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- Giani, Alessandro, et al.
(författare)
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Benchmarking of minimally invasive distal pancreatectomy with splenectomy: European multicentre study
- 2022
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Ingår i: British Journal of Surgery. - : OXFORD UNIV PRESS. - 0007-1323 .- 1365-2168. ; 109:11, s. 1124-1130
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Tidskriftsartikel (refereegranskat)abstract
- This study aimed to assess best achievable outcomes in minimally invasive distal pancreatectomy with splenectomy, applying the Achievable Benchmark of Care method. This method of assessing outcomes should positively encourage comparisons, allowing single surgeons or entire units to anonymously and individually recognize what works well and where there might be room for improvement. Background Benchmarking is the process to used assess the best achievable results and compare outcomes with that standard. This study aimed to assess best achievable outcomes in minimally invasive distal pancreatectomy with splenectomy (MIDPS). Methods This retrospective study included consecutive patients undergoing MIDPS for any indication, between 2003 and 2019, in 31 European centres. Benchmarks of the main clinical outcomes were calculated according to the Achievable Benchmark of Care (ABC (TM)) method. After identifying independent risk factors for severe morbidity and conversion, risk-adjusted ABCs were calculated for each subgroup of patients at risk. Results A total of 1595 patients were included. The ABC was 2.5 per cent for conversion and 8.4 per cent for severe morbidity. ABC values were 160 min for duration of operation time, 8.3 per cent for POPF, 1.8 per cent for reoperation, and 0 per cent for mortality. Multivariable analysis showed that conversion was associated with male sex (OR 1.48), BMI exceeding 30 kg/m(2) (OR 2.42), multivisceral resection (OR 3.04), and laparoscopy (OR 2.24). Increased risk of severe morbidity was associated with ASA fitness grade above II (OR 1.60), multivisceral resection (OR 1.88), and robotic approach (OR 1.87). Conclusion The benchmark values obtained using the ABC method represent optimal outcomes from best achievable care, including low complication rates and zero mortality. These benchmarks should be used to set standards to improve patient outcomes.
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| 2. |
- Bellelli, Giuseppe, et al.
(författare)
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Duration of Postoperative Delirium Is an Independent Predictor of 6-Month Mortality in Older Adults After Hip Fracture
- 2014
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Ingår i: Journal of The American Geriatrics Society. - : Wiley. - 0002-8614 .- 1532-5415. ; 62:7, s. 1335-1340
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To evaluate the association between number of days with delirium and 6-month mortality in elderly adults after hip fracture surgery. DESIGN: Prospective cohort study with 6-month follow-up. SETTING: Orthogeriatric Unit (OGU). PARTICIPANTS: Individuals (mean age = 84.3 +/- 6.4) admitted to the OGU between October 2011 and April 2013 with hip fracture (N = 199). MEASUREMENTS: Postoperative delirium (POD) was assessed daily using the Confusion Assessment Method algorithm and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, criteria. Multivariable Cox regression models were used to evaluate the association between POD of and 6-month mortality after surgery, after adjustment for covariates including age, prefracture residence, Katz activity of daily living score, New Mobility score, diagnosis of prefracture dementia, American Society of Anesthesiologists score, albumin serum levels, Charlson Comorbidity Index, and length of OGU stay. RESULTS: Fifty-seven participants (28.6%) developed POD. In the 6-month period after surgery, 35 (17.6%) participants died: 16 of 57 (28.1%) with POD and 19 / of 142 (13.4%) with no POD. The average duration of POD was 2.0 +/- 3.2 days for participants who died and 0.7 +/- 1.8 days for those who survived (P < .001). After adjusting for covariates, each day of POD in the OGU increased the hazard of dying at 6 months by 17% (hazard ratio = 1.17, 95% confidence interval = 1.07-1.28). CONCLUSION: In older adults undergoing hip fracture surgery, duration of POD is an important prognostic factor for 6-month mortality. Efforts to reduce duration of POD are therefore crucial for these individuals.
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| 3. |
- van Ramshorst, Tess M. E., et al.
(författare)
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Benchmarking of robotic and laparoscopic spleen-preserving distal pancreatectomy by using two different methods
- 2023
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Ingår i: British Journal of Surgery. - : Oxford University Press. - 0007-1323 .- 1365-2168. ; 110:1, s. 76-83
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Tidskriftsartikel (refereegranskat)abstract
- Background Benchmarking is an important tool for quality comparison and improvement. However, no benchmark values are available for minimally invasive spleen-preserving distal pancreatectomy, either laparoscopically or robotically assisted. The aim of this study was to establish benchmarks for these techniques using two different methods. Methods Data from patients undergoing laparoscopically or robotically assisted spleen-preserving distal pancreatectomy were extracted from a multicentre database (2006-2019). Benchmarks for 10 outcomes were calculated using the Achievable Benchmark of Care (ABC) and best-patient-in-best-centre methods. Results Overall, 951 laparoscopically assisted (77.3 per cent) and 279 robotically assisted (22.7 per cent) procedures were included. Using the ABC method, the benchmarks for laparoscopically assisted and robotically assisted spleen-preserving distal pancreatectomy respectively were: 150 and 207 min for duration of operation, 55 and 100 ml for blood loss, 3.5 and 1.7 per cent for conversion, 0 and 1.7 per cent for failure to preserve the spleen, 27.3 and 34.0 per cent for overall morbidity, 5.1 and 3.3 per cent for major morbidity, 3.6 and 7.1 per cent for pancreatic fistula grade B/C, 5 and 6 days for duration of hospital stay, 2.9 and 5.4 per cent for readmissions, and 0 and 0 per cent for 90-day mortality. Best-patient-in-best-centre methodology revealed milder benchmark cut-offs for laparoscopically and robotically assisted procedures, with operating times of 254 and 262.5 min, blood loss of 150 and 195 ml, conversion rates of 5.8 and 8.2 per cent, rates of failure to salvage spleen of 29.9 and 27.3 per cent, overall morbidity rates of 62.7 and 55.7 per cent, major morbidity rates of 20.4 and 14 per cent, POPF B/C rates of 23.8 and 24.2 per cent, duration of hospital stay of 8 and 8 days, readmission rates of 20 and 15.1 per cent, and 90-day mortality rates of 0 and 0 per cent respectively. Conclusion Two benchmark methods for minimally invasive distal pancreatectomy produced different values, and should be interpreted and applied differently. This study established benchmark values for laparoscopically and robotically assisted spleen-preserving distal pancreatectomy in both unselected and low-risk patients using two validated methodologies. The benchmark values require different interpretation and application based on the purpose of benchmarking and the patient cohort, and can be used for in-hospital and interhospital comparison and improvement purposes.
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| 4. |
- Henein, Michael Y., et al.
(författare)
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Biomarkers predict in-hospital major adverse cardiac events in covid-19 patients : A multicenter international study
- 2021
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Ingår i: Journal of Clinical Medicine. - : MDPI. - 2077-0383. ; 10:24
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Tidskriftsartikel (refereegranskat)abstract
- Background: The COVID-19 pandemic carries a high burden of morbidity and mortality worldwide. We aimed to identify possible predictors of in-hospital major cardiovascular (CV) events in COVID-19.Methods: We retrospectively included patients hospitalized for COVID-19 from 10 centers. Clinical, biochemical, electrocardiographic, and imaging data at admission and medications were collected. Primary endpoint was a composite of in-hospital CV death, acute heart failure (AHF), acute myocarditis, arrhythmias, acute coronary syndromes (ACS), cardiocirculatory arrest, and pulmonary embolism (PE).Results: Of the 748 patients included, 141(19%) reached the set endpoint: 49 (7%) CV death, 15 (2%) acute myocarditis, 32 (4%) sustained-supraventricular or ventricular arrhythmias, 14 (2%) cardiocirculatory arrest, 8 (1%) ACS, 41 (5%) AHF, and 39 (5%) PE. Patients with CV events had higher age, body temperature, creatinine, high-sensitivity troponin, white blood cells, and platelet counts at admission and were more likely to have systemic hypertension, renal failure (creatinine ≥ 1.25 mg/dL), chronic obstructive pulmonary disease, atrial fibrillation, and cardiomyopathy. On univariate and multivariate analysis, troponin and renal failure were associated with the composite endpoint. Kaplan–Meier analysis showed a clear divergence of in-hospital composite event-free survival stratified according to median troponin value and the presence of renal failure (Log rank p < 0.001).Conclusions: Our findings, derived from a multicenter data collection study, suggest the routine use of biomarkers, such as cardiac troponin and serum creatinine, for in-hospital prediction of CV events in patients with COVID-19.
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