| 1. |
- Bass, Gary Alan, 1979-, et al.
(författare)
-
Techniques for mesoappendix transection and appendix resection: insights from the ESTES SnapAppy study
- 2023
-
Ingår i: European Journal of Trauma and Emergency Surgery. - : Springer Science and Business Media LLC. - 1863-9933 .- 1615-3146 .- 1863-9941. ; 49, s. 17-32
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction: Surgically managed appendicitis exhibits great heterogeneity in techniques for mesoappendix transection and appendix amputation from its base. It is unclear whether a particular surgical technique provides outcome benefit or reduces complications. Material and methods: We undertook a pre-specified subgroup analysis of all patients who underwent laparoscopic appendectomy at index admission during SnapAppy (ClinicalTrials.gov Registration: NCT04365491). We collected routine, anonymized observational data regarding surgical technique, patient demographics and indices of disease severity, without change to clinical care pathway or usual surgeon preference. Outcome measures of interest were the incidence of complications, unplanned reoperation, readmission, admission to the ICU, death, hospital length of stay, and procedure duration. We used Poisson regression models with robust standard errors to calculate incident rate ratios (IRRs) and 95% confidence intervals (CIs). Results: Three-thousand seven hundred sixty-eight consecutive adult patients, included from 71 centers in 14 countries, were followed up from date of admission for 90days. The mesoappendix was divided hemostatically using electrocautery in 1564(69.4%) and an energy device in 688(30.5%). The appendix was amputated by division of its base between looped ligatures in 1379(37.0%), with a stapler in 1421(38.1%) and between clips in 929(24.9%). The technique for securely dividing the appendix at its base in acutely inflamed (AAST Grade 1) appendicitis was equally divided between division between looped ligatures, clips and stapled transection. However, the technique used differed in complicated appendicitis (AAST Grade 2 +) compared with uncomplicated (Grade 1), with a shift toward transection of the appendix base by stapler (58% vs. 38%; p < 0.001). While no statistical difference in outcomes could be detected between different techniques for division of appendix base, decreased risk of any [adjusted IRR (95% CI): 0.58 (0.41–0.82), p = 0.002] and severe [adjusted IRR (95% CI): 0.33 (0.11–0.96), p = 0.045] complications could be detected when using energy devices. Conclusions: Safe mesoappendix transection and appendix resection are accomplished using heterogeneous techniques. Technique selection for both mesoappendix transection and appendix resection correlates with AAST grade. Higher grade led to more ultrasonic tissue transection and stapled appendix resection. Higher AAST appendicitis grade also correlated with infection-related complication occurrence. Despite the overall well-tolerated heterogeneity of approaches to acute appendicitis, increasing disease acuity or complexity appears to encourage homogeneity of intraoperative surgical technique toward advanced adjuncts.
|
|
| 2. |
- Forssten, Maximilian Peter, 1996-, et al.
(författare)
-
Surgical management of acute appendicitis during the European COVID-19 second wave: safe and effective
- 2023
-
Ingår i: European Journal of Trauma and Emergency Surgery. - : Springer Science and Business Media LLC. - 1863-9933 .- 1615-3146 .- 1863-9941. ; 49, s. 57-67
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction: The COVID-19 (SARS-CoV-2) pandemic drove acute care surgeons to pivot from long established practice patterns. Early safety concerns regarding increased postoperative complication risk in those with active COVID infection promoted antibiotic-driven non-operative therapy for select conditions ahead of an evidence-base. Our study assesses whether active or recent SARS-CoV-2 positivity increases hospital length of stay (LOS) or postoperative complications following appendectomy. Methods: Data were derived from the prospective multi-institutional observational SnapAppy cohort study. This preplanned data analysis assessed consecutive patients aged ≥ 15years who underwent appendectomy for appendicitis (November 2020–May 2021). Patients were categorized based on SARS-CoV-2 seropositivity: no infection, active infection, and prior infection. Appendectomy method, LOS, and complications were abstracted. The association between SARS-CoV-2 seropositivity and complications was determined using Poisson regression, while the association with LOS was calculated using a quantile regression model. Results: Appendectomy for acute appendicitis was performed in 4047 patients during the second and third European COVID waves. The majority were SARS-CoV-2 uninfected (3861, 95.4%), while 70 (1.7%) were acutely SARS-CoV-2 positive, and 116 (2.8%) reported prior SARS-CoV-2 infection. After confounder adjustment, there was no statistically significant association between SARS-CoV-2 seropositivity and LOS, any complication, or severe complications. Conclusion: During sequential SARS-CoV-2 infection waves, neither active nor prior SARS-CoV-2 infection was associated with prolonged hospital LOS or postoperative complication. Despite early concerns regarding postoperative safety and outcome during active SARS-CoV-2 infection, no such association was noted for those with appendicitis who underwent operative management.
|
|
| 3. |
- Anderson, James E., et al.
(författare)
-
A New Approach to Evaluating Trade Policy
- 1991
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- This paper introduces a new measure, the Trade Restrictiveness Index, which measures the restrictiveness of a system of trade protection. The index is a general equilibrium application of the distance function and answers the question: "What uniform set of trade restrictions is equivalent (in welfare terms) to the initial protective structure?" The index is applicable to both tariffs and quotas and allows international and intertemporal comparisons. The index is operational and we provide an empirical example to illustrate its applicability and to show its superiority over commonly used measures.
|
|
| 4. |
- Neary, J. Peter, et al.
(författare)
-
Sectoral Shocks in a Dependent Economy : Long-Run Adjustment and Short-Run Accommodation
- 1981
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- This paper examines the allocation and stabilization consequences of a resource boom in a small open economy. Both the intersectoral allocation of capital and the price of non-traded goods adjust sluggishly; in contrast the nominal exchange rate adjusts instantaneously to ensure that the conditions for uncovered interest parity in the presence of rational exchange-rate expectations are always met. The ability of monetary policy to stabilise the economy is examined, and it is shown that, even when intervention is justified in principle, policy errors which areise from confusing real and monetary shocks may worsen macroeconomic performance.
|
|
| 5. |
- Neary, J. Peter
(författare)
-
The Heckscher-Ohlin Model as an Aggregate
- 1983
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- This paper extends the results of Neary (1979) where it was shown that, when an appropriate aggregation procedure is adopted, many of the properties of the two-factor, two-commodity Heckscher-Ohlin model continue to hold in a general production model with any numbers of goods and factors. In the present paper it is shown that, if the number of goods and factors are the same (though still arbitrarily large) and if joint production and intermediate goods are ruled out, then the parallel between the properties of the standard Heckscher-Ohlin model and the aggregated model is greatly strenghtened. In particular, the equalization of factor prices between "similiar" free-trading economies and, with some additional restrictions, the "magnification" effects associated with the Rybczynski and Stolper-Samuelson theorems are shown to hold in the aggregated model.
|
|
