture (STR) in patients undergoing curative resection of hepatocellular carcinoma (HCC), and to evaluate the impact of STRHCC on long-term survival after hepatectomy. Methods: The clinicopathological parameters of 106 patients with STRHCC and 201 patients with nonruptured HCC who underwent hepatectomy from January 2007 to November 2011 at the Eastern Hepatobiliary Surgery Hospital and Zhongnan Hospital of Wuhan University were analyzed using propensity score matching (PSM) and logistic regression model. Results: Factors including complicated hypertension, cirrhosis, total bilirubin (TB), tumor size, and seroperitoneum were independent predictors of STR. For all 307 HCC patients, the 1-, 3- and 5-year overall survival (OS) rates were 54.0%, 37.3% and 33.8% respectively. After propensity matching scores, the 1-, 3-, and 5-year OS rates in the ruptured group remained significantly lower at 41.5%, 23.5%, and 17.5% when compared with the nonruptured group at 70.8%, 47.1%, and 37.6% respectively, while the 1-, 3-, and 5-year Disease-free survival (DFS) rates between the groups did not differ significantly (50.4%, 35.1%, 27.1% vs 55.4%, 38.2%, 27.4%). STRHCC was significant associated with increased risk of OS, but not of shorter DFS. No significant difference in postoperative morbidity or hospital death was observed between the groups. Conclusion: Factors including complicated hypertension, liver cirrhosis, higher TB levels, tumor size > 5cm, and seroperitoneum are significant predictors of STR. STR results in poorer OS but not DFS in patients undergoing curative resection for HCC. STRHCC has no impact on postoperative morbidity and mortality after hepatectomy.

Laparoscopic-Assisted Abdominal Wall Pexy of Peritoneal Dialysis Catheter

2020 ◽  
pp. 000313482094527
Author(s):  
Wei Wei ◽  
Medhat Fanous
Keyword(s):  
Peritoneal Dialysis ◽  
Abdominal Wall ◽  
White Male ◽  
Peritoneal Dialysis Catheter ◽  
Intraperitoneal Adhesions ◽  
Number Of Patients ◽  
Increased Risk ◽  
The Right ◽  
Stage Renal Disease ◽  
The Impact

Background Peritoneal dialysis (PD) for rural patients with end-stage renal disease (ESRD) is convenient, efficient, and durable. However, patients with a history of previous abdominal surgeries or peritonitis are at an increased risk of PD malfunction. This case highlights the impact of securing the catheter to the abdominal wall laparoscopically to keep the PD catheter in an adhesion-free area to maintain patency and function in a patient with extensive intraperitoneal adhesions. Subject A 76-year-old white male was on PD which later was complicated with peritonitis and sepsis and subsequent catheter removal. A year later, the patient desired replacement of the PD catheter. Intraoperatively, diagnostic laparoscopy revealed significant intraperitoneal adhesions mainly located at the left side of the abdomen with the right side of the abdomen spared. The Tenckhoff PD catheter, which was straightened by a steel stylet, was inserted via a 5-mm trocar. The stylet was removed. The pig tail of the PD catheter was navigated away from the adhesion and directed to the right side of the abdomen for internal fixation. The catheter at 9 cm from the PD catheter cuff was attached to the right paramedian peritoneum. Results PD started 1 week after placement. The patient had excellent inflow and outflow for 14 months to date without complication or need for revision. Conclusion The laparoscopic pexy of the PD catheter to the abdominal wall to keep the catheter in an adhesion-free compartment is beneficial in selected patients. A future study with a larger number of patients is needed to further validate this strategy.

scholarly journals Development and implementation of a discharge pathway protocol for detained offenders with intellectual disabilities

2017 ◽  
Vol 8 (3) ◽  
pp. 144-154 ◽  
Author(s):  
John L. Taylor ◽  
Susan Breckon ◽  
Christopher Rosenbrier ◽  
Polly Cocker
Keyword(s):  
Intellectual Disabilities ◽  
Discharge Planning ◽  
Community Services ◽  
Outcome Data ◽  
Post Discharge ◽  
Readmission Rates ◽  
Content Type ◽  
Lengths Of Stay ◽  
The Right ◽  
The Impact

Purpose Building the Right Support, a national plan for people with intellectual disabilities (ID) in England aims to avoid lengthy stays in hospital for such people. Discharge planning is understood to be helpful in facilitating successful transition from hospital to community services, however, there is little guidance available to help those working with detained patients with ID and offending histories to consider how to affect safe and effective discharges. The paper aims to discuss these issues. Design/methodology/approach In this paper, the development and implementation of a multi-faceted and systemic approach to discharge preparation and planning is described. The impact of this intervention on a range of outcomes was assessed and the views of stakeholders on the process were sought. Findings Initial outcome data provide support for the effectiveness of this intervention in terms of increased rates of discharge, reduced lengths of stay and low readmission rates. Stakeholders viewed the intervention as positive and beneficial in achieving timely discharge and effective post-discharge support. Practical implications People with ID are more likely to be detained in hospital and spend more time in hospital following admission. A planned, coordinated and well managed approach to discharge planning can be helpful in facilitating timely and successful discharges with low risks of readmission. Originality/value This is the first attempt to describe and evaluate a discharge planning intervention for detained offenders with ID. The intervention described appears to be a promising approach but further evaluation across a range of service settings is required.

scholarly journals EPP0630: Trends in Involuntary Admissions for Observation in Malta

2021 ◽  
Author(s):  
Martha Anne Zammit ◽  
Matthew Mark Agius ◽  
Jake Cutajar ◽  
Beppe Micallef Trigona
Keyword(s):  
Mental Healthcare ◽  
Working Hours ◽  
Healthcare Facility ◽  
Legal Framework ◽  
Time Of Day ◽  
Involuntary Admission ◽  
Out Of Hours ◽  
Suicidal Intent ◽  
Increased Risk ◽  
Legal Frameworks

Introduction Schedule II of the 2013 Mental Health Act is part of the legal framework for involuntary admission to a licensed mental healthcare facility in Malta (Mount Carmel Hospital) for observation. Objectives To identify trends in presenting features cited by registered specialists in psychiatry in Schedule II applications as well as impact of time of day on involuntary admission. Methods Schedule II forms relating to all involuntary admissions to Mount Carmel Hospital between 01 June 2018 and 01 June 2019 were retrieved from paper files (n=364). Details relating to reason for using this legal framework were recorded and processed through custom linguistic analysis. Timings of application were also assessed. Data Protection permissions to retrospectively access patient files were obtained. All data collected was de-identified at source. Results The commonest reason for use of Schedule II was psychosis (n=139). Substance abuse was recorded in 68 cases, with alcohol and cannabinoids the commonest substances cited. 155 instances relate to situations of increased risk, the commonest being aggressive behaviour (n=74). 61 cases recorded suicidal intent. Peak use of this schedule occurs between 17:00 and 18:00, which is outside normal working hours. Conclusions Predominance of psychosis as a reason for involuntary admission concurs with trends reported internationally, including recent German, Irish and Dutch reports, as does increased use of involuntary admission with out-of-hours presentations. Practices relating to involuntary admission to a mental healthcare facility in Malta appear to reflect general trends in other European cohorts, despite differing legal frameworks.

scholarly journals TP6.2.8 Impact of patients’ characteristics on operative difficulty and clinical outcomes of laparoscopic cholecystectomy

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Amira Orabi ◽  
Davide Di Mauro ◽  
Ikechukwu Njere ◽  
Marco Ratano ◽  
Sankavi Thavakumar ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Clinical Outcomes ◽  
Postoperative Morbidity ◽  
Technical Difficulty ◽  
Day Case ◽  
Female Ratio ◽  
Exact Test ◽  
Patient Stay ◽  
Operative Difficulty ◽  
The Impact

Abstract Background Laparoscopic cholecystectomy (LC) is a common surgical procedure. Intraoperative findings are highly unpredictable and the operative difficulty varies from straightforward to very challenging procedures. Several studies described predictors of technical difficulty and graded intraoperative findings of LC, however none specifically reported on the effect of such factors on clinical outcomes. This study aims to evaluate the impact of patients’ preoperative characteristics on operative difficulty of LC and clinical outcomes. Methods Data of patients who underwent LC from 2015 to 2017 retrospectively analysed. Subjects were divided into four groups, according to Nassar’s classification of intraoperative difficulty. Differences in frequencies were evaluated with the Fisher’s exact test; logistic regression analysis was used to identify independent variables that were predictors of postoperative morbidity and length of stay. Results A total of 1069 patient were included. Male to female ratio of 1:2.5. Older age, male gender and comorbidities were associated with higher Nassar score (p &lt; 0.0001); Nassar 3 and 4 were predictors of postoperative morbidity(P£0.01). The day case rate was 88.8% (Nassar 1), 86.1% (Nassar 2), 69.6% (Nassar 3), 62.3% (Nassar 4), respectively. Age of 60 and above(P£0.018), ASA 2 or 3(P£0.04) and Nassar 3, 4 (P£0.012), were predictors of increased conversion from day case to in-patient stay. Conclusion LC can be performed on a day case basis even when surgery is technically challenging. However, the need of in-patient stay can be predicted in comorbid old adult men with anticipated higher Nassar’s score.

scholarly journals Care for Patients With Neuromuscular Disorders in the COVID-19 Pandemic Era

2021 ◽  
Vol 12 ◽  
Author(s):  
Yung-Hao Tseng ◽  
Tai-Heng Chen
Keyword(s):  
Care Delivery ◽  
Clinical Care ◽  
Neuromuscular Disorders ◽  
Multidisciplinary Care ◽  
Outcome Data ◽  
Rapid Decline ◽  
Mortality And Morbidity ◽  
Increased Risk ◽  
Practical Guidelines ◽  
The Impact

The coronavirus disease 2019 (COVID-19) pandemic has prompted a rapid and unprecedented reorganization of medical institutions, affecting clinical care for patients with chronic neurological diseases. Although there is no evidence that patients with neuromuscular disorders (NMD) confer a higher infection risk of COVID-19, NMD and its associated therapies may affect the patient's ability to cope with infection or its systemic effects. Moreover, there is a concern that patients with chronic NMD may be at increased risk of manifesting severe symptoms of COVID-19. In particular, as respiratory compromises account for the major cause of mortality and morbidity in NMD patients, newly emerging data also show that the risk of exacerbation caused by COVID-19 accumulates in this particular patient group. For example, patients with motor neuron disease and dystrophinopathies often have ventilatory muscle weakness or cardiomyopathy, which may increase the risk of severe COVID-19 infection. Thus, the COVID-19 pandemic may severely affect NMD patients. Several neurological associations and neuromuscular networks have recently guided the impact of COVID-19 on patients with NMD, especially in managing cardiopulmonary involvements. It is recommended that patients with moderate- to high-risk NMD be sophisticatedly monitored to reduce the risk of rapid decline in cardiopulmonary function or potential deterioration of the underlying NMD. However, limited neuromuscular-specific recommendations for NMD patients who contract COVID-19 and outcome data are lacking. There is an urgent need to properly modify the respiratory care method for NMD patients, especially during the COVID-19 pandemic. Conclusively, COVID-19 is a rapidly evolving field, and the practical guidelines for the management of NMD patients are frequently revised. There must be a close collaboration in a multidisciplinary care team that should support their hospital to define a standardized care method for NMD patients during the COVID pandemic. This article reviews evidence-based practical guidelines regarding care delivery, modification, and education, highlighting the need for team-based and interspecialty collaboration.

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